Abstract
<title>Abstract</title> <p> <bold>Background:</bold> Cancer mortality remains a public health challenge in low- and middle-income settings, where sex-related inequalities may reflect differences in risk exposure, health-seeking behavior, access to services, and social determinants of health. This study assessed sex-related inequalities in age-standardized cancer mortality among adults aged ≥ 15 years across 50 low- and middle-income settings. <bold>Methods:</bold> This cross-sectional comparative study used 2019 secondary data from the World Health Organization Health Equity Assessment Toolkit, built-in database edition, version 7.0. The indicator was the age-standardized cancer mortality rate per 100,000 population among adults aged 15 years and older. Inequality was assessed using the absolute difference, calculated as the female estimate minus the male estimate, and the ratio, calculated as the female estimate divided by the male estimate. <bold>Results:</bold> Male cancer mortality exceeded female mortality in 34 of the 50 settings, whereas female mortality was higher in 16 settings. The mean mortality was 96.43 per 100,000 among females and 109.43 among males, with a mean setting average of 101.04. The average difference was -13.27, and the average ratio was 0.90, indicating a male disadvantage. Somalia showed the largest female disadvantage, with 142.32 among females and 93.24 among males, corresponding to a difference of 49.08 and a ratio of 1.53. Viet Nam showed the largest male disadvantage, with 78.73 among females and 161.93 among males, corresponding to a difference of -83.21 and ratio of 0.49. <bold>Conclusion:</bold> Sex-related inequalities in cancer mortality were evident across all settings. Routine sex-disaggregated surveillance and combined absolute and relative inequality measures are required to guide equity-oriented cancer control policies. <bold>Clinical trial number</bold> : Not applicable </p>