Social differences in health concern both ethics and science. From a public health point-of-view, one must assess actual differences and then try to find explanations. This was made possible for the first time for cancer in Italy via nationwide record-linkage between the 1981 census and the national death index. Over the subsequent six months after census, the study-base included 31,000 deaths for cancer and 18 million person-years at risk. Rate ratios (RR) were estimated through a Poisson regression model adjusted by age and geographic area of residence. Educational level was used as social level indicator. Profound social differences were evident for buccal cavity (RR=3.10 for lowest cf highest educational level), esophagus (RR=3.00), stomach (RR=3.43), and larynx (RR=3.30) among men, and for stomach (RR=2.25) and uterus (RR=1.76) among women. Colon (RR=0.62) and pancreas cancers (RR=0.65) presented an inverse relationship among men, as did colon (RR=0.37), breast (RR=0.56), ovary (RR=0.45), and melanoma (RR=0.62) among women. In conclusion, the Italian population at the beginning of the 1980s had large social differences in the risk of dying from cancer, confirming the patterns commonly found in such other countries as Great Britain, France, and New Zealand. Some dissimilarities, useful for hypothesis generation on the mechanisms of inequality, were evident, such as the generally highest social differences found among northern Italian men and among southern Italian women.
Similar content being viewed by others
References
Office of Population Censuses and Surveys. Fourteenth Annual Report. London, UK: HMSO, 1855.
Towsend P, Davidson N, Whitehead M. Inequalities in Health: the Black Report-the Health Divide. London UK: Penguin Books, 1992.
Office of Population Censuses and Surveys. Occupational Mortality 1979–80, 1982–83, Decennial Supplement. London, UK: HMSO, 1986.
Buell P, Dunn JE, Breslow L. The occupational-social class risks of cancer mortality in men. J Chron Dis 1960; 12: 600–21.
Logan WPD. Cancer Mortality by Occupation and Social Class, Studies on Medical and Population Subjects No. 44. London, UK: HMSO; Lyon, France: International Agency for Research on Cancer, 1982.
Gass R. Krebsmortalität nach Beruf. Sozial und Präventivmedizin 1987; 32: 221–7.
Hirayama T. Life-style and Mortality: A Large Scale Census-based Cohort Study in Japan. Basel, Switzerland: Karger, 1990.
Józan P. Some preliminary results of the study on cancer mortality differentials by socio-economic status. In: 4th Meeting of the UN/WHO/CICRED Network on Socio-economic Differential Mortality in Industrialized Societies. Hungarian Central Statistical Office; United Nations Fund for Population Activities; United Nations Population Division; World Health Organization; Committee for International Cooperation in National Research in Demography, 1986: 156–66.
Lynge E, Thygesen L. Occupational Cancer in Denmark. København, Denmark: 1990.
Näyhä S. Social group and mortality in Finland. Br J Prev Soc Med 1977; 31: 231–7.
Pearce NE, Howard JK. Occupation, social class and male cancer mortality in New Zealand, 1974–78. Int J Epidemiol 1986; 15: 456–62.
Vagerö D, Persson G. Occurrence of cancer in socioeconomic groups in Sweden. An analysis based on the Swedish Cancer Environment Registry. Scand J Soc Med 1986; 14: 151–60.
Bouchardy C, Parkin DM, Khlat M et al. Education and mortality from cancer in São Paulo, Brazil. Ann Epidemiol 1993; 3: 64–70.
Cuello C, Correa P, Haenszel W. Socio-economic class differences in cancer incidence in Cali, Colombia. Int J Cancer 1982; 29: 637–43.
Dosemeci M, Hayes RB, Vetter R, et al. Occupational physical activity, socioeconomic status, and risks of 15 cancer sites in Turkey. Cancer Causes Control 1993; 4: 313–21.
Faggiano F, Zanetti R, Costa G. Cancer risk and social inequalities in Italy. J Epidemiol Comm Health 1994; 48: 447–52.
Smans M, Muir CS, Boyle P. Atlas of Cancer Mortality in the European Economic Community. Lyon, France: International Association for Research on Cancer, 1992; IARC Sci, Pub. No. 107.
Valkonen T. Adult mortality and level of education: A comparison of six countries. In: Fox J, ed. Health Inequalities in European Countries. Gower, UK: Aldershot, 1989.
Cobalti A. Sistemi Scolastici, Mobilità, Disuguaglianze. In: Gallino L, ed. Diseguaglianze ed equità in Europa. Bari, Italy: Laterza, 1993.
ISTAT. La Mortalità Differenziale Secondo Alcuni Fattori Socio-economici-Anni 1981–1982. Roma, Italy: ISTAT, 1990, Note e relazioni n. 2.
World Health Organization. Manual of International Classification of Diseases, Injuries and Causes of Death. 9th Revision. Geneva, Switzerland: WHO, 1977.
Facchini U, Comnasio M, Cantaboni A et al. Geographical variation of cancer mortality in Italy. Int J Epidemiol 1985, 14: 538–548.
Kleinbaum DG, Kupper LL, Muller KE Applied Regression Analysis and Other Multivariate Methods. Boston, MA (USA): PWS-Kent Publishing Co, 1988: 497–512.
Breslow NE, Day NE. Statistical Methods in Cancer Research. Vol. II. The Design and Analysis of Cohort Studies. Lyon, France: International Agency for Research on Cancer, 1987; IARC Sci. Pub. No. 82.
Desplanques G. La Mortalité des Adultes. Paris, France: Institut National de la Statistique et des Etudes Economiques (INSEE), 1985.
Pearce NE, Howard JK. Occupation, social class and male cancer mortality in New Zealand, 1974–78. Int J Epidemiol 1986; 15: 456–62.
Buratta V, Crialesi C, Faggiano F. Differenze sociali nella salute e tendenze temporali: le indagini Istat degli anni '80. Communication at the conference ‘Giornate di studio della popolazione’ held in Bologna 6–7 December 1993.
Stroffolini T, Pasquini P, Mele A. HBsAg carriers among pregnant women in Italy: results from the screening during a vaccination campaign against hepatitis Bull Public Health 1988; 102: 329–33.
Tomatis L, ed. Cancer: Causes, Occurrence and Control. Lyon, France: International Association for Research on Cancer, 1990; IARC Sci. Pub. No. 100.
Vieis P, Fornero G, Magnino A, Giacometti R, Ciccone G. Diagnostic delay, clinical stage, and social class: a hospital based study. J Epidemiol Comm Health 1993, 47: 229.31.
Author information
Authors and Affiliations
Additional information
Data processing was supported partially by a grant from CSI-Piemonte (Consorzio per il Sistema Informativo).
Rights and permissions
About this article
Cite this article
Faggiano, F., Lemma, P., Costa, G. et al. Cancer mortality by educational level in Italy. Cancer Causes Control 6, 311–320 (1995). https://doi.org/10.1007/BF00051406
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00051406