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Time Trends and Income Inequalities in Cancer Incidence and Cancer-Free Life Expectancy – a Cancer Site-Specific Analysis of German Health Insurance Data

Cancer represents a major burden of morbidity and mortality globally. So far, however, little is known on time trends and inequalities in the lengths of life spent free of any cancer. This study steps into this gap by analyzing time trends and income inequalities in cancer-free life expectancy (CFLE...

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Autores principales: Tetzlaff, Fabian, Hoebel, Jens, Epping, Jelena, Geyer, Siegfried, Golpon, Heiko, Tetzlaff, Juliane
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9046985/
https://www.ncbi.nlm.nih.gov/pubmed/35494022
http://dx.doi.org/10.3389/fonc.2022.827028
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author Tetzlaff, Fabian
Hoebel, Jens
Epping, Jelena
Geyer, Siegfried
Golpon, Heiko
Tetzlaff, Juliane
author_facet Tetzlaff, Fabian
Hoebel, Jens
Epping, Jelena
Geyer, Siegfried
Golpon, Heiko
Tetzlaff, Juliane
author_sort Tetzlaff, Fabian
collection PubMed
description Cancer represents a major burden of morbidity and mortality globally. So far, however, little is known on time trends and inequalities in the lengths of life spent free of any cancer. This study steps into this gap by analyzing time trends and income inequalities in cancer-free life expectancy (CFLE). For this retrospective cohort study, data of a large German health insurer were used (N = 3,405,673individuals, 2006–2018). Income inequalities were assessed using individual income (<60% of German average income (GAI) and ≥60% of GAI). Trends in incidence risks were analysed employing proportional-hazard regression models by splitting the observation time into three periods of 52 months. Trends in CFLE in total and for the most common site-specific cancers were calculated based on multiple decrement life tables. Incidence rates declined in almost all cancers and CFLE increased substantially over time (49.1 (95% CI 48.8-49.4) to 51.9 (95% CI 51.6-52.2) years for men, 53.1 (95% CI 52.7-53.5) to 55.4 (95% CI 55.1-55.8) years for women at age 20 for total cancer) and income groups. Considerable income inequalities in cancer risks were evident in both sexes, but were more pronounced in men (total cancer HR 0.86 (95% CI 0.85-0.87)), with higher-income individuals having lower risks. The highest income inequalities were found in colon (HR 0.90 (95% CI 0.87-0.93)), stomach (HR 0.78 (95% CI 0.73-0.84)), and lung cancer (HR 0.58 (95% CI 0.56-0.60)) in men. A reverse gradient was found for skin (HR 1.39 (95% CI 1.30-1.47) men; HR 1.27 (95% CI 1.20-1.35) women) and prostate cancer (HR 1.13 (95% CI 1.11-1.15)). The proportion of CFLE in total life expectancy declined for lung, skin and cervical cancer in women, indicating a relative shortening of lifetime spent cancer-free. In contrast, increasing proportions were found in breast and prostate cancer. To our knowledge, this is the first study analysing trends and income inequalities in CFLE. The life span free of cancer increased clearly over time. However, not all cancer types contributed equally to this positive development. Income inequalities persisted or tended to widen, which underlines the need for increased public health efforts in socioeconomically vulnerable groups.
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spelling pubmed-90469852022-04-29 Time Trends and Income Inequalities in Cancer Incidence and Cancer-Free Life Expectancy – a Cancer Site-Specific Analysis of German Health Insurance Data Tetzlaff, Fabian Hoebel, Jens Epping, Jelena Geyer, Siegfried Golpon, Heiko Tetzlaff, Juliane Front Oncol Oncology Cancer represents a major burden of morbidity and mortality globally. So far, however, little is known on time trends and inequalities in the lengths of life spent free of any cancer. This study steps into this gap by analyzing time trends and income inequalities in cancer-free life expectancy (CFLE). For this retrospective cohort study, data of a large German health insurer were used (N = 3,405,673individuals, 2006–2018). Income inequalities were assessed using individual income (<60% of German average income (GAI) and ≥60% of GAI). Trends in incidence risks were analysed employing proportional-hazard regression models by splitting the observation time into three periods of 52 months. Trends in CFLE in total and for the most common site-specific cancers were calculated based on multiple decrement life tables. Incidence rates declined in almost all cancers and CFLE increased substantially over time (49.1 (95% CI 48.8-49.4) to 51.9 (95% CI 51.6-52.2) years for men, 53.1 (95% CI 52.7-53.5) to 55.4 (95% CI 55.1-55.8) years for women at age 20 for total cancer) and income groups. Considerable income inequalities in cancer risks were evident in both sexes, but were more pronounced in men (total cancer HR 0.86 (95% CI 0.85-0.87)), with higher-income individuals having lower risks. The highest income inequalities were found in colon (HR 0.90 (95% CI 0.87-0.93)), stomach (HR 0.78 (95% CI 0.73-0.84)), and lung cancer (HR 0.58 (95% CI 0.56-0.60)) in men. A reverse gradient was found for skin (HR 1.39 (95% CI 1.30-1.47) men; HR 1.27 (95% CI 1.20-1.35) women) and prostate cancer (HR 1.13 (95% CI 1.11-1.15)). The proportion of CFLE in total life expectancy declined for lung, skin and cervical cancer in women, indicating a relative shortening of lifetime spent cancer-free. In contrast, increasing proportions were found in breast and prostate cancer. To our knowledge, this is the first study analysing trends and income inequalities in CFLE. The life span free of cancer increased clearly over time. However, not all cancer types contributed equally to this positive development. Income inequalities persisted or tended to widen, which underlines the need for increased public health efforts in socioeconomically vulnerable groups. Frontiers Media S.A. 2022-04-14 /pmc/articles/PMC9046985/ /pubmed/35494022 http://dx.doi.org/10.3389/fonc.2022.827028 Text en Copyright © 2022 Tetzlaff, Hoebel, Epping, Geyer, Golpon and Tetzlaff https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Tetzlaff, Fabian
Hoebel, Jens
Epping, Jelena
Geyer, Siegfried
Golpon, Heiko
Tetzlaff, Juliane
Time Trends and Income Inequalities in Cancer Incidence and Cancer-Free Life Expectancy – a Cancer Site-Specific Analysis of German Health Insurance Data
title Time Trends and Income Inequalities in Cancer Incidence and Cancer-Free Life Expectancy – a Cancer Site-Specific Analysis of German Health Insurance Data
title_full Time Trends and Income Inequalities in Cancer Incidence and Cancer-Free Life Expectancy – a Cancer Site-Specific Analysis of German Health Insurance Data
title_fullStr Time Trends and Income Inequalities in Cancer Incidence and Cancer-Free Life Expectancy – a Cancer Site-Specific Analysis of German Health Insurance Data
title_full_unstemmed Time Trends and Income Inequalities in Cancer Incidence and Cancer-Free Life Expectancy – a Cancer Site-Specific Analysis of German Health Insurance Data
title_short Time Trends and Income Inequalities in Cancer Incidence and Cancer-Free Life Expectancy – a Cancer Site-Specific Analysis of German Health Insurance Data
title_sort time trends and income inequalities in cancer incidence and cancer-free life expectancy – a cancer site-specific analysis of german health insurance data
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9046985/
https://www.ncbi.nlm.nih.gov/pubmed/35494022
http://dx.doi.org/10.3389/fonc.2022.827028
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