Risk factors associated with pancreatic cancer at two Johannesburg Academic Hospitals between 2013 and 2015
Kagodora, Shingirai Brenda
Introduction: Pancreatic ductal adenocarcinoma (PDAC) is a devastating diagnosis for anyone as it is associated with a global mortality rate of about 4%, and has few therapeutic interventions that prolong survival as compared to other cancers. Frequent epidemiological reports on PDAC are available in the developed countries, but in South Africa, there is a paucity of epidemiological data on this aggressive cancer. Understanding risk factors will help to assess and develop relevant interventions for asymptomatic high-risk patient populations. Aim: To investigate and explore how various risk factors were associated with PDAC at two public academic hospitals in Johannesburg between 2013 and 2015. Method: This was a secondary unmatched case-control study to assess risk factors for developing PDAC at two public academic hospitals, namely the Chris Hani Baragwanath Academic Hospital (CHBAH) and the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). All cases of PDAC were histologically and/or cytologically confirmed. All participants were >18 years of age, including 139 cases and 139 controls. Data exported from REDCap database included patient demographics and social and medical histories. Proportions used the chi-square test and bivariate logistic regression estimated ORs between individual variables and PDAC. Multivariate logistic regression analysis investigated all possible confounders present in the data. The likelihood ratio test with a p-value of <0.20 was accepted to assimilate data fitting into the model. Results: Eighty two percent of the study population was black. The 50-59 age group accounted for 37% of the cases. Multiple logistic regressions showed the following odds ratios 95% CI and p-values for ages (i) 20-29 [0.11(0.11-1.00) p=0.05] and (ii) 50-59 [2.63(1.03-6.70) p=0.04]. As for diet, the following odds were observed (i) high white meat [0.18(0.04-0.86) p=0.03], (ii) low fish intake [2.17(1.06-4.45) p=0.03], (iii) low consumption of fried food [0.48(0.23-1.00) p=0.05] and (iv) high consumption of vegetables [0.17(0.05-0.61) p=0.007]. In terms of occupation, general workers had the following likelihood [1.79(0.93-3.45) p=0.08] of developing PDAC. Conclusion: Being 50-69 years of age and employed for longer periods than the general norm, was positively associated with PDAC. Additionally, increased consumption of vegetables and white meat was protective against PDAC, whilst a low intake of fish increased PDAC risk. Keywords: Pancreatic cancer, risk factors, epidemiology and case-control.
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirement for the degree of Master of Science in Epidemiology and Biostatistics. November 2017.