Cancer inequalities in incidence and mortality in the State of São Paulo, Brazil 2001–17

Background Cancer disparities exist between and within countries; we sought to compare cancer‐specific incidence and mortality according to area‐level socioeconomic status (SES) in the State of São Paulo, Brazil. Methods Cancer cases diagnosed 2003–2017 in the Barretos region and 2001–2015 in the municipality of São Paulo were obtained from the respective cancer registries. Corresponding cancer deaths were obtained from a Brazilian public government database. Age‐standardized rates for all cancer combined and the six most common cancers were calculated by SES quartiles. Results There were 14,628 cancer cases and 7513 cancer deaths in Barretos, and 472,712 corresponding cases and 194,705 deaths in São Paulo. A clear SES‐cancer gradient was seen in São Paulo, with rates varying from 188.4 to 333.1 in low to high SES areas, respectively. There was a lesser social gradient for mortality, with rates in low to high SES areas ranging from 86.4 to 98.0 in Barretos, and from 99.2 to 100.1 in São Paulo. The magnitude of the incidence rates rose markedly with increasing SES in São Paulo city for colorectal, lung, female breast, and prostate cancer. Conversely, both cervical cancer incidence and mortality rose with lower levels of SES in both regions. Conclusions A clear SES association was seen for cancers of the prostate, female breast, colorectum, and lung for São Paulo. This study offers a better understanding of the cancer incidence and mortality profile according to SES within a highly populated Brazilian state. We noted marked increases in incidence rates with increasing SES in the municipality of São Paulo for cancers of the colorectum, lung, female breast, and prostate. For female breast, lung, and to some extent colorectal cancer, both incidence and mortality rates uniformly rose with increasing SES, whereas for cervical cancer, both incidence and mortality rates declined with increasing SES. For prostate cancer, there was a marked increase in incidence rates with increasing SES, though the inverse was seen for mortality.