Sociocultural Factors, Access to Healthcare, and Lifestyle: Multifactorial Indicators in Association with Colorectal Cancer Risk

被引:14
作者
Andersen, Shaneda Warren [1 ,2 ,6 ]
Zheng, Wei
Steinwandel, Mark [3 ]
Murff, Harvey J.
Lipworth, Loren [4 ]
Blot, William J. [5 ]
机构
[1] Univ Wisconsin Madison, Sch Med & Publ Hlth, Dept Populat Hlth Sci, Madison, WI USA
[2] Univ Wisconsin, Carbone Canc Ctr, Madison, WI USA
[3] Vanderbilt Univ, Vanderbilt Epidemiol Ctr, Vanderbilt Ingram Canc Ctr, Div Epidemiol,Sch Med,Dept Med, Nashville, TN USA
[4] Vanderbilt Univ, Vanderbilt Inst Clin & Translat Res, Int Epidemiol Field Stn, Med Ctr, Rockville, MD USA
[5] Vanderbilt Univ, Dept Med, Med Ctr, Nashville, TN USA
[6] Univ Wisconsin, Sch Med & Publ Hlth, Dept Populat Hlth Sci, 610 Walnut St,707 Off Bldg, Madison, WI 53726 USA
关键词
SOUTHERN COMMUNITY COHORT; SOCIOECONOMIC-STATUS; PHYSICAL-ACTIVITY; AFRICAN-AMERICAN; MORTALITY; RACE; DISPARITIES; GUIDELINES; NUTRITION; OBESITY;
D O I
10.1158/1940-6207.CAPR-22-0090
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Black Americans of low socioeconomic status (SES) have higher colorectal cancer incidence than other groups in the United States. However, much of the research that identifies colorectal cancer risk factors is conducted in cohorts of high SES and non-Hispanic White participants. Adult participants of the Southern Community Cohort Study (N= 75,182) were followed for a median of 12.25 years where 742 incident colorectal cancers were identified. The majority of the cohort are non-Hispanic White or Black and have low household income. Cox models were used to estimate HRs for colorectal cancer incidence associated with sociocultural factors, access to and use of healthcare, and healthy lifestyle scores to represent healthy eating, alcohol intake, smoking, and physical activity. The association between Black race and colorectal cancer was consistent and not diminished by accounting for SES, access to healthcare, or healthy lifestyle [HR = 1.34; 95% confidence interval (CI),1.10-1.63]. Colorectal cancer screening was a strong, risk reduction factor for colorectal cancer (HR = 0.65; 95% CI, 0.55-0.78), and among colorectal cancer-screened, Black race was not associated with risk. Participants with high school education were at lower colorectal cancer risk (HR = 0.81; 95% CI, 0.67-0.98). Income and neighborhood-level SES were not strongly associated with colorectal cancer risk. Whereas individual health behaviors were not associated with risk, participants that reported adhering to >= 3 health behaviors had a 19% (95% CI, 1-34) decreased colorectal cancer risk compared with participants that reported <= 1 behaviors. The association was consistent in fully-adjusted models, although HRs were no longer significant. Colorectal cancer screening, education, and a lifestyle that includes healthy behaviors lowers colorectal cancer risk. Racial disparities in colorectal cancer risk may be diminished by colorectal cancer screening.
引用
收藏
页码:595 / 604
页数:10
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