Socioeconomic position and the risk of gastric and oesophageal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC-EURGAST).

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 520 000 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): 0.43-0.98]. 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.

[1]  F. Clavel-Chapelon,et al.  CagA+ Helicobacter pylori infection and gastric cancer risk in the EPIC‐EURGAST study , 2007, International journal of cancer.

[2]  F. Clavel-Chapelon,et al.  Fruit and vegetable intake and the risk of stomach and oesophagus adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition (EPIC–EURGAST) , 2006, International journal of cancer.

[3]  O. Nyrén,et al.  Socioeconomic Factors and Risk of Esophageal Adenocarcinoma: A Nationwide Swedish Case-Control Study , 2005, Cancer Epidemiology Biomarkers & Prevention.

[4]  D. Shahar,et al.  Diet and eating habits in high and low socioeconomic groups. , 2005, Nutrition.

[5]  C Borrell,et al.  Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries. , 2005, International journal of epidemiology.

[6]  J. Ferlay,et al.  Global Cancer Statistics, 2002 , 2005, CA: a cancer journal for clinicians.

[7]  Giuseppe Costa,et al.  Educational inequalities in cause-specific mortality in middle-aged and older men and women in eight western European populations , 2005, The Lancet.

[8]  M. Wong,et al.  Correlated measurement error--implications for nutritional epidemiology. , 2004, International journal of epidemiology.

[9]  S. Schroeder,et al.  Class - the ignored determinant of the nation's health. , 2004, The New England journal of medicine.

[10]  A. Neugut,et al.  Epidemiology of upper gastrointestinal malignancies. , 2004, Seminars in oncology.

[11]  P. Martikainen,et al.  Pathways between socioeconomic determinants of health , 2004, Journal of Epidemiology and Community Health.

[12]  M. Blaser,et al.  Population attributable risks of esophageal and gastric cancers. , 2003, Journal of the National Cancer Institute.

[13]  N E Day,et al.  European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection , 2002, Public Health Nutrition.

[14]  Susan L Ettner,et al.  Contribution of major diseases to disparities in mortality. , 2002, The New England journal of medicine.

[15]  L. J. Hayes,et al.  Sampling variability of the Kunst-Mackenbach relative index of inequality , 2002, Journal of epidemiology and community health.

[16]  A. Helicobacter,et al.  Gastric cancer and Helicobacter pylori: a combined analysis of 12 case control studies nested within prospective cohorts , 2001, Gut.

[17]  M. Martínez-González,et al.  A systematic review of socio-economic differences in food habits in Europe: consumption of fruit and vegetables , 2000, European Journal of Clinical Nutrition.

[18]  L. Hansson,et al.  Decreasing incidence of both major histologic subtypes of gastric adenocarcinoma – a population-based study in Sweden , 2000, British Journal of Cancer.

[19]  P. McKinney,et al.  Socioeconomic status and risk of adenocarcinoma of the oesophagus and cancer of the gastric cardia in Scotland , 2000, British Journal of Cancer.

[20]  R. Goldbohm,et al.  Socioeconomic status and stomach cancer incidence in men: results from The Netherlands Cohort Study. , 1998, Journal of epidemiology and community health.

[21]  M. Gammon,et al.  Tobacco, alcohol, and socioeconomic status and adenocarcinomas of the esophagus and gastric cardia. , 1997, Journal of the National Cancer Institute.

[22]  Elio Riboli,et al.  The EPIC Project: Rationale and study design , 1997 .

[23]  E. Brunner,et al.  Socio-economic differentials in health: The role of nutrition , 1997, Proceedings of the Nutrition Society.

[24]  J. Mackenbach,et al.  Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe. , 1997, Social science & medicine.

[25]  M. Blaser,et al.  Infection with Helicobacter pylori strains possessing cagA is associated with an increased risk of developing adenocarcinoma of the stomach. , 1995, Cancer research.

[26]  G. Costa,et al.  Cancer risk and social inequalities in Italy. , 1994, Journal of epidemiology and community health.

[27]  R. Hayes,et al.  Adenocarcinoma of the esophagus and esophagogastric junction in White men in the United States: alcohol, tobacco, and socioeconomic factors , 1994, Cancer Causes & Control.

[28]  H. Adami,et al.  Tobacco, alcohol and the risk of gastric cancer. A population‐based case‐control study in Sweden , 1994, International journal of cancer.

[29]  S. Bianchi,et al.  A case-control study of cancers of the gastric cardia in Italy. , 1992, British Journal of Cancer.

[30]  S. Y. Choi,et al.  Effect of cigarette smoking and alcohol consumption in the etiology of cancers of the digestive tract , 1991, International journal of cancer.

[31]  C. McConkey,et al.  Increasing incidence of adenocarcinoma of the gastric cardia and adjacent sites. , 1990, British Journal of Cancer.

[32]  T. Mack,et al.  Life-style, workplace, and stomach cancer by subsite in young men of Los Angeles County. , 1990, Cancer research.

[33]  C. la Vecchia,et al.  Socioeconomic indicators, tobacco and alcohol in the aetiology of digestive tract neoplasms. , 1989, International journal of epidemiology.

[34]  W. Jędrychowski,et al.  A case‐control study of dietary factors and stomach cancer risk in Poland , 1986, International journal of cancer.

[35]  E. Pukkala,et al.  Socioeconomic status and education as risk determinants of gastrointestinal cancer. , 1986, Preventive medicine.

[36]  J M Robins,et al.  Confounding and misclassification. , 1985, American journal of epidemiology.

[37]  P. Laurén,et al.  THE TWO HISTOLOGICAL MAIN TYPES OF GASTRIC CARCINOMA: DIFFUSE AND SO-CALLED INTESTINAL-TYPE CARCINOMA. AN ATTEMPT AT A HISTO-CLINICAL CLASSIFICATION. , 1965, Acta pathologica et microbiologica Scandinavica.

[38]  R. Labianca,et al.  Gastric cancer. , 2009, Critical reviews in oncology/hematology.

[39]  M. Plummer,et al.  Epidemiology of gastric cancer. , 2004, IARC scientific publications.

[40]  植田 美津恵 Helicobacter pylori risk associated with childhood home environment , 2004 .

[41]  J. R. Kelley,et al.  Gastric cancer epidemiology and risk factors. , 2003, Journal of clinical epidemiology.

[42]  A. Jemal,et al.  Global cancer statistics , 2011, CA: a cancer journal for clinicians.

[43]  P. Boffetta Infection with Helicobacter pylori and parasites, social class and cancer. , 1997, IARC scientific publications.

[44]  David R. Williams,et al.  Measuring social class in US public health research: concepts, methodologies, and guidelines. , 1997, Annual review of public health.

[45]  E Riboli,et al.  The EPIC Project: rationale and study design. European Prospective Investigation into Cancer and Nutrition. , 1997, International journal of epidemiology.