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

BackgroundIntra-urban inequalities in mortality have been infrequently analysed in European contexts. The aim of the present study was to analyse patterns of cancer mortality and their relationship with socioeconomic deprivation in small areas in 11 Spanish cities.MethodsIt is a cross-sectional ecological design using mortality data (years 1996-2003). Units of analysis were the census tracts. A deprivation index was calculated for each census tract. In order to control the variability in estimating the risk of dying we used Bayesian models. We present the RR of the census tract with the highest deprivation vs. the census tract with the lowest deprivation.ResultsIn the case of men, socioeconomic inequalities are observed in total cancer mortality in all cities, except in Castellon, Cordoba and Vigo, while Barcelona (RR = 1.53 95%CI 1.42-1.67), Madrid (RR = 1.57 95%CI 1.49-1.65) and Seville (RR = 1.53 95%CI 1.36-1.74) present the greatest inequalities. In general Barcelona and Madrid, present inequalities for most types of cancer. Among women for total cancer mortality, inequalities have only been found in Barcelona and Zaragoza. The excess number of cancer deaths due to socioeconomic deprivation was 16,413 for men and 1,142 for women.ConclusionThis study has analysed inequalities in cancer mortality in small areas of cities in Spain, not only relating this mortality with socioeconomic deprivation, but also calculating the excess mortality which may be attributed to such deprivation. This knowledge is particularly useful to determine which geographical areas in each city need intersectorial policies in order to promote a healthy environment.

[1]  C. Borrell,et al.  Inequalities in mortality in small areas of eleven Spanish cities (the multicenter MEDEA project). , 2010, Health & place.

[2]  M. Boulos,et al.  An eight-year snapshot of geospatial cancer research (2002–2009): clinico-epidemiological and methodological findings and trends , 2011, Medical oncology.

[3]  C. Borrell,et al.  Material deprivation and leading causes of death by gender: evidence from a nationwide small area study , 2001, Journal of epidemiology and community health.

[4]  C. Borrell,et al.  Desigualdad en salud y territorio urbano , 2004 .

[5]  V. Tarasuk,et al.  Socioeconomic patterns of obesity in Canada: modeling the role of health behaviour. , 2007, Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme.

[6]  C. Borrell,et al.  [Constructing a deprivation index based on census data in large Spanish cities(the MEDEA project)]. , 2008, Gaceta sanitaria.

[7]  C. Borrell,et al.  Cancer mortality by educational level in the city of Barcelona , 1999, British Journal of Cancer.

[8]  J. Besag,et al.  Bayesian image restoration, with two applications in spatial statistics , 1991 .

[9]  J. Lagergren,et al.  Oestrogen and the enigmatic male predominance of gastric cancer. , 2008, European journal of cancer.

[10]  A. Leclerc,et al.  Smoking, alcohol drinking, occupational exposures and social inequalities in hypopharyngeal and laryngeal cancer. , 2004, International journal of epidemiology.

[11]  R. Ocaña-Riola.  The misuse of count data aggregated over time for disease mapping , 2007, Statistics in medicine.

[12]  N. Krieger.  Defining and investigating social disparities in cancer: critical issues , 2005, Cancer Causes & Control.

[13]  Andrew Gelman,et al.  General methods for monitoring convergence of iterative simulations , 1998 .

[14]  A. Gelman.  Prior distributions for variance parameters in hierarchical models (comment on article by Browne and Draper) , 2004 .

[15]  J. Benach,et al.  Geographical patterns of excess mortality in Spain explained by two indices of deprivation. , 1999, Journal of epidemiology and community health.

[16]  J. Coveney,et al.  Exploring nutrition knowledge and the demographic variation in knowledge levels in an Australian community sample , 2008, Public Health Nutrition.

[17]  C. Borrell,et al.  Comparability between ICD-9 and ICD-10 for the leading causes of death in Spain. , 2006, Revue d'épidémiologie et de santé publique.

[18]  E. Dowler.  Inequalities in diet and physical activity in Europe , 2001, Public Health Nutrition.

[19]  E. Fernández,et al.  Trends in socioeconomic inequalities in cancer mortality in Barcelona: 1992–2003 , 2009, BMC public health.

[20]  A. D. Diez Roux,et al.  Social Patterning of Chronic Disease Risk Factors in a Latin American City , 2008, Journal of Urban Health.

[21]  Joan Benach,et al.  Politics and health outcomes , 2006, The Lancet.

[22]  C. Muntaner,et al.  Inequalities in health by social class dimensions in European countries of different political traditions. , 2008, International journal of epidemiology.

[23]  P. Gustafson,et al.  Conservative prior distributions for variance parameters in hierarchical models , 2006 .

[24]  M. F. Domínguez-Berjón,et al.  Construcción de un índice de privación a partir de datos censales en grandes ciudades españolas (Proyecto MEDEA) , 2008 .

[25]  J. Wardle,et al.  Sex differences in the association of socioeconomic status with obesity. , 2002, American journal of public health.

[26]  Sylvia Richardson,et al.  A comparison of Bayesian spatial models for disease mapping , 2005, Statistical methods in medical research.

[27]  C. Husten,et al.  Sociocultural Influences on Smoking and Drinking , 2000, Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism.

[28]  J. Ferlay,et al.  Estimates of the cancer incidence and mortality in Europe in 2006. , 2006, Annals of oncology : official journal of the European Society for Medical Oncology.

[29]  J. Mackenbach,et al.  Educational inequalities in smoking among men and women aged 16 years and older in 11 European countries , 2005, Tobacco Control.

[30]  Paolo Vineis,et al.  The role of smoking and diet in explaining educational inequalities in lung cancer incidence. , 2009, Journal of the National Cancer Institute.

[31]  C. la Vecchia,et al.  Cancer mortality in the European Union, 1970-2003, with a joinpoint analysis. , 2007, Annals of oncology : official journal of the European Society for Medical Oncology.

[32]  Giuseppe Costa,et al.  Inequalities in lung cancer mortality by the educational level in 10 European populations. , 2004, European journal of cancer.

[33]  J. Mackenbach,et al.  Socioeconomic inequalities in health in 22 European countries. , 2008, The New England journal of medicine.

[34]  G. Tomlinson,et al.  Menstrual and reproductive risk factors and risk for gastric adenocarcinoma in women: findings from the canadian national enhanced cancer surveillance system. , 2006, Annals of epidemiology.

[35]  N. Krieger.  Ladders, pyramids and champagne: the iconography of health inequities , 2008, Journal of Epidemiology & Community Health.

[36]  O. Lundberg,et al.  Educational differences in cancer mortality among women and men: a gender pattern that differs across Europe , 2008, British Journal of Cancer.

[37]  M. Ruiz-Ramos,et al.  Desigualdades en mortalidad en la ciudad de Sevilla , 2004 .

[38]  J. Mackenbach,et al.  Trends in smoking behaviour between 1985 and 2000 in nine European countries by education , 2005, Journal of Epidemiology and Community Health.

[39]  Silvia Toro-Cárdenas,et al.  Uncontrolled Migrations as a Cause of Inequality in Health and Mortality in Small-area Studies , 2009, Epidemiology.

[40]  Andrew Thomas,et al.  WinBUGS - A Bayesian modelling framework: Concepts, structure, and extensibility , 2000, Stat. Comput..

[41]  S. Kunkel,et al.  Why gender matters: being female is not the same as not being male. , 1996, American journal of preventive medicine.

[42]  Adriana Freitas,et al.  Tendencias de la mortalidad por cáncer en Cataluña, 1985-2004 , 2008 .

[43]  M. C. Leske,et al.  Alcohol, tobacco and breast cancer – collaborative reanalysis of individual data from 53 epidemiological studies, including 58 515 women with breast cancer and 95 067 women without the disease , 2002, British Journal of Cancer.

[44]  J. L. Grand,et al.  Inequalities in health: Some international comparisons , 1987 .

[45]  C. Borrell,et al.  Métodos para la suavización de indicadores de mortalidad: aplicación al análisis de desigualdades en mortalidad en ciudades del Estado español (Proyecto MEDEA) , 2008 .

[46]  Majid Ezzati,et al.  Global Burden of Disease 2005: call for collaborators , 2007, The Lancet.

[47]  J. L. Gutiérrez-Fisac,et al.  Trends in cigarette smoking in Spain by social class. , 2001, Preventive medicine.

[48]  C. Saurina,et al.  Effects of deprivation on the geographical variability of larynx cancer incidence in men, Girona (Spain) 1994-2004. , 2010, Cancer epidemiology.