Epidemiology and Health

Original articles

Higher energy consumption in the evening is associated with increased odds of obesity and metabolic syndrome: findings from the 2016–2018 Korean National Health and Nutrition Examination Survey (7 th KNHANES): Sarang Jeong, Hajoung Lee, Sukyoung Jung, Jee Young Kim, Sohyun Park; Epidemiol Health. 2023;e2023087. Published online September 19, 2023; DOI: https://doi.org/10.4178/epih.e2023087 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Chrono-nutrition emphasizes meal timing in preventing obesity and metabolic disorders. This study explores the impact of temporal dietary patterns(TDPs) on obesity and metabolic syndrome(MetS) in Korean adults aged 20 to 65 years.
METHODS
We utilized dynamic time warping method and Kernel k-means clustering to investigate diet quality and the odds ratios(ORs) of obesity and MetS with different TDPs using data from the 7th Korea Nutrition and Health Examination Survey.
RESULTS
Participants were divided into three groups based on relative energy intake over 24 hours. After adjusting for age and gender, Cluster 3(with the highest proportion of energy intake in the evening) had the lowest Healthy Eating Index scores compared to other clusters. Following adjustment for key covariates, Cluster 3 showed the highest values for Body Mass Index, waist circumference, blood pressure, total cholesterol, and triglycerides. Compared to Cluster 1(with a lower proportion of energy intake in the evening), Cluster 2 and Cluster 3 had ORs for obesity of 1.12 (95% Confidence Interval(CI), 0.97–1.30) and 1.19 (95% CI, 1.03–1.37), respectively. For MetS, the ORs were 1.26 (95% CI, 1.08–1.48) and 1.37 (95% CI, 1.17–1.61) when comparing Cluster 2 and 3 to Cluster 1.
CONCLUSIONS
This study reveals that individuals with higher energy intake in the evening have increased odds of obesity and MetS, even after adjusting for major covariates, including age and total energy intake.; Summary

Socioeconomic inequality in organized and opportunistic screening for colorectal cancer: results from the Korean National Cancer Screening Survey, 2009–2021: Xuan Quy Luu, Kyeongmin Lee, Jae Kwan Jun, Mina Suh, Kui Son Choi; Epidemiol Health. 2023;e2023086. Published online September 17, 2023; DOI: https://doi.org/10.4178/epih.e2023086 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
This study aimed to investigate socioeconomic status (SES)-based inequality in colorectal cancer (CRC) screening in Korea. We assessed whether the rates of opportunistic and organized CRC screening differed according to income and education levels.
METHODS
We analyzed data from the Korean National Cancer Screening Survey (KNCSS) of 27,654 cancer-free individuals, aged 50–74 years, from 2009 to 2021. The weighted cancer screening rates with trends were estimated with the average annual percentage change using joinpoint regression. Inequality was calculated in both relative and absolute terms, based on a Poisson regression model.
RESULTS
The organized screening rate increased significantly from 22.1% in 2009 to 53.1% in 2020 and 50.6% in 2021, with an average annual change of 8.6% (95% confidence interval [CI], 4.9%-12.5%). In contrast, no significant trend was observed for opportunistic screening. The SES inequality in opportunistic screening uptake was indicated by a slope index of inequality (SII) of 9.74% (95% CI, 6.36%-13.12%), relative index of inequality (RII) of 2.18 (95% CI, 1.75%-2.70%) in terms of education level; and an SII of 7.03% (95% CI, 4.09%-9.98%), RII of 1.81 (95% CI, 1.41%-2.31%) in terms of measured income. Although there was an increasing trend in income inequality, no significant SES inequalities were observed in the overall estimates for organized screening.
CONCLUSIONS
Organized CRC screening is effective in improving the participation rate, regardless of SES. However, significant inequalities were found in opportunistic screening, suggesting room for improvement in the overall equity of CRC screening.; Summary

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

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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], 1.25-1.28, middle: PR=1.03; 95% CI, 1.02-1.04). Similar associations were observed for father’s education (tertiary or above: PR=1.11; 95% CI, 1.09-1.13; upper secondary: PR=1.05; 95% CI, 1.03-1.07) and mother’s education (tertiary or above: PR=1.17; 95% CI, 1.15-1.20; upper secondary: PR=1.06; 95% CI, 1.04-1.08). 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, 1.25-1.30; middle: PR=1.03; 95% CI, 1.01-1.05).
CONCLUSIONS
Adolescents with higher SEP exhibited more physical activity and less sedentary time than those with lower SEP.; Summary

Effective vaccination strategies to control COVID-19 in Korea: a modeling study: Youngsuk Ko, Kyong Ran Peck, Yae-Jean Kim, Dong-Hyun Kim, Eunok Jung; Epidemiol Health. 2023;e2023084. Published online September 7, 2023; DOI: https://doi.org/10.4178/epih.e2023084 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
In Korea, as immunity levels of the coronavirus disease 2019 (COVID-19) in the population acquired through previous infections and vaccinations have decreased, booster vaccinations have emerged as a necessary measure to control new outbreaks. The objective of this study was to identify the most suitable vaccination strategy for controlling the surge in COVID-19 cases.
METHODS
A mathematical model was developed to concurrently evaluate the immunity levels induced by vaccines and infections. This model was then employed to investigate the potential for future resurgence and the possibility of control through the use of vaccines and antivirals.
RESULTS
As of May 11, 2023, if the current epidemic trend persists without further vaccination efforts, a peak in resurgence is anticipated to occur around mid-October of the same year. Under the most favorable circumstances, the peak number of severely hospitalized patients could be reduced by 43% (480) compared to the scenario without vaccine intervention (849). Depending on outbreak trends and vaccination strategies, the best timing for vaccination in terms of minimizing this peak varies from May to August 2023.
CONCLUSIONS
Our findings suggest that if the epidemic persist, the best timing for administering vaccinations would need to be earlier than currently outlined in the Korean plan. It is imperative to continue monitoring outbreak trends, as this is key to determining the best vaccination timing in order to manage potential future surges.; Summary

Socioeconomic inequalities in metabolic syndrome and its components in a sample of Iranian Kurdish adults: Pardis Mohammadzadeh, Farhad Moradpour, Bijan Nouri, Farideh Mostafavi, Farid Najafi, Ghobad Moradi; Epidemiol Health. 2023;e2023083. Published online September 3, 2023; DOI: https://doi.org/10.4178/epih.e2023083 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
The worldwide incidence of metabolic syndrome (MetS) has increased in recent decades. In this study, we investigated the socioeconomic inequalities associated with MetS and its components in a sample of the Iranian Kurdish population.
METHODS
We used data from 3996 participants, aged 35 to 70 years, from the baseline phase of the Dehgolan Prospective Cohort Study (February 2018 to March 2019). The concentration index and concentration curve were used to measure inequality and the Blinder-Oaxaca decomposition method was used to examine the contribution of various determinants to the observed socioeconomic inequality in MetS and its components.
RESULTS
The prevalence of MetS was 34.44% (95% CI, 32.97% to 35.93%). The prevalence of MetS was 26.18% for those in the highest socioeconomic status (SES), compared with 40.51% for participants in the lowest SES. There was a significant negative concentration index for MetS (C=-0.13; 95% CI, -0.16 to -0.09), indicating a concentration of MetS among participants with a lower SES. The most prevalent component was abdominal obesity (59.14%) with a significant negative concentration index (C=-0.21; 95% CI, -0.25 to -0.18). According to decomposition analysis, age, gender, and education were the highest contributing factors to inequality in MetS and its components.
CONCLUSIONS
This study showed socioeconomic inequality in MetS. People with a low SES were more likely to have MetS. Therefore, policymakers and health managers need to develop appropriate strategies to reduce these inequalities in MetS across age groups, genders, and education levels, especially among women and the elderly.; Summary

Overall and cause-specific mortality in patients with dementia: a population-based cohort study in Taiwan: Chia-Lun Kuo, Pei-Chen Lee, Li-Jung Elizabeth Ku, Yu Sun, Tsung-Hsueh Lu, Muhammad Atoillah Isfandiari, Chung-Yi Li; Epidemiol Health. 2023;e2023082. Published online August 31, 2023; DOI: https://doi.org/10.4178/epih.e2023082 [Accepted]

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Abstract PDF: Abstract
Objectives
Information regarding the underlying causes of death (UCODs) and standardized mortality ratio (SMR) of dementia is instrumental in formulating medical strategies to prolong life in persons with dementia (PWD). We examined the leading UCODs among PWD and estimated the overall and cause-specific SMRs in relation to dementia in Taiwan.
Methods
Data were retrieved from 2 national datasets: the Taiwan Death Registry and the medical claim datasets of the National Health Insurance program. The observed person-years for each study participant were counted from the date of cohort enrollment to either the date of death or the final day of 2016. Sex-specific and age-specific SMRs were then calculated.
Results
The leading UCOD was circulatory disease, accounting for 25.99% of total deaths (n=3,505), followed by respiratory disease at 21.32% (n=2,875). PWD were at significantly increased risk of all-cause mortality (SMR=2.01), with SMR decreasing with advancing age. A cause-specific analysis revealed that the highest SMRs were associated with nervous system diseases (SMR=7.58) and mental, behavioral, and neurodevelopmental disorders (SMR=4.80). Age appeared to modify SMR, suggesting that younger age at cohort enrollment was linked to higher SMRs for nearly all causes of mortality.
Conclusions
Circulatory and respiratory diseases were the leading UCODs among PWD. The particularly elevated mortality due to nervous system diseases and mental disorders suggests that allocating more resources to neurological and psychiatric services is warranted. The elevated SMRs of various UCODs among younger PWD underscore the need for clinicians to pay particular attention to the medical care provided to these patients.; Summary

Body mass index and prevalence of metabolic syndrome among Korean adults before and after the coronavirus disease 2019 outbreak: a retrospective longitudinal study: Joo-Eun Jeong, Hoon-Ki Park, Hwan-Sik Hwang, Kye-Yeung Park, Myoung-Hye Lee, Seon-Hi Shin, Nayeon Choi; Epidemiol Health. 2023;e2023081. Published online August 29, 2023; DOI: https://doi.org/10.4178/epih.e2023081 [Accepted]

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Abstract PDF: Abstract
Objectives
Studies evaluating weight changes during the coronavirus disease 2019 (COVID-19) pandemic have yielded inconsistent results, and most of those studies were based on self-reported anthropometric measures. We investigated changes in body mass index (BMI), professionally measured waist circumference (WC), and metabolic syndrome components from before to during the pandemic in a sample of the adult population in South Korea.
Methods
This retrospective study included 1,118 men and women (age≥18 years) who underwent health checkups at a university medical center between January 1, 2016, and March 31, 2022. Changes in BMI, lifestyles, and metabolic syndrome components during the pandemic were analyzed using the paired t-test, McNemar test, generalized estimating equations, and repeated-measures analysis of variance.
Results
Changes in body weight, BMI, and body fat percentage during the pandemic were not clinically significant. However, statistically significant results were found for decreased physical activity (p<0.001) and WC (p<0.001), and exacerbation of all metabolic syndrome components (except serum triglyceride levels). Moreover, the metabolic syndrome prevalence increased significantly from 20.2% to 31.2% during the pandemic (p<0.001). The prevalence of abdominal obesity and high fasting blood glucose levels also significantly increased from 2019 to 2021.
Conclusions
Metabolic syndrome, its components, and fat distribution worsened significantly after the implementation of social distancing and lockdowns, despite no clinically significant changes in body weight and BMI. Further studies on the post-pandemic period should investigate the long-term impact of social lockdowns on BMI and the prevalence of metabolic syndrome.; Summary

Increased risk of cancer and cancer-related mortality in middle-aged Korean women with prediabetes and diabetes: a population-based study: Thi Xuan Mai Tran, Soyeoun Kim, Huiyeon Song, Boyoung Park; Epidemiol Health. 2023;e2023080. Published online August 28, 2023; DOI: https://doi.org/10.4178/epih.e2023080 [Accepted]

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Abstract PDF: Abstract
Objectives
This study investigated the risk of developing and dying from all types of cancer, as well as cancer-specific mortality, in women diagnosed with prediabetes and diabetes.
Methods
We included women aged ≥40 years who underwent cancer screening from 2009 to 2014 with follow-up until 2020. Diabetes status was determined based on fasting plasma glucose levels, self-reported history of diabetes, and the use of antidiabetic medication. We quantified the risk of cancer and mortality in the prediabetes and diabetes groups, relative to the normoglycemia group, by calculating adjusted hazard ratios (aHRs).
Results
The study included 8,309,393 participants with a mean age of 52.7±9.7 years. Among these participants, 522,894 cases of cancer and 193,283 deaths were detected. An increased risk of cancer was observed in both the prediabetes group (aHR, 1.03; 95% CI, 1.02–1.04) and the diabetes group (aHR, 1.13; 95% CI, 1.12–1.14). The highest risk was identified in those with diabetes who developed liver (aHR, 1.72; 95% CI, 1.66–1.79), pancreatic (aHR, 1.68; 95% CI, 1.60–1.76), and gallbladder cancer (aHR, 1.43; 95% CI, 1.36–1.51). Women with prediabetes and diabetes exhibited a 1.07-fold (95% CI, 1.05–1.08) and 1.38-fold (95% CI, 1.36–1.41) increased risk of death from cancer, respectively.
Conclusions
Both prediabetes and diabetes were associated with an elevated risk of cancer, as well as an increased risk of death from cancer, in middle-aged Korean women. However, the degree of risk varied depending on the specific site of the cancer.; Summary

Clinical symptom profile of hospitalized COVID-19 Brazilian patients according to SARS-CoV-2 variants: Natália Satchiko Hojo-Souza, Vander Luis de Souza Freitas, Daniel Ludovico Guidoni, Fernanda Hojo de Souza; Epidemiol Health. 2023;e2023079. Published online August 28, 2023; DOI: https://doi.org/10.4178/epih.e2023079 [Accepted]

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Abstract PDF: Abstract
Objectives
The aim of this study was to investigate the prevalence of the main symptoms in Brazilian COVID-19 patients hospitalized during 4 distinct waves, based on their infection with different SARS-CoV-2 variants.
Methods
This study included hospitalized patients who tested positive for SARS-CoV-2 during 15 weeks around the peak of each of 4 waves: W1, ancestral strain/B.1 lineage (2020/05/31 to 2020/09/12); W2, Gamma/P.1 variant (2021/01/31 to 2021/05/15); W3, Omicron variant (2021/12/05 to 2022/03/19); and W4, BA.4/BA.5 subvariants (2022/05/22 to 2022/09/03). Symptom data were extracted from the Brazilian Severe Acute Respiratory Syndrome Database. Relative risks were calculated, and an analysis of symptom networks was performed.
Results
Patients who were hospitalized during the prevalence of the Gamma/P.1 variant demonstrated a higher risk, primarily for symptoms such as fatigue, abdominal pain, low oxygen saturation, and sore throat, than patients hospitalized during the first wave. Conversely, patients who were hospitalized during the predominance of the Omicron variant exhibited a lower relative risk, particularly for symptoms such as loss of smell, loss of taste, diarrhea, fever, respiratory distress, and dyspnea. Similar results were observed in COVID-19 patients who were hospitalized during the wave of the Omicron subvariants BA.4/BA.5. A symptom network analysis, conducted to explore co-occurrence patterns among different variants, revealed significant differential profiles across the 4 waves, with the most notable difference observed between the W2 and W4 networks.
Conclusions
Overall, the relative risks and patterns of symptom co-occurrence associated with different SARS-CoV-2 variants may reflect disease severity.; Summary

Does the father’s job matter? Parental occupation and preterm birth in South Korea: Taemi Kim, Eunseon Gwak, Erdenetuya Bolormaa, Jeong-Won Oh, Jung-won Yoon, Myoung-Hee Kim, Jia Ryu, Seung-Ah Choe; Epidemiol Health. 2023;e2023078. Published online August 24, 2023; DOI: https://doi.org/10.4178/epih.e2023078 [Accepted]

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Abstract PDF: Abstract
Objectives
Limited evidence is available regarding the impact of paternal occupation and its combined effect with maternal occupation on preterm birth. Therefore, we assessed the association of maternal and paternal occupations with preterm birth.
Methods
We used the national birth data of South Korea between 2010 and 2020. Parental occupations were divided into 5 categories: (1) managers; (2) professionals, technicians, and related workers; (3) clerks and support workers; (4) service and sales workers; and (5) manual workers. A multinomial logistic regression model was used to calculate the adjusted odds ratios (aORs) of extremely, very, and moderate-to-late preterm births per occupational category considering individual risk factors.
Results
For the 4,004,976 singleton births, 40.2% of mothers and 95.5% of fathers were employed. Compared to non-employment, employment was associated with a lower risk of preterm birth. Among employed mothers, service and sales occupations were associated with a higher risk of preterm birth than managerial occupations (aOR=1.06; 95% confidence interval [CI], 1.01–1.10 for moderate-to-late preterm births). The father’s manual occupation was associated with a higher risk of preterm birth (aOR=1.10; 95% CI, 1.05–1.13 for moderate-to-late preterm) than managerial occupations. When both parents had high-risk occupations, the risk of preterm birth was higher than in cases where only the mother or neither of the parents had a high-risk occupation.
Conclusions
Paternal occupation was associated with preterm birth regardless of maternal employment and occupation and modified the effect of maternal occupation. Detailed occupational environment data are needed to identify the paternal exposures that increase the risk.; Summary

Special article

Genetically determined alcohol consumption and cancer risk in Korea: Keum Ji Jung, Ji Woo Baek, Sang Yop Shin, Sun Ha Jee; Epidemiol Health. 2023;e2023077. Published online August 23, 2023; DOI: https://doi.org/10.4178/epih.e2023077 [Accepted]

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Abstract PDF: Abstract
Objectives
The purpose of this study was to determine the causal relationship between the genetically determined amount of alcohol consumption and the occurrence of major cancers.
Methods
The data used in this study were from 129,324 people selected from the Korean Cancer Prevention Study-II, the participants of which visited 18 health examination centers between 2004 and 2013. Cancer incidence was confirmed as of 2020 using data from the National Cancer Center. A genome-wide association study (GWAS) on alcohol consumption was performed using PLINK 2.0, and sex, age, chip type, and principal components were adjusted.
Results
From the GWAS, a genetic risk score for alcohol consumption was calculated and genetically determined alcohol consumption (GDAC) was estimated. GDAC was divided into quintile groups and showed significant causal relationships with rectal cancer and liver cancer, but not with other cancers. For liver cancer, an association was shown in the hepatitis B surface antigen (HBsAg)-negative group, and a particularly strong association was found in the over-60-year-old HBsAg-negative group, in which, compared to the GDAC Q1 group, the Q4 group had a 2.35 times higher risk (95% CI, 1.05-5.23), and the Q5 group had a 2.40 times higher risk (95% CI, 1.22-7.01).
Conclusions
The results of this study provided evidence that the amount of alcohol consumed is causally related to the occurrence of rectal cancer and liver cancer in HBsAg-negative individuals. Additional studies should be continued for other cancer types through long-term follow-up.; Summary

Original articles

Aedes aegypti container preference for oviposition and its possible implications for dengue vector surveillance in Delhi, India: Pooja Prasad, Suman Lata, Sanjeev Kumar Gupta, Pawan Kumar, Rekha Saxena, Deepak Kumar Arya, Himmat Singh; Epidemiol Health. 2023;e2023073. Published online August 23, 2023; DOI: https://doi.org/10.4178/epih.e2023073 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Dengue is a mosquito-borne viral disease globally transmitted by Aedes aegypti. The most effective method to prevent the transmission of the disease is proficient vector control. Understanding the breeding behaviour of the responsible vectors is very pertinent in this regard; therefore, the present study was conducted to understand Ae. aegypti behaviour regarding the selection of containers for oviposition in the megacity of Delhi.
METHODS
A household survey in different localities within Delhi was carried out during 2018-2019. All available containers were inspected for the presence of immature Ae. aegypti. In entomological surveillance, the ovipositional preference of Aedes was computed using the breeding preference ratio, container index in the field, and laboratory settings, and associations of dengue cases with monthly variation in environmental factors and container type were also calculated.
RESULTS
The household larval survey in 40 localities showed that 40% of 27,776 water-holding containers in 3,400 houses were plastic, followed by overhead tanks (26.2%), and coolers (12.1%). The most preferred breeding habitat was clay pots (9.3%), followed by metallic containers (8.5%) and solid waste (7.1%). A laboratory-based study showed that Aedes preferred clay containers (81.8%) over 4 other types of containers (plastic, paper, metal, and glass).
CONCLUSIONS
The present study provides a rationale for using clay containers as a possible surveillance tool (ovitraps) or as a vector control tool. This information might aid researchers in developing novel traps and targeting preferred containers for larval control activities during transmission and non-transmission seasons.; Summary

Parental intention to vaccinate daughters with the human papillomavirus vaccine in Korea: a nationwide cross-sectional survey: Yejin Ha, Kyeongmin Lee, Bomi Park, Mina Suh, Jae Kwan Jun, Kui Son Choi; Epidemiol Health. 2023;e2023076. Published online August 17, 2023; DOI: https://doi.org/10.4178/epih.e2023076 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
We aimed to identify and compare the characteristics and factors associated with parental intention to vaccinate daughters under 12 years old against human papillomavirus (HPV), examining data from 2016 and 2020.
METHODS
Data were obtained from the Korean National Cancer Screening Survey conducted in 2016 and 2020. The present study included 3,510 parents with daughters under 12 years old. Changes in parental intention-to-vaccinate rates were calculated. To identify factors associated with parental intention to vaccinate their daughters, the chi-square test and logistic regression analysis were used.
RESULTS
The percentage of respondents intending to vaccinate their daughters increased from 33.4% in 2016 to 58.9% in 2020, constituting a 25.5 percentage point (%p) increase. Since 2016, the proportion of male participants expressing positive intention towards HPV vaccination increased by 31.5%p, while that of female participants demonstrated a 20.9%p increase. Logistic regression analysis indicated that parents with a strong intention to vaccinate their daughters tended to be younger, more educated, and aware of the free vaccination program available, as well as to have a history of HPV vaccination and to have undergone cervical cancer screening within 2 years, compared to those who did not intend to vaccinate. Being a mother with a history of HPV vaccination was the strongest predictor of positive intention to vaccinate a daughter.
CONCLUSIONS
The intention among parents to vaccinate daughters remains relatively low, although it is rising. To increase the HPV vaccination rate, strong recommendations and education should be provided to parents and the younger generation.; Summary

Korea Seroprevalence Study of Monitoring of SARS-COV-2 Antibody Retention and Transmission (K-Sero SMART): findings from national representative sample: Jina Han, Hye Jin Baek, Eunbi Noh, Kyuhyun Yoon, Jung Ae Kim, Sukhyun Ryu, Kay O Lee, No Yai Park, Eunok Jung, Sangil Kim, Hyukmin Lee, Yoo-Sung Hwang, Jaehun Jung, Hun Jae Lee, Sung-il Cho, Sangcheol Oh, Migyeong Kim, Chang-Mo Oh, Byengchul Yu, Young-Seoub Hong, Keonyeop Kim, Sunjae Jung, Mi Ah Han, Moo-Sik Lee, Jung-Jeung Lee, Young Hwangbo, Hyeon Woo Yim, Yu-Mi Kim, Joongyub Lee, Weon-Young Lee, Jae-Hyun Park, Sungsoo Oh, Heui Sug Jo, Hyeongsu Kim, Gilwon Kang, Hae-Sung Nam, Ju-Hyung Lee, Gyung-Jae Oh, Min-Ho Shin, Soyeon Ryu, Tae-Yoon Hwang, Soon-Woo Park, Sang Kyu Kim, Roma Seol, Ki-Soo Park, Su Young Kim, Jun-wook Kwon, Sung Soon Kim, Byoungguk Kim, June-Woo Lee, Eun Young Jang, Ah-Ra Kim, Jeonghyun Nam, Soon Young Lee, Dong-Hyun Kim; Epidemiol Health. 2023;e2023075. Published online August 17, 2023; DOI: https://doi.org/10.4178/epih.e2023075 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
We estimated the population prevalence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including unreported infections, through a Seroprevalence Study of Monitoring of SARS-CoV-2 Antibody Retention and Transmission (K-SMART) in 258 communities throughout Korea.
METHODS
In August 2022, a survey was conducted among 10,000 household members aged 5 years and older, in households selected through two stage probability random sampling. During face-to-face household interviews, participants self-reported their health status, COVID-19 diagnosis and vaccination history, and general characteristics. Subsequently, participants visited a community health center or medical clinic for blood sampling. Blood samples were analyzed for the presence of anti-spike (anti-S) and anti-nucleocapsid (anti-N) SARS-CoV-2 proteins using an electrochemiluminescence immunoassay. To estimate the population prevalence, the PROC SURVEYMEANS statistical procedure was employed, with weighting to reflect demographic data from July 2022.
RESULTS
In total, 9,945 individuals from 5,041 households were surveyed across 258 communities, representing all basic local governments in South Korea. The overall population-adjusted prevalence rates of anti-S and anti-N were 97.6% and 57.1%, respectively. Since the Korea Disease Control and Prevention Agency has reported a cumulative incidence of confirmed cases of 37.8% through July 31, 2022, the proportion of unreported infections among all COVID-19 infection was suggested to be 33.9%.
CONCLUSIONS
The K-SMART represents the first nationwide, community-based seroepidemiologic survey of COVID-19, confirming that most individuals possess antibodies to SARS-CoV-2 and that a significant number of unreported cases existed. Furthermore, this study lays the foundation for a surveillance system to continuously monitor transmission at the community level and the response to COVID-19.; Summary

Cohort profile

Cohort profile: Epidemiologic Questionnaire (EPI-Q) – a scalable, app-based health survey linked to electronic health record and genotype data: Maxwell Salvatore, Dylan Clark-Boucher, Lars G Fritsche, Jacob Ortlieb, Janet Houghtby, Anisa Driscoll, Bryanne Caldwell-Larkins, Jennifer A Smith, Chad M Brummett, Sachin Kheterpal, Lynda Lisabeth, Bhramar Mukherjee; Epidemiol Health. 2023;e2023074. Published online August 8, 2023; DOI: https://doi.org/10.4178/epih.e2023074 [Accepted]

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Abstract PDF: Abstract
The Epidemiologic Questionnaire (EPI-Q) was established to collect broad, uniform, self-reported health data to supplement electronic health record (EHR) and genotype information from participants in the University of Michigan (UM) Precision Health cohorts. Recruitment of EPI-Q participants, who were already enrolled in 1 of 3 ongoing UM Precision Health cohorts—the Michigan Genomics Initiative, Mental Health Biobank, and Metabolism, Endocrinology, and Diabetes cohorts—began in March 2020. Of 54,043 retrospective invitations, 5,577 individuals enrolled, representing a 10.3% response rate. Of these, 3,502 (63.7%) were female, and the average age was 56.1 years (standard deviation, 15.4 years). The baseline survey comprises 11 modules on topics including personal and family health history, lifestyle, and cancer screening and history. Additionally, 11 optional modules cover topics including financial toxicity, occupational exposure, and life meaning. The questions are based on standardized and validated instruments used in other cohorts, and we share resources to expedite development of similar surveys. Data are collected via the MyDataHelps platform, which enables current and future participants to share non-Michigan Medicine EHR data. Recruitment is ongoing. Cohort data are available to those with institutional review board approval; for details, contact the Data Office for Clinical and Translational Research (DataOffice@umich.edu; (734) 615-2100).; Summary

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