Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain.
CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain.
Int J Equity Health. 2023 Aug 2;22(1):145. doi: 10.1186/s12939-023-01970-y.
Lung cancer is the main cause of cancer mortality worldwide and in Spain. Several previous studies have documented socio-economic inequalities in lung cancer mortality but these have focused on specific provinces or cities. The goal of this study was to describe lung cancer mortality in Spain by sex as a function of socio-economic deprivation.
We analysed all registered deaths from lung cancer during the period 2011-2017 in Spain. Mortality data was obtained from the National Institute of Statistics, and socio-economic level was measured with the small-area deprivation index developed by the Spanish Society of Epidemiology, with the census tract of residence at the time of death as the unit of analysis. We computed crude and age-standardized rates per 100,000 inhabitants by sex, deprivation quintile, and type of municipality (rural, semi-rural, urban) considering the 2013 European standard population (ASR-E). We further calculated ASR-E ratios between the most deprived (Q5) and the least deprived (Q1) areas and mapped census tract smoothed standardized lung cancer mortality ratios by sex.
We observed 148,425 lung cancer deaths (80.7% in men), with 73.5 deaths per 100,000 men and 17.1 deaths per 100,000 women. Deaths from lung cancer in men were five times more frequent than in women (ASR-E ratio = 5.3). Women residing in the least deprived areas had higher mortality from lung cancer (ASR-E = 22.2), compared to women residing in the most deprived areas (ASR-E = 13.2), with a clear gradient among the quintiles of deprivation. For men, this pattern was reversed, with the highest mortality occurring in areas of lower socio-economic level (ASR-E = 99.0 in Q5 vs. ASR-E = 86.6 in Q1). These socio-economic inequalities remained fairly stable over time and across urban and rural areas.
Socio-economic status is strongly related to lung cancer mortality, showing opposite patterns in men and women, such that mortality is highest in women residing in the least deprived areas and men residing in the most deprived areas. Systematic surveillance of lung cancer mortality by socio-economic status may facilitate the assessment of public health interventions aimed at mitigating cancer inequalities in Spain.
肺癌是全球和西班牙癌症死亡的主要原因。先前有几项研究记录了肺癌死亡率的社会经济不平等，但这些研究集中在特定的省份或城市。本研究的目的是描述西班牙按性别划分的肺癌死亡率与社会经济剥夺程度的关系。
我们分析了 2011 年至 2017 年期间西班牙所有登记的肺癌死亡病例。死亡率数据来自国家统计局，社会经济水平用西班牙流行病学学会开发的小面积剥夺指数来衡量，以死亡时的居住普查区为分析单位。我们按性别、剥夺五分位数和城市类型（农村、半农村、城市）计算了每 10 万人的粗死亡率和年龄标准化率（考虑到 2013 年欧洲标准人口（ASR-E））。我们进一步计算了最贫困（Q5）和最不贫困（Q1）地区之间的 ASR-E 比值，并按性别绘制了肺癌死亡率标准化比值的普查区平滑图。
我们观察到 148425 例肺癌死亡（80.7%为男性），男性每 100000 人中有 73.5 例死亡，女性每 100000 人中有 17.1 例死亡。男性肺癌死亡人数是女性的五倍（ASR-E 比值=5.3）。居住在最不贫困地区的女性肺癌死亡率较高（ASR-E=22.2），而居住在最贫困地区的女性肺癌死亡率较低（ASR-E=13.2），在剥夺五分位数之间存在明显的梯度。对于男性，这种模式正好相反，社会经济水平较低的地区死亡率最高（Q5 为 ASR-E=99.0，Q1 为 ASR-E=86.6）。这些社会经济不平等在时间上和城乡之间相对稳定。
社会经济地位与肺癌死亡率密切相关，在男性和女性中呈现出相反的模式，即居住在最不贫困地区的女性和居住在最贫困地区的男性的死亡率最高。按社会经济地位系统监测肺癌死亡率有助于评估旨在减轻西班牙癌症不平等的公共卫生干预措施。
