Socioeconomic factors associated with risk of upper aerodigestive tract cancer in Europe

Received 22 May 2009; received in revised form 25 September 2009; accepted 30 September 2009. published online 26 October 2009.

Abstract

Introduction

In 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 methods

A 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.

Results

When 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).

Conclusion

Socioeconomic inequalities for UADT cancers are only observed among men and are not totally explained by smoking, alcohol drinking and diet.

Keywords: Alcohol consumption, Case–control study, Educational status, Upper aerodigestive tract cancer, Socioeconomic, Tobacco smoking

a Dental School, Faculty of Medicine, University of Glasgow, 378 Sauchiehall Street, Glasgow G2 3JZ, UK

b NHS NSS ISD, Edinburgh, UK

c Centre for Epidemiology and Biostatistics, University of Leeds, UK

d Bremen Institute for Prevention Research and Social Medicine (BIPS), Bremen, Germany

e INSERM, U946, Fondation Jean Dausset – CEPH, Paris, France

f CNRS FRE2939, Gustave-Roussy Institute, Villejuif, France

g Geneva Cancer Registry, Geneva, Switzerland

h School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK

i Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Greece

j Department of Epidemiology, Harvard School of Public Health, Boston, USA

k Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic

l Unit of Cancer Epidemiology, CeRMS and University of Turin, Turin, Italy

m Cancer Registry of Norway, Oslo, Norway

n Institut Català d’Oncologia (ICO), IDIBELL, CIBER-ESP L’Hospitalet de Llobregat, Spain

o 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

Corresponding author: Address: Dental School, Faculty of Medicine, University of Glasgow, 378 Sauchiehall Street, Glasgow G2 3JZ, UK. Tel.: +44 (0)141 211 9750; fax: +44 (0)141 353 1593.

PII: S0959-8049(09)00725-4

doi:10.1016/j.ejca.2009.09.028

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