Table 4.

Associations between ACS guidelines score and all-cause and cancer-specific mortality (n = 65,838)

EventsAge-adjustedFully adjusteda
Cause of deathACS scorePerson-years, millionsn (%)HR (95% CI)HR (95% CI)
Any cause
0—37,0152,862 (12.0)1.001.00
4–510,4643,074 (10.7)0.78 (0.74–0.82)0.86 (0.82–0.91)
6–82,2701,170 (8.85)0.62 (0.58–0.66)0.73 (0.68–0.78)
Ptrendb<0.001<0.001
Trendb0.89 (0.88–0.90)0.93 (0.92–0.95)
Any cancer (other than non-melanoma skin cancer)
0–37,015945 (4.00)1.001.00
4–510,4641,003 (3.53)0.80 (0.73–0.88)0.88 (0.81–0.97)
6–82,270408 (3.12)0.68 (0.61–0.77)0.80 (0.71–0.90)
Ptrendb<0.001<0.001
Trendb0.91 (0.89–0.94)0.95 (0.93–0.98)
Breast cancer
0—37,01578 (0.33)1.001.00
4—510,46485 (0.30)0.83 (0.61–1.13)0.90 (0.65–1.23)
6—82,27029 (0.22)0.59 (0.39–0.91)0.67 (0.43–1.03)
Ptrendb0.0080.049
Trendb0.88 (0.81–0.97)0.91 (0.83–1.00)
Colorectal cancer
0—37,01594 (0.40)1.001.00
4—510,46476 (0.27)0.61 (0.45–0.83)0.66 (0.49–0.90)
6—82,27020 (0.15)0.34 (0.21–0.55)0.39 (0.24–0.63)
Ptrendb<0.001<0.001
Trendb0.80 (0.73–0.88)0.83 (0.75–0.91)
Endometrial cancer
0–37,01521 (0.09)1.001.00
4–510,46414 (0.05)0.50 (0.26–0.99)0.49 (0.25–0.98)
6–82,2708 (0.06)0.60 (0.27–1.36)0.59 (0.26–1.37)
Ptrendb0.0860.085
Trendb0.84 (0.69–1.02)0.84 (0.68–1.02)
Ovarian cancer
0–37,01563 (0.27)1.001.00
4–510,46486 (0.30)1.06 (0.76–1.47)1.10 (0.79–1.53)
6–82,27033 (0.25)0.86 (0.56–1.30)0.90 (0.58–1.39)
Ptrendb0.2300.373
Trendb0.94 (0.86–1.04)0.96 (0.87–1.05)
Lung cancer
0–37,015110 (0.47)1.001.00
4–510,464130 (0.46)0.92 (0.71–1.18)1.18 (0.91–1.52)
6–82,27045 (0.34)0.68 (0.48–0.96)1.07 (0.75–1.52)
Ptrendb0.0180.505
Trendb0.91 (0.85–0.98)1.03 (0.95–1.11)
Other cancerc
0–37,015534 (2.26)1.001.00
4–510,464561 (1.97)0.79 (0.70–0.89)0.85 (0.76–0.96)
6–82,270257 (1.96)0.75 (0.65–0.87)0.86 (0.74–1.00)
Ptrendb<0.0010.083
Trendb0.93 (0.90–0.97)0.97 (0.94–1.00)
  • aAdjusted for age (continuous), education (≤high school, some college, ≥college), smoking pack-years (never smoking, <5, 5–19, 20+), NSAID use baseline (yes, no), aspirin use baseline (yes, no), unopposed estrogen use (never, former, current), estrogen + progestin use (never, former, current), multivitamin use baseline (yes, no), race/ethnicity (NHW, Hispanic, black, Asian, Native American, other), energy intake (continuous), parous (yes, no, unknown), mammogram (ever, never; included only in models for any cause, any cancer, breast cancer), colonoscopy/sigmoidoscopy (ever, never; included only in models for any cause, any cancer, colorectal cancer), family history of cancer (yes, no, unknown), and having a current healthcare provider (yes, no).

  • bTrend tested by modeling ACS score as an ordinal variable (0–8).

  • cAny cancer other than breast, colorectal, endometrial, ovarian, lung, and non-melanoma skin cancer.