Describing the association between socioeconomic inequalities and cancer survival: methodological guidelines and illustration with population-based data

Aurélien Belot 1, 2, 3, * Laurent Remontet 3, 4 Bernard Rachet 1 Olivier Dejardin 5, 6 Hadrien Charvat 7 Simona Bara 8 Anne-Valérie Guizard 5, 9 Laurent Roche 3, 4 Guy Launoy 5, 6 Nadine Bossard 3, 10
* Corresponding author
1 LSHTM - London School of Hygiene and Tropical Medicine
2 ANSP - Agence Nationale de la Santé Publique [Saint-Maurice]
3 Service de Biostatistiques [Lyon]
4 LBBE - Laboratoire de Biométrie et Biologie Evolutive - UMR 5558
5 ANTICIPE - Unité de recherche interdisciplinaire pour la prévention et le traitement des cancers
6 Registre des cancers digestifs du Calvados [CHU Caen]
7 Center for Public Health Sciences [Tokyo]
8 Registre des cancers de la Manche
9 Registre général des tumeurs du Calvados
10 Biostatistiques santé
Département biostatistiques et modélisation pour la santé et l'environnement [LBBE]
Abstract : Background: Describing the relationship between socioeconomic inequalities and cancer survival is important but methodologically challenging. We propose guidelines for addressing these challenges and illustrate their implementation on French population-based data. Methods: We analyzed 17 cancers. Socioeconomic deprivation was measured by an ecological measure, the European Deprivation Index (EDI). The Excess Mortality Hazard (EMH), ie, the mortality hazard among cancer patients after accounting for other causes of death, was modeled using a flexible parametric model, allowing for nonlinear and/or time-dependent association between the EDI and the EMH. The model included a cluster-specific random effect to deal with the hierarchical structure of the data. Results: We reported the conventional age-standardized net survival (ASNS) and described the changes of the EMH over the time since diagnosis at different levels of deprivation. We illustrated nonlinear and/or time-dependent associations between the EDI and the EMH by plotting the excess hazard ratio according to EDI values at different times after diagnosis. The median excess hazard ratio quantified the general contextual effect. Lip–oral cavity–pharynx cancer in men showed the widest deprivation gap, with 5-year ASNS at 41% and 29% for deprivation quintiles 1 and 5, respectively, and we found a nonlinear association between the EDI and the EMH. The EDI accounted for a substantial part of the general contextual effect on the EMH. The association between the EDI and the EMH was time dependent in stomach and pancreas cancers in men and in cervix cancer. Conclusion: The methodological guidelines proved efficient in describing the way socioeconomic inequalities influence cancer survival. Their use would allow comparisons between different health care systems.
Keywords : cancer net survival socioeconomic inequalities European Deprivation Index excess mortality hazard flexible parametric model
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Aurélien Belot, Laurent Remontet, Bernard Rachet, Olivier Dejardin, Hadrien Charvat, et al.. Describing the association between socioeconomic inequalities and cancer survival: methodological guidelines and illustration with population-based data. Journal of Clinical Epidemiology, Elsevier, 2018, 10, pp.561 - 573. ⟨10.2147/CLEP.S150848⟩. ⟨inserm-01856003⟩

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