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4 "Yu Sun"
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Original Article
Cardiovascular disease risk disparities between immigrants and native Koreans: a population-based study in Gwangju, Korea
Jung-Ho Yang, Yerin Choi, Ran Lee, Seong Eun Kim, Kyung-Hwa Park, Seong-Woo Choi, BongKyu Sun, Kyunghak Kim, Sun-Seog Kweon
Epidemiol Health. 2025;47:e2025067.   Published online December 8, 2025
DOI: https://doi.org/10.4178/epih.e2025067
  • 4,454 View
  • 98 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Korea is becoming a multiethnic society, with immigrants comprising nearly 5% of the population. Evidence on cardiovascular disease (CVD) risk among immigrants remains limited.
METHODS
We conducted a population-based study of 582 immigrants in Gwangju and 2,328 age-matched and gender-matched native Koreans (2022-2023). Immigrant data were obtained from direct health assessments, while native Korean data were drawn from the Korea National Health and Nutrition Examination Survey. CVD risk was estimated using the Framingham risk score (FRS) and pooled cohort equations (PCE). Logistic regression was employed to compare the odds of elevated risk (10-year CVD risk ≥7.5%), adjusting for socio-demographic and behavioral factors.
RESULTS
Immigrants had a higher prevalence of hypertension (37.3 vs. 16.1%), diabetes (11.5 vs. 5.6%), poor self-rated health (69.6 vs. 61.3%), and unmet medical needs (30.9 vs. 8.9%), as well as lower rates of health checkups and cancer screening (all p<0.001), compared to native Koreans. Elevated CVD risk was more frequent in immigrants (FRS, 31.4 vs. 20.8%; PCE, 33.6 vs. 22.8%). The adjusted odds ratios (95% confidence intervals) were 1.47 (1.14 to 1.88) for FRS and 1.49 (1.07 to 2.08) for PCE. Disparities were greatest among women, adults ≥40 years, uninsured people, low-income groups, and migrants from Central Asia, Russia, and Africa.
CONCLUSIONS
Immigrants in Korea face substantially higher CVD risk than native Koreans, particularly within socioeconomically vulnerable subgroups. Targeted prevention and policies addressing structural barriers are urgently needed.
Summary
Korean summary
국내 거주 이민자는 한국인보다 불리한 건강 상태와 더 높은 심혈관질환 위험을 보였다. 특히 여성, 고령자, 저소득층 등 취약 집단에서 격차가 두드러졌으며, 이는 구조적·사회경제적 요인이 이민자 건강 불평등에 기여함을 보여준다. 이러한 결과는 포용적 보건의료 정책과 맞춤형 예방 전략 마련의 필요성을 시사한다.
Key Message
Immigrants in South Korea face unmet healthcare needs, such as limited screening access, low disease awareness, and undertreatment of dyslipidemia. Our study shows consistently higher cardiovascular risk among immigrants compared with native Koreans, especially among women, older adults, uninsured individuals, and Central Asian migrants. These findings underscore the epidemiological importance of structural and socioeconomic disadvantages in shaping immigrant health disparities and emphasize the need for culturally tailored interventions and inclusive health policies to achieve cardiovascular health equity.
Special Articles
Incidence and case fatality of stroke in Korea, 2011-2020
Jenny Moon, Yeeun Seo, Hyeok-Hee Lee, Hokyou Lee, Fumie Kaneko, Sojung Shin, Eunji Kim, Kyu Sun Yum, Young Dae Kim, Jang-Hyun Baek, Hyeon Chang Kim
Epidemiol Health. 2024;46:e2024003.   Published online December 26, 2023
DOI: https://doi.org/10.4178/epih.e2024003
  • 29,825 View
  • 332 Download
  • 16 Web of Science
  • 13 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Stroke remains the second leading cause of death in Korea. This study was designed to estimate the crude, age-adjusted and age-specific incidence rates, as well as the case fatality rate of stroke, in Korea from 2011 to 2020.
METHODS
We utilized data from the National Health Insurance Services from January 1, 2002 to December 31, 2020, to calculate incidence rates and 30-day and 1-year case fatality rates of stroke. Additionally, we determined sex and age-specific incidence rates and computed age-standardized incidence rates by direct standardization to the 2005 population.
RESULTS
The crude incidence rate of stroke hovered around 200 (per 100,000 person-years) from 2011 to 2015, then surged to 218.4 in 2019, before marginally declining to 208.0 in 2020. Conversely, the age-standardized incidence rate consistently decreased by 25% between 2011 and 2020. When stratified by sex, the crude incidence rate increased between 2011 and 2019 for both sexes, followed by a decrease in 2020. Age-standardized incidence rates displayed a downward trend throughout the study period for both sexes. Across all age groups, the 30-day and 1-year case fatality rates of stroke consistently decreased from 2011 to 2019, only to increase in 2020.
CONCLUSIONS
Despite a decrease in the age-standardized incidence rate, the total number of stroke events in Korea continues to rise due to the rapidly aging population. Moreover, 2020 witnessed a decrease in incidence but an increase in case fatality rates.
Summary
Key Message
This nationwide study using Korean National Health Insurance System data reveals a decade-long downward trend in overall stroke incidence rates. While the crude incidence rate showed a temporary increase from 2016 to 2019 before a slight decline in 2020, the age-standardized incidence rate consistently decreased over the study period. The study emphasizes the significance of continuous monitoring and preventive strategies to address stroke as a public health concern in Korea

Citations

Citations to this article as recorded by  
  • Nationwide Trends in the Incidence and Fatality of Acute Myocardial Infarction and Stroke in Korea, 2011–2023
    Jaewon Khil, Sojung Shin, Seojeong Shin, Jaeyong Lee, Minsung Cho, Na Yeon Ahn, Sang Gyeong Lee, Yeongchang Jo, Seng Chan You, Yeonhee Yoo, Seung-Jun Lee, Jang-Whan Bae, Min Kim, Kyu Sun Yum, Jang-Hyun Baek, Hokyou Lee, Hyeon Chang Kim
    Korean Circulation Journal.2027;[Epub]     CrossRef
  • Perceptions of Integrated Medical Service Among Stroke Patients in South Korea: Self-Reported Web-Based Survey Study
    Han-Gyul Lee, Woo-Sang Jung, Ho Geol Woo, Seungwon Kwon, Sung Hyuk Heo
    Journal of Multidisciplinary Healthcare.2026; Volume 19: 1.     CrossRef
  • Trends in Acute Care and Rehabilitation for First-Ever Stroke Patients: A 12-Year Perspective, the KOSCO Study
    Dae Hyun Kim, Min Kyun Sohn, Jongmin Lee, Deog Young Kim, Yong-Il Shin, Gyung-Jae Oh, Yang-Soo Lee, Min Cheol Joo, So Young Lee, Min-Keun Song, Junhee Han, Jeonghoon Ahn, Ho Seok Lee, Yun-Hee Kim, Won Hyuk Chang
    Journal of Korean Medical Science.2026;[Epub]     CrossRef
  • Herbal medicine evaluation for reimbursement-based post-stroke sequelae (HERB-PSS): a retrospective analysis using Korean health insurance claim data, 2020–2024
    Soo-Dam Kim, Man Young Park, Jiyun Cha, Changsop Yang, Eunbyul Cho, Sungha Kim
    Frontiers in Neurology.2026;[Epub]     CrossRef
  • Time-Dependent Association Between Breast Cancer and Risk of Ischemic Stroke
    Yong-Moon Mark Park, Wonyoung Jung, Bong-sung Kim, Minwoo Lee, Michael G. Fradley, Sindhu J. Malapati, Tasneem Z. Naqvi, Ronda S. Henry-Tillman, Jawahar L. Mehta, Kyungdo Han, Dong Wook Shin
    Neurology.2026;[Epub]     CrossRef
  • Effect of regular exercise on stroke prevention: an instrumental variables approach
    Wonseok Jeong
    BMC Public Health.2025;[Epub]     CrossRef
  • A Study on the Healthcare Workforce and Care for Acute Stroke: Results From the Survey of Hospitals Included in the National Acute Stroke Quality Assessment Program
    Jong Young Lee, Jun Kyeong Ko, Hak Cheol Ko, Hae-Won Koo, Hyon-Jo Kwon, Dae-Won Kim, Kangmin Kim, Myeong Jin Kim, Hoon Kim, Keun Young Park, Kuhyun Yang, Jae Sang Oh, Won Ki Yoon, Dong Hoon Lee, Ho Jun Yi, Heui Seung Lee, Jong-Kook Rhim, Dong-Kyu Jang, Yo
    Journal of Korean Medical Science.2025;[Epub]     CrossRef
  • Confidence-linked and uncertainty-based staged framework for phenotype validation using large language models
    Sumin Lee, Hyeok-Hee Lee, Hokyou Lee, Kyu Sun Yum, Jang-Hyun Baek, Jaewon Khil, Jaeyong Lee, Sojung Shin, Minsung Cho, Na Yeon Ahn, Seng Chan You, Hyeon Chang Kim
    Journal of the American Medical Informatics Association.2025; 32(8): 1320.     CrossRef
  • Association between triglyceride glucose-waist-adjusted waist index and incident stroke in Chinese adults: a prospective cohort study
    Yaqin Ye, Zhenyi He, Jingguo Wu, Junlin Wu, Yanbing Liang
    Frontiers in Nutrition.2025;[Epub]     CrossRef
  • G20 stroke burden 1990–2035: trends, projections and precision health insights
    Rongrong Chen, Xiangwen Li, Ruonan Zhao, Xufei Zhao, Lin Ma, Qi Miao, Rongqiang Zhang
    Neurological Sciences.2025; 46(11): 5863.     CrossRef
  • The Importance of Cost-Effectiveness in New Drug Approval: Stroke Burden and Tenecteplase Efficacy
    Hyuk Sung Kwon, Byung-Jo Kim
    Journal of Clinical Neurology.2025; 21(5): 363.     CrossRef
  • Clinical Practice Guideline for Stroke Rehabilitation in Korea—Part 2: Rehabilitation for Motor and Sensory Function (2024)
    Hyun Haeng Lee, Yong Wook Kim, Hyoung Seop Kim, Seung Nam Yang, Sun Im, Woo-Kyoung Yoo, Joon-Ho Shin, Min-Kyun Oh, Won-Seok Kim, Da-Sol Kim, Won Kee Chang, Seyoung Shin, Sekwang Lee, Doo Young Kim, Sung-Hwa Ko, Yeo Jun Yun, Yookyung Lee, Miyoung Choi, Suk
    Brain & Neurorehabilitation.2025;[Epub]     CrossRef
  • Explainable SHAP-XGBoost models for identifying important social factors associated with the atherosclerotic cardiovascular disease risk score using the LASSO feature selection technique
    Jungtae Choi, Jooeun Jeon, Hyoeun An, Hyeon Chang Kim
    Epidemiology and Health.2025; 47: e2025052.     CrossRef
Identification of acute myocardial infarction and stroke events using the National Health Insurance Service database in Korea
Minsung Cho, Hyeok-Hee Lee, Jang-Hyun Baek, Kyu Sun Yum, Min Kim, Jang-Whan Bae, Seung-Jun Lee, Byeong-Keuk Kim, Young Ah Kim, JiHyun Yang, Dong Wook Kim, Young Dae Kim, Haeyong Pak, Kyung Won Kim, Sohee Park, Seng Chan You, Hokyou Lee, Hyeon Chang Kim
Epidemiol Health. 2024;46:e2024001.   Published online December 26, 2023
DOI: https://doi.org/10.4178/epih.e2024001
  • 27,290 View
  • 305 Download
  • 13 Web of Science
  • 12 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The escalating burden of cardiovascular disease (CVD) is a critical public health issue worldwide. CVD, especially acute myocardial infarction (AMI) and stroke, is the leading contributor to morbidity and mortality in Korea. We aimed to develop algorithms for identifying AMI and stroke events from the National Health Insurance Service (NHIS) database and validate these algorithms through medical record review.
METHODS
We first established a concept and definition of “hospitalization episode,” taking into account the unique features of health claims-based NHIS database. We then developed first and recurrent event identification algorithms, separately for AMI and stroke, to determine whether each hospitalization episode represents a true incident case of AMI or stroke. Finally, we assessed our algorithms’ accuracy by calculating their positive predictive values (PPVs) based on medical records of algorithm-identified events.
RESULTS
We developed identification algorithms for both AMI and stroke. To validate them, we conducted retrospective review of medical records for 3,140 algorithm-identified events (1,399 AMI and 1,741 stroke events) across 24 hospitals throughout Korea. The overall PPVs for the first and recurrent AMI events were around 92% and 78%, respectively, while those for the first and recurrent stroke events were around 88% and 81%, respectively.
CONCLUSIONS
We successfully developed algorithms for identifying AMI and stroke events. The algorithms demonstrated high accuracy, with PPVs of approximately 90% for first events and 80% for recurrent events. These findings indicate that our algorithms hold promise as an instrumental tool for the consistent and reliable production of national CVD statistics in Korea.
Summary
Key Message
In this study, we developed algorithms to identify acute myocardial infarction (AMI) and stroke events from the Korean National Health insurance Service database. To validate them, we conducted retrospective review of medical records across 24 hospitals throughout Korea. The overall positive predictive values for the first and recurrent AMI events were around 92% and 78%, respectively, while those for the first and recurrent stroke events were around 88% and 81%, respectively.

Citations

Citations to this article as recorded by  
  • Nationwide Trends in the Incidence and Fatality of Acute Myocardial Infarction and Stroke in Korea, 2011–2023
    Jaewon Khil, Sojung Shin, Seojeong Shin, Jaeyong Lee, Minsung Cho, Na Yeon Ahn, Sang Gyeong Lee, Yeongchang Jo, Seng Chan You, Yeonhee Yoo, Seung-Jun Lee, Jang-Whan Bae, Min Kim, Kyu Sun Yum, Jang-Hyun Baek, Hokyou Lee, Hyeon Chang Kim
    Korean Circulation Journal.2027;[Epub]     CrossRef
  • Cardiovascular Risk Among Stroke Survivors With Combustible and Electronic Cigarettes: A Nationwide Study in Korean Men
    Joonsang Yoo, Jimin Jeon, Minyoul Baik, Yun Young Choi, Jinkwon Kim
    Journal of the American Heart Association.2026;[Epub]     CrossRef
  • Blood pressure status and risk of cardiovascular disease in older adults aged 75+ without prior cardiovascular events: a nationwide cohort study
    Sangwon Choi, Kyung-Do Han, Kyung-Ho Yu, Byung-Chul Lee, Mi Sun Oh, Dae Young Cheon, Minwoo Lee
    European Journal of Preventive Cardiology.2026;[Epub]     CrossRef
  • Geographic disparities in EVT access and stroke mortality under universal health coverage in South Korea
    Jeehye Lee
    BMC Health Services Research.2026;[Epub]     CrossRef
  • Postacute sequelae of SARS-CoV-2 infection on ophthalmic diseases: a binational cohort study
    Jee Myung Yang, Hayeon Lee, Jaeyu Park, Min Kim, Ho-Seok Sa, Joo Yong Lee, Kyung Rim Sung, Francesco Branda, Krishna Prasad Acharya, Dong Keon Yon
    British Journal of Ophthalmology.2026; : bjo-2025-328412.     CrossRef
  • Effect of a ≥50% Reduction in Low-Density Lipoprotein Cholesterol From Baseline in Patients With Ischemic Stroke
    Minyoul Baik, Jimin Jeon, Joonsang Yoo, Jinkwon Kim
    Neurology.2026;[Epub]     CrossRef
  • Constipation and risk of death and cardiovascular events in patients on hemodialysis
    Sang Cheol Park, Juyoung Jung, Young Eun Kwon, Song In Baeg, Dong-Jin Oh, Do Hyoung Kim, Young-Ki Lee, Hye Min Choi
    Kidney Research and Clinical Practice.2025; 44(1): 155.     CrossRef
  • Body Mass Index Changes and Femur Fracture Risk in Parkinson's Disease: National Cohort Study
    Sung‐Ho Ahn, Hye Sun Lee, Jun‐Hyuk Lee
    Journal of Cachexia, Sarcopenia and Muscle.2025;[Epub]     CrossRef
  • Confidence-linked and uncertainty-based staged framework for phenotype validation using large language models
    Sumin Lee, Hyeok-Hee Lee, Hokyou Lee, Kyu Sun Yum, Jang-Hyun Baek, Jaewon Khil, Jaeyong Lee, Sojung Shin, Minsung Cho, Na Yeon Ahn, Seng Chan You, Hyeon Chang Kim
    Journal of the American Medical Informatics Association.2025; 32(8): 1320.     CrossRef
  • Cardiovascular risk across blood pressure categories defined by the 2024 ESC and 2023 ESH hypertension guidelines: insights from a Korean nationwide cohort study
    Dae young Cheon, Kyung-do Han, Yeon Jung Lee, Jeen Hwa Lee, Myung Soo Park, Sook Jin Lee, Seongwoo Han, Jae Hyuk Choi, Minwoo Lee
    European Journal of Preventive Cardiology.2025;[Epub]     CrossRef
  • Cumulative Cardiovascular Health Score Through Young Adulthood and Cardiovascular and Kidney Outcomes in Midlife
    Jong Hyun Jhee, Kyoung Hwa Ha, Dasom Son, Hyeok-Hee Lee, Eun-Jin Kim, Hyeon Chang Kim, Hokyou Lee
    JAMA Cardiology.2025; 10(11): 1207.     CrossRef
  • Incidence and case fatality of stroke in Korea, 2011-2020
    Jenny Moon, Yeeun Seo, Hyeok-Hee Lee, Hokyou Lee, Fumie Kaneko, Sojung Shin, Eunji Kim, Kyu Sun Yum, Young Dae Kim, Jang-Hyun Baek, Hyeon Chang Kim
    Epidemiology and Health.2023; 46: e2024003.     CrossRef
Original Article
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
  • 22,719 View
  • 152 Download
  • 7 Web of Science
  • 7 Crossref
AbstractAbstract AbstractSummary PDFSupplementary 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.

Citations

Citations to this article as recorded by  
  • Associations of cognitive impairment and functional limitation with all-cause mortality risk in older adults: A population-based study from the National Health and Nutrition Examination Survey
    Wenxiu Zhu, Xuyan Zhao, Qingqin Xu, Yun Xue
    Applied Neuropsychology: Adult.2026; 33(2): 338.     CrossRef
  • Mortality and causes of death among long-term care residents in Helsinki, Finland 2017–2021, a longitudinal cohort study
    Lara Kuokkanen-Estrada, Hanna-Maria Roitto, Ulla L Aalto, Satu K. Jyväkorpi, Riitta K.T. Saarela, Hannu Kautiainen, Kaisu H Pitkälä
    Scandinavian Journal of Public Health.2026; 54(5): 522.     CrossRef
  • Epidemiological burden of Alzheimer's and Parkinson's diseases in East Asia: A comparative review of global burden of disease estimates and national registry data
    Sung-Pin Fan, Po-Chen Liu, Jing-Zhong Wang, Naing Naing Win, Chin-Hsien Lin, Hsien-Ho Lin
    Journal of the Formosan Medical Association.2026; 125: S5.     CrossRef
  • Dementia ascertainment source and place-of-death estimates in Taiwan: A nationwide linkage study
    Yu-Tai Lo, I-Ning Huang, Li-Jung Elizabeth Ku, Daphne I. Ling, Jing-Jy Wang, Yi-Ching Yang, Chung-Yi Li
    Annals of Epidemiology.2026; 123: 110269.     CrossRef
  • Trends in palliative care utilization among older adult decedents with and without cancer in Taiwan: a population-based comparative study
    Yu-Tai Lo, Tzu-Jung Chuang, Yu-Tung Huang, Yi-Lin Wu, Yi-Ching Yang, Chung-Yi Li
    The Lancet Regional Health - Western Pacific.2025; 55: 101479.     CrossRef
  • Dexmedetomidine and postoperative dementia risk in older patients
    Mingyang Sun, Shaihao Fu, Tian Mao, Wei Li, Shaoxuan Cai, Xiaojuan Xie, Wan-Ming Chen, Szu-Yuan Wu, Jiaqiang Zhang
    Age and Ageing.2025;[Epub]     CrossRef
  • 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
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