Area socioeconomic status is independently associated with esophageal cancer mortality in Shandong, China

Kou Kou,Zhentao Fu,Peter David Baade,Michelle Gatton,Susanna Cramb,Xiaolei Guo,Jie Chu,Jiandong Sun,Zilong Lu,Aiqiang Xu

doi:10.1038/s41598-019-42774-x

Abstract

Esophageal cancer (EC) is a leading cause of cancer death in China. Within Shandong Province, a geographic cluster with high EC mortality has been identified, however little is known about how area-level socioeconomic status (SES) is associated with EC mortality in this province. Multilevel models were applied to EC mortality data in 2011–13 among Shandong residents aged 40+ years. Area-level SES factors consisted of residential type (urban/rural) of the sub-county-level units (n = 262) and SES index (range: 0–10) of the county-level units (n = 142). After adjustment for age and sex, residents living in rural areas had a 22% (95% CI: 13–32%) higher risk of dying from EC than those in urban areas. With each unit increase in the SES index, the average risk of dying from EC reduced by 10% (95% CI: 3–18%). The adjustment of area-level SES variables had little impact on the risk ratio of EC mortality between the high-mortality cluster and the rest of Shandong. In conclusion, rural residence and lower SES index are strongly associated with elevated risks of EC death. However, these factors are independent of the high mortality in the cluster area of Shandong. The underlying causes for this geographic disparity need to be further investigated.

Highlights

Esophageal cancer (EC) is an important public health issue in China
We aimed to examine the relationships between residential type, socioeconomic status (SES) index and EC mortality, and explore whether these area-level SES factors explain the previously identified high-mortality cluster in Shandong
The SES indexes of counties located in cluster areas were not significantly different from the rest counties in Shandong based on Mann-Whitney U test (p = 0.962)

Summary

Introduction

Esophageal cancer (EC) is an important public health issue in China. Within the Shandong Province of China, the EC mortality in the eastern region of the province was lower than in the central and western regions, with a consistently high-mortality risk cluster identified in the mid-west region (Fig. 1). Population-based studies considering area-level effects are scarce in China. They are not able to indicate whether, and to what extent, the geographic disparities of EC mortality are due to regional resources. The analysis aims to elucidate potential associations between area-level SES factors and EC mortality among the Shandong population, furthering the understanding of how place matters to www.nature.com/scientificreports/. We aimed to examine the relationships between residential type (sub-county level), SES index (county-level) and EC mortality, and explore whether these area-level SES factors explain the previously identified high-mortality cluster in Shandong

Objectives

Methods

Results

Conclusion