Skip Navigation
Skip to contents

Epidemiol Health : Epidemiology and Health

OPEN ACCESS
SEARCH
Search

Most download articles

Page Path
HOME > Browse articles > Most download articles
238 Most download articles
Filter
Filter
Article category
Keywords
Publication year
Authors
Funded articles

Most-download articles are from the articles published in 2023 during the last three month.

Original Article
Geospatial analysis of neonatal mortality in north-eastern India: a multilevel Bayesian approach
Vidhi Jain, Kh. Jitenkumar Singh, Deboshree Das, Shefali Gupta, Gunjan Singh
Epidemiol Health. 2025;47:e2025021.   Published online April 27, 2025
DOI: https://doi.org/10.4178/epih.e2025021
  • 999 View
  • 115 Download
AbstractAbstract PDF
Abstract
OBJECTIVES
Neonatal mortality remains a significant public health issue in India. This study investigates spatial patterns and contributing factors to neonatal mortality in the north-eastern states, identifying hotspot regions and spatial variations.
METHODS
A sample of 34,222 mothers from India’s National Family Health Survey (NFHS-5, 2019-21) in the north-eastern states was analysed. Descriptive and bivariate analyses were conducted alongside Bayesian multilevel logistic regression using integrated nested Laplace approximation to model neonatal mortality. Spatial hotspot analysis using Getis-Ord Gi* statistics identified clusters of high neonatal mortality, while geographically weighted regression (GWR) was used to examine spatial variations in the relationships between neonatal mortality and contributing factors.
RESULTS
The neonatal mortality rate in the north-eastern states declined from 45 to 21 per 1,000 live births (NFHS-1 to NFHS-5) but remains higher than the national average. Assam reported the highest mortality (42.16%), whereas Sikkim had the lowest (0.87%). Higher mortality was observed among male infants, mothers with advanced age, low maternal education, and mothers who attended less than 5 antenatal care (ANC) visits. Spatial analysis identified hotspots in Assam, Meghalaya, and Tripura. GWR indicated that areas with less than 5 ANC visits had the strongest association with neonatal mortality. Bayesian multilevel analysis highlighted spatial variations of up to 51% across districts in northeast India.
CONCLUSIONS
This study underscores spatial disparities in neonatal mortality across north-eastern India. Addressing childcare practices and healthcare access in hotspot regions is essential for improving new-born health outcomes. The findings provide critical insights for policymakers to develop targeted interventions aimed at reducing neonatal mortality in these underserved areas.
Summary
Special Article
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
  • 32,241 View
  • 783 Download
  • 23 Web of Science
  • 29 Crossref
AbstractAbstract AbstractSummary PDFSupplementary 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.

Citations

Citations to this article as recorded by  
  • 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
  • Associations of lifestyle factors with oral cancer risk: An umbrella review
    Haobo Xu, Zhonglan Gao, Hairong Liu, Liya An, Ting Yang, Bojun Zhang, Guobin LIU, Dali Sun
    Journal of Stomatology Oral and Maxillofacial Surgery.2025; 126(3): 102234.     CrossRef
  • Estudio bibliométrico de las publicaciones sobre cirugía pancreática realizadas por cirujanos españoles
    Juan Jesús Rubio-García, Celia Villodre Tudela, Cándido Alcázar López, Silvia Carbonell Morote, Mariano Franco Campello, Paola Melgar Requena, Adrián Paredes Segura, José Manuel Ramia Ángel
    Cirugía Española.2025; 103(4): 201.     CrossRef
  • Personalized Lifestyle Interventions for Prevention and Treatment of Obesity-Related Cancers: A Call to Action
    Mohamad Motevalli, Fatima Cody Stanford
    Cancers.2025; 17(8): 1255.     CrossRef
  • Bibliometric study of publications on pancreatic surgery carried out by spanish surgeons
    Juan Jesús Rubio-García, Celia Villodre Tudela, Cándido Alcázar López, Silvia Carbonell Morote, Mariano Franco Campello, Paola Melgar Requena, Adrián Paredes Segura, José Manuel Ramia Ángel
    Cirugía Española (English Edition).2025; 103(4): 201.     CrossRef
  • Alcohol consumption and breast lesions: targets for risk-based screening in high-risk Italian women
    Sonia Cerrai, Alessio Lachi, Michela Franchini, Stefania Pieroni, Giada Anastasi, Marco Scalese, Anna Odone, Silvano Gallus, Luc Smits, Sabrina Molinaro
    Breast Cancer.2025;[Epub]     CrossRef
  • Design and Optimization of Surface Plasmon Resonance-Based Non-Invasive Refractive Index Biosensor Using Ag-SiO2 Materials for Alcoholic Beverages Compound Detection
    Trupti Kamani, Shobhit K. Patel, Sana Ben Khalifa, Pankaj Pathak, Saleh Chebaane, Marouan Kouki
    Plasmonics.2025;[Epub]     CrossRef
  • Invisible foes: how air pollution and lifestyle conspire in the rise of colorectal cancer
    Di Zhao, Meng Zhu
    QJM: An International Journal of Medicine.2025;[Epub]     CrossRef
  • Wine Consumption and Lung Cancer Risk: A Systematic Review and Meta-Analysis
    Carlotta Bertola, Camilla Gobbetti, Gaia Baccarini, Roberto Fabiani
    Nutrients.2025; 17(8): 1322.     CrossRef
  • A narrative review on alcohol and alimentary tract cancer with special emphasis on acetaldehyde and oxidative stress
    Helmut Karl Seitz
    Zeitschrift für Gastroenterologie.2025;[Epub]     CrossRef
  • Association of Cigarette Smoking and Alcohol Drinking With Risk of 12 Common Cancers Among Low-Income American Adults in the Southeastern United States
    Jiajun Shi, Wanqing Wen, Qiuyin Cai, Martha J. Shrubsole, Xiao-Ou Shu, Wei Zheng
    Cancer Control.2025;[Epub]     CrossRef
  • Identification of MMP14 and MKLN1 as colorectal cancer susceptibility genes and drug-repositioning candidates from a genome-wide association study
    Dabin Yun, Jung-Ho Yang, Jin-ah Sim, Minjung Kim, Ji Won Park, Seung Yong Jeong, Aesun Shin, Sun-Seog Kweon, Nan Song
    Journal of Translational Medicine.2025;[Epub]     CrossRef
  • Research Progress on Risk Factors and Endoscopic Diagnosis of Gastric Mucosal Intestinal Metaplasia
    思妤 刘
    Advances in Clinical Medicine.2025; 15(05): 1135.     CrossRef
  • Global Cancer Burden Forecast for 204 Countries and Territories, 2022–2050: A Predictive Analysis from the Global Burden of Disease Study 2021
    Jinghao Liang, Yijian Lin, Wenxi Wang, Jingchun Ni, Hongmiao Lin, Zishan Huang, Jihao Qi, Zhaofeng Tan, Hengrui Liang, Jianxing He
    Cancer Letters.2025; 629: 217883.     CrossRef
  • Global burden of breast cancer attributable to alcohol consumption: a multi-regional observational analysis (1990–2021)
    Fangfang Cui, Yuntian Chu, Weiyi Wang, Meihao Ji, Sidong Zhang, Zhengyu Wu, Yadong Song
    Addictive Behaviors.2025; 170: 108426.     CrossRef
  • Patterns of cigarette, e-cigarette, heated tobacco, and alcohol use in solid organ transplant recipients, a pre- versus posttransplant comparison: Survey results from a transplantation center in Poland
    Zuzanna Marczak, Bartosz Olkowski, Olga Maria Rostkowska, Dorota Miszewska-Szyszkowska, Olga Kozińska-Przybył, Tomasz Warężak, Magdalena Durlik
    Tobacco Prevention & Cessation.2025; 11(June): 1.     CrossRef
  • Analysis of Novel DNA Adducts Derived from Acetaldehyde
    Yuuki Betsuyaku, Mina Motohashi, Akira Sassa, Takeji Takamura-Enya, Yukari Totsuka
    Biomolecules.2025; 15(6): 878.     CrossRef
  • Granulocyte function in response to acute alcohol consumption: temporal shifts from proinflammatory activation to antiinflammatory modulation in healthy volunteers
    Ramona Sturm, Florian Haag, Helen Rinderknecht, Jasmin Maria Bülow, Nils Wagner, Julian Zabel, Christian B Bergmann, Ingo Marzi, Borna Relja
    Journal of Leukocyte Biology.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
Original article
Inequality in mortality according to regional deprivation during the COVID-19 pandemic
Min Hui Moon, Min-Hyeok Choi, Young Gyu Ko
Epidemiol Health. 2025;e2025022.   Published online April 29, 2025
DOI: https://doi.org/10.4178/epih.e2025022    [Accepted]
  • 762 View
  • 85 Download
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Vulnerability to coronavirus disease 2019 (COVID-19) is significantly greater in regions with lower socioeconomic status. However, detailed analyses of regional socioeconomic disparities have rarely been conducted in South Korea. This study aimed to identify and compare mortality inequalities associated with regional socioeconomic status across different areas of South Korea during the COVID-19 pandemic.
METHODS
Using cause-of-death statistics from 2020 to 2022, we calculated age-standardized mortality rates (ASMRs) for total mortality, COVID-19 mortality, and pneumonia mortality. The socioeconomic status of each region was assessed using the regional deprivation index. Additionally, we calculated the rate difference (RD), rate ratio (RR), slope index of inequality (SII), and relative index of inequality (RII) for each socioeconomic level to examine the extent of mortality inequality and its temporal changes. These analyses were stratified by sex and urban-rural classification.
RESULTS
The total mortality rate, as well as COVID-19-specific and pneumonia-specific mortality rates, increased during the COVID-19 pandemic. The ASMR for COVID-19 was higher in rural areas (ASMR, 27.79), which have lower healthcare accessibility, compared to urban areas (ASMR, 26.63). However, mortality inequality indicators for COVID-19 were more pronounced in urban areas compared to rural areas (SII [urban: 2.72; rural: -0.05], RII [urban: 0.10; rural: 0.00]). Notably, significant inequalities were observed among men residing in urban areas.
CONCLUSIONS
In disaster situations such as the COVID-19 pandemic, it is essential to implement strategies aimed at reducing overall mortality rates and addressing regional socioeconomic inequalities.
Summary
Korean summary
COVID-19 팬데믹 기간 동안, 지역의 사회경제적 수준은 한국의 사망률에 중요한 영향을 미쳤다. 총사망률, COVID-19 사망률, 폐렴 사망률에 대한 연령표준화사망률(ASMR)은 의료 접근성이 낮고 박탈 수준이 높은 농촌 지역에서 더 높게 나타났으나, 상대적인 사망 불평등은 특히 남성을 중심으로 도시 지역에서 더 두드러지게 나타났다. 이러한 결과는 공중보건 위기 상황에서 건강 불평등이 지역의 사회경제적 수준과 맥락에 따라 복합적으로 작용함을 보여준다. 정책 입안자들은 지역 간 사회경제적 수준에 따른 절대적 불평등과 상대적 불평등을 모두 고려한 맞춤형 개입 전략을 수립하고, 형평한 의료 접근성을 확보함으로써 향후 팬데믹에서의 사망 위험을 줄이기 위한 노력을 강화해야 한다.
Key Message
During the COVID-19 pandemic, regional socioeconomic disparities significantly influenced mortality in Korea. Mortality rates were higher in deprived rural areas, while relative inequalities were more evident in urban men. Tailored policies addressing both absolute and relative inequalities are essential to ensure equitable healthcare access in future crises.
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
  • 3,162 View
  • 156 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
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.
Association between regular dental scaling and stroke risk in patients with periodontal diseases: evidence from a Korean nationwide database
Yu-Rin Kim, Minkook Son, Seon-Rye Kim
Epidemiol Health. 2025;47:e2025020.   Published online April 19, 2025
DOI: https://doi.org/10.4178/epih.e2025020
  • 1,087 View
  • 82 Download
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
This study aimed to evaluate the association between the frequency of dental scaling and the risk of stroke among individuals with moderate-to-severe periodontal diseases and verify the effect of regular dental scaling on stroke risk in this population.
METHODS
In this retrospective study, 25,758 subjects with moderate-to-severe periodontal diseases were selected from the Korean National Health Insurance Service-National Health Screening Cohort database. Based on the frequency of dental scaling, the subjects were divided into three groups: regular, occasional, and infrequent. Restricted cubic splines were used to evaluate hazard ratios (HRs) with 95% confidence intervals (CIs) for stroke. Additionally, landmark analysis was conducted to strengthen the reliability of the results.
RESULTS
There were 293, 111, and 38 stroke cases in the infrequent, occasional, and regular group, respectively. The adjusted HR for stroke in the regular group, compared to that in the infrequent group, was 0.40 (95% CI, 0.29 to 0.57). In the landmark analysis with follow-up after 1 year and after 2 years, the adjusted HR in the regular group compared to that in the infrequent group was 0.41 (95% CI, 0.28 to 0.60) and 0.50 (95% CI, 0.33 to 0.76), respectively.
CONCLUSIONS
Regular dental scaling was significantly associated with a reduced risk of stroke in patients with moderate-to-severe periodontal diseases. These findings may suggest a potential preventive role of dental scaling beyond oral health. Further studies are needed to explore the underlying biological mechanisms linking periodontal care to stroke prevention and to explore causal relationships between dental scaling and stroke risk.
Summary
Korean summary
중등도 이상의 치주염을 가진 성인을 대상으로 분석한 결과, 정기적으로 치석 제거(스케일링)를 시행한 집단은 비정기적 또는 미시행 집단에 비해 뇌졸중 발생 위험이 통계적으로 유의하게 낮은 것으로 나타났다. 이러한 보호 효과는 특히 남성 및 65세 이상 고령층에서 더욱 뚜렷하게 관찰되었다. 본 결과는 정기적인 구강건강관리가 뇌혈관질환 예방에 있어 잠재적인 기여 요인임을 시사한다.
Key Message
Among adults with moderate to severe periodontitis, those who underwent regular dental scaling had a significantly lower risk of stroke compared to those without routine scaling. This protective effect was especially evident in males and individuals aged 65 and older. These results suggest that regular oral healthcare may serve as a potential contributing factor in the prevention of cerebrovascular diseases.
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
  • 4,983 View
  • 255 Download
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
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.

Citations

Citations to this article as recorded by  
  • Relationship between estimated pulse wave velocity trajectories and cardiovascular disease risk in patients with cardiovascular-kidney-metabolic syndrome stages 0–3
    Tingting Chen, Huangyi Yin, Yubo Zhou, Min Liang
    Nutrition, Metabolism and Cardiovascular Diseases.2025; : 104192.     CrossRef
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
  • 2,085 View
  • 136 Download
PDF
Abstract
Summary
Original article
Safety of combination therapy of azilsartan medoxomil and amlodipine: a population-based cohort study
Hyesung Lee, Bin Hong, Chris Tzu-Ting Su, Sungho Bea, Han Eol Jeong, Kyungyeon Jung, Michael Chun-Yuan Cheng, Zoe Chi-Jui Chang, Edward Chia-Cheng Lai, Jongyoung Lee
Epidemiol Health. 2025;e2025029.   Published online May 28, 2025
DOI: https://doi.org/10.4178/epih.e2025029    [Accepted]
  • 821 View
  • 62 Download
AbstractAbstract PDF
Abstract
OBJECTIVES
This study investigated the safety of azilsartan and amlodipine combination therapy versus other angiotensin receptor blockers (ARBs) and amlodipine in patients with hypertension.
METHODS
We conducted a cohort study utilizing healthcare databases from South Korea and Taiwan. Patients aged between 18 and 75 years who were newly prescribed both an ARB and amlodipine within 6 months of hypertension diagnosis were included. Safety outcomes assessed were hypotension, angioedema, acute pancreatitis, hyperkalemia, hypokalemia, toxic liver disease, hepatic failure, nausea and vomiting, and fall-related injury. Hazard ratios (HRs) with 95% confidence intervals (CIs) for each safety outcome associated with azilsartan medoxomil and amlodipine versus other ARBs combined with amlodipine were calculated within a 1:1 propensity score (PS)-matched cohort. Summary HRs across databases were computed using random-effects meta-analysis.
RESULTS
We identified 2,472 eligible patients (1,521 from Korea, 951 from Taiwan) initiating treatment with azilsartan medoxomil and amlodipine, and 671,468 patients (312,322 from Korea, 355,409 from Taiwan) initiating other ARBs with amlodipine. After PS matching, baseline characteristics were well-balanced between treatment groups. During the 180-day follow-up, most adverse outcomes did not occur even once in either group, thus precluding the calculation of HRs. The risk of acute pancreatitis was not significantly different between the azilsartan medoxomil and amlodipine group and the other ARB and amlodipine groups (summary HR, 0.86 [95% CI, 0.14–5.37]).
CONCLUSIONS
In this population-based cohort study, azilsartan medoxomil combined with amlodipine was not associated with an increased risk of adverse outcomes compared to other ARBs combined with amlodipine.
Summary
Original Articles
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
  • 3,201 View
  • 142 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
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.
Gender differences in awareness and practices of cancer prevention recommendations in Korea: a cross-sectional survey
Yoonjoo Choi, Naeun Kim, Jin-Kyoung Oh, Yoon-Jung Choi, Bohyun Park, Byungmi Kim
Epidemiol Health. 2025;47:e2025003.   Published online January 15, 2025
DOI: https://doi.org/10.4178/epih.e2025003
  • 4,055 View
  • 197 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Gender is a major determinant of health behaviors that influences cancer prevention awareness and practices. This study investigated the relationship of the awareness and practice rates of cancer prevention recommendations with gender and socioeconomic status.
METHODS
We used data from the Korean National Cancer Prevention Awareness and Practice Survey (2023). The sample included 4,000 men and women aged 20-74 years. We conducted multiple logistic regression analyses to evaluate associations with the awareness and practices of cancer prevention, and a joinpoint regression analysis using age-standardized rates to analyze trends in awareness and practice rates from 2007 to 2023.
RESULTS
The awareness rates were 79.4% and 81.2% for men and women, respectively. The overall practice rates were substantially lower (43.1% for men and 48.9% for women). For men, awareness rates did not differ significantly by socio-demographic characteristics, but practice rates increased with age (20-29: 15.9%; 60-74: 53.8%). For women, both awareness (20-29: 73.0%; 60-74: 85.7%) and practice (20-29: 16.8%; 60-74: 67.5%) rates increased with age. The easiest recommendations to follow were “reducing salt intake and avoiding burnt or charred foods” (men: 29.9%; women: 28.4%), whereas the most difficult recommendation was “engaging in regular physical activity” (men: 32.5%; women: 34.4%).
CONCLUSIONS
While awareness of cancer prevention recommendations was high, the practice of these recommendations was low. Gender influenced changes in awareness and practice rates over time, reflecting a large gap in practice. Future research should explore appropriate intervention points for cancer prevention practices and the development of more effective cancer prevention policies.
Summary
Korean summary
암 예방에 대한 인식은 남녀 모두 높은 수준이었으나, 실천에서는 성별 차이가 크게 나타났다. 효과적인 암 예방 정책 수립을 위해 성별에 따른 실천 격차를 고려한 전략이 필요하다.
Key Message
Many factors influence cancer prevention awareness and practice, and gender is a crucial determinant of health behaviour in general. This study found that while awareness was reasonably high among both men and women, there was a signifi- cant gender gap in practice. Given the variation in health behaviours by gender, further evaluation of gender effects is nec- essary to inform future policy interventions aimed at improving cancer prevention practices.
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;47:e2025014.   Published online March 27, 2025
DOI: https://doi.org/10.4178/epih.e2025014
  • 1,985 View
  • 68 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
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
Korean summary
본 연구는 기후 관련 재난 후 우울증, 불안, PTSD와 관련된 요인을 파악하였다. 재난의 심각도가 클수록 정신 건강 악화는 더 심각하였으며 특히 노인, 여성, 낮은 교육 수준과 소득을 가진 취약한 그룹이 더 큰 위험에 처해 있었다. 이 결과는 향후 재난 대응에서 이러한 인구집단을 지원하기 위한 맞춤형 정신 건강 개입과 정책의 필요성을 시사한다.
Key Message
We identified factors associated with depression, anxiety, and PTSD following climate-related disasters, highlighting that greater disaster severity correlates with worse mental health outcomes. Vulnerable groups, such as older adults, women, those with lower education and income, are at higher risk. The findings suggest the need for targeted mental health interventions and policies to support these populations in future disaster responses.
Impact of hypertension-related avoidable hospitalization on all-cause mortality in older patients with hypertension: a nationwide retrospective cohort study in Korea
Yehrhee Son, Noorhee Son, Sungyoun Chun, Ki-Bong Yoo, Jung Hyun Chang, Woo-Ri Lee
Epidemiol Health. 2025;47:e2025019.   Published online April 18, 2025
DOI: https://doi.org/10.4178/epih.e2025019
  • 1,283 View
  • 53 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The prevalence of hypertension is increasing as a result of rapid population aging, which elevates the societal burden of the disease. In Korea, the hospitalization rate for hypertension-related admissions exceeds the average reported by the Organization for Economic Cooperation and Development; however, the impact of these hospitalizations has not been evaluated. Therefore, this study investigates the association between hypertension-related avoidable hospitalizations and all-cause mortality.
METHODS
We included patients aged ≥60 years diagnosed with hypertension, identified using data from the National Health Insurance Services Senior Cohort spanning 2008 to 2019. The primary outcome was all-cause mortality measured at 3 years and 5 years after the hypertension diagnosis. The key independent variable was the incidence of hypertension-related avoidable hospitalizations within the first year following the initial hypertension diagnosis. Cox proportional hazards regression analysis was employed to assess these associations. To ensure robust findings and minimize selection bias, several sensitivity analyses were conducted.
RESULTS
Out of 65,686 participants, 397 (0.6%) experienced hypertension-related avoidable hospitalizations within 1 year of their initial hypertension diagnosis. Individuals who experienced such hospitalizations had a significantly higher risk of all-cause mortality compared to those who did not (3-year: hazard ratio [HR], 2.12; 95% confidence interval [CI], 1.53 to 2.94; 5-year: HR, 2.13; 95% CI, 1.68 to 2.68).
CONCLUSIONS
Hypertension-related avoidable hospitalizations among older adults are associated with an increased risk of both short-term and long-term all-cause mortality. These findings underscore the importance of timely hypertension management to prevent such hospitalizations.
Summary
Korean summary
- 고혈압 관련 회피가능한 입원은 한국의 노인 고혈압 환자의 3년 및 5년 사망률과 유의미한 연관성을 보인다. - 사회경제적 및 지역적 건강 격차가 관찰되었으며, 저소득층과 대도시 이외 지역에 거주하는 환자의 사망 위험이 더 높았다. - 약물 복용을 포함한 조기 및 지속적인 고혈압 관리는 회피가능한 입원을 예방하고 장기 생존 결과를 개선하는데에 도움이 될 수 있다.
Key Message
- Hypertension-related avoidable hospitalizations are significantly associated with both 3-year and 5-year all-cause mortality among older patients with hypertension in Korea. - Socioeconomic and regional disparities were observed, with greater mortality risks among patients from low-income groups and non-metropolitan areas. - Early and consistent hypertension management—including medication adherence—may help prevent avoidable hospitalizations and improve long-term survival outcomes.
Association between humidifier disinfectant use duration and lung cancer development in Korea
Sungchan Kang, Jeong-In Hwang, Su Hwan Kim, Hyungryul Lim, Dong-wook Lee, Woojoo Lee, Jong Hun Kim, Sol Yu, Jungyun Lim, Younghee Kim, Kyoung-Nam Kim
Epidemiol Health. 2025;47:e2025023.   Published online May 2, 2025
DOI: https://doi.org/10.4178/epih.e2025023
  • 749 View
  • 44 Download
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
This study was conducted to assess the association between the duration of humidifier disinfectant use and lung cancer development.
METHODS
We analyzed data from 3,605 applicants registered for compensation from the Korean government due to health conditions related to humidifier disinfectant exposure. Among these individuals, 121 were diagnosed with lung cancer at least 4 years after their initial exposure (through December 2021). Hazard ratios (HRs) and 95% confidence intervals (CIs) for lung cancer incidence were estimated according to the duration of disinfectant use using Cox proportional hazards models.
RESULTS
Compared with <5 months of use, the HRs for lung cancer were 1.81 (95% CI, 0.41 to 7.97) for 5-14 months, 2.45 (95% CI, 0.58 to 10.41) for 15-29 months, and 4.61 (95% CI, 1.12 to 18.91) for ≥30 months. Using never smokers with <15 months of use as the reference category, the HRs were 2.97 (95% CI, 1.34 to 6.56) for never smokers with ≥15 months of use, 2.73 (95% CI, 0.94 to 7.95) for current or former smokers with <15 months of use, and 4.74 (95% CI, 1.94 to 11.61) for current or former smokers with ≥15 months of use.
CONCLUSIONS
Our study provides some of the first robust epidemiological evidence that prolonged humidifier disinfectant use contributes to lung cancer development. Future studies—particularly those including unexposed populations—are needed to confirm these findings.
Summary
Korean summary
* 장기간의 가습기 살균제 사용과 폐암 발생의 위험 간에는 정량적 연관성을 발견할 수 있었습니다. * 가습기살균제를 30개월 이상 사용했다고 응답한 사람들은, 가습기살균제를 5개월 미만 사용했다고 응답한 사람들과 비교하여 폐암 발생 위험이 4배 높았습니다.
Key Message
* There is a quantitative association between prolonged humidifier disinfectants use and the risk of lung cancer incidence. * Individuals reported they used humidifier disinfectants for more than 30 months had more than four times higher risk of lung cancer than those of individuals who reported they used humidifier disinfectants for less than five months.
Original articles
Spatial patterns of laboratory-confirmed leptospirosis in northeastern Peninsular Malaysia, 2016–2023
Hazlienor Mohd Hatta, Kamarul Imran Musa, Nik Mohd Hafiz Mohd Fuzi, Paula Moraga
Epidemiol Health. 2025;e2025030.   Published online May 29, 2025
DOI: https://doi.org/10.4178/epih.e2025030    [Accepted]
  • 511 View
  • 37 Download
AbstractAbstract PDF
Abstract
OBJECTIVES
Leptospirosis presents significant public health challenges in endemic regions such as north-eastern Peninsular Malaysia. Spatial analysis is essential for visualising disease incidence and distribution, assessing vulnerability based on geographical and socio-economic factors, and ultimately informing targeted interventions, optimising resource allocation, and enhancing surveillance strategies. This study aimed to determine the incidence and characterise the spatial distribution of leptospirosis in Kelantan, Malaysia.
METHODS
All laboratory-confirmed leptospirosis cases reported in Kelantan between 2016 and 2023 were extracted from the Communicable Disease Control Information System (CDCIS) e-Notifikasi online database. Spatial analyses were performed using the spatstat, spdep, and ggplot2 packages within the RStudio integrated development environment.
RESULTS
The analysis encompassed 1534 laboratory-confirmed leptospirosis cases. The average crude annual incidence of leptospirosis cases per 1000 population from 2016 to 2023 was 0.101 (95% CI: 0.038, 0.164). Incidence varied considerably across districts and subdistricts, initially higher in the north but declining over time, while consistently high and increasing incidence was observed in the southern region. Significant clustering of leptospirosis cases occurred throughout the studied years, except during the COVID-19 pandemic. Hotspots were initially prevalent in northern areas but later emerged in south-eastern and southern regions. Significant spatial autocorrelation evolved from high-low to high-high clusters, particularly evident in central and southern regions.
CONCLUSIONS
This study provides valuable local epidemiological and spatial insights into the endemicity of leptospirosis. The findings highlight the need for targeted interventions and continued surveillance to effectively mitigate the leptospirosis burden in endemic areas.
Summary
Risk of new-onset seizures following immunization against COVID-19: a self-controlled case-series study
Hwa Yeon Ko, Dongwon Yoon, Ju Hwan Kim, Han Eol Jeong, Seung Bong Hong, Won Chul Shin, JU YOUNG SHIN
Epidemiol Health. 2025;e2025024.   Published online May 2, 2025
DOI: https://doi.org/10.4178/epih.e2025024    [Accepted]
  • 791 View
  • 37 Download
AbstractAbstract PDF
Abstract
OBJECTIVES
Despite emerging reports of new-onset seizures (NOS) following COVID-19 vaccination, safety evidence regarding the risk of NOS after vaccination remains limited. We aimed to investigate the potential association between NOS and COVID-19 vaccination.
METHODS
We conducted a self-controlled case series study utilizing a nationwide database linking the COVID-19 vaccination registry and the National Health Information Database (from February 2021 to October 2022). We identified adults (≥18 years) who received COVID-19 vaccination (BNT162b2, ChAdOx1 nCoV-19, mRNA-1273, NVX-CoV2373, or Ad26.COV2.S) and had a diagnosis of NOS accompanied by prescriptions of anti-seizure drugs. The observation period was defined as 240 days following vaccination. We evaluated the risk of NOS during a risk window of 28 days after vaccination compared to the control window (the remaining observation period excluding the risk window). Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were estimated using a conditional Poisson regression model.
RESULTS
Among 42,155,198 COVID-19 vaccine recipients, we identified 1,849 and 4,217 patients with NOS in the risk and control windows, respectively. There was no increased risk of NOS within the 28-day period following vaccination (IRR, 0.99; 95% CI, 0.94–1.05). Although results from subgroup analyses by vaccine type were largely consistent with the main findings (IRR, 0.95; 95% CI, 0.88–1.03 for BNT162b2; IRR, 0.95; 95% CI, 0.77–1.16 for ChAdOx1 nCoV-19; IRR, 1.58; 95% CI, 0.52–4.83 for Ad26.COV2.S), a marginally elevated risk was observed for mRNA-1273 (IRR, 1.21; 95% CI, 1.04–1.42).
CONCLUSIONS
There was no evidence of an increased risk of NOS following COVID-19 vaccination. These findings can be used as safety evidence in clinical decision-making and to bolster public confidence in COVID-19 vaccines. 
Summary

Epidemiol Health : Epidemiology and Health
TOP