Background
Methods
Study participants
Ascertainment of cancer incidence
Cancer-related risk factors
Risk Factor | Adherence Guideline | Adherence Score |
---|---|---|
Physical Activity (# of 20 min activities) | ≥5 per week | 1 |
≥1 per month - < 5 per week | 0.5 | |
<1 per month | 0 | |
Obesity (BMI) | ≥18.5 - ≤ 25 kg/m2
| 1 |
>25 - ≤ 30 kg/m2
| 0.5 | |
<18.5 or >30 kg/m2
| 0 | |
Alcohol Use (# drinks per week) | Women ≤7, Men ≤14 | 1 |
Women >7 - ≤ 14, Men >14 ≤ 28 | 0.5 | |
Women >14, Men >28 | 0 | |
Nutrition (Fruit and Vegetable Servings per day) | ≥5 | 1 |
≥3 - < 5 | 0.5 | |
<3 | 0 |
Statistical analysis
Results
Characteristics of study population
Overall | White | AA | |
---|---|---|---|
Age Category | |||
< 55 years | 64,491 (13.71%) | 61,318 (13.61%) | 3173 (16.13%) |
55-59 years | 106,893 (22.73%) | 101,588 (22.54%) | 5305 (26.96%) |
60-64 years | 132,005 (28.07%) | 126,108 (27.99%) | 5897 (29.97%) |
65-69 years | 150,255 (31.95%) | 145,423 (32.27%) | 4832 (24.56%) |
> =70 years | 16,656 (3.54%) | 16,186 (3.59%) | 470 (2.39%) |
Gender | |||
Male | 280,558 (59.66%) | 272,444 (60.46%) | 8114 (41.24%) |
Female | 189,742 (40.34%) | 178,179 (39.54%) | 11,563 (58.76%) |
Marital Status | |||
Married | 323,303 (69.11%) | 314,122 (70.05%) | 9181 (47.27%) |
Widowed | 51,660 (11.04%) | 48,293 (10.77%) | 3367 (17.34%) |
Divorced | 64,882 (13.87%) | 60,310 (13.45%) | 4572 (23.54%) |
Separated | 5483 (1.17%) | 4445 (0.99%) | 1038 (5.34%) |
Never Married | 22,508 (4.81%) | 21,244 (4.74%) | 1264 (6.51%) |
Education | |||
< 8 years | 27,821 (6.07%) | 25,646 (5.83%) | 2175 (11.66%) |
8-11 years | 93,358 (20.37%) | 89,446 (20.35%) | 3912 (20.98%) |
12 years/High School | 46,651 (10.18%) | 44,926 (10.22%) | 1725 (9.25%) |
Post-High School/Some College | 109,302 (23.85%) | 104,369 (23.74%) | 4933 (26.46%) |
College or post-grad | 181,132 (39.53%) | 175,231 (39.86%) | 5901 (31.65%) |
Health Status | |||
Excellent | 81,207 (17.50%) | 79,438 (17.86%) | 1769 (9.20%) |
Very good | 166,103 (35.80%) | 160,658 (36.13%) | 5445 (28.31%) |
Good | 160,182 (34.53%) | 152,225 (34.23%) | 7957 (41.37%) |
Fair | 48,823 (10.52%) | 45,256 (10.18%) | 3567 (18.55%) |
Poor | 7641 (1.65%) | 7145 (1.61%) | 496 (2.58%) |
State of Residence | |||
CA | 139,633 (29.69%) | 135,081 (29.98%) | 4552 (23.13%) |
FL | 100,509 (21.37%) | 98,147 (21.78%) | 2362 (12.00%) |
GA | 13,663 (2.91%) | 12,468 (2.77%) | 1195 (6.07%) |
LA | 18,225 (3.88%) | 16,901 (3.75%) | 1324 (6.73%) |
MI | 24,420 (5.19%) | 22,254 (4.94%) | 2166 (11.01%) |
NC | 39,889 (8.48%) | 37,678 (8.36%) | 2211 (11.24%) |
NJ | 60,484 (12.86%) | 57,755 (12.82%) | 2729 (13.87%) |
PA | 73,477 (15.62%) | 70,339 (15.61%) | 3138 (15.95%) |
Cancer Type | |||
Any Cancer | 114,392 (24.33%) | 109,971 (23.99%) | 4421 (22.47%) |
Breast Cancer | 12,698 (6.70%) | 12,020 (6.75%) | 678 (5,87%) |
Prostate Cancer | 30,664 (10.93%) | 29,222 (10.73%) | 1442 (17.77%) |
Colorectal Cancer | 10,300 (2.19%) | 9845 (2.19%) | 455 (2.31%) |
Adherence to cancer-related risk factors
Obesity | Alcohol | Smoking | Nutrition | Physical Activity | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
0 | 0.5 | 1 | 0 | 0.5 | 1 | 0 | 0.5 | 1 | 0 | 0.5 | 1 | 0 | 0.5 | 1 | |
Overall | 21.71 | 42.96 | 35.33 | 0.29 | 0.85 | 98.85 | 11.89 | 51.82 | 36.29 | 36.54 | 37.75 | 25.71 | 20.57 | 56.81 | 22.61 |
Gender | |||||||||||||||
Male | 20.47 | 49.87 | 29.66 | 0.40 | 1.15 | 98.45 | 10.37 | 59.29 | 30.34 | 35.40 | 38.17 | 26.43 | 16.91 | 58.25 | 24.84 |
Female | 23.59 | 32.49 | 43.92 | 0.13 | 0.40 | 99.47 | 14.20 | 40.49 | 45.31 | 38.26 | 37.13 | 24.61 | 26.13 | 54.63 | 19.24 |
Race | |||||||||||||||
White | 21.21 | 42.96 | 35.83 | 0.29 | 0.85 | 98.86 | 11.74 | 52.10 | 36.15 | 36.73 | 38.07 | 25.20 | 20.27 | 56.95 | 22.78 |
AA | 34.27 | 42.99 | 22.74 | 0.34 | 0.92 | 98.74 | 15.58 | 44.74 | 39.68 | 31.85 | 29.87 | 38.28 | 28.10 | 53.37 | 18.53 |
Region | |||||||||||||||
Midwest | 26.46 | 42.98 | 30.55 | 0.35 | 0.79 | 98.87 | 13.19 | 50.95 | 35.86 | 36.91 | 37.37 | 25.72 | 24.21 | 56.97 | 18.81 |
North East | 23.58 | 44.34 | 32.09 | 0.26 | 0.76 | 98.97 | 11.69 | 50.45 | 37.86 | 33.38 | 38.61 | 28.01 | 23.70 | 56.48 | 19.83 |
South | 20.95 | 43.20 | 35.85 | 0.33 | 0.96 | 98.71 | 12.92 | 52.97 | 34.11 | 38.96 | 36.90 | 24.15 | 19.58 | 57.01 | 23.41 |
West | 20.11 | 41.38 | 38.51 | 0.29 | 0.89 | 98.83 | 10.60 | 51.83 | 37.56 | 36.46 | 38.07 | 25.47 | 18.27 | 56.86 | 24.87 |
Race-Gender | |||||||||||||||
White Males | 20.27 | 49.87 | 29.85 | 0.40 | 1.14 | 98.46 | 10.23 | 59.41 | 30.36 | 35.44 | 38.38 | 26.18 | 16.73 | 58.31 | 24.96 |
White Females | 22.66 | 32.16 | 45.18 | 0.12 | 0.40 | 99.48 | 14.12 | 40.68 | 45.21 | 38.74 | 37.59 | 23.67 | 25.81 | 54.82 | 19.37 |
AA Males | 27.55 | 49.68 | 22.76 | 0.45 | 1.52 | 98.03 | 15.50 | 54.89 | 29.61 | 34.01 | 30.66 | 35.33 | 23.46 | 56.04 | 20.50 |
AA Females | 39.22 | 38.06 | 22.72 | 0.25 | 0.48 | 99.27 | 15.63 | 37.26 | 47.10 | 30.27 | 29.29 | 40.44 | 31.52 | 51.39 | 17.09 |
Adherence to guidelines and cancer incidence
Any Cancer HR (95% CI) | Breast Cancer HR (95% CI) | Prostate Cancer HR (95% CI) | Colorectal Cancer HR (95% CI) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
All | White | AA | All | White | AA | All | White | AA | All | White | AA | |
Obesity | ||||||||||||
0 | 1.08 (1.06 -1.1) | 1.08 (1.06 - 1.1) | 0.91 (0.83 - 0.99) | 1.16 (1.1 - 1.22) | 1.14 (1.09 - 1.2) | 1.1 (0.89 - 1.37) | 0.87 (0.84-0.89) | 0.87 (0.84 -.89) | 0.89 (0.76 - 1.03) | 1.3 (1.22 - 1.38) | 1.29 (1.2-1.37) | 1.09 (0.83 - 1.43) |
0.5 | 1.04 (1.03 -1.05) | 1.04 (1.03 -1.05) | 0.95 (0.91 - 0.99) | 1.08 (1.05 - 1.1) | 1.07 (1.04 -1.09) | 1.05 (0.94 - 1.17) | 0.93 (0.91-0.95) | 0.93 (0.92 -0.95) | 0.94 (0.87 - 1.02) | 1.14 (1.11 -1.17) | 1.14 (1.11 -1.17) | 1.04 (0.91 - 1.2) |
P-trend
|
<0.001
|
<0.001
|
0.031
|
<0.001
|
<0.001
|
0.3713
|
<0.001
|
<0.001
|
0.1258
|
<0.001
|
<0.001
|
0.53
|
Alcohol | ||||||||||||
0 | 1.55 (1.43 -1.68) | 1.54 (1.44 -1.66) | 1.64 (1.16 - 2.31) | 1.78 (1.26 - 2.51) | 1.5 (1.07 - 2.09) | 2.71 (1.06 - 6.9) | 1.08 (0.92 -1.27) | 1.04 (0.89 - 1.2) | 1.05 (0.56 - 1.95) | 2.02 (1.59 -2.58) | 1.99 (1.59 -2.47) | 3.64 (1.6 - 8.27) |
0.5 | 1.24 (1.19 -1.29) | 1.24 (1.2 -1.29) | 1.28 (1.08 - 1.52) | 1.33 (1.12 - 1.59) | 1.22 (1.04 -1.45) | 1.64 (1.03 - 2.63) | 1.04 (0.96 -1.13) | 1.02 (0.94 - 1.1) | 1.02 (0.75 - 1.4) | 1.42 (1.26 -1.61) | 1.41 (1.26 -1.57) | 1.91 (1.27 - 2.88) |
P-trend
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
0.01763
|
0.037
|
0.359
|
0.65
|
0.89
|
<0.001
|
<0.001
|
0.0036
|
Smoking | ||||||||||||
0 | 1.68 (1.65 -1.72) | 1.7 (1.67 - 1.74) | 1.63 (1.49 - 1.79) | 1.11 (1.05 - 1.18) | 1.12 (1.06 -1.18) | 1.28 (1.02 - 1.6) | 0.83 (0.79 -0.86 | 0.82 (0.79 - .86) | 0.88 (0.75 - 1.05) | 1.41 (1.32 -1.51) | 1.42 (1.33 -1.51) | 1.3 (0.97 - 1.73) |
0.5 | 1.3 (1.28 -1.31) | 1.31 (1.29 -1.32) | 1.28 (1.22 - 1.34) | 1.06 (1.03 - 1.09) | 1.06 (1.03 -1.09) | 1.13 (1.01 - 1.27) | 0.91 (0.89-0.93) | 0.91 (0.89 -0.93) | 0.94 (0.86 - 1.02) | 1.19 (1.15 -1.23) | 1.19 (1.15 -1.23) | 1.14 (0.99 -1.31) |
P-trend
|
0
|
0
|
<0.001
|
<0.001
|
<0.001
|
0.033
|
<0.001
|
<0.001
|
0.1589
|
<0.001
|
<0.001
|
0.07298
|
Nutrition | ||||||||||||
0 | 1.11 (1.09 -1.13) | 1.11 (1.1 - 1.13) | 1.09 (1.01 - 1.17) | 1.07 (1.01 - 1.12) | 1.07 (1.02 -1.12) | 1.13 (0.94 - 1.37) | 1.02 (0.99 -1.05) | 1.02 (0.99 -1.05) | 0.93 (0.82 - 1.06) | 1.13 (1.07 -1.19) | 1.13 (1.08 - 1.2) | 1.15 (0.92 - 1.44) |
0.5 | 1.05 (1.04 -1.06) | 1.05 (1.05 -1.06) | 1.04 (1.01 - 1.08) | 1.03 (1.01 - 1.06) | 1.04 (1.01 -1.06) | 1.06 (0.97 - 1.17) | 1.01 (0.99 -1.03) | 1.01 (0.99 -1.03) | 0.96 (0.91 - 1.03) | 1.06 (1.03 -1.09) | 1.07 (1.04 -1.09) | 1.07 (0.95 - 1.2) |
P-trend
|
<0.001
|
<0.001
|
0.025
|
0.01495
|
0.004
|
0.199
|
0.254
|
0.174
|
0.2847
|
<0.001
|
<0.001
|
0.2305
|
Physical Activity | ||||||||||||
0 | 1.15 (1.13 -1.18) | 1.15 (1.13 -1.17) | 1.18 (1.07 - 1.3) | 1.12 (1.05 - 1.19) | 1.11 (1.05 -1.18) | 1.28 (0.99 - 1.67) | 0.94 (0.90-0.97) | 0.92 (0.88 -0.95) | 1.04 (0.87 - 1.24) | 1.33 (1.24 -1.42) | 1.35 (1.26 -1.44) | 1.15 (0.85 -1.56) |
0.5 | 1.07 (1.06 -1.09) | 1.07 (1.06 -1.08) | 1.09 (1.03 - 1.14) | 1.06 (1.03 - 1.09) | 1.05 (1.02 -1.09) | 1.13 (0.99 - 1.29) | 0.97 (0.95-0.99) | 0.96 (0.94 -0.98) | 1.02 (0.93 - 1.11) | 1.15 (1.11 -1.19) | 1.16 (1.12 - 1.2) | 1.07 (0.92 - 1.25) |
P-trend
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
0.063
|
0.001
|
<0.001
|
0.68
|
<0.001
|
<0.001
|
0.3624
|
Overall Adherence | ||||||||||||
1 | 1.76 (1.7 -1.82) | 1.76 (1.7 - 1.82) | 1.69 (1.42 - 2) | 1.38 (1.26 - 1.52) | 1.38 (1.25 -1.52) | 1.45 (0.93 - 2.25) | 0.79 (0.75-0.85) | 0.70 (0.74 -0.84) | 0.98 (0.73 - 1.33) | 2.06 (1.84 -2.29) | 2.07 (1.86 -2.32) | 1.64 (0.96 - 2.79) |
2 | 1.53 (1.49 -1.56) | 1.53 (1.49 -1.57) | 1.48 (1.3 - 1.68) | 1.28 (1.19 - 1.37) | 1.27 (1.19 -1.37) | 1.32 (0.95 - 1.84) | 0.84 (0.80-0.88) | 0.84 (0.79 -0.88) | 0.98 (0.79 - 1.24) | 1.72 (1.58 -1.86) | 1.73 (1.59 -1.88) | 1.45 (0.97- 2.16) |
3 | 1.33 (1.3 -1.35) | 1.33 (1.31 -1.35) | 1.31 (1.19 - 1.42) | 1.18 (1.12 - 1.23) | 1.18 (1.12 -1.23) | 1.2 (0.96 - 1.5) | 0.89 (0.86-0.92) | 0.89 (0.86 -0.92) | 0.99 (0.85 - 1.15) | 1.43 (1.36 -1.51) | 1.44 (1.36 -1.52) | 1.28 (0.98 - 1.67) |
4 | 1.15 (1.14 -1.16) | 1.15 (1.14 -1.16) | 1.14 (1.09 - 1.19) | 1.08 (1.06 - 1.11) | 1.08 (1.06 -1.11) | 1.1 (0.98 - 1.23) | 0.94 (0.93-0.96) | 0.94 (0.93 -0.96) | 0.99 (0.92 - 1.07) | 1.2 (1.17 - 1.23) | 1.2 (1.17 - 1.23) | 1.13 (0.99 - 1.29) |
P-trend
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
0.101
|
<0.001
|
<0.001
|
0.9207
|
<0.001
|
<0.001
|
0.06741
|
Adherence | All | Mid-West | North East | South | West |
---|---|---|---|---|---|
Any Cancer | |||||
1 | 1.88 (1.82 - 1.95) | 1.84 (1.59 - 2.14) | 2.03 (1.91 - 2.17) | 1.98 (1.87 - 2.10) | 1.64 (1.54 - 1.75) |
2 | 1.61 (1.57 - 1.65) | 1.58 (1.41 - 1.77) | 1.70 (1.63 - 1.79) | 1.67 (1.60 - 1.75) | 1.45 (1.38 - 1.52) |
3 | 1.37 (1.35 - 1.4) | 1.36 (1.26 - 1.46) | 1.43 (1.38 - 1.47) | 1.41 (1.37 - 1.45) | 1.28 (1.24 - 1.32) |
4 | 1.17 (1.16 - 1.18) | 1.17 (1.12 - 1.21) | 1.19 (1.18 - 1.21) | 1.19 (1.17 - 1.20) | 1.13 (1.11 - 1.15) |
5 | Ref | Ref | Ref | Ref | Ref |
Breast Cancer | |||||
1 | 1.44 (1.30 - 1.59) | 2.03 (1.32 - 3.12) | 1.53 (1.26 - 1.85) | 1.36 (1.15 - 1.61) | 1.38 (1.16 - 1.64) |
2 | 1.31 (1.22 - 1.42) | 1.70 (1.23 - 2.35) | 1.37 (1.19 - 1.59) | 1.26 (1.11 - 1.43) | 1.27 (1.12 - 1.45) |
3 | 1.20 (1.14 - 1.26) | 1.42 (1.15 - 1.77) | 1.24 (1.12 - 1.36) | 1.17 (1.07 - 1.27) | 1.17 (1.08 - 1.28) |
4 | 1.10 (1.07 - 1.12) | 1.19 (1.07 - 1.33) | 1.11 (1.06 - 1.17) | 1.08 (1.04 - 1.13) | 1.08 (1.04 - 1.13) |
5 | Ref | Ref | Ref | Ref | Ref |
Prostate Cancer | |||||
1 | 0.77 (0.72 - 0.83) | 0.82 (0.62 - 1.08) | 0.77 (0.68 - 0.87) | 0.79 (0.71 - 0.89) | 0.75 (0.66 - 0.85) |
2 | 0.82 (0.78 - 0.87) | 0.86 (0.70 - 1.06) | 0.83 (0.75 - 0.90) | 0.84 (0.77 - 0.91) | 0.80 (0.73 - 0.88) |
3 | 0.88 (0.85 - 0.91) | 0.91 (0.79 - 1.04) | 0.88 (0.83 - 0.94) | 0.89 (0.84 - 0.94) | 0.86 (0.81 - 0.92) |
4 | 0.94 (0.92 - 0.95) | 0.95 (0.89 - 1.02) | 0.94 (0.91 - 0.97) | 0.94 (0.92 - 0.97) | 0.93 (0.90 - 0.96) |
5 | Ref | Ref | Ref | Ref | Ref |
Colorectal Cancer | |||||
1 | 2.24 (2.00 - 2.52) | 3.43 (2.00 - 5.88) | 2.64 (2.16 - 3.24) | 2.27 (1.87 - 2.75) | 1.72 (1.39 - 2.14) |
2 | 1.83 (1.68 – 2.00) | 2.52 (1.68 - 3.78) | 2.07 (1.78 - 2.41) | 1.85 (1.60 - 2.13) | 1.50 (1.28 - 1.77) |
3 | 1.50 (1.41 - 1.59) | 1.85 (1.42 - 2.42) | 1.63 (1.47 - 1.80) | 1.51 (1.37 - 1.66) | 1.31 (1.18 - 1.46) |
4 | 1.22 (1.19 - 1.26) | 1.36 (1.19 - 1.56) | 1.27 (1.21 - 1.34) | 1.23 (1.17 - 1.29) | 1.15 (1.09 - 1.21) |
5 | Ref | Ref | Ref | Ref | Ref |