, Volume 24, Issue 3, pp 559-565
Date: 22 May 2012

Selected cancers with increasing mortality rates by educational attainment in 26 states in the United States, 1993–2007

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Abstract

Background

Mortality rates continue to increase for liver, esophagus, and pancreatic cancers in non-Hispanic whites and for liver cancer in non-Hispanic blacks. However, the extent to which trends vary by socioeconomic status (SES) is unknown.

Methods

We calculated age-standardized death rates for liver, esophagus, and pancreas cancers for non-Hispanic whites and non-Hispanic blacks aged 25–64 years by sex and level of education (≤12, 13–15, and ≥16 years, as a SES proxy) during 1993–2007 using mortality data from 26 states with consistent education information on death certificates. Temporal trends were evaluated using log-linear regression, and rate ratios (RRs) with 95 % confidence intervals (CIs) compared death rates in persons with ≤12 versus ≥16 years of education.

Results

Generally, death rates increased for cancers of the liver, esophagus, and pancreas in non-Hispanic whites and non-Hispanic blacks (liver cancer only) with ≤12 and 13–15 years of education, with steeper increases in the least educated group. In contrast, rates remained stable in persons with ≥16 years of education. During 1993–2007, the RR (rates in ≤12 versus ≥16 years of education) increased for all three cancers, particularly for liver cancer among men which increased from 1.76 (95 % CI, 1.38–2.25) to 3.23 (95 % CI, 2.78–3.75) in non-Hispanic whites and from 1.28 (95 % CI, 0.71–2.30) to 3.64 (95 % CI, 2.44–5.44) in non-Hispanic blacks.

Conclusions

The recent increase in mortality rates for liver, esophagus, and pancreatic cancers in non-Hispanic whites and for liver cancer in non-Hispanic blacks reflects increases among those with lower education levels.