Selected cancers with increasing mortality rates by educational attainment in 26 states in the United States, 1993-2007.
BACKGROUND
Mortality rates continue to increase for liver, esophagus, and pancreatic cancers in non-Hispanic whites and for liver cancer in non-Hispanic blacks. However, the extent to which trends vary by socioeconomic status (SES) is unknown.


METHODS
We calculated age-standardized death rates for liver, esophagus, and pancreas cancers for non-Hispanic whites and non-Hispanic blacks aged 25-64 years by sex and level of education (≤12, 13-15, and ≥16 years, as a SES proxy) during 1993-2007 using mortality data from 26 states with consistent education information on death certificates. Temporal trends were evaluated using log-linear regression, and rate ratios (RRs) with 95 % confidence intervals (CIs) compared death rates in persons with ≤12 versus ≥16 years of education.


RESULTS
Generally, death rates increased for cancers of the liver, esophagus, and pancreas in non-Hispanic whites and non-Hispanic blacks (liver cancer only) with ≤12 and 13-15 years of education, with steeper increases in the least educated group. In contrast, rates remained stable in persons with ≥16 years of education. During 1993-2007, the RR (rates in ≤12 versus ≥16 years of education) increased for all three cancers, particularly for liver cancer among men which increased from 1.76 (95 % CI, 1.38-2.25) to 3.23 (95 % CI, 2.78-3.75) in non-Hispanic whites and from 1.28 (95 % CI, 0.71-2.30) to 3.64 (95 % CI, 2.44-5.44) in non-Hispanic blacks.


CONCLUSIONS
The recent increase in mortality rates for liver, esophagus, and pancreatic cancers in non-Hispanic whites and for liver cancer in non-Hispanic blacks reflects increases among those with lower education levels.
Surveillance Research Program, American Cancer Society, 250 Williams Street NW, Atlanta, GA 30303, USA. ajemal@cancer.org
Ahmedin
A
Jemal
Edgar P
EP
Simard
Jiaquan
J
Xu
Jiemin
J
Ma
Robert N
RN
Anderson
D000328:Adult; D004067:Digestive System Neoplasms / Q000208:ethnology / Q000401:mortality*; D004522:Educational Status; D004938:Esophageal Neoplasms / Q000208:ethnology / Q000401:mortality; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008113:Liver Neoplasms / Q000208:ethnology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D010190:Pancreatic Neoplasms / Q000208:ethnology / Q000401:mortality; D012307:Risk Factors; D012923:Social Class; D014481:United States / Q000453:epidemiology