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BMJ Open. 2013 Dec 3;3(12):e003754. doi: 10.1136/bmjopen-2013-003754.

Education level and survival after oesophageal cancer surgery: a prospective population-based cohort study.

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1
Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.

Abstract

OBJECTIVES:

This study aimed to investigate whether a higher education level is associated with an improved long-term survival after oesophagectomy for cancer.

DESIGN:

A prospective, population-based cohort study.

SETTING:

Sweden-nationwide.

PARTICIPANTS:

90% of all patients with oesophageal and cardia cancer who underwent a resection in Sweden in 2001-2005 were enrolled in this study (N=600; 80.3% male) and followed up until death or the end of the study period (2012). The study exposure was level of education, defined as compulsory (≤9 years), moderate (10-12 years) or high (≥13 years).

OUTCOME MEASURES:

The main outcome measure was overall 5-year survival after oesophagectomy. Cox regression was used to estimate the associations between education level and mortality, expressed as HRs with 95% CIs, with adjustment for sex, age, tumour stage, histological type, complications, comorbidities and annual surgeon volume. The patient group with highest education was used as the reference category.

RESULTS:

Among the 600 included patients, 281 (46.8%) had compulsory education, 238 (39.7%) had moderate education and 81 (13.5%) had high education. The overall 5-year survival rate was 23.1%, 24.4% and 32.1% among patients with compulsory, moderate and high education, respectively. After adjustment for confounders, a slightly higher, yet not statistically significantly increased point HR was found among the compulsory educated patients (HR 1.08, 95% CI 0.80 to 1.47). In patients with tumour stage IV, increased adjusted HRs were found for compulsory (HR 2.88, 95% CI 1.07 to 7.73) and moderately (HR 2.83, 95% CI 1.15 to 6.95) educated patients. No statistically significant associations were found for the other tumour stages.

CONCLUSIONS:

This study provides limited evidence of an association between lower education and worse long-term survival after oesophagectomy for cancer.

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