Hemminki Kari, Li Xinjun
Department of Biosciences at Novum, Karolinska Institute, 141 57 Huddinge, Sweden.
Cancer Epidemiol Biomarkers Prev. 2003 Sep;12(9):899-904.
Limited data are available on the possible changes in cancer risk brought about by widowhood and divorce, an increasing segment of the population. We calculated standardized incidence ratios (SIRs) for cancer among 47,000 widows/widowers and 60,000 divorced people, based on the Swedish Family-Cancer Database. Persons had to be identified with the same civil status in the census of years 1960 and 1970; the comparison group was married people according to the same censuses. Cancers were followed from years 1971 to 1998. Both increased and decreased SIRs were found, and a consistent pattern emerged. The effects on the divorced were always stronger than those in widows/widowers, irrespective of the direction of the effect. Every significant SIR for a cancer site in widows/widowers was accompanied by a more deviant and significant SIR in the divorced. SIRs between divorced men and women (r=0.83, P<0.0001) and between widows and divorcees correlated (r=0.70, P<0.0001). The overall cancer risk for the divorced was 0.92-0.94, and it was a balance between increased risks at tobacco-, alcohol-, and human papilloma virus-related sites, and decreased risks at most other sites. The data suggest that the changes in lifestyle on the loss of a spouse impact on the incidence of almost every type of cancer. The effects were so large that a failure to consider marital status in epidemiological studies may be a source to bias. Understanding these lifestyle changes may provide new insight in cancer prevention.
关于丧偶和离婚（这一人口中日益增长的部分）所带来的癌症风险可能变化的数据有限。我们基于瑞典家庭癌症数据库，计算了47000名寡妇/鳏夫和60000名离婚者的癌症标准化发病比（SIRs）。在1960年和1970年的人口普查中，这些人必须被确定具有相同的婚姻状况；对照组是根据相同人口普查数据的已婚者。癌症发病情况从1971年追踪至1998年。我们发现了SIRs的上升和下降情况，并且呈现出一种一致的模式。无论影响方向如何，对离婚者的影响总是比对寡妇/鳏夫的影响更强。寡妇/鳏夫中每个癌症部位显著的SIR，在离婚者中都伴随着一个更偏离且显著的SIR。离婚男性和女性之间的SIRs相关（r = 0.83，P < 0.0001），寡妇和离婚者之间的SIRs也相关（r = 0.70，P < 0.0001）。离婚者的总体癌症风险为0.92 - 0.94，这是烟草、酒精和人乳头瘤病毒相关部位风险增加与大多数其他部位风险降低之间的一种平衡。数据表明，配偶丧失后生活方式的改变会影响几乎每种癌症的发病率。这些影响如此之大，以至于在流行病学研究中不考虑婚姻状况可能会导致偏差。了解这些生活方式的变化可能为癌症预防提供新的见解。
