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A Forecasting Model for the Epidemic of Nationally Notifiable Communicable Diseases in Korea.
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Yonggyu Park, Hyoung Ah Kim, Kyung Hwan Cho, Euichul Shin, Kwang Ho Meng
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Korean J Epidemiol. 2000;22(2):108-115.
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PURPOSE
S: The authors derived two forecasting models which can be used as objective tools for detecting epidemics and predicting the future frequencies of communicable diseases.METHODS In this study, regression analysis using trigonometric functions, Box and Jenkins's seasonal ARIMA model were applied to the monthly accumulated data of five nationally notifiable communicable diseases from January 1987 to December 1998 in Korea.RESULTS Between two forecasting models, seasonal ARIMA model gives more precise predicted frequencies than regression model in the neighborhood of the current time points and future time, but the regression model is better in overall agreement between the predicted and observed frequencies during 7 years(1992-1998).CONCLUSIONS These forecasting models can be usefully applied in deciding and carrying out a national policy in preventing epidemics in the future, and graphic program is much helpful to understand the present status of disease occurrence.
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Obesity and Physical Activity Related to Colorectal Adenoma by Anatomic Sites in Korea.
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Mi Kyung Kim, Won Chul Lee, Kyu Yong Choi, Se Young Lee, Sukil Kim, Yang Cha Lee-Kim, Kwang Ho Meng
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Korean J Epidemiol. 1999;21(2):254-265.
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Although the etiology of colorectal adenoma is not yet clear, numerous epidemiologic studies of colorectal adenoma(precursors of cancer) have shown a positive association with obesity and an inverse association with physical activity. The difference of the possible association of colorectal adenoma with body mass index(BMI= wt(kg)/ht2(m2) and physical activity(kcal/day) according to anatomic sites and gender was investigated in this case-control study. Between July 1994 and october 1998, 345 cases of patients(male 181, female 164) with pathologically confirmed incident colorectal adenoma and 1655 control subjects(male 598, female 1,057) were collected from Our Lady of Mercy Hospital, The Catholic University of Korea.
After colonoscopy, self-reported weight and height, together with measures of intensity and time of exercise and lifetime job activity was obtained by the interviewers. Site- and gender-specific odds ratios relative to the lowest tertile of BMI and physical activity were determined using unconditional logistic regression after adjusting for potential confounders. Compared with subjects in the lowest terile of body mass index, multivariate-adjusted odds ratio of right colon for male and female in highest tertile were 1.49(95% CI:0.74-3.01) and 1.96(95% CI:0.93-4.15), respectively. Compared with subjects in the lowest tertile of physical activity, multivariate-adjusted odds ratio of right colon for male and female in highest tertile were 0.66(95% CI:0.35-1.26) and 0.83(95% CI:0.50-1.39), respectively. These results support a positive association between body mass index and occurrence or progression of adenoma in left colon and physical activity is associated with an elevated risk of right colon.
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Incorrect Disease Coding in Medical Insurance Claims and the Effect of Official Intervention: Based on Medical Insurance Claims of 6 Notifiable Acute Communicable Diseases.
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Yong Mun Park, Kwang Ho Meng, Euichul Shin, Kidong Park, Won Chul Lee, Sukil Kim, Jung Hee Jang
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Korean J Epidemiol. 1999;21(2):142-150.
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BACKGROUND
Because of their large size and excellent computerized records of illness and services rendered, the importance of national insurance program is getting much attentions from the public health researchers and the national and local health authorities. In reality, however, most health records from medical insurance program suffer very much from inaccurate disease coding, and therefore, they are practically in no use.METHODS Pattern of incorrect disease coding of 6 Notifiable Acute Communicable Diseases that believed not to have been occurred in Korea lately was reviewed. The reasons of such incorrect codings in different level of medical institutions were studied. This study also attempted to see how an official intervention asking the medical institutions to correct their coding behavior works by comparing the frequencies of incorrect disease coding before and after the intervention.RESULTS Study results showed that more incorrect disease codings came from clinics than hospitals, and non-physician personnel in clinics and hospitals seemed to be responsible for most of the incorrect disease codings. Most frequent diseases coded incorrectly such as cholera and poliomyelitis were the ones that physicians and non-physician personnel in the clinics and hospitals had been familiar with for a long time period.CONCLUSION Even a simple official intervention asking the clinics and hospitals to correct their coding behavior was very effective : total number of incorrect disease codings before intervention (398 cases from 144 institutions) dramatically decreased (14 cases from 8 institutions) after intervention. Significant decrease in incorrect disease coding was found more in small institutions such as clinics and public health facilities than large institutions.
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An Analysis on the Factors Associated with Cancer Screening in a City.
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Woon Nyung Roh, Won Chul Lee, Young Bok Kim, Yong Mun Park, Hong Jae Lee, Kwang Ho Meng
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Korean J Epidemiol. 1999;21(1):81-92.
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This study is aimed at preparing basic data required for establishment of a cancer screening program by examining the status of cancer screenings performed by residents in a community and the factors that have an effect on determination for a cancer screening by residents.
Cervix, breast and stomach cancers were chosen as target cancers of the study due to the fact that merits of screening for these cancers have been proved by studies done in different countries.
In order to find out the status of cancer screening and the factors having an effect on the determination for a cancer screening, 10 Dongs and a total of 1988 people were selected as study area and subjects by a random cluster sampling method, and the subjects were questioned on different aspects by questionnaires. Additionally, in order to find out how cancer screening is performed at medical facilities and how cancer screening is recommended by doctors, medical facilities doing cancer screening were also questioned.
The results of the study are as follows: 1. In the case of the screening of the stomach cancer, 16.1% of male subjects and 25.6% of female subjects turned out to have had one or more screening for the cancer. In the cases of the breast and the cervical cancers, 21.6% and 62.6% of the subjects turned out to have had one or more screenings respectively.
2. As to the screening for the stomach cancer, there was a tendency that more of the subjects with lower level education, excepting those without education, had themselves screened for the cancer. Higher screening rates were shown by the subjects in higher ages, those who visited doctors regularly.
3. As to the screening rate by education levels, a high rate of screening was shown by the subjects with above-university education level and there was not a big difference between the screenings done for high school graduates and for those with lower education levels.
Regarding the rates of screening by age groups the screening rate turned out to be higher with the higher ages. Screening rates, checked on the basis of the income levels, did not show a big differences between income levels.
4. The highest rate of screening for the breast cancer was shown by the subjects with postgraduate level of education and regarding the rate by income level, a slightly higher level was shown by the subjects with the monthly income of the 2,010,000 won, but the difference between the rates of screening by subjects at different income levels was overall not significant.
5. The rates for selecting the health screening facilities were higher in orders of the reasons that 1) they were close: 2) service was excellent and 3) equipment and facilities were good.
Based on the above-mentioned results obtained by the study, it is anticipated that this study will play a vital role as basic data for the development and execution of cancer screening program for a community, and the analysis, done on the basis of the status of the cancer screening, of the factors related to the determination for the cancer screening showed that for the development of a cancer screening program, factors like income levels, education levels, whether people consult doctors regularly and the local government' care for health in a community should be considered, and in addition to which active participation of doctors in the program is also requested.
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A Case-Control Study on dietary Factors of Colorectal Adenomatous Polyps by Sites.
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Mi Kyung Kim, Won Chul Lee, Kyu Yong Choi, Su Kil Kim, Se Young Lee, Yang Cha Lee-Kim, Kwang Ho Meng
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Korean J Epidemiol. 1998;20(1):154-166.
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Colorectal adenomas are benign neoplasm in the large bowel that are thought to be precursors lesion to colorectal cancer. So, studying adenomatous polyps instead of cancer might allow one to measure the diet of relatively asymptomatic subjects closer to the time of the initial neoplastic process. Some dietary factor, or set of factors, apparently plays an impotant role in the etiology of colorectal adenomatous polyps. The difference of the possible association of colorectal adenomatous polyps with dietary risk factors by anatomic subsite and gender was investigated in this case-control study. Between July 1994 and April 1998, 314 cases of patients with pathologically confirmed incident colorectal adenomatous polyps and 88 control subjects were collected from Our Lady of Mercy Hospital, The Catholic University. After colonoscopy, infor-mation on exposure was obtained by the interviewers.
Also, subjects were interviewed using the semiquantitative food frequency questionnaire, and average daily nutrient intakes were calculated. Site- and gender-specific odds ratio relative to the lowest tertile of intake for each nutrient were determined using unconditional logistic regression after adjusting for a number of potential confounders. In females, significant odds ratio were found for b-carotene(0.31, 95% CI, 0.10~0.95), vitamin C(0.11, 95% CI, 0.02~0.61), vitamin-E(0.11, 95% CI, 0.02~0.78) in right colon but only the odds ratio of vitamin E(0.17, 95% CI, 0.03~0.90) was statistically significant in left colon.
Among food groups, the odds ratio of green yellow vegetables was significant(OR=0.21, 95% CI, 0.05~0.96) in right colon.
In males, almost all the above dietary factors were statistically not significant. In males, cigarette smoking appears to be a signigicant risk factor(OR=8.86, 95% CI, 1.10~71.5) in left colon, it was statistically not signigicant(OR=1.63, 95% CI, 0.42~4.76) in the right colon.
Findings fron this study show that many associations of the nutrients with colorectal adenomatous polyps risk are different by anatomic subsite and gender and support the hypothesis that high intake of antioxidant vitamins and green yellow vagetables decreases the risk of polyps.
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Epidemiologic Characteristics of the Pneumoconiosis Patients in Manufacturing Industries.
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Won Chul Lee, Hyeon Woo Yim, Kyung Jae Lee, Se Yong Lee, Kwang Ho Meng, Young Gyu Phee, Hyun Wook Kim, Jung Wan Koo, Young Lim, Im Goung Yun
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Korean J Epidemiol. 1998;20(1):141-153.
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Pneumoconiosis was the first reported occupational disease in Korea and was the most common one until 1990. In the past, most pneumoconiosis patients were found among underground workers in various mines. Recently this occupational disease has increasingly affected workers in manufacturing industries such as ship building, briquette, glass, foundry industries, and so on. In order to investigate the scale of pneumoconiosis in manufacturing industries, we evaluated the detailed medical examination records and insurance deliberation data from 1989 until 1994. Information about work history, medical history, and exposure dust type were collected for each member of the study population. All chest X-rays were interpreted and classified using the International Labor Organization(ILO) scale by three radiologist who have had extensive experience evaluation pneumoconiosis. For the calculation of the incidence rate of manufacturing pneumoconiosis, we analyzed the Specific Health Examination data and estimated the population at risk as a denominator of the incidence rate.
We divided manufacturing industry into 9 subclasses by industrial classification and estimated the incidence rate of pneumoconiosis per 100,000 workers at risk respectively.
The results were as follows, 1. 485 workers were newly diagnosed with pneumoconiosis during 6 years from 1989 to 1994. 482 workers had radiographs consistent with simple pneumoconiosis and three with progressive massive fibrosis.
Among those with radiographs consistent with simple pneumoconiosis, 395 workers(81.4%) had category 1 profusion, 76 workers(15.7%) had category 2 profusion and 11 workers(2.3%) had category 3 profusion. 2. Almost all of them were male(97.9%) and their average age was 48.3 uears.
Manufacturing pneumoconiosis patients were more common in their forties and fifties. 3. The average duration of dust exposure required for the occurrence of pneumoconiosis was 13.5 years. In the case of metal products manufacturing which is mostly related to welding, the average duration of dust exposure was 12.0 years. It was slightly shorter than other manufacturing industries. The average duration of dust exposure required for the occurrence of pneumoconiosis seemed to be shorter in welding operators, even though the welders lung has a weak tissue reaction and the condition is reversible. 4. According to the Industrial classification, 299 cases(61.6%) were found in workers of non-metal mineral products manufacturing, and 56 cases(11.5%) in basic metals industry. 5. The average annual incidence rate of pneumoconiosis in manufacturing industries from 1990 to 1994 was 56.6 per 100,000 workers at risk. On sub-classification, the average annual incidence rate of pneumoconiosis in non-metal mineral products manufacturing industry was the highest among them, showing 479 per 100,000 workers at risk.
6. Radiologic prevalence rate of tuberculosis in these cases was 6.6%. 7. X-ray category profusion in newly diagnosed manufacturing pneumoconiosis varied according to sub-classification. The proportion of category 1 profusion in metal products manufacturing is higher than that in non-metal mineral products manufacturing. 8. The type pattern of small round opacities varied according to sub-classification in manufacturing industry. In non-metal mineral products manufacturing, the small round opacity were observed 25.9% cases with p type, 72.1% with q type and 2.0% with r type respectively. But in metal products manufacturing, the small round opacity were observed 51.4% cases with p type and 48.6% with q type respectively. The cause might be that the exposed dust is different according to job. 9. The type pattern of small round opacities varied according to dust type. Metal dusts showed similar radiologic shape to the coal dusts, but welding fume showed more frequent p type(60.3%) and less frequent q type(377%).
rock dust showed less frequent p types(18.3%) and more frequent q types(75.3%). Since the incidence rate of non-metal manufacturing workers showed higher rate than other manufacturing industry, Preventive measures and health care education should be carefully carried out in these workers.
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A Cross-Sectional Study on Smoking and Tuberculosis Prevalence in Korea.
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Kwang Ho Meng, Se Yong Lee, E G Park
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Korean J Epidemiol. 1997;19(2):103-110.
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In Korea, National Tuberculosis Prevalence surveys have been regularly carried out in every 5 years since 1965 and the 7th one was done on March 27-June 10, 1995. In this 7th survey, three variables related to smoking(smoking experience, number of cigarettes the smokers consume a day, and the age they started smoking) were included in the survey form. This study is a result of an analysis of data on smoking and tuberculosis prevalence for males aged 20 and over to see how the smoking is associated with tuberculosis prevalence of the Korean adult males. It was found that the smoking prevalence of Korean adult males aged 20 and over was 60.8% and the tuberculosis prevalence of Korean adult males was 2.2%. In univariate analysis, tuberculosis prevalence was higher among current and ex-smokers(2.4%) than non-smokers(2.0%), eventhough the difference was not statistically significant. However, in multivariate stratification analysis controlling for age and living place, smoking variables were significantly or marginally associated with tuberculosis prevalence in some strata.
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A Statistical Standard for Detecting Epidemic of Notifiable Acute Communicable Diseases in Korea.
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Yong Gyu Park, Eui Chul Shin, Kwang Ho Meng
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Korean J Epidemiol. 1997;19(1):73-80.
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Many problems have been stated in the surveillance system of notifiable acute communicable diseases in Korea. Lack of objective tools for detecting epidemic is one of the most fundamental. We propose a statistical standard for detecting epidemic of those diseases that could be easily and promptly applicable to the existing data. Suggested standard measure is computed from the median and the spread of upper and lower hinge(spr(H)) which is robust to the assumption of normal distribution, so frequently used in exploratory data analysis as a measure of variation, and the results are compared with those of existing method using recent 3 years from January 1994 to December 1996 of monthly data of 8 notifiable acute communicable diseases in Korea. Monthly pattern of statistical epidemic between the proposed (median) and existing(mean) methods is similar. Therefore, we propose that the statistical epidemic should be defined when the current occurrence exeeds the standards of both methods. When the data collection is made weekly than monthly, the proposed method of determining the time of epidemic will be much helpful for the management of notifiable diseases.
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Communicable Disease Surveillance System and Sentinel Surveillance.
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Eui Chul Shin, Kwang Ho Meng
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Korean J Epidemiol. 1997;19(1):14-21.
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Surveillance is the ongoing and systematic collection, analysis of disease related data and dissemination of the information to the people who need it, and application of it to disease prevention and control. So, it is composed of reportable disease; system of data collection, analysis, distribution; coorporation of medical institution with public health organization and effective control. The most dynamic and important part of surveillance is the feedback mechanism. As for positive ways of feedback, there are dissemination of collected and analysed information and reimbursement to the reporters. Legal punishment is the negative way of feedback. The common systems that the developed countries use for communicable disease surveillance are notifiable disease surveillance, sentinel surveillance, and laboratory surveillance systems.
Notifiable disease surveillance is for the diseases that their impact is serious to the community when epidemic occurs even though the number of cases is small. Most countries have this type of surveillance, but they suffer from low reporting rate. Sentinel surveillance is for the disease which is mild or whose trend is to be traced for the evaluation of the public health programs. Sampled reporters notifies the disease information voluntarily not by law.
Laboratory surveillance is to support the notifiable and sentinel surveillance. It provides laboratory information on the microorganism and antibody level of the disease.
Surveillance of communicable diseases in Korea is totally dependent on the notifiable disease reporting system, and there are many problems involved. To improve the surveillance of communicable diseases, it is strongly recommended that the sentinel and laboratory surveillance systems be adopted.
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Problems and Suggestions for Improvement in Epidemiological Study of Coal Workers' Pneumoconiosis in Korea.
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Im Goung Yun, Young Lim, Won Chul Lee, Kwang Ho Meng, Hyeong Woo Yim
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Korean J Epidemiol. 1996;18(2):131-141.
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Pneumoconisosis was the first reported occupational disease in korea and was the most common occupational disease until 1990. Nowadays pneumoconiosis is the second most common occupational disease which accounts for more than at least 40% of all the occupational diseases in Korea. Many studies have been carried out in the prevalence rate, incidence rate, and risk factors assessment of pneumoconiosis. Workers exposed to dust used to take health examination once annually by the Industrial Safety and Health Act(1981). The number of coal workers has steadily decreased due to coal rationalization projects which have been strongly driven by the government since 1988 and the occupational environment has been improving. So, the incidence rate of pneumoconiosis will probably be lower in the future. But a disease control system administed for patient control and compensation, which is not involved in epidemiologic studies may not figure out the prevalence rate, incidence rate, mortality rate and the extent of severity of pneumoconiosis. Several problems and expected solutions are mentioned here as follows: 1. workers exposed to dust and pneumoconiosis patients are under government control, but the retired workers are not. Since we evaluate only visiting retired workers, we don't know exactly the current status and whole scale of the retired workers. If possible, the construction of cohort in all the retired workers is needed. 2. Since most of pneumoconiosis patients retired from the work and had changed their job, it is difficult to figure out the prevalence rate of pneumoconiosis just depending on the annual health exam for those workers at risk. So, systemic control for all pneumoconiosis patients is needed. 3. It is difficult to diagnose the onset of pneumoconiosis. We make a decision the time when the patient is diagnosed with pneumoconiosis on its onset. It is difficult to estimate it, especially in the case of retired workers because we can evaluate only persons with respiratory symptoms. The solution of such a problem is construction of cohort in all of the retired workers. 4. Because the patients who died outside of hospital don't seem to be reported, the mortality rate of pneumoconiosis is underestimated. So, systemic control and follow-up observation for all pneumoconiosis patients is needed. 5. A definite severity classification criteria for pneumoconiosis hasn't been established in Korea. We should try to make one. 6. Since workers who had exposed to dust in various mines at least 1 yr are subject to pneumoconiosis laws, workers easily don't report their full dust exposure history. Therefore we can't obtain the exact lifetime dust exposure from administrative data. We should try to make basic raw data of whole dust exposure in workers. It's concluded that the construction of cohort in workers who are or were exposed to dust in various mines is required and epidemiologic study of pneumoconiosis should be carried out with the administrative control of pneumoconiosis side by side. With the database of these materials, we can speculate and devise the measure for the further affecting subjects who are presumed to be most common in manufacturing industries.
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The Comparison of the Somatization and Hypochondriacal Trends Between Labor Workers and Managerial Workers.
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Chul Lee, Hee Sook Park, Won Chul Lee, Kwang Ho Meng
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Korean J Epidemiol. 1995;17(2):225-234.
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This study was designed to investigate the difference of somatization and hypochondriacal trends between labor workers and managerial workers. The subjects consisted of 302 workers who were employed at 13 small scale industries in a city of Kyung Kee province. Data collection was done from February 25, 1993 to March 10, 1993. Symptom Check List-90-Somatization(SCL) and Illness Attitude Scale(IAS) which are composed of self-report questionnares were used as measuring instruments. The results were as follows: 1. Mean scores of SCL-90-R-Somatization in labor workers were significantly higher than those in managerial workers and there were significant differences in 7 subscales (pain in heart or chest, nausea of upset stomach, muscle soreness, trouble breathing, hot or cold spells, numbness, lump sensation in throat between to two groups. 2. There was no significant difference in mean scores of illness attitude Scales between labor workers and managerial workers.
However, among the subscale of IAS mean scores of "hypochondriacal beliefs" and "effects of symptom" in labor workers, the mean scores of IAS in labor workers were significantly higher than those in managerial workers. 3.
When compared by educational level, middle school graduates and college graduates of labor workers showed significantly higher mean scores of SCL than those of managerial workers.
4. When compared by employment duration, labor workers who worked less than 5 years showed significantly higher mean of SCL and IAS than those of managerial workers. 5. There were no significant differences in mean scores of SCL and IAS between the levels of subjectively evaluated environmental conditions by the workers themselves of the illumination, organic solvent, noise and dust.
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A case-control study on the risk factors of colorectal adenomatous polyp.
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Mi Kyung Kim, Yang Cha Lee, Kyu Yong Choi, Won Chul Lee, Kyung Jae Lee, Kwang Ho Meng, Yoon Kyong Lee, In Mee Kim
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Korean J Epidemiol. 1995;17(2):167-187.
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The possible association of colorectal adenomatous polyps, a precursor lesion for colorectal cancer, with risk factors including cigarette smoking, alcohol consumption, coffee consumption, family history and dietary factors was investigated in a case-control study. Between January 1993 and March 1995, 143 cases of patients with pathologically confirmed incident colorectal adenomatous polyps and 301 control subjects were collected from Our Lady of Mercy Hospital. Information on exposure was obtained by structured interviews. After adjustment for age and sex, statistically significant odds ratio (highest-lowest tercile) were found for cigarette smoking(5.53; 95% confidence interval CI, 3.26 9.38), coffee consumption (2.01 ; 95% CI 1. 15-3.53). For dietary factors, significant odds ratio were found for yogurt consumption (0.35 ; 95% CI 0.14-0.85) and milk consumption (0.34; 95% CI 0.17-0.70). No significant associations were observed for total fat intake and total fiber intake after adjustment for age, sex and total calorie. Odds ratio of family history of colorectal cancer and/or polyp was 3.05(95% CI 0.84-11.05). Cigarette smoking, coffee consumption, appears to be a significant risk factor, and milk consumption, yogurt consumption appears to be a significant protective factor for colorectal adenomatous polyps.
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Coffee consumption and coronary heart disease
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Kwang Ho Meng
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Korean J Epidemiol. 1990;12(2):131-136.
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The high prevalence of coffee drinking and of coronary heart disease in many countries has led to studies of coffee use as a possible coronary disease risk factor, with conflicting results.
A possible link between coffee consumption and coronary heart disease was first hypothesized by a longitudinal study of heart disease in Chicago in 1963. Since then, there have been many case-control and prospective epidemiological studies supporting the hypothesis. However, the positive association between coffee consumptions and coronary heart disease was contradicted by many other epidemiological studies. Differences in research methods, selection of case and control subjects, type of coffee consumed and brewing process, and amounts normally drunk are often cited as possible reasons for the discordance among the studies.
This paper summarizes the results of those conflicting studies resulted in positive and negative associations between coffee consumption and coronary heart disease, and discusses the reasons for the differences.
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Association between use of reserpine and breast cancer
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Kwang Ho Meng
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Korean J Epidemiol. 1990;12(1):38-43.
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Reserpine was being widely used as a well-established, beneficial treatment for hypertension, when three studies, published in 1974 in the same issue of the Lancet, suggested that reserpine users, compared with non users, had a threefold to fourfold increased risk of developing breast cancer. These results were subsequently contradicted by the results of nine other studies, published between 1975 and 1980.
In a recent review of all those studies, the initial causal association was deemed erroneous, although the reasons for the falsely positive results were not identified. Recently, however, one study done by Horwitz and his colleagues in Yale University claimed that the false association might have been produced by a phenomenon called exclusion bias that were probably happened because patients with cardiovascular disease were rejected as possible controls in the original reserpine-breast cancer case-control study.
This paper summarizes the results of those studies resulted in positive and negative associations between the use of reserpine and breast cancer, and reviews the methodological variations of the studies.
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Problem and improvement of mortality data in Korea
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Kwang Ho Meng
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Korean J Epidemiol. 1989;11(2):150-154.
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Mortality data are needed for purposes of demographic studies and for public health administration. They are needed to make the analysis of past population changes which are required for making projections of population and othe demographic characteristics. Moreover, analysis of mortality data is essential to programs of disease control. Health authorities use mortality data to determine administrative action needed to improve public health in the community.
Unfortunately, however, this valuable health data suffer very much from inaccuracy of death certification and incompleteness of registration in most of the developing countries, and Korea is not an exception.
According to the government statistical report, registration of deaths in Korea has been much improved now and the registration rate is almost 99%. However, the accurcy of death cetification is still very poor because only 40% of them are diagnosed by pysicians.
Several measures can be considered to improve the accuracy of death certification.
1. Rate of death certification by physician should be increased. According to our current system, physician can only certify the death when he or she actually has seen the patient. This is not possible in most of the cases in Korea where the hospital death is not popular yet. The system should be corrected in such a way that physician’s certification can also be made based on the patient’s medical records.
2. Teaching of correctly identifying the cause of death should be strengthened both in medical school and in post-graduate training course. This could decrease the number of symptoms, signs, and ill-defined conditions category of disease classification and increase the quality of mortality data. At present, this unclassified deaths consists of more than 30% of all deaths reported.
3. Availability of mortality data should be increased. In Korea, currently, the mortality data are being analyzed and published only by the Statistical Bureau of Economic Planning- Board. This certainly limits the full usage of the data.
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Vaccine efficacy of BCG against tuberculosis
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Kwang Ho Meng
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Korean J Epidemiol. 1989;11(2):175-182.
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BCG(Bacille Calmette-Guerion) vaccination to control tuberculosis is widly practiced around the world, but conflicting results from several large-scale trials and case-control studies have cast doubt on its effectiveness.
Despite the disappointing results of some studies, however, expert committees of the world Health Organization continue to recommend the mass use of BCG vaccination in developing countries, and stress the need for further research.
This paper reviews some major conflicting results on the vaccine efficacy of BCG against tuberculosis and discusses the causes and effects of the variations.
Major controversial explanations on BCG’s varying efficacy are infection status of certain non-tuberculosis mycobacteria, differences between BCG’s, differences in natural history of infection and disease, variations in host genetics or nutrition, and methodological differences in the trials.
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Korean good clinical products (KGCP) and the prospects of clinical trials in Korea
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Kwang Ho Meng
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Korean J Epidemiol. 1989;11(1):32-41.
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Smoking-Attributable mortality among Korean adults
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Kwang Ho Meng
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Korean J Epidemiol. 1988;10(2):138-145.
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Based on known medical knowledge that cigarette smoking is causally related to many diseases, and the fact that the prevalence rate of smoking among Koreans is high, it can be easily assumed that much of the deaths among Koreans are smoking-related. However, this smoking-attributable mortality has never been calculated simply because there have been no basic data on mortality ratios for smoking-related diseases between smokers and non-smokers in Korea.
This paper firstly attempts to estimate the smoking-attributable mortality among Korean adults by borrowing the Japanese mortality ratios for smoking-related diseases, and using other existing data on smoking prevalence rates of Koreans and their mortality statistics. Number of smoking-related deaths were calculated by applying the percentages of population attributable risks to the estimated number of deaths by diseases and the population attributable risks were obtained by using mortality ratios and population smoking prevalence rates.
Among adult male, the smoking-attributable mortality(21,216) represents 16.60% of total 1985 mortality, whereas the smoking-attributable mortality(3,112) for adult females was 3.51%.
Smoking was supposed to be responsible for 31.61% of all male cancer deaths and 3.71% of all female cancer deaths in Korea.
Male cancers representing high population attributable risk % were cancers of larynx, mouth and pharynx, and lung and bronchus, and the risk percentages were 93.22%, 71.79% and 69.00%, respectively.
Smoking was also responsible for 25.05% of male stomach cancer deaths. Percentages of population attributable risks for the most frequent cancers among females such as cancers of cervix uteri, stomach and liver were 7.15%, 2.61% and 7.25%, respectively.
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Dietary fat and breast cancer
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Won Chul Lee, Kwang Ho Meng
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Korean J Epidemiol. 1988;10(2):164-173.
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Many correlational (ecologic) studies and analytic (i.e., case-control and cohort) studies have been conducted to investigate whether fat and other dietary items contribute to the etiology of breast cancer or not. However, these studies has not established firm conclusion yet. The estimated relative risks could not reveal the strong association and the cohort studies haven’t found positive association. The major problems in these analyses stem from the methodological limitations related to methods of dietary data collection and quantification.
The possible protective role of yellow-green vegetables to breast cancer was discussed, and the need of standardization of the questionnaire to evaluate dietary habits was suggested.
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Does dietary fat play a major role in the epidemic of coronary heart disease?
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Kwang Ho Meng
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Korean J Epidemiol. 1988;10(1):44-50.
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In this paper, controversy on the role of dietary fat in the epidemic of coronary heart disease is reviewed.
Majority view among those from not only public health disciplines but also from those cardiologists and investigators involved in public health considera¬tions of atherosclerosis research is that the coronary heart disease is a public health phenomenon of affluent cultures and mass hyperlipidemia is a prime requisite for mass atherosclerosis.
Because of this, in most of the western countries, the official line since 1950 for management of the epidemic of coronary heart disease has been a dietary treatment. This diet-heart propaganda was further escalated by the recommendations from the American Heart Association.
However, some researchers have different view on diet-heart hypothesis and this paper reviews some of the evidences that they consider the hypothesis is wrong. Methodological issues to be considered in ending the diet-heart question are also discussed.
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Effects of maternal age and parity on twin in births in Korea
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Kwang Ho Meng, Suck Chan Kim, Suck Ho Shin, Jae Shin Ahn
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Korean J Epidemiol. 1988;10(1):86-91.
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Positive effects of increasing maternal age and parity on the incidence of twinning have been well documented by several investigators in United States and other Europian countries.
This case-control type of study attempted to confirm the association in Korea at first by using hospital records from Kangnam St. Mary’s hospital, Seoul.
Case s are total of 101 twin births born in 1982-1986 and controls are 1315 singletons born in 1986. Information other than maternal age and parity such as season of birth, gestation period, birth weight and methods of delivery were also collected and compared between singletons and twins.
No significant associations were found in frequency distribution of twins and singletons by maternal age and parity. However the estimated risk of twinning for women aged 35 years and over was 2.19 times higher than for women aged 34 years and less, and the risk ratio was statistically significant (odds ratio=2.19, 95% C.I.=1.13-4.23).
Less impressive associations of maternal age and parity with incidence of twin births seems to be ascribed to decreased maternal age and parity in recent years in Korea.
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Comparison of infectious disease trends between Korea and Japan
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Kwang Ho Meng
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Korean J Epidemiol. 1987;9(2):165-167.
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Genesis of essential hypertension: role of genetic and environmental factors
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Kwang Ho Meng
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Korean J Epidemiol. 1987;9(2):176-182.
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In reviewing the growth of knowledge concerning hypertension, especially essential hypertension, it is sobering and rather depressing to realize how little progress has been made in our understanding of its etiology. Despite spectacular advances in elucidating the pathophysiological mechanisms that control blood pressure levels and concomitant improvements in treatment as well as voluminous and enthusiastic reasearch, we are still powerless to prevent the rise in blood pressure that is so characteristic a feature of aging in our societies. Again, this is because we still know very little about the etiology of the hypertension. This paper reviews research articles particularly on the role of genetic and environmental factors in the genesis of essential hypertension, and discuss some controversial points the researchers allege in their respective researches.
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The effects of age, birth cohort and body mass index on blood pressure in Korean young adults
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Chung Yill Park, Won Chul Lee, Kwang Ho Meng
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Korean J Epidemiol. 1987;9(2):228-235.
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This study used longitudinal data of 1,348 men and 1,115 women who were employed in financial businesses and followed up for more than 5 years by the Catholic Industrial Medical Center, Catholic University Medical College from 1964 to 1986 to investigate whether there are differences in blood pressure and body mass index among different birth cohorts and whether blood pressure is associated with age and body mass index in each birth cohort. Subjects were classified into 5 birth cohorts in males (1940-44, 1945-49, 1950-54, 1955-59, 1960-64) and into 3 birth cohorts in females (1954-54, 1955-59, 1960-64). An association between systolic blood pressure and age was shown in 3 birth cohorts (1960-64 cohort in males, 1955-59, 1960-64 cohort in females) and the association between diastolic blood pressure and age was shown in 3 birth cohorts (1955-59, 1960-64 cohort in males, 1960-64 cohort in females).
The association between body mass index and age was statistically significant in all 5 cohorts in males. In females, it showed U shape (decreased until 24 yrs old and after that it increased) in all 3 cohorts. The mean blood pressure of each birth cohort was not statistically different among different birth cohorts but mean body mass index showed increasing trends as years go by. Stepwise multiple regression demonstrated that age and body mass index were explaining less than 5% of total variance of systolic blood pressure (and diastolic pressure) in males and females.
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Coffee and pancreas cancer : how is the relationship explained?
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Won Chul Lee, Kwang Ho Meng
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Korean J Epidemiol. 1987;9(1):1-8.
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A descriptive epidemiological study on cancer statistics on Korea based on published literatures on hospital cancer patients
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Kwang Ho Meng, Won Chul Lee
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Korean J Epidemiol. 1987;9(1):139-150.
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There have been many studies on frequencies and characteristics of cancer patients seen at the hospitals in Korea since 1960s. However, each study gives only limited information on cancer in Korea because the relative frequencies of cancer vary so much among the studies mainly because that the specialized fields of cancer is different among the study hospitals.
This study, therefore, summarized and reanalyzed the relative frequency of cancer in Korea according to the personal and other epidemiological characteristics by aggregating all the data that were separately used in those studies in between 1960 and 1984.
This observation indicates that, since 1960, the stomach cancer has increased both in males and females in its relative frequency among all cancers. Liver cancer and lung cancer are the ones that have also markedly increased in recent years particularly in males. In males, those three cancers consists of about 57% of all cancers now.
In females, cervical cancer is the most common cancer in its relative frequency since 1960s. However this cancer has substentially been decreased in recent years whereas the breast cancer has increased.
In age distribution, the relative frequency of cancer has sharply increased at the age of 40 and over both in males and females. Increasing tendency of relative frequency of cancer in the age group of 70 and over in noticeable.
Trends in age distribution of relative frequency of stomach cancer from 1960s to 1970s is very interesting. This analysis shows that the stomach cancer is increasing in younger age group both in males and females while it is decreasing in old age groups. Considering the increased proportion of aged population in recent years, this reveals quite a decrease of stomach cancer in old ages.
On the other hand, the cervical cancer tends to occur more in younger age group. This may be partly because the young women today visit doctors more frequently than before.
Five year survival rates of stomach cancer, colon & rectum cancer, cervical cancer, and female breast cancer are 12.9%, 20.3%, 84.3% and 46.3% respectively. The survival rates showed very wide range among different studies.
The relative low 5-year survival rates we have than expected might be due delayed diagnosis and inappropriate treatment. Only about half of the patients visit hospitals within 6 months after they had noticed symptoms.
Considering that there is relatively easy way of self examination technique, the low frequency of early hospital visits in breast cancer is noticeable.
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Does air pollution cause lung cancer?
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Kwang Ho Meng
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Korean J Epidemiol. 1986;8(2):206-210.
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A review on standardized mortality ratio and proportionate mortality ratio
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Won Chul Lee, Kwang Ho Meng
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Korean J Epidemiol. 1986;8(2):249-259.
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Standardized mortality ratio (SMR) and Proportionate mortality ratio (PMR) are two major indices that are being widely used for studying the risk of death in employed populations because of their simplicities in calculation and their usefullness.
Recently, however, these indices have been known to suffer from several methodological defects. This article reviews these criticisms and some alternative approaches for solving the problems.
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Randomized clinical trial vs. historical control studies
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Kwang Ho Meng
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Korean J Epidemiol. 1986;8(1):1-6.
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High-dose vitamin C and cancer
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Kwang Ho Meng
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Korean J Epidemiol. 1985;7(2):192-194.
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A study on the positive rate of HBsAg and Anti-HBs and the relationship between HBsAg positive and some liver function tests among the multiphasic health screening examinees
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Se Hoon Lee, Chang Yong Cho, Kwang Ho Meng
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Korean J Epidemiol. 1985;7(2):265-273.
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Because of high positive rate of HBsAg among population, its relationship with liver disease and abnormal liver functions has been an important issue in recent years in Korea.
To measure the positive rates of HBsAg and Anti-HBs by different population characteristics and to investigate the relationship of HBsAg positivity with liver functions 2,479 subjects who have visited Multiphasic Health Screening Unit, Kangnam St. Mary's Hospital were studied.
The results obtained from this study were as follows:
1) Positive rate of HBsAg of total study subjects was 9.7%, and it was significantly higher in males(10.8%) than in females(7.4%).
2) In male aged 20~29, the positive rate of HBsAg was as high as 16.3, and it was gradually decreased as age increased. In female, however, there was the tendency of increment in positive rate of HBsAg as age increased.
Positive rate of HBsAg was the highest in sales and service workers(12.1%) and the lowest in laborers and agricultural workers(8.3%). The difference was even statistically significant.
3) Positive rate of Anti-HBs in all study subjects was 37.4%, and those who revealed negative response both in HBsAg and Anti-HBs were 53.3%.
4) HBsAg positivity was statistically associated with abnormal values of liver function tests, such as SGOT, SGPT and TTT. Those with HBsAg positive have abnormal SGOT, SGPT and TTT odds radios of 2.87，2.67 and 2.70, respectively relative to those with HBsAg negative.
These odds ratio was even increased to 4.18, 3.34 and 3.13 respectively if those with HBsAg positive and Anti-HBs negative were compared with those HBsAg negative and Anti-HBs positive.
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Controversies in epidemiology: matching in case-control studies
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Kwang Ho Meng
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Korean J Epidemiol. 1985;7(1):4-7.
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During the last decades, the scholarly development and empirical findings of epidemiology have contributed immensely to the understanding of a range of diseases. It goes without saying that this growth has been driven by the development and utilization of highly advanced study design methods with diverse goals.
However, most epidemiological findings and study designs are subject to different analyses and/or conclusions due to the size or diverse characteristics of the samples, as well as problems inherent to the accuracy and reliability of all study designs. Although some of these controversies involve subjective bias on the part of researchers, most of them reflect legitimate differences in academic viewpoints, and thus may be of particular interest and utility to scholars in the field of epidemiology.
In this paper, the opposing views in some epidemiological controversies will be introduced and their progress will be reviewed, in order to provide better insights into epidemiology for those who wish to obtain a deeper understanding of this field.
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Alcohol and coronary heart disease.
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Kwang Ho Meng
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Korean J Epidemiol. ;15(2):113-118.
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In recent years, a number of epidemiological studies have revealed that habitual moderate alcohol drinking is associated with reduced risk of coronary heart disease.
The apparent pretective effect is not large, but the consistency of the association and the existence of plausible mechanisms increase the likelihood that the negative assoceation is causal.
Possible mechanisms include the effect of regular drinking on increasing high density lipopretein cholesterol and the acute effect of alcohol on depressing platelet aggregation and reducing fibrinogen levels.
However, other studies which have shown that alcohol acutely impairs ventricular function and increases the risk of arrhythmias, suggest the opposite.
Much of this controversy concern the varying definitions of 'heavy' and 'moderate' drinking and some methodological problems.
With considering of these issues, this paper reviews two major questions: does heavy alcohol intake increase the risk of coronary heart disease? And, is moderate intake protective?
This paper, then, concludes that evisdence is far from complete: but it does point towards a pretective effect of moderate alcohol consumption.
However, if alcohol intake were to increase in the population the social and medical consequences would be large.
An increased alcohol intake is therefore not recommended as a community measure for coronary heart disease prevention.
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Smoking habits and the related characteristics of male students of a medical college in Seoul.
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Kwang Ho Meng, Eui Chul Shin
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Korean J Epidemiol. ;15(1):96-104.
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Smoking habits and several selected characteristics of male students of a medical college surveyed to examine the status of smoking habits of male medical students and obtain the baseline information for future antismoking education in medical collge.
Two hundred and sixty five randomly selected students were asked to enter the answers on a structured simple questionnair that included personal characteristics and variables related to their smoking habits.
Major findings obtained from the study are as follows：
1. Smoking rate of male medical students was 54.0%. Those who had experience of failing the entrance examination showed statistically significant higher smoking rate (60.0%) than others.
2. More than half (57.3%) of the smoking students started their smoking after age of 20.44% of smoking premed students had smoked for less than 1 year and 63.0% were smoking less than 10 cigarettes a day.
3. 51.8% of smoking students stated that they started the smoking because of their friend’s recommendation and 44.0%, because of curiosity. 63.6% of smoking students had intention of quiting the smoking in the future. The intention was stronger as the graed increased.
4. 81.8% of smoking students agreed that smoking is harmful to health of their own and others as well. In fact, 73.4% of smoking students were worrying about their health because of their smoking habits.
5. 43.3% of currently non-smoking students stated that had experience of smoking and 13.9% of the non-smoking students stated that they might smoke in the future. This rate was much higher among ex-smokers than other.
This study results suggests that prevalence of smoking among Korean male medical students is very much high compared to that in other coumtries, and the antismoking campaign in medical school should be focused on students in lower grades particularly on those in premedical course.
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A case-control study on risk factors of five major cancers in adult Koreans.
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Kwang Ho Meng
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Korean J Epidemiol. ;15(1):59-73.
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Unlike in the case of communicable infectious diseases, chronic non-infectious diseases such as cancer can not be controlled by eliminating one specific causative agent because the occurance of these diseases is usually associated with several risk factors.
This is why epidemiological studies to identify the risk factors of disease are of great importance in the management of chronic non-infectious diseases and, in fact, many studies of this kinds, particularly for cancer, have been carried out in developed countries since 1960s. Unfortunately, however, there have been very few risk factor studies done so far in Korea.
This study was planned to test the risk factors of five cancers such as stomach cancer, liver cancer, lung cancer, and famale breast cancer and cervical cancer that had been hypothesized in studies of developed countries whether the risk factors were also significant in adult Koreans.
Major findings obtained from this study are as follows :
1. Salty food and the family history of gastric disease death significantly increased the risk of stomach cancer. Adjusted odds ratios of these factors were 1.9 and 2.1 respectively. Those who had not have upper G-1 examinations had also significantly higher risk for stomach cancer than in referent group.
2. For liver cancer, several hypothetical risk factors showed significantly higher risks. They were HBsAg positivity, frequent alcohol intake, family history of liver disease deaths, and the past history of liver fluke infection.
The adjusted odds ratio of HBsAg positivity for liver cancer was 23.5.
3. For lung cancer, only smoking was found to be significantly associated, and the adjusted odds ratio was 6.4.
4. Risk of cervical cancer was significantly higher among the women whose formal educational level was 6 years and below, and whose first age at marriage was 19 and lower. Higher parity was also significantly associated with cervical cancer.
Those who had not experienced cervical examination had 2.5 times higher risk than those who had periodically had the examination.
5. History of benign breast disease, experience of breast feeding, and high fat diet significantly increased the risk of breast cancer.
These study results suggest that much of the five major cancers among adult Koreans were also significantly associated with various bad health behaviors of the people, and this implies that the primary prevention measure of cancer such as health education has to be reinforced together with secondary prevention measure-screening for early diagnosis and treatment.
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