Cardiometabolic Comorbidity along with Individual Health Behaviors and Built Environment Characteristics in Association with Cause-Specific Mortality and Site-Specific Cancer Incidence

Abstract

There are very few studies analyzing the association between multiple cardiometabolic comorbidities with all-cause and cause-specific mortality, particularly among low-income and racial/ethnic minority Americans. We investigated the association of multiple cardiometabolic comorbidities (diabetes, hypertension, myocardial infarction, and stroke) along with individual health behaviors and built environment characteristics with cause-specific mortality and site-specific cancer incidence among predominantly low-income Black and White participants. We used the Southern Community Cohort Study (SCCS) because it has a high representation of both Black individuals (~65%) and low-income adults (>50%). Exposures were assessed at baseline survey while mortality and cancer incidence outcomes were assessed via linkage to state cancer registries and National Death Index Disease outcomes were defined using International Classification of Diseases codes. In the first aim, I analyzed the association of cardiometabolic comorbidities with total mortality and major cause-specific mortality, and evaluated if this association might be modified by race and poverty. In brief, the increase in mortality was significantly elevated with an increasing number of comorbidities, with an HR of 3.81 (95% CI: 3.26-4.46) and a cumulative risk of 62.5% at age 75 years for total mortality for those with four comorbidities. These associations were stronger among Blacks than Whites. Individuals with four comorbidities at age 40 years were estimated to have a 16-year loss in life expectancy compared with those without any comorbidity. For the second aim, I evaluated the association of diabetes with risk of site-specific cancers. Compared to individuals without diabetes, individuals with diabetes had a slightly, but statistically significantly, elevated risk of any cancer (HR: 1.08; 95% CI: 1.01-1.15). Individuals with diabetes also had an elevated risk of certain site-specific cancers, such as colorectal, pancreatic, breast, uterine body, liver and intrahepatic bile duct, and kidney and renal pelvis cancers, as well as non-Hodgkin’s Lymphoma and leukemia; and a reduced risk of oral and pharynx, lung, and ovarian cancers. These results differed when stratified by demographic factors and follow-up time. In the third aim, I evaluated how individual health behaviors and built environment characteristics, such as area deprivation index, after disease diagnosis may affect mortality among diabetes patients. Among diabetes patients, after diagnosis of diabetes, smoking (HR: 1.85; 95% CI: 1.72-2.00), higher alcohol consumption (HR: 1.29; 95% CI: 1.17-1.42), and a greater area deprivation index (HR: 1.15; 95% CI: 0.99-1.33) were associated with an increased risk of all-cause mortality. Conversely, a higher income (HR: 0.41; 95% CI: 0.34-0.50), increased physical activity (HR: 0.65; 95% CI: 0.55-0.76), and a diet with a healthier eating index (HR: 0.77; 95% CI: 0.70-0.84) were all associated with a decreased risk of all-cause mortality. While for the association between BMI and mortality among diabetic individuals, I found mostly no association. Results from these studies suggest that future research is necessary to develop race and culture-specific interventions to reduce the burden for individuals living with cardiometabolic commodities on both mortality and cancer incidence.