Epidemiology and Health

Original Articles

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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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.

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.

Adherence to the Korean National Code Against Cancer and mortality: a prospective cohort study from the Health Examinees-Gem study: Jeeyoo Lee, Aesun Shin, Woo-Kyoung Shin, Ji-Yeob Choi, Daehee Kang; Epidemiol Health. 2025;47:e2025026. Published online May 9, 2025; DOI: https://doi.org/10.4178/epih.e2025026

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OBJECTIVES
The Korean National Code Against Cancer was released in 2006. These guidelines aimed to promote a healthy lifestyle to prevent cancer risk through 10 recommendations. The objective of this study was to investigate the associations between adherence to the Korean National Code Against Cancer and the risk of all-cause, cancer, and cardiovascular disease (CVD) mortality among Koreans.
METHODS
This prospective cohort study included 109,160 Korean adults aged 40 years to 69 years, recruited from 2004 to 2013 in the population-based Health Examinees-Gem Study. The adherence total score was calculated based on 6 items from the Korean National Code Against Cancer: smoking, consuming vegetables and fruits, limiting salty foods, restricting alcohol intake, engaging in physical activity, and maintaining a healthy weight. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations of adherence scores with mortality risk were estimated using a Cox proportional hazards regression model.
RESULTS
During a mean follow-up period of 12.0 years, 3,799 deaths were recorded. According to the multivariable-adjusted model, males in the highest tertile of adherence scores had a lower risk of all-cause, cancer, and CVD mortality compared to those in the lowest tertile (all-cause: HR, 0.67; 95% CI, 0.60 to 0.74; cancer: HR, 0.63; 95% CI, 0.54 to 0.74; CVD: HR, 0.56, 95% CI, 0.43 to 0.73). A similar association was observed among females for all-cause and CVD mortality (all-cause: HR, 0.85; 95% CI, 0.76 to 0.96; CVD: HR, 0.70; 95% CI, 0.51 to 0.97).
CONCLUSIONS
Adherence to the Korean National Code Against Cancer was associated with a reduced risk of all-cause, cancer, and CVD mortality.; Summary

Korean summary
한국인 대규모 집단에서 암예방 수칙 준수도가 높을수록 전체 사망, 암 사망, 심혈관질환 사망 위험이 감소함을 확인하였으며, 암예방수칙의 보급과 준수가 암뿐만 아니라 다른 만성질환으로 인한 사망을 예방하는 데 중요함을 시사한다.

Key Message
We found that greater adherence to the Korean National Code Against Cancer was associated with reduced risks of all-cause, cancer, and cardiovascular disease mortality in a large Korean population, highlighting the importance of promoting this code for public health.

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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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

Association of dietary inflammatory index with mortality risk: a prospective analysis of the Korea National Health and Nutrition Examination Survey: Dahyun Park, Hee Ju Jun, Garam Jo, Soyoung Kwak, Min-Jeong Shin; Epidemiol Health. 2025;47:e2025017. Published online April 9, 2025; DOI: https://doi.org/10.4178/epih.e2025017

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The energy-adjusted dietary inflammatory index (E-DII), a tool developed based on comprehensive research and literature reviews, is used to assess the inflammatory potential of specific diets. Although previous research has demonstrated an association between E-DII and mortality, longitudinal studies investigating a causal relationship in Asian populations are lacking. This study aimed to explore the prospective association between E-DII and the risk of all-cause, cancer, and cardiovascular disease (CVD) mortality using a population-based Korean cohort.

METHODS

The analysis included data from 40,596 individuals who participated in the Korea National Health and Nutrition Examination Survey between 2007 and 2015. The exclusion criteria encompassed the diagnosis of cancer or CVD at baseline, pregnancy at baseline, and death within the first 2 years after baseline. The E-DII was calculated using data from 24-hour dietary recall interviews. Cox proportional hazard regression models were employed to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for mortality risk across E-DII tertiles.

RESULTS

Over an 8.2-year follow-up period, 2,070 deaths were recorded. Compared with the lowest E-DII, a higher index was associated with an increased risk of mortality from all causes (HR, 1.45; 95% CI, 1.25 to 1.69), cancer (HR, 1.41; 95% CI, 1.09 to 1.81), and CVD (HR, 1.53; 95% CI, 1.07 to 2.18). The association between E-DII and all-cause mortality was particularly pronounced among individuals with metabolic conditions.

CONCLUSIONS

Our findings suggest a strong positive association between high E-DII and increased mortality in Korean adults, especially those with metabolic disorders.

Summary

Korean summary
본 연구는 2007–2015년 국민건강영양조사-사망원인통계 연계 데이터를 바탕으로 한국 성인을 대상으로 식이염증지수(E-DII)와 전체, 암, 심혈관질환 사망률 간의 연관성을 분석하였음. 높은 식이염증지수는 전체 사망(HR, 1.45; 95% CI, 1.25–1.69), 암 사망(HR, 1.41; 95% CI, 1.09–1.81), 심혈관질환 사망(HR, 1.53; 95% CI, 1.07–2.18) 위험 증가와 유의하게 관련되었으며, 특히 대사질환 보유자에서 그 연관성이 두드러졌음.

Key Message
This prospective cohort study analyzed nationally representative data from the Korea National Health and Nutrition Examination Survey (2007–2015) to examine the association between the energy-adjusted Dietary Inflammatory Index (E-DII) and mortality risk. A higher E-DII was significantly associated with increased risks of all-cause (HR, 1.45; 95% CI, 1.25–1.69), cancer mortality (HR, 1.41; 95% CI, 1.09–1.81), and cardiovascular mortality (HR, 1.53; 95% CI, 1.07–2.18), particularly among individuals with metabolic disorders.

Citations

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Dietary Inflammatory Index and the Risk of Gastric Precancerous Lesions Among Korean Adults in a Rural Area
Yewon Cho, Dongkyu Lee, Chang Soo Eun, Dong Soo Han, Hyun Ja Kim
Nutrients.2025; 17(22): 3502. CrossRef

Cohort Profile

Cohort profile: a nationwide retrospective cohort of mortality in people living with HIV in Korea, 1985-2020: Taeyoung Kim, Yoonhee Jung, Koun Kim, Jung Wan Park, Jeonghee Yu, Sung-il Cho; Epidemiol Health. 2025;47:e2025002. Published online January 2, 2025; DOI: https://doi.org/10.4178/epih.e2025002

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Abstract Summary PDF: Abstract
The increasing number of people living with human immunodeficiency virus (HIV) in Korea has prompted interest in using the national surveillance system as a database for studying their health. To investigate the relationships between socio-demographic and epidemiological characteristics and mortality rates, a nationwide retrospective cohort was formed by integrating surveillance data with the Cause of Death Statistics from Statistics Korea. This integration included incidence reports, epidemiological investigations, and death reports from the surveillance data, enriched with detailed mortality information from the Cause of Death data. The cohort comprised 17,199 adult Korean individuals diagnosed with HIV infection from 1985 to 2020. By the end of 2020, 2,721 of these individuals were confirmed deceased. The sex ratio of the study participants was 14.3:1.0 (male to female), with 78.2% being under 50 years old at the time of diagnosis. Sexual contact was identified as the primary transmission route, accounting for 75.7% of cases. HIV disease emerged as the predominant cause of death, representing two-thirds (1,817 of 2,721) of the fatalities, followed by injuries and trauma, malignancies, and cardiovascular diseases. Recommendations for further cohort studies may be submitted to the Korea Disease Control and Prevention Agency.; Summary

Korean summary
- 인체면역결핍바이러스 감염인들의 사망과 연관된 요인의 파악을 위해, 질병관리청의 국가 감시체계 데이터와 통계청 사망원인통계를 결합하여 후향적 코호트를 구성하였다. - 구성된 코호트에는 1985-2020년 중 발생이 보고된 대한민국 국적의 19세 이상 감염인 17,199명이 포함되었으며 이 중 2,721명의 사망이 감시체계와 사망원인통계에서 최종 확인되었고, 코호트 데이터는 이들의 사회인구학적 요인, 역학적 요인, 사망원인을 포함한 사망 관련 정보로 구성되어 있다. - 본 코호트에 기반한 연구를 통해 국내 거주하는 한국인 감염인들의 건강을 전반적으로 확인할 수 있을 것으로 생각되며, 감염인 중 사망 위험이 높은 취약군을 확인하는 등 국가 정책의 기반이 되는 과학적 근거를 생산할 수 있기를 기대한다.

Key Message
- By merging KDCA’s national surveillance data and the national mortality statistics, our retrospective cohort data have been established for identifying people living with HIV (PLHIV) at higher risk of mortality. - In the established cohort, incidence reports of 17,199 PLHIV aged 19 or older with Korean nationality and mortality reports of 2,721 were included. The cohort data were composed of their sociodemographic and epidemiologic characteristics, and mortality data including causes of death. - We expect further research based on the cohort to explore Korean PLHIV’s health and mortality risk, and to generate scientific evidence for national policymaking.

Original Articles

Miscarriage, stillbirth, and mortality risk from stroke in women: findings from the PLCO study: Hui Tang, Zhou Li, Yuan Zhang, Mingjun Dai, Xiaoya Wang, Chuan Shao; Epidemiol Health. 2024;46:e2024093. Published online November 25, 2024; DOI: https://doi.org/10.4178/epih.e2024093

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Abstract PDF Supplementary Material: Abstract
OBJECTIVES
Existing evidence suggests that miscarriage and stillbirth are associated with an increased risk of stroke in women. However, the impact of these events on stroke mortality remains unclear. This study aimed to elucidate the potential association between miscarriage and stillbirth and stroke mortality in women.
METHODS
We employed a competing risk model using data from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial to assess the relationship between miscarriage/stillbirth and stroke death. Death from other causes was considered as a competing risk, and we conducted a subgroup analysis to explore the potential impact.
RESULTS
Our study included 68,629 women for miscarriage and 65,343 women for stillbirth. No significant association was observed between miscarriage and stroke mortality (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.84 to 1.10; p=0.58). While a single stillbirth did not show a significant association (HR, 0.81; 95% CI, 0.57 to 1.15; p=0.23), recurrent stillbirth (≥2) was associated with a significantly increased risk of stroke mortality compared to women with no stillbirths (HR, 2.24; 95% CI, 1.45 to 3.46; p<0.001).
CONCLUSIONS
Our findings suggest that recurrent stillbirth, but not single events, is associated with an elevated risk of stroke mortality in women. Further research is warranted to clarify the underlying mechanisms and potential long-term health implications of recurrent pregnancy loss.; Summary

Homelessness and mortality: gender, age, and housing status inequity in Korea: Gum-Ryeong Park, Dawoon Jeong, Seung Won Lee, Hojoon Sohn, Young Ae Kang, Hongjo Choi; Epidemiol Health. 2024;46:e2024076. Published online September 12, 2024; DOI: https://doi.org/10.4178/epih.e2024076

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Abstract

OBJECTIVES
We compared mortality rates among various housing statuses within the homeless population and investigated factors contributing to their deaths, including housing status, gender, and age.

METHODS

Using a comprehensive multi-year dataset (n=15,445) curated by the National Tuberculosis Screening and Case Management Programs, matched with the 2019-2021 Vital Statistics Death Database and National Health Insurance claims data, we calculated age-standardized mortality rates and conducted survival analysis to estimate differences in mortality rates based on housing status.

RESULTS

The mortality rate among the homeless population was twice as high as that of the general population, at 1,159.6 per 100,000 compared to 645.8 per 100,000, respectively. Cancer and cardiovascular diseases were the primary causes of death. Furthermore, individuals residing in shelter facilities faced a significantly higher risk of death than those who were rough sleeping, with an adjusted hazard ratio of 1.70 (95% confidence interval, 1.37 to 2.11). This increased risk was especially pronounced in older adults and women.

CONCLUSIONS

The study highlights the urgent need for targeted interventions, as the homeless population faces significantly higher mortality rates. Older adults and women in shelter facilities are at the highest risk.

Summary

Korean summary
전체 인구의 사망률은 큰 폭으로 줄어들면서 홈리스와 전체 인구 간의 사망 불평등이 1.3배에서 1.8배로 증가했다. 특히 쪽방주민이나 거리 홈리스보다 시설 거주 홈리스의 사망 위험이 더 높았으며, 동일 조건하에서 거리 홈리스 대비 약 1.7배 높은 사망 위험을 보였다. 본 연구는 홈리스의 탈시설화를 촉진하는 정책 전환의 필요성을 시사한다.

Key Message
The mortality rate of the general population has significantly declined, leading to an increase in mortality inequality between the homeless and the general population from 1.3 to 1.8 times. In particular, the mortality risk for homeless individuals in facilities was higher than that of those living in jjokbang or on the streets. This study highlights the need for a policy shift to promote deinstitutionalization for the homeless population.

Citations

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Bezdomność w Polsce. Epidemiologiczne spojrzenie na przyczyny zgonów i implikacje zdrowotne (2015–2022)
Jadwiga Duda, Igor Popiela, Karolina Dudzik, Aleksandra Adamus, Maciej Przygoda, Andrzej Kościsz, Tomasz Konopka
Zdrowie Publiczne i Zarządzanie.2025; 23(1): 29. 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

Impact of body mass index and waist-to-hip ratio on mortality in middle-aged Koreans: a prospective cohort study based on a Health Examinees study: Sooyoung Cho, Aesun Shin, Ji-Yeob Choi, Jong-Koo Lee, Daehee Kang; Epidemiol Health. 2024;46:e2024073. Published online September 2, 2024; DOI: https://doi.org/10.4178/epih.e2024073

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Abstract

OBJECTIVES
We aimed to assess the impact of obesity on mortality in middle-aged Koreans using data from a Health Examinees study.

METHODS

We used data from the participants who had complete information on body size and gave informed consent for the linkage of their data with the national death certificate data. Cox proportional hazard model was used to estimate the hazard ratios and 95% confidence intervals (CIs) of body mass index (BMI) and waist-to-hip ratio (WHR) for all-cause, cardiovascular, and cancer mortality.

RESULTS

A total of 115,961 participants were included in the study. The results showed a U-shaped association between BMI and mortality, indicating that both males and females with BMIs of less than 21.0 kg/m2 and greater than or equal to 30.0 kg/m2 are at increased risk. The results showed that males with a BMI of less than 18.5 kg/m² had a significantly higher risk of all-cause mortality (adjusted hazard ratio [aHR], 2.24; 95% CI, 1.73 to 2.91) and cardiovascular mortality (aHR, 2.27; 95% CI, 1.23 to 4.20). Similarly, males with a WHR of less than 0.80 (aHR, 1.38; 95% CI, 1.08 to 1.77), 0.90 to less than 0.95 (aHR, 1.15; 95% CI, 1.02 to 1.29), and greater than or equal to 0.95 (aHR, 1.28; 95% CI, 1.11 to 1.47) showed an increased risk of all-cause mortality. In females, a BMI of less than 18.0 kg/m2 was linked to a higher risk of cardiovascular mortality (aHR, 2.67; 95% CI, 1.13 to 6.33).

CONCLUSIONS

Being underweight was associated with an increased risk of mortality in both sexes, and the lowest risk of death was found in males who were slightly overweight with a BMI of 23.0-25.0 kg/m2.

Summary

Korean summary
중년 한국인으로 구성된 코호트 연구에서 BMI와 WHR이 원인별 사망에 미치는 영향을 평가함. BMI와 WHR이 사망 원인별 사망률과 U자형 연관성을 보였고, 특히 심혈관 질환에서 이러한 경향을 관찰함.

Key Message
This study examined the association between BMI, WHR, and cause-specific mortality in middle-aged Koreans. Both BMI and WHR showed U-shaped associations with mortality, particularly for cardiovascular outcomes. These findings may indicate a need to carefully consider the optimal BMI cut-off values for Asians to better capture mortality risks.

Citations

Citations to this article as recorded by

Current guidelines and future directions in comprehensive obesity assessment
Sinyoung Cho, Hyuktae Kwon
Korean Journal of Family Medicine.2026; 47(1): 4. CrossRef

Comparative analysis of body mass index and obesity-related anthropometric indices for mortality prediction: a study of the Namwon and Dong-gu cohort in Korea: Ye Rim Kim, Min-Ho Shin, Young-Hoon Lee, Seong-Woo Choi, Hae-Sung Nam, Jeong-Ho Yang, Sun-Seog Kweon; Epidemiol Health. 2024;46:e2024066. Published online July 17, 2024; DOI: https://doi.org/10.4178/epih.e2024066

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Abstract Summary PDF

Abstract

OBJECTIVES
This study investigated the associations between several obesity-related anthropometric indices and mortality in middle-aged and elderly populations to compare the indices’ predictive ability with that of the body mass index (BMI).

METHODS

We analyzed data on 12 indices calculated from 19,805 community-based cohort participants (average age, 63.27 years; median follow-up, 13.49 years). Each index was calculated using directly measured values of height, weight, waist circumference (WC), and hip circumference (HC). We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for each index using Cox regression and evaluated mortality prediction with the Harrell concordance index (c-index).

RESULTS

Adding anthropometric indices to the basic mortality model (c-index, 0.7723; 95% CI, 0.7647 to 0.7799) significantly increased the predictive power of BMI (c-index, 0.7735; 95% CI, 0.7659 to 0.7811), a body shape index (ABSI; c-index, 0.7735; 95% CI, 0.7659 to 0.7810), weight-adjusted waist index (WWI; c-index, 0.7731; 95% CI, 0.7656 to 0.7807), and waist to hip index (WHI; c-index, 0.7733; 95% CI, 0.7657 to 0.7809). The differences between the BMI model and the other 3 models were not statistically significant.

CONCLUSIONS

In predicting all-cause mortality, the ABSI, WWI, and WHI models based on WC or HC had stronger predictive power than conventional risk factors but were not significantly different from the BMI model.

Summary

Korean summary
- 다수의 비만관련 신체계측지표들이 사망률을 유의하게 예측하였지만 체질량지수보다 통계적으로 우월하지는 않았다. - 복부둘레가 고려된 비만지표들이 사망률예측에 더 유용할 것으로 추정된다.

Key Message
- Several obesity indices provided predictive value for all-cause mortality but were not superior to body mass index - Obesity indices that take abdominal circumference into account are likely to be more useful for predicting mortality.

Citations

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A J-shaped association between weight-adjusted waist index and cardiovascular disease: a longitudinal study from the CHARLS database
Jiang Wang, Aizhang Zhu, Rui Zeng, Lihuan Chen, Fayi Xie, Ke Zhu, Tenghui Fan, Dongmei Ye, Yishan Wu, Wan Zhu, Jiahui Bian, Yuxu Huang, Shunrui Xiao, Mengxia Shi, Yi Xiao, Wenwu Zhang, Xiaoming Zhang
BMC Public Health.2025;[Epub] CrossRef
Development of an equation for estimating body fat mass using basic demographic and anthropometric indices
N.V. Zaverukha, N.V. Grygorieva, A.S. Musiienko, N.M. Koshel
INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine).2025; 21(8): 845. CrossRef
Accumulated subcutaneous fat in abdomen is associated with long COVID-19 symptoms among non-hospitalized patients: a prospective observational study
Tingxin Li, Baoming He, Yuping Liu, Chen Wang
Frontiers in Medicine.2024;[Epub] CrossRef

Brief Communication

Timely access to secondary pediatric services in Korea: a key to reducing child and adolescent mortality: Minku Kang, Young June Choe, Hye Sook Min, Saerom Kim, Seung-Ah Choe; Epidemiol Health. 2024;46:e2024059. Published online July 5, 2024; DOI: https://doi.org/10.4178/epih.e2024059

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Abstract Summary PDF

Abstract

OBJECTIVES
Geographic disparities in access to secondary pediatric care remain a significant issue in countries with universal health coverage, including Korea. This study investigated the link between geographic access to secondary pediatric care and mortality rates in children and adolescents (0-19 years) in Korea.

METHODS

We analyzed district-level data to assess the percentage of those aged 0-19 years residing outside of a 60-minute travel radius from the nearest secondary pediatric care provider (accessibility vulnerability index, AVI).

RESULTS

The AVI ranged from 0% to 100% across the districts for the study period. The confidence interval (CI) was -0.30 (95% CI, -0.41 to -0.19) in 2017 and -0.41 (95% CI, -0.52 to -0.30) in 2021, indicating that the proportion of those who could not access care within 60 minutes was disproportionately higher in districts with lower socioeconomic status. We found 8% rise in mortality rates among individuals aged 0-19 years for every 10% increase in AVI (95% CI, 1.06 to 1.10).

CONCLUSIONS

The study highlights disparities in pediatric care access and their impact on child survival, emphasizing the need for improved access to achieve true universal health coverage.

Summary

Korean summary
본 연구는 한국에서 소아 의료 서비스에 대한 지리적 접근성과 아동 사망률 사이의 연관성을 조사하여, 특히 COVID-19 대유행 기간 동안 접근성 제한이 높은 사망률과 관련이 있음을 발견하였다. 이 연구는 아동 및 청소년의 예방 가능한 사망률에 대한 지역 격차를 줄이기 위해 시기적절한 치료 접근성을 개선해야 할 필요성을 강조하였다.

Key Message
The study investigated the link between geographic access to pediatric services and child mortality in South Korea, finding that limited access, particularly during the COVID-19 pandemic, was associated with higher mortality. The research highlights the need for improved access to timely care to reduce regional disparities in preventable deaths among children and adolescents.

Citations

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Caregiver priorities and healthcare outcomes in a pediatric home care service for children with medical complexity: a quasi-experimental study
Kyua Kim, Eunyong Kim, Hyunjin Seo, Myoung Sun Gong, Hooyun Lee, Seung Yeon Kwon, Eun Kyoung Choi
European Journal of Pediatrics.2026;[Epub] CrossRef
Global paediatric workforce crisis: lessons from South Korea
Young June Choe, Kee-Hyoung Lee
Archives of Disease in Childhood.2025; 110(8): 665. CrossRef

Systematic Review

Tea consumption and risk of all-cause, cardiovascular disease, and cancer mortality: a meta-analysis of thirty-eight prospective cohort data sets: Youngyo Kim, Youjin Je; Epidemiol Health. 2024;46:e2024056. Published online June 21, 2024; DOI: https://doi.org/10.4178/epih.e2024056

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Tea consumption has been considered beneficial to human health because tea contains phytochemicals such as polyphenols and theaflavins. We conducted a systematic review and meta-analysis on the association between tea consumption and mortality from all causes, cardiovascular disease (CVD), and cancer to provide a quantitative assessment of current evidence.

METHODS

The PubMed, Web of Science, and Scopus databases were searched through April 2024 to identify eligible studies. Random effects models were used to combine study-specific effect estimates (ESs).

RESULTS

A total of 38 prospective cohort data sets (from 27 papers) with 1,956,549 participants were included in this meta-analysis. The pooled ESs of the highest versus lowest categories of tea consumption were 0.90 (95% confidence interval [CI], 0.86 to 0.95) for all-cause mortality, 0.86 (95% CI, 0.79 to 0.94) for CVD mortality, and 0.90 (95% CI, 0.78 to 1.03) for cancer mortality. In the dose-response analysis, a non-linear association was observed. The greatest risk reductions were observed for the consumption of 2.0 cup/day for all-cause mortality (ES, 0.91; 95% CI, 0.88 to 0.94) and 1.5 cup/day for cancer mortality (ES, 0.92; 95% CI, 0.89 to 0.96), whereas additional consumption did not show a further reduction in the risk of death. A plateau was observed for CVD mortality at moderate consumption levels (1.5-3.0 cup/day), but a sustained reduction in mortality risk was observed at higher intake levels.

CONCLUSIONS

Moderate tea consumption (e.g., 1.5-2.0 cup/day) was associated with lower all-cause, CVD, and cancer mortality compared to no tea consumption. Further well-designed prospective studies are needed for a definitive conclusion.

Summary

Korean summary
차는 전세계적으로 널리 소비되는 음료로 그 공중보건학적 영향력이 크다. 차의 섭취와 만성질환의 관련성은 아직 일관성 있게 결론이 나지 않았는데 최근에 이 주제에 대하여 대규모의 코호트 연구 결과들이 발표된 바 있었다. 38개의 코호트 데이터에 근거한 본 메타분석의 결과는 하루 한 잔 반에서 두 잔의 차를 마시는 것이 총사망위험과 심혈관계질환이나 암으로 인한 사망 위험을 낮추는 것과 관계가 있음을 나타내고 있다.

Key Message
Tea is a commonly consumed beverage worldwide and has a significant public health impact. The association between tea consumption and risk of mortality from chronic disease remains inconsistent, and extensive cohort studies have been published recently. In this meta-analysis, including thirty-eight cohort studies, people who drank one and a half to two cups of tea daily had a lower risk of mortality from all causes, cardiovascular disease, and cancer than those who drank less tea.

Citations

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Bioavailability of Tea Polyphenols: A Key Factor in Understanding Their Mechanisms of Action In Vivo and Health Effects
Mingchuan Yang, Xiangchun Zhang, Chung S. Yang
Journal of Agricultural and Food Chemistry.2025; 73(7): 3816. CrossRef
Associations of a healthy beverage pattern with all-cause and cause-specific mortality among US adults: a nationwide cohort study
Yu Feng, Haoming Wang, Kang Wang, Ziyue Li, Bohao Tan, Qirui Li, Fan Ouyang, Zhangling Chen
Nutrition Journal.2025;[Epub] CrossRef
Color Stability of Three Ceramics After Thermocycling in Coffee, Black Tea, Cola, and Water: An In Vitro Study
Dina Maleki, Donya Maleki, Arayeh Maleki, Helia Zare, AmirHossein SohrabiFar, Boonlert Kukiattrakoon
International Journal of Dentistry.2025;[Epub] CrossRef
The Impact of Tea Consumption on Cardiovascular Health
Farid Aldhuhli, Mohammed Fazal, Gouse Bin Mohammad Shaik, Srijit Das
The Natural Products Journal.2025;[Epub] CrossRef
Beneficial health effects and possible health concerns of tea consumption: a review
Mingchuan Yang, Li Zhou, Zhipeng Kan, Zhoupin Fu, Xiangchun Zhang, Chung S. Yang
Beverage Plant Research.2025;[Epub] CrossRef
Green Tea: A Magical Herb with Miraculous Outcomes
Suraj Bhagwan Khirodkar, Mr. Vinod Chavre
International Journal of Advanced Research in Science Communication and Technology.2025; : 612. CrossRef
Molecular mechanisms of action of DIM and its clinical application
E. A. Nikitina, S. V. Orlova, T. T. Batysheva, N. V. Balashova, M. V. Alekseeva, A. N. Vodolazkaya, E. V. Prokopenko, Kh. A. Magomedova
Medical alphabet.2024; (19): 9. CrossRef

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

Original Articles

Comparison of all-cause mortality associated with non-alcoholic fatty liver disease and metabolic dysfunction-associated fatty liver disease in Taiwan MJ cohort: Wei-Chun Cheng, Hua-Fen Chen, Hsiu-Chi Cheng, Chung-Yi Li; Epidemiol Health. 2024;46:e2024024. Published online January 21, 2024; DOI: https://doi.org/10.4178/epih.e2024024

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The global burden of non-alcoholic fatty liver disease (NAFLD) is rising. An alternative term, metabolic dysfunction-associated fatty liver disease (MAFLD), instead highlights the associated metabolic risks. This cohort study examined patient classifications under NAFLD and MAFLD criteria and their associations with all-cause mortality.

METHODS

Participants who attended a paid health check-up (2012-2015) were included. Hepatic steatosis (HS) was diagnosed ultrasonographically. NAFLD was defined as HS without secondary causes, while MAFLD involved HS with overweight/obesity, type 2 diabetes mellitus, or ≥2 metabolic dysfunctions. Mortality was tracked via the Taiwan Death Registry until November 30, 2022.

RESULTS

Of 118,915 participants, 36.9% had NAFLD, 40.2% had MAFLD, and 32.9% met both definitions. Participants with NAFLD alone had lower mortality, and those with MAFLD alone had higher mortality, than individuals with both conditions. After adjustment for potential confounders, the hazard ratios (HRs) for all-cause mortality were 1.08 (95% confidence interval [CI], 0.78 to 1.48) for NAFLD alone and 1.26 (95% CI, 1.09 to 1.47) for MAFLD alone, relative to both conditions. Advanced fibrosis conferred greater mortality risk, with HRs of 1.93 (95% CI, 1.44 to 2.58) and 2.08 (95% CI, 1.61 to 2.70) for advanced fibrotic NAFLD and MAFLD, respectively. Key mortality risk factors for NAFLD and MAFLD included older age, unmarried status, higher body mass index, smoking, diabetes mellitus, chronic kidney disease, and advanced fibrosis.

CONCLUSIONS

All-cause mortality in NAFLD and/or MAFLD was linked to cardiometabolic covariates, with risk attenuated after multivariable adjustment. A high fibrosis-4 index score, indicating fibrosis, could identify fatty liver disease cases involving elevated mortality risk.

Summary

Key Message
In a cohort study involving 118,915 Taiwanese participants in a paid health check-up program, approximately one-third met both NAFLD (non-alcoholic fatty liver disease) and MAFLD (metabolic dysfunction-associated fatty liver disease) criteria. All-cause mortality associated with NAFLD and/or MAFLD correlated with cardiometabolic factors, though the risk attenuated following multivariable adjustment. A high fibrosis-4 index score, suggestive of liver fibrosis, was predictive of increased mortality risk in FLD (fatty liver disease) cases.

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Association Between Liver Fibrosis and Cause‐Specific Mortality in Japanese Patients With Biopsy‐Confirmed Metabolic Dysfunction–Associated Steatotic Liver Disease: A Prospective Cohort Study / Liver Fibrosis and Mortality in Japanese MASLD
Kyoko Sakai, Toshihide Shima, Hirohisa Oya, Takahiro Miura, Shohei Amioka, Takahiro Nonaka, Shinsaku Fujiishi, Keiichiro Okuda, Kei Terasaki, Kohei Fukumoto, Yasuhide Mitsumoto, Masayuki Mizuno, Takeshi Okanoue
Hepatology Research.2026; 56(1): 33. CrossRef
Genome-wide association study of the fatty liver index in the Taiwanese population reveals shared and population-specific genetic risk factors across ethnicities
Pei Pei Lau, Chun-Yu Wei, Min-Rou Lin, Wan-Hsuan Chou, Yu-Jui Yvonne Wan, Wei-Chiao Chang
Cell & Bioscience.2025;[Epub] CrossRef
Emerging Trends in MAFLD and MASH
Samita Garg, Nizar N. Zein
Diabetes Technology & Therapeutics.2025; 27(S1): S227. CrossRef
Machine learning for predicting all-cause mortality of metabolic dysfunction-associated fatty liver disease: a longitudinal study based on NHANES
Xueni Wang, Huihui Chen, Luqiao Wang, Wenguang Sun
BMC Gastroenterology.2025;[Epub] CrossRef
MAFLD as a Cardiovascular Risk Factor: An Extended Retrospective Study with a Control Group
Małgorzata Szymala-Pędzik, Marcin Piersiak, Maciej Pachana, Karolina Lindner-Pawłowicz, Wioletta Szczepaniak, Małgorzata Sobieszczańska
Journal of Clinical Medicine.2025; 14(12): 4181. CrossRef
Survival machine learning models for predicting all-cause and case-specific mortality risk in metabolic dysfunction-associated fatty liver disease patients
Jingpeng Gao, Nan Zhang, Akemujiang Aximu, Ning Xin, Ziwei Wang, Ping Yan
Scientific Reports.2025;[Epub] CrossRef
Assessing Mortality Disparities Among Non-Alcoholic Fatty Liver Disease Metabolic Dysfunction Fatty Liver Disease and Metabolic Dysfunction-Associated Liver Disease: A Comprehensive Meta-Analysis
Fahad Lakhdhir, Agha Syed Muhammad, Ahmed Nasir Qureshi, Imran A Shaikh, Imran Joher, Jawaria Majeed, Javaria Khan
Cureus.2024;[Epub] CrossRef

Smoking-attributable mortality among Korean adults in 2019: Yeun Soo Yang, Keum Ji Jung, Heejin Kimm, Sunmi Lee, Sun Ha Jee; Epidemiol Health. 2024;46:e2024011. Published online December 19, 2023; DOI: https://doi.org/10.4178/epih.e2024011

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Abstract Summary PDF: Abstract
OBJECTIVES
Tobacco use ranks among the leading preventable causes of death worldwide. This study was conducted to calculate the mortality rate attributable to smoking in Korea for 2019 and to highlight the importance of tracking and monitoring smoking-related deaths for public health purposes.
METHODS
Population attributable risk (PAR) was used to estimate the number of deaths related to smoking in 2019. PAR percentages were applied to the estimated mortality figures for various diseases, with PAR determined based on relative risk (RR). Levin’s formula was used to calculate PAR, and RR was adjusted for age and alcohol consumption using Cox proportional hazards regression model to derive disease-specific regression coefficients. The analysis incorporated previously determined smoking rates from 1985, and use rates of novel tobacco products were not considered.
RESULTS
The findings revealed a total of 67,982 smoking-attributable deaths in Korea in 2019, 56,993 of which occurred in men and 11,049 in women. The PAR of smoking for various causes of death in adult men was highest for lung cancer at 74.9%, followed by pneumonia (29.4%), ischemic heart disease (42.3%), and stroke (30.2%). For women, the PAR for smoking-related death was highest for lung cancer (19.9%), followed by stroke (7.6%), pneumonia (5.7%), and ischemic heart disease (9.1%).
CONCLUSIONS
In countries experiencing rapid fluctuations in smoking rates, including Korea, regular studies on smoking-related mortality is imperative. Furthermore, it is necessary to investigate smoking-related deaths, including the prevalence of novel tobacco product use, to accurately gauge the risks associated with emerging tobacco products.; Summary

Korean summary
이 연구는 2019년 한국에서 흡연으로 인한 사망률을 계산하고 공중 보건 목적을 위한 흡연 관련 사망추적 및 모니터링의 중요성을 강조합니다. 연구 결과, 2019년 한국에서 흡연으로 인해 총 67,982명이 사망했으며, 이 중 남성이 56,993명, 여성이 11,049명이었습니다. 특히 남성의 경우 폐암(74.9%), 여성의 경우 폐암(19.9%)에서 흡연으로 인한 사망 위험이 가장 높게 나타났습니다.

Key Message
This study analyzed deaths attributable to smoking in Korea in 2019, revealing that a total of 67,982 individuals lost their lives due to smoking. Among these, 56,993 were men and 11,049 were women, with the highest smoking-related mortality rate observed in men due to lung cancer at 74.9%, and in women due to lung cancer at 19.9%. Through these findings, this research emphasizes the importance of tracking and monitoring smoking-related deaths for public health.

Increased risk of cancer and cancer-related mortality in middle-aged Korean women with prediabetes and diabetes: a population-based study: Thi Xuan Mai Tran, Soyeoun Kim, Huiyeon Song, Boyoung Park; Epidemiol Health. 2023;45:e2023080. Published online August 28, 2023; DOI: https://doi.org/10.4178/epih.e2023080

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Abstract

OBJECTIVES
This study investigated the risk of developing and dying from all types of cancer, as well as cancer-specific mortality, in women diagnosed with prediabetes and diabetes.

METHODS

We included women aged ≥40 years who underwent cancer screening from 2009 to 2014 with follow-up until 2020. Diabetes status was determined based on fasting plasma glucose levels, self-reported history of diabetes, and the use of antidiabetic medication. We quantified the risk of cancer and mortality in the prediabetes and diabetes groups, relative to the normoglycemia group, by calculating adjusted hazard ratios (aHRs).

RESULTS

The study included 8,309,393 participants with a mean age of 52.7±9.7 years. Among these participants, 522,894 cases of cancer and 193,283 deaths were detected. An increased risk of cancer was observed in both the prediabetes group (aHR, 1.03; 95% confidence interval [CI], 1.02 to 1.04) and the diabetes group (aHR, 1.13; 95% CI, 1.12 to 1.14). The highest risk was identified in those with diabetes who developed liver (aHR, 1.72; 95% CI, 1.66 to 1.79), pancreatic (aHR, 1.68; 95% CI, 1.60 to 1.76), and gallbladder cancer (aHR, 1.43; 95% CI, 1.36 to 1.51). Women with prediabetes and diabetes exhibited a 1.07-fold (95% CI, 1.05 to 1.08) and 1.38-fold (95% CI, 1.36 to 1.41) increased risk of death from cancer, respectively.

CONCLUSIONS

Both prediabetes and diabetes were associated with an elevated risk of cancer, as well as an increased risk of death from cancer, in middle-aged Korean women. However, the degree of risk varied depending on the specific site of the cancer.

Summary

Korean summary
40세 이상의 중년 여성에서 당뇨 또는 당뇨 전 단계는 암 발생 위험과 암으로 인한 사망위험을 증가시킴. 암 종별로는 위암, 대장암, 직장암, 간암, 담낭암, 췌장암, 유방암, 자궁경부암, 자궁암, 신장암, 방광암의 발생 위험이 증가한 반면, 갑상선암의 발생 위험은 감소하였음. 거의 대부분의 암종에서 당뇨는 암으로 인한 사망위험을 증가시킴

Key Message
Both prediabetes and diabetes were independently associated with an overall increased risk of cancer, with a stronger association with malignancies in the liver and pancreas in women. Additionally, both prediabetes and diabetes status are associated with an elevated risk of death from cancer. These findings support the need for prevention and management to reduce cancer-related burden and premature deaths due to cancer, not only in individuals with diabetes but also in those with prediabetes.

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Overview of the prevalence and features of oncological diseases in type 2 diabetes and possible immunological mechanisms
Ya. V. Dvoryanchikov, S. M. Deunezhewa, I. A. Yatskov, V. A. Beloglazov
Problems of Endocrinology.2025; 71(2): 75. CrossRef
Prognostic value of preoperative serum tumor markers in gallbladder cancer
Qianhui Duan, Jie Zhong, Yinghui Song, Sicheng Zhang, Weimin Yi, Chuang Peng, Sulai Liu, Jianping Wu, Lianhong Zou
BMC Gastroenterology.2025;[Epub] CrossRef
A burden of proof study of the effects of exposure to high fasting plasma glucose on the risk of seven types of cancer
Paula Portal Teixeira, Yvonne Yiru Xu, Aleksandr Aravkin, Peng Zheng, Lisa M. Force, Jonathan Kocarnik, Susan McLaughlin, Theo Vos, Hailey Lenox, Simon Hay, Bruce Bartholow Duncan, Verônica Colpani, Chris Murray, Fernando Gerchman, Kanyin Liane Ong
Scientific Reports.2025;[Epub] CrossRef
Prediabetes persistence or remission and subsequent risk of gallbladder cancer: A nationwide cohort study
Joo-Hyun Park, Jung Yong Hong, Kyungdo Han, Young Suk Park, Joon Oh Park, Ho Yeong Lim, Jay J. Shen
European Journal of Cancer.2024; 213: 114312. CrossRef

Did the socioeconomic inequalities in avoidable and unavoidable mortality worsen during the first year of the COVID-19 pandemic in Korea?: Rora Oh, Myoung-Hee Kim, Juyeon Lee, Rangkyoung Ha, Jungwook Kim; Epidemiol Health. 2023;45:e2023072. Published online August 3, 2023; DOI: https://doi.org/10.4178/epih.e2023072

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study examined changes in socioeconomic inequalities in mortality in Korea before and after the outbreak of coronavirus disease 2019 (COVID-19).

METHODS

From 2017 to 2020, age-standardized mortality rates were calculated for all-cause deaths, avoidable deaths (preventable deaths, treatable deaths), and unavoidable deaths using National Health Insurance claims data and Statistics Korea’s cause of death data. In addition, the slope index of inequality (SII) and the relative index of inequality (RII) by six income levels (Medical Aid beneficiary group and quintile of health insurance premiums) were computed to analyze the magnitude and change of mortality inequalities.

RESULTS

All-cause and avoidable mortality rates decreased steadily between 2017 and 2020, whereas unavoidable mortality remained relatively stable. In the case of mortality inequalities, the disparity in all-cause mortality between income classes was exacerbated in 2020 compared to 2019, with the SII increasing from 185.44 to 189.22 and the RII increasing from 3.99 to 4.29. In particular, the preventable and unavoidable mortality rates showed an apparent increase in inequality, as both the SII (preventable: 91.31 to 92.01, unavoidable: 69.99 to 75.38) and RII (preventable: 3.42 to 3.66, unavoidable: 5.02 to 5.89) increased.

CONCLUSIONS

In the first year of the COVID-19 pandemic, mortality inequality continued to increase, although there was no sign of exacerbation. It is necessary to continuously evaluate mortality inequalities, particularly for preventable and unavoidable deaths.

Summary

Korean summary
이 연구는 COVID-19 발생 전후 한국에서의 사망률 추이와 사망률 불평등 변화를 조사했다. 2017~2020년 사이에 총사망률과 회피가능사망률은 줄어들었지만, 사망률의 사회경제적 불평등은 더 커지는 경향을 보였다. 특히 예방가능사망과 회피불가능사망에서 불평등이 커져 지속적인 추적과 평가가 필요하다.

Key Message
This study examined the trends in mortality rates and changes in mortality inequality in Korea before and after the onset of COVID-19. Between 2017 and 2020, while the all-cause and avoidable mortality rates decreased, there was a growing trend of inequality in mortality rates based on income levels. Particularly, inequalities in preventable and unavoidable deaths have increased, emphasizing the need for ongoing evaluation.

Citations

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Avoidable Mortality in its Economic Impact in Almaty City, Kazakhstan
Rauan Kastey, Ermek Dyussembekov, Kuanysh Nikatov, Yevgeniy Zhukov, Arimantas Tamasauskas, Oryngul Jumagaziyeva, Madiyar Umirbayev, Kamila Faizullina
Asian Journal of Social Health and Behavior.2025; 8(3): 141. CrossRef
Incidence and Influencing Factors of Avoidable Mortality in Korea From 2013-2022: Analysis of Cause-of-death Statistics
Jeong Min Yang, Jieun Hwang
Journal of Preventive Medicine and Public Health.2024; 57(6): 540. CrossRef

The association between glaucoma and all-cause mortality in middle-aged and elderly Chinese people: results from the China Health and Retirement Longitudinal Study: Xiaoxu Huang, Mengqiao Xu, Minwen Zhou, Wenjia Liu, Xiaohuan Zhao, Xiaodong Sun; Epidemiol Health. 2023;45:e2023066. Published online July 21, 2023; DOI: https://doi.org/10.4178/epih.e2023066

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This population-based, prospective cohort study investigated the association between glaucoma and mortality in older adults.

METHODS

Participants aged 45 years or older at baseline (47.9% male) were enrolled in 2011 for the China Health and Retirement Longitudinal Study (CHARLS). All-cause mortality was observed during 7 years of follow-up. The baseline data were collected in the 2011 CHARLS, and participants were followed up for 7 years (until 2018). The risk of all-cause mortality was investigated using Cox proportional-hazards regression with age as the time scale, adjusting for significant risk factors and comorbid conditions.

RESULTS

Among the 14,803 participants included, the risk of all-cause death was significantly higher among people with glaucoma than among those without glaucoma, after adjustment for other confounders (hazard ratio [HR], 1.46; 95% confidence interval [CI], 1.04 to 2.03). In a subgroup analysis based on the mean age of death, among those who were 75 years and older (n=1,231), the risk of all-cause death was significantly higher in patients with glaucoma than in those without glaucoma (HR, 1.89; 95% CI, 1.24 to 1.89).

CONCLUSIONS

Participants with glaucoma had a higher risk of all-cause mortality, especially those aged 75 years and above. Our findings revealed potential mechanisms underlying an association between glaucoma and all-cause mortality. They also highlighted the importance of glaucoma management to prevent premature death in middle-aged and older adults.

Summary

Key Message
The present study suggests that glaucoma is associated with a higher rate of mortality in middle-aged and elderly people in China, especially for those aged 75 years and older. This study provides an important reference for the design and evaluation of clinical glaucoma treatment and the management of patients of different ages.

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Exploring association between ambient air pollution and glaucoma in China: a nationwide analysis with predictive modeling based on the China Health and Retirement Longitudinal Study
Xiang Li, Zhan-Yang Luo, Sen Lei, Zhi-Jie Zhang, Jia-feng Tang, Yi-qing Sun
Frontiers in Public Health.2025;[Epub] CrossRef
Estimated glucose disposal rate and its dual role in hyperlipidemia risk and mortality: a secondary analysis of retrospective cohort data from U.S. and Chinese
Shouxin Wei, Sijia Yu, Chuan Qian, Zhengwen Xu, Yindong Jia, Bo Chen
Lipids in Health and Disease.2025;[Epub] CrossRef

Effect of trajectory of employment status on all-cause mortality in the late middle-aged and older population: results of the Korea Longitudinal Study of Aging (2006-2020): Jeong Min Yang, Jae Hyun Kim; Epidemiol Health. 2023;45:e2023056. Published online June 8, 2023; DOI: https://doi.org/10.4178/epih.e2023056

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Abstract

OBJECTIVES
This study conducted a longitudinal analysis of the effect of trajectory of employment status (TES) on all-cause mortality in late middle-aged and older Koreans based on the Korean Longitudinal Study of Aging (KLoSA).

METHODS

After excluding missing values, data on 2,774 participants were analyzed using the chi-square test and the group-based trajectory model (GBTM) for data from the first to fifth KLoSA and the chi-square test, log-rank test, and Cox proportional hazard regression for data from the fifth to eighth KLoSA.

RESULTS

The GBTM analysis identified 5 TES groups: sustained white collar (WC; 18.1%), sustained standard blue collar (BC; 10.8%), sustained self-employed BC (41.1%), WC to job loss (9.9%), and BC to job loss (20.1%). Compared to the sustained WC group, the WC to job loss group had higher mortality at 3 years (hazard ratio [HR], 4.04, p=0.044), 5 years (HR, 3.21, p=0.005), and 8 years (HR, 3.18, p<0.001). The BC to job loss group had higher mortality at 5 years (HR, 2.57, p=0.016) and 8 years (HR, 2.20, p=0.012). Those aged 65 years and older and males in the WC to job loss and BC to job loss groups had an increased risk of death at 5 years and 8 years.

CONCLUSIONS

There was a close association between TES and all-cause mortality. This finding highlights the need for policies and institutional measures to reduce mortality within vulnerable groups with an increased risk of death due to a change in employment status.

Summary

Korean summary
본 연구는 제 1차~8차 한국고령화연구패널을 활용하여 중고령층의 근로활동 궤적과 사망 간의 연관성을 분석하였다. 근로활동 궤적을 파악하기 위하여 집단중심추세모형을 활용하였으며, 총 5가지의 근로활동 궤적을 도출하였다. 도출된 궤적을 바탕으로 카이제곱 검정과 콕스 비례위험모형을 통해 근로활동 궤적과 사망률 간의 연관성을 분석하였다. 연구 결과 화이트칼라에서 실업으로 변화하는 집단과 블루칼라에서 실업으로 변화하는 두 집단에서 사망 간의 유의한 결과를 발견하였으며, 특히, 65세 이상 집단과 남성 집단에서 강한 연관성이 존재하였다. 본 연구 결과를 바탕으로 근로활동 변화로 인해 사망 위험이 증가하는 취약 집단을 위한 정책적, 제도적 방안의 기초자료로서 활용되기를 기대한다.

Key Message
Compared with the sustained White Collar (WC) trajectory group, changed WC to job loss trajectory group and changed BC to job loss trajectory had higher mortality. The over 65 years group and the male group, a strong association between change in employment status and mortality was observed. This study emphasizes the need for policy and institutional measures to reduce mortality for vulnerable groups who are at increased risk of death due to changes in employment status.

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The predictive power of employment trajectories on cognition of older adults: Evidence from Chile
Magdalena Delaporte
Social Science & Medicine.2025; 380: 118281. CrossRef

Association of blood pressure measurements in sitting, supine, and standing positions with the 10-year risk of mortality in Korean adults: Inkyung Baik, Nan Hee Kim, Seong Hwan Kim, Chol Shin; Epidemiol Health. 2023;45:e2023055. Published online June 8, 2023; DOI: https://doi.org/10.4178/epih.e2023055

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Abstract

OBJECTIVES
This prospective cohort study investigated the association between blood pressure (BP) as measured in different body postures and all-cause and cardiovascular (CV) mortality risk.

METHODS

This population-based investigation included 8,901 Korean adults in 2001 and 2002. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured sequentially in the sitting, supine, and standing positions and classified into 4 categories: (1) normal, SBP <120 mmHg and DBP <80 mmHg; (2) high normal/prehypertension, SBP 120-129 mmHg and DBP <80 mmHg/SBP 130-139 mmHg or DBP 80-89 mmHg; (3) grade 1 hypertension (HTN), with SBP 140-159 mmHg or DBP 90-99 mmHg; and (4) grade 2 HTN, SBP ≥160 mmHg or DBP ≥100 mmHg. The date and cause of individual deaths were confirmed in the death record data compiled until 2013. Data were analyzed using Cox proportional hazard regression.

RESULTS

Significant associations were found between the BP categories and all-cause mortality, but only when BPs were measured in the supine position. The multivariate hazard ratios (95% confidence intervals, [CIs]) were 1.36 (95% CI, 1.06 to 1.75) and 1.59 (95% CI, 1.06 to 2.39) for grade 1 HTN and grade 2 HTN, respectively, compared with the normal category. The associations between the BP categories and CV mortality were significant regardless of body posture among participants ≥65 years, whereas they were significant for supine BP measurements only in those <65 years.

CONCLUSIONS

BP measured in the supine position predicted all-cause mortality and CV mortality better than BP measured in other postures.

Summary

Korean summary
본 역학 연구는 한국 성인 8,901명을 연구대상자로 하여 기초조사에서 세가지 자세, 즉 앉은 자세, 누운 자세, 일어선 자세에서 혈압을 측정하고, 이후 10년 동안의 사망 여부를 추적조사하여, 측정 자세에 따른 혈압과 사망 위험과의 관련성을 분석하였다. 그 결과, 누운 자세에서 측정된 고혈압(기준: 수축기 혈압이 140 mmHg 이상 혹은 이완기 혈압이 90 mmHg 이상)인 사람은 정상 혈압(기준: 수축기 혈압이 120 mmHg 미만이고 이완기 혈압이 80 mmHg 미만)인 사람에 비해 36%(1단계 고혈압) 혹은 59%(2단계 고혈압) 가량 총 사망 위험이 유의적으로 증가하는 것으로 나타났다. 이에 비해, 앉은 자세 및 일어선 자세에서 측정, 정의된 고혈압은 총 사망 위험을 증가시켰지만 유의적인 결과를 나타내지 못했다. 추후 연구에서 재확인이 필요하지만, 본 연구 결과가 시사하는 바는 앉은 자세나 일어선 자세보다 누운 자세에서 측정하는 혈압이 총 사망 위험을 더 잘 예측하므로, 고혈압 진단 외의 추가적인 활용 가능성이 있는 것으로 평가된다.

Key Message
The current epidemiological study revealed that blood pressure measured in a supine position could predict all-cause mortality and cardiovascular mortality better than blood pressure measured in a sitting or standing position. As a result, blood pressure measurements in a supine position may be useful in assessing mortality risk.

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Supine blood pressure measurement and its emerging role in cardiovascular risk stratification
Takahiro Komori
Hypertension Research.2026;[Epub] CrossRef
Association of supine versus seated hypertension with cardiovascular events in older adults
Jingjing Hou, Jieying Shi, Song Zhao, Shikai Yu, Bo Wang, Yi Zhang
European Geriatric Medicine.2026;[Epub] CrossRef
Supine Blood Pressure and Risk of Cardiovascular Disease and Mortality
Duc M. Giao, Hannah Col, Fredrick Larbi Kwapong, Ruth-Alma Turkson-Ocran, Long H. Ngo, Jennifer L. Cluett, Lynne Wagenknecht, B. Gwen Windham, Elizabeth Selvin, Pamela L. Lutsey, Stephen P. Juraschek
JAMA Cardiology.2025; 10(3): 265. CrossRef
Central vs. Brachial Blood Pressure and Pulse Pressure Amplification for Mortality Risk Prediction in Patients Undergoing Coronary Angiography
Clara Daschner, Marcus E Kleber, Niklas Ayasse, Ksenija Stach, Gökhan Yücel, Faeq Husain-Syed, Alexander Niessner, Bernd Krüger, Winfried März, Bernhard K Krämer, Babak Yazdani
American Journal of Hypertension.2025; 38(5): 272. CrossRef
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Yoshitsugu Sunagawa, Akio Ishida, Masanobu Yamazato, Yusuke Ohya, Kenya Kusunose
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Song Meiyan, Junwei Zheng, Wu Ying, Chen Wen, Xu Kaizu, Liming Lin
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Supine Blood Pressure and Cardiovascular Risk—Reply
Duc M. Giao, Stephen P. Juraschek
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Sally K. Zimmermann, Kassem Farhat, Samir Zaman, Frances M. Wang, Samir Y. Hirpara, Raviv S. Markovitz, Jiun-Ruey Hu, Paul A. Beach, Stephen P. Juraschek
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Chronic obstructive pulmonary disease mortality trends in Spain, 1980-2020: Lucia Cayuela, José Luis López-Campos, Anna Michela Gaeta, Rocio Reinoso-Arija, Aurelio Cayuela; Epidemiol Health. 2023;45:e2023036. Published online March 18, 2023; DOI: https://doi.org/10.4178/epih.e2023036

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Abstract

OBJECTIVES
In Spain, there has been a recent increase in the mortality rate for chronic obstructive pulmonary disease (COPD) in younger women. This study aimed to analyze trends in the COPD mortality rate in Spain from 1980 to 2020, evaluating any differences between genders and age groups.

METHODS

Death certificates and mid-year population data were obtained from the Spanish National Institute of Statistics. For both genders, age group-specific and standardized (overall and truncated) rates were calculated by the direct method using the world standard population. The data were analyzed using the joinpoint regression method.

RESULTS

In both men and women, the number of COPD deaths increased from 1980 to 1999 (average annual increase of 7% in men and 4% in women), while from 1999 onwards, deaths decreased by -1.0% per year in both genders. In women, there was a significant final period of increase in the 55-59 to 70-74 age groups and a slowing of the decline in the over 75 age group. Additionally, an increase in mortality for the truncated rates was observed for women between 2006 and 2020. In men under 70 years of age, there was an initial period in which death rates remained stable or significantly increased, followed by a period in which they decreased significantly.

CONCLUSIONS

Our study shows age and gender differences in COPD mortality trends in Spain. Although the data show a downward trend, we have identified a worrying increase in the truncated rates in women for the last few years.

Summary

Key Message
Currently, mortality trends for COPD in Spain shows age and gender differences. Although the data show an overall downward trend, we have identified a worrying increase in the truncated rates in women for the last few years. This could be representing the beginning of an epidemic increase in mortality from COPD in women. Consequently, strategies should be strengthened and promoted to prevent smoking in all its forms in the general population, as well as encourage proper cessation treatments.

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Impact of Increased Single-Inhaler Triple Therapy Use in Appropriate Patients on Chronic Obstructive Pulmonary Disease Exacerbations, Mortality, and Medical Costs: PROMETHEUS Spain
Marta Marín-Oto, Jorge Mestre-Ferrándiz, Joaquín Sánchez-Covisa, Carmen Corregidor García, Néstor Martínez-Martínez, John Bell, Melissa Caplen, Prachi D. Bhatt, Jennifer Carioto, Bruce Pyenson
Respiration.2025; : 1. CrossRef

Trends and all-cause mortality associated with multimorbidity of non-communicable diseases among adults in the United States, 1999-2018: a retrospective cohort study: Mengzi Sun, Ling Wang, Xuhan Wang, Li Tong, Lina Jin, Bo Li; Epidemiol Health. 2023;45:e2023023. Published online February 14, 2023; DOI: https://doi.org/10.4178/epih.e2023023

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Multimorbidity of non-communicable diseases (NCDs) has brought enormous challenges to public health, becoming a major medical burden. However, the patterns, temporal trends, and all-cause mortality associated with NCD multimorbidity over time have not been well described in the United States.

METHODS

All adult participants were sourced from nationally representative data from the National Health and Nutrition Examination Survey. In total, 55,081 participants were included in trend analysis, and 38,977 participants were included in Cox regression.

RESULTS

The 5 NCDs with the largest increases over the study period were diabetes, osteoporosis, obesity, liver conditions, and cancer. The estimated prevalence of multimorbidity increased with age, especially for middle-aged participants with 5 or more NCDs; in general, the prevalence of NCD multimorbidity was higher among females than males. Participants with 5 or more NCDs were at 4.49 times the risk of all-cause mortality of participants without any diseases. Significant interactions were found between multimorbidity and age group (p for interaction <0.001), race/ethnicity (p for interaction<0.001), and educational attainment (p for interaction=0.010).

CONCLUSIONS

The prevalence of multiple NCDs significantly increased from 1999 to 2018. Those with 5 or more NCDs had the highest risk of all-cause mortality, especially among the young population. The data reported by this study could serve as a reference for additional NCD research.

Summary

Key Message
This study included a series-cross sectional study and a retrospective cohort study, utilizing nationally representative data from the National Health and Nutrition Examination Survey (NHANES). Multimorbidity of non-communicable diseases (NCDs) has brought enormous challenges to public health, becoming a major medical burden. This study aimed to explore the patterns, temporal trends, and all-cause mortality of multimorbidity of NCDs in the United States from 1999 to 2018, by gender-specific and age-specific. The data reported by this study could serve as a reference for additional NCD research.

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Muhammad Sarim Azad Khan, Asma Chaudhary, Mirha Imran Khan, Ibrahiem Azeem Ajaz, Arham Khalid, Aroosha Waheed, Mohammed Hammad Jaber Amin
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Jackson A. Roberts, Carla Y. Kim, Soonmyung A. Hwang, Amir Hassan, Ethan Covington, Kimia Heydari, Mac Lyerly, James J. Sejvar, Rodrigo Hasbun, Manya Prasad, Kiran T. Thakur
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Self-management difficulties in Swedish older adults and associations with sociodemographic factors, number of conditions, depression and health status
Ingrid Olsson, Sabine Björk, Ulf Isaksson, Tanya Packer, George Kephart, Anna Nordström, Åsa Audulv
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Fanny Petermann‐Rocha, Felipe Diaz‐Toro, Gabriela Nazar, Evelia Apolinar‐Jiménez, Catalina Medina, Salil Deo, Gary O'Donovan
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PLOS ONE.2024; 19(7): e0300154. CrossRef

Systematic Review

Associations of daily diet-related greenhouse gas emissions with the incidence and mortality of chronic diseases: a systematic review and meta-analysis of epidemiological studies: Jee Yeon Hong, Young Jun Kim, Sanghyuk Bae, Mi Kyung Kim; Epidemiol Health. 2023;45:e2023011. Published online December 30, 2022; DOI: https://doi.org/10.4178/epih.e2023011

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Although the entire process extending from food production to dietary consumption makes a large contribution to total greenhouse gas (GHG) emissions, little and inconsistent evidence exists on the epidemiological associations of daily diet-related GHG emissions with chronic disease risk or all-cause mortality. This systematic review and meta-analysis explored the observational epidemiological relationship between daily diet-related GHG emissions and health outcomes, including the risk of chronic diseases and all-cause mortality.

METHODS

Original articles published in English until May 2022 were identified by searching PubMed, Ovid-Embase, Web of Science, CINAHL, and Google Scholar. The extracted data were pooled using both fixed-effects and random-effects meta-analyses and presented as hazard and risk ratios (RRs) with 95% confidence intervals (CIs).

RESULTS

In total, 7 cohort studies (21 study arms) were included for qualitative synthesis and meta-analysis. The GHG emissions of dietary consumption showed a significant positive association with the risk of chronic disease incidence and mortality in both fixed-effects and random-effects models (fixed: RR, 1.04; 95% CI, 1.03 to 1.05; random: RR, 1.04; 95% CI, 1.02 to 1.06). This positive association was robust regardless of how daily diet-related GHG emissions were grouped. More strongly animal- based diets showed higher GHG emissions. However, there were only a few studies on specific chronic diseases, and the subgroup analysis showed insignificant results. There was no evidence of publication bias among the studies (Egger test: p=0.79).

CONCLUSIONS

A higher GHG-emission diet was found to be associated with a greater risk of all-cause mortality.

Summary

Korean summary
식이로부터 배출되는 GHG양은 메타분석의 고정 효과 모델과 확률 효과 모델 모두에서 만성 질환 발병률 및 사망 위험과 유의미한 양의 상관 관계를 보여주었습니다. 동물성 식단은 더 높은 GHG 배출량을 나타냈으나, 특정 만성질환에 대한 연구의 수가 적었고 질환 별 하위군 분석에서 유의미한 결과를 보이지 않았습니다. 결론적으로 온실가스 배출량이 많은 식단은 모든 원인으로 인한 사망 위험이 더 큰 것으로 나타났습니다.

Key Message
Daily food consumption contributes a large part of greenhouse gas (GHG) emissions, however, no review study was conducted. This study is the first review paper that reviews the relationship between greenhouse gas (GHG) emissions from daily diet and chronic disease risk and all-cause mortality. GHG emissions from the daily diet were significantly positively associated with disease risk and mortality. Animal-based diets contributed most to diet-derived GHG emissions. Men tended to have diets with higher GHG emissions compared to women. At times when the response to climate change is urgent, this study can help many policymakers and health officials.

Citations

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Development of the Food Systems–Related Greenhouse Gas Emissions Factor Database Using the Korea National Health and Nutrition Examination Survey (2016–2018)
Jee Yeon Hong, Mi Kyung Kim
Environmental Health Perspectives.2025;[Epub] CrossRef
Association between dietary environmental pressures and major chronic diseases: assessment from the prospective NutriNet-Santé cohort
Emmanuelle Kesse-Guyot, Aurélien Chayre, Elie Perraud, Sylvaine Berger, Annabelle Richard, Justine Berlivet, Mathilde Touvier, Benjamin Allès, Serge Hercberg, Denis Lairon, Philippe Pointereau, Hélène Fouillet, Julia Baudry, Christian Couturier, François
The Lancet Regional Health - Europe.2025; 59: 101481. CrossRef
The Role of a Sustainable Planetary Health Diet in the Prevention of Non-Communicable Diseases and Cause-Specific Mortality: A Narrative Review
Dorota Różańska, Bożena Regulska-Ilow
Foods.2025; 14(22): 3909. CrossRef
The bounds of meta-analytics and an alternative method
Ramalingam Shanmugam, Mohammad Tabatabai, Derek Wilus, Karan P. Singh
Epidemiology and Health.2024; 46: e2024016. CrossRef
Association between Diet-Related Greenhouse Gas Emissions and Mortality among Japanese Adults: The Japan Collaborative Cohort Study
Daiki Watanabe, Kotatsu Maruyama, Akiko Tamakoshi, Isao Muraki
Environmental Health Perspectives.2024;[Epub] CrossRef

Original Articles

Mediation analysis of leisure activities on the association between cognitive function and mortality: a longitudinal study of 42,942 Chinese adults 65 years and older: Xingxing Chen, Wenfan Wu, Xian Zhang, Tingxi Long, Wenyu Zhu, Rundong Hu, Xurui Jin, Lijing L. Yan, Yao Yao; Epidemiol Health. 2022;44:e2022112. Published online November 27, 2022; DOI: https://doi.org/10.4178/epih.e2022112

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Abstract

OBJECTIVES
Previous studies have established associations of cognitive function and leisure activities with mortality. This study aimed to evaluate whether leisure activities causally mediate these associations.

METHODS

This longitudinal study included 42,246 participants aged over 65 years from the Chinese Longitudinal Healthy Longevity Survey. The Mini-Mental State Examination and a self-reported scale were used to measure cognitive status and leisure activities, respectively. We examined the associations of cognitive function and leisure activities with mortality using Cox proportional hazards models. Causal mediation analysis was used to assess whether leisure activities mediated the association between cognitive function and mortality.

RESULTS

Cognitive function and leisure activities were inversely associated with mortality. Leisure activities accounted for 28.3% (95% confidence interval [CI], 25.6 to 31.1) of the total effect of cognitive function and mortality. A higher mediated proportion (PM) was observed for physical leisure activities (PM, 20.1%; 95% CI, 18.0 to 22.3) than for social leisure activities (PM, 17.7%; 95% CI, 15.7 to 19.7). The mediating effect was higher among participants at younger ages (PM, 41.5%; 95% CI, 21.3 to 65.4), those with higher education levels (PM, 30.5%; 95% CI, 25.3 to 36.2), and residents of rural China (PM, 42.5%; 95% CI, 25.4 to 62.5).

CONCLUSIONS

Cognitive function was associated with inverse mortality. Leisure activities significantly mediated this association. Participation in leisure activities at the early stages of mild cognitive impairment could reduce the risk of mortality, which has a major impact on interventional strategies for healthy aging.

Summary

Key Message
Both cognitive function and leisure activities were associated with inverse mortality. Leisure activities were an important mediator of the association between cognitive function and mortality. A planned intervention for leisure activities, at an early stage of mild cognitive impairment, could promote health outcomes and optimally reduce the risk of mortality.

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Integrated healthy lifestyle even in late-life mitigates cognitive decline risk across varied genetic susceptibility
Jun Wang, Chen Chen, Jinhui Zhou, Zinan Xu, Lanjing Xu, Xinwei Li, Zhuchun Zhong, Yuebin Lv, Xiaoming Shi
Nature Communications.2025;[Epub] CrossRef
Physical activity, Vitamin D, and all-cause/cardiovascular mortality: a prospective study in older Chinese adults
Mingrui Chen, Ling Cheng, Sisi Yang, Yan Zhang
BMC Geriatrics.2025;[Epub] CrossRef
Cognitive performance and all-cause mortality in community dwellers of Amerindian ancestry living in rural Ecuador: A population-based, longitudinal prospective study
Oscar H. Del Brutto, Denisse A. Rumbea, Aldo F. Costa, Maitri Patel, Mark J. Sedler, Robertino M. Mera
Clinical Neurology and Neurosurgery.2024; 236: 108053. CrossRef
Change in Healthy Lifestyle and Subsequent Risk of Cognitive Impairment Among Chinese Older Adults: A National Community-Based Cohort Study
Chengxiang Hu, Kexin Jiang, Xiaoyue Sun, Yue He, Runhong Li, Yana Chen, Yuan Zhang, Yuchun Tao, Lina Jin, Lewis A Lipsitz
The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences.2024;[Epub] CrossRef
Gender disparities in physical, psychological, and cognitive multimorbidity among elderly hypertensive populations in rural regions
Yudong Miao, Jiajia Zhang, Jian Wu, Dongfang Zhu, Junwen Bai, Jingbao Zhang, Ruizhe Ren, Dan Guo, Mingyue Zhen, Jinxin Cui, Xinran Li, Wenyong Dong, Clifford Silver Tarimo, Yifei Feng, Zhanlei Shen
International Journal for Equity in Health.2024;[Epub] CrossRef
Healthy lifestyle in late-life, longevity genes, and life expectancy among older adults: a 20-year, population-based, prospective cohort study
Jun Wang, Chen Chen, Jinhui Zhou, Lihong Ye, Yang Li, Lanjing Xu, Zinan Xu, Xinwei Li, Yuan Wei, Junxin Liu, Yuebin Lv, Xiaoming Shi
The Lancet Healthy Longevity.2023; 4(10): e535. CrossRef
Associations of Unhealthy Lifestyle and Nonalcoholic Fatty Liver Disease With Cardiovascular Healthy Outcomes
Wentao Wu, Wen Ma, Shiqi Yuan, Aozi Feng, Li Li, Haoxiao Zheng, Shuna Li, Ningxia He, Yuli Huang, Jun Lyu
Journal of the American Heart Association.2023;[Epub] CrossRef

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

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Abstract Summary PDF Supplementary Material

Abstract

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Summary

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

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

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

Inequitable distribution of excess mortality during the COVID-19 pandemic in Korea, 2020: Jin-Hwan Kim, Saerom Kim, Eunhye Park, Chang-yup Kim; Epidemiol Health. 2022;44:e2022081. Published online September 26, 2022; DOI: https://doi.org/10.4178/epih.e2022081

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Abstract PDF Supplementary Material

Abstract

OBJECTIVES
This study analyzed inequities in excess mortality according to region and socioeconomic position to explain the distribution of excess mortality in Korea in 2020.

METHODS

We acquired weekly all-cause mortality data from January 2015 to December 2020 from (1) the National Health Insurance Database and (2) Vital Statistics. Excess mortality for 2020 was calculated by comparing the weekly observed and expected deaths from the same period (2015-2019) using quasi-Poisson regression.

RESULTS

An inequitable distribution of excess mortality was identified. The estimated excess mortality in Korea was -29,112 (95% confidence interval, -29,832 to -28,391), corresponding to -55 per 100,000, and the ratio of observed deaths to expected deaths was 0.91. Negative excess mortality was observed except for females in the 0-14 age group. Male Medical Aid beneficiaries showed positive excess mortality, while non-disabled and disabled groups showed similar negative values. When the standardized mortality ratio was calculated for the top 10 causes of death, deaths from Alzheimer’s disease and septicemia increased, whereas those from diabetes mellitus and cerebrovascular disease decreased. The decrease in mortality was primarily concentrated in older adults, while the mortality of young females increased due to increased intentional self-harm.

CONCLUSIONS

This study adds essential evidence regarding the overall performance of Korea. The observed inequalities according to various socioeconomic variables indicate that the results of strict measures to control coronavirus disease 2019 were not distributed equitably. Efforts should be made to properly evaluate the current and future problems related to the pandemic.

Summary

Citations

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Excess mortality during and after the COVID-19 emergency in Japan: a two-stage interrupted time-series design
Ganan Devanathan, Paul LC Chua, Shuhei Nomura, Chris Fook Sheng Ng, Nasif Hossain, Akifumi Eguchi, Masahiro Hashizume
BMJ Public Health.2025; 3(1): e002357. CrossRef
The impact of a medical residents' walkout on mortality rates in South Korea, 2024
Jin-Hwan Kim, Saerom Kim
Health Policy.2025; 159: 105375. CrossRef
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Jiwoo Ha, Chang‐yup Kim
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The political effect of medical dominance in South Korea’s COVID-19 response
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The Predestined Failure of the Market Mechanism in Ensuring Health for all in Times of a Pandemic: The Case of the Republic of Korea
Jin-Hwan Kim
International Journal of Social Determinants of Health and Health Services.2025; 55(4): 465. CrossRef
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
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Excess mortality and healthcare costs during the COVID-19 pandemic among patients with ten major chronic diseases in South korea: a nationwide analysis
Jihun Song, Hye Jun Kim, Seogsong Jeong, Sun Jae Park, Hyun-Young Shin, Eun-kyeong Jeong, Jaehun Jung, Geehyuk Kim, Sang Min Park
BMC Infectious Diseases.2025;[Epub] CrossRef
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Daseul Moon, Jeangeun Jeon, Jieun Park, Min-Hyeok Choi, Myoung-Hee Kim, Hongjo Choi
Health Research Policy and Systems.2024;[Epub] CrossRef
Excess Deaths in Korea During the COVID-19 Pandemic: 2020-2022
So-Jin Im, Ji-Yeon Shin, Duk-Hee Lee
Journal of Preventive Medicine and Public Health.2024; 57(5): 480. CrossRef
Did the socioeconomic inequalities in avoidable and unavoidable mortality worsen during the first year of the COVID-19 pandemic in Korea?
Rora Oh, Myoung-Hee Kim, Juyeon Lee, Rangkyoung Ha, Jungwook Kim
Epidemiology and Health.2023; 45: e2023072. CrossRef

Type 2 diabetes mellitus increases the severity of non-fatal injuries, but not the risk of fatal injuries, among driver victims of motor vehicle crashes in Taiwan: I-Lin Hsu, Wen-Hsuan Hou, Ya-Hui Chang, Chung-Yi Li; Epidemiol Health. 2022;44:e2022076. Published online September 16, 2022; DOI: https://doi.org/10.4178/epih.e2022076

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Limited information is available on whether diabetes increases the severity of injuries from motor vehicle crashes (MVCs). This study aimed to investigate the association of type 2 diabetes with injury severity among driver victims of MVCs.

METHODS

This cohort study involved 75,737 adult driver victims with type 2 diabetes from Taiwan’s Police-Reported Traffic Accident Registry in 2015-2017, along with 150,911 sex-, age-, and calendar year-matched controls. The severity level of non- fatal injuries was derived from the International Classification of Diseases Programs for Injury Categorization based on the diagnostic codes of National Health Insurance claims within 3 days after an MVC. Information on fatal injuries within 3 days after an MVC was obtained from the Taiwan Death Registry. Logistic regression models were used to estimate the odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) of injury severity in association with type 2 diabetes.

RESULTS

After adjusting for potential confounders, driver victims with type 2 diabetes experienced significantly higher risks of mild and severe non-fatal injuries than their counterparts without diabetes, with covariate-adjusted ORs of 1.08 (95% CI, 1.05 to 1.11) and 1.28 (95% CI, 1.20 to 1.37), respectively. By contrast, the adjusted OR for fatal injuries was not significantly elevated, at 1.02 (95% CI, 0.89 to 1.18). Similar results were found when car and scooter driver victims were analyzed separately.

CONCLUSIONS

Type 2 diabetes was found to moderately increase the severity of non-fatal injuries from MVCs among car and scooter driver victims.

Summary

Key Message
With 75,737 driver victims with diabetes and 150,911 matched controls, this study showed an 8% and 28% increase in mild and severe non-fatal injury, respectively among driver victims with diabetes. Such increase in risk was equally applied to both car and scooter drivers. No increase in risk of 3-day mortality after crash was found.

Citations

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Prevalence of diabetes mellitus among traumatic patients admitted to Aseer Central Hospital, Aseer Region, Abha, Saudi Arabia: cross-sectional study
Majed Mohammed Al Saleh, Bandar A. Alasmari, Ali Mohammed AlAmri, Mohammed Mabkhoot Mogbel, Ali Saeed Alasmary, Alhussein Ali Almonawar, Saeed Doos S. Almontashri, Hassan Mussa Al Mojamad, Turki Abdullah Al Qahtani, Abdulrahman Mohammed Alshehri, Ibrahim
BMC Endocrine Disorders.2025;[Epub] CrossRef
A population-based study on meteorological conditions in association with motor vehicle collisions among people with type 2 diabetes
Chung-Yi Li, Ya-Hui Chang, Hon-Ping Ma, Ping-Ling Chen, Chang-Ta Chiu, I-Lin Hsu
Environmental Health and Preventive Medicine.2025; 30: 91. CrossRef

Prediction of cancer survivors’ mortality risk in Korea: a 25-year nationwide prospective cohort study: Yeun Soo Yang, Heejin Kimm, Keum Ji Jung, Seulji Moon, Sunmi Lee, Sun Ha Jee; Epidemiol Health. 2022;44:e2022075. Published online September 13, 2022; DOI: https://doi.org/10.4178/epih.e2022075

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aimed to investigate the factors affecting cancer survival and develop a mortality prediction model for Korean cancer survivors. Our study identified lifestyle and mortality risk factors and attempted to determine whether health-promoting lifestyles affect mortality.

METHODS

Among the 1,637,287 participants in the Korean Cancer Prevention Study (KCPS) cohort, 200,834 cancer survivors who were alive after cancer diagnosis were analyzed. Discrimination and calibration for predicting the 10-year mortality risk were evaluated. A prediction model was derived using the Cox model coefficients, mean risk factor values, and mean mortality from the cancer survivors in the KCPS cohort.

RESULTS

During the 21.6-year follow-up, the all-cause mortality rates of cancer survivors were 57.2% and 39.4% in men and women, respectively. Men, older age, current smoking, and a history of diabetes were high-risk factors for mortality, while exercise habits and a family history of cancer were associated with reduced risk. The prediction model discrimination in the validation dataset for both KCPS all-cause mortality and KCPS cancer mortality was shown by C-statistics of 0.69 and 0.68, respectively. Based on the constructed prediction models, when we modified exercise status and smoking status, as modifiable factors, the cancer survivors’ risk of mortality decreased linearly.

CONCLUSIONS

A mortality prediction model for cancer survivors was developed that may be helpful in supporting a healthy life. Lifestyle modifications in cancer survivors may affect their risk of mortality in the future.

Summary

Korean summary
현재 암 생존자의 사망 위험을 평가하는 데 유용한 한국형 암 생존자 사망률 예측 모델은 없습니다. 본 연구에서는 고령, 남성, 현재 흡연, 당뇨병 병력을 포함한 생활양식 요인이 사망의 고위험 요인인 반면, 운동 습관 및 암의 가족력은 사망 위험을 감소시키는 것으로 나타났습니다. 현재 흡연과 운동 습관은 사망 위험에 영향을 미치는 수정 가능한 두 가지 요소로써, 이러한 생활습관 요인으로 구성된 예측모형은 생활습관 교정을 통해 우리나라 암 생존자의 사망률을 낮출 수 있음을 시사합니다.

Key Message
Currently, there is no Korean mortality prediction model for cancer survivors that would be useful in evaluating their risk of mortality. The present study showed that lifestyle factors, including older age, male sex, current smoking, and history of diabetes were high-risk factors for mortality, while exercise habits and a family history of cancer reduced the risk of mortality. Current smoking and exercise habits are the two modifiable factors that affected the risk of mortality. The prediction model comprising these lifestyle factors implies that the risk of mortality of cancer survivors in Korea can be reduced through lifestyle modification.

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A comparative study of health behaviors in adult male cancer survivors and the general male population in Korea: from the Korea national health and nutrition examination survey VII-VIII (2016–2021)
Hyein Jung, Yoonjoo Choi, Byungmi Kim
Supportive Care in Cancer.2025;[Epub] CrossRef
Sex Disparity in Cancer and Non-cancer Mortality among Korean Cancer Survivors
Ansun Jeong, Soyeoun Kim, Somin Jeon, Boyoung Park
Journal of Cancer Prevention.2025; 30(4): 196. CrossRef
COVID-19 Mortality and Severity in Cancer Patients and Cancer Survivors
Jae-Min Park, Hye Yeon Koo, Jae-ryun Lee, Hyejin Lee, Jin Yong Lee
Journal of Korean Medical Science.2024;[Epub] CrossRef
Weight maintenance and gain were significantly associated with lower risk of all-cause and cancer-related mortality in Korean adults who were newly diagnosed with cancer based on the Korean NHIS-HEALS cohort
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Trends and disparities in avoidable, treatable, and preventable mortalities in South Korea, 2001-2020: comparison of capital and non-capital areas: Sang Jun Eun; Epidemiol Health. 2022;44:e2022067. Published online August 16, 2022; DOI: https://doi.org/10.4178/epih.e2022067

24,487 View
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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aimed to describe the regional avoidable mortality trends in Korea and examine the trends in avoidable mortality disparities between the Seoul Capital Area and non-Seoul-Capital areas, thereby exploring the underlying reasons for the trend changes.

METHODS

Age-standardized mortality rates from avoidable causes between 2001-2020 were calculated by region. Regional disparities in avoidable mortality were quantified on both absolute and relative scales. Trends and disparities in avoidable mortality were analyzed using joinpoint regression models.

RESULTS

Avoidable, treatable, and preventable mortalities in Korea decreased at different rates over time by region. The largest decreases were in the non-Seoul-Capital non-metropolitan area for avoidable and preventable mortality rates and the non-Seoul- Capital metropolitan area for treatable mortality rates, despite the largest decline being in the Seoul Capital Area prior to around 2009. Absolute and relative regional disparities in avoidable and preventable mortalities generally decreased. Relative disparities in treatable mortality between areas widened. Regional disparities in all types of mortalities tended to improve after around 2009, especially among males. In females, disparities in avoidable, treatable, and preventable mortalities between areas improved less or even worsened.

CONCLUSIONS

Trends and disparities in avoidable mortality across areas in Korea seem to have varied under the influence of diverse social changes. Enhancing health services to underserved areas and strengthening gender-oriented policies are needed to reduce regional disparities in avoidable mortality.

Summary

Korean summary
2001년부터 2020년까지 회피가능, 예방가능 사망률의 수도권과 비수도권 대도시, 비수도권 비대도시 지역 간 절대적, 상대적 격차는 대체로 감소했지만, 치료가능 사망률의 상대적 격차는 커졌다. 회피가능, 치료가능, 예방가능 사망률의 지역 간 격차는 2009년경 이후에 특히 남성에서 개선됐지만, 여성의 경우 덜 개선되거나 오히려 악화되기도 했다.

Key Message
Regional disparities in avoidable, treatable, and preventable mortalities tended to improve after around 2009, especially among males, but, in females, disparities in all types of mortalities between areas improved less or even worsened.

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Income-based disparities in the risk of distant-stage cervical cancer and 5-year mortality after the introduction of a National Cancer Screening Program in Korea: Erdenetuya Bolormaa, Seung-Ah Choe, Mia Son, Myung Ki, Domyung Paek; Epidemiol Health. 2022;44:e2022066. Published online August 11, 2022; DOI: https://doi.org/10.4178/epih.e2022066

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study assessed the socioeconomic gradient in the risk of distant-stage cervical cancer (CC) at presentation and 5-year mortality for new CC patients after the introduction of a national Cancer Screening Program (NCSP) in Korea.

METHODS

All new CC cases from 2007 to 2017 were retrieved from the Korea Central Cancer Registry database linked with the National Health Information Database of the National Health Insurance Service. The age-standardized cumulative incidence of CC, adjusted odds ratios (ORs) of distant metastasis at presentation, and adjusted all-cause mortality hazard ratios (HRs) within 5 years post-diagnosis were assessed according to the income gradient.

RESULTS

The 11-year age-standardized cumulative incidence of CC ranged from 48.9 to 381.5 per 100,000 women, with the richest quintile having the highest incidence. Of 31,391 new cases, 8.6% had distant metastasis on presentation, which was most frequent among Medical Aid beneficiaries (9.9%). Distant-stage CC was more likely when the income level was lower (OR, 1.46; 95% confidence interval [CI]), 1.28 to 1.67 for the lowest compared to the richest) and among Medical Aid beneficiaries (OR, 1.50; 95% CI, 1.24 to 1.82). The 5-year mortality was greater in the lower-income quintiles and Medical Aid beneficiaries than in the richest quintile.

CONCLUSIONS

The incidence of CC was higher in the richest quintile than in the lower income quintiles, while the risk of distant-stage CC and mortality was higher for women in lower income quintiles in the context of the NCSP. A more focused approach is needed to further alleviate disparities in the timely diagnosis and treatment of CC.

Summary

Korean summary
새로이 자궁경부암을 진단받은 여성에서 소득수준에 따른 진단시 원격 전이가 있을 위험도와 진단 이후 5년 사망위험도를 연령과 체질량 지수등의 개인 수준의 위험 요인을 보정하여 구했다. 소득 수준이 낮을수록, 의료급여 환자일수록 진단시 원격 전이가 있을 위험과 5년 내 사망 위험이 높은 것으로 나타났다. 자궁경부암에 대한 전국민 대상 선별 검사가 있지만 여전히 소득 수준에 따른 자궁경부암의 적시 진단과 진단 후 생존의 불평등이 남아 있으며 이에 대한 추가 정책이 필요하다.

Key Message
This study adds empirical evidence for an income-based disparity in the cancer stage at presentation and five-year survival among cervical cancer patients even in the presence of a universal screening program.

Citations

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Nomogram model for predicting the long-term prognosis of cervical cancer patients: a population-based study in Mato Grosso, Brazil
Sancho Pedro Xavier, Noemi Dreyer Galvão, Marco Aurélio Bertúlio das Neves, Kátia Moreira da Silva, Adila de Queiroz Neves Almeida, Ageo Mario Cândido da Silva
BMC Cancer.2025;[Epub] CrossRef
Individual and community-level determinants of cervical cancer screening among Kenyan women: a multilevel analysis of a Kenya demographic and health surveys 2022
Beminate Lemma Seifu, Angwach Abrham Asnake, Teshale Belayneh, Tesfahun Hailemariam
BMC Cancer.2025;[Epub] CrossRef
Age and socioeconomic disparities in cervical cancer incidence and mortality: a SEER-based analysis
Yuyi Ou, Santosh Chokkakula, Sio Mui Chong, Hao Wang, Andrew In-Cheong Si, Yong Jiang, Liying Huang, Xiaohua Xu, Chengliang Yin, Jun Lyu, Xiaobin Huang, Hui-ling Shang
Frontiers in Public Health.2025;[Epub] CrossRef
Individual and joint effect of socioeconomic status and lifestyle factors on cancer in Korea
Chi Lan Tran, Kui Son Choi, Sun‐Young Kim, Jin‐Kyoung Oh
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Disparities in Cancer Incidence across Income Levels in South Korea
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The association between the socioeconomic deprivation level and ischemic heart disease mortality in Japan: an analysis using municipality-specific data: Tasuku Okui, Tetsuya Matoba, Naoki Nakashima; Epidemiol Health. 2022;44:e2022059. Published online July 14, 2022; DOI: https://doi.org/10.4178/epih.e2022059

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Geographical variation in the standardized mortality ratio (SMR) for ischemic heart disease (IHD) among municipalities has not been assessed in Japan. Additionally, associations between area-level socioeconomic deprivation indices and IHD mortality have not been identified in Japan. The present study investigated this association.

METHODS

Information on IHD mortality was extracted from Vital Statistics data from 2018 to 2020 for each municipality in Japan. The socioeconomic deprivation level was derived from multiple socioeconomic characteristics. We classified municipalities into quintiles based on the deprivation level and investigated the association between the deprivation level and the SMR of IHD. Additionally, a Bayesian spatial regression model was used to investigate this association, adjusting for other municipal characteristics.

RESULTS

Geographical variation in the SMR of IHD was revealed, and municipalities with high SMRs were spatially clustered. There was a weak negative correlation between the socioeconomic deprivation level and the SMRs (correlation coefficient, -0.057 for men and -0.091 for women). In contrast, the regression analysis showed a statistically significant positive association between deprived areas and the IHD mortality rate, and the relative risks for the most deprived municipalities compared with the least deprived municipalities were 1.184 (95% credible interval [CrI], 1.110 to 1.277) and 1.138 (95% CrI, 1.048 to 1.249) for men and women, respectively.

CONCLUSIONS

A weak negative correlation between the socioeconomic deprivation level and the SMR was observed in the descriptive analysis, while the regression analysis showed that living in deprived areas was statistically positively associated with the IHD mortality rate.

Summary

Key Message
We investigated associations between area-level socioeconomic deprivation indices and IHD mortality in Japan using the Vital Statistics data, and a spatial regression analysis showed that living in deprived areas was statistically positively associated with the IHD mortality rate.

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Tasuku Okui
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Eunji Kim, Hokyou Lee, Donald Lloyd-Jones, Young Gyu Ko, Byoung Gwon Kim, Hyeon Chang Kim
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Review

Epidemiology of myocardial infarction in Korea: hospitalization incidence, prevalence, and mortality: Rock Bum Kim, Jang-Rak Kim, Jin Yong Hwang; Epidemiol Health. 2022;44:e2022057. Published online July 12, 2022; DOI: https://doi.org/10.4178/epih.e2022057

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Abstract Summary PDF

Abstract

Few studies have comprehensively presented epidemiological indicators of myocardial infarction in Korea. However, multiple published articles and open-source secondary data on the epidemiology of myocardial infarction are now available. This review summarized the hospitalization incidence, prevalence, and mortality rate of myocardial infarction in Korea using articles and open-source data from the Health Insurance Service and the Department of Statistics, surveys of sample populations, registries of patients, and other sources. The epidemiological indicators of myocardial infarction were compared between Korea and other high-income countries. The incidence of hospitalization due to myocardial infarction in Korea was 43.2 cases per 100,000 population in 2016 and has consistently increased since 2011. It was 2.4 times higher among men than among women. The estimated prevalence among adults over 30 years of age ranged from 0.34% to 0.70% in 2020; it was higher among men and increased with age. The mortality in 2020, which was 19.3 per 100,000 population in 2020, remained relatively stable in recent years. Mortality was higher among men than among women. Based on representative inpatient registry data, the proportion of ST-elevated myocardial infarction decreased until recently, and the median time from symptom onset to hospital arrival was approximately 2 hours and 30 minutes. The hospitalization incidence, prevalence, and mortality rate of myocardial infarction were lower in Korea than in other countries, although there was an increasing trend. Comprehensive national-level support and surveillance systems are needed to routinely collect accurate epidemiological indicators.

Summary

Korean summary
○우리나라의 심근경색증 발생률은 2016년 기준 인구 10만명 당 43.2명으로 추정되며 2011년 이후 증가하고 있음. ○ 30세 이상 인구에서 심근경색증 유병률은 0.34% (건강보험청구데이터) 또는 1.0% (국민건강영양조사)로 추정됨. ○ 전체인구에서 심근경색증으로 인한 사망률은 2019년 인구 10만명 당 18.8명으로 최근 큰 변화가 없거나 약간 감소하는 추세임.

Key Message
This review article showed the hospitalized incidence, prevalence, mortality, and features on patient registry of myocardial infarction in Korea from published articles and opened data sources.

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Original Articles

Blood lipid levels and all-cause mortality in older adults: the Chinese Longitudinal Healthy Longevity Survey 2008-2018: Rongxi Wang, Xiaoyue Yu, Zhiqiang Wang, Yujie Liu, Hui Chen, Shangbin Liu, Chen Xu, Yingjie Chen, Xin Ge, Danni Xia, Ruijie Chang, Gang Xu, Mi Xiang, Ying Wang, Tian Shen, Fan Hu, Yong Cai; Epidemiol Health. 2022;44:e2022054. Published online July 5, 2022; DOI: https://doi.org/10.4178/epih.e2022054

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Proper blood lipid levels are essential for survival in older adults, but inconsistent relationships have been reported between blood lipids and all-cause mortality in the elderly.

METHODS

This retrospective longitudinal study analyzed data from 1,067 Chinese older adults enrolled in the Chinese Longitudinal Healthy Longevity Survey collected in 2008 and followed up until death or December 31, 2018. The outcome was all-cause mortality. Multivariate Cox regression analyses were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) with stratification by age (60-80, 80-100, or ≥100 years) for further analysis. The survival probability according to lipid profile quartiles was calculated using Kaplan-Meier curves and the log-rank test.

RESULTS

The participants’ mean age was 84.84 years, and 57.0% were female. In total, 578 individuals died, and 277 were lost to follow-up. The mean total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels were higher among those who died than among those who survived. Participants in the second HDL-C quartile and the highest LDL-C and triglyceride (TG) quartiles had 28% higher, 23% lower, and 49% lower risks of all-cause mortality, respectively. After further adjustment, the associations remained except for HDL-C, and additional associations were observed between all-cause mortality and the third TC and LDL-C quartiles and the second TG quartile (HR, 1.44; 95% CI, 1.01 to 2.06; HR, 0.68; 95% CI, 0.49 to 0.94; HR, 0.79; 95% CI, 0.62 to 0.99, respectively).

CONCLUSIONS

Older adults should maintain an LDL-C level of 1.91-2.47 mmol/L and a TG level of no less than 1.66 mmol/L.

Summary

Key Message
The retrospective longitudinal study analyzed data from 1067 Chinese older adults enrolled in the Chinese Longitudinal Healthy Longevity Survey. 578 individuals died and 277 were lost to follow-up. Participants in the second HDL-C quartile and the highest LDL-C and TG quartiles had 28% higher, 23% lower, and 49% lower risks of all-cause mortality. After further adjustment, the associations remained except for HDL-C, and additional associations were observed between all-cause mortality and the third TC and LDL-C quartiles and the second TG quartile (HR, 1.44; 95% CI, 1.01 to 2.06; HR, 0.68; 95% CI, 0.49 to 0.94; HR, 0.79; 95% CI, 0.62 to 0.99).

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Prevalence and Factors Associated with Dyslipidemia Among Older Adults in Korea
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Xiaoxuan Feng, Yishou Deng, Chaolei Chen, Xiaocong Liu, Yuqing Huang, Yingqing Feng, Reinhard Depping
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Effect modification of consecutive high concentration days on the association between fine particulate matter and mortality: a multi-city study in Korea: Hyungryul Lim, Sanghyuk Bae, Jonghyuk Choi, Kyung-Hwa Choi, Hyun-Joo Bae, Soontae Kim, Mina Ha, Ho-Jang Kwon; Epidemiol Health. 2022;44:e2022052. Published online June 9, 2022; DOI: https://doi.org/10.4178/epih.e2022052

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Although there is substantial evidence for the short-term effect of fine particulate matter (PM2.5) on daily mortality, few epidemiological studies have explored the effect of prolonged continuous exposure to high concentrations of PM2.5. This study investigated how the magnitude of the mortality effect of PM2.5 exposure is modified by persistent exposure to high PM2.5 concentrations.

METHODS

We analyzed data on the daily mortality count, simulated daily PM2.5 level, mean daily temperature, and relative humidity level from 7 metropolitan cities from 2006 to 2019. Generalized additive models (GAMs) with quasi-Poisson distribution and random-effects meta-analyses were used to pool city-specific effects. To investigate the effect modification of continuous exposure to prolonged high concentrations, we applied categorical consecutive-day variables to the GAMs as effect modification terms for PM2.5.

RESULTS

The mortality risk increased by 0.33% (95% confidence interval [CI], 0.16 to 0.50), 0.47% (95% CI, -0.09 to 1.04), and 0.26% (95% CI, -0.08 to 0.60) for all-cause, respiratory, and cardiovascular diseases, respectively, with a 10 μg/m3 increase in PM2.5 concentration. The risk of all-cause mortality per 10 μg/m3 increase in PM2.5 on the first and fourth consecutive days significantly increased by 0.63% (95% CI, 0.20 to 1.06) and 0.36% (95% CI, 0.01 to 0.70), respectively.

CONCLUSIONS

We found increased risks of all-cause, respiratory, and cardiovascular mortality related to daily PM2.5 exposure on the day when exposure to high PM2.5 concentrations began and when exposure persisted for more than 4 days with concentrations of ≥35 μg/m3. Persistently high PM2.5 exposure had a stronger effect on seniors.

Summary

Korean summary
한국의 7개 대도시를 배경으로 수행한 본 시계열 연구를 통하여 2006년부터 2019년까지의 기간 동안에 초미세먼지의 단기 노출이 일별 사망률을 증가시키며, 교호작용모형을 통해 일평균 35 μg/m3 이상의 고농도 지속기간이 처음 시작되는 날과 넷째 지속일에 이러한 사망효과가 커짐을 보고하였다. 이러한 고농도 지속기간의 교호작용은 65세 이상 연령군에서 더욱 두드러졌다.

Key Message
With our Korean multi-city study design from 2006 to 2019, the short-term effects of PM2.5 on mortality were greater when the high PM2.5 concentration duration began during the day and lasted for approximately 4 days, and the elderly may be more affected by persistently high PM2.5.

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Estimating Health and Economic Benefits from PM2.5 Reduction in Fishery-Based Communities: A Sector-Specific Approach to Sustainable Air Quality Management in the Philippines
James Roy Lesidan, Nadine Grace Caido, Oliver Semblante, Floro Junior Roque, Jejomar Bulan, Jumar Cadondon, Maria Cecilia Galvez, Edgar Vallar
Sustainability.2025; 17(3): 1316. CrossRef

Brief Communication

Occupational inequalities in mortality in Korea: an analysis using nationally representative mortality follow-up data from the late 2000s and after: Eunjeong Noh, Young-Ho Khang; Epidemiol Health. 2022;44:e2022038. Published online April 6, 2022; DOI: https://doi.org/10.4178/epih.e2022038

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Abstract

Many Korean and international studies have found higher mortality rates and poorer health conditions among manual workers than among non-manual workers. However, a recent study using unlinked data argued that since the economic crisis in Korea in the late 2000s, the mortality estimates of male Korean non-manual workers have been higher than those of manual workers. Our work using individually linked data from the late 2000s and after aimed to examine mortality inequality by occupational class. We analyzed Korea National Health and Nutrition Examination Survey data that were individually linked to cause-of-death data. Cox regression analysis was used to identify the hazard ratios for mortality by occupational class. Of 11,766 males aged between 35 and 64, 397 died between 2007 and 2018: 142 died from cancer, 68 from cardiovascular disease, 88 from external causes, and 99 from other causes. After controlling for age, the mortality estimates for manual workers were 1.85 times higher than those for upper non-manual workers (p<0.05). We observed no evidence of reversed mortality inequality among occupational classes in Korea since the 2000s; this previously reported finding might have been due to numerator-denominator bias arising from the use of unlinked data.

Summary

Korean summary
개인 단위 연계자료가 아닌 분모(센서스)-분자(사망신고) 집합 자료를 사용하여 2000년대 후반 경제위기 이후 한국 남성 비육체직의 사망률이 육체직보다 높게 나타난다고 기존의 한 연구가 주장했다. 이 연구는 2000년대 이후 개인 단위로 연계된 코호트 자료를 활용하여 여전히 한국에서 육체직의 사망위험이 비육체직보다 높다는 점을 보임으로써, 기존 연구가 비연계자료의 사용으로 인한 분자-분모 바이어스(numerator-denominator bias) 때문에 그와 같은 결과를 보였다고 지적하였다.

Key Message
This paper using individually linked data from the late 2000s and after observed no evidence of reversed mortality inequality among occupational classes in Korea since the 2000s. The previously reported finding showing reversed occupational mortality inequality might have been due to numerator-denominator bias arising from the use of unlinked data.

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Insurance Types and All-Cause Mortality in Korean Cancer Patients: A Nationwide Population-Based Cohort Study
Jinyoung Shin, Yoon-Jong Bae, Hee-Taik Kang
Journal of Personalized Medicine.2024; 14(8): 861. CrossRef
Mortality of Suicide and Cerebro-Cardiovascular Diseases by Occupation in Korea, 1997–2020
Jungwon Jang, Inah Kim
International Journal of Environmental Research and Public Health.2022; 19(16): 10001. CrossRef

COVID-19: Original Article

Unemployment and COVID-19-related mortality: a historical cohort study of 50,000 COVID-19 patients in Fars, Iran: Alireza Mirahmadizadeh, Mohammad Taghi Badeleh Shamooshaki, Amineh Dadvar, Mohammad Javad Moradian, Mohammad Aryaie; Epidemiol Health. 2022;44:e2022032. Published online March 12, 2022; DOI: https://doi.org/10.4178/epih.e2022032

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Abstract Summary PDF

Abstract

OBJECTIVES
Previous studies have estimated the risk of death associated with unemployment in the coronavirus disease 2019 (COVID-19) pandemic, but no studies have examined unemployment before COVID-19 infection as a risk factor for COVID-19-related mortality. Thus, this study aimed to investigate COVID-19 mortality among this population.

METHODS

Data on 50,038 people aged 25-59 years were collected from 38 agencies in Fars Province, Iran, from February 2020 to July 2021. Follow-up lasted from participants’ diagnosis with COVID-19 based on the results of a reverse transcription-polymerase chain reaction test to participants’ death or the end of the study period. The association between unemployment and COVID-19-related mortality was estimated using the Poisson regression method, and a sensitivity analysis was conducted to calculate the E-value.

RESULTS

Unemployment was associated with a 2.41-fold (95% confidence interval [CI], 2.01 to 2.90) higher age-adjusted and sex-adjusted risk of COVID-19-related mortality. The adjusted Poisson regression analysis showed 8.82 (95% CI, 6.42 to 12.11), 2.84 (95% CI, 1.90 to 4.24), and 1.58 (95% CI, 1.24 to 2.01) times higher risks of COVID-19-related mortality among unemployed people aged 25-39 years, 40-49 years, and 50-59 years, respectively, than among their employed counterparts. Unemployment increased the risk of COVID-19 mortality by 3.31 (95% CI, 2.31 to 4.74) and 2.30 (95% CI, 1.86 to 2.84) times in female and male, respectively. The E-value was 3.43, reflecting the minimum strength of confounding required to shift the association between unemployment and COVID-19-related mortality toward the null.

CONCLUSIONS

Unemployment prior to COVID-19 infection increased the risk of COVID-19-related mortality. COVID-19-related mortality disproportionately impacted unemployed women and younger unemployed people.

Summary

Key Message
This study adds new insights to the existing body of work on the topic of unemployment and COVID-19-related mortality. Unemployment prior to COVID-19 infection was found to increase the risk of COVID-19-related mortality, which disproportionately burdened unemployed female and younger unemployed people. It seems older unemployed people and unemployed males may tend to have more financial resources and savings when they lose a job, making younger unemployed people and unemployed female more vulnerable to financial stress, which can lead to deferred care and increase their risk of COVID-19-related mortality.

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Predictors of COVID-19 mortality at 30 days of hospitalisation in Goma, Democratic Republic of Congo
Cosma Kajabika Luberamihero, Odrade Chabikuli, Claire Sangara Rukiya, Ken Kayembe Mabika, Nzanzu Magazani, Lubula Léopold, Wolfgang Weber, Prince Kimpanga Diangs
Journal of Interventional Epidemiology and Public Health.2026;[Epub] CrossRef
How do socioeconomic determinants of health affect the likelihood of living with HTLV-1 globally? A systematic review with meta-analysis
Nydile Ramesh, Beatrice Cockbain, Graham P. Taylor, Carolina Rosadas
Frontiers in Public Health.2024;[Epub] CrossRef
Modelling the spatial varying relationships between socioeconomic inequalities and COVID-19 mortality in the African subregion
Yaw K. Awuah-Mensah, Eric N. Aidoo
Earth Science Informatics.2024; 17(4): 2959. CrossRef
The Anatomy of Unemployment: Determinants During and After the COVID-19 Crisis
Matus Senci, Lucia Svabova, Tomas Kliestik
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Is there a relationship between internet access and COVID-19 mortality? Evidence from Nigeria based on a spatial analysis
Richard Adeleke
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Determinant Factors of Mortality in Pre-elderly and Elderly Patients With COVID-19 in Jakarta, Indonesia
Thresya Febrianti, Ngabila Salama, Inggariwati, Dwi Oktavia
Journal of Preventive Medicine and Public Health.2023; 56(3): 231. CrossRef
The gamma-Maxwell regression for COVID-19 mortality rates of the 50 U.S. largest cities
N.S.S. da Costa, G.M. Cordeiro
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Original Articles

Independent predictors of depressive symptoms and social isolation on 2-year all-cause mortality among the Korean elderly in a population-based cohort study: gender differences: Hyunsuk Jeong, Hyeon Woo Yim, Beom-Woo Nam; Epidemiol Health. 2022;44:e2022012. Published online January 8, 2022; DOI: https://doi.org/10.4178/epih.e2022012

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study examined whether depressive symptoms and social isolation were independent predictors of 2-year all-cause mortality among the elderly using data from a population-based cohort study.

METHODS

In total, 1,033 participants (320 men and 713 women) older than 60 years of age participated in this study. Depressive symptoms, social isolation status, and socio-demographic and health-related covariates were assessed at baseline. The primary outcome measure was 2-year all-cause mortality. Data were collected through in-person interviews by trained interviewers. The GENMOD procedure was used to calculate relative risks (RRs).

RESULTS

Of the 1,033 participants, 102 (40 men and 62 women) died within the follow-up period of 2 years. During the 2-year follow-up period, 17.8% of depressed men and 12.3% of depressed women died, and 29.8% of socially isolated men and 14.9% of socially isolated women died. Social isolation was an independent predictor of mortality in elderly men (adjusted relative risk [aRR], 4.6, 95% confidence interval [CI], 2.0 to 10.2), while depressive symptoms were an independent predictor of mortality in elderly women (aRR, 2.0; 95% CI, 1.2 to 3.6) when controlling for potential confounding factors. However, the depressive symptoms detected using the geriatric depression scale were not associated with mortality in men, and social isolation was not associated with mortality in women.

CONCLUSIONS

The effects of depressive symptoms and social isolation on 2-year all-cause mortality within an elderly population differed according to gender. Gender-specific community-based interventions must be developed to potentially reduce 2-year all-cause mortality among the elderly.

Summary

Korean summary
본 연구는 지역사회 거주하는 저소득층 노인을 대상으로 한 코호트 연구로 2년 추적조사를 수행하여 사망 원인의 예측인자를 분석하였다. 남성노인에서는 사회적 고립이, 여성노인에서는 우울증상이 2년 모든 사망원인의 독립적인 예측인자였다. 노인의 사망율을 줄이기 위한 지역사회 개입 프로그램은 남성에게는 사회적 고립을 해소를, 여성에게는 우울증상 개선을 위한 프로그램이 요구된다.

Key Message
The effects of depressive symptoms and so¬cial isolation on 2-year all-cause mortality among the elderly dif¬fered according to gender. For elderly men, social isolation increased the risk of 2-year all-cause mortality by 4.6 times compared to those who were not socially isolated. However, the depressive symptoms identified by the GDS-15 were not associated with 2-year all-cause mortality in men. From a public health perspective, these findings suggest that gender-specific community-based interventions are needed to mitigate all-cause mortality among the elderly.

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Loneliness, social isolation, and living alone: a comprehensive systematic review, meta-analysis, and meta-regression of mortality risks in older adults
Agni Nakou, Elena Dragioti, Nikolaos-Stefanos Bastas, Nektaria Zagorianakou, Varvara Kakaidi, Dimitrios Tsartsalis, Stefanos Mantzoukas, Fotios Tatsis, Nicola Veronese, Marco Solmi, Mary Gouva
Aging Clinical and Experimental Research.2025;[Epub] CrossRef
Oral frailty and outcomes: A scoping review
Wei Ting Foo, Sri Karpageshwary K, Angela Frances Hui Wen Yap
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Eleonora Bergo, Marina De Rui, Chiara Ceolin, Pamela Iannizzi, Chiara Curreri, Maria Devita, Camilla Ruffini, Benedetta Chiusole, Alessandra Feltrin, Giuseppe Sergi, Antonella Brunello
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Bo Zhao, Xiaoxu Jiang, Fanlei Kong, Eun Woo Nam
Journal of Affective Disorders.2023; 330: 158. CrossRef
A systematic review and meta-analysis of 90 cohort studies of social isolation, loneliness and mortality
Fan Wang, Yu Gao, Zhen Han, Yue Yu, Zhiping Long, Xianchen Jiang, Yi Wu, Bing Pei, Yukun Cao, Jingyu Ye, Maoqing Wang, Yashuang Zhao
Nature Human Behaviour.2023; 7(8): 1307. CrossRef
Gender Inequalities in Mental Health During the COVID-19 Pandemic: A Population-based Study in Korea
Minku Kang, Sarah Yu, Seung-Ah Choe, Daseul Moon, Myung Ki, Byung Chul Chun
Journal of Preventive Medicine and Public Health.2023; 56(5): 413. CrossRef

Increasing trends in mortality and costs of infectious diseases in Korea: trends in mortality and costs of infectious diseases: Dahye Baik, Byung-Woo Kim, Moran Ki; Epidemiol Health. 2022;44:e2022010. Published online January 3, 2022; DOI: https://doi.org/10.4178/epih.e2022010

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
In an era when the average life expectancy and overall mortality rate have improved, Korea remains at risk for infectious disease outbreaks that place substantial burdens on the healthcare system. This study investigated trends in mortality and the economic burden of infectious diseases.

METHODS

Healthcare data from the Health Insurance Review and Assessment Service (2009-2019) and the Korean Statistics Information Service (1997-2019) were used. We selected 10 infectious disease groups (intestinal infections, tuberculosis, vaccine- preventable diseases, sepsis, viral hepatitis, HIV-related diseases, central nervous system infections, rheumatic heart diseases, respiratory tract infections, and arthropod-borne viral diseases).

RESULTS

The age-standardized mortality rate for infectious diseases increased from 27.2 per 100,000 population in 1997 to 37.1 per 100,000 population in 2019 and has had an upward trend since 2004. During this same period, significant increases were seen in respiratory tract infections and among elderly persons, especially those aged ≥85 years. The costs for infectious diseases increased from 4.126 billion US dollar (USD) in 2009 to 6.612 billion USD in 2019, with respiratory tract infections accounting for 3.699 billion USD (69%). The annual cost per patient for visits for medical care due to infectious diseases increased from 131 USD in 2009 to 204 USD in 2019.

CONCLUSIONS

Mortality among elderly persons and those with respiratory tract infections increased during the study period. The economic burden of infectious diseases has consistently increased, especially for respiratory tract infections. It is therefore essential to establish effective management policies that considers specific infectious diseases and patient groups.

Summary

Korean summary
우리나라의 감염병으로 인한 사망률과 의료비용은 증가하고 있다. 특히 고령층에서의 높은 사망률과 과다한 의료비용 지출을 고려하면, 호흡기 감염 관리에 집중하는 것이 중요하며 각 감염병 그룹별로 효과적인 정책과 효율적인 관리가 필요하다. 본 연구는 COVID-19 발생 이전의 우리나라 감염병의 사망률과 발생, 의료비 부담의 장기적인 추세를 분석한 중요한 레퍼런스가 될 것이다.

Key Message
In Republic of Korea, the mortality trends (1997-2019) and costs (2009-2019) of infectious disease have increased and this study is particularly important reference for identifying the long-term trends including mortality, outbreak, financial burden of infectious disease in Korea before COVID-19 outbreak.

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Michael A. Oluwagbemiga, Jesús Gómez, Sonam Bhattarai, Omnia Ahmed, Bernd Zechmann, Nathaniel F. Adegboyega, Andrés M. Durantini
ACS Applied Engineering Materials.2025; 3(8): 2638. CrossRef
Air pollution and health burden: a generalized additive mixed model approach to PM2.5, life Expectancy, and respiratory infections and tuberculosis in Thailand, Malaysia, and Singapore
Wong Ming Wong, Wunhong Su
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Epidemiological features of the 2024 pertussis outbreak in Gyeonggi Province, Korea
Yeon Hwa Chang, Kyujin Chang, Yeong Jun Ju
Epidemiology and Health.2025; 47: e2025072. CrossRef
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Jongmin Oh, Youn-Hee Lim, Changwoo Han, Dong-Wook Lee, Jisun Myung, Yun-Chul Hong, Soontae Kim, Hyun-Joo Bae
Journal of Preventive Medicine and Public Health.2024; 57(2): 185. CrossRef
Glycaemic status, insulin resistance, and risk of infection-related mortality: a cohort study
Hae Suk Cheong, Yoosoo Chang, Yejin Kim, Eun-Jeong Joo, Min-Jung Kwon, Sarah H Wild, Christopher D Byrne, Seungho Ryu
European Journal of Endocrinology.2023; 188(2): 197. CrossRef
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Evidence-Based Complementary and Alternative Medicine.2022; 2022: 1. CrossRef

Spatiotemporal trends in diabetes-related mortality by school district in the state of Michigan, United States: Nurjannah Nurjannah, Kathleen M. Baker, Duduzile Phindi Mashinini; Epidemiol Health. 2021;43:e2021098. Published online November 9, 2021; DOI: https://doi.org/10.4178/epih.e2021098

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Abstract Summary PDF

Abstract

OBJECTIVES
This study examined the spatiotemporal epidemiological status of diabetes-related death in relation to school district boundaries in the state of Michigan, United States.

METHODS

A retrospective observational study was conducted using death records spanning the years 2007-2014 in Michigan, with school districts as the geographic unit of analysis. Geocoding was performed for each death record. Cluster analysis used spatial autocorrelation with local Moran’s I, and spatiotemporal analysis used the Space Time Pattern Mining tool in ArcGIS Pro 2.1.

RESULTS

The study revealed spatial clusters of high-high locations of diabetes-related mortality rate by school district in Michigan from 2007 to 2014. Spatiotemporal analysis showed grids with intensifying, consecutive, sporadic, and persistent hotspots of diabetes-related death in the Lansing, Royal Oak, Flint City, Berkley, Detroit City, East Lansing, South Lake, and Holt public school districts. These school districts should be prioritized for school-based diabetes prevention programs

CONCLUSIONS

The study demonstrated the presence of various hotspots of diabetes-related deaths within the state of Michigan across the 8-year period of analysis. Understanding spatial and temporal hotspots could further improve our ability to evaluate diabetes burden across both time and space.

Summary

Key Message
Using existing secondary data with spatio-temporal analysis, the study identified diabetes-related death varies across space and time within the state of Michigan, USA at the school district level. This approach provided policy-relevant information to target high-risk school-district when having limited resources to prevent diabetes at schools.

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Logan Beyer, Jeff Blossom, Junyi Chen, Rockli Kim, S.V. Subramanian
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Effects of exposure to ambient air pollution on pulmonary function impairment in Korea: the 2007-2017 Korea National Health and Nutritional Examination Survey: Soo Beom Choi, Sungha Yun, Sun-Ja Kim, Yong Bum Park, Kyungwon Oh; Epidemiol Health. 2021;43:e2021082. Published online October 18, 2021; DOI: https://doi.org/10.4178/epih.e2021082

18,894 View
192 Download
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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aimed to investigate the association between pulmonary function and air pollution using 2007-2017 data from the Korea National Health and Nutrition Examination Survey, a nationwide cross-sectional representative survey.

METHODS

A total of 27,378 participants that had sampling weights from a complex sample survey were included in this study. Using the data for forced expiratory volume in 1 second and forced vital capacity, the participants with pulmonary function impairment were classified according to the criteria of restrictive lung disease and chronic obstructive pulmonary disease (COPD). Exposure to ambient air pollution was estimated using the Community Multiscale Air Quality model. Multivariate linear and logistic regression analyses with complex samples were used to determine the associations between pulmonary function and air pollution after adjusting for covariates.

RESULTS

In total, 13.2% of the participants aged >40 years had COPD, and 10.7% were classified as being in the restrictive lung disease group. According to the multivariate logistic regression model, the odds ratios for the fourth quartiles of particulate matter less than 10 μm in diameter (PM10), particulate matter less than 2.5 μm in diameter (PM2.5) and carbon monoxide (CO) with a 2-year lag period were 1.203 (95% confidence interval [CI], 1.036 to 1.396), 1.283 (95% CI, 1.101 to1.495), and 1.292 (95% CI, 1.110 to 1.504), respectively, using the restrictive lung disease group as an event after adjusting for covariates in the complex sample.

CONCLUSIONS

Long-term exposure to PM10, PM2.5, and CO was significantly associated with pulmonary function, especially restrictive lung disease.

Summary

Korean summary
대기오염이 폐기능에 미치는 영향을 조사하기 위해 2007년부터 2017년까지 국민건강영양조사자료와 대기질 자료를 연계하여 참여자 27,378명의 대기오염 노출량을 추정하여 분석하였다. 나이, 성별, 거주지 동/읍면 구분, 교육수준, 소득수준, 흡연, 비만, 기온, 상대습도 변수들을 보정 후 PM₁₀, PM_2.5, SO2, NO2, CO, O3의 2년평균 노출량을 각각 로지스틱회귀모형으로 분석한 결과 PM₁₀, PM_2.5, CO 와 제한성 환기장애가 연관성을 보였다. 대기오염의 노출은 만성폐쇄성폐질환보다는 제한성 환기장애와 연관이 있었으며 제한성 환기장애는 사망원인과도 연관이 있었다.

Key Message
This study aimed to investigate the association between pulmonary function and air pollution using 2007-2017 data from the Korea National Health and Nutrition Examination Survey. Long-term exposure to PM₁₀, PM_2.5, and CO was significantly associated with pulmonary function, especially restrictive lung disease. Although the COPD criteria do not include the restrictive lung disease group, restrictive lung disease needs to be controlled and managed based on its mortality risk. Reducing air pollution is also necessary to enhance pulmonary function.

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The age-standardized incidence, mortality, and case fatality rates of COVID-19 in 79 countries: a cross-sectional comparison and their correlations with associated factors: Dongui Hong, Sohyae Lee, Yoon-Jung Choi, Sungji Moon, Yoonyoung Jang, Yoon-Min Cho, Hyojung Lee, Sukhong Min, Hyeree Park, Seokyung Hahn, Ji-Yeob Choi, Aesun Shin, Daehee Kang; Epidemiol Health. 2021;43:e2021061. Published online September 8, 2021; DOI: https://doi.org/10.4178/epih.e2021061

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
During the coronavirus disease 2019 (COVID-19) pandemic, crude incidence and mortality rates have been widely reported; however, age-standardized rates are more suitable for comparisons. In this study, we estimated and compared the age-standardized incidence, mortality, and case fatality rates (CFRs) among countries and investigated the relationship between these rates and factors associated with healthcare resources: gross domestic product per capita, number of hospital beds per population, and number of doctors per population.

METHODS

The incidence, mortality, and CFRs of 79 countries were age-standardized using the World Health Organization standard population. The rates for persons 60 years or older were also calculated. The relationships among the rates were analysed using trend lines and coefficients of determination (R2). Pearson correlation coefficients between the rates and the healthcare resource-related factors were calculated.

RESULTS

The countries with the highest age-standardized incidence, mortality, and CFRs were Czechia (14,253 cases/100,000), Mexico (182 deaths/100,000), and Mexico (6.7%), respectively. The R2 between the incidence and mortality rates was 0.852 for all ages and 0.945 for those 60 years or older. The healthcare resources-related factors were associated positively with incidence rates and negatively with CFRs, with weaker correlations among the elderly.

CONCLUSIONS

Compared to age-standardized rates, crude rates showed greater variation among countries. Medical resources may be important in preventing COVID-19-related deaths; however, considering the small variation in fatality among the elderly, preventive measures such as vaccination are more important, especially for the elderly population, to minimize the mortality rates.

Summary

Korean summary
국가별 발생률, 사망률, 치명률을 WHO 표준 인구로 연령표준화하였고, 의료자원과 관계된 지표와의 상관관계를 파악하였다. 2021년 4월 6일 기준, 연령표준화 발생률, 사망률, 치명률이 가장 높은 나라는 각각 체코 (10만명당 14,253명), 멕시코 (10만명당 182명), 멕시코 (6.7%)이며, 60세 이상 노인은 사망률과 치명률이 더 높은 것으로 나타났다. 1인당GDP, 인구당 의사 수, 인구당 병상 수는 발생률과 양의 상관관계가, 치명률과는 음의 상관관계가 있었고 노인에게서는 상관관계가 약하게 나타났다. 코로나바이러스감염증-19로 인한 피해를 최소화하기 위해서 의료자원의 투입과 더불어 노인의 감염예방이 중요할 것이다.

Key Message
The incidence, mortality, and case fatality rates of 79 countries were age-standardized using the WHO standard population. The correlations between the rates and the healthcare resource-related factors were investigated. As of April 6, 2021, the countries with the highest age-standardized incidence, mortality, and case fatality rates were Czechia (14,253 cases/100,000), Mexico (182 deaths/100,000), and Mexico (6.7%), respectively; the mortality and case fatality rates were higher among the elderly. GDP per capita, number of hospital beds per population, and number of doctors per population were associated positively with incidence rate, and negatively with case fatality rates: the correlations were weaker among the elderly. To minimize the burden caused by COVID-19, preventing the elderly from infection is important as well as supply of medical resources.

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Brief Communication

A comparison of meta-analysis results with and without adjustment for the healthy worker effect: cancer mortality among workers in the semiconductor industry: Sung-Ho Hwang, Moon-Young Park, Won Jin Lee, Inho Park, Kimyong Hong, Donguk Park, Kyoung-Mu Lee; Epidemiol Health. 2021;43:e2021057. Published online September 8, 2021; DOI: https://doi.org/10.4178/epih.e2021057

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Abstract Summary PDF

Abstract

OBJECTIVES
This study compared the results of meta-analysis with and without adjustment for the healthy worker effect on the association between working in the semiconductor industry and cancer mortality.

METHODS

Six studies that reported standardized mortality ratios (SMRs) for cancers were selected for meta-analysis. Using a random-effects model, the SMR results from each study were combined for all cancers and leukemias to estimate the summary SMRs (95% confidence interval, CI). To adjust for the healthy worker effect, the relative standardized mortality ratio (rSMR=SMRx/SMRnot x) were calculated using observed and expected counts for the specific cause of interest (i.e., all cancers and leukemias) and the observed and expected counts for all other causes of mortality. Then, the rSMR results were combined to estimate the summary rSMRs (95% CIs).

RESULTS

The SMRs for all causes of mortality among semiconductor industry workers ranged from 0.25 to 0.80, which reflects a significant healthy worker effect. A remarkable difference was found between the summary SMRs and the summary rSMRs. The summary SMR for all cancers was 0.70 (95% CI, 0.63 to 0.79) whereas the summary rSMR was 1.38 (95% CI, 1.20 to 1.59). The summary SMR for leukemia was 0.88 (95% CI, 0.72 to 1.07), and the summary rSMR was 1.88 (95% CI, 1.20 to 2.95).

CONCLUSIONS

Our results suggest that adjustment for the healthy worker effect (i.e., rSMR) may be useful in meta-analyses of cohort studies reporting SMRs.

Summary

Korean summary
본 연구에서는 반도체 근로자의 암사망률을 일반 인구와 비교하여 표준화사망비(SMR)를 제시한 연구를 대상으로 한 메타분석에서, summary SMR값(95% CI)과 건강근로자효과에 대해 보정한 rSMR을 산출한 후 종합한 summary rSMR값(95% CI)을 비교하였다. 모든 암의 경우 summary SMR=0.70 (0.63-0.79), summary rSMR=1.38(1.20-1.59)로 나타났으며, 백혈병의 경우 summary SMR=0.88 (0.72-1.07), summary rSMR=1.88(1.20-2.95)로 나타났다. 본 연구결과는 SMR 연구를 종합하는 메타분석 연구에서 rSMR과 같은 건강근로자효과에 대해 보정하는 방법론을 적용할 수 있음을 보여주는 사례이다.

Key Message
The relevance of epidemiological research reporting the standardized mortality ratios (SMRs) for workers in the semiconductor industry is often limited by the healthy worker effect. One of the simple correction methods in the relative standardized mortality ratio (rSMR). We observed significant rightward shift when the summary rSMRs were compared with the summary rSMRs, which suggest that adjustment for the healthy worker effect (i.e., rSMR) may be useful in meta-analyses of cohort studies reporting SMRs.

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Original Articles

Pain and mortality among older adults in Korea: Chiil Song, Wankyo Chung; Epidemiol Health. 2021;43:e2021058. Published online September 7, 2021; DOI: https://doi.org/10.4178/epih.e2021058

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
With the increasing elderly population with chronic disease, understanding pain and designing appropriate policy interventions to it have become crucial. While pain is a noted mortality risk factor, limited studies exist due to the various causes of pain and the subjectivity of pain expression. This study aimed to examine the relationship between pain and mortality, controlling for other diseases and socio-cultural factors.

METHODS

We analyzed 6,258 individuals aged 45 years or older, the population with the highest prevalence of pain, using the Korean Longitudinal Study of Aging (2006-2016) data and the Cox proportional-hazards model. Further subgroup analyses were conducted by sex and education level to examine differences in the relationship between pain and mortality.

RESULTS

The adjusted hazard ratios of mortality were 1.16 (95% confidence interval [CI], 1.00 to 1.34, model 1) and 1.12 (95% CI, 0.97 to 1.29, model 2) for the individuals in pain depending on the models used, where additional socio-cultural factors were accounted for in model 2. For individuals in severe pain, ratios were significantly higher with 1.23 (95% CI, 1.08 to 1.41, model 1) and 1.16 (95% CI, 1.02 to 1.32, model 2). Further subgroup analyses showed that severe pain was more associated with mortality for males and more educated individuals, with adjusted hazard ratios of 1.29 (95% CI, 1.08 to 1.55, model 2) and 1.62 (95% CI, 1.15 to 2.28, model 2), respectively.

CONCLUSIONS

Pain showed a statistically significant relationship with mortality risk. Family members or medical staff should pay proper attention to pain, particularly severe pain in males and highly educated individuals.

Summary

Korean summary
우리나라의 고령인구와 만성질환의 증가가 가속화됨에 따라, 통증의 문제를 겪는 인구가 증가하고 통증의 사회경제적 영향도 커지고 있어 통증에 대한 엄밀한 분석이 요구된다. 본 연구는 통증을 주로 겪는 중·고령층을 대상으로 생존분석을 통해, 통증이 객관적 지표인 사망위험과 유의미하게 관련이 있음을 보였다. 따라서 환자의 통증 표현은, 특히 남성과 고학력자의 심한 통증 표현은, 사망과 관련이 있는 중요한 지표로 관리될 필요가 있으며 적절한 정책적 접근이 요구된다.

Key Message
With the increasing elderly population with chronic disease, understanding pain and designing appropriate policy interventions to it have become crucial. This study showed that pain had a statistically significant relationship with mortality risk, thus proper attention should be paid to it.

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Association of Pain With Falls and Fractures Among Middle-Aged Korean Community-Dwelling Adults
Shaoli Yao, Xi-wen Chen, Jay Magaziner
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Pain neuroscience education with physical activity improves physical and psychological outcomes in older women with chronic low back pain
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Impact of Pain on Activities of Daily Living in Older Adults: A Cross-Sectional Analysis of Korean Longitudinal Study of Aging (KLoSA)
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Association Between Socioeconomic Inequalities in Pain and All-Cause Mortality in the China Health and Retirement Longitudinal Study: Longitudinal Cohort Study
Zhuo Zhang, Dongmei Xue, Ying Bian
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Sejun Oh, Yeonji Gu, Inbeom Kim, Euha Kwon, Sangheon Lee, Kyounghae Kim
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Sex-specific effects of neuropathic pain on long-term pain behavior and mortality in mice
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Employment status and mortality among Korean men over a 13-year period: Dohee Lim, Kyoung Ae Kong, Hyesook Park, Kyunghee Jung-Choi; Epidemiol Health. 2021;43:e2021055. Published online August 18, 2021; DOI: https://doi.org/10.4178/epih.e2021055

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study explored the effect of employment status on mortality over a 13-year period in Korean men.

METHODS

Data were used from the Korean Labor and Income Panel Study from 1999 to 2012. This study started with 2,737 subjects and included employed men in good health, aged 30-69 years. Deaths were tracked for 13 years from 2000 to 2012. Employment status classifications were: (1) regular employees, (2) precarious employees, (3) petty bourgeoisie, and (4) employers. Hazard ratios (HRs) were calculated using a Cox proportional hazards model, and were adjusted for age, education, income, and occupation, with regular employees as the reference category. To examine the effect of employment status and include employment history, the risk ratios of mortality were measured using the Poisson regression model, considering the duration of each employment and using 0 years as the reference category.

RESULTS

Over the course of the 13-year study, being a precarious employee (HR, 1.84) or petty bourgeoisie (HR, 1.87) at a particular point in time had a negative effect on mortality when compared with regular employees. Furthermore, working as precarious employees or petty bourgeoisie had no positive effect on mortality. A positive effect was observed, however, on the overall mortality risk for regular employees.

CONCLUSIONS

These results suggest that a healthy social policy is needed for precarious employees and petty bourgeoisie to avoid disadvantages in the workplace and the social safety net.

Summary

Korean summary
13년간 추적한 결과, 비정규직 노동자와 고용원이 없는 자영업자가 정규직 노동자에 비해 사망위험이 유의하게 높았다. 정규직 노동자에서는 일하는 것이 사망위험을 낮추는 긍정적인 효과를 관찰할 수 있었으나, 비정규직 노동자나 고용원이 없는 자영업자에서는 일하는 것의 긍정적인 효과를 관찰할 수 없었다. 이는 비정규직 노동자와 고용원이 없는 자영업자에 대한 건강한 사회 정책이 필요함을 시사한다.

Key Message
Over the course of the 13-year study, being a precarious employee or petty bourgeoisie had a negative effect on mortality when compared with regular employees. No positive effect of working was found for precarious employees or petty bourgeoisie, whereas cumulative work as a regular employee was observed to have a positive effect on mortality. These results suggest that a healthy social policy is needed for precarious employees and petty bourgeoisie to avoid disadvantages in the workplace and the social safety net.

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Temporary Employment Is Associated with Poor Dietary Quality in Middle-Aged Workers in Korea: A Nationwide Study Based on the Korean Healthy Eating Index, 2013–2021
Seong-Uk Baek, Myeong-Hun Lim, Yu-Min Lee, Jong-Uk Won, Jin-Ha Yoon
Nutrients.2024; 16(10): 1482. CrossRef
Inequality in Mortality and Cardiovascular Risk Among Young, Low-Income, Self-Employed Workers: Nationwide Retrospective Cohort Study
Byungyoon Yun, Heejoo Park, Jaesung Choi, Juyeon Oh, Juho Sim, Yangwook Kim, Jongmin Lee, Jin-Ha Yoon
JMIR Public Health and Surveillance.2024; 10: e48047. CrossRef

Self-rated health as a predictor of mortality according to cognitive impairment: findings from the Korean Longitudinal Study of Aging (2006-2016): Goun Park, Wankyo Chung; Epidemiol Health. 2021;43:e2021021. Published online April 7, 2021; DOI: https://doi.org/10.4178/epih.e2021021

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Self-rated health is an instrumental variable to assess the overall health status of a population. However, it remains questionable whether it is still useful for cognitively impaired individuals. Therefore, this study aims to analyze whether self-rated health by the cognitively impaired predicts mortality reliably.

METHODS

This study used 7,881 community-dwelling individuals, aged 45 and above, from the Korean Longitudinal Study of Aging (2006-2016). It used the Cox proportional hazard models for analysis. Cognitive status was classified based on the Korean Mini Mental State Examination score and a stratified analysis was used to determine whether the predictability of self-rated health varies according to cognitive status.

RESULTS

For cognitively intact individuals, the adjusted hazard ratios (aHR) of mortality were 2.00 (95% confidence interval [CI], 1.18 to 3.41, model 4) for those with ‘bad’ self-rated health and 2.40 (95% CI, 1.35 to 4.25, model 4) for those with ‘very bad’ self-rated heath, respectively, compared with those with ‘very good’ health. The results remain statistically significant even after adjusting for socio-demographic factors, health status, and health-related behaviors. For cognitively impaired individuals, the aHR of mortality was statistically significant for those with ‘very bad’ self-rated health, compared with those with ‘very good’ health, when socio-demographic factors were accounted for (aHR, 3.03; 95% CI, 1.11 to 8.28, model 2).

CONCLUSIONS

Self-rated health by cognitively impaired individuals remains useful in predicting mortality. It appears to be a valid and reliable health indicator for the rising population with cognitive impairment, especially caused by aging population.

Summary

Korean summary
본 연구는 인지 저하 여부에 따라 주관적 건강의 사망예측력이 달라지는지 확인하기 위해 K-MMSE 로 인지 저하 여부를 나누고 콕스 비례위험모델을 사용하여 분석을 시행하였다. 그 결과, 인지 저하군이 평가한 주관적 건강은 사망을 통계적으로 유의하게 예측하였다. 인구의 고령화로 지역 사회 내에서 인지 저하자가 지속적으로 증가하고 있는 상황에서 주관적 건강은 유효한 사망예측 인자이며 신뢰할 만한 건강지표이다.

Key Message
This study aims to analyze whether self-rated health by the cognitively impaired predicts mortality reliably. We used the Cox proportional hazard models for analysis. Cognitive status was classified based on the K-MMSE score. We found that self-rated health by cognitively impaired individuals remains useful in predicting mortality.

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Renal hyperfiltration, fatty liver index, and the hazards of all-cause and cardiovascular mortality in Finnish men: Mounir Ould Setti, Ari Voutilainen, Tomi-Pekka Tuomainen; Epidemiol Health. 2021;43:e2021001. Published online December 24, 2020; DOI: https://doi.org/10.4178/epih.e2021001

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380 Download
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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Renal hyperfiltration (RHF) and fatty liver are separately associated with adverse health outcomes. In this study, we investigated the mortality hazard of coexisting RHF and fatty liver.

METHODS

Middle-aged men from the Kuopio Ischaemic Disease Risk Factor Study (n=1,552) were followed up for a median of 29 years. Associations among RHF, fatty liver index (FLI) score, age, body mass index, smoking status, alcohol consumption, and hypertension status were assessed using logistic regression. Cox proportional hazards models were used to determine the hazard ratios (HRs) for all-cause and cardiovascular disease (CVD) mortality with respect to RHF and fatty liver.

RESULTS

Of the men, 5% had RHF (n=73), whereas a majority had fatty liver (n=848). RHF was associated specifically with smoking, and fatty liver was associated specifically with overweight. The all-cause mortality hazard was highest (HR, 1.96; 95% confidence interval [CI], 1.27 to 3.01) among men with RHF and fatty liver (n=33). Among men with RHF but normal FLI (n=40), the HR of all-cause mortality was 1.67 (95% CI, 1.15 to 2.42). Among men with fatty liver but a normal estimated glomerular filtration rate (n=527), the HR of all-cause mortality was 1.35 (95% CI, 1.09 to 1.66). CVD mortality hazard was associated with RHF, but not fatty liver. We detected no interaction effect between RHF and fatty liver for all-cause (synergy index, 0.74; 95% CI, 0.21 to 2.67) or CVD (synergy index, 0.94; 95% CI, 0.34 to 2.60) mortality.

CONCLUSIONS

RHF and fatty liver are independently associated with all-cause and CVD mortality

Summary

Key Message
Both prevalent, underdiagnosed, and commonly coexisting, renal hyperfiltration and fatty liver are two notable independent risk factors of all-cause and cardiovascular disease mortality.

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Incidence and mortality of cervical cancer in Vietnam and Korea (1999-2017): Kim Ngoc Tran, Yoon Park, Byung-Woo Kim, Jin-Kyoung Oh, Moran Ki; Epidemiol Health. 2020;42:e2020075. Published online December 16, 2020; DOI: https://doi.org/10.4178/epih.e2020075

26,608 View
327 Download
14 Web of Science
11 Crossref

Abstract Summary PDF

Abstract

OBJECTIVES
Cervical cancer is a major disease burden in Vietnam. This study aimed to estimate the incidence and mortality rates of cervical cancer in Vietnam (1999-2017) in comparison to those in Korea, where a population-based cancer registry and national cervical cancer screening program have been implemented.

METHODS

The estimated incidence and mortality of cervical cancer in Vietnam and Korea (1999-2017) were collected from Global Burden of Disease 2017 study. Estimated age-standardized rates (ASRs) in both countries were calculated utilizing the 1999-2017 population of each country and the World Health Organization standard population. The reported ASRs in Korea were also computed using data on incidence and mortality (1999-2017) and the Korean population from the Korea Statistical Information Service.

RESULTS

In Vietnam, the estimated incidence and mortality of cervical cancer decreased annually by 0.84% and 1.01%. In Korea, the trend of reported incidence showed a dramatic drop (1999-2007 annual percent change [APC], -4.53%) before stably declining (2007-2017 APC, -2.71%). Reported mortality also significantly decreased (2003-2008 APC, -6.63%), and then maintained a stable decline (2008-2017 APC, -3.78%). The incidence and mortality rates were higher in Vietnam than in Korea. The declining trend of incidence and mortality in Vietnam was slower than the corresponding trends in Korea.

CONCLUSIONS

A national screening program should be implemented for Vietnamese women aged over 30 to maintain, or even hasten, the decline in cervical cancer incidence and mortality. A population-based cancer registry may help monitor the effectiveness of a cervical cancer screening program.

Summary

Korean summary
국가 암 등록 체계와 국가 암 검진 프로그램이 아직 마련되지 않은 베트남에서 자궁경부암에 대한 질병부담을 줄일 수 있는 방향성을 제시하고자, 한국의 암 관리 현황과 질병부담을 비교한 연구입니다. 국가 암 등록자료를 구축하고 자궁경부암에 대한 국가 암 검진 프로그램을 도입한 한국과 베트남의 자궁경부암 발생률과 사망률 추이를 비교함으로 베트남에서도 체계적인 암 관리와 예방의 필요성을 강조하고자 한 연구입니다.

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N-Acetyl-L-Cysteine Reduces Cervical Carcinogenesis by Promoting Apoptosis
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Drugs in R&D.2023; 23(2): 165. CrossRef
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