Open Access Open Badges Research article

The distribution of lung cancer across sectors of society in the United Kingdom: a study using national primary care data

Barbara Iyen-Omofoman1*, Richard B Hubbard12, Chris JP Smith1, Emily Sparks3, Emma Bradley3, Alison Bourke4 and Laila J Tata1

Author Affiliations

1 Division of Epidemiology and Public health, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, NG5 1PB, UK

2 Respiratory Biomedical Research Unit, University of Nottingham, UK

3 Experian, Landmark House, Experian Way, NG2 Business Park, Nottingham, NG80 1ZZ, UK

4 CSD Medical Research, 1 Canal Side Studios, 8-14 St Pancras way, London, NW1 OQG, UK

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BMC Public Health 2011, 11:857  doi:10.1186/1471-2458-11-857

Published: 10 November 2011



There is pressing need to diagnose lung cancer earlier in the United Kingdom (UK) and it is likely that research using computerised general practice records will help this process. Linkage of these records to area-level geo-demographic classifications may also facilitate case ascertainment for public health programmes, however, there have as yet been no extensive studies of data validity for such purposes.


To first address the need for validation, we assessed the completeness and representativeness of lung cancer data from The Health Improvement Network (THIN) national primary care database by comparing incidence and survival between 2000 and 2009 with the UK National Cancer Registry and the National Lung Cancer Audit Database. Secondly, we explored the potential of a geo-demographic social marketing tool to facilitate disease ascertainment by using Experian's Mosaic Public Sector ™ classification, to identify detailed profiles of the sectors of society where lung cancer incidence was highest.


Overall incidence of lung cancer (41.4/100, 000 person-years, 95% confidence interval 40.6-42.1) and median survival (232 days) were similar to other national data; The incidence rate in THIN from 2003-2006 was found to be just over 93% of the national cancer registry rate. Incidence increased considerably with area-level deprivation measured by the Townsend Index and was highest in the North-West of England (65.1/100, 000 person-years). Wider variations in incidence were however identified using Mosaic classifications with the highest incidence in Mosaic Public Sector ™types 'Cared-for pensioners, ' 'Old people in flats' and 'Dignified dependency' (191.7, 174.2 and 117.1 per 100, 000 person-years respectively).


Routine electronic data in THIN are a valid source of lung cancer information. Mosaic ™ identified greater incidence differentials than standard area-level measures and as such could be used as a tool for public health programmes to ascertain future cases more effectively.