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

  • Heidarnia, Mohammad Ali (Department of Community Medicine and Health, Medical School, Shahid Beheshti University of Medical Sciences) ;
  • Monfared, Esmat Davoudi (Department of Community Medicine and Health, Medical School, Shahid Beheshti University of Medical Sciences) ;
  • Akbari, Mohammad Esmail (Cancer Research Centre, Shahid Beheshti University of Medical Sciences) ;
  • Yavari, Parvin (Department of Community Medicine and Health, Medical School, Shahid Beheshti University of Medical Sciences) ;
  • Amanpour, Farzaneh (Department of Biostatistics, Paramedical sciences faculty, Shahid Beheshti University of Medical Sciences) ;
  • Mohseni, Maryam (Department of Community Medicine and Health, Medical School, Shahid Beheshti University of Medical Sciences)
  • Published : 2013.09.30


Background: Early in the 21st century, cancers are the second cause of death worldwide. Colon cancer is third most common cancer and one of the few amenable to early diagnosis and treatment. Evaluation of factors affecting this cancer is important to increase survival time. Some of these factors affecting all diseases including cancer are social determinants of health. According to the importance of this disease and relation with these factors, this study was conducted to assess the relationship between social determinants of health and colon cancer survival. Materials and Methods: This was a cross-sectional, descriptive study for patients with colon cancer registered in the Cancer Research Center of Shahid Beheshti University of Medical Science, from April 2005 to November 2006, performed using questionnaires filled by telephone interview with patients (if patients had died, with family members). Data was analyzed with SPSS software (version 19) for descriptive analysis and STATA 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${\pm}$standard deviation of $63{\pm}11.8$ years were included in the study. The five year survival was 68.3%( 387 patients were alive and 172 patients were dead by the end of the study). The Cox proportional hazard regression showed 5-year survival was related to age (HR=0.53, p=0.042 for>50 years versus<50 years old) in first step, gender (HR=0.60, p=0.006 for female versus male) in second step, job (HR=1.7, p=0.001 for manual versus non manual jobs), region of residency (HR=3.49, p=0.018 for west versus south regions), parents in childhood (HR=2.87, p=0.012 for having both 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: Social determinants of health such as job, city region residency and having parents during childhood have significant effects in 5-year survival of colon cancer and it may be better to consider these factors in addition to developing cancer treatment and to focus on these determinants of health in long-time planning.


Social determinant of health;colorectal cancer;survival;Iran


  1. Aarts MJ, Lemmens VE, Louwman MW, et al (2010). Socioeconomic status and changing inequalities in colorectal cancer. A review of the associations with risk, treatment and outcome. Eur J Cancer, 46, 2681-95.
  2. Chau K, Baumann M, Chau N (2013). Socioeconomic inequities patterns of multimorbidity in early adolescence. Int J Equity Health, 12, 65.
  3. Blais S, Dejardin O, Boutreux S, et al (2006). Social determinants of access to reference care centres for patients with colorectal cancer - A multilevel analysis. Eur J Cancer, 42, 3041-8.
  4. Boyle P, Levin B (2008). World Cancer Report 2008, IARC, Lyon. IARC, 42, 13-5.
  5. Burke W, Petersen G, Lynch P, et al (1997). Recommendations for follow-up care of individuals with an inherited predisposition to cancer. JAMA, 277, 915-9.
  6. Dalton SO, Schuz J, Engholm G, et al (2008). Social inequality in incidence of and survival from cancer in a populationbased study in Denmark, 1994-2003: summary of findings. Eur J Cancer, 44, 2074-85.
  7. Dejardin O, Remontet L, Bouvier AM, et al (2006). Socioeconomic and geographic determinants of survival of patients with digestive cancer in France. Br J Cancer, 95, 944-9.
  8. Egeberg R, Halkjaer J, Rottmann N, et al (2008). Social inequality and incidence of and survival from cancers of the colon and rectum in a population-based study in Denmark, 1994-2003. Eur J Cancer, 44, 1978-88.
  9. Eloranta S, Lambert PC, Cavalli-Bjorkman N, et al (2010). Does socioeconomic status influence the prospect of cure from colon cancer - A population-based study in Sweden 1965-2000. Eur J Cancer, 46, 2965-72.
  10. Fereshtehnejad M, Asadi-Lari M, Moradi Lakeh M, et al (2010). Estimation of life expectancy and its association with social determinants of health (SDH) in Urban population of different districts of Tehran in 2008 (Urban HEART Study). Teb Va Tazkiyeh, 77, 103.
  11. Groome PA, Schulze KM, Keller S, et al (2008). Demographic differences between cancer survivors and those who die quickly of their disease. Clin Oncol, 20, 647-56.
  12. Ghafoor A, Jemal A, Ward E, et al (2003). Trends in breast cancer by race and ethnicity. CA Cancer J Clin, 53, 342-55.
  13. Glanz K, Croyle RT, Chollette VY, et al (2003). Cancer-related health disparities in women. Am J Public Health, 93, 292-8.
  14. Gorey KM, Luginaah IN, Bartfay E, et al (2011). Effects of socioeconomic status on colon cancer treatment accessibility and survival in Toronto, Ontario, and San Francisco, California, 1996-2006. Am J Public Health, 101, 112-9.
  15. Hussain SK, Lenner P, Sundquist J, et al (2008). Influence of education level on cancer survival in Sweden. Ann Oncol, 19, 156-62.
  16. Jemal A, Bray F, Center MM, et al (2011). Global cancer statistics. Cancer J Clin, 61, 69-90.
  17. Jemal A, Clegg LX, Ward E, et al (2004). Annual report to the nation on the status of cancer, 1975-2001, with a special feature regarding survival. Cancer, 101, 3-27.
  18. Jorgensen ML, Young JM, Solomon MJ (2013). Adjuvant chemotherapy for colorectal cancer: age differences in factors influencing patients' treatment decisions. Patient Prefer Adherence, 7, 827-34.
  19. Kong CK, Roslani AC, Law CW, et al (2010). Impact of socioeconomic class on colorectal cancer patient outcomes in Kuala Lumpur and Kuching, Malaysia. Asian Pac J Cancer Prev, 11, 969-74.
  20. Li X, Xie Z, Fu Y, et al (2013). Colorectal cancer concealment predicts a poor survival: a retrospective study. Asian Pac J Cancer Prev, 14, 4157-60.
  21. Menvielle G, Luce D, Geoffroy-Perez B, et al (2005). Social inequalities and cancer mortality in France, 1975-1990. Cancer Causes Control, 16, 501-13.
  22. Marmot M, Wilkinson R (2006). The Social Determinants of Health. 2nd ed. New York: Oxford University Press.
  23. Mathers CD, Murray CJL, Lopez AD, et al (2001). Cancer incidence, mortality and survival by site for 14 regions of the world. Geneva, World Health Organization (GPE Discussion Paper No. 13).
  24. Meguid RA, Slidell MB, Wolfgang CL, et al (2008). Is there a difference in survival between right- versus left-sided colon cancers? Ann Surg Oncol, 15, 2388-92.
  25. Møller H, Sandin F, Robinson D, et al (2011). Colorectal cancer survival in socioeconomic groups in England: Variation is mainly in the short term after diagnosis. Eur J Cancer, 48, 46-53.
  26. Niu X, Pawlish K, Roche LM (2010). Cancer survival disparities by race/ethnicity and socioeconomic status in New Jersey. J Health Care Poor Underserved, 21, 144-60.
  27. Rashid MRA, Aziz AFA, Ahmad S, et al (2009). Colorectal cancer patients in a tertiary referral centre in Malaysia: a five year follow-up review. Asian Pac J Cancer Prev, 10, 1163-6.
  28. Robbins AS, Siegel RL, Jemal A (2012). Racial disparities in stage-specific colorectal cancer mortality rates from 1985-2009. J Clin Oncol, 30, 401-5.
  29. Sadjadi A, Nouraie M, Mohagheghi MA, et al (2005). Cancer occurrence in Iran in 2002, an international perspective. Asian Pac J Cancer Prev, 6, 359-63.
  30. Wardle J, McCaffery K, Nadel M, et al (2004). Socioeconomic differences in cancer screening participation: comparing cognitive and psychosocial explanations. Soc Sci Med, 59, 249-61.
  31. Shaw C, Blakely T, Sarfati D, et al (2006). Trends in colorectal cancer mortality by ethnicity and socio-economic position in New Zealand, 1981-99: one country, many stories. Austral New Zealand J Public Health, 30, 64-70.
  32. Singh GK, Miller BA, Hankey BF, et al (2004). Persistent area socioeconomic disparities in US incidence of cervical cancer, mortality, stage, and survival, 1975-2000. Cancer, 101, 1051-7.
  33. Wagstaff A (2002). Poverty and health sector inequalities. Bull World Health Organization, 80, 97-105.
  34. Wray CM, Ziogas A, Hinojosa MW, et al (2009). Tumor subsite location within the colon is prognostic for survival after colon cancer diagnosis. Dis Colon Rectum, 52, 1359-66.
  35. Wrigley H, Roderick P, George S, et al (2005). Inequalities in survival from colorectal cancer: a comparison of the impact of deprivation, treatment and host factors on observed and cause specific survival. J Epidemiol Community Health, 57, 301-9.

Cited by

  1. Survival of Rectal Cancer in Yazd, Iran vol.15, pp.12, 2014,
  2. Survival of Colorectal Cancer Patients in the Presence of Competing-Risk vol.15, pp.15, 2014,
  3. Outcome of Rectal Cancer in Patients Aged 30 Years or Less in the Pakistani Population vol.15, pp.15, 2014,
  4. Down-regulated MYH11 Expression Correlates with Poor Prognosis in Stage II and III Colorectal Cancer vol.15, pp.17, 2014,
  5. Longitudinal Study of Cancer-Related Fatigue in Patients with Colorectal Cancer vol.15, pp.7, 2014,
  6. An Overview of Clinical and Pathological Characteristics and Survival Rate of Colorectal Cancer in Iran vol.2, pp.1, 2014,
  7. Demographic Survey of Four Thousand Patients with 10 Common Cancers in North Eastern Iran over the Past Three Decades vol.15, pp.23, 2015,
  8. Survival of Colorectal Cancer in the Presence of Competing-Risks - Modeling by Weibull Distribution vol.17, pp.3, 2016,
  9. Social determinants of stage IV anal cancer and the impact of pelvic radiotherapy in the metastatic setting vol.6, pp.11, 2017,