http://www.ncbi.nlm.nih.gov/pubmed/18191762?dopt=AbstractPlus
Ann Epidemiol. 2008 Feb;18(2):156-62
Health risk behaviors: examining social inequalities in bladder and
colorectal cancers.
Goy J, Rosenberg MW, King WD.
Department of Community Health and Epidemiology, Queens University,
Kingston, Ontario, Canada.
PURPOSE: The objective of this study is to estimate the proportion
of the relationship between low socioeconomic status (SES) and the
incidence of these cancer types accounted for by health risk behaviors.
METHODS: A study population of 569 bladder, 592 colon, and 558 rectal
cancer cases and 1549 controls was used to investigate health risk
behaviors and SES effects. Odds ratios and 95 % confidence intervals
(CIs) estimated by multivariate logistic regression approximated
relative risks. The explanatory role of health risk behaviors was
assessed by the change in the risk estimate on SES following their
omission from the model. RESULTS: For each cancer site, individual
education remained a predictor of risk after controlling for health risk
behaviors. Adjustments for health risk behaviors (smoking) shifted the
age- and sex-adjusted relative risk (RR) associated with bladder cancer
from 2.24 to 1.74 (29.5%). No health risk behaviors (smoking, diet,
obesity) resulted in substantial change in the low education risk
estimates for colon cancer (RR = 2.88) or rectal cancer (RR = 2.42).
CONCLUSIONS: Given the strength of SES relationships persisting after
adjustment for health risk behaviors, this study suggests that our
knowledge of SES pathways and risk factors for bladder, colon, and
rectal cancers is incomplete.
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