Impact of socio-economic position on cancer stage at presentation: Findings from a large hospital-based study in Germany

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We explored the relationship between socio-economic characteristics and cancer stage at presentation. Patients admitted to a university hospital for diagnosis and treatment of cancer provided data on their education, vocational training, income, employment, job, health insurance and postcode. Tumor stage was classified according to the Union International Contre le Cancer (UICC). To analyze disparities in the likelihood of late-stage (UICC III/IV vs. I/II) diagnoses, logistic regression models adjusting for age and gender were used. Out of 1,012 patients, 572 (59%) had late-stage cancer. Separately tested, increased odds of advanced disease were associated with post-compulsory education compared to college degrees, with apprenticeship and no vocational training, with unemployment, disability pension, jobs with a low hierarchy level, blue collar jobs and with low income. Health insurance and community size were not related with late-stage cancer. Jointly modelled, there was evidence for an independent effect of unemployment (odds ratio (OR) 1.7, CI 1.0–2.8), disability pension (OR 1.8, CI 1.0–3.2) and very low income (OR 2.6, CI 1.1–6.1) on the likelihood of advanced disease stage. It is of great concern that these socio-economic gradients occur even in systems with equal access to health care.What's new?Low-income cancer patients tend to die earlier than more affluent patients. But why is this so? Large cancer registries haven't provided an answer. In this German study, the authors analyzed individual patient data rather than the aggregated datasets of registries. The study found that, even with equal access to health care, low-income and unemployed patients were more likely to present with late-stage cancer at diagnosis. It is important to determine the reasons for this effect, as prognosis is considerably improved with early treatment.

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