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IJE Advance Access first published online on May 20, 2004
This version published online on June 11, 2004
International Journal of Epidemiology, doi:10.1093/ije/dyh090
© 2004 by International Epidemiological Association
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Accepted December 4, 2003

Original paper

Smoking, alcohol drinking, occupational exposures and social inequalities in hypopharyngeal and laryngeal cancer

Gwenn Menvielle 1*, Danièle Luce 1, Paquerette Goldberg 1, Annette Leclerc 1

1 Institut National de la Santé et de la Recherche Médicale, Unité 88-IFR69, Saint-Maurice, France

* To whom correspondence should be addressed. E-mail: Gwenn.Menvielle{at}st-maurice.inserm.fr.


  Abstract

Background Social inequalities with regard to hypopharyngeal and laryngeal cancers are observed in many countries. Differences in alcohol and tobacco consumption are often proposed as an explanation for this finding. The aim of this work was to determine the extent to which alcohol and tobacco consumption, and occupational exposure, explain these inequalities.

Methods A hospital-based case-control study included 504 male cases (105 with glottic, 80 with supraglottic, 97 with epilaryngeal, and 201 with hypopharyngeal cancers) and 242 male controls with non-respiratory cancers. Information about sociodemographic characteristics, detailed alcohol and tobacco consumption, educational level, and occupational history were collected. Odds ratios (OR) and their 95% CI were computed using logistic regressions.

Results When controlling for age only, laryngeal and hypopharyngeal cancers were strongly associated with educational level (OR for low versus high level = 3.22, 95% CI: 2.01, 5.18) and with all indicators based on occupation (OR for ever versus never manual worker = 2.54, 95% CI: 1.78, 3.62). When adjusted for alcohol and tobacco consumption, the OR decreased, but remained significant for occupation (OR for ever manual worker = 1.91, 95% CI: 1.23, 2.95). After further adjustment for occupational exposures, significant associations were no longer observed. Associations differed between subsites.

Conclusions Social inequalities observed for these cancers are not totally explained by alcohol and tobacco consumption; a substantial proportion could be attributable to occupational exposures.

Keywords Educational status, social class, laryngeal and hypopharyngeal neoplasm, alcohol consumption, smoking, occupational exposure

The originally published version of this article contained two errors. In the Results section of the Abstract, the odds ratio for low versus high level of education was wrong; and in the Methods section, EGP was misspelled. The publisher apologizes for these errors.
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Commentary: Socioeconomic status: more than a confounder?
Int. J. Epidemiol., August 1, 2004; 33(4): 806 - 807.
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