Educational inequalities in incidence and mortality trends of four common cancers in Finland
Abstract
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.
Related
- Sex differences in gastrointestinal cancers incidence and mortality among adolescents and young adults in China: an age-period-birth cohort study
- Incidence of intra-axial brain metastases in Eastern Finland.
- Estimated incidence and number of new cases with prenatal alcohol exposure and fetal alcohol spectrum disorders in Finland 1990–2025
- Opposing trends in early-onset dementia incidence across subtypes in Finland, 2016–2024
- Socioeconomic inequalities, phenotypic aging, and the risk of incident upper gastrointestinal cancers
BibTeX
@article{maenpaa2026educational,
title = {{Educational inequalities in incidence and mortality trends of four common cancers in Finland}},
author = {AF Mäenpää and EM Mäkinen and SH Lappi-Heikkinen and TT Tanskanen and VM Partanen and JP Pitkäniemi and KS Seppä and T Myllyaho},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.795},
url = {https://doi.org/10.1093/eurpub/ckag169.795},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Educational inequalities in incidence and mortality trends of four common cancers in Finland
AU - AF Mäenpää
AU - EM Mäkinen
AU - SH Lappi-Heikkinen
AU - TT Tanskanen
AU - VM Partanen
AU - JP Pitkäniemi
AU - KS Seppä
AU - T Myllyaho
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.795
UR - https://doi.org/10.1093/eurpub/ckag169.795
AB - 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.
SN - 1101-1262
SN - 1464-360X
ER -