Epidemiology and Health

Original articles

Parents’ employment and non-chromosomal congenital anomalies in South Korea: a national population cohort study: Kyuwon Kim, Hoyol Jhang, Erdenetuya Bolormaa, Chae Bong Kim, Seung-Ah Choe; Epidemiol Health. 2025;e2025018. Published online April 10, 2025; DOI: https://doi.org/10.4178/epih.e2025018 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
We assessed the association between parents' employment status, including industrial classification, and non-chromosomal congenital anomalies in offspring.
METHODS
We analyzed data from mothers who delivered live births between 2020 and 2022, linking their records with those of their neonates from the National Health Information Service (NHIS) database. Our analysis focused on common industrial classifications representing at least 6% of the total workforce. Congenital anomalies were identified based on neonates’ diagnostic codes. We conducted logistic regression to estimate odds ratios (ORs) of congenital anomalies by the industrial classification of mothers and their partners, adjusting for individual risk factors, with the financial industry serving as the reference category.
RESULTS
Among 338,637 women with a live birth, 148,818 (43.9%) were employed at the time of pregnancy. Employment was associated with a higher risk of congenital anomalies (OR, 1.08; 95% confidence interval [CI], 1.04-1.12). Within the common industrial classifications, health and social work exhibited the highest risk (OR, 1.11; 95% CI, 1.06-1.22) compared to the financial industry. Women employed in general hospitals showed particularly elevated risks (OR, 1.19; 95% CI, 1.04-1.37). Among male partners, the risk estimates were generally imprecise.
CONCLUSIONS
The study indicates that certain industries are linked with a higher risk of congenital anomalies among women workers. These findings underscore the need for enhanced safety measures in high-risk industrial settings to reduce the occurrence of congenital anomalies.; Summary

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

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Abstract PDF: Abstract
OBJECTIVES
The energy-adjusted dietary inflammatory index (E-DII), a tool developed based on comprehensive research and literature reviews, is used to assess the inflammatory potential of specific diets. Although previous research has demonstrated an association between E-DII and mortality, longitudinal studies investigating a causal relationship in Asian populations are lacking. This study aimed to explore the prospective association between E-DII and the risk of all-cause, cancer, and cardiovascular disease (CVD) mortality using a population-based Korean cohort.
METHODS
The analysis included data from 40,596 individuals who participated in the Korea National Health and Nutrition Examination Survey between 2007 and 2015. The exclusion criteria encompassed the diagnosis of cancer or CVD at baseline, pregnancy at baseline, and death within the first 2 years after baseline. The E-DII was calculated using data from 24-hour dietary recall interviews. Cox proportional hazard regression models were employed to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for mortality risk across E-DII tertiles.
RESULTS
Over an 8.2-year follow-up period, 2,070 deaths were recorded. Compared with the lowest E-DII, a higher index was associated with an increased risk of mortality from all causes (HR, 1.45; 95% CI, 1.25 to 1.69), cancer (HR, 1.41; 95% CI, 1.09 to 1.81), and CVD (HR, 1.53; 95% CI, 1.07 to 2.18). The association between E-DII and all-cause mortality was particularly pronounced among individuals with metabolic conditions.
CONCLUSIONS
Our findings suggest a strong positive association between high E-DII and increased mortality in Korean adults, especially those with metabolic disorders.; Summary

Epidemiologic investigation

Spatiotemporal trends in severe complicated influenza among the local population in Taiwan region, 2003-2023: Kangjun Wu, Yujian Lu; Epidemiol Health. 2025;e2025016. Published online April 2, 2025; DOI: https://doi.org/10.4178/epih.e2025016 [Accepted]

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OBJECTIVES
Severe influenza has raised considerable concern worldwide, and its incidence appears to have shifted in the context of globalization. This study aimed to examine the temporal, spatial, and demographic distributions of local severe influenza cases in Taiwan region from January 2003 to June 2023.
METHODS
We aggregated severe complicated influenza cases by month, area (city/county), age, and sex. The age-standardized incidence rate (ASIR) was calculated to compare differences across regions and populations. Yearly incidence rate ratios comparing males to females were also computed to assess sex differences.
RESULTS
A total of 16,459 cases were included from 2003 to 2023. Crude incidence rates per 100,000 population were 0.07–0.14 for 2003–2008, 3.64–9.81 for 2009–2019, and 0.004–1.87 for 2020–2023. Higher incidence rates were observed in Hualien and Taitung Counties, with average ASIRs exceeding 10.0 per 100,000 population, compared to other cities. Except for 2005 and 2007, the incidence among males exceeded that among females, with ASIR ratios ranging from 1.10 to 2.20. The highest incidence was observed among populations aged 0–4 and those aged ≥55.
CONCLUSIONS
The incidence of severe complicated influenza exhibited clear regional and demographic variations in Taiwan region. The observed rebound in incidence calls for increased vigilance to protect vulnerable populations from severe illness.; Summary

Original articles

Palivizumab coverage rates among moderate-to-late preterm infants in Korea: A nationwide cross-sectional study: Seungyeon Kim, Saram Lee, Young June Choe, Ju Sun Heo; Epidemiol Health. 2025;e2025015. Published online April 1, 2025; DOI: https://doi.org/10.4178/epih.e2025015 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Since October 2016, South Korea has implemented a national reimbursement program for palivizumab aimed at moderate-to-late preterm (MLPT) infants born between 32 0/7 and 35 6/7 weeks of gestation during the respiratory syncytial virus (RSV) season (October–March). However, large-scale data on coverage rates and associated factors remain limited. This study evaluated palivizumab coverage rates and identified predictive factors influencing its administration in MLPT infants.
METHODS
This nationwide, population-based cross-sectional study utilized data from the Korean National Health Insurance Service collected between October 2016 and March 2019. MLPT infants eligible for palivizumab reimbursement were divided into administration and non-administration groups. Seasonal and overall coverage rates were assessed. A multivariate logistic regression analysis examined factors associated with palivizumab administration, with a focus on infant and maternal characteristics.
RESULTS
Among 2,843 eligible MLPT infants, 1,201 (42.2%) received palivizumab, while 1,642 (57.8%) did not. Although coverage rates increased annually, they remained suboptimal. Lower palivizumab prophylaxis coverage was observed in infants with higher gestational ages, female sex, absence of low birth weight, those born in March, residents of non-capital areas, infants not admitted to a neonatal intensive care unit (NICU) at birth, and infants of mothers aged <35 years.
CONCLUSIONS
In the initial 3 RSV seasons following the introduction of palivizumab reimbursement for MLPT infants in South Korea, the overall coverage rate was low (42.2%). National policies targeting infants with higher gestational ages, those born in March, and those residing in non-capital areas are necessary to improve coverage and ensure equitable RSV prophylaxis.; Summary

Identifying factors associated with mental health status following climate-related disasters: a nationwide longitudinal panel study in Korea: Eunjin Oh, Jaelim Cho, Changsoo Kim, Hyungryul Lim, Kyoung-Nam Kim; Epidemiol Health. 2025;e2025014. Published online March 27, 2025; DOI: https://doi.org/10.4178/epih.e2025014 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Despite the increasing frequency and intensity of climate-related disasters, identifying factors associated with mental health status remains challenging. This study aimed to determine the factors linked to symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) following heavy rainfall and typhoons.
METHODS
National data on climate-related disaster victims (n=825 for heavy rainfall and n=1,220 for typhoon) from a longitudinal panel in Korea (“Long-term Survey on the Change of Life of Disaster Victims”) and data from individuals unaffected by disasters (n=893) were used. Generalized linear mixed models were employed to evaluate the factors associated with mental health status following climate-related disasters.
RESULTS
Greater disaster severity (e.g., experiencing casualties or asset loss) was associated with higher scores for depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and PTSD (Impact Event Scale-Revised). The association between casualty experience and anxiety score was more pronounced among individuals over 65 years (β [log-transformed score]=1.39; standard error [SE], 0.26; p<0.001), female respondents (β=1.20; SE, 0.20; p<0.001), those with a low education level (β=1.18; SE, 0.25; p<0.001), and those with a low income (β=1.45; SE, 0.26; p<0.001) compared to their counterparts.
CONCLUSIONS
These findings may help guide targeted interventions and shape public health policies and disaster management strategies that prioritize mental health support for the most at-risk populations, ultimately increasing community resilience to climate-related challenges.; Summary

Systematic review

Guts of healthy humans, livestock, and pets harbor critical-priority and high-risk Escherichia coli clones: Idris Nasir Abdullahi, Islem Trabelsi; Epidemiol Health. 2025;e2025013. Published online March 22, 2025; DOI: https://doi.org/10.4178/epih.e2025013 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
In May 2024, the World Health Organization classified carbapenem (CARB)- and third-generation cephalosporin (3GC) resistance (R) in Escherichia coli as a critical priority, whereas colistin (COL) is a "last resort" antibiotic for their treatment. This meta-analysis evaluated the pooled prevalence, high-risk lineages, genetic relatedness, and mechanisms of CARBR, COLR, and 3GCR in Escherichia coli from healthy humans and animals.
METHODS
We conducted a systematic review and meta-analyses following the PRISMA criteria on all eligible studies that reported the analysis of E. coli, and antimicrobial susceptibility to CARB, COL and 3GC in E. coli from gut samples of clinically healthy humans, livestock, and pets from June 2014 to June 2024. Random-effect models and CSI Phylogeny 1.4 were used to determine pooled prevalence rates (PPs) and the relatedness of publicly available E. coli genomes, respectively.
RESULTS
Of the 5034 identified articles, 55 studies were deemed eligible. The overall PPs of 3GCR, CARBR- and COLR E. coli were 19% (95% CI, 14.5%-24.4%), 1.6% (95% CI, 0.8%-3.5%), and 13.3% (95% CI, 8.4%-20.9%), respectively. The PPs of 3GCR-, COLR- and CARBR E. coli significantly varied by hosts, continent, and year of studies (p<0.05). Diverse E. coli lineages were found, including 13 high-risk E. coli sequence types (STs), within which ST10 predominated. Phylogenomic analyses produced 4 clusters of related CARBR- and COLR E. coli strains (< 25 SNP): ST940-blaOXA-181 from humans in Lebanon, ST617-mcr-1 from pigs in China, ST46-mcr-1 from poultry in Tanzania, and ST1720-mcr-1 from goats in France.
CONCLUSIONS
COLR and 3GCR are more frequent than CARBR in gut E. coli. These 10-year epidemiological data highlight the persistence and transmission of critical priority and high-risk E. coli strains in healthy humans and animals, raising significant One Health concerns.; Summary

Erratum

Characteristics of imported and domestic malaria cases in Gyeonggi Province, Korea: Sunghee Hong, Jihye Kim, Soo-Nam Jo, Jong-Hun Kim, Boyoung Park, Bo Youl Choi; Epidemiol Health. 2025;47:e2024087.E. Published online March 17, 2025; DOI: https://doi.org/10.4178/epih.e2024087.E; Corrects: Epidemiol Health 2024;46:e2024087

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Original article

The Uneven Playing Field: Provider Participation and Regional Disparities in Oral Health Examination Rates in South Korea: Hye-Lim Hong, Nam-Hee Kim; Epidemiol Health. 2025;e2025012. Published online March 10, 2025; DOI: https://doi.org/10.4178/epih.e2025012 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
This study investigated regional disparities in adult oral health examination rates in South Korea, despite free oral health screenings by the National Health Insurance Service (NHIS). It focused on the impact of provider factors, such as the availability of dental clinics and non-dental institutions.
METHODS
A cross-sectional analysis of 2022 data from 229 districts was conducted. The dependent variable was the adult oral health examination rate, while independent variables included provider factors, community health status, lifestyle, demographic, and socioeconomic characteristics. Descriptive statistics, Pearson’s correlation, and multiple regression analyses identified significant predictors.
RESULTS
Non-metropolitan areas had higher oral health examination rates (27.4%) than metropolitan areas (25.3%). Correlation analysis showed the general health examination rate (r=0.583) and the number of screening institutions (r=0.234) were the strongest predictors (p<0.001). Regression analysis showed a 1% increase in general health examination rates led to a 1.44% rise in oral health examination rates (p<0.001).
CONCLUSIONS
Despite NHIS policies, significant regional disparities persist, showing that providing screenings alone is insufficient. Integrating oral health screenings with general health examinations is necessary. Policymakers must promote collaboration between dental and non-dental providers to ensure equitable, integrated health services, enhancing preventive care and reducing disparities.; Summary

Original Article

Effects of student human rights ordinances on mental health among middle and high school students in South Korea: a difference-in-differences analysis: Sang Jun Eun; Epidemiol Health. 2025;47:e2025011. Published online March 1, 2025; DOI: https://doi.org/10.4178/epih.e2025011

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Abstract Summary PDF: Abstract
OBJECTIVES
To actively protect and enhance students’ human rights, student human rights ordinances (SHROs) have been enforced in seven provinces in South Korea at different times since 2010. Although human rights are closely linked to mental health, there has been no research on the effectiveness of human rights legislation on adolescent mental health. This study evaluated the effects of SHROs on the mental health of middle and high school students.
METHODS
Repeated cross-sectional data were used, including 1,148,257 respondents from the Korea Youth Risk Behavior Web-based Survey between 2006 and 2023. Probabilities of perceived stress, sleep insufficiency, depressive mood, suicide ideation, and suicide attempt in treated provinces were estimated through a difference-in-differences approach that accounts for treatment effect heterogeneity across groups over time.
RESULTS
SHROs had no consistently significant effects on any mental health outcomes, except for slightly increased suicide ideation in total students (0.7%, 95% confidence interval 0.3% to 1.1%). Suicide attempts in total and male students and perceived stress and sleep insufficiency in female students tended to decrease, while other mental health outcomes tended to increase. Uncertainty in the effect estimates of SHROs increased for all mental health outcomes with possible violations of parallel trends, rendering originally significant effects insignificant.
CONCLUSIONS
SHROs failed to improve mental health of middle and high school students in treated provinces, possibly due to the absence of enforcement mechanisms. Further research is needed on the effectiveness of and effect mechanisms for legal measures to improve human rights on adolescent mental health.; Summary

Korean summary
학생의 인권을 포괄적으로 보장하기 위해 학생인권조례가 시행되었지만 학생인권조례 시행 지역에서 중고등학생의 정신건강은 향상되지 않았는데, 이는 조례에 벌칙 조항 같은 강제성 기전이 없었기 때문이었을 수 있다. 학생인권조례는 중고등학생의 정신건강에 대해 효과가 없었지만 이 연구는 인권 법제의 청소년 정신건강에 대한 효과를 처음으로 평가했다. 인권증진을 위한 법적 수단의 청소년 정신건강에 대한 효과성과 효과 기전에 관하여 추가 연구가 필요하다.

Key Message
Although student human rights ordinances have been enforced in South Korea to comprehensively guarantee human rights for students, they failed to improve the mental health of middle and high school students in treated provinces, possibly due to the absence of enforcement mechanisms such as penalty provisions. Despite the ineffectiveness of student human rights ordinances, this study first estimated the effects of human rights legislation on adolescent mental health. Further research is needed on the effectiveness of and effect mechanisms for legal measures to improve human rights on adolescent mental health.

Original articles

Preventable cancer cases and deaths attributable to deficit of physical activity in Korea from 2015 to 2030: Soseul Sung, Sungji Moon, Jihye An, Jeehi Jung, Hyeon Sook Lee, Youjin Hong, Sangjun Lee, Woojin Lim, Kyungsik Kim, Inah Kim, Jung Eun Lee, Sun Ha Jee, Aesun Shin, Ji-Yeob Choi, Sun-Seog Kweon, Min-Ho Shin, Sangmin Park, Seung-Ho Ryu, Sun Young Yang, Seung Ho Choi, Jeongseon Kim, Sang-Wook Yi, Yoon-Jung Choi, Jeong-Soo Im, Hong Gwan Seo, Sohee Park, Kwang-Pil Ko, Sue K. Park; Epidemiol Health. 2025;e2025010. Published online February 27, 2025; DOI: https://doi.org/10.4178/epih.e2025010 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
This study aimed to determine the population–attributable fractions (PAFs) of cancers using various calculation methods and to estimate the PAFs of cancer incidence and mortality resulting from deficit in physical activity (DPA) from 2015 to 2030, based on data on prevalence rates.
METHODS
The PAF of cancer was estimated using a cohort study–based meta–analysis of relative risk (RR), national prevalence rates of DPA from 2000 to 2015, and national cancer statistics from 2015 to 2030, with a latency of 15 years.
RESULTS
In 2015, DPA contributed to 909 cancer cases and 548 deaths, accounting for 0.42% and 0.68% of new cancer cases and deaths, respectively. By 2030, the PAF values are expected to increase to 1.31% of incidence and 1.80% of mortality, with a continual increase from 2015 to 2030. When the low metabolic equivalent of task (MET) criteria were selected, the PAF values decreased for both incidence and mortality. The PAF calculated with <900 MET–min/week for the sex–specific MET criterion was higher than that calculated with <900 MET–min/week for both incidence and mortality.
CONCLUSIONS
The risk of cancer associated with DPA is expected to rise in both men and women. Future research and strategies should emphasize the promotion of physical activity for cancer prevention, considering its significant implications for public health.; Summary

Preventable cancer cases and deaths attributable to alcohol consumption in Korea from 2015 to 2030: Soseul Sung, Jihye An, Jeehi Jung, Hyeon Sook Lee, Sungji Moon, Inah Kim, Jung Eun Lee, Aesun Shin, Sun Ha Jee, Sun-Seog Kweon, Min-Ho Shin, Sangmin Park, Seung-Ho Ryu, Sun Young Yang, Seung Ho Choi, Jeongseon Kim, Sang-Wook Yi, Yoon-Jung Choi, Youjin Hong, Sangjun Lee, Woojin Lim, Kyungsik Kim, Sohee Park, Jeong-Soo Im, Hong Gwan Seo, Kwang-Pil Ko, Sue K. Park; Epidemiol Health. 2025;e2025009. Published online February 27, 2025; DOI: https://doi.org/10.4178/epih.e2025009 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Alcohol consumption is causally linked to several cancers, and major health organizations classify it as a carcinogen. This study assessed the impact of alcohol consumption on cancer incidence and mortality in Korea in 2015 and 2020, projected trends up to 2030, and compared results based on different criteria.
METHODS
The relative risk of cancer associated with alcohol consumption in Korea was determined through a meta–analysis of alcohol–related relative risks for specific cancers, using primary data from the Korean Cohort Study within the Korean Cohort Consortium. The population–attributable fraction (PAF) was calculated using Levin's formula, incorporating drinking prevalence and the number of cancer cases and deaths, with a 15–year latency period assumed.
RESULTS
In Korea, the PAF for alcohol consumption, based on ever/never drinking criteria, was higher than that calculated using other criteria, except for the PAF based on past and current/never drinking criteria. Alcohol consumption contributed to 3.58% of all cancer cases and 3.28% of cancer deaths in 2015. It accounted for 4.58% of new cancer cases in men and 2.08% in women, with a higher contribution to incidence than mortality (4.00% and 2.25% of cancer deaths in men and women, respectively). Projections indicate that alcohol–related cancer PAF will decrease by 17.2% in men but increase by 70.2% in women by 2030.
CONCLUSIONS
This study highlights the impact of alcohol consumption on cancer in Korea, emphasizing the need for sex–specific regulations to address sex differences.; Summary

Preventable cancer cases and deaths attributable to tobacco smoking in Korea from 2015 to 2030: Soseul Sung, Jihye An, Jeehi Jung, Hyeon Sook Lee, Sungji Moon, Inah Kim, Jung Eun Lee, Aesun Shin, Sun Ha Jee, Sun-Seog Kweon, Min-Ho Shin, Sangmin Park, Seung-Ho Ryu, Sun Young Yang, Seung Ho Choi, Jeongseon Kim, Sang-Wook Yi, Yoon-Jung Choi, Youjin Hong, Sangjun Lee, Woojin Lim, Kyungsik Kim, Daehee Kang, Keun-Young Yoo, Sohee Park, Jeong-Soo Im, Hong Gwan Seo, Hai-Rim Shin, Kwang-Pil Ko, Sue K. Park; Epidemiol Health. 2025;e2025008. Published online February 27, 2025; DOI: https://doi.org/10.4178/epih.e2025008 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Tobacco smoking is a major public health concern worldwide. This study aimed to assess its impact on cancer incidence and mortality by estimating the population attributable fraction (PAF) in the Korean population for 2015 and 2020 and by projecting future trends until 2030.
METHODS
The Korean relative risk (RR) was calculated via a meta–analysis of RRs for individual cancers attributed to tobacco smoking, based on primary data analysis from the Korean Cohort Consortium. The PAF was estimated using the Levin formula with past and current prevalence rates and the number of cancer cases and deaths, assuming a 15–year latency period.
RESULTS
The proportions of cancer cases and deaths in Korea attributable to tobacco smoking were similar to those calculated using Asian and global RRs for both men and women. In 2015 and 2020, tobacco smoking contributed to 14.32% and 13.17% of cancer cases and 21.70% and 20.69% of cancer deaths in adults, respectively. Among Koreans, smoking was responsible for 25.83% of new cancer cases in men in 2015, 23.49% in men in 2020, 1.46% in women in 2015, and 1.68% in women in 2020. In both years, smoking impacted mortality more strongly than incidence in Korean men and women (incidence in men: 25.83% and 23.49%; mortality in men: 32.09% and 30.41%; incidence in women: 1.46% and 1.68%; and mortality in women: 4.70% and 4.96%, respectively).
CONCLUSIONS
Tobacco smoking causes cancers and deaths in Korea, however, it is preventable. Effective control policies that consider trends and vulnerabilities among women are required.; Summary

Brief Communication

Levels of exposure markers among residents in environmentally vulnerable areas in Korea, the general population in Korea, and Asians in the United States: Kyung-Hwa Choi, Dahee Han, Sang-Yong Eom, Yong Min Cho, Young-Seoub Hong, Woo Jin Kim; Epidemiol Health. 2025;47:e2025007. Published online February 25, 2025; DOI: https://doi.org/10.4178/epih.e2025007

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Abstract Summary PDF: Abstract
This study compares biomarker levels among environmentally vulnerable residents in Korea, the general Korean population, and Asians in the United States. We selected 953 exposed residents and 204 controls from the Forensic Research via Omics Markers in Environmental Health Vulnerable Areas (FROM) study (2021-2023), 4,239 participants from the fourth Korean National Environmental Health Survey (2018-2020), and 996 Asians from the U.S. National Health and Nutrition Examination Survey (2017-March 2020). The analyzed biomarkers included blood and urinary metals, urinary metabolites of polycyclic aromatic hydrocarbons, nicotine, volatile organic compounds, and serum perfluorocarbon metabolites. The highest median biomarker levels varied by pollution source among older adults. In refineries, blood lead and cadmium (Cd), as well as urinary Cd and 2-hydroxyfluorene, were highest. Abandoned metal mines exhibited the highest blood and urinary mercury, urinary Cd, total arsenic (As), 2-naphthol, and cotinine levels. Coal-fired power plants showed the highest urinary 1- hydroxyphenanthrene levels, while cement factories had the highest urinary As<sup>3+</sup> levels. Sprawls demonstrated the highest urinary monomethylarsonic acid, 1-hydroxypyrene, and phenylglyoxylic acid levels, and industrial areas recorded the highest levels of trans, trans-muconic acid, benzylmercapturic acid, and 2-methylhippuric acid. In general, biomarker levels were higher among exposed residents in the FROM study than in the general population; however, urinary 2-hydroxyfluorene and As<sup>5+</sup> levels did not differ significantly. Exposure to pollution sources in environmentally vulnerable areas may elevate biomarker levels in residents.; Summary

Korean summary
본 연구는 환경보건 취약지역 거주자, 대한민국의 일반인구집단, 미국에 거주하는 아시아인의 체내 환경유해물질 바이오마커 농도를 비교하였다. 체내 바이오마커의 농도는 석유정제시설, 폐금속광산, 화력발전소 등 환경보건 취약지역의 유형에 따라 차이를 보였다. 본 연구가 가지는 과학적, 역학적 의미는 환경보건 취약지역 유형별 환경유해물질 노출의 차이와 그로 인한 잠재적 건강영향을 알아봄으로써 환경보건 취약계층을 위한 특이적인 중재가 이루어질 수 있도록 하는데 있다.

Key Message
This study examines environmental health risks for vulnerable populations by comparing biomarker levels among exposed residents in Korea, the general Korean population, and Asians in the United States. Biomarker levels were found to be elevated near pollution sources such as refineries, metal mines, and power plants, with variations based on pollutant types. The scientific and epidemiological significance lies in revealing disparities in exposure and potential health effects, thereby contributing to targeted interventions for environmentally vulnerable groups.

Original Articles

Risk of non-cancer respiratory diseases attributed to humidifier disinfectant exposure in Koreans: age-period-cohort and differences-in-difference analyses: Jaiyong Kim, Kyoung Sook Jeong, Seungyeon Heo, Younghee Kim, Jungyun Lim, Sol Yu, Suejin Kim, Sun-Kyoung Shin, Hae-Kwan Cheong, Mina Ha, Epidemiology Expert Committee for Reviewing the Epidemiological Correlations between Humidifier Disinfectant Exposure and Health Effects; Epidemiol Health. 2025;47:e2025006. Published online February 22, 2025; DOI: https://doi.org/10.4178/epih.e2025006

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Abstract Summary PDF: Abstract
OBJECTIVES
Humidifier disinfectants (HDs) were sold in Korea from 1994 until their recall in 2011. We examined the incidence patterns of 8 respiratory diseases before and after the HD recall and estimated the attributable risk in the Korean population.
METHODS
Using National Health Insurance data from 2002 to 2019, we performed age–cohort–period and differences-in-diffference analyses (comparing periods before vs. after the recall) to estimate the population-attributable fraction and the excess number of episodes. The database comprised 51 million individuals (99% of the Korean population). The incidence of 8 diseases—acute upper respiratory infection (AURI), acute lower respiratory infection (ALRI), asthma, pneumonia, chronic sinusitis (CS), interstitial lung disease (ILD), bronchiectasis, and chronic obstructive pulmonary disease (COPD)—was defined by constructing episodes of care based on patterns of medical care and the clinical characteristics of each disease.
RESULTS
The relative risks (RRs) for AURI, ALRI, asthma, pneumonia, CS, and ILD were elevated among younger individuals (with an RR as high as 82.18 for AURI in males), whereas chronic conditions such as bronchiectasis, COPD, and ILD showed higher RRs in older individuals. During the HD exposure period, the population-attributable risk percentage ranged from 4.6% for bronchiectasis to 25.1% for pneumonia, with the excess number of episodes ranging from 6,218 for ILD to 3,058,861 for CS. Notably, females of reproductive age (19-44 years) experienced 1.1-9.2 times more excess episodes than males.
CONCLUSIONS
This study provides epidemiological evidence that inhalation exposure to HDs affects the entire respiratory tract and identifies vulnerable groups.; Summary

Korean summary
- 2002년부터 2012년까지 가습기살균제 흡입 노출은 한국 인구의 호흡기 질환 중 4~25%에 기여했으며, 특히 천식, 폐렴, 간질성폐질환이 젊은 연령층에서 더 큰 영향을 보였다. - 기관지확장증과 간질성폐질환 같은 만성질환에서는 고령층에서 초과 발생 사례 수가 더 많았다. - 어린이, 노인, 가임기 여성이 취약집단으로 확인되었다.

Key Message
- From 2002 to 2012, humidifier disinfectant inhalation exposure contributed to 4–25% of respiratory diseases in Korea, with greater effects among younger people, especially for asthma, pneumonia, and interstitial lung disease. - Older individuals showed more excess episodes for chronic conditions like bronchiectasis and interstitial lung disease. - The young, the elderly, and reproductive-age women were identified as vulnerable groups in association with humidifier disinfectant exposure.

Prevalence of cardiovascular-kidney-metabolic syndrome in Korea: Korea National Health and Nutrition Examination Survey 2011-2021: Sung-Bin Hong, Ji-Eun Kim, Seung Seok Han, Joseph J. Shearer, Jungnam Joo, Ji-Yeob Choi, Véronique L. Roger; Epidemiol Health. 2025;47:e2025005. Published online February 14, 2025; DOI: https://doi.org/10.4178/epih.e2025005

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Abstract Summary PDF: Abstract
OBJECTIVES
The American Heart Association (AHA) recently defined cardiovascular-kidney-metabolic (CKM) syndrome to better characterize the associations among cardiovascular, kidney, and metabolic diseases. Although about 9 in 10 United States adults have at least 1 risk factor for CKM syndrome, its prevalence in other populations is less understood. To fill this gap, we examined the prevalence of CKM syndrome in Korea and its association with demographic and socioeconomic status (SES).
METHODS
Using data from the Korean National Health and Nutrition Examination Survey between 2011 and 2021, we calculated the prevalence of CKM syndrome across the following stages: stage 0 (no risk factors), stage 1 (excess or dysfunctional adiposity), stage 2 (other metabolic risk factors or chronic kidney disease), and stages 3-4 (subclinical/clinical cardiovascular diseases) among adults aged ≥20 years. Weighted analyses were used to estimate prevalence and 95% confidence intervals (CIs) for each CKM syndrome stage, stratified by age, gender, and SES factors.
RESULTS
Among 54,994 Korean adults, the prevalence of CKM syndrome was as follows: stage 0 (25.2%; 95% CI, 24.7 to 25.8), stage 1 (19.3%; 95% CI, 18.9 to 19.7), stage 2 (51.6%; 95% CI, 51.1 to 52.2), and stages 3-4 (3.9%; 95% CI, 3.7 to 4.0). The prevalence of stages 2 and 3-4 was higher in men than in women. In addition, stages 3-4 were more prevalent among rural residents and those with lower education or income.
CONCLUSIONS
About 3 out of 4 Koreans are at risk for CKM syndrome. These findings highlight that CKM syndrome is a global health problem and that interventions are urgently needed to prevent further progression.; Summary

Korean summary
최근, 심장-신장-대사 증후군을 하나로 묶어 관리하는 것의 필요성이 대두되고 있다. 본 연구 결과 20세 이상의 한국 성인들의 74.8%가 심장-신장-대사 증후군의 위험군에 속해 있었다. 또한 그 정도가 증가하는 추세로 나타나 적절한 관리가 필요해 보인다.

Key Message
Recently, the need for an integrated approach to managing cardiovascular-kidney-metabolic (CKM) syndrome has been emphasized. This study found that 74.8% of Korean adults aged 20 and older had a risk for CKM syndrome. Moreover, the prevalence is increasing, highlighting the necessity of proper management.

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