Key Risk Factors, Sex Differences, and the Influence of High-Intensity Exercise on Colorectal Carcinogenesis: A 10-Year Cohort Study Based on 1,120,377 Individuals from the NHISS Data.

Abstract

Colorectal cancer (CRC) is the third most common cancer globally. Therefore, this study aims to examine data from the National Health Insurance Sharing Service (NHISS) to investigate factors influencing colon cancer incidence, focusing on key variables and optimal cutoff points. The patient cohort from the NHISS database included 1,120,377 individuals aged 1-85 years. CRC data were retrieved using diagnostic codes from the Korean Standard Classification of Diseases and Causes of Death. Analyses included logistic regression and receiver operating characteristic curve assessments. In this retrospective cohort study, 1,120,377 patients were analyzed for over 10 years, including 2802 with CRC via propensity score matching (PSM). Key risk factors were blood pressure, fasting blood sugar, liver somatic index, alcohol consumption, smoking duration, and hemoglobin levels. Patients with CRC showed sex differences in gamma-glutamyl transpeptidase (GGT). High-intensity exercise (3 days/week) reduced CRC risk by 26% (p < 0.05). Optimal threshold points for GGT and Charlson Comorbidity Index (CCI) were 23.50 U/L (AUC, 0.52) and 1.50 (AUC, 0.58), respectively. CCI scores were higher in patients with cancer, especially men with peptic ulcers and both sexes with metastatic cancer (p < 0.01). Our findings reveal new risk factors and interventions, including tailored exercise programs for CRC management, highlighting the importance of enhanced preventive strategies and personalized care.