Recent trends in educational inequalities in site-specific cancer mortality among Belgian women during the 1990s-2000s

Katrien Vanthomme, Vrije Universiteit Brussel
Hadewijch Vandenheede, Vrije Universiteit Brussel
Paulien Hagedoorn, Vrije Universiteit Brussel
Sylvie Gadeyne, Vrije Universiteit Brussel

Background According to the “fundamental cause theory”, emerging knowledge on health-enhancing behaviours and technologies results in persisting and even widening health disparities, since higher educated people benefit more from this knowledge. As for cancer, prevention and treatment have improved substantially in recent decades, likely resulting in widening disparities. This study aims to assess socioeconomic inequalities in site-specific cancer mortality in Belgian women, and to examine to what extent these inequalities have changed over time. Data and methods Data were derived from record linkage between the Belgian censuses of 1991 and 2001 and register data on mortality and emigration for the follow-up periods 01/03/1991-31/12/1997 and 01/10/2001-31/07/2008. The database is a unique source of information containing data on mortality, emigration, causes of death, and background characteristics of all individuals legally residing in Belgium at the time of the census. The study population comprised all Belgian female inhabitants aged between 50 to 79 years during the follow-up period. We used educational attainment as measure of socioeconomic position. To obtain the full picture of inequality patterns in cancer mortality, both absolute (age-standardized mortality rates (ASMR)) and relative inequality measures (mortality rate ratios and relative index of inequality, both using Poisson regression) were calculated. Preliminary results Preliminary results indicate that in the 2000s, low-educated women had higher lung and cervix cancer mortality rates compared with high-educated women. Relative inequalities are much more pronounced, indicating inequalities in favour of high-educated women for almost all cancers. For some cancer sites (e.g. bladder and cervix) trends over time are towards less inequalities while for others inequalities are increasing (e.g. oesophagus and lung). Conclusions Consequently, reducing social inequalities should remain high on the public health agenda. Yet, we must bear in mind that public health policies aiming at the general population might also entail persisting or increasing health inequalities.