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
{"title":"Socioeconomic status, smoking, and lung cancer: mediation and bias analysis in the SYNERGY study.","authors":"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","doi":"10.1097/EDE.0000000000001807","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":null,"pages":null},"PeriodicalIF":4.7000,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Epidemiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/EDE.0000000000001807","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
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.
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.