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Background: Empirical evidence from European countries has shown that economic conditions in early life are associated with mortality risk. This study aims to assess the effects of economic conditions in early life, as well as their interaction with parental education, on the risk of adult mortality in the U.S. Methods: To capture exogenous variation of economic conditions early in life, we use the Gross Domestic Product (GDP) cyclical deviation during a respondent's birth year. Using the linked U.S. General Social Survey and National Death Index data (1979–2008), we employed parametric frailty survival models to examine the effects of economic conditions in early life on all-cause and cause-specific mortality. Results: We found that exposure to recession in the first year of life was associated with increased all-cause mortality only among women (hazard ratio = 1.54, 95% CI 1.03–2.31). This adverse effect was also found in women's mortality from cancers (hazard ratio = 2.24, 95% CI 1.18–4.28). We also found a significant interaction between economic conditions in infancy and paternal education on women's mortality risk—higher paternal education was protective against mortality under good economic conditions in infancy; however, higher paternal education was associated with greater mortality risk under poor economic conditions in infancy. We discuss how aspiration theory may explain these results. Conclusion: Our study concludes that worse macroeconomic conditions early in life heighten the risk of mortality among women, and paternal education moderates this relationship. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown an association between living alone and cancer mortality; however, findings by sex and race/ethnicity have generally been inconsistent, and data by socioeconomic status are sparse. The association between living alone and cancer mortality by sex, race/ethnicity, and socioeconomic status in a nationally representative US cohort was examined. Methods: Pooled 1998–2019 data for adults aged 18–64 years at enrollment from the National Health Interview Survey linked to the National Death Index (N = 473,648) with up to 22 years of follow‐up were used to calculate hazard ratios (HRs) for the association between living alone and cancer mortality. Results: Compared to adults living with others, adults living alone were at a higher risk of cancer death in the age‐adjusted model (HR, 1.32; 95% CI, 1.25–1.39) and after additional adjustments for multiple sociodemographic characteristics and cancer risk factors (HR, 1.10; 95% CI, 1.04–1.16). Age‐adjusted models stratified by sex, poverty level, and educational attainment showed similar associations between living alone and cancer mortality, but the association was stronger among non‐Hispanic White adults (HR, 1.33; 95% CI, 1.25–1.42) than non‐Hispanic Black adults (HR, 1.18; 95% CI, 1.05–1.32; p value for difference <.05) and did not exist in other racial/ethnic groups. These associations were attenuated but persisted in fully adjusted models among men (HR, 1.13; 95% CI, 1.05–1.23), women (HR, 1.09; 95% CI, 1.01–1.18), non‐Hispanic White adults (HR, 1.13; 95% CI, 1.05–1.20), and adults with a college degree (HR, 1.22; 95% CI, 1.07–1.39). Conclusions: In this nationally representative study in the United States, adults living alone were at a higher risk of cancer death in several sociodemographic groups. In a nationally representative study with up to 22 years of mortality follow‐up, US working‐age adults experiencing social isolation, measured as living alone, were at a higher risk of cancer death than adults living with others. This association persisted among non‐Hispanic White adults and adults with higher education even after accounting for differences in a wide range of sociodemographic, behavioral, and health characteristics. [ABSTRACT FROM AUTHOR]

Background Cardiovascular and cancer mortality are the two leading causes of death in the developed world including the USA. However, mortality trends for these diseases are highly dynamic, and the geographic landscape is in transition. We analyze patterns of mortality improvement at county level during recent decades focusing on mortality decline and geographic diversity. Methods We grouped age-adjusted mortality rates of cardiovascular and cancer diseases from CDC WONDER for 2959 US counties into 3-year time periods to improve reliability. We calculated percent mortality decrease between 1981–83 and 2016–19 for both causes to quantify mortality improvements for counties. Results Using standard deviation as an index of disparities, place-based cancer mortalities were 68% larger than cardiovascular disparities. Significantly, 566 US counties had same or higher rates of cancer mortality in 2019 as in 1981. The geographic distribution of mortality improvement in either cause tends to favor largely populated areas along coasts. Less-populated, rural places in the interior and southeastern regions were experiencing less improvement. Conclusions At the county level, large place-based disparities exist for both causes of death with the magnitude of disparities being substantially larger for the reduction in cancer deaths. Put differently, place matters, more for cancer than cardiovascular mortality. [ABSTRACT FROM AUTHOR]

The objective of this paper was to examine potential factors contributing to smoking-related cancer mortality trends. Smoking associated cancer mortality data from 1970 to 2016 was extracted from the IARC Cancer Mortality Database and WHO Mortality Database. Data from the United States, Greece, Norway, Chile, and Colombia were analyzed due to variance in annual cigarette consumption per capita, the prevalence of current tobacco use, and geographical similarity. Norwegian males, Chilean males and females, and Colombian males and females saw decreases in cancer mortality rates during the study period; on the other hand, Greek males and females showed unchanged mortality rates, and Norwegian females showed a very slight increase in cancer mortality rates. United States age-standardized mortality rates (ASR) rose from 180.75 deaths per 100,000 persons in the year 1970 to the early 1980s before showing a steady and significant decline to 90.46 deaths per 100,000 persons in 2016. This study shows a strong correlation in developed countries (United States, Norway, and Greece) between advances in cancer therapies, early detection techniques, health screening, and public and legal health initiatives with a decrease in smoking-related cancer mortality rates. In developing countries (Chile and Colombia), widespread H. pylori testing, and treatment advances were found to be the main drivers of decreasing cancer mortality rates. [ABSTRACT FROM AUTHOR]

Background: The American Heart Association recently introduced a novel cardiovascular health (CVH) metric, Life's Essential 8 (LE8), for health promotion. However, the relationship between LE8 and cancer mortality risk remains uncertain., Methods: We investigated 17,076 participants from US National Health and Nutrition Examination Survey (US NHANES) and 272,727 participants from UK Biobank, all free of cancer at baseline. The CVH score, based on LE8 metrics, incorporates four health behaviors (diet, physical activity, smoking, and sleep) and four health factors (body mass index, lipid, blood glucose, and blood pressure). Self-reported questionnaires assessed health behaviors. Primary outcomes were mortality rates for total cancer and its subtypes. The association between CVH score (continuous and categorical variable) and outcomes was examined using Cox model with adjustments. Cancer subtypes-related polygenic risk score (PRS) was constructed to evaluate its interactions with CVH on cancer death risk., Results: Over 141,526 person-years in US NHANES, 424 cancer-related deaths occurred, and in UK Biobank, 8,872 cancer deaths were documented during 3,690,893 person-years. High CVH was associated with reduced overall cancer mortality compared to low CVH (HR 0.58, 95% CI 0.37-0.91 in US NHANES; 0.51, 0.46-0.57 in UK Biobank). Each one-standard deviation increase in CVH score was linked to a 19% decrease in cancer mortality (HR: 0.81; 95% CI: 0.73-0.91) in US NHANES and a 19% decrease (HR: 0.81; 95% CI: 0.79-0.83) in UK Biobank. Adhering to ideal CVH was linearly associated with decreased risks of death from lung, bladder, liver, kidney, esophageal, breast, colorectal, pancreatic, and gastric cancers in UK Biobank. Furthermore, integrating genetic data revealed individuals with low PRS and high CVH exhibited the lowest mortality from eight cancers (HRs ranged from 0.36 to 0.57) compared to those with high PRS and low CVH. No significant modification of the association between CVH and mortality risk for eight cancers by genetic predisposition was observed. Subgroup analyses showed a more pronounced protective association for overall cancer mortality among younger participants and those with lower socio-economic status., Conclusions: Maintaining optimal CVH is associated with a substantial reduction in the risk of overall cancer mortality. Adherence to ideal CVH correlates linearly with decreased mortality risk across multiple cancer subtypes. Individuals with both ideal CVH and high genetic predisposition demonstrated significant health benefits. These findings support adopting ideal CVH as an intervention strategy to mitigate cancer mortality risk and promote healthy aging., (© 2024. The Author(s).)

Objective: In this study, we examined associations between county-level measures of structural racism and county-level cancer incidence and mortality rates between race groups while accounting for factors associated with cancer rates and county-level measures of environmental burden., Methods: To explore this relationship, we conducted multiple linear regression analyses. Data for these analyses came from an index of county-level structural racism and publicly available data on 2015 to 2019 age-adjusted cancer rates from the US Cancer Statistics Data Visualization Tool, 2019 County Health Rankings and Roadmaps, the Environmental Protection Agency's 2006 to 2010 Environmental Quality Index, and 2015 to 2019 estimates from the US Census American Community Survey., Results: County-level structural racism was associated with higher county cancer incidence rates among Black (adjusted incidence rate: 17.4, 95% confidence interval [95% CI]: 9.3, 25.5) and Asian/Pacific Islander populations (adjusted incidence rate: 9.3, 95% CI: 1.8, 16.9) and higher mortality rates for American Indian/Alaskan Native (adjusted mortality rate [AMR]: 17.4, 95% CI: 4.2, 30.6), Black (AMR: 11.9, 95% CI: 8.9, 14.8), and Asian/Pacific Islander (AMR: 4.7, 95% CI: 1.3, 8.1) populations than White populations., Conclusion: Our findings highlight the detrimental impact of structural racism on cancer outcomes among minoritized populations. Strategies aiming to mitigate cancer disparities must embed processes to recognize and address systems, policies, laws, and norms that create and reproduce patterns of discrimination., Competing Interests: Conflict of Interest: No conflict of interest reported by the authors.

Background: There is evidence indicating that both lipoprotein(a) [Lp(a)] and fibrinogen (FIB) are associated with mortality, However, the impact of their combination on mortality has not been determined. Thus, the aim of this study was to examine the association between the combination of Lp(a) and FIB with all-cause and cause-specific mortality., Methods: This prospective cohort study enrolled 4,730 participants from the third National Health and Nutrition Examination Survey. The exposure variables included Lp(a), FIB and their combination, while the outcome variables consisted of all-cause, cardiovascular disease (CVD) and cancer-related mortality. Multivariate COX regression, subgroup analysis, sensitivity analysis and restricted cubic spline (RCS) were used to investigate the association between Lp(a), FIB and their combination with all-cause, CVD and cancer-related mortality., Results: Over a median follow-up period of 235 months, 2,668 individuals died, including 1,051 deaths attributed to CVD and 549 deaths due to cancer. Multivariate Cox regression analyses revealed independent associations between both Lp(a) and FIB with all-cause, CVD, and cancer-related mortality. Compared to participants in the 1st to 50th percentiles of both Lp(a) and FIB, those in the 90th to 100th percentiles exhibited multivariable adjusted HRs of 1.813 (95% CI: 1.419-2.317, P < 0.001), 2.147 (95% CI: 1.483-3.109, P < 0.001) and 2.355 (95% CI: 1.396, 3.973, P = 0.001) for all-cause, CVD and cancer-related mortality, respectively. Subgroup and sensitivity analyses did not substantially attenuate the association between the combination of high Lp(a) and high FIB with the risk of all-cause and CVD-related mortality. Additionally, the RCS analysis showed that the relationship between Lp(a) and the risk of all-cause and cancer-related mortality, as well as the relationship between FIB and the risk of cancer-related mortality, were linear (P for nonlinearity > 0.05). Conversely, the relationship between Lp(a) and the risk of CVD-related mortality, as well as the relationship between FIB and the risk of all-cause and CVD-related mortality, were nonlinear (P for nonlinearity < 0.05)., Conclusions: High levels of Lp(a) and FIB together conferred a greater risk of mortality from all-cause, CVD and cancer., (© 2024. The Author(s).)

Purpose: We aimed to investigate the relationship between overall nutritional status and cancer mortality. Methods: A total of 12 262 US adults from six consecutive surveys of the National Health and Nutrition Examination Survey (NHANES 2003–2014) were analyzed. The overall health nutritional biomarkers index (HNBI) score, capturing characteristics of 17 biomarkers was developed to assess the overall nutritional status. The lower the HNBI score, the healthier nutritional status would be. Hazard ratio (HR) and 95% confidence intervals (95% CIs) were calculated by Cox proportional hazards regression models to evaluate the association between the HNBI score and cancer mortality. Results: The lower overall HNBI score was associated with decreased risk of cancer mortality, compared with participants in the 4th quartile of overall HNBI score, the HR (95% CIs) for participants in the 1st quartiles was 0.54 (0.33–0.89) (P-trend = 0.019). Healthier lifestyle habits and not obesity interacted with HNBI score, compared with participants with higher HNBI score and smoking currently/not exercising regularly/obesity, participants with lower HNBI score and not smoking currently/exercising regularly/not obesity were associated with lower risk of cancer mortality, the HR (95% CIs) were 0.43 (0.26–0.73), 0.57 (0.33–0.97), and 0.62 (0.47–0.97), respectively. These significant associations remained among participants who were followed-up more than 2 years. Conclusion: Our findings suggested that healthier overall nutritional status was associated with lower risk of cancer mortality among US adults. Not smoking, exercise regularly and not obesity interacted with overall nutritional status. Adherence to better overall nutritional status, lifestyle habits and optimal weight would prevent premature death from cancer. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the association between dietary patterns, total mortality, and cancer mortality in the United States. Methods: We identified the four major dietary patterns at baseline from 13,466 participants of the NHANES III cohort using principal component analysis (PCA). Dietary patterns were categorized into 'prudent' (fruits and vegetables), 'western' (red meat, sweets, pastries, oils), 'traditional' (red meat, legumes, potatoes, bread), and 'fish and alcohol'. We estimated hazard ratios for total mortality, and cancer mortality using Cox regression models. Results: A total of 4,963 deaths were documented after a mean follow-up of 19.59 years. Higher adherence to the 'prudent' pattern was associated with the lowest risk of total mortality (5th vs. 1st quintile HR 0.90, 95% CI 0.82–0.98), with evidence that all-cause mortality decreased as consumption of the pattern increased. No evidence was found that the 'prudent' pattern reduced cancer mortality. The 'western' and the 'traditional' patterns were associated with up to 22% and 16% increased risk for total mortality (5th vs. 1st quintile HR 1.22, 95% CI 1.11–1.34; and 5th vs. 1st quintile HR 1.16, 95% CI 1.06–1.27, respectively), and up to 33% and 15% increased risk for cancer mortality (5th vs. 1st quintile HR 1.33, 95% CI 1.10–1.62; and 5th vs. 1st quintile HR 1.15, 95% CI 1.06–1.24, respectively). The associations between adherence to the 'fish and alcohol' pattern and total mortality, and cancer mortality were not statistically significant. Conclusion: Higher adherence to the 'prudent' diet decreased the risk of all-cause mortality but did not affect cancer mortality. Greater adherence to the 'western' and 'traditional' diet increased the risk of total mortality and mortality due to cancer. [ABSTRACT FROM AUTHOR]

Purpose: Understanding how stage at cancer diagnosis influences cause of death, an endpoint that is not susceptible to lead-time bias, can inform population-level outcomes of cancer screening., Methods: Using data from 17 US Surveillance, Epidemiology, and End Results registries for 1,154,515 persons aged 50-84 years at cancer diagnosis in 2006-2010, we evaluated proportional causes of death by cancer type and uniformly classified stage, following or extrapolating all patients until death through 2020., Results: Most cancer patients diagnosed at stages I-II did not go on to die from their index cancer, whereas most patients diagnosed at stage IV did. For patients diagnosed with any cancer at stages I-II, an estimated 26% of deaths were due to the index cancer, 63% due to non-cancer causes, and 12% due to a subsequent primary (non-index) cancer. In contrast, for patients diagnosed with any stage IV cancer, 85% of deaths were attributed to the index cancer, with 13% non-cancer and 2% non-index-cancer deaths. Index cancer mortality from stages I-II cancer was proportionally lowest for thyroid, melanoma, uterus, prostate, and breast, and highest for pancreas, liver, esophagus, lung, and stomach., Conclusion: Across all cancer types, the percentage of patients who went on to die from their cancer was over three times greater when the cancer was diagnosed at stage IV than stages I-II. As mortality patterns are not influenced by lead-time bias, these data suggest that earlier detection is likely to improve outcomes across cancer types, including those currently unscreened., (© 2024. The Author(s).)

Introduction: Comparing cancer mortality and associated risk factors among immigrant populations in a host country to those in their country of origin reveals disparities in cancer risk, access to care, diagnosis, and disease management. This study compares cancer mortality between the German resident population and Germany-born individuals who migrated to the US., Methods: Cancer mortality data from 2008-2018 were derived for Germans from the World Health Organization database and for Germany-born Americans resident in four states (California, Florida, Massachusetts, and New York) from respective Departments of Vital Statistics. We calculated age-standardized mortality rates (ASMRs) using the European standard population and standardized mortality ratios (SMR) compared to the German resident population along with 95% confidence intervals (CIs)., Results: Germany-born American males had lower ASMRs (253.8 per 100,000) than German resident population (325.6 per 100,000). The difference in females was modest, with ASMRs of 200.7 and 203.7 per 100,000, respectively. For all cancers, Germany-born American males had an SMR of 0.72 (95% CI: 0.70-0.74) and females 0.98 (95% CI: 0.95-1.00). Male SMRs among Germany-born Americans were significantly below one for oral cavity, stomach, colorectal, liver, lung, prostate, and kidney cancer. Among females, SMRs were below one for oral cavity, stomach, colorectal, gallbladder, breast, cervix uteri, and kidney cancer. For both sexes, SMRs were over one for bladder cancer (1.14 for males, 1.21 for females). Mortality was higher for lung cancer (SMR: 1.68), non-Hodgkin's lymphoma (1.18) and uterine cancer (1.22) among Germany-born American females compared to the German resident population., Conclusion: Germany-born American males but not females showed lower cancer mortality than German resident population. Disparities may stem from variations in risk factors (e.g., smoking and alcohol use) as well as differences in screening practices and participation, cancer treatment, besides some residual potential "healthy immigrant effect"., Competing Interests: Declaration of Competing Interest All authors have declared no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: Cancer is the second leading cause of death in the United States, and the disease burden is elevated in Appalachian Kentucky, due in part to health behaviors and inequities in social determinants of health. This study's goal was to evaluate Appalachian Kentucky's cancer burden compared to non-Appalachian Kentucky, and Kentucky compared to the United States (excluding Kentucky)., Methods: The following data were analyzed: annual all-cause and all-site cancer mortality rates from 1968 to 2018; 5-year all-site and site-specific cancer incidence and mortality rates from 2014 to 2018; aggregated screening and risk factor data from 2016 to 2018 for the United States (excluding Kentucky), Kentucky, non-Appalachian Kentucky, and Appalachian Kentucky; and human papilloma virus vaccination prevalence by sex from 2018 for the United States and Kentucky., Findings: Since 1968, the United States has experienced a large decrease in all-cause and cancer mortality, but the reduction in Kentucky has been smaller and slower, driven by even smaller and slower reductions within Appalachian Kentucky. Appalachian Kentucky has higher overall cancer incidence and mortality rates and higher rates for several site-specific cancers compared to non-Appalachian Kentucky. Contributing factors include screening rate disparities and increased rates of obesity and smoking., Conclusions: Appalachian Kentucky has experienced persistent cancer disparities, including elevated all-cause and cancer mortality rates for 50+ years, widening the gap between this region and the rest of the country. In addition to addressing social determinants of health, increased efforts aimed at improving health behaviors and increased access to health care resources could help reduce this disparity., (© 2023 National Rural Health Association.)

Health insurance availability and affordability are vital elements in diagnosis and treatment of patients with cancer and thus constitute clinical significance as well. Although past studies have explored the disparity in mortality figures for patients with different insurance statuses, this population-based study is pioneering in analyzing the changes in cancer mortality risks over time amid macroeconomic shifts. The study uses Surveillance Epidemiology and End Results (SEER) data of 424,889 non-elderly patients with breast, cervical, ovarian, and uterine cancer diagnosed during 2007–2010 and 2011–2015. In addition to discussing incidence figures and insurance patterns, the study uses Kaplan-Meier and Cox's proportional hazard models to examine the changes in survival probability and mortality risks for insurance-stratified patients with female-specific cancer across the two time periods. Patients without insurance have an increased risk of mortality over time relative to insured patients. Moreover, uninsured patients face this heightened risk more than Medicaid patients. Despite public policy measures as well as advancements in diagnostic facilities and treatment technology, the increased relative mortality of patients without insurance limits the long-term affordability of cancer treatment for economically vulnerable patients in comparison with insured patients. • Recession caused lower ratio of insured patients, limiting treatment affordability. • Patients with cancer without insurance have higher relative mortality risk than before. • Uninsured patients face the heightened risk more than Medicaid-covered patients. • Over time, mortality gap between patients with and without insurance has widened. [ABSTRACT FROM AUTHOR]

Purpose: Thyroid cancer incidence is rising, possibly secondary to increased imaging and surveillance. Based on rural access to care disparities, we hypothesized that incidence would be greater in urban compared to rural counties with no significant difference in long‐term survival. Methods: An observational study was performed on thyroid cancer patients using Surveillance Epidemiology and End Results data (2000‐2012). Age‐adjusted incidence rates, incidence rate ratios, and survival rates were calculated across rural‐urban designations. Findings: Incidence rates were 11.2, 9.8, and 10.1 per 100,000 for urban, rural‐adjacent, and rural‐nonadjacent counties, respectively. Statistically significantly lower incidence was noted in rural‐adjacent and rural‐nonadjacent compared to urban areas. Five‐year and 10‐year survival was significantly lower in rural‐nonadjacent counties compared to urban counties. Conclusions: Higher incidence and increased long‐term survival for thyroid cancer were noted in urban areas compared to rural areas. It is uncertain if rural‐urban differences in long‐term survival reflect health care disparities, differences in therapy, or other origins. [ABSTRACT FROM AUTHOR]

Background: Cancer contributes substantially to the life expectancy gap between US blacks and whites, and racial cancer disparities remain stubborn to eradicate. Disparities vary geographically, suggesting that they are not inevitable.Methods: The authors examined the relationship between housing discrimination and the size of cancer disparities across large US metropolitan statistical areas (MSAs). MSA-level cancer disparities were measured using data from the US Centers for Disease Control and Prevention. Mortgage discrimination for each MSA was estimated using the Home Mortgage Disclosure Act database, and MSA racial segregation was determined using US Census data. Patterns of housing discrimination and cancer disparities were mapped, and the associations between these place-based factors and cancer disparities across MSAs were measured.Results: Black-to-white cancer mortality disparities (rate ratios) varied geographically, ranging from 1.50 to 0.86; 88% of mortality ratios were >1, indicating higher mortality for blacks. In areas with greater mortgage discrimination, the gap between black and white cancer mortality rates was larger (correlation coefficient [r] = 0.32; P = .001). This relationship persisted in sex-specific analyses (males, r = 0.37; P < .001; females, r = 0.23; P = .02) and in models controlling for confounders. In contrast, segregation was inconsistently associated with disparities. Adjusting for incidence disparities attenuated, but did not eliminate, the correlation between mortgage discrimination and mortality disparities (r = 0.22-0.24), suggesting that cancer incidence and survival each account for part of the mortality disparity.Conclusions: Mortgage discrimination is associated with larger black-to-white cancer mortality disparities. Some areas are exceptions to this trend. Examination of these exceptions and of policies related to housing discrimination may offer novel strategies for explaining and eliminating cancer disparities. [ABSTRACT FROM AUTHOR]

Low neighborhood socioeconomic status has been linked to adverse health outcomes. However, it is unclear whether changing the neighborhood may influence health. We examined 10-year change in neighborhood socioeconomic deprivation in relation to mortality rate among 288,555 participants aged 51–70 years who enrolled in the National Institutes of Health-AARP Diet and Health Study in 1995–1996 (baseline) and did not move during the study. Changes in neighborhood socioeconomic deprivation between 1990 and 2000 were measured by US Census data at the census tract level. All-cause, cardiovascular disease, and cancer deaths were ascertained through annual linkage to the Social Security Administration Death Master File between 2000 and 2011. Overall, our results suggested that improvement in neighborhood socioeconomic status was associated with a lower mortality rate, while deterioration was associated with a higher mortality rate. More specially, a 30-percentile-point reduction in neighborhood deprivation among more deprived neighborhoods was associated with 11% and 19% reductions in the total mortality rate among men and women, respectively. On the other hand, a 30-point increase in neighborhood deprivation in less deprived neighborhoods was associated with an 11% increase in the mortality rate among men. Our findings support a longitudinal association between changing neighborhood conditions and mortality. [ABSTRACT FROM AUTHOR]

We studied the associations of leukocyte telomere length (LTL) with all-cause, cardiovascular disease, and cancer mortality in 12,199 adults participating in 2 population-based prospective cohort studies from Europe (ESTHER) and the United States (Nurses' Health Study). Blood samples were collected in 1989-1990 (Nurses' Health Study) and 2000-2002 (ESTHER). LTL was measured by quantitative polymerase chain reaction. We calculated z scores for LTL to standardize LTL measurements across the cohorts. Cox proportional hazards regression models were used to calculate relative mortality according to continuous levels and quintiles of LTLz scores. The hazard ratios obtained from each cohort were subsequently pooled by meta-analysis. Overall, 2,882 deaths were recorded during follow-up (Nurses' Health Study, 1989-2010; ESTHER, 2000-2015). LTL was inversely associated with age in both cohorts. After adjustment for age, a significant inverse trend of LTL with all-cause mortality was observed in both cohorts. In random-effects meta-analysis, age-adjusted hazard ratios for the shortest LTL quintile compared with the longest were 1.23 (95% confidence interval (CI): 1.04,1.46) for all-cause mortality, 1.29 (95% CI: 0.83, 2.00) for cardiovascular mortality, and 1.10 (95% CI: 0.88, 1.37) for cancer mortality. In this study population with an age range of 43-75 years, we corroborated previous evidence suggesting that LTL predicts all-cause mortality beyond its association with age. [ABSTRACT FROM AUTHOR]

Background: A small change in tea consumption at population level could have large impact on public health. However, the health benefits of tea intake among Americans are inconclusive. Objective: To evaluate the association between tea consumption and all-causes, cardiovascular disease (CVD) and cancer mortality in the Aerobics Center Longitudinal study (ACLS). Methods: 11808 participants (20-82 years) initially free of CVD and cancers enrolled in the ACLS and were followed for mortality. Participants provided baseline self-report of tea consumption (cups/day). During a median follow-up of 16 years, 842 participants died. Of others, 250 died from CVD, and 345 died from cancer, respectively. A Cox proportional hazard model was used to produce hazard ratio (HR) and 95% confidence interval (CI). Results: Compared with participants consuming no tea, tea drinkers had a survival advantage ( Log-2 = 10.2, df = 3, P = 0.017); however, the multivariate hazard ratios (HRs) of all-cause mortality for those drinking 1–7, 8–14, and >14 cups/week were 0.95 (95% CI, 0.81–1.12), 1.00 (95% CI, 0.82–1.22), and 0.98 (95% CI, 0.76–1.25), respectively (P for linear trend = 0.83). The multivariate HR were 1.16 (95% CI, 0.86–1.56), 1.22 (95% CI, 0.85–1.76), and 0.94 (95% CI, 0.56–1.54) for CVD mortality (P for linear trend = 0.47), and 0.97 (95% CI, 0.75–1.25), 0.85 (95% CI, 0.60–1.16), and 0.94 (95% CI, 0.64–1.38) for cancer mortality (P for trend = 0.62). Conclusions: There were week or null relationships between tea consumption and mortality due to all-cause, CVD disease or cancer were observed in ACLS. [ABSTRACT FROM PUBLISHER]

Melanoma is among the most common cancers for adolescents and young adults. Updated information on melanoma among adults <50 is needed. The objective of this study was to examine invasive melanoma in the United States among people aged 15-49years for the group at highest risk, non-Hispanic whites. In 2015, we analyzed population-based cancer registry data from the Centers for Disease Control and Prevention's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results program to examine melanoma incidence and death rates and trends among non-Hispanic whites aged 15-49years by sex and age. We also present incidence trends with regard to thickness and site on the body. Among non-Hispanic whites aged 15-49years, rates were higher among females. Thin melanomas increased among both sexes during 1992-2006 and stabilized during 2006-2012. For the period 1992-2012, melanomas thicker than 4mm increased among males and melanomas 1.01-2.00mm thick increased among females. Melanomas were most commonly diagnosed on the trunk and lower extremity among females and on the trunk and upper extremity among males. Increases in melanoma incidence among non-Hispanic whites aged 15-49years across various thicknesses suggest that melanoma trends are not solely related to increased screening but are, in part, related to true increases. Declines in melanoma rates of about 3% a year from the mid-2000s to 2012 in the youngest age groups offer hope that melanoma incidence may decline in future generations. [ABSTRACT FROM AUTHOR]

Background: Adults in the United States (U.S) can be simultaneously exposed to more than one social risk factor over their lifetime. However, cancer epidemiology tends to focus on single social risk factors at a time. We examined the prospective association between cumulative social risk exposure and deaths from cancer in a nationally representative sample of U.S. adults.Methods: The study included 8745 adults (aged≥40 years) in the NHANES Survey III Mortality Study over a median follow-up of 13.5 years (1988-1994 enrollment dates and 1988 through 2006 for mortality data). Social risk factors (low family income, low education level, minority race, and single-living status) were summed to create a cumulative social risk score (0 to ≥3). We used Cox proportional hazard models to estimate age- and sex-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CI) for the association between cumulative social risk with deaths from all-cancers combined, tobacco-related cancers, and screening-detectable cancers.Results: Deaths from all-cancers combined (P for trend=0.001), tobacco-related cancers (P for trend=<0.001), and lung cancer (P for trend=0.01) increased with an increasing number of social risk factors. As compared with adults with no social risk factors, those exposed to ≥3 social risk factors were at increased risk of deaths from all-cancers combined (HR=1.8, 95% CI=1.3-2.4), tobacco-related cancers (HR=2.6, 95% CI: 1.6-4.0), and lung cancer (HR=2.3, 95% CI=1.3-4.1).Conclusions: U.S. adults confronted by higher amounts of cumulative social risk appear to have increased mortality from all-cancers combined, tobacco-related cancers, and lung cancer. An enhanced understanding of the cumulative effect of social risk factors may be important for targeting interventions to address social disparities in cancer mortality. [ABSTRACT FROM AUTHOR]

Objective: The lack of health insurance reduces access to care and often results in poorer health outcomes. The present study simultaneously assessed the effects of health insurance on cancer and chronic disease mortality, as well as the inter-relationships with diet, obesity, smoking, and inflammatory biomarkers. We hypothesized that public/no insurance versus private insurance would result in increased cancer/chronic disease mortality due to the increased prevalence of inflammation-related lifestyle factors in the underinsured population.Methods: Data from the Third National Health and Nutrition Examination Survey participants (NHANES III;1988-1994) were prospectively examined to assess the effects of public/no insurance versus private insurance and inflammation-related lifestyle factors on mortality risk from cancer, all causes, cardiovascular disease (CVD) and diabetes. Cox proportional hazards regression was performed to assess these relationships.Results: Multivariate regression analyses revealed substantially greater risks of mortality ranging from 35% to 245% for public/no insurance versus private insurance for cancer (HR=1.35; 95% CI=1.09,1.66), all causes (HR=1.54; 95% CI=1.39,1.70), CVD (HR=1.62; 95% CI=1.38,1.90) and diabetes (HR=2.45; 95% CI=1.45,4.14). Elevated CRP, smoking, reduced diet quality and higher BMI were more prevalent in those with public insurance, and were also associated with increased risks of cancer/chronic disease mortality.Discussion: Insurance status was strongly associated with cancer/chronic disease mortality after adjusting for lifestyle factors. The results suggest that inadequate health insurance coverage results in a substantially greater need for preventive strategies that focus on tobacco control, obesity, and improved dietary quality. These efforts should be incorporated into comprehensive insurance coverage programs for all Americans. [ABSTRACT FROM AUTHOR]

In their fiscal year 2021 reports, the US House and Senate Appropriations Committees requested that the National Institutes of Health (NIH) evaluate current research related to women's health and topics that include stagnant cervical cancer survival. In response, the NIH Office of Research on Women's Health, with input from women's health experts; members of the public; representatives from NIH institutes, centers, and offices; and members of the NIH Advisory Committee on Research on Women's Health, reviewed the public health needs and current NIH activities on cervical cancer. The Advancing NIH Research on the Health of Women: A 2021 Conference held in October 2021 reviewed these findings and allowed the identification of opportunities to strengthen research. In this review, the authors summarize public health needs related to cervical cancer and NIH activities in this realm. Cervical cancer has become a rare disease in the United States, yet significant portions of the US population remain under screened or unscreened for cervical cancer, human papillomavirus vaccination rates remain low, access to high-quality treatment remains a challenge for many, and large inequities by race and ethnicity persist. Novel, inclusive, and intentional research is needed to produce improvements in cervical cancer survival within the United States., (© 2022 American Cancer Society.)

Background Urban sprawl has the potential to influence cancer mortality via direct and indirect effects on obesity, access to health services, physical activity, transportation choices and other correlates of sprawl and urbanization. Methods This paper presents a cross-sectional analysis of associations between urban sprawl and cancer mortality in urban and suburban counties of the United States. This ecological analysis was designed to examine whether urban sprawl is associated with total and obesity-related cancer mortality and to what extent these associations differed in different regions of the US. A major focus of our analyses was to adequately account for spatial heterogeneity in mortality. Therefore, we fit a series of regression models, stratified by gender, successively testing for the presence of spatial heterogeneity. Our resulting models included county level variables related to race, smoking, obesity, access to health services, insurance status, socioeconomic position, and broad geographic region as well as a measure of urban sprawl and several interactions. Our most complex models also included random effects to account for any county-level spatial autocorrelation that remained unexplained by these variables. Results Total cancer mortality rates were higher in less sprawling areas and contrary to our initial hypothesis; this was also true of obesity related cancers in six of seven U.S. regions (census divisions) where there were statistically significant associations between the sprawl index and mortality. We also found significant interactions (p < 0.05) between region and urban sprawl for total and obesity related cancer mortality in both sexes. Thus, the association between urban sprawl and cancer mortality differs in different regions of the US. Conclusions Despite higher levels of obesity in more sprawling counties in the US, mortality from obesity related cancer was not greater in such counties. Identification of disparities in cancer mortality within and between geographic regions is an ongoing public health challenge and an opportunity for further analytical work identifying potential causes of these disparities. Future analyses of urban sprawl and health outcomes should consider exploring regional and international variation in associations between sprawl and health. [ABSTRACT FROM AUTHOR]

Background: For myelodysplastic syndromes (MDS) (formerly known as preleukemia), a diverse group of myeloid neoplasms usually involving anemia in elderly persons, trends in U.S. death rates apparently have not been reported. Methods: Trends in annual age-standardized rates per 100,000 from 1999 to 2009 were examined for MDS using multiple causes vs. underlying cause alone, coded on death certificates for U.S. residents. Results: The death rate (all ages combined) for MDS increased from 1999 to 2009, from 1.62 to 1.84 using underlying cause alone and from 2.89 to 3.27 using multiple causes. Rates using multiple causes were about 80% higher than those based on underlying cause alone. From 2001 to 2004 the rate for MDS using underlying cause alone (but not using multiple causes) declined, accompanied by an increase in the rate for deaths from leukemia as underlying cause with mention of MDS; this trend coincided with the advent of the 2001 World Health Organization's reclassification of certain MDS as leukemia. The MDS rate for age 65+ years increased after 2005, whereas the rate for age 25-64 years was low but declined from 2001 to 2003 and then stabilized. For deaths with MDS coded as other than underlying cause, rates did not decline for deaths from each of the two most common causes (i.e., cardiovascular diseases and leukemia). Conclusions: Evidence for decreases in MDS-related mortality rates was limited; the increase at age 65+ years is consistent with increases in incidence rates reported from cancer registries. Using multiple causes of death vs. only the underlying cause results in substantially higher MDS-related death rates, shows the impact of changes in the classification of myeloid neoplasms and emphasizes the importance of reducing cardiovascular disease mortality in MDS patients. [ABSTRACT FROM AUTHOR]

Background: The relationship between vitamin D status and mortality in patients with osteoarthritis (OA) is unknown. This study investigated the associations of serum 25-hydroxyvitamin D [25(OH)D] concentrations with all-cause and cause-specific mortality among American adults with OA., Methods: This study included 2556 adults with OA from the National Health and Nutrition Examination Survey (2001-2014). Death outcomes were ascertained by linkage to National Death Index (NDI) records through 31 December 2015. Cox proportional hazards model and two-piecewise Cox proportional hazards model were used to elucidate the nonlinear relationship between serum 25(OH)D concentrations and mortality in OA patients, and stratified analyses were performed to identify patients with higher mortality risk., Results: During 16,606 person-years of follow-up, 438 all-cause deaths occurred, including 74 cardiovascular disease (CVD)-related and 78 cancer deaths. After multivariable adjustment, lower serum 25(OH)D levels were significantly and nonlinearly associated with higher risks of all-cause and CVD mortality among participants with OA. Furthermore, we discovered L-shaped associations between serum 25(OH)D levels and all-cause and CVD mortality, with mortality plateauing at 54.40 nmol/L for all-cause mortality and 27.70 nmol/L for CVD mortality. Compared to participants with 25(OH)D levels below the inflection points, those with higher levels had a 2% lower risk for all-cause mortality (hazard ratio [HR] 0.98, 95% confidence interval [CI] 0.96-0.99) and 17% lower risk for CVD mortality (HR 0.83, 95% CI 0.72-0.95)., Conclusions: Nonlinear associations of serum 25(OH)D levels with all-cause and CVD mortality were observed in American patients with OA. The thresholds of 27.70 and 54.40 nmol/L for CVD and all-cause mortality, respectively, may represent intervention targets for lowering the risk of premature death and cardiovascular disease, but this needs to be confirmed in large clinical trials., (© 2022. The Author(s).)

[Display omitted] Our understanding of the impact of long-term exposures to PM 2.5 constituents and sources on mortality is limited. To examine associations between long-term exposures to PM 2.5 constituents and sources and cause-specific mortality in US older adults. We obtained demographic and mortality data for 15.4 million Medicare beneficiaries living within the conterminous United States (US) between 2000 and 2008. We assessed PM 2.5 constituents exposures for each beneficiary and used factor analysis and residual-based methods to characterize PM 2.5 sources and mixtures, respectively. In age-, sex-, race- and site- stratified Cox proportional hazard models adjusted for neighborhood socio-economic status (SES), we assessed associations of individual PM 2.5 constituents, sources, and mixtures and cause-specific mortality and examined modification of these associations by participant demographics and location of residence. We assessed the robustness of our findings to additional adjustment for behavioral risk factors and to alternate exposure definitions and exposure windows. Hazard ratios (HR) were highest for all causes of death, except COPD, for PM 2.5 constituents and the coal combustion-related PM 2.5 components, with no evidence of confounding by behavioral covariates. We further found Pb and metal-related PM 2.5 components to be significantly associated with increased HR of all causes of death, except COPD and lung cancer mortality, and nitrate (NO 3 –) and silicon (Si) and associated source-related PM 2.5 components (traffic and soil, respectively) to be significantly associated with increased all-cause, CVD, respiratory and all cancer-related mortality HR. Associations for other examined constituents and mortality were inconsistent or largely null. Our analyses of mixtures were generally consistent with these findings. Mortality HRs were greatest for minority, especially Black, low-income urban, younger, and male beneficiaries. PM 2.5 components related to coal combustion, traffic, and to a lesser extent, soil were strongly associated with mortality from CVD, respiratory disease, and cancer. [ABSTRACT FROM AUTHOR]

Aim Although obesity is an established risk factor for cancer mortality among women, little is known about how body mass index ( BMI) is interacting with certain lifestyle behaviors and sociodemographic characteristics to increase the risk of cancer mortality. The purpose of this study was to use classification trees to examine possible interactions between BMI, smoking, age, poverty level and marital status in identifying high-risk subgroups for all-cause cancer mortality in women. Material and Methods Data from the US National Health Interview Survey linked with the National Death Index from 1990-2004 were used in this study. The data were restricted to women with complete information on all risk factors considered in the analyses. The data were analyzed using descriptive statistics and classification trees. Results Findings revealed that younger women (41-50 years old) who smoked had higher cancer mortality if they were underweight. Even among 51-60-year-old never smokers, we observed an inverse relationship between BMI and mortality. High BMI, however, was not a protective factor in 51-60-year-old women who were not married and did not smoke. Conclusion Classification tree analysis confirms and extends current knowledge about the role of BMI and smoking on cancer mortality by providing preliminary risk profiles. The findings indicate that it is imperative for cancer-related studies to examine BMI and smoking within age-specific groups and in the context of several sociodemographic factors that are known to independently affect cancer mortality. [ABSTRACT FROM AUTHOR]

Background: Since 1971, the annual National Ambient Air Quality Standard (NAAQS) for nitrogen dioxide (NO 2 ) has remained at 53 ppb, the impact of long-term NO 2 exposure on mortality is poorly understood., Objectives: We examined associations between long-term NO 2 exposure (12-month moving average of NO 2 ) below the annual NAAQS and cause-specific mortality among the older adults in the U.S., Methods: Cox proportional-hazard models were used to estimate Hazard Ratio (HR) for cause-specific mortality associated with long-term NO 2 exposures among about 50 million Medicare beneficiaries living within the conterminous U.S. from 2001 to 2008., Results: A 10 ppb increase in NO 2 was associated with increased mortality from all-cause (HR: 1.06; 95% CI: 1.05-1.06), cardiovascular (HR: 1.10; 95% CI: 1.10-1.11), respiratory disease (HR: 1.09; 95% CI: 1.08-1.11), and cancer (HR: 1.01; 95% CI: 1.00-1.02) adjusting for age, sex, race, ZIP code as strata ZIP code- and state-level socio-economic status (SES) as covariates, and PM 2.5 exposure using a 2-stage approach. NO 2 was also associated with elevated mortality from ischemic heart disease, cerebrovascular disease, congestive heart failure, chronic obstructive pulmonary disease, pneumonia, and lung cancer. We found no evidence of a threshold, with positive and significant HRs across the range of NO 2 exposures for all causes of death examined. Exposure-response curves were linear for all-cause, supra-linear for cardiovascular-, and sub-linear for respiratory-related mortality. HRs were highest consistently among Black beneficiaries., Conclusions: Long-term NO 2 exposure is associated with elevated risks of death by multiple causes, without evidence of a threshold response. Our findings raise concerns about the sufficiency of the annual NAAQS for NO 2 ., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Abstract: Background: Myeloproliferative neoplasms (MPNs) are classified as neoplasms of uncertain or unknown behavior in the International Classification of Diseases (ICD) Version 10 and can contribute to risk of death from complications (especially thrombosis). Methods: U.S age-standardized death rates using ICD-Version 10 codes relevant to classical MPN (i.e., polycythemia vera, essential thrombocythemia, and “chronic myeloproliferative disease”) were examined for 1999–2006. The underlying cause of death and also all causes (“multiple causes” or “mentions”) coded on death certificates were considered. Trends were assessed by using percentage change (PC) in rate between 1999 and 2006, and annual percentage change (APC) estimated from linear regression. Results: The decline in death rates was large for MPN, whether based only the underlying cause (PC=−19.7%, APC=−3.4%) or on the substantially higher rates based on any cause (PC=−24.1%, APC=−3.8%), and was consistent by gender and age group (<65 and 65+ years). For deaths with MPN coded as other than the underlying cause, cardiovascular diseases were the most common underlying cause and the ASR for these deaths declined substantially (PC=−40.0%). Conclusions: Use of the underlying cause of death in surveillance will considerably underestimate MPN-related mortality rates in the population. Studies are needed on treatment in random samples of MPN patients from population-based cancer registries. Continued surveillance of MPN-related mortality rates in the population is needed in view of recent attempts (including the use of aspirin) to control cardiovascular complications of MPN. [Copyright &y& Elsevier]

Corporate crime remains more costly and arguably more harmful than street crime and such harms include environmental, air, and water pollution resulting in increasing cancer mortality rates around the globe. More importantly, these corporate crimes are global in nature and facilitated by transnational corporations’ capture of the USA Environmental Protection Agency. [ABSTRACT FROM AUTHOR]

The article presents a study which assesses cancer trends in the U.S. by evaluating generational risk for three cancer groups including tobacco-related cancer, screen-detectable cancer, and cancer which are unrelated to tobacco or screening. Data from the U.S. Surveillance, Epidemiology, and End Results (SEER) Program were analyzed to obtain specific data of incidence and mortality. Results revealed higher risks of cancer unrelated to tobacco or screening in adults compared to their parents.

The article reports on the mortality-related burden of human papillomavirus (HPV)-associated cancers and all malignant cancers in the U.S. in 2003. It states that the HPV-associated cancers among younger individuals and among women contribute more to years of potential life lost (YPLL). It infers that need of HPV vaccination, cancer screening and other effective early detection programs for HPV-associated cancers.

Abstract: Background: Reaching the American Cancer Society challenge goal for the nation to reduce cancer incidence by 25% by 2015 will be influenced in part by the epidemic of obesity. The purpose of this study was to estimate the impact of obesity on the number obesity-attributable incident cancers in the U.S. in 2007 and on trends on cancer incidence rates. Methods: Using estimated relative risks (RRs) for obesity vs. normal weight/height from published meta-analyses and/or large cohort studies, and the prevalence of obese adults from the latest national surveys, attributable risk percent (ARP) and numbers of obesity-attributed incident cancers in 2007 were estimated. Using the ARPs, the impact of obesity trends on trends in incidence rates for certain obesity-related cancers was estimated for the calendar years (1976–1980 through 2001–2004) for which cancer rates and obesity prevalence rates were available. Results: An estimated 33,966 new cancers (4% of all estimated cancers) in males and 50,535 (7% of all estimated cancers) in females diagnosed in 2007, or 6% of all cancers, may be potentially attributable to obesity. Without the impact of rising obesity rates, incidence rates might have declined (instead of remaining stable) from 1988–1994 to 2001–2004 for uterus, breast and certain other cancers. Conclusions: Obesity may contribute to about 6% of U.S. incident cancers, apparently has affected recent trends in incidence rates for certain cancers, and is important because of increasing prevalence in the U.S. population. [Copyright &y& Elsevier]

Background: Cancer survival is influenced by age, comorbidity, and type of cancer. A population-based study was conducted to compare the interplay between age and mortality for different cancers.Methods: This study analyzed 784,378 cases, comprising 22 of the commonest SEER cancers diagnosed between 1984 and 1993. Competing hazards and proportional hazard analyses for cancer-specific and comorbid death were performed.Results: Median follow-up was up to 159 months, and the median age of diagnosis was 67 years. Cancer-specific and comorbid deaths accumulated most within the first years of diagnosis. With the more biologically aggressive cancers, cancer deaths invariably exceeded comorbid deaths. For the remaining 70% of cancers, comorbidity remained the dominant mode of death. Deaths attributable to both cancer and comorbidity accumulated mostly after the seventh decade of life. Cancer site had a 3-fold greater effect on overall survival than age at diagnosis and a 30-fold effect with cancer-specific survival; age at diagnosis had a 5-fold greater effect on comorbid deaths than site.Conclusions: Both the age of the affected individual and the biology of the particular cancer have major influences on cancer survival and mode of death. Cancer is largely a disease of the elderly. Within affected individuals, fatalities attributable to cancer and comorbidity appeared inter-related, with cancer-specific deaths dominating for more lethal cancers and comorbid deaths dominating for the remaining majority. For these reasons, further improvements in overall survival may be best anticipated from better geriatric and general medical management as much as from better cancer management. [ABSTRACT FROM AUTHOR]

Background: Alcohol average volume (quantity multiplied by frequency) has been associated with mortality in drinkers. However, average volume may mask associations due to quantity or frequency alone. Methods: We prospectively assessed relationships between alcohol quantity and frequency, and mortality from all-causes, cardiovascular disease, cancer, and other-causes in a cohort created by linking the 1988 National Health Interview Survey (response rate 87%) to the National Death Index through 2002. Participants were 20,765 current drinkers age ≥ 18 years. At 14-year follow-up 2,547 had died. Results: For quantity, among men who consumed ≥5 drinks (compared to 1 drink) on drinking days, adjusted relative risks (RR) of mortality were: for cardiovascular disease, 1.30 [95% confidence interval (CI) 0.96–1.75; p for linear trend ( p-trend) = 0.0295], for cancer, 1.53 (95% CI 1.11–2.09; p-trend = 0.0026), and for other-causes, 1.42 (95% CI 1.08–1.87; p-trend = 0.0029); among women for other-causes, 2.88 (95% CI 1.61–5.12; p-trend = 0.0010). For frequency, among men in the highest frequency quartile (compared to the lowest), RR were: for cardiovascular disease, 0.79 (95% CI 0.63–0.99; p-trend = 0.0330), for cancer, 1.23 (95% CI 0.95–1.59; p-trend = 0.0461), and for other-causes, 1.30 (95% CI 1.01–1.67; p-trend = 0.0070); among women, for cancer, 1.65 (95% CI 1.12–2.45, p-trend = 0.0031). Average volume obscured effects of quantity alone and frequency alone, particularly for cardiovascular disease in men where quantity and frequency trended in opposite directions. Conclusions: Alcohol quantity and frequency were independently associated with cause-specific mortality. Accumulating evidence of their differential effects may, in the future, be useful for clinical and public health recommendations. [ABSTRACT FROM AUTHOR]

Background: This study examined elderly stage II and III rectal cancer patients' adjuvant chemoradiation therapy adherence, trends in adherence over time, and the relation of levels of adherence to mortality.Methods: The authors studied 2886 stage II and III rectal cancer patients who had surgical resection and who appeared in 1992-1999 linked SEER-Medicare claims data. The authors compared measures of adjuvant radiation and chemotherapy receipt and completion between stage II and III patients. Adjusted risk of cancer-related 5-year mortality was calculated by multivariate logistic regression for different levels of chemoradiation adherence among stage II and III patients.Results: Of the 2886 patients, 45.4% received both adjuvant radiation and chemotherapy. Stage III patients were more likely to receive chemoradiation than stage II patients. The receipt of chemoradiation by stage II patients increased significantly from 1992 to 1999. Stage III patients were more likely to complete radiation therapy (96.6%), chemotherapy (68.2%), and both modalities (67.5%) than stage II patients (91.5%, 49.8%, 47.6%, respectively). Only a complete course of both radiation and chemotherapy for both stage II (relative risk [RR] 0.74; 95% CI, 0.54, 0.97) and III (RR 0.80; 95% CI, 0.65, 0.96) decreased the adjusted 5-year cancer mortality risk compared with counterparts with no adjuvant therapy.Conclusions: Even though stage II rectal cancer patients were less likely than stage III patients to receive and complete adjuvant chemoradiation, both patient groups in the general population had lower cancer-related mortality if they completed chemoradiation. These patients deserve support and encouragement to complete treatment. [ABSTRACT FROM AUTHOR]

Although malignant tumors occur at all ages, cancer dispro- portionately strikes individuals in the age group 65 years and older. Data from the National Cancer Institute Surveil- lance, Epidemiology, and End Results Program for the most recent five-year period, 1998-2002, reveal that 56% of all newly diagnosed cancer patients and 71% of cancer deaths are in this age group. Median ages of cancer patients at death for the major tumors common to both males and fe- males, all races (lung, colorectal, lymphoma, leukemia, pan- creas, stomach, urinary bladder) range from 71 to 77 years. The median age for prostate cancer is 79 years; for ovarian and female breast cancer, the median age is 71 for each tumor. These cancer statistics when cast against the demo- graphic changes occurring in the U.S. population take on ur- gency and importance for cancer treatment and care in our nation's health care system. The U.S. Census Bureau dem- ographic projections indicate that the number of persons 65 years and older in the United States will double from the cur- rent estimate of 35 million persons to a projected 70 million by 2030. Barring any cancer prevention breakthroughs, the expansion of the aged population will likely increase the ab- solute number of older individuals diagnosed and treated for cancer in coming decades. The United States is not unique as an aging developed industrial nation with a high proportion of the cancer burden in the elderly. Other developed industrial countries have a potentiality for increased cancer incidence and mortality as their populations grow older. This paper, using U.S. Bureau of Census demographic projections and current age stan- dardized death rates per 100,000 population (from World- wide Cancer Mortality Statistics, Cancer Mondial, WHO, and the International Association for Research on Cancer) com- pares cancer in the elderly in Italy and the United States. Italy is demographically ranked as the oldest nation in the world. Dimensions of the cancer burden challenge ahead are inferred in the context of two countries with aging popu- lations to underscore the possible increase that demo- graphic factors may have on the magnitude of the cancer problem for older persons in the next 25 years. (Cancer J [ABSTRACT FROM AUTHOR]

Background: Monitoring mortality is a meaningful way to evaluate the effectiveness of cancer control activities. Results of trend analysis for cancer related deaths by race/ethnicity in California from 1970 to 1998 are reported here. Methods: Age-adjusted cancer mortality rates in California were used in the analysis of secular trends. Mortality patterns for selected cancers in all races combined are compared with similar patterns in the US for 1973–1998. Results: The overall cancer mortality rates in California began to decline in 1987 in both men and women. Although mortality trends by site, sex, and race/ethnicity showed significant variations, the overall pattern in California is heavily influenced by trends for the non-Hispanic white (NHW) population and is very similar to the patterns in the US with minor differences in the magnitude and trend. Conclusions: This is the first time that secular trends in cancer mortality for California are presented by race and ethnicity. Despite notable racial differences, the overall trend follows a declining pattern. Detailed explanation of the reasons behind the observed patterns is not included in this report. Some of the differences between California and the US, however, can be explained by differences in the racial and ethnic composition of the two populations. Approximately 45% of the California population has Hispanic (HSP) or Asian origins among whom cancer mortality rates are substantially lower. Another factor is the difference in the intensity and coverage of cancer related activities such as tobacco control. Prevalence of smoking in California is much lower than the rest of the US. [Copyright &y& Elsevier]

Background: Intake time of diet has recently been demonstrated to be associated with the internal clock and circadian pattern. However, whether and how the intake time of minerals would influence the natural course of cancer was largely unknown., Methods: This study aimed to assess the association of mineral intake at different periods with cancer and all-cause mortality. A total of 27,455 participants aged 18-85 years old in the National Health and Nutrition Examination Survey were recruited. The main exposures were the mineral intakes in the morning, afternoon and evening, which were categorized into quintiles, respectively. The main outcomes were mortality of cancer and all causes., Results: During the 178,182 person-years of follow-up, 2680 deaths, including 601 deaths due to cancer, were documented. After adjusting for potential confounders, compared to the participants who were in the lowest quintile(quintile-1) of mineral intakes at dinner, the participants in the highest quintile intake(quintile-5) of dietary potassium, calcium and magnesium had lower mortality risks of cancer (HRpotassium = 0.72, 95% CI:0.55-0.94, P for trend = 0.023; HRcalcium = 0.74, 95% CI:0.57-0.98, P for trend = 0.05; HRmagnesium = 0.75, 95% CI:0.56-0.99, P for trend = 0.037) and all-cause (HRpotassium = 0.83, 95% CI:0.73-0.94, P for trend = 0.012; HRcalcium = 0.87, 95% CI:0.76-0.99, P for trend = 0.025; HRmagnesium = 0.85, 95% CI:0.74-0.97, P for trend = 0.011; HRcopper = 0.80, 95%CI: 0.68-0.94, P for trend = 0.012). Further, equivalently replacing 10% of dietary potassium, calcium and magnesium consumed in the morning with those in the evening were associated with lower mortality risk of cancer (HRpotassium = 0.94, 95%CI:0.91-0.97; HRcalcium = 0.95, 95%CI:0.92-0.98; HRmagnesium = 0.95, 95%CI: 0.92-0.98)., Conclusions: This study demonstrated that the optimal intake time of potassium, calcium and magnesium for reducing the risk of cancer and all-cause mortality was in the evening., (© 2021. The Author(s).)

Background/purpose: Psychological distress can influence cancer mortality through socioeconomic disadvantage, health-risk behaviors, or reduced access to care. These disadvantages can result in higher risks of cancer occurrence, a delayed cancer diagnosis, hamper adherence to treatment, and provoke inflammatory responses leading to cancer. Previous studies have linked psychological distress to cancer mortality. However, studies are lacking for the U.S. population., Methods: This study examines the Kessler six-item psychological distress scale as a risk factor for U.S. cancer mortality using the pooled 1997-2014 data from the National Health Interview Survey (NHIS) linked to National Death Index (NDI) (N = 513,012). Cox proportional hazards regression was used to model survival time as a function of psychological distress and sociodemographic and behavioral covariates., Results: In Cox models with 18 years of mortality follow-up, the cancer mortality risk was 80% higher (hazard ratio [HR] = 1.80; 95% CI = 1.64, 1.97) controlling for age; 61% higher (HR = 1.61; 95% CI = 1.46, 1.76) in the SES-adjusted model, and 33% higher (HR = 1.33; 95% CI = 1.21, 1.46) in the fully-adjusted model among adults with serious psychological distress (SPD), compared with adults without psychological distress. Males, non-Hispanic Whites, and adults with incomes at or above 400% of the federal poverty level had greater cancer mortality risk associated with SPD. Using an 8 years of mortality follow-up, those with SPD had 108% increased adjusted risks of mortality from breast cancer., Conclusion: Our study findings underscore the significance of addressing psychological well-being in the population as a strategy for reducing cancer mortality., (© Society of Behavioral Medicine 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Occupational polycyclic aromatic hydrocarbons (PAHs) exposure has been shown to increase the risk of various cancers and may be associated with carcinogenic mortality. However, no study has explored the relationship between environmental PAH exposure and mortality in general population. The aim of our study was to explore the association between PAH exposure and all-cause, cardiovascular, and cancer mortality in a general US adult population. We analyzed data from the National Health and Nutrition Examination Survey (NHANES 2001-2006) based on the information in this dataset on 692 males and 717 females. PAH exposure was detected using biomarkers from urine samples. Follow-up data on mortality were derived from initial examination of the subjects until death or 31 December 2006 in the NHANES database. We calculated hazard ratios (HRs) of PAH metabolites among all-cause, cardiovascular, and cancer mortality using the multivariate Cox proportional hazards regression model after adjusting for covariates. Among males, 3-phenanthrene was positively associated with increased risk of all-cause mortality (HR 1.043, 95%CI 1.019-1.066). Female participants with higher 2-napthol (HR 1.043, 95%CI 1.014-1.072), 3-fluorene (HR 2.159, 95%CI 1.233-3.779), and 1-phenanthrene (HR = 1.259, 95%CI 1.070-1.481) levels had increased all-cause mortality. In addition, high 3-phenanthrene (HR 1.333, 95%CI 1.008-1.763) and 1-phenanthrene (HR 1.463, 95%CI 1.126-1.900) levels increased the risk of cardiovascular mortality. However, there were no significant findings for cancer mortality in both genders. Environmental PAH exposure among the adult population is associated with non-carcinogenic but not cancer mortality. Future studies are warranted to determine the underlying mechanisms related to these findings.

Aims: To estimate the extent to which the approvals of new pharmacological therapies were associated with cancer mortality in the USA between 2000 and 2016., Materials and Methods: The analysis quantified cancer drug approvals across the 15 tumor types with the highest incidence. Number of approvals in a given time period for each tumor was translated into a treatment stock measure, defined as a weighted sum of new indication approvals since 1976. The primary outcome was the annual tumor-specific cancer mortality, defined as the number of deaths per 100,000 U.S. population. The analysis used a multivariable ordinary least squares and a fixed effects model, controlling for incidence (new cases per 100,000 U.S. population) and the primary exposure, the treatment stock measure by year., Results: Between 2000 and 2016, deaths per 100,000 population across the 15 most common tumor types declined by 24%. Additionally, 10.2 new indications were approved per year across the 15 most common tumor types. Cancer drug approvals were associated with statistically significant deaths averted in 2016 for colorectal cancer (4,991, p  = 0.004), lung cancer (33,825, p  < 0.001), breast cancer (11,502, p  < 0.001), non-Hodgkin's lymphoma (6,636, p  < 0.001), leukemia (4,011, p  < 0.001), melanoma (1,714, p  < 0.001), gastric cancer (758, p  = 0.019), and renal cancer (739, p  < 0.001). Between 2000 and 2016, new cancer treatments were correlated with 1,291,769 ( p  < 0.001) total deaths prevented across the 15 most common tumor types., Limitations and Conclusions: Cancer drug approvals between 2000 and 2016 were associated with significant reduction in deaths from the most common cancers in the USA. Mortality changes were largest in prevalent tumor types with relatively more approvals, i.e. lung cancer, breast cancer, melanoma, lymphoma and leukemia. Future research evaluating the relationship between drug approvals and cancer mortality post 2016 is needed.

Background: To estimate the relationship between inflammatory biomarkers and cancer mortality in a nationally representative sample of the U.S. population while controlling for education, occupation, and income., Methods: Data were obtained from the U.S. National Health and Nutrition Examination Survey from 1988 to 1994 (N = 7817) and 1999-2002 (N = 2344). We fit Cox proportional hazard models to examine the relationship between C-reactive protein (CRP) and fibrinogen with cancer mortality., Results: In the full Cox multivariate model, clinically raised CRP was associated with cancer mortality in NHANES 1988-1994 (> 0.99 mg/dL: 95%CI: 1.04-2.13). However, across two inflammatory biomarkers (CRP and Fibrinogen), two NHANES time periods (1998-1994 and 1999-2002) and three income levels (12 strata in total), Hazard ratio confidence intervals did not include the null only for one association: CRP and cancer mortality among low income participants from 1988 to 1994 (HR = 1.83, 95% CI: 1.10-3.04)., Conclusions: We find evidence that only in one unique stratum is earlier life CRP, and not fibrinogen, associated with prospective cancer mortality. After more complete control for socioeconomic confounding, CRP and fibrinogen do not predict cancer mortality in most subpopulations.

Aims: The prognostic importance of post-diagnosis assessment of cardiorespiratory fitness (CRF) in cancer patients is not well established. We sought to examine the association between CRF and mortality in cancer patients., Methods and Results: This was a single-centre cohort analysis of 1632 patients (58% male; 64 ± 12 years) with adult-onset cancer who were clinically referred for exercise treadmill testing a median of 7 [interquartile range (IQR): 3-12] years after primary diagnosis. Cardiorespiratory fitness was defined as peak metabolic equivalents (METs) achieved during standard Bruce protocol and categorized by tertiles. The association between CRF and all-cause and cause-specific mortality was assessed using multivariable Cox proportional hazard models adjusting for important covariates. Median follow-up was 4.6 (IQR: 2.6-7.0) years; a total of 411 deaths (229, 50, and 132 all-cause, cardiovascular (CV), and cancer related, respectively) occurred during this period. Compared with low CRF (range: 1.9-7.6 METs), the adjusted hazard ratio (HR) for all-cause mortality was 0.38 [95% confidence interval (CI): 0.28-0.52] for intermediate CRF (range: 7.7-10.6 METs) and 0.17 (95% CI: 0.11-0.27) for high CRF (range: 10.7-22.0 METs). The corresponding HRs were 0.40 (95% CI: 0.19-0.86) and 0.41 (95% CI: 0.16-1.05) for CV mortality and 0.40 (95% CI: 0.26-0.60) and 0.16 (95% CI: 0.09-0.28) for cancer mortality, respectively. The adjusted risk of all-cause, CV, and cancer mortality decreased by 26%, 14%, and 25%, respectively with each one MET increment in CRF., Conclusion: Cardiorespiratory fitness is a strong, independent predictor of all-cause, CV, and cancer mortality, even after adjustment for important clinical covariates in patients with certain cancers., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)

Objective: Cancer patients exhibit disparity in mortality risks across demographic divisions as well as insurance groups. The effects of macroeconomic environment also vary for such strata. This study analyses the gaps between mortality risks for male and female cancer patients with and without insurance and examines how such gaps transform over time with macroeconomic shifts., Methods: Demographic, clinical and treatment records of 45,750 melanoma and 91,157 lung cancer patients diagnosed in 2007-2009 and 2011-2013 were extracted from Surveillance, Epidemiology and End Results (SEER) database. Kaplan-Meier test was applied to ascertain survival probability of each insurance group, while Cox proportional hazard model was used to assess relative mortality risk for Medicaid and uninsured patients, for the whole data as well as separately for both time periods and genders., Results: Both the hazard ratios and change thereof over time are greater for female patients without insurance, than for male patients. More than any insurance-gender subgroup, uninsured female patients of melanoma have much increased hazard ratios, from 1.41 [95% confidence interval (CI), 1.04-1.92] to 2.22 [95% CI, 1.67-2.94]., Conclusion: Despite diagnostic improvements and technology advancements, the adverse effects of macroeconomic crisis are associated with increased relative mortality risks for cancer patients without insurance, more for women than men., (© 2020 John Wiley & Sons Ltd.)

Background: The shape of the exposure-response curve for long-term ambient fine particulate (PM 2.5 ) exposure and cause-specific mortality is poorly understood, especially for rural populations and underrepresented minorities., Methods: We used hybrid machine learning and Cox proportional hazard models to assess the association of long-term PM 2.5 exposures on specific causes of death for 53 million U.S. Medicare beneficiaries (aged ≥65) from 2000 to 2008. Models included strata for age, sex, race, and ZIP code and controlled for neighborhood socio-economic status (SES) in our main analyses, with approximately 4 billion person-months of follow-up, and additionally for warm season average of 1-h daily maximum ozone exposures in a sensitivity analysis. The impact of non-traffic PM 2.5 on mortality was examined using two stage models of PM 2.5 and nitrogen dioxide (NO 2 )., Results: A 10 μg /m 3 increase in 12-month average PM 2.5 prior to death was associated with a 5% increase in all-cause mortality, as well as an 8.8, 5.6, and 2.5% increase in all cardiovascular disease (CVD)-, all respiratory-, and all cancer deaths, respectively, in age, gender, race, ZIP code, and SES-adjusted models. PM 2.5 exposures, however, were not associated with lung cancer mortality. Results were not sensitive to control for ozone exposures. PM 2.5 -mortality associations for CVD- and respiratory-related causes were positive and significant for beneficiaries irrespective of their sex, race, age, SES and urbanicity, with no evidence of a lower threshold for response or of lower Risk Ratios (RRs) at low PM 2.5 levels. Associations between PM 2.5 and CVD and respiratory mortality were linear and were higher for younger, Black and urban beneficiaries, but were largely similar by SES. Risks associated with non-traffic PM 2.5 were lower than that for all PM 2.5 and were null for respiratory and lung cancer-related deaths., Conclusions: PM 2.5 was associated with mortality from CVD, respiratory, and all cancer, but not lung cancer. PM 2.5 -associated risks of CVD and respiratory mortality were similar across PM 2.5 levels, with no evidence of a threshold. Blacks, urban, and younger beneficiaries were most vulnerable to the long-term impacts of PM 2.5 on mortality.

The mortality-to-incidence ratio (MIR) can be computed from readily accessible, public-use data on cancer incidence and mortality, and a high MIR value is an indicator of poor survival relative to incidence. Newly available data on congressional district-specific cancer incidence and mortality from the U.S. Cancer Statistics (USCS) database from 2011 to 2015 were used to compute MIR values for overall (all types combined), breast, cervix, colorectal, esophagus, lung, oral, pancreas, and prostate cancer. Congressional districts in the South and Midwest, including MS, AL, and KY, had higher (worse) MIR values for all cancer types combined than for the U.S. as a whole. For all cancers combined, there was a positive correlation between each district's percent of rural residents and the MIR (r = 0.47; p < .001). The MIR for all cancer types combined was lower in districts within states that expanded Medicaid vs. those states that did not expand Medicaid (0.36 vs. 0.38; p < .001). A positive correlation was seen between the proportion of non-Hispanic Black residents and MIR (r = 0.15; p < .01 for all cancers). Lower MIRs were observed in districts in New England and in states that expanded Medicaid. However, there also were some interesting departures from this rule (e.g., Wyoming, South Dakota, parts of Wisconsin and Florida). Rural congressional districts have generally higher MIRs than more urban districts. There is some concern that poorer, more rural states that did not expand Medicaid may experience greater disparities in MIRs relative to Medicaid expansion states in the future., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Introduction: Both short and long sleep have been associated with higher mortality. However, most studies are conducted in predominantly White or Asian populations and little is known about the sleep-mortality relationship in Blacks. Given the high prevalence of short and long sleep in Blacks, it is important to examine the health effects of sleep in this population., Methods: We studied sleep duration in relation to all-cause, cardiovascular and cancer mortality in 55,375 participants age 40-79 at enrollment in the Southern Community Cohort Study, of whom ∼2/3 are Black. Weekday and weekend sleep durations were self-reported. Mortality follow up started at baseline (2002-2009) and was regularly updated until 2015 via linkage to Social Security Administration and the National Death Index. We used Cox proportional hazards model adjusting for multiple covariates to estimate relative risks associated with sleep duration., Results: We found U-shaped relationships between weekday and weekend sleep duration and all-cause mortality, with the effects stronger in Whites than Blacks. Risks for all-cause mortality were significantly elevated by about 25% among Whites and about 10% among Blacks reporting either less than 5 hours or more than 9 hours of sleep compared with those reporting 8 hours of sleep. The associations among Whites but not Blacks were even stronger for cardiovascular disease mortality, whereas no association between sleep duration and cancer mortality was found in either group., Conclusions: Our results suggest that short and long sleep durations may be weaker predictors of total and cardiovascular mortality in Blacks than in Whites., (Copyright © 2019 National Sleep Foundation. All rights reserved.)

Cohort or period components of trends can provide a rationale for new research or point to clues on the effectiveness of control strategies. Graphical display of trends guides models that quantify the experience of a population. In this paper, a method for smoothing rates by single year of age and year is developed and displayed to show the contributions of period and cohort to trends. The magnitude of the contribution of period and/or cohort in a model for trends may be assessed by the percentage of deviance explained and the relative contributions of cohort (C) and period (P) individually, known as the C-P score. The method is illustrated using Surveillance, Epidemiology, and End Results data (1975-2014) on lung and bronchial cancer mortality in females and prostate and colorectal cancer incidence in males. Smoothed age-period and age-cohort rates provide a useful first step in studies of etiology and the impact of disease control without imposing a restrictive model. We found that, in this data set, cohort predominates for female lung and bronchial cancer and period predominates for male prostate cancer. However, the effects change with age for male colorectal cancer incidence, indicating an age shift in relevant exposures. These methods are applied on an interactive website for both incidence and mortality at over 20 cancer sites in the United States., (Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2019.)

Purpose: To examine the association of muscle-strengthening activities (MSA) and cancer mortality., Methods: We pooled data from the 1998 to 2009 National Health Interview Survey (NHIS), which were linked to records in the National Death Index. Mortality follow-up was through 31 December 2011. Based on U.S. federal guidelines for physical activity, we dichotomized MSA and compared those who performed MSA twice a week or more to others with lower MSA. We also examined dose-response relationship of MSA frequency with cancer mortality. Hazard ratios (HR) from Cox regression were computed to estimate the association of MSA with the risk of cancer mortality. Mean follow-up was 7.9 years and the analysis sample size was 310,282., Results: Covariate-adjusted results showed that meeting the MSA guideline was associated with a 19% lower risk of cancer mortality (HR 0.81, 95% CI 0.73, 0.90). We found no evidence of a dose-response relationship between the frequency of performing MSA and cancer mortality., Conclusion: Adhering to the U.S. federal guideline for MSA is associated with lower cancer mortality. Public health programs and policy for cancer prevention and control should promote MSA to further reduce cancer mortality.