Social inequalities in cancer survival: A population-based study using the Costa Rican Cancer Registry

•Costa Rica is experiencing social inequalities in cancer survival after diagnosis.•Patients living in disadvantaged districts experienced poorer survival.•There was no difference according to the area, except for low-lethality cancers at 1 year.•Inequalities were found in low-, medium- and high-let...

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Bibliographic Details
Published in:Cancer epidemiology 2020-04, Vol.65, p.101695-101695, Article 101695
Main Authors: Fantin, Romain, Santamaría-Ulloa, Carolina, Barboza-Solís, Cristina
Format: Article
Language:English
Subjects:
Access to information
Age
Cancer
Cancer survival
Cervical cancer
Cervix
Costa Rica
Diagnosis
Ecological studies
Ecological study
Epidemiology
Health care policy
Health insurance
High income
Income
Inequalities
Lethality
Life expectancy
Life tables
Liver cancer
Local elections
Medical diagnosis
Middle-income country
Mortality
Population
Population studies
Population-based studies
Presidential elections
Rural areas
Socioeconomic factors
Socioeconomics
Survival
Urban areas
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Summary:•Costa Rica is experiencing social inequalities in cancer survival after diagnosis.•Patients living in disadvantaged districts experienced poorer survival.•There was no difference according to the area, except for low-lethality cancers at 1 year.•Inequalities were found in low-, medium- and high-lethality cancers.•Inequalities were found at 1, 2 and 5 years. 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. 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. 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 
ISSN:1877-7821
1877-783X
DOI:10.1016/j.canep.2020.101695