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The Role of Smoking and Diet in Explaining Educational Inequalities in Lung Cancer Incidence.

Gwenn Menvielle 1, 2, 3, * Hendriek Boshuizen 3 Anton Kunst 1 Susanne Dalton 4 Paolo Vineis 5 Manuela Bergmann 6 Silke Hermann 7 Pietro Ferrari 8 Ole Raaschou-Nielsen 4 Anne Tjønneland 4 Rudolf Kaaks 7 Jakob Linseisen 7 Maria Kosti 7 Antonia Trichopoulou 7 Vardis Dilis 7 Domenico Palli 9 Vittorio Krogh 10 Salvatore Panico 11 Rosario Tumino 12 Frederike Büchner 3 Carla van Gils 13 Petra Peeters 13 Tonje Braaten 14 Inger Gram 14 Eiliv Lund 14 Laudina Rodriguez 15 Antonio Agudo 16 Maria-José Sánchez 17, 18 Maria-José Tormo 18, 19 Eva Ardanaz 18, 20 Jonas Manjer 21 Elisabet Wirfält 22, 23 Göran Hallmans 24 Torgny Rasmuson 25 Sheila Bingham 26 Kay-Tee Khaw 26 Naomi Allen 27 Tim Key 27 Paolo Boffetta 8 Eric Duell 8 Nadia Slimani 8 Valentina Gallo 28 Elio Riboli 28 H Bas Bueno-De-Mesquita 3
Abstract : 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 (RII(men) = 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.
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Gwenn Menvielle, Hendriek Boshuizen, Anton Kunst, Susanne Dalton, Paolo Vineis, et al.. The Role of Smoking and Diet in Explaining Educational Inequalities in Lung Cancer Incidence.. JNCI Journal of the National Cancer Institute, 2009, 101, pp.321-330. ⟨10.1093/jnci/djn513⟩. ⟨inserm-00364819⟩

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