Socioeconomic and demographic inequalities in stage at diagnosis and survival among colorectal cancer patients: evidence from a Swiss population-based study.

Feller, Anita; Schmidlin, Kurt; Bordoni, Andrea; Bouchardy, Christine; Bulliard, Jean-Luc; Camey, Bertrand; Konzelmann, Isabelle; Maspoli, Manuela; Wanner, Miriam; Zwahlen, Marcel; Clough-Gorr, Kerri M (2018). Socioeconomic and demographic inequalities in stage at diagnosis and survival among colorectal cancer patients: evidence from a Swiss population-based study. Cancer medicine, 7(4), pp. 1498-1510. WILEY-BLACKWELL 10.1002/cam4.1385

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Socioeconomic inequalities in cancer stage at diagnosis and survival are important public health issues. This study investigates the association between socioeconomic position (SEP) and colorectal cancer (CRC) stage at diagnosis and survival in Switzerland, a European country with highest level of medical facilities and life expectancy. We used population-based CRC data from seven Swiss cantonal cancer registries 2001-2008 (N = 10,088) linked to the Swiss National Cohort (SNC). Follow-up information was available until the end of 2013. SEP was estimated based on education. The association between cancer stage and SEP was assessed using logistic regression models including cancer localization (colon/rectum), sex, age, civil status, urbanity of residence, language region, and nationality (Swiss/non-Swiss). Survival was analyzed using competing risk regressions reporting subhazard ratios (SHRs) for the risk of dying due to CRC. We observed a social gradient for later stage CRC with adjusted odds ratios (ORs) of 1.11 (95% CI: 0.97-1.19) and 1.28 (95% CI: 1.08-1.50) for middle and low SEP compared to high SEP. Further, single compared to married people had elevated odds of being diagnosed at later stages. Survival was lower in patients with CRC with low SEP in the unadjusted model (SHR: 1.18, 95% CI: 1.07-1.30). After adjustment for stage at diagnosis and further sociodemographic characteristics, significant survival inequalities by SEP disappeared but remained for non-Swiss compared to Swiss citizens and for patients living in nonurban areas compared to their urban counterparts. Swiss public health strategies should facilitate equal access to CRC screening and optimal CRC care for all social groups and in all regions of Switzerland.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine

UniBE Contributor:

Feller, Anita Katja; Schmidlin, Kurt; Zwahlen, Marcel and Clough, Kerri

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

2045-7634

Publisher:

WILEY-BLACKWELL

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

27 Feb 2018 14:13

Last Modified:

25 Apr 2018 01:31

Publisher DOI:

10.1002/cam4.1385

PubMed ID:

29479854

Uncontrolled Keywords:

Colorectal cancer health inequalities socioeconomic position stage at diagnosis survival

BORIS DOI:

10.7892/boris.112221

URI:

https://boris.unibe.ch/id/eprint/112221

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