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Smoking, alcohol, diabetes, obesity, socioeconomic status, and the risk of colorectal cancer in a population-based case–control study

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Abstract

Purpose

Although previous research has identified factors that may determine willingness to participate in research, relatively few studies have attempted to quantify the impact non-participation may have on exposure–disease associations. The aims of this study were to (a) investigate the associations between smoking, alcohol, diabetes, obesity, and socioeconomic status and the risk of colorectal cancer in a case–control study (59.7 and 47.2 % response fractions among cases and controls, respectively); and (b) perform sensitivity analyses to examine the possible influence of non-participation.

Methods

Logistic regression was used to estimate the exposure–disease associations. We then investigated the associations between various demographic and health factors and the likelihood that an individual would participate in the case–control study and then performed two sensitivity analyses (sampling weights and multiple imputation) to examine whether non-participation bias may have influenced the exposure–disease associations.

Results

The exposures alcohol, smoking, and diabetes were associated with an increased risk of colorectal cancer. We found some differences between cases and controls when examining the factors associated with the participation in the study, and in the sensitivity analyses, the exposure–disease associations were slightly attenuated when compared with those from the original analysis.

Conclusion

Non-participation may have biased the risk estimates away from the null, but generally not enough to change the conclusions of the study.

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Abbreviations

AOR:

Adjusted odds ratio

BMI:

Body mass index

CI:

Confidence interval

CRC:

Colorectal cancer

OR:

Odds ratio

RR:

Relative risk

WA:

Western Australia

WABOHS:

Western Australian Bowel Health Study

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Acknowledgments

The authors gratefully acknowledge Kieran McCaul for statistical advice, the people who generously gave their time to participate in this research, the clinicians who gave permissions to approach their patients, the WA Cancer Registry staff (Timothy Threlfall in particular) for assistance with case ascertainment and recruitment, and members of the WABOHS team (Cameron Platell, Kieran McCaul, David Crawford, Cassandra Clayforth, Clare Tran, Jenny Landrigan, Beatriz Cuesta-Briand) for study management and collection of data used in this study. This work was supported by the Australian National Health and Medical Research Council (Project Grant #353568, Fellowship #1072266 to TB, and Fellowship 37614900 to LF), the Canadian Institutes of Health Research (Fellowship #300068 to TB), the Michael Smith Foundation for Health Research (Fellowship #5553 to TB), and the Izaak Walton Killam Memorial Fund for Advanced Studies (Honorary UBC Killam Postdoctoral Research Fellowship to TB).

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Cancer Control Research, British Columbia Cancer Agency, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada

    Terry Boyle

  2. School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada

    Terry Boyle

  3. Harry Perkins Institute of Medical Research, The University of Western Australia, Perth, WA, Australia

    Terry Boyle & Kathrin Ringwald

  4. School of Public Health, Curtin University, Perth, WA, Australia

    Lin Fritschi

  5. School of Population Health, The University of Western Australia, Perth, WA, Australia

    Seyed Mehdi Tabatabaei & Jane S. Heyworth

Authors
  1. Terry Boyle
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  2. Lin Fritschi
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  3. Seyed Mehdi Tabatabaei
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  4. Kathrin Ringwald
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  5. Jane S. Heyworth
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Corresponding author

Correspondence to Terry Boyle.

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Boyle, T., Fritschi, L., Tabatabaei, S.M. et al. Smoking, alcohol, diabetes, obesity, socioeconomic status, and the risk of colorectal cancer in a population-based case–control study. Cancer Causes Control 25, 1659–1668 (2014). https://doi.org/10.1007/s10552-014-0470-7

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  • DOI: https://doi.org/10.1007/s10552-014-0470-7

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