Socioeconomic inequalities and oral cancer risk: A systematic review and meta‐analysis of case‐control studies

Abstract

There is uncertainty and limited recognition of the relationship between socioeconomic inequalities and oral cancer. We aimed to quantitatively assess the association between socioeconomic status (SES) and oral cancer incidence risk. A systematic review of casecontrol studies obtained published and unpublished estimates of the SES risk related to oral cancer. Studies were included which reported odds ratios (ORs) and corresponding 95% CIs of oral cancer with respect to SES, or if the estimates could be calculated or obtained. Meta-analyses were performed on subgroups: SES measure, age, sex, global region, development level, time-period and lifestyle factor adjustments; while sensitivity analyses were conducted based on study methodological issues. Forty-one studies provided 15,344 cases and 33,852 controls which met our inclusion criteria. Compared with individuals who were in high SES strata, the pooled ORs for the risk of developing oral cancer were 1.85 (95%CI 1.60, 2.15; n 5 37 studies) for those with low educational attainment; 1.84 (1.47, 2.31; n 5 14) for those with low occupational social class; and 2.41 (1.59, 3.65; n 5 5) for those with low income. Subgroup analyses showed that low SES was significantly associated with increased oral cancer risk in high and lower income-countries, across the world, and remained when adjusting for potential behavioural confounders. Inequalities persist but are perhaps reducing over recent decades. Oral cancer risk associated with low SES is significant and comparable to lifestyle risk factors. Our results provide evidence to steer health policy which focus on lifestyles factors toward an integrated approach incorporating measures designed to tackle the root causes of disadvantage. ' 2008 Wiley-Liss, Inc.Key words: meta-analysis; oral cancer; SES; socioeconomic status; systematic review In 2000, oral cancer (ICD-10 C00-06) was estimated to be the 8th most common cancer worldwide-with an estimated 267,000 new cases and 128,000 deaths, and with the greatest burden in developing countries. 1 Despite a wealth of literature on the effects of poverty and inequality on health, 2 the effect of socioeconomic circumstances on oral cancer is given little recognition in a predominant medical model approach to research and prevention on the risks of the disease. 3 Recent published work on the relationship between socioeconomic status (SES) and oral cancer has mainly been in the form of descriptive epidemiology studies linking routine registry data to census data. From such studies, increased risk of oral cancer appears associated with high levels of area-based socioeconomic deprivation, 4,5 although this was not reflected in a review of incidence studies from across the world which utilised mainly individual measures of SES. 6 Area-based measures are liable to the 'ecological fallacyÕ whereby individuals are allocated SES based on their area of residence. The few analytical studies to focus on SES have also been equivocal, and socioeconomic correlates have recently been found to be c...

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