Confounding Effects of Lifestyle Factors in Cancer Risk Estimation for
Occupational Radiation Exposure
Dublin Core
Title
Confounding Effects of Lifestyle Factors in Cancer Risk Estimation for
Occupational Radiation Exposure
Occupational Radiation Exposure
Subject
Confounding Effects of Lifestyle Factors in Cancer Risk Estimation for
Occupational Radiation Exposure
Occupational Radiation Exposure
Description
The confounding effect of lifestyle factors is an important concern in occupational studies,
particularly when the risk magnitude is relatively small. This study aimed to evaluate the potential
confounding effects of lifestyle factors on the association between radiation exposure and cancer
incidence.
Methods: Data from all Republic of Korean diagnostic medical radiation workers enrolled in the national
dose registry were merged with cancer incidence records up to 2018. Excess relative risks (ERRs) for
cancer were calculated using Poisson regression models to quantify the radiation dose-response relationship. Major lifestyle factors were imputed using multiple imputations by chained equations based
on survey data. The confounding effects were assessed by comparing ERRs before and after adjustment
for lifestyle factors.
Results: The baseline ERR for cancer incidence per Sievert was 0.44 (95% CI: -0.94, 1.83) after adjusting
for attained age, sex, birth year, and employment duration. Further adjustment for lifestyle factors
(smoking status, alcohol consumption, body mass index, physical exercise, sleep duration, and night
shift work) did not substantially modify this risk coefficient, with change-in-estimate values ranging
from 0% to 13.6%. Sensitivity analyses conducted with the survey-based cohort and sex-stratified analyses yielded consistent results.
Conclusion: Our study found little evidence of significant confounding effects from unmeasured lifestyle
factors on cancer risk when basic registry data variables were adjusted among medical radiation
workers. Further studies are warranted to investigate the impact of unmeasured and unknown confounders to improve the accuracy of radiation risk estimates
particularly when the risk magnitude is relatively small. This study aimed to evaluate the potential
confounding effects of lifestyle factors on the association between radiation exposure and cancer
incidence.
Methods: Data from all Republic of Korean diagnostic medical radiation workers enrolled in the national
dose registry were merged with cancer incidence records up to 2018. Excess relative risks (ERRs) for
cancer were calculated using Poisson regression models to quantify the radiation dose-response relationship. Major lifestyle factors were imputed using multiple imputations by chained equations based
on survey data. The confounding effects were assessed by comparing ERRs before and after adjustment
for lifestyle factors.
Results: The baseline ERR for cancer incidence per Sievert was 0.44 (95% CI: -0.94, 1.83) after adjusting
for attained age, sex, birth year, and employment duration. Further adjustment for lifestyle factors
(smoking status, alcohol consumption, body mass index, physical exercise, sleep duration, and night
shift work) did not substantially modify this risk coefficient, with change-in-estimate values ranging
from 0% to 13.6%. Sensitivity analyses conducted with the survey-based cohort and sex-stratified analyses yielded consistent results.
Conclusion: Our study found little evidence of significant confounding effects from unmeasured lifestyle
factors on cancer risk when basic registry data variables were adjusted among medical radiation
workers. Further studies are warranted to investigate the impact of unmeasured and unknown confounders to improve the accuracy of radiation risk estimates
Creator
Eun Jung Park 1,2
, Ye Jin Bang 1
, Won Jin Lee 1,2
, Ye Jin Bang 1
, Won Jin Lee 1,2
Source
https://pdf.sciencedirectassets.com/287282/1-s2.0-S2093791125X00044/1-s2.0-S2093791125000502/main.pdf?X-Amz-Security-Token=IQoJb3JpZ2luX2VjEM3%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FwEaCXVzLWVhc3QtMSJGMEQCIF6idXByJYlOHYp%2B8KvpMW4NGZxxgZL1Y770PsNLAYaFAiA%2FA2miEGik5m6emECpNcfAeg7AJiUTis6hHY34F6XUlCq8BQiV%2F%2F%2F%2F%2F%2F%2F%2F%2F%2F8BEAUaDDA1OTAwMzU0Njg2NSIMlhSvhbXNWxGS%2F0WHKpAF%2FmAIKsHpye17IAjQ1TmIjBrahLaJXnbKYoRDR2YesNykjr5db7oyCdWzh0E2KGA930vYQBG90DRcbFU5rqYNTT9c4w94K4MGOruPbXrleBWeBv61c7erlRpqetVdWy4O%2FF09%2FMD3edeU5JlWzmHcy5LMFg2u1q%2BE9b0%2FEZ8CH2AHWGC3sEy8sLy26R3%2FqAaFu5%2BsrG7gEkOhDNLhGE5fGhs5a8XQKtCX%2FePdbjbDS85R9hYVnUpesgwUOQ3pRf5DPz2Z1x7Lgqu0VDi76UfYwBW%2Bza1y63Sf3wC3hM%2FKPZ5YyH3rhG75ABy1AAcDEFyjwT66BqpJsnfVAlrupWlJhc1901J7vA8Y55DOM9ajzMEURhlYBvAsfW8wGY26jUf6q8%2FTWE2QWPVC9W3Tdr%2Be9zAFATQ1c7VmJpE3XYEIg8qXxc8%2B06RBiz77SjrW6z4cQO2lS%2F8FLmud3ajRFQMSQgHgxOQ2AXiMrDioLO0uLTwTMzZ8sf4ov171xtWYZRifzL1T%2F03D%2B51iaIRv2CDtdtT8a52q3DZ9GWTNEPxnJZuQwIu7guH%2BUis1i1YpIGNJO6cCoj4NuX88LCCUBgszMBMOsOXWsnisa4OIMKlE66uFefOZ0pEhAwnPY5VogdCUtkjZ8u9K%2BqKsH5%2FBUDv9Zs4gEPrJ%2Br9zdMt8KzHx4bmJfGADN7xsJ03Z%2BgKfYk87iAtg%2ByMXHKj1dm5Sx%2FVQnvF2Xi2t9aEX3Qt5eNf7lON261oeMxfnacKnihEZvKwSK4mdNCJJ1phTQI84NNV3JrMTVXLIvUY7emgjQynOjoiglJuAqc4PAij1DXeUw94Bwh02f5ifUQIyF6Wl%2B6wLzLNTAZPV4Gdper5OwAI0MS4wr8OZzQY6sgHgh4bOFkCE9D%2F5YDeno%2BhgwijjtnbFzu%2BQ7yKekNdAX4Rx9YVT0HJzu1l7aEl2PyelodlHruCjEny98bGhatN1TZWrd3e8sfEDVzJM%2BD9CTylw4ykWlKWCHqYHRcFM1bk28EWu2Q2P5KzzXMJCJ1uPB72SvGsYzSBTjUkU2ChJ2XioZajUKmwDq0u52sOUrZGuq%2FFejmfD6hKS7%2BqRmP%2Fa21h4ka6ebqmXF3KsShc9CfXd&X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Date=20260303T043910Z&X-Amz-SignedHeaders=host&X-Amz-Expires=300&X-Amz-Credential=ASIAQ3PHCVTYY2SSXIJP%2F20260303%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Signature=8ddae77805f05ebd0755d533758b56e96336a6d6128681df001dced568383ab1&hash=2f9870b5ca900b6ab8238f6f3016dcf6ad96f30c60ec95fa2b854cae5b43366e&host=68042c943591013ac2b2430a89b270f6af2c76d8dfd086a07176afe7c76c2c61&pii=S2093791125000502&tid=spdf-f54cebe2-16dd-4c77-9779-cc927ba9410c&sid=d2778d995e9d0944b778aee4371d454ba157gxrqa&type=client&tsoh=d3d3LnNjaWVuY2VkaXJlY3QuY29t&rh=d3d3LnNjaWVuY2VkaXJlY3QuY29t&ua=0b015e065157075302&rr=9d65f4b05f59f3f2&cc=id
Publisher
1Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea 2Graduate School of Public Health, Korea University, Seoul, Republic of Korea
Date
28 June 2025
Contributor
Fajar Bagus Wijanarko
Format
PDF
Language
ENGLISH
Type
TEXT
Files
Citation
Eun Jung Park 1,2
, Ye Jin Bang 1
, Won Jin Lee 1,2, “Confounding Effects of Lifestyle Factors in Cancer Risk Estimation for
Occupational Radiation Exposure,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/11985.
Occupational Radiation Exposure,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/11985.