Brown L M, Hoover R, Silverman D, Baris D, Hayes R, Swanson G M, Schoenberg J, Greenberg R, Liff J, Schwartz A, Dosemeci M, Pottern L, Fraumeni J F
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892-7244, USA.
Am J Epidemiol. 2001 Jan 15;153(2):114-22. doi: 10.1093/aje/153.2.114.
Data from a population-based case-control study were used to evaluate the relation between social class factors and squamous cell esophageal cancer and the extent to which alcohol, tobacco, diet, and low income contribute to the higher incidence among Black men than among White men in the United States. A total of 347 male cases (119 White, 228 Black) and 1,354 male controls (743 White, 611 Black) were selected from three US geographic areas (Atlanta, Georgia, Detroit, Michigan, and New Jersey). Cases were residents of the study areas aged 30-79 years who had been diagnosed with histologically confirmed esophageal cancer between 1986 and 1989. The adjusted odds ratios for subjects with annual incomes less than $10,000 versus incomes of $25,000 or more were 4.3 (95% confidence interval: 2.1, 8.7) for Whites and 8.0 (95% confidence interval: 4.3, 15.0) for Blacks. The combination of all four major risk factors-low income, moderate/heavy alcohol intake, tobacco use, and infrequent consumption of raw fruits and vegetables-accounted for almost all of the squamous cell esophageal cancers in Whites (98%) and Blacks (99%) and for 99% of the excess incidence among Black men. Thus, lifestyle modifications, especially a lowered intake of alcoholic beverages, would markedly decrease the incidence of squamous cell esophageal cancer in both racial groups and would narrow the racial disparity in risk. Further studies on the determinants of social class may help to identify a new set of exposures for this tumor that are amenable to intervention.
一项基于人群的病例对照研究数据被用于评估社会阶层因素与食管鳞状细胞癌之间的关系，以及酒精、烟草、饮食和低收入在多大程度上导致了美国黑人男性比白人男性更高的发病率。从美国三个地理区域（佐治亚州亚特兰大、密歇根州底特律和新泽西州）选取了总共347例男性病例（119例白人，228例黑人）和1354例男性对照（743例白人，611例黑人）。病例为研究区域内年龄在30 - 79岁之间、于1986年至1989年间被组织学确诊为食管癌的居民。年收入低于10,000美元的受试者与收入在25,000美元或以上的受试者相比，调整后的优势比白人是4.3（95%置信区间：2.1, 8.7），黑人是8.0（95%置信区间：4.3, 15.0）。所有四个主要危险因素——低收入、中度/重度饮酒、吸烟以及很少食用生水果和蔬菜——几乎导致了白人（98%）和黑人（99%）所有的食管鳞状细胞癌病例，以及黑人男性中99%的额外发病率。因此，改变生活方式，尤其是减少酒精饮料的摄入量，将显著降低两个种族群体食管鳞状细胞癌的发病率，并缩小风险方面的种族差异。对社会阶层决定因素的进一步研究可能有助于确定一组新的、可进行干预的该肿瘤相关暴露因素。
