Contribution of behavioral risk factors and obesity to socioeconomic differences in colorectal cancer incidence Journal Article


Authors: Doubeni, C. A.; Major, J. M.; Laiyemo, A. O.; Schootman, M.; Zauber, A. G.; Hollenbeck, A. R.; Sinha, R.; Allison, J.
Article Title: Contribution of behavioral risk factors and obesity to socioeconomic differences in colorectal cancer incidence
Abstract: 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 19951996 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. © 2012 The Author.
Keywords: adult; aged; middle aged; major clinical study; cancer risk; united states; follow up; follow-up studies; cancer incidence; prospective study; incidence; prevalence; risk factors; body weight; feeding behavior; health behavior; obesity; food habits; smoking; groups by age; risk assessment; self report; questionnaires; colorectal carcinoma; colorectal neoplasms; social status; questionnaire; body mass; body mass index; confounding factors (epidemiology); family history; invasive carcinoma; sex difference; educational status; sedentary lifestyle; health disparity; geographic distribution; high risk behavior; social class; risk-taking; residence characteristics
Journal Title: JNCI: Journal of the National Cancer Institute
Volume: 104
Issue: 18
ISSN: 0027-8874
Publisher: Oxford University Press  
Date Published: 2012-09-19
Start Page: 1353
End Page: 1362
Language: English
DOI: 10.1093/jnci/djs346
PROVIDER: scopus
PUBMED: 22952311
PMCID: PMC3529596
DOI/URL:
Notes: --- - "Cited By (since 1996): 1" - "Export Date: 2 November 2012" - "CODEN: JNCIA" - "Source: Scopus"
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  1. Ann G Zauber
    280 Zauber