Population-Based Cancer Survival in Canada and the United States by Socioeconomic Status: Findings from the CONCORD-2 Study

Abstract

Background: Population-based cancer survival provides insight into the effectiveness of health systems to care for all residents with cancer, including those in marginalized groups.

Methods: Using CONCORD-2 data, we estimated 5-year net survival among patients diagnosed 2004-2009 with one of 10 common cancers, and children diagnosed with acute lymphoblastic leukemia (ALL), by socioeconomic status (SES) quintile, age (0-14, 15-64, ≥65 years), and country (Canada or United States).

Results: In the lowest SES quintile, survival was higher among younger Canadian adults diagnosed with liver (23% vs 15%) and cervical (78% vs 68%) cancers and with leukemia (62% vs 56%), including children diagnosed with ALL (92% vs 86%); and higher among older Americans diagnosed with colon (62% vs 56%), female breast (87% vs 80%), and prostate (97% vs 85%) cancers. In the highest SES quintile, survival was higher among younger Americans diagnosed with stomach cancer (33% vs 27%) and younger Canadians diagnosed with liver cancer (31% vs 23%); and higher among older Americans diagnosed with stomach (27% vs 22%) and prostate (99% vs 92%) cancers.

Conclusions: Among younger Canadian cancer patients in the lowest SES group, greater access to health care may have resulted in higher cancer survival, while higher screening prevalence and access to health insurance (Medicare) among older Americans during the period of this study may have resulted in higher survival for some screen-detected cancers. Higher survival in the highest SES group for stomach and liver may relate to treatment differences. Survival differences by age and SES between Canada and the United States may help inform cancer control strategies.

Keywords: Canada; United States; breast; cancer; cervix; colon; leukemia; liver; net; population-based; prostate; survival.

Figure 1

Five-Year Net Survival (%) for Adults (Aged 15–99 Years) Diagnosed with 1 of 6 Common Cancers During 2004–2009 in Canada and the United States; Separately for Younger Adults (Aged 15–64 Years) and Older Adults (Aged 65–99 years) by Socioeconomic Status (SES) Quintiles (a, stomach; b, colon; c, rectum; d, liver; e, lung; f, leukemia)

Figure 2

Five-year Net Survival (%) for Adults (Aged 15–99 years) Diagnosed with 1 of 4 Common Cancers and Children (Aged 0–14 Years) Diagnosed with Acute Lymphoblastic Leukemia (ALL) During 2004–2009 in Canada and the United States; Separately for Younger Adults (Aged 15–64 Years) and Older Adults (Aged 65–99 Years) by Socioeconomic Status (SES) Quintiles (a, breast [women]; b, cervix; c, ovary; d, prostate; e, ALL)