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Socioeconomic disparities in head and neck cancer survival in Germany: a causal mediation analysis using population-based cancer registry data
PURPOSE: Despite recent improvements in cancer treatment in Germany, a marked difference in cancer survival based on socioeconomic factors persists. We aim to quantify the effect of socioeconomic inequality on head and neck cancer (HNC) survival. METHODS: Information on 20,821 HNC patients diagnosed...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8021523/ https://www.ncbi.nlm.nih.gov/pubmed/33569714 http://dx.doi.org/10.1007/s00432-021-03537-2 |
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author | Bedir, Ahmed Abera, Semaw Ferede Efremov, Ljupcho Hassan, Lamiaa Vordermark, Dirk Medenwald, Daniel |
author_facet | Bedir, Ahmed Abera, Semaw Ferede Efremov, Ljupcho Hassan, Lamiaa Vordermark, Dirk Medenwald, Daniel |
author_sort | Bedir, Ahmed |
collection | PubMed |
description | PURPOSE: Despite recent improvements in cancer treatment in Germany, a marked difference in cancer survival based on socioeconomic factors persists. We aim to quantify the effect of socioeconomic inequality on head and neck cancer (HNC) survival. METHODS: Information on 20,821 HNC patients diagnosed in 2009–2013 was routinely collected by German population-based cancer registries. Socioeconomic inequality was defined by the German Index of Socioeconomic Deprivation. The Cox proportional regression and relative survival analysis measured the survival disparity according to level of socioeconomic deprivation with respective confidence intervals (CI). A causal mediation analysis was conducted to quantify the effect of socioeconomic deprivation mediated through medical care, stage at diagnosis, and treatment on HNC survival. RESULTS: The most socioeconomically deprived patients were found to have the highest hazard of dying when compared to the most affluent (Hazard Ratio: 1.25, 95% CI 1.17–1.34). The most deprived patients also had the worst 5-year age-adjusted relative survival (50.8%, 95% CI 48.5–53.0). Our mediation analysis showed that most of the effect of deprivation on survival was mediated through differential stage at diagnosis during the first 6 months after HNC diagnosis. As follow-up time increased, medical care, stage at diagnosis, and treatment played no role in mediating the effect of deprivation on survival. CONCLUSION: This study confirms the survival disparity between affluent and deprived HNC patients in Germany. Considering data limitations, our results suggest that, within six months after HNC diagnosis, the elimination of differences in stage at diagnosis could reduce survival inequalities. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00432-021-03537-2. |
format | Online Article Text |
id | pubmed-8021523 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-80215232021-04-21 Socioeconomic disparities in head and neck cancer survival in Germany: a causal mediation analysis using population-based cancer registry data Bedir, Ahmed Abera, Semaw Ferede Efremov, Ljupcho Hassan, Lamiaa Vordermark, Dirk Medenwald, Daniel J Cancer Res Clin Oncol Original Article – Cancer Research PURPOSE: Despite recent improvements in cancer treatment in Germany, a marked difference in cancer survival based on socioeconomic factors persists. We aim to quantify the effect of socioeconomic inequality on head and neck cancer (HNC) survival. METHODS: Information on 20,821 HNC patients diagnosed in 2009–2013 was routinely collected by German population-based cancer registries. Socioeconomic inequality was defined by the German Index of Socioeconomic Deprivation. The Cox proportional regression and relative survival analysis measured the survival disparity according to level of socioeconomic deprivation with respective confidence intervals (CI). A causal mediation analysis was conducted to quantify the effect of socioeconomic deprivation mediated through medical care, stage at diagnosis, and treatment on HNC survival. RESULTS: The most socioeconomically deprived patients were found to have the highest hazard of dying when compared to the most affluent (Hazard Ratio: 1.25, 95% CI 1.17–1.34). The most deprived patients also had the worst 5-year age-adjusted relative survival (50.8%, 95% CI 48.5–53.0). Our mediation analysis showed that most of the effect of deprivation on survival was mediated through differential stage at diagnosis during the first 6 months after HNC diagnosis. As follow-up time increased, medical care, stage at diagnosis, and treatment played no role in mediating the effect of deprivation on survival. CONCLUSION: This study confirms the survival disparity between affluent and deprived HNC patients in Germany. Considering data limitations, our results suggest that, within six months after HNC diagnosis, the elimination of differences in stage at diagnosis could reduce survival inequalities. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00432-021-03537-2. Springer Berlin Heidelberg 2021-02-11 2021 /pmc/articles/PMC8021523/ /pubmed/33569714 http://dx.doi.org/10.1007/s00432-021-03537-2 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Original Article – Cancer Research Bedir, Ahmed Abera, Semaw Ferede Efremov, Ljupcho Hassan, Lamiaa Vordermark, Dirk Medenwald, Daniel Socioeconomic disparities in head and neck cancer survival in Germany: a causal mediation analysis using population-based cancer registry data |
title | Socioeconomic disparities in head and neck cancer survival in Germany: a causal mediation analysis using population-based cancer registry data |
title_full | Socioeconomic disparities in head and neck cancer survival in Germany: a causal mediation analysis using population-based cancer registry data |
title_fullStr | Socioeconomic disparities in head and neck cancer survival in Germany: a causal mediation analysis using population-based cancer registry data |
title_full_unstemmed | Socioeconomic disparities in head and neck cancer survival in Germany: a causal mediation analysis using population-based cancer registry data |
title_short | Socioeconomic disparities in head and neck cancer survival in Germany: a causal mediation analysis using population-based cancer registry data |
title_sort | socioeconomic disparities in head and neck cancer survival in germany: a causal mediation analysis using population-based cancer registry data |
topic | Original Article – Cancer Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8021523/ https://www.ncbi.nlm.nih.gov/pubmed/33569714 http://dx.doi.org/10.1007/s00432-021-03537-2 |
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