World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website https://wjon.elmerpub.com

Original Article

Volume 16, Number 4, August 2025, pages 388-396

Association of Low Educational Attainment and Higher Colorectal Cancer Risk: Mediatory Effect of Lifestyle-Associated Factors Within Local Context

↓ Figure 1. Path analysis diagram of association between low educational attainment and risk of colorectal cancer (RMSEA = 0.08, CFI = 0.78, SRMR = 0.07). Values are reported as standardized estimates. *P-value < 0.05. BMI: body mass index; CFI: comparative fit index; CRC: colorectal cancer; RMSEA: root mean square error of approximation; SRMR: standardized root mean-square residual.

↓ **Table 1.** Subjects’ Characteristics of CRC Cases and Controls in the Study Population
Characteristics	Cases (N = 174, %)	Controls (N = 296, %)	P value^a
^aAnalysis was performed using t-test for continuous variable and Chi-square test for categorical variable. BMI: body mass index; CRC: colorectal cancer; IDR: Indonesian Rupiah; SD: standard deviation.
Age (years, mean ± SD)	55.33 ± 12.99	43.07 ± 13.89	< 0.001
Sex			0.458
Female	95 (54.60)	172 (58.11)
Male	79 (45.40)	124 (41.89)
Marital status			0.115
Married	142 (81.61)	223 (75.34)
Not married/divorced/widowed	32 (18.39)	73 (24.66)
Monthly income			0.014
≥ IDR 3,000,000	85 (48.85)	179 (60.47)
< IDR 3,000,000	89 (51.15)	117 (39.53)
Family history of CRC			0.001
No CRC history	137 (78.74)	189 (63.85)
Have family history of CRC	37 (21.26)	107 (36.15)
Physical activity			0.009
Active	21 (12.07)	41 (13.85)
Moderately active	73 (41.95)	158 (53.38)
Moderately inactive	51 (29.31)	49 (16.55)
Inactive	29 (16.67)	48 (16.22)
BMI (kg/m², mean ± SD)	19.83 ± 3.89	25.02 ± 4.86	< 0.001
Smoking status			0.377
Non-smoker	107 (61.49)	194 (65.54)
Smoker	67 (38.51)	102 (34.46)
Education attainment			< 0.001
Completed basic education	95 (54.60)	252 (85.14)
Did not complete basic education	79 (45.40)	44 (14.86)

↓ Table 1. Subjects’ Characteristics of CRC Cases and Controls in the Study Population

Characteristics

Cases (N = 174, %)

Controls (N = 296, %)

P value^a

^aAnalysis was performed using t-test for continuous variable and Chi-square test for categorical variable. BMI: body mass index; CRC: colorectal cancer; IDR: Indonesian Rupiah; SD: standard deviation.

Age (years, mean ± SD)

55.33 ± 12.99

43.07 ± 13.89

< 0.001

Sex

0.458

Female

95 (54.60)

172 (58.11)

Male

79 (45.40)

124 (41.89)

Marital status

0.115

Married

142 (81.61)

223 (75.34)

Not married/divorced/widowed

32 (18.39)

73 (24.66)

Monthly income

0.014

≥ IDR 3,000,000

85 (48.85)

179 (60.47)

< IDR 3,000,000

89 (51.15)

117 (39.53)

Family history of CRC

0.001

No CRC history

137 (78.74)

189 (63.85)

Have family history of CRC

37 (21.26)

107 (36.15)

Physical activity

0.009

Active

21 (12.07)

41 (13.85)

Moderately active

73 (41.95)

158 (53.38)

Moderately inactive

51 (29.31)

49 (16.55)

Inactive

29 (16.67)

48 (16.22)

BMI (kg/m², mean ± SD)

19.83 ± 3.89

25.02 ± 4.86

< 0.001

Smoking status

0.377

Non-smoker

107 (61.49)

194 (65.54)

Smoker

67 (38.51)

102 (34.46)

Education attainment

< 0.001

Completed basic education

95 (54.60)

252 (85.14)

Did not complete basic education

79 (45.40)

44 (14.86)

↓ **Table 2.** Association of Education Attainment and Colorectal Cancer Among Group of Men and Women
Predictors	No. of cases/controls	Model 1	Model 2^a	Model 3^b
^aModel 2 was adjusted with age, sex, marital status, monthly income, and family history of CRC. ^bModel 3 was adjusted with age, sex, marital status, monthly income, family history of CRC, physical activity, BMI, smoking status, red meat, legumes, and vegetables. ^cVariable sex was not entered into the multivariable models. aOR: adjusted odds ratio; BMI: body mass index; 95% CI: 95% confidence interval; OR: odds ratio.
All participants
Completed basic education	95/252	Ref.			Ref.			Ref.
Did not complete basic education (< 12 years)	79/44	4.76	3.07	7.38	3.06	1.86	5.03	2.73	1.43	5.22
Men^a,c
Completed basic education	40/107	Ref.			Ref.			Ref.
Did not complete basic education	39/17	6.14	3.12	12.06	4.65	2.19	9.87	1.05	1.02	1.09
Women
Completed basic education	55/145	Ref.			Ref.			Ref.
Did not complete basic education	40/27	3.91	2.19	6.97	2.02	1.02	4.00	1.56	0.61	3.95

↓ Table 2. Association of Education Attainment and Colorectal Cancer Among Group of Men and Women

Predictors

No. of cases/controls

Model 1

Model 2^a

Model 3^b

95% CI

aOR

95% CI

aOR

95% CI

Lower

Upper

Lower

Upper

Lower

Upper

^aModel 2 was adjusted with age, sex, marital status, monthly income, and family history of CRC. ^bModel 3 was adjusted with age, sex, marital status, monthly income, family history of CRC, physical activity, BMI, smoking status, red meat, legumes, and vegetables. ^cVariable sex was not entered into the multivariable models. aOR: adjusted odds ratio; BMI: body mass index; 95% CI: 95% confidence interval; OR: odds ratio.

All participants

Completed basic education

95/252

Ref.

Did not complete basic education (< 12 years)

79/44

4.76

3.07

7.38

3.06

1.86

5.03

2.73

1.43

5.22

Men^a,c

Completed basic education

40/107

Ref.

Did not complete basic education

39/17

6.14

3.12

12.06

4.65

2.19

9.87

1.05

1.02

1.09

Women

Completed basic education

55/145

Ref.

Did not complete basic education

40/27

3.91

2.19

6.97

2.02

1.02

4.00

1.56

0.61

3.95

↓ **Table 3.** Effect of Low Educational Attainment in Path Analysis of Colorectal Cancer Risk
Low educational attainment	Point estimates	Bootstrapping confidence interval
Values are reported as standardized estimates. BC: bias-corrected.
Direct effect	0.175	0.092	0.259	< 0.001	0.085	0.262	< 0.001
Indirect effect	0.104	0.052	0.158	< 0.001	0.053	0.162	< 0.001
Total effect	0.280	0.190	0.369	< 0.001	0.182	0.379	< 0.001

↓ Table 3. Effect of Low Educational Attainment in Path Analysis of Colorectal Cancer Risk

Low educational attainment

Point estimates

Bootstrapping confidence interval

Percentile

P value

BC percentile

P value

Lower

Upper

Lower

Upper

Values are reported as standardized estimates. BC: bias-corrected.

Direct effect

0.175

0.092

0.259

< 0.001

0.085

0.262

< 0.001

Indirect effect

0.104

0.052

0.158

< 0.001

0.053

0.162

< 0.001

Total effect

0.280

0.190

0.369

< 0.001

0.182

0.379

< 0.001