Menu Close

Estimating and Explaining the Effect of Education and Income on Head and Neck Cancer Risk: INHANCE Consortium Pooled Analysis of 31 Case-Control Studies from 27 Countries


Conway, David I.; Brenner, Darren R.; McMahon, Alex D.; Macpherson, Lorna M. D.; Agudo, Antonio; Ahrens, Wolfgang; Bosetti, Cristina; Brenner, Hermann; Castellsague, Xavier; & Chen, Chu, et al. (2015). Estimating and Explaining the Effect of Education and Income on Head and Neck Cancer Risk: INHANCE Consortium Pooled Analysis of 31 Case-Control Studies from 27 Countries. International Journal of Cancer, 136(5), 1125-1139. PMCID: PMC4531373


Low socioeconomic status has been reported to be associated with head and neck cancer risk. However, previous studies have been too small to examine the associations by cancer subsite, age, sex, global region, and calendar time, and to explain the association in terms of behavioural risk factors. Individual participant data of 23,964 cases with head and neck cancer and 31,954 controls from 31 studies in 27 countries pooled with random effects models. Overall, low education was associated with an increased risk of head and neck cancer (OR = 2.50; 95%CI 2.02- 3.09). Overall one-third of the increased risk was not explained by differences in the distribution of cigarette smoking and alcohol behaviours; and it remained elevated among never users of tobacco and non-drinkers (OR = 1.61; 95%CI 1.13 - 2.31). More of the estimated education effect was not explained by cigarette smoking and alcohol behaviours: in women than in men, in older than younger groups, in the oropharynx than in other sites, in South/Central America than in Europe/North America, and was strongest in countries with greater income inequality. Similar findings were observed for the estimated effect of low vs high household income. The lowest levels of income and educational attainment were associated with more than 2-fold increased risk of head and neck cancer, which is not entirely explained by differences in the distributions of behavioural risk factors for these cancers, and which varies across cancer sites, sexes, countries, and country income inequality levels.


Reference Type

Journal Article

Year Published


Journal Title

International Journal of Cancer


Conway, David I.
Brenner, Darren R.
McMahon, Alex D.
Macpherson, Lorna M. D.
Agudo, Antonio
Ahrens, Wolfgang
Bosetti, Cristina
Brenner, Hermann
Castellsague, Xavier
Chen, Chu
Curado, Maria Paula
Curioni, Otávio Alberto
Maso, Luigino Dal
Daudt, Alexander W.
de Gois Filho, Jose F.
D'Souza, Gypsyamber
Edefonti, Valeria
Fabianova, Eleonora
Fernandez, Leticia
Franceschi, Silvia
Gillison, Maura L.
Hayes, Richard B.
Healy, Claire M.
Herrero, Rolando
Holcatova, Ivana
Jayaprakash, Vijayvel
Kelsey, Karl T.
Kjaerheim, Kristina
Koifman, Sergio
Vecchia, Carlo La
Lagiou, Pagona
Lazarus, Philip
Levi, Fabio
Lissowska, Jolanta
Luce, Daniele
Macfarlane, Tatiana V.
Mates, Dana
Matos, Elena L.
McClean, Michael D.
Menezes, Ana M.
Menvielle, Gwenn
Merletti, Franco
Morgenstern, Hal
Moysich, Kirsten
Muller, Heiko
Muscat, Joshua E.
Olshan, Andrew F.
Purdue, Mark P.
Ramroth, Heribert
Richiardi, Lorenzo
Rudnai, Peter
Schantz, Stimson
Schwartz, Stephen M.
Shangina, Oxana
Simonato, Lorenzo
Smith, Elaine
Stucker, Isabelle
Sturgis, Erich M.
Szeszenia-Dabrowska, Neonila
Talamini, Renato
Thomson, Peter
Vaughan, Thomas L.
Wei, Qingyi
Winn, Deborah M.
Wunsch-Filho, Victor
Yu, Guo-Pei
Zhang, Zuo-Feng
Zheng, Tongzhang
Znaor, Ariana
Boffetta, Paolo
Chuang, Shu-Chun
Lee, Yuan-Chin Amy
Hashibe, Mia
Brennan, Paul