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Hovanec, J.* ; Kendzia, B.* ; Olsson, A.* ; Schüz, J.* ; Kromhout, H.* ; Vermeulen, R.C.H.* ; Peters, S.* ; Gustavsson, P.* ; Migliore, E.* ; Radoi, L.* ; Barul, C.* ; Consonni, D.* ; Caporaso, N.E.* ; Landi, M.T.* ; Field, J.K.* ; Karrasch, S. ; Wichmann, H.-E. ; Siemiatycki, J.* ; Parent, M.E.* ; Richiardi, L.* ; Simonato, L.* ; Jöckel, K.H.* ; Ahrens, W.* ; Pohlabeln, H.* ; Fernández-Tardón, G.* ; Zaridze, D.* ; McLaughlin, J.R.* ; Demers, P.A.* ; Świątkowska, B.* ; Lissowska, J.* ; Pándics, T.* ; Fabianova, E.* ; Mates, D.* ; Schejbalova, M.* ; Foretova, L.* ; Janout, V.* ; Boffetta, P.* ; Forastiere, F.* ; Straif, K.* ; Brüning, T.* ; Behrens, T.*

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

Epidemiology 36, 245-252 (2024)
DOI PMC
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.
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Publication type Article: Journal article
Document type Scientific Article
Corresponding Author
Keywords Confounding ; Mediator ; Misclassification ; Selection Bias ; Ses; Self-reported Smoking; Exposure; Epidemiology; Variants; Validity; Behavior; Cohorts; Cyp2a6
ISSN (print) / ISBN 1044-3983
e-ISSN 1531-5487
Journal Epidemiology
Quellenangaben Volume: 36, Issue: 2, Pages: 245-252 Article Number: , Supplement: ,
Publisher Lippincott Williams & Wilkins
Publishing Place Two Commerce Sq, 2001 Market St, Philadelphia, Pa 19103 Usa
Non-patent literature Publications
Reviewing status Peer reviewed
Institute(s) Institute of Epidemiology (EPI)
Grants German Social Accident Insurance
EC's INCO-COPERNICUS Program
Polish State Committee for Science Research
Roy Castle Foundation
NIH/NCI/DCEG Intramural Research Program
Lombardy Region
Ministry of Labour and Social Affairs
Canadian Institutes of Health Research and Guzzo-SRC Chair in Environment and Cancer
Fondation de France
German Federal Ministry of Education, Science, Research, and Technology
INAIL
Swedish EPA
Swedish Council for Work Life Research
University of Oviedo
Ministry of Health of the Czech Republic-MH CZ-DRO (MMCI)
CIBERESP
Compagnia di San Paolo
European Union Nuclear Fission Safety Program
Europe Against Cancer Program
Italian Association for Cancer Research
Region Piedmont