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    2020-08-14


    References
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    Contents lists available at ScienceDirect
    Lung Cancer
    journal homepage: www.elsevier.com/locate/lungcan
    Association of oral health with lung cancer risk in a low-income 6-NBDG T of African Americans and European Americans in the Southeastern United States
    Hyung-Suk Yoon, Wanqing Wen, Jirong Long, Wei Zheng, William J. Blot, Qiuyin Cai
    Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee, 37203, USA
    Keywords:
    Lung cancer
    Oral health
    Tooth loss
    Tooth decay
    Periodontal disease
    Health disparities 
    Objectives: Previous studies have suggested that poor oral health might increase the risk of lung cancer among European- and Asian- descendants. The association has not been investigated among African Americans or so-cially disadvantaged populations. In this nested case-control study, we investigated whether oral health was associated with lung cancer risk among a low-income population of African Americans and European Americans in the Southeastern United States.
    Materials and methods: A total of 403 incident lung cancer cases and 1612 matched controls from the Southern Community Cohort Study were included. Multivariate conditional logistic regression models were fitted to evaluate the risk of lung cancer linked to tooth loss, tooth decay, and history of periodontal 6-NBDG disease.
    Conclusion: Poor oral health is associated with increased lung cancer risk, and this association appears to vary by race and smoking behavior among a low-income population of African Americans and European Americans in the Southeastern United States.
    1. Introduction
    Lung cancer accounts for approximately 13% of all cancer diagnoses in the United States [1]. The vast majority of lung cancer is attributed to cigarette smoking, but other factors, including radon exposure, air pollution, and dietary habits, are also involved in lung cancer etiology [2,3]. Recently, oral health has been hypothesized as a putative risk indicator in lung cancer. Several studies have suggested that poor oral health is associated with increased risk of lung cancer in European- and Asian- descendants [4–8]. Oral bacterial infections, which induce in-flammation of the gums and tooth loss [9], can progress to systemic inflammation [10] and the generation of nitrosamines [11], an ag-gravation that may be linked to an incremental increased risk of de-veloping various chronic diseases [12], as well as cancers [13]. Fur-thermore, poor oral health is often the result of smoking [14] and/or limited access to regular dental care [15], suggesting that poor oral
    health, especially among socioeconomically disadvantaged populations [16], may predispose them to a greater likelihood of developing lung cancer.
    The association of poor oral health with lung cancer risk has not been investigated among African Americans or among socially dis-advantaged populations. African Americans experience a higher in-cidence of lung cancer than other racial groups [17]. In addition, African Americans are at higher risk for poor oral health. Thus, in the present study, we focused on racial disparities in poor oral health and lung cancer risk. We conducted a nested case-control study within the Southern Community Cohort Study (SCCS), which includes a low-in-come population (half of the SCCS participants have annual household incomes of less than the US $15,000) and a large population of African Americans (two-thirds of the SCCS participants) living in the south-eastern United States. Our objective was to evaluate whether oral health status is associated with lung cancer risk, and whether race and