Trends in educational inequalities in mortality, seven types of cancers, Norway 1971–2002
By Jon Ivar Elstad, Rita Torstensrud, Torkild Hovde Lyngstad and Øystein Kravdal
European Journal of Public Health 22, pages 771-776.
Background: Knowledge about educational disparities in deaths from specific cancer sites is incomplete. Even more scant is information about time trends in educational patterns in specific cancer mortality. This study examines educational inequalities in Norway 1971–2002 for mortality in lung and larynx, colorectal, stomach, melanoma, prostate, breast and cervix uteri cancer.
Methods: A data file encompassing all Norwegian inhabitants registered some time during 1971–2002 while aged 45–74 was constructed with linked information from administrative registers. During an exposure of more than 40 millions person-years, about 87 000 deaths in the analysed cancer types were registered. Absolute and relative inequalities during three periods were analysed by age-standardized deaths rates, hazard regression odds ratios and Relative Index of Inequality.
Results: Educational inequalities in lung and related cancer mortality widened considerably from the 1970s to the 1990s for both sexes. The moderate educational gradient for stomach and cervix uteri cancer persisted, as did the weak gradient for colorectal cancer. No educational differences in prostate cancer were observed in any of the time periods. The modest inverse educational gradients in deaths from breast cancer and melanoma remained at the same level.
Conclusion: Among the seven cancer types examined in this study, only lung cancer mortality showed a clear widening in educational disparities. As lung cancer mortality constitutes a large proportion of all cancer deaths, this increase may result in larger disparities for overall cancer mortality. Some explanations for the observed patterns in cancer mortality are suggested.