British Journal of Oral and Maxillofacial Surgery 48 (2010) 11–17 Available online at www.sciencedirect.com Components of socioeconomic risk associated with head and neck cancer: A population-based case–control study in Scotland David I. Conway a,* , Alex D. McMahon a,1 , Katrina Smith b , Roger Black b , Gerry Robertson c , John Devine d , Patricia A. McKinney e a University of Glasgow, Faculty of Medicine, Dental School, Community Oral Health Section, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK b NHS National Services Scotland, Information Services Division, 1 South Gyle Crescent, Edinburgh, EH12 9EB, UK c Beatson Oncology Centre, Western Infirmary, Glasgow, G11 6NT, UK d The West of Scotland Regional Maxillofacial Unit, Southern General Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK e Centre for Epidemiology and Biostatics, University of Leeds, 30 Hyde Terrace, Leeds, LS2 9LN, UK Accepted 28 March 2009 Available online 28 May 2009 Abstract The complex associations between socioeconomic circumstances and risk for head and neck cancer are under-explored. We investigated components of social class and their relative influence on the risk of head and neck cancers by studying 103 patients (age range 24–80 years) who had been diagnosed with cancer of the head and neck between April 2002 and December 2004, and 91 controls who were randomly selected from general practitioners’ lists. Information about occupation, education, smoking, and alcohol consumption was collected at personal interview. Socioeconomic circumstances were measured at an individual level (education, occupational social class, unemployment), and by area-based measures of deprivation. Odds ratios (OR) and 95% confidence intervals (CI) were computed using unconditional logistic regression and multivariate analyses. People living in the most deprived areas (OR = 4.66, 95% CI 1.79–12.18); and those who were unemployed (OR = 2.27, 95% CI 1.21–4.26) had a significantly higher risk of cancer than those with high levels of educational attainment (OR = 0.17, 95% CI 0.05–0.58). Significance was lost for all measures of social class when adjustments were made for smoking and consumption of alcohol. Smoking was the only significant risk factor (OR = 15.53, 95% CI 5.36–44.99) in the multivariate analysis. A high risk of head and neck cancer was consistently associated with poor socioeconomic circumstances, and there were strong links for specific components however smoking dominated the overall profile of risk. We propose a framework for future socioeconomic analyses. © 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Keywords: Case–control study; Head and neck cancer; Risk factors; SES; Socioeconomic * Corresponding author. Tel.: +44 0 141 211 9802; fax: +44 0 141 353 1593. E-mail addresses: d.conway@dental.gla.ac.uk (D.I. Conway), a.mcmahon@dental.gla.ac.uk (A.D. McMahon), katrina.smith@isd.csa.scot.nhs.uk (K. Smith), roger.black@isd.csa.scot.nhs.uk (R. Black), gerrry.robertson@northglasgow.scot.nhs.uk (G. Robertson), john.devine@sgh.scot.nhs.uk (J. Devine), p.a.mckinney@leeds.ac.uk (P.A. McKinney). 1 Tel.: +44 0 141 211 9802; fax: +44 0 141 353 1593. Introduction Head and neck carcinomas including those of the oral cavity, pharynx, and larynx are often grouped together in descriptive epidemiological studies, aetiological analyses, and reports on clinical management. 1 Worldwide, head and neck cancer is the sixth most com- mon cancer for men and women, and the third most common in developing nations. 2 Although rarer in Europe and North America where it is the 10th most common, 2 in Scotland in 0266-4356/$ – see front matter © 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjoms.2009.03.020