Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany; Medical Faculty Heidelberg, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany.
Finnish Cancer Registry, Unioninkatu 22, 00130 Helsinki, Finland.
Cancer Epidemiol. 2021 Feb;70:101858. doi: 10.1016/j.canep.2020.101858. Epub 2020 Nov 24.
Previous studies have reported lower colorectal cancer (CRC) survival in patients with low compared to high educational levels. We investigated the impact of education on CRC survival by using both individual and area-based information on education.
Patients diagnosed with CRC in Finland in 2007-2016 were followed up for death until the end of 2016. Age-standardized relative survival and relative excess risk of death (RER) were estimated by sex using period approach. RERs were adjusted for age, stage at diagnosis, cancer site, urbanity, hospital district and municipality by using Bayesian piecewise constant excess hazard models. Analyses were conducted including individual (basic, secondary, high) and area-based (quartiles Q1-Q4 based on the proportion of population with basic education) education separately as well as both measures in one model.
We analysed in all 24 462 CRC patients. There was a clear gradient in 5-year relative survival across education groups (men: basic 62 %, secondary 64 %, high 69 %; women: basic 61 %, secondary 67 %, high 71 %). Compared to the basic education group, RER in the high education group was significantly lower. This association was still present after including area-based education in the models (men: RER 0.72, 95 % Confidence interval (CI) 0.64-0.81; women: RER 0.76, 95 % CI 0.59-0.96). Area-based education revealed smaller effect estimates than individual education in CRC survival and no association for men.
Individual education information should be preferred over area-based when survival differences are studied by education. Educational differences in CRC survival are still present in Finland.
先前的研究报告称，与高学历患者相比，低学历患者的结直肠癌（CRC）生存率较低。我们通过使用个体和基于区域的教育信息来研究教育对 CRC 生存率的影响。
2007 年至 2016 年间在芬兰被诊断为 CRC 的患者被随访至 2016 年底的死亡情况。使用时期法按性别估计年龄标准化相对生存率和超额死亡风险比（RER）。使用贝叶斯分段常数超额风险模型，通过年龄、诊断时的分期、癌症部位、城市化程度、医院区和市对 RER 进行调整。分别对个体（基础、中学、高等）和基于区域（基于基础教育人口比例的四分位数 Q1-Q4）的教育进行分析，以及在一个模型中同时分析这两个指标。
我们分析了所有 24462 名 CRC 患者。在教育组之间，5 年相对生存率存在明显的梯度（男性：基础组 62%，中学组 64%，高等组 69%；女性：基础组 61%，中学组 67%，高等组 71%）。与基础教育组相比，高等教育组的 RER 显著降低。在纳入模型中的基于区域的教育后，这种关联仍然存在（男性：RER 0.72，95%置信区间（CI）0.64-0.81；女性：RER 0.76，95%CI 0.59-0.96）。与个体教育相比，基于区域的教育对 CRC 生存率的影响估计值较小，且对男性没有关联。
在研究教育对生存率的影响时，应优先使用个体教育信息而不是基于区域的教育信息。芬兰的 CRC 生存率仍存在教育差异。
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