Time trends in socioeconomic inequalities in cancer mortality: results from a 35 year prospective study in British men.

Sheena E Ramsay,Peter H Whincup,Lucy T Lennon,Sasiwarang Goya Wannamethee,Richard W Morris,Anna Olia Papacosta

doi:10.1186/1471-2407-14-474

Abstract

BackgroundSocioeconomic inequalities in cancer mortality in Britain have been shown to be present in the 1990s and early 2000s. Little is known about on-going patterns in such inequalities in cancer mortality. We examined time trends in socioeconomic inequalities in cancer mortality in Britain between 1978 and 2013.MethodsA socially representative cohort of 7489 British men with data on longest-held occupational social class, followed up for 35 years, in whom 1484 cancer deaths occurred.ResultsThe hazard ratio for cancer mortality for manual vs. non-manual social classes remained unchanged; among men aged 50–59 years it was 1.62 (95%CI 1.17–2.24) between 1980–1990 and 1.65 (95%CI 1.14–2.40) between 1990–2000. The absolute difference (non-manual minus manual) in probability of surviving death from cancer to 70 years remained at 3% over the follow-up. The consistency of risks over time was similar for both smoking-related and non-smoking related cancer mortality.ConclusionSocioeconomic inequalities in cancer mortality in Britain remain unchanged over the last 35 years and need to be urgently addressed.

Highlights

Socioeconomic inequalities in cancer mortality in Britain have been shown to be present in the 1990s and early 2000s
Survival rates for most cancers have improved in the UK, socioeconomic inequalities in survival are known to persist in England, such that those from lower compared to higher socioeconomic groups have an increased risk of cancer mortality [9]
Cancer mortality was ascertained from death certificates with malignant neoplasms identified as the underlying cause of death (International Classification of Diseases, 9th revision (ICD-9) ICD 140–208); smokingrelated cancer deaths included cancers of the lip, tongue, oral cavity and larynx (ICD codes 140, 141, 143–149), oesophagus (ICD 150), pancreas (ICD 157), respiratory tract (ICD 160–163), bladder (ICD 188), kidney (ICD 189), acute myeloid leukemia (ICD 208.0) and stomach (ICD 151.0; excluding noncardia); [16] all other malignant neoplasms were classified as non-smoking related cancers for the analysis

Summary

Introduction

Socioeconomic inequalities in cancer mortality in Britain have been shown to be present in the 1990s and early 2000s. We examined time trends in socioeconomic inequalities in cancer mortality in Britain between 1978 and 2013. Survival rates for most cancers have improved in the UK, socioeconomic inequalities in survival are known to persist in England, such that those from lower compared to higher socioeconomic groups have an increased risk of cancer mortality [9]. Different factors contributing to these inequalities are socioeconomic differences in risk factors (such as tobacco), stage of diagnosis and access to Recent public health policies in the UK have aimed at reducing socioeconomic inequalities in cancer mortality. Given the recent declines in the UK in smoking [15], a leading risk factor for cancer [16], which is strongly socioeconomically patterned [17], we were interested in assessing changes in socioeconomic inequalities separately for smoking and non-smoking related cancer mortality. We have previously demonstrated that inequalities in all-cause and coronary disease mortality (another leading cause of death) have not narrowed in Britain [18], – in this paper we investigate the same issue for cancer mortality

Objectives

Methods

Results

Conclusion