Metabolic syndrome and total cancer mortality in the Third National Health and Nutrition Examination Survey

Purpose

Although metabolic syndrome incidence has substantially increased during the last few decades, it largely remains unclear whether this metabolic disorder is associated with total cancer mortality. The present study was carried out to investigate this important question.

Methods

A total of 687 cancer deaths were identified from 14,916 participants in the third National Health and Nutrition Examination Survey by linking them to the National Death Index database through December 31, 2006. Cox proportional hazards regression was performed to calculate hazard ratios (HR) and 95% confidence intervals (CI) for total cancer mortality in relation to metabolic syndrome and its individual components.

Results

After adjustment for confounders, a diagnosis of metabolic syndrome was associated with 33% elevated total cancer mortality. Compared with individuals without metabolic syndrome, those with 3, 4 and 5 abnormal components had HRs (95% CIs) of 1.28 (1.03–1.59), 1.24 (0.96–1.60), and 1.87 (1.34–2.63), respectively (p-trend?=?0.0003). Systolic blood pressure and serum glucose were associated with an increased risk of death from total cancer [HR (95% CI) for highest vs. lowest quartiles: 1.67 (1.19–2.33), p-trend?=?0.002 and 1.34 (1.04–1.74), p-trend?=?0.003, respectively]. Overall null results were obtained for lung cancer mortality. The effects of metabolic syndrome and its components on non-lung cancer mortality were generally similar to, but somewhat larger than, those for total cancer mortality.

Conclusion

Our study is among the first to reveal that metabolic syndrome is associated with increased total cancer mortality.

     

Lack of Health Insurance Increases All Cause and All Cancer Mortality in Adults: An Analysis of National Health and Nutrition Examination Survey (NHANES III) Data

Background: Public use National Health and Nutrition Examination Survey (NHANES III) and NHANES IIIlinked mortality data were here applied to investigate the association between health insurance coverage and allcause and all cancer mortality in adults. Patients and Methods: NHANES III household adult, laboratory andmortality data were merged. Only patients examined in the mobile examination center (MEC) were included inthis study. The sampling weight employed was WTPFEX6, SDPPSU6 being used for the probability samplingunit and SDPSTRA6 to designate the strata for the survey analysis. All cause and all cancer mortalities wereused as binary outcomes. The effect of health insurance coverage status on all cause and all cancer mortalitieswere analyzed with potential socioeconomic, behavioral and health status confounders. Results: There were 2398sample persons included in this study. The mean age was 40 years and the mean (S.E.) follow up was 171.85 (3.12)person months from the MEC examination. For all cause mortality, the odds ratios (significant p-values) of thecovariates were: age, 1.0095 (0.000); no health insurance coverage (using subjects with health insurance), 1.71(0.092); black race (using non-Hispanic white subjects as the reference group) 1.43, (0.083); Mexican-Americans,0.60 (0.089); DMPPIR, 0.82, (0.000); and drinking hard liquor, 1.014 (0.007). For all cancer mortality, the oddsratio (significant p-values) of the covariates were: age, 1.0072 (0.00); no health insurance coverage, using withhealth coverage as the reference group, 2.91 (0.002); black race, using non-Hispanic whites as the referencegroup, 1.64 (0.047); Mexican Americans, 0.33 (0.008) and smoking, 1.017 (0.118). Conclusion: There was a 70%increase in risk of all cause death and almost 300% of all cancer death for people without any health insurancecoverage.     

Diet and lung cancer mortality: a 1987 National Health Interview Survey cohort study

Objectives: To study the association between diet and lung cancer mortality in the United States. Methods: Records from 20,195 participants with usable dietary data in the 1987 National Health Interview Survey were linked to the National Death Index. Baseline diet was assessed with a 59-item food-frequency questionnaire. Food groups (fruits, vegetables, total meat/poultry/fish, red meats, processed meats, dairy products, breakfast cereals, other starches, added fats, and alcohol) were analyzed in cause-specific Cox proportional hazard regression models adjusted for age, gender and smoking. Results: There were 158 deaths from lung cancer (median follow-up 8.5 years). Frequencies of meat/poultry/fish intake (relative risk [RR] (highest compared to lowest quartile) = 2.0; 95% confidence interval [CI] 1.2–3.5, p for trend [p] < 0.027), and red meat intake (RR = 1.6; CI 1.0–2.6, p < 0.014), were positively and significantly associated with lung cancer mortality. Specifically, the red meats, including pork (RR = 1.6; CI 1.0–2.7, p < 0.028), and ground beef (RR = 2.0; CI 1.1–3.5, p < 0.096) were associated with increased risk, although for ground beef the trend was not significant. Dairy products (RR = 0.5; CI 0.3–0.8, p < 0.009) were inversely associated with lung cancer mortality. There was no statistically significant association between intake of fruits and vegetables and lung cancer mortality. Conclusions: In this nationally representative study, intake of red meats was positively associated with lung cancer mortality while intake of dairy products was inversely associated. While smoking is the major risk for lung cancer mortality, diet may have a contributory role.     

Cancer Survivors Aged 40 Years or Elder are Associated with High Risk of Chronic Kidney Disease: The 2010-2012 Korean National Health and Nutrition Examination Survey

Background: The number of cancer survivors is increasing globally and recently, higher rates of comorbiditiesin cancer survivors have been reported. However, no studies have investigated whether cancer survivors havea higher risk of chronic kidney disease (CKD). Accordingly, our study evaluated the association betweencancer survivors and the risk of CKD using the 2010-2012 Korean National Health and Nutrition ExaminationSurvey. Materials and Methods: A total of 11,407 participants aged 40 years and over were categorized intotwo groups according to cancer experience. Multiple variables were compared and the odds ratios (ORs) forCKD prevalence were calculated using a weighted logistic regression analysis between the two groups. Results:Cancer survivors were older than were those in the non-cancer group, on average, the percentages of glomerularfiltration rate(GFR) lower than 60mL/min/1.73m2, proteinuria, and CKD were significantly higher in cancersurvivors when compared to controls. Weighted logistic regression analyses demonstrated that cancer survivorshad a higher risk for CKD after adjusting for multiple variables (OR (95% confidence interval), 2.88 (1.48-5.59)). Conclusions: Our study demonstrated a possible association between CKD and cancer survival in Koreanadults. Identifying and correcting risk factors for cancer survivors would positively affect prevention of CKDand result in a better cancer prognosis.     

Cancer, cardiovascular disease and diabetes mortality among women with a history of endometrial cancer

Among 7182 women with endometrial cancer in Scotland, standardised mortality ratios (and 95% confidence intervals (CI)) were 6.38 (5.74-7.15) for all cancers and 1.10 (1.00-1.22) for circulatory diseases as underlying cause of death and 2.81 (2.19-3.70) for diabetes as underlying/contributory cause of death.     

Health Screening among HBV Carriers in the Korean National Health and Nutrition Examination Survey V (KNHANES V)

We aimed to investigate the differences in health screening, including medical checkups and cancer screening,between HBV carriers and non-carriers in the Republic of Korea. In the fifth Korean National Health andNutrition Examination Survey (KNHANES V), conducted between 2010 and 2012, 17,865 persons who answeredregarding their HBV-infection status, medical checkup history, liver cancer screening and general cancerscreening within the past years were included in the final analysis. In total, 295 persons were HBV carriers.Logistic regression models were used to compare the health check-up rate between the HBV carriers and non-HBV carriers. The HBV carriers were more likely to have been screened for liver cancer [adjusted odds ratio(OR): 2.83, 95% confidence interval (95%CI): 1.90-4.21] or cancer [OR: 1.44, 95%CI: 1.04-1.99]. The HBVcarriers showed a probability of receiving medical checkups that was identical to that of the non-carriers [OR:0.99, 95%CI: 0.72-1.35]. The HBV carriers, who were at higher risk of developing chronic liver disease, weremore likely to be screened for cancer, including liver cancer, than the non-HBV carriers; no difference in therate of medical checkups was observed between the HBV carriers and non-HBV carriers.     

Site-specific analysis of total serum cholesterol and incident cancer in the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study

We studied the relation of total serum cholesterol to all cancer and site-specific cancer incidence in a cohort based on a probability sample of the United States population. A total of 5125 men (yielding 459 cancers) and 7363 women (398 cancers) were initially examined in 1971-75 and followed a median of 10 yr. An examination of age-adjusted incidence rates by cholesterol level showed an inverse association between cholesterol and all cancer; lung, colorectal, pancreatic, and bladder cancers; and leukemia. In women a weak inverse relation (reflecting an elevated rate among those only in the lowest cholesterol quintile) was apparent for all cancer; more prominent inverse associations were seen for cancers of the lung, pancreas, bladder, cervix, and for leukemia. A more detailed analysis of cholesterol and colorectal cancer revealed little association in both men and women. For an aggregate group of smoking-related cancers, the inverse relation was especially prominent: the multivariate relative risk estimates for subjects in the lowest cholesterol quintile, compared to those in the highest quintile, were 2.1 (1.1-3.8) and 3.3 (1.4-7.8) for men and women, respectively. The inverse association was present for smoking-related cancers diagnosed 6 or more yr after cholesterol determination in both men and women, suggesting that this association cannot be simply dismissed as a preclinical cancer effect. Further investigation of the cholesterol-cancer question, particularly the relation between cholesterol and smoking-related cancers, may provide useful etiological leads.     

Longitudinal associations of blood markers of insulin and glucose metabolism and cancer mortality in the third National Health and Nutrition Examination Survey

Insulin and glucose may influence cancer mortality via their proliferative and anti-apoptotic properties. Using longitudinal data from the nationally representative Third National Health and Nutrition Examination Survey (NHANES III; 1988–1994), with an average follow-up of 8.5 years to death, we evaluated markers of glucose and insulin metabolism, with cancer mortality, ascertained using death certificates or the National Death Index. Plasma glucose, insulin, C-peptide, and lipid concentrations were measured. Anthropometrics, lifestyle, medical, and demographic information was obtained during in-person interviews. After adjusting for age, race, sex, smoking status, physical activity, and body mass index, for every 50 mg/dl increase in plasma glucose, there was a 22% increased risk of overall cancer mortality. Insulin resistance was associated with a 41% (95% confidence interval (CI) (1.07–1.87; p = 0.01) increased risk of overall cancer mortality. These associations were stronger after excluding lung cancer deaths for insulin-resistant individuals (HR: 1.67; 95% CI: 1.15–2.42; p = 0.01), specifically among those with lower levels of physical activity (HR: 2.06; 95% CI: 1.4–3.0; p = 0.0001). Similar associations were observed for other blood markers of glucose and insulin, albeit not statistically significant. In conclusion, hyperglycemia and insulin resistance may be ‘high-risk’ conditions for cancer mortality. Managing these conditions may be effective cancer control tools.     

Cancer Screening Adherence of Asian Women According to Biochemically-verified Smoking Status: Korea National Health and Nutrition Examination Survey

Background: Men and women who smoke tend to show less compliance to screening guidelines than nonsmokers.However, a recent study in Korea showed that self-reported female smokers constituted less than halfof cotinine-verified smokers. Therefore, the aim of this study was to identify hidden smokers using cotinineverifiedmethod and examine cancer screening behavior according to biochemically verified smoking status.Materials and Methods: Among 5,584 women aged 30 years and older who participated in the Fourth and FifthKorea National Health and Nutrition Examination Survey (KNHANES), 372 (6.66%) hidden smokers wereidentified based on interview responses and verified by urinary cotinine levels. We compared cancer-screeningbehavior (cervical, breast, stomach, and colon cancer) of female hidden smokers to that of non-smokers and selfreportedsmokers by cross-sectional analysis. Results: Hidden female smokers had significantly lower adherenceto breast cancer screening compared to non-smokers (aOR (adjusted odds ratio) [95% CI] = 0.71 [0.51–0.98]).Adherence to stomach cancer (aOR [95% CI] = 0.75 [0.54–1.03]) and cervical cancer (aOR [95% CI] = 0.85[0.66–1.10]) screening was also lower among hidden female smokers compared to non-smokers. Self-reported(current) smokers showed lowest adherence to cervical cancer (aOR: 0.64, 95% CI0.47-0.87), breast cancer(0.47 [0.32-0.68]), stomach cancer (0.66[0.46-0.95]), and colon cancer (0.62 [0.38-1.01]) screening compared tonon-smokers, followed by female hidden smokers, then non-smokers. These lower adherence rates of currentsmokers were attenuated after we incorporated hidden smokers into the current smoker group. Conclusions:Cancer screening adherence of female hidden smokers was lower than cotinine-verified non-smokers but higherthan current smokers. Considering the risk of smoking-related cancer among women, identifying hidden smokersis important to encourage appropriate cancer screening.     

Serum calcium and incident and fatal prostate cancer in the National Health and Nutrition Examination Survey

We examined the association between serum calcium levels and the risk for prostate cancer using a prospective cohort, the National Health and Nutrition Examination Survey (NHANES) and the NHANES Epidemiologic Follow-up Study. Eighty-five incident cases of prostate cancer and 25 prostate cancer deaths occurred over 46,188 person-years of follow-up. Serum calcium was determined an average of 9.9 years before the diagnosis of prostate cancer. Comparing men in the top with men in the bottom tertile of serum calcium, the multivariable-adjusted relative hazard for fatal prostate cancer was 2.68 (95% confidence interval, 1.02-6.99; P(trend) = 0.04). For incident prostate cancer, the relative risk for the same comparison was 1.31 (95% confidence interval, 0.77-2.20; P(trend) = 0.34). These results support the hypothesis that high serum calcium or a factor strongly associated with it (e.g., high serum parathyroid hormone) increases the risk for fatal prostate cancer. Our finding of a >2.5-fold increased risk for men in the highest tertile of serum calcium is comparable in magnitude with the risk associated with family history and could add significantly to our ability to identify men at increased risk for fatal prostate cancer.     

Prostate cancer in the elderly: frequency of advanced disease at presentation and disease-specific mortality

BACKGROUND:

The objectives of this study were to determine the frequency of metastatic (M1) prostate cancer (PC) at presentation in different age groups, to examine the association of age with PC‐specific mortality, and to calculate the relative contribution of different age groups to the pool of M1 cases and PC deaths.

METHODS:

Records from 464,918 patients who were diagnosed with PC from 1998 to 2007 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. The patients were categorized according to age into groups ages <50 years, 50 to 54 years, 55 to 59 years, 60 to 64 years, 65 to 69 years, 70 to 74 years, 75 to 79 years, 80 to 84 years, 85 to 89 years, and ≥90 years. The cumulative incidence of death from PC was computed using the Gray method.

RESULTS:

The frequency of M1 PC at presentation was 3% for the group aged <75 years, 5% for the group ages 75 to 79 years, 8% for the group ages 80 to 84 years, 13% for the group ages 85 to 89 years, and 17% for the group aged ≥90 years. The 5‐year cumulative incidence of death from PC was 3% to 4% for all patients with PC in any category aged <75 years, 7% for patients ages 75 to 79 years, 13% for patients ages 80 to 84 years, 20% for patients ages 85 to 89 years, and 30% for patients aged ≥90 years. Although patients aged ≥75 years at PC diagnosis represented just over a quarter (26%) of all PC cases, they contributed almost half (48%) of all M1 cases and more than half (53%) of all PC deaths.

CONCLUSIONS:

Compared with younger patients (aged <75 years), older patients were more likely to present with very advanced disease, had a greater risk of death from PC despite higher death rates from competing causes, and contributed more than half of all PC deaths. Awareness of this issue may improve future outcomes for elderly patients with PC. Cancer 2012;118: 3062–70. © 2011 American Cancer Society.     

Periodontal disease,tooth loss and colorectal cancer risk: Results from the Nurses' Health Study

Periodontal diseases including tooth loss might increase systemic inflammation, lead to immune dysregulation and alter gut microbiota, thereby possibly influencing colorectal carcinogenesis. Few epidemiological studies have examined the association between periodontal diseases and colorectal cancer (CRC) risk. We collected information on the periodontal disease (defined as history of periodontal bone loss) and number of natural teeth in the Nurses' Health Study. A total of 77,443 women were followed since 1992. We used Cox proportional hazard models to calculate multivariable hazard ratios (HRs) and 95% confidence intervals (95% CIs) after adjustment for smoking and other known risk factors for CRC. We documented 1,165 incident CRC through 2010. Compared to women with 25–32 teeth, the multivariable HR (95% CI) for CRC for women with <17 teeth was 1.20 (1.04–1.39). With regard to tumor site, the HRs (95% CIs) for the same comparison were 1.23 (1.01–1.51) for proximal colon cancer, 1.03 (0.76–1.38) for distal colon cancer and 1.48 (1.07–2.05) for rectal cancer. In addition, compared to those without periodontal disease, HRs for CRC were 0.91 (95% CI 0.74–1.12) for periodontal disease, and 1.22 (95% CI 0.91–1.63) when limited to moderate to severe periodontal disease. The results were not modified by smoking status, body mass index or alcohol consumption. Women with fewer teeth, possibly moderate or severe periodontal disease, might be at a modest increased risk of developing CRC, suggesting a potential role of oral health in colorectal carcinogenesis.     

Gender Differences in Marital Disruption among Patients with Cancer: Results from the Korean National Health and Nutrition Examination Survey (KNHANES)

Background: Cancer is a major life event that imposes huge economic and mental burdens on patients and families. In addition, the diagnosis of cancer also causes significant family discordance that can lead to marital problems such as divorce or separation. The aim of this study was to investigate the association and any related gender differences between cancer diagnosis and marital disruption among cancer survivors. Materials and Methods: We used the recent cross-sectional Korea National Health and Nutrition Examination Survey (4th and5th; Years 2008-2012). The study participants were 623 married cancer survivors over the age of 19. A multivariate logistic regression analysis was conducted to estimate odds ratios. Results: After adjusting for socioeconomic status and health-related behaviors, the odds ratio of marital disruption among female cancer survivors compared with male cancer survivors was 3.94 (95%CI 1.30-11.94; p=0.02). The odds ratio of marital disruption for the below-average economic level compared with the above-average economic level was 5.64 (95%CI: 1.03-31.02;p=0.05). When compared with the non-smoking cancer survivors, the smoking cancer survivors had an OR of marital disruption equal to 2.94 (95%CI: 1.08-8.00; p=0.03). Conclusions: The findings of this study suggest that the odds of marital disruption among female cancer survivors are higher than those among their malecouterparts. Medical practitioners should be sensitive to early signs of marital discord in couples affected by a cancer diagnosis. Early identification and psychosocial intervention might reduce the frequency of divorce and separation and thus improve quality of life and quality of care for cancer survivors.     

2012年至2020年重庆地区居民肝癌死亡率及疾病负担变化趋势

目的:了解2012年至2020年重庆地区居民肝癌死亡率及疾病负担变化趋势。方法:肝癌死亡个案病例资料（ICD-10:C22）来源于重庆市全人群死因监测报告数据库。采用SPSS 26.0统计分析死亡率、标化死亡率、早死所致的寿命损失年（years of life lost,YLL）和平均减寿年数（average years of life lost,AYLL）等指标,不同性别与地区间死亡率比较用χ2检验,趋势分析采用年度变化百分比（annual percentage change,APC）表示。结果:2012年重庆市肝癌死亡率与标化死亡率分别为29.87/10万与20.27/10万,2020年重庆市肝癌死亡率与标化死亡率分别为31.21/10万与18.16/10万,死亡率与标化死亡率APC分别为0.39%与-0.83%,变化趋势均无统计学差异（P＞0.05）。2012年至2020年男性历年肝癌死亡率均高于女性,差异均有统计学意义（P＜0.01）。2012年至2020年农村地区历年肝癌死亡率均高于城市,差异均有统计学意义（P＜0.01）。2012年重庆市肝癌导致的YLL率为8.72‰,2020年YLL率为8.02‰,APC为-1.28%,变化趋势无统计学差异（P＞0.05）,AYLL以年均1.66%的速度下降（P＜0.05）。男性AYLL高于女性,分别以年均1.55%（P＜0.05）和1.96%（P＜0.05）的速度下降,城市AYLL低于农村AYLL,城市和农村AYLL总体上分别以年均1.59%（P＜0.05）和1.72%（P＜0.05）的速度下降。结论:重庆市肝癌死亡率较高,早死导致的疾病负担重,男性与农村地区居民是肝癌发生的重点人群。