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Occupational Inequalities in Female Cancer Incidence in Japan: Hospital-based Matched Case-Control Study With Occupational Class

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Occupational Inequalities in Female Cancer Incidence in Japan: Hospital-based Matched Case-Control Study With Occupational Class

Masayoshi Zaitsu et al. SSM Popul Health.

Abstract

Background: Socioeconomic inequalities in female cancer incidence have previously been undocumented in Japan.

Methods: Using a nationwide inpatient dataset (1984-2016) in Japan, we identified 143,806 female cancer cases and 703,157 controls matched for sex, age, admission date, and admitting hospital, and performed a hospital-based matched case-control study. Based on standardized national classification, we categorized patients' socioeconomic status (SES) by occupational class (blue-collar, service, professional, manager), cross-classified by industry sector (blue-collar, service, white-collar). Using blue-collar workers in blue-collar industries as the reference group, we estimated the odds ratio (OR) for each cancer incidence using conditional logistic regression with multiple imputation, adjusted for major modifiable risk factors (smoking, alcohol consumption).

Results: We identified lower risks among higher-SES women for common and overall cancers: e.g., ORs for managers in blue-collar industries were 0.67 (95% confidence interval [CI], 0.46-0.98) for stomach cancer and 0.40 (95% CI, 0.19-0.86) for lung cancer. Higher risks with higher SES were evident for breast cancer: the OR for professionals in service industries was 1.60 (95% CI, 1.29-1.98). With some cancers, homemakers showed a similar trend to subjects with higher SES; however, the magnitude of the OR was weaker than those with higher SES.

Conclusions: Even after controlling for major modifiable risk factors, socioeconomic inequalities were evident for female cancer incidence in Japan.

Keywords: Alcohol; Cancer incidence; Case-control study; Japan; Occupation; Smoking; Socioeconomic status; Women.

Figures

Fig. 1
Fig. 1
Socioeconomic status grouped by longest-held occupational class cross-classified with industrial cluster.
Fig. 2
Fig. 2
Socioeconomic gradients associated with risk for incidence of stomach, lung, and breast cancers. The odds ratio (dot) and 95% confidence interval (bar) were estimated by conditional logistic regression, (a) matched for age, admission date, and admitting hospital and (b) additionally adjusted for smoking and alcohol consumption, with five imputed datasets. The numbers of cases and controls used for analysis were, respectively, 19,840 and 96,658 for stomach cancer, 8,207 and 39,941 for lung cancer, and 24,983 and 122,414 for breast cancer.
Fig. 3
Fig. 3
Socioeconomic gradient associated with risk for overall female cancer incidence. The odds ratio (dot) and 95% confidence interval (bar) were estimated by conditional logistic regression, (a) matched for age, admission date, and admitting hospital and (b) additionally adjusted for smoking and alcohol consumption, with five imputed datasets. The numbers of cases and controls used for analysis were, respectively, 143,806 and 703,157.

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