Analyzing Cancer Survival Rate in the U.S. and Canada by Socioeconomic Status

A paper from the Spring issue of the Journal of Registry Management looks at population-based cancer survival in Canada and the United States by socioeconomic status.

NAACCR colleagues, I would like to share a paper from the Spring issue of the Journal of Registry Management.

The study was a comparative analysis of cancer survival between Canada and the United States using data from the CONCORD-2 study. This was the largest such study and included survival data from 33 NPCR/SEER registries (covering 73% of the U.S. population) and 10 Canadian provincial registries (covering more than 99% of the Canadian population).

I want to thank all NAACCR registries that participated in this study. This work demonstrates the value of comparative analyses. Of critical importance is the fact that all NAACCR member registries collected and reported high-quality data using similar procedures and meeting robust quality standards.

Background

Population-based cancer survival provides insight into the effectiveness of health systems to care for all residents with cancer, including those in marginalized groups.

Methods

Using CONCORD-2 data, we estimated five-year net survival among patients diagnosed 2004–2009 with one of 10 common cancers, and children diagnosed with acute lymphoblastic leukemia (ALL), by socioeconomic status (SES) quintile, age (0–14, 15–64, ≥65 years), and country (Canada or United States).

Results

In the lowest SES quintile, survival was higher among younger Canadian adults diagnosed with liver (23% vs 15%) and cervical (78% vs 68%) cancers and with leukemia (62% vs 56%), including children diagnosed with ALL (92% vs 86%); and higher among older Americans diagnosed with colon (62% vs 56%), female breast (87% vs 80%), and prostate (97% vs 85%) cancers. In the highest SES quintile, survival was higher among younger Americans diagnosed with stomach cancer (33% vs 27%) and younger Canadians diagnosed with liver cancer (31% vs 23%); and higher among older Americans diagnosed with stomach (27% vs 22%) and prostate (99% vs 92%) cancers.

Conclusions

Among younger Canadian cancer patients in the lowest SES group, greater access to health care may have resulted in higher cancer survival, while higher screening prevalence and access to health insurance (Medicare) among older Americans during the period of this study may have resulted in higher survival for some screen-detected cancers. Higher survival in the highest SES group for stomach and liver may relate to treatment differences. Survival differences by age and SES between Canada and the U.S. may help inform cancer control strategies.