Luo Qianlai, Hofmann Jonathan N, Pfeiffer Ruth M, Kitahara Cari M, Song Minkyo, Shiels Meredith S
Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA.
Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.
Int J Cancer. 2023 Jul 1;153(1):64-72. doi: 10.1002/ijc.34516. Epub 2023 Apr 6.
In the United States, renal cell carcinoma (RCC) incidence and the prevalence of obesity, an established risk factor for RCC, have been increasing for several decades. RCC is more common among older individuals. We sought to quantify the contribution of excess adiposity to the rising incidence of RCC among individuals 60 years or older. National Institutes of Health-American Association of Retired Persons Diet and Health Study data (n = 453 859 participants, enrolled in 1995-1996, age at enrollment 50-71 years) were used to estimate multivariable-adjusted hazard ratios (HRs) for RCC across body mass index categories and HRs associated with smoking. Population attributable fractions (PAFs) were calculated using estimated HRs and annual overweight/obesity prevalence from the National Health Interview Survey (1985-2008). PAF estimates were combined with RCC incidence from Surveillance, Epidemiology and End Results-13 to calculate annual percent changes in RCC incidence attributable (and unrelated) to overweight/obesity. We found that between 1995 and 2018, among individuals aged 60 years and older, PAF for overweight/obesity increased from 18% to 29% for all RCCs. In comparison, the PAF for smoking declined from 12% to 9%. RCC incidence increased 1.8% per year (95% confidence interval [CI] 1.5%-2.1%) overall, while RCC incidence attributable to overweight/obesity increased 3.8% per year (95%CI 3.5%-4.2%) and RCC incidence unrelated to overweight/obesity increased 1.2% per year (95% CI 0.9%-1.4%). In conclusion, overweight/obesity appears to have contributed importantly to the rising incidence of RCC in the United States since the mid-1990s. Public health interventions focused on reducing overweight and obesity could help substantially in curbing this trend.
在美国，几十年来，肾细胞癌（RCC）的发病率以及肥胖（RCC的一个既定风险因素）的患病率一直在上升。RCC在老年人中更为常见。我们试图量化超重对60岁及以上人群中RCC发病率上升的影响。利用美国国立卫生研究院-美国退休人员协会饮食与健康研究数据（n = 453859名参与者，于1995 - 1996年入组，入组年龄50 - 71岁）来估计不同体重指数类别下RCC的多变量调整风险比（HRs）以及与吸烟相关的HRs。使用从国家健康访谈调查（1985 - 2008年）中估计的HRs和年度超重/肥胖患病率来计算人群归因分数（PAFs）。PAF估计值与监测、流行病学和最终结果-13中的RCC发病率相结合，以计算归因于（以及与）超重/肥胖相关的RCC发病率的年度百分比变化。我们发现，在1995年至2018年期间，在60岁及以上的人群中，所有RCC的超重/肥胖PAF从18%增加到29%。相比之下，吸烟的PAF从12%下降到9%。总体而言，RCC发病率每年增加1.8%（95%置信区间[CI] 1.5% - 2.1%），而归因于超重/肥胖的RCC发病率每年增加3.8%（95%CI 3.5% - 4.2%），与超重/肥胖无关的RCC发病率每年增加1.2%（95%CI 0.9% - 1.4%）。总之，自20世纪90年代中期以来，超重/肥胖似乎对美国RCC发病率的上升起到了重要作用。专注于减轻超重和肥胖的公共卫生干预措施可能在很大程度上有助于遏制这一趋势。
