Area-level deprivation and oral cancer in England 2012–2016

Vahid Ravaghi,Colum Durkan,Kate Jones,Rebecca Girdler,John Mair-Jenkins,Gill Davies,David Wilcox,Mark Dermont,Sandra White,Yvonne Dailey,Alexander John Morris

doi:10.1016/j.canep.2020.101840

Vahid Ravaghi, Colum Durkan + Show 9 more

Open Access

https://doi.org/10.1016/j.canep.2020.101840

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Journal: Cancer detection and prevention	Publication Date: Oct 27, 2020
Citations: 12	License type: cc-by

Affiliation: Public Health England

Abstract

BackgroundThe relationship between deprivation and oral cancer is complex. We examined magnitude and shape of deprivation-related inequalities in oral cancer in England 2012-2016. MethodsOral cancer was indicated by cancers of the lip and oral cavity (ICD10 C00-C06) and lip, oral cavity and pharynx (C00-C14) and deprivation by the Index of Multiple Deprivation. Deprivation inequality in incidence and mortality rates of oral cancer outcomes was measured using the Relative Index of Inequality (RII). Fractional polynomial regression was used to explore the shape of the relationships between deprivation and oral cancer outcomes. Multivariate regression models were fitted with the appropriate functions to examine the independent effect of deprivation on cancer adjusting for smoking, alcohol and ethnicity. ResultsIncidence rate ratios (IRRs) and mortality rate ratios (MRRs) were greater for more deprived areas. The RII values indicated significant inequalities for oral cancer outcomes but the magnitude of inequalities were greater for mortality. The relationships between deprivation and oral cancer outcomes were curvilinear. Deprivation, Asian ethnicity and alcohol consumption were associated with higher incidence and mortality rates of oral cancer. ConclusionThis is the first study, to our knowledge, exploring the shape of socioeconomic inequalities in oral cancer at neighbourhood level. Deprivation-related inequalities were present for all oral cancer outcomes with a steeper rise at the more deprived end of the deprivation spectrum. Deprivation predicted oral cancer even after accounting for other risk factors.

Highlights

Oral cancer has been linked to lower socioeconomic status in both high income (HICs) and lower middle income countries (LMICs) [1] with those coming from poorer backgrounds being at greater risk [2]
Oral cancer was indicated by cancers of the lip and oral cavity (ICD10 C00-C06) and lip, oral cavity and pharynx (C00-C14) and deprivation by the Index of Multiple Deprivation
Around half of oral cavity cancers and 85–90 % of nasopharyngeal and pharyngeal cancers are attributable to population risk factors [8] and oral cancer is strongly linked to to bacco and alcohol [9], lifestyle risk factors which are associated with deprivation

Summary

Introduction

Oral cancer has been linked to lower socioeconomic status in both high income (HICs) and lower middle income countries (LMICs) [1] with those coming from poorer backgrounds being at greater risk [2]. The shape of socioeconomic inequalities in oral cancer is complex because of the associated risk factors. The shape of socioeconomic inequality in oral cancer is, influenced by the contribution of opposing risk factors. Deprivation inequality in incidence and mortality rates of oral cancer outcomes was measured using the Relative Index of Inequality (RII). The RII values indicated significant inequalities for oral cancer outcomes but the magnitude of inequalities were greater for mortality. Deprivation, Asian ethnicity and alcohol consumption were associated with higher incidence and mortality rates of oral cancer. Conclusion: This is the first study, to our knowledge, exploring the shape of socioeconomic inequalities in oral cancer at neighbourhood level. Deprivation predicted oral cancer even after accounting for other risk factors

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