The effect of social mobility on cancer mortality in Central and Eastern Europe: a multicohort study

Abstract Background Cancer is important cause of death in Central and Eastern Europe (CEE). We assessed effects of SES and social mobility on cancer mortality in CEE. Methods Data from HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) study in Czechia, Poland, and Lithuania were used (23,009 men and women, baseline in 2002-05, total of 1,664 cancer deaths until end 2021). Childhood SES was measured by parental education and household amenities at age 10, and adulthood SES was estimated by principal component analysis based on education, employment, household amenities, and material deprivation. Competing risk models were estimated to investigate effects of childhood and adulthood SES and social mobility on mortality from all cancers and leading cancer types (lung, colorectum, prostate, and breast cancers). Results High adulthood SES was associated with lower mortality from all cancers; fully-adjusted (sub)hazard ratios (HRs), compared with low SES, were: Czechia 0.86 (0.75-0.99), Poland 0.77 (0.62-0.97), Lithuania 0.77 (0.57-1.03)). In Czechia, middle and high adulthood SES were associated with lower risk of breast cancer (HRs=0.52 (0.36-0.75) and 0.23 (0.13-0.42)), in Poland, downward social mobility was linked with increased lung cancer mortality (HR 1.57, 1.21-2.03) and upward social mobility was related to lower breast cancer mortality (HR 0.33, 0.17-0.63). In Lithuania, high adulthood SES and consistent middle/high SES reduced colorectal cancer risk (HRs=0.53 (0.36-0.78) and 0.46 (0.28-0.75)) while all other social mobility patterns were associated with increased breast cancer mortality and decreased lung cancer mortality. Conclusions In these CEE countries, adulthood SES was consistently associated with cancer mortality. Associations with childhood SES and social mobility were less consistent and varied by cancer type. Mapping of social disparities will help designing informed cancer prevention and treatment programmes. Key messages • Adulthood SES instead of childhood SES was associated with cancer mortality in later life in Central and Eastern European countries. • The effects of downward and upward social mobility on cancer mortality were less consistent and varied depending on cancer type.