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. 2018 Dec 6;15(12):2760.
doi: 10.3390/ijerph15122760.

Variation in Nordic Work-Related Cancer Risks after Adjustment for Alcohol and Tobacco

Kristina Kjaerheim  1 , Tor Haldorsen  2 , Elsebeth Lynge  3 , Jan Ivar Martinsen  4 , Eero Pukkala  5   6 , Elisabete Weiderpass  7   8   9   10 , Tom K Grimsrud  11
Affiliations

Variation in Nordic Work-Related Cancer Risks after Adjustment for Alcohol and Tobacco

Kristina Kjaerheim et al. Int J Environ Res Public Health. .

Abstract

Background: Alcohol and tobacco strongly increases the risk of cancers of the tongue, mouth, pharynx, larynx, and oesophagus, and are also established risk factors for cancer of the liver, colon, and rectum. It is well documented that these habits are unequally distributed among occupational groups. Most occupational cohort studies lack information on these potentially important confounders, and may therefore be prone to bias. Aim: The aim of the study is to present Nordic standardized incidence ratios (SIRs) for alcohol and tobacco related cancer by occupation, after adjustment for alcohol and tobacco, and to compare to the unadjusted SIRs. Material and Methods: The study is based on the Nordic Occupational Cancer (NOCCA) database. We used confirmatory factor analysis models for simultaneous analysis of the cancer sites related to alcohol and tobacco, to obtain factors that allow for computation of adjusted expected numbers from the reference rates. We then calculated adjusted SIRs for the relevant cancer sites for each occupation. Results: For some occupations and cancers, the changes of risk estimates were striking, from significantly high to significantly low and vice versa. Among Nordic farmers, unadjusted SIRs for cancer of the mouth and oesophagus were 0.56 (95% confidence interval (CI) 0.51⁻0.61) and 0.67 (CI 0.63⁻0.70), respectively. After adjustment, estimates changed to 1.10 (CI 1.01⁻1.21) and 1.16 (CI 1.10⁻1.22). Unadjusted SIR for pharynx cancer among wood workers was 0.83 (CI 0.75⁻0.91), adjusted SIR was 1.14 (CI 1.03⁻1.25). For larynx cancer, results in the opposite direction were seen: unadjusted SIR for economically inactive was 1.38 (CI 1.31⁻1.46) while the adjusted SIR was 0.91 (CI 0.86⁻0.96). Conclusions: Adjustment for the latent indicators of alcohol and tobacco consumption changed risk estimates for several occupations, gave a less confounded description of risk, and may guide in the identification of true risk factors.

Keywords: alcohol; cancer; confounding; occupation; tobacco.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Unadjusted (blue) and alcohol and tobacco adjusted (red) SIRs for cancer of the tongue among 7,447,726 men in the Nordic countries, by occupation. Follow up 1961–2005.
Figure 2
Figure 2
Unadjusted (blue) and alcohol and tobacco adjusted (red) SIRs for cancer of the mouth among 7,447,726 men in the Nordic countries, by occupation. Follow up 1961–2005.
Figure 3
Figure 3
Unadjusted (blue) and alcohol and tobacco adjusted (red) SIRs for cancer of the pharynx among 7,447,726 men in the Nordic countries, by occupation. Follow up 1961–2005.
Figure 4
Figure 4
Unadjusted (blue) and alcohol and tobacco adjusted (red) SIRs for cancer of the tongue/mouth/pharynx among 7,454,847 women in the Nordic countries, by occupation. Follow up 1961–2005.
Figure 5
Figure 5
Unadjusted (blue) and alcohol and tobacco adjusted (red) SIRs for cancer of the larynx among 7,447,726 men in the Nordic countries, by occupation. Follow up 1961–2005.
Figure 6
Figure 6
Unadjusted (blue) and alcohol and tobacco adjusted (red) SIRs for cancer of the larynx among 7,454,847 women in the Nordic countries, by occupation. Follow up 1961–2005.
Figure 7
Figure 7
Unadjusted (blue) and alcohol and tobacco adjusted (red) SIRs for cancer of the esophagus among 7,447,726 men in the Nordic countries, by occupation. Follow up 1961–2005.
Figure 8
Figure 8
Unadjusted (blue) and alcohol and tobacco adjusted (red) SIRs for cancer of the esophagus among 7,454,847 women in the Nordic countries, by occupation. Follow up 1961–2005.
Figure 9
Figure 9
Unadjusted (blue) and alcohol and tobacco adjusted (red) SIRs for cancer of the liver among 7,447,726 men in the Nordic countries, by occupation. Follow up 1961–2005.
Figure 10
Figure 10
Unadjusted (blue) and alcohol and tobacco adjusted (red) SIRs for cancer of the liver among 7,454,847 women in the Nordic countries, by occupation. Follow up 1961–2005.
Figure 11
Figure 11
Unadjusted (blue) and alcohol and tobacco adjusted (red) SIRs for colon cancer among 7,447,726 men in the Nordic countries, by occupation. Follow up 1961–2005.
Figure 12
Figure 12
Unadjusted (blue) and alcohol and tobacco adjusted (red) SIRs for rectal cancer among 7,447,726 men in the Nordic countries, by occupation. Follow up 1961–2005.
Figure 13
Figure 13
Unadjusted (blue) and adjusted (red) SIRs with 95% confidence intervals for alcohol and tobacco related cancer among male waiters, farmers, and physicians.
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