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. 2025 Feb;13(2):e268-e276.
doi: 10.1016/S2214-109X(24)00446-7.

Variability and social patterning of cancer mortality in 343 Latin American cities: an ecological study

Tania Alfaro  1 , Kevin Martinez-Folgar  2 , Dalia Stern  3 , Maria A Wilches-Mogollon  4 , María Pía Muñoz  5 , Harrison Quick  6 , Marcio Alazraqui  7 , Manuel Ramirez-Zea  8 , J Jaime Miranda  9 , Mariana Lazo  10 , Waleska Teixeira Caiaffa  11 , Ana V Diez Roux  6 , Usama Bilal  6
Affiliations

Variability and social patterning of cancer mortality in 343 Latin American cities: an ecological study

Tania Alfaro et al. Lancet Glob Health. 2025 Feb.

Abstract

Background: Understanding between-city variations in cancer mortality is crucial to inform national and subnational cancer prevention strategies. However, studies at the city level in Latin America are scarce. As part of the Salud Urbana en América Latina (SALURBAL) project, we aimed to describe the variability in cancer mortality rates across 343 cities in nine Latin American countries and the associations of these rates with city-level socioeconomic development.

Methods: This ecological study used data from cities in Argentina, Brazil, Chile, Colombia, Costa Rica, El Salvador, Guatemala, Mexico, and Panama. Vital registration and population data from Jan 1, 2015 to Dec 31, 2019 were used to estimate sex-specific and age-standardised cancer mortality rates for each city, overall and for seven cancer sites (breast, lung, colorectal, stomach, liver, prostate, and cervical), and the associations of these rates with city-level socioeconomic development.

Findings: We found wide variability in cancer mortality by city (overall age-adjusted cancer mortality rates varied by almost three times), sex, and cancer site. Variability between cities within the same country was highest for cervical and prostate cancer. The most common causes of cancer deaths were breast cancer (305 cities) for females and prostate cancer (167 cities) and lung cancer (132 cities) for males. Liver and cervical cancer were the primary cause of cancer mortality in fewer than ten cities each, most of which were in Guatemala and Mexico. Lower city-level socioeconomic development was associated with higher mortality from liver, stomach, cervical, and prostate cancers and lower mortality from breast, colorectal, and lung cancers, with variations by sex.

Interpretation: We found considerable heterogeneity in cancer mortality between cities, geographical patterning, and associations between cancer mortality rates and socioeconomic development. Our results highlight the need to consider city contexts when planning interventions to reduce cancer mortality and when guiding future cancer prevention and control efforts in urban areas within the region.

Funding: Wellcome Trust.

Translations: For the Spanish and Portuguese translations of the abstract see Supplementary Materials section.

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Conflict of interest statement

Declaration of interests All authors are or have been team members of the SALURBAL project. TA is a member of the Center for Cancer Prevention and Control, funded by Fondo de Financiamiento de Centros de Investigación en Áreas Prioritarias, Fondap, Gobierno de Chile; she has received payments to her institution and to travel to SALURBAL meetings, and a consultancy fee from Organon for developing a list of women's health indicators. DS received a grant from the American Diabetes Association with support for attending meetings. JJM received grant support, paid to his institution, from the Alliance for Health Policy and Systems Research, Bloomberg Philanthropies (via the University of North Carolina at Chapel Hill School of Public Health), FONDECYT via CIENCIACTIVA/CONCYTEC, the British Council, the British Embassy, the Newton-Paulet Fund, DFID/MRC/Wellcome Global Health Trials, Fogarty International Center, Grand Challenges Canada, International Development Research Center Canada, Inter-American Institute for Global Change Research, the National Cancer Institute, the National Heart, Lung and Blood Institute, the National Institute of Mental Health, the Swiss National Science Foundation, UKRI BBSRC, UKRI EPSRC, UKRI MRC, the Wellcome Trust, and the World Diabetes Foundation and a contract from Health Action International. JJM has unpaid roles on the data safety monitoring board for the Nigeria Sodium Study; the trial steering committee for INTERACT 3; the international advisory board of the Latin American Brain Health Institute at the Universidad Adolfo Ibáñez, Chile; the consultative board of the Programa de Gastronomía, Facultad de Estudios Interdisciplinarios, Pontificia Universidad Católica del Perú; and the advisory board of the InterAmerican Heart Foundation; and is a co-chair of the Independent Group of Scientists, 2023 Global Sustainable Development Report of the United Nations; a member of the scientific expert committee of the Global Data Collaborative for CV Population Health, World Health Federation, Microsoft, and the Novartis Foundation; a member of the scientific and technical advisory committee of the Alliance for Health Policy and Systems Research, WHO; a member of the WHO technical advisory group on non-communicable disease-related research and innovation at the Noncommunicable Diseases Department, WHO; and a member of the advisory scientific committee of the Instituto de Investigación Nutricional, Peru. ML holds a National Institutes of Health (NIH)-NIDDK grant. ML, UB, and AVDR received payments to their institution from the Wellcome Trust and grants from the NIH. AVDR has roles in the NIH RECOVER Study and is a board member of the Health Effects Institute, unrelated to this study. All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Age-standardised cancer mortality rates, stratified by sex The middle line represents the median city cancer mortality rate, the box limits represent the 25th and 75th percentiles, and the whiskers represent 1·5 times the IQR. Individual datapoints (cities) are shown as dots.
Figure 2
Figure 2
Geographical distribution of overall age-standardised cancer mortality rates, by sex and city
Figure 3
Figure 3
Geographical distribution of age-standardised cancer mortality rates for seven cancers, by sex and city
See this image and copyright information in PMC

Comment in

  • Climate change and NTDs: a perfect storm.
    The Lancet Global Health. The Lancet Global Health. Lancet Glob Health. 2025 Feb;13(2):e172. doi: 10.1016/S2214-109X(25)00014-2. Lancet Glob Health. 2025. PMID: 39890211 No abstract available.

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