Quantifying the contribution of modifiable risk factors to socio-economic inequities in cancer morbidity and mortality: a nationally representative population-based cohort study

被引:15
作者
Nejatinamini, Sara [1 ]
Godley, Jenny [2 ]
Minaker, Leia M. [3 ]
Sajobi, Tolulope T. [1 ]
McCormack, Gavin R. [1 ]
Cooke, Martin J. [3 ]
Nykiforuk, Candace I. J. [4 ]
de Koning, Lawrence [5 ]
Olstad, Dana Lee [1 ]
机构
[1] Univ Calgary, Cumming Sch Med, Dept Community Hlth Sci, 3E16,3280 Hosp Dr NW, Calgary, AB T2N 4Z6, Canada
[2] Univ Calgary, Dept Sociol, Calgary, AB, Canada
[3] Univ Waterloo, Sch Planning, Waterloo, ON, Canada
[4] Univ Alberta, Sch Publ Hlth, Edmonton, AB, Canada
[5] Univ Calgary, Dept Pathol & Lab Med, Calgary, AB, Canada
基金
加拿大健康研究院;
关键词
Socio-economic position; modifiable risk factors; cancer morbidity and mortality; mediation analyses; BODY-MASS INDEX; SOCIAL DETERMINANTS; LUNG-CANCER; LIFE-STYLE; HEALTH BEHAVIORS; INEQUALITIES; ASSOCIATION; DISPARITIES; SMOKING; SMOKERS;
D O I
10.1093/ije/dyab067
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background: Compared with those with a higher socio-economic position (SEP), individuals with a lower SEP have higher cancer morbidity and mortality. However, the contribution of modifiable risk factors to these inequities is not known. This study aimed to quantify the mediating effects of modifiable risk factors to associations between SEP and cancer morbidity and mortality. Methods: This study used a prospective observational cohort design. We combined eight cycles of the Canadian Community Health Survey (2000/2001-2011) as baseline data to identify a cohort of adults (>= 35 years) without cancer at the time of survey administration (n = 309 800). The cohort was linked to the Discharge Abstract Database and the Canadian Mortality Database for cancer morbidity and mortality ascertainment. Individuals were followed from the date they completed the Canadian Community Health Survey until 31 March 2013. Dates of individual first hospitalizations for cancer and deaths due to cancer were captured during this time period. SEP was operationalized using a latent variable combining measures of education and household income. Self-reported modifiable risk factors, including smoking, excess alcohol consumption, low fruit-and-vegetable intake, physical inactivity and obesity, were considered as potential mediators. Generalized structural equation modelling was used to estimate the mediating effects of modifiable risk factors in associations between low SEP and cancer morbidity and mortality in the total population and stratified by sex. Results: Modifiable risk factors together explained 45.6% of associations between low SEP and overall cancer morbidity and mortality. Smoking was the most important mediator in the total population and for males, accounting for 15.5% and 40.2% of the total effect, respectively. For females, obesity was the most important mediator. Conclusions: Modifiable risk factors are important mediators of socio-economic inequities in cancer morbidity and mortality. Nevertheless, more than half of the variance in these associations remained unexplained. Midstream interventions that target modifiable risk factors may help to alleviate inequities in cancer risk in the short term. However, ultimately, upstream interventions that target structural determinants of health are needed to reduce overall socio-economic inequities in cancer morbidity and mortality.
引用
收藏
页码:1498 / 1511
页数:14
相关论文
共 57 条
[1]  
[Anonymous], 2011, Canadian pharmacy services framework, P1
[2]  
[Anonymous], Dietary Screener Questionnaire in the NHANES 2009-10
[3]  
[Anonymous], 2014, The Research Data Centres Information and Technical Bulletin, V6, P1
[4]  
[Anonymous], 2019, POPULATION HLTH SURV
[5]  
[Anonymous], 2017, Canadian Cancer Statistics 2017
[6]   Smoke intake among smokers is higher in lower socioeconomic groups [J].
Bobak, M ;
Jarvis, MJ ;
Skodova, Z ;
Marmot, M .
TOBACCO CONTROL, 2000, 9 (03) :310-312
[7]  
Booth HP, 2017, SSM-POPUL HLTH, V3, P172, DOI 10.1016/j.ssmph.2016.12.012
[8]  
Canadian Institute for Health Information, DISCHARGE ABSTRACT D
[9]   Physical activity and asthma: cause or consequence? A bidirectional longitudinal analysis [J].
Cassim, Raisa ;
Milanzi, Elasma ;
Koplin, Jennifer J. ;
Dharmage, Shyamali C. ;
Russell, Melissa Anne .
JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, 2018, 72 (09) :770-775
[10]  
Colley RC, 2018, HEALTH REP, V29, P3