Poorer Places, Worse Odds: Cancer Gaps by Deprivation and Education

In the UK, across much of Europe and in the US, people living in poorer areas or with less education are more likely to be diagnosed with cancer late, less likely to receive some treatments and more likely to die of it; in the UK they are also more likely to develop it. Around 33,800 UK cancer cases a year are linked with deprivation. Across 18 European countries, about a third of cancer deaths in men were associated with lower or intermediate education.

These gaps are not the product of individual choices. They follow where people live and work, what they were exposed to over decades, how easy it is to take time off for a test, how far the nearest hospital is, and whether services were designed with them in mind. The same pattern appears in countries with very different health systems, and so do the signs that it can be narrowed. This study brings the evidence together, names the measure behind each figure, and sets out what it asks of services.

More cancer is diagnosed in the most deprived areas, and lung cancer accounts for over half the gap in the UK

Deprivation is measured differently in each country. The UK nations each rank small areas with their own index: the English Indices of Deprivation (often called IMD), the Scottish Index of Multiple Deprivation (SIMD), the Welsh Index of Multiple Deprivation (WIMD) and the Northern Ireland Multiple Deprivation Measure (NIMDM). Cancer Research UK’s September 2026 analysis used each one and, because the indices are not directly comparable, did not calculate UK-wide rates by deprivation^[1].

Within each nation the direction is the same. In England, the age-standardised incidence rate for all cancers combined was 694 per 100,000 in the most deprived fifth of areas against 592 in the least deprived, 17% higher. The gap was 21% in Wales, 28% in Scotland and 16% in Northern Ireland, each on its own national index^[1]. The table keeps each figure with its own measure; the differences between nations partly reflect how each index is built, so they should not be read as a ranking.

Age-standardised incidence per 100,000 people, all cancers combined, persons. Data years 2019, 2021 and 2022 (2020 excluded because of COVID-19 disruption); Wales 2020–2022. Source: Cancer Research UK^[1].

Cancer Research UK estimates how many cases are “deprivation-associated” by applying the age-specific incidence rates of the least deprived fifth to the whole population and counting the difference. That gives around 33,800 cases a year, or about 95 a day^[1]. It is a modelled estimate of the gap, not a count of people whose cancer was caused by where they live. Lung cancer accounts for 54% of these cases, and 37% of all lung cancers in the UK are deprivation-associated. Cervical, liver, head and neck cancers and cancer of unknown primary also have large shares^[1]. Cancer Research UK puts the related figure for deaths at around 28,400 a year, from a separate analysis of 2017–2021 data^[1].

The cancers with the largest gaps point to the reasons for them. Cancer Research UK researchers estimated from England’s 2013–2017 incidence data that 61% of the deprivation gap in cancer incidence could have been prevented if nobody had smoked; the share of cancers attributable to smoking was 21.1% in the most deprived fifth of areas against 9.7% in the least^[3]. That is a modelled population estimate, not a verdict on anyone’s illness. The 2026 National Cancer Plan’s technical annex shows that adults in more deprived areas of England are more likely to be living with obesity and to be physically inactive^[4]. These exposures build up over decades, and they cluster where tobacco is most heavily sold, healthy food is hardest to reach and work is most hazardous. That makes them questions for policy, not judgements about people. Our study of cancer linked to modifiable risk factors explains how these population estimates are made.

Across Europe and the US, people with less education or living in poorer places die of cancer at higher rates

Outside the UK, studies more often measure a person’s own education or income than the deprivation of their area. The largest European comparison, led by the International Agency for Research on Cancer (IARC), linked census and death records for adults aged 40–79 in 18 countries between 1990 and 2015, grouping education by the international ISCED scale^[2]. It found that “lower-educated individuals have higher mortality rates for nearly all cancer-types”. Lung cancer contributed most to the gap: the relative risk of dying of lung cancer for lower- compared with higher-educated people was 2.4 among men and 1.8 among women^[2].

The size of the gap depends heavily on the country. In men, the difference in total cancer mortality between lower- and higher-educated groups ranged from 110 per 100,000 person-years in Sweden to 559 in the Czech Republic. In women it ranged from about zero in Slovenia, Italy and Spain to 176 in Denmark. Inequalities were generally greatest in the Baltic countries and in Central and Eastern Europe, where in 2004–2015 up to 46% of men’s and 24% of women’s cancer deaths were associated with lower or intermediate education. Among women, the gaps were large and growing in Northern Europe, including the Nordic countries^[2]. IARC’s inequalities programme sums up the pattern: “Disadvantaged individuals and social groups have disproportionately high cancer mortality for most cancer types”, and because the effect runs as a gradient across the whole population, it is not confined to the poorest^[5].

In the United States the gaps are measured by education, by the long-run poverty of a county and by insurance status, which US registries record. The American Cancer Society’s 2025 report on cancer disparities found that, for adults aged 25–74 in 2019–2023, cancer mortality among people with the least education was higher than among those with the most by 143%–192% in men and 71%–140% in women, depending on racial group. Among men overall, people with 12 years of schooling or fewer died of cancer at 2.61 times the rate of those with 16 years or more. For lung and colorectal cancer, the differences by education were larger than the differences by race^[6].

Place matters too. In “persistent poverty” counties, where at least 20% of residents have been in poverty since 1980, the age-adjusted cancer mortality rate in 2007–2011 was 201.3 per 100,000 a year, against 179.3 in other counties, 12.3% higher. Death rates were higher for lung, colorectal, stomach and liver cancers^[7]. The 2025 disparities report also found cancer mortality in 2019–2023 was 21% higher in non-metropolitan than in large metropolitan counties^[6].

A national study of people aged 18–64 diagnosed with one of 19 common cancers in 2010–2013 found that those insured through Medicaid (the US public programme for people on low incomes) and those with no insurance were significantly more likely than privately insured people to be diagnosed at a late stage (III or IV). Uninsured people also had worse survival at the same stage for 12 of 17 cancers that can be staged^[8]. So the gap is not only about when a cancer is found.

Later diagnosis and less treatment help explain why survival is lower

Higher incidence is only part of the story: once diagnosed, people in the most deprived areas also tend to have worse survival. NHS England’s April 2026 survival release, covering adults in England diagnosed in 2018–2022 and followed up to 2023, states that “Cancer survival is lower in areas with higher deprivation”^[9]. Across 103 cancer groups, age-standardised one-year net survival was lower in the most deprived fifth of areas for most of them; the release’s one named exception is small cell lung cancer (least deprived fifth 0.7 points lower). The gap was 7.8 percentage points for lung cancer, 7.3 for bowel cancer, 2.7 for breast cancer in women and 1.3 for prostate cancer. The widest gaps were for cancer of the oropharynx (13.2 points) and, among women, for the registry group of miscellaneous and unspecified ovarian cancers (17.9 points)^[10]. The smallest gaps were for basal cell carcinoma (0.4 points) and thyroid cancer (0.6)^[10].

Two things drive much of this gap: when cancer is found and what treatment follows. In England, emergency presentation is consistently highest among people living in the most deprived areas and lowest in the least deprived, and it remains the route to diagnosis for a fifth of all cancers^[4]. The plan’s annex notes that emergency presentation is associated with poorer outcomes, including survival^[4]. Our studies of stage at diagnosis and screening uptake cover late diagnosis and screening participation by deprivation in detail.

Treatment gaps appear even at the same stage of disease. In a population-based study of colon cancer in England (diagnoses 2016–2017), people in the most deprived fifth of areas had 0.62 times the odds of having surgery compared with the least deprived. They also had lower odds of chemotherapy after surgery for stage II–III disease (odds ratio 0.73) and of chemotherapy for stage IV disease (0.63)^[11]. For acute myeloid leukaemia in England in 2015–2022, people in the most deprived areas were 6.1% less likely to receive intensive chemotherapy than those in the least deprived. The authors estimate that 247 more people would have received it if everyone had the access of the least deprived group^[12].

Universal health systems narrow the financial barriers, but they do not remove the gap. In a Swedish national cohort (2012–2022) of adults with cirrhosis whose liver cancer was found through surveillance, low socioeconomic status, compared with high, was linked to higher mortality even among those treated with curative intent (adjusted hazard ratio 1.50)^[13]. Registry studies describe these gaps more precisely than they explain them. But the consistency of the pattern across cancers and countries points to how services reach people, not to anything about the people themselves.

The gaps narrow when services are built to reach people

None of these gaps is fixed. In England, the share of cancers diagnosed at stage 1 or 2 rose fastest in the most deprived areas. The difference between the most and least deprived fifths fell from 8.2 percentage points in March 2019 to February 2020 (51.6% against 59.8%) to 6.2 points in October 2024 to September 2025 (56.0% against 62.2%)^[4]. The government’s technical annex credits this mainly to lung cancer screening: “Driven largely by the roll out of lung cancer screening, the most rapid progress has been made in the areas of highest deprivation.”^[4] These are rapid registration figures rather than final statistics, and 6.2 points is still a gap, but the direction is clear.

In the United States, the expansion of Medicaid under the Affordable Care Act offers a natural experiment, because some states expanded it and others did not. In a 2026 registry study of adults aged 18–64 with non-small cell lung cancer (2009–2013 against 2015–2019), insurance coverage rose by 5.06 percentage points in states that expanded Medicaid and by 2.87 points in states that did not, a net 2.22 points. On the same comparison, localised-stage diagnosis rose 1.76 points more in expansion states and three-year overall survival 1.89 points more^[14]. A separate analysis of adults aged 18–59 diagnosed in 2007–2008 and 2014–2015 found that five-year cause-specific survival from lung cancer improved 1.32 percentage points more in expansion than in non-expansion states^[15]. The gains are modest, but they followed a change in policy.

IARC warns that cancer control measures that do not reach less advantaged groups can widen inequalities^[5]; the English and US examples suggest that measures which do reach them can narrow the gap.

What the evidence asks of us

• Measure inequality routinely, using the country’s own measure. The European study’s authors conclude that their findings call for systematic measurement, monitoring and action on cancer inequalities^[2]. Registries that publish incidence, stage, treatment and survival by deprivation, as the UK nations do, make the gaps visible; countries without such data cannot see their own.
• Put prevention where the cases are. With lung cancer making up over half of the UK’s deprivation-associated cases^[1], tobacco control and support to stop smoking that is designed for the most deprived communities are equality measures as much as public health ones.
• Design early diagnosis for the people least well served. The 2026 National Cancer Plan for England commits to completing the national roll-out of lung cancer screening by 2030^[4]. The narrowing early-stage gap suggests that reaching people by need is what makes the difference.
• Audit treatment by deprivation, not only diagnosis. Differences in the odds of surgery and chemotherapy at the same stage^[11][12] show that equal access to a hospital is not the same as equal treatment. Cancer services and commissioners can monitor treatment rates by deprivation fifth and look into the gaps.
• Remove cost barriers to care. In the US, Medicaid expansion was followed by gains in early-stage diagnosis and survival, greater in socioeconomically disadvantaged areas^[14], and the American Cancer Society lists protecting and expanding access to Medicaid among its evidence-based steps to reduce disparities^[6].

Deprivation runs through almost every topic in our cancer research library. The evidence here shows that much of the gap comes from conditions and services that can be changed.

Language: this piece says "people with cancer" and "people living with and after cancer", and describes the illness and its treatment plainly, without combat metaphors. Clinical terms such as "stage", "incidence" and "net survival" are used in the sense the cited source defines them.

Why we're publishing this

Charities, support groups and hospices see these gaps every day: in who is diagnosed late, who struggles to reach appointments and who misses out on treatment. The evidence supports what they already know, and it places the cause where it belongs, in exposures people did not choose and in services that do not yet reach everyone equally. We have gathered it in one place, each figure tied to its country, measure and source, to be used to argue for change.

How to read this data

Deprivation is measured differently everywhere. UK figures use area-based indices (IMD in England, SIMD in Scotland, WIMD in Wales, NIMDM in Northern Ireland), which describe the neighbourhood a person lives in, not their own income. The European study uses each person’s education. US studies use education, county poverty or insurance status. These measures capture different things, so gaps on one cannot be compared directly with gaps on another, and we have not done so.

Incidence, mortality and survival are different measures. Incidence counts new diagnoses; mortality counts deaths in the whole population; net survival describes people already diagnosed. UK incidence and English survival figures here are age-standardised, so differences in the age mix of areas do not explain them. The 33,800 “deprivation-associated” cases and the European shares of deaths “associated with” education are modelled estimates of how much lower the numbers would be if everyone had the rates of the most advantaged group. So is the share of England’s deprivation gap attributed to smoking. None is a count of individuals whose cancer was caused by deprivation or smoking.

Associations, not proof of cause. The treatment and insurance studies are observational. They adjust for some factors, but cannot rule out every other explanation. The Medicaid studies compare states that did and did not expand coverage, which is a stronger design, but still not a trial. Several studies here were read from their abstracts only, and we have used only what the abstracts state. Survival figures describe people diagnosed some years ago, and European mortality data run to 2015.

Use this data

Free to cite with attribution to Better Health For Everyone. Charities, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This article summarises published research for general information. It is not medical advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else's health, please speak to a qualified health professional.

Sources

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2. Vaccarella S, Georges D, Bray F, et al. Socioeconomic inequalities in cancer mortality between and within countries in Europe: a population-based study. The Lancet Regional Health – Europe, 2023. europepmc.org/article/PMC/PMC9929598
3. Payne NWS, Brown KF, Delon C, Kotrotsios Y, Soerjomataram I, Shelton J. Socio-economic deprivation and cancer incidence in England: quantifying the role of smoking. PLoS One, 2022. europepmc.org/article/MED/36129905
4. Department of Health and Social Care. Technical annex to the 2026 National Cancer Plan. GOV.UK, 2026. assets.publishing.service.gov.uk/…/national-cancer-plan-technical-annex.pdf
5. International Agency for Research on Cancer. Cancer Inequalities: social inequalities. IARC, 2026 (accessed). cancer-inequalities.iarc.who.int/social-inequalities
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9. NHS England. Cancer Survival in England, cancers diagnosed 2018 to 2022, followed up to 2023. NHS England Digital, 2026. digital.nhs.uk/…/cancers-diagnosed-2018-to-2022-followed-up-to-2023
10. NHS England. Cancer survival by deprivation – adults (Cancer Survival in England, cancers diagnosed 2018 to 2022). NHS England Digital, 2026. digital.nhs.uk/…/cancer-survival-by-deprivation
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12. Shimizu K, Saito MK, Maringe C, Miyazaki Y, Rachet B. Socioeconomic inequality in treatment of acute myeloid leukaemia (AML) in England, 2015–2022: a population-based study. British Journal of Haematology, 2026. europepmc.org/article/MED/42452790
13. Hagström H, et al. Socioeconomic inequalities in receipt of curative-intent treatment and survival after surveillance-detected hepatocellular carcinoma: a nationwide cohort study. Alimentary Pharmacology & Therapeutics, 2026. europepmc.org/article/MED/42198836
14. Okon M, Han X, Zhao J, et al. Medicaid expansion and place-based disparities in non-small cell lung cancer diagnosis and survival. JAMA Network Open, 2026. europepmc.org/article/MED/42518237
15. Schafer EJ, Johnson CJ, Moraes FY, et al. Association between Medicaid expansion and 5-year survival among individuals diagnosed with cancer. Cancer Discovery, 2025. europepmc.org/article/MED/41058031