All-cause Cancer Mortality Research Articles

Rural cancer disparities from Oklahoma cancer and vital records registries 2016–2020

ObjectivesCompared to Oklahoma, 33 states have higher all-cause cancer incidence rates, but only three states have higher all-cause cancer mortality rates. Given this troubling gap between Oklahoma’s cancer incidence and mortality rankings, in-depth examination of cancer incidence, staging, and mortality rates among this state’s high-risk populations is warranted. This study provides in-depth information on overall and cause-specific cancer incidence and mortality for the rural and urban Oklahoma populations classified by Rural-Urban Continuum Codes (RUCC). MethodsData were publicly available and de-identified, accessed through Oklahoma Statistics on Health Available for Everyone (OK2SHARE). Statistical analysis included calculating age-specific rates, age-adjusted rates, and percentages, as well as assessing temporal patterns using average annual percent change with 95 % confidence intervals determined by Joinpoint regression analysis. FindingsUrban areas had a higher proportion of female breast cancer cases, while large and small rural areas had higher rates of lung and bronchus cancer. Urban residents were more likely to have private insurance and less likely to have Medicare compared to rural residents. Cancer incidence rates increased with age, and men had higher mortality rates than women. Lung and bronchus cancer was the leading cause of cancer death, with lower rates in urban areas compared to rural areas. ConclusionsFindings demonstrate the need to improve the early detection of cancer among the rural populations of Oklahoma. Additionally, the high mortality rates for most types of cancer experienced by the state’s rural population underscores the need to improve cancer detection and treatment in these locations.

Associations Between Relative Grip Strength and the Risk of 15 Cancer Sites

Grip strength is the most commonly used muscle strength proxy in clinical research. However, evidence regarding the associations of grip strength with cancer has been mainly restricted to overall cancer risk. Therefore, this study aims to evaluate the associations between grip strength relative to BMI and 15 cancer sites as well as with all-cause cancer mortality. A total of 445,555 participants (53.8% women, mean age=56.3 years) were recruited across the United Kingdom. The association of grip strength relative to BMI (expressed as 1 SD) with incidence and mortality from 15 cancer sites was investigated using Cox proportional hazard models. All analyses were conducted in April 2021. Over an 8.8-year follow-up period, 37,291 patients were diagnosed with cancer, and 11,363 died of it. After covariate adjustment, higher relative grip strength per 1 SD was associated with a lower risk of incident endometrial (hazard ratio=0.76, 95% CI=0.71, 0.81), liver (hazard ratio=0.81, 95% CI=0.74, 0.88), gallbladder (hazard ratio=0.83, 95% CI=0.73, 0.94), kidney (hazard ratio=0.89, 95% CI=0.84, 0.95), and colorectal (hazard ratio=0.94, 95% CI=0.91, 0.98) cancer as well as with lower risk of gallbladder, colorectal, endometrial, liver, and all-cause cancer mortality. Grip strength relative to BMI was associated with incidence and mortality from endometrial, gallbladder, colorectal, liver, all-cause cancer, and breast and kidney cancer incidence, independent of major confounding factors, including comorbidity, diet, and physical activity.

Fibrinogen-to-Albumin Ratio is Associated with All-Cause Mortality in Cancer Patients.

BackgroundPast studies have identified fibrinogen-to-albumin ratio (FAR) as a novel prognostic immune biomarker in various diseases. Here, we investigated the prognostic value of FAR in all combined cancer mortality.MethodsWe extracted patient data from the Multiparameter Intelligent Monitoring in Intensive Care Database III. FAR was measured prior to hospital admission. Only first admission data from each patient were used. Baseline data were extracted within 24 h after admission. The clinical endpoints were 90- and 365-day all-cause cancer mortality. Cox proportional hazards models and subgroup analyses were used to determine the relationship between FAR and these clinical endpoints.ResultsA total of 652 eligible patients were enrolled. Upon adjusting for age and gender, multivariate analysis revealed correlation between higher FAR values and increased risk of all-cause mortality. After adjusting for more confounding factors, higher FAR values significantly correlated with 90- and 365-day all-cause mortality relative to low FAR values (tertile 3 vs tertile 1: HR, 95% CI: 1.65, 1.15–2.39; 1.52, 1.10–2.10).ConclusionOur findings indicate that FAR may predict the risk of cancer mortality and is an independent prognostic indicator of all-cause mortality in cancer patients.

Model selection applied to 750 outpatient ICD-9 codes identifies hazards important for all-cause cancer mortality in 2 million veterans with 14 years of follow-up.

2053 Background: Cost-benefit analysis before undergoing cancer treatments can involve a broad array of factors, yet existing statistical algorithms are limited to a few of the most commonly observed competing risks. Using 20 years of Veteran medical records from the Veteran’s Administration, we identify a broad array of outpatient descriptors providing contributions to computed mortality comparable in size to common cancers. Methods: 1,911,632 Veterans born between 1927 and 1968 with medical records extending from October 1, 2000 until either recorded death after October 1, 2005 (47%) or observation during CY 2019 were split equally into age-matched test and training sets. The 20 year-long record was split into three intervals: 5 years during which ICD codes were tallied, 14 years of waiting, and establishment of continuation in care during 2019. The 750 most common outpatient ICD9 codes were recorded as present/absent for each patient and used in a generalized linear model to predict subsequent mortality, subject to LASSO model selection and 10-fold cross validation. Gender was included as a covariate as well as age at time of prediction, up to the 4th power. Results: The C-statistic for predicting mortality in 14 years of follow-up was 0.835 on training data and 0.833 on test data when using the 498 codes selected by LASSO. Prevalent codes with the largest model coefficients were (ICD 9 code: model coefficient, # alive/# deceased in test set) congestive heart failure (428.0: 0.66, 9k/48k), chronic airway obstruction (496.: 0.60, 42k/105k), and tobacco use disorder (305.1: 0.54, 107k/123k), while the prevalent codes most protective in comparison to baseline were hyperlipidemia (272.4: -0.21, 211k/225k) and colon cancer screening (V76.51: -0.16, 49k/39k). In comparison, observed cancer ICD 9 coefficients were lung (162.9: 1.03, 1k/7k), colon (153.9: 0.18, 3.1k/7.0k), and prostate (185.: 0.06, 16k/32k). 74 predictors contribute with coefficients greater than colon cancers, such as ‘no household member able to render care’ (V60.4: 0.28, 1.1k/4.2k). Conclusions: A wide variety of structured data contribute at a similar level of importance in prediction of 14-year mortality. While various selection biases, co-linearity of predictors, differences in treatments, and missing data are significant impediments to utilization of predictive models in clinical practice, we have demonstrated an ability to identify and quantify predictors from a large data set with model selection techniques.

Abstract 4190: Impact of comorbidities and nonclinical factors associated with sinonasal cancer all-cause mortality in the United States

Abstract Introduction: The anatomical complexity of the sinonasal region contributes to the poor prognosis and relative rarity of sinonasal cancer. While several studies have focused on the major clinical factors associated with survival, the burden of comorbidities and its impact on all-cause mortality of sinonasal cancer is unknown. Objective: This study aimed at describing the impact of comorbidities and nonclinical factors on all-cause mortality of sinonasal cancer in the United States. Methods: In this retrospective cohort study (n=10769), adult cases of sinonasal cancer (International Classification of Diseases for Oncology, third edition typology codes: C30.0, C30.1, C31.0-C31.3, C31.8, C31.9) diagnosed from 2004 through 2013. The outcome of interest was all-cause mortality. Independent variables included treatment type, time to treatment, staging, comorbidity scoring, histology, HPV test status, age, gender, race, facility type, distance to facility, insurance, local income, and urban level. Survival analysis was conducted via multivariable extended Cox regression with Heaviside adjustment for time-varying component of treatment variables. Results: In this cohort, 79% were whites, 60% males, and mean age of diagnosis was 63.5 years. Approximately 1-in-5 patients (18.6%) had a major comorbidity (Charlson-Deyo score ≥ 1) at the time of sinonasal cancer diagnosis. In the final model, after controlling for clinical factors including stage of presentation, treatment modality, HPV status, and histological subtypes, increasing Charlson-Deyo comorbid score was associated with a corresponding increase in hazard of mortality [(aHR score of 1 = 1.25; 95% CI 1.16, 1.35), (aHR score of 2+ = 1.62; 95% CI 1.42, 1.84). There were significant effects of race and socioeconomic status on all-cause mortality. Males (aHR = 1.11; 95% CI 1.05, 1.18); blacks (aHR = 1.12, 95% CI 1.02, 1.24); those uninsured (aHR = 1.40; 95% CI 1.21, 1.62) or covered by Medicaid (aHR = 1.48; 95% CI 1.31, 1.66); and patients living in zip-codes with lower median income quartile (aHR <$30,000 = 1.17; 95% CI 1.06, 1.29) all had greater hazard of all-cause mortality. Additionally, treatment at community cancer programs was associated with increased hazard of mortality (aHR = 1.14, 95% CI 1.01, 1.28) compared with being treated at an academic/research program. Conclusions: Besides clinical factors such as stage of presentation, severe comorbid disease is most associated with all-cause mortality among patients with sinonasal cancer. Additionally, other nonclinical factors associated with sinonasal cancer all-cause mortality included race, insurance status, income, histological subtypes of the cancers, and comorbidity scores. Understanding the impact of these factors on mortality could help clinicians in disease prognostication and management of patients with sinonasal cancer. Note: This abstract was not presented at the meeting. Citation Format: Premal B. Desai, Aleksandr R. Bukatko, Matthew C. Simpson, Eric Adjei Boakye, Jason W. Greenberg, Greg M. Ward, Ronald J. Walker, Jastin L. Antisdel, Nosayaba Osazuwa-Peters. Impact of comorbidities and nonclinical factors associated with sinonasal cancer all-cause mortality in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4190.

Leisure-time Running And All-cause Cancer Mortality

Leisure-time Running And All-cause Cancer Mortality

Association of diabetes and cancer mortality in American Indians: the Strong Heart Study.

PurposeThe metabolic abnormalities that accompany diabetes mellitus are associated with an increased risk of many cancers. These associations, however, have not been well studied in American Indian populations, which experience a high prevalence of diabetes. The Strong Heart Study is a population-based, prospective cohort study with extensive characterization of diabetes status.MethodsAmong a total cohort of 4,419 participants who were followed for up to 20 years, 430 cancer deaths were identified. ResultsAfter adjusting for sex, age, education, smoking status, drinking status, and body mass index, participants with diabetes at baseline showed an increased risk of gastric (HR 4.09; 95 % CI 1.42–11.79), hepatocellular (HR 2.94; 95 % CI 1.17–7.40), and prostate cancer mortality (HR 3.10; 95 % CI 1.22–7.94). Further adjustment for arsenic exposure showed a significantly increased risk of all-cause cancer mortality with diabetes (HR 1.27; 95 % CI 1.03–1.58). Insulin resistance among participants without diabetes at baseline was associated with hepatocellular cancer mortality (HR 4.70; 95 % CI 1.55–14.26).ConclusionsDiabetes mellitus, and/or insulin resistance among those without diabetes, is a risk factor for gastric, hepatocellular, and prostate cancer in these American Indian communities, although relatively small sample size suggests cautious interpretation. Additional research is needed to evaluate the role of diabetes and obesity on cancer incidence in American Indian communities as well as the importance of diabetes prevention and control in reducing the burden of cancer incidence and mortality in the study population.

Association of Changes in Fitness and Body Composition with Cancer Mortality in Men

Both baseline cardiorespiratory fitness and adiposity predict the risk of cancer mortality. However, the effects of changes in these two factors over time have not been evaluated thoroughly. The aim of this study was to examine the independent and joint associations of changes in cardiorespiratory fitness and body composition on cancer mortality. The cohort consisted of 13,930 men (initially cancer-free) with two or more medical examinations from 1974 to 2002. Cardiorespiratory fitness was assessed by a maximal treadmill exercise test, and body composition was expressed by body mass index (BMI) and percent body fat. Changes in cardiorespiratory fitness and body composition between the baseline and the last examination were classified into loss, stable, and gain groups. There were 386 deaths from cancer during an average of 12.5 yr of follow-up. After adjusting for possible confounders and BMI, change hazard ratios (95% confidence intervals) of cancer mortality were 0.74 (0.57-0.96) for stable fitness and 0.74 (0.56-0.98) for fitness gain. Inverse dose-response relationships were observed between changes in maximal METs and cancer mortality (P for linear trend = 0.05). Neither BMI change nor percent body fat change was associated with cancer mortality after adjusting for possible confounders and maximal METs change. In the joint analyses, men who became less fit had a higher risk of cancer mortality (P for linear trend = 0.03) compared with those who became more fit, regardless of BMI change levels. Being unfit or losing cardiorespiratory fitness over time was found to predict cancer mortality in men. Improving or maintaining adequate levels of cardiorespiratory fitness appears to be important for decreasing cancer mortality in men.

Body mass index, smoking, age and cancer mortality among women: A classification tree analysis

Although obesity is an established risk factor for cancer mortality among women, little is known about how body mass index (BMI) is interacting with certain lifestyle behaviors and sociodemographic characteristics to increase the risk of cancer mortality. The purpose of this study was to use classification trees to examine possible interactions between BMI, smoking, age, poverty level and marital status in identifying high-risk subgroups for all-cause cancer mortality in women. Data from the US National Health Interview Survey linked with the National Death Index from 1990-2004 were used in this study. The data were restricted to women with complete information on all risk factors considered in the analyses. The data were analyzed using descriptive statistics and classification trees. Findings revealed that younger women (41-50 years old) who smoked had higher cancer mortality if they were underweight. Even among 51-60-year-old never smokers, we observed an inverse relationship between BMI and mortality. High BMI, however, was not a protective factor in 51-60-year-old women who were not married and did not smoke. Classification tree analysis confirms and extends current knowledge about the role of BMI and smoking on cancer mortality by providing preliminary risk profiles. The findings indicate that it is imperative for cancer-related studies to examine BMI and smoking within age-specific groups and in the context of several sociodemographic factors that are known to independently affect cancer mortality.

Increased Risk of Cancer Mortality Associated with Cadmium Exposures in Older Americans with Low Zinc Intake

Cadmium (Cd) exposure has been associated with increased cancer risk, and zinc (Zn) appears to reduce that risk. However, little is known about the combined influence of Cd and Zn on cancer risk. The aim of this study was to examine relationships between Cd exposure, Zn intake, and cancer mortality risks. The analyses used 5204 subjects aged 50 yr or older from the Third National Health and Nutrition Examination Survey (NHANES III, 1988–1994) and the mortality follow-up through December 31, 2006. Cox proportional hazards models were used to test associations. In total, 569 cancer deaths were recorded during an average follow-up of 12.4 yr, including 155 from lung, 61 from prostate, and 26 from breast cancer. A positive association between Cd and cancer mortality risk was identified for both genders. Despite limited cause-specific deaths, the increased risk associated with Cd was significant for lung cancer in men. All-cause cancer mortality risk was significantly elevated among women with Zn intakes below the recommended dietary allowance (RDA) compared with women who met the RDA. The effect of low dietary Zn was not observed in men. Similar trends for prostate and breast cancer deaths were not significant. There was a significant inverse association between cancer deaths and the Zn-to-Cd ratio for both genders. Cd exposure is an important independent risk factor of cancer mortality in older Americans and the risk appears exaggerated in those with inadequate dietary Zn. Additional studies are required to elucidate the mechanism(s) by which Zn participates in the carcinogenic influence of Cd.

Metabolic syndrome and risk of cancer mortality in men

Background Metabolic syndrome (MetS) has been linked with an increased risk of developing cancer; however, the association between MetS and cancer mortality remains less clear. Little research has focused on pre-cancer risk factors that may affect the outcome of treatment. The purpose of this study was to examine the association between MetS and all-cancer mortality in men. Methods The participants included 33,230 men aged 20–88 years who were enrolled in the Aerobics Centre Longitudinal Study and who were free of known cancer at the baseline. Results At baseline 28% of all the participants had MetS. During an average of 14 years follow-up, there were a total of 685 deaths due to cancer. MetS at baseline was associated with a 56% greater age-adjusted risk in cancer mortality. Conclusion These data show that MetS is associated with an increased risk of all-cause cancer mortality in men. Based on these findings, it is evident that successful interventions should be identified to attenuate the negative effects of MetS.

The effect of cardiorespiratory fitness and obesity on cancer mortality in women and men.

The purpose of this study was to determine the independent and combined effects of cardiorespiratory fitness and obesity on all-cause cancer mortality for women and men. Using the Lipids Research Clinics Prevalence Study, we examined the relationship of fitness and obesity on cancer mortality among 2585 women and 2890 men followed from 1972-1976 to 1998. Cardiorespiratory fitness was measured using a treadmill test and obesity was assessed using body mass index (BMI) calculated from measured height and weight. Gender-specific hazard ratios (HR) were calculated from proportional hazard models, which included covariates for age, education, smoking, alcohol intake, Keys score, and menopause (women only). Adjusted cancer mortality was significantly lower in the most fit quintile relative to the other four quintiles for men (HR = 0.47; 95% CI, 0.27-0.81) but not for women (HR = 0.84; 95% CI, 0.52-1.36). Adjusted cancer mortality was significantly higher in the highest BMI quintile relative to the other four BMI quintiles for women (HR = 1.49; 95% CI, 1.06-2.09) but not for men (HR = 1.05; 95% CI, 0.77-1.43). Further adjustment for BMI on fitness and adjustment for fitness on BMI did not meaningfully change the HR. There were no significant interactions between fitness and obesity in predicting cancer mortality for either women or men. In this study, high fitness was a stronger predictor of cancer mortality in men, whereas high BMI was a stronger predictor of cancer mortality in women.

Cancer mortality among Iowa farmers: recent results, time trends, and lifestyle factors (United States).

To update the cancer mortality patterns among Iowa (United States) farmers for the years 1987-93 and compare these results with those previously reported for 1971-86 as well as relate the PMR patterns to risk-factor survey data. We extracted usual occupation and cause of death from 88,090 Iowa death certificates for White males aged 20 and older for the years 1987-93. Proportional mortality ratios (PMR), adjusted for age, and 95 percent confidence intervals (CI) were calculated using deaths among nonfarmers to generate expected numbers. We compared lifestyle profiles for farmers and nonfarmers using male controls (n = 1,596) from a population-based case-control study conducted in Iowa from 1986-89. Iowa farmers had deficit PMRs for all-cause cancer mortality (PMR = 0.92, CI = 0.90-0.94) and for lung (PMR = 0.70, CI = 0.66-0.73), liver (PMR = 0.65, CI = 0.50-0.86), and other cancer sites strongly related to smoking and alcohol use. Farmers at all ages had excess deaths for cancers of the prostate (PMR = 1.26, CI = 1.19-1.33), rectum (PMR = 1.29, CI = 1.07-1.56), brain (PMR = 1.10, CI = 0.92-1.32), multiple myeloma (PMR = 1.17, CI = 0.98-1.40), non-Hodgkin's lymphoma (PMR = 1.09, CI = 0.96-1.23), and Hodgkin's disease (PMR = 1.62, CI = 1.04-2.54). Younger farmers (aged 20 to 64 years) had excess deaths for colon cancer (PMR = 1.52, CI =1.26-1.85) and skin melanoma (PMR = 1.60, CI = 1.07-2.38), while older farmers (aged 65+ years) had excess deaths for cancers of the pancreas (PMR = 1.18, CI = 1.04-1.34), lip (PMR = 1.58, CI = 0.59-4.21), and leukemia (PMR = 1.26, CI = 1.09-1.46). Since the 1970s, the PMR for stomach cancer has declined to expected values, while the PMRs for prostate, large intestine, pancreas, and Hodgkin's disease have increased; PMRs for other sites are consistent with earlier data. A survey from 1986-89 showed that farmers, compared with nonfarmers, smoked less, used less alcohol, had less formal education, and consumed more total calories, and calories from protein, fat, and meat while consuming fewer calories from fruits and vegetables. Iowa farmers continue to be at elevated risk of mortality due to certain cancers, and, of particular interest, the risk for prostate and colon cancer appears to be increasing since 1970.