Social inequalities and cancer mortality in France, 1975–1990

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Abstract
Objective: to investigate social inequalities in cancer mortality from 1975 through 1990 among men and women in France. Methods: A sample, that included census data for approximately 1% of the French population, has been followed for mortality from 1975 to 1990. Causes of death were obtained through a record-linkage with the French national cause-of-death file. The analysis was restricted to those aged 35:59 in 1975 and included 61,876 men and 65,291 women. Occupational class, coded according to the social class scheme of Erikson, Goldthorpe and Portecarero in 7 categories, and educational level (in 4 categories) in 1975 have been studied. The analysis has been conducted for 15 cancer sites among men and 13 among women. Analysis used a Cox proportional hazards model. Results: For educational level, inequalities among men were more pronounced for cancers of the pharynx Relative Risk (RR) lowest versus highest educational level=9.2, 95% Confidence Interval (CI) 2.9–29.1, larynx (RR=6.2, CI=3.0:12.6), oral cavity (RR=2.7, CI=1.3–5.3), lung (RR=3.5, CI=2.5–4.8), esophagus (RR=3.1, CI=1.9–5.2), stomach (RR=2.5, CI=1.2–5.3) and rectum (RR=3.4, CI=1.2–9.6). No association between educational level and cancer mortality was observed for cancers of either the colon or lymphatic and hematopoietic tissue. Social inequalities were less pronounced among women but nevertheless observed for cancer of the uterus (RR=1.9, CI=1.0–3.6), stomach (RR=4.1, CI=1.0–17.1) and lung (RR=1.6, CI=0.7–3.7). No associations were found for mortality from breast or ovarian cancers. Results were similar when socioeconomic status was measured by occupational class. Conclusion: The analysis showed substantial inequalities in cancer mortality in France, with large differences according to cancer site.