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How much do smoking and alcohol consumption explain socioeconomic inequalities in head and neck cancer risk?
  1. A F Boing1,
  2. J L Ferreira Antunes2,
  3. M Brasilino de Carvalho3,
  4. J Francisco de Góis Filho4,
  5. L P Kowalski5,
  6. P Michaluart Jr6,
  7. Head and Neck Genome Project/GENCAPO7,
  8. J Eluf-Neto8,
  9. P Boffetta9,
  10. V Wünsch-Filho10
  1. 1Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
  2. 2Faculdade de Odontologia, Universidade de São Paulo, São Paulo, Brazil
  3. 3Hospital Heliópolis, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil
  4. 4Instituto do Câncer Arnaldo Vieira de Carvalho, São Paulo, Brazil
  5. 5Hospital do Câncer A.C. Camargo, São Paulo, Brazil
  6. 6Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
  7. 7See appendix
  8. 8Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
  9. 9International Agency for Research on Cancer, Lyon, France
  10. 10Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
  1. Correspondence to José Leopoldo Ferreira Antunes, Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, 1000 R Arlindo Béttio, sala 81-A1, São Paulo 03828-900, Brazil; leopoldo{at}usp.br

Abstract

Background A higher burden of head and neck cancer has been reported to affect deprived populations. This study assessed the association between socioeconomic status and head and neck cancer, aiming to explore how this association is related to differences of tobacco and alcohol consumption across socioeconomic strata.

Methods We conducted a case-control study in São Paulo, Brazil (1998–2006), including 1017 incident cases of oral, pharyngeal and laryngeal cancer, and 951 sex- and age-matched controls. Education and occupation were distal determinants in the hierarchical approach; cumulative exposure to tobacco and alcohol were proximal risk factors. Outcomes of the hierarchical model were compared with fully adjusted ORs.

Results Individuals with lower education (OR 2.27; 95% CI 1.61 to 3.19) and those performing manual labour (OR 1.55; 95% CI 1.26 to 1.92) had a higher risk of disease. However, 54% of the association with lower education and 45% of the association with manual labour were explained by proximal lifestyle exposures, and socioeconomic status remained significantly associated with disease when adjusted for smoking and alcohol consumption.

Conclusions Socioeconomic differences in head and neck cancer are partially attributable to the distribution of tobacco smoking and alcohol consumption across socioeconomic strata. Additional mediating factors may explain the remaining variation of socioeconomic status on head and neck cancer.

  • Head and neck cancer
  • socioeconomic determinants
  • tobacco smoking
  • alcohol drinking
  • case-control studies
  • cancer epidemiology
  • cancer: smoking
  • public health epidemiology
  • social differences
  • social inequalities

https://doi.org/10.1136/jech.2009.097691

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    Footnotes

    • Complete author list and addresses presented in the Appendix.

    • Funding This work was supported by the European Commission [IC18-CT97-0222]; Ludwig Institute for Research on Cancer and FAPESP (Fundação de Amparo à Pesquisa no Estado de São Paulo) [01/01768-2, 01/12897-8 and 04/12054-9].

    • Competing interests None.

    • Patient consent Obtained.

    • Ethics approval This study was conducted with the approval of the Faculdade de Odontologia, Universidade de São Paulo, Brazil; Hospital Heliópolis, Secretaria de Estado da Saúde de São Paulo, Brazil; Instituto do Câncer Arnaldo Vieira de Carvalho, Brazil; Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brazil.

    • Provenance and peer review Not commissioned; externally peer reviewed.