Epidemiology and Health

Original Articles

Increased risk of cancer and cancer-related mortality in middle-aged Korean women with prediabetes and diabetes: a population-based study: Thi Xuan Mai Tran, Soyeoun Kim, Huiyeon Song, Boyoung Park; Epidemiol Health. 2023;45:e2023080. Published online August 28, 2023; DOI: https://doi.org/10.4178/epih.e2023080

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study investigated the risk of developing and dying from all types of cancer, as well as cancer-specific mortality, in women diagnosed with prediabetes and diabetes.
METHODS
We included women aged ≥40 years who underwent cancer screening from 2009 to 2014 with follow-up until 2020. Diabetes status was determined based on fasting plasma glucose levels, self-reported history of diabetes, and the use of antidiabetic medication. We quantified the risk of cancer and mortality in the prediabetes and diabetes groups, relative to the normoglycemia group, by calculating adjusted hazard ratios (aHRs).
RESULTS
The study included 8,309,393 participants with a mean age of 52.7±9.7 years. Among these participants, 522,894 cases of cancer and 193,283 deaths were detected. An increased risk of cancer was observed in both the prediabetes group (aHR, 1.03; 95% confidence interval [CI], 1.02 to 1.04) and the diabetes group (aHR, 1.13; 95% CI, 1.12 to 1.14). The highest risk was identified in those with diabetes who developed liver (aHR, 1.72; 95% CI, 1.66 to 1.79), pancreatic (aHR, 1.68; 95% CI, 1.60 to 1.76), and gallbladder cancer (aHR, 1.43; 95% CI, 1.36 to 1.51). Women with prediabetes and diabetes exhibited a 1.07-fold (95% CI, 1.05 to 1.08) and 1.38-fold (95% CI, 1.36 to 1.41) increased risk of death from cancer, respectively.
CONCLUSIONS
Both prediabetes and diabetes were associated with an elevated risk of cancer, as well as an increased risk of death from cancer, in middle-aged Korean women. However, the degree of risk varied depending on the specific site of the cancer.; Summary

Korean summary
40세 이상의 중년 여성에서 당뇨 또는 당뇨 전 단계는 암 발생 위험과 암으로 인한 사망위험을 증가시킴. 암 종별로는 위암, 대장암, 직장암, 간암, 담낭암, 췌장암, 유방암, 자궁경부암, 자궁암, 신장암, 방광암의 발생 위험이 증가한 반면, 갑상선암의 발생 위험은 감소하였음. 거의 대부분의 암종에서 당뇨는 암으로 인한 사망위험을 증가시킴

Key Message
Both prediabetes and diabetes were independently associated with an overall increased risk of cancer, with a stronger association with malignancies in the liver and pancreas in women. Additionally, both prediabetes and diabetes status are associated with an elevated risk of death from cancer. These findings support the need for prevention and management to reduce cancer-related burden and premature deaths due to cancer, not only in individuals with diabetes but also in those with prediabetes.

Overall and cause-specific mortality in patients with dementia: a population-based cohort study in Taiwan: Chia-Lun Kuo, Pei-Chen Lee, Li-Jung Elizabeth Ku, Yu Sun, Tsung-Hsueh Lu, Muhammad Atoillah Isfandiari, Chung-Yi Li; Epidemiol Health. 2023;45:e2023082. Published online August 31, 2023; DOI: https://doi.org/10.4178/epih.e2023082

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Information regarding the underlying causes of death (UCODs) and standardized mortality ratio (SMR) of dementia is instrumental in formulating medical strategies to prolong life in persons with dementia (PWD). We examined the leading UCODs among PWD and estimated the overall and cause-specific SMRs in relation to dementia in Taiwan.

METHODS

Data were retrieved from 2 national datasets: the Taiwan Death Registry and the medical claim datasets of the National Health Insurance program. The observed person-years for each study participant were counted from the date of cohort enrollment to either the date of death or the final day of 2016. Sex-specific and age-specific SMRs were then calculated.

RESULTS

The leading UCOD was circulatory disease, accounting for 26.0% of total deaths (n=3,505), followed by respiratory disease at 21.3% (n=2,875). PWD were at significantly increased risk of all-cause mortality (SMR, 2.01), with SMR decreasing with advancing age. A cause-specific analysis revealed that the highest SMRs were associated with nervous system diseases (SMR, 7.58) and mental, behavioral, and neurodevelopmental disorders (SMR, 4.80). Age appeared to modify SMR, suggesting that younger age at cohort enrollment was linked to higher SMRs for nearly all causes of mortality.

CONCLUSIONS

Circulatory and respiratory diseases were the leading UCODs among PWD. The particularly elevated mortality due to nervous system diseases and mental disorders suggests that allocating more resources to neurological and psychiatric services is warranted. The elevated SMRs of various UCODs among younger PWD underscore the need for clinicians to pay particular attention to the medical care provided to these patients.

Summary

Key Message
Circulatory diseases were the leading causes of death in patients with dementia (PWD) in Taiwan, which accounted for 26% of the total deaths, followed by diseases of the respiratory system (21.32%). PWD were at a significantly increased risk of all-cause mortality (SMR: 2.01). A greater increase in cause specific SMR was noted for nervous system diseases (SMR: 7.58) and mental, behavioral and neurodevelopmental disorders (SMR: 4.80). Age tended to modify the SMRs in PWD, which indicated the younger the age of cohort enrollment was, the higher the SMRs of nearly all causes of mortality were.

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Trends in incidence, mortality, dynamic needs and rapid evolution of healthcare in dementia
Ke-Zong Ma, Chaur-Jong Hu
Archives of Gerontology and Geriatrics.2024; 121: 105389. CrossRef

Effective vaccination strategies to control COVID-19 in Korea: a modeling study: Youngsuk Ko, Kyong Ran Peck, Yae-Jean Kim, Dong-Hyun Kim, Eunok Jung; Epidemiol Health. 2023;45:e2023084. Published online September 7, 2023; DOI: https://doi.org/10.4178/epih.e2023084

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
In Korea, as immunity levels of the coronavirus disease 2019 (COVID-19) in the population acquired through previous infections and vaccinations have decreased, booster vaccinations have emerged as a necessary measure to control new outbreaks. The objective of this study was to identify the most suitable vaccination strategy for controlling the surge in COVID-19 cases.
METHODS
A mathematical model was developed to concurrently evaluate the immunity levels induced by vaccines and infections. This model was then employed to investigate the potential for future resurgence and the possibility of control through the use of vaccines and antivirals.
RESULTS
As of May 11, 2023, if the current epidemic trend persists without further vaccination efforts, a peak in resurgence is anticipated to occur around mid-October of the same year. Under the most favorable circumstances, the peak number of severely hospitalized patients could be reduced by 43% (n=480) compared to the scenario without vaccine intervention (n=849). Depending on outbreak trends and vaccination strategies, the best timing for vaccination in terms of minimizing this peak varies from May 2023 to August 2023.
CONCLUSIONS
Our findings suggest that if the epidemic persist, the best timing for administering vaccinations would need to be earlier than currently outlined in the Korean plan. It is imperative to continue monitoring outbreak trends, as this is key to determining the best vaccination timing in order to manage potential future surges.; Summary

Korean summary
본 연구는 자연감염 혹은 백신으로 획득된 면역의 저하를 고려한 수리모델을 사용하여 COVID-19에 대한 백신 접종 전략 분석 결과를 보인다. 시뮬레이션 결과는 추가 백신 접종이 없을 경우 재유행의 정점이 800명을 넘을 것임을 나타내며, 적절한 시기에 백신을 접종하면 최대 재원 위중증환자수를 약 40%까지 줄일 수 있음을 보인다. 본 연구는 확진자 추세의 지속적인 모니터링이 백신 접종의 적정 시기를 결정하고 미래 COVID-19의 재유행을 효과적으로 관리하는 데 필요하다는 점을 강조한다.

Key Message
Our study analyzes strategies for COVID-19 through vaccination, using a mathematical model considering waning immunity from past infections and vaccinations. Results indicate that a resurgence peak would reach more than 800 without further vaccination, and suggest vaccination in proper timing can reduce the peak size of administered severe patients by up to approximately 40%. The study emphasizes the importance of ongoing monitoring of outbreak trends to manage vaccination timing and future COVID-19 surges effectively.

Socioeconomic inequality in organized and opportunistic screening for colorectal cancer: results from the Korean National Cancer Screening Survey, 2009-2021: Xuan Quy Luu, Kyeongmin Lee, Jae Kwan Jun, Mina Suh, Kui Son Choi; Epidemiol Health. 2023;45:e2023086. Published online September 17, 2023; DOI: https://doi.org/10.4178/epih.e2023086

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aimed to investigate socioeconomic status (SES)-based inequality in colorectal cancer (CRC) screening in Korea. We assessed whether the rates of opportunistic and organized CRC screening differed according to income and education levels.

METHODS

We analyzed data from the Korean National Cancer Screening Survey of 27,654 cancer-free individuals, aged 50-74 years, from 2009 to 2021. The weighted cancer screening rates with trends were estimated with the average annual percentage change using joinpoint regression. Inequality was calculated in both relative and absolute terms, based on a Poisson regression model.

RESULTS

The organized screening rate increased significantly from 22.1% in 2009 to 53.1% in 2020 and 50.6% in 2021, with an average annual change of 8.6% (95% confidence interval [CI], 4.9 to 12.5). In contrast, no significant trend was observed for opportunistic screening. The SES inequality in opportunistic screening uptake was indicated by a slope index of inequality (SII) of 9.74% (95% CI, 6.36 to 13.12), relative index of inequality (RII) of 2.18 (95% CI, 1.75 to 2.70) in terms of education level; and an SII of 7.03% (95% CI, 4.09 to 9.98), RII of 1.81 (95% CI, 1.41 to 2.31) in terms of measured income. Although there was an increasing trend in income inequality, no significant SES inequalities were observed in the overall estimates for organized screening.

CONCLUSIONS

Organized CRC screening is effective in improving the participation rate, regardless of SES. However, significant inequalities were found in opportunistic screening, suggesting room for improvement in the overall equity of CRC screening.

Summary

Korean summary
이번 연구는 한국의 대장암 검진에서 사회경제적 수준에 따른 불평등이 있는지를 분석했다. 국가암검진사업 도입 이래로 2009-2021년 연구기간 동안 공공검진을 통한 대장암 수검률은 지속적으로 증가한 반면, 개인검진의 증가는 관찰되지 않았다. 특히 공공 검진의 경우 소득이나 교육수준에 따른 수검률에 차이는 없는 반면, 개인검진에서는 상당한불평등이 관찰되었다.

Key Message
"The study investigated socioeconomic status (SES)-based inequality in colorectal cancer (CRC) screening in Korea. We found that the introduction of the National Cancer Screening Program for CRC effectively increased the participation rate, regardless of the SES of the individuals throughout the study period. However, significant inequalities were observed in opportunistic screening related to education and income."

Citations

Citations to this article as recorded by

Disparities in Cancer Incidence across Income Levels in South Korea
Su-Min Jeong, Kyu-Won Jung, Juwon Park, Nayeon Kim, Dong Wook Shin, Mina Suh
Cancers.2023; 15(24): 5898. CrossRef

Higher energy consumption in the evening is associated with increased odds of obesity and metabolic syndrome: findings from the 2016-2018 Korea National Health and Nutrition Examination Survey (7th KNHANES): Sarang Jeong, Hajoung Lee, Sukyoung Jung, Jee Young Kim, Sohyun Park; Epidemiol Health. 2023;45:e2023087. Published online September 19, 2023; DOI: https://doi.org/10.4178/epih.e2023087

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Chrono-nutrition emphasizes meal timing in preventing obesity and metabolic disorders. This study explores the impact of temporal dietary patterns (TDPs) on obesity and metabolic syndrome (MetS) in Korean adults aged 20 years to 65 years.

METHODS

We utilized dynamic time warping method and Kernel k-means clustering to investigate diet quality and the odds ratios (ORs) of obesity and MetS with different TDPs using data from the 7th Korea National Health and Nutrition Examination Survey.

RESULTS

Participants were divided into three groups based on relative energy intake over 24 hours. After adjusting for age and gender, Cluster 3 (with the highest proportion of energy intake in the evening) had the lowest Healthy Eating Index scores compared to other clusters. Following adjustment for key covariates, Cluster 3 showed the highest values for body mass index, waist circumference, blood pressure, total cholesterol, and triglycerides. Compared to Cluster 1 (with a lower proportion of energy intake in the evening), Cluster 2 and Cluster 3 had ORs for obesity of 1.12 (95% confidence interval [CI], 0.97 to 1.30) and 1.19 (95% CI, 1.03 to 1.37), respectively. For MetS, the ORs were 1.26 (95% CI, 1.08 to 1.48) and 1.37 (95% CI, 1.17 to 1.61) when comparing Cluster 2 and Cluster 3 to Cluster 1.

CONCLUSIONS

This study reveals that individuals with higher energy intake in the evening have increased odds of obesity and MetS, even after adjusting for major covariates, including age and total energy intake.

Summary

Korean summary
본 연구는 하루 중 주요 에너지 섭취 사간에 따른 인구사회학적 특징과 건강지표의 상관성을 분석하였다. 제 7기 국민건강영양조사의 20~65세의 한국 성인을 대상으로 Dynamic Time Warping 방법을 이용하여 군집을 나누어 분석한 결과, 하루 중 저녁시간에 에너지 섭취가 높은 그룹이 그렇지 않은 그룹에 비해 연령이 낮고, 흡연자, 음주자, 스트레스를 느끼는 대상자의 비율이 높았다. 또한, 저녁에 에너지 섭취 비율이 높은 그룹이 그렇지 않은 그룹에 비해 체질량지수, 허리둘레, 혈압, 총 콜레스테롤, 중성지방이 높았으며, 식생활 평가 지수가 가장 낮았다. 마지막으로 하루 섭취하는 총 에너지 양과 생활습관 변수를 보정하고도 저녁에 섭취하는 에너지가 많은 그룹은 그렇지 않은 그룹에 비해 비만 및 대사 증후군 유병이 더 높은 것으로 나타났다.

Key Message
• This study examined the relationship between sociodemographic characteristics and health indicators based on the timing of major energy intake during the day. • Using the Dynamic Time Warping method, the analysis revealed that the group with higher evening energy intake was younger and had a higher proportion of smokers, alcohol consumers, and individuals experiencing stress. • Additionally, the group with higher evening energy intake exhibited higher levels of obesity and metabolic syndrome, even after adjusting for total daily energy intake and lifestyle variables.

Citations

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Association of Dietary Fiber and Measures of Physical Fitness with High-Sensitivity C-Reactive Protein
Ming-Zhen Su, Suyeon Lee, Dayeon Shin
Nutrients.2024; 16(6): 888. CrossRef

Changes in proteinuria and the associated risks of ischemic heart disease, acute myocardial infarction, and angina pectoris in Korean population: Sung Keun Park, Ju Young Jung, Min-Ho Kim, Chang-Mo Oh, Eunhee Ha, Eun Hye Yang, Hyo Choon Lee, Soonsu Shin, Woo Yeon Hwang, Sangho Lee, So Youn Shin, Jae-Hong Ryoo; Epidemiol Health. 2023;45:e2023088. Published online September 30, 2023; DOI: https://doi.org/10.4178/epih.e2023088

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Proteinuria is widely used to predict cardiovascular risk. However, there is insufficient evidence to predict how changes in proteinuria may affect the incidence of cardiovascular disease.
METHODS
The study included 265,236 Korean adults who underwent health checkups in 2003-2004 and 2007-2008. They were categorized into 4 groups based on changes in proteinuria (negative: negative → negative; resolved: proteinuria ≥1+ → negative; incident: negative → proteinuria ≥1+; persistent: proteinuria ≥1+ → proteinuria ≥1+). We conducted 6 years of follow-up to identify the risks of developing ischemic heart disease (IHD), acute myocardial infarction (AMI), and angina pectoris according to changes in proteinuria. A multivariate Cox proportional-hazards model was used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for incident IHD, AMI, and angina pectoris.
RESULTS
The IHD risk (expressed as HR [95% CI]) was the highest for persistent proteinuria, followed in descending order by incident and resolved proteinuria, compared with negative proteinuria (negative: reference, resolved: 1.211 [95% CI, 1.104 to 1.329], incident: 1.288 [95% CI, 1.184 to 1.400], and persistent: 1.578 [95% CI, 1.324 to 1.881]). The same pattern was associated with AMI (negative: reference, resolved: 1.401 [95% CI, 1.048 to 1.872], incident: 1.606 [95% CI, 1.268 to 2.035], and persistent: 2.069 [95% CI, 1.281 to 3.342]) and angina pectoris (negative: reference, resolved: 1.184 [95% CI, 1.065 to 1.316], incident: 1.275 [95% CI, 1.160 to 1.401], and persistent: 1.554 [95% CI, 1.272 to 1.899]).
CONCLUSIONS
Experiencing proteinuria increased the risks of IHD, AMI, and angina pectoris even after proteinuria resolved.; Summary

Korean summary
- 본 연구의 목적은 요 시험지 검사를 통해 확인된 단백뇨의 3-5년간의 변화 수준에 따른 허혈성 심질환, 급성 심근 경색, 협심증의 발생 위험을 평가하는 것이다. - 지속적으로 단백뇨가 음성인 집단에 (negative proteinuria) 비해서, 단백뇨가 있었다 사라진 집단 (resolved proteinuria), 새로이 단백뇨가 생긴 집단 (incident proteinuria), 지속적으로 단백뇨가 존재하는 집단 (persistent proteinuria)은 유의하게 증가한 허혈성 심질환, 급성 심근 경색, 협심증의 발생 위험을 나타내었다. - 이러한 결과는 단백뇨가 일단 발생한 사람은, 나중에 사라지더라도, 관상 동맥 질환에 대한 위험이 높으며, 이에 대한 관리와 주의가 필요하다는 것을 시사한다.

Key Message
- The present study was to evaluate the risk of incident ischemic heart disease, acute myocardial infarction, and angina pectoris according to changes in urine dipstick proteinuria over 3-5 years. - Compared with persistently negative proteinuria (negative → negative), resolved proteinuria (positive → negative), incident proteinuria (negative → positive), and persistent proteinuria (positive → positive) had the increased risk of ischemic heart disease, acute myocardial infarction, and angina pectoris. - These results suggest that once manifested proteinuria lead to the increased risk of coronary artery disease, regardless of changes in proteinuria.

Regional disparities in major cancer incidence in Korea, 1999-2018: Eun Hye Park, Mee Joo Kang, Kyu-Won Jung, Eun Hye Park, E Hwa Yun, Hye-Jin Kim, Hyun-Joo Kong, Chang Kyun Choi, Jeong-Soo Im, Hong Gwan Seo, The Community of Population-Based Regional Cancer Registries; Epidemiol Health. 2023;45:e2023089. Published online October 12, 2023; DOI: https://doi.org/10.4178/epih.e2023089

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study investigated regional disparities in the incidence of 8 major cancers at the municipal level in Korea during 1999-2018 and evaluated the presence or absence of hot spots of cancer clusters during 2014-2018.

METHODS

The Korea National Cancer Incidence Database was used. Age-standardized incidence rates were calculated by gender and region at the municipal level for 4 periods of 5 years and 8 cancer types. Regional disparities were calculated as both absolute and relative measures. The possibility of clusters was examined using global Moran’s I with a spatial weight matrix based on adjacency or distance.

RESULTS

Regional disparities varied depending on cancer type and gender during the 20-year study period. For men, the regional disparities of stomach, colon and rectum, lung, and liver cancer declined, and those of thyroid and prostate cancer recently decreased, despite an overall increasing incidence. For women, regional disparities in stomach, colon and rectum, lung, liver, and cervical cancer declined, that of thyroid cancer recently decreased, despite an overall increasing incidence, and that of breast cancer steadily increased. In 2014-2018, breast cancer (I, 0.61; 95% confidence interval [CI], 0.53 to 0.70) showed a high probability of cancer clusters in women, and liver cancer (I, 0.48; 95% CI, 0.40 to 0.56) showed a high probability of cancer clusters in men.

CONCLUSIONS

Disparities in cancer incidence that were not seen at the national level were discovered at the municipal level. These results could provide important directions for planning and implementing local cancer policies.

Summary

Korean summary
이 연구는 한국 시군구 단위에서 지난 20년(1999-2018)간 주요 8개 암 발생률의 지역 간 격차를 조사하고, 최근 5년(2014-2018)의 암 발생 군집 가능성을 평가했습니다. 지역 간 격차는 여성에서 갑상선암, 남성에서는 폐암이 가장 큰 격차를 보였습니다. 군집 가능성은 여성의 경우 유방암, 남성의 경우 간암에서 가장 높았습니다. 전국 단위에서는 볼 수 없었던 지역 간 격차 및 군집 발생 가능성이 시군구 단위에서 발견되었고, 이러한 결과는 지역에 맞는 암 정책을 기획하고 실행하는 데 중요한 방향을 제시할 수 있을 것입니다.

Key Message
This study investigated regional disparities in the incidence of eight major cancers in Korea at the municipal level during 1999-2018 and assessed the possibility of cancer clusters during 2014-2018. Thyroid cancer in women and lung cancer in men showed the most significant regional disparities. Breast cancer in women and liver cancer in men displayed the highest possibility of clustering. Regional disparities and cancer clusters were identified locally, which were not detected nationally. These findings could provide valuable guidance for developing and implementing cancer policies that are tailored to local needs.

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Hormone Replacement Therapy and Risks of Various Cancers in Postmenopausal Women with De Novo or a History of Endometriosis
Hee Joong Lee, Banghyun Lee, Hangseok Choi, Minkyung Lee, Kyungjin Lee, Tae Kyoung Lee, Sung Ook Hwang, Yong Beom Kim
Cancers.2024; 16(4): 809. CrossRef

Risk of lymphadenopathy from SARS-CoV-2 vaccination in Korea: a self-controlled case series analysis: Mi-Sook Kim, Bongyoung Kim, Jeong Pil Choi, Nam-Kyong Choi, Jung Yeon Heo, Jun Yong Choi, Joongyub Lee, Sang Il Kim; Epidemiol Health. 2023;45:e2023090. Published online October 13, 2023; DOI: https://doi.org/10.4178/epih.e2023090

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
To assess the risk of lymphadenopathy following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination.
METHODS
A self-controlled case series design was used to determine whether the risk of lymphadenopathy was higher in the 1-day to 42-day risk interval after coronavirus disease 2019 (COVID-19) vaccination compared to the control period. In addition, subgroup analyses were conducted according to baseline characteristics, time since vaccination, and sensitivity analyses adjusted for the length of the risk interval.
RESULTS
The risk of developing lymphadenopathy in the risk interval (1-42 days) after COVID-19 vaccination compared to the control period was significantly increased, with a relative incidence (RI) of 1.17 (95% confidence interval [CI], 1.17 to 1.18) when the first, second, and third doses were combined. The RI was greater on the day of vaccination (1.47; 95% CI, 1.44 to 1.50). In subgroup analyses by baseline characteristics, a significantly increased risk or trend toward increased risk was observed in most subgroups except for those aged 70 years and older, with a significant increase in risk in younger individuals, those with a Charlson’s comorbidity index <5, and those who received mRNA vaccines (mRNA-1273>BNT162b2). Within the 1-day to 42-day post-dose risk period, the relative risk was highest during the 1-day to 7-day post-dose period (1.59; 95% CI, 1.57 to 1.60) compared to the control period, and then the risk declined. In the sensitivity analysis, we found that the longer the risk window, the smaller the RI.
CONCLUSIONS
SARS-CoV-2 vaccination is associated with a statistically significant increase in the risk of lymphadenopathy, and this risk was observed only with mRNA vaccines.; Summary

Korean summary
질병관리청의 코로나19 예방접종자료와 국민건강보험공단 자료를 이용하여 수행한 본 자기대조환자군 연구에서 코로나19 백신접종은 42일 내 림프절병증 발생위험을 1.17배 (95% 신뢰구간, 1.17-1.18) 증가시키는 것으로 나타났다. 이러한 위험의 증가는 mRNA 백신에 국한하여 관찰되었으며 연령이 낮을수록, 여성일수록 상대위험도가 높은 것으로 나타났다.

Key Message
This self-controlled case series study, using the Korea Disease Control and Prevention Agency COVID-19 vaccination database and the National Health Insurance Service database, showed an increased risk of developing lymphadenopathy following vaccination (RR 1.17; 95% CI, 1.17 to 1.18). The elevated risk of lymphadenopathy is specifically associated with mRNA platform vaccines, not viral vector vaccines, and is more pronounced in younger individuals and females.

COVID-19: Cohort Profile

Cohort profile: investigating SARS-CoV-2 infection and the health and psychosocial impact of the COVID-19 pandemic in the Canadian CHILD Cohort: Rilwan Azeez, Larisa Lotoski, Aimée Dubeau, Natalie Rodriguez, Myrtha E. Reyna, Tyler Freitas, Stephanie Goguen, Maria Medeleanu, Geoffrey L. Winsor, Fiona S. L. Brinkman, Emily E. Cameron, Leslie Roos, Elinor Simons, Theo J. Moraes, Piush J. Mandhane, Stuart E. Turvey, Shelly Bolotin, Kim Wright, Deborah McNeil, David M. Patrick, Jared Bullard, Marc-André Langlois, Corey R. Arnold, Yannick Galipeau, Martin Pelchat, Natasha Doucas, Padmaja Subbarao, Meghan B. Azad; Epidemiol Health. 2023;45:e2023091. Published online October 13, 2023; DOI: https://doi.org/10.4178/epih.e2023091

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Abstract Summary PDF Supplementary Material: Abstract
The coronavirus disease 2019 (COVID-19) pandemic has affected all Canadian families, with some impacted differently than others. Our study aims to: (1) determine the prevalence and transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among Canadian families, (2) identify predictors of infection susceptibility and severity of SARS-CoV-2, and (3) identify health and psychosocial impacts of the COVID-19 pandemic. This study builds upon the CHILD Cohort Study, an ongoing multi-ethnic general population prospective cohort consisting of 3,454 Canadian families with children born in Vancouver, Edmonton, Manitoba, and Toronto between 2009 and 2012. During the pandemic, CHILD households were invited to participate in the CHILD COVID-19 Add-On Study involving: (1) brief biweekly surveys about COVID-19 symptoms and testing; (2) quarterly questionnaires assessing COVID-19 exposure and testing, vaccination status, physical and mental health, and pandemic-driven life changes; and (3) in-home biological sampling kits to collect blood and stool. In total, 1,462 households (5,378 participants) consented to the CHILD COVID-19 Add-On Study: 2,803 children (mean±standard deviation [SD], 9.0±2.7 years; range, 0-17 years) and 2,576 adults (mean±SD, 43.0±6.5 years; range, 18-85 years). We will leverage the wealth of pre-pandemic CHILD data to identify risk and resilience factors for susceptibility and severity to the direct and indirect pandemic effects. Our short-term findings will inform key stakeholders and knowledge users to shape current and future pandemic responses. Additionally, this study provides a unique resource to study the long-term impacts of the pandemic as the CHILD Cohort Study continues.; Summary

Key Message
· This study of 1,462 Canadian families (5,378 individuals) leverages a decade of extensive pre-pandemic CHILD Cohort Study data to identify risk and resilience factors for susceptibility to the direct and indirect effects of the COVID-19 pandemic. · Our short-term findings will inform key stakeholders and knowledge users to shape current and future pandemic responses. · This study provides a unique resource to study the long-term impacts of the pandemic as the CHILD Cohort Study continues.

Special Article

Cancer risk based on alcohol consumption levels: a comprehensive systematic review and meta-analysis: Seunghee Jun, Hyunjin Park, Ui-Jeong Kim, Eun Jeong Choi, Hye Ah Lee, Bomi Park, Soon Young Lee, Sun Ha Jee, Hyesook Park; Epidemiol Health. 2023;45:e2023092. Published online October 16, 2023; DOI: https://doi.org/10.4178/epih.e2023092

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Alcohol consumption is a well-established risk factor for cancer. Despite extensive research into the relationship between alcohol consumption and cancer risk, the effect of light alcohol consumption on cancer risk remains a topic of debate. To contribute to this discourse, we conducted a comprehensive systematic review and meta-analysis.

METHODS

Our systematic review aimed to investigate the associations between different levels of alcohol consumption and the risk of several cancer types. We focused on analyzing prospective associations using data from 139 cohort studies. Among them, 106 studies were included in the meta-analysis after a quantitative synthesis.

RESULTS

Our analysis did not find a significant association between light alcohol consumption and all-cause cancer risk (relative risk, 1.02; 95% confidence interval, 0.99 to 1.04), but we observed a dose-response relationship. Light alcohol consumption was significantly associated with higher risks of esophageal, colorectal, and breast cancers. Light to moderate drinking was associated with elevated risks of esophageal, colorectal, laryngeal, and breast cancers. Heavy drinking was also found to contribute to the risk of stomach, liver, pancreas, and prostate cancers, thereby increasing the risk of almost all types of cancer. Additionally, females generally had lower cancer risks compared to males.

CONCLUSIONS

Our findings highlight that cancer risks extend beyond heavy alcohol consumption to include light alcohol consumption as well. These findings suggest that there is no safe level of alcohol consumption associated with cancer risk. Our results underscore the importance of public health interventions addressing alcohol consumption to mitigate cancer risks.

Summary

Korean summary
본 연구는 코호트 연구를 기반으로 하여 음주의 수준에 따른 암 위험 연관성에 대해 체계적 문헌고찰(139편)과 메타분석(106편)을 수행하였다. 연구 결과, 음주와 암 위험 사이에 용량-반응 관계가 나타났으며, 소량의 음주는 암 유형에 따라 차이가 있었으나, 식도암, 대장암, 전립선암(남성), 유방암(여성)에서 암 위험과의 연관성이 있음을 발견했다. 따라서, 암 위험 측면에서 음주에 안전한 수준이 없음을 시사하며, 음주와 관련된 잠재적 피해를 완화하기 위해서는 음주 지침 강화와 같은 공중보건개입이 필요하다.

Key Message
The aim of this study was to assess the relationship between different levels of alcohol consumption and the risk of various cancer types through a systematic review and meta-analysis, providing insights into the ongoing debate about alcohol consumption and cancer causality. The findings support a dose-response relationship between alcohol consumption levels and cancer risk and the light alcohol consumption was associated with risks of esophageal, colorectal, prostate (male), and breast (female) cancer. These results emphasize the absence of a safe threshold for alcohol consumption in terms of cancer risk.

Citations

Citations to this article as recorded by

Exploring genetic associations of Crohn’s disease and ulcerative colitis with extraintestinal cancers in European and East Asian populations
Chengdong Yu, Jiawei Xu, Siyi Xu, Lei Tang, Qinyuan Han, Xiaoqiang Zeng, Yanxiao Huang, Tenghua Yu, Zhengkui Sun
Frontiers in Immunology.2024;[Epub] CrossRef

Original Article

Association between PM_2.5 exposure and risk of Parkinson’s disease in individuals with chronic obstructive pulmonary disease in Taiwan: a nested case-control study: Ci-Wen Luo, Yu-Hsiang Kuan, Wen-Ying Chen, Chun-Jung Chen, Frank Cheau-Feng Lin, Stella Chin-Shaw Tsai; Epidemiol Health. 2023;45:e2023094. Published online October 17, 2023; DOI: https://doi.org/10.4178/epih.e2023094

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Abstract Summary PDF: Abstract
OBJECTIVES
This cohort study investigated the correlation between Parkinson’s disease (PD) risk and chronic obstructive pulmonary disease (COPD) risk under particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5) exposure.
METHODS
Data from the National Health Research Institutes of Taiwan were used in this study. The Environmental Protection Administration of Taiwan established an air quality monitoring network for monitoring Taiwan’s general air quality. COPD was indicated by at least 3 outpatient records and 1 hospitalization for COPD. After the implementation of age, sex, and endpoint matching at a 1:4 ratio, 137 patients and 548 patients were included in the case group and control group, respectively. Based on the 2005 World Health Organization (WHO) standards, monthly air particle concentration data were classified into the following 4 groups in analyses of exposure–response relationships: normal level, and 1.0, 1.5, and 2.0 times the WHO level ([concentration ≥2]×25 μg/m3×number of exposure months).
RESULTS
A multivariate logistic regression revealed that the 1.0 and 1.5 WHO level groups did not significantly differ from the normal level group, but the 2.0 WHO level did (odds ratio, 4.091; 95% confidence interval, 1.180 to 14.188; p=0.038).
CONCLUSIONS
Elevated PM2.5 concentrations were significantly correlated with an increased risk of PD among patients with COPD. Furthermore, exposure to high PM2.5 levels can further increase the risk of PD.; Summary

Key Message
This nested case-control study, utilizing data from Taiwan's National Health Research Institutes and after meticulous matching, found that higher exposure to PM2.5 was associated with an increased risk of developing Parkinson's disease among individuals with chronic obstructive pulmonary disease, with those exposed to PM2.5 levels at 2 times the WHO standards having a 4 times higher odds of Parkinson's disease compared to those exposed to normal levels, indicating that air pollution may exacerbate neurological disease risk in those with existing respiratory conditions.

Special Article

Evidence integration on health damage for humidifier disinfectant exposure and legal presumption of causation: Mina Ha, Taehyun Park, Jong-Hyun Lee, Younghee Kim, Jungyun Lim, Yong-Wook Baek, Sol Yu, Hyen-Mi Chung, Kyu Hyuck Chung, Hae-Kwan Cheong, Review Committee for the Epidemiological Correlations between Humidifier Disinfectants Exposure and Health Effects; Epidemiol Health. 2023;45:e2023095. Published online October 24, 2023; DOI: https://doi.org/10.4178/epih.e2023095

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Inhalation exposure to humidifier disinfectants has resulted to various types of health damages in Korea. To determine the epidemiological correlation necessary for presuming the legal causation, we aimed to develop a method to synthesize the entire evidence.
METHODS
Epidemiological and toxicological studies are systematically reviewed. Target health problems are selected by criteria such as frequent complaints of claimants. Relevant epidemiologic studies are reviewed and the risk of bias and confidence level of the total evidence are evaluated. Toxicological literature reviews are conducted on three lines of evidence including hazard information, animal studies, and mechanistic studies, considering the source-to-exposure-to-outcome continuum. The confidence level of the body of evidence is then translated into the toxicological evidence levels for the causality between humidifier disinfectant exposure and health effects. Finally, the levels of epidemiological and toxicological evidence are synthesized.
RESULTS
Under the Special Act revised in 2020, if the history of exposure and the disease occurred/worsened after exposure were approved, and the epidemiological correlation between the exposure and disease was verified, the legal causation is presumed unless the company proves the evidence against it. The epidemiological correlation can be verified through epidemiological investigations, health monitoring, cohort investigations and/or toxicological studies. It is not simply as statistical association as understood in judicial precedents, but a general causation established by the evidence as a whole, i.e., through weight-of-the-evidence approach.
CONCLUSIONS
The weight-of-the-evidence approach differs from the conclusive single study approach and this systematic evidence integration can be used in presumption of causation.; Summary

Korean summary
저자들은 가습기살균제 노출로 인한 건강피해의 법적 인과관계 추정요건인 역학적 상관관계를 확인하기 위한 과정으로서 체계적 문헌고찰과 역학과 독성학의 전체 과학적 근거를 체계적으로 종합하는 방법을 제시하였다. 이것은 법적 증거 방법에서 개별 연구가 가지는 제한점이나 불확실성을 이유로 배척하지 않고, 전체 증거의 부분으로서 종합적으로 접근하는 것을 통해 사실 관계에 도달하는 방법이다. 이 전체증거접근법은 향후 인과관계 추정에서 전범(model)이 될 수 있다.

Key Message
We establish a systematic method for integrating a body of scientific evidence of epidemiology and toxicology to verify the epidemiological correlation, which is essential for presuming legal causation of health damages due to exposure to humidifier disinfectants. In terms of a legal proof, this method does not exclude individual studies due to their limitations or uncertainty but integrates them as part of a body of evidence to arrive at a conclusion that better reflects the truth of the evidence. This weight-of-the-evidence approach can be a model for future causal inference.

Original Article

The physical activity paradox in relation to work ability and health-related productivity loss in Korea: Heejoo Ko, Dohwan Kim, Seong-Sik Cho, Mo-Yeol Kang; Epidemiol Health. 2023;45:e2023096. Published online October 28, 2023; DOI: https://doi.org/10.4178/epih.e2023096

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Abstract PDF: Abstract
OBJECTIVES
The physical activity paradox suggests that occupational physical activity (OPA), unlike leisure-time physical activity (LTPA), may detrimentally impact health. We explored the relationships of OPA and LTPA with work ability (WA) and health-related productivity loss (HRPL).
METHODS
This study included 5,501 workers in Korea who were recruited in 2021 through a web-based cross-sectional questionnaire. The questionnaire was utilized to quantify OPA and LTPA in metabolic equivalents, while WA and HRPL were also measured. Non-parametric regression, using a generalized additive model (GAM), was employed to visualize the relationships of LTPA and OPA with WA and HRPL. Mean differences in WA and HRPL, in relation to OPA and LTPA, were examined using linear regression models. These models were adjusted for covariates including sex, age, body mass index, education level, alcohol consumption, smoking history, insomnia, occupation, hours worked, and income.
RESULTS
The GAM and linear regression analyses revealed that higher LTPA corresponded with higher WA and lower HRPL. In contrast, as OPA increased, WA decreased and HRPL increased. However, within the group with high OPA, HRPL was not significantly lower in the high-LTPA subgroup relative to the low-LTPA subgroup (mean difference=1.92%, p=0.343). This pattern was especially pronounced among workers aged 60 years and older, with an increase in HRPL observed with increasing LTPA among the respondents with high OPA.
CONCLUSIONS
High LTPA levels were associated with elevated WA and diminished HRPL. In contrast, higher levels of OPA were associated with lower WA and higher HRPL.; Summary

Special Article

Limiting the spillover of zoonotic pathogens from traditional food markets in developing countries and a new market design for risk-proofing: Sandeep Ghatak, Kandhan Srinivas, Arockiasamy Arun Prince Milton, Govindarajan Bhuvana Priya, Samir Das, Johanna F. Lindahl; Epidemiol Health. 2023;45:e2023097. Published online October 30, 2023; DOI: https://doi.org/10.4178/epih.e2023097

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Abstract Summary PDF: Abstract
Traditional food markets are age-old systems that primarily serve the food supply needs of society’s less affluent sectors, often operating with minimal infrastructure. These markets are prevalent in low and middle-income countries. However, their hygienic conditions are frequently suboptimal, potentially fostering the emergence and spread of presumptive zoonotic diseases. The recent emergence of zoonotic or potentially zoonotic diseases and their possible links to traditional food markets underscore the need for focused attention on this overlooked issue. The socioeconomic characteristics of traditional food markets reveal that despite the risk of zoonotic pathogen spread, these markets play a crucial role for large segments of the population. These individuals rely on such markets for their livelihood, food, and nutrition. Therefore, a comprehensive set of measures addressing various aspects of traditional food markets is necessary to manage and mitigate the risks of potential zoonotic disease emergence. In this article, we explore various facets of traditional food markets, paying special attention to the risks of zoonotic diseases that urgently require stakeholder attention. We also propose a new market design to prevent the risk of zoonotic spillover and advocate for the development of a Market Hygiene Index for these markets.; Summary

Key Message
Embracing Tradition, Ensuring Safety! Traditional food markets are vital for many communities, supplying food and livelihoods. Yet, their suboptimal hygiene poses potential risks for zoonotic diseases. Our article sheds light on the importance of addressing this issue and offers a new market design for risk-proofing in developing countries. Join the conversation on safeguarding these markets and support the vulnerable for a safer, healthier future!

Original Article

Age-specific findings on lifestyle and trajectories of cognitive function from the Korean Longitudinal Study of Aging: Seungju lim, Eunyoung Yoo, Ickpyo Hong, Ji-Hyuk Park; Epidemiol Health. 2023;45:e2023098. Published online November 2, 2023; DOI: https://doi.org/10.4178/epih.e2023098

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Abstract Summary PDF: Abstract
OBJECTIVES
Few longitudinal studies have explored age-related differences in the relationship between lifestyle factors and cognitive decline. This study investigated lifestyle factors at baseline that slow the longitudinal rate of cognitive decline in young-old (55-64 years), middle-old (65-74 years), and old-old (75+ years) individuals.
METHODS
We conducted an 11-year follow-up that included 6,189 older adults from the Korean Longitudinal Study of Aging, which is a cohort study of community-dwelling older Koreans. Lifestyle factors, including physical activity, social activity (SA), smoking, and alcohol consumption were assessed at baseline. Cognitive function was measured at 2-year intervals over 11 years. Latent growth modeling and multi-group analysis were performed.
RESULTS
The influence of lifestyle factors on the rate of cognitive decline differed by age. Smoking at baseline (-0.05; 95% confidence interval [CI], -0.11 to -0.00, per study wave) accelerated cognitive decline in young-old individuals, whereas frequent participation in SA at baseline (0.02; 95% CI, 0.01 to 0.03, per study wave) decelerated cognitive decline in middle-old individuals. None of the lifestyle factors in this study decelerated cognitive decline in old-old individuals.
CONCLUSIONS
Cognitive strategies based on modifiable lifestyle factors such as smoking cessation in young-old individuals and frequent SA participation in middle-old age individuals may have great potential for preventing cognitive decline. Because the influence of lifestyle factors varied by age group, age-specific approaches are recommended to promote cognitive health.; Summary

Korean summary
본 연구는 국내 노인인구를 연령대별로 구분하여 연소노인(55-64세), 중고령노인(65-74세), 고령노인(75세+)의 인지저하 기울기를 가속 혹은 감속시키는 라이프스타일 요인을 파악하였다. '흡연'은 연소노인의 인지저하를 가속, '사회활동 참여 빈도'는 중고령노인의 인지저하를 감속시키는 것으로 나타났으며, 고령노인의 경우 유의미한 변수가 나타나지 않았다. 본 결과는 노인의 인지건강에 있어 연령대별 차별화된 라이프스타일 전략이 필요할 것을 시사한다.

Key Message
This study aimed to identify lifestyle factors that accelerate or decelerate the cognitive decline slope in the older population in South Korea, categorized by age groups: young-old adults (55-64), middle-old adults (65-74), and old-old adults (75+). The findings indicated that 'smoking' accelerates cognitive decline in young-old adults, while 'frequency of social activity participation' decelerates cognitive decline in middle-old adults. However, no significant lifestyle variables were identified for old-old adults. These results suggest the necessity of differentiated lifestyle strategies based on age groups for promoting cognitive health in the older population.

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