Epidemiology and Health

Original article

Sex-specific predictors of first major chronic disease or cancer events in Korean adults: a linked health screening and claims-based cohort study: Yuri Chai, Soojin Im, Bora Lee, Sungho Won, Hyein Han; Epidemiol Health. 2026;e2026050. Published online August 31, 2026; DOI: https://doi.org/10.4178/epih.e2026050 [Accepted]

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OBJECTIVES
This study aimed to identify sex- and age-specific predictors of the first onset of major chronic disease or cancer among Korean adults using linked National Health Insurance Service (NHIS)–Korean Association of Health Promotion (KAHP) data and a competing risk framework that accounts for death before disease onset.
METHODS
A total of 102,870 adults who underwent KAHP health examinations in 2013 were followed through NHIS claims data until 2022. Nine major chronic diseases and cancers were identified using International Classification of Diseases, 10th Revision codes and clinical criteria. Sex-specific Fine–Gray subdistribution hazard models were fitted to estimate subdistribution hazard ratios. Model performance was evaluated using the time-dependent area under the receiver operating characteristic curve (AUROC) at 5 and 9.5 years.
RESULTS
Age was the strongest predictor of first disease onset in both sexes. Cardiometabolic, inflammatory, liver-related, and lifestyle-related markers showed sex-specific associations. Ischemic heart disease was the most frequent first-occurring disease, accounting for 50.3% and 46.8% of first events in males and females, respectively. Time-dependent AUROC values ranged from 0.72 to 0.73, indicating moderate and stable discrimination.
CONCLUSIONS
Using linked NHIS–KAHP data and a competing risk framework, this study identified sex-specific predictors of first major chronic disease or cancer onset. The models showed moderate and stable discrimination, supporting the value of sex-specific risk assessment for chronic disease prevention and healthy aging.; Summary

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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Abstract Summary 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.

Citations

Citations to this article as recorded by

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