No association between educational level and pancreatic cancer incidence in the European Prospective Investigation into Cancer and Nutrition |
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| Authors: | Petra G.A. van Boeckel Hendriek C. Boshuizen Peter D. Siersema Alina Vrieling Anton E. Kunst Weimin Ye Malin Sund Dominique S. Michaud Valentina Gallo Elizabeth A. Spencer Antonia Trichopoulou Vasiliki Benetou Philippos Orfanos Lluis Cirera Eric J. Duell Sabine Rohrmann Silke Hemann Giovanni Masala Jonas Manjer Amalia Mattiello B. Bueno-de-Mesquita |
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| Affiliation: | 1. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States;2. Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States;3. US Outcomes Research, US Medical Affairs, Merck & Co., North Wales, PA, United States;4. Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States;5. Department of Epidemiology Biostatistics, School of Public Health, Imperial College, London, UK;6. Department of Medicine and Oncology, Cancer Prevention Research Unit, Lady Davis Research Institute of Jewish General Hospital, McGill University, Montreal, Quebec, Canada;7. Channing Division of Network Medicine, Department of Medicine, Brigham and Women''s Hospital, Harvard Medical School, Boston, MA, United States |
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| Abstract: | Introduction: Until now, studies examining the relationship between socioeconomic status and pancreatic cancer incidence have been inconclusive. Aim: To prospectively investigate to what extent pancreatic cancer incidence varies according to educational level within the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Methods: In the EPIC study, socioeconomic status at baseline was measured using the highest level of education attained. Hazard ratios by educational level and a summary index, the relative indices of inequality (RII), were estimated using Cox regression models stratified by age, gender, and center and adjusted for known risk factors. In addition, we conducted separate analyses by age, gender and geographical region. Results: Within the source population of 407, 944 individuals at baseline, 490 first incident primary pancreatic adenocarcinoma cases were identified in 9 European countries. The crude difference in risk of pancreatic cancer according to level of education was small and not statistically significant (RII = 1.14, 95% CI 0.80–1.62). Adjustment for known risk factors reduced the inequality estimates to only a small extent. In addition, no statistically significant associations were observed for age groups (adjusted RII≤ 60 years = 0.85, 95% CI 0.44–1.64, adjusted RII>60 years = 1.18, 95% CI 0.73–1.90), gender (adjusted RIImale = 1.20, 95% CI 0.68–2.10, adjusted RIIfemale = 0.96, 95% CI 0.56–1.62) or geographical region (adjusted RIINorthern Europe = 1.14, 95% CI 0.81–1.61, adjusted RIIMiddle Europe = 1.72, 95% CI 0.93–3.19, adjusted RIISouthern Europe = 0.75, 95% CI 0.32–1.80). Conclusion: Despite large educational inequalities in many risk factors within the EPIC study, we found no evidence for an association between educational level and the risk of developing pancreatic cancer in this European cohort. |
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