Diverging trends in educational inequalities in cancer mortality between men and women in the 2000s in France

BMC Public Health

Danièle Luce²  Eric Jougla³  Grégoire Rey³  Gwenn Menvielle¹ 

[1] University of Versailles Saint Quentin, UMRS 1018, France;Inserm U1085, Irset, Pointe-à-Pitre, Guadeloupe, French West Indies;Inserm, CépiDc, Le Kremlin-Bicêtre, France

关键词: Time trends;    Education;    Women;    Men;    France;    Cancer mortality;   

Others  :  1161812
DOI  :  10.1186/1471-2458-13-823

 received in 2013-04-12, accepted in 2013-09-03,  发布年份 2013

【 摘 要 】

Background

Socioeconomic inequalities in cancer mortality have been observed in different European countries and the US until the end of the 1990s, with changes over time in the magnitude of these inequalities and contrasted situations between countries. The aim of this study is to estimate relative and absolute educational differences in cancer mortality in France between 1999 and 2007, and to compare these inequalities with those reported during the 1990s.

Methods

Data from a representative sample including 1% of the French population were analysed. Educational differences among people aged 30–74 were quantified with hazard ratios and relative indices of inequality (RII) computed using Cox regression models as well as mortality rate difference and population attributable fraction.

Results

In the period 1999–2007, large relative inequalities were found among men for total cancer and smoking and/or alcohol related cancers mortality (lung, head and neck, oesophagus). Among women, educational differences were reported for total cancer, head and neck and uterus cancer mortality. No association was found between education and breast cancer mortality. Slight educational differences in colorectal cancer mortality were observed in men and women. For most frequent cancers, no change was observed in the magnitude of relative inequalities in mortality between the 1990s and the 2000s, although the RII for lung cancer increased both in men and women. Among women, a large increase in absolute inequalities in mortality was observed for all cancers combined, lung, head and neck and colorectal cancer. In contrast, among men, absolute inequalities in mortality decreased for all smoking and/or alcohol related cancers.

Conclusion

Although social inequalities in cancer mortality are still high among men, an encouraging trend is observed. Among women though, the situation regarding social inequalities is less favourable, mainly due to a health improvement limited to higher educated women. These inequalities may be expected to further increase in future years.

【 授权许可】

   
2013 Menvielle et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Karim-Kos HE, De Vries E, Soerjomataram I, Lemmens V, Siesling S, Coebergh JW: Recent trends of cancer in Europe: a combined approach of incidence, survival and mortality for 17 cancer sites since the 1990s. Eur J Cancer 2008, 44(10):1345-1389.
• [2]Menvielle G, Chastang JF, Luce D, Leclerc A: Temporal trends in socioeconomic inequality in mortality in France between 1968 and 1996. Study of educational differences by cause of death. Rev Epidemiol Sante Publique 2007, 55:e1-e8.
• [3]Mackenbach JP, Stirbu I, Roskam AJ, Schaap MM, Menvielle G, Leinsalu M, Kunst AE: Socioeconomic inequalities in health in 22 European countries. N Engl J Med 2008, 358(23):2468-2481.
• [4]Rosvall M, Chaix B, Lynch J, Lindstrom M, Merlo J: Contribution of main causes of death to social inequalities in mortality in the whole population of Scania, Sweden. BMC Public Health 2006, 6:79. BioMed Central Full Text
• [5]Fawcett J, Blakely T: Cancer is overtaking cardiovascular disease as the main driver of socioeconomic inequalities in mortality: New Zealand (1981–99). J Epidemiol Community Health 2007, 61(1):59-66.
• [6]Albano JD, Ward E, Jemal A, Anderson R, Cokkinides VE, Murray T, Henley J, Liff J, Thun MJ: Cancer mortality in the United States by education level and race. J Natl Cancer Inst 2007, 99(18):1384-1394.
• [7]Kinsey T, Jemal A, Liff J, Ward E, Thun M: Secular trends in mortality from common cancers in the United States by educational attainment, 1993–2001. J Natl Cancer Inst 2008, 100(14):1003-1012.
• [8]Singh GK, Miller BA, Hankey BF: Changing area socioeconomic patterns in U.S. cancer mortality, 1950–1998: Part II--Lung and colorectal cancers. J Natl Cancer Inst 2002, 94(12):916-925.
• [9]Singh GK, Miller BA, Hankey BF, Feuer EJ, Pickle LW: Changing area socioeconomic patterns in U.S. cancer mortality, 1950–1998: Part I--All cancers among men. J Natl Cancer Inst 2002, 94(12):904-915.
• [10]Strand BH, Groholt EK, Steingrimsdottir OA, Blakely T, Graff-Iversen S, Naess O: Educational inequalities in mortality over four decades in Norway: prospective study of middle aged men and women followed for cause specific mortality, 1960–2000. BMJ 2010, 340:c654.
• [11]Puigpinos R, Borrell C, Antunes JL, Azlor E, Pasarin MI, Serral G, Pons-Vigues M, Rodriguez-Sanz M, Fernandez E: Trends in socioeconomic inequalities in cancer mortality in Barcelona: 1992–2003. BMC Public Health 2009, 9:35. BioMed Central Full Text
• [12]Menvielle G, Leclerc A, Chastang JF, Luce D, Edisc group: Social inequalities in breast cancer mortality among French women: disappearing educational disparities from 1968 to 1996. Br J Cancer 2006, 94(1):152-155.
• [13]Martikainen P, Valkonen T: Diminishing educational differences in breast cancer mortality among Finnish women: a register-based 25-year follow-up. Am J Public Health 2000, 90(2):277-280.
• [14]Strand BH, Kunst A, Huisman M, Menvielle G, Glickman M, Bopp M, Borell C, Borgan JK, Costa G, Deboosere P, Regidor E, Valkonen T, Mackenbach JP: The reversed social gradient: higher breast cancer mortality in the higher educated compared to lower educated. A comparison of 11 European populations during the 1990s. Eur J Cancer 2007, 43(7):1200-1207.
• [15]Rouault D: The Echantillon Démograhique Permanent: a French equivalent to the Longitudinal Study. Update - News from the LS User Group. 1994, 7:5-13.
• [16]Mackenbach JP, Kunst AE: Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe. Soc Sci Med 1997, 44(6):757-771.
• [17]Ahmad O, Boschi-Pinto C, Murray C, Lozano R, Inoue M: Age standardization of rates: a new WHO world standard. In GPE Discussion Paper Series: World Health Organization; 2001.
• [18]Steenland K, Armstrong B: An overview of methods for calculating the burden of disease due to specific risk factors. Epidemiology 2006, 17(5):512-519.
• [19]Gandini S, Botteri E, Iodice S, Boniol M, Lowenfels AB, Maisonneuve P, Boyle P: Tobacco smoking and cancer: a meta-analysis. Int J Cancer 2008, 122(1):155-164.
• [20]Cavelaars AE, Kunst AE, Geurts JJ, Crialesi R, Grotvedt L, Helmert U, Lahelma E, Lundberg O, Matheson J, Mielck A, Rasmussen NK, Regidor E, do Rosario-Giraldes M, Spuhler T, Mackenbach JP: Educational differences in smoking: international comparison. BMJ 2000, 320(7242):1102-1107.
• [21]Legleye S, Khlat M, Beck F, Peretti-Watel P: Widening inequalities in smoking initiation and cessation patterns: a cohort and gender analysis in France. Drug Alcohol Depend 2011, 117(2–3):233-241.
• [22]Wagenaar KP, de Boer MR, Luce D, Menvielle G: Time trends in educational differences in lung and upper aero digestive tract cancer mortality in France between 1990 and 2007. Cancer Epidemiol 2012, 36(4):329-334.
• [23]Boffetta P, Hashibe M, La Vecchia C, Zatonski W, Rehm J: The burden of cancer attributable to alcohol drinking. Int J Cancer 2006, 119(4):884-887.
• [24]Menvielle G, Leclerc A, Chastang JF, Melchior M, Luce D, Group E: Changes in social inequalities in cancer mortality rates among french Men between 1968 and 1996. Am J Public Health 2007, 97(11):2082-2087.
• [25]Bosetti C, Levi F, Lucchini F, Negri E, La Vecchia C: Lung cancer mortality in European women: recent trends and perspectives. Ann Oncol 2005, 16(10):1597-1604.
• [26]Thomas S, Fayter D, Misso K, Ogilvie D, Petticrew M, Sowden A, Whitehead M, Worthy G: Population tobacco control interventions and their effects on social inequalities in smoking: systematic review. Tob Control 2008, 17(4):230-237.
• [27]Menvielle G, Soerjomataram I, de Vries E, Engholm G, Barendregt JJ, Coebergh JW, Kunst AE: Scenarios of future lung cancer incidence by educational level: modelling study in Denmark. Eur J Cancer 2010, 46(14):2625-2632.
• [28]Besson D: Boissons alcoolisées: 40 ans de baisse de consommation. Insee Première 2004, 966:1-4.
• [29]Cavelaars AE, Kunst AE, Mackenbach JP: Socioeconomic differences in risk factors for morbidity and mortality in the European Community: an international comparison. J Health Psychol 1997, 2:353-372.
• [30]Borrell C, Azlor E, Rodriguez-Sanz M, Puigpinos R, Cano-Serral G, Pasarin MI, Martinez JM, Benach J, Muntaner C: Trends in socioeconomic mortality inequalities in a southern European urban setting at the turn of the 21st century. J Epidemiol Community Health 2008, 62(3):258-266.
• [31]Danaei G, Vander Hoorn S, Lopez AD, Murray CJ, Ezzati M: Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental risk factors. Lancet 2005, 366(9499):1784-1793.
• [32]Singh-Manoux A, Gourmelen J, Lajnef M, Sabia S, Sitta R, Menvielle G, Melchior M, Nabi H, Lanoe JL, Gueguen A, Lert F: Prevalence of educational inequalities in obesity between 1970 and 2003 in France. Obes Rev 2009, 10(5):511-518.
• [33]Goulard H, Boussac-Zarebska M, Bloch J: Evaluation épidemiologique du programme pilote de dépistage organisé du cancer colorectal France. BEH 2007, 2009:2-3.
• [34]Goulard H, Boussac-Zarebska M, Duport N, Bloch J: Facteurs d’adhésion au dépistage organisé du cancer colorectal: étude FADO-colorectal, France, décembre 2006-acril 2007. BEH 2009, 2–3:25-29.
• [35]Villeneuve S, Fevotte J, Anger A, Truong T, Lamkarkach F, Gaye O, Kerbrat P, Arveux P, Miglianico L, Imbernon E, Guenel P: Breast cancer risk by occupation and industry: analysis of the CECILE study, a population-based case–control study in France. Am J Ind Med 2011, 54(7):499-509.
• [36]Gentil-Brevet J, Colonna M, Danzon A, Grosclaude P, Chaplain G, Velten M, Bonnetain F, Arveux P: The influence of socio-economic and surveillance characteristics on breast cancer survival: a French population-based study. Br J Cancer 2008, 98(1):217-224.
• [37]Strand BH, Tverdal A, Claussen B, Zahl PH: Is birth history the key to highly educated women’s higher breast cancer mortality? A follow-up study of 500,000 women aged 35–54. Int J Cancer 2005, 117(6):1002-1006.
• [38]Dano H, Hansen KD, Jensen P, Petersen JH, Jacobsen R, Ewertz M, Lynge E: Fertility pattern does not explain social gradient in breast cancer in denmark. Int J Cancer 2004, 111(3):451-456.
• [39]Menvielle G, Kunst AE, van Gils CH, Peeters PH, Boshuizen H, Overvad K, Olsen A, Tjonneland A, Hermann S, Kaaks R, Bergmann MM, Illner AK, Lagiou P, Trichopoulos D, Trichopoulou A, Palli D, Berrino F, Mattiello A, Tumino R, Sacerdote C, May A, Monninkhof E, Braaten T, Lund E, Quiros JR, Duell EJ, Sanchez MJ, Navarro C, Ardanaz E, Borgquist S, et al.: The contribution of risk factors to the higher incidence of invasive and in situ breast cancers in women with higher levels of education in the European prospective investigation into cancer and nutrition. Am J Epidemiol 2011, 173(1):26-37.
• [40]Rendall M, Couet C, Lappegard T, Robert-Bobee I, Ronsen M, Smallwood S: First births by age and education in Britain, France and Norway. Popul Trends 2005, 121:27-34.
• [41]Duport N, Ancelle-Park R, Boussac-Zarebska M, Uhry Z, Bloch J: Are breast cancer screening practices associated with sociodemographic status and healthcare access? Analysis of a French cross-sectional study. Eur J Cancer Prev 2008, 17(3):218-224.
• [42]Baudier F, Michaud C, Gautier A, Guilbert P: Le dépistage du cancer du sein en France : pratiques et évolution des habitudes dans la population des femmes de 18 à 75 ans, Baromètre santé 2004–2005. BEH 2007, 17:142-144.
• [43]Faggiano F, Partanen T, Kogevinas M, Boffetta P: Socioeconomic differences in cancer incidence and mortality. IARC Sci Publ 1997, 138:65-176.