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Observational Study
. 2019 Aug 2;2(8):e199261.
doi: 10.1001/jamanetworkopen.2019.9261.

Changes in Age Distribution of Obesity-Associated Cancers

Siran M Koroukian  1   2 , Weichuan Dong  1 , Nathan A Berger  2
Affiliations
Observational Study

Changes in Age Distribution of Obesity-Associated Cancers

Siran M Koroukian et al. JAMA Netw Open. .

Abstract

Importance: Recent studies have documented an association between overweight and obesity and certain cancers, as well as an increased incidence of obesity-associated cancers (OACs) in younger individuals. However, although important for cancer-control efforts, it is not known which subgroups of the population are most affected by these changes.

Objective: To examine temporal shifts in age distribution of OACs and non-OACs across race/ethnicity- and sex-specific strata.

Design, setting, and participants: This population-based, cross-sectional study assessed individuals residing in Surveillance, Epidemiology, and End Results sites who were diagnosed with incident OACs and non-OACs from January 1, 2000, to December 31, 2016. Data analysis was performed from August 1, 2018, to June 30, 2019.

Exposure: Study years.

Main outcomes and measures: Changes in the age distribution of incident cases across race/ethnicity- and sex-specific strata over time. For all OACs and non-OACs, changes in the incidence rates, the number of incident cases, and the distribution of the cases across population subgroups were studied. Race/ethnicity- and sex-stratified logistic regression analysis was performed to determine whether the annual change in the odds associated with an age group increased (or decreased) to a greater (or lesser) extent in OACs than in non-OACs. Heat maps were created to highlight the change in the number of cases during the study period for each OAC and select non-OACs.

Results: The study population included 2 665 574 incident OAC cases (70.3% women) and 3 448 126 incident non-OAC cases (32.0% women). From 2000 to 2016, the distribution by age showed that the percentage of incident cases increased in the 50- to 64-year age group for both OACs and non-OACs. The increase in the number of OACs in this age group ranged from 25.3% in non-Hispanic white women to 197.8% in Hispanic men. The change in the number of OACs in the 20- to 49-year age group ranged from -5.9% in non-Hispanic white women to 94.6% in Hispanic women, and the increase in the number of OACs in the 65 years or older group ranged from 2.5% in non-Hispanic white women to 102.0% in Hispanic women. Logistic regression analysis revealed a greater annual increase in the odds for OACs than for non-OACs for individuals in the 50- to 64-year age group but a decrease for individuals in the 65 years or older group. Among men in the 50- to 64-year age group, the OAC to non-OAC ratio of odds ratios (ORs) ranged from 1.005 (95% CI, 1.002-1.008) in non-Hispanic black men to 1.013 (95% CI, 1.012-1.014) in non-Hispanic white men, implying that the annual increase was 0.5% higher for OACs than for non-OACs in non-Hispanic black men and 1.3% higher for OACs than for non-OACs in non-Hispanic white men. Among women in the 50- to 64-year age group, the OAC to non-OAC ratio of ORs ranged from 1.002 (95% CI, 0.999-1.006) in Hispanic women to 1.005 (95% CI, 1.002-1.009) in non-Hispanic black women. In men and women aged 65 or older, the OAC vs non-OAC ratio of ORs was consistently less than 1.000 for all race/ethnicity groups, indicating that whereas the OAC group experienced a decrease in this age group, the non-OACs experienced either a smaller decrease or an increase over time.

Conclusions and relevance: This study indicates that from 2000 to 2016, a shift toward younger age groups occurred in incident OACs. The findings have important public health implications and suggest that interventions to reduce obesity and to implement individualized screening programs are needed.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Koroukian reported receiving grants from Ohio Medicaid Technical Assistance and Policy Program, the National Institutes of Health, and the Centers for Disease Control and Prevention and receiving support through contracts from Cleveland Clinic Foundation, including a subcontract from Celgene Corporation. Mr Dong reported receiving support through contracts from Cleveland Clinic Foundation, including a subcontract from Celgene Corporation and receiving grants from the National Institutes of Health and the CWRU Center for Reducing Health Disparities. Dr Berger reported receiving grants from the National Institutes of Health.

Figures

Figure 1.
Figure 1.. Comparison of Obesity-Associated Cancers (OACs) and Non-OACs in Men by Age- and Race/Ethnicity-Specific Strata
Incidence rate per 100 000 persons, total number of incident cases, and case distribution across age groups are shown for all men.
Figure 2.
Figure 2.. Comparison of Obesity-Associated Cancers (OACs) and Non-OACs in Women by Age- and Race/Ethnicity-Specific Strata
Incidence rate per 100 000 persons, total number of incident cases, and case distribution across age groups are shown for all women.
See this image and copyright information in PMC

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