Alcohol, Tobacco, and Diet in Relation to Esophageal Cancer: The Shanghai Cohort Study

Abstract

Prospective data on environmental exposures, especially with respect to alcohol, tobacco, and diet, in relation to the risk of esophageal cancer in high-risk populations are sparse. We analyzed data from a population-based cohort of 18,244 middle-aged and older men in Shanghai to identify risk factors for esophageal cancer in this high-risk population. The cohort was followed through 2006, and 101 incident esophageal cancer cases were identified. Cox proportional hazards models were used to estimate hazard ratios (HR) and their corresponding 95% confidence intervals (CI) for associations between exposures and esophageal cancer risk. With adjustment for tobacco use and other potential confounders, regular drinkers vs. nondrinkers of alcoholic beverages had a twofold risk of developing esophageal cancer (HR = 2.02, 95% CI = 1.31–3.12). With adjustment for alcohol and other potential confounders, long-term smokers (40+ yr) vs. nonsmokers of cigarettes showed a twofold risk of developing esophageal cancer (HR = 2.06, 95% CI = 1.11–3.82). Increased consumption of fruits (including oranges/tangerines), seafood, and milk were found to be protective against the development of esophageal cancer; HRs were decreased by 40–60% for high vs. low consumers after adjustment for cigarette smoking, alcohol drinking, and other confounders.

ACKNOWLEDGMENTS

We thank Ms. Xue-Li Wang, Ms. Yue-Lan Zhang, and Ms. Jia-Rong Cheng of the Shanghai Cancer Institute for their assistance in data collection and management and the staff of the Shanghai Cancer Registry for their assistance in verifying cancer diagnoses in study subjects. This work was supported by the United States National Institutes of Health (Grant R01 CA43092).

Notes

^a t-test for continuous variables and chi-square test for categorical variables.

^b 1 pack yr equals to 20 cigarettes (1 pack) per day for 1 yr.

^a Abbreviations are as follows: HR, hazard ratios; CI, confidence interval. HRs were calculated using Cox proportional hazards regression models, which included covariates for age at interview, year of interview, and neighborhood of residence at recruitment.

^b HRs were further adjusted for level of education, body mass index, number of drinks consumed per day, number of years of drinking, and summed intakes of preserved food items (in tertiles), fresh fruits (in tertiles), and fresh vegetables (in tertiles).

^c 1 pack yr equals to 20 cigarettes (1 pack) per day for 1 yr.

^a Abbreviations are as follows: HR, hazard ratios; CI, confidence interval. HRs) were calculated using Cox proportional hazards regression models, which included covariates for age at interview, year of interview, and neighborhood of residence at recruitment.

^b HRs were further adjusted for level of education, body mass index, number of years of smoking, and summed intakes of preserved food items (in tertiles), fresh fruits (in tertiles), and fresh vegetables (in tertiles).

^a Abbreviations are as follows: HR, hazard ratio; CI, confidence interval. HRs were calculated using Cox proportional hazards regression models, which included covariates for age at interview, year of interview, and neighborhood of residence at recruitment.

^b HRs were further adjusted for level of education, body mass index, number of years of smoking, and summed intakes of preserved food items (in tertiles), fresh fruits (in tertiles), and fresh vegetables (in tertiles).

^c Subjects who consumed rice wine and/or spirits only were excluded from this analysis; HRs were further adjusted for consumption of rice wine and spirits.

^d Subjects who consumed beer and/or spirits only were excluded from this analysis; HRs were further adjusted for consumption of beer and spirits.

^e Subjects who consumed beer and/or rice wine only were excluded from this analysis; HRs were further adjusted for consumption of beer and rice wine.

^a Abbreviations are as follows: HR, hazard ratio; CI, confidence interval.

^b HRs were calculated using Cox proportional hazards regression models, which included covariates for age at interview, year of interview, neighborhood of residence at recruitment, body mass index, level of education, and summed intakes of preserved food items (in tertiles), fresh fruits (in tertiles), and fresh vegetables (in tertiles).

^c 2-sided P for interaction = 0.99.

^a Abbreviations are as follows: HR, hazard ratio; CI, confidence interval; Adj., adjusted.

^b HRs were calculated using Cox proportional hazards regression models, which included covariates for age at interview, year of interview, and neighborhood of residence at recruitment.

^c HRs were further adjusted for level of education, body mass index, number of years of smoking, number of drinks consumed per day, and number of years of drinking.

^d The average intake of milk was 5.5 times per wk for those who reported “ever consumed,” and it was compared to nondrinkers of milk.

^a Abbreviations are as follows: HR, hazard ratio; CI, confidence interval; Adj., adjusted.

^b HRs were calculated using Cox proportional hazards regression models, which included covariates for age at interview, year of interview, and neighborhood of residence at recruitment.

^c HRs were further adjusted for level of education, body mass index, number of years of smoking, number of drinks consumed per day, and number of years of drinking.