The Role of Smoking and Diet in Explaining Educational Inequalities in Lung Cancer Incidence

被引：72

作者：

Menvielle, Gwenn ^{[1
,2
,3
]}

Boshuizen, Hendriek ^{[2
]}

Kunst, Anton E. ^{[3
]}

Dalton, Susanne O. ^{[4
]}

Vineis, Paolo ^{[5
,27
]}

Bergmann, Manuela M. ^{[6
]}

Hermann, Silke ^{[7
]}

Ferrari, Pietro ^{[8
]}

Raaschou-Nielsen, Ole ^{[4
]}

Tjonneland, Anne ^{[4
]}

Kaaks, Rudolf ^{[7
]}

Linseisen, Jakob ^{[7
]}

Kosti, Maria ^{[9
]}

Trichopoulou, Antonia ^{[9
]}

Dilis, Vardis ^{[9
]}

Palli, Domenico ^{[10
]}

Krogh, Vittorio ^{[11
]}

Panico, Salvatore ^{[12
]}

Tumino, Rosario ^{[13
]}

Buchner, Frederike L. ^{[2
]}

van Gils, Carla H. ^{[14
]}

Peeters, Petra H. M. ^{[14
]}

Braaten, Tonje ^{[15
]}

Gram, Inger T. ^{[15
]}

Lund, Eiliv ^{[15
]}

Rodriguez, Laudina

Agudo, Antonio ^{[16
]}

Sanchez, Maria-Jose ^{[17
]}

Tormo, Maria-Jose ^{[18
]}

Ardanaz, Eva ^{[19
]}

Manjer, Jonas ^{[20
]}

Wirfalt, Elisabet ^{[21
,22
]}

Hallmans, Goran ^{[23
]}

Rasmuson, Torgny ^{[24
]}

Bingham, Sheila ^{[25
]}

Khaw, Kay-Tee ^{[25
]}

Allen, Naomi ^{[26
]}

Key, Tim ^{[26
]}

Boffetta, Paolo ^{[8
]}

Duell, Eric J. ^{[8
]}

Slimani, Nadia ^{[8
]}

Gallo, Valentina ^{[27
]}

Riboli, Elio ^{[27
]}

Bueno-de-Mesquita, H. Bas ^{[2
]}

机构：

[1] Hop Paul Brousse, U687, INSERM, F-94807 Villejuif, France

[2] Natl Inst Publ Hlth & Environm, NL-3720 BA Bilthoven, Netherlands

[3] Erasmus MC, Dept Publ Hlth, Rotterdam, Netherlands

[4] Danish Canc Soc, Inst Canc Epidemiol, Copenhagen, Denmark

[5] Univ Turin, Turin, Italy

[6] German Inst Human Nutr, Dept Epidemiol, Postdam Rehbucke, Germany

[7] German Canc Res Ctr, Div Clin Epidemiol, D-6900 Heidelberg, Germany

[8] Int Agcy Res Canc, F-69372 Lyon, France

[9] Univ Athens, Sch Med, Dept Hyg & Epidemiol, Athens, Greece

[10] Canc Res & Prevent Inst ISPO, Mol & Nutr Epidemiol Unit, Florence, Italy

[11] Italian Natl Ctr Inst, Dept Prevent & Predict Med, Nutr Epidemiol Unit, Milan, Italy

[12] Univ Naples Federico II, Dept Clin & Expt Med, Naples, Italy

[13] Osped Civile MP Arezzo, Canc Registry Azienda, Ragusa, Italy

[14] Univ Med Ctr, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands

[15] Univ Tromso, Inst Community Med, Tromso, Norway

[16] Catalan Inst Oncol, Unit Nutr Environm & Canc, Barcelona, Spain

[17] Andalusian Sch Publ Hlth, Granada, Spain

[18] Murcia Hlth Council, Dept Epidemiol, Murcia, Spain

[19] Publ Hlth Inst Navarra, Pamplona, Spain

[20] Malmo Univ Hosp, Dept Surg, Malmo, Sweden

[21] Dept Clin Sci, Malmo, Sweden

[22] Lund Univ, Lund, Sweden

[23] Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden

[24] Umea Univ, Dept Radiat Sci Oncol, Umea, Sweden

[25] Univ Cambridge, Dept Publ Hlth & Primary Care, MRC Ctr Nutr Epidemiol & Canc Prevent & Survival, Cambridge, England

[26] Univ Oxford, Canc Epidemiol Unit, Oxford, England

[27] Univ London Imperial Coll Sci Technol & Med, Dept Epidemiol & Publ Hlth, London, England

来源：

JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE | 2009年 / 101卷 / 05期

关键词：

SOCIOECONOMIC-STATUS; EUROPEAN COUNTRIES; CIGARETTE-SMOKING; SOCIAL-CLASS; RISK; MORTALITY; MEN; NETHERLANDS; BEHAVIOR; FRUIT;

D O I：

10.1093/jnci/djn513

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Studies in many countries have reported higher lung cancer incidence and mortality in individuals with lower socioeconomic status. To investigate the role of smoking in these inequalities, we used data from 391 251 participants in the European Prospective Investigation into Cancer and Nutrition study, a cohort of individuals in 10 European countries. We collected information on smoking (history and quantity), fruit and vegetable consumption, and education through questionnaires at study entry and gathered data on lung cancer incidence for a mean of 8.4 years. Socioeconomic status was defined as the highest attained level of education, and participants were grouped by sex and region of residence (Northern Europe, Germany, or Southern Europe). Relative indices of inequality (RIIs) of lung cancer risk unadjusted and adjusted for smoking were estimated using Cox regression models. Additional analyses were performed by histological type. During the study period, 939 men and 692 women developed lung cancer. Inequalities in lung cancer risk (RIImen = 3.62, 95% confidence interval [CI] = 2.77 to 4.73, 117 vs 52 per 100 000 person-years for lowest vs highest education level; RIIwomen = 2.39, 95% CI = 1.77 to 3.21, 46 vs 25 per 100 000 person-years) decreased after adjustment for smoking but remained statistically significant (RIImen = 2.29, 95% CI = 1.75 to 3.01; RIIwomen = 1.59, 95% CI = 1.18 to 2.13). Large RIIs were observed among men and women in Northern European countries and among men in Germany, but inequalities in lung cancer risk were reverse (RIIs < 1) among women in Southern European countries. Inequalities differed by histological type. Adjustment for smoking reduced inequalities similarly for all histological types and among men and women in all regions. In all analysis, further adjustment for fruit and vegetable consumption did not change the estimates. Self-reported smoking consistently explains approximately 50% of the inequalities in lung cancer risk due to differences in education.

引用

页码：321 / 330

页数：10

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