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

Cancer Causes Control. 2013 Mar;24(3):559-65. doi: 10.1007/s10552-012-9993-y. Epub 2012 May 22.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Digestive System Neoplasms / ethnology
  • Digestive System Neoplasms / mortality*
  • Educational Status*
  • Esophageal Neoplasms / ethnology
  • Esophageal Neoplasms / mortality
  • Female
  • Health Status Disparities
  • Humans
  • Liver Neoplasms / ethnology
  • Liver Neoplasms / mortality
  • Male
  • Middle Aged
  • Mortality / trends
  • Pancreatic Neoplasms / ethnology
  • Pancreatic Neoplasms / mortality
  • Risk Factors
  • Social Class
  • United States / epidemiology