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Occupational socioeconomic risk associations for head and neck cancer in Europe and South America: individual participant data analysis of pooled case–control studies within the INHANCE Consortium
  1. David I Conway1,
  2. Jan Hovanec2,
  3. Wolfgang Ahrens3,
  4. Alastair Ross1,
  5. Ivana Holcatova4,
  6. Pagona Lagiou5,
  7. Diego Serraino6,
  8. Cristina Canova7,
  9. Lorenzo Richiardi8,
  10. Claire Healy9,
  11. Kristina Kjaerheim10,
  12. Gary J Macfarlane11,
  13. Peter Thomson12,
  14. Antonio Agudo13,
  15. Ariana Znaor14,
  16. Paul Brennan14,
  17. Danièle Luce15,16,17,
  18. Gwenn Menvielle18,
  19. Isabelle Stucker19,20,
  20. Simone Benhamou21,
  21. Heribert Ramroth22,
  22. Paolo Boffetta23,24,
  23. Marta Vilensky25,
  24. Leticia Fernandez26,
  25. Maria Paula Curado27,
  26. Ana Menezes28,
  27. Alexander Daudt29,
  28. Rosalina Koifman30,
  29. Victor Wunsch-Filho31,
  30. Amy Lee Yuan-Chin32,
  31. Mia Hashibe33,
  32. Thomas Behrens2,
  33. Alex D McMahon1
  1. 1 School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
  2. 2 Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
  3. 3 Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
  4. 4 Institute of Hygiene and Epidemiology, Charles University First Faculty of Medicine, Praha, Czech Republic
  5. 5 School of Medicine, National and Kapodistrian University of Athens, Athens, Attica, Greece
  6. 6 Oncology Reference Center, Aviano, Friuli-Venezia Giulia, Italy
  7. 7 Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Veneto, Italy
  8. 8 Department of Medical Sciences, University of Turin, Torino, Piemonte, Italy
  9. 9 School of Dental Science, Trinity College Dublin, Dublin, Ireland
  10. 10 Cancer Registry of Norway, Oslo, Norway
  11. 11 Epidemiology Group, University of Aberdeen, Aberdeen, UK
  12. 12 Faculty of Dentistry, University of Hong Kong, Hong Kong, Hong Kong
  13. 13 Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Hospitalet de Llobregat, Catalunya, Spain
  14. 14 International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
  15. 15 University of Rennes 1—Health Sciences Campus Villejean, Rennes, Bretagne, France
  16. 16 Institute for Research in Health, Environment and Work, National Institute of Health and Medical Research, Rennes, Bretagne, France
  17. 17 School of Advanced Studies in Public Health, Rennes, Bretagne, France
  18. 18 Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
  19. 19 Paris-Sud University, Saint-Aubin, Île-de-France, France
  20. 20 Environmental Epidemiology of Cancer, Centre for Research in Epidemiology and Population Health, National Institute of Health and Medical Research, Villejuif, Île-de-France, France
  21. 21 Gustave-Roussy Institute, Villejuif, Île-de-France, France
  22. 22 Institute of Public Health, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
  23. 23 The Tisch Cancer Institute and Institute for Translational Epidemiology, Mount Sinai School of Medicine, New York, New York, USA
  24. 24 Department of Medical and Surgical Sciences, University of Bologna, Bologna, Emilia-Romagna, Italy
  25. 25 Institute of Oncology Angel H Roffo, University of Buenos Aires, Buenos Aires, Argentina
  26. 26 National Institute of Oncology and Radiobiology, La Habana, Cuba
  27. 27 Epidemiology, AC Camargo Cancer Center International Research Center, Sao Paulo, Brazil
  28. 28 Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
  29. 29 Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
  30. 30 Fundacao Oswaldo Cruz, National School of Public Health, Rio de Janeiro, Brazil
  31. 31 University of Sao Paulo, Sao Paulo, Brazil
  32. 32 Division of Public Health, Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
  33. 33 Division of Public Health, Department of Family and Preventive Medicine, Huntsman Cancer Institute, Salt Lake City, Utah, USA
  1. Correspondence to Prof David I Conway, School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow G12 8QQ, UK; David.Conway{at}


Background The association between socioeconomic disadvantage (low education and/or income) and head and neck cancer is well established, with smoking and alcohol consumption explaining up to three-quarters of the risk. We aimed to investigate the nature of and explanations for head and neck cancer risk associated with occupational socioeconomic prestige (a perceptual measure of psychosocial status), occupational socioeconomic position and manual-work experience, and to assess the potential explanatory role of occupational exposures.

Methods Pooled analysis included 5818 patients with head and neck cancer (and 7326 control participants) from five studies in Europe and South America. Lifetime job histories were coded to: (1) occupational social prestige—Treiman’s Standard International Occupational Prestige Scale (SIOPS); (2) occupational socioeconomic position—International Socio-Economic Index (ISEI); and (3) manual/non-manual jobs.

Results For the longest held job, adjusting for smoking, alcohol and nature of occupation, increased head and neck cancer risk estimates were observed for low SIOPS OR=1.88 (95% CI: 1.64 to 2.17), low ISEI OR=1.74 (95% CI: 1.51 to 1.99) and manual occupations OR=1.49 (95% CI: 1.35 to 1.64). Following mutual adjustment by socioeconomic exposures, risk associated with low SIOPS remained OR=1.59 (95% CI: 1.30 to 1.94).

Conclusions These findings indicate that low occupational socioeconomic prestige, position and manual work are associated with head and neck cancer, and such risks are only partly explained by smoking, alcohol and occupational exposures. Perceptual occupational psychosocial status (SIOPS) appears to be the strongest socioeconomic factor, relative to socioeconomic position and manual/non-manual work.

  • socioeconomic
  • cancer: occupational
  • cancer epidemiology

Data availability statement

Data are available upon reasonable request. Data are available from the corresponding author, DIC, upon reasonable request, with the permission of the INHANCE Consortium.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Data availability statement

Data are available upon reasonable request. Data are available from the corresponding author, DIC, upon reasonable request, with the permission of the INHANCE Consortium.

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  • Twitter @davidiconway

  • Deceased Dr Isabelle Stucker is since deceased.

  • Contributors DIC conceived the study. DIC, ADM, TB, JH, AR and WA designed the study. JH with ADM and TB performed analysis. MH and ALY-C coordinated pooled data. All authors (DIC, JH, WA, AR, IH, PL, DS, CC, LR, CH, KK, GJM, PT, AA, AZ, PB, DL, GM, IS, SB, HR, PB, MV, LF, MPC, AM, AD, RK, VW-F, ALY-C, MH, TB, ADM) reviewed analysis proposal and plan. DIC, TB, JH, AR and ADM drafted the manuscript. All authors read and reviewed the final manuscript. DIC is responsible for the overall content as guarantor.

  • Funding This work was supported by funders of the original studies. ARCAGE (Western Europe): European Community (5th Framework Programme) grant no QLK1-CT-2001-00182; France study: Swiss League against Cancer (KFS1069-09-2000), Fribourg League against Cancer (FOR381.88), Swiss Cancer Research (AKT 617) and Gustave-Roussy Institute (88D28); Germany-Heidelberg study: German Ministry of Education and Research (No. 01GB9702/3); Latin American study: Fondo para la Investigacion Cientifica y Tecnologica (FONCYT) Argentina, IMIM (Barcelona), Fundaco de Amparo a Pesquisa no Estado de Sao Paulo (FAPESP) (No. 01/01768-2), and European Commission (IC18-CT97-0222); INHANCE Pooled Data Project: NCI (R03CA113157, NIDCR R03DE016611). ICARE (France 2001–2007): French National Research Agency (ANR); French National Cancer Institute (INCA); French Agency for Food, Environmental and Occupational Health and Safety (ANSES); French Institute for Public Health Surveillance (InVS); Fondation pour la Recherche Médicale (FRM); Fondation de France; Fondation ARC pour la Recherche sur le Cancer; French Ministry of Labour (Direction Générale du Travail); French Ministry of Health (Direction Générale de la Santé).

  • Competing interests None declared.

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

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