Alicandro Gianfranco, Frova Luisa, Sebastiani Gabriella, El Sayed Iman, Boffetta Paolo, La Vecchia Carlo
Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Vanzetti 5, 20133, Milan, Italy.
Italian National Institute of Statistics, Via Cesare Balbo 16, 00184, Rome, Italy.
Cancer Causes Control. 2017 Sep;28(9):997-1006. doi: 10.1007/s10552-017-0930-y. Epub 2017 Jul 26.
Large studies are needed to evaluate socioeconomic inequality for site-specific cancer mortality. We conducted a longitudinal census-based national study to quantify the relative inequality in cancer mortality among educational levels in Italy.
We linked the 2011 Italian census with the 2012 and 2013 death registries. Educational inequality in overall cancer and site-specific cancer mortality were evaluated by computing the mortality rate ratio (MRR).
A total of 35,708,445 subjects aged 30-74 years and 147,981 cancer deaths were registered. Compared to the lowest level of education (none or primary school), the MRR for all cancers in the highest level (university) was 0.57 (95% CI 0.55; 0.58) in men and 0.84 (95% CI 0.81; 0.87) in women. Higher education was associated with reduced risk of mortality from lip, oral cavity, pharynx, oesophagus, stomach, colon and liver in both sexes. Higher education (university) was associated with decreased risk of lung cancer in men (MRR: 0.43, 95% CI 0.41; 0.46), but not in women (MRR: 1.00, 95% CI 0.92; 1.10). Highly educated women had a reduced risk of mortality from cervical cancer than lower educated women (MRR: 0.39, 95% CI 0.27; 0.56), but they had a similar risk for breast cancer (MRR: 1.01, 95% CI 0.94; 1.09).
Education is inversely associated with total cancer mortality, and the association was stronger in men. Different patterns and trends in tobacco smoking in men and women account for at least most of the gender differences.
需要开展大型研究来评估特定部位癌症死亡率的社会经济不平等状况。我们进行了一项基于人口普查的全国性纵向研究，以量化意大利不同教育水平人群中癌症死亡率的相对不平等程度。
我们将2011年意大利人口普查数据与2012年和2013年的死亡登记数据相链接。通过计算死亡率比（MRR）来评估总体癌症及特定部位癌症死亡率的教育不平等情况。
共登记了35708445名年龄在30 - 74岁的受试者以及147981例癌症死亡病例。与最低教育水平（未接受教育或小学学历）相比，最高教育水平（大学学历）人群中，男性所有癌症的MRR为0.57（95%CI 0.55；0.58），女性为0.84（95%CI 0.81；0.87）。高等教育与男女唇癌、口腔癌、咽癌、食管癌、胃癌、结肠癌和肝癌的死亡风险降低相关。高等教育（大学学历）与男性肺癌死亡风险降低相关（MRR：0.43，95%CI 0.41；0.46），但与女性无关（MRR：1.00，95%CI 0.92；1.10）。高学历女性宫颈癌死亡风险低于低学历女性（MRR：0.39，95%CI 0.27；0.56），但乳腺癌死亡风险与之相似（MRR：1.01，95%CI 0.94；1.09）。
教育与总体癌症死亡率呈负相关，且这种关联在男性中更强。男性和女性吸烟模式及趋势的差异至少是造成性别差异的主要原因。
