title: Does stage of cancer, comorbidity or lifestyle factors explain educational differences in survival after endometrial cancer? A cohort study among Danish women diagnosed 2005-2009.
abstract: BACKGROUND
  Several studies have documented an association between socioeconomic position and survival from gynaecological cancer, but the mechanisms are unclear.
  
  
  OBJECTIVE
  The aim of this study was to examine the association between level of education and survival after endometrial cancer among Danish women; and whether differences in stage at diagnosis and comorbidity contribute to the educational differences in survival.
  
  
  METHODS
  Women with endometrial cancer diagnosed between 2005 and 2009 were identified in the Danish Gynaecological Cancer Database, with information on clinical characteristics, surgery, body mass index (BMI) and smoking status. Information on highest attained education, cohabitation and comorbidity was obtained from nationwide administrative registries. Logistic regression models were used to determine the association between level of education and cancer stage and Cox proportional hazards model for analyses of overall survival.
  
  
  RESULTS
  Of the 3638 patients identified during the study period, 787 had died by the end of 2011. The group of patients with short education had a higher odds ratio (OR) for advanced stage at diagnosis, but this was not statistically significant (adjusted OR 1.20; 95% CI 0.97-1.49). The age-adjusted hazard ratio (HR) for dying of patients with short education was 1.47 (CI 95% 1.17-1.80). Adjustment for cohabitation status, BMI, smoking and comorbidity did not change HRs, but further adjustment for cancer stage yielded a HR of 1.36 (1.11-1.67).
  
  
  CONCLUSIONS
  Early detection in all educational groups might reduce social inequalities in survival, however, the unexplained increased risk for death after adjustment for prognostic factors, warrants increased attention to patients with short education in all age groups throughout treatment and rehabilitation.
authors.affiliation: a Danish Cancer Society Research Center , Copenhagen , Denmark ;
authors.forename: Ulla Holten
authors.initials: UH
authors.lastname: Seidelin
authors.affiliation: a Danish Cancer Society Research Center , Copenhagen , Denmark ;|b Research Centre for Prevention and Health, Glostrup University Hospital , Glostrup , Denmark ;
authors.forename: Else
authors.initials: E
authors.lastname: Ibfelt
authors.affiliation: d Department of Public Health , Section of Social Medicine, University of Copenhagen , Copenhagen , Denmark.
authors.forename: Ingelise
authors.initials: I
authors.lastname: Andersen
authors.affiliation: a Danish Cancer Society Research Center , Copenhagen , Denmark ;
authors.forename: Marianne
authors.initials: M
authors.lastname: Steding-Jessen
authors.affiliation: c The Gynecologic Clinic, The Juliane Marie Centre, Copenhagen University Hospital , Copenhagen , Denmark ;
authors.forename: Claus
authors.initials: C
authors.lastname: Høgdall
authors.affiliation: a Danish Cancer Society Research Center , Copenhagen , Denmark ;|c The Gynecologic Clinic, The Juliane Marie Centre, Copenhagen University Hospital , Copenhagen , Denmark ;
authors.forename: Susanne Krüger
authors.initials: SK
authors.lastname: Kjær
authors.affiliation: a Danish Cancer Society Research Center , Copenhagen , Denmark ;
authors.forename: Susanne Oksbjerg
authors.initials: SO
authors.lastname: Dalton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D004522:Educational Status; D016889:Endometrial Neoplasms / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012907:Smoking / Q000009:adverse effects; D012959:Socioeconomic Factors