Abstract
Objective
This study aimed to examine the differences in cancer risk by regional deprivation in Bavaria, Germany.
Methods
Multilevel Poisson regression analysis was used to evaluate the association between lung and colorectal cancer risk and community deprivation level based on data from the Cancer Registry of Bavaria (2003–2006). The communities (n = 1,408) were classified according to the Bavarian Index of Multiple Deprivation (BIMD), differentiated into quintiles ranging from lowest to highest deprivation.
Results
Increased lung cancer risk in men and colorectal cancer risk in both genders were associated with increasing BIMD. Comparing the most deprived with the least deprived communities, the relative risk for lung cancer incidence in men was 1.39 (95% CI 1.29–1.49), for mortality risk 1.54 (95% CI 1.41–1.68). The relative risk for colorectal cancer incidence in men was 1.30 (95% CI 1.22–1.38) and in women 1.19 (95% CI 1.11–1.27); for mortality risk we found 1.57 (95% CI 1.40–1.76) in men and 1.34 (95% CI 1.19–1.51) in women.
Conclusion
Area-based deprivation is significantly associated with cancer risk in Bavaria.
Similar content being viewed by others
References
Barceló MA, Saez M, Saurina C (2009) Spatial variability in mortality inequalities, socioeconomic deprivation, and air pollution in small areas of the Barcelona Metropolitan Region. Spain Sci Total Environ 407(21):5501–5523
Bloomfield K, Grittner U, Kramer S, Gmel G (2006) Social inequalities in alcohol consumption and alcohol-related problems in the study countries of the EU concerted action ‘Gender, culture and alcohol problems: a multi-national study. Alcohol Alcohol Suppl 41(1):i26–i36
Boffetta P, Kogevinas M, Westerholm P, Saracci R (1997) Exposure to occupational carcinogens and social class differences in cancer occurrence. In: Kogevinas M, Pearce N, Susser M, Boffetta P (eds) Social inequalities and cancer. IARC Scientific Publications 138, pp 331–341
Breckenkamp J, Mielck A, Razum O (2007) Health inequalities in Germany: do regional-level variables explain differentials in cardiovascular risk? BMC Public Health 7:132
Brenner H, Mielck A, Klein R, Ziegler H (1991) The role of socioeconomic factors in the survival of patients with colorectal cancer in Saarland/Germany. J Clin Epidemiol 44(8):807–815
Büchner FL, Bueno-de-Mesquita HB, Ros MM, Overvad K, Dahm CC, Hansen L et al (2010) Variety in fruit and vegetable consumption and the risk of lung cancer in the European prospective investigation into cancer and nutrition. Cancer Epidemiol Biomarkers Prev 19(9):2278–2286
Cancer in Germany 2005/2006 (2010) Incidence and trends. Seventh edition. Robert Koch Institute, Association of Population-based Cancer Registries in Germany (eds). http://edoc.rki.de/documents/rki_fv/re2vZ21t28Ir8Y/PDF/22aJOdYnmXV0I.pdf. Accessed August 2011 [in German]
CDC, Centers for Disease Control and Prevention (2011a) Lung cancer risk factors. http://www.cdc.gov/cancer/lung/basic_info/risk_factors.htm. Accessed August 2011
CDC, Centers for Disease Control and Prevention (2011c) Colorectal cancer risk factors. http://www.cdc.gov/cancer/colorectal/basic_info/risk_factors.htm. Accessed June 2011
CDC, Centres for Disease Control and Prevention (2011b) Lung cancer. http://www.cdc.gov/cancer/lung/. Accessed June 2011
Diez-Roux AV (1998) Bringing context back into epidemiology: variables and fallacies in multilevel analysis. Am J Public Health 88(2):216–222
Eberle A, Luttmann S, Foraita R, Pohlabeln H (2010) Socioeconomic inequalities in cancer incidence and mortality: spatial analysis in Bremen/Germany. J Public Health 18(3):227–235. https://springerlink3.metapress.com/content/j4g7v46r683k1224/resource-secured/?target=fulltext.pdf&sid=zbrowjaq0veh2ui3wy4eqetd&sh=www.springerlink.com. Accessed August 2011
Emaus A, Thune I (2010) Physical activity and lung cancer prevention. Recent Results Cancer Res 86:101–133
Federal Statistical Office (2006) Health in Germany 2006, Bonn. http://www.gbe-bund.de/gbe10/abrechnung.prc_abr_test_logon?p_aid=36353381&p_uid=gast&p_sprache=D&p_knoten=FID&p_suchstring=10114#m34. Accessed November 2011
Finkelstein MM, Jerrett M, Sears MR (2005) Environmental inequality and circulatory disease mortality gradients. J Epidemiol Community Health 59(6):481–487
Flint AJ, Novotny TE (1997) Poverty status and cigarette smoking prevalence and cessation in the United States, 1983–1993: the independent risk of being poor. Tob Control 6(1):14–18
Gomez SL, O’Malley CD, Stroup A, Shema SJ, Satariano WA (2007) Longitudinal, population-based study of racial/ethnic differences in colorectal cancer survival: impact of neighborhood socioeconomic status, treatment and comorbidity. BMC Cancer 7:193
Haynes R, Pearce J, Barnett R (2008) Cancer survival in New Zealand: ethic, social and geographical inequalities. Soc Sci Med 67(6):928–937
Hofferkamp J (2008) Standards for Cancer Registries. Standards for completeness, quality, analysis, management, security and confidentiality of data, Volume III. http://www.naaccr.org/LinkClick.aspx?fileticket=hvFzJKUcRM8%3D&tabid=134&mid=474. Accessed August 2011
Huisman M, Kunst AE, Mackenbach JP (2005) Educational inequalities in smoking among men and women aged 16 years and older in 11 European countries. Tob Control 14(2):106–113
Kaak HJ, Lührs R, Schröder T (1996) Social–spatial distribution of lung cancer mortality in Hamburg. Prävention 3:87–90 [in German]
Kee F, Wilson R, Currie S, Sloan J, Houston R, Rowlands B, Moorehead J (1996) Socioeconomic circumstances and the risk of bowel cancer in Northern Ireland. J Epidemiol Community Health 50(6):640–644
Kruize H, Driessen PP, Glasbergen P, van Egmond KN (2007) Environmental equity and the role of public policy: experiences in the Rijnmond region. Environ Manage 40(4):578–595
Kuhn J, Zirngibl A, Wildner M, Caselmann WH, Kerscher G (2006) Regional mortality differences in Bavaria. Gesundheitswesen 68(8–9):551–556 [in German]
Lancaster GA, Green M, Lane S (2006) Linkage of survey data with district-level lung cancer registrations: a method of bias reduction in ecological studies. J Epidemiol Community Health 60(12):1093–1098
Mackenbach JP, Huisman M, Andersen O, Bopp M, Borgan JK, Borrell C, Costa G, Deboosere P, Donkin A, Gadeyne S, Minder C, Regidor E, Spadea T, Valkonen T, Kunst AE (2004) Inequalities in lung cancer mortality by the educational level in 10 European populations. Eur J Cancer 40(1):126–135
Mackillop WJ, Zhang-Salomons J, Boyd CJ, Groome PA (2000) Associations between community income and cancer incidence in Canada and the United States. Cancer 89(4):901–912
Maier W, Fairburn J, Mielck A (2011) Regional deprivation and mortality in Bavaria. Development of a Community-Based Index of Multiple Deprivation. Gesundheitswesen 2011 Oct 21. [Epub ahead of print] [in German]
Meyer M, Gärtig-Daugs A, Radespiel-Tröger M (2006) Regional differences in cancer mortality in Bavaria. Zeitschrift für Bevölkerungswissenschaft 31(2):231–256 [in German]. http://www.bib-demographie.de/nn_750522/DE/Publikationen/Zeitschrift/2006/heft2meyergaertigdaugsradespieltroeger.html. Accessed August 2011
Morris R, Carstairs V (1991) Which deprivation? A comparison of selected deprivation indexes. J Public Health Med 13(4):318–326
Noble M, Wright G, Smith G, Dibben C (2006) Measuring multiple deprivation at the small-area level. Environment Planning A 38(1):169–185
Pampalon R, Hamel D, Gamache P (2010) Health inequalities in urban and rural Canada: combating inequalities in survival according to an individual and area-based deprivation index. Health Place 16(2):416–420
Parsons NR, Somerville L (2000) Estimation and projection of population lung cancer trends (United Kingdom). Cancer Causes Control 11(5):467–475
Radespiel-Tröger M, Meyer M, Pfahlberg A, Lausen B, Uter W, Gefeller O (2009) Outdoor work and skin cancer incidence: a registry-based study in Bavaria. Int Arch Occup Environ Health 82(3):357–363
Schmid K, Kuwert T, Drexler H (2010) Radon in indoor spaces: an underestimated risk factor for lung cancer in environmental medicine. Dtsch Arztebl Int 107(11):181–186
Soobader M, LeClere FB, Hadden W, Maury B (2001) Using aggregate geographic data to proxy individual socioeconomic status: does size matter? Am J Public Health 91(4):632–636
Spatial carcinoma analysis: regional comparison of colorectal carcinoma incidence in Bavaria in 2006–2008 (2010). The study of the Institute of Cancer Epidemiology at the University of Lübeck and the Association of Statutory Health Insurance Physicians in Bavaria. http://www.ausgezeichnete-patientenversorgung.de/fileadmin/apv/dokumente/Koloskopie_Karzinomanalyse_Zusammenfassung_Studienegebnisse_070410_final.pdf. Accessed August 2011 [in German]
Stirbu I, Kunst A, Mielck A, Mackenbach JP (2007) Educational inequalities in utilization of preventive services among elderly in Europe. In: tackling health inequalities in Europe: an integrated approach EUROTHINE. Final report, 31 August 2007. Department of Public Health University Medical Centre Rotterdam, the Netherlands, pp. 483–99. http://survey.erasmusmc.nl/eurothine/index.php?id=112,0,0,1,0,0. Accessed May 2011
Stringhini S, Sabia S, Shipley M, Brunner E, Nabi H, Kivimaki M, Singh-Manoux A (2010) Association of socioeconomic position with health behaviors and mortality. JAMA 303(12):1159–1166
Voigtländer S, Berger U, Razum O (2010) The impact of regional and neighbourhood deprivation on physical health in Germany: a multilevel study. BMC Public Health 10:403
Acknowledgments
We would like to acknowledge Dr. Alexander V. Kuznetsov, MD (Hons), for his helpful comments during the study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kuznetsov, L., Maier, W., Hunger, M. et al. Regional deprivation in Bavaria, Germany: linking a new deprivation score with registry data for lung and colorectal cancer. Int J Public Health 57, 827–835 (2012). https://doi.org/10.1007/s00038-012-0342-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00038-012-0342-4