Linking of Primary Care Records to Census Data to Study the Association between Socioeconomic Status and Cancer Incidence in Southern Europe: A Nation-Wide Ecological Study
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Area-based measures of economic deprivation are seldom applied to large medical records databases to
establish population-scale associations between deprivation and disease.
Objective: To study the association between deprivation and incidence of common cancer types in a Southern European
region.
Methods: Retrospective ecological study using the SIDIAP (Information System for the Development of Research in Primary
Care) database of longitudinal electronic medical records for a representative population of Catalonia (Spain) and the
MEDEA index based on urban socioeconomic indicators in the Spanish census. Study outcomes were incident cervical,
breast, colorectal, prostate, and lung cancer in 2009–2012. The completeness of SIDIAP cancer recording was evaluated
through linkage of a geographic data subset to a hospital cancer registry. Associations between MEDEA quintiles and cancer
incidence was evaluated using zero-inflated Poisson regression adjusted for sex, age, smoking, alcoholism, obesity,
hypertension, and diabetes.
Results: SIDIAP sensitivity was 63% to 92% for the five cancers studied. There was direct association between deprivation
and lung, colorectal, and cervical cancer: incidence rate ratios (IRR) 1.82 [1.64–2.01], IRR 1.60 [1.34–1.90], IRR 1.22 [1.07–1.38],
respectively, comparing the most deprived to most affluent areas. In wealthy areas, prostate and breast cancers were more
common: IRR 0.92 [0.80–1.00], IRR 0.91 [0.78–1.06]. Adjustment for confounders attenuated the association with lung cancer
risk (fully adjusted IRR 1.16 [1.08–1.25]), reversed the direction of the association with colorectal cancer (IRR 0.90 [0.84–0.95]),
and did not modify the associations with cervical (IRR 1.27 [1.11–1.45]), prostate (0.74 [0.69–0.80]), and breast (0.76 [0.71–
0.81]) cancer.
Conclusions: Deprivation is associated differently with the occurrence of various cancer types. These results provide
evidence that MEDEA is a useful, area-based deprivation index for analyses of the SIDIAP database. This information will be
useful to improve screening programs, cancer prevention and management strategies, to reach patients more effectively,
particularly in deprived urban areas