Socioeconomic Effect of Education on Pancreatic Cancer Risk in Western Europe: An Update on the EPIC Cohorts Study

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  • Lluís Cirera, Department of Health and Social Sciences, University of Murcia, Murcia, Spain., Spanien
  • José María Huerta, CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain., Spanien
  • María Dolores Chirlaque, Department of Health and Social Sciences, University of Murcia, Murcia, Spain., Spanien
  • Kim Overvad
  • Martin Lindström, Department of Clinical Sciences, Social Medicine and Health Policy, Lund University, Malmö, Sweden., Sverige
  • Sara Regnér, Department of Clinical Sciences, Social Medicine and Health Policy, Lund University, Malmö, Sweden., Sverige
  • Anne Tjønneland, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark., Danmark
  • Marie-Christine Boutron-Ruault, Department of Medicine Institute Gustave Roussy, Gustave Roussy and Paris-Sud University, Villejuif Paris-Sud, France., Frankrig
  • Vinciane Rebours, INSERM - UMR 1149, University Paris 7, France., Frankrig
  • Guy Fagherazzi, Department of Medicine Institute Gustave Roussy, Gustave Roussy and Paris-Sud University, Villejuif Paris-Sud, France., Frankrig
  • Verena A Katzke, German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, 69120 Heidelberg, Germany. V.Katzke@Dkfz-Heidelberg.de., Tyskland
  • Heiner Boeing, Department of Epidemiology, German Institute of Human Nutrition (DIfE) 14558 Potsdam-Rehbrücke, Nuthetal, Germany., Tyskland
  • Eleni Peppa, Hellenic Health Foundation, Athens, Greece., Grækenland
  • Antonia Trichopoulou, Hellenic Health Foundation, Athens, Greece., Grækenland
  • Elissavet Valanou, Hellenic Health Foundation, Athens, Greece., Grækenland
  • Domenico Palli, Cancer Risk Factors and Life-Style Epidemiology Unit. Institute for Cancer Research, Prevention and Clinical Network - ISPRO, 50141, Florence, Italy., Italien
  • Sara Grioni, Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy., Italien
  • Salvatore Panico, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Federico II University, Naples, Italy., Italien
  • Rosario Tumino, Cancer Registry and Histopathology Department, "Civic M.P. Arezzo" Hospital, ASP, Ragusa, Italy., Italien
  • Fulvio Ricceri, Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Turin, Italy., Italien
  • Carla van Gils, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands., Holland
  • Roel C H Vermeulen, Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands., Holland
  • Guri Skeie, Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway., Norge
  • Tonje Braaten, Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway., Norge
  • Elisabete Weiderpass, Genetic Epidemiology Group, Folkhälsan Research Center and Faculty of Medicine, University of Helsinki, 00014 Helsinkiv, Finland. Elisabete.Weiderpass@kreftregisteret.no., Norge
  • Susana Merino, Public Health Directorate, Regional Government of Asturias, Oviedo, Spain., Spanien
  • María José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, 18014 Granada, Spain., Spanien
  • Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain., Spanien
  • Eva Ardanaz, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain., Spanien
  • Malin Sund, Department of Public Health; Aarhus University, Denmark., Danmark
  • Kay-Tee Khaw, University of Cambridge, School of Clinical Medicine, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0SP, United Kingdom., Storbritannien
  • Timothy J Key, Cancer Epidemiology Unit, Nuffield Department of Population Health University of Oxford, United Kingdom., Storbritannien
  • Mazda Jenab, Section of Nutrition and Metabolism, International Agency for Research on Cancer, World Health Organization, Lyon, France., Frankrig
  • Sabine Naudin, Section of Nutrition and Metabolism, International Agency for Research on Cancer, World Health Organization, Lyon, France., Frankrig
  • Neil Murphy, Section of Nutrition and Metabolism, International Agency for Research on Cancer, World Health Organization, Lyon, France., Frankrig
  • Dagfinn Aune, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom; National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia., Storbritannien
  • Heather Ward, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom; National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia., Storbritannien
  • Elio Riboli, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom; National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia., Storbritannien
  • Bas Bueno-de-Mesquita, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia., Malaysia
  • Carmen Navarro, Department of Health and Social Sciences, University of Murcia, Murcia, Spain., Spanien
  • Eric J Duell, Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), AvGran Via 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain., Spanien

BACKGROUND: To analyze the potential effect of social inequality on pancreatic cancer risk in Western Europe, by reassessing the association within the European Prospective Investigation into Cancer and Nutrition (EPIC) Study, including a larger number of cases and an extended follow-up.

METHODS: Data on highest education attained were gathered for 459,170 participants (70% women) from 10 European countries. A relative index of inequality (RII) based on adult education was calculated for comparability across countries and generations. Cox regression models were applied to estimate relative inequality in pancreatic cancer risk, stratifying by age, gender, and center, and adjusting for known pancreatic cancer risk factors.

RESULTS: A total of 1,223 incident pancreatic cancer cases were included after a mean follow-up of 13.9 (±4.0) years. An inverse social trend was found in models adjusted for age, sex, and center for both sexes [HR of RII, 1.27; 95% confidence interval (CI), 1.02-1.59], which was also significant among women (HR, 1.42; 95% CI, 1.05-1.92). Further adjusting by smoking intensity, alcohol consumption, body mass index, prevalent diabetes, and physical activity led to an attenuation of the RII risk and loss of statistical significance.

CONCLUSIONS: The present reanalysis does not sustain the existence of an independent social inequality influence on pancreatic cancer risk in Western European women and men, using an index based on adult education, the most relevant social indicator linked to individual lifestyles, in a context of very low pancreatic cancer survival from (quasi) universal public health systems.

IMPACT: The results do not support an association between education and risk of pancreatic cancer.

OriginalsprogEngelsk
TidsskriftCancer Epidemiology, Biomarkers & Prevention
Vol/bind28
Nummer6
Sider (fra-til)1089-1092
Antal sider4
ISSN1055-9965
DOI
StatusUdgivet - jun. 2019

Bibliografisk note

©2019 American Association for Cancer Research.

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