title: The effect of modifiable risk factors on pancreatic cancer mortality in populations of the Asia-Pacific region.
abstract: BACKGROUND
  Pancreatic cancer accounts for about 220,000 deaths each year. Known risk factors are smoking and type 2 diabetes. It remains to be seen whether these risk factors are equally important in Asia and whether other modifiable risk factors have important associations with pancreatic cancer.
  
  
  METHODS
  An individual participant data analysis of 30 cohort studies was carried out, involving 420,310 Asian participants (33% female) and 99,333 from Australia/New Zealand (45% female). Cox proportional hazard models, stratified by study and sex and adjusted for age, were used to quantify risk factors for death from pancreatic cancer.
  
  
  RESULTS
  During 3,558,733 person-years of follow-up, there were 324 deaths from pancreatic cancer (54% Asia and 33% female). Mortality rates (per 100,000 person-years) from pancreatic cancer were 10 for men and 8 for women. The following are age-adjusted hazard ratios (95% confidence interval) for death from pancreatic cancer: for current smoking, 1.61 (1.12-2.32); for diabetes, 1.76 (1.15-2.69); for a 2-cm increase in waist circumference, 1.08 (1.02-1.14). All three relationships remained significant (P < 0.05) after adjustment for other risk factors. There was no evidence of heterogeneity in the strength of these associations between either cohorts from Asia and Australia/New Zealand or between the sexes. In men, the combination of cigarette smoking and diabetes more than doubled the likelihood of pancreatic cancer (2.47; 95% confidence interval, 1.17-5.21) in both regions.
  
  
  CONCLUSIONS
  Smoking, obesity, and diabetes are important and are potentially modifiable risk factors for pancreatic cancer in populations of the Asia-Pacific region. Activities to prevent them can be expected to lead to a major reduction in the number of deaths from this cancer, particularly in Asia with its enormous population.
authors.affiliation: The George Institute, University of Sydney, Australia.
authors.forename: Alireza
authors.initials: A
authors.lastname: Ansary-Moghaddam
authors.forename: Rachel
authors.initials: R
authors.lastname: Huxley
authors.forename: Federica
authors.initials: F
authors.lastname: Barzi
authors.forename: Carlene
authors.initials: C
authors.lastname: Lawes
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohkubo
authors.forename: Xianghua
authors.initials: X
authors.lastname: Fang
authors.forename: Sun Ha
authors.initials: SH
authors.lastname: Jee
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
mesh_terms: D001208:Asia / Q000453:epidemiology; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D048909:Diabetes Complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology