Background: Oesophageal cancer (OC) is a major cause of death in China. This study aims to detect the independent contributions of area- and individual-level factors on OC mortality within a Chinese province.
Methods: Multilevel negative binomial models were used to analyse 45,646 OC deaths out of 135,752,484 person-years extracted from the Shandong Death Registration System. This covered the Shandong population aged 40+ years who died between 2011-2013 across 140 county-level areas in Shandong Province. Area-level SES variables were chosen from Shandong Yearbooks.
Results: Preliminary multilevel regression results indicated that males were 4.5 (95% CI: 4.2-4.9) times more likely to die from OC than females. Compared to younger age group (40-49), the risk ratios were 5.2 (4.8-5.6), 15.5 (14.3-16.8), 35.3 (32.3-38.7), and 59.4 (53.6-65.9) in age groups 50-59, 60-69, 70-79, and 80+ years, respectively. Rural residents had a 1.2 (1.1-1.3) times increased risk of dying from OC. Area-level factors including GDP per capita, average years of school education, and number of hospital beds per capita were not significantly associated with the risk of OC death. Residents living in high-risk areas were 4.0 (2.7-5.9) times more likely to die from OC. There was no evidence to suggest area-level SES factors explained the higher OC mortality in those areas.
Conclusion: The risk of dying of OC is related to individual-level factors, rather than the socioeconomic characteristics of the area where they live. Further investigations are needed to identify the key risk factors of OC death on both an area- and individual-level basis.