title: The turn of the gradient? Educational differences in breast cancer mortality in 18 European populations during the 2000s.
abstract: This study aims to investigate the association between educational level and breast cancer mortality in Europe in the 2000s. Unlike most other causes of death, breast cancer mortality tends to be positively related to education, with higher educated women showing higher mortality rates. Research has however shown that the association is changing from being positive over non-existent to negative in some countries. To investigate these patterns, data from national mortality registers and censuses were collected and harmonized for 18 European populations. The study population included all women aged 30-74. Age-standardized mortality rates, mortality rate ratios, and slope and relative indexes of inequality were computed by education. The population was stratified according to age (women aged 30-49 and women aged 50-74). The relation between educational level and breast cancer mortality was predominantly negative in women aged 30-49, mortality rates being lower among highly educated women and higher among low educated women, although few outcomes were statistically significant. Among women aged 50-74, the association was mostly positive and statistically significant in some populations. A comparison with earlier research in the 1990s revealed a changing pattern of breast cancer mortality. Positive educational differences that used to be significant in the 1990s were no longer significant in the 2000s, indicating that inequalities have decreased or disappeared. This evolution is in line with the "fundamental causes" theory which stipulates that whenever medical insights and treatment become available to combat a disease, a negative association with socio-economic position will arise, independently of the underlying risk factors.
authors.affiliation: Interface Demography, Department of Sociology, Vrij Universiteit Brussel, Brussels, Belgium.|Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands.
authors.forename: S
authors.identifier: 0000-0002-6890-1855
authors.initials: S
authors.lastname: Gadeyne
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, F75012, France.
authors.forename: G
authors.initials: G
authors.lastname: Menvielle
authors.affiliation: Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands.
authors.forename: I
authors.initials: I
authors.lastname: Kulhanova
authors.affiliation: Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Bopp
authors.affiliation: Interface Demography, Department of Sociology, Vrij Universiteit Brussel, Brussels, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Deboosere
authors.affiliation: Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands.|Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: T A
authors.initials: TA
authors.lastname: Eikemo
authors.affiliation: Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Hoffmann
authors.affiliation: Hungarian Demographic Research Institute, Budapest, Hungary.
authors.forename: K
authors.initials: K
authors.lastname: Kovács
authors.affiliation: Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, Sweden.|Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia.
authors.forename: M
authors.initials: M
authors.lastname: Leinsalu
authors.affiliation: Department of Sociology, University of Helsinki, Helsinki, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Martikainen
authors.affiliation: Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Regidor
authors.affiliation: Department of Demography, Charles University, Prague, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Rychtarikova
authors.affiliation: Epidemiology Unit, Local Health Authority TO3 of Piedmont Region, Italy.
authors.forename: T
authors.initials: T
authors.lastname: Spadea
authors.affiliation: Domain for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: B H
authors.initials: BH
authors.lastname: Strand
authors.affiliation: Domain for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: C
authors.initials: C
authors.lastname: Trewin
authors.affiliation: Department of Monitoring and Analyses of Population Health, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland.
authors.forename: B
authors.initials: B
authors.lastname: Wojtyniak
authors.affiliation: Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands.
authors.forename: J P
authors.initials: JP
authors.lastname: Mackenbach
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology; D004522:Educational Status; D062665:Epidemiological Monitoring; D005006:Ethnicity; D005060:Europe; D005260:Female; D006266:Health Education; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors
keywords: Europe; breast cancer mortality; educational differences