Occupational disparities in survival from common cancers in Japan: Analysis of Kanagawa cancer registry
Occupational disparities in survival from common cancers in Japan: Analysis of Kanagawa cancer registry
复制标题
DOI：
10.1016/j.canep.2022.102115
复制
发表时间：
2022-01-29
影响因子：
2.6
通讯作者：
Kawachi, Ichiro
中科院分区：
文献类型：
--
作者：
Zaitsu, Masayoshi;Kobayashi, Yasuki;Kawachi, Ichiro
背景资料：鲜为人知的是，在日本常见的癌症situation.Methods生存的职业差异：从人口为基础的癌症登记处的数据，我们确定了32,870癌症患者在1992年至2011年诊断。我们对患者进行了5年的随访（中位随访时间为5.0年）。对于每个人，我们将他们最长的职业分为5类（上层非手工，下层非手工，手工，农民和其他）以下埃里克森-戈德索普-Portocarero计划。Poisson回归模型用于估计每个职业类别的总体和特定地点死亡率比（MRR）和95%置信区间（CI），并根据性别、年龄和诊断年份进行调整。上层非体力劳动者作为参照组。此外，使用二进制分类的职业（体力劳动者与非体力劳动者），因果中介分析与4向分解进行调查的潜在中介之间的关联职业和总死亡率癌症stage.Results：总体预后良好，在这个人群（5年总生存率为81.7%）。与高层非体力劳动者相比，低层非体力劳动者（MRR=1.14，95%CI 1.05-1.24）和体力劳动者（MRR=1.40，95%CI 1.29-1.53）的总体死亡率和癌症特异性死亡率均较高。在调整了预后因素（分期和治疗）的中介影响后，观察到的职业差异减弱，但在体力劳动者中仍然显着：MRR = 1.23（95%CI 1.08-1.39）。观察到的职业差异往往归因于常见的癌症，即，男性和女性乳腺癌中的胃癌和肺癌。此外，体力劳动者的晚期几率高出1.25倍。在中介分析中，癌症分期的中介作用解释的总体比例为29%（4%由于介导的相互作用和25%由于纯粹的间接作用）。结论：我们记录了职业差异在日本常见癌症的生存。癌症阶段的职业差异可以解释三分之一的生存差异。
Background: Little is known about occupational disparities in survival for common cancer sites in Japan.Methods: Using data from a population-based cancer registry, we identified 32,870 cancer patients diagnosed during 1992-2011. We followed the patients for 5 years (median follow-up time 5.0 years). For each individual, we classified their longest-held occupation into 5 classes (upper non-manual, lower non-manual, manual, farmer, and others) following the Erikson-Goldthorpe-Portocarero scheme. Poisson regression models were used to estimate overall and site-specific mortality rate ratios (MRRs) and 95% confidence intervals (CI) for each occupational class, adjusted for sex, age, and diagnosis year. Upper non-manual workers served as the reference group. Additionally, using a binary categorization of occupations (manual workers versus non-manual workers), a causal mediation analysis with 4-way decomposition was performed to investigate the potential mediation of the association between occupation and overall mortality by cancer stage.Results: Overall prognosis was good in this population (5-year overall survival was 81.7%). Compared with upper non-manual workers, both overall and cancer-specific mortality was higher in lower non-manual workers (MRR=1.14, 95% CI 1.05-1.24) and manual workers (MRR=1.40, 95% CI 1.29-1.53). After adjusting for the mediating influence of prognostic factors (stage and treatment), the observed occupational differences were attenuated but remained significant in manual workers: MRR = 1.23 (95% CI 1.08-1.39). Observed occupational disparities tended to be attributable to common cancers, i.e., stomach and lung among men and female breast cancer. Additionally, manual workers had 1.25 times higher odds for advanced stage. In the mediation analysis, the overall proportion explained by mediating effect of cancer stage was 29% (4% due to mediated interaction and 25% due to pure indirect effect).Conclusion: We documented occupational disparities in survival from commonly-occurring cancers in Japan. Occupational differences in cancer stage may explain one-third of the survival disparities.