Trends and socioeconomic inequalities in cancer survival in England and Wales up to 2001

Abstract

We examined national trends and socioeconomic inequalities in cancer survival in England and Wales during the 1990s, using population-based data on 2.2 million patients who were diagnosed with one of the 20 most common cancers between 1986 and 1999 and followed up to 2001. Patients were assigned to one of five deprivation categories (from 'affluent' to 'deprived') using characteristics of their electoral ward of residence at diagnosis. We estimated relative survival up to 5 years after diagnosis, adjusting separately in each deprivation category for background mortality by age, sex and calendar period. We estimated trends in survival and in the difference in survival between deprivation categories ('deprivation gap') over the periods 1986-90, 1991-95 and 1996-99. We used period analysis to examine likely survival rates in the near future. Survival improved for most cancers in both sexes during the 1990s, and appears likely to continue improving for most cancers in the near future. The deprivation gap in survival between rich and poor was wider for patients diagnosed in the late 1990s than in the late 1980s. Increases in cancer survival in England and Wales during the 1990s are shown to be significantly associated with a widening deprivation gap in survival.

Figures

Figure 1

Relative survival up to 5 years, by calendar period of diagnosis, England and Wales, men with cancer of the rectum diagnosed 1986–99 and followed up to 2001. The dashed curve is derived from period analysis using survival experience during 2000–01.

Figure 2

Five year relative survival (%) by deprivation category and calendar period of diagnosis, England and Wales, men with cancer of the rectum diagnosed in successive calendar periods 1986–99 and followed up to 2001.

Figure 3

Average change every 5 years in relative survival (%) and in the deprivation gap in survival (%): England and Wales, 1- and 5-year survival, selected cancers, men and women diagnosed during the period 1986–99 and followed up to 2001. Prostate cancer was excluded from the regression and the scatter-plot (see text).