title: Socioeconomic position and survival after cervical cancer: influence of cancer stage, comorbidity and smoking among Danish women diagnosed between 2005 and 2010.
abstract: BACKGROUND
  In an attempt to decrease social disparities in cancer survival, it is important to consider the mechanisms by which socioeconomic position influences cancer prognosis. We aimed to investigate whether any associations between socioeconomic factors and survival after cervical cancer could be explained by socioeconomic differences in cancer stage, comorbidity, lifestyle factors or treatment.
  
  
  METHODS
  We identified 1961 cases of cervical cancer diagnosed between 2005 and 2010 in the Danish Gynaecological Cancer database, with information on prognostic factors, treatment and lifestyle. Age, vital status, comorbidity and socioeconomic data were obtained from nationwide administrative registers. Associations between socioeconomic indicators (education, income and cohabitation status) and mortality by all causes were analysed in Cox regression models with inclusion of possible mediators. Median follow-up time was 3.0 years (0.01-7.0).
  
  
  RESULTS
  All cause mortality was higher in women with shorter rather than longer education (hazard ratio (HR), 1.46; 1.20-1.77), among those with lower rather than higher income (HR, 1.32; 1.07-1.63) and among women aged<60 years without a partner rather than those who cohabited (HR, 1.60; 1.29-1.98). Socioeconomic differences in survival were partly explained by cancer stage and less by comorbidity or smoking (stage- and comorbidity-adjusted HRs being 1.07; 0.96-1.19 for education and 1.15; 0.86-1.52 for income).
  
  
  CONCLUSIONS
  Socioeconomic disparities in survival after cervical cancer were partly explained by socioeconomic differences in cancer stage. The results point to the importance of further investigations into reducing diagnosis delay among disadvantaged groups.
authors.affiliation: Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark.
authors.forename: E H
authors.initials: EH
authors.lastname: Ibfelt
authors.forename: S K
authors.initials: SK
authors.lastname: Kjær
authors.forename: C
authors.initials: C
authors.lastname: Høgdall
authors.forename: M
authors.initials: M
authors.lastname: Steding-Jessen
authors.forename: T K
authors.initials: TK
authors.lastname: Kjær
authors.forename: M
authors.initials: M
authors.lastname: Osler
authors.forename: C
authors.initials: C
authors.lastname: Johansen
authors.forename: K
authors.initials: K
authors.lastname: Frederiksen
authors.forename: S O
authors.initials: SO
authors.lastname: Dalton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000191:economics* / Q000401:mortality* / Q000473:pathology
references.citation: J Epidemiol Community Health. 1996 Feb;50(1):51-5
references.pmid: 8762354
references.citation: Gynecol Oncol. 2006 Aug;102(2):278-84
references.pmid: 16434087
references.citation: Obstet Gynecol. 1999 Oct;94(4):509-15
references.pmid: 10511350
references.citation: J Chronic Dis. 1987;40(5):373-83
references.pmid: 3558716
references.citation: Cancer Causes Control. 2010 Oct;21(10):1645-55
references.pmid: 20521091
references.citation: Br J Cancer. 2010 Nov 23;103(11):1742-8
references.pmid: 20978508
references.citation: Cancer. 2004 Sep 1;101(5):1051-7
references.pmid: 15329915
references.citation: Curr Opin Obstet Gynecol. 2007 Feb;19(1):31-6
references.pmid: 17218849
references.citation: J Epidemiol Community Health. 2006 Feb;60(2):95-101
references.pmid: 16415256
references.citation: Scand J Public Health. 2011 Jul;39(7 Suppl):103-5
references.pmid: 21775365
references.citation: Scand J Public Health. 2011 Jul;39(7 Suppl):22-5
references.pmid: 21775345
references.citation: Scand J Public Health. 2011 Jul;39(7 Suppl):30-3
references.pmid: 21775347
references.citation: Gynecol Oncol. 2009 Feb;112(2):365-9
references.pmid: 19036421
references.citation: Cancer. 2009 Jan 1;115(1):166-78
references.pmid: 19097209
references.citation: Gynecol Oncol. 2009 Aug;114(2):346-52
references.pmid: 19411096
references.citation: J Epidemiol Community Health. 2011 Jun;65(6):477-82
references.pmid: 21138896
references.citation: Eur J Cancer. 2012 Nov;48(16):3001-8
references.pmid: 22683170
references.citation: Scand J Public Health. 2011 Jul;39(7 Suppl):72-4
references.pmid: 21775357
references.citation: Eur J Cancer. 2008 Sep;44(14):2003-17
references.pmid: 18662869
references.citation: Cancer. 2008 Mar 15;112(6):1264-71
references.pmid: 18257090
references.citation: J Cancer Res Clin Oncol. 2009 Apr;135(4):533-41
references.pmid: 18841394
references.citation: Int J Gynaecol Obstet. 2006 Nov;95 Suppl 1:S43-103
references.pmid: 17161167
references.citation: J Epidemiol Community Health. 2006 Jan;60(1):7-12
references.pmid: 16361448
references.citation: Eur J Cancer Prev. 2005 Oct;14(5):459-66
references.pmid: 16175050
references.citation: Int J Gynecol Cancer. 2009 Aug;19(6):1107-12
references.pmid: 19820377
references.citation: Int J Radiat Oncol Biol Phys. 2000 May 1;47(2):443-50
references.pmid: 10802372
references.citation: Cancer Epidemiol Biomarkers Prev. 2012 May;21(5):835-42
references.pmid: 22434535
references.citation: IARC Sci Publ. 1997;(138):177-206
references.pmid: 9353665
references.citation: Scand J Public Health. 2011 Jul;39(7 Suppl):91-4
references.pmid: 21775362
references.citation: Gynecol Oncol. 2012 Nov;127(2):283-9
references.pmid: 22819937
references.citation: Soc Sci Med. 2002 Aug;55(4):673-9
references.pmid: 12188471
references.citation: Br J Cancer. 1995 Jun;71(6):1343-7
references.pmid: 7779736
references.citation: J Womens Health (Larchmt). 2006 Oct;15(8):941-51
references.pmid: 17087618
references.citation: J Low Genit Tract Dis. 2010 Oct;14(4):329-38
references.pmid: 20885161
references.citation: Cancer. 2012 Oct 15;118(20):5110-6
references.pmid: 22707306
references.citation: Curr Probl Cancer. 2007 May-Jun;31(3):157-81
references.pmid: 17543946
references.citation: Epidemiology. 2011 Jul;22(4):575-81
references.pmid: 21552129
references.citation: Gynecol Oncol. 2011 Apr;121(1):87-93
references.pmid: 21183210