Skip to main content

Advertisement

SpringerLink
Log in

Identification of socially vulnerable cancer patients — development of a register-based index (rSVI)

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

A Correction to this article was published on 22 December 2022

This article has been updated

Abstract

Background

Social vulnerability is a complex construct which is beyond relying on single measures. If socially vulnerable patients should be identified, we need a composite measure capturing the patient’s overall circumstances. This study presents the development of a social vulnerability index (rSVI) for cancer patients based on administrative data from population-based registers.

Methods

All patients, who died from cancer within 5 years after the cancer diagnosis during 2013–2018 (n = 44,187), were identified and divided in four subcohorts according to survival; index cohort surviving 3–5 years (n = 3044 surviving 3–5 years), cohort 1 (n = 27,170 surviving < 1 year), cohort 2 (n = 9450 surviving 1–2 years), and cohort 3 (n = 4523 surviving 2–3 years). Variables from ten registries on health and social issues were linked to each individual patient. Variables of interest were weighted to construct the rSVI using the index-cohort. rSVI was subsequently tested on the three other cohorts for validation.

Results

The rSVI included weighted values for marital status, ethnicity, education, income, unemployment, psychiatric comorbidity, and somatic comorbidity. The validity of the rSVI was supported by the expected trend in proportions of vulnerable patients when applied on the other cohorts. Single social measures appeared insufficient in identification of vulnerable patients when compared with the rSVI.

Conclusion

The rSVI provides a tool for identification of socially vulnerable cancer patients using administrative data. The index requires further validation in other patient groups and is tested against other measures of vulnerability. Future perspectives are to use the rSVI as predictor of advanced cancer patients’ use of healthcare services.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The data will not be deposited due to Danish law.

Code availability

Stata codes are available on request.

Change history

References

  1. Dalton SO, Schuz J, Enyholm G, Johansen C, Kjaer SK, Steding-Jessen M et al (2008) Social inequality in incidence of and survival from cancer in a population-based study in Denmark, 1994-2003: summary of findings. Eur J Cancer 44:2074–85. https://doi.org/10.1016/j.ejca.2008.06.018

    Article  Google Scholar 

  2. Dalton SO, Olsen MH, Johansen C, Olsen JH, Andersen KK (2019) Socioeconomic inequality in cancer survival - changes over time. A population-based study, Denmark, 1987–2013. Acta Oncol 58:737–44. https://doi.org/10.1080/0284186x.2019.1566772

    Article  Google Scholar 

  3. Neamtu I, Westergaard-Nielsen N (2013) Sources and impact of rising inequality in Denmark. Center for Corporate Performance, Aarhus University. Available from: https://www.cbs.dk/files/cbs.dk/new_papers_4.pdf. Accessed 19 Sept 2021

  4. Udesen CH, Skaarup C, Petersen MNS, Ersbøll AK (2020). Social inequality in health and disease - the development in Denmark in the period 2010–2017 [DANISH]. The Danish Health Authority. Available from: https://www.sst.dk/-/media/Udgivelser/2020/Ulighed-i-sundhed/Social-ulighed-i-sundhed-og-sygdom-tilgaengelig.ashx?la=da&hash=CB63CAD067D942FE54B99034085E78BE9F486A92. Accessed 19 Sept 2021

  5. Andrew MK, Keefe JM (2014) Social vulnerability from a social ecology perspective: a cohort study of older adults from the National Population Health Survey of Canada. BMC Geriatr 14. https://doi.org/10.1186/1471-2318-14-90

  6. Zimmermann A (2017) Social vulnerability as an analytical perspective. Discussion Paper No. 4, Berlin: Population Europe. Available from: https://population-europe.eu/files/documents/pe_discussionpaper4_final_web.pdf. Accessed 30 Apr 2021

  7. Ruof MC (2004) Vulnerability, vulnerable populations, and policy. Kennedy Inst Ethics J 14:411–25. https://doi.org/10.1353/ken.2004.0044

    Article  Google Scholar 

  8. Galobardes B, Shaw M, Lawlor DA, Lynch JW, Davey Smith G (2006) Indicators of socioeconomic position (part 1). J Epidemiol Community Health 60:7–12. https://doi.org/10.1136/jech.2004.023531

    Article  Google Scholar 

  9. Andrew MK, Mitnitski AB, Rockwood K (2008) Social vulnerability, frailty and mortality in elderly people. PLoS ONE 3:e2232. https://doi.org/10.1371/journal.pone.0002232

    Article  CAS  Google Scholar 

  10. Schmidt M, Schmidt SAJ, Adelborg K, Sundboll J, Laugesen K, Ehrenstein V et al (2019) The Danish health care system and epidemiological research: from health care contacts to database records. Clin Epidemiol 11:563–91. https://doi.org/10.2147/CLEP.S179083

    Article  Google Scholar 

  11. Thygesen LC, Ersboll AK (2014) When the entire population is the sample: strengths and limitations in register-based epidemiology. Eur J Epidemiol 29:551–8. https://doi.org/10.1007/s10654-013-9873-0

    Article  Google Scholar 

  12. Silver JK, Raj VS, Fu JB, Wisotzky EM, Smith SR, Kirch RA (2015) Cancer rehabilitation and palliative care: critical components in the delivery of high-quality oncology services. Support Care Cancer 23:3633–43. https://doi.org/10.1007/s00520-015-2916-1

    Article  Google Scholar 

  13. Moustsen IR, Larsen SB, Vibe-Petersen J, Trier K, Bidstrup PE, Andersen KK et al (2015) Social position and referral to rehabilitation among cancer patients. Acta Oncol 54:720–6. https://doi.org/10.3109/0284186x.2014.997836

    Article  Google Scholar 

  14. Oksbjerg Dalton S, Halgren Olsen M, Moustsen IR, Wedell Andersen C, Vibe-Petersen J, Johansen C (2019) Socioeconomic position, referral and attendance to rehabilitation after a cancer diagnosis: a population-based study in Copenhagen, Denmark 2010–2015. Acta Oncol 58:730–6. https://doi.org/10.1080/0284186x.2019.1582800

    Article  Google Scholar 

  15. Adsersen M, Thygesen LC, Neergaard MA, Jensen AB, Sjogren P, Damkier A et al (2019) Cohabitation status influenced admittance to specialized palliative care for cancer patients: a Nationwide Study from the Danish Palliative Care Database. J Palliat Med 22:164–72. https://doi.org/10.1089/jpm.2018.0201

    Article  Google Scholar 

  16. Sampedro Pilegaard M, Knold Rossau H, Lejsgaard E, Kjer Møller JJ, Jarlbaek L, Dalton SO, et al. (2020) Rehabilitation and palliative care for socioeconomically disadvantaged patients with advanced cancer: a scoping review. Acta Oncol:1–12. https://doi.org/10.1080/0284186x.2020.1827156

  17. Danish Research Center for Equality in Cancer (COMPAS). [cited 2021 10–18]. Available from: https://www.compas.dk/]

  18. Gjerstorff ML (2011) The Danish Cancer Registry. Scand J Public Health 39:42–5. https://doi.org/10.1177/1403494810393562

    Article  Google Scholar 

  19. Helweg-Larsen K (2011) The Danish Register of causes of death. Scand J Public Health 39:26–9. https://doi.org/10.1177/1403494811399958

    Article  Google Scholar 

  20. Schmidt M, Pedersen L, Sorensen HT (2014) The Danish Civil Registration System as a tool in epidemiology. Eur J Epidemiol 29:541–549. https://doi.org/10.1007/s10654-014-9930-3

    Article  Google Scholar 

  21. Schmidt M, Schmidt SAJ, Sandegaard JL, Ehrenstein V, Pedersen L, Sørensen HT (2015) The Danish National patient registry: A review of content, data quality, and research potential. Clin Epidemiol 7:449–490. https://doi.org/10.2147/CLEP.S91125

    Article  Google Scholar 

  22. The Danish Agency for Labour Market and Recruitment (2021) DREAM vejledning version 46 [DANISH]. Available from: https://www.dst.dk/Site/Dst/SingleFiles/GetArchiveFile.aspx?fi=6705686690&fo=0&ext=forskning. Accessed 18 Oct 2021

  23. Jensen VM, Rasmussen AW (2011) Danish education registers. Scand J Public Health 39:91–94. https://doi.org/10.1177/1403494810394715

    Article  Google Scholar 

  24. Baadsgaard M, Quitzau J (2011) Danish registers on personal income and transfer payments. Scand J Public Health 39:103–105. https://doi.org/10.1177/1403494811405098

    Article  Google Scholar 

  25. Danish National Board of Health (2010) Register declaration for The National Registry of Alcohol Treatment [DANISH]. Copenhagen. Available from: https://sundhedsdatastyrelsen.dk/-/media/sds/filer/registre-og-services/nationale-sundhedsregistre/sygedomme-laegemidler-og-behandlinger/alkoholregisteret/registerdeklaration-nationale-alkoholbehandlings-register.pdf?la=da. Accessed 18 Oct 2021

  26. The Danish Health Authority (2015) Register declaration for The Registry of Drug Abusers Undergoing Treatment [DANISH]. Copenhagen. Available from: https://sundhedsdatastyrelsen.dk/-/media/sds/filer/registre-og-services/nationale-sundhedsregistre/sygedomme-laegemidler-og-behandlinger/stofmisbrugere-i-behandling/registerdeklaration-for-stofmisbrugere-i-behandling.pdf?la=da#:~:text=0.4%20Form%C3%A5l%20med%20register%20Registerets,opfylde%20Danmarks%20internationale%20forpligtigelser%20ifht. Accessed 18 Oct 2021

  27. Statistics Denmark. Crime statistics [DANISH]. Copenhagen. [cited 2021 10–18]. Available from: https://www.dst.dk/da/Statistik/dokumentation/Times/kriminalstatistik].

  28. Hjollund NH, Larsen FB, Andersen JH (2007) Register-based follow-up of social benefits and other transfer payments: Accuracy and degree of completeness in a Danish interdepartmental administrative database compared with a population-based survey. Scand J Public Health 35:497–502. https://doi.org/10.1080/14034940701271882

    Article  Google Scholar 

  29. Lynge E, Sandegaard JL, Rebolj M (2011) The Danish National Patient Register. Scand J Public Health 39:30–33. https://doi.org/10.1177/1403494811401482

    Article  Google Scholar 

  30. Ferlay J, Colombet M, Soerjomataram I, Dyba T, Randi G, Bettio M et al (2018) Cancer incidence and mortality patterns in Europe: Estimates for 40 countries and 25 major cancers in 2018. Eur J Cancer 103:356–387. https://doi.org/10.1016/j.ejca.2018.07.005

    Article  CAS  Google Scholar 

  31. Hurst SA (2008) Vulnerability in research and health care; describing the elephant in the room? Bioethics 22:191–202. https://doi.org/10.1111/j.1467-8519.2008.00631.x

    Article  Google Scholar 

  32. Hagenaars AJM, Vos Kd, Zaidi MA (1994) Poverty statistics in the late 1980s: research based on micro-data. Luxembourg: Office for Official Publications of the European Communities. ISBN: 9282689824

  33. Benjaminsen L, Birkelund JF, Ememark MH, Andrade SB (2018) Socially marginalized citizens use of the welfare system [DANISH]. Copenhagen. VIVE - Viden til Velfærd. Available from: https://www.vive.dk/media/pure/6999/1717876. Accessed 20 Aug 2021

  34. Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC et al (2005) Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43:1130–1139. https://doi.org/10.1097/01.mlr.0000182534.19832.83

    Article  Google Scholar 

  35. UNESCO (2012) International Standard Classification of Education (ISCED) 2011. UNESCO Institute for Statistics. [Available from: http://uis.unesco.org/sites/default/files/documents/international-standard-classification-of-education-isced-2011-en.pdf]

  36. Nguyen TN, Ngangue P, Bouhali T, Ryan BL, Stewart M, Fortin M (2019) Social vulnerability in patients with multimorbidity: a cross-sectional analysis. Int J Environ Res Public Health 16:1244. https://doi.org/10.3390/ijerph16071244

    Article  Google Scholar 

  37. Kisely S, Forsyth S, Lawrence D (2016) Why do psychiatric patients have higher cancer mortality rates when cancer incidence is the same or lower? Aust N Z J Psychiatry 50:254–263. https://doi.org/10.1177/0004867415577979

    Article  Google Scholar 

  38. Kreek MJ (2011) Extreme marginalization: addiction and other mental health disorders, stigma, and imprisonment. Ann N Y Acad Sci 1231:65–72. https://doi.org/10.1111/j.1749-6632.2011.06152.x

    Article  Google Scholar 

  39. Rutjes AW, Reitsma JB, Coomarasamy A, Khan KS, Bossuyt PM (2007) Evaluation of diagnostic tests when there is no gold standard. A review of methods. Health Technol Assess 11. https://doi.org/10.3310/hta11500

  40. Sánchez-Garrido N, Aguilar-Navarro SG, Ávila-Funes JA, Theou O, Andrew M, Pérez-Zepeda MU (2021) The social vulnerability index, mortality and disability in mexican middle-aged and older adults. Geriatrics 6. https://doi.org/10.3390/geriatrics6010024

  41. Wallace LMK, Theou O, Pena F, Rockwood K, Andrew MK (2015) Social vulnerability as a predictor of mortality and disability: cross-country differences in the survey of health, aging, and retirement in Europe (SHARE). Aging Clin Exp Res 27:365–372. https://doi.org/10.1007/s40520-014-0271-6

    Article  Google Scholar 

  42. Berends L, Garfield JB, Manning V, Buykx P, Lam T, Mugavin J et al (2016) Social disadvantage and past treatment among clients entering public alcohol and drug services in two Australian states. Int J Drug Policy 29:88–90. https://doi.org/10.1016/j.drugpo.2015.12.018

    Article  Google Scholar 

  43. Maschi T, Viola D, M TH, Harrison W, Koskinen L, Bellusa S (2014) Bridging community and prison for older adults: invoking human rights and elder and intergenerational family justice. Int J Prison Health 10:55–73. https://doi.org/10.1108/ijph-04-2013-0017

    Article  Google Scholar 

  44. Gilbert T, Neuburger J, Kraindler J, Keeble E, Smith P, Ariti C et al (2018) Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study. Lancet 391:1775–1782. https://doi.org/10.1016/s0140-6736(18)30668-8

    Article  Google Scholar 

  45. Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang XS et al (2015) Global surveillance of cancer survival 1995–2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet 385:977–1010. https://doi.org/10.1016/s0140-6736(14)62038-9

    Article  Google Scholar 

  46. Corbett T, Bridges J (2019) Multimorbidity in older adults living with and beyond cancer. Curr Opin Support Palliat Care 13:220–224. https://doi.org/10.1097/spc.0000000000000439

    Article  Google Scholar 

Download references

Acknowledgements

Special thanks to the Danish Research Centre for Equality in Cancer (COMPAS) for funding and focusing on enhancing the area of social inequality in cancer. Thanks also go to the University of Southern Denmark and REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care for funding this project.

Funding

This study was supported by The Danish Cancer Society [R223-A13094-18-S68] via the Danish Research Center for Equality in Cancer (COMPAS), faculty scolarship from the Faculty of Health Sciences on University of Southern Denmark, and The Danish Knowledge Centre for Rehabilitation and Palliative care, REHPA.

Author information

Authors and Affiliations

  1. REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark

    Jens-Jakob Kjer Møller, Marc Sampedro Pilegaard & Lene Jarlbaek

  2. Danish Research Centre for Equality in Cancer (COMPAS), Zealand University Hospital, Naestved, Denmark

    Jens-Jakob Kjer Møller & Karen la Cour

  3. Research Unit for User Perspectives and Community-based Interventions, the Research group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark

    Karen la Cour & Marc Sampedro Pilegaard

  4. Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark

    Sören Möller

  5. Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark

    Sören Möller

Authors
  1. Jens-Jakob Kjer Møller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karen la Cour
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marc Sampedro Pilegaard
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sören Möller
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lene Jarlbaek
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

1. JJKM, KlC, and LJ designed the study; JJKM performed the data management and analyses; all authors contributed to the interpretation of the results.

2. JJKM drafted the article. KlC, MSP, SM, and LJ revised the drafts critically for important intellectual content.

3. All authors approved the final version of the article to be published.

4. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Jens-Jakob Kjer Møller.

Ethics declarations

Ethics approval

Not required for registry-based studies in Denmark.

Consent to participate

Not required for registry-based studies in Denmark.

Consent for publication

Not required for registry-based studies in Denmark.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 23 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Møller, JJ.K., la Cour, K., Pilegaard, M.S. et al. Identification of socially vulnerable cancer patients — development of a register-based index (rSVI). Support Care Cancer 30, 5277–5287 (2022). https://doi.org/10.1007/s00520-022-06937-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-022-06937-3

Keywords

Search

Navigation