Socioeconomic positoon and the risk of gastric and overphageal cancer in the European Prospective into Cancer and Nutrition (EPIC-EURGAST)

Research output: Contribution to journalArticle


Objectives To evaluate the association of socioeconomic position with adenocarcinoma of the oesophagus and stomach. Methods The European Prospective Investigation into Cancer and Nutrition (EPIC) cohort comprises about 520000 participants mostly aged 35-70 years. Information on diet and lifestyle was collected at recruitment. After an average follow-up of 6.5 years, 268 cases with adenocarcinoma of the stomach and 56 of the oesophagus were confirmed. We examined the effect of socioeconomic position on cancer risk by means of educational data and a computed Relative Index of Inequality (RII). In a nested case-control study, adjustment for Helicobacter pylori (H. pylori) infection was performed. Results Higher education was significantly associated with a reduced risk of gastric cancer [vs lowest level of education, hazard ratio (HR): 0.64, 95% Confidence intervals (CI): 0.43-0.981. This effect was more pronounced for cancer of the cardia (HR: 0.42, 95% CI: 0.20-0.89) as compared to non-cardia gastric cancer (HR: 0.66, 95% CI: 0.36-1.22). Additionally, the inverse association of educational level and gastric cancer was stronger for cases with intestinal (extreme categories, HR: 0.13, 95% CI: 0.04-0.44) rather than diffuse histological subtype (extreme categories, HR: 0.71 95% CI: 0.37-1.40). In the nested case-control study, inverse but statistically non-significant associations were found after additional adjustment for H. pylori infection [highest vs lowest level of education: Odds ratio (OR) 0.53, 95% CI: 0.24-1.18]. Educational level was non-significantly, inversely associated with carcinoma of the oesophagus. Conclusion A higher socioeconomic position was associated with a reduced risk of gastric adenocarcinoma, which was strongest for cardia cancer or intestinal histological subtype, suggesting different risk profiles according to educational level. These effects appear to be explained only partially by established risk factors.


  • Gabriele Nagel
  • Jakob Linseisen
  • Hendriek C. Boshuizen
  • Guillem Pera
  • Giuseppe Del Giudice
  • Gert P. Westert
  • H. Bas Bueno-de-Mesquita
  • Naomi E. Allen
  • Timothy J. Key
  • Mattijs E. Numans
  • Petra H. M. Peeters
  • Sabina Sieri
  • Henrik Simán
  • Göran Berglund
  • Goran Hallmans
  • Roger Stenling
  • Carmen Martinez
  • Larraitz Arriola
  • Aurelio Barricarte
  • M. Dolores Chirlaque
  • And 24 others
  • Jose R. Quiros
  • Paolo Vineis
  • Giovanna Masala
  • Domenico Palli
  • Salvatore Panico
  • Rosario Tumino
  • Sheila Bingham
  • Heiner Boeing
  • Manuela M. Bergmann
  • Kim Overvad
  • Marie-Christine Boutron-Ruault
  • Francoise Clavel-Chapelon
  • Anja Olsen
  • Anne Tjormeland
  • Antonia Trichopoulou
  • Christina Bamia
  • Stavroula Soukara
  • Jean-Christoph Sabourin
  • Fatima Carneiro
  • Nadia Slimani
  • Mazda Jenab
  • Teresa Norat
  • Elio Riboli
  • Carlos A. Gonzalez
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Public Health, Global Health, Social Medicine and Epidemiology


  • Helicobacter pylori, socioeconomic position, gastric cancer, EPIC
Original languageEnglish
Pages (from-to)66-76
JournalInternational Journal of Epidemiology
Issue number1
Publication statusPublished - 2007
Publication categoryResearch