Comparison of effects of socioeconomic and geographic variations on survival for adults and children with glioma.

Abstract

The authors analyzed the effects of socioeconomic status (SES) and geographic variations on survival rates for adults and children with glioma, studying the data of 30,489 adults and 2940 children from the Cancer Registry in England and Wales. The median survival time and crude survival rates for eight variables (age, sex, morphology, World Health Organization grade, tumor site, SES, geographic region, and period of diagnosis) were calculated using the Kaplan-Meier method. Distributions among different variables were compared using the chi-square test. Cox regressions were performed to estimate the hazard ratios (HR) to death. The median survival time and 1-, 5-, and 10-year crude survival rates for adults were 0.42 years and 29.1, 12, and 7.7%, respectively; the values for children were 9.33 years and 72.69, 54.32, and 49.5%, respectively. Similar gradients in SES from the south to the north exist in both populations (p < 0.001, chi-square test). Multivariate analyses revealed that all eight variables influenced survival in adults, including independent effects of sex (HR 0.94 for female, p < 0.001), SES (HR 1.03/quintile of deprivation, p < 0.001), and geographic region (HR 1.10 for outside southern England, p < 0.001). In children, only five of the eight variables affected survival; sex, SES, and geographic variation did not have an effect. Although age and tumor characteristics are well-known prognostic factors for both adults and children with glioma, SES and geographic variation also play significant roles in the survival of adults. The effects of SES and geographic variation may be directly related to the National Health Service in the United Kingdom.