Educational inequalities in incidence and mortality trends of four common cancers in Finland

Background

Socioeconomic inequalities in cancer outcomes persist also in high-income countries. There is a lack of up-to-date, long-term population-based cohort studies examining educational differences in cancer incidence and mortality, which would cover extended time periods and multiple cancer sites.

Purpose of the study

The aim of this study was to investigate breast, lung, prostate, and colorectal cancer incidence and mortality by educational level in Finland between 1976 and 2023.

Methods

Data on cancer incidence and mortality were obtained from the Finnish Cancer Registry and data on educational level from Statistics Finland. Individuals were classified into basic, secondary or high education group based on the highest completed educational qualification. Age-standardized rates (ASRs) and annual percentage changes (APC) by education group and hazard ratios (HR) between them were estimated to assess differences in cancer incidence, mortality and their trends.

Results

The greatest increase in incidence was found in women with basic education for lung cancer (APC 3.9, [3.6, 4.2] in 2002–2023), resulting in the widest educational disparity among women (HR 0.45, [0.43–0.47] for high vs basic education). Overall, those with high education had the most favorable mortality trends. The largest mortality reductions were seen in lung cancer among those with high education (APC -3.0 [-3.2, -2.8] in men, 1976–2023; -4.3 [-7.3, -1.1] in women, 2017–2023). In the most recent period, mortality was lowest in the high education group for all cancer sites except breast cancer, with HRs ranging from 0.37 for male lung cancer to 0.82 for female colorectal cancer.

Conclusions and implications

The widening of educational inequalities in cancer mortality emphasizes the need for targeted prevention, equitable access to screening and timely treatment, as well as broader population-level policies to reduce socioeconomic differences and promote health equity.

Key messages

• This study showed substantial and persistent educational differences in cancer incidence and particularly mortality in Finland in 1976-2023.

• The results emphasize the need for targeted, cross-sectoral prevention strategies, including equitable access to screening and timely treatment to promote health equity.