ASPO Abstracts
Social Gradient in Cancer Incidence and Mortality: A Systematic Review
Category: Cancer Health Disparities, International Issues in Cancer
Conference Year: 2018
Abstract Body:
This systematic review was conducted to determine if existing relationships in the literature manifest a gradient in cancer mortality and incidence either directly or indirectly with Socioeconomic Position (SEP) for all cancers. We conducted a systematic search of seven electronic databases to identify peer-reviewed empirical articles relating to the influence of Socioeconomic Position (SEP) on cancer incidence and mortality published in English from 1996-2016. We identified 47 relevant articles that evaluated the relationship between SEP and cancer mortality and/or incidence. The majority were cohort (23/47) and ecological (16/47) studies. The most common cancers assessed were Breast (24/47) and Lung (19/47) followed by Colorectal (15/47) and Prostate (12/47). Cancer incidence was an outcome in 29 articles, mortality was an outcome in 11 articles, and only seven articles assessed both. Most studies used individual income, education, occupation, and social class as a measure of SEP; studies that were ecological frequently used neighborhood SES as a measure of SEP. High SEP was consistently associated with both Breast cancer and Melanoma incidence in the U.S. and internationally. The majority of studies also found an inverse relationship between SEP and cancer so that most disadvantaged individuals were at highest risk for Lung and cervical cancer; findings were mixed for other cancers. The relationship between SEP and cancer mortality however were inconsistent between U.S. and European studies; studies in the U.S. generally showed an association with low SEP and higher mortality whereas European studies showed inconsistent findings. The majority of studies attributed life-style factors including smoking, reproductive patterns, diet, physical activity, and alcohol intake, and differences in access to healthcare to the observed gradient. We found evidence of a gradient in cancer incidence and mortality with regard to SEP. The relationship between SEP and cancer incidence and mortality appeared to vary by cancer site and between countries. Further research needs to be conducted to understand potential drivers of the observed gradient.
Keywords: Socioeconomic Position, Cancer, Systematic Review