Inequalities In Cancer Mortality Research Articles

Trends in inequalities in premature cancer mortality by educational level in Colombia, 1998–2007

BackgroundThere is a paucity of studies on socioeconomic inequalities in cancer mortality in developing countries. We examined trends in inequalities in cancer mortality by educational attainment in Colombia during a...

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

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.

Psychosocial Functioning and Intelligence Both Partly Explain Socioeconomic Inequalities in Premature Death. A Population-Based Male Cohort Study

ObjectiveThe possible contributions of psychosocial functioning and intelligence differences to socioeconomic status (SES)-related inequalities in premature death were investigated. None of the previous studies focusing on inequalities in mortality has included measures of both psychosocial functioning and intelligence.MethodsThe study was based on a cohort of 49 321 men born 1949–1951 from the general community in Sweden. Data on psychosocial functioning and intelligence from military conscription at ∼18 years of age were linked with register data on education, occupational class, and income at 35–39 years of age. Psychosocial functioning was rated by psychologists as a summary measure of differences in level of activity, power of initiative, independence, and emotional stability. Intelligence was measured through a multidimensional test. Causes of death between 40 and 57 years of age were followed in registers.ResultsThe estimated inequalities in all-cause mortality by education and occupational class were attenuated with 32% (95% confidence interval: 20–45%) and 41% (29–52%) after adjustments for individual psychological differences; both psychosocial functioning and intelligence contributed to account for the inequalities. The inequalities in cardiovascular and injury mortality were attenuated by as much as 51% (24–76%) and 52% (35–68%) after the same adjustments, and the inequalities in alcohol-related mortality were attenuated by up to 33% (8–59%). Less of the inequalities were accounted for when those were measured by level of income, with which intelligence had a weaker correlation. The small SES-related inequalities in cancer mortality were not attenuated by adjustment for intelligence.ConclusionsDifferences in psychosocial functioning and intelligence might both contribute to the explanation of observed SES-related inequalities in premature death, but the magnitude of their contributions likely varies with measure of socioeconomic status and cause of death. Both psychosocial functioning and intelligence should be considered in future studies.

Socio-Demographic and Geographical Factors in Esophageal and Gastric Cancer Mortality in Sweden

BackgroundSocio-demographic factors and area of residence might influence the development of esophageal and gastric cancer. Large-scale population-based research can determine the role of such factors.MethodsThis population-based cohort study included all Swedish residents aged 30–84 years in 1990–2007. Educational level, marital status, place of birth, and place of residence were evaluated with regard to mortality from esophageal or gastric cancer. Cox regression yielded hazard ratios (HR) with 95% confidence intervals (CI), adjusted for potential confounding.ResultsAmong 84 920 565 person-years, 5125 and 12 230 deaths occurred from esophageal cancer and gastric cancer, respectively. Higher educational level decreased the HR of esophageal cancer (HR = 0.61, 95%CI 0.42–0.90 in women, HR = 0.71, 95%CI 0.60–0.84 in men) and gastric cancer (HR = 0.80, 95%CI 0.63–1.03 in women, HR = 0.73, 95%CI 0.64–0.83 in men). Being unmarried increased HR of esophageal cancer (HR = 1.64, 95%CI 1.35–1.99 in women, HR = 1.64, 95%CI 1.50–1.80 in men), but not of gastric cancer. Being born in low density populated areas increased HR of gastric cancer (HR = 1.23, 95%CI 1.10–1.38 in women, HR = 1.37, 95%CI 1.25–1.50 in men), while no strong association was found with esophageal cancer. Living in densely populated areas increased HR of esophageal cancer (HR = 1.31, 95%CI 1.14–1.50 in women, HR = 1.40, 95%CI 1.29–1.51 in men), but not of gastric cancer.ConclusionThese socio-demographic inequalities in cancer mortality warrant efforts to investigate possible preventable mechanisms and to promote and support healthier lifestyles among deprived groups.

O3-2.2 Linkage of census with mortality and cancer data in New Zealand. [part of symposium ref number 2353, "linkage of data in the study of ethnic inequalities ..."

<h3>Introduction</h3> Ethnicity is difficult to collect in a standard way between health and census datasets, meaning routinely calculated rates are prone to numerator-denominator bias. <h3>Methods</h3> Census and mortality data have been routinely linked in the New Zealand Census-Mortality Study, creating time series data from 1981. More recently, the Cancer trends study has linked cancer registrations. The proportion of eligible mortality / cancer records linked to a census record is now over 80%. Weighting is used to adjust for any linkage bias. <h3>Results</h3> Previously calculated mortality rates for Māori and Pacific people were shown to be underestimated by a quarter due to numerator-denominator bias. Corrected trends in mortality rates since 1981 demonstrate little if any improvement in Māori mortality rates during the 1980s–90s, concurrent with major reforms that impacted more on Māori than non-Māori (eg, unemployment rates among Māori reached 25% in 1992, compared with 7% among Europeans). Other analyses demonstrate that CVD is the major cause of death giving rise to ethnic inequalities in mortality, but as CVD rates fall for all ethnic groups inequalities in mortality are “relocating” to cancer. Inequalities in cancer incidence are less prominent than inequalities in cancer mortality, but nevertheless there are curious findings, such as: higher (and faster rising) breast cancer incidence among Māori, despite a more favourable risk factor profile; and particularly high endometrial and thyroid cancer incidence among Pacific women. There has also been a tremendous reduction in cervical cancer inequalities. <h3>Conclusion</h3> This linkage has allowed accurate research on trends that was hitherto impossible.

Inequalities in participation in an organized national colorectal cancer screening programme: results from the first 2.6 million invitations in England

An organized, population-based, colorectal cancer screening programme was initiated in England in 2006 offering biennial faecal occult blood testing (FOBT) to adults aged 60-69 years. Organized screening programmes with no associated financial costs to the individual should minimize barriers to access for lower socio-economic status (SES) groups. However, SES differences in uptake were observed in the pilot centres of the UK programme, so the aim of this analysis was to identify the extent of inequalities in uptake by SES, ethnic diversity, gender and age in the first 28 months of the programme. Design Cross-sectional analysis of colorectal cancer screening uptake data. Between October 2006 and January 2009, over 2.6 million adults aged 60-69 years were mailed a first FOBT kit by the five regional screening hubs. Uptake was defined as return of a test kit within 13 weeks. We used multivariate generalized linear regression to examine variation by area-based socioeconomic deprivation, area-based ethnicity, gender and age. Uptake was 54%, but showed a gradient across quintiles of deprivation, ranging from 35% in the most deprived quintile to 61% in the least deprived. Multivariate analyses confirmed an independent effect of deprivation, with stronger effects in women and older people. The most ethnically diverse areas also had lower uptake (38%) than other areas (52-58%) independent of SES, age, gender and regional screening hub. Ethnic disparities were more pronounced in men but equivalent across age groups. More women than men returned a kit (56 vs 51%), but there was also an interaction with age, with uptake increasing with age in men (49% at 60-64 years; 53% at 65-69 years) but not women (57 vs 56%). Overall uptake rates in this organized screening programme were encouraging, but nonetheless there was low uptake in the most ethnically diverse areas and a striking gradient by SES. Action to promote equality of uptake is needed to avoid widening inequalities in cancer mortality.

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

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.

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

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

Abstract PR-01: Inequalities in colorectal cancer screening uptake: Results from the first 2.6 million invitations in the organized screening program in the U.K

Abstract Background: An organized, population-based colorectal cancer (CRC) screening program was initiated in England in 2006, offering biennial Fecal Occult Blood testing (FOBt) to adults aged 60 to 69 years, with abnormal results followed up by colonoscopy. Because organized programs use population records to contact all eligible adults by mail, and there are no costs associated with screening or follow-up in the UK National Health Service, barriers to access for lower SES groups should be minimized. However, socioeconomic (SES) differences have been observed across a range of early detection behaviors, making it important to monitor the implementation of a new screening program. The aim of this analysis was to identify the extent of inequalities in uptake by SES, ethnic diversity, gender, and age in the English screening program. Methods: Between October 2006 and January 2009, over 2.6 million adults aged 60-69 years were mailed a first FOBt kit by one of the five regional “Hubs.” Area-level SES was indexed with a composite indicator (the Index of Multiple Deprivation) based on census-derived indicators of income, education, employment, environment, and housing for each postcode sector (containing an average of 3,000 addresses). Area-level ethnic diversity was based on the proportion of nonwhite residents in each postcode sector. Gender and age data were obtained from the Hubs. Screening uptake was defined as return of a test kit within 13 weeks, recorded by the Hub. We used multivariate generalized linear regression to examine variation in uptake by deprivation, ethnicity, gender, and age. Results: Over the study period, 2,658,859 FOBt kits were mailed out, of which 54% were returned. Uptake rates showed a linear gradient across quintiles of deprivation, ranging from 35% in the most deprived quintile to 61% in the least deprived. Multivariate analyses confirmed a significant independent effect of deprivation after adjusting for ethnicity, gender, age and Hub. The association between deprivation and uptake was stronger in women and older people. The most ethnically diverse quintile of areas also had lower uptake rates (38%) than other areas (52% to 58%), independent of SES, age, gender, and Hub. Ethnic disparities were more pronounced in men but equivalent across age groups. More women than men returned a kit (56% vs. 51%). Uptake increased with age in men (49% at 60-64 years; 53% at 65-69 years) but not in women (57% vs. 56%). Conclusion: Uptake of FOBt in the new national CRC screening program in England is encouraging, but these results demonstrate that even though organized programs provide equitable delivery of the opportunity to screen, they do not eradicate inequalities in uptake. The lower uptake associated with ethnic diversity was apparent only in the most diverse quintile, which predominantly comprised inner city areas. In contrast, SES inequalities not only meant dramatically reduced uptake in the most deprived quintile but also showed a linear gradient in uptake across the entire SES spectrum. Reducing inequalities in uptake will require understanding how SES influences screening decision making. Organized programs do not obviate the need for action to promote equality of uptake if they are to avoid creating increased inequalities in cancer mortality. Citation Information: Cancer Prev Res 2010;3(12 Suppl):PR-01.

Commentary: The study by Leinsalu et al. on mortality differentials in Eastern Europe highlights the need for better data

level of cirrhosis in central and eastern Europe be due partly to the quality of alcohol consumed? An exploratory investigation. Addiction 2005;100:536–42. 38 McKee M, Britton A. The positive relationship between alcohol and heart disease in eastern Europe: potential physiological mechanisms. J R Soc Med 1998;91:402–07. 39 Brand DA, Saisana M, Rynn LA, Pennoni F, Lowenfels AB. Comparative analysis of alcohol control policies in 30 countries. PLoS Med 2007;4:e151. 40 Ezendam NP, Stirbu I, Leinsalu M et al. Educational inequalities in cancer mortality differ greatly between countries around the Baltic Sea. Eur J Cancer 2008; 44:454–64.

Social inequalities in cancer incidence and cancer survival: Lessons from Danish studies

The unequal distribution of diseases among population groups has since long attracted the attention of epidemiologists. Largedifferences in disease risk have repeatedly been observed in relationship to socioeconomic indicators, such as educational level,occupational class and household income ( 1). With regards to cancer risk, a first comprehensive review of socioeconomic inequalities waspublished by IARC in 1997 ( 2). This review covered inequalities in cancer mortality, incidence and survival and discussed many possibleexplanations. More recently, there have been numerous studies describing social inequalities in cancer mortality ( 3

Socioeconomic inequalities in lung cancer mortality in 16 European populations

Objectives This paper aims to describe socioeconomic inequalities in lung cancer mortality in Europe and to get further insight into socioeconomic inequalities in lung cancer mortality in different European populations by relating these to socioeconomic inequalities in overall mortality and smoking within the same or reference populations. Particular attention is paid to inequalities in Eastern European and Baltic countries. Methods Data were obtained from mortality registers, population censuses and health interview surveys in 16 European populations. Educational inequalities in lung cancer and total mortality were assessed by direct standardization and calculation of two indices of inequality: the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). SIIs were used to calculate the contribution of inequalities in lung cancer mortality to inequalities in total mortality. Indices of inequality in lung cancer mortality in the age group 40–59 years were compared with indices of inequalities in smoking taking into account a time lag of 20 years. Results The pattern of inequalities in Eastern European and Baltic countries is more or less similar as the one observed in the Northern countries. Among men educational inequalities are largest in the Eastern European and Baltic countries. Among women they are largest in Northern European countries. Whereas among Southern European women lung cancer mortality rates are still higher among the high educated, we observe a negative association between smoking and education among young female adults. The contribution of lung cancer mortality inequalities to total mortality inequalities is in most male populations more than 10%. Important smoking inequalities are observed among young adults in all populations. In Sweden, Hungary and the Czech Republic smoking inequalities among young adult women are larger than lung cancer mortality inequalities among women aged 20 years older. Conclusions Important socioeconomic inequalities exist in lung cancer mortality in Europe. They are consistent with the geographical spread of the smoking epidemic. In the next decades socioeconomic inequalities in lung cancer mortality are likely to persist and even increase among women. In Southern European countries we may expect a reversal from a positive to a negative association between socioeconomic status and lung cancer mortality. Continuous efforts are necessary to tackle socioeconomic inequalities in lung cancer mortality in all European countries.

Educational differences in cancer mortality among women and men: a gender pattern that differs across Europe

We used longitudinal mortality data sets for the 1990s to compare socioeconomic inequalities in total cancer mortality between women and men aged 30–74 in 12 different European populations (Madrid, Basque region, Barcelona, Slovenia, Turin, Switzerland, France, Belgium, Denmark, Norway, Sweden, Finland) and to investigate which cancer sites explain the differences found. We measured socioeconomic status using educational level and computed relative indices of inequality (RII). We observed large variations within Europe for educational differences in total cancer mortality among men and women. Three patterns were observed: Denmark, Norway and Sweden (significant RII around 1.3–1.4 among both men and women); France, Switzerland, Belgium and Finland (significant RII around 1.7–1.8 among men and around 1.2 among women); Spanish populations, Slovenia and Turin (significant RII from 1.29 to 1.88 among men; no differences among women except in the Basque region, where RII is significantly lower than 1). Lung, upper aerodigestive tract and breast cancers explained most of the variations between gender and populations in the magnitude of inequalities in total cancer mortality. Given time trends in cancer mortality, the gap in the magnitude of socioeconomic inequalities in cancer mortality between gender and between European populations will probably decrease in the future.

Cancer mortality differences among urban and rural residents in Lithuania

BackgroundThe aim of this study was to describe and to compare the cancer mortality rates in urban and rural residents in Lithuania.MethodsCancer mortality has been studied using the materials of the Lithuanian cancer registry. For the period 1993–2004 age-standardized urban and rural population mortality rates (World standard) were calculated for all malignant neoplasm's and for stomach, colorectal, lung, prostate, breast and cervical cancers. The annual percentage change (APC) was calculated using log-linear regression model, two-sided Mantel-Haenzel test was used to evaluate differences in cancer mortality among rural and urban populations.ResultsFor males in rural population cancer mortality was higher than in urban (212.2 and 197.0 cases per 100000) and for females cancer mortality was higher in urban population (103.5 and 94.2 cases per 100000, p < 0.05). During the study period the age-standardized mortality rates decreased in both sexes in urban residents. The decreasing mortality trend in urban population was contributed by decline of the rates of lung and stomach cancer in male and breast, stomach and colorectal cancer in female. Mortality rates in both urban and rural population were increasing for prostate and cervical cancers.ConclusionThis study shows that large rural and urban inequalities in cancer mortality exist in Lithuania. The contrast between the health of residents in urban and rural areas invites researchers for research projects to develop, implement, and enhance cancer prevention and early detection intervention strategies for rural populations.

Educational inequalities in cancer mortality differ greatly between countries around the Baltic Sea

Objective To compare educational inequalities in cancer mortality between Poland, Lithuania, Estonia, Finland and Sweden. Methods Data are either follow-up or unlinked cross-sectional studies. The relative index of inequality (RII) and the slope index of inequality (SII) are calculated to express the magnitude of mortality differences according to educational level for all cancers and for specific cancers. Results Large educational inequalities in total cancer mortality were observed, particularly amongst men. Inequalities in upper aero-digestive tract and lung cancer in men and cervix cancer in women were larger in Poland, Lithuania and Estonia, whereas inequalities in lung cancer in women were larger in Finland and Sweden. Conclusions Countries of the Baltic Sea region differ strongly with regard to the magnitude and pattern of the educational inequalities in cancer mortality.

Socioeconomic inequalities in alcohol related cancer mortality among men: to what extent do they differ between Western European populations?

We aim to study socioeconomic inequalities in alcohol related cancers mortality [upper aerodigestive tract (UADT) (oral cavity, pharynx, larynx, oesophagus and liver)] in men and to investigate whether the contribution of these cancers to socioeconomic inequalities in cancer mortality differs within Western Europe. We used longitudinal mortality datasets, including causes of death. Data were collected during the 1990s among men aged 30-74 years in 13 European populations [Madrid, the Basque region, Barcelona, Turin, Switzerland (German and Latin part), France, Belgium (Walloon and Flemish part, Brussels), Norway, Sweden, Finland]. Socioeconomic status was measured using the educational level declared at the census at the beginning of the follow-up period. We conducted Poisson regression analyses and used both relative [Relative index of inequality (RII)] and absolute (mortality rates difference) measures of inequality. For UADT cancers, the RII's were above 3.5 in France, Switzerland (both parts) and Turin whereas for liver cancer they were the highest (around 2.5) in Madrid, France and Turin. The contribution of alcohol related cancer to socioeconomic inequalities in cancer mortality was 29-36% in France and the Spanish populations, 17-23% in Switzerland and Turin, and 5-15% in Belgium and the Nordic countries. We did not observe any correlation between mortality rates differences for lung and UADT cancers, confirming that the pattern found for UADT cancers is not only due to smoking. This study suggests that alcohol use substantially influences socioeconomic inequalities in male cancer mortality in France, Spain and Switzerland but not in the Nordic countries and nor in Belgium.

Changes in Socioeconomic Inequalities in Cancer Mortality Rates Among French Men Between 1968 and 1996

We investigated changes in socioeconomic inequalities in cancer mortality rates among men in France between 1968 and 1996. We used a representative sample of 1% of the French population and studied 4 periods (1968-1974, 1975-1981, 1982-1988, and 1990-1996). Causes of death were obtained by direct linkage with the French national death registry. The socioeconomic position of men aged 35 to 59 years was measured by using the occupational class reported at the time of the census at the beginning of each period. Analyses were conducted for all cancers and specifically for lung, upper aerodigestive tract, esophageal, colorectal, and other cancers. In all analyses, we observed socioeconomic inequalities during the 4 periods considered; the inequalities increased between the first and the last period. Most of the total increase occurred between 1968 and 1981, and inequalities remained stable thereafter. Inequalities were larger when men out of the labor force were included in the analysis. The strongest increase in socioeconomic inequalities over time was observed for upper aerodigestive tract cancer. Although cancer mortality rates have decreased, substantial socioeconomic inequalities in cancer mortality among men remain.

Spotlight

Chan et al., pp. 474–485 For women with breast cancer the odds of survival dramatically change when the tumor progresses from in situ carcinoma to infiltrative cancer. While the noninvasive form causes death in 1% or less, 28–50% of patients with invasive cancer die. The transition from in situ to infiltrative tumor is therefore a key step in breast cancer development. However, current models for studying this step are limited. Chan and colleagues used a rat model, which recapitulated phenotypic changes observed in the in situ- to-invasive transition. They treated rats with N-methyl-N-nitrosourea (NMU), a widely used carcinogen to experimentally induce mammary tumors. Although NMU-induced tumors are typically low-grade in situ carcinomas, they can develop the capacity for invasion following serial transplantation. These scientists found that the majority of transplanted lineages maintained a ductal morphology and biomarker expression, characteristics of noninvasive tumors. In addition, two histological types of invasive tumors were observed: a mesenchymal lineage that resembled human breast carcinosarcomas and one series of transplants that resembled the recently recognized “basal-like” human breast cancer subtype. When the authors compared noninvasive and highly invasive tumors by gene-expression profiling they identified a total of 136 genes that were upregulated in highly invasive tumors. In addition, they identified 83 genes that were downregulated. Both lists included genes involved in cell adhesion, the extracellular matrix, cell cycle progression and signal transduction. The authors propose that a “reprogramming” in gene expression occurs at the in situ-to-invasive transition, leading to a gradual change in the state of cell differentiation. Dimitriadis et al., pp. 486–494 The best established prognostic factor in colorectal cancer is clinical staging. However, within one clinical stage individual survival rates vary, indicating that subgroups of patients exist with predispositions for early recurrence or resistance to current therapeutic strategies. Dimitriadis and colleagues have identified a new molecule that is associated with frequent metastases, early recurrence and short survival in patients with colorectal cancer. This molecule, CRD-BP/IMP1, is a member of the VICKZ family, which is predominantly expressed during embryonal life. It possesses several recognition motifs for ribonucleoproteins and RNA and is implicated in the posttranslational regulation of several genes, including the F-box protein βTrCP1, which is itself linked to colorectal carcinogenesis. When the authors examined expression of CRD-BP/IMP1 in colorectal tumors, they found that, in 50% of the specimens, the factor was markedly expressed, while only a few cells were immunoreactive in normal tissue. Strikingly, the positive cells in normal tissue were located predominantly at or near the bottom of the crypts, a characteristic localization of stem cells, raising the possibility that CRD-BP/IMP1 is a marker for intestinal stem/progenitor cells. Patients with tumors lacking CRD-BP/IMP1 expression had a favorable clinical outcome. By multivariate analysis the absence of CRD-BP/IMP1 expression was found to be an independent, favorable prognostic factor for survival (p = 0.015). In contrast, CRD-BP/IMP1-positive tumors metastasized or recurred more frequently and characterized a subgroup of patients with shorter survival. These data support the model that abnormal expression of CRD-BP/IMP1 may serve as a useful clinical marker to identify subgroups of patients with a poor prognosis, independently of clinical staging. Menvielle et al., pp. 649–655 Alcohol can cause cancer, including malignancies of the upper aerodigestive tract (oral cavity, pharynx, larynx and esophagus) and liver. Mortality from alcohol-related cancers is often linked to socioeconomic status, with higher death rates in individuals with a lower socioeconomic status. Menvielle and colleagues combined data from longitudinal studies performed in 13 European countries to examine the role of alcohol in socioeconomic inequalities in cancer mortality in men. The contribution of alcohol to socioeconomic inequalities in cancer mortality was 29–36% in France and the Spanish populations, 17–23% in Switzerland and Turin (Italy) and 5–15% in Belgium and the Nordic countries. The difference was most prominent in France, showing the highest mortality rate among men with lower secondary education and the lowest mortality rate among men with a higher education. These results suggest that alcohol use substantially influences socioeconomic inequalities in male cancer mortality in France, Spain and Switzerland but not in the Nordic countries or in Belgium.

Socioeconomic inequality of cancer mortality in the United States: a spatial data mining approach

BackgroundThe objective of this study was to demonstrate the use of an association rule mining approach to discover associations between selected socioeconomic variables and the four most leading causes of cancer mortality in the United States. An association rule mining algorithm was applied to extract associations between the 1988–1992 cancer mortality rates for colorectal, lung, breast, and prostate cancers defined at the Health Service Area level and selected socioeconomic variables from the 1990 United States census. Geographic information system technology was used to integrate these data which were defined at different spatial resolutions, and to visualize and analyze the results from the association rule mining process.ResultsHealth Service Areas with high rates of low education, high unemployment, and low paying jobs were found to associate with higher rates of cancer mortality.ConclusionAssociation rule mining with geographic information technology helps reveal the spatial patterns of socioeconomic inequality in cancer mortality in the United States and identify regions that need further attention.

Social inequalities and cancer mortality in France, 1975–1990

to investigate social inequalities in cancer mortality from 1975 through 1990 among men and women in France. A sample, that included census data for approximately 1% of the French population, has been followed for mortality from 1975 to 1990. Causes of death were obtained through a record-linkage with the French national cause-of-death file. The analysis was restricted to those aged 35:59 in 1975 and included 61,876 men and 65,291 women. Occupational class, coded according to the social class scheme of Erikson, Goldthorpe and Portecarero in 7 categories, and educational level (in 4 categories) in 1975 have been studied. The analysis has been conducted for 15 cancer sites among men and 13 among women. Analysis used a Cox proportional hazards model. For educational level, inequalities among men were more pronounced for cancers of the pharynx Relative Risk (RR) lowest versus highest educational level=9.2, 95% Confidence Interval (CI) 2.9-29.1, larynx (RR=6.2, CI=3.0:12.6), oral cavity (RR=2.7, CI=1.3-5.3), lung (RR=3.5, CI=2.5-4.8), esophagus (RR=3.1, CI=1.9-5.2), stomach (RR=2.5, CI=1.2-5.3) and rectum (RR=3.4, CI=1.2-9.6). No association between educational level and cancer mortality was observed for cancers of either the colon or lymphatic and hematopoietic tissue. Social inequalities were less pronounced among women but nevertheless observed for cancer of the uterus (RR=1.9, CI=1.0-3.6), stomach (RR=4.1, CI=1.0-17.1) and lung (RR=1.6, CI=0.7-3.7). No associations were found for mortality from breast or ovarian cancers. Results were similar when socioeconomic status was measured by occupational class. The analysis showed substantial inequalities in cancer mortality in France, with large differences according to cancer site.