Dataset Information

Socio-economic deprivation and cancer incidence in England: Quantifying the role of smoking.

ABSTRACT:

Background

More deprived populations typically experience higher cancer incidence rates and smoking prevalence compared to less deprived populations. We calculated the proportion of cancer cases attributable to smoking by socio-economic deprivation in England and estimated the impact smoking has on the deprivation gap for cancer incidence.

Methods

Data for cancer incidence (2013-2017), smoking prevalence (2003-2007) and population estimates (2013-2017) were split by sex, age-group and deprivation quintile. Relative risk estimates from meta-analyses were used to estimate the population attributable fraction (PAF) for 15 cancer types associated with smoking. The deprivation gap was calculated using age-specific incidence rates by deprivation quintile.

Results

Smoking-related cancer PAFs in England are 2.2 times larger in the most deprived quintile compared to the least deprived quintile (from 9.7% to 21.1%). If everyone had the same smoking prevalence as the least deprived quintile, 20% of the deprivation gap in cancer incidence could have been prevented. If nobody smoked, 61% of the deprivation gap could have been prevented.

Conclusions

The majority of the deprivation gap in cancer incidence could have been prevented in England between 2013-2017 if nobody had smoked. Policy makers should ensure that tobacco control policies reduce overall smoking prevalence by tackling smoking inequalities.

SUBMITTER: Payne NWS

PROVIDER: S-EPMC9491592 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Socio-economic deprivation and cancer incidence in England: Quantifying the role of smoking.

Payne Nick W S NWS Brown Katrina F KF Delon Christine C Kotrotsios Yannis Y Soerjomataram Isabelle I Shelton Jon J

PloS one 20220921 9

<h4>Background</h4>More deprived populations typically experience higher cancer incidence rates and smoking prevalence compared to less deprived populations. We calculated the proportion of cancer cases attributable to smoking by socio-economic deprivation in England and estimated the impact smoking has on the deprivation gap for cancer incidence.<h4>Methods</h4>Data for cancer incidence (2013-2017), smoking prevalence (2003-2007) and population estimates (2013-2017) were split by sex, age-group ...[more]

PMID: 36129905

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Project description:BackgroundSocial gradients for cancer mortality and survival have been reported but are less clear for cancer incidence where social factors external to health care systems are likely to be of more etiologic importance.MethodsWe examined social gradients in cancer incidence using data from the Office for National Statistics Longitudinal Study (ONS-LS), which selects an approximately 1.1% representative sample of the population of England and Wales. Data were analyzed for each successive ten-year census period from 1971-2011 with outcome data to 2016, the latest date available. Socioeconomic position of individuals was assessed using the National Statistics Socio-economic classification (NS-SEC). Areal level deprivation was measured using deciles of the Townsend Index. Cancer outcomes from the National Cancer Intelligence Network linked to the ONS-LS were examined for all cancers, and more common individual cancer sites. We used logistic regression to generate odds ratios to estimate the risk of a first incident cancer within each follow-up period.ResultsThe 1971 ONS-LS census sample population initially comprised 257,803 individuals updated each census; and by 2016 137,755 incident cancer cases. Social gradients in cancer incidence were present for individual cancer sites of lung, stomach, and cervix for both individual and areal measures of socioeconomic standing with the least advantaged having higher incidence rates. Reverse gradients were present for prostate and breast cancers. The relationship of SES to increased cancer incidence for these common cancers is consistent with prior literature, but the striking gradients in these relationships reveal the strong association of SES factors with increasing social disadvantage for these cancers.ConclusionThe findings demonstrate the importance of socioeconomic position in the incidence of some common cancers prior to diagnosis and treatment and reinforces the need for further research to address the contribution of upstream social determinants in the etiology of cancer.

Project description:BackgroundWomen from socio-economically deprived areas are less likely to develop and then to survive breast cancer (BC). Whether associations between deprivation and BC incidence and survival differ by tumour molecular subtypes and mode of detection in Scotland are unknown.MethodsData consisted of 62,378 women diagnosed with invasive BC between 2000 and 2016 in Scotland. Incidence rates and time trends were calculated for oestrogen receptor positive (ER+) and negative (ER-) tumours and stratified by the Scottish Index of Multiple Deprivation (SIMD) quintiles and screening status. SIMD is an area-based measure derived across seven domains: income, employment, education, health, access to services, crime and housing. We calculated adjusted hazard ratios (aHR [95% confidence intervals]) for BC death by immunohistochemical surrogates of molecular subtypes for the most versus the least deprived quintile. We adjusted for mode of detection and other confounders.ResultsIn Scotland, screen-detected ER+tumour incidence increased over time, particularly in the least deprived quintile [Average Annual Percentage Change (AAPC) = 2.9% with 95% CI from 1.2 to 4.7]. No marked differences were observed for non-screen-detected ER+tumours or ER- tumours by deprivation. BC mortality was higher in the most compared to the least deprived quintile irrespective of ER status (aHR = 1.29 [1.18, 1.41] for ER+ and 1.27 [1.09, 1.47] for ER- tumours). However, deprivation was associated with significantly higher mortality for luminal A and HER2-enriched tumours (aHR = 1.46 [1.13, 1.88] and 2.10 [1.23, 3.59] respectively) but weaker associations for luminal B and TNBC tumours that were not statistically significant.ConclusionsDeprivation is associated with differential BC incidence trends for screen-detected ER+tumours and with higher mortality for select tumour subtypes. Future efforts should evaluate factors that might be associated with reduced survival in deprived populations and monitor progress stratified by tumour subtypes and mode of detection.

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Dataset Information

Socio-economic deprivation and cancer incidence in England: Quantifying the role of smoking.

Background

Methods

Results

Conclusions

Publications

Socio-economic deprivation and cancer incidence in England: Quantifying the role of smoking.

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