Lifestyle factors associated with sex differences in Kaposi sarcoma incidence among adult black South Africans: A case-control study

Melitah Motlhale; Freddy Sitas; Debbie Bradshaw; Wenlong Carl Chen; Mwiza Gideon Singini; Chantal Babb de Villiers; Cathryn M Lewis; Mazvita Muchengeti; Tim Waterboer; Christopher G Mathew; Robert Newton; Elvira Singh

doi:10.1016/j.canep.2022.102158

Lifestyle factors associated with sex differences in Kaposi sarcoma incidence among adult black South Africans: A case-control study

Melitah Motlhale, Freddy Sitas, Debbie Bradshaw, Wenlong Carl Chen, Mwiza Gideon Singini, Chantal Babb de Villiers, Cathryn M Lewis, Mazvita Muchengeti, Tim Waterboer, Christopher G Mathew, Robert Newton, Elvira Singh

Health Sciences

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Article number	102158
Number of pages	8
Journal	Cancer Epidemiology
Volume	78
Early online date	11 Apr 2022
DOIs	https://doi.org/10.1016/j.canep.2022.102158
Publication status	Published - Jun 2022

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Motlhale, M., Sitas, F., Bradshaw, D., Chen, W. C., Singini, M. G., de Villiers, C. B., Lewis, C. M., Muchengeti, M., Waterboer, T., Mathew, C. G., Newton, R., & Singh, E. (2022). Lifestyle factors associated with sex differences in Kaposi sarcoma incidence among adult black South Africans: A case-control study. Cancer Epidemiology, 78, Article 102158. https://doi.org/10.1016/j.canep.2022.102158

@article{21ba59efb383492e91164a1e46169866,

title = "Lifestyle factors associated with sex differences in Kaposi sarcoma incidence among adult black South Africans: A case-control study",

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.",

author = "Melitah Motlhale and Freddy Sitas and Debbie Bradshaw and Chen, {Wenlong Carl} and Singini, {Mwiza Gideon} and {de Villiers}, {Chantal Babb} and Lewis, {Cathryn M} and Mazvita Muchengeti and Tim Waterboer and Mathew, {Christopher G} and Robert Newton and Elvira Singh",

year = "2022",

month = jun,

doi = "10.1016/j.canep.2022.102158",

language = "English",

volume = "78",

journal = "Cancer Epidemiology",

issn = "1877-7821",

publisher = "Elsevier",

}

Motlhale, M, Sitas, F, Bradshaw, D, Chen, WC, Singini, MG, de Villiers, CB, Lewis, CM, Muchengeti, M, Waterboer, T, Mathew, CG, Newton, R & Singh, E 2022, 'Lifestyle factors associated with sex differences in Kaposi sarcoma incidence among adult black South Africans: A case-control study', Cancer Epidemiology, vol. 78, 102158. https://doi.org/10.1016/j.canep.2022.102158

TY - JOUR

T1 - Lifestyle factors associated with sex differences in Kaposi sarcoma incidence among adult black South Africans

T2 - A case-control study

AU - Motlhale, Melitah

AU - Sitas, Freddy

AU - Bradshaw, Debbie

AU - Chen, Wenlong Carl

AU - Singini, Mwiza Gideon

AU - de Villiers, Chantal Babb

AU - Lewis, Cathryn M

AU - Muchengeti, Mazvita

AU - Waterboer, Tim

AU - Mathew, Christopher G

AU - Newton, Robert

AU - Singh, Elvira

PY - 2022/6

Y1 - 2022/6

N2 - 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.

AB - 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.

U2 - 10.1016/j.canep.2022.102158

DO - 10.1016/j.canep.2022.102158

M3 - Article

C2 - 35421713

SN - 1877-7821

VL - 78

JO - Cancer Epidemiology

JF - Cancer Epidemiology

M1 - 102158

ER -