What factors influence socioeconomic inequalities in colorectal cancer survival?

Colorectal cancer treatment and survival is improving, but deprived patients continue to receive less than optimal treatment and have lower survival than affluent patients. Population-based data on all patients diagnosed with colorectal cancer in the North West (n=29,563) was linked to hospital admissions (n=6 million) to provide complete information on cancer diagnosis, treatment and other comorbid conditions. In order to handle incomplete data, particularly for stage at diagnosis, multiple imputation was used. Socioeconomic inequalities in survival have been attributed to deprived patients presenting at a more advanced stage or with more comorbid conditions than affluent. In this research there were no socioeconomic variations in stage at diagnosis but deprived patients did have higher levels of comorbidity, which may limit their treatment options. Even after taking clinical and demographic factors into account, deprived patients still received less adjuvant therapy, surgery from high-volume surgeons and treatment in compliance with clinical guidance Socioeconomic inequalities in survival were substantial at one year after diagnosis and could not be explained by clinical or demographic factors, such as stage and comorbidity. Even when deprived patients did receive the same treatment regime or surgery from a higher-volume hospital or higher-volume surgeon survival was lower. The factors contributing to these inequalities in treatment are complex including physical, social, lifestyle and clinical domains. Ensuring equal access to services and equal improvement in survival across all social groups will be a continuing challenge for the NHS. Ultimately, a universal health-care system may not be able to achieve equal survival, because of external factors that cannot be controlled, but ensuring equitable access would be expected to greatly reduce the inequalities in colorectal cancer survival.