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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;45:e2023042.   Published online April 5, 2023
DOI: https://doi.org/10.4178/epih.e2023042
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AbstractAbstract AbstractSummary PDFSupplementary Material
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 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 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 gender.
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
본 연구는 퇴원환자 심층조사를 사용하여 2006년부터 2019년까지 우리나라에서 발생한 업무상 손상의 추세를 연령표준화발생률을 구함으로써 분석하였다. 남녀 모두에서 2010년대 초반 까지는 발생률이 유의하게 감소하는 추세를 보였지만, 2013-2015년 이후부터는 통계적으로 유의하지 않은 점진적 상승 추세가 관찰되었다. 이러한 연구 결과는 업무상 손상을 예방하기 위해 적극적인 정책적 개입이 필요하다는 것을 시사한다.
Key Message
This study analyzed the trends in work-related injury occurrences in South Korea from 2006 to 2019 based on a nationally representative, repeated cross-sectional dataset. Age-standardized rates were calculated and their annual trend was estimated using a JointPoint regression. While both males and females exhibited a significant decline in occupational injury rates until the early 2010s, a non-significant but gradual upward trend has been observed since 2013-2015. These findings underscore the need for active policy interventions to prevent work.
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
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AbstractAbstract AbstractSummary PDFSupplementary Material
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.
No association between genetically predicted C-reactive protein levels and colorectal cancer survival in Korean: two-sample Mendelian randomization analysis
Chang Kyun Choi, Jung-Ho Yang, Min-Ho Shin, Sang-Hee Cho, Sun-Seog Kweon
Epidemiol Health. 2023;45:e2023039.   Published online March 22, 2023
DOI: https://doi.org/10.4178/epih.e2023039
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Elevated C-reactive protein (CRP) levels are associated with an increased risk for colorectal cancer (CRC), as well as a poor prognosis, but it remains unclear whether these associations are causal. This study examined the potential causality between CRP levels and CRC survival using 2-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 a 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 from all causes and 1,622 (25.1%) died from CRC. Genetically predicted CRP levels were not significantly associated with overall or CRC-specific mortality in CRC patients. The hazard difference per 1,000 person-years for overall and CRC-specific mortality per 2-fold increase in CRP levels was -2.92 (95% confidence interval [CI], -14.05 to 8.21) and -0.76 (95% CI, -9.61 to 8.08), respectively. These associations were consistent in a subgroup analysis according to metastasis and a sensitivity analysis excluding possible pleiotropic SNPs.
CONCLUSIONS
Our findings do not support a causal role for genetically predisposed CRP levels in CRC survival.
Summary
Korean summary
이 연구는 two-sample Mendelian randomization (MR)을 이용하여 대장암에서 C-reactive protein와 사망률 간의 관련성을 평가하였다. Two-sample MR은 한국유전체역학조사사업 (the Korean Genome and Epidemiology Study, KoGES) 참가자 59,605명에서 혈청 C-reactive protein에 대한 전장유전체 분석을 시행하여 7개의 단일염기다형성을 선별하였고, 화순암역학연구-대장암 (thw Hwasun Cancer Epidemiology Study-Colon and Rectum Cancer, HCES-CRC)에 등록된 6,460명 대장암 환자에서 그 7개 단일염기다형성과 사망률 간의 관련성을 평가한 결과를 이용하였다. 그 결과, 높은 혈청 C-reactive protein을 가지는 유전적 성향은 대장암 환자에서 사망률과의 통계적으로 유의한 관련성을 찾을 수 없었다.
Key Message
This study employed a two-sample Mendelian randomization (MR) analysis to investigate the relationship between serum C-reactive protein (CRP) levels and mortality in colorectal cancer. The analysis utilized genome-wide association analysis (GWAS) data from 59,605 participants in the Korean Genome and Epidemiology Study (KoGES) for serum CRP and 6,460 colorectal cancer cases from the Hwasun Cancer Epidemiology Study-Colon and Rectum Cancer for mortality. Our findings suggest that there is no statistically significant association between genetically predisposed serum CRP levels and mortality. Consequently, our study does not support a causal effect of CRP on mortality in colorectal cancer.
Disease burden of prostate cancer from 2014 to 2019 in the United States: estimation from the Global Burden of Disease Study 2019 and Medical Expenditure Panel Survey
Shen Lin, Dong Lin, Yiyuan Li, Lixian Zhong, Wei Zhou, Yajing Wu, Chen Xie, Shaohong Luo, Xiaoting Huang, Xiongwei Xu, Xiuhua Weng
Epidemiol Health. 2023;45:e2023038.   Published online March 21, 2023
DOI: https://doi.org/10.4178/epih.e2023038
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The aim of this study was to evaluate the disease burden of prostate cancer (PC) and assess key influencing factors associated with the disease expenditures of PC in the United States.
METHODS
The total deaths, incidence, prevalence, and disability-adjusted life-years of PC were obtained from the Global Burden of Disease Study 2019. The Medical Expenditure Panel Survey was used to estimate healthcare expenditures and productivity loss and to investigate patterns of payment and use of healthcare resources in the United States. A multivariable logistic regression model was conducted to identify key factors influencing expenditures.
RESULTS
For patients aged 50 and older, the burden for all age groups showed a modest increase over the 6-year period. Annual medical expenditures were estimated to range from US$24.8 billion to US$39.2 billion from 2014 to 2019. The annual loss in productivity for patients was approximately US$1,200. The top 3 major components of medical costs were hospital inpatient stays, prescription medicines, and office-based visits. Medicare was the largest source of payments for survivors. In terms of drug consumption, genitourinary tract agents (57.0%) and antineoplastics (18.6%) were the main therapeutic drugs. High medical expenditures were positively associated with age (p=0.005), having private health insurance (p=0.016), more comorbidities, not currently smoking (p=0.001), and patient self-perception of fair/poor health status (p<0.001).
CONCLUSIONS
From 2014 to 2019, the national real-world data of PC revealed that the disease burden in the United States continued to increase, which was partly related to patient characteristics.
Summary
Key Message
This study quantified the disease burden of prostate cancer and showed that the burden is still substantial in the US from 2014-2019. This study explored the patients’ payment sources for healthcare expenditures and identified the top types of healthcare service expenditure for PC survivors. Moreover, this study also assessed key influencing factors for the high healthcare expenditures, which were associated with some demographic characteristics, such as age, having private health insurance, more comorbidities, smoking situation, and patients’ self-perceived health status.
The association of dietary patterns with incident chronic kidney disease and kidney function decline among middle-aged Korean adults: a cohort study
Jialei Fu, Sangah Shin
Epidemiol Health. 2023;45:e2023037.   Published online March 21, 2023
DOI: https://doi.org/10.4178/epih.e2023037
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study assessed the association of dietary patterns with the incidence of chronic kidney disease (CKD) and kidney function decline among Korean adults.
METHODS
Data were collected from the records of 20,147 men and 39,857 women who participated in the Health Examinees study. Principal component analysis was used to identify 3 dietary patterns (prudent, flour-based food and meat, and white rice-based), and CKD risk was defined using the Epidemiology Collaboration equation for estimated glomerular filtration rate: (eGFR) <60 mL/min/1.73 m<sup>2</sup>. A kidney function decline was defined as a >25% decrease in eGFR from baseline.
RESULTS
During the 4.2-year follow-up, 978 participants developed CKD and 971 had a 25% decline in kidney function. After adjusting for potential impact variables, compared with the lowest quartile of the prudent dietary pattern, participants in the highest quartile had a 37% lower risk of kidney function decline among men (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.47 to 0.85); while higher adherence to the flour-based food and meat dietary pattern was associated with an increased risk of CKD in both men (HR, 1.63; 95% CI, 1.22 to 2.19) and women (HR, 1.47; 95% CI, 1.05 to 2.05) as well as a decline in kidney function in both men (HR, 1.49; 95% CI, 1.07 to 2.07) and women (HR, 1.77; 95% CI, 1.33 to 2.35).
CONCLUSIONS
Although a higher adherence to the prudent dietary pattern was inversely associated with the risk of kidney function decline in men, there was no association with CKD risk. In addition, a higher adherence to the flour-based food and meat dietary pattern increased the risk of CKD and kidney function decline. Further clinical trials are needed to confirm these associations.
Summary
Korean summary
건강한 식이패턴(prudent dietary pattern)은 한국 남성의 신장기능 저하 위험을 감소와 관련성이 있었다. 반면, 밀가루 음식과 육류 위주의 식이패턴(Flour-based food and meat dietary pattern)은 남성과 여성 모두에서 신장 기능 저하 위험뿐만 아니라, 만성신장질환(CKD) 위험의 증가와 관련이 있었다. 본 연구의 결과는 한국 성인에서 식사패턴이 신장 기능 및 만성 신장 질환의 발생에 미치는 영향을 확인하였다.
Key Message
1. Better adherence to the prudent dietary pattern may lower the risk of kidney function decline in Korean man. 2. A higher adherence to the flour-based food and meat dietary pattern may higher the risk of chronic kidney disease and kidney function decline.
Chronic obstructive pulmonary disease mortality trends in Spain, 1980-2020
Lucia Cayuela, José Luis López-Campos, Anna Michela Gaeta, Rocio Reinoso-Arija, Aurelio Cayuela
Epidemiol Health. 2023;45:e2023036.   Published online March 18, 2023
DOI: https://doi.org/10.4178/epih.e2023036
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
In Spain, there has been a recent increase in the mortality rate for chronic obstructive pulmonary disease (COPD) in younger women. This study aimed to analyze trends in the COPD mortality rate in Spain from 1980 to 2020, evaluating any differences between genders and age groups.
METHODS
Death certificates and mid-year population data were obtained from the Spanish National Institute of Statistics. For both genders, age group-specific and standardized (overall and truncated) rates were calculated by the direct method using the world standard population. The data were analyzed using the joinpoint regression method.
RESULTS
In both men and women, the number of COPD deaths increased from 1980 to 1999 (average annual increase of 7% in men and 4% in women), while from 1999 onwards, deaths decreased by -1.0% per year in both genders. In women, there was a significant final period of increase in the 55-59 to 70-74 age groups and a slowing of the decline in the over 75 age group. Additionally, an increase in mortality for the truncated rates was observed for women between 2006 and 2020. In men under 70 years of age, there was an initial period in which death rates remained stable or significantly increased, followed by a period in which they decreased significantly.
CONCLUSIONS
Our study shows age and gender differences in COPD mortality trends in Spain. Although the data show a downward trend, we have identified a worrying increase in the truncated rates in women for the last few years.
Summary
Key Message
Currently, mortality trends for COPD in Spain shows age and gender differences. Although the data show an overall downward trend, we have identified a worrying increase in the truncated rates in women for the last few years. This could be representing the beginning of an epidemic increase in mortality from COPD in women. Consequently, strategies should be strengthened and promoted to prevent smoking in all its forms in the general population, as well as encourage proper cessation treatments.
Impact of statin treatment on cardiovascular events in patients with retinal vein occlusion: a nested case-control study in Korea
Joonsang Yoo, Joo Youn Shin, Jimin Jeon, Jinkwon Kim
Epidemiol Health. 2023;45:e2023035.   Published online March 15, 2023
DOI: https://doi.org/10.4178/epih.e2023035
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Retinal vein occlusion (RVO) is associated with an increased risk of future cardiovascular events. Statin therapy is a key cornerstone in prevention for patients at high cardiovascular risk. However, little is known about the role of statin therapy for patients with RVO. This study evaluated whether statin treatment in patients with RVO was associated with a lower risk of cardiovascular events.
METHODS
A population-based, nested case-control study was conducted with a cohort of newly diagnosed RVO patients without prior cardiovascular disease between 2008 and 2020 using a nationwide health claims database in Korea. From this cohort of RVO patients, we identified cases of cardiovascular events (stroke or myocardial infarction) after RVO and matched controls based on sex, age, insurance type, antiplatelet use, and underlying comorbidities using 1:2 incidence density sampling.
RESULTS
Using a cohort of 142,759 patients with newly diagnosed RVO, we selected 6,810 cases and 13,620 matched controls. A significantly lower risk of cardiovascular events (adjusted odds ratio, 0.604; 95% confidence interval, 0.557 to 0.655) was observed in RVO patients with statin treatment than in those without statin treatment. Statin treatment was associated with a reduced risk for both stroke and myocardial infarction after RVO. Longer statin treatment after RVO was associated with a lower risk for cardiovascular events.
CONCLUSIONS
Statin treatment was associated with a lower risk for future cardiovascular events in patients with newly diagnosed RVO. Further studies are warranted to clarify the potential cardiovascular preventive role of statins in patients with RVO.
Summary
Korean summary
· 망막정맥폐색 환자들은 심뇌혈관질환의 발생 위험이 높다고 알려져 있다. · 이번 연구를 통해 망막정맥폐색의 발생 이후 스타틴을 복용한 환자들에서 심근경색 및 뇌졸중 발생 위험도가 감소함을 확인하였다. · 고위험군인 망막정맥폐색 환자들에서 적극적인 스타틴의 사용이 심뇌혈관질환의 예방에 도움이 될 수 있을 것이다.
Key Message
· Statin was associated with a lower risk of cardiovascular events in RVO patients. · The reduced risk was observed in both stroke and myocardial infarction after RVO. · Statins might be a good candidate for cardiovascular prevention in RVO patients.
The association between obesity and glaucoma in older adults: evidence from the China Health and Retirement Longitudinal Study
Xiaohuan Zhao, Qiyu Bo, Junran Sun, Jieqiong Chen, Tong Li, Xiaoxu Huang, Minwen Zhou, Jing Wang, Wenjia Liu, Xiaodong Sun
Epidemiol Health. 2023;45:e2023034.   Published online March 9, 2023
DOI: https://doi.org/10.4178/epih.e2023034
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
This study evaluated the association between obesity and glaucoma in middle-aged and older people. A population-based retrospective cohort study was conducted using data from the China Health and Retirement Longitudinal Study.
METHODS
Glaucoma was assessed via self-reports. Multivariate logistic regression analysis and a Cox proportional hazards model were used to assess the relationship between obesity and glaucoma risk.
RESULTS
Older males living in urban areas who were single, smokers, and non-drinkers were found to have a significantly higher incidence of glaucoma (all p<0.05). Diabetes, hypertension, and kidney disease were also associated with higher glaucoma risk, while dyslipidemia was associated with lower risk (all p<0.05). After the model was adjusted for demographic, socioeconomic, and health-related variables, obesity was significantly associated with a 10.2% decrease in glaucoma risk according to the Cox proportional hazards model (hazard ratio, 0.90; 95% confidence interval [CI], 0.83 to 0.97) and an 11.8% risk reduction in the multivariate logistic regression analysis (odds ratio, 0.88; 95% CI, 0.80 to 0.97). A further subgroup analysis showed that obesity was associated with a reduced risk of glaucoma in people living in rural areas, in smokers, and in those with kidney disease (all p<0.05). Obesity also reduced glaucoma risk in people with diabetes, hypertension, or dyslipidemia more than in healthy controls (all p<0.05).
CONCLUSIONS
This cohort study suggests that obesity was associated with a reduced risk of glaucoma, especially in rural residents, smokers, and people with kidney disease. Obesity exerted a stronger protective effect in people with diabetes, hypertension, or dyslipidemia than in healthy people.
Summary
Key Message
Glaucoma is a neurodegenerative disease and the leading cause of irreversible vision loss worldwide. The diagnosis of glaucoma is frequently delayed, as it may be asymptomatic until a relatively late stage. Thus, there is a need to identify protective and risk factors for glaucoma. Glaucoma is a multifactorial disease, and the impact of obesity on glaucoma risk remains uncertain. This study evaluated the association between obesity and glaucoma in middle-aged and older people. This cohort study suggests that obesity was associated with a reduced risk of glaucoma, especially in rural residents, smokers, and people with kidney disease.
Trends in socioeconomic inequalities in obesity among Korean adolescents: the Korea Youth Risk Behavior Web-based Survey (KYRBS) 2006 to 2020
Eunji Kim, Ga Bin Lee, Dong Keon Yon, Hyeon Chang Kim
Epidemiol Health. 2023;45:e2023033.   Published online March 7, 2023
DOI: https://doi.org/10.4178/epih.e2023033
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  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study investigated recent trends in the prevalence of obesity among Korean adolescents and explored socioeconomic disparities in obesity.
METHODS
This study used annual self-reported data on height, weight, and socioeconomic information from the Korea Youth Risk Behavior Web-based Survey from 2006 to 2020. With a 95.8% response rate, the sample consisted of 818,210 adolescents. Obesity prevalence was calculated according to 4 socioeconomic indicators (household income, father’s educational attainment, mother’s educational attainment, and urbanicity). Socioeconomic inequality was quantified using the relative index of inequality (RII).
RESULTS
The overall prevalence of obesity increased, doubling from 5.9% in 2006 to 11.7% in 2020. Boys and high school students showed a higher prevalence. The RIIs in household income and parental educational attainments significantly increased with time, indicating a growing inequality in obesity. Socioeconomic disadvantages had a greater influence on obesity among girls. The most recent RII values for boys were 1.25 for income, 1.79 for the father’s education, and 1.45 for the mother’s education, whereas the corresponding values for girls were 2.49, 3.17, and 2.62, respectively.
CONCLUSIONS
These findings highlight growing inequalities in adolescent obesity according to household income and parental educational attainments, especially for girls and middle schoolers.
Summary
Korean summary
2006년부터 2020년까지 청소년 비만의 유병은 증가 추세에 있을 뿐 아니라, 가정의 경제상태, 부모의 학력수준에 따른 비만의 위험 격차도 점점 심해지는 추세를 보였다. 특히, 남학생과 고등학생의 비만 유병률이 높게 나타났으나, 사회경제적 지표에 따른 비만의 불평등 격차는 여학생과 중학생에서 높게 나타났다.
Key Message
Not only the prevalence but also socioeconomic inequality in adolescent obesity increased between 2006 and 2020. The potential impact of socioeconomic disparity on obesity was greater in girls and middle school students than their counterparts.

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Risk of chronic periodontitis in patients with obstructive sleep apnea in Korea: a nationwide retrospective cohort study
Seon-Rye Kim, Minkook Son, Yu-Rin Kim
Epidemiol Health. 2023;45:e2023032.   Published online March 6, 2023
DOI: https://doi.org/10.4178/epih.e2023032
  • 2,592 View
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The aim of this study was to determine whether the development of chronic periodontitis is more likely among patients who have been newly diagnosed with obstructive sleep apnea (OSA) through an analysis of representative data from the general population.
METHODS
A nationwide, population-based, retrospective cohort study was conducted using patient records from the Korean National Health Insurance Service database. For the period 2004-2019, patient data were categorized into 2 groups: a diagnosis of OSA (747 subjects) and no diagnosis of OSA (1,494 subjects). Subsequently, 1:2 propensity score matching was performed to ensure the homogeneity of the 2 groups. To analyze the risk of incident chronic periodontitis, a Cox proportional-hazards model was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs).
RESULTS
In the Kaplan-Meier curve, the disease-free probability was significantly lower in the OSA group than in the non-OSA group (p for log-rank test=0.001). The crude HR for the association between OSA and chronic periodontitis was 1.29 (95% CI, 1.16 to 1.43). The multivariable-adjusted HR was calculated at 1.28 (95% CI, 1.15 to 1.42).
CONCLUSIONS
This study confirmed a relationship between OSA and chronic periodontitis. Therefore, OSA patients require oral care to prevent the progression of chronic periodontitis from mild to severe.
Summary
Korean summary
폐쇄성수면무호흡증 환자의 만성치주염 발생위험 차이를 분석한 결과, 폐쇄성수면무호흡증 그룹에서 만성치주염의 발생위험이 높았다. 따라서 폐쇄성수면무호흡증 환자의 만성치주염 초기치료 및 질환의 진행이 되지 않도록 전문가의 효과적인 구강관리가 필요할 것이다.
Key Message
As a result of analyzing the difference in the risk of chronic periodontitis among patients with obstructive sleep apnea, the risk of chronic periodontitis was higher in the obstructive sleep apnea group. Therefore, effective oral care by experts will be necessary to prevent the initial treatment of chronic periodontitis and progression of the disease in patients with obstructive sleep apnea.
Impaired pulmonary function mediates the impact of preterm birth on later-life stroke: a 2-step, multivariable Mendelian randomization study
Xingzhi Guo, Peng Tang, Chen Hou, Yue Liu, Rui Li
Epidemiol Health. 2023;45:e2023031.   Published online March 3, 2023
DOI: https://doi.org/10.4178/epih.e2023031
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  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Observational studies have suggested an association between preterm birth and stroke in late adulthood, but it remains unclear whether the association is causal. The purpose of this study was to evaluate the causal effects of gestational age on stroke and to determine the pathophysiological mechanisms underlying the causal associations.
METHODS
Two-sample Mendelian randomization (MR) was performed to assess the causal effects of fetal gestational duration, early preterm birth (EPB), preterm birth, or postterm birth on stroke and its subtypes. Two-step Mendelian randomization (TSMR) and multivariable Mendelian randomization (MVMR) were additionally used to determine the role of common stroke risk factors, including cardiovascular diseases, hypertension, pulmonary impairment, inflammation, and metabolic diseases, in mediating the causal associations between gestational age and stroke and its subtypes.
RESULTS
Genetically predicted EPB increased the risk of cardioembolic stroke (CES; odds ratio [OR], 1.115; 95% confidence interval [CI], 1.036 to 1.200; p=0.004) and large artery stroke (LAS; OR, 1.131; 95% CI, 1.031 to 1.241; p=0.009). The TSMR results showed that EPB was associated with a lower forced expiratory volume in the first second and forced vital capacity ratio (FEV1/FVC) (β=-0.020; 95% CI, -0.035 to -0.005; p=0.009), which increased the risk of CES and LAS. Further MVMR analysis showed that the associations between EPB and stroke disappeared after adjustment for FEV1/FVC.
CONCLUSIONS
Our data demonstrate that EPB is causally associated with an elevated risk of CES and LAS, and that pulmonary dysfunction mediates the causal impact of EPB on CES and LAS.
Summary
Key Message
Genetically predicted early preterm birth (EPB) is significantly associated with an increased risk of cardioembolic stroke (CES) and large artery stroke (LAS). Further multivariable Mendelian randomization analysis demonstrates that pulmonary impairment mediates the causal impact of EPB on CES and LAS in adulthood.

Citations

Citations to this article as recorded by  
  • Causal associations of circulating Helicobacter pylori antibodies with stroke and the mediating role of inflammation
    Xingzhi Guo, Peng Tang, Xin Zhang, Rui Li
    Inflammation Research.2023; 72(6): 1193.     CrossRef
  • Methodological approaches, challenges, and opportunities in the application of Mendelian randomisation to lifecourse epidemiology: A systematic literature review
    Grace M. Power, Eleanor Sanderson, Panagiota Pagoni, Abigail Fraser, Tim Morris, Claire Prince, Timothy M. Frayling, Jon Heron, Tom G. Richardson, Rebecca Richmond, Jessica Tyrrell, Nicole Warrington, George Davey Smith, Laura D. Howe, Kate M. Tilling
    European Journal of Epidemiology.2023;[Epub]     CrossRef
Tobacco consumption, sales, and output as monitoring indicators in the era of the tobacco endgame: a Korean example
Hana Kim, Hee-kyoung Nam, Heewon Kang
Epidemiol Health. 2023;45:e2023030.   Published online February 27, 2023
DOI: https://doi.org/10.4178/epih.e2023030
  • 3,046 View
  • 133 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The consumption, sales, and output of tobacco products each suggest different areas of intervention for tobacco control. In the era of the tobacco endgame, as increasingly stronger supply-side measures are implemented, multifaceted indicators that assess both supply and/or demand are required. We aimed to estimate the consumption of cigarette and heated tobacco products (HTPs) and sought agreement between the various indicators.
METHODS
The annual cigarette and HTP consumption in 2014-2020 was calculated using the frequency and intensity of cigarette use from representative surveys of adults and adolescents by sex and age. Sales and output data were acquired from governmental sources. Spearman correlation coefficients and Bland–Altman plots were used to compare the indicators.
RESULTS
Tobacco output, cigarette sales, and cigarette consumption were greatest in 2014. The HTP consumption calculated for 2020 was 292.28 million packs. Cigarette consumption and sales correlated significantly, as did tobacco output and tobacco sales. A Bland–Altman plot comparing the difference between cigarette consumption and sales showed that this difference was largest in 2014, immediately before cigarette prices increased. With the exception of a single year, all cigarette consumption values were within the limits of agreement for cigarette sales and tobacco output.
CONCLUSIONS
Our analyses showed agreement between demand-side (tobacco consumption) and supply-side (sales and output) indicators. We recommend using all indicators to monitor the impacts of tobacco control on both demand and supply sides. The systematic use of various indicators is critical to achieve the end of the tobacco epidemic.
Summary
Korean summary
공급 제한 중심의 담배 종결전 정책 채택을 고려하는 국가가 증가하고 있다. 이에 따라, 흡연율과 같은 전통적인 지표 외에 공급 측면의 지표가 필요한 상황이다. 담배 소비량, 판매량 및 반출량을 비교 분석한 결과, 지표 간 일치도가 높았으나 정책이 강화되는 시점에 지표 간 격차가 증가하는 것을 확인할 수 있었다. 담배규제 및 종결전 정책 모니터링을 위해 수요 및 공급 측면 지표 모두를 활용할 필요가 있다.
Key Message
The tobacco endgame, which aims to put an end to the tobacco epidemic once and for all, provides supply-focused measures, in addition to the traditional demand-focused measures based on MPOWER strategies. Thus, new supply-focused indicators are required to supplement the traditional demand-side indicators such as tobacco use prevalence and consumption. Our analysis showed that consumption, sales, and output were generally in good agreement. Yet, substantial gaps were identified when tobacco control measures were strengthened. Each indicator is imperfect in isolation, and we suggest to use all consumption, sales, and output indicators in the national health objectives (e.g. Health Plan 2030).
Clinical traits and systemic risks of familial diabetes mellitus according to age of onset and quantity: an analysis of data from the community-based KoGES cohort study
Ju-Yeun Lee, Kyungsik Kim, Sangjun Lee, Woo Ju An, Sue K. Park
Epidemiol Health. 2023;45:e2023029.   Published online February 23, 2023
DOI: https://doi.org/10.4178/epih.e2023029
  • 3,299 View
  • 191 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The aim of this study was to clarify the clinical trait of familial diabetes mellitus (DM) by analyzing participants’ risk of DM according to the age of DM onset in parents and siblings, and to evaluate individuals’ risk of DM-associated cardiometabolic diseases.
METHODS
Altogether, 211,173 participants aged ≥40 years from the Korean Genome and Epidemiology Study were included in this study. The participants were divided into groups based on the number (1 or 2 relatives) and age of onset (no DM and early, common, or late onset) of familial DM. Participants’ risk of DM was assessed using a Cox regression model with hazard ratios and 95% confidence intervals (CIs). A logistic regression model with odds ratios was used to evaluate associations among the participants’ likelihood of acquiring cardiometabolic diseases such as hypertension, chronic kidney disease (CKD), and cardiovascular disease.
RESULTS
The risk of developing DM was 2.02-fold (95% CI, 1.88 to 2.18) and 2.88-fold (95% CI, 2.50 to 3.33) higher, respectively, in participants with 1 and 2 family members diagnosed with familial DM. It was 2.72-fold (95% CI, 2.03 to 3.66) higher in those with early-onset familial DM. In the early-onset group, the respective risks of hypertension and CKD were 1.87-fold (95% CI, 1.37 to 2.55) and 4.31-fold (95% CI, 2.55 to 7.27) higher than in the control group.
CONCLUSIONS
The risk of DM and related cardiometabolic diseases was positively associated with the number of family members diagnosed with DM and an early diagnosis in family members with DM.
Summary
Korean summary
본 연구는 한국인유전체역학조사사업 역학자료를 이용하여, 당뇨병을 진단받은 가족 구성원 (부모 및 형제)의 수가 많고 당뇨병이 조기에 발생할수록 개인의 당뇨발생 위험도가 높아짐을 보고하였습니다. 또한 당뇨병이 조기에 발생한 가족구성원이 있을 경우 개인의 일부 심대사질환과의 연관성이 있을 수 있음을 설명하였습니다.
Key Message
This study demonstrated that the risk of diabetes in individuals was significantly associated with the quantity and the onset of family members diagnosed with diabetes. We also explained that having a family member with early-onset diabetes can be associated with some cardiometabolic diseases in individuals.
Physical activity, sedentary behavior, and cardiovascular disease risk in Korea: a trajectory analysis
Jina Han, Yeong Jun Ju, Soon Young Lee
Epidemiol Health. 2023;45:e2023028.   Published online February 22, 2023
DOI: https://doi.org/10.4178/epih.e2023028
  • 3,392 View
  • 217 Download
  • 1 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
To identify the distinct trajectories of sedentary behavior (SB) and explore whether reduced cardiovascular disease (CVD) risk was associated with a distinct trajectory of physical activity (PA).
METHODS
We analyzed data from 6,425 people who participated in the Korean Health Panel Survey over a period of 10 years. The participants’ self-reported SB and PA were assessed annually, and trajectory groups were identified using a group-based trajectory model for longitudinal data analysis. Logistic regression analysis was performed to assess the association between CVD risk (10-year cumulative incidence) and the trajectories of SB and PA. The adjusted variables included socio-demographic factors, the predisposing diseases of CVD, and baseline health behaviors.
RESULTS
Trajectory analysis identified 4 SB trajectory groups: SB group 1 (low and slightly increasing trend, 53.1%), SB group 2 (high and rapidly decreasing trend, 14.7%), SB group 3 (high and slightly decreasing trend, 9.9%), and SB group 4 (low and rapidly increasing trend, 22.2%). The 3 PA trajectory groups were PA group 1 (moderate and slightly decreasing trend, 32.1%), PA group 2 (low and slightly decreasing trend, 57.3%), and PA group 3 (maintained inactivity, 10.7%). By the 10-year follow-up, 577 cases of incident CVD had occurred. We also noted a 50% reduction in the risk of CVD when SB group 4 was accompanied by PA group 1 (odds ratio, 0.50; 95% confidence interval, 0.28 to 0.90).
CONCLUSIONS
Despite increased time spent in SB, maintaining PA about 2 days to 3 days per week reduced the occurrence of CVD.
Summary

Citations

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  • Effects of physical activity and sedentary behaviors on cardiovascular disease and the risk of all-cause mortality in overweight or obese middle-aged and older adults
    Yongqiang Zhang, Xia Liu
    Frontiers in Public Health.2024;[Epub]     CrossRef
National trends and projection of chronic kidney disease incidence according to etiology from 1990 to 2030 in Iran: a Bayesian age-period-cohort modeling study
Fatemeh Shahbazi, Amin Doosti-Irani, Alireza Soltanian, Jalal Poorolajal
Epidemiol Health. 2023;45:e2023027.   Published online February 17, 2023
DOI: https://doi.org/10.4178/epih.e2023027
  • 2,521 View
  • 137 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Chronic kidney disease (CKD) is a major public health problem worldwide. Predicting CKD incidence rates and case numbers at the national and global levels is vital for planning CKD prevention programs.
METHODS
Data on CKD incidence rates and case numbers in Iran from 1990 to 2019 were extracted from the Global Burden of Disease online database. The average annual percentage change was computed to determine the temporal trends in CKD age-standardized incidence rates from 1990 to 2019. A Bayesian age-period-cohort model was used to predict the CKD incidence rate and case numbers through 2030.
RESULTS
Nationally, CKD cases increased from 97,300 in 1990 to 315,500 in 2019. The age-specific CKD incidence rate increased from 168.52 per 100,000 to 382.98 per 100,000 during the same period. Between 2020 and 2030, the number of CKD cases is projected to rise to 423,300. The age-specific CKD incidence rate is projected to increase to 469.04 in 2030 (95% credible interval, 399.20 to 538.87). In all age groups and etiological categories, the CKD incidence rate is forecasted to increase by 2030.
CONCLUSIONS
CKD case numbers and incidence rates are anticipated to increase in Iran through 2030. The high level of CKD incidence in people with diabetes mellitus, hypertension, and glomerulonephritis, as well as in older people, suggests a deficiency of attention to these populations in current prevention plans and highlights their importance in future programs for the national control of CKD.
Summary
Key Message
Based on our findings, it is predicted that the number of chronic kidney patients in Iran will reach 423,300 people by 2030. Additionally, the age-specific incidence rate of chronic kidney disease (CKD) is projected to increase to 469.04 in the same year. The CKD incidence rate is forecasted to increase by 2030 in all age groups and etiological categories, including type 1 diabetes mellitus, type 2 diabetes mellitus, hypertension, glomerulonephritis, and other causes.

Epidemiol Health : Epidemiology and Health