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

David I Conway (Lead / Corresponding author), Darren R Brenner, Alex D McMahon, Lorna M D Macpherson, Antonio Agudo, Wolfgang Ahrens, Cristina Bosetti, Hermann Brenner, Xavier Castellsague, Chu Chen, Maria Paula Curado, Otávio A Curioni, Luigino Dal Maso, Alexander W Daudt, José F de Gois Filho, Gypsyamber D'Souza, Valeria Edefonti, Eleonora Fabianova, Leticia Fernandez, Silvia FranceschiMaura Gillison, Richard B Hayes, Claire M Healy, Rolando Herrero, Ivana Holcatova, Vijayvel Jayaprakash, Karl Kelsey, Kristina Kjaerheim, Sergio Koifman, Carlo La Vecchia, Pagona Lagiou, Philip Lazarus, Fabio Levi, Jolanta Lissowska, Daniele Luce, Tatiana V Macfarlane, Dana Mates, Elena Matos, Michael McClean, Ana M Menezes, Gwenn Menvielle, Franco Merletti, Hal Morgenstern, Kirsten Moysich, Heiko Müller, Joshua Muscat, Andrew F Olshan, Mark P Purdue, Heribert Ramroth, Lorenzo Richiardi, Peter Rudnai, Stimson Schantz, Stephen M Schwartz, Oxana Shangina, Lorenzo Simonato, Elaine Smith, Isabelle Stucker, Erich M Sturgis, Neonila Szeszenia-Dabrowska, Renato Talamini, Peter Thomson, Thomas L Vaughan, Qingyi Wei, Deborah M Winn, Victor Wunsch-Filho, Guo-Pei Yu, Zuo-Feng Zhang, Tongzhang Zheng, Ariana Znaor, Paolo Boffetta, Shu-Chun Chuang, Marianoosh Ghodrat, Yuan-Chin Amy Lee, Mia Hashibe, Paul Brennan

Research output: Contribution to journalArticlepeer-review

108 Citations (Scopus)


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 behavioral 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 behaviors; and it remained elevated among never users of tobacco and nondrinkers (OR = 1.61; 95% CI = 1.13 - 2.31). More of the estimated education effect was not explained by cigarette smoking and alcohol behaviors: 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 versus 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 behavioral risk factors for these cancers and which varies across cancer sites, sexes, countries and country income inequality levels.

Original languageEnglish
Pages (from-to)1125-39
Number of pages15
JournalInternational Journal of Cancer
Issue number5
Early online date4 Jul 2014
Publication statusPublished - 1 Mar 2015


  • Alcohol Drinking
  • Case-Control Studies
  • Education
  • Female
  • Follow-Up Studies
  • Global Health
  • Head and Neck Neoplasms
  • Humans
  • Income
  • Male
  • Meta-Analysis as Topic
  • Middle Aged
  • Prognosis
  • Risk Factors
  • Smoking
  • Socioeconomic Factors
  • Comparative Study
  • Journal Article
  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, N.I.H., Intramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.


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