Epidemiology and Health

Original Articles

A prospective association between dietary mushroom intake and the risk of type 2 diabetes: the Korean Genome and Epidemiology Study–Cardiovascular Disease Association Study: Yu-Mi Kim, Hye Won Woo, Min-Ho Shin, Sang Baek Koh, Hyeon Chang Kim, Mi Kyung Kim; Epidemiol Health. 2024;46:e2024017. Published online January 8, 2024; DOI: https://doi.org/10.4178/epih.e2024017

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Mushrooms, known for their nutritious and functional components, are considered healthy and medicinal. This study investigated the prospective association between dietary mushroom consumption and the incidence of type 2 diabetes among Korean adults aged ≥40 years.
METHODS
In total, 16,666 participants who were not taking anti-diabetic medication or insulin and had normal fasting blood glucose (FBG; <126 mg/dL) were included. We used the cumulative average dietary consumption of mushrooms as an exposure metric, calculated from food frequency questionnaires at every follow-up, along with covariates collected during a baseline survey. To estimate incidence rate ratios (IRRs) for type 2 diabetes, a modified Poisson regression model with a robust error estimator was applied.
RESULTS
In multivariable models, dietary mushroom consumption was inversely associated with type 2 diabetes incidence in both genders (men: IRR, 0.65; 95% confidence interval [CI], 0.47 to 0.90; plinearity=0.043 in the highest quartile (Q4) vs. the lowest quartile (Q1); women: IRR, 0.70; 95% CI, 0.54 to 0.93; plinearity=0.114 in Q4 vs. Q1). The inverse association remained after adjustment for dietary factors instead of dietary quality index, the baseline FBG, and the exclusion of incidence within the first year. Additionally, no significant interaction was found regarding the risk of type 2 diabetes between dietary mushroom consumption and participants’ gender or other factors.
CONCLUSIONS
Dietary mushroom consumption was inversely linked with the risk of type 2 diabetes incidence in both genders, indicating the beneficial role of mushrooms in preventing the disease.; Summary

Korean summary
- 흔히 사용하는 버섯의 식이 섭취량이 증가함에 따라 한국 40세 이상 성인에서 제2형 당뇨병 발생 위험이 낮았다. - 이러한 역관계는 성별과 다양한 식이 배경에서도 일관성을 유지하였고, 이는 버섯이 제2형 당뇨병 예방에 있어 잠재적인 식이요소로서의 가능성을 보여주는성을 보여주는 보여주는 결과이다.

Key Message
• Increased dietary consumption of commonly used mushrooms is associated with a lower risk of type 2 diabetes incidence among adults aged 40 years or older in Korea. • This inverse relationship remains consistent across genders and various dietary backgrounds, underscoring the potential of mushrooms as a preventive dietary component against.

Determinants of unhealthy living by gender, age group, and chronic health conditions across districts in Korea using the 2010-2017 Community Health Surveys: Thi Tra Bui, Thi Huyen Trang Nguyen, Jinhee Lee, Sun Young Kim, Jin-Kyoung Oh; Epidemiol Health. 2024;46:e2024014. Published online January 4, 2024; DOI: https://doi.org/10.4178/epih.e2024014

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
We investigated the prevalence and determinants of unhealthy living by gender, age, and comorbidities across Korean districts.
METHODS
For 806,246 men and 923,260 women from 245 districts who participated in the 2010-2017 Korean Community Health Surveys, risk scores were calculated based on obesity, physical inactivity, smoking, and high-risk alcohol consumption, each scored from 0 (lowest risk) to 2 (highest risk). A risk score ≥4 was defined as indicating unhealthy living, and weighted proportions were calculated for each district. Using multivariate regression, an ecological model including community socioeconomic, interpersonal, and neighborhood factors was examined by gender, age, and comorbidities.
RESULTS
The mean age-standardized rate of unhealthy living was 24.05% for men and 4.91% for women (coefficients of variation, 13.94% and 29.51%, respectively). Individuals with chronic diseases more frequently exhibited unhealthy lifestyles. Unhealthy lifestyles were associated with educational attainment (β-coefficients: men, -0.21; women, -0.15), high household income (β=0.08 and 0.03, respectively), pub density (β=0.52 and 0.22, respectively), and fast-food outlet density (β=2.81 and 1.63, respectively). Negative associations were observed with manual labor, social activity participation, and hospital bed density. Unhealthy living was positively associated with living alone among women and with being unemployed among middle-aged men. Access to parks was negatively associated with unhealthy living among young men and women. The ecological model explained 32% of regional variation in men and 41% in women.
CONCLUSIONS
Improving the neighborhood built and socioeconomic environment may reduce regional disparities in lifestyle behaviors; however, the impacts may vary according to socio-demographic traits and comorbidities.; Summary

Korean summary
- 시군구 지역단위의 불건강생활(흡연, 음주, 비만, 신체활동 부족 각 0-2점, 합 4점 이상 불건강) 유병률은 여자보다 남자에서 높고, 연령이 높아지면서 감소한다. - 지역사회 환경개선(술집 개수, 패스트푸드점 밀도, 공원 면적, 병상밀도)과 사회경제적 수준 강화(교육수준, 가구소득, 고용)를 통해 생활습관적 건강행태의 지역 격차를 줄일 수 있다. - 이러한 향상 노력의 효과는 지역의 건강상태 수준이나 사회인구학적 특성에 따라 다를 수 있다.

Key Message
• District prevalence rates of unhealthy living were higher among men than women and decreased with advancing age. • Efforts to reduce regional disparities in lifestyle behaviors could benefit from enhancements to the neighborhood environment and the socioeconomic status of the area. • The effectiveness of such improvements may vary based on socio-demographic characteristics and health conditions.

Folate, vitamin B12, and homocysteine status in the Korean population: data from the 2013-2015 Korea National Health and Nutrition Examination Survey: Sihan Song, Bo Mi Song, Hyun-Young Park; Epidemiol Health. 2024;46:e2024007. Published online December 11, 2023; DOI: https://doi.org/10.4178/epih.e2024007

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
We aimed to assess the serum folate, vitamin B12, and homocysteine status in Korean adolescents and adults using national data.
METHODS
Blood samples were collected from participants aged ≥10 years in the Korea National Health and Nutrition Examination Survey 2013-2015. The stored serum samples were used to measure folate, vitamin B12, and homocysteine concentrations. A total of 8,016 participants were included in this analysis. Unweighted descriptive statistics and adjusted geometric means of the B vitamins and homocysteine concentrations were estimated.
RESULTS
Females had higher serum folate and vitamin B12 concentrations and lower serum homocysteine concentrations than males. Folate deficiency (<6.8 nmol/L) and hyperhomocysteinemia (>15 μmol/L) were found in 8.6% and 11.8% of males, respectively. Approximately 3% of males had low or marginally low vitamin B12 status (≤221 pmol/L). Folate and vitamin B12 deficiencies and hyperhomocysteinemia were found in <2% of females. Suboptimal folate status was prevalent among adolescents and young adults, while suboptimal vitamin B12 status and hyperhomocysteinemia were relatively higher in older adults. Adjusted mean homocysteine concentrations were sharply decreased from the first to second decile of serum folate in males.
CONCLUSIONS
In the Korean population, the proportion of males who achieved desirable folate and homocysteine concentrations were lower than those of females. Although most Koreans have adequate vitamin B12, a suboptimal folate status is common, particularly among adolescents and young adults. These findings could establish a foundation for public health initiatives aimed at improving folate levels in the Korean population.; Summary

Korean summary
엽산과 비타민B12는 전 생애에 걸쳐 건강에 영향을 미치는 필수 비타민이다. 그러나 해당 비타민 상태에 대한 국내 자료는 부족한 실정이다. 본 연구는 국민건강영양조사 참여자로부터 수집된 혈청으로부터 엽산, 비타민B12, 그리고 이들의 기능성 지표인 호모시스테인 농도를 측정하였고 성별과 연령별 분포와 적합 상태를 평가하였다. 엽산 결핍과 고호모시스테인혈증은 남성에서 높은 유병률을 가졌다. 적정 엽산 상태를 충족하지 못하는 비율은 청소년과 젊은 성인에서 흔하게 관찰되었다. 대부분의 한국인은 충분한 비타민B12 수준을 가졌으나, 노인의 경우 정기적인 평가가 필요하다. 본 연구는 한국인이 최적의 엽산과 비타민B12 상태를 유지하기 위한 기반적 근거를 제공한다.

Key Message
Folate and vitamin B12 have significant health impacts throughout the life cycle. However, national-level data on B vitamins in Korea are limited. Serum folate, vitamin B12, and homocysteine concentrations were measured from samples stored during the national survey. In our study, the proportions of folate deficiency and hyperhomocysteinemia were higher in men than in women.Suboptimal folate status was common among adolescents and young adults. Most Koreans had adequate levels of vitamin B12; however, regular monitoring is warranted, especially in the older population. The current data provide a future direction for achieving optimal B vitamin status in the Korean population.

Systematic Review

Dietary intake and cancer incidence in Korean adults: a systematic review and meta-analysis of observational studies: Ji Hyun Kim, Shinyoung Jun, Jeongseon Kim; Epidemiol Health. 2023;45:e2023102. Published online November 30, 2023; DOI: https://doi.org/10.4178/epih.e2023102

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Abstract Summary PDF Supplementary Material: Abstract
Cancer is a major health burden in Korea, and dietary factors have been suggested as putative risk factors for cancer development at various sites. This study systematically reviewed the published literature investigating the associations between dietary factors and cancer incidence among Korean adults, following the Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines. We focused on the 5 most studied cancer sites (stomach, colorectum, breast, thyroid, and cervix) as outcomes and dietary exposures with evidence levels greater than limited-suggestive according to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) panel’s judgment for any of the cancer sites. This resulted in the inclusion of 72 studies. Pooled estimates of the impact of dietary factors on cancer risk suggested protective associations of fruits and vegetables with risks for gastric cancer (GC), colorectal cancer (CRC), and breast cancer (BC) and dietary vitamin C with the risk of GC, as well as a harmful association between fermented soy products and the risk of GC. Despite the limited number of studies, we observed consistent protective associations of dietary fiber with GC and dietary fiber, coffee, and calcium with CRC. These findings are largely consistent with the WCRF/AICR expert report. However, pooled estimates for the associations of other salt-preserved foods with GC, meat with CRC, and dietary carotenoids and dairy products with BC did not reach statistical significance. Further studies with prospective designs, larger sample sizes, and diverse types of dietary factors and cancer sites are necessary.; Summary

Korean summary
한국 성인을 대상으로 주요 암종 발생과 관련된 식이 요인을 탐색한 72개 역학연구들을 체계적으로 리뷰하고 메타 분석한 결과, 과일 및 채소는 위암, 대장암, 유방암에 대한 보호 효과가 있으며, 식이 비타민 C는 위암 예방에 도움이 된다는 결과가 확인되었다. 반면, 염장 식품 중 발효 대두 제품은 위암 발생 위험을 증가시킬 수 있다. 향후 식이 섭취와 밀접하게 관련되었으나 기존 국내 연구가 부족한 암종과 다양한 식이 요인의 영향을 탐색하는 대규모 전향적 코호트 연구가 요구된다.

Key Message
We conducted a systematic review and meta-analysis on the associations between dietary factors and cancer incidence among Korean adults. Pooled estimates suggested protective associations of fruits and vegetables with risks for gastric cancer (GC), colorectal cancer (CRC), and breast cancer (BC) and dietary vitamin C with the risk of GC, as well as a harmful association between fermented soy products and GC risk. Further research is warranted, emphasizing longitudinal designs, larger sample sizes, and a comprehensive exploration of dietary factors, with a specific focus on anatomical sites with a substantial burden of disease but understudied in the context of diet.

Original Articles

Risk factors for early-onset lung cancer in Korea: analysis of a nationally representative population-based cohort: Jihun Kang, Taeyun Kim, Kyung-Do Han, Jin-Hyung Jung, Su-Min Jeong, Yo Hwan Yeo, Kyuwon Jung, Hyun Lee, Jong Ho Cho, Dong Wook Shin; Epidemiol Health. 2023;45:e2023101. Published online November 21, 2023; DOI: https://doi.org/10.4178/epih.e2023101

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
We examined the associations of socioeconomic factors, health behaviors, and comorbidities with early-onset lung cancer.
METHODS
The study included 6,794,287 individuals aged 20-39 years who participated in a Korean national health check-up program from 2009 to 2012. During the follow-up period, 4,684 participants developed lung cancer. Multivariable Cox regression analysis was used to estimate the independent associations of potential risk factors with incident lung cancer.
RESULTS
Older age (multivariable hazard ratio [mHR], 1.13; 95% confidence interval [CI], 1.12 to 1.14) and female sex (mHR, 1.62; 95% CI, 1.49 to 1.75) were associated with increased lung cancer risk. Current smoking was also associated with elevated risk (<10 pack-years: mHR, 1.12; 95% CI, 1.01 to 1.24; ≥10 pack-years: mHR, 1.30; 95% CI, 1.18 to 1.45), but past smoking was not. Although mild alcohol consumption (<10 g/day) was associated with lower lung cancer risk (mHR, 0.92; 95% CI, 0.86 to 0.99), heavier alcohol consumption (≥10 g/day) was not. Higher income (highest vs. lowest quartile: mHR, 0.86; 95% CI, 0.78 to 0.94), physical activity for at least 1,500 metabolic equivalent of task-min/wk (vs. non-exercisers: mHR, 0.83; 95% CI, 0.69 to 0.99) and obesity (vs. normal weight: mHR, 0.89; 95% CI, 0.83 to 0.96) were associated with lower lung cancer risk, whereas metabolic syndrome was associated with increased risk (mHR, 1.13; 95% CI, 1.03 to 1.24).
CONCLUSIONS
In young adults, age, female sex, smoking, and metabolic syndrome were risk factors for early-onset lung cancer, while high income, physical activity, and obesity displayed protective effects.; Summary

Korean summary
나이, 여성, 흡연, 그리고 대사 증후군은 조기 발생 폐암의 위험도 증가와 연관이 있었다. 반면에 높은 소득, 신체 활동, 비만은 젊은 성인에서 폐암 발생의 위험도 감소와 연관성을 나타내었다.

Key Message
Age, female sex, smoking, and metabolic syndrome were risk factors for early-onset lung cancer. While, high income, physical activity, and obesity displayed protective effects on the development of lung cancer in young adults.

Age-specific findings on lifestyle and trajectories of cognitive function from the Korean Longitudinal Study of Aging: Seungju lim, Eunyoung Yoo, Ickpyo Hong, Ji-Hyuk Park; Epidemiol Health. 2023;45:e2023098. Published online November 2, 2023; DOI: https://doi.org/10.4178/epih.e2023098

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Abstract Summary PDF: Abstract
OBJECTIVES
Few longitudinal studies have explored age-related differences in the relationship between lifestyle factors and cognitive decline. This study investigated lifestyle factors at baseline that slow the longitudinal rate of cognitive decline in young-old (55-64 years), middle-old (65-74 years), and old-old (75+ years) individuals.
METHODS
We conducted an 11-year follow-up that included 6,189 older adults from the Korean Longitudinal Study of Aging, which is a cohort study of community-dwelling older Koreans. Lifestyle factors, including physical activity, social activity (SA), smoking, and alcohol consumption were assessed at baseline. Cognitive function was measured at 2-year intervals over 11 years. Latent growth modeling and multi-group analysis were performed.
RESULTS
The influence of lifestyle factors on the rate of cognitive decline differed by age. Smoking at baseline (-0.05; 95% confidence interval [CI], -0.11 to -0.00, per study wave) accelerated cognitive decline in young-old individuals, whereas frequent participation in SA at baseline (0.02; 95% CI, 0.01 to 0.03, per study wave) decelerated cognitive decline in middle-old individuals. None of the lifestyle factors in this study decelerated cognitive decline in old-old individuals.
CONCLUSIONS
Cognitive strategies based on modifiable lifestyle factors such as smoking cessation in young-old individuals and frequent SA participation in middle-old age individuals may have great potential for preventing cognitive decline. Because the influence of lifestyle factors varied by age group, age-specific approaches are recommended to promote cognitive health.; Summary

Korean summary
본 연구는 국내 노인인구를 연령대별로 구분하여 연소노인(55-64세), 중고령노인(65-74세), 고령노인(75세+)의 인지저하 기울기를 가속 혹은 감속시키는 라이프스타일 요인을 파악하였다. '흡연'은 연소노인의 인지저하를 가속, '사회활동 참여 빈도'는 중고령노인의 인지저하를 감속시키는 것으로 나타났으며, 고령노인의 경우 유의미한 변수가 나타나지 않았다. 본 결과는 노인의 인지건강에 있어 연령대별 차별화된 라이프스타일 전략이 필요할 것을 시사한다.

Key Message
This study aimed to identify lifestyle factors that accelerate or decelerate the cognitive decline slope in the older population in South Korea, categorized by age groups: young-old adults (55-64), middle-old adults (65-74), and old-old adults (75+). The findings indicated that 'smoking' accelerates cognitive decline in young-old adults, while 'frequency of social activity participation' decelerates cognitive decline in middle-old adults. However, no significant lifestyle variables were identified for old-old adults. These results suggest the necessity of differentiated lifestyle strategies based on age groups for promoting cognitive health in the older population.

Regional disparities in major cancer incidence in Korea, 1999-2018: Eun Hye Park, Mee Joo Kang, Kyu-Won Jung, Eun Hye Park, E Hwa Yun, Hye-Jin Kim, Hyun-Joo Kong, Chang Kyun Choi, Jeong-Soo Im, Hong Gwan Seo, The Community of Population-Based Regional Cancer Registries; Epidemiol Health. 2023;45:e2023089. Published online October 12, 2023; DOI: https://doi.org/10.4178/epih.e2023089

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study investigated regional disparities in the incidence of 8 major cancers at the municipal level in Korea during 1999-2018 and evaluated the presence or absence of hot spots of cancer clusters during 2014-2018.

METHODS

The Korea National Cancer Incidence Database was used. Age-standardized incidence rates were calculated by gender and region at the municipal level for 4 periods of 5 years and 8 cancer types. Regional disparities were calculated as both absolute and relative measures. The possibility of clusters was examined using global Moran’s I with a spatial weight matrix based on adjacency or distance.

RESULTS

Regional disparities varied depending on cancer type and gender during the 20-year study period. For men, the regional disparities of stomach, colon and rectum, lung, and liver cancer declined, and those of thyroid and prostate cancer recently decreased, despite an overall increasing incidence. For women, regional disparities in stomach, colon and rectum, lung, liver, and cervical cancer declined, that of thyroid cancer recently decreased, despite an overall increasing incidence, and that of breast cancer steadily increased. In 2014-2018, breast cancer (I, 0.61; 95% confidence interval [CI], 0.53 to 0.70) showed a high probability of cancer clusters in women, and liver cancer (I, 0.48; 95% CI, 0.40 to 0.56) showed a high probability of cancer clusters in men.

CONCLUSIONS

Disparities in cancer incidence that were not seen at the national level were discovered at the municipal level. These results could provide important directions for planning and implementing local cancer policies.

Summary

Korean summary
이 연구는 한국 시군구 단위에서 지난 20년(1999-2018)간 주요 8개 암 발생률의 지역 간 격차를 조사하고, 최근 5년(2014-2018)의 암 발생 군집 가능성을 평가했습니다. 지역 간 격차는 여성에서 갑상선암, 남성에서는 폐암이 가장 큰 격차를 보였습니다. 군집 가능성은 여성의 경우 유방암, 남성의 경우 간암에서 가장 높았습니다. 전국 단위에서는 볼 수 없었던 지역 간 격차 및 군집 발생 가능성이 시군구 단위에서 발견되었고, 이러한 결과는 지역에 맞는 암 정책을 기획하고 실행하는 데 중요한 방향을 제시할 수 있을 것입니다.

Key Message
This study investigated regional disparities in the incidence of eight major cancers in Korea at the municipal level during 1999-2018 and assessed the possibility of cancer clusters during 2014-2018. Thyroid cancer in women and lung cancer in men showed the most significant regional disparities. Breast cancer in women and liver cancer in men displayed the highest possibility of clustering. Regional disparities and cancer clusters were identified locally, which were not detected nationally. These findings could provide valuable guidance for developing and implementing cancer policies that are tailored to local needs.

Citations

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Hormone Replacement Therapy and Risks of Various Cancers in Postmenopausal Women with De Novo or a History of Endometriosis
Hee Joong Lee, Banghyun Lee, Hangseok Choi, Minkyung Lee, Kyungjin Lee, Tae Kyoung Lee, Sung Ook Hwang, Yong Beom Kim
Cancers.2024; 16(4): 809. CrossRef

Trends in the effects of socioeconomic position on physical activity levels and sedentary behavior among Korean adolescents: Hunju Lee, Hyowon Choi, Sang Baek Koh, Hyeon Chang Kim; Epidemiol Health. 2023;45:e2023085. Published online September 8, 2023; DOI: https://doi.org/10.4178/epih.e2023085

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We examined trends in physical activity and sedentary behavior in Korean adolescents, and their association with socioeconomic position (SEP).

METHODS

We used data from the Korea Youth Risk Behavior Survey, a nationwide study involving students aged 12-19 conducted between 2009 and 2021. SEP was assessed based on economic status, parental education attainment, and urbanization. Physical activity was categorized into vigorous physical activity, moderate physical activity, and muscle training, and sedentary time was also measured. We conducted the log-binomial regression to calculate prevalence ratios (PRs) and prevalence differences.

RESULTS

Our analysis included a total of 593,896 students. We observed an increasing trend in physical activity, but a worsening trend in sedentary behavior. A positive association was found between an adolescent’s physical activity and SEP indicators, except for urbanization. Adolescents with higher economic status engaged in more vigorous physical activity (high: PR, 1.26; 95% confidence interval [CI], 1.25 to 1.28; middle: PR, 1.03; 95% CI, 1.02 to 1.04). Similar associations were observed for father’s education (tertiary or above: PR, 1.11; 95% CI, 1.09 to 1.13; upper secondary: PR, 1.05; 95% CI, 1.03 to 1.07) and mother’s education (tertiary or above: PR, 1.17; 95% CI, 1.15 to 1.20; upper secondary: PR, 1.06; 95% CI, 1.04 to 1.08). Adolescents with higher economic status also showed a higher compliance rate with the guideline restricting sedentary time to 2 hours per day (high: PR, 1.28; 95% CI, 1.25 to 1.30; middle: PR, 1.03; 95% CI, 1.01 to 1.05).

CONCLUSIONS

Adolescents with higher SEP exhibited more physical activity and less sedentary time than those with lower SEP.

Summary

Korean summary
본 연구는 2009년부터 2021년까지 청소년의 사회경제적 지위가 신체활동과 좌식생활습관에 미치는 영향을 분석하였다. 청소년의 경제적 상태, 아버지와 어머니의 교육수준이 높을수록 청소년의 신체활동이 증가하고 좌식생활이 감소하였다. 그러나 청소년이 사는 지역의 도시화 정도는 영향을 미치지 않았다.

Key Message
This article analyzes the effects of an adolescent's socio-economic position on their physical activity and sedentary behavior from 2009 to 2021. The higher the adolescent's economic status, father's education, or mother's education, the more they engaged in physical activity and the less time they spent in sedentary behaviors. However, the level of urbanization in the area where the adolescent resided had no effect.

Citations

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Using structural equation modeling to explore the influences of physical activity, mental health, well-being, and loneliness on Douyin usage at bedtime
Hongcheng Luo, Xing Zhang, Songpeng Su, Mingyang Zhang, Mingyue Yin, Siyuan Feng, Rui Peng, Hansen Li
Frontiers in Public Health.2024;[Epub] CrossRef

Did the socioeconomic inequalities in avoidable and unavoidable mortality worsen during the first year of the COVID-19 pandemic in Korea?: Rora Oh, Myoung-Hee Kim, Juyeon Lee, Rangkyoung Ha, Jungwook Kim; Epidemiol Health. 2023;45:e2023072. Published online August 3, 2023; DOI: https://doi.org/10.4178/epih.e2023072

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study examined changes in socioeconomic inequalities in mortality in Korea before and after the outbreak of coronavirus disease 2019 (COVID-19).
METHODS
From 2017 to 2020, age-standardized mortality rates were calculated for all-cause deaths, avoidable deaths (preventable deaths, treatable deaths), and unavoidable deaths using National Health Insurance claims data and Statistics Korea’s cause of death data. In addition, the slope index of inequality (SII) and the relative index of inequality (RII) by six income levels (Medical Aid beneficiary group and quintile of health insurance premiums) were computed to analyze the magnitude and change of mortality inequalities.
RESULTS
All-cause and avoidable mortality rates decreased steadily between 2017 and 2020, whereas unavoidable mortality remained relatively stable. In the case of mortality inequalities, the disparity in all-cause mortality between income classes was exacerbated in 2020 compared to 2019, with the SII increasing from 185.44 to 189.22 and the RII increasing from 3.99 to 4.29. In particular, the preventable and unavoidable mortality rates showed an apparent increase in inequality, as both the SII (preventable: 91.31 to 92.01, unavoidable: 69.99 to 75.38) and RII (preventable: 3.42 to 3.66, unavoidable: 5.02 to 5.89) increased.
CONCLUSIONS
In the first year of the COVID-19 pandemic, mortality inequality continued to increase, although there was no sign of exacerbation. It is necessary to continuously evaluate mortality inequalities, particularly for preventable and unavoidable deaths.; Summary

Korean summary
이 연구는 COVID-19 발생 전후 한국에서의 사망률 추이와 사망률 불평등 변화를 조사했다. 2017~2020년 사이에 총사망률과 회피가능사망률은 줄어들었지만, 사망률의 사회경제적 불평등은 더 커지는 경향을 보였다. 특히 예방가능사망과 회피불가능사망에서 불평등이 커져 지속적인 추적과 평가가 필요하다.

Key Message
This study examined the trends in mortality rates and changes in mortality inequality in Korea before and after the onset of COVID-19. Between 2017 and 2020, while the all-cause and avoidable mortality rates decreased, there was a growing trend of inequality in mortality rates based on income levels. Particularly, inequalities in preventable and unavoidable deaths have increased, emphasizing the need for ongoing evaluation.

Adherence to the World Cancer Research Fund/American Institute for Cancer Research and Korean Cancer Prevention Guidelines and cancer risk: a prospective cohort study from the Health Examinees-Gem study: Jeeyoo Lee, Aesun Shin, Woo-Kyoung Shin, Ji-Yeob Choi, Daehee Kang, Jong-Koo Lee; Epidemiol Health. 2023;45:e2023070. Published online August 1, 2023; DOI: https://doi.org/10.4178/epih.e2023070

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Abstract

OBJECTIVES
The purpose of this study was to explore the association between adherence to 2 cancer prevention recommendations and cancer risk.

METHODS

In total, 104,386 individuals aged 40-69 years old who were recruited between 2004 and 2013 in the Health Examinees-Gem study were included. Adherence scores were constructed based on 8 items from the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations, including body weight, physical activity, diet, alcohol consumption and breastfeeding, and on 6 items from the Korean cancer prevention guidelines (smoking status, eating vegetables and fruits, salty foods, alcohol intake, physical activity, and body weight). A Cox proportional hazards model was used to estimate the associations between adherence scores and the risk of total and 5 major cancers.

RESULTS

The multivariable hazard ratio (HR) for total cancer with the high adherence score versus the lowest score (4.25-7.00 vs. 0.00-3.25) for the WCRF/AICR guidelines was 0.91 (95% confidence interval [CI], 0.82 to 1.00) in men. A reduced breast cancer risk was observed among women with the highest score. Men within the highest category of the Korean cancer prevention guideline score (3.25-6.00) had an HR of 0.80 (95% CI, 0.73 to 0.88) for developing total cancer compared to men within the lowest score (0.00-2.50). The higher adherence group among men showed lower risks of developing stomach, colorectal, and lung cancers.

CONCLUSIONS

Adhering to guidelines for cancer prevention can help to reduce the risk of developing cancer in Korean men. The association might differ by cancer type and gender.

Summary

Korean summary
- 암예방 가이드라인 준수가 실제로 암 발생을 예방하는지에 대한 해외 연구들이 다수 있으나 한국을 포함한 아시아 국가에서 수행된 연구는 없다. - 국제암연구재단 암예방수칙과 한국 암예방수칙을 준수하는 한국인 남성에서 암 발생 감소가 관찰되었다. 이러한 관련성은 암종에 따라 다르게 나타났다.

Key Message
- The adherence to the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) guidelines on cancer prevention has been addressed in several studies in Western countries. -Among the Korean population, adherence to WCRF/AICR cancer prevention guidelines as well as the Korean cancer prevention guidelines helps prevent cancer in men. Association varies by gender and type of cancer.

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Compliance with the WCRF/AICR Recommendations in Qualitative Adaptation and the Occurrence of Breast Cancer: A Case-Control Study
Beata Stasiewicz, Lidia Wadolowska, Maciej Biernacki, Malgorzata Anna Slowinska, Ewa Stachowska
Cancers.2024; 16(2): 468. CrossRef

Trends in dietary intake and food sources of long-chain polyunsaturated fatty acids among Korean adults between 2007 and 2018: Jae Eun Shim, Youngmi Lee, SuJin Song; Epidemiol Health. 2023;45:e2023069. Published online August 1, 2023; DOI: https://doi.org/10.4178/epih.e2023069

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Abstract PDF: Abstract
OBJECTIVES
This study examined trends in the dietary intake and food sources of long-chain polyunsaturated fatty acids (LC-PUFAs) in Korean adults from 2007 to 2018.
METHODS
In total, 46,307 adults (aged 19-64 years) were selected from the 2007-2018 Korea National Health and Nutrition Examination Surveys. Dietary data were obtained using 24-hour dietary recall. Intake levels and food sources of LC-PUFAs, including alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and linoleic acid (LA), were evaluated across the survey years and assessed based on compliance with dietary recommendations over the 2007-2018 period. Linear trends in LC-PUFAs intake levels over time were examined through multiple linear regression analysis.
RESULTS
From 2007 to 2018, ALA and LA consumption increased from 1.1 g (0.5% of energy) to 1.4 g (0.6% of energy) and from 8.6 g (3.9% of energy) to 10.0 g (4.5% of energy), respectively. EPA intake decreased from 0.14 g to 0.12 g, and EPA+DHA intake showed a decreasing trend. The proportion of individuals who did not meet the recommended intake of EPA+DHA (250 mg/day) increased (64.4 to 68.4%). Regarding changes in food sources of ALA and LA, the contributions from mayonnaise, eggs, and bread increased, while those from plant food sources decreased. Among food sources of EPA and DHA, anchovy, saury, and Atka mackerel showed lower contributions over time.
CONCLUSIONS
Our findings suggest that strategies to encourage the consumption of EPA and DHA from healthy food sources are necessary to improve cardiovascular health in the Korean population.; Summary

Effect of trajectory of employment status on all-cause mortality in the late middle-aged and older population: results of the Korea Longitudinal Study of Aging (2006-2020): Jeong Min Yang, Jae Hyun Kim; Epidemiol Health. 2023;45:e2023056. Published online June 8, 2023; DOI: https://doi.org/10.4178/epih.e2023056

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study conducted a longitudinal analysis of the effect of trajectory of employment status (TES) on all-cause mortality in late middle-aged and older Koreans based on the Korean Longitudinal Study of Aging (KLoSA).
METHODS
After excluding missing values, data on 2,774 participants were analyzed using the chi-square test and the group-based trajectory model (GBTM) for data from the first to fifth KLoSA and the chi-square test, log-rank test, and Cox proportional hazard regression for data from the fifth to eighth KLoSA.
RESULTS
The GBTM analysis identified 5 TES groups: sustained white collar (WC; 18.1%), sustained standard blue collar (BC; 10.8%), sustained self-employed BC (41.1%), WC to job loss (9.9%), and BC to job loss (20.1%). Compared to the sustained WC group, the WC to job loss group had higher mortality at 3 years (hazard ratio [HR], 4.04, p=0.044), 5 years (HR, 3.21, p=0.005), and 8 years (HR, 3.18, p<0.001). The BC to job loss group had higher mortality at 5 years (HR, 2.57, p=0.016) and 8 years (HR, 2.20, p=0.012). Those aged 65 years and older and males in the WC to job loss and BC to job loss groups had an increased risk of death at 5 years and 8 years.
CONCLUSIONS
There was a close association between TES and all-cause mortality. This finding highlights the need for policies and institutional measures to reduce mortality within vulnerable groups with an increased risk of death due to a change in employment status.; Summary

Korean summary
본 연구는 제 1차~8차 한국고령화연구패널을 활용하여 중고령층의 근로활동 궤적과 사망 간의 연관성을 분석하였다. 근로활동 궤적을 파악하기 위하여 집단중심추세모형을 활용하였으며, 총 5가지의 근로활동 궤적을 도출하였다. 도출된 궤적을 바탕으로 카이제곱 검정과 콕스 비례위험모형을 통해 근로활동 궤적과 사망률 간의 연관성을 분석하였다. 연구 결과 화이트칼라에서 실업으로 변화하는 집단과 블루칼라에서 실업으로 변화하는 두 집단에서 사망 간의 유의한 결과를 발견하였으며, 특히, 65세 이상 집단과 남성 집단에서 강한 연관성이 존재하였다. 본 연구 결과를 바탕으로 근로활동 변화로 인해 사망 위험이 증가하는 취약 집단을 위한 정책적, 제도적 방안의 기초자료로서 활용되기를 기대한다.

Key Message
Compared with the sustained White Collar (WC) trajectory group, changed WC to job loss trajectory group and changed BC to job loss trajectory had higher mortality. The over 65 years group and the male group, a strong association between change in employment status and mortality was observed. This study emphasizes the need for policy and institutional measures to reduce mortality for vulnerable groups who are at increased risk of death due to changes in employment status.

The association of dietary patterns with incident chronic kidney disease and kidney function decline among middle-aged Korean adults: a cohort study: Jialei Fu, Sangah Shin; Epidemiol Health. 2023;45:e2023037. Published online March 21, 2023; DOI: https://doi.org/10.4178/epih.e2023037

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study assessed the association of dietary patterns with the incidence of chronic kidney disease (CKD) and kidney function decline among Korean adults.
METHODS
Data were collected from the records of 20,147 men and 39,857 women who participated in the Health Examinees study. Principal component analysis was used to identify 3 dietary patterns (prudent, flour-based food and meat, and white rice-based), and CKD risk was defined using the Epidemiology Collaboration equation for estimated glomerular filtration rate: (eGFR) <60 mL/min/1.73 m2. A kidney function decline was defined as a >25% decrease in eGFR from baseline.
RESULTS
During the 4.2-year follow-up, 978 participants developed CKD and 971 had a 25% decline in kidney function. After adjusting for potential impact variables, compared with the lowest quartile of the prudent dietary pattern, participants in the highest quartile had a 37% lower risk of kidney function decline among men (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.47 to 0.85); while higher adherence to the flour-based food and meat dietary pattern was associated with an increased risk of CKD in both men (HR, 1.63; 95% CI, 1.22 to 2.19) and women (HR, 1.47; 95% CI, 1.05 to 2.05) as well as a decline in kidney function in both men (HR, 1.49; 95% CI, 1.07 to 2.07) and women (HR, 1.77; 95% CI, 1.33 to 2.35).
CONCLUSIONS
Although a higher adherence to the prudent dietary pattern was inversely associated with the risk of kidney function decline in men, there was no association with CKD risk. In addition, a higher adherence to the flour-based food and meat dietary pattern increased the risk of CKD and kidney function decline. Further clinical trials are needed to confirm these associations.; Summary

Korean summary
건강한 식이패턴(prudent dietary pattern)은 한국 남성의 신장기능 저하 위험을 감소와 관련성이 있었다. 반면, 밀가루 음식과 육류 위주의 식이패턴(Flour-based food and meat dietary pattern)은 남성과 여성 모두에서 신장 기능 저하 위험뿐만 아니라, 만성신장질환(CKD) 위험의 증가와 관련이 있었다. 본 연구의 결과는 한국 성인에서 식사패턴이 신장 기능 및 만성 신장 질환의 발생에 미치는 영향을 확인하였다.

Key Message
1. Better adherence to the prudent dietary pattern may lower the risk of kidney function decline in Korean man. 2. A higher adherence to the flour-based food and meat dietary pattern may higher the risk of chronic kidney disease and kidney function decline.

Physical activity, sedentary behavior, and cardiovascular disease risk in Korea: a trajectory analysis: Jina Han, Yeong Jun Ju, Soon Young Lee; Epidemiol Health. 2023;45:e2023028. Published online February 22, 2023; DOI: https://doi.org/10.4178/epih.e2023028

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Abstract PDF

Abstract

OBJECTIVES
To identify the distinct trajectories of sedentary behavior (SB) and explore whether reduced cardiovascular disease (CVD) risk was associated with a distinct trajectory of physical activity (PA).

METHODS

We analyzed data from 6,425 people who participated in the Korean Health Panel Survey over a period of 10 years. The participants’ self-reported SB and PA were assessed annually, and trajectory groups were identified using a group-based trajectory model for longitudinal data analysis. Logistic regression analysis was performed to assess the association between CVD risk (10-year cumulative incidence) and the trajectories of SB and PA. The adjusted variables included socio-demographic factors, the predisposing diseases of CVD, and baseline health behaviors.

RESULTS

Trajectory analysis identified 4 SB trajectory groups: SB group 1 (low and slightly increasing trend, 53.1%), SB group 2 (high and rapidly decreasing trend, 14.7%), SB group 3 (high and slightly decreasing trend, 9.9%), and SB group 4 (low and rapidly increasing trend, 22.2%). The 3 PA trajectory groups were PA group 1 (moderate and slightly decreasing trend, 32.1%), PA group 2 (low and slightly decreasing trend, 57.3%), and PA group 3 (maintained inactivity, 10.7%). By the 10-year follow-up, 577 cases of incident CVD had occurred. We also noted a 50% reduction in the risk of CVD when SB group 4 was accompanied by PA group 1 (odds ratio, 0.50; 95% confidence interval, 0.28 to 0.90).

CONCLUSIONS

Despite increased time spent in SB, maintaining PA about 2 days to 3 days per week reduced the occurrence of CVD.

Summary

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Effects of physical activity and sedentary behaviors on cardiovascular disease and the risk of all-cause mortality in overweight or obese middle-aged and older adults
Yongqiang Zhang, Xia Liu
Frontiers in Public Health.2024;[Epub] CrossRef

COVID-19: Health Statistics

Changes in food and nutrient intakes in Korean adults before and during the COVID-19 pandemic: data from the 2011-2020 Korea National Health and Nutrition Examination Survey: Kyungwon Oh, Suyeon Park, Sihyun Park, Sungha Yun, Hongseok Choi, Eun Kyeong Jeong; Epidemiol Health. 2023;45:e2023015. Published online February 1, 2023; DOI: https://doi.org/10.4178/epih.e2023015

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study was to examine the changes in dietary habits and food and nutrient intakes between before (2019) and during (2020) the coronavirus disease 2019 (COVID-19) pandemic from the Korea National Health and Nutrition Examination Survey (KNHANES).

METHODS

A total of 54,995 participants aged ≥19 years who participated in the 2011-2020 KNHANES were included. The 10-year trend (2011-2020) and differences between 2019 and 2020 for dietary habits and food and nutrient intakes were estimated using SAS.

RESULTS

In the past 10 years (2011-2020), the dietary habits (increase in skipping meals and eating out), food intake (increase in meats and decrease in fruits and vegetables), and nutrient intake (increase in fat and decrease in sodium) in adults have changed. When comparing between 2019 and 2020, there were 4.6%p decrease in the eating out more than once a day. On the other hand, there were no significant differences in the intakes of food, energy and most of nutrients between 2019 and 2020, except for the proportion of energy intake from fat (1.0%p increase) and carbohydrate (1.0%p decrease).

CONCLUSIONS

Although a change in dietary habits from before to during the COVID-19 pandemic was observed, food and nutrient intakes have not deteriorated markedly and appear similar to the trends in the past 10 years. Throughout the COVID-19 pandemic, it is necessary to monitor the effects of changes in dietary habits on health as well as food and nutrient intakes.

Summary

Korean summary
코로나19 유행 전, 후 비교 시, 외식 감소, 가정식 섭취 증가 등 식생활은 변화가 있었으나 주요 식품 및 영양소 섭취는 큰 변화없이 최근 10년간의 추이가 지속되고 있었다.

Key Message
Although a change in dietary habits from before to during the COVID-19 pandemic was observed, food and nutrient intakes have not deteriorated markedly and appear similar to the trends in the past 10 years in Korean adults.

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Citations to this article as recorded by

Comparative study on the health and dietary habits of Korean male and female adults before and after the coronavirus disease 2019 pandemic: utilizing data from the 8th Korea National Health and Nutrition Examination Survey (2019–2021)
Chaemin Kim, Eunjung Kim
Korean Journal of Community Nutrition.2024; 29(1): 65. CrossRef

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