- Volume 13 Issue 6
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Measuring Socioeconomic Disparities in Cancer Incidence in Tehran, 2008
- Rohani-Rasaf, Marzieh (Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences) ;
- Moradi-Lakeh, Maziar (Gastrointestinal and Liver Disease Research Centre, Knowledge Utilization Research Centre, Tehran University of Medical Sciences) ;
- Ramezani, Rashid (Cancer Department, Ministry of Health and Medical Education) ;
- Asadi-Lari, Mohsen (Oncopathology Research Centre, Tehran University of Medical Sciences)
- Published : 2012.06.30
Background: Health disparities exist among and within countries, while developing and low income countries suffer more. The aim of this study was to quantify cancer disparities with regard to socioeconomic position (SEP) in 22 districts of Tehran, Iran. Method: According to the national cancer registry, 7599 new cancer cases were recorded within 22 districts of Tehran in 2008. Based on combined data from census and a population-based health equity study (Urban HEART), socioeconomic position (SEP) was calculated for each district. Index of disparity, absolute and relative concentration indices (ACI & RCI) were used for measuring disparities in cancer incidence. Results: The overall cancer age standardised rate (ASR) was 117.2 per 100,000 individuals (120.4 for men and 113.5 for women). Maximum ASR in both genders was seen in districts 6, 3, 1 and 2. Breast, colorectal, stomach, skin and prostate were the most common cancers. Districts with higher SEP had higher ASR (r=0.9, p<0.001). Positive ACI and RCI indicated that cancer cases accumulated in districts with high SEP. Female disparity was greater than for men in all measures. Breast, colorectal, prostate and bladder ASR ascended across SEP groups. Negative ACI and RCI in cervical and skin cancers in women indicate their aggregation in lower SEP groups. Breast cancer had the highest absolute disparities measure. Conclusion: This report provides an appropriate guide and new evidence on disparities across geographical, demographic and particular SEP groups. Higher ASR in specific districts warrants further research to investigate the background predisposing factors.
Cancer incidence;socioeconomic disparity;ASR;geographical information system;Tehran, Iran
- Aarts MJ, van der Aa MA, Coebergh JW, et al (2010). Reduction of socioeconomic inequality in cancer incidence in the South of the Netherlands during 1996-2008. Eur J Cancer, 46, 2633-46. https://doi.org/10.1016/j.ejca.2010.07.039
- Ahmad OB, Boschi-Pinto C, Lopez AD, et al (2009). Age standardization of rates: a new WHO standard. GPE Discussion Paper Series: No.31. Geneva EIP/GPE/EBD, World Health Organization.
- Anderson RN, Rosenberg HM (1998). Report of the second workshop on age adjustment. Vital Health Stat, 4, 1-37.
- Armstrong B, Doll R (1975). Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices. Int J Cancer, 15, 617-31. https://doi.org/10.1002/ijc.2910150411
- Asadi-Lari M, Vaez-Mahdavi MR, Faghihzadeh S, et al (2010). The application of Urban health equity assessment and response tool (Urban HEART) in Tehran; concepts and framework. Med J Islamic Republic of Iran, 24, 175-85.
- Bernard P, Charafeddine R, Frohlich KL, et al (2007). Health inequalities and place: a theoretical conception of neighbourhood. Soc Sci Med, 65, 1839-52. https://doi.org/10.1016/j.socscimed.2007.05.037
- Bigby J, Holmes MD (2005). Disparities across the breast cancer continuum. Cancer Causes Control, 16, 35-44. https://doi.org/10.1007/s10552-004-1263-1
- Black RE, Cousens S, Johnson HL, et al (2010). Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet, 375, 1969-87. https://doi.org/10.1016/S0140-6736(10)60549-1
- Braveman P, Starfield B, Geiger HJ, et al (2001). World Health Report 2000: how it removes equity from the agenda for public health monitoring and policy. BMJ, 323, 678-81. https://doi.org/10.1136/bmj.323.7314.678
- Burack TS, Burack WR, Knowlden NF (1983). Cancer II. Distortions in standardized rates. J Occup Med, 25, 737-44. https://doi.org/10.1097/00043764-198310000-00013
- Chen E (2010). Digging deeper: understanding the biological mechanisms that connect low socioeconomic status to poor health. Arch Pediatr Adolesc Med, 164, 495-6. https://doi.org/10.1001/archpediatrics.2010.46
- d de Kok IM, van Lenthe FJ, Avendano M, et al (2008). Childhood social class and cancer incidence: results of the globe study. Soc Sci Med, 66, 1131-9. https://doi.org/10.1016/j.socscimed.2007.11.035
- Faggiano F, Partanen T, Kogevinas M, et al (1997). Socioeconomic differences in cancer incidence and mortality. Social inequalities and cancer. N. Pearce, M. Susser and P. Boffetta. Lyon, IARC Scientific Publications: 65-176.
- Forman D, Burley VJ (2006). Gastric cancer: global pattern of the disease and an overview of environmental risk factors. Best Pract Res Clin Gastroenterol, 20, 633-49. https://doi.org/10.1016/j.bpg.2006.04.008
- Fukuda Y, Nakamura K, Takano T (2004). Municipal socioeconomic status and mortality in Japan: sex and age differences, and trends in 1973-1998. Soc Sci Med, 59, 2435-45. https://doi.org/10.1016/j.socscimed.2004.04.012
- Gakidou EE, Murray CJ, Frenk J (2000). Defining and measuring health inequality: an approach based on the distribution of health expectancy. Bull WHO, 78, 42-54.
- Galobardes B, Shaw M, Lawlor DA, et al (2006). Indicators of socio-economic position. Methods in social epidemiology. J. M. Oakes and J. S. Kaufman. San Fransisco, CA, John Wiley.
- Gilligan T (2005). Social disparities and prostate cancer: mapping the gaps in our knowledge. Cancer Causes Control , 16, 45-53. https://doi.org/10.1007/s10552-004-1291-x
- Harper S, Lynch J (2005). Selected Comparisons of Measures of Health Disparities: A Review Using Databases Relevant to Healthy People 2010 Cancer-Related Objectives. N. C. Institute. NCI Cancer Surveillance Monogr Series Number 7.
- Harper S, J Lynch (2010). Methods for Measuring Cancer Disparities: Using Data Relevant to Healthy People 2010 Cancer-Related Objectives, National Cancer Institute.
- Harper S, Lynch J, Meersman SC, et al (2008). An overview of methods for monitoring social disparities in cancer with an example using trends in lung cancer incidence by areasocioeconomic position and race-ethnicity, 1992-2004. Am J Epidemiol, 167, 889-99. https://doi.org/10.1093/aje/kwn016
- Hoffman RM, Stone SN, Espey D, et al (2005). Differences between men with screening-detected versus clinically diagnosed prostate cancers in the USA. BMC Cancer, 5, 27. https://doi.org/10.1186/1471-2407-5-27
- IAEA (2011). Inequity in Cancer Care: A Global Perspective. IAEA HUMAN HEALTH REPORTS. Vienna, Austria, International Atomic Energy Agency: 51.
- Jones NR, Williamson A, Foote M, et al (2010). Cancer health disparities persist among African Americans in Wisconsin. WMJ, 109, 267-73.
- Kakwani N, Wagstaff A, van Doorslaer E (1997). Socioeconomic inequalities in health: measurement, computation, and statistical inference. J Econometrics, 77, 87-103. https://doi.org/10.1016/S0304-4076(96)01807-6
- Kaplan GA (1996). People and places: contrasting perspectives on the association between social class and health. Int J Health Serv, 26, 507-19. https://doi.org/10.2190/4CUU-7B3G-G4XR-0K0B
- Khedmati E, Forouzan AS, Majdzadeh R et al (2012). Understanding determinants of socioeconomic inequality in mental health in Iran's capital, Tehran: a concentration index decomposition approach. Int J Equity Health, 11, 18. https://doi.org/10.1186/1475-9276-11-18
- Krieger N ( 2005). Defining and investigating social disparities in cancer: critical issues. Cancer Causes and Control, 16, 5-14. https://doi.org/10.1007/s10552-004-1251-5
- Larijani B, Shirzad M, Mohagheghi MA, et al (2004). Epidemiologic analysis of the Tehran cancer institute data system registry (TCIDSR). Asian Pac J Cancer Prev, 5, 36-9.
- Lawlor DA, Sterne JA, Tynelius P, et al (2006). Association of childhood socioeconomic position with cause-specific mortality in a prospective record linkage study of 1,839,384 individuals. Am J Epidemiol, 164, 907-15. https://doi.org/10.1093/aje/kwj319
- Lee HY, Park EC, Jun JK, et al (2010). Trends in socioeconomic disparities in organized and opportunistic gastric cancer screening in Korea (2005-2009). Cancer Epidemiol Biomarkers & Prev, 19, 1919-26. https://doi.org/10.1158/1055-9965.EPI-09-1308
- Mackenbach J, Stirbu I, Roskam A, et al (2008). Socioeconomic inequalities in health in 22 European countries. N Engl J Med, 358, 2468-81. https://doi.org/10.1056/NEJMsa0707519
- Menvielle G, Boshuizen H, Kunst AE, et al (2009a). The role of smoking and diet in explaining educational inequalities in lung cancer incidence. J Natl Cancer Inst, 101, 321-30. https://doi.org/10.1093/jnci/djn513
- Menvielle G, Boshuizen H, Kunst AE, et al (2009b). Occupational exposures contribute to educational inequalities in lung cancer incidence among men: Evidence from the EPIC prospective cohort study. Int J Cancer, 126, 1928-35.
- Merletti F, Galassi C, Spadea T (2011). The socioeconomic determinants of cancer. Environ Health, 10, 7. https://doi.org/10.1186/1476-069X-10-7
- Messer LC (2008). Invited commentary: measuring social disparities in health--what was the question again? Am J Epidemiol, 167, 900-4. https://doi.org/10.1093/aje/kwn019
- Moradi-Lakeh M, Ramezani M, Naghavi M (2007). Equality in safe delivery and its determinants in Iran. Arch Iran Med, 10, 446-51.
- Morra P, Bagli S, Spadoni G (2006). The analysis of human health risk with a detailed procedure operating in a GIS environment. Environ Int, 32, 444-54. https://doi.org/10.1016/j.envint.2005.10.003
- Mosavi-Jarrahi A, Moini M, Mohagheghi MA, et al (2007). Clustering of childhood cancer in the inner city of Tehran metropolitan area: a GIS-based analysis. Int J Hyg Environ Health, 210, 113-9. https://doi.org/10.1016/j.ijheh.2006.08.005
- Murray CJ, Gakidou EE, Frenk J (1999). Health inequalities and social group differences: what should we measure? Bull WHO, 77, 537-43.
- Naess O, Claussen B, Thelle DS, et al (2005). Four indicators of socioeconomic position: relative ranking across causes of death. Scand J Public Health, 33, 215-21. https://doi.org/10.1080/14034940410019190
- Natale-Pereira A, Enard KR, Nevarez L, et al (2011). The role of patient navigators in eliminating health disparities. Cancer, 117, 3541-50. https://doi.org/10.1002/cncr.26264
- Pearce J, Boyle P (2005). Examining the relationship between lung cancer and radon in small areas across Scotland. Health Place, 11, 275-82. https://doi.org/10.1016/j.healthplace.2004.06.006
- Pearcy JN, Keppel KG (2002). A summary measure of health disparity. Public Health Rep, 117, 273-80. https://doi.org/10.1016/S0033-3549(04)50161-9
- Power C, Hypponen E, Davey Smith G (2005). Socioeconomic position in childhood and early adult life and risk of mortality: a prospective study of the mothers of the 1958 British birth cohort. Am J Public Health, 95, 1396-402. https://doi.org/10.2105/AJPH.2004.047340
- Rohani Rasaf M, Rohani Rasaf MR, Rahimi F, et al (2011). Distribution of cancer incidence in districts and neighbourhoods of a number of Tehran districts in 1386. Razi J Med Sci, 18, 34-45.
- Rosenberg MW, Wilson K (2000). Gender, poverty and location: how much difference do they make in the geography of health inequalities? Soc Sci Med, 51, 275-87. https://doi.org/10.1016/S0277-9536(99)00453-0
- Santelli JS, Lowry R, Brener N, et al (2000). The association of sexual behaviors with socioeconomic status, family structure, and race/ethnicity among US adolescents. Am J Public Health, 90, 1582-8. https://doi.org/10.2105/AJPH.90.10.1582
- Shavers VL (2007). Measurement of socioeconomic status in health disparities research. J Natl Med Assoc, 99, 1013-23.
- Smits J, Monden C (2009). Length of life inequality around the globe. Soc Sci Med, 68, 1114-23. https://doi.org/10.1016/j.socscimed.2008.12.034
- Spadea T, d'Errico A, Demaria M, et al (2009). Educational inequalities in cancer incidence in Turin, Italy. Eur J Cancer Prev, 18, 169-78. https://doi.org/10.1097/CEJ.0b013e3283265bc9
- Spadea T, Zengarini N, Kunst A, et al (2010). Cancer risk in relationship to different indicators of adult socioeconomic position in Turin, Italy. Cancer Causes Control, 21, 1117-30. https://doi.org/10.1007/s10552-010-9539-0
- Tobias M, Searle P (2006). Does geography explain ethnic inequalities in health in New Zealand? Aust N Z J Public Health, 30, 457-60. https://doi.org/10.1111/j.1467-842X.2006.tb00464.x
- Vagero D, Leinsalu M (2005). Health inequalities and social dynamics in Europe. BMJ, 331, 186-7. https://doi.org/10.1136/bmj.331.7510.186
- Yiengprugsawan V, Lim LLY, Carmichael GA, et al (2007). Measuring and decomposing inequity in self-reported morbidity and self-assessed health in Thailand. Int J Equity Hlth, 6, 23. https://doi.org/10.1186/1475-9276-6-23
- The Social Ecology of Cervical Cancer: The Challenges to Pap Smear Screening vol.04, pp.12, 2013, https://doi.org/10.4236/ijcm.2013.412A1004
- Correlation of Cancer Incidence with Diet, Smoking and Socio-Economic Position Across 22 Districts of Tehran in 2008 vol.14, pp.3, 2013, https://doi.org/10.7314/APJCP.2013.14.3.1669
- Social Disparity in Breast and Ovarian Cancer Incidence in Iran, 2003-2009: A Time Trend Province-Level Study vol.16, pp.4, 2013, https://doi.org/10.4048/jbc.2013.16.4.372
- Incidence and Mortality of Female Breast Cancer in Jiangsu, China vol.15, pp.6, 2014, https://doi.org/10.7314/APJCP.2014.15.6.2727
- Parents' and Health-Care Providers' Perspectives on Side-Effects of Childhood Cancer Treatment in Indonesia vol.15, pp.8, 2014, https://doi.org/10.7314/APJCP.2014.15.8.3593
- A Systematic Review Over the Incidence of Colorectal Cancer in Iran vol.3, pp.1, 2015, https://doi.org/10.17795/acr-25724
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