Socioeconomic inequalities in cancer mortality: Is Costa Rica an exception to the rule?

Abstract

Socioeconomic inequalities in cancer mortality have been described for a range of cancers sites worldwide, using diverse measures of socioeconomic position (SEP). These studies have shown a negative social gradient where lower SEP was associated with greater odds of having cancer, particularly in men. However, there is a lack of information regarding low and middle-income countries. The objective of our study was to analyze the relationship between the socioeconomic characteristics of patients' residential districts and mortality due to cancer in Costa Rica between 2011 and 2017. An ecological study at the level of the district of residence was conducted using the multilevel mixed-effects Poisson regression. All cancer-caused deaths between January 1, 2011 and December 31, 2017 were included (n = 32,117). Eleven cancer sites were analyzed independently. The 477 Costa Rican districts were divided by area (urban/mixed/rural) and wealth using census data. Allcancer combined a significant association between cancer mortality and wealth was found. Cancer mortality was lower in the poorest as compared to the richest districts (IRR Q4 = 0.79 [0.73-0.86]). The majority of cancer sites followed a similar pattern, showing a positive social gradient. These results contradict the international literature mostly conducted in high-income countries. These findings confirmed the importance of conducting studies in middle-income countries, since the socioeconomic and cultural contexts are different from those in high-income countries, which influence the social distribution of lifestyles and risk behaviors.

Relationship between childhood obesity and socio-economic status among primary school children in Costa Rica

“…Each district was described using the Population and Housing Census 2011. Population and Housing Census covered 94 % of the population of Costa Rica (24) .…”

“…The geographic location type and development level were assigned from the school district, using a previously published methodology. A district is considered urban if more than 80 % of its population lives in urban areas, mixed if 20 to 80 % live in an urban area and rural if less than 20 % of its population lives in urban areas (24) . It should be noted that in Costa Rica, the rural area is less developed than the urban area (25) .…”

“…The percentage of people with at least one Basic Unmet Needs is used to measure poverty at the geographical level. It comprises four dimensions: access to a decent shelter, access to a healthy life, access to knowledge and access to other goods and services (24) . The type of institution was classified between public and private.…”

Complex Social Gradient in Life Expectancy in Costa Rica: an Ecological Study with 24-Million Person-Years Follow-Up

“…An ecological study at the level of the electoral district was conducted, performing a methodology previously used in a Costa Rican cancer mortality study recently published (25). Costa Rica, with 5 million inhabitants, is administratively divided into 481 districts (in 2018).…”

“…BUN indicator comprises four dimensions: access to a decent shelter, access to a healthy life, access to knowledge and access to other goods and services. We previously used BUN indicator to measure health inequalities in Costa Rica (25,27). For further information on BUN indicator, please see (28).…”