Epidemiology and Health

Volume 23 (2); December 2001

Original Articles

Study on the External Causes of Mortality In Korea.: Rim Hak Kim, Chul Hyun Nam, Gui Hee Kim, Sung Woo Kim; Korean J Epidemiol. 2001;23(2):64-74.

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Abstract PDF: Abstract
PURPOSE
This study was conducted to analysis the trends and states of external auses of mortality in Korea from 1985 to 1998.
METHODS
This study was based on data published in 1985-1998 from the annual report of cause of death statistics of National Statistical Office.
RESULTS
In the proportion of total death cases during 1985-1998, External causes of mortality was ranged from 11 percent to 15 percent. Death rate(per 100,000) of external causes of mortality(ECM) decreased recently from 85.7 in 1991 to 68.9 in 1998. Death rate of ECM in male was 2.6 times higher than that of female. Among total cases of ECM, the first leading cause of death was transport accidents. intentional self-harm was the second leading cause of death(26.8 percent in 1998). In trends of death rate(per 100,000) for ECM during 1885-1998, there were decreased for following causes of death; transport accidents, falls, accidental drowning and submersion, exposure to smoke, fire and flames, accidential poisoning by and exposure to noxious substances, Death rates of ententional self-harm and assault were increased during the periods. The age specific death rate increased with age for all ECM except for assault. The risk of death caused by ECM was higher in aged 65 and over than in ages 0-19 years among all ECM. The risk of death for male aged 65 and over were 6.9 times in transport accidents, 26 times in fall, 37 times in accidential poisoning by and exposure to noxious substances, and 18 times in intentional self-harm compared with 0-19 years. The risk of death for female aged 65 and over were 27 times in fall, 22 times in accidential poisoning by and exposure to noxious substances compared with 0-19 years. In seasonal variation of ECM cases for 1998. There was highest proportion in August(10.4 percent). The highest proportion by death seasion were winter(32.7 percent) in exposure to smoke, fire and flames, summer(27,7 percent) in fall, summer(52.4 percent) in accidental drowning and submersion, summer in 32.0 percent) in accidential poisoning by and exposure to noxious substances, spring(28.2 percent) in intentional self-harm, assault. and autumn(28.2 percent) in transport accidents.
CONCLUSION
Above results suggest that a preventive education program for safety accidents should be developed by considering gender and age of the objecties and seasons of the year.; Summary

The Effect of Work Department, Income and Job Status on the Workplace Injury Rates in One Car Manufacturing Factory.: Mi A Son; Korean J Epidemiol. 2001;23(2):52-63.

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Abstract PDF: Abstract
PURPOSE
There has been little research into socio-economic factors and work condition s as risk factors for workplace injuries in Korea. Separating work from social class is difficult as the social division of labour is at the origin of social class (1). The objective of this study is to investigate the relationship of working conditions and socio-economic factors with workplace injury rates.
METHODS
Three year-follow up data sets for workplace injury data analysis for retrospective cohort study were obtained linking the total workforce and workplace injuries between 1995 and 1997. The Proportional Hazards Model (Cox regression) is used to estimate the hazard ratios for workplace injury by different possible risk factors: work department, income, job status, age and tenure.
RESULTS
The press, body and engine departments have higher hazard rates for severe injuries; the press, engine, and supporting departments for lower-back pain; and the assembly line (with wider confidence interval) and supporting departments for Herniated Intervertebral Discs. Lower waged workers have higher rates of workplace injuries, especially for lower-back pain. Workers with low job status have higher rates than foremen or supervisors. Thus, socio-economic factors and work department contribute independently to workplace injury rates.
CONCLUSIONS
Even though this study could not fully investigate the relationship between socio-economic factors and working conditions, the working conditions as well as socioeconomic factors need to be considered as risk factors of workplace injuries in the workplace.; Summary

A Comparison of Occupation, Education, and Cause of Death from National Death Certificates and Deaths Data Due to Workplace Injuries from WELCO in Korea.: Mia Son; Korean J Epidemiol. 2001;23(2):44-51.

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Abstract PDF: Abstract
PURPOSE
The variables (occupation, education, cause of death, age, and sex) on death certificates can be used for health related studies, however, there has been little research on health related studies using death certificates in Korea. Also, the validity of the values of these variables on death certificates is questionable in Korea. Therefore, we compared occupation, data obtained from WELCO(Korea Labour Welfare Corporation) between 1995 and 1997.
METHODS
WELCO data on deaths due to workplace injury between 1995-1997 were merged with data from NSO on deaths occurring during the same period, using social security numbers. Out of a total of 7,698 deaths due to workplace injury reported to WELCO between 1995 and 1997, final study population are linked to 6,513 deaths among aged 20-64 between 1995 and 1997. On linking the data sets, two different sources of data are cross-tabulated to determine the percentage of agreement. Expected agreement and Kappa index are also calculated.
RESULTS
The results are as follows : Some manual workers are promoted into the non-manual group in the national death data from the National Statistics Office. Educational groups are promoted or demoted between NSO and WELCO death data. The Kappa index for occupational group is 0.49 when the occupational groups are categorised as manual and non-manual workers. The Kappa index is 0.50 in the two-category classification for education : beyond and below university levels; 0.32 in the three-category classification : university, high-school and less than middle-school; 0.25 in the four category classification : university, high-school, middle-school and less than elementary school. The Kappa index is 0.69 for the three-category disease classification : injury, poisoning and certain other consequences of external causes (S00-T98, ICD10), disease of the circulatory system(I00-I99, ICD10) and other disease categories except the two-category classification. The Kappa index for the 5-year age band is 0.99. There is no disagreement for the sex.
CONCLUSIONS
The comparison between national workplace injury data and national death data and tells us that occupational and educational variables are not in the range of 'excellent agreement' suggested by Koch(1997). Our comparison study suggests strong prediction of random errors as well as systemic errors. As for the cause of death, injury and cardiovascular disease from the NSO data are well-matched with those from the WELCO workplace injury death data. However, this comparison may have a limitation as the present study is confined to comparing only the categories of infury and cardiovascular disease. This study suggests that national death data as well as workplace injury data need to be improved for use as health indicators in studies relating socio-economic factors and working conditions to mortality in Korea.; Summary

An Epidemiologic Study on the Nosocomial Bloodstream Infection in Two Hospitals.: Mi Jeung Ahn, Chang Kyu Lee, Chae Seung Lim, You Cheol Shin, Soon Duck Kim; Korean J Epidemiol. 2001;23(2):33-43.

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Abstract PDF: Abstract
PURPOSE
In this study, nosocomial bloodstream infection rate and fatality rate for 774 and 386 patients, who whose blood cultivation were obtained after 48 hours of hospitalization between March 1999 and February 2000 in two university hospitals, were sought. A distribution of etiologic agent and risk factors of the nosocoial bloodstream infection were also investigated.
METHODS
This study was carried out through medical record review and a structural questionnaire. Besides registers of microbe cultivation in the department of clinical pathology and medical records of patients were checked. The nosocomial bloodstream infection was also checked through medical records of patients using the standard of CDC. Statistical analysis were performed using SAS 6.12.
RESULTS
The nosocomial bloodstream infection rate in hospital K and hospital A were 3.9 and 3.5 per 1,000 discharged patients, respectively. Although the rates were increased accoding to patients' age, they were different by medical departments, showing the highest level in the ICU. The fatality rate from nosocomial bloodstream infection in hospital K and hospital A were 12.5% and 21.8%, respectively. A distribution of etiologic agent of the nosocomial bloodstream infection in hospital K was 17 cases(21.8%) of Coagulase negative staphylococcus(CNS), 12 cases(15.0%) of Staphylococcus aureus and 8 cases(10.0%) of Enterococcus spp. For hospital A, it was 14 cases925.4%) of Coagulase negative taphylococcus(CNS), 9 cases(16.4%) of Staphylococcus aureus and 7 cases(12.7%) of Klebsiella pneumoniae. While risk factors of the nosocomial bloodstream infection edentified in hospital K were ICU, intracranial injury and hospitalization period, those for hospital A were a use of the central nenous tube, intracranial injury and hospitalization period.
CONCLUSION
It is expected that nosocomial bloodstream infection increases as aged group increases by the change of the population structure, as the usage of invasive instrument increases by development of new medical instrument as well as large scale hospitals. For these reasons, further studies developing countermeasures against nosocomial bloodstream infection are recommended.; Summary

Intervention Study for the Effectiveness of Alcohol Restriction to Blood Pressure.: Yeon Ee Song, Kang Sook Lee; Korean J Epidemiol. 2001;23(2):25-32.

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Abstract PDF: Abstract
PURPOSE
To assess whether blood pressure is reduced by the intervention of intensive weekly counseling to lower alcohol intake for 12 weeks in heavy drinkers with elevated blood pressure, we conducted the quasi-experimental study through workplace health promotion program.
METHODS
Thirty workers with an average intake of alcohol over 180 g/week(2 bottles of Soju, Korean popular liquor) and with over 90 mm Hg in diastolic blood pressure(DBP) or over 140 mm Hg systolic blood pressure(SBP) assigned to intervention group(15 men, IG) and control group(15 men, CG) voluntarily. Mean age was 47.2 6.5 and 43.0 5.4 years old respectivel. The goal of intervention was below 45g/week(1/2 bottle of Soju).
RESULTS
Average weekly alcohol intake after 12 weeks in IG was significantly reduced(before 300.6 114.8g/week, after 24.8 24.5g/week) compared with CG(before 334.4 150.7g/week, after 311.3 150.8g/week). In IG, SBP(before 141.5 9.4mm Hg, after 128.7 13.0mm Hg) and DBP(before 95.5 6.3mm Gg, after 88.0 10.8mm Hg) was significantly decreased after 12 weeks of alcohol restriction program, but in CG there was no change.
CONCLUSION
Restriction program of alcohol intake in workplace was so effective to reduce blood pressure among hypertensives, although this study has a limitation of small subjects, short duration of follow up and no randomized controlled design.; Summary

Epidemiology of Malaria in Korea, 2000.: Jung Sik Yoo, Kyung Hee Lee, Un Yeong Goh, Jong Soo Lee, Byung Guk Yang; Korean J Epidemiol. 2001;23(2):19-24.

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Abstract PDF: Abstract
PURPOSE
In Korea, vivax malaria re-emerged in 1993 and the outbreak continued in several areas near the DMZ until now. This study was conducted to define the epidemiologic pattern of malaria in Korea and to examine the changes comparing to the one in 1999.
METHODS
We collected information about civilian, veteran patients through the National malaria surveillance system and soldier from the Ministry of National Defense. We analyze epidemiological characteristics of malaria by groups (civilian, veteran, soldier).
RESULTS
The reported cases of malaria in 2000 were 4,142 that number is an increase of 14% in numbers compared with those of 1999's. Most of cases occured in 17 counties nearby DMZ and from May to October(98.7%) seasonally. The incidence rates (per 100,000) in 2000 by residence were 17.0 in Gangwon-Do, 15.5 in Incheon Metropolitan city, 10.3 in Gyeonggi-Do was dereased. The risk area in 2000 were 17 counties located nearly DMZ and the high risk area were 5 counties where the incidence rate greater than 100. In case of civilian and veteran, the time required to diagnosis from onset of symptom was 8.1 days on the average.
CONCLUSION
Epidemiologic pattern of malaria in 2000 did not differ from the one in 1999. Et showed regional spread (increasing risk area) but incidence rate was lowered in the high risk area of 1999. And it is necessary that we pay more attention to Gangwon-Do and Incheon metrocity to reduce the incidence rate in 2001.; Summary

Correlation Study on Clinical Laboratory Findings with Occupational Exposure to Low Dose Ionizing Radiation in Nuclear Workers in Korea.: Young Khi Lim, Keun Young Yoo; Korean J Epidemiol. 2001;23(2):8-18.

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Abstract PDF: Abstract
PURPOSE
Even though atomic energy and radioisotope had been made for a peaceful purpose, some of the public do't feel safe possibly due to potential exposure to ionizing radiation. While health effects of high level radiation are almost deterministic, the stochastic effects of the 'low-dose radiation' have not come to a correct conclusion. This correlation study was conducted to assess the health effect due to potential exposure th low-dose radiation in the nuclear power plants workers in Korea.
METHODS
The study subjects was selected among the nuclear workers. Among those who attend the epidemiologic survey for screening of any malignancies done by the study group of Seoul National University Hospital during 1992-1993, 1) those who had undertaken both the physical examination with clinical laboratory tests and the direct interview with questionnaire, 2) male workers, and 3) those with record on radiation dosimetry as well as employment records in the company. Correlation analysis with Pearson's correlation coefficients and quantitative analysis with normal ranges of various tests were done by the PC-SAS for window.
RESULTS
Total cumulative radiation doses was relatively low, ranging 1 mSv at the lowest to 391 mSv at the highest. Moreover, mostly 68.7% of the subjects was within lower limit of total cumulative doses under 10 mSv. Among the clinical laboratory test, statistical significant correlation was see in hemoglobin(HGB), creatinine(CRE), and carcinoembryonic antigen(CEA).
CONCLUSION
This study concluded that health effect of occupational exposure to low-dose ionizing radiation is minimal or, if any, extremely lower than expected in the nuclear power plants workers in Korea. Major limitation of this study is that the healthy worker effect could not excluded. A large-scale prospective epidemiologic study on the relationship between radiation exposure and health hazard is needed to draw a more valid conclusion.; Summary

Review

Is Breast Cancer Incidence Rate Further Increasing in Korea?.: Keun Young Yoo, Hai Rin Shin, Sue Kyung Park, Ha Chung Yoon, Ae Sun Shin, Dae Hee Kang, Dong Young Noh, Kuk Jin Choe; Korean J Epidemiol. 2001;23(2):1-7.

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Abstract: Abstract
Breast cancer ranks second to stomach cancer as a primary cancer site. An increasing trend in mortality and morbidity of breast cancet has been shown since 1980s. Studies on migrant populations, in which higher incidences were shown than population in their motherlands, indicated the importance of environmental factors on breast cancer development. Older age, family history of breast cancer, early menarche, late menopause, late full-term pregnancy, never-having had a breast-fed child, and postmenopausal obesity were idenrified as risk factors in Korea. These are not different from risk factors detected in western countries. Nevertheless, a ^-shape age-specific incidences surve is shown in Korea shose incidence is relatively low. In western countries, where incidence rates are high, the incidences increase with age in a straight line. This difference may be explained by the "Estrogen-Augmented-:rogesterone Hypothesis" that is relevant to sex hormones. In fact, a nuch lower estradiol levels was reported in Korean women compared to those in American. On the other hand, genetic polymorphism is expected for future research on breast cancer etiology. Only preventive strategies based on epidemiology of breast cancer in Korea may effective to counter this malignancy in Korean women.; Summary

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