Trends and Socio-Economic Inequalities in Cancer Survival of Patients with Hodgkin’s Lymphoma Diagnosed in England and Wales between 1986 and 1999.

Background: Similar to other cancers in England and Wales, survival from Hodgkin’s lymphoma is influenced socially patterned, with those in the most deprived groups showing worse survival rates. Survival from Hodgkin’s lymphoma increased during the 1980s, however, so did the gap in survival between the most affluent and most deprived groups. It is not known whether the suggested widening of this gap continued into the 1990s.

Objective: To examine trends in relative survival (RS) from Hodgkin’s lymphoma in England and Wales diagnosed between 1986 and 1999. It explores how survival varies by socio-economic background and how these differences change over time.

Methods: Anonymized data of 14,831 patients with Hodgkin’s lymphoma diagnosed in England and Wales between 1986 and 1999 and followed up until the end of 2001 were analyzed. We estimated 5-year relative survival (ratio of observed survival of cancer patients and survival that would have been expected if the patients had had the same age- and sex-specific mortality in each time period as the general population). We examined the periods 1986-1990, 1991–1995 and 1996–2001. Patients were assigned to one of five deprivation categories based on the area of residence, from ‘affluent’ to ‘deprived’ using both the Carstairs score (Carstairs 1995) and the ward income domain score, a subcomponent of the indices of multiple deprivation. We estimated differences in survival between the deprivation categories using linear regression, weighted by the variance of the relative survival estimate. Men and women were analyzed separately.

Results: Among men 5-year relative survival improved consistently and statistically significant from 76% in the late 1980s to 83% in the early 1990s. The 5-year relative survival improved on average by 4.23% (95% CI 1.22 to 7.25, p=0.007) every five years. For women there was no evidence that RS improved over time (RS 0.89, 95% CI −3.04; 4.82, p-value = 0.66). For both men and women there was evidence for a deprivation gap in survival. Relative survival at 5 years was on average 5% percent less in men from poor (‘deprived’) areas compared to men from wealthy (‘affluent’) areas (RS −4.9; 95% CI −9.5; −0.39, p=0.036). In women the RS at 5 years was 6% less in women from poor areas compared to women from wealthy areas (RS −6.12; 95% CI −12. to −0.24, p=0.04). There is no conclusive evidence whether the survival gap by deprivation changed over time.

Conclusion: Relative survival of patients diagnosed with Hodgkin’s lymphoma in England and Wales improved only for men, but not for women. The existing deprivation gap in relative survival for both men and women confirms that cancer survival depends on socio-economic background and is inequitable. More research is required to better understand how socio-economic factors affect survival from Hodgkin’s lymphoma.