Abstract
Upper gastrointestinal (UGI) cancer, including esophageal and gastric, is one of the most common cancers in the world. Hence, the determination of risk factors of UGI helps to reduce the economic and social burden of this cancer in communities. In Iran, the consumption of opium because of its neighborhood with Afghanistan are considerable. In this study, we examine the causal effect of opium use on the time to UGI cancer death. Based on the Golestan Cohort Study (GCS) in northeastern of Iran, about 50000 adults were enrolled to the study for four years (2004–2008) and followed annually until July 2018. We used “parametric g-formula” to study the causal effect of opium use on the time to death due to UGI. In this study, the information of 49946 individuals due to missingness were analyzed. So the median of follow-up time was 144 months and the prevalence of opium use was 17% (about 8489 persons). During the follow-up period, 593 (1.2%) death from upper gastrointestinal cancer were reported. The study showed that the effect of opium use on the time to UGI death was statistically significant (adjusted risk-ratio based on parametric g-formula = 1.31, 95% CI: [1.04, 1.65]). Additionally, the Population Attributable Fraction (PAF) in UGI cancer deaths of opium use was estimated 5.3% (95% CI: [0.6%, 11.3%]). Our results showed a causal effect of opium use on the intensity of upper gastrointestinal cancer death.
Highlights
According to the World Health Organization (WHO), in 2016, 71% of all deaths were related to Non-communicable diseases that 22% of such deaths were caused by cancers [1]
The Golestan Cohort Study (GCS) is a prospective cohort study. It was launched in January 2004 and study participants were selected using a random sampling of persons without a history of upper gastrointestinal cancer who lived in the Golestan province, northeast of Iran and in June 2008 the goal of 50,000 subjects was reached and the enrollment was closed
We aimed to examine the marginal causal effect of opium use on Upper gastrointestinal (UGI) cancer mortality using the g-formula method
Summary
This study aimed to estimate the marginal causal effect of opium on upper gastrointestinal cancer death using a more appropriate model named parametric g-formula that reports suitable marginal index, Relative Risk (RR), as an effect size. We aimed to examine the marginal causal effect of opium use on UGI cancer mortality using the g-formula method
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