Table 4.
Hazard ratios and 95% confidence intervals for risk of lethal prostate cancer by select lifestyle factors in HPFS (1990–2010) and PHS (1987–2010)*
| Life | Exposures updated over follow-up | Exposures updated until date of diagnosis for case patients | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Person-years of follow-up | No. of lethal prostate cancer cases | Age-adjusted HR (95% CI) |
Multivariable- adjusted HR (95% CI)† |
Multivariable- adjusted HR (95% CI)‡ |
Person-years of follow-up | No. of lethal prostate cancer cases | Age-adjusted HR (95% CI) |
Multivariable- adjusted HR (95% CI)† |
Multivariable- adjusted HR (95% CI)‡ | |
| Lifestyle factors, HPFS | ||||||||||
| BMI, kg/m2§ | ||||||||||
| <30 | 659 766 | 516 | 0.88 (0.67 to 1.16) | 0.88 (0.67 to 1.16) | 0.93 (0.71 to 1.23) | 660 041 | 518 | 0.91 (0.69 to 1.20) | 0.90 (0.68 to 1.19) | 0.93 (0.71 to 1.23) |
| ≥30 (Ref) | 83 234 | 60 | 1 | 1 | 1 | 82 959 | 58 | 1 | 1 | 1 |
| Vigorous physical activity|| | ||||||||||
| Low (Ref) | 587 119 | 503 | 1 | 1 | 1 | 586 337 | 483 | 1 | 1 | 1 |
| High | 155 881 | 73 | 0.62 (0.48 to 0.79) | 0.61 (0.47 to 0.78) | 0.64 (0.50 to 0.82) | 156 663 | 93 | 0.79 (0.63 to 0.99) | 0.80 (0.64 to 1.00) | 0.83 (0.66 to 1.05) |
| Smoking status¶ | ||||||||||
| Never or quit ≥10 y | 624 248 | 496 | 0.83 (0.65 to 1.06) | 0.83 (0.65 to 1.06) | 0.88 (0.69 to 1.13) | 623 662 | 484 | 0.72 (0.57 to 0.90) | 0.72 (0.57 to 0.91) | 0.75 (0.59 to 0.95) |
| Current or quit <10 y (Ref) | 118 752 | 80 | 1 | 1 | 1 | 119 338 | 92 | 1 | 1 | 1 |
| Tomato intake# | ||||||||||
| Low (Ref) | 604 899 | 496 | 1 | 1 | 1 | 605 273 | 494 | 1 | 1 | 1 |
| High | 138 101 | 80 | 0.80 (0.63 to 1.01) | 0.80 (0.63 to 1.01) | 0.82 (0.65 to 1.05) | 137 728 | 82 | 0.83 (0.65 to 1.05) | 0.84 (0.66 to 1.06) | 0.85 (0.67 to 1.08) |
| Fatty fish intake** | ||||||||||
| Low (Ref) | 598 883 | 508 | 1 | 1 | 1 | 598 883 | 501 | 1 | 1 | 1 |
| High | 144 118 | 68 | 0.77 (0.59 to 0.99) | 0.76 (0.58 to 0.98) | 0.83 (0.64 to 1.07) | 144 118 | 75 | 0.85 (0.66 to 1.09) | 0.86 (0.67 to 1.10) | 0.91 (0.71 to 1.17) |
| Processed meat intake†† | ||||||||||
| Low | 570 057 | 425 | 0.75 (0.62 to 0.91) | 0.75 (0.62 to 0.91) | 0.78 (0.64 to 0.94) | 569 682 | 424 | 0.76 (0.63 to 0.91) | 0.76 (0.62 to 0.91) | 0.78 (0.64 to 0.94) |
| High (Ref) | 172 944 | 151 | 1 | 1 | 1 | 173 318 | 152 | 1 | 1 | 1 |
| Lifestyle factors, PHS | ||||||||||
| BMI, kg/m2§ | ||||||||||
| <30 | 362 901 | 309 | 0.72 (0.48 to 1.07) | 0.72 (0.48 to 1.08) | 0.74 (0.49 to 1.10) | 363 167 | 312 | 0.80 (0.52 to 1.21) | 0.78 (0.51 to 1.20) | 0.79 (0.52 to 1.21) |
| ≥30 (Ref) | 26 316 | 28 | 1 | 1 | 1 | 26 050 | 25 | 1 | 1 | 1 |
| Vigorous physical activity|| | ||||||||||
| Low (Ref) | 330 472 | 277 | 1 | 1 | 1 | 330 612 | 282 | 1 | 1 | 1 |
| High | 58 745 | 60 | 1.07 (0.80 to 1.43) | 1.12 (0.83 to 1.49) | 1.14 (0.85 to 1.52) | 58 605 | 55 | 0.97 (0.72 to 1.31) | 1.04 (0.77 to 1.40) | 1.07 (0.79 to 1.45) |
| Smoking status¶ | ||||||||||
| Never or quit ≥10 y | 329 936 | 284 | 0.74 (0.55 to 1.01) | 0.79 (0.58 to 1.08) | 0.81 (0.59 to 1.11) | 329 214 | 273 | 0.61 (0.46 to 0.81) | 0.65 (0.49 to 0.87) | 0.66 (0.49 to 0.88) |
| Current or quit <10 y (Ref) | 59 281 | 53 | 1 | 1 | 1 | 60 003 | 64 | 1 | 1 | 1 |
| Tomato intake# | ||||||||||
| Low (Ref) | 227 745 | 173 | 1 | 1 | 1 | 228 043 | 175 | 1 | 1 | 1 |
| High | 161 472 | 164 | 1.09 (0.88 to 1.36) | 1.08 (0.86 to 1.35) | 1.09 (0.87 to 1.36) | 161 174 | 162 | 1.09 (0.87 to 1.35) | 1.08 (0.87 to 1.35) | 1.10 (0.88 to 1.37) |
| Fatty fish intake** | ||||||||||
| Low (Ref) | 330 186 | 287 | 1 | 1 | 1 | 330 926 | 296 | 1 | 1 | 1 |
| High | 59 031 | 60 | 0.79 (0.56 to 1.12) | 0.82 (0.58 to 1.16) | 0.80 (0.57 to 1.14) | 58 291 | 43 | 0.66 (0.46 to 0.95) | 0.70 (0.49 to 1.01) | 0.69 (0.48 to 0.99) |
| Processed meat intake†† | ||||||||||
| Low | 322 053 | 265 | 0.72 (0.55 to 0.94) | 0.73 (0.55 to 0.96) | 0.75 (0.57 to 0.99) | 322 400 | 270 | 0.79 (0.60 to 1.04) | 0.82 (0.62 to 1.08) | 0.86 (0.64 to 1.14) |
| High (Ref) | 67 164 | 72 | 1 | 1 | 1 | 66 817 | 67 | 1 | 1 | 1 |
* Cox proportional hazards regression with two-sided P values. We used a four- to six-year lag for all exposures to reduce the potential for reverse causation. Follow-up for the Health Professionals Follow-up Study began in 1990, using exposures ascertained in 1986. Follow-up for the Physicians’ Health Study started in 1987, using exposures ascertained starting in 1982. CI = confidence interval; HPFS = Health Professionals Follow-up Study; HR = hazard ratio; PFS = Physicians’ Health Study.
† Adjusted for age in months (continuous), race (white, nonwhite, missing), diabetes (yes, no, missing), multivitamin use (yes, no, missing), and vitamin E use (yes, no, missing). We used age as the time scale, stratified by calendar time in two-year intervals. Additionally adjusted for random assignment status (aspirin, beta-carotene, both, or neither) in the PHS. The six individual factors were additionally adjusted for the other five factors.
‡ The six individual factors were additionally adjusted for the other five factors.
§ Current height and weight were assessed at baseline. Weight was assessed biennially in the HPFS and nine times over follow-up in the PHS.
|| HPFS: Physical activity was assessed biennially. Low: <3 hrs/wk vigorous and <7 hrs/wk brisk walking. High: ≥3 hrs/wk vigorous and/or ≥7 hrs/wk brisk walking. PHS: Days per week of vigorous physical activity (enough to sweat) assessed at baseline and four times over follow-up. Low: <5 days/wk. High: ≥5 days/wk.
¶ HPFS: Smoking status assessed biennially. PHS: Smoking status assessed at baseline and four times over follow-up.
# HPFS: Average of cumulative tomato (raw), tomato juice, tomato sauce, salsa, and pizza intake, assessed every four years. Low: <7 serv/wk. High: ≥7 serv/wk. PHS: Average of cumulative intake of tomato and tomato juice, assessed at baseline and ten times over follow-up. Low: <4 serv/wk. High: ≥4 serv/wk.
** HPFS: Average of cumulative fatty fish intake (eg, mackerel, salmon, sardines, bluefish, swordfish), assessed every four years. Low: <1 serv/wk. High: ≥1 serv/wk. PHS: Fatty fish intake assessed once between 1982 and 1985. Low: <1 serv/wk. High: ≥1 serv/wk.
†† HPFS: Average of cumulative processed meat intake assessed every four years. One serving of total processed red meat = one beef or pork hot dog; two slices of bacon; salami, bologna, or other processed meat sandwich; 57g or two links of other processed meats (eg, sausage, kielbasa, etc.). Low: <3 serv/wk. High: ≥3 serv/wk. PHS: One serving of total processed red meat = one hot dog; two slices of bacon; one piece/slice of sausage, salami, bologna, or other processed meat. Hot dog intake assessed once between 1981 and 1985. Low: <1 serv/wk. High: ≥ 1 serv/wk. Hot dogs, bacon, and other processed meat assessed once between 1997 and 2001. Change cut-point to Low: <3 serv/wk. High: ≥3 serv/wk.