Economic status and survival of cancer patients

The relation of economic status to survival was studied for 39 kinds of cancer representing all types for which 60 or more indigent patients were seen in University of Iowa Hospital for primary care during the years 1940–1969. For every type the indigent patients had poorer survival than non-indigent patients. Quality of care would be eliminated as a major variable since a second group of “ward” patients of higher economic status was available for comparison and the differences were substantially greater between the two groups of teaching patients than between the “clinic pay” and “private” patients. Age differences and differences in stage of disease accounted for less than half of the survival deficits in the indigents. The two important problems were high mortality from causes other than cancer and excess cancer mortality not accounted for by stage differences, particularly among patients who should have had 5-year survival rates between 40 and 70%. In these patients cancer recurred more often and earlier among the indigent. We postulate host differences associated with poverty that could also account for much of the observed Black-White differences as well as some international differences in cancer survival rates.