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Patient education-level affects treatment allocation and prognosis in esophageal- and gastroesophageal junctional cancer in Sweden

Linder, Gustav; Sandin, Fredrik; Johansson, Jan LU ; Lindblad, Mats; Lundell, Lars and Hedberg, Jakob (2018) In Cancer Epidemiology 52. p.91-98
Abstract

Background Low socioeconomic status and poor education elevate the risk of developing esophageal- and junctional cancer. High education level also increases survival after curative surgery. The present study aimed to investigate associations, if any, between patient education-level and treatment allocation after diagnosis of esophageal- and junctional cancer and its subsequent impact on survival. Methods A nation-wide cohort study was undertaken. Data from a Swedish national quality register for esophageal cancer (NREV) was linked to the National Cancer Register, National Patient Register, Prescribed Drug Register, Cause of Death Register and educational data from Statistics Sweden. The effect of education level (low; ≤9 years,... (More)

Background Low socioeconomic status and poor education elevate the risk of developing esophageal- and junctional cancer. High education level also increases survival after curative surgery. The present study aimed to investigate associations, if any, between patient education-level and treatment allocation after diagnosis of esophageal- and junctional cancer and its subsequent impact on survival. Methods A nation-wide cohort study was undertaken. Data from a Swedish national quality register for esophageal cancer (NREV) was linked to the National Cancer Register, National Patient Register, Prescribed Drug Register, Cause of Death Register and educational data from Statistics Sweden. The effect of education level (low; ≤9 years, intermediate; 10–12 years and high >12 years) on the probability of allocation to curative treatment was analyzed with logistic regression. The Kaplan-Meier-method and Cox proportional hazard models were used to assess the effect of education on survival. Results A total of 4112 patients were included. In a multivariate logistic regression model, high education level was associated with greater probability of allocation to curative treatment (adjusted OR: 1.48, 95% CI: 1.08–2.03, p = 0,014) as was adherence to a multidisciplinary treatment-conference (adjusted OR: 3.13, 95% CI: 2.40–4.08, p < 0,001). High education level was associated with improved survival in the patients allocated to curative treatment (HR: 0.82, 95% CI: 0.69–0.99, p = 0,036). Discussion In this nation-wide cohort of esophageal- and junctional cancer patients, including data regarding many confounders, high education level was associated with greater probability of being offered curative treatment and improved survival.

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author
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Curative treatment, Education level, Esophageal cancer, Inequality in cancer treatment, Multi-disciplinary conference
in
Cancer Epidemiology
volume
52
pages
8 pages
publisher
Elsevier
external identifiers
  • scopus:85039724407
ISSN
1877-7821
DOI
10.1016/j.canep.2017.12.008
language
English
LU publication?
no
id
bd918163-903b-4fc5-bcf7-a9065476b4e3
date added to LUP
2018-01-23 13:58:44
date last changed
2018-05-29 11:38:14
@article{bd918163-903b-4fc5-bcf7-a9065476b4e3,
  abstract     = {<p>Background Low socioeconomic status and poor education elevate the risk of developing esophageal- and junctional cancer. High education level also increases survival after curative surgery. The present study aimed to investigate associations, if any, between patient education-level and treatment allocation after diagnosis of esophageal- and junctional cancer and its subsequent impact on survival. Methods A nation-wide cohort study was undertaken. Data from a Swedish national quality register for esophageal cancer (NREV) was linked to the National Cancer Register, National Patient Register, Prescribed Drug Register, Cause of Death Register and educational data from Statistics Sweden. The effect of education level (low; ≤9 years, intermediate; 10–12 years and high &gt;12 years) on the probability of allocation to curative treatment was analyzed with logistic regression. The Kaplan-Meier-method and Cox proportional hazard models were used to assess the effect of education on survival. Results A total of 4112 patients were included. In a multivariate logistic regression model, high education level was associated with greater probability of allocation to curative treatment (adjusted OR: 1.48, 95% CI: 1.08–2.03, p = 0,014) as was adherence to a multidisciplinary treatment-conference (adjusted OR: 3.13, 95% CI: 2.40–4.08, p &lt; 0,001). High education level was associated with improved survival in the patients allocated to curative treatment (HR: 0.82, 95% CI: 0.69–0.99, p = 0,036). Discussion In this nation-wide cohort of esophageal- and junctional cancer patients, including data regarding many confounders, high education level was associated with greater probability of being offered curative treatment and improved survival.</p>},
  author       = {Linder, Gustav and Sandin, Fredrik and Johansson, Jan and Lindblad, Mats and Lundell, Lars and Hedberg, Jakob},
  issn         = {1877-7821},
  keyword      = {Curative treatment,Education level,Esophageal cancer,Inequality in cancer treatment,Multi-disciplinary conference},
  language     = {eng},
  pages        = {91--98},
  publisher    = {Elsevier},
  series       = {Cancer Epidemiology},
  title        = {Patient education-level affects treatment allocation and prognosis in esophageal- and gastroesophageal junctional cancer in Sweden},
  url          = {http://dx.doi.org/10.1016/j.canep.2017.12.008},
  volume       = {52},
  year         = {2018},
}