Neighborhood deprivation and lung cancer incidence and mortality: a multilevel analysis from Sweden.
BACKGROUND
Neighborhood deprivation has been implicated in lung cancer but no study has simultaneously analyzed the potential effect of neighborhood deprivation on both lung cancer incidence and mortality, after adjusting for individual-level socioeconomic factors, and comorbidities. The aim of this study was to analyze whether there is an association between neighborhood deprivation and incidence and mortality rates of lung cancer, beyond individual-level characteristics.


METHODS
The incident and mortality cases of lung cancer were determined in the entire Swedish population aged over 50 (3.2 million individuals) between 2000 and 2010. Multilevel logistic regression was used in the analysis with individual-level characteristics (age, marital status, family income, education, immigration status, urban/rural status, mobility, and comorbidities) at the first level and level of neighborhood deprivation at the second level. A neighborhood deprivation index, constructed from the variables education, income, unemployment, and welfare assistance, was used to assess the level of neighborhood deprivation.


RESULTS
There was a strong association between level of neighborhood deprivation and incidence and mortality of lung cancer. In the fully adjusted model, the odds of lung cancer were 1.27 and 1.32, respectively, in the most deprived neighborhood. The between-neighborhood variance (i.e., the random intercept) was over 1.96 times the standard error in all models, indicating that there were significant differences in incidence and mortality rates of lung cancer between neighborhoods.


CONCLUSIONS
Results suggest that neighborhood deprivation is associated with incident and mortality cases of lung cancer in Sweden, independently of individual-level characteristics.
*Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden; and †Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA.
Xinjun
X
Li
Jan
J
Sundquist
Bengt
B
Zöller
Kristina
K
Sundquist
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000191:economics / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011204:Poverty Areas; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome