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We developed a population-based multilevel study. Data were drawn from nine Spanish population-based cancer registries (Albacete, Bizkaia, Castellón, Cuenca, Girona, Gipuzkoa, Granada, Navarra, and Tarragona) that participated in the European High Resolution Studies (TRANSCAN-HIGHCARE project within ERA-Net) [7]. Supplementary Figure S1 shows the location, within peninsular Spain, of the nine provinces of the study. Colorectal, lung, and breast cancer cases >18 years and diagnosed during the period 2010–2013 by census tract level, including their age, sex, and year of diagnosis, were included in the study. Case codes were C18–C21 with malignant behavior (/3) for colorectal, C34.0–C34.9 with malignant behavior (/3) for lung, and C50.0–C50.9 with malignant behavior (/3) or in situ (/2) for breast cancer among females according to the topography code of the International Classification of Diseases for Oncology, 3rd Edition [8]. Colorectal cancer data were used in a previous work to assess socioeconomic inequalities (measured with SDI) on survival in Spain [9].

Population-based figures broken down by census tract level, age, calendar year, and sex were obtained from the Spanish Statistical Office. The SDI was created by Duque et al. [6] using data from the Spanish 2011 census conducted by the Spanish National Statistics Institute. The index includes information from six indicators mainly related to employment and education: percentage of manual workers (employed or unemployed), percentage of occasional workers (employed or unemployed), percentage of the population with insufficient education, and percentage of main homes without internet access [6]. The index has no direct information about income, but in the sensitivity analysis, we found a direct association between SDI and average income per census tract [10] (Supplementary Figure S2). We used the SDI divided in quintiles (Q), where Q5 represents the most deprived areas and Q1 the least deprived areas.

The internal review board of the Andalusian School of Public Health (CP17/00206) and the biomedical ethics committee of the Department of Health of the Andalusian Regional Government (study 0072-N-18) approved the study protocol.

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