Macek Pawel, Biskup Malgorzata, Terek-Derszniak Malgorzata, Manczuk Marta, Krol Halina, Naszydlowska Edyta, Smok-Kalwat Jolanta, Gozdz Stanislaw, Zak Marek
Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University, Kielce, Poland.
Department of Epidemiology and Cancer Control, Holycross Cancer Centre, Kielce, Poland.
Front Oncol. 2020 Nov 30;10:545078. doi: 10.3389/fonc.2020.545078. eCollection 2020.
The study aimed to identify the association between the lifestyle-related factors and the cancer-specific, or non-cancer-specific mortality, when accompanied by a competing risk. Two statistical methods were applied, i.e., cause-specific hazard (CSH), and sub-distribution hazard ratio (SHR). Their respective key advantages, relative to the actual study design, were addressed, as was overall application potential.
Source data from 4,584 residents (34.2% men), aged 45-64 years, were processed using two different families of regression models, i.e., CSH and SHR; principal focus upon the impact of lifestyle-related factors on the competing risk of cancer and non-cancer mortality. The results were presented as hazard ratios (HR) with 95% confidence intervals (95% CI).
Age, smoking status, and family history of cancer were found the leading risk factors for cancer death; the risk of non-cancer death higher in the elderly, and smoking individuals. Non-cancer mortality was strongly associated with obesity and hypertension. Moderate to vigorous physical activity decreased the risk of death caused by cancer and non-cancer causes.
Specific, lifestyle-related factors, instrumental in increasing overall, and cancer-specific mortality, are modifiable through health-promoting, individually pursued physical activities. Regular monitoring of such health-awareness boosting pursuits seems viable in terms of public health policy making.
本研究旨在确定生活方式相关因素与癌症特异性或非癌症特异性死亡率之间的关联，同时考虑竞争风险。应用了两种统计方法，即特定病因风险（CSH）和亚分布风险比（SHR）。阐述了它们相对于实际研究设计各自的主要优势以及总体应用潜力。
对4584名年龄在45 - 64岁的居民（34.2%为男性）的源数据使用两种不同的回归模型族进行处理，即CSH和SHR；主要关注生活方式相关因素对癌症和非癌症死亡竞争风险的影响。结果以风险比（HR）及95%置信区间（95%CI）呈现。
年龄、吸烟状况和癌症家族史被发现是癌症死亡的主要危险因素；老年人和吸烟者的非癌症死亡风险更高。非癌症死亡率与肥胖和高血压密切相关。中度至剧烈的体育活动可降低癌症和非癌症原因导致的死亡风险。
特定的生活方式相关因素，有助于增加总体死亡率和癌症特异性死亡率，可通过促进健康的个人体育活动来改变。就公共卫生政策制定而言，定期监测此类增强健康意识的行为似乎是可行的。
