Burden of cancers attributable to modifiable risk factors in Malaysia

Abstract Background This is a systematic assessment of the burden of cancers in Malaysia in 2018 using epidemiologic approach. The purpose of this study was to identify the proportion of cancers in Malaysia that were attributable to the modifiable risk factors of excess weight, alcohol intake, physical inactivity, tobacco smoking and to estimate the number of cancer cases that could be prevented if the exposure to the modifiable risk factor was reduced. Methods We estimated the Population Attributable Fraction (PAF) of the modifiable risk factors to cancers incidences in Malaysia. The two parameters used for the estimation were exposure prevalence from national representative surveys and the relative risk of getting the cancers from worldwide literature review. Results Among 38,426 cancer incidences in 2018 from Globocan data, we estimated that 22.2% (95% confidence interval (CI):14.9 to 29.6%) of the cancer incidences included in this study were attributable to the investigated modifiable risk factors. 39.1% (95% CI:27.2 to 49.7%) and 10.5% (95% CI:5.8 to 15.7%) of cancers in male and female respectively, were attributable to the studied modifiable risk factors. The top main cancers attributed by the risk factors were lung cancer (65.1%; 95% CI:56.4 to 72.9%), laryngeal cancer (63.6%; 95% CI:39.9 to 80.5%), and oesophageal cancer (51.5%; 95% CI:39.9 to 62.0%). For each risk factor studied across genders, tobacco smoking contributed the most (14.3%; 95% CI:9.9 to 17.3%), followed by excess weight (7.0%; 95% CI:4.1 to 10.2%), physical inactivity (1.0%; 95% CI:0.4 to 1.7%) and alcohol intake (0.6%; 95% CI:0.2 to 1.0%). Conclusion Findings from this study suggests that tobacco smoking and excess weight are the two predominant factors out of the four studied risk factors for cancer cases in Malaysia. Nationwide public health prevention campaigns tailored to these risk factors are recommended. However, the other risk factors such as physical inactivity and alcohol intake shall not be neglected. PAFs are estimated based on the best available data that we have currently. Regular collection of other risk factor exposure prevalence data is vital for future analyses.

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Preventability of Colorectal Cancer in Saudi Arabia: Fraction of Cases Attributable to Modifiable Risk Factors in 2015–2040

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17010320 ◽

2020 ◽

Vol 17 (1) ◽

pp. 320 ◽

Cited By ~ 3

Author(s):

Abdulmohsen Al-Zalabani

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Saudi Arabia ◽

Tobacco Smoking ◽

Physical Inactivity ◽

Current Smoker ◽

Excess Weight ◽

Modifiable Risk Factors ◽

Men And Women ◽

Prevention Interventions

A rise in colorectal cancer (CRC) burden is expected around the globe. This study aimed to determine the population attributable fractions (PAFs) of CRC cases contributed by modifiable risk factors in Saudi Arabia. The PAF was calculated for modifiable risk factors with strong evidences of a causal association with CRC. CRC incidence was obtained from the National Cancer Registry, relative risks were retrieved from recent meta-analysis studies, and the prevalence of exposure to risk factors was obtained from national surveys. Conventional statistical formulas were used to calculate PAFs from registered CRC cases, stratified by sex. Three scenarios were proposed to make projections and present the expected effects of prevention interventions on the number of CRC cases in Saudi Arabia for 2025–2040. The results showed the largest fraction of attributable CRC cases among men and women was contributed by physical inactivity (16.13% and 16.45%), followed by excess weight (obesity: 9.71% and 6.93%; overweight: 6.05% and 1.9%); and tobacco smoking (current smoker: 3.04% and 0.18%; former smoker: 3.29% and 0.12%). We estimated that the number of projected cases attributable to physical inactivity, smoking, and excess weight in men and women would increase from 807 and 315 in 2025 to 1360 and 556 in 2040, respectively. In conclusion, physical inactivity, being overweight or obese, and tobacco smoking are major lifestyle factors affecting the incidence of CRC in Saudi Arabia. Prevention interventions and public health programs to reduce their prevalence are warranted.

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Regional variations in the economic burden attributable to excess weight, physical inactivity and tobacco smoking across British Columbia

Health Promotion and Chronic Disease Prevention in Canada ◽

10.24095/hpcdp.36.4.02 ◽

2016 ◽

Vol 36 (4) ◽

pp. 76-86 ◽

Cited By ~ 4

Author(s):

H. Krueger ◽

J.M. Koot ◽

D.P. Rasali ◽

S. E. Gustin ◽

M. Pennock

Keyword(s):

Risk Factors ◽

British Columbia ◽

Tobacco Smoking ◽

Economic Burden ◽

Physical Inactivity ◽

Excess Weight ◽

Prevalence Rates ◽

Population Attributable Fractions ◽

Attributable Fractions ◽

Social Environmental

Introduction Prevalence rates of excess weight, tobacco smoking and physical inactivity vary substantially by geographical region within British Columbia (B.C.). The purpose of this study is to determine the potential reduction in economic burden in B.C. if all regions in the province achieved prevalence rates of these three risk factors equivalent to those of the region with the lowest rates. Methods We used a previously developed approach based on population-attributable fractions to estimate the economic burden associated with the various risk factors. Sexspecific relative risk and age/sex-specific prevalence data was used in the modelling. Results The annual economic burden attributable to the three risk factors in B.C. was about $5.6 billion in 2013, with a higher proportion of this total attributable to excess weight ($2.6 billion) than to tobacco smoking ($2.0 billion). While B.C. has lower prevalence rates of the risk factors than any other Canadian province, there is significant variation within the province. If each region in the province were to achieve the best prevalence rates for the three risk factors, then $1.4 billion (24% of the $5.6 billion) in economic burden could be avoided annually. Conclusion There are notable disparities in the prevalence of each risk factor across health regions within B.C., which were mirrored in each region’s attributable economic burden. A variety of social, environmental and economic factors likely drive some of this geographical variation and these underlying factors should be considered when developing prevention programs.

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The Effect of Sex and Wealth on Population Attributable Risk Factors for Dementia in South Africa

Frontiers in Neurology ◽

10.3389/fneur.2021.766705 ◽

2021 ◽

Vol 12 ◽

Author(s):

Kirsten Bobrow ◽

Tina Hoang ◽

Deborah E. Barnes ◽

Raquel C. Gardner ◽

Isabel E. Allen ◽

...

Keyword(s):

Risk Factors ◽

South Africa ◽

Risk Factor ◽

Social Determinants Of Health ◽

Social Isolation ◽

Social Determinants ◽

Physical Inactivity ◽

Modifiable Risk Factors ◽

Dementia Risk ◽

Low Education

Background and Aims: South Africa is a middle-income country with high levels of income inequality and a rapidly aging population and increasing dementia prevalence. Little is known about which risk factors for dementia are important and how they differ by social determinants of health as well as key demographic characteristics such as sex and wealth. We sought to calculate the population attributable risks (PARs) for established potentially modifiable risk factors for dementia among these different groups.Methods: We obtained risk factor prevalence from population-based surveys for established dementia risk factors (diabetes, midlife hypertension, midlife obesity, physical inactivity, depression, smoking, low educational attainment, social isolation). We used relative risk estimates reported in previous meta-analyses and estimated PARs using Levin's formula and accounting for communality. We tested for one-way and two-way interactions by sex and wealth using Pearson's χ2. In stratified analyses, we performed tests for trend using logistic regression.Results: The prevalence of established risk factors for dementia ranged from 5% for depression to 64% for low education. After accounting for communality, the risk factors contributing the greatest PAR were low education (weighted PAR 12%, 95% CI 7% to 18%), physical inactivity (9, 5–14%), and midlife hypertension (6, 5–14%). Together, 45% of dementia cases may be attributable to modifiable risk factors (95% CI 25–59%). We found significant interactions (p < 0.005) between sex, wealth, or both (sex * wealth) and each risk factor except social isolation and physical activity. Low education was inversely associated with wealth in both male and female. The PAR for midlife hypertension, obesity, and diabetes was associated with increasing wealth, and was higher in female. In contrast, the PAR for smoking was higher in male (8% vs. 2%) and was associated with increasing wealth among female only. We found that either a strategy of large reductions in selected risk factors with the highest PAR (midlife hypertension, smoking, physical inactivity) or small reductions across all risk factors could potentially reduce dementia cases by as many as 250,000 by 2050.Discussions: The potential impact on dementia risk by decreasing exposure to established dementia risk factors is large and differs by sex and social determinants of health like wealth. Risk factor PAR should inform national and local health policy dementia initiatives in South Africa including which risk factors to target in the whole population and which to target in high-risk groups for maximum public health benefit.

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The economic benefits of risk factor reduction in Canada: Tobacco smoking, excess weight and physical inactivity

Can J Public Health ◽

10.17269/cjph.105.4084 ◽

2014 ◽

Vol 105 (1) ◽

pp. e69-e78 ◽

Cited By ~ 39

Author(s):

Hans Krueger ◽

Donna Turner ◽

Joshua Krueger ◽

A. Elizabeth Ready

Keyword(s):

Risk Factor ◽

Tobacco Smoking ◽

Physical Inactivity ◽

Economic Benefits ◽

Excess Weight ◽

Risk Factor Reduction

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Age- and sex-specific modifiable risk factor profiles of dementia: evidence from the UK Biobank

10.21203/rs.3.rs-1057766/v1 ◽

2021 ◽

Author(s):

Hui Chen ◽

Yaying Cao ◽

Yuan Ma ◽

Geng Zong ◽

Changzheng Yuan

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Alcohol Intake ◽

Health Condition ◽

Modifiable Risk Factors ◽

Uk Biobank ◽

Younger Adults ◽

Moderate Alcohol Intake ◽

The Uk ◽

Age And Sex

Abstract Background: To inform targeted preventive strategies of dementia, systematic investigation in its age- and sex-specific modifiable risk factor profiles in the general adult population is warranted.Methods: We used data of 372,867 adults free from dementia at baseline (2006-2010) in the UK Biobank, and followed them up until March 2021. We assigned participants into five groups according to their age and into two groups according to their sex. We estimated the age- and sex-specific hazard ratios (HRs) using Cox proportional hazard models and calculated the corresponding population attributable fractions (PAFs) for dementia attributable to three major categories of modifiable risk factors, including socioeconomic (low education level, high Townsend deprivation index), lifestyle (non-moderate alcohol intake, current smoking, suboptimal diet, non-regular physical exercise, and sleep duration <=6 or >=8 hrs/d), and health condition (hypertension, diabetes, cardiovascular diseases, and depressive symptom) risk factors.Findings: During 4,338,030 person-years of follow-up, 113, 146, 360, 1,087, and 2,002 of participants across five increasing age groups (40-<50, 50-<55, 55-<60, 60-<65, or >=65 y), respectively, were newly diagnosed with dementia. Five out of eleven modifiable risk factors showed significantly stronger associations with dementia among younger adults than in relatively older adults (P-interactions < 0.05), including non-moderate alcohol intake (HR [95% confidence interval, CI]=1.90 [1.35, 2.68] for participants 50-<55 y vs. 1.22 [1.11, 1.35] for participants > 65 y), suboptimal diet (1.86 [1.26, 2.74] for participants 40-< 50 y vs. 0.96 [0.86, 1.06] for participants > 65 y), hypertension (1.52 [0.96, 2.42] vs. 1.08 [0.99, 1.19]), CVD (4.20 [2.15, 8.22] vs. 1.64 [1.45, 1.85]), and diabetes (3.09 [1.60, 6.00] vs. 1.73 [1.51, 2.00]). We observed no significant difference in dementia risk factor profiles between women and men. Dementia cases attributable to three categories of risk factors all decreased with age, with the PAFs (95% CI) for sociodemographic, lifestyle, and health condition risk factors being 52.56% (22.98%, 82.15%), 46.57% (8.08%, 85.06%), and 35.42% (24.09%, 46.75%) for participants aged 40-<50 y, and 12.29% (3.82%, 20.75%), 13.01% (2.53%, 23.49%), and 15.85% (11.81%, 19.90%) for those over 65 y.Interpretation: This study identified stronger association and greater attributable risk of several modifiable risk factors for dementia among younger adults, underscoring the importance of preventive strategies from an earlier age across adult life course to reduce the risk of dementia.

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The impact of risk factors for dementia in China

Age and Ageing ◽

10.1093/ageing/afaa048 ◽

2020 ◽

Vol 49 (5) ◽

pp. 850-855 ◽

Cited By ~ 1

Author(s):

Yingxu Liu ◽

Shu Zhang ◽

Yasutake Tomata ◽

Dieta Nurrika ◽

Yumi Sugawara ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Chinese Population ◽

Physical Inactivity ◽

Population Attributable Fraction ◽

Cross Sectional ◽

National Surveys ◽

Low Education ◽

The Impact ◽

Incidence Of Dementia

Abstract Brief summary We evaluated the impact of seven risk factors for dementia in China. Physical inactivity, midlife hypertension and low education are proposed to be the largest fraction contributors to dementia. 55% of dementia were attributable to one or more of the seven risk factors. Background Previous studies have highlighted the impact of seven risk factors (midlife obesity, physical inactivity, smoking, low education, diabetes mellitus, midlife hypertension and depression) against dementia. However, the impact of these risk factors on dementia has not been evaluated among the Chinese population. Objective To clarify the impact of seven major risk factors on the incidence of dementia in China. Design The prevalence of risk factors was derived from the latest national surveys. Relative risks of corresponding risk factors were derived from the latest cohort or cross-sectional studies. Setting and subjects Three national surveys were included in the present study to obtain prevalence data of seven risk factors: the China Chronic Disease and Risk Factor Surveillance Survey (CCDRFSS) (2013), which covered about 170,000 adults (aged ≥18 years) from 31 provinces; (2) China National Survey of Chronic Kidney Disease (CNSCKD) (2010), which covered about 50,000 adults (aged ≥18 years) from 13 provinces; and (3) China Family Panel Studies Survey (CFPSS) (2012), which covered about 30,000 adults (aged ≥18 years) from 25 provinces. Methods Levin’s formula was used to calculate the population attributable fraction (PAF) for each risk factor for dementia. The combined PAF of the seven risk factors was calculated assuming the independence of each risk factor. Results Physical inactivity (PAF, 24.3%), midlife hypertension (PAF, 22.1%) and low education (PAF: 11.9%) were the top three factors that contributed to dementia. The total PAF of the seven risk factors was 55% in the Chinese population. Conclusions promotion of physical activity, control of hypertension and improvement of nationwide educational level may be helpful public health strategies to decrease the incidence of dementia in China.

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Lifestyle Risk Factors for Cardiovascular Disease in Relation to COVID-19 Hospitalization: A Community-Based Cohort Study of 387,109 Adults in UK

10.1101/2020.05.09.20096438 ◽

2020 ◽

Cited By ~ 12

Author(s):

Mark Hamer ◽

Mika Kivimaki ◽

Catharine R Gale ◽

George David Batty

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cohort Study ◽

Hospital Admission ◽

Physical Inactivity ◽

Alcohol Intake ◽

Lifestyle Risk Factors ◽

Wide Range ◽

Lifestyle Risk ◽

The Impact

Aims: It is important to identify characteristics of people who may be most at risk of COVID19 to inform policy and intervention. Little is known about the impact of unhealthy lifestyles including smoking, physical inactivity, obesity, and excessive alcohol intake. We conducted the first large scale general population study on lifestyle risk factors for COVID19. Methods: Prospective cohort study with national registry linkage to hospitalisation for COVID19. Participants were 387,109 men and women (56.4, SD 8.8 yr; 55.1% women) residing in England from UK Biobank study. Physical activity, smoking, and alcohol intake, were assessed by questionnaire at baseline (2006 to 2010). Body mass index, from measured height and weight, was used as an indicator of overall obesity. Outcome was cases of COVID19 serious enough to warrant a hospital admission from 16 March 2020 to 26 April 2020. Results: There were 760 COVID19 cases. After adjustment for age, sex and mutually for each lifestyle factor, physical inactivity (Relative risk, 1.32, 95% confidence interval, 1.10, 1.58), smoking (1.42;1.12, 1.79) and obesity (2.05 ;1.68, 2.49) but not heavy alcohol consumption (1.12; 0.93, 1.35) were all related to COVID19. We also found a dose dependent increase in risk of COVID19 with less favourable lifestyle scores, such that participants in the most adverse category had four fold higher risk (4.41; 2.52, 7.71) compared to people with the most optimal lifestyle. This gradient was little affected after adjustment for a wide range of covariates. Based on UK risk factor prevalence estimates, unhealthy behaviours in combination accounted for up to 51% of the population attributable fraction of severe COVID19. Conclusions and Relevance: Our findings suggest that an unhealthy lifestyle synonymous with an elevated risk of non-communicable disease is also a risk factor for COVID19 hospital admission, accounting for up to half of severe cases. Adopting simple lifestyle changes could lower the risk of severe infection.

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Race- and Sex-Specific Population Attributable Fractions of Incident Heart Failure

Circulation Heart Failure ◽

10.1161/circheartfailure.120.008113 ◽

2021 ◽

Author(s):

Arjun Sinha ◽

Hongyan Ning ◽

Mercedes R. Carnethon ◽

Norrina B. Allen ◽

John T. Wilkins ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Risk Factor ◽

Black Women ◽

Population Attributable Fraction ◽

Population Based ◽

Competing Risk ◽

Modifiable Risk Factors ◽

Risk Of Death ◽

Obesity Hypertension

Background: Race- and sex-specific differences in heart failure (HF) risk may be related to differential burden and effect of risk factors. We estimated the population attributable fraction (PAF), which incorporates both prevalence and excess risk of HF associated with each risk factor (obesity, hypertension, diabetes, current smoking, and hyperlipidemia), in specific race-sex groups. Methods: A pooled cohort was created using harmonized data from 6 US longitudinal population-based cohorts. Baseline measurements of risk factors were used to determine prevalence. Relative risk of incident HF was assessed using a piecewise constant hazards model adjusted for age, education, other modifiable risk factors, and the competing risk of death from non-HF causes. Within each race-sex group, PAF of HF was estimated for each risk factor individually and for all risk factors simultaneously. Results: Of 38 028 participants, 55% were female and 22% Black. Hypertension had the highest PAF among Black men (28.3% [18.7–36.7]) and women (25.8% [16.3%–34.2%]). In contrast, PAF associated with obesity was the highest in White men (21.0% [14.6–27.0]) and women (17.9% [12.8–22.6]). Diabetes disproportionately contributed to HF in Black women (PAF, 16.4% [95% CI, 12.7%–19.9%]). The cumulative PAF of all 5 risk factors was the highest in Black women (51.9% [39.3–61.8]). Conclusions: The observed differences in contribution of risk factors across race-sex groups can inform tailored prevention strategies to mitigate disparities in HF burden. This novel competing risk analysis suggests that a sizeable proportion of HF risk may not be associated with modifiable risk factors.

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The prevalence of risk factors associated with non-communicable diseases in Afghan refugees in southern Iran: a cross-sectional study

BMC Public Health ◽

10.1186/s12889-021-10482-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Erfan Taherifard ◽

Mohammad Javad Moradian ◽

Ehsan Taherifard ◽

Abdolrasool Hemmati ◽

Behnaz Rastegarfar ◽

...

Keyword(s):

Risk Factors ◽

Tobacco Smoking ◽

Physical Inactivity ◽

Vegetable Intake ◽

Vegetable Consumption ◽

Communicable Diseases ◽

Cross Sectional ◽

Non Communicable Diseases ◽

Afghan Refugees ◽

Southern Iran

Abstract Background Refugees are highly vulnerable to many health-related risks. Monitoring non-communicable diseases (NCDs) is of overriding importance in these populations. This study aimed to investigate the prevalence of risk factors for NCDs amongst Afghan refugees in a refugee camp located in southern Iran. Methods This cross-sectional sturdy was conducted in 2018. Risk factors such as inadequate nutrition, physical inactivity, tobacco smoking, obesity and overweight, hypertension (HTN), elevated fasting plasma glucose (FPG), and dyslipidaemia were assessed. Data were gathered with a modified WHO STEPS procedure. Prevalence and age-standardized prevalence and their 95% confidence intervals (CI) were estimated. Results The estimated prevalence were 94% for inadequate fruit/vegetable consumption, 18% for physical inactivity, 9% for tobacco smoking, 3% for FPG, 20% for HTN, 51% for central obesity, 24% for overweight, 19% for obesity, and 69% for dyslipidaemia. Conclusions Except for inadequate fruit and vegetable intake and dyslipidaemia, the prevalence of other NCD risk factors was low among Afghan refugees in Iran. Raising awareness about healthy diet and its importance and the provision of more affordable fruit and vegetables are two effective measures toward improving the health of refugees in Iran.

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Exposure to paternal tobacco smoking increased child hospitalization for lower respiratory infections but not for other diseases in Vietnam

Scientific Reports ◽

10.1038/srep45481 ◽

2017 ◽

Vol 7 (1) ◽

Cited By ~ 6

Author(s):

Reiko Miyahara ◽

Kensuke Takahashi ◽

Nguyen Thi Hien Anh ◽

Vu Dinh Thiem ◽

Motoi Suzuki ◽

...

Keyword(s):

Risk Factor ◽

Tobacco Smoking ◽

Respiratory Infections ◽

Disease Incidence ◽

Population Attributable Fraction ◽

Birth Cohort Study ◽

Effective Interventions ◽

Paternal Smoking ◽

Observation Period

Abstract Exposure to environmental tobacco smoke (ETS) is an important modifiable risk factor for child hospitalization, although its contribution is not well documented in countries where ETS due to maternal tobacco smoking is negligible. We conducted a birth cohort study of 1999 neonates between May 2009 and May 2010 in Nha Trang, Vietnam, to evaluate paternal tobacco smoking as a risk factor for infectious and non-infectious diseases. Hospitalizations during a 24-month observation period were identified using hospital records. The effect of paternal exposure during pregnancy and infancy on infectious disease incidence was evaluated using Poisson regression models. In total, 35.6% of 1624 children who attended follow-up visits required at least one hospitalization by 2 years of age, and the most common reason for hospitalization was lower respiratory tract infection (LRTI). Paternal tobacco smoking independently increased the risk of LRTI 1.76-fold (95% CI: 1.24–2.51) after adjusting for possible confounders but was not associated with any other cause of hospitalization. The population attributable fraction indicated that effective interventions to prevent paternal smoking in the presence of children would reduce LRTI-related hospitalizations by 14.8% in this epidemiological setting.

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