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Volume 41; 2019
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Original Articles
Determinants of early initiation of breastfeeding in Peru: analysis of the 2018 Demographic and Family Health Survey
Akram Hernández-Vásquez, Horacio Chacón-Torrico
Epidemiol Health. 2019;41:e2019051.   Published online December 25, 2019
DOI: https://doi.org/10.4178/epih.e2019051
  • 12,818 View
  • 281 Download
  • 7 Web of Science
  • 9 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
Early initiation of breastfeeding (EIBF) is one of the most cost-effective strategies to reduce neonatal mortality. We sought to determine the prevalence and determinants of EIBF in Peru.
METHODS
We performed a cross-sectional analytical study of the 2018 Peruvian Demographic and Family Health Survey as a secondary data source. In total, 19,595 children born during the 5 years prior to the survey were included in the study. The dependent variable (EIBF status), socio-demographic variables, and pregnancy-related variables were analyzed using a multivariate logistic regression model to identify the determinants of EIBF.
RESULTS
The prevalence of EIBF in the study population was 49.7%. Cesarean deliveries were associated with a lower likelihood of EIBF (adjusted odds ratio [aOR], 0.06; 95% confidence interval [CI], 0.05 to 0.07) than were vaginal deliveries. Newborns born at public health centers (aOR, 1.37; 95% CI, 1.15 to 1.65) had a higher rate of EIBF than those not born at public or private health centers. Women from the jungle region (aOR, 2.51; 95% CI, 2.17 to 2.89) had higher odds of providing EIBF than those from the coast. Mothers with more than a secondary education (aOR, 0.65; 95% CI, 0.55 to 0.76) were less likely to breastfeed during the first hour of the newborn’s life than women with primary or no education.
CONCLUSIONS
More than half of Peruvian children do not breastfeed during the first hour after birth. The major determinants of EIBF status were the delivery mode and the region of maternal residence. Strategies are needed to promote early breastfeeding practices.
Summary

Citations

Citations to this article as recorded by  
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    World Journal of Clinical Pediatrics.2024;[Epub]     CrossRef
  • Prevalence of essential newborn care in home and facility births in the Peruvian Amazon: analysis of census data from programme evaluation in three remote districts of the Loreto region
    Stefan Reinders, Magaly M. Blas, Melissa Neuman, Luis Huicho, Carine Ronsmans
    The Lancet Regional Health - Americas.2023; 18: 100404.     CrossRef
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    Siddika Songül Yalçin
    Revista de Salud Pública.2023; 25(1): 1.     CrossRef
  • Strong Negative Association between Cesarean Delivery and Early Initiation of Breastfeeding Practices among Vietnamese Mothers—A Secondary Analysis of the Viet Nam Sustainable Development Goal Indicators on Children and Women Survey
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    Nutrients.2023; 15(21): 4501.     CrossRef
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    Pediatrics & Neonatology.2023;[Epub]     CrossRef
  • Effects of maternal education on early initiation and exclusive breastfeeding practices in sub-Saharan Africa: a secondary analysis of Demographic and Health Surveys from 2015 to 2019
    Wako Golicha Wako, Zelalem Wayessa, Anteneh Fikrie
    BMJ Open.2022; 12(3): e054302.     CrossRef
  • Timing of Breastfeeding Initiation Mediates the Association between Delivery Mode, Source of Breastfeeding Education, and Postpartum Depression Symptoms
    Xinran Shen, Shunna Lin, Hui Li, Nubiya Amaerjiang, Wen Shu, Menglong Li, Huidi Xiao, Sofia Segura-Pérez, Rafael Pérez-Escamilla, Xin Fan, Yifei Hu
    Nutrients.2022; 14(14): 2959.     CrossRef
  • Determinants of early initiation of breast feeding among mothers of children aged less than 24 months in Ethiopia: A community-based cross-sectional study
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    BMJ Open.2022; 12(10): e062905.     CrossRef
  • Socioeconomic determinants and inequalities in exclusive breastfeeding among children in Peru
    Akram Hernández-Vásquez, Rodrigo Vargas-Fernández
    Frontiers in Nutrition.2022;[Epub]     CrossRef
The double burden of malnutrition among adults in India: evidence from the National Family Health Survey-4 (2015-16)
Mili Dutta, Y Selvamani, Pushpendra Singh, Lokender Prashad
Epidemiol Health. 2019;41:e2019050.   Published online December 18, 2019
DOI: https://doi.org/10.4178/epih.e2019050
  • 14,419 View
  • 304 Download
  • 32 Web of Science
  • 37 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
India still faces the burden of undernutrition and communicable diseases, and the prevalence of overweight/obesity is steadily increasing. The discourse regarding the dual burden of underweight and overweight/obesity has not yet been widely explored in both men and women. The present study assessed the determinants of underweight and overweight/obesity in India among adult men and women aged 15-49.
METHODS
Population-based cross-sectional and nationally representative data from the National Family Health Survey-4 (2015-16), consisting of a sample of men and women, were analyzed. Stratified 2-stage sampling was used in the NFHS-4 study protocol. In the present study, bivariate and adjusted multinomial logistic regression analyses were performed to determine the correlates of underweight and overweight/obesity.
RESULTS
The results suggested a persistently high prevalence of underweight coexisting with an increased prevalence of overweight/obesity in India. The risk of underweight was highest in the central and western regions and was also relatively high among those who used either smoking or smokeless tobacco. Overweight/obesity was more prevalent in urban areas, in the southern region, and among adults aged 35-49. Furthermore, level of education and wealth index were positively associated with overweight/obesity. More educated and wealthier adults were less likely to be underweight.
CONCLUSIONS
In India, underweight has been prevalent, and the prevalence of overweight/obesity is increasing rapidly, particularly among men. The dual burden of underweight and overweight/obesity is alarming and needs to be considered; public health measures to address this situation must also be adopted through policy initiatives.
Summary

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Review
A systematic review of barriers and motivators to physical activity in elderly adults in Iran and worldwide
Soudabeh Yarmohammadi, Hossein Mozafar Saadati, Mohtasham Ghaffari, Ali Ramezankhani
Epidemiol Health. 2019;41:e2019049.   Published online November 29, 2019
DOI: https://doi.org/10.4178/epih.e2019049
  • 17,641 View
  • 428 Download
  • 44 Web of Science
  • 53 Crossref
AbstractAbstract PDFSupplementary Material
Abstract
OBJECTIVES
This study was conducted to identify and characterize the barriers and motivations to physical activity (PA) for elderly adults in Iran and other countries.
METHODS
We searched 6 databases (PubMed, Embase, Scopus, Web of Science, Magiran, and the Scientific Information Database) from 2000 to the November 2017, using “aged 60 and over,” “physical activity” or “exercise,” and “motivator” and “barrier” as keywords. Two reviewers independently performed the search, screening, and quality assessment of the studies.
RESULTS
In total, 34 papers were finally included in the study. The most important barriers, based on the frequency of factors, included physical problems, having no companions, and physical barriers to walking. The motivators included improving one’s physical condition, being social, and suitability of the physical environment.
CONCLUSIONS
Important motivators and barriers to PA were more closely related to intrapersonal factors than to the interpersonal and environmental domains. The barriers and motivators to PA in the elderly were not markedly different between Iran and other countries. Therefore, a general strategy could be designed to improve PA in the elderly.
Summary

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Original Articles
Ebola virus disease outbreak in Korea: use of a mathematical model and stochastic simulation to estimate risk
Youngsuk Ko, Seok-Min Lee, Soyoung Kim, Moran Ki, Eunok Jung
Epidemiol Health. 2019;41:e2019048.   Published online November 24, 2019
DOI: https://doi.org/10.4178/epih.e2019048
  • 11,154 View
  • 208 Download
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
According to the World Health Organization, there have been frequent reports of Ebola virus disease (EVD) since the 2014 EVD pandemic in West Africa. We aim to estimate the outbreak scale when an EVD infected person arrives in Korea.
METHODS
Western Africa EVD epidemic mathematical model SEIJR or SEIJQR was modified to create a Korean EVD outbreak model. The expected number of EVD patients and outbreak duration were calculated by stochastic simulation under the scenarios of Best case, Diagnosis delay, and Case missing.
RESULTS
The 2,000 trials of stochastic simulation for each scenario demonstrated the following results: The possible median number of patients is 2 and the estimated maximum number is 11 when the government intervention is proceeded immediately right after the first EVD case is confirmed. With a 6-day delay in diagnosis of the first case, the median number of patients becomes 7, and the maximum, 20. If the first case is missed and the government intervention is not activated until 2 cases of secondary infection occur, the median number of patients is estimated at 15, and the maximum, at 35.
CONCLUSIONS
Timely and rigorous diagnosis is important to reduce the spreading scale of infection when a new communicable disease is inflowed into Korea. Moreover, it is imperative to strengthen the local surveillance system and diagnostic protocols to avoid missing cases of secondary infection.
Summary
Korean summary
본 연구는 수학적 모델과 확률 시뮬레이션 기법을 이용하여 국내에 유입되지 않았던 에볼라바이러스병(EVD)의 확산 위험도를 정량적으로 예측하는 첫 번째 연구이다. 또한 이 연구를 통해 에볼라바이러스병 환자의 유입 시 발생 가능한 진단 지연 혹은 유입 미인지 상황을 가정하여 발생할 수 있는 2차 감염자 수 및 감염 종식까지의 기간을 계산했고 에볼라바이러스 유입 대비 실시간모니터링의 중요성과 확산 시 상황에 따른 최대 일일 환자수를 합리적으로 제시할 수 있다.

Citations

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  • Estimating the Transmission Risk of COVID-19 in Nigeria: A Mathematical Modelling Approach
    Irany FA, Akwafuo SE, Abah T, Mikler AR
    Journal of Health Care and Research.2020; 1(3): 135.     CrossRef
Physical activity level in Korean adults: the Korea National Health and Nutrition Examination Survey 2017
Ki-Yong An
Epidemiol Health. 2019;41:e2019047.   Published online November 9, 2019
DOI: https://doi.org/10.4178/epih.e2019047
  • 34,214 View
  • 249 Download
  • 21 Web of Science
  • 20 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study investigated physical activity (PA) participation based on demographic, physical, and psychological variables in Korean adults.
METHODS
Participants were divided into four groups (combined, aerobic only, resistance only, and neither) based on meeting the PA guidelines using moderate and vigorous PA time and resistance exercise frequency from the Korea National Health and Nutrition Examination Survey 2017. The association between meeting the PA guidelines and demographic, medical, fitness, lifestyle, and psychological variables were analyzed using complex samples crosstabs and a general linear model.
RESULTS
Of the 5,820 Korean adults, 66.0% did not meet any of the guidelines. Among demographic factors, sex, age, marital status, income, education level, occupation, and employment status were associated with meeting the PA guidelines. Chronic disease prevalence, weight, waist circumference, body mass index, diastolic blood pressure, glucose, high-density lipoprotein and triglyceride levels, hand-grip strength, resting heart rate, and family history of chronic disease in the medical and fitness variables; frequency of drinking and eating breakfast, total calorie, water, protein, and fat intake in the lifestyle variables; and perceived stress, depression, suicidal thoughts, and quality of life in the psychological variables were associated with meeting PA guidelines.
CONCLUSIONS
Most Korean adults participate in insufficient PA. Moreover, individuals who are socially underprivileged, have low-income or poor physical and mental health conditions participated in relatively less PA. Our findings suggest that government and individual efforts are required to increase PA and resolve health inequality in Korean adults.
Summary
Korean summary
2017년 국민건강영양조사 자료를 분석한 결과, 한국 성인들의 신체활동 실천율은 매우 낮았으며, 특히, 사회적 약자나 저소득층, 신체적, 정신적 건강 위험요인이 높은 사람들에게 더 낮게 나타났다. 신체활동은 건강증진을 위한 가장 경제적이며 효율적인 방법으로써, 신체활동 참여를 늘리고 건강불평등을 해소하기 위한 정부, 의료기관, 교육기관은 물론 국민 개개인의 신체활동에 대한 인식개선과 적극적인 노력이 필요하다.

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Review
The global prevalence of dental healthcare needs and unmet dental needs among adolescents: a systematic review and meta-analysis
Mahin Ghafari, Samira Bahadivand-Chegini, Tayebeh Nadi, Amin Doosti-Irani
Epidemiol Health. 2019;41:e2019046.   Published online October 27, 2019
DOI: https://doi.org/10.4178/epih.e2019046
  • 14,453 View
  • 245 Download
  • 9 Web of Science
  • 7 Crossref
AbstractAbstract PDFSupplementary Material
Abstract
OBJECTIVES
Access to dental healthcare services is a major determinant of dental health in communities. This meta-analysis was conducted to estimate the global prevalence of dental needs and of unmet dental needs in adolescents.
METHODS
PubMed, Web of Science, and Scopus were searched in June 2018. The summary measures included the prevalence of met and unmet dental needs. A meta-analysis was performed using the inverse variance method to obtain pooled summary measures. Out of 41,661 retrieved articles, 57 were ultimately included.
RESULTS
The pooled prevalence of orthodontic treatment needs was 46.0% (95% confidence interval [CI], 38.0 to 53.0), that of general treatment needs was 59.0% (95% CI, 42.0 to 75.0), that of periodontal treatment needs was 71.0% (95% CI, 46.0 to 96.0), and that of malocclusion treatment needs was 39.0% (95% CI, 28.0 to 50.0). The pooled prevalence of unmet dental needs was 34.0% (95% CI, 27.0 to 40.0).
CONCLUSIONS
The highest and lowest prevalence of unmet dental needs were found in Southeast Asia and Europe, respectively. The prevalence of dental needs was higher in the countries of the Americas and Europe than in other World Health Organization (WHO) regions. The prevalence of unmet dental needs was higher in Southeast Asia and Africa than in other WHO regions.
Summary

Citations

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Original Articles
Evaluating maternal and child health indicators for the Sustainable Development Goals in 2018: what is Iran’s position?
Elham Khatooni, Isa Akbarzadeh, Elham Abdalmaleki, Zhaleh Abdi, Elham Ahmadnezhad
Epidemiol Health. 2019;41:e2019045.   Published online October 11, 2019
DOI: https://doi.org/10.4178/epih.e2019045
  • 10,460 View
  • 168 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
Since many Millennium Development Goals (MDGs) were not achieved, countries including Iran—despite achieving some of the MDGs—need regular planning to achieve the Sustainable Development Goals (SDGs) by 2030. This article examines maternal and child health indicators in the early years of the SDGs in Iran relative to several other countries.
METHODS
This study was carried out through a secondary analysis of maternal and child health indicators in Iran. The results were compared with data from other countries divided into three groups: countries with upper-middle income levels, countries in the Eastern Mediterranean region, and the countries covered by the Outlook Document 1,404 (a regional classification). Then, the relationship between these indicators and the Human Development Index was investigated.
RESULTS
Iran has attained better results than other countries with respect to maternal mortality, family planning, skilled birth attendance, under-5 deaths, incidence of hepatitis B, diphtheria-tetanus-pertussis vaccination coverage, and antenatal care. In contrast, Iran performed worse than other countries with respect to under-5 wasting, under-5 stunting, and care-seeking behavior for children.
CONCLUSIONS
Overall, among the 11 indicators surveyed, Iran has attained better-than-average results and seems to be improving. We recommend that Iran continue interventions in the field of maternal and child health.
Summary

Citations

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  • Iranian women's birth experiences: a cross-sectional study
    Mona Ghobadi, Farzaneh Pazandeh, Barbara Potrata, Ehsan Kazemnejad Lili
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Estimating the medical capacity required to administer mass prophylaxis: a hypothetical outbreak of smallpox virus infection in Korea
Sangwoo Tak, Soomin Lim, Heesu Kim
Epidemiol Health. 2019;41:e2019044.   Published online October 10, 2019
DOI: https://doi.org/10.4178/epih.e2019044
  • 9,239 View
  • 165 Download
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The aim of this study was to estimate the medical surge capacity required for mass prophylaxis based on a hypothetical outbreak of smallpox.
METHODS
We performed a simulation using the Bioterrorism and Epidemic Outbreak Response Model and varied some important parameters, such as the number of core medical personnel and the number of dispensing clinics.
RESULTS
Gaps were identified in the medical surge capacity of the Korean government, especially in the number of medical personnel who could respond to the need for mass prophylaxis against smallpox.
CONCLUSIONS
The Korean government will need to train 1,000 or more medical personnel for such an event, and will need to prepare many more dispensing centers than are currently available.
Summary
Korean summary
본 연구는 이미 박멸된 감염병인 두창이 발생됨을 가상하여 대규모 백신접종의 시나리오를 바탕으로 의료인력과 접종에 필요한 보건의료시설의 가용여부를 분석하였다. 두창 발생 1년 이내에 전국민의 70%를 대상으로 백신접종을 완료하기 위해서는 최소 1,000 명 이상의 훈련된 의료인력이 필요하며, 현재 병의원 시설을 포함하여 보건소 등을 백신 접종을 위한 시설로 활용하기 위해서 체계적인 대비노력이 필요한 것으로 판단된다. 한국정부의 대비역량에 대한 좀 더 면밀한 분석이 요구된다.
Effects of living in the same region as one’s workplace on the total fertility rate of working women in Korea
Yeon-Yong Kim, Hee-Jin Kang, Seongjun Ha, Jong Heon Park
Epidemiol Health. 2019;41:e2019043.   Published online October 9, 2019
DOI: https://doi.org/10.4178/epih.e2019043
  • 65,535 View
  • 156 Download
  • 2 Web of Science
  • 4 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The lowest-low fertility status of Korea has continued for the past 17 years despite governmental efforts to encourage childbirth. As the number of working women has increased, their residence patterns have changed; however, the impact of this factor has yet to be explored. Therefore, this study was conducted to investigate the effects of residence patterns relative to the workplace on the total fertility rate of working women.
METHODS
Information on eligibility and healthcare utilization was obtained from the National Health Information Database between 2011 and 2015. The study participants were working women aged 15-49 years. We classified their residence relative to their workplace into 3 patterns: same municipality, same province, and different province. The total fertility rate was calculated and logistic regression was performed of childbirth according to residence pattern, adjusting for age, insurance contribution quartile, size of the workplace, year of birth, and province of residence.
RESULTS
The total fertility rates of working women from 2011 to 2015 were 1.091, 1.139, 1.048, 1.073, and 1.103, respectively. The total fertility rate by residence pattern was highest in women residing in the same municipality as their workplace. After adjustment, the odds of childbirth in women from the same municipality and the same province were 21.6% and 16.0% higher than those of women residing in a different province, respectively.
CONCLUSIONS
The total fertility rate was higher among women living near their workplace. Therefore, effective policy measures should be taken to promote the proximity of working women’s workplace and residence.
Summary
Korean summary
이 연구를 통하여 직장과 동일한 시군구에 거주하는 직장 여성의 출산율이 타 시군구 및 타 시도에 거주하는 경우보다 더 높게 나타나는 것을 확인하였다. 기존 인구사회학적 특성 위주의 출산 관련 연구에 비해 이 연구에서는 직장과 거주지의 차이의 영향을 확인하였다는 데 의의가 있다. 저출산 대책에 대한 다양한 정책적 접근이 요구되는 시점에 직장 여성의 출산율을 높이기 위하여 거주지 대책 등이 종합적으로 고려될 수 있음을 시사한다.

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  • HASTA GÖZÜYLE ANNE DOSTU HASTANE KRİTERLERİ
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    Journal of Healthcare Management and Leadership.2023; (1): 1.     CrossRef
  • No One Size Fits All. Women Commercial Farm Employment and Fertility in Ethiopia: A Study of Saudi Star and MERTI Agricultural Development Farms☆
    Chalachew Getahun Desta
    Rural Sociology.2022; 87(3): 1017.     CrossRef
  • Global patterns of breast cancer incidence and mortality: A population‐based cancer registry data analysis from 2000 to 2020
    Shaoyuan Lei, Rongshou Zheng, Siwei Zhang, Shaoming Wang, Ru Chen, Kexin Sun, Hongmei Zeng, Jiachen Zhou, Wenqiang Wei
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Effects of adults’ health behaviors and combinations thereof on health outcomes: an analysis using National Health Insurance Service of Korea cohort data
Hyun-Jung Park, Eun-Jung Kim
Epidemiol Health. 2019;41:e2019042.   Published online October 8, 2019
DOI: https://doi.org/10.4178/epih.e2019042
  • 10,681 View
  • 162 Download
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The purpose of this study was to estimate the effects of health-risk behaviors, alone and in combination, on health outcomes.
METHODS
This study used sample cohort data provided by the National Health Insurance Service focusing on the use of hospital services, direct medical expenses, length of stay, and re-entry rate according to health-risk behaviors. A frequency analysis and the chi-square test were used to investigate associations between the demographic characteristics of study subjects and their health-risk behaviors. The strength of the association of each factor was calculated as the odds ratio in a crossover analysis.
RESULTS
Obesity had the largest effect, especially in combination with smoking and drinking. In particular, significant associations were shown with the duration of hospitalization and direct medical expenses. After adjustment for sex, age, economic status, and pre-existing medical conditions, the duration of hospitalization was 7.37 times longer and that of medical expenses was 5.18 times higher in the obese group relative to the non-obese group. Drinking showed a statistically significant association with the number of days of hospitalization. After adjusting for the control variables, the number of hospital days was 1.24 longer in the drinking group than in the non-drinking group.
CONCLUSIONS
An analysis of combinations of health risk factors showed obesity had the largest effect.
Summary
Korean summary
본 연구에서는 건강위해행동이 건강결과에 미치는 영향을 추정하고, 건강위해행동 간 상호작용을 분석하여 보다 다차원적 측면에서 건강위해행동과 건강결과 간 관계를 다루었다. 그 결과, 흡연, 비만, 음주 중 1개의 위해행위를 가지고 있는 경우, 흡연 집단에서 모든 건강결과와의 관련성이 통계적으로 유의미하지 않았으나, 비만의 경우, 입원일수와 직접의료비간의 관련성이 유의미하였고, 특히, 비만한 집단의 경우, 성별, 연령, 경제적 수준 및 기저 질환을 보정한 후, 그렇지 않은 집단과 비교하여 입원일수와 의료비의 유의미한 증가가 확인되었다. 건강위험행태요인의 조합을 조사하여, 어떤 경우 건강행태에 영향을 크게 미치는지를 분석한 결과, 비만의 영향이 가장 큰 것으로 분석되었으며, 흡연과 음주, 단일의 건강위험행태보다, 비만과 함께 건강위험행태가 동반되었을 때 그 영향이 증가하였다.

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  • Risk and protective behaviors for chronic non-communicable diseases among Brazilian adults
    R.B.N. de Carvalho, F. Rauber, R.M. Claro, R.B. Levy
    Public Health.2021; 195: 7.     CrossRef
Alcohol-related emergency department visits and income inequality in New York City, USA: an ecological study
Kathleen H. Reilly, Katherine Bartley, Denise Paone, Ellenie Tuazon
Epidemiol Health. 2019;41:e2019041.   Published online October 8, 2019
DOI: https://doi.org/10.4178/epih.e2019041
  • 10,568 View
  • 168 Download
  • 5 Web of Science
  • 6 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
Previous research has found that greater income inequality is related to problematic alcohol use across a variety of geographical areas in the USA and New York City (NYC). Those studies used self-reported data to assess alcohol use. This study examined the relationship between within-neighborhood income inequality and alcohol-related emergency department (ED) visits.
METHODS
The study outcome was the alcohol-related ED visit rate per 10,000 persons between 2010 and 2014, using data obtained from the New York Statewide Planning and Research Cooperative System. The main predictor of interest was income inequality, measured using the Gini coefficient from the American Community Survey (2010-2014) at the public use microdata area (PUMA) level (n=55) in NYC. Variables associated with alcohol-related ED visits in bivariate analyses were considered for inclusion in a multivariable model.
RESULTS
There were 420,568 alcohol-related ED visits associated with a valid NYC address between 2010 and 2014. The overall annualized NYC alcohol-related ED visit rate was 100.7 visits per 10,000 persons. The median alcohol ED visit rate for NYC PUMAs was 88.0 visits per 10,000 persons (interquartile range [IQR], 64.5 to 133.5), and the median Gini coefficient was 0.48 (IQR, 0.45 to 0.51). In the multivariable model, a higher neighborhood Gini coefficient, a lower median age, and a lower percentage of male residents were independently associated with the alcohol-related ED visit rate.
CONCLUSIONS
This study found that higher neighborhood income inequality was associated with higher neighborhood alcohol-related ED visit rates. The precise mechanism of this relationship is not understood, and further investigation is warranted to determine temporality and to assess whether the results are generalizable to other locales.
Summary

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    He Chen, Jing Ning, Hongwei Hu, Haotian He
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Data Profile
Family tree database of the National Health Information Database in Korea
Yeon-Yong Kim, Hae-young Hong, Kyu-Dong Cho, Jong Heon Park
Epidemiol Health. 2019;41:e2019040.   Published online October 1, 2019
DOI: https://doi.org/10.4178/epih.e2019040
  • 12,811 View
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
We constructed the family tree database (DB) by using a new family code system that can logically express interpersonal family relationships and by comparing and complementing health insurance eligibility data and resident register data of the National Health Information Database (NHID). In the family tree DB, Parents and grandparents are matched for more than 95% of those who were born between 2010 and 2017. Codes for inverse relationships and extended relationships are generated using sequences of the three-digit basic family codes. The family tree DB contains variables such as sex, birth year, family relations, and degree of kinship (maximum of 4) between subjects and family members. Using the family tree DB, we find that prevalence rates of hypertension, diabetes, ischemic heart disease, cerebrovascular disease, and cancer are higher for those with family history. The family tree DB may omit some relationships due to incomplete past data, and some family relations cannot be uniquely determined because the source data only contain relationships between head and members of the household. The family tree DB is a part of the NHID, and researchers can submit requests for data on the website at http://nhiss.nhis.or.kr. Requested data will be provided after approval from the data service review board. However, the family tree DB can be limitedly provided for studies with high public value in order to maximize personal information protection.
Summary
Korean summary
가족관계도(family tree) DB는 건강보험공단이 보유하는 건강보험 가입자정보와 행정전산망 정보를 바탕으로 가공·구축된 자료다. 4촌까지의 가족 관계를 파악할 수 있으며, 세대주 중심의 관계코드가 아닌 개인 단위의 논리적 기호로 구성된 관계코드를 통해 촌수, 계통, 성별을 구분하도록 하였다. 이를 바탕으로 의학적, 사회정책적으로 다양한 연구가 가능하다.

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    Yong Hoon Kim, Ae-Young Her, Seung-Woon Rha, Byoung Geol Choi, Se Yeon Choi, Jae Kyeong Byun, Dong Oh Kang, Won Young Jang, Woohyeun Kim, Ju Yeol Baek, Woong Gil Choi, Tae Soo Kang, Jihun Ahn, Sang-Ho Park, Sung Hun Park, Ji Yeon Hong, Ji Young Park, Min-
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Original Article
Distribution and social determinants of overweight and obesity: a cross-sectional study of non-pregnant adult women from the Malawi Demographic and Health Survey (2015-2016)
Leonard Mndala, Abhay Kudale
Epidemiol Health. 2019;41:e2019039.   Published online September 27, 2019
DOI: https://doi.org/10.4178/epih.e2019039
  • 13,151 View
  • 270 Download
  • 13 Web of Science
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AbstractAbstract PDF
Abstract
OBJECTIVES
Hitherto regarded as a public health issue of well-heeled nations, overweight and obesity have emerged as a problem of concern in developing nations. Although social and demographic factors are equally important as proximal lifestyle factors affecting health, their role is neither well researched nor well understood. We conducted a novel study to determine the distribution, prevalence, and social and demographic determinants of overweight/obesity in Malawi.
METHODS
A population-based, quantitative cross-sectional study using data from the Malawi Demographic and Health Survey (2015-2016) was conducted among non-pregnant women aged 18-49 years. A total of 6,443 women were included in the analysis. Overweight/obesity, defined as a body mass index (BMI) ≥25.0 kg/m2 , was the main outcome variable. The analysis was done in SPSS version 20.0; after calculating descriptive statistics, bivariate and multivariate logistic regression was conducted to evaluate associations and determine odds.
RESULTS
In total, 16.8% and 6.3% of women were overweight and obese, respectively (p<0.001). Overweight and obesity were more prevalent in urban than in rural areas. The BMI distribution among women varied across different background characteristics. Women from the Ngoni ethnicity were more likely to be overweight/obese than others (adjusted odds ratio [aOR], 1.54; 95% confidence interval [CI], 1.14 to 2.08). Socioeconomic status (SES) and the age of the respondent were highly significant determinants that were strongly associated with being overweight/obese. The richest women were 3 times more likely to be overweight/obese than the poorest (aOR, 3.30; 95% CI, 2.46 to 4.43).
CONCLUSIONS
Overweight and obesity were highly prevalent and significantly associated with increasing SES, age, and being from the Ngoni ethnicity. Holistic interventions should also focus on improving social determinants in order to entirely curb the epidemic.
Summary

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Special Article
Causes and countermeasures for repeated outbreaks of hepatitis A among adults in Korea
Moran Ki, Hyunjin Son, Bo Youl Choi
Epidemiol Health. 2019;41:e2019038.   Published online September 22, 2019
DOI: https://doi.org/10.4178/epih.e2019038
  • 12,340 View
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
The 2019 hepatitis A outbreak has become increasingly prevalent among adults in Korea and is the largest outbreak since that in 2009-2010. The incidence in the current outbreak is highest among adults aged 35-44 years, corresponding to the peak incidence among those aged 25-34 years 10 years ago. This may indicate a cohort effect in the corresponding age group. Causes of these repeated outbreaks of hepatitis A in Korea are low level of immunity among adults, Korean food culture that consumes raw seafood such as salted clam and inadequate public health system. Among countermeasures, along with general infectious disease control measures including control of the infectious agent, infection spread, and host, urgent actions are needed to review the vaccination policy and establish an adequate public health system.
Summary
Korean summary
2019년 한국 성인의 A형 간염 유행은 10년전 대규모 유행 이후 가장 큰 규모로발생하고 있다. 주 발생 연령이 10년전 유행보다 10세가 증가한 35-44세로 나타나 연령 코호트 효과라 볼 수 있다. 우리나라의 A형 간염 반복 유행의 원인은 성인의 낮은 집단면역수준, 어패류 생식문화, 공중보건의료체계 미비 등으로 보인다. 이에 대한 대책은 일반적인 감염관리대책인 감염원관리, 전파관리, 숙주관리와 함께 효율적인 백신접종정책, 공고한 공중보건관리체계 마련 등의 근본적 대책이 시급하다.

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Original Article
Epidemiological characteristics of HIV infected Korean: Korea HIV/AIDS Cohort Study
Yunsu Choi, Bo Youl Choi, Soo Min Kim, Sang Il Kim, June Kim, Jun Young Choi, Shin-Woo Kim, Joon Young Song, Youn Jeong Kim, Dae Won Park, Hyo Youl Kim, Hee-Jung Choi, Mee-Kyung Kee, Young Hyun Shin, Myeongsu Yoo
Epidemiol Health. 2019;41:e2019037.   Published online September 3, 2019
DOI: https://doi.org/10.4178/epih.e2019037
  • 14,910 View
  • 338 Download
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
To manage evidence-based diseases, it is important to identify the characteristics of patients in each country.
METHODS
The Korea HIV/AIDS Cohort Study seeks to identify the epidemiological characteristics of 1,442 Korean individuals with human immunodeficiency virus (HIV) infection (12% of Korean individuals with HIV infection in 2017) who visited 21 university hospitals nationwide. The descriptive statistics were presented using the Korea HIV/AIDS cohort data (2006-2016).
RESULTS
Men accounted for 93.3% of the total number of respondents, and approximately 55.8% of respondents reported having an acute infection symptom. According to the transmission route, infection caused by sexual contact accounted for 94.4%, of which 60.4% were caused by sexual contact with the same sex or both males and females. Participants repeatedly answered the survey to decrease depression and anxiety scores. Of the total participants, 89.1% received antiretroviral therapy (ART). In the initial ART, 95.3% of patients were treated based on the recommendation. The median CD4 T-cell count at the time of diagnosis was 229.5 and improved to 331 after the initial ART. Of the patients, 16.6% and 9.4% had tuberculosis and syphilis, respectively, and 26.7% had pneumocystis pneumonia. In the medical history, sexually transmitted infectious diseases showed the highest prevalence, followed by endocrine diseases. The main reasons for termination were loss to follow-up (29.9%) and withdrawal of consent (18.7%).
CONCLUSIONS
Early diagnosis and ART should be performed at an appropriate time to prevent the development of new infection.
Summary
Korean summary
국내 감염인은 대부분 성 접촉으로 인해 감염되었고, 감염인의 약 90%가 치료를 경험하였다. 하지만 여전히 결핵, 매독, 주폐포자충 폐렴 등과 같은 HIV 관련 질환의 유병률이 높았고, 치료를 통해 수명이 연장되어 노화 혹은 치료 약제 부작용과 관련된 HIV 비 관련 만성 질환의 유병률도 높았다. 향후 감염인의 HIV/AIDS 비 관련 질환에 대한 연구 및 사망 원인 등에 대한 후속 연구가 필요하겠다.

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