Individual SES and cancer survival
UK linked-data analysis shows both area deprivation and individual SES shape cancer survival, with wider absolute gaps in the most deprived areas.
Source
An investigation of cancer survival inequalities associated with individual-level socio-economic status, area-level deprivation, and contextual effects, in a cancer patient cohort in England and Wales
Study at a glance
- Design
- Cohort — ONS Longitudinal Study; excess mortality models by SES markers
- N
- N=9276 · 1522 men + 1237 women colorectal; 3044 prostate; 3473 breast (ONS Longitudinal Study analysis cohort)
- Population
- People with colorectal, prostate, or breast cancer in the ONS Longitudinal Study
- Outcome
- Excess mortality / net-survival gaps by area deprivation and individual SES
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Individual SES and cancer survival
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Cohort: 1522 men and 1237 women with colorectal; 3044 men prostate; 3473 women breast cancer.
The analysis cohort included 1522 men and 1237 women with colorectal cancer, 3044 men with prostate cancer, and 3473 women with breast cancer.
Absolute survival gap 29.6% in most deprived vs 9.1% in least deprived areas.
Net survival estimates showed that the absolute difference between groups with lowest and highest survival in the most deprived areas was 29.6%, compared to 9.1% in the least deprived areas (Fig. C).
What they did
Using ONS Longitudinal Study cancer patients, authors modelled excess mortality for colorectal, prostate, and breast cancers by area deprivation and individual education/occupation/income markers.
What they found
Less deprived areas had lower excess hazard (e.g., prostate EHR 0.80); absolute net-survival gaps between best/worst individual SES profiles were 29.6% in most deprived vs 9.1% in least deprived areas.
The limits
What it doesn't show
Observational inequalities do not identify a single causal mechanism or evaluate a specific intervention.
Key terms
- Excess hazard ratio (EHR)
- Relative excess mortality versus a reference SES group.
- Net survival
- Survival from cancer after accounting for other-cause mortality.
- Area deprivation
- Neighbourhood socio-economic disadvantage measure.
- Individual-level SES
- Person education, occupation, and income indicators.
- ONS Longitudinal Study
- 1% England/Wales census-linked longitudinal sample.
- Context-dependent inequality
- Individual SES gaps that differ by area deprivation.
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Absolute SES survival gap in most deprived areas?
Common questions
Cancers studied?
Colorectal, prostate, and breast.
Prostate area EHR?
0.80 for less vs more deprived areas.
Absolute gap contrast?
29.6% in most deprived vs 9.1% in least deprived areas.
Policy implication?
Need both area- and individual-level interventions.
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