Abstract
BackgroundSocio-demographic factors and area of residence might influence the development of esophageal and gastric cancer. Large-scale population-based research can determine the role of such factors.MethodsThis population-based cohort study included all Swedish residents aged 30–84 years in 1990–2007. Educational level, marital status, place of birth, and place of residence were evaluated with regard to mortality from esophageal or gastric cancer. Cox regression yielded hazard ratios (HR) with 95% confidence intervals (CI), adjusted for potential confounding.ResultsAmong 84 920 565 person-years, 5125 and 12 230 deaths occurred from esophageal cancer and gastric cancer, respectively. Higher educational level decreased the HR of esophageal cancer (HR = 0.61, 95%CI 0.42–0.90 in women, HR = 0.71, 95%CI 0.60–0.84 in men) and gastric cancer (HR = 0.80, 95%CI 0.63–1.03 in women, HR = 0.73, 95%CI 0.64–0.83 in men). Being unmarried increased HR of esophageal cancer (HR = 1.64, 95%CI 1.35–1.99 in women, HR = 1.64, 95%CI 1.50–1.80 in men), but not of gastric cancer. Being born in low density populated areas increased HR of gastric cancer (HR = 1.23, 95%CI 1.10–1.38 in women, HR = 1.37, 95%CI 1.25–1.50 in men), while no strong association was found with esophageal cancer. Living in densely populated areas increased HR of esophageal cancer (HR = 1.31, 95%CI 1.14–1.50 in women, HR = 1.40, 95%CI 1.29–1.51 in men), but not of gastric cancer.ConclusionThese socio-demographic inequalities in cancer mortality warrant efforts to investigate possible preventable mechanisms and to promote and support healthier lifestyles among deprived groups.
Highlights
The incidence of esophageal adenocarcinoma has increased over the last decades in high-income countries, including Sweden, whereas the incidence of esophageal squamous cell carcinoma and gastric cancer has decreased.[1,2]
The main risk factors are gastroesophageal reflux and obesity for esophageal adenocarcinoma,[3,4] tobacco smoking and heavy alcohol drinking for esophageal squamous cell carcinoma,[5] and infection with Helicobacter pylori (H. pylori) for gastric cancer.[6,7]
Low socioeconomic position has been shown to be associated with an increased risk of all these cancers, regardless of whether it is measured by educational level,[8,9,10,11,12,13,14,15] income,[10,12] occupation,[8,10,11,12,13,15,16] or material deprivation.[12,17]
Summary
This population-based cohort study included all Swedish residents aged 30–84 years in 1990–2007. Cox regression yielded hazard ratios (HR) with 95% confidence intervals (CI), adjusted for potential confounding
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