Social inequality in incidence and mortality of malignant neoplasms of lip, oral cavity and pharynx: Is Costa Rica an international paradox?
Fecha
2021-04-20
Tipo
artículo original
Autores
Barboza Solís, Cristina
Reyes Carmona, Jessie
Fantin, Romain Clement
Título de la revista
ISSN de la revista
Título del volumen
Editor
Resumen
Objectives: Low socioeconomic position (SEP) has been associated with higher incidences
and mortality of lip, oral cavity and pharynx (LOP) cancers in the vast majority
of countries with available data. The origins of health inequalities in cancer are socioeconomic,
although they vary by time and country. Evidence from Low-and
Middle-income
Countries (LMICs) remains scarce. This study aims to identify and describe
socioeconomic inequalities in LOP cancers incidence and mortality in Costa Rica.
The hypothesis tested is that people leaving in low-SEP
districts in Costa Rica have
greater incidence and mortality rates of lip, oral cavity and pharynx cancers.
Methods: The 10th revision of the International Classification of Diseases (ICD-10)
was used to define cancer sites. Data come from a national population-based
Cancer
Registry with 100% completeness to study incidence. Incidence rate included all new
cases of LOP cancer diagnosed from January 1, 2011, and December 31, 2015, for
a total of 2 798 517 individuals, 13 832 524 years of follow-up
and 601 LOP cases.
Mortality rate was extracted from the National Death Index, including 2 739 733
individuals, 23 950 240 person-years
of follow-up
and 586 LOP cancer deaths, from
January 1, 2010, to December 31, 2018. The 2011 Census (with 94% of Costa Rican
inhabitants) was used to characterize the urbanicity and wealth of 477 districts.
Survival models were performed for both incidence and mortality, allowing to consider
existing competitive risks. Cox models were used for incidence, and parametric
survival models based on a Gompertz distribution for mortality.
Results: The study found that people who lived in the most socioeconomically disadvantaged
areas had lower probabilities of developing LOP cancers than people in the
richest districts. The same pattern for mortality, however, was not significant.
Conclusions: The hypothesis that incidence and mortality of LOP cancers will show a
positive social gradient was not confirmed in this study, contradicting the existing literature.
This could be explained by the social distribution of risky health behaviours,
more frequent in socially advantaged populations.
Descripción
Palabras clave
COSTA RICA, Ecological study, Health inequalities, Oral cancer, Oral cavity, Pharynx and lip cancers incidence, Cancers mortality, Social inequalities