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Inequality in dental flossing behavior among Korean adults based on household income levels
Zi-Lan Wang, Eun-Jae Choi, Seung-Hee Ryu, Seon-Jip Kim, Hyun-Jae Cho
Epidemiol Health. 2024;e2024052.   Published online May 24, 2024
DOI: https://doi.org/10.4178/epih.e2024052    [Accepted]
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Abstract
OBJECTIVES
The aim of this study was to estimate the association between household income and dental flossing.
METHODS
This cross-sectional study investigated the impact of household income on flossing among 9,391 adults aged 30+ with ≥20 natural teeth, utilizing data from the seventh Korea National Health and Nutrition Examination Survey (2016-2018). Outcome measures included flossing (yes/no), with income categorized into 4 levels: lowest, medium to low, medium to high, and highest. Logistic regression, adjusted for age, gender, brushing frequency, recent dental exams, periodontitis, smoking, and alcohol use, was employed to evaluate the influence of socioeconomic status on oral hygiene practices.
RESULTS
In the highest income group, flossing was 62.6% more prevalent than in the lowest income group (adjusted odds ratio [aOR], 1.63; 95% CI, 1.27-2.08). The strongest association between income levels and flossing was observed in individuals aged ≥70 years (aOR, 3.64; 95% CI, 1.86-7.11), with a decreasing strength of association in the 60s (aOR, 1.72; 95% CI, 1.05-2.84) and 50s age groups (aOR, 1.69; 95% CI, 1.07-2.68). Higher-income women demonstrated a higher frequency of flossing than their lower-income counterparts (aOR, 1.67; 95% CI, 1.24-2.23). Higher-income individuals without periodontitis were more likely to floss (aOR, 1.64; 95% CI, 1.23-2.18), and among those with periodontitis, flossing was significantly associated only with the highest income category (aOR, 1.64; 95% CI, 1.10-2.44).
CONCLUSIONS
The findings of this study indicate a significant correlation between higher household income levels and an increased prevalence of flossing.
Summary
Dietary mercury intake, the IL23R rs10889677 polymorphism, and the risk of gastric cancer: a hospital-based case-control study
Ji Hyun Kim, Madhawa Gunathilake, Jeonghee Lee, Il Ju Choi, Young-Il Kim, Jeongseon Kim
Epidemiol Health. 2024;e2024051.   Published online May 21, 2024
DOI: https://doi.org/10.4178/epih.e2024051    [Accepted]
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AbstractAbstract
Abstract
OBJECTIVES
Mercury can stimulate immune responses through T helper 17 (Th17). The gene IL23R is a key factor in Th17 function, which may also contribute to digestive tract diseases. The aim of this study was to observe the associations between dietary mercury and gastric cancer (GC) and to investigate whether the IL23R rs10889677 polymorphism modifies those associations.
METHODS
This case-control study included 377 patients with GC and 756 healthy controls. Dietary mercury intake (total mercury and methylmercury) was assessed using a dietary heavy metal database incorporated into the food frequency questionnaire. IL23R genetic polymorphism rs10889677 (A>C) was genotyped. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using unconditional logistic regression models with adjustments for potential confounders.
RESULTS
A higher dietary methylmercury intake was associated with an elevated risk of GC (OR for the highest versus lowest tertile [T3 vs. T1]=2.02; 95% CI, 1.41–2.91; p for trend <0.001). The IL23R rs10889677 reduced the risk of GC in individuals who carried at least 1 minor allele (OR=0.62; 95% CI, 0.46–0.83; p=0.001; AC/CC vs. AA). Individuals with a C allele exhibited a lower susceptibility to GC through methylmercury intake than those with the AA genotype (OR for the T3 of methylmercury and AA carriers=2.93; 95% CI, 1.77–4.87; and OR for the T3 of methylmercury and AC/CC genotype=1.30; 95% CI, 0.76–2.21; p-interaction=0.013).
CONCLUSIONS
Our findings suggest that a genetic polymorphism, rs10889677 in IL23R, plays a role in modifying the association between dietary methylmercury intake and the risk of GC.
Summary
Association of healthy lifestyle factors with the risk of hypertension, dyslipidemia, and their comorbidity in Korea: results from the Korea National Health and Nutrition Examination Survey 2019–2021
Ji-Sook Kong, Mi Kyung Kim
Epidemiol Health. 2024;e2024049.   Published online May 1, 2024
DOI: https://doi.org/10.4178/epih.e2024049    [Accepted]
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AbstractAbstract PDF
Abstract
OBJECTIVES
We investigated the association of individual healthy lifestyle factors (HLFs) and their combined healthy lifestyle score (HLS) with hypertension and/or dyslipidemia.
METHODS
We analyzed data from 10,693 adults aged ≥19 from the 2019 to 2021 Korea National Health and Nutrition Examination Survey. HLS was evaluated based on smoking status, alcohol consumption, body mass index (BMI), diet, and physical activity. Using logistic regression models, we estimated odds ratios (ORs) with 95% confidence intervals (CIs) to evaluate the associations of HLFs and HLS with hypertension, dyslipidemia, and their comorbidity.
RESULTS
The prevalence of hypertension alone, dyslipidemia alone, and their comorbidity was 8.69%, 24.6%, and 15.0%, respectively. Multivariable models showed an inverse association of hypertension (OR, 0.37; 95% CI; 0.30–0.46) and dyslipidemia (OR, 0.36; 95% CI, 0.32–0.41) with healthy BMI. Hypertension was inversely associated with healthy alcohol consumption (OR, 0.46; 95% CI, 0.35–0.61) and diet (OR, 0.79; 95% CI, 0.63–0.99), whereas dyslipidemia was inversely associated with non-smoking (OR, 0.51; 95% CI, 0.43–0.60). Physical activity was inversely associated with their comorbidity (OR, 0.69; 95% CI, 0.56–0.85). Adherence to HLS was associated with significantly lower odds of hypertension (81%), dyslipidemia (66%), and their conditions (89%) (all ptrend<0.001). Stratified analyses consistently showed inverse associations between HLS and hypertension and/or dyslipidemia independently of demographic factors (pinteractions>0.05).
CONCLUSIONS
HLFs were associated with lower risk for hypertension and/or dyslipidemia. Obesity may contribute significantly to the risk of these conditions, while relevant HLFs for individual chronic diseases may vary significantly.
Summary
Causal effect of serum matrix metalloproteinase levels on venous thromboembolism: a Mendelian randomization study
Deheng Han, Fangcong Yu, Liangrong Zheng
Epidemiol Health. 2024;e2024046.   Published online April 24, 2024
DOI: https://doi.org/10.4178/epih.e2024046    [Accepted]
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Abstract
OBJECTIVES
Serum matrix metalloproteinase (MMP) levels are associated with cardiovascular diseases. However, the causal associations between serum levels of specific MMPs and venous thromboembolism (VTE) remain unclear. The present study sought to explore the causal relationship between serum MMP levels and VTE by using the Mendelian randomization (MR) method.
METHODS
In this study 2-sample MR study, the exposure data on serum MMP levels were derived from genome-wide association studies involving 21,758 individuals from 13 cohorts of European descent. The outcome data on VTE, including deep vein thrombosis and pulmonary embolism, were derived from the FinnGen research project. The primary method used was the inverse-variance weighting method. The MR-Egger intercept test and the Cochran Q test were used to evaluate pleiotropy and heterogeneity.
RESULTS
Using the inverse-variance weighting method, higher serum MMP-12 levels were found to be associated with an increased risk of VTE (odds ratio, 1.04; 95% confidence interval, 1.01–1.07; p=0.0015). Moreover, there was a weak association between the levels of certain MMPs and VTE. Sensitivity analyses revealed no significant heterogeneity and pleiotropy in our study, and the Steiger directionality test did not reveal a significant reverse causation association.
CONCLUSIONS
There is a causal association between MMP-12 levels and VTE, which may have substantial implications for the diagnostic and therapeutic strategies used for VTE.
Summary
Changes in food sufficiency among Korean adults in urban and rural areas during the COVID-19 pandemic: an analysis of the 7th and 8th Korea National Health and Nutrition Examination Survey
Sarang Jeong, Jin-Young Jeong, Sohyun Park
Epidemiol Health. 2024;e2024045.   Published online April 16, 2024
DOI: https://doi.org/10.4178/epih.e2024045    [Accepted]
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AbstractAbstract PDF
Abstract
OBJECTIVES
Understanding changes in food sufficiency within various demographic groups during emergency situations, such as the global coronavirus disease 2019 (COVID-19) pandemic, is crucial in formulating public health policies for future preparedness. This study investigated potential differences between urban and rural residents in food sufficiency trends during the COVID-19 pandemic and examined how these changes varied according to sociodemographic factors.
METHODS
This cross-sectional study analyzed data from 19,724 adults aged 20 years and older, utilizing information from the 7th–8th Korea National Health and Nutrition Examination Survey (2018–2021).
RESULTS
In urban areas, across all subpopulations, food sufficiency improved significantly during the COVID-19 period relative to pre-pandemic levels (p<0.001). However, in rural regions, a significant increase in food sufficiency during the COVID-19 era was observed only among women, with an odds ratio of 1.42 (confidence interval, 1.06 to 1.89). Nevertheless, no significant interaction terms were found between region and various sociodemographic factors regarding changes in food sufficiency during the COVID-19 period.
CONCLUSIONS
During the COVID-19 pandemic, food sufficiency among urban residents improved compared to the pre-pandemic era, whereas their rural counterparts saw no such improvement. Additionally, no significant interaction was detected between urban versus rural areas and changes in food sufficiency during the COVID-19 period. These findings indicate the need for targeted food policies to prepare for potential future pandemics, particularly in rural areas, where food sufficiency did not improve.
Summary
Predicting over-the-counter antibiotic use in rural Pune, India, using machine learning methods
Pravin Arun Sawant, Sakshi Shantanu Hiralkar, Yogita Purushottam Hulsurkar, Mugdha Sharad Phutane, Uma Satish Mahajan, Abhay Machindra Kudale
Epidemiol Health. 2024;e2024044.   Published online April 13, 2024
DOI: https://doi.org/10.4178/epih.e2024044    [Accepted]
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AbstractAbstract PDF
Abstract
OBJECTIVES
Over-the-counter (OTC) antibiotic use can cause antibiotic resistance, threatening global public health gains. To counter OTC use, this study used machine learning (ML) methods to identify predictors of OTC antibiotic use in rural Pune, India.
METHODS
The features of OTC antibiotic use were selected using stepwise logistic, lasso, random forest, XGBoost, and Boruta algorithms. Regression and tree-based models with all confirmed and tentatively important features were built to predict the use of OTC antibiotics. Five-fold cross-validation was used to tune the models’ hyperparameters. The final model was selected based on the highest area under the curve (AUROC) with a 95% confidence interval and the lowest log-loss.
RESULTS
In rural Pune, the prevalence of OTC antibiotic use was 35.9% (95% CI, 31.56%-40.46%). The perception that buying medicines directly from a medicine shop/pharmacy is useful, using antibiotics for eye-related complaints, more household members consuming antibiotics, and longer duration and higher doses of antibiotic consumption in rural blocks and other social groups were confirmed as important features by the Boruta algorithm. The final model was the XGBoost+Boruta model with 7 predictors (AUROC=0.934; 95% CI, 0.8906-0.9782; log-loss=0.2793) log-loss.
CONCLUSIONS
XGBoost+Boruta, with 7 predictors, was the most accurate model for predicting OTC antibiotic use in rural Pune. Using OTC antibiotics for eye-related complaints, higher consumption of antibiotics and the perception that buying antibiotics directly from a medicine shop/pharmacy is useful were identified as key factors for planning interventions to improve awareness about proper antibiotic use.
Summary
Profiling the socioeconomic characteristics, dietary intake, and health status of Korean older adults for nutrition plan customization: a comparison of principal component, factor, and cluster analyses
Kyungsook Woo, Kirang Kim
Epidemiol Health. 2024;e2024043.   Published online April 12, 2024
DOI: https://doi.org/10.4178/epih.e2024043    [Accepted]
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AbstractAbstract PDF
Abstract
OBJECTIVES
This study was conducted to establish profiles of socioeconomic characteristics, dietary intake, and health status among Korean older adults by employing 3 multivariate analysis techniques.
METHODs
Data were obtained from 1,352 adults aged 65 years and older who participated in the 2019 Korea National Health and Nutrition Examination Survey. Principal component analysis (PCA), factor analysis (FA), and cluster analysis (CA) were utilized for profiling, with data preprocessing undertaken to facilitate these approaches.
RESULTS
PCA, FA, and CA yielded similar results, reflecting the high common variance among the variables. PCA identified 4 components, accounting for 71.6% of the accumulated variance. FA revealed 5 factors, displaying a Kaiser-Meyer-Olkin value of 0.51 and explaining 74.3% of the total variance. Finally, CA grouped the participants into 4 clusters (R2=0.465). Both PCA and FA identified dietary intake (energy, protein, carbohydrate, etc.), social support from family (incorporating family structure, number of family numbers, and engagement in social eating), and health status (encompassing oral, physical, and subjective health) as key factors. CA classified Korean older adults into 4 distinct typologies, with significant differences observed in dietary intake, health status, and household income (p<0.01).
CONCLUSIONS
The study utilized PCA, FA, and CA to analyze profiling domains and derive characteristics of older adults in Korea, followed by a comparison of the results. The variables defining the clusters in CA were consistent with those identified by PCA and FA.
Summary
Association of decreased estimated glomerular filtration rate with lung cancer risk in the Korean population
Soonsu Shin, Min-Ho Kim, Chang-Mo Oh, Hyejin Chun, Eunhee Ha, Hyo Choon Lee, Seong Ho Moon, Dong-Young Lee, Dosang Cho, Sangho Lee, Min Hyung Jung, Jae-Hong Ryoo
Epidemiol Health. 2024;e2024041.   Published online March 20, 2024
DOI: https://doi.org/10.4178/epih.e2024041    [Accepted]
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AbstractAbstract PDF
Abstract
OBJECTIVES
Inconsistent results are available regarding the association between low estimated glomerular filtration rate (eGFR) and lung cancer risk. We aimed to explore the risk of lung cancer according to eGFR category in the Korean population.
METHODS
We included 358,293 adults who underwent health checkups between 2009 and 2010, utilizing data from the National Health Insurance Service-National Sample Cohort. Participants were categorized into 3 groups based on their baseline eGFR, as determined using the Chronic Kidney Disease Epidemiology Collaboration equation: group 1 (eGFR ≥90 mL/min/1.73m2), group 2 (eGFR ≥60 to <90mL/min/1.73m2), and group 3 (eGFR <60 mL/min/1.73m2). Incidences of lung cancer were identified using the corresponding codes from the International Classification of Diseases, 10th Revision. Multivariate Cox proportional hazard models were employed to calculate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for lung cancer incidence up to 2019.
RESULTS
In multivariate analysis, group 2 exhibited a 26.5% higher risk of developing lung cancer than group 1 (HR, 1.265; 95% CI, 1.189 to 1.346). Furthermore, group 3 demonstrated a 72.5% elevated risk of lung cancer relative to group 1 (HR, 1.725; 95% CI, 1.577 to 1.887). Among participants with dipstick proteinuria of 2+ or greater, group 3 faced a significantly higher risk of lung cancer than group 1 (HR, 2.928; 95% CI, 1.375 to 6.237).
CONCLUSION
Low eGFR was significantly associated with increased lung cancer risk within the Korean population. A particularly robust association was observed in individuals with severe proteinuria, emphasizing the need for further investigation.
Summary
Effect of the human papillomavirus vaccine on the risk of genital warts: a nationwide cohort study of South Korean adolescent girls
Jaeyoung Cho, Eun Mi Kim, Jihye Kim, Ju-Young Shin, Eui Hyeok Kim, Jong Heon Park, Seunghyun Lewis Kwon, Geun-Yong Kwon, Soon-Ae Shin, Jaiyong Kim
Epidemiol Health. 2024;e2024040.   Published online March 18, 2024
DOI: https://doi.org/10.4178/epih.e2024040    [Accepted]
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AbstractAbstract PDF
Abstract
OBJECTIVES
The purpose of this study was to assess the effectiveness of human papillomavirus (HPV) vaccination administered to adolescent girls through South Korea’s National Immunization Program.
METHODS
This retrospective cohort study included individuals who were 12 to 13 years old, whether vaccinated or unvaccinated, between July 2016 and December 2017. The incidence of genital warts (GWs) was monitored through 2021. Time-stratified hazard ratios (HRs) were estimated, adjusting for birth year, socioeconomic status, and the level of urbanization of the region, and were presented with 95% confidence intervals (CIs). Data were sourced from the Immunization Registry Integration System, linked with the National Health Information Database.
RESULTS
The study included 332,062 adolescent girls, with an average follow-up period of approximately 4.6 years. Except for the first year, the HRs for the vaccinated group were lower than those for the unvaccinated group. The HRs for specific cutoff years were as follows: year 2, 0.62 (95% CI, 0.31 to 1.13); year 3, 0.58 (95% CI, 0.35 to 0.96); and year 4 and beyond, 0.39 (95% CI, 0.28 to 0.52).
CONCLUSIONS
Our findings indicate that HPV vaccination was associated with a reduction in the risk of GWs among adolescent girls. Notably, this reduction became significant as the incidence of GWs increased with age.
Summary
Unraveling trends in schistosomiasis: deep learning insights into national control programs in China
Qing Su, Cici Xi Chen Bauer, Robert Bergquist, Zhiguo Cao, Fenghua Gao, Yi Hu, Zhijie Zhang
Epidemiol Health. 2024;e2024039.   Published online March 13, 2024
DOI: https://doi.org/10.4178/epih.e2024039    [Accepted]
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AbstractAbstract PDF
Abstract
OBJECTIVES
To achieve the ambitious goal of eliminating schistosome infections, the Chinese government has implemented diverse control strategies. This study explored the progress of the 2 most recent national schistosomiasis control programs in an endemic area along the Yangtze River in China.
METHODS
We obtained village-level parasitological data from cross-sectional surveys combined with environmental data in Anhui Province, China from 1997 to 2015. A convolutional neural network (CNN) based on a hierarchical integro-difference equation (IDE) framework (i.e., CNN-IDE) was used to model spatio-temporal variations in schistosomiasis. Two traditional models were also constructed for comparison with 2 evaluation indicators: the mean-squared prediction error (MSPE) and continuous ranked probability score (CRPS).
RESULTS
The CNN-IDE model was the optimal model, with the lowest overall average MSPE of 0.04 and the CRPS of 0.19. From 1997 to 2011, the prevalence exhibited a notable trend: it increased steadily until peaking at 1.6 per 1000 in 2005, then gradually declined, stabilizing at a lower rate of approximately 0.6 per 1000 in 2006, and approaching zero by 2011. During this period, noticeable geographic disparities in schistosomiasis prevalence were observed; high-risk areas were initially dispersed, followed by contraction. Predictions for the period 2012 to 2015 demonstrated a consistent and uniform decrease.
CONCLUSIONS
The proposed CNN-IDE model captured the intricate and evolving dynamics of schistosomiasis prevalence, offering a promising alternative for future risk modeling of the disease. The comprehensive strategy is expected to help diminish schistosomiasis infection, emphasizing the necessity to continue implementing this strategy.
Summary
COVID-19: Original Article
Worsening of health disparities across COVID-19 pandemic stages in Korea
Hyejin Lee, Hyunwoo Nam, Jae-ryun Lee, Hyemin Jung, Jin Yong Lee
Epidemiol Health. 2024;46:e2024038.   Published online March 13, 2024
DOI: https://doi.org/10.4178/epih.e2024038
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
With the end of the coronavirus disease 2019 (COVID-19) pandemic, the health outcomes of this disease in Korea must be examined. We aimed to investigate health outcomes and disparities linked to socioeconomic status during the COVID-19 pandemic in Korea and to identify risk factors for hospitalization and mortality.
METHODS
This nationwide retrospective study incorporated an analysis of individuals with and without COVID-19 in Korea between January 1, 2020 and December 31, 2022. The study period was divided into 4 stages. Prevalence, hospitalization, mortality, and case-fatality rates were calculated per 100,000 population. Multivariate logistic regression was performed to identify risk factors for COVID-19 hospitalization and mortality.
RESULTS
Overall, the incidence rate was 40,601 per 100,000 population, the mortality rate was 105 per 100,000 population, and the case-fatality rate was 259 per 100,000 cases. A total of 12,577,367 new cases (24.5%) were recorded in stage 3 and 8,979,635 cases (17.5%) in stage 4. Medical Aid recipients displayed the lowest 3-year cumulative incidence rate (32,737 per 100,000) but the highest hospitalization (5,663 cases per 100,000), mortality (498 per 100,000), and case-fatality (1,521 per 100,000) rates. Male sex, older age, lower economic status, non-metropolitan area of residence, high Charlson comorbidity index, and disability were associated with higher risk of hospitalization and death. Vaccination was found to reduce mortality risk.
CONCLUSIONS
As the pandemic progressed, surges were observed in incidence, hospitalization, and mortality, exacerbating disparities associated with economic status and disability. Nevertheless, Korea has maintained a low case-fatality rate across all economic groups.
Summary
Korean summary
국민건강보험공단 자료를 이용하여 2020-2022년 후향적 코호트를 구축하여 시기별 코로나19 유병률, 입원률, 사망률, 치명률과 장애, 소득에 따른 건강격차를 확인하였을 때, 코로나19 대유행이 진행됨에 따라 발병률, 입원률, 사망률이 급증하고 건강 격차가 확대되었다. 그러나 이러한 격차에도 불구하고 한국은 다른 국가들과 비교하여 모든 소득수준에서 낮은 치명률을 유지하였다.
Original article
Interactions between vitamin B2, the MTRR rs1801394 and MTR rs1805087 genetic polymorphisms, and colorectal cancer risk in a Korean population
Madhawa Gunathilake, Minji Kim, Jeonghee Lee, Jae Hwan Oh, Hee Jin Chang, Dae Kyung Sohn, Aesun Shin, Jeongseon Kim
Epidemiol Health. 2024;e2024037.   Published online March 11, 2024
DOI: https://doi.org/10.4178/epih.e2024037    [Accepted]
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AbstractAbstract PDF
Abstract
OBJECTIVES
We explored whether the association between vitamin B2 and colorectal cancer (CRC) risk could be modified by the MTRR rs1801394 and MTR rs1805087 genetic polymorphisms and examined whether the interaction effects are sex-specific.
METHODS
We performed a case‒control study involving 1,420 CRC patients and 2,840 controls from the Korea National Cancer Center. Dietary vitamin B2 intake was assessed using a semiquantitative food frequency questionnaire, and the association with CRC was evaluated. Genotyping was performed using an Illumina MEGA-Expanded Array. For gene-nutrient interaction analysis, pre-matched (1,081 patients and 2,025 controls) and matched (1,081 patients and 1,081 controls) subsets were included. Unconditional and conditional logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).
RESULTS
A higher intake of vitamin B2 was associated with a significantly lower CRC risk (OR=0.65; 95% CI, 0.51-0.82; p<0.001). Carriers of at least 1 minor allele of MTRR rs1801394 showed a significantly higher CRC risk (OR=1.43; 95% CI, 1.12-1.83). Men homozygous for the major allele (A) of MTRR rs1801394 and who had a higher intake of vitamin B2 had a significantly lower CRC risk (OR=0.31; 95% CI, 0.18-0.54; p-interaction=0.02). In MTR rs1805087, men homozygous for the major allele (A) and who had a higher vitamin B2 intake had a significantly lower CRC risk (OR=0.38; 95% CI, 0.25-0.60; p-interaction<0.001).
CONCLUSIONS
The MTRR rs1801394 and MTR rs1805087 genetic polymorphisms may modify the association between vitamin B2 and CRC risk, particularly in men. However, further studies are warranted to confirm these interaction results.
Summary
Original Articles
Association between plant-based diets and the risk of coronary heart disease predicted using the Framingham Risk Score in Korean men: data from the HEXA cohort study
Khongorzul Ganbat, Bayarmaa Nasan Ulzii, Sangah Shin
Epidemiol Health. 2024;46:e2024035.   Published online February 28, 2024
DOI: https://doi.org/10.4178/epih.e2024035
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
This study investigated the potential correlation between 4 plant-based diet indices and the predicted risk of coronary heart disease (CHD) in Korean men using the Framingham Risk Score.
METHODS
The study included 12,356 men participants (aged ≥40 years) from the Health Examinees Study. Dietary intake was estimated using a validated food frequency questionnaire. Four plant-based diet indices were measured, including the overall plant-based diet index, the healthy plant-based diet index (hPDI), the unhealthy plant-based diet index (uPDI), and the pro-vegetarian diet index. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for the predicted 10-year risk of CHD.
RESULTS
The study found that individuals in the highest hPDI quintile had a 19% lower risk score for CHD based on the Framingham Risk Score (model 3: HR, 0.80; 95% CI, 0.69 to 0.93; p for trend=0.010). In stratified analyses, the highest pro-vegetarian diet index was associated with a lower risk score for CHD in physically active individuals (HR, 0.74; 95% CI, 0.59 to 0.93; p for interaction=0.020). Conversely, the highest uPDI was associated with the highest risk score for CHD in those with a body mass index of ≥25 kg/m2 and a waist circumference ≥90 cm.
CONCLUSIONS
This prospective cohort study highlights the positive role of adhering to a high hPDI diet in the prevention of CHD in Korean men. Further prospective studies are needed to determine the association between various plant-based diet indices and the risk of CHD in Asian populations with different dietary habits.
Summary
Korean summary
본 연구는 한국 남성의 관상 동맥 심장 질환(CHD) 위험을 줄이는데 있어서 식이 패턴, 특히 건강한 식물성 식이 지수의 역할이 중요함을 강조한다. 높은 hPDI지수를 가진 사람이 CHD 위험이 유의미하게 19% 감소하는 것은 건강한 식물성 기반 식단 선택이 심혈관 건강에 미칠 수 있는 잠재된 영향력을 강조한다.
Predictive ability of the Chinese visceral adiposity index for incident hypertension in working-aged Koreans
Ju Young Jung, Chang-Mo Oh, Hyun chul Jo, Sung Keun Park
Epidemiol Health. 2024;46:e2024034.   Published online February 27, 2024
DOI: https://doi.org/10.4178/epih.e2024034
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The Chinese visceral adiposity index (CVAI) was developed to assess visceral adipose tissue in the Asian population. This study evaluated the predictive ability of the CVAI for incident hypertension in Korean adults.
METHODS
The study participants included 128,577 Koreans without hypertension. They were grouped in quartiles according to body mass index (BMI), waist circumference (WC), visceral adipose index (VAI), and CVAI values. The Cox proportional hazard assumption was used to evaluate the hazard ratio (HR) and 95% confidence interval (CI) for incident hypertension (adjusted HR [95% CI]) according to quartile level across a follow-up period of 6.9 years. Subgroup analyses were conducted by gender and obesity. The area under the curve was calculated to compare the predictive abilities of all indices (BMI, WC, VAI, and CVAI) for incident hypertension.
RESULTS
The CVAI was proportionally associated with the risk of hypertension in all participants (quartile 1: reference; quartile 2: 1.71 [95% CI, 1.59 to 1.82]; quartile 3: 2.41 [95% CI, 2.25 to 2.58]; and quartile 4: 3.46 [95% CI, 3.23 to 3.71]). Time dependent receiver operating characteristic curve analysis indicated that the CVAI was superior to BMI, WC, and VAI in predicting hypertension at the 2-year, 4-year, 6-year, and 8-year follow-ups. This finding was also observed in the gender and obesity subgroups. The predictive ability of the CVAI was greater in the women and non-obese subgroups than in the men and obese subgroups.
CONCLUSIONS
The CVAI was a stronger predictor of hypertension than BMI, WC, and VAI.
Summary
Korean summary
고혈압은 심혈관 질환의 주요 원인이다. 내장 지방은 비만에서 고혈압의 병태 생리에 중요한 역할을 한다. 최근의 연구는 Chinese visceral adiposity index (CVAI)가 다른 비만 지표 보다 아시아 인에서 심혈관 질환의 고 위험군을 더욱 잘 구분해 낸다는 것을 보고하였다. 우리는 체질량 지수, 허리 둘레, visceral adiposity index, CVAI의 고혈압에 대한 예측력을 비교 하였다. 우리의 연구는 CVAI가 고혈압을 예측하는데 있어 다른 지표 보다 우월하다는 것을 보여주었다.
Influence of practice location on prescribing, diabetes care, and colorectal cancer screening among Czech general practitioners during the COVID-19 pandemic
Jan Bělobrádek, Luděk Šídlo, Tom Philipp
Epidemiol Health. 2024;46:e2024033.   Published online February 23, 2024
DOI: https://doi.org/10.4178/epih.e2024033
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Abstract
OBJECTIVES
The provision of primary health care was not interrupted during the coronavirus disease 2019 (COVID-19) pandemic in Czechia, although the capacity and resources of providers changed. We examined how the pandemic affected individual general practices throughout 2017-2021, focusing on differences between urban and rural practices.
METHODS
We analysed data from the largest health insurance company in Czechia, which provides care to 4.5 million people (60% of the population). We evaluated the prescription volume, diabetes care procedures, and faecal immunochemical test (FIT) in preventive care and new pandemic-related procedures (remote consultations, testing, and vaccinations). For the spatial distribution of practices, we adapted the Organisation for Economic Cooperation and Development typology.
RESULTS
We observed minimal declines in 2020 in the rate of prescribing (-1.0%) and diabetes care (-5.1%), with a rapid resumption in 2021, but a substantial decline in FIT (-17.8% in 2020) with slow resumption. Remote consultations were used by 94% of all practices regardless of location, with testing and vaccinations more commonly performed by rural general practitioners (GPs).
CONCLUSIONS
Primary care in Czechia rose to the challenge of the COVID-19 pandemic, as shown by the finding that the volume of healthcare services provided through primary care did not decrease across most of the monitored parameters. This study also confirmed that rural GPs provide more care in-house, both in terms of prescribing and procedures performed in their practices. Future studies will need to focus on preventive care, which the pandemic has dampened in GP practices in Czechia.
Summary

Epidemiol Health : Epidemiology and Health