Epidemiology and Health

Original article

Prediction of the 10-year risk of atherosclerotic cardiovascular disease in the Korean population: Sangwoo Park, Yong-Giun Kim, Soe Hee Ann, Young-Rak Cho, Shin-Jae Kim, Seungbong Han, Gyung-Min Park; Epidemiol Health. 2023;e2023052. Published online May 12, 2023; DOI: https://doi.org/10.4178/epih.e2023052 [Accepted]

389 View
12 Download

Abstract PDF: Abstract
OBJECTIVES
Proper risk assessment is important for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). However, no validated risk prediction tools are currently in use in Korea. This study sought to develop a 10-year risk prediction model for incident ASCVD.
METHODS
Using the National Sample Cohort of Korea, 325,934 subjects aged 20–80 years without previous ASCVD were enrolled. ASCVD was defined as a composite of cardiovascular death, myocardial infarction, and stroke. The Korean ASCVD risk prediction (K-CVD) model was developed separately for men and women using the development dataset and validated in the validation dataset. Furthermore, the model performance was compared with the Framingham Risk Score (FRS) and pooled cohort equation (PCE).
RESULTS
Over 10 years of follow-up, 4,367 ASCVD events occurred in the overall population. The predictors of ASCVD included in the model were age, smoking status, diabetes, systolic blood pressure, lipid profiles, urine protein, and lipid-lowering and blood pressure-lowering treatment. The K-CVD model had good discrimination and strong calibration in the validation dataset (time-dependent area under the curve=0.846; 95% CI, 0.828–0.864; calibration χ2=4.73, goodness-of-fit p=0.32). Compared with our model, both FRS and PCE showed worse calibration, overestimating ASCVD risk in the Korean population.
CONCLUSIONS
Through a nationwide cohort, we developed a model for 10-year ASCVD risk prediction in a contemporary Korean population. The K-CVD model showed excellent discrimination and calibration in Koreans. This population-based risk prediction tool would help to appropriately identify high-risk individuals and provide preventive interventions in the Korean population.; Summary

Korean summary

Key Message

Special article

The Korea National Disability Registration System: Miso Kim, Wonyoung Jung, So Young Kim, Jong Hyock Park, Dong Wook Shin; Epidemiol Health. 2023;e2023053. Published online May 11, 2023; DOI: https://doi.org/10.4178/epih.e2023053 [Accepted]

295 View
34 Download

Abstract PDF: Abstract
The Korea National Disability Registration System (KNDRS) was established in 1989 to provide social welfare benefits based on predefined criteria for disability registration and an objective medical assessment using a disability grading system. Disability registration requires (1) a medical examination by a qualified specialist physician and (2) a medical advisory meeting to review the degree of disability. Medical institutions and specialists for the diagnosis of disabilities are legally stipulated, and medical records for a specified period are required to support the diagnosis. The number of disability types has gradually expanded, and 15 disability types have been legally defined. As of 2021, 2.645 million people were registered as disabled, accounting for approximately 5.1% of the total population. Among the 15 disability types, disabilities of the extremities account for the largest proportion (45.1%). Previous studies have investigated the epidemiology of disabilities using data from the KNDRS, combined predominantly with data from the National Health Insurance Research Database (NHIRD). Korea has a mandatory public health insurance system that covers the entire Korean population, and the National Health Insurance Services manages all eligibility information, including disability types and severity ratings. In short, the KNDRS-NHIRD is a significant data resource for research on the epidemiology of disabilities.; Summary

Korean summary

Key Message

Original articles

Association of the dietary inflammatory index with phenotypic age: Mengzi Sun, Jiaxin Fang, Wenhui Gao, Yue He, Yanan Ma, Lina Jin; Epidemiol Health. 2023;e2023051. Published online May 4, 2023; DOI: https://doi.org/10.4178/epih.e2023051 [Accepted]

483 View
65 Download

Abstract PDF: Abstract
Objectives
One of the underlying mechanisms of aging is chronic inflammation, which has been closely associated with daily diet. Phenotypic age (PhenoAge) has been used as an index to track the aging process before diseases show clinical symptoms. The present study aimed to explore the association between the dietary inflammatory index (DII) and PhenoAge.
Methods
In total, 9275 adults aged 20 years old and over in the National Health and Nutrition Examination Survey (NHANES) were involved in this study. Dietary patterns were classified as pro-inflammatory or anti-inflammatory according to the DII. PhenoAge was regarded as a continuous variable, and linear regression was used to explore its association with dietary inflammation. Stratified analyses by sex, age, race, physical exercise, smoking status, drinking status, and body mass index were used to test the sensitivity of these associations.
Results
The median value of PhenoAge was 38.60 years and 39.76 years for the participants with anti-inflammatory and pro-inflammatory diets, respectively. A pro-inflammatory diet was positively associated with PhenoAge (β=0.73; 95% CI, 0.31–1.14), compared with participants who had an anti-inflammatory diet. There was an interaction between dietary inflammation and age for PhenoAge (pinteraction<0.001). The strength of the association between a pro-inflammatory diet and PhenoAge was stronger as age increased.
Conclusions
A pro-inflammatory diet was associated with a higher PhenoAge, and the association was strongest in the elderly. We recommended reducing dietary inflammation to delay phenotypic aging, especially for the elderly.; Summary

Korean summary

Key Message

A comparison of methods for the measurement of adherence to antihypertensive multidrug therapy and the clinical consequences: a retrospective cohort study using the Korean nationwide claims database: Minji Jung, Eunjung Choo, Sukhyang Lee; Epidemiol Health. 2023;e2023050. Published online May 1, 2023; DOI: https://doi.org/10.4178/epih.e2023050 [Accepted]

413 View
0 Download

Abstract: Abstract
Objectives
In observational studies, the methods used to measure medication adherence may affect assessments of the clinical outcomes of drug therapy. This study estimated medication adherence to multidrug therapy in patients with hypertension using different measurement methods and compared their impacts on clinical outcomes.
Methods
This was a retrospective cohort study using the Korean National Health Insurance Service–National Sample Cohort database (2006-2015). Adults diagnosed with hypertension who initiated multidrug antihypertensive therapy in the index year 2007 were included. Adherence was defined as over 80% compliance. Adherence to multidrug antihypertensive therapy was measured in 3 ways using the proportion of days covered (PDC) with 2 approaches to the end-date of the study observations: PDC with at least one drug (PDCwith≥1), PDC with a duration weighted mean (PDCwm), and the daily polypharmacy possession ratio (DPPR). The primary clinical outcome was a composite of cardiovascular and cerebrovascular disease-specific hospitalizations or all-cause mortality.
Results
In total, 4,226 patients who initiated multidrug therapy for hypertension were identified. The mean adherence according to the predefined measurements varied from 72.7% to 79.8%. Non-adherence was associated with an increased risk of a primary outcome. The hazard ratios (95% confidence intervals) primary outcomes varied from 1.38 (1.19‐1.59) to 1.44 (1.25‐1.67).
Conclusions
Non-adherence to multidrug antihypertensive therapy was significantly associated with an increased risk of a primary clinical outcome. Across the varying estimates based on different methods, medication adherence levels were similar. These findings may provide evidence to support decision-making when assessing medication adherence.; Summary

Korean summary

Key Message

Changes in metabolic syndrome and risk of breast and endometrial cancers according to menopause: Thi Xuan Mai Tran, Soyeoun Kim, Boyoung Park; Epidemiol Health. 2023;e2023049. Published online May 1, 2023; DOI: https://doi.org/10.4178/epih.e2023049 [Accepted]

392 View
0 Download

Abstract: Abstract
Objectives
This study investigated how changes in metabolic syndrome (MetS) are associated with the subsequent risk of breast and endometrial cancer according to menopausal status.
Methods
This cohort study, using data from the National Health Insurance Service database, included women aged ≥40 years who underwent 2 biennial cancer screenings (2009–2010 and 2011–2012) and were followed up until 2020. Participants were grouped into MetS-free, MetS-recovery, MetS-development, and MetS-persistent groups. Menopausal status (premenopausal, perimenopausal, and postmenopausal) was assessed at 2 screenings. Cox proportional hazard regression was used to assess the association between MetS changes and cancer risk.
Results
In 3,031,980 women, breast and endometrial cancers were detected in 39,184 and 4,298, respectively. Compared with the MetS-free group, those who recovered, developed, or had persistent MetS showed an increased risk of breast cancer, with adjusted hazard ratios (aHRs) of 1.05, 1.05, and 1.11, respectively (p<0.005). MetS persistence was associated with an increased risk of breast cancer in postmenopausal women (aHR=1.12, 95% CI, 1.08–1.16) but not in premenopausal or perimenopausal women. MetS persistence was associated with an increased risk of endometrial cancer in premenopausal, perimenopausal, and postmenopausal women, with aHRs of 1.41 (95% CI, 1.17–1.70), 1.59 (95% CI, 1.19–2.12), and 1.47 (95% CI, 1.32–1.63), respectively.
Conclusions
Increased breast cancer risk was associated with recovered, developed, and persistent MetS in postmenopausal women. Meanwhile, increased endometrial cancer risk was found in obese women who recovered from MetS or persistently had MetS, regardless of menopausal status, when compared to MetS-free women.; Summary

Korean summary

Key Message

Cohort profile

Integrated database-based Screening Cohort for Asian Nomadic descendants in China (Scan-China): Insights on prospective ethnicity-focused cancer screening: Yuelin Yu, Liying Qiao, Jing Han, Weiwei Wang, Weiwei Kang, Yunjing Zhang, Shu Shang, Ruogu Meng, Lin Zhuo, Siyan Zhan, Yunfeng Xi, Shengfeng Wang; Epidemiol Health. 2023;e2023048. Published online April 18, 2023; DOI: https://doi.org/10.4178/epih.e2023048 [Accepted]

392 View
20 Download

Abstract PDF: Abstract
Established in 2017, the Screening Cohort for Asian Nomadic descendants (Scan-China) has benefited over 180,000 members of a multi-ethnic population, particularly individuals of Mongolian descent compared with the general population (Han ethnicity), in the Inner Mongolia Autonomous Region, China. This cohort study aims to evaluate the effectiveness of cancer screening and serve as a real-world data platform for cancer studies. The 6 most prevalent cancers in China are considered—namely, breast, lung, colorectal, gastric, liver and esophageal cancer. After baseline cancer risk assessments and screening tests, both active and passive follow-up (based on the healthcare insurance database, cancer registry, the front page of hospital medical records, and death certificates) will be conducted to trace participants’ onset and progression of cancers and other prevalent chronic diseases. Scan-China has preliminarily found a disproportionately lower screening participation rate and higher incidence/mortality rates of esophageal and breast cancer among the Mongolian population than among their Han counterparts. Further research will explore the cancer burden, natural history, treatment patterns, and risk factors of the target cancers; Summary

Korean summary

Key Message

Epidemiologic investigation

Epidemiological investigation of a food-borne outbreak in a kindergarten: Kyoung Mi Kim, Eun-Suk Cho, Seong Bae Ahn, Eun Ok Kang, Jong-Myon Bae; Epidemiol Health. 2023;e2023047. Published online April 17, 2023; DOI: https://doi.org/10.4178/epih.e2023047 [Accepted]

416 View
37 Download

Abstract PDF: Abstract
Objectives
On Monday, September 6, 2021, at a kindergarten in Jeju Province, a large number of children vomited and developed food poisoning symptoms, and this necessitated an epidemiological investigation.
Methods
The team surveyed symptoms and food intake history of kindergarten children, teachers, and workers who ate lunch between September 2 (Thu) and September 6 (Mon), excluding weekends. In addition to rectal swabs, environmental samples from preserved foods, cooking utensils, drinking water, and refrigerator handles were collected. Pulsed field gel electrophoresis for genetic fingerprint analysis (PFGE) was also performed.
Results
There were 19 cases among 176 subjects, which indicated an attack rate of 10.8%. The epidemic curve showed a unimodal shape, and the average incubation period was 2.6 h. While no food was statistically significant in food intake history, the analysis of 35 rectal smear samples detected Bacillus cereus in 7 children, 4 teachers, and 1 cooking staff. Enterotoxins were also detected in 12 samples. Out of 38 environmental samples, Bacillus cereus and enterotoxins were detected in the morning snack cereal, lunch bean sprouts, and afternoon snack steamed potatoes on Monday, September 6th. The result of the PFGE test on 10 isolates of Bacillus cereus showed that there was no genetic homology.
Conclusions
Our results indicated that this outbreak was simultaneously caused by various strains of Bacillus cereus from the environment.; Summary

Korean summary

Key Message

Original articles

Association of multiple anthropometric indices with hypertension in 944,760 elderly Chinese people: Lirong Dong, Yuanyuan Wang, Jinshui Xu, Yang Zhou, Guiju Sun, Dakang Ji, Haijian Guo, Baoli Zhu; Epidemiol Health. 2023;e2023046. Published online April 17, 2023; DOI: https://doi.org/10.4178/epih.e2023046 [Accepted]

320 View
36 Download

Abstract PDF: Abstract
Objectives
The aims of this study were to update the latest data on the prevalence of hypertension (HTN) in the elderly Chinese population and to assess relationships between new anthropometric indices and HTN.
Methods
Data were obtained from the Basic Public Health Service (BPHS) survey for Jiangsu Province, China. A total of 944,760 people aged 65 years and older were included in this study. Blood pressure (BP) was measured by trained investigators. Body weight, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WtHR), conicity index (COI), body roundness index (BRI), and a body shape index (ABSI) were included in the analysis as anthropometric indices. Logistic regression analysis and restricted cubic splines were used to evaluate the association of anthropometric indices with HTN.
Results
The prevalence of HTN among elderly residents of Jiangsu Province was 64.7% (95% CI: 64.6%–64.8%). After adjusting for multiple covariates, all anthropometric indices except ABSI showed significant nonlinear positive dose-response associations with HTN across sex (pnonlinear < 0.001). Among participants with BMI < 28 kg/m2, abnormal weight, WC, WtHR, BRI, COI, and ABSI were positively associated with HTN.
Conclusions
The prevalence of HTN in the elderly in Jiangsu Province is gradually increasing. It is necessary to consider the combination of ABSI and COI with BMI for screening elderly individuals for HTN in follow-up prospective studies.; Summary

Korean summary

Key Message

Risk of cancer, cardiovascular disease, thromboembolism, and mortality in patients with rheumatoid arthritis receiving Janus kinase inhibitors: a real-world retrospective observational study using Korean health insurance data: Hong Ki Min, Hyeongsu Kim, Ho Jin Jeong, Se Hee Kim, Hae-Rim Kim, Sang-Heon Lee, KunSei Lee, Soon-Ae Shin, Jong Heon Park; Epidemiol Health. 2023;e2023045. Published online April 15, 2023; DOI: https://doi.org/10.4178/epih.e2023045 [Accepted]

513 View
86 Download

Abstract PDF: Abstract
Objectives
This study investigated whether Janus kinase inhibitors (JAKis) raise the risk of cardiovascular disease (CVD), venous thromboembolism (VTE), and cancer in patients with rheumatoid arthritis (RA).
Methods
We conducted a real-world retrospective observational study using data obtained from the Korean National Health Insurance Service database. Two data sets were analyzed: tumor necrosis factor inhibitor (TNFi)/JAKi-naive RA patients (set 1) and all RA patients who used TNFis or JAKis (set 2). The incidence rate ratios (IRRs) and hazard ratios (HRs) for acute myocardial infarction (AMI), stroke, CV-related mortality, major adverse cardiovascular events (MACE), VTE, arterial thromboembolism (ATE), cancer, and all-cause mortality were compared between the JAKi and TNFi groups.
Results
Set 1 included 1,596 RA patients (JAKi group: 645; TNFi group: 951), and set 2 included 11,765 RA patients (JAKi group: 2,498; TNFi group: 9,267). No adverse events (AEs) showed significantly higher IRRs in the JAKi groups than in the TNFi groups of sets 1 and 2. The HRs for MACE in the JAKi groups of sets 1 and 2 were 0.59 (95% CI, 0.35–0.99) and 0.80 (95% CI, 0.67–0.97), respectively. The JAKi group of set 2 showed a significantly higher risk of all-cause mortality (HR=1.71; 95% CI, 1.32–2.2), but the other AEs did not demonstrate increased risks in the JAKi groups.
Conclusions
In this study, JAKis did not increase the risk of AMI, stroke, CV-related mortality, MACE, VTE, ATE, or cancer in Korean RA patients relative to TNFis.; Summary

Korean summary

Key Message

Associations of breastfeeding duration and the total number of children breastfed with self-reported osteoarthritis in women 50 years and older: a cross-sectional study: Dajeong Ham, Sanghyuk Bae; Epidemiol Health. 2023;e2023044. Published online April 13, 2023; DOI: https://doi.org/10.4178/epih.e2023044 [Accepted]

335 View
33 Download

Abstract PDF: Abstract
OBJECTIVES
Osteoarthritis is the most common joint disease, with a higher prevalence among women than men. The present study aimed to examine the associations of breastfeeding duration and the total number of children breastfed with osteoarthritis in Korean women aged 50 years and older.
METHODS
In this cross-sectional study, we used representative data from the Korea National Health and Nutrition Examination Survey, phases 5 through 7 (2010–2018). Our analysis included 10,102 women aged ≥50 years. Osteoarthritis experience was defined as whether a physician had ever diagnosed osteoarthritis. Breastfeeding duration was categorized as 1-6 months, 7-24 months, and ≥25 months. The total number of children breastfed was categorized as 1–2, 3–4, and≥5. The covariates were health behavior characteristics and risks of diseases (smoking, drinking, physical activity, body mass index, diabetes, hypertension, oral contraceptive use, and menopause) as well as socioeconomic characteristics (income, educational level, and occupation). A multiple logistic regression model was used to investigate associations between osteoarthritis and aspects of breastfeeding experience.
RESULTS
Compared to the non-breastfeeding group, the breastfeeding group had an odds ratio (OR) of 1.55 (95% confidence interval [CI], 1.18-2.03) for osteoarthritis. Those who reported breastfeeding for >25 months had an OR of 1.56 (95% CI, 1.19-2.06).
CONCLUSIONS
The advantages of breastfeeding are already well known, but the present study suggests that women who breastfeed children for a longer time may have a higher risk of osteoarthritis after middle age.; Summary

Korean summary

Key Message

Review paper

The associations of obesity phenotypes with the risk of hypertension and its transitions among middle-aged and older Chinese adults: Ziyue Sheng, Shang Lou, Jin Cao, Weidi Sun, Yaojia Shen, Yunhan Xu, Ziyan Ren, Wen Liu, Qian Yi, Peige Song; Epidemiol Health. 2023;e2023043. Published online April 10, 2023; DOI: https://doi.org/10.4178/epih.e2023043 [Accepted]

533 View
0 Download

Abstract: Abstract
Objectives
This study aimed to investigate the associations of obesity phenotypes with hypertension stages, phenotypes, and transitions among middle-aged and older Chinese.
Methods
Using the 2011–2015 waves of the China Health and Retirement Longitudinal Study (CHARLS), we conducted a cross-sectional analysis included 9015 subjects and a longitudinal analysis included 4961 subjects, with 4872 having full data on the hypertension stage and 4784 having full data on the hypertension phenotype. Based on body mass index and waist circumstance, subjects were categorized into 4 mutually exclusive obesity phenotypes: normal weight with no central obesity (NWNCO), abnormal weight with no central obesity (AWNCO), normal weight with central obesity (NWCO), and abnormal weight with central obesity (AWCO). Hypertension stages were classified into normotension, pre-hypertension, stage 1 hypertension, and stage 2 hypertension. Hypertension phenotypes were categorized as normotension, pre-hypertension, isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH). The association between obesity phenotypes and hypertension was estimated by logistic regression. A comparison between different sexes was conducted by testing the interaction effect of sex.
Results
NWCO was associated with normal → stage 2 (OR: 1.95, 95% CI: 1.11-3.42), maintained stage 1 (OR: 1.62, 95% CI: 1.14-2.29), and normal → ISH (OR: 1.39, 95% CI: 1.05-1.85). AWCO was associated with normal → stage 1 (OR: 1.75, 95% CI: 1.40-2.19), maintained stage 1 (OR: 2.77, 95% CI: 2.06-3.72), maintained stage 2 (OR: 2.80, 95% CI: 1.50-5.25), normal → ISH (OR: 1.56, 95% CI: 1.20-2.02), and normal → SDH (OR: 2.54, 95% CI: 1.72-3.75). An interaction effect of sex existed in the association between obesity phenotypes and hypertension stages.
Conclusions
This study highlights the importance of various obesity phenotypes and sex differences in hypertension progression. Tailored interventions for different obesity phenotypes may be warranted in hypertension management, taking into account sex-specific differences to improve outcomes.; Summary

Korean summary

Key Message

Original article

Estimated trends in hospitalizations due to occupational injuries in Korea based on the Korean National Hospital Discharge In-depth Injury Survey (2006-2019): Seong-Uk Baek, Won-Tae Lee, Min-Seok Kim, Myeong-Hun Lim, Jin-Ha Yoon; Epidemiol Health. 2023;e2023042. Published online April 5, 2023; DOI: https://doi.org/10.4178/epih.e2023042 [Accepted]

382 View
22 Download

Abstract PDF: Abstract
Objectives
In recent years, occupational injuries have sparked a huge social and political debate. Thus, in this study, we focused on the characteristics and trends of occupational injuries requiring hospitalization in South Korea.
Methods
The Korea National Hospital Discharge In-depth Injury Survey was designed to estimate the annual number and characteristics of all injury-related hospitalizations in South Korea. The annual number of hospitalizations due to occupational injuries and the age-standardized rates (ASRs) were estimated from 2006 to 2019. The annual percentage change (APC) and average annual percentage change (AAPC) of ASRs and their 95% confidence intervals (CIs) were calculated using joinpoint regression. All analyses were stratified by sex.
Results
In men, the APC of the ASRs of all-cause occupational injuries was -3.1% (95% CI, -4.5% to -1.7%) in 2006–2015. However, a non-significant upward trend was observed after 2015 (APC=3.3%; 95% CI, -1.6% to 8.5%). In women, the APC of all-cause occupational injuries was -8.6% (95% CI, -12.1% to -5.1%) in 2006–2012. However, a non-significant upward trend was observed after 2012 (APC=2.1%; 95% CI, -0.9% to 5.2%). A recent upward trend in stabbing injuries was observed after 2012 (APC=4.7%; 95% CI, -1.8% to 11.8%) in women. A non-significant overall increasing trend was also observed for occupational injuries caused by exposure to extreme temperatures (AAPC=3.7%; 95% CI, -1.1% to 8.7%) in women.
Conclusions
A recent upward trend in all-cause injury hospitalizations and hospitalizations caused by stabbing injuries was observed. Therefore, active policy interventions are required to prevent occupational injuries.; Summary

Korean summary

Key Message

Original Article

Association of group-level segregation with cardiovascular health in older adults: an analysis of data from the Korean Social Life, Health, and Aging Project: Sung-Ha Lee, Hyeok-Hee Lee, Kiho Sung, Yoosik Youm, Hyeon Chang Kim; Epidemiol Health. 2023;45:e2023041. Published online April 4, 2023; DOI: https://doi.org/10.4178/epih.e2023041

649 View
66 Download

Abstract Summary PDF: Abstract
OBJECTIVES
The adverse health effects of individual-level social isolation (e.g., perceived loneliness) have been well documented in older adults. However, little is known about the impact of collective-level social isolation on health outcomes. We sought to examine the association of group-level segregation with cardiovascular health (CVH) in older adults.
METHODS
From the prospective Korean Social Life, Health, and Aging Project database, we identified 528 community-dwelling older adults who were aged ≥60 years or were married to those aged ≥60 years. Participants who belonged to smaller social groups separate from the major social group were defined as group-level-segregated. The CVH score was calculated as the number of ideal non-dietary CVH metrics (0-6), as modified from the American Heart Association’s Life’s Simple 7. Using ordinal logistic regression models, we assessed cross-sectional and longitudinal associations between group-level segregation and CVH.
RESULTS
Of the 528 participants (mean age, 71.7 years; 60.0% female), 108 (20.5%) were segregated at baseline. In the crosssectional analysis, group-level segregation was significantly associated with lower odds of having a higher CVH score at baseline after adjusting for socio-demographic factors and cognitive function (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.43 to 0.95). Among 274 participants who completed an 8-year follow-up, group-level segregation at baseline was marginally associated with lower odds of having a higher CVH score at 8 years (OR, 0.49; 95% CI, 0.24 to 1.02).
CONCLUSIONS
Group-level segregation was associated with worse CVH. These findings imply that the social network structure of a community may influence its members’ health status.; Summary

Korean summary
본 연구는 “한국인의 사회적 삶, 건강과 노화에 대한 조사”(Korean Social Life, Health and Aging Project, KSHAP)에서 측정한 한 지역 내의 사회적 연결망 자료를 이용하여 사회적 분리와 심혈관 건강 사이의 관계를 살펴보았다. 그 결과, 사회적 분리는 비만, 고혈압, 콜레스테롤, 흡연, 음주 신체적 활동 등을 종합한 ‘라이프 심플 7’ 지표와 부정적인 관련성을 보였으며, 8년 후 추적 조사에서도 이 패턴이 유지되었다. 본 연구 결과는 사회적, 집단적 분리 현상이 신체적 건강에도 악영향을 초래할 수 있음을 시사한다.

Key Message
Using the prospective Korean Social Life, Health, and Aging Project (KSHAP) database, we discovered that group-level segregation was significantly associated with worse cardiovascular health (CVH). Also, we observed a tendency for baseline group-level segregation to be linked to worse CVH after an 8-year follow-up period. These findings emphasize the significance of group-level segregation as a potential contributing factor in the health outcomes of older adults.

Epidemiologic investigation

Detecting mpox infection in the early epidemic: an epidemiologic investigation of the third and fourth cases in the Republic of Korea: Taeyoung Kim, Eonjoo Park, Juk Suk Eun, Eun-young Lee, Ji Won Mun, Yunsang Choi, Sinyoung Lee, Hansol Yeom, Eunkyoung Kim, Jongmu Kim, Jihyun Choi, Jinho Ha, Sookkyung Park; Epidemiol Health. 2023;e2023040. Published online March 23, 2023; DOI: https://doi.org/10.4178/epih.e2023040 [Accepted]

772 View
72 Download

Abstract PDF: Abstract
Objectives
As few mpox cases have been reported in the Republic of Korea, we aimed to identify the characteristics of mpox infection by describing our epidemiologic investigation of a female patient (index patient, the third case in Korea) and a physician who was infected by a needlestick injury (the fourth case).
Methods
We conducted contact tracing and exposure risk evaluation through interviews with these 2 patients and their physicians and contacts, as well as field investigations at each facility visited by the patients during their symptomatic periods. We then classified contacts into 3 levels according to their exposure risk and managed them to minimize further transmission by recommending quarantine and vaccination for post-exposure prophylaxis and monitoring their symptoms.
Results
The index patient had sexual contact with a male foreigner during a trip to Dubai, which was considered the probable route of transmission. In total, 27 healthcare-associated contacts across 7 healthcare facilities and 9 community contacts were identified. These contacts were classified into high (7 contacts), medium (9 contacts), and low (20 contacts) exposure risk groups. One high-risk contact was identified as a secondary patient: a physician who was injured while collecting specimens from the index patient.
Conclusions
The index patient visited several medical facilities due to progressive symptoms prior to isolation. Although the 2022 mpox epidemic mainly affected young men, especially men who have sex with men, physicians should also consider mpox transmission in the general population for the timely detection of mpox-infected patients.; Summary

Korean summary

Key Message

Original article

No association between C-reactive protein and colorectal cancer survival: Two-sample Mendelian randomization analysis: Chang Kyun Choi, Jung-Ho Yang, Min-Ho Shin, Sang-Hee Cho, Sun-Seog Kweon; Epidemiol Health. 2023;e2023039. Published online March 22, 2023; DOI: https://doi.org/10.4178/epih.e2023039 [Accepted]

738 View
74 Download

Abstract PDF: Abstract
Objectives
Elevated C-reactive protein (CRP) is associated with an increased risk for, and poor prognosis of, colorectal cancer (CRC), but it remains unclear whether these associations are causal. This study examined potential causality between CRP levels and CRC survival using two-sample Mendelian randomization (MR).
Methods
From the Korean Genome and Epidemiology Study, a genome-wide association study (n = 59,605), 7 single nucleotide polymorphisms (SNPs) related to log2-transformed CRP levels were extracted as instrumental variables for CRP levels. The associations between the genetically predicted CRP and CRC-specific and overall mortality among CRC patients (n=6,460) were evaluated by Aalen’s additive hazard model. The sensitivity analysis excluded the SNP related to the blood lipid profile.
Results
During a median of 8.5 years of follow-up, among 6,460 CRC patients, 2,676 (41.4%) CRC patients died, 1,622 (25.1%) from CRC. Genetically predicted CRP was not significantly associated with the overall or CRC-specific mortality in CRC patients. The hazard difference per 1,000 person-year (95% confidence interval) for overall and CRC-specific mortality per two-fold increase in CRP was -2.92 (-14.05–8.21) and -0.76 (-9.61–8.08), respectively. These associations were consistent in subgroup analysis according to metastasis and sensitivity analysis excluding the possible pleiotropic SNP.
Conclusions
Our findings do not support causal roles for genetically predisposed CRP levels in CRC survival.; Summary

Korean summary

Key Message

First
Prev
Page of 90
Next
Last

Article category