Document Type

Article

Publication Date

1997

Publication Title

American Journal of Public Health

Volume

87

Issue

7

First Page

1156

Last Page

1163

DOI

http://dx.doi.org/10.2105/AJPH.87.7.1156

Keywords

Health Services Accessibility, Humans, Michigan/epidemiology, Neoplasms/mortality, Neoplasms/prevention & control, Ontario/epidemiology, Registries, SEER Program, Social Class, Survival Analysis, Survivors, Urban Population

Abstract

OBJECTIVES: This study examined whether socioeconomic status has a differential effect on the survival of adults diagnosed with cancer in Canada and the United States.

METHODS: The Ontario Cancer Registry and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program provided a total of 58,202 and 76,055 population-based primary malignant cancer cases for Toronto, Ontario, and Detroit, Mich, respectively. Socioeconomic data for each person's residence at time of diagnosis were taken from population censuses.

RESULTS: In the US cohort, there was a significant association between socioeconomic status and survival for 12 of the 15 most common cancer sites; in the Canadian cohort, there was no such association for 12 of the 15 sites. Among residents of low-income areas, persons in Toronto experienced a survival advantage for 13 of 15 cancer sites at 1- and 5-year follow-up. No such between-country differentials were observed in the middle- or high-income groups.

CONCLUSIONS: The consistent pattern of a survival advantage in Canada observed across various cancer sites and follow-up periods suggests that Canada's more equitable access to preventive and therapeutic health care services is responsible for the difference.

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