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Brief Communication
Excess mortality from gastric cancer in Korea during the COVID-19 pandemic, 2020–2023
Gyeongil Kim, Ji-Yeon Shin, Yu-Mi Lee, Duk-Hee Lee
Epidemiol Health. 2026;48:e2026021.   Published online May 26, 2026
DOI: https://doi.org/10.4178/epih.e2026021
  • 1,093 View
  • 37 Download
AbstractAbstract AbstractSummary PDF
Abstract
The coronavirus disease 2019 (COVID-19) pandemic substantially disrupted cancer care, leading to declines in screening, diagnosis, and treatment. Gastric cancer is particularly vulnerable to such disruptions because reductions in mortality depend largely on early detection and timely treatment. This study estimated excess mortality from gastric cancer in Korea during the COVID-19 pandemic. Expected gastric cancer deaths during the pandemic were estimated by applying linear regression to age-specific mortality trends from 2015 to 2019. Excess mortality was quantified using annual P-scores. Gastric cancer mortality declined steadily before the pandemic, but this decline attenuated during the pandemic period. Annual P-scores increased progressively, from +3.8% in 2020 and +5.5% in 2021 to +10.6% in 2022 and +20.7% in 2023. By age group, individuals aged 60–79 years showed the largest increases, reaching +46.6% in 2023, whereas minimal excess mortality was observed among those aged 20–59 years. Among adults aged ≥80 years, excess mortality became apparent only in 2023 (+12.8%). Overall, a progressive increase in excess mortality due to gastric cancer was observed in Korea during the COVID-19 pandemic, particularly among individuals aged 60–79 years. These findings suggest that the pandemic adversely affected gastric cancer control and underscore the need for continued monitoring.
Summary
Korean summary
- 코로나19 팬데믹은 암의 조기진단과 적기 치료에 큰 영향을 미친 것으로 알려져 있으며, 위암은 이러한 조기진단과 치료 여부에 따라 예후가 크게 좌우되는 대표적인 암종이다. - 본 연구는 팬데믹 이전(2015~2019년) 연령별 위암 사망률 추이를 바탕으로 2020~2023년의 기대사망자 수를 추정하고, 이를 이용하여 팬데믹 기간 동안 한국의 위암 초과사망을 P-score로 산출하였다. - 팬데믹 이전에는 한국의 연령표준화 위암 사망률이 뚜렷한 감소 추세를 보였으나, 팬데믹 기간 동안 이러한 감소 추세가 둔화되었다. 위암 초과사망은 2020년 3.8%에서 2023년 20.7%까지 지속적으로 증가하였으며, 이러한 증가는 주로 60~79세 연령군에서 관찰되었다.
Key Message
- The COVID-19 pandemic disrupted cancer screening and treatment, particularly for gastric cancer, where early diagnosis is critical for survival. - Using age-specific gastric cancer mortality trends from 2015–2019, we estimated expected deaths during 2020–2023 and quantified excess mortality in South Korea using P-scores. - The pre-pandemic decline in age-standardized gastric cancer mortality slowed during the pandemic. Excess mortality increased from 3.8% in 2020 to 20.7% in 2023, with the largest increases observed among adults aged 60–79 years.
Original Articles
Gastric cancer risk is reduced by a predominance of antioxidant factors in the oxidative balance: a hospital-based case-control study in Korea
Jimi Kim, Jeonghee Lee, Il Ju Choi, Young-Il Kim, Jeongseon Kim
Epidemiol Health. 2022;44:e2022089.   Published online October 17, 2022
DOI: https://doi.org/10.4178/epih.e2022089
  • 19,195 View
  • 108 Download
  • 12 Web of Science
  • 11 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Gastric carcinogenesis is linked to oxidative stress from both exogenous and endogenous exposures. This study aimed to determine the association between the risk of gastric cancer and the oxidative balance score (OBS), which comprises antioxidant and pro-oxidant factors, including diet and lifestyle.
METHODS
For this hospital-based case-control study, 808 controls and 404 patients with gastric cancer who had clinical records indicating <i>Helicobacter pylori</i> infection and the histological subtype of cancer were recruited. The OBS was determined based on diet and lifestyle factors obtained from a 106-item semiquantitative food frequency questionnaire and a constructed questionnaire. Logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).
RESULTS
A higher OBS was associated with a reduced gastric cancer risk (OR, 0.49; 95% CI <sub>T3 vs. T1,</sub> 0.33 to 0.71; p for trend <0.001). In a subgroup analysis, antioxidant factors showed inverse associations with gastric cancer risk (OR, 0.53; 95% CI <sub>T3 vs. T1,</sub> 0.35 to 0.79; p for trend=0.003). A stronger association with antioxidant factors was observed in patients with intestinal gastric cancer (OR, 0.34; 95% CI <sub>T3 vs. T1,</sub> 0.19 to 0.62; p for trend<0.001) and those with <i>H. pylori</i> infection (OR, 0.57; 95% CI <sub>T3 vs. T1,</sub> 0.37 to 0.88; p for trend=0.014).
CONCLUSIONS
A predominance of antioxidant factors compared to pro-oxidant factors from diet and lifestyle reduced the risk of gastric cancer. The combined effect of oxidative stress, which involves an altered balance between antioxidants and pro-oxidants, is important for modulating the risk of gastric cancer.
Summary
Korean summary
본 연구에서는 한국인 암 발생의 상위권을 차지하는 위암 발병률에 대해 영양소, 식품, 생활습관 등 항산화와 산화촉진 요인으로 구성된 산화 균형 점수(Oxidative Balance Score)와의 연관성을 비교 분석하였습니다. 산화촉진 요인에 비해 항산화 관련 요인에서 위암 발생의 위험이 유의하게 감소함을 나타냈습니다.
Key Message
The aim of this study was to determine the association between the risk of gastric cancer and the oxidative balance score comprising antioxidant and pro-oxidants factors, including diet and lifestyle. We found that predominantly antioxidants from diet and lifestyle, in contrast to pro-oxidants, reduce the risk of gastric cancer.

Citations

Citations to this article as recorded by  
  • The association between oxidative balance score and gallstones in adults: a population-based study
    Yuxiao Yang, Jia Wang, Yuan Liu, Jiali Yu, Guanyu Chen, Shiyu Du
    Frontiers in Nutrition.2025;[Epub]     CrossRef
  • Associations between oxidation balance score and abdominal aortic calcification, and the mediating role of glycohemoglobin: a nationally representative cross-sectional study from NHANES
    Heqian Liu, Yifei Wu, Zhenyu Liu, Hongzhi Ren, Ya Wu, Yong Liu
    Frontiers in Nutrition.2025;[Epub]     CrossRef
  • Mechanistic study on the effects of acerola cherry concentrate on LPS-induced IEC-6 cell injury and Vinorelbine-induced immune function damage in zebrafish
    Huilin Zhu, Dingli Wang, Jindan Han, Ling Tong, Yanqing Li, Cuifeng Cao, Lalai Zikela, Zhuoli Yu, Xinyao Li, Hui Zhou, Songtao Li, Libing Chen, Qiang Han
    Journal of Functional Foods.2025; 131: 106949.     CrossRef
  • Association between oxidative balance score and prostate specific antigen among older US adults
    Jintao Li, Chao Yang, Kui Xiang
    Frontiers in Public Health.2024;[Epub]     CrossRef
  • The systemic oxidative stress score has a prognostic value on gastric cancer patients undergoing surgery
    Xinyu Wang, Limin Zhang
    Frontiers in Oncology.2024;[Epub]     CrossRef
  • Association of oxidative balance score with Helicobacter pylori infection and mortality among US population
    Lei Peng, Yongping Sun, Zhenghui Zhu, Yuanyuan Li
    European Journal of Nutrition.2024; 63(7): 2499.     CrossRef
  • Correlations between oxidative balance score and female asthma among U.S. adults
    Xiao Qi, Tianlei Zhou, Jianlei Tang
    Scientific Reports.2024;[Epub]     CrossRef
  • Association between oxidative balance scores and all-cause and cardiovascular disease-related mortality in patients with type 2 diabetes: data from the national health and nutrition examination survey (2007–2018)
    Hao Wang, Yan-Lin Chen, Xiang-Ming Li, Qi Wu, Yan Xu, Jin-Song Xu
    BMC Public Health.2024;[Epub]     CrossRef
  • Oxidative balance score and the potential for suffering rheumatoid arthritis: a cross-sectional study
    Yimin Zhang, Hao Yu, Jianfei Fu, Renjie Zhuo, Jin Xu, Liya Liu, Manyun Dai, Zhen Li
    Frontiers in Immunology.2024;[Epub]     CrossRef
  • An oxidative stress biomarkers predict prognosis in gastric cancer patients receiving immune checkpoint inhibitor
    Guiming Deng, Hao Sun, Rong Huang, Hongming Pan, Yanjiao Zuo, Ruihu Zhao, Zhongze Du, Yingwei Xue, Hongjiang Song
    Frontiers in Oncology.2023;[Epub]     CrossRef
  • Oxidative balance score and risk of cancer: a systematic review and meta-analysis of observational studies
    Motahareh Hasani, Seyedeh Parisa Alinia, Maryam Khazdouz, Sahar Sobhani, Parham Mardi, Hanieh-Sadat Ejtahed, Mostafa Qorbani
    BMC Cancer.2023;[Epub]     CrossRef
The risk of gastric cancer according to changes in smoking status among Korean men
Sung Keun Park, Min-Ho Kim, Chang-Mo Oh, Eunhee Ha, Eun Hye Yang, Woo Yeon Hwang, Ann Hee You, Jae-Hong Ryoo
Epidemiol Health. 2022;44:e2022086.   Published online October 7, 2022
DOI: https://doi.org/10.4178/epih.e2022086
  • 20,615 View
  • 236 Download
  • 9 Web of Science
  • 9 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Smoking is a risk factor for gastric cancer. Studies have shown that the risk of gastric cancer can vary by smoking status and smoking amount at a single point in time. However, few data have been reported about the effect of changes in smoking status over time on the risk of gastric cancer.
METHODS
This study collected data from the National Health Insurance Corporation in Korea on 97,700 Korean men without gastric cancer who underwent health check-ups from 2002 to 2013. The smoking status (never smoked, quit smoking, and currently smoking) of study participants was assessed in 2003-2004 and 2009, and the results were categorized into 7 groups: never-never, never-quit, never-current, quit-quit, quit-current, current-quit, and current-current. Participants were followed until 2013 to identify incident gastric cancer. A multivariate Cox proportional hazard model was used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for incident gastric cancer according to changes in smoking status and smoking amount (pack-years).
RESULTS
Compared with group 1 (never-never), participants currently smoking in 2009 (never-current, quit-current, and current-current) had higher HRs for gastric cancer (never-quit: 1.077; 95% CI, 0.887 to 1.306, never-current: 1.347; 95% CI, 0.983 to1.846, quit-quit: 1.086; 95% CI, 0.863 to 1.366, quit-current: 1.538; 95% CI, 1.042 to 2.269, current-quit: 1.339; 95% CI, 1.077 to 1.666, and current-current: 1.589; 95% CI, 1.355 to 1.864, respectively). The risk for gastric cancer was highest in heavy smokers, followed by moderate smokers.
CONCLUSIONS
In all categories of smoking status, current smoking was associated with the highest risk of gastric cancer. Heavy smoking was associated with an increased risk of gastric cancer, even in former smokers.
Summary
Korean summary
현재 흡연자의 경우 과거 흡연여부와 관계 없이 위암의 위험성이 가장 증가한다. 과거 흡연자의 경우에는 흡연량이 많은 경우에는 위암의 위험성이 증가한다. 이런 결과는 금연이나 흡연량을 줄이는 것이 위암의 위험성을 감소시키는데 매우 중요한 요인이란 것을 확인할 수 있다.
Key Message
Current smoking was associated with an increased risk of gastric cancer, regardless of previous smoking status. Although former smoking was not associated with an increased risk of gastric cancer, former smokers with a history of heavy smoking had an increased risk of gastric cancer. These results suggest that smoking cessation and reducing smoking amounts are both important factors in reducing the risk of gastric cancer.

Citations

Citations to this article as recorded by  
  • Improved hypopharyngeal visibility and early cancer detection using the modified Killian method during esophagogastroduodenoscopy in patients at high risk of head and neck cancer
    Yuki Yoshida, Yohei Ikenoyama, Toru Ogura, Hiroto Suzuki, Aiji Hattori, Yuhei Umeda, Akina Shigefuku, Yasuko Fujiwara, Misaki Nakamura, Yasuhiko Hamada, Noriyuki Horiki, Hayato Nakagawa
    Esophagus.2026; 23(3): 620.     CrossRef
  • Current Understanding of Optimal Prevention of Helicobacter pylori-Induced Cancer
    Adesola Oje, Jonathan Galati, Richard M. Peek
    Gastroenterology Clinics of North America.2025; 54(2): 397.     CrossRef
  • Impact of smoking and opium cessation on gastrointestinal cancer risk: A 15-year longitudinal study in Golestan Cohort
    Masoume Mansouri, Ali Sheidaei, Hossein Poustchi, Gholamreza Roshandel, Reza Malekzadeh, Akram Pourshams, Sadaf G. Sepanlou
    Scientific Reports.2025;[Epub]     CrossRef
  • Gastroesophageal disease risk and inhalational exposure a systematic review and meta-analysis
    Daniel Hyun Kim, Sanjiti Podury, Aida Fallah Zadeh, Tara Mahmoodi, Sophia Kwon, Gabriele Grunig, Mengling Liu, Anna Nolan
    Scientific Reports.2025;[Epub]     CrossRef
  • Association between smoking cessation and recurrence of gastric cancer: A retrospective study based on the National Health and Nutrition Examination Surveys (NHANES) 1999-2018
    Yonglin Li, Yanhong Liang
    Innovative Healthcare in Medicine and Nursing.2025; 1(1): 12.     CrossRef
  • ATR-CHK1 Axis Inhibitors in Gastric Cancer Treatment
    Mateusz Kciuk, Renata Gruszka, Marta Aleksandrowicz, Agnieszka Śliwińska, Renata Kontek
    International Journal of Molecular Sciences.2025; 26(16): 7709.     CrossRef
  • Gastric dysplasia in random biopsies: the influence of Helicobacter pylori infection and alcohol consumption in the presence of a lesion
    Ana Isabel Ferreira, Tiago Lima Capela, Vítor Macedo Silva, Sofia Xavier, Pedro Boal Carvalho, Joana Magalhães, José Cotter
    Scandinavian Journal of Gastroenterology.2024; 59(2): 125.     CrossRef
  • Lifestyle Behaviors in Patients With Gastric Cancer: Continuous Need for Alcohol Abstinence and Muscle Strength Training Education
    Ji Won Seo, Kyu Na Lee, Kyung Do Han, Ki Bum Park
    Journal of Gastric Cancer.2024; 24(3): 316.     CrossRef
  • Gastric cancer—Epidemiology, modifiable and non-modifiable risk factors, challenges and opportunities: An updated review
    Tajul Islam Mamun, Sabrina Younus, Md. Hashibur Rahman
    Cancer Treatment and Research Communications.2024; 41: 100845.     CrossRef
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