Authors' results and conclusions: One-thousand three-hundred and thirty-seven references were collected in the initial search. After discarding duplicates and undertaking the first phase of selection (by title and abstract), 154 papers remained. The most common motive for exclusion was that the study did not investigate cancer inequalities. In a second selection phase (the full reading of the papers), eight papers that could not be retrieved and 90 that did not meet the inclusion criteria were excluded.Finally, 56 papers remained of which 45 clearly addressed the main objective of the present review whereas 11 did not seek to identify cancer inequalities amongst their main objectives but did provide data in this respect. In 12 of the 45 papers dealing directly with cancer inequalities, the variable analysed was incidence of any sort of cancer in 12 papers (one of which also dealt with the use of services), mortality due to cancer was the theme of 11 papers, and the use of health services was studied in 23 papers. These 23 studies were subdivided by the specific themes of research: 12 investigated the influence of socioeconomic variables on prevention and use of cancer early detection programmes (most were focused on breast and cervical cancer); 4 addressed the inequalities in diagnosing and treating cancer; 4 dealt with the relationship between socioeconomic variables and aspects related to caring for terminally ill cancer patients; and 3 papers analysed a variety of themes. Economic status, educational level, employment, residence (rural/urban) and sex were the most frequently studied variables as possible axes of inequalities.The journals with the greatest number of papers were Gaceta Sanitaria, Oncología, Medicina Clínica, Atención Primaria, Revista Española de Salud Pública, European Journal of Cancer Prevention, and the Journal of Epidemiology and Community Health. The institutions involved in the greatest number of studies were the Instituto Municipal de la Salud in Barcelona, the Instituto de Salud Carlos III and the Fundación Parc Taulí. The methodological quality was assessed in the 14 individual-based studies published between 2000 and 2007 and ten were considered to be of high quality.

Authors' recommendations: 1) Research addressed at identifying cancer inequalities in Spain can be considered scarce, at least insofar as it is published as papers in scientific journals. The exception is for the area of the use of services to prevent femalespecific cancers (breast and cervical cancers). The methodological quality of the studies conducted in recent years (2000-2007) can be considered as satisfactory. 2) Most associations between socioeconomic variables and incidence of cancer are, with certain exceptions, compatible with higher incidence in more disadvantaged population groups. However, associations between this type of variables and mortality due to cancer do not always lead to the conclusion that an inequality has been identified.3) Studies investigating the existence of inequalities in the use of women cancer screening (breast and cervical cancer) generally coincide in finding that there are socioeconomic inequalities in the use of screening. The scarcity of studies into inequalities in the use of other types of health services, such as diagnosis, treatment and palliative care, makes it impossible to draw firm conclusions in this respect.4) Studies into the place of death of cancer patients coincide in finding that patients living in rural areas more frequently die at home whereas those living in urban areas more frequently die in a hospital.

Project Status: Completed

URL for project: https://www.aetsa.org/publicacion/investigacion-en-espana-sobre-desigualdades-en-la-incidencia-mortalidad-prevencion-y-atencion-del-cancer-estudio-bibliometrico-y-de-revision-de-la-literatura/

Year Published: 2009

URL for published report: https://www.aetsa.org/download/publicaciones/antiguas/AETSA_2007-16_Desigualdad_Cancer.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Andalusian Health Technology Assessment Area

Contact Address: Area de Evaluacion de Tecnologias Sanitarias Sanitarias de Andalucia (AETSA) Avda. Innovación, s/n Edificio Arena 1. Sevilla (Spain) Tel. +34 955 006 309

Contact Name: aetsa.csalud@juntadeandalucia.es

Contact Email: aetsa.csalud@juntadeandalucia.es

Copyright: Andalusian Agency for Health Technology Assessment (AETSA)