Combinations of lifestyle behaviors and cancer risk among Korean adults

Abstract

Combinations of lifestyle behaviors may lead to different cancer risks. This study aimed to identify the latent classes based on lifestyle behavior trajectories and to investigate the association between these latent classes and cancer risk. Participants in the 2002-2003 National Health Insurance Service general health examination were included. Data on smoking, alcohol drinking, body mass index (BMI), and physical activity measured four times between 2002 and 2009 were analyzed. Incident cancer cases were tracked from 2010 to 2018. Patterns of alcohol drinking, smoking, BMI, and physical activity and latent classes based on trajectories of smoking, alcohol drinking, BMI, and physical activity were identified. Among 2,735,110 adults (1,787,486 men and 947,624 women), 111,218 (69,089 men and 42,129 women) developed incident cancer. Six latent classes of lifestyle behavior were identified, with Class 1 (healthy class) involving only 0.2% of men and 0.5% of women. The highest risk class in males tended to be steady light drinkers and steady moderate smokers, have steady low frequency of physical activity, and be obese. This class showed a 1.47 times higher (95% CI = 1.29-1.69) risk of all cancers than did the healthy class. Among women, there was only an association between the highest risk class (tendency to be non-drinkers, light smokers) and colorectal cancer (HR = 1.70, 95% CI = 1.02-2.83). Only a small percentage of participants maintained a long-term healthy lifestyle. Identifying classes of behavior combinations and their links to cancer development is therefore critical for cancer prevention.

Figure 1

Participant selection flowchart.

Figure 2

Trajectories of lifestyle behaviors among men.

Figure 3

Trajectories of lifestyle behaviors among women.

Figure 4

Latent classes of alcohol consumption, smoking, physical activity, and BMI trajectories and the association of these classes with cancer incidence among men. (A) Percentage men in each trajectory category for each behavior in each class. Latent classes are represented by rows, and each behavior trajectory is represented by a column. For each behavior, the left column represents the lower risk trajectory, and the right column represents the higher risk trajectory. (B) Hazard ratios for each of the five types of cancer and for overall cancers for each class with the healthy class (class 1) as reference and adjusted for age, income, and chronic viral hepatitis B or C for liver cancer.

Figure 5

Latent classes of alcohol consumption, smoking, physical activity, and BMI trajectories and the association of these classes with cancer incidence among women. (A) Percentage of women in each trajectory category for each behavior in each class. Latent classes are represented by rows, and each behavior trajectory is represented by a column. For each behavior, the left column represents the lower risk trajectory, and the right column represents the higher risk trajectory. (B) Hazard ratios for each of the five types of cancer and for overall cancers for each class, with the healthy class (class 1) as reference, adjusted for age, income, and chronic viral hepatitis B or C for liver cancer.