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Volume 46; 2024
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Original Articles
Contrasting income-based inequalities in incidence and mortality of breast cancer in Korea, 2006-2015
Jinwook Bahk, Hee-Yeon Kang, Young-Ho Khang, Kyunghee Jung-Choi
Epidemiol Health. 2024;46:e2024074.   Published online September 11, 2024
DOI: https://doi.org/10.4178/epih.e2024074
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Breast cancer incidence and mortality rates in Korea are increasing. This study analyzed income-based inequalities in the incidence and mortality of women breast cancer from 2006 to 2015, using national data that covered all Korean women.
METHODS
We used the National Health Information Database from 2006 to 2015. For women aged 20 and older, the age-standardized incidence and mortality rates of breast cancer per 100,000 by income quintile per year were calculated using the direct method. The rate ratio and rate difference (RD) of the age-standardized incidence and mortality rates of breast cancer per 100,000 between the top and bottom income quintiles were calculated as relative and absolute measures for inequalities.
RESULTS
When comparing 2006 and 2015, both the incidence and mortality rates of breast cancer increased. The lowest income quintile experienced higher mortality rates despite having lower incidence rates. In 2015, the income-based RD in incidence and mortality rates between the highest and lowest income quintiles (Q1-Q5) was -19.9 (95% confidence interval [CI], -24.3 to -15.5) and 4.4 (95% CI, 2.9 to 5.8), respectively. Throughout this period, there was no statistically significant trend in income-based disparities in breast cancer incidence and mortality. The age-specific contributions to the absolute magnitude of inequality (RD) in incidence and mortality were more pronounced among middle-aged women than among older women.
CONCLUSIONS
This study found that breast cancer in Korea exhibited pro-rich inequalities in mortality despite pro-poor inequalities in incidence. More equitable policies for screening and treatment of breast cancer are needed.
Summary
Korean summary
2006년부터 2015년 한국의 유방암 불평등 추세를 분석하면, 소득수준이 낮은 여성의 발생률은 상대적으로 낮음에도 불구하고 사망률은 높은 양상을 보였다. 유방암 검진과 치료에 있어 보다 형평성을 고려한 정책이 요구된다.
Key Message
This study found that breast cancer in Korea exhibited pro-rich inequalities in mortality despite pro-poor inequalities in incidence. More equitable policies for screening and treatment of breast cancer are needed.
Gender-specific associations among neck circumference, the rs9939609 FTO gene polymorphism, and the 14-year risk of metabolic syndrome in the Korean adult population
Inkyung Baik
Epidemiol Health. 2024;46:e2024072.   Published online August 23, 2024
DOI: https://doi.org/10.4178/epih.e2024072
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Limited data exist on the relation between neck circumference (NC) and the risk of developing metabolic syndrome (MS). This study investigated gender-specific associations between NC and the 14-year risk of MS and explored the impact of the FTO rs9939609 polymorphism on these associations.
METHODS
This population-based prospective cohort study involved 2,666 participants (1,301 men and 1,365 women), who were free of MS at baseline (2005-2006). Incident MS cases, defined by the presence of 3 or more criteria regarding blood pressure and blood levels of glucose, triglycerides, and high-density lipoprotein cholesterol, were identified through biennial examinations until 2020. NC measurements taken at baseline and between 2013 and 2014 were analyzed using Cox proportional hazard regression to determine gender-specific associations with MS risk.
RESULTS
Controlling for potential confounders such as waist circumference (WC), significant associations were observed in both genders. Individuals in the highest NC quartile exhibited more than a 2-fold higher MS risk than those in the lowest quartile; with hazard ratios of 2.37 (95% confidence interval [CI], 1.74 to 3.22) for men and 2.65 (95% CI, 1.89 to 3.72) for women (p for trend <0.001). No significant interaction was found between the <i>FTO</i> polymorphism and NC. In diagnostic test analyses, NC and WC demonstrated comparable area under the curve values in both genders.
CONCLUSIONS
The findings suggest that NC is as effective as WC for predicting the incidence of MS.
Summary
Korean summary
허리둘레는 고혈압, 고혈당, 고지혈증의 위험과 밀접한 관련성을 나타내므로, 대사증후군의 구성 요소로 사용되어 왔다. 하지만 허리둘레 측정 시 피험자의 복장, 자세, 공복 및 식후 상태, 호흡 상태에 따라 측정 오차가 발생한다고 알려졌다. 본 연구는 한국 성인을 대상으로 14년간 진행된 전향적 코호트 연구 자료를 분석하여 목둘레가 허리둘레를 대신해서 대사증후군 위험을 예측할 수 있다는 결과를 확인하였다.
Key Message
Waist circumference has served as an anthropometric component of metabolic syndrome based on data regarding close associations with high blood pressure, hyperglycemia, and dyslipidemia. However, measurement errors of waist circumference due to the subject’s clothing, posture, fasting or postprandial state, and respiratory phase have been pointed out. This 14-year prospective cohort study including Korean adults has revealed that neck circumference can serve as a comparative indicator to waist circumference for predicting metabolic syndrome risk.
Data Profile
Data profile: the Korean Workers’ Compensation-National Health Insurance Service (KoWorC-NHIS) cohort
Jeehee Min, Eun Mi Kim, Jaiyong Kim, Jungwon Jang, Youngjin Choi, Inah Kim
Epidemiol Health. 2024;46:e2024071.   Published online August 19, 2024
DOI: https://doi.org/10.4178/epih.e2024071
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AbstractAbstract PDF
Abstract
The Korean Workers’ Compensation-National Health Insurance Service (KoWorC-NHIS) cohort was established to investigate the longitudinal health outcomes of Korean workers who have been compensated for occupational injuries or diseases. This cohort study, which utilized data spanning from 2004 to 2015, merged workers’ compensation insurance claim data with the National Health Insurance Database (NHID), encompassing 858,793 participants. The data included socio-demographic factors such as age, sex, income, address, insurance type, and disability grade. It also covered the types of occupational accidents, International Classification of Diseases, 10th revision codes for diseases or accidents, work tenure, industry, occupation code, and company size. Additional details such as the occupational hire date, date of claim, date of recognition, and affected body parts were recorded. The cohort predominantly consisted of male workers (80.0%), with the majority experiencing their first occupational accident in their 40s (27.6%) or 50s (25.3%). Notably, 93.1% of the cases were classified as occupational injuries. By integrating this data with that from the NHID, updates on health utilization, employment status, and income changes were made annually. The follow-up period for this study is set to conclude in 2045.
Summary
Original Article
Genetic associations and parent-of-origin effects of PVRL1 in non-syndromic cleft lip with or without cleft palate across multiple ethnic populations
Ji Wan Park, Geon Kang, Seung-Hak Baek, Young Ho Kim
Epidemiol Health. 2024;46:e2024069.   Published online August 9, 2024
DOI: https://doi.org/10.4178/epih.e2024069
  • 1,881 View
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AbstractAbstract PDFSupplementary Material
Abstract
OBJECTIVES
This study investigated the associations of <i>PVRL1</i> gene variants with non-syndromic cleft lip with or without cleft palate (NSCL/P) by evaluating transmission distortion and parent-of-origin (POO) effects in multiple ethnic populations.
METHODS
We conducted allelic and genotypic transmission disequilibrium tests (TDT) on 10 single-nucleotide variants (SNVs) in <i>PVRL1</i> using data from 142 Korean families with an affected child. POO effects were analyzed using the POO likelihood ratio test, comparing transmission rates of maternally and paternally inherited alleles. To assess generalizability and ethnic heterogeneity, we compared results from Korean families with data from the Center for Craniofacial and Dental Genetics, which included 2,226 individuals from 497 European and 245 Asian trios.
RESULTS
TDT analysis identified significant over-transmission of the rs7940667 (G361V) C allele in Korean families (p=0.007), a finding replicated in both Asian (p=6.5×10<sup>-7</sup>) and European families (p=1.6×10<sup>-10</sup>). Eight SNVs showed strong TDT evidence in larger Asian and European datasets after multiple comparison corrections (p<0.0073). Of these, 4 SNVs (rs7940667, rs7103685, rs7129848, and rs4409845) showed particularly robust association (p<5×10<sup>-8</sup>). POO analysis revealed significant maternal over-transmission of the rs10790330-A allele in Korean families (p=0.044). This finding was replicated in European families (p=9.0×10<sup>-4</sup>). Additionally, 3 other SNVs, rs7129848 (p=0.001) and the linked SNVs rs3935406 and rs10892434 (p=0.025), exhibited maternal over-transmission in the validation datasets.
CONCLUSIONS
Our findings provide robust evidence supporting the associations of <i>PVRL1</i> variants with NSCL/P susceptibility. Further research is necessary to explore the potential clinical applications of these findings.
Summary
Brief Communication
The association between employee lifestyles and the rates of mental health-related absenteeism and turnover in Japanese companies
Atsuya Fujimoto, Hiroshi Kanegae, Kaori Kitaoka, Mizuki Ohashi, Kunio Okada, Koichi Node, Kenkichi Takase, Hiroshi Fukuda, Tomoyuki Miyazaki, Yuichiro Yano
Epidemiol Health. 2024;46:e2024068.   Published online August 2, 2024
DOI: https://doi.org/10.4178/epih.e2024068
  • 1,772 View
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AbstractAbstract PDF
Abstract
We assessed the association of employee lifestyles (e.g., smoking, exercise, drinking, and sleep habits) with mental health-related absenteeism and turnover rates utilizing data from the annual Health and Productivity Management survey by Japan’s Ministry of Economy, Trade and Industry. This analysis included data from 1,748 companies, encompassing 4,199,021 employees. The average proportions of mental health-related absenteeism and employee turnover rates were 1.1±1.0% and 5.0±5.0%, respectively. In multivariable regression models that incorporated all lifestyle factors and confounders, a 1 percentage point increase in the proportion of employees who slept well was associated with reductions in their turnover rate (mean, -0.020%; 95% confidence interval [CI], -0.038 to -0.002) and in mental health-related absenteeism (mean, -0.005%; 95% CI, -0.009 to 0.001). A similar increase in the proportion of employees engaging in regular physical activity corresponded with a 0.005% decrease in the prevalence of mental health-related absenteeism (95% CI, -0.010 to -0.001). A 1 percentage point increase in the proportion of employees who smoked was associated with a 0.013% reduction in mental health-related absenteeism (95% CI, -0.017 to -0.008). Nonetheless, the current study’s observational and cross-sectional design restricted the ability to establish causality between employee lifestyle factors and mental health issues.
Summary
Original Articles
Association of the Korean-specific food-based index of dietary inflammatory potential with the risk of mild cognitive impairment in Korean older adults
Se Yeon Hwang, Chong-Su Kim, Mi Kyung Kim, Yoonkyoung Yang, Yoon Jung Yang
Epidemiol Health. 2024;46:e2024067.   Published online July 25, 2024
DOI: https://doi.org/10.4178/epih.e2024067
  • 1,060 View
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
This study aimed to examine the association between the food-based index of dietary inflammatory potential (FBDI) and the risk of mild cognitive impairment (MCI) in Korean older adults.
METHODS
The subjects were 798 Korean adults aged 60 years and older. The FBDI was calculated based on the intake of 7 anti-inflammatory and 3 inflammatory food groups. Cognitive function was assessed using the Korean version of the Mini-Mental State Examination. A general linear model and multiple logistic regression were applied to assess the association between FBDI and the risk of MCI.
RESULTS
As the FBDI increased, the intake of white rice, cookies/candies, and sweetened drinks tended to increase, but the intake of niacin, β-carotene, calcium, and potassium tended to decrease (p for trend<0.05). The highest FBDI group had a higher MCI risk (odds ratio [OR], 1.60; 95% confidence interval [CI], 1.01 to 2.52) than the lowest FBDI group, adjusted for gender, age, and education level; and this trend was significant in a fully adjusted model (p for trend=0.039). No significant associations were found in men after adjusting for confounding factors. Among women, MCI risk increased as the FBDI increased (p for trend=0.007); and the highest FBDI group had a higher MCI risk (OR, 2.22; 95% CI, 1.04 to 4.74) than the lowest FBDI group in a fully adjusted model.
CONCLUSIONS
These results suggest that the appropriate intake of anti-inflammatory foods and nutrients may be associated with a reduced risk of MCI among older adults.
Summary
Korean summary
본 연구는 60세 이상 노인을 대상으로 한국인 맞춤형 식이 염증 지표와 경도인지장애 위험 사이의 연관성을 조사하였다. 식이 염증 지표 점수는 7개의 항염증 식품 그룹과 3개의 염증 식품 그룹의 섭취를 기반으로 계산하였는데, 식이 염증 지표 점수가 높은 노인들은 경도인지장애 위험이 더 높은 경향이 있음이 확인되었다. 이러한 연구 결과는 염증을 억제하는 식품과 영양소의 적절한 섭취가 경도인지장애 위험 감소와 연관되어 있음을 시사한다.
Key Message
Our study investigated the association between the Korean-specific food-based index of dietary inflammatory potential (FBDI) and risk of mild cognitive impairment (MCI) in adults aged 60 and older. The FBDI was calculated based on the intake of 7 anti-inflammatory and 3 inflammatory food groups. The result showed that older adults with a higher FBDI tended to have a higher risk of MCI. These findings suggest that the appropriate intake of anti- inflammatory foods and nutrients may be associated with a reduced risk of MCI among older adults.
Comparative analysis of body mass index and obesity-related anthropometric indices for mortality prediction: a study of the Namwon and Dong-gu cohort in Korea
Ye Rim Kim, Min-Ho Shin, Young-Hoon Lee, Seong-Woo Choi, Hae-Sung Nam, Jeong-Ho Yang, Sun-Seog Kweon
Epidemiol Health. 2024;46:e2024066.   Published online July 17, 2024
DOI: https://doi.org/10.4178/epih.e2024066
  • 1,234 View
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  • 1 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
This study investigated the associations between several obesity-related anthropometric indices and mortality in middle-aged and elderly populations to compare the indices’ predictive ability with that of the body mass index (BMI).
METHODS
We analyzed data on 12 indices calculated from 19,805 community-based cohort participants (average age, 63.27 years; median follow-up, 13.49 years). Each index was calculated using directly measured values of height, weight, waist circumference (WC), and hip circumference (HC). We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for each index using Cox regression and evaluated mortality prediction with the Harrell concordance index (c-index).
RESULTS
Adding anthropometric indices to the basic mortality model (c-index, 0.7723; 95% CI, 0.7647 to 0.7799) significantly increased the predictive power of BMI (c-index, 0.7735; 95% CI, 0.7659 to 0.7811), a body shape index (ABSI; c-index, 0.7735; 95% CI, 0.7659 to 0.7810), weight-adjusted waist index (WWI; c-index, 0.7731; 95% CI, 0.7656 to 0.7807), and waist to hip index (WHI; c-index, 0.7733; 95% CI, 0.7657 to 0.7809). The differences between the BMI model and the other 3 models were not statistically significant.
CONCLUSIONS
In predicting all-cause mortality, the ABSI, WWI, and WHI models based on WC or HC had stronger predictive power than conventional risk factors but were not significantly different from the BMI model.
Summary
Korean summary
- 다수의 비만관련 신체계측지표들이 사망률을 유의하게 예측하였지만 체질량지수보다 통계적으로 우월하지는 않았다. - 복부둘레가 고려된 비만지표들이 사망률예측에 더 유용할 것으로 추정된다.
Key Message
- Several obesity indices provided predictive value for all-cause mortality but were not superior to body mass index - Obesity indices that take abdominal circumference into account are likely to be more useful for predicting mortality.

Citations

Citations to this article as recorded by  
  • Accumulated subcutaneous fat in abdomen is associated with long COVID-19 symptoms among non-hospitalized patients: a prospective observational study
    Tingxin Li, Baoming He, Yuping Liu, Chen Wang
    Frontiers in Medicine.2024;[Epub]     CrossRef
COVID-19 infection and severe clinical outcomes in patients with kidney disease by vaccination status: a nationwide cohort study in Korea
Jieun Woo, Ahhyung Choi, Jaehun Jung, Ju-Young Shin
Epidemiol Health. 2024;46:e2024065.   Published online July 17, 2024
DOI: https://doi.org/10.4178/epih.e2024065
  • 1,005 View
  • 65 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Patients with kidney disease have been prioritized for coronavirus disease 2019 (COVID-19) vaccination due to their susceptibility to COVID-19 infection. However, little evidence exists regarding these patients’ vulnerability to COVID-19 post-vaccination. Thus, we evaluated the risk of COVID-19 in patients with kidney disease compared to individuals without kidney disease according to vaccination status.
METHODS
A retrospective cohort study was conducted using the Korean nationwide COVID-19 registry linked with National Health Insurance Service claims data (2018-2021). Among individuals aged 12 years or older, 2 separate cohorts were constructed: a COVID-19-vaccinated cohort and an unvaccinated cohort. Within each cohort, the risk of COVID-19 infection and all-cause mortality, hospitalization, and emergency room visits within 30 days of COVID-19 infection were compared between patients with and without kidney disease. To adjust for potential confounding, we used propensity score matching. Hazard ratios (HRs) for each outcome were estimated using a Cox proportional hazard model.
RESULTS
We identified 785,390 and 836,490 individuals in the vaccinated and unvaccinated cohorts, respectively. Compared to patients without kidney disease, patients with kidney disease were at a higher risk of COVID-19 infection in both the vaccinated cohort (HR, 1.08; 95% confidence interval [CI], 1.02 to 1.16) and the unvaccinated cohort (HR, 1.09; 95% CI, 0.99 to 1.20). Likewise, patients with kidney disease generally were at higher risk for severe clinical outcomes within 30 days of COVID-19 infection. Subgroup and sensitivity analyses showed generally consistent results.
CONCLUSIONS
Our study observed excess risk of COVID-19 in patients with kidney disease, highlighting the importance of ongoing attention to these patients even post-vaccination.
Summary
Korean summary
본 연구는 신장 질환이 없는 사람과 비교하여 신장 질환이 있는 환자의 COVID-19 위험을 백신 접종 여부에 따라 평가하였습니다. 백신 접종 여부와 상관없이 신장 질환이 있는 환자는 신장 질환이 없는 환자에 비해 코로나19 감염 및 코로나19 감염 이후 사망, 입원, 응급실 방문의 위험이 더 높았습니다. 즉, 이러한 연구 결과는 백신 접종 후에도 신장 질환이 있는 환자에 대한 코로나19에 대한 지속적인 주의가 필요함을 시사합니다.
Key Message
This study evaluated the risk of COVID-19 in patients with kidney disease compared to patients without kidney disease according to vaccination status. Compared to patients without kidney disease, patients with kidney disease were at a higher risk of COVID-19 infection and severe clinical outcomes after COVID-19 infection in both the vaccinated cohort and the unvaccinated cohort. These findings highlighted the importance of ongoing attention to these patients even post-vaccination.
Association between smoking status and subclinical coronary atherosclerosis in asymptomatic Korean individuals
Hyeji Lee, Jinhee Ha, Kyung Sun Park, Young-Jee Jeon, Sangwoo Park, Soe Hee Ann, Yong-Giun Kim, Yongjik Lee, Woon Jung Kwon, Seong Hoon Choi, Seungbong Han, Gyung-Min Park
Epidemiol Health. 2024;46:e2024064.   Published online July 16, 2024
DOI: https://doi.org/10.4178/epih.e2024064
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
In this study, we sought to evaluate the association between smoking status and subclinical coronary atherosclerosis, as detected by coronary computed tomography angiography (CCTA), in asymptomatic individuals.
METHODS
We retrospectively analyzed 9,285 asymptomatic participants (mean age, 53.7±8.0 years; n=6,017, 64.8% male) with no history of coronary artery disease (CAD) who had undergone self-referred CCTA. Of these participants, 4,333 (46.7%) were considered never smokers, 2,885 (31.1%) former smokers, and 2,067 (22.3%) current smokers. We assessed the degree and characteristics of subclinical coronary atherosclerosis using CCTA, with obstructive CAD defined as a diameter stenosis of at least 50%.
RESULTS
Compared with never-smokers, former smokers exhibited no significant differences in the probabilities of obstructive CAD, any coronary plaque, calcified plaque, or mixed plaque, as determined using adjusted odds ratios (aORs; p>0.05 for all). However, the risk of non-calcified plaque was significantly higher in former smokers (aOR, 1.34; 95% confidence interval [CI], 1.00 to 1.78; p=0.048). Current smokers had significantly higher rates of obstructive CAD (aOR, 1.46; 95% CI, 1.10 to 1.96; p=0.010), any coronary plaque (aOR, 1.41; 95% CI, 1.20 to 1.65; p<0.001), calcified plaque (aOR, 1.32; 95% CI, 1.13 to 1.55; p=0.001), non-calcified plaque (aOR, 1.72; 95% CI, 1.28 to 2.32; p<0.001), and mixed plaque (aOR, 2.00; 95% CI, 1.39 to 2.86; p<0.001) compared to never smokers.
CONCLUSIONS
This cross-sectional study revealed a significant association between current smoking and subclinical coronary atherosclerosis, as detected on CCTA. Additionally, former smoking demonstrated an association with non-calcified plaque, indicating elevated cardiovascular risk.
Summary
Korean summary
- 현재흡연은 무증상 관상동맥 죽상경화증의 독립적인 예측 인자이다. - 과거흡연은 초기 죽상경화증과 취약성을 반영하는 비석회화 플라크와 관련이 있다. - 무증상 관상동맥 죽상경화증을 예방하기 위해 적절한 금연 전략이 필요하다.
Key Message
- Current smoking is an independent predictor of subclinical coronary atherosclerosis. - Former smoking is associated with non-calcified plaque reflecting the early atherosclerosis and vulnerability. - Appropriate strategies for smoking cessation are needed to prevent subclinical coronary atherosclerosis.
Combined effect of anemia and chronic rhinitis on hearing loss in Korean adults: a nationwide observational study
Yeong Jun Ju, Woorim Kim, Jina Han, Soon Young Lee
Epidemiol Health. 2024;46:e2024063.   Published online July 15, 2024
DOI: https://doi.org/10.4178/epih.e2024063
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Studies have suggested an association between hearing loss and anemia. Hearing loss has also been linked to rhinitis, which is characterized by inflammation of the nasal mucous membranes and sinus mucosa. Few studies have concurrently explored the relationships between hearing loss, anemia, and rhinitis. This study was conducted to investigate the association between hearing loss and anemia and to further analyze the potential role of rhinitis in this relationship.
METHODS
Data were collected from the 2020 Korea National Health and Nutrition Examination Survey. Hearing loss was measured with an audiometer in a soundproof booth and was defined as at least moderate impairment (as indicated by a pure-tone average of ≥41 dB in the better-hearing ear). The association between hearing loss and anemia was analyzed using multivariable logistic regression. The combined effect of anemia and rhinitis on hearing loss was assessed with an interaction term.
RESULTS
Among the 2,772 participants, 477 (17.2%) exhibited hearing loss. Participants with anemia were more likely to experience hearing loss than those without anemia (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.07 to 2.33). Furthermore, the odds of hearing loss were greater in participants with both anemia and rhinitis (OR, 3.79; 95% CI, 1.93 to 7.43) relative to those without either condition.
CONCLUSIONS
Anemia was associated with hearing loss in individuals aged 40 years and older. Based on the analysis of combined effects, participants with anemia and chronic rhinitis were more likely to experience hearing loss than individuals without these conditions.
Summary
Korean summary
빈혈은 흔하고 잠재적으로 가역적인 상태이기 때문에, 이 연관성을 검토하는 것은 조기 및 효과적인 중재의 새로운 기회를 제시할 수 있습니다. 이 연구는 빈혈과 청력 손실 사이의 연관성을 평가하고, 이 관계에서 비염의 역할을 추가적으로 조사하는 것을 목표로 하였습니다. 연구 결과, 빈혈이 있는 개인들은 청력 손실을 겪을 가능성이 더 높다는 것이 확인되었으며, 특히 비염을 동시에 겪고 있는 경우에 두드러지게 나타났습니다. 이를 바탕으로, 청력 손실과 관련된 공중보건 문제를 해결하는 데 있어 빈혈과 비염의 효과적인 관리의 필요성을 강조합니다.
Key Message
Given that anemia is a prevalent and potentially reversible condition, examining this correlation could present novel opportunities for early and effective intervention. This study aimed to evaluate the association between anemia and hearing impairment, while further investigating the role of rhinitis in this relationship. Our findings indicated that individuals with anemia had a higher likelihood of experiencing hearing loss, particularly among those simultaneously affected by chronic rhinitis. Therefore, we emphasize the critical need for effective management of both anemia and rhinitis in addressing public health challenges related to hearing impairment.
Data Profile
Introduction to the forensic research via omics markers in environmental health vulnerable areas (FROM) study
Jung-Yeon Kwon, Woo Jin Kim, Yong Min Cho, Byoung-gwon Kim, Seungho Lee, Jee Hyun Rho, Sang-Yong Eom, Dahee Han, Kyung-Hwa Choi, Jang-Hee Lee, Jeeyoung Kim, Sungho Won, Hee-Gyoo Kang, Sora Mun, Hyun Ju Yoo, Jung-Woong Kim, Kwan Lee, Won-Ju Park, Seongchul Hong, Young-Seoub Hong
Epidemiol Health. 2024;46:e2024062.   Published online July 12, 2024
DOI: https://doi.org/10.4178/epih.e2024062
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AbstractAbstract AbstractSummary PDF
Abstract
This research group (forensic research via omics markers in environmental health vulnerable areas: FROM) aimed to develop biomarkers for exposure to environmental hazards and diseases, assess environmental diseases, and apply and verify these biomarkers in environmentally vulnerable areas. Environmentally vulnerable areas—including refineries, abandoned metal mines, coal-fired power plants, waste incinerators, cement factories, and areas with high exposure to particulate matter—along with control areas, were selected for epidemiological investigations. A total of 1,157 adults, who had resided in these areas for over 10 years, were recruited between June 2021 and September 2023. Personal characteristics of the study participants were gathered through a survey. Biological samples, specifically blood and urine, were collected during the field investigations, separated under refrigerated conditions, and then transported to the laboratory for biomarker analysis. Analyses of heavy metals, environmental hazards, and adducts were conducted on these blood and urine samples. Additionally, omics analyses of epigenomes, proteomes, and metabolomes were performed using the blood samples. The biomarkers identified in this study will be utilized to assess the risk of environmental disease occurrence and to evaluate the impact on the health of residents in environmentally vulnerable areas, following the validation of diagnostic accuracy for these diseases.
Summary
Korean summary
환경보건 취약지역 주민을 대상으로 실시한 현장 역학 조사에서 혈액과 소변 시료를 안정적으로 확보하였다. 현장에서 확보한 시료는 즉시 이송하여 오믹스 분석을 통해 환경유해인자별, 환경성질환별 특이적인 바이오마커를 개발한다.
Key Message
Blood and urine samples were stably obtained from on-site epidemiological investigations done on residents in environmental health vulnerable areas, and samples obtained from the sites were immediately transported to the omics laboratory after separation under biobank system. Through this analysis, we aimed to develop biomarkers specific to each environmental hazard and disease.
Original Article
Toxicological evidence integration to confirm the biological plausibility of the association between humidifier disinfectant exposure and respiratory diseases using the AEP-AOP framework
Ha Ryong Kim, Jun Woo Kim, Jong-Hyeon Lee, Younghee Kim, Jungyun Lim, Yong-Wook Baek, Sunkyoung Shin, Mina Ha, Hae-Kwan Cheong, Kyu Hyuck Chung, Review Committee for the Epidemiological Correlations between Humidifier Disinfectants Exposure and Health Effects
Epidemiol Health. 2024;46:e2024060.   Published online July 7, 2024
DOI: https://doi.org/10.4178/epih.e2024060
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Exposure to humidifier disinfectants has been linked to respiratory diseases, including interstitial lung disease, asthma, and pneumonia. Consequently, numerous toxicological studies have explored respiratory damage as both a necessary and sufficient condition for these diseases. We systematically reviewed and integrated evidence from toxicological studies by applying the evidence integration method established in previous research to confirm the biological plausibility of the association between exposure and disease.
METHODS
We conducted a literature search focusing on polyhexamethylene guanidine phosphate (PHMG) and chloromethylisothiazolinone/methylisothiazolinone (CMIT/MIT), the primary ingredients in humidifier disinfectants. We selected relevant studies based on their quality and the population, exposure, comparator, outcome (PECO) statements. These studies were categorized into three lines of evidence: hazard information, animal studies, and mechanistic studies. Based on a systematic review, we integrated the evidence to develop an aggregate exposure pathway–adverse outcome pathway (AEP-AOP) model for respiratory damage. The reliability and relevance of our findings were assessed by comparing them with the hypothesized pathogenic mechanisms of respiratory diseases.
RESULTS
By integrating toxicological evidence for each component of the AEP-AOP framework for PHMG and CMIT/MIT, we developed an AEP-AOP model that elucidates how disinfectants released from humidifiers expose target sites, triggering molecular initiating events and key events that ultimately lead to respiratory damage. This model exhibits high reliability and relevance to the pathogenesis of respiratory diseases.
CONCLUSIONS
The AEP-AOP model developed in this study provides strong evidence, based on evidence-based toxicology, that exposure to humidifier disinfectants causes respiratory diseases. This model demonstrates the pathways leading to respiratory damage, a hallmark of these conditions.
Summary
Korean summary
- PHMG와 CMIT/MIT에 대한 AEP-AOP 프레임워크와 독성학적 근거종합 방법에 의해 가습기살균제의 호흡기계 손상 AEP-AOP 모델을 개발하였다. - 이 모델은 가습기살균제 복합 노출과 호흡기계 질환 간의 인과성을 규명하는 과학적 근거를 제공하며, 향후 다양한 살균제 성분의 호흡기계 건강영향을 예측하는데 활용할 수 있다.
Key Message
• The AEP-AOP model for humidifier disinfectant-induced respiratory damage developed by the AEP-AOP frameworks for PHMG and CMIT/MIT, along with the toxicological evidence integration method. • This model provides a scientific basis for establishing causality between mixed exposure to humidifier disinfectants and respiratory diseases, and can be used in the future to predict the health effects of various disinfectant ingredients.
Brief Communication
Timely access to secondary pediatric services in Korea: a key to reducing child and adolescent mortality
Minku Kang, Young June Choe, Hye Sook Min, Saerom Kim, Seung-Ah Choe
Epidemiol Health. 2024;46:e2024059.   Published online July 5, 2024
DOI: https://doi.org/10.4178/epih.e2024059
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Geographic disparities in access to secondary pediatric care remain a significant issue in countries with universal health coverage, including Korea. This study investigated the link between geographic access to secondary pediatric care and mortality rates in children and adolescents (0-19 years) in Korea.
METHODS
We analyzed district-level data to assess the percentage of those aged 0-19 years residing outside of a 60-minute travel radius from the nearest secondary pediatric care provider (accessibility vulnerability index, AVI).
RESULTS
The AVI ranged from 0% to 100% across the districts for the study period. The confidence interval (CI) was -0.30 (95% CI, -0.41 to -0.19) in 2017 and -0.41 (95% CI, -0.52 to -0.30) in 2021, indicating that the proportion of those who could not access care within 60 minutes was disproportionately higher in districts with lower socioeconomic status. We found 8% rise in mortality rates among individuals aged 0-19 years for every 10% increase in AVI (95% CI, 1.06 to 1.10).
CONCLUSIONS
The study highlights disparities in pediatric care access and their impact on child survival, emphasizing the need for improved access to achieve true universal health coverage.
Summary
Korean summary
본 연구는 한국에서 소아 의료 서비스에 대한 지리적 접근성과 아동 사망률 사이의 연관성을 조사하여, 특히 COVID-19 대유행 기간 동안 접근성 제한이 높은 사망률과 관련이 있음을 발견하였다. 이 연구는 아동 및 청소년의 예방 가능한 사망률에 대한 지역 격차를 줄이기 위해 시기적절한 치료 접근성을 개선해야 할 필요성을 강조하였다.
Key Message
The study investigated the link between geographic access to pediatric services and child mortality in South Korea, finding that limited access, particularly during the COVID-19 pandemic, was associated with higher mortality. The research highlights the need for improved access to timely care to reduce regional disparities in preventable deaths among children and adolescents.
Cohort Profile
Cohort profile: the Taiwan Initiative for Geriatric Epidemiological Research - a prospective cohort study on cognition
Pei-Iun Hsieh, Te-Hsuan Huang, Jeng-Min Chiou, Jen-Hau Chen, Yen-Ching Chen
Epidemiol Health. 2024;46:e2024057.   Published online June 25, 2024
DOI: https://doi.org/10.4178/epih.e2024057
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AbstractAbstract AbstractSummary PDF
Abstract
The Taiwan Initiative for Geriatric Epidemiological Research (TIGER) was founded in 2011 to elucidate the interrelationships among various predictors of global and domain-specific cognitive impairment, with the aim of identifying older adults with an increased risk of dementia in the preclinical phase. TIGER, a population-based prospective cohort, recruited 605 and 629 (total of 1,234) older adults (aged 65 and above) at baseline (2011-2013 and 2019-2022) of phase I and II, respectively. Participants have undergone structured questionnaires, global and domain-specific cognitive assessments, physical exams, and biological specimen collections at baseline and biennial follow-ups to date. By 2022, TIGER I has included 4 biennial follow-ups, with the participants comprising 53.9% female and having a mean age of 73.2 years at baseline. After an 8-year follow-up, the annual attrition rate was 6.1%, reflecting a combination of 9.9% of participants who passed away and 36.2% who dropped out. TIGER has published novel and multidisciplinary research on cognitive-related outcomes in older adults, including environmental exposures (indoor and ambient air pollution), multimorbidity, sarcopenia, frailty, biomarkers (brain and retinal images, renal and inflammatory markers), and diet. TIGER’s meticulous design, multidisciplinary data, and novel findings elucidate the complex etiology of cognitive impairment and frailty, offering valuable insights into factors that can be used to predict and prevent dementia in the preclinical phase.
Summary
Key Message
1. The Taiwan Initiative for Geriatric Epidemiological Research (TIGER), established in 2001, aims to fill the knowledge gap regarding the longitudinal associations between environmental exposure, clinical factors, and performance in global and cognitive domains. 2. TIGER has made significant findings in various aspects, including the effects of exposure to low-level air pollutants, indoor air quality, clinical factors (brain and retinal images, dental health), nutrition, and biomarkers on cognition over time. 3. TIGER's multidisciplinary data and advanced analysis elucidate the predictors of cognitive impairment, identifying older adults at increased risk of dementia in the preclinical phase for early prevention and intervention.
Systematic Review
Tea consumption and risk of all-cause, cardiovascular disease, and cancer mortality: a meta-analysis of thirty-eight prospective cohort data sets
Youngyo Kim, Youjin Je
Epidemiol Health. 2024;46:e2024056.   Published online June 21, 2024
DOI: https://doi.org/10.4178/epih.e2024056
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Tea consumption has been considered beneficial to human health because tea contains phytochemicals such as polyphenols and theaflavins. We conducted a systematic review and meta-analysis on the association between tea consumption and mortality from all causes, cardiovascular disease (CVD), and cancer to provide a quantitative assessment of current evidence.
METHODS
The PubMed, Web of Science, and Scopus databases were searched through April 2024 to identify eligible studies. Random effects models were used to combine study-specific effect estimates (ESs).
RESULTS
A total of 38 prospective cohort data sets (from 27 papers) with 1,956,549 participants were included in this meta-analysis. The pooled ESs of the highest versus lowest categories of tea consumption were 0.90 (95% confidence interval [CI], 0.86 to 0.95) for all-cause mortality, 0.86 (95% CI, 0.79 to 0.94) for CVD mortality, and 0.90 (95% CI, 0.78 to 1.03) for cancer mortality. In the dose-response analysis, a non-linear association was observed. The greatest risk reductions were observed for the consumption of 2.0 cup/day for all-cause mortality (ES, 0.91; 95% CI, 0.88 to 0.94) and 1.5 cup/day for cancer mortality (ES, 0.92; 95% CI, 0.89 to 0.96), whereas additional consumption did not show a further reduction in the risk of death. A plateau was observed for CVD mortality at moderate consumption levels (1.5-3.0 cup/day), but a sustained reduction in mortality risk was observed at higher intake levels.
CONCLUSIONS
Moderate tea consumption (e.g., 1.5-2.0 cup/day) was associated with lower all-cause, CVD, and cancer mortality compared to no tea consumption. Further well-designed prospective studies are needed for a definitive conclusion.
Summary
Korean summary
차는 전세계적으로 널리 소비되는 음료로 그 공중보건학적 영향력이 크다. 차의 섭취와 만성질환의 관련성은 아직 일관성 있게 결론이 나지 않았는데 최근에 이 주제에 대하여 대규모의 코호트 연구 결과들이 발표된 바 있었다. 38개의 코호트 데이터에 근거한 본 메타분석의 결과는 하루 한 잔 반에서 두 잔의 차를 마시는 것이 총사망위험과 심혈관계질환이나 암으로 인한 사망 위험을 낮추는 것과 관계가 있음을 나타내고 있다.
Key Message
Tea is a commonly consumed beverage worldwide and has a significant public health impact. The association between tea consumption and risk of mortality from chronic disease remains inconsistent, and extensive cohort studies have been published recently. In this meta-analysis, including thirty-eight cohort studies, people who drank one and a half to two cups of tea daily had a lower risk of mortality from all causes, cardiovascular disease, and cancer than those who drank less tea.

Epidemiol Health : Epidemiology and Health
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