Introduction Squamous oesophageal carcinoma is more prevalent in those with lower socio-economic status. Little is known about this for oesophageal adenocarcinoma (OAC). Anecdotally, OAC has been observed in higher socio-economic groups. Barrett’s oesophagus (BO) is the only known precursor of OAC. This study investigates the association between BO and social deprivation using the 2010 Index of Multiple Deprivation (IMD).
Methods Patients: 1076 BO diagnosed in Rotherham, between April 1978 and August 2012. IMD: The Office for National Statistics (ONS) divides England into geographical areas each with a similar population size termed Lower Layer Super Output Areas (LSOA). The 2010 IMD comprising a combination of 38 separate indicators is assigned to each LSOA. Every residential postcode is assigned to a LSOA and thus an IMD. This was applied to the postcodes of Rotherham patients at time of BO diagnosis. IMD Quintiles were derived by dividing the distribution of all IMD scores in England into 5 equal categories. The 6257 residential postcodes for Rotherham and the 1076 BO patients were placed in the quintiles relevant to their IMD score. Analysis: Chi square goodness of fit tests were used to compare the observed (O) distribution of BO to the expected (E). Analysis was stratified into those diagnosed before 2001 and 2001 onwards, this being the median year of diagnosis.
Results (See Table) 2/3rds of all Rotherham postcodes fell into the 2 most deprived quintiles. The O/E IMD distribution of the BO cohort diagnosed before 2001 was similar to that of the Rotherham population but highly significant differences emerged later (p = 0.0001): the two least deprived quintiles had 170 BO patients against 124 expected (37% increase).
Conclusion No single factor is likely to explain the change observed in the last decade, however, the highly significant difference observed points to a strong association between lower deprivation and increasing risk of BO. To the best of our knowledge this is the first report showing a quantitative link between BO and socio-economic status, which may form a basis for the apparent socio-economic shift between squamous oesophageal cancer and OAC.
Disclosure of Interest None Declared.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.