Socioeconomic status and lung cancer incidence in men in The Netherlands: is there a role for occupational exposure?
OBJECTIVE
To evaluate the influence of occupational exposure to carcinogens in explaining the association between socioeconomic status and lung cancer.


METHODS
A prospective cohort study. Data on diet, other lifestyle factors, sociodemographic characteristics and job history were collected by means of a self administered questionnaire. Follow up for incident cancer was established by record linkage with a national pathology register and with regional cancer registries.


METHODS
Population originating from 204 municipalities in The Netherlands.


METHODS
These comprised 58 279 men aged 55-69 years in September 1986. After 4.3 years of follow up there were 470 microscopically confirmed incident lung cancer cases with complete data on dietary habits and job history.


RESULTS
Estimation of occupational exposure to asbestos, paint dust, polycyclic aromatic hydrocarbons, and welding fumes was carried out by two experts, using information on job history from the baseline questionnaire. Socioeconomic status was measured by means of highest attained level of education and two indicators based on occupation. In the initial multivariate analyses of socioeconomic status and lung cancer, adjustment was made for age, smoking habits, intake of vitamin C, beta-carotene and retinol, and history of chronic obstructive pulmonary disease or asthma. Additional adjustment for occupational exposure to the four carcinogens mentioned above did not change the inverse association between the level of education and lung cancer risk (initial model: RR highest/lowest level of education = 0.53; 95% CI 0.34, 0.82; additional model: RR highest/lowest level of education = 0.53; 95% CI 0.34, 0.84). Nor was the association between the two occupation based indicators of socioeconomic status and lung cancer risk influenced by occupational exposure to carcinogens. The effect of occupational exposure on the association between the level of education and lung cancer risk did not differ between ex-smokers and current smokers.


CONCLUSIONS
Occupational exposure to asbestos, paint dust, polycyclic aromatic hydrocarbons, and welding fumes could not explain the inverse association between socioeconomic status and lung cancer risk. More research which explicitly addresses possible explanations for the association between socioeconomic status and lung cancer risk is needed.
van Loon
A J
AJ
University of Limburg, Department of Epidemiology, Maastricht, The Netherlands.
Goldbohm
R A
RA
Kant
I J
IJ
Swaen
G M
GM
Kremer
A M
AM
van den Brandt
P A
PA
D000368:Aged; D001194:Asbestos / Q000009:adverse effects; D001249:Asthma / Q000150:complications / Q000453:epidemiology; D002273:Carcinogens; D015331:Cohort Studies; D004391:Dust / Q000009:adverse effects; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000150:complications; D008175:Lung Neoplasms / Q000150:complications / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D016273:Occupational Exposure / Q000009:adverse effects*; D010150:Paint / Q000009:adverse effects; D011084:Polycyclic Aromatic Hydrocarbons / Q000009:adverse effects; D011446:Prospective Studies; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects; D012959:Socioeconomic Factors; D014896:Welding
D002273:Carcinogens; D004391:Dust; D011084:Polycyclic Aromatic Hydrocarbons; D001194:Asbestos