CN32 - Socioeconomic status and cancer: An umbrella review and burden estimation study

Background

Socioeconomic status (SES) is a significant social determinant of health disparities, especially in cancer. Our study aims to assess the association between SES and cancer-related outcomes and the disease burden of cancer.

Methods

A comprehensive search of the PubMed, EMBASE, and Cochrane Library databases was conducted, from inception to 14/01/2024. Meta-analysis evaluating the association between SES and any cancer-related outcomes were included. All results were re-analysed and methodological and evidence quality assessed by AMSTAR2 and GRADE. The study was pre-registered with PROSPERO, CRD42023484344.

Results

34 meta-analysis and 157 unique outcomes were included from the 8,601 retrieved articles. Through GRADE and evidence classification criteria, one outcome was classified as “High” and 13 as “Moderate”, and 10 outcomes were classified as “Class I” and 16 as “Class II”. High quality evidence suggests the lowest versus highest SES was associated with reduced accessibility of immunotherapy (Class I). Moderate quality evidence suggests the lowest versus highest SES was associated with reduced accessibility of KRAS testing for colorectal cancer (Class III) and targeted therapy for cancer (Class III). Low quality evidence suggests the lower SES is associated with reduced accessibility of precision treatment for melanoma (Class I), reduced overall survival for leukaemia (Class I) and breast cancer screening rates (Class II) and increased incidence of lung (Class I). In addition, higher Human Development Index countries exhibiting significantly higher cancer incidence-associated disease burden. From 2010 to 2019, the disability adjusted life years (DALYs) associated with cancer incidence increased by 7,022.32 years per 100,000 people (a 37.91% increase) in higher SES countries, which was more pronounced in males than in females.

Conclusions

SES is a significant factor influencing cancer incidence, prognosis, access to treatment, and the burden of disease. There is an urgent need to enhance equity in cancer treatment globally, especially in low- and middle-income countries with limited resources. Therefore, public health initiatives and policy development should consider these socioeconomic factors, in order to achieve more equitable outcomes.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.