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Redondo-Sánchez D, Fernández-Navarro P, Rodríguez-Barranco M, Nuñez O, Petrova D, García-Torrecillas JM, Jiménez-Moleón JJ, Sánchez MJ. Socio-economic inequalities in lung cancer mortality in Spain: a nation-wide study using area-based deprivation. Int J Equity Health 2023; 22:145. [PMID: 37533035 PMCID: PMC10399030 DOI: 10.1186/s12939-023-01970-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Lung cancer is the main cause of cancer mortality worldwide and in Spain. Several previous studies have documented socio-economic inequalities in lung cancer mortality but these have focused on specific provinces or cities. The goal of this study was to describe lung cancer mortality in Spain by sex as a function of socio-economic deprivation. METHODS We analysed all registered deaths from lung cancer during the period 2011-2017 in Spain. Mortality data was obtained from the National Institute of Statistics, and socio-economic level was measured with the small-area deprivation index developed by the Spanish Society of Epidemiology, with the census tract of residence at the time of death as the unit of analysis. We computed crude and age-standardized rates per 100,000 inhabitants by sex, deprivation quintile, and type of municipality (rural, semi-rural, urban) considering the 2013 European standard population (ASR-E). We further calculated ASR-E ratios between the most deprived (Q5) and the least deprived (Q1) areas and mapped census tract smoothed standardized lung cancer mortality ratios by sex. RESULTS We observed 148,425 lung cancer deaths (80.7% in men), with 73.5 deaths per 100,000 men and 17.1 deaths per 100,000 women. Deaths from lung cancer in men were five times more frequent than in women (ASR-E ratio = 5.3). Women residing in the least deprived areas had higher mortality from lung cancer (ASR-E = 22.2), compared to women residing in the most deprived areas (ASR-E = 13.2), with a clear gradient among the quintiles of deprivation. For men, this pattern was reversed, with the highest mortality occurring in areas of lower socio-economic level (ASR-E = 99.0 in Q5 vs. ASR-E = 86.6 in Q1). These socio-economic inequalities remained fairly stable over time and across urban and rural areas. CONCLUSIONS Socio-economic status is strongly related to lung cancer mortality, showing opposite patterns in men and women, such that mortality is highest in women residing in the least deprived areas and men residing in the most deprived areas. Systematic surveillance of lung cancer mortality by socio-economic status may facilitate the assessment of public health interventions aimed at mitigating cancer inequalities in Spain.
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Grants
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- PI18/01593 EU/FEDER Instituto de Salud Carlos III
- PI18/01593 EU/FEDER Instituto de Salud Carlos III
- PI18/01593 EU/FEDER Instituto de Salud Carlos III
- Not applicable Acciones de Movilidad CIBERESP, 2022
- JC2019-039691-I Juan de la Cierva Fellowship from the Ministry of Science and the National Research Agency of Spain
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Affiliation(s)
- Daniel Redondo-Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain.
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain.
- Escuela Andaluza de Salud Pública, Granada, 18080, Spain.
| | - Pablo Fernández-Navarro
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, 28029, Spain
| | - Miguel Rodríguez-Barranco
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Escuela Andaluza de Salud Pública, Granada, 18080, Spain
| | - Olivier Nuñez
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, 28029, Spain
| | - Dafina Petrova
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Escuela Andaluza de Salud Pública, Granada, 18080, Spain
| | - Juan Manuel García-Torrecillas
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Emergency and Research Unit, Torrecárdenas University Hospital, Almería, 04009, Spain
| | - Jose Juan Jiménez-Moleón
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, 18071, Spain
| | - María-José Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Escuela Andaluza de Salud Pública, Granada, 18080, Spain
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Martinez-Beneito MA, Vergara-Hernández C, Botella-Rocamora P, Corpas-Burgos F, Pérez-Panadés J, Zurriaga Ó, Aldasoro E, Borrell C, Cabeza E, Cirera L, Delfrade Osinaga J, Fernández-Somoano A, Gandarillas A, Lorenzo Ruano PL, Marí-Dell’Olmo M, Nolasco A, Prieto-Salceda MD, Ramis R, Rodríguez-Sanz M, Sánchez-Villegas P. Geographical Variability in Mortality in Urban Areas: A Joint Analysis of 16 Causes of Death. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115664. [PMID: 34070635 PMCID: PMC8197960 DOI: 10.3390/ijerph18115664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 01/29/2023]
Abstract
The geographical distribution of mortality has frequently been studied. Nevertheless, those studies often consider isolated causes of death. In this work, we aim to study the geographical distribution of mortality in urban areas, in particular, in 26 Spanish cities. We perform an overall study of 16 causes of death, considering that their geographical patterns could be dependent and estimating the dependence between the causes of death. We study the deaths in these 26 cities during the period 1996-2015 at the census tract level. A multivariate disease mapping model is used in order to solve the potential small area estimation problems that these data could show. We find that most of the geographical patterns found show positive correlations. This suggests the existence of a transversal geographical pattern, common to most causes of deaths, which determines those patterns to a higher/lower extent depending on each disease. The causes of death that exhibit that underlying pattern in a more prominent manner are chronic obstructive pulmonary disease (COPD), lung cancer, and cirrhosis for men and cardiovascular diseases and dementias for women. Such findings are quite consistent for most of the cities in the study. The high positive correlation found between geographical patterns reflects the existence of both high and low-risk areas in urban settings, in general terms for nearly all the causes of death. Moreover, the high-risk areas found often coincide with neighborhoods known for their high deprivation. Our results suggest that dependence among causes of death is a key aspect to be taken into account when mapping mortality, at least in urban contexts.
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Affiliation(s)
- Miguel A. Martinez-Beneito
- Departament d’Estadística e Investigaciò Opertiva, Universitat de València, 46100 Burjassot, Spain
- CIBER de Epidemiología y Salud Pública, 28029 Madrid, Spain; (F.C.-B.); (Ó.Z.); (C.B.); (L.C.); (J.D.O.); (A.F.-S.); (M.M.-D.); (R.R.); (M.R.-S.)
- Correspondence:
| | | | - Paloma Botella-Rocamora
- Dirección General de Salut Pública i Adiccions, Conselleria de Sanitat Universal y Salut Pública, 46020 Valencia, Spain; (P.B.-R.); (J.P.-P.)
| | - Francisca Corpas-Burgos
- CIBER de Epidemiología y Salud Pública, 28029 Madrid, Spain; (F.C.-B.); (Ó.Z.); (C.B.); (L.C.); (J.D.O.); (A.F.-S.); (M.M.-D.); (R.R.); (M.R.-S.)
- FISABIO Foundation, 46020 Valencia, Spain;
| | - Jordi Pérez-Panadés
- Dirección General de Salut Pública i Adiccions, Conselleria de Sanitat Universal y Salut Pública, 46020 Valencia, Spain; (P.B.-R.); (J.P.-P.)
| | - Óscar Zurriaga
- CIBER de Epidemiología y Salud Pública, 28029 Madrid, Spain; (F.C.-B.); (Ó.Z.); (C.B.); (L.C.); (J.D.O.); (A.F.-S.); (M.M.-D.); (R.R.); (M.R.-S.)
- FISABIO Foundation, 46020 Valencia, Spain;
- Dirección General de Salut Pública i Adiccions, Conselleria de Sanitat Universal y Salut Pública, 46020 Valencia, Spain; (P.B.-R.); (J.P.-P.)
- Departament de Medicina Preventiva, Salut Pública, Ciències de l’Alimentación, Toxicología i Medicina Legal, Universitat de València, 46010 Valencia, Spain
| | - Elena Aldasoro
- Dirección de Salud Pública y Adicciones, 48013 Bilbao, Spain;
| | - Carme Borrell
- CIBER de Epidemiología y Salud Pública, 28029 Madrid, Spain; (F.C.-B.); (Ó.Z.); (C.B.); (L.C.); (J.D.O.); (A.F.-S.); (M.M.-D.); (R.R.); (M.R.-S.)
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), 08025 Barcelona, Spain
| | - Elena Cabeza
- Institut d’investigació sanitària de les Illes Balears, 07120 Palma de Mallorca, Spain;
| | - Lluís Cirera
- CIBER de Epidemiología y Salud Pública, 28029 Madrid, Spain; (F.C.-B.); (Ó.Z.); (C.B.); (L.C.); (J.D.O.); (A.F.-S.); (M.M.-D.); (R.R.); (M.R.-S.)
- Department of Epidemiology, Regional Health Council-IMIB-Arrixaca, 30008 Murcia, Spain
| | - Josu Delfrade Osinaga
- CIBER de Epidemiología y Salud Pública, 28029 Madrid, Spain; (F.C.-B.); (Ó.Z.); (C.B.); (L.C.); (J.D.O.); (A.F.-S.); (M.M.-D.); (R.R.); (M.R.-S.)
- Instituto de Salud Pública y Laboral de Navarra, 31003 Pamplona, Spain
| | - Ana Fernández-Somoano
- CIBER de Epidemiología y Salud Pública, 28029 Madrid, Spain; (F.C.-B.); (Ó.Z.); (C.B.); (L.C.); (J.D.O.); (A.F.-S.); (M.M.-D.); (R.R.); (M.R.-S.)
- IUOPA-Medicine Department, Universidad de Oviedo, 33006 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33001 Oviedo, Spain
| | | | | | - Marc Marí-Dell’Olmo
- CIBER de Epidemiología y Salud Pública, 28029 Madrid, Spain; (F.C.-B.); (Ó.Z.); (C.B.); (L.C.); (J.D.O.); (A.F.-S.); (M.M.-D.); (R.R.); (M.R.-S.)
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), 08025 Barcelona, Spain
| | - Andreu Nolasco
- Universidad de Alicante, 03690 San Vicente del Raspeig, Spain;
| | | | - Rebeca Ramis
- CIBER de Epidemiología y Salud Pública, 28029 Madrid, Spain; (F.C.-B.); (Ó.Z.); (C.B.); (L.C.); (J.D.O.); (A.F.-S.); (M.M.-D.); (R.R.); (M.R.-S.)
- Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Maica Rodríguez-Sanz
- CIBER de Epidemiología y Salud Pública, 28029 Madrid, Spain; (F.C.-B.); (Ó.Z.); (C.B.); (L.C.); (J.D.O.); (A.F.-S.); (M.M.-D.); (R.R.); (M.R.-S.)
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), 08025 Barcelona, Spain
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Costa C, Freitas A, Almendra R, Santana P. The Association between Material Deprivation and Avoidable Mortality in Lisbon, Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228517. [PMID: 33212953 PMCID: PMC7698341 DOI: 10.3390/ijerph17228517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/04/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022]
Abstract
There is considerable evidence pointing to the existence of a socioeconomic gradient in mortality, which tends to be steeper in urban areas. Similar to other European cities, Lisbon is far from homogeneous since considerable geographical inequalities exist between the more advantaged and the more deprived neighborhoods. The main goals of this study are to describe the geographical pattern of premature deaths (before 65 years old), avoidable deaths (preventable and amenable to healthcare) and cause-specific mortality (HIV/AIDS and suicide) in Lisbon, at the lower administrative level (civil parish, in Portuguese: Freguesia), and analyze the statistical association between mortality risk and deprivation, before (1999–2003) and during the economic crisis (2008–2012). Smoothed Standardized Mortality Ratios (sSMR) and Relative Risk (RR) with 95% credible intervals were calculated to identify the association between mortality and deprivation. The analysis of the geographical distribution of cause-specific mortality reveals that civil parishes with high sSMR in the first period continued to present higher mortality rates in the second. Moreover, a significant statistical association was found between all the causes of death and deprivation, except suicide. These findings contribute to understanding how social conditions influence health outcomes and can offer insights about potential policy directions for local government.
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Affiliation(s)
- Claudia Costa
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal; (A.F.); (R.A.); (P.S.)
- Correspondence:
| | - Angela Freitas
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal; (A.F.); (R.A.); (P.S.)
| | - Ricardo Almendra
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal; (A.F.); (R.A.); (P.S.)
- Department of Geography and Tourism, University of Coimbra, 3004-530 Coimbra, Portugal
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal; (A.F.); (R.A.); (P.S.)
- Department of Geography and Tourism, University of Coimbra, 3004-530 Coimbra, Portugal
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