title: No association between educational level and pancreatic cancer incidence in the European Prospective Investigation into Cancer and Nutrition.
abstract: 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.
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. p.g.a.vanboeckel@umcutrecht.nl
authors.forename: Petra G A
authors.initials: PG
authors.lastname: van Boeckel
authors.forename: Hendriek C
authors.initials: HC
authors.lastname: Boshuizen
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
authors.forename: Alina
authors.initials: A
authors.lastname: Vrieling
authors.forename: Anton E
authors.initials: AE
authors.lastname: Kunst
authors.forename: Weimin
authors.initials: W
authors.lastname: Ye
authors.forename: Malin
authors.initials: M
authors.lastname: Sund
authors.forename: Dominique S
authors.initials: DS
authors.lastname: Michaud
authors.forename: Valentina
authors.initials: V
authors.lastname: Gallo
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Spencer
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Benetou
authors.forename: Philippos
authors.initials: P
authors.lastname: Orfanos
authors.forename: Lluis
authors.initials: L
authors.lastname: Cirera
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Duell
authors.forename: Sabine
authors.initials: S
authors.lastname: Rohrmann
authors.forename: Silke
authors.initials: S
authors.lastname: Hemann
authors.forename: Giovanni
authors.initials: G
authors.lastname: Masala
authors.forename: Jonas
authors.initials: J
authors.lastname: Manjer
authors.forename: Amalia
authors.initials: A
authors.lastname: Mattiello
authors.forename: Bjorn
authors.initials: B
authors.lastname: Lindkvist
authors.forename: María-José
authors.initials: MJ
authors.lastname: Sánchez
authors.forename: Valeria
authors.initials: V
authors.lastname: Pala
authors.forename: Petra H M
authors.initials: PH
authors.lastname: Peeters
authors.forename: Tonje
authors.initials: T
authors.lastname: Braaten
authors.forename: Anne
authors.initials: A
authors.lastname: Tjonneland
authors.forename: Susanne Oksbjerg
authors.initials: SO
authors.lastname: Dalton
authors.forename: Nerea
authors.initials: N
authors.lastname: Larranaga
authors.forename: Miren
authors.initials: M
authors.lastname: Dorronsoro
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.forename: Anne-Kathrin
authors.initials: AK
authors.lastname: Illner
authors.forename: Eva
authors.initials: E
authors.lastname: Ardanaz
authors.forename: M
authors.initials: M
authors.lastname: Marron
authors.forename: K
authors.initials: K
authors.lastname: Straif
authors.forename: E
authors.initials: E
authors.lastname: Riboli
authors.forename: B
authors.initials: B
authors.lastname: Bueno-de-Mesquita
mesh_terms: 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