Socio-economic and socio-demographic inequalities in cancer incidence and survival in the older population of England and Wales
Andy Sloggett and Emily Grundy, London School of Hygiene & Tropical Medicine
[Project number 20059]
Much of the work on inequalities in cancer incidence and survival has focused on inequalities by socio-economic status, whether measured at the individual or the area level. Those from more disadvantaged groups or areas experience a higher incidence of many cancers (with some notable exceptions and almost invariably a poorer prognosis. The recent major Office for National Statistics study of cancer survival in England and Wales (the "Survival Trends" study - Coleman et al 1999), for example, used cancer registry data to examine survival from 47 forms of cancer in adults over the period 1971-90. Results showed marked variations in survival according to area characteristics (score on the Carstairs' deprivation index).
Existing research on this topic, using representative population based data, is limited. The 1999 ONS Survival Trends study, while important and influential, was based entirely on data from cancer registries and consequently had some limitations. In particular inequalities according to characteristics other than age, gender and place of residence could not be examined.
We intend to investigate inequalities in cancer incidence and survival in the population of England and Wales aged 45 years and over. Approximately 90% of adult male cancers, and 75% of adult female cancers occur above the age of 45. All cancer registrations between the years of 1981 and 1994, to all LS members aged 45+ will be included in the study. For parts of the study comparing socio-economic and household variables at 1971, 1981 and 1991 censuses we will focus on the cohorts aged 45+ at the 1981 census. Our focus will be on socio-economic and geographic variations, socio-demographic differentials (in particular household and family structure and history), ethnicity and the possible interactive effects of disadvantages in more than one of these domains. We will also analyse changes in circumstances following registration of cancer. This will provide policy relevant information on the domestic circumstances of cancer sufferers and allow us to examine family variations between social groups in response to cancer.
The proposed analysis of the LS would have the broad aim of investigating associations between disadvantage, both socio-economic and socio-demographic, and cancer incidence and survival; thus providing policy relevant information on the circumstances of people with cancer. These aims would be achieved by addressing the following main research questions:
1. How was cancer incidence (1981-99) associated with cumulative indicators
of disadvantage, 1971-91?
2. How was cancer incidence and survival post 1981 associated with change in socio-economic and socio-demographic circumstances 1971-81 and 1991?
3. What were the family and household circumstances of those with cancer in 1981 (prevalent cases) and how different were these for those still alive in 1991.
4. What were the characteristics of main co-residents of cancer sufferers (prevalent cases) in 1991?
5. Is cancer incidence a precursor of household change and, if so how does family/household structure change following a diagnosis of cancer?
6. Does cancer-free life expectancy vary between health regions and by social group?