Tackling cancer inequalities in Scotland

Transcription

1 7/7/21 Tackling cancer inequalities in Scotland Birmingham 17 th June 21 1 Absolute range: Healthy life expectancy Males Scotland 1999/ to 25/6 (Data not available 23/4) Source: Scottish Government Health Analytical Services (28) Long-term monitoring of health inequalities 1

2 7/7/21 Absolute range: Alcohol related mortality 45-74y Scotland (European Age-Standardised Rates per 1,) Source: Scottish Government Health Analytical Services (28) Long-term monitoring of health inequalities Absolute range: Cancer incidence (all sites) <75y Scotland (European Age-Standardised Rates per 1,) Source: Scottish Government Health Analytical Services (28) Long-term monitoring of health inequalities 2

3 Rate per 1, 7/7/21 Absolute range: Cancer mortality 45-74y Scotland (European Age-Standardised Rates per 1,) Bronchus and lung Cancer of the trachea, bronchus and lung (ICD-1 C33-C34) Age-standardised incidence and mortality rates by SIMD 26 deprivation quintile, persons Incidence Mortality (Least deprived) (Most deprived) Deprivation quintile 3

4 Average number of cases per year (bars) Rate per 1, ASR per 1 population (lines) 7/7/21 Lung cancer incidence Males, observed cases Females, observed cases Males, model estimates Females, model estimates Melanoma Malignant melanoma of the skin (ICD-1 C43) Age-standardised incidence and mortality rates by SIMD 26 deprivation quintile, persons Incidence Mortality (Least deprived) (Most deprived) Deprivation quintile 4

5 Rate per 1, Rate per 1, 7/7/21 Prostate Cancer of the prostate (ICD-1 C61) Age-standardised incidence and mortality rates by SIMD 26 deprivation quintile, males Incidence Mortality (Least deprived) (Most deprived) Deprivation quintile Breast cancer Cancer of the female breast (ICD-1 C5) Age-standardised incidence and mortality rates by SIMD 26 deprivation quintile, females Incidence Mortality (Least deprived) (Most deprived) Deprivation quintile 5

6 7/7/21 Comparison of lung cancer mortality in West of Scotland and 3 major cohorts 5 West of Scotland 4 Average annual 3 death rate 2 /1, 1 UK doctors American Cancer Society volunteers US veterans Average num ber of cigarettes sm oked daily Lung cancer mortality by social class 1 8 manual 6 Rate per 1, 4 2 non-manual never daily cigarette consumption 6

7 7/7/21 Breast cancer - incidence and mortality rate deprivation category incidence mortality Deprivation & tumour size % Affluent Intermediate Deprived Deprivation Group Tumour size 1-1mm 11-2mm 21-5mm >5mm *p<.1 Glasgow Breast Cancer

8 7/7/21 Deprivation & Node Positivity % Node +ve Affluent Intermediate Deprived Deprivation Group Glasgow Breast Cancer 95- Deprivation & ER Status % Affluent Intermediate Deprived Deprivation Group ER status ER Neg 5-24% 25-49% >5% Glasgow Breast Cancer 95-8

9 7/7/21 Deprivation & histological grade % Affluent Intermediate Deprived Deprivation Group Grade 1 Grade 2 Grade 3 *p<.1 Glasgow Breast Cancer 95- Aaron Antonovsky

10 7/7/21 Sense of coherence......expresses the extent to which one has a feeling of confidence that the stimuli deriving from one's internal and external environments in the course of living are structured, predictable and explicable, that one has the internal resources to meet the demands posed by these stimuli and, finally, that these demands are seen as challenges, worthy of investment and engagement." 1

11 7/7/21 For the creation of health......the social and physical environment must be: Comprehensible Manageable Meaningful...or the individual would experience chronic stress The Founders Network -46 Evening Cortisol Levels Increase with Months of Orphanage Rearing * Months of Orphanage Rearing *linear trendline 11

12 nmol/l /7/21 Salivary Cortisol STRESS AND GRADE OF EMPLOYMENT: MEN Higher Grade Lower Grade Time of Day Steptoe et al. 23, Psychosomatic Medicine, 65, Environmental determinants of inflammatory status affluen t deprived CRP (median) mg/dl Depcat % smokers Never-smokers Smokers

13 7/7/21 Chronicity of stress by telomere length and perceived stress by telomere length Epel, Elissa S. et al. (24) Proc. Natl. Acad. Sci. USA 11, Copyright 24 by the National Academy of Sciences Telomere length in twins by occupation 13

14 7/7/21 Health Assets A health asset is any factor or resource which enhances the ability of individuals, communities and populations to maintain their health and sustain wellbeing. The assets can operate as protective and promoting facors to buffer against life s stresses Morgan 29 14

15 7/7/21 Health Deficits approach Focuses on problems, needs and deficiencies in a community such as deprivation, illness and health damaging behaviours. It designs services to fill the gaps and fix the problems. As a result, communities can feel disempowered. People become passive recipients of services rather than active agents in their own lives The Asset Approach Identifies and makes viable the health assets in a community Sees citzens as co-producers of their own health rather than passive recipients of services Supports individuals health and wellbeing through enhancing skills for resilience, relationships, knowledge and self esteem Promotes community networks that can provide caring and empowerment 15

16 Average Annual Number of Cancer Diagnoses 7/7/21 Health related behaviours Worthwhile Opportunity, decent housing, social networks, self esteem and sense of control Manageable Consistent parenting, safe, nurturing early years, supportive education Comprehensible PREVENTABLE FRACTION Average annual preventable colorectal, breast and lung cancer diagnoses by life style 3, 2,5 2, 1,5 1, Body Fatness Alcohol Fruit & Veg Smoking Physical Ex 16

17 Rate per 1, 7/7/21 Bronchus and lung Cancer of the trachea, bronchus and lung (ICD-1 C33-C34) Age-standardised incidence and mortality rates by SIMD 26 deprivation quintile, persons Incidence Mortality (Least deprived) (Most deprived) Deprivation quintile 17