Studies have persistently associated esophageal squamous cell carcinoma (ESCC) risk with low socioeconomic status (SES), but this association is unexplored in Kashmir, an area with a high incidence of ESCC in the northernmost part of India. We carried out a case-control study to assess the association of multiple indicators of SES and ESCC risk in the Kashmir valley. A total number of 703 histologically confirmed ESCC cases and 1664 controls matched to the cases for age, sex, and district of residence were recruited from October 2008 to January 2012. Conditional logistic regression models were used to calculate unadjusted and adjusted odds ratios and 95% confidence intervals. Composite wealth scores were constructed based on the ownership of several appliances using multiple correspondence analyses. Higher education, living in a kiln brick or concrete house, use of liquefied petroleum gas and electricity for cooking, and higher wealth scores all showed an inverse association with ESCC risk. Compared to farmers, individuals who had government jobs or worked in the business sector were at lower risk of ESCC, but this association disappeared in fully adjusted models. Occupational strenuous physical activity was strongly associated with ESCC risk. In summary, we found a strong relationship of low SES and ESCC in Kashmir. The findings need to be studied further to understand the mechanisms through which such SES parameters increase ESCC risk. (Cancer Sci 2013; 104: 1231-1236 E sophageal cancer is the sixth most common cause of cancer deaths in the world, (1) but approximately 83% of its incident cases and 86% of deaths occur in developing countries.(1) There are two main forms of esophageal cancer, squamous cell carcinoma and adenocarcinoma.(2) Esophageal squamous cell carcinoma is the most common histological type of esophageal cancer globally (3) and constitutes 90% of cases in the high-risk region in Central Asia, often referred to as the "esophageal cancer belt".(3-5) Because of the high incidence and poor prognosis, ESCC contributes significantly to the cancer burden in the belt and some other high-incidence countries.(6) However, the etiology of ESCC is yet an open question in these areas.Studies have reported an association between low SES and ESCC.(5,7-12) Although low SES is not a biological cause of cancer, it may influence the risk through behavior, lifestyle, environmental exposure, and diet. Low SES may also be a measure of access to the basic resources required to achieve and maintain good health. (13) ESCC is the most common cancer in Kashmir, (14,15) a part of northern most India and the Asian esophageal cancer belt. Although the SES of the population in the region is generally low, (16) no study from Kashmir has investigated in detail the association between low SES and ESCC. Hence, we carried out a case-control study to examine this association. Many factors, including income, profession, housing, and education can determine SES.(17) Therefore, as recommended in previous reports, (18,19) we selected...