TY - JOUR

T1 - Socioeconomic status and risk of lung cancer by histological subtype in the Nordic countries

AU - Pizzato, Margherita

AU - Martinsen, Jan Ivar

AU - Heikkinen, Sanna

AU - Vignat, Jerome

AU - Lynge, Elsebeth

AU - Sparén, Pär

AU - La Vecchia, Carlo

AU - Pukkala, Eero

AU - Vaccarella, Salvatore

N1 - Publisher Copyright: © 2022 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

PY - 2022/4

Y1 - 2022/4

N2 - Background: While the excess in lung cancer risk among lower socioeconomic status individuals has been widely described, the magnitude of this association across lung cancer subtypes, as well as histotype-related long-term incidence trends, are inconclusively reported. Aims: We explored the variation in the incidence of the three main lung cancer histotypes (i.e. squamous cell carcinoma, small cell carcinoma and adenocarcinoma) by socioeconomic status (SES, i.e. upper and lower white collar, upper and lower blue collar, and farming/forestry/fishing) in the adult population of four Nordic countries (i.e. Sweden, Norway, Finland and Denmark). Materials & Methods: We have used data from the Nordic Occupational Cancer Study (NOCCA), computing age-standardized incidence rates per 100,000 person-years truncated at ages 50–69 years, by sex, histotype, country and SES, for the period 1971–2005. We estimated relative risks and the corresponding 95% confidence intervals through Poisson regression models, including terms for SES, age, sex and country, as indicated. Results: A clear socioeconomic gradient, with a progressive increase in lung cancer risk as SES level decreases, was observed in all subtypes and in both sexes. Favourable lung cancer incidence trends were seen among men for squamous cell and small cell carcinomas, although for adenocarcinomas rates were increasing everywhere except for Finland. Among women, upward temporal trends were seen in all SES groups and for all subtypes, although rates increased to a greater extent for low, compared to high, SES, especially in Denmark and Norway. Farmers showed comparatively lower risks compared to other SES categories. Discussion: This prospective cohort study shows that substantial socioeconomic inequalities in the incidence of the most important lung cancer histotypes exist in the Nordic Countries, and that these inequalities are on the rise, especially among women. Conclusion: Smoking habits are likely to largely explain the observed social gradient for lung cancer histotypes in both sexes.

AB - Background: While the excess in lung cancer risk among lower socioeconomic status individuals has been widely described, the magnitude of this association across lung cancer subtypes, as well as histotype-related long-term incidence trends, are inconclusively reported. Aims: We explored the variation in the incidence of the three main lung cancer histotypes (i.e. squamous cell carcinoma, small cell carcinoma and adenocarcinoma) by socioeconomic status (SES, i.e. upper and lower white collar, upper and lower blue collar, and farming/forestry/fishing) in the adult population of four Nordic countries (i.e. Sweden, Norway, Finland and Denmark). Materials & Methods: We have used data from the Nordic Occupational Cancer Study (NOCCA), computing age-standardized incidence rates per 100,000 person-years truncated at ages 50–69 years, by sex, histotype, country and SES, for the period 1971–2005. We estimated relative risks and the corresponding 95% confidence intervals through Poisson regression models, including terms for SES, age, sex and country, as indicated. Results: A clear socioeconomic gradient, with a progressive increase in lung cancer risk as SES level decreases, was observed in all subtypes and in both sexes. Favourable lung cancer incidence trends were seen among men for squamous cell and small cell carcinomas, although for adenocarcinomas rates were increasing everywhere except for Finland. Among women, upward temporal trends were seen in all SES groups and for all subtypes, although rates increased to a greater extent for low, compared to high, SES, especially in Denmark and Norway. Farmers showed comparatively lower risks compared to other SES categories. Discussion: This prospective cohort study shows that substantial socioeconomic inequalities in the incidence of the most important lung cancer histotypes exist in the Nordic Countries, and that these inequalities are on the rise, especially among women. Conclusion: Smoking habits are likely to largely explain the observed social gradient for lung cancer histotypes in both sexes.

KW - lung cancer

KW - Nordic countries

KW - socioeconomic status

U2 - 10.1002/cam4.4548

DO - 10.1002/cam4.4548

M3 - Journal article

C2 - 35166068

AN - SCOPUS:85124605641

VL - 11

SP - 1850

EP - 1859

JO - Cancer Medicine

JF - Cancer Medicine

SN - 2045-7634

IS - 8

ER -