Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Cancer Med. 2019 Jun;8(6):3261-3268. doi: 10.1002/cam4.2138. Epub 2019 Apr 5.
Little is known about occupational class differences in pancreatic cancer survival.
Using a population-based cancer registry in Japan, 3 578 patients with incident pancreatic cancer (1970-2011) were followed up for 5 years (median follow-up time 0.42 years). We classified patients into four occupational classes based on their longest-held jobs: white-collar (professional and managers), service, blue-collar, and those not actively employed. Using white-collar class as the reference group, hazard ratios (HRs) and 95% confidence intervals (CIs) for overall death were estimated by Cox proportional hazard model. Covariates included age, sex, and year of diagnosis. Prognostic variables (pathology, stage, and treatment) and smoking behaviors were additionally adjusted as possible mediating factors.
Overall survival was poor in this population (median, 0.50 and 0.33 years in white-collar and service classes, respectively). Compared with white-collar patients, survival was significantly poorer across all occupational classes, most pronounced in the service worker group: mortality HRs ranged from 1.11 (95% CI 1.00-1.24) in blue-collar workers to 1.24 (95% CI 1.12-1.37) in service workers. Even after controlling for potential mediating factors, service workers showed worse survival.
We documented occupational class disparities in pancreatic cancer survival in Japan. Even in the setting of lethal prognostic cancer with universal health coverage, high-occupational class groups may enjoy a health advantage.
关于胰腺癌生存的职业阶层差异知之甚少。
利用日本一个基于人群的癌症登记处，对 3578 名（1970-2011 年）患有新发胰腺癌的患者进行了 5 年的随访（中位随访时间为 0.42 年）。我们根据患者的最长工作时间将其分为四类职业：白领（专业和管理人员）、服务、蓝领和未积极就业者。以白领职业为参照组，使用 Cox 比例风险模型估计全因死亡的风险比（HR）和 95%置信区间（CI）。协变量包括年龄、性别和诊断年份。将预后变量（病理、分期和治疗）和吸烟行为作为可能的中介因素进行进一步调整。
该人群的总体生存率较差（中位生存期分别为白领和服务类患者的 0.50 年和 0.33 年）。与白领患者相比，所有职业类别的生存率均显著较差，服务工作者组最为明显：死亡率 HR 范围从蓝领工人的 1.11（95%CI 1.00-1.24）到服务工作者的 1.24（95%CI 1.12-1.37）。即使在控制了潜在的中介因素后，服务工作者的生存率仍较差。
我们记录了日本胰腺癌生存的职业阶层差异。即使在全民健康覆盖的致命预后癌症环境下，高职业阶层群体也可能享有健康优势。
