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Original article Adherence to the Korean National Code Against Cancer and mortality: a prospective cohort study from the Health Examinees-Gem study
Jeeyoo Lee1orcid , Aesun Shin1,2,3,4,5orcid , Woo-Kyoung Shin6orcid , Ji-Yeob Choi2,7,8orcid , Daehee Kang1,2orcid
Epidemiol Health 2025;e2025026
DOI: https://doi.org/10.4178/epih.e2025026 [Accepted]
Published online: May 9, 2025
1Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
2Cancer Research Institute, Seoul National University, Seoul , Korea
3Interdisciplinary Program in Cancer Biology Major, Seoul National University College of Medicine, Seoul , Korea
4Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul , Korea
5Medical Research Center, Genomic Medicine Institute, Seoul National University College of Medicine, Seoul , Korea
6Division of Food and Pharmaceutical Technology, Mokwon University, Daejeon, Korea
7Department of Biomedical Science, Seoul National University Graduate School, Seoul , Korea
8Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul , Korea
Corresponding author:  Aesun Shin,
Email: shinaesun@snu.ac.kr
Received: 24 February 2025   • Revised: 11 April 2025   • Accepted: 23 April 2025
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Abstract

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 to 69 years, recruited from 2004 to 2013 in the population-based Health Examinees-Gem Study (HEXA-G). 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, men 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=0.60–0.74; cancer: HR=0.63, 95% CI=0.54–0.74; CVD: HR=0.56, 95% CI=0.43–0.73). A similar association was observed among women for all-cause and CVD mortality (all-cause: HR=0.85, 95% CI=0.76–0.96; CVD: HR=0.70, 95% CI=0.51–0.97).
CONCLUSIONS
Adherence to the Korean National Code Against Cancer was associated with a reduced risk of all-cause, cancer, and CVD mortality.

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