Social mobility and cancer mortality in Central and Eastern Europe: a multicohort study.

Social determinants of cancer mortality in Central and Eastern Europe (CEE) have been relatively under-researched. This study investigated associations of socioeconomic status (SES) and intergenerational social mobility with cancer mortality in three countries of the region. Data from the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study in the Czech Republic, Poland, and Lithuania were used (23 009 men and women, an average follow-up of 17 years, and a total of 2383 cancer deaths through the end of 2024). Childhood SES was measured by parental education and household amenities at age 10, and adulthood SES was measured by education, employment, household amenities, and material deprivation. Principal component analysis based on polychoric correlation matrix reduced the dimensionality of SES variables. Competing risk models estimated subdistribution hazard ratios (SHRs) for the associations of SES and social mobility with mortality from all cancers and two leading cancer types (lung and colorectal cancers). Compared to low adulthood SES, high adulthood SES was associated with lower total and lung cancer mortality (fully adjusted SHRs were 0.85 (95% confidence interval [CI], 0.76-0.94) and 0.79 (0.62-1.00), respectively). Compared to stable low SES, stable middle or high SES was associated with lower overall cancer mortality (fully adjusted SHR was 0.88 [95% CI, 0.77-1.00]), while associations of downward and upward mobility with cancer mortality varied by cancer type and country. Adulthood SES and intergenerational social mobility, but not childhood SES, were associated with cancer mortality in later life in CEE. These results may help inform cancer prevention and treatment programmes.