Educational differences in incidence of cancer in Lithuania, 2001–2009

Abstract

This study used population-based census-linked cancer incidence data to identify patterns of educational differentials in the risk of cancer by detailed sites of cancer in Lithuania. The study is based on the linkage between all records of the 2001 population census, all records from the Lithuanian Cancer Registry (cancer incidence), and all death and emigration records from Statistics Lithuania for the period between 6 April 2001 and 31 December 2009. The study population (cohort) includes all permanent residents of Lithuania aged 30-74 years on the day of the census (6 April 2001). The study found that cancers of the lip, mouth, and pharynx, esophagus, stomach, larynx, urinary bladder, pancreas, and lung for men and cancers of the cervix uteri, lung, and colon for women show a statistically significant inverse educational gradient with excess incidence in the lowest educational group. At the same time, a reversed cancer risk gradient with the highest incidence for the higher education group was observed for thyroid cancer, melanoma, nonmelanoma skin cancers, and non-Hodgkin lymphomas. This group also includes prostate cancer, kidney cancer, and multiple myeloma for men and cancer of the pancreas, breast cancer, cancer of the colon, and cancer of the uterus for women. The associations between education and cancer incidence observed in this study reflect the concordance between social status and lifestyle-related risk factors for cancer. Cancer awareness in society has also contributed toward the observed higher risk of cancer, which is usually promoted more by patients with higher education.

Incidence and mortality of kidney cancers, and human development index in Asia; a matter of concern

“…Also, in United States, in the lowest level of education in the population, kidney cancer mortality rate is 2.6 times higher than the highest level of education (55). It was shown that risk of kidney cancer in men is inversely related to higher education levels (56). …”

Socioeconomic inequalities in cancer incidence in Europe: a comprehensive review of population-based epidemiological studies

“…53 Recent European registry-based studies that looked at the incidence of stomach cancer as a whole found about 1.5-times (range from 1.1 to about 2) increased risk in lower SES individuals, predominantly men. 16,19,[29][30][31][32]45,54,55 Rarely, no association could be confirmed for either sex. 17,25,29 There seem to be no major differences in terms of which SES indicator is used, though an Italian study, after adjusting for individuals' education, occupational class and housing characteristics, found no additional effect of area deprivation.…”

“…16,17,19,27,32,36,[45][46][47] Yet again, incidence in women seems to be less influenced by SES than in men. In several European countries, men of the lowest social standing or from the most deprived regions had between 1.3 to 3.0-times the risk of developing cancer of the oesophagus, whereas many studies found either less increased 45,46 or could not confirm an increased risk 17,19,32,47 for women, though even in the latter case the effect estimates were always positive, often with a discernible trend across SES categories. Given that different risk factors have been identified for the two major histological types, adenocarcinoma and squamous cell carcinoma (SCC), invaluable information comes from studies that investigated these subtypes and attempted to control for known risk factors in order to clarify to what extent they contribute to inequality.…”

“…With respect to individual level SES (Supplementary table 2), lowest education was associated with a more than threefold risk in certain studies (RR for men and women generally around 1.8 and 1.5, respectively). 13,14,[23][24][25][31][32][33]36 Very few studies have failed to confirm an increased risk, and only for women. 29,30 Occupational social class, the second most studied indicator of SES, is also a more prominent factor for men.…”

“…Many European studies have shown cancers of the upper aerodigestive tract (UADT) to be strongly associated with lower SES (Supplementary tables 4 and 5). [15][16][17][18][19]27,29,30,32,[36][37][38][39][40][41][42][43][44] As with lung cancer, the association is much stronger for men than women. In Italian 29,30 , Lithuanian 32 and multi-country European 42 studies for example, excess incidence of UADT and head and neck cancers among the lowest educated could only be confirmed for men.…”