Dietary Factors and Early-Onset Colorectal Cancer in the United States-an Ecologic Analysis.
Dietary Factors and Early-Onset Colorectal Cancer in the United States-an Ecologic Analysis.
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DOI：
10.1158/1055-9965.epi-22-0442
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发表时间：
2023-02-06
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早发性结直肠癌（EOCRC;例如，自20世纪90年代以来，美国50岁之前确诊的糖尿病患者人数大幅增加，但根本原因仍不清楚。我们研究了1977-2016年美国25-49岁成人中饮食因素与EOCRC发病率之间的生态学关联，使用负二项回归模型，考虑年龄，时期和种族。这些模型还纳入了年龄均值中心（AMC）方法，以解决年龄的潜在混淆。我们按性别对分析进行分层，并计算每个研究因素的发病率比（IRR）。研究因素数据（18个变量）来自重复的国家调查; EOCRC发病率数据来自监测流行病学和最终结果计划。结果表明，年龄对EOCRC相关性的混淆可能存在于某些研究因素中（例如，钙摄入量），AMC可以减轻混淆。EOCRC发病率与吸烟（男性IRR [95% CI]：1.17 [1.10-1.24];女性1.15 [1.09-1.21]）和饮酒（男性IRR [95% CI]：1.08 [1.04-1.12];女性1.08 [1.04-1.11]）呈正相关。对于大多数其他研究因素（例如，纤维和钙）。饮酒与EOCRC呈正相关，自20世纪80年代以来，年轻人中饮酒量增加，这可能是自20世纪90年代以来EOCRC发病率增加的原因。AMC方法可能有助于减轻类似生态分析中的年龄混淆。饮酒量的增加可能是最近年轻人结直肠癌发病率增加的原因。
Incidence of early-onset colorectal cancer (EOCRC; e.g., diagnosed before age 50) in the US has increased substantially since the 1990s but the underlying reasons remain unclear. We examined the ecologic associations between dietary factors and EOCRC incidence in adults aged 25-49 during 1977-2016 in the US, using negative binomial regression models, accounting for age, period, and race. The models also incorporated an age-mean centering (AMC) approach to address potential confounding by age. We stratified the analysis by sex and computed incidence rate ratio (IRR) for each study factor. Study factor data (for 18 variables) came from repeated national surveys; EOCRC incidence data came from the Surveillance Epidemiology, and End Results Program. Results suggest that confounding by age on the association with EOCRC likely existed for certain study factors (e.g., calcium intake), and that AMC can alleviate the confounding. EOCRC incidence was positively associated with smoking (IRR [95% CI]: 1.17 [1.10-1.24] for men; 1.15 [1.09-1.21] for women) and alcohol consumption (IRR [95% CI]: 1.08 [1.04-1.12] for men; 1.08 [1.04-1.11] for women). No strong associations were found for most other study factors (e.g., fiber and calcium). Alcohol consumption was positively associated with EOCRC and has increased among young adults since the 1980s, which may have contributed to the EOCRC incidence increases since the 1990s. The AMC approach may help alleviate age confounding in similar ecologic analyses. Increases in alcohol consumption may have contributed to the recent increases in colorectal cancer incidence among young adults.