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1. Chronic and remitting trajectories of depressive symptoms in the elderly. Characterization and risk factors

Author

Carrière, Isabelle, Farré, Amandine, Proust-Lima, Cécile, Ryan, Joanne, Ancelin, Marie-Laure, Ritchie, Karen, Neuropsychiatrie : recherche épidémiologique et clinique (PSNREC), Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Paediatrics [Melbourne], Melbourne Medical School [Melbourne], Faculty of Medicine, Dentistry and Health Sciences [Melbourne], University of Melbourne-University of Melbourne-Faculty of Medicine, Dentistry and Health Sciences [Melbourne], University of Melbourne-University of Melbourne, Dept of Epidemiology and Public Health, Imperial College London, The 3C Study is conducted under a partnership agreement between the Institut National de la Santé et de la Recherche Médicale (Inserm), Victor-Segalen Bordeaux 2 University, and Sanofi-Aventis. The 3C-Study was also supported by the Caisse Nationale Maladie des Travailleurs Salariés, Direction Générale de la Santé, MGEN, the Institut de la Longévité, Agence Française de Sécurité Sanitaire des Produits de Santé, the Regional Governments of Aquitaine, Bourgogne and Languedoc-Roussillon, the Fondation de France, the Ministry of Research-Inserm Programme 'Cohorts and collection of biological material', Novartis, the 'ANR-Agence Nationale de la Recherche-The French National Research Agency' under the 'Programme National de Recherche en Alimentation et nutrition humaine', project 'COGINUT ANR-06-PNRA-005', the 'Programme Longévité et vieillissement', project 07-LVIE-004' and 07-LVIE 003 01, the Institut de Recherche en Santé Publique (IReSP), Paris, France., ANR-06-PNRA-0005,COGINUT,COGINUT : Cognition, anti-oxydants, acides gras: approche interdisciplinaire du rôle de la nutrition dans le vieillissement du cerveau(2006), ANR-07-LVIE-0004,ESPRIT-VIE,Interaction entre la vulnérabilité génétique, la dysrégulation biologique et le stress dans la dépression du sujet âgé(2007), and ANR-07-LVIE-0003,COGICARE,Histoire naturelle du déclin cognitif et du besoin de soins chez le sujet âgé(2007)

Subjects
aged, depressive symptoms, cohort studies, [SDV.MHEP.PSM]Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health, risk factors, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Abstract

International audience; AimsIn elderly general population sub-syndromal clinically significant levels of depressive symptoms are highly prevalent and associated with high co-morbidity and increased mortality risk. However changes in depressive symptoms over time and etiologic factors have been difficult to characterize notably due to methodological shortcomings. Our objective was to differentiate trajectories of depressive symptoms over 10 years in community-dwelling elderly men and women using statistical modelling methods which take into account intra-subject correlation and individual differences as well as to examine current and life-time risk factors associated with different trajectories. MethodsParticipants aged 65 and over were administered standardised questionnaires and underwent clinical examinations at baseline and after 2, 4, 7 and 10 years. Trajectories over time of the Center for Epidemiologic Studies Depression scores were modelled in 517 men and 736 women separately with latent class mixed models which include both a linear mixed model to describe latent classes of trajectories and a multinomial logistic model to characterize the latent trajectories according to baseline covariates (socio-demographic, lifestyle, clinical, genetic characteristics and stressful life events). ResultsIn both genders two different profiles of symptom changes were observed over the 10-year follow-up. For 9.1% of men and 25% of women a high depressive symptom trajectory was found with a trend toward worsening in men. The majority of the remaining men and women showed decreasing symptomatology over time, falling from clinically significant to very low levels of depressive symptoms. In large multivariate class membership models, mobility limitations (odds ratio (OR)=4.5, 95% confidence interval (CI) 1.6-12.9 and OR=4.9, 95% CI 2.3-10.7, in men and women respectively), ischemic pathologies (OR=2.9, 95% CI 1.0-8.3 and OR=3.1, 95%CI 1.0-9.9), and recent stressful events (OR=4.5, 95% CI 1.1-18.5, OR=3.2, 95%CI 1.6-6.2) were associated with a poor symptom course in both gender as well as diabetes in men (OR=3.5, 95% CI 1.1-10.9) and childhood traumatic experiences in women (OR=3.1, 95% CI 1.6-5.8). ConclusionsThis prospective study was able to differentiate patterns of chronic and remitting depressive symptoms in elderly people with distinct symptom courses and risk factors for men and women. These findings may inform prevention programmes designed to reduce the chronic course of depressive symptomatology.

Published
2017

2. Chronic and remitting trajectories of depressive symptoms in the elderly. Characterization and risk factors

Author

Karen Ritchie, Joanne Ryan, Amandine Farré, Marie-Laure Ancelin, Cécile Proust-Lima, Isabelle Carrière, Neuropsychiatrie : recherche épidémiologique et clinique (PSNREC), Université Montpellier 1 (UM1)-Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Paediatrics [Melbourne], Melbourne Medical School [Melbourne], Faculty of Medicine, Dentistry and Health Sciences [Melbourne], University of Melbourne-University of Melbourne-Faculty of Medicine, Dentistry and Health Sciences [Melbourne], University of Melbourne-University of Melbourne, Dept of Epidemiology and Public Health, Imperial College London, The 3C Study is conducted under a partnership agreement between the Institut National de la Santé et de la Recherche Médicale (Inserm), Victor-Segalen Bordeaux 2 University, and Sanofi-Aventis. The 3C-Study was also supported by the Caisse Nationale Maladie des Travailleurs Salariés, Direction Générale de la Santé, MGEN, the Institut de la Longévité, Agence Française de Sécurité Sanitaire des Produits de Santé, the Regional Governments of Aquitaine, Bourgogne and Languedoc-Roussillon, the Fondation de France, the Ministry of Research-Inserm Programme 'Cohorts and collection of biological material', Novartis, the 'ANR-Agence Nationale de la Recherche-The French National Research Agency' under the 'Programme National de Recherche en Alimentation et nutrition humaine', project 'COGINUT ANR-06-PNRA-005', the 'Programme Longévité et vieillissement', project 07-LVIE-004' and 07-LVIE 003 01, the Institut de Recherche en Santé Publique (IReSP), Paris, France., ANR-06-PNRA-0005,COGINUT,COGINUT : Cognition, anti-oxydants, acides gras: approche interdisciplinaire du rôle de la nutrition dans le vieillissement du cerveau(2006), ANR-07-LVIE-0004,ESPRIT-VIE,Interaction entre la vulnérabilité génétique, la dysrégulation biologique et le stress dans la dépression du sujet âgé(2007), and ANR-07-LVIE-0003,COGICARE,Histoire naturelle du déclin cognitif et du besoin de soins chez le sujet âgé(2007)

Subjects
Male, medicine.medical_specialty, Epidemiology, Population, Comorbidity, Article, 03 medical and health sciences, 0302 clinical medicine, depressive symptoms, cohort studies, Diabetes mellitus, Diabetes Mellitus, Prevalence, medicine, Humans, risk factors, Prospective Studies, Mortality, education, Psychiatry, Prospective cohort study, Depression (differential diagnoses), Aged, 80 and over, Depressive Disorder, education.field_of_study, Depression, Public Health, Environmental and Occupational Health, Odds ratio, medicine.disease, Confidence interval, 3. Good health, 030227 psychiatry, Psychiatry and Mental health, aged, Socioeconomic Factors, Cardiovascular Diseases, [SDV.MHEP.PSM]Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, Independent Living, Psychology, 030217 neurology & neurosurgery, Demography, Cohort study
Abstract

Background.In elderly general population sub-syndromal clinically significant levels of depressive symptoms are highly prevalent and associated with high co-morbidity and increased mortality risk. However changes in depressive symptoms over time and etiologic factors have been difficult to characterise notably due to methodological shortcomings. Our objective was to differentiate trajectories of depressive symptoms over 10 years in community-dwelling elderly men and women using statistical modelling methods which take into account intra-subject correlation and individual differences as well as to examine current and life-time risk factors associated with different trajectories.Methods.Participants aged 65 and over were administered standardised questionnaires and underwent clinical examinations at baseline and after 2, 4, 7 and 10 years. Trajectories over time of the Center for Epidemiologic Studies Depression scores were modelled in 517 men and 736 women separately with latent class mixed models which include both a linear mixed model to describe latent classes of trajectories and a multinomial logistic model to characterise the latent trajectories according to baseline covariates (socio-demographic, lifestyle, clinical, genetic characteristics and stressful life events).Results.In both genders two different profiles of symptom changes were observed over the 10-year follow-up. For 9.1% of men and 25% of women a high depressive symptom trajectory was found with a trend toward worsening in men. The majority of the remaining men and women showed decreasing symptomatology over time, falling from clinically significant to very low levels of depressive symptoms. In large multivariate class membership models, mobility limitations [odds ratio (OR) = 4.5, 95% confidence interval (CI) 1.6–12.9 and OR = 4.9, 95% CI 2.3–10.7, in men and women respectively], ischemic pathologies (OR = 2.9, 95% CI 1.0–8.3 and OR = 3.1, 95% CI 1.0–9.9), and recent stressful events (OR = 4.5, 95% CI 1.1–18.5, OR = 3.2, 95% CI 1.6–6.2) were associated with a poor symptom course in both gender as well as diabetes in men (OR = 3.5, 95% CI 1.1–10.9) and childhood traumatic experiences in women (OR = 3.1, 95% CI 1.6–5.8).Conclusions.This prospective study was able to differentiate patterns of chronic and remitting depressive symptoms in elderly people with distinct symptom courses and risk factors for men and women. These findings may inform prevention programmes designed to reduce the chronic course of depressive symptomatology.

Published
2017

3. Chronic and remitting trajectories of depressive symptoms in the elderly. Characterization and risk factors

Author

Carrière, Isabelle, Farré, Amandine, Proust-Lima, Cécile, Ryan, Joanne, Ancelin, Marie-Laure, Ritchie, Karen, Carrière, Isabelle, Programme National de Recherches en Alimentation et Nutrition Humaine (PNRA) - COGINUT : Cognition, anti-oxydants, acides gras: approche interdisciplinaire du rôle de la nutrition dans le vieillissement du cerveau - - COGINUT2006 - ANR-06-PNRA-0005 - PNRA - VALID, Longévité et vieillissement - Interaction entre la vulnérabilité génétique, la dysrégulation biologique et le stress dans la dépression du sujet âgé - - ESPRIT-VIE2007 - ANR-07-LVIE-0004 - LVIE - VALID, Longévité et vieillissement - Histoire naturelle du déclin cognitif et du besoin de soins chez le sujet âgé - - COGICARE2007 - ANR-07-LVIE-0003 - LVIE - VALID, Neuropsychiatrie : recherche épidémiologique et clinique (PSNREC), Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Paediatrics [Melbourne], Melbourne Medical School [Melbourne], Faculty of Medicine, Dentistry and Health Sciences [Melbourne], University of Melbourne-University of Melbourne-Faculty of Medicine, Dentistry and Health Sciences [Melbourne], University of Melbourne-University of Melbourne, Dept of Epidemiology and Public Health, Imperial College London, The 3C Study is conducted under a partnership agreement between the Institut National de la Santé et de la Recherche Médicale (Inserm), Victor-Segalen Bordeaux 2 University, and Sanofi-Aventis. The 3C-Study was also supported by the Caisse Nationale Maladie des Travailleurs Salariés, Direction Générale de la Santé, MGEN, the Institut de la Longévité, Agence Française de Sécurité Sanitaire des Produits de Santé, the Regional Governments of Aquitaine, Bourgogne and Languedoc-Roussillon, the Fondation de France, the Ministry of Research-Inserm Programme 'Cohorts and collection of biological material', Novartis, the 'ANR-Agence Nationale de la Recherche-The French National Research Agency' under the 'Programme National de Recherche en Alimentation et nutrition humaine', project 'COGINUT ANR-06-PNRA-005', the 'Programme Longévité et vieillissement', project 07-LVIE-004' and 07-LVIE 003 01, the Institut de Recherche en Santé Publique (IReSP), Paris, France., ANR-06-PNRA-0005,COGINUT,COGINUT : Cognition, anti-oxydants, acides gras: approche interdisciplinaire du rôle de la nutrition dans le vieillissement du cerveau(2006), ANR-07-LVIE-0004,ESPRIT-VIE,Interaction entre la vulnérabilité génétique, la dysrégulation biologique et le stress dans la dépression du sujet âgé(2007), and ANR-07-LVIE-0003,COGICARE,Histoire naturelle du déclin cognitif et du besoin de soins chez le sujet âgé(2007)

Subjects
aged, depressive symptoms, cohort studies, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.MHEP.PSM]Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health, [SDV.MHEP.PSM] Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health, risk factors, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Abstract

International audience; AimsIn elderly general population sub-syndromal clinically significant levels of depressive symptoms are highly prevalent and associated with high co-morbidity and increased mortality risk. However changes in depressive symptoms over time and etiologic factors have been difficult to characterize notably due to methodological shortcomings. Our objective was to differentiate trajectories of depressive symptoms over 10 years in community-dwelling elderly men and women using statistical modelling methods which take into account intra-subject correlation and individual differences as well as to examine current and life-time risk factors associated with different trajectories. MethodsParticipants aged 65 and over were administered standardised questionnaires and underwent clinical examinations at baseline and after 2, 4, 7 and 10 years. Trajectories over time of the Center for Epidemiologic Studies Depression scores were modelled in 517 men and 736 women separately with latent class mixed models which include both a linear mixed model to describe latent classes of trajectories and a multinomial logistic model to characterize the latent trajectories according to baseline covariates (socio-demographic, lifestyle, clinical, genetic characteristics and stressful life events). ResultsIn both genders two different profiles of symptom changes were observed over the 10-year follow-up. For 9.1% of men and 25% of women a high depressive symptom trajectory was found with a trend toward worsening in men. The majority of the remaining men and women showed decreasing symptomatology over time, falling from clinically significant to very low levels of depressive symptoms. In large multivariate class membership models, mobility limitations (odds ratio (OR)=4.5, 95% confidence interval (CI) 1.6-12.9 and OR=4.9, 95% CI 2.3-10.7, in men and women respectively), ischemic pathologies (OR=2.9, 95% CI 1.0-8.3 and OR=3.1, 95%CI 1.0-9.9), and recent stressful events (OR=4.5, 95% CI 1.1-18.5, OR=3.2, 95%CI 1.6-6.2) were associated with a poor symptom course in both gender as well as diabetes in men (OR=3.5, 95% CI 1.1-10.9) and childhood traumatic experiences in women (OR=3.1, 95% CI 1.6-5.8). ConclusionsThis prospective study was able to differentiate patterns of chronic and remitting depressive symptoms in elderly people with distinct symptom courses and risk factors for men and women. These findings may inform prevention programmes designed to reduce the chronic course of depressive symptomatology.

Published
2017

4. Occupational exposures contribute to educational inequalities in lung cancer incidence among men: Evidence from the EPIC prospective cohort study

Author

Kim Overvad, Fabrizio Veglia, Domenico Palli, Valentina Gallo, Eva Ardanaz, Eric J. Duell, Laudina Rodríguez, Rosario Tumino, Ello Riboli, Lluís Cirera, Paolo Vineis, Paolo Boffetta, Anton E. Kunst, Jakob Linseisen, Kay-Tee Khaw, Gwenn Menvielle, Silke Hermann, Sheila Bingham, Antonio Agudo, Rudolf Kaaks, Jone Miren Altzibar Arozena, H. Bas Bueno-de-Mesquita, Pietro Ferrari, Anne Tjønneland, Ole Raaschou-Nielsen, Nadia Slimani, Vittorio Krogh, Manuela M. Bergmann, Hendriek Boshuizen, María José Sánchez, Susanne Oksbjerg Dalton, Santé publique et épidémiologie des déterminants professionnels et sociaux de la santé, Epidémiologie, sciences sociales, santé publique (IFR 69), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), National Institute for Public Health and the Environment [Bilthoven] (RIVM), Department of Public Health, Erasmus University Medical Center [Rotterdam] (Erasmus MC), University of Torino and CPO-Piemonte, Università degli studi di Torino (UNITO), Dept of Epidemiology and Public Health, Imperial College London, Institute of Cancer Epidemiology, Danish Cancer Society, Dept of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke (DIfE), Division of Cancer Epidemiology, German Cancer Research Center - Deutsches Krebsforschungszentrum [Heidelberg] (DKFZ), ISI Foundation Institute for Scientific Interchange, Unit of Nutrition, Environment, and Cancer, Catalan Institute of Oncology, Department of Cardiology and Department of Clinical Epidemiology, Aarhus University Hospital, Institute of Epidemiology, Helmholtz-Zentrum München (HZM), Molecular and Nutritional Epidemiology Unit, CSPO-Scientific Institute of Tuscany, Department of Preventive & Predictive Medicine, Italian National Center Institute, Cancer Registry Azienda, Civile - M.P.Arezzo Hospital, Public Health and Participation Directorate, Health and Health Care Service Council, Unit of Nutrition, Environment and Cancer, Andalusian School of Public Health [Granada], CIBER Epidemiologia y Salud Publica, CIBER de Epidemiología y Salud Pública (CIBERESP), Public Health Division of Guipuzcoa, Basque Government, Department of Epidemiology, Murcia Health Council, Public Health Institute of Navarra, MRC Centrer for Nutritional Epidemiology and Cancer Prevention and Survival, and University of Cambridge [UK] (CAM)

Subjects
Cancer Research, medicine.medical_specialty, MESH: Socioeconomic Factors, men, medicine.disease_cause, Asbestos, MESH: Occupational Exposure, MESH: Proportional Hazards Models, 03 medical and health sciences, 0302 clinical medicine, Environmental health, Epidemiology, medicine, 030212 general & internal medicine, MESH: Incidence, Lung cancer, Prospective cohort study, MESH: Cohort Studies, education, MESH: Humans, Proportional hazards model, business.industry, Incidence (epidemiology), occupational exposure, medicine.disease, MESH: Male, MESH: Prospective Studies, 3. Good health, European Prospective Investigation into Cancer and Nutrition, Surgery, MESH: Lung Neoplasms, Oncology, 030220 oncology & carcinogenesis, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Lung cancer incidence, business, MESH: Educational Status, Cohort study
Abstract

International audience; The aim of this study is to investigate to what extent occupational exposures may explain socioeconomic inequalities in lung cancer incidence after adjusting for smoking and dietary factors. Analyses were based on a subsample of the European Prospective Investigation into Cancer and Nutrition (EPIC study), a prospective cohort. The analyses included 703 incident lung cancer cases among men in Denmark, the United Kingdom, Germany, Italy, Spain and Greece. The socioeconomic position was measured using the highest level of education. The estimates of relative indices of inequality (RII) were computed with Cox regression models. We first adjusted for smoking (with detailed information on duration and quantity) and dietary factors (fruits and vegetables consumption) and then for occupational exposures. The exposure to three carcinogens [asbestos, heavy metals and polycyclic aromatic hydrocarbons (PAH)] was analyzed. The occupational exposures explained 14% of the socioeconomic inequalities remaining after adjustment for smoking and fruits and vegetables consumption. The inequalities remained nevertheless statistically significant. The RII decreased from 1.87 (95% CI: 1.36-2.56) to 1.75 (1.27-2.41). The decrease was more pronounced when adjusting for asbestos than for heavy metals or PAH. Analyses by birth cohort suggested an effect of occupational exposures among older men, while due to small number of endpoints, no conclusion could be drawn about the role of occupational exposures in educational inequalities among younger men. Our study revealed that the impact of occupational exposures on socioeconomic inequalities in cancer incidence, rarely studied until now, exists while of modest magnitude.

Published
2010

5. Occupational exposures contribute to educational inequalities in lung cancer incidence among men: Evidence from the EPIC prospective cohort study.: Occupation and educational inequalities in lung cancer

Author

Menvielle, Gwenn, Boshuizen, Hendriek, Kunst, Anton, Vineis, Paolo, Dalton, Susanne, Bergmann, Manuela, Hermann, Silke, Veglia, Fabrizio, Ferrari, Pietro, Overvad, Kim, Raaschou-Nielsen, Ole, Tjønneland, Anne, Kaaks, Rudolf, Linseisen, Jakob, Palli, Domenico, Krogh, Vittorio, Tumino, Rosario, Rodriguez, Laudina, Agudo, Antonio, Sánchez, Maria-José, Arozena, Jone Miren Altzibar, Cirera, Lluis, Ardanaz, Eva, Bingham, Sheila, Khaw, Kay-Tee, Boffetta, Paolo, Duell, Eric, Slimani, Nadia, Gallo, Valentina, Riboli, Elio, Bueno-De-Mesquita, H Bas, Kaniewski, Nadine, Santé publique et épidémiologie des déterminants professionnels et sociaux de la santé, Epidémiologie, sciences sociales, santé publique (IFR 69), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), National Institute for Public Health and the Environment [Bilthoven] (RIVM), Department of Public Health, Erasmus University Medical Center [Rotterdam] (Erasmus MC), University of Torino and CPO-Piemonte, Università degli studi di Torino = University of Turin (UNITO), Dept of Epidemiology and Public Health, Imperial College London, Institute of Cancer Epidemiology, Danish Cancer Society, Dept of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke (DIfE), Division of Cancer Epidemiology, German Cancer Research Center - Deutsches Krebsforschungszentrum [Heidelberg] (DKFZ), ISI Foundation Institute for Scientific Interchange, Unit of Nutrition, Environment, and Cancer, Catalan Institute of Oncology, Department of Cardiology and Department of Clinical Epidemiology, Aarhus University Hospital, Institute of Epidemiology, Helmholtz Zentrum München = German Research Center for Environmental Health, Molecular and Nutritional Epidemiology Unit, CSPO-Scientific Institute of Tuscany, Department of Preventive & Predictive Medicine, Italian National Center Institute, Cancer Registry Azienda, Civile - M.P.Arezzo Hospital, Public Health and Participation Directorate, Health and Health Care Service Council, Unit of Nutrition, Environment and Cancer, Andalusian School of Public Health [Granada], CIBER Epidemiologia y Salud Publica, CIBER de Epidemiología y Salud Pública (CIBERESP), Public Health Division of Guipuzcoa, Basque Government, Department of Epidemiology, Murcia Health Council, Public Health Institute of Navarra, MRC Centrer for Nutritional Epidemiology and Cancer Prevention and Survival, and University of Cambridge [UK] (CAM)

Subjects
education, MESH: Socioeconomic Factors, MESH: Humans, men, occupational exposure, MESH: Male, MESH: Occupational Exposure, MESH: Prospective Studies, MESH: Lung Neoplasms, MESH: Proportional Hazards Models, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Incidence, Lung cancer incidence, MESH: Educational Status, MESH: Cohort Studies
Abstract

International audience; The aim of this study is to investigate to what extent occupational exposures may explain socioeconomic inequalities in lung cancer incidence after adjusting for smoking and dietary factors. Analyses were based on a subsample of the European Prospective Investigation into Cancer and Nutrition (EPIC study), a prospective cohort. The analyses included 703 incident lung cancer cases among men in Denmark, the United Kingdom, Germany, Italy, Spain and Greece. The socioeconomic position was measured using the highest level of education. The estimates of relative indices of inequality (RII) were computed with Cox regression models. We first adjusted for smoking (with detailed information on duration and quantity) and dietary factors (fruits and vegetables consumption) and then for occupational exposures. The exposure to three carcinogens [asbestos, heavy metals and polycyclic aromatic hydrocarbons (PAH)] was analyzed. The occupational exposures explained 14% of the socioeconomic inequalities remaining after adjustment for smoking and fruits and vegetables consumption. The inequalities remained nevertheless statistically significant. The RII decreased from 1.87 (95% CI: 1.36-2.56) to 1.75 (1.27-2.41). The decrease was more pronounced when adjusting for asbestos than for heavy metals or PAH. Analyses by birth cohort suggested an effect of occupational exposures among older men, while due to small number of endpoints, no conclusion could be drawn about the role of occupational exposures in educational inequalities among younger men. Our study revealed that the impact of occupational exposures on socioeconomic inequalities in cancer incidence, rarely studied until now, exists while of modest magnitude.

Published
2010

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