Effects of socioeconomic status on esophageal adenocarcinoma stage at diagnosis, receipt of treatment, and survival: A population-based cohort study

The incidence of esophageal adenocarcinoma (EAC) is increasing worldwide and has overtaken squamous histology in occurrence. We studied the impact of socioeconomic status (SES) on EAC stage at diagnosis, receipt of treatment, and survival. A population-based retrospective cohort study was conducted using Ontario Cancer Registry-linked administrative health data. Multinomial logistic regression was used to examine the association between SES (income quintile) and stage at EAC diagnosis and EAC treatment. Survival times following EAC diagnosis were estimated using Kaplan-Meier method. Cox proportional-hazards regression analysis was used to examine the association between SES and EAC survival. Between 2003–2012, 2,125 EAC cases were diagnosed. Median survival for the lowest-SES group was 10.9 months compared to 11.6 months for the highest-SES group; the 5-year survival was 9.8% vs. 15.0%. Compared to individuals in the highest-SES group, individuals in the lowest-SES category experienced no significant difference in EAC treatment (91.6% vs. 93.3%, P = 0.314) and deaths (78.9% vs. 75.6%, P = 0.727). After controlling for covariates, no significant associations were found between SES and cancer stage at diagnosis and EAC treatment. Additionally, after controlling for age, gender, urban/rural residence, birth country, health region, aggregated diagnosis groups, cancer stage, treatment, and year of diagnosis, no significant association was found between SES and EAC survival. Moreover, increased mortality risk was observed among those with older age (P = 0.001), advanced-stage of EAC at diagnosis (P P

食管腺癌（esophageal adenocarcinoma, EAC）的发病率在全球范围内持续攀升，目前其发病人数已超越食管鳞状细胞癌。本研究旨在探讨社会经济地位（socioeconomic status, SES）对食管腺癌确诊时分期、治疗接受情况及生存结局的影响。
本研究采用基于人群的回顾性队列研究设计，依托安大略癌症登记处关联的行政健康数据开展。研究运用多项逻辑回归分析，探究社会经济地位（以收入五分位划分）与食管腺癌确诊分期及治疗情况的关联；采用Kaplan-Meier法估算食管腺癌确诊后的生存时间，并通过Cox比例风险回归模型分析社会经济地位与患者生存结局的关联。
2003至2012年间，共计确诊2125例食管腺癌病例。社会经济地位最低组的中位生存期为10.9个月，最高组为11.6个月；5年生存率分别为9.8%与15.0%。与社会经济地位最高组人群相比，最低组人群的食管腺癌治疗接受率无显著差异（91.6% vs 93.3%，P=0.314），死亡率亦无显著差异（78.9% vs 75.6%，P=0.727）。
在控制协变量后，未发现社会经济地位与食管腺癌确诊分期及治疗情况存在显著关联。此外，在调整年龄、性别、城乡居住地、出生国家、健康区域、汇总诊断组、癌症分期、治疗情况及确诊年份后，社会经济地位与食管腺癌患者生存结局仍未呈现显著关联。同时，研究观察到高龄人群（P=0.001）、确诊时为晚期食管腺癌的人群死亡风险升高（P P