Part II: Inequalities in oral cancer in relation to relative deprivation of area
4.6.1 Incidence in relation to deprivation 1 Excluded cases both methods
4.6.4.5 Cases included for the IMD 2000 analysis (method 4)
3,659 (96.3%) males and 2,211 (96.3%) females in the TCR data had stage information recorded and could be assigned an IMD 2000 index score via a valid
1998 Ward.
4 .6 .5 Results of statistical analyses
Tables 4.17 to 4.24 show the results of the relationship between the crude odds of late presentation and relative deprivation according to sex and analytical method.
Likelihood ratio tests could not be undertaken when models were not nested (often the result co-linear factors being dropped).
There were inadequate numbers of cases to provide reliable estimates o f the effect of deprivation quintiles individually on late stage presentation for lip cancers. However, there were sufficient cases to model the effect o f deprivation if a linear relationship is assumed to exist across deprivation quintiles, and so Table 4.17 presents only these results. For males, the method based on the Townsend index indicated that the odds o f late presentation increased significantly with worsening relative deprivation of area o f residence. The other method showed no such gradient in males. For females, neither analytical approach indicated that area deprivation affected the odds of presenting late.
For tongue cancers there was no evidence that deprivation affected the odds of presenting late for males. One method produced a borderline significant result for females (using the IMD 2000, p=0.049), while the other method indicated no evidence o f a relationship (Townsend, p=0.240). However, the direction and magnitude o f the ‘relationship’ was similar in females for both methods (OR=1.078 (Townsend), 0R=1.131 (IMD 2000)).
For all other intra-oral sites there was no evidence that deprivation affected the odds o f presenting with late disease for either males or females. These results were consistent irrespective o f the analytical method employed.
Table 4.17. Effect of quintile of deprivation on odds of late stage at presentation for lip cancer (ICD-9 140)
Males - method 3
Quintile of deprivation (Townsend) (n= 279)
1 (least deprived - baseline ) Each successive quintile assuming a linear relationship OR 1 1.700 1.147 95% Cl 2.520 P-value 0.008 Males - method 4
Quintile of deprivation (IMD 2000) (n=280)
1 (least deprived - baseline )
Each successive quintile assuming a linear relationship OR 1 0.803 0.551 95% Cl 1.169 P-value 0.252 Females - method 3
Quintile of deprivation (Townsend) (n=96)
1 (least deprived - baseline )
Each successive quintile assuming a linear relationship OR 1 0.984 0.431 95% Cl 2.243 P-value 0.969 Females - method 4
Quintile of deprivation (IMD 2000) (n=97)
1 (least deprived - baseline ) Each successive quintile assuming a linear relationship OR 1 1.523 0.662 95% Cl 3.502 P-value 0.323
Table 4.18. Effect of quintile of deprivation on odds of late stage at presentation
Males - method 3
Quintile of deprivation (n= 945) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 1.243 0.804 1.923 0.328
3 1.058 0.681 1.645 0.802
4 0.857 0.547 1.343 0.501
5 (most deprived) 1.258 0.815 1.942 0.300 Assuming a linear relationship for 1.009 0.916 1.112 0.854 deprivation quintile (n= 945)
LR test for difference between models 0.232 Males - method 4
Quintile of deprivation (n= 954) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 1.155 0.745 1.791 0.518
3 1.061 0.683 1.648 0.792
4 0.833 0.544 1.275 0.401
5 (most deprived) 1.156 0.761 1.757 0.497 Assuming a linear relationship for 0.997 0.908 1.096 0.958 deprivation quintile (n= 954)
LR test for difference between models 0.349 Females - method 3
Quintile of deprivation (n= 637) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 0.987 0.582 1.675 0.963
3 0.981 0.582 1.652 0.942
4 0.932 0.537 1.618 0.802
5 (most deprived) 1.536 0.887 2.659 0.125 Assuming a linear relationship for 1.078 0.951 1.221 0.240 deprivation quintile (n= 637)
LR test for difference between models 0.476 Females - method 4
Quintile of deprivation (n= 641) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 1.600 0.925 2.757 0.093
3 1.541 0.908 2.616 0.109
4 1.490 0.849 2.615 0.165
5 (most deprived) 1.905 1.091 3.327 0.023 Assuming a linear relationship for 1.131 1.001 1.279 0.049 deprivation quintile (n= 641)
Table 4.19. Effect of quintile of deprivation on odds of late stage at presentation for mouth cancer (ICD-9 143-145)
Males - method 3
Quintile of deprivation (n= 1,067) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 1.183 0.753 1.860 0.466
3 0.897 0.573 1.406 0.636
4 1.266 0.818 1.960 0.289
5 (most deprived) 1.186 0.782 1.799 0.421 Assuming a linear relationship for 1.043 0.950 1.146 0.379 deprivation quintile (n= 1,067)
LR test for difference between models 0.472 Males - method 4
Quintile of deprivation (n= 1,074) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 1.014 0.643 1.598 0.954
3 1.356 0.881 2.086 0.167
4 0.852 0.531 1.367 0.505
5 (most deprived) 1.218 0.798 1.858 0.360 Assuming a linear relationship for 1.028 0.935 1.131 0.563 deprivation quintile (n= 1,074)
LR test for difference between models 0.164 Females - method 3
Quintile of deprivation (n= 769) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 1.150 0.705 1.877 0.576
3 1.130 0.685 1.864 0.632
4 1.437 0.866 2.384 0.160
5 (most deprived) 0.984 0.575 1.684 0.954 Assuming a linear relationship for 1.025 0.913 1.150 0.676 deprivation quintile (n= 769)
LR test for difference between models 0.490 Females - method 4
Quintile of deprivation (n= 770) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 0.932 0.567 1.534 0.782
3 1.051 0.640 1.726 0.845
4 1.103 0.668 1.819 0.702
5 (most deprived) 0.762 0.442 1.314 0.328 Assuming a linear relationship for 0.971 0.864 1.091 0.621 deprivation quintile (n= 770)
Table 4.20. Effect of quintile of deprivation on odds of late stage at presentation
Males - method 3
Quintile of deprivation (n= 589) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 1.550 0.903 2.662 0.112
3 1.378 0.809 2.347 0.238
4 1.531 0.918 2.551 0.102
5 (most deprived) 1.134 0.698 1.841 0.613 Assuming a linear relationship for 1.021 0.915 1.139 0.712 deprivation quintile (n= 589)
LR test for difference between models 0.243 Males - method 4
Quintile of deprivation (n= 595) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 1.146 0.675 1.944 0.505
3 1.190 0.687 2.063 0.535
4 1.150 0.672 1.965 0.509
5 (most deprived) 1.348 0.822 2.211 0.237 Assuming a linear relationship for 1.063 0.952 1.188 0.275 deprivation quintile (n= 595)
LR test for difference between models 0.966 Females - method 3
Quintile of deprivation (n= 281) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 0.742 0.324 1.700 0.481
3 1.810 0.872 3.757 0.111
4 1.094 0.511 2.341 0.817
5 (most deprived) 0.955 0.458 1.991 0.901 Assuming a linear relationship for 1.016 0.861 1.199 0.854 deprivation quintile (n= 281)
LR test for difference between models 0.124 Females - method 4
Quintile of deprivation (n= 283) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 0.438 0.201 0.955 0.038
3 0.923 0.425 2.007 0.840
4 0.667 0.315 1.411 0.289
5 (most deprived) 0.428 0.197 0.930 0.032 Assuming a linear relationship for 0.885 0.747 1.049 0.159 deprivation quintile (n= 283)
Table 4.21. Effect of quintile of deprivation on odds of late stage at presentation
Males - method 3
Quintile of deprivation (n= 541) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 0.904 0.502 1.630 0.738
3 0.811 0.476 1.381 0.440
4 0.842 0.479 1.480 0.550
5 (most deprived) 1.050 0.616 1.790 0.857 Assuming a linear relationship for 1.011 0.896 1.141 0.860 deprivation quintile (n= 541)
LR test for difference between models 0.702 Males - method 4
Quintile of deprivation (n= 542) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 0.870 0.490 1.546 0.635
3 1.222 0.695 2.151 0.486
4 0.951 0.540 1.676 0.863
5 (most deprived) 1.023 0.590 1.776 0.934 Assuming a linear relationship for 1.013 0.898 1.144 0.829 deprivation quintile (n= 542)
LR test for difference between models 0.646 Females - method 3
Quintile of deprivation (n= 312) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 1.333 0.633 2.809 0.449
3 1.404 0.653 3.019 0.386
4 1.561 0.745 3.271 0.238
5 (most deprived) 1.676 0.784 3.585 0.183 Assuming a linear relationship for 1.126 0.953 1.330 0.164 deprivation quintile (n= 312)
LR test for difference between models 0.973 Females - method 4
Quintile of deprivation (n= 314) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 1.392 0.628 3.083 0.415
3 1.082 0.506 2.316 0.838
4 1.842 0.901 3.766 0.094
5 (most deprived) 1.714 0.770 3.813 0.187 Assuming a linear relationship for 1.156 0.972 1.376 0.102 deprivation quintile (n= 314)
Table 4.22. Effect of quintile of deprivation on odds of late stage at presentation for pharynx and ill-defined sites in lip, oral cavity and pharynx’ cancer (ICD-9 149)
Males - method 3
Quintile of deprivation (n= 214) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 1.033 0.391 2.730 0.948
3 0.686 0.259 1.815 0.448
4 1.147 0.459 2.863 0.770
5 (most deprived) 0.990 0.397 2.467 0.982 Assuming a linear relationship for 1.016 0.832 1.242 0.873 deprivation quintile (n= 214)
LR test for difference between models 0.684 Males - method 4
Quintile of deprivation (n= 214) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 1.220 0.464 3.210 0.687
3 1.303 0.514 3.307 0.577
4 0.905 0.366 2.238 0.829
5 (most deprived) 1.491 0.605 3.671 0.385 Assuming a linear relationship for 1.050 0.860 1.282 0.632 deprivation quintile (n= 214)
LR test for difference between models 0.667 Females - method 3
Quintile of deprivation (n= 106) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 1.319 0.375 4.636 0.666
3 1.000 0.281 3.556 1.000
4 0.938 0.265 3.313 0.920
5 (most deprived) 1.364 0.370 5.028 0.641 Assuming a linear relationship for 1.023 0.765 1.367 0.878 deprivation quintile (n= 106)
LR test for difference between models 0.909 Females - method 4
Quintile of deprivation (n= 106) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 0.383 0.110 1.335 0.132
3 0.808 0.212 3.073 0.755
4 0.856 0.286 2.558 0.780
5 (most deprived) 0.808 0.212 3.073 0.755 Assuming a linear relationship for 1.017 0.765 1.354 0.906 deprivation quintile (n= 106)
LR test for difference between models 0.444
Table 4.23. Effect of quintile of deprivation on odds of late stage at presentation for oral cancer (ICD-9 140,141,143-146,148,149)
Males - method 3
Quintile of deprivation (n= 3,635) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 1.191 0.948 1.497 0.134
3 1.025 0.819 1.283 0.829
4 1.167 0.932 1.462 0.178
5 (most deprived) 1.255 1.012 1.556 0.039 Assuming a linear relationship for 1.046 0.996 1.098 0.070 deprivation quintile (n= 3,635)
LR test for difference between models 0.374 Males - method 4
Quintile of deprivation (n= 3,659) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 1.082 0.861 1.360 0.497
3 1.186 0.947 1.486 0.136
4 0.961 0.766 1.205 0.728
5 (most deprived) 1.231 0.992 1.528 0.059 Assuming a linear relationship for 1.032 0.983 1.083 0.199 deprivation quintile (n= 3,659)
LR test for difference between models 0.112 Females - method 3
Quintile of deprivation (n= 2,201) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 1.036 0.777 1.381 0.812
3 1.227 0.924 1.629 0.158
4 1.238 0.925 1.656 0.151
5 (most deprived) 1.263 0.940 1.698 0.122 Assuming a linear relationship for 1.067 1.000 1.140 0.052 deprivation quintile (n= 2,201)
LR test for difference between models 0.878 Females - method 4
Quintile of deprivation (n= 2,211) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 1.001 0.748 1.338 0.996
3 1.197 0.900 1.592 0.216
4 1.286 0.969 1.706 0.082
5 (most deprived) 1.072 0.793 1.449 0.651 Assuming a linear relationship for 1.044 0.977 1.115 0.203 deprivation quintile (n= 2,211)
Table 4.24. Effect of quintile of deprivation on odds of late stage at presentation for intra-oral cancer (ICD-9 141,143-146,148,149)
Males - method 3
Quintile of deprivation (n= 3,356) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 1.186 0.937 1.500 0.155
3 0.997 0.792 1.254 0.978
4 1.101 0.875 1.385 0.411
5 (most deprived) 1.163 0.934 1.450 0.178 Assuming a linear relationship for 1.025 0.975 1.077 0.335 deprivation quintile (n= 3,356)
LR test for difference between models 0.375 Males - method 4
Quintile of deprivation (n= 3,379) Odds ratio 95% Cl P-value 1 (least deprived - baseline ) 1
2 1.077 0.852 1.361 0.537
3 1.210 0.960 1.524 0.107
4 0.941 0.746 1.187 0.608
5 (most deprived) 1.219 0.977 1.520 0.079 Assuming a linear relationship for 1.029 0.979 1.081 0.264 deprivation quintile (n= 3,379)
LR test for difference between models 0.070 Females - method 3
Quintile of deprivation (n= 2,105) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 1.056 0.790 1.413 0.712
3 1.204 0.904 1.603 0.205
4 1.216 0.906 1.633 0.192
5 (most deprived) 1.261 0.935 1.701 0.128 Assuming a linear relationship for 1.063 0.995 1.136 0.072 deprivation quintile (n= 2,105)
LR test for difference between models 0.952 Females - method 4
Quintile of deprivation (n= 2,114) OR 95% Cl P-value 1 (least deprived - baseline ) 1
2 0.994 0.741 1.333 0.967
3 1.134 0.851 1.512 0.391
4 1.240 0.931 1.652 0.141
5 (most deprived) 1.060 0.782 1.438 0.707 Assuming a linear relationship for 1.038 0.971 1.109 0.277 deprivation quintile (n= 2,114)