Socio-economic inequalities in the incidence of four common cancers: a population-based registry study

Abstract

Objectives: To investigate the relationship between socio-economic circumstances and cancer incidence in Scotland in recent years.

Study design: Population-based study using cancer registry data.

Methods: Data on incident cases of colorectal, lung, female breast, and prostate cancer diagnosed between 2001 and 2012 were obtained from a population-based cancer registry covering a population of approximately 2.5 million people in the West of Scotland. Socio-economic circumstances were assessed based on postcode of residence at diagnosis, using the Scottish Index of Multiple Deprivation (SIMD). For each cancer, crude and age-standardised incidence rates were calculated by quintile of SIMD score, and the number of excess cases associated with socio-economic deprivation was estimated.

Results: 93,866 cases met inclusion criteria, comprising 21,114 colorectal, 31,761 lung, 23,757 female breast, and 15,314 prostate cancers. Between 2001 and 2006, there was no consistent association between socio-economic circumstances and colorectal cancer incidence, but 2006-2012 saw an emerging deprivation gradient in both sexes. The incidence rate ratio (IRR) for colorectal cancer between most deprived and least deprived increased from 1.03 (95% confidence interval [CI] 0.91-1.16) to 1.24 (95% CI 1.11-1.39) during the study period. The incidence of lung cancer showed the strongest relationship with socio-economic circumstances, with inequalities widening across the study period among women from IRR 2.66 (95% CI 2.33-3.05) to 2.91 (95% CI 2.54-3.33) in 2001-03 and 2010-12, respectively. Breast and prostate cancer showed an inverse relationship with socio-economic circumstances, with lower incidence among people living in more deprived areas.

Conclusion: Significant socio-economic inequalities remain in cancer incidence in the West of Scotland, and in some cases are increasing. In particular, this study has identified an emerging, previously unreported, socio-economic gradient in colorectal cancer incidence among women as well as men. Actions to prevent, mitigate, and undo health inequalities should be a public health priority.

Keywords: Cancer incidence; Cancer registry; Health inequalities; Socio-economic circumstances.

Fig. 1

Age-standardised incidence of colorectal cancer for (a) males and (b) females, by deprivation quintile and period of incidence (with 95% confidence intervals).

Fig. 2

Trends in age-adjusted incidence rate ratio for (a) males and (b) females between most and least deprived quintiles.

Fig. 3

Age-standardised incidence of lung cancer for (a) males and (B) females, by deprivation quintile and period of incidence (with 95% confidence intervals).

Fig. 4

Age-standardised incidence of breast cancer, by deprivation quintile and period of incidence (with 95% confidence intervals).

Fig. 5

Age-standardised incidence of prostate cancer, by deprivation quintile and period of incidence (with 95% confidence intervals).