TY - JOUR
T1 - The role of smoking and diet in explaining educational inequalities in lung cancer incidence
AU - Menvielle, Gwenn
AU - Boshuizen, Hendriek
AU - Kunst, Anton E.
AU - Dalton, Susanne O.
AU - Vineis, Paolo
AU - Bergmann, Manuela M.
AU - Hermann, Silke
AU - Ferrari, Pietro
AU - Raaschou-Nielsen, Ole
AU - Tjønneland, Anne
AU - Kaaks, Rudolf
AU - Linseisen, Jakob
AU - Kosti, Maria
AU - Trichopoulou, Antonia
AU - Dilis, Vardis
AU - Palli, Domenico
AU - Krogh, Vittorio
AU - Panico, Salvatore
AU - Tumino, Rosario
AU - Büchner, Frederike L.
AU - Van Gils, Carla H.
AU - Peeters, Petra H.M.
AU - Braaten, Tonje
AU - Gram, Inger T.
AU - Lund, Eiliv
AU - Rodriguez, Laudina
AU - Agudo, Antonio
AU - Sánchez, Maria José
AU - Tormo, Maria José
AU - Ardanaz, Eva
AU - Manjer, Jonas
AU - Wirfält, Elisabet
AU - Hallmans, Göran
AU - Rasmuson, Torgny
AU - Bingham, Sheila
AU - Khaw, Kay Tee
AU - Allen, Naomi
AU - Key, Tim
AU - Boffetta, Paolo
AU - Duell, Eric J.
AU - Slimani, Nadia
AU - Gallo, Valentina
AU - Riboli, Elio
AU - Bueno-De-Mesquita, H. Bas
N1 - Funding Information:
Fondation pour la Recherche Médicale (SPE 20051105244 to G.M.); The European Commission, through the Eurocadet project (from the commission of the European Communities Research Directorate-General, Grant no. EUROCADET:SP23-CT-2005-006528 to Department of Public Health, Erasmus MC, Rotterdam, the Netherlands); European Prospective Investigation into Cancer and Nutrition (EPIC) was supported by the European Commission: Public Health and Consumer Protection Directorate 1993 – 2004 and the Research Directorate-General 2005 – 2008. The EPIC study was funded by “Europe Against Cancer” Programme of the European Commission (SANCO); Ligue contre le Cancer (France); Société 3M (France); Mutuelle Générale de l ’ Education Nationale; Institut National de la Santé et de la Recherche Médicale; German Cancer Aid; German Cancer Research Center; German Federal Ministry of Education and Research; Danish Cancer Society; Red Temática de Investigación Cooperativa de Centros de Cáncer (C03/10); the participating regional governments and institutions of Murcia, Navarra, Asturias, Pais Vasco y Andalucia, Spain; Cancer Research UK; Medical Research Council, United Kingdom; Stroke Association, United Kingdom; British Heart Foundation; Department of Health, United Kingdom; Food Standards Agency, United Kingdom; The Wellcome Trust, United Kingdom; Greek Ministry of Education; Greek Ministry of Health and Social Solidarity; Hellenic Health Foundation; Italian Association for Research on Cancer; Dutch Ministry of Public Health, Welfare and Sports; Dutch Ministry of Health; Dutch Prevention Funds; LK Research Funds; Dutch Zorg Onderzoek Nederland; World Cancer Research Fund; Swedish Cancer Society; Swedish Scientific Council; Regional Government of Vasterbotten and Skane, Sweden; Norwegian Cancer Society; and Foundation to Promote Research into Functional Vitamin B 12 Deficiency, Norway. Some authors are partners of Environmental Cancer Risk, Nutrition and Individual Susceptibility, a network of excellence of the European Commission (6FP contract 513943). A.A. and P.V. were supported by Environmental Cancer Risk, Nutrition and Individual Susceptibility .
PY - 2009/3
Y1 - 2009/3
N2 - Background: Studies in many countries have reported higher lung cancer incidence and mortality in individuals with lower socioeconomic status. Methods: To investigate the role of smoking in these inequalities, we used data from 391 251 participants in the European Prospective Investigation into Cancer and Nutrition study, a cohort of individuals in 10 European countries. We collected information on smoking (history and quantity), fruit and vegetable consumption, and education through questionnaires at study entry and gathered data on lung cancer incidence for a mean of 8.4 years. Socioeconomic status was defined as the highest attained level of education, and participants were grouped by sex and region of residence (Northern Europe, Germany, or Southern Europe). Relative indices of inequality (RIIs) of lung cancer risk unadjusted and adjusted for smoking were estimated using Cox regression models. Additional analyses were performed by histological type. Results: During the study period, 939 men and 692 women developed lung cancer. Inequalities in lung cancer risk (RII men = 3.62, 95% confidence interval [CI] = 2.77 to 4.73, 117 vs 52 per 100 000 person-years for lowest vs highest education level; RII women = 2.39, 95% CI = 1.77 to 3.21, 46 vs 25 per 100 000 person-years) decreased after adjustment for smoking but remained statistically significant (RIImen = 2.29, 95% CI = 1.75 to 3.01; RII women = 1.59, 95% CI = 1.18 to 2.13). Large RIIs were observed among men and women in Northern European countries and among men in Germany, but inequalities in lung cancer risk were reverse (RIIs < 1) among women in Southern European countries. Inequalities differed by histological type. Adjustment for smoking reduced inequalities similarly for all histological types and among men and women in all regions. In all analysis, further adjustment for fruit and vegetable consumption did not change the estimates. Conclusion: Self-reported smoking consistently explains approximately 50% of the inequalities in lung cancer risk due to differences in education.
AB - Background: Studies in many countries have reported higher lung cancer incidence and mortality in individuals with lower socioeconomic status. Methods: To investigate the role of smoking in these inequalities, we used data from 391 251 participants in the European Prospective Investigation into Cancer and Nutrition study, a cohort of individuals in 10 European countries. We collected information on smoking (history and quantity), fruit and vegetable consumption, and education through questionnaires at study entry and gathered data on lung cancer incidence for a mean of 8.4 years. Socioeconomic status was defined as the highest attained level of education, and participants were grouped by sex and region of residence (Northern Europe, Germany, or Southern Europe). Relative indices of inequality (RIIs) of lung cancer risk unadjusted and adjusted for smoking were estimated using Cox regression models. Additional analyses were performed by histological type. Results: During the study period, 939 men and 692 women developed lung cancer. Inequalities in lung cancer risk (RII men = 3.62, 95% confidence interval [CI] = 2.77 to 4.73, 117 vs 52 per 100 000 person-years for lowest vs highest education level; RII women = 2.39, 95% CI = 1.77 to 3.21, 46 vs 25 per 100 000 person-years) decreased after adjustment for smoking but remained statistically significant (RIImen = 2.29, 95% CI = 1.75 to 3.01; RII women = 1.59, 95% CI = 1.18 to 2.13). Large RIIs were observed among men and women in Northern European countries and among men in Germany, but inequalities in lung cancer risk were reverse (RIIs < 1) among women in Southern European countries. Inequalities differed by histological type. Adjustment for smoking reduced inequalities similarly for all histological types and among men and women in all regions. In all analysis, further adjustment for fruit and vegetable consumption did not change the estimates. Conclusion: Self-reported smoking consistently explains approximately 50% of the inequalities in lung cancer risk due to differences in education.
UR - http://www.scopus.com/inward/record.url?scp=62349133401&partnerID=8YFLogxK
U2 - 10.1093/jnci/djn513
DO - 10.1093/jnci/djn513
M3 - Article
C2 - 19244178
AN - SCOPUS:62349133401
SN - 0027-8874
VL - 101
SP - 321
EP - 330
JO - Journal of the National Cancer Institute
JF - Journal of the National Cancer Institute
IS - 5
ER -