Abstract
OBJECTIVE: The aim of this study is to assess to what extent individual and area-level socioeconomic position (SEP) are associated to head and neck cancer (HNC) mortality and to what extent they contribute to regional variation in HNC mortality in Belgium.
MATERIALS AND METHODS: Data on men aged 40-64 are collected from a population based dataset based on the 2001 Belgian census linked to register data on emigration and mortality for 2001-2011. Individual SEP is measured using education, employment status and housing conditions. Deprivation at municipal level is measured by a deprivation index. Absolute mortality differences are estimated by age standardised mortality rates. Multilevel Poisson models are used to estimate the association and interaction between HNC mortality and individual and area-level SEP, and to estimate the regional variation in HNC mortality.
RESULTS: HNC mortality rates are significantly higher for men with a low SEP and men living in deprived areas. Cross-level interactions indicate that the association between individual SEP and HNC mortality is conditional on area deprivation. HNC mortality in deprived areas is especially high among high-SEP men. As a result, social disparities appear to be smaller in more deprived areas. Regional variation in HNC mortality was significant. Population composition partially explains this regional variation, while area deprivation and cross-level interactions explains little.
CONCLUSION: Both individual and area-level deprivation are important determinants of HNC mortality. Underlying trends in incidence and survival, and risk factors, such as alcohol and tobacco use, should be explored further.
Original language | English |
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Pages (from-to) | 76-82 |
Number of pages | 7 |
Journal | Oral Oncology |
Volume | 61 |
DOIs | |
Publication status | Published - Oct 2016 |
Externally published | Yes |
Keywords
- Belgium/epidemiology
- Cohort Studies
- Head and Neck Neoplasms/mortality
- Humans
- Socioeconomic Factors