Mediating Role of Lifestyle Behaviors in the Association between Education and Cancer: Results from the European Prospective Investigation into Cancer and Nutrition

被引：4

作者：

Macciotta, Alessandra ^{[1
]}

Catalano, Alberto ^{[1
]}

Giraudo, Maria Teresa ^{[2
]}

Weiderpass, Elisabete ^{[3
]}

Ferrari, Pietro ^{[3
]}

Freisling, Heinz ^{[3
]}

Colorado-Yohar, Sandra M. ^{[4
,5
,6
]}

Santiuste, Carmen ^{[4
,5
]}

Amiano, Pilar ^{[5
,7
]}

Heath, Alicia K. ^{[8
]}

Ward, Heather A. ^{[8
]}

Christakoudi, Sofia ^{[8
,9
]}

Vineis, Paolo ^{[8
]}

Singh, Deependra ^{[3
]}

Vaccarella, Salvatore ^{[3
]}

Schulze, Matthias B. ^{[10
,11
]}

Hiensch, Anouk E. ^{[12
]}

Monninkhof, Evelyn M. ^{[12
]}

Katzke, Verena ^{[13
]}

Kaaks, Rudolf ^{[13
]}

Tumino, Rosario ^{[14
]}

Lazzarato, Fulvio ^{[15
]}

Milani, Lorenzo ^{[16
]}

Agudo, Antonio ^{[17
]}

Dahm, Christina C. ^{[18
]}

Baglietto, Laura ^{[19
,20
]}

Perduca, Vittorio ^{[20
,21
]}

Severi, Gianluca ^{[20
,22
]}

Grioni, Sara ^{[23
]}

Panico, Salvatore ^{[24
]}

Ardanaz, Eva ^{[5
,25
]}

Borch, Kristin B. ^{[26
]}

Benebo, Faith O. ^{[26
]}

Braaten, Tonje ^{[26
]}

Sanchez, Maria-Jose ^{[5
,27
,28
,29
]}

Giachino, Claudia ^{[1
]}

Sacerdote, Carlotta ^{[15
]}

Ricceri, Fulvio ^{[1
,30
]}

机构：

[1] Univ Turin, Dept Clin & Biol Sci, Turin, Italy

[2] Univ Turin, Dept Math G Peano, Turin, Italy

[3] Int Agcy Canc Res IARC WHO, Lyon, France

[4] Murcia Reg Hlth Council, Dept Epidemiol, IMIB Arrixaca, Murcia, Spain

[5] CIBER Epidemiol & Salud Publ CIBERESP, Madrid, Spain

[6] Univ Antioquia, Natl Fac Publ Hlth, Res Grp Demog & Hlth, Medellin, Colombia

[7] Minist Hlth Basque Govt, Sub Directorate Publ Hlth & Addict Gipuzkoa, Biodonostia Hlth Res Inst, San Sebastian, Spain

[8] Imperial Coll London, Sch Publ Hlth, Dept Epidemiol & Biostat, London, England

[9] Kings Coll London, MRC Ctr Transplantat, London, England

[10] German Inst Human Nutr, Dept Mol Epidemiol, Nuthetal, Germany

[11] Univ Potsdam, Inst Nutr Sci, Potsdam, Germany

[12] Univ Utrecht, Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands

[13] German Canc Res Ctr, Div Canc Epidemiol, Heidelberg, Germany

[14] AIRE ONLUS, Hyblean Assoc Epidemiol Res, Ragusa, Italy

[15] Citta Salute & Sci Univ Hosp, Unit Canc Epidemiol, Turin, Italy

[16] Univ Turin, Dept Med Sci, Turin, Italy

[17] Catalan Inst Oncol ICO, Unit Nutr & Canc, Barcelona, Spain

[18] Aarhus Univ, Dept Publ Hlth, Aarhus, Denmark

[19] Univ Pisa, Dept Clin & Expt Med, Pisa, Italy

[20] Paris Saclay Univ, Exposome & Hered Team, CESP, UVSQ,INSERM,Gustave Roussy, Villejuif, France

[21] Univ Paris, Lab MAP5, UMR CNRS 8145, Paris, France

[22] Univ Florence, Dept Stat Comp Sci & Applicat G Parenti DISIA, Florence, Italy

[23] Fdn IRCCS Ist Nazl Tumori Milano, Epidemiol & Prevent Unit, Milan, Italy

[24] Univ Naples Federico II, Dipartmento Med Clin & Chirurg, Naples, Italy

[25] Navarre Publ Hlth Inst, Pamplona, Spain

[26] UiT Arctic Univ Norway, Dept Community Med, Tromso, Norway

[27] Escuela Andaluza Salud Publ EASP, Granada, Spain

[28] Inst Invest Biosanitaria Ibs, Granada, Spain

[29] Univ Granada, Dept Prevent Med & Publ Hlth, Granada, Spain

[30] Reg Hlth Serv ASL TO3, Unit Epidemiol, Grugliasco, TO, Italy

来源：

CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION | 2023年 / 32卷 / 01期

基金：

英国医学研究理事会; 瑞典研究理事会;

关键词：

SOCIOECONOMIC-STATUS; BREAST-CANCER; RISK-FACTORS; COUNTRIES; SURVIVAL; LEVEL; WOMEN; DIET; INEQUALITIES; UPDATE;

D O I：

10.1158/1055-9965.EPI-22-0777

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background: Many studies have shown that socioeconomic position (SEP) is associated with the incidence of malignant tumors at different sites. This study aims to estimate the association between educational level (as proxy for SEP) and cancer incidence and to understand whether the observed associations might be partially explained by lifestyle behaviors.Methods: The analyses were performed on data from the Euro-pean Prospective Investigation into Cancer and Nutrition (EPIC) study, globally and by sex. We used Cox proportional hazards models together with mediation analysis to disentangle the total effect (TE) of educational level [measured through the Relative Index of Inequality (RII)] on cancer incidence into pure direct (PDE) and total indirect (TIE) effect, unexplained and explained by mediators, respectively. PDE and TIE were then combined to compute the proportions mediated (PM).Results: After an average of 14 years of follow-up, 52,422 malignant tumors were ascertained. Low educated participants showed higher risk of developing stomach, lung, kidney (in wom-en), and bladder (in men) cancers, and, conversely, lower risk of melanoma and breast cancer (in post-menopausal women), when compared with more educated participants. Mediation analyses showed that portions of the TE of RII on cancer could be explained by site-specific related lifestyle behaviors for stomach, lung, and breast (in women).Conclusions: Cancer incidence in Europe is determined at least in part by a socioeconomically stratified distribution of risk factors.Impact: These observational findings support policies to reduce cancer occurrence by altering mediators, such as lifestyle behaviors, particularly focusing on underprivileged strata of the population.

引用

页码：132 / 140

页数：9

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