title: Occupational exposures contribute to educational inequalities in lung cancer incidence among men: Evidence from the EPIC prospective cohort study.
abstract: 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.
authors.affiliation: 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.
authors.forename: Gwenn
authors.initials: G
authors.lastname: Menvielle
authors.affiliation: The National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: Hendriek
authors.initials: H
authors.lastname: Boshuizen
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Anton E
authors.initials: AE
authors.lastname: Kunst
authors.affiliation: University of Torino, Torino, Italy.|Department of Epidemiology and Public Health, Imperial College, London, United Kingdom.
authors.forename: Paolo
authors.initials: P
authors.lastname: Vineis
authors.affiliation: Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.
authors.forename: Susanne O
authors.initials: SO
authors.lastname: Dalton
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition, Postdam Rehbücke, Germany.
authors.forename: Manuela M
authors.initials: MM
authors.lastname: Bergmann
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Hermann
authors.affiliation: ISI Foundation, Torino, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Veglia
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ferrari
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg, Denmark.
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.affiliation: Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.
authors.forename: Ole
authors.initials: O
authors.lastname: Raaschou-Nielsen
authors.affiliation: Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kaaks
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.|Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.
authors.forename: Jakob
authors.initials: J
authors.lastname: Linseisen
authors.affiliation: Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Palli
authors.affiliation: Department of Preventive and Predictive Medicine, Nutritional Epidemiology Unit, Italian National Center Institute, Milan, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Krogh
authors.affiliation: Cancer Registry Azienda, Ospedaliera "Civile M.P. Arezzo", Ragusa, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.affiliation: Public Health and Participation Directorate (Health and Health Care Service Council), Asturias, Spain.
authors.forename: Laudina
authors.initials: L
authors.lastname: Rodriguez
authors.affiliation: Unit of Nutrition, Environment, and Cancer, Catalan Institute of Oncology, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Agudo
authors.affiliation: Andalusian School of Public Health, Granada, Spain.|CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
authors.forename: Maria-José
authors.initials: MJ
authors.lastname: Sánchez
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.|Public Health Division of Guipuzcoa, Basque Government, Basque, Spain.
authors.forename: Jone Miren Altzibar
authors.initials: JMA
authors.lastname: Arozena
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.|Department of Epidemiology, Murcia Health Council, Murcia, Spain.
authors.forename: Lluis
authors.initials: L
authors.lastname: Cirera
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.|Public Health Institute of Navarra, Pamplona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Ardanaz
authors.affiliation: MRC Center for Nutritional Epidemiology and Cancer Prevention and Survival, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Sheila
authors.initials: S
authors.lastname: Bingham
authors.affiliation: MRC Center for Nutritional Epidemiology and Cancer Prevention and Survival, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Duell
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: Nadia
authors.initials: N
authors.lastname: Slimani
authors.affiliation: Department of Epidemiology and Public Health, Imperial College, London, United Kingdom.
authors.forename: Valentina
authors.initials: V
authors.lastname: Gallo
authors.affiliation: Department of Epidemiology and Public Health, Imperial College, London, United Kingdom.
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
authors.affiliation: The National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: H Bas
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
mesh_terms: 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