Spatial disparities in cancer incidence and mortality, indicating gaps in prevention and/or care

Abstract

Background

There is a rich literature on the distribution of cancer incidence and mortality in socioeconomically different regions of the world, but none of the studies has compared the spatial distribution of mortality and morbidity to see if they are consistent with each other.

Methods

All malignant neoplasms and separately by cervical, colorectal, breast, pancreatic, lung and oral cancers were studied in the Hungarian population aged 25-64 years for the period 2007-2018 at the municipality level by sex. In each case, the spatial distribution of morbidity and mortality and their clusters were compared with each other and with the level of deprivation using disease mapping, spatial regression, risk analysis and spatial scan statistics.

Results

All-cause cancer morbidity and mortality showed a significant association with deprivation. However, the slope of the increase in mortality with increasing deprivation was much steeper than for morbidity in both sexes. The association between deprivation and morbidity was not consistent across all cancers. No significant association was found for male colorectal cancer (RR: 1.003; 95%CI 0.986-1.019), pancreatic cancer (1.014; 95%CI 0.983-1.045) and female colorectal cancer morbidity (RR: 0.977; 95%CI 0.991-1.029), whereas a negative association was found for breast cancer morbidity (RR: 0.977; 95%CI 0.963-0.991). In contrast, a positive association between deprivation and mortality was found for each type of cancer, although with different RRs. However, disease mapping analyses showed only partial overlap between high-risk morbidity and mortality areas, often independent of deprivation.

Conclusions

Our results highlight not only the diverse relationship between the epidemiological situation and deprivation, but also the disproportionate relationship between cancer morbidity and mortality, thus identifying geographical regions and sub-regions with populations that require special public health attention.

Key messages

• Comparative spatial analysis of cancer morbidity and mortality at the municipality level is strongly recommended to identify populations in need of targeted cancer prevention and/or care.

• The usefulness of comparative spatial analysis of cancer morbidity and mortality is demonstrated in Hungary, one of the countries with the most unfavourable cancer burden in international comparison.