Association between educational level and risk of cancer in HIV-infected individuals and the background population: Population-based cohort study 1995-2011

Rebecca Legarth, Lars H Omland, Susanne O Dalton, Gitte Kronborg, Carsten S Larsen, Court Pedersen, Gitte Pedersen, Jan Gerstoft, Niels Obel

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Abstract

BACKGROUND:  Risk of cancer is increased in HIV-infection. To our knowledge, no previous study has examined the association between socioeconomic position and risk and prognosis of cancer among HIV-infected individuals.

METHODS:  Population-based cohort-study including HIV-infected individuals diagnosed in Denmark 1995-2011 (without intravenous drug abuse or hepatitis C infection) (n=3,205), and a comparison cohort from the background population individually-matched by age, gender and country of birth (n=22,435). Educational level (low or high) and cancer events were identified in Danish national registers. Cumulative incidences, Incidence rate ratio (IRR) and survival using Kaplan-Meier methods were estimated.

RESULTS:  Low educational level was associated with increased risk of cancer among HIV-infected individuals compared to the comparison cohort: all cancers (Adjusted-IRRs: 1.4(95% CI;1.1-1.7) vs. 1.1(95% CI;0.9-1.2)), tobacco- & alcohol-related cancers (2.1(95% CI;1.3-3.4) vs. 1.3(95% CI;1.1-1.6)), and other cancers (1.7(95% CI;1.1-2.8) vs. 0.9(95% CI;0.7-1.0)). No association with educational level was found for Infection-related or Ill-defined cancers. 1-year-survival was not associated with educational level, but 5-year-survival following Infection-related and Ill-defined cancers was lower among HIV-infected individuals with low educational level.

CONCLUSION:  Education is associated with risk and prognosis of some cancers in HIV-infection, and this association diverges from what is observed in the background population.

Original languageEnglish
JournalJournal of Infectious Diseases
Volume212
Issue number10
Pages (from-to)1552-1562
ISSN0022-1899
DOIs
Publication statusPublished - 22. Apr 2015

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Cohort Studies
HIV
Population
Neoplasms
Intravenous Substance Abuse
Incidence
Denmark
Hepatitis C
Alcohols
Education

Bibliographical note

e-pub

Cite this

Legarth, Rebecca ; Omland, Lars H ; Dalton, Susanne O ; Kronborg, Gitte ; Larsen, Carsten S ; Pedersen, Court ; Pedersen, Gitte ; Gerstoft, Jan ; Obel, Niels. / Association between educational level and risk of cancer in HIV-infected individuals and the background population : Population-based cohort study 1995-2011. In: Journal of Infectious Diseases. 2015 ; Vol. 212, No. 10. pp. 1552-1562.
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title = "Association between educational level and risk of cancer in HIV-infected individuals and the background population: Population-based cohort study 1995-2011",
abstract = "BACKGROUND:  Risk of cancer is increased in HIV-infection. To our knowledge, no previous study has examined the association between socioeconomic position and risk and prognosis of cancer among HIV-infected individuals.METHODS:  Population-based cohort-study including HIV-infected individuals diagnosed in Denmark 1995-2011 (without intravenous drug abuse or hepatitis C infection) (n=3,205), and a comparison cohort from the background population individually-matched by age, gender and country of birth (n=22,435). Educational level (low or high) and cancer events were identified in Danish national registers. Cumulative incidences, Incidence rate ratio (IRR) and survival using Kaplan-Meier methods were estimated.RESULTS:  Low educational level was associated with increased risk of cancer among HIV-infected individuals compared to the comparison cohort: all cancers (Adjusted-IRRs: 1.4(95{\%} CI;1.1-1.7) vs. 1.1(95{\%} CI;0.9-1.2)), tobacco- & alcohol-related cancers (2.1(95{\%} CI;1.3-3.4) vs. 1.3(95{\%} CI;1.1-1.6)), and other cancers (1.7(95{\%} CI;1.1-2.8) vs. 0.9(95{\%} CI;0.7-1.0)). No association with educational level was found for Infection-related or Ill-defined cancers. 1-year-survival was not associated with educational level, but 5-year-survival following Infection-related and Ill-defined cancers was lower among HIV-infected individuals with low educational level.CONCLUSION:  Education is associated with risk and prognosis of some cancers in HIV-infection, and this association diverges from what is observed in the background population.",
author = "Rebecca Legarth and Omland, {Lars H} and Dalton, {Susanne O} and Gitte Kronborg and Larsen, {Carsten S} and Court Pedersen and Gitte Pedersen and Jan Gerstoft and Niels Obel",
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Association between educational level and risk of cancer in HIV-infected individuals and the background population : Population-based cohort study 1995-2011. / Legarth, Rebecca; Omland, Lars H; Dalton, Susanne O; Kronborg, Gitte; Larsen, Carsten S; Pedersen, Court; Pedersen, Gitte; Gerstoft, Jan; Obel, Niels.

In: Journal of Infectious Diseases, Vol. 212, No. 10, 22.04.2015, p. 1552-1562.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Association between educational level and risk of cancer in HIV-infected individuals and the background population

T2 - Population-based cohort study 1995-2011

AU - Legarth, Rebecca

AU - Omland, Lars H

AU - Dalton, Susanne O

AU - Kronborg, Gitte

AU - Larsen, Carsten S

AU - Pedersen, Court

AU - Pedersen, Gitte

AU - Gerstoft, Jan

AU - Obel, Niels

N1 - e-pub

PY - 2015/4/22

Y1 - 2015/4/22

N2 - BACKGROUND:  Risk of cancer is increased in HIV-infection. To our knowledge, no previous study has examined the association between socioeconomic position and risk and prognosis of cancer among HIV-infected individuals.METHODS:  Population-based cohort-study including HIV-infected individuals diagnosed in Denmark 1995-2011 (without intravenous drug abuse or hepatitis C infection) (n=3,205), and a comparison cohort from the background population individually-matched by age, gender and country of birth (n=22,435). Educational level (low or high) and cancer events were identified in Danish national registers. Cumulative incidences, Incidence rate ratio (IRR) and survival using Kaplan-Meier methods were estimated.RESULTS:  Low educational level was associated with increased risk of cancer among HIV-infected individuals compared to the comparison cohort: all cancers (Adjusted-IRRs: 1.4(95% CI;1.1-1.7) vs. 1.1(95% CI;0.9-1.2)), tobacco- & alcohol-related cancers (2.1(95% CI;1.3-3.4) vs. 1.3(95% CI;1.1-1.6)), and other cancers (1.7(95% CI;1.1-2.8) vs. 0.9(95% CI;0.7-1.0)). No association with educational level was found for Infection-related or Ill-defined cancers. 1-year-survival was not associated with educational level, but 5-year-survival following Infection-related and Ill-defined cancers was lower among HIV-infected individuals with low educational level.CONCLUSION:  Education is associated with risk and prognosis of some cancers in HIV-infection, and this association diverges from what is observed in the background population.

AB - BACKGROUND:  Risk of cancer is increased in HIV-infection. To our knowledge, no previous study has examined the association between socioeconomic position and risk and prognosis of cancer among HIV-infected individuals.METHODS:  Population-based cohort-study including HIV-infected individuals diagnosed in Denmark 1995-2011 (without intravenous drug abuse or hepatitis C infection) (n=3,205), and a comparison cohort from the background population individually-matched by age, gender and country of birth (n=22,435). Educational level (low or high) and cancer events were identified in Danish national registers. Cumulative incidences, Incidence rate ratio (IRR) and survival using Kaplan-Meier methods were estimated.RESULTS:  Low educational level was associated with increased risk of cancer among HIV-infected individuals compared to the comparison cohort: all cancers (Adjusted-IRRs: 1.4(95% CI;1.1-1.7) vs. 1.1(95% CI;0.9-1.2)), tobacco- & alcohol-related cancers (2.1(95% CI;1.3-3.4) vs. 1.3(95% CI;1.1-1.6)), and other cancers (1.7(95% CI;1.1-2.8) vs. 0.9(95% CI;0.7-1.0)). No association with educational level was found for Infection-related or Ill-defined cancers. 1-year-survival was not associated with educational level, but 5-year-survival following Infection-related and Ill-defined cancers was lower among HIV-infected individuals with low educational level.CONCLUSION:  Education is associated with risk and prognosis of some cancers in HIV-infection, and this association diverges from what is observed in the background population.

U2 - 10.1093/infdis/jiv247

DO - 10.1093/infdis/jiv247

M3 - Journal article

C2 - 25904603

VL - 212

SP - 1552

EP - 1562

JO - Journal of Infectious Diseases

JF - Journal of Infectious Diseases

SN - 0022-1899

IS - 10

ER -