title: Educational level and risk of colorectal cancer in EPIC with specific reference to tumor location.
abstract: Existing evidence is inconclusive on whether socioeconomic status (SES) and educational inequalities influence colorectal cancer (CRC) risk, and whether low or high SES/educational level is associated with developing CRC. The aim of our study was to investigate the relationship between educational level and CRC. We studied data from 400,510 participants in the EPIC (European Prospective Investigation into Cancer and Nutrition) study, of whom 2,447 developed CRC (colon: 1,551, rectum: 896, mean follow-up 8.3 years). Cox proportional hazard regression analysis stratified by age, gender and center, and adjusted for potential confounders were used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI). Relative indices of inequality (RII) for education were estimated using Cox regression models. We conducted separate analyses for tumor location, gender and geographical region. Compared with participants with college/university education, participants with vocational secondary education or less had a nonsignificantly lower risk of developing CRC. When further stratified for tumor location, adjusted risk estimates for the proximal colon were statistically significant for primary education or less (HR 0.73, 95%CI 0.57-0.94) and for vocational secondary education (HR 0.76, 95%CI 0.58-0.98). The inverse association between low education and CRC risk was particularly found in women and Southern Europe. These associations were statistically significant for CRC, for colon cancer and for proximal colon cancer. In conclusion, CRC risk, especially in the proximal colon, is lower in subjects with a lower educational level compared to those with a higher educational level. This association is most pronounced in women and Southern Europe.
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands.
authors.forename: Anke M
authors.initials: AM
authors.lastname: Leufkens
authors.forename: Fränzel J B
authors.initials: FJ
authors.lastname: Van Duijnhoven
authors.forename: Hendriek C
authors.initials: HC
authors.lastname: Boshuizen
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
authors.forename: Anton E
authors.initials: AE
authors.lastname: Kunst
authors.forename: Traci
authors.initials: T
authors.lastname: Mouw
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.forename: Anja
authors.initials: A
authors.lastname: Olsen
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Boutron-Ruault
authors.forename: Françoise
authors.initials: F
authors.lastname: Clavel-Chapelon
authors.forename: Sophie
authors.initials: S
authors.lastname: Morois
authors.forename: Vittorio
authors.initials: V
authors.lastname: Krogh
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.forename: Salvatore
authors.initials: S
authors.lastname: Panico
authors.forename: Silvia
authors.initials: S
authors.lastname: Polidoro
authors.forename: Domenico
authors.initials: D
authors.lastname: Palli
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kaaks
authors.forename: Birgit
authors.initials: B
authors.lastname: Teucher
authors.forename: Tobias
authors.initials: T
authors.lastname: Pischon
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.forename: Philippos
authors.initials: P
authors.lastname: Orfanos
authors.forename: Ioulia
authors.initials: I
authors.lastname: Goufa
authors.forename: Petra H M
authors.initials: PH
authors.lastname: Peeters
authors.forename: Guri
authors.initials: G
authors.lastname: Skeie
authors.forename: Tonje
authors.initials: T
authors.lastname: Braaten
authors.forename: Laudina
authors.initials: L
authors.lastname: Rodríguez
authors.forename: Leila
authors.initials: L
authors.lastname: Lujan-Barroso
authors.forename: Maria-José
authors.initials: MJ
authors.lastname: Sánchez-Pérez
authors.forename: Carmen
authors.initials: C
authors.lastname: Navarro
authors.forename: Aurelio
authors.initials: A
authors.lastname: Barricarte
authors.forename: Sophia
authors.initials: S
authors.lastname: Zackrisson
authors.forename: Martin
authors.initials: M
authors.lastname: Almquist
authors.forename: Goran
authors.initials: G
authors.lastname: Hallmans
authors.forename: Richard
authors.initials: R
authors.lastname: Palmqvist
authors.forename: Konstantinos K
authors.initials: KK
authors.lastname: Tsilidis
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.forename: Nick
authors.initials: N
authors.lastname: Wareham
authors.forename: Valentina
authors.initials: V
authors.lastname: Gallo
authors.forename: Mazda
authors.initials: M
authors.lastname: Jenab
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
authors.forename: H Bas
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000453:epidemiology*; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012923:Social Class