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Occupational exposures contribute to educational inequalities in lung cancer incidence among men: Evidence from the EPIC prospective cohort study.: Occupation and educational inequalities in lung cancer

Gwenn Menvielle 1, 2, 3, * Hendriek Boshuizen 2 Anton Kunst 3 Paolo Vineis 4, 5 Susanne Dalton 6 Manuela Bergmann 7 Silke Hermann 8 Fabrizio Veglia 9 Pietro Ferrari 10 Kim Overvad 11 Ole Raaschou-Nielsen 6 Anne Tjønneland 6 Rudolf Kaaks 8 Jakob Linseisen 8, 12 Domenico Palli 13 Vittorio Krogh 14 Rosario Tumino 15 Laudina Rodriguez 16 Antonio Agudo 17 Maria-José Sánchez 18, 19 Jone Miren Altzibar Arozena 19, 20 Lluis Cirera 19, 21 Eva Ardanaz 19, 22 Sheila Bingham 23 Kay-Tee Khaw 23 Paolo Boffetta 10 Eric Duell 10 Nadia Slimani 10 Valentina Gallo 5 Elio Riboli 5 H Bas Bueno-De-Mesquita 2
Abstract : The aim of this study is to investigate to what extent occupational exposures may explain socioeconomic inequalities in lung cancer incidence after adjusting for smoking and dietary factors. Analyses were based on a subsample of the European Prospective Investigation into Cancer and Nutrition (EPIC study), a prospective cohort. The analyses included 703 incident lung cancer cases among men in Denmark, the United Kingdom, Germany, Italy, Spain and Greece. The socioeconomic position was measured using the highest level of education. The estimates of relative indices of inequality (RII) were computed with Cox regression models. We first adjusted for smoking (with detailed information on duration and quantity) and dietary factors (fruits and vegetables consumption) and then for occupational exposures. The exposure to three carcinogens [asbestos, heavy metals and polycyclic aromatic hydrocarbons (PAH)] was analyzed. The occupational exposures explained 14% of the socioeconomic inequalities remaining after adjustment for smoking and fruits and vegetables consumption. The inequalities remained nevertheless statistically significant. The RII decreased from 1.87 (95% CI: 1.36-2.56) to 1.75 (1.27-2.41). The decrease was more pronounced when adjusting for asbestos than for heavy metals or PAH. Analyses by birth cohort suggested an effect of occupational exposures among older men, while due to small number of endpoints, no conclusion could be drawn about the role of occupational exposures in educational inequalities among younger men. Our study revealed that the impact of occupational exposures on socioeconomic inequalities in cancer incidence, rarely studied until now, exists while of modest magnitude.
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Gwenn Menvielle, Hendriek Boshuizen, Anton Kunst, Paolo Vineis, Susanne Dalton, et al.. Occupational exposures contribute to educational inequalities in lung cancer incidence among men: Evidence from the EPIC prospective cohort study.: Occupation and educational inequalities in lung cancer. International Journal of Cancer, Wiley, 2010, 126 (8), pp.1928-35. ⟨10.1002/ijc.24924⟩. ⟨inserm-00425464⟩

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