The inverse association between cancer history and incident cognitive impairment: Addressing attrition bias
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View abstract on PubMed
Summary
This summary is machine-generated.Cancer history is linked to a reduced risk of cognitive impairment, even when accounting for mortality. However, cancer also increases the risk of all-cause mortality.
Area Of Science
- Gerontology
- Epidemiology
- Oncology
Background
- The inverse relationship between cancer and cognitive impairment is well-documented.
- The role of statistical handling of attrition, such as death and censoring, in this association remains unclear.
Purpose Of The Study
- To investigate the association between cancer history and incident cognitive impairment.
- To evaluate the impact of competing risks, specifically all-cause mortality, on this association using various statistical models.
Main Methods
- Analysis of data from the Health, Aging, and Body Composition Study (n=2604) excluding participants with baseline cognitive impairment or stroke.
- Utilized multiple competing-risks models including cause-specific, subdistribution, and marginal hazards, alongside composite-outcome and all-cause mortality models.
- Adjusted for covariates such as demographics, apolipoprotein E ε4 status, lifestyle factors, and other health conditions.
Main Results
- After covariate adjustment, cause-specific and marginal hazard ratios (HRs) indicated an inverse association between cancer history and cognitive impairment (HR ≈ 0.84).
- The subdistribution HR was 0.764, suggesting a reduced hazard of cognitive impairment in individuals with cancer history.
- Cancer history was positively associated with all-cause mortality (HR = 1.813), indicating an increased risk of death.
Conclusions
- Competing risks models confirmed an inverse association between cancer history and incident cognitive impairment, robust to the competing risk of death.
- The choice of estimand in competing risks models influenced the specific findings, highlighting the importance of model selection.
- Cancer history was associated with a 16% lower hazard of cognitive impairment and an 81% higher hazard of all-cause mortality.
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