Risk for Esophageal Cancer Based on Lifestyle Factors-Smoking, Alcohol Consumption, and Body Mass Index: Insight from a South Korean Population Study in a Low-Incidence Area

Abstract

Esophageal cancer constitutes a global public health challenge. However, South Korean population-specific information on the association of lifestyle (smoking, alcohol consumption, and obesity status) with esophageal cancer risk is sparse. This nested case-control study analyzed the Korean national health screening cohort data (2002-2019) of 1114 patients with esophageal cancer and 4456 controls (1:4 propensity-score matched for sex, age, income, and residential region). Conditional and unconditional logistic regression analyses, after adjustment for multiple covariates, determined the effects of lifestyle factors on esophageal cancer risk. Smoking and alcohol consumption increased the esophageal cancer risk (adjusted odds ratio [95% confidence interval]: 1.37 [1.15-1.63] and 1.89 [1.60-2.23], respectively). Overweight (body mass index [BMI] ≥ 23 to <25 kg/m²), obese I (BMI ≥ 25 to <30 kg/m²), or obese II (BMI ≥ 30 kg/m²) categories had reduced odds of esophageal cancer (0.76 [0.62-0.92], 0.59 [0.48-0.72], and 0.47 [0.26-0.85], respectively). In the subgroup analyses, the association of incident esophageal cancer with smoking and alcohol consumption persisted, particularly in men or those aged ≥55 years, whereas higher BMI scores remained consistently associated with a reduced esophageal cancer likelihood across all age groups, in both sexes, and alcohol users or current smokers. Underweight current smokers exhibited a higher propensity for esophageal cancer. In conclusion, smoking and alcohol drinking may potentially increase the risk, whereas weight maintenance, with BMI ≥ 23 kg/m², may potentially decrease the risk, for esophageal cancer in the South Korean population. Lifestyle modification in the specific subgroups may be a potential strategy for preventing esophageal cancer.

Keywords: alcohol consumption; body mass index; cancer risk; esophageal cancer; national health screening cohort research database; smoking.

Figure 1

The participant selection process employed in this study is depicted in the following schematic illustration. Initially, a total of 514,866 participants were included. From this pool, 1114 participants diagnosed with esophageal cancer were matched in a 1:4 ratio with 4456 control participants based on age, sex, income, and region of residence. BMI, body mass index; ICD-10; International Classification of Diseases, 10th Revision; KNHIS-HSC, Korean National Health Insurance Service-Health Screening Cohort.

Figure 2

Forest plots illustrating the adjusted odds ratios (aOR) and corresponding 95% confidence intervals (CIs) for lifestyle factors including smoking, alcohol consumption, and obesity status in relation to incident esophageal cancer.

Figure 3

Forest plots for adjusted odd ratios (aOR) (95% confidence intervals, CIs) of smoking, alcohol consumption, and body mass index for esophageal cancer in each stratified group according to age and sex.

Figure 4

Forest plots for adjusted odd ratios (aORs) (95% confidence intervals, CIs) of smoking, alcohol consumption, and body mass index for esophageal cancer in each group.