BACKGROUND: The association between socioeconomic disadvantage (low education and/or income) and head and neck cancer is well established, with smoking and alcohol consumption explaining up to three-quarters of the risk. We aimed to investigate the nature of and explanations for head and neck cancer risk associated with occupational socioeconomic prestige (a perceptual measure of psychosocial status), occupational socioeconomic position and manual-work experience, and to assess the potential explanatory role of occupational exposures. METHODS: Pooled analysis included 5818 patients with head and neck cancer (and 7326 control participants) from five studies in Europe and South America. Lifetime job histories were coded to: (1) occupational social prestige-Treiman's Standard International Occupational Prestige Scale (SIOPS); (2) occupational socioeconomic position-International Socio-Economic Index (ISEI); and (3) manual/non-manual jobs. RESULTS: For the longest held job, adjusting for smoking, alcohol and nature of occupation, increased head and neck cancer risk estimates were observed for low SIOPS OR=1.88 (95% CI: 1.64 to 2.17), low ISEI OR=1.74 (95% CI: 1.51 to 1.99) and manual occupations OR=1.49 (95% CI: 1.35 to 1.64). Following mutual adjustment by socioeconomic exposures, risk associated with low SIOPS remained OR=1.59 (95% CI: 1.30 to 1.94). CONCLUSIONS: These findings indicate that low occupational socioeconomic prestige, position and manual work are associated with head and neck cancer, and such risks are only partly explained by smoking, alcohol and occupational exposures. Perceptual occupational psychosocial status (SIOPS) appears to be the strongest socioeconomic factor, relative to socioeconomic position and manual/non-manual work.

Cancer Registry of Norway Oslo Norway

Department of Cardiac Thoracic and Vascular Sciences and Public Health University of Padua Padova Veneto Italy

Department of Medical and Surgical Sciences University of Bologna Bologna Emilia Romagna Italy

Department of Medical Sciences University of Turin Torino Piemonte Italy

Division of Public Health Department of Family and Preventive Medicine and Huntsman Cancer Institute University of Utah School of Medicine Salt Lake City Utah USA

Division of Public Health Department of Family and Preventive Medicine Huntsman Cancer Institute Salt Lake City Utah USA

Environmental Epidemiology of Cancer Centre for Research in Epidemiology and Population Health National Institute of Health and Medical Research Villejuif Île de France France

Epidemiology AC Camargo Cancer Center International Research Center Sao Paulo Brazil

Epidemiology Group University of Aberdeen Aberdeen UK

Faculty of Dentistry University of Hong Kong Hong Kong Hong Kong

Federal University of Pelotas Pelotas Rio Grande do Sul Brazil

Fundacao Oswaldo Cruz National School of Public Health Rio de Janeiro Brazil

Gustave Roussy Institute Villejuif Île de France France

Hospital de Clinicas de Porto Alegre Porto Alegre Rio Grande do Sul Brazil

Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Ruhr University Bochum Bochum Nordrhein Westfalen Germany

Institute for Research in Health Environment and Work National Institute of Health and Medical Research Rennes Bretagne France

Institute of Hygiene and Epidemiology Charles University 1st Faculty of Medicine Praha Czech Republic

Institute of Oncology Angel H Roffo University of Buenos Aires Buenos Aires Argentina

Institute of Public Health University of Heidelberg Heidelberg Baden Württemberg Germany

International Agency for Research on Cancer Lyon Rhône Alpes France

Leibniz Institute for Prevention Research and Epidemiology Bremen Germany

National Institute of Oncology and Radiobiology La Habana Cuba

Oncology Reference Center Aviano Friuli Venezia Giulia Italy

Paris Sud University Saint Aubin Île de France France

School of Advanced Studies in Public Health Rennes Bretagne France

School of Dental Science Trinity College Dublin Dublin Ireland

School of Medicine Dentistry and Nursing University of Glasgow Glasgow UK

School of Medicine National and Kapodistrian University of Athens Athens Attica Greece

Sorbonne Université INSERM Institut Pierre Louis d'Epidémiologie et de Santé Publique Paris France

The Tisch Cancer Institute and Institute for Translational Epidemiology Mount Sinai School of Medicine New York New York USA

Unit of Nutrition and Cancer Cancer Epidemiology Research Program Catalan Institute of Oncology Hospitalet de Llobregat Catalunya Spain

University of Rennes 1 Health Sciences Campus Villejean Rennes Bretagne France

University of Sao Paulo Sao Paulo Brazil

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