Educational inequalities and regional variation in colorectal cancer survival in Finland

Isabelle Finke; Karri Seppä; Nea Malila; Lina Jansen; Hermann Brenner; Janne Pitkäniemi

doi:10.1016/j.canep.2020.101858

Educational inequalities and regional variation in colorectal cancer survival in Finland

Isabelle Finke
, Karri Seppä^*
, Nea Malila
, Lina Jansen
, Hermann Brenner
, Janne Pitkäniemi

^*Corresponding author for this work

Health Sciences

Research output: Contribution to journal › Article › Scientific › peer-review

7 Citations (Scopus)

Abstract

Background: Previous studies have reported lower colorectal cancer (CRC) survival in patients with low compared to high educational levels. We investigated the impact of education on CRC survival by using both individual and area-based information on education. Methods: Patients diagnosed with CRC in Finland in 2007–2016 were followed up for death until the end of 2016. Age-standardized relative survival and relative excess risk of death (RER) were estimated by sex using period approach. RERs were adjusted for age, stage at diagnosis, cancer site, urbanity, hospital district and municipality by using Bayesian piecewise constant excess hazard models. Analyses were conducted including individual (basic, secondary, high) and area-based (quartiles Q1-Q4 based on the proportion of population with basic education) education separately as well as both measures in one model. Results: We analysed in all 24 462 CRC patients. There was a clear gradient in 5-year relative survival across education groups (men: basic 62 %, secondary 64 %, high 69 %; women: basic 61 %, secondary 67 %, high 71 %). Compared to the basic education group, RER in the high education group was significantly lower. This association was still present after including area-based education in the models (men: RER 0.72, 95 % Confidence interval (CI) 0.64−0.81; women: RER 0.76, 95 % CI 0.59−0.96). Area-based education revealed smaller effect estimates than individual education in CRC survival and no association for men. Conclusion: Individual education information should be preferred over area-based when survival differences are studied by education. Educational differences in CRC survival are still present in Finland.

Original language	English
Article number	101858
Journal	Cancer Epidemiology
Volume	70
Early online date	24 Oct 2020
DOIs	https://doi.org/10.1016/j.canep.2020.101858
Publication status	Published - Feb 2021
Publication type	A1 Journal article-refereed

Funding

In Finland, municipalities are self-governing units, have the right to levy taxes and are responsible for providing the basic services for their residents. Most of the municipalities are small (median 6000 residents), but there are eight large municipalities with between 110,000 and 280,000 residents and the capital municipality Helsinki with a population of 630,000. The Finnish health system is highly decentralized as municipalities were obliged to organize primary care through municipal health centres since the Primary Health Care Act of 1972 [ 26 , 27 ]. Specialist care is provided by 21 hospital districts funded by their member municipalities [ 27 ]. Each hospital district comprises one or several hospitals, including one central hospital. Five of these central hospitals are university hospitals. Residents of a given municipality needing hospital treatment are primarily treated in their own central hospital. In addition, the Ministry of Social Affairs and Health regulates the centralization of certain treatments such as demanding surgical treatments [ 27 ]. In the treatment of colorectal cancer, rectal cancer surgery was mainly centralized to the five university hospitals in 2017 (Government Decree 582/2017) [ 26 ]. This work was supported by the German Cancer Aid [grant number 70112090 ].

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being
SDG 4 Quality Education

Keywords

Area-based
Cancer registry
INLA
Population-based
Relative survival
Socioeconomic status

Publication forum classification

Publication forum level 1

ASJC Scopus subject areas

Epidemiology
Oncology
Cancer Research

Access to Document

10.1016/j.canep.2020.101858

Cite this

@article{ec30c9ea34b74d0083c078164b487b94,

title = "Educational inequalities and regional variation in colorectal cancer survival in Finland",

abstract = "Background: Previous studies have reported lower colorectal cancer (CRC) survival in patients with low compared to high educational levels. We investigated the impact of education on CRC survival by using both individual and area-based information on education. Methods: Patients diagnosed with CRC in Finland in 2007{\textendash}2016 were followed up for death until the end of 2016. Age-standardized relative survival and relative excess risk of death (RER) were estimated by sex using period approach. RERs were adjusted for age, stage at diagnosis, cancer site, urbanity, hospital district and municipality by using Bayesian piecewise constant excess hazard models. Analyses were conducted including individual (basic, secondary, high) and area-based (quartiles Q1-Q4 based on the proportion of population with basic education) education separately as well as both measures in one model. Results: We analysed in all 24 462 CRC patients. There was a clear gradient in 5-year relative survival across education groups (men: basic 62 \%, secondary 64 \%, high 69 \%; women: basic 61 \%, secondary 67 \%, high 71 \%). Compared to the basic education group, RER in the high education group was significantly lower. This association was still present after including area-based education in the models (men: RER 0.72, 95 \% Confidence interval (CI) 0.64−0.81; women: RER 0.76, 95 \% CI 0.59−0.96). Area-based education revealed smaller effect estimates than individual education in CRC survival and no association for men. Conclusion: Individual education information should be preferred over area-based when survival differences are studied by education. Educational differences in CRC survival are still present in Finland.",

keywords = "Area-based, Cancer registry, INLA, Population-based, Relative survival, Socioeconomic status",

author = "Isabelle Finke and Karri Sepp{\"a} and Nea Malila and Lina Jansen and Hermann Brenner and Janne Pitk{\"a}niemi",

note = "Funding Information: In Finland, municipalities are self-governing units, have the right to levy taxes and are responsible for providing the basic services for their residents. Most of the municipalities are small (median 6000 residents), but there are eight large municipalities with between 110,000 and 280,000 residents and the capital municipality Helsinki with a population of 630,000. The Finnish health system is highly decentralized as municipalities were obliged to organize primary care through municipal health centres since the Primary Health Care Act of 1972 [ 26 , 27 ]. Specialist care is provided by 21 hospital districts funded by their member municipalities [ 27 ]. Each hospital district comprises one or several hospitals, including one central hospital. Five of these central hospitals are university hospitals. Residents of a given municipality needing hospital treatment are primarily treated in their own central hospital. In addition, the Ministry of Social Affairs and Health regulates the centralization of certain treatments such as demanding surgical treatments [ 27 ]. In the treatment of colorectal cancer, rectal cancer surgery was mainly centralized to the five university hospitals in 2017 (Government Decree 582/2017) [ 26 ]. Funding Information: This work was supported by the German Cancer Aid [grant number 70112090 ]. Publisher Copyright: {\textcopyright} 2020 Elsevier Ltd Copyright: Copyright 2020 Elsevier B.V., All rights reserved.",

year = "2021",

month = feb,

doi = "10.1016/j.canep.2020.101858",

language = "English",

volume = "70",

journal = "Cancer Epidemiology",

issn = "1877-7821",

publisher = "Elsevier",

}

TY - JOUR

T1 - Educational inequalities and regional variation in colorectal cancer survival in Finland

AU - Finke, Isabelle

AU - Seppä, Karri

AU - Malila, Nea

AU - Jansen, Lina

AU - Brenner, Hermann

AU - Pitkäniemi, Janne

N1 - Funding Information: In Finland, municipalities are self-governing units, have the right to levy taxes and are responsible for providing the basic services for their residents. Most of the municipalities are small (median 6000 residents), but there are eight large municipalities with between 110,000 and 280,000 residents and the capital municipality Helsinki with a population of 630,000. The Finnish health system is highly decentralized as municipalities were obliged to organize primary care through municipal health centres since the Primary Health Care Act of 1972 [ 26 , 27 ]. Specialist care is provided by 21 hospital districts funded by their member municipalities [ 27 ]. Each hospital district comprises one or several hospitals, including one central hospital. Five of these central hospitals are university hospitals. Residents of a given municipality needing hospital treatment are primarily treated in their own central hospital. In addition, the Ministry of Social Affairs and Health regulates the centralization of certain treatments such as demanding surgical treatments [ 27 ]. In the treatment of colorectal cancer, rectal cancer surgery was mainly centralized to the five university hospitals in 2017 (Government Decree 582/2017) [ 26 ]. Funding Information: This work was supported by the German Cancer Aid [grant number 70112090 ]. Publisher Copyright: © 2020 Elsevier Ltd Copyright: Copyright 2020 Elsevier B.V., All rights reserved.

PY - 2021/2

Y1 - 2021/2

N2 - Background: Previous studies have reported lower colorectal cancer (CRC) survival in patients with low compared to high educational levels. We investigated the impact of education on CRC survival by using both individual and area-based information on education. Methods: Patients diagnosed with CRC in Finland in 2007–2016 were followed up for death until the end of 2016. Age-standardized relative survival and relative excess risk of death (RER) were estimated by sex using period approach. RERs were adjusted for age, stage at diagnosis, cancer site, urbanity, hospital district and municipality by using Bayesian piecewise constant excess hazard models. Analyses were conducted including individual (basic, secondary, high) and area-based (quartiles Q1-Q4 based on the proportion of population with basic education) education separately as well as both measures in one model. Results: We analysed in all 24 462 CRC patients. There was a clear gradient in 5-year relative survival across education groups (men: basic 62 %, secondary 64 %, high 69 %; women: basic 61 %, secondary 67 %, high 71 %). Compared to the basic education group, RER in the high education group was significantly lower. This association was still present after including area-based education in the models (men: RER 0.72, 95 % Confidence interval (CI) 0.64−0.81; women: RER 0.76, 95 % CI 0.59−0.96). Area-based education revealed smaller effect estimates than individual education in CRC survival and no association for men. Conclusion: Individual education information should be preferred over area-based when survival differences are studied by education. Educational differences in CRC survival are still present in Finland.

AB - Background: Previous studies have reported lower colorectal cancer (CRC) survival in patients with low compared to high educational levels. We investigated the impact of education on CRC survival by using both individual and area-based information on education. Methods: Patients diagnosed with CRC in Finland in 2007–2016 were followed up for death until the end of 2016. Age-standardized relative survival and relative excess risk of death (RER) were estimated by sex using period approach. RERs were adjusted for age, stage at diagnosis, cancer site, urbanity, hospital district and municipality by using Bayesian piecewise constant excess hazard models. Analyses were conducted including individual (basic, secondary, high) and area-based (quartiles Q1-Q4 based on the proportion of population with basic education) education separately as well as both measures in one model. Results: We analysed in all 24 462 CRC patients. There was a clear gradient in 5-year relative survival across education groups (men: basic 62 %, secondary 64 %, high 69 %; women: basic 61 %, secondary 67 %, high 71 %). Compared to the basic education group, RER in the high education group was significantly lower. This association was still present after including area-based education in the models (men: RER 0.72, 95 % Confidence interval (CI) 0.64−0.81; women: RER 0.76, 95 % CI 0.59−0.96). Area-based education revealed smaller effect estimates than individual education in CRC survival and no association for men. Conclusion: Individual education information should be preferred over area-based when survival differences are studied by education. Educational differences in CRC survival are still present in Finland.

KW - Area-based

KW - Cancer registry

KW - INLA

KW - Population-based

KW - Relative survival

KW - Socioeconomic status

U2 - 10.1016/j.canep.2020.101858

DO - 10.1016/j.canep.2020.101858

M3 - Article

C2 - 33246249

AN - SCOPUS:85096575576

SN - 1877-7821

VL - 70

JO - Cancer Epidemiology

JF - Cancer Epidemiology

M1 - 101858

ER -

Educational inequalities and regional variation in colorectal cancer survival in Finland

Abstract

Funding

UN SDGs

Keywords

Publication forum classification

ASJC Scopus subject areas

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