Population attributable fraction of Esophageal squamous cell carcinoma due to smoking and alcohol in Uganda

Abstract

BackgroundDespite the high rates and regional variation of esophageal squamous cell carcinoma (ESCC) in East Africa, the contributions of smoking and alcohol to the ESCC burden in the general population are unknown.MethodsWe conducted a case-control study of patients presenting for upper gastrointestinal endoscopic examination at Mbarara Regional Referral Hospital, Uganda. Sociodemographic data including smoking and alcohol intake were collected prior to endoscopy. Cases were those with histological diagnosis of ESCC and controls were participants with normal endoscopic examination and gastritis/duodentitis or normal histology. We used odds ratios associated with ESCC risk to determine the population attributable fractions for smoking, alcohol use, and a combination of smoking and alcohol use among adults aged 30 years or greater who underwent upper gastrointestinal endoscopy.ResultsOur study consisted of 67 cases and 142 controls. Median age was 51 years (IQR 40–64); and participants were predominantly male (59 %). Dysphagia and/or odynophagia as indications for endoscopy were significantly more in cases compared to controls (72 % vs 6 %, p < 0.0001). Male gender and increasing age were statistically associated with ESCC. In the unadjusted models, the population attributable fraction of ESCC due to male gender was 55 %, female gender - 49 %, smoking 20 %, alcohol 9 % and a combination of alcohol & smoking 15 %. After adjusting for gender and age, the population attributable fraction of ESCC due to smoking, alcohol intake and a combination of alcohol & smoking were 16, 10, and 13 % respectively.ConclusionIn this population, 13 % of esophageal squamous cell carcinoma cases would be avoided if smoking and alcohol use were discontinued. These results suggest that other important risk factors for ESCC in southwestern Uganda remain unknown.

Esophageal cancer male to female incidence ratios in Africa: A systematic review and meta-analysis of geographic, time and age trends

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Burden, trends, and risk factors of esophageal cancer in China from 1990 to 2017: an up-to-date overview and comparison with those in Japan and South Korea

“…Tobacco smoking remains the key risk factor for EC. Indeed, smoking reportedly accounts for a larger percentage of risk in developed regions or countries [ 26 ], whereas relatively lower attributable risk has been observed in less developed regions or countries [ 27 , 28 ]. In contrast, our study revealed that the percentages of ASDs and DALYs owing to tobacco were higher in China (less developed country) than in Japan and South Korea (developed countries).…”

Socioeconomic status is inversely associated with esophageal squamous cell carcinoma risk: results from a population-based case-control study in China

“…The composite wealth score, based on the ownership of household appliances and other variables, was inversely associated with ESCC risk. Tobacco smoking [ 21 ], alcohol drinking [ 22 ], and poor oral health [ 23 ], which are also associated with SES, most likely affect the occurrence of ESCC, and thus the association between SES and ESCC risk may be confounded by these factors. However, the association remained statistically significant after adjustment for these and other potential confounding factors, thus SES is an independent risk factor of ESCC apart from these factors.…”