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  • br The present study has several strengths First we


    The present study has several strengths. First, we performed a po-pulation-based nested case-control study that included a relatively large number of African Americans and a low-income population, while most previous studies have been conducted among European- and Asian-descendants from populations with relatively higher socioeconomic statuses. As such, our results provide unique and important insights regarding features of oral health and lung cancer risk among the low-income Arachidonoyl 2\'-Chloroethylamide and among African Americans, who are at greater risk for both poor oral health and lung cancer. Second, the prospective design allows us to evaluate the potential causal associations between oral health and lung cancer. Third, comprehensive exposure data were collected from the SCCS participants that allowed us to adjust for po-tential confounders in the data analyses. The present study also has several limitations that warrant consideration. First, the information on oral health was self-reported. Because oral health information was collected before lung cancer diagnosis, however, the misclassification is likely to be small. Recent research has demonstrated that the accuracy of self-reported periodontal disease is moderate among postmenopausal women with the severe disease and who regularly visit a dentist [35]. Second, sample sizes are relatively small for European Americans and for some of the strata, such as for never smokers, and the point esti-mates may not be stable. Further studies are needed to confirm our findings.
    5. Conclusions
    Our findings indicate that poor oral health, as measured by tooth loss, tooth decay, and periodontal disease, is associated with an in-creased risk of lung cancer, and that this association is more evident among African Americans and heavy smokers. Based on our results, an increase in promoting oral health and tobacco cessation programs among African Americans and low-income populations in the United States could help reduce the incidence of lung cancer.
    Ethical approval
    All participants provided informed written consent before entering the study. The SCCS protocol was reviewed and approved by institu-tional review boards at Vanderbilt University and Meharry Medical College.
    Conflict of interest
    The authors declare no potential conflicts of interest.
    Data collection was performed by the Survey and Biospecimen Shared Resource which is supported in part by the Vanderbilt-Ingram Cancer Arachidonoyl 2\ Center (P30CA68485). The authors thank the study participants and research staff of the Southern Community Cohort Study for their con-tribution to this study. We thank Ms. Nan Kennedy and Dr. Mary Shannon Byers for assistance with editing and manuscript preparation.
    Data on SCCS cancer cases used in this publication were provided by the Alabama Statewide Cancer Registry; Kentucky Cancer Registry, Lexington, KY; Tennessee Department of Health, Office of Cancer Surveillance; Florida Cancer Data System; North Carolina Central Cancer Registry, North Carolina Division of Public Health; Georgia Comprehensive Cancer Registry; Louisiana Tumor Registry; Mississippi Cancer Registry; South Carolina Central Cancer Registry; Virginia Department of Health, Virginia Cancer Registry; Arkansas Department of Health, Cancer Registry, 4815 W. Markham, Little Rock, AR 72,205. The Arkansas Central Cancer Registry is fully funded by a grant from National Program of Cancer Registries, Centers for Disease Control and Prevention (CDC). Data on SCCS cancer cases from Mississippi were collected by the Mississippi Cancer Registry which participates in the National Program of Cancer Registries (NPCR) of the Centers for Disease Control and Prevention (CDC). The contents of this publication are solely the responsibility of the authors and do not necessarily re-present the official views of the CDC or the Mississippi Cancer Registry.
    [16] Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Disparities in Oral Health, (n.d.). (Accessed January 29, 2018).
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