Epidemiology and Health

Original Articles

Estimation and change of edentulism among the Korean population: Korea National Health and Nutrition Examination Survey 2007-2018: Na-Hyeon Yu, Ah Ra Shin, Song Vogue Ahn, Keun-Bae Song, Youn-Hee Choi; Epidemiol Health. 2021;43:e2021020. Published online April 2, 2021; DOI: https://doi.org/10.4178/epih.e2021020

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Abstract

OBJECTIVES
To estimate the prevalence of edentulism according to the socio-demographic variables of Korean adults between 2007 and 2018 and to analyze the trends.

METHODS

This study was conducted using raw data from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2007 to 2018. Edentulism was defined as the absence of upper and lower teeth or the retained root of the missing teeth. To obtain the prevalence of edentulism, complex sample frequency analysis and regression analysis were performed according to the socio-demographic variables to represent the national population. The Korean population structure in 2005 was exploited as a standard population to calculate age-standardized edentulism.

RESULTS

The prevalence of edentulism in 2016-2018 was 9.7% in the Korean elderly, and the change of age-standardized edentulism steadily declined over time from 2007, 12.8%. In particular, it decreased by approximately 20% in the period between 2016 and 2018 compared to that in 2007 for those in their 80s. The trend of the prevalence according to gender decreased significantly in women. According to the level of education, the greatest decrease was seen in the group with the lowest education, although the prevalence itself was higher than that seen in those who were more educated.

CONCLUSIONS

The prevalence of edentulism among the older Korean population has decreased over time. However, the concern is on those with lower education and men as these groups are still at higher risk for edentulism.

Summary

Korean summary
치아상실은 구강건강의 지표로써 현재 국외에서는 무치악 유병률 추이 파악뿐만 아니라 다국 간의 비교가 이루어지고 있지만 아시아의 주요국가 중 하나인 한국의 무치악 유병률 추이에 대해서는 아직 연구되지 않았다. 연구 결과, 2016-2018년 한국 노인의 무치악 유병률은 9.72%였으며, 연령표준화된 무치악 유병률의 변화는 2007 년 12.8 %에서 꾸준히 감소했다. 결론적으로 무치악으로 어려움을 겪을 수 있는 교육수준이 낮은 노인과 남성에 대해선 지속적인 관심이 필요하다.

Key Message
Tooth loss is an indicator of oral health. At present, not only the trend of edentulous prevalence is being identified abroad, but also multi-country comparisons are being made, but the trend of edentulous prevalence in Korea, one of the major Asian countries, has not been studied. As a result of the study, the prevalence of edentulous in Korea in 2016-2018 was 9.72%, and the change in the age-standardized edentulous prevalence steadily decreased from 12.8% in 2007. In conclusion, continuous attention is needed for the elderly and men with low educational standards who may suffer from edentulous.

Citations

Citations to this article as recorded by

Comparison of the oral health status and costs of the provision of dental care in ten high-income countries
Rüdiger Saekel
Journal of Dental Health, Oral Disorders & Therapy.2024; 15(1): 23. CrossRef
Trend in the Incidence of Severe Partial Edentulism among Adults Using the Korean National Health Insurance Service Claim Data, 2014–2018
Hyeonjeong Go, Hoi-In Jung, Song Vogue Ahn, Jeonghoon Ahn, Hosung Shin, Atsuo Amano, Youn-Hee Choi
Yonsei Medical Journal.2024; 65(4): 234. CrossRef
A preclinical study comparing single- and double-root 3D-printed Ti–6Al–4V implants
Inna Chung, Jungwon Lee, Ling Li, Yang-Jo Seol, Yong-Moo Lee, Ki-Tae Koo
Scientific Reports.2023;[Epub] CrossRef
Oral health status and behavior in elderly Koreans with periodontal disease
Sae‐Rom Lee, Mi Ah Han, Jong Park, So Yeon Ryu, So Yeong Kim
Journal of Public Health Dentistry.2022; 82(4): 378. CrossRef
High exposure to phthalates is associated with HbA1c worsening in type 2 diabetes subjects with and without edentulism: a prospective pilot study
Alessandro Mengozzi, Fabrizia Carli, Samantha Pezzica, Edoardo Biancalana, Amalia Gastaldelli, Anna Solini
Diabetology & Metabolic Syndrome.2022;[Epub] CrossRef
Incidence of edentulism among older adults using the Korean National Health Insurance Service database, 2013-2018
Hyeonjeong Go, Eun-Kyong Kim, Hoi-In Jung, Song Vogue Ahn, Hosung Shin, Atsuo Amano, Youn-Hee Choi
Epidemiology and Health.2022; 44: e2022091. CrossRef

Estimated incidence of juvenile-onset recurrent respiratory papillomatosis in Korea: Jin-Kyoung Oh, Hwa Young Choi, Minji Han, Yuh-Seog Jung, Sang Joon Lee, Moran Ki; Epidemiol Health. 2021;43:e2021019. Published online March 10, 2021; DOI: https://doi.org/10.4178/epih.e2021019

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Abstract

OBJECTIVES
Recurrent respiratory papillomatosis (RRP) is caused by human papillomavirus (HPV) types 6 and 11 and is potentially preventable through vaccination. This study estimated the incidence of juvenile-onset RRP before the implementation of the national HPV vaccination program in Korea.

METHODS

We conducted a cohort study using claims data provided by a mandatory insurance program to estimate the incidence of RRP and associated healthcare use. Patients with juvenile RRP were defined as those aged ≤12 years with ≥2 admissions or ≥2 outpatient visits during which they received the International Classification of Diseases, 10th revision code for benign neoplasms of the larynx (D14.1).

RESULTS

During 2002-2014, 123 children (74 boys and 49 girls) were diagnosed with RRP. The patients had a mean of 6.5 person-years of follow-up. The incidence was estimated at 0.30/100,000 person-years. The median age at diagnosis was 4.0 years (mean, 4.3). Thirty-six (29.3%) patients underwent surgery, including 23 patients (18.7%) who underwent 2 or more surgical procedures. Severe disease, measured by more frequent surgical procedures and shorter time intervals between consecutive operations, was associated with a younger age at diagnosis.

CONCLUSIONS

The estimated incidence of juvenile-onset RRP in Korea was similar to that reported in other countries. The RRP burden should continue to be monitored using National Health Insurance Service claims data.

Summary

Korean summary
재발성호흡기유두종증은 사람유두종바이러스에 의해 발현되는 희귀 질환이다. 건강보험 청구자료를 활용하여 2002년 이후 출생아 전수 중 2014년까지 후두양성종양으로 2회이상 입원 또는 2회이상 외래진료를 받은 어린이 코호트를 관찰하여 재발성호흡기유두종증 발생률을 추정하였다. 총 123명의 재발성호흡기유두종증 환자가 발생하였으며 (발생률 10만인년당 0.30명), 평균 첫 진단시기는 4세인 것으로 나타났다. 2회 이상 수술적 치료를 받은 경우는 18.7%였다.

Key Message
Recurrent respiratory papillomatosis (RRP) is caused by human papillomavirus (HPV). We conducted a cohort study using claims data to estimate the incidence of RRP. Patients with juvenile RRP were defined as those aged ≤12 years with ≥2 admissions or ≥2 outpatient visits with diagnosis for benign neoplasms of the larynx. During 2002-2014, 123 children were diagnosed with RRP. The incidence was estimated at 0.30/100,000 person-years. The median age at diagnosis was 4.0 years. Twenty three patients (18.7%) underwent 2 or more surgical procedures.

Citations

Citations to this article as recorded by

Global epidemiology of HPV-associated recurrent respiratory papillomatosis and effect of vaccination
RY Seedat, FG Dikkers
Future Virology.2022; 17(5): 265. CrossRef

Comorbidity network analysis related to obesity in middle-aged and older adults: findings from Korean population-based survey data: Hye Ah Lee, Hyesook Park; Epidemiol Health. 2021;43:e2021018. Published online March 5, 2021; DOI: https://doi.org/10.4178/epih.e2021018

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Abstract

OBJECTIVES
We conducted a comorbidity network analysis using data from the seventh Korea National Health and Nutrition Examination Survey to systematically quantify obesity-related comorbidities.

METHODS

The study included 11,712 subjects aged 45 to 80 (5,075 male and 6,637 female). A prevalent disease was defined as a specific disease for which a subject had been diagnosed by a doctor and was being treated. Comorbidity network analysis was performed for diseases with a prevalence of 1% or more, including overweight and obesity. We estimated the observed-to-expected ratio of all possible disease pairs with comorbidity strength and visualized the network of obesity-related comorbidities.

RESULTS

In subjects over 45 years old, 37.3% of people had a body mass index over 25.0 kg/m2. The most common prevalent disease was hypertension (42.3%), followed by dyslipidemia (17.4%) and diabetes (17.0%). Overweight and obese subjects were 2.1 times (95% confidence interval, 1.9 to 2.3) more likely to have a comorbidity (i.e., 2 or more diseases) than normal-weight subjects. Metabolic diseases such as hypertension, dyslipidemia, diabetes, and osteoarthritis were directly associated with overweight and obesity. The probability of coexistence for each of those 4 diseases was 1.3 times higher than expected. In addition, hypertension and dyslipidemia frequently coexisted in overweight and obese female along with other diseases. In obese male, dyslipidemia and diabetes were the major diseases in the comorbidity network.

CONCLUSIONS

Our results provide evidence justifying the management of metabolic components in obese individuals. In addition, our results will help prioritize interventions for comorbidity reduction as a public health goal.

Summary

Korean summary
본 연구는 비만 관련 동반질환을 체계적으로 정량화하기 위해, 제7차 (2016-2018) 국민건강영양조사 자료를 이용하여 동반질환 네트워크 분석을 수행하였습니다. 45세 이상 성인에서 비만(체질량지수≥25.0 kg/m²)은 정상체중에 비해 동반질환에 대한 위험이 2.1배 높은 것으로 나타났습니다. 동반질환 네트워크에서는 고혈압과 이상지질혈증이 비만 여성의 주요 질환 이였으며, 이상지질혈증과 당뇨병은 비만 남성의 주요 질환인 것으로 나타났습니다. 본 연구결과는 비만 관련 동반질환 감소를 위한 중재의 우선 순위를 정하는데 도움이 될 것이라고 생각됩니다.

Key Message
We conducted a comorbidity network analysis using data from the seventh (2016-2018) Korea National Health and Nutrition Examination Survey to systematically quantify obesity-related comorbidities. In subjects over 45 years old, obese (body mass index ≥ 25.0 kg/m²) subjects were 2.1 times more likely to have a comorbidity than normal-weight subjects. In the comorbidity network, hypertension and dyslipi¬demia were the major diseases in obese females, and dyslipidemia and diabetes were the major diseases in obese males. Our results will help prioritize interventions for reducing obesity-related comorbidities.

Citations

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Metabolically healthy obese individuals are still at high risk for diabetes: Application of the marginal structural model
Hye Ah Lee, Hyesook Park
Diabetes, Obesity and Metabolism.2024; 26(2): 431. CrossRef
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Chiyoung Lee, Sijia Wei, Eleanor S. McConnell, Hideyo Tsumura, Tingzhong (Michelle) Xue, Wei Pan
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Waquar Ahmed, T. Muhammad, CV Irshad
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Ye Chen, Huixia Ji, Yang Shen, Dandan Liu
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Comorbidity increases the risk of pulmonary tuberculosis: a nested case-control study using multi-source big data
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Diagnostics.2023; 13(3): 488. CrossRef
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Shyam Kumar Sudhakar, Shreya Sridhar, Satvika Char, Kathan Pandya, Kaustav Mehta
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Journal of Cancer Survivorship.2023;[Epub] CrossRef
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Jin Suk Ra
Osong Public Health and Research Perspectives.2023; 14(5): 379. CrossRef
Progression and trajectory network of age-related functional impairments and their combined associations with mortality
Hui Chen, Binghan Wang, Rongxia Lv, Tianjing Zhou, Jie Shen, Huan Song, Xiaolin Xu, Yuan Ma, Changzheng Yuan
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Mika Kivimäki, Timo Strandberg, Jaana Pentti, Solja T Nyberg, Philipp Frank, Markus Jokela, Jenni Ervasti, Sakari B Suominen, Jussi Vahtera, Pyry N Sipilä, Joni V Lindbohm, Jane E Ferrie
The Lancet Diabetes & Endocrinology.2022; 10(4): 253. CrossRef
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Kyung Hwan Jegal, Mi Mi Ko, Bo-Young Kim, Mi Ju Son, Sungha Kim, Alessandro de Sire
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International Journal of Cardiology.2022; 368: 17. CrossRef
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Epidemiology and Health.2022; 44: e2022113. CrossRef

The effect of demographic characteristics on the relationship between smoking and dry mouth in Iran: a cross-sectional, case-control study: Shahla Kakoei, Amir Hossein Nekouei, Sina Kakooei, Hamid Najafipour; Epidemiol Health. 2021;43:e2021017. Published online February 28, 2021; DOI: https://doi.org/10.4178/epih.e2021017

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Abstract Summary PDF

Abstract

OBJECTIVES
The effect of age, sex, and other demographic factors on the relationship between smoking and dry mouth remains unknown. The aim of this study was to investigate the effects of demographic characteristics on the relationship between dry mouth, also known as xerostomia, and smoking.

METHODS

This case-control study included 5,640 randomly-selected subjects from the second phase of the Kerman Coronary Artery Disease Risk Factors Study, which observed 10,000 participants from 2014 to 2018. A checklist was used to record the participants’ demographic characteristics and smoking frequency. Each participant completed a six-item Fox questionnaire to measure dry mouth as a dependent variable. The interaction terms of daily cigarette smoking with sex, age, educational level, and marital status were entered into the model. Non-significant terms were removed using hierarchical model selection.

RESULTS

Of the sample, 3,429 (60.8%) did not have dry mouth and were analyzed as controls, whereas 2,211 (39.2%) had xerostomia and were deemed to be cases. Smokers were more likely to have dry mouth in all ages and both sexes (p < 0.001). As male became older, the chance of having dry mouth increased more rapidly than among female smokers (p < 0.001). In addition, female smokers were more likely to have dry mouth than male smokers (p < 0.001).

CONCLUSIONS

The likelihood of dry mouth among daily smokers depended on age and sex. Female smokers were more likely to have dry mouth, and its likelihood increased with age in daily smokers of both sexes, though more rapidly in males.

Summary

Key Message
The relationship between dry mouth as a distressing condition and smoking has been confirmed by many studies, but so far the severity and weakness of this relationship have not been studied in terms of demographic variables. We showed that the female smokers were more likely to have dry mouth. The chance of having dry mouth increase in a male smoker more than a female smoker as age increases.

Citations

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The prevalence of xerostomia among e-cigarette or combustible tobacco users: A systematic review and meta-analysis
Xingtong Guo, Lili Hou, Xuepei Peng, Fuyou Tang
Tobacco Induced Diseases.2023; 21(February): 1. CrossRef
World Workshop on Oral Medicine VIII: Development of a core outcome set for dry mouth: a systematic review of outcome domains for xerostomia
Paswach Wiriyakijja, Sven Eric Niklander, Alan Roger Santos-Silva, Michal Kuten Shorrer, Melanie Louise Simms, Alessandro Villa, Vidya Sankar, Alexander Ross Kerr, Richeal Ni Riordain, Siri Beier Jensen, Konstantina Delli
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology.2023; 135(6): 827. CrossRef
Xerostomia as a key predictor of physical frailty among community-dwelling older adults in Japan: a five-year prospective cohort study from The Otassha Study
Yuki Ohara, Masahori Iwasaki, Maki Shirobe, Hisashi Kawai, Ayako Edahiro, Keiko Motokawa, Yoshinori Fujiwara, Hunkyung Kim, Kazushige Ihara, Shuichi Obuchi, Yutaka Watanabe, Hirohiko Hirano
Archives of Gerontology and Geriatrics.2022; 99: 104608. CrossRef
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Yan Cheng, Huimin Tong, Xiaoqian Li, Xiaomin Zhang, Ju Fang, Rongli Yue, Nan Huang, Jing Tian, Feiyan Yu, Ying Gao
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Cohort Profile

Cohort profile: the Ewha Birth and Growth Study: Hye Ah Lee, Bohyun Park, Jungwon Min, Eun Jeong Choi, Ui Jeong Kim, Hyun Jin Park, Eun Ae Park, Su Jin Cho, Hae Soon Kim, Hwayoung Lee, Young Ju Kim, Young Sun Hong, Eui-Jung Kim, Eun Hee Ha, Hyesook Park; Epidemiol Health. 2021;43:e2021016. Published online February 22, 2021; DOI: https://doi.org/10.4178/epih.e2021016

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Abstract

With the introduction of life-course epidemiology, researchers realized the importance of identifying risk factors in early life to prevent chronic diseases. This led to the establishment of the Ewha Birth and Growth Study in 2001; the study is a prospective birth cohort designed to provide evidence of early life risk factors for a child’s growth and health. Participants were recruited from those who visited Ewha Womans University Mokdong Hospital (a tertiary hospital in southwest Seoul, Korea) for prenatal care at 24-28 weeks of gestation. In total, 891 mothers enrolled in this study between 2001 and 2006 and their offspring (n=940) were followed-up. Regular check-up examinations of offspring were conducted at 3 years, 5 years, and 7 years of age and every year thereafter. To consider age-related health issues, extensive data were collected using questionnaires and measurements. In 2021, the study subjects will reach 19 years of age, and we are planning a check-up examination for early adulthood. About 20 years have passed since the cohort data were collected, and we have published results on childhood health outcomes associated with prenatal and birth characteristics, genetic and epigenetic characteristics related to childhood metabolism, the effects of exposure to endocrine disruptors, and dietary patterns in childhood. Recently, we started reporting on topics related to adolescent health. The findings will facilitate identification of early life risk factors for chronic diseases and the development of interventions for diseases later in life.

Summary

Korean summary
이화영아성장코호트는 만성질환 예방을 위한 생애초기 위험인자에 대한 근거를 제공하기 위해 2001년에 시작되었습니다. 이화영아성장코호트는 국내에서 선도적인 장기 추적관찰 연구로, 소아기 건강과 관련된 산전 및 출생 시 특징, 소아기 대사와 관련된 유전적 혹은 후성학적 특성, 내분비 장애물질 노출에 따른 영향, 소아기의 식이패턴과 같은 다양한 연구결과들을 발표하였습니다. 추후 청년기의 자료 수집을 계획하고 있으며, 우리의 연구결과는 만성질환 예방을 위한 중재 개발에 기여할 것으로 기대됩니다.

Key Message
To provide evidence of early life risk factors for the prevention of chronic diseases, the Ewha Birth and Growth Study was started in 2001. The Ewha Birth and Growth cohort is a leading long-term follow-up study in Korea, and we have published results on childhood health outcomes associated with prenatal and birth characteristics, genetic and epigenetic characteristics related to childhood metabolism, the effects of exposure to endocrine disruptors, and dietary patterns in childhood. We are planning to collect data for early adulthood, and our findings will contribute to the development of interventions to prevent chronic diseases.

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Data Profile

Establishment of the Korea National Health and Nutrition Examination Survey air pollution study dataset for the researchers on the health impact of ambient air pollution: Myung-Jae Hwang, Jisun Sung, Miryoung Yoon, Jong-Hun Kim, Hui-Young Yun, Dae-Ryun Choi, Youn-Seo Koo, Kyungwon Oh, Sungha Yun, Hae-Kwan Cheong; Epidemiol Health. 2021;43:e2021015. Published online February 8, 2021; DOI: https://doi.org/10.4178/epih.e2021015

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Abstract

To provide a nationwide representative dataset for the study on health impact of air pollution, we combined the data from the Korea National Health and Nutrition Examination Survey with the daily air quality and weather data by matching the date of examination and the residential address of the participants. The database of meteorological factors and air quality as sources of exposure data were estimated using the Community Multiscale Air Quality model. The linkage dataset was merged by three ways; administrative district, si-gun-gu (city, county, and district), and geocode (in latitude and longitude coordinate units) based on the participants’ residential address, respectively. During the study period, the exposure dataset of 85,018 individuals (38,306 men and 46,712 women) whose examination dates were recorded were obtained. According to the definition of exposure period, the dataset was combined with the data on short-term, mid-term, and long-term exposure to air pollutants and the meteorological indices. Calculation of the daily merged dataset’s average air pollution linked by si-gun-gu and geocode units showed similar results. This study generated a daily average of meteorological indices and air pollution exposure dataset for all regions including rural and remote areas in Korea for 11 years. It is expected to provide a platform for the researchers studying the health impact of air pollution and climate change on the representative population and area, which may facilitate the establishment of local health care plans by understanding the residents’ health status at the local as well as national level.

Summary

Korean summary
-2007년부터 2017년까지 11년간 국민건강영양조사의 검진조사 대상자의 검진일자와 지리정보를 기준으로 85,018명에 대해 기상 및 대기오염 모델링 자료를 결합하여 조사 대상자의 거주지주소를 이용하여 시·군·구 단위와 주소 기반 위경도 좌표를 기준으로 각각 노출자료를 결합함. -대기오염의 단기노출, 중기노출, 장기노출의 건강영향을 평가하기 위해 지연효과(lag effect)를 적용하여 각 건강자료와 결합함. -기상 및 대기오염 모델링 자료와 연계된 국민건강영양조사의 활용을 위한 data profile을 제시함.

Key Message
-We built a dataset for air pollution research by combining meteorological and air pollution modeling data through CMAQ for 85,018 individuals based on the date of examination and geographic information of the Korea National Health and Nutrition Examination Survey participants for 11 years, from 2007 to 2017. -Each exposure data was combined based on si-gun-gu (city, county, and district) and geocode (in latitude and longitude coordinate units) based on the participants’ residential address. -To evaluate the health effects of short-, medium- and long-term air pollution exposure, the lag values of days, months, and years was applied and combined with each health data. -A data profile was presented for the Korea National Health and Nutrition Examination Survey linked to meteorological and air pollution modeling data.

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Association between ambient particulate matter levels and hypertension: results from the Korean Genome and Epidemiology Study
Sewhan Na, Jong-Tae Park, Seungbeom Kim, Jinwoo Han, Saemi Jung, Kyeongmin Kwak
Annals of Occupational and Environmental Medicine.2023;[Epub] CrossRef
Effect of Short- to Long-Term Exposure to Ambient Particulate Matter on Cognitive Function in a Cohort of Middle-Aged and Older Adults: KoGES
Jane J. Lee, Ji Hyun Kim, Dae Sub Song, Kyoungho Lee
International Journal of Environmental Research and Public Health.2022; 19(16): 9913. CrossRef
Long-Term Effects of Ambient Particulate and Gaseous Pollutants on Serum High-Sensitivity C-Reactive Protein Levels: A Cross-Sectional Study Using KoGES-HEXA Data
Ji Hyun Kim, Hae Dong Woo, Sunho Choi, Dae Sub Song, Jung Hyun Lee, Kyoungho Lee
International Journal of Environmental Research and Public Health.2022; 19(18): 11585. CrossRef
Effects of exposure to ambient air pollution on pulmonary function impairment in Korea: the 2007-2017 Korea National Health and Nutritional Examination Survey
Soo Beom Choi, Sungha Yun, Sun-Ja Kim, Yong Bum Park, Kyungwon Oh
Epidemiology and Health.2021; 43: e2021082. CrossRef

Original Article

Inherently high uncertainty in predicting the time evolution of epidemics: Seung-Nam Park, Hyong-Ha Kim, Kyoung Beom Lee; Epidemiol Health. 2021;43:e2021014. Published online February 8, 2021; DOI: https://doi.org/10.4178/epih.e2021014

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Abstract Summary PDF

Abstract

OBJECTIVES
Amid the spread of coronavirus disease 2019 (COVID-19), with its high infectivity, we have relied on mathematical models to predict the temporal evolution of the disease. This paper aims to show that, due to active behavioral changes of individuals and the inherent nature of infectious diseases, it is complicated and challenging to predict the temporal evolution of epidemics.

METHODS

A modified susceptible-exposed-infectious-hospitalized-removed (SEIHR) compartment model with a discrete feedback-controlled transmission rate was proposed to incorporate individuals’ behavioral changes into the model. To figure out relative uncertainties in the infection peak time and the fraction of the infected population at the peak, a deterministic method and 2 stochastic methods were applied.

RESULTS

A relatively small behavioral change of individuals with a feedback constant of 0.02 in the modified SEIHR model resulted in a peak time delay of up to 50% using the deterministic method. Incorporating stochastic methods into the modified model with a feedback constant of 0.04 suggested that the relative random uncertainty of the maximum fraction of infections and that of the peak time for a population of 1 million reached 29% and 9%, respectively. Even without feedback, the relative uncertainty of the peak time increased by up to 20% for a population of 100,000.

CONCLUSIONS

It is shown that uncertainty originates from stochastic properties of infections. Without a proper selection of the evolution scenario, active behavioral changes of individuals could serve as an additional source of uncertainty.

Summary

Korean summary
이 논문은 감염병에 대응하는 개인의 능동적 행동 변화와 감염병의 고유한 특성 때문에 그 진행을 예측하는 것은 복잡하고 도전적인 작업이라는 것을 보이기 위한 것이다. 이런 행동 변화를 고려하기 위하여 감염률에 피드백 제어를 줄 수 있는 SEIHR 수정 모델을 제안하였다. 최대 감염까지 경과 시간과 최대 감염률의 상대 불확도를 계산하기 위하여 하나의 결정론적 방법과 두 가지의 확률론적 방법 적용하였다. 감염병 예측의 불확도는 감염의 확률론적 성질에 기인하는 것을 알 수 있었다. 적절한 진행의 시나리오를 설정하지 못할 경우 개인의 능동적 행동 변화가 추가적인 불확도 요인이 될 것이다.

Key Message
This paper is to show that, due to active behavioral changes of individuals and inherent natures of infectious diseases, it is complicated and challenging to predict the temporal evolutions. A modified-SEIHR compartment model with a discretely feedback-controlled transmission rate was proposed to incorporate the behavioral changes of individuals into the model. To figure out relative uncertainties in the infection peak times and the fraction of the infected population at the peak, a deterministic method and two stochastic methods were applied. It is shown that the uncertainty of the prediction originates from stochastic properties of the infections. Without a proper selection of the evolution scenarios, the active behavioral changes of individuals could cause an additional uncertainty.

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Modeling Supply and Demand Dynamics of Vaccines against Epidemic-Prone Pathogens: Case Study of Ebola Virus Disease
Donovan Guttieres, Charlot Diepvens, Catherine Decouttere, Nico Vandaele
Vaccines.2023; 12(1): 24. CrossRef
Evolution and consequences of individual responses during the COVID-19 outbreak
Wasim Abbas, Masud M. A., Anna Park, Sajida Parveen, Sangil Kim, Siew Ann Cheong
PLOS ONE.2022; 17(9): e0273964. CrossRef

Systematic review

Does antiretroviral therapy cause congenital malformations? A systematic review and meta-analysis: Fekadu Mazengia Alemu, Alemayehu Worku Yalew; Epidemiol Health. 2021;43:e2021008. Published online February 3, 2021; DOI: https://doi.org/10.4178/epih.e2021008

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Abstract

OBJECTIVES
This meta-analysis investigated the risk of congenital anomalies among infants of human immunodeficiency virus-infected pregnant women who were exposed to antiretroviral therapy (ART).

METHODS

Cohort studies, case-control studies, randomized controlled trials, and controlled clinical trials were reviewed by searching MEDLINE/PubMed, Embase, Web of Science, Scopus, AIDSLINE, CINAHL, Cochrane Library, and Google/Google Scholar. Methodological quality was assessed using the GRADE evaluation. A DerSimonian and Laird random-effects model was used. Subgroup analyses and meta-regression were used to investigate heterogeneity.

RESULTS

The electronic searches yielded 765 items. After quality assessment and grading, 30 studies were suitable for metaanalysis. In total, 1,461 congenital anomalies were found among 53,186 births. Children born to women receiving combined antiretroviral therapy (cART) had an approximately 10% higher risk of developing congenital anomalies (relative risk [RR], 1.09; 95% confidence interval [CI], 1.04 to 1.14). A subgroup analysis found no significant difference in the risk of congenital anomalies between cART and efavirenz users. However, zidovudine and protease inhibitor (RR, 1.09; 95% CI, 1.00 to 1.19) users were found to have a 10% increased risk of congenital anomalies, and integrase inhibitor users had a 60% increase in risk (RR, 1.61; 95% CI, 1.60 to 2.43). The subgroup results should be interpreted cautiously because of the moderate heterogeneity (I2 =58%).

CONCLUSIONS

The use of protease inhibitors, integrase inhibitors, zidovudine, and newer drugs should be carefully considered in pregnant women. Further studies are needed to address environmental, nutrition, and adherence factors related to ART. Establishing a congenital anomalies surveillance system is recommended.

Summary

Key Message
New drugs are coming to the market and effective ART is available, yet toxicity issues and harmful outcomes during pregnancy, including major congenital anomalies, preterm delivery, anemia, and low birth weight, are of increasing concern among clinicians and program managers. In the development of either WHO or National ARV guidelines, clinical management of patients therefore, careful consideration should be taken in the inclusion of PI-based inhibitors, integrase inhibitors, Zidovudine, and newer drugs. Establishing a congenital anomalies surveillance system is recommended.

Citations

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Understanding clinical outcome measures reported in HIV pregnancy studies involving antiretroviral-naive and antiretroviral-experienced women
Ahizechukwu C Eke, Rahel D Gebreyohannes, Anna M Powell
The Lancet Infectious Diseases.2023; 23(4): e151. CrossRef
Fifteen-minute consultation: How to approach the initial discussions of dysmorphism with parents
Kate Frances Parmenter, Sharon English, Jennifer Campbell
Archives of disease in childhood - Education & practice edition.2023; : edpract-2023-325658. CrossRef

Original Article

Human papillomavirus: footprints in the population of western India: Ashi Robert Thobias, Kinjal Ankit Patel, Supreet Dhananjay Bhatt, Kruti Ashvinkumar Mehta, Chetana Deepal Parekh, Pariseema Sharad Dave, Prabhudas Shankarbhai Patel; Epidemiol Health. 2021;43:e2021013. Published online February 3, 2021; DOI: https://doi.org/10.4178/epih.e2021013

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Abstract Summary PDF: Abstract
OBJECTIVES
Cancer is a multi-factorial disease, with various intrinsic and environmental factors contributing to its occurrence. Human papillomavirus (HPV) has been associated with the occurrence of many cancers. India severely suffers from 3 HPV-associated cancers (cervical cancer, oral cancer, and oropharyngeal cancer). Hence, the present study aimed to evaluate the HPV burden in these 3 cancers among patients from the western region of India.
METHODS
DNA was isolated from samples from 400 cervical cancer, 127 oral cancer, and 75 oropharyngeal cancer patients. Polymerase chain reaction was performed using degenerate primers for HPV infection.
RESULTS
Overall, HPV infection was observed in 87% of cervical cancer cases, 12.5% of oral cancer cases, and 26.7% of oropharyngeal cancer cases when analyzed with a cumulative detection method using the MY 09/11, GP 5+/6+, and CP I/II primer sets.
CONCLUSIONS
A significant prevalence of HPV infection was detected in all 3 cancers using the degenerate primer sets. This finding implies that testing for HPV infection using multiple primer sets is crucial for determining its actual prevalence in various malignancies.; Summary

Key Message
The study emphasised the need to screen population of India for HPV infection for better prognosis and disease management and showcases a perfect screening module to efficiently screen the HPV strains.

COVID-19: Perspective

COVID-19 herd immunity in the absence of a vaccine: an irresponsible approach: Jade Khalife, Derrick VanGennep; Epidemiol Health. 2021;43:e2021012. Published online February 3, 2021; DOI: https://doi.org/10.4178/epih.e2021012

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Abstract

As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread rapidly throughout the human population, the concept of “herd immunity” has attracted the attention of both decision-makers and the general public. In the absence of a vaccine, this entails that a large proportion of the population will be infected to develop immunity that would limit the severity and/or extent of subsequent outbreaks. We argue that adopting such an approach should be avoided for several reasons. There are significant uncertainties about whether achieving herd immunity is possible. If possible, achieving herd immunity would impose a large burden on society. There are gaps in protection, making it difficult to shield the vulnerable. It would defeat the purpose of avoiding harm caused by the virus. Lastly, dozens of countries are showing that containment is possible.

Summary

Key Message
Pursuing herd immunity without a vaccine involves numerous uncertainties, is costly in terms of lives and disease, is ineﬀective, and - being unethical and uncompassionate - is not compatible with human dignity and development.

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Analyzing natural herd immunity media discourse in the United Kingdom and the United States
Marco Zenone, Jeremy Snyder, Alessandro Marcon, Timothy Caulfield, Veena Sriram
PLOS Global Public Health.2022; 2(1): e0000078. CrossRef
Evaluation of science advice during the COVID-19 pandemic in Sweden
Nele Brusselaers, David Steadson, Kelly Bjorklund, Sofia Breland, Jens Stilhoff Sörensen, Andrew Ewing, Sigurd Bergmann, Gunnar Steineck
Humanities and Social Sciences Communications.2022;[Epub] CrossRef
Is COVID-19 Herd Immunity Influenced by Population Densities of Cities?
Yuval Arbel, Yifat Arbel, Amichai Kerner, Miryam Kerner
Sustainability.2022; 14(16): 10286. CrossRef
Effective strategies against COVID-19 and the importance of infection sequelae
Jade Khalife
Global Health Research and Policy.2022;[Epub] CrossRef
Herd immunity: challenges and the way forward in Korea
Jiyoung Oh, Sohyun Kim, Boyeong Ryu, Minjoung Shin, Bryan Inho Kim
Epidemiology and Health.2021; 43: e2021054. CrossRef
COVID-19 vaccine uptake and vaccine hesitancy in Indian patients with cancer: A questionnaire-based survey
Vanita Noronha, George Abraham, SureshKumar Bondili, Annu Rajpurohit, RakeshP Menon, Shreya Gattani, Mehak Trikha, Rajanigandha Tudu, KishoreKumar Kota, AjayKumar Singh, Prahalad Elamarthi, GoutamSantosh Panda, RahulKumar Rai, MadalaRavi Krishna, SravanKu
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COVID-19 vaccine hesitancy in India
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Cancer Research, Statistics, and Treatment.2021; 4(3): 437. CrossRef

Systematic Review

Association between gallstones and the risk of biliary tract cancer: a systematic review and meta-analysis: Dan Huang, Hyundeok Joo, Nan Song, Sooyoung Cho, Woosung Kim, Aesun Shin; Epidemiol Health. 2021;43:e2021011. Published online February 3, 2021; DOI: https://doi.org/10.4178/epih.e2021011

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Biliary tract cancers (BTCs) are rare but highly fatal. Although the etiology of BTC is poorly understood, gallstones are proposed to be a major risk factor. We conducted a systematic review and meta-analysis to examine the associations between gallstone characteristics and BTC risk.

METHODS

We searched the MEDLINE, Embase, and Cochrane Central databases and systematically reviewed cohort and case-control studies published before April 9, 2018. All the included studies reported appropriate risk estimates and confidence intervals (CIs) for associations between the presence, size, number, or duration of gallstones and the risk of BTC, including gallbladder cancer (GBC), extrahepatic bile duct cancer (EBDC), and ampulla of Vater cancer (AOVC). Summary odds ratios (ORs) and their 95% CIs were calculated using a random-effects model in the meta-analysis. Subgroup analyses were conducted to inspect sources of potential heterogeneity, and the Egger test was performed to assess publication bias.

RESULTS

Seven cohort studies and 23 case-control studies in Asian, European, and American populations were included. The presence of gallstones was associated with an increased risk of BTC (OR, 4.38; 95% CI, 3.23 to 5.93; I2=91.2%), GBC (OR, 7.26; 95% CI, 4.33 to 12.18), EBDC (OR, 3.17; 95% CI, 2.24 to 4.50), and AOVC (OR, 3.28; 95% CI, 1.33 to 8.11). Gallstone size (>1 vs. <1 cm; OR, 1.88; 95% CI, 1.10 to 3.22) was significantly associated with the risk of GBC.

CONCLUSIONS

Gallstone characteristics, such as presence, size, and number, are associated with an increased risk of BTC. However, significantly high heterogeneity in the meta-analyses is a limitation of this study.

Summary

Korean summary
The prevalence of APCT-detected sacroiliitis in CD patients was higher than that in controls, but the condition was asymptomatic. The clinical significance of asymptomatic sacroiliitis in Korean CD patients remains unclear.

Key Message
본 연구에서는 체계적 문헌고찰과 메타분석법을 활용하여 여러 선행연구에서 담도계암 전반과 담석의 다양한 특성사이에 연관성이 있는지 탐구하였다. 총 30개의 문헌을 분석한 결과 담석의 존재 여부가 담도계암과 각 하위 암의 위험을 모두 높이는 것으로 나타났고, 담석의 크기가 클수록 담낭암의 위험이 높은 것으로 드러났다. 본 연구는 담석과 담도계암 전반의 연관성에 대해 체계적으로 정리한 최초의 문헌으로서 담석과 담도계암의 관계에 대한 이해의 폭을 넓히고, 추후 해당 주제로 추가 연구를 수행하는 데에 있어 기준점이 될 수 있으리라 기대한다.

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Data Profile

Data resource profile: the allergic disease database of the Korean National Health Insurance Service: Sunyong Yoo, Dong-Wook Kim, Young-Eun Kim, Jong Heon Park, Yeon-Yong Kim, Kyu-dong Cho, Mi-Ji Gwon, Jae-In Shin, Eun-Joo Lee; Epidemiol Health. 2021;43:e2021010. Published online January 21, 2021; DOI: https://doi.org/10.4178/epih.e2021010

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Abstract

Researchers have been interested in probing how the environmental factors associated with allergic diseases affect the use of medical services. Considering this demand, we have constructed a database, named the Allergic Disease Database, based on the National Health Insurance Database (NHID). The NHID contains information on demographic and medical service utilization for approximately 99% of the Korean population. This study targeted 3 major allergic diseases, including allergic rhinitis, atopic dermatitis, and asthma. For the target diseases, our database provides daily medical service information, including the number of daily visits from 2013 and 2017, categorized by patients’ characteristics such as address, sex, age, and duration of residence. We provide additional information, including yearly population, a number of patients, and averaged geocoding coordinates by eup, myeon, and dong district code (the smallest-scale administrative units in Korea). This information enables researchers to analyze how daily changes in the environmental factors of allergic diseases (e.g., particulate matter, sulfur dioxide, and ozone) in certain regions would influence patients’ behavioral patterns of medical service utilization. Moreover, researchers can analyze long-term trends in allergic diseases and the health effects caused by environmental factors such as daily climate and pollution data. The advantages of this database are easy access to data, additional levels of geographic detail, time-efficient data-refining and processing, and a de-identification process that minimizes the exposure of identifiable personal information. All datasets included in the Allergic Disease Database can be downloaded by accessing the National Health Insurance Service data sharing webpage (https://nhiss.nhis.or.kr).

Summary

Korean summary
알레르기질환DB는 환경적 변화와 의료이용 연관성 연구를 지원하기 위해 만들어진 누구나 다운로드 가능한 공개용DB이다. 알레르기질환DB는 한국 전국민의 사회인구학적 특성 및 의료이용 정보가 구축되어 있는 국민건강보험공단의 국민건강정보DB를 활용하여 구축되었다. 알레르기질환DB는 2013년~2017년 알레르기성 비염, 아토피, 천식 상병코드로 청구된 의료이용 정보를 제공하고 있으며, 이를 활용하여 특정 지역에 다양한 환경적 변화와 의료이용과의 연관성 연구 등에 활발히 활용될 것으로 기대된다.

Key Message
The Allergic Disease Database based on the National Health Insurance Data is constructed for analyzing how environmental factors affect the use of medical services. The database provides most Korean medical service information of allergic diseases, such as allergic rhinitis, atopic dermatitis, and asthma from 2013 and 2017. This information enables researchers to study how daily changes of environmental factors in certain regions would influence patients’ behavioral patterns of medical service utilization. Moreover, researchers can analyze the long-term trend of allergic diseases, and health effects caused by environmental factors such as daily climate and pollution data.

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Original Articles

Strongyloides stercoralis and other intestinal parasites in patients receiving immunosuppressive drugs in northern Iran: a closer look at risk factors: Leila Mirzaei, Keyhan Ashrafi, Zahra Atrkar Roushan, Mohammad Reza Mahmoudi, Irandokht Shenavar Masooleh, Behnaz Rahmati, Farshid Saadat, Hamed Mirjalali, Meysam Sharifdini; Epidemiol Health. 2021;43:e2021009. Published online January 20, 2021; DOI: https://doi.org/10.4178/epih.e2021009

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Abstract Summary PDF

Abstract

OBJECTIVES
The objective of this study was to evaluate the prevalence of Strongyloides stercoralis and other intestinal parasites in patients receiving immunosuppressive drugs in northern Iran and to investigate related risk factors.

METHODS

This cross-sectional study was conducted among 494 patients receiving immunosuppressive drugs, including cancer patients undergoing chemotherapy (n=188) and those treated with prolonged corticosteroid administration (n=306). All fresh fecal samples were examined using the direct wet-mount, formalin ethyl acetate concentration, and agar plate culture techniques.

RESULTS

In total, 16.8% of patients were positive for at least 1 intestinal parasite; the helminthic and protozoan infection rates were 5.1% and 12.3%, respectively. The infection rate was significantly higher in corticosteroid-treated individuals (19.6%) than cancer patients (12.2%) (p<0.05). The prevalence rate of S. stercoralis among patients receiving chemotherapy and those treated with corticosteroids were 4.3% and 5.2%, respectively. The prevalence rate of S. stercoralis infection was significantly higher in older patients (p<0.05).

CONCLUSIONS

Strongyloidiasis is one of the most common parasites among patients receiving immunosuppressive drugs in northern Iran. Early diagnosis and proper treatment of these patients are necessary to minimize the complications of severe strongyloidiasis.

Summary

Key Message
This study showed strongyloidiasis is one of the most common parasitic diseases among patients receiving immunosuppressive drugs in northern Iran and early diagnosis before chemotherapy or steroid therapy is necessary.

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Seropositivity Rates of Strongyloides stercoralis Antibody in the Southeastern Region of Republic of Korea: A Single-Center Retrospective Study
Taehwa Kim, Seungjin Lim
The Korean Journal of Parasitology.2022; 60(3): 181. CrossRef
The Coexistence of Blastocystis spp. in Humans, Animals and Environmental Sources from 2010–2021 in Asia
Adedolapo Aminat Rauff-Adedotun, Farah Haziqah Meor Termizi, Nurshafarina Shaari, Ii Li Lee
Biology.2021; 10(10): 990. CrossRef
Comparison of Molecular and Parasitological Methods for Diagnosis of Human Trichostrongylosis
Mehdi Pandi, Meysam Sharifdini, Keyhan Ashrafi, Zahra Atrkar Roushan, Behnaz Rahmati, Nayereh Hajipour
Frontiers in Cellular and Infection Microbiology.2021;[Epub] CrossRef

Socioeconomic disparities in Korea by health insurance type during the COVID-19 pandemic: a nationwide study: Han Eol Jeong, Jongseong Lee, Hyun Joon Shin, Ju-Young Shin; Epidemiol Health. 2021;43:e2021007. Published online January 13, 2021; DOI: https://doi.org/10.4178/epih.e2021007

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study explored socioeconomic disparities in Korea using health insurance type as a proxy during the ongoing coronavirus disease 2019 (COVID-19) pandemic.

METHODS

We conducted a retrospective cohort study using Korea’s nationwide healthcare database, which contained all individuals who received a diagnostic test for COVID-19 (n=232,390) as of May 15, 2020. We classified our cohort by health insurance type into beneficiaries of the National Health Insurance (NHI) or Medicaid programs. Our study outcomes were infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19-related outcomes, a composite of all-cause death, intensive care unit admission, and mechanical ventilation use. We estimated age-, sex-, and Charlson comorbidity index score–adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using a multivariable logistic regression analysis.

RESULTS

Of the 218,070 NHI and 14,320 Medicaid beneficiaries who received COVID-19 tests, 7,777 and 738 tested positive, respectively. The Medicaid beneficiaries were older (mean age, 57.5 vs. 47.8 years), more likely to be males (47.2 vs. 40.2%), and had a higher comorbidity burden (mean CCI, 2.0 vs. 1.7) than NHI beneficiaries. Compared to NHI beneficiaries, Medicaid beneficiaries had a 22% increased risk of SARS-CoV-2 infection (aOR, 1.22; 95% CI, 1.09 to 1.38), but had no significantly elevated risk of COVID-19-related outcomes (aOR 1.10, 95% CI 0.77 to 1.57); the individual events of the composite outcome yielded similar findings.

CONCLUSIONS

As socioeconomic factors, with health insurance as a proxy, could serve as determinants during the current pandemic, pre-emptive support is needed for high-risk groups to slow its spread.

Summary

Korean summary
사회경제적 수준과 코로나19 발생률 및 예후 간 연관성 등 코로나19로 인한 건강 불평등 현상은 아직 확인된 바가 없다. 건강보험 가입자 대비 의료급여 수급권자에서 SARS-CoV-2의 감염 위험이 더 높게 나타났다. 코로나19의 확산을 늦추기 위해서는, 의료급여 수급권자를 비롯한 취약계층 대상의 선제적 지원이 제공되어야 한다.

Key Message
Socioeconomic status, with health insurance as a proxy, could explain health inequalities in clinical outcomes, diverse disease incidence and prognosis, during the COVID-19 pandemic.

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Obinna C. Godfrey, Eze A. Adindu, Uwem O. Edet, Elizabeth N. Mbim, Gabriel C. Eze, Fredrick C. Asogwa, Innocent Benjamin, Terkumbur E. Gber, Rawlings A. Timothy, Hitler Louis
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Predictors of anticipated coping behavior at myocardial infarction symptom onset among a nationwide sample of Korean adults: Kyong Sil Park; Epidemiol Health. 2021;43:e2021006. Published online January 3, 2021; DOI: https://doi.org/10.4178/epih.e2021006

10,722 View
360 Download

Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This cross-sectional study based on the health belief model investigated predictors of anticipated coping behavior at myocardial infarction (MI) symptom onset using secondary data from the 2017 Korea Community Health Survey.
METHODS
Modifying variables (socioeconomic, health knowledge, perceived threat) were selected as independent variables and anticipated coping behavior at MI symptom onset as the dependent variable. Calling 911 was classified as the correct anticipated coping behavior, while visiting a hospital or an oriental hospital, calling family, and others were classified as incorrect.
RESULTS
Of 227,740 participants, 83.2% reported correct anticipated coping behaviors. The likelihood of calling 911 was low if participants experienced atypical symptoms (jaw, neck, back, arm, and shoulder pain), even if they were aware of those symptoms. However, 69.9% of participants who were aware of typical symptoms (chest pain) stated that they would call-911. Sex, age, hypertension, dyslipidemia, obesity, and awareness of MI symptoms affected the correct anticipated coping behavior.
CONCLUSIONS
Correct coping abilities among the general public are vitally important for early treatment of MI patients and reduction of hospitalization time. Members of the general public in their 20s and 30s, 60 years of age or older, with cardiovascular risk factors (male sex, hypertension, dyslipidemia, and obesity), and who are not aware of MI symptoms should be educated about the typical and atypical symptoms of MI. Emergency medical services should be called without delay if needed, and public relations activities should be carried out to raise awareness that anyone can use emergency medical services.; Summary

Korean summary
심근경색증 증상 발현 시 올바른 대처 행동을 위해 20-39세, 60세 이상, 남성, 고혈압, 이상지질혈증, 비만이 있는 대상자, 심근경색증 증상을 인지하지 못하는 대상자에게 심근경색증의 전형적, 비전형적 증상에 대해 교육해야 한다. 또한, 환자 발생 시 지체없이 응급의료서비스 신고해야하며, 누구나 응급의료서비스를 이용할 수 있도록 인식 전환을 위한 홍보활동을 시행해야 한다.

Key Message
Those in their 20s and 30s, 60 years of age or older, male, with cardiovascular risk factors, and who are not aware of MI symptoms should be educated about the typical and atypical symptoms of MI. Public relations activities should be carried out to raise awareness that anyone can use EMS.

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