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

Research output: Contribution to journalArticle


title = "Socioeconomic Effect of Education on Pancreatic Cancer Risk in Western Europe: An Update on the EPIC Cohorts Study",
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.",
author = "Llu{\'i}s Cirera and Huerta, {Jos{\'e} Mar{\'i}a} and Chirlaque, {Mar{\'i}a Dolores} and Kim Overvad and Martin Lindstr{\"o}m and Sara Regn{\'e}r and Anne Tj{\o}nneland and Marie-Christine Boutron-Ruault and Vinciane Rebours and Guy Fagherazzi and Katzke, {Verena A} and Heiner Boeing and Eleni Peppa and Antonia Trichopoulou and Elissavet Valanou and Domenico Palli and Sara Grioni and Salvatore Panico and Rosario Tumino and Fulvio Ricceri and {van Gils}, Carla and Vermeulen, {Roel C H} and Guri Skeie and Tonje Braaten and Elisabete Weiderpass and Susana Merino and S{\'a}nchez, {Mar{\'i}a Jos{\'e}} and Nerea Larra{\~n}aga and Eva Ardanaz and Malin Sund and Kay-Tee Khaw and Key, {Timothy J} and Mazda Jenab and Sabine Naudin and Neil Murphy and Dagfinn Aune and Heather Ward and Elio Riboli and Bas Bueno-de-Mesquita and Carmen Navarro and Duell, {Eric J}",
note = "{\circledC}2019 American Association for Cancer Research.",
year = "2019",
doi = "10.1158/1055-9965.EPI-18-1153",
language = "English",
volume = "28",
pages = "1089--1092",
journal = "Cancer Epidemiology Biomarkers and Prevention",
issn = "1538-7755",
publisher = "American Association for Cancer Research",
number = "6",