Adherence to the Korean National Code Against Cancer and mortality: a prospective cohort study from the Health Examinees-Gem study

OBJECTIVES: The Korean National Code Against Cancer was released in 2006. These guidelines aimed to promote a healthy lifestyle to prevent cancer risk through 10 recommendations. The objective of this study was to investigate the associations between adherence to the Korean National Code Against Cancer and the risk of all-cause, cancer, and cardiovascular disease (CVD) mortality among Koreans. METHODS: This prospective cohort study included 109,160 Korean adults aged 40 years to 69 years, recruited from 2004 to 2013 in the population-based Health Examinees-Gem Study. The adherence total score was calculated based on 6 items from the Korean National Code Against Cancer: smoking, consuming vegetables and fruits, limiting salty foods, restricting alcohol intake, engaging in physical activity, and maintaining a healthy weight. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations of adherence scores with mortality risk were estimated using a Cox proportional hazards regression model. RESULTS: During a mean follow-up period of 12.0 years, 3,799 deaths were recorded. According to the multivariable-adjusted model, males in the highest tertile of adherence scores had a lower risk of all-cause, cancer, and CVD mortality compared to those in the lowest tertile (all-cause: HR, 0.67; 95% CI, 0.60 to 0.74; cancer: HR, 0.63; 95% CI, 0.54 to 0.74; CVD: HR, 0.56, 95% CI, 0.43 to 0.73). A similar association was observed among females for all-cause and CVD mortality (all-cause: HR, 0.85; 95% CI, 0.76 to 0.96; CVD: HR, 0.70; 95% CI, 0.51 to 0.97). CONCLUSIONS: Adherence to the Korean National Code Against Cancer was associated with a reduced risk of all-cause, cancer, and CVD mortality.