Time trends in cancer incidence and cancer-free life years – developments of income inequalities in breast and prostate cancer based on German health insurance data

Fabian Tetzlaff , Robert Koch-Institute
Jens Hoebel, Division of Social Determinants of Health, Robert Koch-Institute
Jelena Epping, Hannover Medical School
Siegfried Geyer, Hannover Medical School
Juliane Tetzlaff , Hannover Medical School

Breast and prostate cancer represent two of the most common cancers in many high-income countries. So far, however, evidence is missing on time trends and social inequalities in life years spend free of cancer (CFLY). The aim of the study is to analyse time trends and income inequalities in CFLY. The analyses are based on the data of a large German health insurer (AOK Niedersachsen) from 2006 to 2018 (N ˜ 2.8 to 3.5 million individuals). Inequalities were classified according to two income groups (<60% of German average income (GAI) and = 60% GAI). To analyse time trends in incidence, proportional-hazard regression models were employed. CFLY were calculated based on multiple decrement life tables. The analyses reveal substantial declines in breast and prostate cancer incidence over time. CFLY differ substantially between income groups, with men and women with higher incomes having higher numbers of CFLY. Regardless of sex and income group, increases in CFLY were observed for breast and prostate cancer. However, increases differed by income group advantaging men with higher incomes. Among women, no income inequalities in breast cancer were observe initially. Finally, in the third period a reversed gradient emerged, which fostered the increases in CFLY in the low income group. This is one of the few studies analysing trends in CFLY showing clear increases in CFLY. However, not all income groups benefitted equally from this positive development. More research is needed to understand the dynamics of inequalities in incidence and CFLY over time.

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 Presented in Session P1. Postercafe