Frequent low dose alcohol intake increases gastric cancer risk: the Health Examinees-Gem (HEXA-G) study

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Figure 1
Flow chart of the study population. HEXA, Health Examinees Study; GC, gastric cancer.

Table 1

Baseline characteristics of the HEXA-G study population included in the alcohol consumption analysis (n = 128,218)^†

Characteristics	Men (n = 42,152)				P value*	Women (n = 86,066)				P value*
	Non-drinker (n = 8,968)		Drinker (n = 33,184)			Non-drinker (n = 58,825)		Drinker (n = 27,241)
	n	(%)	n	(%)		n	(%)	n	(%)
Follow-up year (mean ± SD)	8.7	(2.0)	8.7	(2.0)	0.640	8.8	(2.1)	8.7	(2.1)	<0.001
Age (mean ± SD)	55.0	(8.4)	52.7	(8.3)	<0.001	53.4	(7.8)	49.6	(7.0)	<0.001
Family history of GC	786	(8.8)	2,670	(8.1)	0.068	5,053	(8.6)	2,239	(8.2)	0.192
Education					<0.001					<0.001
≤Middle school	2,044	(22.8)	6,681	(20.1)		22,566	(38.4)	8,681	(31.9)
High school diploma	3,525	(39.3)	13,728	(41.4)		24,264	(41.3)	12,764	(46.9)
≥College degree	3,251	(36.3)	12,369	(37.3)		11,148	(19.0)	5,490	(20.2)
Married/cohabitation	8,401	(93.7)	31,147	(93.9)	0.005	51,203	(87.0)	23,337	(85.7)	<0.001
Ever smokers^‡	4,887	(54.5)	25,566	(77.0)	<0.001	1,146	(2.0)	1,882	(6.9)	<0.001
Regular exercisers	4,165	(46.4)	13,936	(42.0)	<0.001	29,319	(49.8)	12,777	(46.9)	<0.001
BMI (kg/m², mean ± SD)	23.7	(4.5)	23.7	(1.1)	<0.001	23.7	(2.5)	23.7	(4.1)	<0.001
Total energy intake (kcal, mean ± SD)	563.7	(115.3)	1,871.0	(559.7)	<0.001	1,700.36	(568.0)	1,736.64	(605.2)	<0.001

HEXA-G, Health Examinees-Gem study; GC, gastric cancer; BMI, body mass index.

*Student’s t-test for continuous variables; chi-square test for categorical variables.

^†Data for continuous variables are presented as mean ± standard deviation (SD); all other variables are presented as n (%).

^‡Ever smokers is defined as lifetime smokers with ≥20 pack-years.

Table 2

Associations between gastric cancer and alcohol consumption status, and the duration, frequency, and amount of ethanol consumed

Variables	Men (n = 42,152)							Variables	Women (n = 86,066)
Variables	n	Person-years	GC	(%)	HR^†	95% CI		Variables	n	Person-years	GC	(%)	HR^†	95% CI
Status								Status
Non-drinker	8,968	77,924	87	(1.0)	1.00	Ref		Non-drinker	58,825	515,102	283	(0.5)	1.00	Ref
Drinker	33,184	287,973	375	(1.1)	1.31	1.03	1.66	Drinker	27,241	235,840	102	(0.4)	1.00	0.79	1.26
Duration								Duration
Non-drinker	8,968	77,924	87	1.0	1.00	Ref		Non-drinker	58,825	515,102	283	0.5	1.00	Ref
≤20 years	7,718	67,077	59	0.8	1.39	0.99	1.97	≤10 years	3,448	31,250	15	0.4	1.12	0.66	1.89
>20 years	24,782	214,205	311	1.3	1.32	1.03	1.68	>10 years	22,331	189,090	82	0.4	1.01	0.78	1.30
P trend					0.03			P trend					0.93
Frequency								Frequency
Non-drinker	8,968	77,924	87	(1.0)	1.00	Ref		Non-drinker	58,825	515,102	283	(0.5)	1.00	Ref
≤1 time/week	9,856	85,099	113	(1.2)	1.32	1.00	1.75	<1 time/week	7,467	63,972	27	(0.4)	0.94	0.63	1.39
2–3 times/week	11,148	96,494	111	(1.0)	1.19	0.89	1.58	1 time/week	11,746	101,817	47	(0.4)	1.09	0.80	1.50
4 times/week	7,056	60,619	78	(1.1)	1.35	0.99	1.85	≥2 times/week	6,817	57,811	22	(0.3)	0.94	0.60	1.45
≥5 times/week	4,194	36,152	64	(1.5)	1.62	1.17	2.25	P trend					0.41
P trend					0.02
Amount of ethanol^‡								Amount of ethanol^‡
Non-drinker	8,968	77,924	87	(1.0)	1.00	Ref		Non-drinker	58,825	515,102	283	(0.5)	1.00	Ref
<10 g/week	14,373	123,873	159	(1.1)	1.25	0.96	1.63	<10 g/week	7,990	68,661	32	(0.4)	1.00	0.69	1.44
10–30 g/week	10,315	89,243	118	(1.1)	1.37	1.03	1.83	10–20 g/week	8,972	77,883	36	(0.4)	1.09	0.77	1.56
>30 g/week	7,602	65,621	91	(1.2)	1.47	1.08	1.99	>20 g/week	9,086	77,215	28	(0.3)	0.92	0.62	1.37
P trend					0.03			P trend					0.49
Continuous, per 1 SD					1.00	1.00	1.00	Continuous, per 1 SD					0.87	0.65	1.17

GC, gastric cancer; HR, hazard ratio; CI, confidence interval; SD, standard drink.

^†Adjusted for education, smoking status, marital status, family history of gastric cancer, exercise, BMI, and total energy intake.

^‡Amount of ethanol refers to the amount of pure alcohol found in all alcohol beverages consumed by study participants, converted to grams per week.

Table 3

Association between alcohol consumption patterns and gastric cancer in men

Consumption pattern	Frequency	Amount of ethanol	n	Person-years	GC	(%)	HR^†	95% CI
Non-drinker			8,968	77,924	87	(1.0)	0.78	0.61	0.99
Infrequent-light	<5 times/week	<40 g ethanol/day	25,884	223,795	282	(1.1)	1.00	Ref
Infrequent-heavy	<5 times/week	≥40 g ethanol/day	1,085	9,293	12	(1.1)	1.14	0.64	2.03
Frequent-light	≥5 times/week	<40 g ethanol/day	1,959	16,689	35	(1.8)	1.46	1.02	2.07
Frequent-heavy	≥5 times/week	≥40 g ethanol/day	2,173	18,964	27	(1.2)	1.04	0.70	1.54