Influence of socio-economic deprivation on outcomes for patients diagnosed with gastric cancer.
OBJECTIVE
Socio-economic deprivation has an influence on the outcome for patients diagnosed with breast, colorectal and bronchial cancer, but there are few data on its association with gastric cancer. The aim of this study was to determine the influence of socio-economic deprivation on outcomes for patients with gastric cancer.


METHODS
Three hundred and thirty consecutive patients with gastric adenocarcinoma presenting to a single hospital between 1 October 1995 and 30 June 2004 were studied prospectively and deprivation scores calculated using the National Assembly for Wales Indices of Multiple Deprivation. The patients were subdivided into quintiles for analysis.


RESULTS
Inhabitants of the most deprived areas (quintile 5) were younger at presentation (median 70 years versus 74 years, p=0.007), and experienced longer delays in diagnosis (18 weeks versus 9 weeks, p=0.02) when compared with patients from the least deprived areas (quintile 1). Operative mortality was 3-fold higher for patients from the most deprived areas when compared with patients from less deprived areas (15% versus 5%, p=0.03). There was no correlation between stage of disease and socio-economic deprivation. For patients undergoing potentially curative surgery, the 5-year survival for patients from the most deprived areas was 32%, compared with 66% for patients from the least deprived areas (p=0.03).


CONCLUSIONS
Socio-economic deprivation was associated with younger age at diagnosis, longer diagnostic delay, greater operative mortality and a shorter duration of survival following R0 gastrectomy. These poorer outcomes were not explained by the stage of disease at diagnosis.
Stephens
Michael R
MR
Department of Surgery, Gwent Healthcare NHS Trust, Royal Gwent Hospital, Cardiff Road, Newport NP20 2UB, Wales, UK.
Blackshaw
Guy R J C
GR
Lewis
Wyn G
WG
Edwards
Paul
P
Barry
Jonathon D
JD
Hopper
Neil A
NA
Allison
Miles C
MC
D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D018572:Disease-Free Survival; D042241:Early Diagnosis; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D005791:Patient Care / Q000592:standards* / Q000639:trends; D011183:Postoperative Complications / Q000628:therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D012959:Socioeconomic Factors; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D015996:Survival Rate; D006113:United Kingdom