Socio-economic factors

From Cancer Guidelines Wiki

Aspects that may impact on surveillance colonoscopy following adenoma detection or curative resection for colorectal cancer and in the setting of dysplasia surveillance in inflammatory bowel disease


Social and economic circumstances are recognised determinants of access to health care.[1][2][3] Those who are less affluent or socially deprived have shorter lives, during which they suffer more illness than those who are more economically favoured.[1][4][5] However, economic affluence does not preclude ignorance, which of itself can require special management measures in attempting to assure appropriate outcomes in a surveillance setting.

In preparing clinical management guidelines and recommendations, it is appropriate to consider a range of factors that may impact on patients during their ongoing care.[1][6]

Whilst economic factors are of significance, there are other individual features that, while impacting on economics, are independently of clinical and management importance. Income, education, literacy, occupation or employment, level of interest, place of residence and ethnicity may individually or collectively produce a state of deprivation that can affect patient risk factors and possibly affect access to or compliance with health care services, as well as outcomes of care.[1][2][3][5][7][8][9][10][11][12][13] The National Health and Medical Research Council has recognised these factors in its Handbook, “Using Socioeconomic evidence in clinical practice guidelines”.[1]

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Clinical questions:

magifying glass icon Issues requiring more clinical research study

  • Carefully planned studies are required to specifically address surveillance colonoscopy and colorectal cancer and possibly inflammatory bowel disease in indigenous people.
  • Resources will be required to assist in implementation of guideline recommendations in indigenous communities.

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  1. 1.0 1.1 1.2 1.3 1.4 National Health and Medical Research Council. Using socioeconomic evidence in clinical practice guidelines. NHMRC 2002 Abstract available at
  2. 2.0 2.1 Rosso S, Faggiano F, Zanetti R, Costa G. Social class and cancer survival in Turin, Italy. J Epidemiol Community Health 1997;51(1):30-34.
  3. 3.0 3.1 Ciccone G, Prastaro C, Ivaldi C, Giacometti R, Vineis P. Access to hospital care, clinical stage and survival from colorectal cancer according to socio-economic status. Ann Oncol 2000;11(9):1201-1204.
  4. Australian Institute of Health and Welfare. Chapter 3 and 4. Australia's Health 2008.
  5. 5.0 5.1 Kogevinas M, Porta M. Socioeconomic differences in cancer survival: a review of the evidence. IARC Sci Publ 1997;(138):177-206.
  6. Australian Cancer Network Colorectal Cancer Guidelines Revision Committee. Clinical practice guidelines for the prevention, early detection and management of colorectal cancer. The Cancer Council Australia and Australian Cancer Network 2005.
  7. Carstairs V. Multiple deprivation and health state. Community Med 1981 Jan 1;3(1):4-13.
  8. Townsend P, Simpson D, Tibbs N. Inequalities in health in the city of Bristol: a preliminary review of statistical evidence. Int J Health Ser 1985;15(4):637-663.
  9. Rosengren A, Wilhelmsen L. Cancer incidence, mortality from cancer and survival in men of different occupational classes. Eur J Epidemiol 2004;19(6):533-540.
  10. Woods LM, Rachet B, Coleman MP. Origins of socio-economic inequlities in cancer survival: a review. Ann Oncol 2006;17(1): 5-19.
  11. Auvinen A, Karjalainen S. Possible explanations for social class differences in cancer patient survival. IARC Sci Publ 1997;(138):377-397.
  12. McArdle CS, Hole DJ. Outcome following surgery of colorectal cancer: analysis by hospital after adjustment for case-mix and deprivation. BR J Cancer 2002;86(3):331-335.
  13. Raine R, Wong W, Scholes S, Ashton C, Obichere A, Ambler G. Social variations in access to hospital care for patients with colorectal, breast and lung cancer between 1999 and 2006: retrospective analysis of hospital episode statistics. BMJ 2010;340:b5479.

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