Abstract 4818: Cancer disparities in Chile: Unveiling the impact of educational disparities and regional variances on mortality rates
Authors: Paz Cook, Fabio Paredes, Jorge Jimenez de la Jara
Journal: Cancer Research (2024)

Abstract Differences in education not only influence our access to good-quality and timely healthcare but also impact our ability to make healthy decisions, access nutritious food, and inhabit healthy and safe physical and psychological environments. Consequently, these factors have contributed to an increase in cancer incidence and mortality among individuals with lower levels of education. To assess the mortality rate based on education, we utilized census data and the national mortality register, comparing the cancer mortality rate between those with more than 12 years of education and those with less than 8 years. We employed a Poisson regression model, with the number of deceased individuals as the dependent variable and age, along with gender, region of residence, and education level as covariates. The natural logarithm of the population served as an offset. The exponential of the estimated betas in this regression represents the Relative Index of Inequality (RII), comparing individuals with a low educational level to those with a high educational level. We conducted the analysis using SPSS version 17.0 and SAS version 9.4, considering values with p-values less than or equal to 0.05 as significant, with a confidence interval of 95%. Our findings indicate that two cancer sites are particularly affected by these educational differences, gallbladder (RII(95%CI): 5.43 (4.0-7.5)) and gastric (RII(95%CI): 4.09 (3.5-4.8)) with additional disparities when comparing by gender (RII gallbladder in women (95%CI): 7.06 (5.0-10.9)). Interestingly, even though Chile is a relatively small country, there are significant variations of mortality by geographical region (RII(95%CI): 1.3 (1.1-1.5) to 3.1 (2.3-4.0)), in terms of magnitude and cancer sites, suggesting the influence of environmental factors. The results of this study should serve as a basis for decentralization and the development of a cancer policy that considers territorial differences in resource allocation and plans specific screening and early detection strategies tailored to the epidemiologic and sociodemographic profile. We also conducted a mortality analysis comparing education levels across age intervals. Our findings reveal that, up to the age of 60, mortality is significantly higher among individuals with less than 8 years of schooling. However, beyond the age of 60, the group with higher mortality comprises individuals with 9-12 years of education. This suggests that they may be more capable of affording health services and accessing screening and diagnosis compared to the less educated group but are still diagnosed at later stages when curative treatment is not feasible. In addition, this group has the highest tobacco consumption in the country. Citation Format: Paz Cook, Fabio Paredes, Jorge Jimenez de la Jara. Cancer disparities in Chile: Unveiling the impact of educational disparities and regional variances on mortality rates [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4818.