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2 "Jeong Min Yang"
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Original Articles
The impact of health behavior trajectories on all-cause and cause-specific mortality: an analysis using the National Health Insurance Service-National Health Screening Cohort in Korea
Jeong Min Yang, Jieun Hwang
Epidemiol Health. 2026;48:e2026029.   Published online June 12, 2026
DOI: https://doi.org/10.4178/epih.e2026029
  • 1,502 View
  • 92 Download
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Non-communicable diseases account for approximately 75% of global deaths and nearly 80% of deaths in Korea. Although the World Health Organization emphasizes the long-term management of multiple health behaviors (HBs), most studies have examined individual behaviors over short periods, thereby overlooking behavioral changes and their long-term effects. This study assessed how combined health behavior trajectories (HBTs) were associated with mortality risk, with consideration of sex-specific and age-specific differences.
METHODS
Using the National Health Insurance Service-National Health Screening Cohort in Korea, we analyzed 167,343 Korean adults aged 40–79 years, including 95,226 male participants and 72,117 female participants. The mean follow-up duration was 10.34 years for male participants and 10.65 years for female participants. Group-based multi-trajectory modeling was used to identify trajectories of tobacco use, alcohol consumption, physical activity, and body mass index. Associations with all-cause, cancer, and cardiovascular disease (CVD) mortality were examined using time-dependent Cox proportional hazards models stratified by sex and age.
RESULTS
Six distinct HBTs were identified in each sex, including a decreasing-risk trajectory that reflected improvements across multiple behaviors. Among male participants, the higher severe-risk group had markedly elevated all-cause mortality (hazard ratio [HR], 2.02; 95% confidence interval [CI], 1.63 to 2.51) and CVD mortality (HR, 3.17; 95% CI, 2.01 to 4.99). Among female participants, the severe-risk group had significantly higher risks of all-cause mortality (HR, 1.83; 95% CI, 1.43 to 2.34), cancer mortality (HR, 1.91; 95% CI, 1.20 to 3.05), and CVD mortality (HR, 2.68; 95% CI, 1.77 to 4.05). The decreasing-risk trajectory was associated with lower all-cause mortality in both sexes, particularly among individuals aged ≥65 years (male participants: HR, 0.87; 95% CI, 0.80 to 0.94; female participants: HR, 0.88; 95% CI, 0.79 to 0.98).
CONCLUSIONS
Distinct sex-specific HBTs were strongly associated with mortality. Sustained improvements across multiple HBs were associated with substantially lower long-term mortality. These findings support preventive health policies that target middle-aged and older populations.
Summary
Korean summary
• 흡연, 음주, 신체활동, 체질량지수의 장기 결합 궤적은 전체 사망률, 암 사망률, 심혈관질환 사망률과 강한 성별 특이적 연관성을 보였다. • 지속적 흡연과 음주로 특징지어지는 궤적, 특히 불건강한 체질량지수 패턴과 결합된 경우 사망 위험이 상당히 높았으며, 남성에서 가장 두드러졌다. • 여러 행동에서 지속적 개선을 보이는 위험 감소 궤적은 전체 사망률의 유의한 감소와 연관되었으며, 65세 이상 성인에서 강한 음의 연관성이 존재하였다. • 공중보건 정책은 중장년 및 노년층의 조기 사망을 줄이기 위해 여러 건강행동의 동시 개선을 촉진하는 생애주기적 접근을 우선해야 한다.
Effect of trajectory of employment status on all-cause mortality in the late middle-aged and older population: results of the Korea Longitudinal Study of Aging (2006-2020)
Jeong Min Yang, Jae Hyun Kim
Epidemiol Health. 2023;45:e2023056.   Published online June 8, 2023
DOI: https://doi.org/10.4178/epih.e2023056
  • 18,888 View
  • 222 Download
  • 4 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study conducted a longitudinal analysis of the effect of trajectory of employment status (TES) on all-cause mortality in late middle-aged and older Koreans based on the Korean Longitudinal Study of Aging (KLoSA).
METHODS
After excluding missing values, data on 2,774 participants were analyzed using the chi-square test and the group-based trajectory model (GBTM) for data from the first to fifth KLoSA and the chi-square test, log-rank test, and Cox proportional hazard regression for data from the fifth to eighth KLoSA.
RESULTS
The GBTM analysis identified 5 TES groups: sustained white collar (WC; 18.1%), sustained standard blue collar (BC; 10.8%), sustained self-employed BC (41.1%), WC to job loss (9.9%), and BC to job loss (20.1%). Compared to the sustained WC group, the WC to job loss group had higher mortality at 3 years (hazard ratio [HR], 4.04, p=0.044), 5 years (HR, 3.21, p=0.005), and 8 years (HR, 3.18, p<0.001). The BC to job loss group had higher mortality at 5 years (HR, 2.57, p=0.016) and 8 years (HR, 2.20, p=0.012). Those aged 65 years and older and males in the WC to job loss and BC to job loss groups had an increased risk of death at 5 years and 8 years.
CONCLUSIONS
There was a close association between TES and all-cause mortality. This finding highlights the need for policies and institutional measures to reduce mortality within vulnerable groups with an increased risk of death due to a change in employment status.
Summary
Korean summary
본 연구는 제 1차~8차 한국고령화연구패널을 활용하여 중고령층의 근로활동 궤적과 사망 간의 연관성을 분석하였다. 근로활동 궤적을 파악하기 위하여 집단중심추세모형을 활용하였으며, 총 5가지의 근로활동 궤적을 도출하였다. 도출된 궤적을 바탕으로 카이제곱 검정과 콕스 비례위험모형을 통해 근로활동 궤적과 사망률 간의 연관성을 분석하였다. 연구 결과 화이트칼라에서 실업으로 변화하는 집단과 블루칼라에서 실업으로 변화하는 두 집단에서 사망 간의 유의한 결과를 발견하였으며, 특히, 65세 이상 집단과 남성 집단에서 강한 연관성이 존재하였다. 본 연구 결과를 바탕으로 근로활동 변화로 인해 사망 위험이 증가하는 취약 집단을 위한 정책적, 제도적 방안의 기초자료로서 활용되기를 기대한다.
Key Message
Compared with the sustained White Collar (WC) trajectory group, changed WC to job loss trajectory group and changed BC to job loss trajectory had higher mortality. The over 65 years group and the male group, a strong association between change in employment status and mortality was observed. This study emphasizes the need for policy and institutional measures to reduce mortality for vulnerable groups who are at increased risk of death due to changes in employment status.

Citations

Citations to this article as recorded by  
  • Estimation of healthy worker survivor bias among middle-aged populations in Korea
    Byungyoon Yun, Beom Kyung Kim, Sung-In Jang, Laura S Rozek, Heejin Kimm, Juyeon Oh, Jin-Ha Yoon
    International Journal of Epidemiology.2026;[Epub]     CrossRef
  • Association between irregular social rhythm and all-cause mortality, death by illness, suicide and accidental death: a 19-year community-based cohort study in Japan
    Megumi Hazumi, Zui C Narita, Naoaki Kuroda, Mayumi Kataoka, Hiroaki Hori, Yoshinori Cho, Mariko Hanafusa, Rieko Kanehara, Taiki Yamaji, Motoki Iwasaki, Manami Inoue, Shoichiro Tsugane, Norie Sawada
    BMJ Public Health.2026; 4(3): e004543.     CrossRef
  • The predictive power of employment trajectories on cognition of older adults: Evidence from Chile
    Magdalena Delaporte
    Social Science & Medicine.2025; 380: 118281.     CrossRef
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