Trends in cancer incidence by socioeconomic deprivation in Germany in 2007 to 2018: An ecological registry-based study |
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| Authors: | Lina Jansen Lars Schwettmann Christian Behr Andrea Eberle Bernd Holleczek Christina Justenhoven Hiltraud Kajüter Kirsi Manz Frederik Peters Ron Pritzkuleit Andrea Schmidt-Pokrzywniak Eunice Sirri Fabian Tetzlaff Sven Voigtländer Volker Arndt |
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| Institution: | 1. Epidemiological Cancer Registry Baden-Württemberg, German Cancer Research Center (DKFZ), Heidelberg, Germany;2. Division for Health Economics, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany;3. Cancer Registry Rheinland-Palatinate gGmbH, Mainz, Germany;4. Bremen Cancer Registry, Leibniz-Institute for Prevention Research and Epidemiology: BIPS, Bremen, Germany;5. Cancer Registry Saarland, Saarbrücken, Germany;6. Cancer Registry of North Rhine-Westphalia, Bochum, Germany;7. Cancer Registry Mecklenburg-Western Pomerania, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany;8. Cancer Registry Hamburg, Hamburg, Germany;9. Institute for Cancer Epidemiology, University Lübeck, Cancer Registry Schleswig-Holstein, Lübeck, Germany;10. Clinical Cancer Registry Sachsen-Anhalt gGmbH, Halle, Germany;11. Epidemiological Cancer Registry Lower Saxony, Registerstelle, Oldenburg, Germany;12. Division of Social Determinants of Health, Robert Koch-Institute, Berlin, Germany;13. Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Nürnberg, Germany |
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| Abstract: | Age-standardized cancer incidence has decreased over the last years for many cancer sites in developed countries. Whether these trends led to narrowing or widening socioeconomic inequalities in cancer incidence is unknown. Using cancer registry data covering 48 million inhabitants in Germany, the ecological association between age-standardized total and site specific (colorectal, lung, prostate and breast) cancer incidence in 2007 to 2018 and a deprivation index on district level (aggregated to quintiles) was investigated. Incidence in the most and least deprived districts were compared using Poisson models. Average annual percentage changes (AAPCs) and differences in AAPCs between deprivation quintiles were assessed using Joinpoint regression analyses. Age-standardized incidence decreased strongly between 2007 and 2018 for total cancer and all cancer sites (except female lung cancer), irrespective of the level of deprivation. However, differences in the magnitude of trends across deprivation quintiles resulted in increasing inequalities over time for total cancer, colorectal and lung cancer. For total cancer, the incidence rate ratio between the most and least deprived quintile increased from 1.07 (95% confidence interval: 1.01-1.12) to 1.23 (1.12-1.32) in men and from 1.07 (1.01-1.13) to 1.20 (1.14-1.26) in women. Largest inequalities were observed for lung cancer with 82% (men) and 88% (women) higher incidence in the most vs the least deprived regions in 2018. The observed increase in inequalities in cancer incidence is in alignment with trends in inequalities in risk factor prevalence and partly utilization of screening. Intervention programs targeted at socioeconomically deprived and urban regions are highly needed. |
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| Keywords: | cancer deprivation Germany incidence trends |
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