Combined life-style factors and all-causes and cancer-specific mortality in Korea
한국인 사망과 관련된 건강 행태요인의 복합위험도에 관한 코호트 연구

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의과대학 의학과
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서울대학교 대학원
risk factorrisk scorepremature deathcancer deathcombined health effectcohort studyKMCCKorean
학위논문 (석사)-- 서울대학교 대학원 : 의학과 예방의학 전공, 2013. 2. 유근영.
Lifestyle factors such as obesity, smoking habit and alcohol drinking habit are known to be associated with increased risk of all-cause mortality in Korea. However, little has examined the association of combined life-style factors with the risk of mortality.

The study population of 15,740 participants over 20 years old was selected from the Korean Multi-center Cancer Cohort (KMCC) study. Information on lifestyle factors was obtained through structured questionnaire interview. The total number of persons who completed the follow-up through the Death Certificate database of the National Statistical Office was 145,218.4 person-years by the end of December 31, 2008. The total number of death during the study period was 1,094 persons, and 474 deaths were due to cancer and 229 persons were due to cardio-vascular diseases. Each risk factor was dichotomized based on the previous study as follows
body mass index (BMI) under 22.6 or over 27.5 kg/m2 versus 22.6~27.5 kg/m2
current or past smokers versus non-smokers
non-drinkers or drinkers with alcohol amount of 90 gram per week or more versus drinkers less than 90 grams per week. Combined effect of three risk factors was estimated in two different ways
according to the number of risk factors qualitatively, and to the combined risk scores ranged from 0 to 14 quantitatively. The hazard ratios (HRs) and 95% confidence intervals (CI) for mortality were estimated by Cox’s proportional hazard regression model adjusting for age, sex, locality, education, marriage, and the past history of chronic diseases.

The risk of dying was 1.47 times (95% CI = 1.27~1.69) in BMI, 1.50 times (95% CI=1.25~1.79) in smoking habit, and 1.36 times (95% CI=1.08~1.72) higher in alcohol drinking habit than the baseline hazard. The HRs for cancer death was 1.35 (95% CI=1.10~1.66) in BMI, and 1.75 (95% CI=1.32~2.33) in smoking habit, but not statistically significant in alcohol drinking habit.
The HRs for both all-causes mortality and cancer mortality showed linearly increasing pattern with statistical significant according to the number of risk factor (p<0.001). Overall, the combined effect of lifestyle factors was more prominent in female. Particularly noteworthy was that the risk of dying increases according to the combined risk score increasing (p<0.001). Subjects with highest score (1`0~14) had significantly at the greatest risk of deaths (HR=3.46, 95% CI=1.89-6.32). The risk of dying was more prominent in female and participants under age<60.

This study confirms abnormal BMI, smoking habit and alcohol drinking habit are major risk factor of premature deaths, as well as cancer death in Korea. Combined effect of lifestyle factors would additively be associated with marked increased risks of both all-causes and cancer-specific death in Korea.
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College of Medicine/School of Medicine (의과대학/대학원)Dept. of Medicine (의학과)Theses (Master's Degree_의학과)
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