Lung cancer and socioeconomic status in a pooled analysis of case-control studies

Hovanec, Jan; Siemiatycki, Jack; Conway, David I.; Olsson, Ann; Stücker, Isabelle; Guida, Florence; Jöckel, Karl‐Heinz; Pohlabeln, Hermann; Ahrens, Wolfgang; Brüske, Irene; Wichmann, Heinz‐Erich; Gustavsson, Per; Consonni, Dario; Merletti, Franco; Richiardi, Lorenzo; Simonato, Lorenzo; Fortes, Cristina; Parent, Marie‐Élise; McLaughlin, John; Demers, Paul A.; Landi, Maria Teresa; Caporaso, Neil E.; Tardón, Adonina; Заридзе, Давид; Szeszenia-Da̧browska, Neonila; Rudnai, Péter; Lissowska, Jolanta; Fabiánovà, Eleonóra; Field, John K.; Dumitru, Rodica Stanescu; Bencko, Vladimír; Foretová, Lenka; Janout, Vladimí­r; Kromhout, Hans; Vermeulen, Roel; Boffetta, Paolo; Straif, Kurt; Schüz, Joachim; Kendzia, Benjamin; Pesch, Beate; Brüning, Thomas; Behrens, Thomas

doi:10.1371/journal.pone.0192999

Cited by 101 publications

(74 citation statements)

References 41 publications

(54 reference statements)

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“…The difference might be explained by socioeconomic disparity between respondents and nonrespondents. Low socioeconomic status is a risk factor for lung cancer even when adjusting for smoking status 20,21 : respondents were younger, more often of Danish ethnicity and had higher socioeconomic status than non-respondents. Therefore, the predictive values of lung cancer alarm symptoms reported here might not be generalisable to patients with low socioeconomic status.…”

Section: Discussionmentioning

confidence: 97%

Predictive values of lung cancer alarm symptoms in the general population: a nationwide cohort study

Haastrup

Jarbøl

Balasubramaniam

et al. 2020

npj Prim. Care Respir. Med.

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We aimed to firstly determine the 1-year predictive values of lung cancer alarm symptoms in the general population and to analyse the proportion of alarm symptoms reported prior to diagnosis, and secondly analyse how smoking status and reported contact with general practitioners (GPs) regarding lung cancer alarm symptoms influence the predictive values. The study was a nationwide prospective cohort study of 69,060 individuals aged ≥40 years, randomly selected from the Danish population. Using information gathered in a survey regarding symptoms, lifestyle and healthcare-seeking together with registry information on lung cancer diagnoses in the subsequent year, we calculated the predictive values and likelihood ratios of symptoms that might be indicative of lung cancer. Furthermore, we analysed how smoking status and reported contact with GPs regarding the alarm symptoms affected the predictive values. We found that less than half of the patients had reported an alarm symptom six months prior to lung cancer diagnosis. The positive predictive values of the symptoms were generally very low, even for patients reporting GP contact regarding an alarm symptom. The highest predictive values were found for dyspnoea, hoarseness, loss of appetite and for current heavy smokers. The negative predictive values were high, all close to 100%. Given the low positive predictive values, our findings emphasise that diagnostic strategies should not focus on single, specific alarm symptoms, but should perhaps focus on different clusters of symptoms. For patients not experiencing alarm symptoms, the risk of overlooking lung cancer is very low.

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Section: Discussionmentioning

confidence: 97%

Predictive values of lung cancer alarm symptoms in the general population: a nationwide cohort study

Haastrup

Jarbøl

Balasubramaniam

et al. 2020

npj Prim. Care Respir. Med.

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show abstract

“…2019;4:e190004. https://doi.org/10.20900/mo.20190004 with the incidence of lung cancer at both country [17] and individual level even after adjusting for smoking in Europe and Canada [18] and African American [19]. We have to note that this finding at aggregated level cannot be used to explain the association of smoking and risk of lung cancer at individual levels, but it would provide evidence that a study of individual smoking and lung cancer should consider such kind factors at an aggregated level.…”

Section: Discussionmentioning

confidence: 99%

Association of Smoking Prevalence and Alcohol Use with Risk of Lung Cancer: Ecological Evidence

2019

Med One

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Background: Smoking and alcohol use are two common behaviors that affect human health. However, few studies have examined their association with risk of lung cancer with ecological data. Methods: The dependent variable was the estimate of world agestandardized incidence of lung cancer in 2018. Independent variables included the smoking prevalence by gender in 2010 and 2000, which considered potential latency of lung cancer, the rate of alcohol use by gender in 2010, and the gross domestic product (GDP) per capita in 2010 and 2000. A linear regression model was used for statistical data analysis. Results: Both simple and multiple linear regression analysis showed that the prevalence of women's smoking affected the incidence of lung cancer overall (t = 4.96; P < 0.0001), in men (t = 4.56; P < 0.0001) and in women (t = 3.22; P < 0.0001) even when socioeconomic development measured by the GDP per capita was adjusted. These associations were consistent in the overall (t = 4.59; P < 0.0001) and men (t = 3.37; P = 0.001), but stronger in women (t = 4.67; P < 0.0001) when the estimates of smoking prevalence in 2000 were used; and the GDP per capita was significantly associated with the incidence of lung cancer as well. Interestingly, the ratio of smoking prevalence between men and women in 2000 explained about 10% (P = 0.0006; R 2 = 0.097) of the variation in the ratio of lung cancer incidence between men and women even after adjusting for socioeconomic development. However, we did not find an association of alcohol use with the incidence of lung cancer at an aggregated level. Conclusion: At an aggregated level, the women's smoking prevalence is associated with the incidence of lung cancer and gender difference in smoking is associated with the ratio of lung cancer incidence between men and women, providing strong evidence for the relationship of smoking and lung cancer.

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“…This may not be true. For example, low-educated nonsmokers might suffer from a higher risk of lung cancer than high-educated non-smokers due to other exposures [24], which could have contributed to an overestimation of smoking-attributable mortality among the low educated. The PGW method also does not distinguish between exposure and susceptibility to smoking, both of which may vary by level of education.…”

Section: Limitations and Strengthsmentioning

confidence: 99%

Smoking and Inequalities in Mortality in 11 European Countries: A Birth Cohort Analysis

Long

Nusselder

Martikainen

et al. 2020

Preprint

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Purpose: To study the trends of smoking-attributable mortality among the low- and high-educated in consecutive birth cohorts in 11 European countries. Methods: Register-based mortality data were collected among adults aged 30 to 79 years in 11 European countries between 1971 and 2012. Smoking-attributable deaths were estimated indirectly from lung cancer mortality rates using the Preston-Glei-Wilmoth method. Rate ratios and rate differences among the low and high-educated were estimated and used to estimate the contribution of inequality in smoking-attributable mortality to inequality in total mortality.Results: In most countries, smoking-attributable mortality decreased in consecutive birth cohorts born between 1906 and 1961 among low and high-educated men and high-educated women, but not among low-educated women among whom it increased. Relative educational inequalities in smoking-attributable mortality increased among both men and women with no signs of turning points. Absolute inequalities were stable among men but slightly increased among women. The contribution of inequality in smoking-attributable mortality to inequality in total mortality decreased in consecutive generations among men but increased among women. Conclusions: Generations born during the twentieth century are at different stages of the smoking epidemic. Smoking might become less important as a driver of inequalities in total mortality among men in the future. However, among women, smoking threatens to further widen inequalities in total mortality.

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Lung cancer and socioeconomic status in a pooled analysis of case-control studies

Cited by 101 publications

References 41 publications

Predictive values of lung cancer alarm symptoms in the general population: a nationwide cohort study

Predictive values of lung cancer alarm symptoms in the general population: a nationwide cohort study

Association of Smoking Prevalence and Alcohol Use with Risk of Lung Cancer: Ecological Evidence

Smoking and Inequalities in Mortality in 11 European Countries: A Birth Cohort Analysis

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