Social Determinants of Health and 5-year Survival of Colorectal Cancer


Background: Early in the 21st century, cancers are the second cause of death worldwide. Colon cancer isthird most common cancer and one of the few amenable to early diagnosis and treatment. Evaluation of factorsaffecting this cancer is important to increase survival time. Some of these factors affecting all diseases includingcancer are social determinants of health. According to the importance of this disease and relation with thesefactors, this study was conducted to assess the relationship between social determinants of health and coloncancer survival. Materials and
Methods: This was a cross-sectional, descriptive study for patients with coloncancer registered in the Cancer Research Center of Shahid Beheshti University of Medical Science, from April2005 to November 2006, performed using questionnaires filled by telephone interview with patients (if patientshad died, with family members). Data was analyzed with SPSS software (version 19) for descriptive analysis andSTATA software for survival analysis including log rank test and three step Cox Proportional Hazard regression.
Results: Five hundred fifty nine patients with ages ranging from 23 to 88 years with mean± standard deviationof 63±11.8 years were included in the study. The five year survival was 68.3%( 387 patients were alive and 172patients were dead by the end of the study). The Cox proportional hazard regression showed 5-year survivalwas related to age (HR=0.53, p=0.042 for>50 years versus<50 years old) in first step, gender (HR=0.60, p=0.006for female versus male) in second step, job (HR=1.7, p=0.001 for manual versus non manual jobs), region ofresidency (HR=3.49, p=0.018 for west versus south regions), parents in childhood (HR=2.87, p=0.012 for havingboth parents versus not having), anatomical cancer location (HR=2.16, p<0.033 for colon versus rectal cancer)and complete treatment (HR=5.96, p<0.001 for incomplete versus complete treatment).
Conclusions: Socialdeterminants of health such as job, city region residency and having parents during childhood have significanteffects in 5-year survival of colon cancer and it may be better to consider these factors in addition to developingcancer treatment and to focus on these determinants of health in long-time planning.