O-80 Towards occupational health equity metrics estimating the burden of lung cancer attributed to three occupational carcinogens by socio-economic position

Introduction

Lung cancer was the most common type of cancer attributed to occupational exposures in France in 2015, with 5621 cases in men (89% of all work-related cases) and 294 cases in women (80%). Some of the main lung carcinogens, like silica dust and diesel exhausts, are part of contemporary working environments. Moreover, such exposures were still ten times more frequent among skilled workers than among managers in 2017 in France. Our aim was to quantify the impact of known occupational carcinogens depending on socio-economic position (SEP) in order to integrate exposure inequities into burden of disease estimates.

Material and Methods

We used the population-based ICARE case-control study that included 2926 lung cancer cases and 3555 frequency-matched controls covering 13% of the French population. Applying the distributive property of attributable risk, we compared the burden of lung cancer according to SEP, taking into account asbestos, silica, diesel motor exhaust (DME), and smoking. We used different modelling strategies to compare R and Stata packages and other sources of variation in the estimates (exposure metrics and SEP indicators).

Results

In men, partitioning the attributable fraction by SEP showed that the burden largely concentrated among less qualified and lower SEP groups, even after adjusting for smoking. Based on socio-occupational group, the combined AF (for 3 occupational carcinogens) was as high as 26.7% (95%CI 22.5;30.8) for blue-collar workers and as low as 0.2% (95%CI -1.35;1.64) for managers. The disparities were also large based on education, occupational social prestige and occupational trajectory. The exposure profiles of women did not allow to make reliable estimates.

Conclusions

While attempting to quantify the burden of avoidable lung cancer, it is useful to complement population-wide approaches with a focus on specific sub-groups defined by SEP, as the modifiable exposures (behavioural, work-related and others) are not evenly distributed.