Social class differences in lung cancer mortality: risk factor explanations using two Scottish cohort studies
Social class differences in lung cancer mortality: risk factor explanations using two Scottish cohort studies
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DOI：
10.1093/ije/30.2.268
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发表时间：
2001-04-01
影响因子：
7.7
通讯作者：
Hawthorne, VM
中科院分区：
文献类型：
--
作者：
Hart, CL;Hole, DJ;Hawthorne, VM
方法对Renfrew/Paisley一般人群研究中的7052名男性和8354名女性以及Collaborative研究中的4021名工作男性进行了20年的死亡随访。结果体力劳动者比非体力劳动者吸烟更多，晨痰更多，肺功能更差，生活更贫困地区。体力劳动人群的肺癌死亡率高于非体力劳动人群。与非体力劳动者相比，体力劳动者的肺癌死亡风险明显更高。在Renfrew/Paisley研究中，仅根据年龄进行调整，吸烟调整后的男性肺癌死亡风险降低到1.41(95%CI：1.12-1.77)，在Renfrew/Paisley研究中，女性为1.28(95%CI：0.94-1.75)，在Collaborative研究中，男性为1.43(95%CI：1.02-2.01)。对肺功能、痰和剥夺类别的调整可以降低风险，这些风险对Renfrew/Paisley研究中的男性具有临界性意义，而对Renfrew/Paisley研究中的女性和Collaborative研究中的男性没有意义。增加额外的社会经济变量(仅在合作研究中可用)，完全缩小了体力劳动和非体力劳动社会阶层之间的差异。结论除了吸烟的影响外，不同社会阶层之间的肺癌风险也存在差异。这可以用肺部健康状况不佳、生活条件不佳和社会经济状况不佳来解释。除反吸烟措施外，减少社会经济不平等并针对肺功能较差的人寻求戒烟帮助，可能有助于降低未来肺癌的发病率和死亡率。
Background The study investigated differences in lung cancer mortality risk between social classes.Methods Twenty years of mortality follow-up were analysed in 7052 men and 8354 women from the Renfrew/Paisley general population study and 4021 working men from the Collaborative study.Results More manual than non-manual men and women smoked, reported morning phlegm, had worse lung function and lived in more deprived areas. Lung cancer mortality rates were higher in manual than non-manual men and women. Significantly higher lung cancer mortality risks were seen for manual compared to non-manual workers when adjusting for age only and adjustment for smoking reduced these risks to 1.41 (95% CI: 1.12-1.77) for men in the Renfrew/Paisley study, 1.28 (95% CI:0.94-1.75) for women in the Renfrew/Paisley study and 1.43 (95% CI:1.02-2.01) for men in the Collaborative study. Adjustment for lung function, phlegm and deprivation category attenuated the risks which were of borderline significance for men in the Renfrew/Paisley study and non significant for women in the Renfrew/Paisley study and men in the Collaborative study. Adding extra socioeconomic variables, available in the Collaborative study only, reduced the difference between the manual and non-manual social classes completely.Conclusions There is a difference in lung cancer risk between social classes, in addition to the effect of smoking. This can be explained by poor lung health, deprivation and poor socioeconomic conditions throughout life. As well as anti-smoking measures, reducing socioeconomic inequalities and targeting individuals with poor lung function for help with smoking cessation could help reduce future lung cancer incidence and mortality.