4. Comparative Quantification of Mortality and Burden of Disease Attributable to Selected Risk Factors

Table 4.5: Individual and Joint Contributions of Risk Factors to Mortality and Burden of Disease from Site-Specific Cancers

Individual and Joint Contributions of Risk Factors to Mortality and Burden of Disease from Site-Specific Cancers
World
Cancer typeDeathsProportion of global disease burden (%) [total: 1.54 billion DALYs(3,0)]PAFs for individual risk factors for mortality (first number) and disease burden (second number)Joint PAF - mortality (%)Joint PAF - disease burden (%)
Mouth and oropharynx311,6330.30Alcohol use (16%; 18%), smoking (42%; 42%)5254
Esophagus437,5110.39Alcohol use (26%; 27%), smoking (42%; 42%), low fruit and vegetable intake (18%; 19%)6263
Stomach841,6930.73Smoking (13%; 13%), low fruit and vegetable intake (18%; 19%)2830
Colon and rectal613,7400.53Overweight and obesity (11%; 12%), physical inactivity (15%; 16%), low fruit and vegetable intake (2%; 2%)1314
Liver606,4410.59Smoking (14%; 14%), alcohol use (25%; 25%), contaminated injections in health care setting (18%; 19%)4747
Pancreas226,9810.19Smoking (22%; 22%)2222
Trachea, bronchus, and lung1,226,5741.04Smoking (70%; 67%), low fruit and vegetable intake (11%; 12%), indoor smoke from household use of solid fuels (1%; 1%), urban air pollution (5%; 5%)7674
Breast472,4240.52Alcohol use (5%; 5%), overweight and obesity (9%; 8%), physical inactivity (10%; 10%)2119
Cervix uteri234,7280.27Smoking (2%; 2%), unsafe sex (100%; 100%)a100100
Corpus uteri70,8810.10Overweight and obesity (40%; 46%)4042
Bladder175,3180.14Smoking (28%; 27%)2827
Leukemia263,1690.32Smoking (9%; 6%)96
Selected other neoplasmsb145,8020.14Alcohol use (6%; 5%)65
All other neoplasms1,391,5071.27None of the selected risk factors00
All cancers7,018,4026.53Alcohol use (5%; 5%), smoking (21%; 21%), low fruit and vegetable intake (5%; 5%), indoor smoke from household use of solid fuels (<0.5%; <0.5%), urban air pollution (1%; 1%), overweight and obesity (2%; 2%), physical inactivity (2%; 2%), contaminated injections in health care setting (2%; 2%), unsafe sex (3%; 4%)3534
Low- and middle-income countries
Cancer typeDeathsProportion of regional disease burden (%) [total: 1.39 billion DALYs(3,0)]PAFs for individual risk factors for mortality (first number) and disease burden (second number)Joint PAF - mortality (%)Joint PAF - disease burden (%)
Mouth and oropharynx271,0740.29Alcohol use (14%; 15%), smoking (37%; 39%)4850
Esophagus379,7600.38Alcohol use (24%; 25%), smoking (37%; 39%), low fruit and vegetable intake (19%; 20%)5860
Stomach695,4260.69Smoking (11%; 11%), low fruit and vegetable intake (19%; 20%)2729
Colon and rectal356,9490.36Overweight and obesity (9%; 9%), physical inactivity (15%; 16%), low fruit and vegetable intake (2%; 3%)1112
Liver504,4070.57Smoking (11%; 12%), alcohol use (23%; 24%), contaminated injections in health care setting (21%; 22%)4546
Pancreas116,8270.12Smoking (15%; 16%)1516
Trachea, bronchus, and lung770,9380.77Smoking (60%; 59%), low fruit and vegetable intake (13%; 13%), indoor smoke from household use of solid fuels (2%; 2%), urban air pollution (7%; 7%)6968
Breast317,1950.40Alcohol use (4%; 4%), overweight and obesity (7%; 7%), physical inactivity (10%; 10%)1817
Cervix uteri218,0640.27Smoking (2%; 2%), unsafe sex (100%; 100%)a100100
Corpus uteri43,9260.07Overweight and obesity (37%; 39%)3739
Bladder116,6820.11Smoking (21%; 21%)2121
Leukemia190,0590.28Smoking (6%; 4%)64
Selected other neoplasmsb88,7060.11Alcohol use (4%; 4%)44
All other neoplasms882,0010.95None of the selected risk factors00
All cancers4,952,0145.37Alcohol use (5%; 6%), smoking (18%; 19%), low fruit and vegetable intake (6%; 6%), indoor smoke from household use of solid fuels (<0.5%; <0.5%), urban air pollution (1%; 1%), overweight and obesity (1%; 2%), physical inactivity (2%; 2%), contaminated injections in health care setting (2%; 2%), unsafe sex (4%; 5%)3434
High-income countries
Cancer typeDeathsProportion of regional disease burden (%) [total: 149.2 million DALYs(3,0)]PAFs for individual risk factors for mortality (first number) and disease burden (second number)Joint PAF - mortality (%)Joint PAF - disease burden (%)
Mouth and oropharynx40,5590.39Alcohol use (33%; 35%), smoking (71%; 71%)8080
Esophagus57,7520.47Alcohol use (41%; 43%), smoking (71%; 71%), low fruit and vegetable intake (12%; 13%)8586
Stomach146,2671.09Smoking (25%; 25%), low fruit and vegetable intake (12%; 13%)3435
Colon and rectal256,7912.13Overweight and obesity (14%; 15%), physical inactivity (14%; 16%), low fruit and vegetable intake (1%; 2%)1517
Liver102,0330.82Smoking (29%; 29%), alcohol use (32%; 33%), contaminated injections in health care setting (3%; 4%)5254
Pancreas110,1540.83Smoking (30%; 30%)3030
Trachea, bronchus, and lung455,6363.62Smoking (86%; 84%), low fruit and vegetable intake (8%; 9%), indoor smoke from household use of solid fuels (0%; 0%), urban air pollution (3%; 3%)8786
Breast155,2301.68Alcohol use (9%; 9%), overweight and obesity (13%; 12%), physical inactivity (9%; 10%)2726
Cervix uteri16,6630.21Smoking (11%; 10%), unsafe sex (100%; 100%)a100100
Corpus uteri26,9550.39Overweight and obesity (43%; 46%)4346
Bladder58,6360.45Smoking (41%; 41%)4141
Leukemia73,1100.62Smoking (17%; 15%)1715
Selected other neoplasmsb57,0950.37Alcohol use (8%; 9%)89
All other neoplasms509,5074.28None of the selected risk factors00
All cancers2,066,38817.35Alcohol use (4%; 5%), smoking (29%; 29%), low fruit and vegetable intake (3%; 3%), indoor smoke from household use of solid fuels (0%; 0%), urban air pollution (1%; 1%), overweight and obesity (3%; 4%), physical inactivity (2%; 3%), contaminated injections in health care setting (<0.5%; <0.5%), unsafe sex (1%; 1%)3737

Source: Authors' calculations.

Note: Risk factors are those listed in table 4.1.

a. Currently, a proportion of human papilloma virus (HPV) infections that lead to cervix uteri cancer are transmitted through routes other than sexual contact. The PAF for unsafe sex, as defined in the CRA project (Slaymaker and others 2004), measures the current population-level cervix cancer mortality that would be reduced, had there never been any sexual transmission of infection (that is, the consequences of past and current exposure, as we do for accumulated hazards of smoking). By considering the health consequences of past and current exposure, nearly all sexually transmitted diseases are attributable to unsafe sex. This is because, in the absence of sexual transmission in the past, current infections transmitted through other forms of contact would not occur if the infected hosts acquired their infection sexually (and so on in the sequence of past infected hosts).

b. This category includes neoplasms under the ICD-9 three-digit codes 210-239.

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