An investigation of cancer survival inequalities associated with individual-level socio-economic status, area-level deprivation, and contextual effects, in a cancer patient cohort in England and Wales

Background People living in more deprived areas of high-income countries have lower cancer survival than those in less deprived areas. However, associations between individual-level socio-economic circumstances and cancer survival are relatively poorly understood. Moreover, few studies have addressed contextual effects, where associations between individual-level socio-economic status and cancer survival vary depending on area-based deprivation. Methods Using 9276 individual-level observations from a longitudinal study in England and Wales, we examined the association with cancer survival of area-level deprivation and individual-level occupation, education, and income, for colorectal, prostate and breast cancer patients aged 20–99 at diagnosis. With flexible parametric excess hazard models, we estimated excess mortality across individual-level and area-level socio-economic variables and investigated contextual effects. Results For colorectal cancers, we found evidence of an association between education and cancer survival in men with Excess Hazard Ratio (EHR) = 0.80, 95% Confidence Interval (CI) = 0.60;1.08 comparing “degree-level qualification and higher” to “no qualification” and EHR = 0.74 [0.56;0.97] comparing “apprenticeships and vocational qualification” to “no qualification”, adjusted on occupation and income; and between occupation and cancer survival for women with EHR = 0.77 [0.54;1.10] comparing “managerial/professional occupations” to “manual/technical,” and EHR = 0.81 [0.63;1.06] comparing “intermediate” to “manual/technical”, adjusted on education and income. For breast cancer in women, we found evidence of an association with income (EHR = 0.52 [0.29;0.95] for the highest income quintile compared to the lowest, adjusted on education and occupation), while for prostate cancer, all three individual-level socio-economic variables were associated to some extent with cancer survival. We found contextual effects of area-level deprivation on survival inequalities between occupation types for breast and prostate cancers, suggesting wider individual-level inequalities in more deprived areas compared to least deprived areas. Individual-level income inequalities for breast cancer were more evident than an area-level differential, suggesting that area-level deprivation might not be the most effective measure of inequality for this cancer. For colorectal cancer in both sexes, we found evidence suggesting area- and individual-level inequalities, but no evidence of contextual effects. Conclusions Findings highlight that both individual and contextual effects contribute to inequalities in cancer outcomes. These insights provide potential avenues for more effective policy and practice.

Interpretations based on delayed-domain (dis)appearance in printed advertising

In the Cognitive Linguistics literature, the way viewers understand printed ads whose interpretation is based on metaphors and/or metonymies is conditioned by the principle whereby the source and target domains are called upon by the linguistic expression at roughly the same time (cf. Gibbs, 2006). Nonetheless, Herrero-Ruiz (2019) has shown how certain contextual effects are generated when one of the metaphoric/metonymic domains appears at a later stage in the interpretation process (direct vs. delayed domain appearance). In this paper, we shall describe various analytical patterns grounded in this new perspective as well as the specific interpretive routes that they imply. In doing so, we offer an alternative to the existing approaches that try to account for the possible interpretations printed ads based on metaphors and/or metonymies may elicit.

Going in circles? The influence of the electoral cycle on the party behaviour in parliament

Most analyses dealing with the interaction of parties in parliament assume their interests to be fixed between elections. However, a rational perspective suggests that parties adapt their behaviour throughout the legislative term. I argue that this change is influenced by incentives and possibilities to shape legislation and the need to distinguish oneself from competitors. While for government parties it matters whether they have to share offices, for opposition parties the influence on policy-making is important. By examining the sentiment of all parliamentary speeches on bill proposals from six established democracies over more than twenty years, I analyse institutional and contextual effects. The results show that single-party governments tend to become more positive towards the end of the legislative cycle compared to coalition governments. On the other hand, opposition parties under minority governments, or with more institutionalised influence on government bills, show a more negative trend in comparison to their counterparts.