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

IF 4.7 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Jan Hovanec, Benjamin Kendzia, Ann Olsson, Joachim Schüz, Hans Kromhout, Roel Vermeulen, Susan Peters, Per Gustavsson, Enrica Migliore, Loredana Radoi, Christine Barul, Dario Consonni, Neil E Caporaso, Maria Teresa Landi, John K Field, Stefan Karrasch, Heinz-Erich Wichmann, Jack Siemiatycki, Marie-Elise Parent, Lorenzo Richiardi, Lorenzo Simonato, Karl-Heinz Jöckel, Wolfgang Ahrens, Hermann Pohlabeln, Guillermo Fernández-Tardón, David Zaridze, John R McLaughlin, Paul A Demers, Beata Świątkowska, Jolanta Lissowska, Tamás Pándics, Eleonora Fabianova, Dana Mates, Miriam Schejbalova, Lenka Foretova, Vladimír Janout, Paolo Boffetta, Francesco Forastiere, Kurt Straif, Thomas Brüning, Thomas Behrens
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引用次数: 0

Abstract

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.

社会经济地位、吸烟和肺癌:SYNERGY 研究中的中介和偏差分析。
背景:低社会经济地位(SES)群体肺癌风险的增加仅部分归因于吸烟习惯。通过量化潜在的偏差来研究与低社会经济地位相关的持续风险的工作很少:基于 12 项病例对照研究,包括国际 SYNERGY 项目的 18 个中心(16,550 例病例,20,147 例对照),我们通过多元逻辑回归估算了 SES 对肺癌的直接控制效应(CDE),并对年龄、研究中心和吸烟习惯进行了调整,同时按性别进行了分层。我们通过反比例加权法进行了中介分析,以估计自然直接效应(NDE)和通过吸烟习惯产生的自然间接效应。我们考虑了吸烟状况的误分类、选择偏倚和遗传风险造成的未测量中介结果混淆,既单独考虑了这些因素,也进行了多重定量偏倚分析,并使用引导法创建了95%模拟区间(SI):对肺癌风险进行的社会经济地位中介分析估计,吸烟对男性和女性的平均影响比例分别为43%和33%。偏倚分析降低了社会经济地位对肺癌的直接影响,在多重偏倚分析中,选择偏倚对肺癌风险的降低作用最强。较低社会经济地位组的肺癌风险仍然增加,男性[第四与第一(最高)社会经济地位四分位数:CDE 1.50 (SI 1.32-1.69)]的肺癌风险高于女性[CDE 1.20 (SI 1.01-1.45)]。NDE与CDE相似,尤其是男性:结论:偏差调整降低了较低社会经济地位群体的直接肺癌风险估计值。然而,低社会经济地位人群的风险仍然较高,这可能是由于职业危害或其他环境暴露造成的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Epidemiology
Epidemiology 医学-公共卫生、环境卫生与职业卫生
CiteScore
6.70
自引率
3.70%
发文量
177
审稿时长
6-12 weeks
期刊介绍: Epidemiology publishes original research from all fields of epidemiology. The journal also welcomes review articles and meta-analyses, novel hypotheses, descriptions and applications of new methods, and discussions of research theory or public health policy. We give special consideration to papers from developing countries.
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