title: Socio-economic deprivation: a significant determinant affecting stage of oral cancer diagnosis and survival.
abstract: Many factors contribute to socioeconomic status (SES), yet in most survival studies only income is used as a measure for determining SES. We used a complex, composite, census-based metric for socioeconomic deprivation to better distinguish individuals with lower SES and assess its impact on survival and staging trends of oral cancers.
  
  
  
  Oropharyngeal (OPC) and oral cavity cancer (OCC) cases were identified from the British Columbia cancer registry between 1981-2009 and placed into affluent and deprived neighborhoods using postal codes linked to VANDIX (a composite SES index based on 7 census variables encompassing income, housing, family structure, education, and employment). Stage and cancer-specific survival rates were examined by sex, SES, and time period.
  
  
  
  Approximately 50 % of OPC and OCC cases of both sexes resided in SES deprived neighborhoods. Numbers of cases have increased in recent years for all but OCC in men. The deprivation gap in survival between affluent and deprived neighborhoods widened in recent years for OPC and OCC in men, while decreasing for OPC and increasing slightly for OCC in women. Greater proportions of OCC cases were diagnosed at later stage disease for both sexes residing in deprived neighborhoods, a trend not seen for OPC.
  
  
  
  SES remains a significant independent determinant of survival for both OPC and OCC when using a composite metric for SES. OPC survival rates among men have improved, albeit at slower rates in deprived communities. OCC screening programs need to be targeted towards SES-deprived neighborhoods where greater proportions of cases were diagnosed at a later stage and survival rates have significantly worsened in both sexes.
authors.affiliation: Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada. drajitauluck@gmail.com.|Cancer Control Research Department, BC Cancer Agency, Vancouver, Canada. drajitauluck@gmail.com.|BC Oral Cancer Prevention Program, BC Cancer Agency Research Centre, 675 W. 10th Ave, 3rd Floor, Room 119, Vancouver, B.C, V5Z1L3, Canada. drajitauluck@gmail.com.
authors.forename: Ajit
authors.identifier: 0000-0002-8748-2596
authors.initials: A
authors.lastname: Auluck
authors.affiliation: Department of Geography, Simon Fraser University, Burnaby, BC, Canada.
authors.forename: Blake Byron
authors.initials: BB
authors.lastname: Walker
authors.affiliation: Cancer Control Research Department, BC Cancer Agency, Vancouver, Canada.
authors.forename: Greg
authors.initials: G
authors.lastname: Hislop
authors.affiliation: Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada.|Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.|Division of Cardiology, Providence Health Care, Vancouver, Canada.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Lear
authors.affiliation: Department of Geography, Simon Fraser University, Burnaby, BC, Canada.
authors.forename: Nadine
authors.initials: N
authors.lastname: Schuurman
authors.affiliation: Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada.|Cancer Control Research Department, BC Cancer Agency, Vancouver, Canada.
authors.forename: Miriam
authors.initials: M
authors.lastname: Rosin
mesh_terms: D017677:Age Distribution; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D009062:Mouth Neoplasms / Q000473:pathology*; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000473:pathology*; D012042:Registries; D017678:Sex Distribution; D012923:Social Class; D016019:Survival Analysis