Education and gastric cancer risk—An individual participant data meta-analysis in the StoP project consortium

Matteo Rota, Gianfranco Alicandro, Claudio Pelucchi, Rossella Bonzi, Paola Bertuccio, Jinfu Hu, Zuo Feng Zhang, Kenneth C. Johnson, Domenico Palli, Monica Ferraroni, Guo Pei Yu, Carlotta Galeone, Lizbeth López-Carrillo, Joshua Muscat, Nuno Lunet, Ana Ferro, Weimin Ye, Amelie Plymoth, Reza Malekzadeh, David ZaridzeDmitry Maximovitch, Manolis Kogevinas, Nerea Fernández de Larrea, Jesus Vioque, Eva M. Navarrete-Muñoz, Shoichiro Tsugane, Gerson S. Hamada, Akihisa Hidaka, Mohammadreza Pakseresht, Alicja Wolk, Niclas Håkansson, Raúl Ulises Hernández-Ramírez, Malaquias López-Cervantes, Mary Ward, Farhad Pourfarzi, Lina Mu, Robert C. Kurtz, Areti Lagiou, Pagona Lagiou, Paolo Boffetta, Stefania Boccia, Eva Negri, Carlo La Vecchia

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25 Scopus citations


Low socioeconomic position (SEP) is a strong risk factor for incidence and premature mortality from several cancers. Our study aimed at quantifying the association between SEP and gastric cancer (GC) risk through an individual participant data meta-analysis within the “Stomach cancer Pooling (StoP) Project”. Educational level and household income were used as proxies for the SEP. We estimated pooled odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) across levels of education and household income by pooling study-specific ORs through random-effects meta-analytic models. The relative index of inequality (RII) was also computed. A total of 9,773 GC cases and 24,373 controls from 25 studies from Europe, Asia and America were included. The pooled OR for the highest compared to the lowest level of education was 0.60 (95% CI, 0.44–0.84), while the pooled RII was 0.45 (95% CI, 0.29–0.69). A strong inverse association was observed both for noncardia (OR 0.39, 95% CI, 0.22–0.70) and cardia GC (OR 0.47, 95% CI, 0.22–0.99). The relation was stronger among H. pylori negative subjects (RII 0.14, 95% CI, 0.04–0.48) as compared to H. pylori positive ones (RII 0.29, 95% CI, 0.10–0.84), in the absence of a significant interaction (p = 0.28). The highest household income category showed a pooled OR of 0.65 (95% CI, 0.48–0.89), while the corresponding RII was 0.40 (95% CI, 0.22–0.72). Our collaborative pooled-analysis showed a strong inverse relationship between SEP indicators and GC risk. Our data call for public health interventions to reduce GC risk among the more vulnerable groups of the population.

Original languageEnglish (US)
Pages (from-to)671-681
Number of pages11
JournalInternational Journal of Cancer
Issue number3
StatePublished - Feb 1 2020

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research


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