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. Büchner; Carla 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

doi:10.1093/jnci/djn513

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. Büchner

Carla 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

Family , Population and Preventative Medicine

National Institute of Public Health and the Environment
Erasmus University Rotterdam
Institut national de la santé et de la recherche médicale
Hôpital Paul Brousse
Danish Cancer Society
University of Turin
Imperial College London
German Institute of Human Nutrition Potsdam-Rehbruecke
German Cancer Research Center
International Agency for Research on Cancer
National and Kapodistrian University of Athens
Centro Per Lo Studio E La Prevenzione Oncologica
Italian National Center Institute
University of Naples Federico II
Azienda Ospedaliera Civile M.P. Arezzo
Utrecht University
University of Tromsø – The Arctic University of Norway
Public Health Directorate
Institute Catala Oncologia
Escuela Andaluza de Salud Publica
CIBER Epidemiología y Salud Pública (CIBERESP)
IMIB-Arrixaca
Instituto de Salud Publica, Pamplona
Lund University
Umeå University
University of Cambridge
University of Oxford

Research output: Contribution to journal › Article › peer-review

81 Scopus citations

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 (RII_men = 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 language	English
Pages (from-to)	321-330
Number of pages	10
Journal	Journal of the National Cancer Institute
Volume	101
Issue number	5
DOIs	https://doi.org/10.1093/jnci/djn513
State	Published - Mar 2009

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Menvielle, G., Boshuizen, H., Kunst, A. E., Dalton, S. O., Vineis, P., Bergmann, M. M., 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., ... 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

@article{33dc6e8dd7a74677986e94f9f13044a7,

title = "The role of smoking and diet in explaining educational inequalities in lung cancer incidence",

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\}",

year = "2009",

month = mar,

doi = "10.1093/jnci/djn513",

language = "English",

volume = "101",

pages = "321--330",

journal = "Journal of the National Cancer Institute",

issn = "0027-8874",

number = "5",

}

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

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.

UR - https://www.scopus.com/pages/publications/62349133401

U2 - 10.1093/jnci/djn513

DO - 10.1093/jnci/djn513

M3 - Article

C2 - 19244178

AN - SCOPUS:62349133401

SN - 0027-8874

VL - 101

SP - 321

EP - 330

JO - Journal of the National Cancer Institute

JF - Journal of the National Cancer Institute

IS - 5

ER -

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

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