Quantifying the contribution of modifiable risk factors to socio-economic inequities in cancer morbidity and mortality: a nationally representative population-based cohort study

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dc.contributor.authorNejatinamini, Sara
dc.contributor.authorGodley, Jenny
dc.contributor.authorMinaker, Leia M
dc.contributor.authorSajobi, Tolulope T
dc.contributor.authorMcCormack, Gavin R
dc.contributor.authorCooke, Martin J
dc.contributor.authorNykiforuk, Candace I J
dc.contributor.authorKoning, Lawrence de
dc.contributor.authorOlstad, Dana Lee
dc.date.accessioned2022-03-09T22:29:27Z
dc.date.available2022-03-09T22:29:27Z
dc.date.issued2021-04-12
dc.description.abstractCompared with those with a higher socio-economic position (SEP), individuals with a lower SEP have higher cancer morbidity and mortality. However, the contribution of modifiable risk factors to these inequities is not known. This study aimed to quantify the mediating effects of modifiable risk factors to associations between SEP and cancer morbidity and mortality. Methods: This study used a prospective observational cohort design. We combined eight cycles of the Canadian Community Health Survey (2000/2001-2011) as baseline data to identify a cohort of adults (≥35 years) without cancer at the time of survey administration (n = 309 800). The cohort was linked to the Discharge Abstract Database and the Canadian Mortality Database for cancer morbidity and mortality ascertainment. Individuals were followed from the date they completed the Canadian Community Health Survey until 31 March 2013. Dates of individual first hospitalizations for cancer and deaths due to cancer were captured during this time period. SEP was operationalized using a latent variable combining measures of education and household income. Self-reported modifiable risk factors, including smoking, excess alcohol consumption, low fruit-and-vegetable intake, physical inactivity and obesity, were considered as potential mediators. Generalized structural equation modelling was used to estimate the mediating effects of modifiable risk factors in associations between low SEP and cancer morbidity and mortality in the total population and stratified by sex. Results: Modifiable risk factors together explained 45.6% of associations between low SEP and overall cancer morbidity and mortality. Smoking was the most important mediator in the total population and for males, accounting for 15.5% and 40.2% of the total effect, respectively. For females, obesity was the most important mediator. Conclusions: Modifiable risk factors are important mediators of socio-economic inequities in cancer morbidity and mortality. Nevertheless, more than half of the variance in these associations remained unexplained. Midstream interventions that target modifiable risk factors may help to alleviate inequities in cancer risk in the short term. However, ultimately, upstream interventions that target structural determinants of health are needed to reduce overall socio-economic inequities in cancer morbidity and mortality.en_US
dc.description.grantingagencyCanadian Institutes of Health Research (CIHR)en_US
dc.identifier.citationNejatinamini, S., Godley, J., Minaker, L. M., Sajobi, T. T., McCormack, G. R., Cooke, M. J., ... & Olstad, D. L. (2021). Quantifying the contribution of modifiable risk factors to socio-economic inequities in cancer morbidity and mortality: a nationally representative population-based cohort study. International Journal of Epidemiology, 50(5), 1498-1511.en_US
dc.identifier.doihttp://dx.doi.org/10.1093/ije/dyab067en_US
dc.identifier.urihttp://hdl.handle.net/1880/114454
dc.publisherInternational Epidemiological Association [Associate Organisation], Oxford University Press [University Publisher]en_US
dc.publisher.departmentCommunity Health Sciencesen_US
dc.publisher.facultyCumming School of Medicineen_US
dc.publisher.hasversionacceptedVersionen_US
dc.publisher.institutionUniversity of Calgaryen_US
dc.publisher.policyhttps://academic.oup.com/journals/pages/access_purchase/rights_and_permissions/author_self_archiving_policy?login=falseen_US
dc.subjectSocio-economic positionen_US
dc.subjectcancer morbidity and mortalityen_US
dc.subjectmediation analysesen_US
dc.subjectmodifiable risk factorsen_US
dc.titleQuantifying the contribution of modifiable risk factors to socio-economic inequities in cancer morbidity and mortality: a nationally representative population-based cohort studyen_US
ucalgary.item.requestcopytrueen_US
ucalgary.scholar.levelFacultyen_US
ucalgary.scholar.levelGraduateen_US
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