Educational inequalities in cancer incidence and mortality in Lithuania: a record linkage study.
BACKGROUND
The aim of this study is to describe associations between incidence and mortality by major cancer sites and education in Lithuania.


METHODS
The study is based on the linkage between all records of the 2001 population census and all records from Lithuanian Cancer Registry (cancer incidence) and Statistics Lithuania (deaths) for the period between 1 July 2001 and 31 December 2004. Education-specific incidence and mortality rate ratios were estimated by means of multivariate Poisson regression models.


RESULTS
We found both the positive and inverse educational gradients in cancer incidence and mortality. The risk of developing cancer (all sites) was lower among men and women with the lowest education, whereas cancer mortality was higher among lower educated men. The higher educational level was also associated with an increased risk of prostate cancer among men and an increased risk of breast cancer among women. However, prostate cancer mortality was the highest in the lowest education group, whereas breast cancer mortality among women did not show any statistically significant differences. Lower educated men had significantly higher incidence and mortality due to lung and stomach cancers. Strikingly high incidence and mortality due to cervix cancer was observed among women with secondary and lower than secondary education.


CONCLUSIONS
The results point to inequalities in early diagnosis and survival from cancer and failures ensuring equal access to medical care. Further more in-depth studies are needed in order to understand the nature and determinants of these inequalities.
Lithuanian Cancer Registry, Institute of Oncology, Vilnius University, Vilnius, Lithuania. giedre.smailyte@vuoi.lt
Giedre
G
Smailyte
Domantas
D
Jasilionis
Dalia
D
Ambrozaitiene
Vlada
V
Stankuniene
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology; D002423:Cause of Death; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D015994:Incidence; D008097:Lithuania / Q000453:epidemiology; D008175:Lung Neoplasms / Q000453:epidemiology; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000145:classification / Q000453:epidemiology*; D011471:Prostatic Neoplasms / Q000453:epidemiology; D012042:Registries / Q000706:statistics & numerical data; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D013274:Stomach Neoplasms / Q000453:epidemiology; D015996:Survival Rate