Occupational class, occupational mobility and cancer incidence among middle-aged men and women: a prospective study of the French GAZEL cohort*.
OBJECTIVE
To examine the association between occupational class, occupational mobility and cancer incidence in the 1990s.


METHODS
Prospective study of 14,853 men and 5493 women employed by a large French company. Incident cases (any cancer, smoking and alcohol-related, breast) were ascertained through a validated company-based cancer registry (1990-2002). Hazard ratios (HRs) by occupational class and by career-long occupational mobility were calculated adjusting for age, marital status, tobacco and alcohol consumption, weight, diet, asbestos exposure, family history of cancer, and reproductive history.


RESULTS
359 male cancers (107 smoking and alcohol-related) and 208 female cases (120 breast cancers) were observed. Male clerks and manual workers were at high risk, particularly of smoking and alcohol-related cancers (compared to managers, age-adjusted HRs: 2.95 95% CI 1.37-6.38 and 2.18 95% CI 1.15-4.11). Adjusting for specific health behaviors and other cancer risk factors reduced this gradient (fully-adjusted HRs respectively 1.95 95% CI 0.89-4.27 and 1.54 95% CI 0.80-2.97). The risk was also associated with occupational mobility. We found no association between women's occupational class and cancer.


CONCLUSIONS
The incidence of smoking and alcohol-related cancers among French men shows a strong socioeconomic gradient. Policies addressing these social disparities are needed.
Melchior
Maria
M
INSERM U88-IFR69, 14 rue du Val d'Osne, 94415, Saint-Maurice, France. maria.melchior@st-maurice.inserm.fr
Goldberg
Marcel
M
Krieger
Nancy
N
Kawachi
Ichiro
I
Menvielle
Gwenn
G
Zins
Marie
M
Berkman
Lisa F
LF
D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects; D002322:Career Mobility; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D009790:Occupations; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D012923:Social Class; D012959:Socioeconomic Factors