국민건강보험 청구자료원을 활용한 저용량 아스피린 장기 복용의 폐암 예방 효과 연구

Abstract

Background and aims: There is increasing evidence to support the link between aspirin use and lung cancer risk reduction. However, the impact of low-dose aspirin use on lung cancer risk and a more effective group for lung cancer prevention by low-dose aspirin use are controversial. We aimed to investigate the potential chemopreventive effects of low-dose aspirin on lung cancer risk and a more effective group for lung cancer prevention by low-dose aspirin use. Methods: This study was performed using the Korean National Health Information Database (KNHID) from 2002 to 2015. A total of 12,969,400 subjects, aged 40 to 84 years, were enrolled in the study. Lung cancer patients were identified during 5 years of follow-up, and the duration of low-dose aspirin use during the 9 years before follow-up was calculated. We tested the chemopreventive effect of low-dose aspirin use on the risk of lung cancer using competing risk analysis (Fine and Gray model) that considered death as a competing risk. Results: During the 5 years of follow-up, a total of 63,040 subjects were diagnosed with lung cancer. When compared with no aspirin use, 5–6 years (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.92–0.99), 7–8 years (HR, 0.94; 95% CI, 0.90–0.99), and 9 years (HR, 0.89; 95% CI, 0.84–0.94) of aspirin use was significantly associated with reduced lung cancer risk. After stratified analysis, a significant reduction in lung cancer risk was observed in people ≥65 years of age, and nondiabetic patients. Conclusions: The long-term use of low-dose aspirin for more than 5 years was associated with a decreased risk of lung cancer, with the strongest evidence of chemopreventive benefits observed in elderly and nondiabetic patients. On the other hand, Sex types, obesity, and smoking history did not affect the chemopreventive effect of aspirin.;본 연구는 국민건강보험 청구자료원을 활용하여 저용량 아스피린의 장기간 복용에 따른 폐암의 예방효과를 확인하고, 성별, 연령, 체질량지수, 흡연상태를 층화하여 어떤 집단에서 특히 저용량 아스피린의 폐암 예방 효과가 잘 나타나는지 확인하고자 한다. 국민건강보험 청구자료원 중 맞춤형연구 데이터베이스 (database, DB)를 사용하였고, 통계분석 방법은 경쟁 위험 분석 (competing risk analysis) 중 하나인 Fine and Gray model과 전통적인 생존 분석 (conventional survival analysis)인 Cox proportional hazard model을 사용하였다. 주요 연구 결과를 요약하면 맞춤형연구 DB 분석 결과에서는 5년 이상 저용량 아스피린을 복용한 군에서 폐암 예방효과가 있었다. 성별, 나이, 체질량지수, 당뇨병 유무, 흡연상태로 층화하였을 때는, 65세 이상 성인과 당뇨병을 진단받지 않은 성인에서 폐암 예방효과가 있었고, 성별, 체질량 지수, 흡연 상태는 저용량 아스피린의 폐암 예방효과에 영향을 주지 않았다. 이러한 결과는 5년 이상 장기간 저용량 아스피린을 복용할 경우 폐암을 예방할 수 있다는 결과를 나타내며, 특히 65세 이상 성인과 당뇨병이 없는 성인에서 폐암 예방효과가 더 유의하게 나타날 수 있음을 시사한다.