Association of Low Educational Attainment and Higher Colorectal Cancer Risk: Mediatory Effect of Lifestyle-Associated Factors Within Local Context
Bibliographic record
Abstract
Background: Educational attainment may influence colorectal cancer (CRC) risks, though the association remains inconclusive. The association might be mediated by health behaviors. This study aimed to explore the association of education on risks of CRC and to elucidate the mediatory effects of lifestyle-associated factors. Methods: This case-control study included 174 cases and 296 healthy controls. We used a semi-structured questionnaire to collect information on participants' sociodemographic factors (age, sex, marital status, monthly income, and family history of CRC) and lifestyle-associated behaviors (smoking status, physical activity, and frequency of red meat, legumes, and vegetables intake). Body mass index (BMI) was calculated using body mass measured at first contact. Participants' education was categorized into those who completed basic education (≥ 12 years) and those who did not complete basic education (< 12 years). Logistic and multiple logistic regression analyses were employed to test the correlation between education and risk of CRC, adjusted by sociodemographic and lifestyle-associated factors. Path analysis was performed to test the mediatory effect of lifestyle-associated behaviors on the correlation. Results: Participants with lower educational attainment had higher odds of CRC (odds ratio (OR) = 4.76, 95% confidence interval (CI) = 3.07 - 7.38), and the association remained consistent when adjusted by sociodemographic factors (adjusted OR (aOR) = 3.06, 95% CI = 1.86 - 5.03) and combined with lifestyle-associated behaviors (aOR = 2.73, 95% CI = 1.43 - 5.22). The association were consistent among men (OR = 6.14, 95% CI = 3.12 - 12.06; aOR = 4.65, 95% CI = 2.19 - 9.87; aOR = 1.05, 95% CI = 1.02 - 1.09), yet no longer significant among women when adjusted with sociodemographic and lifestyle-associated factors (OR = 3.91, 95% CI = 2.19 - 6.97; aOR = 2.02, 95% CI = 1.02 - 4.00; aOR = 1.56, 95% CI = 0.61 - 3.95). Path analysis showed that the association between educational attainment and risk of CRC was mediated by physical activity, BMI, and intake of red meat, legumes, and vegetables. Conclusion: In our study, educational attainment was inversely correlated with the odds of CRC and might be mediated by physical activity, BMI, and intake of red meat, legumes, and vegetables. Taking other sociodemographic and lifestyle-associated factors into account, the association between lower educational attainment and higher odds of CRC was more substantial among men. These findings highlight the importance of promoting education and healthy lifestyle behaviors, particularly among men, as an essential part of targeted public health strategies in reducing burden of CRC.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".