Gender and Race Inequalities in Oral Cancer Mortality

INTRODUCTION: Inequalities of oral cancer are persistent in contemporary population settings and need to be continuously monitored. Appropriately accounting for inequalities in health outcomes may improve theoretical models adjusting proximal aetiological hypotheses for distal determinants. The objective of this study was to assess differences of recent trends in oral cancer mortality across gender and racial strata. 

METHODS: Official information on deaths and population in the city of Sao Paulo, Brazil, 2003 to 2009, were used to estimate death rates caused by oral cancer (C00 to C10, International Classification of Diseases, 10th Revision), as adjusted for age and stratified by gender (females and males) and race (blacks and whites). The Prais-Winsten auto-regression procedure was used to analyse time series. 

RESULTS: During the study period, 8,505 individuals living in the city of Sao Paulo died of oral cancer. Rates increased for females (Annual Percent Change APC=+4.4%, 95% Confidence Interval +1.4;+7.5), and levelled off for men (APC=+1.3%, 95%CI –1.4;+3.9), thus inverting previous trends among genders in the city. Whereas death rates were stationary for whites (APC=–1.1%, 95%CI –4.4;+2.4), a high increase was observed for blacks: APC=+9.1% (95%CI +5.5;+12.9). Oral cancer mortality in blacks almost doubled during this period, and surpassed mortality in whites. Analogous observations were reported for site-specific types of oral cancer (oral cavity, tongue, oropharynx and salivary glands). 

CONCLUSIONS: We reported discrepancies of oral cancer trends across gender and racial strata that are unfair, avoidable and unnecessary. Differences in the burden of disease are unlikely to disappear in the short term; therefore, comprehending why the disease associates with specific population groups may contribute to spot opportunities for effective cancer prevention. The surveillance of oral cancer mortality across gender and racial groups may contribute to implementing policies aimed at concurrently reducing the overall burden of disease and inequalities in health.