"Cancers & Préventions" U1086 INSERM-UCN, Team Labeled « Ligue Contre le Cancer », Centre François Baclesse, Avenue Général Harris, 14076 Caen, France.
Sorbonne Université, UPMC Univ Paris 6, INSERM, Institut Pierre Louis d'Epidémiologie et Santé Publique (IPLESP UMRS 1136) 75012 Paris, France.
Oral Oncol. 2017 Aug;71:144-149. doi: 10.1016/j.oraloncology.2017.06.014. Epub 2017 Jun 26.
While it is known that cancer risk is related to area-level socioeconomic status, the extent to which these inequalities are explained by contextual effects is poorly documented especially for head and neck cancer.
A case-control study, ICARE, included 2415 head and neck cancer cases and 3555 controls recruited between 2001 and 2007 from 10 French regions retrieved from a general cancer registry. Individual socioeconomic status was assessed using marital status, highest educational level and occupational social class. Area-level socioeconomic status was assessed using the French version of the European Deprivation Index (EDI). The relationship between both individual and area-based socioeconomic level and the risk of head and neck cancer was assessed by multilevel analyses.
A higher risk for head and neck cancer was found in divorced compared with married individuals (OR=2.14, 95% CI=1.78-2.57), for individuals with a basic school-leaving qualification compared with those with higher education (OR=4.55 95% CI=3.72-5.57), for manual workers compared with managers (OR=4.91, 95% CI=3.92-6.15) and for individuals living in the most deprived areas compared with those living in the most affluent ones (OR=1.98, 95% CI=1.64-2.41). The influence of area-level socioeconomic status measured by EDI remained after controlling for individual socioeconomic characteristics (OR=1.51; 95% confidence interval: 1.23-1.85, p-value=0.0003).
The role of individual socioeconomic status in the risk of head and neck cancer is undeniable, although contextual effects of deprived areas also increase the susceptibility of individuals developing the disease.
虽然已知癌症风险与地区社会经济地位有关，但这些不平等在多大程度上可以通过背景效应来解释，特别是对于头颈部癌症，这方面的证据很少。
这是一项病例对照研究，纳入了 2001 年至 2007 年期间从法国 10 个地区的一般癌症登记处中招募的 2415 例头颈部癌症病例和 3555 例对照。个体社会经济地位通过婚姻状况、最高教育水平和职业社会阶层来评估。地区社会经济地位通过法国版欧洲剥夺指数（EDI）来评估。使用多水平分析评估个体和基于地区的社会经济水平与头颈部癌症风险之间的关系。
与已婚者相比，离异者发生头颈部癌症的风险更高（OR=2.14，95%CI=1.78-2.57）；与具有较高教育程度者相比，具有基本离校资格者的风险更高（OR=4.55，95%CI=3.72-5.57）；与管理人员相比，体力劳动者的风险更高（OR=4.91，95%CI=3.92-6.15）；与生活在最贫困地区者相比，生活在最富裕地区者的风险更高（OR=1.98，95%CI=1.64-2.41）。在控制个体社会经济特征后，用 EDI 测量的地区社会经济地位的影响仍然存在（OR=1.51；95%置信区间：1.23-1.85，p 值=0.0003）。
个体社会经济地位在头颈部癌症风险中的作用不可否认，尽管贫困地区的背景效应也会增加个体发病的易感性。
