RT Journal Article
SR Electronic
T1 P330 Quantifying mediating effects of smoking and occupational exposures in the relation between education and lung cancer
JF Occupational and Environmental Medicine
JO Occup Environ Med
FD BMJ Publishing Group Ltd
SP A232
OP A232
DO 10.1136/oemed-2016-103951.645
VO 73
IS Suppl 1
A1 Menvielle, Gwenn
A1 Franck, Jeanna-eve
A1 Stücker, Isabelle
A1 Luce, Danièle
YR 2016
UL http://oem.bmj.com/content/73/Suppl_1/A232.3.abstract
AB Background Smoking only partly explains the higher lung cancer incidence observed among socially deprived people. Occupational exposures may account for part of these inequalities, but this issue has been little investigated. We investigated the extent to which smoking and occupational exposures to asbestos, silica and diesel motor exhaust mediated the association between education and lung cancer incidence in men.Methods We analysed data from a large French population-based case-control study, the ICARE study (1976 lung cancers and 2648 controls). Detailed information on lifelong tobacco consumption and occupational exposures to various carcinogens was collected. We conducted inverse probability-weighted marginal structural models.Results A strong association was observed between education and lung cancer risk. The indirect effect through smoking varied by educational level, with the strongest indirect effect observed for those with the lowest education (OR = 1.34 (1.14–1.57)). The indirect effect through occupational exposures was substantial among men with primary (OR = 1.22 (1.15–1.30) for asbestos and silica) or vocational secondary education (OR = 1.18 (1.12–1.25)). The contribution of smoking to educational differences in lung cancer incidence ranged from 22% (10–34) for men with primary education to 31% (−3–84) for men with a high school degree. The contribution of occupational exposures ranged from 15% (10–20) for men with a high school degree to 20% (13–28) for men with vocational secondary education.Conclusion Our results highlight the urgent need for public health policies that aim at decreasing exposure to carcinogens at work, in addition to tobacco control policies, if we want to reduce socioeconomic inequalities in the cancer field.