Esther de Vries1, Ivan Arroyave2, Constanza Pardo3, Carolina Wiesner3, Raul Murillo3, David Forman4, Alex Burdorf5, Mauricio Avendaño6. 1. International Agency for Research on Cancer, Section of Cancer Information, Lyon, France Cancer Surveillance and Epidemiology Group, National Cancer Institute, Bogota, Colombia Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands. 2. Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands Epidemiology Group and Department of Specific Sciences in Public Health, National School of Public Health, University of Antioquia, Medellin, Colombia. 3. Cancer Surveillance and Epidemiology Group, National Cancer Institute, Bogota, Colombia. 4. International Agency for Research on Cancer, Section of Cancer Information, Lyon, France. 5. Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands. 6. Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands LSE Health, Department of Social Policy, London School of Economics and Political Science, London, UK Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, USA.
Abstract
BACKGROUND: There is a paucity of studies on socioeconomic inequalities in cancer mortality in developing countries. We examined trends in inequalities in cancer mortality by educational attainment in Colombia during a period of epidemiological transition and rapid expansion of health insurance coverage. METHODS: Population mortality data (1998-2007) were linked to census data to obtain age-standardised cancer mortality rates by educational attainment at ages 25-64 years for stomach, cervical, prostate, lung, colorectal, breast and other cancers. We used Poisson regression to model mortality by educational attainment and estimated the contribution of specific cancers to the slope index of inequality in cancer mortality. RESULTS: We observed large educational inequalities in cancer mortality, particularly for cancer of the cervix (rate ratio (RR) primary vs tertiary groups=5.75, contributing 51% of cancer inequalities), stomach (RR=2.56 for males, contributing 49% of total cancer inequalities and RR=1.98 for females, contributing 14% to total cancer inequalities) and lung (RR=1.64 for males contributing 17% of total cancer inequalities and 1.32 for females contributing 5% to total cancer inequalities). Total cancer mortality rates declined faster among those with higher education, with the exception of mortality from cervical cancer, which declined more rapidly in the lower educational groups. CONCLUSIONS: There are large socioeconomic inequalities in preventable cancer mortality in Colombia, which underscore the need for intensifying prevention efforts. Reduction of cervical cancer can be achieved through reducing human papilloma virus infection, early detection and improved access to treatment of preneoplastic lesions. Reinforcing antitobacco measures may be particularly important to curb inequalities in cancer mortality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
BACKGROUND: There is a paucity of studies on socioeconomic inequalities in cancer mortality in developing countries. We examined trends in inequalities in cancer mortality by educational attainment in Colombia during a period of epidemiological transition and rapid expansion of health insurance coverage. METHODS: Population mortality data (1998-2007) were linked to census data to obtain age-standardised cancer mortality rates by educational attainment at ages 25-64 years for stomach, cervical, prostate, lung, colorectal, breast and other cancers. We used Poisson regression to model mortality by educational attainment and estimated the contribution of specific cancers to the slope index of inequality in cancer mortality. RESULTS: We observed large educational inequalities in cancer mortality, particularly for cancer of the cervix (rate ratio (RR) primary vs tertiary groups=5.75, contributing 51% of cancer inequalities), stomach (RR=2.56 for males, contributing 49% of total cancer inequalities and RR=1.98 for females, contributing 14% to total cancer inequalities) and lung (RR=1.64 for males contributing 17% of total cancer inequalities and 1.32 for females contributing 5% to total cancer inequalities). Total cancer mortality rates declined faster among those with higher education, with the exception of mortality from cervical cancer, which declined more rapidly in the lower educational groups. CONCLUSIONS: There are large socioeconomic inequalities in preventable cancer mortality in Colombia, which underscore the need for intensifying prevention efforts. Reduction of cervical cancer can be achieved through reducing human papilloma virus infection, early detection and improved access to treatment of preneoplastic lesions. Reinforcing antitobacco measures may be particularly important to curb inequalities in cancer mortality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Sam Harper; John Lynch; Stephen C Meersman; Nancy Breen; William W Davis; Marsha E Reichman Journal: Am J Epidemiol Date: 2008-03-15 Impact factor: 4.897
Authors: Carlos A Munoz-Zuluaga; José David Gallo-Pérez; Andrés Pérez-Bustos; Mavalynne Orozco-Urdaneta; Karen Druffel; Lida P Cordoba-Astudillo; Luis G Parra-Lara; Carolina Velez-Mejia; Farah El-Sharkawy; Katherin Zambrano-Vera; Raúl H Erazo; Mary C King; Armando Sardi Journal: JCO Oncol Pract Date: 2021-01-08
Authors: Armando Sardi; Mavalynne Orozco-Urdaneta; Carolina Velez-Mejia; Andres H Perez-Bustos; Carlos Munoz-Zuluaga; Farah El-Sharkawy; Luis Gabriel Parra-Lara; Patricia Córdoba; David Gallo; Michelle Sittig; Mary Caitlin King; Carol Nieroda; Katherin Zambrano-Vera; John Singer Journal: J Glob Oncol Date: 2019-07