Cancer risk and social inequalities in Italy

Study objective - To investigate social differences in cancer incidence in Turin, Italy in 1985-87. Design - A cancer incidence follow up study of the Turin population in relation to socioeconomic characteristics was performed through record linkage between the 1981 census and the cancer registry. A case-control study nested in the cohort was analysed, where cases were subjects with a new diagnosis of cancer in 1985-87 and controls were a sample of the Turin population, frequency matched by sex and age group. Incidence odd ratios (ORs) were calculated for social classes (defined by education, housing tenure, and socioeconomic group) using a logistic regression model. Setting - The study population comprised subjects included in the 1981 Turin census (≃ 1 100 000) who were still alive, 20-69 years old, and were resident in Turin in the middle of study period. Participants - The analyses were based on 4215 male and 3451 female cases, and on 16 913 male and 13 838 female controls. Main results - Compared with the highest educational level, the men in the lowest one showed an OR>2 for respiratory cancers; OR=1.48 for stomach cancer; and ORs<0.7 for skin, colorectal, and prostate cancers. Women with a primary school education were protected against colorectal (OR=0.71), skin (OR=0.59), and breast cancer (OR=0.66) compared with university degree women, but were at risk for cancer of the cervix (OR=2.33) and stomach cancer (OR=2.84). The association between educational level (primary school v university) and lung cancer risk is negative for men (OR=2.47) and positive for women (OR=0.62), while the association with housing tenure is negative for both sexes (OR=1.44). Conclusions - The socioeconomic distribution of some risk factors (for example smoking, alcohol, and diet) in Italy can partially explain the differences in respiratory and digestive cancers. 'Unbalanced' health promotion interventions, targeted at social groups with the highest prevalences of risk factors, and national policies for increasing the level of education in the country may play an important role in reducing social differences in cancer risk.