Abstract
BackgroundSocioeconomic inequalities in cancer mortality have been observed in different European countries and the US until the end of the 1990s, with changes over time in the magnitude of these inequalities and contrasted situations between countries. The aim of this study is to estimate relative and absolute educational differences in cancer mortality in France between 1999 and 2007, and to compare these inequalities with those reported during the 1990s.MethodsData from a representative sample including 1% of the French population were analysed. Educational differences among people aged 30–74 were quantified with hazard ratios and relative indices of inequality (RII) computed using Cox regression models as well as mortality rate difference and population attributable fraction.ResultsIn the period 1999–2007, large relative inequalities were found among men for total cancer and smoking and/or alcohol related cancers mortality (lung, head and neck, oesophagus). Among women, educational differences were reported for total cancer, head and neck and uterus cancer mortality. No association was found between education and breast cancer mortality. Slight educational differences in colorectal cancer mortality were observed in men and women. For most frequent cancers, no change was observed in the magnitude of relative inequalities in mortality between the 1990s and the 2000s, although the RII for lung cancer increased both in men and women. Among women, a large increase in absolute inequalities in mortality was observed for all cancers combined, lung, head and neck and colorectal cancer. In contrast, among men, absolute inequalities in mortality decreased for all smoking and/or alcohol related cancers.ConclusionAlthough social inequalities in cancer mortality are still high among men, an encouraging trend is observed. Among women though, the situation regarding social inequalities is less favourable, mainly due to a health improvement limited to higher educated women. These inequalities may be expected to further increase in future years.
Highlights
Socioeconomic inequalities in cancer mortality have been observed in different European countries and the US until the end of the 1990s, with changes over time in the magnitude of these inequalities and contrasted situations between countries
Between 1990–1998 and 1999–2007, the age-standardized cancer mortality rates (MR) strongly decreased among men from 375 to 312 whereas it remained stable among women
In the period 1999–2007, when compared with men with tertiary education, the hazard ratios (HR) of total cancer mortality was significantly elevated in all the other educational groups, ranging from 1.30 among men with upper secondary general education to 2.40 (2.102.73) among men without any diploma (Table 1)
Summary
Socioeconomic inequalities in cancer mortality have been observed in different European countries and the US until the end of the 1990s, with changes over time in the magnitude of these inequalities and contrasted situations between countries. Socioeconomic inequalities in cancer rates are an important contributor to socioeconomic inequalities in total mortality. During the 1990s, Time trends in socioeconomic inequalities in cancer mortality differ by cancer site and by country. In France, inequalities in total cancer and specific cancer site mortality increased until the end of the 1990s both in men and women [2]. Educational differences in mortality disappeared during the 1990s in France [12] as in Finland [13], whereas higher mortality rates among higher educated women were still observed in most countries [14]
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