Evaluation Of Multi-Morbidity In The European Investigation Into Cancer And Nutrition (EPIC) Study
Cristian RICCI, International Agency for Research on Cancer, France
FREISLING H. 1
, MULLER D. 2
, BAGNARDI V. 3
, JENAB M. 1
, ROMIEU I. 1
, FERRARI P. 1
1 Nutritional Epidemiology Group, Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
2 2Department of Epidemiology and Biostatistics Imperial College, London, UK
3 3Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Italy
Recent trends in population ageing triggered increasing research to evaluate the occurrence and determinants of multi-morbidity. In this study the association between major modifiable lifestyle factors and the risk of multi-morbidity, defined here as the development of at least two conditions among cancer, coronary heart disease (CHD) or type II diabetes (T2D), was evaluated. Etiological relationships between morbid conditions were also investigated.
Incident events of CHD and T2D were assessed in the EPIC-CVD and EPIC-InterAct studies respectively, and were linked to incident cancers in the EPIC study over the period 1991-2007. The association between multi-morbidity risk and modifiable lifestyles factors was assessed using multinomial logistic models. The association between previous morbid conditions and the risk of developing a second disease was modelled using time-dependent covariates in Cox models.
During a median follow-up of 7.4 years, 42,371 cancer, 13,604 T2D and 10,463 CHD events occurred. A total of 60,190 and 3,467 study participants developed, respectively, one and two morbid events. When compared with normal BMI(18.5 Conclusions
Modifiable risk factors are strongly associated to the risk of multi-morbidity, thus suggesting a great potential for disease prevention policies. This study confirmed that developing T2D and CHD increases the risk of subsequent cancer development.