The role of smoking and diet in explaining educational inequalities in lung cancer incidence

Gwenn Menvielle, Hendriek Boshuizen, Anton E. Kunst, Susanne O. Dalton, Paolo Vineis, Manuela M. Bergmann, Silke Hermann, Pietro Ferrari, Ole Raaschou-Nielsen, Anne Tjønneland, Rudolf Kaaks, Jakob Linseisen, Maria Kosti, Antonia Trichopoulou, Vardis Dilis, Domenico Palli, Vittorio Krogh, Salvatore Panico, Rosario Tumino, Frederike L. BüchnerCarla H. Van Gils, Petra H M Peeters, Tonje Braaten, Inger T. Gram, Eiliv Lund, Laudina Rodriguez, Antonio Agudo, Maria José Sánchez, Maria José Tormo, Eva Ardanaz, Jonas Manjer, Elisabet Wirfält, Göran Hallmans, Torgny Rasmuson, Sheila Bingham, Kay Tee Khaw, Naomi Allen, Tim Key, Paolo Boffetta, Eric J. Duell, Nadia Slimani, Valentina Gallo, Elio Riboli, H. Bas Bueno-De-Mesquita

Research output: Contribution to journalArticle

Abstract

Background: Studies in many countries have reported higher lung cancer incidence and mortality in individuals with lower socioeconomic status. Methods: To investigate the role of smoking in these inequalities, we used data from 391 251 participants in the European Prospective Investigation into Cancer and Nutrition study, a cohort of individuals in 10 European countries. We collected information on smoking (history and quantity), fruit and vegetable consumption, and education through questionnaires at study entry and gathered data on lung cancer incidence for a mean of 8.4 years. Socioeconomic status was defined as the highest attained level of education, and participants were grouped by sex and region of residence (Northern Europe, Germany, or Southern Europe). Relative indices of inequality (RIIs) of lung cancer risk unadjusted and adjusted for smoking were estimated using Cox regression models. Additional analyses were performed by histological type. Results: During the study period, 939 men and 692 women developed lung cancer. Inequalities in lung cancer risk (RII men = 3.62, 95% confidence interval [CI] = 2.77 to 4.73, 117 vs 52 per 100 000 person-years for lowest vs highest education level; RII women = 2.39, 95% CI = 1.77 to 3.21, 46 vs 25 per 100 000 person-years) decreased after adjustment for smoking but remained statistically significant (RIImen = 2.29, 95% CI = 1.75 to 3.01; RII women = 1.59, 95% CI = 1.18 to 2.13). Large RIIs were observed among men and women in Northern European countries and among men in Germany, but inequalities in lung cancer risk were reverse (RIIs <1) among women in Southern European countries. Inequalities differed by histological type. Adjustment for smoking reduced inequalities similarly for all histological types and among men and women in all regions. In all analysis, further adjustment for fruit and vegetable consumption did not change the estimates. Conclusion: Self-reported smoking consistently explains approximately 50% of the inequalities in lung cancer risk due to differences in education.

Original languageEnglish
Pages (from-to)321-330
Number of pages10
JournalJournal of the National Cancer Institute
Volume101
Issue number5
DOIs
Publication statusPublished - Mar 2009

Fingerprint

Lung Neoplasms
Smoking
Diet
Incidence
Confidence Intervals
Education
Social Class
Vegetables
Germany
Fruit
Proportional Hazards Models
Cohort Studies
History
Mortality

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Menvielle, G., Boshuizen, H., Kunst, A. E., Dalton, S. O., Vineis, P., Bergmann, M. M., ... Bueno-De-Mesquita, H. B. (2009). The role of smoking and diet in explaining educational inequalities in lung cancer incidence. Journal of the National Cancer Institute, 101(5), 321-330. https://doi.org/10.1093/jnci/djn513

The role of smoking and diet in explaining educational inequalities in lung cancer incidence. / Menvielle, Gwenn; Boshuizen, Hendriek; Kunst, Anton E.; Dalton, Susanne O.; Vineis, Paolo; Bergmann, Manuela M.; Hermann, Silke; Ferrari, Pietro; Raaschou-Nielsen, Ole; Tjønneland, Anne; Kaaks, Rudolf; Linseisen, Jakob; Kosti, Maria; Trichopoulou, Antonia; Dilis, Vardis; Palli, Domenico; Krogh, Vittorio; Panico, Salvatore; Tumino, Rosario; Büchner, Frederike L.; Van Gils, Carla H.; Peeters, Petra H M; Braaten, Tonje; Gram, Inger T.; Lund, Eiliv; Rodriguez, Laudina; Agudo, Antonio; Sánchez, Maria José; Tormo, Maria José; Ardanaz, Eva; Manjer, Jonas; Wirfält, Elisabet; Hallmans, Göran; Rasmuson, Torgny; Bingham, Sheila; Khaw, Kay Tee; Allen, Naomi; Key, Tim; Boffetta, Paolo; Duell, Eric J.; Slimani, Nadia; Gallo, Valentina; Riboli, Elio; Bueno-De-Mesquita, H. Bas.

In: Journal of the National Cancer Institute, Vol. 101, No. 5, 03.2009, p. 321-330.

Research output: Contribution to journalArticle

Menvielle, G, Boshuizen, H, Kunst, AE, Dalton, SO, Vineis, P, Bergmann, MM, Hermann, S, Ferrari, P, Raaschou-Nielsen, O, Tjønneland, A, Kaaks, R, Linseisen, J, Kosti, M, Trichopoulou, A, Dilis, V, Palli, D, Krogh, V, Panico, S, Tumino, R, Büchner, FL, Van Gils, CH, Peeters, PHM, Braaten, T, Gram, IT, Lund, E, Rodriguez, L, Agudo, A, Sánchez, MJ, Tormo, MJ, Ardanaz, E, Manjer, J, Wirfält, E, Hallmans, G, Rasmuson, T, Bingham, S, Khaw, KT, Allen, N, Key, T, Boffetta, P, Duell, EJ, Slimani, N, Gallo, V, Riboli, E & Bueno-De-Mesquita, HB 2009, 'The role of smoking and diet in explaining educational inequalities in lung cancer incidence', Journal of the National Cancer Institute, vol. 101, no. 5, pp. 321-330. https://doi.org/10.1093/jnci/djn513
Menvielle, Gwenn ; Boshuizen, Hendriek ; Kunst, Anton E. ; Dalton, Susanne O. ; Vineis, Paolo ; Bergmann, Manuela M. ; Hermann, Silke ; Ferrari, Pietro ; Raaschou-Nielsen, Ole ; Tjønneland, Anne ; Kaaks, Rudolf ; Linseisen, Jakob ; Kosti, Maria ; Trichopoulou, Antonia ; Dilis, Vardis ; Palli, Domenico ; Krogh, Vittorio ; Panico, Salvatore ; Tumino, Rosario ; Büchner, Frederike L. ; Van Gils, Carla H. ; Peeters, Petra H M ; Braaten, Tonje ; Gram, Inger T. ; Lund, Eiliv ; Rodriguez, Laudina ; Agudo, Antonio ; Sánchez, Maria José ; Tormo, Maria José ; Ardanaz, Eva ; Manjer, Jonas ; Wirfält, Elisabet ; Hallmans, Göran ; Rasmuson, Torgny ; Bingham, Sheila ; Khaw, Kay Tee ; Allen, Naomi ; Key, Tim ; Boffetta, Paolo ; Duell, Eric J. ; Slimani, Nadia ; Gallo, Valentina ; Riboli, Elio ; Bueno-De-Mesquita, H. Bas. / The role of smoking and diet in explaining educational inequalities in lung cancer incidence. In: Journal of the National Cancer Institute. 2009 ; Vol. 101, No. 5. pp. 321-330.
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abstract = "Background: Studies in many countries have reported higher lung cancer incidence and mortality in individuals with lower socioeconomic status. Methods: To investigate the role of smoking in these inequalities, we used data from 391 251 participants in the European Prospective Investigation into Cancer and Nutrition study, a cohort of individuals in 10 European countries. We collected information on smoking (history and quantity), fruit and vegetable consumption, and education through questionnaires at study entry and gathered data on lung cancer incidence for a mean of 8.4 years. Socioeconomic status was defined as the highest attained level of education, and participants were grouped by sex and region of residence (Northern Europe, Germany, or Southern Europe). Relative indices of inequality (RIIs) of lung cancer risk unadjusted and adjusted for smoking were estimated using Cox regression models. Additional analyses were performed by histological type. Results: During the study period, 939 men and 692 women developed lung cancer. Inequalities in lung cancer risk (RII men = 3.62, 95{\%} confidence interval [CI] = 2.77 to 4.73, 117 vs 52 per 100 000 person-years for lowest vs highest education level; RII women = 2.39, 95{\%} CI = 1.77 to 3.21, 46 vs 25 per 100 000 person-years) decreased after adjustment for smoking but remained statistically significant (RIImen = 2.29, 95{\%} CI = 1.75 to 3.01; RII women = 1.59, 95{\%} CI = 1.18 to 2.13). Large RIIs were observed among men and women in Northern European countries and among men in Germany, but inequalities in lung cancer risk were reverse (RIIs <1) among women in Southern European countries. Inequalities differed by histological type. Adjustment for smoking reduced inequalities similarly for all histological types and among men and women in all regions. In all analysis, further adjustment for fruit and vegetable consumption did not change the estimates. Conclusion: Self-reported smoking consistently explains approximately 50{\%} of the inequalities in lung cancer risk due to differences in education.",
author = "Gwenn Menvielle and Hendriek Boshuizen and Kunst, {Anton E.} and Dalton, {Susanne O.} and Paolo Vineis and Bergmann, {Manuela M.} and Silke Hermann and Pietro Ferrari and Ole Raaschou-Nielsen and Anne Tj{\o}nneland and Rudolf Kaaks and Jakob Linseisen and Maria Kosti and Antonia Trichopoulou and Vardis Dilis and Domenico Palli and Vittorio Krogh and Salvatore Panico and Rosario Tumino and B{\"u}chner, {Frederike L.} and {Van Gils}, {Carla H.} and Peeters, {Petra H M} and Tonje Braaten and Gram, {Inger T.} and Eiliv Lund and Laudina Rodriguez and Antonio Agudo and S{\'a}nchez, {Maria Jos{\'e}} and Tormo, {Maria Jos{\'e}} and Eva Ardanaz and Jonas Manjer and Elisabet Wirf{\"a}lt and G{\"o}ran Hallmans and Torgny Rasmuson and Sheila Bingham and Khaw, {Kay Tee} and Naomi Allen and Tim Key and Paolo Boffetta and Duell, {Eric J.} and Nadia Slimani and Valentina Gallo and Elio Riboli and Bueno-De-Mesquita, {H. Bas}",
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TY - JOUR

T1 - The role of smoking and diet in explaining educational inequalities in lung cancer incidence

AU - Menvielle, Gwenn

AU - Boshuizen, Hendriek

AU - Kunst, Anton E.

AU - Dalton, Susanne O.

AU - Vineis, Paolo

AU - Bergmann, Manuela M.

AU - Hermann, Silke

AU - Ferrari, Pietro

AU - Raaschou-Nielsen, Ole

AU - Tjønneland, Anne

AU - Kaaks, Rudolf

AU - Linseisen, Jakob

AU - Kosti, Maria

AU - Trichopoulou, Antonia

AU - Dilis, Vardis

AU - Palli, Domenico

AU - Krogh, Vittorio

AU - Panico, Salvatore

AU - Tumino, Rosario

AU - Büchner, Frederike L.

AU - Van Gils, Carla H.

AU - Peeters, Petra H M

AU - Braaten, Tonje

AU - Gram, Inger T.

AU - Lund, Eiliv

AU - Rodriguez, Laudina

AU - Agudo, Antonio

AU - Sánchez, Maria José

AU - Tormo, Maria José

AU - Ardanaz, Eva

AU - Manjer, Jonas

AU - Wirfält, Elisabet

AU - Hallmans, Göran

AU - Rasmuson, Torgny

AU - Bingham, Sheila

AU - Khaw, Kay Tee

AU - Allen, Naomi

AU - Key, Tim

AU - Boffetta, Paolo

AU - Duell, Eric J.

AU - Slimani, Nadia

AU - Gallo, Valentina

AU - Riboli, Elio

AU - Bueno-De-Mesquita, H. Bas

PY - 2009/3

Y1 - 2009/3

N2 - Background: Studies in many countries have reported higher lung cancer incidence and mortality in individuals with lower socioeconomic status. Methods: To investigate the role of smoking in these inequalities, we used data from 391 251 participants in the European Prospective Investigation into Cancer and Nutrition study, a cohort of individuals in 10 European countries. We collected information on smoking (history and quantity), fruit and vegetable consumption, and education through questionnaires at study entry and gathered data on lung cancer incidence for a mean of 8.4 years. Socioeconomic status was defined as the highest attained level of education, and participants were grouped by sex and region of residence (Northern Europe, Germany, or Southern Europe). Relative indices of inequality (RIIs) of lung cancer risk unadjusted and adjusted for smoking were estimated using Cox regression models. Additional analyses were performed by histological type. Results: During the study period, 939 men and 692 women developed lung cancer. Inequalities in lung cancer risk (RII men = 3.62, 95% confidence interval [CI] = 2.77 to 4.73, 117 vs 52 per 100 000 person-years for lowest vs highest education level; RII women = 2.39, 95% CI = 1.77 to 3.21, 46 vs 25 per 100 000 person-years) decreased after adjustment for smoking but remained statistically significant (RIImen = 2.29, 95% CI = 1.75 to 3.01; RII women = 1.59, 95% CI = 1.18 to 2.13). Large RIIs were observed among men and women in Northern European countries and among men in Germany, but inequalities in lung cancer risk were reverse (RIIs <1) among women in Southern European countries. Inequalities differed by histological type. Adjustment for smoking reduced inequalities similarly for all histological types and among men and women in all regions. In all analysis, further adjustment for fruit and vegetable consumption did not change the estimates. Conclusion: Self-reported smoking consistently explains approximately 50% of the inequalities in lung cancer risk due to differences in education.

AB - Background: Studies in many countries have reported higher lung cancer incidence and mortality in individuals with lower socioeconomic status. Methods: To investigate the role of smoking in these inequalities, we used data from 391 251 participants in the European Prospective Investigation into Cancer and Nutrition study, a cohort of individuals in 10 European countries. We collected information on smoking (history and quantity), fruit and vegetable consumption, and education through questionnaires at study entry and gathered data on lung cancer incidence for a mean of 8.4 years. Socioeconomic status was defined as the highest attained level of education, and participants were grouped by sex and region of residence (Northern Europe, Germany, or Southern Europe). Relative indices of inequality (RIIs) of lung cancer risk unadjusted and adjusted for smoking were estimated using Cox regression models. Additional analyses were performed by histological type. Results: During the study period, 939 men and 692 women developed lung cancer. Inequalities in lung cancer risk (RII men = 3.62, 95% confidence interval [CI] = 2.77 to 4.73, 117 vs 52 per 100 000 person-years for lowest vs highest education level; RII women = 2.39, 95% CI = 1.77 to 3.21, 46 vs 25 per 100 000 person-years) decreased after adjustment for smoking but remained statistically significant (RIImen = 2.29, 95% CI = 1.75 to 3.01; RII women = 1.59, 95% CI = 1.18 to 2.13). Large RIIs were observed among men and women in Northern European countries and among men in Germany, but inequalities in lung cancer risk were reverse (RIIs <1) among women in Southern European countries. Inequalities differed by histological type. Adjustment for smoking reduced inequalities similarly for all histological types and among men and women in all regions. In all analysis, further adjustment for fruit and vegetable consumption did not change the estimates. Conclusion: Self-reported smoking consistently explains approximately 50% of the inequalities in lung cancer risk due to differences in education.

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