Neighbourhood socioeconomic status and individual lung cancer risk: Evaluating long-term exposure measures and mediating mechanisms
Neighbourhood socioeconomic status and individual lung cancer risk: Evaluating long-term exposure measures and mediating mechanisms
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DOI：
10.1016/j.socscimed.2013.08.005
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发表时间：
2013-11-01
影响因子：
5.4
通讯作者：
Brauer, Michael
中科院分区：
文献类型：
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作者：
Hystad, Perry;Carpiano, Richard M.;Brauer, Michael
社区社会经济地位（SES）与许多慢性疾病有关，但关于其与肺癌发病率的关系的信息很少。这一结果提出了两个关键的实证挑战：较长的潜伏期需要研究参与者的居住历史和长期社区特征；以及关于许多风险因素的充分数据，以测试邻里社会经济地位与肺癌发病率之间的假设中介途径。分析了一项大型加拿大人群肺癌病例对照研究的城市参与者数据，我们调查了与这些挑战相关的三个问题。首先，我们研究了从20年的居住历史和5次全国人口普查中得出的长期社区SES与肺癌发病率之间是否存在关联。其次，当使用基于不同潜伏期或研究进入时间的邻里SES测量时，我们确定了这种长期邻里SES关联是如何变化的。第三，我们估计了一系列个人层面的吸烟行为、其他健康行为以及环境和职业暴露对长期社区SES的调节程度。分层逻辑回归模型的结果显示，在对个体社会经济地位进行调整后，长期社区社会经济地位指数（OR: 1.46; 95% Cl: 1.13-1.89）中，生活在最贫困地区的肺癌病例的几率明显高于生活在最贫困地区的五分之一。在调整吸烟行为和其他已知和可疑的肺癌危险因素后，这种关联仍然显著（OR: 1.38; 1.01-1.88）。观察到长期和研究入门社区SES测量之间的重要差异，后者的衰减效应估计超过50%。吸烟行为是长期邻居SES效应的最强部分中介途径。这项研究首次考察了长期的社区SES对肺癌风险的影响，需要更多的研究来进一步确定社区环境可能影响肺癌风险的具体、可改变的途径。(C) 2013 Elsevier Ltd.版权所有。
Neighbourhood socioeconomic status (SES) has been associated with numerous chronic diseases, yet little information exists on its association with lung cancer incidence. This outcome presents two key empirical challenges: a long latency period that requires study participants' residential histories and long-term neighbourhood characteristics; and adequate data on many risk factors to test hypothesized mediating pathways between neighbourhood SES and lung cancer incidence. Analysing data on urban participants of a large Canadian population-based lung cancer case-control study, we investigate three issues pertaining to these challenges. First, we examine whether there is an association between long-term neighbourhood SES, derived from 20 years of residential histories and five national censuses, and lung cancer incidence. Second, we determine how this long-term neighbourhood SES association changes when using neighbourhood SES measures based on different latency periods or at time of study entry. Third, we estimate the extent to which long-term neighbourhood SES is mediated by a range of individual-level smoking behaviours, other health behaviours, and environmental and occupational exposures. Results of hierarchical logistic regression models indicate significantly higher odds of lung cancer cases residing in the most compared to the least deprived quintile of the long-term neighbourhood SES index (OR: 1.46; 95% Cl: 1.13-1.89) after adjustment for individual SES. This association remained significant (OR: 1.38; 1.01-1.88) after adjusting for smoking behaviour and other known and suspected lung cancer risk factors. Important differences were observed between long-term and study entry neighbourhood SES measures, with the latter attenuating effect estimates by over 50 percent. Smoking behaviour was the strongest partial mediating pathway of the long-term neighbourhood SES effect. This research is the first to examine the effects of long-term neighbourhood SES on lung cancer risk and more research is needed to further identify specific, modifiable pathways by which neighbourhood context may influence lung cancer risk. (C) 2013 Elsevier Ltd. All rights reserved.