Influence of education level on cancer survival in Sweden

• Published in: Annals of oncology Vol. 19; no. 1; pp. 156 - 162
• Main Authors: Hussain, S. K., Lenner, P., Sundquist, J., Hemminki, K.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.01.2008; Oxford Publishing Limited (England)
• Subjects: Adult; Aged; Antineoplastic agents; Biological and medical sciences; cancer; Databases, Factual; education; Educational Status; Female; Humans; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Neoplasms - mortality; Organ Specificity; Pharmacology. Drug treatments; Proportional Hazards Models; Registries; survival; Survival Analysis; Sweden - epidemiology; Sweden; Europe; cancer; education; survival; Malignant tumor; Education level; Education; Survival; Cancer
• ISSN: 0923-7534; 1569-8041; 1569-8041
• DOI: 10.1093/annonc/mdm413

Background: While cancer survival at several sites has historically been shown to vary by education level, a current comprehensive assessment of survival following a cancer diagnosis in Sweden, a country with universal health care and cancer screening, has yet to be carried out. Methods: Using the 2006 update of the Swedish Family-Cancer Database and Cox's proportional hazards regression methods, we calculate the adjusted hazard ratio (HR) and 95% confidence interval to estimate the influence of education level on site-specific cancer survival. Results: Significant positive associations between education level and cancer survival were observed following a diagnosis of upper aerodigestive track cancer, colon cancer, pancreatic cancer, lung cancer, kidney cancer, urinary bladder cancer, melanoma, non-Hodgkin's lymphoma, breast cancer, endometrial cancer, cervical cancer, prostate cancer, and testicular cancer. Although the HRs differed between cancer sites, compared with women and men completing <9 years of education, university graduates were associated with a significant 40% improved survival for all cancer sites combined. Conclusions: Survival differences by education level were observed for both indolent and aggressive malignancies.