title: Exercise Decreases and Smoking Increases Bladder Cancer Mortality.
abstract: The aim of this study was to investigate modifiable lifestyle factors of smoking, exercise, and obesity with bladder cancer mortality.
  
  
  
  We used mortality-linked data from the National Health Information Survey from 1998 through 2006. The primary outcome was bladder cancer-specific mortality. The primary exposures were self-reported smoking status (never- vs. former vs. current smoker), self-reported exercise (dichotomized as "did no exercise" vs. "light, moderate, or vigorous exercise in ≥ 10-minute bouts"), and body mass index. We utilized multivariable adjusted Cox proportional hazards regression models, with delayed entry to account for age at survey interview.
  
  
  
  Complete data were available on 222,163 participants, of whom 96,715 (44%) were men and 146,014 (66%) were non-Hispanic whites, and among whom we identified 83 bladder cancer-specific deaths. In multivariate analyses, individuals who reported any exercise were 47% less likely (adjusted hazard ratio [HRadj], 0.53; 95% confidence interval [CI], 0.29-0.96; P = .038) to die of bladder cancer than "no exercise". Compared with never-smokers, current (HRadj, 4.24; 95% CI, 1.89-9.65; P = .001) and former (HRadj, 2.95; 95% CI, 1.50-5.79; P = .002) smokers were 4 and 3 times more likely, respectively, to die of bladder cancer. There were no significant associations of body mass index with bladder cancer mortality.
  
  
  
  Exercise decreases and current smoking increases the risk of bladder cancer-specific mortality. These data suggest that exercise and smoking cessation interventions may reduce bladder cancer death.
authors.affiliation: Department of Urology, University of Texas Health Science Center San Antonio, San Antonio, TX. Electronic address: mliss008@gmail.com.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Liss
authors.affiliation: Biostatistics Shared Resource, Moores Comprehensive Cancer Center, University of California San Diego, La Jolla, CA.
authors.forename: Martha
authors.initials: M
authors.lastname: White
authors.affiliation: Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA.
authors.forename: Loki
authors.initials: L
authors.lastname: Natarajan
authors.affiliation: Department of Urology, University of California San Diego, La Jolla, CA.
authors.forename: J Kellogg
authors.initials: JK
authors.lastname: Parsons
mesh_terms: D000368:Aged; D015992:Body Mass Index; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D001749:Urinary Bladder Neoplasms / Q000208:ethnology / Q000401:mortality*
keywords: Bladder cancer; Exercise; Modifiable risk factor; Mortality; Smoking