Epidemiology and Health

Sun Ha Jee

44 Articles

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

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

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

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

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;46:e2024070. Published online August 19, 2024; DOI: https://doi.org/10.4178/epih.e2024070

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Abstract Summary PDF Supplementary Material: 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 (n=159,844) and the Korean Genome and Epidemiology Study (n=72,299). Data on ischemic stroke were obtained from BioBank Japan (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

Korean summary
이 연구는 혈청 빌리루빈의 세 가지 형태(총, 직접, 간접 빌리루빈)와 허혈성 뇌졸중 간의 인과적 연관성을 다루었습니다. 다변수 멘델리안 무작위 분석(MVMR)을 통해 간접 빌리루빈이 허혈성 뇌졸중 위험을 유의미하게 감소시키는 것으로 나타났습니다. 이 결과는 빌리루빈의 항산화 역할과 허혈성 뇌졸중 간의 상관관계를 심화 이해하는 데 기여합니다.

Key Message
This study investigated the causal associations between three forms of serum bilirubin (total, direct, and indirect) and ischemic stroke. Multivariable Mendelian randomization (MVMR) analysis revealed a significant inverse association between indirect bilirubin and the risk of ischemic stroke. These findings contribute to a deeper understanding of the relationship between bilirubin's antioxidant role and ischemic stroke.

Causal effect of fasting serum glucose on atherosclerotic cardiovascular disease: a multivariable Mendelian randomization: Su Hyun Lee, Heejin Kimm, Byung-Wan Lee, Chung Mo Nam, So Young Kim, Sunmi Lee, Sun Ha Jee; Epidemiol Health. 2024;46:e2024096. Published online December 6, 2024; DOI: https://doi.org/10.4178/epih.e2024096

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Abstract Summary PDF: Abstract
OBJECTIVES
Observational studies have reported that diabetes is a risk factor that increases the risk of atherosclerotic cardiovascular disease (ASCVD). However, the causal relationship remains a matter of debate. This study aimed to analyze the relationship between fasting serum glucose (FSG) and ASCVD.
METHODS
This study used data from the Korean Cancer Prevention Study-II (KCPS-II) Biobank, consisting of 159,844 people recruited with consent from 18 health examination centers from 2004 to 2013. Outcomes were confirmed based on diagnoses on hospital discharge summaries from National Health Insurance System. We used linear and non-linear Mendelian randomization (MR) methods. The outcome data were obtained from KCPS-II, and the exposure data were derived from the Korean Genome Epidemiology Study.
RESULTS
First, a prospective cohort study estimated that for each 10 mg/dL increase in FSG level, the risk of ASCVD increased by 4% (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.03 to 1.05). Second, the 2-sample MR study showed that every 10 mg/dL increase in FSG influenced the risk of ASCVD (odds ratio [OR], 1.11; 95% CI, 1.04 to 1.18). Third, the multivariable MR study showed that the OR per 10 mg/dL increase in FSG on ASCVD was 1.14 (p<0.001). Similar results were found for a 10 mg/dL increase in FSG and ischemic heart disease (IHD), but a significant relationship with stroke was not found. When performing non-linear MR, a linear relationship was observed between fasting blood sugar and ASCVD, including IHD and stroke.
CONCLUSIONS
FSG showed a linear and causal association with IHD, but not with stroke.; Summary

Korean summary
그동안 당뇨병이 심뇌혈관질환 발생에 위험요인이라는 역학적인 관찰연구는 많이 발표되었지만, 이러한 관련성에 대한 인과적 관련성에 대부분 연구는 서양인을 대상으로 발표되었고, 한국인 자료를 통해 발표된 적은 없었다. 이 연구는 관찰연구의 제한점으로 부각되는 혼란변수와 측정오류에 덜 영향을 받는 새로운 방법론으로써 다변수 멘델리언 무작위화 방법을 사용하여 공복혈당과 심뇌혈관질환의 인과성을 분석하였다. 분석결과, 공복혈당은 허혈성 심질환 발생위험에 인과적인을 관련성을 보였고 뇌졸중에 대해서는 인과적이지 않았다.

Key Message
Over the years, numerous epidemiological observational studies have reported that diabetes is a risk factor for cardiovascular and cerebrovascular diseases. However, most of these studies examining this association were conducted on Western populations, and no studies have been published using Korean data. This study employed a new methodology—multivariable Mendelian randomization—which is less affected by confounding factors and measurement errors, often highlighted as limitations of observational studies, to analyze the causal relationship between fasting glucose levels and cardiovascular and cerebrovascular diseases. The analysis revealed a causal relationship between fasting glucose levels and the risk of ischemic heart disease, while no causal association was observed with stroke.

Genetically determined alcohol consumption and cancer risk in Korea: Keum Ji Jung, Ji Woo Baek, Sang Yop Shin, Sun Ha Jee; Epidemiol Health. 2023;45:e2023077. Published online August 23, 2023; DOI: https://doi.org/10.4178/epih.e2023077

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Abstract Summary PDF

Abstract

OBJECTIVES
The purpose of this study was to determine the causal relationship between the genetically determined amount of alcohol consumption and the occurrence of major cancers.

METHODS

The data used in this study were from 129,324 people selected from the Korean Cancer Prevention Study-II, the participants of which visited 18 health examination centers between 2004 and 2013. Cancer incidence was confirmed as of 2020 using data from the National Cancer Center. A genome-wide association study (GWAS) on alcohol consumption was performed using PLINK 2.0, and sex, age, chip type, and principal components were adjusted.

RESULTS

From the GWAS, a genetic risk score for alcohol consumption was calculated and genetically determined alcohol consumption (GDAC) was estimated. GDAC was divided into quintile groups and showed significant causal relationships with rectal cancer and liver cancer, but not with other cancers. For liver cancer, an association was shown in the hepatitis B surface antigen (HBsAg)-negative group, and a particularly strong association was found in the over-60-year-old HBsAg-negative group, in which, compared to the GDAC Q1 group, the Q4 group had a 2.35 times higher risk (95% confidence interval [CI], 1.05 to 5.23), and the Q5 group had a 2.40 times higher risk (95% CI, 1.09 to 5.30).

CONCLUSIONS

The results of this study provided evidence that the amount of alcohol consumed is causally related to the occurrence of rectal cancer and liver cancer in HBsAg-negative individuals. Additional studies should be continued for other cancer types through long-term follow-up.

Summary

Korean summary
본 연구는 유전적으로 결정되는 음주량과 주요 암 발생 사이의 인과 관계를 밝히고자 하였다. 그 결과 유전적으로 결정되는 음주량이 증가할수록 직장암 발생 위험이 높아졌고, 특히 HBsAg 음성인 사람에서 간암 발생 위험이 높아지는 것으로 밝혀졌다.

Key Message
The purpose of this study was to reveal the causal relationship between genetically determined alcohol consumption and the incidence of major cancers. As a result, it was found that as the genetically determined amount of alcohol consumed increases, the risk of rectal cancer increases, and especially in people who are HBsAg negative, the risk of liver cancer increases.

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A pan-cancer analysis of the prognostic implication and oncogenic role of tubulin epsilon and delta complex 2 (TEDC2) in human tumors
Yang Liu, Jie Zhu, Jing Shen, Yuting Lu, Ke Pan, Chuan Tong, Yao Wang
Frontiers in Immunology.2024;[Epub] CrossRef
Cancer risk based on alcohol consumption levels: a comprehensive systematic review and meta-analysis
Seunghee Jun, Hyunjin Park, Ui-Jeong Kim, Eun Jeong Choi, Hye Ah Lee, Bomi Park, Soon Young Lee, Sun Ha Jee, Hyesook Park
Epidemiology and Health.2023; 45: e2023092. CrossRef

Cancer risk based on alcohol consumption levels: a comprehensive systematic review and meta-analysis: Seunghee Jun, Hyunjin Park, Ui-Jeong Kim, Eun Jeong Choi, Hye Ah Lee, Bomi Park, Soon Young Lee, Sun Ha Jee, Hyesook Park; Epidemiol Health. 2023;45:e2023092. Published online October 16, 2023; DOI: https://doi.org/10.4178/epih.e2023092

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Alcohol consumption is a well-established risk factor for cancer. Despite extensive research into the relationship between alcohol consumption and cancer risk, the effect of light alcohol consumption on cancer risk remains a topic of debate. To contribute to this discourse, we conducted a comprehensive systematic review and meta-analysis.

METHODS

Our systematic review aimed to investigate the associations between different levels of alcohol consumption and the risk of several cancer types. We focused on analyzing prospective associations using data from 139 cohort studies. Among them, 106 studies were included in the meta-analysis after a quantitative synthesis.

RESULTS

Our analysis did not find a significant association between light alcohol consumption and all-cause cancer risk (relative risk, 1.02; 95% confidence interval, 0.99 to 1.04), but we observed a dose-response relationship. Light alcohol consumption was significantly associated with higher risks of esophageal, colorectal, and breast cancers. Light to moderate drinking was associated with elevated risks of esophageal, colorectal, laryngeal, and breast cancers. Heavy drinking was also found to contribute to the risk of stomach, liver, pancreas, and prostate cancers, thereby increasing the risk of almost all types of cancer. Additionally, females generally had lower cancer risks compared to males.

CONCLUSIONS

Our findings highlight that cancer risks extend beyond heavy alcohol consumption to include light alcohol consumption as well. These findings suggest that there is no safe level of alcohol consumption associated with cancer risk. Our results underscore the importance of public health interventions addressing alcohol consumption to mitigate cancer risks.

Summary

Korean summary
본 연구는 코호트 연구를 기반으로 하여 음주의 수준에 따른 암 위험 연관성에 대해 체계적 문헌고찰(139편)과 메타분석(106편)을 수행하였다. 연구 결과, 음주와 암 위험 사이에 용량-반응 관계가 나타났으며, 소량의 음주는 암 유형에 따라 차이가 있었으나, 식도암, 대장암, 전립선암(남성), 유방암(여성)에서 암 위험과의 연관성이 있음을 발견했다. 따라서, 암 위험 측면에서 음주에 안전한 수준이 없음을 시사하며, 음주와 관련된 잠재적 피해를 완화하기 위해서는 음주 지침 강화와 같은 공중보건개입이 필요하다.

Key Message
The aim of this study was to assess the relationship between different levels of alcohol consumption and the risk of various cancer types through a systematic review and meta-analysis, providing insights into the ongoing debate about alcohol consumption and cancer causality. The findings support a dose-response relationship between alcohol consumption levels and cancer risk and the light alcohol consumption was associated with risks of esophageal, colorectal, prostate (male), and breast (female) cancer. These results emphasize the absence of a safe threshold for alcohol consumption in terms of cancer risk.

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Unraveling the bidirectional link between cancer and dementia and the impact of cancer therapies on dementia risk: A systematic review and meta‐analysis
Liwei Ma, Edwin C. K. Tan, Benjamin Goudey, Liang Jin, Yijun Pan
Alzheimer's & Dementia.2025;[Epub] CrossRef
Exploring genetic associations of Crohn’s disease and ulcerative colitis with extraintestinal cancers in European and East Asian populations
Chengdong Yu, Jiawei Xu, Siyi Xu, Lei Tang, Qinyuan Han, Xiaoqiang Zeng, Yanxiao Huang, Tenghua Yu, Zhengkui Sun
Frontiers in Immunology.2024;[Epub] CrossRef
The Impact of Tobacco Smoking and Alcohol Consumption on the Development of Gastric Cancers
Waku Hatta, Tomoyuki Koike, Naoki Asano, Yutaka Hatayama, Yohei Ogata, Masahiro Saito, Xiaoyi Jin, Kaname Uno, Akira Imatani, Atsushi Masamune
International Journal of Molecular Sciences.2024; 25(14): 7854. CrossRef
Genetic Heterogeneity Across Dimensions of Alcohol Use Behaviors
Jeanne E. Savage, Peter B. Barr, Tanya Phung, Younga H. Lee, Yingzhe Zhang, Vivia V. McCutcheon, Tian Ge, Jordan W. Smoller, Lea K. Davis, Jacquelyn Meyers, Bernice Porjesz, Danielle Posthuma, Travis T. Mallard, Sandra Sanchez-Roige
American Journal of Psychiatry.2024; 181(11): 1006. CrossRef
To Drink or Not to Drink? Investigating Alcohol’s Impact on Prostate Cancer Risk
Aris Kaltsas, Michael Chrisofos, Evangelos N. Symeonidis, Athanasios Zachariou, Marios Stavropoulos, Zisis Kratiras, Ilias Giannakodimos, Asterios Symeonidis, Fotios Dimitriadis, Nikolaos Sofikitis
Cancers.2024; 16(20): 3453. CrossRef
Factors associated with acquiring exercise habits through health guidance for metabolic syndrome among middle-aged Japanese workers: A machine learning approach
Jiawei Wan, Kyohsuke Wakaba, Takeshi Onoue, Kazuyo Tsushita, Yoshio Nakata
Preventive Medicine Reports.2024; 48: 102915. CrossRef
Development of an algorithm for identifying paraneoplastic ischemic stroke in association with lung, pancreatic, and colorectal cancer
Rebecca Kassubek, Marc-Andre G. R. Winter, Jens Dreyhaupt, Mona Laible, Jan Kassubek, Albert C. Ludolph, Jan Lewerenz
Therapeutic Advances in Neurological Disorders.2024;[Epub] CrossRef
Alimentación y cáncer
Carlos A. González Svatetz
FMC - Formación Médica Continuada en Atención Primaria.2024; 31(8): 403. CrossRef
Alcohol consumption and its association with cancer, cardiovascular, liver and brain diseases: a systematic review of Mendelian randomization studies
Naouras Bouajila, Cloé Domenighetti, Henri-Jean Aubin, Mickael Naassila
Frontiers in Epidemiology.2024;[Epub] CrossRef
Prévention et dépistage des cancers dans les rhumatismes inflammatoires chroniques
Elodie Mamou, Laetitia Morardet, Djaha Mogni, Bruno Fautrel, Laure Gossec
Revue du Rhumatisme.2024;[Epub] CrossRef
Global, regional, and national trends in gastric cancer burden: 1990-2021 and projections to 2040
Tao Zhang, Yiqun Zhang, Xiaofei Leng
Frontiers in Oncology.2024;[Epub] CrossRef
Alcohol Consumption and Breast and Ovarian Cancer Development: Molecular Pathways and Mechanisms
Francesca Fanfarillo, Brunella Caronti, Marco Lucarelli, Silvia Francati, Luigi Tarani, Mauro Ceccanti, Maria Grazia Piccioni, Loredana Verdone, Micaela Caserta, Sabrina Venditti, Giampiero Ferraguti, Marco Fiore
Current Issues in Molecular Biology.2024; 46(12): 14438. CrossRef

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.

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Comparisons of the prediction models for undiagnosed diabetes between machine learning versus traditional statistical methods
Seong Gyu Choi, Minsuk Oh, Dong–Hyuk Park, Byeongchan Lee, Yong-ho Lee, Sun Ha Jee, Justin Y. Jeon
Scientific Reports.2023;[Epub] CrossRef
Factors related to undiagnosed diabetes in Korean adults: a secondary data analysis
Bohyun Kim
Journal of Korean Biological Nursing Science.2023; 25(4): 295. CrossRef

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

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Abstract Summary PDF Supplementary Material

Abstract

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Summary

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

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

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Jae-Min Park, Hye Yeon Koo, Jae-ryun Lee, Hyejin Lee, Jin Yong Lee
Journal of Korean Medical Science.2024;[Epub] CrossRef
Weight maintenance and gain were significantly associated with lower risk of all-cause and cancer-related mortality in Korean adults who were newly diagnosed with cancer based on the Korean NHIS-HEALS cohort
Yong-June Kim, Seung Park, Won Tae Kim, Yoon-Jong Bae, Yonghwan Kim, Hee-Taik Kang
Medicine.2023; 102(47): e36184. CrossRef

Bilirubin and risk of ischemic heart disease in Korea: a two-sample Mendelian randomization study: Christina Jeon, Ji-Young Lee, Sun Ju Lee, Keum Ji Jung, Heejin Kimm, Sun Ha Jee; Epidemiol Health. 2019;41:e2019034. Published online July 12, 2019; DOI: https://doi.org/10.4178/epih.e2019034

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Bilirubin is an endogenous antioxidant that protects cells against oxidative stress. Increased plasma levels of bilirubin have been associated with a reduced risk of ischemic heart disease (IHD) in previous studies. Nonetheless, whether those associations reflect a true protective effect of bilirubin on IHD, rather than confounding or reverse causation, remains unknown. Therefore, we applied two-sample Mendelian randomization to evaluate the causal association between bilirubin levels and IHD risk in a Korean population.

METHODS

A total of 5 genetic variants—TRPM8 (rs10490012), USP40 (rs12993249), ATG16L1 (rs2119503), SLCO1B1 (rs4149014), and SLCO1B3 (rs73233620)—were selected as genetic instruments for serum bilirubin levels using a communitybased cohort, the Korean Genome and Epidemiology Study, comprising 33,598 subjects. We then evaluated their impact on IHD using the Korean Cancer Prevention Study-II cohort.

RESULTS

Among the 5 instrumental variables that showed significant associations with serum bilirubin levels, rs12993249 (USP40) showed the most significant association (p<2.36×10-105). However, we found no significant association between serum bilirubin levels and IHD. Sensitivity analyses demonstrated a consistent association, suggesting that our observations were robust.

CONCLUSIONS

Using two-sample Mendelian randomization, we found no association between serum bilirubin levels and IHD. Further studies that confirm the observed interactions among other ethnicities are warranted.

Summary

Korean summary
이 연구는 대규모 한국인 코호트를 이용하여, 빌리루빈과 허혈성 심장질환의 인과성을 규명한 연구결과이다. 특히 두 가지 자료를 이용한 멘델리안 무작위배정 연구방법을 적용하여, 한국인을 대상으로 빌리루빈과 허혈성 심장질환의 인과성을 처음으로 규명한 점이 큰 시사점을 가진다.

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Xiao-Jie Zhang, He Fei, Chong-Yuan Sun, Ze-Feng Li, Zheng Li, Chun-Guang Guo, Dong-Bing Zhao
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Chaoxiu Li, Wenying Wu, Yumeng Song, Shuang Xu, Xiaomei Wu
Frontiers in Cardiovascular Medicine.2022;[Epub] CrossRef
Another Reason to Cut Down on Alcohol?
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Serum bilirubin and kidney function: a Mendelian randomization study
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Heme Oxygenase-1 and Blood Bilirubin Are Gradually Activated by Oral D-Glyceric Acid
O. Petteri Hirvonen, Maarit Lehti, Heikki Kyröläinen, Heikki Kainulainen
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Exploring the causal pathway from bilirubin to CVD and diabetes in the UK biobank cohort study: Observational findings and Mendelian randomization studies
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Relationship between binge drinking experience and suicide attempts in Korean adolescents: based on the 2013 Korean Youth Risk Behavior Web-based Survey: Kyeong Hyang Byeon, Sun Ha Jee, Jae Woong Sull, Bo Young Choi, Heejin Kimm; Epidemiol Health. 2018;40:e2018046. Published online September 26, 2018; DOI: https://doi.org/10.4178/epih.e2018046

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Abstract PDF Supplementary Material

Abstract

OBJECTIVES
Suicide and drinking problems in adolescents are increasing every year, and it is known that suicide is related to drinking. This study aims to identify the relationship between binge drinking experience (BDE) and suicide attempts in Korean adolescents.

METHODS

The Ninth Korean Youth Risk Behavior Web-based Survey (KYRBS), conducted in 2013, was used for analysis. Multiple logistic regression analysis was used to identify the relationship between BDE and suicide attempts, and the relationship between BDE and suicide attempts in middle and high school students was stratified by age.

RESULTS

BDE and suicide attempts were highly related. The odds ratio (OR) of attempted suicide in BDE was 1.63 times (95% confidence interval [CI], 1.28 to 2.09) higher then non-drinking in males. And the OR of attempted suicide in females was 1.21 times (95% CI, 1.07 to 1.37) higher then non-drinking in non-BDE, 1.79 times (95% CI, 1.47 to 2.19) higher in BDE. BDE was associated with suicide attempts in males aged 12 or 13 years (OR, 3.97; 95% CI, 1.57 to 10.03) and in females aged 15 years (OR, 2.66; 95% CI, 1.79 to 3.96).

CONCLUSIONS

BDE is an important factor related to suicide attempts in adolescents. In order to reduce suicide attempts, it is necessary to educate the youth about the regulation of BDE and drinking prevention.

Summary

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Impaired fasting glucose, single-nucleotide polymorphisms, and risk for colorectal cancer in Koreans: Keum Ji Jung, Miyong To Kim, Sun Ha Jee; Epidemiol Health. 2016;38:e2016002. Published online January 6, 2016; DOI: https://doi.org/10.4178/epih.e2016002

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Abstract Summary PDF

Abstract

OBJECTIVES
Numerous studies have demonstrated that fasting serum glucose (FSG) levels and certain single-nucleotide polymorphisms (SNPs) are related to an increased risk of colorectal cancer (CRC); however, their combined effects are still unclear.

METHODS

Of a total of 144,527 men and women free of cancer at baseline, 317 developed CRC during 5.3 years of follow-up. A case-cohort study (n=1,691) was used, consisting of participants with a DNA sample available. Three well-known SNPs (rs3802842, rs6983267, rs10795668) were genotyped. Hazard ratios (HR) and 95% confidence intervals (CI) of CRC, colon and rectal cancer were calculated, with the Cox proportional hazard models.

RESULTS

The crude incidence rates per 100,000 person-years were 41.1 overall, 48.4 for men, and 29.3 for women. Among participants with dysglycemia, SNPs rs3802842 and rs6983267 were both associated with an increased risk of CRC (HR, 3.2; 95% CI, 1.9 to 5.5 and HR, 1.8; 95% CI, 1.1 to 3.1, respectively) and rectal cancer (HR, 3.4; 95% CI, 1.8 to 6.6 and HR, 3.3; 95% CI, 1.6 to 7.1, respectively). The interaction effect of dysglycemia and SNPs was positive, that is, resulted in an elevated risk of CRC, but was not statistically significant.

CONCLUSIONS

This study demonstrates that both high FSG and certain SNPs are major risk factors for CRC and rectal cancer but that they did not interact synergistically. The difference in effect size of the SNPs according to CRC subtype (i.e., colon or rectal cancer) and presence of dysglycemia merits further research.

Summary

Korean summary
본 연구에서는 공복혈당농도와 대장암과 관련된 단일염기다형성(SNP)과의 관련성을 살펴 보았다. 높은 공복혈당농도와 단일염기다형성(SNP_rs3802842, rs6983267)은 대장암의 주요한 위험요인이었으나, 두 가지 요인의 상호작용으로 인한 시너지 효과는 없는 것으로 나타났다. 대장암의 아형에 따른 다른 효과 크기와 이상혈당증 유무에 따른 향후 연구가 더 필요할 것으로 생각된다.

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The effect of smoking on lung cancer: ethnic differences and the smoking paradox: Keum Ji Jung, Christina Jeon, Sun Ha Jee; Epidemiol Health. 2016;38:e2016060. Published online December 20, 2016; DOI: https://doi.org/10.4178/epih.e2016060

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Abstract Summary PDF

Abstract

The objectives of this review were to determine whether the smoking paradox still exists and to summarize possible explanations for the smoking paradox. Based on published data, we compared the risk of cigarette smoking for lung cancer in Western and Asian countries. We extracted data from the relevant studies about annual tobacco consumption, lung cancer mortality rates according to smoking status from each country, and possible explanations for the smoking paradox. A significantly greater risk of lung cancer death was found among current smokers in Asian countries than among nonsmokers, with relative risks (RRs) of 4.0 to 4.6 for Koreans, 3.7 to 5.1 for Japanese, and 2.4 to 6.5 for Chinese. Although a significantly greater risk of lung cancer was present among current smokers in Asian countries, the RRs in Asian countries were much lower than those reported in Western countries (range, 9.4 to 23.2). Possible explanations for the smoking paradox included epidemiologic characteristics, such as the smoking amount, age at smoking initiation, and the use of filtered or mild tobacco. The smoking paradox definitely exists, but may be explained by major epidemiologic characteristics. Therefore, the smoking paradox should not be interpreted as indicating that tobacco is safer or less harmful for Asians.

Summary

Korean summary
흡연이 폐암에 미치는 관련성의 인종 차이 흡연은 폐암의 가장 큰 원인으로 알려져 있다. 그러나 흡연이 폐암에 미치는 관련성의 크기는 영국, 미국 등 서양에서 발표된 연구결과에서 10-20배 정도로 보고되고 있으나 한국, 일본, 중국 등 동양에서 발표된 연구에서 3-5배 정도로 낮게 보고되고 있다. 이러한 차이는 흡연유행, 담배성분, 흡연자 특성, 그리고 유전적인 차이로 일부 설명되고 있으나 아직 완전히 이해되어진 상태는 아니다. 이는 공중보건학적으로 매우 중요한 의미를 가지므로 동서양의 직접적인 비교연구가 필요할 것으로 생각된다.

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ADIPOQ Gene Variants Associated with Susceptibility to Obesity and Low Serum Adiponectin Levels in Healthy Koreans: Ji Wan Park, Jungyong Park, Sun Ha Jee; Epidemiol Health. 2011;33:e2011003. Published online April 25, 2011; DOI: https://doi.org/10.4178/epih/e2011003

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Abstract

<sec><title>OBJECTIVES</title>This study aimed to measure the association between the adiponectin, C1Q and collagen domain-containing (<italic>ADIPOQ</italic>) gene variants and obesity in Koreans.</sec><sec><title>METHODS</title>Three single nucleotide polymorphisms located in the <italic>ADIPOQ</italic> gene were genotyped in a population-based cross-sectional study of 986 healthy Koreans. Three different case-control groups (i.e. G1, G2, and G3) were defined according to body mass index (BMI) and serum adiponectin levels. Allelic and genotypic associations of this gene with obesity were measured using multivariate logistic regression analyses in each group.</sec><sec><title>RESULTS</title>The G allele of -11377C>G, a polymorphism located in the promoter region of the <italic>ADIPOQ</italic> gene (odds ratio (OR), 1.48; 95% confidence interval, 1.13-1.94) and most haplotypes including this allele significantly increased the risk for obesity. However, the OR decreased from 3.98 (G1 group) to 2.90 (G2 group) and 2.30 (G3 group) when a less strict definition of obesity was used. Most haplotypes, including this allele, significantly increased the risk of obesity. The statistical evidence from the GG genotype of -11377C>G (OR, 3.98) and the GT/GT diplotype composed of -11377G>C and +45T>G (OR, 5.20) confirmed the contribution of the G allele toward a predisposition for obesity.</sec><sec><title>CONCLUSION</title>These results suggest the contribution of the <italic>ADIPOQ</italic> gene toward susceptibility to obesity in healthy Koreans. The high-risk genotypes and haplotypes identified here may provide more information for identifying individuals who are at risk of obesity.</sec>

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Adiponectin is Associated with Impaired Fasting Glucose in the Non-Diabetic Population: Sang Yeun Kim, Sun Ju Lee, Hyoun Kyoung Park, Ji Eun Yun, Myoungsook Lee, Jidong Sung, Sun Ha Jee; Epidemiol Health. 2011;33:e2011007. Published online August 20, 2011; DOI: https://doi.org/10.4178/epih/e2011007

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<sec><title>OBJECTIVES</title>Adiponectin is strongly associated with diabetes in the Western population. However, whether adiponectin is independently associated with impaired fasting glucose (IFG) in the non-obese population is unknown.</sec><sec><title>METHODS</title>The serum adiponectin, insulin resistance (IR), and waist circumference (WC) of 27,549 healthy Koreans were measured. Individuals were then classified into tertile groups by gender. IFG was defined as a fasting serum glucose of 100-125 mg/dL without diabetes. IR was calculated using the homeostasis model assessment of insulin resistance (HOMA-IR). The association of adiponectin and IFG was determined using logistic regression analysis.</sec><sec><title>RESULTS</title>WC and adiponectin were associated with IFG in both men and women. However, the association of WC with IFG was attenuated in both men and women after adjustment for the HOMA-IR. Adiponectin was still associated with IFG after adjustment for and stratification by HOMA-IR in men and women. Strong combined associations of IR and adiponectin with IFG were observed in men and women. Multivariate adjusted odds ratios (ORs) (95% confidence interval [CI]) among those in the highest tertile of IR and the lowest tertile of adiponectin were 9.8 (7.96 to 12.07) for men and 24.1 (13.86 to 41.94) for women.</sec><sec><title>CONCLUSION</title>These results suggest that adiponectin is strongly associated with IFG, and point to adiponectin as an additional diagnostic biomarker of IFG in the non-diabetic population.</sec>

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Cardiovascular Risk Factors for Incident Hypertension in the Prehypertensive Population: Soo Jeong Kim, Jakyoung Lee, Sun Ha Jee, Chung Mo Nam, Kihong Chun, Il Soo Park, Soon Young Lee; Epidemiol Health. 2010;32:e2010003. Published online May 1, 2010; DOI: https://doi.org/10.4178/epih/e2010003

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<sec><title>OBJECTIVES</title>The aim of this study was to investigate the effect of changes in cardiovascular disease (CVD) risk factors on progression from prehypertension (PreHTN) to hypertension (HTN) using an 8-yr prospective Korean Cancer Prevention Study (KCPS) by the National Health Insurance Corporation (NHIC) in Korea.</sec><sec><title>METHODS</title>A total of 16,229 subjects, aged 30 to 54, with new onset preHTN at baseline (1994-1996) in a biennial national medical exam were selected and followed up till 2004 at 2-yr intervals. All subjects underwent a biennial health examination including biochemical measurements and behavior. The log-rank test was performed to assess the relationship between changes in CVD risk factors and progression to HTN. The Cox proportional hazard model was used to identify factors influencing progression to HTN.</sec><sec><title>RESULTS</title>With regards the progression rate in men, ex-smokers (42.9%), abstainers (37.5%), and regular exercisers (37.6%) showed a slower progression rate than continuous smokers (49.5%) and continuous drinkers (50.9%). In women, those who participated in regular exercise (22.6%) had a lower rate of progression than continuous non-exercisers (36.1%). According to the results of the Cox proportional hazard model, improvements in smoking (hazard ratio [HR], 0.756), drinking (HR, 0.669), regular exercise (HR, 0.653), body mass index (HR, 0.715), and total cholesterol (HR, 0.788) played a protective role in progression to HTN in men, while in women, participating in regular exercise (HR, 0.534) was beneficial.</sec><sec><title>CONCLUSION</title>Improvements in CVD-related behaviors diminished the progression rate of HTN. This study suggests that individuals with PreHTN should be targeted for specific health behavioral intervention to prevent the progression of HTN.</sec>

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Association between Alcohol Intake and Abdominal Obesity among the Korean Population: Mikyung Ryu, Heejin Kimm, Jaeseong Jo, Sun Ju Lee, Sun Ha Jee; Epidemiol Health. 2010;32:e2010007. Published online May 19, 2010; DOI: https://doi.org/10.4178/epih/e2010007

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<sec><title>OBJECTIVES</title>Although abdominal obesity has been reported to be highly related with alcohol intake, the results are still inconclusive. Therefore, this study was conducted to explore the association between alcohol and abdominal obesity among the Korean population.</sec><sec><title>METHODS</title>This study included 8,603 participants (men: 5,195, women: 3,408) aged 30 to 87 who visited the health promotion centers in Seoul for routine health examinations from April, 2006 to June, 2007. Abdominal obesity was defined as WC ≥90 cm for men and ≥85 cm for women in accordance with the Korean Society for the Study of Obesity. For ever drinkers, total alcohol consumption in grams was classified into four groups (group 1, non-drinkers; group 2, 1-10 g of alcohol per day; group 3, 11-20 g of alcohol per day; and group 4, over 20 g of alcohol per day).</sec><sec><title>RESULTS</title>The mean age of the study population was 45.4 yr old (men) and 45.3 yr (women). The average waist circumference was 85.3 cm in men and 75.3 cm in women. A high alcohol intake was associated with high waist circumference in both genders. In multivariate analysis, the group of men and women drinkers consuming >20 g in a day had a large waist circumference compared with men and women non-drinkers.</sec><sec><title>CONCLUSION</title>This study showed that a high alcohol intake was related to high waist circumference. Such association remained independently even after adjustment for smoking, which is strongly related to abdominal obesity.</sec>

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Oksoo Kim, Hae Ok Jeon
Nursing & Health Sciences.2011; 13(4): 457. CrossRef

Examples and outlook of family-based cohort study.: Jae Woong Sull, Sue Kyung Park, Heechoul Ohrr, Sun Ha Jee; Korean J Epidemiol. 2008;30(1):49-59. Published online June 30, 2008; DOI: https://doi.org/10.4178/kje.2008.30.1.49

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Family-based designs are commonly used in genetic association studies to identify and to locate genes that underlie complex diseases. In this paper, we review two examples of genome-wide association studies using family-based cohort studies, including the Framingham Heart Study and International Multi-Center ADHD Genetics Project. We also review statistical methods of family-based designs, including the transmission disequilibrium test (TDT), linkage analysis, and imprinting effect analysis. In addition, we evaluate the strengths and limitations of the family-based cohort design. Despite the costs and difficulties in carrying out this type of study, a family-based cohort study can play avery important role in genome wide studies. First, the design will be free from biases due to population heterogeneity or stratification. Moreover, family-based designs provide the opportunity to conduct joint tests of linkage and association. Finally, family-based designs also allow access to epigenetic phenomena like imprinting. The family-based cohort design should be given careful consideration in planning new studies for genome-wide strategies.; Summary

Evaluation of risk prediction model for stroke risk based on Cox's and Weibull model in Korea.: Youn Nam Kim, Ur Rin Cho, Byung Ho Nam, Il Soo Park, Sun Ha Jee; Korean J Epidemiol. 2008;30(1):41-48. Published online June 30, 2008; DOI: https://doi.org/10.4178/kje.2008.30.1.41

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OBJECTIVE: The objective was to compare Cox proportional hazards model and Weibull model for predicting long-term probabilities for stroke risk in the Korean Cancer Prevention Study(KCPS).
METHODS
The subjects comprised of 385,279 Korean aged 55 to 64 years who received health insurance from the National Health Insurance Corporation and who had medical examinations in 1992 and 1995. 70% of the subjects were used for model building and the rest for model evaluation. The final prediction model for stroke includes age, systolic blood pressure, diabetes, total cholesterol and smoking. Subjects were follow-up for identification of incident stroke cases between 1993 and 2005. Comparisons included predicted coefficients of stroke risk factors, incidence probabilities over 10 years, and the area under a receiver operating characteristics (ROC) curve for both Cox's proportional hazard model and Weibull model.
RESULTS
The average age of study population was 55.5 years in men and 56.3 years in women, respectively. Percentage of men and women in study population were 58.0% and 42.0%, respectively. The study findings satisfied proportionality according to the two models. There was no significant difference in coefficients between the two models of prediction models in men and in women. Moreover, there was no difference in incidence probabilities of stroke and c-statistics. C-statistics were 0.68 for men as same as for women.
CONCLUSION
There was no difference for the prediction of the stroke risk in the Korean population using Cox's proportional hazard model and Weibull model, thus the two models were found to be efficient for this purpose.; Summary

The Association Between Adiponectin and Diabetes in the Korean Population.: Sun Ha Jee, Hee Yeon Lee, Sun Ju Lee, Ji Eun Yun, Eun Jung Jee, Hye Yun Song, Sang Yeun Kim, Jungyong Park, Hyon Suk Kim; Korean J Epidemiol. 2007;29(2):176-186.

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BACKGROUND
As indicators of obesity, waist circumference (WC), body mass index (BMI), and adiponectin are well known risk factor for diabetes mellitus. The objectives of this study were to measure the independent association between these obesity indicators and diabetes and to examine the combined effect of these indicators on diabetes in a Korean population.
METHODS
The WC, BMI, and serum adiponectin were measured in 6,505 healthy Koreans and were classified into tertile groups for men and women. The independent and combined associations of the obesity indicators with diabetes were measured using logistic regression analyses. Diabetes was defined as fasting serum glucose greater than 126 mg/dL or taking medication.
RESULTS
Levels of adiponectin were inversely associated with BMI and WC and directly associated with age and high density lipoprotein cholesterol (HDL) cholesterol (P <0.001). After adjusting for age, WC, and other lifestyle factors, low levels of adiponectin were associated with an increased prevalence of diabetes. Further adjustment for HDL cholesterol and triglyceride attenuated this association in both men and women. The best cut-off value of adiponectin in terms of identifying the presence of diabetes was 5.5 /ml with a sensitivity and specificity of 46.7% and 63.9% for men and 9.5 /ml with a sensitivity and specificity of 68.2% and 55.2 for women.
CONCLUSIONS
These results suggest that adiponectin was associated with diabetes. The association was independent of WC and was partly modified by HDL and triglyceride. There were no effect modifications of adiponectin with WC on diabetes.; Summary

Development of ELISA-kit of Quantitative Analysis for Adiponectin and Their Correlation with Cardiovascular Risk Factors.: Sun Ha Jee, Seungbok Lee, Sungsik Min, Jungyong Park, Hyon Suk Kim, Sang Yeun Kim, Ji Eun Yun, Sun Ju Lee, Eun Jung Jee, Hee Yeon Lee, Hye Yun Song; Korean J Epidemiol. 2007;29(2):165-175.

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PURPOSE
S: To develop a rapid, sensitive, qualitative ELISA-kit for serum adiponectin and examine correlation with adiponectin and cardiovascular risk factors.
METHODS
On the base of monoclonal antibodies against adiponectin, apply indirect ELISA to study the performance parameter of the kit. The correlation was examined between adiponectin and cardiovascular risk factors including waist circumference, body mass index, triglyceride, and HDL cholesterol.
RESULTS
The limited concentration of detection of the ELISA-kit was 1ug/ml. Linearity with R&D system and AdipoGen with this ELISA-kit was acceptable: the linear equation with R&D system was y=1.0116x + 0.4629 (R2=0.97) and linear equation with AdipoGen was y=0.9562x + 1.1961 (R2=0.93), respectively. The average recovery rate of the ELISA-kit ranged 92 to 104%. The correlation coefficient of waist circumference with adiponectin was -0.2276 (p<0.0001) among men and -0.2328 (p<0.0001) among women.
CONCLUSION
This ELISA-kit was quick, sensitive, and stable and can be used to determine adiponectin in serum.; Summary

The association between insulin resistance and Framingham risk score among type 2 diabetes.: Hee Sook Park, Ji Eun Yun, Soo Jin Yoon, Eurin Cho, Kyung A Ahn, Seok Won Park, Chul Woo Ahn, Dae Jung Kim, Young Duk Song, Young Ju Choi, Mi Ae Cho, Eun Jig Lee, Kap Bum Huh, Sun Ha Jee; Korean J Epidemiol. 2007;29(1):46-58.

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BACKGROUND
AND PURPOSE: Insulin resistance has been known to be associated with the risk of cardiovascular diseases. However, the relationship with Framingham risk score among type 2 diabetes has not been well known. We investigated the relationship between insulin resistance (IR) and the Framingham risk score(FRS) among type 2 diabetes in Korea.
METHODS
We estimated the 5-year risk of ischemic heart disease(IHD) based on Framingham equation among 1,941 diabetes patients(1,294 men and 647 women), who visited Huh's clinic, enrolled from January 2003 to June 2006. IR, which was measured by insulin tolerance test (ITT), was divided into five groups(Q1 to Q5). High risk of IHD was defined as upper 10 percentile of FRS. Multivariate regression and logistic regression models were used to see independent association of higher quintiles of IR level, compared with lowest quintile(Q1) for the risk of IHD.
RESULTS
Mean (+/-standard deviation) 5-year FRS of study subjects were 8.40%(+/-6.89) for men and 5.92%(+/-5.23) for women. There were significant correlation between IR, body mass index, HbA1C, fasting glucose, triglyceride, LDL-cholesterol, C-peptide and FRS in both men and women. After adjusting for triglyceride, LDL-cholesterol, C-peptide, multivariate regression model analysis showed that IR was independently associated with the FRS. A positive association between IR and high risk of IHD was observed in men: highest versus lowest quintile of IR (odds ratio 5.45 in men and 4.71 in women).
CONCLUSION
Increased IR level was independently associated with risk of IHD measured by FRS among type 2 diabetes in Korea.; Summary

Framingham Equation Model Overestimates Risk of Ischemic Heart Disease in Korean Men and Women.: Kyung A Ahn, Ji Eun Yun, Eo Rin Cho, Chung Mo Nam, Yangsu Jang, Sun Ha Jee; Korean J Epidemiol. 2006;28(2):162-170.

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BACKGROUND
The prediction of the absolute risk of ischemic heart disease (IHD) is commonly based on the risk prediction equations, originated from the Framingham Heart Study.
METHOD
Framingham equation model was applied to participants from 2001 Korean National Health and Nutrition Examination Survey (KNHNES) to estimate the 5 year risk of IHD among Koreans ranging from 30 to 74 year-olds. The estimated risks were compared to the incidence and admission rates from two statistical reports among Koreans. Five year admission rate was estimated by the annual report from National Health Insurance Corporation (NHIC).
RESULTS
The average ages (standard deviation) were 34.31(27.23) year-old for KNHNES and 48.26(12.87) year-old for Framingham population used in this study. The risk of IHD predicted by the Framingham equation model substantially exceeded the risks actually reported in Korea. Five-year predicted risks by Framingham equation model were 4.86% for men and 1.93% for women; whereas from incidence data in Korea, five-year risks for acute myocardial infarction (AMI) were for 0.47% for men and 0.18% for women. These AMI incidence was similar to the admission rate (0.34 for men and 0.15 for women) estimated by NHIC. Also, 5-year admission rate of IHD were 1.16 for men and 0.78 for women. The magnitude of risk overestimation by Framingham mode is approximately at least 150 to 320%.
CONCLUSION
Korean guidelines for the management for high risk group of IHD need to develop and correct for overestimation to avoid inflation of costs in primary prevention.; Summary

Smoking-Attributable Mortality Among Korean Adults: 1981-2003.: Sun Ha Jee, Ja Kyoung Lee, Il Soon Kim; Korean J Epidemiol. 2006;28(1):92-99.

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OBJECTIVES
Cigarette smoking has been widely recognized as a major risk factor for lung cancer and other diseases in Western countries. In Korea, male cigarette smoking prevalence is among the world's highest and smoking has also become a strong risk factor for lung cancer and cardiovascular diseases. The objectives of the study were to calculate the smoking-attributable mortality in Korea and to predict future smoking-attributable mortality based on the observed data.
METHODS
Number of smoking-attributable deaths were calculated by applying the percentages of population attributable risks (PARs) to the estimated number of deaths by diseases. In this study, PARs were obtained by using relative risks from Korean Cancer Prevention Study and population smoking prevalence.
RESULTS
Among adult male, the smoking-attributable mortality (40,087) represents 30.75% of total 2003 mortality, whereas the smoking-attributable mortality (6,120) for adult females was 5.70%. Smoking was supposed to be responsible for 37.29% of all male cancer and 26.73% of all male cardiovascular diseases, whereas smoking for 4.68% of all female cancer and 5.93% of all female cardiovascular diseases in Korea.
CONCLUSION
Smoking actually represents a remarkable burden of avoidable deaths in Korea. Smoking-attributable mortality appears to continue increasing in the last years.; Summary

Insulin resistance and cancer.: Hee Jin Kim, Sun Ha Jee; Korean J Epidemiol. 2005;27(2):38-50.

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Both obesity and diabetes have been proposed as risk factors of cancer. Obesity may be a more significant health problem, which can increase the risk of cancer and cardiovascular disease, which is the most common cause of death. Insulin resistance and metabolic syndrome are suspected of being correlated with cancer risk. Most studies are carried out on the assumption that obesity, diabetes, cardiovascular disease, and cancer are different conditions. However, they have common risk factors-smoking, obesity, and physical inactivity. Although the pathways leading to these diseases are unknown, we brought a focus into the multi-dimensional pathways instead of single pathogenesis. The interaction between pathogenesis can be thought to start from risk factors, and through pathogenesis, diseases can also lead to a severe cause of death. Epidemic of obesity and diabetes is a significant and growing public health problem. This paper reviewed the evidences of the correlation between insulin resistances and cancer and we explored whether insulin resistance may contribute to carcinogenesis.; Summary

Smoking and cause of death in Korea: 11 years follow-up prospective study.: Sun Ha Jee, Ji Eun Yun, Jung Yong Park, Jae Woong Sull, Il Soon Kim; Korean J Epidemiol. 2005;27(1):182-190.

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OBJECTIVE: In Korea, male smoking prevalence is among the world's highest and mortality rates from smoking-caused cancers, particularly lung cancer, are escalating. This cohort study examined the effects of cigarette smoking on the risk of mortality from all causes, cancers and cardiovascular diseases(CVD), and characterized the relationship of the risk with the amount and duration of cigarette smoking.
METHOD
A eleven-year prospective cohort study was carried out of on 1,207,592 Koreans, 30 to 95 years of age. The study population includes participants in a national insurance program, who completed a questionnaire on smoking and other risk factors. The main outcome measures were death from all causes, cancer and CVD, obtained through record linkage. At baseline, 482,997 men(60.0%) and 19,755(5.3%) women were current cigarette smokers.
RESULTS
In multivariate Cox proportional hazards models, controlling for age, alcohol drinking, exercise, and obesity, current smoking among men increased the risks of mortality from all cause death (relative risk[RR], 1.56; 95% confidence interval[CI], 1.52~1.59), all cancer (1.75, 1.68~1.82), and CVD(1.46, 1.38~1.55). Similar results were found for mortality among women. Smoking also increased the risks of mortality for cancer of the lung(4.60, 4.09~5.33) and other cancers, including larynx, bile duct, esophagus, liver, stomach, pancreas, bladder, and also leukemia. Current smoking among women increased the risk of lung cancer mortality(RR=2.83, 95% CI 2.38~3.36).
CONCLUSION
In Korea, smoking is an independent risk factor for death from all causes, CVD and a number of major cancers. The findings affirm the need for aggressive tobacco control in Korea in order to minimize the epidemic of smoking-caused disease.; Summary

Heritability and segregation analysis of the level of HDL-cholesterol.: Ji Eun Yun, Chung Mo Nam, Il Suh, Sun Ha Jee; Korean J Epidemiol. 2004;26(2):43-53.

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OBJECTIVES
The purpose of this study was to investigate the familial correlation and heritability in HDL cholesterol through segregation analysis.
METHODS
This study, based on data from 11,117 Korean individuals ascertained pedigrees who had participated in 1998 and 2001 Korean National Health & Nutrition Examination Survey. The subjects of segregation analysis were 4,688 Korean who had more than five members in their family.
RESULTS
Serum lipid levels revealed strong familial correlation among spouses, parent-offspring and siblings with low correlation of spouse. The heritability of HDL cholesterol was 54.8% after controlling for age, age2, gender, agexgender, waist circumference, smoking, alcohol drinking, exercise and education. Two models of inheritance, the Mendelian dominant model and the Mendelian codominant model were found in HDL cholesterol. In the codominant model, the predicted HDL-cholesterol for genotype AA, AB, and BB were 44.96, 49.13, and 69.67 mg/dl, respectively. However the Mendelian codominant model only was found in high risk families.
CONCLUSIONS
In conclusion, randomly ascertained Korean families of this study showed strong familial aggregation in HDL cholesterol. The results suggested that the variations in HDL cholesterol may be influencing by major effect of gene.; Summary

Development of the Individualized Health Risk Appraisal Model of Breast Cancer Risk in Korean Women.: Sun Ha Jee, Ji Won Song, Chung Mo Nam; Korean J Epidemiol. 2004;26(1):50-58.

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OBJECTIVES
The objectives of this study were to develop a health risk appraisal (HRA) model of breast cancer and to evaluate the model's ability to accurately predict ndividual breast cancer risk.
METHOD
The sample data were from a prospective cohort study in Korea with a follow-up period of 8 years in Korea (1995-2002). The cohort was composed of 108,708 Korean women, aged 30 to 64 years, who received health insurance from the Korea Medical Insurance Corporation and who underwent a medical evaluation in 1994. Between 1995 and 2002 (1,138,349 person-year), there were 772 incident cases of breast cancer (67.8/100,000 person-years). First, we developed the HRA based on the Cox proportional hazard models using a prospective cohort data with half-split data (50% random sample). Second, using Cox proportional hazard models, we compared the probability of breast cancer predicted by the model to the actual number of cases observed in the other 50% of the random sample of the study population.
RESULTS
The HRA Cox proportional hazard model of breast cancer developed in the study included age, age2, age at menarche, and lactation. Multivariate Cox proportional hazards models were used to test the HRA model validation. Compared with women in the lowest 10 percentile of subjects, women in the highest 10 percentile had an increased risk of breast cancer (relative risk, 3.701; 95% confidence interval, 2.554 to 5.364).
CONCLUSION
The model's performance was satisfactory for estimating breast cancer risk for individual women aged 30-64 years.; Summary

Estimation of heritability attributable to single-locus effects with a regression of offspring on mid-parent (ROMP) method for cardiovascular risk factors.: Sun Ha Jee, Jung Yong Park, Ji Eun Yoon, Minji Kim, Eun Young Cho, Yang soo Jang; Korean J Epidemiol. 2003;25(1):24-31.

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PURPOSE
The objective of this study was to estimate the heritability attributable to single-locus effects with a regression of offspring on mid-parent (ROMP) method for cardiovascular risk factors.
METHODS
The regression of offspring on mid-parent is determined with and without the inclusion of a single-locus effect, and the difference between the slopes of these two regression is an estimate of the heritability attributable to the single-locus effect. The study population included 1,550 family members of 295 patients, derived from cardiovascular genome center. The risk factors considered were total serum cholesterol, triglyceride, LDL cholesterol, apoAI and apoB. Heritability was estimated from the slope of the linear regression of offspring on mid-parents.
RESULTS
Estimated heritability was 35 to 46% for total cholesterol with 6.2% attributable to polymorphism S128R. For triglyceride, the estimated heritability was 47.6% with 2% attributable to polymorphism G-217A. The heritability was 36-46% for LDL-cholesterol. For LDL cholesterol, S128R specific effect was 8.7%. Estimated heritability was 62.2% for apoAI with 3.2% attributable to polymorphism G-217A and 58 to 75% for apoB with 5.4% attributable to polymorphism S128R.
CONCLUSIONS
These traits were significantly associated with polymorphism S128R. These results highlight the importance of considering genetic factors in studies of cardiovascular risk factors. Unlike traditional population-based tests of association, ROMP appears to be robust with respect to population stratification.; Summary

Test-retest Reliability of a Self-Administered Smoking Questionnaire for Middle and High School Students.: Sun Ha Jee, Ji Eun Yoon, Soyoung Won, Sujung Kim, Il Suh; Korean J Epidemiol. 2003;25(1):16-23.

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PURPOSE
Since 1988, the annual or biannual survey was conducted by Korean Association of Smoking and Health (KASH) to examine the smoking rate, knowledge and attitude on smoking of students attending middle and high school in Korea. The objective of this study was to investigate the test-retest reliability of self-administered smoking questionnaire for Korean middle and high school students.
METHODS
For the test-retest study, we sampled 30 school among 106 schools which participated in annual survey on June of 2002. Among 30 schools, 26 schools (86.7%) were responded for this study.
RESULTS
1) For the subjects of 1st and 2nd surveys, there were no difference on smoking related variable including attitude, knowledge, perceived health status, father's smoking status, friend's smoking status, willingness to smoke, and readiness to quit smoking 2) For middle school students among male, current smoking rates were 3.5% for 1st survey and 3.0% for 2nd survey, which was statistically no significant. For high school students, however, current smoking rate of 1st survey was higher (21.1%) than that of 2nd (18.2%), although the rate was not significantly differed. 3) For middle school students among female, current smoking rates were 1.1% for 1st survey and 3.3% for 2nd survey, which was statistically no significant. Corresponding rate for high school students were 9.8% and 11.4%, respectively.
CONCLUSION
The results indicated that smoking questionnaire has been conducted by KASH is reliable for use in estimation for prevalence of smoking for middle and high school students.; Summary

The Study on Active and Environmental Tobacco Smoke in Biological Samples among High School Students in Korea .: Sun Ha Jee, Su jung Kim, So young Won, Ho Sang Shin, Chang Su Kim, Hee Ja Kim; Korean J Epidemiol. 2002;24(1):83-92.

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PURPOSE
The objective of this study was to determine the active and environmental tobacco smoke (ETS) in biological samples (plasma, saliva and urine) among high school students in Korea.
METHODS
Study samples were from 99 nonsmoker or smoking volunteers from high school in Kyungki-do in 2000. ETS was defined as the having smokers of their family members or their friends. Urinary samples were extracted with ethyl ether at pH 10.5, and the extract was injected in GC-NPD. Plasma or saliva was extracted with methylene chloride at pH 10.5 and the quantification was performed with GC-MS (SIM). Peak shapes and quantitation of nicotine and cotinine were excellent, with linear calibration curves over a wide range of 1 to 3000 ng/mL.
RESULTS
The results are as followings1. The prevalence of smoking among study subjects were 18.2% among males and 6.1% among females. A 69.7% of total subjects among both males and females were exposed at ETS. 2. The primary metabolite cotinine of nicotine was good indicator of ETS exposure in nonsmokers. Salivary cotinine was found to be highly correlated to the concentration of cotinine in plasma (r=0.9480). 3. Urine cotinine was increased among those with smokers in their family members, while salivary or blood cotinine was increased among with smoking friends. 4. Blood cotinine was highly correlated with salivary cotinine, but it was relatively poorly correlated with urine cotinine.
CONCLUSIONS
In conclusion, the results show how the students in high school in Korea suffer from secondhand smoke. It appeared that salivary cotinine was easy to collect and best way to predict the ETS among adolescents; Summary

Genetic Contribution to Cardiovascular Risk Factors in Korea: The Results from the 1998 Korean Nationwide Health and Nutrition Examination Survey.: Sun Ha Jee; Korean J Epidemiol. 2001;23(1):36-42.

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PURPOSE
The purpose of this study was to estimate the heritability for cardiovascular disease(CVD) risk factors such as obesity, serum lipids, blood pressure and putative other risk factors.
METHODS
Familial correlations and heritability in CVD risk factors were investigated with use of data from a community-based sample of 435 families involving 2,507 persons collected in the 1998 Korean Nationwide Nutrition and Health Examination Survey over the period November to December in 1998. The risk factors considered were obesity indexes such as waist circumference(WC), hip circumference(HC), waist-to-hip ratio(WHR), body mass index(BMI), serum lipids(total cholesterol, LDL- and HDL- cholesterol and triglyceride), systolic and diastolic blood pressure(SBP and DBP) and other putative risk factors(fasting blood sugar, creatinine, platelet, blood urea nitrate).
RESULTS
First, the estimated heritabilites for obesity variables were 49.5% for WC, 46.6% for BMI, 43.2% for WHR and 39.2% for HC. Second, the estimated heritabilites for well-established CVD risk factors were 53% for LDL-cholesterol, 52% for total cholesterol, 52% for HDL-cholesterol, 24% for triglyceride, 39% for SBP and 30% for DBP. Third, the estimated heritabilites for the putative CVD risk factors were 39% for platelet, 39% for fasting blood sugar, 34% for blood urea nitrate, and 32% for creatinine level.
CONCLUSION
Future linkage studies in these families may be worthwhile to further clarify the molecular basis for biological mechanisms controlling these CVD risk factors showing high heritability.; Summary

Segregation Analysis of Serum LDL-cholesterol in Korean Families of Coronary Heart Disease Patients.: Jung Yong Park, Sun Ha Jee, Kyung Soon Song, Won Heum Shim, Soo Jeong Kim; Korean J Epidemiol. 2000;22(2):116-123.

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PURPOSE
S: The aim of this study was to investigate the familial correlation of lipid profile and the mode of inheritance of LDL-cholesterol through segregation analysis. The study population included 414 family members of 67 Probands who had a coronary heart disease.
METHODS
Gene frequency(qH) of the allele for high LDL-cholesterol levels, means of each genotypes, and other putative gene related parameters were estimated. Maximum likelihood methods were used to fit several genetic and nongenetic modes of inheritance to these data to determine if an unobserved Mendelian major gene could explain the familial distribution of LDL-cholesterol. LDL-cholesterol levels were adjusted for age, gender, body mass index, smoking and alcohol consumption.
RESULTS
LDL-cholesterol levels revealed familial correlation among spouses, parent-offsprings and siblings with correlations of 0.10, 0.22, and 0.32, respectively. The heritability of LDL-cholesterol was 53%. Two models of inheritance in LDL-cholesterol distribution, the Mendelian codominant model and the polygenic equal transmission model were found. Comparison of these two models in each family among 67 families showed that thiry-six families favored the major gene model with Mendelian codominant and thirty-one families favored the polygenic model of equal transmission. In families favoring Mendelian codominant inheritance, means of each genotypes; LL, HL, HH were 102.1, 143.3, 248.4 mg/dl and gene frequency of H allele was 0.08. In families favoring equal transmission inheritance, means of each genotypes were 101.6, 122.7, 185.5 mg/dl and gene frequency of H allele was 0.14.
CONCLUSIONS
In conclusion, families of coronary heart disease patients of this study showed substantial familial correlation and results suggested that variation in LDL-cholesterol may be influenced by major gene effect.; Summary

A Study of Major Gene Dominant Family for Factor VII Concentration: Segregation Analysis.: Sun Ha Jee, Kyung Sooon Song, Won Heum Shim, Il Suh, Hyun Kyung Kim, Young Sup Yoon, Eunna Go, Jung Yong Park, Miyang Kim, Sujeong Kim; Korean J Epidemiol. 1999;21(2):176-184.

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Elevated plasma level of factor VII is a risk factor for coronary artery disease. We investigated environmental, familial, and genetic influences on factor VII levels. We used maximum likelihood segregation analysis to fit several genetic and nongenetic modes of inheritance to the data to determine whether Mendelian inheritance of a major gene could best explain the familial distribution of factor VII. The study population included 414 family members of 67 subjects who had undergone elective coronary arteriography. The factor VII level was adjusted for age, gender, body mass index, smoking and alcohol drinking (R2=20.6%). Factor VII levels revealed strong familial aggregation with estimated correlation spouse of 0.12, parent-offspring of 0.31, and siblings of 0.40. Regressive models were used to examine inter-individual variation in adjusted factor VII levels in these 67 families. This analysis strongly favored a major gene model with codominant transmission. Genotypic means were 111.6, 123.2, and 184.3% with relative frequencies of 59.4%, 35.4%, and 5.2%. This putative major gene explains 39.9% of the total variance of factor VII. Likelihood was used to search for etiologic heterogeneity by sorting pedigrees into groups that favor one model over another. Compared to pedigrees less favoring Mendelian models, pedigrees favoring Mendelian codominant models have almost 8 times earlier onset of coronary heart disease. These family data suggest that there are strong familial and genetic effects on the factor VII activity in these high risk families. Therefore, linkage studies in these families may be worthwhile to clarify the molecular basis of factor VII levels.; Summary

The Changing Pattern of Cigarette Smoking of Students in Junior and Senior High Schools in Korea: 1988-1997.: Il Suh, Sun Ha Jee, Soh Yoon Kim, Dong Choun Shin, Soh Yeon Ryu, Il Soon Kim; Korean J Epidemiol. 1998;20(2):257-266.

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In order to examine the actual condition of smoking, the change of knowledge and the attitude on smoking of the students attending junior and senior high schools in Korea, the survey was performed six times ranging from 1988 to 1997. The first two years, the survey was performed only for male students. Since 1991, both male and female students were surveyed. The students in junior and senior high school were selected by a random sampling method and surveyed by mail. In this survey, the number of classes of Junior and senior high schools in Korea was a sampling unit, and the classes were selected in proportion to the number of classes of each city and each county. The total number of respondents was 3,437 in 1988, 3,055 in 1989, 6,087 in 1991(2,923 of male, 3,164 of female), 7,067 in 1993(3,162 of male, 3,905 of female), 5,412 in 1995(2,598 of male, 2,814 of female), 4,754 in 1997(2,281 of male, 2,473 of female). The results obtained from the data analysis are as follows; 1.The ratio of smokers among male junior high school students has increased from 1.8% in 1988 to 3.9% in 1997. The ratio of smokers among female junior high school students has increased from 1.2% in 1991 to 3.9% in 1997. The ratio of smokers among male senior high school students has increased from 23.9% in 1988 to 35.3% in 1997. The ratio of smokers among male senior high school students has increased from 23.9% in 1988 to 35.3% 1997. And the ratio of smokers among female senior high school students has increased from 3.0% in 1991 to 8.7% in 1997. Especially the ratio of smokers among female junior high school students is same as that of male in 1997. 2. With respect to areas, the number of current smokers and the experienced ones was higher in the county than in the city in 1988. But in 1997, the number of current smokers and the experienced one is higher in the city than in the county. 3. In respect of whether or not there is a smoker among the member of a family, the odds ratio of smoking among the male senior high school students was 1.70 in 1988 and 1.94 in 1997. the odds ratio of smoking among female senior high school students was 1.43 in 1991 and 1.98 in 1997. This result showed that the effect of family smoking on adolescent smoking has not decreased.; Summary

A Case-Control Study on Risk Factors of CHD: Vegetable consumption and risk for CHD in Korean men.: Kyung Won Oh, Il Suh, Kang Hee lee, Chung Mo Nam, Suk Il Kim, Hyung Gon Kang, Sun Ha Jee, Seung Yun Cho, Won Heum Shim; Korean J Epidemiol. 1998;20(2):234-245.

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The purpose of this study was to investigate the association of vegetable consumption with the incidence of CHD in Korean men by a case-control study. The case group consisted of 108 patients with EKG-confirmed myocardial infarct or angiographically-confirmed(>or=50% stenosis) angina pectoris admitted to a university teaching hospital in Seoul, Korea. Controls were 142 age-matched patients admitted to the departments of ophthalmology and orthopedic surgery at the same hospital. Dietary intake was assessed by a nutritionist using a semiquantitative food frequency method, while body mass index (BMI), tobacco use, and past history of cardiovascular disease were determined during an interview and examination. The consumption of vegetables was classified by the average frequency of intake(less than 3 times/week, 3~4 times/week, 5~6 times/week, more than once/day). The percentage of subjects who consumed vegetables less than 3 times per week was 29.6% for cases and 17.6% for controls; while men who consumed vegetavle more than once per day were 16.7% for cases and 32.4% for controls. After the adjustment for age, body mass index, and tobacco use, the odds ratio of men who consumed vegetables at least once per day was 0.38(95% confidence interval, 0.18-0.85) compared with men who consumed vegetables less than three times per week. These results suggested that in a population with a relatively low fat intake, consumption of vegetables at least once per day may reduce the risk of CHD in men.; Summary

Segregation Analysis in Genetic Epidemiology.: Sun Ha Jee; Korean J Epidemiol. 1997;19(2):95-102.

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Abstract PDF: Abstract
Genetic epidemiology is an emerging field with diverse interests, one that represents an important interaction between the two parent disciplines: genetics and epidemiology. Segregation analysis was originally designed to test whether or not an observed mixture of phenotypes among offspring is compatible with Mendelian inheritance. Over the years, segregation analysis has broadened to encompass, but the ultimate goal is the same: to test for compatibility with Mendelian expectations by estimating parameters of a given model of inheritance. Segregation analysis tests explicit models of inheritance on family data. The analytic strategy relies heavily on fitting genetic models, along with a few arbitrary nongenetic models, and selecting the model that best explains the data. While showing an adequate fit to a genetic model of inheritance in a single data set does not constitute proof that a trait or disease is in truth under genetic control, it may be considered strong statistical evidence. Even though segregation analysis has its limitations, it remains a powerful tool for identifying genetic mechanisms that may control traits associated with disease or contribute to disease risk.; Summary

Comparisons of cholera bacilli positive and negative patients in symptoms and laboratory findings among 1991 cholera patients.: Hee Choul Ohrr, Sun Ha Jee, Kyu Sang Kim, Yun Hwan Lee; Korean J Epidemiol. 1996;18(2):713-181.

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Abstract: Abstract
Among 130 cholera patients treated in Seohae Hospital in 1991, 86 were cholera bacilli positive and remaining 44 were negative. All cholera bacilli 'positive' patients were confirmed bacteriologically by National Institute for Health team. Cholera related symptoms and laboratory findings were gathered by interviews and medical records surveys. Symptoms and some serological laboratory findings are compared between cholera bacilli 'positive' and 'negative' patients in 1991 cholera epidemic. Results are as follows: 1. There were no differences in symptoms distribution and in mean values of all serological laboratory tests done between two groups. These facts support that both cholera bacilli 'positive' and 'negative' patients are persons who have cholera bacilli infection. 2. The age distribution of the cholera bacilli 'negative' group tended to be much younger than that of 'positive' group. The infection source of this group is believed to be the environmental reservoir. This findings suggests that cholera bacilli 'negative' patients have the possibility of endemic characteristics. We think it is worth investigating Vibrio cholera antibody titers of people in area with frequent cholera epidemics in Korea.; Summary

A Study on the Effect of Symptoms to Diagnosis Interval on the Cancer Survival.: Hee Jung Kang, Hee Choul Ohrr, Hee Ok Kim, Sun Ha Jee, Tae Yong Shon; Korean J Epidemiol. 1996;18(2):160-172.

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For many years, members of medical profession have believed that the shorter symptoms to diagnosis interval(SDI) might be related to early stages and that the prompt treatments might improve survival rates in cancer patients. But this notion has been challenged by many researches for many years. This study was conducted to investigate the effects of SDI on the cancer survival for 221 stomach cancer cases, 106 lung cancer cases, 74 liver cancer cases and 59 cervix cancer cases. These cancer cases are registered ones in Kanghwa Cancer Registery Program from 1987 to 1991. Relationships among SDI, stages of cancers, operation rates, and survival were analysed. Results are as follows: 1. SDI was not related to stages of cancer. There were no difference in the distribution of stages among five SDI subgroups. 2. This data did not support that SDI affects the survival of stomach cancer patients. The cancer stages did affect survival in stomach cancer patients though. 3. Our data did not support that SDI affects cancer survival. A Cox proportional hazard model showed that SDI does not play a important role in cancer survival controlling age, gender, stage and other variables in the model. Further studies are highly expected to clarify the relationships between SDI and cancer survivals. Researches with bigger sample size and more sophisticated variables would be needed.; Summary

Self Rated Health and Mortality in Elderly Kangwha Cohort, 8-year follow up.: Hee Choul Ohrr, Sun Ha Jee, Il Soon Kim; Korean J Epidemiol. 1994;16(2):172-180.

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The effect of self rated health on all cause mortality was. examined in a community residents sample of 2, 848 men and 3, 534 women aged 55 years or over who has been followed for eight years, 1985-1993. This longitudinal study, conducted in Kangwha County, Keanggido, began in 1985 with baseline examinations of physical and life style characteristics. The results indicate that the self-rated health has a profound and independent effect on all cause mortality during the study period. Cox's hazard model estimates that persons with 'poor' self-rated health has 1.7 times (CI 1.2-2. 6) higher risk of all cause mortality than persons with 'excellent' self-rated health and persons with 'worst' one has 4.2 (CI 2.6-6.2) in male. Estimates for women are similar to those of men. Further researchs to investigate the effects on cause specfic mortality and effects to reveal the work mechanism of self-rated health are highly expected.; Summary

A Case-control Study of Risk Factors in Stomach Cancer.: Sang In Lee, Hee Choul Ohrr, Sun Ha Jee, Jung Sook Joo; Korean J Epidemiol. 1994;16(2):145-154.

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Stomach cancer is the most common cancer in Korea with highest mortality. Therefore, finding risk factors involved in its prevention is vitally important. Case-control study was done to demonstrate the relationship between smoking, drinking, food, nutrition, 5% salt solution and the incidence of stomach cancer. The study group consisted of 82 patients with stomach cancers confirmed by pathology as case group and 113 patients with chronic superficial gastritis as control. General characteristics, smoking and drinking habits, dietary habit according to food groups, individual preference to salty and spicy foods were analyzed. Subjects had undergone taste test with 10cc of 0.5% salt solution. Age adjusted odds ratios by Mantel-Haenszel test were performed for each variable. 1. Smoking in males had no direct relationship with incidence of stomach cancer, but in females there is a higher odds ratio in smoking group (OR=2.63). Drin-king had no effect on the odds ratio in males, whereas in females, the odds ratio was significantly decreased in drinking group (OR=0.25). 2. Consumption of fruits in females showed a protec-tive effect on developing stomach cancer (OR=0.41). Males who had more protein and iron intake were found to have significantly higher odds ratio for stomach cancer risk (protein OR=2.86, iron OR=5.18). 3. Salty diet habit in females showed a higher odds ratio for stomach cancer risk (OR=2.49). No correlation was found between spicy diet habit with stomach cancer. 4. Male subjects who did not feel salty with 0.5% salt solution showed significantly increased odds ratio (OR=4.59) for stomach cancer. This study is limited due to fact that the number of subjects was not large enough for indepth evaluation and that other confounding factors other than age was not sufficiently controlled. Further investigation that concerns ingestion of fruit group, the level of subjects' taste to 0.5% salt solution, and protein and iron intake on a larger scale is recommended.; Summary

Effect of anti-smoking education on male high school students.: Tack Min Kim, Sun Ha Jee, Heechoul Ohr; Korean J Epidemiol. 1992;14(2):175-183.

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In order to examine the effect of an anti - smoking education method on smoking, a untreated control group design with pretest and posttest study were conducted with self - completing questionnaire in 1990 and 1991. A total of 247 male students from one high school in Wonju made the experimental group and another 236 students made the comparison group in this study. Anti - smoking education, with a forty - minute demonstration about danger of smoking and a twenty - minute - long video tape education, was given to the experiment group. The results were as follows : 1. The smoking prevalence of the experiment group and the comparision group were 11.5% and 14.5% respectively at baseline. Smoking prevalence of the experiment group increased to 16.0% and that of comparison group increased to 16.4% respectively after one year interval of antismoking education to the experiment group. 2. The baseline smoking knowlege score of experiment group was 29.7 and that of comparison group was 31.9. Those scores collected after one year interval ware 31.9 and 33.2 respectively. 3. The odds ratios for smoking estimated from a unconditional logistic regression analysis were 4.8 (p<0.01) for students with a smoking friends as the best friend, 1.02 (p<0.05) for one score increase in knowledge of smoking health hazard and 0.8 (p<0.05) for anti - smoking education. This study implicates it is unlikely that a common anti - smoking programme would be effective for male high school students. To devlelop effective measures for preventing high school boys’ smoking it is highly recommended to carry out further researches in details of anti - smoking education.; Summary

Smoking and female lung cancer by morphological types, a case-control study.: Heechoul Ohr, Il Soon Kim, Sun Ha Jee, Tae Yong Sohn; Korean J Epidemiol. 1992;14(2):151-159.

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The relationship between smoking and female lung cancer was examined according to the morphological subtypes. Two data sets were analyzed. One is the data comprising 235 pathologically confirmed female primary lung cancer patients and 940 community control frequency matched at a ratio of 1 : 4 within ten-year-sized birth cohorts from Kangwha county female residents. The other is the data with 125 female lung cancer patients and 125 controls who are either patients’ sisters or friends where telephone surveys were used as the data collecting methods. The telephone interview survey limited the number of the latter data which need information of the patients' sisters or friends who made the controls. The morphology of the lung cancers were categorized in three types i. e. adenocarcinoma, squamous cell carcinoma and small cell carcinoma. Odds ratios were estimated by unconditional logistic regression analysis controlling age at first diagnosis as a confounder.
Results
are as follows： 1. The odds ratios of smoking were estimated to be 1.6(p>0.05) for adencoarcinama, 3.2 (p<0.01) for squamous cell carcinomas, and 7.1 (p<0.01) for small cell carcinomas in the logistic model with 235 cases and 940 controls The odds ration estimated in the model with 125 cases and 125 controls showed almost the same values as the former. 2. Females with less than 20 pack-year were estimated to have 1.8 times (p<0.05)higher risk of lung cancer than non-smokers and those with 20 or more pack-year were estimated to have 5.0 times (p<0.01) higher risk. The estimate for small cell carcinoma was 13.5(p<0.01) for females with 20 or more pack-year. 3. The odds ratio estimates of lung cancer were 1.8 (p<0.05) for those who began to smoke after their forties and 2.7(p<0.05) for those who began to smoke before forty-year old. This tendency was observed in every subtype of lung cancer. This report reconfirms that there are different associations between smoking and morphological types of lung cancers, the absolute values of odds ratio being smaller than those of other countries, however. This finding implicates that further researches are needed to confirm the size of contribution of smoking to Korean female lung cancers. And the second step shall be the reason of low association between smoking and lung cancer, conditioned to this finding is true.; Summary

Cholera in Korea, 1991: models of transmission.: Han Joong Kim, Il Suh, Hee Choul Oh, Kyoo Sang Kim, Sun Ha Jee, Soon Young Lee, Sun Hee Lee; Korean J Epidemiol. 1991;13(2):123-139.

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In August-September 1991，Korea had a cholera epidemic caused by Vibrio El Tor Ogawa with 92 bacteriologically confirmed cases and 8 deaths. Seochun-gun Choongnam, Kunsan-si and Okgu-gun Chunbuk area, which are located near the mid-west coast of the country, were mainly affected. Vibrio cholerae were isolated from sewage water, sea water, squid and shell-fish tested during the epidemic, and an epidemiologic study found that consumption of raw shellfish or fish was the most probable source of cholera infection. Vibrio cholerae were thought to have spread from foreign countries and there were some evidence that an environmental reservoir of cholera might play a role in the transmission of cholera in this epidemic.; Summary

Epidemiological characteristics of cholera epidemic in Korea, 1991.: Hee Choul Oh, Jong Ku Park, Mook Shik Kim, Kyoo Sang Kim, Sun Ha Jee, Soon Young Lee, Sun Hee Lee; Korean J Epidemiol. 1991;13(2):112-122.

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From July 30th through September 9th, 1991, 188 cases of cholera were reported throughout most provinces in Korea. Of the cases 92 were bacteriologically confirmed and 96 were diagnosed by clinical symptoms. Through screening of the cholera epidemic area residents 58 inapparent infections were discovered and 8 deaths occurred. A population interview survey was conducted to the people inhabiting the five villages at the two epidemic foci, Sochon and Okgu. Other various information sources such as reported cases to health centers or quarantine stations, medical records of some hospitals, and laboratory findings of National Institute of Health were used to describe the cholera epidemic. Data from these sources were rearranged and analysed on an individual bases. Epidemiological characteristics of the 1991 cholera epidemic of Korea are as follows: 1. Vibrio cholerae biotype El Tor, sero type Ogawa was the causitive agent. 2. The epidemic duration was 25 days from August 13th to September 7th. 3. Epidemiological investigation of the two epidemic foci-Sochon, and Okgu counties-in the west coastal regions of the Korean penisula-revealed that 155 cases occurred in explosive outbreaks amounting to 82.5% of the total 188 noted cholera cases. 4. The epidemic curve of the 1991 cholera epidemic showed that of a typical point-source outbreak suggesting that there were few secondary infected cases. 5. Lower incidence rates among younger age groups and higher incidence rates among older age groups were noted. These findings support that this cholera outbreak was epidemic not endemic. These findings suggest that epidemiological characteristecs of the 1991 cholera epidemic differ from those of 1980 or before, in number of patients, duration of epidemic and the epidemic curve pattern. The authors suspect that improved national and personal hygiene might explain the difference.; Summary

Mortality of Koreans in the fourth decade of age: Il Soon Kim, Sun Ha Jee, Hee Choul Oh, Il Suh; Korean J Epidemiol. 1990;12(2):191-210.

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The Mortality experience among Koreans in their forties during the past eight yeasrs was compared to the countries, of Singapore, Czechoslovakia, Hungary, Poland, U.S.A.，U.K., Japan, and Germany in order to determine the mortality status and structure of Koreans in the fifth decade of age. The major findings are as follows ； 1. The age — specific and sex — specific death rates of Koreans showed a continuous decrease during the past eight years. When compared to other countries, the death rate among males in Korea was similar to or lower than the rate in the developing countries but higher than the rate in the developed countries. On the other hand, there was no significant difference in death rates among females compared with the developed countries. 2. When comparing the causes of death among Koreans with the Japanese, infections disease was 3.4 — 4.5 times greater and chronic non—infectious desease was 1.5 — 2.1 times greater, for both sexes. Pulmonary tuberculosis was 30 times higher for males in their twenties to fities, and hepatic carcinoma and gastric carcinoma were 4 一 7 times and 1.5 — 2 times higher, respectively, for males in their thirties to forties. The higher death rates among Koreans compared with the developed countries are attributed to infectious disease, hepatic carcinoma, and gastric carcinoma, which have decreased in recent years. In conclusion, the death rates of Koreans in their forties are higher compared with the developed countries but lower compared to the developing countries, along the lines of socioeconomic achievement.; Summary

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