Health Inequalities : Health Inequalities - Inequalities in cancer mortality

Inequalities in total cancer mortality

Total cancer mortality rates are higher among lower educated men than among higher educated men (Faggiano et al., 1997; Borrell et al., 2003; Mackenbach et al., 1999; Doornbos & Kromhout, 1990; Faggiano et al., 1995; Menvielle et al., 2005; Davey Smith et al., 1991; Menvielle et al., 2007).

Among women, the educational gradient in cancer mortality is much smaller than among men and even absent in Spanish regions and Slovenia.

See Chart Relative indices of inequality related to education and mortality rates for total cancer mortality.

Most earlier studies were conduced in Southern Europe and did not find any variation in total cancer mortality by socioeconomic status among women (Faggiano et al., 1997; Borrell et al., 2003; Menvielle et al., 2005; Michelozzi, 1999).

Inequalities in lung cancer mortality

Lung cancer is the most common death from cancer (almost 20% from total cancer mortality) (Ferlay et al., 2007).

Socioeconomic differences in lung cancer mortality are present in many countries. Although there is quite some variation in the size of inequalities in lung cancer mortality, lung cancer mortality is higher among men with a lower socioeconomic status in all countries (Mackenbach et al., 2004; van der Van der Heyden et al., 2007). See Table Relative indices of inequality for lung cancer mortality in men in selected countries by age.

Among women, more variation in the pattern of lung cancer mortality by education is observed than among men. In the Northern European and Continental populations, lung cancer mortality is higher among women with a low education. In Southern European populations and Slovenia, a low socioeconomic status is associated with a lower lung cancer mortality. See Table Relative indices of inequality for lung cancer mortality in women in selected countries by age.

Inequalities in smoking and lung cancer

Patterns of educational differences in lung cancer mortality differ according to population and gender. The differences in lung cancer mortality found between populations reflect differences in the smoking epidemic between countries.

‘Smoking epidemic’ is a concept used to describe the diffusion of the smoking habit in a population. The general pattern is that first, higher smoking rates are observed among people with a high socioeconomic position, but later smoking rates are higher among people with a low socioeconomic position.

in Slovenia and Spain, smoking occurs more often among highly educated women (but among men the reverse pattern is observed).
in Nordic countries, Belgium and Switzerland, smoking is more common among women with a low education.
France and Northern Italy (Turin) show an intermediate situation.

Also see details Inequalities in life style, and the EUphacts on Smoking, and Lung cancer.

Schrijvers C (RIVM), Kunst AE (EUR-MGZ), Bovendeur I (RIVM). Health Inequalities - Inequalities in cancer mortality . In: EUPHIX, EUphocus. Bilthoven: RIVM, <http://www.euphix.org> EUphocus\ Health Inequalities, 5 June 2008.

Literature and data sources

Borrell C, Cortes I, Artazcoz L, Molinero E, Moncada S. Social inequalities in mortality in a retrospective cohort of civil cervants in Barcelona. Int J Epidemiol, 2003; 32(3): 386-389.

Davey Smith G, Leon D, Shipley MJ, Rose G. Socioeconomic differentials in cancer among men. Int J Epidemiol, 1991; 20(2): 339-345.

Doornbos G, Kromhout D. Educational level and mortality in a 32-year follow-up study of 18-year-old men in the Netherlands. Int J Epidemiol, 1990; 19(2): 374-379.

Faggiano F, Lemma P, Costa G, Gnavi R, Pagnanelli F. Cancer mortality by educational level in Italy. Cancer Causes Control, 1995; 6(4): 311-320.

Faggiano F, Partanen T, Kogevinas M, Boffetta P. Socioeconomic differences in cancer incidence and mortality. IARC Sci Publ., 1997; (138): 65-176.

Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P. Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol., 2007; 18(3): 581-592.

Heyden J van der, Kunst A, Esnaola S, Borrell C, Kalediene R, Cox B, et al. Socio-economic inequalities in lung cancer mortality in Europe: an update. Chapter 5. In: Tackling Health Inequalities in Europe: an Integrated Approach. Eurothine Final Report. Rotterdam: Department of Public Health, University Medical Centre Rotterdam, 2007.

Mackenbach JP, Huisman M, Anderson O, Bopp M, Borgan JK, Borell C, et al. Inequalities in lung cancer mortality by the educational level in 10 European populations. Eur J Cancer, 2004; 40: 126-135.

Mackenbach JP, Kunst AE, Groenhof F, Borgan JK, Costa G, Faggiano F, et al. Socioeconomic inequalities in mortality among women and among men: an international study. Am J Public Health, 1999; 89(12): 1800-1806.

Menvielle G, Kunst AE, Stirbu I, et al. Educational differences in cancer mortality among women and men: a gender pattern that differs across Europe. Chapter 4. In: Tackling Health Inequalities in Europe: an Integrated Approach. Eurothine Final Report. Rotterdam: Department of Public Health, University Medical Centre Rotterdam, 2007.

Menvielle G, Luce D, Geoffroy-Perez B, Chastang JF, Leclerc A, Edisc Group. Social inequalities and cancer mortality in France, 1975-1990. Cancer Causes Control, 2005; 16(5): 501-513.

Michelozzi P, Perucci CA, Forastiere F, Fusco D, Ancona C, Dell’Orco V. Inequality in health: socioeconomic differentials in mortality in Rome, 1990-1995. J Epidemiol Community Health. 1999; 53(11): 687-693. .