Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria.
Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
Int J Colorectal Dis. 2023 Apr 5;38(1):91. doi: 10.1007/s00384-023-04383-z.
Educational status is used as a proxy for socioeconomic status. While lower levels of education are generally associated with poorer health, the data on the relationship between educational status and colorectal neoplasia is heterogenous. The aim of our study was to examine this relationship and to adjust the association between educational status and colorectal neoplasia for other health parameters.
We included 5977 participants undergoing a screening colonoscopy in Austria. We split the cohort into patients with lower (n = 2156), medium (n = 2933), and higher (n = 459) educational status. Multivariable multilevel logistic regression models were fitted to evaluate the association between educational status and the occurrence of any or advanced colorectal neoplasia. We adjusted for age, sex, metabolic syndrome, family history, physical activity, alcohol consumption, and smoking status.
We found that the rates of any neoplasia (32%) were similar between the educational strata. However, patients with higher (10%) educational status evidenced significantly higher rates of advanced colorectal neoplasia compared to medium (8%) and lower (7%) education. This association remained statistically significant after multivariable adjustment. The difference was entirely driven by neoplasia in the proximal colon.
Our study found that higher educational status was associated with a higher prevalence of advanced colorectal neoplasia compared to medium and lower educational status. This finding remained significant even after adjusting for other health parameters. Further research is needed to understand the underlying reasons for the observed difference, especially with regard to the specific anatomical distribution of the observed difference.
教育程度常被用作社会经济地位的替代指标。虽然较低的教育程度通常与较差的健康状况相关，但有关教育程度与结直肠肿瘤之间关系的数据存在差异。我们的研究目的是检验这种关系，并调整教育程度与结直肠肿瘤之间的关联，以纳入其他健康参数。
我们纳入了在奥地利接受筛查性结肠镜检查的 5977 名参与者。我们将队列分为受教育程度较低（n=2156）、中等（n=2933）和较高（n=459）的患者。使用多变量多层次逻辑回归模型评估教育程度与任何或高级结直肠肿瘤发生之间的关联。我们调整了年龄、性别、代谢综合征、家族史、身体活动、酒精摄入和吸烟状况。
我们发现，任何肿瘤的发生率（32%）在教育程度之间相似。然而，与中等（8%）和较低（7%）教育程度相比，受教育程度较高（10%）的患者有显著更高的高级结直肠肿瘤发生率。这种关联在多变量调整后仍然具有统计学意义。这种差异完全是由近端结肠的肿瘤引起的。
我们的研究发现，与中等和较低教育程度相比，较高的教育程度与更高级别结直肠肿瘤的患病率更高相关。即使在调整了其他健康参数后，这种发现仍然具有统计学意义。需要进一步研究以了解观察到的差异的潜在原因，特别是观察到的差异在特定解剖分布方面的原因。
