Skip to main content

Risk of Several Cancers is Higher in Urban Areas after Adjusting for Socioeconomic Status. Results from a Two-Country Population-Based Study of 18 Common Cancers

Journal of Urban Health volume 91, pages 510–525 (2014)Cite this article

Abstract

Some studies suggest that there are urban–rural variations in cancer incidence but whether these simply reflect urban–rural socioeconomic variation is unclear. We investigated whether there were urban–rural variations in the incidence of 18 cancers, after adjusting for socioeconomic status. Cancers diagnosed between 1995 and 2007 were extracted from the population-based National Cancer Registry Ireland and Northern Ireland Cancer Registry and categorised by urban–rural status, based on population density of area of residence at diagnosis (rural <1 person per hectare, intermediate 1–15 people per hectare, urban >15 people per hectare). Relative risks (RR) were calculated by negative binomial regression, adjusting for age, country and three area-based markers of socioeconomic status. Risks were significantly higher in both sexes in urban than rural residents with head and neck (males RR urban vs. rural = 1.53, 95 % CI 1.42–1.64; females RR = 1.29, 95 % CI 1.15–1.45), esophageal (males 1.21, 1.11–1.31; females 1.21, 1.08–1.35), stomach (males 1.36, 1.27–1.46; females 1.19, 1.08–1.30), colorectal (males 1.14, 1.09–1.18; females 1.04, 1.00–1.09), lung (males 1.54, 1.47–1.61; females 1.74, 1.65–1.84), non-melanoma skin (males 1.13, 1.10–1.17; females 1.23, 1.19–1.27) and bladder (males 1.30, 1.21–1.39; females 1.31, 1.17–1.46) cancers. Risks of breast, cervical, kidney and brain cancer were significantly higher in females in urban areas. Prostate cancer risk was higher in rural areas (0.94, 0.90–0.97). Other cancers showed no significant urban–rural differences. After adjusting for socioeconomic variation, urban–rural differences were evident for 12 of 18 cancers. Variations in healthcare utilization and known risk factors likely explain some of the observed associations. Explanations for others are unclear and, in the interests of equity, warrant further investigation.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

FIGURE 1
FIGURE 2

References

  1. International Agency for Research on Cancer. CI5. Cancer Incidence in Five Continents. 2013 Available at URL: http://ci5.iarc.fr/ [Accessed March 26, 2013]

  2. Pukkala E. Cancer maps of Finland: an example of small area-based mapping. Rec Res Cancer Research. 1989; 114: 208–215.

    Article  CAS  Google Scholar 

  3. Draper G. The geographical epidemiology of childhood leukaemia and non-Hodgkin’s lymphoma in Great Britain 1966–83. London: Office of Population Censuses and Surveys; 1991.

    Google Scholar 

  4. Siesling S, van der Aa MA, Coebergh JW, Pukkala E. The Working Group of The Netherlands Cancer Registry. Time-space trends in cancer incidence in the Netherlands in 1989–2003. Int J Cancer. 2008; 122: 2106–2014.

    Article  CAS  PubMed  Google Scholar 

  5. Aragones N, Perez-Gomez B, Pollan M, et al. The striking geographical pattern of gastric cancer mortality in Spain: environmental hypotheses revisited. BMC Cancer. 2009; 9: 316.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Carsin AE, Sharp L, Comber H. Geographical, urban/rural and socioeconomic variations in nonmelanoma skin cancer incidence: a population-based study in Ireland. Br J Dermatol. 2011; 164: 822–829.

    Article  CAS  PubMed  Google Scholar 

  7. Tenbensel T, Eagle S, Ashton T. Comparing health policy agendas across 11 high income countries: islands of difference in a sea of similarity. Health Policy. 2011; 106: 29–36.

    Article  Google Scholar 

  8. Ritsatakis A. Equity and the social determinants of health in European cities. J Urban Health. 2013; 90(Suppl 1): 92–104.

    Google Scholar 

  9. Monroe AC, Ricketts TC, Savitz LA. Cancer in rural versus urban populations: a review. J Rural Health. 1992; 8: 212–220.

    Article  CAS  PubMed  Google Scholar 

  10. Wilkinson D, Cameron K. Cancer and cancer risk in South Australia: what evidence of a rural–urban health differential? Aust J Rural Health. 2004; 12: 61–66.

    Article  PubMed  Google Scholar 

  11. Dey S, Soliman AS, Hablas A, et al. Urban–rural differences in breast cancer incidence in Egypt (1999–2006). Breast. 2010; 19: 417–423.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Riaz SP, Horton M, Kang J, Mak V, Luchtenborg M, Moller H. Lung cancer incidence and survival in England: an analysis by socioeconomic deprivation and urbanisation. J Thorac Oncol. 2011; 6: 2005–2010.

    Article  PubMed  Google Scholar 

  13. Yang CY, Hseih YL. The relationship between population density and cancer mortality in Taiwan. Jap J Cancer Research. 1998; 89: 355–360.

    Article  CAS  Google Scholar 

  14. Smailyte G, Kurtinaitis J. Cancer mortality differences among urban and rural residents in Lithuania. BMC Public Health. 2008; 8: 56.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Obertova Z, Brown C, Holmes M, Lawrenson R. Prostate cancer incidence and mortality in rural men—a systematic review of the literature. Rural Remote Health. 2012; 12: 2039.

    CAS  PubMed  Google Scholar 

  16. Singh GK, Siahpush M, Williams SD. Changing urbanisation patterns in US lung cancer mortality, 1950–2007. J Comm Health. 2012; 37: 412–420.

    Article  Google Scholar 

  17. Sharp L, Foll P, Deady S, O’Ceilleachair A, Buicke C, Carsin AE. Where do people with lung cancer die and how is this changing? A population-based study. Ir Med J. 2010; 103: 262–264.

    CAS  PubMed  Google Scholar 

  18. Ó Céilleachair A, Finn C, Deady S, Carsin AE, Sharp L. Have developments in palliative care services impacted on place of death of colorectal cancer patients in Ireland? A population-based study. Ir J Med Sci. 2011; 180: 91–96.

    Article  PubMed  Google Scholar 

  19. Kogevinas M, Pearce N, Susser M, Boffetta P. Social inequalities and cancer. IARC Scientific Publications no. 138. Lyon: International Agency for Research on Cancer; 1997.

    Google Scholar 

  20. Gartner A, Farewell D, Roach P, Dunstan F. Rural/urban mortality differences in England and Wales and the effect of deprivation adjustment. Soc Sci Med. 2011; 72: 1685–1694.

    Article  PubMed  Google Scholar 

  21. National Cancer Registry. Data Quality and Completeness at the Irish National Cancer Registry. Cork: National Cancer Registry; 2012.

  22. Donnelly DW, Gavin AT, Comber H. Cancer in Ireland 1994–2004: a comprehensive report. Belfast/Cork: Northern Ireland Cancer Registry/National Cancer Registry; 2009.

    Google Scholar 

  23. Ferlay J, Burkhard C, Whelan S, Parkin DM. Check and conversion programs for cancer registries. IARC/IACR tools for cancer registries. Lyon: International Agency for Research on Cancer; 2005.

    Google Scholar 

  24. Northern Ireland Statistics and Research Agency. Central Postcode Directory. 2013. Available at URL: http://www.nisra.gov.uk/geography/postcode.htm [Accessed March 26, 2013]

  25. An Post. GeoDirectory. 2013. Available at URL: http://www.geodirectory.ie/ [Accessed March 26, 2013]

  26. Northern Ireland Statistics and Research Agency. Mid-year population estimates. 2013. Available at URL: http://www.nisra.gov.uk/demography/default.asp17.htm [Accessed March 26, 2013]

  27. Northern Ireland Statistics and Research Agency. 2001 Census. 2013. Available at URL: http://www.nisra.gov.uk/Census/2001Census.html [Accessed March 26, 2013]

  28. Central Statistics Office. Census 2002, 1996 Results and Earlier Censuses. 2013. Available at URL: http://www.cso.ie/en/census/census20021996resultsandearliercensuses/ [Accessed March 26, 2013]

  29. Central Statistics Office. Population. 2013. Available at URL: http://www.cso.ie/en/releasesandpublications/population/ [Accessed March 26, 2013]

  30. Central Statistics Office. Survey on Income and Living Conditions (SILC) Thematic Report on the Elderly, 2004 and 2009. 2011 Available at URL: http://www.cso.ie/en/media/csoie/releasespublications/documents/silc/2009/Thematic%20Report%20on%20the%20Elderly%202004%20and%202009.pdf [Accessed September 13, 2013]

  31. Breslow NE. Extra-Poisson variation in log-linear models. Appl Stat. 1984; 33: 38–44.

    Article  Google Scholar 

  32. Faggiano F, Partanan T, Kogevinas M, Boffetta P. Socioeconomic differences in cancer incidence and mortality. IARC Scientific Publication. 1997; 138: 65–176.

    Google Scholar 

  33. Pukkala E, Weiderpass E. Time trends in socioeconomic differences in incidence rates of cancers of the breast and female genital organs (Finland, 1971–1995). Int J Cancer. 1999; 81: 56–61.

    Article  CAS  PubMed  Google Scholar 

  34. National Cancer Intelligence Network. Cancer incidence by deprivation, England, 1995–2004. London: National Cancer Intelligence Network Coordinating Centre; 2008.

    Google Scholar 

  35. Aarts MJ, Lemmens VE, Louwman MW, Kunst AE, Coebergh JW. Socioeconomic status and changing inequalities in colorectal cancer? A review of the associations with risk, treatment and outcome. Eur J Cancer. 2010; 46: 2681–2695.

    Article  PubMed  Google Scholar 

  36. Doherty VR, Brewster DH, Jensen S, Gorman D. Trends in skin cancer incidence by socioeconomic position in Scotland, 1978–2004. Br J Cancer. 2010; 102: 1661–1664.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Gilligan T. Social disparities and prostate cancer: mapping the gaps in our knowledge. Cancer Causes Control. 2005; 16: 45–53.

    Article  PubMed  Google Scholar 

  38. Menvielle G, Kunst A. Social inequalities in cancer incidence and cancer survival: lessons from Danish studies. Eur J Cancer. 2008; 44: 1933–1937.

    Article  PubMed  Google Scholar 

  39. National Cancer Registry/Northern Ireland Cancer Registry. All-Ireland Cancer Atlas 1995–2007. Cork/Belfast: National Cancer Registry/Northern Ireland Cancer Registry; 2011.

  40. Farmer J, Iverson L, Campbell NC, Guest C, Chesson R, Deans G, et al. Rural/urban differences in accounts of patients’ initial decisions to consult primary care. Health Place. 2006; 12: 210–221.

    Article  PubMed  Google Scholar 

  41. Nolan A. A dynamic analysis of GP visiting in Ireland: 1995–2001. Health Econ. 2007; 16: 129–143.

    Article  PubMed  Google Scholar 

  42. Morrissey K, Clarke G, Ballas D, Hynes S, O’Donoghue C. Examining access to GP services in rural Ireland using microsimulation data. Area. 2008; 40: 354–364.

    Article  Google Scholar 

  43. Potosky AL, Miller BA, Albertsen PC, Kramer BS. The role of increasing detection in the rising incidence of prostate cancer. J Am Med Assoc. 1995; 273: 548–552.

    Article  CAS  Google Scholar 

  44. Carsin AE, Drummond FJ, Black A, et al. Impact of PSA testing and prostatic biopsy on cancer incidence and mortality: comparative study between the Republic of Ireland and Northern Ireland. Cancer Causes Control. 2010; 21: 1523–1531.

    Article  PubMed  Google Scholar 

  45. Gormley GJ, Catney D, McCall JR, Reilly PM, Gavin AT. Prostate-specific antigen testing: uncovering primary care influences. BJU Int. 2006; 98: 996–1000.

    Article  PubMed  Google Scholar 

  46. Drummond FJ, Carsin AE, Sharp L, Comber H. Factors prompting PSA-testing of asymptomatic men in a country with no guidelines: a national survey of general practitioners. BMC Fam Pract. 2009; 10: 3.

    Article  PubMed Central  PubMed  Google Scholar 

  47. McGahan CE, Blanks RG, Moss SM. Reasons for variation in coverage in the NHS cervical screening programme. Cytopathol. 2001; 12: 354–366.

    Article  CAS  Google Scholar 

  48. Kinnear H, Rosato M, Mairs A, Hall C, O’Reilly D. The low uptake of breast screening in cities is a major public health issue and may be due to organisational factors: a census-based record linkage study. Breast. 2011; 20: 460–463.

    Article  CAS  PubMed  Google Scholar 

  49. Bain NSC, Campbell NC. Treating patients with colorectal cancer in rural and urban areas: a qualitative study of the patients’ perspective. Fam Pract. 2000; 17: 475–479.

    Article  CAS  PubMed  Google Scholar 

  50. Baade P, Dasgupta P, Aitken J, Turrell G. Geographic remoteness and risk of advanced colorectal cancer at diagnosis in Queensland: a multilevel study. Br J Cancer. 2011; 105: 1039–1041.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  51. Baade P, Turrell G, Aitken JF. Geographical remoteness, area-level socioeconomic disadvantage and advanced breast cancer: a cross-sectional, multilevel study. J Epidemiol Comm Health. 2011; 65: 1037–1043.

    Article  Google Scholar 

  52. Tracey EA, Roder DM, Currow DC. What factors affect the odds of NSW cancer patients presenting with localised as opposed to more advanced cancer? Cancer Causes Control. 2012; 23: 255–262.

    Article  CAS  PubMed  Google Scholar 

  53. Secretan B, Straif K, Baan R, et al. A review of human carcinogens—Part E: tobacco, areca nut, alcohol, coal smoke, and salted fish. Lancet Oncol. 2009; 10: 1033–1034.

    Article  PubMed  Google Scholar 

  54. International Agency for Research on Cancer. IARC monographs on the evaluation of carcinogenic risks to humans. Volume 83. Tobacco smoke and involuntary smoking. Lyon: International Agency for Research on Cancer; 2004.

    Google Scholar 

  55. Hashibe M, Brennan P, Chuang SC, et al. Interaction between tobacco and alcohol use and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. Cancer Epidemiol Biomarkers Prev. 2009; 18: 541–550.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  56. Morgan K, McGee H, Watson D, et al. SLÁN 2007: survey of lifestyle, attitudes & nutrition in Ireland. Main Report. Dublin: Department of Health & Children; 2008.

    Google Scholar 

  57. Bosch FX, Lorincz A, Muñoz N, Meijer CJ, Shah KV. The causal relation between human papillomavirus and cervical cancer. J Clin Pathol. 2002; 55: 244–265.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  58. McInerney J, Pilkington L, Keegan H, et al. Human papillomavirus prevalence and genotype distribution in the Irish cervical screening population. J Cytopathol. 2008; 19(Suppl 2): 13.

    Google Scholar 

  59. Anderson L, O’Rorke M, Jamison J, Wilson R, Gavin A, on behalf of the HPV Working Group members. Prevalence of human papillomavirus in women attending cervical screening in the UK and Ireland: new data from Northern Ireland and a systematic review and meta-analysis. J Med Virol. 2013; 85: 295–308.

    Google Scholar 

  60. Gandini S, Sera F, Cattaruzza MS, Pasquini P, Picconi O, Boyle P, et al. Meta-analysis of risk factors for cutaneous melanoma: II. Sun exposure. Eur J Cancer. 2005; 41: 45–60.

    Article  PubMed  Google Scholar 

  61. Eklund G, Malec E. Sunlight and incidence of cutaneous malignant melanoma. Effect of latitude and domicile in Sweden. Scand J Plast Reconstruct Surg. 1978; 12: 231–241.

    Article  CAS  Google Scholar 

  62. Agredano YZ, Chan JL, Kimball RC, Kimball AB. Accessibility to air travel correlates strongly with increasing melanoma incidence. Melanoma Res. 2006; 16: 77–81.

    Article  PubMed  Google Scholar 

  63. Gavin A, Boyle R, Donnelly D, Donnelly C, Gordon S, McElwee G, et al. Trends in skin cancer knowledge, sun protection practises and behaviours in the Northern Ireland population. Eur J Public Health. 2012; 22: 408–412.

    Article  PubMed  Google Scholar 

  64. Irish Cancer Society. Sun Smart. Barometer Research. Conducted by Behaviour & Attitudes Marketing Research. Dublin: Irish Cancer Society; 2007.

    Google Scholar 

  65. Vineis P, Husgafvel-Pursiainen K. Air pollution and cancer: biomarker studies in human populations. Carcinogen. 2005; 26: 1846–1855.

    Article  CAS  Google Scholar 

  66. Hart C, Ecob R, Smith GD. People, places and coronary heart disease risk factors: a multilevel analysis of the Scottish Heart Health Study archive. Soc Sci Med. 1997; 45: 893–902.

    Article  CAS  PubMed  Google Scholar 

  67. Lahti-Koski M, Taskinen O, Simila M, Mannisto S, Laatikainen T, Kneckt P, et al. Mapping geographical variation in obesity in Finland. Eur J Public Health. 2008; 18: 637–643.

    Article  PubMed  Google Scholar 

  68. Løkkegaard E, Lidegaard O, Møller LN, Agger C, Andreasen AH, Jørgensen T. Hormone replacement therapy in Denmark, 1995–2004. Acta Obstet Gynecol Scand. 2007; 86: 1342–1351.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We are grateful to the tumour registration officers and the data processing staff in the two registries who collected the data which formed the basis of this paper. We thank the Ordnance Survey of Ireland and Ordnance Survey Northern Ireland for the maps of electoral divisions and wards. Ordnance Survey Ireland map is reproduced under OSI licence number NCRI/03/05. The Northern Ireland map is Crown Copyright and is reproduced with permission of Land and Property Services under delegated authority from the Controller of Her Majesty’s Stationery Office.

The Northern Ireland Cancer Registry is funded by the Public Health Agency and the National Cancer Registry Ireland by the Department of Health. The funders had no role in study design; data collection, analysis and interpretation; writing the report; or the decision to submit the paper for publication.

Author information

Authors and Affiliations

  1. National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Kinsale Road, Cork, Ireland

    Linda Sharp, Sandra Deady, Neil McCluskey & Harry Comber

  2. Northern Ireland Cancer Registry, Belfast, UK

    David Donnelly & Anna Gavin

  3. Graduate Entry Medical School, University of Limerick, Limerick, Ireland

    Avril Hegarty

  4. Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain

    Anne-Elie Carsin

Authors
  1. Linda Sharp
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Donnelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Avril Hegarty
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anne-Elie Carsin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sandra Deady
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Neil McCluskey
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anna Gavin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Harry Comber
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Linda Sharp.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Sharp, L., Donnelly, D., Hegarty, A. et al. Risk of Several Cancers is Higher in Urban Areas after Adjusting for Socioeconomic Status. Results from a Two-Country Population-Based Study of 18 Common Cancers. J Urban Health 91, 510–525 (2014). https://doi.org/10.1007/s11524-013-9846-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11524-013-9846-3

Keywords

  • Urbanisation
  • Cancer
  • Incidence
  • Inequalities
  • Socioeconomic status