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• W2076230814 startingPage "478" @default.
• W2076230814 abstract "478 Brief communication SOCIAL, PROGNOSTIC, AND THERAPEUTIC FACTORS ASSOCIATED WITH CANCER SURVIVAL: A POPULATION-BASED STUDY IN METROPOLITAN DETROIT, MICHIGAN Previously, we studied the effect of socioeconomic status (SES) on cancer survival among adults of Toronto, Ontario and Detroit, Michigan.1 Detroiters' survival was significantly worse among people from lower SES areas for 12 of 15 relatively common types of cancer. In contrast, no such SESsurvival associations were found for 12 of 15 cancer types in Toronto. Between-country analysis, which compared cases arising from Toronto and Detroit's low-income areas, revealed a significant Toronto survival advantage for 13 of 15 most prevalent cancers. Other studies demonstrated that such Canadian advantage was maintained even with a conservative comparison of Toronto's poor with Detroit's near poor,2 as well as in other Canada-U.S. comparative locales.35 Furthermore, SES acted as an effect modifier, that is, significant country-by-SES interactions were observed. Canadian survival advantages were observed only among the ecologically defined poor (residents of low-income neighborhoods). The present study aims to advance understanding of the factors associated with such disadvantaged survival among people with cancer in the United States. Nine of 10 U.S. studies on cancer survival during the past 10 years have found a significant disadvantage with low SES.1,3,6 Survival among those of relatively high SES was found to be 49 percent greater than that of their lower status counterparts. A similar SES-cancer survival association, although of attenuated magnitude (13 percent differential), has also been observed in other developed continental European and Nordic countries, as well as Australia .740 Interestingly, the aggregate SES-cancer survival differential among Canadian cohorts has been found to be only 3 percent.15,11,12 Health care systems differences, such as the greater representation of universally accessible single-payer systems in Nordic and other European countries, and Canada, may parsimoniously account for the greatly diminished SES-cancer survival associations found in these countries compared with the United States. Studies of race and cancer survival have provided further evidence for an SESsurvival association in the United States.1316 Cumulative cancer survival among blacks was found to be approximately 43 percent less than that of Received May 28, 2002; revised December 18, 2002; accepted January 24, 2003. Journal of Health Care for the Poor and Underserved · Vol. 14, No. 4 · 2003 Gorey et al. 479 whites, but this difference diminished to only 8 percent in studies that provided any adjustment for socioeconomic factors or health care access.17 This analytic picture seems straightforward, but its valid policy interpretation is complicated by a number of other known relationships. For example, in the United States, such social factors as SES and race are both highly associated with cancer prognostic and treatment factors,1825 which themselves are highly associated with cancer survival in the United States and other countries .2628 Moreover, the associations of social factors with tumor biology in the United States2932 and the associations of social factors with prognosis and treatment in other countries, including Canada,3336 have all been observed to be extremely small or nonsignificant. Separately, each of these meta-estimates seems to be most consistent with a systemic, rather than an individual biological -behavioral, account. This study aims to measure the relative weight of all these factors—social, biological, standard prognostic, and therapeutic—in predicting cancer survival among a well-defined U.S. population. Method Cancer cases from the population of metropolitan Detroit, Michigan (3.9 million in 1990; Wayne, Oakland, and Macomb counties) were ascertained by the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program.3739 Primary, malignant, adult (25 years of age or older), microscopically confirmed cases among the most common cancer sites with relatively good prognoses (five-year survival 50 percent or greater for any SES group) were included in the analysis: breast (ICD-9 code 174), prostate (185), colon (153), rectum (154), bladder (188), kidney (189), corpus uteri (182), cervix uteri (180), and oral (141-9).40 These cancers, which account for 57 percent of all incident cases in metropolitan Detroit, may reasonably be expected to be most..." @default.
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• W2076230814 date "2003-01-01" @default.
• W2076230814 modified "2023-09-25" @default.
• W2076230814 title "Social, Prognostic, and Therapeutic Factors Associated with Cancer Survival: A Population-Based Study in Metropolitan Detroit, Michigan" @default.
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• W2076230814 doi "https://doi.org/10.1353/hpu.2010.0694" @default.
• W2076230814 hasPubMedCentralId "https://www.ncbi.nlm.nih.gov/pmc/articles/2919559" @default.
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