Article Dans Une Revue Epidemiology Année : 2024

Socioeconomic status, smoking, and lung cancer: mediation and bias analysis in the SYNERGY study

1 IPA - Institute for Prevention and Occupational Medicine of the German Social Accident Insurance
2 CIRC - IARC - Centre International de Recherche contre le Cancer - International Agency for Research on Cancer
3 Universiteit Utrecht / Utrecht University [Utrecht]
4 Karolinska Institutet = Karolinska Institute [Stockholm]
5 UNITO - Università degli studi di Torino = University of Turin
6 CESP - Centre de recherche en épidémiologie et santé des populations
7 Irset - Institut de recherche en santé, environnement et travail
8 IRCCS - Istituto di Ricovero e Cura a Carattere Scientifico
9 NCI-NIH - National Cancer Institute [Bethesda]
10 University of Liverpool
11 LMU - Ludwig Maximilian University [Munich] = Ludwig Maximilians Universität München
12 HMGU - Helmholtz Zentrum München = German Research Center for Environmental Health
13 UdeM - Université de Montréal
14 INRS - Institut National de la Recherche Scientifique [Québec]
15 AOUP - Azienda Ospedale Università di Padova = Hospital-University of Padua
16 Universität Duisburg-Essen = University of Duisburg-Essen [Essen]
17 Leibniz Institute for Prevention Research and Epidemiology - BIPS
18 Universidad de Oviedo = University of Oviedo
19 N.N. Blokhin National Medical Research Center of Oncology
20 University of Toronto
21 Occupational Cancer Research Centre
22 NIOM - Nofer Institute of Occupational Medicine
23 MCMCC - Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology
24 UK - Univerzita Karlova [Praha, Česká republika] = Charles University [Prague, Czech Republic] = Université Charles [Prague, Republique tchèque]
25 MMCI - Masaryk Memorial Cancer Institute
26 Palacky University Olomouc
27 SBU - Stony Brook University [SUNY]
28 UNIBO - Alma Mater Studiorum Università di Bologna = University of Bologna [Bologne]
29 Imperial College London
30 ISGlobal - Instituto de Salud Global - Institute For Global Health [Barcelona]
John K Field
Jack Siemiatycki
John R. Mclaughlin
Paul Demers
Tamás Pándics
  • Fonction : Auteur
Eleonora Fabianova
Dana Mates
Vladimir Janout
Francesco Forastiere

Résumé

Background: Increased lung-cancer risks for low socioeconomic status (SES) groups are only partially attributable to smoking habits. Little effort has been made to investigate the persistent risks related to low SES by quantification of potential biases. Methods: Based on 12 case-control studies, including 18 centers of the international SYNERGY project (16,550 cases, 20,147 controls), we estimated controlled direct effects (CDE) of SES on lung cancer via multiple logistic regression, adjusted for age, study center, and smoking habits, and stratified by sex. We conducted mediation analysis by inverse odds ratio weighting to estimate natural direct effects (NDE) and natural indirect effects via smoking habits. We considered misclassification of smoking status, selection bias, and unmeasured mediator-outcome confounding by genetic risk, both separately as well as by multiple quantitative bias analysis, using bootstrap to create 95% simulation intervals (SI). Results: Mediation analysis of lung-cancer risks for SES estimated mean proportions of 43% in men and 33% in women attributable to smoking. Bias analyses decreased direct effects of SES on lung cancer, with selection bias showing the strongest reduction in lung-cancer risk in the multiple bias analysis. Lung-cancer risks remained increased for lower SES groups, with higher risks in men [4th versus 1st (highest) SES quartile: CDE 1.50 (SI 1.32-1.69)] than women [CDE 1.20 (SI 1.01-1.45)]. NDE were similar to CDE, particularly in men. Conclusions: Bias adjustment lowered direct lung-cancer risk estimates of lower SES groups. However, risks for low SES remained elevated, likely attributable to occupational hazards or other environmental exposures.

Dates et versions

hal-04771466 , version 1 (07-11-2024)

Identifiants

Citer

Jan Hovanec, Benjamin Kendzia, Ann Olsson, Joachim Schüz, Hans Kromhout, et al.. Socioeconomic status, smoking, and lung cancer: mediation and bias analysis in the SYNERGY study. Epidemiology, 2024, ⟨10.1097/ede.0000000000001807⟩. ⟨hal-04771466⟩
108 Consultations
0 Téléchargements

Altmetric

Partager

  • More