Linking of Primary Care Records to Census Data to Study the Association between Socioeconomic Status and Cancer Incidence in Southern Europe: A Nation-Wide Ecological Study

Abstract

BackgroundArea-based measures of economic deprivation are seldom applied to large medical records databases to establish population-scale associations between deprivation and disease.ObjectiveTo study the association between deprivation and incidence of common cancer types in a Southern European region.MethodsRetrospective ecological study using the SIDIAP (Information System for the Development of Research in Primary Care) database of longitudinal electronic medical records for a representative population of Catalonia (Spain) and the MEDEA index based on urban socioeconomic indicators in the Spanish census. Study outcomes were incident cervical, breast, colorectal, prostate, and lung cancer in 2009–2012. The completeness of SIDIAP cancer recording was evaluated through linkage of a geographic data subset to a hospital cancer registry. Associations between MEDEA quintiles and cancer incidence was evaluated using zero-inflated Poisson regression adjusted for sex, age, smoking, alcoholism, obesity, hypertension, and diabetes.ResultsSIDIAP sensitivity was 63% to 92% for the five cancers studied. There was direct association between deprivation and lung, colorectal, and cervical cancer: incidence rate ratios (IRR) 1.82 [1.64–2.01], IRR 1.60 [1.34–1.90], IRR 1.22 [1.07–1.38], respectively, comparing the most deprived to most affluent areas. In wealthy areas, prostate and breast cancers were more common: IRR 0.92 [0.80–1.00], IRR 0.91 [0.78–1.06]. Adjustment for confounders attenuated the association with lung cancer risk (fully adjusted IRR 1.16 [1.08–1.25]), reversed the direction of the association with colorectal cancer (IRR 0.90 [0.84–0.95]), and did not modify the associations with cervical (IRR 1.27 [1.11–1.45]), prostate (0.74 [0.69–0.80]), and breast (0.76 [0.71–0.81]) cancer.ConclusionsDeprivation is associated differently with the occurrence of various cancer types. These results provide evidence that MEDEA is a useful, area-based deprivation index for analyses of the SIDIAP database. This information will be useful to improve screening programs, cancer prevention and management strategies, to reach patients more effectively, particularly in deprived urban areas.

Disparities in cancer incidence by area-level socioeconomic status in the French West Indies

“…We found a higher risk of prostate cancer in the category of medium deprivation, and overall the lowest incidence of prostate cancer was observed in the least deprived category. A number of studies, using individual or area-based indicators of social position, reported a higher risk in those with a high socioeconomic status [6,[19][20][21], although other found no or negative associations, especially among African American men [22,23]. The high incidence in the most favored groups is generally attributed to a higher rate of screening, leading to the detection of indolent cases and overdiagnosis.…”

Oral Bisphosphonate Use and All-Cause Mortality in Patients With Moderate–Severe (Grade 3B-5D) Chronic Kidney Disease: A Population-Based Cohort Study

“…Information collected included all the variables listed previously for the CPRD data . For the socioeconomic status the Medea Index was used with R and Q± as those with no information available on Medea Index, Q1 as the least deprived, and Q5 as the most deprived …”

Familial clustering of oropharyngeal squamous cell carcinoma in the Utah population

“…It remains unclear whether high‐risk sexual behaviors known to influence the risk of developing HPV‐related oropharyngeal SCC are more likely to occur in family members of patients with HPV‐associated malignancies. Socioeconomic status, which is familial, has been associated with the risk of developing cervical cancer, likely through access to preventative care . However, again, it is unlikely that shared behaviors alone would result in elevated risks to relatives as distant as third‐degree.…”

“…Socioeconomic status, which is familial, has been associated with the risk of developing cervical cancer, likely through access to preventative care. 11 However, again, it is unlikely that shared behaviors alone would result in elevated risks to relatives as distant as third-degree. Given the ubiquitous nature of HPV exposure, 12 genetic susceptibility to HPV-related malignancies may well play a role.…”