Abstract
Design
A multicentre case–control study.
Case/control selection
Cases were defined as those diagnosed with primary squamous cell tumours of the UADT between 2002 and 2005. Diagnoses included malignant cancers of the oral cavity, oropharynx, hypo-pharynx, larynx or oesophagus. Incident cases were ascertained through weekly monitoring of head and neck cancer clinics in hospital departments and confirmed by pathology department records. Controls were frequency-matched to cases by sex and age (five-year groups). In the UK centres, population controls were randomly selected from the same community medical practice list as the corresponding cases. Specifically, for each case, a total of 10 controls were selected, matched by age and sex. Potential controls were approached in a random order one at a time until one agreed to participate. In all other centres, hospital controls were used. Only controls with a recently diagnosed disease were accepted, and admission diagnoses related to alcohol, tobacco or diet were excluded. Eligible diagnoses included endocrine and metabolic; genito-urinary; skin, subcutaneous tissue and musculoskeletal; gastro-intestinal; circulatory; ear, eye and mastoid; nervous system diseases; trauma and plastic surgery. The proportion of controls within a specific diagnostic group could not exceed 33% of the total in any particular centre.
Data analysis
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)
Conclusions
Socioeconomic inequalities for UADT cancers are only observed among men and are not totally explained by smoking, alcohol drinking and diet.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Johnson S, McDonald JT, Corsten MJ . Socioeconomic factors in head and neck cancer. J Otolaryngol Head Neck Surg 2008; 37: 597–601
Johnson S, McDonald JT, Corsten M, Rourke R . Socio-economic status and head and neck cancer incidence in Canada: a case-control study. Oral Oncol 2010; 46: 200–203
Conway DI, Petticrew M, Malborough H, Berthiller J, Hasibe M, Macpherson LM . Socioeconomic inequalities and oral cancer risk: a systematic review and meta-analysis of case-control studies. Int J Cancer 2008; 122: 2811–2819
Anderson ZJ, Lassen CF, Clemmensen IH . Social inequality and incidence of and survival from cancers of the mouth, pharynx and larynx in a population-based study in Denmark, 1994-2003. Eur J Cancer 2008; 44: 1950–1961.
Conway DI, McMahon AD, Smith K, et al. Components of socioeconomic risk associated with head and neck cancer: a population-based case-control study in Scotland. Br J Oral Maxillofac Surg 2010; 48: 11–17.
Hashibe M, Jacob BJ, Thomas G, et al. Socioeconomic status, lifestyle factors and oral premalignant lesions. Oral Oncol 2003; 39: 664–671
Seeman T, Merkin SS, Crimmins E, Koretz B, Charette S, Karlamangla A . Education, income and enthic differences in cumulative biological risk profiles in a national sample of US adults: NHANES III (1988–1994). Soc Sci Med 2008; 66: 72–87.
Steptoe A, Hamer M, Butcher L, et al. Educational attainment but not measures of current socioeconomic circumstances are associated with leukocyte telomere length in healthy older men and women. Brain Behav Immun. Epub 2011 Apr 23; doi: 10.1016/jbbi.2011.04.010.
McEwen BS . Protective and damaging effects of stress mediators. N Engl J Med 1998; 338: 171–179.
McEwen BS, Stellar E . Stress and the individual. Mechanisms leading to disease. Arch Intern Med 1993; 153: 2093–3101.
Author information
Authors and Affiliations
Additional information
Address for correspondence: Dr.DI Conway, Dental School, Faculty of Medicine, University of Glasgow, 378 Sauchiehall Street, Glasgow G2 3JZ, UK. E-mail: d.conway@dental.gla.ac.uk
Conway DI, McKinney PA, McMahon AD, et al. Socioeconomic factors associated with risk of upper aerodigestive tract cancer in Europe. Eur J Cancer 2010; 46: 588–598. Epub 2009 Oct 24.
Rights and permissions
About this article
Cite this article
Al-Dakkak, I., Khadra, M. Socio-economic status and upper aerodigestive tract cancer. Evid Based Dent 12, 87–88 (2011). https://doi.org/10.1038/sj.ebd.6400815
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.ebd.6400815
