Cancer
Educational attainment and mortality among World Trade Center Health Registry enrollees diagnosed with cancer after 9/11 Mst Afroza Parvin* Mst Afroza Parvin Parvin Parvin Parvin New York City Department of Health and Mental Hygiene, World Trade Center Health Registry
Individuals exposed to the World Trade Center (WTC) terrorist attacks on 9/11/2001 have elevated risks for certain cancers, highlighting the need to identify determinants of mortality after cancer diagnosis in this population. Our prior work identified racial/ethnic disparities in cancer mortality among WTC-exposed individuals. It is unknown whether educational attainment, a determinant of cancer survival in the general population, also contributes to disparities. We used WTC Health Registry data to examine associations between educational attainment (≤high school (HS) degree, some college, bachelor’s degree, graduate degree) and mortality among 6,603 individuals who were aged ≥25 at enrollment in 2003-2004 and were diagnosed with a first cancer after 9/11/2001. Cox proportional hazards models were used to evaluate all-cause mortality, with cause-specific Cox models assessing cancer-specific and non-cancer mortality. Person-time was calculated from cancer diagnosis to death or censoring on 12/31/2022, with left truncation applied for participants diagnosed before study enrollment. Premature mortality was also assessed among cases diagnosed before age 65 (n=4,467), with censoring at age 65. Models were stratified by age at diagnosis and adjusted for demographic, clinical, and prognostic factors. There were 1,965 deaths (817 premature) over follow-up. Compared to individuals with a graduate degree, those with ≤HS degree had higher risks of all-cause (HR=1.26, 95% CI=1.09-1.44) and cancer-specific (HR=1.23, 95% CI=1.04-1.47) mortality; no association was found for non-cancer mortality. Similar patterns were observed for premature mortality (all-cause: HR=1.37, 95% CI=1.08–1.74; cancer-specific: HR=1.36, 95% CI=1.04–1.79). Findings support that education is associated with cancer-specific mortality, including premature deaths, among 9/11-exposed individuals, highlighting the need for targeted monitoring and support for those with lower education in this population.