Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea.
National Cancer Control Institute, National Cancer Center, Goyang, South Korea.
Cancer Med. 2023 Aug;12(16):17389-17402. doi: 10.1002/cam4.6359. Epub 2023 Jul 25.
There is limited evidence on the individual and joint effect of socioeconomic status (SES) and unhealthy lifestyle on cancer. Therefore, this study aimed to examine the effects of these factors on cancer incidence and mortality.
In this population-based cohort study, income was used as the proxy of SES. A combined unhealthy lifestyle score was obtained using data on smoking, alcohol consumption, physical activity, and body mass index. Hazard ratios were estimated using a Cox proportional hazards model.
The study included data on 8,353,169 participants (median follow-up period, 17 years). Although the association between low income and cancer incidence varied depending on cancer type, low income consistently increased the risk of cancer-related death with a social gradient. Unhealthy behaviors increased the risk of cancer incidence and mortality, except for thyroid and breast cancer in women and prostate cancer in men. Compared with the wealthiest and healthiest individuals, the poorest and unhealthiest men and women showed 2.1-fold (2.05-2.14) and 1.36-fold (1.31-1.41) higher risk of cancer-related death, respectively. The joint effect was most robust for lung, liver, head, and neck cancers in men and liver and cervical cancers in women; further, the effect was stronger with cancer-specific mortality than with incidence.
In conclusion, income and combined healthy lifestyle behaviors have individual and joint effects on cancer incidence and mortality. The effect varies by cancer type and sex.
关于社会经济地位（SES）和不健康生活方式对癌症的单独和联合影响，证据有限。因此，本研究旨在探讨这些因素对癌症发病率和死亡率的影响。
在这项基于人群的队列研究中，收入被用作 SES 的代表。通过吸烟、饮酒、身体活动和体重指数的数据获得了一个综合的不健康生活方式评分。使用 Cox 比例风险模型估计了风险比。
本研究纳入了 8353169 名参与者的数据（中位随访期为 17 年）。尽管低收入与癌症发病率之间的关联因癌症类型而异，但低收入始终与癌症相关的死亡风险增加存在社会梯度。不健康的行为增加了癌症发病率和死亡率的风险，但女性的甲状腺癌和乳腺癌以及男性的前列腺癌除外。与最富有和最健康的个体相比，最贫穷和最不健康的男性和女性的癌症相关死亡风险分别高出 2.1 倍（2.05-2.14）和 1.36 倍（1.31-1.41）。这种联合作用在男性的肺癌、肝癌、头颈部癌症和女性的肝癌和宫颈癌中最为显著；此外，与癌症发病率相比，这种作用在癌症特异性死亡率方面更强。
总之，收入和综合健康的生活方式行为对癌症的发病率和死亡率有单独和联合的影响。这种影响因癌症类型和性别而异。
