Epidemiology and Health

Original Articles

Evaluation of an air quality warning system for vulnerable and susceptible individuals in Korea: an interrupted time series analysis: YouHyun Park, Jun Hyuk Koo, Hoyeon Jeong, Ji Ye Jung, Changsoo Kim, Dae Ryong Kang; Epidemiol Health. 2023;45:e2023020. Published online February 14, 2023; DOI: https://doi.org/10.4178/epih.e2023020

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Abstract

OBJECTIVES
This study was conducted to elucidate the effects of an air quality warning system (AQWS) implemented in January 2015 in Korea by analyzing changes in the incidence and exacerbation rates of environmental diseases.

METHODS

Data from patients with environmental diseases were extracted from the National Health Insurance Service-National Sample Cohort database from 2010 to 2019, and data on environmental risk factors were acquired from the AirKorea database. Patient and meteorological data were linked based on residential area. An interrupted time series analysis with Poisson segmented regression was used to compare the rates before and after AQWS introduction. Adjustment variables included seasonality, air pollutants (carbon monoxide, nitrogen dioxide, sulfur dioxide, particulate matter less than 10 μm in diameter, and ozone), temperature, and humidity.

RESULTS

After AQWS implementation, the incidence of asthma gradually decreased by 20.5%. Cardiovascular disease and stroke incidence also significantly decreased (by 34.3 and 43.0%, respectively). However, no immediate or gradual decrease was identified in the exacerbation rate of any environmental disease after AQWS implementation. Sensitivity analyses were performed according to age, disability, and health insurance coverage type. Overall, the AQWS effectively mitigated the occurrence of most environmental diseases in Korea. However, the relationships between alarm system implementation and reduced incidence differed among diseases based on the characteristics of vulnerable and sensitive individuals.

CONCLUSIONS

Our results suggest that by tailoring the AQWS to demographic and sociological characteristics and providing enhanced education about the warning system, interventions can become an efficient policy tool to decrease air pollution-related health risks.

Summary

Korean summary
한국에서 미세먼지경보제의 시행은 환경성질환의 발생률을 점진적으로 감소시켰으나, 민감·취약계층 특징에 따라 정책 시행에 영향을 받은 환경성질환 종류는 상이하였다. 한편, 기존 환경성질환 환자의 악화(입원 또는 응급실 방문)의 경우 미세먼지경보제 시행으로 인한 영향은 파악되지 않았다.

Key Message
Air Quality Warning System (AQWS) effectively mitigated the occurrence of most environmental diseases in Korea. The relationships between alarm system implementation and reduced incidence differed among diseases based on the characteristics of vulnerable and sensitive individuals.

Citations

Citations to this article as recorded by

Trends in the Use of Air Quality Indexes in Asthma Studies
Angie Daniela Barrera-Heredia, Carlos Alfonso Zafra-Mejía, Alejandra Cañas Arboleda, María José Fernández Sánchez, Liliana López-Kleine, Adriana Rojas Moreno
Atmosphere.2024; 15(7): 847. CrossRef
Personal Strategies to Reduce the Cardiovascular Impacts of Environmental Exposures
Luke J. Bonanni, Jonathan D. Newman
Circulation Research.2024; 134(9): 1197. CrossRef

Admission route and use of invasive procedures during hospitalization for acute myocardial infarction: analysis of 2007-2011 National Health Insurance database: Hyungseon Yeom, Dae Ryong Kang, Seong Kyung Cho, Seung Won Lee, Dong-Ho Shin, Hyeon Chang Kim; Epidemiol Health. 2015;37:e2015022. Published online May 1, 2015; DOI: https://doi.org/10.4178/epih/e2015022

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Abstract

OBJECTIVES
The goal of this study was to investigate trends in admission to the emergency department and the use of invasive or surgical procedures during hospitalization for acute myocardial infarction (AMI) in Korea.

METHODS

The National Health Insurance (NHI) claims database between 2007 and 2011 was used. We identified all admission claims that included codes from the tenth revision of the International Classification of Diseases beginning with I21 as the primary or secondary diagnosis. Information about the admission route, admission date, discharge date, and whether coronary artery angiography, angioplasty, or bypass surgery was performed was also obtained from the NHI database.

RESULTS

Of the 513,886 relevant admission claims over the five years encompassed by this study, 295,001 discrete episodes of admission for AMI were identified by analyzing the date and length of each admission and the interval between admissions. The number of AMI admissions gradually decreased from 66,883 in 2007 to 47,656 in 2011. The number and proportion of admissions through the emergency department also decreased from 38,118 (57.0%) in 2007 to 24,001 (50.4%) in 2011. However, during the same period, admissions in which invasive or surgical procedures were performed increased from 15,342 (22.9%) to 17,505 (36.7%).

CONCLUSIONS

The reported numbers of emergency department visits and admissions for AMI decreased from 2007 to 2011. However, only a small portion of the patients underwent invasive or surgical procedures during hospitalization, although the number of admissions involving invasive or surgical procedures has increased. These findings suggest that simply counting the number of admission claims cannot provide valid information on trends in AMI occurrence.

Summary

Korean summary
급성심근경색 환자의 급성기 의료이용행태를 조사하기 위해 2007년부터 2011년까지 급성심근경색증 진단명(ICD-10 코드 I21.x)을 포함하는 입원 청구자료 513,886건을 분석하였다. 총 295,001건의 독립된 입원 에피소드를 추출하여 분석한 결과, 5년동안 전체 입원건수와 응급실 경유 입원건수는 감소한 반면, 진단 또는 치료 목적의 침습적 시술을 동반한 입원은 증가하였다. 건강보험청구자료를 이용하여 급성심근경색증 발생 규모를 파악할 때, 진단명만으로는 정확한 추계가 어려우며 관련 시술 등의 의료이용 정보를 추가하는 것이 필요할 것이다.

Citations

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Cardiovascular risk of Janus kinase inhibitors compared with biologic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis without underlying cardiovascular diseases: a nationwide cohort study
Yun-Kyoung Song, Gaeun Lee, Jinseub Hwang, Ji-Won Kim, Jin-Won Kwon
Frontiers in Pharmacology.2023;[Epub] CrossRef
Effect of Sodium-Glucose Cotransporter Inhibitors on Major Adverse Cardiovascular Events and Hospitalization for Heart Failure in Patients With Type 2 Diabetes Mellitus and Atrial Fibrillation
Chang Hee Kwon, Ye-Jee Kim, Min-Ju Kim, Myung-Jin Cha, Min Soo Cho, Gi-Byoung Nam, Kee-Joon Choi, Jun Kim
The American Journal of Cardiology.2022; 178: 35. CrossRef
Using real-world data for supporting regulatory decision making: Comparison of cardiovascular and safety outcomes of an empagliflozin randomized clinical trial versus real-world data
Ha Young Jang, In-Wha Kim, Jung Mi Oh
Frontiers in Pharmacology.2022;[Epub] CrossRef
Epidemiology of cardiovascular disease and its risk factors in Korea
Hyeon Chang Kim
Global Health & Medicine.2021; 3(3): 134. CrossRef
Major Adverse Cardiovascular Events in Antidepressant Users Within Patients With Ischemic Heart Diseases
Jae Hyun Kim, Yun-Kyoung Song, Ha Young Jang, Ju-Young Shin, Hae-Young Lee, Yong Min Ahn, Jung Mi Oh, In-Wha Kim
Journal of Clinical Psychopharmacology.2020; 40(5): 475. CrossRef
Antidepressant Use and the Risk of Major Adverse Cardiovascular Events in Patients Without Known Cardiovascular Disease: A Retrospective Cohort Study
Ha Young Jang, Jae Hyun Kim, Yun-Kyoung Song, Ju-Young Shin, Hae-Young Lee, Yong Min Ahn, Jung Mi Oh, In-Wha Kim
Frontiers in Pharmacology.2020;[Epub] CrossRef
Changing Disease Trends in the Northern Gyeonggi-do Province of South Korea from 2002 to 2013: A Big Data Study Using National Health Information Database Cohort
Young Soo Kim, Dong-Hee Lee, Hiun Suk Chae, Kyungdo Han
Osong Public Health and Research Perspectives.2018; 9(5): 248. CrossRef
Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016
Theo Vos, Amanuel Alemu Abajobir, Kalkidan Hassen Abate, Cristiana Abbafati, Kaja M Abbas, Foad Abd-Allah, Rizwan Suliankatchi Abdulkader, Abdishakur M Abdulle, Teshome Abuka Abebo, Semaw Ferede Abera, Victor Aboyans, Laith J Abu-Raddad, Ilana N Ackerman,
The Lancet.2017; 390(10100): 1211. CrossRef

Validity of Stature-predicted Equations using Knee Height for Elderly and Mobility Impaired Persons in Koreans: In Cheol Hwang, Kyoung Kon Kim, Hee Cheol Kang, Dae Ryong Kang; Epidemiol Health. 2009;31:e2009004. Published online October 12, 2009; DOI: https://doi.org/10.4178/epih/e2009004

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Abstract PDF

Abstract

<sec><title>OBJECTIVES</title>This study aimed to establish a stature-predicted equation using knee height, and perform a clinical validation on a Korean population.</sec><sec><title>METHODS</title>Using nationwide data obtained from 'Size Korea 2004', a stature-predicted equation was drawn and cross validation was performed using knee height in 5,063 subjects (2,532 males, 1,785 premenopausal females, and 746 postmenopausal females) who were aged between 20 and 69 yr. The formula was then applied to an elderly group (7 males and 26 females) and a mobility-impaired group (25 males and 14 females) in a real clinical setting. A stature-predicted equation was estimated using knee height and age based on multiple linear regression analysis. Cross validation was performed using paired t-test, and validation using clinical data was performed using Wilcoxon signed rank test.</sec><sec><title>RESULTS</title>In three groups (males, premenopausal females, and postmenopausal females), a cross validation was performed for a stature-predicted equation which was drawn using knee height and age. There were no significant differences between recorded height and estimated height in the elderly group (mean difference±interquartile range (IQR): male 0.65±4.65 cm, female -0.10±3.65 cm) and the mobility-impaired group (mean difference±IQR: male -0.23±5.45 cm, female 1.64±5.36 cm).</sec><sec><title>CONCLUSION</title>If several limitations could be overcome, the Korean-specific equations using knee height drawn from this study could be applied to actual clinical settings with Korean elderly or mobility-impaired people.</sec>

Summary

Citations

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Anthropometric Equations to Determine Maximum Height in Adults ≥ 60 Years: A Systematic Review
Arnulfo Ramos-Jiménez, Rosa P. Hernández-Torres, Isaac A. Chávez-Guevara, José A. Alvarez-Sanchez, Marco A. García-Villalvazo, Miguel Murguía-Romero
International Journal of Environmental Research and Public Health.2022; 19(9): 5072. CrossRef
Height Prediction Using the Knee Height Measurement Among Indonesian Children
Fernando Rumapea, Eddy Fadlyana, Meita Dhamayanti, Rodman Tarigan, Rahmayani Rahmayani, Kusnandi Rusmil
Food and Nutrition Bulletin.2021; 42(2): 247. CrossRef
A Knee Height Equation for Estimating Height of Vietnamese Adults
Tu Huu Nguyen, Yen Ngoc Ma, Linh Thuy Nguyen
Nutrition Today.2021; 56(6): 306. CrossRef
Bayes factor: A useful tool to quantitatively evaluate and compare performance of multiple stature estimation equations
Yangseung Jeong, Ashlin P. Harris, Omar Ali, Yochun Jung
Forensic Science International.2020; 312: 110299. CrossRef
Estimating the height of elderly nursing home residents: Which equation to use?
Marcos Felipe Silva de Lima, Larissa Praça de Oliveira, Natália Louise de Araújo Cabral, Laura Camila Pereira Liberalino, Ursula Viana Bagni, Kenio Costa de Lima, Clélia de Oliveira Lyra, Gary Liguori
PLOS ONE.2018; 13(10): e0205642. CrossRef
Accuracy of height estimation and tidal volume setting using anthropometric formulas in an ICU Caucasian population
Erwan L’her, Jérôme Martin-Babau, François Lellouche
Annals of Intensive Care.2016;[Epub] CrossRef
Enteral nutritional intake in adult korean intensivecare patients
Hyunjung Kim, Nancy A. Stotts, Erika S. Froelicher, Marguerite M. Engler, Carol Porter
American Journal of Critical Care.2013; 22(2): 126. CrossRef
Adequacy of early enteral nutrition in adult patients in the intensive care unit
Hyunjung Kim, Nancy A Stotts, Erika S Froelicher, Marguerite M Engler, Carol Porter, Heejeong Kwak
Journal of Clinical Nursing.2012; 21(19pt20): 2860. CrossRef
The estimation of body height from ulna length in healthy adults from different ethnic groups
A. M. Madden, T. Tsikoura, D. J. Stott
Journal of Human Nutrition and Dietetics.2012; 25(2): 121. CrossRef

Relationship Between Earlobe Crease and Brachial-ankle Pulse Wave Velocity in Non-hypertensive, Non-diabetic Adults in Korea: Sang In Choi, Hee Cheol Kang, Choon Ok Kim, Seung Beom Lee, Won Ju Hwang, Dae Ryong Kang; Epidemiol Health. 2009;31:e2009002. Published online October 12, 2009; DOI: https://doi.org/10.4178/epih/e2009002

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Abstract PDF

Abstract

<sec><title>OBJECTIVES</title>Several studies have found a significant association between the presence of earlobe crease (ELC) and cardiovascular disease (CVD). Brachial-ankle Pulse Wave Velocity (baPWV) is a non-invasive and useful measure of arterial stiffness predicting cardiovascular events and mortality. However, few studies have reported the relationship between ELC and baPWV as a new measure of arterial stiffness. The purpose of this study was to determine whether ELC is related to baPWV in non-diabetic, non-hypertensive, and apparently healthy Korean adults.</sec><sec><title>METHODS</title>A cross-sectional study was conducted on 573 non-hypertensive, non-diabetic Korean adults aged 20-80 yr. Subjects were stratified into three groups according to gender and menopausal status. baPWV was measured by an automatic waveform analyser. The association between ELC and baPWV was assessed by multiple linear regression analysis after adjusting for conventional cardiovascular disease risk factors including age, gender, blood pressure, lipid profile, and smoking status etc.</sec><sec><title>RESULTS</title>The overall frequency of ELC was 19.02% and the subjects with ELC showed significantly higher mean baPWV (p<0.0001). Multiple linear regression of subjects revealed that the presence of ELC was independently associated with baPWV (male, p<0.0001; premenopausal female p=0.0162; postmenopausal female p=0.0208).</sec><sec><title>CONCLUSION</title>ELC had a significant correlation with baPWV, independently controlling for other classical cardiovascular risk factors in adults aged 20 yr or older. ELC is an important surrogate marker of increased arterial stiffness as measured by baPWV in Korean adults.</sec>

Summary

Citations

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Diagonal earlobe crease and long-term survival after myocardial infarction
Christian Thilo, Christine Meisinger, Margit Heier, Wolfgang von Scheidt, Inge Kirchberger
BMC Cardiovascular Disorders.2021;[Epub] CrossRef
Association between serum carbohydrate antigen 19-9 levels and leukoaraiosis in middle-aged and older adults: A cross-sectional study
Da-Hye Son, Hye Sun Lee, Yong-Jae Lee
Atherosclerosis.2020; 292: 188. CrossRef
Association Between the Frank Sign and Cardiovascular Events
Saleh Nazzal, Arnon Blum
Southern Medical Journal.2018; 111(8): 504. CrossRef
Reevaluation of the earlobe types in Koreans
K.E. Kim, W.J. Song, D.K. Kim
HOMO.2018; 69(6): 377. CrossRef
The role of diagonal earlobe as evidence of coronary artery disease in a Salahiddin province- Iraqi population
Omar Raheem Khalaf AL-Obaidi, Rasha Abduladheem Yaseen
IOP Conference Series: Materials Science and Engineering.2018; 454: 012120. CrossRef
Prevalence of Earlobe Creases and Their Association With History of Cardiovascular Disease in Patients Undergoing Hemodialysis: A Cross‐Sectional Study
Minako Wakasugi, Junichiro James Kazama, Kazuko Kawamura, Suguru Yamamoto, Masaaki Nagai, Kentaro Omori, Saori Yokota, Hirokazu Fujikawa, Ikuo Aoike, Tsukasa Omori, Ichiei Narita
Therapeutic Apheresis and Dialysis.2017; 21(5): 478. CrossRef
Diagonal Earlobe Crease is a Visible Sign for Cerebral Small Vessel Disease and Amyloid-β
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Scientific Reports.2017;[Epub] CrossRef
Visible aging signs as risk markers for ischemic heart disease: Epidemiology, pathogenesis and clinical implications
Mette Christoffersen, Anne Tybjærg-Hansen
Ageing Research Reviews.2016; 25: 24. CrossRef
Diagonal earlobe crease and coronary artery disease in a Chinese population
Xing-li Wu, Ding-you Yang, Yu-sheng Zhao, Wen-hui Chai, Ming-lei Jin
BMC Cardiovascular Disorders.2014;[Epub] CrossRef
Earlobe Crease May Provide Predictive Information on Asymptomatic Peripheral Arterial Disease in Patients Clinically Free of Atherosclerotic Vascular Disease
Levent Korkmaz, Mustafa Tarık Ağaç, Zeydin Acar, Hakan Erkan, Ismail Gurbak, Ibrahim Halil Kurt, Huseyin Bektas, Erdinc Pelit, Ayca Ata Korkmaz, Şükrü Çelik
Angiology.2014; 65(4): 303. CrossRef
Association Between Earlobe Crease and the Metabolic Syndrome in a Cross-sectional Study
Eun Hee Kang, Hee Cheol Kang
Epidemiology and Health.2012; 34: e2012004. CrossRef
Diagonal Ear Lobe Crease and Coronary Artery Disease
Damir Fabijanić, Viktor Čulić
The American Journal of Cardiology.2012; 110(9): 1385. CrossRef

A study on Statistical Method for Controlling the Effect of Intermediate Events: Application to the Control of the Healthy Worker Effect.: Chung Mo Nam, Jinheum Kim, Dae Ryong Kang, Yeon Soon Ahn, Hoo Yeon Lee, Dae Hee Lee; Korean J Epidemiol. 2002;24(1):7-16.

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Abstract PDF: Abstract
PURPOSE
The healthy worker effect is an important issue in occupational epidemiology. This study was conducted to propose a new method to test the relation between exposure and mortality in the presence of the healthy worker effect.
METHODS
In this study, the healthy worker hire effect was assumed to operate as a confounding variable of health status at the beginning of employment and healthy worker survival effect as a confounding and intermediate variable of employment status. In addition, the proposed method reflects the length bias sampling caused by changing of an employment status. Simulation studies were also carried out to compare the proposed method with Cox's time dependent covariates models .
RESULTS
The theoretical development of the healthy worker survival effect is based on the result that an observation with change of an employment status requires that the survival time without intermediate event exceeds the waiting time for the intermediate event. According to our simulation studies, both the proposed method and Cox's time dependent covariates model which includes the change of employment status as time dependent covariates seem to be satisfactory at 5% significance level. However, Cox's time dependent covariates models without or with the change of employment status as time fixed covariate are unsatisfactory. The proposed test is superior in power to tests based on Cox's model.
CONCLUSIONS
The healthy worker effect may not be controlled by classical Cox's proportional hazards models. The proposed method performed well in the presence of healthy worker effect in terms of level and power; Summary

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