Socioeconomic Deprivation and the Burden of Head and Neck Cancer- Regional variations of Incidence and Mortality in Merseyside and Cheshire, North West, England.


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Bilal G Taib1,Jill Oakley2,Yvonne Daley3,Ian Hodge4,Paul Wright2,Ruth du Plessis5,Joseph Rylands6,David Taylor-Robinson7,Sue Povall7,Andrew Schache6,Richard Shaw6,Ann Dingle4,Terry Jones7
1Royal Liverpool University Hospital,2Cheshire West and Chester Public Health Team,3Public Health England,4Cheshire and Merseyside Strategic Clinical Networks,5Cheshire and Merseyside Collaborative Service,6Aintree University Hospital,7University of Liverpool

Abstract

Background

Regional variations in deprivation exist resulting in stark geographical gradients for some head and neck cancers. The Merseyside and Cheshire Cancer Network (MCCN) contains amongst the most deprived Local Authorities (LAs) in the country including Liverpool which was rated the most deprived LA in England in 2010.

 

This study examines the distribution of disease burden across the region comparing it to national trends and several deprivation measures.

Method

We undertook a descriptive study of data sourced from the UK Cancer Information Service combining it with indicators of deprivation and lifestyle at small geographical areas within the nine Local Authorities of Merseyside and Cheshire for cancers ICD C00-C14 and C30-32 within 3 cohorts 1998-2000, 2008-2010 and 2009-2011.

 

Data from the North West of England, Greater Manchester and England were used as comparator regions and statistical analysis were made using 95% confidence intervals. To obtain a more detailed analyses Middle Super Output Area (MSOA) data was also used to map incidence and mortality rates within the region. 

Results

The incidence of head and neck cancer has increased across the region from 1998-2000 to 2008-2010 with a peak incidence for Liverpool males at 35 per 100,000 population which is higher than less economically developed regions in South America, the Indian subcontinent and South Africa.

 

Five LAs (Liverpool, Sefton, Knowsley, Halton and Wirral) had statistically significantly higher HANC incidence rates than England but only Liverpool (7.6 per 1000,000 population) had a statistically significantly higher mortality rate.

 

Our data revealed that certain MSOAs contribute disproportionately to the significant effect of incidence and mortality within LAs. Income deprivation had the strongest correlation with both incidence (r =0.59) and mortality (r =0.53) of head and neck cancer.

Conclusion

Our study emphasizes vast geographical variations within the MCCN which need to be addressed through public health measures.