Epidemiology and Health

Original Articles

Association of group-level segregation with cardiovascular health in older adults: an analysis of data from the Korean Social Life, Health, and Aging Project: Sung-Ha Lee, Hyeok-Hee Lee, Kiho Sung, Yoosik Youm, Hyeon Chang Kim; Epidemiol Health. 2023;45:e2023041. Published online April 4, 2023; DOI: https://doi.org/10.4178/epih.e2023041

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Abstract Summary PDF: Abstract
OBJECTIVES
The adverse health effects of individual-level social isolation (e.g., perceived loneliness) have been well documented in older adults. However, little is known about the impact of collective-level social isolation on health outcomes. We sought to examine the association of group-level segregation with cardiovascular health (CVH) in older adults.
METHODS
From the prospective Korean Social Life, Health, and Aging Project database, we identified 528 community-dwelling older adults who were aged ≥60 years or were married to those aged ≥60 years. Participants who belonged to smaller social groups separate from the major social group were defined as group-level-segregated. The CVH score was calculated as the number of ideal non-dietary CVH metrics (0-6), as modified from the American Heart Association’s Life’s Simple 7. Using ordinal logistic regression models, we assessed cross-sectional and longitudinal associations between group-level segregation and CVH.
RESULTS
Of the 528 participants (mean age, 71.7 years; 60.0% female), 108 (20.5%) were segregated at baseline. In the crosssectional analysis, group-level segregation was significantly associated with lower odds of having a higher CVH score at baseline after adjusting for socio-demographic factors and cognitive function (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.43 to 0.95). Among 274 participants who completed an 8-year follow-up, group-level segregation at baseline was marginally associated with lower odds of having a higher CVH score at 8 years (OR, 0.49; 95% CI, 0.24 to 1.02).
CONCLUSIONS
Group-level segregation was associated with worse CVH. These findings imply that the social network structure of a community may influence its members’ health status.; Summary

Korean summary
본 연구는 “한국인의 사회적 삶, 건강과 노화에 대한 조사”(Korean Social Life, Health and Aging Project, KSHAP)에서 측정한 한 지역 내의 사회적 연결망 자료를 이용하여 사회적 분리와 심혈관 건강 사이의 관계를 살펴보았다. 그 결과, 사회적 분리는 비만, 고혈압, 콜레스테롤, 흡연, 음주 신체적 활동 등을 종합한 ‘라이프 심플 7’ 지표와 부정적인 관련성을 보였으며, 8년 후 추적 조사에서도 이 패턴이 유지되었다. 본 연구 결과는 사회적, 집단적 분리 현상이 신체적 건강에도 악영향을 초래할 수 있음을 시사한다.

Key Message
Using the prospective Korean Social Life, Health, and Aging Project (KSHAP) database, we discovered that group-level segregation was significantly associated with worse cardiovascular health (CVH). Also, we observed a tendency for baseline group-level segregation to be linked to worse CVH after an 8-year follow-up period. These findings emphasize the significance of group-level segregation as a potential contributing factor in the health outcomes of older adults.

Clinical traits and systemic risks of familial diabetes mellitus according to age of onset and quantity: an analysis of data from the community-based KoGES cohort study: Ju-Yeun Lee, Kyungsik Kim, Sangjun Lee, Woo Ju An, Sue K. Park; Epidemiol Health. 2023;45:e2023029. Published online February 23, 2023; DOI: https://doi.org/10.4178/epih.e2023029

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
The aim of this study was to clarify the clinical trait of familial diabetes mellitus (DM) by analyzing participants’ risk of DM according to the age of DM onset in parents and siblings, and to evaluate individuals’ risk of DM-associated cardiometabolic diseases.
METHODS
Altogether, 211,173 participants aged ≥40 years from the Korean Genome and Epidemiology Study were included in this study. The participants were divided into groups based on the number (1 or 2 relatives) and age of onset (no DM and early, common, or late onset) of familial DM. Participants’ risk of DM was assessed using a Cox regression model with hazard ratios and 95% confidence intervals (CIs). A logistic regression model with odds ratios was used to evaluate associations among the participants’ likelihood of acquiring cardiometabolic diseases such as hypertension, chronic kidney disease (CKD), and cardiovascular disease.
RESULTS
The risk of developing DM was 2.02-fold (95% CI, 1.88 to 2.18) and 2.88-fold (95% CI, 2.50 to 3.33) higher, respectively, in participants with 1 and 2 family members diagnosed with familial DM. It was 2.72-fold (95% CI, 2.03 to 3.66) higher in those with early-onset familial DM. In the early-onset group, the respective risks of hypertension and CKD were 1.87-fold (95% CI, 1.37 to 2.55) and 4.31-fold (95% CI, 2.55 to 7.27) higher than in the control group.
CONCLUSIONS
The risk of DM and related cardiometabolic diseases was positively associated with the number of family members diagnosed with DM and an early diagnosis in family members with DM.; Summary

Korean summary
본 연구는 한국인유전체역학조사사업 역학자료를 이용하여, 당뇨병을 진단받은 가족 구성원 (부모 및 형제)의 수가 많고 당뇨병이 조기에 발생할수록 개인의 당뇨발생 위험도가 높아짐을 보고하였습니다. 또한 당뇨병이 조기에 발생한 가족구성원이 있을 경우 개인의 일부 심대사질환과의 연관성이 있을 수 있음을 설명하였습니다.

Key Message
This study demonstrated that the risk of diabetes in individuals was significantly associated with the quantity and the onset of family members diagnosed with diabetes. We also explained that having a family member with early-onset diabetes can be associated with some cardiometabolic diseases in individuals.

Nationwide trends in the incidence of tuberculosis among people with disabilities in Korea: a nationwide serial cross-sectional study: Jinsoo Min, So Young Kim, Jong Eun Park, Yeon Yong Kim, Jong Hyock Park; Epidemiol Health. 2022;44:e2022098. Published online October 28, 2022; DOI: https://doi.org/10.4178/epih.e2022098

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OBJECTIVES
Studies on the association between disabilities and tuberculosis (TB) are scarce. We aimed to assess the risk of active TB disease among people with disabilities.
METHODS
We conducted a nationwide serial cross-sectional study using national registry linkage databases from 2008 to 2017. The crude and age-standardized and sex-standardized incidence rates of TB were analyzed for each year according to the presence, type, and severity of disabilities. The crude incidence rate and odds of developing TB disease were examined with a multivariable logistic regression model using data from 2017.
RESULTS
The overall incidence of active TB decreased between 2008 and 2017. The age- and sex-standardized incidence rates of TB disease among people with disabilities were significantly higher than among those without disabilities throughout all observed years (p<0.001). As of 2017, the population with disabilities had a higher crude incidence rate of active TB disease than that without disabilities (119.9/100,000 vs. 48.5/100,000 person-years, p<0.001), regardless of sex, income level, and place of residence. Compared to those without disabilities, those with disabilities had higher odds of active TB (adjusted odds ratio [aOR], 1.19; 95% confidence interval [CI], 1.15 to 1.24). Individuals with mental disabilities (aOR, 1.51; 95% CI, 1.24 to1.84) had the highest odds of active TB incidence, followed by those with developmental disabilities (aOR, 1.30; 95% CI, 1.09 to 1.55).
CONCLUSIONS
People with disabilities are at a greater risk of developing TB disease. Active screening and care for TB cases would be beneficial for people with disabilities.; Summary

Korean summary
장애가 있는 사람은 이차적 건강 문제가 발생할 가능성이 더 높고 그들의 건강결정요인은 결핵 발생 위험 요인과 겹친다. 장애인은 비장애인에 비해 연령과 성별에 관계없이 활동성 결핵 발병률이 현저히 높았으며, 장애 유형 중 정신장애와 발달장애가 결핵에 더 취약한 것으로 나타났다. 장애인과 같이 결핵 감염 위험이 있는 취약계층을 파악하고 이들에게 결핵진단 및 항결핵치료의 어려움을 극복할 수 있도록 다학제적 지원을 제공하는 것이 중요하겠다.

Key Message
People with disabilities are more likely to develop secondary health conditions and their social determinants of health overlap with the risk factors for developing TB disease. We found that compared to people without disabilities, a markedly higher incidence of active TB disease among people with disabilities regardless of age and sex, and mental and developmental disabilities among types of disability were more prone to TB disease. It is critical to identify the vulnerable populations, such as people with disabilities, at risk of developing TB infection and provide them with multidisciplinary support to overcome any barriers during TB diagnosis and anti-TB treatment.

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.

Local-level spatiotemporal dynamics of COVID-19 transmission in the Greater Seoul Area, Korea: a view from a Bayesian perspective: Youngbin Lym, Hyobin Lym, Ki-Jung Kim; Epidemiol Health. 2022;44:e2022016. Published online January 13, 2022; DOI: https://doi.org/10.4178/epih.e2022016

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Abstract Summary PDF: Abstract
OBJECTIVES
The purpose of this study was to enhance the understanding of the local-level spatiotemporal dynamics of COVID-19 transmission in the Greater Seoul Area (GSA), Korea, after its initial outbreak in January 2020.
METHODS
Using the weekly aggregates of coronavirus disease 2019 (COVID-19) cases of 77 municipalities in the GSA, we examined the relative risks of COVID-19 infection across local districts over 50 consecutive weeks in 2020. To this end, we employed a spatiotemporal generalized linear mixed model under the hierarchical Bayesian framework. This allowed us to empirically examine the random effects of spatial alignments, temporal autocorrelation, and spatiotemporal interaction, along with fixed effects. Specifically, we utilized the conditional autoregressive and the weakly informative penalized complexity priors for hyperparameters of the random effects.
RESULTS
Spatiotemporal interaction dominated the overall variability of random influences, followed by spatial correlation, whereas the temporal correlation appeared to be small. Considering these findings, we present dynamic changes in the spread of COVID-19 across local municipalities in the GSA as well as regions at elevated risk for further policy intervention.
CONCLUSIONS
The outcomes of this study can contribute to advancing our understanding of the local-level COVID-19 spread dynamics within densely populated regions in Korea throughout 2020 from a different perspective, and will contribute to the development of regional safety planning against infectious diseases.; Summary

Korean summary
본 논문은 수도권 지역에서 코로나바이러스가 처음 발생한 2020년 1월 이후 12월 말까지 총 50주 동안 수도권 내 지자체 수준에서의 코로나 19 전염병에 대한 시공간적 확산 역동성을 파악하기 위한 연구이다. 데이터 기반의 실증분석을 위한 계층적 베이지언 기법 기반의 시공간 일반화 선형 혼합모형의 결과에 따르면, 확률효과 중 시공간적 상호작용의 영향성이 가장 크게 나타났고, 다음으로는 공간자기상관에 의한 영향 순으로 나타난 반면, 시간에 의한 확률효과는 상대적으로 적게 도출되었다. 연구의 결과를 종합하여, 본 연구에서는 지도 기반의 코로나 19 위험 및 그 위험의 시공간적 변화를 제시하고, 향후 전염병에 대한 정책대응에 활용될 수 있도록 하였다.

Key Message
This study investigates the local-level spatiotemporal dynamics of COVID-19 transmission in the Greater Seoul Area, Korea, after its initial outbreak in January 2020. We adopt a flexible hierarchical Bayesian method so as to account for latent influences of space and time along with the fixed effects by covariates. The results suggest that spatiotemporal interaction dominates the overall variability of random influences, followed by spatial correlation, while the temporal effect appears to be small. Based on these findings, we present maps that depict dynamic changes of COVID-19 infection as well as regions of elevated risks for further policy consideration.

The predictive value of resting heart rate in identifying undiagnosed diabetes in Korean adults: Korea National Health and Nutrition Examination Survey: Dong-Hyuk Park, Wonhee Cho, Yong-Ho Lee, Sun Ha Jee, Justin Y. Jeon; Epidemiol Health. 2022;44:e2022009. Published online January 3, 2022; DOI: https://doi.org/10.4178/epih.e2022009

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
The purpose of this study was (1) to examine whether the addition of resting heart rate (RHR) to the existing undiagnosed diabetes mellitus (UnDM) prediction model would improve predictability, and (2) to develop and validate UnDM prediction models by using only easily assessable variables such as gender, RHR, age, and waist circumference (WC).
METHODS
Korea National Health and Nutrition Examination Survey (KNHANES) 2010, 2012, 2014, 2016 data were used to develop the model (model building set, n=19,675), while the data from 2011, 2013, 2015, 2017 were used to validate the model (validation set, n=19,917). UnDM was defined as a fasting glucose level ≥126 mg/dL or glycated hemoglobin ≥6.5%; however, doctors have not diagnosed it. Statistical package for the social sciences logistic regression analysis was used to determine the predictors of UnDM.
RESULTS
RHR, age, and WC were associated with UnDM. When RHR was added to the existing model, sensitivity was reduced (86 vs. 73%), specificity was increased (49 vs. 65%), and a higher Youden index (35 vs. 38) was expressed. When only gender, RHR, age, and WC were used in the model, a sensitivity, specificity, and Youden index of 70%, 67%, and 37, respectively, were observed.
CONCLUSIONS
Adding RHR to the existing UnDM prediction model improved specificity and the Youden index. Furthermore, when the prediction model only used gender, RHR, age, and WC, the outcomes were not inferior to those of the existing prediction model.; Summary

Korean summary
당뇨병 미인지 또는 미진단은 적절한 치료 시작 시기를 늦추고 당뇨병 합병증 발생의 위험을 높이기 때문에, 각국은 당뇨병 예측 모형을 개발하여 당뇨병을 조기에 예측하고, 치료 시기를 앞당기기 위해 노력하고 있다. 본 연구는 기존의 한국인 당뇨병 예측 모형에 안정시심박수를 추가 변수로 포함시켜, 예측 모형의 성능이 일부개선되는 것을 확인하였고, 더 나아가 나이, 허리 둘레, 그리고 안정시심박수를 포함하여 예측 모형을 개발하고, 그 성능을 확인하였다. 본 연구에서는 간단하게 측정이 가능한 허리 둘레와 안정시심박수 그리고 나이만 포함한 예측 모형이 기존의 예측 모형과 비교해 성능이 열등하지 않은 것을 확인하였다.

Key Message
Higher RHR is associated with increased risk of diabetes. When RHR is added to the Korean undiagnosed diabetes risk score model (Age, Family history of diabetes, Hypertension, Waist circumference, Smoking, Alcohol consumption), the model somewhat increased its predictability of undiagnosed diabetes. Furthermore, the prediction model developed only using age, waist circumference and RHR, which anyone can easily measure or access, had similar predictability to the previous undiagnosed diabetes risk prediction model. The results of this study may help develop future strategies or applications for predicting early undiagnosed diabetes.

Late eating, blood pressure control, and cardiometabolic risk factors among adults with hypertension: results from the Korea National Health and Nutrition Examination Survey 2010-2018: Jee-Seon Shim, Hyeon Chang Kim; Epidemiol Health. 2021;43:e2021101. Published online November 24, 2021; DOI: https://doi.org/10.4178/epih.e2021101

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Despite growing concerns regarding the timing of eating, little is known about the association between late eating and health. This study aimed to investigate whether late eating is associated with blood pressure (BP) control and cardiometabolic risk factors among Korean adults with hypertension.
METHODS
Data from the Korea National Health and Nutrition Examination Survey 2010-2018 were used. Adults with hypertension aged 30-79 years (n=13,361) were included in this study. Dietary intake and information on meal timing were assessed using 1-day 24-hour recall. Late eating was defined as after the median midpoint between the times of the first and the last eating episode during the recall day. Logistic and linear regression models were used to estimate the associations of late eating with BP control and cardiometabolic risk factors.
RESULTS
Among late eaters, there were more men than women. Compared to early eaters, late eaters were younger, had a higher body mass index (BMI) and unhealthier habits, and their overall dietary quality score was lower. A negative association between late eating and BP control was found in a univariate model (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.94 to 1.12), but this association disappeared after adjustment for confounders (OR, 1.03; 95% CI, 0.94 to 1.12). Late eating was independently associated with higher BMI (p=0.03) and blood triglyceride concentration (p<0.01).
CONCLUSIONS
Our results do not support a link between late eating and BP control among adults with hypertension, but suggest that late eating is associated with cardiometabolic risk factors.; Summary

Korean summary
식사시간이 건강에 미치는 영향에 대한 관심이 증가하고 있지만, 이에 대한 근거는 많지 않다. 이 연구는 국민건강영양조사 자료를 활용하여 고혈압이 있는 성인의 늦은 식사와 혈압 조절, 심장대사 위험인자의 연관성을 분석하였다. 늦은 식사와 혈압 조절의 독립적 연관성은 찾지 못했지만, 늦은 식사는 높은 체질량지수, 혈중 지질 농도와 연관성을 보여 식사 시간 조정이 고혈압 환자의 예후 개선을 위한 유용한 대책이 될 수 있으리라는 근거를 지지한다.

Key Message
This study investigated whether late eating is associated with blood pressure (BP) control and cardiometabolic risk factors among Korean adults with hypertension using data from the Korea National Health and Nutrition Examination Survey 2010–2018. We did not find an independent association between late eating and BP control among Korean adults with hypertension, but found that late eating was significantly associated with higher BMI and a higher blood concentration of triglycerides, independent of potential confounders. Our findings support the suggestion that a time-based dietary approach can be used as a useful strategy to improve the prognosis of adults with hypertension.

Cohort Profile

The Dehgolan Prospective Cohort Study (DehPCS) on non-communicable diseases in a Kurdish community in the west of Iran: Farhad Moradpour, Ebrahim Ghaderi, Ghobad Moradi, Mojdeh Zarei, Amjad Mohamadi Bolbanabad, Bakhtiar Piroozi, Azad Shokri; Epidemiol Health. 2021;43:e2021075. Published online October 1, 2021; DOI: https://doi.org/10.4178/epih.e2021075

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Abstract

The Dehgolan Prospective Cohort Study (DehPCS) was conducted to examine and identify risk factors for the most prevalent non-communicable diseases (NCDs). In addition, in order to examine participants’ health status, socioeconomic status, behavioral factors, nutritional status, and environmental exposures, the DehPCS collected, analyzed, and stored blood, urine, nail, and hair samples to conduct genetic studies and identify biomarkers and other biological determinants of NCDs. In total, 3,996 adults aged 35 to 70 from the general population participated in the study from February 2018 to March 2019. Of them, 43.7% were women. The first follow-up wave was conducted with 3,995 participants. Information on a wide range of variables was collected, including on socioeconomic status, lifestyle, nutritional status, habits, physical examination findings, medication use, and medical history. Proxy variables such as body mass index, metabolic equivalent task score, wealth index, and macronutrients and micronutrients were calculated. The most common self-reported diseases in descending order were kidney stones, hypertension, and fatty liver. The prevalence of diabetes and hypertension was 9.3% and 33.4%, respectively. All data, samples, and measurements will be collected again at 5-year intervals. Thus, it will be possible to examine time-dependent changes in the risk factors of NCDs. The DehPCS can be used to study the relationships among genetics, lifestyle, socioeconomic status, and environmental risk factors and the most prevalent NCDs in case-cohort studies using a nested case-control design that will be applied to the cohort infrastructure. Researchers can also submit pre-proposals via the following web address: http://c.ddrc.ac.ir/persianaccess/Account/Login.

Summary

Korean summary

Key Message
• The DehPCS was designed to examine NCDs among the Kurdish population, who are located in a wide area between the northwest of the Zagros Mountains and the eastern Taurus Mountains covering Turkey, Iraq, Iran, and Syria. • In total, 3,996 adults aged 35 to 70 from the general population participated in the study. • All data, samples, and measurements from the registration phase will be collected again at 5-, 10-, and 15-year intervals. • After labeling, aliquots were placed in a freezer at -70°C to enable ongoing studies of the samples in the future.

Citations

Citations to this article as recorded by

Validity of self‐reported hypertension and related factors in the adult population: Preliminary results from the cohort in the west of Iran
Negar Piri, Yousef Moradi, Reza Ghanei Gheshlagh, Mahsa Abdullahi, Eghbal Fattahi, Farhad Moradpour
The Journal of Clinical Hypertension.2023; 25(2): 146. CrossRef
The association between nutrients and occurrence of COVID‐19 outcomes in the population of Western Iran: A cohort study
Dana Vaisi, Farhad Moradpour, Shadieh Mohammadi, Daem Roshani, Yousef Moradi
The Clinical Respiratory Journal.2023;[Epub] CrossRef
Socio-demographic correlates of diabetes self-reporting validity: a study on the adult Kurdish population
Farhad Moradpour, Negar Piri, Hojat Dehghanbanadaki, Ghobad Moradi, Mahdiyeh Fotouk-Kiai, Yousef Moradi
BMC Endocrine Disorders.2022;[Epub] CrossRef
Prevalence of prediabetes, diabetes, diabetes awareness, treatment, and its socioeconomic inequality in west of Iran
Farhad Moradpour, Satar Rezaei, Bakhtiar Piroozi, Ghobad Moradi, Yousef Moradi, Negar Piri, Azad Shokri
Scientific Reports.2022;[Epub] CrossRef

Original Articles

The classification capability of the Asia Pacific Colorectal Screening score in Korea: an analysis of the Cancer Screenee Cohort: Xuan Quy Luu, Kyeongmin Lee, Jeongseon Kim, Dae Kyung Sohn, Aesun Shin, Kui Son Choi; Epidemiol Health. 2021;43:e2021069. Published online September 16, 2021; DOI: https://doi.org/10.4178/epih.e2021069

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Abstract

OBJECTIVES
This study aimed to validate a simple risk assessment tool for estimating the advanced colorectal neoplasia (ACN) risk at colonoscopy screenings and potential factors relevant for implementing this tool in the Korean population.

METHODS

Our study analyzed data from the Cancer Screenee Cohort Study conducted by the National Cancer Center in Korea. The risk level was assessed using the Asia Pacific Colorectal Screening (APCS) score developed by the Asia-Pacific Working Group on Colorectal Cancer. Logistic regression models were used to examine the associations between colorectal-related outcomes and the risk level by APCS score. The discriminatory performance of the APCS score for various colorectal-related outcomes was assessed using C-statistics.

RESULTS

In 12,520 individuals, 317 ACN cases and 4,528 adenoma cases were found. The APCS tool successfully classified the study population into different risk groups, and significant differences in the ACN rate and other outcomes were observed. The APCS score demonstrated acceptable discrimination capability with area under the curve values ranging from 0.62 to 0.65 for various outcomes. The results of the multivariate logistic regression model revealed that the high-risk group had a 3.1-fold higher risk of ACN (95% confidence interval, 2.08 to 4.67) than the average-risk group. Body mass index (BMI) was identified as a significant predictor of ACN in both multivariate and subgroup analyses.

CONCLUSIONS

Our study highlighted significant differences in colorectal-related screening outcomes by colorectal risk level measured using the APCS score, and BMI could be used to improve the discriminatory capability of the APCS score.

Summary

Korean summary
검진의 위해성을 줄이면서 동시에 이득을 최대화할 수 있는 최적의 검진 프로그램은 암 발생 위험도를 고려하는 것이다. 이 연구는 Asia-Pacific Working Group on Colorectal Cancer에서 제안한 “Asia Pacific Colorectal Screening Score (APCS)”가 한국인에서 대장암 발생 위험도를 선별적으로 잘 구분해 낼 수 있음을 보여주었다. 나아가 대장암의 위험도 점수를 산출하는데 체질량지수가 중요한 예측 변수라는 것을 확인하였고, 한국인에서 대장암 발생 위험도의 변별력을 향상시키기 위해 기존의 APCS에 체질량지수를 추가할 것을 제안하였다.

Key Message
This study highlighted that the Asia Pacific Colorectal Screening Score by the Asia-Pacific Working Group on Colorectal Cancer could successfully classify Korean screenees into different risk groups with acceptable discriminatory capability. Furthermore, our study results also suggest that BMI is a significant predictor of colorectal-related health outcomes, which could be potentially added to the original APCS score for improving its discriminatory power.

Citations

Citations to this article as recorded by

A Comparison of Single and Combined Schemes of Asia-Pacific Colorectal Screening, Faecal Immunochemical and Stool Deoxyribonucleic Acid Testing for Community Colorectal Cancer Screening
Yuan Ze, Huiming Tu, Lin Zhang, Yu Bai, Yilin Ren, Xin Chen, Yuzheng Xue, Renjuan Sun, Yuling Yang, Jie Yang, Xuan Zhou, Li Liu
Journal of Multidisciplinary Healthcare.2023; Volume 16: 571. CrossRef
Advances in Screening Methods for Colorectal Cancer
碗宜张
Advances in Clinical Medicine.2023; 13(03): 2995. CrossRef
A scoping review of risk-stratified bowel screening: current evidence, future directions
J. M. Cairns, S. Greenley, O. Bamidele, D. Weller
Cancer Causes & Control.2022; 33(5): 653. CrossRef

Preventable causes of cancer in Texas by race/ethnicity: tobacco smoking: Franciska J. Gudenkauf, Aaron P. Thrift; Epidemiol Health. 2021;43:e2021046. Published online July 13, 2021; DOI: https://doi.org/10.4178/epih.e2021046

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Abstract PDF: Abstract
OBJECTIVES
Tobacco smoking is classified as carcinogenic to humans (International Agency for Research on Cancer Group 1). We aimed to estimate the percentage and number of incident cancer cases diagnosed in Texas in 2015 that were attributable to tobacco smoking, and we examined differences in the proportions of smoking-attributable cancers between the major racial/ethnic subgroups of the population.
METHODS
We calculated population-attributable fractions for cancers attributable to tobacco smoking using prevalence data from the Texas Behavioral Risk Factor Surveillance System and relative risks associated with smoking status from pooled analyses of cohort studies or meta-analyses. Cancer incidence data were collected from the Texas Cancer Registry.
RESULTS
We estimated that 19,000 excess cancer cases or 18.4% of all cancers diagnosed in 2015 in Texans aged ≥ 25 years were caused by tobacco smoking. Males had a higher overall proportion of cancers attributable to tobacco smoking than females (male, 23.3%, 11,993 excess cases; female, 13.5%, 7,006 cases). Approximately 20% of cancer cases in non-Hispanic Whites and non-Hispanic Blacks were attributable to tobacco smoking compared to 12.8% among Hispanics.
CONCLUSIONS
Despite ongoing public health campaigns combatting tobacco use, this preventable behavior still contributes significantly to cancer incidence in Texas. Racial/ethnic differences in smoking prevalence and smoking-attributable cancer incidence should be considered when designing cancer prevention programs.; Summary

Korean summary

Key Message
Tobacco smoking remains a major contributor to cancer burden in the United States, particularly among men, non-Hispanic whites and non-Hispanic Blacks due to historically higher smoking rates.

Cohort Profile

Cohort profile: the Ewha Birth and Growth Study: Hye Ah Lee, Bohyun Park, Jungwon Min, Eun Jeong Choi, Ui Jeong Kim, Hyun Jin Park, Eun Ae Park, Su Jin Cho, Hae Soon Kim, Hwayoung Lee, Young Ju Kim, Young Sun Hong, Eui-Jung Kim, Eun Hee Ha, Hyesook Park; Epidemiol Health. 2021;43:e2021016. Published online February 22, 2021; DOI: https://doi.org/10.4178/epih.e2021016

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9 Citations

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Abstract

With the introduction of life-course epidemiology, researchers realized the importance of identifying risk factors in early life to prevent chronic diseases. This led to the establishment of the Ewha Birth and Growth Study in 2001; the study is a prospective birth cohort designed to provide evidence of early life risk factors for a child’s growth and health. Participants were recruited from those who visited Ewha Womans University Mokdong Hospital (a tertiary hospital in southwest Seoul, Korea) for prenatal care at 24-28 weeks of gestation. In total, 891 mothers enrolled in this study between 2001 and 2006 and their offspring (n=940) were followed-up. Regular check-up examinations of offspring were conducted at 3 years, 5 years, and 7 years of age and every year thereafter. To consider age-related health issues, extensive data were collected using questionnaires and measurements. In 2021, the study subjects will reach 19 years of age, and we are planning a check-up examination for early adulthood. About 20 years have passed since the cohort data were collected, and we have published results on childhood health outcomes associated with prenatal and birth characteristics, genetic and epigenetic characteristics related to childhood metabolism, the effects of exposure to endocrine disruptors, and dietary patterns in childhood. Recently, we started reporting on topics related to adolescent health. The findings will facilitate identification of early life risk factors for chronic diseases and the development of interventions for diseases later in life.

Summary

Korean summary
이화영아성장코호트는 만성질환 예방을 위한 생애초기 위험인자에 대한 근거를 제공하기 위해 2001년에 시작되었습니다. 이화영아성장코호트는 국내에서 선도적인 장기 추적관찰 연구로, 소아기 건강과 관련된 산전 및 출생 시 특징, 소아기 대사와 관련된 유전적 혹은 후성학적 특성, 내분비 장애물질 노출에 따른 영향, 소아기의 식이패턴과 같은 다양한 연구결과들을 발표하였습니다. 추후 청년기의 자료 수집을 계획하고 있으며, 우리의 연구결과는 만성질환 예방을 위한 중재 개발에 기여할 것으로 기대됩니다.

Key Message
To provide evidence of early life risk factors for the prevention of chronic diseases, the Ewha Birth and Growth Study was started in 2001. The Ewha Birth and Growth cohort is a leading long-term follow-up study in Korea, and we have published results on childhood health outcomes associated with prenatal and birth characteristics, genetic and epigenetic characteristics related to childhood metabolism, the effects of exposure to endocrine disruptors, and dietary patterns in childhood. We are planning to collect data for early adulthood, and our findings will contribute to the development of interventions to prevent chronic diseases.

Citations

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Prospective association between phthalate exposure in childhood and liver function in adolescence: the Ewha Birth and Growth Cohort Study
Seonhwa Lee, Hye Ah Lee, Bohyun Park, Hyejin Han, Young Sun Hong, Eun Hee Ha, Hyesook Park
Environmental Health.2023;[Epub] CrossRef
BMI trajectory and inflammatory effects on metabolic syndrome in adolescents
Ui-Jeong Kim, Eun Jeong Choi, Hyunjin Park, Hye Ah Lee, Bohyun Park, Jungwon Min, Eun Ae Park, Su Jin Cho, Hae Soon Kim, Hwayoung Lee, Young Ju Kim, Young Sun Hong, Eun Hee Ha, Seungyoun Jung, Hyesook Park
Pediatric Research.2023;[Epub] CrossRef
The Effect of Childhood Obesity or Sarcopenic Obesity on Metabolic Syndrome Risk in Adolescence: The Ewha Birth and Growth Study
Hyunjin Park, Seunghee Jun, Hye-Ah Lee, Hae Soon Kim, Young Sun Hong, Hyesook Park
Metabolites.2023; 13(1): 133. CrossRef
Synergistic effect of serum uric acid and body mass index trajectories during middle to late childhood on elevation of liver enzymes in early adolescence: Findings from the Ewha Birth and Growth Study
Sung Hee Lee, Eun Jeong Choi, Ui Jeong Kim, Hyunjin Park, Bomi Park, Hye Ah Lee, Hyesook Park, Linglin Xie
PLOS ONE.2023; 18(4): e0282830. CrossRef
The association between urinary cotinine level and metabolic syndrome profiles among adolescents: findings from the Ewha Birth and growth study
Hyunjin Park, Ui-Jeong Kim, Eun Jeong Choi, Seunghee Jun, Bomi Park, Hye Ah Lee, Hae Soon Kim, Hyesook Park
BMC Public Health.2023;[Epub] CrossRef
The Mediating Effect of Inflammation between the Dietary and Health-Related Behaviors and Metabolic Syndrome in Adolescence
Ui-Jeong Kim, Eun-Jeong Choi, Hyunjin Park, Hye-Ah Lee, Bomi Park, Haesoon Kim, Youngsun Hong, Seungyoun Jung, Hyesook Park
Nutrients.2022; 14(11): 2339. CrossRef
Precision medicine via the integration of phenotype-genotype information in neonatal genome project
Xinran Dong, Tiantian Xiao, Bin Chen, Yulan Lu, Wenhao Zhou
Fundamental Research.2022; 2(6): 873. CrossRef
Association of participation in the Northern Finland Birth Cohort 1986 with mental disorders and suicidal behaviour
Martta Kerkelä, Mika Gissler, Juha Veijola
Epidemiology and Health.2022; 44: e2022005. CrossRef
Trajectory patterns for continuous metabolic syndrome score in childhood and the cardiovascular risk in adolescence
Eun Jeong Choi, Hye Ah Lee, Bomi Park, Bohyun Park, Hae Soon Kim, Young Sun Hong, Hyesook Park
Scientific Reports.2021;[Epub] CrossRef

Original Articles

Strongyloides stercoralis and other intestinal parasites in patients receiving immunosuppressive drugs in northern Iran: a closer look at risk factors: Leila Mirzaei, Keyhan Ashrafi, Zahra Atrkar Roushan, Mohammad Reza Mahmoudi, Irandokht Shenavar Masooleh, Behnaz Rahmati, Farshid Saadat, Hamed Mirjalali, Meysam Sharifdini; Epidemiol Health. 2021;43:e2021009. Published online January 20, 2021; DOI: https://doi.org/10.4178/epih.e2021009

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3 Citations

Abstract PDF

Abstract

OBJECTIVES
The objective of this study was to evaluate the prevalence of Strongyloides stercoralis and other intestinal parasites in patients receiving immunosuppressive drugs in northern Iran and to investigate related risk factors.

METHODS

This cross-sectional study was conducted among 494 patients receiving immunosuppressive drugs, including cancer patients undergoing chemotherapy (n=188) and those treated with prolonged corticosteroid administration (n=306). All fresh fecal samples were examined using the direct wet-mount, formalin ethyl acetate concentration, and agar plate culture techniques.

RESULTS

In total, 16.8% of patients were positive for at least 1 intestinal parasite; the helminthic and protozoan infection rates were 5.1% and 12.3%, respectively. The infection rate was significantly higher in corticosteroid-treated individuals (19.6%) than cancer patients (12.2%) (p<0.05). The prevalence rate of S. stercoralis among patients receiving chemotherapy and those treated with corticosteroids were 4.3% and 5.2%, respectively. The prevalence rate of S. stercoralis infection was significantly higher in older patients (p<0.05).

CONCLUSIONS

Strongyloidiasis is one of the most common parasites among patients receiving immunosuppressive drugs in northern Iran. Early diagnosis and proper treatment of these patients are necessary to minimize the complications of severe strongyloidiasis.

Summary

Korean summary

Key Message
This study showed strongyloidiasis is one of the most common parasitic diseases among patients receiving immunosuppressive drugs in northern Iran and early diagnosis before chemotherapy or steroid therapy is necessary.

Citations

Citations to this article as recorded by

Seropositivity Rates of Strongyloides stercoralis Antibody in the Southeastern Region of Republic of Korea: A Single-Center Retrospective Study
Taehwa Kim, Seungjin Lim
The Korean Journal of Parasitology.2022; 60(3): 181. CrossRef
The Coexistence of Blastocystis spp. in Humans, Animals and Environmental Sources from 2010–2021 in Asia
Adedolapo Aminat Rauff-Adedotun, Farah Haziqah Meor Termizi, Nurshafarina Shaari, Ii Li Lee
Biology.2021; 10(10): 990. CrossRef
Comparison of Molecular and Parasitological Methods for Diagnosis of Human Trichostrongylosis
Mehdi Pandi, Meysam Sharifdini, Keyhan Ashrafi, Zahra Atrkar Roushan, Behnaz Rahmati, Nayereh Hajipour
Frontiers in Cellular and Infection Microbiology.2021;[Epub] CrossRef

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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2 Citations

Abstract 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

Korean 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.

Citations

Citations to this article as recorded by

Sex-specific association of body mass index and fatty liver index with prevalence of renal hyperfiltration: a cross sectional study using Japanese health check-up data
Atsushi Kitazawa, Yoshiharu Fukuda
BMC Nephrology.2023;[Epub] CrossRef
Fatty Liver Index Independently Predicts All-Cause Mortality in Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis but No Substantial Liver Disease
Pil Gyu Park, Jung Yoon Pyo, Sung Soo Ahn, Hyun Joon Choi, Jason Jungsik Song, Yong-Beom Park, Ji Hye Huh, Sang-Won Lee
Frontiers in Cardiovascular Medicine.2022;[Epub] CrossRef

Brief Communication

Testosterone levels and cause-specific mortality in the older French men without metabolic syndrome: Nasser Laouali, Sylvie Brailly-Tabard, Catherine Helmer, Marie-Laure Ancelin, Christophe Tzourio, Alexis Elbaz, Anne Guiochon-Mantel, Marianne Canonico; Epidemiol Health. 2020;42:e2020036. Published online June 1, 2020; DOI: https://doi.org/10.4178/epih.e2020036

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Abstract PDF Supplementary Material: Abstract
OBJECTIVES
Previous studies have reported controversial findings regarding the association of testosterone with mortality in older men. This heterogeneity might be partially explained by comorbidities and the presence of metabolic syndrome, as well as differential associations according to causes of death.
METHODS
We used data from a random subsample of the Three-City study, in which hormone levels were measured in 338 men ≥65 years without metabolic syndrome who were followed-up for 12 years. Vital status was determined for all participants from different sources. We used inverse-probability-weighted Cox regression to estimate the hazard ratios (HRs) of cause-specific mortality and 95% confidence intervals (CIs).
RESULTS
Over the follow-up period, 130 men died (30 from cardiovascular disease, 45 from cancer, 55 from other causes). The association of testosterone with mortality showed significant heterogeneity across causes of death (p=0.027 and p=0.022 for total and bioavailable testosterone, respectively). Higher testosterone levels were associated with increased cardiovascular mortality (HR for 1-standard deviation increase, 1.86; 95% CI, 1.28 to 2.71 and 1.50; 95% CI, 1.04 to 2.17 for total and bioavailable testosterone, respectively). By contrast, there were no significant associations of testosterone with mortality from cancer and other causes.
CONCLUSIONS
Our data suggest that the association of testosterone with mortality in men without metabolic syndrome might be differential according to the cause of death. These findings may partially explain the heterogeneity across studies on the relationship between testosterone levels and mortality.; Summary

Korean summary

Key Message

Original Article

Trends in prediabetes and diabetes prevalence and associated risk factors in Vietnamese adults: That Thanh Ton, Anh Thi Ngoc Tran, Ich Thanh Do, Hoa Nguyen, Thi Thanh Binh Nguyen, Minh Tu Nguyen, Van Anh Bao Ha, Anh Quoc Tran, Huu Khoi Hoang, Binh Thang Tran; Epidemiol Health. 2020;42:e2020029. Published online May 11, 2020; DOI: https://doi.org/10.4178/epih.e2020029

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5 Citations

Abstract PDF Supplementary Material

Abstract

OBJECTIVES
The prevalence of diabetes mellitus is rapidly increasing in Vietnam, particularly among adults aged over 45 years. This study estimated trends in diabetes and prediabetes prevalence and determined risk factors in Vietnamese adults (over 45 years).

METHODS

A cross-sectional study was conducted based on data from an annual diabetes screening program among people aged 45-69 years in an urban city in central Vietnam (Da Nang). Joinpoint regression analyses were performed to calculate the annual percentage change and p_trend-values. Multinomial logistic regression analysis was used to determine risk factors.

RESULTS

In total, 3,765 men and 9,149 women were included in this analysis. The age-adjusted prevalence of diabetes and prediabetes in 2017 was 11.4% and 52.9%, respectively. The prevalence of diabetes was higher in men (15.1%) than in women (10.3%), but that of prediabetes was similar in both genders (53.4% vs. 52.8%). The prevalence of prediabetes significantly increased during the study period, whereas no upward or downward trend for diabetes was observed. The prevalence of obesity, abdominal obesity, hypertension, and dyslipidemia showed no obvious trend. Obesity, a high waist-to-hip ratio, hypertension, more severe abdominal obesity, and dyslipidemia were significantly associated with a higher risk of diabetes and prediabetes.

CONCLUSIONS

Diabetes and prediabetes were more prevalent among people aged over 45 years than in the general population. Da Nang has experienced a marked increase in the prevalence of prediabetes. These findings have significant implications regarding the need for nationwide public health interventions and management aiming at diabetes prevention and control.

Summary

Korean summary

Key Message

Citations

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Rural-urban differentials of prevalence and lifestyle determinants of pre-diabetes and diabetes among the elderly in southwest China
Yi Zhao, Hui-fang Li, Xia Wu, Guo-hui Li, Allison Rabkin Golden, Le Cai
BMC Public Health.2023;[Epub] CrossRef
Effectiveness of Textured Soybean Protein on Blood Biochemistry in Vietnamese Type 2 Diabetes Mellitus Patients
Ngoc Thi TA, Hien Thi Thu NGO, Phuong Mai NGUYEN, Thu Thi TRUONG, Giang Huong NGUYEN, Hang Thi Dieu DINH, Linh Thuy NGUYEN, Huong Thi LE, Khan Cong NGUYEN, Shigeru YAMAMOTO
Journal of Nutritional Science and Vitaminology.2022; 68(1): 32. CrossRef
Diabetes self-management and its associated factors among patients with diabetes in central Vietnam: A cross-sectional study
Van Bang Nguyen, Kim Huong Pham Thi, Thi Xuan Nguyen, Nguyen Tuyen Linh Pham, Van Vy Hau Nguyen, Chi Van Le, Muhammad Sajid Hamid Akash
PLOS ONE.2022; 17(7): e0270901. CrossRef
The prevalence of excess weight among Vietnamese adults: A pooled analysis of 58 studies with more 430 thousand participants over the last three decades
Tran Thai Phuc, Tran Quang Duc, Vu Thi Quynh Chi, Phan Ngoc Quang
Nutrition and Health.2022; : 026010602211294. CrossRef
Diabetes-Related Distress and Its Associated Factors Among Patients with Diabetes in Vietnam

Van Bang Nguyen, Tam Thi Tran, Thi Ly Dang, Van Vy Hau Nguyen, Binh Thang Tran, Chi Van Le, Nguyen Dinh Toan
Psychology Research and Behavior Management.2020; Volume 13: 1181. CrossRef

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