A cohort study into head and neck cancer mortality in Belgium (2001–11): Are individual socioeconomic differences conditional on area deprivation?

• Low individual socioeconomic position (SEP) and area deprivation are associated with higher head and neck (HNC) mortality.
• The association between individual SEP and HNC mortality is conditional on area deprivation.
• Socioeconomic disparities in HNC mortality are smallest in deprived municipalities.
• Population composition partly explains regional variation in HNC mortality in Belgium.

ObjectiveThe aim of this study is to assess to what extent individual and area-level socioeconomic position (SEP) are associated to head and neck cancer (HNC) mortality and to what extent they contribute to regional variation in HNC mortality in Belgium.Materials and methodsData on men aged 40–64 are collected from a population based dataset based on the 2001 Belgian census linked to register data on emigration and mortality for 2001–2011. Individual SEP is measured using education, employment status and housing conditions. Deprivation at municipal level is measured by a deprivation index. Absolute mortality differences are estimated by age standardised mortality rates. Multilevel Poisson models are used to estimate the association and interaction between HNC mortality and individual and area-level SEP, and to estimate the regional variation in HNC mortality.ResultsHNC mortality rates are significantly higher for men with a low SEP and men living in deprived areas. Cross-level interactions indicate that the association between individual SEP and HNC mortality is conditional on area deprivation. HNC mortality in deprived areas is especially high among high-SEP men. As a result, social disparities appear to be smaller in more deprived areas. Regional variation in HNC mortality was significant. Population composition partially explains this regional variation, while area deprivation and cross-level interactions explains little.ConclusionBoth individual and area-level deprivation are important determinants of HNC mortality. Underlying trends in incidence and survival, and risk factors, such as alcohol and tobacco use, should be explored further.