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Quantifying the mediating effects of smoking and occupational exposures in the relation between education and lung cancer: the ICARE study

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Abstract

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. We analyzed data from a large French population-based case–control study (1976 lung cancers, 2648 controls). Detailed information on lifelong tobacco consumption and occupational exposures to various carcinogens was collected. We conducted inverse probability-weighted marginal structural models. A strong association was observed between education and lung cancer. 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 to 84) for men with a high school degree. The contribution of occupational exposures to asbestos and silica ranged from 15 % (10–20) for men with a high school degree to 20 % (13–28) for men with vocational secondary education. 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.

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Acknowledgments

This work was supported by a grant from the French Agency for Food, Environmental and Occupational Health and Safety (ANSES) [grant number EST-2009/1/65] and by a Grant from La Fondation ARC pour la Recherche sur le Cancer. The ICARE study was funded by French National Research Agency (ANR); French National Cancer Institute (INCA); French Agency for Food, Environmental and Occupational Health and Safety (ANSES); French Institute for Public Health Surveillance (InVS); Fondation pour la Recherche Médicale (FRM); Fondation de France; La Fondation ARC pour la Recherche sur le Cancer; Ministry of Labour (Direction Générale du Travail); and Ministry of Health (Direction Générale de la Santé).

Members of ICARE Study Group

Registre des cancers du Calvados, France (Anne-Valérie Guizard); Registre des cancers du Doubs, France (Arlette Danzon, Anne-Sophie Woronoff); Registre des cancers du Bas-Rhin, France (Michel Velten); Registre des cancers du Haut-Rhin, France (Antoine Buemi, Émilie Marrer); Registre des cancers de l’Hérault, France (Brigitte Tretarre); Registre des cancers de l’Isère, France (Marc Colonna, Patricia Delafosse); Registre des cancers de Loire-Atlantique-Vendée, France (Paolo Bercelli, Florence Molinie); Registre des cancers de la Manche, France (Simona Bara); Registre des cancers de la Somme, France (Benedicte Lapotre-Ledoux, Nicole Raverdy); Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Environmental epidemiology of cancer Team, Villejuif, France (Sylvie Cénée, Oumar Gaye, Florence Guida, Farida Lamkarkach, Loredana Radoï, Marie Sanchez, Isabelle Stücker); Inserm Epidemiologic Cohorts Unit - UMS 011 INSERM-UVSQ, Villejuif, France (Matthieu Carton, Diane Cyr, Annie Schmaus). Unité Mixte de Recherche Épidémiologique et de Surveillance Transport Travail Environnement (UMRESTTE), France (Joëlle Févotte, Corinne Pilorget). Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France (Gwenn Menvielle). Inserm U 1085 – IRSET, Pointe-à-Pitre, France (Danièle Luce).

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Authors and Affiliations

  1. Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), 75012, Paris, France

    Gwenn Menvielle & Jeanna-eve Franck

  2. Inserm UMRS 1018, CESP Centre for Research in Epidemiology and Population Health, Environmental Epidemiology of Cancer, Villejuif, France

    Loredana Radoï, Marie Sanchez & Isabelle Stücker

  3. University of Paris Descartes, Paris, France

    Loredana Radoï

  4. University of Paris Sud 11, Kremlin-Bicêtre, France

    Marie Sanchez & Isabelle Stücker

  5. Unité Mixte de Recherche Épidémiologique et de Surveillance Transport Travail Environnement (UMRESTTE), Université Claude Bernard Lyon 1, 69373, Lyon, France

    Joëlle Févotte

  6. Calvados Cancer Registry, Caen, France

    Anne-Valérie Guizard

  7. Inserm U 1085, IRSET, Pointe-à-Pitre, France

    Danièle Luce

  8. University of Rennes 1, Rennes, France

    Danièle Luce

Authors
  1. Gwenn Menvielle
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  2. Jeanna-eve Franck
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  3. Loredana Radoï
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  4. Marie Sanchez
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  5. Joëlle Févotte
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  6. Anne-Valérie Guizard
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  7. Isabelle Stücker
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  8. Danièle Luce
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Consortia

ICARE study group

  • Anne-Sophie Woronoff
  • , Anne-Valérie Guizard
  • , Annie Schmaus
  • , Antoine Buemi
  • , Arlette Danzon
  • , Benedicte Lapotre-Ledoux
  • , Brigitte Tretarre
  • , Corinne Pilorget
  • , Danièle Luce
  • , Diane Cyr
  • , Émilie Marrer
  • , Farida Lamkarkach
  • , Florence Guida
  • , Florence Molinie
  • , Gwenn Menvielle
  • , Isabelle Stücker
  • , Joëlle Févotte
  • , Loredana Radoï
  • , Marc Colonna
  • , Marie Sanchez
  • , Matthieu Carton
  • , Michel Velten
  • , Nicole Raverdy
  • , Oumar Gaye
  • , Paolo Bercelli
  • , Patricia Delafosse
  • , Simona Bara
  •  & Sylvie Cénée

Corresponding author

Correspondence to Gwenn Menvielle.

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Menvielle, G., Franck, Je., Radoï, L. et al. Quantifying the mediating effects of smoking and occupational exposures in the relation between education and lung cancer: the ICARE study. Eur J Epidemiol 31, 1213–1221 (2016). https://doi.org/10.1007/s10654-016-0182-2

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