Michael Rosskamp, Julie Verbeeck, Freija Verdoodt, Harlinde De Schutter

SOCIALE ASPECTEN

SOCIOECONOMIC POSITION, CANCER INCIDENCE AND STAGE AT DIAGNOSIS – A NATIONWIDE COHORT STUDY

ONDERZOEKSPROJECT

PROBLEEM- EN DOELSTELLING(EN)

Socioeconomic (SE) position is associated with cancer incidence, survival and mortality. However, the direction and magnitude of this relationship differs across cancer types, geographical regions and SE parameters. The aim of this study was to evaluate and characterize the associations between SE and sociodemographic (SD) indicators at individual level, and the risk of being diagnosed with different cancer types at the Belgian population level. Cancer stage being a major determinant for prognosis, a second aim was to explore the association between SE position and cancer stage availability and distribution.

ONDERZOEKSOPZET

Individual level data of the 2001 census for persons aged 25 years or older, was linked to the nationwide Belgian Cancer Registry for diagnoses during 2004-2013. Three SE or SD parameters (education level, household composition and housing conditions) and six cancer types (lung cancer, colon cancer, rectum cancer, head and neck cancers, female breast cancer and malignant melanoma) were considered. Incidence rate ratios (IRR) were assessed through Poisson regression models and stage-specific analyses conducted through logistic regression models and reported as odds ratios (OR). Analyses included multivariable-adjusted models, incorporating age, region of residence and self-reported health at time of census and estimates were reported with 95% confidence interval [95%-CI].

RESULTATEN

The study cohort encompassed almost seven million individuals. Deprived groups showed higher risks for lung and head and neck cancers, whereas an inverse relation was observed for female breast cancer and malignant melanoma (IRR for head and neck cancers in men for the lowest compared to the highest education was 1.31 [1.23-1.39] compared to 0.56 [0.51-0.61] for malignant melanoma). Typically, associations were more pronounced in men than in women (IRR for lung in men for the lowest compared to the highest education was 2.00 [1.93-2.06] compared to 1.63 [1.54-1.72] in women). Lower socioeconomic position was associated with reduced chances of being diagnosed with a known stage or early stage at diagnosis, with the strongest disparities in male lung cancer (OR for being diagnosed with unknown stage, low-comfort compared to high-comfort housing: 1.23[1.16-1.31]) and female breast cancer (OR for being diagnosed with advanced stage, low-comfort compared to high-comfort housing: 1.32[1.25-1.40]).

KLINISCHE- MAATSCHAPPELIJKE- EN/OF WETENSCHAPPELIJKE RELEVANTIE

This nationwide study highlights the association of distinct SE and SD factors at the individual level with cancer risk and stage at diagnosis in Belgium. SE inequalities in cancer are an important public health issue. An improved understanding of the interplay between SE position and cancer risk increases possibilities to launch targeted interventions to reduce the SE gradient. Earlier detection and prevention measures should especially focus on population groups being at higher risk of advanced stage diagnosis.

ALGEMENE INFORMATIE

• Projectverantwoordelijken: Harlinde De Schutter, Freija Verdoodt • Uitvoerders: Michael Rosskamp, Julie Verbeeck, Freija Verdoodt, Harlinde De

Schutter • Organisatie: Belgian Cancer Registry • Contactgegevens: Freija.Verdoodt@kankerregister.org - +32 2 211 08 01 • Termijn project: 1/01/2016 - 31/12/2019 • Financiering: Kom op tegen Kanker • Partners: prof. Sylvie Gadeyne (PhD student), Victoria Sass (PhD student,

Sociology Department - Interface Demography) • Publicatie: https://doi.org/10.3390/cancers13050933

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