Epidemiology and Health

Public affairs reporting: Korean Society of Epidemiology; Korean J Epidemiol. 1989;11(2):284-284.

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List of membership: Korean Society of Epidemiology; Korean J Epidemiol. 1989;11(2):275-283.

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Articles of association: Korean Society of Epidemiology; Korean J Epidemiol. 1989;11(2):274-274.

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Cohort study on the asymptomatic chronic carrier rate of hepatitis B virus among male adults in Korea: Byung Joo Park, Yoon Ok Ahn; Korean J Epidemiol. 1989;11(2):263-273.

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In Korea, the rates of hepatitis B virus (HBV) infection and hepatocellular carcinoma (HCC) incidence, a major risk factor for which is HBV infection, are among the highest in the world. Therefore, in order to establish strategies for the prevention of HBV infection and HCC, the natural history of HBV infection should be urgently investigated; in particular, it is important to estimate the rate of asymptomatic chronic HBV infections, because individuals with such infections are considered at risk of chronic liver diseases such as HCC. In order to identify the prevalence of chronic HBV infections among adult males, 1495 individuals without any abnormal findings during their regular physical checkup in 1986 were randomly selected from the population insured by the Korea Medical Insurance Corporation. Radioimmunoassay (RIA) tests were performed on the subjects to detect the serological markers of HBV; namely, hepatitis B surface antigen (HBsAg), antibody to the hepatitis B surface antigen (anti-HBs) and antibody to the hepatitis B core antigen (anti-HBc), and direct interviews were conducted to determine participants’ history of hepatitis B vaccination. Of these subjects, 624 healthy males who were found to be nonvaccinees were selected and followed up for 2 years. In 1988, re-tests of the three serological markers of the hepatitis B virus using RIA testing, as well as physical checkups including liver function tests, were performed. The final study population of 370 adult males consisted of those who had no abnormal findings in either physical checkups, had not been vaccinated against HBV, and received a re-test of the serological markers of HBV after the follow-up period. The point prevalence rate of HBsAg among the 370 men enrolled was 9.6% (95% confidence interval [CI]=6.6-12.6), and after the 2-year follow-up period, the rate increased to a significantly higher level (13.0%; 95% CI=9.6-16.6). The rate of asymptomatic chronic carriers whose HBsAg tests continued to be positive during the 2-year follow-up period was 6.2% (95% CI=3.7-8.7), corresponding to 60% of the point prevalence at the time of enrollment. The age-adjusted chronic carrier rate calculated using males 20-59 years of age from the 1985 Nationwide Population and Housing Census data as a standard population was 6.2%(95% CI=6.19-6.21). The asymptomatic chronic carrier rates by age group were 6.8%in their 20s and 30s, 5.6%in their 40s, and 4.3%in their 50s; a decreasing trend according to age was found, but it was not statistically significant. The number of asymptomatic chronic carriers in Korea as of 1985 was estimated to be around 1.3 million men between their 20s and 50s. The serological profiles of the HBV markers suggested frequent loss and acquisition of the serological markers during the 2 years. While the prevalence of susceptible decreased from 14.1% at the time of enrollment to 12.7% at the end of the 2-year follow-up, the prevalence of HBsAg increased significantly. Thus, studies more precisely elucidating the mechanisms underlying these patterns in serological profiles are needed; Summary

Prevalence rates and epidemiological characteristics of chronic diseases among Koreans in the demonstration area of health insurance program: Joung Soon Kim, Moon OK Ryun, Hyo Jee Joung; Korean J Epidemiol. 1989;11(2):246-262.

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Rapid industrialization and an enormous economic growth during last decades since 1960 has changed disease pattern considerably in Korea; from infectious diseases to degenerative diseases in terms of major causes of mortality and morbidity. This study was carried out in the six health insurance demonstration areas with around 620,000 population to identify chronic diseases of public health importance by collecting and analyzing data for its prevalence and epidemiologic characteristics. The definition of chronic disease is adopted from the operational definition of chronic condition used in USA health survey though crude. The results are summarized as followings: 1. The overall prevalence rate of chronic diseases per 100,000 population was 8193 persons for males and 11070 persons for females, 1.4 times more among females. musculoskeletal system, diseases of the nervous system, mental disorders, chronic obstructive lung diseases and hypertensive diseases for males, diseases of musculoskeletal system, mental disorders, diseases of nervous system, hypertensive diseases and chronic obstructive lung diseases for females. 3. The chronic diseases that revealed higher prevalence more than two times among male population than female were syphilis and other venereal diseases(x 3.4), malignant neoplasms of respiratory organs(x 2.2), and open wounds(x 2.2); diseases of higher prevalence among females were malignant neoplasms of genitourinary system(x 5), malignant neoplasms of bone, connective tissue(x 2. Five leading chronic diseases were diseases of 2.1), and neoplasms of unspecified nature(x 2.3). 4. When the chronic diseases of this study as compared with that of other countries, i.e., data of interview survey in Japan(1980) and U.S.A.(1986), the prevalence of chronic diseases of infectious nature such as tuberculosis and diseases of ear and mastoid precess are much higher among Koreans but the diseases of degenerative nature such as hypertensive diseases, cerebrovascular diseases, chronic obstructive lung diseases, ischemic heart diseases, diseases of pulmonary circulation and diabetes mellitus were much lower among Koreans.; Summary

Correlates of blood pressure during childhood: Jong Ku Park, Bong Suk Cha, Myung Keyn Lee, Gap Jun Yoon, Sei Jin Chang; Korean J Epidemiol. 1989;11(2):232-245.

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Blood pressure of 3,833 school children aged 6 to 14 years has been measured in April to June 1989 at Wonju county, Kangwon, Korea. The objectives of this study were to identify the distribution of blood pressure in school children, and the factors related to that. The mean blood pressure increased by age in both sexes but are higher in female. Systolic blood pressure was highest in blood group O and lowest in blood group B. Blood pressures were correlated positively with age, Quetelet index, Kaup index, height, weight, sitting height, arm circumference, triceps skinfold thickness, air temperature, altitude, pulse rate, serum total protein, albumin, globulin, uric aicd, glucose, and triglyceride, and negatively with LDL-cholesterol. Most of the correlation coefficients were higher with systolic blood pressure than with diastolic blood pressure. In multiple regression analysis, 43.6% of the variation in systolic blood pressure was explained with weight, pulse rate, age, arm circumference, height, and triceps skinfold thickness and 32.3% of that in diastolic blood pressure was explained with weight, age, pulse rate, and triceps skinfold thickness.; Summary

A study of the seroconversion rates of anti-HBs and the duration of anti-HBs persistence after hepatitis B vaccination: Bok Soon Han, Il Soon Kim, Il Suh; Korean J Epidemiol. 1989;11(2):215-231.

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When the patients were contracted with acute type B hepatitis, most of them recover completely. But approximately 15-20% of them may have chronic hepatitis, liver cirrhosis or hepatoma. For the prevention of serious type B hepatitis, many different products of vaccine were developed. And there were many researches on the effectiveness, security, and immunity of these products. The purpose of this study is to assess the seroconversion rates of Anti HBs with PHA method and the duration of Anti HBs persistence after hepatitis B vaccination. The factors relevant to the rates and duration were analyzed using x2 test and survival analysis based on the data from self-written questionares, blood test and chart Reviews from Oct 1988 to May 1989. The results were as follows; 1. The seroconversion rates of Anti HBs was 67.2%. 2. The statistically significant variables influencing seroconversion rates of Anti HBs after HBV vaccination were sex, age, type of vaccines, blood types, smoking. 3. The seroconversion rates for male and female were 62.1%, and 75.5%, respectively. These rates were statistically significant(p<0.05). For male, the age specific rates for 19-29, 30-39, 40-49, 50 over were 73.6%, 57.3%, 74.6%, 52.0%, respectively. These rates were also statistically significant(p<0.05). 4. Of the 661 cases of completely HBV vaccinated persons, 444 cases(67.2%) were responders with vaccination. Their 5 year survival rate of Ant HBs was 57.3%. 5. The statistically significant variables influencing survival time of Anti HBs were Q index, and past history of liver diseases. The lower the Q index, the more mean survival time of Anti HBs. The mean survival time of Anti HBs for the persons with no history of liver disease was longer than that of the persons with history of liver disease. 6. The mean survival time of Anti HBs of Q index group for the average weight, overweight and obesity were 55.82 months，51.37 months and 35.57 months, respectively. 7. The mean survival time of Anti HBs for the persons with no history of liver disease, the persons with history of liver disease were 57.31 months and 40.01 months, respectively.; Summary

Birth cohort observation of cigarette smoking in Korea: Hae Sook Lee, Il Soon Kim, Young Pyo Hong, Byung Won Jin; Korean J Epidemiol. 1989;11(2):209-214.

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A birth cohort analysis was performed in order to investigate trends in the smoking status of Koreans during the past decades. We used the secondary data of the national smoking survey which conducted by the Korean National Tuber¬culosis Association in 1985. The sample consisted of 29,181 people representing the total population over 15 years of age as a result of stratified multi-stage probability sampling. The results were as follows: 1. The overall prevalence of current smokers over 15 years of age was 61.5% in males and 6.8% in females. 2. The cohort observation revealed important differences in smoking patterns between men and women. The incidence of smoking was highest during the 20-24 age group in all male birth cohorts while the incidence was highest during the 40-49 age group in female birth cohorts. The more recent the birth cohort was, the earlier age smoking began. 3. The smoking prevalence was very low before 20 years of age and it increased sharply during the ages 20-29. The level was maintained after 30 and finally decreased after 50. The lifetime smoking rate was highest among those born from 1951 through 1960 in men, whereas it was highest among those born from 1901-1910 in women.; Summary

A comparative study on cigarette smoking of male students in middle and high school in Korea (1988-1989): Hae Sook Lee, Il Soon Kim, Il Suh; Korean J Epidemiol. 1989;11(2):198-208.

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In order to examine the actual condition of smoking, the change of knowledge and attitude on smoking of the male students attending middle and high school in Korea, the surveys were performed twice ranging from 1988 to 1989. The male students in middle and high school were selected by a random sampling method and surveyed by mail. In this survey, the number of classes of middle and high schools in Korea was a sampling unit, and the classes were selected in proportion to each city and each county. The total number of respondents was 3,055 in 1989(1,602 of middle school students, 1,453 of high school students). The results obtained from the data analysis are as follows; 1. The ratio of smoker in 1989 was 1.5% among middle school students and 32.0% among high school students. The ratio of current smokers and experienced among middle school students has increased from 18.7% to 24.5% and among high school students the ratio has increased by 58.0%. The ratio of smoking among high school students was on the increase significantly as the grade becomes higher. Especially, in the case of third grade high school students, the ratio of smokers who have ever experienced smoking was 72.4%. This result showed that there was little change in the case of middle school students in comparision the first survey(1.8%), while in the case of high school students the ratio has increased by 8.1% in comparision with the first survey(23.9%). 2. With respect to the area, the number of current smokers and experienced among middle and high school students was higher in county then in city. This result showed difference from the first survey in which the number of current smokers and experienced among middle school students was higher in city than in county. 3. In the respect of whether or not there is a smoker among the number of a family, the ratio was 72.3% in middle school students and 75.1% in high school students. This result showed that the ratio of current smoking and the past experience of smoking were significantly higher among the students who had a smoker in their family. 4. In the first survey, the strongest motivation of smoking among middle school students was “from curiosity” and the next was “to join with the friends”while in the second survey the strongest motivation was “from curiosity"(36.4%) and the next was “to release stress”. In the case of high school students strongest motivation in the first survey was “to release stress”(31.0%)，while in the second survey the ratio of “from curiosity”(31.4%) was the highest. 5. The average number of cigarette per day among middle school students was less than 5(60.0%), and this result was same as the first survey. In the case of high school students the average number of cigarettes per day was 6-10 in the first survey, but in the second survey it changed to less than 5(45.9%). 6. The most preferred cigarette among the current smokers was “Eighty-eight”(40.9%) in middle school students, which is same as the first survey. But in the case of high school students the preference tendency has changed from “Sol”(52.2%) to “Eighty-eight(76.0%). The tendency to prefer a foreign cigarette of high school students was significantly higher in cities than in counties. 7. Almost all of the middle and high school students knew about the harmful effect of smoking on health and only 1.2% of middle school students and 2.5% of high school students answered that smoking did not affect our health. In their attitudes on smoking, 79.2% of middle school students and 46.6% of high school students regarded smoking as undesirable behavior, because it can do harm to themselves and other people. This result is almost same as the first survey. 8. Most of current smokers wanted to give up smoking(77.3% of middle school students and 79.1% of high school students) in the same manner as the first survey because of the harmful effect of cigarette smoking on health.; Summary

A study on leptospiral infection among cows and pigs by culture and microagglutination test: Joung Soon Kim, Hee Jung Kim, Yong Heo, Sun Il Park, Byung Chun Lee, Hyun Chil Mun, Sung Sam Kim, Young Hee Oh; Korean J Epidemiol. 1989;11(2):191-197.

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This study of leptospiral infections among cows and pigs were carried out to find out possible role of these domestic animals as an infection source for humans, and the magnitude of economic loss due to abortions caused by leptospiral infections among these domestic animals. Blood samples of 459 cows in May and 446 heads in November 1989 were collected from 19 villages of Kyunggi Province. These samples were cultured and serologically tested. Kidney of 200 pigs from all over the country were collected from a governmental slaughter house and cultured for isolation of leptospires.
Results
obtained are as followings: 1. Only one strain of leptospires, most strongly reactive to Pomona antibody, was isolated from duplicated cultures of 905 cow blood samples in EMJH medium. 2. Serological test by MAT with seven reference strains and three locally isolated strains was positive in 12% of the sample in May and 26% in November samples; positive rate increased slightly as the age of cows increased, however, there was no difference in positive rate by sex, type of cow and area. 3. There was no statistically significant association between abortion history among cows(one year-period) and positive MAT. 4. No leptospires was isolated from 200 pig kidneys cultured, probably because they were all too young to be infected; most of them were around six-month old and raised in professional pig farms.; Summary

Electromicroscopic study on morphological structure of leptospires: Joung Soon Kim, Chul Jong Yoon; Korean J Epidemiol. 1989;11(2):183-190.

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Six reference strains and three locally isolated strains of leptospires were electronmicroscopically studied to examine possibility of differentiating serovars. Fifty leptospires from each serovar were randomly taken from specimen to measure their length, width, number of coiling and handedness of coiling. Means and standard deviations of each measure were computed and tested for difference by Tukey’s HSD test. Handedness of coiling was measured in terms of proportion in Percentage. Tightness of coiling was compared by number of coiling per micrometer of length. Summarized results and conclusion are as following: 1. Each measuring index was not specific enough to differentiate serovar although there was a strong tendency to be similar for the same serovar or serogroup. 2. When all indices were used in combination the specificity of the measurement increased with better differentiation between serovars, suggesting that if a few more indices are added to, and the validity and reliability of this preliminary study is confirmed, the method could be very useful.; Summary

Vaccine efficacy of BCG against tuberculosis: Kwang Ho Meng; Korean J Epidemiol. 1989;11(2):175-182.

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BCG(Bacille Calmette-Guerion) vaccination to control tuberculosis is widly practiced around the world, but conflicting results from several large-scale trials and case-control studies have cast doubt on its effectiveness. Despite the disappointing results of some studies, however, expert committees of the world Health Organization continue to recommend the mass use of BCG vaccination in developing countries, and stress the need for further research. This paper reviews some major conflicting results on the vaccine efficacy of BCG against tuberculosis and discusses the causes and effects of the variations. Major controversial explanations on BCG’s varying efficacy are infection status of certain non-tuberculosis mycobacteria, differences between BCG’s, differences in natural history of infection and disease, variations in host genetics or nutrition, and methodological differences in the trials.; Summary

Perspective and transition of death causes among Koreans: Joung Soon Kim; Korean J Epidemiol. 1989;11(2):155-174.

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Problem and improvement of mortality data in Korea: Kwang Ho Meng; Korean J Epidemiol. 1989;11(2):150-154.

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Mortality data are needed for purposes of demographic studies and for public health administration. They are needed to make the analysis of past population changes which are required for making projections of population and othe demographic characteristics. Moreover, analysis of mortality data is essential to programs of disease control. Health authorities use mortality data to determine administrative action needed to improve public health in the community. Unfortunately, however, this valuable health data suffer very much from inaccuracy of death certification and incompleteness of registration in most of the developing countries, and Korea is not an exception. According to the government statistical report, registration of deaths in Korea has been much improved now and the registration rate is almost 99%. However, the accurcy of death cetification is still very poor because only 40% of them are diagnosed by pysicians. Several measures can be considered to improve the accuracy of death certification. 1. Rate of death certification by physician should be increased. According to our current system, physician can only certify the death when he or she actually has seen the patient. This is not possible in most of the cases in Korea where the hospital death is not popular yet. The system should be corrected in such a way that physician’s certification can also be made based on the patient’s medical records. 2. Teaching of correctly identifying the cause of death should be strengthened both in medical school and in post-graduate training course. This could decrease the number of symptoms, signs, and ill-defined conditions category of disease classification and increase the quality of mortality data. At present, this unclassified deaths consists of more than 30% of all deaths reported. 3. Availability of mortality data should be increased. In Korea, currently, the mortality data are being analyzed and published only by the Statistical Bureau of Economic Planning- Board. This certainly limits the full usage of the data.; Summary

Epidemiological usefulness of registered death information in Korea: Il Soon Kim; Korean J Epidemiol. 1989;11(2):143-149.

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