A Competing Risk Analysis of Adherence to the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention and Obesity-Related Cancer Risk in Hispanic/Latino Adults in the NIH-AARP Diet and Health Study
Menée aux Etats-Unis à l'aide de données portant sur 9 204 Américains d'origine hispanique (durée médiane de suivi : 10,5 ans), cette étude analyse l'association entre le niveau d'adhésion aux recommandations 2012 de l'"American Cancer Society" sur les comportements de santé (nutrition et activité physique) pour la prévention des cancers et le risque de cancer lié à l'obésité (619 cas)
Incidence of obesity-related cancers (ORCs) is rising among U.S. Hispanic/Latino adults, which may be partly due to inadequate engagement in healthy lifestyle behaviors. Prior research on cancer prevention guideline adherence and cancer risk has not considered competing events that may lead to misinterpreting the magnitude of risk between guideline adherence and cancer incidence. Among Hispanic/Latino adults (N=9,204) in the NIH-AARP Diet and Health Study, we examined the association between adherence to the 2012 American Cancer Society (ACS) guidelines (high, moderate, low) on nutrition and physical activity for cancer prevention and risk of any first observed ORC using Fine and Gray methods for competing risk analysis. Over a median of 10.5 years of follow-up, there were 619 first ORCs. The cumulative risk of ORC over a 15-year period was not significantly different across ACS guideline adherence categories (high cumulative incidence function (CIF): 2.2% - 5.8%; moderate CIF: 2.2% - 6.6%; low CIF: 2.3% - 6.7%, PGray's log rank = 0.690). In competing risk analysis, high (compared to low) adherence to the ACS guidelines was associated with reduced probability of ORC (subdistribution hazard (SHR): 0.76, 95% CI: 0.58 – 0.996, P=0.047), with evidence of a linear trend for increasing adherence (Ptrend = 0.039). Our findings were consistent with hypothesized inverse associations between ACS guideline adherence and ORC incidence accounting for competing risks. These findings suggest a need for continued public health efforts focused on promoting engagement in healthy lifestyle behaviors to reduce ORC incidence among U.S. Hispanic/Latino adults.