Epidemiology and Health

Volume 46; 2024

Original Articles

Prevalence and trends of cigarette smoking among adults with HIV infection compared with the general population in Korea: Boyoung Park, Yoonyoung Jang, Taehwa Kim, Yunsu Choi, Kyoung Hwan Ahn, Jung Ho Kim, Hye Seong, Jun Yong Choi, Hyo Youl Kim, Joon Young Song, Shin-Woo Kim, Hee Jung Choi, Dae Won Park, Young Kyung Yoon, Sang Il Kim; Epidemiol Health. 2024;46:e2024097. Published online December 16, 2024; DOI: https://doi.org/10.4178/epih.e2024097

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Abstract Summary PDF: Abstract
OBJECTIVES
This study compared the current smoking prevalence among adults with human immunodeficiency virus (HIV) infection to that of the general Korean population and analyzed changes in smoking prevalence and cessation rates from 2009 to 2020.
METHODS
The study included a total of 10,980 adults with HIV infection who underwent a health screening examination (National Health Insurance Service-National Health Information Database; NHIS-NHID), 1,230 individuals with HIV infection who participated in the Korea HIV/AIDS Cohort (KoCosHIV), and 76,783 participants from the Korea National Health and Nutrition Examination Survey (KNHANES). We estimated the current smoking prevalence and the quit ratio, defined as the ratio of former smokers to ever-smokers.
RESULTS
In the NHIS-NHID and KoCosHIV studies, the prevalence of current and former smoking among adults with HIV was 44.2% (95% confidence interval [CI], 43.2 to 45.1) and 15.6% (95% CI, 14.9 to 16.3), and 47.7% (95% CI, 43.7 to 51.8) and 16.9% (95% CI, 11.8 to 22.0), respectively. In the KNHANES, these rates were 22.5% and 18.1%, respectively. The standardized prevalence ratio of current smoking among adults with HIV was 1.76 in the NHIS-NHID and 1.97 in the KoCosHIV. Furthermore, the likelihood of quitting smoking was lower among adults with HIV than in the general population (NHIS-NHID: 26.1%; 95% CI, 25.0 to 27.1; KoCosHIV: 26.2%; 95% CI, 20.2 to 32.1; KNHANES: 44.6%; 95% CI, 44.5 to 44.6). Among HIV-positive adults, there was a 1.53% decline in the current smoking rate and a 2.86% increase in the quit ratio.
CONCLUSIONS
Adults with HIV were more likely to smoke and less likely to quit smoking than the general adult population. Tobacco screening and cessation strategies should specifically target this population.; Summary

Korean summary
HIV 감염자에서 일반인구와 비교한 현재흡연의 표준화 유병비는 1.76-1.97이었음 HIV 감염자의 현재 흡연율은 연평균 1.53% 감소하고, 흡연자의 금연율은 연평균 2.86% 증가함 HIV 감염자들은 일반인구와 비교해서 흡연율이 높고,흡연자의 금연율은 낮음

Key Message
The standardized prevalence ratio of current smoking among adults with HIV compared with general population was 1.76 ~ 1.97. Among HIV-positive adults, there was a 1.53% decline in the current smoking rate and a 2.86% increase in the quit ratio. Adults with HIV were more likely to smoke and less likely to quit smoking than the general adult population.

Causal effect of fasting serum glucose on atherosclerotic cardiovascular disease: a multivariable Mendelian randomization: Su Hyun Lee, Heejin Kimm, Byung-Wan Lee, Chung Mo Nam, So Young Kim, Sunmi Lee, Sun Ha Jee; Epidemiol Health. 2024;46:e2024096. Published online December 6, 2024; DOI: https://doi.org/10.4178/epih.e2024096

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Abstract Summary PDF: Abstract
OBJECTIVES
Observational studies have reported that diabetes is a risk factor that increases the risk of atherosclerotic cardiovascular disease (ASCVD). However, the causal relationship remains a matter of debate. This study aimed to analyze the relationship between fasting serum glucose (FSG) and ASCVD.
METHODS
This study used data from the Korean Cancer Prevention Study-II (KCPS-II) Biobank, consisting of 159,844 people recruited with consent from 18 health examination centers from 2004 to 2013. Outcomes were confirmed based on diagnoses on hospital discharge summaries from National Health Insurance System. We used linear and non-linear Mendelian randomization (MR) methods. The outcome data were obtained from KCPS-II, and the exposure data were derived from the Korean Genome Epidemiology Study.
RESULTS
First, a prospective cohort study estimated that for each 10 mg/dL increase in FSG level, the risk of ASCVD increased by 4% (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.03 to 1.05). Second, the 2-sample MR study showed that every 10 mg/dL increase in FSG influenced the risk of ASCVD (odds ratio [OR], 1.11; 95% CI, 1.04 to 1.18). Third, the multivariable MR study showed that the OR per 10 mg/dL increase in FSG on ASCVD was 1.14 (p<0.001). Similar results were found for a 10 mg/dL increase in FSG and ischemic heart disease (IHD), but a significant relationship with stroke was not found. When performing non-linear MR, a linear relationship was observed between fasting blood sugar and ASCVD, including IHD and stroke.
CONCLUSIONS
FSG showed a linear and causal association with IHD, but not with stroke.; Summary

Korean summary
그동안 당뇨병이 심뇌혈관질환 발생에 위험요인이라는 역학적인 관찰연구는 많이 발표되었지만, 이러한 관련성에 대한 인과적 관련성에 대부분 연구는 서양인을 대상으로 발표되었고, 한국인 자료를 통해 발표된 적은 없었다. 이 연구는 관찰연구의 제한점으로 부각되는 혼란변수와 측정오류에 덜 영향을 받는 새로운 방법론으로써 다변수 멘델리언 무작위화 방법을 사용하여 공복혈당과 심뇌혈관질환의 인과성을 분석하였다. 분석결과, 공복혈당은 허혈성 심질환 발생위험에 인과적인을 관련성을 보였고 뇌졸중에 대해서는 인과적이지 않았다.

Key Message
Over the years, numerous epidemiological observational studies have reported that diabetes is a risk factor for cardiovascular and cerebrovascular diseases. However, most of these studies examining this association were conducted on Western populations, and no studies have been published using Korean data. This study employed a new methodology—multivariable Mendelian randomization—which is less affected by confounding factors and measurement errors, often highlighted as limitations of observational studies, to analyze the causal relationship between fasting glucose levels and cardiovascular and cerebrovascular diseases. The analysis revealed a causal relationship between fasting glucose levels and the risk of ischemic heart disease, while no causal association was observed with stroke.

A decision tree model for traffic accident prediction among food delivery riders in Thailand: Muslimah Molo, Suttida Changsan, Lila Madares, Ruchirada Changkwanyeun, Supang Wattanasoei, Supa Vittaporn, Patcharin Khamnuan, Surangrat Pongpan, Kasama Pooseesod, Sayambhu Saita; Epidemiol Health. 2024;46:e2024095. Published online November 26, 2024; DOI: https://doi.org/10.4178/epih.e2024095

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Abstract PDF: Abstract
OBJECTIVES
Food delivery riders (FDRs) play a crucial role in the food delivery industry but face considerable challenges, including a rising number of traffic accidents. This study aimed to examine the incidence of traffic accidents and develop a decision tree model to predict the likelihood of traffic accidents among FDRs.
METHODS
A cross-sectional study was conducted with 257 FDRs in Chiang Mai and Lampang Province, Thailand. Participants were interviewed using questionnaires and provided self-reports of accidents over the previous 6 months. Univariable logistic regression was used to identify factors influencing traffic accidents. Subsequently, a decision tree model was developed to predict traffic accidents using a training and validation dataset split in a 70:30 ratio.
RESULTS
The results indicated that 45.1% of FDRs had been involved in a traffic accident. The decision tree model identified several significant predictors of traffic accidents, including delivering food in the rain, job stress, fatigue, inadequate sleep, and the use of a modified motorcycle, achieving a prediction accuracy of 66.5%.
CONCLUSIONS
Based on this model, we recommend several measures to minimize accidents among FDRs: ensuring adequate sleep, implementing work-rest schedules to mitigate fatigue, managing job-related stress effectively, inspecting motorcycle conditions before use, and exercising increased caution when delivering food during rainy conditions.; Summary

Systematic Review

A meta-analysis of the association between adolescent pregnancy and the risk of gynecological cancers: Bita Azmi-Naei, Fatemeh Shahbazi, Nazanin Azmi-Naei, Jalal Poorolajal; Epidemiol Health. 2024;46:e2024094. Published online November 26, 2024; DOI: https://doi.org/10.4178/epih.e2024094

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Abstract PDF: Abstract
OBJECTIVES
Despite several investigations, the association between adolescent pregnancy and gynecological cancers has yet to be conclusively established. To further explore this association, we conducted a meta-analysis of observational studies.
METHODS
We conducted a comprehensive search of databases such as PubMed, Web of Science, and Scopus to identify studies investigating the link between adolescent pregnancy and gynecologic cancers. This search continued until February 20, 2023. To assess the heterogeneity among the studies, we used the I2-statistics. We also explored the potential presence of publication bias using the Begg and Egger tests. The overall effect sizes were reported as either risk ratio or odds ratio, accompanied by a 95% confidence interval (CI), using a random-effects model.
RESULTS
From an initial pool of 25,436 studies, a total of 76 studies involving 13,991,683 participants met the predefined eligibility criteria. The analysis indicated that the overall effect size for individuals having their first pregnancy at age 20 or older, compared to those having it before age 20, was 0.54 (95% CI, 0.50 to 0.59) for cervical cancer, 0.82 (95% CI, 0.77 to 0.88) for ovarian cancer, and 0.96 (95% CI, 0.89 to 1.04) for uterine cancer.
CONCLUSIONS
Our findings suggest that experiencing one’s initial pregnancy at the age of 20 or above is associated with a significantly reduced risk of cervical and ovarian cancer. However, no significant association was found between first pregnancy at this age and uterine cancer.; Summary

Original Article

Miscarriage, stillbirth, and mortality risk from stroke in women: findings from the PLCO study: Hui Tang, Zhou Li, Yuan Zhang, Mingjun Dai, Xiaoya Wang, Chuan Shao; Epidemiol Health. 2024;46:e2024093. Published online November 25, 2024; DOI: https://doi.org/10.4178/epih.e2024093

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Abstract PDF: Abstract
OBJECTIVES
Existing evidence suggests that miscarriage and stillbirth are associated with an increased risk of stroke in women. However, the impact of these events on stroke mortality remains unclear. This study aimed to elucidate the potential association between miscarriage and stillbirth and stroke mortality in women.
METHODS
We employed a competing risk model using data from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial to assess the relationship between miscarriage/stillbirth and stroke death. Death from other causes was considered as a competing risk, and we conducted a subgroup analysis to explore the potential impact.
RESULTS
Our study included 68,629 women for miscarriage and 65,343 women for stillbirth. No significant association was observed between miscarriage and stroke mortality (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.84 to 1.10; p=0.58). While a single stillbirth did not show a significant association (HR, 0.81; 95% CI, 0.57 to 1.15; p=0.23), recurrent stillbirth (≥2) was associated with a significantly increased risk of stroke mortality compared to women with no stillbirths (HR, 2.24; 95% CI, 1.45 to 3.46; p<0.001).
CONCLUSIONS
Our findings suggest that recurrent stillbirth, but not single events, is associated with an elevated risk of stroke mortality in women. Further research is warranted to clarify the underlying mechanisms and potential long-term health implications of recurrent pregnancy loss.; Summary

Epidemiologic Investigation

Epidemiological characteristics and risk factors of suspected and confirmed mpox cases during the 2022-2023 epidemic in the Capital Region, Korea: Mingyeol Shim, Soo Hyeon Cho, Seung Eun Lee, Taeyoung Kim; Epidemiol Health. 2024;46:e2024092. Published online November 24, 2024; DOI: https://doi.org/10.4178/epih.e2024092

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Abstract Summary PDF: Abstract
OBJECTIVES
This study investigated the general characteristics of laboratory-confirmed mpox patients in the Capital Region of Korea, as well as the risk factors for mpox infection, particularly focusing on the characteristics of polymerase chain reaction (PCR)-positive and PCR-negative cases.
METHODS
We investigated 160 adults, excluding 4 minors, from 164 suspected mpox patients reported in Seoul, Gyeonggi, Incheon, and Gangwon from June 21, 2022 to October 31, 2023. Data were collected via telephone and face-to-face interviews. A statistical analysis of the general characteristics of the infection was conducted using frequency analysis and logistic regression.
RESULTS
Of the 160 suspected cases of mpox, 59.3% (n=95) tested positive via mpox-PCR. Among the confirmed cases, 97.9% (n=93) were male. PCR-positive patients typically presented with genital and anal skin rashes or mucosal lesions, accompanied by pain. Additionally, 35.5% (n=33) of the male patients had human immunodeficiency virus (HIV) infections. Most confirmed cases (94.7%, 90/95) were believed to have contracted mpox through sexual contact during the maximal incubation period of 21 days prior to symptom onset, with a significant number reporting same-sex or casual contact. The most commonly collected and highest-yielding specimens from PCR-positive patients were from skin or mucosal lesions, whereas blood samples demonstrated the lowest percent positivity.
CONCLUSIONS
In the Capital Region, most PCR-positive cases were male patients in their 30s who had sexual contacts and exhibited symptoms, aligning with findings from previous studies. These results provide a foundation for the differential diagnosis concerning mpox infection and the selection of PCR-test samples in clinical settings.; Summary

Korean summary
- 대한민국 수도권의 mpox 의심환자 160명 중 59.3%(n=95)가 mpox-PCR 검사에서 양성으로 확인되었다. - 확진 환자 중 97.9%(n=93)는 남성이었고 35.5%(n=33)는 HIV에 감염되었으며 엠폭스 감염의 위험요인으로는 일회성 파트너와의 성적 접촉, 항문생식기 병변, 병변 부위의 통증이 포함되었다. - 양성 환자의 검체 특성은 피부 및 점막 병변 샘플이 가장 높은 양성률을 보였고, 혈액 샘플은 가장 낮은 양성률을 보였다.

Key Message
- Of the 160 suspected mpox cases in the Capital Region of South Korea, 59.3% (n=95) were confirmed as PCR-positive. - Among the confirmed cases, 97.9% were male and 35.5% were infected with HIV, and risk factors of mpox infection included sexual contact with casual partner, anogenital lesion, and pain on lesions. - Skin and mucosal lesion samples had the highest positivity rate, while blood samples had the lowest.

Letter

Letter to the Editor: Mediating effect of lower extremity muscle on the relationship between obesity and osteoarthritis in middle-aged and elderly women in Korea: based on the 2009-2011 Korea National Health and Nutrition Examination Survey: Jinyue Chen, Haozhu Chen; Epidemiol Health. 2024;46:e2024091. Published online November 22, 2024; DOI: https://doi.org/10.4178/epih.e2024091

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PDF: Abstract; Summary

Original Article

Effect of long-term blood pressure trajectory on the future development of chronic kidney disease: an analysis of data from the Korean National Insurance Health Checkup Study: Wonmook Hwang, Eu Jin Lee, Jae-Hyeong Park, Soon-Ki Ahn; Epidemiol Health. 2024;46:e2024090. Published online November 19, 2024; DOI: https://doi.org/10.4178/epih.e2024090

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Abstract Summary PDF: Abstract
OBJECTIVES
Chronic kidney disease (CKD) is a prevalent health issue that causes the irreversible loss of functioning nephrons, end-stage renal disease, cardiovascular disease, and premature mortality. Hypertension is the leading cause of CKD. However, the effect of long-term blood pressure (BP) changes on the development of CKD is still unknown. Therefore, the current study investigated the association between BP trajectory and the future development of CKD.
METHODS
In this study, 246,874 individuals aged ≥40 years who underwent health examinations during the screening period (2002-2009) were evaluated. The systolic blood pressure (SBP) trajectory was determined using latent-class mixture modeling. New-onset CKD was identified during the follow-up period (2010-2019). The association between SBP trajectories and new-onset CKD was assessed.
RESULTS
In total, 111,900 adults (53,420 females, 51.9±6.4 years old) presented with 2 SBP trajectory classes: class 1 (n=66,935) and class 2 (n=44,965). During the follow-up period, patients with SBP trajectory class 2 had an approximately 2.1-fold increased risk of developing CKD (unadjusted hazard ratio [HR], 2.11; 95% confidence interval [CI], 1.99 to 2.25; p<0.001). In the multivariate analysis adjusted for other significant variables, SBP trajectory class 2 was significantly associated with CKD in males (HR, 1.09; 95% CI, 1.00 to 1.19; p=0.037), but not in females (HR, 1.06; 95% CI, 0.95 to 1.18; p=0.321).
CONCLUSIONS
An elevated longitudinal BP was associated with a higher incidence of CKD in male participants aged ≥40 years. Nevertheless, further studies are needed to validate the clinical significance of an elevated SBP trajectory on CKD development.; Summary

Korean summary
궤적분석으로 평가한 수축기 혈압의 지속적 상승은 40세 이상의 남성 피험자에서 만성 신장 질환 발생률 증가와 관련이 있었다.

Key Message
Elevated longitudinal systolic blood pressure, as determined by trajectory, was found to be associated with an increased risk of developing chronic kidney disease in male subjects over the age of 40.

Cohort Profile

Cohort study profile: a cohort of Korean atomic bomb survivors and their offspring: Hamin Lee, Jin-Wu Nam, Mi Kyung Kim, Inah Kim, Yu-Mi Kim, Boyoung Park; Epidemiol Health. 2024;46:e2024089. Published online November 18, 2024; DOI: https://doi.org/10.4178/epih.e2024089

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Abstract Summary PDF: Abstract
The Korean Atomic Bomb Survivor Cohort (K-ABC) study was designed to investigate the health impacts of atomic bomb exposure on Korean survivors and to explore whether these effects are passed down genetically to their descendants. This paper outlines the study’s design, data collection methods, baseline socio-demographic characteristics, exposure status, and disease prevalence among the participants, based on survey responses and health examinations. From 2020 to 2024, a total of 2,544 individuals, comprising 1,109 atomic bomb survivors (G1), 1,193 children of G1 (G2), and 242 grandchildren of G1 (G3), consented to participate in the study. Of these, 1,828 participants (659 in G1, 927 in G2, and 242 in G3) completed the survey and underwent health examinations, representing a participation rate of 71.9%. Exposure information was gathered using a questionnaire and verified through records from the Korean Red Cross and a handbook issued by the Japanese government. Disease prevalence was determined based on participants’ self-reported physician diagnoses. This study presents details about the K-ABC study and provides baseline data on the participants recruited. These data will be valuable for interpreting the results of future K-ABC studies.; Summary

Korean summary
한국인 원폭피해자 코호트 연구는 1945년 일본에서 원자폭탄에 피폭된 원폭 피해자 1세와 이들의 자녀인 2세, 3세의 건강과 질병 위험도을 장기적으로 조사한다. 이를 위해 2020년부터 2023년까지 설문조사를 통해 정보를 수집하였고, 이후 설문조사와 함께 건강보험공단, 국립암센터, 통계청 등 공공 기관에서 보유하고 있는 데이터를 연계하여 추적관찰을 수행해 나갈 예정이다.

Key Message
The Korean atomic bomb survivor’s cohort study investigates the long-term health and disease risks of first generation atomic bomb survivors exposed in Japan in 1945, as well as their second generation and third generations. From 2020 to 2023, information was collected through surveys. Follow-up will be conducted through surveys and secondary data linkage from public institutions such as the National Health Insurance Service, the Korea Central Cancer Registry, and Statistics Korea.

Original Articles

Importance of younger age group and high inflammatory status in the association between periodontal disease and diabetes mellitus: results from the Korea National Health and Nutrition Examination Survey 2012-2018: Hyunmin Lee, Myung-Hee Shin; Epidemiol Health. 2024;46:e2024088. Published online November 15, 2024; DOI: https://doi.org/10.4178/epih.e2024088

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Abstract Summary PDF

Abstract

OBJECTIVES
Although previous studies have demonstrated an association between periodontal disease (PD) and diabetes mellitus (DM), the influence of age and the mediating role of inflammation have seldom been explored. This study investigated this association while considering the modifying effects of age and inflammatory status.

METHODS

This study included 29,491 participants from the 2012-2018 Korea National Health and Nutrition Examination Survey. The community periodontal index (CPI) was assessed by trained dentists using the World Health Organization CPI probe. PD was defined as a CPI score of 3 or 4. Pre-existing and incident DM were identified based on serum glucose levels, a history of DM diagnosis, medication use, and insulin injections. Serum high-sensitivity C-reactive protein (hs-CRP) levels were utilized as an indicator of chronic inflammation.

RESULTS

PD and DM exhibited a significant association, which was more pronounced with incident DM than with pre-existing DM, particularly in individuals younger than 65 years. Among those aged 20-44 years, the odds ratio of incident DM for CPI=4 versus CPI=0 was 2.61 (95% confidence interval, 1.16 to 6.09). High hs-CRP levels (>3 mg/L) were also associated with DM, especially in individuals with PD. This association was stronger with incident DM than with pre-existing DM. A notable joint effect was observed in younger individuals and those with PD.

CONCLUSIONS

The association between PD and DM was more pronounced in younger age groups and those with higher levels of inflammation. Therefore, early interventions for PD in younger patients may be crucial for preventing DM.

Summary

Korean summary
- 치주 질환과 당뇨병 사이의 연관성은 젊은 연령과 염증 수치가 높게 나타난 대상에서 더 두드러지게 나타남 - 치주 질환과 높은 염증 수치를 동시에 가지고 있을 경우의 당뇨 오즈비는 각각의 오즈비 합보다 더 크게 나타나 시너지 효과를 보였음 - 젊은 치주 질환 환자에 대한 조기 개입은 당뇨병 예방에 중요하게 작용할 수 있음

Key Message
• The association between PD and DM was more pronounced in younger age groups and those with higher levels of in- flammation. • The odds of DM increased synergistically for those with both PD and high inflammatory status. • Therefore, early interventions for PD in younger patients may be crucial for preventing DM.

Citations

Citations to this article as recorded by

Resveratrol supplementation as a non-surgical treatment in periodontitis and related systemic conditions
Caterina Vinciguerra, Loredana Bellia, Graziamaria Corbi, Sandro Rengo, Alessandro Cannavo
Journal of Traditional and Complementary Medicine.2024;[Epub] CrossRef

Characteristics of imported and domestic malaria cases in Gyeonggi Province, Korea: Sunghee Hong, Jihye Kim, Soo-Nam Jo, Jong-Hun Kim, Boyoung Park, Bo Youl choi; Epidemiol Health. 2024;46:e2024087. Published online November 8, 2024; DOI: https://doi.org/10.4178/epih.e2024087

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Abstract Summary PDF: Abstract
OBJECTIVES
This study explored 11 years of malaria data from mandatory reporting in Gyeonggi Province, Korea, to provide information for prevention strategies by linkage to nationwide health claims data.
METHODS
Reported malaria cases in Gyeonggi Province from 2011 to 2021 were linked to medical usage data from the National Health Insurance Database. Data about hospitalization, antibiotic prescription and duration, malarial species, and sociodemographic information of the cases were included.
RESULTS
Between 2011 and 2021, a total of 3,011 malaria cases were reported, consisting of 2,828 domestic (93.9%) and 183 imported (6.1%) cases. Over 80% of the cases involved males, with the majority of patients being in their 20s. Both domestic and imported cases peaked between June and August over the years. Imported cases had a higher hospitalization rate (66.9%) compared to domestically-acquired cases (54.9%). There was a significant variation in treatment rates, with 80.7% of imported cases and 74.6% of domestic cases receiving treatment. For domestic cases, chloroquine combined with primaquine was the most commonly prescribed treatment (77.0%), while atovaquone-proguanil was frequently used for imported cases (25.9%). Plasmodium vivax was the predominant species in domestic cases (94.9%), whereas P. malariae was more common in imported cases (62.3%). The overall number of reported malaria cases declined following a sharp decrease in imported cases in 2020 and 2021.
CONCLUSIONS
Despite a decreasing trend in malaria cases reported in Gyeonggi Province, imported cases exhibited higher hospitalization rates and different antibiotic prescription and treatment patterns, reflecting the presence of a different malarial species.; Summary

Korean summary
- 2011년부터 2021년까지 경기도에서 보고된 말라리아 사례 중 94%는 국내 발생이었으며, 80% 이상이 남성이었습니다. - 국내 발생은 20대에서 가장 많았으며, Plasmodium vivax가 주요 원인균으로 확인되었습니다. - 해외 유입 사례는 Plasmodium malariae가 지배적이며, 더 높은 입원율과 치료율을 보였습니다.

Key Message
- Between 2011 and 2021, 94% of malaria cases reported in Gyeonggi Province were domestically acquired, with over 80% of cases involving male patients. - Domestic cases were most common among individuals in their 20s, with Plasmodium vivax being the dominant species. - Imported cases primarily involved Plasmodium malariae, which showed higher hospitalization and treatment rates.

An outbreak of Clostridium perfringens infection on a training ship anchored in Busan, Korea: Seonmi Kim, Hyunjin Son; Epidemiol Health. 2024;46:e2024086. Published online November 7, 2024; DOI: https://doi.org/10.4178/epih.e2024086

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Abstract Summary PDF: Abstract
OBJECTIVES
In September 2023, an outbreak of food-borne disease occurred among students on a training ship docked in Busan. This was an epidemiological investigation with the aim of improving infection prevention activities and group meal service practices on board ships.
METHODS
In this study, a case was defined as an individual who experienced diarrhea more than twice a day during their training period aboard the training ship. A total of 171 exposed individuals including 6 food handlers was well-defined; therefore, a retrospective cohort study was conducted. We administered a questionnaire and conducted laboratory tests including 38 rectal swab samples. Relative risk (95% confidence interval) for each food item was calculated.
RESULTS
Of the 165 students and school staff members, 41 met the case definition, resulting in an attack rate of 24.8%; all cases were students. The shape of the epidemic curve was unimodal, with the peak from 00:00 to 06:00 on September 7, 2023. Clostridium perfringens was detected in 9 cases, and no other pathogens were found. Significant relative risk was shown in 11 different food items.
CONCLUSIONS
C. perfringens was the causative pathogen of this outbreak on the training ship. Due to the lack of preserved food samples, the exact source of infection could not be confirmed. Ships are not classified as collective dining facilities, leaving them in a management blind spot. Therefore, specialized guidelines, voluntary inspections by the operating entities, and continuous education for managers and staff are necessary.; Summary

Korean summary
부산의 훈련선에서 발생한 식중독은 Clostridium perfringens에 감염되어 발생한 것으로 확인되었으며, 165명 중 24.8%가 감염되었고, 2023년 9월 7일 0시에서 6시 사이에 유행곡선의 정점을 기록했다. 본 연구는 선박이 집단 급식시설로 분류되지 않아 관리의 사각지대에 놓인 점을 감안하여, 전문적인 가이드라인과 지속적인 교육, 자발적인 점검이 필요함을 제언하고 있다.

Key Message
A food-borne disease outbreak occurred on a training ship in Busan, affecting a significant number of people with Clostridium perfringens infection. Among the 165 people, the attack rate was 24.8%, with the epidemic peak occurring between 0:00 and 06:00 on September 7, 2023. This study recommends implementing specialized guidelines, voluntary inspections, and continuous education to improve infection prevention practices on ships, which are not classified as collective dining facilities and thus remain in a management blind spot.

Associations between taxi drivers’ aggressive driving behavior and sleep, cognition, and psychological factors in Korea: negative binomial regression analysis: Jong Sun Ok, Hyeongsu Kim, Soo Young An, Mi Young Kim; Epidemiol Health. 2024;46:e2024085. Published online October 17, 2024; DOI: https://doi.org/10.4178/epih.e2024085

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Abstract Summary PDF: Abstract
OBJECTIVES
Aggressive driving behavior is a significant predictor of traffic accidents. In particular, the driving behavior of taxi drivers is a critical issue that can impact the safety of both drivers and passengers. This study explored the sleep, cognitive, and psychological factors associated with taxi drivers’ aggressive driving behavior.
METHODS
In this descriptive study, a self-report questionnaire was distributed to taxi drivers in Seoul and Gyeonggi Province from August 22, 2022 to December 30, 2022. In all, 992 respondents were analyzed using negative binomial regression.
RESULTS
The mean score for aggressive driving behavior among taxi drivers was 13.76±11.47, with sub-scores of 3.46±3.48 for lapse, 3.31±3.16 for error, and 6.99±5.76 for violation. Contributing factors included sleep disorders, cognitive decline, and psychological factors. A higher score for aggressive driving behavior was associated with an increased severity of insomnia and daytime sleepiness, higher rates of cognitive failure, and elevated levels of depression and stress.
CONCLUSIONS
Our findings highlight the importance of addressing the sleep, cognitive, and psychological factors associated with aggressive driving behaviors among taxi drivers. Further study is needed to evaluate the causal relationship. In addition, it is imperative to develop educational programs and interventions to manage these issues effectively.; Summary

Korean summary
택시 기사의 안전운전 행동은 교통사고, 운전자와 승객의 안전과 연결된 이슈이다. 기존 연구에서 택시 기사의 가파른 고령화와 열악한 직업 환경 등이 과격한 운전행위의 영향요인으로 보고하고 있다. 이 연구에서 택시기사의 수면, 인지기능 및 심리적인 요인도 과격한 운전행위와 관련이 있음으로 보여주고 있다.

Key Message
It is important to predict taxi drivers’ aggressive driving behavior to decrease the traffic accidents that result from such be- havior. Previous studies have shown that general and occupational characteristics have a significant impact on aggressive driving behavior, whereas research on the psychological factors is limited. Our comprehensive investigation of the psycho- logical factors as well as the sleep factors and cognitive functions of taxi drivers (as part of a rapidly aging population) showed a significant relationship between these factors and aggressive driving behavior.

The prevention and response to infectious diseases in long-term care facilities in Korea: a nationwide survey: Sun Hee Na, Joong Sik Eom, Sun Bean Kim, Hyung Jin Yoon, So Yeon Yoo, Kyeong Sook Cha, Jong Rim Choi, Ji Youn Choi, Si Hyeon Han, Jin Ju Park, Tark Kim, Jacob Lee; Epidemiol Health. 2024;46:e2024084. Published online October 17, 2024; DOI: https://doi.org/10.4178/epih.e2024084

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Abstract Summary PDF: Abstract
OBJECTIVES
Long-term care facilities (LTCFs) are communal environments for patients with chronic diseases or older adults, making them particularly susceptible to significant harm during infectious disease outbreaks. Nonetheless, LTCFs have historically been subject to less stringent infection prevention and control (IPC) mandates. This study aimed to assess the current state of LTCFs and to develop an IPC system tailored for these facilities following the coronavirus disease 2019 (COVID-19) pandemic.
METHODS
We conducted an online survey of 11,366 LTCFs in Korea from December 30, 2022 to January 20, 2023, to evaluate the components of IPC in LTCFs. The infectious diseases targeted for IPC included COVID-19, influenza, and scabies. Additionally, we compared institution-based and home-based long-term care insurance facilities.
RESULTS
Overall, 3,537 (31.1%) LTCFs responded to the survey, comprising 1,819 (51.4%) institution-based and 1,718 (48.6%) home-based facilities. A majority (87.4%, 2,376/2,720) of these facilities experienced COVID-19 outbreaks. However, only 42.2% of home-based facilities, in contrast to 90.6% of institution-based facilities, were equipped to manage concurrent COVID-19 cases. Similarly, while 92.1% of institution-based facilities were capable of managing influenza, only 50.5% of home-based facilities could do the same. The incidence of scabies was significantly higher in institution-based facilities than in home-based ones (26.1 vs. 4.3%). Additionally, 88.7% of institution-based facilities managed scabies cases effectively, compared to only 42.1% of home-based facilities.
CONCLUSIONS
Approximately half of the LTCFs had a basic capacity to respond to infectious diseases. However, there were differences in response capabilities between institution-based facilities and home-based facilities.; Summary

Korean summary
장기요양기관을 대상으로 실태조사가 시행되었습니다. 50% 기관에서 감염병에 대한 기본 대응능력을 가지고 있었지만 시설급여기관과 재가급여기관 사이 대응능력에 차이가 있었습니다.

Key Message
A survey of long-term care facilities (LTCFs) was conducted. Fifty per cent of LTCFs had a basic capacity to respond to infectious diseases. However, there were differences in response capacity between institution-based and home-based facilities.

Sex-specific associations between dietary legume subtypes and type 2 diabetes in a prospective cohort study: Hye Won Woo, Sangmo Hong, Min-Ho Shin, Sang Baek Koh, Hyeon Chang Kim, Yu-Mi Kim, Mi Kyung Kim; Epidemiol Health. 2024;46:e2024083. Published online October 17, 2024; DOI: https://doi.org/10.4178/epih.e2024083

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Dietary soy, known for its high phytoestrogen content, has been suggested to exhibit a sex-specific association with type 2 diabetes. However, evidence regarding the sex-specific associations of different legume subtypes with type 2 diabetes remains scarce. We aimed to evaluate whether habitual consumption of soy and non-soy legumes (beans and peanuts) was prospectively and sex-specifically associated with the risk of type 2 diabetes incidence, taking into considering significant sex-specific genetic factors beyond legume consumption.
METHODS
A total of 16,666 participants (96,945 person-years) were followed and 945 incident cases were observed. Cumulative intake of legume subtypes was calculated using a food frequency questionnaire administered at baseline and during the revisit surveys.
RESULTS
Non-soy legumes are inversely associated with type 2 diabetes in both men and women. Dietary soy intake, however, demonstrated a unilaterally interacting sex-specific association with type 2 diabetes risk (pinteraction for sex=0.017). Specifically, there was a significant inverse association with type 2 diabetes risk in women (incidence rate ratio, 0.66; 95% confidence interval, 0.48 to 0.80; ptrend=0.007), but no such association was observed in men. This sex-specific association persisted and even appeared antagonistic in minor allele carriers of 2 novel single nucleotide polymorphisms, rs10196939 (LRRTM4) and rs11750158 (near GFPT2) (pinteraction for sex=0.001 and 0.011, respectively).
CONCLUSIONS
Habitual consumption of legumes shows protective impacts against type 2 diabetes, although these benefits vary by sex. Non-soy legumes provide health advantages for both men and women, whereas soy consumption seems to be beneficial exclusively for women.; Summary

Korean summary
콩류 섭취는 제2형 당뇨병 예방에 도움이 되는데, 대두를 제외한 콩류와 땅콩은 남녀 모두에게 건강상의 이점이 있는 반면, 대두는 여성에게만 보호적 이점이 있는 것으로 관찰되었다. 대두 섭취는 남성과 여성에서 서로 다른 영향을 미치는 것으로 관찰되었으며, 이는 대두 섭취의 건강상의 영향이 성별에 따라 다르게 나타날 수 있음을 시사하였다.

Key Message
Our findings showed that while legume consumption was protective against type 2 diabetes, beans and peanuts demonstrated health benefits in both sexes, whereas soy's protective benefits were observed only in women. Soy consumption was observed to have different effects between men and women, suggesting that the health impact of soy intake may differ by sex.

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