Socioeconomic factors associated with risk of upper aerodigestive tract cancer in Europe |
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| Authors: | D.I. Conway P.A. McKinney A.D. McMahon W. Ahrens N. Schmeisser S. Benhamou C. Bouchardy G.J. Macfarlane T.V. Macfarlane P. Lagiou P. Minaki V. Bencko I. Holcátová F. Merletti L. Richiardi K. Kjaerheim A. Agudo X. Castellsague R. Talamini L. Barzan P. Brennan |
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| Affiliation: | 1. Dental School, Faculty of Medicine, University of Glasgow, 378 Sauchiehall Street, Glasgow G2 3JZ, UK;2. NHS NSS ISD, Edinburgh, UK;3. Centre for Epidemiology and Biostatistics, University of Leeds, UK;4. Bremen Institute for Prevention Research and Social Medicine (BIPS), Bremen, Germany;5. INSERM, U946, Fondation Jean Dausset – CEPH, Paris, France;6. CNRS FRE2939, Gustave-Roussy Institute, Villejuif, France;7. Geneva Cancer Registry, Geneva, Switzerland;8. School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK;9. Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Greece;10. Department of Epidemiology, Harvard School of Public Health, Boston, USA;11. Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic;12. Unit of Cancer Epidemiology, CeRMS and University of Turin, Turin, Italy;13. Cancer Registry of Norway, Oslo, Norway;14. Institut Català d’Oncologia (ICO), IDIBELL, CIBER-ESP L’Hospitalet de Llobregat, Spain;15. Unit of Epidemiology and Biostatistics, Centro di Riferimento Oncologico – IRCCS, Aviano, Italy;p. Head and Neck Department, General Hospital, Pordenone, Italy;q. Department of Environmental Medicine and Public Health, University of Padova, Padova, Italy;r. University of Newcastle Dental School, Newcastle, UK;s. Croatian National Cancer Registry, Zagreb, Croatia;t. Trinity College School of Dental Science, Dublin, Ireland;u. International Agency for Research on Cancer, Lyon, France;1. Professor, Department of Otorhinolaryngology, King George Medical University, Lucknow, UP, India;2. Resident, Department of Otorhinolaryngology, King George Medical University, Lucknow, UP, India;1. Department of Medicine, Faculty of Medicine, University of Gezira, Wad Medani, Sudan;2. Department of Oncology, National Cancer Institute, University of Gezira, Wad Medani, Sudan;3. Department of Pathology, Faculty of Medicine, University of Gezira, Wad Medani, Sudan;4. Department of Molecular Biology, National Cancer Institute, University of Gezira, Wad Medani, Sudan;1. Department of Epidemiological Methods and Etiologic Research, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany;2. Institute for Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany;3. Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany;4. Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia;5. Estonian Genome Center, University of Tartu, Tartu, Estonia;6. Center of Translational Genomics, University of Tartu, Tartu, Estonia;7. Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece;8. Faculty of Health Professions, Athens Technological Educational Institute, Athens, Greece;9. Geneva Cancer Registry, Institute of Social and Preventive Medicine, Geneva Cancer Registry, IMSP, University of Geneva, Geneva, Switzerland;10. Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University of Prague, Prague, Czech Republic;11. Department of Medical Sciences, Cancer Epidemiology Unit, CeRMS and CPO Piemonte University of Turin, Turin, Italy;12. Cancer Registry of Norway, Oslo, Norway;13. Catalan Institute of Oncology (ICO), CIBERESP, IDIBELL, L''Hospitalet de Llobregat, Barcelona, Spain;14. School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom;15. Department of Family and Preventive Medicine, Division of Public Health, School of Medicine, University of Utah, Utah, USA;p. Aviano Cancer Centre, Aviano, Italy;q. General Hospital of Pordenone, Pordenone, Italy;r. National Heart and Lung Institute, Imperial College London, London, United Kingdom;s. Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padova, Padova, Italy;t. School of Dental Sciences, University of Newcastle, Newcastle, United Kingdom;u. Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, United Kingdom;v. Glasgow Dental School, College of Medical, Veterinary and Life Sciences, College of Medicine, University of Glasgow, Glasgow, United Kingdom;w. Croatian National Cancer Registry, Zagreb, Croatia;x. Trinity College School of Dental Science, Dublin, Ireland;y. School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland;z. International Agency for Research on Cancer (IARC), Lyon, France;11. Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University of Mainz, Mainz, Germany;12. Catalan Institute of Oncology (ICO), IDIBELL, L''Hospitalet de Llobregat, Barcelona, Spain;13. Huntsman Cancer Institute, Salt Lake City, Utah, USA;1. Department of Pediatric Neurology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain;2. Neuroimmunology, Institut d''Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain;1. Department of Otorhinolaryngology, IMS and SUM Hospital, Siksha “O” Anusandhan University, K8, Kalinganagar, Bhubaneswar 751003, Odisha, India;2. Department of Anesthesia, IMS and SUM Hospital, Siksha “O” Anusandhan University, K8, Kalinganagar, Bhubaneswar 751003, Odisha, India;3. Department of Pathology, Apollo Hospital, Bhubaneswar, Odisha, India;4. Central Research Laboratory, IMS and SUM Hospital, Siksha “O” Anusandhan University, K8, Kalinganagar, Bhubaneswar 751003, Odisha, India |
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| Abstract: | IntroductionIn the European Union, there are 180,000 new cases of upper aerodigestive tract (UADT) cancer cases per year – more than half of whom will die of the disease. Socioeconomic inequalities in UADT cancer incidence are recognised across Europe. We aimed to assess the components of socioeconomic risk both independently and through their influence on the known behavioural risk factors of smoking, alcohol consumption and diet.Patients and methodsA multicentre case–control study with 2198 cases of UADT cancer and 2141 controls from hospital and population sources was undertaken involving 14 centres from 10 countries. Personal interviews collected information on demographics, lifetime occupation history, smoking, alcohol consumption and diet. Socioeconomic status was measured by education, occupational social class and unemployment. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed using unconditional logistic regression.ResultsWhen controlling for age, sex and centre significantly increased risks for UADT cancer were observed for those with low versus high educational attainment OR = 1.98 (95% CI 1.67, 2.36). Similarly, for occupational socioeconomic indicators – comparing the lowest versus highest International Socio-Economic Index (ISEI) quartile for the longest occupation gave OR = 1.60 (1.28, 2.00); and for unemployment OR = 1.64 (1.24, 2.17). Statistical significance remained for low education when adjusting for smoking, alcohol and diet behaviours OR = 1.29 (1.06, 1.57) in the multivariate analysis. Inequalities were observed only among men but not among women and were greater among those in the British Isles and Eastern European countries than in Southern and Central/Northern European countries. Associations were broadly consistent for subsite and source of controls (hospital and community).ConclusionSocioeconomic inequalities for UADT cancers are only observed among men and are not totally explained by smoking, alcohol drinking and diet. |
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