Individual and contextual deprivation: Association with cancer outcomes and implications for cancer policy

An investigation of cancer survival inequalities associated with individual-level socio-economic status, area-level deprivation, and contextual effects, in a cancer patient cohort in England and Wales

The aim of this ESRC funded project (2019 – 2021) was to quantify simultaneously the impact of individual and contextual levels of deprivation on the excess mortality hazard, and to describe how the contextual level of deprivation modifies the association between the individual level of deprivation and the excess mortality hazard.

It is well known that more deprived patients experience lower net survival compared to less deprived patients. Almost exclusively, the studies where this has been shown have been using area-based measures. This is where an individual patient’s deprivation level is assigned according to the characteristics of a small administrative geography within which the patient resided at diagnosis. Actually, these area-based measures quantify ecological, rather than individual, level of deprivation. It is of public health interest to directly measure the impact of deprivation at the individual level, and to understand how ecological and individual level effects interplay (contextual effects).

The results of our analyses provided new insights to understand whether the effect of deprivation varies according to the socio-economic context, for example, whether poor patients in more deprived areas experience higher or lower excess mortality compared to poor patients living in less deprived areas. These data have the potential to enable policies aimed at reducing socio-economic differences in cancer outcomes to be more effectively targeted.