Inequity of upper gastrointestinal cancer distribution and survival with socioeconomic deprivation: a population-based study.
BACKGROUND
It is postulated that patients with upper gastrointestinal cancers from affluent classes have better survival outcomes than those from deprived backgrounds. We aimed to analyze the incidence, mortality, and survival trends of esophageal, gastric, and pancreatic cancers in West Midlands, England, from 1986 to 2000 in terms of socioeconomic deprivation.


METHODS
A well-validated demographic score, the Townsend Band, was employed as a measure of socioeconomic status. Data were collated from a cancer registry database; the individuals were allocated to 1 of 5 Townsend bands by using the postcodes at diagnosis. Relative survival rates were calculated by using stratified actuarial life tables, regression trend analysis at 1 and 5 years was performed, and the P value was derived from a t test statistic.


RESULTS
An increase in esophageal cancer incidence was more marked in the affluent categories (127%), compared with the deprived categories (57%). Gastric cancer incidence fell preferentially by 31% and 47% in the most-deprived men and women, respectively, but remained relatively unchanged in the affluent groups. A marginal overall decrease in pancreatic cancer incidence masked preferential increases in the most-affluent men (39%) and women (41%). Small increases in 1- and 5-year survival were noted in affluent subgroups, with the 1-year survival advantage for esophageal cancer achieving significant levels in the most-affluent categories (P = .05).


CONCLUSIONS
The esophageal cancer incidence increased preferentially in the affluent groups but with a marginally better survival rate. The gastric cancer incidence decreased noticeably in the most-deprived groups, suggesting that improvements in hygiene with consequent reduction in Helicobacter pylori primarily could be responsible. Pancreatic cancer trends were unrelated to social deprivation and warrant further studies.
Dutta Roy
Subhajit
S
Research Unit, Department of Surgery, Leighton Hospital, South Cheshire, Birmingham, United Kingdom. subhodr@aol.com
Kupp
Daniel V
DV
Slavin
John P
JP
Corless
David J
DJ
Deakin
Mark
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004739:England / Q000453:epidemiology; D004938:Esophageal Neoplasms / Q000191:economics / Q000401:mortality; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000191:economics* / Q000401:mortality*; D006801:Humans; D015994:Incidence; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000191:economics / Q000401:mortality; D011203:Poverty / Q000706:statistics & numerical data*; D012042:Registries; D012959:Socioeconomic Factors; D013274:Stomach Neoplasms / Q000191:economics / Q000401:mortality; D015996:Survival Rate