Abstract
Background: Reducing socioeconomic inequalities in cancer is a priority for the public health agenda. A systematic assessment and benchmarking of socioeconomic inequalities in cancer across many countries and over time in Europe is not yet available. Methods: Census-linked, whole-of-population cancer-specific mortality data by socioeconomic position, as measured by education level, and sex were collected, harmonized, analysed, and compared across 18 countries during 1990–2015, in adults aged 40–79. We computed absolute and relative educational inequalities; temporal trends using estimated-annual-percentage-changes; the share of cancer mortality linked to educational inequalities. Findings: Everywhere in Europe, lower-educated individuals have higher mortality rates for nearly all cancer-types relative to their more highly-educated counterparts, particularly for tobacco/infection-related cancers [relative risk of lung cancer mortality for lower- versus higher-educated = 2.4 (95% confidence intervals: 2.1–2.8) among men; = 1.8 (95% confidence intervals: 1.5–2.1) among women]. However, the magnitude of inequalities varies greatly by country and over time, predominantly due to differences in cancer mortality among lower-educated groups, as for many cancer-types higher-educated have more similar (and lower) rates, irrespective of the country. Inequalities were generally greater in Baltic/Central/East-Europe and smaller in South-Europe, although among women large and rising inequalities were found in North–Europe (relative risk of all cancer mortality for lower- versus higher-educated ≥1.4 in Denmark, Norway, Sweden, Finland and the England/Wales). Among men, rate differences (per 100,000 person-years) in total-cancer mortality for lower-vs-higher-educated groups ranged from 110 (Sweden) to 559 (Czech Republic); among women from approximately null (Slovenia, Italy, Spain) to 176 (Denmark). Lung cancer was the largest contributor to inequalities in total-cancer mortality (between-country range: men, 29–61%; women, 10–56%). 32% of cancer deaths in men and 16% in women (but up to 46% and 24%, respectively in Baltic/Central/East-Europe) were associated with educational inequalities. Interpretation: Cancer mortality in Europe is largely driven by levels and trends of cancer mortality rates in lower-education groups. Even Nordic-countries, with a long-established tradition of equitable welfare and social justice policies, witness increases in cancer inequalities among women. These results call for a systematic measurement, monitoring and action upon the remarkable socioeconomic inequalities in cancer existing in Europe. Funding: This study was done as part of the LIFEPATH project, which has received financial support from the European Commission (Horizon 2020 grant number 633666), and the DEMETRIQ project, which received support from the European Commission (grant numbers FP7-CP-FP and 278511). SV and WN were supported by the French Institut National du Cancer (INCa) (Grant number 2018-116). PM was supported by the Academy of Finland (#308247, # 345219) and the European Research Council under the European Union's Horizon 2020 research and innovation programme (grant agreement No 101019329). The work by Mall Leinsalu was supported by the Estonian Research Council (grant PRG722).
| Original language | English |
|---|---|
| Article number | 100551 |
| Journal | The Lancet Regional Health - Europe |
| Volume | 25 |
| DOIs | |
| Publication status | Published - Feb 2023 |
Bibliographical note
Funding Information:The permission of the Office for National Statistics (ONS) to use the Longitudinal Study is gratefully acknowledged, as is the help provided by staff of the Centre for Longitudinal Study Information & User Support (CeLSIUS). CeLSIUS is supported by the ESRC Census of Population Programme (award reference ES/K000365/1). The authors alone are responsible for the interpretation of the data. This work contains statistical data from ONS, which is Crown Copyright. The use of the ONS statistical data in this work does not imply the endorsement of the ONS in relation to the interpretation or analysis of the statistical data. This work uses research datasets, which might not exactly reproduce National Statistics aggregates. Aggregated data on deaths and person years by age group, sex and level of education for Hungary between 1999 and 2012 were obtained and harmonized by Erasmus MC as part of the DEMETRIQ project and LIFEPATH project. The mortality data for Switzerland were obtained from the Swiss National Cohort, which is based on mortality and census data provided by the Federal Statistical Office and supported by the Swiss National Science Foundation. Mortality data for Slovenia were provided by the Statistical Office of the Republic of Slovenia and supported by the Slovenian Research Agency (research core funding No. P3-0429, Slovenian Research Programme for Comprehensive Cancer Control SLORApro). We acknowledge Eva-Maria Asamer, Carme Borell, Guesepe Costa, Ramune Kalediene, Olle Lundberg, Gwenn Menvielle, Jitka Rychtaříková, Heine Strand, Chris White, Bodgan Wojtyniak for providing data. We would like to thank Morena Sarzo from IARC for the production of the infographic shown in Fig. 3.
Role of the funding source:
The funding sources had no role in the collection, study
design, analysis, and interpretation of data; in the
writing of the report; or in the decision to submit the
article.
Publisher Copyright:
© 2022
