TY - JOUR
T1 - Educational level and risk of colorectal cancer in EPIC with specific reference to tumor location
AU - Leufkens, Anke M.
AU - van Duijnhoven, Fränzel J. B.
AU - Boshuizen, Hendriek C.
AU - Siersema, Peter D.
AU - Kunst, Anton E.
AU - Mouw, Traci
AU - Tjønneland, Anne
AU - Olsen, Anja
AU - Overvad, Kim
AU - Boutron-Ruault, Marie-Christine
AU - Clavel-Chapelon, Françoise
AU - Morois, Sophie
AU - Krogh, Vittorio
AU - Tumino, Rosario
AU - Panico, Salvatore
AU - Polidoro, Silvia
AU - Palli, Domenico
AU - Kaaks, Rudolf
AU - Teucher, Birgit
AU - Pischon, Tobias
AU - Trichopoulou, Antonia
AU - Orfanos, Philippos
AU - Goufa, Ioulia
AU - Peeters, Petra H. M.
AU - Skeie, Guri
AU - Braaten, Tonje
AU - Rodríguez, Laudina
AU - Lujan-Barroso, Leila
AU - Sánchez-Pérez, Maria-José
AU - Navarro, Carmen
AU - Barricarte, Aurelio
AU - Zackrisson, Sophia
AU - Almquist, Martin
AU - Hallmans, Goran
AU - Palmqvist, Richard
AU - Tsilidis, Konstantinos K.
AU - Khaw, Kay-Tee
AU - Wareham, Nick
AU - Gallo, Valentina
AU - Jenab, Mazda
AU - Riboli, Elio
AU - Bueno-de-Mesquita, H. Bas
PY - 2012
Y1 - 2012
N2 - Existing evidence is inconclusive on whether socioeconomic status (SES) and educational inequalities influence colorectal cancer (CRC) risk, and whether low or high SES/educational level is associated with developing CRC. The aim of our study was to investigate the relationship between educational level and CRC. We studied data from 400,510 participants in the EPIC (European Prospective Investigation into Cancer and Nutrition) study, of whom 2,447 developed CRC (colon: 1,551, rectum: 896, mean follow-up 8.3 years). Cox proportional hazard regression analysis stratified by age, gender and center, and adjusted for potential confounders were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI). Relative indices of inequality (RII) for education were estimated using Cox regression models. We conducted separate analyses for tumor location, gender and geographical region. Compared with participants with college/university education, participants with vocational secondary education or less had a nonsignificantly lower risk of developing CRC. When further stratified for tumor location, adjusted risk estimates for the proximal colon were statistically significant for primary education or less (HR 0.73, 95% CI 0.57-0.94) and for vocational secondary education (HR 0.76, 95% CI 0.58-0.98). The inverse association between low education and CRC risk was particularly found in women and Southern Europe. These associations were statistically significant for CRC, for colon cancer and for proximal colon cancer. In conclusion, CRC risk, especially in the proximal colon, is lower in subjects with a lower educational level compared to those with a higher educational level. This association is most pronounced in women and Southern Europe
AB - Existing evidence is inconclusive on whether socioeconomic status (SES) and educational inequalities influence colorectal cancer (CRC) risk, and whether low or high SES/educational level is associated with developing CRC. The aim of our study was to investigate the relationship between educational level and CRC. We studied data from 400,510 participants in the EPIC (European Prospective Investigation into Cancer and Nutrition) study, of whom 2,447 developed CRC (colon: 1,551, rectum: 896, mean follow-up 8.3 years). Cox proportional hazard regression analysis stratified by age, gender and center, and adjusted for potential confounders were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI). Relative indices of inequality (RII) for education were estimated using Cox regression models. We conducted separate analyses for tumor location, gender and geographical region. Compared with participants with college/university education, participants with vocational secondary education or less had a nonsignificantly lower risk of developing CRC. When further stratified for tumor location, adjusted risk estimates for the proximal colon were statistically significant for primary education or less (HR 0.73, 95% CI 0.57-0.94) and for vocational secondary education (HR 0.76, 95% CI 0.58-0.98). The inverse association between low education and CRC risk was particularly found in women and Southern Europe. These associations were statistically significant for CRC, for colon cancer and for proximal colon cancer. In conclusion, CRC risk, especially in the proximal colon, is lower in subjects with a lower educational level compared to those with a higher educational level. This association is most pronounced in women and Southern Europe
U2 - https://doi.org/10.1002/ijc.26030
DO - https://doi.org/10.1002/ijc.26030
M3 - Article
C2 - 21412763
SN - 0020-7136
VL - 130
SP - 622
EP - 630
JO - International journal of cancer. Journal international du cancer
JF - International journal of cancer. Journal international du cancer
IS - 3
ER -