Socioeconomic Effect of Education on Pancreatic Cancer Risk in Western Europe: An Update on the EPIC Cohorts Study
Year: 2019
Type: article
Abstract: 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.
Authors: Lluís Cirera, José María Huerta, María Dolores Chirlaque, Kim Overvad, Martin Lindström, Sara Regnér, Anne Tjønneland, Marie-Christine Boutron-Ruault, Vinciane Rebours, Guy Fagherazzi, Verena A. Katzke, Heiner Boeing, Eleni Peppa, Antonia Trichopoulou, Elissavet Valanou, Domenico Palli, Sara Grioni, Salvatore Panico, Rosario Tumino, Fulvio Ricceri, Carla van Gils, Roel C.H. Vermeulen, Guri Skeie, Tonje Braaten, Elisabete Weiderpass, Susana Merino, María José Sánchez, Nerea Larrañaga, Eva Ardanaz, Malin Sund, Kay-Tee Khaw, Timothy J. Key, Mazda Jenab, Sabine Naudin, Neil Murphy, Dagfinn Aune, Heather Ward, Elio Riboli, Bas Bueno-de-Mesquita, Carmen Navarro, Eric J. Duell
Institutions: Instituto Murciano de Investigación Biosanitaria, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Universidad de Murcia, Aarhus University, Lund University, University of Copenhagen, Danish Cancer Society, Université Paris-Sud, Inserm, Université de Versailles Saint-Quentin-en-Yvelines, Université Paris-Saclay, Institut Gustave Roussy, Centre de recherche en Epidémiologie et Santé des Populations, Hôpital Beaujon, Centre de Recherche sur l'Inflammation, German Cancer Research Center, German Institute of Human Nutrition, Hellenic Health Foundation, Fondazione IRCCS Istituto Nazionale dei Tumori, Federico II University Hospital, University of Naples Federico II, University of Turin, University Medical Center Utrecht, Utrecht University, UiT The Arctic University of Norway, University of Helsinki, Karolinska Institutet, Cancer Registry of Norway, Folkhälsans Forskningscentrum, Gobierno del Principado de Asturias, Universidad de Granada, Instituto de Investigación Biosanitaria de Granada, Andalusian School of Public Health, Basque Government, Instituto de Salud Pública de Navarra, Navarre Institute of Health Research, University of Cambridge, Addenbrooke's Hospital, University of Oxford, Centre international de recherche sur le cancer, Imperial College London, University of Malaya, National Institute for Public Health and the Environment, Institut d'Investigació Biomédica de Bellvitge, Institut Català d'Oncologia
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2948958067