Background: Reducing socioeconomic inequalities in cancer is currently recognized as a matter of social justice and human rights, and prioritized in the public health agenda. Socioeconomic inequalities influence any stage of the cancer continuum and are largely preventable because they stem from modifiable factors, such as inequalities in exposure to risk factors, access to healthcare, early diagnosis, and treatment options. Moreover, socioeconomic inequalities may vary over time, across countries and cancer types. Providing reliable and representative data is thus essential to inform policy development and to tackle the burden of cancer and associated inequalities.
?Objectives: The EU-CanIneq project aims to map socioeconomic inequalities in cancer mortality in 2015-2019 in 27 European Member States¹ plus Iceland and Norway.
Methods: Population-based mortality data by education level and sex were collected and harmonized for 16 European countries for individuals aged 40–79 years across different time periods. Extrapolation methods based on linear regression models were used to fill temporal gaps; while geographical gaps were filled by combining previously mentioned with publicly available data on cancer mortality, population, and population distribution by education level. Educational level was classified according to the 2011 International Standard Classification of Education into primary (ISCED 0–2), secondary (ISCED 3–4), and tertiary (ISCED 5–8) levels and used as an indicator of socioeconomic condition. For all 29 countries, age-standardized mortality rates (ASMRs) per 100,000 individuals in the period 2015-2019 were estimated using the 2013 European Standard Population for all cancers and for six specific cancer types (colorectum, lung, stomach, prostate, breast and cervix).
Results: In the period 2015-2019, socioeconomic inequalities in cancer mortality were found in all countries, with primary educated individuals generally showing higher ASMRs as compared to tertiary educated individuals. Nevertheless, the magnitude of inequalities varied substantially across countries, between men and women, and by cancer type. Countries from the Baltic/Central/East area showed both the highest mortality rates and the largest inequalities in total cancer mortality in men. In women, the highest ASMRs and the largest inequalities for total cancer were found in countries from both the North and the Baltic/Central/East Europe. Inequalities were observed for all cancer types, and lung cancer was the largest contributor to socioeconomic inequalities in cancer mortality in almost all countries and sexes. The contribution of cervical, colorectal, and stomach cancers to inequalities was also substantial, particularly in countries of the Baltic/Central/East Europe.
Conclusions: Findings reveal that the burden of cancer in Europe is unevenly distributed across and within populations, and follows a clear social gradient, with its impact increasing as socioeconomic status declines. Socioeconomic inequalities in cancer mortality exist everywhere in Europe, and the most disadvantaged individuals suffer more the burden of cancer. It is essential to develop appropriate strategies to tackle socioeconomic inequalities between and within countries in order to reduce the clinical, economic, and wider social burden of cancer in Europe.

¹ Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden