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The Combined Effect of Individual and Neighborhood Socioeconomic Status on Cancer Survival Rates

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  • Chun-Ming Chang
  • Yu-Chieh Su
  • Ning-Sheng Lai
  • Kuang-Yung Huang
  • Sou-Hsin Chien
  • Yu-Han Chang
  • Wei-Cheng Lian
  • Ta-Wen Hsu
  • Ching-Chih Lee

Abstract

Background: This population-based study investigated the relationship between individual and neighborhood socioeconomic status (SES) and mortality rates for major cancers in Taiwan. Methods: A population-based follow-up study was conducted with 20,488 cancer patients diagnosed in 2002. Each patient was traced to death or for 5 years. The individual income-related insurance payment amount was used as a proxy measure of individual SES for patients. Neighborhood SES was defined by income, and neighborhoods were grouped as living in advantaged or disadvantaged areas. The Cox proportional hazards model was used to compare the death-free survival rates between the different SES groups after adjusting for possible confounding and risk factors. Results: After adjusting for patient characteristics (age, gender, Charlson Comorbidity Index Score, urbanization, and area of residence), tumor extent, treatment modalities (operation and adjuvant therapy), and hospital characteristics (ownership and teaching level), colorectal cancer, and head and neck cancer patients under 65 years old with low individual SES in disadvantaged neighborhoods conferred a 1.5 to 2-fold higher risk of mortality, compared with patients with high individual SES in advantaged neighborhoods. A cross-level interaction effect was found in lung cancer and breast cancer. Lung cancer and breast cancer patients less than 65 years old with low SES in advantaged neighborhoods carried the highest risk of mortality. Prostate cancer patients aged 65 and above with low SES in disadvantaged neighborhoods incurred the highest risk of mortality. There was no association between SES and mortality for cervical cancer and pancreatic cancer. Conclusions: Our findings indicate that cancer patients with low individual SES have the highest risk of mortality even under a universal health-care system. Public health strategies and welfare policies must continue to focus on this vulnerable group.

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  • Chun-Ming Chang & Yu-Chieh Su & Ning-Sheng Lai & Kuang-Yung Huang & Sou-Hsin Chien & Yu-Han Chang & Wei-Cheng Lian & Ta-Wen Hsu & Ching-Chih Lee, 2012. "The Combined Effect of Individual and Neighborhood Socioeconomic Status on Cancer Survival Rates," PLOS ONE, Public Library of Science, vol. 7(8), pages 1-10, August.
    • Handle: RePEc:plo:pone00:0044325
    DOI: 10.1371/journal.pone.0044325
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    4. Tsu Jen Kuo & Pei Chen Wu & Pei Ling Tang & Chun-Hao Yin & Chi Hsiang Chu & Yao-Min Hung, 2019. "Effects of continuity of care on the postradiotherapy survival of working-age patients with oral cavity cancer: A nationwide population-based cohort study in Taiwan," PLOS ONE, Public Library of Science, vol. 14(12), pages 1-17, December.
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    7. Chin-Chia Wu & Ta-Wen Hsu & Chun-Ming Chang & Chia-Hui Yu & Yuh-Feng Wang & Ching-Chih Lee, 2014. "The Effect of Individual and Neighborhood Socioeconomic Status on Gastric Cancer Survival," PLOS ONE, Public Library of Science, vol. 9(2), pages 1-6, February.
    8. Klein, Jens & von dem Knesebeck, Olaf, 2015. "Socioeconomic inequalities in prostate cancer survival: A review of the evidence and explanatory factors," Social Science & Medicine, Elsevier, vol. 142(C), pages 9-18.
    9. Chan‐Hoong Leong & Soo Jiuan Tan & Elizabeth A. Minton & Siok Kuan Tambyah, 2021. "Economic hardship and neighborhood diversity: Influences on consumer well‐being," Journal of Consumer Affairs, Wiley Blackwell, vol. 55(4), pages 1226-1248, December.
    10. Wei-Yin Kuo & Han-Sheng Hsu & Pei-Tseng Kung & Wen-Chen Tsai, 2021. "Impact of Socioeconomic Status on Cancer Incidence Risk, Cancer Staging, and Survival of Patients with Colorectal Cancer under Universal Health Insurance Coverage in Taiwan," IJERPH, MDPI, vol. 18(22), pages 1-17, November.
    11. Shih-Hsien Yang & Su-Feng Chen & Shin Nieh & Chia-Lin Liu & Yaoh-Shiang Lin & Ching-Chih Lee & Fu-Huang Lin, 2017. "The Effect of Individual and Neighbourhood Socioeconomic Status on Diabetes Mellitus Survival in Working Age Patients in Taiwan," PLOS ONE, Public Library of Science, vol. 12(1), pages 1-11, January.
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