gms | German Medical Science

Background: Socio-economic inequalities in cancer survival are well-documented. Patients living in more deprived areas have lower cancer survival rates, coupled with higher cancer stage at diagnosis and higher mortality rates. Jansen et al. showed that socio-economic inequalities in the incidence ratio of various cancers have increased between 2007 and 2018 [1]. Neighbourhoods influence people’s health through health behaviours, access to resources, psychosocial mechanisms, and material deprivation [2]. This means that even in cities with a good healthcare infrastructure, people may have unequal access to it.

For some cancers, population-wide screening programmes have been introduced to increase the chances of early diagnosis. In Germany, the general population is invited for gynaecological and colorectal cancer screenings (for ages 20-65 and 50-65 years, respectively), while they need to be informed by their doctors or inform themselves about other cancer screenings [3]. Previous studies have shown that patients from lower socio-economic backgrounds are often diagnosed later, which may be related to unequal uptake of screening programmes.

The present study investigates the differences in the stage of cancer at diagnosis of cancers with good screening programmes (colorectal carcinoma, melanoma, cervical cancer, breast cancer and prostate cancer) between districts with different socioeconomic structures in Frankfurt.

Methods: Patients included in this study were all treated at the University Hospital of Frankfurt with a primary diagnosis of colorectal cancer (International Classification of Disease (ICD10) C18-20), melanoma (C43), female breast (C50), cervical (C53) and prostate cancer (C61). The primary outcome is the UICC stage at diagnosis (I to IV). Data comes from routinely collected electronic medical records.

For each cancer diagnosis, a multilevel multinomial logistic regression model will be calculated, with patient at level 1 and district at level 2. At the district level, the analysis will control for median district income, unemployment rate and percentage of non-German residents. Data on the socio-economic structure of the district has been provided by the City of Frankfurt. At the individual level, the analysis will control for gender, age, and insurance status (private vs. public).

Results: A total of 3287 participants will be included in the study.

We have not been able to complete the full analysis (results will be updated if abstract is accepted).

Preliminary ordinal logistics regression analysis revealed that men with melanoma are diagnosed later than women (β = -0.44, p = .006). The insurance status did not influence the stage at diagnosis.

On a district level, higher unemployment was related to later diagnosis of colorectal cancer (β = -0.16, p = 0.04) and a higher median income was related to a higher stage at diagnosis for prostate cancer (β = 0.43, p = 0.003).

Discussion: Results will be discussed in the light of current policy and research, and it their potential to inform cancer care and prevention in Frankfurt. As a comprehensive cancer centre, the Frankfurt University Tumour Centre plays a key role in this. By involving local authorities in the design and dissemination of the study, findings can guide city-wide health initiatives.

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.