Risk of dying from cancer in some poorer distrits of England over 70% higher than wealthy districts

Analysis of the risk of dying from the cancers with the largest death toll across the 314 districts in England finds that in 2019 the highest risk of death from cancer was in northern cities such as Liverpool, Manchester, Hull and Newcastle, and in coastal areas to the east of London.

The risk of dying from cancer before 80 years of age ranged from one in ten in Westminster to one in six in Manchester for women, and from one in eight in Harrow to one in five in Manchester for men.

Nationally, the risk of dying from cancer declined for both men and women from 2002-2019, from one in six to one in eight for women and from one in five to one in six for men.

The risk of dying from a cancer was associated with poverty for both sexes, and the greatest inequality across regions was for cancers with risk factors such as smoking, alcohol and obesity, and for those which could be prevented or detected early by screening programs.

The risk of dying from the 10 forms of cancer with the largest death toll varies massively depending on the district in England where people live, according to a study published in The Lancet Oncology.

Cancer is now the leading cause of death in England, having overtaken cardiovascular diseases. However, there is a lack of data on the risk of dying from different types of cancer, and how much this risk has changed over the last 20 years, on a district-level.

This study is the first to estimate how much the risk of dying from cancer in England has changed from 2002 to the onset of the COVID-19 pandemic for areas as small as local authority districts.

What the researchers say: “Although our study brings the good news that the overall risk of dying from cancer has decreased across all English districts in the last 20 years, it also highlights the astounding inequality in cancer deaths in different districts around England,” said the senior author of the study.

The researchers used death records in England from 2002 to 2019 to measure the number of deaths caused by the 10 cancers causing the most deaths in the 314 regions in England. Using a statistical model that could handle small numbers, they estimated the risk of dying before 80 years of age from each of the 10 cancer types for men and women in each district for each year between 2002 to 2019.

The authors also used the proportion of the district population claiming income-related benefits due to being out-of-work or having low earnings to work out the relationship between risk of dying from cancer and poverty in the district.

Nationally, the risk of dying from cancer before 80 years of age declined for both sexes from 2002-2019, from one in six to one in eight for women and from one in five to one in six for men. However, some regions had a larger decline than others.

For women, the greatest district-level reduction in the risk of dying from a cancer was nearly five times that of the smallest (30.1% decline in Camden, compared to a 6.6% decline in Tendring). For men, the largest decrease was triple that of the smallest (36.7% in Tower Hamlets compared to 12.8% in Blackpool). Overall, wealthier districts in London achieved the largest declines.

Overall inequality was the greatest killer.

In 2019, the risk of dying from cancer before 80 years of age ranged from one in 10 in Westminster to one in six in Manchester for women, and from one in eight in Harrow to one in five in Manchester for men.

The risk of dying from cancer was higher for both men and women in districts with more poverty. In part, this was due to the risk of dying from lung cancer—the leading cancer cause of death for both sexes—being strongly linked with poverty. Lung cancer was also one of the cancers with the most inequality in risk of dying across different districts, with women in Knowlsey in 2019 having triple the risk of dying from lung cancer than those in Waverley, and men in Manchester having triple the risk of dying from lung cancer than men in Guildford.

“The greatest inequality across districts was for the risk of dying from cancers where factors such as smoking (and air quality), alcohol (and addictive drugs generally) and obesity have a large influence on the risk of getting cancer,” the researchers explain. “Due to funding cuts, many local authorities have reduced their budgets for smoking cessation since 2010. Our data shows we cannot afford to lose these public health programs and are in urgent need of the reintroduction and strengthening of national and local policies which combat smoking and alcohol.”

“Access to cancer screening and diagnostic services which can prevent cancer or catch it early are key in reducing some of the inequalities our study highlights. Those who are more deprived are less likely to be able to access and engage with cancer screening. To change this, there needs to be investment in new ways to reach under-served groups, such as screening ‘pop-ups’ in local areas like supermarkets and working with community organizations and faith groups,” added the lead author.

So, what? This study is yet another one showing how the rising level of inequality all over the world will lead to more variation in life expectancy. Already we have a situation where in the richer parts of my home city, New York, the average age of death is in the 90s whereas in poorer districts it is up to 20 years less.