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Liu X, Zhang X, Ruan G, Zheng X, Chen Y, Zhang X, Liu T, Ge Y, Shi H. Relationship between educational level and survival of patients with cancer: A multicentre cohort study. Cancer Med 2024; 13:e7141. [PMID: 38545856 PMCID: PMC10974719 DOI: 10.1002/cam4.7141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 03/13/2024] [Accepted: 03/17/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Although socioeconomic factors are important determinants of population mortality, the effect of educational level on the survival of patients with cancer in China is unclear. This study aimed to assess whether educational level is associated with the prognosis of patients with cancer and to explore the mediators of this association. METHODS This multicentre cohort study included 18,251 patients diagnosed with cancer between May 2013 and December 2018. The main parameters measured were overall survival (OS) and all-cause mortality. The relationship between educational level and all-cause mortality was assessed using multifactor-corrected Cox survival analysis. Logistic regression was used to analyze the association between educational level and patient-generated subjective global assessment (PG-SGA). RESULTS The mean age of the 18,251 participants (men, 9939 [54.4%]) was 57.37 ± 11.66 years. Multifactorial survival analysis showed that patients survived longer with increasing education (university and above vs. elementary school and below; p = p = <0.001, HR = 0.84, 95% CI: 0.77-0.92), and the differences were statistically significant in different subgroups. The potential impact factors included sex, age, TNM stage, and PG-SGA score. Logistic regression showed a significant negative association between educational level and the modifiable factor PG-SGA (secondary vs. primary and below; p = 0.004, HR = 0.90, 95% CI: 0.83-0.97; university and above vs. primary and below; p < 0.001, HR = 0.79, 95% CI: 0.71-0.88). CONCLUSIONS Educational level was a significant prognostic factor for patients with cancer, independent of other known prognostic factors. This association was further improved by modifying the nutritional status.
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Affiliation(s)
- Xiao‐Yue Liu
- Department of Gastrointestinal SurgeryBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- National Clinical Research Center for Geriatric DiseasesXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Xi Zhang
- Department of Gastrointestinal SurgeryBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- National Clinical Research Center for Geriatric DiseasesXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Guo‐Tian Ruan
- Department of Gastrointestinal SurgeryBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- National Clinical Research Center for Geriatric DiseasesXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Xin Zheng
- Department of Gastrointestinal SurgeryBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- National Clinical Research Center for Geriatric DiseasesXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Yue Chen
- Department of Gastrointestinal SurgeryBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- National Clinical Research Center for Geriatric DiseasesXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Xiao‐Wei Zhang
- Department of Gastrointestinal SurgeryBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- National Clinical Research Center for Geriatric DiseasesXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Tong Liu
- Department of Gastrointestinal SurgeryBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- National Clinical Research Center for Geriatric DiseasesXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Yi‐Zhong Ge
- Department of Gastrointestinal SurgeryBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- National Clinical Research Center for Geriatric DiseasesXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Han‐Ping Shi
- Department of Gastrointestinal SurgeryBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- National Clinical Research Center for Geriatric DiseasesXuanwu Hospital, Capital Medical UniversityBeijingChina
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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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García-Castrillo P, González-Álvarez MA. Inequality in the Face of Death: The Income Gradient in Mortality of the Spanish Pre-Recession Working-Age Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312379. [PMID: 34886105 PMCID: PMC8657191 DOI: 10.3390/ijerph182312379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022]
Abstract
The purpose of this paper is to evaluate the association between socioeconomic status (SES) and mortality over a three-year period for working-age Spaniards (2007-2009), paying particular attention to the effect of income level. The analysis is relatively new in Spain, and the studies are limited. Neither income nor wealth are included in existing Spanish mortality studies. The main reason for this limitation is the nature of the data sets used, mainly Census Records. We overcome this problem by using data on 693,994 individuals taken from a Social Security sampling and used to estimate the probabilities of death for each income decile and the mortality rate ratios in three different models: (1) using only income, controlled by age and sex, (2) adding socio-economic and geographical variables, and (3) adding level of education. However, the data used here also have some limitations. They do not include government employees, the military or the Department of Justice personnel, whose exclusion we believe causes an under-representation of highly educated people in our sample. The results confirm that there is a non-linear relationship between mortality and income. This non-linear relationship implies that income redistribution resulting from progressive taxation systems could lead to higher reductions in mortality for low-income groups than the reductions induced in the mortality of the high-income population, thus reducing overall mortality.
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Permanyer I, Spijker J, Blanes A, Renteria E. Longevity and Lifespan Variation by Educational Attainment in Spain: 1960-2015. Demography 2019; 55:2045-2070. [PMID: 30324395 DOI: 10.1007/s13524-018-0718-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
For a long time, studies of socioeconomic gradients in health have limited their attention to between-group comparisons. Yet, ignoring the differences that might exist within groups and focusing on group-specific life expectancy levels and trends alone, one might arrive at overly simplistic conclusions. Using data from the Spanish Encuesta Sociodemográfica and recently released mortality files by the Spanish Statistical Office (INE), this is the first study to simultaneously document (1) the gradient in life expectancy by educational attainment groups, and (2) the inequality in age-at-death distributions within and across those groups for the period between 1960 and 2015 in Spain. Our findings suggest that life expectancy has been increasing for all education groups but particularly among the highly educated. We observe diverging trends in life expectancy, with the differences between the low- and highly educated becoming increasingly large, particularly among men. Concomitantly with increasing disparities across groups, length-of-life inequality has decreased for the population as a whole and for most education groups, and the contribution of the between-group component of inequality to overall inequality has been extremely small. Even if between-group inequality has increased over time, its contribution has been too small to have sizable effects on overall inequality. In addition, our results suggest that education expansion and declining within-group variability might have been the main drivers of overall lifespan inequality reductions. Nevertheless, the diverging trends in longevity and lifespan inequality across education groups represent an important phenomenon whose underlying causes and potential implications should be investigated in detail.
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Affiliation(s)
- Iñaki Permanyer
- Centre d'Estudis Demogràfics, Carrer de Ca n'Altayó, Edifici E-2, Campus de la UAB, 08193, Cerdanyola del Vallès, Spain.
| | - Jeroen Spijker
- Centre d'Estudis Demogràfics, Carrer de Ca n'Altayó, Edifici E-2, Campus de la UAB, 08193, Cerdanyola del Vallès, Spain
| | - Amand Blanes
- Centre d'Estudis Demogràfics, Carrer de Ca n'Altayó, Edifici E-2, Campus de la UAB, 08193, Cerdanyola del Vallès, Spain
| | - Elisenda Renteria
- Centre d'Estudis Demogràfics, Carrer de Ca n'Altayó, Edifici E-2, Campus de la UAB, 08193, Cerdanyola del Vallès, Spain
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ARGHITTU A, DETTORI M, MASIA M, AZARA A, DEMPSEY E, CASTIGLIA P. Social deprivation indexes and anti-influenza vaccination coverage in the elderly in Sardinia, Italy, with a focus on the Sassari municipality. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 59:E45-E50. [PMID: 31016267 PMCID: PMC6419305 DOI: 10.15167/2421-4248/jpmh2018.59.4s2.1077] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/20/2018] [Indexed: 11/18/2022]
Abstract
The aim of the present study was to evaluate the relationship between social deprivation indexes and anti-influenza vaccination coverage in the elderly population (over 65 years old) in Sardinia. This relationship was first observed in a regional context. An already-known deprivation index was used, and its trivial relationship with anti-influenza vaccination coverage was evaluated. Secondly, the same relationship was assessed in the homogeneous area of the Municipality of Sassari. This required the adoption of an ad hoc deprivation index, which allowed us to stratify the population into deprivation groups and to correlate vaccination coverage with socio-economic variables. The results showed that regional anti-influenza vaccination coverage increased linearly as deprivation decreased. This trend was confirmed in the Municipality of Sassari. Pearson’s analysis highlighted factors that significantly correlate with vaccination coverage. In Sardinia, the relationship between anti-influenza vaccination coverage and socio-economic status is consistent with the international panorama, and highlights the necessity to implement interventions to promote vaccination coverage among the elderly.
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Affiliation(s)
- A. ARGHITTU
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - M. DETTORI
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - M.D. MASIA
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - A. AZARA
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - E. DEMPSEY
- Department of Humanities and Social Sciences, University of Sassari, Italy
| | - P. CASTIGLIA
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
- Paolo Castiglia, Department of Medical, Surgical and Experimental Sciences, University of Sassari, via Padre Manzella 4, 07100 Sassari. Tel. +39 079 228032 - Fax +39 079 228054 - E-mail:
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Rodríguez-Sanz M, Gotsens M, Marí dell’Olmo M, Borrell C. Trends in mortality inequalities in an urban area: the influence of immigration. Int J Equity Health 2019; 18:37. [PMID: 30808362 PMCID: PMC6390301 DOI: 10.1186/s12939-019-0939-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/14/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Nearly 20% of the population in Barcelona is foreign-born and this percentage rises to up to 40% in some neighborhoods. Consequently, migration health patterns may play an important role in trends in socioeconomic geographical inequalities in mortality. The objective of this study was to analyze the trend in socioeconomic inequalities in mortality between neighborhoods in Barcelona during the period 2001-2012 in the foreign-born and Spanish-born population. METHODS Repeated cross-sectional design of the population aged 25-64 years in Barcelona between 2001 and 2012. Hierarchical data consisted of yearly mortality linked-population. The variables analyzed were age, sex, education, and country of birth (Spanish-born, foreign-born), neighborhood of residence, and the socioeconomic level of the neighborhoods using quartiles of unemployment rates. Age-standardized mortality rates were estimated, and mixed Poisson regressions were applied using generalized linear mixed models, including two random effects to consider the intracorrelation within neighborhoods and across years. RESULTS The number of foreign-born residents aged 25-64 increased notably in disadvantaged neighborhoods. Approximately 9% of premature deaths occurred in foreign-born individuals. Premature mortality rates were higher in disadvantaged neighborhoods and in the Spanish-born population in all periods. Despite the stabilized socioeconomic inequalities in mortality in the Spanish-born population, no inequalities were found between neighborhoods in foreign-born men and women. CONCLUSIONS Evidence of the 'healthy migrant' effect in mortality and socioeconomic inequalities in mortality was found in Barcelona, which seems to alter the distribution of mortality through time and space, related to the low levels of premature mortality and the selective residence of immigrants in socioeconomically disadvantaged neighborhoods.
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Affiliation(s)
- Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona, Lesseps, 1, 08023 Barcelona, Spain
- Institut d’Investigacio Biomedica (IIB Sant Pau), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Barcelona, Spain
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, Lesseps, 1, 08023 Barcelona, Spain
- Institut d’Investigacio Biomedica (IIB Sant Pau), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Barcelona, Spain
| | - Marc Marí dell’Olmo
- Agència de Salut Pública de Barcelona, Lesseps, 1, 08023 Barcelona, Spain
- Institut d’Investigacio Biomedica (IIB Sant Pau), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Barcelona, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Lesseps, 1, 08023 Barcelona, Spain
- Institut d’Investigacio Biomedica (IIB Sant Pau), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Barcelona, Spain
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Vanthomme K, Vandenheede H, Hagedoorn P, Gadeyne S. Evolution of educational inequalities in site-specific cancer mortality among Belgian men between the 1990s and 2000s using a "fundamental cause" perspective. BMC Cancer 2017; 17:470. [PMID: 28679369 PMCID: PMC5498997 DOI: 10.1186/s12885-017-3461-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 06/27/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND According to the "fundamental cause" theory, emerging knowledge on health-enhancing behaviours and technologies results in health disparities. This study aims to assess (trends in) educational inequalities in site-specific cancer mortality in Belgian men in the 1990s and the 2000s using this framework. METHODS Data were derived from record linkage between the Belgian censuses of 1991 and 2001 and register data on mortality. The study population comprised all Belgian men aged 50-79 years during follow-up. Both absolute and relative inequality measures have been calculated. RESULTS Despite an overall downward trend in cancer mortality, educational differences are observed for the majority of cancer sites in the 2000s. Generally, inequalities are largest for mortality from preventable cancers. Trends over time in inequalities are rather stable compared with the 1990s. CONCLUSIONS Educational differences in site-specific cancer mortality persist in the 2000s in Belgium, mainly for cancers related to behavioural change and medical interventions. Policy efforts focussing on behavioural change and healthcare utilization remain crucial in order to tackle these increasing inequalities.
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Affiliation(s)
- Katrien Vanthomme
- Interface Demography, Department of Social Research, Faculty of Economic and Social Sciences and Solvay Business School, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Hadewijch Vandenheede
- Interface Demography, Department of Social Research, Faculty of Economic and Social Sciences and Solvay Business School, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Paulien Hagedoorn
- Interface Demography, Department of Social Research, Faculty of Economic and Social Sciences and Solvay Business School, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Sylvie Gadeyne
- Interface Demography, Department of Social Research, Faculty of Economic and Social Sciences and Solvay Business School, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
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8
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Vanthomme K, Vandenheede H, Hagedoorn P, Gadeyne S. Evolution of socioeconomic inequalities in site-specific cancer mortality among Belgian women between 1991 and 2008 using a fundamental cause approach. Cancer Causes Control 2017; 28:829-840. [DOI: 10.1007/s10552-017-0921-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 06/27/2017] [Indexed: 10/19/2022]
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Froehner M, Koch R, Propping S, Liebeheim D, Hübler M, Baretton GB, Hakenberg OW, Wirth MP. Level of education and mortality after radical prostatectomy. Asian J Androl 2017; 19:173-177. [PMID: 28051039 PMCID: PMC5312214 DOI: 10.4103/1008-682x.178487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Estimating the risk of competing mortality is of importance in men with early prostate cancer to choose the most appropriate way of management and to avoid over- or under-treatment. In this study, we investigated the impact of the level of education in this context. The study sample consisted of 2630 patients with complete data on level of education (college, university degree, master craftsmen, comparable profession, or others), histopathological tumor stage (organ confined or extracapsular), lymph node status (negative or positive), and prostatectomy specimen Gleason score (<7, 7, or 8–10) who underwent radical prostatectomy between 1992 and 2007. Overall, prostate cancer-specific, competing, and second cancer-related mortalities were study endpoints. Cox proportional hazard models for competing risks were used to study combined effects of the variables on these endpoints. A higher level of education was independently associated with decreased overall mortality after radical prostatectomy (hazard ratio [HR]: 0.75, 95% confidence interval [95% CI]: 0.62–0.91, P = 0.0037). The mortality difference was attributable to decreased second cancer mortality (HR: 0.59, 95% CI: 0.40–0.85, P = 0.0052) and noncancer mortality (HR: 0.73, 95% CI: 0.55–0.98, P = 0.0345) but not to differences in prostate cancer-specific mortality (HR: 1.16, 95% CI: 0.79–1.69, P = 0.4536 in the full model). In conclusion, the level of education might serve as an independent prognostic parameter supplementary to age, comorbidity, and smoking status to estimate the risk of competing mortality and to choose optimal treatment for men with early prostate cancer who are candidates for radical prostatectomy.
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Affiliation(s)
- Michael Froehner
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Rainer Koch
- Department of Medical Statistics and Biometry, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Stefan Propping
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Dorothea Liebeheim
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Matthias Hübler
- Department of Anesthesiology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Gustavo B Baretton
- Department of Pathology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Oliver W Hakenberg
- Department of Urology, University of Rostock, Ernst-Heydemann-Strasse 6, D-18055 Rostock, Germany
| | - Manfred P Wirth
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
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Rodríguez-Sanz M, Gotsens M, Marí-Dell'Olmo M, Mehdipanah R, Borrell C. Twenty years of socioeconomic inequalities in premature mortality in Barcelona: The influence of population and neighbourhood changes. Health Place 2016; 39:142-52. [PMID: 27105035 DOI: 10.1016/j.healthplace.2016.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 02/18/2016] [Accepted: 03/04/2016] [Indexed: 11/30/2022]
Abstract
The objective of this study was to analyse trends in socioeconomic inequalities in premature mortality in Barcelona from 1992 to 2011, accounting for population changes. We conducted a repeated cross-sectional study of the Barcelona population (25-64 years) using generalized linear mixed models for trend analysis, and found that socioeconomic inequalities in premature mortality persisted between neighbourhoods, but tended to diminish. However, the reduction in inequality was related to an increase in the number of foreign-born individuals mainly in socioeconomic disadvantaged neighbourhoods, in which the decrease in premature mortality was more marked. To study trends in geographical inequalities in mortality, it is essential to understand demographic changes occurred in different places related to local levels of deprivation.
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Affiliation(s)
- Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Universitat Pompeu Fabra, Barcelona, Spain.
| | - Mercè Gotsens
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Marc Marí-Dell'Olmo
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Roshanak Mehdipanah
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Department of Health Behavior & Health Education, University of Michigan School of Public Health, USA
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Universitat Pompeu Fabra, Barcelona, Spain
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11
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Relative index of inequality and slope index of inequality: a structured regression framework for estimation. Epidemiology 2016; 26:518-27. [PMID: 26000548 DOI: 10.1097/ede.0000000000000311] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The relative index of inequality and the slope index of inequality are the two major indices used in epidemiologic studies for the measurement of socioeconomic inequalities in health. Yet the current definitions of these indices are not adapted to their main purpose, which is to provide summary measures of the linear association between socioeconomic status and health in a way that enables valid between-population comparisons. The lack of appropriate definitions has dissuaded the application of suitable regression methods for estimating the slope index of inequality. METHODS We suggest formally defining the relative and slope indices of inequality as so-called least false parameters, or more precisely, as the parameters that provide the best approximation of the relation between socioeconomic status and the health outcome by log-linear and linear models, respectively. From this standpoint, we establish a structured regression framework for inference on these indices. Guidelines for implementation of the methods, including R and SAS codes, are provided. RESULTS The new definitions yield appropriate summary measures of the linear association across the entire socioeconomic scale, suitable for comparative studies in epidemiology. Our regression-based approach for estimation of the slope index of inequality contributes to an advancement of the current methodology, which mainly consists of a heuristic formula relying on restrictive assumptions. A study of the educational inequalities in all-cause and cause-specific mortality in France is used for illustration. CONCLUSION The proposed definitions and methods should guide the use and estimation of these indices in future studies.
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Parreira VG, Meira KC, Guimarães RM. Socioeconomic differentials and mortality from colorectal cancer in large cities in Brazil. Ecancermedicalscience 2016; 10:614. [PMID: 26823683 PMCID: PMC4720492 DOI: 10.3332/ecancer.2016.614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Indexed: 12/29/2022] Open
Abstract
The objective of this study was to compare the mortality pattern of colorectal cancer according to the social development profile of the large Brazilian cities. This was an ecological study that used as units of analysis Brazilian municipalities that were considered to be large (i.e. over 100,000 inhabitants). The social indicators adopted were obtained from the Atlas of Human Development in Brazil. Mortality data came from the Mortality Information System (MIS), represented by codes C18, C19, and C20. For data analysis, municipalities were characterised according to the indicator profile used by multivariate classification cluster analysis. It was observed that the Southeast, South, and Midwest regions concentrated over 90% of cities in the group of more developed municipalities, while the North and Northeast regions were represented by 60% of cities in the group of less developed municipalities. The mortality pattern of colorectal cancer in both groups was different, with a higher average mortality rate from colorectal cancer for populations living in cities from the more developed group (p = 0.02). The mortality rate from this cancer was shown to be directly proportional to the Municipal Human Developlemnt Index (MHDI) and inversely proportional to the inequality indicator (p < 0.001); therefore the highest means were observed among the municipalities with better socioeconomic conditions. It is important to consider social disparities to ensure equity in healthcare policy management.
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Affiliation(s)
| | - Karina Cardoso Meira
- Universidade Federal do Rio Grande do Norte, Escola de Enfermagem de Natal, Brazil
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13
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Vicens GR, Zafra MS, Moreno-Crespi J, Ferrer BCS, Marcos-Gragera R. Incidence variation of prostate and cervical cancer according to socioeconomic level in the Girona Health Region. BMC Public Health 2014; 14:1079. [PMID: 25325921 PMCID: PMC4287549 DOI: 10.1186/1471-2458-14-1079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 08/05/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The main aim of this study, using a spatial-temporal model, is to analyse the link between a deprivation index and the incidence of prostate and cervical cancer in the Girona Health Region (GHR). METHODS This is a population-based study which includes all the inhabitants in the GHR in the period 1993-2006. In order to assess prostate/cervical cancer risk, Besag, York and Mollie (BYM)'s spatial-temporal version of the model was used and four random effects were introduced: (non-spatial) unstructured variability, spatial dependency, temporal dependency and spatial-temporal interaction. As an explanatory variable, a deprivation index was introduced at the census tract level. Furthermore, the percentage of the population between 45-64 years of age and over-65 was also considered as explanatory variables. RESULTS In the case of prostate cancer, all the variables which were introduced into the model showed a significant correlation with the relative risk, except for the second quintile of the deprivation index. Furthermore, as the index increased the correlation became negative and lower. Thus, the correlation between the relative risk and the two age bands proved to be lower, the higher the age was. In the case of cervical cancer, only the correlation between the over-65 age band and the relative risk was found to be statistically significant and positive. CONCLUSIONS In the case of prostate cancer, the results obtained in the GHR are in line with similar analyses. However, in the case of cervical cancer, no significant relationship between incidences in this location or economic status was found.
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Affiliation(s)
- Gemma Renart Vicens
- />Research Group on Statistics, Applied Economics and Health (GRECS), CIBER of Epidemiology and Public Health (CIBERESP), University of Girona, Campus de Montilivi, Girona, 17071 Spain
| | - Marc Saez Zafra
- />Research Group on Statistics, Applied Economics and Health (GRECS), CIBER of Epidemiology and Public Health (CIBERESP), University of Girona, Campus de Montilivi, Girona, 17071 Spain
| | - Judit Moreno-Crespi
- />Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona Biomedical Research Institute, Girona, Spain
| | - Bernat C Serdà Ferrer
- />Departament d’Infermeria. Universitat de Girona (UdG), Girona Biomedical Research Institute, Girona, Spain
| | - Rafael Marcos-Gragera
- />Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona Biomedical Research Institute, Girona, Spain
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14
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Xin KP, Du ML, Liu ZY, Wang WR, Qian YG, Liu L, Lv YF, Sun J. Colorectal cancer mortality in Inner Mongolia between 2008 and 2012. World J Gastroenterol 2014; 20:8209-8214. [PMID: 25009394 PMCID: PMC4081694 DOI: 10.3748/wjg.v20.i25.8209] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 01/27/2014] [Accepted: 04/03/2014] [Indexed: 02/07/2023] Open
Abstract
AIM: To determine the extent of colorectal cancer (CRC) mortality and the association between demographic characteristics and CRC mortality in Inner Mongolia.
METHODS: Data were collected from the Death Registry System, maintained by the Inner Mongolia Centers for Disease Control and Prevention, from 2008 to 2012. Deaths were classified according to the International Classification of Disease, 10th Revision. Years of life lost, average years of life lost (AYLL), and mortality were calculated over the five years between 2008 and 2012. A conditional logistic regression model was used to analyze the association between marital status, occupational status, education level, area of residence, and the risk of CRC.
RESULTS: The AYLL of CRC was 17.39 years. The average mortality of CRC was 5.6/100000. People living in urban areas and having a higher education level had a significantly higher risk of CRC (OR = 1.74 and 95%CI: 1.29-2.35, P < 0.001 and OR = 2.39, 95%CI: 1.76-3.25, P < 0.001, respectively). People who were employed had a lower risk of CRC (OR = 0.64, 95%CI: 0.48-0.86, P = 0.003). The mortality of CRC was positively correlated with the education level (P < 0.001). No statistically significant association was observed between marital status and CRC risk (P = 0.259).
CONCLUSION: Living in urban areas, higher education level and unemployment are associated with CRC mortality in Inner Mongolia.
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Manser CN, Bauerfeind P. Impact of socioeconomic status on incidence, mortality, and survival of colorectal cancer patients: a systematic review. Gastrointest Endosc 2014; 80:42-60.e9. [PMID: 24950641 DOI: 10.1016/j.gie.2014.03.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/05/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Christine N Manser
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Zurich University Hospital, Zurich, Switzerland
| | - Peter Bauerfeind
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Zurich University Hospital, Zurich, Switzerland
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Singh GK, Siahpush M, Altekruse SF. Time trends in liver cancer mortality, incidence, and risk factors by unemployment level and race/ethnicity, United States, 1969-2011. J Community Health 2014; 38:926-40. [PMID: 23689953 DOI: 10.1007/s10900-013-9703-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This study examined unemployment and racial/ethnic disparities in liver cancer mortality, incidence, survival, and risk factors in the United States between 1969 and 2011. Census-based unemployment rates were linked to 1969-2009 county-level mortality and incidence data, whereas 2006-2011 National Health Interview Surveys were used to examine variations in hepatitis infection and alcohol consumption. Age-adjusted mortality rates, risk-ratios, and rate-differences were calculated by year, sex, race, and county-unemployment level. Log-linear, Poisson, and logistic regression and disparity indices were used to model trends and differentials. Although liver-cancer mortality rose markedly for all groups during 1969-2011, higher unemployment levels were associated with increased mortality and incidence rates in each time period. Both absolute and relative inequalities in liver cancer mortality according to unemployment level increased over time for both males and females and for those aged 25-64 years. Compared to the lowest-unemployment group, those aged 25-64 in the highest-unemployment group had 56 and 115 % higher liver-cancer mortality in 1969-1971 and 2005-2009, respectively. Regardless of unemployment levels, Asian/Pacific Islanders and Hispanics had the highest mortality and incidence rates. The adjusted odds of hepatitis infection and heavy drinking were 38-39 % higher among the unemployed than employed. Liver-cancer mortality and incidence have risen steadily among all racial/ethnic, sex, and socioeconomic groups. Faster increases in mortality among the highest-unemployment group have led to a widening gap in mortality over time. Disparities in mortality and incidence are consistent with similar inequalities in hepatitis infection and alcohol consumption.
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Affiliation(s)
- Gopal K Singh
- US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 5600 Fishers Lane, Room 18-41, Rockville, MD 20857, USA.
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17
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Abdoli G, Bottai M, Moradi T. Cancer mortality by country of birth, sex, and socioeconomic position in Sweden, 1961-2009. PLoS One 2014; 9:e93174. [PMID: 24682217 PMCID: PMC3969357 DOI: 10.1371/journal.pone.0093174] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 03/03/2014] [Indexed: 01/26/2023] Open
Abstract
In 2010, cancer deaths accounted for more than 15% of all deaths worldwide, and this fraction is estimated to rise in the coming years. Increased cancer mortality has been observed in immigrant populations, but a comprehensive analysis by country of birth has not been conducted. We followed all individuals living in Sweden between 1961 and 2009 (7,109,327 men and 6,958,714 women), and calculated crude cancer mortality rates and age-standardized rates (ASRs) using the world population for standardization. We observed a downward trend in all-site ASRs over the past two decades in men regardless of country of birth but no such trend was found in women. All-site cancer mortality increased with decreasing levels of education regardless of sex and country of birth (p for trend <0.001). We also compared cancer mortality rates among foreign-born (13.9%) and Sweden-born (86.1%) individuals and determined the effect of education level and sex estimated by mortality rate ratios (MRRs) using multivariable Poisson regression. All-site cancer mortality was slightly higher among foreign-born than Sweden-born men (MRR = 1.05, 95% confidence interval 1.04-1.07), but similar mortality risks was found among foreign-born and Sweden-born women. Men born in Angola, Laos, and Cambodia had the highest cancer mortality risk. Women born in all countries except Iceland, Denmark, and Mexico had a similar or smaller risk than women born in Sweden. Cancer-specific mortality analysis showed an increased risk for cervical and lung cancer in both sexes but a decreased risk for colon, breast, and prostate cancer mortality among foreign-born compared with Sweden-born individuals. Further studies are required to fully understand the causes of the observed inequalities in mortality across levels of education and countries of birth.
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Affiliation(s)
- Gholamreza Abdoli
- Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Biostatistics and Epidemiology, Kermanshah University of Medical Sciences, Kermanshah, Iran
- * E-mail:
| | - Matteo Bottai
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tahereh Moradi
- Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centrum for Epidemiology and Social Medicine, Healthcare Provision, Stockholm, Sweden
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18
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Li BL, Jiang GX, Xue Q, Zhang H, Wang C, Zhang GX, Xu ZY. Dairy consumption and risk of esophageal squamous cell carcinoma: A meta-analysis of observational studies. Asia Pac J Clin Oncol 2014; 12:e269-79. [PMID: 24673835 DOI: 10.1111/ajco.12183] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2014] [Indexed: 01/19/2023]
Abstract
AIM Inconsistent results regarding the relations between consumption of dairy products and the risk of esophageal squamous cell carcinoma (ESCC) have been reported. In this report, we summarized the evidence by a meta-analysis of observational studies. METHODS Eligible studies published up to January 31, 2013 were retrieved via both computer searches and a manual review of references. Random-effects models were used to calculate the summary relative risk (SRR) based on high versus low and dose-response analysis. RESULTS A total of 19 studies with 4315 ESCC cases were included in this meta-analysis. Overall, there were no significant associations between intakes of total dairy products, milk, cheese and butter and ESCC for the highest versus lowest intake categories (total dairy products: SRR 1.03, 95% confidence interval [CI]: 0.60-1.77; milk: SRR 0.93, 95% CI: 0.74-1.16; cheese: SRR 0.84, 95% CI: 0.61-1.15; butter: SRR 1.77, 95% CI 0.85-3.75). A significant inverse association was found for yogurt consumption (SRR 0.73, 95% CI: 0.54-0.98). There was high heterogeneity among studies on total dairy products, milk and butter; however, little or no heterogeneity was observed among studies on cheese and yogurt. CONCLUSION No associations between consumption of milk, dairy products, butter or cheese and risk of ESCC were found, while yogurt consumption may have a protective effect. However, these associations may be subject to high levels of heterogeneity or confounding, and further efforts should be made to confirm these findings.
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Affiliation(s)
- Bai-Ling Li
- Department of Cardiothoracic Surgery, Changhai Hospital of Second Military Medical University, Shanghai, China
| | - Geng-Xi Jiang
- Department of Cardiothoracic Surgery, Changhai Hospital of Second Military Medical University, Shanghai, China
| | - Qing Xue
- Department of Cardiothoracic Surgery, Changhai Hospital of Second Military Medical University, Shanghai, China
| | - Hao Zhang
- Department of Cardiothoracic Surgery, Changhai Hospital of Second Military Medical University, Shanghai, China
| | - Chong Wang
- Department of Cardiothoracic Surgery, Changhai Hospital of Second Military Medical University, Shanghai, China
| | - Guan-Xin Zhang
- Department of Cardiothoracic Surgery, Changhai Hospital of Second Military Medical University, Shanghai, China
| | - Zhi-Yun Xu
- Department of Cardiothoracic Surgery, Changhai Hospital of Second Military Medical University, Shanghai, China
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Menvielle G, Rey G, Jougla E, Luce D. Diverging trends in educational inequalities in cancer mortality between men and women in the 2000s in France. BMC Public Health 2013; 13:823. [PMID: 24015917 PMCID: PMC3847008 DOI: 10.1186/1471-2458-13-823] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 09/03/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Socioeconomic inequalities in cancer mortality have been observed in different European countries and the US until the end of the 1990s, with changes over time in the magnitude of these inequalities and contrasted situations between countries. The aim of this study is to estimate relative and absolute educational differences in cancer mortality in France between 1999 and 2007, and to compare these inequalities with those reported during the 1990s. METHODS Data from a representative sample including 1% of the French population were analysed. Educational differences among people aged 30-74 were quantified with hazard ratios and relative indices of inequality (RII) computed using Cox regression models as well as mortality rate difference and population attributable fraction. RESULTS In the period 1999-2007, large relative inequalities were found among men for total cancer and smoking and/or alcohol related cancers mortality (lung, head and neck, oesophagus). Among women, educational differences were reported for total cancer, head and neck and uterus cancer mortality. No association was found between education and breast cancer mortality. Slight educational differences in colorectal cancer mortality were observed in men and women. For most frequent cancers, no change was observed in the magnitude of relative inequalities in mortality between the 1990s and the 2000s, although the RII for lung cancer increased both in men and women. Among women, a large increase in absolute inequalities in mortality was observed for all cancers combined, lung, head and neck and colorectal cancer. In contrast, among men, absolute inequalities in mortality decreased for all smoking and/or alcohol related cancers. CONCLUSION Although social inequalities in cancer mortality are still high among men, an encouraging trend is observed. Among women though, the situation regarding social inequalities is less favourable, mainly due to a health improvement limited to higher educated women. These inequalities may be expected to further increase in future years.
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Affiliation(s)
- Gwenn Menvielle
- Inserm U1018, Center for Epidemiology and Population Health, Occupational and social determinants of health, Bat 15/16 Hôpital Paul Brousse, 16 ave Paul Vaillant Couturier, Villejuif Cedex 94807, France
- University of Versailles Saint Quentin, UMRS 1018, France
| | | | | | - Danièle Luce
- Inserm U1018, Center for Epidemiology and Population Health, Occupational and social determinants of health, Bat 15/16 Hôpital Paul Brousse, 16 ave Paul Vaillant Couturier, Villejuif Cedex 94807, France
- University of Versailles Saint Quentin, UMRS 1018, France
- Inserm U1085, Irset, Pointe-à-Pitre, Guadeloupe, French West Indies
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Aguilar I, Compés L, Feja C, Rabanaque MJ, Martos C. Gastric cancer incidence and geographical variations: the influence of gender and rural and socioeconomic factors, Zaragoza (Spain). Gastric Cancer 2013; 16:245-53. [PMID: 22806416 DOI: 10.1007/s10120-012-0175-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 06/12/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Socioeconomic status (SES) and rural factors have been shown to be associated with gastric cancer epidemiology. The aim of this study was to identify geographical variations in gastric cancer incidence in Zaragoza province (Spain) during the period 1993-2002, and their association with SES and rural factors. METHODS Incident cases were extracted from the population-based Zaragoza Cancer Registry. The geographical analysis unit was the census tract (CT) in Zaragoza city (N = 462) and the municipalities for the rest of the province (N = 292). Four indexes were applied: two deprivation and two rurality indexes, included in a Bayesian risk model discretized in quartiles. Standardized incidence ratios (SIRs) were calculated using the incidence rates in Spain. SIRs were adjusted by a Bayesian generalized linear mixed model (GLMM). RESULTS From 1993 to 2002, 1,309 cases of gastric cancer were registered in Zaragoza city and 578 in the rest of the province. High risk was observed in CTs for the peripheral areas of the city. The incidence risk in men was 2 (95 % confidence interval [CI] 1.22-2.98) times higher in the most deprived CTs compared with the least deprived CTs, but no statistically significant differences were found in women. Municipalities with higher risk were observed in the north of the province, but no significant association was found with SES. Regarding the rurality index, a positive trend was observed in women, but it was statistically significant only for the most rural quartile (2.49, 95 % CI 1.07-4.92). CONCLUSIONS Geographical differences in gastric cancer incidence were detected. Although these differences could be partially explained by the deprivation index for men in Zaragoza city, deprivation index cannot explain geographical differences for women. In the rest of the province, the rurality index 1991 could explain, at least for women, geographical differences. It is still necessary to develop a deprivation index suitable for small municipalities.
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Affiliation(s)
- Isabel Aguilar
- Division of Public Health, University of Zaragoza, C/Domingo Miral S/N, 50009, Zaragoza, Spain.
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21
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Buso DL, Longo-Mbenza B, Bovet P, van den Borne B, Okwe AN, Mzingelwa M. Deaths rates in public hospitals of eastern cape province of South Africa. IRANIAN JOURNAL OF PUBLIC HEALTH 2012; 41:19-25. [PMID: 23641386 PMCID: PMC3640777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 11/18/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND South Africa (SA) is experiencing a rapid epidemiologic transition as a consequence of political, economic and social changes. In this study we described, based on hospital data, the mortality patterns of Non communicable Diseases (NCD), Communicable Diseases (CD), the NCD/CD ratios, and the trends of deaths. METHODS We conducted a cross-sectional survey of all deaths occurring in several public hospitals in the Eastern Cape Province of SA between 2002 and 2006. Causes of deaths were coded according to the ICD 10 Edition. RESULTS A total of 107380 admissions responded to the inclusion criteria between 2002 and 2006. The crude death rate was 4.3% (n=4566) with a mean age of 46±21 years and a sex ratio of 3.1 men (n=3453): 1 woman (n=1113). Out of all deaths, there were 62.9% NCD (n=2872) vs. 37.1% CD (n=1694) with NCD/CD ratio of 1.7. The ratio NCD/CD deaths in men was 1.3 (n=1951/1502) vs. NCD/CD deaths in women of 1.9 (n=735/378). The peak of deaths was observed in winter season. The majority of NCD deaths were at age of 30-64 years, whereas the highest rate of CD deaths was at age< 30 years. The trend of deaths including the majority of NCD, increased from 2002 to 2006. There was a tendency of increase in tuberculosis deaths, but a tendency of decrease in HIV/AIDS deaths was from 2002 to 2006. CONCLUSION Non-communicable diseases are the leading causes of deaths in rural Eastern Cape province of SA facing Post-epidemiologic transition stages. We recommend overarching priority actions for the response to the Non-communicable Diseases: policy change, prevention, treatment, international cooperation, research, monitoring, accountability, and re-orientation of health systems.
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Affiliation(s)
- DL Buso
- Walter Sisulu University, Faculty of Health Sciences, Mthatha, Eastern Cap, South Africa
| | - B Longo-Mbenza
- Walter Sisulu University, Faculty of Health Sciences, Mthatha, Eastern Cap, South Africa
| | - P Bovet
- Institute of Social and Preventive Medicine, University of Lausanne, Switzerland
| | - B van den Borne
- Dept. of Health Promotion, Faculty of Medicine, Maastricht University, The Nederland
| | - A Nge Okwe
- Biostatistics Unit, LOMO MEDICAL Center and Heart of Africa Center of Cardiology DRC, South Africa
| | - M Mzingelwa
- Walter Sisulu University, Faculty of Health Sciences, Mthatha, Eastern Cap, South Africa
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22
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Singh GK, Williams SD, Siahpush M, Mulhollen A. Socioeconomic, Rural-Urban, and Racial Inequalities in US Cancer Mortality: Part I-All Cancers and Lung Cancer and Part II-Colorectal, Prostate, Breast, and Cervical Cancers. J Cancer Epidemiol 2012; 2011:107497. [PMID: 22496688 PMCID: PMC3307012 DOI: 10.1155/2011/107497] [Citation(s) in RCA: 300] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 11/02/2011] [Accepted: 11/16/2011] [Indexed: 12/28/2022] Open
Abstract
We analyzed socioeconomic, rural-urban, and racial inequalities in US mortality from all cancers, lung, colorectal, prostate, breast, and cervical cancers. A deprivation index and rural-urban continuum were linked to the 2003-2007 county-level mortality data. Mortality rates and risk ratios were calculated for each socioeconomic, rural-urban, and racial group. Weighted linear regression yielded relative impacts of deprivation and rural-urban residence. Those in more deprived groups and rural areas had higher cancer mortality than more affluent and urban residents, with excess risk being marked for lung, colorectal, prostate, and cervical cancers. Deprivation and rural-urban continuum were independently related to cancer mortality, with deprivation showing stronger impacts. Socioeconomic inequalities existed for both whites and blacks, with blacks experiencing higher mortality from each cancer than whites within each deprivation group. Socioeconomic gradients in mortality were steeper in nonmetropolitan than in metropolitan areas. Mortality disparities may reflect inequalities in smoking and other cancer-risk factors, screening, and treatment.
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Affiliation(s)
- Gopal K Singh
- US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 5600 Fishers Lane, Room 18-41, Rockville, MD 20857, USA
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Elstad JI, Torstensrud R, Lyngstad TH, Kravdal O. Trends in educational inequalities in mortality, seven types of cancers, Norway 1971-2002. Eur J Public Health 2011; 22:771-6. [DOI: 10.1093/eurpub/ckr181] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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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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Aarts MJ, Lemmens VEPP, Louwman MWJ, Kunst AE, Coebergh JWW. Socioeconomic status and changing inequalities in colorectal cancer? A review of the associations with risk, treatment and outcome. Eur J Cancer 2010; 46:2681-95. [PMID: 20570136 DOI: 10.1016/j.ejca.2010.04.026] [Citation(s) in RCA: 162] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 04/15/2010] [Accepted: 04/28/2010] [Indexed: 11/15/2022]
Abstract
BACKGROUND Upcoming mass screening for colorectal cancer (CRC) makes a review of recent literature on the association with socioeconomic status (SES) relevant, because of marked and contradictory associations with risk, treatment and outcome. METHODS The Pubmed database using the MeSH terms 'Neoplasms' or 'Colorectal Neoplasms' and 'Socioeconomic Factors' for articles added between 1995 and 1st October 2009 led to 62 articles. RESULTS Low SES groups exhibited a higher incidence compared with high SES groups in the US and Canada (range risk ratio (RR) 1.0-1.5), but mostly lower in Europe (RR 0.3-0.9). Treatment, survival and mortality all showed less favourable results for people with a lower socioeconomic status: Patients with a low SES received less often (neo)adjuvant therapy (RR ranging from 0.4 to 0.99), had worse survival rates (hazard ratio (HR) 1.3-1.8) and exhibited generally the highest mortality rates up to 1.6 for colon cancer in Europe and up to 3.1 for rectal cancer. CONCLUSIONS A quite consistent trend was observed favouring individuals with a high SES compared to those with a low SES that still remains in terms of treatment, survival and thus also mortality. We did not find evidence that the low/high SES gradients for treatment chosen and outcome are decreasing. To meet increasing inequalities in mortality from CRC in Europe for people with a low SES and to make mass screening successful, a high participation rate needs to be realised of low SES people in the soon starting screening program.
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Affiliation(s)
- Mieke J Aarts
- Eindhoven Cancer Registry, Comprehensive Cancer Centre South (IKZ), P.O. Box 231, 5600 AE Eindhoven, The Netherlands.
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Borrell C, Marí-Dell'olmo M, Serral G, Martínez-Beneito M, Gotsens M. Inequalities in mortality in small areas of eleven Spanish cities (the multicenter MEDEA project). Health Place 2010; 16:703-11. [PMID: 20399699 DOI: 10.1016/j.healthplace.2010.03.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 03/04/2010] [Accepted: 03/09/2010] [Indexed: 10/19/2022]
Abstract
The objectives of this study are to identify inequalities in mortality among census tracts of 11 Spanish cities in the period 1996-2003 and to analyse the relationship between these geographical inequalities and socioeconomic deprivation. It is a cross-sectional ecological study where the units of analysis are census tracts. We obtained an index of socioeconomic deprivation and estimated SMR by each census tract using hierarchical Bayesian models which take into account the spatial structure. In the majority of the cities geographical patterns in total mortality were found in both sexes, which were similar to those for the index of socioeconomic deprivation. Among men, four specific causes of death (lung cancer, ischemic heart diseases, respiratory diseases and cirrhosis) were positively associated with deprivation in the majority of cities. Among women the specific causes diabetes and cirrhosis were positively associated, while lung cancer was negatively associated with deprivation. The excess of mortality related with deprivation was 59,445 deaths among men and 23,292 among women. These results highlight the importance of intra-urban inequalities in health.
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Burrows S, Auger N, Roy M, Alix C. Socio-economic inequalities in suicide attempts and suicide mortality in Québec, Canada, 1990-2005. Public Health 2010; 124:78-85. [PMID: 20181370 DOI: 10.1016/j.puhe.2010.01.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 11/30/2009] [Accepted: 01/13/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Little research has evaluated changes in the association between area deprivation and suicidal behaviour over time. This study investigated patterns in suicide attempts and suicide mortality according to material deprivation in the province of Québec, Canada between 1990 and 2005. STUDY DESIGN Ecological analysis. METHODS Data on suicide attempts were extracted from the hospital discharge summary database (n=47,516) and data on suicides were extracted from the Québec death file (n=20,851). Gender- and age-specific (10-24, 25-44, 45-64 and > or = 65 years) suicide attempt and mortality rates were calculated for four time periods (1990-1993, 1994-1997, 1998-2001 and 2002-2005) for the entire Québec population aged 10 years and older residing in 162 communities ranked by decile of material deprivation. Absolute and relative measures of inequality were calculated to summarize differences between the most and least materially deprived areas. Commonly used methods of suicidal behaviour were examined. RESULTS Differentials in suicide attempt hospitalization between the most and least deprived areas were present for all age groups, and these decreased slightly among males and increased among females over time. Inequalities in suicide attempts were greatest among young adults (age 25-44 years) for both genders, and were smallest among the elderly (> or = 65 years). For suicide mortality, differentials increased among females but not males; these differentials were greatest among males and 25-44 year olds, and smallest among the elderly. Differentials in commonly used methods were evident for poisoning hospitalizations in both genders and for hanging deaths among males. CONCLUSIONS In Québec, differences in suicide attempts and mortality between the most and least materially deprived areas persisted or even increased over time. Inequalities were more pronounced for suicide attempts than for suicide mortality, and were greatest among adults of working age. Strategies to reduce socio-economic differences in suicidal behaviour may be important.
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Affiliation(s)
- S Burrows
- Research Centre of the University of Montreal Hospital Centre, 1301 rue Sherbrooke Est, Montréal, Québec, H2L 1M3, Canada. stephanie.burrows. [corrected]
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Dalmau-Bueno A, García-Altés A, Marí-Dell’Olmo M, Pérez K, Kunst AE, Borrell C. Veintidós años de evolución de las desigualdades socioeconómicas en la mortalidad en la ciudad de Barcelona. GACETA SANITARIA 2010; 24:20-7. [DOI: 10.1016/j.gaceta.2009.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 05/20/2009] [Accepted: 06/02/2009] [Indexed: 11/25/2022]
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[Incidence of bronchopulmonary cancer in Castilla y Leon and Cantabria in the year 2007. A study by the Castilla y Leon and Cantabria Respiratory Diseases Society (SOCALPAR)]. Arch Bronconeumol 2009; 46:7-14. [PMID: 19879034 DOI: 10.1016/j.arbres.2009.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 08/09/2009] [Accepted: 09/14/2009] [Indexed: 11/21/2022]
Abstract
INTRODUCTION This study sets out to find out the incidence and other epidemiological characteristics of bronchopulmonary cancer in patients living in Cantabria and Castilla y Leon (Spain) and comparing the current data obtained in the last communities with that obtained 10 years ago in a similar study. PATIENTS AND METHODS Prospective, multicentre study using information (age, sex, residence, smoking habits and histology) obtained from all patients diagnosed during the year 2007. RESULTS A total of 1486 patients were included--1295 males (87.1%) and 191 females (12.9%)--, of whom 1145 lived in Castilla y Leon--1010 males (88.2%) and 135 females (11.8%)--, and 341 in Cantabria--285 males (83.6%) and 56 females (16.4%)--. The incidence rates per 100,000 inhabitants adjusted to the world standard population were significantly higher in Cantabria [29.53; (males: 52.9; females: 9.76)] than in Castilla y Leon [21.35; (males: 38.31; females: 5.58)]. A total of 90.24% were smokers (males: 96.12% and women: 49.17%). The main histology types were: squamous, 32, 82%; adenocarcinoma, 28.74%, and small cell carcinomas, 18.33%. In Castilla y Leon, from 1997 to 2007, the numbers went from 920 to 1010 in males and from 95 to 135 in females (a crude rate increase of 10.5% in males and 43% in females), and showed a decrease in squamous tumours and an increase in adenocarcinomas. CONCLUSIONS The incidence rates of bronchopulmonary cancer in 2007 were significantly higher in Cantabria than those of Castilla y Leon. The 2007 rates in this community were higher than in 1997 in both males and females.
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