Al-Dakkak Imad
Centre for Evidence-based Dentistry, Oxford, UK.
Evid Based Dent. 2010;11(2):57-8. doi: 10.1038/sj.ebd.6400726.
This was a population-based case-control study. CASE-CONTROL SELECTION: Eligible patients were aged between 18 and 80 years and had a primary histopathological diagnosis made between April 2002 and December 2004. Diagnosis included malignant cancers of the oral cavity, oropharynx, hypopharynx or larynx. Incident cases were identified through weekly monitoring of head and neck cancer clinics in hospital departments and were confirmed by pathology department records. Controls matched by age (5-year age band) and sex were randomly selected from the lists of general practitioners.
Information about occupation, education, smoking and alcohol consumption was collected at personal interview. Socioeconomic circumstances were measured at an individual level (education, occupational social class, unemployment), and by area-based measures of deprivation. Odds ratios (OR) and corresponding 95% confidence intervals (CI) were computed by unconditional logistic regression and were adjusted for age and sex. This model was repeated to assess for potential independent effects of the range of socioeconomic components after adjusting for smoking and alcohol consumption. Interactions between smoking and consumption of alcohol, and between individual and area-based measures for socioeconomic factors were tested by the likelihood ratio test. In addition, the most important behavioural risk factors and socioeconomic variables were entered into a stepwise multivariate logistic regression model. All statistical analyses were carried out using Statistical Analysis System (SAS; Cary, North Carolina, USA) software.
The study population included 103 cancer patients (38 women and 65 men), and 91 controls (39 women and 52 men). Individuals living in the most deprived areas (OR, 4.66; 95% CI, 1.79- 12.18) and those who were unemployed (OR, 2.27; 95% CI, 1.21- 4.26) had a significantly higher risk of cancer than people who had high levels of educational attainment (OR, 0.17; 95% CI, 0.05-0.58). Significance was lost for all measures of social class when adjustments were made for smoking and consumption of alcohol. When the most important behavioural and socioeconomic factors were combined in a fully adjusted multivariate analysis, smoking was the only significant risk factor (OR, 15.53; 95% CI, 5.36-44.99) found to be independently associated with head and neck cancers.
A high risk of head and neck cancer was consistently associated with poor socioeconomic circumstances. There were strong links for specific components but smoking dominated the overall profile of risk. More detailed research into the nature of such associations is needed in the future.
这是一项基于人群的病例对照研究。
符合条件的患者年龄在18至80岁之间，于2002年4月至2004年12月间获得原发性组织病理学诊断。诊断包括口腔、口咽、下咽或喉的恶性肿瘤。通过每周监测医院科室的头颈癌诊所确定新发病例，并经病理科记录证实。按年龄（5岁年龄组）和性别匹配的对照从全科医生名单中随机选取。
通过个人访谈收集有关职业、教育、吸烟和饮酒情况的信息。社会经济状况在个体层面（教育、职业社会阶层、失业情况）以及基于区域的贫困程度衡量指标方面进行测定。比值比（OR）和相应的95%置信区间（CI）通过无条件逻辑回归计算得出，并对年龄和性别进行了调整。在对吸烟和饮酒情况进行调整后，重复该模型以评估社会经济因素范围的潜在独立影响。通过似然比检验对吸烟与饮酒之间以及个体和基于区域的社会经济因素衡量指标之间的相互作用进行了测试。此外，将最重要的行为风险因素和社会经济变量纳入逐步多元逻辑回归模型。所有统计分析均使用统计分析系统（SAS；美国北卡罗来纳州卡里）软件进行。
研究人群包括103例癌症患者（38名女性和65名男性）以及91名对照（39名女性和52名男性）。生活在最贫困地区的个体（OR，4.66；95%CI，1.79 - 12.18）以及失业者（OR，2.27；95%CI，1.21 - 4.26）患癌症的风险显著高于受过高等教育的人群（OR，0.17；95%CI，0.05 - 0.58）。在对吸烟和饮酒情况进行调整后，所有社会阶层衡量指标的显著性均消失。在全面调整的多变量分析中，将最重要的行为和社会经济因素综合考虑时，吸烟是唯一被发现与头颈癌独立相关的显著风险因素（OR，15.53；95%CI，5.36 - 44.99）。
头颈癌的高风险始终与社会经济状况不佳相关。特定因素之间存在紧密联系，但吸烟在总体风险概况中占主导地位。未来需要对这种关联的性质进行更详细的研究。
