Epidemiology and Health

Original article

Sex-specific associations among neck circumference, the rs9939609 FTO gene polymorphism, and the 14-year risk of metabolic syndrome: Inkyung Baik; Epidemiol Health. 2024;e2024072. Published online August 23, 2024; DOI: https://doi.org/10.4178/epih.e2024072 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Limited data exist on the relation between neck circumference (NC) and the risk of developing metabolic syndrome (MS). This study investigated sex-specific associations between NC and the 14-year risk of MS and explored the impact of the FTO rs9939609 polymorphism on these associations.
METHODS
This population-based prospective cohort study involved 2,666 participants (1,301 men and 1,365 women), who were free of MS at baseline (2005–2006). Incident MS cases, defined by the presence of 3 or more criteria regarding blood pressure and blood levels of glucose, triglycerides, and high-density lipoprotein cholesterol, were identified through biennial examinations until 2020. NC measurements taken at baseline and between 2013 and 2014 were analyzed using Cox proportional hazard regression to determine sex-specific associations with MS risk.
RESULTS
Controlling for potential confounders such as waist circumference (WC), significant associations were observed in both sexes. Individuals in the highest NC quartile exhibited more than a 2-fold higher MS risk than those in the lowest quartile; with hazard ratios of 2.37 (95% CI, 1.74 to 3.22) for men and 2.65 (95% CI, 1.89 to 3.72) for women (p-value for trend <0.001). No significant interaction was found between the FTO polymorphism and NC. In diagnostic test analyses, NC and WC demonstrated comparable area under the curve values in both sexes.
CONCLUSIONS
The findings suggest that NC is as effective as WC for predicting the incidence of MS.; Summary

Data profile

Data resource profile: the Korean Workers’ Compensation-National Health Insurance Service (KoWorC-NHIS) cohort: Jeehee Min, Eun Mi Kim, Jaiyong Kim, Jungwon Jang, Youngjin Choi, Inah Kim; Epidemiol Health. 2024;e2024071. Published online August 19, 2024; DOI: https://doi.org/10.4178/epih.e2024071 [Accepted]

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The KoWorC-NHIS cohort was established to investigate the longitudinal health outcomes of Korean workers who have been compensated for occupational injuries or diseases. This cohort study, which utilized data spanning from 2004 to 2015, merged workers' compensation insurance claim data with the National Health Insurance Database (NHID), encompassing 858,793 participants. The data included sociodemographic factors such as age, sex, income, address, insurance type, and disability grade. It also covered the types of occupational accidents, International Classification of Diseases, 10th revision codes for diseases or accidents, work tenure, industry, occupation code, and company size. Additional details such as the occupational hire date, date of claim, date of recognition, and affected body parts were recorded. The cohort predominantly consisted of male workers (80%), with the majority experiencing their first occupational accident in their 40s (27.6%) or 50s (25.3%). Notably, 93.1% of the cases were classified as occupational injuries. By integrating this data with that from the NHID, updates on health utilization, employment status, and income changes were made annually. The follow-up period for this study is set to conclude in 2045.; Summary

Original article

Causal association between serum bilirubin and ischemic stroke: multivariable Mendelian randomization: Jong Won Shin, Keum Ji Jung, Mikyung Ryu, Jungeun Kim, Heejin Kimm, Sun Ha Jee; Epidemiol Health. 2024;e2024070. Published online August 19, 2024; DOI: https://doi.org/10.4178/epih.e2024070 [Accepted]

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OBJECTIVES
Previous research has predominantly focused on total bilirubin levels without clearly distinguishing between direct and indirect bilirubin. In this study, the differences between these forms were examined, and their potential causal relationships with ischemic stroke were investigated.
METHODS
Two-sample multivariable Mendelian randomization (MVMR) analysis was employed, extracting summary data on bilirubin from the Korean Cancer Prevention Study-II (KCPS-II; n=159,844) and the Korean Genome and Epidemiology Study (KoGES; n=72,299). Data on ischemic stroke were obtained from BioBank Japan (BBJ; n=201,800). Colocalization analysis was performed, focusing on the UGT1A1, SLCO1B1, and SLCO1B3 genes, which are the primary loci associated with serum bilirubin levels.
RESULTS
Crude 2-sample Mendelian randomization analysis revealed a significant negative association between total bilirubin levels and ischemic stroke. However, in MVMR analyses, only indirect bilirubin demonstrated a significant negative association with ischemic stroke (odds ratio, 0.76; 95% confidence interval, 0.59 to 0.98). Colocalization analysis did not identify a shared causal variant between the 3 genetic loci related to indirect bilirubin and the risk of ischemic stroke.
CONCLUSIONS
Our study establishes a causal association between higher genetically determined levels of serum indirect bilirubin and reduced risk of ischemic stroke in an Asian population. Future research should include more in-depth analysis of shared genetic variants between indirect bilirubin and ischemic stroke.; Summary

Original Article

Genetic associations and parent-of-origin effects of PVRL1 in nonsyndromic cleft lip with or without cleft palate across multiple ethnic populations: Ji Wan Park, Geon Kang, Seung-Hak Baek, Young Ho Kim; Epidemiol Health. 2024;46:e2024069. Published online August 9, 2024; DOI: https://doi.org/10.4178/epih.e2024069

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OBJECTIVES
This study investigated the associations of PVRL1 gene variants with nonsyndromic cleft lip with or without cleft palate (NSCL/P) by evaluating transmission distortion and parent-of-origin (POO) effects in multiple ethnic populations.
METHODS
We conducted allelic and genotypic transmission disequilibrium tests (TDT) on 10 single-nucleotide variants (SNVs) in PVRL1 using data from 142 Korean families with an affected child. POO effects were analyzed using the POO likelihood ratio test, comparing transmission rates of maternally and paternally inherited alleles. To assess generalizability and ethnic heterogeneity, we compared results from Korean families with data from the Center for Craniofacial and Dental Genetics, which included 2,226 individuals from 497 European and 245 Asian trios.
RESULTS
TDT analysis identified significant over-transmission of the rs7940667 (G361V) C allele in Korean families (p=0.007), a finding replicated in both Asian (p=6.5x10-7) and European families (p=1.6x10-10). Eight SNVs showed strong TDT evidence in larger Asian and European datasets after multiple comparison corrections (p<0.007). Of these, 4 SNVs (rs7940667, rs7103685, rs7129848, and rs4409845) showed particularly robust association (p<5x10-8). POO analysis revealed significant maternal over-transmission of the rs10790330-A allele in Korean families (p=0.044). This finding was replicated in European families (p=9.010-4). Additionally, 3 other SNVs, rs7129848 (p=0.001) and the linked SNVs rs3935406 and rs10892434 (p=0.025), exhibited maternal over-transmission in the validation datasets.
CONCLUSIONS
Our findings provide robust evidence supporting the associations of PVRL1 variants with NSCL/P susceptibility. Further research is necessary to explore the potential clinical applications of these findings.; Summary

Brief communication

The association between employee lifestyles and the rates of mental health-related absenteeism and turnover in Japanese companies: Atsuya Fujimoto, Hiroshi Kanegae, Kaori Kitaoka, Mizuki Ohashi, Kunio Okada, Koichi Node, Kenkichi Takase, Hiroshi Fukuda, Tomoyuki Miyazaki, Yuichiro Yano; Epidemiol Health. 2024;e2024068. Published online August 2, 2024; DOI: https://doi.org/10.4178/epih.e2024068 [Accepted]

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We assessed the association of employee lifestyles (e.g., smoking, exercise, drinking, and sleep habits) with mental health-related absenteeism and turnover rates utilizing data from the annual Health and Productivity Management survey by Japan's Ministry of Economy, Trade and Industry. This analysis included data from 1,748 companies, encompassing 4,199,021 employees. The average proportions of mental health-related absenteeism and employee turnover rates were 1.1% (±1.0%) and 5.0% (±5.0%), respectively. In multivariable regression models that incorporated all lifestyle factors and confounders, a 1 percentage point increase in the proportion of employees who slept well was associated with reductions in their turnover rate (mean -0.020%; 95% CI, -0.038% to -0.002%) and in mental health-related absenteeism (mean -0.005%; 95% CI, -0.009% -0.001%). A similar increase in the proportion of employees engaging in regular physical activity corresponded with a 0.005% decrease in the prevalence of mental health-related absenteeism (95% CI, -0.010% to -0.001%). A 1 percentage point increase in the proportion of employees who smoked was associated with a 0.013% reduction in mental health-related absenteeism (95% CI, -0.017% to -0.008%). Nonetheless, the current study's observational and cross-sectional design restricted the ability to establish causality between employee lifestyle factors and mental health issues.; Summary

Original articles

Association of the Korean-specific food-based index of dietary inflammatory potential with the risk of mild cognitive impairment in Korean older adults: Se Yeon Hwang, Chong-Su Kim, Mi Kyung Kim, Yoonkyoung Yang, Yoon Jung Yang; Epidemiol Health. 2024;e2024067. Published online July 25, 2024; DOI: https://doi.org/10.4178/epih.e2024067 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
This study aimed to examine the association between the food-based index of dietary inflammatory potential (FBDI) and the risk of mild cognitive impairment (MCI) in Korean older adults.
METHODS
The subjects were 798 Korean adults aged 60 years and older. The FBDI was calculated based on the intake of 7 anti-inflammatory and 3 inflammatory food groups. Cognitive function was assessed using the Korean version of the Mini-Mental State Examination (MMSE-KC). A general linear model and multiple logistic regression were applied to assess the association between FBDI and the risk of MCI.
RESULTS
As the FBDI increased, the intake of white rice, cookies/candies, and sweetened drinks tended to increase, but the intake of niacin, β-carotene, calcium, and potassium tended to decrease (p for trend < 0.05). The highest FBDI group had a higher MCI risk (odds ratio [OR], 1.60; 95% CI, 1.01 - 2.52) than the lowest FBDI group, adjusted for sex, age, and education level; and this trend was significant in a fully adjusted model (p for trend = 0.039). No significant associations were found in men after adjusting for confounding factors. Among women, MCI risk increased as the FBDI increased (p for trend = 0.007); and the highest FBDI group had a higher MCI risk (OR, 2.22; 95% CI, 1.04 - 4.74) than the lowest FBDI group in a fully adjusted model.
CONCLUSIONS
These results suggest that the appropriate intake of anti-inflammatory foods and nutrients may be associated with a reduced risk of MCI among older adults.; Summary

Comparative analysis of body mass index and obesity-related anthropometric indices for mortality prediction: a study of the Namwon and Dong-gu cohorts: Ye-Rim Kim, Min-Ho Shin, Young-Hoon Lee, Seong-Woo Choi, Hae-Sung Nam, Jeong-Ho Yang, Sun-Seog Kweon; Epidemiol Health. 2024;e2024066. Published online July 17, 2024; DOI: https://doi.org/10.4178/epih.e2024066 [Accepted]

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OBJECTIVES
This study investigated the associations between several obesity-related anthropometric indices and mortality in middle-aged and elderly populations to compare the indices’ predictive ability with that of the body mass index (BMI).
METHODS
We analyzed data on 12 indices calculated from 19,805 community-based cohort participants (average age, 63.27 years; median follow-up, 13.49 years). Each index was calculated using directly measured values of height, weight, waist circumference (WC), and hip circumference (HC). We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for each index using Cox regression and evaluated mortality prediction with the Harrell c-index.
RESULTS
Adding anthropometric indices to the basic mortality model (c-index 0.7723; 95% CI, 0.7647-0.7799) significantly increased the predictive power of BMI (c-index 0.7735; 95% CI, 0.7659-0.7811), a body shape index (ABSI, c-index 0.7735; 95% CI, 0.7659-0.7810), weight-adjusted waist index (WWI, c-index 0.7731; 95% CI, 0.7656-0.7807), and waist to hip index (WHI, c-index 0.7733; 95% CI, 0.7657-0.7809). The differences between the BMI model and the other 3 models were not statistically significant.
CONCLUSIONS
In predicting all-cause mortality, the ABSI, WWI, and WHI models based on WC or HC had stronger predictive power than conventional risk factors but were not significantly different from the BMI model.; Summary

COVID-19 infection and severe clinical outcomes in patients with kidney disease by vaccination status: Jieun Woo, Ahhyung Choi, Jaehun Jung, JU YOUNG SHIN; Epidemiol Health. 2024;e2024065. Published online July 17, 2024; DOI: https://doi.org/10.4178/epih.e2024065 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Patients with kidney disease have been prioritized for coronavirus disease 2019 (COVID-19) vaccination due to their susceptibility to COVID-19 infection. However, little evidence exists regarding these patients’ vulnerability to COVID-19 post-vaccination. Thus, we evaluated the risk of COVID-19 in patients with kidney disease compared to individuals without kidney disease according to vaccination status.
METHODS
A retrospective cohort study was conducted using the Korean nationwide COVID-19 registry linked with NHIS claims data (2018-2021). Among individuals aged 12 years or older, 2 separate cohorts were constructed: a COVID-19-vaccinated cohort and an unvaccinated cohort. Within each cohort, the risk of COVID-19 infection and all-cause mortality, hospitalization, and emergency room visits within 30 days of COVID-19 infection were compared between patients with and without kidney disease. To adjust for potential confounding, we used propensity score matching. Hazard ratios (HRs) for each outcome were estimated using a Cox proportional hazard model.
RESULTS
We identified 785,390 and 836,490 individuals in the vaccinated and unvaccinated cohorts, respectively. Compared to patients without kidney disease, patients with kidney disease were at a higher risk of COVID-19 infection in both the vaccinated cohort (HR, 1.08; 95% CI, 1.02-1.16) and the unvaccinated cohort (HR, 1.09; 95% CI, 0.99-1.20). Likewise, patients with kidney disease generally were at higher risk for severe clinical outcomes within 30 days of COVID-19 infection. Subgroup and sensitivity analyses showed generally consistent results.
CONCLUSIONS
Our study observed excess risk of COVID-19 in patients with kidney disease, highlighting the importance of ongoing attention to these patients even post-vaccination.; Summary

Association between smoking status and subclinical coronary atherosclerosis in asymptomatic individuals: Hyeji Lee, Jinhee Ha, Kyung Sun Park, Young-Jee Jeon, Sangwoo Park, Soe Hee Ann, Yong-Giun Kim, Yongjik Lee, Woon Jung Kwon, Seong Hoon Choi, Seungbong Han, Gyung-Min Park; Epidemiol Health. 2024;e2024064. Published online July 16, 2024; DOI: https://doi.org/10.4178/epih.e2024064 [Accepted]

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OBJECTIVES
In this study, we sought to evaluate the association between smoking status and subclinical coronary atherosclerosis, as detected by coronary computed tomography angiography (CCTA), in asymptomatic individuals.
METHODS
We retrospectively analyzed 9,285 asymptomatic participants (mean age, 53.7±8.0 years; 6,017 [64.8%] male) with no history of coronary artery disease (CAD) who had undergone self-referred CCTA. Of these participants, 4,333 (46.7%) were considered never smokers, 2,885 (31.1%) former smokers, and 2,067 (22.3%) current smokers. We assessed the degree and characteristics of subclinical coronary atherosclerosis using CCTA, with obstructive CAD defined as a diameter stenosis of at least 50%.
RESULTS
Compared with never-smokers, former smokers exhibited no significant differences in the probabilities of obstructive CAD, any coronary plaque, calcified plaque, or mixed plaque, as determined using adjusted odds ratios (aORs; p>0.05 for all). However, the risk of non-calcified plaque was significantly higher in former smokers (aOR, 1.34; 95% confidence interval [CI], 1.00 to 1.78; p=0.048). Current smokers had significantly higher rates of obstructive CAD (aOR, 1.46; 95% CI, 1.10 to 1.96; p=0.010), any coronary plaque (aOR, 1.41; 95% CI, 1.20 to 1.65; p<0.001), calcified plaque (aOR, 1.32; 95% CI, 1.13 to 1.55; p=0.001), non-calcified plaque (aOR, 1.72; 95% CI, 1.28 to 2.32; p<0.001), and mixed plaque (aOR, 2.00; 95% CI, 1.39 to 2.86; p<0.001) compared to never smokers.
CONCLUSIONS
This cross-sectional study revealed a significant association between current smoking and subclinical coronary atherosclerosis, as detected on CCTA. Additionally, former smoking demonstrated an association with non-calcified plaque, indicating elevated cardiovascular risk.; Summary

Combined effect of anemia and chronic rhinitis on hearing loss in Korean adults: a nationwide observational study: Yeong Jun Ju, Woorim Kim, Jina Han, Soon Young Lee; Epidemiol Health. 2024;e2024063. Published online July 15, 2024; DOI: https://doi.org/10.4178/epih.e2024063 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Studies have suggested an association between hearing loss and anemia. Hearing loss has also been linked to rhinitis, which is characterized by inflammation of the nasal mucous membranes and sinus mucosa. Few studies have concurrently explored the relationships between hearing loss, anemia, and rhinitis. This study was conducted to investigate the association between hearing loss and anemia and to further analyze the potential role of rhinitis in this relationship.
METHODS
Data were collected from the 2020 Korea National Health and Nutrition Examination Survey. Hearing loss was measured with an audiometer in a soundproof booth and was defined as at least moderate impairment (as indicated by a pure-tone average of ≥41 dB in the better-hearing ear). The association between hearing loss and anemia was analyzed using multivariable logistic regression. The combined effect of anemia and rhinitis on hearing loss was assessed with an interaction term.
RESULTS
Among the 2,772 participants, 477 (17.2%) exhibited hearing loss. Participants with anemia were more likely to experience hearing loss than those without anemia (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.07 to 2.33). Furthermore, the odds of hearing loss were greater in participants with both anemia and rhinitis (OR, 3.79; 95% CI, 1.93 to 7.43) relative to those without either condition.
CONCLUSIONS
Anemia was associated with hearing loss in individuals aged 40 years and older. Based on the analysis of combined effects, participants with anemia and chronic rhinitis were more likely to experience hearing loss than individuals without these conditions.; Summary

Data profile

Introduction to the Forensic Research via Omics Markers in Environmental Health Vulnerable Areas (FROM) study: Jung-Yeon Kwon, Woo Jin Kim, Yong Min Cho, Byoung-gwon Kim, Seungho Lee, Jee Hyun Rho, Sang-Yong Eom, Dahee Han, Kyung-Hwa Choi, Jang-Hee Lee, Jeeyoung Kim, Sungho Won, Hee-Gyoo Kang, Sora Mun, Hyun Ju Yoo, Jung-Woong Kim, Kwan Lee, Won-Ju Park, Seongchul Hong, Young-Seoub Hong; Epidemiol Health. 2024;e2024062. Published online July 12, 2024; DOI: https://doi.org/10.4178/epih.e2024062 [Accepted]

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Abstract PDF: Abstract
This research group (FROM) aimed to develop biomarkers for exposure to environmental hazards and diseases, assess environmental diseases, and apply and verify these biomarkers in environmentally vulnerable areas. Environmentally vulnerable areas—including refineries, abandoned metal mines, coal-fired power plants, waste incinerators, cement factories, and areas with high exposure to particulate matter—along with control areas, were selected for epidemiological investigations. A total of 1,157 adults, who had resided in these areas for over 10 years, were recruited between June 2021 and September 2023. Personal characteristics of the study participants were gathered through a survey. Biological samples, specifically blood and urine, were collected during the field investigations, separated under refrigerated conditions, and then transported to the laboratory for biomarker analysis. Analyses of heavy metals, environmental hazards, and adducts were conducted on these blood and urine samples. Additionally, omics analyses of epigenomes, proteomes, and metabolomes were performed using the blood samples. The biomarkers identified in this study will be utilized to assess the risk of environmental disease occurrence and to evaluate the impact on the health of residents in environmentally vulnerable areas, following the validation of diagnostic accuracy for these diseases.; Summary

Original article

Development and validation of the Health Literacy Index for the Community (HLIC) for the Korean National Health and Nutrition and Examination Survey: Junghee Yoon, Soo Jin Kang, Mangyeong Lee, Juhee Cho; Epidemiol Health. 2024;e2024061. Published online July 10, 2024; DOI: https://doi.org/10.4178/epih.e2024061 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
We developed and validated the Health Literacy Index for the Community (HLIC) to assess the health literacy of the Korean population within the framework of the Korean National Health and Nutrition and Examination Survey.
METHODS
The HLIC was developed through 1) defining the conceptual framework and generating the item pool and 2) finalizing the items and identifying the cutoff value. Interviews were conducted to examine items' face validity, and a cross-sectional survey was performed to analyze the item-response theory and Rasch models to investigate the instrument's psychometric properties.
RESULTS
In this study of 1,041 participants, most had no difficulty understanding health information; however, 67.9% struggled to assess the reliability of health information from the internet or media. A 4-factor structure was identified through factor analysis, leading to the exclusion of some items. This resulted in 10 items across 4 domains: 1) disease prevention, 2) health promotion, 3) health care, and 4) technology and resources. The HLIC demonstrated good internal consistency, with a Cronbach's ɑ of 0.87. It also showed high test-retest reliability and correlations with other health literacy instruments. A sociodemographic analysis of the HLIC revealed disparities in health literacy across various age groups, education levels, and income brackets.
CONCLUSIONS
The HLIC was developed to systematically measure health literacy in Korea's general population. Its simplicity and conciseness ensure reliability and validity and improve its accessibility, making it particularly suitable for the broader Korean population, including those with lower literacy levels.; Summary

Review paper

Toxicological evidence integration to confirm the biological plausibility of the association between humidifier disinfectant exposure and respiratory diseases using the AEP-AOP framework: Ha Ryong Kim, Jun Woo Kim, Jong-Hyeon Lee, Younghee Kim, Jungyun Lim, Yong-Wook Baek, Sunkyoung Shin, Mina Ha, Hae-Kwan Cheong, Kyu Hyuck Chung, Review Committee for the Epidemiological Correlations between Humidifier Disinfectant Exposure and Disease; Epidemiol Health. 2024;e2024060. Published online July 7, 2024; DOI: https://doi.org/10.4178/epih.e2024060 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Exposure to humidifier disinfectants has been linked to respiratory diseases, including interstitial lung disease, asthma, and pneumonia. Consequently, numerous toxicological studies have explored respiratory damage as both a necessary and sufficient condition for these diseases. We systematically reviewed and integrated evidence from toxicological studies by applying the evidence integration method established in previous research to confirm the biological plausibility of the association between exposure and disease.
METHODS
We conducted a literature search focusing on polyhexamethylene guanidine phosphate (PHMG) and chloromethylisothiazolinone/methylisothiazolinone (CMIT/MIT), the primary ingredients in humidifier disinfectants. We selected relevant studies based on their quality and the population, exposure, comparator, outcome (PECO) statements. These studies were categorized into 3 lines of evidence: hazard information, animal studies, and mechanistic studies. Based on a systematic review, we integrated the evidence to develop an aggregate exposure pathway–adverse outcome pathway (AEP-AOP) model for respiratory damage. The reliability and relevance of our findings were assessed by comparing them with the hypothesized pathogenic mechanisms of respiratory diseases.
RESULTS
The integration of each AEP-AOP component for PHMG and CMIT/MIT led to the development of an AEP-AOP model, wherein disinfectants released from humidifiers in aerosol or gaseous form reached target sites, causing respiratory damage through molecular initiating events and key events. The model demonstrated high reliability and relevance to the pathogenesis of respiratory diseases.
CONCLUSIONS
The AEP-AOP model developed in this study provides strong evidence that exposure to humidifier disinfectants causes respiratory diseases. This model demonstrates the pathways leading to respiratory damage, a hallmark of these conditions.; Summary

Brief Communication

Timely access to secondary pediatric services in Korea: a key to reducing child and adolescent mortality: Minku Kang, Young June Choe, Hye Sook Min, Saerom Kim, Seung-Ah Choe; Epidemiol Health. 2024;46:e2024059. Published online July 5, 2024; DOI: https://doi.org/10.4178/epih.e2024059

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Abstract Summary PDF: Abstract
OBJECTIVES
Geographic disparities in access to secondary pediatric care remain a significant issue in countries with universal health coverage, including Korea. This study investigated the link between geographic access to secondary pediatric care and mortality rates in children and adolescents (0-19 years) in Korea.
METHODS
We analyzed district-level data to assess the percentage of those aged 0-19 years residing outside of a 60-minute travel radius from the nearest secondary pediatric care provider (accessibility vulnerability index, AVI).
RESULTS
The AVI ranged from 0% to 100% across the districts for the study period. The confidence interval (CI) was -0.30 (95% CI, -0.41 to -0.19) in 2017 and -0.41 (95% CI, -0.52 to -0.30) in 2021, indicating that the proportion of those who could not access care within 60 minutes was disproportionately higher in districts with lower socioeconomic status. We found 8% rise in mortality rates among individuals aged 0-19 years for every 10% increase in AVI (95% CI, 1.06 to 1.10).
CONCLUSIONS
The study highlights disparities in pediatric care access and their impact on child survival, emphasizing the need for improved access to achieve true universal health coverage.; Summary

Korean summary
본 연구는 한국에서 소아 의료 서비스에 대한 지리적 접근성과 아동 사망률 사이의 연관성을 조사하여, 특히 COVID-19 대유행 기간 동안 접근성 제한이 높은 사망률과 관련이 있음을 발견하였다. 이 연구는 아동 및 청소년의 예방 가능한 사망률에 대한 지역 격차를 줄이기 위해 시기적절한 치료 접근성을 개선해야 할 필요성을 강조하였다.

Key Message
The study investigated the link between geographic access to pediatric services and child mortality in South Korea, finding that limited access, particularly during the COVID-19 pandemic, was associated with higher mortality. The research highlights the need for improved access to timely care to reduce regional disparities in preventable deaths among children and adolescents.

Methods

Validation of self-reported morbidities of the Korean Atomic Bomb Survivor Cohort: Ansun Jeong, Thi Xuan Mai Tran, Seong-geun Moon, Mi Kyung Kim, Inah Kim, Yu-Mi Kim, Boyoung Park; Epidemiol Health. 2024;e2024058. Published online June 28, 2024; DOI: https://doi.org/10.4178/epih.e2024058 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
This study aimed to evaluate the agreement of disease status collected through a survey of the Korean Atomic Bomb Survivor Cohort (K-ABC), compared with medical claim records from the Korean National Health Insurance Service (NHIS) database and the Korean Central Cancer Registry (KCCR).
METHODS
Data on the lifetime physician-diagnosed morbidities of 1,215 K-ABC participants were collected through an interviewer-administered questionnaire between 2020 and 2022. Survey data were linked to the NHIS and KCCR databases. Eleven diseases were included for validation. We evaluated the following indicators: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, the area under the curve (AUC), and the kappa coefficient.
RESULTS
The mean (standard deviation) age was 62.1 (18.7) years, and 42.6% of the participants were aged ≥70 years. Hypertension and cataracts showed the highest prevalence rates (33.8% and 28.8%, respectively). Hypertension, diabetes, and cancer demonstrated high sensitivity (>0.8) and specificity (>0.9), whereas diabetes, cancer, myocardial infarction, angina pectoris, and asthma exhibited high accuracy (>0.9). In contrast, arthritis, allergic rhinitis, and asthma showed low sensitivity (<0.4) and kappa values (<0.3). In the participants aged ≥70 years, the kappa value was ≥0.4 for all diseases except arthritis, allergic rhinitis, and asthma.
CONCLUSIONS
The results from this initial analysis showed relatively high agreement between the survey and NHIS/KCCR databases, especially for hypertension, diabetes, and cancer. Our findings suggest that the information on morbidities collected through the questionnaires in this cohort was valid for both younger and older individuals.; Summary

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