Supplement Comprehensive Tables – Review Socioeconomic status and colorectal cancer 1
Table 1A. Associations betweenincidence of colon andrectalcancer and socioeconomic status inU.S. and Canada.
Risk of low vs. high SESAuthor, year / Study base / Indicators / Classes / Type of measurement / N / Males / N / Females / Adjusted for….
Colon
Gorey, 1995 1 / U.S., New York, cancer registry, longitudinal,1979-1986 / Near poverty status (<200% of federal criterion) / 2 / RR* (95%CI)$ / 3825 / 1.39 (1.24-1.55)# / 4262 / 1.48 (1.33-1.65) / Age
Gorey, 1998 2 / Canada, Ontario, cancer registry, longitudinal, >25y, diagnosed 1986-1993 / % below low-income cut off / 2 / Standardized incidence rate ratio / 1372 / 1.11 (1.02-1.20) / 1294 / 0.99 (0.97-1.01) / Age
Krieger, 1999 3 / U.S., California, longitudinal 1988-1992 / % working class, professional, poverty, education / 3 / Incidence rate ratio / ? / 1.3 (1.1-1.6) / 1.3 (1.1-1.6) / Age
Mackillop, 20004 / U.S.: SEER data, longitudinal, new cases 1988-1992
Canada: Ontario cancer registry,longitudinal, new cases 1989-1993 / Household income (deciles) / 10 / Canada
U.S.
RR / ? / 1.20 (1.10-1.33)
1.08 (1.08-1.14) / ? / 1.15 (1.05-1.28)
1.10 (1.03-1.16) / Age
Shipp, 2005
5 / U.S., Alabama,longitudinal, 14y, 1996-1999 / Education (%≥25y that completed 12y of schooling)
Median household income
% below poverty level / %? / RR / 5788 / 0.91 (0.85-0.97)
0.99 (0.98-1.01)
1.02 (0.93-1.09) / Both sexes / Gender, age, race, SES factor
Mouw, 2008 6 / U.S., NIH-AARP study, longitudinal, 1995-1996, max 8.2y follow up, 50-71year / Education / 6 / RR / 2791 / 1.10 (0.94-1.29) / 1182 / 1.37 (1.06-1.77) / Age, race, smoking, energy, BMI, physical activity, married, family history of cancer
Rectal
Gorey, 1995 1 / U.S., New York, cancer registry,longitudinal, 1979-1986 / Near poverty status (<200% of federal criterion) / 2 / RR / 1930 / 1.36 (1.16-1.60) / 1517 / 1.64 (1.39-1.94) / Age
Gorey, 1998 2 / Canada, Ontario, cancer registry, longitudinal, >25y, diagnosed 1986-1993 / % below low-income cut off / 2 / Standardized incidence rate ratio / 689 / 1.25 (1.08-1.44) / 460 / 1.04 (1.01-1.07) / Age
Mackillop, 20004 / U.S.: SEER data,longitudinal, new cases 1988-1992
Canada: Ontario cancer registry,longitudinal,new cases 1989-1993 / Household income (deciles) / 10 / Canada
U.S.
RR / ? / 1.23 (1.09-1.43)
1.19 (1.10-1.32) / ? / 1.00 (0.94-1.08)
1.02 (0.98-1.05) / Age
Mouw, 2008 6 / U.S., NIH-AARP study, longitudinal, 1995-1996, max 8.2y follow up, 50-71year / Education / 6 / RR / 1135 / 1.50 (1.17-1.92) / 461 / 1.05 (0.68-1.62) / Age, race, smoking, energy, BMI, physical activity, married, family history of cancer
* RR: relative risk or risk ratio;
$ 95%CI: 95% confidence interval;
# Values in bold are statistically significant.
Table 1B. Associations between incidence of colon andrectal cancer and socioeconomic status inEurope, Australia and South Korea.
Risk of low vs. high SESAuthor, year / Study base / Indicators / Classes / Type of measurement / N / Males / N / Females / Adjusted for….
Colon
Van Loon, 1995 7 / The Netherlands, longitudinal, follow-up of 3500 healthy subjects, 55-69 years, 1986 -1989 / Education
Occupational history
Social standing+ / 5
4
6 / RR* (95%CI)$ / 157 / 1.00 (0.54-1.85)
1.41 (0.77-2.56)
0.38 (0.19-0.76)# / 155 / 1.14 (0.50-2.56)
1.39 (0.67-2.94)
1.22 (0.26-5.88) / Age, quetelet index, cholecystectomy, alcohol intake, large bowel cancer in family, physical activity at work
Marshall, 1999 8 / France, case control, employees electricity/gas company, 1988-1992 / Socioprofessional hierarchy
Employee category / 6
3 / Odds ratio / 35 / 2.4 (0.8-7.2)
1.2 (0.4-3.4) / None
Tavani, 1999 9 / Italy, 2 case control studies (1985-1991 and 1991-1996), cases and controls 19-79y, controls admitted to hospitals for factors unrelated to CRC / Education
Social class (based on level of head of household’s occupation) / 4
5 / High vs. low
Odds ratio / 1051 / 0.41 (0.31-0.53)
0.43 (0.34-0.55) / 852 / 0.78 (0.53-1.14)
0.75 (0.58-0.97) / Study/centre, age, coffee intake, smoking, alcohol and vegetable intake
Pisa, 2000 10 / Italy, case control study: controls were admitted to patients in hospitals, 19-74 years, 1992- 1996 / Education
Occupation / 5
8 / Odds ratio / 686 / 0.26 (0.15-0.43)
0.42 (0.26-0.67) / 533 / 0.33 (0.18-0.63)
0.77 (0.43-1.43) / Age, centre, occupational physical activity, total intake of energy, vegetables and carbohydrates
Bouchardy, 2002
11 / Switzerland, longitudinal,Geneva cancer registry, men ≥25y, 1980-1993 / Occupation / 3766 / ↑SES ↑risk (many data, for each profession)
Hemminki, 2003 12 / Sweden, longitudinal,Swedish Family Cancer database, 1961-1998 / Education / 7 / Standardized incidence ratio / 9303 / 1.11 (1.04-1.18) / 10354 / 0.90 (0.81-0.99) / Age, period, region
Braaten, 2005 13 / Norway,longitudinal, 102433 women (30-69 year) filled in questionnaire 1991-1997, follow-up till 2001 / Education / 4 / RR / 205 / 1.23 (0.70-2.20) / Adjusted for age
Weiderpass, 2006 14 / Finland,longitudinal,follow-up of 45-69 y, 1971-1995 / Social class (education, occupation, industrial status, industry groupings) / 4 / Standardized incidence ratio / 3062 / 0.78 (0.69-0.86) vs. 1.37 (1.24-1.51)[RR=0.6] / 3269 / 0.92 (0.85-1.01) vs. 1.13 (1.00-1.27) [RR=0.8] / Age, period
Egeberg, 2008 15 / Denmark, longitudinal, >30y, 1994-2003 / Education
Disposable income
Social class (occupation)+
Housing Tenure
Size of dwelling / 3
3
6
2
4 / Incidence rate ratio
manual vs. creative core / 4894
4969
4503 4889 4969 / 0.93 (0.85-1.01)
1.01 (0.94-1.08)
0.70 (0.61-0.81)
1.19 (1.12-1.26) 1.30 (1.10-1.52) / 4636
4684
3256 4642 4684 / 1.02 (0.93-1.12)
0.94 (0.88-1.01)
0.87 (0.67-1.14)
0.98 (0.93-1.05)
0.86 (0.67-1.11) / Calendar period, age, level of education, disposable income
Spadea, 2009 16 / Italy, Turin, longitudinal,30-74y on 1 January 1985, follow-up till 31 December 1999 / Educational level / 3 / Relative risk
1985-1999
1985-1989
1990-1994
1995-1999 / 2061 632 634 792 / 0.93 (0.83-1.04)
0.73 (0.60-0.90)
1.12 (0.90-1.38)
1.00 (0.82-1.21) / 1778 539 563 680 / 0.93 (0.80-1.07)
0.79 (0.61-1.03)
1.00 (0.77-1.30)
1.04 (0.82-1.30) / Age, area of birth
Burnley, 1997 17 / Australia, longitudinal, New South Wales cancer registry, diagnosis 1985-1991, 40-74 years / Median income (I)
Jarman index (J)+ / Pearson correlation / ? / 40-64 years:
I: 0.27
J: -0.21 (n.s.)
65-74 years:
I: 0.38
J: -0.08 / Age
Pearce, 1997 18 / New Zealand, longitudinal,men 15-64y, deaths 1984-1987 / Elley-Irving scale+ / 6 / Incidence per 100,000 person years / ? / 8.9 vs. 12.9 p-value for trend 0.15 / Age
Kim, 2008 19 / South Korea, longitudinal,Korean National cancer registry, 2001 / Income / 6 / Relative index of inequalities per 100,000 population / ? / 0.98 (0.61-1.57) / ? / 0.69 (0.59-0.80) / Age
Rectal
Tavani, 1999 9 / Italy, 2 case control studies (1985-1991 and 1991-1996), cases and controls 19-79y, controls admitted to hospitals for factors unrelated to CRC / Education;
social class (based on level of head of household’s occupation) / 4
5 / High vs. low
Odds ratio / 684 / 0.41 (0.31-0.53)
0.85 (0.63-1.16) / 452 / 0.99 (0.60-1.64)
0.85 (0.61-1.19) / Study/centre, age, coffee intake, smoking, alcohol and vegetable intake
Pisa, 2000 10 / Italy, case control study: controls were admitted to patients in hospitals, 19-74 years, 1992- 1996 / Education
Occupation / 5
8 / Odds ratio / 435 / 0.77 (0.42-1.43)
1.11 (0.67-2.00) / 290 / 0.31 (0.14-0.67)
0.83 (0.38-2.0) / Age, centre, occupational physical activity, total intake of energy, vegetables and carbohydrates
Bouchardy, 2002
11 / Switzerland, longitudinal,Geneva cancer registry, men ≥25y, 1980-1993 / Occupation / 2541 / No association
Hemminki, 2003 12 / Sweden, longitudinal,Swedish Family Cancer database, 1961-1998 / Education / 7 / Standardized incidence ratio / 6658 / 0.83 (0.76-0.91) / 5120 / 0.92 (0.80-1.06) / Age, period, region
Braaten, 2005 13 / Norway, longitudinal, 102433 women (30-69 year) filled in questionnaire 1991-1997, follow-up till 2001 / Education / 4 / RR / 112 / 0.63 (0.33-1.20) / Age
Weiderpass, 2006 14 / Finland, longitudinal,follow-up of 45-69 y, 1971-1995 / Social class (education, occupation, industrial status, industry groupings) / 4 / Standardized incidence ratio / 2855 / 0.92 (0.83-1.02) vs. 0.98 (0.86-1.10) [RR=0.9] / 2419 / 0.92 (0.83-1.01) vs. 1.10 (0.95-1.26) [RR=0.8] / Age, period
Egeberg, 2008 15 / Denmark, longitudinal,>30y, 1994-2003 / Education
Disposable income
Social class (occupation)+
Housing Tenure
Size of dwelling / 3
3
6
2
4 / Incidence rate ratio
manual vs. creative core / 4206 4276
3918
4238 4276 / 1.02 (0.93-1.12)
1.09 (1.01-1.18)
0.83 (0.73-0.97)
1.17 (1.10-1.25)
1.16 (0.97-1.39) / 2868 2901
2137
2866 2901 / 1.12 (1.00-1.27)
0.99 (0.90-1.07)
0.92 (0.60-1.07)
1.04 (0.96-1.13)
1.07 (0.78-1.45) / Calendar period, age, level of education, disposable income
Spadea, 2009 16 / Italy, Turin, longitudinal,30-74y on 1 January 1985, follow-up till 31 December 1999 / Educational level / 3 / Relative risk
1985-1999
1985-1989
1990-1994
1995-1999 / 1006 344 369 388 / 1.27 (1.07-1.50)
0.94 (0.71-1.25)
1.57 (1.15-2.14) 1.44 (1.09-1.91) / 860 279 302 277 / 1.16 (0.94-1.43)
1.09 (0.73-1.63)
1.27 (0.88-1.84)
1.08 (0.76-1.55) / Age, area of birth
Pearce, 1997 18 / New Zealand, longitudinal,men 15-64y, deaths 1984-1987 / Elley-Irving scale+ / 6 / Incidence per 100,000 person years / ? / 9.3 vs. 7.9 [RR=1.2] / Age
Kim, 2008 19 / South Korea, longitudinal,Korean National cancer registry, 2001 / Income / 6 / Relative index of inequalities per 100,000 population / ? / 0.97 (0.66-1.43) / ? / 1.29 (0.84-1.98) / Age
* RR: relative risk or risk ratio [brackets represent relative risks calculated from the data]
$ 95%CI: 95% confidence interval;
# Values in bold are statistically significant;
+ Jarman index: elderly living alone, one parent families, unskilled, unemployment, overcrowding; Elley-Irving scale: occupation, income and education; social standing: based on an ordering of occupational titles according to social standing; social class (occupation): agricultural (e.g. farmers, fisherman) vs. creative core (e.g. researchers, designers, architects).
Table 2. Associations betweenTreatment of Colon, Rectal or Colorectal Cancer and Socioeconomic Status.
Odds for receiving treatment for low vs. high SES patientsColon / Rectal / Colorectal
Author, year / Study base / Indicators / Classes / Social scale / Therapy / N / N / N (stage) / Adjusted for…..
Roetzheim, 2000 20 / U.S., longitudinal,Florida cancer registry, 1994 / Education (E) Income (I) / 2
5 / (E): OR* (95% CI)$
(I): change in odds of receiving therapy per increase in income category / Surgery / 9551 / E 0.68 (0.47-0.99)#
I 0.93 (0.85-1.02) / Age, sex, marital status, smoking, urban residence, comorbidity, anatomic site, stage at diagnosis, community measures of education and income level
Radiotherapy / E 0.78 (0.55-1.10)
I 0.90 (0.83-0.98) / 1.02 (0.49-2.15)
0.79 (0.67-0.93)
Chemotherapy / E 0.84 (0.59-1.19)
I 0.98 (0.90-1.06)
Schrag, 200121 / U.S., longitudinal,SEER data, ≥65 years, 1992-1996 / Income / 4 / Any adjuvant radiation
Adjuvant radiotherapy and chemotherapy / 1670 / 0.92 (0.63-1.33)
0.73 (0.51-1.06) / Stage, comorbidity, operation, age, sex, race
Campbell, 2002 22 / U.K., longitudinal, Scotland, 1995-1996 / Carstairs deprivation scores+ / 5 / Surgery / 653 / 0.52 (0.14-1.87) / Age, stage, emergency admission, distance to center
Radiotherapy / 0.85 (0.38-1.91)
Chemotherapy / 0.49 (0.22-1.10)
VanEenwyk,2002 23 / U.S., longitudinal,Washington cancer registry, 1996-1997 / Income / 4 / Chance of not receiving adjuvant therapy / 632 / 2.3 (1.5-3.4) / 0.7 (0.4-1.3) / Age, stage, health care insurance payer
Ayanian, 2003
24 / U.S., longitudinal,California cancer registry, ≥18 years, 1996-1997 / Income / 4 / Adjuvant chemotherapy / 1449 / 0.8 (0.6-1.1) / Age, sex, race, rural residence, marital status, cancer site and stage, comorbidity, region, hospital volume, accredited hospital tumour registry, teaching hospital, hospital with radiation therapy, hospital clustering
Adjuvant radiotherapy / 0.7 (0.4-1.4)
Hall, 2005 25 / Australia, longitudinal,Western Australian Data Linkage system, 1991-2001 / Combination of occupation, income, education, housing / 5 / Likelihood of surgery / 12474 / 1.13 (0.88-1.45) / age, gender, calendar period, comorbidity, indigenous status, marital status, admission type, histology of cancer, accessibility, location of hospital, insurance classification, hospital status
Lemmens, 2005 26 / The Netherlands, longitudinal,Eindhoven Cancer Registry, 65-79 years, 1995-2001 / Combination of income and value of house / 3 / Chemotherapy / 577 / 0.5 (p=0.02) / Age, sex, comorbidity, stage, grade, period of diagnosis
McGory, 200627 / U.S., longitudinal,California Cancer Registry, 1994-2001 / % below poverty level / 2 / Chemotherapy / 13231 / 0.991 (0.988-0.995) / 2644 (II)
2774 (III) / 0.992 (0.986-0.998)
0.992 (0.986-0.997) / Age, sex, race, comorbidity, insurance, year of diagnosis
Radiotherapy / 2644 (II)
2774 (III) / 0.993 (0.987-0.999)
0.991 (0.986-0.996)
Vulto, 2007 28 / The Netherlands, longitudinal,Eindhoven Cancer Registry, 1996-2005 / Combination of income and value of house / 3 / Radiotherapy / 2008 / 1.1 (0.8-1.7) / Age, sex, comorbidity, stage, primary radiotherapy
Byers, 2008 29 / U.S., longitudinal,7 state registries, 1997. REGIONAL STAGE / Combination of education and income / 3 / % that received treatment / Chemotherapy / 2156 / 50 vs. 56% [RR=0.9] / -
Meulenbeld, 2008 30 / The Netherlands, longitudinal,Eindhoven Cancer Registry, >40 years, 1990-2004 / Combination of income and value of house / 3 / % that received treatment / Chemotherapy 1990-1994
1995-1999
2000-2002
2003-2004 / 1769 / 11% vs. 22%[RR=0.5]
15% vs. 37%[RR=0.4]
30% vs. 53%[RR=0.6]
47% vs. 50%[RR=0.9] / -
Tilney, 200831 / England, longitudinal,patients undergoing APER or anterior resection, 1996-2004 / Index of Multiple Deprivation+ / APER (abdominoperineal excision of rectum) / 13109 / 1.589 (1.449-1.744) / Age, sex, emergency admission, year of diagnosis
Harris, 200932 / U.K., longitudinal,Birmingham Heartlands Hospital, 2000-2007 / Index of Multiple Deprivation / 5 / % that received treatment / Resectional surgery
Of which permanent stoma / 486 / 79.2 vs. 93%
40.8 vs. 30% / -
Tilney, 2009 33 / Great Britain and Ireland, longitudinal,2000-2005 / Index of multiple deprivation+ / 5 / OR / APER (abdominoperineal excision of rectum) / 2625 / 1.638 (1.362-1.969) / Year of study, sex, neoadjuvant therapy
* OR: odds ratio [brackets represent relative risks calculated from the data]
$ 95%CI: 95% confidence interval;
# Values in bold are statistically significant;
+ Carstairs index: overcrowding, employment, social class, car ownership; Index of multiple deprivation: income, employment, health and disability, education, skills and training, houses and services, living environment, crime.
Table 3A. Associations between survival (relative survival) from colon and rectal cancer and socioeconomic status.
Survival of patients with low vs. high SESAuthor, year / Study base / Indicators / classes / Type of measurement / N / Male / N / Female / Adjusted for….
Colon
Gorey, 1997 34 / U.S. and Canada, longitudinal,SEER data and Ontario Cancer Registry, diagnosis 1986-1992 / Income (adjusted for household size and tied to consumer price index) / 3 / Survival rate ratio (95% CI)$ / U.S. 1-year 4198
U.S. 5-year 1242
Canada 1-year 3457
Canada 5-year 1441 / 0.90 (0.86-0.94)#
0.78 (0.65-0.94)
0.97 (0.92-1.02)
0.97 (0.84-1.11) / 4319
1421
3487
1507 / 0.94 (0.89-0.99)
0.82 (0.69-0.98)
1.06 (1.01-1.12)
1.33 (1.14-1.55) / Age
Shack, 2007 35 / U.K., Scotland, longitudinal,diagnosis 1996-2000, 15-99 years / Scottish indices of multiple deprivation score+ / 5 / Absolute difference in relative survival 5 years (poor minus rich) / 4969 patients / -5.7% / 5061 / -6.1% / -
Egeberg, 2008 15 / Denmark, longitudinal, >30y, 1994-2003 / Education
Disposable income
Social class
Housing Tenure
Size of dwelling / 3
3
6
2
4 / 5-year relative survival (%)
(creative core vs. manual) / 4866
4940
4480
4862
4940 / 42 vs. 46% [RR=0.9]*
40 vs. 46% [RR=0.9]
49 vs. 48% [RR=1.0]]
39 vs. 46% [RR=0.8]
36 vs. 49% [RR=0.7] / 4602
4650
3228
4608
4650 / 46 vs. 49% [RR=0.9]
45 vs. 55% [RR=0.8]
42 vs. 45% [RR=0.9]
47 vs. 49% [RR=1.0]
37 vs. 51% [RR=0.7]
Mitry, 2009 36 / England and Wales, longitudinal,1986-1999, 15-99 year / 1986-1995: Carstairs deprivation index+
1996-1999:Indices of Multiple Deprivation+ / 5 / Absolute deprivation gap:
1-year relative survival
5-year relative survival / 1986-1990 ?
1991-1995 ?
1996-1999 ?
Average change every 5 years
1986-1990 ?
1991-1995 ?
1996-1999 ?Average change every 5 years / -2.9 (-4.5, -1.2)
-5.1 (-6.6, -3.6)
-7.1 (-8.7, -5.6)
-2.2 (-3.5, -1.0)
-2.2 (-4.1, -0.3)
-4.3 (-6.1, -2.6)
-5.7 (-8.0, -3.4)
-1.9 (-3.4, -0.3) / ?
?
?
?
?
? / -4.2 (-5.7, -2.6)
-5.3 (-6.8, -3.9)
-6.7 (-8.3, -5.1)
-1.4 (-2.5, -0.2)
-3.3 (-5.0, -1.6)
-6.2 (-7.8, -4.5)
-7.3 (-9.4, -5.1)
-2.2 (-3.6, -0.8)
Rectal
Gorey, 1997 34 / U.S. and Canada, longitudinal,SEER data and Ontario Cancer Registry, diagnosis 1986-1992 / Income (adjusted for household size and tied to consumer price index) / 3 / Survival rate ratio / U.S. 1-year 1976
U.S. 5-year 645
Canada 1-year 1615
Canada 5-year 646 / 0.88 (0.83-0.93)
0.87 (0.69-1.09)
0.96 (0.89-1.03)
0.90 (0.72-1.12) / 1579
505
1220
507 / 0.89 (0.80-0.99)
0.80 (0.61-1.05)
1.02 (0.89-1.17)
1.05 (0.81-1.37) / Age
Shack, 2007 35 / U.K., Scotland, longitudinal,diagnosis 1996-2000, 15-99 years / Scottish indices of multiple deprivation score+ / 5 / Absolute difference in relative survival 5 years (poor minus rich) / 3190 / -5.3 / 2227 / -8.0 / -
Egeberg, 2008 15 / Denmark, longitudinal,>30y, 1994-2003 / Education
Disposable income
Social class
Housing Tenure
Size of dwelling / 3
3
6
2
4 / 5-year relative survival (%)
(manual vs. creative core) / 4177
4247
3893
4209
4247 / 44 vs. 50% [RR=0.9]
41 vs. 51% [RR=0.8]
46 vs. 56% [RR=0.8]
43 vs. 48% [RR=0.9]
41 vs. 48% [RR=0.9] / 2862
2895
2132
2860
2895 / 51 vs. 57% [RR=0.9]
49 vs. 58% [RR=0.8]
68 vs. 72% [RR=0.9]
50 vs. 55% [RR=0.9]
29 vs. 59% [RR=0.5]
Harris, 200932 / U.K., longitudinal,Birmingham Heartlands Hospital, 2000-2007 / Index of Multiple Deprivation+ / 5 / Overall 5-year survival (%)
5-year survival among those with resectional surgery (%) / 486
334 / 32.8 vs. 64.0%[RR=0.5]
49.9 vs. 72.0% [RR=0.7] / Both sexes
Both sexes / -
Mitry, 2009 37 / England and Wales, longitudinal,1986-1999, 15-99 year / Carstairs deprivation index+ (1986-1995; car ownership, overcrowding, unemployment; social class IV or V of household)
1996-1999: Indices of Multiple Deprivation+ / 5 / Absolute deprivation gap:
1-year relative survival
5-year relative survival / 1986-1990 ?
1991-1995 ?
1996-1999 ?
Average change every 5 years
1986-1990 ?
1991-1995 ?
1996-1999 ? Average change every 5 years / -5.4 (-7.3, -3.6)
-4.8 (-6.4, -3.1)
-8.1 (-9.7, -6.4)
-1.4 (-2.7, -0.1)
-4.7 (-6.8, -2.6)
-6.0 (-8.0, -4.0)
-9.4 (-12.0, -6.8)
-2.4 (-4.1, -0.6) / ?
?
?
?
?
? / -4.6 (-6.7, -2.5)
-4.4 (-6.4, -2.5)
-6.9 (-9.0, -4.9)
-1.2 (-2.8, 0.3)
-3.7 (-6.1, -1.3)
-6.7 (-9.0, -4.3)
-8.3 (-11.4, -5.2)
-2.5 (-4.5, -0.5)
* RR: relative risk or risk ratio [brackets represent relative risks calculated from the data]
$ 95%CI: 95% confidence interval;
# Values in bold are statistically significant;
+ Scottish index of multiple deprivation: income, employment, health, education, skills and training, housing, geographic access and crime; Carstairs index: overcrowding, employment, social class, car ownership; Index of multiple deprivation: income, employment, health and disability, education, skills and training, houses and services, living environment, crime.
Table 3B. Associations between survival (risk of death) from colon, rectal and colorectal cancer and socioeconomic status.
Survival of patients with low vs. high SESAuthor, year / Study base / Indicators / classes / Type of measurement / N / Male / N / Female / Adjusted for….
Colon
Auvinen, 1995 38 / Finland, longitudinal,Cancer Registry, diagnosis 1971-1985, 25-64 years / Occupation / 4 / RR* (95% CI)$ / 2685 / 1.04 (0.82-1.33) / 3449 / 1.22 (0.98-1.49) / General mean, follow-up year, year of diagnosis, age at diagnosis/social class interaction
Dickman, 1998 39 / Finland, longitudinal,cancer registry, diagnosis 1977-1985, follow-up to 1992 / Occupational status / 4 / Excess risk of death in low vs. high SES / Follow-up time, social class, sex, age, age by follow-up interaction
Lemmens, 2005 26 / The Netherlands, longitudinal,Eindhoven cancer registry, 65-79 years, 1995-2001 / Combination of income and value of house / 3 / Hazard ratio of dying / 577 / 1.0 / Both sexes / Age, sex, comorbidity, adjuvant chemotherapy, stage, grade, period of diagnosis
Zhang-Salomons, 2006 40 / Canada (Ca): longitudinal,Ontario Cancer Registry, diagnosis 1989-1993, ≥25 years, follow-up till 1999,
U.S.: Detroit, longitudinal, SEER, diagnosis 1988-1992, follow-up till 1998 / Income (I)
% below poverty (P)
Education
Occupation / 5
5 / Relative risk of dying 5-year / 5388
8061 / U.S. I: 1.36#
P: 1.46
Ca I: 1.07
P: 1.05 / Both sexes / Age, sex
Hussain, 2008
41 / Sweden, longitudinal,Swedish Family-cancer database, 30-64 years, 1990-2004 / Education / 4 / Hazard ratio / 2240 / 1.23 / 2051 / 1.33 / Age time period
Le, 2008 42 / U.S., longitudinal,California Cancer Registry, 1994-2003 / Combination of education, income and occupation / 5 / Hazard ratio / ? / 1.26 / Both sexes / Age at diagnosis, sex, histology, site in colon, race, stage, surgery, radiation, chemotherapy
Meulenbeld, 2008
30 / Netherlands, longitudinal,Eindhoven cancer registry, ≥40 years, metastasis, 1990-2004 / Combination of value of housing and income / 3 / Hazard ratio / 1769 / 1.02 (0.91-1.16) / Age, sex, chemotherapy, comorbidity, number of tumour sites
Yu, 2008 43 / Australia, New South Wales, longitudinal,1996-2000 / Combination of educational and occupational levels / 5 / Relative excess risk of death / ? / 1.14 / Both sexes / Age group at diagnosis, sex, year of follow up, stage
Rectal
Auvinen, 1995 38 / Finland, longitudinal,Cancer Registry, diagnosis 1971-1985, 25-64 years / Occupation / 4 / Risk of death / 2605 / 1.54 / 2460 / 1.79 / General mean, follow-up year, year of diagnosis, age at diagnosis/social class interaction
Dickman, 1998 39 / Finland, longitudinal,cancer registry, diagnosis 1977-1985, follow-up to 1992 / Occupational status / 4 / Excess risk of death / 5619 / 38% (28-47) / Both sexes / Follow-up time, social class, sex, age, age by follow-up interaction
Lemmens, 2005 26 / The Netherlands, longitudinal,Eindhoven cancer registry, 65-79 years, 1995-2001 / Combination of income and value of house / 3 / Hazard ratio of dying / Age, sex, comorbidity, adjuvant chemotherapy, stage, grade, period of diagnosis
Zhang-Salomons, 2006 40 / Canada (Ca): longitudinal,Ontario Cancer Registry, diagnosis 1989-1993, ≥25 years, follow-up till 1999,
U.S.: Detroit, longitudinal,SEER, diagnosis 1988-1992, follow-up till 1998 / Income (I)
% below poverty (P)
Education
Occupation / 5
5 / Relative risk of dying 5-year / 2304
3331 / U.S. I: 1.61
P: 1.57
Ca I: 1.20
P: 1.00 / Both sexes / Age, sex
Hussain, 2008
41 / Sweden, longitudinal,Swedish Family-cancer database, 30-64 years, 1990-2004 / Education / 4 / Hazard ratio / 1463 / 1.15 (0.96-1.37) / 795 / 1.20 (0.91-1.59) / Age time period
Le, 2008 42 / U.S., longitudinal,California Cancer Registry, 1994-2003 / Combination of education, income and occupation / 5 / Hazard ratio / ? / 1.33 (1.24-1.42) / Both sexes / Age at diagnosis, sex, histology, site in rectum, race, stage, surgery, radiation, chemotherapy
Meulenbeld, 2008
30 / Netherlands, longitudinal,Eindhoven cancer registry, ≥40 years, metastasis, 1990-2004 / Combination of value of housing and income / 3 / Hazard ratio / Age, sex, chemotherapy, comorbidity, number of tumour sites
Yu, 2008 43 / Australia, New South Wales, longitudinal,1996-2001 / Combination of educational and occupational levels / 5 / Relative excess risk of death / ? / 1.11 / Both sexes / Age group at diagnosis, sex, year of follow up, stage
* RR: relative risk or risk ratio
$ 95%CI: 95% confidence interval;
# Values in bold are statistically significant.
Table 4A. Associations between mortality from colorectal cancer and socioeconomic status, U.S.
Relative risk of dying, low vs. high SESAuthor, year / Study base, diagnosis (yr) / Indicators / classes / Type of measurement / N / Males / N / Females / Adjusted for….
Colorectal
Singh, 2002 44 / U.S., longitudinal, county mortality data, 1950-1998 / 11 indicators: combination of education (2x), income (3x), occupation, unemployment, housing (2x),
access to phone, households without plumbing / 5 / RR*/100,000 (95% CI)$ / 25-64 year:
1950: 0.44 (0.38-0.51)#
1998: 1.26 (1.13-1.39)
>65 year:
1950: 0.40 (0.36-0.45)
1990: 0.78 (0.72-0.83) / 25-64 year:
1950: 0.56 (0.49-0.64)
1998: 1.22 (1.07-1.36)
>65 year:
1950: 0.58 (0.53-0.65)
1992: 0.88 (0.83-0.94) / Age
Steenland, 2002 45 / U.S., longitudinal, 2 cohorts: 1959-1972 and 1982-1996. >45y / Education / 5 / Mortality rate ratios
1959-1972
1982-1996 / 0.96 (0.86-1.08)
1.10 (0.97-1.25) / 1.27 (1.12-1.44)
1.21 (1.01-1.40) / Age, smoking, body mass index, diet, alcohol, prevalent hypertension, menopausal status (women)
Singh, 2003 46 / U.S. mortality, longitudinal,SEER cancer incidence, stage, treatment, and survival data were linked to county and census tract poverty rates from the 1990 census. 1995-1999 / % below poverty level / 3 / Mortality rate per 100,000 / 70139
deaths in all 3 SES groups / 26.16 (25.56-26.76) vs. 25.54 (25.21-25.88) [RR=1.0]* / 71695 / 17.82 (17.42-18.24) vs. 18.14 (17.91-18.37) [RR=1.0] / Age
Steenland, 200447 / U.S., longitudinal,27 states, 1984-1997 / Combination of occupation and Nam-Powers scores+ / 4 / Rate ratios / ? / 1.21 (1.16-1.27) / 0.91 (0.86-0.96) / Age, calendar year, gender, race
Albano, 2007
48 / U.S., longitudinal,47 states and WashingtonD.C., cancer deaths 25-64y, 2001 / Education / 2 / Relative risk of death / 5749 / 1.81 (1.73-1.89) / 4103 / 1.7 (1.63-1.82) / Age
Chu, 2007 49 / U.S., longitudinal,SEER, mortality 1990-2000 / % below poverty / 3 / Mortality rate per 100000
1990-1994
1995-2000 / ? / 27.8 vs. 29.7 [RR=0.9]
25.8 vs. 25.6 [RR=1.0] / ? / 18.8 vs. 20.1 [RR=0.9]
17.5 vs. 17.9 [RR=1.0] / Age
Kinsey, 2008 50 / U.S., longitudinal,43 states and District of Colombia, 1993-2001, 25-64 year / Education / 4 / Rate ratios of death per 100,000 population / ? / 1993: 1.5 (1.4-1.6)
2001: 2.0 (1.9-2.2) / ? / 1993: 1.4 (1.3-1.6)
2001: 1.9 (1.7-2.1) / Age
* RR: relative risk or risk ratio [brackets represent relative risks calculated from the data]
$ 95%CI: 95% confidence interval;
# Values in bold are statistically significant;
+ Nam Powers score: income and education.
Supplement Comprehensive Tables – Review Socioeconomic status and colorectal cancer 1
Table 4B. Associations between mortality from colon and rectal cancer and socioeconomic status, Europe, Japan and Australia.
Relative risk of dying, low vs. high SESAuthor, year / Study base, diagnosis (yr) / Indicators / classes / Type of measurement / N / Male / N / Female / Adjusted for….
Colon
Faggiano, 1995 51 / Italy, longitudinal,deaths within 6 months after 1981 census are linked to death index, 18-74 years / Education / 6 / RR* (95% CI)$ / 892 / 0.62 (0.38-1.02) / 700 / 0.37(0.20-0.69)# / Age, area of residence
Smith, 1996 52 / Australia, longitudinal,New South Wales Central Cancer Registry, 1987-1991 / Income, education and occupation / Odds ratio / 1714 / 1.05 (0.92-1.22) / 1666 / 1.15 (0.99-1.33) / Age
Burnley, 1997 17 / Australia, longitudinal,New South Wales cancer registry, mortality 1986-1993 (occupation), 1985-1991 (income, Jarman index), 40-64 years (occupation), 40-74 years (income, Jarman index) / Occupation (O) Income (I)
Jarman index (J)+ / 8
4 / Deaths per 100,000 (O, I), correlation with mortality rates (J) / 734
1986-1989
1990-1993
1986-1989
1990-1993 / O:
20.6 vs. 32.1 [RR=0.6]
29.1 vs. 41.8 (p-values?) [RR=0.7]
I:
0.91 (P<0.05 compared to 1.0) vs. 1.04 (n.s.)
J: 40-64 years:
-0.17
65-74 years: 0.01 / Age
Menvielle, 2005
53 / France, longitudinal,follow-up of 1% of population 35-39 years in 1975, 1975-1990 / Education
Occupational class / 4
7 / Relative index of inequality / 203 186 / 0.9 (0.6-1.6)
1.6 (1.0-2.7) / 147
81 / 1.0 (0.5-1.8)
0.6 (0.3-1.4) / Age, period
Lawlor, 2006 54 / Sweden, longitudinal,cohort of 0-16y Swedish (N=1824064) born in 1944-1960, follow-up from 1970 to 2001. / Parents’ occupation / 5 / Hazard ratio / ? / 0.96 (0.80-1.16) / ? / 0.97 (0.80-1.18) / Age
Puigpinós, 2009 55 / Spain, longitudinal,residents in Barcelona 1992-2003, 20y and older / Education / 5 / Relative Index of inequality / ?
1992-1994
1995-1997
1998-2000
2001-2003 / 1.25 (0.94-1.65)
1.09 (0.84-1.41)
1.01 (0.79-1.28)
1.05 (0.82-1.34) / ? / 0.94 (0.68-1.31)
1.41 (1.00-1.97)
1.19 (0.88-1.63)
1.47 (1.06-2.04) / Age
Rectal
Faggiano, 1995 51 / Italy, longitudinal,deaths within 6 months after 1981 census are linked to death index, 18-74 years / Education / 6 / Mortality
Rate ratio / 560 / 0.52 (0.25-1.11) / 374 / 1.69 (0.82-3.51) / Age, area of residence
Smith, 1996 52 / Australia, longitudinal,New South Wales Central Cancer Registry, 1987-1991 / Income, education and occupation / Odds ratio / 1034 / 0.78 (0.65-0.94) / 734 / 0.94 (0.75-1.19) / Age
Menvielle, 2005
53 / France, longitudinal,follow-up of 1% of population 35-39 years in 1975, 1975-1990 / Education
Occupational class / 4
7 / Relative index of inequality / 93 81 / 2.9 (1.3-6.4)
3.1 (1.4-6.8) / 56 / 1.0 (0.4-2.6)
Not available / Age, period
Puigpinós, 2009 55 / Spain, longitudinal,residents in Barcelona 1992-2003, 20y and older / Education / 5 / Relative Index of inequality / ?
1992-1994
1995-1997
1998-2000
2001-2003 / 1.44 (0.87-2.40)
1.57 (0.96-2.57)
2.85 (1.76-4.60)
1.66 (1.05-2.63) / ? / 1.28 (0.67-2.44)
1.80 (0.95-3.43)
1.40 (0.77-2.56)
0.96 (0.53-1.73) / Age
Colorectal
Pollock, 1997 56 / U.K., South Thames region, longitudinal,cancer registry data, 40-99 years, 1987-1992 / Townsend deprivation score+ / 10 / Standardized mortality ratio / 21905 / 104 (91-120) vs. 100 (90-111) [RR=1.0] / both sexes / Age, sex
Rosengren, 2004 57 / Sweden, longitudinal, diagnosis 1970-1972, 51-59 years, follow-up till 1992 / Occupation / 5 / Mortality per 100000 person years / 43 deaths / 51 vs. 29 [RR=1.8] / -
Shaw, 2006
58 / Australia, longitudinal,linkage of mortality and census data, 25-77 years, 1981-1999, data shown 1996-1999 / Income education / 5
5 / Relative index of inequality / ? / 1.72 (1.27-2.33)
1.39 (0.94-2.06) / ? / 1.41 (1.0-1.98)
1.28 (0.95-1.74) / Age
Menvielle, 2007 59 / France, longitudinal,1% of population, 35-59 years, 1968-1996 / Occupational class (Erikson, Goldthorpe, Portecarero) / 7 / Relative index of inequality
1968-1974
1975-1981
1982-1988
1990-1996 / Number of deaths:
70
66
58
71 / 2.53 (1.08-5.92)
3.13 (1.29-7.57)
2.07 (0.81-5.28)
2.48 (1.06-5.82) / Age
Ezendam, 2008 60 / Either cohort or cross-sectional data were included. Deaths 35-79 years.
Poland: data collection from 2001-2003, Lithuania 2000-2002, Estonia 1998-2002, Finland and Sweden: total population 1990-2000 / Education / 4 / Relative index of inequality: risk of dying / ?
?
?
?
? / Poland: 1.19 (1.11-1.28)
Lithuania: 0.66 (0.52-0.83)Estonia: 0.91 (0.70-1.19)
Finland: 0.94 (0.81-1.09)
Sweden: 1.10 (1.01-1.20) / ?
?
?
?
? / 1.12 (1.03-1.21)
1.16 (0.90-1.49)
0.83 (0.64-1.08)
1.03 (0.88-1.21)
1.29 (1.17-1.41) / Age
Menvielle, 2008
61 / longitudinal,Mortality among cancer patients in Madrid, Basque region, Barcelona, Slovenia, Turin, Switzerland, France, Belgium, Denmark, Norway, Sweden, Finland was compared, 30-74 years, 1990s / Education / 3 / Relative index of inequality (ratio of mortality rates) / ? / RII>1.0 in 9 out of 12 countries, ranging 0.92 (0.69-1.24) to 1.58 (1.06-2.34) / ? / RII>1.0 in 10 out of 12 countries, ranging 0.77 (0.44-1.33) to 1.36 (1.00-1.84) / Age
Nishi, 2008 62 / Japan, longitudinal,Life Span Study atomic bomb survivors (not or negligibly exposed to radiation), ≤75 years, 1980-2003 / Education / 3 / Hazard ratio / 159 deaths / 1.14 (0.72-1.79) / 189 / 0.71 (0.31-1.67) / Age, BMI, smoking, radiation, city
* RR: relative risk or risk ratio [brackets represent relative risks calculated from the data]