Epidemiology and Health

Original Article

Interaction between vitamin E intake and a COMT gene variant on colorectal cancer risk among Korean adults: a case-control study: Shinyoung Jun, Madhawa Gunathilake, Jeonghee Lee, Jae Hwan Oh, Hee Jin Chang, Dae Kyung Sohn, Aesun Shin, Jeongseon Kim; Epidemiol Health. 2023;45:e2023100. Published online November 14, 2023; DOI: https://doi.org/10.4178/epih.e2023100

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Previous human trials have not supported the anticarcinogenic effect of vitamin E despite biological plausibility and considerable epidemiological evidence. A possible explanation for this inconsistency is the interactive effect of the catechol-O-methyltransferase (COMT) gene and supplemental vitamin E on cancer. We examined whether a COMT gene variant modulates the effect of dietary vitamin E intake on colorectal cancer (CRC) risk.
METHODS
In this case-control study of Korean adults (975 cases and 975 age- and sex-matched controls), dietary vitamin E density (mg/1,000 kcal) was measured using a semiquantitative food frequency questionnaire, COMT single nucleotide polymorphism (SNP) rs740603 (A>G) was genotyped, and CRC was verified histologically. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using unconditional logistic regression models with adjustments for potential confounders.
RESULTS
Higher vitamin E density was associated with a lower risk of CRC (highest vs. lowest quartiles: OR, 0.72; 95% CI, 0.55 to 0.96; p-for-trend=0.002). When stratified by COMT SNP rs740603 genotype, the inverse association between vitamin E density and CRC risk was confined to those with at least 1 A allele (≥median vs. <median: OR, 0.63; 95% CI, 0.51 to 0.78). The interaction between rs740603 and vitamin E density was significant (p-for-interaction=0.020). No direct association was observed between COMT SNP rs740603 and CRC risk (OR, 1.08; 95% CI, 0.83 to 1.41).
CONCLUSIONS
Our findings support a role for a genetic polymorphism in COMT in modifying the association between dietary vitamin E intake and CRC.; Summary

Korean summary
본 연구는 국립암센터에서 수집한 대장암 환자-대조군 자료를 활용하여, catechol-O-methyltransferase (COMT) 유전자의 단일염기다형성(SNP)에 따라 비타민 E 섭취와 대장암 위험 간의 연관성이 달라지는지 파악하고자 하였다. 분석 결과, COMT SNP rs740603의 유전자형에 따라 식이를 통한 비타민 E 섭취 밀도와 대장암 위험 간의 연관성이 다르게 나타나 COMT 유전자와 비타민 E 섭취 간의 상호작용이 대장암 발생 위험에 영향을 미칠 가능성이 있음을 제시하였다.

Key Message
In this case-control study of Korean adults, we examined whether a polymorphism in the catechol-O-methyltransferase (COMT) gene modulates the effect of dietary vitamin E intake on colorectal cancer risk. Our results suggest that the inverse association between vitamin E density and colorectal cancer risk is confined to carriers of the COMT rs740603 A allele. The findings of our study support the interactive effect of the COMT gene and vitamin E intake on colorectal cancer risk.

Systematic Review

Dietary intake and cancer incidence in Korean adults: a systematic review and meta-analysis of observational studies: Ji Hyun Kim, Shinyoung Jun, Jeongseon Kim; Epidemiol Health. 2023;45:e2023102. Published online November 30, 2023; DOI: https://doi.org/10.4178/epih.e2023102

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Cancer is a major health burden in Korea, and dietary factors have been suggested as putative risk factors for cancer development at various sites. This study systematically reviewed the published literature investigating the associations between dietary factors and cancer incidence among Korean adults, following the Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines. We focused on the 5 most studied cancer sites (stomach, colorectum, breast, thyroid, and cervix) as outcomes and dietary exposures with evidence levels greater than limited-suggestive according to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) panel’s judgment for any of the cancer sites. This resulted in the inclusion of 72 studies. Pooled estimates of the impact of dietary factors on cancer risk suggested protective associations of fruits and vegetables with risks for gastric cancer (GC), colorectal cancer (CRC), and breast cancer (BC) and dietary vitamin C with the risk of GC, as well as a harmful association between fermented soy products and the risk of GC. Despite the limited number of studies, we observed consistent protective associations of dietary fiber with GC and dietary fiber, coffee, and calcium with CRC. These findings are largely consistent with the WCRF/AICR expert report. However, pooled estimates for the associations of other salt-preserved foods with GC, meat with CRC, and dietary carotenoids and dairy products with BC did not reach statistical significance. Further studies with prospective designs, larger sample sizes, and diverse types of dietary factors and cancer sites are necessary.; Summary

Korean summary
한국 성인을 대상으로 주요 암종 발생과 관련된 식이 요인을 탐색한 72개 역학연구들을 체계적으로 리뷰하고 메타 분석한 결과, 과일 및 채소는 위암, 대장암, 유방암에 대한 보호 효과가 있으며, 식이 비타민 C는 위암 예방에 도움이 된다는 결과가 확인되었다. 반면, 염장 식품 중 발효 대두 제품은 위암 발생 위험을 증가시킬 수 있다. 향후 식이 섭취와 밀접하게 관련되었으나 기존 국내 연구가 부족한 암종과 다양한 식이 요인의 영향을 탐색하는 대규모 전향적 코호트 연구가 요구된다.

Key Message
We conducted a systematic review and meta-analysis on the associations between dietary factors and cancer incidence among Korean adults. Pooled estimates suggested protective associations of fruits and vegetables with risks for gastric cancer (GC), colorectal cancer (CRC), and breast cancer (BC) and dietary vitamin C with the risk of GC, as well as a harmful association between fermented soy products and GC risk. Further research is warranted, emphasizing longitudinal designs, larger sample sizes, and a comprehensive exploration of dietary factors, with a specific focus on anatomical sites with a substantial burden of disease but understudied in the context of diet.

Original Article

Age-specific effects of ozone on pneumonia in Korean children and adolescents: a nationwide time-series study: Kyoung-Nam Kim, Youn-Hee Lim, Sanghyuk Bae, In Gyu Song, Soontae Kim, Yun-Chul Hong; Epidemiol Health. 2022;44:e2022002. Published online December 28, 2021; DOI: https://doi.org/10.4178/epih.e2022002

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Abstract

OBJECTIVES
The aim of this study was to estimate the age-specific effects of 8-hour maximum ozone levels on pneumonia in children and adolescents.

METHODS

We performed quasi-Poisson regression analyses for individuals of 0-4 years, 5-9 years, 10-14 years, and 15-19 years of age using nationwide time-series data from the Korea (2011-2015). We constructed distributed lag linear models employing a generalized difference-in-differences method and controlling for other air pollutants.

RESULTS

A 10.0-parts per billion increase in 8-hour maximum ozone levels was associated with a higher risk of hospital admissions due to pneumonia at 0-4 (relative risk [RR], 1.02; 95% confidence interval [CI], 1.01 to 1.03) and 5-9 years of age (RR, 1.06; 95% CI, 1.04 to 1.08), but not at 10-14 (RR, 1.01; 95% CI, 0.98 to 1.04) or 15-19 years of age (RR, 1.01; 95% CI, 0.97 to 1.06). The association between ozone and hospital admissions due to pneumonia was stronger in cool seasons (from November to April) than in warm seasons (from May to October), but was similar between boys and girls.

CONCLUSIONS

Short-term exposure to ozone was associated with a higher risk of pneumonia at 0-4 years and 5-9 years of age, but not at 10-14 years or 15-19 years of age. Our findings can help identify vulnerable periods, determine the target populations for public health interventions, and establish air pollution standards.

Summary

Korean summary
-어린이와 청소년에서 대기오염물질인 오존에 단기 노출되었을 때 폐렴으로 인한 입원 위험이 증가하는지를 건강보험공단 청구자료를 이용하여 구축한 시계열자료로 분석하였다. -0-4세, 5-9세 군에서는 오존 단기 노출 시 폐렴으로 인한 입원 위험이 증가하였으나 10-14세, 15-19세 군에서는 입원 위험 증가가 관찰되지 않았다.

Key Message
• The effects of ozone levels on hospital admissions for pneumonia were evaluated. • We used quasi-Poisson time-series models and a difference-in-differences method. • Ozone levels increased hospital admissions for pneumonia at ages 0–4 and 5–9 years. • Evidence for the effects of ozone levels on pneumonia was not found at older ages.

Citations

Citations to this article as recorded by

Challenges of Air Pollution and Health in East Asia
Xihao Du, Renjie Chen, Haidong Kan
Current Environmental Health Reports.2024;[Epub] CrossRef
Intraday exposure to ambient ozone and emergency department visits among children: a case-crossover study in southern China
Jiahong Ren, Lifeng Zhu, Yachen Li, Haiyi Li, Qian Hu, Jian Zhu, Qingyan Zhang, Yunquan Zhang
Environmental Science and Pollution Research.2023; 30(30): 74853. CrossRef

Epidemiologic Investigation

An outbreak of hepatitis A associated with salted clams in Busan, Korea: Hyunjin Son, Miyoung Lee, Youngduck Eun, Wonseo Park, Kyounghee Park, Sora Kwon, Seungjin Kim, Changhoon Kim; Epidemiol Health. 2022;44:e2022003. Published online December 29, 2021; DOI: https://doi.org/10.4178/epih.e2022003

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Abstract

OBJECTIVES
In July 2019, there were multiple reports on patients with hepatitis A among the visitors of a restaurant in Busan. The current study presents the results of an epidemiological investigation and outlines the supplementary measures that would help with hepatitis A control.

METHODS

A cohort study was conducted for all 2,865 customers who visited restaurant A from June to July. Using a standardized questionnaire, participants reported the presence of hepatitis A symptoms and whether they had consumed any of 19 food items. As for participants who had visited public health centers, their specimens were collected.

RESULTS

From the study cohort, 155 participants (5.4%) had confirmed hepatitis A. The epidemic curve was unimodal, and the median number of days from the restaurant visit to symptom onset was 31 days. A genotype analysis indicated that 89 of 90 tested patients had hepatitis A virus (HAV) genotype 1A. The results of a multivariate logistic regression analysis indicated that the ingestion of salted clams increased the risk of hepatitis A by 68.12 times (95% confidence interval [CI], 9.22 to 510.87). In an unopened package of salted clams found and secured through traceback investigation, HAV genotype 1A was detected.

CONCLUSIONS

To prevent people from ingesting uncooked clams, there needs to be more efforts to publicize the dangers of uncooked clams; the food sampling test standards for salted clams should also be expanded. Furthermore, a laboratory surveillance system based on molecular genetics should be established to detect outbreaks earlier.

Summary

Korean summary
2019년 7월, 부산시의 한 식당을 방문한 사람에서 다수의 A형간염 환자가 신고되었다. 2019년 6월 1일부터 7월 28일까지 해당 식당을 방문하여 카드 결제를 한 사람과 동반자 2,865명 전체를 대상으로 코호트 조사를 수행하였다. A형간염에 확진 된 사람은 총 155명으로 발병률은 5.4%였다. 다변량 로지스틱 회귀분석 결과 조개젓 섭취는 A형간염 발병 위험을 68.62배(95% CI, 9.22 to 510.87) 증가시키는 것으로 나타났다. 익히지 않은 조개류를 섭취하지 않도록 더욱 홍보를 강화해야 한다.

Key Message
In July 2019, there were multiple reports on patients with hepatitis A among the visitors of a restaurant in Bu¬san. A cohort study was conducted for all 2,865 customers who visited the restaurant from June to July. From the study cohort, 155 participants (5.4%) had confirmed hepatitis A. The results of a multivariate logistic regression analysis indicated that the ingestion of salted clams increased the risk of hepatitis A by 68.12 times. To prevent people from ingesting uncooked clams, there needs to be more efforts to publicize the dangers of uncooked clams.

Citations

Citations to this article as recorded by

Investigating the spatio-temporal variation of hepatitis A in Korea using a Bayesian model
Jaehong Jeong, Mijeong Kim, Jungsoon Choi
Frontiers in Public Health.2023;[Epub] CrossRef
A Study on the Detection Rate of Hepatitis A from Gastroenteritis Patients and the Genotype Analysis of Hepatitis A Virus in Busan
Sun Hee Park, Chanhee Kim, Summi Lee, Jihye Jeong, Junghye Choi, Seung Ju Lee
Journal of Bacteriology and Virology.2023; 53(2): 74. CrossRef
Influence of temperature and precipitation on the incidence of hepatitis A in Seoul, Republic of Korea: a time series analysis using distributed lag linear and non-linear model
Kiook Baek, Jonghyuk Choi, Jong-Tae Park, Kyeongmin Kwak
International Journal of Biometeorology.2022; 66(9): 1725. CrossRef

Original Articles

Association of participation in the Northern Finland Birth Cohort 1986 with mental disorders and suicidal behaviour: Martta Kerkelä, Mika Gissler, Juha Veijola; Epidemiol Health. 2022;44:e2022005. Published online January 3, 2022; DOI: https://doi.org/10.4178/epih.e2022005

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Abstract

OBJECTIVES
In prospective follow-up studies, participants are normally contacted during the follow-up period. Even though the idea is not to intervene, the studies conducted during follow-up may affect the target population. Our hypotheses were that participation in the prospective Northern Finland Birth Cohort 1986 study (NFBC 1986) increased the use of mental health services and reduced suicidal behaviour due to participation in follow-up studies.

METHODS

The NFBC 1986 study covered people with an expected date of birth between July 1985 and June 1986 in northern Finland (n=9,396). The participants of the NFBC 1986 were followed since the antenatal period with follow-ups including clinical examinations. The comparison cohort comprised people born in the same area in 1987 (n=8,959), who were not contacted. Registry data on psychiatric treatment, suicide attempts, and suicides were available. Crude risk ratios (RRs) and adjusted (for marital status and education) Mantel-Haenszel RRs were reported.

RESULTS

No increase in mental disorders were found in NFBC 1986 compared to comparison cohort. In the crude RR analysis of female participants, a lower risk for suicide attempts was found (RR, 0.67; 95% confidence interval, 0.49 to 0.92; p=0.011).

CONCLUSIONS

The results did not support our first hypothesis regarding the increased use of mental health services in the NFBC 1986 cohort. However, our second hypothesis gained some support as female participants of the NFBC 1986 had a lower risk of suicide attempts, although it was not due to a higher number of participants receiving psychiatric treatment.

Summary

Key Message
Female members of the longitudinal Northern Finland Birth Cohort 1986 study did have less psychiatric diagnosis in several diagnosis classes than comparison cohort, which may indicate that different follow-up studies conducted in the prospective birth cohort studies may affect to the study population.

Citations

Citations to this article as recorded by

Association between participation in the Northern Finland Birth Cohort 1966 study and use of psychiatric care services
Martta Kerkelä, Mika Gissler, Tanja Nordström, Juha Veijola, Silva Ibrahimi
PLOS ONE.2023; 18(3): e0282714. CrossRef
Association between participation in the Northern Finland Birth Cohorts and cardiometabolic disorders
Martta Kerkelä, Mika Gissler, Tanja Nordström, Olavi Ukkola, Juha Veijola
Annals of Medicine.2023; 55(1): 1123. CrossRef

Evidence of the importance of contact tracing in fighting COVID-19: Okyu Kwon; Epidemiol Health. 2022;44:e2022006. Published online January 3, 2022; DOI: https://doi.org/10.4178/epih.e2022006

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Abstract

OBJECTIVES
We analyzed data to determine whether there are distinguishing characteristics depending on the success or failure of control for coronavirus disease 2019 (COVID-19) by country in the trend of the daily number of confirmed cases and the number of tests.

METHODS

We obtained the number of confirmed cases and tests per day for almost every country in the world from Our World in Data. The Pearson correlation between the two time series was calculated according to the time delay to analyze the relationship between the number of tests and the number of cases with a lag.

RESULTS

For each country, we obtained the time lag that makes the maximum correlation between the number of confirmed cases and the number of tests for COVID-19. It can be seen that countries whose time lag making maximum correlation lies in a special section between about 15 days and 20 days are generally been successful in controlling COVID-19. That section looks like a trench on the battlefield.

CONCLUSIONS

We have seen the possibility that the success in mitigating COVID-19 can be expressed as a simple indicator of the time lag of the correlation between confirmed cases and tests. This time lag indicator is presumably reflected by efforts to actively trace the infected persons.

Summary

Korean summary
일일 신규 확진자 수와 검사자 수 시계열의 상관관계에서의 시간지연 값은 방역의 성공을 평가할 수 있는 지표가 될 수 있음을 여러 국가의 실제 데이터로부터 확인할 수 있었다. 이 시간 지연은 역학 조사에 따른 감염자 발굴의 노력의 결과로 이해할 수 있을 것이다.

Key Message
It was confirmed from actual data from several countries that the time delay value in the correlation between the number of daily new confirmed cases and the number of tests can be an indicator to evaluate the success of quarantine. This time delay can be understood as a result of efforts to discover infected persons according to epidemiological investigations.

Citations

Citations to this article as recorded by

Looking under the lamp-post: quantifying the performance of contact tracing in the United States during the SARS-CoV-2 pandemic
Henry Bayly, Madison Stoddard, Debra Van Egeren, Eleanor J Murray, Julia Raifman, Arijit Chakravarty, Laura F White
BMC Public Health.2024;[Epub] CrossRef
From Crisis to Control: Amidst and Postpandemic Data Protection Concerns in Singapore and Vietnam through the Lens of Techno-Solutionism and Efficient Violation of Privacy Rights
Vy Ngo Nguyen Thao
Law and Development Review.2024;[Epub] CrossRef
Global transmission of COVID-19 — A gravity model approach
Hyungsoo Woo, Okyu Kwon, Jae-Suk Yang
International Journal of Modern Physics C.2023;[Epub] CrossRef

Impact of water fluoridation on dental caries decline across racial and income subgroups of Brazilian adolescents: Rafael Aiello Bomfim, Paulo Frazão; Epidemiol Health. 2022;44:e2022007. Published online January 3, 2022; DOI: https://doi.org/10.4178/epih.e2022007

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
The aim of this study was to assess the impact of community water fluoridation (CWF) on differences in dental caries decline across racial and socioeconomic subgroups of Brazilian adolescents.
METHODS
Two nationwide Brazilian population-based oral health surveys were used (Brazilian Oral Health Survey 2003 and 2010). In total, 7,198 adolescents from 15 years to 19 years old living in 50 cities investigated in both surveys were included. The mean numbers of untreated decayed teeth (DT) according to racial (Whites vs. Browns/Blacks) and socioeconomic subgroups (at or above the minimum wage per capita vs. under) were analysed. Difference-in-differences negative binomial regressions were adjusted by schooling, age, and sex. Decayed, missing, and filled teeth and DT prevalence, calculated as a categorical variable, were used in sensitivity analyses.
RESULTS
The adjusted difference of reduction in DT was similar across socioeconomic subgroups (β=-0.05; 95% confidence interval [CI], -0.45 to 0.35) and favoured, but not to a significant degree, Whites (β=-0.34; 95% CI, -0.74 to 0.04) compared to Brown/Blacks in fluoridated areas. In non-fluoridated areas, significant differences were observed in the mean number of DT, favouring the higher socioeconomic subgroup (β=-0.26; 95% CI, -0.53 to -0.01) and Whites (β=-0.40; 95% CI, -0.69 to -0.11) in relation to their counterparts. The sensitivity analyses confirmed the findings.
CONCLUSIONS
The similar reduction in DT across income subgroups suggests that CWF has had a beneficial effect on tackling income inequalities in dental caries within a 7-year timeframe.; Summary

Key Message
Community Water Fluoridation tackled income and racial inequalities in dental caries in adolescents aged 15-19 years between 2003 and 2010 in Brazil.

The predictive value of resting heart rate in identifying undiagnosed diabetes in Korean adults: Korea National Health and Nutrition Examination Survey: Dong-Hyuk Park, Wonhee Cho, Yong-Ho Lee, Sun Ha Jee, Justin Y. Jeon; Epidemiol Health. 2022;44:e2022009. Published online January 3, 2022; DOI: https://doi.org/10.4178/epih.e2022009

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Abstract

OBJECTIVES
The purpose of this study was (1) to examine whether the addition of resting heart rate (RHR) to the existing undiagnosed diabetes mellitus (UnDM) prediction model would improve predictability, and (2) to develop and validate UnDM prediction models by using only easily assessable variables such as gender, RHR, age, and waist circumference (WC).

METHODS

Korea National Health and Nutrition Examination Survey (KNHANES) 2010, 2012, 2014, 2016 data were used to develop the model (model building set, n=19,675), while the data from 2011, 2013, 2015, 2017 were used to validate the model (validation set, n=19,917). UnDM was defined as a fasting glucose level ≥126 mg/dL or glycated hemoglobin ≥6.5%; however, doctors have not diagnosed it. Statistical package for the social sciences logistic regression analysis was used to determine the predictors of UnDM.

RESULTS

RHR, age, and WC were associated with UnDM. When RHR was added to the existing model, sensitivity was reduced (86 vs. 73%), specificity was increased (49 vs. 65%), and a higher Youden index (35 vs. 38) was expressed. When only gender, RHR, age, and WC were used in the model, a sensitivity, specificity, and Youden index of 70%, 67%, and 37, respectively, were observed.

CONCLUSIONS

Adding RHR to the existing UnDM prediction model improved specificity and the Youden index. Furthermore, when the prediction model only used gender, RHR, age, and WC, the outcomes were not inferior to those of the existing prediction model.

Summary

Korean summary
당뇨병 미인지 또는 미진단은 적절한 치료 시작 시기를 늦추고 당뇨병 합병증 발생의 위험을 높이기 때문에, 각국은 당뇨병 예측 모형을 개발하여 당뇨병을 조기에 예측하고, 치료 시기를 앞당기기 위해 노력하고 있다. 본 연구는 기존의 한국인 당뇨병 예측 모형에 안정시심박수를 추가 변수로 포함시켜, 예측 모형의 성능이 일부개선되는 것을 확인하였고, 더 나아가 나이, 허리 둘레, 그리고 안정시심박수를 포함하여 예측 모형을 개발하고, 그 성능을 확인하였다. 본 연구에서는 간단하게 측정이 가능한 허리 둘레와 안정시심박수 그리고 나이만 포함한 예측 모형이 기존의 예측 모형과 비교해 성능이 열등하지 않은 것을 확인하였다.

Key Message
Higher RHR is associated with increased risk of diabetes. When RHR is added to the Korean undiagnosed diabetes risk score model (Age, Family history of diabetes, Hypertension, Waist circumference, Smoking, Alcohol consumption), the model somewhat increased its predictability of undiagnosed diabetes. Furthermore, the prediction model developed only using age, waist circumference and RHR, which anyone can easily measure or access, had similar predictability to the previous undiagnosed diabetes risk prediction model. The results of this study may help develop future strategies or applications for predicting early undiagnosed diabetes.

Citations

Citations to this article as recorded by

Comparisons of the prediction models for undiagnosed diabetes between machine learning versus traditional statistical methods
Seong Gyu Choi, Minsuk Oh, Dong–Hyuk Park, Byeongchan Lee, Yong-ho Lee, Sun Ha Jee, Justin Y. Jeon
Scientific Reports.2023;[Epub] CrossRef
Factors related to undiagnosed diabetes in Korean adults: a secondary data analysis
Bohyun Kim
Journal of Korean Biological Nursing Science.2023; 25(4): 295. CrossRef

Increasing trends in mortality and costs of infectious diseases in Korea: trends in mortality and costs of infectious diseases: Dahye Baik, Byung-Woo Kim, Moran Ki; Epidemiol Health. 2022;44:e2022010. Published online January 3, 2022; DOI: https://doi.org/10.4178/epih.e2022010

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Abstract

OBJECTIVES
In an era when the average life expectancy and overall mortality rate have improved, Korea remains at risk for infectious disease outbreaks that place substantial burdens on the healthcare system. This study investigated trends in mortality and the economic burden of infectious diseases.

METHODS

Healthcare data from the Health Insurance Review and Assessment Service (2009-2019) and the Korean Statistics Information Service (1997-2019) were used. We selected 10 infectious disease groups (intestinal infections, tuberculosis, vaccine- preventable diseases, sepsis, viral hepatitis, HIV-related diseases, central nervous system infections, rheumatic heart diseases, respiratory tract infections, and arthropod-borne viral diseases).

RESULTS

The age-standardized mortality rate for infectious diseases increased from 27.2 per 100,000 population in 1997 to 37.1 per 100,000 population in 2019 and has had an upward trend since 2004. During this same period, significant increases were seen in respiratory tract infections and among elderly persons, especially those aged ≥85 years. The costs for infectious diseases increased from 4.126 billion US dollar (USD) in 2009 to 6.612 billion USD in 2019, with respiratory tract infections accounting for 3.699 billion USD (69%). The annual cost per patient for visits for medical care due to infectious diseases increased from 131 USD in 2009 to 204 USD in 2019.

CONCLUSIONS

Mortality among elderly persons and those with respiratory tract infections increased during the study period. The economic burden of infectious diseases has consistently increased, especially for respiratory tract infections. It is therefore essential to establish effective management policies that considers specific infectious diseases and patient groups.

Summary

Korean summary
우리나라의 감염병으로 인한 사망률과 의료비용은 증가하고 있다. 특히 고령층에서의 높은 사망률과 과다한 의료비용 지출을 고려하면, 호흡기 감염 관리에 집중하는 것이 중요하며 각 감염병 그룹별로 효과적인 정책과 효율적인 관리가 필요하다. 본 연구는 COVID-19 발생 이전의 우리나라 감염병의 사망률과 발생, 의료비 부담의 장기적인 추세를 분석한 중요한 레퍼런스가 될 것이다.

Key Message
In Republic of Korea, the mortality trends (1997-2019) and costs (2009-2019) of infectious disease have increased and this study is particularly important reference for identifying the long-term trends including mortality, outbreak, financial burden of infectious disease in Korea before COVID-19 outbreak.

Citations

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Validation of operational definitions of mortality in a nationwide hemodialysis population using the Health Insurance Review and Assessment Service databases of Korea
Dong Hee Lee, Ye-Jee Kim, Hyangkyoung Kim, Hyung Seok Lee
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Mortality Burden Due to Short-term Exposure to Fine Particulate Matter in Korea
Jongmin Oh, Youn-Hee Lim, Changwoo Han, Dong-Wook Lee, Jisun Myung, Yun-Chul Hong, Soontae Kim, Hyun-Joo Bae
Journal of Preventive Medicine and Public Health.2024; 57(2): 185. CrossRef
Glycaemic status, insulin resistance, and risk of infection-related mortality: a cohort study
Hae Suk Cheong, Yoosoo Chang, Yejin Kim, Eun-Jeong Joo, Min-Jung Kwon, Sarah H Wild, Christopher D Byrne, Seungho Ryu
European Journal of Endocrinology.2023; 188(2): 197. CrossRef
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Evidence-Based Complementary and Alternative Medicine.2022; 2022: 1. CrossRef

COVID-19: Brief Communication

Trends in gastrointestinal infections before and during non-pharmaceutical interventions in Korea in comparison with the United States: Soyeoun Kim, Jinhyun Kim, Bo Youl Choi, Boyoung Park; Epidemiol Health. 2022;44:e2022011. Published online January 3, 2022; DOI: https://doi.org/10.4178/epih.e2022011; Correction in: Epidemiol Health 2022;44(0):e2022011.E

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Abstract Summary PDF

Abstract

OBJECTIVES
This study examined how trends in the weekly frequencies of gastrointestinal infectious diseases changed before and during the coronavirus disease 2019 (COVID-19) pandemic in Korea, and compared them with the trends in the United States.

METHODS

We compared the weekly frequencies of gastrointestinal infectious diseases (16 bacterial and 6 viral diseases) in Korea during weeks 5-52 before and after COVID-19. In addition, the weekly frequencies of 5 gastrointestinal infectious diseases in the United States (data from the Centers for Disease Control and Prevention) that overlapped with those in Korea were compared.

RESULTS

The mean weekly number of total cases of gastrointestinal infectious diseases in Korea showed a significant decrease (from 522 before COVID-19 to 245 after COVID-19, p<0.01). Only bacterial gastrointestinal infectious diseases caused by Campylobacter increased significantly; other bacterial gastrointestinal infectious diseases showed either a decrease or no change. The incidence of all other viral diseases decreased. In the United States, the weekly numbers of Salmonella, Campylobacter, typhoid, shigellosis, and hepatitis A virus cases sharply decreased after the COVID-19 outbreak. The weekly case numbers of all viral diseases markedly decreased in both countries; however, bacterial gastrointestinal infectious diseases showed a different pattern.

CONCLUSIONS

The incidence of gastrointestinal infectious diseases decreased after the COVID-19 outbreak. In contrast, Campylobacter infections showed an increasing trend in Korea, but a decreasing trend in the United States. Further studies are needed to elucidate the different trends in bacterial and viral infectious diseases before and after non-pharmaceutical interventions and between different countries.

Summary

Korean summary
한국과 미국 모두 코로나-19 발생 이후 위장관 감염 질환의 발생은 감소하고 있습니다. 하지만, 미국과 달리 한국에서는 캄필로박터 감염은 증가 하고 있습니다. 이는 COVID-19이 발생한 이후 캄필로박터 감염의 열악한 통제의 가능성을 설명할 수 있습니다.

Key Message
The incidence of gastrointestinal infectious diseases decreased after the COVID-19 outbreak, however, campylobacter infections showed an increasing trend in Korea, unlike the United States, which could explain the poor control of Campylobacter.

Citations

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Impact of the COVID‐19 pandemic on the circulation of other pathogens in England
Lauren J. Hayes, Hannah Uri, Denisa Bojkova, Jindrich Cinatl, Mark N. Wass, Martin Michaelis
Journal of Medical Virology.2023;[Epub] CrossRef
Understanding the impact of the COVID-19 pandemic response on GI infection surveillance trends in England, January 2020–April 2022
Nicola K. Love, Amy Douglas, Saheer Gharbia, Helen Hughes, Roger Morbey, Isabel Oliver, Gillian E. Smith, Alex J. Elliot
Epidemiology and Infection.2023;[Epub] CrossRef
Trends for Syndromic Surveillance of Norovirus in Emergency Department Data Based on Chief Complaints
Soyeoun Kim, Sohee Kim, Bo Youl Choi, Boyoung Park
The Journal of Infectious Diseases.2023;[Epub] CrossRef
Trends in Gastrointestinal Infections during the COVID-19 Pandemic and Concerns of Post-Pandemic Resurgence in Japan
Takuma Higurashi, Shigeki Tamura, Noboru Misawa, Nobuyuki Horita
Diseases.2023; 12(1): 4. CrossRef
Characteristics and related factors of waterborne and foodborne infectious disease outbreaks before and after the onset of the COVID-19 pandemic (2017–2021) in the Republic of Korea: a descriptive study
Eunkyoung Kim, Bryan Inho Kim
Osong Public Health and Research Perspectives.2023; 14(6): 483. CrossRef

Methods

Development and validation of the Pediatric-Youth Hyperphagia Assessment for Prader-Willi syndrome: Sung Yoon Cho, Danbee Kang, Minji Im, Aram Yang, Min-Sun Kim, Jiyeon Kim, Eu-Seon Noh, Eun Kyung Kwon, Eujin Choi, Sunju Han, Young Ah Park, Min Jung Kwak, Youngha Kim, Juhee Cho, Dong-Kyu Jin; Epidemiol Health. 2022;44:e2022014. Published online January 10, 2022; DOI: https://doi.org/10.4178/epih.e2022014

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Abstract Summary PDF: Abstract
OBJECTIVES
Hyperphagia is a highly stressful, life-threatening feature of Prader-Willi syndrome (PWS). It is important to assess this complex behavior accurately over time. This study aimed to develop and validate the Pediatric-Youth Hyperphagia Assessment for Prader-Willi syndrome (PYHAP) as a tool targeting children and adolescents.
METHODS
After an extensive literature review and qualitative interviews, the final version of the PYHAP with 14 questions in 3 domains (verbal [5], behavior [4], and social [5]) was developed and tested at Samsung Medical Center in Seoul, Korea from July 2018 to September 2019. Exploratory factor analysis and confirmatory factor analysis (CFA) were performed to confirm construct validity. The correlations between the PYHAP and the Korean Children’s Eating Behavior Questionnaire (K-CEBQ) were calculated to evaluate convergent and discriminant validity. Criterion validity and the validity of the response categories were also tested.
RESULTS
Cronbach’s alpha coefficient of the PYHAP was 0.91. The fit indices for CFA were good (comparative fit index, 0.87; standardized root mean squared residual, 0.08). The domains of the PYHAP were closely correlated with the relevant domains of the K-CEBQ. The accuracy of the PYHAP score for predicting uncontrolled hyperphagia was good (area under the curve, 0.75; 95% confidence interval, 0.65 to 0.85).
CONCLUSIONS
The PYHAP was confirmed to be a reliable and valid tool to evaluate hyperphagia in children and adolescents with PWS via caregivers’ assessments. It is recommended to use the PYHAP to communicate with parents or caregivers about patients’ hyperphagia or to monitor and manage extreme behaviors in children with PWS.; Summary

Korean summary
프래더 윌리 증후군에서 '조절되지 않는 식욕'은 환자의 수명과 삶의 질에 매우 중요한 문제로, 최근 식욕 억제제 개발을 위한 연구가 활발히 이뤄지고 있으나 약제의 유효성을 객관적으로 평가하는 도구는 부족한 상황입니다. 본 연구는 주부양자를 통하여 평가가 가능한 프래더윌리 증후군 소아청소년 환자들의 식욕심각도 평가도구를 개발하였고, 그것의 신뢰성과 타당성을 입증하였습니다.

Key Message
Pediatric-Youth Hyperphagia Assessment for Prader-Willi syndrome (PYHAP) is a reliable and valid tool to evaluate hyperphagia in children and adolescents with PWS via caregivers’ assessments.

Original Articles

Local-level spatiotemporal dynamics of COVID-19 transmission in the Greater Seoul Area, Korea: a view from a Bayesian perspective: Youngbin Lym, Hyobin Lym, Ki-Jung Kim; Epidemiol Health. 2022;44:e2022016. Published online January 13, 2022; DOI: https://doi.org/10.4178/epih.e2022016

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Abstract

OBJECTIVES
The purpose of this study was to enhance the understanding of the local-level spatiotemporal dynamics of COVID-19 transmission in the Greater Seoul Area (GSA), Korea, after its initial outbreak in January 2020.

METHODS

Using the weekly aggregates of coronavirus disease 2019 (COVID-19) cases of 77 municipalities in the GSA, we examined the relative risks of COVID-19 infection across local districts over 50 consecutive weeks in 2020. To this end, we employed a spatiotemporal generalized linear mixed model under the hierarchical Bayesian framework. This allowed us to empirically examine the random effects of spatial alignments, temporal autocorrelation, and spatiotemporal interaction, along with fixed effects. Specifically, we utilized the conditional autoregressive and the weakly informative penalized complexity priors for hyperparameters of the random effects.

RESULTS

Spatiotemporal interaction dominated the overall variability of random influences, followed by spatial correlation, whereas the temporal correlation appeared to be small. Considering these findings, we present dynamic changes in the spread of COVID-19 across local municipalities in the GSA as well as regions at elevated risk for further policy intervention.

CONCLUSIONS

The outcomes of this study can contribute to advancing our understanding of the local-level COVID-19 spread dynamics within densely populated regions in Korea throughout 2020 from a different perspective, and will contribute to the development of regional safety planning against infectious diseases.

Summary

Korean summary
본 논문은 수도권 지역에서 코로나바이러스가 처음 발생한 2020년 1월 이후 12월 말까지 총 50주 동안 수도권 내 지자체 수준에서의 코로나 19 전염병에 대한 시공간적 확산 역동성을 파악하기 위한 연구이다. 데이터 기반의 실증분석을 위한 계층적 베이지언 기법 기반의 시공간 일반화 선형 혼합모형의 결과에 따르면, 확률효과 중 시공간적 상호작용의 영향성이 가장 크게 나타났고, 다음으로는 공간자기상관에 의한 영향 순으로 나타난 반면, 시간에 의한 확률효과는 상대적으로 적게 도출되었다. 연구의 결과를 종합하여, 본 연구에서는 지도 기반의 코로나 19 위험 및 그 위험의 시공간적 변화를 제시하고, 향후 전염병에 대한 정책대응에 활용될 수 있도록 하였다.

Key Message
This study investigates the local-level spatiotemporal dynamics of COVID-19 transmission in the Greater Seoul Area, Korea, after its initial outbreak in January 2020. We adopt a flexible hierarchical Bayesian method so as to account for latent influences of space and time along with the fixed effects by covariates. The results suggest that spatiotemporal interaction dominates the overall variability of random influences, followed by spatial correlation, while the temporal effect appears to be small. Based on these findings, we present maps that depict dynamic changes of COVID-19 infection as well as regions of elevated risks for further policy consideration.

Citations

Citations to this article as recorded by

A Review of Bayesian Spatiotemporal Models in Spatial Epidemiology
Yufeng Wang, Xue Chen, Feng Xue
ISPRS International Journal of Geo-Information.2024; 13(3): 97. CrossRef

Dairy product consumption and type 2 diabetes among Korean adults: a prospective cohort study based on the Health Examinees (HEXA) study: Jiaqi Zhang, Kyungjoon Lim, Sangah Shin; Epidemiol Health. 2022;44:e2022019. Published online February 4, 2022; DOI: https://doi.org/10.4178/epih.e2022019

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
It has been suggested that the consumption of dairy products helps lower the prevalence of type 2 diabetes (T2D). We investigated the association between the consumption of dairy products and T2D events in middle-aged Korean adults.

METHODS

We followed up 53,288 participants (16,895 male and 36,393 female) in the Health Examinees (HEXA) study. The consumption of dairy products was assessed using the self-administered food frequency questionnaire, and T2D was defined according to the 2015 treatment guidelines of the Korean Diabetes Association. Hazard ratios (HRs) and 95% confidence intervals (CIs) between the consumption of dairy products and the risk of T2D were calculated using Cox proportional hazards models after adjusting for potential confounders. Spline regression was used to better represent the association between the consumption of dairy products and the risk of T2D.

RESULTS

Among male, those with higher consumption of dairy products had a significantly lower risk of T2D than those who consumed essentially no dairy products (HR, 0.73; 95% CI, 0.58 to 0.91). In particular, consumption of yogurt (HR, 0.75; 95% CI, 0.60 to 0.93; ptrend=0.035) and cheese (HR, 0.66; 95% CI, 0.49 to 0.89; ptrend=0.005) was negatively associated with the incidence of T2D in male. In female, daily consumption of 1 serving of yogurt decreased the risk of T2D by 11%.

CONCLUSIONS

The association between the consumption of dairy products and the risk of T2D differed by sex and dairy product type. Further prospective studies are needed to confirm these associations.

Summary

Korean summary
본 연구는 한국인유전체역학조사사업의 도시코호트 기반조사와 추적조사에 참여한 40-69세 한국 성인 53 288명의 유제품 섭취와 제2형 당뇨병 발생 위험도를 분석하였다. 요거트와 치즈를 포함한 유제품 섭취가 많을수록 남성의 제2형 당뇨병 위험도가 낮아졌다. 요거트 섭취량을 하루에 한번 증가하면 여성의 제2형 당뇨병 위험도가 감소하다. 유제품 소비와 제2형 당뇨병의 위험도의 연관성은 성별과 유제품에 따라 다르다. 이를 확인하기 위해서는 추가 연구가 필요하다.

Key Message
The study aimed to assess the association between the consumption of dairy products and type 2 diabetes events in Korean adults. Data was from the Health Examinees Study among 53 288 participants. Higher consumption of dairy products including yogurt and cheese was associated with a lower risk of developing type 2 diabetes in men. Increasing yogurt intake by one serving/day reduces the risk of type 2 diabetes in women. The association between the consumption of dairy products and the risk of type 2 diabetes differed by gender and dairy product type. Further studies are needed to confirm this.

Citations

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Cheese consumption and multiple health outcomes: an umbrella review and updated meta-analysis of prospective studies
Mingjie Zhang, Xiaocong Dong, Zihui Huang, Xue Li, Yue Zhao, Yingyao Wang, Huilian Zhu, Aiping Fang, Edward L. Giovannucci
Advances in Nutrition.2023; 14(5): 1170. CrossRef
Effect of Milk and Cultured Milk Products on Type 2 Diabetes: A Global Systematic Review and Meta-analysis of Prospective Cohort Studies
Viswanathan Mohan, Kuzhandhaivelu Abirami, Valangaiman Sriram Manasa, Anandakumar Amutha, Balaji Bhavadharini, Rinky Rajput, Nagarajan Lakshmipriya, Chowdary Sruthi, Ranjit Mohan Anjana, Ranjit Unnikrishnan, Vasudevan Sudha, Kamala Krishnaswamy
Journal of the Indian Institute of Science.2023; 103(1): 167. CrossRef
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A. Nithya, Sourav Misra, Chirasmita Panigrahi, Chandrakant Genu Dalbhagat, Hari Niwas Mishra
Food Chemistry Advances.2023; 3: 100381. CrossRef
Dairy intake and risk of type 2 diabetes: results of a large prospective cohort
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Hyein Jung, Geongu Lee, Kyungjoon Lim, Sangah Shin
Nutrition, Metabolism and Cardiovascular Diseases.2022; 32(11): 2515. CrossRef
Association between dairy consumption and the risk of diabetes: A prospective cohort study from the China Health and Nutrition Survey
Yucheng Yang, Xiaona Na, Yuandi Xi, Menglu Xi, Haibing Yang, Zhihui Li, Ai Zhao
Frontiers in Nutrition.2022;[Epub] CrossRef
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Nutrition, Metabolism and Cardiovascular Diseases.2022; 32(12): 2760. CrossRef

The relationship between poor sleep quality measured by the Pittsburgh Sleep Quality Index and smoking status according to sex and age: an analysis of the 2018 Korean Community Health Survey: Jun Hyun Hwang, Soon-Woo Park; Epidemiol Health. 2022;44:e2022022. Published online February 14, 2022; DOI: https://doi.org/10.4178/epih.e2022022

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Abstract

OBJECTIVES
Multiple studies have found that cigarette smokers are more likely to experience sleep disturbances than non-smokers. This study aimed to examine various associations between smoking and sleep quality according to sex and age, which have yet to be sufficiently examined in prior studies.

METHODS

Data analysis was conducted using a nationally representative sample of 224,986 Korean adults who participated in the 2018 Korea Community Health Survey. Sleep quality, as the dependent variable, was measured using the Pittsburgh Sleep Quality Index (PSQI), with PSQI scores indicating either good (≤4 points) or poor (>5 points) sleep quality. Multiple logistic regression analysis was performed considering socio-demographic factors, health behaviors, comorbidities, and psychological factors as covariates.

RESULTS

The overall weighted prevalence of poor sleep quality was 39.4% (95% confidence interval, 39.1 to 39.7). In the multivariate model that excluded psychological factors, poor sleep quality positively correlated to smoking for both sexes and all age groups except for male aged ≥65 years. However, in the full model that included psychological factors, statistically significant odds ratios (approximately 1.5) for poor sleep quality according to smoking status were only observed for female under 65 years of age.

CONCLUSIONS

The relationship between poor sleep quality and smoking status differed according to sex and age. In order to improve the quality of sleep, it is necessary to intervene smoking cessation along with solving psychological problems, especially female in middle age and younger.

Summary

Korean summary
한국 성인의 39.4%는 수면의 질(피츠버그 수면의 질 지수(PSQI) 기준)이 낮았다. 성별 및 연령에 따라 흡연과 수면의 질 사이의 관련성은 다르게 나타났다. 구체적으로는 65세 이하의 여성에서 흡연은 수면의 질 악화와 관련성이 있었으나, 남성 또는 65세 이상 여성에서는 흡연과 수면의 질 간 유의한 관련성을 보이지 않았다.

Key Message
In order to improve the quality of sleep, it is necessary to intervene smoking cessation along with solving psychological problems, especially female in middle age and younger.

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Nora Alafif
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The Microbiota–Gut–Brain Axis in Metabolic Syndrome and Sleep Disorders: A Systematic Review
Adriano dos Santos, Serena Galiè
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The association between passive smoking and sleep quality in a Chinese hypertensive population: A cross-sectional study
Niuniu Sun+, Yang Ni+, Yuqian Deng, Jiale Qi, Zhenjie Yu, Chang Wu, Juan He, Yibo Wu
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Network analysis of smoking-related sleep characteristics in Chinese adults
Yuting Xie, Peiyuan Sun, Huang Huang, Jianjun Wu, Yue Ba, Guoyu Zhou, Fangfang Yu, Daming Zhang, Yaqun Zhang, Ranran Qie, Zhuolun Hu, Kaiyong Zou, Yawei Zhang
Annals of Medicine.2024;[Epub] CrossRef
The associations between working conditions and subjective sleep quality among female migrant care workers
I-Ming Chen, Tzu-Yun Lin, Yi-Ling Chien, Jennifer Yi-Ying Chen, Jen-Hui Chan, Shih-Cheng Liao, Po-Hsiu Kuo, Hsi-Chung Chen
Frontiers in Public Health.2023;[Epub] CrossRef

Secular trends and related factors in leisure-time sedentary behavior among Koreans: an analysis of data from the 2011-2017 Korea Community Health Survey: Hyun-Ju Seo, Min-Jung Choi, Soon-Ki Ahn; Epidemiol Health. 2022;44:e2022023. Published online February 14, 2022; DOI: https://doi.org/10.4178/epih.e2022023

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Abstract Summary PDF

Abstract

OBJECTIVES
Sedentary behavior has gradually increased and has become a public health problem. Therefore, this study investigated trends in weekday leisure-time sedentary behaviors, as well as characteristic socio-demographic and lifestyle correlates in Korean adults.

METHODS

We analyzed data from 914,946 adults aged ≥19 years who participated in the Korea Community Health Survey (2011, 2013, 2015, and 2017). Leisure-time sedentary behavior was categorized as a binary variable (<4 and ≥4 hr/day). Multivariable regression analysis was used to model the prevalence of sedentary behavior and estimate odds ratios.

RESULTS

The prevalence of leisure-time sedentary behavior decreased from 15.2% to 14.4% in men and from 16.6% to 16.0% in women between 2011 and 2017, respectively. However, a significant increase was observed in subjects with an education lower than high school in both genders (β coefficient=0.12 for men and 0.08 for women, p for trend <0.001). Women in the lowest household income level (β coefficient=0.08, p for trend=0.001) and with poor subjective health status (β coefficient=0.05, p for trend=0.013) showed an increasing trend. Other factors associated with sedentary behavior were age, education level, body mass index, household income, walking activity, perceived stress level, and subjective health status in both genders.

CONCLUSIONS

Identifying the secular trends and correlates of sedentary behavior by gender and associated factors will provide empirical evidence for developing public health campaigns and promotion programs to reduce sedentary behavior in Koreans.

Summary

Korean summary
본 연구는 지역사회건강조사에서 2011년부터 2017년까지 격년으로 수집된 성인의 좌식행동에 대한 시간적 추세와 관련 요인에 대해 분석한 시계열 단면연구이다. 분석결과, 주중 여가시간에 4시간 이상 앉아 있는 경우는 남성의 경우 15.2%에서 14.4%로, 여성의 경우 16.6%에서 16.0%로 감소되었다. 그러나, 남녀 모두에서 노인인 경우, 중졸 이하의 학력을 가진 경우, 소득수준이 월 100만원 미만인 경우, 주관적 건강상태가 부정적인 경우 좌식행동이 증가하였다. 따라서, 본 연구에서 나타난 좌식행동 관련 요인을 가진 대상자를 목표집단으로 한 건강증진 및 공중보건 캠페인이 개발 및 실행될 필요가 있다.

Key Message
This study is a serial cross-sectional study analyzing the temporal trend and related factors of sedentary behavior of adults using KCHS collected biennially from 2011 to 2017. The prevalence of leisure-time sedentary behavior decreased from 15.2% to 14.4% in men and from 16.6% to 16.0% in women, respectively. However, elderly, subjects with an education lower than high school, with the lowest household income level, and with poor subjective health status showed an increasing sedentary behavior trend. These findings suggest that health promotion and public health campaigns are need to reduce the prevalence of sedentary behavior in population with related factors.

Citations

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Association between long working hours and physical inactivity in middle-aged and older adults: a Korean longitudinal study (2006–2020)
Seong-Uk Baek, Won-Tae Lee, Min-Seok Kim, Myeong-Hun Lim, Jin-Ha Yoon, Jong-Uk Won
Journal of Epidemiology and Community Health.2023; 77(6): 355. CrossRef

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