Social inequalities in cancer survival: A population-based study using the Costa Rican Cancer Registry
artículo original
Fecha
2020Autor
Fantin, Romain Clement
Santamaría Ulloa, Carolina
Barboza Solís, Cristina
Metadatos
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Background: Social inequalities in survival after cancer diagnosis have been described in several high-income
countries, all cancer sites combined and for several specific cancer sites. The objective of this study was to
analyze 5-year net survival after cancer diagnosis in a middle-income country (Costa Rica), according to the
characteristics at the district level.
Methods: Costa Rican Cancer Registry is a national population-based registry. All cases diagnosed between
January 1, 2011 and December 31, 2015 were included (N = 46,904). Deaths that occurred before December 31,
2018 were identified. An ecological study was implemented. The 477 districts were described using the 2011
Census. Urbanity and wealth was assessed. Socioeconomic inequalities in cancer survival were measured using
multivariable flexible parametric models. Life tables by socio-economic status were used.
Results: 5-year net survival ranged from 9% for liver cancer to 98 % for in situ cervical cancer. Patients living in
socioeconomically disadvantaged districts experienced poorer cancer survival at 5 years, after taking into account the inequalities in survival in the general population (HR = 1.23, p < 0.01). This result was robust and
was found at 1, 2 and 5 years, in all-cancer combined, and in low-, medium- and high-lethality cancers. There
was no difference according to the area, except for low-lethality cancers at 1 year.
Discussion: Despite its universal and solidarity-based health system, Costa Rica is experiencing social inequalities
in survival after cancer diagnosis