title: Quantifying the mediating effects of smoking and occupational exposures in the relation between education and lung cancer: the ICARE study.
abstract: Smoking only partly explains the higher lung cancer incidence observed among socially deprived people. Occupational exposures may account for part of these inequalities, but this issue has been little investigated. We investigated the extent to which smoking and occupational exposures to asbestos, silica and diesel motor exhaust mediated the association between education and lung cancer incidence in men. We analyzed data from a large French population-based case-control study (1976 lung cancers, 2648 controls). Detailed information on lifelong tobacco consumption and occupational exposures to various carcinogens was collected. We conducted inverse probability-weighted marginal structural models. A strong association was observed between education and lung cancer. The indirect effect through smoking varied by educational level, with the strongest indirect effect observed for those with the lowest education (OR = 1.34 (1.14-1.57)). The indirect effect through occupational exposures was substantial among men with primary (OR = 1.22 (1.15-1.30) for asbestos and silica) or vocational secondary education (OR = 1.18 (1.12-1.25)). The contribution of smoking to educational differences in lung cancer incidence ranged from 22 % (10-34) for men with primary education to 31 % (-3 to 84) for men with a high school degree. The contribution of occupational exposures to asbestos and silica ranged from 15 % (10-20) for men with a high school degree to 20 % (13-28) for men with vocational secondary education. Our results highlight the urgent need for public health policies that aim at decreasing exposure to carcinogens at work, in addition to tobacco control policies, if we want to reduce socioeconomic inequalities in the cancer field.
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), 75012, Paris, France. gwenn.menvielle@inserm.fr.
authors.forename: Gwenn
authors.identifier: 0000-0002-3261-6366
authors.initials: G
authors.lastname: Menvielle
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), 75012, Paris, France.
authors.forename: Jeanna-Eve
authors.initials: JE
authors.lastname: Franck
authors.affiliation: Inserm UMRS 1018, CESP Centre for Research in Epidemiology and Population Health, Environmental Epidemiology of Cancer, Villejuif, France.|University of Paris Descartes, Paris, France.
authors.forename: Loredana
authors.initials: L
authors.lastname: Radoï
authors.affiliation: Inserm UMRS 1018, CESP Centre for Research in Epidemiology and Population Health, Environmental Epidemiology of Cancer, Villejuif, France.|University of Paris Sud 11, Kremlin-Bicêtre, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Sanchez
authors.affiliation: Unité Mixte de Recherche Épidémiologique et de Surveillance Transport Travail Environnement (UMRESTTE), Université Claude Bernard Lyon 1, 69373, Lyon, France.
authors.forename: Joëlle
authors.initials: J
authors.lastname: Févotte
authors.affiliation: Calvados Cancer Registry, Caen, France.
authors.forename: Anne-Valérie
authors.initials: AV
authors.lastname: Guizard
authors.affiliation: Inserm UMRS 1018, CESP Centre for Research in Epidemiology and Population Health, Environmental Epidemiology of Cancer, Villejuif, France.|University of Paris Sud 11, Kremlin-Bicêtre, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Stücker
authors.affiliation: Inserm U 1085, IRSET, Pointe-à-Pitre, France.|University of Rennes 1, Rennes, France.
authors.forename: Danièle
authors.initials: D
authors.lastname: Luce
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D015984:Causality; D015897:Comorbidity; D004522:Educational Status; D005260:Female; D005602:France / Q000453:epidemiology; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology*; D016273:Occupational Exposure / Q000706:statistics & numerical data*; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D012959:Socioeconomic Factors
keywords: France; Incidence; Lung cancer; Men; Occupational exposure; Smoking