Romain Fantin1, Carolina Santamaría Ulloa2, Cristina Barboza Solís3. 1. Centro Centroamericano de Población, Universidad de Costa Rica, San José, Costa Rica; Escuela de Salud Pública, Facultad de Medicina, Universidad de Costa Rica, San José, Costa Rica; Escuela de Medicina, Facultad de Medicina, Universidad de Costa Rica, San José, Costa Rica. Electronic address: romain.fantin@ucr.ac.cr. 2. Instituto de Investigaciones en Salud, Universidad de Costa Rica, San José, Costa Rica. 3. Facultad de Odontología, Universidad de Costa Rica, San José, Costa Rica.
Abstract
BACKGROUND: The main evidence regarding social inequalities in cancer risk comes from industrialized countries. The aim of this manuscript was to analyze the association between cancer incidence and socioeconomic position (SEP) in a middle-income country (Costa Rica) between 2011 and 2015. METHODS: An ecological study at the level of the electoral district was conducted. The 477 districts were divided by area and wealth using the 2011 Census. The sample was defined using the National Electoral Rolls used for presidential elections of 2006 and 2010 (N = 2 798 517). 44 799 cancer cases were included coming from the Costa Rican Cancer Registry. Cox models were used. RESULTS: All cancer sites combined, we observed a positive gradient, with incidence being lower in the poorest districts than in the wealthiest (HRQ2 = 0.98 [0.93-1.03], HRQ3 = 0.92 [0.85-0.99], HRQ4 = 0.83 [0.77-0.88]). For colon, skin, breast, prostate, thyroid and other cancer sites, a positive social gradient was observed. For stomach, lung, and cervical (invasive or in-situ) cancers, a negative social gradient was found. For uterine cancer and lymphoma (no-Hodgkin), there was no significant relationship between wealth and incidence. For skin cancer, incidence was higher in rural as compared to urban areas after adjustment for wealth. For lung, cervical and uterine cancer, incidence was lower in rural as compared to urban area after adjustment for wealth. CONCLUSIONS: The all-cancer combined results were in contradiction with the international literature but confirmed recent study results in Costa Rica. It confirmed the importance of studying socioeconomic inequalities in middle-income countries.
BACKGROUND: The main evidence regarding social inequalities in cancer risk comes from industrialized countries. The aim of this manuscript was to analyze the association between cancer incidence and socioeconomic position (SEP) in a middle-income country (Costa Rica) between 2011 and 2015. METHODS: An ecological study at the level of the electoral district was conducted. The 477 districts were divided by area and wealth using the 2011 Census. The sample was defined using the National Electoral Rolls used for presidential elections of 2006 and 2010 (N = 2 798 517). 44 799 cancer cases were included coming from the Costa Rican Cancer Registry. Cox models were used. RESULTS: All cancer sites combined, we observed a positive gradient, with incidence being lower in the poorest districts than in the wealthiest (HRQ2 = 0.98 [0.93-1.03], HRQ3 = 0.92 [0.85-0.99], HRQ4 = 0.83 [0.77-0.88]). For colon, skin, breast, prostate, thyroid and other cancer sites, a positive social gradient was observed. For stomach, lung, and cervical (invasive or in-situ) cancers, a negative social gradient was found. For uterine cancer and lymphoma (no-Hodgkin), there was no significant relationship between wealth and incidence. For skin cancer, incidence was higher in rural as compared to urban areas after adjustment for wealth. For lung, cervical and uterine cancer, incidence was lower in rural as compared to urban area after adjustment for wealth. CONCLUSIONS: The all-cancer combined results were in contradiction with the international literature but confirmed recent study results in Costa Rica. It confirmed the importance of studying socioeconomic inequalities in middle-income countries.
Authors: Benjamin Gallo Marin; David X Zheng; Andres Amaya; Daniel Marin Gamboa; Fabio S Frech; Kathleen M Mulligan; Rocío Oliva; Arturo Soto; Helena Kuhn Journal: Int J Dermatol Date: 2021-11-23 Impact factor: 2.736