TY - JOUR
T1 - Socioeconomic effect of education on pancreatic cancer risk in western Europe
T2 - An update on the EPIC cohorts study
AU - Cirera, Lluís
AU - Huerta, Jose María
AU - Chirlaque, María Dolores
AU - Overvad, Kim
AU - Lindstrom, Martin
AU - Regner, Sara
AU - Tjønneland, Anne
AU - Boutron-Ruault, Marie Christine
AU - Rebours, Vinciane
AU - Fagherazzi, Guy
AU - Katzke, Verena A.
AU - Boeing, Heiner
AU - Peppa, Eleni
AU - Trichopoulou, Antonia
AU - Valanou, Elissavet
AU - Palli, Domenico
AU - Grioni, Sara
AU - Panico, Salvatore
AU - Tumino, Rosario
AU - Ricceri, Fulvio
AU - Van Gils, Carla
AU - Vermeulen, Roel C.H.
AU - Skeie, Guri
AU - Braaten, Tonje
AU - Weiderpass, Elisabete
AU - Merino, Susana
AU - Sanchez, María Jose
AU - Larranaga, Nerea
AU - Ardanaz, Eva
AU - Sund, Malin
AU - Khaw, Kay Tee
AU - Key, Timothy J.
AU - Jenab, Mazda
AU - Naudin, Sabine
AU - Murphy, Neil
AU - Aune, Dagfinn
AU - Ward, Heather
AU - Riboli, Elio
AU - Bueno-De-Mesquita, Bas
AU - Navarro, Carmen
AU - Duell, Eric J.
N1 - Publisher Copyright:
© 2019 American Association for Cancer Research.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85067195833&partnerID=8YFLogxK
U2 - 10.1158/1055-9965.EPI-18-1153
DO - 10.1158/1055-9965.EPI-18-1153
M3 - Article
C2 - 31160392
AN - SCOPUS:85067195833
SN - 1055-9965
VL - 28
SP - 1089
EP - 1092
JO - Cancer Epidemiology Biomarkers and Prevention
JF - Cancer Epidemiology Biomarkers and Prevention
IS - 6
ER -