Upper gastrointestinal endoscopic screening serves as a primary prevention approach by reducing modifiable risk factors

Table 1 Effects of upper gastrointestinal endoscopic screening in multivariable analysis on the cessation of cigarette smoking, alcohol drinking and unhealthy dietary habits

Variable	Cessation of cigarette smoking (n = 5600)1		Cessation of alcohol drinking (n = 4949)2		Reduction of unhealthy dietary habit (n = 24629)3
	Outcome events/total (%)	Adjusted OR (95%CI)	Outcome events/total (%)	Adjusted OR (95%CI)	Outcome events/total (%)	Adjusted OR (95%CI)
Screening
Control arm	681/2815 (24.19)	Reference	960/2497 (38.45)	Reference	5059/12790 (39.55)	Reference
Screening arm	775/2785 (27.83)	1.20 (1.06-1.36)	1114/2452 (45.43)	1.33 (1.19-1.50)	4870/11839 (41.14)	1.07 (1.02-1.13)

¹The cessation of cigarette smoking was defined as those reporting to be current smokers at baseline but not current smokers at the repeat questionnaire. The final model was adjusted for baseline age (continuous), sex (categorical), baseline body mass index (continuous), household income (continuous), education (categorical), marital status (categorical), occupation (categorical), baseline gastrointestinal symptoms score (continuous), family history of cancer (categorical), self-reported personal disease history at baseline (categorical), baseline alcohol drinking status (categorical), years of cigarette smoking at baseline (continuous), lifetime cigarette consumption at baseline (continuous), and cigarette smoking in family members at baseline (categorical).

²The cessation of alcohol drinking was defined as those reporting to be current drinkers at baseline but not current drinkers at the repeat questionnaire.

³The reduction in unhealthy dietary habits was defined as individuals with an unhealthy dietary habit score change [the unhealthy dietary score difference (repeat questionnaire minus baseline) divided by the baseline dietary habit score] less than -0.20.

OR: Odds ratio.

Table 2 Subgroup analysis of the uptake of upper gastrointestinal endoscopic screening for cessation of cigarette smoking, alcohol drinking and unhealthy dietary habits

Variable	Cessation of cigarette smoking (n = 5600)1		Cessation of alcohol drinking (n = 4949)2		Reduction of unhealthy dietary habit (n = 24629)3
	Outcome events/total (%)	Adjusted OR (95%CI)	Outcome events/total (%)	Adjusted OR (95%CI)	Outcome events/total (%)	Adjusted OR (95%CI)
Screening status
Control arm	681/2815 (24.19)	Reference	960/2497 (38.45)	Reference	5059/12790 (39.55)	Reference
Subjects decline UGI endoscopy	20/88 (22.73)	1.09 (0.65-1.83)	33/85 (38.82)	1.18 (0.75-1.87)	156/389 (40.10)	1.04 (0.85-1.28)
Subjects complete UGI endoscopy but without biopsy	663/2465 (26.90)	1.15 (1.01-1.31)	974/2145 (45.41)	1.35 (1.19-1.52)	4314/10591 (40.73)	1.06 (1.00-1.11)
Subjects complete UGI endoscopy with biopsy	92/232 (39.66)	1.77 (1.32-2.35)	107/222 (48.20)	1.27 (0.96-1.69)	400/859 (46.57)	1.31 (1.14-1.50)

¹The cessation of cigarette smoking was defined as those reporting to be current smokers at baseline but not current smokers at the repeat questionnaire. The final model was adjusted for baseline age (continuous), sex (categorical), baseline body mass index (continuous), household income (continuous), education (categorical), marital status (categorical), occupation (categorical), baseline gastrointestinal symptoms score (continuous), family history of cancer (categorical), self-reported personal disease history at baseline (categorical), baseline alcohol drinking status (categorical), years of cigarette smoking at baseline (continuous), lifetime cigarette consumption at baseline (continuous), and cigarette smoking in family members at baseline (categorical).

²The cessation of alcohol drinking was defined as those reporting to be current drinkers at baseline but not current drinkers at the repeat questionnaire.

³The reduction in unhealthy dietary habits was defined as individuals with an unhealthy dietary habit score change [the unhealthy dietary score difference (repeat questionnaire minus baseline) divided by the baseline dietary habit score] less than -0.20.

OR: Odds ratio; UGI: Upper gastrointestinal.

Table 3 Effects of upper gastrointestinal endoscopic screening on cessation of cigarette smoking, alcohol drinking and unhealthy dietary habit, stratified by sex, baseline age and baseline gastrointestinal symptoms score

Stratified variable	Cessation of cigarette smoking (n = 5600)1			Cessation of alcohol drinking (n = 4949)2			Reduction of unhealthy dietary habit (n = 24629)3
	Outcome events/total (%)	Adjusted OR (95%CI)	P value	Outcome events/total (%)	Adjusted OR (95%CI)	P value	Outcome events/total (%)	Adjusted OR (95%CI)	P value
Sex
Female	48/94 (51.06)	1.50 (0.58-3.85)	0.399	42/63 (66.67)	1.56 (0.37-6.53)	0.546	5550/13255 (41.87)	1.12 (1.04-1.20)	0.002
Male	1408/5506 (25.57)	1.19 (1.05-1.35)	0.007	2032/4886 (41.59)	1.32 (1.17-1.49)	< 0.001	4379/11374 (38.50)	1.02 (0.94-1.10)	0.617
Interaction4			0.557			0.181			0.033
Baseline age
< 60	700/3241 (21.60)	1.16 (0.98-1.38)	0.089	1108/3026 (36.62)	1.16 (0.99-1.35)	0.061	5752/14515 (39.63)	1.03 (0.96-1.10)	0.451
≥ 60	756/2359 (32.05)	1.23 (1.03-1.47)	0.024	966/1923 (50.23)	1.66 (1.38-2)	< 0.001	4177/10114 (41.30)	1.14 (1.05-1.24)	0.001
Interaction4			0.589			0.004			0.130
Baseline gastrointestinal symptoms score
0	795/3092 (25.71)	1.16 (0.98-1.37)	0.087	997/2586 (38.55)	1.41 (1.20-1.67)	< 0.001	5322/13578 (39.20)	1.08 (1.01-1.16)	0.029
≥ 1	661/2508 (26.36)	1.25 (1.04-1.51)	0.018	1077/2363 (45.58)	1.26 (1.07-1.49)	0.007	4607/11051 (41.69)	1.06 (0.98-1.14)	0.158
Interaction4			0.488			0.436			0.662

¹The cessation of cigarette smoking was defined as those reporting to be current smokers at baseline but not current smokers at the repeat questionnaire. The final model was adjusted for baseline age (continuous), sex (categorical), baseline body mass index (continuous), household income (continuous), education (categorical), marital status (categorical), occupation (categorical), baseline gastrointestinal symptoms score (continuous), family history of cancer (categorical), self-reported personal disease history at baseline (categorical), baseline alcohol drinking status (categorical), years of cigarette smoking at baseline (continuous), lifetime cigarette consumption at baseline (continuous), and cigarette smoking in family members at baseline (categorical). The stratified variable was not included in the final model in the corresponding stratified analysis.

²The cessation of alcohol drinking was defined as those reporting to be current drinkers at baseline but not current drinkers at the repeat questionnaire.

³The reduction in unhealthy dietary habits was defined as individuals with an unhealthy dietary habit score change [the unhealthy dietary score difference (repeat questionnaire minus baseline) divided by the baseline dietary habit score] less than -0.20.

⁴Interaction terms between each stratified variable and the screening status were tested using the Wald-test.

OR: Odds ratio.