Table 4.
Associations between ACS guidelines score and all-cause and cancer-specific mortality (n = 65,838)
| Cause of death | ACS score | Person-years, millions | Events n (%) |
Age-adjusted HR (95% CI) |
Fully adjusteda HR (95% CI) |
|---|---|---|---|---|---|
| Any cause | |||||
| 0—3 | 7,015 | 2,862 (12.0) | 1.00 | 1.00 | |
| 4–5 | 10,464 | 3,074 (10.7) | 0.78 (0.74–0.82) | 0.86 (0.82–0.91) | |
| 6–8 | 2,270 | 1,170 (8.85) | 0.62 (0.58–0.66) | 0.73 (0.68–0.78) | |
| Ptrendb | <0.001 | <0.001 | |||
| Trendb | 0.89 (0.88–0.90) | 0.93 (0.92–0.95) | |||
| Any cancer (other than non-melanoma skin cancer) | |||||
| 0–3 | 7,015 | 945 (4.00) | 1.00 | 1.00 | |
| 4–5 | 10,464 | 1,003 (3.53) | 0.80 (0.73–0.88) | 0.88 (0.81–0.97) | |
| 6–8 | 2,270 | 408 (3.12) | 0.68 (0.61–0.77) | 0.80 (0.71–0.90) | |
| Ptrendb | <0.001 | <0.001 | |||
| Trendb | 0.91 (0.89–0.94) | 0.95 (0.93–0.98) | |||
| Breast cancer | |||||
| 0—3 | 7,015 | 78 (0.33) | 1.00 | 1.00 | |
| 4—5 | 10,464 | 85 (0.30) | 0.83 (0.61–1.13) | 0.90 (0.65–1.23) | |
| 6—8 | 2,270 | 29 (0.22) | 0.59 (0.39–0.91) | 0.67 (0.43–1.03) | |
| Ptrendb | 0.008 | 0.049 | |||
| Trendb | 0.88 (0.81–0.97) | 0.91 (0.83–1.00) | |||
| Colorectal cancer | |||||
| 0—3 | 7,015 | 94 (0.40) | 1.00 | 1.00 | |
| 4—5 | 10,464 | 76 (0.27) | 0.61 (0.45–0.83) | 0.66 (0.49–0.90) | |
| 6—8 | 2,270 | 20 (0.15) | 0.34 (0.21–0.55) | 0.39 (0.24–0.63) | |
| Ptrendb | <0.001 | <0.001 | |||
| Trendb | 0.80 (0.73–0.88) | 0.83 (0.75–0.91) | |||
| Endometrial cancer | |||||
| 0–3 | 7,015 | 21 (0.09) | 1.00 | 1.00 | |
| 4–5 | 10,464 | 14 (0.05) | 0.50 (0.26–0.99) | 0.49 (0.25–0.98) | |
| 6–8 | 2,270 | 8 (0.06) | 0.60 (0.27–1.36) | 0.59 (0.26–1.37) | |
| Ptrendb | 0.086 | 0.085 | |||
| Trendb | 0.84 (0.69–1.02) | 0.84 (0.68–1.02) | |||
| Ovarian cancer | |||||
| 0–3 | 7,015 | 63 (0.27) | 1.00 | 1.00 | |
| 4–5 | 10,464 | 86 (0.30) | 1.06 (0.76–1.47) | 1.10 (0.79–1.53) | |
| 6–8 | 2,270 | 33 (0.25) | 0.86 (0.56–1.30) | 0.90 (0.58–1.39) | |
| Ptrendb | 0.230 | 0.373 | |||
| Trendb | 0.94 (0.86–1.04) | 0.96 (0.87–1.05) | |||
| Lung cancer | |||||
| 0–3 | 7,015 | 110 (0.47) | 1.00 | 1.00 | |
| 4–5 | 10,464 | 130 (0.46) | 0.92 (0.71–1.18) | 1.18 (0.91–1.52) | |
| 6–8 | 2,270 | 45 (0.34) | 0.68 (0.48–0.96) | 1.07 (0.75–1.52) | |
| Ptrendb | 0.018 | 0.505 | |||
| Trendb | 0.91 (0.85–0.98) | 1.03 (0.95–1.11) | |||
| Other cancerc | |||||
| 0–3 | 7,015 | 534 (2.26) | 1.00 | 1.00 | |
| 4–5 | 10,464 | 561 (1.97) | 0.79 (0.70–0.89) | 0.85 (0.76–0.96) | |
| 6–8 | 2,270 | 257 (1.96) | 0.75 (0.65–0.87) | 0.86 (0.74–1.00) | |
| Ptrendb | <0.001 | 0.083 | |||
| Trendb | 0.93 (0.90–0.97) | 0.97 (0.94–1.00) | |||
Adjusted for age (continuous), education (≤high school, some college, ≥college), smoking pack-years (never smoking, <5, 5–19, 20+), NSAID use baseline (yes, no), aspirin use baseline (yes, no), unopposed estrogen use (never, former, current), estrogen + progestin use (never, former, current), multivitamin use baseline (yes, no), race/ethnicity (NHW, Hispanic, black, Asian, Native American, other), energy intake (continuous), parous (yes, no, unknown), mammogram (ever, never; included only in models for any cause, any cancer, breast cancer), colonoscopy/sigmoidoscopy (ever, never; included only in models for any cause, any cancer, colorectal cancer), family history of cancer (yes, no, unknown), and having a current healthcare provider (yes, no).
Trend tested by modeling ACS score as an ordinal variable (0–8).
Any cancer other than breast, colorectal, endometrial, ovarian, lung, and non-melanoma skin cancer.