Gianfranco Alicandro1,2, Paola Bertuccio3,4, Giulia Collatuzzo5, Claudio Pelucchi4, Rossella Bonzi4, Linda M Liao6, Charles S Rabkin6, Rashmi Sinha6, Eva Negri4,5,7, Michela Dalmartello4, David Zaridze8, Dmitry Maximovich8, Jesus Vioque9,10, Manoli Garcia de la Hera9,10, Shoichiro Tsugane11,12, Akihisa Hidaka11, Gerson Shigueaki Hamada13, Lizbeth López-Carrillo14, Raúl Ulises Hernández-Ramírez15, Reza Malekzadeh16, Farhad Pourfarzi17, Zuo-Feng Zhang18, Robert C Kurtz19, M Constanza Camargo6, Maria Paula Curado20, Nuno Lunet21,22,23, Paolo Boffetta5,24, Carlo La Vecchia4. 1. Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy. gianfranco.alicandro@unimi.it. 2. Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. gianfranco.alicandro@unimi.it. 3. Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy. 4. Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy. 5. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. 6. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA. 7. Pegaso Online University, Naples, Italy. 8. Department of Clinical Epidemiology, N.N. Blokhin National Medical Research Center for Oncology, Moscow, Russia. 9. Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernandez (ISABIAL-UMH), Alicante, Spain. 10. Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain. 11. Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan. 12. National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan. 13. Nikkei Disease Prevention Center, São Paulo, Brazil. 14. Mexico National Institute of Public Health, Morelos, Mexico. 15. Department of Biostatistics, Yale School of Public Health, Yale School of Medicine, New Haven, CT, USA. 16. Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran. 17. Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil, Iran. 18. Department of Epidemiology, UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA. 19. Department of Medicine, Memorial Sloan Kettering Cancer Centre, New York, NY, USA. 20. Centro Internacional de Pesquisa, A. C. Camargo Cancer Center, São Paulo, Brasil. 21. EPIUnit-Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal. 22. Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal. 23. Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal. 24. Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA.
Abstract
BACKGROUND: The causal pathway between high education and reduced risk of gastric cancer (GC) has not been explained. The study aimed at evaluating the mediating role of lifestyle factors on the relationship between education and GC METHODS: Ten studies with complete data on education and five lifestyle factors (smoking, alcohol drinking, fruit and vegetable intake, processed meat intake and salt consumption) were selected from a consortium of studies on GC including 4349 GC cases and 8441 controls. We created an a priori score based on the five lifestyle factors, and we carried out a counterfactual-based mediation analysis to decompose the total effect of education on GC into natural direct effect and natural indirect effect mediated by the combined lifestyle factors. Effects were expressed as odds ratios (ORs) with a low level of education as the reference category. RESULTS: The natural direct and indirect effects of high versus low education were 0.69 (95% CI: 0.62-0.77) and 0.96 (95% CI: 0.95-0.97), respectively, corresponding to a mediated percentage of 10.1% (95% CI: 7.1-15.4%). The mediation effect was limited to men. CONCLUSIONS: The mediation effect of the combined lifestyle factors on the relationship between education and GC is modest. Other potential pathways explaining that relationship warrants further investigation.
BACKGROUND: The causal pathway between high education and reduced risk of gastric cancer (GC) has not been explained. The study aimed at evaluating the mediating role of lifestyle factors on the relationship between education and GC METHODS: Ten studies with complete data on education and five lifestyle factors (smoking, alcohol drinking, fruit and vegetable intake, processed meat intake and salt consumption) were selected from a consortium of studies on GC including 4349 GC cases and 8441 controls. We created an a priori score based on the five lifestyle factors, and we carried out a counterfactual-based mediation analysis to decompose the total effect of education on GC into natural direct effect and natural indirect effect mediated by the combined lifestyle factors. Effects were expressed as odds ratios (ORs) with a low level of education as the reference category. RESULTS: The natural direct and indirect effects of high versus low education were 0.69 (95% CI: 0.62-0.77) and 0.96 (95% CI: 0.95-0.97), respectively, corresponding to a mediated percentage of 10.1% (95% CI: 7.1-15.4%). The mediation effect was limited to men. CONCLUSIONS: The mediation effect of the combined lifestyle factors on the relationship between education and GC is modest. Other potential pathways explaining that relationship warrants further investigation.
Authors: Claudia Santucci; Greta Carioli; Paola Bertuccio; Matteo Malvezzi; Ugo Pastorino; Paolo Boffetta; Eva Negri; Cristina Bosetti; Carlo La Vecchia Journal: Eur J Cancer Prev Date: 2020-09 Impact factor: 2.497
Authors: Katrin Hausdorf; Elizabeth Eakin; David Whiteman; Carla Rogers; Joanne Aitken; Beth Newman Journal: Cancer Causes Control Date: 2008-08-15 Impact factor: 2.506