Socioeconomic disparities in treatment and survival of esophageal and gastric cancer in The Netherlands

A nationwide population-based study in the Netherlands (where all inhabitants are required to have health insurance that covers standard medical care) investigated socioecomic status (SES)-related disparitities in treatment and survival of gastric or esophageal cancer diagnosed in 2015-2022. Patients were stratified into three SES groups using median disposible houshold income per postal code area; additional stratification was performed by histological subtype. The study included 30,184 esophagogastric patients. In curable gastric cancer, patients with middle income had significantly higher likelihood of receiving surgery compared to low income (OR 1.48; p<0.001). For esophageal cancer, both middle- (OR 1.17; pxtagstartz0.001) and high-income patients (OR 1.27; pxtagstartz0.001) were more likely to undergo surgery than those with low income. In palliative setting, middle- and high-income patients were also more likely to receive systemic therapy. Relative survival analyses further demonstrated that middle- and high-income groups consistently had higher median and 5-year survival compared to the low-income group. The authors conclude that despite universal health insurance, SES-related disparities in treatment and survival of gastroesophageal cancer patients persist in The Netherlands.