Open Access Research

Cancer mortality inequalities in urban areas: a Bayesian small area analysis in Spanish cities

Rosa Puigpinós-Riera123*, Marc Marí-Dell'Olmo12, Mercè Gotsens12, Carme Borrell124, Gemma Serral12, Carlos Ascaso3, Montse Calvo5, Antonio Daponte26, Felicitas M Domínguez-Berjón7, Santiago Esnaola5, Ana Gandarillas8, Gonzalo López-Abente9, Carmen M Martos1011, Miguel A Martínez-Beneito10, Agustín Montes-Martínez122, Imanol Montoya5, Andreu Nolasco13, Isabel M Pasarín124, Maica Rodríguez-Sanz12, Marc Sáez142 and Pablo Sánchez-Villegas6

Author Affiliations

1 Servei de Sistemes d'Informació Sanitaria, Agència de Salut Pública de Barcelona, Barcelona, Spain

2 CIBER Epidemiología y Salud Pública (CIBERESP), Parc de Recerca Biomédica de Barcelona, Barcelona, Spain

3 Departament de Salut Pública, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain

4 Universitat Pompeu Fabra, Barcelona, Spain

5 Estudios e investigación Sanitaria, Departamento de Sanidad y Consumo. Gobierno Vasco, Vitoria-Gasteiz, Spain

6 Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN), Area de Salud Pública y Protección de la Salud, Escuela Andaluza de Salud Pública, Granada, Spain

7 Servicio de Informes de Salud y Estudios, Instituto de Salud Pública, Dirección General de Salud Pública y Alimentación, Consejería de Sanidad, Comunidad de Madrid

8 Servicio de Epidemiologia, Dirección General de Atención Primaria, Comunidad de Madrid

9 Area de Epidemiología Ambiental y Cáncer, Centro Nacional de Epidemiología, Madrid, Spain

10 Area de Desigualdades en Salud, Centro Superior de Investigación en Salud Pública de Valencia, Spain

11 Instituto Aragonés de Ciencias de la Salud, Aragón, Spain

12 Departamento de Medicina Preventiva e Saude Pública, Universidade de Santiago de Compostela, Spain

13 Unitat d'Investigació en Anàlisi de la Mortalitat i Estadística Sanitaria, Departament d'Infermeria Comunitària, Medecina Preventiva i Salut Pública i Història de la Ciencia, Universitat d'Alacant, Spain

14 Research Group on Statistics, Applied Economics and Health (GRECS), University of Girona, Spain

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International Journal of Health Geographics 2011, 10:6  doi:10.1186/1476-072X-10-6

Published: 13 January 2011



Intra-urban inequalities in mortality have been infrequently analysed in European contexts. The aim of the present study was to analyse patterns of cancer mortality and their relationship with socioeconomic deprivation in small areas in 11 Spanish cities.


It is a cross-sectional ecological design using mortality data (years 1996-2003). Units of analysis were the census tracts. A deprivation index was calculated for each census tract. In order to control the variability in estimating the risk of dying we used Bayesian models. We present the RR of the census tract with the highest deprivation vs. the census tract with the lowest deprivation.


In the case of men, socioeconomic inequalities are observed in total cancer mortality in all cities, except in Castellon, Cordoba and Vigo, while Barcelona (RR = 1.53 95%CI 1.42-1.67), Madrid (RR = 1.57 95%CI 1.49-1.65) and Seville (RR = 1.53 95%CI 1.36-1.74) present the greatest inequalities. In general Barcelona and Madrid, present inequalities for most types of cancer. Among women for total cancer mortality, inequalities have only been found in Barcelona and Zaragoza. The excess number of cancer deaths due to socioeconomic deprivation was 16,413 for men and 1,142 for women.


This study has analysed inequalities in cancer mortality in small areas of cities in Spain, not only relating this mortality with socioeconomic deprivation, but also calculating the excess mortality which may be attributed to such deprivation. This knowledge is particularly useful to determine which geographical areas in each city need intersectorial policies in order to promote a healthy environment.