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Original articles
Associations between taxi drivers’ aggressive driving behavior and sleep, cognition, and psychological factors: negative binomial regression analysis
Jong Sun Ok, Soo young An, Mi Young Kim, Hyeongsu Kim
Epidemiol Health. 2024;e2024085.   Published online October 17, 2024
DOI: https://doi.org/10.4178/epih.e2024085    [Accepted]
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Abstract
OBJECTIVES
Aggressive driving behavior is a significant predictor of traffic accidents. In particular, the driving behavior of taxi drivers is a critical issue that can impact the safety of both drivers and passengers. This study explored the sleep, cognitive, and psychological factors associated with taxi drivers’ aggressive driving behavior.
METHODS
In this descriptive study, a self-report questionnaire was distributed to taxi drivers in Seoul and Gyeonggi Province from August 22 to December 30, 2022. In all, 992 respondents were analyzed using negative binomial regression.
RESULTS
The mean score for aggressive driving behavior among taxi drivers was 13.76 ± 11.47, with sub-scores of 3.46 ± 3.48 for lapse, 3.31 ± 3.16 for error, and 6.99 ± 5.76 for violation. Contributing factors included sleep disorders, cognitive decline, and psychological factors. A higher score for aggressive driving behavior was associated with an increased severity of insomnia and daytime sleepiness, higher rates of cognitive failure, and elevated levels of depression and stress.
CONCLUSIONS
Our findings highlight the importance of addressing the sleep, cognitive, and psychological factors associated with aggressive driving behaviors among taxi drivers. Further study is needed to evaluate the causal relationship. In addition, it is imperative to develop educational programs and interventions to manage these issues effectively.
Summary
The prevention and response to infectious diseases in long-term care facilities in Korea: a nationwide survey
Sun Hee Na, Joong Sik Eom, Sun Bean Kim, Hyung Jin Yoon, So Yeon Yoo, Kyeong Sook Cha, Jong Rim Choi, Ji Yeon Choi, Si Hyeon Han, Jin Ju Park, Tark Kim, Jacob Lee
Epidemiol Health. 2024;e2024084.   Published online October 17, 2024
DOI: https://doi.org/10.4178/epih.e2024084    [Accepted]
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Abstract
OBJECTIVES
Long-term care facilities (LTCFs) are communal environments for patients with chronic diseases or older adults, making them particularly susceptible to significant harm during infectious disease outbreaks. Nonetheless, LTCFs have historically been subject to less stringent infection prevention and control (IPC) mandates. This study aimed to assess the current state of LTCFs and to develop an IPC system tailored for these facilities following the coronavirus disease 2019 (COVID-19) pandemic.
METHODS
We conducted an online survey of 11,366 LTCFs in Korea from December 30, 2022 to January 20, 2023, to evaluate the components of IPC in LTCFs. The infectious diseases targeted for IPC included COVID-19, influenza, and scabies. Additionally, we compared institution-based and home-based long-term care insurance facilities.
RESULTS
Overall, 3,537 (31.1%) LTCFs responded to the survey, comprising 1,819 (51.4%) institution-based and 1,718 (48.6%) home-based facilities. A majority (87.4%, 2,376/2,720) of these facilities experienced COVID-19 outbreaks. However, only 42% of home-based facilities, in contrast to 90.6% of institution-based facilities, were equipped to manage concurrent COVID-19 cases. Similarly, while 92.1% of institution-based facilities were capable of managing influenza, only 50.5% of home-based facilities could do the same. The incidence of scabies was significantly higher in institution-based facilities than in home-based ones (26.1% vs. 4.3%). Additionally, 88.7% of institution-based facilities managed scabies cases effectively, compared to only 42.1% of home-based facilities.
CONCLUSIONS
Approximately half of the LTCFs had a basic capacity to respond to infectious diseases. However, there were differences in response capabilities between institution-based facilities and home-based facilities.
Summary
Sex-specific associations between dietary legume subtypes and type 2 diabetes in a prospective cohort study
Hye Won Woo, Sangmo Hong, Min-Ho Shin, Sang Baek Koh, Hyeon Chang Kim, Yu-Mi Kim, Mi Kyung Kim
Epidemiol Health. 2024;e2024083.   Published online October 17, 2024
DOI: https://doi.org/10.4178/epih.e2024083    [Accepted]
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AbstractAbstract PDF
Abstract
OBJECTIVES
Dietary soy, known for its high phytoestrogen content, has been suggested to exhibit a sex-specific association with type 2 diabetes. However, evidence regarding the sex-specific associations of different legume subtypes with type 2 diabetes remains scarce. We aimed to evaluate whether habitual consumption of soy and non-soy legumes (beans and peanuts) was prospectively and sex-specifically associated with the risk of type 2 diabetes incidence, taking into considering significant sex-specific genetic factors beyond legume consumption.
METHODS
A total of 16,666 participants (96,945 person-years) were followed and 945 incident cases were observed. Cumulative intake of legume subtypes was calculated using a food frequency questionnaire administered at baseline and during the revisit surveys.
RESULTS
Non-soy legumes are inversely associated with type 2 diabetes in both men and women. Dietary soy intake, however, demonstrated a unilaterally interacting sex-specific association with type 2 diabetes risk (pinteraction for sex=0.0173). Specifically, there was a significant inverse association with type 2 diabetes risk in women (incidence rate ratio, 0.66; 95% confidence interval, 0.48 to 0.80; ptrend=0.0066), but no such association was observed in men. This sex-specific association persisted and even appeared antagonistic in minor allele carriers of 2 novel single nucleotide polymorphisms, rs10196939 (LRRTM4) and rs11750158 (near GFPT2) (pinteraction for sex=0.0014 and 0.0112, respectively).
CONCLUSIONS
Habitual consumption of legumes shows protective impacts against type 2 diabetes, although these benefits vary by sex. Non-soy legumes provide health advantages for both men and women, whereas soy consumption seems to be beneficial exclusively for women.
Summary
Association between the safety climate and occupational injury in the Korean working population: a cross-sectional study
Jeehee Min, Tae-Won Jang, Hye-Eun Lee, Mo-Yeol Kang, Seong-Sik Cho
Epidemiol Health. 2024;e2024082.   Published online October 1, 2024
DOI: https://doi.org/10.4178/epih.e2024082    [Accepted]
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AbstractAbstract PDF
Abstract
OBJECTIVES
Preventing occupational injuries remains a significant challenge in Korea. A positive safety climate can contribute to reducing workplace injuries. However, the impact of safety climate on preventing occupational injuries among the Korean workforce has not been adequately explored. Therefore, this study aimed to investigate the relationship between the perceived safety climate and occupational injuries within the Korean working population.
METHODS
This study used baseline data from the Korean Work, Sleep, and Health Study (KWSH). The safety climate was measured using the brief version of the Nordic Safety Climate Questionnaire. Occupational injury was determined by whether injuries or accidents had occurred at workplaces in the past year. Logistic regression analysis was performed to examine the association between the safety climate and occupational injury.
RESULTS
Participants who reported an unfavorable workplace safety climate were more likely to experience occupational injuries. Multiple logistic regression analysis revealed that the adjusted odds ratio (OR) for occupational injuries in an unfavorable safety climate was 2.20 (95% confidence interval [CI], 1.38–3.51) compared to a favorable safety climate. Specifically, factors such as “not encouraging employees to follow safety rules when on a tight schedule” (OR, 2.02; 95% CI, 1.25–3.24) and “not helping each other work safely” (OR, 1.98; 95% CI, 1.17–3.25) were significantly associated with occupational injuries.
CONCLUSIONS
An unfavorable safety climate was associated with increased occupational injuries among Korean workers. Improving the safety climate in the workplace may reduce occupational injuries in Korea.
Summary
Analyzing the dynamics of complicated and uncomplicated appendicitis during the COVID-19 pandemic in Seoul: a multifaceted time series approach
Kiook Baek, Chulyong Park
Epidemiol Health. 2024;e2024081.   Published online October 1, 2024
DOI: https://doi.org/10.4178/epih.e2024081    [Accepted]
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Abstract
OBJECTIVES
This study investigated the impact of the COVID-19 pandemic and associated control strategies on the incidence of appendicitis in Seoul, using data from 2018 to 2020 from South Korea's National Health Insurance.
METHODS
We analyzed records of total, complicated, and uncomplicated appendicitis cases, as well as the ratio of complicated to uncomplicated appendicitis, using natural spline and piecewise regression models to identify trends and breakpoints. Bayesian structural time-series (BSTS) models were used to evaluate the causal impact of social distancing on appendicitis incidences.
RESULTS
The spline regression analysis indicated decreasing trends in both total and uncomplicated appendicitis cases. Conversely, the incidence of complicated appendicitis and the ratio of complicated to uncomplicated cases increased. Breakpoints for a decline in uncomplicated appendicitis and a rise in the ratio occurred at 31 weeks in 2020 (95% confidence interval [CI], 23.2 to 38.8) and at 33.9 weeks (95% CI, 28.3 to 39.6), respectively. The BSTS model demonstrated a 7.8% reduction in total appendicitis cases (95% credible interval [CrI], -12.0% to -3.3%). It also showed a 17% decrease in uncomplicated cases (95% CrI, -22% to -12%) and increases of 13% (95% CrI, 4.9% to 22.0%) in complicated cases and 39% (95% CrI, 27.0% to 53.0%) in the ratio of complicated to uncomplicated appendicitis.
CONCLUSIONS
The COVID-19 pandemic resulted in a decrease in both total and uncomplicated appendicitis cases, while the number of complicated cases increased. Reduced medical visits likely accounted for these changes. Strategies are needed to manage changes in disease pathophysiology resulting from altered healthcare utilization during health crises.
Summary
Systematic review
Adverse health effects of climate change and air pollution in people with disabilities: a systematic review
Nakyung Rhim, Seohyun Lee, Kyung-Hwa Choi
Epidemiol Health. 2024;e2024080.   Published online September 27, 2024
DOI: https://doi.org/10.4178/epih.e2024080    [Accepted]
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Abstract
Global warming and air pollution adversely affect the health of the entire human population, particularly older adults, people with disabilities (PWDs), and children. In this systematic review, we investigated the adverse health effects of climate change and air pollution in PWDs. We conducted a comprehensive literature search of the PubMed database using the terms “disab*,” “air pollution,” and “climate change” on July 4, 2023, and August 8, 2023 and searched the Web of Science (WOS) database on December 28, 2023. We identified 425 and 1169 studies on climate change cited in PubMed and WOS, respectively, as well as 333 studies on air pollution in PubMed and 495 studies on air pollution in WOS. The studies were classified by type of exposure, and full-text screening was conducted to confirm that the population, intervention or exposure, comparator, outcome statement, and inclusion and exclusion criteria were met. The Newcastle-Ottawa Scale was used to assess the quality of the included cohort and case-control studies and for data analysis. In extreme temperatures, PWDs experienced higher rates of injury, heat-related illness, functional impairment, heart disease, mental disorders, and mortality than people who were nondisabled (ND). Exposure to air pollution resulted in higher rates of obesity, cardiovascular disease, poststroke neurological and functional disability, and mortality in PWDs than in people who were ND. Therefore, because PWDs were more affected by climate change and air pollution than people who were ND, sensitive policies and preparedness measures should be developed for PWDs.
Summary
Original articles
The role of supervisor support in the association between night work and depressive symptoms: a gender-stratified analysis of 22,422 full-time wage workers in South Korea
Hee Won Kim, Ji-Hwan Kim, Garin Lee, Hye-Lin Lee, Hayoung Lee, Seung-Sup Kim
Epidemiol Health. 2024;e2024079.   Published online September 25, 2024
DOI: https://doi.org/10.4178/epih.e2024079    [Accepted]
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AbstractAbstract PDF
Abstract
OBJECTIVES
This study investigated the relationship between night work, supervisor support, and depressive symptoms among full-time wage workers, with a focus on gender differences.
METHODS
A nationwide sample of 22,422 full-time wage workers from the Sixth Korean Working Conditions Survey (2020-2021) was analyzed. Experiences of night work were categorized into 5 groups based on the number of night work days per month: 0, 1-5, 6-10, 11-15, and 16-31. Depressive symptoms were evaluated using the 5-item World Health Organization Well-Being Index. Supervisor support was assessed with 5 items.
RESULTS
Workers who engaged in 1-5 days (prevalence ratio [PR], 1.23; 95% CI, 1.12-1.36) and 6-10 days (PR, 1.17; 95% CI, 1.06-1.30) of night work per month exhibited a higher prevalence of depressive symptoms than those without night work. After stratifying by supervisor support levels, workers with 1-5, 6-10 and 11-15 days of night work per month were more likely to experience depressive symptoms compared to those without night work in the low supervisor support group. In contrast, no association was found between night work (≥ 6 days) and depressive symptoms in the high supervisor support group. Furthermore, gender differences were notable: female workers with 6-10 days (PR, 1.45; 95% CI, 1.23-1.70), and 11-15 days (PR, 1.43; 95% CI, 1.08-1.90) of night work per month exhibited a higher prevalence of depressive symptoms, whereas their male counterparts did not. This pattern of gender difference was also found among those with low supervisor support.
CONCLUSIONS
Supervisor support may mitigate the adverse effects of night work on depressive symptoms among full-time wage workers, with differences manifested across genders.
Summary
Temporal trends in the prevalence, incidence, and mortality of cardiac amyloidosis in South Korea over 12 years
You-Jung Choi, Yun Jin Choi, Ji Eun Lee, Jah Yeon Choi, Geum Joon Cho, Jin Oh Na
Epidemiol Health. 2024;e2024078.   Published online September 15, 2024
DOI: https://doi.org/10.4178/epih.e2024078    [Accepted]
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Abstract
Objectives
This study investigated the prevalence, incidence, and prognosis of cardiac amyloidosis (CA) in South Korea.
Methods
This retrospective nationwide population-based study used the Health Insurance Review and Assessment Service databases between 2008 and 2020. All patients diagnosed with amyloidosis were included, and those with a diagnosis of heart failure or cardiomyopathy were classified as having CA. Both the special code for amyloidosis (V121), which enables coverage of medical expenses, and the corresponding International Classification of Diseases, 10th Revision codes for amyloidosis (E850–E854, E858, E859) were used to improve the reliability of amyloidosis diagnosis.
Results
Among 2,239 patients with amyloidosis, 758 met the criteria for CA (mean age, 64.4±11.9 years; 59.1% male). The mean age of patients with CA increased from 59.5±14.7 years in 2009 to 68.1±13.9 years in 2020. The incidence and prevalence increased from 0.09 (95% confidence interval [CI], 0.06–0.12) to 0.22 (95% CI, 0.18–0.27) per 100,000 person-years and 0.20 (95% CI, 0.16–0.25) to 1.30 (95% CI, 0.12–0.42) per 100,000 persons, respectively (all p<0.001). Patients with light-chain CA showed similar trends. In-hospital mortality decreased from 17.3% (95% CI, 9.23%–29.6%) to 6.1% (95% CI, 4.21%–8.48%) between 2009 and 2020. While age-specific in-hospital mortality was significantly higher in patients aged ≥70 years (p=0.004), no significant age-specific difference in in-hospital mortality was observed in patients with CA aged <70 years (p=0.981).
Conclusions
The prevalence and incidence of CA have increased in South Korea, predominantly affecting older individuals, particularly males. Notably, in-hospital mortality decreased significantly.
Summary
The associations of cardiovascular and lifestyle factors with mortality from chronic kidney disease as the underlying cause: the JACC study
Shuai Guo, Tomoko Sankai, Kazumasa Yamagishi, Tomomi Kihara, Akiko Tamakoshi, Hiroyasu Iso
Epidemiol Health. 2024;e2024077.   Published online September 13, 2024
DOI: https://doi.org/10.4178/epih.e2024077    [Accepted]
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AbstractAbstract PDF
Abstract
OBJECTIVES
This study investigated conventional cardiovascular and lifestyle risk factors affecting mortality from chronic kidney disease as the underlying cause in the general Japanese population.
METHODS
We conducted an 18.8-year follow-up study of 44,792 men and 61,522 women aged 40-79 from the Japan Collaborative Cohort Study for Evaluation of Cancer Risk between 1986 and 1990. Cox proportional hazard models were used to analyze the association between risk factors and mortality from chronic kidney disease.
RESULTS
During the follow-up period, 373 participants (185 men and 188 women) died from chronic kidney disease. A body mass index of ≥27 kg/m2 (hazard ratio [95% confidence interval] = 2.00 [1.19-3.36] for men and 1.91 [1.19-3.07] for women, compared with 23.0-24.9 kg/m2), a history of hypertension (2.32 [1.67-3.22] for men and 2.01 [1.44-2.81] for women) and a history of diabetes mellitus (5.21 [3.68-7.37] for men and 7.10 [4.93-10.24] for women) were associated with an increased risk of mortality from chronic kidney disease in both sexes. In men, smoking was also associated with an increased risk (1.91 [1.25-2.90]), while current drinking (0.58 [0.34-0.98] for <23 g/day, 0.48 [0.29-0.80] for 23-45 g/day and 0.53 [0.32-0.86] for ≥46 g/day) and exercising ≥5 hours/week (0.42 [0.18-0.96]) were associated with a lower risk. Similar but non-significant associations for smoking and drinking were observed in women.
CONCLUSIONS
In addition to a history of hypertension and a history of diabetes mellitus, body mass index, smoking status, drinking status, and exercise habits were associated with the risk of mortality from chronic kidney disease.
Summary
Homelessness and mortality: gender, age, and housing status inequity in South Korea
Gum-Ryeong Park, Dawoon Jeong, Seung-Won Lee, Hojoon Sohn, Young Ae Kang, Hongjo Choi
Epidemiol Health. 2024;e2024076.   Published online September 12, 2024
DOI: https://doi.org/10.4178/epih.e2024076    [Accepted]
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AbstractAbstract PDF
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 (TB) 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 1159.6 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 1.702 (95% CI, 1.369-2.115). 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
Epidemic characteristics of measles and efforts to control measles infections in Zhejiang Province, China
Rui Yan, Mengya Yang, He Hanqing, Feng Yan, Zhou Yang, Tang Xuewen, Deng Xuan, Zhu Yao, Yuxia Du, Can Chen, Cao Kexin, Shigui Yang
Epidemiol Health. 2024;e2024075.   Published online September 11, 2024
DOI: https://doi.org/10.4178/epih.e2024075    [Accepted]
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AbstractAbstract PDF
Abstract
OBJECTIVES
Several countries have successfully eliminated measles, and China is making significant strides toward achieving this goal. This study focused on investigating the patterns of measles infections in Zhejiang Province, China, as well as control measures. The objective was to provide valuable insights that could contribute to the development of nationwide elimination strategies.
METHODS
We analyzed measles surveillance data from 2005 to 2022 in Zhejiang Province. We utilized a joinpoint regression model to examine trends in measles. Additionally, we employed SaTScan software (version 9.5) to identify spatial-temporal clusters. Finally, we used an age-period-cohort model to assess the effects of age, period, and cohort.
RESULTS
The age-standardized incidence rate (ASIR) of measles infection in Zhejiang Province from 2005 to 2022 was 5.24 per 100,000, showing a consistent and significant downward trend with an annual percentage change of -24.93% (p<0.05). After 2020, the ASIR for measles infection fell to below 0.1 per 100,000. The majority of measles cases occurred in individuals either without an immunization history or with an unknown immunization status, representing 41.06% and 41.40% of the cases from 2010 to 2022, respectively. According to data from the National Measles Surveillance System, the annual rate of discarded measles cases from 2009 to 2014, and the annual rate of discarded measles and rubella cases from 2015 to 2022, were both above 2 per 100,000, indicating the high sensitivity of the measles surveillance system.
CONCLUSIONS
The significant reduction in measles incidence from 2005 to 2022 demonstrates substantial progress in Zhejiang Province towards the elimination of measles.
Summary
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;e2024073.   Published online September 2, 2024
DOI: https://doi.org/10.4178/epih.e2024073    [Accepted]
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AbstractAbstract AbstractSummary PDF
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 (HRs) 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 men and women with BMIs of less than 21 kg/m2 and greater than or equal to 30 kg/m2 are at increased risk. The results showed that men with a BMI of less than 18.5 kg/m² had a significantly higher risk of all-cause mortality (adjusted HR: 2.24 [95% CI: 1.73–2.91]) and cardiovascular mortality (2.27 [1.23–4.20]). Similarly, men with a WHR of less than 0.80 (1.38 [1.08–1.77]), 0.90 to less than 0.95 (1.15 [1.02–1.29]), and greater than or equal to 0.95 (1.28 [1.11–1.47]) showed an increased risk of all-cause mortality. In women, a BMI of less than 18 kg/m² was linked to a higher risk of cardiovascular mortality (2.67 [1.13–6.33]).
CONCLUSIONS
Being underweight was associated with an increased risk of mortality in both sexes, and the lowest risk of death was found in men who were slightly overweight with a BMI of 23-25 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.
Causal association between serum bilirubin and ischemic stroke: multivariable Mendelian randomization
Jong Won Shin, Keum Ji Jung, Mikyung Ryu, Jungeun Kim, Heejin Kimm, Sun Ha Jee
Epidemiol Health. 2024;e2024070.   Published online August 19, 2024
DOI: https://doi.org/10.4178/epih.e2024070    [Accepted]
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AbstractAbstract PDF
Abstract
OBJECTIVES
Previous research has predominantly focused on total bilirubin levels without clearly distinguishing between direct and indirect bilirubin. In this study, the differences between these forms were examined, and their potential causal relationships with ischemic stroke were investigated.
METHODS
Two-sample multivariable Mendelian randomization (MVMR) analysis was employed, extracting summary data on bilirubin from the Korean Cancer Prevention Study-II (KCPS-II; n=159,844) and the Korean Genome and Epidemiology Study (KoGES; n=72,299). Data on ischemic stroke were obtained from BioBank Japan (BBJ; n=201,800). Colocalization analysis was performed, focusing on the UGT1A1, SLCO1B1, and SLCO1B3 genes, which are the primary loci associated with serum bilirubin levels.
RESULTS
Crude 2-sample Mendelian randomization analysis revealed a significant negative association between total bilirubin levels and ischemic stroke. However, in MVMR analyses, only indirect bilirubin demonstrated a significant negative association with ischemic stroke (odds ratio, 0.76; 95% confidence interval, 0.59 to 0.98). Colocalization analysis did not identify a shared causal variant between the 3 genetic loci related to indirect bilirubin and the risk of ischemic stroke.
CONCLUSIONS
Our study establishes a causal association between higher genetically determined levels of serum indirect bilirubin and reduced risk of ischemic stroke in an Asian population. Future research should include more in-depth analysis of shared genetic variants between indirect bilirubin and ischemic stroke.
Summary
Development and validation of the Health Literacy Index for the Community (HLIC) for the Korean National Health and Nutrition and Examination Survey
Junghee Yoon, Soo Jin Kang, Mangyeong Lee, Juhee Cho
Epidemiol Health. 2024;e2024061.   Published online July 10, 2024
DOI: https://doi.org/10.4178/epih.e2024061    [Accepted]
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
We developed and validated the Health Literacy Index for the Community (HLIC) to assess the health literacy of the Korean population within the framework of the Korean National Health and Nutrition and Examination Survey.
METHODS
The HLIC was developed through 1) defining the conceptual framework and generating the item pool and 2) finalizing the items and identifying the cutoff value. Interviews were conducted to examine items' face validity, and a cross-sectional survey was performed to analyze the item-response theory and Rasch models to investigate the instrument's psychometric properties.
RESULTS
In this study of 1,041 participants, most had no difficulty understanding health information; however, 67.9% struggled to assess the reliability of health information from the internet or media. A 4-factor structure was identified through factor analysis, leading to the exclusion of some items. This resulted in 10 items across 4 domains: 1) disease prevention, 2) health promotion, 3) health care, and 4) technology and resources. The HLIC demonstrated good internal consistency, with a Cronbach's ɑ of 0.87. It also showed high test-retest reliability and correlations with other health literacy instruments. A sociodemographic analysis of the HLIC revealed disparities in health literacy across various age groups, education levels, and income brackets.
CONCLUSIONS
The HLIC was developed to systematically measure health literacy in Korea's general population. Its simplicity and conciseness ensure reliability and validity and improve its accessibility, making it particularly suitable for the broader Korean population, including those with lower literacy levels.
Summary
Korean summary
본 연구는 한국인의 건강 문해력을 평가하기 위해 지역사회 건강정보 이해능력 측정도구(Health Literacy Index for the Community, HLIC)를 개발하고 검증하였다. 그 결과, 많은 사람들이 인터 넷이나 미디어에서 얻은 정보의 신뢰성을 평가하는 데 어려움을 겪고 있으며, 연령, 교육 수준, 소 득에 따라 건강정보 이해능력 격차가 존재함을 확인하였다. 특히 본 도구는 높은 신뢰도와 타당성 을 입증하였으며, 이를 통해 한국인의 격차를 파악하고 맞춤형 개입을 위한 중요한 정보를 제공하 는 도구로서의 유용성을 확인하였다.
Key Message
This study developed and validated the Health Literacy Index for the Community (HLIC) to assess the health literacy of Koreans, finding that many had difficulties to assess its reliability from Internet or media sources, and disparities in health literacy were observed across age, education level, and income. The HLIC demonstrated strong reliability and validity, highlighting its utility for identifying health literacy gaps and informing targeted interventions in Korea.
Methods
Validation of self-reported morbidities of the Korean Atomic Bomb Survivor Cohort
Ansun Jeong, Thi Xuan Mai Tran, Seong-geun Moon, Mi Kyung Kim, Inah Kim, Yu-Mi Kim, Boyoung Park
Epidemiol Health. 2024;e2024058.   Published online June 28, 2024
DOI: https://doi.org/10.4178/epih.e2024058    [Accepted]
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Abstract
OBJECTIVES
This study aimed to evaluate the agreement of disease status collected through a survey of the Korean Atomic Bomb Survivor Cohort (K-ABC), compared with medical claim records from the Korean National Health Insurance Service (NHIS) database and the Korean Central Cancer Registry (KCCR).
METHODS
Data on the lifetime physician-diagnosed morbidities of 1,215 K-ABC participants were collected through an interviewer-administered questionnaire between 2020 and 2022. Survey data were linked to the NHIS and KCCR databases. Eleven diseases were included for validation. We evaluated the following indicators: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, the area under the curve (AUC), and the kappa coefficient.
RESULTS
The mean (standard deviation) age was 62.1 (18.7) years, and 42.6% of the participants were aged ≥70 years. Hypertension and cataracts showed the highest prevalence rates (33.8% and 28.8%, respectively). Hypertension, diabetes, and cancer demonstrated high sensitivity (>0.8) and specificity (>0.9), whereas diabetes, cancer, myocardial infarction, angina pectoris, and asthma exhibited high accuracy (>0.9). In contrast, arthritis, allergic rhinitis, and asthma showed low sensitivity (<0.4) and kappa values (<0.3). In the participants aged ≥70 years, the kappa value was ≥0.4 for all diseases except arthritis, allergic rhinitis, and asthma.
CONCLUSIONS
The results from this initial analysis showed relatively high agreement between the survey and NHIS/KCCR databases, especially for hypertension, diabetes, and cancer. Our findings suggest that the information on morbidities collected through the questionnaires in this cohort was valid for both younger and older individuals.
Summary

Epidemiol Health : Epidemiology and Health
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