Unemployment and Lung Cancer Incidence in the Province of Opole - Brief Report

SUMMARYIn this geostatistical analysis we present the results of interrelation between unemployment rate and lung cancer incidence ratios in the Province of Opole, Poland. In the study, unemployment statistics and population data were analyzed together with the registered (histopathologically confirmed) lung cancer cases (C34, ICD10) in sex-stratified working age population (18-65 years). The data were collected in the years 2006-2008 in the Statistical Office in Opole and Opole Cancer Registry, Poland. The statistically significant positive correlation/interrelation between unemployment rate and lung cancer incidence ratios in male population was established; in females, this effect was statistically insignificant. The obtained results are consistent with the most up-to-date reports supporting the thesis that a higher burden of disease is observed in more deprived areas. The statistics may have practical relevance in terms of improving health status of the local population following economic reforms.Key words: unemployment, lung cancer, spatial modeling, standardized incidence ratio, interrelationINTRODUCTIONUnemployment itself is not considered to be a risk factor, however, low pay, exposure to hazards associated with job insecurity and the adoption of a lifestyle in which a higher degree of risk is accepted may induce a health damaging behaviour that can lead to a wide range of diseases, including psychological disorders and cancer (1). Research has considerably advanced our understanding of these interrelations (2). For example, unemployment was associated with an increased risk of suicide and death from undetermined causes (3), and especially individuals aged 36-44 were at the greatest excess risks (2). However, some authors have reported that unemployment is associated mainly with minor psychological disorders (1) and most studies have failed to find a positive association between depressed mood due to joblessness and a higher risk of developing cancer later in life. However, it is estimated that unemployed men compared to employed men have a 40% to 70% excess risk of lung cancer as well as an almost 25% excess cancer mortality compared to men in the labour force (4). Thus, unemployed men seem to have an excess lung cancer risk due to smoking habit (4-6).However, opposite results can also be found in recent literature (7). Data from one study indicate that unemployment contributes to healthier dietary and exercise behaviour in addition to healthier smoking and drinking habits. When total consumption decreases, consumption of expensive goods (like tobacco and alcohol) also tends to decrease. Healthier lifestyle habits reduce incidence rates of some types of cancer as well as mortality during and after recessions. The percentage of people who die from certain cancers falls as unemployment rises. The author suggests that a one-percentage-point increase in unemployment will result in about 3,500 fewer deaths nationwide from lung cancer in the following years (7).As regards other cancers, unexpectedly high unemployment is associated with reduced odds ratios for the registered breast tumors in San Francisco Bay Area. It is explained that fear of job loss may distract women from breast self-examination and the identification of suspicious breast signs. The authors also appeal that breast cancer control efforts should be intensified during periods of unexpectedly high unemployment (8). In Ireland cancer atlas (9), we can find the information that wards and electoral divisions (EDs) with the highest levels of unemployment had a 10% higher risk of male bladder cancer than those with the lowest levels. Moreover, sex inequalities of socioeconomic gradient (including unemployment) in lung cancer mortality were also reported (10) - the socioeconomic gradient of mortality in men was negative for Barcelona and positive for Sao Paulo, whereas for women the gradient was positive in both cities.The purpose of this paper is to estimate the association between unemployment rate and lung cancer incidence ratios. …