Cancer mortality inequalities in urban areas: a Bayesian small area analysis in Spanish cities

Marc Marí-Dell’olmo ,Ana Gandarillas,Rosa Puigpinós‐Riera ,Isabel M Pasarín,Marc Sáez,Agustín Montes-Martínez,Montse Calvo,Gonzalo López‐Abente ,Mercè Gotsens,Carlos Ascaso,Antonio Daponte,Carmen Martos ,M Felícitas Domínguez‐Berjón ,Gemma Serral,Imanol Montoya,Miguel A Martínez-Beneito ,Santiago Esnaola,Andreu Nolasco,Carme Borrell,Pablo Sánchez‐Villegas ,Maica Rodríguez-Sanz

doi:10.1186/1476-072x-10-6

Abstract

BackgroundIntra-urban inequalities in mortality have been infrequently analysed in European contexts. The aim of the present study was to analyse patterns of cancer mortality and their relationship with socioeconomic deprivation in small areas in 11 Spanish cities.MethodsIt is a cross-sectional ecological design using mortality data (years 1996-2003). Units of analysis were the census tracts. A deprivation index was calculated for each census tract. In order to control the variability in estimating the risk of dying we used Bayesian models. We present the RR of the census tract with the highest deprivation vs. the census tract with the lowest deprivation.ResultsIn the case of men, socioeconomic inequalities are observed in total cancer mortality in all cities, except in Castellon, Cordoba and Vigo, while Barcelona (RR = 1.53 95%CI 1.42-1.67), Madrid (RR = 1.57 95%CI 1.49-1.65) and Seville (RR = 1.53 95%CI 1.36-1.74) present the greatest inequalities. In general Barcelona and Madrid, present inequalities for most types of cancer. Among women for total cancer mortality, inequalities have only been found in Barcelona and Zaragoza. The excess number of cancer deaths due to socioeconomic deprivation was 16,413 for men and 1,142 for women.ConclusionThis study has analysed inequalities in cancer mortality in small areas of cities in Spain, not only relating this mortality with socioeconomic deprivation, but also calculating the excess mortality which may be attributed to such deprivation. This knowledge is particularly useful to determine which geographical areas in each city need intersectorial policies in order to promote a healthy environment.

Highlights

Cancer has been considered a modern disease [1] due to its being linked with an increase in life expectancy.According to the study “The Global Burden of Diseases”, 58.8 million people died during 2004, death being due to cancer in one eighth of them
This study was carried out in the framework of a project known as MEDEA (Socioeconomic and environmental inequalities in mortality in small areas of Spanish cities - http://www.proyectomedea.org/) conducted jointly by 10 Spanish research groups
As the scale of the deprivation index is adimensional, to illustrate the impact of deprivation on mortality we present, for every cancer cause of death and city, the Relative Risk (RR) of the census tract with percentile 95 of the deprivation index vs. the census tract with percentile 5

Summary

Introduction

Cancer has been considered a modern disease [1] due to its being linked with an increase in life expectancy. According to the study “The Global Burden of Diseases”, 58.8 million people died during 2004, death being due to cancer in one eighth of them. Despite the rise in incidence, cancer mortality is tending to decline in the European. A rise has been detected in inequalities, both in between socioeconomic groups, and between countries and geographical areas [6,7,8,9]. Intra-urban inequalities in mortality have been infrequently analysed in European contexts. The aim of the present study was to analyse patterns of cancer mortality and their relationship with socioeconomic deprivation in small areas in 11 Spanish cities

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