title: Risk factors cannot explain the higher prevalence rates of precancerous colorectal lesions in men.
abstract: BACKGROUND
  Prevalence of (pre)cancerous colorectal lesions are higher in men than in women, although transition rates from advanced lesions to cancer is similar in both sexes. Our aim was to investigate whether the sex-specific difference in incidence of premalignant colorectal lesions might be explained by the impact of risk factors.
  
  
  METHODS
  A cross-sectional study analysing health check-up examinations and screening colonoscopies performed within a national quality assurance program.
  
  
  RESULTS
  A total of 25 409 patients were included in this study, 50.8% were women. Median age for both sexes was 60 years (interquartile range (IQR) 54-67). A multivariable model showed that risk factors mediated only 0.6 of the 10.4% gender gap in adenoma and 0.47 of the 3.2% gender gap in advanced adenoma detection rate. Smoking was the only independent risk factor with a varying sex-specific effect (men OR 1.46, CI 1.29, 1.64, women OR 1.76, CI 1.53, 2.06) and advanced adenomas (men OR 1.06, CI 0.80-1.42; women OR 2.08, CI 1.52-2.83). Independent risk factors for adenomas were BMI (OR 1.35 per IQR, CI 1.25-1.47) and triglyceride level (OR 1.03 per IQR, CI 1.00-1.06); for advanced adenomas physical activity (none vs regular: OR 1.54, CI 1.18-2.00, occasional vs regular: OR 1.17, CI 1.00-1.38), cholesterol level (OR 1.13 per IQR, CI 1.02-1.25), blood glucose level (OR 1.05 per IQR, CI 1.01-1.09) and alcohol score (OR 1.09 per IQR, CI 1.01-1.18).
  
  
  CONCLUSIONS
  Risk factors cannot explain higher prevalence rates in men. Results of this study strongly underline the need for sex-specific screening recommendations.
authors.affiliation: Division of Gastroenterology and Hepatology, Deptartment of Internal Medicine III, Medical University of Vienna, Vienna, Austria.|Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology (OEGGH), Vienna, Austria.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Waldmann
authors.affiliation: Department of Clinical Biometry, Medical University of Vienna, Vienna, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Heinze
authors.affiliation: Division of Gastroenterology and Hepatology, Deptartment of Internal Medicine III, Medical University of Vienna, Vienna, Austria.|Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology (OEGGH), Vienna, Austria.
authors.forename: Arnulf
authors.initials: A
authors.lastname: Ferlitsch
authors.affiliation: Division of Gastroenterology and Hepatology, Deptartment of Internal Medicine III, Medical University of Vienna, Vienna, Austria.|Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology (OEGGH), Vienna, Austria.
authors.forename: Irina
authors.initials: I
authors.lastname: GessI
authors.affiliation: Division of Gastroenterology and Hepatology, Deptartment of Internal Medicine III, Medical University of Vienna, Vienna, Austria.|Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology (OEGGH), Vienna, Austria.
authors.forename: Daniela
authors.initials: D
authors.lastname: Sallinger
authors.affiliation: Division of Gastroenterology and Hepatology, Deptartment of Internal Medicine III, Medical University of Vienna, Vienna, Austria.|Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology (OEGGH), Vienna, Austria.
authors.forename: Philip
authors.initials: P
authors.lastname: Jeschek
authors.affiliation: Division of Gastroenterology and Hepatology, Deptartment of Internal Medicine III, Medical University of Vienna, Vienna, Austria.|Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology (OEGGH), Vienna, Austria.
authors.forename: Martha
authors.initials: M
authors.lastname: Britto-Arias
authors.affiliation: Division of Gastroenterology and Hepatology, Deptartment of Internal Medicine III, Medical University of Vienna, Vienna, Austria.|Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology (OEGGH), Vienna, Austria.
authors.forename: Petra
authors.initials: P
authors.lastname: Salzl
authors.affiliation: Main Association of the Austrian Social Insurance Institutions, Vienna, Austria.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Fasching
authors.affiliation: Institute of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.
authors.forename: Bernd
authors.initials: B
authors.lastname: Jilma
authors.affiliation: Institute for Environmental Hygiene, Medical University of Vienna, Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Kundi
authors.affiliation: Division of Gastroenterology and Hepatology, Deptartment of Internal Medicine III, Medical University of Vienna, Vienna, Austria.|Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology (OEGGH), Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Trauner
authors.affiliation: Division of Gastroenterology and Hepatology, Deptartment of Internal Medicine III, Medical University of Vienna, Vienna, Austria.|Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology (OEGGH), Vienna, Austria.
authors.forename: Monika
authors.initials: M
authors.lastname: Ferlitsch
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors