Abstract Alcohol consumption is a modifiable risk factor for several cancers. Previous studies have also shown a positive association between alcohol and cancer progression, recurrence and cancer-related death. Few studies have been conducted to characterize alcohol consumption patterns among cancer survivors compared to cancer-free individuals. This cross-sectional study combined data from NHANES between 1999-2016 to compare alcohol consumption behaviors among adults with a history of cancer to cancer-free population controls. Multinomial logistic regression was used to calculate the adjusted odds ratios (aOR) and 95% confidence intervals (CI) of drinking status among survivors (former drinkers; current drinkers; never drinkers) compared to controls. Multivariable logistic regression models were also used within current drinkers to calculate the adjusted odds of binge drinking and exceeding moderate drinking. Models were adjusted for demographic and socioeconomic factors. A total of 3,113 survivors and 39,527 controls were included. Compared with controls, survivors were less likely to be current drinkers (63.4% vs. 72.6% in controls) and were more likely to be former drinkers (24.4% vs. 15.5% in controls). The odds of being current drinkers vs. never drinkers was significantly lower among survivors compared with controls (aOR: 0.84, 95% CI: 0.71-0.99, p-value: 0.04), while no significant odds of being former drinkers vs. never drinkers was observed. When comparing survivors to controls by cancer type, breast cancer survivors had lower odds of being current drinkers vs. never drinkers (aOR: 0.67, 95% CI: 0.51-0.88, p-value<0.01), and they also had significant lower odds of binge drinking when compared with controls (aOR: 0.43, 95% CI: 0.20-0.95, p-value: 0.04). Prostate cancer survivors had higher odds of being current drinker vs. never drinker compared with controls; however, the result was not significant (aOR: 1.33, 95% CI: 0.92-2.11, p-value: 0.18) and the multivariable logistic regression models showed that current drinkers had lower odds of being exceeding moderate drinkers (aOR:0.71, 95% CI: 0.50-1.00, p-value: 0.05) and being binge drinkers (aOR: 0.35, 95% CI: 0.16-0.74, p-value<0.01) compared with controls. We also observed significant higher odds of being binge drinkers among cervical cancer survivors (aOR:2.51, 95% CI: 1.27-4.92, p-value<0.01). No significant association between cancer status and drinking behaviors were observed by the number of cancers diagnosed and the years since diagnosis. Our findings suggest that cancer survivors are at lower odds of being current drinkers when compared with cancer-free population controls. Given the high odds of binge drinking among cervical cancer survivors, public health strategies are needed to reduce alcohol consumption in this group. Citation Format: Junrui Lyu, Maneet Kaur, Avonne E. Connor. A national study of alcohol consumption patterns among population-based U.S. cancer survivors compared with cancer-free controls [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB089.
Importance The associations of changes in sleep patterns with incident cardiovascular disease (CVD) are not fully elucidated, and whether these associations are modified by genetic susceptibility remains unknown. Objectives To investigate the associations of 5-year changes in sleep patterns with incident CVD and whether genetic susceptibility modifies these associations. Design, Setting, and Participants This prospective cohort study of the Dongfeng-Tongji cohort was conducted from 2008 to 2018 in China. Eligible participants included those with complete sleep information at baseline survey (2008-2010) and the first follow-up survey (2013); participants who had no CVD or cancer in 2013 were prospectively assessed until 2018. Statistical analysis was performed in November 2023. Exposures Five-year changes in sleep patterns (determined by bedtime, sleep duration, sleep quality, and midday napping) between 2008 and 2013, and polygenic risk scores (PRS) for coronary heart disease (CHD) and stroke. Main Outcomes and Measures Incident CVD, CHD, and stroke were identified from 2013 to 2018. Cox proportional hazards regression models were applied to estimate hazard ratios (HRs) and 95% CIs. Results Among 15 306 individuals (mean [SD] age, 65.8 [7.4] years; 8858 [57.9%] female and 6448 male [42.1%]), 5474 (35.78%) had persistent unfavorable sleep patterns and 3946 (25.8%) had persistent favorable sleep patterns. A total of 3669 incident CVD cases were documented, including 2986 CHD cases and 683 stroke cases, over a mean (SD) follow-up of 4.9 (1.5) years. Compared with those with persistent unfavorable sleep patterns, individuals with persistent favorable sleep patterns over 5 years had lower risks of incident CVD (HR, 0.80; 95% CI, 0.73-0.87), CHD (HR, 0.84; 95% CI, 0.76-0.92), and stroke (HR, 0.66; 95% CI, 0.54-0.82) in the subsequent 5-year period. No significant effect modification by PRS was observed for sleep pattern change and CHD or stroke risk. However, sleep pattern changes and PRS were jointly associated with the CHD and stroke risk in a dose-dependent manner, with the lowest risk being among those with persistent favorable sleep patterns combined with low PRS (HR for CHD, 0.65; 95% CI, 0.52-0.82 and HR for stroke, 0.48; 95% CI, 0.29-0.79). Conclusions and Relevance In this cohort study of middle-aged and older Chinese adults, individuals with persistent favorable sleep patterns had a lower CVD risk, even among those with higher genetic risk. These findings highlight the importance of maintaining favorable sleep patterns for CVD prevention.
Objective: To analyze the trend of mortality and incidence of colorectal cancer among urban residents in Guangzhou from 1972 to 2015 and to predict the mortality of colorectal cancer from 2016 to 2025. Methods: The mortality data of colorectal cancer among urban residents in Guangzhou were collected from the death registration of malignant tumors of Guangzhou Health Statistics Bureau (1972-1979), Guangzhou Health Statistics (1980-2001), Guangzhou Cancer Registration Annual Report (2002-2009) and China Cancer Registration Annual Report (2010-2015). The incidence of colorectal cancer was collected from Guangzhou Cancer Registration Annual Report (2002-2009) and China Cancer Registration Annual Report (2010-2015). The incidence and mortality data of colorectal cancer coded as C18-C21 in 10th Edition of International Classification of Diseases (ICD-10) were obtained from the above data, and the demographic data were from the Guangzhou Municipal Bureau of Statistics. Joinpoint model was used to calculate the annual change percentage (APC) and average annual change percentage (AAPC) of colorectal cancer mortality and incidence among urban residents in Guangzhou from 1972 to 2015 and from 2002 to 2015. ARIMA model was used to predict colorectal cancer mortality from 2016 to 2025. Results: There were 19 309 colorectal cancer deaths among urban residents in Guangzhou from 1972 to 2015. The crude mortality rate of colorectal cancer increased from 4.33/100 000 to 24.89/100 000 (AAPC=4.2%, P<0.001). A total of 24 033 new cases of colorectal cancer were reported in Guangzhou from 2002 to 2015. The crude incidence rate of colorectal cancer increased from 22.95/100 000 to 52.81/100 000 (AAPC=6.6%, P<0.001). The mortality rate of colorectal cancer among urban residents of Guangzhou would continuously increase from 2016 to 2025 and reach 29.53/100 000 in 2025. Conclusion: The mortality rate of colorectal cancer among urban residents of Guangzhou from 1972 to 2015 and the incidence rate of colorectal cancer from 2002 to 2015 both show an upward trend. The mortality rate will increase from 2016 to 2025.
Abstract Purpose. Cancer survivors are more likely to report having a poor health status when compared to the general population; however, few studies have focused on the impact of cancer on perceived health status, in combination with other healthcare utilization and access outcomes, among women from disadvantaged health populations.Methods. 25,741 women with and without a history of cancer from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2016 contributed data. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression models for the associations between cancer status and healthcare utilization and access outcomes. Models were stratified by race/ethnicity, federal poverty level (FPL), education, and comorbidities. Results. A total of 2,415 (9.4%) women had a history of cancer with breast cancer as the most common site ( n =704, 29.2%). While most survivors were non-Hispanic white (68.4%), 15.2% were Hispanic, 12.1% were non-Hispanic Black, and 4.3% were additional racial/ethnic groups. Survivors were 1.28 times more likely to report fair/poor perceived health status (95% CI, 1.09-1.50), 1.61 times more likely to report hospitalizations in the last year (95% CI, 1.40-1.86), and 1.37 times more likely to see a mental health provider within the last year (95% CI, 1.12-1.66) compared to controls. Race/ethnicity and FPL were the only significant effect modifiers.Conclusion. Our study identifies disparities in health status and healthcare utilization among female cancer survivors and recognizes the importance of evaluating these associations among disadvantaged health populations. These findings could inform future cancer survivorship care.
OBJECTIVE: We use the person-centered Pathway to Treatment framework to assess the scope of evidence on disparities in endometrial cancer stage at diagnosis. This report is intended to facilitate interventions, research, and advocacy that reduce disparities. DATA SOURCES: We completed a structured search of electronic databases: PubMed, EMBASE, Scopus, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials databases. Included studies were published between January 2000 and 2023 and addressed marginalized population(s) in the United States with the ability to develop endometrial cancer and addressed variable(s) outlined in the Pathway to Treatment. METHODS OF STUDY SELECTION: Our database search strategy was designed for sensitivity to identify studies on disparate prolongation of the Pathway to Treatment for endometrial cancer, tallying 2,171. Inclusion criteria were broad, yet only 24 studies addressed this issue. All articles were independently screened by two reviewers. TABULATION, INTEGRATION, AND RESULTS: Twenty-four studies were included: 10 on symptom appraisal, five on help seeking, five on diagnosis, and 10 on pretreatment intervals. Quality rankings were heterogeneous, between 3 and 9 (median 7.2) per the Newcastle–Ottawa Scale. We identified three qualitative, two participatory, and two intervention studies. Studies on help seeking predominantly investigate patient-driven delays. When disease factors were controlled for, delays of the pretreatment interval were independently associated with racism toward Black and Hispanic people, less education, lower socioeconomic status, and nonprivate insurance. CONCLUSIONS: Evidence gaps on disparities in timeliness of endometrial cancer care reveal emphasis of patient-driven help-seeking delays, reliance on health care–derived databases, underutilization of participatory methods, and a paucity of intervention studies. SYSTEMATIC REVIEW REGISTRATION: Given that PROSPERO was not accepting systematic scoping review protocols at the time this study began, this study protocol was shared a priori through Open Science Framework on January 13, 2021 (doi: 10.17605/OSF.IO/V2ZXY), and through peer review publication on April 13, 2021 (doi: https://doi.org/10.1186/s13643-021-01649-x).
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