Socio-economic patterning in early mortality of patients aged 0-49 years diagnosed with primary bone cancer in Great Britain, 1985-2008


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Richard McNally1,Karen Blakey1,Richard Feltbower2,Peter James1,Gillian Libby1,Charles Stiller3,Paul Norman4,Craig Gerrand5
1Institute of Health & Society, Newcastle University,2Division of Epidemiology and Biostatistics, School of Medicine,,3National Cancer Registration and Analysis Service, Public Health England,4School of Geography, University of Leeds,5Newcastle upon Tyne Hospitals NHS Foundation Trust

Abstract

Background

Studies have shown marked improvements in survival between 1981 and 2000 for Ewing sarcoma patients but no improvement for osteosarcoma patients. The aim of this study was to explore socio-economic patterning in early mortality rates for osteosarcoma and Ewing sarcoma.

Method

The study population contained all osteosarcoma and Ewing sarcoma cases, aged 0-49 years, diagnosed in Great Britain 1985-2008 and followed to 31/12/2009. Logistic regression models were used to calculate the risk of dying within three months, six months, one year, three years and five years after diagnosis. Associations with the Townsend deprivation score and its components (unemployment, non-car ownership, non-home ownership and household overcrowding) were examined at small-area level. Urban/rural status was studied at larger regional levels of aggregation.

Results

The study analysed 2432 osteosarcoma and 1619 Ewing sarcoma cases. For osteosarcoma, after adjustment for age, mortality at three months, six months and one year was associated with higher area unemployment, OR=1.05 (95% CI 1.00, 1.10), OR=1.04 (95% CI 1.01, 1.08) and OR=1.04 (95% CI 1.02, 1.06) respectively per 1% increase in unemployment. In addition, mortality at six months was associated with greater household non-car ownership, OR=1.02 (95% CI 1.00, 1.03) though neither unemployment nor car ownership remained statistically significant when both were included in the same model. For Ewing sarcoma, there was no significant associations between mortality and overall Townsend score, nor with any of its four components for any time period after diagnosis. For both osteosarcoma and Ewing sarcoma increasing mortality was associated with less urban and more remote rural areas. 

Conclusion

This study found that for osteosarcoma, early mortality was associated with residence at diagnosis in areas of higher unemployment, suggesting risk of early death may be socio-economically determined. For both osteosarcoma and Ewing sarcoma, distance from urban centres may lead to greater risk of early death.