Lung cancer: Is there an association with socioeconomic status in The Netherlands?

Abstract

Study objective - To evaluate if there are differences in lung cancer incidence between socioeconomic groups in the Netherlands and if so, if smoking habits and other lifestyle characteristics could explain these differences. Design - Prospective cohort study. Base line measurement included information on socioeconomic status, smoking habits, and other covariates by means of a self administered questionnaire. Follow up was established by computerised record Linkage to cancer registries and a pathology register. Setting - Population originating from 204 municipalities in The Netherlands. Participants - 58 279 men aged 55-69 years in September 1986. After 3.3 years of follow up 490 microscopically confirmed incident lung cancer cases were detected. Main results - An inverse association between lung cancer risk and highest level of education was found, which persisted after adjustment for age, smoking, dietary in take of vitamin C, β-carotene and retinol (rate ratio (RR) highest/lowest level of education = 0.52, 95% CI 0.33, 0.82, trend p < 0.001). Men with a lower white collar profession had a significantly lower relative rate of lung cancer compared with blue collar workers (RR = 0.66, 95% CI 0.47, 0.96), but after adjustment for smoking habits this difference was reduced (RR = 0.73, 95% CI 0.51, 1.08). Conclusions - There is an inverse association between highest level of education and lung cancer, which is still apparent after adjustment for age, smoking, dietary intake of vitamin C, beta-carotene and retinol. The significantly lower lung cancer risk of lower white collar workers compared with the risk of blue collar workers could be partially explained by smoking habits.