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IJE Advance Access first published online on January 16, 2007
This version published online on March 12, 2007
International Journal of Epidemiology, doi:10.1093/ije/dyl275
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2007; all rights reserved.

Socioeconomic position and the risk of gastric and oesophageal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC-EURGAST)

Gabriele Nagel1,2,*, Jakob Linseisen1, Hendriek C Boshuizen3, Guillem Pera4, Giuseppe Del Giudice5, Gert P Westert3, H Bas Bueno-de-Mesquita3, Naomi E Allen6, Timothy J Key6, Mattijs E Numans7, Petra HM Peeters7, Sabina Sieri8, Henrik Siman13, Goran Berglund13, Goran Hallmans14, Roger Stenling15, Carmen Martinez16, Larraitz Arriola17, Aurelio Barricarte18, M Dolores Chirlaque19, Jose R Quiros20, Paolo Vineis9,30, Giovanna Masala10, Domenico Palli10, Salvatore Panico11, Rosario Tumino12, Sheila Bingham21, Heiner Boeing22, Manuela M Bergmann22, Kim Overvad23, Marie-Christine Boutron-Ruault25, Francoise Clavel-Chapelon25, Anja Olsen24, Anne Tjonneland24, Antonia Trichopoulou26, Christina Bamia26, Stavroula Soukara26, Jean-Christoph Sabourin27, Fatima Carneiro28, Nadia Slimani29, Mazda Jenab29, Teresa Norat29,30, Elio Riboli29,30 and Carlos A González4

1 Division of Clinical Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany.
2 Department of Epidemiology, University Ulm, Ulm, Germany.
3 National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
4 Department of Epidemiology, Catalan Institute of Oncology, Barcelona, Spain.
5 IRIS Research Center, Chiron Vaccines, Siena, Italy.
6 Cancer Research UK Epidemiology Unit, University of Oxford, UK.
7 Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Netherlands.
8 Department of Epidemiology. National Cancer Institute, Milan, Italy.
9 Cancer Epidemiology Department. University of Turin, Italy.
10 Molecular and Nutritional Epidemiology Unit, CSPO-Scientific Institute of Tuscany, Florence, Italy.
11 Dipartimento di Medicina Clinica e Sperimentale, Federico II University, Naples, Italy.
12 Cancer Registry, Azienda Ospedaliera "Civile - M.P.Arezzo", Ragusa, Italy.
13 Malmö Diet and Cancer Study, Lund University, Malmö, Sweden.
14 Department of Public Health and Clinical Medicine, Nutritional Research, University of Umeå, Sweden.
15 Department Medical Biosciences, Pathology, Umeå University, Sweden.
16 Andalusian School of Public Health, Granada, Spain.
17 Public Health Department of Guipuzkoa, San Sebastian, Spain.
18 Public Health Institute, Navarra, Spain.
19 Epidemiology Department, Murcia health Council, Murcia, Spain.
20 Dirección General de Salud Pública, Consejería de Salud y Servicios Sanitarios Asturias, Spain.
21 MRC Dunn Human Nutrition Unit, Cambridge, UK.
22 German Institute of Human Nutrition, Potsdam-Rehbücke, Germany.
23 Department of Clinical Epidemiology, Aalborg Hospital and Aarhus University Hospital.
24 Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.
25 INSERM, U 521, Institut Gustave Roussy, Villejuif, France.
26 Department of Hygiene and Epidemiology, Medical School, University of Athens, Greece.
27 Département de Pathologie Institut Gustave Roussy, Villejuif, France.
28 Institute of Molecular Pathology and Immunology of University of Porto (IPATIMUP) and Faculty of Medicine/H.S.Joao, Porto, Portugal.
29 Unit of Nutrition and Cancer, International Agency for Research on Cancer, Lyon, France.
30 Imperial College, London, UK.

* Corresponding author: Department of Epidemiology, University of Ulm, Helmholtzstr.22, 89081 Ulm, Germany. E-mail: gabriele.nagel{at}uni-ulm.de


  Abstract

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 520 000 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): 0.43–0.98]. 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.

Keywords Socioeconomic position, gastric cancer, Helicobacter pylori, EPIC

Accepted 9 November 2006


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