Epidemiology and Health

Perspective

Misattribution of Korea’s malaria elimination status in 1979: Roma Seol, Youngtaek Kim; Epidemiol Health. 2025;47:e2025070. Published online December 10, 2025; DOI: https://doi.org/10.4178/epih.e2025070

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Abstract Summary PDF: Abstract
This study aimed to trace the origin and propagation of the common but incorrect belief that the World Health Organization (WHO) declared Republic of Korea (ROK) malaria-free in 1979. We conducted a source-based historical review of WHO Weekly Epidemiological Record (WER), regional reports from WHO’s Western Pacific Regional Office (WPRO), United States Department of Defense (DoD) health reports, and scholarly and web-based citations. WHO WER 1981 identified the Democratic People’s Republic of Korea (DPRK) as one of the countries that had eliminated malaria by 1979. WHO/WPRO, to which ROK belongs, reported that malaria had not been eliminated in ROK as of 1980. Misinterpretations within United States DoD documents incorrectly attributed this certification to ROK, resulting in widespread citation errors across academic literature and online sources. The misattribution of DPRK’s elimination status to ROK derives from a misreading of WHO records and has persisted for decades through repeated, unverified citations. Strengthening source accuracy and citation practices is essential for ensuring reliability in global health reporting.; Summary

Korean summary
- WHO는 1979년에 대한민국을 말라리아 퇴치국으로 인증한 바 없으며, 해당 인증은 북한에만 적용되었다. - 이 잘못된 통념은 WHO 문헌의 오해석과 미국 국방부 문헌을 통한 반복 인용으로 학술 문헌과 온라인 자료 전반에 확산되었다.

Key Message
-The World Health Organization did not certify the Republic of Korea as malaria-free in 1979; this status applied exclusively to the Democratic People’s Republic of Korea. -This persistent misconception originated from misinterpretation of WHO records and was amplified through U.S. Department of Defense publications and repeated citations.

Original Articles

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

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Abstract Summary PDF: 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.

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: 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.

Dental implant removal rates and related factors in older adults in Korea: a cross-sectional study using National Health Insurance Sharing Service database: Hyang-Ah Park, A-Rang Lim, Jae-In Ryu; Epidemiol Health. 2025;47:e2025064. Published online December 3, 2025; DOI: https://doi.org/10.4178/epih.e2025064

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Abstract Summary PDF: Abstract
OBJECTIVES
Dental implants have been covered by the National Health Insurance for older adults in Korea since 2014. As the number of implant treatments has increased, the occurrence of related complications has also grown. While many clinical studies have examined mechanical and biological complications, few epidemiological studies using national data have identified population-level risk factors. This study aimed to determine the dental implant removal rate and related factors among older adults based on the Andersen Behavioral Model.
METHODS
A cross-sectional analysis was conducted using the National Health Insurance Service–National Sample Cohort. Logistic regression analyses were performed to identify factors associated with implant removal. Unadjusted and stepwise cumulative models were applied for predisposing, enabling, and need factors. All analyses were conducted using SPSS version 26.0, with statistical significance set at α=0.05.
RESULTS
The overall dental implant removal rate among older adults was approximately 0.4%. Higher removal rates were observed among males, those aged 65-69, current smokers, individuals with diabetes, and the self-employed group with higher income levels. Current smokers had 1.75 times higher odds of implant removal (95% confidence interval, 1.39 to 2.22) than non- smokers or former smokers.
CONCLUSIONS
Targeted education, management, and preventive interventions for high-risk groups, including smokers and patients with diabetes, are necessary to improve implant success and reduce complications. These findings provide population- based evidence to inform public health strategies that promote successful implant outcomes among older adults.; Summary

Korean summary
이 연구는 국가 단위의 빅데이터 코호트를 이용해 치과 임플란트 제거에 관해 시행한 선행 연구가 없었기 때문에 국가 빅데이터를 활용해 치과 임플란트 제거율과 관련 요인을 파악하기 위해 Anderson Model을 기반으로 다요인 분석을 실시하였다. 전체 치과 임플란트 제거율은 약 0.4%였으며, 남성, 젊은 연령, 건강보험 가입자, 상위 소득분위 자영업자, 당뇨병, 흡연, 유산소 신체 활동 실천자에서 더 높게 나타났다. 특히 현재 흡연자인 경우 치과 임플란트 제거율을 경험할 확률이 1.8배 높았다. 따라서, 치과 임플란트 시술의 성공률을 높이기 위해서는 위험요인에 대해 명시한 가이드라인 제작이 필수적이다.

Key Message
This study conducted a multifactorial analysis based on the Andersen model to identify factors associated with dental implant removal using national big data, addressing the lack of prior studies that examined these determinants sufficiently. The dental implant removal rate among all subjects was approximately 0.4%, and higher removal rates were observed among men, younger individuals, those receiving medical benefits, the self-employed group with higher income quintiles, and individuals with diabetes, smoking habits, or engagement in aerobic physical activity. Current smokers had a 1.8-fold higher probability of implant removal. These findings reinforce the importance of developing and implementing guidelines to increase the success rate of dental implants.

Associations between usual source of care characteristics and health outcomes in diabetes mellitus: a focus on medication adherence and healthy behaviors in Korea: Seung Eun Lee, Chul-Woung Kim, Ji Eun Bae, Jee Hyun Choi; Epidemiol Health. 2025;47:e2025063. Published online December 2, 2025; DOI: https://doi.org/10.4178/epih.e2025063

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Abstract Summary PDF: Abstract
OBJECTIVES
This study investigated the associations between usual source of care (USC) characteristics, which incorporate primary care functions, and medication adherence and healthy behaviors in Korean adults with diabetes.
METHODS
We used data from 1,543 adults with diabetes in the 2020 Korea Health Panel Survey. USC was categorized into 5 types based on whether a regular doctor was identified and whether that provider fulfilled comprehensiveness and coordination functions. Multivariable logistic regression was used to assess associations with medication adherence and healthy behaviors.
RESULTS
A significant difference in medication adherence was observed by USC type, although no significant associations emerged for healthy behaviors (smoking, drinking, exercise). Compared to the group without a USC, patients whose regular doctor fulfilled either function were 2.38 times more likely to adhere (odds ratio [OR], 2.38; 95% confidence interval [CI], 1.70 to 3.32), and those whose doctor fulfilled both functions were 1.84 times more likely to adhere (OR, 1.84; 95% CI, 1.31 to 2.59). This association was particularly strong for adherence to medication dosage, frequency, and timing.
CONCLUSIONS
The findings underscore that the functional quality of the USC, particularly the fulfillment of comprehensiveness and coordination, is crucial in improving medication adherence. Simply having a USC is insufficient. The lack of association with healthy behaviors suggests that physicians may focus more on pharmacological control, highlighting the need for multifaceted interventions.; Summary

Korean summary
본 연구는 단순히 주치의가 있는 것만으로는 당뇨병 환자의 복약 순응에 불충분하며, 일차 의료 기능을 충실히 수행하는 상용치료원만이 복약 순응과 유의한 관련이 있음을 입증했습니다. 하지만 상용치료원이 건강 행동 개선과는 관련이 없음을 확인하여, 의료진이 생활 습관 개선에는 영향을 주지 못하고 있음을 시사했습니다. 이러한 결과는 만성질환 관리를 개선하기 위해 상용치료원의 일차 의료 기능을 강화해야 한다는 정책적 근거를 제공합니다.

Key Message
This study shows that simply having a usual source of care (USC) is insufficient; only USCs that fully perform primary care functions are significantly associated with better medication adherence in diabetic patients. However, USC was not linked to improved health behaviors, suggesting providers fail to influence lifestyle changes. The findings provide policy evidence to reinforce the primary care functions of USCs to enhance chronic disease management.

The delayed cancer treatment and economic inequality in Korea: results of common cancers by the time-to-surgery: Noorhee Son, Woo-Ri Lee, Dong-Woo Choi, Kyu-Tae Han; Epidemiol Health. 2025;47:e2025056. Published online September 27, 2025; DOI: https://doi.org/10.4178/epih.e2025056

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Growing concerns regarding the concentration of cancer treatment in the capital city in Korea have raised questions about equitable access to timely and optimal patient care. In this study, we evaluated the impact of time-to-surgery (TTS) on healthcare utilization and outcomes, with the goal of providing policy recommendations for effective quality assessment of cancer care.
METHODS
This retrospective cohort study analyzed data from 2011 to 2021 obtained from National Health Insurance Service claims. A generalized estimating equation and a Cox proportional hazards model were applied to assess the effects of TTS on length of stay (LOS), medical costs, and 5-year mortality among patients diagnosed with lung, liver, and colorectal cancers. Subgroup analyses were conducted based on patients’ baseline economic status.
RESULTS
Among patients who underwent surgical treatment for lung, liver, or colorectal cancer, 20.4%, 11.4%, and 11.4% experienced treatment delays, respectively. Regardless of cancer type, longer TTS was associated with prolonged LOS and higher medical costs. Moreover, patients with extended TTS demonstrated an increased risk of 5-year mortality. Disparities by income level were evident, with greater differences observed in the lower-income group.
CONCLUSIONS
This study highlights the importance of timely surgical treatment for patients with cancer, particularly in relation to income-based disparities. These findings emphasize the need to improve Korea’s concentrated cancer care delivery system to enhance healthcare efficiency and address health literacy gaps affecting treatment by income level.; Summary

Korean summary
- 수술 환자의 약 10%~20%에서 치료 지연이 발생했다. - 수술까지 대기시간이 길수록 재원일수가 늘고, 의료비용이 증가하며, 5년 사망위험이 높았다. - 소득수준에 따른 격차가 확인되었고, 저소득층에서 불리한 영향이 더 크게 나타났다.

Key Message
- Among surgical patients, approximately 10–20% experienced treatment delays. - Longer time-to-surgery (TTS) was linked to prolonged length of stay (LOS), higher medical costs, and an increased 5-year mortality risk. - Income-level disparities were evident, with more pronounced adverse differences in lower-income groups.

Decentralized pandemic response and health equity: an analysis of socioeconomic disparities in COVID-19 mortality in Japan: Hasan Jamil, Aminu Abubakar Kende, Shuhei Nomura, Fumiya Inoue, Takao Suzuki, Stuart Gilmour; Epidemiol Health. 2025;47:e2025049. Published online August 28, 2025; DOI: https://doi.org/10.4178/epih.e2025049

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Global data often link greater socioeconomic deprivation to higher coronavirus disease 2019 (COVID-19) mortality. However, whether decentralized governance can mitigate this disparity by enabling tailored, equitable local responses remains unclear. We assessed whether Japan’s decentralized pandemic response moderated the association between area-level socioeconomic deprivation and COVID-19 mortality across municipalities.
METHODS
We analyzed 20,760 COVID-19 deaths from all Japanese municipalities during 2020-2021. We computed standardized mortality ratios using national age-specific and sex-specific rates to derive expected counts. We then fit a Bayesian spatial Poisson regression model with the log of expected counts as an offset to estimate smoothed relative risks (RRs). The Area Deprivation Index (ADI) represented the primary predictor; structured and unstructured random effects captured spatial correlation and residual variability.
RESULTS
Mapping of smoothed RRs, categorized into quintiles, revealed higher mortality risk in northern, central, and western municipalities, with lower risk in southern and scattered central regions. Contradicting global trends, deprivation and COVID-19 mortality demonstrated an inverse association (ADI coefficient, -0.095; 95% credible interval, -0.173 to -0.018), indicating that more deprived municipalities exhibited lower RRs for COVID-19 mortality (9.1% reduction per 1-unit increase in ADI).
CONCLUSIONS
The inverse relationship between area deprivation and COVID-19 mortality in Japan contrasts with global patterns. Although Japan’s decentralized health system ensured equitable access to COVID-19 treatment, lower mortality in more deprived areas likely reflects additional protective factors, including population density patterns and community-specific adaptations. These findings underscore the complex interplay between socioeconomic conditions and health outcomes during global health emergencies.; Summary

Key Message
Japan exhibited an inverse COVID-19 mortality pattern: 9% lower risk per unit increase in area deprivation, contrasting with patterns elsewhere. This occurred where universal healthcare access and decentralized public health infrastructure operated in a geographic context of rural, lower-density deprived areas. The convergence of health system characteristics, population distribution, and social factors likely produced this divergence from typical pandemic inequities.

Risk factors for Q fever incidence in Korea: a comparative analysis using frequentist and Bayesian methods: Ji-Hyun Son, Sung-Dae Park; Epidemiol Health. 2025;47:e2025046. Published online August 20, 2025; DOI: https://doi.org/10.4178/epih.e2025046

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Abstract Summary PDF: Abstract
OBJECTIVES
This study investigated the principal determinants of human Q fever incidence and explored regional variation between metropolitan cities and provinces in Korea.
METHODS
Panel data on human Q fever incidence, livestock populations, and facility metrics were collected across 17 metropolitan cities and provinces from 2017 to 2024. Analytical approaches included frequentist models (ordinary least squares [OLS], random effects [RE], fixed effects [FE]) and Bayesian models.
RESULTS
Frequentist panel analysis indicated that slaughterhouse count was positively associated with Q fever incidence in both pooled OLS (β=1.20, p<0.001) and RE models (β=1.03, p<0.001), but not in the FE model (β=0.14, p=0.65). After correcting for serial correlation using Driscoll-Kraay standard errors, livestock population (β=0.55, p<0.01), livestock market count (β=-2.01, p<0.05), and livestock Q fever cases (β=-0.11, p<0.01) were significantly associated with human incidence. A Bayesian FE model confirmed a significant relationship between slaughterhouses and human Q fever incidence (posterior mean: 0.87; 95% credible interval [CrI], 0.21 to 1.42), providing more stable inference with limited samples and allowing probabilistic uncertainty estimation. A Bayesian hierarchical model revealed a stronger association in metropolitan cities (posterior mean, 1.46; 95% CrI, 0.34 to 2.57) than in provinces (1.22), while livestock population remained significant in provinces (0.94; 95% CrI, 0.15 to 1.74).
CONCLUSIONS
In Korea, slaughterhouse density was the main determinant of Q fever in metropolitan cities and livestock density was the primary risk factor in provinces. These findings underscore the need for region-specific preventive strategies and reinforce the value of a One Health approach.; Summary

Korean summary
본 연구는 대한민국 내 큐열(Q fever) 발생의 주요 위험 요인이 지역별로 다르다는 것을 규명하였다. 광역시(metropolitan cities)에서는 도축장 밀도가, 도(provinces)에서는 가축 사육 밀도가 사람에서 큐열 발생의 주된 위험 요인으로 확인되었다. 이러한 결과는 사람, 동물, 환경의 건강을 통합적으로 고려하는 원헬스(One Health) 접근법에 기반하여 각 지역 특성에 맞는 예방 전략이 필요함을 강조한다.

Key Message
This study identified that the primary risk factors for Q fever in Korea vary by region. Slaughterhouse density was the main determinant of human Q fever incidence in metropolitan cities, whereas livestock density was the primary risk factor in provinces. These findings underscore the need for region-specific preventive strategies based on a One Health approach, which integrally considers human, animal, and environmental health.

Trends in sustainable dietary patterns in United States adults, 2007-2018: Sukyoung Jung, Heather A. Young, Barbara H. Braffett, Samuel J. Simmens, Eunice Hong Lim Lee, Cynthia L. Ogden; Epidemiol Health. 2025;47:e2025045. Published online August 18, 2025; DOI: https://doi.org/10.4178/epih.e2025045

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Adopting sustainable diets is essential for improving both human and planetary health, and such diets should be evaluated from a multidimensional perspective. We characterized trends in sustainable dietary patterns, quantified by the sustainable diet index for United States (SDI-US) adults, along with trends in diet quality, diet-related environmental impacts, food affordability, and food practices.

METHODS

This study analyzed data from the National Health and Nutrition Examination Survey (2007-2018) for adults aged ≥20 years (n=25,543). The SDI-US (range, 4-20 points), with higher scores indicating more sustainable diets, was calculated using 24-hour dietary recall data and responses to consumer and dietary behavior questionnaires. Mean total SDI-US scores, sub-indices, and 12 individual indicators were estimated for each survey cycle. Trends were assessed using orthogonal polynomial contrasts in regression models.

RESULTS

From 2007 to 2018, total SDI-US scores showed no significant overall trend (overall mean, 13.1). Nutritional and socio-cultural indicators remained relatively stable, whereas the economic indicator (food expenditures) worsened from 21.4% to 26.4% (p<0.05, linear trend) between 2007-2008 and 2017-2018. Environmental impacts initially worsened between 2007-2008 and 2013-2014 but improved through 2017-2018 (all p<0.05, quadratic trend). When stratified by age (p for interaction <0.001), a slight decline in SDI-US was observed among adults aged ≥60 years (14.1 to 13.9, p<0.001).

CONCLUSIONS

From 2007 to 2018, total SDI-US scores largely remained unchanged, although declines occurred among adults ≥60 years and scores remained lower among adults aged 20-39 years. Ongoing monitoring and coordinated improvements across all dimensions are needed to advance sustainable diets in all age groups.

Summary

Korean summary
- 본 연구는 미국 국민건강영양조사에 참여한 20세 성인 25,543명을 대상으로 세계식량기구의 다차원적 지속가능한 식이 지수(SDI-US)를 활용하여 12년간의 추이를 분석하였다. - 전체 SDI-US 점수는 전체적으로 큰 변화가 없었으나, 경제적 지표는 악화되고 환경 지표는 최근 개선을 보였고, 60세 이상 성인에서는 SDI-US 점수가 감소하였으며, 20-39세 성인에서는 낮은 수준이 유지되었다. - 지속가능한 식이로의 전환을 위해 지속적 모니터링과 연령대별 맞춤형 정책이 필요하다.

Key Message
Among 25,543 US adults aged 20 years and older, overall sustainable diet index (SDI-US) scores showed no significant change between 2007 and 2018. While food expenditure share worsened and environmental indicators recently improved, declines were observed among older adults (≥60 years) and lower scores persisted among younger adults (20–39 years). These findings highlight the need for ongoing monitoring and tailored strategies to promote sustainable diets across age groups.

Citations

Citations to this article as recorded by

From baseline expectations to high-barrier signals: Mapping Indonesian generation Z's sustainable food consumption through item response theory and motive-based segmentation
Kristia Kristia, Sándor Kovács, Nádasi Levente Sándor
Cleaner and Responsible Consumption.2026; 20: 100369. CrossRef

Association between psychosocial safety climate and depression risk among Korean workers: Soo Kyung Cho, Seong-Sik Cho, Maureen F. Dollard, May Young Loh, Mo-Yeol Kang; Epidemiol Health. 2025;47:e2025044. Published online August 13, 2025; DOI: https://doi.org/10.4178/epih.e2025044

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Abstract Summary PDF: Abstract
OBJECTIVES
Psychosocial safety climate (PSC) reflects an organization’s commitment to safeguarding workers’ psychological health and safety. While international evidence links low PSC to poor mental health outcomes, its association with depression has not been well established in Korea. This study aimed to examine the relationship between PSC and depression among Korean workers, utilizing a large-scale, population-based survey.
METHODS
We analyzed data from 5,337 wage employees who participated in the fifth wave of the Korean Work, Sleep, and Health Study. Depression was measured using the 9-item Patient Health Questionnaire, and PSC was assessed with a validated 4-item scale. Participants were classified into low-risk, intermediate-risk, and high-risk groups based on their PSC scores. Multivariable logistic regression was conducted to estimate the association between PSC and depression, with stratified analyses performed according to gender, age, and occupational characteristics.
RESULTS
The prevalence of depression increased as PSC scores decreased. Compared to the low-risk group, the intermediate-risk and high-risk PSC groups exhibited 1.19 times and 2.69 times higher risks of depression, respectively, suggesting a clear exposure-response relationship. Stratified analyses indicated that associations were stronger among individuals without union representation or access to occupational health and safety resources.
CONCLUSIONS
These findings underscore the critical role of PSC in workplace mental health. Promoting a high PSC may help reduce depression risk and support mental well-being among workers. Interventions considering vulnerable subgroups are warranted to create psychologically safer work environments in Korea.; Summary

Korean summary
-본 연구에서는 한국 근로자에서 심리사회적 안전풍토(PSC) 점수가 낮을수록 우울 위험이 유의하게 높아짐을 확인하였다. -PSC 중간위험군과 고위험군의 우울 위험은 저위험군에 비해 각각 1.19배, 2.69배 높았다. -연구 결과는 근로자의 정신건강 증진과 국가적 정책 수립을 위해 직장에서의 PSC 강화를 강조한다.

Key Message
-This study demonstrates that lower psychosocial safety climate (PSC) scores are associated with a significantly higher risk of depression among Korean workers. -The risk of depression was 1.19 times higher in the intermediate-risk PSC group and 2.69 times higher in the high-risk PSC group compared with the low-risk group. -Findings highlight the importance of strengthening PSC in workplaces to improve employee mental health and guide national policies.

Individual- and neighborhood-level factors influencing diet quality: a multilevel analysis using Korea National Health and Nutrition Examination Survey data, 2010-2019: Dahyun Park, Min-Jeong Shin, S V Subramanian, Clara Yongjoo Park, Rockli Kim; Epidemiol Health. 2025;47:e2025043. Published online August 4, 2025; DOI: https://doi.org/10.4178/epih.e2025043

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Although environmental factors influence lifestyle choices, few studies have examined how individual-level and neighborhood-level socio-demographic factors interact to affect diet quality in Korea. We investigated the associations between multilevel factors and diet quality among Korean adults and explored potential interactions by gender and age.
METHODS
We conducted a cross-sectional analysis of 42,035 adults from 1,671 towns using data from the Korea National Health and Nutrition Examination Survey (2010-2019) and the Population and Housing Census of Korea (2010-2019). Individual-level variables included gender, age, education, income, number of household members, smoking, drinking, physical activity, and subjective health status. Neighborhood-level variables included residential area, housing type, number of restaurants per capita, population size, and the proportion of low-income households and older adults. Associations with the Korean Healthy Eating Index (KHEI) were assessed using 2-level hierarchical models.
RESULTS
Of the total variance in KHEI, 5.2% was attributable to neighborhood-level differences. Individual-level factors explained 48.1% of variance at the neighborhood-level, while neighborhood-level factors accounted for an additional 12.4%. Individuals living in rural areas, non-apartment housing, neighborhoods with higher proportions of low-income households and older adults, or in areas with smaller populations, had lower KHEI scores than their counterparts. In random slope models with cross-level interaction terms, diet quality among adults aged 70 years and older varied significantly according to neighborhood- level characteristics.
CONCLUSIONS
Both individual-level and neighborhood-level factors influence diet quality in Korea, with older adults being especially vulnerable to neighborhood characteristics. Multilevel approaches are needed to identify at-risk populations and improve dietary outcomes.; Summary

Korean summary
한국에서 식이 질은 개인적 요인 뿐 만 아니라 지역사회 수준 요인에 의해서도 유의하게 영향을 받는다. 농촌 거주, 비아파트 주거, 저소득층 또는 고령 인구 비율이 높은 지역에 거주하는 경우 한국 건강식이 지수(KHEI) 점수가 낮게 나타났다. 특히 노인은 불리한 지역사회 환경에 더욱 취약하여, 젊은 성인보다 더 강한 교차 수준 상호작용을 보였다.

Key Message
Both individual- and neighborhood-level factors significantly influence diet quality in Korea. Rural residence, non-apartment housing, and neighborhoods with higher proportions of low-income or elderly residents were associated with lower Korean Healthy Eating Index (KHEI) scores. Older adults were especially vulnerable to adverse neighborhood environments, show- ing stronger cross-level interactions than younger adults.

Can resident registration expiration statistics due to death be used for near-real-time mortality tracking? A validation study using 2023 data from Korea: Jin-Hwan Kim; Epidemiol Health. 2025;47:e2025042. Published online August 3, 2025; DOI: https://doi.org/10.4178/epih.e2025042

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Abstract Summary PDF: Abstract
OBJECTIVES
Real-time mortality tracking is essential for public health surveillance, especially during emergencies such as the coronavirus disease 2019 (COVID-19) pandemic. In Korea, delayed availability of vital statistics (VS) data has hindered timely mortality monitoring. This study evaluates whether National Administrative Data (NAD) on resident registration expiration due to death, provided by the Ministry of Interior and Safety, could serve as a reliable alternative for near real-time mortality surveillance.
METHODS
We compared mortality counts between VS and NAD for 2023 at multiple geographic levels (county, province, and nation) and across demographic strata (sex and age groups). The analysis was conducted in 3 stages: comparing overall mortality counts, analyzing county-level distributions, and assessing equivalence through correlation analyses, scatter plots, and density plots.
RESULTS
NAD showed strong agreement with VS at the national level, reporting only 0.4% more deaths overall (0.2% for male, 0.6% for female). Notable differences were observed in early childhood mortality, with NAD showing 16.8% fewer deaths for neonates (age 0) and 14.8% more for ages 1-4, as well as in monthly variations (5-9%). Correlation analyses indicated extremely high consistency between the 2 data sources across all geographic levels (correlation coefficients ≥0.999), especially at the national and provincial levels.
CONCLUSIONS
NAD provides a reliable alternative to VS for real-time mortality surveillance in Korea, providing comparable accuracy with much-improved timeliness. Although some variations are present in specific age groups and monthly trends, these can be addressed through appropriate analytical strategies. The recent availability of sex-specific and age-specific data in NAD since 2023 establishes it as a valuable infrastructure for mortality surveillance.; Summary

Korean summary
- 행정자료(NAD)는 통계청 사망통계(VS)와 높은 일치도를 보여 신속한 사망 감시체계 구축에 활용할 수 있다. - 2023년부터 NAD에 성별·연령별 정보가 포함됨에 따라, 한국의 공중보건 위기 대응을 위한 핵심적인 사망 감시 인프라로 발전할 수 있게 되었다.

Key Message
- National Administrative Data (NAD) demonstrates high concordance with Vital Statistics (VS), making it applicable for establishing rapid mortality surveillance systems. - With the inclusion of sex- and age-specific information since 2023, NAD has evolved into a critical mortality surveillance infrastructure for South Korea's public health emergency response.

Cohort Profile

The 2019 Rio Grande birth cohort: profile of a Brazilian 5-year study on mental health conditions: Rafaela Costa Martins, Francine dos Santos Costa, Cauane Blumenberg, Thais Martins-Silva, Romina Buffarini, Juraci Almeida Cesar, Christian Loret de Mola; Epidemiol Health. 2025;47:e2025039. Published online July 21, 2025; DOI: https://doi.org/10.4178/epih.e2025039

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Abstract Summary PDF Supplementary Material

Abstract

We established the 2019 Rio Grande birth cohort to investigate the life course epidemiology of mental health and its intergenerational transmission. In 2019, we systematically identified all hospital births in the city of Rio Grande, located in Southern Brazil. Mothers who delivered a singleton liveborn child were administered a standardized, face-to-face questionnaire. In 2020, we conducted 2 follow-up assessments (WebCOVID-19 1 and 2), a third in 2021-22 (WebCOVID-19-3), and a fourth in 2023-24 (WebPOST-COVID). Across these follow-ups, we collected data on socio-demographic, environmental, and behavioral factors pertaining to both mother and child, as well as maternal mental health. Child mental health and development were specifically evaluated during the fourth follow-up. At baseline, 2,051 mothers were interviewed. Response rates for the online follow-ups were 54.1%, 51.1%, 48.7%, and 34.6%, respectively. In WebCOVID-19-3, the highest prevalence rates for depression (34.7%) and anxiety (33.1%) were observed. This cohort provides novel insights into maternal mental health, child development, and post-coronavirus disease 2019 behaviors, emphasizing culturally specific risk factors. Our findings are based on both published and ongoing studies. Data may be requested upon reasonable request.

Summary

Key Message
The 2019 Rio Grande Birth Cohort is a prospective study that has been following over 2,000 mothers and their children since 2019. It is designed specifically to understand the intergenerational transmission of mental health problems. The cohort's unique design combines detailed face-to-face questionnaires at baseline with remote, web-based follow-ups, and serves as a comprehensive overview of the cohort's methodology, data collection instruments, and study design, demonstrating its potential to generate valuable insights into maternal and child health.

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Changes in habits among mothers during the period of social isolation due to COVID-19 in the municipality of Rio Grande, Rio Grande do Sul, Brazil
Jefferson Sales da Silva, Pâmela Moraes Volz, Rafaela Costa Martins, Francine dos Santos Costa, Cauane Blumenberg, Thais Martins Silva, Romina Buffarini, Lorena Goulart Vieira, Patricia Cota Lima, Zulema Mamani Condori, Caroline Lisset Dominguez Herido, C
Revista Brasileira de Epidemiologia.2025;[Epub] CrossRef

Original Articles

Health literacy in Korea: findings from the 2023 Korea National Health and Nutrition Examination Survey: Sunhye Choi, Yukyeong Kang, Hyejin Kim, Kyungwon Oh; Epidemiol Health. 2025;47:e2025037. Published online July 9, 2025; DOI: https://doi.org/10.4178/epih.e2025037

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Abstract Summary PDF

Abstract

OBJECTIVES
This study aimed to assess health literacy and identify vulnerable groups, providing a basis for developing health policies aimed at improving health literacy, using data from the 2023 Korea National Health and Nutrition Examination Survey (KNHANES).

METHODS

The health literacy measurement tool used in the 2023 KNHANES comprised a total of 10 items spanning the domains of disease prevention, health promotion, healthcare, and technology and resources. Health literacy was analyzed in relation to socio-demographic characteristics and major health behaviors among 5,906 adults aged 19 years or older, using the SAS program.

RESULTS

As of 2023, the overall prevalence of adequate health literacy among adults was 60.4%. Adequate health literacy was higher in women (62.2%) than in men (58.6%). Younger individuals exhibited higher levels of health literacy, with those aged 19–64 years at 65.9%, compared to only 40.3% among those aged 65 or older. Higher income and education levels were also associated with greater health literacy. Regarding health behavior characteristics, individuals practicing healthy lifestyles, such as non-smoking, engaging in physical activity, and undergoing health checkups, demonstrated higher health literacy than those who did not engage in such behaviors.

CONCLUSIONS

Six out of 10 Korean adults demonstrated adequate health literacy, but significant differences were observed according to socio-demographic characteristics (e.g., age and education) and health behaviors (e.g., smoking and physical activity). Tailored education and policy initiatives are necessary to improve health literacy, particularly targeting older adults, low-income groups, individuals with lower education, and those who do not practice healthy lifestyles.

Summary

Korean summary
2023년 국민건강영양조사를 통해 우리 국민의 건강정보이해능력을 처음으로 조사한 결과, 우리나라 성인 10명 중 6명은 적절한 건강정보이해능력을 갖고 있었다. 건강정보이해능력은 고령, 낮은 교육수준, 건강생활 비실천 등에서 낮아 취약군의 건강정보이해능력 향상을 위한 맞춤형 교육과 정보 제공 등 다양한 방안 모색이 필요하다.

Key Message
According to the results of the 2023 KNHANES—the first nationwide assessment of health literacy in Korea—6 out of 10 Korean adults had adequate health literacy. Diverse strategies—including targeted education and information provision—are needed to improve health literacy among vulnerable groups such as older adults, those with low education and individuals who do not practice healthy lifestyles.

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The Effects of Health Literacy, Social Support, and Health-Promoting Behaviors on Metabolic Syndrome Among Middle-Aged and Older Women Living in Rural Areas of Republic of Korea
Eun-Kyung Lee, Yong-Sook Eo
Healthcare.2025; 13(24): 3279. CrossRef

Associations of self-rated health, depression, and work ability with employee control over working time: Heejoo Ko, Seong-Sik Cho, Jaesung Choi, Mo-Yeol Kang; Epidemiol Health. 2025;47:e2025036. Published online July 8, 2025; DOI: https://doi.org/10.4178/epih.e2025036

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Abstract Summary PDF: Abstract
OBJECTIVES
Work-time control (WTC), defined as employees’ ability to influence their work schedules, is a crucial determinant of work-life balance and well-being. This study aims to evaluate the associations between WTC and health-related outcomes among Korean workers and examine potential effect modifications by working hours and shift work status.
METHODS
This study analyzed data from the 2024 wave of the Korean Work, Sleep, and Health Study, a nationwide panel study of workers aged 19 years to 70 years (n=5,195). WTC was measured using a 6-item scale, and participants were categorized into low (≤12) or high (>12) WTC groups. Outcomes included self-rated health (SRH), depression (measured by the Patient Health Questionnaire-9), and work ability (WA; measured by the Work Ability Index). Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for poor SRH, moderate-to-severe depression, and poor WA, adjusting for demographic and occupational variables. Subgroup analyses assessed effect modifications by working hours and shift work.
RESULTS
Higher WTC was associated with lower odds of poor SRH (OR, 0.73; 95% CI, 0.62 to 0.86), moderate-to-severe depression (OR, 0.71; 95% CI, 0.61 to 0.83), and poor WA (OR, 0.62; 95% CI, 0.46 to 0.84). These associations were significant among daytime workers but not shift workers. The protective effects of WTC were attenuated among workers whose working hours exceeding 52 hr/wk.
CONCLUSIONS
Higher WTC is associated with better health and work outcomes, emphasizing its importance for employee well-being. However, its benefits may be limited among shift workers and employees working excessive hours.; Summary

Korean summary
- 근로시간 통제권(WTC)이 높은 근로자는 주관적 건강상태가 더 좋고, 우울 위험이 낮으며, 근로능력이 높은 것으로 나타났다. - 이러한 보호 효과는 주간 근로자에서만 유의하였으며, 근로시간이 주 52시간을 초과할 경우 효과가 약화되었다.

Key Message
- Higher work-time control (WTC) was associated with better self-rated health, lower risk of depression, and improved work ability among Korean workers. - The protective effects of WTC were significant for daytime workers but not for shift workers, and benefits diminished when weekly working hours exceeded 52.

Occurrence rate and estimated economic burden of pulp and periapical disease treatment among Korean older adults: a national population-based retrospective study: Hyeonjeong Go, Masae Kuboniwa, Youn-Hee Choi; Epidemiol Health. 2025;47:e2025035. Published online July 3, 2025; DOI: https://doi.org/10.4178/epih.e2025035

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Abstract Summary PDF: Abstract
OBJECTIVES
Maintaining healthy dentition is essential for the overall health of older adults. Treatment of pulp and periapical disease (PPD) is crucial for preserving teeth. This study assessed the occurrence rate and economic burden of PPD treatment in an older Korean population.
METHODS
Data were obtained for adults aged ≥65 years from the Korean National Health Insurance Services from 2014 to 2018. The occurrence rate was defined as the proportion of individuals who received ≥1 PPD treatment. The economic burden was estimated using both direct and indirect expenditures, calculated from a societal perspective. Regression analysis was performed to evaluate yearly trends in occurrence rate and economic burden.
RESULTS
Direct costs, which included insured and non-insured medical expenses, ranged from US$13.79 million to US$10.47 million. Indirect costs, comprising transportation and time costs, ranged from US$0.89 million to US$0.80 million. Total costs declined from US$14.68 million to US$11.36 million. The occurrence rate of PPD treatment decreased significantly from 1.24% to 0.91% (p<0.05). The economic burden also demonstrated a statistically significant downward trend, with total PPD costs decreasing from 0.00099% to 0.00066% of Korea’s GDP, and from 0.63% to 0.30% of the annual total dental care benefit costs between 2014 and 2018 (p<0.05).
CONCLUSIONS
The occurrence rate and estimated economic burden of PPD treatment significantly decreased among older Korean adults from 2014 to 2018. Conservative approaches to tooth preservation contribute to more effective oral health policies and help reduce the economic burden of oral disease treatments in an aging society.; Summary

Korean summary
· 한국 노년층에서 치수 및 치근단 질환 치료의 발생률과 경제적 부담은 연구 기간 동안 통계적으로 유의미하게 감소했습니다. · 이러한 연구 결과는 보존적 치과 치료가 고령화 사회에서 구강 질환으로 인한 경제적 부담을 줄이는 효과적인 구강 보건 정책이 될 수 있음을 시사합니다.

Key Message
· The occurrence rate and economic burden of pulp and periapical disease (PPD) treatment among older Korean adults have shown a statistically significant decrease over the study period. · These findings suggest that conservative dental treatment can serve as an effective oral health policy for reducing the economic burden of oral diseases in an aging society.

COVID-19: Cohort Profile

Cohort profile: Cardiovascular Metabolic Etiological Research Center COVID-19 Mental Health Survey (CC-MHS): Sun Jae Jung, Dongkyu Lee, Ji Su Yang, Sunghyuk Kang, Hyejin Kim, Jeong Hyun Ahn, Yunseong Heo, Jieun Noh, Changhyun Kim, Hyeon Chang Kim; Epidemiol Health. 2025;47:e2025033. Published online June 30, 2025; DOI: https://doi.org/10.4178/epih.e2025033

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Abstract Summary PDF: Abstract
The Cardiovascular Metabolic Etiological Research Center COVID-19 Mental Health Survey (CC-MHS) is a comprehensive longitudinal cohort study investigating the mental health impact of the coronavirus disease 2019 pandemic by utilizing pre-existing baseline data from the Cardiovascular Metabolic Etiological Research Center cohort (2013-2018). This study assesses physical health, lifestyle changes, and mental health using validated tools, including the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and the PTSD Checklist for DSM-5, and evaluates a population of urban and suburban Korean participants across multiple dimensions. Through online surveys, the research identified gender-specific social support mechanisms, showing that men benefit from larger social networks, whereas women derive protective effects from stronger emotional connections. Key findings underscore complex interactions among demographic factors, psychological variables, and public health responses, especially in the context of vaccination attitudes and trust in pandemic management. The CC-MHS delivers critical insights into mental health trajectories during global health crises, offering valuable evidence for developing adaptive public health strategies and for understanding the intricate relationships between individual psychological resilience and broader societal health challenges.; Summary

Korean summary
본 CC-MHS 코호트는 팬데믹 이전 4,060명 대상 CMERC 기초자료 활용하였다 본 CC-MHS 코호트는 우울, 불안, PTSD 등 정신건강 평가를 7차례 추적조사하였다. 본 코호트에서는 성별 보호요인과 사회적 지지·신뢰의 중요성 규명하였다.

Key Message
In CC-MHS, we utilized pre-pandemic baseline data from 4,060 adults in the CMERC cohort. We conducted 7 waves of mental health surveys assessing depression, anxiety, PTSD, and resilience. In this cohort, we identified gender-specific protective factors and emphasized the importance of social support and trust.

Original Articles

Socioeconomic inequality in organized and opportunistic screening for breast cancer: results from the Korean National Cancer Screening Survey, 2009-2021: Yejin Ha, Xuan Quy Luu, Woorim Kim, Jae Kwan Jun, Mina Suh, Kui Son Choi; Epidemiol Health. 2025;47:e2025031. Published online May 30, 2025; DOI: https://doi.org/10.4178/epih.e2025031

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Breast cancer screening rates have increased since the introduction of the National Cancer Screening Program (NCSP) in Korea. However, it remains unclear whether socioeconomic inequalities have improved, particularly according to screening type. This study investigated inequalities in organized (government-led) and opportunistic (individually initiated) screening, stratified by education and income levels.
METHODS
Data were obtained from the Korean National Cancer Screening Survey, conducted annually from 2009 to 2021, involving approximately 1,700 women each year except in 2009. Trends were analyzed using joinpoint regression to calculate average annual percent changes (AAPCs). Socioeconomic inequalities were assessed using the slope index of inequality (SII) and relative index of inequality (RII).
RESULTS
Organized screening rates increased from 42.0% in 2009 to 60.2% in 2021 (AAPC, 1.9; 95% confidence interval [CI], 0.7 to 3.4), whereas opportunistic screening rates declined from 13.3% to 11.2% (AAPC, -5.4; 95% CI, -8.7 to -2.3). For organized screening, individuals with lower education levels exhibited higher participation, resulting in negative inequality indices (SII, -5.37%; RII, 0.80). No significant income-based inequality was found (SII, 1.60%; RII, 1.07). However, opportunistic screening demonstrated significant inequalities by both education (SII, 5.37%; RII, 1.92) and income (SII, 5.90%; RII, 1.96), with higher participation rates among more advantaged groups.
CONCLUSIONS
The NCSP has improved breast cancer screening rates and reduced income-related inequality in organized screening. However, educational and income-based inequalities persist in opportunistic screening. To reduce screening inequities, policy efforts are needed to further promote the NCSP, including improving program quality and providing financial support for follow-up examinations.; Summary

Korean summary
본 연구는 한국의 유방암 검진에서 검진 유형에 따른 사회경제적 불평등을 분석하였다. 국가 검진에서는 전체 수검률이 증가하고 소득 관련 불평등이 감소한 반면 개인 검진에서는 사회경제적 불평등이 여전히 존재하였다. 유방암 검진의 불평등을 줄이기 위해 지속적이고 집중적인 정책 노력이 필요하다.

Key Message
This study examined socioeconomic inequality in breast cancer screening in Korea by screening type. While organized screening has improved overall participation and reduced income-related inequality, socioeconomic inequalities remain in opportunistic screening. Continued and targeted policy efforts for the NCSP are necessary to further reduce inequality in breast cancer screening.

Mortality burden attributable to long-term exposure to fine particulate matter among older adults in Korea: Jongmin Oh, Jisun Myung, Changwoo Han, Hyun-Joo Bae, Soontae Kim, Yun-Chul Hong, Dong-Wook Lee, Youn-Hee Lim; Epidemiol Health. 2025;47:e2025028. Published online May 28, 2025; DOI: https://doi.org/10.4178/epih.e2025028

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study aimed to evaluate the association between long-term exposure to particulate matter with an aerodynamic diameter <2.5 μm (PM2.5) and cause-specific mortality among older adults in Korea, providing insights into the evolving public health burden in an aging society.
METHODS
We analyzed national insurance claims data spanning 2010-2019. Modeled PM2.5 concentrations were assigned to participants according to their residential districts. We employed time-varying Cox proportional hazard models, using age as the time scale, adjusted for potential confounders. Six cause-specific mortalities were considered: ischemic heart disease (IHD), stroke, chronic obstructive pulmonary disease (COPD), acute lower respiratory infection (ALRI), lung cancer (LC), and type 2 diabetes mellitus (T2DM). Annual excess deaths attributable to long-term PM2.5 exposure were calculated.
RESULTS
A total of 5,360,032 older adults were followed from 2010 to 2019. Hazard ratios (HRs) per 10 μg/m3 increase in 12-month PM2.5 concentration were as follows: IHD, 1.068 (95% CI, 1.040 to 1.097); stroke, 1.023 (95% CI, 1.003 to 1.043); ALRI, 1.050 (95% CI, 1.026 to 1.076); COPD, 1.114 (95% CI, 1.072 to 1.157); T2DM, 1.046 (95% CI, 1.007 to 1.086); and LC, 0.972 (95% CI, 0.948 to 0.996). Excess deaths attributable to long-term PM2.5 exposure were estimated at 4,888 (95% CI, 2,304 to 7,323) in 2010 and 5,179 (95% CI, 2,585 to 7,648) in 2019.
CONCLUSIONS
Although PM2.5 levels in Korea have shown a declining trend over the past decade, mortality among older adults associated with long-term PM2.5 exposure has not significantly decreased, likely due to the rapid aging of the population.; Summary

Korean summary
2010–2019년 동안 대한민국 노인 536만 명 대상의 후향적 코호트 연구를 수행하였다. 장기적인 초미세먼지(PM2.5) 노출은 허혈성 심질환, 뇌졸중, 하기도 감염, 만성폐쇄성폐질환, 제2형 당뇨병으로 인한 사망 위험 증가와 관련성이 있었다. 연간 PM2.5 농도는 감소했으나, 고령화로 인해 PM2.5에 기인한 초과 사망은 2010년 4,888명에서 2019년 5,179명으로 증가하였다. 대기질 개선에도 불구하고 고령화로 인해 PM2.5로 인한 사망 부담은 여전히 중요한 공중보건 문제이다.

Key Message
A retrospective cohort of 5.36 million older adults was followed from 2010 to 2019 in Korea. Long-term PM2.5 exposure was associated with increased mortality from IHD, stroke, ALRI, COPD, and T2DM. Although annual PM2.5 concentrations declined, excess deaths rose from 4,888 in 2010 to 5,179 in 2019, largely driven by population aging. Despite improvements in air quality, the PM2.5-related mortality burden remains a significant public health concern due to population aging.

Social capital and regional influences: key predictors of unmet dental care needs among older adults in Korea: Ji-Yeon Lim, Ju-Mi Lee, Hae-Sung Nam; Epidemiol Health. 2025;47:e2025025. Published online May 7, 2025; DOI: https://doi.org/10.4178/epih.e2025025

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Abstract Summary PDF

Abstract

OBJECTIVES
Access to dental services is essential for improving quality of life, and social capital plays a key role in facilitating that access. This study aimed to identify individual-level and regional-level factors, including social capital, that predict unmet dental care needs among older adults.

METHODS

We analyzed data from 59,414 older adults obtained from the 2023 Korea Community Health Survey and the Korean Statistical Information Service, employing a 2-level multilevel model. The dependent variables comprised 3 types of unmet dental care needs: overall, due to lack of acceptability, and due to economic reasons. Twelve independent variables, including social capital and other individual and regional factors, were examined.

RESULTS

The prevalence of unmet needs was 14.15% overall, 8.70% for acceptability reasons, and 4.85% for economic reasons. Lower individual social capital was associated with higher odds of unmet dental care needs, whereas regional social capital factors demonstrated no significant association. Residing in regions with higher fiscal independence ratios was related to an increased likelihood of economic unmet needs (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.09 to 1.52). In contrast, a greater density of dentists per 10,000 population was inversely associated with overall and acceptability-related unmet needs (OR, 0.82 for both; 95% CI, 0.73 to 0.92 and 0.73 to 0.93, respectively).

CONCLUSIONS

Individual social capital and specific regional factors—namely, fiscal independence and density of dentists—may represent important determinants of unmet dental care needs among older adults. Policy interventions aimed at reducing unmet needs should consider these variables.

Summary

Korean summary
· 낮은 사회적 자본(이웃에 대한 낮은 신뢰, 적은 연락빈도, 배우자의 부재, 낮은 사회참여)은 노인의 미충족 치과의료경험을 증가시킨다. · 지역의 높은 재정자립도는 경제성 결여로 인한 미충족 치과의료경험을 증가시키며, 인구 1만명당 치과의사수가 높을수록 전체, 수용성 결여로 인한 미충족 치과의료경험을 감소시킨다.

Key Message
· Lower social capital (lower levels of trust in neighbors, less frequent contact, absence of a spouse, and lack of social participation) increases the risk of unmet dental care needs among older adults. · Higher regional fiscal independence increases unmet dental care needs due to economic reasons, while a greater density of dentists reduces overall unmet dental care needs and those due to lack of acceptability.

Citations

Citations to this article as recorded by

Mobility Limitations and Self-Perceived Unmet Dental Needs Among Korean Adults: A Nationwide Multilevel Analysis for Integrated Care
Han-Nah Kim, Nam-Hee Kim
International Dental Journal.2026; 76(2): 109371. CrossRef

Inequality in mortality according to regional deprivation during the COVID-19 pandemic: Min Hui Moon, Young Gyu Ko, Min Hyeok Choi; Epidemiol Health. 2025;47:e2025022. Published online April 29, 2025; DOI: https://doi.org/10.4178/epih.e2025022

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Vulnerability to coronavirus disease 2019 (COVID-19) is significantly greater in regions with lower socioeconomic status (SES). However, detailed analyses of regional socioeconomic disparities have rarely been conducted in Korea. This study aimed to identify and compare mortality inequalities associated with regional SES across different areas of Korea during the COVID-19 pandemic.
METHODS
Using cause-of-death statistics from 2020 to 2022, we calculated age-standardized mortality rates (ASMRs) for total mortality, COVID-19 mortality, and pneumonia mortality. The SES of each region was assessed using the regional deprivation index. Additionally, we calculated the rate difference, rate ratio, slope index of inequality (SII), and relative index of inequality (RII) for each socioeconomic level to examine the extent of mortality inequality and its temporal changes. These analyses were stratified by gender and urban-rural classification.
RESULTS
The total mortality rate, as well as COVID-19-specific and pneumonia-specific mortality rates, increased during the COVID-19 pandemic. The ASMR for COVID-19 was higher in rural areas (ASMR, 27.79), which have lower healthcare accessibility, compared to urban areas (ASMR, 26.63). However, mortality inequality indicators for COVID-19 were more pronounced in urban areas compared to rural areas (SII: urban, 2.72; rural, -0.05, RII: urban, 0.10; rural, 0.00). Notably, significant inequalities were observed among men residing in urban areas.
CONCLUSIONS
In disaster situations such as the COVID-19 pandemic, it is essential to implement strategies aimed at reducing overall mortality rates and addressing regional socioeconomic inequalities.; Summary

Korean summary
COVID-19 팬데믹 기간 동안, 지역의 사회경제적 수준은 한국의 사망률에 중요한 영향을 미쳤다. 총사망률, COVID-19 사망률, 폐렴 사망률에 대한 연령표준화사망률(ASMR)은 의료 접근성이 낮고 박탈 수준이 높은 농촌 지역에서 더 높게 나타났으나, 상대적인 사망 불평등은 특히 남성을 중심으로 도시 지역에서 더 두드러지게 나타났다. 이러한 결과는 공중보건 위기 상황에서 건강 불평등이 지역의 사회경제적 수준과 맥락에 따라 복합적으로 작용함을 보여준다. 정책 입안자들은 지역 간 사회경제적 수준에 따른 절대적 불평등과 상대적 불평등을 모두 고려한 맞춤형 개입 전략을 수립하고, 형평한 의료 접근성을 확보함으로써 향후 팬데믹에서의 사망 위험을 줄이기 위한 노력을 강화해야 한다.

Key Message
During the COVID-19 pandemic, regional socioeconomic disparities significantly influenced mortality in Korea. Mortality rates were higher in deprived rural areas, while relative inequalities were more evident in urban men. Tailored policies addressing both absolute and relative inequalities are essential to ensure equitable healthcare access in future crises.

Geospatial analysis of neonatal mortality in north-eastern India: a multilevel Bayesian approach: Vidhi Jain, Kh. Jitenkumar Singh, Deboshree Das, Shefali Gupta, Gunjan Singh; Epidemiol Health. 2025;47:e2025021. Published online April 27, 2025; DOI: https://doi.org/10.4178/epih.e2025021

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Abstract PDF: Abstract
OBJECTIVES
Neonatal mortality remains a significant public health issue in India. This study investigates spatial patterns and contributing factors to neonatal mortality in the north-eastern states, identifying hotspot regions and spatial variations.
METHODS
A sample of 34,222 mothers from India’s National Family Health Survey (NFHS-5, 2019-21) in the north-eastern states was analysed. Descriptive and bivariate analyses were conducted alongside Bayesian multilevel logistic regression using integrated nested Laplace approximation to model neonatal mortality. Spatial hotspot analysis using Getis-Ord Gi* statistics identified clusters of high neonatal mortality, while geographically weighted regression (GWR) was used to examine spatial variations in the relationships between neonatal mortality and contributing factors.
RESULTS
The neonatal mortality rate in the north-eastern states declined from 45 to 21 per 1,000 live births (NFHS-1 to NFHS-5) but remains higher than the national average. Assam reported the highest mortality (42.16%), whereas Sikkim had the lowest (0.87%). Higher mortality was observed among male infants, mothers with advanced age, low maternal education, and mothers who attended less than 5 antenatal care (ANC) visits. Spatial analysis identified hotspots in Assam, Meghalaya, and Tripura. GWR indicated that areas with less than 5 ANC visits had the strongest association with neonatal mortality. Bayesian multilevel analysis highlighted spatial variations of up to 51% across districts in northeast India.
CONCLUSIONS
This study underscores spatial disparities in neonatal mortality across north-eastern India. Addressing childcare practices and healthcare access in hotspot regions is essential for improving new-born health outcomes. The findings provide critical insights for policymakers to develop targeted interventions aimed at reducing neonatal mortality in these underserved areas.; Summary

Impact of hypertension-related avoidable hospitalization on all-cause mortality in older patients with hypertension: a nationwide retrospective cohort study in Korea: Yehrhee Son, Noorhee Son, Sungyoun Chun, Ki-Bong Yoo, Jung Hyun Chang, Woo-Ri Lee; Epidemiol Health. 2025;47:e2025019. Published online April 18, 2025; DOI: https://doi.org/10.4178/epih.e2025019

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
The prevalence of hypertension is increasing as a result of rapid population aging, which elevates the societal burden of the disease. In Korea, the hospitalization rate for hypertension-related admissions exceeds the average reported by the Organization for Economic Cooperation and Development; however, the impact of these hospitalizations has not been evaluated. Therefore, this study investigates the association between hypertension-related avoidable hospitalizations and all-cause mortality.
METHODS
We included patients aged ≥60 years diagnosed with hypertension, identified using data from the National Health Insurance Services Senior Cohort spanning 2008 to 2019. The primary outcome was all-cause mortality measured at 3 years and 5 years after the hypertension diagnosis. The key independent variable was the incidence of hypertension-related avoidable hospitalizations within the first year following the initial hypertension diagnosis. Cox proportional hazards regression analysis was employed to assess these associations. To ensure robust findings and minimize selection bias, several sensitivity analyses were conducted.
RESULTS
Out of 65,686 participants, 397 (0.6%) experienced hypertension-related avoidable hospitalizations within 1 year of their initial hypertension diagnosis. Individuals who experienced such hospitalizations had a significantly higher risk of all-cause mortality compared to those who did not (3-year: hazard ratio [HR], 2.12; 95% confidence interval [CI], 1.53 to 2.94; 5-year: HR, 2.13; 95% CI, 1.68 to 2.68).
CONCLUSIONS
Hypertension-related avoidable hospitalizations among older adults are associated with an increased risk of both short-term and long-term all-cause mortality. These findings underscore the importance of timely hypertension management to prevent such hospitalizations.; Summary

Korean summary
- 고혈압 관련 회피가능한 입원은 한국의 노인 고혈압 환자의 3년 및 5년 사망률과 유의미한 연관성을 보인다. - 사회경제적 및 지역적 건강 격차가 관찰되었으며, 저소득층과 대도시 이외 지역에 거주하는 환자의 사망 위험이 더 높았다. - 약물 복용을 포함한 조기 및 지속적인 고혈압 관리는 회피가능한 입원을 예방하고 장기 생존 결과를 개선하는데에 도움이 될 수 있다.

Key Message
- Hypertension-related avoidable hospitalizations are significantly associated with both 3-year and 5-year all-cause mortality among older patients with hypertension in Korea. - Socioeconomic and regional disparities were observed, with greater mortality risks among patients from low-income groups and non-metropolitan areas. - Early and consistent hypertension management—including medication adherence—may help prevent avoidable hospitalizations and improve long-term survival outcomes.

Systematic Review

Guts of healthy humans, livestock, and pets harbor critical-priority and high-risk Escherichia coli clones: Idris Nasir Abdullahi, Islem Trabelsi; Epidemiol Health. 2025;47:e2025013. Published online March 22, 2025; DOI: https://doi.org/10.4178/epih.e2025013

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Abstract PDF Supplementary Material: Abstract
OBJECTIVES
In May 2024, the World Health Organization classified carbapenem (CARB)- and third-generation cephalosporin (3GC) resistance (R) in <italic>Escherichia coli</italic> as a critical priority, whereas colistin (COL) is a “last resort” antibiotic for their treatment. This meta-analysis evaluated the pooled prevalence, high-risk lineages, genetic relatedness, and mechanisms of CARBR, COLR, and 3GCR in <italic>E. coli</italic> from healthy humans and animals.
METHODS
We conducted a systematic review and meta-analyses following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria on all eligible studies that reported the analysis of <italic>E. coli</italic>, and antimicrobial susceptibility to CARB, COL and 3GC in <italic>E. coli</italic> from gut samples of clinically healthy humans, livestock, and pets from June 2014 to June 2024. Random-effect models and conserved signature indels phylogeny 1.4 were used to determine pooled prevalence rates (PPs) and the relatedness of publicly available <italic>E. coli</italic> genomes, respectively.
RESULTS
Of the 5,034 identified articles, 64 studies were deemed eligible. The overall PPs of 3GCR, CARBR, and COLR <italic>E. coli</italic> were 22.5% (95% confidence interval [CI], 17.5 to 28.3), 2.2% (95% CI, 1.0 to 4.7), and 15.5% (95% CI, 10.8 to 21.8), respectively. The PPs of 3GCR-, COLR- and CARBR <italic>E. coli</italic> significantly varied by hosts, continent, and year of studies (p<0.05). Diverse <italic>E. coli</italic> lineages were found, including 13 high-risk <italic>E. coli</italic> sequence types (STs), within which ST10 predominated. Phylogenomic analyses produced 4 clusters of related CARBR- and COLR <italic>E. coli</italic> strains (<25 single nucleotide polymorphism): ST940-<italic>bla</italic>OXA-181 from humans in Lebanon, ST617-<italic>mcr</italic>-1 from pigs in China, ST46-<italic>mcr</italic>-1 from poultry in Tanzania, and ST1720-<italic>mcr</italic>-1 from goats in France.
CONCLUSIONS
COLR and 3GCR are more frequent than CARBR in gut <italic>E. coli</italic>. These 10-year epidemiological data highlight the persistence and transmission of critical priority and high-risk <italic>E. coli</italic> strains in healthy humans and animals, raising significant One Health concerns.; Summary

Original Articles

The uneven playing field: provider participation and regional disparities in oral health examination rates in Korea: Hye-Lim Hong, Nam-Hee Kim; Epidemiol Health. 2025;47:e2025012. Published online March 10, 2025; DOI: https://doi.org/10.4178/epih.e2025012

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Abstract Summary PDF: Abstract
OBJECTIVES
This study investigated regional disparities in adult oral health examination rates in Korea, despite free oral health screenings by the National Health Insurance Service (NHIS). It focused on the impact of provider factors, such as the availability of dental clinics and non-dental institutions.
METHODS
A cross-sectional analysis of 2022 data from 229 districts was conducted. The dependent variable was the adult oral health examination rate, while independent variables included provider factors, community health status, lifestyle, demographic, and socioeconomic characteristics. Descriptive statistics, Pearson’s correlation, and multiple regression analyses identified significant predictors.
RESULTS
Non-metropolitan areas had higher oral health examination rates (27.4%) than metropolitan areas (25.3%). Correlation analysis showed the general health examination rate (r=0.583) and the number of screening institutions (r=0.234) were the strongest predictors (p<0.001). Regression analysis showed a 1% increase in general health examination rates led to a 1.44% rise in oral health examination rates (p<0.001).
CONCLUSIONS
Despite NHIS policies, significant regional disparities persist, showing that providing screenings alone is insufficient. Integrating oral health screenings with general health examinations is necessary. Policymakers must promote collaboration between dental and non-dental providers to ensure equitable, integrated health services, enhancing preventive care and reducing disparities.; Summary

Korean summary
이 연구는 전국 229개 시군구의 성인 구강검진 수검률을 분석하여 지역 간 격차가 크다는 점을 확인하였다. 해결방안으로 구강검진을 일반건강검진과 통합하고, 비치과 기관의 참여를 확대하는 것이 지역 접근성 및 형평성 개선에 효과적인 전략으로 제시하였다.

Key Message
This study analyzed adult oral health examination rates across 229 districts in Korea and confirmed the existence of substantial regional disparities. Integrating oral health screenings into general health check-ups and expanding the participation of non- dental institutions were proposed as effective strategies for improving regional accessibility and equity.

Effects of student human rights ordinances on mental health among middle and high school students in South Korea: a difference-in-differences analysis: Sang Jun Eun; Epidemiol Health. 2025;47:e2025011. Published online March 1, 2025; DOI: https://doi.org/10.4178/epih.e2025011

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
To actively protect and enhance students’ human rights, student human rights ordinances (SHROs) have been enforced in seven provinces in South Korea at different times since 2010. Although human rights are closely linked to mental health, there has been no research on the effectiveness of human rights legislation on adolescent mental health. This study evaluated the effects of SHROs on the mental health of middle and high school students.
METHODS
Repeated cross-sectional data were used, including 1,148,257 respondents from the Korea Youth Risk Behavior Web-based Survey between 2006 and 2023. Probabilities of perceived stress, sleep insufficiency, depressive mood, suicide ideation, and suicide attempt in treated provinces were estimated through a difference-in-differences approach that accounts for treatment effect heterogeneity across groups over time.
RESULTS
SHROs had no consistently significant effects on any mental health outcomes, except for slightly increased suicide ideation in total students (0.7%, 95% confidence interval 0.3% to 1.1%). Suicide attempts in total and male students and perceived stress and sleep insufficiency in female students tended to decrease, while other mental health outcomes tended to increase. Uncertainty in the effect estimates of SHROs increased for all mental health outcomes with possible violations of parallel trends, rendering originally significant effects insignificant.
CONCLUSIONS
SHROs failed to improve mental health of middle and high school students in treated provinces, possibly due to the absence of enforcement mechanisms. Further research is needed on the effectiveness of and effect mechanisms for legal measures to improve human rights on adolescent mental health.; Summary

Korean summary
학생의 인권을 포괄적으로 보장하기 위해 학생인권조례가 시행되었지만 학생인권조례 시행 지역에서 중고등학생의 정신건강은 향상되지 않았는데, 이는 조례에 벌칙 조항 같은 강제성 기전이 없었기 때문이었을 수 있다. 학생인권조례는 중고등학생의 정신건강에 대해 효과가 없었지만 이 연구는 인권 법제의 청소년 정신건강에 대한 효과를 처음으로 평가했다. 인권증진을 위한 법적 수단의 청소년 정신건강에 대한 효과성과 효과 기전에 관하여 추가 연구가 필요하다.

Key Message
Although student human rights ordinances have been enforced in South Korea to comprehensively guarantee human rights for students, they failed to improve the mental health of middle and high school students in treated provinces, possibly due to the absence of enforcement mechanisms such as penalty provisions. Despite the ineffectiveness of student human rights ordinances, this study first estimated the effects of human rights legislation on adolescent mental health. Further research is needed on the effectiveness of and effect mechanisms for legal measures to improve human rights on adolescent mental health.

A comparison of the outcomes of families with children aged less than 2 who received universal versus sustained nurse home visiting services in Korea: a cross-sectional study: Yu-Mi Kim, Sun Hwa Park, Kyung Ja June, Sung-Hyun Cho, Ji Yun Lee, Hong-Jun Cho, Young-Ho Khang; Epidemiol Health. 2025;47:e2025004. Published online February 6, 2025; DOI: https://doi.org/10.4178/epih.e2025004

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aimed to compare maternal outcomes and the home environment between non‑vulnerable families with children under 2 receiving universal home visiting services and vulnerable families receiving sustained home visiting services.

METHODS

This study was conducted in Seoul, Korea, where the country’s first nurse‑led early childhood home visiting program was introduced. A total of 551 mother‑child dyads participated in cross‑sectional surveys conducted at various child ages (6±2 weeks, 6±1 months, 12±1 months, and 24±1 months). Universal home visiting services were provided within six weeks postpartum to non‑vulnerable families, while vulnerable families received sustained services consisting of 25 visits over 24 months. Maternal knowledge of sudden infant death syndrome (SIDS) and childcare, maternal distress, and the Korean Infant‑Toddler Home Observation for Measurement of Environment (K‑IT‑HOME) were assessed.

RESULTS

Overall, the universal home visitation group demonstrated higher levels of maternal knowledge regarding SIDS and childcare compared to the sustained home visitation group (all p-values <0.05), while the sustained home visitation group reported higher levels of maternal distress (p<0.001). The total K‑IT‑HOME score was 1.47 points higher in the universal home visitation group than in the sustained home visitation group (p<0.001). No significant differences were observed in the acceptance, organization, or involvement subscales of the K‑IT‑HOME (all p-values >0.05).

CONCLUSIONS

This study demonstrated that disparities in maternal outcomes and home environments persisted in early childhood between the sustained and universal home visitation groups.

Summary

Korean summary
이 연구는 단면 조사로, 보편방문 가족(취약하지 않은 가정)과 지속방문 가족(취약한 가정)을 네 시점(출산 후 6±2주, 6±1개월, 12±1개월, 24±1개월)에서 엄마의 결과 지표와 가정환경 지표를 비교하였다. 이 연구의 결과는 조기 아동기 지속적 가정 방문 프로그램만으로는 엄마의 결과 지표와 가정환경 지표의 격차를 완전히 없애기에 충분치 않다는 점을 시사한다.

Key Message
This study is a cross-sectional survey comparing outcomes between universal home visitation group (non-vulnerable families) and sustained home visitation group (vulnerable families) at four time points: 6±2 weeks postpartum, 6±1 months postpartum, 12±1 months postpartum, and 24±1 months postpartum. Study results suggest that merely implementing a maternal and early childhood sustained home-visiting program is insufficient to close the gap in maternal outcomes and home environments.

Citations

Citations to this article as recorded by

Six-Month Outcomes of a Nurse Home Visiting Program in Korea: A Randomized Trial
Young-Ho Khang, Yu-Mi Kim, Joo Hyun Kim, Hyunsook Hong, Jungok Yu, Rora Oh, Kyung Ja June, Sung-Hyun Cho, Ji Yun Lee, Hong-Jun Cho
Pediatrics.2026;[Epub] CrossRef

Cohort Profile

Cohort study profile: a cohort of Korean atomic bomb survivors and their offspring: Hamin Lee, Jin-Wu Nam, Mi Kyung Kim, Inah Kim, Yu-Mi Kim, Boyoung Park; Epidemiol Health. 2024;46:e2024089. Published online November 18, 2024; DOI: https://doi.org/10.4178/epih.e2024089

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Abstract

The Korean Atomic Bomb Survivor Cohort (K-ABC) study was designed to investigate the health impacts of atomic bomb exposure on Korean survivors and to explore whether these effects are passed down genetically to their descendants. This paper outlines the study’s design, data collection methods, baseline socio-demographic characteristics, exposure status, and disease prevalence among the participants, based on survey responses and health examinations. From 2020 to 2024, a total of 2,544 individuals, comprising 1,109 atomic bomb survivors (G1), 1,193 children of G1 (G2), and 242 grandchildren of G1 (G3), consented to participate in the study. Of these, 1,828 participants (659 in G1, 927 in G2, and 242 in G3) completed the survey and underwent health examinations, representing a participation rate of 71.9%. Exposure information was gathered using a questionnaire and verified through records from the Korean Red Cross and a handbook issued by the Japanese government. Disease prevalence was determined based on participants’ self-reported physician diagnoses. This study presents details about the K-ABC study and provides baseline data on the participants recruited. These data will be valuable for interpreting the results of future K-ABC studies.

Summary

Korean summary
한국인 원폭피해자 코호트 연구는 1945년 일본에서 원자폭탄에 피폭된 원폭 피해자 1세와 이들의 자녀인 2세, 3세의 건강과 질병 위험도을 장기적으로 조사한다. 이를 위해 2020년부터 2023년까지 설문조사를 통해 정보를 수집하였고, 이후 설문조사와 함께 건강보험공단, 국립암센터, 통계청 등 공공 기관에서 보유하고 있는 데이터를 연계하여 추적관찰을 수행해 나갈 예정이다.

Key Message
The Korean atomic bomb survivor’s cohort study investigates the long-term health and disease risks of first generation atomic bomb survivors exposed in Japan in 1945, as well as their second generation and third generations. From 2020 to 2023, information was collected through surveys. Follow-up will be conducted through surveys and secondary data linkage from public institutions such as the National Health Insurance Service, the Korea Central Cancer Registry, and Statistics Korea.

Citations

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Validation of self-reported cancer diagnoses in the Korean Atomic Bomb Survivor Cohort study
Hamin Lee, Jin-Wu Nam, Mi Kyung Kim, Inah Kim, Yu-Mi Kim, Boyoung Park
Cancer Epidemiology.2025; 97: 102817. CrossRef

Systematic Review

Adverse health effects of climate change and air pollution in people with disabilities: a systematic review: Nakyung Rhim, Seohyun Lee, Kyung-Hwa Choi; Epidemiol Health. 2024;46:e2024080. Published online September 27, 2024; DOI: https://doi.org/10.4178/epih.e2024080

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Abstract

Global warming and air pollution adversely affect the health of the entire human population, particularly older adults, people with disabilities (PWDs), and children. In this systematic review, we investigated the adverse health effects of climate change and air pollution in PWDs. We conducted a comprehensive literature search of the PubMed database using the terms “disab*,” “air pollution,” and “climate change” on July 4, 2023, and August 8, 2023 and searched the Web of Science (WOS) database on December 28, 2023. We identified 425 and 1,169 studies on climate change cited in PubMed and WOS, respectively, as well as 333 studies on air pollution in PubMed and 495 studies on air pollution in WOS. The studies were classified by type of exposure, and full-text screening was conducted to confirm that the population, intervention or exposure, comparator, outcome statement, and inclusion and exclusion criteria were met. The Newcastle-Ottawa Scale was used to assess the quality of the included cohort and case-control studies and for data analysis. In extreme temperatures, PWDs experienced higher rates of injury, heat-related illness, functional impairment, heart disease, mental disorders, and mortality than people who were non-disabled (ND). Exposure to air pollution resulted in higher rates of obesity, cardiovascular disease, poststroke neurological and functional disability, and mortality in PWDs than in people who were ND. Therefore, because PWDs were more affected by climate change and air pollution than people who were ND, sensitive policies and preparedness measures should be developed for PWDs.

Summary

Korean summary
전체 인구, 특히 취약 계층의 건강은 기후 변화와 대기 오염으로 인해 부정적인 영향을 받을 수 있습니다. 본 체계적 고찰 연구는 장애인이 비장애인에 비해 환경적 요인에 노출되어 더 심각한 신체적, 정신적 건강 문제를 겪는다는 것을 보여줍니다.

Key Message
The health of the entire human population, especially vulnerable people, might be negatively impacted by climate change and air pollution. This systematic review study implies that people with disabilities (PWDs) suffer more severe physical and mental health consequences from exposure to environmental challenges compared to non-disabled individuals.

Citations

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Duration-specific effects of extreme heat on mortality among people with disabilities in Korea: a nationwide population-based study
Kyung-Hwa Choi, Jonghyuk Choi, Ho-Jang Kwon, Mina Ha, Yoonhyeok Choi, Hyungryul Lim
Environmental Research.2026; 289: 123375. CrossRef
Mediation of Fine Particulate Matter on the Association Between Daily Temperature and Mortality
Dajeong Ham, Youn-Hee Lim, Soontae Kim, Ho-Jang Kwon, Sanghyuk Bae
Journal of Korean Medical Science.2025;[Epub] CrossRef
Ambient fine particulate matter and mortality risk among people with disability in Korea based on the National Health Insurance database: a retrospective cohort study
Jonghyuk Choi, Hyungryul Lim, Ho-Jang Kwon, Mina Ha, Soontae Kim, Kyung-Hwa Choi
BMC Public Health.2025;[Epub] CrossRef
Cardiometabolic Diseases and Mental Health Disorders in Korean Adults With Disabilities: A 3-Year Retrospective Analysis and Risk Comparison
Shiva Raj Acharya, NamKwen Kim, Navin Ray, Diwash Timilsina
American Journal of Preventive Medicine.2025; 69(3): 107938. CrossRef
Climate Change, Air Pollution and the Global Obesity Syndemic: a Review of Current Evidence
Natalia G. Vallianou, Dimitris C. Kounatidis, Eleni V. Geladari, Angelos Evangelopoulos, Vasileios Kaldis, Theodora Stratigou, Apostolos A. Evangelopoulos, Irene Karampela, Maria Dalamaga
Current Obesity Reports.2025;[Epub] CrossRef

Original Articles

The role of supervisor support in the association between night work and depressive symptoms: a gender-stratified analysis of 22,422 full-time wage workers in Korea: Hee Won Kim, Ji-Hwan Kim, Garin Lee, Hye-Lin Lee, Hayoung Lee, Seung-Sup Kim; Epidemiol Health. 2024;46:e2024079. Published online September 25, 2024; DOI: https://doi.org/10.4178/epih.e2024079

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study investigated the relationship between night work, supervisor support, and depressive symptoms among full-time wage workers, with a focus on gender differences.

METHODS

A nationwide sample of 22,422 full-time wage workers from the Sixth Korean Working Conditions Survey (2020-2021) was analyzed. Experiences of night work were categorized into 5 groups based on the number of night work days per month: 0, 1-5, 6-10, 11-15, and 16-31. Depressive symptoms were evaluated using the 5-item World Health Organization Well-Being Index. Supervisor support was assessed with 5 items.

RESULTS

Workers who engaged in 1-5 days (prevalence ratio [PR], 1.23; 95% confidence interval [CI], 1.12 to 1.36) and 6- 10 days (PR, 1.17; 95% CI, 1.06 to 1.30) of night work per month exhibited a higher prevalence of depressive symptoms than those without night work. After stratifying by supervisor support levels, workers with 1-5 days, 6-10 days, and 11-15 days of night work per month were more likely to experience depressive symptoms compared to those without night work in the low supervisor support group. In contrast, no association was found between night work (≥6 days) and depressive symptoms in the high supervisor support group. Furthermore, gender differences were notable: female workers with 6-10 days (PR, 1.45; 95% CI, 1.23 to 1.70), and 11-15 days (PR, 1.43; 95% CI, 1.08 to 1.90) of night work per month exhibited a higher prevalence of depressive symptoms, whereas their male counterparts did not. This pattern of gender difference was also found among those with low supervisor support.

CONCLUSIONS

Supervisor support may mitigate the adverse effects of night work on depressive symptoms among full-time wage workers, with differences manifested across genders.

Summary

Korean summary
야간 노동을 하는 사람들의 숫자가 급격히 늘어나고 있다. 이들이 겪는 여러 정신건강의 어려움이 사회적으로 문제가 되고 있지만, 그와 관련해 상사의 사회적 지지가 어떠한 영향을 주고 또 그 영향이 성별에 따라 어떻게 다른 지 충분히 연구된 바 없다. 한국의 6 차 근로환경조사를 분석한 결과, 한달에 1-10 일 야간 노동을 하는 사람들에게서 우울증상이 높게 나타났다. 성별 층화 분석했을 때, 한달에 6-15 일 야간 근무를 하는 여성이 상사의 사회적 지지를 받지 못할 경우 우울 증상이 특히 두드러지는 것으로 나타났습니다. 이번 연구는 야간 노동이 정신 건강에 미치는 부정적 영향을 확인하고, 직장에서의 사회적 지지와 건강한 조직 문화를 조성할 필요성을 보여준다.

Key Message
Night workers play a crucial role in society yet face unique mental health challenges. While a growing body of research have focused on their health problems, the role of supervisor support remains unexplored. Using a nationally representative dataset of workers in Korea, we found that night work was associated with depressive symptoms, especially for those working 1- 10 nights monthly and for females conducting 6-15 days of night work. Strong supervisor support may modify these effects. Our findings underscore the need for organizations to acknowledge the adverse mental health consequences of night work and to foster a supportive workplace culture.

Citations

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Network of job demands-resources and depressive symptoms in clinical nursing interns: A cross-sectional study
Li Chen, Yuanzi Chen, Qiaoyan Wu, Haiyan Wang, Yunjian Qu, Zhangyi Wang
Nurse Education Today.2026; 159: 106962. CrossRef

Contrasting income-based inequalities in incidence and mortality of breast cancer in Korea, 2006-2015: Jinwook Bahk, Hee-Yeon Kang, Young-Ho Khang, Kyunghee Jung-Choi; Epidemiol Health. 2024;46:e2024074. Published online September 11, 2024; DOI: https://doi.org/10.4178/epih.e2024074

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Abstract

OBJECTIVES
Breast cancer incidence and mortality rates in Korea are increasing. This study analyzed income-based inequalities in the incidence and mortality of women breast cancer from 2006 to 2015, using national data that covered all Korean women.

METHODS

We used the National Health Information Database from 2006 to 2015. For women aged 20 and older, the age-standardized incidence and mortality rates of breast cancer per 100,000 by income quintile per year were calculated using the direct method. The rate ratio and rate difference (RD) of the age-standardized incidence and mortality rates of breast cancer per 100,000 between the top and bottom income quintiles were calculated as relative and absolute measures for inequalities.

RESULTS

When comparing 2006 and 2015, both the incidence and mortality rates of breast cancer increased. The lowest income quintile experienced higher mortality rates despite having lower incidence rates. In 2015, the income-based RD in incidence and mortality rates between the highest and lowest income quintiles (Q1-Q5) was -19.9 (95% confidence interval [CI], -24.3 to -15.5) and 4.4 (95% CI, 2.9 to 5.8), respectively. Throughout this period, there was no statistically significant trend in income-based disparities in breast cancer incidence and mortality. The age-specific contributions to the absolute magnitude of inequality (RD) in incidence and mortality were more pronounced among middle-aged women than among older women.

CONCLUSIONS

This study found that breast cancer in Korea exhibited pro-rich inequalities in mortality despite pro-poor inequalities in incidence. More equitable policies for screening and treatment of breast cancer are needed.

Summary

Korean summary
2006년부터 2015년 한국의 유방암 불평등 추세를 분석하면, 소득수준이 낮은 여성의 발생률은 상대적으로 낮음에도 불구하고 사망률은 높은 양상을 보였다. 유방암 검진과 치료에 있어 보다 형평성을 고려한 정책이 요구된다.

Key Message
This study found that breast cancer in Korea exhibited pro-rich inequalities in mortality despite pro-poor inequalities in incidence. More equitable policies for screening and treatment of breast cancer are needed.

Citations

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Impact of fragmented care on cancer outcomes among korean women with breast and cervical cancer: a focus on regional and economic disparities
Sun Jung Kim, Noorhee Son, Woo-Ri Lee, Dong-Woo Choi, Seojin Park, Kyu-Tae Han
International Journal for Equity in Health.2025;[Epub] CrossRef

Data Profile

Data profile: the Korean Workers’ Compensation-National Health Insurance Service (KoWorC-NHIS) cohort: Jeehee Min, Eun Mi Kim, Jaiyong Kim, Jungwon Jang, Youngjin Choi, Inah Kim; Epidemiol Health. 2024;46:e2024071. Published online August 19, 2024; DOI: https://doi.org/10.4178/epih.e2024071

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Abstract Summary PDF

Abstract

The Korean Workers’ Compensation-National Health Insurance Service (KoWorC-NHIS) cohort was established to investigate the longitudinal health outcomes of Korean workers who have been compensated for occupational injuries or diseases. This cohort study, which utilized data spanning from 2004 to 2015, merged workers’ compensation insurance claim data with the National Health Insurance Database (NHID), encompassing 858,793 participants. The data included socio-demographic factors such as age, sex, income, address, insurance type, and disability grade. It also covered the types of occupational accidents, International Classification of Diseases, 10th revision codes for diseases or accidents, work tenure, industry, occupation code, and company size. Additional details such as the occupational hire date, date of claim, date of recognition, and affected body parts were recorded. The cohort predominantly consisted of male workers (80.0%), with the majority experiencing their first occupational accident in their 40s (27.6%) or 50s (25.3%). Notably, 93.1% of the cases were classified as occupational injuries. By integrating this data with that from the NHID, updates on health utilization, employment status, and income changes were made annually. The follow-up period for this study is set to conclude in 2045.

Summary

Korean summary
KoWorC-NHIS Cohort (산재보험-국민건강보험공단 코호트) 는 2004년부터 2015년까지 산업재해를 경험한 근로자들의 장기적인 건강 결과를 추적 조사하기 위해 구축된 코호트이다. 이 코호트에는 총 858,793명의 근로자가 등록되었으며, 대다수는 남성 (80%)이었고, 업무상 사고 (93.1%)를 경험한 것으로 나타났다. 이 코호트를 활용하여 산업재해 피해 근로자들의 장기적인 건강영향을 분석할 수 있으며, 취약 계층 근로자의 건강을 보호하기 위한 예방 정책 수립의 근거로 활용할 수 있다.

Key Message
The KoWorC-NHIS Cohort (Workers' Compensation Insurance-National Health Insurance Service Cohort) was established to track the long-term health outcomes of workers who experienced occupational injuries and illnesses from 2004 to 2015. The cohort includes a total of 858,793 workers, with the majority being male (80%) and having experienced occupational accidents (93.1%). This cohort can be used to analyze the long-term health effects on workers who have suffered occupational injuries, and can serve as evidence for establishing preventive policies to protect the health of vulnerable workers.

Citations

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Machine learning-based prediction of dissatisfaction after occupational injury: a retrospective cohort study using the nationwide Korean workers’ compensation insurance database
Youjin Lee, Taeyeon Kim, Dahyeon Koo, Dougho Park
BMJ Open.2025; 15(11): e103321. CrossRef

Brief Communication

The association between employee lifestyles and the rates of mental health-related absenteeism and turnover in Japanese companies: Atsuya Fujimoto, Hiroshi Kanegae, Kaori Kitaoka, Mizuki Ohashi, Kunio Okada, Koichi Node, Kenkichi Takase, Hiroshi Fukuda, Tomoyuki Miyazaki, Yuichiro Yano; Epidemiol Health. 2024;46:e2024068. Published online August 2, 2024; DOI: https://doi.org/10.4178/epih.e2024068

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Abstract PDF: Abstract
We assessed the association of employee lifestyles (e.g., smoking, exercise, drinking, and sleep habits) with mental health-related absenteeism and turnover rates utilizing data from the annual Health and Productivity Management survey by Japan’s Ministry of Economy, Trade and Industry. This analysis included data from 1,748 companies, encompassing 4,199,021 employees. The average proportions of mental health-related absenteeism and employee turnover rates were 1.1±1.0% and 5.0±5.0%, respectively. In multivariable regression models that incorporated all lifestyle factors and confounders, a 1 percentage point increase in the proportion of employees who slept well was associated with reductions in their turnover rate (mean, -0.020%; 95% confidence interval [CI], -0.038 to -0.002) and in mental health-related absenteeism (mean, -0.005%; 95% CI, -0.009 to 0.001). A similar increase in the proportion of employees engaging in regular physical activity corresponded with a 0.005% decrease in the prevalence of mental health-related absenteeism (95% CI, -0.010 to -0.001). A 1 percentage point increase in the proportion of employees who smoked was associated with a 0.013% reduction in mental health-related absenteeism (95% CI, -0.017 to -0.008). Nonetheless, the current study’s observational and cross-sectional design restricted the ability to establish causality between employee lifestyle factors and mental health issues.; Summary

Original Article

Development and validation of the Health Literacy Index for the Community for the Korean National Health and Nutrition and Examination Survey: Junghee Yoon, Soo Jin Kang, Mangyeong Lee, Juhee Cho; Epidemiol Health. 2024;46:e2024061. Published online July 10, 2024; DOI: https://doi.org/10.4178/epih.e2024061

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Abstract

OBJECTIVES
We developed and validated the Health Literacy Index for the Community (HLIC) to assess the health literacy of the Korean population within the framework of the Korean National Health and Nutrition and Examination Survey.

METHODS

The HLIC was developed through (1) defining the conceptual framework and generating the item pool and (2) finalizing the items and identifying the cut-off value. Interviews were conducted to examine items’ face validity, and a cross-sectional survey was performed to analyze the item-response theory and Rasch models to investigate the instrument’s psychometric properties.

RESULTS

In this study of 1,041 participants, most had no difficulty understanding health information; however, 67.9% struggled to assess the reliability of health information from the Internet or media. A 4-factor structure was identified through factor analysis, leading to the exclusion of some items. This resulted in 10 items across 4 domains: (1) disease prevention, (2) health promotion, (3) health care, and (4) technology and resources. The HLIC demonstrated good internal consistency, with a Cronbach’s α of 0.87. It also showed high test-retest reliability and correlations with other health literacy instruments. A socio-demographic analysis of the HLIC revealed disparities in health literacy across various age groups, education levels, and income brackets.

CONCLUSIONS

The HLIC was developed to systematically measure health literacy in Korea’s general population. Its simplicity and conciseness ensure reliability and validity and improve its accessibility, making it particularly suitable for the broader Korean population, including those with lower literacy levels.

Summary

Korean summary
본 연구는 한국인의 건강 문해력을 평가하기 위해 지역사회 건강정보 이해능력 측정도구(Health Literacy Index for the Community, HLIC)를 개발하고 검증하였다. 그 결과, 많은 사람들이 인터 넷이나 미디어에서 얻은 정보의 신뢰성을 평가하는 데 어려움을 겪고 있으며, 연령, 교육 수준, 소 득에 따라 건강정보 이해능력 격차가 존재함을 확인하였다. 특히 본 도구는 높은 신뢰도와 타당성 을 입증하였으며, 이를 통해 한국인의 격차를 파악하고 맞춤형 개입을 위한 중요한 정보를 제공하 는 도구로서의 유용성을 확인하였다.

Key Message
This study developed and validated the Health Literacy Index for the Community (HLIC) to assess the health literacy of Koreans, finding that many had difficulties to assess its reliability from Internet or media sources, and disparities in health literacy were observed across age, education level, and income. The HLIC demonstrated strong reliability and validity, highlighting its utility for identifying health literacy gaps and informing targeted interventions in Korea.

Citations

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Health literacy by occupation in Korea
In Cheol Hwang, Hong-Yup Ahn
Journal of Epidemiology and Community Health.2025; 79(12): 963. CrossRef
Health literacy and its relationship with mental health: A nationwide Korean survey
Yoo Jeong Lee, Ki Dong Ko, In Cheol Hwang, Hong Yup Ahn
Asian Journal of Psychiatry.2025; 111: 104628. CrossRef
Digital Health Literacy in the General Population: National Cross-Sectional Survey Study
Junghee Yoon, Seongwoo Yang, Soo Jin Kang, Mangyeong Lee, Dokyoon Kim, Joungwon Park, Su Jin Kim, Jiyoon Han, Jungin Joo, Juhee Cho
Journal of Medical Internet Research.2025; 27: e67780. CrossRef
Cross-sectional analysis of sociodemographic factors associated with self-reported and knowledge-based health literacy in Korea using data from KNHANES 2023
Ki Young Huh, Ildae Song
Scientific Reports.2025;[Epub] CrossRef
Health literacy in Korea: findings from the 2023 Korea National Health and Nutrition Examination Survey
Sunhye Choi, Yukyeong Kang, Hyejin Kim, Kyungwon Oh
Epidemiology and Health.2025; 47: e2025037. CrossRef
Impact of Sleep, Mental Health, and Health Literacy on Health-Related Quality of Life in Patients with Allergic Rhinitis: A Secondary Analysis of the 2023 Korea National Health and Nutrition Examination Survey
Gaeun Kim, Moonhee Gang
Journal of Korean Academy of Fundamentals of Nursing.2025; 32(3): 389. CrossRef
Health literacy mediates the association of education levels with engagement in leisure-time physical activity and muscle-strengthening exercise: a population-based study of Korea
Seong-Uk Baek, Jin-Ha Yoon
Postgraduate Medical Journal.2025;[Epub] CrossRef
Psychometric of the Ferrer-Urbina multidimensional scale of sexual self concept (MSSSC) in the Iranian population
Yeganeh Dadashzadeh Sangary, Mohammad Hassan Asayesh, Ali Asgharzadeh, Zahra Naghsh
BMC Psychology.2025;[Epub] CrossRef

Cohort Profile

Cohort profile: understanding health service system needs for people with intellectual disability using linked data in New South Wales, Australia: Simone Reppermund, Preeyaporn Srasuebkul, Claire M. Vajdic, Sallie-Anne Pearson, Rachael E. Moorin, Julian N. Trollor; Epidemiol Health. 2024;46:e2024054. Published online June 12, 2024; DOI: https://doi.org/10.4178/epih.e2024054

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Abstract

This cohort profile describes one of the largest linked datasets in the world concerning the health of people with intellectual disability. The cohort comprises a retrospective group of 100,089 individuals with intellectual disability who received disability and/or health services in New South Wales, Australia. Of these participants, 34% were female, with a median age at cohort entry of 3 years (interquartile range, 0-19). A separate comparator cohort included 455,677 individuals, matched by 5-year age group, sex, and residential postcode at a 5:1 ratio. Initial results indicate that between 2001 and 2018, people with intellectual disability experienced more than double the rate of hospitalisations (538 vs. 235 per 1,000 person-years), as well as markedly higher rates of emergency department presentations (707 vs. 379 per 1,000 person-years) and use of ambulatory mental health services (1,012 vs. 157 per 1,000 person-years), relative to the comparator cohort. The largest disparities in hospital admissions were for mental disorders, dialysis, and diseases of the nervous system and sense organs. Furthermore, individuals with intellectual disability had more than double the rate of dispensed medications found in the comparator cohort. Of these medications, 46.6% were for the treatment of nervous system conditions, as opposed to 24.7% for the comparator cohort. The mean±standard deviation age at death was 52±19 years for people with intellectual disability and 64±22 years for the comparator participants.

Summary

Key Message
This cohort study of individuals with intellectual disability is one of the largest internationally looking at health profiles and health service use. The goal is to improve the health and well-being of individuals with intellectual disability by informing the development of services, variations in prescribing practices, and access to preventative health services.

Citations

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Prevalence of psychiatric conditions in people with intellectual disability: A record linkage study in New South Wales, Australia
Samuel RC Arnold, Yunhe Huang, Preeyaporn Srasuebkul, Rachael C Cvejic, Stefan C Michalski, Julian N Trollor
Australian & New Zealand Journal of Psychiatry.2025; 59(5): 433. CrossRef
Predictors of mental illness onset in adolescents and adults with intellectual disability: A retrospective cohort study in New South Wales, Australia
Stefan C Michalski, Yunhe Huang, Preeyaporn Srasuebkul, Rachael C Cvejic, Samuel RC Arnold, Julian N Trollor
Australian & New Zealand Journal of Psychiatry.2025; 59(12): 1095. CrossRef
Contraception use in women with intellectual disability: a retrospective cohort study
Yunhe Huang, Peiwen Liao, Preeyaporn Srasuebkul, Pramudie Gunaratne, Julian Trollor
BMJ Sexual & Reproductive Health.2025; : bmjsrh-2025-202938. CrossRef

Original Articles

Inequality in dental flossing behavior among Korean adults based on household income levels: Zi-Lan Wang, Eun-Jae Choi, Seung-Hee Ryu, Seon-Jip Kim, Hyun-Jae Cho; Epidemiol Health. 2024;46:e2024052. Published online May 24, 2024; DOI: https://doi.org/10.4178/epih.e2024052

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Abstract

OBJECTIVES
The aim of this study was to estimate the association between household income and dental flossing.

METHODS

This cross-sectional study investigated the impact of household income on flossing among 9,391 adults aged 30+ with ≥20 natural teeth, utilizing data from the seventh Korea National Health and Nutrition Examination Survey (2016-2018). Outcome measures included flossing (yes/no), with income categorized into 4 levels: lowest, medium to low, medium to high, and highest. Logistic regression, adjusted for age, gender, brushing frequency, recent dental exams, periodontitis, smoking, and alcohol use, was employed to evaluate the influence of socioeconomic status on oral hygiene practices.

RESULTS

In the highest income group, flossing was 62.6% more prevalent than in the lowest income group (adjusted odds ratio [aOR], 1.63; 95% CI, 1.27 to 2.08). The strongest association between income levels and flossing was observed in individuals aged ≥70 years (aOR, 3.64; 95% CI, 1.86 to 7.11), with a decreasing strength of association in the 60s (aOR, 1.72; 95% CI, 1.05 to 2.84) and 50s age groups (aOR, 1.69; 95% CI, 1.07 to 2.68). Higher-income women demonstrated a higher frequency of flossing than their lower-income counterparts (aOR, 1.67; 95% CI, 1.24 to 2.23). Higher-income individuals without periodontitis were more likely to floss (aOR, 1.64; 95% CI, 1.23 to 2.18), and among those with periodontitis, flossing was significantly associated only with the highest income category (aOR, 1.64; 95% CI, 1.10 to 2.44).

CONCLUSIONS

The findings of this study indicate a significant correlation between higher household income levels and an increased prevalence of flossing.

Summary

Korean summary
이 연구는 치실 사용이 개인의 건강행동 습관뿐만 아니라 사회경제적 지위에 의해 크게 영향을 받는다는 점을 강조합니다. 높은 소득층이 치실을 더 자주 사용하는 경향이 있으며, 이는 교육 수준과 건강 문해력, 경제적 여유와 관련이 있습니다. 공중보건 계획에서 경제적 요인을 고려하고, 치과 위생 교육과 제품 접근성을 개선해야 합니다.

Key Message
This study highlights that the use of dental floss is significantly influenced not only by personal health behavior habits but also by socioeconomic status. Individuals in higher income classes tend to use dental floss more frequently, which is associated with higher levels of education, health literacy, and economic resources. Public health planning should take economic factors into account and focus on improving dental hygiene education and access to dental care products.

Citations

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Histopathogenesis of proximal caries: An expanded hypothesis
Frederico Barbosa de Sousa, Nikolas Paganini Alves de Oliveira
Medical Hypotheses.2026; 206: 111851. CrossRef
Central adiposity indices and inflammatory markers mediate the association between life’s crucial 9 and periodontitis in US adults
Jia-Jie Guo, Qi-Qi Hang, Ting Xu, Wei-Xuan Liang, Jia-Kun Gao, Hong-Biao Ou, Fu-Zhen Jiang, Xi-Chen-Hui Qiu, Zu-Zhang Tian, Yu-zhong Zhang, Jing Zhang
Lipids in Health and Disease.2025;[Epub] CrossRef

Association of healthy lifestyle factors with the risk of hypertension, dyslipidemia, and their comorbidity in Korea: results from the Korea National Health and Nutrition Examination Survey 2019-2021: Ji-Sook Kong, Mi Kyung Kim; Epidemiol Health. 2024;46:e2024049. Published online May 1, 2024; DOI: https://doi.org/10.4178/epih.e2024049

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We investigated the association of individual healthy lifestyle factors (HLFs) and their combined healthy lifestyle score (HLS) with hypertension and/or dyslipidemia.

METHODS

We analyzed data from 10,693 adults aged ≥19 from the 2019 to 2021 Korea National Health and Nutrition Examination Survey. HLS was evaluated based on smoking status, alcohol consumption, body mass index (BMI), diet, and physical activity. Using logistic regression models, we estimated odds ratios (ORs) with 95% confidence intervals (CIs) to evaluate the associations of HLFs and HLS with hypertension, dyslipidemia, and their comorbidity.

RESULTS

The prevalence of hypertension alone, dyslipidemia alone, and their comorbidity was 8.7%, 24.6%, and 15.0%, respectively. Multivariable models showed an inverse association of hypertension (OR, 0.37; 95% CI, 0.30 to 0.46) and dyslipidemia (OR, 0.36; 95% CI, 0.32 to 0.41) with healthy BMI. Hypertension was inversely associated with healthy alcohol consumption (OR, 0.46; 95% CI, 0.35 to 0.61) and diet (OR, 0.79; 95% CI, 0.63 to 0.99), whereas dyslipidemia was inversely associated with non-smoking (OR, 0.51; 95% CI, 0.43 to 0.60). Physical activity was inversely associated with their comorbidity (OR, 0.69; 95% CI, 0.56 to 0.85). Adherence to HLS was associated with significantly lower odds of hypertension (81%), dyslipidemia (66%), and their conditions (89%) (all ptrend<0.001). Stratified analyses consistently showed inverse associations between HLS and hypertension and/or dyslipidemia independently of demographic factors (pinteractions>0.05).

CONCLUSIONS

HLFs were associated with lower risk for hypertension and/or dyslipidemia. Obesity may contribute significantly to the risk of these conditions, while relevant HLFs for individual chronic diseases may vary significantly.

Summary

Korean summary
건강한 생활 습관 요인(HLFs)의 개별 구성 요인들은 고혈압 및 이상지질혈증의 동반 위험과 각각의 상태와 음의 연관성을 보였다. 다양한 HLFs 중에서 BMI 상태가 중요한 요인으로 확인되었지만, 개별 만성 질환에 대한 관련 HLFs는 상당히 다를 수 있다. 또한, 명확한 용량-반응 관계가 관찰되어, 더 HLFs를 준수할수록 고혈압, 이상지질혈증 및 그들의 동반 가능성이 유의미하게 감소하는 것으로 나타났다.

Key Message
Individual components of healthy lifestyle factors (HLFs) were inversely associated with the risk of comorbid hypertension and dyslipidemia, as well as with each condition. Among the various HLFs, BMI status was identified as a significant factor, while relevant HLFs for individual chronic diseases may vary significantly. Additionally, clear dose-response associations were observed, indicating that adherence to more HLFs was significantly associated with decreasing odds of hypertension, dyslipidemia, and their comorbidity.

Citations

Citations to this article as recorded by

Prevalence of dyslipidemia and its associated risk factors in hypertensive population: A single-center cross-sectional study in southern China
Junming Sun, Bin Huang, Weikun Zhao, Qiurui Li, Siwei Yin, Ying Zhang, Rongjie Huang
Journal of the Renin-Angiotensin-Aldosterone System.2025;[Epub] CrossRef
Nutriomics and artificial intelligence nutrition obesity cohort (NAINOC): a design paper for a prospective cohort for nutrition and obesity research
Minyoung Lee, Sungha Park, Soo-Hyun Park, Ho-Young Park, Yu Ra Lee, Min-Sun Kim, Miso Nam, Jangho Lee, Hyein Seo, Yong-ho Lee, Chan Joo Lee, Jae-Ho Park, Hye Hyun Yoo, Hyun-Jin Kim, Kyong-Oh Shin, Yoshikazu Uchida, Kyungho Park
Clinical Hypertension.2025;[Epub] 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

COVID-19: Original Article

Changes in food sufficiency among Korean adults in urban and rural areas during the COVID-19 pandemic: an analysis of the 7th and 8th Korea National Health and Nutrition Examination Survey: Sarang Jeong, Jin-Young Jeong, Sohyun Park; Epidemiol Health. 2024;46:e2024045. Published online April 16, 2024; DOI: https://doi.org/10.4178/epih.e2024045

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Abstract Summary PDF: Abstract
OBJECTIVES
Understanding changes in food sufficiency within various demographic groups during emergency situations, such as the global coronavirus disease 2019 (COVID-19) pandemic, is crucial in formulating public health policies for future preparedness. This study investigated potential differences between urban and rural residents in food sufficiency trends during the COVID-19 pandemic and examined how these changes varied according to socio-demographic factors.
METHODS
This cross-sectional study analyzed data from 19,724 adults aged 20 years and older, utilizing information from the 7th-8th Korea National Health and Nutrition Examination Survey (2018-2021).
RESULTS
In urban areas, across all subpopulations, food sufficiency improved significantly during the COVID-19 period relative to pre-pandemic levels (p<0.001). However, in rural regions, a significant increase in food sufficiency during the COVID-19 era was observed only among female, with an odds ratio of 1.42 (95% confidence interval, 1.06 to 1.89). Nevertheless, no significant interaction terms were found between region and various socio-demographic factors regarding changes in food sufficiency during the COVID-19 period.
CONCLUSIONS
During the COVID-19 pandemic, food sufficiency among urban residents improved compared to the pre-pandemic era, whereas their rural counterparts saw no such improvement. Additionally, no significant interaction was detected between urban versus rural areas and changes in food sufficiency during the COVID-19 period. These findings indicate the need for targeted food policies to prepare for potential future pandemics, particularly in rural areas, where food sufficiency did not improve.; Summary

Korean summary
- 본 연구는 COVID-19 팬데믹 동안 도시와 농촌 지역의 성인들 사이에서 식품 충분성의 변화를 조사하고, 이 변화를 사회인구학적 요인에 따라 분석하였다.
- 연구 결과, 코로나19 기간 동안 도시 지역의 다양한 인구통계학적 하위 그룹에서 식품 충분성이 크게 증가했으며, 농촌 지역에서는 여성들을 제외하고는 유의미한 변화가 나타나지 않았다.
- 본 연구는 향후 팬데믹 대비를 위한 식품 충분성 정책을 개발할 때 인구통계학적 요인과 지역적 차이를 고려하는 것이 중요하며, 특히 농촌 지역에서의 필요성을 강조한다.

Key Message
- This study examined changes in food sufficiency among adults in urban and rural areas during the COVID-19 pandemic, focusing on socio-demographic factors.
- Findings revealed that food sufficiency significantly increased in urban areas across various demographic subgroups during the COVID-19 period, while rural areas showed no significant overall change, except for an increase among women.
- The study highlights the importance of considering socio-demographic factors and regional differences, particularly the need for targeted food assistance programs in rural areas, for future pandemic preparedness.

COVID-19: Original Article

Worsening of health disparities across COVID-19 pandemic stages in Korea: Hyejin Lee, Hyunwoo Nam, Jae-ryun Lee, Hyemin Jung, Jin Yong Lee; Epidemiol Health. 2024;46:e2024038. Published online March 13, 2024; DOI: https://doi.org/10.4178/epih.e2024038

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Abstract Summary PDF

Abstract

OBJECTIVES
With the end of the coronavirus disease 2019 (COVID-19) pandemic, the health outcomes of this disease in Korea must be examined. We aimed to investigate health outcomes and disparities linked to socioeconomic status during the COVID-19 pandemic in Korea and to identify risk factors for hospitalization and mortality.

METHODS

This nationwide retrospective study incorporated an analysis of individuals with and without COVID-19 in Korea between January 1, 2020 and December 31, 2022. The study period was divided into 4 stages. Prevalence, hospitalization, mortality, and case-fatality rates were calculated per 100,000 population. Multivariate logistic regression was performed to identify risk factors for COVID-19 hospitalization and mortality.

RESULTS

Overall, the incidence rate was 40,601 per 100,000 population, the mortality rate was 105 per 100,000 population, and the case-fatality rate was 259 per 100,000 cases. A total of 12,577,367 new cases (24.5%) were recorded in stage 3 and 8,979,635 cases (17.5%) in stage 4. Medical Aid recipients displayed the lowest 3-year cumulative incidence rate (32,737 per 100,000) but the highest hospitalization (5,663 cases per 100,000), mortality (498 per 100,000), and case-fatality (1,521 per 100,000) rates. Male sex, older age, lower economic status, non-metropolitan area of residence, high Charlson comorbidity index, and disability were associated with higher risk of hospitalization and death. Vaccination was found to reduce mortality risk.

CONCLUSIONS

As the pandemic progressed, surges were observed in incidence, hospitalization, and mortality, exacerbating disparities associated with economic status and disability. Nevertheless, Korea has maintained a low case-fatality rate across all economic groups.

Summary

Korean summary
국민건강보험공단 자료를 이용하여 2020-2022년 후향적 코호트를 구축하여 시기별 코로나19 유병률, 입원률, 사망률, 치명률과 장애, 소득에 따른 건강격차를 확인하였을 때, 코로나19 대유행이 진행됨에 따라 발병률, 입원률, 사망률이 급증하고 건강 격차가 확대되었다. 그러나 이러한 격차에도 불구하고 한국은 다른 국가들과 비교하여 모든 소득수준에서 낮은 치명률을 유지하였다.

Key Message
Using data from the National Health Insurance Service, a retrospective cohort for the years 2020-2022 was established. By examining the COVID-19 prevalence rate, hospitalisation rate, mortality rate, and case-fatality rate, along with health disparities based on disability and economic status, as the pandemic progressed, there was a surge in incidence, hospitalisation, and mortality, widening disparities related to economic status and disability. Despite these disparities, Korea has maintained a low case-fatality rate across all economic groups.

Citations

Citations to this article as recorded by

The intersection of health inequalities and COVID‐19: Evidence from National Health Insurance Big Data in South Korea
Jaehyun Nam, Sarah Jiyoon Kwon, Wonik Lee, Eunji Kim
American Journal of Community Psychology.2026;[Epub] CrossRef

COVID-19: Original Article

Influence of practice location on prescribing, diabetes care, and colorectal cancer screening among Czech general practitioners during the COVID-19 pandemic: Jan Bělobrádek, Luděk Šídlo, Tom Philipp; Epidemiol Health. 2024;46:e2024033. Published online February 23, 2024; DOI: https://doi.org/10.4178/epih.e2024033

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The provision of primary health care was not interrupted during the coronavirus disease 2019 (COVID-19) pandemic in Czechia, although the capacity and resources of providers changed. We examined how the pandemic affected individual general practices throughout 2017-2021, focusing on differences between urban and rural practices.

METHODS

We analysed data from the largest health insurance company in Czechia, which provides care to 4.5 million people (60% of the population). We evaluated the prescription volume, diabetes care procedures, and faecal immunochemical test (FIT) in preventive care and new pandemic-related procedures (remote consultations, testing, and vaccinations). For the spatial distribution of practices, we adapted the Organisation for Economic Cooperation and Development typology.

RESULTS

We observed minimal declines in 2020 in the rate of prescribing (-1.0%) and diabetes care (-5.1%), with a rapid resumption in 2021, but a substantial decline in FIT (-17.8% in 2020) with slow resumption. Remote consultations were used by 94% of all practices regardless of location, with testing and vaccinations more commonly performed by rural general practitioners (GPs).

CONCLUSIONS

Primary care in Czechia rose to the challenge of the COVID-19 pandemic, as shown by the finding that the volume of healthcare services provided through primary care did not decrease across most of the monitored parameters. This study also confirmed that rural GPs provide more care in-house, both in terms of prescribing and procedures performed in their practices. Future studies will need to focus on preventive care, which the pandemic has dampened in GP practices in Czechia.

Summary

Key Message
Primary care in Czechia has effectively adapted to the changes brought about by the COVID-19 pandemic. Minimal impact was observed in prescribtions and diabetic patient care. There was a significant decline in colorectal cancer screening, with a slow restitution after the pandemic subsided. Rural GPs consistently provided in-house treatment and have higher shares of both prescribing and diabetes care, as well as performing more COVID-19 specific procedures.

Citations

Citations to this article as recorded by

Effect of Age, Practice Location and Covid-19 on the Use of POCT Methods by General Practitioners in Czechia in 2017–2021
Jan Bělobrádek, Luděk Šídlo, Tom Philipp
Acta Medica (Hradec Kralove, Czech Republic).2025; 68(3): 87. CrossRef

Original Articles

Adherence to the American Cancer Society guidelines on nutrition and physical activity for cancer survivors and biomarkers of inflammation among breast cancer survivors: Minji Kang, Sihan Song, Hyun Jeong Cho, Zisun Kim, Hyun Jo Youn, Jihyoung Cho, Jun Won Min, Yoo Seok Kim, Sang-Woon Choi, Jung Eun Lee; Epidemiol Health. 2024;46:e2024026. Published online January 25, 2024; DOI: https://doi.org/10.4178/epih.e2024026

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study investigated whether adherence to the overall lifestyle recommendations in the American Cancer Society (ACS) guidelines on nutrition and physical activity for cancer survivors was associated with inflammation in breast cancer survivors.

METHODS

The study included 409 women who had undergone breast cancer surgery at least 1 year before enrollment. A generalized linear model was used to estimate the least square means and 95% confidence intervals of plasma levels of inflammatory markers according to lifestyle factors defined in terms of adherence to the ACS guidelines.

RESULTS

Higher overall adherence scores were associated with lower levels of high-sensitivity C-reactive protein (hs-CRP) (p for trend=0.015) and higher levels of adiponectin (p for trend=0.009). Similar significant associations of hs-CRP (p for trend= 0.004) and adiponectin (p for trend=0.010) levels were observed with the score for the body mass index (BMI) component of the adherence score. A higher diet component score was associated with a higher adiponectin level (p for trend=0.020), but there was no significant association for the physical activity component score.

CONCLUSIONS

The present study’s findings suggest that maintaining a healthy lifestyle according to the ACS guidelines was associated with beneficial effects on inflammatory marker levels, especially hs-CRP and adiponectin, among breast cancer survivors. Among the 3 components of lifestyle guidelines, the BMI component exhibited the most similar tendency to the overall adherence score in relation to inflammatory indicators. Further prospective and intervention studies are needed to investigate longitudinal associations between lifestyle factors and inflammatory markers among breast cancer survivors.

Summary

Korean summary
- 한국인 유방암 생존자를 대상으로 한 연구에서, 암 생존자를 위한 영양 및 신체 활동에 관한 미국암협회 (American Cancer Society, ACS) 지침을 따라 건강한 생활 습관을 유지하는 것이 혈중 염증 마커 수준, 특히 낮은 hs-CRP와 높은 adiponectin 수준과 관련이 있었습니다.
- 체질량지수 (Body Mass Index, BMI)를 적절한 수준 (18.5-23 kg/m²)으로 유지하는 것은 낮은 hs- CRP 수준과 높은 adiponectin 수준과 관련이 있는 것으로 나타났습니다.
- 또한, 과일, 야채 및 통곡물이 풍부하고 적색육 및 가공육을 적게 섭취하는 건강한 식단은 혈중 adiponectin 수치가 높은 것과 관련이 있었습니다.

Key Message
• Maintaining a healthy lifestyle according to the American Cancer Society (ACS) Guidelines on Nutrition and Physical Activity for Cancer Survivors was associated with favorable levels of inflammatory markers, especially in hs-CRP and adiponectin among breast cancer survivors.
• Maintaining an adequate BMI of 18.5 to 23 kg/m2 was associated with lower levels of hs-CRP and higher adiponectin levels.
• In addition, a healthy diet — indicating a diet high in fruits, vegetables, and whole grains, and low in red and processed meats — was associated with higher adiponectin levels.

Citations

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Dietary isoflavone intake among breast cancer survivors and cancer-free women
Sihan Song, Hyeong-Gon Moon, Dong-Young Noh, So-Youn Jung, Eun Sook Lee, Zisun Kim, Hyun Jo Youn, Jihyoung Cho, Young Bum Yoo, Se Kyung Lee, Jeong Eon Lee, Seok Jin Nam, Yoo Seok Kim, Jun Won Min, Shinyoung Jun, Hyojee Joung, Jung Eun Lee
Nutrition Research and Practice.2025; 19(1): 80. CrossRef
Dietary intake and plasma isoflavones are inversely associated with inflammatory markers in breast cancer survivors: A cross-sectional study
Sihan Song, Zisun Kim, Hyun Jo Youn, Jihyoung Cho, Yoo Seok Kim, Jun Won Min, Sang-Woon Choi, Adrian A. Franke, Shinyoung Jun, Hyojee Joung, Jung Eun Lee
Nutrition Research.2025; 138: 22. CrossRef
Adherence to the Mediterranean diet and mortality in cancer survivors: a Nationwide study with mediation and subgroup analyses
Bowen Zha, Lizhou Dou, Chen Zhang, Shun He, Guiqi Wang
Frontiers in Nutrition.2025;[Epub] CrossRef

Association between dietary and behavioral-based oxidative balance score and phenotypic age acceleration: a cross-sectional study of Americans: Dongzhe Wu, Yulin Shen, Chaoyi Qu, Peng Huang, Xue Geng, Jianhong Zhang, Zhijian Rao, Qiangman Wei, Shijie Liu, Jiexiu Zhao; Epidemiol Health. 2024;46:e2024023. Published online January 18, 2024; DOI: https://doi.org/10.4178/epih.e2024023

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
In light of the rise in the global aging population, this study investigated the potential of the oxidative balance score (OBS) as an indicator of phenotypic age acceleration (PhenoAgeAccel) to better understand and potentially slow down aging.

METHODS

Utilizing data from the National Health and Nutrition Examination Survey collected between 2001 and 2010, including 13,142 United States adults (48.7% female and 51.2% male) aged 20 and above, OBS and PhenoAgeAccel were calculated. Weighted generalized linear regression models were employed to explore the associations between OBS and PhenoAgeAccel, including a sex-specific analysis.

RESULTS

The OBS demonstrated significant variability across various demographic and health-related factors. There was a clear negative correlation observed between the higher OBS quartiles and PhenoAgeAccel, which presented sex-specific results: the negative association between OBS and PhenoAgeAccel was more pronounced in male than in female. An analysis using restricted cubic splines revealed no significant non-linear relationships. Interaction effects were noted solely in the context of sex and hyperlipidemia.

CONCLUSIONS

A higher OBS was significantly associated with a slower aging process, as measured by lower PhenoAgeAccel. These findings underscore the importance of OBS as a biomarker in the study of aging and point to sex and hyperlipidemia as variables that may affect this association. Additional research is required to confirm these results and to investigate the biological underpinnings of this relationship.

Summary

Key Message
• The study found a significant negative correlation between the oxidative balance score (OBS) and phenotypic age acceleration (PhenoAgeAccel), with higher OBS associated with slower biological aging. This association was more pronounced in males, and significant in individuals with high cholesterol.
• OBS can serve as an effective biomarker for studying the aging process and its association with lifestyle and dietary factors.

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Association between methyl donor nutrients’ dietary intake with phenotypic aging among US adults: a cross-sectional study from NHANES 2005–2018
Yong Li, Da Peng, Zhenyuan Yu, Jiaqi Deng, Lijuan Zhao, Ruoyan Cao
Scientific Reports.2025;[Epub] CrossRef
Dose-response relationship between sleep duration and mediation of phenotypic age acceleration: A cross-sectional study
Yujia Liu, Kai Qiao
Medicine.2025; 104(40): e44786. CrossRef
Association of oxidative balance score with chronic kidney disease: NHANES 1999-2018
Haibin Wen, Xianhua Li, Jiangming Chen, Yi Li, Nailong Yang, Ning Tan
Frontiers in Endocrinology.2024;[Epub] CrossRef
Association between oxidative balance score and diabetic kidney disease, low estimated glomerular filtration rate and albuminuria in type 2 diabetes mellitus patients: a cross-sectional study
Cong Liu, Jiju Yang, Hongdian Li, Yuanyuan Deng, Pengfei He, Jiao Zhang, Mianzhi Zhang
Frontiers in Endocrinology.2024;[Epub] CrossRef
Dose–response relationship of dietary Omega-3 fatty acids on slowing phenotypic age acceleration: a cross-sectional study
Dongzhe Wu, Yishuai Jia, Yujia Liu, Mingyu Shang
Frontiers in Nutrition.2024;[Epub] CrossRef
Dose-response relationship between leisure-time physical activity patterns and phenotypic age acceleration in American adults: A cross-sectional analysis
Dongzhe Wu, Peng Huang, Xue Geng, Chaoyi Qu, Zhijian Rao, Jianhong Zhang, Yulin Shen, Qiangman Wei, Shijie Liu, Jiexiu Zhao
Journal of Exercise Science & Fitness.2024; 22(4): 445. CrossRef

The effect of public hospital closure on the death of long-term inpatients in Korea: Taeuk Kang, Minsung Sohn, Changwoo Shon; Epidemiol Health. 2024;46:e2024022. Published online January 17, 2024; DOI: https://doi.org/10.4178/epih.e2024022

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Abstract Summary PDF

Abstract

OBJECTIVES
This study aimed to examine the changes in health outcomes and the patterns of medical institution utilization among patients with long-term stays in public hospitals following the closure of a public medical center. It also sought to present a proposal regarding the role of public hospitals in countries with healthcare systems predominantly driven by private entities, such as Korea.

METHODS

To assess the impact of a public healthcare institution closure on health outcomes in a specific region, we utilized nationally representative health insurance claims data. A retrospective cohort study was conducted for this analysis.

RESULTS

An analysis of the medical utilization patterns of patients after the closure of Jinju Medical Center showed that 67.4% of the total medical usage was redirected to long-term care hospitals. This figure is notably high in comparison to the 20% utilization rate of nursing hospitals observed among patients from other medical facilities. These results indicate that former patients of Jinju Medical Center may have experienced limitations in accessing necessary medical services beyond nursing care. After accounting for relevant mortality factors, the analysis showed that the mortality rate in closed public hospitals was 2.47 (95% confidence interval, 0.85 to 0.96) times higher than in private hospitals.

CONCLUSIONS

The closure of public medical institutions has resulted in unmet healthcare needs, and an observed association was observed with increased mortality rates. It is essential to define the role and objectives of public medical institutions, taking into account the distribution of healthcare resources and the conditions of the population.

Summary

Korean summary
본 연구는 사회보험제도를 기반으로 하고 있는 한국의 상황에서 지방의 공공의료기관 폐쇄가 환자들의 건강에 어떠한 영향을 미쳤는지를 확인하고자 국민건강보험 청구자료를 기반으로 후향적코호트 자료를 구축하여 분석을 시행하였다. 연구결과 장기 입원 환자의 67.4%가 장기요양병원을 의료를 이용하였고, 이는 비교집단의 장기요양 이용비율인 20% 수준보다 3배 가량 높은 수치로, 의료이용에 일부 제약이 발생하였을 가능성을 시사하는 것이다. 폐업 후 1년 이내 사망률을 비교한 결과, 인근지역 내 민간병원 환자와 비교하여 공공의료기관 입원환자의 사망확률은 2.67배였고, 의료급여 수급권자들의 사망확률은 고소득 5분위에 비해 2.24배 높은 것으로 나타났다.

Key Message
Even in Korea's healthcare system with high medical accessibility, adverse health impacts have been observed due to the closure of public healthcare institutions. Systematic policy development is necessary to evaluate essential medical service provision and allocate medical resources comprehensively.

Citations

Citations to this article as recorded by

Impacts of Inner-City Hospital Closures on Access to Surgical Care in Urban Communities
Eliel N. Arrey, Anahit Mehranian, Aaron M. Alford
The American Surgeon™.2026; 92(1): 129. CrossRef

Association of plain water intake with self-reported depression and suicidality among Korean adolescents: Jung Woo Lee, Yookyung Kim; Epidemiol Health. 2024;46:e2024019. Published online January 9, 2024; DOI: https://doi.org/10.4178/epih.e2024019

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Abstract

OBJECTIVES
Adolescent depression and suicidality are serious health problems worldwide. Lower plain water intake has been proposed as a risk factor for depression in adults. This study investigated the association of daily plain water intake with self-reported depression and suicidality among Korean adolescents.

METHODS

We used nationwide data from 112,250 students aged 12-18 years who participated in the Korean Youth Risk Behavior Web-based Surveys in 2019 and 2020. Daily plain water intake was categorized as <1 glass, 1-2 glasses, and ≥3 glasses. The adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for self-reported depression and suicidality were calculated using multiple regression analyses.

RESULTS

The weighted prevalence rates of self-reported depression, suicidal ideation, suicide planning, and suicide attempts were 26.7%, 12.0%, 3.8%, and 2.5%, respectively. Of the participants, 3.9%, 18.5%, and 77.7% were categorized into the <1 glass/day, 1-2 glass/day, and ≥3 glass/day groups, respectively. Compared to the reference group (≥3 glass/day), the lowest level of water intake (<1 glass/day) was associated with higher odds of self-reported depression (aOR, 1.30; 95% CI, 1.20 to 1.39), suicidal ideation (aOR, 1.39; 95% CI, 1.27 to 1.55), suicide planning (aOR, 1.46; 95% CI, 1.25 to 1.69), and suicide attempts (aOR, 1.38; 95% CI, 1.15 to 1.67). Moderately lower water intake (1-2 glass/day) showed slightly increased odds of self-reported depression (aOR, 1.05; 95% CI, 1.01 to 1.10) and suicidal ideation (aOR, 1.08; 95% CI, 1.03 to 1.14).

CONCLUSIONS

Lower plain water intake was significantly associated with a higher risk of self-reported depression and suicidality among Korean adolescents. Since this cross-sectional study is unable to establish a causal relationship, it underscores the need for additional longitudinal research.

Summary

Korean summary
- 한국 청소년들에서 하루 물 섭취량이 적을수록 스스로 느끼는 우울감과 자살성향 위험이 증가하였다. - 이 연구는 하루 물 섭취량 측정이 청소년 우울증과 자살성향을 선별할 수 있음을 시사한다.

Key Message
- Lower daily plain water intake is significantly associated with a higher risk of self-reported depression and suicidality in Korean adolescents. - It suggests that daily plain water consumption could potentially serve as a screening indicator to identify depression and suicidality in adolescents.

Citations

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Association between plain water intake and the risk of osteoporosis among middle-aged and elderly people in the United States: a cross-sectional study
Xudong Wang, Meng Wang, Zijian Guo, Chuan Xiang
Frontiers in Nutrition.2025;[Epub] CrossRef
Association of constipation with suicidal ideation among US adults and the partial mediating role of depression
Pengfei Wang, Yan Wang, Hong Li, Feng Gao, Xiaojie Huang, Ying Ye, Xiaohua Yan, Yishun Jin
Scientific Reports.2025;[Epub] CrossRef
Mitigating Weight Gain Side Effects by Reducing Sugar-Sweetened Beverage Consumption in Youth Newly Prescribed Second-Generation Antipsychotic Medication
Kristin Bussell, Heidi Wehring, Susan dosReis, Raymond C. Love, Jason Schiffman, John Sorkin, Zhaoyong Feng, Sarah Edwards, Erin Hager, Elizabeth A. Dennis, Kathleen Connors, Kathryn McDonald, Meredith Roberts, Emily Wolfe, Shlomo Resnik, Gloria Reeves
Nutrients.2025; 18(1): 24. CrossRef

Socioeconomic inequality in health-related quality of life among Korean adults with chronic disease: an analysis of the Korean Community Health Survey: Thi Huyen Trang Nguyen, Thi Tra Bui, Jinhee Lee, Kui Son Choi, Hyunsoon Cho, Jin-Kyoung Oh; Epidemiol Health. 2024;46:e2024018. Published online January 8, 2024; DOI: https://doi.org/10.4178/epih.e2024018

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Abstract Summary PDF

Abstract

OBJECTIVES
Health-related quality of life is crucial for people dealing with chronic illness. This study investigated the quality of life in individuals with 5 common chronic conditions in Korea. We also analyzed socioeconomic factors such as education, income, occupation, and urbanization to identify determinants of inequality.

METHODS

Using 2016 Korea Community Health Survey data, we examined individuals aged 30 or older with chronic diseases (diabetes, hypertension, cardiovascular disease, hyperlipidemia, arthritis) using the EuroQol 5-Dimension 3 Level tool. We analyzed the associations between socioeconomic factors (education, income, occupation, urbanization) and quality of life using descriptive statistics and regression analysis. Inequality indices (relative inequality index, absolute inequality index) were used to measure inequality in quality of life.

RESULTS

Individuals with higher income levels showed a 1.95-fold higher likelihood of a better quality of life than those with the lowest income. The lowest income group had higher odds of mobility (adjusted odds ratio [aOR], 2.2), self-care (aOR, 2.1), activity limitations (aOR, 2.4), pain/discomfort (aOR, 1.8), and anxiety/depression (aOR, 2.3). Educational disparities included a 3-fold increase in mobility and daily activity problems for those with elementary or lower education. Well-educated participants had a 1.94 times higher quality of life, with smaller differences in anxiety/depression and self-management. The income gap accounted for 14.1% of variance in quality-of-life disparities.

CONCLUSIONS

Addressing socioeconomic disparities in the quality of life for individuals with chronic diseases necessitates tailored interventions and targeted health policies. This research informs policymakers in developing focused initiatives to alleviate health inequities. It emphasizes the importance of mental health support and ensuring affordable, accessible healthcare services.

Summary

Korean summary
- 지역사회건강조사 자료를 통해 확인한 한국인에게 호발하는 만성질환자(당뇨, 고혈압, 심혈관질환, 고지혈증, 관절염)에서 삶의 질 점수(EQ-5D)는 평균 0.7점으로, 남성에서 높고, 연령이 높을수록 낮다. - 소득이 낮거나 교육수준이 낮은 군에서 삶의 질이 상대적으로 낮으며, 특히 운동능력, 자기관리, 통증/불편, 불안/우울 각각에서 두배 가량 어려움을 겪는 것으로 나타났다. - 만성질환자에서 삶의 질은 사회경제적 여건에 따라 격차가 존재하므로, 취약한 계층 발굴과 지원이 필요하다.

Key Message
- Quality of life score (EQ-5D) in patients with chronic diseases (i.e., diabetes, hypertension, cardiovascular disease, hyperlipidemia, and arthritis) that are prevalent in Koreans identified through data from community health surveys averaged 0.7, lower in women than in men, and decreased by age. - Low-income or low-educated patients have relatively low quality of life, and they have more than twice as much problem in mobility, self-care, pain/discomfort, and anxiety/depression. - Disparities in quality of life in patients with chronic diseases according to socioeconomic conditions have been found, and support for the vulnerable is needed.

Citations

Citations to this article as recorded by

Analysis of asthma incidence and mortality rates among children aged 0–14 in 204 countries from 1990 to 2019
Fei Cheng, Li He, Dachuan Deng, Jinhui Zhang, Cheng Liu
Journal of Asthma.2025; 62(1): 45. CrossRef
Feasibility of Using the EuroQol-5 Dimensions to Identify Masticatory Discomfort in Community-Dwelling Older Adults
Han-Nah Kim, Nam-Hee Kim
Journal of Dental Hygiene Science.2025; 25(3): 237. CrossRef
Health-related Quality of Life in Multimorbid Adults: A Random Forest Cross-sectional Analysis of the Korean National Health and Nutrition Examination Survey
Moonchang You, Geun-Myun Kim
Journal of Korean Academy of psychiatric and Mental Health Nursing.2025; 34(3): 349. CrossRef

An epidemic of cataract surgery in Korea: the effects of private health insurance on the National Health Insurance Service: Hyejin Lee, Soo-Hee Hwang, Choon-Seon Park, Seol-Hee Chung, Catherine L. Chen, Jin Yong Lee, Jin Soo Lee; Epidemiol Health. 2024;46:e2024015. Published online January 6, 2024; DOI: https://doi.org/10.4178/epih.e2024015

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
In Korea, the National Health Insurance Service (NHIS) covers essential healthcare expenses, including cataract surgery. To address concerns that private health insurance (PHI) might have inflated the need for such procedures, we investigated the extent of the PHI-attributable increase in cataract surgery and its impact on NHIS-reimbursed expenses.

METHODS

This retrospective, observational study uses nationwide claims data for cataract surgery from 2016 to 2020. We examined trends in utilization and cost, and we estimated the excess numbers of (1) cataract operations attributable to PHI and (2) types of intraocular lenses used for cataract surgery in 2020.

RESULTS

Between 2016 and 2020, a 36.8% increase occurred in the number of cataract operations, with increases of 63.5% and 731.8% in the total healthcare costs reimbursed by NHIS and PHI, respectively. Over a 5-year period, the surgical rate per 100,000 people doubled for patients aged <65 years (from 328 in 2016 to 664 in 2020). Among the 619,771 cases in 2020 of cataract surgery reimbursed by the Korean diagnosis-related group system, more non-NHIS-covered intraocular lenses were used for patients aged <65 years than ≥65 years (68.1 vs. 14.2%). In 2020 alone, an estimated 129,311 excess operations occurred, accounting for an excess cost of US$115 million.

CONCLUSIONS

A dramatic increase in the number and cost of cataract operations has occurred over the last 5 years. The PHI-related increase in operations resulted in increased costs to NHIS. Measures to curtail the non-indicated use of cataract surgery should be implemented regarding PHI.

Summary

Korean summary
백내장 수술에서 실손보험으로 인한 의료비 증가 수준을 확인하고 건강보험급여 비용에 미치는 영향을 조사했을 때 2016년과 2020년 사이에 백내장 수술 건수는 36.8% 증가했으며, 건강보험과 실손보험에서 지급한 총 의료 비용은 각각 63.5%와 731.8% 증가했다. 백내장 수술은 65세 미만에서 주로 증가하였으며, 이 연령층은 공단에서 급여하지 않는 고가의 인공수정체를 더 많이 사용하였다. 추정 초과 수술 건수는 2020년에만 129,311건으로 1억 1,500만 달러의 초과 비용이 발생했다.

Citations

Citations to this article as recorded by

Global prevalence of cataract surgery
Hassan Hashemi, Faezeh Fayaz, Alireza Hashemi, Mehdi Khabazkhoob
Current Opinion in Ophthalmology.2025; 36(1): 10. CrossRef
The association between health literacy, private health insurance, and medical expenditure in South Korea
Jeehye Lee, Hye Sook Min, Dong-Hee Ryu
BMC Health Services Research.2025;[Epub] CrossRef

Determinants of unhealthy living by gender, age group, and chronic health conditions across districts in Korea using the 2010-2017 Community Health Surveys: Thi Tra Bui, Thi Huyen Trang Nguyen, Jinhee Lee, Sun Young Kim, Jin-Kyoung Oh; Epidemiol Health. 2024;46:e2024014. Published online January 4, 2024; DOI: https://doi.org/10.4178/epih.e2024014

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We investigated the prevalence and determinants of unhealthy living by gender, age, and comorbidities across Korean districts.

METHODS

For 806,246 men and 923,260 women from 245 districts who participated in the 2010-2017 Korean Community Health Surveys, risk scores were calculated based on obesity, physical inactivity, smoking, and high-risk alcohol consumption, each scored from 0 (lowest risk) to 2 (highest risk). A risk score ≥4 was defined as indicating unhealthy living, and weighted proportions were calculated for each district. Using multivariate regression, an ecological model including community socioeconomic, interpersonal, and neighborhood factors was examined by gender, age, and comorbidities.

RESULTS

The mean age-standardized rate of unhealthy living was 24.05% for men and 4.91% for women (coefficients of variation, 13.94% and 29.51%, respectively). Individuals with chronic diseases more frequently exhibited unhealthy lifestyles. Unhealthy lifestyles were associated with educational attainment (β-coefficients: men, -0.21; women, -0.15), high household income (β=0.08 and 0.03, respectively), pub density (β=0.52 and 0.22, respectively), and fast-food outlet density (β=2.81 and 1.63, respectively). Negative associations were observed with manual labor, social activity participation, and hospital bed density. Unhealthy living was positively associated with living alone among women and with being unemployed among middle-aged men. Access to parks was negatively associated with unhealthy living among young men and women. The ecological model explained 32% of regional variation in men and 41% in women.

CONCLUSIONS

Improving the neighborhood built and socioeconomic environment may reduce regional disparities in lifestyle behaviors; however, the impacts may vary according to socio-demographic traits and comorbidities.

Summary

Korean summary
- 시군구 지역단위의 불건강생활(흡연, 음주, 비만, 신체활동 부족 각 0-2점, 합 4점 이상 불건강) 유병률은 여자보다 남자에서 높고, 연령이 높아지면서 감소한다. - 지역사회 환경개선(술집 개수, 패스트푸드점 밀도, 공원 면적, 병상밀도)과 사회경제적 수준 강화(교육수준, 가구소득, 고용)를 통해 생활습관적 건강행태의 지역 격차를 줄일 수 있다. - 이러한 향상 노력의 효과는 지역의 건강상태 수준이나 사회인구학적 특성에 따라 다를 수 있다.

Key Message
• District prevalence rates of unhealthy living were higher among men than women and decreased with advancing age. • Efforts to reduce regional disparities in lifestyle behaviors could benefit from enhancements to the neighborhood environment and the socioeconomic status of the area. • The effectiveness of such improvements may vary based on socio-demographic characteristics and health conditions.

Citations

Citations to this article as recorded by

A Community-Based, Lifestyle Behavioral Intervention Based on the Extended Theory of Planned Behavior for Postmenopausal Women at Cardiometabolic Risk: A Randomized Controlled Trial
Sooyeon Park, Jina Choo
Western Journal of Nursing Research.2025; 47(7): 573. CrossRef
Feasibility of Using the EuroQol-5 Dimensions to Identify Masticatory Discomfort in Community-Dwelling Older Adults
Han-Nah Kim, Nam-Hee Kim
Journal of Dental Hygiene Science.2025; 25(3): 237. CrossRef

Systematic Review

Effectiveness of community-based interventions for older adults living alone: a systematic review and meta-analysis: Inhye Kim, Hyunseo An, Sohyeon Yun, Hae Yean Park; Epidemiol Health. 2024;46:e2024013. Published online January 3, 2024; DOI: https://doi.org/10.4178/epih.e2024013

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Abstract

OBJECTIVES
This study examined the effectiveness of community-based interventions designed for older adults living alone through a systematic review and meta-analysis.

METHODS

The study incorporated 4 randomized controlled trials (RCTs) and 5 non-RCTs to evaluate various interventions. The methodological quality of these studies was assessed using the Downs and Black checklist, while Q-statistic and I-square tests were performed to examine statistical heterogeneity. Additionally, visual inspection of funnel plots and the trim-and-fill method were employed to investigate potential publication bias. Of the 2,729 identified studies, 9 met the criteria for inclusion in this review. Independent variables were categorized into 5 groups (physical activity, nutrition, social relationships, social participation, and combined intervention) to examine their effects. Dependent variables were similarly classified into 5 subgroups to identify the specific effects of the interventions.

RESULTS

Interventions focusing on nutrition and combined approaches were the most effective, yielding effect sizes of 0.96 (95% confidence interval [CI], 0.66 to 1.25) and 0.43 (95% CI, 0.26 to 0.60), respectively. The interventions had the greatest impacts on the health behavior and mental health of the participants, with effect sizes of 0.98 (95% CI, 0.73 to 1.22) for health behavior and 0.67 (95% CI, 0.19 to 1.16) for mental health.

CONCLUSIONS

This study suggests a direction for the development of community-based interventions tailored to the needs of older adults living alone. Additionally, it provides evidence to inform policy decisions concerning this demographic.

Summary

Korean summary
본 연구는 독거 노인들 대상으로 한 지역사회 기반 중재의 효과에 대하여 탐색하고 그 효과 크기를 확인하기 위하여 체계적고찰 및 메타분석을 실시하였다. 영양 및 복합 중재가 특히 효과적이었으며, 이는 건강 행동과 정신건강에 있어 중요한 긍정적 효과를 나타내어 추후 개별적 맞춤 중재의 잠재적 효과성을 나타낸다. 이러한 발견은 독거노인 집단의 웰빙 향상을 위한 프로그램과 정책 입안에 근거로 활용될 수 있다.

Key Message
This systematic review and meta-analysis evaluated the impact of community-based interventions for older adults living alone, incorporating 9 studies to assess effectiveness in areas like nutrition and combined strategies. Results indicated significant benefits, particularly in health behavior and mental health, demonstrating the potential of tailored interventions. These findings support the development of targeted programs and policy decisions aimed at improving the well-being of this demographic.

Citations

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Falls among older adults: An exploration of trends, clinical outcomes, predisposing risk factors, and intervention strategies
Sanjan Kumar, Francis Cruz, Zackary Yates, Quratulain Amin, Muhammad Usman Awan, Philip Lee, Sarthak Kumar, Adel Elkbuli
The American Journal of Surgery.2025; 245: 116385. CrossRef
A DESCRIPTIVE STUDY ON TRIGLYCERIDE AND BLOOD GLUCOSE LEVELS IN THE ELDERLY POPULATION
Ika Ainur Rofiah, Lasiyati Yuswo Yani
INTERNATIONAL JOURNAL OF NURSING AND MIDWIFERY SCIENCE (IJNMS).2025; 9(1): 102. CrossRef
Prevalence and associated factors of physical-psychological-cognitive multimorbidity in Chinese community-dwelling older adults: a cross-sectional study
Lin Lin, Di-fei Duan, Linjia Yan, Hai yan He
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Effectiveness of a resilience-building nursing intervention on psychological well-being in Arab community-dwelling older adults
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Original Article

Identifying pregnancy episodes and estimating the last menstrual period using an administrative database in Korea: an application to patients with systemic lupus erythematosus: Yu-Seon Jung, Yeo-Jin Song, Jihyun Keum, Ju Won Lee, Eun Jin Jang, Soo-Kyung Cho, Yoon-Kyoung Sung, Sun-Young Jung; Epidemiol Health. 2024;46:e2024012. Published online December 19, 2023; DOI: https://doi.org/10.4178/epih.e2024012

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Abstract

OBJECTIVES
This study developed an algorithm for identifying pregnancy episodes and estimating the last menstrual period (LMP) in an administrative claims database and applied it to investigate the use of pregnancy-incompatible immunosuppressants among pregnant women with systemic lupus erythematosus (SLE).

METHODS

An algorithm was developed and applied to a nationwide claims database in Korea. Pregnancy episodes were identified using a hierarchy of pregnancy outcomes and clinically plausible periods for subsequent episodes. The LMP was estimated using preterm delivery, sonography, and abortion procedure codes. Otherwise, outcome-specific estimates were applied, assigning a fixed gestational age to the corresponding pregnancy outcome. The algorithm was used to examine the prevalence of pregnancies and utilization of pregnancy-incompatible immunosuppressants (cyclophosphamide [CYC]/mycophenolate mofetil [MMF]/methotrexate [MTX]) and non-steroidal anti-inflammatory drugs (NSAIDs) during pregnancy in SLE patients.

RESULTS

The pregnancy outcomes identified in SLE patients included live births (67%), stillbirths (2%), and abortions (31%). The LMP was mostly estimated with outcome-specific estimates for full-term births (92.3%) and using sonography procedure codes (54.7%) and preterm delivery diagnosis codes (37.9%) for preterm births. The use of CYC/MMF/MTX decreased from 7.6% during preconception to 0.2% at the end of pregnancy. CYC/MMF/MTX use was observed in 3.6% of women within 3 months preconception and 2.5% during 0-7 weeks of pregnancy.

CONCLUSIONS

This study presents the first pregnancy algorithm using a Korean administrative claims database. Although further validation is necessary, this study provides a foundation for evaluating the safety of medications during pregnancy using secondary databases in Korea, especially for rare diseases.

Summary

Korean summary
임산부의 약물 사용 안전성에 대한 근거 제공을 위해 실제 인구집단에서의 임신 중 약물 치료 안전성을 평가하는 청구자료 기반 연구가 중요하다. 본 연구에서는 국내 청구자료에 적용할 수 있는 임신 정의 및 임신 결과 조작적 정의 알고리즘을 개발하였다. 본 알고리즘은 임신 결과 간의 우선순위를 고려한 계층 구조를 활용하며, 조기 분만 및 초음파 검사 코드 등을 통해 최종 월경 기간을 추정하였다. 또한 알고리즘을 전신홍반루푸스 환자에 적용하여 유산, 사산 등의 유병률을 산출하고 임신 중 잠재적으로 부적절한 면역억제제 사용을 파악하여 국내 청구자료의 특성을 고려한 임신 중 약물 사용 연구의 기반을 마련하였다.

Key Message
Limited safety data for pregnant women prompted recent studies on medication during pregnancy using real-world databases. This study developed a tailored algorithm for Korean healthcare claims database, employing a hierarchy of pregnancy outcomes and incorporating pre-term delivery and sonography codes for last menstrual period estimation. Applied to systemic lupus erythematosus (SLE) patients, this study presented the prevalence and drug utilization pattern of pregnancy-incompatible immunosuppressants from preconception to pregnancy end, laying a foundation for further claims database studies on medication pregnancy safety.

Citations

Citations to this article as recorded by

Utilisation patterns of immunomodulators and pregnancy outcomes in systemic lupus erythematosus: Insights from Korean national data
Yu-Seon Jung, Yeo-Jin Song, Hyeon Ji Lee, Eunji Kim, Soo-Kyung Cho, Yoon-Kyoung Sung, Sun-Young Jung
Lupus.2025; 34(2): 140. CrossRef
Narrative Review of National Health Insurance Claims Data for Gestational Age Calculation and Vaccine Safety Evaluation in Pregnancy
Taemi Kim, Seung-Ah Choe
Health Insurance Review & Assessment Service Research.2025; 5(2): 98. CrossRef
Neurodevelopmental delays in children born after medically assisted reproduction: a national population cohort study
Seung-Ah Choe, Eunseon Gwak, Juyoung Lee, Jung Hye Byeon, Ju-Young Shin, Seungbong Han, Jee Hyun Kim
Journal of Neurodevelopmental Disorders.2025;[Epub] CrossRef
Immunosuppressant use and adverse pregnancy outcomes in women with systemic lupus erythematosus: a retrospective cohort study in Korea
Yu-Seon Jung, Yeo-Jin Song, Eun Jin Jang, Soo-Kyung Cho, Yoon-Kyoung Sung, Sun-Young Jung
Rheumatology.2025;[Epub] CrossRef

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