Table 4.
Odds Ratios for Head and Neck Cancer According to Snuff Use and Cigarette Smoking, by Tumor Site, Sex, and Age, Among US Studies in the INHANCE Consortium, 1981–2006a
| Variable and Snuff Use | Smoking Status | |||||||
|---|---|---|---|---|---|---|---|---|
| Never Cigarette Smoking | Ever Cigarette Smoking | |||||||
| No. of Cases | No. of Controls | ORb | 95% CI | No. of Cases | No. of Controls | ORc | 95% CI | |
| Tumor Site | ||||||||
| Oral cavity | ||||||||
| Never user | 379 | 3,056 | 1 | Referent | 1,479 | 4,462 | 1 | Referent |
| Ever user | 20 | 62 | 3.01 | 1.63, 5.55 | 43 | 164 | 0.86 | 0.57, 1.30 |
| Missing data | 0 | 0 | 0 | 1 | ||||
| Gum | ||||||||
| Never user | 52 | 3,056 | 1 | Referent | 241 | 4,462 | 1 | Referent |
| Ever user | 10 | 62 | 12.70 | 4.76, 33.7 | 8 | 164 | 1.15 | 0.45, 2.90 |
| Missing data | 0 | 0 | 0 | 1 | ||||
| Pharynx | ||||||||
| Never user | 499 | 3,056 | 1 | Referent | 1,888 | 4,462 | 1 | Referent |
| Ever user | 18 | 62 | 1.22 | 0.65, 2.27 | 74 | 164 | 0.94 | 0.67, 1.31 |
| Missing data | 0 | 0 | 1 | 1 | ||||
| Hypopharynxd | ||||||||
| Never user | 33 | 2,845 | 1 | Referent | 282 | 4,081 | 1 | Referent |
| Ever user | 3 | 59 | 3.00 | 0.66, 13.6 | 10 | 158 | 0.90 | 0.40, 2.03 |
| Missing data | 0 | 0 | 0 | 1 | ||||
| Oropharynx | ||||||||
| Never user | 466 | 3,056 | 1 | Referent | 1,606 | 4,462 | 1 | Referent |
| Ever user | 15 | 62 | 1.07 | 0.55, 2.08 | 64 | 164 | 0.94 | 0.67, 1.31 |
| Missing data | 0 | 0 | 1 | 1 | ||||
| Oral cavity/pharynx NOS | ||||||||
| Never user | 181 | 3,056 | 1 | Referent | 505 | 4,462 | 1 | Referent |
| Ever user | 4 | 62 | 0.90 | 0.27, 2.96 | 16 | 164 | 0.92 | 0.47, 1.82 |
| Missing data | 0 | 0 | 2 | 1 | ||||
| Larynxd | ||||||||
| Never user | 69 | 2,146 | 1 | Referent | 1,058 | 2,786 | 1 | Referent |
| Ever user | 2 | 50 | —e | — | 34 | 136 | 0.65 | 0.52, 1.10 |
| Missing data | 0 | 0 | 0 | 1 | ||||
| SCC (all sites) | ||||||||
| Never user | 921 | 3,056 | 1 | Referent | 4,173 | 4,462 | 1 | Referent |
| Ever user | 39 | 62 | 1.60 | 1.00, 2.57 | 154 | 164 | 0.87 | 0.66, 1.16 |
| Missing data | 0 | 0 | 2 | 1 | ||||
| Demographic Factors | ||||||||
| Sex | ||||||||
| Female | ||||||||
| Never user | 391 | 1,344 | 1 | Referent | 1,301 | 1,161 | 1 | Referent |
| Ever user | 20 | 12 | 8.89 | 3.59, 22.0 | 23 | 9 | 0.92 | 0.35, 2.43 |
| Missing data | 0 | 0 | 2 | 0 | ||||
| Male | ||||||||
| Never user | 737 | 1,712 | 1 | Referent | 3,629 | 3,301 | 1 | Referent |
| Ever user | 24 | 50 | 0.86 | 0.49, 1.51 | 144 | 155 | 0.81 | 0.61, 1.07 |
| Missing data | 0 | 0 | 1 | 1 | ||||
| Age group, years | ||||||||
| <45 | ||||||||
| Never user | 214 | 520 | 1 | Referent | 380 | 465 | 1 | Referent |
| Ever user | 11 | 19 | 1.21 | 0.51, 2.87 | 24 | 28 | 0.96 | 0.48, 1.95 |
| Missing data | 0 | 0 | 1 | 0 | ||||
| ≥45 | ||||||||
| Never user | 914 | 2,536 | 1 | Referent | 4,550 | 3,997 | 1 | Referent |
| Ever user | 33 | 43 | 1.88 | 1.10, 3.21 | 143 | 136 | 0.82 | 0.61, 1.10 |
| Missing data | 0 | 0 | 2 | 1 | ||||
| Race/ethnicity | ||||||||
| White | ||||||||
| Never user | 975 | 2,512 | 1 | Referent | 3,976 | 3,718 | 1 | Referent |
| Ever user | 33 | 47 | 1.48 | 0.88, 2.48 | 125 | 148 | 0.79 | 0.58, 1.05 |
| Missing data | 0 | 0 | 2 | 1 | ||||
| Nonwhite | ||||||||
| Never user | 153 | 544 | 1 | Referent | 954 | 744 | 1 | Referent |
| Ever user | 11 | 15 | 2.82 | 1.05, 7.57 | 42 | 16 | 1.23 | 0.59, 2.59 |
| Missing data | 0 | 0 | 1 | 0 | ||||
Abbrevations: CI, confidence interval; INHANCE, International Head and Neck Cancer Epidemiology; NOS, not otherwise specified; OR, odds ratio; SCC, squamous cell carcinoma.
a The Boston study (14) (500 cases and 630 controls) was excluded from analyses of snuff use because information on snuff use was not available.
b Adjusted for sex, age (years), race/ethnicity (white, nonwhite), educational level (less than high school, high school or more), frequency of alcohol use (mL/day, truncated at the 95th percentile among alcohol drinkers to account for extreme values), duration of cigar smoking use (years), and duration of pipe smoking (years). ORs stratified by sex were not adjusted for sex. ORs stratified by race/ethnicity were not adjusted for race/ethnicity.
c Adjusted for the same variables as those for never cigarette smokers, plus duration of cigarette smoking (years).
d Hypopharynx analyses did not include the Seattle study (15, 18) because information on tumors of the hypopharynx was not reported in that study. Larynx analyses did not include the Seattle and US multicenter (16) studies because information on tumors of the larynx was not reported in those studies.
e Unstable estimate.