Epidemiology and Health

Most-download articles are from the articles published in 2022 during the last three month.

Original Article

Folate, vitamin B12, and homocysteine status in the Korean population: data from the 2013-2015 Korea National Health and Nutrition Examination Survey: Sihan Song, Bo Mi Song, Hyun-Young Park; Epidemiol Health. 2024;46:e2024007. Published online December 11, 2023; DOI: https://doi.org/10.4178/epih.e2024007

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
We aimed to assess the serum folate, vitamin B12, and homocysteine status in Korean adolescents and adults using national data.
METHODS
Blood samples were collected from participants aged ≥10 years in the Korea National Health and Nutrition Examination Survey 2013-2015. The stored serum samples were used to measure folate, vitamin B12, and homocysteine concentrations. A total of 8,016 participants were included in this analysis. Unweighted descriptive statistics and adjusted geometric means of the B vitamins and homocysteine concentrations were estimated.
RESULTS
Females had higher serum folate and vitamin B12 concentrations and lower serum homocysteine concentrations than males. Folate deficiency (<6.8 nmol/L) and hyperhomocysteinemia (>15 μmol/L) were found in 8.6% and 11.8% of males, respectively. Approximately 3% of males had low or marginally low vitamin B12 status (≤221 pmol/L). Folate and vitamin B12 deficiencies and hyperhomocysteinemia were found in <2% of females. Suboptimal folate status was prevalent among adolescents and young adults, while suboptimal vitamin B12 status and hyperhomocysteinemia were relatively higher in older adults. Adjusted mean homocysteine concentrations were sharply decreased from the first to second decile of serum folate in males.
CONCLUSIONS
In the Korean population, the proportion of males who achieved desirable folate and homocysteine concentrations were lower than those of females. Although most Koreans have adequate vitamin B12, a suboptimal folate status is common, particularly among adolescents and young adults. These findings could establish a foundation for public health initiatives aimed at improving folate levels in the Korean population.; Summary

Korean summary
엽산과 비타민B12는 전 생애에 걸쳐 건강에 영향을 미치는 필수 비타민이다. 그러나 해당 비타민 상태에 대한 국내 자료는 부족한 실정이다. 본 연구는 국민건강영양조사 참여자로부터 수집된 혈청으로부터 엽산, 비타민B12, 그리고 이들의 기능성 지표인 호모시스테인 농도를 측정하였고 성별과 연령별 분포와 적합 상태를 평가하였다. 엽산 결핍과 고호모시스테인혈증은 남성에서 높은 유병률을 가졌다. 적정 엽산 상태를 충족하지 못하는 비율은 청소년과 젊은 성인에서 흔하게 관찰되었다. 대부분의 한국인은 충분한 비타민B12 수준을 가졌으나, 노인의 경우 정기적인 평가가 필요하다. 본 연구는 한국인이 최적의 엽산과 비타민B12 상태를 유지하기 위한 기반적 근거를 제공한다.

Key Message
Folate and vitamin B12 have significant health impacts throughout the life cycle. However, national-level data on B vitamins in Korea are limited. Serum folate, vitamin B12, and homocysteine concentrations were measured from samples stored during the national survey. In our study, the proportions of folate deficiency and hyperhomocysteinemia were higher in men than in women.Suboptimal folate status was common among adolescents and young adults. Most Koreans had adequate levels of vitamin B12; however, regular monitoring is warranted, especially in the older population. The current data provide a future direction for achieving optimal B vitamin status in the Korean population.

Original article

Public holidays increased the transmission of COVID-19 in Japan, 2020–2021: a mathematical modelling study: Jiaying Qiao, Hiroshi Nishiura; Epidemiol Health. 2024;e2024025. Published online January 22, 2024; DOI: https://doi.org/10.4178/epih.e2024025 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Although the role of specific holidays in modifying transmission dynamics of infectious diseases has received some research attention, the epidemiological impact of public holidays on the transmission of coronavirus disease 2019 (COVID-19) remains unclear.
METHODS
To assess the extent of increased transmission frequency during public holidays, we collected COVID-19 incidence and mobility data in Hokkaido, Tokyo, Aichi, and Osaka from 15 February 2020 to 30 September 2021. Models linking the estimated effective reproduction number (Rt) with raw or adjusted mobility, public holidays, and the state of emergency declaration were developed. The best-fit model included public holidays as an essential input variable, and was used to calculate counterfactuals of Rt in the absence of holidays.
RESULTS
During public holidays, on average, Rt increased by 5.71%, 3.19%, 4.84%, and 24.82% in Hokkaido, Tokyo, Aichi, and Osaka, respectively, resulting in a total increase of 580 (95% confidence interval [CI], 213–954), 2,209 (95% CI, 1,230–3,201), 1,086 (95% CI, 478–1,686), and 5,211 (95% CI, 4,554–5,867) cases that were attributable to the impact of public holidays.
CONCLUSIONS
Public holidays intensified the transmission of COVID-19, highlighting the importance of considering public holidays in designing appropriate public health and social measures in the future.; Summary

Original Article

The association between migraine and Parkinson’s disease: a nationwide cohort study in Korea: Woo-Seok Ha, Jaeho Kim, Hee Won Hwang, Sue Hyun Lee, Ji In Kim, Jin Yong Hong, Sang Hyun Park, Kyung Do Han, Min Seok Baek; Epidemiol Health. 2024;46:e2024010. Published online December 18, 2023; DOI: https://doi.org/10.4178/epih.e2024010

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Clinical studies have suggested an association between migraine and the occurrence of Parkinson’s disease (PD). However, it is unknown whether migraine affects PD risk. We aimed to investigate the incidence of PD in patients with migraine and to determine the risk factors affecting the association between migraine and PD incidence.
METHODS
Using the Korean National Health Insurance System database (2002-2019), we enrolled all Koreans aged ≥40 years who participated in the national health screening program in 2009. International Classification of Diseases (10th revision) diagnostic codes and Rare Incurable Diseases System diagnostic codes were used to define patients with migraine (within 12 months of enrollment) and newly diagnosed PD.
RESULTS
We included 214,193 patients with migraine and 5,879,711 individuals without migraine. During 9.1 years of follow-up (55,435,626 person-years), 1,973 (0.92%) and 30,664 (0.52%) individuals with and without migraine, respectively, were newly diagnosed with PD. Following covariate adjustment, patients with migraine showed a 1.35-fold higher PD risk than individuals without migraine. The incidence of PD was not significantly different between patients with migraine with aura and those without aura. In males with migraine, underlying dyslipidemia increased the risk of PD (p=0.012). In contrast, among females with migraine, younger age (<65 years) increased the risk of PD (p=0.038).
CONCLUSIONS
Patients with migraine were more likely to develop PD than individuals without migraine. Preventive management of underlying comorbidities and chronic migraine may affect the incidence of PD in these patients. Future prospective randomized clinical trials are warranted to clarify this association.; Summary

Korean summary
편두통 환자들은 편두통이 없는 이들보다 장기적으로 파킨슨병이 발병할 위험이 더 높습니다. 더불어, 이 관계는 편두통의 아형(전조 vs. 무전조)보다는 편두통의 빈도(삽화성 vs. 만성)와 더 밀접한 연관성을 갖는 것으로 보입니다.

Key Message
Patients with migraine are more likely to develop Parkinson’s disease than individuals without migraine. Furthermore, this association appears to be more strongly linked to the frequency of migraines (episodic vs. chronic) rather than the subtype of migraine (with aura vs. without aura).

Systematic review

The Effectiveness of Protein Supplementation Combined with Resistance Exercise Program Among Community-Dwelling Older Adults with Sarcopenia: A Systematic Review and Meta-analysis: Phatcharaphon Whaikid, Noppawan Piaseu; Epidemiol Health. 2024;e2024030. Published online February 14, 2024; DOI: https://doi.org/10.4178/epih.e2024030 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
ImprovingThe combination of protein supplementation and resistance exercise shows promise for improving and maintaining muscle mass, strength, and performance through protein supplementation combined with resistance exercise is promising in older adults with sarcopenia. The objective of the presentThis systematic review isaimed to examineevaluate the effects of protein supplementation combined with resistance exercisethis combination on muscle mass, muscle strength, and physical performance amongin community-dwelling older adults with sarcopenia.
METHODS
ComprehensiveWe conducted a comprehensive search across fourof 4 electronic databases,includes: PubMed, Scopus, Embase, and the Medline library, spanningMEDLINE Library. The search covered literature from January 2013 to January 2023, following and followed the Preferred Reporting Items for Systematic ReviewReviews and Meta-AnalysisAnalyses (PRISMA) guidelines. Two independent reviewers evaluateassessed the methodological quality and individualof each study using the standard critical appraisal instrumenttool from the Johanna Briggs Institute (JBI. The meta). Meta-analysis was performed usingwith the JBI Sumari program.
RESULTS
A total of The review included 7 randomized controlled trials and 1 quasi -experimental study consisting, encompassing a total of 854 older adultsparticipants aged 60 years and above were included in this review. The duration of the studies. The study durations ranged from 10 to 24 weeks. TheAn analysis using aof standardized mean difference (SMD) revealeddifferences (SMDs) showed that protein supplementation combined with resistance exercise significantly increased muscle mass (SMD=0.95 (; 95% CI:, 0.13,-1.78),; p< 0.05),) and muscle strength (SMD=0.32 (; 95% CI: 0.08, 0.08-0.56),; p< 0.05).
CONCLUSIONS
The smallAlthough the limited number of RCTs constrains the strengthrandomized controlled trials restricts the robustness of our conclusions. Nevertheless, our findings indicate, the evidence suggests that protein supplementation combined with resistance exercise effectively enhancesis effective in enhancing muscle mass and strength amongin community-dwelling older adults with sarcopenia.; Summary

Original Article

Identifying pregnancy episodes and estimating the last menstrual period using an administrative database in Korea: an application to patients with systemic lupus erythematosus: Yu-Seon Jung, Yeo-Jin Song, Jihyun Keum, Ju Won Lee, Eun Jin Jang, Soo-Kyung Cho, Yoon-Kyoung Sung, Sun-Young Jung; Epidemiol Health. 2024;46:e2024012. Published online December 19, 2023; DOI: https://doi.org/10.4178/epih.e2024012

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study developed an algorithm for identifying pregnancy episodes and estimating the last menstrual period (LMP) in an administrative claims database and applied it to investigate the use of pregnancy-incompatible immunosuppressants among pregnant women with systemic lupus erythematosus (SLE).
METHODS
An algorithm was developed and applied to a nationwide claims database in Korea. Pregnancy episodes were identified using a hierarchy of pregnancy outcomes and clinically plausible periods for subsequent episodes. The LMP was estimated using preterm delivery, sonography, and abortion procedure codes. Otherwise, outcome-specific estimates were applied, assigning a fixed gestational age to the corresponding pregnancy outcome. The algorithm was used to examine the prevalence of pregnancies and utilization of pregnancy-incompatible immunosuppressants (cyclophosphamide [CYC]/mycophenolate mofetil [MMF]/methotrexate [MTX]) and non-steroidal anti-inflammatory drugs (NSAIDs) during pregnancy in SLE patients.
RESULTS
The pregnancy outcomes identified in SLE patients included live births (67%), stillbirths (2%), and abortions (31%). The LMP was mostly estimated with outcome-specific estimates for full-term births (92.3%) and using sonography procedure codes (54.7%) and preterm delivery diagnosis codes (37.9%) for preterm births. The use of CYC/MMF/MTX decreased from 7.6% during preconception to 0.2% at the end of pregnancy. CYC/MMF/MTX use was observed in 3.6% of women within 3 months preconception and 2.5% during 0-7 weeks of pregnancy.
CONCLUSIONS
This study presents the first pregnancy algorithm using a Korean administrative claims database. Although further validation is necessary, this study provides a foundation for evaluating the safety of medications during pregnancy using secondary databases in Korea, especially for rare diseases.; Summary

Korean summary
임산부의 약물 사용 안전성에 대한 근거 제공을 위해 실제 인구집단에서의 임신 중 약물 치료 안전성을 평가하는 청구자료 기반 연구가 중요하다. 본 연구에서는 국내 청구자료에 적용할 수 있는 임신 정의 및 임신 결과 조작적 정의 알고리즘을 개발하였다. 본 알고리즘은 임신 결과 간의 우선순위를 고려한 계층 구조를 활용하며, 조기 분만 및 초음파 검사 코드 등을 통해 최종 월경 기간을 추정하였다. 또한 알고리즘을 전신홍반루푸스 환자에 적용하여 유산, 사산 등의 유병률을 산출하고 임신 중 잠재적으로 부적절한 면역억제제 사용을 파악하여 국내 청구자료의 특성을 고려한 임신 중 약물 사용 연구의 기반을 마련하였다.

Key Message
Limited safety data for pregnant women prompted recent studies on medication during pregnancy using real-world databases. This study developed a tailored algorithm for Korean healthcare claims database, employing a hierarchy of pregnancy outcomes and incorporating pre-term delivery and sonography codes for last menstrual period estimation. Applied to systemic lupus erythematosus (SLE) patients, this study presented the prevalence and drug utilization pattern of pregnancy-incompatible immunosuppressants from preconception to pregnancy end, laying a foundation for further claims database studies on medication pregnancy safety.

Systematic Review

Effectiveness of community-based interventions for older adults living alone: a systematic review and meta-analysis: Inhye Kim, Hyunseo An, Sohyeon Yun, Hae Yean Park; Epidemiol Health. 2024;46:e2024013. Published online January 3, 2024; DOI: https://doi.org/10.4178/epih.e2024013

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study examined the effectiveness of community-based interventions designed for older adults living alone through a systematic review and meta-analysis.
METHODS
The study incorporated 4 randomized controlled trials (RCTs) and 5 non-RCTs to evaluate various interventions. The methodological quality of these studies was assessed using the Downs and Black checklist, while Q-statistic and I-square tests were performed to examine statistical heterogeneity. Additionally, visual inspection of funnel plots and the trim-and-fill method were employed to investigate potential publication bias. Of the 2,729 identified studies, 9 met the criteria for inclusion in this review. Independent variables were categorized into 5 groups (physical activity, nutrition, social relationships, social participation, and combined intervention) to examine their effects. Dependent variables were similarly classified into 5 subgroups to identify the specific effects of the interventions.
RESULTS
Interventions focusing on nutrition and combined approaches were the most effective, yielding effect sizes of 0.96 (95% confidence interval [CI], 0.66 to 1.25) and 0.43 (95% CI, 0.26 to 0.60), respectively. The interventions had the greatest impacts on the health behavior and mental health of the participants, with effect sizes of 0.98 (95% CI, 0.73 to 1.22) for health behavior and 0.67 (95% CI, 0.19 to 1.16) for mental health.
CONCLUSIONS
This study suggests a direction for the development of community-based interventions tailored to the needs of older adults living alone. Additionally, it provides evidence to inform policy decisions concerning this demographic.; Summary

Korean summary
본 연구는 독거 노인들 대상으로 한 지역사회 기반 중재의 효과에 대하여 탐색하고 그 효과 크기를 확인하기 위하여 체계적고찰 및 메타분석을 실시하였다. 영양 및 복합 중재가 특히 효과적이었으며, 이는 건강 행동과 정신건강에 있어 중요한 긍정적 효과를 나타내어 추후 개별적 맞춤 중재의 잠재적 효과성을 나타낸다. 이러한 발견은 독거노인 집단의 웰빙 향상을 위한 프로그램과 정책 입안에 근거로 활용될 수 있다.

Key Message
This systematic review and meta-analysis evaluated the impact of community-based interventions for older adults living alone, incorporating 9 studies to assess effectiveness in areas like nutrition and combined strategies. Results indicated significant benefits, particularly in health behavior and mental health, demonstrating the potential of tailored interventions. These findings support the development of targeted programs and policy decisions aimed at improving the well-being of this demographic.

Original Articles

Validation of the Korean Academy of Geriatric Dentistry screening questionnaire and oral frailty diagnostic criteria in community-dwelling older adults: Jeong-Hyun Kang, Seong-Chan Park, Hoi-In Jung, Sun Jae Jung, Hye-Jin Park, Soo-Min Kim, Min-Ji Jo, Yun-Seon Lee, Sun-Young Han; Epidemiol Health. 2024;46:e2024008. Published online December 11, 2023; DOI: https://doi.org/10.4178/epih.e2024008

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study aimed to establish the validity—specifically, the sensitivity and specificity—of the screening questionnaire and diagnostic criteria for oral frailty proposed by the Korean Academy of Geriatric Dentistry (KAGD) among community-dwelling older adults.
METHODS
This study enrolled 100 participants. Among various definitions of oral frailty, this study used the criteria proposed by Tanaka as the reference test. The screening questionnaire consisted of 11 items for screening physical frailty, chewing ability, swallowing difficulties, oral dryness, and tongue and lip motor function. Each question had a different scoring weight, and if the total score was 1 or higher, an oral frailty diagnostic examination proposed by the KAGD would be recommended. The diagnostic test was the oral frailty diagnostic criteria proposed by the KAGD including 6 measures: chewing ability, occlusal force, tongue pressure, oral dryness, swallowing difficulty, and oral hygiene. If a participant exhibited 2 or more positive measures, this participant was classified as “oral frail.” The screening questionnaire was analyzed using a cut-off value of 1 or higher, while the diagnostic criteria utilized a cut-off of 2 or more positive measures. Sensitivity and specificity were calculated.
RESULTS
The screening questionnaire showed significant power for screening oral frailty (area under the receiver operating characteristic curve, 0.783; sensitivity, 87.8%; specificity, 52.5%). The diagnostic accuracy of the newly proposed diagnostic criteria was acceptable (sensitivity, 95.1%; specificity, 42.4%).
CONCLUSIONS
The newly proposed screening questionnaire and diagnostic criteria in Korea appear to be a useful tool to identify oral frailty in community-dwelling older adults.; Summary

Korean summary
본 연구는 지역사회에 거주하는 노인들의 구강 노쇠에 대한 선별검사 설문지와 진단 기준을 검증하는 것을 목표로 했습니다. 민감도와 특이도가 계산되었으며, 스크리닝 설문지는 구강 노쇠를 식별하는 데 상당한 힘을 보여주었고(민감도 87.8%, 특이도 52.5%), 진단 기준은 수용 가능한 정확도(민감도 95.1%, 특이도 42.4%)를 나타냈습니다. 연구 결과는 제안된 선별 설문지와 진단 기준이 한국 지역사회에 거주하는 노인들의 구강 노쇠를 식별하는 데 유용한 도구임을 시사합니다.

Key Message
This study aimed to validate a screening questionnaire and diagnostic criteria for oral frailty among older adults living in the community. Sensitivity and specificity were calculated, with the screening questionnaire demonstrating a significant power for identifying oral frailty (sensitivity 87.8%, specificity 52.5%) and the diagnostic criteria showing acceptable accuracy (sensitivity 95.1%, specificity 42.4%). The findings suggest that the proposed screening questionnaire and diagnostic criteria are valuable tools for identifying oral frailty in community-dwelling older adults in Korea.

Associations of active and passive tobacco exposure with elevated blood pressure in Korean adolescents: Hyerin Park, Hyunsuk Jeong, Hyeon Woo Yim, Sanghyuk Bae; Epidemiol Health. 2024;46:e2024028. Published online February 13, 2024; DOI: https://doi.org/10.4178/epih.e2024028

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
To test the hypothesis that tobacco exposure is associated with elevated blood pressure (EBP) in Korean adolescents, and that the association is dose dependent.
METHODS
This cross-sectional study used data from the 2011-2020 Korea National Health and Nutrition Survey (KNHANES). Subjects were eligible if they were 13-18 years at the time of participation in KNHANES. Tobacco exposure was defined by urine cotinine level. The main outcomes were EBP and hypertension. Statistical analyses were conducted using SAS version 9.4 with appropriate sampling weights to account for the complex survey design, stratification, and cluster variable.
RESULTS
A total of 2,518 adolescents was included in the analysis, representing 2.5 million Korean adolescents. The mean± standard deviation participant age was 15.3±1.7 years, and 55.3% were male. The number of participants with active tobacco smoke exposure was 283 (11.2%), passive tobacco smoke exposure was 145 (5.8%), and no smoke exposure was 2,090 (83.0%). Analysis of the 2,518 urine-cotinine-verified participants showed that tobacco smoke exposure had a significant effect on EBP: with an odds of elevated blood pressure of 3.00 (95% confidence interval [CI], 1.14 to 7.89). The odds of hypertension were 3.61 (95% CI, 1.13 to 11.49) in the active smoking group compared with the no tobacco exposure group after adjustment for potential confounders.
CONCLUSIONS
It is necessary to present a range of public health plans to reduce tobacco exposure that affects adolescents’ blood pressure, and further research with a larger number of participants using urine cotinine as a biomarker is needed.; Summary

Korean summary
청소년기의 고혈압은 성인기의 다양한 질병을 초래할 수 있는 주요 원인이다. 흡연과 고혈압의 관계에 관한 다수의 연구들이 있으나 상반된 결과들이 보고되었고 국내 청소년의 직 간접적 담배 연기 노출과 혈압과의 연관성은 명확하게 밝혀지지 않았다. 따라서 본 연구에서는 한국 청소년에서 담배 연기 노출과 혈압 상승과의 연관성을 확인해 보고자 하였다. 연구 결과 직접 흡연을 하는 청소년들은 비흡연군에 비하여 3배 이상 혈압이 증가하는 것으로 나타났다.

Key Message
Hypertension during adolescence is a leading cause of disease in adults. The relationship between smoking and hypertension has been studied, but findings between studies are conflicting. Nicotine is a known toxin, but the relationship between active and passive smoking and blood pressure in adolescents is not clear. So that we tested and found adolescents in Korea who were active smokers showed over 3-fold increased risk of elevated blood pressure.

Special Articles

Incidence and case fatality of stroke in Korea, 2011-2020: Jenny Moon, Yeeun Seo, Hyeok-Hee Lee, Hokyou Lee, Fumie Kaneko, Sojung Shin, Eunji Kim, Kyu Sun Yum, Young Dae Kim, Jang-Hyun Baek, Hyeon Chang Kim; Epidemiol Health. 2024;46:e2024003. Published online December 26, 2023; DOI: https://doi.org/10.4178/epih.e2024003

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Stroke remains the second leading cause of death in Korea. This study was designed to estimate the crude, age-adjusted and age-specific incidence rates, as well as the case fatality rate of stroke, in Korea from 2011 to 2020.
METHODS
We utilized data from the National Health Insurance Services from January 1, 2002 to December 31, 2020, to calculate incidence rates and 30-day and 1-year case fatality rates of stroke. Additionally, we determined sex and age-specific incidence rates and computed age-standardized incidence rates by direct standardization to the 2005 population.
RESULTS
The crude incidence rate of stroke hovered around 200 (per 100,000 person-years) from 2011 to 2015, then surged to 218.4 in 2019, before marginally declining to 208.0 in 2020. Conversely, the age-standardized incidence rate consistently decreased by 25% between 2011 and 2020. When stratified by sex, the crude incidence rate increased between 2011 and 2019 for both sexes, followed by a decrease in 2020. Age-standardized incidence rates displayed a downward trend throughout the study period for both sexes. Across all age groups, the 30-day and 1-year case fatality rates of stroke consistently decreased from 2011 to 2019, only to increase in 2020.
CONCLUSIONS
Despite a decrease in the age-standardized incidence rate, the total number of stroke events in Korea continues to rise due to the rapidly aging population. Moreover, 2020 witnessed a decrease in incidence but an increase in case fatality rates.; Summary

Key Message
This nationwide study using Korean National Health Insurance System data reveals a decade-long downward trend in overall stroke incidence rates. While the crude incidence rate showed a temporary increase from 2016 to 2019 before a slight decline in 2020, the age-standardized incidence rate consistently decreased over the study period. The study emphasizes the significance of continuous monitoring and preventive strategies to address stroke as a public health concern in Korea

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

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Abstract Summary PDF Supplementary 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

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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

Identification of acute myocardial infarction and stroke events using the National Health Insurance Service database in Korea: Minsung Cho, Hyeok-Hee Lee, Jang-Hyun Baek, Kyu Sun Yum, Min Kim, Jang-Whan Bae, Seung-Jun Lee, Byeong-Keuk Kim, Young Ah Kim, JiHyun Yang, Dong Wook Kim, Young Dae Kim, Haeyong Pak, Kyung Won Kim, Sohee Park, Seng Chan You, Hokyou Lee, Hyeon Chang Kim; Epidemiol Health. 2024;46:e2024001. Published online December 26, 2023; DOI: https://doi.org/10.4178/epih.e2024001

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Abstract Summary PDF

Abstract

OBJECTIVES
The escalating burden of cardiovascular disease (CVD) is a critical public health issue worldwide. CVD, especially acute myocardial infarction (AMI) and stroke, is the leading contributor to morbidity and mortality in Korea. We aimed to develop algorithms for identifying AMI and stroke events from the National Health Insurance Service (NHIS) database and validate these algorithms through medical record review.

METHODS

We first established a concept and definition of “hospitalization episode,” taking into account the unique features of health claims-based NHIS database. We then developed first and recurrent event identification algorithms, separately for AMI and stroke, to determine whether each hospitalization episode represents a true incident case of AMI or stroke. Finally, we assessed our algorithms’ accuracy by calculating their positive predictive values (PPVs) based on medical records of algorithm-identified events.

RESULTS

We developed identification algorithms for both AMI and stroke. To validate them, we conducted retrospective review of medical records for 3,140 algorithm-identified events (1,399 AMI and 1,741 stroke events) across 24 hospitals throughout Korea. The overall PPVs for the first and recurrent AMI events were around 92% and 78%, respectively, while those for the first and recurrent stroke events were around 88% and 81%, respectively.

CONCLUSIONS

We successfully developed algorithms for identifying AMI and stroke events. The algorithms demonstrated high accuracy, with PPVs of approximately 90% for first events and 80% for recurrent events. These findings indicate that our algorithms hold promise as an instrumental tool for the consistent and reliable production of national CVD statistics in Korea.

Summary

Key Message
In this study, we developed algorithms to identify acute myocardial infarction (AMI) and stroke events from the Korean National Health insurance Service database. To validate them, we conducted retrospective review of medical records across 24 hospitals throughout Korea. The overall positive predictive values for the first and recurrent AMI events were around 92% and 78%, respectively, while those for the first and recurrent stroke events were around 88% and 81%, respectively.

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Incidence and case fatality rates of stroke in Korea, 2011-2020
Jenny Moon, Yeeun Seo, Hyeok-Hee Lee, Hokyou Lee, Fumie Kaneko, Sojung Shin, Eunji Kim, Kyu Sun Yum, Young Dae Kim, Jang-Hyun Baek, Hyeon Chang Kim
Epidemiology and Health.2023; : e2024003. CrossRef

Incidence and case fatality of acute myocardial infarction in Korea, 2011-2020: Yeeun Seo, Jenny Moon, Hyeok-Hee Lee, Hyeon Chang Kim, Fumie Kaneko, Sojung Shin, Eunji Kim, Jang-Whan Bae, Byeong-Keuk Kim, Seung Jun Lee, Min Kim, Hokyou Lee; Epidemiol Health. 2024;46:e2024002. Published online December 26, 2023; DOI: https://doi.org/10.4178/epih.e2024002

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Cardiovascular diseases are a leading cause of mortality worldwide, and acute myocardial infarction (AMI) is particularly fatal condition. We evaluated the incidence and case fatality rates of AMI in Korea from 2011 to 2020.
METHODS
We utilized data from the National Health Insurance Services to calculate crude, age-standardized, and age-specific incidence rates, along with 30-day and 1-year case fatality rates, of AMI from 2011 to 2020. Age-standardized incidence rates were determined using direct standardization to the 2005 population.
RESULTS
The crude incidence rate of AMI per 100,000 person-years consistently increased from 44.7 in 2011 to 68.3 in 2019, before decreasing slightly to 66.2 in 2020. The age-standardized incidence rate of AMI displayed a 19% rise from 2011 to 2019, followed by a slight decline in 2020. The increasing trend for AMI incidence was more pronounced in males than in females. Both 30-day and 1-year case fatality rates remained stable among younger individuals but showed a decrease among older individuals. There was a minor surge in case fatality in 2020, particularly among recurrent AMI cases.
CONCLUSIONS
Over the past decade, the AMI incidence rate in Korea has consistently increased, with a slight downturn in 2020. The case fatality rate has remained relatively stable except for a minor increase in 2020. This study provides data for continuous surveillance, the implementation of targeted interventions, and the advancement of research aimed at AMI in Korea.; Summary

Key Message
This study observed the incidence rate of acute myocardial infarction using data from Korean National Health Insurance Service. From 2011 to 2019, the incidence rate increased, but there was a slight decrease in 2020. Additionally, the fatality rate remained relatively stable throughout the study period, except for an increase in 2020. The study emphasizes the importance of continuous monitoring and preventive strategies for effective management of acute myocardial infarction.

Original articles

Adherence to the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Survivors and Biomarkers of Inflammation among Breast Cancer Survivors: Minji Kang, Sihan Song, Hyun Jeong Cho, Zisun Kim, Hyun Jo Youn, Jihyoung Cho, Jun Won Min, Yoo Seok Kim, Sang-Woon Choi, Jung Eun Lee; Epidemiol Health. 2024;e2024026. Published online January 25, 2024; DOI: https://doi.org/10.4178/epih.e2024026 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
This study investigated whether adherence to the overall lifestyle recommendations in the American Cancer Society (ACS) guidelines on nutrition and physical activity for cancer survivors was associated with inflammation in breast cancer survivors.
METHODS
The study included 409 women who had undergone breast cancer surgery at least 1 year before enrollment. A generalized linear model was used to estimate the least square mean and 95% confidence interval of plasma levels of inflammatory markers according to lifestyle factors defined in terms of adherence to the ACS guidelines.
RESULTS
Higher overall adherence scores were associated with lower levels of high-sensitivity C-reactive protein (hs-CRP) (p for trend=0.0153) and higher levels of adiponectin (p for trend=0.0095). Similar significant associations of hs-CRP (p for trend=0.0040) and adiponectin (p for trend=0.0097) levels were observed with the score for the body mass index (BMI) component of the adherence score. A higher diet component score was associated with a higher adiponectin level (p for trend=0.0198), but there was no significant association for the physical activity component score.
CONCLUSIONS
The present study's findings suggest that maintaining a healthy lifestyle according to the ACS guidelines was associated with beneficial effects on inflammatory marker levels, especially hs-CRP and adiponectin, among breast cancer survivors. Among the 3 components of lifestyle guidelines, the BMI component exhibited the most similar tendency to the overall adherence score in relation to inflammatory indicators. Further prospective and intervention studies are needed to investigate longitudinal associations between lifestyle factors and inflammatory markers among breast cancer survivors.; Summary

Association between dietary and behavioral-based oxidative balance score and phenotypic age acceleration: a cross-sectional study: Dongzhe Wu, Yulin Shen, Chaoyi Qu, Peng Huang, Xue Geng, Jianhong Zhang, Zhijian Rao, Qiangman Wei, Shijie Liu, Jiexiu Zhao; Epidemiol Health. 2024;e2024023. Published online January 18, 2024; DOI: https://doi.org/10.4178/epih.e2024023 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
In light of the rise in the global aging population, this study investigated the potential of the oxidative balance score (OBS) as an indicator of phenotypic age acceleration (PhenoAgeAccel) to better understand and potentially slow down aging.
METHODS
Utilizing data from the National Health and Nutrition Examination Survey (NHANES) collected between 2001 and 2010, including 13,142 U.S. adults (48.75% female and 51.25% male) aged 20 and above, OBS and PhenoAgeAccel were calculated. Weighted generalized linear regression models were employed to explore the associations between OBS and PhenoAgeAccel, including a sex-specific analysis.
RESULTS
The OBS demonstrated significant variability across various demographic and health-related factors. There was a clear negative correlation observed between the higher OBS quartiles and PhenoAgeAccel, which presented sex-specific results: the negative association between OBS and PhenoAgeAccel was more pronounced in men than in women. An analysis using restricted cubic splines revealed no significant nonlinear relationships. Interaction effects were noted solely in the context of sex and hyperlipidemia.
CONCLUSIONS
A higher OBS was significantly associated with a slower aging process, as measured by lower PhenoAgeAccel. These findings underscore the importance of OBS as a biomarker in the study of aging and point to sex and hyperlipidemia as variables that may affect this association. Additional research is required to confirm these results and to investigate the biological underpinnings of this relationship.; Summary

Original Article

Decrease in household secondhand smoking among Korean adolescents associated with smoke-free policies: grade-period-cohort and interrupted time series analyses: Hana Kim, Heewon Kang, Sung-il Cho; Epidemiol Health. 2024;46:e2024009. Published online December 13, 2023; DOI: https://doi.org/10.4178/epih.e2024009

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Smoke-free areas have expanded and related campaigns have been implemented since 1995 in Korea. As a result, household secondhand smoke (SHS) exposure has decreased over the past 15 years. We assessed the cohort effect, the effect of a 2008 campaign on household SHS exposure, and the impact of a complete smoking ban in public places along with increased penalties, as implemented in December 2011.
METHODS
Nationally representative cross-sectional 15-wave survey data of Korean adolescents were used. The 810,516 participants were classified into 6 grade groups, 15 period groups, and 20 middle school admission cohorts. An age-period-cohort analysis, conducted with the intrinsic estimator method, was used to assess the cohort effect of household SHS exposure, and interrupted-time series analyses were conducted to evaluate the effects of the smoke-free policy and the campaign.
RESULTS
For cohorts who entered middle school from 2002 to 2008, the risk of household SHS exposure decreased among both boys and girls. Immediately after implementation of the smoke-free policy, the prevalence of household SHS exposure by period decreased significantly for boys (coefficient, -8.96; p<0.05) and non-significantly for girls (coefficient, -6.99; p=0.07). After the campaign, there was a significant decrease in household SHS exposure by cohort among boys, both immediately and post-intervention (coefficient, -4.84; p=0.03; coefficient, -1.22; p=0.02, respectively).
CONCLUSIONS
A school-admission-cohort effect was found on household SHS exposure among adolescents, which was associated with the smoke-free policy and the campaign. Anti-smoking interventions should be implemented consistently and simultaneously.; Summary

Korean summary
지난 15년 동안 한국 청소년의 가정 내 간접흡연 노출은 감소했다. 가정 내 간접흡연 노출에 대하여 중학교 입학 코호트 효과가 존재하였다. 또한, 청소년의 가정 내 간접흡연 노출 감소는 2011년 12월 공공장소에서의 금연구역 규제와 2008년 시행된 캠페인과 연관되어 있었다.

Key Message
Household secondhand smoke (SHS) exposure among Korean adolescents has decreased over the past 15 years. There was a school admission cohort effect on household SHS exposure. A complete smoking ban in public space with increased penalties in December 2011 and a campaign in 2008 to avoid SHS exposure were associated with reduced household SHS exposure among adolescents.

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