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Datta BK, Coughlin SS, Majeed B. Inequities in routine preventive care utilization among persons with overweight/obesity in the United States: An analysis of nativity, racial and ethnic identity, and socioeconomic status. DIALOGUES IN HEALTH 2023; 2:100125. [PMID: 37377782 PMCID: PMC10292657 DOI: 10.1016/j.dialog.2023.100125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 06/29/2023]
Abstract
Extant literature documented various health disparities among immigrants and racial and ethnically marginalized individuals in the United States. However, health disparities in the intersection of nativity and race are generally less visited. This cross-sectional study assessed utilization of routine preventive care among adults with overweight/obesity at the junction of their nativity, racial/ethnic identity, and socioeconomic status (i.e., income and education). Pooling data on 120,184 adults with overweight/obesity from the 2013-2018 waves of the National Health Interview Survey (NHIS), we estimated modified Poisson regressions with robust standard errors to obtain adjusted prevalence rates of preventive care visit, receiving flu shot, and having blood pressure, cholesterol and blood glucose screened. We found that immigrant adults with overweight/obesity had lower rates of utilization of all five preventive care services. However, these patterns varied by racial and ethnic sub-populations. While White immigrants had comparable rates of cholesterol and blood glucose screening, they had 2.7%, 2.9%, and 14.5% lower rates of preventive care visit, blood pressure screening, and getting a flu shot respectively, compared to native-born Whites. These patterns were similar for Asian immigrants as well. Black immigrants, on the other hand, had comparable rates of getting a flu shot and blood glucose screening, and had 5.2%, 4.9%, and 4.9% lower rates of preventive care visit, blood pressure screening, and cholesterol screening respectively. Lastly, the rates of utilization among Hispanic immigrants were significantly lower (ranging from 9.2% to 20%) than those of their native-born counterparts for all five preventive care services. These rates further varied by education, income, and length of stay in the US, within the racial and ethnic subgroups. Our findings thus suggest a complex relationship between nativity and racial/ethnic identity in relation to preventive care utilization among adults with overweight/obesity.
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Affiliation(s)
- Biplab Kumar Datta
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Steven S. Coughlin
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Ban Majeed
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Seetharaman S, Matson PA, Trent ME, McCartney Swamy A, Marcell AV. Association of Adolescents' Body Mass Index Classification With Preventive Clinical Care Receipt. J Adolesc Health 2023; 73:1046-1052. [PMID: 37690010 PMCID: PMC10841196 DOI: 10.1016/j.jadohealth.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 05/28/2023] [Accepted: 06/26/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE To examine differences in screening and advising for modifiable risk behaviors during well-visits based on adolescents' body mass index categories. METHODS Retrospective analyses were conducted with the National Institute of Health's NEXT Generation Health Study data, a nationally representative cohort of 10th graders. In wave 1 (2010), adolescents were classified as being underweight (<4.99th percentile), normal-weight (5-84.99th percentile), overweight (85-94.99th percentile), or with obesity (≥95th percentile) based on the body mass index categories described by the Centers for Disease Control and Prevention. In wave 2 (2011), adolescents were asked by their provider about smoking, alcohol use, use of other drugs, sexual activity, nutrition, and exercise, and whether they were advised about risks associated with these behaviors. RESULTS The sample consisted of 1,639 eligible participants as follows: 57.8% females, 63.3% 16-year-olds, 47.8% non-Hispanic Whites, 41.5% living in the South, 75.4% with health insurance, and 29.8% with low family affluence. Screening rates for overweight compared to normal-weight males were 51% reduced for smoking, 46% for alcohol use, 47% for other drug use, 57% for nutrition, and 47% for exercise. Screening rates were 40% reduced for other drug use for males with obesity, and 89% reduced for alcohol use for underweight males compared to normal-weight males. Advice receipt for females with obesity compared to normal-weight females was 90% increased for nutrition and 78% increased for exercise. DISCUSSION Overweight male adolescents reported being less likely to be screened across almost all preventive service topics representing missed opportunities for care delivery.
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Affiliation(s)
- Sujatha Seetharaman
- Division of Pediatric Endocrinology, The Warren Alpert School of Medicine of Brown University, Providence, Rhode Island.
| | - Pamela A Matson
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Maria E Trent
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Annemarie McCartney Swamy
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Arik V Marcell
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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Ebner DW, Burger KN, Broderick B, Mahoney DW, Kellogg TA, Acosta A, Kisiel JB. Positive Predictive Value for Multitarget Stool DNA After Bariatric and Metabolic Surgery. GASTRO HEP ADVANCES 2023; 2:902-910. [PMID: 37876832 PMCID: PMC10597571 DOI: 10.1016/j.gastha.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
BACKGROUND AND AIMS Bariatric and metabolic surgery (BMS) may adversely affect noninvasive stool tests for colorectal cancer (CRC) screening through several mechanisms. Multitarget stool DNA (mt-sDNA) is approved for CRC screening; however, performance in post-BMS patients is unknown. As the rates of BMS are anticipated to increase with rising incidence of obesity, it is important to evaluate mt-sDNA test performance among these patients. METHODS In a multisite academic and community-based practice, we obtained mt-sDNA results from 10/2014 to 12/2019 through electronic records and an institutional BMS registry. Average CRC risk patients with BMS prior to a positive mt-sDNA underwent a detailed chart review. Follow-up colonoscopy findings were compared to those among BMS patients screened with colonoscopy alone and a historical cohort of patients without BMS, screened by mt-sDNA. The primary study endpoint was the positive predictive value (PPV) for advanced colorectal neoplasia. RESULTS Among 336 average-risk patients who had mt-sDNA after BMS, mt-sDNA was positive in 49 (14.6%), 47/49 (96%) underwent follow-up colonoscopy, and the PPV for advanced neoplasia was 12/47 (25.5%). This is similar to the PPV for advanced colorectal neoplasia (425/1542, 28%) in a historical cohort of persons without prior BMS, screened by mt-sDNA at our center (P = .86). Among those who had prior BMS, the rate of advanced neoplasia was higher after mt-sDNA compared to screening colonoscopy alone. CONCLUSION Despite anatomic and physiologic mechanisms that could alter blood or DNA content in stool, BMS does not appear to adversely affect the PPV of mt-sDNA.
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Affiliation(s)
- Derek W. Ebner
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Kelli N. Burger
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Brendan Broderick
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Douglas W. Mahoney
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Todd A. Kellogg
- Division of Endocrine & Metabolic Surgery, Mayo Clinic, Rochester, USA Minnesota
| | - Andres Acosta
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - John B. Kisiel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Samman E, Mkuu R, Zhang X, Scummings S, Burdine J. Body Mass Index and Breast and Cervical Cancer Screening. WOMEN'S HEALTH REPORTS 2022; 3:508-514. [PMID: 35651991 PMCID: PMC9148662 DOI: 10.1089/whr.2021.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/20/2022]
Abstract
Background: Breast and cervical cancer screening are responsible for dramatically reducing cancer deaths. Overweight and obesity are associated with deleterious health outcomes, including increased risk of developing cancer. This study adds to the existing literature examining the association of having overweight and obesity and receipt of breast or cervical cancer screening. Methods: Using the 2013 Brazos Valley Community Health Needs Assessment, we examined the association between body mass index (BMI) and receipt of breast or cervical cancer screening among women meeting age recommendations for breast cancer and cervical cancer screening (n = 1979 and n = 2040), respectively. We used SPSS 22 statistical software for descriptive and logistic regression analysis. Results: Overall, 26.6% of women missed the breast cancer screening guidelines, and 13.3% missed the cervical cancer screening guidelines. BMI had a weak association with missing cervical cancer screenings (odds ratio [OR] = 1.02; confidence interval [CI] = 1.01–1.04), but no association with missing breast cancer screenings (OR = 1.01; CI = 0.99–1.03). Higher age, race (non-White), rural area, no health insurance, smoking, and delayed health care were associated with missing breast cancer screenings. Higher age, marital status (single), lower education, no health insurance, smoking, and delayed health care were associated with missing cervical cancer screening. Further research is needed to better understand the association using larger, more diverse samples.
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Affiliation(s)
- Elfreda Samman
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Rahma Mkuu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida Gainesville, Florida, USA
| | - Xiaoying Zhang
- Department of Health and Kinesiology, College of Education & Human Development, Texas A&M University, USA
| | - Shelby Scummings
- Department of Statistics, College of Science, Texas A&M University, USA
| | - James Burdine
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, Texas, USA
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Hernández-García M, Molina-Barceló A, Vanaclocha-Espi M, Zurriaga Ó, Pérez-Gómez B, Aragonés N, Amiano P, Altzibar JM, Castaño-Vinyals G, Sala M, Ederra M, Martín V, Gómez-Acebo I, Vidal C, Tardón A, Marcos-Gragera R, Pollán M, Kogevinas M, Salas D. Differences in breast cancer-risk factors between screen-detected and non-screen-detected cases (MCC-Spain study). Cancer Causes Control 2021; 33:125-136. [PMID: 34817770 PMCID: PMC8739309 DOI: 10.1007/s10552-021-01511-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 10/15/2021] [Indexed: 12/14/2022]
Abstract
Purpose The variation in breast cancer (BC)-risk factor associations between screen-detected (SD) and non-screen-detected (NSD) tumors has been poorly studied, despite the interest of this aspect in risk assessment and prevention. This study analyzes the differences in breast cancer-risk factor associations according to detection method and tumor phenotype in Spanish women aged between 50 and 69. Methods We examined 900 BC cases and 896 controls aged between 50 and 69, recruited in the multicase–control MCC-Spain study. With regard to the cases, 460 were detected by screening mammography, whereas 144 were diagnosed by other means. By tumor phenotype, 591 were HR+, 153 were HER2+, and 58 were TN. Lifestyle, reproductive factors, family history of BC, and tumor characteristics were analyzed. Logistic regression models were used to compare cases vs. controls and SD vs. NSD cases. Multinomial regression models (controls used as a reference) were adjusted for case analysis according to phenotype and detection method. Results TN was associated with a lower risk of SD BC (OR 0.30 IC 0.10–0.89), as were intermediate (OR 0.18 IC 0.07–0.44) and advanced stages at diagnosis (OR 0.11 IC 0.03–0.34). Nulliparity in postmenopausal women and age at menopause were related to an increased risk of SD BC (OR 1.60 IC 1.08–2.36; OR 1.48 IC 1.09–2.00, respectively). Nulliparity in postmenopausal women was associated with a higher risk of HR+ (OR 1.66 IC 1.15–2.40). Age at menopause was related to a greater risk of HR+ (OR 1.60 IC 1.22–2.11) and HER2+ (OR 1.59 IC 1.03–2.45) tumors. Conclusion Reproductive risk factors are associated with SD BC, as are HR+ tumors. Differences in BC-risk factor associations according to detection method may be related to prevailing phenotypes among categories. Supplementary Information The online version contains supplementary material available at 10.1007/s10552-021-01511-4.
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Affiliation(s)
- Marta Hernández-García
- Cancer and Public Health Area, Foundation for the Promotion of Health and Biomedical Research of Valencia Region(FISABIO), Avda. Catalunya 21, 46020, Valencia, Spain
| | - Ana Molina-Barceló
- Cancer and Public Health Area, Foundation for the Promotion of Health and Biomedical Research of Valencia Region(FISABIO), Avda. Catalunya 21, 46020, Valencia, Spain.
| | - Mercedes Vanaclocha-Espi
- Cancer and Public Health Area, Foundation for the Promotion of Health and Biomedical Research of Valencia Region(FISABIO), Avda. Catalunya 21, 46020, Valencia, Spain
| | - Óscar Zurriaga
- Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine Department, University of Valencia, Avda. Vicent Andrés Estellés, s/n, 46100, Burjassot, Valencia, Spain
- Joint Research Unit on Rare Diseases, FISABIO-UVEG, Avda. Catalunya 21, 46020, Valencia, Spain
- Directorate General of Public Health, Avda. Catalunya 21, 46020, Valencia, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Pérez-Gómez
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Epidemiology of Chronic Diseases, National Center of Epidemiology, Carlos III Health Institute (ISCIII), Avda. Monforte de Lemos 5, 28029, Madrid, Spain
| | - Nuria Aragonés
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Epidemiology Section, Public Health Division, Department of Health of Madrid, C/San Martín de Porres, 6, 28035, Madrid, Spain
| | - Pilar Amiano
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Epidemiology of Chronic and Communicable Diseases Group, Biodonostia Health Research Institute, Doctor Begiristain, s/n, 20014, San Sebastián, Spain
- Sub Directorate for Public Health and Addictions of Gipuzkoa, Ministry of Health of the Basque Government, 2013, San Sebastian, Spain
| | - Jone M Altzibar
- Epidemiology of Chronic and Communicable Diseases Group, Biodonostia Health Research Institute, Doctor Begiristain, s/n, 20014, San Sebastián, Spain
- ISGlobal, Barcelona Institute for Global Health, Doctor Aiguader 88, 08003, Barcelona, Spain
| | - Gemma Castaño-Vinyals
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- ISGlobal, Barcelona Institute for Global Health, Doctor Aiguader 88, 08003, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Doctor Aiguader 88, 08003, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10-12, 08002, Barcelona, Spain
| | - María Sala
- IMIM (Hospital del Mar Medical Research Institute), Doctor Aiguader 88, 08003, Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - María Ederra
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Navarra Public Health Institute, C/ Leyre, 15, 31003, Navarra, Spain
- IdiSNA, Navarra Institute for Health Research, C/Irunlarrea, 3, 31008, Pamplona, Spain
| | - Vicente Martín
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- The Research Group in Gene - Environment and Health Interactions (GIIGAS), Biomedicine Institute (IBIOMED), University of León, Vegazana Campus, s/n, 24071, León, Spain
| | - Inés Gómez-Acebo
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Cantabria University- IDIVAL, C/Cardenal Herrera Oria, s/n, Santander, 39011, Cantabria, Spain
| | - Carmen Vidal
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Cancer Screening Unit, Catalan Institute of Oncology, Duran I Reynals Hospital, Avda. de La Gran Via de L'Hospitalet, 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Early Detection of Cancer Research Group, EPIBELL Program, Bellvitge Biomedical Research Institute, Avda. de La Granvia de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Adonina Tardón
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Oncology Institute (IUOPA), University of Oviedo, Edificio Santiago Gascón, Campus El Cristo B, 33006, Oviedo, Spain
| | - Rafael Marcos-Gragera
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology. Sant Ponç, Avda de França, 0, 17007, Girona, Spain
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, [Girona Biomedical Research Institute] IDIBGI, C/ del Dr. Castany, s/n, Salt, 17190, Girona, Spain
| | - Marina Pollán
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- National Center of Epidemiology Directorate, Carlos III Health Institute (ISCIII), Avda. Monforte de Lemos 5, 28029, Madrid, Spain
| | - Manolis Kogevinas
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- ISGlobal, Barcelona Institute for Global Health, Doctor Aiguader 88, 08003, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Doctor Aiguader 88, 08003, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10-12, 08002, Barcelona, Spain
| | - Dolores Salas
- Cancer and Public Health Area, Foundation for the Promotion of Health and Biomedical Research of Valencia Region(FISABIO), Avda. Catalunya 21, 46020, Valencia, Spain
- Directorate General of Public Health, Avda. Catalunya 21, 46020, Valencia, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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Cho G, Chang VW. Obesity and the Receipt of Prescription Pain Medications in the US. J Gen Intern Med 2021; 36:2631-2638. [PMID: 33555551 PMCID: PMC8390709 DOI: 10.1007/s11606-020-06581-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/29/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Little is known about disparities in pain treatment associated with weight status despite prior research on weight-based discrepancies in other realms of healthcare and stigma among clinicians. OBJECTIVE To investigate the association between weight status and the receipt of prescription analgesics in a nationally representative sample of adults with back pain, adjusting for the burden of pain. DESIGN Cross-sectional analyses using the Medical Expenditure Panel Survey (2010-2017). PARTICIPANTS Five thousand seven hundred ninety-one civilian adults age ≥ 18 with back pain. MAIN MEASURES We examine the odds of receiving prescription analgesics for back pain by weight status using logistic regression. We study the odds of receiving (1) any pain prescription, (2) three pain prescription categories (opioid only, non-opioid only, the combination of both), and (3) opioids conditional on having a pain prescription. KEY RESULTS The odds of receiving pain prescriptions increase monotonically across weight categories, when going from normal weight to obesity II/III, despite adjustments for the burden of pain. Relative to normal weight, higher odds of receiving any pain prescription is associated with obesity I (OR = 1.30 [95% CI = 1.04-1.63]) and obesity II/III (OR = 1.72 [95% CI = 1.36-2.18]). Obesity II/III is also associated with higher odds of receiving opioids only (OR = 1.53 [95% CI = 1.16-2.02]), non-opioids only (OR = 1.77 [95% CI = 1.21-2.60]), and a combination of both (OR = 2.48 [95% CI = 1.44-4.29]). Obesity I is associated with increased receipt of non-opioids only (OR = 1.55 [95% CI = 1.07-2.23]). Conditional on having a pain prescription, the odds of receiving opioids are comparable across weight categories. CONCLUSIONS This study suggests that, relative to those with normal weight, adults with obesity are more likely to receive prescription analgesics for back pain, despite adjustments of the burden of pain. Hence, the possibility of weight-based undertreatment is not supported. These findings are reassuring because individuals with obesity generally experience a higher prevalence of back pain. The possibility of over-treatment associated with obesity, however, may warrant further investigation.
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Affiliation(s)
- Gawon Cho
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Virginia W Chang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA. .,Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA.
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Charkhchi P, Schabath MB, Carlos RC. Breast, Cervical, and Colorectal Cancer Screening Adherence: Effect of Low Body Mass Index in Women. J Womens Health (Larchmt) 2020; 29:996-1006. [PMID: 31928405 DOI: 10.1089/jwh.2019.7739] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Purpose: Health-related behaviors among underweight women have received less attention than overweight and obese women in the United States. Our purposes were to estimate the rate and modifiers of breast, cervical, and colorectal cancer screening adherence among underweight women and compare it to other body mass index (BMI) categories. Materials and Methods: We used sampling weighted data from 2016 Behavioral Risk Factor Surveillance System (BRFSS) of age-eligible women (breast cancer screening, n = 163,164; cervical, n = 113,883 and colorectal, n = 128,287). We defined breast, cervical, and colorectal cancer screening using the US Preventive Services Task Force (USPSTF) guidelines. We calculated the prevalence of screening among four BMI categories (underweight <18.5, normal weight ≥18.5 to <25, overweight ≥25 to <30, and obese ≥30). Logistic regression models assessed the independent effect of BMI on screening adherence. Results: Underweight women had significantly lower breast (62.9%), cervical (67.5%), and colorectal (62.6%) cancer screening rates compared to other BMI categories. In logistic regression models, being underweight was associated with decreased odds of breast (odds ratio [OR] = 0.66; 95% confidence interval [CI] = 0.49-0.88) and cervical (OR = 0.54, 95% CI = 0.34-0.84), but not colorectal (OR = 0.88; 95% CI = 0.66-1.18) cancer screening adherence. We did not demonstrate a significant association between obesity and screening rates for any of the three cancers. Underweight women reported higher rates of smoking and lower levels of educational attainment, income, and insurance coverage compared to all other groups. Higher rates of chronic illness and health access hardship were observed among underweight women. Conclusion: BMI variably affects cancer screening. Compared to normal-weight women, being underweight is associated with breast and cervical cancer screening nonadherence. Promoting breast and cervical cancer screening among this currently underserved population may reduce future disparities.
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Affiliation(s)
- Paniz Charkhchi
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Ruth C Carlos
- Department of Radiology, University of Michigan, Ann Arbor, Michigan.,Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan
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Miles RC, Lehman CD, Mercaldo SF, Tamimi RM, Dontchos BN, Narayan AK. Obesity and breast cancer screening: Cross-sectional survey results from the behavioral risk factor surveillance system. Cancer 2019; 125:4158-4163. [PMID: 31393609 DOI: 10.1002/cncr.32430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/17/2019] [Accepted: 07/07/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Postmenopausal obese women demonstrate an elevated breast cancer risk and experience increased breast cancer morbidity and mortality compared with women with a normal body mass index (BMI). However, to the authors' knowledge, prior studies have yielded inconclusive results regarding the effects of obesity on mammography screening adherence. Using national cross-sectional survey data, the objective of the current study was to assess the current association between increasing BMI and use of mammography screening. METHODS Cross-sectional survey data from the 2016 Behavioral Risk Factor Surveillance System, a state-based national telephone survey of noninstitutionalized adults in the United States, was used to identify the association between mammography screening use and increasing incremental BMI categories, including normal (18.5-24.9 kg/m2 ), overweight (25-29.9 kg/m2 ), obese class I (30-34.9 kg/m2 ), obese class II (35-39.9 kg/m2 ), and obese class III (>40 kg/m2 ), with adjustments for potential confounders. A multivariable logistic regression model was used to evaluate the effect of each BMI category on self-reported mammography use, using unadjusted and adjusted odds ratios. Effect modification by race/ethnicity was determined by testing interaction terms using Wald tests. RESULTS Of 116,343 survey respondents, 33.5% (38,984 respondents) had a normal BMI, 32.6% (37,969 respondents) were overweight, 19.3% (22,416 respondents) were classified as obese class I, 8.4% (9791 respondents) were classified as obese class II, and 6.2% (7183 respondents) were classified as obese class III. There was no statistically significant difference (P < .05) observed with regard to mammography use between women with a normal BMI and obese women from each obese class (classes I-III) when compared individually. There also was no evidence of effect modification by race (P = .53). CONCLUSIONS In contrast to prior reports, the results of the current study demonstrated no association between obesity and adherence to screening mammography. These findings may relate to the increasing social acceptance of obesity among women from all racial/ethnic groups and the removal of weight-related facility-level barriers over time.
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Affiliation(s)
- Randy C Miles
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Constance D Lehman
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sarah F Mercaldo
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Rulla M Tamimi
- Channing Institute, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Brian N Dontchos
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anand K Narayan
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Eisenberg D, Noria S, Grover B, Goodpaster K, Rogers AM. ASMBS position statement on weight bias and stigma. Surg Obes Relat Dis 2019; 15:814-821. [DOI: 10.1016/j.soard.2019.04.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 04/27/2019] [Indexed: 12/14/2022]
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Heerman WJ, Bennett WL, Kraschnewski JL, Nauman E, Staiano AE, Wallston KA. Willingness to participate in weight-related research as reported by patients in PCORnet clinical data research networks. BMC OBESITY 2018; 5:10. [PMID: 29507737 PMCID: PMC5831204 DOI: 10.1186/s40608-018-0187-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 02/23/2018] [Indexed: 11/19/2022]
Abstract
Background Since 2014 the Patient Centered Outcomes Research Institute (PCORI) has funded 13 Clinical Data Research Networks (CDRNs) around the country to support large-scale comparative effectiveness research and pragmatic clinical trials. To provide guidance for future recruitment efforts among CDRNs this study described differential willingness to participate in weight-related research by body mass index (BMI) and sociodemographic characteristics. Methods During 2014–2016 we surveyed participants from three CDRNs including the Mid-South CDRN, REACHnet, and the PaTH Network, representing 14 medical centers. Participants were eligible if they were ≥18 years, had ≥2 weights and ≥1 height in the electronic health record. Respondents were recruited face-to-face in primary care and specialty clinics, and via email from doctors’ offices, patient registries and health systems’ patient portals. Data was collected on willingness to participate in weight-related research (four items combined into a single scale; range 4–12), BMI, and sociodemographics (age, sex, number of people in household, marital status, education level, race, and ethnicity). Adjusted ordinal regression models tested associations between participant characteristics and willingness to participate in weight-related research. Results Among 11,624 respondents, mean BMI was 29.6 (SD 7.6) kg/m2. Mean willingness to participate in weight-related research was 7.1 (SD 2.5). More respondents were willing to participate in studies with lower burden: healthy lifestyles (82.2%), genetics (71.3%), medication (52.2%), and surgery (22.6%). In adjusted models, higher BMI was associated with greater willingness to participate in weight-related research (OR = 1.13) as were younger age (OR = 0.98), being a woman (OR 1.59), and college education (OR = 1.72) (all p < 0.001). Conclusions Associations among BMI, age, sex, and education level with willingness to participate in weight-related research highlight the need for future research to reduce barriers for populations less willing to engage in weight-related research.
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Affiliation(s)
- William J Heerman
- 1Vanderbilt University Medical Center, 2146 Belcourt Ave, 2nd Floor, Nashville, TN 37212 USA
| | - Wendy L Bennett
- 2The Johns Hopkins University School of Medicine, Baltimore, MD USA
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Seibert RG, Hanchate AD, Berz JP, Schroy PC. National Disparities in Colorectal Cancer Screening Among Obese Adults. Am J Prev Med 2017; 53:e41-e49. [PMID: 28236517 DOI: 10.1016/j.amepre.2017.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/17/2016] [Accepted: 01/05/2017] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Obesity is a major risk factor for colorectal cancer (CRC), particularly among men. The purpose of this study was to characterize the prevalence of guideline-adherent CRC screening among obese adults using nationally representative data, assess trends in screening strategies, and identify obesity-specific screening barriers. METHODS Data from 8,550 respondents aged 50-75 years in the 2010 National Health Interview Survey, representing >70 million adults, were analyzed in 2015 using multivariable logistic regression. Prevalence of guideline-adherent CRC screening, endoscopic versus fecal occult blood test screening, and reasons for non-adherence were compared across BMI categories. RESULTS Obese class III men (BMI ≥40), compared with normal-weight men, were significantly less likely to be adherent to screening guidelines (38.7% vs 55.8%, AOR=0.35, 95% CI=0.17, 0.75); less likely to have used an endoscopic test (36.7% vs 53.0%, AOR=0.37, 95% CI=0.18, 0.79); and had a trend toward lower fecal occult blood test use (4.2% vs 8.9%, AOR=0.42, 95% CI=0.14, 1.27). Among women, odds of guideline adherence and use of different screening modalities were similar across all BMI categories. Reasons for non-adherence differed by gender and BMI; lacking a physician screening recommendation differed significantly among men (29.7% obese class III vs 15.4% non-obese, p=0.04), and pain/embarrassment differed significantly among women (11.6% obese class III vs 2.6% non-obese, p=0.002). CONCLUSIONS Despite elevated risk, severely obese men were significantly under-screened for CRC. Addressing the unique screening barriers of obese adults may promote screening uptake and lessen disparities among the vulnerable populations most affected by obesity.
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Affiliation(s)
- Ryan G Seibert
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts.
| | - Amresh D Hanchate
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts; VA Boston Healthcare System, Boston, Massachusetts
| | - Jonathan P Berz
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Paul C Schroy
- Section of Gastroenterology, Boston University School of Medicine, Boston, Massachusetts
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Stock D, Paszat LF, Rabeneck L. Colorectal cancer mortality reduction is associated with having at least 1 colonoscopy within the previous 10 years among a population-wide cohort of screening age. Gastrointest Endosc 2016; 84:133-41. [PMID: 26769406 DOI: 10.1016/j.gie.2015.12.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 12/30/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Colonoscopy has been demonstrated to be effective in colorectal cancer (CRC) mortality reduction, although current screening guidelines have yet to be evaluated. We assessed the protective benefit of colonoscopy within the previous 10 years and whether this effect is maintained with age. METHODS We used administrative data to compare risk of CRC death (CCD) across colonoscopy utilization among a population-wide cohort comprising individuals aged 60 to 80 years (N = 1,509,423). Baseline and time-dependent colonoscopy exposure models were assessed in the context of competing "other causes of death" (OCDs). Cumulative incidence of CCD and OCD across colonoscopy exposure, over follow-up, was estimated. Relative hazards were computed by age strata (60-69 years, 70-74 years, 75+ years) and proximal and distal cancer subsites. RESULTS At least 1 colonoscopy during 10 years before baseline was estimated to provide a 51% reduced hazard of CCD (hazard ratio [HR] 0.49; 95% confidence interval [CI], 0.45-0.54) over the following 8 years. When colonoscopy was modeled as a time-dependent covariate, the risk of CCD was further diminished (multivariable-adjusted HR 0.36; 95% CI, 0.33-0.38). Stratified analyses suggested moderately attenuated CCD risk reduction among the oldest age group; however, consideration of OCDs suggest that this is related to competing risks. CCD risk reduction related to colonoscopy was lower for proximal cancers. CONCLUSIONS Colonoscopy within the previous 10 years provides substantial protective benefit for average-risk individuals over 60 years. CCD risk reduction may be maintained well beyond 74 years, a common upper age limit recommended by screening guidelines.
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Affiliation(s)
- David Stock
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Lawrence F Paszat
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Linda Rabeneck
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Cancer Care Ontario, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Clark LH, Jackson AL, Soo AE, Orrey DC, Gehrig PA, Kim KH. Extremes in body mass index affect overall survival in women with cervical cancer. Gynecol Oncol 2016; 141:497-500. [DOI: 10.1016/j.ygyno.2016.03.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/23/2016] [Accepted: 03/26/2016] [Indexed: 10/21/2022]
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Harris JA, Moniz MH, Iott B, Power R, Griggs JJ. Obesity and the receipt of influenza and pneumococcal vaccination: a systematic review and meta-analysis. BMC OBESITY 2016; 3:24. [PMID: 27200179 PMCID: PMC4855336 DOI: 10.1186/s40608-016-0105-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/28/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Obesity is a risk factor for inadequate receipt of recommended preventive care services. The objective of this study was to assess the relationship between increasing body mass index and receipt of influenza and pneumococcal vaccinations. A systematic review of the PubMed, Embase, and Web of Science databases was conducted from January 1966 to May 2015 for cohort and cross-sectional studies that assessed the relationship between body mass index and the receipt of vaccinations for influenza and pneumococcus. Separate meta-analyses by obesity classification were performed using a random effects model. RESULTS Six cross-sectional and three cohort studies were included. Average vaccine uptake was 50.4 % for influenza vaccination and 34.6 % for pneumococcal vaccination. Compared to normal weight patients, combined odds ratio (95 % confidence interval) for influenza vaccination was 1.11 (95 % CI 0.97-1.25) for obese (≥30 kg/m(2)) patients. When the outcome was reported by obesity class, combined odds ratios of influenza vaccination were 1.13 (95 % CI 1.02-1.24) for Class I (30-34.9 kg/m(2)) obesity, 1.21 (95 % CI 1.05-1.37) for Class II obesity (35-39.9 kg/m(2)), and 1.19 (95 % CI 0.95-1.42) for Class III obesity (≥40 kg/m(2)) patients. Compared to normal weight patients, combined odds ratio of pneumococcal vaccination were 1.20 (95 % CI 1.13-1.27) for obese patients. When the outcome was reported by obesity class, combined odds ratios were 1.08 (95 % CI 1.04-1.13) for Class I obesity patients, 1.13 (95 % CI 1.10-1.16) for Class II obesity patients, and 1.26 (95 % CI 1.15-1.38) for Class III obesity patients for pneumococcal vaccination. CONCLUSIONS Combined findings from the current literature suggest that adults with obesity are more likely than non-obese peers to receive vaccination for influenza and pneumococcus. However, suboptimal vaccination coverage was observed across all body sizes, so future interventions should focus on improving vaccination rates for all adults.
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Affiliation(s)
- John A Harris
- Department of Obstetrics and Gynecology, University of Michigan, 2800 Plymouth Road, Building #10 Room G016, Ann Arbor, MI 48109-2800 USA
| | - Michelle H Moniz
- Department of Obstetrics and Gynecology, University of Michigan, 2800 Plymouth Road, Building #10 Room G016, Ann Arbor, MI 48109-2800 USA
| | - Brad Iott
- Division of General Internal Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Building #10 Room G016, Ann Arbor, MI 48109-2800 USA
| | - Robyn Power
- Division of General Internal Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Building #10 Room G016, Ann Arbor, MI 48109-2800 USA
| | - Jennifer J Griggs
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, 2800 Plymouth Rd, Building 16 Room 400S, Ann Arbor, MI 48109-2800 USA
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15
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Association Between Obesity During Pregnancy and the Adequacy of Prenatal Care. Matern Child Health J 2015; 20:158-163. [DOI: 10.1007/s10995-015-1815-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Linardakis M, Papadaki A, Smpokos E, Micheli K, Vozikaki M, Philalithis A. Relationship of behavioral risk factors for chronic diseases and preventive health services utilization among adults, aged 50+, from eleven European countries. J Public Health (Oxf) 2015. [DOI: 10.1007/s10389-015-0683-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Association between self-reported depression and screening colonoscopy participation. J Ambul Care Manage 2015; 36:345-55. [PMID: 24402077 DOI: 10.1097/jac.0b013e3182a3e73f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The impact of depression on participation in screening colonoscopy is poorly characterized. This study attempts to understand this relationship by conducting a cross-sectional analysis on a nationally representative sample of adults aged 50 to 75 years without a history of colorectal cancer or inflammatory bowel disease from the 2009 Medical Expenditures Panel Survey. Multivariable analysis shows that the odds of having a current colonoscopy is 1.3 times higher for individuals with depression compared with those without depression (odds ratio = 1.3; 95% confidence interval = 1.1-1.7). These findings suggest that depression may not be a risk factor for underutilization of CRC screening.
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Bean-Mayberry B, Bastian L, Trentalange M, Murphy TE, Skanderson M, Allore H, Reyes-Harvey E, Maisel NC, Gaetano V, Wright S, Haskell S, Brandt C. Associations between provider designation and female-specific cancer screening in women Veterans. Med Care 2015; 53:S47-54. [PMID: 25767975 PMCID: PMC5477654 DOI: 10.1097/mlr.0000000000000323] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In 2010, the Department of Veterans Affairs Healthcare System (VA) implemented policy to provide Comprehensive Primary Care (for acute, chronic, and female-specific care) from designated Women's Health providers (DWHPs) at all VA sites. However, since that time no comparisons of quality measures have been available to assess the level of care for women Veterans assigned to these providers. OBJECTIVES To evaluate the associations between cervical and breast cancer screening rates among age-appropriate women Veterans and designation of primary-care provider (DWHP vs. non-DWHP). RESEARCH DESIGN Cross-sectional analyses using the fiscal year 2012 data on VA women's health providers, administrative files, and patient-specific quality measures. SUBJECTS The sample included 37,128 women Veterans aged 21 through 69 years. MEASURES Variables included patient demographic and clinical factors (ie, age, race, ethnicity, mental health diagnoses, obesity, and site), and provider factors (ie, DWHP status, sex, and panel size). Screening measures were defined by age-appropriate subgroups using VA national guidelines. RESULTS Female-specific cancer screening rates were higher among patients assigned to DWHPs (cervical cytology 94.4% vs. 91.9%, P<0.0001; mammography 86.3% vs. 83.3%, P<0.0001). In multivariable models with adjustment for patient and provider characteristics, patients assigned to DWHPs had higher odds of cervical cancer screening (odds ratio, 1.26; 95% confidence interval, 1.07-1.47; P<0.0001) and breast cancer screening (odds ratio, 1.24; 95% CI, 1.10-1.39; P<0.0001). CONCLUSIONS As the proportion of women Veterans increases, assignment to DWHPs may raise rate of female-specific cancer screening within VA. Separate evaluation of sex neutral measures is needed to determine whether other measures accrue benefits for patients with DWHPs.
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Affiliation(s)
- Bevanne Bean-Mayberry
- VA Greater Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Lori Bastian
- VA Connecticut Healthcare System, West Haven
- Department of Internal Medicine, University of Connecticut Health Center, Farmington
| | - Mark Trentalange
- Department of Internal Medicine, School of Medicine, New Haven, CT
| | | | | | - Heather Allore
- Department of Internal Medicine, School of Medicine, New Haven, CT
| | | | - Natalya C. Maisel
- VA Palo Alto Health Care System, HSR&D Center for Innovation to Implementation (Ci2i), Palo Alto, CA
| | - Vera Gaetano
- VA Connecticut HSR&D Pain, Research, Informatics, Multimorbidities, and Education (Prime) Center, West Haven, CT
| | - Steven Wright
- Office of Analytics & Business Intelligence (10P2B), Durham, NC
| | - Sally Haskell
- VA Connecticut Healthcare System, West Haven
- Department of Internal Medicine, School of Medicine, New Haven, CT
- Women’s Health Services, Patient Care Services, VA Central Office, Washington, DC
| | - Cynthia Brandt
- VA Connecticut Healthcare System, West Haven
- Yale University School of Medicine, Yale Center for Medical Informatics, West Haven, CT
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Ricardo-Rodrigues I, Jiménez-García R, Hernández-Barrera V, Carrasco-Garrido P, Jiménez-Trujillo I, López de Andrés A. Social disparities in access to breast and cervical cancer screening by women living in Spain. Public Health 2015; 129:881-8. [PMID: 25818014 DOI: 10.1016/j.puhe.2015.02.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 12/07/2014] [Accepted: 02/15/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To describe uptake of breast and cervical cancer screening by women living in Spain, analyse the possible associated social and health factors, and compare uptake rates with those obtained in previous surveys. STUDY DESIGN Cross-sectional study using data from the 2011 Spanish national health survey. METHODS Uptake of breast cancer screening was analysed by asking women aged 40-69 years whether they had undergone mammography in the previous two years. Uptake of cervical cancer screening was analysed by asking women aged 25-65 years whether they had undergone cervical cytology in the previous three years. Independent variables included sociodemographic characteristics, and variables related to health status and lifestyle. RESULTS Seventy-two percent of women had undergone mammography in the previous two years. Having private health insurance increased the probability of breast screening uptake four-fold [odds ratio (OR) 3.96, 95% confidence interval (CI) 2.71-5.79], and being an immigrant was a negative predictor for breast screening uptake. Seventy percent of women had undergone cervical cytology in the previous three years. Higher-educated women were more likely to have undergone cervical cancer screening (OR 2.59, 95% CI 1.97-3.40), and obese women and women living in rural areas were less likely to have undergone cervical cancer screening. There have been no relevant improvements in uptake rates of either breast or cervical cancer screening since 2006. CONCLUSION Uptake of breast and cervical cancer screening could be improved in Spain, and uptake rates have stagnated over recent years. Social disparities have been detected with regard to access to these screening tests, indicating that it is necessary to continue researching and optimizing prevention programmes in order to improve uptake and reduce these disparities.
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Affiliation(s)
- I Ricardo-Rodrigues
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcórcon, Spain
| | - R Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcórcon, Spain.
| | - V Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcórcon, Spain
| | - P Carrasco-Garrido
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcórcon, Spain
| | - I Jiménez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcórcon, Spain
| | - A López de Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcórcon, Spain
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Pool AC, Kraschnewski JL, Cover LA, Lehman EB, Stuckey HL, Hwang KO, Pollak KI, Sciamanna CN. The impact of physician weight discussion on weight loss in US adults. Obes Res Clin Pract 2015; 8:e131-9. [PMID: 24743008 DOI: 10.1016/j.orcp.2013.03.003] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 02/01/2013] [Accepted: 03/19/2013] [Indexed: 11/19/2022]
Abstract
PROBLEM The increasing prevalence of overweight and obesity in the United States and worldwide is at epidemic levels. Physicians may play a vital role in addressing this epidemic. We aimed to examine the association of a physician's discussion of patients’ weight status with self-reported weight loss. We hypothesized that physician discussion of patients’ being overweight is associated with increased weight loss in patients with overweight and obesity. METHODS Data analysis of participants (n = 5054) in the National Health and Nutritional Examination Survey (NHANES) in 2005-2008. The main outcome was rates of self-reported weight loss and the association with physicians’ discussion of their patients’ weight status. RESULTS Overweight and obese participants were significantly more likely to report a 5% weight loss in the past year if their doctor had told them they were overweight (adjusted OR (AOR) 1.88; 95% CI 1.45-2.44; AOR 1.79; 95% CI 1.30-2.46, respectively). CONCLUSIONS Physicians’ direct discussion of their patients’ weight status is associated with clinically significant patient weight loss and may be a targetable intervention. Further studies are needed to determine if increasing physician discussion of patients’ weight status leads to significant weight loss.
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Affiliation(s)
- Andrew C Pool
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Jennifer L Kraschnewski
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Lindsay A Cover
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Erik B Lehman
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Heather L Stuckey
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Kevin O Hwang
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Kathryn I Pollak
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Christopher N Sciamanna
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
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Kuperman EF, Tobin K, Kraschnewski JL. Comparing Resident Self-Report to Chart Audits for Quality Improvement Projects: Accurate Reflection or Cherry-Picking? J Grad Med Educ 2014; 6:675-9. [PMID: 26140117 PMCID: PMC4477561 DOI: 10.4300/jgme-d-13-00371.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 04/28/2014] [Accepted: 06/23/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Resident engagement in quality improvement is a requirement for graduate medical education, but the optimal means of instruction and evaluation of resident progress remain unknown. OBJECTIVE To determine the accuracy of self-reported chart audits in measuring resident adherence to primary care clinical practice guidelines. METHODS During the 2010-2011 academic year, second- and third-year internal medicine residents at a single, university hospital-based program performed chart audits on 10 patients from their primary care clinic to determine adherence to 16 US Preventive Services Task Force primary care guidelines. We compared residents' responses to independent audits of randomly selected patient charts by a single external reviewer. RESULTS Self-reported data were collected by 18 second-year and 15 third-year residents for 330 patients. Independently, 70 patient charts were randomly selected for review by an external auditor. Overall guideline compliance was significantly higher on self-reported audits compared to external audits (82% versus 68%, P < .001). Of 16 guidelines, external audits found significantly lower rates of adherence for 5 (tetanus vaccination, osteoporosis screening, colon cancer screening, cholesterol screening, and obesity screening). Chlamydia screening was more common in audited charts than in self-reported data. Although third-year residents self-reported higher guideline adherence than second-year residents (86% versus 78%, P < .001), external audits for third-year residents found lower overall adherence (64% versus 72%, P = .040). CONCLUSIONS Residents' self-reported chart audits may significantly overestimate guideline adherence. Increased supervision and independent review appear necessary to accurately evaluate resident performance.
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Callegari LS, Nelson KM, Arterburn DE, Prager SW, Schiff MA, Schwarz EB. Factors associated with lack of effective contraception among obese women in the United States. Contraception 2014; 90:265-71. [DOI: 10.1016/j.contraception.2014.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 04/29/2014] [Accepted: 05/01/2014] [Indexed: 12/30/2022]
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Gutiérrez Angulo ML, Amenabar Azurmendi MD, Cuesta Solé ML, Prieto Esteban I, Mancebo Martínez S, Iglesias Alonso A. Prevalence of obesity recorded in Primary Care. ACTA ACUST UNITED AC 2014; 61:469-73. [PMID: 24846816 DOI: 10.1016/j.endonu.2014.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 03/28/2014] [Accepted: 03/31/2014] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To ascertain the prevalence of obesity and overweight recording in primary care (PC) clinical records. DESIGN A descriptive, cross-sectional study. SETTING The study was conducted in three urban, primary care centers in Gipuzkoa. PARTICIPANTS 620 computerized clinical records randomly selected from a population of 63,820. Patient age older than 14 years was the only inclusion criterion. MAIN MEASUREMENTS Recording of the clinical episode referring to obesity and/or overweight. Other variables included age, sex, body mass index (BMI), waist circumference, comorbidity (diabetes, hypertension, heart failure, among others), and variability of the record made by healthcre professionals at each center. Statistical analysis included a Chi-square test or a Fisher's test for low frequencies. A value of P<.05 was considered significant. Analysis was performed using SPSS(®) v.21 software. RESULTS Prevalence of recorded obesity was 6%, and 78.4% of those with recorded obesity were women. Overweight was recorded in 3% of subjects, of which 33.2% were women. BMI was recorded in 170 cases (27%). At least one comorbidity was found in 241 subjects (39%). Association of BMI with presence of comorbidity was statistically significant (P=.0001). Recording of obesity was associated to presence of comorbidity (P =.0002). CONCLUSIONS This study confirmed that prevalence of obesity is underestimated, mainly because it is inadequately recorded in clinical histories; that prevalence increases in the presence of other risk factors; and that there is a significant variability in data collection between healthcare professionals.
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Affiliation(s)
| | | | | | - Irene Prieto Esteban
- Atención Primaria, Centro de Salud Gros, Osakidetza, San Sebastián, Gipuzkoa, España
| | - Sara Mancebo Martínez
- Atención Primaria, Centro de Salud Gros, Osakidetza, San Sebastián, Gipuzkoa, España
| | - Amparo Iglesias Alonso
- Atención Primaria, Centro de Salud Beraun-Errentería, Osakidetza, Errenteria, Gipuzkoa, España
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Obese older adults report high satisfaction and positive experiences with care. BMC Health Serv Res 2014; 14:220. [PMID: 24885429 PMCID: PMC4052349 DOI: 10.1186/1472-6963-14-220] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 05/13/2014] [Indexed: 11/10/2022] Open
Abstract
Background Obese, older adults often have multiple chronic conditions resulting in multiple health care encounters. However, their satisfaction and experiences with care are not well understood. The objective of this study was to examine the independent impact of obesity on patient satisfaction and experiences with care in adults 65 years of age and older with Medigap insurance. Methods Surveys were mailed to 53,286 randomly chosen adults with an AARP® Medicare Supplement Insurance Plan insured by UnitedHealthcare Insurance Company (for New York residents, UnitedHealthcare Insurance Company of New York) in 10 states. Following adjustment for non-response bias, multivariate regression modeling was used to adjust for demographic, socioeconomic and health status differences to estimate the independent impact of weight on satisfaction and experiences with care. Outcome variables included four global and four composite measures of satisfaction and experiences with care. Results 21.4% of the respondents were obese. Relative to normal weight, obesity was significantly associated with higher patient satisfaction and better experiences with care in seven of the eight ratings measured. Conclusions Obese individuals were more satisfied and had better experiences with care. Obese individuals had more office visits and discussions about nutrition, exercise and medical checks. This may have led to increased attentiveness to care, explaining the increase in satisfaction and better experiences with care. Given the high level of satisfaction and experiences with care in older, obese adults, opportunities exist for clinicians to address weight concerns in this population.
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Federman DG, Pitkin P, Carbone V, Concato J, Kravetz JD. Screening for prostate cancer: are digital rectal examinations being performed? Hosp Pract (1995) 2014; 42:103-107. [PMID: 24769789 DOI: 10.3810/hp.2014.04.1108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Prostate cancer is common and prostate cancer screening is controversial; this retrospective observational study was conducted to determine the prevalence of digital rectal examination (DRE) in those in whom a prostate-specific antigen (PSA) test was performed. METHODS A manual review was performed of the electronic medical record for male veterans in the VA Connecticut Healthcare System without a history of known prostate cancer aged between 50 and 74 years who underwent PSA testing. MAIN OUTCOMES Documentation of DRE (or refusal) within 12 months before or after the performance of a PSA test. RESULTS Less than half (47.6%) of patients underwent DRE. An additional 6.9% were offered DRE and refused. Although the provider gender was not associated with DRE, resident physicians were less likely to perform DRE than nonresidents; P = 0.01. Patients whose PSA was > 4.0 ng/mL were more likely to undergo DRE than those whose PSA was ≤ 4.0 ng/mL; P = 0.002. Those with body mass index (BMI) > 40 kg/m 2 were less likely to undergo DRE than those with BMI < 30 kg/m 2 ; P = 0.04. CONCLUSIONS Screening for prostate cancer remains controversial. We found a low rate of DRE among veterans in whom prostate cancer screening was entertained. Although the provider gender does not seem to influence DRE, resident physicians were less likely to perform DRE than other providers. Our finding that BMI > 40 kg/m 2 is associated with a lower rate of DRE than those with BMI < 30 kg/m 2 is consistent with screening for other cancers and should be explored further.
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Affiliation(s)
- Daniel G Federman
- VA Connecticut Healthcare System, West Haven, CT, and Yale University School of Medicine, New Haven, CT.
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Abstract
Mobile mammography services are typically offered as a means to increase access and adherence to mammography screenings. As mobile mammography becomes a viable strategy to increase screening, a 3 year study of such a state-wide program in WV found surprisingly high rates of obesity within the study population. Thus, the objectives were to: (1) describe the demographic characteristics and comorbidities of women who utilized the WV program, and (2) determine the association between body mass index (BMI) and personal health and screening history, preventive care and wellness behaviors, nutrition and exercise behaviors, and demographics. Data collected from 1,099 women, age 40 and above, were analyzed using descriptive statistics, bivariate analyses, and a multivariate regression model. The majority (60.4 %) were married, had an income <$25,000 (59.2 %), and had health insurance (53.5 %). Major comorbidities were hypertension (49 %) and high cholesterol (43.9 %). Based on BMI scores, 884 participants were either overweight (26.6 %), mildly obese (27.7 %), moderately obese (15.1 %), or severely obese (11.1 %). Bivariate analyses indicated that increasing BMI was significantly associated with factors such as having hypertension or diabetes, limited daily activities, perceived health, and not smoking or drinking. The regression model was significant (p < 0.001; R2 = 0.425) indicating that women who engaged in preventive care behaviors were less likely to be obese than those who did not. The WV mobile mammography program appeared to attract women who were disproportionately obese and had multiple comorbidities, thus providing a great opportunity for targeted interventions related to improving preventive care and screening behaviors.
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Kraschnewski JL, McCall-Hosenfeld JS, Weisman CS. Prospective association between body mass index and receipt of preventive services: results from the Central Pennsylvania Women's Health Study (CePAWHS). Prev Med 2012; 54:302-5. [PMID: 22391575 PMCID: PMC3345091 DOI: 10.1016/j.ypmed.2012.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 02/16/2012] [Accepted: 02/17/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We examine whether overweight and obesity are associated with disparities in clinical preventive services receipt in a unique, prospective, population-based cohort of reproductive-age women. METHOD We used data from the Central Pennsylvania Women's Health Study (CePAWHS) longitudinal survey of women ages 18-45. The baseline random-digit-dial telephone survey was conducted in 2004-2005 and a second telephone interview two years later; 1342 participants comprised the analytic sample. Dependent variables were seven preventive services identified at follow-up. In addition to baseline body mass index (BMI) category, independent variables were selected based on the behavioral model of health services utilization. RESULTS Forty-six percent of the sample was classified as normal weight, 28% as overweight, and 26% as obese. In adjusted analyses, women who were overweight and obese, compared to women with normal weight, were more likely to receive preventive counseling for diet/nutrition, physical activity, and weight management (p<0.01). Overweight and obese women received more cholesterol and diabetes screening (p<0.05 and p<0.01, respectively). However, there were no differences by BMI category in receipt of Pap testing or reproductive counseling. CONCLUSION Overall, we found that women with overweight and obesity were more likely to receive preventive services, especially services relevant for overweight and obese populations.
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Eheman C, Henley SJ, Ballard-Barbash R, Jacobs EJ, Schymura MJ, Noone AM, Pan L, Anderson RN, Fulton JE, Kohler BA, Jemal A, Ward E, Plescia M, Ries LAG, Edwards BK. Annual Report to the Nation on the status of cancer, 1975-2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer 2012. [PMID: 22460733 DOI: 10.1002/cncr.27514;+10.1002/cncr.27514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Annual updates on cancer occurrence and trends in the United States are provided through collaboration between the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR). This year's report highlights the increased cancer risk associated with excess weight (overweight or obesity) and lack of sufficient physical activity (<150 minutes of physical activity per week). METHODS Data on cancer incidence were obtained from the CDC, NCI, and NAACCR; data on cancer deaths were obtained from the CDC's National Center for Health Statistics. Annual percent changes in incidence and death rates (age-standardized to the 2000 US population) for all cancers combined and for the leading cancers among men and among women were estimated by joinpoint analysis of long-term trends (incidence for 1992-2008 and mortality for 1975-2008) and short-term trends (1999-2008). Information was obtained from national surveys about the proportion of US children, adolescents, and adults who are overweight, obese, insufficiently physically active, or physically inactive. RESULTS Death rates from all cancers combined decreased from 1999 to 2008, continuing a decline that began in the early 1990s, among men and among women in most racial and ethnic groups. Death rates decreased from 1999 to 2008 for most cancer sites, including the 4 most common cancers (lung, colorectum, breast, and prostate). The incidence of prostate and colorectal cancers also decreased from 1999 to 2008. Lung cancer incidence declined from 1999 to 2008 among men and from 2004 to 2008 among women. Breast cancer incidence decreased from 1999 to 2004 but was stable from 2004 to 2008. Incidence increased for several cancers, including pancreas, kidney, and adenocarcinoma of the esophagus, which are associated with excess weight. CONCLUSIONS Although improvements are reported in the US cancer burden, excess weight and lack of sufficient physical activity contribute to the increased incidence of many cancers, adversely affect quality of life for cancer survivors, and may worsen prognosis for several cancers. The current report highlights the importance of efforts to promote healthy weight and sufficient physical activity in reducing the cancer burden in the United States.
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Affiliation(s)
- Christie Eheman
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Eheman C, Henley SJ, Ballard-Barbash R, Jacobs EJ, Schymura MJ, Noone AM, Pan L, Anderson RN, Fulton JE, Kohler BA, Jemal A, Ward E, Plescia M, Ries LAG, Edwards BK. Annual Report to the Nation on the status of cancer, 1975-2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer 2012; 118:2338-66. [PMID: 22460733 PMCID: PMC4586174 DOI: 10.1002/cncr.27514] [Citation(s) in RCA: 329] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 02/03/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Annual updates on cancer occurrence and trends in the United States are provided through collaboration between the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR). This year's report highlights the increased cancer risk associated with excess weight (overweight or obesity) and lack of sufficient physical activity (<150 minutes of physical activity per week). METHODS Data on cancer incidence were obtained from the CDC, NCI, and NAACCR; data on cancer deaths were obtained from the CDC's National Center for Health Statistics. Annual percent changes in incidence and death rates (age-standardized to the 2000 US population) for all cancers combined and for the leading cancers among men and among women were estimated by joinpoint analysis of long-term trends (incidence for 1992-2008 and mortality for 1975-2008) and short-term trends (1999-2008). Information was obtained from national surveys about the proportion of US children, adolescents, and adults who are overweight, obese, insufficiently physically active, or physically inactive. RESULTS Death rates from all cancers combined decreased from 1999 to 2008, continuing a decline that began in the early 1990s, among men and among women in most racial and ethnic groups. Death rates decreased from 1999 to 2008 for most cancer sites, including the 4 most common cancers (lung, colorectum, breast, and prostate). The incidence of prostate and colorectal cancers also decreased from 1999 to 2008. Lung cancer incidence declined from 1999 to 2008 among men and from 2004 to 2008 among women. Breast cancer incidence decreased from 1999 to 2004 but was stable from 2004 to 2008. Incidence increased for several cancers, including pancreas, kidney, and adenocarcinoma of the esophagus, which are associated with excess weight. CONCLUSIONS Although improvements are reported in the US cancer burden, excess weight and lack of sufficient physical activity contribute to the increased incidence of many cancers, adversely affect quality of life for cancer survivors, and may worsen prognosis for several cancers. The current report highlights the importance of efforts to promote healthy weight and sufficient physical activity in reducing the cancer burden in the United States.
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Affiliation(s)
- Christie Eheman
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Abstract
Although obesity is a well-known risk factor for several cancers, its role on cancer survival is poorly understood. We conducted a systematic literature review to assess the current evidence evaluating the impact of body adiposity on the prognosis of the three most common obesity-related cancers: prostate, colorectal, and breast. We included 33 studies of breast cancer, six studies of prostate cancer, and eight studies of colo-rectal cancer. We note that the evidence overrepresents breast cancer survivorship research and is sparse for prostate and colorectal cancers. Overall, most studies support a relationship between body adiposity and site-specific mortality or cancer progression. However, most of the research was not specifically designed to study these outcomes and, therefore, several methodological issues should be considered before integrating their results to draw conclusions. Further research is urgently warranted to assess the long-term impact of obesity among the growing population of cancer survivors.
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Affiliation(s)
- Niyati Parekh
- Department of Nutrition, Food Studies and Public Health, New York University, New York, NY 10003, USA
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Eheman C, Henley SJ, Ballard-Barbash R, Jacobs EJ, Schymura MJ, Noone AM, Pan L, Anderson RN, Fulton JE, Kohler BA, Jemal A, Ward E, Plescia M, Ries LAG, Edwards BK. Annual Report to the Nation on the status of cancer, 1975-2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer 2012. [PMID: 22460733 DOI: 10.1002/cncr.27514; 10.1002/cncr.27514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Annual updates on cancer occurrence and trends in the United States are provided through collaboration between the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR). This year's report highlights the increased cancer risk associated with excess weight (overweight or obesity) and lack of sufficient physical activity (<150 minutes of physical activity per week). METHODS Data on cancer incidence were obtained from the CDC, NCI, and NAACCR; data on cancer deaths were obtained from the CDC's National Center for Health Statistics. Annual percent changes in incidence and death rates (age-standardized to the 2000 US population) for all cancers combined and for the leading cancers among men and among women were estimated by joinpoint analysis of long-term trends (incidence for 1992-2008 and mortality for 1975-2008) and short-term trends (1999-2008). Information was obtained from national surveys about the proportion of US children, adolescents, and adults who are overweight, obese, insufficiently physically active, or physically inactive. RESULTS Death rates from all cancers combined decreased from 1999 to 2008, continuing a decline that began in the early 1990s, among men and among women in most racial and ethnic groups. Death rates decreased from 1999 to 2008 for most cancer sites, including the 4 most common cancers (lung, colorectum, breast, and prostate). The incidence of prostate and colorectal cancers also decreased from 1999 to 2008. Lung cancer incidence declined from 1999 to 2008 among men and from 2004 to 2008 among women. Breast cancer incidence decreased from 1999 to 2004 but was stable from 2004 to 2008. Incidence increased for several cancers, including pancreas, kidney, and adenocarcinoma of the esophagus, which are associated with excess weight. CONCLUSIONS Although improvements are reported in the US cancer burden, excess weight and lack of sufficient physical activity contribute to the increased incidence of many cancers, adversely affect quality of life for cancer survivors, and may worsen prognosis for several cancers. The current report highlights the importance of efforts to promote healthy weight and sufficient physical activity in reducing the cancer burden in the United States.
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Affiliation(s)
- Christie Eheman
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Anderson GL, Neuhouser ML. Obesity and the Risk for Premenopausal and Postmenopausal Breast Cancer: Table 1. Cancer Prev Res (Phila) 2012; 5:515-21. [DOI: 10.1158/1940-6207.capr-12-0091] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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