Epidemiology and Health

Original articles

Adherence to the Korean National Code Against Cancer and mortality: a prospective cohort study from the Health Examinees-Gem study: Jeeyoo Lee, Aesun Shin, Woo-Kyoung Shin, Ji-Yeob Choi, Daehee Kang; Epidemiol Health. 2025;e2025026. Published online May 9, 2025; DOI: https://doi.org/10.4178/epih.e2025026 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
The Korean National Code Against Cancer was released in 2006. These guidelines aimed to promote a healthy lifestyle to prevent cancer risk through 10 recommendations. The objective of this study was to investigate the associations between adherence to the Korean National Code Against Cancer and the risk of all-cause, cancer, and cardiovascular disease (CVD) mortality among Koreans.
METHODS
This prospective cohort study included 109,160 Korean adults aged 40 to 69 years, recruited from 2004 to 2013 in the population-based Health Examinees-Gem Study (HEXA-G). The adherence total score was calculated based on 6 items from the Korean National Code Against Cancer: smoking, consuming vegetables and fruits, limiting salty foods, restricting alcohol intake, engaging in physical activity, and maintaining a healthy weight. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations of adherence scores with mortality risk were estimated using a Cox proportional hazards regression model.
RESULTS
During a mean follow-up period of 12.0 years, 3,799 deaths were recorded. According to the multivariable-adjusted model, men in the highest tertile of adherence scores had a lower risk of all-cause, cancer, and CVD mortality compared to those in the lowest tertile (all-cause: HR=0.67, 95% CI=0.60–0.74; cancer: HR=0.63, 95% CI=0.54–0.74; CVD: HR=0.56, 95% CI=0.43–0.73). A similar association was observed among women for all-cause and CVD mortality (all-cause: HR=0.85, 95% CI=0.76–0.96; CVD: HR=0.70, 95% CI=0.51–0.97).
CONCLUSIONS
Adherence to the Korean National Code Against Cancer was associated with a reduced risk of all-cause, cancer, and CVD mortality.; Summary

Social capital and regional influences: key predictors of unmet dental care needs among older adults in South Korea: Ji-Yeon Lim, Ju-Mi Lee, Hae-Sung Nam; Epidemiol Health. 2025;e2025025. Published online May 7, 2025; DOI: https://doi.org/10.4178/epih.e2025025 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Access to dental services is essential for improving quality of life, and social capital plays a key role in facilitating that access. This study aimed to identify individual- and regional-level factors, including social capital, that predict unmet dental care needs among older adults.
METHODS
We analyzed data from 59,414 older adults obtained from the 2023 Korea Community Health Survey and the Korean Statistical Information Service, employing a 2-level multilevel model. The dependent variables comprised 3 types of unmet dental care needs: overall, due to lack of acceptability, and due to economic reasons. Twelve independent variables, including social capital and other individual and regional factors, were examined.
RESULTS
The prevalence of unmet needs was 14.15% overall, 8.70% for acceptability reasons, and 4.85% for economic reasons. Lower individual social capital was associated with higher odds of unmet dental care needs, whereas regional social capital factors demonstrated no significant association. Residing in regions with higher fiscal independence ratios was related to an increased likelihood of economic unmet needs (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.09 to 1.52). In contrast, a greater density of dentists per 10,000 population was inversely associated with overall and acceptability-related unmet needs (OR, 0.82 for both; 95% CI, 0.73 to 0.92 and 0.73 to 0.93, respectively).
CONCLUSIONS
Individual social capital and specific regional factors—namely, fiscal independence and density of dentists—may represent important determinants of unmet dental care needs among older adults. Policy interventions aimed at reducing unmet needs should consider these variables.; Summary

Risk of new-onset seizures following immunization against COVID-19: a self-controlled case-series study: Hwa Yeon Ko, Dongwon Yoon, Ju Hwan Kim, Han Eol Jeong, Seung Bong Hong, Won Chul Shin, JU YOUNG SHIN; Epidemiol Health. 2025;e2025024. Published online May 2, 2025; DOI: https://doi.org/10.4178/epih.e2025024 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Despite emerging reports of new-onset seizures (NOS) following COVID-19 vaccination, safety evidence regarding the risk of NOS after vaccination remains limited. We aimed to investigate the potential association between NOS and COVID-19 vaccination.
METHODS
We conducted a self-controlled case series study utilizing a nationwide database linking the COVID-19 vaccination registry and the National Health Information Database (from February 2021 to October 2022). We identified adults (≥18 years) who received COVID-19 vaccination (BNT162b2, ChAdOx1 nCoV-19, mRNA-1273, NVX-CoV2373, or Ad26.COV2.S) and had a diagnosis of NOS accompanied by prescriptions of anti-seizure drugs. The observation period was defined as 240 days following vaccination. We evaluated the risk of NOS during a risk window of 28 days after vaccination compared to the control window (the remaining observation period excluding the risk window). Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were estimated using a conditional Poisson regression model.
RESULTS
Among 42,155,198 COVID-19 vaccine recipients, we identified 1,849 and 4,217 patients with NOS in the risk and control windows, respectively. There was no increased risk of NOS within the 28-day period following vaccination (IRR, 0.99; 95% CI, 0.94–1.05). Although results from subgroup analyses by vaccine type were largely consistent with the main findings (IRR, 0.95; 95% CI, 0.88–1.03 for BNT162b2; IRR, 0.95; 95% CI, 0.77–1.16 for ChAdOx1 nCoV-19; IRR, 1.58; 95% CI, 0.52–4.83 for Ad26.COV2.S), a marginally elevated risk was observed for mRNA-1273 (IRR, 1.21; 95% CI, 1.04–1.42).
CONCLUSIONS
There was no evidence of an increased risk of NOS following COVID-19 vaccination. These findings can be used as safety evidence in clinical decision-making and to bolster public confidence in COVID-19 vaccines.; Summary

Association between humidifier disinfectant use duration and lung cancer development in the Republic of Korea: Sungchan Kang, Jeong-In Hwang, Su Hwan Kim, Hyungryul Lim, Dong-wook Lee, Woojoo Lee, Jong Hun Kim, Sol Yu, Jungyun Lim, Younghee Kim, Kyoung-Nam Kim; Epidemiol Health. 2025;e2025023. Published online May 2, 2025; DOI: https://doi.org/10.4178/epih.e2025023 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
This study was conducted to assess the association between the duration of humidifier disinfectant use and lung cancer development.
METHODS
We analyzed data from 3,605 applicants registered for compensation from the Korean government due to health conditions related to humidifier disinfectant exposure. Among these individuals, 121 were diagnosed with lung cancer at least 4 years after their initial exposure (through December 2021). Hazard ratios (HRs) and 95% confidence intervals (CIs) for lung cancer incidence were estimated according to the duration of disinfectant use using Cox proportional hazards models.
RESULTS
Compared with <5 months of use, the HRs for lung cancer were 1.81 (95% CI, 0.41 to 7.97) for 5–14 months, 2.45 (95% CI, 0.58 to 10.41) for 15–29 months, and 4.61 (95% CI, 1.12 to 18.91) for ≥30 months. Using never smokers with <15 months of use as the reference category, the HRs were 2.97 (95% CI, 1.34 to 6.56) for never smokers with ≥15 months of use, 2.73 (95% CI, 0.94 to 7.95) for current or former smokers with <15 months of use, and 4.74 (95% CI, 1.94 to 11.61) for current or former smokers with 15 months of use.
CONCLUSIONS
Our study provides some of the first robust epidemiological evidence that prolonged humidifier disinfectant use contributes to lung cancer development. Future studies—particularly those including unexposed populations—are needed to confirm these findings.; Summary

Inequality in mortality according to regional deprivation during the COVID-19 pandemic: Min Hui Moon, Min-Hyeok Choi, Young Gyu Ko; Epidemiol Health. 2025;e2025022. Published online April 29, 2025; DOI: https://doi.org/10.4178/epih.e2025022 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Vulnerability to coronavirus disease 2019 (COVID-19) is significantly greater in regions with lower socioeconomic status. However, detailed analyses of regional socioeconomic disparities have rarely been conducted in South Korea. This study aimed to identify and compare mortality inequalities associated with regional socioeconomic status across different areas of South Korea during the COVID-19 pandemic.
METHODS
Using cause-of-death statistics from 2020 to 2022, we calculated age-standardized mortality rates (ASMRs) for total mortality, COVID-19 mortality, and pneumonia mortality. The socioeconomic status of each region was assessed using the regional deprivation index. Additionally, we calculated the rate difference (RD), rate ratio (RR), slope index of inequality (SII), and relative index of inequality (RII) for each socioeconomic level to examine the extent of mortality inequality and its temporal changes. These analyses were stratified by sex and urban-rural classification.
RESULTS
The total mortality rate, as well as COVID-19-specific and pneumonia-specific mortality rates, increased during the COVID-19 pandemic. The ASMR for COVID-19 was higher in rural areas (ASMR, 27.79), which have lower healthcare accessibility, compared to urban areas (ASMR, 26.63). However, mortality inequality indicators for COVID-19 were more pronounced in urban areas compared to rural areas (SII [urban: 2.72; rural: -0.05], RII [urban: 0.10; rural: 0.00]). Notably, significant inequalities were observed among men residing in urban areas.
CONCLUSIONS
In disaster situations such as the COVID-19 pandemic, it is essential to implement strategies aimed at reducing overall mortality rates and addressing regional socioeconomic inequalities.; Summary

Geospatial analysis of neonatal mortality in North-eastern India: a multilevel Bayesian approach: Vidhi Jain, Kh. Jitenkumar Singh, Deboshree Das, Shefali Gupta, Gunjan Singh; Epidemiol Health. 2025;e2025021. Published online April 27, 2025; DOI: https://doi.org/10.4178/epih.e2025021 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Neonatal mortality remains a significant public health issue in India. This study investigates spatial patterns and contributing factors to neonatal mortality in the north-eastern states, identifying hotspot regions and spatial variations.
METHODS
A sample of 34,222 mothers from NFHS-5 (2019–21) in the north-eastern states was analysed. Descriptive and bivariate analyses were conducted alongside Bayesian multilevel logistic regression using Integrated Nested Laplace Approximation (INLA) to model neonatal mortality. Spatial hotspot analysis using Getis-Ord Gi* statistics identified clusters of high neonatal mortality, while geographically weighted regression (GWR) was used to examine spatial variations in the relationships between neonatal mortality and contributing factors.
RESULTS
The neonatal mortality rate in the north-eastern states declined from 45 to 21 per 1,000 live births (NFHS-1 to NFHS-5) but remains higher than the national average. Assam reported the highest mortality (42.16%), whereas Sikkim had the lowest (0.87%). Higher mortality was observed among male infants, mothers with advanced age, low maternal education, and mothers who attended less than 5 antenatal care (ANC) visits. Spatial analysis identified hotspots in Assam, Meghalaya, and Tripura. GWR indicated that areas with less than 5 ANC visits had the strongest association with neonatal mortality. Bayesian multilevel analysis highlighted spatial variations of up to 51% across districts in northeast India.
CONCLUSIONS
This study underscores spatial disparities in neonatal mortality across north-eastern India. Addressing childcare practices and healthcare access in hotspot regions is essential for improving new-born health outcomes. The findings provide critical insights for policymakers to develop targeted interventions aimed at reducing neonatal mortality in these underserved areas.; Summary

Association between regular dental scaling and stroke risk in patients with periodontal diseases: evidence from a Korean nationwide database: Yu-Rin Kim, Minkook Son, Seon-Rye Kim; Epidemiol Health. 2025;e2025020. Published online April 19, 2025; DOI: https://doi.org/10.4178/epih.e2025020 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
This study aimed to evaluate the association between the frequency of dental scaling and the risk of stroke among individuals with moderate-to-severe periodontal diseases and verify the effect of regular dental scaling on stroke risk in this population.
METHODS
In this retrospective study, 25,758 subjects with moderate-to-severe periodontal diseases were selected from the Korean National Health Insurance Service-National Health Screening cohort database. Based on the frequency of dental scaling, the subjects were divided into three groups: regular, occasional, and infrequent. Restricted cubic splines were used to evaluate hazard ratios (HR) with 95% confidence intervals (CI) for stroke. Additionally, landmark analysis was conducted to strengthen the reliability of the results.
RESULTS
There were 293, 111, and 38 stroke cases in the infrequent, occasional, and regular group, respectively. The adjusted HR for stroke in the regular group, compared to that in the infrequent group, was 0.40 (95% CI, 0.29–0.57). In the landmark analysis with follow-up after 1 year and after 2 years, the adjusted HR in the regular group compared to that in the infrequent group was 0.41 (95% CI, 0.28–0.60) and 0.50 (95% CI, 0.33–0.76), respectively.
CONCLUSIONS
Regular dental scaling was significantly associated with a reduced risk of stroke in patients with moderate-to-severe periodontal diseases. These findings may suggest a potential preventive role of dental scaling beyond oral health. Further studies are needed to explore the underlying biological mechanisms linking periodontal care to stroke prevention and to explore causal relationships between dental scaling and stroke risk.; Summary

Impact of hypertension-related avoidable hospitalization on all-cause mortality in older patients with hypertension: a nationwide retrospective cohort study in South Korea: Yehrhee Son, Noorhee Son, Sungyoun Chun, Ki-Bong Yoo, Jung Hyun Chang, Woo-Ri Lee; Epidemiol Health. 2025;e2025019. Published online April 18, 2025; DOI: https://doi.org/10.4178/epih.e2025019 [Accepted]

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OBJECTIVES
The prevalence of hypertension is increasing as a result of rapid population aging, which elevates the societal burden of the disease. In South Korea, the hospitalization rate for hypertension-related admissions exceeds the average reported by the Organization for Economic Co-operation and Development; however, the impact of these hospitalizations has not been evaluated. Therefore, this study investigates the association between hypertension-related avoidable hospitalizations and all-cause mortality.
METHODS
We included patients aged ≥60 years diagnosed with hypertension, identified using data from the National Health Insurance Services Senior Cohort spanning 2008 to 2019. The primary outcome was all-cause mortality measured at 3 and 5 years after the hypertension diagnosis. The key independent variable was the incidence of hypertension-related avoidable hospitalizations within the first year following the initial hypertension diagnosis. Cox proportional hazards regression analysis was employed to assess these associations. To ensure robust findings and minimize selection bias, several sensitivity analyses were conducted.
RESULTS
Out of 65,686 participants, 397 (0.6%) experienced hypertension-related avoidable hospitalizations within 1 year of their initial hypertension diagnosis. Individuals who experienced such hospitalizations had a significantly higher risk of all-cause mortality compared to those who did not (3-year: hazard ratio (HR) 2.12, 95% confidence interval (CI) 1.53–2.94; 5-year: HR, 2.13; 95% CI, 1.68–2.68).
CONCLUSIONS
Hypertension-related avoidable hospitalizations among older adults are associated with an increased risk of both short-term and long-term all-cause mortality. These findings underscore the importance of timely hypertension management to prevent such hospitalizations.; Summary

Parents’ employment and non-chromosomal congenital anomalies in South Korea: a national population cohort study: Kyuwon Kim, Hoyol Jhang, Erdenetuya Bolormaa, Chae Bong Kim, Seung-Ah Choe; Epidemiol Health. 2025;e2025018. Published online April 10, 2025; DOI: https://doi.org/10.4178/epih.e2025018 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
We assessed the association between parents' employment status, including industrial classification, and non-chromosomal congenital anomalies in offspring.
METHODS
We analyzed data from mothers who delivered live births between 2020 and 2022, linking their records with those of their neonates from the National Health Information Service (NHIS) database. Our analysis focused on common industrial classifications representing at least 6% of the total workforce. Congenital anomalies were identified based on neonates’ diagnostic codes. We conducted logistic regression to estimate odds ratios (ORs) of congenital anomalies by the industrial classification of mothers and their partners, adjusting for individual risk factors, with the financial industry serving as the reference category.
RESULTS
Among 338,637 women with a live birth, 148,818 (43.9%) were employed at the time of pregnancy. Employment was associated with a higher risk of congenital anomalies (OR, 1.08; 95% confidence interval [CI], 1.04-1.12). Within the common industrial classifications, health and social work exhibited the highest risk (OR, 1.11; 95% CI, 1.06-1.22) compared to the financial industry. Women employed in general hospitals showed particularly elevated risks (OR, 1.19; 95% CI, 1.04-1.37). Among male partners, the risk estimates were generally imprecise.
CONCLUSIONS
The study indicates that certain industries are linked with a higher risk of congenital anomalies among women workers. These findings underscore the need for enhanced safety measures in high-risk industrial settings to reduce the occurrence of congenital anomalies.; Summary

Association of dietary inflammatory index with mortality risk: a prospective analysis of the Korea National Health and Nutrition Examination Survey: Dahyun Park, Hee Ju Jun, Garam Jo, Soyoung Kwak, Min-Jeong Shin; Epidemiol Health. 2025;e2025017. Published online April 9, 2025; DOI: https://doi.org/10.4178/epih.e2025017 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
The energy-adjusted dietary inflammatory index (E-DII), a tool developed based on comprehensive research and literature reviews, is used to assess the inflammatory potential of specific diets. Although previous research has demonstrated an association between E-DII and mortality, longitudinal studies investigating a causal relationship in Asian populations are lacking. This study aimed to explore the prospective association between E-DII and the risk of all-cause, cancer, and cardiovascular disease (CVD) mortality using a population-based Korean cohort.
METHODS
The analysis included data from 40,596 individuals who participated in the Korea National Health and Nutrition Examination Survey between 2007 and 2015. The exclusion criteria encompassed the diagnosis of cancer or CVD at baseline, pregnancy at baseline, and death within the first 2 years after baseline. The E-DII was calculated using data from 24-hour dietary recall interviews. Cox proportional hazard regression models were employed to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for mortality risk across E-DII tertiles.
RESULTS
Over an 8.2-year follow-up period, 2,070 deaths were recorded. Compared with the lowest E-DII, a higher index was associated with an increased risk of mortality from all causes (HR, 1.45; 95% CI, 1.25 to 1.69), cancer (HR, 1.41; 95% CI, 1.09 to 1.81), and CVD (HR, 1.53; 95% CI, 1.07 to 2.18). The association between E-DII and all-cause mortality was particularly pronounced among individuals with metabolic conditions.
CONCLUSIONS
Our findings suggest a strong positive association between high E-DII and increased mortality in Korean adults, especially those with metabolic disorders.; Summary

Epidemiologic investigation

Spatiotemporal trends in severe complicated influenza among the local population in Taiwan region, 2003-2023: Kangjun Wu, Yujian Lu; Epidemiol Health. 2025;e2025016. Published online April 2, 2025; DOI: https://doi.org/10.4178/epih.e2025016 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Severe influenza has raised considerable concern worldwide, and its incidence appears to have shifted in the context of globalization. This study aimed to examine the temporal, spatial, and demographic distributions of local severe influenza cases in Taiwan region from January 2003 to June 2023.
METHODS
We aggregated severe complicated influenza cases by month, area (city/county), age, and sex. The age-standardized incidence rate (ASIR) was calculated to compare differences across regions and populations. Yearly incidence rate ratios comparing males to females were also computed to assess sex differences.
RESULTS
A total of 16,459 cases were included from 2003 to 2023. Crude incidence rates per 100,000 population were 0.07–0.14 for 2003–2008, 3.64–9.81 for 2009–2019, and 0.004–1.87 for 2020–2023. Higher incidence rates were observed in Hualien and Taitung Counties, with average ASIRs exceeding 10.0 per 100,000 population, compared to other cities. Except for 2005 and 2007, the incidence among males exceeded that among females, with ASIR ratios ranging from 1.10 to 2.20. The highest incidence was observed among populations aged 0–4 and those aged ≥55.
CONCLUSIONS
The incidence of severe complicated influenza exhibited clear regional and demographic variations in Taiwan region. The observed rebound in incidence calls for increased vigilance to protect vulnerable populations from severe illness.; Summary

Original articles

Palivizumab coverage rates among moderate-to-late preterm infants in Korea: A nationwide cross-sectional study: Seungyeon Kim, Saram Lee, Young June Choe, Ju Sun Heo; Epidemiol Health. 2025;e2025015. Published online April 1, 2025; DOI: https://doi.org/10.4178/epih.e2025015 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Since October 2016, South Korea has implemented a national reimbursement program for palivizumab aimed at moderate-to-late preterm (MLPT) infants born between 32 0/7 and 35 6/7 weeks of gestation during the respiratory syncytial virus (RSV) season (October–March). However, large-scale data on coverage rates and associated factors remain limited. This study evaluated palivizumab coverage rates and identified predictive factors influencing its administration in MLPT infants.
METHODS
This nationwide, population-based cross-sectional study utilized data from the Korean National Health Insurance Service collected between October 2016 and March 2019. MLPT infants eligible for palivizumab reimbursement were divided into administration and non-administration groups. Seasonal and overall coverage rates were assessed. A multivariate logistic regression analysis examined factors associated with palivizumab administration, with a focus on infant and maternal characteristics.
RESULTS
Among 2,843 eligible MLPT infants, 1,201 (42.2%) received palivizumab, while 1,642 (57.8%) did not. Although coverage rates increased annually, they remained suboptimal. Lower palivizumab prophylaxis coverage was observed in infants with higher gestational ages, female sex, absence of low birth weight, those born in March, residents of non-capital areas, infants not admitted to a neonatal intensive care unit (NICU) at birth, and infants of mothers aged <35 years.
CONCLUSIONS
In the initial 3 RSV seasons following the introduction of palivizumab reimbursement for MLPT infants in South Korea, the overall coverage rate was low (42.2%). National policies targeting infants with higher gestational ages, those born in March, and those residing in non-capital areas are necessary to improve coverage and ensure equitable RSV prophylaxis.; Summary

Identifying factors associated with mental health status following climate-related disasters: a nationwide longitudinal panel study in Korea: Eunjin Oh, Jaelim Cho, Changsoo Kim, Hyungryul Lim, Kyoung-Nam Kim; Epidemiol Health. 2025;e2025014. Published online March 27, 2025; DOI: https://doi.org/10.4178/epih.e2025014 [Accepted]

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Abstract Summary PDF: Abstract
OBJECTIVES
Despite the increasing frequency and intensity of climate-related disasters, identifying factors associated with mental health status remains challenging. This study aimed to determine the factors linked to symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) following heavy rainfall and typhoons.
METHODS
National data on climate-related disaster victims (n=825 for heavy rainfall and n=1,220 for typhoon) from a longitudinal panel in Korea (“Long-term Survey on the Change of Life of Disaster Victims”) and data from individuals unaffected by disasters (n=893) were used. Generalized linear mixed models were employed to evaluate the factors associated with mental health status following climate-related disasters.
RESULTS
Greater disaster severity (e.g., experiencing casualties or asset loss) was associated with higher scores for depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and PTSD (Impact Event Scale-Revised). The association between casualty experience and anxiety score was more pronounced among individuals over 65 years (β [log-transformed score]=1.39; standard error [SE], 0.26; p<0.001), female respondents (β=1.20; SE, 0.20; p<0.001), those with a low education level (β=1.18; SE, 0.25; p<0.001), and those with a low income (β=1.45; SE, 0.26; p<0.001) compared to their counterparts.
CONCLUSIONS
These findings may help guide targeted interventions and shape public health policies and disaster management strategies that prioritize mental health support for the most at-risk populations, ultimately increasing community resilience to climate-related challenges.; Summary

Korean summary
본 연구는 기후 관련 재난 후 우울증, 불안, PTSD와 관련된 요인을 파악하였다. 재난의 심각도가 클수록 정신 건강 악화는 더 심각하였으며 특히 노인, 여성, 낮은 교육 수준과 소득을 가진 취약한 그룹이 더 큰 위험에 처해 있었다. 이 결과는 향후 재난 대응에서 이러한 인구집단을 지원하기 위한 맞춤형 정신 건강 개입과 정책의 필요성을 시사한다.

Key Message
We identified factors associated with depression, anxiety, and PTSD following climate-related disasters, highlighting that greater disaster severity correlates with worse mental health outcomes. Vulnerable groups, such as older adults, women, those with lower education and income, are at higher risk. The findings suggest the need for targeted mental health interventions and policies to support these populations in future disaster responses.

Systematic review

Guts of healthy humans, livestock, and pets harbor critical-priority and high-risk Escherichia coli clones: Idris Nasir Abdullahi, Islem Trabelsi; Epidemiol Health. 2025;e2025013. Published online March 22, 2025; DOI: https://doi.org/10.4178/epih.e2025013 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
In May 2024, the World Health Organization classified carbapenem (CARB)- and third-generation cephalosporin (3GC) resistance (R) in Escherichia coli as a critical priority, whereas colistin (COL) is a "last resort" antibiotic for their treatment. This meta-analysis evaluated the pooled prevalence, high-risk lineages, genetic relatedness, and mechanisms of CARBR, COLR, and 3GCR in Escherichia coli from healthy humans and animals.
METHODS
We conducted a systematic review and meta-analyses following the PRISMA criteria on all eligible studies that reported the analysis of E. coli, and antimicrobial susceptibility to CARB, COL and 3GC in E. coli from gut samples of clinically healthy humans, livestock, and pets from June 2014 to June 2024. Random-effect models and CSI Phylogeny 1.4 were used to determine pooled prevalence rates (PPs) and the relatedness of publicly available E. coli genomes, respectively.
RESULTS
Of the 5034 identified articles, 55 studies were deemed eligible. The overall PPs of 3GCR, CARBR- and COLR E. coli were 19% (95% CI, 14.5%-24.4%), 1.6% (95% CI, 0.8%-3.5%), and 13.3% (95% CI, 8.4%-20.9%), respectively. The PPs of 3GCR-, COLR- and CARBR E. coli significantly varied by hosts, continent, and year of studies (p<0.05). Diverse E. coli lineages were found, including 13 high-risk E. coli sequence types (STs), within which ST10 predominated. Phylogenomic analyses produced 4 clusters of related CARBR- and COLR E. coli strains (< 25 SNP): ST940-blaOXA-181 from humans in Lebanon, ST617-mcr-1 from pigs in China, ST46-mcr-1 from poultry in Tanzania, and ST1720-mcr-1 from goats in France.
CONCLUSIONS
COLR and 3GCR are more frequent than CARBR in gut E. coli. These 10-year epidemiological data highlight the persistence and transmission of critical priority and high-risk E. coli strains in healthy humans and animals, raising significant One Health concerns.; Summary

Original article

The Uneven Playing Field: Provider Participation and Regional Disparities in Oral Health Examination Rates in South Korea: Hye-Lim Hong, Nam-Hee Kim; Epidemiol Health. 2025;e2025012. Published online March 10, 2025; DOI: https://doi.org/10.4178/epih.e2025012 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
This study investigated regional disparities in adult oral health examination rates in South Korea, despite free oral health screenings by the National Health Insurance Service (NHIS). It focused on the impact of provider factors, such as the availability of dental clinics and non-dental institutions.
METHODS
A cross-sectional analysis of 2022 data from 229 districts was conducted. The dependent variable was the adult oral health examination rate, while independent variables included provider factors, community health status, lifestyle, demographic, and socioeconomic characteristics. Descriptive statistics, Pearson’s correlation, and multiple regression analyses identified significant predictors.
RESULTS
Non-metropolitan areas had higher oral health examination rates (27.4%) than metropolitan areas (25.3%). Correlation analysis showed the general health examination rate (r=0.583) and the number of screening institutions (r=0.234) were the strongest predictors (p<0.001). Regression analysis showed a 1% increase in general health examination rates led to a 1.44% rise in oral health examination rates (p<0.001).
CONCLUSIONS
Despite NHIS policies, significant regional disparities persist, showing that providing screenings alone is insufficient. Integrating oral health screenings with general health examinations is necessary. Policymakers must promote collaboration between dental and non-dental providers to ensure equitable, integrated health services, enhancing preventive care and reducing disparities.; Summary

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Accepted articles