The association between neighborhood socioeconomic status and lung cancer incidence and mortality risk: A systematic review and meta-analysis of cohort studies from North America, Europe, and Asia.

Abstract

This study aimed to synthesize evidence on the association between neighborhood socioeconomic status (n-SES) and lung cancer incidence and mortality risk. A systematic search of Web of Science (1900-), PubMed/MEDLINE (1948-), Scopus (1960-), Embase (1947-), and Cochrane (1993-) was conducted through March 18, 2026, without restrictions. Pooled relative effect estimates were calculated using random-effects models. Study quality was assessed via Newcastle-Ottawa Scale, and publication bias using Egger's regression asymmetry test and trim-and-fill. Included studies were conducted in North America, Europe, and Asia and involved 5,904,415 participants. Lower n-SES was associated with higher lung cancer incidence (pooled relative effect estimate = 1.33; 95% confidence interval [CI]: 1.05, 1.68; I² = 98.4%; p = 0.01; n = 8; low certainty) and mortality (pooled relative effect estimate = 1.17; 95% CI: 1.06, 1.30; I² = 99.4%; p < 0.01; n = 10; moderate certainty). Stronger incidence associations were observed among individuals <65 years and in European populations, whereas studies from the USA reported higher mortality risks than Asian or European cohorts. This study shows low n-SES is associated with higher lung cancer incidence and mortality. Policymakers may consider n-SES in cancer risk assessments and prioritize targeted interventions in disadvantaged neighborhoods, including enhanced screening, smoking cessation support, and community-based health promotion.