Education and gastric cancer risk – An individual participant data meta-analysis in the StoP project consortium
Menée à partir de données de 25 études conduites en Europe, en Asie et en Amérique et portant sur 9 773 patients atteints d'un cancer de l'estomac et sur 24 373 témoins, cette méta-analyse évalue l'association entre le statut socio-économique (niveau d'éducation, revenus du foyer) et le risque de développer la maladie
Low socioeconomic position (SEP) is a strong risk factor for incidence and premature mortality from several cancers. This study aimed at quantifying the association between SEP and gastric cancer (GC) risk through an individual participant data meta-analysis within the “Stomach cancer Pooling (StoP) Project”. Educational level and household income were used as proxies for the SEP. We estimated pooled odds-ratios (ORs) and the corresponding 95% confidence intervals (CIs) across levels of education and household income by pooling study-specific ORs through random-effects meta-analytic models. The relative index of inequality (RII) was also computed. A total of 9,773 GC cases and 24,373 controls from 25 studies from Europe, Asia and America were included. The pooled OR for the highest compared to the lowest level of education was 0.60 (95% CI, 0.44-0.84), while the pooled RII was 0.45 (95% CI, 0.29-0.69). A strong inverse association was observed both for non-cardia (OR 0.39, 95% CI, 0.22-0.70) and cardia GC (OR 0.47, 95% CI, 0.22-0.99). The relation was stronger among H. pylori negative subjects (RII 0.14, 95% CI, 0.04-0.50) as compared to H. pylori positive ones (RII 0.35, 95% CI, 0.12-1.05), in the absence of a significant interaction (p=0.28). The highest household income category showed a pooled OR of 0.65 (95% CI, 0.48-0.89), the corresponding RII being 0.40 (95% CI, 0.22-0.72). Our collaborative pooled-analysis showed a strong inverse relationship between SEP indicators and GC risk. Our data call for public health interventions to reduce GC risk among the more vulnerable groups of the population. This article is protected by copyright. All rights reserved.