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
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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.