Socioeconomic distribution of cancer of the lung in New Haven

Cohart, Edward M.

doi:10.1002/1097-0142(1955)8:6<1126::aid-cncr2820080606>3.0.co;2-h

Cited by 28 publications

(3 citation statements)

References 4 publications

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“…Social class diVerences have been studied most extensively among cancer patients, the first reports dating back to the 1950s [33][34][35] and later research conducted in the USA, 8 21 26 27 Europe, 1 2 6 7 12 Japan, 9 and Australia. 23 Although results have been somewhat conflicting, the largest population-based studies have reported social class diVerences in survival for several, but not all, types of cancer.…”

mentioning

confidence: 99%

Measuring social class differences in cancer patient survival: is it necessary to control for social class differences in general population mortality? A Finnish population-based study

Dickman

Auvinen

Voutilainen

et al. 1998

Journal of Epidemiology & Community Health

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Study objectives-Estimation of cancer patient survival by social class has been performed using observed, corrected (cause specific), and relative (with expected survival based on the national population) survival rates. Each of these measures are potentially biased and the optimal method is to calculate relative survival rates using social class specific death rates to estimate expected survival. This study determined the degree to which the choice of survival measure aVects the estimation of social class diVerences in cancer patient survival. Setting and participants-All Finnish residents diagnosed with at least one of 10 common malignant neoplasms during the period 1977-1985 were identified from the Finnish Cancer Registry and followed up for deaths to the end of 1992. Design-Survival rates were calculated by site, sex, and age at 5, 10, and 15 years subsequent to diagnosis for each of three measures of survival; relative survival, corrected (cause specific) survival, and relative survival adjusted for social class diVerences in general mortality. Regression models were fitted to each set of rates for the first five years of follow up. Main results-The degree of variation in relative survival resulting from social class decreased, although did not disappear, after controlling for social class diVerences in general mortality. The results obtained using corrected survival were close to those obtained using relative survival with a social class correction. The diVerences between the three measures were largest when the proportion of deaths from other causes was large, for example, in cancers with high survival, among older patients, and for longer follow up times. Conclusions-Although each of the three measures gave comparable results, it is recommended that relative survival rates are used with expected survival adjusted for social class when studying social class variation in cancer patient survival. If this is not an available option, it is recommended that corrected survival rates are used. Relative survival rates without the social class correction overestimate social class diVerences and should be used with caution.

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confidence: 99%

Measuring social class differences in cancer patient survival: is it necessary to control for social class differences in general population mortality? A Finnish population-based study

Dickman

Auvinen

Voutilainen

et al. 1998

Journal of Epidemiology & Community Health

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“…In many countries lung cancer rates vary by geographical area, socioeconomic class, occupational group and smoking habit, and decade (Fox, 1989;OPCS, 1986;Williams and Horm, 1977;Pearce and Howard, 1986;Levi et al, 1988;Cohart, 1955;Horm and Kessler, 1986). The British Registrar General's decennial series of reports on occupational mortality are a rich source of information on these variations.…”

Section: Confoundingmentioning

confidence: 99%

Epidemiological Evidence on the Carcinogenicity of Silica: Factors in Scientific Judgement

2000

The Annals of Occupational Hygiene

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In view of the extended debate and differing opinions on whether crystalline silica is a human carcinogen, we have reviewed a selection of epidemiological reports, to identify the areas of uncertainty and disagreement. We have chosen to examine the papers which in a recent review were considered to provide the least confounded examinations of an association between silica exposure and cancer risk. We also refer to a study of the mortality of coalminers very recently reported by ourselves and colleagues. We find that parts of the evidence are coherent but there are contradictions. On examination this resolves mostly into differences between types of studies. The three types of epidemiological study included are: (i) exposure-response studies, the most powerful for the confirmation of a relationship between a specific exposure and a health effect; (ii) descriptive studies in which incidence of disease in an exposed population is compared with that in a reference population; and (iii) studies of incidence of disease in subjects on silicosis case-registers. Descriptive studies frequently though not invariably suggest an excess lung cancer risk in silica-exposed workers compared with the general population, but exposure-response studies consistently fail to confirm that the cause is exposure to quartz. A single exposure-response study of cristobalite suggests a positive relation. Both sets of evidence have weaknesses. There are uncertainties on whether the excess risks in the descriptive studies are related to silica exposure or to lifestyle, including smoking habits. There are doubts on whether the exposure estimates in some of the exposure-response studies were sufficiently reliable to detect a small risk or weak association, though they are unlikely to have missed a strong effect. Studies of subjects on silicosis case registers consistently show an excess of lung cancer, but it is not clear to what extent these increased risks represent a direct effect of silica exposure, a secondary effect of the silicosis, preferential inclusion of subjects suffering from the effects of smoking, or bias in diagnostic accuracy. This not unnaturally leads to differences in opinion, exacerbated by variations in the strength of proof required by different experts. The main scientific uncertainties in the evidence are: 1. Whether, in the descriptive studies, the excess lung cancer rates in silica-exposed workers are explicable in terms of smoking habits, socio-economic class differences and inappropriate comparison populations. Better smoking information and more carefully chosen comparison populations are needed; 2. Whether the exposure-response studies could have missed a real relationship between silica exposure and lung cancer, if one exists. Many of the exposure-response studies were conducted with great care, but weaknesses, in the available data on which the exposure estimations were based, could have caused a real relationship of lung cancer and silica exposure to be missed. These studies were sufficiently powerful to demonstr...

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“…The existence of other important lung-cancer effects associated with such characteristics as socioeconomic class cannot be questioned. Cohart 55 found that the poorest economic class had a 40 percent higher lungcancer incidence than the remaining population of New Haven, Connecticut. Results from the 10-city morbidity survey 56 have revealed a sharp gradient in lung-cancer incidence, by income class, for white males, which is consistent with Cohart's findings.…”

Section: Evidence For Other Etiological Factorsmentioning

confidence: 99%

Smoking and Lung Cancer: Recent Evidence and a Discussion of Some Questions

1959

JNCI: Journal of the National Cancer Institute

216

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Socioeconomic distribution of cancer of the lung in New Haven

Cited by 28 publications

References 4 publications

Measuring social class differences in cancer patient survival: is it necessary to control for social class differences in general population mortality? A Finnish population-based study

Measuring social class differences in cancer patient survival: is it necessary to control for social class differences in general population mortality? A Finnish population-based study

Epidemiological Evidence on the Carcinogenicity of Silica: Factors in Scientific Judgement

Smoking and Lung Cancer: Recent Evidence and a Discussion of Some Questions

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