title: Do stage of disease, comorbidity or access to treatment explain socioeconomic differences in survival after ovarian cancer? - A cohort study among Danish women diagnosed 2005-2010.
abstract: OBJECTIVE
  In order to reduce social inequality in cancer survival, knowledge is needed about where in the cancer trajectory disparities occur, and how social and health-related aspects may interact. We aimed to determine whether socioeconomic factors are related to cancer diagnosis stage, and whether socioeconomic disparities in survival after ovarian cancer can be explained by socioeconomic differences in cancer stage, comorbidity, treatment or lifestyle factors.
  
  
  METHODS
  In the Danish Gynaecological Cancer Database we identified 2873 cases of ovarian cancer diagnosed between 2005 and 2010. From this data we retrieved information on prognostic factors, treatment information and lifestyle factors. Age, vital status, comorbidity, education, income and cohabitation status were ascertained from nationwide administrative registers. Associations were analyzed with logistic regression and Cox regression models.
  
  
  RESULTS
  Educational level was weakly associated with cancer stage. Short education, lower income and living without a partner were related to poorer survival after ovarian cancer. Among women with early cancer stage, HR (95% CI) for death was 1.75 (1.20-2.54) in shorter compared to longer educated women. After adjustment for comorbid conditions, cancer stage, tumour histology, operation status and lifestyle factors, socioeconomic differences in survival persisted.
  
  
  CONCLUSIONS
  Socioeconomic disparities in survival after ovarian cancer were to some extent, but not fully explained by differences in important prognostic factors, suggesting further investigations into this problem, however implying that socially less advantaged ovarian cancer patients should receive attention during cancer treatment and rehabilitation.
authors.affiliation: Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark; Research Centre for Prevention and Health, Glostrup University Hospital, Nordre Ringvej 57, DK-2600 Glostrup, Denmark. Electronic address: else.helene.ibfelt@regionh.dk.
authors.forename: Else Helene
authors.initials: EH
authors.lastname: Ibfelt
authors.affiliation: Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark.
authors.forename: Susanne Oksbjerg
authors.initials: SO
authors.lastname: Dalton
authors.affiliation: The Gynecologic Clinic, The Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
authors.forename: Claus
authors.initials: C
authors.lastname: Høgdall
authors.affiliation: Department of Obstetrics and Gynecology, Hillerød Hospital, Copenhagen University Hospital, Dyrehavevej 29, DK-3400 Hillerød, Denmark.
authors.forename: Carsten Lindberg
authors.initials: CL
authors.lastname: Fagö-Olsen
authors.affiliation: Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark.
authors.forename: Marianne
authors.initials: M
authors.lastname: Steding-Jessen
authors.affiliation: Research Centre for Prevention and Health, Glostrup University Hospital, Nordre Ringvej 57, DK-2600 Glostrup, Denmark.
authors.forename: Merete
authors.initials: M
authors.lastname: Osler
authors.affiliation: Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark.
authors.forename: Christoffer
authors.initials: C
authors.lastname: Johansen
authors.affiliation: Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Frederiksen
authors.affiliation: Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark; The Gynecologic Clinic, The Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
authors.forename: Susanne K
authors.initials: SK
authors.lastname: Kjær
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003718:Denmark; D004522:Educational Status; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007182:Income; D008019:Life Style; D016015:Logistic Models; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology; D016016:Proportional Hazards Models; D012959:Socioeconomic Factors
keywords: Cancer treatment; Comorbidity; Denmark; Early detection of cancer; Lifestyle factors; Ovarian cancer; Socioeconomic factors; Survival