Epidemiology and Health

Original Articles

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

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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

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
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.2024; : 1. CrossRef

Changes in the treatment rate of patients newly diagnosed with stage IV cancer near the end of life from 2012 to 2017 in Korea: Kyuwoong Kim, Hyun Jung Jho, So Jung Park, Bohyun Park, Jin Young Choi; Epidemiol Health. 2023;45:e2023021. Published online February 14, 2023; DOI: https://doi.org/10.4178/epih.e2023021

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study aimed to evaluate changes in the cancer treatment rate among patients newly diagnosed with stage IV cancer using socio-demographic and clinical subgroups in a nationwide cohort of Korean patients.
METHODS
This retrospective, national-level study used the Korea Central Cancer Registry (KCCR), which is linked to the National Health Insurance Service (NHIS) database, from January 1, 2012 to December 31, 2017. The records of patients newly diagnosed with stage IV of the 5 cancers with the highest cancer-related mortality rate were identified to analyze changes in the treatment rate. The main outcome examined in this study was the change in the cancer treatment rate between 2012 and 2017, as measured using the annual percent change (APC).
RESULTS
A total of 106,082 patients with newly diagnosed gastric, colorectal, liver, pancreatic, and lung cancers at the end of life (EoL) were identified from the KCCR-NHIS database. Of these patients, 76,533 (72.1%) received cancer treatment. Over the study period (2012-2017), the proportion of patients who received cancer treatment at EoL decreased by 8.3%, with an APC of -2.1% (95% confidence interval, -2.6 to -1.6). This declining trend of cancer treatment among patients with advanced cancer stage at EoL was consistent among socio-demographic and clinical subgroups.
CONCLUSIONS
The proportion of untreated patients with stage IV cancer is increasing in the Korea. For patients who are not undergoing standard cancer treatment near EoL, an alternative care plan, such as early palliative care, should be considered.; Summary

Korean summary
국민건강보험공단과 중앙암등록본부 자료를 활용하여 4기 암환자의 암 치료 비율 추이를 분석한 결과 2012년부터 2017년까지 위암, 대장암, 간암, 췌장암, 폐암으로 진단받은 4기 암환자들의 암 치료 비율의 연간비율변화는 8.3% 감소하는 것으로 나타났다. 이러한 결과는 인구사회학적 및 임상적 특성에 관계없이 일관되었다. 본 연구결과는 말기에 가까운 4기 암 환자들이 표준 치료를 받지 못하는 경우, 조기 완화의료와 같은 대안적인 계획을 고려할 필요가 있음을 시사한다.

Key Message
● Between 2012 and 2017, there was a significant decrease in the treatment rate among these patients, though most still received cancer treatment. ● Alternative clinical choices, such as the early utilization of hospice and palliative care, may improve quality of life and reduce the need for aggressive care for such patients.

Cause-specific mortality in Korea during the first year of the COVID-19 pandemic: Jinwook Bahk, Kyunghee Jung-Choi; Epidemiol Health. 2022;44:e2022110. Published online November 23, 2022; DOI: https://doi.org/10.4178/epih.e2022110

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Abstract

OBJECTIVES
This study aimed to examine the trends in total mortality between 1998 and 2020 and to compare the changes in a wide range of detailed causes of death between 2020 (i.e., during the coronavirus disease 2019 [COVID-19] pandemic) and the previous year in Korea.

METHODS

We used registered population and mortality data for the years 1998-2020 obtained from Statistics Korea. The age-standardized all-cause mortality rate and the annual percent change between 1998 and 2020 were determined. The rate ratio and rate difference of the age-standardized mortality rate between 2019 and 2020 were calculated.

RESULTS

The age-standardized all-cause mortality rate in Korea has been on a downward trend since 1998, and the decline continued in 2020. In 2020, 950 people died from COVID-19, accounting for 0.3% of all deaths. Mortality decreased for most causes of death; however, the number of deaths attributed to sepsis and aspiration pneumonia increased between 2019 and 2020 for both men and women. Age-specific mortality rates decreased or remained stable between 2019 and 2020 for all age groups, except women aged 25-29. This increase was mainly attributed to a higher number of suicide deaths.

CONCLUSIONS

This study shed light on the issues of sepsis and aspiration pneumonia despite the successful response to COVID-19 in Korea in 2020. Cases of death from sepsis and aspiration pneumonia should be identified and monitored. In addition, it is necessary to develop a proactive policy to address suicide among young people, especially young women.

Summary

Korean summary
1998년 이래 한국의 연령표준화 총사망률은 지속적으로 감소하였고, 이러한 경향은 코로나19 대유행 첫해인 2020년에도 관찰되었다. 대부분 사망원인별 사망률이 코로나19 대유행이후에도 감소하였으나, 패혈증 및 흡인성 폐렴으로 인한 사망자가 남성과 여성 모두에서 증가했다. 연령별 사망률에서는 25-29세 여성을 제외한 모든 연령대에서 2019년에 비해 2020년 사망률이 감소하거나 유지되었고, 25-29세 여성의 사망률 증가는 주로 자살 사망의 증가에 기인했다.

Key Message
During 1988-2020, the age-standardized all-cause mortality rate in Korea has been on a downward trend and the decline continued in 2020. In 2020, mortality decreased for most causes of death, however, the number of deaths attributed to sepsis and aspiration pneumonia increased between 2019 and 2020. Age-specific mortality rates decreased or remained stable between 2019 and 2020 for all age groups, except women aged 25-29. This was mainly attributed to increased suicide deaths.

Citations

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Suicide mortality rates in Japan before and beyond the COVID‐19 pandemic era
Motohiro Okada, Ryusuke Matsumoto, Eishi Motomura
Psychiatry and Clinical Neurosciences Reports.2024;[Epub] CrossRef
Temporal Fluctuations of Suicide Mortality in Japan from 2009 to 2023 Using Government Databases
Ryusuke Matsumoto, Eishi Motomura, Motohiro Okada
European Journal of Investigation in Health, Psychology and Education.2024; 14(4): 1086. CrossRef
Unraveling the impact of the COVID-19 pandemic on the mortality trends in Belgium between 2020–2022
Yessika Adelwin Natalia, Johan Verbeeck, Christel Faes, Thomas Neyens, Geert Molenberghs
BMC Public Health.2024;[Epub] CrossRef
Evaluation of the effect of the COVID-19 pandemic on the all-cause, cause-specific mortality, YLL, and life expectancy in the first 2 years in an Iranian population—an ecological study
Zahra Pirayesh, Seyed Mohammad Riahi, Ali Bidokhti, Toba Kazemi
Frontiers in Public Health.2023;[Epub] CrossRef

Data Profile

The Korea National Health and Nutrition Examination Survey data linked Cause of Death data: Sungha Yun, Kyungwon Oh; Epidemiol Health. 2022;44:e2022021. Published online February 9, 2022; DOI: https://doi.org/10.4178/epih.e2022021

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Abstract

The Korea National Health and Nutrition Examination Survey (KNHANES) is a national health survey that is conducted annually to assess the health and and health-related behaviors of Korean population. To utilize KNHANES data to studies of mortality risk factors, the Korea Disease Control and Prevention Agency (KDCA) constructed a database linking KNHANES data to cause-of-death statistics in Statistics Korea, made available to researchers since 2020. The KNHANES data were linked to the Cause of Death Statistics based on resident registration numbers for subjects aged 19 years or older who agreed to link the data. The linkage rate between 2007-2015 National Health and Nutrition Examination Survey and 2007-2019 Cause of Death Statistics was 97.1%. In the linked dataset, the total death rate was 6.6%, of which neoplasms accounted for the highest death rate (32.1%), followed by circulatory system disease (22.7%) and respiratory system disease (11.5%). The linked dataset was made available through the Research Data Center of the KDCA after a review of the research proposal, and will be made available after periodical updates.

Summary

Korean summary
1. 국민건강영양조사 자료가 사망 위험요인 규명 연구에 활용되도록 통계청의 사망원인통계와 연계자료 구축함 2. 2007~2015년 국민건강영양조사와 2007~2019년 사망원인통계의 연계율은 97.1%이었음 3. 국민건강영양조사-사망원인통계 연계자료는 2020년부터 연구자에게 질병관리청 내 학술연구자료처리실를 통해 제공되고 있음

Key Message
1. To utilize the Korea National Health and Nutrition Examination Survey (KNHANES) data to studies of mortality risk factors, the data were linked to the Cause of Death Statistics in the Statistics Korea. 2. The linkage rate between the 2007-2015 KNHANES and the 2007-2019 Cause of Death Statistics was 97.1%. 3. The Korea National Health and Nutrition Examination Survey data linked Cause of Death data have been provided to researchers through the Research Data Center in the Korea Disease Control and Prevention Agency (KDCA) since 2020.

Citations

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Risk of all-cause mortality is associated with multiple health-related lifestyle behaviors and does not differ between urban and rural areas in Korea
Seunghee Kim, Clara Yongjoo Park
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Journal of the Korean Neurological Association.2024; 42(4): 361. CrossRef
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Original Articles

A comprehensive study of deaths due to exposure to humidifier disinfectant in Korea: focusing on medical records, assessment of exposure to humidifier disinfectants, and causes of death: Yeong Jun Ju, Seungho Lee, Seungsoo Sheen, Dong-Woo Choi, Jong-Han Leem, Soon Young Lee; Epidemiol Health. 2021;43:e2021091. Published online November 1, 2021; DOI: https://doi.org/10.4178/epih.e2021091

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Abstract

OBJECTIVES
We aimed to determine the characteristics of the deceased victims of deaths caused by exposure to humidifier disinfectants, and present the distribution of the victims’ data submitted for damage application, demographic characteristics, imaging findings, characteristics of humidifier disinfectant exposure, and distribution of the causes of death.

METHODS

An integrated database of victims was established using the medical records data of 1,413 victims submitted during the application for death damage caused by exposure to humidifier disinfectants, and the demographic characteristics, medical records, imaging findings, exposure characteristics, and cause of death were examined.

RESULTS

The average numbers of data submissions of each applicant for death damage were 3.0 medical use records. A total of 608 (43.0%) victims had more than one finding of acute, subacute, or chronic interstitial lung diseases. The average daily and cumulative use times of the victims were 14.40 and 24,645.81 hours, respectively, indicating greater exposure in this group than in the survivors. The humidifier disinfectants’ components comprised polyhexamethylene guanidine (72.8%), chloromethylisothiazolinone/methylisothiazolinone (10.5%), other components (15.0%), and oligo-[2-(2-ethoxy)-ethoxyethyl] guanidine chloride (1.5%). The components’ distribution was 67.8% for single-component use, which was higher than that in the survivors (59.8%). The distribution of the causes of death were: respiratory diseases (54.4%), neoplasms (16.8%), and circulatory diseases (6.3%). Other interstitial lung diseases (65.5%) were the most common cause of death among those who died due to respiratory diseases.

CONCLUSIONS

Careful discussions of appropriate remedies should be conducted based on a comprehensive understanding of the characteristics of the deceased victims, considering their specificities and limitations.

Summary

Korean summary
가습기 살균제 사망 피해 신청자 들 중 건강피해를 인정받지 못한 신청자들이 여전히 많이 남아있으며 (약 40%), 피해판정의 복잡성과 다양한 이슈들이 산적해 있어 사망 피해 신청자들의 적정 구제를 위해 종합적인 특성파악을 바탕으로 세심한 관점에서의 검토가 필요하다. 특히, 가습기 살균제 사망 피해 신청자의 특수성과 피해구제의 제한점을 고려하여야 하며, 기계적인 건강피해 판정을 지양하고 사망 피해 신청자 중심의 세밀한 특성 파악을 바탕으로 다양한 전문가집단이 참여하는 종합적인 논의를 통해 적정구제를 이루어 나가야 함을 제안한다.

Key Message
Careful discussions of appropriate remedies should be conducted based on a comprehensive understanding of the characteristics of the deceased victims, considering their specificities and limitations.

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Polyhexamethylene Guanidine Phosphate Enhanced Procoagulant Activity through Oxidative-Stress-Mediated Phosphatidylserine Exposure in Platelets
Ju Hee Choi, Keunyoung Kim
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Jun Woo Kim, Hyung Sik Kim, Ha Ryong Kim, Kyu Hyuck Chung
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Metabolite analysis of 14C-labeled chloromethylisothiazolinone/methylisothiazolinone for toxicological consideration of inhaled isothiazolinone biocides in lungs
Jung Eun Park, Seung-Hun Ryu, Satoshi Ito, Hyunil Shin, Young-Hee Kim, Jongho Jeon
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Toxicity and Safety Analysis of Polyhexamethylene Guanidine: A Comprehensive Systematic Review
Ivan Ivanov, Daria Kirillova, Kenes Erimbetov, Denis Shatalov
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Journal of Korean Medical Science.2022;[Epub] CrossRef

The burden of infectious and cardiovascular diseases in India from 2004 to 2014: Kajori Banerjee, Laxmi Kant Dwivedi; Epidemiol Health. 2016;38:e2016057. Published online December 14, 2016; DOI: https://doi.org/10.4178/epih.e2016057

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Abstract PDF

Abstract

OBJECTIVES
In India, both communicable and non-communicable diseases have been argued to disproportionately affect certain socioeconomic strata of the population. Using the 60th (2004) and 71st (2014) rounds of the National Sample Survey, this study assessed the balance between infectious diseases and cardiovascular diseases (CVD) from 2004 to 2014, as well as changes in the disease burden in various socioeconomic and demographic subpopulations.

METHODS

Prevalence rates, hospitalization rates, case fatality rates, and share of in-patients deaths were estimated to compare the disease burdens at these time points. Logistic regression and multivariate decomposition were used to evaluate changes in disease burden across various socio-demographic and socioeconomic groups.

RESULTS

Evidence of stagnation in the infectious disease burden and rapid increase in the CVD burden was observed. Along with the drastic increase in case fatality rate, share of in-patients deaths became more skewed towards CVD from 2004 to 2014. Logistic regression analysis demonstrated a significant shift of the chance of succumbing to CVD from the privileged class, comprising non-Scheduled Castes and Tribes, more highly educated individuals, and households with higher monthly expenditures, towards the underprivileged population. Decomposition indicated that a change in the probability of suffering from CVD among the subcategories of age, social groups, educational status, and monthly household expenditures contributed to the increase in CVD prevalence more than compositional changes of the population from 2004 to 2014.

CONCLUSIONS

This study provides evidence of the ongoing tendency of CVD to occur in older population segments, and also confirms the theory of diffusion, according to which an increased probability of suffering from CVD has trickled down the socioeconomic gradient.

Summary

Citations

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Comparing the Effectiveness of Different Approaches to Raise Awareness About Antimicrobial Resistance in Farmers and Veterinarians of India
Garima Sharma, Florence Mutua, Ram Pratim Deka, Rajeshwari Shome, Samiran Bandyopadhyay, Bibek Ranjan Shome, Naresh Goyal Kumar, Delia Grace, Tushar Kumar Dey, Johanna Lindahl
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India’s Opportunities and Challenges in Establishing a Twin Registry: An Unexplored Human Resource for the World’s Second-Most Populous Nation
Ruby Dhar, Shweta Rana, Tryambak Pratap Srivastava, Arnab Nayek, Jai Bhagwan Sharma, Digjeet Kaur, Krishna R. Kalari, Harpreet Singh, Subhradip Karmakar
Twin Research and Human Genetics.2022; 25(3): 156. CrossRef
COVID-19 pandemic effects on the distribution of healthcare services in India: A systematic review
Nirav Nimavat, Mohammad Mehedi Hasan, Sundip Charmode, Gowthamm Mandala, Ghanshyam R Parmar, Ranvir Bhangu, Israr Khan, Shruti Singh, Amit Agrawal, Ashish Shah, Vishi Sachdeva
World Journal of Virology.2022; 11(4): 186. CrossRef
Temporal decomposition of life years lived with disability in India: a growing demographic concern
Kajori Banerjee, Srei Chanda, Laxmi Kant Dwivedi
BMC Public Health.2019;[Epub] CrossRef
Undernutrition and Overnutrition Burden for Diseases in Developing Countries: The Role of Oxidative Stress Biomarkers to Assess Disease Risk and Interventional Strategies
Francesca Mastorci, Cristina Vassalle, Kyriazoula Chatzianagnostou, Claudio Marabotti, Khawer Siddiqui, Ahmed Eba, Soueid Mhamed, Arun Bandopadhyay, Marco Nazzaro, Mirko Passera, Alessandro Pingitore
Antioxidants.2017; 6(2): 41. CrossRef

Risk factors for maternal mortality in the west of Iran: a nested case-control study: Jalal Poorolajal, Behnaz Alafchi, Roya Najafi Vosoogh, Sahar Hamzeh, Masoomeh Ghahramani; Epidemiol Health. 2014;36:e2014028. Published online November 8, 2014; DOI: https://doi.org/10.4178/epih/e2014028

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Abstract PDF

Abstract

OBJECTIVES
With a gradual decline in maternal mortality in recent years in Iran, this study was conducted to identify the remaining risk factors for maternal death.

METHODS

This 8-year nested case-control study was conducted in Hamadan Province, in the west of Iran, from April 2006 to March 2014. It included 185 women (37 cases and 148 controls). All maternal deaths that occurred during the study period were considered cases. For every case, four women with a live birth were selected as controls from the same area and date. Conditional logistic regression analysis was performed and the odds ratio (OR) and its 95% confidence interval (CI) were obtained for each risk factor.

RESULTS

The majority of cases were aged 20-34 years, died in hospital, and lived in urban areas. The most common causes of death were bleeding, systemic disease, infection, and pre-eclampsia. The OR estimate of maternal death was 8.48 (95% CI=1.26-56.99) for advanced maternal age (≥35 years); 2.10 (95% CI=0.07-65.43) for underweight and 10.99 (95% CI=1.65-73.22) for overweight or obese women compared to those with normal weight; 1.56 (95% CI=1.08-2.25) for every unit increase in gravidity compared to those with one gravidity; 1.73 (95% CI=0.34-8.88) for preterm labors compared to term labors; and 17.54 (95% CI= 2.71-113.42) for women with systemic diseases.

CONCLUSIONS

According to our results, advanced maternal age, abnormal body mass index, multiple gravidity, preterm labor, and systemic disease were the main risk factors for maternal death. However, more evidence based on large cohort studies in different settings is required to confirm our results.

Summary

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Study on the External Causes of Mortality In Korea.: Rim Hak Kim, Chul Hyun Nam, Gui Hee Kim, Sung Woo Kim; Korean J Epidemiol. 2001;23(2):64-74.

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Abstract PDF: Abstract
PURPOSE
This study was conducted to analysis the trends and states of external auses of mortality in Korea from 1985 to 1998.
METHODS
This study was based on data published in 1985-1998 from the annual report of cause of death statistics of National Statistical Office.
RESULTS
In the proportion of total death cases during 1985-1998, External causes of mortality was ranged from 11 percent to 15 percent. Death rate(per 100,000) of external causes of mortality(ECM) decreased recently from 85.7 in 1991 to 68.9 in 1998. Death rate of ECM in male was 2.6 times higher than that of female. Among total cases of ECM, the first leading cause of death was transport accidents. intentional self-harm was the second leading cause of death(26.8 percent in 1998). In trends of death rate(per 100,000) for ECM during 1885-1998, there were decreased for following causes of death; transport accidents, falls, accidental drowning and submersion, exposure to smoke, fire and flames, accidential poisoning by and exposure to noxious substances, Death rates of ententional self-harm and assault were increased during the periods. The age specific death rate increased with age for all ECM except for assault. The risk of death caused by ECM was higher in aged 65 and over than in ages 0-19 years among all ECM. The risk of death for male aged 65 and over were 6.9 times in transport accidents, 26 times in fall, 37 times in accidential poisoning by and exposure to noxious substances, and 18 times in intentional self-harm compared with 0-19 years. The risk of death for female aged 65 and over were 27 times in fall, 22 times in accidential poisoning by and exposure to noxious substances compared with 0-19 years. In seasonal variation of ECM cases for 1998. There was highest proportion in August(10.4 percent). The highest proportion by death seasion were winter(32.7 percent) in exposure to smoke, fire and flames, summer(27,7 percent) in fall, summer(52.4 percent) in accidental drowning and submersion, summer in 32.0 percent) in accidential poisoning by and exposure to noxious substances, spring(28.2 percent) in intentional self-harm, assault. and autumn(28.2 percent) in transport accidents.
CONCLUSION
Above results suggest that a preventive education program for safety accidents should be developed by considering gender and age of the objecties and seasons of the year.; Summary

A Comparison of Occupation, Education, and Cause of Death from National Death Certificates and Deaths Data Due to Workplace Injuries from WELCO in Korea.: Mia Son; Korean J Epidemiol. 2001;23(2):44-51.

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Abstract PDF: Abstract
PURPOSE
The variables (occupation, education, cause of death, age, and sex) on death certificates can be used for health related studies, however, there has been little research on health related studies using death certificates in Korea. Also, the validity of the values of these variables on death certificates is questionable in Korea. Therefore, we compared occupation, data obtained from WELCO(Korea Labour Welfare Corporation) between 1995 and 1997.
METHODS
WELCO data on deaths due to workplace injury between 1995-1997 were merged with data from NSO on deaths occurring during the same period, using social security numbers. Out of a total of 7,698 deaths due to workplace injury reported to WELCO between 1995 and 1997, final study population are linked to 6,513 deaths among aged 20-64 between 1995 and 1997. On linking the data sets, two different sources of data are cross-tabulated to determine the percentage of agreement. Expected agreement and Kappa index are also calculated.
RESULTS
The results are as follows : Some manual workers are promoted into the non-manual group in the national death data from the National Statistics Office. Educational groups are promoted or demoted between NSO and WELCO death data. The Kappa index for occupational group is 0.49 when the occupational groups are categorised as manual and non-manual workers. The Kappa index is 0.50 in the two-category classification for education : beyond and below university levels; 0.32 in the three-category classification : university, high-school and less than middle-school; 0.25 in the four category classification : university, high-school, middle-school and less than elementary school. The Kappa index is 0.69 for the three-category disease classification : injury, poisoning and certain other consequences of external causes (S00-T98, ICD10), disease of the circulatory system(I00-I99, ICD10) and other disease categories except the two-category classification. The Kappa index for the 5-year age band is 0.99. There is no disagreement for the sex.
CONCLUSIONS
The comparison between national workplace injury data and national death data and tells us that occupational and educational variables are not in the range of 'excellent agreement' suggested by Koch(1997). Our comparison study suggests strong prediction of random errors as well as systemic errors. As for the cause of death, injury and cardiovascular disease from the NSO data are well-matched with those from the WELCO workplace injury death data. However, this comparison may have a limitation as the present study is confined to comparing only the categories of infury and cardiovascular disease. This study suggests that national death data as well as workplace injury data need to be improved for use as health indicators in studies relating socio-economic factors and working conditions to mortality in Korea.; Summary

An Epidemiologic Study on Sudden Deaths of Cattle Occurred in Kyongju.: Hyun Sul Lim, Hae Kwan Cheong, Jung Ran Kim, Ik Jung Kim, Gyoung Yim Ha; Korean J Epidemiol. 2001;23(1):59-68.

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Abstract PDF: Abstract
PURPOSE
This study was conducted to provide the baseline data for the epidemiologic and microbiologic investigation for the etiology of sudden deaths of cattle in Sara-Ri, Seo Myun, Kyongju.
METHODS
This survey was performed between April 11 and 22, 1994. Epidemiologic investigation consisted of interview of the residents, as well as pathologic and microbiologic test on tissues and blood samples from cardiac puncture.
RESULTS
The dead numbers of cattle were 149 in 35 households during about 20 years. The cows(63.9%) were more than bulls(36.1%) and most of them were raised in playpen(95.7%). The first death occurred in 1974, and then number of deaths increased until 1994. Besides the age of cattle at death was over two years old (88.3%), most of them(69.4%) died within one hour after onset of noticeable symptom by the farmers. The most common symptom of cattle at death was 'sudden death after screaming(71.1%)' and 'seizure (33.3%)'. Colonies from blood of case 3 showed double hemolysis in blood agar plate. The microbiologic test results in the culture of Clostridium perfringens. The pathological features were characterized as most of renal tubules revealed coagulative necrosis. Some gram-positive bacilli are scattered in interstitium.
CONCLUSIONS
Above results suggest C. perfringens as a possible pathogen of this ourbreak in livestock. The possibility of human infection, although nonfatal, and lack of vaccination against C. perfringens raises a need for stronger preventive action toward this communicable disease of cattle on this village.; Summary

Actual Conditions and Pitfalls of Death Statistics Based on the Current Death Registration System in Korea.: Jin Ho Chun, Kyung Sook Lee; Korean J Epidemiol. 2000;22(2):124-135.

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Abstract PDF: Abstract
BACKGROUND
Death statistics is the most basic one among health-related statistics. This study was conducted to propose actual data to improve the quality of death statistics through a review of the contents of total registered death reports which are primary sources of death statistics.
METHODS
The author reviewed the recent regulations about the death registration and analyzed contents of the total 1,383 death certificates written out from January, 1998 to December, 1999 in a county of Kyungsangnamdo, Korea.
RESULTS
The two laws - the Family Registration Act and the Medical Act that mainly control death registration, and the two legal forms - death certificates and death report form that actually used were not accorded. This is a reason why there occurred frequent mistakes in the current death registration. Also, there was no way to correct the incomplete contents of death certificate primarily written by doctors. Among 1,383 death report cases, 83.9% of death was due to illness. The causes of the death were generally incredible; diverse expression even on the same disease, incorrect and inadequate expression, not standardized by standard classification of disease, and unwritten or 'unknown' especially in case of the intermediate underlying and underlying cause. The major place of death was home(67.8%) and medical facilities(22.3%). And, it considered that the welfare facilities should be added as one of the place of death. The proportion of the doctors' diagnosis for death was as high as 96.6%, however, the death certificates issued by a clinic had many problems in aspect of accuracy and completeness. In the time spent for the death report, 98.0% reported within the legal term of one month.
CONCLUSIONS
The authors propose the followings to improve the quality of death statistics. First of all, contents of the two laws should be unified. Secondly, concerns and professionalism of the personnel who deal with death registration are should be strengthened. Thirdly, the regular and reinforcing training for the doctors and the officials who issue the death certificates should be emphasized with consistent upgrade of the standard guidelines. Fourthly, the death reporting system should be qualified through the validation of the contents of the death report forms, i.e., checked by medical doctor or medical professionals in the Community Health Center in the process of the receipt, informing, and report.; Summary

An Epidemiologic Investigation on the Mode of Transmission of the Lethal Salmonellosis Outbreak in Hamyang County.: Jang Rak Kim, Sang Won Lee, Hong Bin Kim, Jin Cha, Kwang Hyun Lee, Kang Woo Bae; Korean J Epidemiol. 1999;21(2):185-194.

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Abstract PDF: Abstract
An outbreak of Salmonella enteritidis epidemic involving about 200 inpatients of gastroenteritis and 1 death occurred among about 750 participants from Hamyang County who attended 4 wedding lunch parties at one buffet restaurant on April 25, 1999. There were also many patients including 1 death among about 500 participants outside Hamyang County who attended same parties. Person to person interviews made to 155 inpatients revealed that distribution of incubation periods was between 1 to 34 hours with median time, 13-14 hours. A retrospective cohort study was conducted to investigate the mode of transmission. Telephone interviews were made to party participants (except 61 inpatients who already had been interviewed personally) on symptoms and on which they had eaten among 40 served foods including water at the parties and data among 288 persons were available for the analyses. One hundred and ninety one interviewees had more than two symptoms among symptoms of diarrhea(more than 3 times), abdominal pain, and fever, which gave an attack rate of 66.3%(191/288). The relative short incubation period and high attack rate suggested the presence of higher infecting dose in this epidemic. Logistic regression analysis revealed that the probable infective foods were boiled cockle, gamju, boiled midodok, fried rices, eomook, and boiled pig's trotter. Salmonella enteritidis were identified in the specimens of boiled cockle, cooked beef, and uncooked beef. Only boiled cockle was both an epidemiological and microbiological infective food. There might be cross-contaminations between several served foods, which meant presence of many contaminated foods by Salmonella enteritidis with different stage of their multiplications. Efforts to inspect food service areas and educate foodhandlers in good personal hygiene and proper foodhandling practices should be strengthened to reduce the incidences of salmonellosis in Korea.; Summary

A Time Series Analysis of the Death Rates and Rectangularization of the Survival Curve, 1970-2010.: Yong Gyu Park, Kyung Hwan Cho; Korean J Epidemiol. 1997;19(2):210-219.

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Abstract PDF: Abstract
As the population of senior people has been increased rapidly during the past 30 years in Koera, the health policy and related research in this field are strongly demanded to manage various problems which can be derived from the gerontic phenomenon. We estimated the death rates up to 2010 using the annual mortality data published by the National Statistical Office from 1970 to 1995 by time series analysis and calculated the survival curves, life expectancy by life table method with modified Graville's formular and proposed several measures which can be used in describing the theory of retangularization of survival curves and compression of mortality hypothesis. According to the results, the relative and absolute rectangularization and the convergency of survival curves were observed, and all the Keyfitz's H, NH, SD, and CV decreased while the life expectancy increased in the period of 1970 to 2010. So we conclude that the hypothesis of mortality compression suggested by Fries explains the changing pattern of aged population in Korea very well.; Summary

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