Lifestyle factors associated with sex differences in Kaposi sarcoma incidence among adult black South Africans: A case-control study |
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| Institution: | 1. National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa;2. Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa;3. Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa;4. Centre for Primary Health Care and Equity, School of Population Health, University of New South Wales Sydney, Australia;5. Menzies Centre of Health Policy, School of Public Health, University of Sydney, Australia;6. Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;7. Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;8. Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, SE5 8AF, United Kingdom;9. Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King’s College London, SE1 9RT, United Kingdom;10. South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa;11. Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany;12. MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda;13. University of York, York, United Kingdom |
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| Abstract: | Kaposi Sarcoma (KS) is endemic in several countries in Southern and Eastern Africa, relatively rare worldwide but a leading cancer among people living with HIV. KS has always been more common in adult males than females. We assessed the prevalence of known cancer modifying factors (parity, hormonal contraceptive use in females, sex-partners, smoking and alcohol consumption in both sexes), and their relationship to KS, and whether any of these could account for the unequal KS sex ratios. We calculated logistic regression case-control adjusted odds ratios (ORadj), and 95% confidence intervals (95%CI), between KS and each of the modifying factors, using appropriate comparison controls. Controls were cancer types that had no known relationship to exposures of interest (infection or alcohol or smoking or contraceptive use). The majority of the 1275 KS cases were HIV positive (97%), vs. 15.7% in 10,309 controls. The risk of KS among those with HIV was high in males (ORadj=116.70;95%CI=71.35–190.88) and females (ORadj=93.91;95%CI=54.22–162.40). Among controls, the prevalence of smoking and alcohol consumption was five and three times higher in males vs. females. We found a positive association between KS and heavy vs. non-drinking (ORadj=1.31;95%CI=1.03–1.67), and in current heavy vs. never smokers (ORadj=1.82;95%CI=1.07–3.10). These associations remained positive for alcohol consumption (but with wider CIs) after stratification by sex, and restriction to HIV positive participants. We found no evidence of interactions of smoking and alcohol by sex. Smoking and alcohol consumption may provide a possible explanation for the KS sex differences, given both exposures are more common in men, but confounding and bias cannot be fully ruled out. The role smoking and alcohol play in relation to viral loads of HIV/KSHV, differences in immunological responses or other genetic differences between males and females warrant further studies. |
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| Keywords: | Kaposi sarcoma HIV Sex ratio Johannesburg cancer study South Africa |
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