Epidemiology and Health

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Levels of exposure markers among residents in environmentally vulnerable areas in Korea, the general population in Korea, and Asians in the United States: Kyung-Hwa Choi, Dahee Han, Sang-Yong Eom, Yong Min Cho, Young-Seoub Hong, Woo Jin Kim; Epidemiol Health. 2025;47:e2025007. Published online February 25, 2025; DOI: https://doi.org/10.4178/epih.e2025007

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This study compares biomarker levels among environmentally vulnerable residents in Korea, the general Korean population, and Asians in the United States. We selected 953 exposed residents and 204 controls from the Forensic Research via Omics Markers in Environmental Health Vulnerable Areas (FROM) study (2021-2023), 4,239 participants from the fourth Korean National Environmental Health Survey (2018-2020), and 996 Asians from the U.S. National Health and Nutrition Examination Survey (2017-March 2020). The analyzed biomarkers included blood and urinary metals, urinary metabolites of polycyclic aromatic hydrocarbons, nicotine, volatile organic compounds, and serum perfluorocarbon metabolites. The highest median biomarker levels varied by pollution source among older adults. In refineries, blood lead and cadmium (Cd), as well as urinary Cd and 2-hydroxyfluorene, were highest. Abandoned metal mines exhibited the highest blood and urinary mercury, urinary Cd, total arsenic (As), 2-naphthol, and cotinine levels. Coal-fired power plants showed the highest urinary 1- hydroxyphenanthrene levels, while cement factories had the highest urinary As3+ levels. Sprawls demonstrated the highest urinary monomethylarsonic acid, 1-hydroxypyrene, and phenylglyoxylic acid levels, and industrial areas recorded the highest levels of trans, trans-muconic acid, benzylmercapturic acid, and 2-methylhippuric acid. In general, biomarker levels were higher among exposed residents in the FROM study than in the general population; however, urinary 2-hydroxyfluorene and As5+ levels did not differ significantly. Exposure to pollution sources in environmentally vulnerable areas may elevate biomarker levels in residents.; Summary

Korean summary
본 연구는 환경보건 취약지역 거주자, 대한민국의 일반인구집단, 미국에 거주하는 아시아인의 체내 환경유해물질 바이오마커 농도를 비교하였다. 체내 바이오마커의 농도는 석유정제시설, 폐금속광산, 화력발전소 등 환경보건 취약지역의 유형에 따라 차이를 보였다. 본 연구가 가지는 과학적, 역학적 의미는 환경보건 취약지역 유형별 환경유해물질 노출의 차이와 그로 인한 잠재적 건강영향을 알아봄으로써 환경보건 취약계층을 위한 특이적인 중재가 이루어질 수 있도록 하는데 있다.

Key Message
This study examines environmental health risks for vulnerable populations by comparing biomarker levels among exposed residents in Korea, the general Korean population, and Asians in the United States. Biomarker levels were found to be elevated near pollution sources such as refineries, metal mines, and power plants, with variations based on pollutant types. The scientific and epidemiological significance lies in revealing disparities in exposure and potential health effects, thereby contributing to targeted interventions for environmentally vulnerable groups.

The association between employee lifestyles and the rates of mental health-related absenteeism and turnover in Japanese companies: Atsuya Fujimoto, Hiroshi Kanegae, Kaori Kitaoka, Mizuki Ohashi, Kunio Okada, Koichi Node, Kenkichi Takase, Hiroshi Fukuda, Tomoyuki Miyazaki, Yuichiro Yano; Epidemiol Health. 2024;46:e2024068. Published online August 2, 2024; DOI: https://doi.org/10.4178/epih.e2024068

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We assessed the association of employee lifestyles (e.g., smoking, exercise, drinking, and sleep habits) with mental health-related absenteeism and turnover rates utilizing data from the annual Health and Productivity Management survey by Japan’s Ministry of Economy, Trade and Industry. This analysis included data from 1,748 companies, encompassing 4,199,021 employees. The average proportions of mental health-related absenteeism and employee turnover rates were 1.1±1.0% and 5.0±5.0%, respectively. In multivariable regression models that incorporated all lifestyle factors and confounders, a 1 percentage point increase in the proportion of employees who slept well was associated with reductions in their turnover rate (mean, -0.020%; 95% confidence interval [CI], -0.038 to -0.002) and in mental health-related absenteeism (mean, -0.005%; 95% CI, -0.009 to 0.001). A similar increase in the proportion of employees engaging in regular physical activity corresponded with a 0.005% decrease in the prevalence of mental health-related absenteeism (95% CI, -0.010 to -0.001). A 1 percentage point increase in the proportion of employees who smoked was associated with a 0.013% reduction in mental health-related absenteeism (95% CI, -0.017 to -0.008). Nonetheless, the current study’s observational and cross-sectional design restricted the ability to establish causality between employee lifestyle factors and mental health issues.; Summary

Timely access to secondary pediatric services in Korea: a key to reducing child and adolescent mortality: Minku Kang, Young June Choe, Hye Sook Min, Saerom Kim, Seung-Ah Choe; Epidemiol Health. 2024;46:e2024059. Published online July 5, 2024; DOI: https://doi.org/10.4178/epih.e2024059

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Abstract

OBJECTIVES
Geographic disparities in access to secondary pediatric care remain a significant issue in countries with universal health coverage, including Korea. This study investigated the link between geographic access to secondary pediatric care and mortality rates in children and adolescents (0-19 years) in Korea.

METHODS

We analyzed district-level data to assess the percentage of those aged 0-19 years residing outside of a 60-minute travel radius from the nearest secondary pediatric care provider (accessibility vulnerability index, AVI).

RESULTS

The AVI ranged from 0% to 100% across the districts for the study period. The confidence interval (CI) was -0.30 (95% CI, -0.41 to -0.19) in 2017 and -0.41 (95% CI, -0.52 to -0.30) in 2021, indicating that the proportion of those who could not access care within 60 minutes was disproportionately higher in districts with lower socioeconomic status. We found 8% rise in mortality rates among individuals aged 0-19 years for every 10% increase in AVI (95% CI, 1.06 to 1.10).

CONCLUSIONS

The study highlights disparities in pediatric care access and their impact on child survival, emphasizing the need for improved access to achieve true universal health coverage.

Summary

Korean summary
본 연구는 한국에서 소아 의료 서비스에 대한 지리적 접근성과 아동 사망률 사이의 연관성을 조사하여, 특히 COVID-19 대유행 기간 동안 접근성 제한이 높은 사망률과 관련이 있음을 발견하였다. 이 연구는 아동 및 청소년의 예방 가능한 사망률에 대한 지역 격차를 줄이기 위해 시기적절한 치료 접근성을 개선해야 할 필요성을 강조하였다.

Key Message
The study investigated the link between geographic access to pediatric services and child mortality in South Korea, finding that limited access, particularly during the COVID-19 pandemic, was associated with higher mortality. The research highlights the need for improved access to timely care to reduce regional disparities in preventable deaths among children and adolescents.

Citations

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Global paediatric workforce crisis: lessons from South Korea
Young June Choe, Kee-Hyoung Lee
Archives of Disease in Childhood.2024; : archdischild-2024-327893. CrossRef

Assessing the impact and implications of the revised Act on the Aggravated Punishment of Specific Crimes in preventing child traffic injuries in school zones in Korea: an interrupted time series analysis: Hong Jin Ku, Jin-Hwan Kim, Young June Choe, Seung Ah Choe, Mark R. Zonfrillo; Epidemiol Health. 2024;46:e2024032. Published online February 21, 2024; DOI: https://doi.org/10.4178/epih.e2024032

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Abstract Summary PDF: Abstract
In 2019, a child’s death in Korea led to legislation that imposed stricter penalties for school zone traffic violations. We assessed the impact of that legislation using 2017-2022 Traffic Accident Analysis System data. Adjusted analyses revealed a significant decline in severe injuries in school zones, decreasing from 11 cases to 8 cases per month (p=0.017). The legislation correlated with a reduced risk of all child traffic injuries (risk ratio, 0.987; 95% confidence interval, 0.977 to 0.997; p=0.002), indicating its efficacy in curbing accidents.; Summary

Korean summary
2019년 민식이법 도입 후 소아 교통사고에 미치는 영향을 평가하고자 하였다. 2017-2022 교통사고 분석 시스템 데이터를 통해 그 효과를 평가했고, 학군지역에서 심각한 부상이 월 평균 11건에서 8건으로 감소했다(p=0.017). 또한, 모든 어린이 교통사고 위험 비율도 감소했고(risk ratio, 0.987, 95% CI, 0.977-0.997; p=0.002), 사고 예방에 효과적임을 입증했다. 이 연구는 학군지역 어린이 안전에 법 조치의 긍정적 영향을 강조하며, 지속적인 도로 안전 강화의 중요성을 강조한다.

Key Message
Revised legislation in Korea, following a child’s tragic death, enforced stricter penalties for school zone traffic violations. Analysis of 2017-2022 data showed a significant decrease in severe injuries from 11 to 8 cases monthly (p=0.017). The legislation also reduced the risk of all child traffic injuries (risk ratio, 0.987; 95% CI, 0.977 to 0.997; p=0.002), demonstrating its effectiveness in preventing accidents. This study underscores the legislation’s positive impact on child safety in school zones, emphasizing the importance of ongoing enforcement efforts for road safety.

Association between cardiac arrhythmia before pregnancy and gestational diabetes: a nationwide population-based study in Korea: You-Jung Choi, Won Young Wi, Geum Joon Cho, Jin Oh Na; Epidemiol Health. 2023;45:e2023103. Published online December 4, 2023; DOI: https://doi.org/10.4178/epih.e2023103

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Given the higher prevalence of cardiac arrhythmias in individuals with diabetes, we investigated the relationship between cardiac arrhythmias and the incidence of gestational diabetes (GDM). This retrospective cohort study utilized data from the Korean Health Insurance Service database, encompassing 1,113,729 women who gave birth between January 2007 and December 2015. After excluding those who did not undergo National Health Screening tests within 1 year prior to pregnancy, those with multifetal pregnancies, and those diagnosed with diabetes, we analyzed 365,880 singleton pregnancies without a history of diabetes. Of these, 3,253 (0.9%) had cardiac arrhythmias, including premature extra beats, supraventricular tachyarrhythmias, and/or atrial flutter/fibrillation. GDM occurred in 31,938 (8.7%) subjects during pregnancy, and was more prevalent in women with cardiac arrhythmia than in those without (14.9 vs. 8.7%, p<0.001). In the multivariate analysis, the association between cardiac arrhythmia and GDM remained statistically significant (adjusted odds ratio, 1.78; 95% confidence interval, 1.61 to 1.97; p<0.001). Subgroup analysis revealed that the risk of GDM was consistently statistically significant in subjects with cardiac arrhythmia, regardless of age, body mass index, and the presence or absence of chronic hypertension. Therefore, cardiac arrhythmias before and during pregnancy appear to be associated with an increased risk of developing GDM.; Summary

Korean summary
본 연구에서는 부정맥과 임신성 당뇨병의 발생과의 관계를 확인인하기 위하여 2007년부터 2015년까지 국민건강보험 공단 데이터를 이용하여 분만력을 가진 1,113,729명의 여성을 대상으로 진행되었습니다. 최종 분석은 과거 당뇨병 진단병력을 가지고 있는 환자를 제외하고 365,880건의 단태아 임산부를 포함하였고, 전체 대상자 중 31,938 (8.7%)에서 임신성 당뇨병을 확인하였습니다. 그 중 부정맥 병력이 확인되지 않은 임산부와 비교하였을 때, 부정맥 병력이 있는 경우 임신 기간 중 임신성 당뇨병 발생률이 높았으며 (8.7% vs. 14.9%, p<0.001), 다변량 분석에서도 부정맥과 임신 당뇨병 간의 연관성이 통계적으로 유의미하게 나타났습니다 (adjusted odds ratio, 1.78; 95% confidence interval, 1.61 to 1.97; p<0.001). 따라서, 본 연구는 임신 전후의 부정맥 병력은 임신성 당뇨병 발병 위험 증가와 관련 있음을 시사합니다.

Key Message
This nationwide population-based cross-sectional study using the Korean Health Insurance Service database showed that women with a history of cardiac arrhythmia had an elevated risk of incident GDM during pregnancy. The prevalence of GDM was significantly higher in women with cardiac arrhythmias (8.7% vs. 14.9%). There was a statistically significant association between cardiac arrhythmia and GDM (adjusted odds ratio: 1.78), suggesting that cardiac arrhythmias before and during pregnancy are linked to an increased risk of developing GDM, independent of age, BMI, and chronic hypertension.

Prevalence of SARS-CoV-2 infection among urban cleaning and solid waste management workers during transmission of the Omicron variant in Brazil: Paulo Ricardo Martins-Filho, Joyce Thayane da Conceição dos Santos, Márcia Santos Rezende, Fernanda Oliveira de Carvalho, Érica Santos dos Reis, Waneska de Souza Barboza, Taise Ferreira Cavalcante, Cliomar Alves dos Santos, Lucindo José Quintans-Júnior, Renata Grespan, Cristiane Bani Corrêa, Tatiana Rodrigues de Moura, Dulce Marta Schimieguel, Jullyana de Souza Siqueira Quintans, Adriano Antunes de Souza Araújo; Epidemiol Health. 2023;45:e2023025. Published online February 16, 2023; DOI: https://doi.org/10.4178/epih.e2023025

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Abstract

This study estimated the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in urban cleaning and solid waste management workers during the transmission of the Omicron variant in one of the poorest regions of Brazil (the state of Sergipe). Nasopharyngeal swabs were collected from 494 workers, and the presence of SARS-CoV-2 RNA was tested by quantitative reverse-transcriptase polymerase chain reaction. Data on socio-demographic characteristics, comorbidities, vaccination status, mask use, and use of public transport to commute to the workplace were collected. The prevalence with a 95% confidence interval (CI) was calculated from the proportion of SARS-CoV-2 positive cases among the total number of individuals tested. The prevalence ratio (PR) with a 95% CI was the measure of association used to evaluate the relationship between SARS-CoV-2 infection and the exposure variables. The prevalence of SARS-CoV-2 infection was 22.5% (95% CI, 19.0 to 26.4). Individuals under the age of 40 had a higher prevalence of infection (PR, 1.53; 95% CI, 1.03 to 2.30) as well as those who did not believe in the protective effect of vaccines (PR, 1.78; 95% CI, 1.05 to 2.89). Our results indicate the need for better guidance on preventive measures against coronavirus disease 2019 among urban cleaning and solid waste management workers.

Summary

Key Message
Urban cleaning and waste management workers in Brazil faced a significant risk of SARSCoV-2 infection during the Omicron variant transmission, with higher rates observed among younger individuals and those skeptical about vaccine protection.

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Exploring intelligent solution for potentially viral municipal solid waste management in China: Research and development of a smart management platform based on the logic of "Requirement-Function-Application"
Ying Li, Sisi Zhang, Yao Qu, Ajuan Yuan, Haoxiang Chen
Process Safety and Environmental Protection.2025; 195: 106774. CrossRef

Prevalence and methodological quality of systematic reviews in Korean medical journals: Seong Jung Kim, Mi Ah Han, Jae Hung Jung, Eu Chang Hwang, Hae Ran Kim, Sang Eun Yoon, Seo-Hee Kim, Pius Kim, So-Yeong Kim; Epidemiol Health. 2023;45:e2023017. Published online February 6, 2023; DOI: https://doi.org/10.4178/epih.e2023017

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Abstract

This study aimed to assess and evaluate the prevalence and methodological quality of systematic reviews (SRs) published in major Korean medical journals (KMJs). The top 15 journals with the highest Korean Medical Citation Index, published between 2018 to 2021, were selected. We assessed the methodological quality of SRs using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). In total, 126 SRs were included, with an average of 32 SRs being reported annually. The overall prevalence of SRs in KMJs was 2.8%, with an increase from 2.6% in 2018 to 3.4% in 2021. Overall, the methodological quality of SRs was low (9.5% low, 90.5% critically low). More than 80% of the studies adhered to critical domain items such as a comprehensive literature search and risk of bias assessment, but for items such as protocol registration and listing excluded studies and the justification for exclusion, the adherence rate was less than 15%. While the number of SRs in KMJs steadily increased, the overall confidence in the methodological quality was low to critically low. Therefore, in order to provide the best evidence for decision-making in clinical and public health areas, editors, reviewers, and authors need to pay more attention to improving the quality of SRs.

Summary

Korean summary
한국의학저널에서 체계적 문헌고찰의 수는 꾸준히 증가했지만 방법론적 품질은 전반적으로 낮았다. 임상 및 공중 보건 분야에서 의사 결정을 위한 최상의 근거를 제공하기 위해 편집자, 심사자 및 저자는 체계적 문헌고찰의 품질을 개선하는 데 더 많은 관심을 기울여야 할 것이다.

Key Message
While the number of systematic reviews in Korean medical journals steadily increased, the overall confidence of methodological quality was low to critically low. Therefore, in order to provide the best evidence for decision-making in clinical and public health areas, editors, reviewers, and authors need to pay more attention to improving the quality of systematic reviews.

Citations

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RETRACTED: A methodological framework for rigorous systematic reviews: Tailoring comprehensive analyses to clinicians and healthcare professionals
Stefano Mancin, Marco Sguanci, Giuliano Anastasi, Lea Godino, Alessio Lo Cascio, Emanuela Morenghi, Michela Piredda, Maria Grazia De Marinis
Methods.2024; 225: 38. CrossRef
The status quo of systematic reviews published in high-impact journals in Korea: a study focused on protocol registration and GRADE use
Mi Ah Han, Seong Jung Kim, Eu Chang Hwang, Jae Hung Jung
Epidemiology and Health.2022; 44: e2022108. CrossRef

Self-reported adverse events after 2 doses of COVID-19 vaccine in Korea: Yunhyung Kwon, Insob Hwang, Mijeong Ko, Hyungjun Kim, Seontae Kim, Soon-Young Seo, Enhi Cho, Yeon-Kyeng Lee; Epidemiol Health. 2023;45:e2023006. Published online December 26, 2022; DOI: https://doi.org/10.4178/epih.e2023006

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Abstract Summary PDF

Abstract

OBJECTIVES
In Korea, a national coronavirus disease 2019 (COVID-19) vaccination program was implemented, including 4 vaccines against COVID-19. A text messaging-based survey, in addition to a passive adverse event reporting system, was launched to quickly report unusual symptoms post-vaccination. This study compared the frequency of adverse events after COVID-19 vaccination based on the vaccine type and the type of 2-dose regimen (homologous or heterologous).

METHODS

Self-reported adverse events were collected through a text-message survey for 7 days after each vaccination. This study included 50,950 vaccine recipients who responded to the survey at least once. Informed consent to receive surveys via text was obtained from the vaccine recipients on the date of first vaccination.

RESULTS

The recipients of mRNA vaccines reported local and systemic reactions 1.6 times to 2.8 times more frequently after dose 2 than after dose 1 (p<0.001), whereas ChAdOx1-S recipients reported significantly fewer local and systemic reactions after dose 2 than after dose 1 (p<0.001). Local and systemic reactions were approximately 2 times and 4 times more frequent for heterologous vaccination than for BNT162b2/BNT162b2 and ChAdOx1-S/ChAdOx1-S regimens, respectively. Young individuals, female, and those receiving heterologous vaccine regimens including ChAdOx1-S/BNT162b2 vaccines reported more adverse events than older participants, male, and those with homologous vaccine regimens.

CONCLUSIONS

Although a heterologous regimen, youth, and female sex were associated with a higher risk of adverse reactions after COVID-19 vaccination, no critical issues were noted. Active consideration of heterologous schedules based on the evidence of efficacy and safety appears desirable.

Summary

Korean summary
본 연구는 코로나19 백신 접종 후 7일 동안 문자 설문조사를 통해 50,950명이 자가 보고한 이상반응자료를 분석하였다. mRNA 백신 접종자는1회 접종 후보다 2회 접종 후 국소 이상반응 및 전신이상반응을 1.6~2.8배 더 자주 보고한 반면, ChAdOx1-S 백신 접종자는1회 접종 후 보다 2회 접종 후 이상반응을 더 적게 보고하였다. 동종 백신접종 보다 교차 접종의 경우 2-4배 더 많은 이상반응을 보고 하였다. COVID-19 백신 접종 후 교차접종, 젊은 연령, 여성의 경우 좀 더 많은 이상반응을 보고하였지만,중대한 문제는 보고되지 않았다.

Key Message
Self-reported adverse events were collected through a text-message survey from 50,950 recipients for 7 days after COVID-19 vaccination. The mRNA vaccine recipients reported local and systemic reactions 1.6 to 2.8 times more frequently after dose 2 than after dose 1, whereas ChAdOx1-S recipients reported significantly fewer local and systemic reactions after dose 2 than after dose 1. Local and systemic reactions were approximately 2 to 4 times more frequent for heterologous vaccination than for homologous regimens. Although a heterologous regimen, youth, and female were associated with a higher risk of adverse reac¬tions after COVID-19 vaccination, no critical issues were noted.

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Safety of a second homologous Ad26.COV2.S vaccine among healthcare workers in the phase 3b implementation Sisonke study in South Africa
Azwidihwi Takalani, Michelle Robinson, Phumeza Jonas, Annie Bodenstein, Vuyelo Sambo, Barry Jacobson, Vernon Louw, Jessica Opie, Jonny Peter, Pradeep Rowji, Ishen Seocharan, Tarylee Reddy, Nonhlanhla Yende-Zuma, Kentse Khutho, Ian Sanne, Linda-Gail Bekker
Vaccine.2024; 42(6): 1195. CrossRef
Comparative safety of monovalent and bivalent mRNA COVID-19 booster vaccines in adolescents aged 12 to 17 years in the Republic of Korea
Mijeong Ko, Seontae Kim, Seok-Kyoung Choi, Seung Hwan Shin, Yeon-Kyeng Lee, Yunhyung Kwon
Osong Public Health and Research Perspectives.2024; 15(4): 364. CrossRef
Retinal Vascular Occlusions After COVID-19 Vaccination in South Korea: A Nation-Wide Population-Based Study
Yeji Kim, Kyungdo Han, Jae Hui Kim
Ophthalmic Epidemiology.2024; : 1. CrossRef
A Nationwide Survey of mRNA COVID-19 Vaccinee’s Experiences on Adverse Events and Its Associated Factors
Dongwon Yoon, Ha-Lim Jeon, Yunha Noh, Young June Choe, Seung-Ah Choe, Jaehun Jung, Ju-Young Shin
Journal of Korean Medical Science.2023;[Epub] CrossRef

Clinical severity according to the primary infection variant in patients with suspected SARS-CoV-2 reinfection in Korea: Myung-Jae Hwang, Insob Hwang, Chungmin Park, Hanul Park, Taejong Son, Jong-Hun Kim; Epidemiol Health. 2023;45:e2023007. Published online December 21, 2022; DOI: https://doi.org/10.4178/epih.e2023007

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Abstract Summary PDF

Abstract

OBJECTIVES
We aimed to evaluate the severity of suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection according to variants of concern in Gyeongsangbuk-do and Daegu, Korea.

METHODS

The database of coronavirus disease 2019 (COVID-19) cases reported from epidemiological investigations through the integrated system operated by the Korea Disease Control and Prevention Agency, from January 20, 2020 to May 7, 2022 was combined with data from the Health Insurance Review and Assessment Service system. The severity odds ratio (SOR) in secondary infection episodes compared with primary infection was estimated using a generalized linear model with a binomial distribution.

RESULTS

In all patients, the SOR of SARS-CoV-2 reinfection was 0.89 (95% confidence interval [CI], 0.82 to 0.95), and the severity was lower than in the first infection. Patients who had been vaccinated within 91 days showed a more attenuated SOR (0.85; 95% CI, 0.74 to 0.98). However, despite vaccination, in patients with both primary and secondary infections caused by the Omicron variant, the severity was reduced to a lesser extent than in patients primarily infected with other variants.

CONCLUSIONS

We could make efforts to relieve the severity of COVID-19 in vulnerable populations, in which death is more likely, by recommending booster vaccinations in case of a resurgence.

Summary

Korean summary
국내 COVID-19 확진자들의 중증도 증가 위험은 재감염(2차감염) 시 감소하였지만, 1차감염과 재감염 모두 오미크론론 변이가 우세하였던 시기인 경우에는 오히려 증가하였다. 특히 마지막 예방접종일로부터 91일 이상인 확진자들과 60세이상 인구에서는 중증도 증가 위험이 더 높았다. 우리는 COVID-19가 장기화됨에 따라 취약인구집단에 대해 추가 예방접종을 권고함으로써 재감염시 중증도가 증가하는 것을 예방해야 할 필요가 있다.

Key Message
As COVID-19 prolongs, there is a need to recommend booster vaccinations for vulnerable populations to prevent the potential for increased severity in the event of reinfection.

Citations

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Changes in the intrinsic severity of severe acute respiratory syndrome coronavirus 2 according to the emerging variant: a nationwide study from February 2020 to June 2022, including comparison with vaccinated populations
Boyeong Ryu, Eunjeong Shin, Dong Hwi Kim, HyunJu Lee, So Young Choi, Seong-Sun Kim, Il-Hwan Kim, Eun-Jin Kim, Sangwon Lee, Jaehyun Jeon, Donghyok Kwon, Sungil Cho
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Jung Eun Kim, Heejin Choi, Minji Lee, Chang Hyeong Lee
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Nature Communications.2023;[Epub] CrossRef

Occupational inequalities in mortality in Korea: an analysis using nationally representative mortality follow-up data from the late 2000s and after: Eunjeong Noh, Young-Ho Khang; Epidemiol Health. 2022;44:e2022038. Published online April 6, 2022; DOI: https://doi.org/10.4178/epih.e2022038

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Abstract Summary PDF Supplementary Material

Abstract

Many Korean and international studies have found higher mortality rates and poorer health conditions among manual workers than among non-manual workers. However, a recent study using unlinked data argued that since the economic crisis in Korea in the late 2000s, the mortality estimates of male Korean non-manual workers have been higher than those of manual workers. Our work using individually linked data from the late 2000s and after aimed to examine mortality inequality by occupational class. We analyzed Korea National Health and Nutrition Examination Survey data that were individually linked to cause-of-death data. Cox regression analysis was used to identify the hazard ratios for mortality by occupational class. Of 11,766 males aged between 35 and 64, 397 died between 2007 and 2018: 142 died from cancer, 68 from cardiovascular disease, 88 from external causes, and 99 from other causes. After controlling for age, the mortality estimates for manual workers were 1.85 times higher than those for upper non-manual workers (p<0.05). We observed no evidence of reversed mortality inequality among occupational classes in Korea since the 2000s; this previously reported finding might have been due to numerator-denominator bias arising from the use of unlinked data.

Summary

Korean summary
개인 단위 연계자료가 아닌 분모(센서스)-분자(사망신고) 집합 자료를 사용하여 2000년대 후반 경제위기 이후 한국 남성 비육체직의 사망률이 육체직보다 높게 나타난다고 기존의 한 연구가 주장했다. 이 연구는 2000년대 이후 개인 단위로 연계된 코호트 자료를 활용하여 여전히 한국에서 육체직의 사망위험이 비육체직보다 높다는 점을 보임으로써, 기존 연구가 비연계자료의 사용으로 인한 분자-분모 바이어스(numerator-denominator bias) 때문에 그와 같은 결과를 보였다고 지적하였다.

Key Message
This paper using individually linked data from the late 2000s and after observed no evidence of reversed mortality inequality among occupational classes in Korea since the 2000s. The previously reported finding showing reversed occupational mortality inequality might have been due to numerator-denominator bias arising from the use of unlinked data.

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Insurance Types and All-Cause Mortality in Korean Cancer Patients: A Nationwide Population-Based Cohort Study
Jinyoung Shin, Yoon-Jong Bae, Hee-Taik Kang
Journal of Personalized Medicine.2024; 14(8): 861. CrossRef
Mortality of Suicide and Cerebro-Cardiovascular Diseases by Occupation in Korea, 1997–2020
Jungwon Jang, Inah Kim
International Journal of Environmental Research and Public Health.2022; 19(16): 10001. CrossRef

Dynamics of hospitalizations and in-hospital deaths from COVID-19 in northeast Brazil: a retrospective analysis based on the circulation of SARS-CoV-2 variants and vaccination coverage: Paulo Ricardo Martins-Filho, Adriano Antunes de Souza Araújo, Lucindo José Quintans-Júnior, Bárbara dos Santos Soares, Waneska de Souza Barboza, Taise Ferreira Cavalcante, Victor Santana Santos; Epidemiol Health. 2022;44:e2022036. Published online April 5, 2022; DOI: https://doi.org/10.4178/epih.e2022036

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Abstract Summary PDF

Abstract

This study investigated the dynamics of hospitalizations and in-hospital deaths from coronavirus disease 2019 (COVID-19) throughout the pandemic in northeast Brazil, the Brazilian region with the worst socioeconomic indicators. In total, 141,445 cases, 8,213 hospital admissions, and 1,644 in-hospital deaths from COVID-19 were registered from March 14, 2020 to February 5, 2022. The overall rates of hospitalization and in-hospital deaths were 5.8% and 20.0%, respectively. The hospitalization and death rates significantly decreased over time, which may have been related to progress in vaccination. During the spread of the Gamma variant (January to June 2021), most hospitalized individuals were young adults, and approximately 40% of deaths occurred in this age group. During the predominance of Delta (July to December 2021), over 75% of deaths occurred among the elderly and unvaccinated or partially vaccinated individuals. This rate decreased to 42.3% during the transmission of the Omicron variant (January to February 2022), during which 34.6% of deaths were recorded among fully vaccinated individuals (2 doses) and 23.1% among those who received full vaccination and a booster. The Omicron-driven third wave was associated with a rise in the proportion of deaths among vaccinated individuals, especially among those who had not received a booster dose.

Summary

Key Message
The Omicron-driven third wave in Brazil was associated with a rise in the proportion of deaths among vaccinated individuals, especially among those who had not received a booster dose

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Yawei Wang, Hau Chi So, Nicole Ngai Yung Tsang, Siu Kan Kwok, Benjamin J Cowling, Gabriel M Leung, Dennis Kai Ming Ip
The Lancet Infectious Diseases.2025; 25(3): 276. CrossRef
Understanding SARS-CoV-2 spike glycoprotein clusters and their impact on immunity of the population from Rio Grande do Norte, Brazil
Diego Gomes Teixeira, João Firmino Rodrigues-Neto, Dayse Caroline Severiano da Cunha, Selma Maria Bezerra Jeronimo
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Elijah Huang, Siddharth Kurkure, Yui Seo, Kristie Lau, Jose Puglisi
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Martha Débora Lira Tenório, Gabriel Valentim dos Santos Menezes Siqueira, Gustavo Costa Caldas, Roque Pacheco de Almeida, Amélia Ribeiro de Jesus, Paulo Ricardo Martins-Filho
European Archives of Oto-Rhino-Laryngology.2024; 281(12): 6677. CrossRef
OVERVIEW OF VACCINATION STATUS AND COMORBIDITIES IN DEATHS DUE TO COVID-19 OMICRON VARIANT IN RIAU PROVINCE, 2022
Rajunitrigo Rajunitrigo, Irwan Muryanto, Renti Mahkota, Fajri Marindra Siregar, Nina Elvita, Eka Malfasari, Mega Utami Basra, Marwanty Marwanty
Jurnal Berkala Epidemiologi.2024; 12(2): 134. CrossRef
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Trends in gastrointestinal infections before and during non-pharmaceutical interventions in Korea in comparison with the United States: Soyeoun Kim, Jinhyun Kim, Bo Youl Choi, Boyoung Park; Epidemiol Health. 2022;44:e2022011. Published online January 3, 2022; DOI: https://doi.org/10.4178/epih.e2022011; Correction in: Epidemiol Health 2022;44(0):e2022011.E

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Abstract Summary PDF

Abstract

OBJECTIVES
This study examined how trends in the weekly frequencies of gastrointestinal infectious diseases changed before and during the coronavirus disease 2019 (COVID-19) pandemic in Korea, and compared them with the trends in the United States.

METHODS

We compared the weekly frequencies of gastrointestinal infectious diseases (16 bacterial and 6 viral diseases) in Korea during weeks 5-52 before and after COVID-19. In addition, the weekly frequencies of 5 gastrointestinal infectious diseases in the United States (data from the Centers for Disease Control and Prevention) that overlapped with those in Korea were compared.

RESULTS

The mean weekly number of total cases of gastrointestinal infectious diseases in Korea showed a significant decrease (from 522 before COVID-19 to 245 after COVID-19, p<0.01). Only bacterial gastrointestinal infectious diseases caused by Campylobacter increased significantly; other bacterial gastrointestinal infectious diseases showed either a decrease or no change. The incidence of all other viral diseases decreased. In the United States, the weekly numbers of Salmonella, Campylobacter, typhoid, shigellosis, and hepatitis A virus cases sharply decreased after the COVID-19 outbreak. The weekly case numbers of all viral diseases markedly decreased in both countries; however, bacterial gastrointestinal infectious diseases showed a different pattern.

CONCLUSIONS

The incidence of gastrointestinal infectious diseases decreased after the COVID-19 outbreak. In contrast, Campylobacter infections showed an increasing trend in Korea, but a decreasing trend in the United States. Further studies are needed to elucidate the different trends in bacterial and viral infectious diseases before and after non-pharmaceutical interventions and between different countries.

Summary

Korean summary
한국과 미국 모두 코로나-19 발생 이후 위장관 감염 질환의 발생은 감소하고 있습니다. 하지만, 미국과 달리 한국에서는 캄필로박터 감염은 증가 하고 있습니다. 이는 COVID-19이 발생한 이후 캄필로박터 감염의 열악한 통제의 가능성을 설명할 수 있습니다.

Key Message
The incidence of gastrointestinal infectious diseases decreased after the COVID-19 outbreak, however, campylobacter infections showed an increasing trend in Korea, unlike the United States, which could explain the poor control of Campylobacter.

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Trends for Syndromic Surveillance of Norovirus in Emergency Department Data Based on Chief Complaints
Soyeoun Kim, Sohee Kim, Bo Youl Choi, Boyoung Park
The Journal of Infectious Diseases.2024; 230(1): 103. CrossRef
Trends in Nationally Notifiable Infectious Diseases in Humans and Animals during COVID-19 Pandemic, South Korea
Taehee Chang, Sung-il Cho, Dae sung Yoo, Kyung-Duk Min
Emerging Infectious Diseases.2024;[Epub] CrossRef
Impact of non-pharmaceutical interventions during the COVID-19 pandemic on pathogens transmitted via food in the Netherlands
Roan Pijnacker, Lapo Mughini-Gras, Linda Verhoef, Maaike van den Beld, Eelco Franz, Ingrid Friesema
Epidemiology and Infection.2024;[Epub] CrossRef
Impact of the COVID‐19 pandemic on the circulation of other pathogens in England
Lauren J. Hayes, Hannah Uri, Denisa Bojkova, Jindrich Cinatl, Mark N. Wass, Martin Michaelis
Journal of Medical Virology.2023;[Epub] CrossRef
Understanding the impact of the COVID-19 pandemic response on GI infection surveillance trends in England, January 2020–April 2022
Nicola K. Love, Amy Douglas, Saheer Gharbia, Helen Hughes, Roger Morbey, Isabel Oliver, Gillian E. Smith, Alex J. Elliot
Epidemiology and Infection.2023;[Epub] CrossRef
Trends in Gastrointestinal Infections during the COVID-19 Pandemic and Concerns of Post-Pandemic Resurgence in Japan
Takuma Higurashi, Shigeki Tamura, Noboru Misawa, Nobuyuki Horita
Diseases.2023; 12(1): 4. CrossRef
Characteristics and related factors of waterborne and foodborne infectious disease outbreaks before and after the onset of the COVID-19 pandemic (2017–2021) in the Republic of Korea: a descriptive study
Eunkyoung Kim, Bryan Inho Kim
Osong Public Health and Research Perspectives.2023; 14(6): 483. CrossRef

A comparison of meta-analysis results with and without adjustment for the healthy worker effect: cancer mortality among workers in the semiconductor industry: Sung-Ho Hwang, Moon-Young Park, Won Jin Lee, Inho Park, Kimyong Hong, Donguk Park, Kyoung-Mu Lee; Epidemiol Health. 2021;43:e2021057. Published online September 8, 2021; DOI: https://doi.org/10.4178/epih.e2021057

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Abstract Summary PDF

Abstract

OBJECTIVES
This study compared the results of meta-analysis with and without adjustment for the healthy worker effect on the association between working in the semiconductor industry and cancer mortality.

METHODS

Six studies that reported standardized mortality ratios (SMRs) for cancers were selected for meta-analysis. Using a random-effects model, the SMR results from each study were combined for all cancers and leukemias to estimate the summary SMRs (95% confidence interval, CI). To adjust for the healthy worker effect, the relative standardized mortality ratio (rSMR=SMRx/SMRnot x) were calculated using observed and expected counts for the specific cause of interest (i.e., all cancers and leukemias) and the observed and expected counts for all other causes of mortality. Then, the rSMR results were combined to estimate the summary rSMRs (95% CIs).

RESULTS

The SMRs for all causes of mortality among semiconductor industry workers ranged from 0.25 to 0.80, which reflects a significant healthy worker effect. A remarkable difference was found between the summary SMRs and the summary rSMRs. The summary SMR for all cancers was 0.70 (95% CI, 0.63 to 0.79) whereas the summary rSMR was 1.38 (95% CI, 1.20 to 1.59). The summary SMR for leukemia was 0.88 (95% CI, 0.72 to 1.07), and the summary rSMR was 1.88 (95% CI, 1.20 to 2.95).

CONCLUSIONS

Our results suggest that adjustment for the healthy worker effect (i.e., rSMR) may be useful in meta-analyses of cohort studies reporting SMRs.

Summary

Korean summary
본 연구에서는 반도체 근로자의 암사망률을 일반 인구와 비교하여 표준화사망비(SMR)를 제시한 연구를 대상으로 한 메타분석에서, summary SMR값(95% CI)과 건강근로자효과에 대해 보정한 rSMR을 산출한 후 종합한 summary rSMR값(95% CI)을 비교하였다. 모든 암의 경우 summary SMR=0.70 (0.63-0.79), summary rSMR=1.38(1.20-1.59)로 나타났으며, 백혈병의 경우 summary SMR=0.88 (0.72-1.07), summary rSMR=1.88(1.20-2.95)로 나타났다. 본 연구결과는 SMR 연구를 종합하는 메타분석 연구에서 rSMR과 같은 건강근로자효과에 대해 보정하는 방법론을 적용할 수 있음을 보여주는 사례이다.

Key Message
The relevance of epidemiological research reporting the standardized mortality ratios (SMRs) for workers in the semiconductor industry is often limited by the healthy worker effect. One of the simple correction methods in the relative standardized mortality ratio (rSMR). We observed significant rightward shift when the summary rSMRs were compared with the summary rSMRs, which suggest that adjustment for the healthy worker effect (i.e., rSMR) may be useful in meta-analyses of cohort studies reporting SMRs.

Citations

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The healthy participant effect: insights and results from a population-based case–control study on breast cancer
Kevin Maldonado-Cañón, Annika Möhl, Nadia Obi, Sabine Behrens, Fabian Flaßkamp, Petra Seibold, Jenny Chang-Claude, Heiko Becher
American Journal of Epidemiology.2025; 194(4): 1058. CrossRef
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Turid Austin Wæhler, Tor Ingebrigtsen
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Hydrogen peroxide as an auxiliary treatment for COVID-19 in Brazil: a randomized double-blind clinical trial: Marielle Bazzo Di Domênico, Kauê Collares, Renan Brandenburg dos Santos, Ulysses Lenz, Vinícius Picoli Antunes, Vinicius Webber Godinho, Henrique Cesca, Thales Henrique Jincziwski Ponciano, Pedro Henrique Corazza; Epidemiol Health. 2021;43:e2021051. Published online August 3, 2021; DOI: https://doi.org/10.4178/epih.e2021051

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Abstract Summary PDF

Abstract

OBJECTIVES
This study evaluated the effectiveness of hydrogen peroxide (H2O2) as mouthwash and nasal spray on symptom relief in coronavirus disease 2019 (COVID-19) patients.

METHODS

Patients positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), who were treated in a hospital or at home, and patients’ family members (not positive for SARS-CoV-2), were randomized into 2 groups: experimental (1% H2O2 for gargling, 0.5% H2O2 for nasal wash), and control. Patients gargled the solution 3 times a day, and applied the nasal spray twice a day, for a 7-day period. Family members received the same treatment as the treated COVID-19 patient. The researchers contacted patients every 2 days over an 8-day period. An average post-treatment interval of 8 days passed before testing family members.

RESULTS

The most frequent symptoms on day 0 were cough, loss of taste, and hyposmia; there were no significant differences between groups, independent of the period. The symptom of dyspnea presented a significant difference between days 2 and 4 (p<0.05). Among family members, 86.0% had no antibodies, 2.3% had antibodies, and 11.6% had active infections (4 in the experimental group and 6 in the control group). The most frequent adverse effects in the H2O2 group were a burning throat and nose.

CONCLUSIONS

H2O2 was not effective for the relief of COVID-19 symptoms and was associated with reports of transient adverse effects.

Summary

Key Message
The hydrogen peroxide (H2O2) at low concentrations disrupts the lipid membranes of some viruses through the action of oxygen free radicals. Nevertheless, the data obtained in the present study demonstrated that the use of the H2O2 as mouthwash and nasal spray was not effective on symptom relief in patients with COVID-19. Moreover, it was associated with transient adverse effects such as burning sensations in the nose and throat. Thus, the authors of this study advise against the use of H2O2 as a mouthwash and nasal spray to relieve COVID-19 symptoms and transmission.

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Ludovic de Gabory, Sophie Vallet, Gaëlle Naelten, Chantal Raherison-Semjen
European Archives of Oto-Rhino-Laryngology.2024; 281(7): 3625. CrossRef
Preprocedural Viral Load Effects of Oral Antiseptics on SARS-CoV-2 in Patients with COVID-19: A Systematic Review
Miriam Ting, Alex Dahlkemper, Jeremy J. Schwartz, Manzel Woodfork, Jon B. Suzuki
Biomedicines.2023; 11(6): 1694. CrossRef
Efficacy of Mouth Rinses and Nasal Spray in the Inactivation of SARS-CoV-2: A Systematic Review and Meta-Analysis of In Vitro and In Vivo Studies
Majdy Idrees, Bridget McGowan, Amr Fawzy, Abdulwahab Ali Abuderman, Ramesh Balasubramaniam, Omar Kujan
International Journal of Environmental Research and Public Health.2022; 19(19): 12148. CrossRef
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Cancer incidence in the Tobruk area, eastern Libya: first results from Tobruk Medical Centre: Faisal Ismail, Ahmed G. Elsayed, Islam El-Garawani, Eman Abdelsameea; Epidemiol Health. 2021;43:e2021050. Published online August 3, 2021; DOI: https://doi.org/10.4178/epih.e2021050

13,900 View
352 Download
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Abstract Summary PDF

Abstract

OBJECTIVES
Cancer is a major cause of morbidity and mortality worldwide, and it is an increasing problem in developing countries. Estimation of the incidence of cancer is important, especially in regions with limited epidemiological data on cancer. Therefore, the aim of this study was to provide an updated report on the incidence of cancers in the Tobruk region in eastern Libya.

METHODS

Data on cancer patients from the records of the Department of Histopathology of Tobruk Medical Centre from January 2013 to June 2020 were included.

RESULTS

In total, 402 cases were recorded. Men patients accounted for 30.3% (n=122) of cases, and women patients represented 69.6% (n=280). The overall mean age at the time of the first diagnosis was 49.0±17.1 years. The most common malignancies were breast and uterine cancer in women (18.4%, n=74; 15.9%, n=64, respectively), colorectal cancer (11.6%, n=47; 26 in women and 21 in men), bladder cancer (8.2%, n=33; 8 in women and 25 in men), and thyroid cancer (8.0%, n=32; 23 in women and 9 in men).

CONCLUSIONS

Breast and uterine cancers were the most common cancers in women, and bladder and colorectal cancer were the most common cancers in men, followed by colorectal cancer in both genders. These data will help health authorities launch preventive plans for cancer in the region. Further studies to identify aetiological factors and cancer-related risk factors need to be conducted in the region.

Summary

Key Message
Cancer incidence in the Tobruk area, eastern Libya: first results from Tobruk Medical Centre; cancer is a major cause of morbidity and mortality worldwide and so in Libya; this is an updated report on the incidence of cancers in the Tobruk region in eastern Libya.

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Ming-Jie Jia, Shen Wang, Yu Li, Xing-Ning Liu, Feng Jiang, Hui-Lin Li
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Tariq Alferis
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Cancer Patterns among Patients Admitted to the Oncology Department at Benghazi Medical Center, Libya (2013-2017)
Naeima Hussein, Fathi Omar
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