Understanding differences in cancer survival between populations

A new approach and application to breast cancer survival differentials between Danish regions

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Abstract

Large variations in cancer survival have been recorded between populations, e.g., between countries or between regions in a country. To understand the determinants of cancer survival differentials between populations, researchers have often applied regression analysis. We here propose the use of a non-parametric decomposition method to quantify the exact contribution of specific components to the absolute difference in cancer survival between two populations. Survival differences are here decomposed into the contributions of differences in stage at diagnosis, population age structure, and stage-and-age-specific survival. We demonstrate the method with the example of differences in one-year and five-year breast cancer survival between Denmark's five regions. Differences in stage at diagnosis explained 45% and 27%, respectively, of the one- and five-year survival differences between Zealand and Central Denmark for patients diagnosed between 2008 and 2010. We find that the introduced decomposition method provides a powerful complementary analysis and has several advantages compared with regression models: No structural or distributional assumptions are required; aggregated data can be used; and the use of absolute differences allows quantification of the survival that could be gained by improving, for example, stage at diagnosis relative to a reference population, thus feeding directly into health policy evaluation.

Original languageEnglish
Article number3093
JournalInternational Journal of Environmental Research and Public Health
Volume16
Issue number17
ISSN1661-7827
DOIs
Publication statusPublished - 26. Aug 2019

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Population
Neoplasms
Denmark
Health Policy
Regression Analysis
Research Personnel

Keywords

  • Denmark
  • breast cancer
  • decomposition
  • regions
  • stage at diagnosis
  • survival

Cite this

@article{ff50eba020864245a5b7604cabc8bd9e,
title = "Understanding differences in cancer survival between populations: A new approach and application to breast cancer survival differentials between Danish regions",
abstract = "Large variations in cancer survival have been recorded between populations, e.g., between countries or between regions in a country. To understand the determinants of cancer survival differentials between populations, researchers have often applied regression analysis. We here propose the use of a non-parametric decomposition method to quantify the exact contribution of specific components to the absolute difference in cancer survival between two populations. Survival differences are here decomposed into the contributions of differences in stage at diagnosis, population age structure, and stage-and-age-specific survival. We demonstrate the method with the example of differences in one-year and five-year breast cancer survival between Denmark's five regions. Differences in stage at diagnosis explained 45{\%} and 27{\%}, respectively, of the one- and five-year survival differences between Zealand and Central Denmark for patients diagnosed between 2008 and 2010. We find that the introduced decomposition method provides a powerful complementary analysis and has several advantages compared with regression models: No structural or distributional assumptions are required; aggregated data can be used; and the use of absolute differences allows quantification of the survival that could be gained by improving, for example, stage at diagnosis relative to a reference population, thus feeding directly into health policy evaluation.",
keywords = "Denmark, breast cancer, decomposition, regions, stage at diagnosis, survival",
author = "{Bergeron Boucher}, Marie-Pier and James Oeppen and Holm, {Niels Vilstrup} and Nielsen, {Hanne Melgaard} and Rune Lindahl-Jacobsen and Wensink, {Maarten Jan}",
year = "2019",
month = "8",
day = "26",
doi = "10.3390/ijerph16173093",
language = "English",
volume = "16",
journal = "International Journal of Environmental Research and Public Health",
issn = "1661-7827",
publisher = "MDPI",
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TY - JOUR

T1 - Understanding differences in cancer survival between populations

T2 - A new approach and application to breast cancer survival differentials between Danish regions

AU - Bergeron Boucher, Marie-Pier

AU - Oeppen, James

AU - Holm, Niels Vilstrup

AU - Nielsen, Hanne Melgaard

AU - Lindahl-Jacobsen, Rune

AU - Wensink, Maarten Jan

PY - 2019/8/26

Y1 - 2019/8/26

N2 - Large variations in cancer survival have been recorded between populations, e.g., between countries or between regions in a country. To understand the determinants of cancer survival differentials between populations, researchers have often applied regression analysis. We here propose the use of a non-parametric decomposition method to quantify the exact contribution of specific components to the absolute difference in cancer survival between two populations. Survival differences are here decomposed into the contributions of differences in stage at diagnosis, population age structure, and stage-and-age-specific survival. We demonstrate the method with the example of differences in one-year and five-year breast cancer survival between Denmark's five regions. Differences in stage at diagnosis explained 45% and 27%, respectively, of the one- and five-year survival differences between Zealand and Central Denmark for patients diagnosed between 2008 and 2010. We find that the introduced decomposition method provides a powerful complementary analysis and has several advantages compared with regression models: No structural or distributional assumptions are required; aggregated data can be used; and the use of absolute differences allows quantification of the survival that could be gained by improving, for example, stage at diagnosis relative to a reference population, thus feeding directly into health policy evaluation.

AB - Large variations in cancer survival have been recorded between populations, e.g., between countries or between regions in a country. To understand the determinants of cancer survival differentials between populations, researchers have often applied regression analysis. We here propose the use of a non-parametric decomposition method to quantify the exact contribution of specific components to the absolute difference in cancer survival between two populations. Survival differences are here decomposed into the contributions of differences in stage at diagnosis, population age structure, and stage-and-age-specific survival. We demonstrate the method with the example of differences in one-year and five-year breast cancer survival between Denmark's five regions. Differences in stage at diagnosis explained 45% and 27%, respectively, of the one- and five-year survival differences between Zealand and Central Denmark for patients diagnosed between 2008 and 2010. We find that the introduced decomposition method provides a powerful complementary analysis and has several advantages compared with regression models: No structural or distributional assumptions are required; aggregated data can be used; and the use of absolute differences allows quantification of the survival that could be gained by improving, for example, stage at diagnosis relative to a reference population, thus feeding directly into health policy evaluation.

KW - Denmark

KW - breast cancer

KW - decomposition

KW - regions

KW - stage at diagnosis

KW - survival

U2 - 10.3390/ijerph16173093

DO - 10.3390/ijerph16173093

M3 - Journal article

VL - 16

JO - International Journal of Environmental Research and Public Health

JF - International Journal of Environmental Research and Public Health

SN - 1661-7827

IS - 17

M1 - 3093

ER -