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Leung L, Lavoué J, Siemiatycki J, Guénel P, Koushik A. Occupational environment and ovarian cancer risk. Occup Environ Med 2023; 80:489-497. [PMID: 37429725 DOI: 10.1136/oemed-2022-108557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 03/30/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVES To investigate employment in an occupation or industry and specific occupational exposures in relation to ovarian cancer risk. METHODS In a population-based case-control study conducted in Montreal, Canada (2011-2016), lifetime occupational histories were collected for 491 cases of ovarian cancer and 897 controls. An industrial hygienist coded the occupation and industry of each participant's job. Associations with ovarian cancer risk were estimated for each of several occupations and industries. Job codes were linked to the Canadian job-exposure matrix, thereby generating exposure histories to many agents. The relationship between exposure to each of the 29 most prevalent agents and ovarian cancer risk was assessed. Odds ratios and 95% confidence intervals (OR (95% CI)) for associations with ovarian cancer risk were estimated using logistic regression and controlling for multiple covariates. RESULTS Elevated ORs (95% CI) were observed for employment ≥10 years as Accountants (2.05 (1.10 to 3.79)); Hairdressers, Barbers, Beauticians and Related Workers (3.22 (1.25 to 8.27)); Sewers and Embroiderers (1.85 (0.77 to 4.45)); and Salespeople, Shop Assistants and Demonstrators (1.45 (0.71 to 2.96)); and in the industries of Retail Trade (1.59 (1.05 to 2.39)) and Construction (2.79 (0.52 to 4.83)). Positive associations with ORs above 1.42 were seen for high cumulative exposure versus never exposure to 18 agents: cosmetic talc, ammonia, hydrogen peroxide, hair dust, synthetic fibres, polyester fibres, organic dyes and pigments, cellulose, formaldehyde, propellant gases, aliphatic alcohols, ethanol, isopropanol, fluorocarbons, alkanes (C5-C17), mononuclear aromatic hydrocarbons, polycyclic aromatic hydrocarbons from petroleum and bleaches. CONCLUSIONS Certain occupations, industries and specific occupational exposures may be associated with ovarian cancer risk. Further research is needed to provide a more solid grounding for any inferences in this regard.
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Affiliation(s)
- Lisa Leung
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Quebec, Canada
- Inserm U1018, CESP, Team Exposome and Heredity, Université Paris-Saclay, Villejuif, France
- Université de Montréal Hospital Research Centre, CRCHUM, Montreal, Quebec, Canada
| | - Jérôme Lavoué
- Université de Montréal Hospital Research Centre, CRCHUM, Montreal, Quebec, Canada
- Department of Environmental and Occupational Health, Université de Montréal, Montreal, Quebec, Canada
| | - Jack Siemiatycki
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Quebec, Canada
- Université de Montréal Hospital Research Centre, CRCHUM, Montreal, Quebec, Canada
| | - Pascal Guénel
- Inserm U1018, CESP, Team Exposome and Heredity, Université Paris-Saclay, Villejuif, France
| | - Anita Koushik
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Quebec, Canada
- Université de Montréal Hospital Research Centre, CRCHUM, Montreal, Quebec, Canada
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Redondo-Sánchez D, Fernández-Navarro P, Rodríguez-Barranco M, Nuñez O, Petrova D, García-Torrecillas JM, Jiménez-Moleón JJ, Sánchez MJ. Socio-economic inequalities in lung cancer mortality in Spain: a nation-wide study using area-based deprivation. Int J Equity Health 2023; 22:145. [PMID: 37533035 PMCID: PMC10399030 DOI: 10.1186/s12939-023-01970-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Lung cancer is the main cause of cancer mortality worldwide and in Spain. Several previous studies have documented socio-economic inequalities in lung cancer mortality but these have focused on specific provinces or cities. The goal of this study was to describe lung cancer mortality in Spain by sex as a function of socio-economic deprivation. METHODS We analysed all registered deaths from lung cancer during the period 2011-2017 in Spain. Mortality data was obtained from the National Institute of Statistics, and socio-economic level was measured with the small-area deprivation index developed by the Spanish Society of Epidemiology, with the census tract of residence at the time of death as the unit of analysis. We computed crude and age-standardized rates per 100,000 inhabitants by sex, deprivation quintile, and type of municipality (rural, semi-rural, urban) considering the 2013 European standard population (ASR-E). We further calculated ASR-E ratios between the most deprived (Q5) and the least deprived (Q1) areas and mapped census tract smoothed standardized lung cancer mortality ratios by sex. RESULTS We observed 148,425 lung cancer deaths (80.7% in men), with 73.5 deaths per 100,000 men and 17.1 deaths per 100,000 women. Deaths from lung cancer in men were five times more frequent than in women (ASR-E ratio = 5.3). Women residing in the least deprived areas had higher mortality from lung cancer (ASR-E = 22.2), compared to women residing in the most deprived areas (ASR-E = 13.2), with a clear gradient among the quintiles of deprivation. For men, this pattern was reversed, with the highest mortality occurring in areas of lower socio-economic level (ASR-E = 99.0 in Q5 vs. ASR-E = 86.6 in Q1). These socio-economic inequalities remained fairly stable over time and across urban and rural areas. CONCLUSIONS Socio-economic status is strongly related to lung cancer mortality, showing opposite patterns in men and women, such that mortality is highest in women residing in the least deprived areas and men residing in the most deprived areas. Systematic surveillance of lung cancer mortality by socio-economic status may facilitate the assessment of public health interventions aimed at mitigating cancer inequalities in Spain.
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Grants
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- PI18/01593 EU/FEDER Instituto de Salud Carlos III
- PI18/01593 EU/FEDER Instituto de Salud Carlos III
- PI18/01593 EU/FEDER Instituto de Salud Carlos III
- Not applicable Acciones de Movilidad CIBERESP, 2022
- JC2019-039691-I Juan de la Cierva Fellowship from the Ministry of Science and the National Research Agency of Spain
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Affiliation(s)
- Daniel Redondo-Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain.
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain.
- Escuela Andaluza de Salud Pública, Granada, 18080, Spain.
| | - Pablo Fernández-Navarro
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, 28029, Spain
| | - Miguel Rodríguez-Barranco
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Escuela Andaluza de Salud Pública, Granada, 18080, Spain
| | - Olivier Nuñez
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, 28029, Spain
| | - Dafina Petrova
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Escuela Andaluza de Salud Pública, Granada, 18080, Spain
| | - Juan Manuel García-Torrecillas
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Emergency and Research Unit, Torrecárdenas University Hospital, Almería, 04009, Spain
| | - Jose Juan Jiménez-Moleón
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, 18071, Spain
| | - María-José Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Escuela Andaluza de Salud Pública, Granada, 18080, Spain
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Adekpedjou A, Dabo‐Niang S. Semiparametric estimation with spatially correlated recurrent events. Scand Stat Theory Appl 2020. [DOI: 10.1111/sjos.12480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Akim Adekpedjou
- Department of Mathematics and Statistics Missouri University of Science and Technology
| | - Sophie Dabo‐Niang
- Laboratoire Paul Painvelé UMR CNRS 8524, INRIA‐MODAL University of Lille
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Hajizadeh M, Johnston G, Manos D. Socio-economic inequalities in lung cancer incidence in Canada, 1992–2010: results from the Canadian Cancer Registry. Public Health 2020; 185:189-195. [DOI: 10.1016/j.puhe.2020.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 01/12/2023]
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Gardy J, Dejardin O, Thobie A, Eid Y, Guizard AV, Launoy G. Impact of socioeconomic status on survival in patients with ovarian cancer. Int J Gynecol Cancer 2019; 29:792-801. [PMID: 30712018 DOI: 10.1136/ijgc-2018-000097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/07/2018] [Accepted: 12/28/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Socioeconomic status may impact survival in cancer patients. This study assessed whether low socioeconomic status has an impact on survival in patients with ovarian cancer and investigated whether differences in survival may be explained by type of therapy received. METHODS The study population comprised 318 patients with ovarian cancer diagnosed between 2011 and 2015 in the François Baclesse regional cancer care center in Caen, North-West France. Socioeconomic status was assessed by using the European deprivation index and overall survival was calculated at 3 years. RESULTS The unadjusted 3-year overall survival rate was 52% (95% CI 47 to 58). In a multivariable logistic regression model, a low socioeconomic status was associated with a lower probability of surgical resection (OR 0.34, 95% CI 0.16 to 0.74). A high socioeconomic status was associated with improved survival, adjusted for age, performance status, grade, and International Federation of Gynecology and Obstetrics (FIGO) stage (adjusted HR 1.53, 95% CI 1.04 to 2.26). When adjusting for treatment variables, there was no longer any significant difference in survival according to socioeconomic status (adjusted HR 1.24, 95% CI 0.83 to 1.84). CONCLUSIONS Higher socioeconomic status is associated with a greater probability of undergoing surgical resection and with improved survival in patients with ovarian cancer.
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Affiliation(s)
- Joséphine Gardy
- "ANTICIPE" U1086 INSERM-UCN, Centre François Baclesse, Caen, France .,Calvados General Cancer Registry, Caen, France.,Calvados Digestive Cancer Registry, Caen, France
| | - Olivier Dejardin
- "ANTICIPE" U1086 INSERM-UCN, Centre François Baclesse, Caen, France.,University Hospital of Caen, Caen, France
| | - Alexandre Thobie
- "ANTICIPE" U1086 INSERM-UCN, Centre François Baclesse, Caen, France
| | - Yassine Eid
- "ANTICIPE" U1086 INSERM-UCN, Centre François Baclesse, Caen, France
| | - Anne-Valérie Guizard
- "ANTICIPE" U1086 INSERM-UCN, Centre François Baclesse, Caen, France.,Calvados General Cancer Registry, Caen, France
| | - Guy Launoy
- "ANTICIPE" U1086 INSERM-UCN, Centre François Baclesse, Caen, France.,Calvados Digestive Cancer Registry, Caen, France.,University Hospital of Caen, Caen, France
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Bertaut A, Coudert J, Bengrine L, Dancourt V, Binquet C, Douvier S. Does mammogram attendance influence participation in cervical and colorectal cancer screening? A prospective study among 1856 French women. PLoS One 2018; 13:e0198939. [PMID: 29927995 PMCID: PMC6013094 DOI: 10.1371/journal.pone.0198939] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 05/29/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND We aimed to determine participation rates and factors associated with participation in colorectal (fecal occul blood test) and cervical cancer (Pap-smear) screening among a population of women participating in breast cancer screening. METHODS From August to October 2015, a self-administered questionnaire was sent by post to 2 900 women aged 50-65, living in Côte-d'Or, France, and who were up to date with mammogram screening. Polytomic logistic regression was used to identify correlates of participation in both cervical and colorectal cancer screenings. Participation in all 3 screenings was chosen as the reference. RESULTS Study participation rate was 66.3% (n = 1856). Besides being compliant with mammogram, respectively 78.3% and 56.6% of respondents were up to date for cervical and colorectal cancer screenings, while 46.2% were compliant with the 3 screenings. Consultation with a gynecologist in the past year was associated with higher chance of undergoing the 3 screenings or female cancer screenings (p<10-4), when consultation with a GP was associated with higher chance of undergoing the 3 screenings or organized cancer screenings (p<0.05). Unemployment, obesity, age>59 and yearly flu vaccine were associated with a lower involvement in cervical cancer screening. Women from high socio-economic classes were more likely to attend only female cancer screenings (p = 0.009). Finally, a low level of physical activity and tobacco use were associated with higher risk of no additional screening participation (p<10-3 and p = 0.027). CONCLUSIONS Among women participating in breast screening, colorectal and cervical cancer screening rates could be improved. Including communication about these 2 cancer screenings in the mammogram invitation could be worth to explore.
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Affiliation(s)
- Aurélie Bertaut
- Methodology and Biostatistics Unit, Centre Georges François Leclerc, Dijon, France
- * E-mail:
| | - Julien Coudert
- Medical Oncology Unit, Centre Georges François Leclerc, Dijon, France
| | - Leila Bengrine
- Medical Oncology Unit, Centre Georges François Leclerc, Dijon, France
| | - Vincent Dancourt
- ADECA 21-58, « Association pour le dépistage des cancers Côte-d’Or », Dijon, France
| | - Christine Binquet
- INSERM U1231-EPICAD Team, Burgundy-Franche Comte University, Dijon, France
- INSERM CIC1432, University Hospital, Dijon, France
| | - Serge Douvier
- Department of Gynecologic and Oncologic Surgery, University Hospital, Dijon, France
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Global Inequality in the Incidence and Mortality Rates of Esophageal Cancer: A Country-Level Analysis. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2018. [DOI: 10.5812/ijcm.10059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Fassier JB, Lamort-Bouché M, Broc G, Guittard L, Péron J, Rouat S, Carretier J, Fervers B, Letrilliart L, Sarnin P. Developing a Return to Work Intervention for Breast Cancer Survivors with the Intervention Mapping Protocol: Challenges and Opportunities of the Needs Assessment. Front Public Health 2018; 6:35. [PMID: 29527521 PMCID: PMC5829033 DOI: 10.3389/fpubh.2018.00035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/31/2018] [Indexed: 01/02/2023] Open
Abstract
Return to work (RTW) is an important step for breast cancer survivors (BCSs). However, they face many barriers that affect particularly women with low socioeconomic status (SES). Health care, workplace, and insurance actors lack knowledge and collaborate poorly. No intervention to date has proven effective to reduce social disparities in employment after breast cancer. The intervention mapping (IM) protocol is being used in France to develop, implement, and evaluate an intervention to facilitate and sustain RTW after breast cancer [FAciliter et Soutenir le retour au TRAvail après un Cancer du Sein (FASTRACS) project]. The research question of this study was to elicit the needs for RTW after breast cancer from various stakeholders' point of view. The aim of this study was to describe the process and the preliminary results of the needs assessment of the FASTRACS project. Different methods were followed to (a) establish and work with a planning group and (b) conduct a needs assessment to create a logic model of the problem. A planning group was organized to gather the stakeholders with the research team. A review of the literature and indicators was conducted to identify the magnitude of the problem and the factors influencing RTW. A qualitative inquiry was conducted with 12 focus groups and 48 individual semi-structured interviews to explore the needs and experience of the stakeholders. The results of these tasks were the proposition of a charter of partnership to structure the participative process, a review of the scientific evidence and indicators, and the description by the stakeholders of their needs and experience. Many stakeholders disagreed with the concept of "early intervention." They advocated for a better support of BCSs during their RTW, emphasized as a process. Anticipation, intersectoral collaboration, and workplace accommodation were mentioned to fit the needs of the BCS and their environment. A logic model of the problem was elaborated from these data. The ability of the model to consider specific characteristics of women with low SES is discussed, with a view to developing the FASTRACS intervention through the next steps of the IM protocol.
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Affiliation(s)
- Jean-Baptiste Fassier
- UMRESTTE UMR T_9405, Unité mixte de recherche Epidémiologique et de Surveillance Transport Travail Environnement, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Service de médecine et santé au travail, Hospices civils de Lyon, Lyon, France
| | - Marion Lamort-Bouché
- UMRESTTE UMR T_9405, Unité mixte de recherche Epidémiologique et de Surveillance Transport Travail Environnement, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Collège universitaire de médecine générale, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Guillaume Broc
- UMRESTTE UMR T_9405, Unité mixte de recherche Epidémiologique et de Surveillance Transport Travail Environnement, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Laure Guittard
- HESPER, Health Services and Performance Research, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Pôle IMER, Hospices civils de Lyon, Lyon, France
| | - Julien Péron
- Laboratoire de Biométrie et Biologie Evolutive LBBE – UMR 5558, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Service d’oncologie médicale. Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Hospices civils de Lyon, Pierre-Bénite, France
| | - Sabrina Rouat
- GRePS – EA 4163 (Groupe de Recherche en Psychologie Sociale), Université Lumière Lyon 2, Université de Lyon, Lyon, France
| | - Julien Carretier
- Centre Léon Bérard, Département Cancer et Environnement, Lyon, France
| | - Béatrice Fervers
- Centre Léon Bérard, Département Cancer et Environnement, Lyon, France
- Faculté Lyon Est, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Laurent Letrilliart
- Collège universitaire de médecine générale, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- HESPER, Health Services and Performance Research, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Philippe Sarnin
- GRePS – EA 4163 (Groupe de Recherche en Psychologie Sociale), Université Lumière Lyon 2, Université de Lyon, Lyon, France
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Andrade JOM, Santos CADST, Oliveira MC. Associated factors with oral cancer: a study of case control in a population of the Brazil's Northeast. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 18:894-905. [PMID: 26982303 DOI: 10.1590/1980-5497201500040017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 07/14/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study aimed at assessing the association between factors such as age, sex, skin color, occupation, educational level, marital status, place of residence, and tobacco and alcohol consumptions and oral cancer in individuals in a city in the northeast of Brazil between 2002 and 2012. METHODS This is a case-control study. The case group consisted of 127 people attended at the Oral Injury Reference Center with histopathological diagnosis of oral squamous cell carcinoma. The control group consisted of 254 individuals treated at the same center. The study considered two controls for each case. The cases and controls were adjusted according to sex and age. Univariate and bivariate analyses were performed (Pearson χ2-test) to verify the correlation between the dependent variable (oral cancer) and the independent variables; odds ratio (OR) and the confidence interval of 95% (95%CI) were calculated. Finally, in the multivariate analysis, it was used as the hierarchical model with logistic regression to explain the interrelationships between the independent variables and oral cancer. RESULTS Consumption of more than 20 cigarettes per day [OR = 6.64; 95%CI 2.07 - 21.32; p ≤ 0.001], an excessive alcohol consumption [OR = 3.25; 95%CI 1.03 - 10.22; p ≤ 0.044], and the synergistic consumption of tobacco and alcohol [OR = 9.65; 95%CI 1.57 - 59.08; p ≤ 0.014] are the most important risk factors for oral cancer. CONCLUSION It was concluded that tobacco and alcohol consumptions are the most important factors for the development of oral cancer. Sociodemographic factors were not associated with this neoplasm after adjusting for smoking and drinking.
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Affiliation(s)
| | | | - Márcio Campos Oliveira
- Departamento de Ciências da Saúde, Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brazil
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Rasouli MA, Moradi G, Roshani D, Nikkhoo B, Ghaderi E, Ghaytasi B. Prognostic factors and survival of colorectal cancer in Kurdistan province, Iran: A population-based study (2009-2014). Medicine (Baltimore) 2017; 96:e5941. [PMID: 28178134 PMCID: PMC5312991 DOI: 10.1097/md.0000000000005941] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/19/2016] [Accepted: 12/27/2016] [Indexed: 01/05/2023] Open
Abstract
Colorectal cancer (CRC) survival varies at individual and geographically level. This population-based study aimed to evaluating various factors affecting the survival rate of CRC patients in Kurdistan province.In a retrospective cohort study, patients diagnosed as CRC were collected through a population-based study from March 1, 2009 to 2014. The data were collected from Kurdistan's Cancer Registry database. Additional information and missing data were collected reference to patients' homes, medical records, and pathology reports. The CRC survival was calculated from the date of diagnosis to the date of cancer-specific death or the end of follow-up (cutoff date: October 2015). Kaplan-Meier method and log-rank test were used for the univariate analysis of survival in various subgroups. The proportional-hazard model Cox was also used in order to consider the effects of different factors on survival including age at diagnosis, place of residence, marital status, occupation, level of education, smoking, economic status, comorbidity, tumor stage, and tumor grade.A total number of 335 patients affected by CRC were assessed and the results showed that 1- and 5-year survival rate were 87% and 33%, respectively. According to the results of Cox's multivariate analysis, the following factors were significantly related to CRC survival: age at diagnosis (≥65 years old) (HR 2.08, 95% CI: 1.17-3.71), single patients (HR 1.62, 95% CI: 1.10-2.40), job (worker) (HR 2.09, 95% CI: 1.22-3.58), educational level: diploma or below (HR 0.61, 95% CI: 0.39-0.92), wealthy economic status (HR 0.51, 95% CI: 0.31-0.82), tumor grade in poorly differentiated (HR 2.25, 95% CI: 1.37-3.69), and undifferentiated/anaplastic grade (HR 2.90, 95% CI: 1.67-4.98).We found that factors such as low education, inappropriate socioeconomic status, and high tumor grade at the time of disease diagnosis were effective in the poor survival of CRC patients in Kurdistan province; this, which need more attention.
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Affiliation(s)
- Mohammad Aziz Rasouli
- Student Research Committee
- Department of Epidemiology and Biostatistics, Faculty of Medicine
| | - Ghobad Moradi
- Social Determinants of Health Research Center
- Department of Epidemiology and Biostatistics, Faculty of Medicine
| | - Daem Roshani
- Social Determinants of Health Research Center
- Department of Epidemiology and Biostatistics, Faculty of Medicine
| | - Bahram Nikkhoo
- Department of Pathology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ebrahim Ghaderi
- Social Determinants of Health Research Center
- Department of Epidemiology and Biostatistics, Faculty of Medicine
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Pakzad R, Mohammadian-Hafshejani A, Khosravi B, Soltani S, Pakzad I, Mohammadian M, Salehiniya H, Momenimovahed Z. The incidence and mortality of esophageal cancer and their relationship to development in Asia. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:29. [PMID: 26889482 DOI: 10.3978/j.issn.2305-5839.2016.01.11] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Esophageal cancer is the most common cancer in less developed countries. It is necessary to understand epidemiology of the cancer for planning. The aim of this study was to evaluate the incidence and mortality of esophageal cancer, and its relationship with Human Development Index (HDI) and its components in Asia in 2012. METHODS This study was an Ecological study, which conducted based on GLOBOCAN project of WHO for Asian counters. We assess the correlation between standardized incidence rates (SIR) and standardized mortality rates (SMR) of esophageal cancer with HDI and its components with using of SPSS18. RESULTS A total of 337,698 incidence (70.33% were males and 29.87% females. Sex ratio was 2.37) and 296,734 death (69.45% in men and 30.54% in women. The sex ratio was 2.27) esophageal cancer was recorded in Asian countries in 2012. Five countries with the highest SIR and SMR of esophageal cancer were Turkmenistan, Mongolia and Tajikistan, Bangladesh and China respectively. Correlation between HDI and SIR was -0.211 (P=0.159), in men -0.175 (P=0.244) and in women -0.231 (P=0.123). Also between HDI and SMR -0.250 (P=0.094) in men -0.226 (P=0.131) and in women -0.251 (P=0.037). CONCLUSIONS The incidence of esophageal cancer is more in less developed and developing countries. Statistically significant correlation was not found between standardized incidence and mortality rates of esophageal cancer, and HDI and its dimensions, except for life expectancy at birth.
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Affiliation(s)
- Reza Pakzad
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 2 Epidemiologist, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran ; 3 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 4 Department of Microbiology, Medical School, Ilam University Of Medical Sciences, Ilam, Iran ; 5 Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran ; 6 Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran ; 7 Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran ; 8 Students' Scientific Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 9 Qom University of Medical Sciences, Qom, Iran
| | - Abdollah Mohammadian-Hafshejani
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 2 Epidemiologist, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran ; 3 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 4 Department of Microbiology, Medical School, Ilam University Of Medical Sciences, Ilam, Iran ; 5 Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran ; 6 Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran ; 7 Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran ; 8 Students' Scientific Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 9 Qom University of Medical Sciences, Qom, Iran
| | - Bahman Khosravi
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 2 Epidemiologist, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran ; 3 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 4 Department of Microbiology, Medical School, Ilam University Of Medical Sciences, Ilam, Iran ; 5 Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran ; 6 Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran ; 7 Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran ; 8 Students' Scientific Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 9 Qom University of Medical Sciences, Qom, Iran
| | - Shahin Soltani
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 2 Epidemiologist, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran ; 3 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 4 Department of Microbiology, Medical School, Ilam University Of Medical Sciences, Ilam, Iran ; 5 Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran ; 6 Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran ; 7 Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran ; 8 Students' Scientific Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 9 Qom University of Medical Sciences, Qom, Iran
| | - Iraj Pakzad
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 2 Epidemiologist, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran ; 3 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 4 Department of Microbiology, Medical School, Ilam University Of Medical Sciences, Ilam, Iran ; 5 Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran ; 6 Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran ; 7 Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran ; 8 Students' Scientific Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 9 Qom University of Medical Sciences, Qom, Iran
| | - Mahdi Mohammadian
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 2 Epidemiologist, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran ; 3 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 4 Department of Microbiology, Medical School, Ilam University Of Medical Sciences, Ilam, Iran ; 5 Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran ; 6 Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran ; 7 Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran ; 8 Students' Scientific Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 9 Qom University of Medical Sciences, Qom, Iran
| | - Hamid Salehiniya
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 2 Epidemiologist, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran ; 3 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 4 Department of Microbiology, Medical School, Ilam University Of Medical Sciences, Ilam, Iran ; 5 Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran ; 6 Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran ; 7 Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran ; 8 Students' Scientific Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 9 Qom University of Medical Sciences, Qom, Iran
| | - Zohre Momenimovahed
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 2 Epidemiologist, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran ; 3 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 4 Department of Microbiology, Medical School, Ilam University Of Medical Sciences, Ilam, Iran ; 5 Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran ; 6 Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran ; 7 Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran ; 8 Students' Scientific Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 9 Qom University of Medical Sciences, Qom, Iran
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Jasilionis D, Smailyte G, Vincerzevskiene I, Shkolnikov VM. Educational differentials in cancer mortality and avoidable deaths in Lithuania, 2001-2009: a census-linked study. Int J Public Health 2015; 60:919-26. [PMID: 26427860 DOI: 10.1007/s00038-015-0745-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 08/19/2015] [Accepted: 09/21/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES We investigate relative mortality inequalities by education for detailed cancer sites and provide estimates of deaths which could have been avoided through the elimination of these inequalities. METHODS A census-linked dataset based on a follow-up of all residents registered in the 2001 census was used for the analysis. Mortality rate ratios were estimated by employing multivariate Poisson regression models for count data. RESULTS An inverse educational gradient was observed for 11 cancer sites among men and for three cancer sites among women. Substantial shares of these cancer deaths would have been avoided if mortality among less educated groups had been the same as mortality among highly educated groups. CONCLUSIONS Cancer control plans must consider socioeconomic inequalities and propose ways to improve prevention measures aimed at disadvantaged groups.
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Affiliation(s)
- Domantas Jasilionis
- Max Planck Institute for Demographic Research, Konrad Zuse Str. 1, 18057, Rostock, Germany.
- Lithuanian Social Research Centre, Vilnius, Lithuania.
| | - Giedre Smailyte
- Lithuanian Social Research Centre, Vilnius, Lithuania
- National Cancer Institute, Vilnius, Lithuania
| | - Ieva Vincerzevskiene
- Lithuanian Social Research Centre, Vilnius, Lithuania
- National Cancer Institute, Vilnius, Lithuania
| | - Vladimir M Shkolnikov
- Max Planck Institute for Demographic Research, Konrad Zuse Str. 1, 18057, Rostock, Germany
- New School of Economics, Center for Demographic Studies, Moscow, Russian Federation
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Martins JD, Mascarenhas Andrade JO, Freitas VS, Araújo TM. Determinantes sociais de saúde e a ocorrência de câncer oral: uma revisão sistemática de literatura. Rev Salud Publica (Bogota) 2015. [DOI: 10.15446/rsap.v16n5.40083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
<p><strong>Objetivo</strong> O objetivo deste artigo é revisar a literatura sobre os determinantes sociais de saúde e sua associação com o desenvolvimento do câncer oral.</p><p><strong>Métodos</strong> A busca sistemática foi realizada na base de dados eletrônica Pubmed para acessar artigos relevantes publicados de todos os anos disponíveis até 2012. Listas de referências dos artigos selecionados foram examinadas para identificar artigos adicionais. Vinte e um artigos foram incluídos no estudo.</p><p><strong>Resultados</strong> Apesar das dificuldades em fazer comparações entre os artigos, devido à falta de uniformidade na definição dos determinantes sociais da saúde e do pequeno número de publicações sobre o assunto, os resultados mostraram uma forte associação entre privação social, status socioeconômico e renda, educação e ocupação com câncer oral.</p><p><strong>Conclusão</strong> É importante que novos trabalhos sejam realizados visando estudar com mais profundidade essa associação, compreender melhor a ocorrência do câncer oral e a sua prevenção. Além disso, é necessária a elaboração de políticas sociais com vistas à melhoria das condições de vida da população, uma vez que, os resultados evidenciam que melhores condições de vida constituem fator de proteção para o câncer oral.</p>
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Heidarnia MA, Monfared ED, Akbari ME, Yavari P, Amanpour F, Mohseni M. Social determinants of health and 5-year survival of colorectal cancer. Asian Pac J Cancer Prev 2014; 14:5111-6. [PMID: 24175785 DOI: 10.7314/apjcp.2013.14.9.5111] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early in the 21st century, cancers are the second cause of death worldwide. Colon cancer is third most common cancer and one of the few amenable to early diagnosis and treatment. Evaluation of factors affecting this cancer is important to increase survival time. Some of these factors affecting all diseases including cancer are social determinants of health. According to the importance of this disease and relation with these factors, this study was conducted to assess the relationship between social determinants of health and colon cancer survival. MATERIALS AND METHODS This was a cross-sectional, descriptive study for patients with colon cancer registered in the Cancer Research Center of Shahid Beheshti University of Medical Science, from April 2005 to November 2006, performed using questionnaires filled by telephone interview with patients (if patients had died, with family members). Data was analyzed with SPSS software (version 19) for descriptive analysis and STATA software for survival analysis including log rank test and three step Cox Proportional Hazard regression. RESULTS Five hundred fifty nine patients with ages ranging from 23 to 88 years with mean ± standard deviation of 63 ± 11.8 years were included in the study. The five year survival was 68.3%( 387 patients were alive and 172 patients were dead by the end of the study). The Cox proportional hazard regression showed 5-year survival was related to age (HR=0.53, p=0.042 for>50 years versus<50 years old) in first step, gender (HR=0.60, p=0.006 for female versus male) in second step, job (HR=1.7, p=0.001 for manual versus non manual jobs), region of residency (HR=3.49, p=0.018 for west versus south regions), parents in childhood (HR=2.87, p=0.012 for having both parents versus not having), anatomical cancer location (HR=2.16, p<0.033 for colon versus rectal cancer) and complete treatment (HR=5.96, p<0.001 for incomplete versus complete treatment). CONCLUSIONS Social determinants of health such as job, city region residency and having parents during childhood have significant effects in 5-year survival of colon cancer and it may be better to consider these factors in addition to developing cancer treatment and to focus on these determinants of health in long-time planning.
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Affiliation(s)
- Mohammad Ali Heidarnia
- Department of Community Medicine and Health, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran E-mail :
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Karimi M, Geoffroy-Perez B, Fouquet A, Latouche A, Rey G. Socioprofessional trajectories and mortality in France, 1976-2002: a longitudinal follow-up of administrative data. J Epidemiol Community Health 2014; 69:339-46. [PMID: 25516611 DOI: 10.1136/jech-2014-204615] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Occupying a low socioeconomic position is associated with increased mortality risk. To disentangle this association, previous studies considered various dimensions of socioeconomic trajectories across the life course. However, they used a limited number of stages. We simultaneously examined various dimensions of the whole professional trajectory and its association with mortality. METHODS We used a large sample (337,706 men and 275,378 women) of the data obtained by linking individuals' annual occupation (collected in 1976-2002 from a representative panel of the French salaried population in the semipublic and private sectors) with causes of death obtained from registries. All-cause and cause-specific HRs were estimated using Cox's regression models adjusted for the occupational class at the beginning of the follow-up, the current occupational class, the transition rates between occupational categories and the duration of time spent in occupational categories. RESULTS An increase in the time spent in the clerk class increased men and women's cardiovascular mortality risk compared with that in the upper class (HRs=1.59 (1.14 to 2.20) and 2.65 (1.14 to 6.13) for 10 years increase, respectively, for men and women). Men with a high rate of transitions had about a 1.2-fold increased risk of all-cause and external-cause mortality compared with those without transitions during their professional life. This association was also observed for women's all-cause mortality. CONCLUSIONS Strong associations between professional trajectories and mortality from different causes of death were found. Long exposure to lower socioeconomic conditions was associated with increased mortality risk from various causes of death. The results also suggest gradual associations between transition rates and mortality.
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Affiliation(s)
| | | | - Aurélie Fouquet
- Département Santé-Travail, Institut de Veille Sanitaire, Saint-Maurice, France
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Callera F, Callera AF, Rosa ES. Trends in mortality of adult patients diagnosed with myeloid leukemia from 1994 to 2011 in southeastern Brazil. Rev Bras Hematol Hemoter 2014; 37:7-11. [PMID: 25638760 PMCID: PMC4318848 DOI: 10.1016/j.bjhh.2014.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 07/11/2014] [Indexed: 11/19/2022] Open
Abstract
Objective To evaluate trends in mortality among adults with myeloid leukemia in the Vale do Paraíba, State of São Paulo. Methods Data from the Brazilian National Health Service database DATASUS provided the number of deaths caused by myeloid leukemia and the number of inhabitants per year in the Regional Health Division XVII from 1994 to 2011. Registries were categorized according to gender into four age ranges (over 20 years, 20–49, 50–69 and over 70 years) for an estimation of the annual percent change for age-adjusted mortality rates. The percent changes were calculated using the Joinpoint regression analysis model. Results Overall, a significant decline per year was demonstrated for the entire sample (over 20 years) across the 18-year period studied (annual percent change: −5.59%; 95% CI: −8.5 to −2.5% for males; p-value < 0.05 and −7.02%; 95% CI −11.2 to −2.8% for females; p-value < 0.05) with no significant difference between genders. In an analysis using two Joinpoints, significant drops were observed from 1994 to 2001 (annual percent change: −21.22%; 95% confidence interval: −27.9 to −13.9%; p-value < 0.05) and from 1994 to 2003 (annual percent change: −12.86%; 95% confidence interval −22.2 to −2.5%; p-value < 0.05) for men and women, respectively. The declining trends were greatest for patients aged over 70 years with the age-adjusted mortality rates in younger groups declining non-significantly except for males aged 50–69 years old. Conclusion Our data suggest a significant decline per year in age-adjusted mortality rates of adult patients diagnosed with myeloid leukemia from 1994 to 2011 in the Vale do Paraíba, State of São Paulo.
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Trends in socio-economic inequalities in mortality by sex in Ireland from the 1980s to the 2000s. Ir J Med Sci 2014; 184:613-21. [PMID: 25156180 DOI: 10.1007/s11845-014-1189-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 08/19/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND It has been recognised for some time that mortality rates vary across social class groups, with lower rates in the higher social classes. Internationally, but particularly in Ireland, many studies on the topic of inequalities in mortality have been confined to men, partly because the most frequently used socioeconomic classification, that based on occupation, can less easily be applied to women. Where research does exist, studies indicate that health inequalities are greater for men than for women. Given the issues around classification, there remains however, little knowledge of the socio-economic inequalities in female mortality in Ireland. AIMS Using annual mortality data from the Irish Central Statistics Office over the period 1984-2008 this paper calculates crude and standardised mortality rates per 100,000 population for men and women in different socio-economic groups (SEG) and examines trends in these over time. This means that for the first time, longitudinal comparisons can be made between men and women across an important period of recent Irish history. RESULTS There is a significant gradient in mortality rates across SEG for both men and women with the absolute and relative differential between professional and manual occupational groups increasing between the 1980s and 2000s even though the mortality rates were falling over time for all SEG groups for both sexes. CONCLUSIONS The results confirm international findings that women generally have smaller gradients than men across SEG with the ratio of male/female differentials (i.e. the ratio of the male SEG rate ratio to the female SEG rate ratio) decreasing between the 1980s and 2000s from 1.25 to 1.07.
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Manser CN, Bauerfeind P. Impact of socioeconomic status on incidence, mortality, and survival of colorectal cancer patients: a systematic review. Gastrointest Endosc 2014; 80:42-60.e9. [PMID: 24950641 DOI: 10.1016/j.gie.2014.03.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/05/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Christine N Manser
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Zurich University Hospital, Zurich, Switzerland
| | - Peter Bauerfeind
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Zurich University Hospital, Zurich, Switzerland
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Socioeconomic status and epithelial ovarian cancer survival in Sweden. Cancer Causes Control 2014; 25:1063-73. [PMID: 24906473 DOI: 10.1007/s10552-014-0407-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 05/28/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate socioeconomic disparities in epithelial ovarian cancer (EOC) survival in Sweden. METHODS A cohort of 635 women with invasive EOC who participated in a nationwide population-based case-control study was included in the present population-based prospective study. Women were diagnosed with EOC between 1993 and 1995. Mortality until 31 December 2007 was determined through linkage with the Swedish Cause of Death Registry. Clinical data (tumor stage and tumor differentiation) and indicators of socioeconomic status (SES, education level, and annual individual disposable income) were retrieved from medical records and a nationwide database, respectively. The Cox proportional hazards regression model and the Laplace regression model were used to estimate the effect of clinical factors and SES on EOC survival. RESULTS The main factors associated with EOC survival were tumor stage and tumor differentiation: women with stage II, III, and IV tumors had a greater mortality risk than those with stage I tumors [hazard ratio (HR) 2.65, 95 % confidence interval (CI) 1.73-4.07; HR 6.69, 95 % CI 4.85-9.22; HR 12.84, 95 % CI 8.90-18.66, respectively]. After adjustment for these tumor characteristics, no clear association remained between our indicators of SES and EOC survival, but better survival was observed among women with stage IV tumors and a higher income level, and among women with poorly differentiated tumors and a higher education level. Nevertheless, there was no evidence of extended survival among women with higher compared to lower SES. CONCLUSIONS Our study provides no convincing evidence of an association between SES and EOC survival in Sweden.
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From deindustrialization to individual health-related quality of life: Multilevel evidence of contextual predictors, mediators and modulators across French regions, 2003. Health Place 2013; 22:140-52. [DOI: 10.1016/j.healthplace.2013.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 03/05/2013] [Accepted: 03/17/2013] [Indexed: 11/19/2022]
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Rey G, Rican S, Luce D, Menvielle G, Jougla E. Measuring social inequalities in cause-specific mortality in France: comparison between linked and unlinked approaches. Rev Epidemiol Sante Publique 2013; 61:221-31. [PMID: 23647937 DOI: 10.1016/j.respe.2012.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 08/22/2012] [Accepted: 11/05/2012] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Monitoring the time trends in socioeconomic inequalities in mortality by cause is a key public health issue. The aim of this study was to compare methods to measure social inequalities in cause-specific mortality in the French population aged 25-55 years. More specifically, it compares bias and precision related to the use of occupational class declared at the last census (linked data) to the one declared at the time of death on the death certificate (unlinked data). METHODS We used a representative sample of 1% of the French population. Causes of death were obtained by direct linkage with the French national death registry. Occupational class was classified into eight categories. Taking professionals and managers as the reference, relative risks of mortality by cause and their 95% confidence intervals were estimated using Poisson models for the 1983-1989, 1991-1997, and 2000-2006 periods. The relative risks were calculated with both linked data and exhaustive unlinked data. RESULTS Over the 2000-2006 period, occupational classes declared at census and on the death certificate were consistent for half of the deaths. Relative risks for manual workers were found to be similar between the two approaches over the 1983-1989 and 1991-1997 periods, and higher for the unlinked approach over the 2000-2006 period. Over the latter period, the order and magnitude of relative risks varied similarly by occupational class and cause of death for both approaches. Confidence intervals obtained from linked data were wide. CONCLUSION Occupational class derived from the death certificate must be used with caution as a measure for epidemiological purposes and the available linked data do not allow accurate estimates of social inequalities in cause-specific mortality. Other solutions should be considered in order to improve the follow-up of social inequalities in mortality. This would require the collection of educational level on the death certificate or the linkage of the cause of death database with other exhaustive and informative databases.
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Affiliation(s)
- G Rey
- Inserm, CépiDc, 80, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
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Aguilar I, Compés L, Feja C, Rabanaque MJ, Martos C. Gastric cancer incidence and geographical variations: the influence of gender and rural and socioeconomic factors, Zaragoza (Spain). Gastric Cancer 2013; 16:245-53. [PMID: 22806416 DOI: 10.1007/s10120-012-0175-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 06/12/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Socioeconomic status (SES) and rural factors have been shown to be associated with gastric cancer epidemiology. The aim of this study was to identify geographical variations in gastric cancer incidence in Zaragoza province (Spain) during the period 1993-2002, and their association with SES and rural factors. METHODS Incident cases were extracted from the population-based Zaragoza Cancer Registry. The geographical analysis unit was the census tract (CT) in Zaragoza city (N = 462) and the municipalities for the rest of the province (N = 292). Four indexes were applied: two deprivation and two rurality indexes, included in a Bayesian risk model discretized in quartiles. Standardized incidence ratios (SIRs) were calculated using the incidence rates in Spain. SIRs were adjusted by a Bayesian generalized linear mixed model (GLMM). RESULTS From 1993 to 2002, 1,309 cases of gastric cancer were registered in Zaragoza city and 578 in the rest of the province. High risk was observed in CTs for the peripheral areas of the city. The incidence risk in men was 2 (95 % confidence interval [CI] 1.22-2.98) times higher in the most deprived CTs compared with the least deprived CTs, but no statistically significant differences were found in women. Municipalities with higher risk were observed in the north of the province, but no significant association was found with SES. Regarding the rurality index, a positive trend was observed in women, but it was statistically significant only for the most rural quartile (2.49, 95 % CI 1.07-4.92). CONCLUSIONS Geographical differences in gastric cancer incidence were detected. Although these differences could be partially explained by the deprivation index for men in Zaragoza city, deprivation index cannot explain geographical differences for women. In the rest of the province, the rurality index 1991 could explain, at least for women, geographical differences. It is still necessary to develop a deprivation index suitable for small municipalities.
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Affiliation(s)
- Isabel Aguilar
- Division of Public Health, University of Zaragoza, C/Domingo Miral S/N, 50009, Zaragoza, Spain.
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Abstract
The classification of sites in tumors of the oral cavity, oropharynx, pharynx, and hypopharynx varies in the literature. More than 90% of these tumors of the mucosal lining are classified as squamous cell carcinoma developed from premalignant lesions such as leukoplakia and erythroleukoplakia. These carcinomas are associated to environmental and lifestyle risk factors, among which tobacco and alcohol play a major role. In addition to tobacco smoking, tobacco chewing is another risk factor as well as chewing betel quid and areca nut in Asia. Certain strains of virus, such as the sexually transmitted human papilloma virus, also play a carcinogenetic role. The temporal trends in incidence of these tumors relate to environmental factors; there is an increase in tendency in countries without prevention and a decrease in countries having an active policy of prevention of alcohol and tobacco consumption. In contrast, an increased incidence occurs in the world at tumor sites related to human papilloma virus infection in relation to changes in sexual habits.
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Klassen AC, Smith KC. The enduring and evolving relationship between social class and breast cancer burden: a review of the literature. Cancer Epidemiol 2011; 35:217-34. [PMID: 21470929 DOI: 10.1016/j.canep.2011.02.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 01/13/2011] [Accepted: 02/16/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Breast cancer in women has historically been seen as a "cancer of affluence" and there is a well-documented higher incidence among women of higher social class, as well as in societies with higher resources. However, the relationship between social class and breast cancer disease characteristics, especially those associated with poorer prognosis, is less well documented, and the overall relationship between breast cancer mortality and social class has been shown to vary. Furthermore, rapid changes in women's health and health-related behaviors in societies around the world may have an impact on both incidence and mortality patterns for breast cancer in the future. METHODS A PUBMED search on breast cancer and social class (incorporating the MeSH-nested concept of SES) yielded 403 possible studies published between 1978 and 2009, of which 90 met criteria for review. Our review discusses conceptualization and measurement of women's social class in each study, as well as findings related to breast cancer incidence, tumor biology or mortality, associated with social class. FINDINGS We found mostly consistent evidence that breast cancer incidence continues to be higher in higher social class groups, with some modification of risk with adjustment for known risk factors, including physical activity and reproductive history. However, biologic characteristics associated with poorer prognosis were negatively associated with social class (i.e., greater occurrence among disadvantaged women), and mortality from breast cancer showed inconsistent relationship to social class. CONCLUSIONS We discuss these studies in relation to the growing burden of breast cancer among low resource groups and countries, and the need for cancer control strategies reflecting the emerging demographics of breast cancer risk.
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Affiliation(s)
- Ann C Klassen
- Department of Community Health and Prevention, Drexel University School of Public Health, USA.
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Windenberger F, Rican S, Jougla E, Rey G. Spatiotemporal association between deprivation and mortality: trends in France during the nineties. Eur J Public Health 2011; 22:347-53. [PMID: 21459841 DOI: 10.1093/eurpub/ckr029] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Monitoring the time course of socio-economic inequalities in mortality is a key public health issue. The aim of this study is to analyse this trend at an ecological level, in mainland France, over the 1990s, using a deprivation index enabling time comparisons. METHODS Deprivation indexes (FDep) were built using the 1990 and 1999 data and the same methodology. The indices were defined as the first component of a principal component analysis including four specific socio-economic variables. The time course of the association between mortality and deprivation was evaluated on the 'commune' geographic scale (36 000 U in mainland France), without considering spatial autocorrelation and on the larger 'canton' scale (3700 U), considering spatial autocorrelation. The analysis was carried out by gender, age and degree of urbanicity and applied to general mortality and a specific subcategory: 'avoidable' deaths. RESULTS Area-level socio-economic inequalities in mortality tended to increase during the 1990s. For the period 1997-2001, the standard mortality ratio (SMR) was 24% higher for the communes in the most deprived quintile than for those in the least deprived quintile, while this differential was of 20% for the period 1988-92. This increase in the differentials concerned especially males and people in the age group of <65 years. For both men and women, it was stronger for the 'avoidable' mortality subcategory. CONCLUSION As observed at the individual level in previous studies, area-level socio-economic inequalities in health increased during the nineties, while general health improved.
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Baker DP, Leon J, Smith Greenaway EG, Collins J, Movit M. The education effect on population health: a reassessment. POPULATION AND DEVELOPMENT REVIEW 2011; 37:307-32. [PMID: 21984851 PMCID: PMC3188849 DOI: 10.1111/j.1728-4457.2011.00412.x] [Citation(s) in RCA: 206] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Demographic research frequently reports consistent and significant associations between formal educational attainment and a range of health risks such as smoking, drug abuse, and accidents, as well as the contraction of many diseases, and health outcomes such as mortality—almost all indicating the same conclusion: better-educated individuals are healthier and live longer. Despite the substantial reporting of a robust education effect, there is inadequate appreciation of its independent influence and role as a causal agent. To address the effect of education on health in general, three contributions are provided: 1) a macro-level summary of the dimensions of the worldwide educational revolution and a reassessment of its causal role in the health of individuals and in the demographic health transition are carried out; 2) a meta-analysis of methodologically sophisticated studies of the effect of educational attainment on all-cause mortality is conducted to establish the independence and robustness of the education effect on health; and 3) a schooling-cognition hypothesis about the influence of education as a powerful determinant of health is developed in light of new multidisciplinary cognitive research.
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Employment relations, social class and health: A review and analysis of conceptual and measurement alternatives. Soc Sci Med 2010; 71:2130-40. [DOI: 10.1016/j.socscimed.2010.09.038] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 08/12/2010] [Accepted: 09/29/2010] [Indexed: 11/17/2022]
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Aarts MJ, Lemmens VEPP, Louwman MWJ, Kunst AE, Coebergh JWW. Socioeconomic status and changing inequalities in colorectal cancer? A review of the associations with risk, treatment and outcome. Eur J Cancer 2010; 46:2681-95. [PMID: 20570136 DOI: 10.1016/j.ejca.2010.04.026] [Citation(s) in RCA: 162] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 04/15/2010] [Accepted: 04/28/2010] [Indexed: 11/15/2022]
Abstract
BACKGROUND Upcoming mass screening for colorectal cancer (CRC) makes a review of recent literature on the association with socioeconomic status (SES) relevant, because of marked and contradictory associations with risk, treatment and outcome. METHODS The Pubmed database using the MeSH terms 'Neoplasms' or 'Colorectal Neoplasms' and 'Socioeconomic Factors' for articles added between 1995 and 1st October 2009 led to 62 articles. RESULTS Low SES groups exhibited a higher incidence compared with high SES groups in the US and Canada (range risk ratio (RR) 1.0-1.5), but mostly lower in Europe (RR 0.3-0.9). Treatment, survival and mortality all showed less favourable results for people with a lower socioeconomic status: Patients with a low SES received less often (neo)adjuvant therapy (RR ranging from 0.4 to 0.99), had worse survival rates (hazard ratio (HR) 1.3-1.8) and exhibited generally the highest mortality rates up to 1.6 for colon cancer in Europe and up to 3.1 for rectal cancer. CONCLUSIONS A quite consistent trend was observed favouring individuals with a high SES compared to those with a low SES that still remains in terms of treatment, survival and thus also mortality. We did not find evidence that the low/high SES gradients for treatment chosen and outcome are decreasing. To meet increasing inequalities in mortality from CRC in Europe for people with a low SES and to make mass screening successful, a high participation rate needs to be realised of low SES people in the soon starting screening program.
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Affiliation(s)
- Mieke J Aarts
- Eindhoven Cancer Registry, Comprehensive Cancer Centre South (IKZ), P.O. Box 231, 5600 AE Eindhoven, The Netherlands.
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Borrell C, Marí-Dell'olmo M, Serral G, Martínez-Beneito M, Gotsens M. Inequalities in mortality in small areas of eleven Spanish cities (the multicenter MEDEA project). Health Place 2010; 16:703-11. [PMID: 20399699 DOI: 10.1016/j.healthplace.2010.03.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 03/04/2010] [Accepted: 03/09/2010] [Indexed: 10/19/2022]
Abstract
The objectives of this study are to identify inequalities in mortality among census tracts of 11 Spanish cities in the period 1996-2003 and to analyse the relationship between these geographical inequalities and socioeconomic deprivation. It is a cross-sectional ecological study where the units of analysis are census tracts. We obtained an index of socioeconomic deprivation and estimated SMR by each census tract using hierarchical Bayesian models which take into account the spatial structure. In the majority of the cities geographical patterns in total mortality were found in both sexes, which were similar to those for the index of socioeconomic deprivation. Among men, four specific causes of death (lung cancer, ischemic heart diseases, respiratory diseases and cirrhosis) were positively associated with deprivation in the majority of cities. Among women the specific causes diabetes and cirrhosis were positively associated, while lung cancer was negatively associated with deprivation. The excess of mortality related with deprivation was 59,445 deaths among men and 23,292 among women. These results highlight the importance of intra-urban inequalities in health.
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Frederiksen BL, Osler M, Harling H, Ladelund S, Jørgensen T. Do patient characteristics, disease, or treatment explain social inequality in survival from colorectal cancer? Soc Sci Med 2009; 69:1107-15. [PMID: 19695753 DOI: 10.1016/j.socscimed.2009.07.040] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Indexed: 10/20/2022]
Abstract
This paper investigates the association between individually measured socioeconomic status (SES) and all-cause survival in colorectal cancer patients, and explores whether factors related to the patient, the disease, or the surgical treatment mediate the observed social gradient. The data were derived from a nationwide clinical database of all adenocarcinomas of the colon or rectum diagnosed in Denmark between 2001 and 2004 (inclusive). These data were linked to those from several central registries providing information on income, education, and housing status, as well as to data on comorbidity from previous hospitalizations and use of medication. Only patients with colorectal cancer as their first primary tumour and those born after 1920 were included. A total of 8763 patients were included in the study. Cox proportional hazard regression models revealed a positive social gradient in survival for increasing levels of education and income, and in owners versus renters of housing. A series of regression analyses were used to test potential mediators of the association between the socioeconomic indicators and survival by stepwise inclusion of lifestyle factors (smoking, alcohol intake, body mass index), comorbidity, stage of disease, mode of admission, type of operation, specialization of the surgeon, and curative versus palliative resection. A causal diagram guided the analyses. Inclusion of comorbidity, and to a lesser extent lifestyle, reduced the variation associated with SES, while no evidence of a mediating effect was found for disease or surgical treatment factors. This indicates that the difference in survival among colorectal cancer patients from different social groups was probably not caused by unintentional differences in treatment factors related to surgery, and suggests that primary prevention of chronic diseases among the socially deprived might be one way to reduce social differences in prognosis.
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Puigpinós R, Borrell C, Antunes JLF, Azlor E, Pasarín MI, Serral G, Pons-Vigués M, Rodríguez-Sanz M, Fernández E. Trends in socioeconomic inequalities in cancer mortality in Barcelona: 1992-2003. BMC Public Health 2009; 9:35. [PMID: 19166582 PMCID: PMC2640474 DOI: 10.1186/1471-2458-9-35] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 01/23/2009] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The objective of this study was to assess trends in cancer mortality by educational level in Barcelona from 1992 to 2003. METHODS The study population comprised Barcelona inhabitants aged 20 years or older. Data on cancer deaths were supplied by the system of information on mortality. Educational level was obtained from the municipal census. Age-standardized rates by educational level were calculated. We also fitted Poisson regression models to estimate the relative index of inequality (RII) and the Slope Index of Inequalities (SII). All were calculated for each sex and period (1992-1994, 1995-1997, 1998-2000, and 2001-2003). RESULTS Cancer mortality was higher in men and women with lower educational level throughout the study period. Less-schooled men had higher mortality by stomach, mouth and pharynx, oesophagus, larynx and lung cancer. In women, there were educational inequalities for cervix uteri, liver and colon cancer. Inequalities of overall and specific types of cancer mortality remained stable in Barcelona; although a slight reduction was observed for some cancers. CONCLUSION This study has identified those cancer types presenting the greatest inequalities between men and women in recent years and shown that in Barcelona there is a stable trend in inequalities in the burden of cancer.
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Affiliation(s)
- Rosa Puigpinós
- Servei de Sistemes d'Informació Sanitaria, Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Departament de Salut Pública, Facultat de Medicina. Universitat de Barcelona, Barcelona, Spain
| | - Carme Borrell
- Servei de Sistemes d'Informació Sanitaria, Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra., Barcelona, Spain
| | | | - Enric Azlor
- Servei de Sistemes d'Informació Sanitaria, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - M Isabel Pasarín
- Servei de Sistemes d'Informació Sanitaria, Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra., Barcelona, Spain
| | - Gemma Serral
- Servei de Sistemes d'Informació Sanitaria, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Mariona Pons-Vigués
- Servei de Sistemes d'Informació Sanitaria, Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
| | - Maica Rodríguez-Sanz
- Servei de Sistemes d'Informació Sanitaria, Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control and Research Unit, Institut6 Català d'Oncologia (ICO-IDIBELL), l'Hospitalet de lobregat (Barcelona), Spain
- Department of Clinical Sciences, Campus of Bellvitge, Universitat de Barcelona, l'Hospitalet de Llobregat (Barcelona), Spain
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Sex and socioeconomic inequalities of lung cancer mortality in Barcelona, Spain and São Paulo, Brazil. Eur J Cancer Prev 2008; 17:399-405. [DOI: 10.1097/cej.0b013e3282f75f17] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Menvielle G, Kunst A. Social inequalities in cancer incidence and cancer survival: Lessons from Danish studies. Eur J Cancer 2008; 44:1933-7. [DOI: 10.1016/j.ejca.2008.06.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Accepted: 06/20/2008] [Indexed: 11/25/2022]
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Social inequality and incidence of and survival from cancers of the colon and rectum in a population-based study in Denmark, 1994–2003. Eur J Cancer 2008; 44:1978-88. [DOI: 10.1016/j.ejca.2008.06.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 06/06/2008] [Accepted: 06/16/2008] [Indexed: 02/01/2023]
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Antunes JLF, Borrell C, Pérez G, Boing AF, Wünsch-Filho V. Inequalities in mortality of men by oral and pharyngeal cancer in Barcelona, Spain and São Paulo, Brazil, 1995-2003. Int J Equity Health 2008; 7:14. [PMID: 18533020 PMCID: PMC2430700 DOI: 10.1186/1475-9276-7-14] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Accepted: 06/04/2008] [Indexed: 12/03/2022] Open
Abstract
Background Large inequalities of mortality by most cancers in general, by mouth and pharynx cancer in particular, have been associated to behaviour and geopolitical factors. The assessment of socioeconomic covariates of cancer mortality may be relevant to a full comprehension of distal determinants of the disease, and to appraise opportune interventions. The objective of this study was to compare socioeconomic inequalities in male mortality by oral and pharyngeal cancer in two major cities of Europe and South America. Methods The official system of information on mortality provided data on deaths in each city; general censuses informed population data. Age-adjusted death rates by oral and pharyngeal cancer for men were independently assessed for neighbourhoods of Barcelona, Spain, and São Paulo, Brazil, from 1995 to 2003. Uniform methodological criteria instructed the comparative assessment of magnitude, trends and spatial distribution of mortality. General linear models assessed ecologic correlations between death rates and socioeconomic indices (unemployment, schooling levels and the human development index) at the inner-city area level. Results obtained for each city were subsequently compared. Results Mortality of men by oral and pharyngeal cancer ranked higher in Barcelona (9.45 yearly deaths per 100,000 male inhabitants) than in Spain and Europe as a whole; rates were on decrease. São Paulo presented a poorer profile, with higher magnitude (11.86) and stationary trend. The appraisal of ecologic correlations indicated an unequal and inequitably distributed burden of disease in both cities, with poorer areas tending to present higher mortality. Barcelona had a larger gradient of mortality than São Paulo, indicating a higher inequality of cancer deaths across its neighbourhoods. Conclusion The quantitative monitoring of inequalities in health may contribute to the formulation of redistributive policies aimed at the concurrent promotion of wellbeing and social justice. The assessment of groups experiencing a higher burden of disease can instruct health services to provide additional resources for expanding preventive actions and facilities aimed at early diagnosis, standardized treatments and rehabilitation.
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Social inequalities in the incidence and case fatality of cancers of the lung, the stomach, the bowels, and the breast. Cancer Causes Control 2008; 19:965-74. [PMID: 18431680 DOI: 10.1007/s10552-008-9162-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Accepted: 04/09/2008] [Indexed: 01/13/2023]
Abstract
OBJECTIVE In order to examine health inequalities in terms of incidences and case fatalities in a German health insurance population. Lung cancer, stomach cancer, intestinal carcinoma, and breast cancer were considered. Social differentiation was depicted by income and occupational position in order to examine which one is more strongly associated with incidence and case fatality. METHODS Analyses were performed using data from a statutory health insurance (n = 170,848). Incomes were divided into quintiles, and subjects were grouped according to occupational status. RESULTS For lung cancer incidence a gradient between the highest and the lowest 20% of the income distribution emerged. The relative risk of the lowest category was RR = 7.03, for occupational position the figure was RR = 6.98. For stomach cancer the relative risks were RR = 5.33 for income and RR = 7.11 for occupational position. For intestinal carcinoma only income was significantly related with incidence (RR = 4.37 for the lowest 20% of the income distribution), and for breast cancer incidence no social inequalities were found. For case fatality increased relative risks emerged for lung cancer, but only for income. CONCLUSIONS Income and occupational position were associated with cancer incidence with the exception of breast cancer. Apart from lung cancer, case fatalities were unrelated to measures of social differentiation.
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Menvielle G, Kunst AE, Stirbu I, Strand BH, Borrell C, Regidor E, Leclerc A, Esnaola S, Bopp M, Lundberg O, Artnik B, Costa G, Deboosere P, Martikainen P, Mackenbach JP. Educational differences in cancer mortality among women and men: a gender pattern that differs across Europe. Br J Cancer 2008; 98:1012-9. [PMID: 18283307 PMCID: PMC2266850 DOI: 10.1038/sj.bjc.6604274] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
We used longitudinal mortality data sets for the 1990s to compare socioeconomic inequalities in total cancer mortality between women and men aged 30–74 in 12 different European populations (Madrid, Basque region, Barcelona, Slovenia, Turin, Switzerland, France, Belgium, Denmark, Norway, Sweden, Finland) and to investigate which cancer sites explain the differences found. We measured socioeconomic status using educational level and computed relative indices of inequality (RII). We observed large variations within Europe for educational differences in total cancer mortality among men and women. Three patterns were observed: Denmark, Norway and Sweden (significant RII around 1.3–1.4 among both men and women); France, Switzerland, Belgium and Finland (significant RII around 1.7–1.8 among men and around 1.2 among women); Spanish populations, Slovenia and Turin (significant RII from 1.29 to 1.88 among men; no differences among women except in the Basque region, where RII is significantly lower than 1). Lung, upper aerodigestive tract and breast cancers explained most of the variations between gender and populations in the magnitude of inequalities in total cancer mortality. Given time trends in cancer mortality, the gap in the magnitude of socioeconomic inequalities in cancer mortality between gender and between European populations will probably decrease in the future.
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Affiliation(s)
- G Menvielle
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Ribeiro KB, Lopes LF, de Camargo B. Trends in childhood leukemia mortality in Brazil and correlation with social inequalities. Cancer 2007; 110:1823-31. [PMID: 17786938 DOI: 10.1002/cncr.22982] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Mortality from childhood leukemia has declined substantially in developed countries but less markedly in the developing world. This study was designed to describe mortality trends in childhood leukemia and the impact of social inequalities on these trends in Brazil from 1980 to 2002. METHODS Cancer mortality data by cause and estimates of resident population stratified by age and sex were obtained from the Brazilian Mortality Information System (SIM) for the years 1980 to 2002. Age-standardized (ages 0-19 years) mortality rates were calculated by the direct method using the 1960 world standard population. Trends were modeled using linear regression with 3-year moving average rates as the dependent variable and with the midpoint of the calendar year interval (1991) as the independent variable. The Index of Social Exclusion was used to classify the 27 Brazilian states. Pearson correlation was used to describe the correlation between social exclusion and variations in mortality in each state. RESULTS Age-standardized mortality rates for boys decreased from 2.05 per 100,000 habitants in 1984 to 1.44 100,000 habitants in 1995, whereas the observed corresponding decline among girls was from 1.60 per 100,000 habitants in 1986 to 1.14 per 100,000 habitants in 1995. Statistically significant declining trends in mortality rates were observed for boys (adjusted correlation coefficient [r(2)] = 0.68; P < .001) and girls (adjusted r(2) = 0.62; P < .001). Significant negative correlations between social inequality and changes in mortality were noted for boys (r = -0.66; P = .001) and for girls (r = -0.78; P < .001). CONCLUSIONS A consistent decrease in mortality rates from childhood leukemia was noted in Brazil. Higher decreases in mortality were observed in more developed states, possibly reflecting better health care.
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Affiliation(s)
- Karina B Ribeiro
- Hospital Cancer Registry, Hospital A. C. Camargo, São Paulo, Brazil.
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Menvielle G, Kunst AE, Stirbu I, Borrell C, Bopp M, Regidor E, Heine Strand B, Deboosere P, Lundberg O, Leclerc A, Costa G, Chastang JF, Esnaola S, Martikainen P, Mackenbach JP. Socioeconomic inequalities in alcohol related cancer mortality among men: to what extent do they differ between Western European populations? Int J Cancer 2007; 121:649-55. [PMID: 17415714 PMCID: PMC2756593 DOI: 10.1002/ijc.22721] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We aim to study socioeconomic inequalities in alcohol related cancers mortality [upper aerodigestive tract (UADT) (oral cavity, pharynx, larynx, oesophagus and liver)] in men and to investigate whether the contribution of these cancers to socioeconomic inequalities in cancer mortality differs within Western Europe. We used longitudinal mortality datasets, including causes of death. Data were collected during the 1990s among men aged 30-74 years in 13 European populations [Madrid, the Basque region, Barcelona, Turin, Switzerland (German and Latin part), France, Belgium (Walloon and Flemish part, Brussels), Norway, Sweden, Finland]. Socioeconomic status was measured using the educational level declared at the census at the beginning of the follow-up period. We conducted Poisson regression analyses and used both relative [Relative index of inequality (RII)] and absolute (mortality rates difference) measures of inequality. For UADT cancers, the RII's were above 3.5 in France, Switzerland (both parts) and Turin whereas for liver cancer they were the highest (around 2.5) in Madrid, France and Turin. The contribution of alcohol related cancer to socioeconomic inequalities in cancer mortality was 29-36% in France and the Spanish populations, 17-23% in Switzerland and Turin, and 5-15% in Belgium and the Nordic countries. We did not observe any correlation between mortality rates differences for lung and UADT cancers, confirming that the pattern found for UADT cancers is not only due to smoking. This study suggests that alcohol use substantially influences socioeconomic inequalities in male cancer mortality in France, Spain and Switzerland but not in the Nordic countries and nor in Belgium.
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Affiliation(s)
- Gwenn Menvielle
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Thuret A, Geoffroy-Perez B, Luce D, Goldberg M, Imbernon E. A 26-year cohort mortality study of French construction workers aged 20 to 64 years. J Occup Environ Med 2007; 49:546-56. [PMID: 17495697 DOI: 10.1097/jom.0b013e3180577714] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this report was to study the cause-specific mortality of French workers in the construction industry. METHODS From a cohort of 12,788 male workers, standardized mortality ratios (SMRs) and 95% confidence intervals (CI) were calculated for the years between 1974 and 1999 for workers aged 20 to 64 years. RESULTS All-cause mortality was significantly increased (SMR=111, CI=106-206). Excess mortality was found for cancers (SMR=125, CI=117-134), especially for the oral cavity and pharynx (SMR=134, CI=108-163), digestive (SMR=120, CI=104-137) and respiratory (SMR=143, CI=128-159) systems; cerebrovascular disease (SMR=130, CI=106-158); diseases of the digestive system (SMR=130, CI=113-149), and accidental falls (SMR=158, CI=105-125). Excess risks were limited to blue-collar workers. CONCLUSIONS Despite a probable role of lifestyle and potential limitations of the study, elevated mortality was observed for several causes possibly related to occupational factors.
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Affiliation(s)
- Anne Thuret
- Département Santé-Travail, Institut de Veille Sanitaire, Saint-Maurice, France.
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Menvielle G, Leclerc A, Chastang JF, Melchior M, Luce D. Changes in socioeconomic inequalities in cancer mortality rates among French men between 1968 and 1996. Am J Public Health 2007; 97:2082-7. [PMID: 17395842 PMCID: PMC2040363 DOI: 10.2105/ajph.2005.073429] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We investigated changes in socioeconomic inequalities in cancer mortality rates among men in France between 1968 and 1996. METHODS We used a representative sample of 1% of the French population and studied 4 periods (1968-1974, 1975-1981, 1982-1988, and 1990-1996). Causes of death were obtained by direct linkage with the French national death registry. The socioeconomic position of men aged 35 to 59 years was measured by using the occupational class reported at the time of the census at the beginning of each period. Analyses were conducted for all cancers and specifically for lung, upper aerodigestive tract, esophageal, colorectal, and other cancers. RESULTS In all analyses, we observed socioeconomic inequalities during the 4 periods considered; the inequalities increased between the first and the last period. Most of the total increase occurred between 1968 and 1981, and inequalities remained stable thereafter. Inequalities were larger when men out of the labor force were included in the analysis. The strongest increase in socioeconomic inequalities over time was observed for upper aerodigestive tract cancer. CONCLUSIONS Although cancer mortality rates have decreased, substantial socioeconomic inequalities in cancer mortality among men remain.
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Affiliation(s)
- Gwenn Menvielle
- National Institute of Health and Medical Research, Saint-Maurice, France.
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Dalton SO, Düring M, Ross L, Carlsen K, Mortensen PB, Lynch J, Johansen C. The relation between socioeconomic and demographic factors and tumour stage in women diagnosed with breast cancer in Denmark, 1983-1999. Br J Cancer 2006; 95:653-9. [PMID: 16909141 PMCID: PMC2360690 DOI: 10.1038/sj.bjc.6603294] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The authors investigated the association between socioeconomic position and stage of breast cancer at the time of diagnosis in a nationwide Danish study. All 28 765 women with a primary invasive breast cancer diagnosed between 1983 and 1999 were identified in a nationwide clinical database and information on socioeconomic variables was obtained from Statistics Denmark. The risk of being diagnosed with a high-risk breast cancer, that is size >20 mm, lymph-node positive, ductal histology/high histologic grade and hormone receptor negative, was analysed by multivariate logistic regression. The adjusted odds ratio (OR) for high-risk breast cancer was reduced with longer education with a 12% reduced risk (95% confidence interval (CI), 0.80,0.96) in women with higher education and increased with reduced disposable income (low income group: OR, 1.22; 95% CI, 1.10,1.34). There was an urban–rural gradient, with higher risk among rural women (OR 1.10; 95 % CI, 1.02, 1.18) and lower risk among women in the capital suburbs (OR, 0.85; 95% CI, 0.78, 0.93) and capital area (OR, 0.93; 95% CI, 0.84–1.02). These factors were significant only for postmenopausal women, although similar patterns were observed among the premenopausal women, suggesting a subgroup of aggressive premenopausal breast cancers less influenced by socioeconomic factors.
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Affiliation(s)
- S O Dalton
- Department for Psychosocial Cancer Research, Institute of Cancer Epidemiology, Danish Cancer Society, Strandboulevarden 49, Copenhagen DK-2100, Denmark.
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Leclerc A, Chastang JF, Menvielle G, Luce D. Socioeconomic inequalities in premature mortality in France: Have they widened in recent decades? Soc Sci Med 2006; 62:2035-45. [PMID: 16162384 DOI: 10.1016/j.socscimed.2005.08.031] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Indexed: 10/25/2022]
Abstract
An increase in social inequalities in premature mortality has been observed in the last decades in various European countries. In France, large inequalities have been reported for several years, but the changes over time have been only partially examined. The study was based on the analysis of a large longitudinal data set. Four periods of 7 years following a census were compared. Deaths in the period (21,003 deaths for men, 9,418 for women) were recorded and studied according to socioeconomic status (SES) at the census. Relative Index of Inequality (RII) was calculated in order to quantify the magnitude of inequalities among those employed, and also in the entire population, with specific categories for those inactive. The results showed that the magnitude of inequalities remained mainly stable over time for men and women working at the time of the census. However, for the entire population, a strong increase in the magnitude of social inequalities was observed. For men the RIIs increased from 3.53 in the first period to 6.54 in the most recent period. For women, the corresponding figures were 1.94 and 3.88. The increase was observed also for specific causes of deaths: cancer and cardiovascular diseases for both sexes, and external causes for men. In spite of a global decrease in the mortality over the period, the absolute differences between the top and the bottom of the socioeconomic scale did not change. The results highlight the importance of temporal changes in mortality associated with an increase of unemployment, changes in the labour market, and the consequences of selective exclusion from work. The classification of those not working is an important point to consider in the study of social inequalities.
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Affiliation(s)
- Annette Leclerc
- INSERM, U 687 HNSM, 14 rue de val d' Osne, 94410 St-Maurice, France.
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Sass C, Guéguen R, Moulin JJ, Abric L, Dauphinot V, Dupré C, Giordanella JP, Girard F, Guenot C, Labbe E, La Rosa E, Magnier P, Martin E, Royer B, Rubirola M, Gerbaud L. Comparaison du score individuel de précarité des Centres d'examens de santé, EPICES, à la définition socio-administrative de la précarité. SANTE PUBLIQUE 2006; 18:513-22. [PMID: 17294755 DOI: 10.3917/spub.064.0513] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In French Health Examination Centres, populations in deprived situation were usually defined by administrative criteria The aim of the study was to investigate whether EPICES, a new individual index of deprivation, was more strongly related to health status than an administrative classification. The EPICES score was calculated on the basis of 11 weighted questions related to material and social deprivation. Participants were 197, 389 men and women, aged over 18, encountered in 2002 in French Health Examination Centres. Relationships between health status, health-related behaviours, access to health care, EPICES and the administrative classification of deprivation were analyzed by logistic regression. The associations between EPICES and the study variables were stronger than those observed for the administrative definition. The comparison also showed socially disadvantaged people with poor health identified by the EPICES score who were not by the administrative classification. These results showed that the EPICES score can be a useful tool to improve the identification of deprived people having health problems associated to deprivation.
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Affiliation(s)
- C Sass
- Centre Technique d'Appui et de Formation des Centres d'Examens de Santé (Cetaf) 67-69, avenue Rochetaillée, BP 167, 42012 Saint-Ettienne Cedex 02, France.
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