Department of Otolaryngology - Head and Neck Surgery, The University of Ottawa, The Ottawa Hospital, S3, 501 Smyth Rd., Ottawa, ON, Canada.
Oral Oncol. 2010 Mar;46(3):200-3. doi: 10.1016/j.oraloncology.2009.12.004. Epub 2010 Feb 6.
In an earlier study we identified an increased incidence of head and neck cancer (HNC) in individuals with lower socio-economic status (SES) in the United States. The objective of this study was to determine if lower SES is associated with a similar increase in the incidence of HNC in Canadian patients. We obtained data on SES (income, education and immigration status), demographic characteristics, frequency of dental visits and smoking behavior for adult patients residing in the Eastern Ontario region who were referred to the Ottawa Regional Cancer Centre with HNC. We compared the SES and frequency of dental visits of these HNC patients with the SES and frequency of dental visits of a control sample in the same region from the 2004-2005 Statistics Canada Canadian Community Health Survey (CCHS 3.1). We then performed a logistic regression analysis on the combined sample of patients and controls using incidence of HNC as the dependent variable. This allowed us to eliminate confounding variables such as tobacco intake and to isolate the effect of SES, frequency of dental visits, and immigration status on HNC incidence. There was a statistically significant decrease in the incidence of HNC among adults with a higher median family income (OR=0.5429, CI=[.3352, .8795]). Also, adults with less than grade 8 education had significantly higher rates of HNC than adults who had completed high school (OR 3.65, CI=[1.88, 7.08]). As well, immigrants had a significantly lower incidence of HNC than Canadian born adults (OR=0.3825, CI=[.2063, .7090]). Lastly, we found that individuals who typically visited a dentist less than once per year had a significantly higher incidence of HNC than individuals who typically visited a dentist at least once per year (OR=1.69, CI=[1.01, 2.83]). Even when controlling for tobacco intake, the incidence of HNC in Eastern Ontario was higher in patients with lower median family income and less than grade 8 education. It was higher in individuals who visited a dentist less than once per year, and lower in immigrants to Canada. This was similar to what has been observed in the United States. Further study into the reason for this increased incidence of HNC in patients with lower SES is warranted.
在之前的一项研究中，我们发现美国社会经济地位（SES）较低的个体患头颈部癌症（HNC）的发病率增加。本研究的目的是确定 SES 较低是否与加拿大患者 HNC 发病率的类似增加有关。我们获得了居住在安大略省东部地区的成年患者的 SES（收入、教育和移民状况）、人口统计学特征、牙科就诊频率和吸烟行为的数据，这些患者因 HNC 被转诊到渥太华地区癌症中心。我们将这些 HNC 患者的 SES 和牙科就诊频率与同一地区 2004-2005 年加拿大社区健康调查（CCHS 3.1）的对照样本的 SES 和牙科就诊频率进行了比较。然后，我们对患者和对照样本的组合进行了逻辑回归分析，将 HNC 的发病率作为因变量。这使我们能够消除吸烟等混杂变量，并隔离 SES、牙科就诊频率和移民状况对 HNC 发病率的影响。收入中位数较高的成年人中 HNC 的发病率呈统计学显著下降（OR=0.5429，CI=[.3352，.8795]）。此外，未完成高中学业的成年人患 HNC 的比例明显高于完成高中学业的成年人（OR 3.65，CI=[1.88，7.08]）。同样，移民的 HNC 发病率明显低于加拿大出生的成年人（OR=0.3825，CI=[.2063，.7090]）。最后，我们发现每年去看牙医少于一次的个体患 HNC 的发病率明显高于每年至少去看牙医一次的个体（OR=1.69，CI=[1.01，2.83]）。即使控制了吸烟量，安大略省东部地区 HNC 的发病率在收入中位数较低和未完成高中学业的患者中也较高。每年去看牙医少于一次的个体发病率较高，移民发病率较低。这与在美国观察到的情况类似。有必要进一步研究 SES 较低的患者 HNC 发病率增加的原因。
