Deprivation Indices and Gastro-Oesophageal Cancers in Westmidlands (England) over 15 Years – A Study

Background: For most major cancers there is good evidence that patients from affluent neighbourhoods survive better than deprived patients. We decided to look at the incidence, mortality and survival trends of gastro-oesophageal cancers in West Midlands, England from 1984 to 1999 and analyse the results in terms of socio-economic deprivation.

Methods: Data was collected from West Midlands cancer registry and geographical information system. The Townsend Score was employed as a measure of deprivation including 4 proxy indicators of socioeconomic status collapsed into quintiles. Individual cases were allocated to one of 5 deprivation categories using the postcode at diagnosis. Relative survival rates were calculated using actuarial life tables. Trend analysis at 1 and 5 years was calculated and p value derived from t-test statistic at 95% CI.

Results: Rises in oesophageal cancer incidence. were most marked in the most affluent (127%) Gastric cancer incidence and mortality rates showed sharp decrease in the most deprived categories. 1 year survival for oesophageal cancers achieved statistically significant levels in the most affluent groups (p=0.05). 189 deaths would have been avoided between 1989–1993 if most deprived patients had rates similar to their affluent counterparts.

Conclusions: Rise in oesophageal cancer incidence may be related to increased drinking by a core of hardened smokers amongst the most affluent categories. The biggest improvements in incidence, mortality and survival were seen for gastric cancer especially in the most deprived groups suggesting that improvements in hygiene with consequent reduction in H pylori may be primarily responsible.