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Review
The evolution of sampling in epidemiology: from classical probability models to AI-enhanced recruitment and active learning
Sulaiman Abubakar Musa
Epidemiol Health. 2026;48:e2026019.   Published online May 5, 2026
DOI: https://doi.org/10.4178/epih.e2026019
  • 1,177 View
  • 29 Download
AbstractAbstract AbstractSummary PDF
Abstract
Sampling is a foundational element of epidemiological research because it determines the validity, efficiency, and generalizability of population-based inferences. Classical probability and non-probability sampling methods have long underpinned public health study design by providing robust frameworks for unbiased estimation and causal inference. However, the rapid expansion of digital health data, electronic health records, and large-scale online cohorts has exposed important limitations in these largely static sampling frameworks. This narrative review traces the evolution of sampling in epidemiology from traditional probability-based designs to contemporary artificial intelligence-enhanced recruitment strategies, with particular emphasis on active learning and adaptive sampling. By synthesizing classical statistical theory with emerging machine-learning approaches and recent methodological advances, this review argues that the future of epidemiological sampling lies in hybrid frameworks that preserve statistical rigor while leveraging algorithm-driven adaptability. Methodological opportunities, ethical risks, and implications for low-income and middle-income countries are critically examined.
Summary
Key Message
- Epidemiological sampling is evolving from static, design-based probability frameworks toward dynamic, AI-enhanced systems that improve efficiency and responsiveness in large-scale studies. - While classical sampling remains essential for inferential validity, integrating active learning and algorithmic recruitment enables researchers to prioritize high-information cases and navigate resource-constrained environments more effectively. - The future of the field lies in hybrid frameworks that combine statistical rigor with adaptive machine-learning strategies, provided these are supported by robust ethical governance to mitigate algorithmic bias and address health inequities.
Systematic Review
Confounding and the healthy worker survivor effect in studies of medical radiation workers: a systematic review of methodological approaches
Eun Jung Park, Kyoungyeol Yuk, Jaeho Jeong, Won Jin Lee
Epidemiol Health. 2026;48:e2026009.   Published online February 4, 2026
DOI: https://doi.org/10.4178/epih.e2026009
  • 4,785 View
  • 113 Download
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
Confounding and the healthy worker survivor effect (HWSE) represent major methodological challenges in epidemiology, particularly in studies of low-dose exposures, where effect sizes are small and risk estimates can be readily distorted by bias. This systematic review aimed to summarize the methods used to adjust for confounding and the HWSE in studies of medical radiation workers. We systematically searched PubMed and Embase for studies of medical radiation workers from inception through June 30, 2025. Studies reporting excess risk estimates for any health outcomes associated with occupational radiation exposure were included. Study selection followed the PECO (Population, Exposure, Comparator, Outcome) criteria, and data were synthesized descriptively. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in PROSPERO (CRD42024589851). Sixteen eligible studies from 3 countries were identified, all of which were rated as high quality. To control for confounding, regression was used in all studies, followed by stratification (62.5%) and restriction (18.8%). Age, sex, and birth year were adjusted for in all models, with smoking being the next most frequently controlled variable. To mitigate the HWSE, only a single approach, adjustment for employment characteristics, was identified, and it was applied in 3 studies (18.8%). No other approaches, including restriction or g-methods, were employed. Although confounding is generally addressed using conventional analytical approaches, the HWSE has rarely been considered in studies of medical radiation workers. More comprehensive strategies that explicitly account for the HWSE are needed to improve the validity of risk estimates, particularly in low-dose occupational studies.
Summary
Korean summary
교란 및 건강근로자 생존효과는 역학 연구에서 해결해야 할 중요한 과제이며, 특히 저노출 연구에서는 효과 크기가 상대적으로 작아 이러한 영향에 더욱 취약하다. 연구 결과, 의료방사선종사자 연구에서 교란은 회귀분석 및 층화와 같은 전통적인 방법을 통해 적절히 보정되고 있지만, 건강근로자 생존효과를 줄이기 위한 방법은 대부분의 연구에서 적용되지 않고 있다. 향후 역학 연구에서는 보다 정확한 위험도 평가를 위해 건강근로자 생존효과를 줄이기 위한 다양한 방법의 적용이 필요하다.
Key Message
Confounding and the healthy worker survivor effect (HWSE) are major methodological challenges in epidemiology, particu- larly in studies involving low-dose exposure. Although confounding is generally considered to have only a limited impact in occupational epidemiology, a variety of analytical methods have nonetheless been applied to control it. In contrast, the HWSE, despite being widely recognized as a major source of bias, has rarely been mitigated in practice. More comprehensive strat- egies that explicitly account for the HWSE are needed to improve the validity of risk estimates.

Citations

Citations to this article as recorded by  
  • Cardiovascular composite events and the healthy worker effect among noise-exposed workers: a retrospective cohort study
    Jiahui Liu, Qi Li, Jiamin Liu
    Frontiers in Public Health.2026;[Epub]     CrossRef
Original Article
Comparison of HIV characteristics across 3 datasets: the Korea HIV/AIDS Cohort Study prospective, retrospective, and national reporting system
Yunsu Choi, Jun Yong Choi, Bo Youl Choi, Bo Young Park, Shin-Woo Kim, Joon Young Song, Jung Ho Kim, Sang Il Kim
Epidemiol Health. 2024;46:e2024055.   Published online June 18, 2024
DOI: https://doi.org/10.4178/epih.e2024055
  • 16,136 View
  • 154 Download
  • 2 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The Korea HIV/AIDS Cohort Study has been conducted prospectively for 18 years. However, it faces limitations in representing the entire population of patients with human immunodeficiency virus (HIV) in Korea. To address these limitations and validate the study design, we analyzed characteristics across several HIV datasets.
METHODS
We compared epidemiological and clinical characteristics from 3 datasets: the Korea HIV/AIDS Cohort Study (dataset 1, n=1,562), retrospective cohort data (dataset 2, n=2,665), and the national HIV reporting system of the Korea Disease Control and Prevention Agency (KDCA) (dataset 3, n=17,403).
RESULTS
The demographic characteristics of age, sex, and age at HIV diagnosis did not differ significantly across datasets. However, dataset 3 contained a higher proportion of patients diagnosed after 2008 (69.5%) than the other datasets. Regarding transmission routes, same-sex contact accounted for a greater proportion of dataset 1 (59.8%) compared to datasets 2 (20.9%) and 3 (32.6%). The proportion of patients with CD4 T-cell counts below 200/mm<sup>3</sup> at HIV diagnosis was higher in datasets 1 (39.4%) and 2 (33.3%) compared to dataset 3 (16.3%). Initial HIV viral load measurements were not obtained for dataset 3.
CONCLUSIONS
The Korea HIV/AIDS Cohort Study demonstrated representativeness regarding the demographic characteristics of Korean patients. Of the sources, dataset 1 contained the most data on transmission routes. While the KDCA data encompassed all HIV patients, it lacked detailed clinical information. To improve the representativeness of the Korea HIV/AIDS Cohort Study, we propose expanding and revising the cohort design and enrolling more patients who have been recently diagnosed.
Summary
Korean summary
장기간 운영된 코호트 연구는 다양한 편향으로 인해 모집단의 대표성을 잃을 수 있다. 대표성을 높이기 위해서는 편향을 최소화하고 지속적으로 변화하는 임상 역학적 지침과 특성을 반영할 수 있어야 한다. 지난 18년간 운영된 한국 HIV/AIDS 코호트 연구에서는 코호트 연구 참여 기관에 방문하는 감염인 중 연구 참여자와 비참여자의 특성을 비교하고, 질병관리청 신고자료와의 분포를 비교한 결과, 코호트 연구에 참여하는 것만으로도 대상자 특성에 차이가 있음을 밝혔다. 이에 따라 편향을 최소화하고 대표성을 높일 수 있도록 코호트 연구 설계를 대대적으로 개편하고, 향후 지속될 연구 설계를 제안한다.

Citations

Citations to this article as recorded by  
  • Trends in cancer incidence among people with human immunodeficiency virus in South Korea: a nationwide National Health Insurance Service data-based study
    Yeon Jeong Jeong, Youn Jeong Kim, Sang Il Kim, Yoon Hee Jun, Boyoung Park, Yunsu Choi, Jun Yong Choi, Jung Ho Kim, Hyo Youl Kim, Jang Wook Sohn, Joon Young Song, Shin-Woo Kim, YeonJae Kim, Hee Jung Choi
    International Journal of Infectious Diseases.2026; 167: 108658.     CrossRef
  • 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
    Epidemiology and Health.2025; 47: e2025002.     CrossRef
  • 한국 HIV/AIDS 코호트 연구의 과거, 현재, 그리고 미래
    윤수 최, 윤정 김, 보영 박, 준용 최, 신우 김, 준영 송, 보율 최, 상일 김
    Public Health Weekly Report.2025; 18(50): 23.     CrossRef
Methods
Intervention meta-analysis: application and practice using R software
Sung Ryul Shim, Seong-Jang Kim
Epidemiol Health. 2019;41:e2019008.   Published online March 28, 2019
DOI: https://doi.org/10.4178/epih.e2019008
  • 42,396 View
  • 707 Download
  • 122 Web of Science
  • 112 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
The objective of this study was to describe general approaches for intervention meta-analysis available for quantitative data synthesis using the R software. We conducted an intervention meta-analysis using two types of data, continuous and binary, characterized by mean difference and odds ratio, respectively. The package commands for the R software were “metacont”, “metabin”, and “metagen” for the overall effect size, “forest” for forest plot, “metareg” for meta-regression analysis, and “funnel” and “metabias” for the publication bias. The estimated overall effect sizes, test for heterogeneity and moderator effect, and the publication bias were reported using the R software. In particular, the authors indicated methods for calculating the effect sizes of the target studies in intervention meta-analysis. This study focused on the practical methods of intervention meta-analysis, rather than the theoretical concepts, for researchers with no major in statistics. Through this study, the authors hope that many researchers will use the R software to more readily perform the intervention meta-analysis and that this will in turn generate further related research.
Summary
Korean summary
통계프로그램으로서의 R이 대세인 연구환경에서 R을 활용한 체계적인 메타분석 안내서가 요구되어지며 본 연구는 이에 대한 좋은 해답이 될 것이다. 더욱이 본 연구는 메타분석 (Intervention meta-analysis)의 이론과 더불어 R을 활용한 실습위주의 내용으로 구성되어져 있어 누구나 쉽게 실행할 수 있을 것이다. 본 연구를 통하여 많은 연구자들이 보다 쉽게 본인의 연구분야에 적용하여 관련 연구가 활성화되기를 바란다.

Citations

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    Journal of Midwifery & Women's Health.2026; 71(1): 26.     CrossRef
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    Seon‐Min Lee, Sung Ryul Shim, Yu Jin Jung, Taeho Greg Rhee, Kyum‐Yil Kwon
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    Journal of Movement Disorders.2026; 19(1): 67.     CrossRef
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    Euro-Mediterranean Journal for Environmental Integration.2026;[Epub]     CrossRef
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    Jieun Shin, Taeho Greg Rhee, Seong-Jang Kim, Sung Ryul Shim
    Journal of Evidence-Based Practice.2026; 2(1): 1.     CrossRef
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    Roger S. McIntyre, Stephen M. Stahl, Sung Ryul Shim, Maurizio Pompili, Joseph F. Goldberg, Christoph U. Correll, Angela T. H. Kwan, Christine E. Dri, Heidi Xu, Maj Vinberg, Taeho Greg Rhee
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    JAMA Psychiatry.2026;[Epub]     CrossRef
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    Shreya Kulshreshtha, Sujata Satapathy, Rajesh Sagar, Renu Sharma, Reeta Mahey
    Clinical Child Psychology and Psychiatry.2026;[Epub]     CrossRef
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    Claire A. Price, Debbie Cooke, Freda Mold, Nadia A. S. Smith, Martyn Winn, Agnieszka Lemanska
    Cancer Medicine.2026;[Epub]     CrossRef
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    Ruben De Groote, Edoardo Beatrici, Maria Peraire Lores, Stefano Puliatti, Marco Amato, Elio Mazzone, Rui Farinha, Artur Paludo, Claudia Collà Ruvolo, Eleonora Balestrazzi, Luigi Nocera, Carlo Andrea Bravi, Federico Piramide, Marco Paciotti, Adele Piro, Si
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    Yimei Zhang, Jie Gao, Xiaoshan Huang, Shasha Li, Mengqian Wu, Yiran Lin, Nikki G. Lobczowski
    Canadian Journal of Science, Mathematics and Technology Education.2026;[Epub]     CrossRef
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    Kleuber Arias Meireles Martins, Mariana Menezes Corcinio, Bruno Arias Meireles Martins, Giovana Menegucci, Isabela Coutinho Faria
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Review Article
A review of methods to estimate the visibility factor for bias correction in network scale-up studies
Aliakbar Haghdoost, Milad Ahmadi Gohari, Ali Mirzazadeh, Farzaneh Zolala, Mohammad Reza Baneshi
Epidemiol Health. 2018;40:e2018041.   Published online August 16, 2018
DOI: https://doi.org/10.4178/epih.e2018041
  • 25,570 View
  • 168 Download
  • 11 Web of Science
  • 6 Crossref
AbstractAbstract PDF
Abstract
Network scale-up is an indirect size estimation method, in which participants are questioned on sensitive behaviors of their social network members. Therefore, the visibility of the behavior affects the replies and estimates. Many attempts to estimate visibility have been made. The aims of this study were to review the main methods used to address visibility and to provide a summary of reported visibility factors (VFs) across populations. We systematically searched relevant databases and Google. In total, 15 studies and reports that calculated VFs were found. VF calculation studies have been applied in 9 countries, mostly in East Asia and Eastern Europe. The methods applied were expert opinion, comparison of NSU with another method, the game of contacts, social respect, and the coming-out rate. The VF has been calculated for heavy drug users, people who inject drugs (PWID), female sex workers (FSWs) and their clients, male who have sex with male (MSM), alcohol and methamphetamine users, and those who have experienced extra-/pre-marital sex and abortion. The VF varied from 1.4% in Japan to 52.0% in China for MSM; from 34.0% in Ukraine to 111.0% in China for FSWs; and from 12.0% among Iranian students to 57.0% in Ukraine for PWID. Our review revealed that VF estimates were heterogeneous, and were not available for most settings, in particular the Middle East and North Africa region, except Iran. More concrete methodologies to estimate the VF are required.
Summary

Citations

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  • A decade of change: trends in drug and alcohol use in Iran (2010–2019)
    Saiedeh Haji-Maghsoudi, Azam Rastegari, Ali Akbar Haghdoost, Ahmad Hajebi, Seyed Ebrahim Ghoddousi, Toktam Khojasteh Bojnourdi, Hamid Sharifi, Mohammad Reza Baneshi
    BMC Public Health.2026;[Epub]     CrossRef
  • An Empirical Comparison of a Traditional Strategy and Network Scale-Up Method for Prevalence Estimation of Child Trafficking in Sierra Leone
    Hui Yi, Kyle Vincent, David Okech, Jody Clay-Warner, Jiacheng Li, Tenshi Kawashima, Timothy G. Edgemon, Lydia Aletraris, Fred Hassan Konteh
    Crime & Delinquency.2025; 71(5): 1558.     CrossRef
  • Estimating the Social Visibility of Abortions in Uganda and Ethiopia Using the Game of Contacts
    Margaret Giorgio, Solomon Shiferaw, Fredrick Makumbi, Assefa Seme, Simon Peter Sebina Kibira, Sarah Nabukeera, Selena Anjur‐Dietrich, Mahari Yihdego, Niguse Tadele, Elizabeth Sully
    Studies in Family Planning.2024; 55(4): 291.     CrossRef
  • Thirty Years of The Network Scale-up Method
    Ian Laga, Le Bao, Xiaoyue Niu
    Journal of the American Statistical Association.2021; 116(535): 1548.     CrossRef
  • Using Social Networks to Estimate the Number of COVID-19 Cases: The Incident (Hidden COVID-19 Cases Network Estimation) Study Protocol
    Honoria Ocagli, Danila Azzolina, Giulia Lorenzoni, Silvia Gallipoli, Matteo Martinato, Aslihan Acar, Paola Berchialla, Dario Gregori
    International Journal of Environmental Research and Public Health.2021; 18(11): 5713.     CrossRef
  • Novel approaches to estimating abortion incidence
    Gilda Sedgh, Sarah C. Keogh
    Reproductive Health.2019;[Epub]     CrossRef
Brief Communication
Relationship between shipping amounts of olive flounder aquacultured from Jejudo and the reported events of acute food poisoning by Kudoa septempunctata in 2015, South Korea: an ecological study
Jong-Myon Bae
Epidemiol Health. 2017;39:e2017041.   Published online September 6, 2017
DOI: https://doi.org/10.4178/epih.e2017041
  • 26,278 View
  • 236 Download
  • 3 Web of Science
  • 4 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Confirmation of <i>Kudoa septempunctata</i> (<i>K. septempunctata</i>) as the pathogenic agent causing acute food poisoning remains under debate owing to inconsistencies in the reproducibility of experimental evidence. Higher intake of olive flounder infected with <i>K. septempunctata</i> would result in increased diagnosis of food poisoning by <i>K. septempunctata</i>, if the latter was one of the causal agents of acute food poisoning. The aim was to evaluate the relationship between the shipping amount of olive flounder aquacultured from Jejudo and the incidence of <i>K. septempunctata</i> food poisoning in 2015, Korea.
METHODS
Data of shipping amounts between March 2014 and February 2016 and of monthly reported events of <i>Kudoa</i> food poisoning were taken from Jejudo Fish-Culture Fisheries Cooperatives and Korea Centers for Disease Control and Prevention, respectively. Non-parametric correlation analyses were conducted.
RESULTS
Shipping amounts indicated the seasonal changes according to variation of consumption. Spearman’s rho and Kendall’s tau-a between the monthly shipping amounts and the reported events in 2015 were 0.39 (p=0.21) and 0.27 (p=0.20), respectively.
CONCLUSIONS
An independent relationship was noted between the shipping amount and the reported events, which contrasted with the claim that the virulence of <i>K. septempunctata</i> caused acute food poisoning.
Summary
Korean summary
질병관리본부가 보고한 2015년도 쿠도아 식중독 발생 사례의 월별 분포와, 같은 기간에 제주도 수산협동조합이 국내 시장에 제공한 출하량 간의 상관성 (correlation)을 알아보았을 때, 유의한 관련성이 없었다. 이는 칠성 쿠도아충이 급성식중독을 일으킨다는 주장을 의심케 하는 근거의 하나이다.

Citations

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  • Epidemiology of Kudoa septempunctata food poisoning in Japan from 2013 to 2023
    Yoshiro Hadano, Hirotake Mori, Yuichiro Tanaka, Aongart Mahittikorn, Satoshi Ohno
    Scientific Reports.2026;[Epub]     CrossRef
  • 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
    Epidemiology and Health.2026; 48: e2026003.     CrossRef
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    Jorge C. Eiras, Gyan Deb Barman, Sukanya Chanda, Ashis Kumar Panigrahi
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  • Additional experimental and epidemiologic studies for evaluating pathogenecity of Kudoa septempunctata should be needed
    Jong-Myon Bae
    International Journal of Food Microbiology.2018; 266: 222.     CrossRef
Method
Assessing measurement error in surveys using latent class analysis: application to self-reported illicit drug use in data from the Iranian Mental Health Survey
Kazem Khalagi, Mohammad Ali Mansournia, Afarin Rahimi-Movaghar, Keramat Nourijelyani, Masoumeh Amin-Esmaeili, Ahmad Hajebi, Vandad Sharif, Reza Radgoodarzi, Mitra Hefazi, Abbas Motevalian
Epidemiol Health. 2016;38:e2016013.   Published online April 10, 2016
DOI: https://doi.org/10.4178/epih.e2016013
  • 26,542 View
  • 270 Download
AbstractAbstract PDF
Abstract
Latent class analysis (LCA) is a method of assessing and correcting measurement error in surveys. The local independence assumption in LCA assumes that indicators are independent from each other condition on the latent variable. Violation of this assumption leads to unreliable results. We explored this issue by using LCA to estimate the prevalence of illicit drug use in the Iranian Mental Health Survey. The following three indicators were included in the LCA models: five or more instances of using any illicit drug in the past 12 months (indicator A), any use of any illicit drug in the past 12 months (indicator B), and the self-perceived need of treatment services or having received treatment for a substance use disorder in the past 12 months (indicator C). Gender was also used in all LCA models as a grouping variable. One LCA model using indicators A and B, as well as 10 different LCA models using indicators A, B, and C, were fitted to the data. The three models that had the best fit to the data included the following correlations between indicators: (AC and AB), (AC), and (AC, BC, and AB). The estimated prevalence of illicit drug use based on these three models was 28.9%, 6.2% and 42.2%, respectively. None of these models completely controlled for violation of the local independence assumption. In order to perform unbiased estimations using the LCA approach, the factors violating the local independence assumption (behaviorally correlated error, bivocality, and latent heterogeneity) should be completely taken into account in all models using well-known methods.
Summary
Methods
Meta-epidemiology
Jong-Myon Bae
Epidemiol Health. 2014;36:e2014019.   Published online September 25, 2014
DOI: https://doi.org/10.4178/epih/e2014019
  • 35,788 View
  • 212 Download
  • 14 Web of Science
  • 19 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
The concept of meta-epidemiology has been introduced with considering the methodological limitations of systematic review for intervention trials. The paradigm of meta-epidemiology has shifted from a statistical method into a new methodology to close gaps between evidence and practice. Main interest of meta-epidemiology is to control potential biases in previous quantitative systematic reviews and draw appropriate evidences for establishing evidence-base guidelines. Nowadays, the network meta-epidemiology was suggested in order to overcome some limitations of meta-epidemiology. To activate meta-epidemiologic studies, implementation of tools for risk of bias and reporting guidelines such as the Consolidated Standards for Reporting Trials (CONSORT) should be done.
Summary
Korean summary
질적연구는 보건의료의 복잡성을 이해하는데 매우 유용함에도 불구하고, 메타분석을 수행하는 체계적 고찰에서는 다루어지지 않는다. 그렇지만 보건의료의 질적 향상을 도모하려면 질적 연구의 결과를 보건의료 결정과정에서 반영해야 한다. 질적 연구 결과들을 합성하려는 여러 시도들이 있어온 것을 요약하고, 관련한 용어들을 정리하여 질적연구와 이를 합성하는 서술적 고찰이 활성화되는 바탕을 마련코자 한다.

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Note
Bias in Cancer Screening Evaluation.
Sang Heon Yoon, Hyeon Woo Yim, Won Chul Lee
Korean J Epidemiol. 2008;30(1):12-24.   Published online June 30, 2008
DOI: https://doi.org/10.4178/kje.2008.30.1.12
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AbstractAbstract PDF
Abstract
Cancer screening evaluation will be a important issue in Korea in near future. Bias in cancer screening evaluation is well known by concept, but it is not applied yet using the data from screening program of Korea. So introducing the way how the bias is adjusted will be helpful. This review deals with the type, meaning, the way how the bias is adjusted, and examples. Especially, lead-time bias, length bias and self-selection bias were focused. Adjusting bias is one of the imperative step for epidemiologic analysis. Understanding the background concept and experience using the screening program data will be helpful for estimating the effectiveness of national screening program of Korea.
Summary

Citations

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  • Evidence-based National Cancer Screening program of Korea
    Won-Chul Lee
    Journal of the Korean Medical Association.2011; 54(10): 1028.     CrossRef
Original Article
Reproducibility of information on cardiovascular risk factors and self-rated health status collected in the National Health Insurance Corporation health examination among 94,183 Korean military personnel.
Ki Ho Park
Korean J Epidemiol. 2005;27(2):51-60.
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AbstractAbstract PDF
Abstract
While health examination data from the National Health Insurance Corporation (NHIC) have been used by many researchers for investigating the risk factors of cardiovascular disease or cancer, most studies have used measurements made on a single occasion at the start of the study (baseline measurements only) or 2 initial measurements in the beginning of the study period for their analyses. This study was conducted to investigate the reproducibility of information on cardiovascular risk factors and self-rated health status collected in the NHIC health examinations by performing measurement and re-measurement data analysis techniques. A total of 94,183 military personnel, including commissioned and noncommissioned officers and public service workers, who had participated in both the 1998 and 2001 NHIC health examinations were included in this study. Reproducibility was excellent regarding height, weight, and body mass index. However, reproducibility was unsatisfactory for cardiovascular risk factors and self-rated health status. In particular, low reproducibility was exhibited for blood pressure and physical exercise in both men and women. This study emphasizes the importance of considering regression dilution biases when conducting studies for disease risk factors using large population cohort data.
Summary
Review
Bias related to Nutritional Epidemiology.
Won Chul Lee, Jin Hee Lee
Korean J Epidemiol. 2003;25(1):39-46.
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AbstractAbstract PDF
Abstract
Bias is the main problem that should be considered in epidemiologic research. Information bias caused by measurement error and confounding caused by total energy intake are listed as the main biases in nutritional epidemiology and the concept, fact and the methods for adjusting effects of these biases are discussed. The biases which can be caused during the nutritional epidemiologic research process are listed and discussed. The pros and cons of the continuous data and categorical data of the nutrients and the ways how to categorize the data are reviewed. During the analysis of food and nutrient data, multiple comparison and publication bias are prone to be encountered, and these should be considered in interpretation of the results. Understanding of the biases will lead us to make valuable nutritional epidemiologic research and these lead the application of the research results to control the prevalent noncommunicable diseases.
Summary
Original Articles
Outbreak of Salmonellosis Misdiagnosed with Amebiasis in Gumi City and Chilgok County, Korea.
Hyun Sul Lim, Geun Ryang Bae, Tai Soon Yong
Korean J Epidemiol. 2002;24(1):54-62.
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AbstractAbstract PDF
Abstract
PURPOSE
S: In May 29, 1999, the health department in Gumi city received a report from a local pediatrician that three children who attended a kindergarten were diagnosed with amebic dysentery. By May 31, fifteen more children from the same kindergarten were diagnosed with amebic dysentery. We conducted an investigation in order to verify the diagnosis, and to implement appropriate control measures.
METHODS
We conducted a questionnaire survey on 264 children in 3 kindergarten in Gumi city. Furthermore, 726 children in 4 kindergarten and 13 academies in Chilgok county whose lunch is supplied by the same unlicensed catering company were monitored for diarrheal symptoms.
RESULTS
Of 264 children in Gumi city, 74 children fitted the case definition (attack rate, 28%). Of 726 children in Chilgok county, 50 children were reported to have diarrheal symptoms. The clinical picture was dominated by the following symptoms; abdominal pain (85.1%), fever (83.8%), headache (50.0%), chilling (45.9%), vomiting (28.4%). The median duration of diarrhea was 2 days, and the median frequency of diarrhea was 3 times/day. Salmonella Typhimurium of the same antibiogram pattern were isolated from fifteen cases. However, no evidence of amebiasis was found from laboratory results or epidemiologic pattern.
CONCLUSIONS
: This epidemic was caused by Salmonella Typhimurium, which were present in lunch supplied by the unlicensed catering company. Improvement of the diagnostic ability in local health centers as well as public health centers and reinforcement of strict protocols regarding appropriate management of catering services should be emphasized
Summary
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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AbstractAbstract 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
Methodologic Considerations on the Cohort Study of Risk Factors of Stomach Cancer: On the Incompleteness of Case Ascertainment.
Moo Song Lee, Wee Chang Kang, Dong Hyun Kim, Jong Myun Bae, Myung Hee Shin, Young Jo Lee, Yoon Ok Ahn
Korean J Epidemiol. 1997;19(2):152-160.
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AbstractAbstract PDF
Abstract
BACKGROUND
AND PURPOSE: The authors conducted the study to evaluate the incompleteness of follow-up as well as the validity of the diagnostic code in the medical insurance databases in a cohort study. They also suggested several useful regression models for the analysis of such incomplete data.
METHODS
The subjects of Seoul Cohort(n=14,533) were followed up for three and a half years. Based on the chart reviews of the subjects who had the diagnostic code of gastric cancer in the medical insurance databases, forty-four cases of gastric cancer were idenfified, using cancer registry databases and death certificates as the secondary source. Regression coefficients and the associated p-values were estimated using the following six methods and the results were compared with each other. Method 1: The subjects with the diagnostic code in the medical insurance databases were considered as the cases of gastric cancer.
Method
2: The confirmed cases were considered as the cases of gastric cancer. Method 3: The cases were the subjects with the diagnositc code whose diagnosis was confirmed by medical chart reriew. Method 4: Ordinal logistic regression.
Method
5: Weighted logistic regression. Method 6: Polytomous logistic regression RESULTS: A total of 12,541 subjects were followed up excluding censored cases. One hundred and nine subjects were diagnosed with gastric cancer in the medical utilization databases: forty-three were probable cases whose dianosis was not confrimed by chart review, twenty-six were ruled out and 26 were confirmed cases. Another 14 cases were confirmed using the cancer registry and death certificates. Using the secondary sources, four another cases were confirmed and 44 cases were confirmed during follow-up. In method 1, past history of gastritis and gastric ulcer was significant risk factor whereas intake frequency of fresh vegetable, ice cream and coffee was associated with significantly decreased risk. In the second and the sixth method, green tea was a significant protective factor, whereas in methods 3-5, no significant variables were found.
CONCLUSIONS
Polytomous logistic regression was the preferred method in the cohort study using secondary sources of information for the follow-up, and it provided additional information for the risk factor identification, especially for the specificity of the risk factors.
Summary
Epidemiol Health : Epidemiology and Health
© Korean Society of Epidemiology.
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