The objective of this paper was to assess sex and socioeconomic inequalities in lung cancer mortality in two major cities of Europe and South America. Official information on mortality and population allowed the estimation of sex- and age-specific death rates for Barcelona, Spain and São Paulo, Brazil (1995–2003). Mortality trends and levels were independently assessed for each city and subsequently compared. Rate ratios assessed by Poisson regression analysis addressed hypotheses of association between the outcome and socioeconomic covariates (human development index, unemployment and schooling) at the inner-city area level. Barcelona had a higher mortality in men (76.9/100 000 inhabitants) than São Paulo (38.2/100 000 inhabitants); although rates were decreasing for the former (−2%/year) and levelled-off for the latter. Mortality in women ranked similarly (9.1 for Barcelona, 11.5 for São Paulo); with an increasing trend for women aged 35–64 years (+7.7%/year in Barcelona and +2.4%/year in São Paulo). The socioeconomic gradient of mortality in men was negative for Barcelona and positive for São Paulo; for women, the socioeconomic gradient was positive in both cities. Negative gradients indicate that deprived areas suffer a higher burden of disease; positive gradients suggest that prosmoking lifestyles may have been more prevalent in more affluent areas during the last decades. Sex and socioeconomic inequalities of lung cancer mortality reinforce the hypothesis that the epidemiologic profile of cancer can be improved by an expanded access to existing technology of healthcare and prevention. The continuous monitoring of inequalities in health may contribute to the concurrent promotion of well-being and social justice.