Socioeconomic status and site-specific cancer incidence, a Bayesian approach in a French Cancer Registries Network study

Socioeconomic status and site-specific cancer incidence, a Bayesian approach in a French Cancer Registries Network study 18 / 22

Table of Contents




Abstract

Objectives The objective of this study was to identify and compare cancer sites whose incidence is influenced by social deprivation. Methods The study population comprised 189 144 cases of cancer diagnosed between 2006 and 2009, recorded in member registries of the French Network of Cancer Registries. The social environment was assessed at an aggregate level using the European Deprivation Index (EDI). The association between incidence and socioeconomic status was assessed by a geographical Bayesian Poisson model permitting to reduce the overall variability and to smooth the relative risks by sharing information provided by multiple geographic units. Results For cancers of the stomach, liver, lips-mouth-pharynx, and lung, a higher incidence in deprived populations was found for both sexes as well as for cancers of the larynx, esophagus, pancreas, and bladder in males and cervical cancer in females. For melanoma, prostate, testis, ovarian, and breast, a higher incidence in affluent populations was observed. The highest relative risks of the lowest social class compared with the highest social class were found for larynx (RR=1.67 [1.43;1.95]), lips-mouth pharynx (RR=1.89 [1.72;2.07]) and lung (RR=1.59 [1.50;1.68]) in males and for cervix (RR=1.62 [1.40;1.88]) and lips-mouth-pharynx (RR=1.56 [1.30;1.86]) in females. Conclusions By estimating the burden of social deprivation on cancer incidence throughout France, this study enables us to measure the gains that could be obtained by implementing targeted prevention efforts.

 Keywords:  Cancer incidence, Deprivation, Social environment, Site-specific approach, Cancer registries, Bayesian modeling

Introduction

For many years, large health inequalities have been observed in developed countries, even in countries that have egalitarian health systems. These inequalities find their means of expression through various chronic diseases such as cardiovascular disease, respiratory disease, diabetes, cancer, and many others. In France, cancer is the cause of death that best reveals the social inequalities in health (Mackenbach et al., 2008). Continual observation of the relationship between socioeconomic status and cancer mortality is a fundamental tool for public surveillance and the implementation of preventive measures. In France, one of the priorities announced in the Cancer Plan 2014–2019 is to “study the geographical 3 and socioeconomic disparities in incidence and survival of cancer using social deprivation indices” (Plan Cancer 2014-2019).

Concerning social disparities in cancer incidence, some relationships going in both directions are already well known. Cancer sites associated with low social status usually include lung (Eberle et al., 2010; Hystad et al., 2013; Hwang et al., 2013; Boscoe et al., 2014; Sharpe et al., 2014) upper aerodigestive tract (Dalton et al., 2008; Eberle et al., 2010; Boscoe et al., 2014; Sharpe et al., 2014), liver (Boscoe et al., 2014; Sharpe et al., 2014), cervix (Dalton et al., 2008; Benard et al. 2008; Eberle et al., 2010; Boscoe et al., 2014), bladder (Eberle et al., 2010), stomach (Dalton et al., 2008; Boscoe et al., 2014) and esophagus (Dalton et al., 2008; Levi et al., 2013; Boscoe et al., 2014); those associated with high social level include breast (Robert et al., 2004; Dalton et al., 2008; Eberle et al., 2010; Boscoe et al., 2014), prostate (Dalton et al., 2008; Cheng et al., 2009; Eberle et al., 2010; Boscoe et al., 2014) and melanoma (Dalton et al., 2008; Eberle et al., 2010; Hausauer et al., 2011 ; Boscoe et al., 2014).

However, few studies examining the relationship between socioeconomic status and cancer incidence have been conducted in Europe, and existing studies often covering only one specific site. From a public health point of view, it is important to compare the extent of the influence of social deprivation on the incidence of various cancers, to implement those preventive measures that will have the greatest impact on public health. Measuring and comparing the impact of social deprivation on cancer incidence between countries and over time will facilitate the development of more efficient national and supranational policies to tackle social inequalities.

Such comparison requires reliable, accurate, and comparable data on the cancer incidence and socioeconomic environment of the population. Regarding incidence, the increasing international standardization of rules for cancer registration creates valuable data provided by cancer registries, for use now and in the future.

With respect to the socio-economic environment, because individual socioeconomic data are often absent or poorly collected in routine health databases, individual social status is often assessed using socioeconomic characteristics of the place of residence 4 (Krieger et al., 1997).

Townsend demonstrated the relevance of the concept of relative deprivation and the necessity of taking into account both the objective and subjective dimensions of poverty (Townsend, 1987). From a European perspective, the recent European Deprivation Index (EDI), which incorporates such concepts into its construction, permits socioeconomic environment measures to be compared or at least makes them transferable between different European countries, despite socio-cultural differences (Pornet et al., 2012).

Moreover, when patient addresses are available, the EDI is usable at the smallest geographic level for which census data are available. In France, patient addresses have been routinely recorded in cancer registries since 2006, thereby enabling, after geocoding, the examination of the relationship between social environment and cancer incidence and its evolution over time, at a very small geographic scale. The objective of this study was to investigate the link between socioeconomic environment and incidence for the 15 most frequent solid tumors and the three most frequent hematopoietic malignancies in France by using a Bayesian model taking into account the geographic nature of the data.

Results

A total of 189 144 cancer cases were analyzed, with 100 299 men and 78 845 women. These cancers were divided according to the 16 analyzed departments. Tables 2 and 3 present the results of the analysis using the continuous version of the EDI obtained with all available data.

The Potthoff-Whittinghill test was non-significant for the majority of sites in both sexes. Moran test was significant for all sites in both males and females, which confirms a geographical structure in the data and justified modeling. A statistically significant higher incidence among disadvantaged individuals was observed for cancers of the stomach, liver, lips-mouth-pharynx, and lung in both sexes. This significant over-incidence was also found for cancers of the larynx, esophagus, pancreas, and bladder in men and for cervical cancer in women.

A significantly higher incidence in advantaged individuals was observed for melanoma in both sexes. This significant over-incidence was also found for prostate and testicular cancers in men, and ovarian and breast cancers in women. By examining the values of the coefficient estimates associated with the EDI variable, this link between deprivation and incidence was particularly strong for cancers of the larynx, lips-mouth-pharynx, and lung and for melanoma (with a negative sign) in men, and for cancers of the cervix, stomach, liver, lips mouth-pharynx and for melanoma (with a negative sign) in women.

Supplementary Tables S1 and S2 summarize the analysis results for each department in males and females. For the stomach, liver, lips-mouth-pharynx, and lung sites, for which a significant positive association with deprivation was found in the global analysis, the trend was similar in the majority of areas. A similar observation was made for melanoma, prostate, and breast with a negative association. A negative association manner was found for ovary and thyroid for females in a majority of areas but 8 never in a significant manner, with a similar observation made for the central nervous system in males.

Conflicting results, with positive and negative associations depending on the area, were found for colon rectum, pancreas, kidney, bladder, and hematopoietic sites. Tables 4 and 5 present the results of the analysis using the categorical version of the EDI (estimation and 95% credible interval). Figure 1 graphically represents the relative risks of the most disadvantaged group (under the fifth quintile of the EDI) compared with the most favored group (above the first quintile of the EDI).

Relative risk was more than 1.5 for lips-mouth-pharynx, larynx, and lung sites in males, and for cervix and lips-mouth-pharynx in females; the other significant relative risk were found for liver and stomach sites in both sexes. Melanoma exhibited the highest inverse relative risk with deprivation for both sexes, with ovary, breast, and prostate being the other sites inversely associated in a significant way; the testis site was borderline.

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FULL Paper PDF file:

FichieSOCIOECONOMIC STATUS AND SITE-SPECIFIC CANCER INCIDENCE A BAYESIAN APPROACH IN A FRENCH CANCER REGISTRIES NETWORK STUDYr HALEJCP2016

Socioeconomic status and site-specific cancer incidence, a Bayesian approach in a French Cancer Registries Network study

Josephine Bryere, Olivier Dejardin, Ludivine Launay, Marc Colonna, Pascale Grosclaude, Guy Launoy

To cite this version:

Josephine Bryere, Olivier Dejardin, Ludivine Launay, Marc Colonna, Pascale Grosclaude, et al.. Socioeconomic status and site-specific cancer incidence, a Bayesian approach in a French Cancer Registries Network study. European Journal of Cancer Prevention, Lippincott, Williams & Wilkins, 2016, 00, pp.0 – 000. ff10.1097/CEJ.0000000000000326ff. ffhal-02363581f

HAL Id: hal-02363581

https://hal.archives-ouvertes.fr/hal-02363581

Submitted on 4 Dec 2019

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Socioeconomic status and site-specific cancer incidence, a Bayesian approach in a French Cancer Registries Network study

Josephine Bryere, Olivier Dejardin, Ludivine Launay, Marc Colonna, Pascale Grosclaude, Guy Launoy To cite this version: Josephine Bryere, Olivier Dejardin, Ludivine Launay, Marc Colonna, Pascale Grosclaude, et al.. Socioeconomic status and site-specific cancer incidence, a Bayesian approach in a French Cancer Registries Network study. European Journal of Cancer Prevention, Lippincott, Williams & Wilkins, 2016, 00, pp.0 – 000. ff10.1097/CEJ.0000000000000326ff. ffhal-02363581ff 1

SOCIOECONOMIC STATUS AND SITE-SPECIFIC CANCER INCIDENCE A BAYESIAN APPROACH IN A FRENCH CANCER REGISTRIES NETWORK STUDY J

oséphine Bryerea, Olivier Dejardina, Ludivine Launaya, Marc Colonnab,d, Pascale Grosclaudec,d, Guy Launoya,d, and French Network of Cancer registries (FRANCIM). a U1086 INSERM-UCBN, “Cancers & Preventions”, Equipe labellisée Ligue Contre le Cancer, Caen, France b Registre des cancers de l’Isère, CHU, Grenoble, France c Registre des cancers du Tarn, Institut Claudius Regaud, Toulouse, France d Réseau Français des Registres des Cancers, Faculté de médecine, Toulouse, France

Corresponding author: Joséphine Bryere, “Cancers & Préventions” U1086 INSERM-UCBN, Centre François Baclesse, Avenue Général Harris, 14076 Caen, France,

 Tel: +33(0)231458611, Fax: +33(0)231458630

email: josephine.bryere@inserm.fr Running head: Socioeconomic status and cancer incidence Funding: This work was supported by Institut National de la Sante et de la Recherche Médicale, the Basse-Normandie regional government, and the Ligue Nationale Contre le Cancer. Conflict of interest: None declared

Acknowledgments

We thank the staff of each member registry of the FRANCIM network that participated in the collection of data.

Ethics

The study protocol was approved by French ethical committees, the CCTIRS (Comité Consultatif Sur le Traitement de l’Information) and CNIL (Commission Nationale de l’Informatique et des Libertés) (Authorization N°913013).

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Professor Siavosh Kaviani was born in 1961 in Tehran. He had a professorship. He holds a Ph.D. in Software Engineering from the QL University of Software Development Methodology and an honorary Ph.D. from the University of Chelsea.

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Nasim Gazerani was born in 1983 in Arak. She holds a Master's degree in Software Engineering from UM University of Malaysia.

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Maryam kakaei was born in 1984 in Arak. She holds a Master's degree in Software Engineering from Azad University of Arak.