No association between educational level and pancreatic cancer incidence in the European Prospective Investigation into Cancer and Nutrition.
BACKGROUND
Until now, studies examining the relationship between socioeconomic status and pancreatic cancer incidence have been inconclusive.


OBJECTIVE
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 RII(male)=1.20, 95% CI 0.68-2.10, adjusted RII(female)=0.96, 95% CI 0.56-1.62) or geographical region (adjusted RII(Northern Europe)=1.14, 95% CI 0.81-1.61, adjusted RII(Middle Europe)=1.72, 95% CI 0.93-3.19, adjusted RII(Southern Europe)=0.75, 95% CI 0.32-1.80).


CONCLUSIONS
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.
van Boeckel
Petra G A
PG
National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. p.g.a.vanboeckel@umcutrecht.nl
Boshuizen
Hendriek C
HC
Siersema
Peter D
PD
Vrieling
Alina
A
Kunst
Anton E
AE
Ye
Weimin
W
Sund
Malin
M
Michaud
Dominique S
DS
Gallo
Valentina
V
Spencer
Elizabeth A
EA
Trichopoulou
Antonia
A
Benetou
Vasiliki
V
Orfanos
Philippos
P
Cirera
Lluis
L
Duell
Eric J
EJ
Rohrmann
Sabine
S
Hemann
Silke
S
Masala
Giovanni
G
Manjer
Jonas
J
Mattiello
Amalia
A
Lindkvist
Bjorn
B
Sánchez
María-José
MJ
Pala
Valeria
V
Peeters
Petra H M
PH
Braaten
Tonje
T
Tjonneland
Anne
A
Dalton
Susanne Oksbjerg
SO
Larranaga
Nerea
N
Dorronsoro
Miren
M
Overvad
Kim
K
Illner
Anne-Kathrin
AK
Ardanaz
Eva
E
Marron
M
M
Straif
K
K
Riboli
E
E
Bueno-de-Mesquita
B
B
D000230:Adenocarcinoma / Q000453:epidemiology* / Q000473:pathology; D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000453:epidemiology* / Q000473:pathology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors