Min-Hyung Kim1, Jooyoung Chang2, Warrick Junsuk Kim3, Samprit Banerjee4, Sang Min Park5,6. 1. Division of Health Informatics, Department of Health Policy and Research, Joan & Sanford I. Weill Medical College of Cornell University, New York City, NY, USA. 2. Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea. 3. Noncommunicable Diseases and Health Promotion, World Health Organization Regional Office for the Western Pacific, Manila, Philippines. 4. Division of Biostatistics & Epidemiology, Department of Health Policy and Research, Joan & Sanford I. Weill Medical College of Cornell University, New York City, NY, USA. 5. Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea. smpark.snuh@gmail.com. 6. Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. smpark.snuh@gmail.com.
Abstract
OBJECTIVES: Many studies have found evidence that aspirin has protective effects against certain cancers, but quantitative dose-response data have been available only on a limited basis. This study aimed to confirm the dose-response relationship of aspirin usage and gastric cancer and to estimate the cumulative dose threshold of aspirin to achieve protective effects against gastric cancer in the general population. METHODS: A total of 461,489 individuals in a population-based longitudinal cohort provided by the National Health Insurance Services (NHIS) in the Republic of Korea were observed from 2007 to 2012 to identify gastric cancer incident cases. The pharmacy claims data of these individuals from 2002 to 2006 were reviewed to assess cumulative medication exposure using the defined daily dose (DDD) system. Hazard ratios (HRs) of aspirin use for gastric cancer were estimated using multivariate Cox Proportional Hazard regression. Sensitivity analyses, including propensity-score matching and a nested case-control design, were performed to evaluate the variability caused by study design. RESULTS: A total of 5674 incident gastric cancers were identified from 2,965,500 person-years of follow-up observation, giving an overall incidence rate of 191.00 gastric cancers per 100,000 person-years. Compared to non-users, those with aspirin use of ≥3 DDD-years showed a statistically significant protective effect of aspirin use against gastric cancer; the adjusted HR (95% confidence intervals) were 0.79 (0.63-0.98) and 0.63 (0.48-0.83) for those with aspirin use of 3-4 DDD-years and 4-5 DDD-years, respectively (P for trend < 0.001). Sensitivity analyses using propensity-score matching and a nested case-control design consistently showed a chemopreventive effect of aspirin. CONCLUSION: Long-term aspirin use was associated with reduced gastric cancer incidence in the general population of South Korea when the cumulative dose was >3 DDD-years.
OBJECTIVES: Many studies have found evidence that aspirin has protective effects against certain cancers, but quantitative dose-response data have been available only on a limited basis. This study aimed to confirm the dose-response relationship of aspirin usage and gastric cancer and to estimate the cumulative dose threshold of aspirin to achieve protective effects against gastric cancer in the general population. METHODS: A total of 461,489 individuals in a population-based longitudinal cohort provided by the National Health Insurance Services (NHIS) in the Republic of Korea were observed from 2007 to 2012 to identify gastric cancer incident cases. The pharmacy claims data of these individuals from 2002 to 2006 were reviewed to assess cumulative medication exposure using the defined daily dose (DDD) system. Hazard ratios (HRs) of aspirin use for gastric cancer were estimated using multivariate Cox Proportional Hazard regression. Sensitivity analyses, including propensity-score matching and a nested case-control design, were performed to evaluate the variability caused by study design. RESULTS: A total of 5674 incident gastric cancers were identified from 2,965,500 person-years of follow-up observation, giving an overall incidence rate of 191.00 gastric cancers per 100,000 person-years. Compared to non-users, those with aspirin use of ≥3 DDD-years showed a statistically significant protective effect of aspirin use against gastric cancer; the adjusted HR (95% confidence intervals) were 0.79 (0.63-0.98) and 0.63 (0.48-0.83) for those with aspirin use of 3-4 DDD-years and 4-5 DDD-years, respectively (P for trend < 0.001). Sensitivity analyses using propensity-score matching and a nested case-control design consistently showed a chemopreventive effect of aspirin. CONCLUSION: Long-term aspirin use was associated with reduced gastric cancer incidence in the general population of South Korea when the cumulative dose was >3 DDD-years.
Authors: Young-Il Kim; Young Ae Kim; Hak Jin Kim; Su-Hyun Kim; Yul Hwangbo; Jae Gyu Kim; Jae J Kim; Il Ju Choi Journal: Korean J Intern Med Date: 2020-11-25 Impact factor: 2.884
Authors: Dag Holmberg; Joonas H Kauppila; Fredrik Mattsson; Johannes Asplund; Wilhelm Leijonmarck; Shao-Hua Xie; Jesper Lagergren Journal: Gastric Cancer Date: 2022-02-15 Impact factor: 7.701