Abstract
IntroductionGeographical variations in cancer mortality can be explained, in part, by their association with social inequalities. The objective of our study was to analyse the spatial pattern of mortality in relation to the most common causes of cancer in the Spanish autonomous community of Andalusia and its possible association with social inequalities.Materials and methodsA small area cross-sectional study in Andalusia, with census tracts as units of spatial analysis, for the period 2002–2013. Cases and person-years, sex and age group came from the Longitudinal Population Database of Andalusia. Standardized mortality rates and smoothed risk ratios were calculated using the Besag, York and Mollié model for lung, colorectal, breast, prostate, bladder and stomach cancer. In order to evaluate the association with social inequalities we included the deprivation index of the census tract as a covariate.ResultsThe results show an East-West mortality pattern with higher risk in the west for lung and bladder cancer among men, and breast cancer among women. For all of Andalusia, the association between deprivation index of the census tract and mortality relative risks is positive and significant for lung, stomach and bladder cancers in men, while in women we observed a negative association for lung cancer and a positive for stomach cancer.ConclusionsKnowledge regarding the spatial distribution of cancer mortality and the socioeconomic inequalities related should contribute to the design of specific health and social policies–aimed at tackling cancer mortality and social inequalities in areas of high mortality and/or levels of deprivation.
Highlights
Geographical variations in cancer mortality can be explained, in part, by their association with social inequalities
For all of Andalusia, the association between deprivation index of the census tract and mortality relative risks is positive and significant for lung, stomach and bladder cancers in men, while in women we observed a negative association for lung cancer and a positive for stomach cancer
Knowledge regarding the spatial distribution of cancer mortality and the socioeconomic inequalities related should contribute to the design of specific health and social policies
Summary
Geographical variations in cancer mortality can be explained, in part, by their association with social inequalities. Spain has a National Health System, which during the period 1981–2002 suffered a process of devolution of health care to the 17 autonomous communities that conform the country This resulted in a decentralized health system with universal coverage for primary, specialized and hospital care, with minimal territorial differences in access to health care services [4].Andalusia, situated in the south of -Spain, is the second largest autonomous community by area, occupying 17.25% of Spanish territory. It is the fourth most populated region in Europe, and the most populous in Spain, with 8.50 million inhabitants. A total 74% of Andalusian municipalities are at the highest levels of deprivation, with the most pronounced socio-economic inequalities being found in eastern Andalusia [5]
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