{
  "abstract": "Introduction Socioeconomic inequalities are key contributors to cancer disparities. We explored the associations between individual-level socioeconomic status (SES) indicators (composite wealth score, educational attainment and rural/urban residence) and site-specific cancer incidence and mortality.Methods For this prospective study, we used data from 49 776 participants of the Golestan Cohort Study in northeastern Iran, enrolled in 2004–2008. Follow-up continued until first primary cancer diagnosis, death, loss to follow-up, or 31 March 2021. We used Cox proportional hazard regression models to estimate HRs and 95% CI, adjusted for several cancer risk factors and all SES indicators.Results Over a 14-year median follow-up, the highest wealth score quartile, compared with the lowest, was associated with reduced oesophageal (HR=0.61; 95% CI 0.43 to 0.88) and gastric (HR=0.61; 95% CI 0.43 to 0.86) but elevated breast (HR=2.54; 95% CI 1.32 to 4.89) cancer incidence. The highest education level, compared with none, was associated with reduced oesophageal (HR=0.43; 95% CI 0.24 to 0.79), gastric (HR=0.54; 95% CI 0.35 to 0.84), hepatobiliary (HR=0.33; 95% CI 0.13 to 0.83) and lung (HR=0.44; 95% CI 0.20 to 1.00) cancer incidence. Urban residence was associated with decreased oesophageal (HR=0.63; 95% CI 0.44 to 0.90) but increased colorectal (HR=1.72; 95% CI 1.17 to 2.54), breast (HR=2.37; 95% CI 1.52 to 3.71), hepatobiliary (HR=1.70; 95% CI 1.00 to 2.87) and prostate (HR=2.60; 95% CI 1.24 to 5.45) cancer incidence. Cancer mortality analyses showed similar associations though a few results were not statistically significant due to small sample sizes.Conclusions Low wealth score, lack of formal education and rural residence were associated with disparate cancer incidence and mortality, particularly gastrointestinal cancers, in this predominantly rural population from a low- and middle-income country.",
  "authors": [
    {
      "affiliations": [
        "Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"
      ],
      "name": "Mahdokht Naghash"
    },
    {
      "affiliations": [
        "Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"
      ],
      "name": "Nogol Motamed-Gorji"
    },
    {
      "affiliations": [
        "Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"
      ],
      "name": "Nazgol Motamed-Gorji"
    },
    {
      "affiliations": [
        "Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran (the Islamic Republic of)"
      ],
      "name": "Gholamreza Roshandel"
    },
    {
      "affiliations": [
        "Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"
      ],
      "name": "Hossein Poustchi"
    },
    {
      "affiliations": [
        "Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"
      ],
      "name": "Maryam Sharafkhah"
    },
    {
      "affiliations": [
        "Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"
      ],
      "name": "Akram Pourshams"
    },
    {
      "affiliations": [
        "Surveillance, Prevention, and Health Services Research, American Cancer Society, Atlanta, Georgia, USA"
      ],
      "name": "Farhad Islami"
    },
    {
      "affiliations": [
        "Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran (the Islamic Republic of)"
      ],
      "name": "Masoud Khoshnia"
    },
    {
      "affiliations": [
        "Tobacco Control Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA"
      ],
      "name": "Neal D Freedman"
    },
    {
      "affiliations": [
        "Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland, USA"
      ],
      "name": "Sanford M Dawsey"
    },
    {
      "affiliations": [
        "Department of Biology, School of Computer, Mathematical and Natural Sciences, Morgan State University, Baltimore, Maryland, USA"
      ],
      "name": "Farin Kamangar"
    },
    {
      "affiliations": [
        "Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA",
        "Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy"
      ],
      "name": "Paolo Boffetta"
    },
    {
      "affiliations": [
        "International Agency for Research on Cancer, Lyon, France"
      ],
      "name": "Paul Brennan"
    },
    {
      "affiliations": [
        "Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland, USA"
      ],
      "name": "Christian C Abnet"
    },
    {
      "affiliations": [
        "Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"
      ],
      "name": "Reza Malekzadeh"
    },
    {
      "affiliations": [
        "Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland, USA"
      ],
      "name": "Arash Etemadi"
    }
  ],
  "title": "Socioeconomic disparities in site-specific cancer incidence and mortality: Golestan cohort study",
  "uid": "1a5a5761-56d4-5b28-af8d-f663edf6d1fe"
}