Epidemiology and Health

Volume 47; 2025

Erratum

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. 2025;47:e2024087.E. Published online March 17, 2025; DOI: https://doi.org/10.4178/epih.e2024087.E; Corrects: Epidemiol Health 2024;46:e2024087

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Original Articles

Association between regular dental scaling and stroke risk in patients with periodontal diseases: evidence from a Korean nationwide database: Yu-Rin Kim, Minkook Son, Seon-Rye Kim; Epidemiol Health. 2025;47:e2025020. Published online April 19, 2025; DOI: https://doi.org/10.4178/epih.e2025020

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Abstract Summary PDF: Abstract
OBJECTIVES
This study aimed to evaluate the association between the frequency of dental scaling and the risk of stroke among individuals with moderate-to-severe periodontal diseases and verify the effect of regular dental scaling on stroke risk in this population.
METHODS
In this retrospective study, 25,758 subjects with moderate-to-severe periodontal diseases were selected from the Korean National Health Insurance Service-National Health Screening Cohort database. Based on the frequency of dental scaling, the subjects were divided into three groups: regular, occasional, and infrequent. Restricted cubic splines were used to evaluate hazard ratios (HRs) with 95% confidence intervals (CIs) for stroke. Additionally, landmark analysis was conducted to strengthen the reliability of the results.
RESULTS
There were 293, 111, and 38 stroke cases in the infrequent, occasional, and regular group, respectively. The adjusted HR for stroke in the regular group, compared to that in the infrequent group, was 0.40 (95% CI, 0.29 to 0.57). In the landmark analysis with follow-up after 1 year and after 2 years, the adjusted HR in the regular group compared to that in the infrequent group was 0.41 (95% CI, 0.28 to 0.60) and 0.50 (95% CI, 0.33 to 0.76), respectively.
CONCLUSIONS
Regular dental scaling was significantly associated with a reduced risk of stroke in patients with moderate-to-severe periodontal diseases. These findings may suggest a potential preventive role of dental scaling beyond oral health. Further studies are needed to explore the underlying biological mechanisms linking periodontal care to stroke prevention and to explore causal relationships between dental scaling and stroke risk.; Summary

Korean summary
중등도 이상의 치주염을 가진 성인을 대상으로 분석한 결과, 정기적으로 치석 제거(스케일링)를 시행한 집단은 비정기적 또는 미시행 집단에 비해 뇌졸중 발생 위험이 통계적으로 유의하게 낮은 것으로 나타났다. 이러한 보호 효과는 특히 남성 및 65세 이상 고령층에서 더욱 뚜렷하게 관찰되었다. 본 결과는 정기적인 구강건강관리가 뇌혈관질환 예방에 있어 잠재적인 기여 요인임을 시사한다.

Key Message
Among adults with moderate to severe periodontitis, those who underwent regular dental scaling had a significantly lower risk of stroke compared to those without routine scaling. This protective effect was especially evident in males and individuals aged 65 and older. These results suggest that regular oral healthcare may serve as a potential contributing factor in the prevention of cerebrovascular diseases.

Impact of hypertension-related avoidable hospitalization on all-cause mortality in older patients with hypertension: a nationwide retrospective cohort study in Korea: Yehrhee Son, Noorhee Son, Sungyoun Chun, Ki-Bong Yoo, Jung Hyun Chang, Woo-Ri Lee; Epidemiol Health. 2025;47:e2025019. Published online April 18, 2025; DOI: https://doi.org/10.4178/epih.e2025019

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
The prevalence of hypertension is increasing as a result of rapid population aging, which elevates the societal burden of the disease. In Korea, the hospitalization rate for hypertension-related admissions exceeds the average reported by the Organization for Economic Cooperation and Development; however, the impact of these hospitalizations has not been evaluated. Therefore, this study investigates the association between hypertension-related avoidable hospitalizations and all-cause mortality.
METHODS
We included patients aged ≥60 years diagnosed with hypertension, identified using data from the National Health Insurance Services Senior Cohort spanning 2008 to 2019. The primary outcome was all-cause mortality measured at 3 years and 5 years after the hypertension diagnosis. The key independent variable was the incidence of hypertension-related avoidable hospitalizations within the first year following the initial hypertension diagnosis. Cox proportional hazards regression analysis was employed to assess these associations. To ensure robust findings and minimize selection bias, several sensitivity analyses were conducted.
RESULTS
Out of 65,686 participants, 397 (0.6%) experienced hypertension-related avoidable hospitalizations within 1 year of their initial hypertension diagnosis. Individuals who experienced such hospitalizations had a significantly higher risk of all-cause mortality compared to those who did not (3-year: hazard ratio [HR], 2.12; 95% confidence interval [CI], 1.53 to 2.94; 5-year: HR, 2.13; 95% CI, 1.68 to 2.68).
CONCLUSIONS
Hypertension-related avoidable hospitalizations among older adults are associated with an increased risk of both short-term and long-term all-cause mortality. These findings underscore the importance of timely hypertension management to prevent such hospitalizations.; Summary

Korean summary
- 고혈압 관련 회피가능한 입원은 한국의 노인 고혈압 환자의 3년 및 5년 사망률과 유의미한 연관성을 보인다. - 사회경제적 및 지역적 건강 격차가 관찰되었으며, 저소득층과 대도시 이외 지역에 거주하는 환자의 사망 위험이 더 높았다. - 약물 복용을 포함한 조기 및 지속적인 고혈압 관리는 회피가능한 입원을 예방하고 장기 생존 결과를 개선하는데에 도움이 될 수 있다.

Key Message
- Hypertension-related avoidable hospitalizations are significantly associated with both 3-year and 5-year all-cause mortality among older patients with hypertension in Korea. - Socioeconomic and regional disparities were observed, with greater mortality risks among patients from low-income groups and non-metropolitan areas. - Early and consistent hypertension management—including medication adherence—may help prevent avoidable hospitalizations and improve long-term survival outcomes.

Parents’ employment and non-chromosomal congenital anomalies in Korea: a national population cohort study: Kyuwon Kim, Hoyol Jhang, Erdenetuya Bolormaa, Chae Bong Kim, Seung-Ah Choe; Epidemiol Health. 2025;47:e2025018. Published online April 10, 2025; DOI: https://doi.org/10.4178/epih.e2025018

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Abstract Summary PDF: Abstract
OBJECTIVES
We assessed the association between parents’ employment status, including industrial classification, and non-chromosomal congenital anomalies in offspring.
METHODS
We analyzed data from mothers who delivered live births between 2020 and 2022, linking their records with those of their neonates from the National Health Information Service (NHIS) database. Our analysis focused on common industrial classifications representing at least 6% of the total workforce. Congenital anomalies were identified based on neonates’ diagnostic codes. We conducted logistic regression to estimate odds ratios (ORs) of congenital anomalies by the industrial classification of mothers and their partners, adjusting for individual risk factors, with the financial industry serving as the reference category.
RESULTS
Among 338,637 women with a live birth, 148,818 (43.9%) were employed at the time of pregnancy. Employment was associated with a higher risk of congenital anomalies (OR, 1.08; 95% confidence interval [CI], 1.04 to 1.12). Within the common industrial classifications, health and social work exhibited the highest risk (OR, 1.11; 95% CI, 1.06 to 1.22) compared to the financial industry. Women employed in general hospitals showed particularly elevated risks (OR, 1.19; 95% CI, 1.04 to 1.37). Among male partners, the risk estimates were generally imprecise.
CONCLUSIONS
The study indicates that certain industries are linked with a higher risk of congenital anomalies among women workers. These findings underscore the need for enhanced safety measures in high-risk industrial settings to reduce the occurrence of congenital anomalies.; Summary

Korean summary
- 2020~2022년 출산 여성 338,637명 중 43.9%가 임신 중 고용 상태였으며, 고용된 상태는 비염색체성 선천 기형 위험 증가와 연관됨(오즈비=1.08; 95% 신뢰구간[CI] 1.04–1.12). - 산업별 분석에서 금융업을 참조 기준으로 할 때, 보건·사회복지업이 가장 높은 위험을 보였고(1.11; 95% CI 1.06–1.22), 특히 종합병원에 근무하는 여성에서 위험이 특히 높았음(1.19; 95% CI 1.04–1.37). - 남성 파트너에서는 선천 기형 위험을 높이는 산업 분류는 뚜렷하지 않았으며 위험 추정치의 신뢰 구간이 전반적으로 넓고 정밀도가 낮았음.

Key Message
- Among 338,637 women who delivered between 2020 and 2022, 43.9% were employed during pregnancy, and employment status was associated with an increased risk of non-chromosomal congenital anomalies (OR 1.08; 95% confidence interval [CI] 1.04–1.12). - Compared to the financial industry, health and social work showed the highest risk (OR 1.11; 95% CI 1.06–1.22), with women working in general hospitals exhibiting an even greater elevated risk (OR 1.19; 95% CI 1.04–1.37). - Risk estimates by industrial classification for male partners were generally imprecise, with wide confidence intervals.

Association of dietary inflammatory index with mortality risk: a prospective analysis of the Korea National Health and Nutrition Examination Survey: Dahyun Park, Hee Ju Jun, Garam Jo, Soyoung Kwak, Min-Jeong Shin; Epidemiol Health. 2025;47:e2025017. Published online April 9, 2025; DOI: https://doi.org/10.4178/epih.e2025017

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Abstract Summary PDF: Abstract
OBJECTIVES
The energy-adjusted dietary inflammatory index (E-DII), a tool developed based on comprehensive research and literature reviews, is used to assess the inflammatory potential of specific diets. Although previous research has demonstrated an association between E-DII and mortality, longitudinal studies investigating a causal relationship in Asian populations are lacking. This study aimed to explore the prospective association between E-DII and the risk of all-cause, cancer, and cardiovascular disease (CVD) mortality using a population-based Korean cohort.
METHODS
The analysis included data from 40,596 individuals who participated in the Korea National Health and Nutrition Examination Survey between 2007 and 2015. The exclusion criteria encompassed the diagnosis of cancer or CVD at baseline, pregnancy at baseline, and death within the first 2 years after baseline. The E-DII was calculated using data from 24-hour dietary recall interviews. Cox proportional hazard regression models were employed to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for mortality risk across E-DII tertiles.
RESULTS
Over an 8.2-year follow-up period, 2,070 deaths were recorded. Compared with the lowest E-DII, a higher index was associated with an increased risk of mortality from all causes (HR, 1.45; 95% CI, 1.25 to 1.69), cancer (HR, 1.41; 95% CI, 1.09 to 1.81), and CVD (HR, 1.53; 95% CI, 1.07 to 2.18). The association between E-DII and all-cause mortality was particularly pronounced among individuals with metabolic conditions.
CONCLUSIONS
Our findings suggest a strong positive association between high E-DII and increased mortality in Korean adults, especially those with metabolic disorders.; Summary

Korean summary
본 연구는 2007–2015년 국민건강영양조사-사망원인통계 연계 데이터를 바탕으로 한국 성인을 대상으로 식이염증지수(E-DII)와 전체, 암, 심혈관질환 사망률 간의 연관성을 분석하였음. 높은 식이염증지수는 전체 사망(HR, 1.45; 95% CI, 1.25–1.69), 암 사망(HR, 1.41; 95% CI, 1.09–1.81), 심혈관질환 사망(HR, 1.53; 95% CI, 1.07–2.18) 위험 증가와 유의하게 관련되었으며, 특히 대사질환 보유자에서 그 연관성이 두드러졌음.

Key Message
This prospective cohort study analyzed nationally representative data from the Korea National Health and Nutrition Examination Survey (2007–2015) to examine the association between the energy-adjusted Dietary Inflammatory Index (E-DII) and mortality risk. A higher E-DII was significantly associated with increased risks of all-cause (HR, 1.45; 95% CI, 1.25–1.69), cancer mortality (HR, 1.41; 95% CI, 1.09–1.81), and cardiovascular mortality (HR, 1.53; 95% CI, 1.07–2.18), particularly among individuals with metabolic disorders.

Epidemiologic Investigation

Spatiotemporal trends in severe complicated influenza among the local population in Taiwan region, 2003-2023: Kangjun Wu, Yujian Lu; Epidemiol Health. 2025;47:e2025016. Published online April 2, 2025; DOI: https://doi.org/10.4178/epih.e2025016

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Severe influenza has raised considerable concern worldwide, and its incidence appears to have shifted in the context of globalization. This study aimed to examine the temporal, spatial, and demographic distributions of local severe influenza cases in Taiwan region from January 2003 to June 2023.
METHODS
We aggregated severe complicated influenza cases by month, area (city/county), age, and sex. The age-standardized incidence rate (ASIR) was calculated to compare differences across regions and populations. Yearly incidence rate ratios comparing males to females were also computed to assess sex differences.
RESULTS
A total of 16,459 cases were included from 2003 to 2023. Crude incidence rates per 100,000 population were 0.07-0.14 for 2003-2008, 3.64-9.81 for 2009-2019, and 0.00-1.87 for 2020-2023. Higher incidence rates were observed in Hualien and Taitung Counties, with average ASIRs exceeding 10.00 per 100,000 population, compared to other cities. Except for 2005 and 2007, the incidence among males exceeded that among females, with ASIR ratios ranging from 1.10 to 2.20. The highest incidence was observed among populations aged 0-4 and those aged ≥55.
CONCLUSIONS
The incidence of severe complicated influenza exhibited clear regional and demographic variations in Taiwan region. The observed rebound in incidence calls for increased vigilance to protect vulnerable populations from severe illness.; Summary

Key Message
In Taiwan Region, the incidence rate of severe complicated influenza was significantly higher between 2009 and 2019 compared to the periods both preceding and following this decade, with a notable resurgence trend emerging in 2023. Severe complicated influenza cases exhibited distinct spatial clustering patterns, particularly concentrated in Taichung and Hualien. Males faced elevated morbidity risks, while both young children and the elderly showed heightened vulnerability—though the elderly population drove the majority of cases.

Original Articles

Palivizumab coverage rates among moderate-to-late preterm infants in Korea: a nationwide cross-sectional study: Seungyeon Kim, Saram Lee, Young June Choe, Ju Sun Heo; Epidemiol Health. 2025;47:e2025015. Published online April 1, 2025; DOI: https://doi.org/10.4178/epih.e2025015

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Since October 2016, Korea has implemented a national reimbursement program for palivizumab aimed at moderate-to-late preterm (MLPT) infants born between 32 0/7 weels and 35 6/7 weeks of gestation during the respiratory syncytial virus (RSV) season (October–March). However, large-scale data on coverage rates and associated factors remain limited. This study evaluated palivizumab coverage rates and identified predictive factors influencing its administration in MLPT infants.
METHODS
This nationwide, population-based cross-sectional study utilized data from the Korean National Health Insurance Service collected between October 2016 and March 2019. MLPT infants eligible for palivizumab reimbursement were divided into administration and non-administration groups. Seasonal and overall coverage rates were assessed. A multivariate logistic regression analysis examined factors associated with palivizumab administration, with a focus on infant and maternal characteristics.
RESULTS
Among 2,843 eligible MLPT infants, 1,201 (42.2%) received palivizumab, while 1,642 (57.8%) did not. Although coverage rates increased annually, they remained suboptimal. Lower palivizumab prophylaxis coverage was observed in infants with higher gestational ages, female sex, absence of low birth weight, those born in March, residents of non-capital areas, infants not admitted to a neonatal intensive care unit at birth, and infants of mothers aged <35 years.
CONCLUSIONS
In the initial 3 RSV seasons following the introduction of palivizumab reimbursement for MLPT infants in Korea, the overall coverage rate was low (42.2%). National policies targeting infants with higher gestational ages, those born in March, and those residing in non-capital areas are necessary to improve coverage and ensure equitable RSV prophylaxis.; Summary

Korean summary
- 한국에서 중후기 미숙아를 대상으로 팔리비주맙 예방접종이 도입된 이후, 초기 3개 RSV 유행 시즌 동안 전체 예방접종률은 42.2%로 낮은 수준에 머물렀다. - 재태주수가 높은 영아, 3월 출생 영아, 그리고 비수도권 거주 영아에서 예방접종률이 유의하게 낮았다.

Key Message
- In Korea, following the introduction of palivizumab for MLPT infants, the overall coverage rate during the initial 3 RSV seasons was low (42.2%). - Infants with higher gestational ages, those born in March, and residents of non-capital areas exhibited significantly lower coverage rates.

Identifying factors associated with mental health status following climate-related disasters: a nationwide longitudinal panel study in Korea: Eunjin Oh, Jaelim Cho, Changsoo Kim, Hyungryul Lim, Kyoung-Nam Kim; Epidemiol Health. 2025;47:e2025014. Published online March 27, 2025; DOI: https://doi.org/10.4178/epih.e2025014

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Despite the increasing frequency and intensity of climate-related disasters, identifying factors associated with mental health status remains challenging. This study aimed to determine the factors linked to symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) following heavy rainfall and typhoons.
METHODS
National data on climate-related disaster victims (n=825 for heavy rainfall and n=1,220 for typhoon) from a longitudinal panel in Korea (“Long-term Survey on the Change of Life of Disaster Victims”) and data from individuals unaffected by disasters (n=893) were used. Generalized linear mixed models were employed to evaluate the factors associated with mental health status following climate-related disasters.
RESULTS
Greater disaster severity (e.g., experiencing casualties or asset loss) was associated with higher scores for depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and PTSD (Impact Event Scale-Revised). The association between casualty experience and anxiety score was more pronounced among individuals over 65 years (β [log-transformed score], 1.39; standard error [SE], 0.26; p<0.001), female respondents (β, 1.20; SE, 0.20; p<0.001), those with a low education level (β, 1.18; SE, 0.25; p<0.001), and those with a low income (β, 1.45; SE, 0.26; p<0.001) compared to their counterparts.
CONCLUSIONS
These findings may help guide targeted interventions and shape public health policies and disaster management strategies that prioritize mental health support for the most at-risk populations, ultimately increasing community resilience to climate-related challenges.; Summary

Korean summary
본 연구는 기후 관련 재난 후 우울증, 불안, PTSD와 관련된 요인을 파악하였다. 재난의 심각도가 클수록 정신 건강 악화는 더 심각하였으며 특히 노인, 여성, 낮은 교육 수준과 소득을 가진 취약한 그룹이 더 큰 위험에 처해 있었다. 이 결과는 향후 재난 대응에서 이러한 인구집단을 지원하기 위한 맞춤형 정신 건강 개입과 정책의 필요성을 시사한다.

Key Message
We identified factors associated with depression, anxiety, and PTSD following climate-related disasters, highlighting that greater disaster severity correlates with worse mental health outcomes. Vulnerable groups, such as older adults, women, those with lower education and income, are at higher risk. The findings suggest the need for targeted mental health interventions and policies to support these populations in future disaster responses.

The uneven playing field: provider participation and regional disparities in oral health examination rates in Korea: Hye-Lim Hong, Nam-Hee Kim; Epidemiol Health. 2025;47:e2025012. Published online March 10, 2025; DOI: https://doi.org/10.4178/epih.e2025012

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Abstract Summary PDF: Abstract
OBJECTIVES
This study investigated regional disparities in adult oral health examination rates in Korea, despite free oral health screenings by the National Health Insurance Service (NHIS). It focused on the impact of provider factors, such as the availability of dental clinics and non-dental institutions.
METHODS
A cross-sectional analysis of 2022 data from 229 districts was conducted. The dependent variable was the adult oral health examination rate, while independent variables included provider factors, community health status, lifestyle, demographic, and socioeconomic characteristics. Descriptive statistics, Pearson’s correlation, and multiple regression analyses identified significant predictors.
RESULTS
Non-metropolitan areas had higher oral health examination rates (27.4%) than metropolitan areas (25.3%). Correlation analysis showed the general health examination rate (r=0.583) and the number of screening institutions (r=0.234) were the strongest predictors (p<0.001). Regression analysis showed a 1% increase in general health examination rates led to a 1.44% rise in oral health examination rates (p<0.001).
CONCLUSIONS
Despite NHIS policies, significant regional disparities persist, showing that providing screenings alone is insufficient. Integrating oral health screenings with general health examinations is necessary. Policymakers must promote collaboration between dental and non-dental providers to ensure equitable, integrated health services, enhancing preventive care and reducing disparities.; Summary

Korean summary
이 연구는 전국 229개 시군구의 성인 구강검진 수검률을 분석하여 지역 간 격차가 크다는 점을 확인하였다. 해결방안으로 구강검진을 일반건강검진과 통합하고, 비치과 기관의 참여를 확대하는 것이 지역 접근성 및 형평성 개선에 효과적인 전략으로 제시하였다.

Key Message
This study analyzed adult oral health examination rates across 229 districts in Korea and confirmed the existence of substantial regional disparities. Integrating oral health screenings into general health check-ups and expanding the participation of non- dental institutions were proposed as effective strategies for improving regional accessibility and equity.

Effects of student human rights ordinances on mental health among middle and high school students in South Korea: a difference-in-differences analysis: Sang Jun Eun; Epidemiol Health. 2025;47:e2025011. Published online March 1, 2025; DOI: https://doi.org/10.4178/epih.e2025011

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
To actively protect and enhance students’ human rights, student human rights ordinances (SHROs) have been enforced in seven provinces in South Korea at different times since 2010. Although human rights are closely linked to mental health, there has been no research on the effectiveness of human rights legislation on adolescent mental health. This study evaluated the effects of SHROs on the mental health of middle and high school students.
METHODS
Repeated cross-sectional data were used, including 1,148,257 respondents from the Korea Youth Risk Behavior Web-based Survey between 2006 and 2023. Probabilities of perceived stress, sleep insufficiency, depressive mood, suicide ideation, and suicide attempt in treated provinces were estimated through a difference-in-differences approach that accounts for treatment effect heterogeneity across groups over time.
RESULTS
SHROs had no consistently significant effects on any mental health outcomes, except for slightly increased suicide ideation in total students (0.7%, 95% confidence interval 0.3% to 1.1%). Suicide attempts in total and male students and perceived stress and sleep insufficiency in female students tended to decrease, while other mental health outcomes tended to increase. Uncertainty in the effect estimates of SHROs increased for all mental health outcomes with possible violations of parallel trends, rendering originally significant effects insignificant.
CONCLUSIONS
SHROs failed to improve mental health of middle and high school students in treated provinces, possibly due to the absence of enforcement mechanisms. Further research is needed on the effectiveness of and effect mechanisms for legal measures to improve human rights on adolescent mental health.; Summary

Korean summary
학생의 인권을 포괄적으로 보장하기 위해 학생인권조례가 시행되었지만 학생인권조례 시행 지역에서 중고등학생의 정신건강은 향상되지 않았는데, 이는 조례에 벌칙 조항 같은 강제성 기전이 없었기 때문이었을 수 있다. 학생인권조례는 중고등학생의 정신건강에 대해 효과가 없었지만 이 연구는 인권 법제의 청소년 정신건강에 대한 효과를 처음으로 평가했다. 인권증진을 위한 법적 수단의 청소년 정신건강에 대한 효과성과 효과 기전에 관하여 추가 연구가 필요하다.

Key Message
Although student human rights ordinances have been enforced in South Korea to comprehensively guarantee human rights for students, they failed to improve the mental health of middle and high school students in treated provinces, possibly due to the absence of enforcement mechanisms such as penalty provisions. Despite the ineffectiveness of student human rights ordinances, this study first estimated the effects of human rights legislation on adolescent mental health. Further research is needed on the effectiveness of and effect mechanisms for legal measures to improve human rights on adolescent mental health.

Brief Communication

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

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Abstract Summary PDF Supplementary Material: Abstract
This study compares biomarker levels among environmentally vulnerable residents in Korea, the general Korean population, and Asians in the United States. We selected 953 exposed residents and 204 controls from the Forensic Research via Omics Markers in Environmental Health Vulnerable Areas (FROM) study (2021-2023), 4,239 participants from the fourth Korean National Environmental Health Survey (2018-2020), and 996 Asians from the U.S. National Health and Nutrition Examination Survey (2017-March 2020). The analyzed biomarkers included blood and urinary metals, urinary metabolites of polycyclic aromatic hydrocarbons, nicotine, volatile organic compounds, and serum perfluorocarbon metabolites. The highest median biomarker levels varied by pollution source among older adults. In refineries, blood lead and cadmium (Cd), as well as urinary Cd and 2-hydroxyfluorene, were highest. Abandoned metal mines exhibited the highest blood and urinary mercury, urinary Cd, total arsenic (As), 2-naphthol, and cotinine levels. Coal-fired power plants showed the highest urinary 1- hydroxyphenanthrene levels, while cement factories had the highest urinary As<sup>3+</sup> levels. Sprawls demonstrated the highest urinary monomethylarsonic acid, 1-hydroxypyrene, and phenylglyoxylic acid levels, and industrial areas recorded the highest levels of trans, trans-muconic acid, benzylmercapturic acid, and 2-methylhippuric acid. In general, biomarker levels were higher among exposed residents in the FROM study than in the general population; however, urinary 2-hydroxyfluorene and As<sup>5+</sup> levels did not differ significantly. Exposure to pollution sources in environmentally vulnerable areas may elevate biomarker levels in residents.; Summary

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

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

Original Articles

Risk of non-cancer respiratory diseases attributed to humidifier disinfectant exposure in Koreans: age-period-cohort and differences-in-difference analyses: Jaiyong Kim, Kyoung Sook Jeong, Seungyeon Heo, Younghee Kim, Jungyun Lim, Sol Yu, Suejin Kim, Sun-Kyoung Shin, Hae-Kwan Cheong, Mina Ha, Epidemiology Expert Committee for Reviewing the Epidemiological Correlations between Humidifier Disinfectant Exposure and Health Effects; Epidemiol Health. 2025;47:e2025006. Published online February 22, 2025; DOI: https://doi.org/10.4178/epih.e2025006

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Humidifier disinfectants (HDs) were sold in Korea from 1994 until their recall in 2011. We examined the incidence patterns of 8 respiratory diseases before and after the HD recall and estimated the attributable risk in the Korean population.
METHODS
Using National Health Insurance data from 2002 to 2019, we performed age–cohort–period and differences-in-diffference analyses (comparing periods before vs. after the recall) to estimate the population-attributable fraction and the excess number of episodes. The database comprised 51 million individuals (99% of the Korean population). The incidence of 8 diseases—acute upper respiratory infection (AURI), acute lower respiratory infection (ALRI), asthma, pneumonia, chronic sinusitis (CS), interstitial lung disease (ILD), bronchiectasis, and chronic obstructive pulmonary disease (COPD)—was defined by constructing episodes of care based on patterns of medical care and the clinical characteristics of each disease.
RESULTS
The relative risks (RRs) for AURI, ALRI, asthma, pneumonia, CS, and ILD were elevated among younger individuals (with an RR as high as 82.18 for AURI in males), whereas chronic conditions such as bronchiectasis, COPD, and ILD showed higher RRs in older individuals. During the HD exposure period, the population-attributable risk percentage ranged from 4.6% for bronchiectasis to 25.1% for pneumonia, with the excess number of episodes ranging from 6,218 for ILD to 3,058,861 for CS. Notably, females of reproductive age (19-44 years) experienced 1.1-9.2 times more excess episodes than males.
CONCLUSIONS
This study provides epidemiological evidence that inhalation exposure to HDs affects the entire respiratory tract and identifies vulnerable groups.; Summary

Korean summary
- 2002년부터 2012년까지 가습기살균제 흡입 노출은 한국 인구의 호흡기 질환 중 4~25%에 기여했으며, 특히 천식, 폐렴, 간질성폐질환이 젊은 연령층에서 더 큰 영향을 보였다. - 기관지확장증과 간질성폐질환 같은 만성질환에서는 고령층에서 초과 발생 사례 수가 더 많았다. - 어린이, 노인, 가임기 여성이 취약집단으로 확인되었다.

Key Message
- From 2002 to 2012, humidifier disinfectant inhalation exposure contributed to 4–25% of respiratory diseases in Korea, with greater effects among younger people, especially for asthma, pneumonia, and interstitial lung disease. - Older individuals showed more excess episodes for chronic conditions like bronchiectasis and interstitial lung disease. - The young, the elderly, and reproductive-age women were identified as vulnerable groups in association with humidifier disinfectant exposure.

Prevalence of cardiovascular-kidney-metabolic syndrome in Korea: Korea National Health and Nutrition Examination Survey 2011-2021: Sung-Bin Hong, Ji-Eun Kim, Seung Seok Han, Joseph J. Shearer, Jungnam Joo, Ji-Yeob Choi, Véronique L. Roger; Epidemiol Health. 2025;47:e2025005. Published online February 14, 2025; DOI: https://doi.org/10.4178/epih.e2025005

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
The American Heart Association (AHA) recently defined cardiovascular-kidney-metabolic (CKM) syndrome to better characterize the associations among cardiovascular, kidney, and metabolic diseases. Although about 9 in 10 United States adults have at least 1 risk factor for CKM syndrome, its prevalence in other populations is less understood. To fill this gap, we examined the prevalence of CKM syndrome in Korea and its association with demographic and socioeconomic status (SES).
METHODS
Using data from the Korean National Health and Nutrition Examination Survey between 2011 and 2021, we calculated the prevalence of CKM syndrome across the following stages: stage 0 (no risk factors), stage 1 (excess or dysfunctional adiposity), stage 2 (other metabolic risk factors or chronic kidney disease), and stages 3-4 (subclinical/clinical cardiovascular diseases) among adults aged ≥20 years. Weighted analyses were used to estimate prevalence and 95% confidence intervals (CIs) for each CKM syndrome stage, stratified by age, gender, and SES factors.
RESULTS
Among 54,994 Korean adults, the prevalence of CKM syndrome was as follows: stage 0 (25.2%; 95% CI, 24.7 to 25.8), stage 1 (19.3%; 95% CI, 18.9 to 19.7), stage 2 (51.6%; 95% CI, 51.1 to 52.2), and stages 3-4 (3.9%; 95% CI, 3.7 to 4.0). The prevalence of stages 2 and 3-4 was higher in men than in women. In addition, stages 3-4 were more prevalent among rural residents and those with lower education or income.
CONCLUSIONS
About 3 out of 4 Koreans are at risk for CKM syndrome. These findings highlight that CKM syndrome is a global health problem and that interventions are urgently needed to prevent further progression.; Summary

Korean summary
최근, 심장-신장-대사 증후군을 하나로 묶어 관리하는 것의 필요성이 대두되고 있다. 본 연구 결과 20세 이상의 한국 성인들의 74.8%가 심장-신장-대사 증후군의 위험군에 속해 있었다. 또한 그 정도가 증가하는 추세로 나타나 적절한 관리가 필요해 보인다.

Key Message
Recently, the need for an integrated approach to managing cardiovascular-kidney-metabolic (CKM) syndrome has been emphasized. This study found that 74.8% of Korean adults aged 20 and older had a risk for CKM syndrome. Moreover, the prevalence is increasing, highlighting the necessity of proper management.

A comparison of the outcomes of families with children aged less than 2 who received universal versus sustained nurse home visiting services in Korea: a cross-sectional study: Yu-Mi Kim, Sun Hwa Park, Kyung Ja June, Sung-Hyun Cho, Ji Yun Lee, Hong-Jun Cho, Young-Ho Khang; Epidemiol Health. 2025;47:e2025004. Published online February 6, 2025; DOI: https://doi.org/10.4178/epih.e2025004

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study aimed to compare maternal outcomes and the home environment between non‑vulnerable families with children under 2 receiving universal home visiting services and vulnerable families receiving sustained home visiting services.
METHODS
This study was conducted in Seoul, Korea, where the country’s first nurse‑led early childhood home visiting program was introduced. A total of 551 mother‑child dyads participated in cross‑sectional surveys conducted at various child ages (6±2 weeks, 6±1 months, 12±1 months, and 24±1 months). Universal home visiting services were provided within six weeks postpartum to non‑vulnerable families, while vulnerable families received sustained services consisting of 25 visits over 24 months. Maternal knowledge of sudden infant death syndrome (SIDS) and childcare, maternal distress, and the Korean Infant‑Toddler Home Observation for Measurement of Environment (K‑IT‑HOME) were assessed.
RESULTS
Overall, the universal home visitation group demonstrated higher levels of maternal knowledge regarding SIDS and childcare compared to the sustained home visitation group (all p-values <0.05), while the sustained home visitation group reported higher levels of maternal distress (p<0.001). The total K‑IT‑HOME score was 1.47 points higher in the universal home visitation group than in the sustained home visitation group (p<0.001). No significant differences were observed in the acceptance, organization, or involvement subscales of the K‑IT‑HOME (all p-values >0.05).
CONCLUSIONS
This study demonstrated that disparities in maternal outcomes and home environments persisted in early childhood between the sustained and universal home visitation groups.; Summary

Korean summary
이 연구는 단면 조사로, 보편방문 가족(취약하지 않은 가정)과 지속방문 가족(취약한 가정)을 네 시점(출산 후 6±2주, 6±1개월, 12±1개월, 24±1개월)에서 엄마의 결과 지표와 가정환경 지표를 비교하였다. 이 연구의 결과는 조기 아동기 지속적 가정 방문 프로그램만으로는 엄마의 결과 지표와 가정환경 지표의 격차를 완전히 없애기에 충분치 않다는 점을 시사한다.

Key Message
This study is a cross-sectional survey comparing outcomes between universal home visitation group (non-vulnerable families) and sustained home visitation group (vulnerable families) at four time points: 6±2 weeks postpartum, 6±1 months postpartum, 12±1 months postpartum, and 24±1 months postpartum. Study results suggest that merely implementing a maternal and early childhood sustained home-visiting program is insufficient to close the gap in maternal outcomes and home environments.

Gender differences in awareness and practices of cancer prevention recommendations in Korea: a cross-sectional survey: Yoonjoo Choi, Naeun Kim, Jin-Kyoung Oh, Yoon-Jung Choi, Bohyun Park, Byungmi Kim; Epidemiol Health. 2025;47:e2025003. Published online January 15, 2025; DOI: https://doi.org/10.4178/epih.e2025003

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Gender is a major determinant of health behaviors that influences cancer prevention awareness and practices. This study investigated the relationship of the awareness and practice rates of cancer prevention recommendations with gender and socioeconomic status.
METHODS
We used data from the Korean National Cancer Prevention Awareness and Practice Survey (2023). The sample included 4,000 men and women aged 20-74 years. We conducted multiple logistic regression analyses to evaluate associations with the awareness and practices of cancer prevention, and a joinpoint regression analysis using age-standardized rates to analyze trends in awareness and practice rates from 2007 to 2023.
RESULTS
The awareness rates were 79.4% and 81.2% for men and women, respectively. The overall practice rates were substantially lower (43.1% for men and 48.9% for women). For men, awareness rates did not differ significantly by socio-demographic characteristics, but practice rates increased with age (20-29: 15.9%; 60-74: 53.8%). For women, both awareness (20-29: 73.0%; 60-74: 85.7%) and practice (20-29: 16.8%; 60-74: 67.5%) rates increased with age. The easiest recommendations to follow were “reducing salt intake and avoiding burnt or charred foods” (men: 29.9%; women: 28.4%), whereas the most difficult recommendation was “engaging in regular physical activity” (men: 32.5%; women: 34.4%).
CONCLUSIONS
While awareness of cancer prevention recommendations was high, the practice of these recommendations was low. Gender influenced changes in awareness and practice rates over time, reflecting a large gap in practice. Future research should explore appropriate intervention points for cancer prevention practices and the development of more effective cancer prevention policies.; Summary

Korean summary
암 예방에 대한 인식은 남녀 모두 높은 수준이었으나, 실천에서는 성별 차이가 크게 나타났다. 효과적인 암 예방 정책 수립을 위해 성별에 따른 실천 격차를 고려한 전략이 필요하다.

Key Message
Many factors influence cancer prevention awareness and practice, and gender is a crucial determinant of health behaviour in general. This study found that while awareness was reasonably high among both men and women, there was a signifi- cant gender gap in practice. Given the variation in health behaviours by gender, further evaluation of gender effects is nec- essary to inform future policy interventions aimed at improving cancer prevention practices.

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