Regional Inequalities in Lung Cancer Mortality in Belgium at the Beginning of the 21st Century: The Contribution of Individual and Area-Level Socioeconomic Status and Industrial Exposure

Abstract

Being a highly industrialized country with one of the highest male lung cancer mortality rates in Europe, Belgium is an interesting study area for lung cancer research. This study investigates geographical patterns in lung cancer mortality in Belgium. More specifically it probes into the contribution of individual as well as area-level characteristics to (sub-district patterns in) lung cancer mortality. Data from the 2001 census linked to register data from 2001–2011 are used, selecting all Belgian inhabitants aged 65+ at time of the census. Individual characteristics include education, housing status and home ownership. Urbanicity, unemployment rate, the percentage employed in mining and the percentage employed in other high-risk industries are included as sub-district characteristics. Regional variation in lung cancer mortality at sub-district level is estimated using directly age-standardized mortality rates. The association between lung cancer mortality and individual and area characteristics, and their impact on the variation of sub-district level is estimated using multilevel Poisson models. Significant sub-district variations in lung cancer mortality are observed. Individual characteristics explain a small share of this variation, while a large share is explained by sub-district characteristics. Individuals with a low socioeconomic status experience a higher lung cancer mortality risk. Among women, an association with lung cancer mortality is found for the sub-district characteristics urbanicity and unemployment rate, while for men lung cancer mortality was associated with the percentage employed in mining. Not just individual characteristics, but also area characteristics are thus important determinants of (regional differences in) lung cancer mortality.

Effect of socioeconomic status on stage at diagnosis of lung cancer in a hospital‐based multicenter retrospective clinical epidemiological study in China, 2005–2014

“…There were several plausible explanatory factors for this phenomenon in China. However, individuals with low educational level or low income seem to be less likely to seek medical advice or undergo treatment for a cough or hoarseness, prone to smoking [32], or lived close to cancer causing substances, such as asbestos, arsenic, coal, and diesel engine exhaust [9,33]. According to the result of the 2015 China Adult Tobacco Survey, the percent of current smoking rate with low education level (middle school degree or below) was higher (60.0%) compared with high education level (college degree or above) in men (41.9%) [34].…”

“…However, there are no certain criteria of judging the degree of area-level social-economic status. Each researcher utilized these SES indices according to their own criteria so far [9,36,37]. So there is lack of comparative data for the several indicators.…”

“…Individual-level SES data were obtained and measured based on two indicators from CRF of the retrospective survey: an individual's educational level and occupational rank, based on Hollingshead's personal rating of people's relative social standing in New Haven, CT, in the early 1960s [23]. Education represents knowledge and skills; occupation captures material and social resources and assets [9]. Education was categorized to five levels: illiterate, primary school, middle school, high school, and college degree or above.…”

“…In China, highly unequal distribution of insurance benefits still exists under the current social health insurance programs, especially for the vulnerable groups such as children, women, low-income, and rural population [2,3]. The possible underlying causes of the different cancer outcomes among social groups include health care provision according to socioeconomic areas [4][5][6], health-related behaviors of individuals [7,8], and environmental or occupational exposures across socioeconomic groups [9][10][11]. Up to now, there is inconsistent evidence of the association between socioeconomic status (SES) and lung cancer stage from the current studies in non-Chinese populations.…”

“…The socioeconomic measurements have proved useful to monitor health inequalities and can provide fundamental implications for prevention initiatives and resource allocation [16][17][18]. To date, the role of SES, either at individual or area level, in shaping lung cancer risk has only been examined from outside of China [9,12,[19][20][21]. Since each study has used different variables and different approaches to estimate individual or neighborhood socioeconomic conditions, the accumulated evidence is difficult to assess systematically in China.…”