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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Karen Blakey1, Richard Feltbower2, Roger Parslow2, Peter James1, Charles Stiller3, Paul Norman4, Craig Gerrand5, Richard McNally1
1Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK, 2Paediatric Epidemiology Group, University of Leeds, Leeds, UK, 3Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, UK, 4School of Geography, University of Leeds, Leeds, UK, 5(NICR) Northern Institute for Cancer Research

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. 

Background

The study aim was to explore socio-economic patterning in early mortality rates for osteosarcoma and Ewing sarcoma. Early mortality was considered as a proxy for delayed diagnosis.

Method

All cases of osteosarcoma and Ewing sarcoma aged 0-49 years, diagnosed in Great Britain during 1985-2008 were included. Case data were provided through regional cancer registries. Logistic regression models analyzed the odds of early mortality at fixed periods (3, 6 and 12 months). Associations with a time series of Townsend deprivation score and its components (percentage of households over-crowded, non-car ownership, non-home ownership, or residents unemployed) were examined at small-area level (census ward for England and Wales, postcode sector for Scotland). Odds ratios (ORs) and 95% confidence intervals (CIs) are presented. Statistical significance was taken to be P < 0.05.

Results

The study analyzed 2432 osteosarcoma cases aged 0-49 years (786, 1203 and 443 aged 0-14, 15-29 and 30-49 years respectively) and 1619 Ewing sarcoma cases (646, 769 and 204 aged 0-14, 15-29 and 30-49 years respectively).

For osteosarcoma, after adjustment for age, mortality at 3, 6 and 12 months was not significantly linked with Townsend deprivation (P=0.253, 0.252 & 0.148 respectively). However it was significantly greater in areas of higher unemployment (OR= 1.06, (CI 1.02, 1.11; P=0.018); OR = 1.04 (CI 1.01, 1.08; P=0.020), OR = 1.04 (CI 1.02, 1.06; P=0.001) per 1% increase in unemployment respectively). For Ewing sarcoma there were no significant associations between mortality and Townsend deprivation score at 3, 6 and 12 months after diagnosis (P=0.996, 0.134 & 0.200 respectively), nor with any of its four components.

Conclusion

This study has revealed an important finding. For osteosarcoma, early mortality was associated with residence in areas of higher unemployment. This finding suggests that delays in diagnosis of osteosarcoma may be socio-economically determined.