Neighborhood deprivation and mortality in individuals with cancer: A multilevel analysis from Sweden
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.
Available from: Bernard Silke
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Deprivation in the general population predicts mortality. We have investigated its relevance to an acute medical admission, using a database of all emergency admissions to St James' Hospital, Dublin, over a 10-year period (2002-11).
All emergency admissions, based on geocoding of residence, were allocated to a Small Area Health Research Unit division, with a corresponding deprivation index. We then examined this index as a univariate (unadjusted) and independent (adjusted) predictor of 30-day in-hospital mortality.
The 30-day in-hospital mortality, over the 10-year period, was higher for those in the upper half of the deprivation distribution (9.6 vs. 8.6%; P = 0.002). Indeed, there was a stepwise increase in 30-day mortality over the quintiles of deprivation from 7.3% (Quintile 1) to 8.8, 10.0, 10.0 and 9.3%, respectively. Univariate logistic regression of the deprivation indices (quintiles) against outcome showed an increased risk (P = 0.002) of a 30-day death with odds ratios (ORs), respectively (compared with lowest deprivation quintile) of 1.39 [95% confidence intervals (CI) 1.21, 1.58], 1.47 (95% CI 1.29, 1.68), 1.44 (95% CI 1.26, 1.64) and 1.39 (95% CI 1.22, 1.59). The deprivation index was an independent predictor of outcome in a model when adjusted for illness severity and co-morbidity. The fully adjusted OR for a 30-day death was increased by 31% (P = 0.001) for patients in the upper half of the deprivation index distribution (OR 1.35; 95% CI 1.23, 1.48; P < 0.001).
Deprivation, independent of co-morbidity or acute illness severity, is an independent predictor of 30-day mortality in acute medical admissions.
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ABSTRACT: Breast cancer is the most prevalent malignancy in women worldwide and is a growing concern due to rising incidence and ongoing ethnic disparities in both incidence and mortality. A number of factors likely contribute to these trends including rising rates of obesity and diabetes across the globe and differences in genetic predisposition. Here, we emphasize Hispanic populations and summarize what is currently known about obesity, diabetes and individual genetic predisposition as they relate to ethnic disparities in breast cancer incidence and mortality. In addition, we discuss potential contributions to breast cancer aetiology from molecular mechanisms associated with obesity and diabetes including dyslipidemia, hyperglycaemia, hyperinsulinaemia, endocrine dysfunction and inflammation. We propose that unique differences in diet and lifestyle coupled with individual genetic predisposition and endocrine/immune dysfunction explain most of the ethnic disparities seen in breast cancer incidence and mortality.
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Neighborhood deprivation has been implicated in lung cancer but no study has simultaneously analyzed the potential effect of neighborhood deprivation on both lung cancer incidence and mortality, after adjusting for individual-level socioeconomic factors, and comorbidities. The aim of this study was to analyze whether there is an association between neighborhood deprivation and incidence and mortality rates of lung cancer, beyond individual-level characteristics.
The incident and mortality cases of lung cancer were determined in the entire Swedish population aged over 50 (3.2 million individuals) between 2000 and 2010. Multilevel logistic regression was used in the analysis with individual-level characteristics (age, marital status, family income, education, immigration status, urban/rural status, mobility, and comorbidities) at the first level and level of neighborhood deprivation at the second level. A neighborhood deprivation index, constructed from the variables education, income, unemployment, and welfare assistance, was used to assess the level of neighborhood deprivation.
There was a strong association between level of neighborhood deprivation and incidence and mortality of lung cancer. In the fully adjusted model, the odds of lung cancer were 1.27 and 1.32, respectively, in the most deprived neighborhood. The between-neighborhood variance (i.e., the random intercept) was over 1.96 times the standard error in all models, indicating that there were significant differences in incidence and mortality rates of lung cancer between neighborhoods.
Results suggest that neighborhood deprivation is associated with incident and mortality cases of lung cancer in Sweden, independently of individual-level characteristics.
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