title: Impact of socio-economic position on cancer stage at presentation: Findings from a large hospital-based study in Germany.
abstract: We explored the relationship between socio-economic characteristics and cancer stage at presentation. Patients admitted to a university hospital for diagnosis and treatment of cancer provided data on their education, vocational training, income, employment, job, health insurance and postcode. Tumor stage was classified according to the Union International Contre le Cancer (UICC). To analyze disparities in the likelihood of late-stage (UICC III/IV vs. I/II) diagnoses, logistic regression models adjusting for age and gender were used. Out of 1,012 patients, 572 (59%) had late-stage cancer. Separately tested, increased odds of advanced disease were associated with post-compulsory education compared to college degrees, with apprenticeship and no vocational training, with unemployment, disability pension, jobs with a low hierarchy level, blue collar jobs and with low income. Health insurance and community size were not related with late-stage cancer. Jointly modelled, there was evidence for an independent effect of unemployment (odds ratio (OR) 1.7, CI 1.0-2.8), disability pension (OR 1.8, CI 1.0-3.2) and very low income (OR 2.6, CI 1.1-6.1) on the likelihood of advanced disease stage. It is of great concern that these socio-economic gradients occur even in systems with equal access to health care.
authors.affiliation: Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre, Mainz, Germany.|University Cancer Centre, Mainz, Germany.|Mainz-Frankfurt, German Consortium of Translational Cancer Research, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Singer
authors.affiliation: Department of Medical Psychology and Medical Sociology, University Medical Centre, Leipzig, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Roick
authors.affiliation: Department of Obstetrics and Gynaecology, University Medical Centre, Leipzig, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Briest
authors.affiliation: Department of Obstetrics and Gynaecology, University Medical Centre, Leipzig, Germany.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Stark
authors.affiliation: Department of General Surgery, University Medical Centre, Leipzig, Germany.
authors.forename: Ines
authors.initials: I
authors.lastname: Gockel
authors.affiliation: Department of Otolaryngology, University Medical Centre, Leipzig, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Boehm
authors.affiliation: Department of Radiation-Oncology, University Medical Centre, Leipzig, Germany.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Papsdorf
authors.affiliation: Department of Neurosurgery, University Medical Centre, Leipzig, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Meixensberger
authors.affiliation: Department of Hepatology and Gastroenterology, University Medical Centre Charité, Campus Virchow Clinic, Berlin, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Müller
authors.affiliation: Department of Orthopaedics, University Medical Centre, Leipzig, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Prietzel
authors.affiliation: Department of Maxillofacial Surgery, University Medical Centre, Leipzig, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Schiefke
authors.affiliation: Department of Urology, University Medical Centre, Leipzig, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Dietel
authors.affiliation: Department of Pneumology, University Medical Centre, Leipzig, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Bräunlich
authors.affiliation: Department of Medical Psychology and Medical Sociology, University Medical Centre, Leipzig, Germany.
authors.forename: Helge
authors.initials: H
authors.lastname: Danker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000473:pathology*; D012959:Socioeconomic Factors
keywords: education; health disparities; income; rural/urban; screening; unemployment