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Santi I, Kroll LE, Dietz A, Becher H, Ramroth H. Occupation and educational inequalities in laryngeal cancer: the use of a job index. BMC Public Health 2013; 13:1080. [PMID: 24246148 PMCID: PMC4225569 DOI: 10.1186/1471-2458-13-1080] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 11/18/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies tried to assess the association between socioeconomic status and laryngeal cancer. Alcohol and tobacco consumption explain already a large part of the social inequalities. Occupational exposures might explain a part of the remaining but the components and pathways of the socioeconomic contribution have yet to be fully disentangled. The aim of this study was to evaluate the role of occupation using different occupational indices, differentiating between physical, psycho-social and toxic exposures and trying to summarize the occupational burden into one variable. METHODS A population-based case-control study conducted in Germany in 1998-2000 included 208 male cases and 702 controls. Information on occupational history, smoking, alcohol consumption and education was collected with face-to-face interviews. A recently developed job-classification index was used to account for the occupational burden. A sub-index focussed on jobs involving potentially carcinogenic agents (CAI) for the upper aero digestive tract. RESULTS When adjusted for smoking and alcohol consumption, higher odds ratios (ORs) were found for lower education. This OR decreased after further adjustment using the physical and psycho-social job indices (OR = 3.2, 95%-CI: 1.5-6.8), similar to the OR using the sub-index CAI (OR = 3.0, 95%-CI: 1.4-6.5). CONCLUSIONS The use of an easily applicable control variable, simply constructed on standard occupational job classifications, provides the possibility to differentiate between educational and occupational contributions. Such an index might indirectly reflect the effect of carcinogenic agents, which are not collected in many studies.
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Affiliation(s)
- Irene Santi
- Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany.
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Menvielle G, Boshuizen H, Kunst AE, Vineis P, Dalton SO, Bergmann M, Hermann S, Veglia F, Ferrari P, Overvad K, Raaschou-Nielsen O, Tjønneland A, Kaaks R, Linseisen J, Palli D, Krogh V, Tumino R, Rodriguez L, Agudo A, Sánchez MJ, Arozena JMA, Cirera L, Ardanaz E, Bingham S, Khaw KT, Boffetta P, Duell E, Slimani N, Gallo V, Riboli E, Bueno-De-Mesquita HB. Occupational exposures contribute to educational inequalities in lung cancer incidence among men: Evidence from the EPIC prospective cohort study. Int J Cancer 2010; 126:1928-1935. [PMID: 19810107 PMCID: PMC2873305 DOI: 10.1002/ijc.24924] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The aim of this study is to investigate to what extent occupational exposures may explain socioeconomic inequalities in lung cancer incidence after adjusting for smoking and dietary factors. Analyses were based on a subsample of the European Prospective Investigation into Cancer and Nutrition (EPIC study), a prospective cohort. The analyses included 703 incident lung cancer cases among men in Denmark, the United Kingdom, Germany, Italy, Spain and Greece. The socioeconomic position was measured using the highest level of education. The estimates of relative indices of inequality (RII) were computed with Cox regression models. We first adjusted for smoking (with detailed information on duration and quantity) and dietary factors (fruits and vegetables consumption) and then for occupational exposures. The exposure to three carcinogens [asbestos, heavy metals and polycyclic aromatic hydrocarbons (PAH)] was analyzed. The occupational exposures explained 14% of the socioeconomic inequalities remaining after adjustment for smoking and fruits and vegetables consumption. The inequalities remained nevertheless statistically significant. The RII decreased from 1.87 (95% CI: 1.36-2.56) to 1.75 (1.27-2.41). The decrease was more pronounced when adjusting for asbestos than for heavy metals or PAH. Analyses by birth cohort suggested an effect of occupational exposures among older men, while due to small number of endpoints, no conclusion could be drawn about the role of occupational exposures in educational inequalities among younger men. Our study revealed that the impact of occupational exposures on socioeconomic inequalities in cancer incidence, rarely studied until now, exists while of modest magnitude.
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Affiliation(s)
- Gwenn Menvielle
- Santé publique et épidémiologie des déterminants professionnels et sociaux de la santé
INSERM : U687IFR69Université Paris Sud - Paris XIUniversité de Versailles-Saint Quentin en YvelinesHôpital Paul Brousse 16, av Paul Vaillant Couturier 94807 VILLEJUIF,FR
- RIVM, National Institute of Public Health and Environment
National Institute of Public Health and EnvironmentBilthoven,NL
- Department of Public Health
University Medical Center RotterdamErasmus MC Rotterdam,NL
| | - Hendriek Boshuizen
- RIVM, National Institute of Public Health and Environment
National Institute of Public Health and EnvironmentBilthoven,NL
| | - Anton E. Kunst
- Department of Public Health
University Medical Center RotterdamErasmus MC Rotterdam,NL
| | - Paolo Vineis
- University of Torino and CPO-Piemonte
Università degli studi di TorinoTorino,IT
- Dept of Epidemiology and Public Health
Imperial College LondonGB
| | | | - Manuela Bergmann
- Dept of Epidemiology
German Institute of Human NutritionPostdam Rehbücke,DE
| | - Silke Hermann
- Division of Cancer Epidemiology
German Cancer Research CenterHeidelberg,DE
| | | | - Pietro Ferrari
- Nutrition and hormon group
International Agency for Research on CancerLyon,FR
| | - Kim Overvad
- Department of Epidemiology and Social Medecine
University of AarhusDK
| | | | - Anne Tjønneland
- Institute of Cancer Epidemiology
Danish Cancer SocietyCopenhague,DK
| | - Rudolf Kaaks
- Division of Cancer Epidemiology
German Cancer Research CenterHeidelberg,DE
| | - Jakob Linseisen
- Division of Cancer Epidemiology
German Cancer Research CenterHeidelberg,DE
- Institute of Epidemiology
Helmholtz Zentrum MünchenNeuherberg,DE
| | - Domenico Palli
- Molecular and Nutritional Epidemiology Unit
CSPO-Scientific Institute of TuscanyFlorence,IT
| | - Vittorio Krogh
- Department of Preventive & Predictive Medicine
Italian National Center InstituteNutritional Epidemiology Unit Milan,FR
| | - Rosario Tumino
- Cancer Registry Azienda
Ospedaliera "Civile M.P. Arezzo"Ragusa,IT
| | - Laudina Rodriguez
- Public Health and Participation Directorate
Health and Health Care Service CouncilAsturias,ES
| | - Antonio Agudo
- Unit of Nutrition, Environment and Cancer
Catalan Institute of OncologyBarcelona,ES
| | - Maria-José Sánchez
- Andalusian School of Public Health
Andalusian School of Public HealthGranada,ES
- CIBER Epidemiologia y Salud Publica
CIBERESPES
| | | | - Lluis Cirera
- CIBER Epidemiologia y Salud Publica
CIBERESPES
- Department of Epidemiology
Murcia Health CouncilMurcia,ES
| | - Eva Ardanaz
- CIBER Epidemiologia y Salud Publica
CIBERESPES
- Public Health Institute of Navarra
Public Health Institute of NavarraPamplona,ES
| | - Sheila Bingham
- MRC Centrer for Nutritional Epidemiology and Cancer Prevention and Survival
University of CambridgeCambridge,GB
| | - Kay-Tee Khaw
- MRC Centrer for Nutritional Epidemiology and Cancer Prevention and Survival
University of CambridgeCambridge,GB
| | - Paolo Boffetta
- Nutrition and hormon group
International Agency for Research on CancerLyon,FR
| | - Eric Duell
- Nutrition and hormon group
International Agency for Research on CancerLyon,FR
| | - Nadia Slimani
- Nutrition and hormon group
International Agency for Research on CancerLyon,FR
| | - Valentina Gallo
- Dept of Epidemiology and Public Health
Imperial College LondonGB
| | - Elio Riboli
- Dept of Epidemiology and Public Health
Imperial College LondonGB
| | - H Bas Bueno-De-Mesquita
- RIVM, National Institute of Public Health and Environment
National Institute of Public Health and EnvironmentBilthoven,NL
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Berthet L. ["Psychogenesis" of cancer: attribution or reality?]. Presse Med 2009; 38:1016-8. [PMID: 19428216 DOI: 10.1016/j.lpm.2008.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 03/24/2008] [Accepted: 03/27/2008] [Indexed: 10/20/2022] Open
Affiliation(s)
- Laurence Berthet
- Département d'évaluation et traitement de douleur- Médecine palliative, Hôpital Pasteur, F-06002 Nice, France.
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