title: How much do smoking and alcohol consumption explain socioeconomic inequalities in head and neck cancer risk?
abstract: BACKGROUND
  A higher burden of head and neck cancer has been reported to affect deprived populations. This study assessed the association between socioeconomic status and head and neck cancer, aiming to explore how this association is related to differences of tobacco and alcohol consumption across socioeconomic strata.
  
  
  METHODS
  We conducted a case-control study in São Paulo, Brazil (1998-2006), including 1017 incident cases of oral, pharyngeal and laryngeal cancer, and 951 sex- and age-matched controls. Education and occupation were distal determinants in the hierarchical approach; cumulative exposure to tobacco and alcohol were proximal risk factors. Outcomes of the hierarchical model were compared with fully adjusted ORs.
  
  
  RESULTS
  Individuals with lower education (OR 2.27; 95% CI 1.61 to 3.19) and those performing manual labour (OR 1.55; 95% CI 1.26 to 1.92) had a higher risk of disease. However, 54% of the association with lower education and 45% of the association with manual labour were explained by proximal lifestyle exposures, and socioeconomic status remained significantly associated with disease when adjusted for smoking and alcohol consumption.
  
  
  CONCLUSIONS
  Socioeconomic differences in head and neck cancer are partially attributable to the distribution of tobacco smoking and alcohol consumption across socioeconomic strata. Additional mediating factors may explain the remaining variation of socioeconomic status on head and neck cancer.
authors: Centro de Ciéncias da Saúde, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.
authors: A F
authors: AF
authors: Boing
authors: J L Ferreira
authors: JL
authors: Antunes
authors: M Brasilino
authors: MB
authors: de Carvalho
authors: J Francisco
authors: JF
authors: de Góis Filho
authors: L P
authors: LP
authors: Kowalski
authors: P
authors: P
authors: Michaluart
authors: J
authors: J
authors: Eluf-Neto
authors: P
authors: P
authors: Boffetta
authors: V
authors: V
authors: Wünsch-Filho
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology*; D001938:Brazil / Q000453:epidemiology; D016001:Confidence Intervals; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000209:etiology; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D020379:Risk Adjustment; D012907:Smoking / Q000453:epidemiology*; D012923:Social Class