title: The Joint Effects of Lifestyle Factors and Comorbidities on the Risk of Colorectal Cancer: A Large Chinese Retrospective Case-Control Study.
abstract: BACKGROUND
  Colorectal cancer (CRC) is a major cause of cancer morbidity and mortality. In previous epidemiologic studies, the respective correlation between lifestyle factors and comorbidity and CRC has been extensively studied. However, little is known about their joint effects on CRC.
  
  
  METHODS
  We conducted a retrospective case-control study of 1,144 diagnosed CRC patients and 60,549 community controls. A structured questionnaire was administered to the participants about their socio-demographic factors, anthropometric measures, comorbidity history and lifestyle factors. Logistic regression model was used to calculate the odds ratio (ORs) and 95% confidence intervals (95%CIs) for each factor. According to the results from logistic regression model, we further developed healthy lifestyle index (HLI) and comorbidity history index (CHI) to investigate their independent and joint effects on CRC risk.
  
  
  RESULTS
  Four lifestyle factors (including physical activities, sleep, red meat and vegetable consumption) and four types of comorbidity (including diabetes, hyperlipidemia, history of inflammatory bowel disease and polyps) were found to be independently associated with the risk of CRC in multivariant logistic regression model. Intriguingly, their combined pattern- HLI and CHI demonstrated significant correlation with CRC risk independently (ORHLI: 3.91, 95%CI: 3.13-4.88; ORCHI: 2.49, 95%CI: 2.11-2.93) and jointly (OR: 10.33, 95%CI: 6.59-16.18).
  
  
  CONCLUSIONS
  There are synergistic effects of lifestyle factors and comorbidity on the risk of colorectal cancer in the Chinese population.
authors.affiliation: Department of Oncology and Pancreatic Cancer Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.|Shanghai Key Laboratory of Pancreatic Disease, Shanghai, China.
authors.forename: Junjie
authors.initials: J
authors.lastname: Hang
authors.affiliation: Songjiang Center of Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.
authors.forename: Binxin
authors.initials: B
authors.lastname: Cai
authors.affiliation: Department of Oncology and Pancreatic Cancer Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.|Shanghai Key Laboratory of Pancreatic Disease, Shanghai, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Xue
authors.affiliation: Department of Oncology and Pancreatic Cancer Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.|Shanghai Key Laboratory of Pancreatic Disease, Shanghai, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Oncology and Pancreatic Cancer Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.|Shanghai Key Laboratory of Pancreatic Disease, Shanghai, China.
authors.forename: Hai
authors.initials: H
authors.lastname: Hu
authors.affiliation: Department of Oncology and Pancreatic Cancer Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.|Shanghai Key Laboratory of Pancreatic Disease, Shanghai, China.
authors.forename: Yangyang
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Oncology and Pancreatic Cancer Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.|Shanghai Key Laboratory of Pancreatic Disease, Shanghai, China.
authors.forename: Shujuan
authors.initials: S
authors.lastname: Ren
authors.affiliation: Songjiang Center of Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.
authors.forename: Jiajin
authors.initials: J
authors.lastname: Wu
authors.affiliation: Songjiang Center of Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.
authors.forename: Meiying
authors.initials: M
authors.lastname: Zhu
authors.affiliation: Department of Oncology and Pancreatic Cancer Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.|Shanghai Key Laboratory of Pancreatic Disease, Shanghai, China.
authors.forename: Donghui
authors.initials: D
authors.lastname: Chen
authors.affiliation: Department of Oncology and Pancreatic Cancer Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.|Shanghai Key Laboratory of Pancreatic Disease, Shanghai, China.
authors.forename: Haiyan
authors.initials: H
authors.lastname: Yang
authors.affiliation: Department of Oncology and Pancreatic Cancer Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.|Shanghai Key Laboratory of Pancreatic Disease, Shanghai, China.
authors.forename: Liwei
authors.initials: L
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D044466:Asian People; D016022:Case-Control Studies; D002681:China / Q000453:epidemiology; D003111:Colonic Polyps / Q000453:epidemiology; D015179:Colorectal Neoplasms / Q000453:epidemiology*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004032:Diet; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology; D008019:Life Style; D008297:Male; D008460:Meat; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D012189:Retrospective Studies; D012307:Risk Factors; D012890:Sleep / Q000502:physiology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014675:Vegetables; D055815:Young Adult