Area socioeconomic status is independently associated with esophageal cancer mortality in Shandong, China.

Esophageal cancer (EC) is a leading cause of cancer death in China. Within Shandong Province, a geographic cluster with high EC mortality has been identified, however little is known about how area-level socioeconomic status (SES) is associated with EC mortality in this province. Multilevel models were applied to EC mortality data in 2011-13 among Shandong residents aged 40+ years. Area-level SES factors consisted of residential type (urban/rural) of the sub-county-level units (n = 262) and SES index (range: 0-10) of the county-level units (n = 142). After adjustment for age and sex, residents living in rural areas had a 22% (95% CI: 13-32%) higher risk of dying from EC than those in urban areas. With each unit increase in the SES index, the average risk of dying from EC reduced by 10% (95% CI: 3-18%). The adjustment of area-level SES variables had little impact on the risk ratio of EC mortality between the high-mortality cluster and the rest of Shandong. In conclusion, rural residence and lower SES index are strongly associated with elevated risks of EC death. However, these factors are independent of the high mortality in the cluster area of Shandong. The underlying causes for this geographic disparity need to be further investigated.

Effect of age at diagnosis of breast cancer on the patterns and risk of mortality from all causes: a population-based study in Australia.

AIMS: This retrospective, population-based study investigated the patterns and risks of mortality from breast cancer, other cancers and non-cancer causes according to the age at diagnosis of breast cancer. METHODS: Mortality was assessed in all Australian women (n = 179,653) aged 30-79 years who were diagnosed with breast cancer between 1982 and 2004 and who survived a minimum of 1 year. The mean follow up was 6.3 years (range 0-23 years). RESULTS: Before December 2005, 52,934 women had died (34,459 of breast cancer, 5019 of other cancers and 13,456 of non-cancer causes). There was an inverse age-related relative risk of mortality (calculated as the standardized mortality ratio [SMR]) from breast cancer (linear trend across age P < 0.01). For breast cancer survivors the age-adjusted SMR was 0.99 for other cancers and 0.81(P < 0.01) for non-cancer causes in comparison with the general population. The SMR for other cancers and non-cancer causes was highest in the 30-39-year-old age group (2.13, P < 0.01 and 2.15, P < 0.01, respectively), and progressively decreased with increasing age, with the 70-79-year-old age group having significantly reduced SMR (0.95, P < 0.05, and 0.78, P < 0.01, respectively, compared with the age-matched general population). CONCLUSION: There was an inverse age-related relative risk of death from breast cancer, other cancers and non-cancer causes. These findings suggest that younger Australian women require long-term health surveillance and that older women with limited comorbidities require optimal treatment of their breast cancer.