title: The effect of individual and neighborhood socioeconomic status on esophageal cancer survival in working-age patients in Taiwan.
abstract: Esophageal cancer is the sixth leading cause of cancer mortality. More than 90% of patients with esophageal cancer in Taiwan have squamous cell carcinoma. Survival of such patients is related to socioeconomic status (SES). We studied the association between SES (individual and neighborhood) and the survival of working-age patients with esophageal cancer in Taiwan. A population-based study was conducted of 4097 patients diagnosed with esophageal cancer between 2002 and 2006. Each was traced for 5 years or until death. Individual SES was defined by enrollee job category. Neighborhood SES was based on household income and dichotomized into advantaged or disadvantaged. Multilevel logistic regression was used to compare the survival rates by SES group after adjustment for possible confounding and risk factors. Hospital and neighborhood SES were used as random effects in multilevel logistic regression. In patients younger than 65 years, 5-year overall survival rates were worst for those with low individual SES living in disadvantaged neighborhoods. After adjustment for patient characteristics, esophageal cancer patients with high individual SES had a 39% lower risk of mortality than those with low individual SES (odds ratio 0.61, 95% confidence interval 0.48-0.77). Patients living in disadvantaged areas with high individual SES were more likely to receive surgery than those with low SES (odds ratio 1.45, 95% confidence interval 1.11-1.89). Esophageal cancer patients with low individual SES have the worst 5-year survival, even with a universal healthcare system. Public health, education, and social welfare programs should address the inequality of esophageal cancer survival.
authors.affiliation: Division of Colorectal Surgery Division of General Surgery, Department of Surgery Cancer Center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi School of Medicine, Tzu Chi University, Hualien Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi Department of Otorhinolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung Department of Otolaryngology, Head and Neck Surgery, Tri-Service General Hospital School of Medicine, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Chin-Chia
authors.initials: CC
authors.lastname: Wu
authors.forename: Chun-Ming
authors.initials: CM
authors.lastname: Chang
authors.forename: Ta-Wen
authors.initials: TW
authors.lastname: Hsu
authors.forename: Cheng-Hung
authors.initials: CH
authors.lastname: Lee
authors.forename: Jian-Han
authors.initials: JH
authors.lastname: Chen
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Huang
authors.forename: Ching-Chih
authors.initials: CC
authors.lastname: Lee
mesh_terms: D000367:Age Factors; D000368:Aged; D004938:Esophageal Neoplasms / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012923:Social Class; D015996:Survival Rate; D013624:Taiwan