title: Education level and survival after oesophageal cancer surgery: a prospective population-based cohort study.
abstract: OBJECTIVE
  This study aimed to investigate whether a higher education level is associated with an improved long-term survival after oesophagectomy for cancer.
  
  
  METHODS
  A prospective, population-based cohort study.
  
  
  METHODS
  Sweden-nationwide.
  
  
  METHODS
  90% of all patients with oesophageal and cardia cancer who underwent a resection in Sweden in 2001-2005 were enrolled in this study (N=600; 80.3% male) and followed up until death or the end of the study period (2012). The study exposure was level of education, defined as compulsory (≤9 years), moderate (10-12 years) or high (≥13 years).
  
  
  METHODS
  The main outcome measure was overall 5-year survival after oesophagectomy. Cox regression was used to estimate the associations between education level and mortality, expressed as HRs with 95% CIs, with adjustment for sex, age, tumour stage, histological type, complications, comorbidities and annual surgeon volume. The patient group with highest education was used as the reference category.
  
  
  RESULTS
  Among the 600 included patients, 281 (46.8%) had compulsory education, 238 (39.7%) had moderate education and 81 (13.5%) had high education. The overall 5-year survival rate was 23.1%, 24.4% and 32.1% among patients with compulsory, moderate and high education, respectively. After adjustment for confounders, a slightly higher, yet not statistically significantly increased point HR was found among the compulsory educated patients (HR 1.08, 95% CI 0.80 to 1.47). In patients with tumour stage IV, increased adjusted HRs were found for compulsory (HR 2.88, 95% CI 1.07 to 7.73) and moderately (HR 2.83, 95% CI 1.15 to 6.95) educated patients. No statistically significant associations were found for the other tumour stages.
  
  
  CONCLUSIONS
  This study provides limited evidence of an association between lower education and worse long-term survival after oesophagectomy for cancer.
authors.affiliation: Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Nele
authors.initials: N
authors.lastname: Brusselaers
authors.forename: Rickard
authors.initials: R
authors.lastname: Ljung
authors.forename: Fredrik
authors.initials: F
authors.lastname: Mattsson
authors.forename: Asif
authors.initials: A
authors.lastname: Johar
authors.forename: Anna
authors.initials: A
authors.lastname: Wikman
authors.forename: Pernilla
authors.initials: P
authors.lastname: Lagergren
authors.forename: Jesper
authors.initials: J
authors.lastname: Lagergren