Lifestyle factors and long-term survival in patients with chronic non-cancer pain: a nationwide cohort study in South Korea

PurposeThis study aimed to investigate the association of modifiable lifestyle factors with long-term survival outcomes in patients with chronic non-cancer pain (CNCP) in South Korea.MethodsThis population-based cohort study used data from the National Health Insurance Service database in South Korea. We considered three lifestyle factors from the standard health examination (smoking status, alcohol consumption, and physical activity).ResultsA total of 1,298,314 patients with CNCP were analyzed; moreover, the 5-year all-cause mortality rate was 3.3% (42,875 patients). In the multivariable Cox regression model, in the previous-smoker and current-smoker groups, it was 5% (hazard ratio [HR]:1.05, 95% confidence interval [CI]:1.02-1.08; P = 0.003) and 65% (HR: 1.65, 95% CI: 1.60-1.69; P < 0.001) higher, respectively, than that in the never-smoker group. The 5-year all-cause mortality was 19% (HR: 1.19, 95% CI: 1.14-1.24; P < 0.001) higher in the heavy-alcohol-consumption group than in the non-alcohol-consumption group. Compared with those without mild physical activity, patients who engaged in mild physical activity for 1-3 (HR: 0.89, 95% CI: 0.87-0.92; P < 0.001), 4-5 (HR: 0.88, 95% CI: 0.86-0.91; P < 0.001), and 6-7 (HR: 0.90, 95% CI: 0.88-0.93; P < 0.001) days per week exhibited a significantly decreased 5-year all-cause mortality. The association between moderate/intensive physical activity and 5-year all-cause mortality yielded similar results.ConclusionLifestyle factors, including previous/current smoking, heavy alcohol consumption, and physical activity, were associated with a higher 5-year all-cause mortality risk among patients with CNCP in South Korea.