Epidemiology and Health

Original Articles

The association between the consumption of raw Kudoa septempunctata–infected farmed Paralichthys olivaceus and gastrointestinal symptoms: Jihye An, En-Joo Jung, Soon-Ok Lee, Jong-Hoon Choi, JungHee Kim, Sung-Jong Hong, Sung-Hee Hong, Jung-Won Ju, Hyungjun Kim, Kwang-Pil Ko; Epidemiol Health. 2026;48:e2026003. Published online January 19, 2026; DOI: https://doi.org/10.4178/epih.e2026003

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Kudoa septempunctata has been identified as the causative agent of food poisoning following the consumption of raw farmed Paralichthys olivaceus. However, cohort studies providing robust evidence for an association between K. septempunctata and gastrointestinal symptoms remain limited. This prospective cohort study investigated the association between the consumption of K. septempunctata–infected farmed P. olivaceus and the occurrence of gastrointestinal symptoms.
METHODS
Individuals who purchased raw farmed P. olivaceus between 2020 and 2021 were selected as the study population. Study data included 2 rounds of questionnaire surveys administered before and after consumption, 2 muscle specimens obtained from each purchased fish, and human biological specimens collected from individuals who developed gastrointestinal symptoms within 24 hours after consumption. Data were analyzed using the chi-square test and t-test, and the association between consumption of K. septempunctata–infected farmed P. olivaceus and gastrointestinal symptoms was evaluated using relative risk estimates between exposure groups.
RESULTS
The relative risk of gastrointestinal symptoms associated with exposure to K. septempunctata–infected P. olivaceus ranged from 71.2 (95% confidence interval [CI], 27.0 to 178.6) to 124.5 (95% CI, 43.5 to 355.0) across the 2 case definitions. A strong and statistically significant association was observed between exposure to K. septempunctata–infected P. olivaceus and the development of acute gastrointestinal symptoms.
CONCLUSIONS
These findings indicate both an association and a causal relationship between consumption of K. septempunctata–infected farmed P. olivaceus and the onset of gastrointestinal symptoms.; Summary

Korean summary
본 연구는 Kudoa septempunctata에 감염된 광어회 섭취가 위장관 증상과 연관되며, 감염 강도와 섭취량에 따라 증상의 중증도가 증가한다는 전향적 근거를 제시한다. 이러한 결과는 역학적 공백을 보완하며, 감시체계 강화와 예방 중심의 정책 마련의 필요성을 강조한다.

Key Message
This study provides prospective evidence that consumption of raw halibut infected with Kudoa septempunctata is associated with gastrointestinal symptoms, with the severity of symptoms increasing with the intensity of infection and the amount consumed. These results address a gap in epidemiological knowledge and highlight the need for strengthened surveillance systems and prevention-focused policies.

Fraction of cancer incidence and mortality attributable to dietary factors in Korea from 2015 to 2030: Hyun Jeong Cho, Jin Young Yoo, Ga-Eun Yie, An Na Kim, Soseul Sung, Sungji Moon, Youjin Hong, Sangjun Lee, Inah Kim, Kwang-Pil Ko, Sun-Seog Kweon, Jung Eun Lee, Sue K. Park; Epidemiol Health. 2025;47:e2025065. Published online December 8, 2025; DOI: https://doi.org/10.4178/epih.e2025065

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Dietary factors play an important role in modifying cancer risk. This study aimed to assess the proportion of cancer incidence and mortality in Korea attributable to dietary factors from 2015 to 2030.
METHODS
We estimated the population-attributable fraction (PAF) of cancer incidence and mortality using dietary intake levels, exposure rates, and relative risks (RRs). Intake and exposure rates were derived from the Korean National Health and Nutrition Examination Survey, assuming a 15-year latency. RRs were obtained from meta-analyses of Korean cohort and case- control studies.
RESULTS
In 2020, 6.08% of cancer cases and 5.70% of deaths in Korea were attributable to dietary factors. High salted vegetable intake (2.12% for incidence and 1.78% for deaths) and low intake of non-starchy vegetables and fruits (1.92 and 2.34%, respectively) were major contributors. However, high intakes of red meat and processed meat showed low PAFs, each less than 1%. The projected PAF for cancer attributable to high salted vegetable intake is expected to decrease substantially to 1.17% in 2030. In contrast, the PAF linked to low intake of non-starchy vegetables and fruits is projected to remain relatively stable.
CONCLUSIONS
Our findings provide evidence that dietary factors make a substantial contribution to cancer incidence and mortality in Korea. This study highlights that reducing salted vegetable intake and encouraging a diet rich in non-starchy vegetables and fruits may support cancer prevention efforts. Continuous monitoring of dietary trends remains crucial for reducing the cancer burden.; Summary

Korean summary
2020년 기준으로 식이 요인은 암 발생과 사망의 일정 비율을 차지하였으며, 여러 식이 요인 중에서는 염장채소의 높은 섭취와 비전분 채소 및 과일의 낮은 섭취가 상대적으로 높은 기여를 보였다. 이러한 결과는 식이 요인별 암 부담의 차이를 이해하고, 향후 식이 섭취 양상에 대한 지속적인 관찰과 공중보건적 검토의 필요성을 시사한다.

Key Message
In 2020, dietary factors accounted for a proportion of the cancer burden, with high intake of salted vegetables and low intake of non-starchy vegetables and fruits showing the largest contributions among dietary factors examined. These findings suggest the need for continued assessment of dietary patterns and their potential relevance in public health discussions on cancer prevention.

Preventable cancer cases and deaths attributable to alcohol consumption 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, Seungho Ryu, Sun Young Yang, Seung Ho Choi, Jeongseon Kim, Sang-Wook Yi, Yoon-Jung Choi, Youjin Hong, Sangjun Lee, Woojin Lim, Kyungsik Kim, Sohee Park, Jeong-Soo Im, Hong Gwan Seo, Kwang-Pil Ko, Sue K. Park; Epidemiol Health. 2025;47:e2025009. Published online February 27, 2025; DOI: https://doi.org/10.4178/epih.e2025009

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Alcohol consumption is causally linked to several cancers, and major health organizations classify it as a carcinogen. This study assessed the impact of alcohol consumption on cancer incidence and mortality in Korea in 2015 and 2020, projected trends up to 2030, and compared results based on different criteria.

METHODS

The relative risk of cancer associated with alcohol consumption in Korea was determined through a meta-analysis of alcohol-related relative risks for specific cancers, using primary data from the Korean Cohort Study within the Korean Cohort Consortium. The population-attributable fraction (PAF) was calculated using Levin’s formula, incorporating drinking prevalence and the number of cancer cases and deaths, with a 15-year latency period assumed.

RESULTS

In Korea, the PAF for alcohol consumption, based on ever/never drinking criteria, was higher than that calculated using other criteria, except for the PAF based on past and current/never drinking criteria. Alcohol consumption contributed to 3.58% of all cancer cases and 3.28% of cancer deaths in 2015. It accounted for 4.58% of new cancer cases in male and 2.08% in female, with a higher contribution to incidence than mortality (4.00 and 2.25% of cancer deaths in male and female, respectively). Projections indicate that alcohol-related cancer PAF will decrease by 17.2% in male but increase by 70.2% in female by 2030.

CONCLUSIONS

This study highlights the impact of alcohol consumption on cancer in Korea, emphasizing the need for sex-specific regulations to address sex differences.

Summary

Korean summary
2015년 알콜 섭취는 한국에서 전체 암 발생의 3.58%, 암 사망의 3.28%를 차지했으며, 남성(4.58%)이 여성(2.08%)보다 더 큰 영향을 받았음. 2030년까지 남성의 알콜 관련 암 발생률은 감소할 것으로 예상되지만, 여성에서는 급증할 것으로 보임. 이러한 결과는 특히 여성에서 증가하는 추세를 반영하여 성별 맞춤형 공공 보건 정책의 필요성을 시사함.

Key Message
In 2015, alcohol consumption was responsible for 3.58% of all cancer cases and 3.28% of cancer deaths in Korea, with a more significant impact on males (4.58% of new cases) than females (2.08%). Projections indicate a decrease in alcohol-related cancer cases among males but a sharp increase in females by 2030. These findings highlight the need for sex-specific public health measures to address the growing impact of alcohol on cancer, particularly the increasing trend in female cases.

Citations

Citations to this article as recorded by

Application and interpretation of attributable fraction measures from clinical practice to policy: a narrative review
Sue Kyung Park
Journal of the Korean Medical Association.2026; 69(5): 411. CrossRef

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, Seungho 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;47:e2025008. Published online February 27, 2025; DOI: https://doi.org/10.4178/epih.e2025008

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Abstract Summary PDF Supplementary Material

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 male and female. 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 male in 2015, 23.49% in male in 2020, 1.46% in female in 2015, and 1.68% in female in 2020. In both years, smoking impacted mortality more strongly than incidence in Korean male and female (incidence in male: 25.83% and 23.49%; mortality in male: 32.09% and 30.41%; incidence in female: 1.46% and 1.68%; and mortality in female: 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 female are required.

Summary

Korean summary
한국에서 흡연으로 인한 암 부담은 2015년 발생 14.32%, 사망 21.70%였고 2020년에는 발생 13.17%, 사망 20.69%로 나타남. 두 해 모두 남성에서 부담이 훨씬 컸음(남성: 발생 2015년 25.83%, 2020년 23.49%; 사망 2015년 32.09%, 2020년 30.41% / 여성: 발생 2015년 1.46%, 2020년 1.68%; 사망 2015년 4.70%, 2020년 4.96%). 흡연은 예방 가능한 주요 원인이므로, 여성의 취약성과 추세를 고려한 보다 강력한 금연·규제 정책 강화가 필요함.

Key Message
In Korea, tobacco smoking accounted for 14.32% of incident cancers and 21.70% of cancer deaths in 2015, and 13.17% of incidence and 20.69% of mortality in 2020. The burden was much greater in men than in women in both years (men: incidence 25.83% in 2015 and 23.49% in 2020; mortality 32.09% in 2015 and 30.41% in 2020; women: incidence 1.46% in 2015 and 1.68% in 2020; mortality 4.70% in 2015 and 4.96% in 2020). Smoking remains a preventable driver of substantial cancer incidence and mortality, calling for stronger control policies that also address emerging vulnerabilities among women.

Citations

Citations to this article as recorded by

Application and interpretation of attributable fraction measures from clinical practice to policy: a narrative review
Sue Kyung Park
Journal of the Korean Medical Association.2026; 69(5): 411. CrossRef

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, Seungho 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;47:e2025010. Published online January 27, 2025; DOI: https://doi.org/10.4178/epih.e2025010

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Abstract Summary PDF Supplementary Material

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/wk for the sex-specific MET criterion was higher than that calculated with <900 MET-min/wk for both incidence and mortality.

CONCLUSIONS

The risk of cancer associated with DPA is expected to rise in both male and female. Future research and strategies should emphasize the promotion of physical activity for cancer prevention, considering its significant implications for public health.

Summary

Korean summary
2015년 신체활동 부족(deficit in physical activity, DPA)에 의한 인구집단기여분율(population-attributable fraction, PAF)은 암 발생 0.42%(909건), 암 사망 0.68%(548건)였으며 2030년에는 각각 1.31%, 1.80%로 증가할 것으로 예측됨. 남녀 모두에서 DPA로 인한 암 부담이 증가하고 있으므로, 암 예방을 위한 신체활동 증진 전략을 강화할 필요가 있음.

Key Message
In 2015, deficit in physical activity (DPA) accounted for 0.42% of incident cancers (909 cases) and 0.68% of cancer deaths (548 deaths), with population-attributable fraction (PAF) values projected to rise to 1.31% for incidence and 1.80% for mortality by 2030. The cancer burden attributable to DPA is increasing in both sexes, underscoring the need to strengthen population-level physical-activity promotion for prevention.

Citations

Citations to this article as recorded by

Application and interpretation of attributable fraction measures from clinical practice to policy: a narrative review
Sue Kyung Park
Journal of the Korean Medical Association.2026; 69(5): 411. CrossRef

Cohort Profile

Korea Nurses’ Health Study and the health of reproductive-aged women: a cohort profile: Chiyoung Cha, Heeja Jung, Sue Kim, Jung Eun Lee, Kwang-Pil Ko, Eunyoung Cho, Hyun-Young Park, Joong-Yeon Lim, Bo Mi Song, Sihan Song, Soojin Park, Aram Cho; Epidemiol Health. 2024;46:e2024048. Published online April 30, 2024; DOI: https://doi.org/10.4178/epih.e2024048

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Abstract

The Korea Nurses’ Health Study (KNHS) is an ongoing, large-scale, prospective cohort study of women nurses, focusing on the effects of occupational, environmental, and lifestyle factors on the health of women. The first KNHS survey was performed in 2013-2014 (n=20,613). As of December 2023, 11 follow-up surveys have been conducted. Participants who were pregnant were asked to participate in the early pregnancy survey (n=2,179) and postpartum survey after giving birth (n=2,790). The main variables included socio-demographic, work-related, lifestyle, physical, mental, and women’s health factors. Blood, urine, and toenail samples were collected from a participant subgroup of the first survey (n=1,983). The subgroups of the second survey completed a food frequency questionnaire in 2019 (n=300) and 2021 (n=871). In 2020, a subgroup of the first survey answered a coronavirus disease 2019-related survey (n=975). To examine various health-related factors in young adults, new participants were added to the KNHS cohort in the 11th (n=1,000) and 12th (n=1,002) surveys. The KNHS cohort will help identify health and illness determinants in Korean women. Data can be accessed at https://coda.nih.go.kr/frt/index.do.

Summary

Korean summary
한국간호사건강연구(Korea Nurses’ Health Study, KNHS)는 2013년부터 수행되고 있는 대규모 전향적 추적관찰 코호트 연구이다. 본 연구는 질병력, 약물복용력, 임신력, 여성건강, 정신건강(우울, 스트레스, 피로 등), 생활습관(흡연, 음주, 신체활동, 수면 등), 근무특성을 조사하여 여성건강에 장기적으로 미치는 영향을 파악하고 한국 고유의 여성건강 결정요인을 도출하는 것을 목표로 한다.

Key Message
The Korea Nurses' Health Study (KNHS) is a large-scale, prospective cohort study that has been conducted since 2013. It measures various factors affecting reproductive-aged women, including disease history, medication usage, pregnancy, women's health characteristic, mental health (such as depression, stress, and fatigue), lifestyle characteristic (including smoking, drinking, and physical activity, sleep), and work-related characteristics. The study aims to understand the long-term impact on women's health and identify unique determinants of women's health specific to Korea.

Citations

Citations to this article as recorded by

Do physical activity, psychological health, and food group intake change in early pregnancy before and during COVID-19? A secondary analysis of cohort data from the Korea Nurses’ Health Study
Chiyoung Cha, Jung Eun Lee, Jin-hui Han
Women's Health Nursing.2025; 31(1): 22. CrossRef
Factors Affecting Nonresponse Among Female Participants in the Korea Nurses’ Health Study: Longitudinal Cohort Survey Study
Young Taek Kim, Chiyoung Cha, Gumhee Baek, Bohye Kim, Bo Mi Song, Joong-Yeon Lim, Hyun-Young Park, Juh Hyun Shin
JMIR Public Health and Surveillance.2025; 11: e68038. CrossRef

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