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Estimating the potential survival gains by eliminating socioeconomic and sex inequalities in stage at diagnosis of melanoma.

Rutherford MJ, Ironmonger L, Ormiston-Smith N, Abel GA, Greenberg DC, Lyratzopoulos G, Lambert PC - Br. J. Cancer (2015)

Bottom Line: There were pronounced socioeconomic and sex inequalities in the proportion of patients diagnosed at stages III-IV (12 and 8% for least deprived men and women and 25 and 18% for most deprived men and women, respectively).For an annual cohort of 1025 incident cases in the East of England, eliminating sex and deprivation differences in stage at diagnosis would postpone approximately 24 deaths to beyond 5 years from diagnosis.Using appropriate weighting, the equivalent estimate for England would be around 215 deaths, representing 11% of all deaths observed within 5 years from diagnosis in this population.

View Article: PubMed Central - PubMed

Affiliation: Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK.

ABSTRACT

Background: Although inequalities in cancer survival are thought to reflect inequalities in stage at diagnosis, little evidence exists about the size of potential survival gains from eliminating inequalities in stage at diagnosis.

Methods: We used data on patients diagnosed with malignant melanoma in the East of England (2006-2010) to estimate the number of deaths that could be postponed by completely eliminating socioeconomic and sex differences in stage at diagnosis after fitting a flexible parametric excess mortality model.

Results: Stage was a strong predictor of survival. There were pronounced socioeconomic and sex inequalities in the proportion of patients diagnosed at stages III-IV (12 and 8% for least deprived men and women and 25 and 18% for most deprived men and women, respectively). For an annual cohort of 1025 incident cases in the East of England, eliminating sex and deprivation differences in stage at diagnosis would postpone approximately 24 deaths to beyond 5 years from diagnosis. Using appropriate weighting, the equivalent estimate for England would be around 215 deaths, representing 11% of all deaths observed within 5 years from diagnosis in this population.

Conclusions: Reducing socioeconomic and sex inequalities in stage at diagnosis would result in substantial reductions in deaths within 5 years of a melanoma diagnosis.

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Related in: MedlinePlus

Stage-standardised survival for two example age groups (50–59 and 70–79 years) for men with melanoma. The left panel is stage standardised to the observed stage distribution, showing the observed survival estimates across deprivation groups. The three other panels relate to the three alternative stage standardisations. The alternative stage standardisations show the survival estimates across deprivation groups that would be achieved if the stage distribution could be improved to match that of females, the least deprived or the least deprived females, respectively.
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fig1: Stage-standardised survival for two example age groups (50–59 and 70–79 years) for men with melanoma. The left panel is stage standardised to the observed stage distribution, showing the observed survival estimates across deprivation groups. The three other panels relate to the three alternative stage standardisations. The alternative stage standardisations show the survival estimates across deprivation groups that would be achieved if the stage distribution could be improved to match that of females, the least deprived or the least deprived females, respectively.

Mentions: Figure 1 shows the stage-standardised estimates of relative survival for two example age groups (50–59 and 70–79 years) for men. This shows the impact of removing inequalities in stage at diagnosis on the survival estimates, and at the same time it also illustrates inequalities in survival that would have remained if stage differences had been removed. The ‘sex-standardised' panel of Figure 1 shows the improvements for men that are seen by stage standardising to the stage distribution of women (Table 1) (within age and deprivation groups). For men aged 50–59 years, survival across all deprivation groups improves by standardising to the stage distribution observed for women, particularly for the more deprived patients. This is due to the combination of differential survival across stages for men (Supplementary Online Material) and differences in stage at diagnosis by sex in this age group, including between the most affluent men and women (Table 1). Improvements in survival are also seen for men aged 70–79 years by stage standardising to the stage distribution of women, although the effects are more modest for more deprived patients in this age category. The ‘deprivation-standardised' panel of Figure 1 shows the improvements seen by stage standardising to the stage distribution of the least deprived patients (Table 1). This has a stark impact on survival when compared with the observed relative survival estimates, particularly for the most deprived group (deprivation group 5). The pattern is consistent for the two age groups shown in Figure 1. The final panel shows the improvements for men that are seen by stage standardising to the stage distribution of the most affluent women in each age and deprivation group (Table 1). This gives the combined impact of improvement for men that would be observed if both sex and socioeconomic inequalities in stage at diagnosis were eliminated.


Estimating the potential survival gains by eliminating socioeconomic and sex inequalities in stage at diagnosis of melanoma.

Rutherford MJ, Ironmonger L, Ormiston-Smith N, Abel GA, Greenberg DC, Lyratzopoulos G, Lambert PC - Br. J. Cancer (2015)

Stage-standardised survival for two example age groups (50–59 and 70–79 years) for men with melanoma. The left panel is stage standardised to the observed stage distribution, showing the observed survival estimates across deprivation groups. The three other panels relate to the three alternative stage standardisations. The alternative stage standardisations show the survival estimates across deprivation groups that would be achieved if the stage distribution could be improved to match that of females, the least deprived or the least deprived females, respectively.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4385984&req=5

fig1: Stage-standardised survival for two example age groups (50–59 and 70–79 years) for men with melanoma. The left panel is stage standardised to the observed stage distribution, showing the observed survival estimates across deprivation groups. The three other panels relate to the three alternative stage standardisations. The alternative stage standardisations show the survival estimates across deprivation groups that would be achieved if the stage distribution could be improved to match that of females, the least deprived or the least deprived females, respectively.
Mentions: Figure 1 shows the stage-standardised estimates of relative survival for two example age groups (50–59 and 70–79 years) for men. This shows the impact of removing inequalities in stage at diagnosis on the survival estimates, and at the same time it also illustrates inequalities in survival that would have remained if stage differences had been removed. The ‘sex-standardised' panel of Figure 1 shows the improvements for men that are seen by stage standardising to the stage distribution of women (Table 1) (within age and deprivation groups). For men aged 50–59 years, survival across all deprivation groups improves by standardising to the stage distribution observed for women, particularly for the more deprived patients. This is due to the combination of differential survival across stages for men (Supplementary Online Material) and differences in stage at diagnosis by sex in this age group, including between the most affluent men and women (Table 1). Improvements in survival are also seen for men aged 70–79 years by stage standardising to the stage distribution of women, although the effects are more modest for more deprived patients in this age category. The ‘deprivation-standardised' panel of Figure 1 shows the improvements seen by stage standardising to the stage distribution of the least deprived patients (Table 1). This has a stark impact on survival when compared with the observed relative survival estimates, particularly for the most deprived group (deprivation group 5). The pattern is consistent for the two age groups shown in Figure 1. The final panel shows the improvements for men that are seen by stage standardising to the stage distribution of the most affluent women in each age and deprivation group (Table 1). This gives the combined impact of improvement for men that would be observed if both sex and socioeconomic inequalities in stage at diagnosis were eliminated.

Bottom Line: There were pronounced socioeconomic and sex inequalities in the proportion of patients diagnosed at stages III-IV (12 and 8% for least deprived men and women and 25 and 18% for most deprived men and women, respectively).For an annual cohort of 1025 incident cases in the East of England, eliminating sex and deprivation differences in stage at diagnosis would postpone approximately 24 deaths to beyond 5 years from diagnosis.Using appropriate weighting, the equivalent estimate for England would be around 215 deaths, representing 11% of all deaths observed within 5 years from diagnosis in this population.

View Article: PubMed Central - PubMed

Affiliation: Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK.

ABSTRACT

Background: Although inequalities in cancer survival are thought to reflect inequalities in stage at diagnosis, little evidence exists about the size of potential survival gains from eliminating inequalities in stage at diagnosis.

Methods: We used data on patients diagnosed with malignant melanoma in the East of England (2006-2010) to estimate the number of deaths that could be postponed by completely eliminating socioeconomic and sex differences in stage at diagnosis after fitting a flexible parametric excess mortality model.

Results: Stage was a strong predictor of survival. There were pronounced socioeconomic and sex inequalities in the proportion of patients diagnosed at stages III-IV (12 and 8% for least deprived men and women and 25 and 18% for most deprived men and women, respectively). For an annual cohort of 1025 incident cases in the East of England, eliminating sex and deprivation differences in stage at diagnosis would postpone approximately 24 deaths to beyond 5 years from diagnosis. Using appropriate weighting, the equivalent estimate for England would be around 215 deaths, representing 11% of all deaths observed within 5 years from diagnosis in this population.

Conclusions: Reducing socioeconomic and sex inequalities in stage at diagnosis would result in substantial reductions in deaths within 5 years of a melanoma diagnosis.

Show MeSH
Related in: MedlinePlus