Epidemiology and Health

COVID-19: Original Article

Lack of compensation for COVID-19-related overtime work and its association with burnout among EMS providers in Korea: Ji-Hwan Kim, Jaehong Yoon, Soo Jin Kim, Ja Young Kim, Jinwook Bahk, Seung-Sup Kim; Epidemiol Health. 2023;45:e2023058. Published online June 15, 2023; DOI: https://doi.org/10.4178/epih.e2023058

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study examined the association between lack of compensation for COVID-19-related overtime work (LCCOW) and burnout among emergency medical service (EMS) providers in Seoul, Korea.
METHODS
We conducted a cross-sectional survey of 693 EMS providers in Seoul, Korea. Participants were classified into 3 groups according to their experience of coronavirus disease 2019 (COVID-19)-related overtime work and LCCOW: (1) “did not experience,” (2) “experienced and was compensated,” and (3) “experienced and was not compensated.” Burnout was measured using the Korean version of the Copenhagen Burnout Inventory, which has 3 subdomains: personal burnout (PB), work-related burnout (WRB), and citizen-related burnout (CRB). Multiple linear regression was applied to examine whether LCCOW was associated with burnout after adjusting for potential confounders.
RESULTS
In total, 74.2% of participants experienced COVID-19-related overtime work, and 14.6% of those who worked overtime experienced LCCOW. COVID-19-related overtime work showed a statistically non-significant association with burnout. However, the association differed by LCCOW. Compared to the “did not experience” group, the “experienced and was not compensated” group was associated with PB (β=10.519; 95% confidence interval [CI], 3.455 to 17.584), WRB (β=10.339; 95% CI, 3.398 to 17.280), and CRB (β=12.290; 95% CI, 6.900 to 17.680), whereas no association was observed for the “experienced and was compensated” group. Furthermore, an analysis restricted to EMS providers who worked overtime due to COVID-19 showed that LCCOW was associated with PB (β=7.970; 95% CI, 1.064 to 14.876), WRB (β=7.276; 95% CI, 0.270 to 14.283), and CRB (β=10.000; 95% CI, 3.435 to 16.565).
CONCLUSIONS
This study suggests that LCCOW could be critical in worsening burnout among EMS providers who worked overtime due to COVID-19.; Summary

Korean summary
본 연구는 2021년에 진행된 서울시 구급대원 693 명의 설문조사 자료를 이용해서 COVID-19으로 인한 초과근무 경험에 대한 보상 부족과 번아웃의 연관성을 살펴보았다. 초과근무 경험이 없었던 구급대원의 번아웃 점수와 비교할 때, 초과근무 경험이 있고 항상 적절한 보상을 받은 구급대원의 번아웃 점수는 통계적으로 유의한 차이가 관찰되지 않았지만, 초과근무 경험이 있고 적절한 보상을 받지 못한 적이 있는 구급대원의 번아웃 점수는 통계적으로 유의하게 높게 나타났다. 초과근무를 경험한 구급대원으로 한정한 분석에서는 적절한 보상을 항상 받은 구급대원에 비해서 적절한 보상을 받지 못한 적이 있는 구급대원의 번아웃 점수가 통계적으로 유의하게 높았다.

Key Message
Using a survey of 693 EMS providers in Seoul, Korea, we examined the association between lack of compensation for COVID-19-related overtime work (LCCOW) and burnout. Higher scores of burnouts were observed among those with LCCOW, but not among those without LCCOW, compared to the EMS providers who did not experience overtime work due to COVID-19. Furthermore, in the analysis restricted to EMS providers who had worked overtime due to COVID-19, LCCOW was associated with burnout.

Original Articles

Outbreak of carbapenem-resistant Enterobacterales at a long-term care facility in Seoul, Korea: surveillance and intervention mitigation strategies: Yoojin Park, Euncheol Son, Young June Choe, Cho Ryok Kang, Sangmi Roh, Young Ok Hwang, Sung-il Cho, Jihwan Bang; Epidemiol Health. 2023;45:e2023057. Published online June 9, 2023; DOI: https://doi.org/10.4178/epih.e2023057

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Abstract Summary PDF

Abstract

OBJECTIVES
Because effective decolonization options are not available, and treatment options are limited, carbapenem-resistant Enterobacterales (CRE) constitute increasingly threatening nosocomial pathogens. To prevent CRE-associated transmission and ensure patient safety, healthcare personnel and everyone in contact with CRE-infected patients must implement stringent infection control practices. This report describes a CRE outbreak, possibly related to a caregiver at a long-term care facility (LTCF), and presents a new surveillance model to improve the infection control of CRE in Seoul, Korea.

METHODS

The Seoul Metropolitan Government surveillance system identified an outbreak of CRE in an LTCF in 2022. We obtained data on the demographic characteristics and contact histories of the inpatients, medical staff, and caregivers. To isolate the inpatients and employees exposed to CRE, we used rectal swab samples and environmental sampling during the study period (May-December 2022).

RESULTS

We identified 18 cluster cases (1 caregiver and 17 inpatients) and 12 sporadic cases with CRE, and conducted a complete 197-day follow-up of all cases in the LTCF’s isolation wards.

CONCLUSIONS

This investigation demonstrated that our surveillance model and targeted intervention, based on the cooperation of the municipal government, public health center, and infection control advisory committee, effectively contained the epidemic at the LTCF. Measures to improve the compliance of all employees in LTCFs with infection control guidelines should also be adopted.

Summary

Korean summary
서울시 CRE 감시체계를 통해 2022년 한 요양병원의 집단발생을 인지하였다. 현장역학조사를 실시하여 18명의 집단발생 사례(1명 간병인, 17명 입원환자)와 12명의 산발적인 사례를 확인하였고 감염관리 컨설팅을 통해 유행을 확산을 방지하는 중재를 시행하였다.

Key Message
The Seoul Metropolitan Government surveillance system identified an outbreak of carbapenem-resistant Enterobacterales (CRE) in a long-term care facility (LTCF) in 2022. We identified 18 cluster cases (1 caregiver and 17 inpatients) and 12 sporadic cases with CRE. In the current study, we could demonstrate that our surveillance model and targeted intervention, based on the cooperation of the municipal government, public health center, and infection control advisory committee, effectively contained the epidemic at the LTCF. Measures to improve the compliance of all employees in LTCFs with infection control guidelines should also be adopted.

Citations

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Role of Probiotics in Preventing Carbapenem-Resistant Enterobacteriaceae Colonization in the Intensive Care Unit: Risk Factors and Microbiome Analysis Study
Jung-Hwan Lee, Jongbeom Shin, Soo-Hyun Park, Boram Cha, Ji-Taek Hong, Don-Haeng Lee, Kye Sook Kwon
Microorganisms.2023; 11(12): 2970. CrossRef

Effect of trajectory of employment status on all-cause mortality in the late middle-aged and older population: results of the Korea Longitudinal Study of Aging (2006-2020): Jeong Min Yang, Jae Hyun Kim; Epidemiol Health. 2023;45:e2023056. Published online June 8, 2023; DOI: https://doi.org/10.4178/epih.e2023056

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study conducted a longitudinal analysis of the effect of trajectory of employment status (TES) on all-cause mortality in late middle-aged and older Koreans based on the Korean Longitudinal Study of Aging (KLoSA).
METHODS
After excluding missing values, data on 2,774 participants were analyzed using the chi-square test and the group-based trajectory model (GBTM) for data from the first to fifth KLoSA and the chi-square test, log-rank test, and Cox proportional hazard regression for data from the fifth to eighth KLoSA.
RESULTS
The GBTM analysis identified 5 TES groups: sustained white collar (WC; 18.1%), sustained standard blue collar (BC; 10.8%), sustained self-employed BC (41.1%), WC to job loss (9.9%), and BC to job loss (20.1%). Compared to the sustained WC group, the WC to job loss group had higher mortality at 3 years (hazard ratio [HR], 4.04, p=0.044), 5 years (HR, 3.21, p=0.005), and 8 years (HR, 3.18, p<0.001). The BC to job loss group had higher mortality at 5 years (HR, 2.57, p=0.016) and 8 years (HR, 2.20, p=0.012). Those aged 65 years and older and males in the WC to job loss and BC to job loss groups had an increased risk of death at 5 years and 8 years.
CONCLUSIONS
There was a close association between TES and all-cause mortality. This finding highlights the need for policies and institutional measures to reduce mortality within vulnerable groups with an increased risk of death due to a change in employment status.; Summary

Korean summary
본 연구는 제 1차~8차 한국고령화연구패널을 활용하여 중고령층의 근로활동 궤적과 사망 간의 연관성을 분석하였다. 근로활동 궤적을 파악하기 위하여 집단중심추세모형을 활용하였으며, 총 5가지의 근로활동 궤적을 도출하였다. 도출된 궤적을 바탕으로 카이제곱 검정과 콕스 비례위험모형을 통해 근로활동 궤적과 사망률 간의 연관성을 분석하였다. 연구 결과 화이트칼라에서 실업으로 변화하는 집단과 블루칼라에서 실업으로 변화하는 두 집단에서 사망 간의 유의한 결과를 발견하였으며, 특히, 65세 이상 집단과 남성 집단에서 강한 연관성이 존재하였다. 본 연구 결과를 바탕으로 근로활동 변화로 인해 사망 위험이 증가하는 취약 집단을 위한 정책적, 제도적 방안의 기초자료로서 활용되기를 기대한다.

Key Message
Compared with the sustained White Collar (WC) trajectory group, changed WC to job loss trajectory group and changed BC to job loss trajectory had higher mortality. The over 65 years group and the male group, a strong association between change in employment status and mortality was observed. This study emphasizes the need for policy and institutional measures to reduce mortality for vulnerable groups who are at increased risk of death due to changes in employment status.

Association of blood pressure measurements in sitting, supine, and standing positions with the 10-year risk of mortality in Korean adults: Inkyung Baik, Nan Hee Kim, Seong Hwan Kim, Chol Shin; Epidemiol Health. 2023;45:e2023055. Published online June 8, 2023; DOI: https://doi.org/10.4178/epih.e2023055

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This prospective cohort study investigated the association between blood pressure (BP) as measured in different body postures and all-cause and cardiovascular (CV) mortality risk.

METHODS

This population-based investigation included 8,901 Korean adults in 2001 and 2002. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured sequentially in the sitting, supine, and standing positions and classified into 4 categories: (1) normal, SBP <120 mmHg and DBP <80 mmHg; (2) high normal/prehypertension, SBP 120-129 mmHg and DBP <80 mmHg/SBP 130-139 mmHg or DBP 80-89 mmHg; (3) grade 1 hypertension (HTN), with SBP 140-159 mmHg or DBP 90-99 mmHg; and (4) grade 2 HTN, SBP ≥160 mmHg or DBP ≥100 mmHg. The date and cause of individual deaths were confirmed in the death record data compiled until 2013. Data were analyzed using Cox proportional hazard regression.

RESULTS

Significant associations were found between the BP categories and all-cause mortality, but only when BPs were measured in the supine position. The multivariate hazard ratios (95% confidence intervals, [CIs]) were 1.36 (95% CI, 1.06 to 1.75) and 1.59 (95% CI, 1.06 to 2.39) for grade 1 HTN and grade 2 HTN, respectively, compared with the normal category. The associations between the BP categories and CV mortality were significant regardless of body posture among participants ≥65 years, whereas they were significant for supine BP measurements only in those <65 years.

CONCLUSIONS

BP measured in the supine position predicted all-cause mortality and CV mortality better than BP measured in other postures.

Summary

Korean summary
본 역학 연구는 한국 성인 8,901명을 연구대상자로 하여 기초조사에서 세가지 자세, 즉 앉은 자세, 누운 자세, 일어선 자세에서 혈압을 측정하고, 이후 10년 동안의 사망 여부를 추적조사하여, 측정 자세에 따른 혈압과 사망 위험과의 관련성을 분석하였다. 그 결과, 누운 자세에서 측정된 고혈압(기준: 수축기 혈압이 140 mmHg 이상 혹은 이완기 혈압이 90 mmHg 이상)인 사람은 정상 혈압(기준: 수축기 혈압이 120 mmHg 미만이고 이완기 혈압이 80 mmHg 미만)인 사람에 비해 36%(1단계 고혈압) 혹은 59%(2단계 고혈압) 가량 총 사망 위험이 유의적으로 증가하는 것으로 나타났다. 이에 비해, 앉은 자세 및 일어선 자세에서 측정, 정의된 고혈압은 총 사망 위험을 증가시켰지만 유의적인 결과를 나타내지 못했다. 추후 연구에서 재확인이 필요하지만, 본 연구 결과가 시사하는 바는 앉은 자세나 일어선 자세보다 누운 자세에서 측정하는 혈압이 총 사망 위험을 더 잘 예측하므로, 고혈압 진단 외의 추가적인 활용 가능성이 있는 것으로 평가된다.

Key Message
The current epidemiological study revealed that blood pressure measured in a supine position could predict all-cause mortality and cardiovascular mortality better than blood pressure measured in a sitting or standing position. As a result, blood pressure measurements in a supine position may be useful in assessing mortality risk.

Citations

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Safety of midodrine in patients with heart failure with reduced ejection fraction: a retrospective cohort study
Ming-Ju Wu, Cheng-Hsu Chen, Shang-Feng Tsai
Frontiers in Pharmacology.2024;[Epub] CrossRef

Barriers to COVID-19 vaccine surveillance: the issue of under-reporting adverse events: Yunha Noh, Hwa Yeon Ko, Ju Hwan Kim, Dongwon Yoon, Young June Choe, Seung-Ah Choe, Jaehun Jung, Ju-Young Shin; Epidemiol Health. 2023;45:e2023054. Published online June 7, 2023; DOI: https://doi.org/10.4178/epih.e2023054

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study investigated the reporting rates of adverse events following immunization (AEFIs) to the spontaneous reporting system (SRS) and its predictors among individuals with AEFIs after coronavirus disease 2019 (COVID-19) vaccination.

METHODS

A cross-sectional, web-based survey was conducted from December 2, 2021 to December 20, 2021, recruiting participants >14 days after completion of a primary COVID-19 vaccination series. Reporting rates were calculated by dividing the number of participants who reported AEFIs to the SRS by the total number of participants who experienced AEFIs. We estimated adjusted odds ratios (aORs) using multivariate logistic regression to determine factors associated with spontaneous AEFIs reporting.

RESULTS

Among 2,993 participants, 90.9% and 88.7% experienced AEFIs after the first and second vaccine doses, respectively (reporting rates, 11.6 and 12.7%). Furthermore, 3.3% and 4.2% suffered moderate to severe AEFIs, respectively (reporting rates, 50.5 and 50.0%). Spontaneous reporting was more prevalent in female (aOR, 1.54; 95% confidence interval [CI], 1.31 to 1.81); those with moderate to severe AEFIs (aOR, 5.47; 95% CI, 4.45 to 6.73), comorbidities (aOR, 1.31; 95% CI, 1.09 to 1.57), a history of severe allergic reactions (aOR, 2.02; 95% CI, 1.47 to 2.77); and those who had received mRNA-1273 (aOR, 1.25; 95% CI, 1.05 to 1.49) or ChAdOx1 (aOR, 1.62; 95% CI, 1.15 to 2.30) vaccines versus BNT162b2. Reporting was less likely in older individuals (aOR, 0.98; 95% CI, 0.98 to 0.99 per 1-year age increment).

CONCLUSIONS

Spontaneous reporting of AEFIs after COVID-19 vaccination was associated with younger age, female sex, moderate to severe AEFIs, comorbidities, history of allergic reactions, and vaccine type. AEFIs under-reporting should be considered when delivering information to the community and in public health decision-making.

Summary

Korean summary
본 연구는 국내 19-49세 성인을 대상으로, 코로나19 예방 백신 접종 후 이상반응 경험에 대한 자발적 보고율을 조사하고, 자발적 보고와 관련된 요인을 파악하고자 하였다. 2021년 12월 2일부터 20일까지 온라인 설문조사를 통하여 자료를 수집하였으며, 연구대상자는 코로나19 예방 백신의 기초접종을 완료한 후 2주 경과한 19-49세 성인으로, 전국 대표성을 확보하기 위해 성별, 연령, 지역별로 층화하여 모집하였다. 이상반응 자발적 보고율은 1차 접종과 2차 접종 후 각각 약 11.6%, 12.7%로 나타났으며, 중등도에서 중증의 이상반응에 대한 자발적 보고율은 약 50.5%, 50.0%로 나타났다. 이상반응 자발적 보고율 관련 영향요인으로는 젊은 연령층, 여성, 이상반응의 중증도, 동반질환, 알러지 반응 이력, 기초접종 백신 종류가 포함되었다.

Key Message
Spontaneous reporting rates of adverse events following immunization (AEFIs) against coronavirus disease 2019 (COVID-19) were low, at around 12 % of any AEFIs and 50 % of moderate-to-severe AEFIs. Younger age, female sex, severe AEFIs, comorbidities, history of allergic reactions, and the type of COVID-19 vaccine were associated with the AEFIs reporting.

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Anbukkani Subbian, Jeevithan Shanmugam, Uma Ram
Indian Journal of Obstetrics and Gynecology Research.2024; 11(1): 70. CrossRef

Prediction of the 10-year risk of atherosclerotic cardiovascular disease in the Korean population: Sangwoo Park, Yong-Giun Kim, Soe Hee Ann, Young-Rak Cho, Shin-Jae Kim, Seungbong Han, Gyung-Min Park; Epidemiol Health. 2023;45:e2023052. Published online May 12, 2023; DOI: https://doi.org/10.4178/epih.e2023052

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Proper risk assessment is important for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). However, no validated risk prediction tools are currently in use in Korea. This study sought to develop a 10-year risk prediction model for incident ASCVD.
METHODS
Using the National Sample Cohort of Korea, 325,934 subjects aged 20-80 years without previous ASCVD were enrolled. ASCVD was defined as a composite of cardiovascular death, myocardial infarction, and stroke. The Korean atherosclerotic cardiovas cular disease risk prediction (K-CVD) model was developed separately for men and women using the development dataset and validated in the validation dataset. Furthermore, the model performance was compared with the Framingham risk score (FRS) and pooled cohort equation (PCE).
RESULTS
Over 10 years of follow-up, 4,367 ASCVD events occurred in the overall population. The predictors of ASCVD included in the model were age, smoking status, diabetes, systolic blood pressure, lipid profiles, urine protein, and lipid-lowering and blood pressure-lowering treatment. The K-CVD model had good discrimination and strong calibration in the validation dataset (time-dependent area under the curve=0.846; 95% confidence interval, 0.828 to 0.864; calibration χ2=4.73, goodness-of-fit p=0.32). Compared with our model, both FRS and PCE showed worse calibration, overestimating ASCVD risk in the Korean population.
CONCLUSIONS
Through a nationwide cohort, we developed a model for 10-year ASCVD risk prediction in a contemporary Korean population. The K-CVD model showed excellent discrimination and calibration in Koreans. This population-based risk prediction tool would help to appropriately identify high-risk individuals and provide preventive interventions in the Korean population.; Summary

Korean summary
국민건강보험공단 표본 코호트를 이용하여, 한국인 인구에서 10년 죽상경화성 심혈관질환 위험 예측 (K-CVD) 모델을 개발하였다. 한국인 인구집단을 기반으로 개발된 K-CVD 모델은 한국 인구집단에서 판별력과 교정력 측면에서 우수한 성능을 보여주었다. K-CVD 모델은 한국인 집단에서 심혈관질환의 고위험군을 적절하게 식별하고, 예방적 중재를 시행하는데 있어 도움이 될 것으로 생각된다.

Key Message
Using a nationwide cohort, the Korean ASCVD risk prediction (K-CVD) model was developed for 10-year ASCVD risk prediction. The K-CVD model showed excellent discrimination and calibration in a contemporary Korean population. This population-based risk prediction tool would help to appropriately identify high-risk individuals and provide preventive interventions in the Korean population.

Special Article

The Korea National Disability Registration System: Miso Kim, Wonyoung Jung, So Young Kim, Jong Hyock Park, Dong Wook Shin; Epidemiol Health. 2023;45:e2023053. Published online May 11, 2023; DOI: https://doi.org/10.4178/epih.e2023053

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Abstract Summary PDF Supplementary Material

Abstract

The Korea National Disability Registration System (KNDRS) was established in 1989 to provide social welfare benefits based on predefined criteria for disability registration and an objective medical assessment using a disability grading system. Disability registration requires (1) a medical examination by a qualified specialist physician and (2) a medical advisory meeting to review the degree of disability. Medical institutions and specialists for the diagnosis of disabilities are legally stipulated, and medical records for a specified period are required to support the diagnosis. The number of disability types has gradually expanded, and 15 disability types have been legally defined. As of 2021, 2.645 million people were registered as disabled, accounting for approximately 5.1% of the total population. Among the 15 disability types, disabilities of the extremities account for the largest proportion (45.1%). Previous studies have investigated the epidemiology of disabilities using data from the KNDRS, combined predominantly with data from the National Health Insurance Research Database (NHIRD). Korea has a mandatory public health insurance system that covers the entire Korean population, and the National Health Insurance Services manages all eligibility information, including disability types and severity ratings. In short, the KNDRS-NHIRD is a significant data resource for research on the epidemiology of disabilities.

Summary

Korean summary
한국에서는 장애의 유형과 장애 유형별 장애정도를 장애인 복지법에서 규정하고 있다. 우리는 한국의 장애등록제도의 역사와 장애등록절차 그리고 장애유형별 통계 현황에 대해서 다루고자 한다.

Key Message
In Korea, the types and severity levels of disabilities are legally defined by the Korea National Disability Registration System (KNDRS). We address the history of the KNDRS, disability registration procedures, and current statistics.

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Original Articles

Association of the dietary inflammatory index with phenotypic age in the United States adults: Mengzi Sun, Jiaxin Fang, Wenhui Gao, Yue He, Yanan Ma, Lina Jin; Epidemiol Health. 2023;45:e2023051. Published online May 4, 2023; DOI: https://doi.org/10.4178/epih.e2023051

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
One of the underlying mechanisms of aging is chronic inflammation, which has been closely associated with daily diet. Phenotypic age (PhenoAge) has been used as an index to track the aging process before diseases show clinical symptoms. The present study aimed to explore the association between the dietary inflammatory index (DII) and PhenoAge.

METHODS

In total, 9,275 adults aged 20 years old and over in the National Health and Nutrition Examination Survey were involved in this study. Dietary patterns were classified as pro-inflammatory or anti-inflammatory according to the DII. PhenoAge was regarded as a continuous variable, and linear regression was used to explore its association with dietary inflammation. Stratified analyses by sex, age, race, physical exercise, smoking status, drinking status, and body mass index were used to test the sensitivity of these associations.

RESULTS

The median value of PhenoAge was 38.60 years and 39.76 years for the participants with anti-inflammatory and pro-inflammatory diets, respectively. A pro-inflammatory diet was positively associated with PhenoAge (β=0.73; 95% confidence interval, 0.31 to 1.14), compared with participants who had an anti-inflammatory diet. There was an interaction between dietary inflammation and age for PhenoAge (pinteraction<0.001). The strength of the association between a pro-inflammatory diet and PhenoAge was stronger as age increased.

CONCLUSIONS

A pro-inflammatory diet was associated with a higher PhenoAge, and the association was strongest in the elderly. We recommended reducing dietary inflammation to delay phenotypic aging, especially for the elderly.

Summary

Key Message
One of the underlying mechanisms of aging is chronic inflammation, which has been closely associated with daily diet, and phenotypic age (PhenoAge) has been used as an index to track the aging process before diseases show clinical symptoms. The present study found that a pro-inflammatory diet was associated with a higher PhenoAge, and the association was strongest in the elderly. We recommended reducing dietary inflammation to delay phenotypic aging, especially for the elderly.

Citations

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The association between methylmalonic acid, a biomarker of mitochondria dysfunction, and phenotypic age acceleration: A population-based study
Bing Cao, Yu Xue, Dan Liu
Archives of Gerontology and Geriatrics.2024; 117: 105176. CrossRef
Association of pro-inflammatory diet with increased risk of gallstone disease: a cross-sectional study of NHANES January 2017–March 2020
Jinnian Cheng, Qian Zhuang, Weiyi Wang, Ji Li, Lu Zhou, Ying Xu, Haiqin Zhang, Zixu Zhang, Fengli Zhou, Daming Yang, Yimin Chu, Haixia Peng
Frontiers in Nutrition.2024;[Epub] CrossRef

A comparison of methods for the measurement of adherence to antihypertensive multidrug therapy and the clinical consequences: a retrospective cohort study using the Korean nationwide claims database: Minji Jung, Eunjung Choo, Sukhyang Lee; Epidemiol Health. 2023;45:e2023050. Published online May 1, 2023; DOI: https://doi.org/10.4178/epih.e2023050

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
In observational studies, the methods used to measure medication adherence may affect assessments of the clinical outcomes of drug therapy. This study estimated medication adherence to multidrug therapy in patients with hypertension using different measurement methods and compared their impacts on clinical outcomes.
METHODS
This was a retrospective cohort study using the Korean National Health Insurance Service–National Sample Cohort database (2006-2015). Adults diagnosed with hypertension who initiated multidrug antihypertensive therapy in the index year 2007 were included. Adherence was defined as over 80% compliance. Adherence to multidrug antihypertensive therapy was measured in 3 ways using the proportion of days covered (PDC) with 2 approaches to the end-date of the study observations: PDC with at least one drug (PDCwith≥1), PDC with a duration weighted mean (PDCwm), and the daily polypharmacy possession ratio (DPPR). The primary clinical outcome was a composite of cardiovascular and cerebrovascular disease-specific hospitalizations or all-cause mortality.
RESULTS
In total, 4,226 patients who initiated multidrug therapy for hypertension were identified. The mean adherence according to the predefined measurements varied from 72.7% to 79.8%. Non-adherence was associated with an increased risk of a primary outcome. The hazard ratios (95% confidence intervals, CIs) primary outcomes varied from 1.38 (95% CI, 1.19 to 1.59) to 1.44 (95% CI, 1.25 to 1.67).
CONCLUSIONS
Non-adherence to multidrug antihypertensive therapy was significantly associated with an increased risk of a primary clinical outcome. Across the varying estimates based on different methods, medication adherence levels were similar. These findings may provide evidence to support decision-making when assessing medication adherence.; Summary

Korean summary
- 여섯 가지 다중약물 순응도 평가 방법을 적용했을 때, 고혈압제 병용 요법 순응도는 70~80%으로 유사한 결과값을 보였다. - 순응군 대비 비순응군에서 심혈관질환 관련 입원 및 전체 사망 위험 증가가 1.4배 높았다.

Key Message
-In Korea, adherence to multidrug antihypertensive therapy was approximately 70~80% across the six measurements. -Similar impacts of adherence to multidrug antihypertensive therapy upon the clinical consequences with a 4-folds increased risk across the six measurements. -We provide evidence for decision-making of applying adherence measurement in observational analysis.

Changes in metabolic syndrome and the risk of breast and endometrial cancer according to menopause in Korean women: Thi Xuan Mai Tran, Soyeoun Kim, Boyoung Park; Epidemiol Health. 2023;45:e2023049. Published online May 1, 2023; DOI: https://doi.org/10.4178/epih.e2023049

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study investigated how changes in metabolic syndrome (MetS) are associated with the subsequent risk of breast and endometrial cancer according to menopausal status.

METHODS

This cohort study, using data from the National Health Insurance Service database, included women aged ≥40 years who underwent 2 biennial cancer screenings (2009-2010 and 2011-2012) and were followed up until 2020. Participants were grouped into MetS-free, MetS-recovery, MetS-development, and MetS-persistent groups. Menopausal status (premenopausal, perimenopausal, and postmenopausal) was assessed at 2 screenings. Cox proportional hazard regression was used to assess the association between MetS changes and cancer risk.

RESULTS

In 3,031,980 women, breast and endometrial cancers were detected in 39,184 and 4,298, respectively. Compared with the MetS-free group, those who recovered, developed, or had persistent MetS showed an increased risk of breast cancer, with adjusted hazard ratios (aHRs) of 1.05, 1.05, and 1.11, respectively (p<0.005). MetS persistence was associated with an increased risk of breast cancer in postmenopausal women (aHR, 1.12, 95% confidence interval [CI], 1.08 to 1.16) but not in premenopausal or perimenopausal women. MetS persistence was associated with an increased risk of endometrial cancer in premenopausal, perimenopausal, and postmenopausal women, with aHRs of 1.41 (95% CI, 1.17 to 1.70), 1.59 (95% CI, 1.19 to 2.12), and 1.47 (95% CI, 1.32 to 1.63), respectively.

CONCLUSIONS

Increased breast cancer risk was associated with recovered, developed, and persistent MetS in postmenopausal women. Meanwhile, increased endometrial cancer risk was found in obese women who recovered from MetS or persistently had MetS, regardless of menopausal status, when compared to MetS-free women.

Summary

Korean summary
- 폐경후 여성에서 대사증후군이 회복되었거나, 지속적으로 대사증후군을 앓고 있거나, 대사증후군이 발병한 여성은 유방암 위험과 관련이 있었습니다. - 한편, 폐경 상태와 관계없이 대사증후군에서 회복되었거나 지속적으로 대사증후군를 앓고 있는 비만 여성은 대사증후군이 없는 여성에 비해 자궁내막암 위험이 증가하는 것으로 나타났습니다.

Key Message
- Increased breast cancer risk was associated with recovered, developed, and persistent MetS in postmenopausal women. - Increased endometrial cancer risk was found in obese women who recovered from MetS or persistently had MetS, regardless of menopausal status, when compared to MetS-free women.

Citations

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Melatonin, BAG-1 and cortisol circadian interactions in tumor pathogenesis and patterned immune responses
George Anderson
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Vidhi Motlani, Gunjan Motlani, Soumya Pamnani, Akshat Sahu, Neema Acharya
Cureus.2023;[Epub] CrossRef

Cohort Profile

Integrated database-based Screening Cohort for Asian Nomadic descendants in China (Scan-China): Insights on prospective ethnicity-focused cancer screening: Yuelin Yu, Liying Qiao, Jing Han, Weiwei Wang, Weiwei Kang, Yunjing Zhang, Shu Shang, Ruogu Meng, Lin Zhuo, Siyan Zhan, Yunfeng Xi, Shengfeng Wang; Epidemiol Health. 2023;45:e2023048. Published online April 18, 2023; DOI: https://doi.org/10.4178/epih.e2023048

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Abstract Summary PDF Supplementary Material: Abstract
Established in 2017, the Screening Cohort for Asian Nomadic descendants in China (Scan-China) has benefited over 180,000 members of a multi-ethnic population, particularly individuals of Mongolian descent compared with the general population (Han ethnicity), in the Inner Mongolia Autonomous Region, China. This cohort study aims to evaluate the effectiveness of cancer screening and serve as a real-world data platform for cancer studies. The 6 most prevalent cancers in China are considered—namely, breast, lung, colorectal, gastric, liver and esophageal cancer. After baseline cancer risk assessments and screening tests, both active and passive follow-up (based on the healthcare insurance database, cancer registry, the front page of hospital medical records, and death certificates) will be conducted to trace participants’ onset and progression of cancers and other prevalent chronic diseases. Scan-China has preliminarily found a disproportionately lower screening participation rate and higher incidence/mortality rates of esophageal and breast cancer among the Mongolian population than among their Han counterparts. Further research will explore the cancer burden, natural history, treatment patterns, and risk factors of the target cancers.; Summary

Key Message
- Scan-China is the first and largest electronic health data (EHD)-integrated cancer screening program for the Mongolian ethnicity in Inner Mongolia. - Scan-China aims to evaluate the effectiveness of screening interventions, particularly on ethnic minorities, portray the natural history, explore risk factors and summarize treatment patterns and updated outcomes of prevalent tumors/other chronic diseases. - Scan-China database comprises baseline cancer risk assessment, screening tests results, active follow-up investigation for participants at high risk and EHD-integrated passive follow-up. Data sources for passive follow-up include healthcare insurance database, cancer registry, front page of hospital medical record and death certificates.

Epidemiologic Investigation

Epidemiological investigation of a food-borne outbreak in a kindergarten, Jeju Province, Korea: Kyoung Mi Kim, Eun Suk Cho, Seong Bae Ahn, Eun Ok Kang, Jong-Myon Bae; Epidemiol Health. 2023;45:e2023047. Published online April 17, 2023; DOI: https://doi.org/10.4178/epih.e2023047

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
On Monday, September 6, 2021, at a kindergarten in Jeju Province, a large number of children vomited and developed food poisoning symptoms, and this necessitated an epidemiological investigation.
METHODS
The team surveyed symptoms and food intake history of kindergarten children, teachers, and workers who ate lunch between September 2 (Thursday) and September 6 (Monday), excluding weekends. In addition to rectal swabs, environmental samples from preserved foods, cooking utensils, drinking water, and refrigerator handles were collected. Pulsed field gel electrophoresis (PFGE) for genetic fingerprint analysis was also performed.
RESULTS
There were 19 cases among 176 subjects, which indicated an attack rate of 10.8%. The epidemic curve showed a unimodal shape, and the average incubation period was 2.6 hours. While no food was statistically significant in food intake history, the analysis of 35 rectal smear samples detected Bacillus cereus in 7 children, 4 teachers, and 1 cooking staff. Enterotoxins were also detected in 12 samples. Out of 38 environmental samples, B. cereus and enterotoxins were detected in the morning snack cereal, lunch bean sprouts, and afternoon snack steamed potatoes on Monday, September 6th. The result of the PFGE test on 10 isolates of B. cereus showed that there was no genetic homology.
CONCLUSIONS
Our results indicated that this outbreak was simultaneously caused by various strains of B. cereus from the environment.; Summary

Korean summary
모 유치원에서 제공한 급식 취식아동에서 발열이 없고 구토형의 주증상인 식중독이 발생되었다. 평균 잠복기 2.6시간 (최소 0.8, 최대 4.5시간)이며, 인체 및 환경 검체에서 바실러스 세레우스 균이 분리되었다. 이에 해당 집단발생은 구토형 바실러스 세레우스 감염증에 의한 식중독을 결론지었다.

Key Message
A large number of children in a kindergarten vomited suddenly. The average incubation period was 2.6 hours (min 0.8, max 4.5 hours) with uni-modal shape in the epidemic curve. Bacillus cereus and entertoxin were detected in rectal smear and environmental samples.

Original Articles

Association of multiple anthropometric indices with in 944,760 elderly Chinese people: Lirong Dong, Yuanyuan Wang, Jinshui Xu, Yang Zhou, Guiju Sun, Dakang Ji, Haijian Guo, Baoli Zhu; Epidemiol Health. 2023;45:e2023046. Published online April 17, 2023; DOI: https://doi.org/10.4178/epih.e2023046

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The aims of this study were to update the latest data on the prevalence of hypertension (HTN) in the elderly Chinese population and to assess relationships between new anthropometric indices and HTN.

METHODS

Data were obtained from the Basic Public Health Service (BPHS) survey for Jiangsu Province, China. A total of 944,760 people aged 65 years and older were included in this study. Blood pressure was measured by trained investigators. Body weight, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WtHR), conicity index (COI), body roundness index (BRI), and a body shape index (ABSI) were included in the analysis as anthropometric indices. Logistic regression analysis and restricted cubic splines were used to evaluate the association of anthropometric indices with HTN.

RESULTS

The prevalence of HTN among elderly residents of Jiangsu Province was 64.7% (95% confidence interval, 64.6 to 64.8). After adjusting for multiple covariates, all anthropometric indices except ABSI showed significant non-linear positive dose-response associations with HTN across sex (pnonlinear<0.001). Among participants with BMI <28 kg/m2, abnormal weight, WC, WtHR, BRI, COI, and ABSI were positively associated with HTN.

CONCLUSIONS

The prevalence of HTN in the elderly in Jiangsu Province is gradually increasing. It is necessary to consider the combination of ABSI and COI with BMI for screening elderly individuals for HTN in follow-up prospective studies.

Summary

Key Message
We have conducted a comprehensive review of the supplementary material and have implemented the necessary modifications. We would like to extend our sincere apologies for any inconvenience that may have been caused during your work. Additionally, we have taken note of the fact that certain fields within the Author Contribution and ORCID sections were not previously verified. To rectify this situation and eliminate any potential ambiguity, we have diligently re-entered the information in question.

Citations

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Comparison of seven anthropometric indexes to predict hypertension plus hyperuricemia among U.S. adults
Ye Li, Ling Zeng
Frontiers in Endocrinology.2024;[Epub] CrossRef

Risk of cancer, cardiovascular disease, thromboembolism, and mortality in patients with rheumatoid arthritis receiving Janus kinase inhibitors: a real-world retrospective observational study using Korean health insurance data: Hong Ki Min, Hyeongsu Kim, Ho Jin Jeong, Se Hee Kim, Hae-Rim Kim, Sang-Heon Lee, KunSei Lee, Soon-Ae Shin, Jong Heon Park; Epidemiol Health. 2023;45:e2023045. Published online April 15, 2023; DOI: https://doi.org/10.4178/epih.e2023045

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study investigated whether Janus kinase inhibitors (JAKis) raise the risk of cardiovascular disease (CVD), venous thromboembolism (VTE), and cancer in patients with rheumatoid arthritis (RA).

METHODS

We conducted a real-world retrospective observational study using data obtained from the Korean National Health Insurance Service database. Two data sets were analyzed: tumor necrosis factor inhibitor (TNFi)/JAKi-naive RA patients (set 1) and all RA patients who used TNFis or JAKis (set 2). The incidence rate ratios (IRRs) and hazard ratios (HRs) for acute myocardial infarction (AMI), stroke, cardiovascular (CV)-related mortality, major adverse cardiovascular events (MACE), VTE, arterial thromboembolism (ATE), cancer, and all-cause mortality were compared between the JAKi and TNFi groups.

RESULTS

Set 1 included 1,596 RA patients (JAKi group: 645; TNFi group: 951), and set 2 included 11,765 RA patients (JAKi group: 2,498; TNFi group: 9,267). No adverse events (AEs) showed significantly higher IRRs in the JAKi groups than in the TNFi groups of sets 1 and 2. The HRs for MACE in the JAKi groups of sets 1 and 2 were 0.59 (95% confidence [CI], 0.35 to 0.99) and 0.80 (95% CI, 0.67 to 0.97), respectively. The JAKi group of set 2 showed a significantly higher risk of all-cause mortality (HR, 1.71; 95% CI, 1.32 to 2.20), but the other AEs did not demonstrate increased risks in the JAKi groups.

CONCLUSIONS

In this study, JAKis did not increase the risk of AMI, stroke, CV-related mortality, MACE, VTE, ATE, or cancer in Korean RA patients relative to TNFis.

Summary

Korean summary
1. 한국인 류마티스관절염 환자를 대상으로 한 실제임상자료 결과, JAK 억제제가 종양괴사인자 억제제에 비해 심혈관질환, 혈전증, 암 등의 심각한 부작용을 증가시키지는 않았다. 2. 본 연구를 토대로 한국인 대상자에서 JAK 억제제가 심혈관질환 등의 심각한 부작용을 증가시키는지에 대한 재평가가 필요하다.

Key Message
1. The real word-data based results showed that risks of MACE, thromboembolism, and cancers were not increased in Korean RA patients with JAK inhibitor when compared to Korean RA patients with TNF inhibitors. 2. Therefore, the risk of serious adverse events of JAK inhibitors in Korean population should be reconsidered and reassessed before adding black box warning of JAK inhibitors.

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RMD Open.2023; 9(4): e003630. CrossRef
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Hannah Bower, Thomas Frisell, Daniela di Giuseppe, Benedicte Delcoigne, Ulf Lindström, Carl Turesson, Katerina Chatzidionysiou, Elisabet Lindqvist, Ann Knight, Helena Forsblad-d'Elia, Johan Askling
RMD Open.2023; 9(4): e003648. CrossRef

Associations of breastfeeding duration and the total number of children breastfed with self-reported osteoarthritis in Korea women 50 years and older: a cross-sectional study: Dajeong Ham, Sanghyuk Bae; Epidemiol Health. 2023;45:e2023044. Published online April 13, 2023; DOI: https://doi.org/10.4178/epih.e2023044

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Osteoarthritis is the most common joint disease, with a higher prevalence among women than men. The present study aimed to examine the associations of breastfeeding duration and the total number of children breastfed with osteoarthritis in Korean women aged 50 years and older.
METHODS
In this cross-sectional study, we used representative data from the Korea National Health and Nutrition Examination Survey, phases 5 through 7 (2010-2018). Our analysis included 10,102 women aged ≥50 years. Osteoarthritis experience was defined as whether a physician had ever diagnosed osteoarthritis. Breastfeeding duration was categorized as 1-6 months, 7-24 months, and ≥25 months. The total number of children breastfed was categorized as 1-2, 3-4, and ≥5. The covariates were health behavior characteristics and risks of diseases (smoking, drinking, physical activity, body mass index, diabetes, hypertension, oral contraceptive use, and menopause) as well as socioeconomic characteristics (income, educational level, and occupation). A multiple logistic regression model was used to investigate associations between osteoarthritis and aspects of breastfeeding experience.
RESULTS
Compared to the non-breastfeeding group, the breastfeeding group had an odds ratio (OR) of 1.55 (95% confidence interval [CI], 1.18 to 2.03) for osteoarthritis. Those who reported breastfeeding for >25 months had an OR of 1.56 (95% CI, 1.19 to 2.06).
CONCLUSIONS
The advantages of breastfeeding are already well known, but the present study suggests that women who breastfeed children for a longer time may have a higher risk of osteoarthritis after middle age.; Summary

Korean summary
골관절염은 가장 흔한 관절 질환이며 유병률은 여성에서 더 높다. 본 연구는 국민건강영양조사의 50세 이상 여성 10,130명을 대상으로 모유수유경험과 골관절염의 유병율 사이의 연관성을 분석하였다. 모유 수유의 이점은 이미 잘 알려져 있지만, 모유 수유 기간이 길수록 골관절염에 걸릴 가능성이 더 높음을 관찰하였다.

Key Message
Osteoarthritis is one of the most common disorders in elderly women and identifying risk factors may contribute to screening and early treatment. In the present article, we analyzed the association of breastfeeding and related factors with prevalent osteoarthritis in Korea National Health and Nutrition Examination Survey. The advantages of breastfeeding are already well known, but we observed that the longer the breastfeeding duration was the more likely the woman has osteoarthritis.

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