Epidemiology and Health

Most-download articles are from the articles published in 2023 during the last three month.

Original Article

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: 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.

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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10 Web of Science
16 Crossref

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

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Chengdong Yu, Jiawei Xu, Siyi Xu, Lei Tang, Qinyuan Han, Xiaoqiang Zeng, Yanxiao Huang, Tenghua Yu, Zhengkui Sun
Frontiers in Immunology.2024;[Epub] CrossRef
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International Journal of Molecular Sciences.2024; 25(14): 7854. CrossRef
Genetic Heterogeneity Across Dimensions of Alcohol Use Behaviors
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American Journal of Psychiatry.2024; 181(11): 1006. CrossRef
To Drink or Not to Drink? Investigating Alcohol’s Impact on Prostate Cancer Risk
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Factors associated with acquiring exercise habits through health guidance for metabolic syndrome among middle-aged Japanese workers: A machine learning approach
Jiawei Wan, Kyohsuke Wakaba, Takeshi Onoue, Kazuyo Tsushita, Yoshio Nakata
Preventive Medicine Reports.2024; 48: 102915. CrossRef
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Alcohol consumption and its association with cancer, cardiovascular, liver and brain diseases: a systematic review of Mendelian randomization studies
Naouras Bouajila, Cloé Domenighetti, Henri-Jean Aubin, Mickael Naassila
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Original Articles

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.

Prospective association between handgrip strength in childhood and the metabolic syndrome score and insulin resistance indices in adolescence: an analysis based on the Ewha Birth and Growth Study: Seunghee Jun, Hyunjin Park, Hyelim Lee, Hye Ah Lee, Young Sun Hong, Hyesook Park; Epidemiol Health. 2025;47:e2025001. Published online January 2, 2025; DOI: https://doi.org/10.4178/epih.e2025001

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Low handgrip strength (HGS) in children and adolescents might be associated with the risk of metabolic syndrome (MetS) and insulin resistance. This study prospectively evaluated the association between HGS in childhood and MetS in adolescence.
METHODS
Based on data from the Ewha Birth and Growth Study, this study analyzed HGS at ages 7 to 9 and metabolic indices at ages 13 to 15. In total, 219 participants were analyzed. The risk of MetS was evaluated using the continuous metabolic syndrome score (cMetS), and insulin resistance was assessed using fasting blood insulin and homeostasis model assessment of insulin resistance (HOMA-IR). Relative HGS in childhood was determined by dividing HGS by body weight and categorized as sex-specific quartiles.
RESULTS
This study found an inverse association between relative HGS levels in childhood and MetS and insulin resistance in adolescence. For each 1-group increase in relative HGS quartiles, cMetS (standarard [Std] β=-0.64, p<0.01), HOMA-IR (Std β=-0.21, p<0.01), and fasting blood insulin (Std β=-0.21, p<0.01) all decreased on average. These associations remained significant even after adjusting for confounding factors.
CONCLUSIONS
Our study showed a prospective association between HGS in childhood and the risk of MetS and insulin resistance in adolescence. It provides significant epidemiological evidence, emphasizing the importance of efforts to increase muscle strength from a young age to mitigate the risk of MetS and insulin resistance in adolescence.; Summary

Korean summary
본 연구는 소아기 악력 수준이 청소년기의 대사증후군 및 인슐린 저항성과 연관이 있음을 발견했음. 이러한 결과는 소아기 근력 향상이 향후 대사 위험을 완화하는데 중요함을 강조함.

Key Message
This study found that higher childhood relative handgrip strength was inversely associated with metabolic syndrome and insulin resistance in adolescence. The findings emphasize the importance of enhancing muscle strength early in life to mitigate metabolic risks.

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.

Cohort Profile

Cohort profile: a nationwide retrospective cohort of mortality in people living with HIV in Korea, 1985-2020: Taeyoung Kim, Yoonhee Jung, Koun Kim, Jung Wan Park, Jeonghee Yu, Sung-il Cho; Epidemiol Health. 2025;47:e2025002. Published online January 2, 2025; DOI: https://doi.org/10.4178/epih.e2025002

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Abstract Summary PDF: Abstract
The increasing number of people living with human immunodeficiency virus (HIV) in Korea has prompted interest in using the national surveillance system as a database for studying their health. To investigate the relationships between socio-demographic and epidemiological characteristics and mortality rates, a nationwide retrospective cohort was formed by integrating surveillance data with the Cause of Death Statistics from Statistics Korea. This integration included incidence reports, epidemiological investigations, and death reports from the surveillance data, enriched with detailed mortality information from the Cause of Death data. The cohort comprised 17,199 adult Korean individuals diagnosed with HIV infection from 1985 to 2020. By the end of 2020, 2,721 of these individuals were confirmed deceased. The sex ratio of the study participants was 14.3:1.0 (male to female), with 78.2% being under 50 years old at the time of diagnosis. Sexual contact was identified as the primary transmission route, accounting for 75.7% of cases. HIV disease emerged as the predominant cause of death, representing two-thirds (1,817 of 2,721) of the fatalities, followed by injuries and trauma, malignancies, and cardiovascular diseases. Recommendations for further cohort studies may be submitted to the Korea Disease Control and Prevention Agency.; Summary

Korean summary
- 인체면역결핍바이러스 감염인들의 사망과 연관된 요인의 파악을 위해, 질병관리청의 국가 감시체계 데이터와 통계청 사망원인통계를 결합하여 후향적 코호트를 구성하였다. - 구성된 코호트에는 1985-2020년 중 발생이 보고된 대한민국 국적의 19세 이상 감염인 17,199명이 포함되었으며 이 중 2,721명의 사망이 감시체계와 사망원인통계에서 최종 확인되었고, 코호트 데이터는 이들의 사회인구학적 요인, 역학적 요인, 사망원인을 포함한 사망 관련 정보로 구성되어 있다. - 본 코호트에 기반한 연구를 통해 국내 거주하는 한국인 감염인들의 건강을 전반적으로 확인할 수 있을 것으로 생각되며, 감염인 중 사망 위험이 높은 취약군을 확인하는 등 국가 정책의 기반이 되는 과학적 근거를 생산할 수 있기를 기대한다.

Key Message
- By merging KDCA’s national surveillance data and the national mortality statistics, our retrospective cohort data have been established for identifying people living with HIV (PLHIV) at higher risk of mortality. - In the established cohort, incidence reports of 17,199 PLHIV aged 19 or older with Korean nationality and mortality reports of 2,721 were included. The cohort data were composed of their sociodemographic and epidemiologic characteristics, and mortality data including causes of death. - We expect further research based on the cohort to explore Korean PLHIV’s health and mortality risk, and to generate scientific evidence for national policymaking.

Original Articles

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: 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.

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

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

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

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

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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Systematic Review

The effectiveness of protein supplementation combined with resistance exercise programs among community-dwelling older adults with sarcopenia: a systematic review and meta-analysis: Phatcharaphon Whaikid, Noppawan Piaseu; Epidemiol Health. 2024;46:e2024030. Published online February 14, 2024; DOI: https://doi.org/10.4178/epih.e2024030

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Abstract Summary PDF

Abstract

OBJECTIVES
The combination of protein supplementation and resistance exercise shows promise for improving and maintaining muscle mass, strength, and performance in older adults with sarcopenia. This systematic review aimed to evaluate the effects of this combination on muscle mass, muscle strength, and physical performance in community-dwelling older adults with sarcopenia.

METHODS

We conducted a comprehensive search of 4 electronic databases: PubMed, Scopus, Embase, and the MEDLINE Library. The search covered literature from January 2013 to January 2023 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent reviewers assessed the methodological quality of each study using the standard critical appraisal tool from the Joanna Briggs Institute (JBI). Meta-analysis was performed with the JBI Sumari program.

RESULTS

The review included 7 randomized controlled trials and 1 quasi-experimental study, encompassing a total of 854 participants aged 60 years and above. The study durations ranged from 10 weeks to 24 weeks. An analysis of standardized mean differences (SMDs) showed that protein supplementation combined with resistance exercise significantly increased muscle mass (SMD, 0.95; 95% confidence interval [CI], 0.13 to 1.78; p<0.05) and muscle strength (SMD, 0.32; 95% CI, 0.08 to 0.56; p<0.05).

CONCLUSIONS

Although the limited number of randomized controlled trials restricts the robustness of our conclusions, the evidence suggests that protein supplementation combined with resistance exercise is effective in enhancing muscle mass and strength in community-dwelling older adults with sarcopenia.

Summary

Key Message
Sarcopenia is a significant health concern. Given the contextual variations and the diverse factors that contribute to the prevalence of sarcopenia, delivering precision interventions to older adults diagnosed with sarcopenia who still reside in the community poses unique challenges. Therefore, precision interventions are vital for proper and feasible treatment planning, especially for early management actions, to reduce the impact of sarcopenia and its associated adverse effects in older adults. Our systematic review and meta-analysis showed that protein supplementation combined with resistance exercise is effective in enhancing muscle mass and strength in community-dwelling older adults with sarcopenia.

Citations

Citations to this article as recorded by

Protein supplementation alone or combined with exercise for sarcopenia and physical frailty: A systematic review and meta-analysis of randomized controlled trials
Yoshihiro Yoshimura, Ayaka Matsumoto, Tatsuro Inoue, Masatsugu Okamura, Masafumi Kuzuya
Archives of Gerontology and Geriatrics.2025; 131: 105783. CrossRef
The diagnosis and treatment of sarcopenia and sarcopenic obesity
Basel Habboub, Robert Speer, Markus Gosch, Katrin Singler
Deutsches Ärzteblatt international.2025;[Epub] CrossRef
The Impact of Protein in Post-Menopausal Women on Muscle Mass and Strength: A Narrative Review
Katherine Elizabeth Black, Penelope Matkin-Hussey
Physiologia.2024; 4(3): 266. CrossRef

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: 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.

Systematic Review

Adverse health effects of climate change and air pollution in people with disabilities: a systematic review: Nakyung Rhim, Seohyun Lee, Kyung-Hwa Choi; Epidemiol Health. 2024;46:e2024080. Published online September 27, 2024; DOI: https://doi.org/10.4178/epih.e2024080

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Abstract

Global warming and air pollution adversely affect the health of the entire human population, particularly older adults, people with disabilities (PWDs), and children. In this systematic review, we investigated the adverse health effects of climate change and air pollution in PWDs. We conducted a comprehensive literature search of the PubMed database using the terms “disab*,” “air pollution,” and “climate change” on July 4, 2023, and August 8, 2023 and searched the Web of Science (WOS) database on December 28, 2023. We identified 425 and 1,169 studies on climate change cited in PubMed and WOS, respectively, as well as 333 studies on air pollution in PubMed and 495 studies on air pollution in WOS. The studies were classified by type of exposure, and full-text screening was conducted to confirm that the population, intervention or exposure, comparator, outcome statement, and inclusion and exclusion criteria were met. The Newcastle-Ottawa Scale was used to assess the quality of the included cohort and case-control studies and for data analysis. In extreme temperatures, PWDs experienced higher rates of injury, heat-related illness, functional impairment, heart disease, mental disorders, and mortality than people who were non-disabled (ND). Exposure to air pollution resulted in higher rates of obesity, cardiovascular disease, poststroke neurological and functional disability, and mortality in PWDs than in people who were ND. Therefore, because PWDs were more affected by climate change and air pollution than people who were ND, sensitive policies and preparedness measures should be developed for PWDs.

Summary

Korean summary
전체 인구, 특히 취약 계층의 건강은 기후 변화와 대기 오염으로 인해 부정적인 영향을 받을 수 있습니다. 본 체계적 고찰 연구는 장애인이 비장애인에 비해 환경적 요인에 노출되어 더 심각한 신체적, 정신적 건강 문제를 겪는다는 것을 보여줍니다.

Key Message
The health of the entire human population, especially vulnerable people, might be negatively impacted by climate change and air pollution. This systematic review study implies that people with disabilities (PWDs) suffer more severe physical and mental health consequences from exposure to environmental challenges compared to non-disabled individuals.

Citations

Citations to this article as recorded by

Mediation of Fine Particulate Matter on the Association Between Daily Temperature and Mortality
Dajeong Ham, Youn-Hee Lim, Soontae Kim, Ho-Jang Kwon, Sanghyuk Bae
Journal of Korean Medical Science.2025;[Epub] CrossRef

Original articles

Preventable cancer cases and deaths attributable to deficit of physical activity in Korea from 2015 to 2030: Soseul Sung, Sungji Moon, Jihye An, Jeehi Jung, Hyeon Sook Lee, Youjin Hong, Sangjun Lee, Woojin Lim, Kyungsik Kim, Inah Kim, Jung Eun Lee, Sun Ha Jee, Aesun Shin, Ji-Yeob Choi, Sun-Seog Kweon, Min-Ho Shin, Sangmin Park, Seung-Ho Ryu, Sun Young Yang, Seung Ho Choi, Jeongseon Kim, Sang-Wook Yi, Yoon-Jung Choi, Jeong-Soo Im, Hong Gwan Seo, Sohee Park, Kwang-Pil Ko, Sue K. Park; Epidemiol Health. 2025;e2025010. Published online February 27, 2025; DOI: https://doi.org/10.4178/epih.e2025010 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
This study aimed to determine the population–attributable fractions (PAFs) of cancers using various calculation methods and to estimate the PAFs of cancer incidence and mortality resulting from deficit in physical activity (DPA) from 2015 to 2030, based on data on prevalence rates.
METHODS
The PAF of cancer was estimated using a cohort study–based meta–analysis of relative risk (RR), national prevalence rates of DPA from 2000 to 2015, and national cancer statistics from 2015 to 2030, with a latency of 15 years.
RESULTS
In 2015, DPA contributed to 909 cancer cases and 548 deaths, accounting for 0.42% and 0.68% of new cancer cases and deaths, respectively. By 2030, the PAF values are expected to increase to 1.31% of incidence and 1.80% of mortality, with a continual increase from 2015 to 2030. When the low metabolic equivalent of task (MET) criteria were selected, the PAF values decreased for both incidence and mortality. The PAF calculated with <900 MET–min/week for the sex–specific MET criterion was higher than that calculated with <900 MET–min/week for both incidence and mortality.
CONCLUSIONS
The risk of cancer associated with DPA is expected to rise in both men and women. Future research and strategies should emphasize the promotion of physical activity for cancer prevention, considering its significant implications for public health.; Summary

Preventable cancer cases and deaths attributable to tobacco smoking in Korea from 2015 to 2030: Soseul Sung, Jihye An, Jeehi Jung, Hyeon Sook Lee, Sungji Moon, Inah Kim, Jung Eun Lee, Aesun Shin, Sun Ha Jee, Sun-Seog Kweon, Min-Ho Shin, Sangmin Park, Seung-Ho Ryu, Sun Young Yang, Seung Ho Choi, Jeongseon Kim, Sang-Wook Yi, Yoon-Jung Choi, Youjin Hong, Sangjun Lee, Woojin Lim, Kyungsik Kim, Daehee Kang, Keun-Young Yoo, Sohee Park, Jeong-Soo Im, Hong Gwan Seo, Hai-Rim Shin, Kwang-Pil Ko, Sue K. Park; Epidemiol Health. 2025;e2025008. Published online February 27, 2025; DOI: https://doi.org/10.4178/epih.e2025008 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Tobacco smoking is a major public health concern worldwide. This study aimed to assess its impact on cancer incidence and mortality by estimating the population attributable fraction (PAF) in the Korean population for 2015 and 2020 and by projecting future trends until 2030.
METHODS
The Korean relative risk (RR) was calculated via a meta–analysis of RRs for individual cancers attributed to tobacco smoking, based on primary data analysis from the Korean Cohort Consortium. The PAF was estimated using the Levin formula with past and current prevalence rates and the number of cancer cases and deaths, assuming a 15–year latency period.
RESULTS
The proportions of cancer cases and deaths in Korea attributable to tobacco smoking were similar to those calculated using Asian and global RRs for both men and women. In 2015 and 2020, tobacco smoking contributed to 14.32% and 13.17% of cancer cases and 21.70% and 20.69% of cancer deaths in adults, respectively. Among Koreans, smoking was responsible for 25.83% of new cancer cases in men in 2015, 23.49% in men in 2020, 1.46% in women in 2015, and 1.68% in women in 2020. In both years, smoking impacted mortality more strongly than incidence in Korean men and women (incidence in men: 25.83% and 23.49%; mortality in men: 32.09% and 30.41%; incidence in women: 1.46% and 1.68%; and mortality in women: 4.70% and 4.96%, respectively).
CONCLUSIONS
Tobacco smoking causes cancers and deaths in Korea, however, it is preventable. Effective control policies that consider trends and vulnerabilities among women are required.; Summary

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