Educational differences in lung cancer mortality in male smokers

Background To assess the extent of lung cancer mortality differentials by e ducation while adjusting for exposure to tobacco smoke and asbestos based o n survey questions. Methods Alpha-Tocopherol, Beta Carotene Cancer Prevention (ATBC) Study of 5 0-69-year-old Finnish male smokers enrolled 1985-1988. These analyses are b ased on the placebo group and the alpha-tocopherol supplementation group, a ltogether 14 011 men, with full information on tobacco smoking. Mortality f ollow-up was to the end of April 1993 and it was based on the complete deat h certificate register of the Statistics Finland, Results Lung cancer mortality of basic-educated men was 32% (rate ratio [RR ] = 1.32; 95% CI : 0.93-1.87) higher than that of better-educated men in th e ATBC Study. The excess is practically unchanged when additional adjustmen t was made for age at initiation, duration of smoking, current smoking at b aseline and at first follow-up, smoke inhalation, occupational exposure to asbestos and interactions between asbestos exposure and all smoking variabl es. This excess mortality was about 40% of the similar excess observed in t he general population of men of similar age. Conclusions Educational differences in lung cancer mortality in the total F innish population are likely to be mainly caused by differences in exposure , particularly to active smoking. Further understanding of the determinants and consequences of socio-economic differences in smoking behaviour are of major scientific and public health importance.