Larsen Inger Kristin, Myklebust Tor Åge, Babigumira Ronnie, Vinberg Elina, Møller Bjørn, Ursin Giske
Cancer Registry of Norway, Oslo, Norway.
Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway.
Acta Oncol. 2020 Nov;59(11):1300-1307. doi: 10.1080/0284186X.2020.1817548. Epub 2020 Sep 14.
Several studies have shown an association between socioeconomic status and incidence of cancer. In this study, we have examined the association between socioeconomic factors, using income and education as proxies, and cancer incidence in Norway, a country known to be egalitarian, with universal access to health care and scoring high on the human development index.
We linked individual data for the total Norwegian population with information on all cancer patients registered in the Cancer Registry of Norway (CRN) with any cancer diagnosed between 2012 and 2016. Data on education, and individual income, were provided from Statistics Norway. We used Poisson regression to obtain incidence rate ratios (IRR) across education and income levels for 23 cancer sites.
A total of 9 cancers among men and 13 cancers among women were observed to have significantly higher incidence rates in cases with the lowest level of education. Melanoma for both sexes, testis and prostate cancer in men, and breast cancer in women were found to have a higher incidence rate among those with the highest level of education. The largest differences in IRR were found for lung cancer, where men and women with college or university education as their highest completed education had a two- to threefold decreased risk, compared to those with primary school (IRR men; 0.40 [0.37-0.43], women 0.34 [0.31-0.37]). The results for income mirrored the results for education among men, while for women we did not observe many differences in cancer risk across income groups.
Our findings were consistent with findings from other studies showing that the incidence rate of cancer differs across levels of socioeconomic status. We may need behavioral change campaigns focused on lifestyle changes that lower the risk of cancer and target perhaps to those with lower socioeconomic status.
多项研究表明社会经济地位与癌症发病率之间存在关联。在本研究中，我们以收入和教育为代表，考察了社会经济因素与挪威癌症发病率之间的关联。挪威是一个以平等主义著称的国家，全民享有医疗保健，在人类发展指数方面得分很高。
我们将挪威总人口的个体数据与挪威癌症登记处（CRN）登记的所有癌症患者信息相链接，这些患者在2012年至2016年间被诊断患有任何癌症。教育程度和个人收入数据由挪威统计局提供。我们使用泊松回归来获取23个癌症部位在不同教育程度和收入水平下的发病率比（IRR）。
在教育程度最低的人群中，男性有9种癌症、女性有13种癌症的发病率显著更高。发现黑色素瘤在两性中、男性的睾丸癌和前列腺癌以及女性的乳腺癌在教育程度最高的人群中发病率更高。肺癌的发病率比差异最大，与小学学历者相比，最高学历为大专或大学学历的男性和女性患肺癌的风险降低了两到三倍（男性IRR为0.40[0.37 - 0.43]，女性为0.34[0.31 - 0.37]）。男性收入方面的结果与教育程度方面的结果相似，而女性在不同收入组之间的癌症风险未观察到明显差异。
我们的研究结果与其他研究结果一致，表明癌症发病率在不同社会经济地位水平上存在差异。我们可能需要开展侧重于生活方式改变以降低癌症风险的行为改变运动，并可能针对社会经济地位较低的人群。
