Excess incidence of squamous cell esophageal cancer among US black men: Role of social class and other risk factors

Linda Morris Brown, Robert Hoover, Debra Silverman, Dalsu Baris, Richard Hayes, G. Marie Swanson, Janet Schoenberg, Raymond Greenberg, Jonathan Liff, Ann Schwartz, Mustafa Dosemeci, Linda Pottern, Joseph F. Fraumeni

Research output: Contribution to journalArticlepeer-review

242 Scopus citations


Data from a population-based case-control study were used to evaluate the relation between social class factors and squamous cell esophageal cancer and the extent to which alcohol, tobacco, diet, and low income contribute to the higher incidence among Black men than among White men in the United States. A total of 347 male cases (119 White, 228 Black) and 1,354 male controls (743 White, 611 Black) were selected from three US geographic areas (Atlanta, Georgia, Detroit, Michigan, and New Jersey). Cases were residents of the study areas aged 30-79 years who had been diagnosed with histologically confirmed esophageal cancer between 1986 and 1989. The adjusted odds ratios for subjects with annual incomes less than $10,000 versus incomes of $25,000 or more were 4.3 (95% confidence interval: 2.1, 8.7) for Whites and 8.0 (95% confidence interval: 4.3, 15.0) for Blacks. The combination of all four major risk factors - low income, moderate/heavy alcohol intake, tobacco use, and infrequent consumption of raw fruits and vegetables - accounted for almost all of the squamous cell esophageal cancers in Whites (98%) and Blacks (99%) and for 99% of the excess incidence among Black men. Thus, lifestyle modifications, especially a lowered intake of alcoholic beverages, would markedly decrease the incidence of squamous cell esophageal cancer in both racial groups and would narrow the racial disparity in risk. Further studies on the determinants of social class may help to identify a new set of exposures for this tumor that are amenable to intervention.

Original languageEnglish (US)
Pages (from-to)114-122
Number of pages9
JournalAmerican Journal of Epidemiology
Issue number2
StatePublished - Jan 15 2001
Externally publishedYes


  • Alcohol drinking
  • Case-control studies
  • Diet
  • Esophageal neoplasms
  • Racial stocks
  • Risk factors
  • Social class
  • Tobacco

ASJC Scopus subject areas

  • Epidemiology


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