title: Regional disparities in cancer mortality across the rural-urban axis: a case study from north-eastern Greece.
abstract: BACKGROUND
  The aim of this study was to identify differences in cancer mortality in north-eastern Greece, to describe potential drivers operating at the population level and to propose practical interventions and mitigation strategies.
  
  
  METHODS
  Cancer mortality data were collected from local registries using the WHO 10th edition of International Classification of Disease (ICD-10). The direct standardization method was used to address demographic differences in the two regions, with the Standard European Population as reference. Rate ratios (RR) were employed for comparisons and 95% confidence intervals (95%CI) were calculated according to the Poisson approximation method.
  
  
  RESULTS
  An increased risk of digestive system cancers (excluding liver neoplasms) was observed in rural versus urban areas (RR=1.25, 95%CI=1.02-1.54). Stomach cancer, in particular, was more prevalent in the older cohorts (>65 years), suggesting a historical epidemiological perspective. A more pronounced discrepancy was observed for prostate cancer mortality (RR=1.86, 95%CI=1.10-3.14), indicating a strong positive correlation with rurality.
  
  
  CONCLUSIONS
  Cancer mortality disparities have been observed between rural and urban regions of north-eastern Greece. Health promotion and education, including improved access to medical facilities and early cancer screening, can help mitigate the burden and extend survival rates. Decreasing cancer staging at the time of diagnosis and reversing social and economic inequalities is key for combating these types of malignancy.
authors.affiliation: Democritus University of Thrace, Dragana, Alexandroupolis, Greece. cnikolae@med.duth.gr.
authors.forename: Christos
authors.initials: C
authors.lastname: Nikolaidis
authors.affiliation: Democritus University of Thrace, Dragana, Alexandroupolis, Greece. itentes@med.duth.gr.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Tentes
authors.affiliation: Democritus University of Thrace, Dragana, Alexandroupolis, Greece. lialiari@med.duth.gr.
authors.forename: Theodoros
authors.initials: T
authors.lastname: Lialiaris
authors.affiliation: Democritus University of Thrace, Dragana, Alexandroupolis, Greece. tconstan@med.duth.gr.
authors.forename: Thedoros C
authors.initials: TC
authors.lastname: Constantinidis
authors.affiliation: Democritus University of Thrace, Dragana, Alexandroupolis, Greece. akortsar@med.duth.gr.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Kortsaris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003147:Communication Disorders; D004190:Disasters; D055088:Early Detection of Cancer; D005260:Female; D006115:Greece / Q000453:epidemiology; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control; D019982:Organizational Case Studies; D016012:Poisson Distribution; D011156:Population Density; D011314:Preventive Health Services; D016730:Program Development; D012015:Reference Standards; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data*
keywords: Cancer; Determinants of Health; Diabetes; Environmental Health; Epidemiology; Europe; Health Scientist; Informatics; Primary Health Care; Public Health; Researcher