{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T10:27:26Z","timestamp":1781605646530,"version":"3.54.5"},"reference-count":54,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007941","name":"Addis Ababa University","doi-asserted-by":"publisher","award":["6417"],"award-info":[{"award-number":["6417"]}],"id":[{"id":"10.13039\/501100007941","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001009","name":"Bristol Myers Squibb Foundation","doi-asserted-by":"publisher","award":["61329475"],"award-info":[{"award-number":["61329475"]}],"id":[{"id":"10.13039\/100001009","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: While smoking is the dominant global driver of lung cancer, less than a quarter of Ethiopian patients have ever smoked, pointing to locally relevant risk factors. Evidence to guide prevention and early detection in resource-limited settings is scanty. Methods: To address this gap, we conducted a multicenter matched case\u2013control study including 351 histopathologically confirmed primary lung cancer cases and 702 hospital-based controls matched by sex, age (\u00b15 years), and residence. Directed acyclic graphs informed the selection of variables, and multivariable hierarchical conditional logistic regression was used to identify risk factors beyond smoking. Results: The analysis shows that lung cancer was independently associated with low education, wealth, solid-fuel use, occupational exposure, insufficient physical activity, meat-based and processed food dietary patterns, secondhand smoke (SHS), prior tuberculosis, and family history of cancer. Subgroup analysis by sex revealed consistent associations across males and females, but exposure distributions explained sex-specific patterns: smoking, occupational exposure, meat-based diets, and family history were more common among males, whereas SHS, the use of solid fuels, and processed food dietary patterns predominated in females. Conclusions: Lung cancer in Ethiopia appears to be associated with several factors in addition to smoking. Gender-sensitive public health interventions targeting these locally relevant risk factors are essential for effective prevention and early detection.<\/jats:p>","DOI":"10.3390\/cancers18060914","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T14:46:31Z","timestamp":1773326791000},"page":"914","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Lung Cancer Risk Factors Beyond Smoking in Ethiopia: A Multicenter Matched Case\u2013Control Study"],"prefix":"10.3390","volume":"18","author":[{"given":"Nathan","family":"Estifanos","sequence":"first","affiliation":[{"name":"School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia"},{"name":"College of Medicine and Health Science, Wollo University, Dessie P.O. Box 1145, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gudina","family":"Egata","sequence":"additional","affiliation":[{"name":"School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4709-3606","authenticated-orcid":false,"given":"Adamu","family":"Addissie","sequence":"additional","affiliation":[{"name":"School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahel Argaw","family":"Kebede","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aschalew","family":"Worku","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amsalu","family":"Bekele","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biruk","family":"Habtamu","sequence":"additional","affiliation":[{"name":"Oncology Department, School of Medicine, College of Health Sciences, Haramaya University, Harar P.O. Box 235, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selam","family":"Tesfaye","sequence":"additional","affiliation":[{"name":"Department of Oncology, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma P.O. Box 378, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aman Yesuf","family":"Endries","sequence":"additional","affiliation":[{"name":"School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia"},{"name":"School of Public Health, St Paul\u2019s Hospital Millennium Medical College, Addis Ababa P.O. Box 1271, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zemzem","family":"Shigute","sequence":"additional","affiliation":[{"name":"International Institute of Social Studies (ISS), Erasmus University Rotterdam, P.O. Box 29776 The Hague, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anagaw Derseh","family":"Mebratie","sequence":"additional","affiliation":[{"name":"School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Getnet","family":"Alemu","sequence":"additional","affiliation":[{"name":"Institute of Development and Policy Research, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5659-6569","authenticated-orcid":false,"given":"Arjun S.","family":"Bedi","sequence":"additional","affiliation":[{"name":"International Institute of Social Studies (ISS), Erasmus University Rotterdam, P.O. Box 29776 The Hague, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Negussie","family":"Deyessa","sequence":"additional","affiliation":[{"name":"School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1038\/s41571-023-00798-3","article-title":"The Global Burden of Lung Cancer: Current Status and Future Trends","volume":"20","author":"Leiter","year":"2023","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_2","first-page":"229","article-title":"Global Cancer Statistics 2022: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. 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