TY - JOUR
T1 - Mediating effects of cancer risk factors on the association between race and cancer incidence
T2 - analysis of the NIH-AARP Diet and Health Study
AU - Akinyemiju, Tomi
AU - Moore, Justin Xavier
AU - Pisu, Maria
N1 - Funding Information:
Dr. Akinyemiju was supported by grant P30AG031054 from the Deep South Resource Center for Minority Aging Research (RCMAR) and grant K01TW010271 from the NIH . Dr. Moore received grant support from grants R25 CA47888 , T32190194 (Colditz) and also supported by the foundation for Barnes Jewish Hospital and by Siteman Cancer Center from the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.
Funding Information:
Dr. Akinyemiju was supported by grant P30AG031054 from the Deep South Resource Center for Minority Aging Research (RCMAR) and grant K01TW010271 from the NIH. Dr. Moore received grant support from grants R25 CA47888, T32190194 (Colditz) and also supported by the foundation for Barnes Jewish Hospital and by Siteman Cancer Center from the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.
Funding Information:
This research was supported in part by the Intramural Research Program of the NIH, National Cancer Institute. Cancer incidence data from the Atlanta metropolitan area were collected by the Georgia Center for Cancer Statistics, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia. Cancer incidence data from California were collected by the California Cancer Registry, California Department of Public Health's Cancer Surveillance and Research Branch, Sacramento, California. Cancer incidence data from the Detroit metropolitan area were collected by the Michigan Cancer Surveillance Program, Community Health Administration, Lansing, Michigan. The Florida cancer incidence data used in this report were collected by the Florida Cancer Data System (Miami, Florida) under contract with the Florida Department of Health, Tallahassee, Florida. The views expressed herein are solely those of the authors and do not necessarily reflect those of the FCDC or FDOH. Cancer incidence data from Louisiana were collected by the Louisiana Tumor Registry, Louisiana State University Health Sciences Center School of Public Health, New Orleans, Louisiana. Cancer incidence data from New Jersey were collected by the New Jersey State Cancer Registry, The Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey. Cancer incidence data from North Carolina were collected by the North Carolina Central Cancer Registry, Raleigh, North Carolina. Cancer incidence data from Pennsylvania were supplied by the Division of Health Statistics and Research, Pennsylvania Department of Health, Harrisburg, Pennsylvania. The Pennsylvania Department of Health specifically disclaims responsibility for any analyses, interpretations, or conclusions. Cancer incidence data from Arizona were collected by the Arizona Cancer Registry, Division of Public Health Services, Arizona Department of Health Services, Phoenix, Arizona. Cancer incidence data from Texas were collected by the Texas Cancer Registry, Cancer Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas. Cancer incidence data from Nevada were collected by the Nevada Central Cancer Registry, Division of Public and Behavioral Health, State of Nevada Department of Health and Human Services, Carson City, Nevada. The authors are indebted to the participants in the NIH-AARP Diet and Health Study for their outstanding cooperation. The authors also thank Sigurd Hermansen and Kerry Grace Morrissey from Westat for study outcomes ascertainment and management and Leslie Carroll at Information Management Services for data support and analysis.
Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2018/1
Y1 - 2018/1
N2 - Purpose: Racial disparities exist in the prevalence of cancer-related risk factors and incidence of cancer. The objective of this study is to determine if cancer-related risk factors mediate the association between race and cancer incidence. Methods: We performed prospective analysis of data from the National Institutes of Health–American Association of Retired Persons Diet and Health Study, years 1995 through 2011. We compared differences in baseline characteristics between black and white participants using χ 2 tests and Wilcoxon tests, as appropriate. We determined risk of any cancer and the most common cancer types (i.e., breast, prostate, and colorectal) using Cox Proportional hazards models, adjusted for age, sex, marital status, education, health status, region, and adherence to guidelines on cancer-related risk factors (i.e., body mass index [BMI], smoking status, physical activity, nutrition, and alcohol consumption). We examined the mediation effect of cancer-related risk factors on the association between race and cancer incidence. Results: Among 425,152 participants, 16,110 (3.79%) were black, and 409,042 (96.21%) were white. The white participants were more likely to be aged 65 years and older (35.33% vs. 25.93%), male (60.88% vs. 42.67%), married (70.37% vs. 48.26%), reside in Western US (30.14% vs. 23.88%), be physically active (46.72% vs. 41.94%), and have higher adherence scores (3.14 vs. 3.04). Blacks had reduced risk of breast cancer (adjusted hazard ratio [HR]: 0.82, 95% confidence intervals [CI]: 0.74–0.90) but higher risk of prostate (adjusted HR: 1.86, 95% CI: 1.75–1.98) and colorectal cancer (adjusted HR: 1.17, 95% CI: 1.05–1.31) compared with whites. Nutrition mediated the association between race and breast cancer (6.35% mediated, P <.01), whereas BMI mediated the association between race and colorectal cancer (7.99% mediated, P <.01). Conclusions: Blacks were at reduced risk of breast cancer but increased risks for prostate and colorectal cancer incidence. Nutrition and BMI exerted small but significant mediating effects on the racial disparity in risk of breast and colorectal cancers, respectively.
AB - Purpose: Racial disparities exist in the prevalence of cancer-related risk factors and incidence of cancer. The objective of this study is to determine if cancer-related risk factors mediate the association between race and cancer incidence. Methods: We performed prospective analysis of data from the National Institutes of Health–American Association of Retired Persons Diet and Health Study, years 1995 through 2011. We compared differences in baseline characteristics between black and white participants using χ 2 tests and Wilcoxon tests, as appropriate. We determined risk of any cancer and the most common cancer types (i.e., breast, prostate, and colorectal) using Cox Proportional hazards models, adjusted for age, sex, marital status, education, health status, region, and adherence to guidelines on cancer-related risk factors (i.e., body mass index [BMI], smoking status, physical activity, nutrition, and alcohol consumption). We examined the mediation effect of cancer-related risk factors on the association between race and cancer incidence. Results: Among 425,152 participants, 16,110 (3.79%) were black, and 409,042 (96.21%) were white. The white participants were more likely to be aged 65 years and older (35.33% vs. 25.93%), male (60.88% vs. 42.67%), married (70.37% vs. 48.26%), reside in Western US (30.14% vs. 23.88%), be physically active (46.72% vs. 41.94%), and have higher adherence scores (3.14 vs. 3.04). Blacks had reduced risk of breast cancer (adjusted hazard ratio [HR]: 0.82, 95% confidence intervals [CI]: 0.74–0.90) but higher risk of prostate (adjusted HR: 1.86, 95% CI: 1.75–1.98) and colorectal cancer (adjusted HR: 1.17, 95% CI: 1.05–1.31) compared with whites. Nutrition mediated the association between race and breast cancer (6.35% mediated, P <.01), whereas BMI mediated the association between race and colorectal cancer (7.99% mediated, P <.01). Conclusions: Blacks were at reduced risk of breast cancer but increased risks for prostate and colorectal cancer incidence. Nutrition and BMI exerted small but significant mediating effects on the racial disparity in risk of breast and colorectal cancers, respectively.
KW - Cancer incidence
KW - Mediation
KW - Racial disparities
KW - Risk factors
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U2 - 10.1016/j.annepidem.2017.11.003
DO - 10.1016/j.annepidem.2017.11.003
M3 - Article
C2 - 29217211
AN - SCOPUS:85036644465
SN - 1047-2797
VL - 28
SP - 33-40.e2
JO - Annals of Epidemiology
JF - Annals of Epidemiology
IS - 1
ER -
