Socioeconomic inequalities in cancer mortality between and within countries in Europe: a population-based study

作者：Salvatore Vaccarella, Damien Georges, Freddie Bray, Ophira Ginsburg, Hadrien Charvat, Pekka Martikainen, Henrik Brønnum‐Hansen, Patrick Deboosere, Matthias Bopp, Mall Leinsalu, Barbara Artnik, Valentina Lorenzoni, Esther de Vries, Michael Marmot, Paolo Vineis, Johan Mackenbach, Wilma J. Nusselder · 发表于：The Lancet Regional Health - Europe · 年份：2022 · DOI：10.1016/j.lanepe.2022.100551 · 被引用次数：160 · 研究领域：Global Cancer Incidence and Screening、Health disparities and outcomes、Cancer survivorship and care

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 inequal...