Abstract
Simple SummaryAn association between socioeconomic status (SES) and cancer risk has been reported, but little is known in Asia. We revealed an association between SES, including education level and areal deprivation index (ADI), and digestive tract cancers in Japan. Lower SES was associated with an increased risk of digestive cancers. For stomach cancer, the positive association with ADI disappeared following an additional adjustment of Helicobacter pylori infection and/or atrophic gastritis status. Cancer prevention policy should consider both individual and regional perspectives by the integration of SES in the target population.Although socioeconomic status (SES) has been associated with cancer risk, little research on this association has been done in Japan. To evaluate the association between SES and digestive tract cancer risk, we conducted a case-control study for head and neck, esophageal, stomach, and colorectal cancers in 3188 cases and the same number of age- and sex-matched controls within the framework of the Hospital-based Epidemiological Research Program at Aichi Cancer Center III (HERPACC III). We employed the education level and areal deprivation index (ADI) as SES indicators. The association was evaluated with odds ratios (ORs) and 95% confidence intervals (CIs) by conditional logistic models adjusted for potential confounders. Even after allowance for known cancer risk factors, the education level showed linear inverse associations with head and neck, stomach, and colorectal cancers. Compared to those educated to junior high school, those with higher education showed statistically significantly lower risks of cancer (0.43 (95% CI: 0.27–0.68) for head and neck, 0.52 (0.38–0.69) for stomach, and 0.52 (0.38–0.71) for colorectum). Consistent with these results for the educational level, the ADI in quintiles showed positive associations with head and neck, esophageal, and stomach cancers (p-trend: p = 0.035 for head and neck, p = 0.02 for esophagus, and p = 0.013 for stomach). Interestingly, the positive association between ADI and stomach cancer risk disappeared in the additional adjustment for Helicobacter pylori infection and/or atrophic gastritis status. In conclusion, a lower SES was associated with an increased risk of digestive cancers in Japan and should be considered in cancer prevention policies for the target population.
Highlights
Digestive tract cancers are among the most common tumor types, affecting over 4.1 million people worldwide and causing 2.6 million deaths in 2018 [1]
Current smoking was more prevalent in the cases, and cumulative exposure to cigarettes was clearly higher in the cases (38.5% in cases and 23.5% in controls for head and neck, 46.5% in cases and 23.3% in controls for esophagus, 30.3% in cases and 22.6% in controls for stomach, and 22.7% in cases and 20.4% in controls for colorectal)
4 Some cases were excluded because the areal deprivation index was unknown or other (4 cases of head and neck cancer, 7 cases of esophageal cancer, 9 cases of stomach cancer, and 3 cases of colorectal cancer were excluded). In this case–control study, we identified an association between socioeconomic status (SES) and digestive tract cancer risks in 3188 cases and the same number of age- and sex-matched controls
Summary
Digestive tract cancers are among the most common tumor types, affecting over 4.1 million people worldwide and causing 2.6 million deaths in 2018 [1]. They are common in Asia [1,2]. There is a need for research that can disentangle the effects of these socioeconomic factors and preventable factors on digestive tract cancer risks. Given that a variety of individual exposures may have common socioeconomic causes at the population level, it is important to discuss cancer prevention from both an individual and regional perspective, with a particular focus on lower SES regions. Few studies have examined the association between socioeconomic differences and cancer risks in Japan
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