Understanding racial disparities in renal cell carcinoma incidence: estimates of population attributable risk in two US populations

Purpose: Renal cell carcinoma (RCC) incidence is higher among black than white Americans. The reasons for this disparity remain unclear. Methods: We calculated race- and sex-specific population attributable risk percentages (PAR%) and their 95% confidence intervals (CI) for hypertension and chronic kidney disease (CKD) among black and white subjects ≥ 50 years of age from the US Kidney Cancer Study (USKC; 965 cases, 953 controls), a case–control study in Chicago and Detroit, and a nested case–control study in the Kaiser Permanente Northern California health care network (KPNC; 2,162 cases, 21,484 controls). We also estimated PAR% for other modifiable RCC risk factors (cigarette smoking, obesity) in USKC. Results: In USKC, the PAR% for hypertension was 50% (95% CI 24–77%) and 44% (95% CI 25–64%) among black women and men, respectively, and 29% (95% CI 13–44%) and 27% (95% CI 14–39%) for white women and men, respectively. In KPNC, the hypertension PAR% was 40% (95% CI 18–62%) and 23% (95% CI 2–44%) among black women and men, and 27% (95% CI 20–35%) and 19% (95% CI 14–24%) among white women and men, respectively. The PAR% for CKD in both studies ranged from 7 to 10% for black women and men but was negligible (<1%) for white subjects. In USKC, the PAR% for current smoking was 20% and 8% among black and white men, respectively, and negligible and 8.6% for black and white women, respectively. The obesity PAR% ranged from 12 to 24% across all race/sex strata. Conclusions: If the associations found are causal, interventions that prevent hypertension and CKD among black Americans could potentially eliminate the racial disparity in RCC incidence (hypothetical black:white RCC incidence ratio of 0.5).