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Small-Area Geographic and Socioeconomic Inequalities in Colorectal Cancer in Cyprus

Author

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  • Konstantinos Giannakou

    (Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia 1516, Cyprus)

  • Demetris Lamnisos

    (Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia 1516, Cyprus)

Abstract

Colorectal cancer (CRC) is one of the leading causes of death and morbidity worldwide. To date, the relationship between regional deprivation and CRC incidence or mortality has not been studied in the population of Cyprus. The objective of this study was to analyse the geographical variation of CRC incidence and mortality and its possible association with socioeconomic inequalities in Cyprus for the time period of 2000–2015. This is a small-area ecological study in Cyprus, with census tracts as units of spatial analysis. The incidence date, sex, age, postcode, primary site, death date in case of death, or last contact date of all alive CRC cases from 2000–2015 were obtained from the Cyprus Ministry of Health’s Health Monitoring Unit. Indirect standardisation was used to calculate the sex and age Standardise Incidence Ratios (SIRs) and Standardised Mortality Ratios (SMRs) of CRC while the smoothed values of SIRs, SMRs, and Mortality to Incidence ratio (M/I ratio) were estimated using the univariate Bayesian Poisson log-linear spatial model. To evaluate the association of CRC incidence and mortality rate with socioeconomic deprivation, we included the national socioeconomic deprivation index as a covariate variable entering in the model either as a continuous variable or as a categorical variable representing quartiles of areas with increasing levels of socioeconomic deprivation. The results showed that there are geographical areas having 15% higher SIR and SMR, with most of those areas located on the east coast of the island. We found higher M/I ratio values in the rural, remote, and less dense areas of the island, while lower rates were observed in the metropolitan areas. We also discovered an inverted U-shape pattern in CRC incidence and mortality with higher rates in the areas classified in the second quartile (Q2-areas) of the socioeconomic deprivation index and lower rates in rural, remote, and less dense areas (Q4-areas). These findings provide useful information at local and national levels and inform decisions about resource allocation to geographically targeted prevention and control plans to increase CRC screening and management.

Suggested Citation

  • Konstantinos Giannakou & Demetris Lamnisos, 2022. "Small-Area Geographic and Socioeconomic Inequalities in Colorectal Cancer in Cyprus," IJERPH, MDPI, vol. 20(1), pages 1-15, December.
    • Handle: RePEc:gam:jijerp:v:20:y:2022:i:1:p:341-:d:1015006
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    References listed on IDEAS

    as
    1. Demetris Lamnisos & Nicos Middleton & Nikoletta Kyprianou & Michael A. Talias, 2019. "Geodemographic Area Classification and Association with Mortality: An Ecological Study of Small Areas of Cyprus," IJERPH, MDPI, vol. 16(16), pages 1-13, August.
    2. Lindström, Martin & Hanson, Bertil S. & Östergren, Per-Olof, 2001. "Socioeconomic differences in leisure-time physical activity: the role of social participation and social capital in shaping health related behaviour," Social Science & Medicine, Elsevier, vol. 52(3), pages 441-451, February.
    3. Julian Besag & Jeremy York & Annie Mollié, 1991. "Bayesian image restoration, with two applications in spatial statistics," Annals of the Institute of Statistical Mathematics, Springer;The Institute of Statistical Mathematics, vol. 43(1), pages 1-20, March.
    4. Lee, Duncan, 2013. "CARBayes: An R Package for Bayesian Spatial Modeling with Conditional Autoregressive Priors," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 55(i13).
    Full references (including those not matched with items on IDEAS)

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