Educational inequality in cancer mortality: a record linkage study of over 35 million Italians

Abstract

Education is inversely associated with total cancer mortality, and the association was stronger in men. Different patterns and trends in tobacco smoking in men and women account for at least most of the gender differences.

Education and gastric cancer risk—An individual participant data meta‐analysis in the StoP project consortium

“…Our results are in agreement with previous case–control and cohort studies investigating the relation between SEP and GC risk. In the EPIC cohort study, high education was associated with a 36% reduced risk of GC (hazard ratio, HR 0.64, 95% CI, 0.43–0.98), and the effect was more pronounced for cardia (HR 0.42, 95% CI, 0.20–0.89) as compared to noncardia cancers (HR 0.66, 95% CI, 0.36–1.22) .…”

“…A Swedish cohort study including more than 4.7 million participants with follow‐up from 1991 to 2010 found a decreased incidence of cardia (incidence rate ratio [IRR] 0.74, 95% CI, 0.63–0.87) and noncardia GC (IRR 0.59, 95% CI, 0.54–0.66) among highly educated men, and among those above the highest quintile of household income (IRR 0.75, 95% CI, 0.65–0.86 for cardia GC, and IRR 0.79, 95% CI, 0.73–0.86 for noncardia GC), while in women the association emerged only for education, and was limited to noncardia GC (IRR 0.64, 95% CI, 0.56–0.73) . A strong inverse association emerged also in a recent large longitudinal Italian census‐based study reporting reduced mortality among highly educated individuals in both sexes, with standardized mortality ratio of 0.41 in men and 0.50 in women for the highest compared to the lowest level of education …”

“…42 A strong inverse association emerged also in a recent large longitudinal Italian census-based study reporting reduced mortality among highly educated individuals in both sexes, with standardized mortality ratio of 0.41 in men and 0.50 in women for the highest compared to the lowest level of education. 8 The disparities in GC risk among socioeconomic classes have been attributed to the uneven distribution of lifestyle risk factors for GC that favors people in the highest SEP, with differences in smoking, 44 alcohol drinking 45 and dietary habits 46 being thought to play a major role. However, when we adjusted for these risk factors, the magnitude of the association remained strong, suggesting that the reduced risk of GC associated with a high SEP operates through more complex pathways than those related to modifiable risk factors.…”

“…Gastric cancer (GC) is one of the neoplasms most strongly associated with low SEP . Almost 1 million new GC cases are diagnosed every year worldwide, and despite a steady fall in incidence over the last several decades, GC is still the third leading cause of cancer mortality…”

“…Gastric cancer (GC) is one of the neoplasms most strongly associated with low SEP. [5][6][7][8] Almost 1 million new GC cases are diagnosed every year worldwide, and despite a steady fall in incidence over the last several decades, GC is still the third leading cause of cancer mortality. 9 Thus, an accurate quantification of the impact of SEP on GC risk is of major importance to plan public health interventions aimed to reduce GC incidence and socioeconomic disparities.…”