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@ARTICLE{Tetzlaff:304287,
      author       = {F. Tetzlaff and B. Barnes and L. Jansen$^*$ and F. Peters
                      and A. Schultz and A. Katalinic and K. Kraywinkel and N.
                      Michalski and E. Nowossadeck and J. Hoebel},
      title        = {{W}idening socioeconomic inequalities in cancer incidence
                      and related potential to reduce cancer between 2008 and 2019
                      in {G}ermany.},
      journal      = {Scientific reports},
      volume       = {15},
      number       = {1},
      issn         = {2045-2322},
      address      = {[London]},
      publisher    = {Springer Nature},
      reportid     = {DKFZ-2025-01827},
      pages        = {32232},
      year         = {2025},
      abstract     = {Background Cancer is one of the main causes of a high
                      burden of disease and one of the strongest contributors to
                      earlier mortality among lower socioeconomic groups in
                      Germany. Therefore, studying socio-economic inequalities in
                      cancer incidence is of high relevance from a public-health
                      and health-equity lens. The aim of this study was to examine
                      in more depth time trends in socioeconomic inequalities in
                      cancer incidence and the related potential for reducing the
                      incidence of specific cancers across Germany. Methods We
                      used epidemiologic data from the Centre for Cancer Registry
                      Data at the Robert Koch Institute and official population
                      statistics for Germany from 2008 to 2019. To analyse trends
                      in socioeconomic inequalities in cancer incidence, we used
                      an ecological study design and linked the cancer registry
                      and population data with the German Index of Socioeconomic
                      Deprivation at district level. We calculated standardised
                      cancer incidence rates for the most common cancers by
                      area-level socioeconomic deprivation and estimated the Slope
                      and Relative Index of Inequality (SII, RII) to determine the
                      extent of area-level socioeconomic inequalities in the risk
                      of cancer. In a what-if analysis, counterfactual scenarios
                      were used to calculate how much lower cancer incidence could
                      be if socioeconomic inequalities in incidence were reduced
                      or eliminated. Results Due to less favourable trends of
                      cancer incidence in more deprived areas, socioeconomic
                      inequalities in cancer incidence has widened to the
                      detriment of residents in highly deprived areas. This was
                      observed for all cancers combined and for several common
                      cancers such as stomach, colorectal and lung cancer among
                      both women and men. In 2017-19, total cancer incidence was
                      $18\%$ (women: RII 1,18) and $49\%$ (men: RII 1,49) higher
                      in the most than in the least deprived area. Reverse
                      inequalities were observed for skin melanoma in both sexes
                      and female breast cancer, the lowest incidence being among
                      residents of highly deprived districts. For 2017-19, the
                      what-if analysis showed that the annual number of newly
                      diagnosed cancers cases would be 9,100-76,000 cases fewer if
                      the socioeconomic gap in cancer incidence between districts
                      could be narrowed or eliminated. Conclusions In Germany,
                      socioeconomic inequalities in cancer incidence have widened
                      in recent decades. Tackling cancer risks in deprived areas
                      could reduce those inequalities and the burden of cancer
                      overall. Our study emphasises the growing importance of
                      structural approaches in cancer prevention for reducing
                      health inequalities in Germany.},
      keywords     = {Humans / Germany: epidemiology / Neoplasms: epidemiology /
                      Incidence / Female / Male / Socioeconomic Factors /
                      Registries / Middle Aged / Aged / Adult / Health Status
                      Disparities / Area-level socioeconomic inequalities (Other)
                      / Deprivation (Other) / GISD (Other) / Germany (Other) /
                      Social determinants (Other) / Trends cancer incidence
                      (Other)},
      cin          = {M110},
      ddc          = {600},
      cid          = {I:(DE-He78)M110-20160331},
      pnm          = {319H - Addenda (POF4-319H)},
      pid          = {G:(DE-HGF)POF4-319H},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40890381},
      doi          = {10.1038/s41598-025-17859-5},
      url          = {https://inrepo02.dkfz.de/record/304287},
}