Variation in the risk for liver and gallbladder cancers in socioeconomic and occupational groups in Sweden with etiological implications

Objectives: To examine the associations between socioeconomic/occupational factors and liver cancer at various anatomic sites (including primary liver, gallbladder and other cancers). Methods: We carried out a follow-up study on the economically active Swedish population, based on the Swedish Family-Cancer Database. Standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated in different social classes and occupations. Results: For primary liver cancer, farmers were at a decreased risk; increased risks were observed for male sales agents, journalists, seamen, waiters, cooks and female beverage manufacture workers. Similar patterns were observed for gallbladder cancer; workers employed as journalists, sales agents, cooks and stewards, and public safety workers showed increased risk. Only male transport workers showed increased risk of cancers in other parts. Conclusions: Occupations with high consumption of alcohol and/or high prevalence of smoking associated with a risk of liver and gallbladder cancers. The present study suggests that the effects of socioeconomic factors on liver cancer of different subsites are similar; alcohol drinking is a risk factor of gallbladder cancer because of the covariation of primary liver and gallbladder cancers in occupational groups.     

Socioeconomic and occupational groups and risk of asthma in Sweden

AIM: To investigate possible associations between hospitalization for asthma and socioeconomic status and occupation. METHODS: A nationwide database was constructed by linking Swedish Census data to the Hospital Discharge Register (1987-2004). The hospital diagnoses of asthma were based on the International Classification of Diseases. Standardized incidence ratios were calculated for different socioeconomic and occupational groups. Ninety-five per cent confidence intervals were calculated assuming a Poisson distribution. RESULTS: A total of 13,202 male and 11,876 female hospitalizations for asthma were retrieved at ages >30 years. The socioeconomic groups with < 9 years of education were associated with a significantly increased risk of hospitalization for asthma. Among male occupations, increased risks were noted for farmers, mechanics and iron and metal workers, welders, bricklayers, workers in food manufacture, packers, loaders and warehouse workers, waiters and chimney sweeps with prolonged exposures in two censuses. For female occupations, increased risks were observed among assistant nurses, religious, juridical and other social science-related workers, drivers, mechanics and iron and metalware workers and wood workers. CONCLUSIONS: The present study suggests that socioeconomic status (low educational level) and occupation have an effect on the population's risk of hospitalization for asthma.     

Smoking habits and their confounding effects among occupational groups in Sweden

Smoking habits among different occupational groups in Sweden were estimated from nation wide surveys of living conditions in 1977 and 1980/81. These surveys were conducted by Statistics Sweden and consist of interviews covering the Swedish population aged 16-74 years. The sample includes about 12,000 persons for each of the two investigations. The results show that those who may be exposed to excess risks in their work environment, smoke more than those in other occupational groups. Transport and manufacturing workers, miners, wood and paper workers and painters, for example, have higher rates of daily smokers than the national average. The highest rates, however, were found among the category of early retired or unemployed. These findings confirm that an appropriate evaluation of occupationally-related diseases affected by smoking must take smoking data into consideration. If smoking data are available from other sources, adjusted work-related risks could be calculated. This presumes the absence of interaction effects. Procedures are given and illustrated. The paper also discusses the declining trends in smoking habits between 1977 and 1980/81 and possible reasons for differences in smoking habits between occupations.     

Risk of lymphoma subtypes by occupational exposure in Southern Italy

Background

Occupational exposure is known to play a role in the aetiology of lymphomas. The aim of the present work was to explore the occupational risk of the major B-cell lymphoma subtypes using a case–control study design.

Methods

From 2009 to 2014, we recruited 158 lymphoma cases and 76 controls in the provinces of Bari and Taranto (Apulia, Southern Italy). A retrospective assessment of occupational exposure based on complete work histories and the Carcinogen Exposure (CAREX) job-exposure matrix was performed.

Results

After adjusting for major confounding factors, farmers showed an increased risk of diffuse large B-cell lymphoma (DLBCL) [odds ratio (OR)?=?10.9 (2.3–51.6)] and multiple myeloma (MM) [OR?=?16.5 (1.4–195.7)]; exposure to the fungicide Captafol was significantly associated with risk of non-Hodgkin lymphoma (NHL) [OR?=?2.6 (1.1–8.2)], particularly with the risk of DLBCL [OR?=?5.3 (1.6–17.3)].

Conclusions

Agricultural activity seems to be a risk factor for developing lymphoma subtypes, particularly DLBCL, in the provinces of Bari and Taranto (Apulia Region, Southern Italy). Exposure to the pesticides Captafol, Paraquat and Radon might be implicated.

Trial registration

Protocol number UNIBA 2207WEJLZB_004 registered 22/09/2008.

     

Occurrence of cancer in socioeconomic groups in Sweden. An analysis based on the Swedish Cancer Environment Registry

We wanted to examine the distribution of cancer by socioeconomic group in Sweden. For this purpose the 1960 Census population was followed up for the whole period 1961-79 by means of the Swedish Cancer Environment Registry. Cancer morbidity in five socioeconomic groups was analysed for each of 50 cancer sites. An association was found between several sites and particular socioeconomic groups. For instance, there are elevated rates of lung cancer and stomach cancer among blue collar workers; colon cancer and breast cancer among white collar workers and lip and stomach cancer among self-employed farmers. The overall cancer morbidity was close to the expected levels for all groups except self-employed farmers, who showed a marked deficit.     

Childhood leukemia and socioeconomic status in Canada

BACKGROUND: Leukemia is one of the most common potentially fatal illnesses in children, and its causes are not well understood. Although socioeconomic status (SES) has been related to leukemia in some studies, this apparent association may be attributable to ascertainment or participation bias. This study was undertaken to determine whether there is a difference in incidence of childhood leukemia for different levels of SES, as measured by neighborhood income, in an unselected population case group. METHODS: All cases of childhood leukemia diagnosed in the years 1985-2001 were identified from population-based cancer registries in Canada. Postal codes for the place of residence at diagnosis were used to ascertain the census neighborhoods for cases. We constructed neighborhood-based income quintiles from census population data, and stratified the population at risk by sex and 5-year age groupings. Age-standardized incidence rates and 95% confidence intervals (CIs) were calculated. We used Poisson regression to compare incidence rate ratios (RRs) across income quintiles. RESULTS: A slightly lower relative risk of childhood leukemia was observed in the poorest quintile compared with the richest (RR = 0.87; 95% CI = 0.80-0.95). The lower risk in the poorest quintile was restricted to acute lymphoid leukemia (0.86; 0.78-0.95) and was strengthened slightly by restriction to urban areas (0.83; 0.74-0.93). CONCLUSIONS: This analysis suggests that high SES is a true risk factor for childhood leukemia and that inconsistent results from other studies may be related to differences in case ascertainment or study participation.     

Exploring occupational balance in adults in Sweden

Abstract

Aim: The aim of this study was to describe the relationship between occupational balance (measured by the occupational balance questionnaire [OBQ]) and self-rated health and life satisfaction. A secondary aim was to explore differences in occupational balance among adults in Sweden. Methods: The 153 participants (63% women), recruited using convenience sampling, answered a questionnaire comprising demographic questions, the OBQ, one item about self-rated health, and one about life satisfaction. The OBQ was analysed for correlation with subjective health and life satisfaction. The OBQ and its individual items were also analysed for correlations with age and for differences between men and women and participants living with children younger than 18 years versus not. Results: The OBQ was significantly positively correlated to self-rated health and life satisfaction, supporting the relationship between occupational balance and health. No significant correlation between age and the total OBQ was identified but some differences in occupational balance, related to whether the participant was living with or without children at home, were revealed. Conclusions: The results should be interpreted with caution due to the nature of the sample and data but they can serve as a point of departure for further studies and hypotheses regarding occupational balance in different populations.     

Confounding by variable smoking habits in different occupational groups

Smoking habits of different occupational groups were studied in a sample of persons who participated in health screening examinations carried out by the mobile clinic of the Institute of Occupational Health (Helsinki, Finland). The sample consisted of 1 990 men and 1 044 women. The smoking habits of the study population as a whole conformed with those of the entire Finnish population. Distinct differences in smoking habits were found, however, in different occupational groups. The effect of smoking habits on tentative rate ratios of lung cancer in occupational groups were estimated with a procedure presented by Olav Axelson. The groups were selected from extreme ends of the smoking habit variable. Extreme estimates were taken to maximize the confounding effect of smoking. When occupational groups were contrasted with the general population, the confounding effect was found to be smaller than usually believed.     

The influence of socioeconomic status on stillbirth risk in Sweden

BACKGROUND: Low socioeconomic status (SES) is generally associated with increased risk of stillbirth, but the mechanisms have rarely been investigated. Our aim was to study the association between SES and risk of stillbirth, and to assess whether any differences in risk are mediated by other maternal socio-demographic or anthropometrical characteristics, differences in lifestyle, or attendance at antenatal care. METHODS: Population-based individually-matched case-control study including 702 cases of stillbirth and 702 controls among Swedish primiparous women giving birth 1987-1996. We estimated the risk of stillbirth, and subgroups of stillbirth, for various categories of SES. Odds ratios (OR) with 95% CI, estimated by conditional logistic regression, were used to approximate the relative risk. The estimates were adjusted for maternal age, height, body mass index, cigarette smoking, and when necessary mother's country of birth. RESULTS: Compared with women who were high level white-collar workers, the adjusted risks of stillbirth were as follows: unskilled blue-collar workers, 2.2 (95% CI : 1.3- 3.7), skilled blue-collar workers, 2.4 (95% CI : 1.3-4.1), low level white-collar workers, 1.9 (95% CI : 1.2-3.2), and intermediate level white-collar workers 1.4 (95% CI : 0.9-2.4). These risks were not substantially changed when we further adjusted for attendance at antenatal care, previous reproductive history, or excluded pregnancies with maternal diseases, and pregnancy-related disorders. Low social class was most associated with risks of term antepartum and intrapartum stillbirths. CONCLUSIONS: Low SES increases the risk of stillbirth. The association could not be explained by any of the factors we studied, and the underlying reasons remain unclear.     

Barriers and bridges to client-centred occupational therapy in Sweden

This study investigates barriers to client-centred practice and solutions to overcome these barriers as experienced by Swedish occupational therapists. A British questionnaire was translated into Swedish and completed by 97 occupational therapists. The questionnaire consists of three sections: background information; a list of barriers identified in a literature review; and a list of methods to resolve barriers. The results show that the highest ranked barrier was “the therapist does not know enough about client-centred practice”. The highest ranked method to resolve barriers was “management and peer support for use of client-centred practice”. Introducing client-centred practice takes time, commitment, education, training, interview skills, discussions with colleagues, and reflection on the therapists’ own attitudes.     

Alcohol-related deaths contribute to socioeconomic differentials in mortality in Sweden

BACKGROUND: This study aims at estimating the contribution of alcohol to socioeconomic mortality differentials in Sweden. METHODS: Data were obtained from a Census-linked Deaths Registry. Participants in the 1980 and 1990 censuses were included with a follow-up of mortality 1990-1995. Socioeconomic status was assigned from occupation in 1990 or 1980. Alcohol-related deaths were defined from underlying or contributory causes. Poison regressions were applied to compute age-adjusted mortality rate ratios for all-causes, alcohol-related and other causes among 30-79-year-olds. The contribution of alcohol to mortality differentials was calculated from absolute differences. RESULTS: Around 5% (9,547) of all deaths were alcohol-related (30-79 years). For both sexes, manual workers, lower nonmanuals, entrepreneurs and unclassifiable groups had significantly higher alcohol-related mortality than did upper nonmanuals. Male farmers had significantly lower such mortality. The contribution of alcohol to excess mortality over that of upper nonmanuals was greatest among middle-aged (40-59 years) men who were manual workers or who belonged to a group of 'unclassifiable & others' (25-35%). It was of considerable size also for middle-aged lower nonmanuals (both sexes), male entrepreneurs, female manual workers and 'unclassifiable & others'. Among men, the total contribution of alcohol (30-79 years) was estimated at 16% for manual workers, 10% for lower nonmanuals and 7% for entrepreneurs; and among women, 6% (manual workers, lower nonmanuals) and 3% (entrepreneurs). CONCLUSION: Although deaths related to alcohol were probably underreported (e.g. accidents), alcohol clearly contributes to socioeconomic mortality differentials in Sweden. The size of this contribution depends strongly on age (peak among the middle-aged) and gender (greatest among men).     

The utilization of general hospitals by occupational groups in Finland

The utilization of general hospitals in Finland in 1974 was studied according to occupational groups. The material was based on two registers; the register of hospital utilization kept by the National Board of Health and the register for the Population and Housing Census prepared by the Central Statistical Office in Finland. The differences in hospital utilization do not depend only on differences in morbidity; hospital utilization is also associated with the availability of services and with the illness behaviour of the people—factors which also differ from occupational group to occupational group.The utilization of hospital services was quantified by recording the number of patients discharged from hospitals. The highest age-standardized utilization by males was found in industry (186/1000 population), being 1.6 times greater than in administration, 1.4 times greater than in agriculture, 1.3 times greater than in transport and services and 1.1 times greater than in sales.The greatest utilization by females was found in sales (262/1000 population and in industry (239/1000 population), being 1.3 times greater in sales than in administration. Differences between occupational groups were generally smaller than among males.The utilization of hospital services was compared with mortality in these occupational groups. There is a rather strong positive correlation (r = 0.7) between hospital utilization and mortality in males. In agriculture the utilization was lower than average in comparison with mortality. In administration and industry the utilization was at the same level as mortality.     

Equity in specialist waiting times by socioeconomic groups: evidence from Spain

In countries with publicly financed health care systems, waiting time—rather than price—is the rationing mechanism for access to health care services. The normative statement underlying such a rationing device is that patients should wait according to need and irrespective of socioeconomic status or other non-need characteristics. The aim of this paper is to test empirically that waiting times for publicly funded specialist care do not depend on patients’ socioeconomic status. Waiting times for specialist care can vary according to the type of medical specialty, type of consultation (review or diagnosis) and the region where patients’ reside. In order to take into account such variability, we use Bayesian random parameter models to explain waiting times for specialist care in terms of need and non-need variables. We find that individuals with lower education and income levels wait significantly more time than their counterparts.     

Diet and eating habits in high and low socioeconomic groups

OBJECTIVE: We measured the difference of dietary intake and eating habits across socioeconomic statuses (SESs) in Israel. METHODS: Participants were randomly recruited from three high SES municipalities and three low SES municipalities in the Negev. Participants were interviewed at home with 24-h food questionnaires that included additional questions regarding health and eating habits. Nutrient and energy intakes were compared between groups, as were major contributors to the energy and food groups. RESULTS: One hundred sixteen participants from the high SES group and 206 from the low SES entered the study. Those in the low SES group were older, heavier, less educated, and less physically active. Dietary intake among the participants in the low SES group was significantly lower in protein, monounsaturated fat, and most vitamins and minerals (thiamine, riboflavin, niacin, vitamin C, calcium, magnesium, and iron). Conversely, vitamin E intake was higher in the low SES group. In the low SES group, the main contributors to energy intake were breads, oils, and sugars. Oils, fats, and citrus fruits were consumed more among subjects in the low SES group, whereas dairy products, grains, and legumes were consumed less by subjects in the high SES group. CONCLUSION: In a detailed survey conducted in two distinct populations, we found poorer diet quality in the low SES group. The root causes for such divergence need further study. As smoking declines in the modern world, nutrition will become the key risk factor in many diseases. Further research and educational and legislative initiatives are needed to curtail this risk.     

Pro-cyclical mortality across socioeconomic groups and health status

Using variation across geographic regions, a number of studies from the U.S. and other developed countries have found more deaths in economic upturns and less deaths in economic downturns. We use data from regions in Norway for 1977–2008 and find the same pro-cyclical patterns. Using individual-level register data for the identical population, we find that disadvantaged socioeconomic groups are not hit harder by pro-cyclical mortality than advantaged groups. We also find that other indicators of deteriorated health (than death), like becoming disabled, are pro-cyclical. Overall, our analysis suggests that pro-cyclical mortality is rather related to deaths of people already in deteriorated health than to people of low socioeconomic status.     

Teenage childbearing and long-term socioeconomic consequences: a case study in Sweden

CONTEXT: Whether long-term socioeconomic problems experienced by many teenage mothers are a reflection of preexisting disadvantage or are consequences of teenage motherhood per se remains unclear. METHODS: National data on all women born in Sweden from 1941 to 1970 who were younger than age 30 when they first gave birth (N=888,044) were analyzed. The outcome measures, assessed during adulthood, were employment status, socioeconomic status, educational attainment, single motherhood, family size, receipt of disability pension and dependence on welfare. Multiple logistic regression techniques were used to adjust for maternal birth cohort and for socioeconomic background of the woman's family. RESULTS: Compared with Swedish women who first gave birth at ages 20-24, those who were teenage mothers had significantly increased odds of each unfavorable socioeconomic outcome in later life, even after the data were adjusted for family socioeconomic situation and maternal birth cohort. For example, teenage motherhood was positively associated with low educational attainment (odds ratios of 1.7-1.9, depending on the specific age during adolescence when the woman gave birth), with single living arrangements (odds ratios, 1.5-2.3), with high parity (odds ratios, 2.6-6.0), with collecting a disability pension (odds ratios, 1.6-1.9) and with welfare dependency (odds ratios, 1.9-2.6). These trends were usually linear, with the highest odds ratios corresponding to women who had had their first child at the youngest ages. CONCLUSIONS: A longitudinal analysis of record-linkage data from Sweden supports the view that childbearing during adolescence poses a risk for socioeconomic disadvantage in later life--even for adolescents from relatively comfortable backgrounds and for those who studied beyond elementary school.