Difference between urban and rural regions in Japan in estimated risk of esophageal cancer based on a health risk appraisal model that includes an alcohol flushing questionnaire

Background Many environmental and genetic factors are presumed to be involved in the etiology of esophageal squamous cell carcinoma (ESCC). We developed a health risk appraisal model that includes an alcohol flushing questionnaire (HRA-F) to estimate the ESCC risk. The purpose of this study was to use the HRA-F model to assess regional differences in the ESCC risk between rural and urban regions in Japan. Methods We compared the HRA-F scores for risk of ESCC of 1,043 medical screening examinees (442 men and 601 women) in a rural region of Oita Prefecture and 1,016 medical screening examinees (610 men and 406 women) in a central region of Tokyo, Japan. Results After adjustment for age, there was no difference between the frequencies of current or former facial flushers in the two populations. Oita men consumed more alcohol than Tokyo men, but Oita women consumed less alcohol than Tokyo women. There was no difference between Oita and Tokyo in the suppressive effect of flushing on alcohol consumption. Oita individuals of both genders reported less smoking, lower green and yellow vegetable intake, and lower fruit intake than did Tokyo individuals. The risk of ESCC quantitatively assessed based on the HRA-F scores was higher in Oita men than in Tokyo men, but a higher proportion of women were at high risk in Tokyo than in Oita. Conclusion The HRA-F model was useful for identifying regional differences in ESCC risk and persons at high risk of ESCC in the Japanese population.