Deprivation and smoking trends among lung cancer patients before and after the Greek economic crisis. Insights from the Cancer Registry of Crete.

Abstract

Introduction Τo provide insights on Lung Cancer (LC) and the associated risk factors before-after the economic crisis in Crete, Greece. To assess the smoking habits of LC patients during the austerity period. Material and Methods The study was conducted in Crete, Greece. Data (5,057 LC cases) were obtained from the Cancer Registry of Crete (CRC). Age-Standardized Incidence and Mortality Rates (ASIR, ASMR/100,000/year), adjusted Charlson’s Comorbidity Index (CCI%), deprivation index (HPI-2) and exposure to Outdoor Air Pollution (OAP) were estimated. The analysis was performed for two time periods (Period A: 1992-2008; Period B: 2009-2013). Results ASIR presented a significant increase during the economic crisis, while even higher increase was observed in ASMR (Period A: ASMR=30.5/100,000/year; Period B: ASMR=43.8/100,000/year; p<0.001). A significant increase was also observed in smokers (Variation rate=7.4; p=0.02) during the austerity period. After 2009, a significant increase of the LC hot spots was observed in several sub-regions of Crete (p=0.04), mainly due to smoking and deprivation levels increase. The risk of LC mortality increased even more among smokers (RR=5.7; 95%CI=5.2-6.3) and individuals living in highly deprived geographical regions (RR=5.4; 95%=5.1-5.8) during the austerity period. The impact of the multiple LC predictors resulted in adjusted RRs ranging from 0.7 to 5.7 within the island (p<0.05). Conclusions The increased LC burden after the onset of the economic crisis, along with a changing pattern of LC predictors stress the urgent need of targeted interventions and cancer control programs focusing on the most deprived or vulnerable population groups.

Keywords

• cigarette smoking
• deprivation
• lung cancer
• economic crisis
• risk factors