The impact of life tables adjusted for smoking on the socio-economic difference in net survival for laryngeal and lung cancer.
BACKGROUND
Net survival is a key measure in cancer control, but estimates for cancers that are strongly associated with smoking may be biased. General population life tables represent background mortality in net survival, but may not adequately reflect the higher mortality experienced by smokers.


METHODS
Life tables adjusted for smoking were developed, and their impact on net survival and inequalities in net survival for laryngeal and lung cancers was examined.


RESULTS
The 5-year net survival estimated with smoking-adjusted life tables was consistently higher than the survival estimated with unadjusted life tables: 7% higher for laryngeal cancer and 1.5% higher for lung cancer. The impact of using smoking-adjusted life tables was more pronounced in affluent patients; the deprivation gap in 5-year net survival for laryngeal cancer widened by 3%, from 11% to 14%.


CONCLUSIONS
Using smoking-adjusted life tables to estimate net survival has only a small impact on the deprivation gap in survival, even when inequalities are substantial. Adjusting for the higher, smoking-related background mortality did increase the estimates of net survival for all deprivation groups, and may be more important when measuring the public health impact of differences or changes in survival, such as avoidable deaths or crude probabilities of death.
Cancer Research UK Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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L
Ellis
Cancer Research UK Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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MP
Coleman
Cancer Research UK Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
B
B
Rachet
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000191:economics / Q000401:mortality*; D015993:Life Tables; D008175:Lung Neoplasms / Q000191:economics / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000009:adverse effects / Q000191:economics / Q000401:mortality*; D012923:Social Class; D016019:Survival Analysis