Epidemiology and Health

COVID-19: Special Article

Changes in mental health of Korean adolescents before and during the COVID-19 pandemic: a special report using the Korea Youth Risk Behavior Survey: Bomi Park, Jihee Kim, Jieun Yang, Sunhye Choi, Kyungwon Oh; Epidemiol Health. 2023;45:e2023019. Published online February 14, 2023; DOI: https://doi.org/10.4178/epih.e2023019

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Abstract

OBJECTIVES
We aimed to study the effects of the coronavirus disease 2019 (COVID-19) pandemic on adolescents’ mental health in Korea.

METHODS

We used data from the Korea Youth Risk Behavior Survey 2018-2021 with 227,139 students aged 12-18 years. We estimated the differences in depressive symptoms, suicidal ideation, and stress perception before (2018-2019) and during (2020-2021) the pandemic, as well as before (2019), the first year (2020) of, and the second year (2021) of the pandemic. We also examined whether COVID-19 is statistically associated with mental health.

RESULTS

In both male and female adolescents, the prevalence of depressive symptoms, suicidal ideation, and stress perception was higher in the “not living with family,” “low household economic status,” and “self-rated unhealthy status” subgroups. The prevalence of depressive symptoms and stress perception was higher in middle school students. Adolescents were less likely to experience depressive symptoms (adjusted odds ratio [aOR], 0.86; 95% confidence interval [CI], 0.83 to 0.89), suicidal ideation (aOR, 0.80; 95% CI, 0.76 to 0.83), and stress perception (aOR, 0.76; 95% CI, 0.74 to 0.79) in 2020 than in 2019. However, there were more depressive symptoms (aOR, 1.06; 95% CI, 1.02 to 1.09), suicidal ideation (aOR, 1.15; 95% CI, 1.10 to 1.21), and stress perception (aOR, 1.19; 95% CI, 1.16 to 1.23) in 2021 than in 2020.

CONCLUSIONS

The COVID-19 pandemic had positive impacts on mental health of adolescents in its early stages but has had negative impacts as the pandemic continues. Attention should be paid to adolescents who are particularly vulnerable to the mental health effects of the pandemic.

Summary

Korean summary
The results from a nationally representative data showed that mental health in adolescents was improved in the first year of the COVID-19 pandemic compared to before the COVID-19 pandemic, but it was deteriorated in the second year of the pandemic compared to the first year.

Key Message
본 연구에서는 대규모 건강조사를 이용하여 코로나19가 장기화됨에 따른 영향을 평가하고자 하였다. 2018년-2021년 청소년건강행태조사에 참여한 만 12-18세 청소년 227,139 명을 대상으로 분석한 결과, 코로나19 유행 첫번째 해(2020년)에는 코로나19 유행 이전에 비해 정신건강이 개선되었으나, 코로나19 유행 두 번째 해(2021년)에는 코로나19 유행 첫 번째 해에 비해 청소년 정신건강이 나빠졌다. 또한 가족과 함께 거주하지 않는 경우, 가정 경제 수준이 낮은 경우, 본인이 건강하지 않다고 인지하는 경우에 더 취약하였다.

Citations

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Changes in Mental Health Among Adolescents in South Korea Before and After COVID-19: An Interrupted Time Series Analysis From 2015 to 2022
Yeonjae Kim, Hyewon Park, YooWha Bhan, Donghwan Lee, Chang-Mo Oh, Weon Young Lee, Bomi Park
Journal of Adolescent Health.2024;[Epub] CrossRef
Excess mortality during the Coronavirus disease pandemic in Korea
Changwoo Han, Hoyeon Jang, Juhwan Oh
BMC Public Health.2023;[Epub] CrossRef
A Comparison of Changes in Health Behavior, Obesity, and Mental Health of Korean Adolescents Before and During the COVID-19 Pandemic: Online Cross-Sectional Study
Mi-Sun Lee, Hooyeon Lee
Psychiatry Investigation.2023; 20(11): 1086. CrossRef

COVID-19: Special Article

Changes in health behaviors and obesity of Korean adolescents before and during the COVID-19 pandemic: a special report using the Korea Youth Risk Behavior Survey: Chang-Mo Oh, Yangha Kim, Jieun Yang, Sunhye Choi, Kyungwon Oh; Epidemiol Health. 2023;45:e2023018. Published online February 14, 2023; DOI: https://doi.org/10.4178/epih.e2023018

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aimed to investigate changes in health behaviors, including cigarette smoking, alcohol drinking, physical activity, dietary behaviors, and obesity, before and during the coronavirus disease 2019 (COVID-19) pandemic using the Korea Youth Risk Behavior Survey (KYRBS) database.

METHODS

KYRBS data from 2015 to 2021 were used in this study. Differences in health behaviors between before (pre-pandemic period: 2018-2019) and during (pandemic period: 2020-2021) the pandemic were examined. Differences were compared using linear regression and the chi-square test considering the complex survey design after adjusting for grade level.

RESULTS

The prevalence of current cigarette smoking and current alcohol drinking significantly decreased in both male and female students during the pandemic compared to the pre-pandemic period. However, the prevalence of obesity significantly increased in both male and female students during the same period. When examining physical activity and dietary behaviors closely related to obesity, fast food consumption increased and fruit consumption decreased during the pandemic in both male and female students, whereas no significant changes in physical activity were observed in either male or female students.

CONCLUSIONS

The deterioration of adolescent dietary behaviors and an increase in the prevalence of obesity can increase the future disease burden, and concerted efforts at the individual and national levels are needed to reduce obesity and promote healthy dietary behaviors.

Summary

Korean summary
이 연구는 한국 청소년건강행태조사자료(KYRBS)를 사용하여 코로나19 유행 전후의 우리나라 청소년들의 흡연, 음주, 신체활동, 식습관, 비만 등의 건강행태의 변화에 대하여 살펴보고자 하였다. 이 연구에서는 2015년부터 2021년까지의 청소년건강행태조사자료를 사용하여, 코로나19 유행 이전 (2018-2019년)과 코로나 유행 이후 (2020-2021년) 기간의 건강행태의 변화에 대하여 조사하였다. 학년레벨을 보정한 후, 복합표본설계를 고려하여 로지스틱 회귀분석과 카이제곱검정을 이용하여 코로나19 유행 이전 (2018-2019년)과 비교하여, 코로나 유행 이후 (2020-2021년) 기간의 건강행태의 변화가 있었는지에 대하여 확인하였다. 그 결과, 코로나19 유행 이전 (2018-2019년)과 비교하여, 코로나19 유행 기간(2020-2021년) 동안에 현재흡연율과 현재음주율이 유의하게 감소하였다. 그러나 동일한 기간 동안에 남학생과 여학생 모두에서 비만율이 유의하게 증가하였는데, 비만율과 관련된 신체활동 및 식습관에 대하여 살펴보았을 때, 신체활동에서는 유의한 변화가 없었던 반면, 남학생과 여학생 모두에서 패스트푸드 섭취는 증가하고 과일섭취가 감소한 것으로 나타났다. 따라서 코로나19 유행기간 동안 흡연율 및 음주율 등의 청소년 건강에 유익한 변화도 있었으나, 비만율도 같이 증가한 것을 확인할 수 있었다. 청소년기의 식습관의 악화 및 비만율의 증가는 미래 우리나라의 질병부담을 증가시킬 수 있기 때문에, 청소년의 비만율을 낮추고 건강한 식습관을 증진시키기 위한 개인 및 사회 차원의 노력이 필요하다.

Key Message
-The current cigarette smoking and current alcohol drinking rates significantly decreased among Korean adolescents during the pandemic period compared to the pre-pandemic period. -On the other hand, the obesity rate increased significantly especially among Korean male adolescents, which is accompanied by changes in dietary habits such as an increase in fast food intake and a decrease in fruit intake.

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Effects of changes in daily life attributed to COVID-19 on allergic diseases among Korean adolescents
Miso Park, Mi Ah Han, Jong Park, Seong Woo Choi
Journal of Asthma.2024; : 1. CrossRef
Exploring Disparities for Obesity in Korea Using Hierarchical Age-Period-Cohort Analysis With Cross-Classified Random Effect Models
Chang Kyun Choi, Jung-Ho Yang, Sun-Seog Kweon, Min-Ho Shin
Journal of Korean Medical Science.2024;[Epub] CrossRef
Association of parental depression with adolescent children’s psychological well-being and health behaviors
Sung-In Kim, Sung Min Kim, Sun Jae Park, Jihun Song, Jaewon Lee, Kyae Hyung Kim, Sang Min Park
BMC Public Health.2024;[Epub] CrossRef
A Comparison of Changes in Health Behavior, Obesity, and Mental Health of Korean Adolescents Before and During the COVID-19 Pandemic: Online Cross-Sectional Study
Mi-Sun Lee, Hooyeon Lee
Psychiatry Investigation.2023; 20(11): 1086. CrossRef
Changes in Adolescent Health Behavior and the Exacerbation of Economic Hardship During the COVID-19 Pandemic: A Cross-sectional Study from the Korea Youth Risk Behavior Survey
Chaeeun Kim, Haeun Lee, Kyung-Hee Jung-Choi, Hyesook Park
Journal of Preventive Medicine and Public Health.2023;[Epub] CrossRef

COVID-19: Health Statistics

Changes in food and nutrient intakes in Korean adults before and during the COVID-19 pandemic: data from the 2011-2020 Korea National Health and Nutrition Examination Survey: Kyungwon Oh, Suyeon Park, Sihyun Park, Sungha Yun, Hongseok Choi, Eun Kyeong Jeong; Epidemiol Health. 2023;45:e2023015. Published online February 1, 2023; DOI: https://doi.org/10.4178/epih.e2023015

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study was to examine the changes in dietary habits and food and nutrient intakes between before (2019) and during (2020) the coronavirus disease 2019 (COVID-19) pandemic from the Korea National Health and Nutrition Examination Survey (KNHANES).

METHODS

A total of 54,995 participants aged ≥19 years who participated in the 2011-2020 KNHANES were included. The 10-year trend (2011-2020) and differences between 2019 and 2020 for dietary habits and food and nutrient intakes were estimated using SAS.

RESULTS

In the past 10 years (2011-2020), the dietary habits (increase in skipping meals and eating out), food intake (increase in meats and decrease in fruits and vegetables), and nutrient intake (increase in fat and decrease in sodium) in adults have changed. When comparing between 2019 and 2020, there were 4.6%p decrease in the eating out more than once a day. On the other hand, there were no significant differences in the intakes of food, energy and most of nutrients between 2019 and 2020, except for the proportion of energy intake from fat (1.0%p increase) and carbohydrate (1.0%p decrease).

CONCLUSIONS

Although a change in dietary habits from before to during the COVID-19 pandemic was observed, food and nutrient intakes have not deteriorated markedly and appear similar to the trends in the past 10 years. Throughout the COVID-19 pandemic, it is necessary to monitor the effects of changes in dietary habits on health as well as food and nutrient intakes.

Summary

Korean summary
코로나19 유행 전, 후 비교 시, 외식 감소, 가정식 섭취 증가 등 식생활은 변화가 있었으나 주요 식품 및 영양소 섭취는 큰 변화없이 최근 10년간의 추이가 지속되고 있었다.

Key Message
Although a change in dietary habits from before to during the COVID-19 pandemic was observed, food and nutrient intakes have not deteriorated markedly and appear similar to the trends in the past 10 years in Korean adults.

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Comparative study on the health and dietary habits of Korean male and female adults before and after the coronavirus disease 2019 pandemic: utilizing data from the 8th Korea National Health and Nutrition Examination Survey (2019–2021)
Chaemin Kim, Eunjung Kim
Korean Journal of Community Nutrition.2024; 29(1): 65. CrossRef
Assessing dietary bisphenol A exposure among Koreans: comprehensive database construction and analysis using the Korea National Health and Nutrition Examination Survey
Yoonjoo Lee, Jiyun Baek, Youngjoo Kwon
Food Additives & Contaminants: Part A.2024; 41(8): 1018. CrossRef
Association of dietary habits with general and abdominal obesity in Korean children and adolescents: cluster analysis of nationwide population survey data
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Frontiers in Endocrinology.2024;[Epub] CrossRef

COVID-19: Health Statistics

Changes in the management of hypertension, diabetes mellitus, and hypercholesterolemia in Korean adults before and during the COVID-19 pandemic: data from the 2010-2020 Korea National Health and Nutrition Examination Survey: Yoonjung Kim, Suyeon Park, Kyungwon Oh, Hongseok Choi, Eun Kyeong Jeong; Epidemiol Health. 2023;45:e2023014. Published online February 1, 2023; DOI: https://doi.org/10.4178/epih.e2023014

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aimed to analyze the changes in chronic disease management indicators, including hypertension, diabetes mellitus, and hypercholesteremia, from 2010-2020 and before (2019) and during (2020) the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

This study included 58,504 individuals aged ≥30 years who participated in the Korea National Health and Nutrition Examination Survey 2010-2020. Trends in the prevalence, awareness, treatment, and control of chronic diseases and the difference in those between before and during the COVID-19 pandemic were analyzed using the SAS program PROC SURVEYREG.

RESULTS

From 2010-2020, the awareness, treatment, and control in adults aged ≥30 years for hypertension and hypercholesterolemia continuously improved, whereas no significant change in the management indicators of diabetes mellitus was observed. The prevalence of hypertension, diabetes mellitus, and hypercholesterolemia in men increased from before to during the COVID- 19 pandemic. However, there was no significant change in the management indicators of hypertension and diabetes mellitus in men and women, and the awareness, treatment, and control rates for hypercholesterolemia increased by 5.5%p, 6.9%p, and 4.1%p respectively.

CONCLUSIONS

In 2020, the first year of the COVID-19 pandemic, the prevalence of hypertension, diabetes mellitus, and hypercholesterolemia increased, but the management indicators of the chronic diseases did not significantly deteriorate. Considering the ongoing COVID-19 pandemic, it is necessary to monitor changes in chronic disease management indicators and to develop efficient and accessible chronic disease prevention and management programs.

Summary

Korean summary
국민건강영양조사 자료를 분석한 결과 11년간(2010-2020년) 성인의 고혈압, 고콜레스테롤혈증 인지율, 치료율, 치료자 중 조절률은 개선된 반면 당뇨병은 변화가 없었다. 코로나19 유행 전(2019년)·후(2020년) 비교시 남자에서 고혈압, 당뇨병, 고콜레스테롤혈증 유병률이 증가했다. 그러나 고혈압, 당뇨병 관리지표는 변화가 없었고, 고콜레스테롤혈증 관리지표만 개선되었다.

Key Message
The rates of awareness, treatment, and control in adults aged ≥30 years for hypertension and hypercholesterolemia continuously improved, whereas no significant change in the management indicators of diabetes mellitus was observed over the past 11 years (2010-2020). The prevalence of hypertension, diabetes mellitus, and hypercholesterolemia in men increased from before (2019) to during (2020) the COVID-19 pandemic. However, there was no significant change in the management indicators of hypertension and diabetes mellitus in men and women, and that of hypercholesterolemia improved.

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Jung-Hyun Won, Yesol Hong, Siun Kim, Howard Lee
Frontiers in Public Health.2024;[Epub] CrossRef
Impact of the COVID-19 Pandemic on Obesity, Metabolic Parameters and Clinical Values in the South Korean Adult Population
Anna Kim, Eun-yeob Kim, Jaeyoung Kim
Journal of Clinical Medicine.2024; 13(10): 2814. CrossRef
Effects of the COVID-19 Pandemic on the Medical Use of Elderly Patients with Hypertension: A Nationwide Cohort Study in Korea
Eunbyul Cho, Sujeong Han, Jae-ryun Lee, Hyejin Lee, Bumjo Oh
Korean Journal of Family Medicine.2024; 45(5): 283. CrossRef
Topic Modeling-Based Analysis of News Keywords Related to Patients with Diabetes during the COVID-19 Pandemic
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International Journal of Molecular Sciences.2023; 24(14): 11576. CrossRef

COVID-19: Special Article

Smoking, drinking, and physical activity among Korean adults before and during the COVID-19 pandemic: a special report of the 2020 Korea National Health and Nutrition Examination Survey: Sunhye Choi, Jinwook Bahk, Suyeon Park, Kyungwon Oh, Kyunghee Jung-Choi; Epidemiol Health. 2022;44:e2022043. Published online April 25, 2022; DOI: https://doi.org/10.4178/epih.e2022043

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aimed to describe trends in health behaviours between 2011 and 2020 and compare the changes in these behaviours between the 2020 COVID-19 pandemic and previous periods according to socio-demographic variables.

METHODS

This study used data from the 2011 to 2020 Korea National Health and Nutrition Examination Survey. Current cigarette smoking, high-risk drinking, and inadequate physical activity levels were used as health behaviour indicators. The age-standardized prevalence, differences in prevalence between the periods, and the annual percentage change (APC) were calculated.

RESULTS

Current cigarette smoking showed a decreasing trend (APC, -2.6), high-risk drinking remained unchanged, and inadequate physical activity levels increased (APC, 3.5) during 2011-2020. There were significant differences in high-risk drinking (3.1%p; 95% confidence interval [CI], 0.3 to 5.9) and inadequate physical activity levels (4.3%p; 95% CI, 0.4 to 8.1) between 2019 and 2020 in men. Among men, increased high-risk drinking was found in those aged 40-49 years, non-single households, urban residents, and the middle and highest income groups between 2019 and 2020. The low educational group and manual workers among men aged 30-59 years also showed an increased proportion of high-risk drinking. Inadequate physical activity levels also increased among men between 2019 and 2020 in those aged 30-39 years, non-single households, urban residents, and the upper-middle-income group.

CONCLUSIONS

In the first year of the COVID-19 pandemic, Korean men’s high-risk drinking and inadequate physical activity levels increased. In addition to social efforts to reduce the spread of infectious diseases, active measures to positively change health behaviour are needed.

Summary

Korean summary
코로나 대유행 첫 해인 2020년, 한국 남성에서 고위험음주와 부적절한 신체 활동 수준이 증가하였다. 감염성 질환 대유행 시기, 확산을 차단하기 위한 사회적 노력과 더불어 건강행태에 부정적인 여파가 미치지 않도록 적극적인 대책이 필요함을 시사한다.

Key Message
In the first year of the COVID-19 pandemic, Korean men’s high-risk drinking and inadequate physical activity levels increased. Despite Korea's positive performance in various indicators during the COVID-19 pandemic, the socioeconomic and cultural effects of COVID-19 have affected people's health behaviour. In addition to social efforts to reduce the spread of infectious diseases, active measures to positively change health behaviour are needed.

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Changes in food and nutrient intakes in Korean adults before and during the coronavirus disease 2019 pandemic : data from the 2011-2020 Korea National Health and Nutrition Examination Survey
Kyungwon Oh, Suyeon Park, Sihyun Park, Sungha Yun, Hongseok Choi, Eun Kyeong Jeong
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Changes in the management of hypertension, diabetes mellitus, and hypercholesterolemia in Korean adults before and during the COVID-19 pandemic: data from the 2010-2020 Korea National Health and Nutrition Examination Survey
Yoonjung Kim, Suyeon Park, Kyungwon Oh, Hongseok Choi, Eun Kyeong Jeong
Epidemiology and Health.2023; 45: e2023014. CrossRef
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COVID-19: Special Article

Mental health of Korean adults before and during the COVID-19 pandemic: a special report of the 2020 Korea National Health and Nutrition Examination Survey: Hyunsuk Jeong, Suyeon Park, Jihee Kim, Kyungwon Oh, Hyeon Woo Yim; Epidemiol Health. 2022;44:e2022042. Published online April 25, 2022; DOI: https://doi.org/10.4178/epih.e2022042

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Coronavirus disease 2019 (COVID-19) and the associated social distancing, limited freedom, and fear of an uncertain future are expected to have substantial mental health effects. We investigated mental health responses in the community during the first year of the COVID-19 pandemic in Korea.

METHODS

We used 2016-2019 and 2020 data from the Korea National Health and Nutrition Examination Survey (KNHANES) to assess pre-pandemic and pandemic mental health status, respectively, in terms of perceived severe stress, depression, and suicidal plans. All analyses were gender-stratified. Pre-specified subgroup analyses were performed according to age, employment status, and household income.

RESULTS

The percentage of Korean adults with suicidal plans increased significantly from 1.3%p (95% confidence interval [CI], 1.1 to 1.5) in 2016-2019 to 1.8%p (95% CI, 1.4 to 2.1) in 2020. Individuals in their 20s and 40s showed a marked increase in suicidal plans (1.2%p; 95% CI, 0.0 to 2.3 and 0.9%p; 95% CI, 0.0 to 1.8, respectively). In men, depression and perceived severe stress increased significantly from pre-COVID-19 to 2020. There was a 2.4%p (95% CI, 0.8 to 4.0) increase in depression among standard workers and a 2.9%p increase in depression in individuals in the second-highest quintile of household income from 2016 and 2018 to 2020.

CONCLUSIONS

As COVID-19 continued, mental health issues such as suicidal plans, depression, and severe stress increased significantly in young men and people in the second-highest quintile of household income. Proactive community mental health efforts are needed to prevent increases in the suicide rate resulting from prolonged exposure to the COVID-19 pandemic.

Summary

Korean summary
코로나19 이전에 비해 코로나19 유행 첫 해 동안에 전체 인구에서 자살 계획 유병율이 유의하게 증가하였고 특히 20대-40대에서 증가 비율이 높았다. PHQ-9으로 측정한 우울증 유병율은 전체 남성에서 증가하였고 특히 30대 남성에서 증가 비율이 높았다. 코로나19 영향으로 자살 계획과 우울증과 같은 정신 건강 문제가 젊은 성인에서 크게 증가하였기 때문에 이러한 정신건강 문제가 자살률 증가로 이어지는 것을 방지하기 위해 국가적 차원의 체계적인 정책과 적극적인 지역사회 정신건강 중재가 필요하다.

Key Message
There was a significant increase in the prevalence of suicidal plan in the overall population during the first year of COVID-19 pandemic compared to pre-COVID-19. In particular, suicide plans increased among those in their 20s and 40s. The prevalence of PHQ-9 detected depression increased in all men, especially among men in their 30s. As mental health problems such as suicide planning and depression have significantly increased among young adults due to the impact of COVID-19, systematic policies at the national level and active community mental health interventions are needed to prevent these mental health problems from leading to an increase in suicide rates.

Citations

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COVID-19: Special Article

Obesity, hypertension, diabetes mellitus, and hypercholesterolemia in Korean adults before and during the COVID-19 pandemic: a special report of the 2020 Korea National Health and Nutrition Examination Survey: Ga Bin Lee, Yoonjung Kim, Suyeon Park, Hyeon Chang Kim, Kyungwon Oh; Epidemiol Health. 2022;44:e2022041. Published online April 25, 2022; DOI: https://doi.org/10.4178/epih.e2022041

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We investigated trends in obesity, hypertension, diabetes, and hypercholesterolemia before and during the coronavirus disease 2019 (COVID-19) pandemic in the Korean adult population.

METHODS

Data from 60,098 participants in the Korea National Health and Nutritional Examination Survey between 2011 and 2020 aged ≥19 were used. The age-standardized prevalence and annual percent changes (APCs) were calculated for obesity (body mass index ≥25 kg/m2), hypertension (systolic/diastolic blood pressure ≥140/90 mmHg or under treatment), diabetes (hemoglobin A1c ≥6.5%, fasting glucose ≥126 mg/dL, physician diagnosis, or under treatment), and hypercholesterolemia (total cholesterol ≥240 mg/dL or under treatment).

RESULTS

Over the past decade (2011-2020), the age-standardized APCs (95% confidence intervals) for obesity, hypertension, diabetes and hypercholesterolemia were 3.0% (2.1 to 3.8), 0.1% (-1.3 to 1.5), 1.5% (-1.0 to 4.0) and 8.0% (5.7 to 10.3), respectively, in men; and -0.2% (-1.5 to 1.2), -0.5% (-1.9 to 0.9), -0.1% (-2.3 to 2.2) and 5.9% (3.9 to 8.0), respectively, in women. In 2020 compared to the previous 3 years (2017-2019), obesity, hypertension, diabetes, and hypercholesterolemia increased in men (6.0, 1.8, 1.9, and 2.8%p, respectively), but an increase was not apparent in women (2.5, -1.1, 0.8, and 0.7%p, respectively).

CONCLUSIONS

An increase in major chronic diseases was observed in Korean adults, especially men, during the COVID-19 pandemic. In order to reduce the burden of cardiovascular and metabolic diseases in the future, effective intervention strategies need to be developed according to the characteristics of the target groups.

Summary

Korean summary
한국인의 비만, 고혈압, 당뇨 및 고지혈증 유병률은 지난 10년간 전반적으로 증가하는 경향을 보였다. 특히, 코로나 19가 유행한 2020년에 남성의 주요 만성질환 유병률은 지난 3년 평균치와 비교하였을 때 모두 유의하게 증가하였다. 반면, 여성에서 만성질환 유병률의 뚜렷한 증가는 관찰되지 않았다.

Key Message
During COVID-19 pandemic, the overall increase in major chronic diseases was observed in Korean adults, and this trend was prominent in men. Accordingly, target-specific intervention strategies need to be developed to reduce the burden of cardiovascular and metabolic diseases in the future.

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COVID-19: Original Article

Seroprevalence of SARS-CoV-2 antibodies in the community based on participants in the 2020 Korea National Health and Nutrition Examination Survey: Ah-Ra Kim, Dohsik Minn, Su Hwan Kim, Hyeon Nam Do, Byoungguk Kim, Young Sill Choi, Dong-Hyun Kim, Eun-Jee Oh, Kyungwon Oh, Donghyok Kwon, Jun-Wook Kwon, Sung Soon Kim, June-Woo Lee; Epidemiol Health. 2022;44:e2022028. Published online February 21, 2022; DOI: https://doi.org/10.4178/epih.e2022028

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Abstract Summary PDF

Abstract

OBJECTIVES
The Korea National Health and Nutrition Examination Survey (KNHANES) is a nationwide cross-sectional surveillance system that assesses the health and nutritional status of the Korean population. To evaluate the occurrence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the community, we investigated the prevalence of anti-SARS-CoV-2 antibodies in the sera of KNHANES participants.

METHODS

Subjects were recruited between April 24 and December 12, 2020. In total, 5,284 subjects aged 10-90 years from 17 regions participated. SARS-CoV-2 antibodies were screened using the Elecsys Anti-SARS-CoV-2 assay. Positive samples were verified using 4 different SARS-CoV-2 antibody assays and the plaque reduction neutralizing test. The final seropositivity criteria were a positive screening test and at least 1 positive result from the 5 additional tests.

RESULTS

Almost half (49.2%; 2,600/5,284) of participants were from metropolitan areas, 48.9% were middle-aged (40-69 years), and 20.5% were in their 20s or younger. The seropositivity rate was 0.09% (5/5,284). Three of the 5 antibody-positive subjects had a history of infection, of whom 2 were infected abroad and 1 was infected in a local cluster outbreak.

CONCLUSIONS

The low SARS-CoV-2 antibody seroprevalence in Korea indicates that there have been few coronavirus disease 2019 (COVID-19) cases due to successful COVID-19 management measures (e.g., diagnostic tests for overseas arrivals, national social distancing, and strict quarantine measures). Moreover, asymptomatic infections were uncommon due to active polymerase chain reaction testing. However, hidden infections may exist in the community, requiring the continuation of quarantine and vaccination measures.

Summary

Korean summary
코로나19에 대한 방역대책 및 예방접종 정책 수립을 위한 과학적 근거를 확보하기 위하여 2020년도 국민건강영양조사(이하 국건영) 참여자 5,284명에 대해 코로나19 항체보유율을 조사함. 그 결과 2020년도 국건영 참여자의 항체양성률은 0.09%(5/5,284)였으며, 이중 확진 이력이 있는 사람은 3명이었음. 따라서 지역사회 미진단 감염자는 2명으로 확인됨. 국내 항체보유율은 해외 사례에 비해 낮으며, 이는 적극적인 방역관리에 따른 것으로 사료되며, 지역사회에 미진단 감염자가 존재함이 확인되어 이들에 대한 철저한 관리가 요구됨.

Key Message
The low SARS-CoV-2 antibody seroprevalence in Korea indicates that there have been few COVID-19 cases due to successful management measures, however, hidden infections may exist in the community, requiring the continuation of quarantine and vaccination measures.

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Data Profile

The Korea National Health and Nutrition Examination Survey data linked Cause of Death data: Sungha Yun, Kyungwon Oh; Epidemiol Health. 2022;44:e2022021. Published online February 9, 2022; DOI: https://doi.org/10.4178/epih.e2022021

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Abstract Summary PDF Supplementary Material

Abstract

The Korea National Health and Nutrition Examination Survey (KNHANES) is a national health survey that is conducted annually to assess the health and and health-related behaviors of Korean population. To utilize KNHANES data to studies of mortality risk factors, the Korea Disease Control and Prevention Agency (KDCA) constructed a database linking KNHANES data to cause-of-death statistics in Statistics Korea, made available to researchers since 2020. The KNHANES data were linked to the Cause of Death Statistics based on resident registration numbers for subjects aged 19 years or older who agreed to link the data. The linkage rate between 2007-2015 National Health and Nutrition Examination Survey and 2007-2019 Cause of Death Statistics was 97.1%. In the linked dataset, the total death rate was 6.6%, of which neoplasms accounted for the highest death rate (32.1%), followed by circulatory system disease (22.7%) and respiratory system disease (11.5%). The linked dataset was made available through the Research Data Center of the KDCA after a review of the research proposal, and will be made available after periodical updates.

Summary

Korean summary
1. 국민건강영양조사 자료가 사망 위험요인 규명 연구에 활용되도록 통계청의 사망원인통계와 연계자료 구축함 2. 2007~2015년 국민건강영양조사와 2007~2019년 사망원인통계의 연계율은 97.1%이었음 3. 국민건강영양조사-사망원인통계 연계자료는 2020년부터 연구자에게 질병관리청 내 학술연구자료처리실를 통해 제공되고 있음

Key Message
1. To utilize the Korea National Health and Nutrition Examination Survey (KNHANES) data to studies of mortality risk factors, the data were linked to the Cause of Death Statistics in the Statistics Korea. 2. The linkage rate between the 2007-2015 KNHANES and the 2007-2019 Cause of Death Statistics was 97.1%. 3. The Korea National Health and Nutrition Examination Survey data linked Cause of Death data have been provided to researchers through the Research Data Center in the Korea Disease Control and Prevention Agency (KDCA) since 2020.

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Original Articles

Effects of exposure to ambient air pollution on pulmonary function impairment in Korea: the 2007-2017 Korea National Health and Nutritional Examination Survey: Soo Beom Choi, Sungha Yun, Sun-Ja Kim, Yong Bum Park, Kyungwon Oh; Epidemiol Health. 2021;43:e2021082. Published online October 18, 2021; DOI: https://doi.org/10.4178/epih.e2021082

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aimed to investigate the association between pulmonary function and air pollution using 2007-2017 data from the Korea National Health and Nutrition Examination Survey, a nationwide cross-sectional representative survey.

METHODS

A total of 27,378 participants that had sampling weights from a complex sample survey were included in this study. Using the data for forced expiratory volume in 1 second and forced vital capacity, the participants with pulmonary function impairment were classified according to the criteria of restrictive lung disease and chronic obstructive pulmonary disease (COPD). Exposure to ambient air pollution was estimated using the Community Multiscale Air Quality model. Multivariate linear and logistic regression analyses with complex samples were used to determine the associations between pulmonary function and air pollution after adjusting for covariates.

RESULTS

In total, 13.2% of the participants aged >40 years had COPD, and 10.7% were classified as being in the restrictive lung disease group. According to the multivariate logistic regression model, the odds ratios for the fourth quartiles of particulate matter less than 10 μm in diameter (PM10), particulate matter less than 2.5 μm in diameter (PM2.5) and carbon monoxide (CO) with a 2-year lag period were 1.203 (95% confidence interval [CI], 1.036 to 1.396), 1.283 (95% CI, 1.101 to1.495), and 1.292 (95% CI, 1.110 to 1.504), respectively, using the restrictive lung disease group as an event after adjusting for covariates in the complex sample.

CONCLUSIONS

Long-term exposure to PM10, PM2.5, and CO was significantly associated with pulmonary function, especially restrictive lung disease.

Summary

Korean summary
대기오염이 폐기능에 미치는 영향을 조사하기 위해 2007년부터 2017년까지 국민건강영양조사자료와 대기질 자료를 연계하여 참여자 27,378명의 대기오염 노출량을 추정하여 분석하였다. 나이, 성별, 거주지 동/읍면 구분, 교육수준, 소득수준, 흡연, 비만, 기온, 상대습도 변수들을 보정 후 PM₁₀, PM_2.5, SO2, NO2, CO, O3의 2년평균 노출량을 각각 로지스틱회귀모형으로 분석한 결과 PM₁₀, PM_2.5, CO 와 제한성 환기장애가 연관성을 보였다. 대기오염의 노출은 만성폐쇄성폐질환보다는 제한성 환기장애와 연관이 있었으며 제한성 환기장애는 사망원인과도 연관이 있었다.

Key Message
This study aimed to investigate the association between pulmonary function and air pollution using 2007-2017 data from the Korea National Health and Nutrition Examination Survey. Long-term exposure to PM₁₀, PM_2.5, and CO was significantly associated with pulmonary function, especially restrictive lung disease. Although the COPD criteria do not include the restrictive lung disease group, restrictive lung disease needs to be controlled and managed based on its mortality risk. Reducing air pollution is also necessary to enhance pulmonary function.

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Joint effect of long-term exposure to ambient air pollution on the prevalence of chronic obstructive pulmonary disease using the Korea National Health and Nutrition Examination Survey 2010–2019
Eunjin Kwon, Taiyue Jin, Young-Ah You, Byungmi Kim
Chemosphere.2024; 358: 142137. CrossRef
PM10-bound microplastics and trace metals: A public health insight from the Korean subway and indoor environments
Debananda Roy, Jayun Kim, Minjoo Lee, Seunga Kim, Joonhong Park
Journal of Hazardous Materials.2024; 477: 135156. CrossRef
Association between exposure to ambient particulate matter and high sensitivity C-reactive protein: A nationwide study in South Korea, 2015–2018
Seong-Uk Baek, Jong-Uk Won, Yu-Min Lee, Jin-Ha Yoon
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Airborne Exposure of the Cornea to PM10 Induces Oxidative Stress and Disrupts Nrf2 Mediated Anti-Oxidant Defenses
Mallika Somayajulu, Sharon A. McClellan, Robert Wright, Ahalya Pitchaikannu, Bridget Croniger, Kezhong Zhang, Linda D. Hazlett
International Journal of Molecular Sciences.2023; 24(4): 3911. CrossRef

Trends in the prevalence and management of major metabolic risk factors for chronic disease over 20 years: findings from the 1998-2018 Korea National Health and Nutrition Examination Survey: Yoonjung Kim, Sun Jin Nho, Gyeongji Woo, Hyejin Kim, Suyeon Park, Youngtaek Kim, Ok Park, Kyungwon Oh; Epidemiol Health. 2021;43:e2021028. Published online April 19, 2021; DOI: https://doi.org/10.4178/epih.e2021028

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390 Download
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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We aimed to explore trends in the prevalence and management of obesity, hypertension, diabetes, and hypercholesterolemia in Korean adults from 1998 to 2018 using data from the Korea National Health and Nutrition Examination Survey (KNHANES).

METHODS

The study participants included 79,753 individuals aged ≥ 30 years who had participated in the health examination and health interview of the first (1998) to the seventh (2016-2018) KNHANES. The prevalence and management as well as annual percent change (APC) in chronic diseases were analyzed using SAS and the Joinpoint software program.

RESULTS

The prevalence of obesity in men significantly increased from 26.8% in 1998 to 44.7% in 2018 (APC= 1.9, p< 0.001), whereas that in women decreased slightly from 30.5% in 1998 to 28.3% in 2018 (APC= -0.5, p< 0.001). The prevalence of hypertension in men was 33.2% in 2018, with no significant change, whereas that in women slightly decreased to 23.1% in 2018 (APC= -0.9, p< 0.001). The prevalence of diabetes in men increased slightly from 10.5% in 2005 to 12.9% in 2018 (APC= 1.6, p< 0.001), whereas that in women remained at approximately 8%, with no significant change. The prevalence of hypercholesterolemia in both men and women increased 3-fold in 2018 (20.9% in men [APC = 8.2, p < 0.001] and 21.4% in women [APC= 7.1, p< 0.001]) compared to that in 2005. The awareness rate, treatment rate, and control rate of hypertension and hypercholesterolemia increased 2-3 fold. Regarding diabetes, the treatment rate increased, but the control rate did not change.

CONCLUSIONS

Over the past 20 years, the prevalence of obesity (in men), diabetes, and hypercholesterolemia has increased and management indicators, such as the awareness rate, treatment rate, and control rate of chronic diseases, have improved continuously.

Summary

Korean summary
국민건강영양조사(1998-2018) 자료를 활용하여 우리나라 성인의 비만, 고혈압, 당뇨병, 고콜레스테롤혈증 유병률 및 관리수준을 분석한 결과, 20년 동안 비만(남자), 당뇨병, 고콜레스테롤혈증 만성질환의 유병 수준은 악화되고 있는 반면, 만성질환의 인지율, 치료율, 치료자 중 조절률 등 관리지표는 지속적으로 개선되고 있었다.

Key Message
We examined trends in the prevalence and management of obesity, hypertension, diabetes, and hypercholesterolemia in Korean adults from the 1998-2018 Korea National Health and Nutrition Examination Survey. Over the past 20 years, the prevalence of obesity (in men), diabetes, and hypercholesterolemia has increased and management indicators, such as the awareness rate, treatment rate, and control rate of chronic diseases, have improved continuously.

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Trends in food and nutrient intake over 20 years: findings from the 1998-2018 Korea National Health and Nutrition Examination Survey: Sanghui Kweon, Jin Young Park, Myungsook Park, Yangha Kim, So Yeong Yeon, Leena Yoon, Sungha Yun, Suyeon Park, Ji Eun Yang, Youngtaek Kim, Ok Park, Kyungwon Oh; Epidemiol Health. 2021;43:e2021027. Published online April 19, 2021; DOI: https://doi.org/10.4178/epih.e2021027

13,789 View
384 Download
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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We aimed to examine the current status and trends of food and nutrient intake in the Korean population over the past 20 years using the data from the Korea National Health and Nutrition Examination Survey (KNHANES).

METHODS

We conducted a survey of 116,284 subjects over the age of one year in Korea, who participated in the KNHANES between 1998 and 2018. We collected data on the subjects’ intake for the day before using the 24-hour recall method. The annual percent change (APC) in the food groups and nutrient intake were calculated using SAS and Joinpoint software.

RESULTS

The intake of grains (APC=-0.4, p<0.05) and vegetables (APC=-0.8, p<0.05) was observed to decrease. In contrast, the intake of beverages, meat, dairy, and eggs increased. In particular, beverage intake increased by more than four times (APC=9.2, p<0.05). There was no significant change in energy intake. However, the proportion of energy intake from carbohydrates decreased by approximately 5%p (APC=-0.3, p<0.05), whereas that from fat increased by approximately 5%p (APC= 1.1, p<0.05). Additionally, there were decreases in the proportion of energy intake from breakfast and homemade meals and increases in the energy intake from snacks, dining out, and convenience food. The intake of vitamin C (APC=-3.2, p<0.05) and sodium (APC=-2.3, p<0.05) significantly decreased.

CONCLUSIONS

Over the past 20 years, there has been decreases in the intake of grains, vegetables, carbohydrates, sodium, and vitamin C and increases in the intake of beverages, dairy, meat, eggs, and fat. Since nutritional status is an important factor in the prevention and management of chronic diseases, it should be continuously monitored.

Summary

Korean summary
국민건강영양조사(1998-2018) 자료를 활용하여 우리 국민의 지난 20년간의 식품 및 영양소 섭취 현황 및 추이를 분석한 결과, 곡류, 채소류, 탄수화물, 나트륨, 비타민 C 섭취 감소, 음료류, 우유류, 육류, 난류, 지방 섭취 증가 등 식품 및 영양소 섭취에 변화가 있었다.

Key Message
We examined the current status and trends of food and nutrient intake in the Korean population using the data from the 1998-2018 Korea National Health and Nutrition Examination Survey. Over the past 20 years, there have been decreases in the intake of grains, vegetables, carbohydrates, sodium, and vitamin C and increases in the intake of beverages, dairy, meat, eggs, and fat.

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Trends in health behaviors over 20 years: findings from the 1998-2018 Korea National Health and Nutrition Examination Survey: Soyeon Kim, Sunhye Choi, Jihee Kim, Suyeon Park, Young-Taek Kim, Ok Park, Kyungwon Oh; Epidemiol Health. 2021;43:e2021026. Published online April 19, 2021; DOI: https://doi.org/10.4178/epih.e2021026

14,946 View
366 Download
28 Web of Science
23 Crossref

Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aimed to examine the trends in health behaviors in Korean population using data from the Korea National Health and Nutrition Examination Survey (KNHANES).

METHODS

The subjects were 96,408 adults aged 19 years or older who participated in the first (1998) through seventh (2016-2018) KNHANES health interview. The prevalence of health behaviors (cigarette smoking, alcohol drinking, and physical activity) and annual percent change (APC) were estimated using SAS and the Joinpoint program.

RESULTS

The prevalence of current cigarette smoking in men decreased by 2.8%p (APC= -2.8, p< 0.001) annually over the 20-year period, and the prevalence of exposure to secondhand smoke at home substantially decreased compared to 2005 (APC= -8.8, p< 0.001). Compared to 2005, the prevalence of current alcohol drinking in women, but not men, increased (APC= 2.0, p< 0.001), and the prevalence of binge drinking decreased in men (APC= -0.7, p< 0.001) and increased in women (APC= 2.4, p< 0.001). The prevalence of aerobic physical activity decreased from 2014 in both gendersd (p< 0.001). The prevalence of healthy behaviors practice (non-smoking, alcohol abstinence, and aerobic physical activity) was down-trending (APC= -5.3, p< 0.001), especially among women (APC= -6.4, p< 0.001).

CONCLUSIONS

Over the past 20 years, smoking behaviors improved. However, drinking behavior was unchanged and physical activity indicators markedly decreased. More active programs are necessary for improving health behaviors, which are major risk factors linked to chronic diseases.

Summary

Korean summary
국민건강영양조사(1998-2018) 자료를 활용하여 지난 20년간 성인의 건강행태를 분석한 결과 흡연율과 간접흡연 노출률은 지속적으로 감소하였고, 신체활동 실천율 또한 감소하였다. 월간음주율과 폭음률의 경우 남자는 큰 변화가 없었던 반면 여자는 모두 증가하였다.

Key Message
This study aimed to examine the trends in health behaviors in Korean population using data from the 1998-2018 Korea National Health and Nutrition Examination Survey (KNHANES). Over the past 20 years, the prevalence of cigarette smoking and exposure to secondhand smoke in Korean adults consistently decreased, as well as the prevalence of physical activity. There was no considerable change in men, whereas in women, the prevalence of alcohol drinking and binge drinking both increased.

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Methods

Korea National Health and Nutrition Examination Survey, 20th anniversary: accomplishments and future directions: Kyungwon Oh, Yoonjung Kim, Sanghui Kweon, Soyeon Kim, Sungha Yun, Suyeon Park, Yeon-Kyeng Lee, Youngtaek Kim, Ok Park, Eun Kyeong Jeong; Epidemiol Health. 2021;43:e2021025. Published online April 19, 2021; DOI: https://doi.org/10.4178/epih.e2021025

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Abstract Summary PDF Supplementary Material

Abstract

The Korea National Health and Nutrition Examination Survey (KNHANES) was initiated in 1998 to provide evidence for the development and evaluation of health policies and programs. The Korea Disease Control and Prevention Agency is responsible for the KNHANES and has conducted it as a series of surveys. Over the past 20 years, efforts to produce accurate, timely, and nationwide health statistics have been refined by establishing a continuous annual survey system with full-time field staff, incrementally expanding survey components, collaborating with relevant academic societies for quality control, and revising the survey methods. Additionally, the utility of the collected data was increased by linking the KNHANES data with related data from other government agencies or institutions and making the overall data publicly available on the official website of KNHANES (https://knhanes.kdca.go.kr). Additional long-term plans are being developed, including plans to continue producing nationwide health indicators and invigorating the utilization of the KNHANES data.

Summary

Korean summary
국민건강영양조사는 국민건강증진법제16조에 근거하여 1998년부터 우리 국민의 건강수준, 건강행태, 식품 및 영양소 섭취 실태에 대한 국가단위 통계를 산출하는 조사사업이다. 본 연구에서는 건강지표 생산 확대, 조사 자료 활용도 향상 등 20년간의 성과를 요약하고 사회환경과 조사여건 변화를 반영한 건강통계 생산의 발전 방안을 제시하였다.

Key Message
The Korea National Health and Nutrition Examination Survey (KNHANES) is an ongoing surveillance system that was initiated in 1998 based on Ar¬ticle 16 of the National Health Promotion Act to produce nationwide statistics regarding the health status, health behaviors, and food and nutrient consumption of the Korean population. In this study, the 20-year accomplishments of the KNHANES including vigorous production of health indicators and improvement of data utilization are summarized, and future plans are presented to improve the health statistics to reflect changes in the social and survey environments.

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Data Profile

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

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Abstract Summary PDF Supplementary Material

Abstract

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

Summary

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

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

Citations

Citations to this article as recorded by

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