Socioeconomic Inequalities in Cancer Survival in New Zealand: The Role of Extent of Disease at Diagnosis

We examined socioeconomic inequalities in cancer survival in New Zealand among 132,006 people ages 15 to 99 years who had a cancer registered (1994-2003) and were followed up to 2004. Relative survival rates (RSR) were calculated using deprivation-specific life tables. A census-based measure of socioeconomic posi-tion (New Zealand deprivation based on the 1996 cen-sus) based on residence at the time of cancer registration was used. All RSRs were age-standardized, and further standardization was used to investigate the effect of extent of disease at diagnosis on survival. Weighted lin-ear regression was used to estimate the deprivation gap (slope index of inequality) between the most and least deprived cases. Socioeconomic inequalities in cancer survival were evident for all of the major cancer sites, with the deprivation gap being particularly high for prostate (0.15), kidney and uterus (both0.14), bladder (0.12), colorectum (0.10), and brain (+0.10). Account-ing for extent of disease explained some of the inequal-ities in survival from breast and colorectal cancer and melanoma and all of the deprivation gaps in survival of cervical cancer; however, it did not affect RSRs for can-cers of the kidney, uterus, and brain. No substantial dif-ferences between the total compared with the non-Māori population were found, indicating that the findings were not due to confounding by ethnicity. In summary, socioeconomic disparities in survival were consistent for nearly all cancer sites, persisted in ethnic-specific anal-yses, and were only partially explained by differential extent of disease at diagnosis. Further investigation of reasons for persisting inequalities is required. (Cancer Epidemiol Biomarkers Prev 2009;18(3):915–21