Neighborhood deprivation and mortality in individuals with cancer: a multilevel analysis from Sweden.
ABSTRACT Little information is available on the effect of neighborhood deprivation on mortality in individuals with cancer. The aim of this study was to investigate the effect of level of neighborhood deprivation on mortality after a wide range of cancer diagnoses. This 1990-2004 follow-up study included all individuals in Sweden aged 25-74 years and used multilevel logistic regression with individual-level variables at the first level and the level of neighborhood deprivation at the second level. There was a relationship between the level of neighborhood deprivation and mortality for both men and women with cancer. The model accounted for age and socioeconomic factors. For individuals with cancer, the overall risk of mortality was 24% higher for men and 20% higher for women living in the most deprived neighborhoods than in those living in the least deprived neighborhoods. In men and women with kidney, urinary bladder, and endocrine gland cancers, squamous cell carcinoma of the skin, and non-Hodgkin's lymphoma, mortality differed according to the level of neighborhood deprivation. In men with cancer of the prostate, testes, upper aerodigestive tract, colon, rectum, and lung, mortality differed according to the level of neighborhood deprivation. Mortality differences were also found in women with cancer of the breast, cervix, endometrium, and small intestine, and leukemia. In conclusion, neighborhood deprivation predicts the risk of mortality among adults with certain cancers.