Contribution of behavioral risk factors and obesity to socioeconomic differences in colorectal cancer incidence
Authors
Doubeni, Chyke A.Major, Jacqueline M.
Laiyemo, Adeyinka O.
Schootman, Mario
Zauber, Ann G.
Hollenbeck, Albert R.
Sinha, Rashmi
Allison, Jeroan J.
UMass Chan Affiliations
Department of Quantitative Health SciencesMeyers Primary Care Institute
Department of Family Medicine and Community Health
Document Type
Journal ArticlePublication Date
2012-09-19Keywords
Colorectal NeoplasmsSocioeconomic Factors
Health Behavior
Obesity
Behavior and Behavior Mechanisms
Community Health and Preventive Medicine
Epidemiology
Health Services Research
Neoplasms
Preventive Medicine
Primary Care
Metadata
Show full item recordAbstract
BACKGROUND:Health behaviors are known risk factors for colorectal cancer and are more common in low socioeconomic status (SES) populations. We evaluated the extent to which behavioral risk factors and body mass index (BMI) explain SES disparities in colorectal cancer incidence, overall and by tumor location. METHODS: We analyzed prospective National Institutes of Health-AARP Diet and Health Study data on 506 488 participants who were recruited in 1995-1996 from six US states and two metropolitan areas and followed through 2006. Detailed baseline data on risk factors for colorectal cancer, including health behaviors, were obtained using questionnaires. SES was measured by self-reported education and census-tract data. The outcome was primary incident invasive colorectal adenocarcinoma. Poisson regression was used to estimate the association between SES and risk of incident colorectal cancer, with adjustment for age, sex, race and ethnicity, family history, and state of residence. The model estimates were used to derive percentage mediation by behavioral risk factors; bias-corrected 95% confidence intervals were obtained through bootstrap techniques. RESULTS: Seven-thousand six-hundred seventy-six participants developed colorectal cancer during follow-up. SES differences in prevalence of physical inactivity, unhealthy diet, smoking, and unhealthy weight each explained between 11.3% (BMI) and 21.6% (diet) of the association between education and risk of colorectal cancer and between 8.6% (smoking) and 15.3% (diet) of the association between neighborhood SES and risk of colorectal cancer. Health behaviors and BMI combined explained approximately 43.9% (95% CI = 35.1% to 57.9%) of the association of education and 36.2% (95% CI = 28.0% to 51.2%) of the association of neighborhood SES with risk of colorectal cancer. The percentage explained by all factors and BMI combined was largest for right colon cancers and smallest for rectal cancers. CONCLUSION: A substantial proportion of the socioeconomic disparity in risk of new-onset colorectal cancer, and particularly of right colon cancers, may be attributable to the higher prevalence of adverse health behaviors in low-SES populations.Source
J Natl Cancer Inst. 2012 Sep 19;104(18):1353-62. Epub 2012 Sep 5. Link to article on publisher's site
DOI
10.1093/jnci/djs346Permanent Link to this Item
http://hdl.handle.net/20.500.14038/30902PubMed ID
22952311Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1093/jnci/djs346