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Linking of Primary Care Records to Census Data to Study the Association between Socioeconomic Status and Cancer Incidence in Southern Europe: A Nation-Wide Ecological Study

Author

Listed:
  • Maria Garcia-Gil
  • Josep-Maria Elorza
  • Marta Banque
  • Marc Comas-Cufí
  • Jordi Blanch
  • Rafel Ramos
  • Leonardo Méndez-Boo
  • Eduardo Hermosilla
  • Bonaventura Bolibar
  • Daniel Prieto-Alhambra

Abstract

Background: Area-based measures of economic deprivation are seldom applied to large medical records databases to establish population-scale associations between deprivation and disease. Objective: To study the association between deprivation and incidence of common cancer types in a Southern European region. Methods: Retrospective ecological study using the SIDIAP (Information System for the Development of Research in Primary Care) database of longitudinal electronic medical records for a representative population of Catalonia (Spain) and the MEDEA index based on urban socioeconomic indicators in the Spanish census. Study outcomes were incident cervical, breast, colorectal, prostate, and lung cancer in 2009–2012. The completeness of SIDIAP cancer recording was evaluated through linkage of a geographic data subset to a hospital cancer registry. Associations between MEDEA quintiles and cancer incidence was evaluated using zero-inflated Poisson regression adjusted for sex, age, smoking, alcoholism, obesity, hypertension, and diabetes. Results: SIDIAP sensitivity was 63% to 92% for the five cancers studied. There was direct association between deprivation and lung, colorectal, and cervical cancer: incidence rate ratios (IRR) 1.82 [1.64–2.01], IRR 1.60 [1.34–1.90], IRR 1.22 [1.07–1.38], respectively, comparing the most deprived to most affluent areas. In wealthy areas, prostate and breast cancers were more common: IRR 0.92 [0.80–1.00], IRR 0.91 [0.78–1.06]. Adjustment for confounders attenuated the association with lung cancer risk (fully adjusted IRR 1.16 [1.08–1.25]), reversed the direction of the association with colorectal cancer (IRR 0.90 [0.84–0.95]), and did not modify the associations with cervical (IRR 1.27 [1.11–1.45]), prostate (0.74 [0.69–0.80]), and breast (0.76 [0.71–0.81]) cancer. Conclusions: Deprivation is associated differently with the occurrence of various cancer types. These results provide evidence that MEDEA is a useful, area-based deprivation index for analyses of the SIDIAP database. This information will be useful to improve screening programs, cancer prevention and management strategies, to reach patients more effectively, particularly in deprived urban areas.

Suggested Citation

  • Maria Garcia-Gil & Josep-Maria Elorza & Marta Banque & Marc Comas-Cufí & Jordi Blanch & Rafel Ramos & Leonardo Méndez-Boo & Eduardo Hermosilla & Bonaventura Bolibar & Daniel Prieto-Alhambra, 2014. "Linking of Primary Care Records to Census Data to Study the Association between Socioeconomic Status and Cancer Incidence in Southern Europe: A Nation-Wide Ecological Study," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-7, October.
    • Handle: RePEc:plo:pone00:0109706
    DOI: 10.1371/journal.pone.0109706
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    References listed on IDEAS

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    1. Krieger, N., 1992. "Overcoming the absence of socioeconomic data in medical records: Validation and application of a census-based methodology," American Journal of Public Health, American Public Health Association, vol. 82(5), pages 703-710.
    2. Maria T Sánchez-Santos & Marco Mesa-Frias & Minkyoung Choi & Eveline Nüesch & Angel Asunsolo-Del Barco & Antoinette Amuzu & George Davey Smith & Shah Ebrahim & David Prieto-Merino & Juan P Casas, 2013. "Area-Level Deprivation and Overall and Cause-Specific Mortality: 12 Years’ Observation on British Women and Systematic Review of Prospective Studies," PLOS ONE, Public Library of Science, vol. 8(9), pages 1-1, September.
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    1. Connolly, Sheelah & Russell, Helen & Henry, Edward, 2021. "Returning to employment following a diagnosis of cancer: An Irish survey," Research Series, Economic and Social Research Institute (ESRI), number SUSTAT103, June.
    2. Eduardo Hermosilla & Ermengol Coma & Junqing Xie & Shuo Feng & Carmen Cabezas & Leonardo Méndez-Boo & Francesc Fina & Elisabet Ballo & Montserrat Martínez & Manuel Medina-Peralta & Josep Maria Argimon, 2022. "Comparative effectiveness and safety of homologous two-dose ChAdOx1 versus heterologous vaccination with ChAdOx1 and BNT162b2," Nature Communications, Nature, vol. 13(1), pages 1-7, December.

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