生活方式因素健康分值与男性癌症发病的公共卫生学评价

摘要

目的 探讨生活方式因素及健康分值对上海市成年男性恶性肿瘤发病的影响.方法 利用2002-2006年上海市男性健康队列(SMHS)的基线调查资料,至2009年12月最近一次随访,男性队列累积收集恶性肿瘤新病例2033例.根据吸炯(吸烟计0分,不吸烟计1分)、饮酒(≥1 drinks/d计0分,＜1drinks/d计1分)、BMI(＜18.5 kg/m2或≥28 kg/m2计0分,18.5～27.9 kg/m2计1分)、体力活动(＜54 Met-hours/week计0分,≥54 Met-hours/week计1分)、蔬菜水果摄入(＜451g/d计0分,≥451 g/d计1分)五种常见生活方式因素建立健康生活方式分值表,分值分布范围为0(最不健康生活方式)至5(最健康生活方式)分.采用Cox回归模型估计健康生活方式分值与癌症的相对危险度(HR)及其95％CI.结果 相对于得分为0或者1分的人群组,得分为2～5分人群组发生癌症的HR值分别为0.77(95％CI:0.66 ～ 0.90)、0.67(95％CI:0.58 ～ 0.78)、0.56(95％CI:0.47 ～ 0.65)、0.51(95％CI:0.42 ～ 0.62).健康生活方式得分少于3项的人群癌症发病归因危险度百分比(PAR％)为10.4％(95％CI:7.3％ ～ 13.5％).结论 不吸烟、不过量饮酒,保持正常体型,适当体育锻炼及多食蔬菜水果可较显著降低癌症的发生,保持健康的生活方式具有显著的公共卫生学效益.%Objective To evaluate the effects of combined lifestyle-related factors and risk of cancer incidence among adult men in urban Shanghai.Methods Information was obtained from 60 817 men in the Shanghai Men' s Health Study (2002-2006) program and 2033 incident cancers who were confirmed at the end of 2009.A healthy lifestyle score (HLS) system was developed,based on five lifestyle-related factors,and participants were scored one point for each of the healthy behaviour:never smoked,alcohol intake less than 1 drink/day,under normal weight range (18.5-27.9 kg/m2),physical activity (≥ 54 Met-hours/week),fruit and vegetable intake ≥451 g/day,the else would score as zero.The total score would range from zero to five.Cox regression model was used to evaluate the associations between combined lifestyle-related factors and the cancer incidence.Results Compared to men having scores as zero or one,the hazard ratios (95％ confidence intervals) for men with two,three,four,five health behaviour scores were 0.77 (95％CI:0.66,0.90),0.67 (95％CI:0.58,0.78),0.56(95％ CI:0.47,0.65),0.51 (95％ CI:0.42,0.62),respectively.The population attributable risks for cancer incidence was 10.4％ for those having scores less than 3 items.Conclusion Never smoked,moderate alcohol intake,maintaining normal weight,being physically fit,and having enough daily fruit and vegetable intake were associated with lower risk of total cancer incidence in men.Our data showed that healthy lifestyle could significantly benefit the public health programs of the population.