Risk Factors of Incident Lung Cancer in Patients with Non-Cystic Fibrosis Bronchiectasis: A Korean Population-Based Study

Abstract

Simple Summary Our study evaluated the risk factors of incident lung cancer in subjects with newly diagnosed bronchiectasis, using a large nationwide database. In this study, we showed that male sex, overweight, current smoking, living in rural areas, and comorbid COPD were independently associated with a higher risk of incident lung cancer in participants with bronchiectasis, while mild alcohol consumption was negatively associated with lung cancer development in those with bronchiectasis. To our knowledge, this is the first study assessing the risk factors of lung cancer in patients with bronchiectasis, and it would be helpful for clinicians at real practice. Background: Patients with non-cystic fibrosis bronchiectasis have an increased risk of lung cancer, followed by higher mortality in this population. Because the risk factors of lung cancer have not been well identified, this study aimed to investigate the risk factors of lung cancer in individuals with newly diagnosed bronchiectasis. Methods: This cohort study using the Korean National Health Insurance Service database identified 7425 individuals with incident bronchiectasis among those who participated in the health screening exam in 2009. The cohort was followed from baseline to the date of incident: lung cancer, death, or until the end of the study period. We investigated the risk factors of lung cancer in participants with bronchiectasis using the Cox-proportional hazard models. Results: During median 8.3 years of follow-up duration, 1.9% (138/7425) developed lung cancer. In multivariable analyses, significant factors associated with increased risk of incident lung cancer included: males (adjusted hazard ratio [HR] = 3.54, 95% confidence interval [CI] = 2.17-5.79) than females, the overweight (adjusted HR = 1.55, 95% CI = 1.03-2.35) than the normal weight, current smokers (adjusted HR = 3.10, 95% CI = 2.00-4.79) than never smokers, participants living in the rural area (adjusted HR = 2.54, 95% CI = 1.68-3.85) than those living in the metropolitan area. Among comorbidities, chronic obstructive pulmonary disease was associated with an increased risk of lung cancer (adjusted HR = 1.46, 95% CI = 1.01-2.13) in participants with bronchiectasis. In contrast, mild alcohol consumption was associated with reduced risk of lung cancer (adjusted HR = 0.47, 95% CI = 0.29-0.74) in those with bronchiectasis. Conclusion: This Korean population-based study showed that males, current smoking, overweight, living in rural areas, and comorbid chronic obstructive pulmonary disease are associated with increased risk of lung cancer in individuals with bronchiectasis.