The combined effect of individual and neighborhood socioeconomic status on nasopharyngeal cancer survival.
BACKGROUND
The relationship between individual and neighborhood socioeconomic status (SES) and mortality rates in patients with nasopharyngeal carcinoma (NPC) is unknown. This population-based study aimed to examine the association between SES and survival of patients with NPC in Taiwan.


METHODS
A population-based follow-up study was conducted of 4691 patients diagnosed with NPC between 2002 and 2006. Each patient was traced to death or for 5 years. Individual SES was defined by enrollee job category. Neighborhood SES was based on household income dichotomized into advantaged and disadvantaged areas. Cox proportional hazards model was used to compare the death-free survival rates between the different SES groups after adjusting for possible confounding factors and risk factors.


RESULTS
In NPC patients below the age of 65 years, 5-year overall survival rates were worst for those with low individual SES living in disadvantaged neighborhoods. After adjusting for patient characteristics (age, gender, Charlson Comorbidity Index Score), NPC patients with low individual SES residing in disadvantaged neighborhoods were found to have a 2-fold higher risk of mortality than patients with high individual SES residing in advantaged neighborhoods. We found no significant difference in mortality rates between different SES groups in NPC patients aged 65 and above.


CONCLUSIONS
Our findings indicate that NPC patients with low individual SES who live in disadvantaged neighborhoods have the higher risk of mortality than their more privileged counterparts. Public health strategies and welfare policies would be well advised to try to offset the inequalities in health care and pay more attention to addressing the needs of this vulnerable group.
Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Ting-Shou
TS
Chang
Chun-Ming
CM
Chang
Ta-Wen
TW
Hsu
Yaoh-Shiang
YS
Lin
Ning-Sheng
NS
Lai
Yu-Chieh
YC
Su
Kuang-Yung
KY
Huang
Hung-Lung
HL
Lin
Ching-Chih
CC
Lee
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000453:epidemiology* / Q000401:mortality; D011159:Population Surveillance; D012111:Residence Characteristics; D012923:Social Class; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology