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      Cancer mortality inequalities in urban areas: a Bayesian small area analysis in Spanish cities

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          Intra-urban inequalities in mortality have been infrequently analysed in European contexts. The aim of the present study was to analyse patterns of cancer mortality and their relationship with socioeconomic deprivation in small areas in 11 Spanish cities.


          It is a cross-sectional ecological design using mortality data (years 1996-2003). Units of analysis were the census tracts. A deprivation index was calculated for each census tract. In order to control the variability in estimating the risk of dying we used Bayesian models. We present the RR of the census tract with the highest deprivation vs. the census tract with the lowest deprivation.


          In the case of men, socioeconomic inequalities are observed in total cancer mortality in all cities, except in Castellon, Cordoba and Vigo, while Barcelona (RR = 1.53 95%CI 1.42-1.67), Madrid (RR = 1.57 95%CI 1.49-1.65) and Seville (RR = 1.53 95%CI 1.36-1.74) present the greatest inequalities. In general Barcelona and Madrid, present inequalities for most types of cancer. Among women for total cancer mortality, inequalities have only been found in Barcelona and Zaragoza. The excess number of cancer deaths due to socioeconomic deprivation was 16,413 for men and 1,142 for women.


          This study has analysed inequalities in cancer mortality in small areas of cities in Spain, not only relating this mortality with socioeconomic deprivation, but also calculating the excess mortality which may be attributed to such deprivation. This knowledge is particularly useful to determine which geographical areas in each city need intersectorial policies in order to promote a healthy environment.

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          Most cited references 44

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          Socioeconomic inequalities in health in 22 European countries.

          Comparisons among countries can help to identify opportunities for the reduction of inequalities in health. We compared the magnitude of inequalities in mortality and self-assessed health among 22 countries in all parts of Europe. We obtained data on mortality according to education level and occupational class from census-based mortality studies. Deaths were classified according to cause, including common causes, such as cardiovascular disease and cancer; causes related to smoking; causes related to alcohol use; and causes amenable to medical intervention, such as tuberculosis and hypertension. Data on self-assessed health, smoking, and obesity according to education and income were obtained from health or multipurpose surveys. For each country, the association between socioeconomic status and health outcomes was measured with the use of regression-based inequality indexes. In almost all countries, the rates of death and poorer self-assessments of health were substantially higher in groups of lower socioeconomic status, but the magnitude of the inequalities between groups of higher and lower socioeconomic status was much larger in some countries than in others. Inequalities in mortality were small in some southern European countries and very large in most countries in the eastern and Baltic regions. These variations among countries appeared to be attributable in part to causes of death related to smoking or alcohol use or amenable to medical intervention. The magnitude of inequalities in self-assessed health also varied substantially among countries, but in a different pattern. We observed variation across Europe in the magnitude of inequalities in health associated with socioeconomic status. These inequalities might be reduced by improving educational opportunities, income distribution, health-related behavior, or access to health care. Copyright 2008 Massachusetts Medical Society.
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            Bayesian image restoration, with two applications in spatial statistics

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              Estimates of the cancer incidence and mortality in Europe in 2006.

               J Ferlay,  P Autier,  M Boniol (2007)
              Monitoring the evolution of the cancer burden in Europe is of great value. Estimates of the cancer burden in Europe have been published for 2004 and estimates are now being presented for cancer incidence and mortality in Europe for 2006. The most recent sources of cancer incidence and mortality data have been collected and projections have been carried out using short-term prediction methods to produce estimated rates for 2006. Additional estimation was required where national incidence data were not available, and the method involved the projection of the aggregations of cancer incidence and mortality data from representative cancer registries. The estimated 2006 rates were applied to the corresponding estimated country population to obtain the best estimates of the cancer incidence and mortality in Europe in 2006. In 2006 in Europe, there were an estimated 3,191,600 cancer cases diagnosed (excluding nonmelanoma skin cancers) and 1,703,000 deaths from cancer. The most common form of cancers was breast cancer (429,900 cases, 13.5% of all cancer cases), followed by colorectal cancers (412,900, 12.9%) and lung cancer (386,300, 12.1%). Lung cancer, with an estimated 334,800 deaths (19.7% of total), was the most common cause of death from cancer, followed by colorectal (207,400 deaths), breast (131,900) and stomach (118,200) cancers. The total number of new cases of cancer in Europe appears to have increased by 300,000 since 2004. With an estimated 3.2 million new cases (53% occurring in men, 47% in women) and 1.7 million deaths (56% in men, 44% in women) each year, cancer remains an important public health problem in Europe and the ageing of the European population will cause these numbers to continue to increase even if age-specific rates remain constant. Evidence-based public health measures exist to reduce the mortality of breast and colorectal cancer while the incidence of lung cancer, and several other forms of cancer, could be diminished by improved tobacco control.

                Author and article information

                Int J Health Geogr
                International Journal of Health Geographics
                BioMed Central
                13 January 2011
                : 10
                : 6
                [1 ]Servei de Sistemes d'Informació Sanitaria, Agència de Salut Pública de Barcelona, Barcelona, Spain
                [2 ]CIBER Epidemiología y Salud Pública (CIBERESP), Parc de Recerca Biomédica de Barcelona, Barcelona, Spain
                [3 ]Departament de Salut Pública, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
                [4 ]Universitat Pompeu Fabra, Barcelona, Spain
                [5 ]Estudios e investigación Sanitaria, Departamento de Sanidad y Consumo. Gobierno Vasco, Vitoria-Gasteiz, Spain
                [6 ]Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN), Area de Salud Pública y Protección de la Salud, Escuela Andaluza de Salud Pública, Granada, Spain
                [7 ]Servicio de Informes de Salud y Estudios, Instituto de Salud Pública, Dirección General de Salud Pública y Alimentación, Consejería de Sanidad, Comunidad de Madrid
                [8 ]Servicio de Epidemiologia, Dirección General de Atención Primaria, Comunidad de Madrid
                [9 ]Area de Epidemiología Ambiental y Cáncer, Centro Nacional de Epidemiología, Madrid, Spain
                [10 ]Area de Desigualdades en Salud, Centro Superior de Investigación en Salud Pública de Valencia, Spain
                [11 ]Instituto Aragonés de Ciencias de la Salud, Aragón, Spain
                [12 ]Departamento de Medicina Preventiva e Saude Pública, Universidade de Santiago de Compostela, Spain
                [13 ]Unitat d'Investigació en Anàlisi de la Mortalitat i Estadística Sanitaria, Departament d'Infermeria Comunitària, Medecina Preventiva i Salut Pública i Història de la Ciencia, Universitat d'Alacant, Spain
                [14 ]Research Group on Statistics, Applied Economics and Health (GRECS), University of Girona, Spain
                Copyright ©2011 Puigpinós-Riera et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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