Socioeconomic status and head and neck cancer.
Socioeconomic status and head and neck cancer.
复制标题
DOI：
10.1038/sj.ebd.6400726
复制
发表时间：
2010-01-01
影响因子：
--
通讯作者：
Al-Dakkak, Imad
中科院分区：
文献类型：
--
作者：
Al-Dakkak, Imad
设计：以人群为基础的病例对照研究。病例对照选择：符合条件的患者年龄在18至80岁之间，在2002年4月至2004年12月期间进行了初步组织病理学诊断。诊断包括口腔、口咽、下咽或喉的恶性癌症。通过每周监测医院科室的头颈部癌症诊所来确定事件病例，并通过病理科记录加以确认。对照组按年龄（5岁年龄段）和性别从全科医生名单中随机选择。数据分析：在个人访谈中收集有关职业、教育、吸烟和饮酒的信息。社会经济情况是在个人一级（教育、职业社会阶层、失业）和以地区为基础的贫困措施来衡量的。通过非条件Logistic回归计算比值比（OR）和相应的95%置信区间（CI），并根据年龄和性别进行调整。重复该模型，以评估调整吸烟和饮酒后社会经济成分范围的潜在独立影响。吸烟和饮酒之间的相互作用，以及个人和基于区域的社会经济因素的措施进行了测试的似然比检验。此外，最重要的行为风险因素和社会经济变量进入逐步多元逻辑回归模型。所有的统计学分析均使用统计分析系统（SAS;卡里，北卡罗来纳州，美国）software.Results：研究人群包括103名癌症患者（38名女性和65名男性）和91名对照（39名女性和52名男性）。生活在最贫困地区（OR，4.66; 95%CI，1.79- 12.18）和失业者（OR，2.27; 95%CI，1.21- 4.26）的个人患癌症的风险显著高于受教育程度高的人（OR，0.17; 95%CI，0.05-0.58）。当对吸烟和饮酒进行调整时，所有社会阶层的衡量标准都失去了意义。当将最重要的行为和社会经济因素结合在一项完全调整的多变量分析中时，吸烟是唯一与头颈癌独立相关的重要风险因素（OR，15.53; 95%CI，5.36-44.99）。结论：头颈癌的高风险始终与不良的社会经济环境相关。某些特定的成分有很强的联系，但吸烟在整体风险中占主导地位。今后需要对这种联系的性质进行更详细的研究。
DESIGN: This was a population-based case-control study. CASE-CONTROL SELECTION: Eligible patients were aged between 18 and 80 years and had a primary histopathological diagnosis made between April 2002 and December 2004. Diagnosis included malignant cancers of the oral cavity, oropharynx, hypopharynx or larynx. Incident cases were identified through weekly monitoring of head and neck cancer clinics in hospital departments and were confirmed by pathology department records. Controls matched by age (5-year age band) and sex were randomly selected from the lists of general practitioners.DATA ANALYSIS: Information about occupation, education, smoking and alcohol consumption was collected at personal interview. Socioeconomic circumstances were measured at an individual level (education, occupational social class, unemployment), and by area-based measures of deprivation. Odds ratios (OR) and corresponding 95% confidence intervals (CI) were computed by unconditional logistic regression and were adjusted for age and sex. This model was repeated to assess for potential independent effects of the range of socioeconomic components after adjusting for smoking and alcohol consumption. Interactions between smoking and consumption of alcohol, and between individual and area-based measures for socioeconomic factors were tested by the likelihood ratio test. In addition, the most important behavioural risk factors and socioeconomic variables were entered into a stepwise multivariate logistic regression model. All statistical analyses were carried out using Statistical Analysis System (SAS; Cary, North Carolina, USA) software.RESULTS: The study population included 103 cancer patients (38 women and 65 men), and 91 controls (39 women and 52 men). Individuals living in the most deprived areas (OR, 4.66; 95% CI, 1.79- 12.18) and those who were unemployed (OR, 2.27; 95% CI, 1.21- 4.26) had a significantly higher risk of cancer than people who had high levels of educational attainment (OR, 0.17; 95% CI, 0.05-0.58). Significance was lost for all measures of social class when adjustments were made for smoking and consumption of alcohol. When the most important behavioural and socioeconomic factors were combined in a fully adjusted multivariate analysis, smoking was the only significant risk factor (OR, 15.53; 95% CI, 5.36-44.99) found to be independently associated with head and neck cancers.CONCLUSIONS: A high risk of head and neck cancer was consistently associated with poor socioeconomic circumstances. There were strong links for specific components but smoking dominated the overall profile of risk. More detailed research into the nature of such associations is needed in the future.