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

Abstract

Socioeconomic status (SES) is suspected to influence the risk of esophageal squamous-cell carcinoma (ESCC) in China, however, the evidence is still inconclusive and the selection of SES indicators remains inconsistent. In current study, we examined the association between SES and risk of ESCC based on a population-based case-control study in Taixing, China, with 1298 histopathology-confirmed cases and 1900 controls recruited between October 2010 and September 2013. Data on SES indicators was collected using a structured questionnaire. We constructed a composite wealth score based on the ownership of a series of household appliances and other variables by using multiple correspondence analysis (MCA). We used unconditional logistic regression to estimate odds ratios (ORs) with 95% confidence intervals (CIs) of ESCC in association with SES indicators. SES was inversely associated with ESCC risk in current study. Higher education (secondary high school or above vs illiteracy, OR=0.60, 95%CI, 0.41-0.87), larger house area per person (>70 vs <45 square meters, OR=0.71, 95%CI, 0.59-0.86) and higher wealth score (5th quintile (high) vs 1st quintile (low), OR=0.43, 95%CI, 0.32-0.57) were associated with a decreased risk of ESCC. Subjects possessing several household appliances >5 years also had a lower ESCC risk. Whereas physical labor (very active vs sedentary, OR=1.69, 95%CI, 1.27-2.26) and larger families (≥6 vs <3 in household, OR=1.63, 95%CI, 1.30-2.03) increased the risk of ESCC. These findings confirm the strong inverse association between SES and ESCC risk. Future studies are needed to verify these findings and identify contributing factors underlying the observed associations.

A Distinct Epidemiologic Pattern of Precancerous Lesions of Esophageal Squamous Cell Carcinoma in a High-risk Area of Huai'an, Jiangsu Province, China

“…Inverse dose-response association between risk of ESCC and socioeconomic status including educational level and annual income was reported previously (12). However, such statistical significance was not observed in our adjusted results of socioeconomic status, and age obviously affects the results of socioeconomic status.…”

A nomogram for screening esophageal squamous cell carcinoma based on environmental risk factors in a high-incidence area of China: a population-based case-control study

“…The relationships between all identified environmental risk factors and ESCC risk have been well discussed in our previous articles [15,[17][18][19][20][21]. Although several predictive variables may not directly cause ESCC, they might be surrogate variables and their predictive values are notable [34,35].…”

“…The male and female adult height were converted into four categories according to the published nonlinear relationship (male cutoff values:162, 170 and 174; female cutoff values:152, 156 and 160, respectively, unit: centimeter) [21]. Family wealth score was calculated based on the ownership of valuable home items using a multiple correspondence analysis, and was further categorized as approximate quintiles among control participants [19]. The cumulative missing and filled teeth number, smoking packyears and daily intensity of alcohol drinking among the exposed were categorized by the median.…”

“…Because more than 95% of esophageal cancer cases are ESCC in China, the current study only focuses on prediction of ESCC risk [3]. We have performed a large population-based case-control study of upper gastrointestinal cancers in Taixing, a high-incidence area in China, and have systematically assessed environmental risk factors of ESCC, including family history of esophageal cancer [15], poor hygiene [16,17], tobacco and alcohol [18], low socioeconomic status [19], hot tea drinking [20], low BMI and high adult height [21], the interaction of genetic susceptibility and selected exposures [22,23], and gastric atrophy [24]. However, the combined effects of candidate risk factors have not been systematically explored.…”

Alcohol Intake Interacts with Functional Genetic Polymorphisms of Aldehyde Dehydrogenase (ALDH2) and Alcohol Dehydrogenase (ADH) to Increase Esophageal Squamous Cell Cancer Risk

“…Wealth score was calculated on the basis of ownership of a series of household appliances, including a car, television, and washing machine, as well as on the basis of other variables, such as size of house area per person, by using a multiple correspondence analysis. 20 These scores were categorized by quantiles of observed coordinates in the correspondence analysis among the controls. The confounders were factors with crude significant association with ESCC (see Supplementary Table 2), as well as conventional confounders observed in the literature, such as age and sex.…”