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Smoking-Attributable Mortality Among Korean Adults: 1981-2003.
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Sun Ha Jee, Ja Kyoung Lee, Il Soon Kim
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Korean J Epidemiol. 2006;28(1):92-99.
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OBJECTIVES
Cigarette smoking has been widely recognized as a major risk factor for lung cancer and other diseases in Western countries. In Korea, male cigarette smoking prevalence is among the world's highest and smoking has also become a strong risk factor for lung cancer and cardiovascular diseases. The objectives of the study were to calculate the smoking-attributable mortality in Korea and to predict future smoking-attributable mortality based on the observed data.METHODS Number of smoking-attributable deaths were calculated by applying the percentages of population attributable risks (PARs) to the estimated number of deaths by diseases. In this study, PARs were obtained by using relative risks from Korean Cancer Prevention Study and population smoking prevalence.RESULTS Among adult male, the smoking-attributable mortality (40,087) represents 30.75% of total 2003 mortality, whereas the smoking-attributable mortality (6,120) for adult females was 5.70%. Smoking was supposed to be responsible for 37.29% of all male cancer and 26.73% of all male cardiovascular diseases, whereas smoking for 4.68% of all female cancer and 5.93% of all female cardiovascular diseases in Korea.CONCLUSION Smoking actually represents a remarkable burden of avoidable deaths in Korea. Smoking-attributable mortality appears to continue increasing in the last years.
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Smoking and cause of death in Korea: 11 years follow-up prospective study.
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Sun Ha Jee, Ji Eun Yun, Jung Yong Park, Jae Woong Sull, Il Soon Kim
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Korean J Epidemiol. 2005;27(1):182-190.
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OBJECTIVE: In Korea, male smoking prevalence is among the world's highest and mortality rates from smoking-caused cancers, particularly lung cancer, are escalating. This cohort study examined the effects of cigarette smoking on the risk of mortality from all causes, cancers and cardiovascular diseases(CVD), and characterized the relationship of the risk with the amount and duration of cigarette smoking.METHOD A eleven-year prospective cohort study was carried out of on 1,207,592 Koreans, 30 to 95 years of age. The study population includes participants in a national insurance program, who completed a questionnaire on smoking and other risk factors. The main outcome measures were death from all causes, cancer and CVD, obtained through record linkage. At baseline, 482,997 men(60.0%) and 19,755(5.3%) women were current cigarette smokers.RESULTS In multivariate Cox proportional hazards models, controlling for age, alcohol drinking, exercise, and obesity, current smoking among men increased the risks of mortality from all cause death (relative risk[RR], 1.56; 95% confidence interval[CI], 1.52~1.59), all cancer (1.75, 1.68~1.82), and CVD(1.46, 1.38~1.55). Similar results were found for mortality among women. Smoking also increased the risks of mortality for cancer of the lung(4.60, 4.09~5.33) and other cancers, including larynx, bile duct, esophagus, liver, stomach, pancreas, bladder, and also leukemia.
Current smoking among women increased the risk of lung cancer mortality(RR=2.83, 95% CI 2.38~3.36).CONCLUSION In Korea, smoking is an independent risk factor for death from all causes, CVD and a number of major cancers. The findings affirm the need for aggressive tobacco control in Korea in order to minimize the epidemic of smoking-caused disease.
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The Changing Pattern of Cigarette Smoking of Students in Junior and Senior High Schools in Korea: 1988-1997.
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Il Suh, Sun Ha Jee, Soh Yoon Kim, Dong Choun Shin, Soh Yeon Ryu, Il Soon Kim
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Korean J Epidemiol. 1998;20(2):257-266.
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In order to examine the actual condition of smoking, the change of knowledge and the attitude on smoking of the students attending junior and senior high schools in Korea, the survey was performed six times ranging from 1988 to 1997. The first two years, the survey was performed only for male students. Since 1991, both male and female students were surveyed. The students in junior and senior high school were selected by a random sampling method and surveyed by mail. In this survey, the number of classes of Junior and senior high schools in Korea was a sampling unit, and the classes were selected in proportion to the number of classes of each city and each county. The total number of respondents was 3,437 in 1988, 3,055 in 1989, 6,087 in 1991(2,923 of male, 3,164 of female), 7,067 in 1993(3,162 of male, 3,905 of female), 5,412 in 1995(2,598 of male, 2,814 of female), 4,754 in 1997(2,281 of male, 2,473 of female).
The results obtained from the data analysis are as follows; 1.The ratio of smokers among male junior high school students has increased from 1.8% in 1988 to 3.9% in 1997.
The ratio of smokers among female junior high school students has increased from 1.2% in 1991 to 3.9% in 1997.
The ratio of smokers among male senior high school students has increased from 23.9% in 1988 to 35.3% in 1997. The ratio of smokers among male senior high school students has increased from 23.9% in 1988 to 35.3% 1997. And the ratio of smokers among female senior high school students has increased from 3.0% in 1991 to 8.7% in 1997. Especially the ratio of smokers among female junior high school students is same as that of male in 1997. 2. With respect to areas, the number of current smokers and the experienced ones was higher in the county than in the city in 1988. But in 1997, the number of current smokers and the experienced one is higher in the city than in the county. 3. In respect of whether or not there is a smoker among the member of a family, the odds ratio of smoking among the male senior high school students was 1.70 in 1988 and 1.94 in 1997. the odds ratio of smoking among female senior high school students was 1.43 in 1991 and 1.98 in 1997. This result showed that the effect of family smoking on adolescent smoking has not decreased.
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Self Rated Health and Mortality in Elderly Kangwha Cohort, 8-year follow up.
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Hee Choul Ohrr, Sun Ha Jee, Il Soon Kim
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Korean J Epidemiol. 1994;16(2):172-180.
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The effect of self rated health on all cause mortality was.
examined in a community residents sample of 2, 848 men and 3, 534 women aged 55 years or over who has been followed for eight years, 1985-1993. This longitudinal study, conducted in Kangwha County, Keanggido, began in 1985 with baseline examinations of physical and life style characteristics. The results indicate that the self-rated health has a profound and independent effect on all cause mortality during the study period. Cox's hazard model estimates that persons with 'poor' self-rated health has 1.7 times (CI 1.2-2. 6) higher risk of all cause mortality than persons with 'excellent' self-rated health and persons with 'worst' one has 4.2 (CI 2.6-6.2) in male. Estimates for women are similar to those of men. Further researchs to investigate the effects on cause specfic mortality and effects to reveal the work mechanism of self-rated health are highly expected.
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Smoking and female lung cancer by morphological types, a case-control study.
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Heechoul Ohr, Il Soon Kim, Sun Ha Jee, Tae Yong Sohn
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Korean J Epidemiol. 1992;14(2):151-159.
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The relationship between smoking and female lung cancer was examined according to the morphological subtypes. Two data sets were analyzed. One is the data comprising 235 pathologically confirmed female primary lung cancer patients and 940 community control frequency matched at a ratio of 1 : 4 within ten-year-sized birth cohorts from Kangwha county female residents. The other is the data with 125 female lung cancer patients and 125 controls who are either patients’ sisters or friends where telephone surveys were used as the data collecting methods.
The telephone interview survey limited the number of the latter data which need information of the patients' sisters or friends who made the controls.
The morphology of the lung cancers were categorized in three types i. e. adenocarcinoma, squamous cell carcinoma and small cell carcinoma. Odds ratios were estimated by unconditional logistic regression analysis controlling age at first diagnosis as a confounder.
Results are as follows：
1. The odds ratios of smoking were estimated to be 1.6(p>0.05) for adencoarcinama, 3.2 (p<0.01) for squamous cell carcinomas, and 7.1 (p<0.01) for small cell carcinomas in the logistic model with 235 cases and 940 controls The odds ration estimated in the model with 125 cases and 125 controls showed almost the same values as the former.
2. Females with less than 20 pack-year were estimated to have 1.8 times (p<0.05)higher risk of lung cancer than non-smokers and those with 20 or more pack-year were estimated to have 5.0 times (p<0.01) higher risk. The estimate for small cell carcinoma was 13.5(p<0.01) for females with 20 or more pack-year.
3. The odds ratio estimates of lung cancer were 1.8 (p<0.05) for those who began to smoke after their forties and 2.7(p<0.05) for those who began to smoke before forty-year old. This tendency was observed in every subtype of lung cancer.
This report reconfirms that there are different associations between smoking and morphological types of lung cancers, the absolute values of odds ratio being smaller than those of other countries, however. This finding implicates that further researches are needed to confirm the size of contribution of smoking to Korean female lung cancers. And the second step shall be the reason of low association between smoking and lung cancer, conditioned to this finding is true.
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A study on time-series changes of visual acuity and related factorsfor high school students in Seoul.
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Jiyeon Park, Il Soon Kim, Hee Choul Oh
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Korean J Epidemiol. 1991;13(1):52-62.
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The purpose of this study was to observe the ten-year changes of visual acuity and to determine the factors of reducing visual acuity-especially learning musical instrument-. For the study, data from ten-years health record of one high school in Seoul that checked by school yearly and self-written questionnaire was analysed. The subject of study were 314 (150 : male, 164 : female).
The results of study were summarized as follows.
1. The average visual scuity of female was more reduced than male by aging during past ten years. The oneset of low average visual acuity that defined less than 1.0 in this study was third grade of elemantary school in femals and second grade of middle school in male. In male, the rate of low visual acuity increased by aging but in female the rate fluctuated.
2. The propotion of low visual acuity at third grade of high school was 54.0% in male, 74.0% in female.
3. The performance of middle and high school was associated with low visual acuity but not statistically significant in female, other general factors of visual acuity were statistically insignificant.
4. In family history of visual acuity, low visual acuity were associated with putting on mother’s and brother’s glasses but not statistically significant.
5. The group of low visual acuity at third grade of high school was longer in learning musical instrument than group of normal visual acuity but not statistically significant.
6. The average visual acuity of group learning musical instrument was lower than group not learnig. The onset of low average visual acuity of group learning musical instrument was earlier than group not learning.
7. By the period of learning musical instrument, rate of low visual acuity were increased and statistically significant, but by the level of operating instrument was not statistically significant.
To sum up the results, visual acuity was gradually reduced by aging and the onset of low visual acuity of female was earlier than male. At all age the average of female’s visual acuity was lower than male’s.
The onset of low visual acuity of group learning musical instrument was earlier than group not learning musical instrument and the average visual acuity of group learning musical instrument was lower than group not learning musical instrument.
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Mortality of Koreans in the fourth decade of age
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Il Soon Kim, Sun Ha Jee, Hee Choul Oh, Il Suh
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Korean J Epidemiol. 1990;12(2):191-210.
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The Mortality experience among Koreans in their forties during the past eight yeasrs was compared to the countries, of Singapore, Czechoslovakia, Hungary, Poland, U.S.A.，U.K., Japan, and Germany in order to determine the mortality status and structure of Koreans in the fifth decade of age.
The major findings are as follows ；
1. The age — specific and sex — specific death rates of Koreans showed a continuous decrease during the past eight years. When compared to other countries, the death rate among males in Korea was similar to or lower than the rate in the developing countries but higher than the rate in the developed countries. On the other hand, there was no significant difference in death rates among females compared with the developed countries.
2. When comparing the causes of death among Koreans with the Japanese, infections disease was 3.4 — 4.5 times greater and chronic non—infectious desease was 1.5 — 2.1 times greater, for both sexes. Pulmonary tuberculosis was 30 times higher for males in their twenties to fities, and hepatic carcinoma and gastric carcinoma were 4 一 7 times and 1.5 — 2 times higher, respectively, for males in their thirties to forties.
The higher death rates among Koreans compared with the developed countries are attributed to infectious disease, hepatic carcinoma, and gastric carcinoma, which have decreased in recent years. In conclusion, the death rates of Koreans in their forties are higher compared with the developed countries but lower compared to the developing countries, along the lines of socioeconomic achievement.
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Recent trends of infant death rates and its determinants in Korea
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Seung Hyung Han, Il Soon Kim
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Korean J Epidemiol. 1990;12(1):57-80.
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The purpose of this research was to estimate the infant mortality rates in Korea and to determine related factors. For the study, data from the National Fertility and Family Health Survey conducted by Korea Institute for Population and Health in 1988 was analyzed. The units of analysis were all births that occurred after 1974 from 7922 married women. The specific objectives of this research were, firstly, to calculate annual infant, perinatal death rates by fiscal years, and secondly, to identify determinants of infant death by applying the proportional hazard model and logistic regression model.
The results of the study are summarized below.
1. Infant death rates declined from 28.4 in 1974-1975 to 13.9 in 1984-1985, perinatal death rates from 28.2 to 15.3, and neonatal death rates from 19.8 to 11.2(rates per 1,000 births).
2. By applying the proportional hazard model and multiple logistic analyses to the data from all births after 1974, residence, parity, the experience of infant death, occupation and inter-birth interval were shown to be significant risk factors, while the data from the birth cohorts of 1980-1987 showed that only parity and residence were significant and their relative risks were above 2. By analyzing the data from the last births after 1983, parity, residence, inter-birth interval and occupation of the head of the household were shown to be significant and the relative risk of the vaccination status of children was 2.2 and proved to be the most important factor.
To sum up the results, the infant death rates showed a steep decline during the period between the latter part of 1970's and the earlier part of 1980’s, mainly due to the rapid economic and social development of Korea and to the decrease in fertility caused by population control policies in the 1970's. Other effective health care policies expedited such a decline.
After the middle of the 1980’s, the speed of descent seemed to slow down. Strong policies for maternal child health care are required in order to bring the level of infant death rates to 6, which are considered to be the lowest rates that can be achieved by modern medicine.
One of the reasons why the infant death rates are still high in rural areas and in mothers of high parity can be explained by the fact that they belong to a higher risk group and have been excluded from maternal-child health care programs.
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Epidemiological usefulness of registered death information in Korea
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Il Soon Kim
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Korean J Epidemiol. 1989;11(2):143-149.
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A comparative study on cigarette smoking of male students in middle and high school in Korea (1988-1989)
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Hae Sook Lee, Il Soon Kim, Il Suh
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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.
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Birth cohort observation of cigarette smoking in Korea
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Hae Sook Lee, Il Soon Kim, Young Pyo Hong, Byung Won Jin
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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.
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A study of the seroconversion rates of anti-HBs and the duration of anti-HBs persistence after hepatitis B vaccination
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Bok Soon Han, Il Soon Kim, Il Suh
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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.
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Ethical consideration in clinical trials
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Il Soon Kim
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Korean J Epidemiol. 1989;11(1):27-31.
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A study on cigarette smoking of male students in middle and high school in Korea
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Il Suh, Hae Sook Lee, Myongsei Sohn, Il Soon Kim, Dong Choun Shin, Young Yee Choi
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Korean J Epidemiol. 1988;10(2):219-229.
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In order to examine the smoking rate, knowlege and attitude on smoking of male students attending middle and high school in Korea a study was performed at the period between July 11 and July 23, 1988.
In each grade 10 classes were sampled and surveyed and the total number of respondents was 3,437.
The results were as follows;
1. Proportion of current smoker among middle school students was less than 3%, but it was increased very rapidly among high school students.
So proportion of smoker was 9.5%, 19.1% and 40.4% among first second and third grade students respectively.
Proportion of ex-smoker was 16.9% among middle school students and 28.1% among high school students.
Proportion of current smoker and ex-smoker were significantly higher among students in city than students in rural area.
2. Proportion of smoker and ex-smoker among students who had smoker in their family were significantly higher than those who had no smoker in their family.
3. Most frequent motivation to smoking was “from curiosity(40.0%)” among smokers in middle school and “to release stress(31.0%)” among smokers in high schools.
4. The proportion of smokers who smoke a cigarette regularly was 31.3% among smokers in middle school and 51.7% among smokers in high school. Sixty percent of smokers in middle school smoked less than 5 cigarettes per day and 76.0% of smokers in high school smoked less than 10 cigarettes per day.
5. Almost all respondents(99.1% in middle school, 98.8% in high school) knew about the harmful effect of cigarette smoking on health and cigarette smoking was regarded as undesirable behavior to 79.5% of middle school students and 49.3% of high school students.
6. Most smokers(63.3% in middle school, 73.8% in high school) wanted to quit smoking due to the harmful effect of cigarette smoking on health.
So family factors were found to be significantly correlated with smoking students. A effective method to release stress and to quit smoking should to be suggested for students.
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A seroepidemiologic study on scrub typhus in Koje island
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Il Suh, Sang Nae Cho, Il Soon Kim, Young Joon Kim, Joon Yong Bang, Eun Cheol Park, Kyung Jong Lee, Ki Hong Jeun, Moon Shik Kim, Dae Kyu Oh
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Korean J Epidemiol. 1988;10(2):230-238.
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In order to examine the past infection rate an incidence of Scrub typhus a seroepidemiologi study was performed in Koje County. Paired serums were collected from 518 residents in Sadeung and Koje myun.
Serum were analyzed by ELISA for detection o IgG to R. tsutsugamushi, and were also analyzed by Microscopic Agglutination test for Leptospirosis.
First serum were collected from Aug. 25 to Aug. 31, 1987 and second serum were collected from Jan. 13 to Jan 31, 1988.
The result summarized as follows:
1. One hunderd seventy people(33.9%) had a experience of infection by R. tsutsugamushi： among 501 subjects. The past infection rate was significantly higher in female than that in male and it was increased according to age. By occupation farmers showed the highest infection rate.
2. The incidence rate of Scrub typhus was estimated 4.7%(19 people among 405 subjects) during the study period. The incidence rate was also significantly higher in female than that in male and 40-49 age group showed the highest incidence rate.
3. Two people(0.4%) were reacted to Microscopic Agglutnation test for Leptospirosis. Among 501 sujects and these two people were also reacted to ELISA for Scrub typhus.
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Cancer registered in Korea
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Il Suh, Il Soon Kim
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Korean J Epidemiol. 1988;10(1):40-43.
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A study on the effect of regional health insurance upon the appendectomy rate
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Yo Hwan Yang, Il Soon Kim, Hee Choul Oh
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Korean J Epidemiol. 1988;10(1):109-123.
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The objective of this study is to identify the change of the incidence and patterns of appendectomy due to the introduction of regional health insurance.
In order to compare the appendectomy rate before and after the introduction of regional health insurance, survey was performed in Kangwha county were the regional health insurance has implemented for all residents since July 1, 1982.
Seventy risidents from 3 townships (Seonwon, Buleun and Naega Myun) had received appendectomy from July 1, 1977 to June 30, 1982 and 790 people among all residents in the county had received appendectomy for the next 5 years(1982. 7.1-1987. 6.30).
The results are as follows:
1. The appendectomy rate before insurance was 8.7/10,000, but it was increased significantly to 22.4/10,000 after the insurance.
2. The appendectomy rate among young age group was increased remarkably, especially, the rate was increased by 12.4 times for female teen age group.
3. While the percentage of perforated appendicitis among appendectomy cases was decreased after the insurance, the rate of perforated appendicitis per 10,000 population was increased to only 1.9 times.
4. The appendectomy rate was increased more in the high economic group than that in low economic group.
5. During the 5 years after insurance, while the appendectomy rate had been increased steadily, complicated appendicitis rate had not been increased annually. Perforated appendicitis rate was slightly increased, but it was not statistically significant.
6. Higher levels of appendectomy rates in all clinical types were noted in high economic group compared with the low economic group.
7. Appendectomy rates and perforated appendicitis rate among the residents in islands (the lowest accessibility group) were higher than those of Myun and Eup. But it was not statistically significant.
From this result it was found that there are remarkable increase in appendectomy rate and appendicitis rate in Korean rural area after the implementation of regional health insurance. The reason for such increase may be due to the spontaneous remissions of appendicitis before insurance without surgery. To understand this phenomenon, there is a need to study the natural history of appendicitis in population for the further study.
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Physical characteristics of workers and industrial accidents
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Yong Joon Kim, Il Soon Kim, Il Suh, Kee Hong Chun
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Korean J Epidemiol. 1987;9(2):205-216.
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To investigate the relationship between physical characteristics of workers and industrial accidents, a case-control study was carried out using matched samples of 281 injured workers and 843 non-injured workers. Age, types of work and duration of employment were matched, and their physical characteristics at the time of employment were analzed.
Results were summarized below;
1) Physical characteristics such as hearing ability, body weight, and visual acuity in the injured group were significantly lower than those in control group whereas measurements of blood pressure, hemoglobin, and urinalysis and color blindness showed no differences in two groups.
2) The relative risks of physical characteristics for industrial accidents, expressed in terms of odds ratios, were 13.2 for hearing loss, 1.8 for impairment of visual acuity and 1.6 for underweight.
3) Hearing ability, body weight, and visual acuity were selected as significant factors influencing industrial accidents based on log-linear model. Odds ratio from logistic regression analysis were 3.6 for hearing loss. 1.3 for underweight, 1.2 for the impairment of visual acuity.
Since physical characteristics such as hearing impairement. underweight, and impairement of visual acuity were shown to increases industrial accident risk, the workers with these problems revealed at employment or periodic health examination should be assigned to the job which is more suitable for their physical fitness. Especially, those of who have hearing impairment should be closely supervised in order to prevent industrial accident since it was identified as the most significant risk factor among the three.
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An epidemiologic study on scrub typhus in Koje island
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Il Suh, Il Soon Kim, Byung Yool Cheon, Young Joon Kim, Yun Sop Chong
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Korean J Epidemiol. 1987;9(1):17-27.
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Abstract
Scrub typhus was reported in 1986 for the first time among Korean. Koje island was suspected of an endemic area because many patients with symptoms like scrub typhus were reported. To identify endemicity and epidemiologic characteristics of the disease an epidemiologic survey was conducted from Oct. 1 to Nov. 30 in Koje island. Patients with similar symptoms and signs suspected of scrub typhus were reported from 7 clinics in Koje island during the survey period. Bloods were drawn from those suspected patients and interviews were followed.
Final diagnosis of scrub typhus was made by Indirect immunoperoxidase test in addition to clinical signs and symptoms.
The endemicity of scrub typhus was identified. Incidence rate of scrub typhus in Koje island in 1986 was estimated to be exceeding 14.4 per 100,000 population. The rate was slightly higher in woman than that of man and majority of patients were aged between 20 and 60. Any special findings in relation with occupation of patients were unable to identify with present study.
The major clinical symptoms were high fever, rash, loss of appetite, fatigue, headache and lymphnode enlargement. Eschar which is a pathognomonic finding of the disease was observed in 7 patients out of 15 serologically confirmed cases. The duration of illness was about 6 to 20 days.
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Prevalence and changes of HBsAg and Anti-HBs for one year period in natural status and after hepatitis B vaccination
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Il Soon Kim, Hee Choul Oh, Yoon Lee, Joo Duck Kim, Won Yong Lee
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Korean J Epidemiol. 1987;9(1):40-48.
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Familial aggregation and intrafamilial transmission of hepatitis B
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Hee Choul Oh, Il Soon Kim
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Korean J Epidemiol. 1987;9(1):49-56.
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This study was carried out in a rural area, Kangwha County to investigate familial aggregation of hepatitis B infection and to obtain knowledge on relative importance of vertical and horizontal transmission of hepatitis B within family members. Eight hundred and twenty eight persons from 391 households were examined for hepatitis B surface antigen(HBsAg)and antibody( anti — HBs)tested by ELISA method in 1984 and 1985. Results are as follows.
1. Strong familial aggregation of hepatitis B infection was observed.
2. Spouse concordance rate of HBsAg positive and both HBsAg and anti-HBs positive were 43.6% and 53.3% repectively, and these rates did not show statistical difference from those of total study population.
3. Mother with positive HBsAg was important to determine their children's HBV infection.
4. Horizontal transmission of hepatitis B between spouses seemed to take minor part of total hepatitis B infection among adults.
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Summary
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Changes in mortality rates and cause of death in Kangwha county for the past 10 years (1975-1985)
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Hee Choul Oh, Yong Ho Lee, Il Soon Kim
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Korean J Epidemiol. 1987;9(1):87-95.
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To identify the changes in trends of death rates and causes of death for the population of Kangwha County for the past 10 years from 1975 to 1985, the total 652 death occurred during the study period(1981-1985) in three townships(Sunwon, Naega，Buleon Myuns)were analysed and compared with the previous five-year data(1975-1980).
All death with causes of death were identified and confirmed by health project team consisted of a family health worker, Myun health workers, a public health nurse and field project director.
The major findings of this study were as below:
1. Age adjusted death rate in average for the five-year period(1981-1985) was 5.6 per 1,000 population, 6.9 in male and 4.3 in female respectively which are about 20% reduction in death rate compared with the previous 5 years.
2. In general, age specific death rates revealed an U shaped curve for the past 10 year periods(1975-1985). The age specific death rates particularly for ages under 20 have markedly for both sexes for the study period.
3. Infant and neonatal death rates were markedly decreased from 18.8 and 12.9 per 1,000 live births in the previous period to 8.9 and 4.5 per 1,000 live births in average for the study period. The prematurity was the most common cause of neonatal death both the two study periods one case of neonatal tetanus was found during the 5 year study period.
4. The most common cause of death was cerebrovascular diseases with the magnitude of 139.1 per 100,000 population, in 5 year average, 148.9 in male and 122.5 in female. However, it showed a decreasing trend in comparing with the previous period(180.8 per 100,000:1975-1980)
5. The next leading cause of death was malignant neoplasms with magnitude of 120.7 per 100,000 population, 143.9 in male and 87.5 in female. However, an increasing trend in comparing with the previous period(94.5 per 100,000:1975-1980). All types of accidents rose to the 3rd from the 4th leading causes of death.
6. 84.4% of all deaths were due to any type of disease entities and suicide and poisoning/accidents comprised 5.7% and 5.4% respectively.
7. The proportion of treatment received from health care facilities(including drug stores, herb clinics, hospitals) prior to death increased, from 57.0% in 1975 to 68.1% in 1985. The most common place of death occurred was residence of their own(with 86.7%) and only 5.0% of deaths were occurred in hospital. This pattern persisted without changes for the past 10 years.
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A case-control study for risk factors of peptic ulcer
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Hee Choul Oh, Il Soon Kim
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Korean J Epidemiol. 1986;8(2):221-232.
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A case-control study was conducted to identify risk factors for peptic ulcer with the cases composed of patients who were endoscopically diagnosed from May 1, 1983 to June 30, 1986 in the Kang-wha Community Hospital. A total of 173 duodenal ulcer and a total of 103 benign gastric ulcer cases were studied and the control groups were twice matched by sex and age. Statistically significant variables were screened by X2-test, which were entered to the multiple logistic model to calculate the odds ratios for risk factors.
The results were as follows:
1) Odds ratios of three main effects were preference of spicy food 5.6, salty food 5.6, and presence of life event 2.0 for duodenal ulcer respectively. The interaction term between preference of spicy food and salty food was 7.4 whereas odds ratio of drinking alcohol for duodenal ulcer was 0.5.
2) Although preference of spicy food and smoking were statistically significant respectively, their odds ratios could not be determined for benign gastric ulcer because the multiple logistic model was statistically rejected.
3) A multiple logistic analysis showed that the risk factors for duodenal and gastric ulcer were different in composition of risk factors studied here.
4) As in implication for further study, some objective methods to measure preference for spicy and salty food are needed to confirm them to be risk factors of peptic ulcer and new approaches are also needed to understand the effects of stress on peptic ulcer in terms of interactions with stress relieving factors.
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Panel discussion : AIDS control
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Il Soon Kim, Yong Ik Kim, Joung Soon Kim, Taik Sung Nam, Hak Kyun Shin, Yoon Ok Ahn, Won Ha Yoo, Won Young Lee, Jung Bock Lee
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Korean J Epidemiol. 1985;7(2):187-191.
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A study on the anti-HBs prevalence between occupationally risk and non-risk groups in terms of hepatitis B virus exposure
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Hee Choul Oh, Il Soon Kim
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Korean J Epidemiol. 1985;7(2):259-264.
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This study was performed to find HBsAg and Anti-HBs prevalence between the two groups. One group, defined as occupationally risk group, consists of persons who treat patients personally or who deal with blood as their daily activity. The other group, defined as occupationally non-risk group, consists of remaining persons in the study. The data were collected from the annual screening physical check-up which was performed in 1984 for 2,631 teaching, clerical and other personnel of Y university. RPHA method was used for the detection of HBsAg and Anti-HBs.
The results from the analysis are summarized as follows:
1) No difference was observed in HBsAg positive rate between occupationally risk (6.9%) and non-risk group(7.1%) but showed significant difference in HBsAg or Anti-HBs positive rate between the two groups(24.2% and 19.4%, P<0.01). This finding suggests that there is higher risk to expose to Hapatitis B Virus(HBV) in occupationally risk group than in non-risk one.
2) Difference in HBsAg or Anti-HBs positive rate between occupationally risk and non-risk group was statistically significant for the 20~29 age group but not for the remaining age groups. This finding suggests that vaccination against hepatitis B(HB) is highly recomrmanded to this age group especially for those who take this highly risk occupation.
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The cancer registry program in Kangwha County: The first report (July 1982- June 1984)
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Il Soon Kim, Han Joong Kim, Hee Chul Oh, Byong Soo Kim, Yoon Lee
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Korean J Epidemiol. 1984;6(1):100-111.
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The Cancer Registry Program in Kangwha County, the firs community based cancer registry program in Korea, has been launched since July 1, 1982. Two factors made it possible to develop this program in Kangwha County. One is that the county-wide compulsory health insurance program initiated by the government has been implemented in the county as an experiment from July 1, 1982. This health insurance program has largely removed the economic barrier of the people in the medical care utilization and also under the health insuraance program the medical utilization records are being piled up in the office of health insurance cooperatives in the form of the bill requested by the clinics and hospitals after they treat patients. The second factor is the availability of the community hospital in the county, which has been serving the Kangwha population for the past 5 years. This means that cancer patients in the county can easily seek medical care and their medical records re easily available.
Since early 1970’s the mortality patterns of the Korean population has been changed from the infection diseases to the non-infections chronic diseases. Among chronic diseases stroke and malignant neoplasms have been reported to be the leading causes of death. It is, therefore, urgent for epidemiologist to collect very basic information on the magnitude and incidence of various such diseases for the epidemiologic studies and disease control as well. The first systematic step to challenge the cancer should be the cancer registry program.
The number of target population of the Cancer Registry Program in Kangwha County is 88,851 as of December 31, 1983. The initial detection of cancer was made by reviewing all the bills requested from the various clinics and hospitals compiled in the office of the Regional Health Insurance Cooperatives. All the malignant neoplosms (ICD 140-208 in 9th edition) were included in the program.
The diagnosis of cancer was confirmed by a team of physician and a nurse with the medical records kept in the clinics and hospitals based on the diagnostic criteria recommended by WHO. Home visitings were also made to those of cancer cases confirmed in every 6 months for the follow up and for the collection of relevant information directly from the patients.
223 cancer cases were registered during the first two years of the program. The annual incidence rate adjusted by the world population for male was 147.6 and for female 99.8 per 100,000 population.
The most common cancer was the stomach cancer which comprised 37.7% of total cancer cases in both sexes. The annual incidence rate of the stomach cancer was 64.9 in male and 30.6 in female per 100,000 population. The lung cancer (24.3) and liver cancer(13.9) were the next common cancer in mate. The cervical cancer (19.7) was the second commonest cancer in female.
The survival rates of patients with cancer after the appearance of the first symptom and also after the diagnosis were low in general due to the delayed detection and inadequate treatment. The medical seeking patterns were also studied.
The small number of the target population appears to be one of the weak points of the Program. The complete follow up with home visiting is identified as the strong point of the program.
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Summary
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Study of risk factors for hypertension in a rural adult population
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Il Soon Kim, Il Suh, Hee Chul Oh, Yong Ho Lee, Dae Kyu Oh
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Korean J Epidemiol. 1981;3(1):37-43.
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Arterial blood pressures, height, weight, skinfold thickness, blood pressure, 2 lead ECG, serum cholesterol of 1169 voluntary participants whose age were between 40-64 were examined in a rural community Korea in order to identify risk factors in developing CVD.
The influences of 19 enables on the blood pressure were examined and their independent association with blood pressure was analyzed by means of multiple regression analysis. The most important factors influencing both systolic and diastolic blood pressure were: age, weight, height and cholesterol. The following factors were identified significantly correlated with blood pressure： pulse rate, hemoglobin and triglyceride.
All 19 variables including modified variable from weight, height and age (Ponderal index, Quetelet index, age2, age3, weight2, weight3) could explain 14.4% of total variation of systolic blood pressure and 20.5% of total variation of diastolic blood pressure. Among 25 variables the most important factors influencing systolic blood pressure were: Ponderai index, age, Quetelet index, cholesterol and pulse rate.
With these 5 variables 13% of total variation of systolic blood pressure could be explained. The most important factors influencing diastolic blood pressure were: weight, cholesterol, ponderal index, hemoglobin and triglyceride. With these 5 variables 16% of total variation of diastolic blood pressure could be explained.
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Mortality in Kang Wha county, 1975-1980
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Yong Ho Lee, Hee Choul Oh, Il Soon Kim
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Korean J Epidemiol. 1981;3(1):65-70.
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To identify mortality pattern of a rural community, the total death, 711 occurred in three townships (Sunwon, Naega, Buleon Myuns) in Kang Wha County during 1975-1980 were studied.
All death was reported weekly to health workers by 37 family health workers of villages. Causes of death was identified by one public health nurse & three public physicians using questionnaries.
This study focuses on death rates & causes of death.
The following is brief summary of results of the study.
1) Crude death rates
The trend in the crude death rates showed slowly downward tendency & especially male. 5-year (1976-1980) average crude death rates was 7.9 per 1,000 and 8.6 in male & 7.2 in female.
2) Age-specific death rates revealed a U-shape & similiar patterns were shown during the study period.
3) The trend in the infant death rates showed also downward tendency. 5-year average infant death rate was 12.9 per 1,000 live births and the neonatal death rate 18.8. The most common cause of neonatal deaths was prematurity.
4) Proportional Mortality Indicators ranged between 71%-83%.
5) The most common cause of deaths was cerebrovascular diseases (180.8 per 100,000) and was followed by malignant neoplasms (94.5 per 100,000).
The death due to pulmonay tuberculosis ranked 5 with a death rate of 47.2 per 100,000 and the death due to pneumonia & respiratory diseases ranked 10 with a death rates of 11.5 per 100,000.
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Summary
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Efficiency of cholera vaccination
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Il Soon Kim
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Korean J Epidemiol. 1980;2(1):18-20.
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Prevalence rate, incidence rate, case fatality ratio and death rate for stroke in Kang Wha county, 1976-1979
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Il Soon Kim, Jong Ku Park, Hee Chull Oh
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Korean J Epidemiol. 1980;2(1):83-88.
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To identify magnitude and dynamicity of stroke incidence and death, a series of community based studies on stroke was conducted from 1976 to 1979 in Kang Wha Island.
Because of poor coverage of quality medical care and poor death registry system of Korea the accurate, reliable death rate and causes of death are largely unknown. For instance the death rates so far reported in Korea due to stroke were varied from 26 to 221 per 100,000 population. This big variation was largely due to the incomplete death registration and unreliable diagnosis for causes of death in Korea.
However, all the records have unanimously shown that the stroke death has been the most common cause of deaths in Korea.
The Kang Wha County where Yonsei University has developed community health demonstration project since 1975 and where health information system is well established was chosen for this study. A prevalence survey was conducted as of May 1, 1979 and the incidence and death rates were computed with events occurred for the past 4years from 1976 to 1979. The diagnosis of stroke was made by two physicians with predetermined criteria.
The prevalence rate for stroke was 272 per 100,000 population which is considered to be very low compare with that of other countries.
The incidence rate for stroke was 254 and death rate 195 per 100,000. These rates are considered to be one of the highest in the world.
The high incidence and death rates and low prevalence rate for stroke were caused by very high case fatality ratio which was 65.8%.
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Comparative study of mortality pattern between Korea and Japan
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Il Soon Kim
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Korean J Epidemiol. 1979;1(1):47-54.
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KSE
