Occupational exposures contribute to educational inequalities in lung cancer incidence among men: Evidence from the EPIC prospective cohort study.
The aim of this study is to investigate to what extent occupational exposures may explain socioeconomic inequalities in lung cancer incidence after adjusting for smoking and dietary factors. Analyses were based on a subsample of the European Prospective Investigation into Cancer and Nutrition (EPIC study), a prospective cohort. The analyses included 703 incident lung cancer cases among men in Denmark, the United Kingdom, Germany, Italy, Spain and Greece. The socioeconomic position was measured using the highest level of education. The estimates of relative indices of inequality (RII) were computed with Cox regression models. We first adjusted for smoking (with detailed information on duration and quantity) and dietary factors (fruits and vegetables consumption) and then for occupational exposures. The exposure to three carcinogens [asbestos, heavy metals and polycyclic aromatic hydrocarbons (PAH)] was analyzed. The occupational exposures explained 14% of the socioeconomic inequalities remaining after adjustment for smoking and fruits and vegetables consumption. The inequalities remained nevertheless statistically significant. The RII decreased from 1.87 (95% CI: 1.36-2.56) to 1.75 (1.27-2.41). The decrease was more pronounced when adjusting for asbestos than for heavy metals or PAH. Analyses by birth cohort suggested an effect of occupational exposures among older men, while due to small number of endpoints, no conclusion could be drawn about the role of occupational exposures in educational inequalities among younger men. Our study revealed that the impact of occupational exposures on socioeconomic inequalities in cancer incidence, rarely studied until now, exists while of modest magnitude.
Menvielle
Gwenn
G
The National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.|Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.|Inserm U687, Villejuif, France.
Boshuizen
Hendriek
H
The National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
Kunst
Anton E
AE
Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
Vineis
Paolo
P
University of Torino, Torino, Italy.|Department of Epidemiology and Public Health, Imperial College, London, United Kingdom.
Dalton
Susanne O
SO
Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.
Bergmann
Manuela M
MM
Department of Epidemiology, German Institute of Human Nutrition, Postdam Rehbücke, Germany.
Hermann
Silke
S
Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.
Veglia
Fabrizio
F
ISI Foundation, Torino, Italy.
Ferrari
Pietro
P
International Agency for Research on Cancer, Lyon, France.
Overvad
Kim
K
Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg, Denmark.
Raaschou-Nielsen
Ole
O
Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.
Tjønneland
Anne
A
Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.
Kaaks
Rudolf
R
Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.
Linseisen
Jakob
J
Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.|Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.
Palli
Domenico
D
Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy.
Krogh
Vittorio
V
Department of Preventive and Predictive Medicine, Nutritional Epidemiology Unit, Italian National Center Institute, Milan, Italy.
Tumino
Rosario
R
Cancer Registry Azienda, Ospedaliera "Civile M.P. Arezzo", Ragusa, Italy.
Rodriguez
Laudina
L
Public Health and Participation Directorate (Health and Health Care Service Council), Asturias, Spain.
Agudo
Antonio
A
Unit of Nutrition, Environment, and Cancer, Catalan Institute of Oncology, Barcelona, Spain.
Sánchez
Maria-José
MJ
Andalusian School of Public Health, Granada, Spain.|CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
Arozena
Jone Miren Altzibar
JMA
CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.|Public Health Division of Guipuzcoa, Basque Government, Basque, Spain.
Cirera
Lluis
L
CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.|Department of Epidemiology, Murcia Health Council, Murcia, Spain.
Ardanaz
Eva
E
CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.|Public Health Institute of Navarra, Pamplona, Spain.
Bingham
Sheila
S
MRC Center for Nutritional Epidemiology and Cancer Prevention and Survival, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
Khaw
Kay-Tee
KT
MRC Center for Nutritional Epidemiology and Cancer Prevention and Survival, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
Boffetta
Paolo
P
International Agency for Research on Cancer, Lyon, France.
Duell
Eric
E
International Agency for Research on Cancer, Lyon, France.
Slimani
Nadia
N
International Agency for Research on Cancer, Lyon, France.
Gallo
Valentina
V
Department of Epidemiology and Public Health, Imperial College, London, United Kingdom.
Riboli
Elio
E
Department of Epidemiology and Public Health, Imperial College, London, United Kingdom.
Bueno-de-Mesquita
H Bas
HB
The National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
D015331:Cohort Studies; D004522:Educational Status; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D016273:Occupational Exposure / Q000009:adverse effects*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012959:Socioeconomic Factors