1Work Health Institute, Total Health Care Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
2Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
3Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
4Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
5Division of Gastroenterology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
6Samsung Health Research Institute, Samsung Electronics Co. Ltd., Hwaseong, Korea
7Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Korea
8Department of Occupational and Environmental Medicine, Hanyang University College of Medicine, Seoul, Korea
Copyright © 2023 by the Korean Cancer Association
This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Ethical Statement
This study was approved by the Institutional Review Board of Kangbuk Samsung Hospital, which waived the requirement for informed consent due to the use of anonymized data routinely collected as part of a health check-up program and already linked to mortality data from the Korea National Statistical Office (IRB No. 2011-01-030-005 for the general Kangbuk Samsung Health Study protocol and 2021-10-032 for the present study).
Author Contributions
Conceived and designed the analysis: Lee JA, Chang Y, Ryu S.
Acquisition, analysis, or interpretation of data: Lee JA, Chang Y, Kim Y, Park DI, Park SK, Park HY, Koh J, Lee SJ, Ryu S.
Wrote the paper: Lee JA, Chang Y.
Critical revision of the manuscript for important intellectual content: Lee JA, Chang Y, Kim Y, Park DI, Park SK, Park HY, Koh J, Lee SJ, Ryu S.
Statistical analysis: Chang Y, Ryu S.
Obtained funding: Chang Y, Ryu S.
Supervision: Chang Y, Ryu S.
Conflicts of Interest
Conflict of interest relevant to this article was not reported.
Characteristic | Colonoscopic screening | p-value | |
---|---|---|---|
Never | Ever | ||
No. | 357,325 | 170,721 | |
Age (yr) | 38.1 (38.0–38.1) | 43.5 (43.5–43.6) | < 0.001 |
Male sex (%) | 48.3 (48.1–48.4) | 61.6 (61.4–61.9) | < 0.001 |
BMI (kg/m2) | 23.3 (23.3–23.3) | 23.4 (23.4–23.4) | < 0.001 |
Current smoker (%) | 22.8 (22.7–23.0) | 21.0 (20.8–21.2) | < 0.001 |
Alcohol intake (%)b) | 18.0 (17.9–18.1) | 22.8 (22.6–23.0) | < 0.001 |
Regular exercise (%)c) | 15.3 (15.1–15.4) | 16.4 (16.2–16.6) | < 0.001 |
Highest education level (%)d) | 78.2 (78.0–78.3) | 75.8 (75.5–76.0) | < 0.001 |
Obesity (%)e) | 28.2 (28.1–28.4) | 29.5 (29.3–29.7) | < 0.001 |
Diabetes (%) | 4.4 (4.4–4.5) | 4.6 (4.5–4.7) | 0.013 |
Hypertension (%) | 14.1 (14.0–14.2) | 13.4 (13.2–13.5) | < 0.001 |
History of CVD (%) | 5.6 (5.5–5.6) | 4.5 (4.4–4.6) | < 0.001 |
Medication for hyperlipidemia (%) | 2.6 (2.5–2.6) | 3.5 (3.5–3.6) | < 0.001 |
Family history of cancer | 22.8 (22.6–22.9) | 27.9 (27.6–28.1) | < 0.001 |
Systolic BP (mmHg) | 111.7 (111.6–111.7) | 110.6 (110.5–110.6) | < 0.001 |
Diastolic BP (mmHg) | 71.6 (71.6–71.7) | 70.8 (70.7–70.8) | < 0.001 |
Glucose (mg/dL) | 95.9 (95.9–96.0) | 93.3 (93.2–93.3) | < 0.001 |
Total cholesterol (mg/dL) | 192.0 (191.9–192.1) | 193.9 (193.8–194.1) | < 0.001 |
LDL-C (mg/dL) | 115.3 (115.2–115.4) | 120.0 (119.8–120.1) | < 0.001 |
HDL-C (mg/dL) | 57.2 (57.1–57.2) | 57.9 (57.9–58.0) | < 0.001 |
Triglycerides (mg/dL) | 117.5 (117.2–117.7) | 106.7 (106.4–107.1) | < 0.001 |
ALT (U/L) | 23.5 (23.4–23.5) | 26.2 (26.1–26.3) | < 0.001 |
hsCRP (mg/L) | 1.1 (1.1–1.1) | 1.1 (1.1–1.1) | < 0.001 |
HOMA-IRb) | 1.76 (1.76–1.77) | 1.45 (1.44–1.46) | < 0.001 |
ALT, alanine aminotransferase; BMI, body mass index; BP, blood pressure; CVD, cardiovascular disease; HDL-C, high-density lipoprotein cholesterol; HOMA-IR, homeostasis model assessment of insulin resistance; hsCRP, high-sensitivity C-reactive protein; LDL-C, low-density lipoprotein cholesterol.
a) Adjusted for age and sex,
b) ≥ 20 g/day,
c) ≥ 3 times/wk,
d) ≥ College graduate,
e) BMI ≥ 25 kg/m2.
Colonoscopy screening | Person-years | No. of events | Mortality rate (per 105 PY) | Age and sex-adjusted HR (95% CI) | Multivariable-adjusted HRa) (95% CI) | HR (95% CI)b) in the model using time-dependent variables |
---|---|---|---|---|---|---|
Total | ||||||
Never | 12,775,275.0 | 6,790 | 53.1 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Ever | 4,034,204.7 | 3,257 | 80.7 | 0.87 (0.81–0.95) | 0.89 (0.82–0.96) | 0.67 (0.62–0.73) |
Age < 45 yr | ||||||
Never | 11,295,458.0 | 3,681 | 32.6 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Ever | 2,873,664.7 | 1,075 | 37.4 | 1.01 (0.87–1.17) | 1.02 (0.88–1.18) | 0.86 (0.75–0.99) |
Age ≥ 45 yr | ||||||
Never | 1,479,817.2 | 3,109 | 210.1 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Ever | 1,160,540.0 | 2,182 | 188.0 | 0.80 (0.73–0.86) | 0.81 (0.75–0.89) | 0.71 (0.65–0.78) |
p=0.021 for the overall interaction between age and colonoscopic screening for all-cause mortality (time-dependent model). CI, confidence interval; CVD, cardiovascular disease; HR, hazard ratio; PY, person-years.
a) Cox proportional hazard models with inverse probability weights with age as a time scale were used to estimate HRs and 95% CIs. The multivariable-adjusted model was adjusted for age (time scale), sex, year of screening examination, study center, obesity, smoking status, regular exercise, alcohol intake, educational level, family history of cancer, medication for hyperlipidemia, history of diabetes, history of hypertension, and history of CVD,
b) Estimated from Cox proportional hazard models with inverse probability weights with colonoscopic screening, obesity, smoking status, regular exercise, alcohol intake, educational level, medication for hyperlipidemia, history of diabetes, history of hypertension, and history of CVD as time-dependent variables and baseline age, sex, study center, year of screening examination, education level, and family history of cancer as time-fixed variables.
Colonoscopy screening | Person-years | No. of events | Mortality rate (per 105 PY) | Age and sex-adjusted HR (95% CI) | Multivariable-adjusted HRa) (95% CI) | HR (95% CI)b) in the model using time-dependent variables |
---|---|---|---|---|---|---|
Total | ||||||
Never | 12,775,275.0 | 165 | 1.3 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Ever | 4,034,204.7 | 61 | 1.5 | 0.63 (0.34–1.17) | 0.68 (0.36–1.30) | 0.50 (0.31–0.80) |
Age < 45 yr | ||||||
Never | 11,295,458.0 | 64 | 0.6 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Ever | 2,873,664.7 | 17 | 0.6 | 0.95 (0.24–3.76) | 1.09 (0.26–4.59) | 0.47 (0.15–1.44) |
Age ≥ 45 yr | ||||||
Never | 1,479,817.2 | 101 | 6.8 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Ever | 1,160,540.0 | 44 | 3.8 | 0.53 (0.30–0.93) | 0.57 (0.32–1.00) | 0.52 (0.31–0.87) |
p=0.931 for the overall interaction between age and colonoscopic screening for colorectal cancer mortality (time-dependent model). CI, confidence interval; CVD, cardiovascular disease; HR, hazard ratio; PY, person-years.
a) Cox proportional hazard models with inverse probability weights with age as a time scale were used to estimate HRs and 95% CIs. The multivariable-adjusted model was adjusted for age (time scale), sex, year of screening examination, study center, obesity, smoking status, regular exercise, alcohol intake, educational level, family history of cancer, medication for hyperlipidemia, history of diabetes, history of hypertension, and history of CVD,
b) Estimated from Cox proportional hazard models with inverse probability weights with colonoscopic screening, obesity, smoking status, regular exercise, alcohol intake, educational level, medication for hyperlipidemia, history of diabetes, history of hypertension, and history of CVD as time-dependent variables and baseline age, sex, study center, year of screening examination, education level, and family history of cancer as time-fixed variables.
Estimated
Characteristic | Colonoscopic screening | p-value | |
---|---|---|---|
Never | Ever | ||
No. | 357,325 | 170,721 | |
Age (yr) | 38.1 (38.0–38.1) | 43.5 (43.5–43.6) | < 0.001 |
Male sex (%) | 48.3 (48.1–48.4) | 61.6 (61.4–61.9) | < 0.001 |
BMI (kg/m2) | 23.3 (23.3–23.3) | 23.4 (23.4–23.4) | < 0.001 |
Current smoker (%) | 22.8 (22.7–23.0) | 21.0 (20.8–21.2) | < 0.001 |
Alcohol intake (%) |
18.0 (17.9–18.1) | 22.8 (22.6–23.0) | < 0.001 |
Regular exercise (%) |
15.3 (15.1–15.4) | 16.4 (16.2–16.6) | < 0.001 |
Highest education level (%) |
78.2 (78.0–78.3) | 75.8 (75.5–76.0) | < 0.001 |
Obesity (%) |
28.2 (28.1–28.4) | 29.5 (29.3–29.7) | < 0.001 |
Diabetes (%) | 4.4 (4.4–4.5) | 4.6 (4.5–4.7) | 0.013 |
Hypertension (%) | 14.1 (14.0–14.2) | 13.4 (13.2–13.5) | < 0.001 |
History of CVD (%) | 5.6 (5.5–5.6) | 4.5 (4.4–4.6) | < 0.001 |
Medication for hyperlipidemia (%) | 2.6 (2.5–2.6) | 3.5 (3.5–3.6) | < 0.001 |
Family history of cancer | 22.8 (22.6–22.9) | 27.9 (27.6–28.1) | < 0.001 |
Systolic BP (mmHg) | 111.7 (111.6–111.7) | 110.6 (110.5–110.6) | < 0.001 |
Diastolic BP (mmHg) | 71.6 (71.6–71.7) | 70.8 (70.7–70.8) | < 0.001 |
Glucose (mg/dL) | 95.9 (95.9–96.0) | 93.3 (93.2–93.3) | < 0.001 |
Total cholesterol (mg/dL) | 192.0 (191.9–192.1) | 193.9 (193.8–194.1) | < 0.001 |
LDL-C (mg/dL) | 115.3 (115.2–115.4) | 120.0 (119.8–120.1) | < 0.001 |
HDL-C (mg/dL) | 57.2 (57.1–57.2) | 57.9 (57.9–58.0) | < 0.001 |
Triglycerides (mg/dL) | 117.5 (117.2–117.7) | 106.7 (106.4–107.1) | < 0.001 |
ALT (U/L) | 23.5 (23.4–23.5) | 26.2 (26.1–26.3) | < 0.001 |
hsCRP (mg/L) | 1.1 (1.1–1.1) | 1.1 (1.1–1.1) | < 0.001 |
HOMA-IR |
1.76 (1.76–1.77) | 1.45 (1.44–1.46) | < 0.001 |
ALT, alanine aminotransferase; BMI, body mass index; BP, blood pressure; CVD, cardiovascular disease; HDL-C, high-density lipoprotein cholesterol; HOMA-IR, homeostasis model assessment of insulin resistance; hsCRP, high-sensitivity C-reactive protein; LDL-C, low-density lipoprotein cholesterol.
a)Adjusted for age and sex,
b)≥ 20 g/day,
c)≥ 3 times/wk,
d)≥ College graduate,
e)BMI ≥ 25 kg/m2.
All-cause mortality by colonoscopic screening
Colonoscopy screening | Person-years | No. of events | Mortality rate (per 105 PY) | Age and sex-adjusted HR (95% CI) | Multivariable-adjusted HR |
HR (95% CI) |
---|---|---|---|---|---|---|
Total | ||||||
Never | 12,775,275.0 | 6,790 | 53.1 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Ever | 4,034,204.7 | 3,257 | 80.7 | 0.87 (0.81–0.95) | 0.89 (0.82–0.96) | 0.67 (0.62–0.73) |
Age < 45 yr | ||||||
Never | 11,295,458.0 | 3,681 | 32.6 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Ever | 2,873,664.7 | 1,075 | 37.4 | 1.01 (0.87–1.17) | 1.02 (0.88–1.18) | 0.86 (0.75–0.99) |
Age ≥ 45 yr | ||||||
Never | 1,479,817.2 | 3,109 | 210.1 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Ever | 1,160,540.0 | 2,182 | 188.0 | 0.80 (0.73–0.86) | 0.81 (0.75–0.89) | 0.71 (0.65–0.78) |
p=0.021 for the overall interaction between age and colonoscopic screening for all-cause mortality (time-dependent model). CI, confidence interval; CVD, cardiovascular disease; HR, hazard ratio; PY, person-years.
a)Cox proportional hazard models with inverse probability weights with age as a time scale were used to estimate HRs and 95% CIs. The multivariable-adjusted model was adjusted for age (time scale), sex, year of screening examination, study center, obesity, smoking status, regular exercise, alcohol intake, educational level, family history of cancer, medication for hyperlipidemia, history of diabetes, history of hypertension, and history of CVD,
b)Estimated from Cox proportional hazard models with inverse probability weights with colonoscopic screening, obesity, smoking status, regular exercise, alcohol intake, educational level, medication for hyperlipidemia, history of diabetes, history of hypertension, and history of CVD as time-dependent variables and baseline age, sex, study center, year of screening examination, education level, and family history of cancer as time-fixed variables.
Colorectal cancer mortality by colonoscopic screening
Colonoscopy screening | Person-years | No. of events | Mortality rate (per 105 PY) | Age and sex-adjusted HR (95% CI) | Multivariable-adjusted HR |
HR (95% CI) |
---|---|---|---|---|---|---|
Total | ||||||
Never | 12,775,275.0 | 165 | 1.3 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Ever | 4,034,204.7 | 61 | 1.5 | 0.63 (0.34–1.17) | 0.68 (0.36–1.30) | 0.50 (0.31–0.80) |
Age < 45 yr | ||||||
Never | 11,295,458.0 | 64 | 0.6 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Ever | 2,873,664.7 | 17 | 0.6 | 0.95 (0.24–3.76) | 1.09 (0.26–4.59) | 0.47 (0.15–1.44) |
Age ≥ 45 yr | ||||||
Never | 1,479,817.2 | 101 | 6.8 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Ever | 1,160,540.0 | 44 | 3.8 | 0.53 (0.30–0.93) | 0.57 (0.32–1.00) | 0.52 (0.31–0.87) |
p=0.931 for the overall interaction between age and colonoscopic screening for colorectal cancer mortality (time-dependent model). CI, confidence interval; CVD, cardiovascular disease; HR, hazard ratio; PY, person-years.
a)Cox proportional hazard models with inverse probability weights with age as a time scale were used to estimate HRs and 95% CIs. The multivariable-adjusted model was adjusted for age (time scale), sex, year of screening examination, study center, obesity, smoking status, regular exercise, alcohol intake, educational level, family history of cancer, medication for hyperlipidemia, history of diabetes, history of hypertension, and history of CVD,
b)Estimated from Cox proportional hazard models with inverse probability weights with colonoscopic screening, obesity, smoking status, regular exercise, alcohol intake, educational level, medication for hyperlipidemia, history of diabetes, history of hypertension, and history of CVD as time-dependent variables and baseline age, sex, study center, year of screening examination, education level, and family history of cancer as time-fixed variables.
ALT, alanine aminotransferase; BMI, body mass index; BP, blood pressure; CVD, cardiovascular disease; HDL-C, high-density lipoprotein cholesterol; HOMA-IR, homeostasis model assessment of insulin resistance; hsCRP, high-sensitivity C-reactive protein; LDL-C, low-density lipoprotein cholesterol. Adjusted for age and sex, ≥ 20 g/day, ≥ 3 times/wk, ≥ College graduate, BMI ≥ 25 kg/m2.
p=0.021 for the overall interaction between age and colonoscopic screening for all-cause mortality (time-dependent model). CI, confidence interval; CVD, cardiovascular disease; HR, hazard ratio; PY, person-years. Cox proportional hazard models with inverse probability weights with age as a time scale were used to estimate HRs and 95% CIs. The multivariable-adjusted model was adjusted for age (time scale), sex, year of screening examination, study center, obesity, smoking status, regular exercise, alcohol intake, educational level, family history of cancer, medication for hyperlipidemia, history of diabetes, history of hypertension, and history of CVD, Estimated from Cox proportional hazard models with inverse probability weights with colonoscopic screening, obesity, smoking status, regular exercise, alcohol intake, educational level, medication for hyperlipidemia, history of diabetes, history of hypertension, and history of CVD as time-dependent variables and baseline age, sex, study center, year of screening examination, education level, and family history of cancer as time-fixed variables.
p=0.931 for the overall interaction between age and colonoscopic screening for colorectal cancer mortality (time-dependent model). CI, confidence interval; CVD, cardiovascular disease; HR, hazard ratio; PY, person-years. Cox proportional hazard models with inverse probability weights with age as a time scale were used to estimate HRs and 95% CIs. The multivariable-adjusted model was adjusted for age (time scale), sex, year of screening examination, study center, obesity, smoking status, regular exercise, alcohol intake, educational level, family history of cancer, medication for hyperlipidemia, history of diabetes, history of hypertension, and history of CVD, Estimated from Cox proportional hazard models with inverse probability weights with colonoscopic screening, obesity, smoking status, regular exercise, alcohol intake, educational level, medication for hyperlipidemia, history of diabetes, history of hypertension, and history of CVD as time-dependent variables and baseline age, sex, study center, year of screening examination, education level, and family history of cancer as time-fixed variables.