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Journal of Public Health Advance Access published online on June 19, 2008
Journal of Public Health, doi:10.1093/pubmed/fdn044
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© The Author 2008, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved

Using funnel plots to explore variation in cancer mortality across primary care trusts in South-East England


Elizabeth Davies, Senior Lecturer in Cancer Registration1
Vivian Mak, Information Analyst1
Jamie Ferguson, Consultant in Public Health Medicine2
Stephen Conaty, Consultant in Public Health Medicine3
Henrik Møller, Director and Professor of Cancer Epidemiology1

1 King's College London, Thames Cancer Registry, 42 Weston Street, London SE1 3QD, UK
2 Lambeth Primary Care Trust, Department of Public Health, 1 Lower Marsh, London SE1 7NT, UK
3 Islington Primary Care Trust, 338-346 Goswell Road, London EC1V 7LQ, UK


Address correspondence to E. A. Davies, E-mail: elizabeth.davies{at}kcl.ac.uk


  Abstract

Background In 2004, the English government set a target to reduce the difference in cancer mortality in those aged under 75 between spearhead primary care trusts (PCTs) and all others by 6% in 2010.

Methods We used mortality data for 2002–04 to calculate the age-standardized cancer mortality rates in 11 spearhead and 65 non-spearhead PCTs in South-East England. We calculated the ratio of each rate to that for England and Wales overall, and plotted these within funnel plots.

Results Age-standardized cancer mortality ratios for males varied widely. The 11 spearhead PCTs had the highest mortality and six fell outside three standard deviations of the distribution of the funnel. Removing mortality due to lung cancer greatly reduced this variation and caused the outliers to shift down within the normal range. Ratios for females showed less variation, although those for spearheads were higher. One high outlier was unaffected by removing mortality due to lung cancer, other smoking-related cancers or breast cancer.

Conclusion Current variation in PCT cancer mortality is materially influenced by past patterns of smoking in men but less so in women. Effective smoking cessation policies should decrease inequalities in male cancer mortality, but will take time and be less effective in decreasing female inequalities.

Keywords: cancer, epidemiology, statistics


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