Decomposing Socioeconomic Inequalities in Cancer Mortality: The Roles of Incidence and Survival in Belgium, 2004–2013

Joachim Gotink , Vrije Universiteit Brussel
Freija Verdoodt, BCR
Sylvie Gadeyne, VUB

Cancer remains a leading cause of death in Belgium, but the mechanisms driving socioeconomic inequalities in cancer mortality are insufficiently understood. Mortality differences may stem from unequal cancer occurrence (incidence) or from disparities in survival post-diagnosis. Understanding this distinction is key for designing effective public health interventions. Using linked nationwide data from the 2001 Belgian Census, cancer registry (2004–2013), and mortality records, we examined all adults aged 30–79 years. Educational attainment served as the primary socioeconomic indicator. We quantified inequalities in cancer incidence and mortality using Poisson regression and decomposed mortality inequalities into components driven by incidence and by survival. Analyses were stratified by sex and age group (30–49, 50–79 years). Lower-educated men and women generally showed higher incidence and mortality for most cancers, following the typical social gradient, except melanoma and female breast cancer, which were more common among higher-educated groups. Among younger adults, mortality inequalities were mainly incidence-driven, particularly for lung, stomach, and cervical cancer. In older adults, survival differences played a more prominent role. Lung cancer stood out as almost entirely incidence-driven across all groups. Our findings reveal that socioeconomic inequalities in cancer outcomes vary substantially by cancer type, sex, and age. While prevention remains crucial, the growing role of survival disparities highlights the need for equitable access to timely diagnosis and high-quality treatment. Disentangling incidence and survival contributions offers valuable insight for targeted cancer control policies.

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 Presented in Session 38. Flash Session Social Inequalities in Mortality