[Regional concentration of social disadvantage and of risks for lung cancer and colon cancer: systematic review and recommendations for research]

Abstract

Objectives: Individual health status is influenced by individual social characteristics (age, gender, income usw.) and by the social characteristics of the regional environment in which the person lives. This is true also for lung cancer and colon cancer, two of the most common cancer sites in Germany. No systematic review about the social and regional distribution of lung cancer and colon cancer has been published in German-speaking countries yet. However, it could allow us to deepen the discussion regarding explanations of cancer risks and potential interventions.

Methods: Lung cancer and colon cancer have been selected because they are the two most common gender-independent cancer sites in Germany. A systematic literature search has been conducted via the Medline database using PubMed. 2 groups of regional differences have been distinguished, first by socio-economic characteristics (e. g., average household income) and second by urban vs. rural characteristics. The publications have then been analysed in a systematic way.

Results: 17 publications could be found, just 2 of them are from a German-speaking country (one each from Germany and Switzerland). The results concerning incidence and mortality can be summarised in the following way: The risks for lung cancer increase with decreasing socio-economic status of the region, but no clear association could be found for colon cancer. Some studies include information on urban-rural differences. They show that the risks for lung cancer are higher in urban as compared to rural areas; for colon cancer, again, no clear associations could be found.

Conclusion: The review shows that some studies have already looked at social and regional differences in lung cancer and colon cancer, and that these associations have hardly been discussed in German-speaking countries as yet. We still do not know why lung cancer risks are especially high in low status regions, even if individual smoking is accounted for. The answer could probably be provided by risks such as air pollution. Therefore, a balanced strategy for reducing health inequalities should not just focus on improving individual health behaviour, but also on reducing the regional risks factors.