Mediating Role of Lifestyle Behaviors in the Association between Education and Cancer: Results from the European Prospective Investigation into Cancer and Nutrition-Reference-Cited by-同舟云学术

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

Published:2022-10-28 Issue:1 Volume:32 Page:132-140
ISSN:1055-9965
Container-title:Cancer Epidemiology, Biomarkers & Prevention
language:en
Short-container-title:

Author:

Macciotta Alessandra¹^ORCID,Catalano Alberto¹^ORCID,Giraudo Maria Teresa²^ORCID,Weiderpass Elisabete³^ORCID,Ferrari Pietro³^ORCID,Freisling Heinz³^ORCID,Colorado-Yohar Sandra M.⁴⁵⁶^ORCID,Santiuste Carmen⁴⁵^ORCID,Amiano Pilar⁵⁷^ORCID,Heath Alicia K.⁸^ORCID,Ward Heather A.⁸^ORCID,Christakoudi Sofia⁸⁹^ORCID,Vineis Paolo⁸^ORCID,Singh Deependra³^ORCID,Vaccarella Salvatore³^ORCID,Schulze Matthias B.¹⁰¹¹^ORCID,Hiensch Anouk E.¹²^ORCID,Monninkhof Evelyn M.¹²^ORCID,Katzke Verena¹³^ORCID,Kaaks Rudolf¹³^ORCID,Tumino Rosario¹⁴^ORCID,Lazzarato Fulvio¹⁵^ORCID,Milani Lorenzo¹⁶^ORCID,Agudo Antonio¹⁷^ORCID,Dahm Christina C.¹⁸^ORCID,Baglietto Laura¹⁹²⁰^ORCID,Perduca Vittorio²¹²⁰^ORCID,Severi Gianluca²⁰²²^ORCID,Grioni Sara²³^ORCID,Panico Salvatore²⁴^ORCID,Ardanaz Eva⁵²⁵^ORCID,Borch Kristin B.²⁶^ORCID,Benebo Faith O.²⁶^ORCID,Braaten Tonje²⁶^ORCID,Sánchez Maria-Jose⁵²⁷²⁸²⁹^ORCID,Giachino Claudia¹^ORCID,Sacerdote Carlotta¹⁵^ORCID,Ricceri Fulvio¹³⁰^ORCID

Affiliation:

1. 1Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.

2. 2Department of Mathematics “G. Peano,” University of Turin, Turin, Italy.

3. 3International Agency for Cancer Research (IARC-WHO), Lyon, France.

4. 4Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.

5. 5CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.

6. 6Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín, Colombia.

7. 7Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, Biodonostia Health Research Institute, San Sebastian, Spain.

8. 8Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.

9. 9MRC Centre for Transplantation, King's College London, Great Maze Pond, London, United Kingdom.

10. 10Department of Molecular Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany.

11. 11Institute of Nutritional Science, University of Potsdam, Potsdam, Germany.

12. 12Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands.

13. 13Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.

14. 14Hyblean Association for Epidemiological Research, AIRE-ONLUS, Ragusa, Italy.

15. 15Unit of Cancer Epidemiology, “Città della salute e della scienza” University-Hospital, Turin, Italy.

16. 16Department of Medical Science, University of Turin, Turin, Italy.

17. 17Unit of Nutrition and Cancer, Catalan Institute of Oncology—ICO, L'Hospitalet de Llobregat, Barcelona, Spain.

18. 18Department of Public Health, Aarhus University, Aarhus, Denmark.

19. 19Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.

20. 20Paris–Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, Villejuif, France.

21. 21Laboratoire MAP5 (UMR CNRS 8145), Université de Paris, Paris, France.

22. 22Department of Statistics, Computer Science and Applications "G. Parenti" (DISIA), University of Florence, Florence, Italy.

23. 23Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy.

24. 24Dipartmento Di Medicina Clinica E Chirurgia Federico II University, Naples, Italy.

25. 25Navarre Public Health Institute, Pamplona, Spain.

26. 26Department of Community Medicine, UiT, the Arctic University of Norway, Tromsø, Norway.

27. 27Escuela Andaluza de Salud Pública (EASP), Granada, Spain.

28. 28Instituto de Investigación Biosanitaria ibs, Granada, Spain.

29. 29Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.

30. 30Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy.

Abstract

Abstract 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 European 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 women), 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.

Funder

Università degli Studi di Torino

Publisher

American Association for Cancer Research (AACR)

Subject

Oncology,Epidemiology

Link

https://aacrjournals.org/cebp/article-pdf/doi/10.1158/1055-9965.EPI-22-0777/3219511/epi-22-0777.pdf

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