Objective To assess the effectiveness of the NHS Cancer Plan (2000) and subsequent national cancer policy initiatives in improving cancer survival and reducing socioeconomic inequalities in survival in England.
Design Population based cohort study.
Setting England.
Population More than 3.5 million registered patients aged 15-99 with a diagnosis of one of the 24 most common primary, malignant, invasive neoplasms between 1996 and 2013.
Main outcome measures Age standardised net survival estimates by cancer, sex, year, and deprivation group. These estimates were modelled using regression model with splines to explore changes in the cancer survival trends and in the socioeconomic inequalities in survival.
Results One year net survival improved steadily from 1996 for 26 of 41 sex-cancer combinations studied, and only from 2001 or 2006 for four cancers. Trends in survival accelerated after 2006 for five cancers. The deprivation gap observed for all 41 sex-cancer combinations among patients with a diagnosis in 1996 persisted until 2013. However, the gap slightly decreased for six cancers among men for which one year survival was more than 65% in 1996, and for cervical and uterine cancers, for which survival was more than 75% in 1996. The deprivation gap widened notably for brain tumours in men and for lung cancer in women.
Conclusions Little evidence was found of a direct impact of national cancer strategies on one year survival, and no evidence for a reduction in socioeconomic inequalities in cancer survival. These findings emphasise that socioeconomic inequalities in survival remain a major public health problem for a healthcare system founded on equity.

中文翻译：

---

1996-2013 年英国国家癌症政策对癌症生存趋势和社会经济不平等的影响：基于人口的研究

目的评估英国 NHS 癌症计划 (2000) 和随后的国家癌症政策举措在提高癌症生存率和减少生存方面的社会经济不平等方面的有效性。
设计基于人群的队列研究。
设置英格兰。
人口1996 年至 2013 年间，超过 350 万年龄在 15-99 岁之间的登记患者被诊断患有 24 种最常见的原发性、恶性、侵袭性肿瘤之一。
主要结果指标按癌症、性别、年份和贫困组划分的年龄标准化净生存估计。这些估计值使用带有样条的回归模型进行建模，以探索癌症生存趋势的变化和生存的社会经济不平等。
结果在所研究的 41 种性癌组合中，有 26 种的一年净生存率从 1996 年开始稳步提高，而从 2001 年或 2006 年开始，四种癌症的净生存率只有 2001 年或 2006 年才有稳步提高。2006 年之后，五种癌症的生存率趋势加速。在 1996 年诊断的患者中，所有 41 种性癌组合中观察到的剥夺差距一直持续到 2013 年。然而，1996 年男性中的 6 种癌症的一年生存率超过 65%，以及宫颈癌和宫颈癌的差距略有缩小。子宫癌，1996 年生存率超过 75%。男性脑肿瘤和女性肺癌的贫困差距显着扩大。
结论几乎没有证据表明国家癌症战略对一年生存率有直接影响，也没有证据表明癌症生存率的社会经济不平等有所减少。这些发现强调，对于建立在公平基础上的医疗保健系统来说，生存方面的社会经济不平等仍然是一个主要的公共卫生问题。