The European Journal of Public Health Advance Access originally published online on July 15, 2008
The European Journal of Public Health 2008 18(5):466-472; doi:10.1093/eurpub/ckn052
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Social factors and health |
Education in relation to incidence of and mortality from cancer and cardiovascular disease in Japan
Shinichiro Ito1, Ribeka Takachi2,3, Manami Inoue3, Norie Kurahashi3, Motoki Iwasaki3, Shizuka Sasazuki3, Hiroyasu Iso4, Yoshitaka Tsubono2,5, Shoichiro Tsugane3 and for the JPHC Study Group*
1 Tohoku University School of Law, Sendai, Japan
2 Department of Clinical Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan
3 Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
4 Public Health, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
5 Division of Health Policy, Tohoku University School of Public Policy, Sendai, Japan
Correspondence: Yoshitaka Tsubono, Division of Health Policy, Tohoku University School of Public Policy, 27-1 Kawauchi, Aoba-ku, Sendai-shi, Miyagi 980-8576 Japan, tel: +81-22-795-5940, fax: +81-22-795-5940, e-mail: ytsubono{at}gmail.com
Received September 26, 2007 , accepted May 8, 2008
Background: Although lower education has been associated with poorer health, few studies have examined whether lower education affects mortality, incidence, both or neither of cancer and cardiovascular disease. Methods: The authors conducted a population-based prospective cohort study among 39 228 men and women who were aged 40–59 years and lived in four areas in Japan. Information on education and lifestyle variables were obtained by a self-administered questionnaire in 1990. Follow-up until the end of 2002 (for incidence) or 2003 (for mortality) ascertained 2573 and 1251 incident cases of cancer and cardiovascular disease, respectively, and 2430 deaths (1064 from cancer, 548 from cardiovascular disease and 818 from other causes). Results: After adjustment for demographic and lifestyle variables, <10 years of education, as compared with >12 years of education, was associated with significantly higher mortality from all causes [hazard ratio (HR) = 1.22, 95% confidence interval (CI): 1.05–1.42] and cardiovascular disease (HR = 1.44, 95% CI: 1.01–2.06), but was not associated with higher incidence of cardiovascular disease (HR = 0.96, 95% CI: 0.78–1.18) or higher mortality or incidence of cancer. Conclusion: The findings suggest that lower education is associated with higher mortality from all causes and cardiovascular disease among the Japanese population that is not totally attributable to lifestyle differences or higher cardiovascular disease incidence.
Keywords: cancer, cardiovascular disease, education, prospective study, socioeconomic status
*The members of the JPHC study group are listed in the Appendix.
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