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Beyer K, Kasasa S, Anguzu R, Lukande R, Nambooze S, Amulen PM, Zhou Y, Nansereko B, Jankowski C, Oyana T, Savino D, Feustel K, Wabinga H. High-resolution disease maps for cancer control in low-resource settings: A spatial analysis of cervical cancer incidence in Kampala, Uganda. J Glob Health 2022; 12:04032. [PMID: 35493778 PMCID: PMC9022722 DOI: 10.7189/jogh.12.04032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background The global burden of cervical cancer is concentrated in low-and middle-income countries (LMICs), with the greatest burden in Africa. Targeting limited resources to populations with the greatest need to maximize impact is essential. The objectives of this study were to geocode cervical cancer data from a population-based cancer registry in Kampala, Uganda, to create high-resolution disease maps for cervical cancer prevention and control planning, and to share lessons learned to optimize efforts in other low-resource settings. Methods Kampala Cancer Registry records for cervical cancer diagnoses between 2008 and 2015 were updated to include geographies of residence at diagnosis. Population data by age and sex for 2014 was obtained from the Uganda Bureau of Statistics. Indirectly age-standardized incidence ratios were calculated for sub-counties and estimated continuously across the study area using parish level data. Results Overall, among 1873 records, 89.6% included a valid sub-county and 89.2% included a valid parish name. Maps revealed specific areas of high cervical cancer incidence in the region, with significant variation within sub-counties, highlighting the importance of high-resolution spatial detail. Conclusions Population-based cancer registry data and geospatial mapping can be used in low-resource settings to support cancer prevention and control efforts, and to create the potential for research examining geographic factors that influence cancer outcomes. It is essential to support LMIC cancer registries to maximize the benefits from the use of limited cancer control resources.
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Affiliation(s)
- Kirsten Beyer
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Ronald Anguzu
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Robert Lukande
- Makerere University, Kampala, Uganda
- Kampala Cancer Registry, Kampala, Uganda
| | - Sarah Nambooze
- Makerere University, Kampala, Uganda
- Kampala Cancer Registry, Kampala, Uganda
| | - Phoebe M Amulen
- Makerere University, Kampala, Uganda
- Kampala Cancer Registry, Kampala, Uganda
| | - Yuhong Zhou
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | | | | | | | - Henry Wabinga
- Makerere University, Kampala, Uganda
- Kampala Cancer Registry, Kampala, Uganda
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Villanueva C, Chang J, Bartell SM, Ziogas A, Bristow R, Vieira VM. Contribution of Geographic Location to Disparities in Ovarian Cancer Treatment. J Natl Compr Canc Netw 2020; 17:1318-1329. [PMID: 31693984 DOI: 10.6004/jnccn.2019.7325] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 06/03/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND More than 14,000 women in the United States die of ovarian cancer (OC) every year. Disparities in survival have been observed by race and socioeconomic status (SES), and vary spatially even after adjusting for treatment received. This study aimed to determine the impact of geographic location on receiving treatment adherent to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for OC, independent of other predictors. PATIENTS AND METHODS Women diagnosed with all stages of epithelial OC (1996-2014) were identified through the California Cancer Registry. Generalized additive models, smoothing for residential location, were used to calculate adjusted odds ratios (ORs) and 95% CIs for receiving nonadherent care throughout California. We assessed the impact of distance traveled for care, distance to closest high-quality hospital, race/ethnicity, and SES on receipt of quality care, adjusting for demographic and cancer characteristics and stratifying by disease stage. RESULTS Of 29,844 patients with OC, 11,419 (38.3%) received guideline-adherent care. ORs for nonadherent care were lower in northern California and higher in Kern and Los Angeles counties. Magnitudes of associations with location varied by stage (OR range, 0.45-2.19). Living farther from a high-quality hospital increased the odds of receiving nonadherent care (OR, 1.18; 95% CI, 1.07-1.29), but travel >32 km to receive care was associated with decreased odds (OR, 0.76; 95% CI, 0.70-0.84). American Indian/other women were more likely to travel greater distances to receive care. Women in the highest SES quintile, those with Medicare insurance, and women of non-Hispanic black race were less likely to travel far. Patients who were Asian/Pacific Islander lived the closest to a high-quality hospital. CONCLUSIONS Among California women diagnosed with OC, living closer to a high-quality center was associated with receiving adherent care. Non-Hispanic black women were less likely to receive adherent care, and women with lower SES lived farthest from high-quality hospitals. Geographic location in California is an independent predictor of adherence to NCCN Guidelines for OC.
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Affiliation(s)
- Carolina Villanueva
- Program in Public Health, Susan and Henry Samueli College of Health Sciences
| | - Jenny Chang
- Department of Medicine, School of Medicine, and
| | - Scott M Bartell
- Program in Public Health, Susan and Henry Samueli College of Health Sciences.,Department of Statistics, Donald Bren School of Information and Computer Sciences, University of California, Irvine, Irvine, California
| | | | - Robert Bristow
- Chao Family Comprehensive Cancer Center, Orange, California; and.,Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine, School of Medicine, Orange, California
| | - Verónica M Vieira
- Program in Public Health, Susan and Henry Samueli College of Health Sciences.,Chao Family Comprehensive Cancer Center, Orange, California; and
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Simkin J, Erickson AC, Otterstatter MC, Dummer TJB, Ogilvie G. Current State of Geospatial Methodologic Approaches in Canadian Population Oncology Research. Cancer Epidemiol Biomarkers Prev 2020; 29:1294-1303. [PMID: 32299848 DOI: 10.1158/1055-9965.epi-20-0092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/25/2020] [Accepted: 04/10/2020] [Indexed: 11/16/2022] Open
Abstract
Geospatial analyses are increasingly used in population oncology. We provide a first review of geospatial analysis in Canadian population oncology research, compare to international peers, and identify future directions. Geospatial-focused peer-reviewed publications from 1992-2020 were compiled using PubMed, MEDLINE, Web of Science, and Google Scholar. Abstracts were screened for data derived from a Canadian cancer registry and use of geographic information systems. Studies were classified by geospatial methodology, geospatial unit, location, cancer site, and study year. Common limitations were documented from article discussion sections. Our search identified 71 publications using data from all provincial and national cancer registries. Thirty-nine percent (N = 28) were published in the most recent 5-year period (2016-2020). Geospatial methodologies included exposure assessment (32.4%), identifying spatial associations (21.1%), proximity analysis (16.9%), cluster detection (15.5%), and descriptive mapping (14.1%). Common limitations included confounding, ecologic fallacy, not accounting for residential mobility, and small case/population sizes. Geospatial analyses are increasingly used in Canadian population oncology; however, efforts are concentrated among a few provinces and common cancer sites, and data are over a decade old. Limitations were similar to those documented internationally, and more work is needed to address them. Organized efforts are needed to identify common challenges, develop leading practices, and identify shared priorities.
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Affiliation(s)
- Jonathan Simkin
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada. .,BC Cancer, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Anders C Erickson
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Office of the Provincial Health Officer, Government of British Columbia, Victoria, British Columbia, Canada
| | - Michael C Otterstatter
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Trevor J B Dummer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,BC Cancer, Vancouver, British Columbia, Canada
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,BC Cancer, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada.,BC Centre for Disease Control, Vancouver, British Columbia, Canada
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Wei Y, Zhu J. Blood levels of endocrine-disrupting metals and prevalent breast cancer among US women. Med Oncol 2019; 37:1. [DOI: 10.1007/s12032-019-1328-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 10/28/2019] [Indexed: 11/28/2022]
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Ambient air emissions of polycyclic aromatic hydrocarbons and female breast cancer incidence in US. Med Oncol 2018; 35:88. [DOI: 10.1007/s12032-018-1150-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/02/2018] [Indexed: 12/17/2022]
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Bladder Cancer Mortality in the United States: A Geographic and Temporal Analysis of Socioeconomic and Environmental Factors. J Urol 2015; 195:290-6. [PMID: 26235377 DOI: 10.1016/j.juro.2015.07.091] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE We assessed the association of temporal, socioeconomic and environmental factors with bladder cancer mortality in the United States. Our hypothesis was that bladder cancer mortality is associated with distinct environmental and socioeconomic factors with effects varying by region, race and gender. MATERIALS AND METHODS NCI (National Cancer Institute) age adjusted, county level bladder cancer mortality data from 1950 to 2007 were analyzed to identify clusters of increased bladder cancer death using the Getis-Ord Gi* statistic. Socioeconomic, clinical and environmental data were assessed using geographically weighted spatial regression analysis adjusting for spatial autocorrelation. County level socioeconomic, clinical and environmental data were obtained from national databases, including the United States Census, CDC (Centers for Disease Control and Prevention), NCHS (National Center for Health Statistics) and County Health Rankings. RESULTS Bladder cancer mortality hot spots and risk factors for bladder cancer death differed significantly by gender, race and geographic region. From 1996 to 2007 smoking, unemployment, physically unhealthy days, air pollution ozone days, percent of houses with well water, employment in the mining industry and urban residences were associated with increased rates of bladder cancer mortality (p <0.05). Model fit was significantly improved in hot spots compared to all American counties (R(2) = 0.20 vs 0.05). CONCLUSIONS Environmental and socioeconomic factors affect bladder cancer mortality and effects appear to vary by gender and race. Additionally there were temporal trends of bladder cancer hot spots which, when persistent, should be the focus of individual level studies of occupational and environmental factors.
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Hanley JP, Jackson E, Morrissey LA, Rizzo DM, Sprague BL, Sarkar IN, Carr FE. Geospatial and Temporal Analysis of Thyroid Cancer Incidence in a Rural Population. Thyroid 2015; 25:812-22. [PMID: 25936441 PMCID: PMC4507126 DOI: 10.1089/thy.2015.0039] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The increasing incidence of thyroid cancer has resulted in the rate tripling over the past 30 years. Reasons for this increase have not been established. Geostatistics and geographic information system (GIS) tools have emerged as powerful geospatial technologies to identify disease clusters, map patterns and trends, and assess the impact of ecological and socioeconomic factors (SES) on the spatial distribution of diseases. In this study, these tools were used to analyze thyroid cancer incidence in a rural population. METHODS Thyroid cancer incidence and socio-demographic factors in Vermont (VT), United States, between 1994 and 2007 were analyzed by logistic regression and geospatial and temporal analyses. RESULTS The thyroid cancer age-adjusted incidence in Vermont (8.0 per 100,000) was comparable to the national level (8.4 per 100,000), as were the ratio of the incidence of females to males (3.1:1) and the mortality rate (0.5 per 100,000). However, the estimated annual percentage change was higher (8.3 VT; 5.7 U.S.). Incidence among females peaked at 30-59 years of age, reflecting a significant rise from 1994 to 2007, while incidence trends for males did not vary significantly by age. For both females and males, the distribution of tumors by size did not vary over time; ≤1.0 cm, 1.1-2.0 cm, and >2.0 cm represented 38%, 22%, and 40%, respectively. In females, papillary thyroid cancer (PTC) accounted for 89% of cases, follicular (FTC) 8%, medullary (MTC) 2%, and anaplastic (ATC) 0.6%, while in males PTC accounted for 77% of cases, FTC 15%, MTC 1%, and ATC 3%. Geospatial analysis revealed locations and spatial patterns that, when combined with multivariate incidence analyses, indicated that factors other than increased surveillance and access to healthcare (physician density or insurance) contributed to the increased thyroid cancer incidence. Nine thyroid cancer incidence hot spots, areas with very high normalized incidence, were identified based on zip code data. Those locations did not correlate with urban areas or healthcare centers. CONCLUSIONS These data provide evidence of increased thyroid cancer incidence in a rural population likely due to environmental drivers and SES. Geospatial modeling can provide an important framework for evaluation of additional associative risk factors.
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Affiliation(s)
- John P. Hanley
- Department of Civil and Environmental Engineering, School of Engineering, University of Vermont, Burlington, Vermont
| | - Erin Jackson
- Department of Biology, College of Arts and Sciences, University of Vermont, Burlington, Vermont
| | - Leslie A. Morrissey
- Rubinstein School of Environment and Natural Resources, University of Vermont, Burlington, Vermont
| | - Donna M. Rizzo
- Department of Civil and Environmental Engineering, School of Engineering, University of Vermont, Burlington, Vermont
| | - Brian L. Sprague
- Department of Surgery, College of Medicine, University of Vermont, Burlington, Vermont
| | - Indra Neil Sarkar
- Center for Clinical and Translational Science and Department of Microbiology and Molecular Genetics, College of Medicine, University of Vermont, Burlington, Vermont
| | - Frances E. Carr
- Department of Pharmacology, College of Medicine, University of Vermont, Burlington, Vermont
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Pruitt SL, Davidson NO, Gupta S, Yan Y, Schootman M. Missed opportunities: racial and neighborhood socioeconomic disparities in emergency colorectal cancer diagnosis and surgery. BMC Cancer 2014; 14:927. [PMID: 25491412 PMCID: PMC4364088 DOI: 10.1186/1471-2407-14-927] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 11/26/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Disparities by race and neighborhood socioeconomic status exist for many colorectal cancer (CRC) outcomes, including screening use and mortality. We used population-based data to determine if disparities also exist for emergency CRC diagnosis and surgery. METHODS We examined two emergency CRC outcomes using 1992-2005 population-based U.S. SEER-Medicare data. Among CRC patients aged ≥66 years, we examined racial (African American vs. white) and neighborhood poverty disparities in two emergency outcomes defined as: 1) newly diagnosed CRC or 2) CRC surgery associated with: obstruction, perforation, or emergency inpatient admission. Multilevel logistic regression (patients nested in census tracts) analyses adjusted for sociodemographic, tumor, and clinical covariates. RESULTS Of 83,330 CRC patients, 29.1% were diagnosed emergently. Of 55,046 undergoing surgery, 26.0% had emergency surgery. For both outcomes, race and neighborhood poverty disparities were evident. A significant race by poverty interaction (p < .001) was noted: poverty rate was associated with both outcomes among African Americans, but not whites. Compared to whites in low poverty (<10%) neighborhoods, African Americans in high poverty (≥20%) neighborhoods had increased odds of emergency diagnosis (AOR: 1.50, 95% CI: 1.38-1.63) and surgery (AOR: 1.63, 95% CI: 1.47-1.81). CONCLUSIONS Emergency CRC outcomes are associated with high poverty residence among African Americans in this population-based study, potentially contributing to observed disparities in CRC morbidity and mortality. Targeted efforts to increase CRC screening among African Americans living in high poverty neighborhoods could reduce preventable disparities.
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Affiliation(s)
- Sandi L Pruitt
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd E1, 410D Dallas, TX, USA.
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Ruktanonchai CW, Pindolia DK, Striley CW, Odedina FT, Cottler LB. Utilizing spatial statistics to identify cancer hot spots: a surveillance strategy to inform community-engaged outreach efforts. Int J Health Geogr 2014; 13:39. [PMID: 25304037 PMCID: PMC4271483 DOI: 10.1186/1476-072x-13-39] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 10/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Utilization of spatial statistics and Geographic Information Systems (GIS) technologies remain underrepresented in the community-engagement literature, despite its potential role in informing community outreach efforts and in identifying populations enthusiastic to participate in biomedical and health research. Such techniques are capable not only of examining the epidemiological relationship between the environment and a disease, but can also focus limited resources and strategically inform where on the landscape outreach efforts may be optimized. METHODS These analyses present several spatial statistical techniques among the HealthStreet population, a community-engaged organization with aims to link underrepresented populations to medical and social care as well as opportunities to participate in University-sponsored research. Local Indicators of Spatial Association (LISA) and Getis-Ord Gi*(d) statistics are utilized to examine where cancer-related "hot spots" exist among minority and non-minority HealthStreet respondents within Alachua County, Florida, United States (US). Interest in research is also reported, by minority status and lifetime history of cancer. RESULTS Overall, spatial clustering of cancer was observed to vary by minority status, suggesting disparities may exist among minorities and non-minorities in regards to where cancer is occurring. Specifically, significant hot spots of cancer were observed among non-minorities in more urban areas throughout Alachua County, Florida, US while more rural clusters were observed among minority members, specifically west and southwest of urban city limits. CONCLUSIONS These results may help focus future outreach efforts to include underrepresented populations in health research, as well as focus preventative and palliative oncological care. Further, global community engaged studies and community outreach efforts outside of the United States may use similar methods to focus limited resources and recruit underrepresented populations into health research.
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Affiliation(s)
- Corrine W Ruktanonchai
- />Department of Epidemiology, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL 32610-0231 USA
| | - Deepa K Pindolia
- />Clinton Health Access Initiative, 383 Dorchester Avenue, Boston, MA 02127 USA
| | - Catherine W Striley
- />Department of Epidemiology, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL 32610-0231 USA
| | - Folakemi T Odedina
- />Department Pharmaceutical Outcomes and Policy, University of Florida, 1225 Center Drive, HPNP 3334, PO Box 100496, Gainesville, FL 32610-0496 USA
- />Department of Radiation Oncology, University of Florida, Health Science Center, PO Box 100385, Gainesville, FL 32610-0385 USA
| | - Linda B Cottler
- />Department of Epidemiology, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL 32610-0231 USA
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Ward MM, Ullrich F, Matthews K, Rushton G, Goldstein MA, Bajorin DF, Hanley A, Lynch CF. Who does not receive treatment for cancer? J Oncol Pract 2013; 9:20-6. [PMID: 23633967 DOI: 10.1200/jop.2012.000829] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Little has been published on nontreatment of cancer, yet the National Cancer Data Base (NCDB) indicates that 9.2% of patients receive no first course of treatment. Because the NCDB is limited to accredited cancer programs, there is potential for the actual rate to differ. We sought to understand the rate and characteristics of patients with cancer who receive no first course of treatment in a more population-representative data source. MATERIALS AND METHODS The Iowa Cancer Registry (ICR) strives to capture 100% of newly diagnosed cancer cases among Iowa residents, regardless of where they are diagnosed or treated. RESULTS In the ICR from 2004 to 2010, 12.3% of newly diagnosed patients with cancer did not receive a first course of treatment, which is 48% higher than the NCDB data for the state of Iowa (8.3%) during the same time period. Logistic regression indicated that nontreatment was more common in certain cancers (ie, small-cell and non-small-cell lung/bronchial cancers and low-grade non-Hodgkin lymphoma), advanced stages, older patients, those receiving treatment recommendations at nonaccredited cancer programs, and patients who never consulted an oncologist, radiation therapist, or surgeon. Distance to treatment facilities was not related to nontreatment. CONCLUSION The rate of nontreatment varies by cancer type and stage and is higher in patients receiving initial treatment recommendations in nonaccredited cancer programs than in accredited cancer programs. This pattern seems to be correlated with patient characteristics but also may be related to provider and facility characteristics available to people locally that influence both patient and provider decision making.
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Puigpinós-Riera R, Marí-Dell'Olmo M, Gotsens M, Borrell C, Serral G, Ascaso C, Calvo M, Daponte A, Domínguez-Berjón FM, Esnaola S, Gandarillas A, López-Abente G, Martos CM, Martínez-Beneito MA, Montes-Martínez A, Montoya I, Nolasco A, Pasarín IM, Rodríguez-Sanz M, Sáez M, Sánchez-Villegas P. Cancer mortality inequalities in urban areas: a Bayesian small area analysis in Spanish cities. Int J Health Geogr 2011; 10:6. [PMID: 21232096 PMCID: PMC3033786 DOI: 10.1186/1476-072x-10-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 01/13/2011] [Indexed: 11/10/2022] Open
Abstract
Background Intra-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. Methods It 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. Results In 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. Conclusion This 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.
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Affiliation(s)
- Rosa Puigpinós-Riera
- Servei de Sistemes d'Informació Sanitaria, Agència de Salut Pública de Barcelona, Barcelona, Spain.
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