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The choice of operation for rectal cancer is complex. In addition to clinical factors, we hypothesized the socioeconomic background influences the decision.Data on civil status, education and income were linked to the Swedish Rectal Cancer Registry 1995-2005 (n = 16 713) and analysed by logistic regression, adjusting for age, sex, stage, distance from the anal verge, type of hospital and region.Unmarried patients were least likely (OR 0.76; 95% CI 0.64-0.88) and university educated men most likely (OR 1.30; 1.04-1.62) to have an anterior resection (AR). Patients with the highest income (Q4) had an AR more often than all others (OR income Q1 0.80; 0.69-0.94, income Q2 0.85; 0.73-0.98 and income Q3 0.86; 0.75-0.98). Uiniversity educated patients were least likely to have an abdominoperineal resection (OR 0.78; 0.63-0.98).The choice of operation for rectal cancer is not socio-economically neutral. Factors including comorbidity and smoking may explain the differences to some extent but inequality in the ‘quality of treatment is also possible.