Table 3.
Multivariable-adjusted HRs and 95% CIs for digestive system cancer risk in quintiles of the ELIH scores among men and women*,†,‡
| Anatomic location of cancer | Quintile 1 (reference) | Quintile 2 | Quintile 3 | Quintile 4 | Quintile 5 | Ptrend§ |
|---|---|---|---|---|---|---|
| Total digestive system | ||||||
| Men, cases (n = 2170) | 358 | 367 | 410 | 435 | 600 | |
| Men, HR (95% CI) | 1.00 | 1.03 (0.89 to 1.19) | 1.12 (0.97 to 1.29) | 1.19 (1.03 to 1.37) | 1.62 (1.41 to 1.85) | <.001 |
| Women, cases (n = 2445) | 427 | 420 | 484 | 524 | 590 | |
| Women, HR (95% CI) | 1.00 | 0.98 (0.86 to 1.12) | 1.08 (0.95 to 1.23) | 1.14 (1.00 to 1.30) | 1.35 (1.19 to 1.53) | <.001 |
| No. cases | 927 | 949 | 973 | 897 | 868 | |
| Pooled HR (95% CI)‖ | 1.00 | 1.00 (0.91 to 1.11) | 1.09 (0.99 to 1.21) | 1.16 (1.06 to 1.28) | 1.47 (1.23 to 1.76) | <.001 |
| Digestive tract | ||||||
| Men, cases (n = 1716) | 275 | 287 | 326 | 345 | 483 | |
| Men, HR (95% CI) | 1.00 | 1.05 (0.89 to 1.24) | 1.15 (0.98 to 1.36) | 1.23 (1.05 to 1.45) | 1.71 (1.47 to 1.99) | <.001 |
| Women, cases (n = 1859) | 337 | 308 | 379 | 387 | 448 | |
| Women, HR (95% CI) | 1.00 | 0.92 (0.79 to 1.07) | 1.07 (0.93 to 1.24) | 1.08 (0.93 to 1.25) | 1.30 (1.13 to 1.50) | <.001 |
| No. cases | 718 | 713 | 740 | 716 | 694 | |
| Pooled HR (95% CI) | 1.00 | 0.98 (0.86 to 1.11) | 1.11 (0.99 to 1.24) | 1.15 (1.01 to 1.31) | 1.49 (1.14 to 1.95) | .001 |
| Mouth/pharynx to small intestine | ||||||
| Men, cases (n = 488) | 73 | 91 | 105 | 88 | 131 | |
| Men, HR (95% CI) | 1.00 | 1.21 (0.89 to 1.66) | 1.41 (1.04 to 1.90) | 1.18 (0.86 to 1.61) | 1.64 (1.23 to 2.20) | .002 |
| Women, cases (n = 427) | 81 | 56 | 87 | 94 | 109 | |
| Women, HR (95% CI) | 1.00 | 0.72 (0.51 to 1.02) | 1.07 (0.79 to 1.45) | 1.13 (0.84 to 1.53) | 1.39 (1.03 to 1.86) | .001 |
| No. cases | 174 | 192 | 179 | 188 | 183 | |
| Pooled HR (95% CI) | 1.00 | 0.94 (0.57 to 1.57) | 1.23 (0.94 to 1.61) | 1.15 (0.93 to 1.43) | 1.51 (1.23 to 1.86) | <.001 |
| Stomach | ||||||
| Men, cases (n = 126) | 19 | 27 | 28 | 21 | 31 | |
| Men, HR (95% CI) | 1.00 | 1.44 (0.80 to 2.61) | 1.45 (0.80 to 2.61) | 1.18 (0.63 to 2.22) | 1.62 (0.90 to 2.89) | .21 |
| Women, cases (n = 118) | 21 | 23 | 27 | 23 | 24 | |
| Women, HR (95% CI) | 1.00 | 0.64 (0.32 to 1.30) | 1.05 (0.57 to 1.92) | 1.13 (0.62 to 2.05) | 1.64 (0.94 to 2.87) | .01 |
| No. cases | 38 | 55 | 49 | 53 | 49 | |
| Pooled HR (95% CI) | 1.00 | 0.99 (0.45 to 2.17) | 1.24 (0.81 to 1.88) | 1.15 (0.75 to 1.78) | 1.63 (1.09 to 2.44) | .007 |
| Colorectum | ||||||
| Men, cases (n = 1232) | 203 | 198 | 220 | 258 | 353 | |
| Men, HR (95% CI) | 1.00 | 0.99 (0.82 to 1.21) | 1.06 (0.87 to 1.28) | 1.26 (1.04 to 1.52) | 1.74 (1.46 to 2.07) | <.001 |
| Women, cases (n = 1439) | 257 | 253 | 293 | 294 | 342 | |
| Women, HR (95% CI) | 1.00 | 0.98 (0.82 to 1.17) | 1.08 (0.91 to 1.27) | 1.06 (0.90 to 1.26) | 1.28 (1.09 to 1.51) | <.001 |
| No. cases | 547 | 523 | 561 | 532 | 513 | |
| Pooled HR (95% CI) | 1.00 | 0.99 (0.87 to 1.12) | 1.07 (0.94 to 1.21) | 1.15 (0.97 to 1.36) | 1.49 (1.10 to 2.01) | .02 |
| Digestive accessory organs | ||||||
| Men, cases (n = 454) | 83 | 80 | 84 | 90 | 117 | |
| Men, HR (95% CI) | 1.00 | 0.96 (0.70 to 1.30) | 1.02 (0.75 to 1.38) | 1.07 (0.79 to 1.45) | 1.33 (1.00 to 1.78) | .02 |
| Women, cases (n = 586) | 90 | 112 | 105 | 137 | 142 | |
| Women, HR (95% CI) | 1.00 | 1.21 (0.92 to 1.60) | 1.10 (0.83 to 1.46) | 1.37 (1.04 to 1.79) | 1.51 (1.15 to 1.98) | .001 |
| No. cases | 219 | 236 | 233 | 181 | 164 | |
| Pooled HR (95% CI) | 1.00 | 1.09 (0.86 to 1.37) | 1.06 (0.86 to 1.30) | 1.22 (0.97 to 1.55) | 1.43 (1.17 to 1.73) | <.001 |
| Pancreas | ||||||
| Men, cases (n = 346) | 66 | 66 | 66 | 66 | 82 | |
| Men, HR (95% CI) | 1.00 | 0.99 (0.70 to 1.40) | 0.99 (0.70 to 1.39) | 0.97 (0.69 to 1.38) | 1.16 (0.84 to 1.62) | .37 |
| Women, cases (n = 494) | 77 | 94 | 94 | 99 | 130 | |
| Women, HR (95% CI) | 1.00 | 1.21 (0.90 to 1.64) | 1.19 (0.88 to 1.61) | 1.18 (0.88 to 1.60) | 1.69 (1.27 to 2.26) | <.001 |
| No. cases | 182 | 200 | 174 | 148 | 139 | |
| Pooled HR (95% CI) | 1.00 | 1.11 (0.88 to 1.39) | 1.10 (0.87 to 1.38) | 1.09 (0.87 to 1.36) | 1.42 (0.98 to 2.04) | .047 |
| Liver and gallbladder | ||||||
| Men, cases (n = 108) | 17 | 14 | 18 | 24 | 35 | |
| Men, HR (95% CI) | 1.00 | 0.83 (0.40 to 1.69) | 1.12 (0.57 to 2.18) | 1.48 (0.79 to 2.78) | 2.02 (1.12 to 3.65) | .002 |
| Women, cases (n = 169) | 26 | 28 | 24 | 51 | 40 | |
| Women, HR (95% CI) | 1.00 | 1.03 (0.60 to 1.77) | 0.83 (0.48 to 1.46) | 1.74 (1.08 to 2.80) | 1.41 (0.85 to 2.33) | .03 |
| No. cases | 56 | 54 | 65 | 54 | 50 | |
| Pooled HR (95% CI) | 1.00 | 0.95 (0.62 to 1.46) | 0.94 (0.61 to 1.44) | 1.64 (1.12 to 2.40) | 1.64 (1.11 to 2.40) | .001 |
ELIH scores were adjusted for total energy intake using the residual method. Lower scores indicate insulin sensitive lifestyles, and higher scores indicate hyperinsulinemic lifestyles. CI = confidence interval; ELIH = empirical lifestyle index for hyperinsulinemia; HR = hazard ratio; NSAIDs = nonsteroidal anti-inflammatory drugs.
Heterogeneity for risk was tested using duplication method cause-specific Cox regression analyses.
All analyses were adjusted for the following potential confounding variables: race, family history of cancer, history of endoscopy, multivitamin use, total alcohol intake, pack-years of smoking, regular aspirin use, regular NSAIDs use, and additionally for menopausal status, and postmenopausal hormone use in women.
The P value for linear trend across ELIH quintiles was the P value of the ordinal variable constructed by assigning quintile medians to all participants in the quintile. Models for linear trend were adjusted for all covariates listed in footnote previously.
HR were pooled using random effects meta-analysis (all such values).