Socio-Environmental Patterns Associated with Cancer Mortality: A Study Based on a Quality of Life Approach

Document Type : Research Articles


1 Institute of Health Sciences Research (INICSA), Faculty of Medical Sciences, National Scientific and Technical Research Council (CONICET), University of Córdoba, Tandil, Argentina.

2 Biostatistics Unit, School of Nutrition, Faculty of Medical Sciences, University of Córdoba, Tandil, Argentina.

3 Institute of Geography, History and Social Sciences (IGEHCS), National Scientific and Technical Research Council (CONICET), National University of the Center of the Province of Buenos Aires, Tandil, Argentina.


Background: With 18.6% of total deaths due to malignant tumors in 2016, cancer is the second leading death cause
in Argentina. While there is a broad consensus on common risk factors at the individual cancer level, those operating
at a contextual level have been poorly studied in developing countries. The objective of our study was to identify
socio-environmental patterns in Argentina (2010), emphasizing quality of life, and to explore their associations with the
spatial distribution of cancer mortality in the country. Methods: The study was conducted in 525 geographical divisions
nested into 24 provinces. Sex-specific crude and age-standardized mortality rates (ASMR) for cancer (2009-2011 period)
were calculated. Empirically derived socio-environmental patterns were identified through principal-component factor
analysis on a selected set of variables: an urban scale and 29 indicators of a quality of life index in Argentina for 2010.
Two-level Poisson regression models were used to estimate associations between the ASMR and the continuous factor
scores for socio-environmental patterns as covariates. A random intercept was included to account for spatial variability
in the ASMR distribution using Stata software. Results: Four socio-environmental patterns were identified, termed
“Contexts with urban-related resources or cultural capital”, “Socioeconomically prosperous contexts”, “Environments
with anthropic exposures” and “Plains region” (cumulative explained variance=57%). High mortality rates were found
in counties characterized by socioeconomically prosperous contexts (RR=1.025 in women; 1.088 in men) and plain
landscapes (RR=1.057 and 1.117, respectively). Counties featuring urban or cultural resources demonstrated increased
mortality in women (RR=1.015, 95%CI=1.005-1.025), whereas rising rates associated with environments having
anthropic exposures (RR=1.008, 95%CI=1.001-1.016) were observed only for men. Conclusion: This study identified
four characteristic socio-environmental patterns in Argentina which incorporate features of quality of life, accounting
to some extent for the differential burden of cancer mortality in this country.


Main Subjects

Volume 19, Issue 11
November 2018
Pages 3045-3052
  • Receive Date: 09 October 2017
  • Revise Date: 24 May 2018
  • Accept Date: 22 October 2018
  • First Publish Date: 01 November 2018