In the face of cancer, people are not all equal. An individual’s likelihood of survival following a cancer diagnosis depends on many factors. These include tumor characteristics, such as site, size and spread; demographic factors such as age; but also where people are born and live along with the conditions of daily life – the so called social determinants of health. This broader environment impacts on how healthy our lives are, how early cancer is detected and what kind of treatment we receive.
We examined comparative cancer survival in New South Wales (NSW), the most populous state in Australia, over a 30-year period and identified higher risk of cancer death for those living in socio-economically disadvantaged areas and outside major cities. These survival disparities remained when we took into account differences in age, cancer stage at diagnosis, potential other causes of deaths, and differences in cancer site between population groups.
癌症存活中的差异可以通过因素来解释，因为在使用来自癌症注册管理机构的数据时我们不能轻易衡量。我们的研究无法考虑的因素包括合并症，健康行为，社会支持和临床癌症护理。这些因素可能会影响整体癌症生存和任何存活差异。
治疗质量
新的治疗方案和技术以及新治疗的临床试验可能不得剥夺人口群体
Treatment is an important factor to consider when assessing cancer survival differences. There is evidence thatdisadvantaged population groups may receive less optimal treatment。新的治疗方案和技术以及新治疗的临床试验可能不得剥夺人口群体。
虽然我们无法确定我们研究中发现的多少生存差异是通过不同的访问和/或治疗质量的驱动，但预计普遍的医疗保健系统将减少人口群体之间健康状况的一些差异。尽管澳大利亚普遍保健系统，但社会经济地位较低的人在新南威尔士州的癌症成果较差。
我们研究的结果不太可能对新南威尔士州或澳大利亚特定。事实上，较低的社会经济地位和降低癌症生存之间的关联已经存在demonstrated in several countries， 包含其他也具有普遍健康覆盖范围和广泛的社会安全网的国家。这进一步强调癌症生存差异并非完全解释，也不是通过卫生保健系统相关因素来修复;更广泛的社会经济背景似乎正在施加影响力。
在南威尔士州，生活在社会经济弱势地区的人们死亡的比较风险随着时间的推移而增加。对于每个人来说，癌症生存随着时间的推移而得到了改善，但似乎改善了更大或更快地发生了更快的人，因此生存缺口增加了。
移民中的癌症生存
We also examined cancer survival by migrant status and grouped people based on their country of birth into those from English-speaking and non-English speaking countries. Australia has a large migrant population with more than a quarter of the population born outside Australia.
由于文化，语言和健康识字障碍，移民组可能处于健康成果方面处于不利地位。然而，根据我们的结果，在其他英语国家出生的人具有类似的风险，与非英语国家的人与澳大利亚出生的癌症死亡风险较低。
根据我们的结果......与澳大利亚出生的人出生的癌症死亡风险较低
This is perhaps surprising especially if we assume that language skills are associated with capacity to navigate through the health system, and that these navigation skills translate into better health outcomes.
在非英语国家出生的人的人们可能会更好地生存是部分人工活动。移民通常比一般人群更健康（所谓的“健康的移民”效应）。他们也可能返回他们的祖国以获得他们生命的最后阶段，因此他们死亡的信息不会在被诊断患有癌症的国家记录。
考虑到我们的以前的发现that people born outside Australia had slightly higher risk of being diagnosed with advanced stage cancer, loss to follow-up appears to be a plausible explanation for recorded cancer survival advantage for some migrant groups in our study.
社会经济劣势是一个复杂的概念，对如何最好地衡量它并不达成共识。几个因素，包括教育，收入，就业和家庭背景对一个人的社会经济地位有所不同。我们使用基于区域的措施来测量社会经济劣势，这可能与个人的社会阶层或位置不相对应。
为了能够发展有针对性的行动和干预，需要更深入地了解推动促进癌症生存中的社会经济差异的原因。这些因素可能超出了卫生部门的直接责任。因此，来自不同部门的服务提供商的适当资源和协调输入对于关闭社会经济癌症生存差距至关重要。
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