title: Trends in inequalities in premature cancer mortality by educational level in Colombia, 1998-2007.
abstract: BACKGROUND
  There is a paucity of studies on socioeconomic inequalities in cancer mortality in developing countries. We examined trends in inequalities in cancer mortality by educational attainment in Colombia during a period of epidemiological transition and rapid expansion of health insurance coverage.
  
  
  METHODS
  Population mortality data (1998-2007) were linked to census data to obtain age-standardised cancer mortality rates by educational attainment at ages 25-64 years for stomach, cervical, prostate, lung, colorectal, breast and other cancers. We used Poisson regression to model mortality by educational attainment and estimated the contribution of specific cancers to the slope index of inequality in cancer mortality.
  
  
  RESULTS
  We observed large educational inequalities in cancer mortality, particularly for cancer of the cervix (rate ratio (RR) primary vs tertiary groups=5.75, contributing 51% of cancer inequalities), stomach (RR=2.56 for males, contributing 49% of total cancer inequalities and RR=1.98 for females, contributing 14% to total cancer inequalities) and lung (RR=1.64 for males contributing 17% of total cancer inequalities and 1.32 for females contributing 5% to total cancer inequalities). Total cancer mortality rates declined faster among those with higher education, with the exception of mortality from cervical cancer, which declined more rapidly in the lower educational groups.
  
  
  CONCLUSIONS
  There are large socioeconomic inequalities in preventable cancer mortality in Colombia, which underscore the need for intensifying prevention efforts. Reduction of cervical cancer can be achieved through reducing human papilloma virus infection, early detection and improved access to treatment of preneoplastic lesions. Reinforcing antitobacco measures may be particularly important to curb inequalities in cancer mortality.
authors.affiliation: International Agency for Research on Cancer, Section of Cancer Information, Lyon, France Cancer Surveillance and Epidemiology Group, National Cancer Institute, Bogota, Colombia Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Esther
authors.identifier: http://orcid.org/0000-0002-5560-2258
authors.initials: E
authors.lastname: de Vries
authors.affiliation: Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands Epidemiology Group and Department of Specific Sciences in Public Health, National School of Public Health, University of Antioquia, Medellin, Colombia.
authors.forename: Ivan
authors.initials: I
authors.lastname: Arroyave
authors.affiliation: Cancer Surveillance and Epidemiology Group, National Cancer Institute, Bogota, Colombia.
authors.forename: Constanza
authors.initials: C
authors.lastname: Pardo
authors.affiliation: Cancer Surveillance and Epidemiology Group, National Cancer Institute, Bogota, Colombia.
authors.forename: Carolina
authors.initials: C
authors.lastname: Wiesner
authors.affiliation: Cancer Surveillance and Epidemiology Group, National Cancer Institute, Bogota, Colombia.
authors.forename: Raul
authors.initials: R
authors.lastname: Murillo
authors.affiliation: International Agency for Research on Cancer, Section of Cancer Information, Lyon, France.
authors.forename: David
authors.initials: D
authors.lastname: Forman
authors.affiliation: Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Alex
authors.initials: A
authors.lastname: Burdorf
authors.affiliation: Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands LSE Health, Department of Social Policy, London School of Economics and Political Science, London, UK Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, USA.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Avendaño
mesh_terms: D000328:Adult; D002423:Cause of Death / Q000639:trends; D003105:Colombia / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061213:Mortality, Premature / Q000639:trends*; D009369:Neoplasms / Q000145:classification / Q000401:mortality*; D016012:Poisson Distribution; D012923:Social Class
keywords: CANCER; DEVELOPING COUNTR; EDUCATION; INEQUALITIES; MORTALITY