Association between Obesity and Cancer: An Analysis Using the Competing Risk Regression Approach

Abstract

Cox model has been the commonly used method in past analyses of association between obesity and the risk estimates of cancer in situations where the subjects have also died (or could die) of noncancer events (competing events). The Cox model does not address the presence of competing events convincingly. The competing risk approach accommodates the fact that individuals who died of other causes (competing events) will never die of cancer and thus provides more realistic estimates. This study uses the competing risk approach to study the association of obesity and cancer mortality and compare the analysis results with those based on the traditional Cox model. It was seen that while the cause-specific hazard rate of cancer is significantly higher for obese population compared to normal weight population, the difference is not significant using competing risk approach. We demonstrated that higher cause-specific hazard rate does not necessarily imply higher incidence rate and in situations involving competing events we recommend using competing risk approach in addition to the Cox regression model.