Inequalities in mortality from leading cancers in districts of England from 2002 to 2019: population-based high-resolution spatiotemporal analysis of vital registration data

Background: Cancers are the leading cause of death in England. Our aim was to estimate trends from 2002-2019 in mortality from leading cancers for the 314 districts in England. Methods: We used vital registration data in England from 2002 to 2019 for ten leading cancers by sex according to the total number of deaths over the study period, and a residual group of all other cancers. We used a Bayesian hierarchical model to obtain robust estimates of age- and cause-specific death rates. We applied life tables to calculate the probability of dying between birth and 80 years of age by sex, cancer cause of death, district and year. We report Spearman rank correlation between the probability of dying from a cancer and district-level poverty in 2019. Findings: In 2019, the probability of dying from a cancer ranged from 0.10 (95% credible interval 0.10-0.11) to 0.17 (0.16-0.18) for women and from 0.12 (0.12-0.13) to 0.22 (0.21-0.23) for men. The most unequal cancers were lung cancer for women (3.7-times (3.2-4.4) variation between the districts with the highest and lowest probabilities of dying) and stomach cancer for men (3.2-times (2.6-4.1)). The cancers with the least geographical variability were lymphoma and multiple myeloma (1.2-times (1.1-1.4) for women and 1.2-times (1.0-1.4) for men), and leukaemia (1.1-times (1.0-1.4) for women and 1.2-times (1.0-1.5) for men). The correlation between probability of dying from a cancer and district poverty was 0.74 (0.72-0.76) for women and 0.79 (0.78-0.81) for men. The probability of dying declined in all districts from 2002 to 2019: the reductions ranged from 6.6% (0.3-13.1%) to 30.1% (25.6-34.5%) for women and 12.8% (7.1-18.8%) to 36.7% (32.2-41.2%) for men. Interpretation: Cancers with modifiable risk factors and potential for screening for pre-cancerous lesions had heterogeneous trends and the greatest inequality. Reducing these inequalities requires addressing factors affecting both incidence and survival at the local level. Funding: Wellcome Trust, Imperial College London, UKRI (MRC), National Institute of Health Researc