Sociodemographic Factors and Stage of Cancer at Diagnosis: A Population-Based Study in South India
PURPOSE: Lower socioeconomic status is associated with inferior cancer survival in high-income countries, but whether this applies to low- and middle-income countries is not well described. Here, we use a population-based cancer registry to explore the association between educational level and stage...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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American Society of Clinical Oncology
2019-07-01
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| Series: | Journal of Global Oncology |
| Online Access: | http://ascopubs.org/doi/10.1200/JGO.18.00160 |
| _version_ | 1818412059955560448 |
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| author | Aleyamma Mathew Preethi Sara George Kunnambath Ramadas Beela Sarah Mathew Aswin Kumar Sivasevan Roshni Krishnan Nair Lalithamma Jayakumar Christopher M. Booth |
| author_facet | Aleyamma Mathew Preethi Sara George Kunnambath Ramadas Beela Sarah Mathew Aswin Kumar Sivasevan Roshni Krishnan Nair Lalithamma Jayakumar Christopher M. Booth |
| author_sort | Aleyamma Mathew |
| collection | DOAJ |
| description | PURPOSE: Lower socioeconomic status is associated with inferior cancer survival in high-income countries, but whether this applies to low- and middle-income countries is not well described. Here, we use a population-based cancer registry to explore the association between educational level and stage of cancer at diagnosis in South India. METHODS: We used the Trivandrum District population-based cancer registry to identify all cases of breast and cervical cancer (women) and oral cavity (OC) and lung cancer (men) who were diagnosed from 2012 to 2014. Educational status—classified as illiterate/primary school, middle school, or secondary school or higher—was the primary exposure of interest. Primary outcome was the proportion of patients with advanced stage disease at diagnosis defined as stage III and IV (breast, cervix, or OC) or regional/metastatic (lung). RESULTS: The study population included 4,547 patients with breast (n = 2,283), cervix (n = 481), OC (n = 797), and lung (n = 986) cancer. Educational status was 22%, 19%, and 26% for illiterate/primary, middle, and secondary school or higher, respectively. Educational status was missing for 33% of patients. The proportion of all patients with advanced stage disease was 37% (breast), 39% (cervix), 67% (OC), and 88% (lung). Patients with illiterate/primary school educational status were considerably more likely to have advanced breast cancer (50% v 39% v 36%; P < .001), cervix cancer (46% v 43% v 24%; P = .002), and OC cancer (77% v 76% v 59%; P < .001) compared with patients with higher educational levels. The proportion of patients with advanced lung cancer did not vary across educational levels (89% v 84% v 88%; P = .350). CONCLUSION: A substantial proportion of patients in South India have advanced cancer at the time of diagnosis. This is particularly true among those with the lowest levels of education. Future health awareness and preventive interventions must target less-educated communities to reduce delays in seeking medical care for cancer. |
| first_indexed | 2024-12-14T10:41:18Z |
| format | Article |
| id | doaj.art-faf6f0baf2b340839c2392347d101570 |
| institution | Directory Open Access Journal |
| issn | 2378-9506 |
| language | English |
| last_indexed | 2024-12-14T10:41:18Z |
| publishDate | 2019-07-01 |
| publisher | American Society of Clinical Oncology |
| record_format | Article |
| series | Journal of Global Oncology |
| spelling | doaj.art-faf6f0baf2b340839c2392347d1015702022-12-21T23:05:41ZengAmerican Society of Clinical OncologyJournal of Global Oncology2378-95062019-07-01511010.1200/JGO.18.001601Sociodemographic Factors and Stage of Cancer at Diagnosis: A Population-Based Study in South IndiaAleyamma Mathew0Preethi Sara George1Kunnambath Ramadas2Beela Sarah Mathew3Aswin Kumar4Sivasevan Roshni5Krishnan Nair Lalithamma Jayakumar6Christopher M. Booth7Regional Cancer Centre, Trivandrum, IndiaRegional Cancer Centre, Trivandrum, IndiaRegional Cancer Centre, Trivandrum, IndiaRegional Cancer Centre, Trivandrum, IndiaRegional Cancer Centre, Trivandrum, IndiaRegional Cancer Centre, Trivandrum, IndiaMedical College, Trivandrum, IndiaQueen’s University, Kingston, Ontario, CanadaPURPOSE: Lower socioeconomic status is associated with inferior cancer survival in high-income countries, but whether this applies to low- and middle-income countries is not well described. Here, we use a population-based cancer registry to explore the association between educational level and stage of cancer at diagnosis in South India. METHODS: We used the Trivandrum District population-based cancer registry to identify all cases of breast and cervical cancer (women) and oral cavity (OC) and lung cancer (men) who were diagnosed from 2012 to 2014. Educational status—classified as illiterate/primary school, middle school, or secondary school or higher—was the primary exposure of interest. Primary outcome was the proportion of patients with advanced stage disease at diagnosis defined as stage III and IV (breast, cervix, or OC) or regional/metastatic (lung). RESULTS: The study population included 4,547 patients with breast (n = 2,283), cervix (n = 481), OC (n = 797), and lung (n = 986) cancer. Educational status was 22%, 19%, and 26% for illiterate/primary, middle, and secondary school or higher, respectively. Educational status was missing for 33% of patients. The proportion of all patients with advanced stage disease was 37% (breast), 39% (cervix), 67% (OC), and 88% (lung). Patients with illiterate/primary school educational status were considerably more likely to have advanced breast cancer (50% v 39% v 36%; P < .001), cervix cancer (46% v 43% v 24%; P = .002), and OC cancer (77% v 76% v 59%; P < .001) compared with patients with higher educational levels. The proportion of patients with advanced lung cancer did not vary across educational levels (89% v 84% v 88%; P = .350). CONCLUSION: A substantial proportion of patients in South India have advanced cancer at the time of diagnosis. This is particularly true among those with the lowest levels of education. Future health awareness and preventive interventions must target less-educated communities to reduce delays in seeking medical care for cancer.http://ascopubs.org/doi/10.1200/JGO.18.00160 |
| spellingShingle | Aleyamma Mathew Preethi Sara George Kunnambath Ramadas Beela Sarah Mathew Aswin Kumar Sivasevan Roshni Krishnan Nair Lalithamma Jayakumar Christopher M. Booth Sociodemographic Factors and Stage of Cancer at Diagnosis: A Population-Based Study in South India Journal of Global Oncology |
| title | Sociodemographic Factors and Stage of Cancer at Diagnosis: A Population-Based Study in South India |
| title_full | Sociodemographic Factors and Stage of Cancer at Diagnosis: A Population-Based Study in South India |
| title_fullStr | Sociodemographic Factors and Stage of Cancer at Diagnosis: A Population-Based Study in South India |
| title_full_unstemmed | Sociodemographic Factors and Stage of Cancer at Diagnosis: A Population-Based Study in South India |
| title_short | Sociodemographic Factors and Stage of Cancer at Diagnosis: A Population-Based Study in South India |
| title_sort | sociodemographic factors and stage of cancer at diagnosis a population based study in south india |
| url | http://ascopubs.org/doi/10.1200/JGO.18.00160 |
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