欧洲癌症与营养前瞻性调查（EPIC-EURGAST）中的社会经济地位与胃癌和食管癌风险
Socioeconomic position and the risk of gastric and oesophageal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC-EURGAST).
作者信息
Nagel Gabriele, Linseisen Jakob, Boshuizen Hendriek C, Pera Guillem, Del Giudice Giuseppe, Westert Gert P, Bueno-de-Mesquita H Bas, Allen Naomi E, Key Timothy J, Numans Mattijs E, Peeters Petra Hm, Sieri Sabina, Siman Henrik, Berglund Goran, Hallmans Goran, Stenling Roger, Martinez Carmen, Arriola Larraitz, Barricarte Aurelio, Chirlaque M Dolores, Quiros Jose R, Vineis Paolo, Masala Giovanna, Palli Domenico, Panico Salvatore, Tumino Rosario, Bingham Sheila, Boeing Heiner, Bergmann Manuela M, Overvad Kim, Boutron-Ruault Marie-Christine, Clavel-Chapelon Francoise, Olsen Anja, Tjonneland Anne, Trichopoulou Antonia, Bamia Christina, Soukara Stavroula, Sabourin Jean-Christoph, Carneiro Fatima, Slimani Nadia, Jenab Mazda, Norat Teresa, Riboli Elio, González Carlos A
机构信息
Division of Clinical Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany.
出版信息
Int J Epidemiol. 2007 Feb;36(1):66-76. doi: 10.1093/ije/dyl275. Epub 2007 Jan 16.
OBJECTIVES
To evaluate the association of socioeconomic position with adenocarcinoma of the oesophagus and stomach.
METHODS
The European Prospective Investigation into Cancer and Nutrition (EPIC) cohort comprises about 520 000 participants mostly aged 35-70 years. Information on diet and lifestyle was collected at recruitment. After an average follow-up of 6.5 years, 268 cases with adenocarcinoma of the stomach and 56 of the oesophagus were confirmed. We examined the effect of socioeconomic position on cancer risk by means of educational data and a computed Relative Index of Inequality (RII). In a nested case-control study, adjustment for Helicobacter pylori (H. pylori) infection was performed.
RESULTS
Higher education was significantly associated with a reduced risk of gastric cancer [vs lowest level of education, hazard ratio (HR): 0.64, 95% Confidence intervals (CI): 0.43-0.98]. This effect was more pronounced for cancer of the cardia (HR: 0.42, 95% CI: 0.20-0.89) as compared to non-cardia gastric cancer (HR: 0.66, 95% CI: 0.36-1.22). Additionally, the inverse association of educational level and gastric cancer was stronger for cases with intestinal (extreme categories, HR: 0.13, 95% CI: 0.04-0.44) rather than diffuse histological subtype (extreme categories, HR: 0.71 95% CI: 0.37-1.40). In the nested case-control study, inverse but statistically non-significant associations were found after additional adjustment for H. pylori infection [highest vs lowest level of education: Odds ratio (OR) 0.53, 95% CI: 0.24-1.18]. Educational level was non-significantly, inversely associated with carcinoma of the oesophagus.
CONCLUSION
A higher socioeconomic position was associated with a reduced risk of gastric adenocarcinoma, which was strongest for cardia cancer or intestinal histological subtype, suggesting different risk profiles according to educational level. These effects appear to be explained only partially by established risk factors.
目的
评估社会经济地位与食管癌和胃癌的关联。
方法
欧洲癌症与营养前瞻性调查（EPIC）队列包括约52万名年龄大多在35 - 70岁的参与者。在招募时收集了饮食和生活方式信息。经过平均6.5年的随访，确诊了268例胃癌病例和56例食管癌病例。我们通过教育数据和计算得出的不平等相对指数（RII）来研究社会经济地位对癌症风险的影响。在一项巢式病例对照研究中，对幽门螺杆菌（H. pylori）感染进行了校正。
结果
高等教育与胃癌风险降低显著相关[与最低教育水平相比，风险比（HR）：0.64，95%置信区间（CI）：0.43 - 0.98]。与非贲门胃癌（HR：0.66，95% CI：0.36 - 1.22）相比，这种效应在贲门癌中更为明显（HR：0.42，95% CI：0.20 - 0.89）。此外，教育水平与胃癌的负相关在肠型（极端类别，HR：0.13，95% CI：0.04 - 0.44）而非弥漫型组织学亚型（极端类别，HR：0.71，95% CI：0.37 - 1.40）的病例中更强。在巢式病例对照研究中，在对幽门螺杆菌感染进行额外校正后，发现了负相关但无统计学意义的关联[最高与最低教育水平：比值比（OR）0.53，95% CI：0.24 - 1.18]。教育水平与食管癌呈非显著负相关。
结论
较高的社会经济地位与胃腺癌风险降低相关，这在贲门癌或肠型组织学亚型中最为明显，提示根据教育水平存在不同的风险特征。这些效应似乎仅部分由既定的风险因素解释。
Zotero 插件