Life course social mobility and risk of upper aerodigestive tract cancer in men

Occupational Mobility and Chronic Health Conditions in Middle and Later Life: A Systematic Review

BACKGROUND

Occupational mobility at various stages in the life course may have a cumulative impact on health outcomes and trajectory. This study aims to (1) systematically review empirical evidence regarding the impact of intergenerational and intra-generational occupational mobility on chronic health conditions in middle and later life; and (2) assess the collective evidence on the health consequences of different types of occupational mobility.

METHOD

A systematic review of literature was carried out by searching three databases (PubMed, PsycINFO, and SocINDEX) and the reference lists. Eligible studies examined the impact of occupational mobility on at least one chronic health condition among adults aged 35 years or above. The quality of each included study was assessed by standardized tools.

RESULTS

Out of 170 identified publications, 16 studies based on 12 independent data sets met the inclusion criteria. There is moderately strong evidence that downward intergenerational occupational mobility and stable low occupational status across generations were associated with worse chronic health conditions. The relationships to chronic health conditions were more pronounced for intergenerational occupational mobility than for intra-generational occupational mobility. Gender differences were observed in the relationship between occupational mobility and health.

CONCLUSION

Career advancement interventions should target both the career starters and older employees. More generous unemployment insurance systems are suggested in less egalitarian countries, especially during economic recession periods. Future studies of occupational mobility should give more attention to women and people from developing and Eastern countries.

Dietary Risk Factors in Upper Aero-Digestive Tract Cancers

The Upper AeroDigestive Tract (UADT) cancers are most common, invasive and have high morbidity. The two leading risk factors, smoking and alcohol, are well known but there is a long list of other risk factors which are not that well talked about. The aim of this study was to ascertain the dietary factors which could be important in their prevention.The PubMed and Google Scholar databases were searched for relevant studies from January 2001 to November 2021. Refined grains were found directly related to the risk of UADT cancer while the whole grain cereals were found protective. Significant inverse associations were observed for the highest compared to the lowest tertile of whole grains and yellow/orange vegetables. Stricter adherence to the Mediterranean diet was seen associated with a substantial and significant decrease in UADT cancer risk. A significant inverse association was also found between yoghurt intake and UADT cancer risk. Consumption of three or more cups of coffee per day was found to have a significant inverse association with UADT cancer. Carcinogenicity of cannabis consumption was observed for regular cannabis smokers (> 1 per day for years). The current study concludes that the protective dietary factors have substantial activity in the prevention of UADT cancer. Nevertheless, basic research is required in investigating the role of these dietary factors and valid biomarkers will be important for chemoprevention studies. The basic research on risk factors on the basis of current knowledge would ultimately lead to the better prevention of UADT cancer.

Intragenerational social mobility and depressive symptoms. Results from the French CONSTANCES cohort study

BACKGROUND

To further explain the association between low socioeconomic position and increased risk of poor health, research started to consider life course conditions, including previous occupational positions and patterns of social mobility in the analysis. We describe patterns of intragenerational social mobility and investigate their associations with depressive symptoms.

METHODS

We use data from the French CONSTANCES study, a population-based cohort and restrict the sample to people aged 45 to 60. Based on detailed retrospective data with annual information on respondents' occupational position, we assess the modal social class for two time periods - early adulthood (age 25-34) and mid-adulthood (age 35-44). Depressive symptoms are measured by the Centre for Epidemiologic Studies Depression Scale (CES-D), using sex-specific cut-points.

RESULTS

Our study reveals that most respondents remained in stable working careers, but these careers were less frequent amongst participants with lower socioeconomic positions compared with higher ones. In contrast to several earlier findings we observe no independent associations of intragenerational social mobility processes and health once the social positions of origin and destination are considered. However, our findings confirm a social gradient in the prevalence of depressive symptoms for stable working careers.

CONCLUSIONS

Our findings underline the importance of integrating data into analysis on starting and ending points of social mobility processes within entire histories of labor market participation.

Occupational prestige trajectory and the risk of lung and head and neck cancer among men and women in France

OBJECTIVES

This study aimed at investigating the associations between occupational prestige trajectories and lung and head and neck (HN) cancer risk and to assess to what extent smoking, alcohol drinking, and occupational exposures contribute to these associations.

METHODS

Using data from the ICARE case-control study (controls (2676 men/715 women), lung cancers (2019 men/558 women), HN cancers (1793 men/305 women), we defined occupational prestige trajectories using group-based modeling of longitudinal data. We conducted logistic regression models.

RESULTS

Among men, a gradient was observed from the downward "low to very low" trajectory to the stable very high trajectory. The associations were reduced when adjusting for tobacco and alcohol consumption and occupational exposures. Among women, when compared to the stable high trajectory, there was an increased cancer risk in all trajectories. The associations remained globally unchanged or even increased after adjustment for tobacco and alcohol consumption and did not change when adjusting for occupational exposures. The ORs were smaller for lung than for HN cancers in men.

CONCLUSIONS

Occupational prestige trajectory is strongly associated with lung and HN cancer risk in men and women.

Emerging and established global life-style risk factors for cancer of the upper aero-digestive tract

INTRODUCTION

Upper aero-digestive tract cancer is a multidimensional problem, international trends showing complex rises and falls in incidence and mortality across the globe, with variation across different cultural and socio-economic groups. This paper seeks some explanations and identifies some research and policy needs.

METHODOLOGICAL APPROACH

The literature illustrates the multifactorial nature of carcinogenesis. At the cellular level, it is viewed as a multistep process involving multiple mutations and selection for cells with progressively increasing capacity for proliferation, survival, invasion, and metastasis. Established and emerging risk factors, in addition to changes in incidence and prevalence of cancers of the upper aero-digestive tract, were identified.

RISK FACTORS

Exposure to tobacco and alcohol, as well as diets inadequate in fresh fruits and vegetables, remain the major risk factors, with persistent infection by particular so-called "high risk" genotypes of human papillomavirus increasingly recognised as also playing an important role in a subset of cases, particularly for the oropharynx. Chronic trauma to oral mucosa from poor restorations and prostheses, in addition to poor oral hygiene with a consequent heavy microbial load in the mouth, are also emerging as significant risk factors.

CONCLUSIONS

Understanding and quantifying the impact of individual risk factors for these cancers is vital for health decision-making, planning and prevention. National policies and programmes should be designed and implemented to control exposure to environmental risks, by legislation if necessary, and to raise awareness so that people are provided with the information and support they need to adopt healthy lifestyles.

Life-course socioeconomic status and breast and cervical cancer screening: analysis of the WHO's Study on Global Ageing and Adult Health (SAGE)

OBJECTIVES

Socioeconomic differences in screening have been well documented in upper-income countries; however, few studies have examined socioeconomic status (SES) over the life-course in relation to cancer screening in lower-income and middle-income countries. Here, we examine individual, parental and life-course SES differences in breast and cervical cancer screening among women in India, China, Mexico, Russia and South Africa.

SETTING

Data from the WHO's Study on Global Ageing and Adult Health (SAGE) 2007-2008 data were used for survey-weighted multivariable regression analysis. We examined the association between individual, parental and life-course SES in relation to breast and cervical cancer screening using education-based and employment-based measures of SES.

PARTICIPANTS

22 283 women aged 18-65 years, recruited from China, India, Mexico, Russia and South Africa.

RESULTS

Having a college degree (OR 4.18; 95% CI 2.36 to 7.40) increased the odds of breast cancer screening compared with no formal education. Women with higher parental SES were almost 10 times more likely to receive breast cancer screening (OR 9.84; 95% CI 1.75 to 55.5) compared with women with low parental SES. Stable higher life-course (OR 3.07; 95% CI 1.96 to 4.79) increased breast cancer screening by threefold and increased cervical cancer screening by more than fourfold (OR 4.35; 95% CI 2.94 to 6.45); however, declining life-course SES was associated with reduced breast cancer screening (OR 0.26; 95% CI 0.08 to 0.79) compared to low life-course SES.

CONCLUSIONS

Higher individual, parental and life-course SES was positively associated with breast and cervical cancer screening, although education-based SES measures were stronger predictors of screening compared with employment-based measures. Improving knowledge of the benefits of cancer screening and integrating cancer screening into routine healthcare practice for low SES women are actionable strategies that may significantly improve screening rates in low-income and middle-income countries.

Occupational prestige, social mobility and the association with lung cancer in men

BACKGROUND

The nature of the association between occupational social prestige, social mobility, and risk of lung cancer remains uncertain. Using data from the international pooled SYNERGY case-control study, we studied the association between lung cancer and the level of time-weighted average occupational social prestige as well as its lifetime trajectory.

METHODS

We included 11,433 male cases and 14,147 male control subjects. Each job was translated into an occupational social prestige score by applying Treiman's Standard International Occupational Prestige Scale (SIOPS). SIOPS scores were categorized as low, medium, and high prestige (reference). We calculated odds ratios (OR) with 95 % confidence intervals (CI), adjusting for study center, age, smoking, ever employment in a job with known lung carcinogen exposure, and education. Trajectories in SIOPS categories from first to last and first to longest job were defined as consistent, downward, or upward. We conducted several subgroup and sensitivity analyses to assess the robustness of our results.

RESULTS

We observed increased lung cancer risk estimates for men with medium (OR = 1.23; 95 % CI 1.13-1.33) and low occupational prestige (OR = 1.44; 95 % CI 1.32-1.57). Although adjustment for smoking and education reduced the associations between occupational prestige and lung cancer, they did not explain the association entirely. Traditional occupational exposures reduced the associations only slightly. We observed small associations with downward prestige trajectories, with ORs of 1.13, 95 % CI 0.88-1.46 for high to low, and 1.24; 95 % CI 1.08-1.41 for medium to low trajectories.

CONCLUSIONS

Our results indicate that occupational prestige is independently associated with lung cancer among men.

Life course models for upper aero-digestive tract cancer

Upper aero-digestive tract (UADT) cancers are collectively cancers of various human body sites, such as the oral cavity, pharynx, oesophagus and larynx. Worldwide, they are the fourth most frequent cancer type and the fourth most common cause of mortality from cancer. Many studies have shown that several chronic diseases, such as cancer, which occur more commonly in later adulthood, are influenced by social and psychological circumstances during birth, childhood, adolescence and early adult life. It is suggested that the build up of problematic circumstances throughout life is the cause of disease, rather than circumstances that happen at one point in time. UADT cancer is a chronic disease of complex multifactorial origin and most of the underlying exposures/risks cannot be considered as individual factors or in isolation, as they act at different levels, which differ from time to time. Thus, life-course epidemiology, rather than drawing false dichotomies between different risk factors of the underlying disease, attempts to integrate biological and social risk processes that cause the chronic disease. It studies how socially patterned exposures during all stages of life--childhood, adolescence and early adult--influence disease risk in adulthood and socio-economic position and hence may account for social inequalities in adult health and mortality. Furthermore, varying health effects, according to the timing or duration of exposure to socio-economic circumstances, may indicate important traces to the causes of cancer. In this paper, we have attempted to draw a conceptual framework on the relationships between socio-economic inequalities, oral health risk factors along the life-course of an individual and incidence of UADT cancer.

Oral health, dental care and mouthwash associated with upper aerodigestive tract cancer risk in Europe: the ARCAGE study

OBJECTIVE

We aimed to assess the association of oral health (OH), dental care (DC) and mouthwash with upper-aerodigestive tract (UADT) cancer risk, and to examine the extent that enzymes involved in the metabolism of alcohol modify the effect of mouthwash.

MATERIALS AND METHODS

The study included 1963 patients with incident cancer of the oral cavity, oropharynx, hypopharynx, larynx or esophagus and 1993 controls. Subjects were interviewed about their oral health and dental care behaviors (which were converted to scores of OH and DC respectively), as well as smoking, alcohol drinking, diet, occupations, medical conditions and socio-economic status. Blood samples were taken for genetic analyses. Mouthwash use was analyzed in relation to the presence of polymorphisms of alcohol-metabolizing genes known to be associated with UADT. Adjusted odds ratios (ORs) and 95%-confidence intervals [CI] were estimated with multiple logistic regression models adjusting for multiple confounders.

RESULTS

Fully adjusted ORs of low versus high scores of DC and OH were 2.36[CI=1.51-3.67] and 2.22[CI=1.45-3.41], respectively, for all UADT sites combined. The OR for frequent use of mouthwash use (3 or more times/day) was 3.23[CI=1.68-6.19]. The OR for the rare variant ADH7 (coding for fast ethanol metabolism) was lower in mouthwash-users (OR=0.53[CI=0.35-0.81]) as compared to never-users (OR=0.97[CI=0.73-1.29]) indicating effect modification (pheterogeneity=0.065) while no relevant differences were observed between users and non-users for the variant alleles of ADH1B, ADH1C or ALDH2.

CONCLUSIONS

Poor OH and DC seem to be independent risk factors for UADT because corresponding risk estimates remain substantially elevated after detailed adjustment for multiple confounders. Whether mouthwash use may entail some risk through the alcohol content in most formulations on the market remains to be fully clarified.

The Rotterdam Study: 2012 objectives and design update

The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, oncological, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over a 1,000 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.