Socioeconomic positoon and the risk of gastric and overphageal cancer in the European Prospective into Cancer and Nutrition (EPIC-EURGAST)
Socioeconomic positoon and the risk of gastric and overphageal cancer in the European Prospective into Cancer and Nutrition (EPIC-EURGAST)
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DOI：
10.1093/ije/dyl275
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发表时间：
2007-02-01
影响因子：
7.7
通讯作者：
Gonzalez, Carlos A.
中科院分区：
文献类型：
--
作者：
Nagel, Gabriele;Linseisen, Jakob;Gonzalez, Carlos A.
目的探讨社会经济地位与食管腺癌和胃腺癌的关系。方法欧洲癌症与营养前瞻性调查(EPIC)队列约520000人，年龄35-70岁。在招募时收集了有关饮食和生活方式的信息。平均随访6.5年，确诊胃腺癌268例，食道腺癌56例。我们通过教育数据和计算的相对不平等指数(RII)检验了社会经济地位对癌症风险的影响。在嵌套式病例对照研究中，对幽门螺杆菌(H.Pylori)感染进行了调整。结果受教育程度越高，患胃癌的风险越低[受教育程度越低，危险比(HR)：0.64，95%可信区间(CI)：0.43~0.981]。与非贲门癌(HR：0.66，95%CI：0.36-1.22)相比，贲门癌的这种影响更为明显(HR：0.42，95%CI：0.20-0.89)。此外，在肠型(极端分类，HR：0.13，95%CI：0.04-0.44)而不是弥漫组织学亚型(极端分类，HR：0.71，95%CI：0.37-1.40)的病例中，教育程度与胃癌的负关联更强。在嵌套病例对照研究中，在对幽门螺杆菌感染进行额外调整后，发现了相反但在统计学上没有显著意义的关联[最高教育程度与最低教育水平：优势比(OR)0.53，95%CI：0.24-1.18]。结论社会经济地位越高，患胃腺癌的风险越低，其中以贲门癌和肠道组织学亚型的相关性最强，提示不同文化程度的人群患胃腺癌的风险分布不同。这些影响似乎只能部分地用既定的风险因素来解释。
Objectives To evaluate the association of socioeconomic position with adenocarcinoma of the oesophagus and stomach.Methods The European Prospective Investigation into Cancer and Nutrition (EPIC) cohort comprises about 520000 participants mostly aged 35-70 years. Information on diet and lifestyle was collected at recruitment. After an average follow-up of 6.5 years, 268 cases with adenocarcinoma of the stomach and 56 of the oesophagus were confirmed. We examined the effect of socioeconomic position on cancer risk by means of educational data and a computed Relative Index of Inequality (RII). In a nested case-control study, adjustment for Helicobacter pylori (H. pylori) infection was performed.Results Higher education was significantly associated with a reduced risk of gastric cancer [vs lowest level of education, hazard ratio (HR): 0.64, 95% Confidence intervals (CI): 0.43-0.981. This effect was more pronounced for cancer of the cardia (HR: 0.42, 95% CI: 0.20-0.89) as compared to non-cardia gastric cancer (HR: 0.66, 95% CI: 0.36-1.22). Additionally, the inverse association of educational level and gastric cancer was stronger for cases with intestinal (extreme categories, HR: 0.13, 95% CI: 0.04-0.44) rather than diffuse histological subtype (extreme categories, HR: 0.71 95% CI: 0.37-1.40). In the nested case-control study, inverse but statistically non-significant associations were found after additional adjustment for H. pylori infection [highest vs lowest level of education: Odds ratio (OR) 0.53, 95% CI: 0.24-1.18]. Educational level was non-significantly, inversely associated with carcinoma of the oesophagus.Conclusion A higher socioeconomic position was associated with a reduced risk of gastric adenocarcinoma, which was strongest for cardia cancer or intestinal histological subtype, suggesting different risk profiles according to educational level. These effects appear to be explained only partially by established risk factors.