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Variability and social patterning of cancer mortality in 343 Latin American cities: an ecological study
Journal article   Open access   Peer reviewed

Variability and social patterning of cancer mortality in 343 Latin American cities: an ecological study

Tania Alfaro, Kevin Martinez-Folgar, Dalia Stern, Maria A Wilches-Mogollon, María Pía Muñoz, Harrison Quick, Marcio Alazraqui, Manuel Ramirez-Zea, J Jaime Miranda, Mariana Lazo, …
The Lancet global health, v 13(2), e268
01 Feb 2025
DOI: https://doi.org/10.1016/S2214-109X(24)00446-7
PMID: 39890227
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1016/s2214-109x(24)00446-7View
Published, Version of Record (VoR)Open Access (License Unspecified),  Open
url
https://doi.org/10.1016/S2214-109X(24)00446-7View
Published, Version of Record (VoR) Open

Abstract

Understanding between-city variations in cancer mortality is crucial to inform national and subnational cancer prevention strategies. However, studies at the city level in Latin America are scarce. As part of the Salud Urbana en América Latina (SALURBAL) project, we aimed to describe the variability in cancer mortality rates across 343 cities in nine Latin American countries and the associations of these rates with city-level socioeconomic development.BACKGROUNDUnderstanding between-city variations in cancer mortality is crucial to inform national and subnational cancer prevention strategies. However, studies at the city level in Latin America are scarce. As part of the Salud Urbana en América Latina (SALURBAL) project, we aimed to describe the variability in cancer mortality rates across 343 cities in nine Latin American countries and the associations of these rates with city-level socioeconomic development.This ecological study used data from cities in Argentina, Brazil, Chile, Colombia, Costa Rica, El Salvador, Guatemala, Mexico, and Panama. Vital registration and population data from Jan 1, 2015 to Dec 31, 2019 were used to estimate sex-specific and age-standardised cancer mortality rates for each city, overall and for seven cancer sites (breast, lung, colorectal, stomach, liver, prostate, and cervical), and the associations of these rates with city-level socioeconomic development.METHODSThis ecological study used data from cities in Argentina, Brazil, Chile, Colombia, Costa Rica, El Salvador, Guatemala, Mexico, and Panama. Vital registration and population data from Jan 1, 2015 to Dec 31, 2019 were used to estimate sex-specific and age-standardised cancer mortality rates for each city, overall and for seven cancer sites (breast, lung, colorectal, stomach, liver, prostate, and cervical), and the associations of these rates with city-level socioeconomic development.We found wide variability in cancer mortality by city (overall age-adjusted cancer mortality rates varied by almost three times), sex, and cancer site. Variability between cities within the same country was highest for cervical and prostate cancer. The most common causes of cancer deaths were breast cancer (305 cities) for females and prostate cancer (167 cities) and lung cancer (132 cities) for males. Liver and cervical cancer were the primary cause of cancer mortality in fewer than ten cities each, most of which were in Guatemala and Mexico. Lower city-level socioeconomic development was associated with higher mortality from liver, stomach, cervical, and prostate cancers and lower mortality from breast, colorectal, and lung cancers, with variations by sex.FINDINGSWe found wide variability in cancer mortality by city (overall age-adjusted cancer mortality rates varied by almost three times), sex, and cancer site. Variability between cities within the same country was highest for cervical and prostate cancer. The most common causes of cancer deaths were breast cancer (305 cities) for females and prostate cancer (167 cities) and lung cancer (132 cities) for males. Liver and cervical cancer were the primary cause of cancer mortality in fewer than ten cities each, most of which were in Guatemala and Mexico. Lower city-level socioeconomic development was associated with higher mortality from liver, stomach, cervical, and prostate cancers and lower mortality from breast, colorectal, and lung cancers, with variations by sex.We found considerable heterogeneity in cancer mortality between cities, geographical patterning, and associations between cancer mortality rates and socioeconomic development. Our results highlight the need to consider city contexts when planning interventions to reduce cancer mortality and when guiding future cancer prevention and control efforts in urban areas within the region.INTERPRETATIONWe found considerable heterogeneity in cancer mortality between cities, geographical patterning, and associations between cancer mortality rates and socioeconomic development. Our results highlight the need to consider city contexts when planning interventions to reduce cancer mortality and when guiding future cancer prevention and control efforts in urban areas within the region.Wellcome Trust.FUNDINGWellcome Trust.For the Spanish and Portuguese translations of the abstract see Supplementary Materials section.TRANSLATIONSFor the Spanish and Portuguese translations of the abstract see Supplementary Materials section.

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being
#5 Gender Equality

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Public, Environmental & Occupational Health
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