title: Social determinants of health and 5-year survival of colorectal cancer.
abstract: BACKGROUND
  Early in the 21st century, cancers are the second cause of death worldwide. Colon cancer is third most common cancer and one of the few amenable to early diagnosis and treatment. Evaluation of factors affecting this cancer is important to increase survival time. Some of these factors affecting all diseases including cancer are social determinants of health. According to the importance of this disease and relation with these factors, this study was conducted to assess the relationship between social determinants of health and colon cancer survival.
  
  
  METHODS
  This was a cross-sectional, descriptive study for patients with colon cancer registered in the Cancer Research Center of Shahid Beheshti University of Medical Science, from April 2005 to November 2006, performed using questionnaires filled by telephone interview with patients (if patients had died, with family members). Data was analyzed with SPSS software (version 19) for descriptive analysis and STATA software for survival analysis including log rank test and three step Cox Proportional Hazard regression.
  
  
  RESULTS
  Five hundred fifty nine patients with ages ranging from 23 to 88 years with mean ± standard deviation of 63 ± 11.8 years were included in the study. The five year survival was 68.3%( 387 patients were alive and 172 patients were dead by the end of the study). The Cox proportional hazard regression showed 5-year survival was related to age (HR=0.53, p=0.042 for>50 years versus<50 years old) in first step, gender (HR=0.60, p=0.006 for female versus male) in second step, job (HR=1.7, p=0.001 for manual versus non manual jobs), region of residency (HR=3.49, p=0.018 for west versus south regions), parents in childhood (HR=2.87, p=0.012 for having both parents versus not having), anatomical cancer location (HR=2.16, p<0.033 for colon versus rectal cancer) and complete treatment (HR=5.96, p<0.001 for incomplete versus complete treatment).
  
  
  CONCLUSIONS
  Social determinants of health such as job, city region residency and having parents during childhood have significant effects in 5-year survival of colon cancer and it may be better to consider these factors in addition to developing cancer treatment and to focus on these determinants of health in long-time planning.
authors.affiliation: Department of Community Medicine and Health, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran E-mail : mohseny.maryam0@gmail.com.
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Heidarnia
authors.forename: Esmat Davoudi
authors.initials: ED
authors.lastname: Monfared
authors.forename: Mohammad Esmail
authors.initials: ME
authors.lastname: Akbari
authors.forename: Parvin
authors.initials: P
authors.lastname: Yavari
authors.forename: Farzaneh
authors.initials: F
authors.lastname: Amanpour
authors.forename: Maryam
authors.initials: M
authors.lastname: Mohseni
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology; D003430:Cross-Sectional Studies; D018572:Disease-Free Survival; D005191:Family Characteristics; D005260:Female; D005843:Geography; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009790:Occupations / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012737:Sex Factors; D064890:Social Determinants of Health / Q000706:statistics & numerical data*; D055815:Young Adult