{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T02:35:34Z","timestamp":1794278134209,"version":"4.9.0"},"reference-count":55,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100023448","name":"Robert Koch-Institut","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100023448","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>Background Cancer is one of the main causes of a high burden of disease and one of the strongest contributors to earlier mortality among lower socioeconomic groups in Germany. Therefore, studying socio-economic inequalities in cancer incidence is of high relevance from a public-health and health-equity lens. The aim of this study was to examine in more depth time trends in socioeconomic inequalities in cancer incidence and the related potential for reducing the incidence of specific cancers across Germany. Methods We used epidemiologic data from the Centre for Cancer Registry Data at the Robert Koch Institute and official population statistics for Germany from 2008 to 2019. To analyse trends in socioeconomic inequalities in cancer incidence, we used an ecological study design and linked the cancer registry and population data with the German Index of Socioeconomic Deprivation at district level. We calculated standardised cancer incidence rates for the most common cancers by area-level socioeconomic deprivation and estimated the Slope and Relative Index of Inequality (SII, RII) to determine the extent of area-level socioeconomic inequalities in the risk of cancer. In a what-if analysis, counterfactual scenarios were used to calculate how much lower cancer incidence could be if socioeconomic inequalities in incidence were reduced or eliminated. Results Due to less favourable trends of cancer incidence in more deprived areas, socioeconomic inequalities in cancer incidence has widened to the detriment of residents in highly deprived areas. This was observed for all cancers combined and for several common cancers such as stomach, colorectal and lung cancer among both women and men. In 2017\u201319, total cancer incidence was 18% (women: RII 1,18) and 49% (men: RII 1,49) higher in the most than in the least deprived area. Reverse inequalities were observed for skin melanoma in both sexes and female breast cancer, the lowest incidence being among residents of highly deprived districts. For 2017\u201319, the what-if analysis showed that the annual number of newly diagnosed cancers cases would be 9,100\u201376,000 cases fewer if the socioeconomic gap in cancer incidence between districts could be narrowed or eliminated. Conclusions In Germany, socioeconomic inequalities in cancer incidence have widened in recent decades. Tackling cancer risks in deprived areas could reduce those inequalities and the burden of cancer overall. Our study emphasises the growing importance of structural approaches in cancer prevention for reducing health inequalities in Germany. <\/jats:p>","DOI":"10.1038\/s41598-025-17859-5","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T17:22:36Z","timestamp":1756747356000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Widening socioeconomic inequalities in cancer incidence and related potential to reduce cancer between 2008 and 2019 in Germany"],"prefix":"10.1038","volume":"15","author":[{"given":"Fabian","family":"Tetzlaff","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Barnes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Jansen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik","family":"Peters","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annemarie","family":"Schultz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Katalinic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Kraywinkel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels","family":"Michalski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enno","family":"Nowossadeck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Hoebel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,1]]},"reference":[{"key":"17859_CR1","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1007\/s00103-024-03862-0","volume":"67","author":"J Hoebel","year":"2024","unstructured":"Hoebel, J. et al. Socioeconomic deprivation and premature mortality in germany, 1998\u20132021: an ecological study with what-if scenarios of inequality reduction.[Sozio\u00f6konomische Deprivation und vorzeitige Sterblichkeit in Deutschland 1998\u20132021: Eine \u00f6kologische Studie mit What-if-Szenarien der Ungleichheitsreduktion]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 67, 528\u2013537 (2024).","journal-title":"Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz"},{"key":"17859_CR2","doi-asserted-by":"publisher","first-page":"e295","DOI":"10.1016\/S2468-2667(24)00049-5","volume":"9","author":"F Tetzlaff","year":"2024","unstructured":"Tetzlaff, F. et al. Age-specific and cause-specific mortality contributions to the socioeconomic gap in life expectancy in germany, 2003\u20132021: an ecological study. Lancet Public. Health. 9, e295\u2013e305 (2024).","journal-title":"Lancet Public. Health"},{"key":"17859_CR3","first-page":"785","volume":"119","author":"M Porst","year":"2022","unstructured":"Porst, M. et al. The burden of disease in Germany at the National and regional level. Dtsch. Arztebl Int. 119, 785\u2013792 (2022).","journal-title":"Dtsch. Arztebl Int."},{"key":"17859_CR4","doi-asserted-by":"publisher","first-page":"1886","DOI":"10.1086\/512712","volume":"112","author":"E Willson Andrea","year":"2007","unstructured":"Willson Andrea, E., Shuey Kim, M., Elder, J. & Glen, H. Cumulative advantage processes as mechanisms of inequality in life course health. Am. J. Sociol. 112, 1886\u20131924 (2007).","journal-title":"Am. J. Sociol."},{"key":"17859_CR5","doi-asserted-by":"publisher","first-page":"951","DOI":"10.1093\/eurpub\/ckv111","volume":"25","author":"H Kr\u00f6ger","year":"2015","unstructured":"Kr\u00f6ger, H., Pakpahan, E. & Hoffmann, R. What causes health inequality? A systematic review on the relative importance of social causation and health selection. Eur. J. Public. Health. 25, 951\u2013960 (2015).","journal-title":"Eur. J. Public. Health"},{"key":"17859_CR6","doi-asserted-by":"publisher","first-page":"3029","DOI":"10.1002\/ijc.33114","volume":"147","author":"J Lortet-Tieulent","year":"2020","unstructured":"Lortet-Tieulent, J. et al. Profiling global cancer incidence and mortality by socioeconomic development. Int. J. Cancer. 147, 3029\u20133036 (2020).","journal-title":"Int. J. Cancer"},{"key":"17859_CR7","doi-asserted-by":"publisher","first-page":"1144","DOI":"10.1016\/j.ejca.2013.10.014","volume":"51","author":"J Lortet-Tieulent","year":"2015","unstructured":"Lortet-Tieulent, J. et al. Convergence of decreasing male and increasing female incidence rates in major tobacco-related cancers in Europe in 1988\u20132010. Eur. J. Cancer. 51, 1144\u20131163 (2015).","journal-title":"Eur. J. Cancer"},{"key":"17859_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2478\/raon-2020-0008","volume":"54","author":"A Mihor","year":"2020","unstructured":"Mihor, A. et al. Socioeconomic inequalities in cancer incidence in europe: a comprehensive review of population-based epidemiological studies. Radiol. Oncol. 54, 1\u201313 (2020).","journal-title":"Radiol. Oncol."},{"key":"17859_CR9","doi-asserted-by":"publisher","first-page":"100551","DOI":"10.1016\/j.lanepe.2022.100551","volume":"25","author":"S Vaccarella","year":"2023","unstructured":"Vaccarella, S. et al. Socioeconomic inequalities in cancer mortality between and within countries in europe: a population-based study. Lancet Reg. Health Europe. 25, 100551 (2023).","journal-title":"Lancet Reg. Health Europe"},{"key":"17859_CR10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/10732748211011956","volume":"28","author":"N Afshar","year":"2021","unstructured":"Afshar, N., English, D. R. & Milne, R. L. Factors explaining Socio-Economic inequalities in cancer survival: A systematic review. Cancer Control. 28, 1\u201333 (2021).","journal-title":"Cancer Control"},{"key":"17859_CR11","doi-asserted-by":"publisher","first-page":"187","DOI":"10.3389\/fpubh.2019.00187","volume":"7","author":"R Westerman","year":"2019","unstructured":"Westerman, R. & M\u00fchlichen, M. Avoidable cancer mortality in Germany since reunification: regional variation and sex differences. Front. Public. Health. 7, 187 (2019).","journal-title":"Front. Public. Health"},{"key":"17859_CR12","doi-asserted-by":"crossref","unstructured":"Tetzlaff, F. et al., Time trends and income inequalities in cancer incidence and cancer-free life expectancy: a cancer site-specific analysis of German health insurance data. Front Oncol 12. (2022).","DOI":"10.3389\/fonc.2022.827028"},{"key":"17859_CR13","doi-asserted-by":"publisher","first-page":"402","DOI":"10.3389\/fonc.2018.00402","volume":"8","author":"J Hoebel","year":"2018","unstructured":"Hoebel, J. et al. Socioeconomic inequalities in total and Site-Specific cancer incidence in germany: A Population-Based registry study. Front. Oncol. 8, 402 (2018).","journal-title":"Front. Oncol."},{"issue":"10","key":"17859_CR14","doi-asserted-by":"publisher","first-page":"1784","DOI":"10.1002\/ijc.34662","volume":"153","author":"L Jansen","year":"2023","unstructured":"Jansen, L. et al. Trends in cancer incidence by socioeconomic deprivation in Germany in 2007 to 2018: an ecological registry-based study. Int. J. Cancer. 153 (10), 1784\u20131796 (2023).","journal-title":"Int. J. Cancer"},{"key":"17859_CR15","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1002\/ijc.33553","volume":"149","author":"I Finke","year":"2021","unstructured":"Finke, I. et al. Small-area analysis on socioeconomic inequalities in cancer survival for 25 cancer sites in Germany. Int. J. Cancer. 149, 561\u2013572 (2021).","journal-title":"Int. J. Cancer"},{"key":"17859_CR16","first-page":"2","volume":"7","author":"N Michalski","year":"2022","unstructured":"Michalski, N. et al. German index of socioeconomic deprivation (GISD): revision, update and applications. J. Health Monit. 7, 2\u201323 (2022).","journal-title":"J. Health Monit."},{"key":"17859_CR17","doi-asserted-by":"publisher","first-page":"e0242433","DOI":"10.1371\/journal.pone.0242433","volume":"15","author":"F Tetzlaff","year":"2020","unstructured":"Tetzlaff, F. et al. Compression, expansion, or maybe both? Growing inequalities in lung cancer in Germany. PLoS One. 15, e0242433 (2020).","journal-title":"PLoS One"},{"key":"17859_CR18","doi-asserted-by":"crossref","unstructured":"Arndt, V. et al. Data from population-based cancer registration for secondary data analysis: methodological challenges and perspectives. Gesundheitswesen 82, S62-S71\u00a0(2020).","DOI":"10.1055\/a-1009-6466"},{"key":"17859_CR19","unstructured":"Robert Koch-Institut. Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. (eds.). Krebs in Deutschland f\u00fcr 2019\/2020. Berlin (2023)."},{"key":"17859_CR20","unstructured":"Research data centre of the Federal Statistical Offices. Population Figures (Tables 12411-04-01-4 and 12411-04-02-4) [Fortschreibung des Bev\u00f6lkerungsstandes (Tabelle 12411-04-01-4 und 12411-04-02-4)] (2024)."},{"key":"17859_CR21","unstructured":"Michalski, N. et al., German Index of Socioeconomic Deprivation (GISD). Berlin, Zenodo\u00a0(2022)."},{"key":"17859_CR22","doi-asserted-by":"publisher","first-page":"1158","DOI":"10.1002\/cncr.35133","volume":"130","author":"K Yang","year":"2024","unstructured":"Yang, K. et al. Diabetes mellitus in long-term survivors with colorectal, breast, or prostate cancer: prevalence and prognosis. A population-based study. Cancer 130, 1158\u20131170 (2024).","journal-title":"Cancer"},{"key":"17859_CR23","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1007\/s00761-023-01413-x","volume":"29","author":"A Schultz","year":"2023","unstructured":"Schultz, A. et al. Faktenblatt: epidemiologie des Zervixkarzinoms in Deutschland 2009 Bis 2019. Die Onkologie. 29, 927\u2013931 (2023).","journal-title":"Die Onkologie"},{"key":"17859_CR24","doi-asserted-by":"publisher","first-page":"17833","DOI":"10.1038\/s41598-023-45254-5","volume":"13","author":"F Tetzlaff","year":"2023","unstructured":"Tetzlaff, F. et al. Widening area-based socioeconomic inequalities in cancer mortality in Germany between 2003 and 2019. Sci. Rep. 13, 17833 (2023).","journal-title":"Sci. Rep."},{"key":"17859_CR25","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1002\/sim.4780100317","volume":"10","author":"AJ Dobson","year":"1991","unstructured":"Dobson, A. J. et al. Confidence intervals for weighted sums of Poisson parameters. Stat. Med. 10, 457\u2013462 (1991).","journal-title":"Stat. Med."},{"key":"17859_CR26","unstructured":"Eurostat Revision of the European Standard Population. Report of Eurostat\u2019s Task force \u2013 2013 Edition (Publications Office of the European Union, 2013)."},{"key":"17859_CR27","doi-asserted-by":"publisher","first-page":"730","DOI":"10.1136\/jech-2015-207018","volume":"70","author":"JP Mackenbach","year":"2016","unstructured":"Mackenbach, J. P. et al. The arithmetic of reducing relative and absolute inequalities in health: a theoretical analysis illustrated with European mortality data. J. Epidemiol. Community Health. 70, 730\u2013736 (2016).","journal-title":"J. Epidemiol. Community Health"},{"key":"17859_CR28","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1016\/0277-9536(91)90212-U","volume":"33","author":"A Wagstaff","year":"1991","unstructured":"Wagstaff, A., Paci, P. & van Doorslaer, E. On the measurement of inequalities in health. Soc. Sci. Med. 33, 545\u2013557 (1991).","journal-title":"Soc. Sci. Med."},{"key":"17859_CR29","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1136\/jech.2010.112680","volume":"65","author":"JP Mackenbach","year":"2011","unstructured":"Mackenbach, J. P., Meerding, W. J. & Kunst, A. E. Economic costs of health inequalities in the European union. J. Epidemiol. Community Health. 65, 412\u2013419 (2011).","journal-title":"J. Epidemiol. Community Health"},{"key":"17859_CR30","unstructured":"Whitehead, M. & Dahlgren, G. Levelling Up (Part 1): A Discussion Paper on Concepts and Principles for Tackling Social Inequities in Health. (Copenhagen, 2006)."},{"key":"17859_CR31","doi-asserted-by":"publisher","first-page":"e297","DOI":"10.1371\/journal.pmed.0040297","volume":"4","author":"JP Vandenbroucke","year":"2007","unstructured":"Vandenbroucke, J. P. et al. Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. PLoS Med. 4, e297 (2007).","journal-title":"PLoS Med."},{"key":"17859_CR32","doi-asserted-by":"publisher","first-page":"100063","DOI":"10.1016\/j.lanepe.2021.100063","volume":"4","author":"L Jansen","year":"2021","unstructured":"Jansen, L. et al. Socioeconomic deprivation and cancer survival in a metropolitan area: an analysis of cancer registry data from hamburg, Germany. Lancet Reg. Health Europe. 4, 100063 (2021).","journal-title":"Lancet Reg. Health Europe"},{"key":"17859_CR33","first-page":"166","volume":"69","author":"KR Yabroff","year":"2019","unstructured":"Yabroff, K. R. et al. Minimizing the burden of cancer in the united states: goals for a high-performing health care system. CA Cancer J. Clin. 69, 166\u2013183 (2019).","journal-title":"CA Cancer J. Clin."},{"key":"17859_CR34","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1002\/ijc.32767","volume":"147","author":"A Katalinic","year":"2020","unstructured":"Katalinic, A. et al. Breast cancer incidence and mortality before and after implementation of the German mammography screening program. Int. J. Cancer. 147, 709\u2013718 (2020).","journal-title":"Int. J. Cancer"},{"key":"17859_CR35","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1007\/s00103-012-1655-4","volume":"56","author":"A Starker","year":"2013","unstructured":"Starker, A. & Sa\u00df, A. C. Participation in cancer screening in germany: results of the German health interview and examination survey for adults (DEGS1). [Inanspruchnahme von Krebsfr\u00fcherkennungsuntersuchungen: Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 56, 858\u2013867 (2013).","journal-title":"Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz"},{"key":"17859_CR36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.puhe.2024.04.036","volume":"233","author":"A Altov\u00e1","year":"2024","unstructured":"Altov\u00e1, A. et al. Educational inequalities in cervical cancer screening participation in 24 European countries. Public. Health. 233, 1\u20137 (2024).","journal-title":"Public. Health"},{"key":"17859_CR37","doi-asserted-by":"publisher","first-page":"712","DOI":"10.1093\/ije\/dyr008","volume":"40","author":"C von Wagner","year":"2011","unstructured":"von Wagner, C. et al. Inequalities in participation in an organized National colorectal cancer screening programme: results from the first 2.6 million invitations in England. Int. J. Epidemiol. 40, 712\u2013718 (2011).","journal-title":"Int. J. Epidemiol."},{"key":"17859_CR38","doi-asserted-by":"publisher","first-page":"105829","DOI":"10.1016\/j.ypmed.2019.105829","volume":"129","author":"S Dumont","year":"2019","unstructured":"Dumont, S. et al. Skin cancer screening in switzerland: Cross-sectional trends (1997\u20132012) in socioeconomic inequalities. Prev. Med. 129, 105829 (2019).","journal-title":"Prev. Med."},{"key":"17859_CR39","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1093\/eurpub\/ckz236","volume":"30","author":"I Mosquera","year":"2020","unstructured":"Mosquera, I. et al. Inequalities in participation in colorectal cancer screening programmes: a systematic review. Eur. J. Public. Health. 30, 416\u2013425 (2020).","journal-title":"Eur. J. Public. Health"},{"key":"17859_CR40","doi-asserted-by":"publisher","first-page":"589","DOI":"10.4054\/DemRes.2015.32.20","volume":"32","author":"A van Raalte","year":"2015","unstructured":"van Raalte, A., Myrskyl\u00e4, M. & Martikainen, P. The role of smoking on mortality compression. Demographic Res. 32, 589\u2013620 (2015).","journal-title":"Demographic Res."},{"key":"17859_CR41","doi-asserted-by":"publisher","first-page":"1399","DOI":"10.1007\/s00103-018-2821-0","volume":"61","author":"A Wienecke","year":"2018","unstructured":"Wienecke, A. & Kraywinkel, K. Tobacco-associated cancers in Germany-incidence and mortality trends since 1995. [Tabakassoziierte Krebserkrankungen in Deutschland \u2013 Entwicklung der Inzidenz und Mortalit\u00e4t seit 1995]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 61, 1399\u20131406 (2018).","journal-title":"Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz"},{"key":"17859_CR42","doi-asserted-by":"publisher","first-page":"1365","DOI":"10.1007\/s00103-018-2817-9","volume":"61","author":"J Zeiher","year":"2018","unstructured":"Zeiher, J. et al. Trends in smoking among adults in germany: evidence from seven population-based health surveys from 1991\u20132015. [Zeitliche Trends beim Rauchverhalten Erwachsener in Deutschland: Ergebnisse sieben bundesweiter Gesundheitssurveys 1991\u20132015]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 61, 1365\u20131376 (2018).","journal-title":"Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz"},{"key":"17859_CR43","doi-asserted-by":"publisher","first-page":"1606932","DOI":"10.3389\/ijph.2024.1606932","volume":"69","author":"S Sperlich","year":"2024","unstructured":"Sperlich, S. et al. Widening educational inequalities in physical health due to the obesity Trend?-A mediation analysis using the German Socio-Economic panel study. Int. J. Public. Health. 69, 1606932 (2024).","journal-title":"Int. J. Public. Health"},{"key":"17859_CR44","doi-asserted-by":"crossref","unstructured":"Perol, O. et al., Systematic screening for occupational exposures in lung cancer patients: a prospective French cohort. Int J. Environ. Res. Public. Health 15. (2018).","DOI":"10.3390\/ijerph15010065"},{"key":"17859_CR45","doi-asserted-by":"publisher","first-page":"1388","DOI":"10.1007\/s00103-018-2818-8","volume":"61","author":"B Kuntz","year":"2018","unstructured":"Kuntz, B. et al. Time trends of occupational differences in smoking behaviour of employed men and women in germany: results of the 1999\u20132013 microcensus. [Zeitliche Entwicklung berufsgruppenspezifischer Unterschiede im Rauchverhalten von erwerbst\u00e4tigen M\u00e4nnern und Frauen in Deutschland: Ergebnisse des Mikrozensus 1999\u20132013]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 61, 1388\u20131398 (2018).","journal-title":"Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz"},{"key":"17859_CR46","doi-asserted-by":"publisher","first-page":"1677","DOI":"10.1111\/add.15335","volume":"116","author":"T Gredner","year":"2021","unstructured":"Gredner, T. et al. Impact of reducing alcohol consumption through price-based policies on cancer incidence in Germany 2020-50-a simulation study. Addiction 116, 1677\u20131688 (2021).","journal-title":"Addiction"},{"key":"17859_CR47","unstructured":"Joossens, L. et al. The Tobacco Control Scale 2021 in Europe (Smoke Free Partnership, Catalan Institute of Oncology, 2022)."},{"key":"17859_CR48","doi-asserted-by":"publisher","first-page":"e0272202","DOI":"10.1371\/journal.pone.0272202","volume":"17","author":"NWS Payne","year":"2022","unstructured":"Payne, N. W. S. et al. Socio-economic deprivation and cancer incidence in england: quantifying the role of smoking. PLoS One. 17, e0272202 (2022).","journal-title":"PLoS One"},{"key":"17859_CR49","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1136\/tobaccocontrol-2015-052766","volume":"26","author":"G Gregoraci","year":"2017","unstructured":"Gregoraci, G. et al. Contribution of smoking to socioeconomic inequalities in mortality: a study of 14 European countries, 1990\u20132004. Tob. Control. 26, 260\u2013268 (2017).","journal-title":"Tob. Control"},{"key":"17859_CR50","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1136\/tobaccocontrol-2011-050294","volume":"21","author":"M Thun","year":"2012","unstructured":"Thun, M. et al. Stages of the cigarette epidemic on entering its second century. Tob. Control. 21, 96\u2013101 (2012).","journal-title":"Tob. Control"},{"key":"17859_CR51","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.socscimed.2014.06.033","volume":"127","author":"F Pampel","year":"2015","unstructured":"Pampel, F. et al. Cohort changes in educational disparities in smoking: france, Germany and the united States. Soc. Sci. Med. 127, 41\u201350 (2015).","journal-title":"Soc. Sci. Med."},{"key":"17859_CR52","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1186\/s12889-021-10576-4","volume":"21","author":"F Tetzlaff","year":"2021","unstructured":"Tetzlaff, F. et al. Socioeconomic inequalities in lung cancer - a time trend analysis with German health insurance data. BMC Public. Health. 21, 538 (2021).","journal-title":"BMC Public. Health"},{"key":"17859_CR53","doi-asserted-by":"publisher","first-page":"1117","DOI":"10.1111\/1467-9566.12562","volume":"39","author":"JP Mackenbach","year":"2017","unstructured":"Mackenbach, J. P. et al. Fundamental causes\u2019 of inequalities in mortality: an empirical test of the theory in 20 European populations. Sociol. Health Illn. 39, 1117\u20131133 (2017).","journal-title":"Sociol. Health Illn."},{"issue":"Suppl 2","key":"17859_CR54","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1177\/00333549141291S206","volume":"129","author":"P Braveman","year":"2014","unstructured":"Braveman, P. & Gottlieb, L. The social determinants of health: it\u2019s time to consider the causes of the causes. Public. Health Rep. 129 (Suppl 2), 19\u201331 (2014).","journal-title":"Public. Health Rep."},{"key":"17859_CR55","first-page":"324","volume":"68","author":"S Vaccarella","year":"2018","unstructured":"Vaccarella, S. et al. Reducing social inequalities in cancer: setting priorities for research. CA Cancer J. Clin. 68, 324\u2013326 (2018).","journal-title":"CA Cancer J. Clin."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-17859-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-17859-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-17859-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,6]],"date-time":"2025-09-06T19:30:17Z","timestamp":1757187017000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-17859-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,1]]},"references-count":55,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["17859"],"URL":"https:\/\/doi.org\/10.1038\/s41598-025-17859-5","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,1]]},"assertion":[{"value":"13 September 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declared no potential conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The authors did not conduct any studies on humans or animals for this article.\u00a0Cancer registry data collection and processing was carried out in accordance with all applicable legislation on cancer registration. The study was performed in accordance with the recommendations of the World Medical Association\u2019s Declaration of Helsinki.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"32232"}}