Does geodemographic segmentation explain differences in route of cancer diagnosis above and beyond person-level sociodemographic variables?


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Chloe Bright, Carolynn Gildea, Jennifer Lai, Lucy Elliss-Brookes, Georgios Lyratzopoulos

Abstract

Background

Emergency diagnosis of cancer is associated with poorer short-term survival and may reflect delayed help-seeking. Optimal targeting of interventions to raise awareness of cancer symptoms is therefore needed.

Method

We examined the risk of emergency presentation (not restricted to A&E admissions) of lung and colorectal cancer (diagnosed in 2016). For each cancer site separately, we used logistic regression (outcome emergency/non-emergency presentation) adjusting for patient-level variables (age, sex, income deprivation, ethnicity) with/without adjustment for Mosaic geodemographic segmentation group (Mosaic groups classify people into groups based on age, deprivation, consumer patterns, wealth, communication preferences, household make-up and lifestyle). Adjusted proportions in emergency presentations were calculated.

Results

36,194 and 32,984 patients with lung and colorectal cancer were included in the analysis. Greater levels of deprivation were strongly associated with greater odds of emergency presentation, even after adjustment for Mosaic group (Odds Ratio most/least deprived group=1.67 adjusted [excluding Mosaic], 1.28 adjusted [including Mosaic], p<0.001 for both, for colorectal; respective OR values of 1.42 and 1.18 for lung, p<0.001 for both). Similar findings were observed for increasing age. There was large variation in risk of emergency presentation between Mosaic groups (crude OR for highest/lowest risk group=2.30, adjusted [including patient-level variables] OR=1.89, for colorectal; respective values of 1.59 and 1.66 for lung). This equates to a large variation between the highest and lowest risk Mosaic group in terms of adjusted proportions in emergency presentations (Colorectal: 11%-point difference, 31% of Transient Renters vs. 20% of Prestige Positions; Lung: 10%-point difference, (39% of Rental Hubs vs. 29% of Senior Security).

Conclusion

Large differences in risk of emergency presentation in cancer patients can be explained by geodemographic segmentation group, above and beyond variation by age, sex, income deprivation and ethnicity.

Impact statement

The findings provide proof of principle for the use of geodemographic segmentation information, in addition to the more frequently used socio-demographic variables. For example, it could be used to help to target public health interventions to reduce inequalities in routes to diagnosis for cancer. 


Acknowledgement: This work includes patient data collated by the National Cancer Registration and Analysis Service (NCRAS).