Socioeconomic deprivation and cancer survival in Germany: An ecological analysis in 200 districts in Germany

Abstract

Although socioeconomic inequalities in cancer survival have been demonstrated both within and between countries, evidence on the variation of the inequalities over time past diagnosis is sparse. Furthermore, no comprehensive analysis of socioeconomic differences in cancer survival in Germany has been conducted. Therefore, we analyzed variations in cancer survival for patients diagnosed with one of the 25 most common cancer sites in 1997-2006 in ten population-based cancer registries in Germany (covering 32 million inhabitants). Patients were assigned a socioeconomic status according to the district of residence at diagnosis. Period analysis was used to derive 3-month, 5-year and conditional 1-year and 5-year age-standardized relative survival for 2002-2006 for each deprivation quintile in Germany. Relative survival of patients living in the most deprived district was compared to survival of patients living in all other districts by model-based period analysis. For 21 of 25 cancer sites, 5-year relative survival was lower in the most deprived districts than in all other districts combined. The median relative excess risk of death over the 25 cancer sites decreased from 1.24 in the first 3 months to 1.16 in the following 9 months to 1.08 in the following 4 years. Inequalities persisted after adjustment for stage. These major regional socioeconomic inequalities indicate a potential for improving cancer care and survival in Germany. Studies on individual-level patient data with access to treatment information should be conducted to examine the reasons for these socioeconomic inequalities in cancer survival in more detail. What's new? Around the world, affluent patients survive cancer better than impoverished ones, regardless of access to health insurance. In this study, the authors provide the first detailed analysis of how socio-economic condition correlates with cancer survival in Germany, where all have health insurance. Using population-based registries, they compared survival rates for 25 cancer sites. After adjusting for stage, they still found that patients in the poorest district had a lower five-year survival rate than those in all other districts combined. The inequality was worst in the first three months, but persisted throughout the five years. © 2013 UICC.