Socioeconomic differences in adherence to the World Cancer Research Fund Cancer Prevention Recommendations in the UK Biobank cohort

Abstract

BackgroundThe combined incidence rate of all cancers is higher in deprived population groups than in least-deprived groups. Approximately 40% of cancers in the UK are attributable to lifestyle risk factors, such as smoking and obesity, which are also socioeconomically patterned, and which suggests that public health strategies for primary cancer prevention might need to be tailored according to socioeconomic status. The World Cancer Research Fund and American Institute for Cancer Research's Cancer Prevention Recommendations aim to reduce cancer risk. We investigated socioeconomic status differences in adherence to these recommendations within the cohort of the UK Biobank prospective study. MethodsWe used data from participants in the UK Biobank prospective cohort study recruited between 2006 and 2010. Socioeconomic status was assessed by means of the Townsend deprivation index and participants were categorised according to deprivation quartiles. Scores for adherence to the Cancer Prevention Recommendations were calculated from dietary, physical activity, and body composition data via the recommended standardised scoring system, ranging from 0 (unhealthier lifestyle) to 7 (healthier lifestyle) points. Regression models were run to investigate associations between socioeconomic status and total score, adjusting for age, sex, ethnicity, and smoking status. Associations between adherence to individual recommendations and socioeconomic status were investigated using chi-square tests. FindingsData from 150 649 participants (median age 57 years [IQR 50–63]; 79 322 [53%] women and 71 327 [47%] men) were included. The mean total adherence score was 3·58 points (SD 1·04). Adherence score was not associated with socioeconomic status (p=0·13), but was significantly related to age, sex, ethnicity, and smoking status (p<0·0001). Adherence to the recommendations for bodyweight, physical activity, and intake of fruit, vegetables, and dietary fibre was lower for the most deprived group (p<0·0001). In contrast, less deprived participants were less likely to meet the recommendations for the intake of alcohol, red and processed meat, ultra-processed foods, and sugary drinks (p<0·0001) InterpretationOur findings provide evidence on which specific recommendations for cancer prevention could be tailored, or targeted, towards those in different socioeconomic status groups. FundingWereld Kanker Onderzoek Fonds (grant number IIG_FULL_2020_032), as part of the World Cancer Research Fund International Grant Programme.