Socio-economic patterning in early mortality of patients aged 0–49 years diagnosed with primary bone cancer in Great Britain, 1985–2008
Menée en Grande-Bretagne à partir de données portant sur 2 432 patients atteints d'un ostéosarcome et sur 1 619 patients atteints d'un sarcome d'Ewing diagnostiqué entre 1985 et 2008 avant l'âge de 50 ans, cette étude analyse l'association entre des indicateurs socioéconomiques (lieu de résidence, zone rurale/urbaine, foyer possédant une voiture, taux de chômage dans la zone géographique du lieu de résidence, etc.) et la mortalité prématurée (3, 6, 12 mois et 3 et 5 ans après le diagnostic)
Background : Studies have shown marked improvements in survival between 1981 and 2000 for Ewing sarcoma patients but not for osteosarcoma. This study aimed to explore socio-economic patterning in early mortality rates for both tumours. Procedure : The study analysed all 2432 osteosarcoma and 1619 Ewing sarcoma cases, aged 0–49 years, diagnosed in Great Britain 1985–2008 and followed to 31/12/2009. Logistic regression models were used to calculate risk of dying within three months, six months, one year, three years and five years after diagnosis. Associations with Townsend deprivation score and its components were examined at small-area level. Urban/rural status was studied at larger regional level. Results : For osteosarcoma, after age adjustment, mortality at three months, six months and one year was associated with higher area unemployment, OR = 1.05 (95% CI 1.00, 1.10), OR = 1.04 (95% CI 1.01, 1.08) and OR = 1.04 (95% CI 1.02, 1.06) respectively per 1% increase in unemployment. Mortality at six months was associated with greater household non-car ownership, OR = 1.02 (95% CI 1.00, 1.03). For Ewing sarcoma, there were no significant associations between mortality and overall Townsend score, nor its components for any time period. For both tumours increasing mortality was associated with less urban and more remote rural areas. Conclusions : This study found that for osteosarcoma, early mortality was associated with residence at diagnosis in areas of higher unemployment, suggesting risk of early death may be socio-economically determined. For both tumours, distance from urban centres may lead to greater risk of early death.
Cancer Epidemiology 2018