Abstract
BackgroundIn many high-income countries cancer mortality rates have declined, however, socioeconomic inequalities in cancer mortality have widened over time with those in the most deprived areas bearing the greatest burden. Less is known about the contribution of specific cancers to inequalities in total cancer mortality. MethodsUsing high-quality routinely collected population and mortality records we examine long-term trends in cancer mortality rates in Scotland by age group, sex, and area deprivation. We use the decomposed slope and relative indices of inequality to identify the specific cancers that contribute most to absolute and relative inequalities, respectively, in total cancer mortality. ResultsCancer mortality rates fell by 24 % for males and 10 % for females over the last 35 years; declining across all age groups except females aged 75+ where rates rose by 14 %. Lung cancer remains the most common cause of cancer death. Mortality rates of lung cancer have more than halved for males since 1981, while rates among females have almost doubled over the same period. ConclusionCurrent relative inequalities in total cancer mortality are dominated by inequalities in lung cancer mortality, but with contributions from other cancer sites including liver, and head and neck (males); and breast (females), stomach and cervical (younger females). An understanding of which cancer sites contribute most to inequalities in total cancer mortality is crucial for improving cancer health and care, and for reducing preventable cancer deaths.
Highlights
Cancer is the second leading cause of death worldwide with approximately one in six deaths globally [1], and one in four deaths in Europe and in the UK, due to cancer
Less is known about the contribution of specific cancers to inequalities in total cancer mortality
Cancer mortality rates fell by 24 % for males and 10 % for females over the last 35 years; declining across all age groups except females aged 75+ where rates rose by 14 %
Summary
Cancer is the second leading cause of death worldwide with approximately one in six deaths globally [1], and one in four deaths in Europe and in the UK, due to cancer. It is the leading cause of death in Scotland (population of approximately 5.4 million) with 16,250 cancer deaths recorded in 2018 (27 % of total deaths). While current male lung cancer mortality rates in Scotland are comparable to European rates, rates for females in Scotland are more than twice the rates for females in Europe [6,7]. Less is known about the contribution of specific cancers to inequalities in total cancer mortality
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