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Determinants of regional differences in lung cancer mortality in the Netherlands

Author

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  • Kunst, A.E.
  • Looman, C.W.N.
  • Mackenbach, J.P.

Abstract

Although regional differences in lung cancer mortality are likely to be attributable to regional differences in tobacco smoking, studies in various countries found only weak relationships. This paper aimed at explaining regional differences in lung cancer mortality in the Netherlands. In a first step, clues for the role of smoking were obtained from a detailed description of regional mortality differences. These differences were found to be strongly determined by cohort effects: they vary between birth cohorts, and have been stable for over 30 years. Regional mortality differences reflect a diffusion of the lung cancer epidemic from high-income regions to low-income regions. These findings are suggestive of a relationship with regional differences in trends in cigarette smoking. In a second step, by means of multiple regression analysis, mortality differences in 1980-84 were related to available data on cigarette smoking and two other possible risk factors: work in transport and manufacturing industry, and air contamination. The independent variables referred to the 1970s. Positive associations with various smoking measures were found for women, but for men the associations were weak or non-existent. Mortality differences among men 45-64 years were associated with work in transport and manufacturing industry. Strong associations with air contamination were found for men and women 65 years and older. Additional analysis showed that regional differences in lung cancer among old men were strongly associated with smoking in 1930, i.e. half a century before. Changes in the regional pattern of tobacco consumption between 1930 and 1970 explain why smoking in 1970 is not associated with mortality differences in the 1980s. This shows that the explanation of regional lung cancer death rates sometimes has to go far back in time. The strong association with air contamination does not constitute firm evidence of an effect, but should be considered as a stimulus to carry out further analysis on the excess lung cancer mortality in polluted regions.

Suggested Citation

  • Kunst, A.E. & Looman, C.W.N. & Mackenbach, J.P., 1993. "Determinants of regional differences in lung cancer mortality in the Netherlands," Social Science & Medicine, Elsevier, vol. 37(5), pages 623-631, September.
    • Handle: RePEc:eee:socmed:v:37:y:1993:i:5:p:623-631
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    Citations

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    Cited by:

    1. Paulien Hagedoorn & Hadewijch Vandenheede & Didier Willaert & Katrien Vanthomme & Sylvie Gadeyne, 2016. "Regional Inequalities in Lung Cancer Mortality in Belgium at the Beginning of the 21st Century: The Contribution of Individual and Area-Level Socioeconomic Status and Industrial Exposure," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-18, January.
    2. Graziella Caselli & Loredana Cerbara & Frank Heinsg & Rosa Maria Lipsi, 2003. "What Impact Do Contextual Variables Have on the Changing Geography of Mortality in Italy?," European Journal of Population, Springer;European Association for Population Studies, vol. 19(4), pages 339-373, December.
    3. Fukuda, Yoshiharu & Nakamura, Keiko & Takano, Takehito, 2004. "Increased excess deaths in urban areas: quantification of geographical variation in mortality in Japan, 1973-1998," Health Policy, Elsevier, vol. 68(2), pages 233-244, May.
    4. Fanny Janssen & Alette Spriensma, 2012. "The contribution of smoking to regional mortality differences in the Netherlands," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 27(9), pages 233-260.
    5. van der Meer, Joost B. W. & van den Bos, Johannes & Mackenbach, Johan P., 1996. "Socioeconomic differences in the utilization of health services in a Dutch population: the contribution of health status," Health Policy, Elsevier, vol. 37(1), pages 1-18, July.
    6. Ivana Kulhánová & Rasmus Hoffmann & Terje Eikemo & Gwenn Menvielle & Johan Mackenbach, 2014. "Educational inequalities in mortality by cause of death: first national data for the Netherlands," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 59(5), pages 687-696, October.

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