Alcohol Consumption and Mortality in the Korean Multi-center Cancer Cohort Study / 예방의학회지

OBJECTIVES: To examine the association between alcohol consumption habit, types of beverages, alcohol consumption quantity, and overall and cancer-specific mortality among Korean adults. METHODS: The alcohol consumption information of a total of 16 320 participants who were 20 years or older from the Korean Multi-center Cancer Cohort were analyzed to examine the association between alcohol consumption habit and mortality (median follow-up of 9.3 years). The Cox proportional hazard model was used to estimate the hazard ratio (HR) of alcohol consumption to mortality adjusting for age, sex, geographic areas, education, smoking status, and body mass index. RESULTS: Alcohol drinkers showed an increased risk for total mortality compared with never drinkers (HR, 1.72; 95% confidence interval [CI], 1.38 to 2.14 for past drinkers; HR, 1.21; 95% CI, 1.06 to 1.39 for current drinkers), while past drinkers only were associated with higher risk for cancer deaths (HR, 1.84; 95% CI, 1.34 to 2.53). The quantity of alcohol consumed per week showed a J-shaped association with risk of mortality. Relative to light drinkers (0.01 to 90 g/wk), never drinkers and heavy drinkers (>504 g/wk) had an increased risk for all-cause and cancer deaths: (HR, 1.18; 95% CI, 0.96 to 1.45) and (HR, 1.39; 95% CI, 1.05 to 1.83) for all-cause mortality; and (HR, 1.55; 95% CI, 1.15 to 2.11) and (HR, 2.07; 95% CI, 1.39 to 3.09) for all cancer mortality, respectively. Heavy drinkers (>504 g/wk) showed an elevated risk for death from stomach and liver cancers. CONCLUSIONS: The present study supports the existence of a J-shaped association between alcohol consumption quantity and the risk of all-cause and cancer deaths. Heavy drinkers had an increased risk of death from cancer overall and liver and stomach cancer.

Completeness of Cancer Case Ascertainment in Korea Radiation Effect and Epidemiology Cohort Study

The aim of this study was to evaluate whether the completeness of case ascertainment during the follow-up of a cohort differed between the exposed and the nonexposed groups in Korea Radiation Effect and Epidemiology Cohort (KREEC). The completeness was defined as the proportion of the number of detected cases to the number of estimated cases, in which the estimation was performed by capture-recapture method. Data were obtained from the cancer registries, death certificates, and medical records during years 2004-2007. Among 11,367 subjects in the exposed group and 24,809 subjects in the unexposed group, the completeness of cancer case ascertainment were 88.2% vs 87.2% in cancer registry, 38.2% vs 41.1% in death certificate and 57.9% vs 62.0% in medical records data, 96.9% vs 97.1% for all combined sources and were not statistically different between the two groups. In conclusion, the method of ascertaining the cases in the KREEC was not biased depending on the exposure status, and thus adds credibility to the outcomes of the KREEC study as well as confirming the incident cases in the two groups.

Power Estimation and Follow-Up Period Evaluation in Korea Radiation Effect and Epidemiology Cohort Study / 예방의학회지

OBJECTIVES: The objective of this study was to calculate sample size and power in an ongoing cohort, Korea radiation effect and epidemiology cohort (KREEC). METHOD: Sample size calculation was performed using PASS 2002 based on Cox regression and Poisson regression models. Person-year was calculated by using data from '1993-1997 Total cancer incidence by sex and age, Seoul' and Korean statistical informative service. RESULTS: With the assumption of relative risk=1.3, exposure:non-exposure=1:2 and power=0.8, sample size calculation was 405 events based on a Cox regression model. When the relative risk was assumed to be 1.5 then number of events was 170. Based on a Poisson regression model, relative risk=1.3, exposure:non-exposure=1:2 and power=0.8 rendered 385 events. Relative risk of 1.5 resulted in a total of 157 events. We calculated person-years (PY) with event numbers and cancer incidence rate in the non-exposure group. Based on a Cox regression model, with relative risk=1.3, exposure:non-exposure=1:2 and power=0.8, 136 245PY was needed to secure the power. In a Poisson regression model, with relative risk=1.3, exposure:non-exposure=1:2 and power=0.8, person-year needed was 129517PY. A total of 1939 cases were identified in KREEC until December 2007. CONCLUSIONS: A retrospective power calculation in an ongoing study might be biased by the data. Prospective power calculation should be carried out based on various assumptions prior to the study.

Cigarette Smoking and Mortality in the Korean Multi-center Cancer Cohort (KMCC) Study / 예방의학회지

OBJECTIVES: The aim of this study was to evaluate the association between cigarette smoking and total mortality, cancer mortality and other disease mortalities in Korean adults. METHODS: A total of 14 161 subjects of the Korean Multi-center Cancer Cohort who were over 40 years of age and who were cancer-free at baseline enrollment reported their lifestyle factors, including the smoking status. The median follow-up time was 6.6 years. During the follow-up period from 1993 to 2005, we identified 1159 cases of mortality, including 260 cancer mortality cases with a total of 91 987 person-years, by the national death certificate. Cox proportional hazard regression model was used to estimate the hazard ratio (HR) of cigarette smoking for total mortality, cancer mortality and disease-specific mortality, as adjusted for age, gender, the geographic area and year of enrollment, the alcohol consumption status, the education level and the body mass index (BMI). RESULTS: Cigarette smoking was significantly associated with an increased risk of total mortality, all-cancer mortality and lung cancer mortality (p-trend, <0.01, <0.01, <0.01, respectively). Compared to non-smoking, current smokers were at a higher risk for mortality [HR (95% CI)=1.3 (1.1-1.5) for total mortality; HR (95% CI)=1.6 (1.1-2.2) for all-cancer mortality; HR (95% CI)=3.9 (1.9-7.7) for lung cancer mortality]. CONCLUSIONS: This study's results suggest that cigarette smoking might be associated with total mortality, all-cancer mortality and especially lung cancer mortality among Korean adults.