Occupation and educational inequalities in laryngeal cancer: the use of a job index.
BACKGROUND
Previous studies tried to assess the association between socioeconomic status and laryngeal cancer. Alcohol and tobacco consumption explain already a large part of the social inequalities. Occupational exposures might explain a part of the remaining but the components and pathways of the socioeconomic contribution have yet to be fully disentangled. The aim of this study was to evaluate the role of occupation using different occupational indices, differentiating between physical, psycho-social and toxic exposures and trying to summarize the occupational burden into one variable.


METHODS
A population-based case-control study conducted in Germany in 1998-2000 included 208 male cases and 702 controls. Information on occupational history, smoking, alcohol consumption and education was collected with face-to-face interviews. A recently developed job-classification index was used to account for the occupational burden. A sub-index focussed on jobs involving potentially carcinogenic agents (CAI) for the upper aero digestive tract.


RESULTS
When adjusted for smoking and alcohol consumption, higher odds ratios (ORs) were found for lower education. This OR decreased after further adjustment using the physical and psycho-social job indices (OR = 3.2, 95%-CI: 1.5-6.8), similar to the OR using the sub-index CAI (OR = 3.0, 95%-CI: 1.4-6.5).


CONCLUSIONS
The use of an easily applicable control variable, simply constructed on standard occupational job classifications, provides the possibility to differentiate between educational and occupational contributions. Such an index might indirectly reflect the effect of carcinogenic agents, which are not collected in many studies.
Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany. Irene.Santi@uni-heidelberg.de.
Irene
I
Santi
Lars Eric
LE
Kroll
Andreas
A
Dietz
Heiko
H
Becher
Heribert
H
Ramroth
D002273:Carcinogens / Q000633:toxicity; D016022:Case-Control Studies; D004522:Educational Status; D005858:Germany / Q000453:epidemiology; D054624:Health Status Disparities; D006801:Humans; D007822:Laryngeal Neoplasms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology*; D016273:Occupational Exposure / Q000009:adverse effects / Q000706:statistics & numerical data; D009790:Occupations / Q000706:statistics & numerical data*; D011584:Psychology; D012307:Risk Factors
D002273:Carcinogens