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Review Paper
Beyond cohort versus case-control: the primacy of exposure assessment over study design in occupational cancer epidemiology
Yangwoo Kim, Dong-Uk Park
Epidemiol Health. 2026;48:e2026026.   Published online June 8, 2026
DOI: https://doi.org/10.4178/epih.e2026026
  • 3,088 View
  • 57 Download
AbstractAbstract AbstractSummary PDF
Abstract
In occupational cancer epidemiology, prospective cohort studies are conventionally ranked above case-control studies. However, exposure assessment quality—central to occupational risk estimation—receives less methodological attention than study design. This review argues that divergent cohort and case-control risk estimates reflect exposure assessment limitations rather than study design. Three findings support this. First, variance decomposition demonstrates that group-level exposure assignment attenuates effect estimates by a reliability ratio approaching zero as within-worker variability becomes dominant. Second, Berkson error in job-exposure matrices, combined with model non-linearity, biases estimates toward the null. Third, the healthy worker effect, immortal time bias, and left truncation compound misclassification and shift cohort estimates further toward the null. Two case studies illustrate this pattern. For night shift work and breast cancer, the case-control odds ratio (OR) of 1.34 contrasted with the cohort relative risk (RR) of 0.98; at 30 years’ cumulative exposure, these estimates were 1.88 and 1.13. For welding fumes and lung cancer, the pooled cohort RR of 1.29 contrasted with a case-control OR of 1.87; Sørensen’s cohort, using individual breathing-zone measurements, recovered a hazard rate ratio of 2.34 at the highest cumulative exposure. Thus, an occupational cancer study’s inferential value depends on its exposure assessment method rather than its design label. Group-level assignment attenuates effect estimates and may compromise etiological inference regardless of nominal design. Individual exposure reconstruction—through occupational interviews, industrial hygiene assessment, or personal monitoring—supports precise dose-response estimation. Quality assessment tools and meta-analyses should stratify evidence by exposure assessment method rather than design label.
Summary
Korean summary
본 연구에서는 직업성 암 역학 연구에서 코호트 연구, 환자-대조군 연구 등 역학 연구 설계보다 노출평가의 질이 효과 추정의 정확성을 좌우한다고 주장하고자 한다. 직업명이나 직무노출매트릭스와 같은 집단수준 노출 할당은 측정오차와 구조적 편향이 결합되어 연관성을 영가설 방향으로 약화시킬 수 있는 반면, 개인수준에서의 노출 측정과 그에 따른 노출 재구성은 용량-반응 관계를 더 잘 포착할 수 있다. 따라서 직업성 암 역학 연구에서 코호트와 환자-대조군 연구의 근거를 평가하거나 메타분석 연구를 진행할 때에는 역학 연구 설계를 다루는 것에만 머무르지 않고 노출평가 방법과 그 정밀도에 따라 층화하는 연구 방법론의 정립이 필요하다.
Key Message
For occupational carcinogens with long latency, group-level exposure assignment in prospective cohort studies systemati- cally attenuates risk estimates. Regulatory and quality-assessment frameworks should evaluate studies by the precision of their exposure information—distinguishing individual-level reconstruction from group-level assignment—rather than by their nominal design label. Null findings from cohorts relying on job-title classification warrant caution due to this systematic attenuation.
Original Article
Estimated trends in hospitalizations due to occupational injuries in Korea based on the Korean National Hospital Discharge In-depth Injury Survey (2006-2019)
Seong-Uk Baek, Won-Tae Lee, Min-Seok Kim, Myeong-Hun Lim, Jin-Ha Yoon
Epidemiol Health. 2023;45:e2023042.   Published online April 5, 2023
DOI: https://doi.org/10.4178/epih.e2023042
  • 20,733 View
  • 162 Download
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
In recent years, occupational injuries have sparked a huge social and political debate. Thus, in this study, we focused on the characteristics and trends of occupational injuries requiring hospitalization in Korea.
METHODS
The Korea National Hospital Discharge In-depth Injury Survey was designed to estimate the annual number and characteristics of all injury-related hospitalizations in Korea. The annual number of hospitalizations due to occupational injuries and the age-standardized rates (ASRs) were estimated from 2006 to 2019. The annual percentage change (APC) and average annual percentage change (AAPC) of ASRs and their 95% confidence intervals (CIs) were calculated using joinpoint regression. All analyses were stratified by gender.
RESULTS
In men, the APC of the ASRs of all-cause occupational injuries was -3.1% (95% CI, -4.5 to -1.7) in 2006-2015. However, a non-significant upward trend was observed after 2015 (APC, 3.3%; 95% CI, -1.6 to 8.5). In women, the APC of all-cause occupational injuries was -8.6% (95% CI, -12.1 to -5.1) in 2006-2012. However, a non-significant upward trend was observed after 2012 (APC, 2.1%; 95% CI, -0.9 to 5.2). A recent upward trend in stabbing injuries was observed after 2012 (APC, 4.7%; 95% CI, -1.8 to 11.8) in women. A non-significant overall increasing trend was also observed for occupational injuries caused by exposure to extreme temperatures (AAPC, 3.7%; 95% CI, -1.1 to 8.7) in women.
CONCLUSIONS
A recent upward trend in all-cause injury hospitalizations and hospitalizations caused by stabbing injuries was observed. Therefore, active policy interventions are required to prevent occupational injuries.
Summary
Korean summary
본 연구는 퇴원환자 심층조사를 사용하여 2006년부터 2019년까지 우리나라에서 발생한 업무상 손상의 추세를 연령표준화발생률을 구함으로써 분석하였다. 남녀 모두에서 2010년대 초반 까지는 발생률이 유의하게 감소하는 추세를 보였지만, 2013-2015년 이후부터는 통계적으로 유의하지 않은 점진적 상승 추세가 관찰되었다. 이러한 연구 결과는 업무상 손상을 예방하기 위해 적극적인 정책적 개입이 필요하다는 것을 시사한다.
Key Message
This study analyzed the trends in work-related injury occurrences in South Korea from 2006 to 2019 based on a nationally representative, repeated cross-sectional dataset. Age-standardized rates were calculated and their annual trend was estimated using a JointPoint regression. While both males and females exhibited a significant decline in occupational injury rates until the early 2010s, a non-significant but gradual upward trend has been observed since 2013-2015. These findings underscore the need for active policy interventions to prevent work.

Citations

Citations to this article as recorded by  
  • Factors Affecting Mortality and Distribution of Co-morbidities in Chronic Obstructive Pulmonary Disease
    Sung-Soo Kim
    Journal of Health Informatics and Statistics.2024; 49(1): 35.     CrossRef
COVID-19: Perspective
Prevention of exposure to and spread of COVID-19 using air purifiers: challenges and concerns
Seunghon Ham
Epidemiol Health. 2020;42:e2020027.   Published online April 17, 2020
DOI: https://doi.org/10.4178/epih.e2020027
  • 40,682 View
  • 1,378 Download
  • 33 Web of Science
  • 29 Crossref
AbstractAbstract PDF
Abstract
Coronavirus disease 2019 (COVID-19) is now a pandemic. The Korean government has declared a red alert, which is the highest level of the national infectious disease alert system, and the World Health Organization has similarly declared its highest-level pandemic alert (phase 6). The spread of COVID-19 is an unprecedented worldwide public health problem that governments and individuals must work to overcome. Recently, an infection cluster arose in a call center in Seoul. To support call center companies, the Korean Ministry of Employment and Labor has proposed covering the costs of installing partitions and air purifiers, providing hand sanitizers, and supplying masks to prevent droplet and aerosol infections. Air purifiers are expected to be installed on the floor with the exhaust outlets at a higher level, such as the level of the desks or breathing zones of workers. When a worker coughs or releases droplets near a colleague’s respiratory system, the droplets may spread throughout the call center via air flow from air purifier. In this fashion, a single infected person can give rise to an infection cluster. Attempts to prevent infection must not lead to new infections, and the installation of air purifiers may cause new problems. Therefore, using air purifiers to control the spread of COVID-19 should be approached with caution.
Summary

Citations

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    J. Dinesh Peter, D. Raveena Judie Dolly, D. J. Jagannath, S. Allen Livingston
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    Processes.2024; 12(9): 1917.     CrossRef
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    Atmosphere.2023; 14(10): 1520.     CrossRef
  • Portable Air Purifiers’ Predicted Efficacy in Mitigating Airborne Pathogen Transmission in an Office Room Featuring Mixing Ventilation
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    Fluids.2023; 8(12): 307.     CrossRef
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    Neurogastroenterology & Motility.2022;[Epub]     CrossRef
  • COVID-19 and Air purifiers Use
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    International Journal of Preventive Medicine.2022;[Epub]     CrossRef
  • Transforming healthcare through a digital revolution: A review of digital healthcare technologies and solutions
    Nithesh Naik, B. M. Zeeshan Hameed, Nilakshman Sooriyaperakasam, Shankeeth Vinayahalingam, Vathsala Patil, Komal Smriti, Janhavi Saxena, Milap Shah, Sufyan Ibrahim, Anshuman Singh, Hadis Karimi, Karthickeyan Naganathan, Dasharathraj K. Shetty, Bhavan Pras
    Frontiers in Digital Health.2022;[Epub]     CrossRef
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    Sustainability.2022; 14(18): 11281.     CrossRef
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    Materials Today.2022; 60: 201.     CrossRef
  • SARS-CoV-2 airborne transmission: a review of risk factors and possible preventative measures using air purifiers
    Mahshab Sheraz, Kaleem Anwar Mir, Ali Anus, Van Cam Thi Le, Seungdo Kim, Van Quyet Nguyen, Woo Ram Lee
    Environmental Science: Processes & Impacts.2022; 24(12): 2191.     CrossRef
  • Influenza and Influenza Vaccine: A Review
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    Journal of Midwifery & Women's Health.2021; 66(1): 45.     CrossRef
  • Airborne transmission of virus-laden aerosols inside a music classroom: Effects of portable purifiers and aerosol injection rates
    Sai Ranjeet Narayanan, Suo Yang
    Physics of Fluids.2021;[Epub]     CrossRef
  • Application of Portable Air Purifiers for Mitigating COVID-19 in Large Public Spaces
    Zhiqiang (John) Zhai, He Li, Robert Bahl, Keith Trace
    Buildings.2021; 11(8): 329.     CrossRef
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    Noelia Araújo-Vila, Jose A. Fraiz-Brea, Alexandra Matos Pereira
    Sustainability.2021; 13(15): 8449.     CrossRef
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    Ki Joon Heo, Inyong Park, Gunhee Lee, Keejung Hong, Bangwoo Han, Jae Hee Jung, Sang Bok Kim
    International Journal of Environmental Research and Public Health.2021; 18(16): 8426.     CrossRef
  • Improved estimates of 222 nm far-UVC susceptibility for aerosolized human coronavirus via a validated high-fidelity coupled radiation-CFD code
    Andrew G. Buchan, Liang Yang, David Welch, David J. Brenner, Kirk D. Atkinson
    Scientific Reports.2021;[Epub]     CrossRef
  • Genomic Variations in the Structural Proteins of SARS-CoV-2 and Their Deleterious Impact on Pathogenesis: A Comparative Genomics Approach
    Taj Mohammad, Arunabh Choudhury, Insan Habib, Purva Asrani, Yash Mathur, Mohd Umair, Farah Anjum, Alaa Shafie, Dharmendra Kumar Yadav, Md. Imtaiyaz Hassan
    Frontiers in Cellular and Infection Microbiology.2021;[Epub]     CrossRef
  • Reducing indoor particle exposure using mobile air purifiers—Experimental and numerical analysis
    Adrian Tobisch, Lukas Springsklee, Lisa-Franziska Schäfer, Nico Sussmann, Martin J. Lehmann, Frederik Weis, Raoul Zöllner, Jennifer Niessner
    AIP Advances.2021;[Epub]     CrossRef
  • The CO2 assessment in a school classroom for an optimal natural ventilation strategy = The CO2 assessment in a school classroom for an optimal natural ventilation strategy
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    Building & Management.2021; 5(3): 29.     CrossRef
  • Practical Mitigation Strategies for Countering the Spread of Aerosolized COVID-19 Virus (SARS-CoV-2) Using Ventilation and HEPA Air Purifiers: A Literature Review
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    Journal of Geoscience and Environment Protection.2021; 09(09): 166.     CrossRef
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    Cochrane Database of Systematic Reviews.2020;[Epub]     CrossRef
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    Cochrane Database of Systematic Reviews.2020;[Epub]     CrossRef
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    Journal of the Taiwan Institute of Chemical Engineers.2020; 116: 67.     CrossRef
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