Abstract
BACKGROUND: Brain cancer is an important public health concern in terms of its burden and the cost of its treatment. Evidence on determinants of brain cancer incidence and survival are sparse and inconsistent. We aimed to explore the pre-diagnostic factors for brain cancer incidence and survival in northeastern Iran. METHODS: Data for the current study were derived from the Golestan Cohort Study, the largest cohort study in the Middle East on over 50,000 participants aged 40 to 75 years with a median follow-up of 15 years. Minimally adjusted and multiple Cox proportional hazards models were used to investigate the association of demographic and behavioral risk factors with brain cancer incidence and survival. RESULTS: Out of the 49,783 cancer free participants recruited at baseline, 77 patients were diagnosed with brain cancer and 62 patients were deceased till the end of the follow-up. Annual cancer mortality rate was 0.31 (95% Confidence Interval: 0.24 - 0.39), one-year survival was 38%, and the median survival was 0.72 years. In the multiple model, Turkmen ethnicity (Hazard Ratio = 0.42 (0.23-0.76)), urban residence (HR = 0.46 (0.25-0.84)), overweight or obesity (HR = 0.48 (0.25-0.93)), and history of animal contact (HR = 0.43 (0.19-0.96)) were associated with a better survival. Patients diagnosed with brain cancer had higher prevalence of hypertension, opium use, and smoking compared to cancer free participants. CONCLUSIONS: Our results indicate a complex interplay of demographic and life style risk factors influencing both the incidence and prognosis of brain cancer. Further research is mandated to inform policy makers of potentially effective preventive initiatives to reduce the burden of this cancer.