Abstract
BackgroundOral cancer is an important health issue, with changing incidence in many countries. Oropharyngeal cancer (OPC, in tonsil and oropharygeal areas) is increasing, while oral cavity cancer (OCC, other sites in the mouth) is decreasing. There is the need to identify high risk groups and communities for further study and intervention. The objective of this study was to determine how the incidence of OPC and OCC varied by neighbourhood socioeconomic status (SES) in British Columbia (BC), including the magnitude of any inequalities and temporal trends.MethodsICDO-3 codes were used to identify OPC and OCC cases in the BC Cancer Registry from 1981–2010. Cases were categorized by postal codes into SES quintiles (q1-q5) using VANDIX, which is a census-based, multivariate weighted index based on neighbourhood average household income, housing tenure, educational attainment, employment and family structure. Age-standardized incidence rates were determined for OPC and OCC by sex and SES quintiles and temporal trends were then examined.ResultsIncidence rates are increasing in both men and women for OPC, and decreasing in men and increasing in women for OCC. This change is not linear or proportionate between different SES quintiles, for there is a sharp and dramatic increase in incidence according to the deprivation status of the neighbourhood. The highest incidence rates in men for both OPC and OCC were observed in the most deprived SES quintile (q5), at 1.7 times and 2.2 times higher, respectively, than men in the least deprived quintile (q1). For OPC, the age-adjusted incidence rates significantly increased in all SES quintiles with the highest increase observed in the most deprived quintile (q5). Likewise, the highest incidence rates for both OPC and OCC in women were observed in the most deprived SES quintile (q5), at 2.1 times and 1.8 times higher, respectively, than women in the least deprived quintile (q1).ConclusionWe report on SES disparities in oral cancer, emphasizing the need for community-based interventions that address access to medical care and the distribution of educational and health promotion resources among the most SES deprived communities in British Columbia.
Highlights
Oral cancer is an important health issue, with changing incidence in many countries
In our previous research in British Columbia (BC), we found that the incidence is increasing among both men and women for oropharyngeal cancers (OPC, in tonsil and oropharygeal areas), and decreasing among men for oral cavity cancer (OCC, other sites in the mouth) [18]
Greater proportions of Oropharyngeal cancer (OPC) cases were diagnosed in more recent years for men than women (P = 0.004), whereas greater proportions of Oral cavity cancer (OCC) cases were diagnosed in more recent years for women than men (P < 0.001)
Summary
Oral cancer is an important health issue, with changing incidence in many countries. Oropharyngeal cancer (OPC, in tonsil and oropharygeal areas) is increasing, while oral cavity cancer (OCC, other sites in the mouth) is decreasing. An important reason for these differences relates to socioeconomic inequities because people residing in poorer neighbourhoods have higher prevalence of high risk behaviours such as smoking and alcohol and less access to health care services. Their research suggested that in comparison to populations with higher SES, the risk of developing oral cancer was 1.85 times higher with lower educational attainment, 1.84 times higher with low occupational social class and 2.41 times higher with lower income. They suggested that lower SES was significantly associated with increased oral cancer risk in high and lower income countries, which remained after adjusting for potential behavioural confounders. It is important to ascertain the risk of oral cancers according to SES status
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