Is Cancer Protective for Subsequent Alzheimer's Disease Risk? Evidence From the Utah Population Database.
OBJECTIVE
Several studies have suggested that cancer is associated with a reduced risk of the development of Alzheimer's disease (AD). This study seeks to improve our understanding of the association between cancer and the development of AD by showing how mortality selection alters this relationship.


METHODS
A retrospective cohort study was carried out examining 92,425 individuals (47,873 women and 44,552 men) from the Utah Population Database with and without a history of any primary cancer identified by the Utah Cancer Registry. All individuals were aged 65-79 years and free of dementia in 1992 and followed for upwards of 18 years (1992-2009) for AD ascertainment, which was identified using diagnostic information from Medicare claims data.


RESULTS
We replicate previous results suggesting that cancer is associated with reduced risk of subsequent AD under specific statistical model specifications. However, these results should not be interpreted as evidence of an etiological association. We conclude that higher rates of overall mortality among individuals with cancer relative to those without cancer induce the widely reported putative protective association with cancer.


CONCLUSIONS
Careful consideration of model specification and the profound effects of mortality selection in the older adult population is essential when investigating the relationship between aging-related diseases such as cancer and AD. We show that cancer does not provide protection from AD as previously described in the literature. Social scientists seeking to understand social disparities in disease outcomes among older adults may therefore want to strongly consider the role of mortality selection which, if uncorrected, may generate biased associations.
Population Sciences, Huntsman Cancer Institute.|Department of Family and Preventive Medicine, University of Utah, Salt Lake City.
Heidi A
HA
Hanson
Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, Salt Lake City, Utah.
Kevin P
KP
Horn
Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, Salt Lake City, Utah.
Kelli M
KM
Rasmussen
Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, Salt Lake City, Utah.
John M
JM
Hoffman
Population Sciences, Huntsman Cancer Institute.|Department of Family and Consumer Studies, University of Utah, Salt Lake City.
Ken R
KR
Smith
D000368:Aged; D000544:Alzheimer Disease / Q000401:mortality* / Q000517:prevention & control*; D002423:Cause of Death; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D015233:Models, Statistical; D009369:Neoplasms / Q000401:mortality*; D065840:Protective Factors; D012306:Risk; D015996:Survival Rate; D014589:Utah
Alzheimer’s disease; Competing risks; Dementia; Mortality selection