title: Estimating and explaining the effect of education and income on head and neck cancer risk: INHANCE consortium pooled analysis of 31 case-control studies from 27 countries.
abstract: Low socioeconomic status has been reported to be associated with head and neck cancer risk. However, previous studies have been too small to examine the associations by cancer subsite, age, sex, global region and calendar time and to explain the association in terms of behavioral risk factors. Individual participant data of 23,964 cases with head and neck cancer and 31,954 controls from 31 studies in 27 countries pooled with random effects models. Overall, low education was associated with an increased risk of head and neck cancer (OR = 2.50; 95% CI = 2.02 - 3.09). Overall one-third of the increased risk was not explained by differences in the distribution of cigarette smoking and alcohol behaviors; and it remained elevated among never users of tobacco and nondrinkers (OR = 1.61; 95% CI = 1.13 - 2.31). More of the estimated education effect was not explained by cigarette smoking and alcohol behaviors: in women than in men, in older than younger groups, in the oropharynx than in other sites, in South/Central America than in Europe/North America and was strongest in countries with greater income inequality. Similar findings were observed for the estimated effect of low versus high household income. The lowest levels of income and educational attainment were associated with more than 2-fold increased risk of head and neck cancer, which is not entirely explained by differences in the distributions of behavioral risk factors for these cancers and which varies across cancer sites, sexes, countries and country income inequality levels.
authors.affiliation: Glasgow Dental School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.
authors.forename: David I
authors.initials: DI
authors.lastname: Conway
authors.forename: Darren R
authors.initials: DR
authors.lastname: Brenner
authors.forename: Alex D
authors.initials: AD
authors.lastname: McMahon
authors.forename: Lorna M D
authors.initials: LM
authors.lastname: Macpherson
authors.forename: Antonio
authors.initials: A
authors.lastname: Agudo
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Ahrens
authors.forename: Cristina
authors.initials: C
authors.lastname: Bosetti
authors.forename: Hermann
authors.initials: H
authors.lastname: Brenner
authors.forename: Xavier
authors.initials: X
authors.lastname: Castellsague
authors.forename: Chu
authors.initials: C
authors.lastname: Chen
authors.forename: Maria Paula
authors.initials: MP
authors.lastname: Curado
authors.forename: Otávio A
authors.initials: OA
authors.lastname: Curioni
authors.forename: Luigino
authors.initials: L
authors.lastname: Dal Maso
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Daudt
authors.forename: José F
authors.initials: JF
authors.lastname: de Gois Filho
authors.forename: Gypsyamber
authors.initials: G
authors.lastname: D'Souza
authors.forename: Valeria
authors.initials: V
authors.lastname: Edefonti
authors.forename: Eleonora
authors.initials: E
authors.lastname: Fabianova
authors.forename: Leticia
authors.initials: L
authors.lastname: Fernandez
authors.forename: Silvia
authors.initials: S
authors.lastname: Franceschi
authors.forename: Maura
authors.initials: M
authors.lastname: Gillison
authors.forename: Richard B
authors.initials: RB
authors.lastname: Hayes
authors.forename: Claire M
authors.initials: CM
authors.lastname: Healy
authors.forename: Rolando
authors.initials: R
authors.lastname: Herrero
authors.forename: Ivana
authors.initials: I
authors.lastname: Holcatova
authors.forename: Vijayvel
authors.initials: V
authors.lastname: Jayaprakash
authors.forename: Karl
authors.initials: K
authors.lastname: Kelsey
authors.forename: Kristina
authors.initials: K
authors.lastname: Kjaerheim
authors.forename: Sergio
authors.initials: S
authors.lastname: Koifman
authors.forename: Carlo
authors.initials: C
authors.lastname: La Vecchia
authors.forename: Pagona
authors.initials: P
authors.lastname: Lagiou
authors.forename: Philip
authors.initials: P
authors.lastname: Lazarus
authors.forename: Fabio
authors.initials: F
authors.lastname: Levi
authors.forename: Jolanta
authors.initials: J
authors.lastname: Lissowska
authors.forename: Daniele
authors.initials: D
authors.lastname: Luce
authors.forename: Tatiana V
authors.initials: TV
authors.lastname: Macfarlane
authors.forename: Dana
authors.initials: D
authors.lastname: Mates
authors.forename: Elena
authors.initials: E
authors.lastname: Matos
authors.forename: Michael
authors.initials: M
authors.lastname: McClean
authors.forename: Ana M
authors.initials: AM
authors.lastname: Menezes
authors.forename: Gwenn
authors.initials: G
authors.lastname: Menvielle
authors.forename: Franco
authors.initials: F
authors.lastname: Merletti
authors.forename: Hal
authors.initials: H
authors.lastname: Morgenstern
authors.forename: Kirsten
authors.initials: K
authors.lastname: Moysich
authors.forename: Heiko
authors.initials: H
authors.lastname: Müller
authors.forename: Joshua
authors.initials: J
authors.lastname: Muscat
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Olshan
authors.forename: Mark P
authors.initials: MP
authors.lastname: Purdue
authors.forename: Heribert
authors.initials: H
authors.lastname: Ramroth
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Richiardi
authors.forename: Peter
authors.initials: P
authors.lastname: Rudnai
authors.forename: Stimson
authors.initials: S
authors.lastname: Schantz
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Schwartz
authors.forename: Oxana
authors.initials: O
authors.lastname: Shangina
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Simonato
authors.forename: Elaine
authors.initials: E
authors.lastname: Smith
authors.forename: Isabelle
authors.initials: I
authors.lastname: Stucker
authors.forename: Erich M
authors.initials: EM
authors.lastname: Sturgis
authors.forename: Neonila
authors.initials: N
authors.lastname: Szeszenia-Dabrowska
authors.forename: Renato
authors.initials: R
authors.lastname: Talamini
authors.forename: Peter
authors.initials: P
authors.lastname: Thomson
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Vaughan
authors.forename: Qingyi
authors.initials: Q
authors.lastname: Wei
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Winn
authors.forename: Victor
authors.initials: V
authors.lastname: Wunsch-Filho
authors.forename: Guo-Pei
authors.initials: GP
authors.lastname: Yu
authors.forename: Zuo-Feng
authors.initials: ZF
authors.lastname: Zhang
authors.forename: Tongzhang
authors.initials: T
authors.lastname: Zheng
authors.forename: Ariana
authors.initials: A
authors.lastname: Znaor
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.forename: Shu-Chun
authors.initials: SC
authors.lastname: Chuang
authors.forename: Marianoosh
authors.initials: M
authors.lastname: Ghodrat
authors.forename: Yuan-Chin
authors.initials: YC
authors.lastname: Amy Lee
authors.forename: Mia
authors.initials: M
authors.lastname: Hashibe
authors.forename: Paul
authors.initials: P
authors.lastname: Brennan
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects*; D016022:Case-Control Studies; D004493:Education; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006258:Head and Neck Neoplasms / Q000209:etiology*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D012959:Socioeconomic Factors
keywords: epidemiology; head and neck cancer; socioeconomic inequalities