Disparities by province, age, and sex in site-specific cancer burden attributable to 23 potentially modifiable risk factors in China: a comparative risk assessment

Abstract

Background Understanding disparities in the burden of cancer attributable to different risk factors is crucial to inform and improve cancer prevention and control. In this report, we estimate the site-specific population-attributable fractions (PAFs) for 23 potentially modifiable risk factors across all provinces in China. MethodsIn this comparative risk assessment study, we used 2014 cancer mortality data for adults from 978 countylevel surveillance points in 31 provinces of mainland China. Risk-factor prevalence estimates were obtained from representative surveys. We used summary relative risks obtained from several recent large-scale pooled analyses or high-quality meta-analyses of studies in China. We calculated PAFs using multiple formulae incorporating exposure prevalence and relative risk data stratified by age, sex and province and then combined to create summary PAFs by sex, cancer site, and risk factors. Findings About 1 036 004 cancer deaths (45•2% of all cancer deaths [95% CI 44•0-46•4]) in China in 2014 in adults aged 20 years or older were attributable to 23 evaluated risk factors. The PAF was higher in men (51•2% [95% CI 50•0-52•4]) than in women (34•9% [33•6-36•2]), with the leading risk factors being active smoking in men and low fruit intake in women. By province, the PAF in both sexes combined ranged from 35•2% in Shanghai to 52•9% in Heilongjiang, while the PAF varied from 40•9% in Shanghai to 56•4% in Guangdong among men and from 26•9% in Shanghai to 48•0% in Heilongjiang among women. The highest PAF among men was smoking in all 31 provinces, whereas among women it varied among low fruit intake (14 provinces), hepatitis B virus infection (seven provinces), smoking (six provinces), excess bodyweight (three provinces), and human papilloma virus infection (one province).Interpretation The PAFs of cancers attributable to potentially modifiable risk factors vary substantially across provinces in China. Regional adoption of effective primary cancer prevention strategies has a vast potential to reduce the burden of cancer and disparities in China. Smoking, poor diet, and infection warrant particular policy attention as they contributed a large proportion to the total cancer burden.

Cancer burden of major cancers in China: A need for sustainable actions

“…The priority of primary prevention is to find possible risk factors associated with cancer risk. A series of epidemiological studies were conducted to identify potential risk factors [19‐22] which provided critical evidence for targeted interventions. Nationally, cigarette smoking is considered as the main cause of lung cancer [23].…”

Diagnostic value of the lymphocyte-to-monocyte and albumin-to-globulin ratios in patients with colon cancer

“…Authors' information 1 Department of Clinical Laboratory, First A liated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China. 2 Department of Blood Transfusion, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi Zhuang Autonomous Region, China.…”

“…Colon cancer comprised the highest incidence in tumors of the digestive system and represented a commonly diagnosed malignant tumor worldwide in 2018 [1]; it was the fourth most frequent cause of cancer morbidity and fth leading cause of cancer mortality in China in 2015 [2]. Due to the lack of obvious clinical manifestations, most colon cancer patients have silent symptoms for years.…”

The Interactive Association between Sodium Intake, Alcohol Consumption and Hypertension among Elderly in Northern China

“…The global sodium intake survey found that the average sodium intake of residents was 10.06 g/d [7], as well as the fifth dietary survey conducted in China found it was 14 g/d, which is double than the WHO's recommended intake [8]. Additionally, heavy alcohol consumption has become a leading risk factor for hypertension [9]. In 2016, the global drinking population accounted for 32.5%.…”