Changes in Smoking, Alcohol Consumption, and the Risk of Thyroid Cancer: A Population-Based Korean Cohort Study
Abstract
:Simple Summary
Abstract
1. Introduction
2. Methods
2.1. Study Design and Population
2.2. Smoking and Alcohol Consumption
2.3. Potential Confounders
2.4. Outcome Measurement
2.5. Statistical Analysis
3. Results
3.1. Risk of Thyroid Cancer by Changes in Cigarette Smoking
3.2. Risk of Thyroid Cancer by Changes in Alcohol Consumption
3.3. Risk of Thyroid Cancer by Joint Effect of Changes in Smoking and Alcohol Consumption
4. Discussion
4.1. Smoking and Thyroid Cancer
4.2. Changes in Smoking and Thyroid Cancer
4.3. Alcohol Intake and Thyroid Cancer
4.4. Changes in Alcohol Consumption and Thyroid Cancer
4.5. Joint Effect of Changes in Smoking and Alcohol Intake
4.6. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | Total (N = 4,430,070) | Thyroid Cancer (N = 29,447) | Non-Cancer (N = 4,400,623) | p-Value |
---|---|---|---|---|
Age (year) | 55.6 ± 10.0 | 53.4 ± 8.4 | 55.6 ± 10.0 | <0.001 |
Sex (male) (N, %) | 2,256,101 (50.9) | 6757 (23.0) | 2,249,344 (51.1) | <0.001 |
Body mass index (kg/m2) | 24.0 ± 3.0 | 24.2 ± 3.1 | 24.0 ± 3.0 | <0.001 |
Residence (urban area) (N, %) | 1,986,395 (44.8) | 14,312 (48.6) | 1,972,083 (44.8) | <0.001 |
Smoking intensity (N, %) | <0.001 | |||
Non-smokers | 3,597,067 (81.2) | 27,063 (91.9) | 3,570,004 (81.1) | |
Light (<0.5 pack/day) | 91,272 (2.2) | 338 (1.2) | 90,934 (2.1) | |
Moderate (0.5–1 pack/day) | 324,851 (7.3) | 967 (3.3) | 323,884 (7.4) | |
Heavy (≥1 pack/day) | 416,880 (9.4) | 1079 (3.7) | 415,801 (9.5) | |
Smoking duration (year) (N, %) | <0.001 | |||
Non-smoker | 2,818,291 (63.6) | 24,395 (82.8) | 2,793,896 (63.5) | |
<5 | 64,215 (1.5) | 304 (1.0) | 63,911 (1.5) | |
5–9 | 84,124 (1.9) | 333 (1.1) | 83,791 (1.9) | |
10–19 | 353,904 (8.0) | 1303 (4.4) | 352,601 (8.0) | |
20–29 | 603,648 (13.6) | 1925 (6.5) | 601,723 (13.7) | |
≥30 | 505,888 (11.4) | 1187 (4.0) | 504,701 (11.5) | |
Smoking history (pack-year) (N, %) | <0.001 | |||
Non-smoker | 2,818,291 (63.6) | 24,395 (82.8) | 2,793,896 (63.5) | |
<10 | 398,411 (9,0) | 1562 (5.3) | 396,849 (9.0) | |
10–19 | 463,189 (10.5) | 1459 (5.0) | 461,730 (10.5) | |
20–29 | 368,321 (8.3) | 1060 (3.6) | 367,261 (8.4) | |
≥30 | 381,858 (8.6) | 971 (3.3) | 380,887 (8.7) | |
Alcohol intake (N, %) | <0.001 | |||
None | 2,561,862 (57.8) | 20,601 (70.0) | 2,541,261 (57.8) | |
Mild (<15 g/day) | 1,146,967 (25.9) | 6354 (21.6) | 1,140,613 (25.9) | |
Moderate (15–30 g/day) | 433,527 (9.8) | 1553 (5.3) | 431,974 (9.8) | |
Heavy (≥30 g/day) | 287,714 (6.5) | 939 (3.2) | 286,775 (6.5) | |
Regular exercise (yes) (N, %) | 971,781 (22.0) | 6390 (21.7) | 965,391 (21.9) | 0.326 |
Income level (N, %) | ||||
Q1 | 1,013,349 (22.9) | 7265 (24.7) | 1,006,084 (22.9) | |
Q2 | 799,440 (18.1) | 5636 (19.1) | 793,804 (18.0) | |
Q3 | 1,033,766 (23.3) | 6330 (21.5) | 1,027,436 (23.4) | |
Q4 | 1,583,515 (35.7) | 10,216 (34.7) | 1,573,299 (35.8) | |
Comorbidities (yes) (N, %) | ||||
Diabetes mellitus, yes | 530,288 (12.0) | 2685 (9.1) | 527,603 (12.0) | <0.001 |
Dyslipidemia, yes | 1,593,542 (36.0) | 10,017 (34.2) | 1,583,525 (36.0) | <0.001 |
Smoking Intensity | Total | Incidence | Person-Years | Incidence Rate | Sustained Non-Smokers as the Reference | Smoking Status at the First Examination as the Reference | |||||
---|---|---|---|---|---|---|---|---|---|---|---|
At Initial | At 2-Year Follow-Up | Crude HR (95% CI) | Age and Sex Adjusted HR (95% CI) | Multivariate Adjusted * HR (95% CI) | Crude HR (95% CI) | Age and Sex Adjusted HR (95% CI) | Multivariate Adjusted * HR (95% CI) | ||||
None | None | 3,414,941 | 26,400 | 21,623,575.19 | 1.22 | 1 (Reference) | 1 (Reference) | 1 (Reference) | 1 (Reference) | 1 (Reference) | 1 (Reference) |
Light | 26,539 | 128 | 166,011.36 | 0.77 | 0.63 (0.53, 0.75) | 0.93 (0.78, 1.10) | 0.96 (0.81, 1.15) | 0.63 (0.53, 0.75) | 0.92 (0.78, 1.10) | 0.96 (0.81, 1.14) | |
Moderate | 51,311 | 189 | 322,074.03 | 0.59 | 0.48 (0.42, 0.55) | 0.87 (0.75, 1.00) | 0.90 (0.78, 1.04) | 0.48 (0.42, 0.55) | 0.86 (0.75, 0.996) | 0.89 (0.77, 1.03) | |
Heavy | 48,927 | 145 | 306,819.47 | 0.47 | 0.39 (0.33, 0.45) | 0.79 (0.67, 0.93) | 0.81 (0.69, 0.96) | 0.39 (0.33, 0.46) | 0.78 (0.66, 0.92) | 0.81 (0.69, 0.95) | |
Light | None | 33,505 | 150 | 209,655.97 | 0.72 | 0.58 (0.50, 0.69) | 0.82 (0.70, 0.97) | 0.84 (0.72, 0.99) | 1.23 (0.97, 1.56) | 1.11 (0.87, 1.41) | 1.09 (0.86, 1.39) |
(<0.5 pack/day) | Light | 33,710 | 122 | 209,883.87 | 0.58 | 0.47 (0.40, 0.57) | 0.73 (0.61, 0.88) | 0.77 (0.65, 0.92) | 1 (Reference) | 1 (Reference) | 1 (Reference) |
Moderate | 16,365 | 54 | 101,994.49 | 0.53 | 0.43 (0.33, 0.56) | 0.75 (0.57, 0.98) | 0.79 (0.60, 1.03) | 0.91 (0.66, 1.26) | 1.03 (0.75, 1.42) | 1.06 (0.77, 1.46) | |
Heavy | 4317 | 11 | 26,862.08 | 0.41 | 0.33 (0.19, 0.60) | 0.66 (0.37, 1.20) | 0.70 (0.39, 1.27) | 0.71 (0.38, 1.31) | 0.93 (0.50, 1.72) | 0.99 (0.53, 1.85) | |
Moderate | None | 72,326 | 257 | 454,445.36 | 0.57 | 0.46 (0.41, 0.52) | 0.85 (0.75, 0.96) | 0.86 (0.76, 0.98) | 1.24 (1.06, 1.43) | 1.18 (1.01, 1.37) | 1.11 (0.95, 1.29) |
(0.5–1 pack/day) | Light | 24,256 | 65 | 151,153.64 | 0.43 | 0.35 (0.28, 0.45) | 0.63 (0.49, 0.80) | 0.67 (0.52, 0.85) | 0.94 (0.73, 1.22) | 0.86 (0.67, 1.12) | 0.86 (0.67, 1.12) |
Moderate | 181,138 | 521 | 1,136,992.88 | 0.46 | 0.37 (0.34, 0.41) | 0.71 (0.65, 0.78) | 0.75 (0.68, 0.82) | 1 (Reference) | 1 (Reference) | 1 (Reference) | |
Heavy | 53,944 | 137 | 337,421.79 | 0.41 | 0.33 (0.28, 0.39) | 0.66 (0.56, 0.78) | 0.69 (0.59, 0.82) | 0.89 (0.73, 1.07) | 0.93 (0.77, 1.12) | 0.95 (0.79, 1.15) | |
Heavy | None | 76,295 | 256 | 479,001.41 | 0.53 | 0.44 (0.39, 0.49) | 0.92 (0.81, 1.04) | 0.92 (0.81, 1.05) | 1.32 (1.14, 1.52) | 1.31 (1.14, 1.51) | 1.23 (1.06, 1.42) |
(≥1 pack/day) | Light | 6767 | 23 | 42,107.32 | 0.55 | 0.45 (0.30, 0.67) | 0.91 (0.61, 1.37) | 0.95 (0.63, 1.44) | 1.34 (0.89, 2.04) | 1.28 (0.85, 1.94) | 1.29 (0.85, 1.95) |
Moderate | 76,037 | 203 | 475,687.6 | 0.43 | 0.35 (0.30, 0.40) | 0.71 (0.62, 0.81) | 0.74 (0.65, 0.86) | 1.05 (0.90, 1.23) | 1.02 (0.88, 1.20) | 1.04 (0.89, 1.22) | |
Heavy | 309,692 | 786 | 1,939,574.2 | 0.41 | 0.33 (0.31, 0.36) | 0.69 (0.64, 0.74) | 0.71 (0.66, 0.77) | 1 (Reference) | 1 (Reference) | 1 (Reference) |
Drinking Habit | Total | Incidence | Person-Years | Incidence Rate | Sustained Non-Drinkers as the Reference | Drinking Status at the First Examination as the Reference | |||||
---|---|---|---|---|---|---|---|---|---|---|---|
At Initial | At 2-Year Follow-Up | Crude HR (95% CI) | Age and Sex Adjusted HR (95% CI) | Multivariate Adjusted * HR (95% CI) | Crude HR (95% CI) | Age and Sex Adjusted HR (95% CI) | Multivariate Adjusted * HR (95% CI) | ||||
None | None | 2,192,774 | 18,230 | 13,866,850.42 | 1.31 | 1 (Reference) | 1 (Reference) | 1 (Reference) | 1 (Reference) | 1 (Reference) | 1 (Reference) |
Light | 291,663 | 2096 | 1,844,051.74 | 1.14 | 0.86 (0.83, 0.90) | 0.96 (0.92, 1.01) | 0.97 (0.92, 1.01) | 0.86 (0.83, 0.90) | 0.96 (0.91, 1.00) | 0.96 (0.92, 1.01) | |
Moderate | 41,871 | 184 | 263,993.07 | 0.70 | 0.53 (0.46, 0.61) | 0.90 (0.78, 1.04) | 0.91 (0.78, 1.05) | 0.53 (0.46, 0.61) | 0.90 (0.78, 1.04) | 0.91 (0.78, 1.05) | |
Heavy | 23,916 | 103 | 149,949.06 | 0.69 | 0.52 (0.43, 0.63) | 1.05 (0.87, 1.28) | 1.07 (0.88, 1.31) | 0.52 (0.43, 0.63) | 1.06 (0.87, 1.29) | 1.07 (0.88, 1.31) | |
Light | None | 299,509 | 2073 | 1,891,864.16 | 1.10 | 0.83 (0.80, 0.87) | 0.95 (0.91, 1.00 | 0.95 (0.91, 1.00) | 1.28 (1.22, 1.35) | 1.06 (0.998, 1.12) | 1.04 (0.99, 1.10) |
(<15 g/day) | Light | 647,455 | 3499 | 4,093,232.18 | 0.85 | 0.65 (0.63, 0.67) | 0.89 (0.86, 0.93) | 0.90 (0.87, 0.94) | 1 (Reference) | 1 (Reference) | 1 (Reference) |
Moderate | 133,920 | 514 | 845,656.2 | 0.61 | 0.46 (0.42, 0.50) | 0.86 (0.78, 0.94) | 0.87 (0.80, 0.96) | 0.71 (0.65, 0.78) | 0.95 (0.87, 1.05) | 0.97 (0.88, 1.06) | |
Heavy | 40,495 | 139 | 254,802.99 | 0.55 | 0.41 (0.35, 0.49) | 0.85 (0.72, 1.00) | 0.87 (0.74, 1.03) | 0.64 (0.54, 0.76) | 0.94 (0.79, 1.11) | 0.96 (0.81, 1.14) | |
Moderate | None | 43,044 | 192 | 270,033.78 | 0.71 | 0.54 (0.47, 0.62) | 0.93 (0.81, 1.08) | 0.92 (0.80, 1.07) | 1.30 (1.11, 1.53) | 1.08 (0.91, 1.28) | 1.04 (0.87, 1.23) |
(15–30 g/day) | Light | 156,105 | 593 | 984,286.9 | 0.60 | 0.46 (0.42, 0.50) | 0.85 (0.78, 0.93) | 0.87 (0.80, 0.95) | 1.11 (0.99, 1.24) | 0.99 (0.89, 1.12) | 0.99 (0.88, 1.11) |
Moderate | 171,760 | 590 | 1,083,760.29 | 0.54 | 0.41 (0.38, 0.45) | 0.86 (0.79, 0.93) | 0.88 (0.81, 0.96) | 1 (Reference) | 1 (Reference) | 1 (Reference) | |
Heavy | 77,300 | 236 | 487,076.76 | 0.48 | 0.37 (0.32, 0.42) | 0.80 (0.70, 0.91) | 0.83 (0.72, 0.94) | 0.90 (0.77, 1.03) | 0.93 (0.80, 1.08) | 0.93 (0.80, 1.09) | |
Heavy | None | 26,535 | 106 | 164,722.03 | 0.64 | 0.49 (0.40, 0.59) | 1.01 (0.84, 1.23) | 1.00 (0.83, 1.22) | 1.28 (1.04, 1.58) | 1.14 (0.92, 1.42) | 1.10 (0.88, 1.38) |
(≥30 g/day) | Light | 51,744 | 166 | 325,094.71 | 0.51 | 0.39 (0.33, 0.45) | 0.79 (0.68, 0.92) | 0.81 (0.69, 0.95) | 1.02 (0.85, 1.21) | 0.90 (0.75, 1.08) | 0.90 (0.75, 1.08) |
Moderate | 85,976 | 265 | 540,585.87 | 0.49 | 0.37 (0.33, 0.42) | 0.81 (0.72, 0.92) | 0.84 (0.74, 0.95) | 0.98 (0.84, 1.14) | 0.93 (0.80, 1.08) | 0.93 (0.80, 1.09) | |
Heavy | 146,003 | 461 | 917,300.52 | 0.50 | 0.38 (0.35, 0.42) | 0.88 (0.80, 0.97) | 0.90 (0.82, 1.00) | 1 (Reference) | 1 (Reference) | 1 (Reference.) |
Smoking/Drinking Status | Total | Incidence | Person-Years | Incidence Rate | Sustained Non-Smokers/Non-Drinkers as the Reference | Smoking/Drinking Status at the First Examination as the Reference | |||||
---|---|---|---|---|---|---|---|---|---|---|---|
At Initial | At 2-Year Follow-Up | Crude HR (95% CI) | Age and Sex Adjusted HR (95% CI) | Multivariate Adjusted * HR (95% CI) | Crude HR (95% CI) | Age and Sex Adjusted HR (95% CI) | Multivariate Adjusted * HR (95% CI) | ||||
Non/Non | Non/Non | 1,785,110 | 16,868 | 11,324,959.38 | 1.49 | 1 (Reference) | 1 (Reference) | 1 (Reference) | 1 (Reference) | 1 (Reference) | 1 (Reference) |
Ever/Non | 66,436 | 256 | 412,878.93 | 0.62 | 0.42 (0.37, 0.47) | 0.96 (0.84, 1.09) | 0.98 (0.86, 1.11) | 0.42 (0.37, 0.47) | 0.96 (0.84, 1.09) | 0.97 (0.85, 1.10) | |
Non/Ever | 198,752 | 1867 | 1,259,568.95 | 1.48 | 0.99 (0.95, 1.04) | 0.98 (0.93, 1.02) | 0.98 (0.93, 1.03) | 0.99 (0.95, 1.04) | 0.97 (0.92, 1.02) | 0.97 (0.92, 1.01) | |
Ever/Ever | 57,537 | 199 | 362,044.38 | 0.55 | 0.37 (0.32, 0.42) | 0.82 (0.71, 0.94) | 0.82 (0.71, 0.94) | 0.37 (0.32, 0.42) | 0.81 (0.70, 0.94) | 0.80 (0.69, 0.93) | |
Ever/Non | Non/Non | 62,027 | 215 | 385,074.89 | 0.56 | 0.37 (0.33, 0.43) | 0.79 (0.69, 0.91) | 0.81 (0.71, 0.93) | 1.09 (0.94, 1.27) | 0.96 (0.83, 1.12) | 0.96 (0.82, 1.12) |
Ever/Non | 279,201 | 891 | 1,743,937.22 | 0.51 | 0.34 (0.32, 0.37) | 0.81 (0.75, 0.87) | 0.83 (0.77, 0.90) | 1 (Reference) | 1 (Reference) | 1 (Reference) | |
Non/Ever | 10,003 | 33 | 62,762.42 | 0.53 | 0.35 (0.25, 0.50) | 0.74 (0.53, 1.05) | 0.76 (0.54, 1.07) | 1.03 (0.73, 1.46) | 0.92 (0.65, 1.30) | 0.92 (0.65, 1.31) | |
Ever/Ever | 91,158 | 284 | 573,618.11 | 0.50 | 0.33 (0.30, 0.37) | 0.76 (0.67, 0.86) | 0.77 (0.68, 0.87) | 0.97 (0.85, 1.11) | 0.95 (0.83, 1.09) | 0.93 (0.81, 1.06) | |
Non/Ever | Non/Non | 205,146 | 1795 | 1,301,114.31 | 1.38 | 0.93 (0.88, 0.97) | 0.94 (0.90, 0.99) | 0.94 (0.90, 0.99) | 1.20 (1.13, 1.27) | 1.05 (0.99, 1.11) | 1.05 (0.99, 1.11) |
Ever/Non | 12,887 | 47 | 80,215.72 | 0.59 | 0.39 (0.29, 0.52) | 0.94 (0.70, 1.25) | 0.96 (0.72, 1.28) | 0.51 (0.38, 0.68) | 1.02 (0.77, 1.37) | 1.05 (0.79, 1.40) | |
Non/Ever | 429,147 | 3140 | 2,719,020.09 | 1.15 | 0.77 (0.75, 0.80) | 0.89 (0.86, 0.93) | 0.89 (0.86, 0.93) | 1 (Reference) | 1 (Reference) | 1 (Reference) | |
Ever/Ever | 82,773 | 281 | 522,052.53 | 0.54 | 0.36 (0.32, 0.41) | 0.84 (0.75, 0.95) | 0.85 (0.75, 0.96) | 0.47 (0.41, 0.53) | 0.93 (0.82, 1.06) | 0.94 (0.83, 1.07) | |
Ever/Ever | Non/Non | 48,008 | 171 | 300,505.18 | 0.57 | 0.38 (0.33, 0.44) | 0.83 (0.71, 0.97) | 0.84 (0.72, 0.98) | 1.20 (1.03, 1.40) | 1.11 (0.95, 1.30) | 1.10 (0.94,1.29) |
Ever/Non | 103,047 | 358 | 644,784.76 | 0.56 | 0.37 (0.33, 0.41) | 0.87 (0.78, 0.98) | 0.89 (0.79, 0.99) | 1.17 (1.05, 1.31) | 1.19 (1.06, 1.32) | 1.20 (1.07, 1.34) | |
Non/Ever | 80,098 | 306 | 504,629.93 | 0.61 | 0.41 (0.36, 0.46) | 0.90 (0.80, 1.01) | 0.90 (0.80, 1.01) | 1.28 (1.14, 1.44) | 1.21 (1.07, 1.36) | 1.20 (1.07, 1.36) | |
Ever/Ever | 918,740 | 2736 | 5,786,093.86 | 0.47 | 0.32 (0.30, 0.33) | 0.73 (0.69, 0.77) | 0.72 (0.68, 0.77) | 1 (Reference) | 1 (Reference) | 1 (Reference) |
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Yeo, Y.; Han, K.; Shin, D.-W.; Kim, D.; Jeong, S.-M.; Chun, S.; Choi, I.-Y.; Jeon, K.-H.; Kim, T.-H. Changes in Smoking, Alcohol Consumption, and the Risk of Thyroid Cancer: A Population-Based Korean Cohort Study. Cancers 2021, 13, 2343. https://doi.org/10.3390/cancers13102343
Yeo Y, Han K, Shin D-W, Kim D, Jeong S-M, Chun S, Choi I-Y, Jeon K-H, Kim T-H. Changes in Smoking, Alcohol Consumption, and the Risk of Thyroid Cancer: A Population-Based Korean Cohort Study. Cancers. 2021; 13(10):2343. https://doi.org/10.3390/cancers13102343
Chicago/Turabian StyleYeo, Yohwan, Kyungdo Han, Dong-Wook Shin, Dahye Kim, Su-Min Jeong, Sohyun Chun, In-Young Choi, Keun-Hye Jeon, and Tae-Hyuk Kim. 2021. "Changes in Smoking, Alcohol Consumption, and the Risk of Thyroid Cancer: A Population-Based Korean Cohort Study" Cancers 13, no. 10: 2343. https://doi.org/10.3390/cancers13102343