Proportion of Cancer Cases Attributable to Excess Body Weight by US State, 2011-2015
Proportion of Cancer Cases Attributable to Excess Body Weight by US State, 2011-2015
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DOI：
10.1001/jamaoncol.2018.5639
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发表时间：
2019-03-01
期刊：
影响因子：
28.4
通讯作者：
Jemal, Ahmedin
中科院分区：
文献类型：
--
作者：
Islami, Farhad;Sauer, Ann Goding;Jemal, Ahmedin
超重（EBW）是癌症的一个既定原因。尽管美国各州的EBW患病率存在差异，但各州EBW相关癌症负担的信息很少;这一信息将有助于确定癌症控制措施的优先次序。目的计算人口归因分数（PAF）2011年至2015年，在所有50个州和哥伦比亚特区，30岁或30岁以上的成年人中，和参与者来自行为风险因素监测系统的国家级自我报告的体重指数（BMI [计算为体重（kg）除以身高（m）的平方]）数据通过性别，年龄，种族/民族和教育进行调整，使用国家健康和营养检查调查中客观测量的BMI值。从美国癌症统计数据库中获得了各州年龄和性别特异性癌症发病率数据。所有分析均在2018年2月15日至2018年7月17日期间进行。主要结局和指标使用4种高BMI类别的性别、年龄和州特异性调整的患病率估计值以及来自大规模汇总分析或荟萃分析的相应相对风险来计算美国各州食管腺癌、多发性骨髓瘤和贲门癌的PAF，结直肠、肝脏、胆囊、胰腺、女性乳腺、子宫体、卵巢、肾脏和肾盂以及甲状腺。估计有37670例男性癌症病例（占所有癌症病例的4.7%，不包括非黑色素瘤皮肤癌）和74690例女性癌症病例2011年至2015年，美国30岁或以上的人（9.6%）归因于EBW。在男性和女性中，在具有最高和最低PAF的州之间，归因于EBW的癌症比例至少有1.5倍的差异。在男性中，PAF的范围从蒙大拿州的3.9%（95% CI，3.6%-4.3%）到德克萨斯州的6.0%（95% CI，5.6%-6.4%）。女性的PAF大约是男性的两倍，范围从夏威夷的7.1%（95% CI，6.7%-7.6%）到哥伦比亚特区的11.4%（95% CI，10.7%-12.2%）。最大的PAF被发现主要是在南部和中西部各州，以及阿拉斯加和哥伦比亚特区。结论和相关性的比例癌症归因于EBW各州之间的变化，但EBW占至少1/17的所有事件癌症在每个州。需要广泛实施已知的社区和个人层面的干预措施，以减少不健康食品的获取和营销（例如，通过对含糖饮料征税），并促进和增加健康食品和体育活动以及预防保健的获取。
IMPORTANCE Excess body weight (EBW) is an established cause of cancer. Despite variations in the prevalence of EBW among US states, there is little information on the EBW-related cancer burden by state; this information would be useful for setting priorities for cancer-control initiatives.OBJECTIVE To calculate the population attributable fraction (PAF) of incident cancer cases attributable to EBW among adults 30 years or older in 2011to 2015 in all 50 states and the District of Columbia.DESIGN, SETTING, AND PARTICIPANTS State-level, self-reported body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]) data from the Behavioral Risk Factor Surveillance System were adjusted by sex, age, race/ethnicity, and education using objectively measured BMI values from the National Health and Nutrition Examination Survey. Age- and sex-specific cancer incidence data by state were obtained from the US Cancer Statistics database. All analyses were performed between February 15, 2018, and July 17, 2018.MAIN OUTCOMES AND MEASURES Sex-, age-, and state-specific adjusted prevalence estimates for 4 high BMI categories and corresponding relative risks from large-scale pooled analyses or meta-analyses were used to compute the PAFs for each US state for esophageal adenocarcinoma, multiple myeloma, and cancers of the gastric cardia, colorectum, liver, gallbladder, pancreas, female breast, corpus uteri, ovary, kidney and renal pelvis, and thyroid.RESULTS Each year, an estimated 37 670 cancer cases in men (4.7% of all cancer cases excluding nonmelanoma skin cancers) and 74 690 cancer cases in women (9.6%) 30 years or older in the United States were attributable to EBW from 2011to 2015. In both men and women, there was at least a 1.5-fold difference in the proportions of cancers attributable to EBW between states with the highest and lowest PAFs. Among men, the PAF ranged from 3.9% (95% CI, 3.6%-4.3%) in Montana to 6.0% (95% CI, 5.6%-6.4%) in Texas. The PAF for women was approximately twice as high as for men, ranging from 7.1% (95% CI, 6.7%-7.6%) in Hawaii to 11.4% (95% CI, 10.7%12.2%) in the District of Columbia. The largest PAFs were found mostly in southern and midwestern states, as well as Alaska and the District of Columbia.CONCLUSIONS AND RELEVANCE The proportion of cancers attributable to EBW varies among states, but EBW accounts for at least 1 in 17 of all incident cancers in each state. Broad implementation of known community- and individual-level interventions is needed to reduce access to and marketing of unhealthy foods (eg, through a tax on sugary drinks) and to promote and increase access to healthy foods and physical activity, as well as preventive care.