Variability and social patterning of cancer mortality in 343 Latin American cities: an ecological study.

Abstract

Background: Understanding between-city variations in cancer mortality is crucial to inform national and subnational cancer prevention strategies. However, studies at the city level in Latin America are scarce. As part of the Salud Urbana en América Latina (SALURBAL) project, we aimed to describe the variability in cancer mortality rates across 343 cities in nine Latin American countries and the associations of these rates with city-level socioeconomic development.

Methods: This ecological study used data from cities in Argentina, Brazil, Chile, Colombia, Costa Rica, El Salvador, Guatemala, Mexico, and Panama. Vital registration and population data from Jan 1, 2015 to Dec 31, 2019 were used to estimate sex-specific and age-standardised cancer mortality rates for each city, overall and for seven cancer sites (breast, lung, colorectal, stomach, liver, prostate, and cervical), and the associations of these rates with city-level socioeconomic development.

Findings: We found wide variability in cancer mortality by city (overall age-adjusted cancer mortality rates varied by almost three times), sex, and cancer site. Variability between cities within the same country was highest for cervical and prostate cancer. The most common causes of cancer deaths were breast cancer (305 cities) for females and prostate cancer (167 cities) and lung cancer (132 cities) for males. Liver and cervical cancer were the primary cause of cancer mortality in fewer than ten cities each, most of which were in Guatemala and Mexico. Lower city-level socioeconomic development was associated with higher mortality from liver, stomach, cervical, and prostate cancers and lower mortality from breast, colorectal, and lung cancers, with variations by sex.

Interpretation: We found considerable heterogeneity in cancer mortality between cities, geographical patterning, and associations between cancer mortality rates and socioeconomic development. Our results highlight the need to consider city contexts when planning interventions to reduce cancer mortality and when guiding future cancer prevention and control efforts in urban areas within the region.

Funding: Wellcome Trust.

Translations: For the Spanish and Portuguese translations of the abstract see Supplementary Materials section.