TY - JOUR
T1 - The mediating role of combined lifestyle factors on the relationship between education and gastric cancer in the Stomach cancer Pooling (StoP) Project
AU - Alicandro, Gianfranco
AU - Bertuccio, Paola
AU - Collatuzzo, Giulia
AU - Pelucchi, Claudio
AU - Bonzi, Rossella
AU - Liao, Linda M.
AU - Rabkin, Charles S.
AU - Sinha, Rashmi
AU - Negri, Eva
AU - Dalmartello, Michela
AU - Zaridze, David
AU - Maximovich, Dmitry
AU - Vioque, Jesus
AU - Garcia de la Hera, Manoli
AU - Tsugane, Shoichiro
AU - Hidaka, Akihisa
AU - Hamada, Gerson Shigueaki
AU - López-Carrillo, Lizbeth
AU - Hernández-Ramírez, Raúl Ulises
AU - Malekzadeh, Reza
AU - Pourfarzi, Farhad
AU - Zhang, Zuo Feng
AU - Kurtz, Robert C.
AU - Camargo, M. Constanza
AU - Curado, Maria Paula
AU - Lunet, Nuno
AU - Boffetta, Paolo
AU - La Vecchia, Carlo
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Nature Limited.
PY - 2022
Y1 - 2022
N2 - Background: The causal pathway between high education and reduced risk of gastric cancer (GC) has not been explained. The study aimed at evaluating the mediating role of lifestyle factors on the relationship between education and GC Methods: Ten studies with complete data on education and five lifestyle factors (smoking, alcohol drinking, fruit and vegetable intake, processed meat intake and salt consumption) were selected from a consortium of studies on GC including 4349 GC cases and 8441 controls. We created an a priori score based on the five lifestyle factors, and we carried out a counterfactual-based mediation analysis to decompose the total effect of education on GC into natural direct effect and natural indirect effect mediated by the combined lifestyle factors. Effects were expressed as odds ratios (ORs) with a low level of education as the reference category. Results: The natural direct and indirect effects of high versus low education were 0.69 (95% CI: 0.62–0.77) and 0.96 (95% CI: 0.95–0.97), respectively, corresponding to a mediated percentage of 10.1% (95% CI: 7.1–15.4%). The mediation effect was limited to men. Conclusions: The mediation effect of the combined lifestyle factors on the relationship between education and GC is modest. Other potential pathways explaining that relationship warrants further investigation.
AB - Background: The causal pathway between high education and reduced risk of gastric cancer (GC) has not been explained. The study aimed at evaluating the mediating role of lifestyle factors on the relationship between education and GC Methods: Ten studies with complete data on education and five lifestyle factors (smoking, alcohol drinking, fruit and vegetable intake, processed meat intake and salt consumption) were selected from a consortium of studies on GC including 4349 GC cases and 8441 controls. We created an a priori score based on the five lifestyle factors, and we carried out a counterfactual-based mediation analysis to decompose the total effect of education on GC into natural direct effect and natural indirect effect mediated by the combined lifestyle factors. Effects were expressed as odds ratios (ORs) with a low level of education as the reference category. Results: The natural direct and indirect effects of high versus low education were 0.69 (95% CI: 0.62–0.77) and 0.96 (95% CI: 0.95–0.97), respectively, corresponding to a mediated percentage of 10.1% (95% CI: 7.1–15.4%). The mediation effect was limited to men. Conclusions: The mediation effect of the combined lifestyle factors on the relationship between education and GC is modest. Other potential pathways explaining that relationship warrants further investigation.
UR - https://www.scopus.com/pages/publications/85130820411
U2 - 10.1038/s41416-022-01857-9
DO - 10.1038/s41416-022-01857-9
M3 - Article
C2 - 35624300
AN - SCOPUS:85130820411
SN - 0007-0920
JO - British Journal of Cancer
JF - British Journal of Cancer
ER -