Association between Chronic Disease Risk Score and Cancer Risk: a Cohort Study

Abstract

Background As with other chronic diseases, cancer presents a multidimensional state. And many chronic diseases share common risk factors with cancers. The association between a single chronic disease indicator and the risk of cancer is weak, so it is significant to construct a risk score composed of multiple chronic disease indicators and analyze its association with the risk of cancer. Objective To investigate the association between chronic disease risk score and cancer risk. Methods This study selected a total of 18 009 eligible individuals who had participated in Tianjin Chronic Disease Risk and Health Management Cohort Study and undergone physical examination in Health Management Center, Tianjin Medical University General Hospital from January 2015 to December 2019. All subjects completed the health risk assessment questionnaire, physical examination, and laboratory examination. Follow-up ended on the day of cancer occurrence or the day of follow-up termination (December 31, 2019) . Multivariate Cox regression model was used to evaluate the relationship of the risk of cancer (used as the dependent variable) with each of the chronic disease related indicators〔consisting of BMI, waist circumference, blood pressure, blood glucose, total cholesterol, triglyceride, uric acid, total bilirubin, heart rate, and estimated glomerular filtration rate (used as independent variables) 〕. And then the comprehensive score of chronic disease risk was calculated, and the cancer risk in tertile groups of the score 〔low-score group (<6 points) , medium-score group (6-8 points) , and high-score group (≥9 points) 〕 was assessed by Cox regression analysis. Results A total of 71 835 person-years (median 4.00 years) were followed up, and 91 cases (33 males and 58 females) were diagnosed with cancer. Compared with low-score group (n=6 403) , the HR value (95%CI) of cancer risk was 2.16〔95%CI (1.20, 3.90) , P=0.011〕in medium-score group (n=6 459) , and 3.08〔95%CI (1.72, 5.50) , P<0.001〕 in high-score group (n=5 147) (Ptrend<0.001) , which satisfied the proportional hazards hypothesis test (χ2=1.98, P=0.371) . For per point increase in the chronic disease risk score, the risk of cancer increased by 17%〔95%CI (9%, 25%) , P<0.001〕, which satisfied the proportional hazards hypothesis test (χ2=0.31, P=0.579) . Compared with females in low-score group, the females in high-score group had an increased risk of cancer, with HR value (95%CI) of 3.00〔95%CI (1.32, 6.82) , P=0.009〕, which satisfied the proportional hazards hypothesis test (χ2=1.24, P=0.538) . For per point increase in the chronic disease risk score, the risk of cancer in females increased by 21%〔95%CI (10%, 33%) , P<0.001〕. Conclusion The higher the chronic disease risk score, the higher cancer risk, and the association was significant in females, but not in males.

Keywords

• neoplasms|chronic disease|risk score|risk factor|physical examination|cox regression model|cohort study