Epidemiology and Health

Original Articles

Socioeconomic status and adverse pregnancy outcome increase the risk of long-term cardiovascular disease: an analysis using the UK Biobank: Ji Hoi Kim, Un Yung Choi, Jeesun Lee, Manu Shivakumar, Dokyoon Kim, Kue Hyun Kang, So-hee Kim, Haibin Bai, Chan-Wook Park, Joong Shin Park, Juwon Lim, Jeehoon Kang, Soo Heon Kwak, Seung Mi Lee; Epidemiol Health. 2025;47:e2025075. Published online December 25, 2025; DOI: https://doi.org/10.4178/epih.e2025075

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Abstract PDF Supplementary Material: Abstract
OBJECTIVES
Adverse pregnancy outcomes (APOs) and low socioeconomic status (SES) are both associated with an increased long-term risk of atherosclerotic cardiovascular disease (ASCVD). In this analysis, we evaluated whether the association between a history of APO and ASCVD risk varies across different SES groups.
METHODS
We conducted this analysis using data from the UK Biobank, a large prospective cohort including participants aged 40 years to 69 years recruited between 2006 and 2010, with ongoing follow-up. APOs included hypertensive disorders of pregnancy, gestational diabetes mellitus, low birth weight (<2.5 kg), and stillbirth. At enrollment, SES was assessed using the following indicators: household income, education, employment, and Townsend Deprivation Index. The adjusted hazard ratio (aHR) for new-onset ASCVD was analyzed according to history of APO and SES categories.
RESULTS
Among 146,064 women, those with a history of APO had a higher risk of new-onset ASCVD and overall lower SES—including lower income, less education, higher unemployment, and greater deprivation—compared with those without APO (p<0.001). The increased ASCVD risk associated with APO history was significant only in the low SES group (aHR, 1.26; 95% confidence interval [CI], 1.16 to 1.36), but not in the high SES group (aHR, 1.07; 95% CI, 0.74 to 1.55, p=0.716).
CONCLUSIONS
We found that women with low SES were more vulnerable to the adverse effects of APO history, resulting in a greater increase in ASCVD risk. This study highlights the need for SES-tailored preventive policies to reduce long-term cardiovascular disease in women with a history of APO.; Summary

Identifying adverse reactions following COVID-19 vaccination in Korea using data from active surveillance: a text mining approach: Hye Ah Lee, Bomi Park, Chung Ho Kim, Yeonjae Kim, Hyunjin Park, Seunghee Jun, Hyelim Lee, Seunghyun Lewis Kwon, Yesul Heo, Hyungmin Lee, Hyesook Park, COVID-19 Vaccine Safety Research Committee; Epidemiol Health. 2025;47:e2025034. Published online June 30, 2025; DOI: https://doi.org/10.4178/epih.e2025034

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Unstructured text data collected through vaccine safety surveillance systems can identify previously unreported adverse reactions and provide critical information to enhance these systems. This study explored adverse reactions using text data collected through an active surveillance system following coronavirus disease 2019 (COVID-19) vaccination.
METHODS
We performed text mining on 2,608 and 2,054 records from 2 survey seasons (2023-2024 and 2024-2025), in which participants reported health conditions experienced within 7 days of vaccination using free-text responses. Frequency analysis was conducted to identify key terms, followed by subgroup analyses by sex, age, and concomitant influenza vaccination. In addition, semantic network analysis was used to examine terms reported together.
RESULTS
The analysis identified several common (≥1%) adverse events, such as respiratory symptoms, sleep disturbances, lumbago, and indigestion, which had not been frequently noted in prior literature. Moreover, less frequent (≥0.1 to <1.0%) adverse reactions affecting the eyes, ears, and oral cavity were also detected. These adverse reactions did not differ significantly in frequency based on the presence or absence of simultaneous influenza vaccination. Co-occurrence analysis and estimation of correlation coefficients further revealed associations between frequently co-reported symptoms.
CONCLUSIONS
This study utilized text mining to uncover previously unrecognized adverse reactions associated with COVID-19 vaccination, thereby broadening our understanding of the vaccine’s safety profile. The insights obtained may inform future investigations into vaccine-related adverse reactions and improve the processing of text data in surveillance systems.; Summary

Korean summary
* 본 연구는 COVID-19 백신 접종 후 자가 보고된 증상을 텍스트 마이닝으로 분석하여, 이전에 알려지지 않았던 부작용을 확인하였습니다. * 본 연구 결과는 백신 부작용에 대한 이해를 높이고, 향후 연구 및 감시 체계 개선에 중요한 통찰력을 제공합니다.

Key Message
* This study used text mining of self-reported symptoms following COVID-19 vaccination to identify previously unrecognized adverse reactions. * Our findings enhance the understanding of vaccine side effects and provide valuable insights for future research and surveillance system improvement.

Prospective association between handgrip strength in childhood and the metabolic syndrome score and insulin resistance indices in adolescence: an analysis based on the Ewha Birth and Growth Study: Seunghee Jun, Hyunjin Park, Hyelim Lee, Hye Ah Lee, Young Sun Hong, Hyesook Park; Epidemiol Health. 2025;47:e2025001. Published online January 2, 2025; DOI: https://doi.org/10.4178/epih.e2025001

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Low handgrip strength (HGS) in children and adolescents might be associated with the risk of metabolic syndrome (MetS) and insulin resistance. This study prospectively evaluated the association between HGS in childhood and MetS in adolescence.
METHODS
Based on data from the Ewha Birth and Growth Study, this study analyzed HGS at ages 7 to 9 and metabolic indices at ages 13 to 15. In total, 219 participants were analyzed. The risk of MetS was evaluated using the continuous metabolic syndrome score (cMetS), and insulin resistance was assessed using fasting blood insulin and homeostasis model assessment of insulin resistance (HOMA-IR). Relative HGS in childhood was determined by dividing HGS by body weight and categorized as sex-specific quartiles.
RESULTS
This study found an inverse association between relative HGS levels in childhood and MetS and insulin resistance in adolescence. For each 1-group increase in relative HGS quartiles, cMetS (standarard [Std] β=-0.64, p<0.01), HOMA-IR (Std β=-0.21, p<0.01), and fasting blood insulin (Std β=-0.21, p<0.01) all decreased on average. These associations remained significant even after adjusting for confounding factors.
CONCLUSIONS
Our study showed a prospective association between HGS in childhood and the risk of MetS and insulin resistance in adolescence. It provides significant epidemiological evidence, emphasizing the importance of efforts to increase muscle strength from a young age to mitigate the risk of MetS and insulin resistance in adolescence.; Summary

Korean summary
본 연구는 소아기 악력 수준이 청소년기의 대사증후군 및 인슐린 저항성과 연관이 있음을 발견했음. 이러한 결과는 소아기 근력 향상이 향후 대사 위험을 완화하는데 중요함을 강조함.

Key Message
This study found that higher childhood relative handgrip strength was inversely associated with metabolic syndrome and insulin resistance in adolescence. The findings emphasize the importance of enhancing muscle strength early in life to mitigate metabolic risks.

Systematic Review

Handgrip strength thresholds associated with metabolic syndrome risk in children and adolescents: a systematic review and meta-analysis: Hye Ah Lee, Seunghee Jun, Hyesook Park; Epidemiol Health. 2024;46:e2024047. Published online April 24, 2024; DOI: https://doi.org/10.4178/epih.e2024047

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3 Crossref

Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Certain studies have reported that handgrip strength (HGS) is associated with metabolic health risks in children and adolescents, and some studies have suggested HGS thresholds for identifying poor metabolic health. Therefore, we aimed to determine the HGS thresholds associated with metabolic syndrome (MetS) in children and adolescents through a systematic review.

METHODS

We searched 3 electronic databases from their inception until October 2023 to identify original papers that focused on children and adolescents and assessed their risks of MetS according to specific HGS values. Studies were selected for inclusion through a planned screening process based on specific criteria. The Quality Assessment Tool for Diagnostic Accuracy Studies version 2 (QUADAS-2) was used to evaluate quality, and a meta-analysis was performed using the diagmeta R package to suggest the optimal thresholds.

RESULTS

From the search, 8 studies were selected for this systematic review. For detecting MetS risk, the optimal threshold for HGS (defined as relative HGS by adjusting for body mass) was found to be 0.422, with a sensitivity of 76.7% (95% confidence interval [CI], 64.0 to 85.8) and a specificity of 62.9% (95% CI, 56.9 to 68.5). The stratification analysis by sex resulted in optimal thresholds of 0.416 for boys and 0.376 for girls. Additionally, when the data were stratified by age, the thresholds were 0.356 for children and 0.416 for adolescents.

CONCLUSIONS

Our results provide practical information for detecting high-risk groups and encouraging strength-related activities that may reduce the risk of MetS in children and adolescents.

Summary

Korean summary
- 본 연구는 체계적 고찰 및 메타 분석을 수행하여 아동 및 청소년의 대사 증후군(MetS) 위험을 감지하기 위한 최적의 악력 임계값을 제안했습니다. - 본 연구 결과는 아동 및 청소년의 대사 증후군(MetS) 위험을 줄이기 위해 근력 관련 활동이 필요한 고위험군을 식별하는 데 사용할 수 있으므로 1차 임상 및 공공 의료에 실용적인 정보를 제공합니다.

Key Message
- This study conducted a systematic review and meta-analysis to propose the optimal handgrip strength (HGS) threshold for detecting the risk of metabolic syndrome in children and adolescents. - The results provide practical information for primary clinical and public healthcare, as they can be used to identify high-risk groups in need of strength-related interventions to reduce the risk of metabolic syndrome in children and adolescents.

Citations

Citations to this article as recorded by

Handgrip Strength Thresholds to Detect Cardiometabolic Risk in Youth: Cross‐Sectional Study and Meta‐Analysis
Antonio García‐Hermoso, Rodrigo Yáñez‐Sepúlveda, Ignacio Hormazábal‐Aguayo, Jacinto Muñoz‐Pardeza, Vicente Martínez‐Vizcaíno, Juan Hurtado‐Almonacid, Yasmin Ezzatvar
Journal of Cachexia, Sarcopenia and Muscle.2025;[Epub] CrossRef
Disability-Related Disparities in Preventive Healthcare Access in South Korea: Insights From National Health Insurance Data
Sujin Kim, Boyoung Jeon
International Journal of Public Health.2025;[Epub] CrossRef
Trends and distributional characteristics in handgrip strength of 1,082,296 children and adolescents in China: an analysis from five representative cross-sectional surveys from 2000 to 2019
Ziteng Li, Chengyue Li
BMC Public Health.2025;[Epub] CrossRef

Special Article

Cancer risk based on alcohol consumption levels: a comprehensive systematic review and meta-analysis: Seunghee Jun, Hyunjin Park, Ui-Jeong Kim, Eun Jeong Choi, Hye Ah Lee, Bomi Park, Soon Young Lee, Sun Ha Jee, Hyesook Park; Epidemiol Health. 2023;45:e2023092. Published online October 16, 2023; DOI: https://doi.org/10.4178/epih.e2023092

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1,158 Download
44 Web of Science
57 Crossref

Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Alcohol consumption is a well-established risk factor for cancer. Despite extensive research into the relationship between alcohol consumption and cancer risk, the effect of light alcohol consumption on cancer risk remains a topic of debate. To contribute to this discourse, we conducted a comprehensive systematic review and meta-analysis.

METHODS

Our systematic review aimed to investigate the associations between different levels of alcohol consumption and the risk of several cancer types. We focused on analyzing prospective associations using data from 139 cohort studies. Among them, 106 studies were included in the meta-analysis after a quantitative synthesis.

RESULTS

Our analysis did not find a significant association between light alcohol consumption and all-cause cancer risk (relative risk, 1.02; 95% confidence interval, 0.99 to 1.04), but we observed a dose-response relationship. Light alcohol consumption was significantly associated with higher risks of esophageal, colorectal, and breast cancers. Light to moderate drinking was associated with elevated risks of esophageal, colorectal, laryngeal, and breast cancers. Heavy drinking was also found to contribute to the risk of stomach, liver, pancreas, and prostate cancers, thereby increasing the risk of almost all types of cancer. Additionally, females generally had lower cancer risks compared to males.

CONCLUSIONS

Our findings highlight that cancer risks extend beyond heavy alcohol consumption to include light alcohol consumption as well. These findings suggest that there is no safe level of alcohol consumption associated with cancer risk. Our results underscore the importance of public health interventions addressing alcohol consumption to mitigate cancer risks.

Summary

Korean summary
본 연구는 코호트 연구를 기반으로 하여 음주의 수준에 따른 암 위험 연관성에 대해 체계적 문헌고찰(139편)과 메타분석(106편)을 수행하였다. 연구 결과, 음주와 암 위험 사이에 용량-반응 관계가 나타났으며, 소량의 음주는 암 유형에 따라 차이가 있었으나, 식도암, 대장암, 전립선암(남성), 유방암(여성)에서 암 위험과의 연관성이 있음을 발견했다. 따라서, 암 위험 측면에서 음주에 안전한 수준이 없음을 시사하며, 음주와 관련된 잠재적 피해를 완화하기 위해서는 음주 지침 강화와 같은 공중보건개입이 필요하다.

Key Message
The aim of this study was to assess the relationship between different levels of alcohol consumption and the risk of various cancer types through a systematic review and meta-analysis, providing insights into the ongoing debate about alcohol consumption and cancer causality. The findings support a dose-response relationship between alcohol consumption levels and cancer risk and the light alcohol consumption was associated with risks of esophageal, colorectal, prostate (male), and breast (female) cancer. These results emphasize the absence of a safe threshold for alcohol consumption in terms of cancer risk.

Citations

Citations to this article as recorded by

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COVID-19: Original Article

Changes in eating behaviors according to household income in adolescents during the COVID-19 pandemic: findings from the Korea National Health and Nutrition Examination Survey: Hye Ah Lee, Ho Jung Lee, Bomi Park, Yoonhee Shin, Hyunjin Park, Hyesook Park; Epidemiol Health. 2022;44:e2022102. Published online November 9, 2022; DOI: https://doi.org/10.4178/epih.e2022102

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
To assess social inequalities in changes in dietary behaviors among adolescents during the coronavirus disease 2019 (COVID-19) pandemic, we compared changes in dietary behavior indicators by household income.

METHODS

Using cross-sectional data from the 2019 and 2020 Korea National Health and Nutrition Examination Survey, the prevalence of dietary behaviors in adolescents (12-18 years old) was estimated and changes in dietary behaviors during the COVID-19 pandemic were evaluated. We assessed changes in dietary behaviors with a household income (as a measure of socioeconomic status, SES) disparity.

RESULTS

During the COVID-19 pandemic, the average consumption of vegetables decreased and food insecurity worsened. Adolescents were more likely to skip breakfast than before COVID-19 (33.1 and 37.4%). Soft drink consumption also increased in 2020 from 2019 (7.6 and 14.8%), especially among boys. Average sugar intake and sodium intake showed a tendency to decrease only in girls, but there was no significant difference according to SES level. Skipping breakfast was particularly evident in the low-SES group, and the difference according to household income level (high vs. low) was greater during COVID-19 than before. The prevalence of soft drink consumption increased significantly in the low-SES group, but the rate of increase did not differ by SES level.

CONCLUSIONS

We found that the social disparity in skipping breakfast was further aggravated during the COVID-19 pandemic. To reach a better understanding of the dietary behaviors of adolescents, continuous monitoring is necessary.

Summary

Korean summary
국민건강영양조사 자료를 활용하여, COVID-19 팬데믹 전후 청소년의 식생활 변화 및 가구소득 수준에 따른 차이를 평가하였다. 대체로, 평균 채소 섭취량은 감소하고 탄산음료 소비는 증가한 것으로 나타났으며, 아침식사 결식율도 약간 증가한 것으로 나타났다. 게다가, 가구소득 수준에 따라 평가하였을 때, 아침식사 결식율 증가는 가구소득이 높은 군에 비해 가구소득 수준이 낮은 군에서 두드러진 것으로 나타났다. COVID-19 팬데믹이 장기화됨에 따라, 청소년의 식생활 변화에 대해서는 지속적인 모니터링이 필요하다.

Key Message
Using data from the 2019 and 2020 Korea National Health and Nutrition Examination Survey, changes in dietary behaviors of adolescents (12-18 years old) during the COVID-19 pandemic were evaluated. During the COVID-19 pandemic, average consumption of vegetables decreased and consumption of soft drinks increased in 2020 from 2019 (7.6% and 14.8%). In addition, the social disparity in skipping breakfast among adolescents was further aggravated. To reach a better understanding of the dietary behaviors of adolescents, continuous monitoring is necessary.

Citations

Citations to this article as recorded by

Dietary Changes of Youth during the COVID-19 Pandemic: A Systematic Review
Nicolas Woods, Jamie A Seabrook, Holly Schaafsma, Shauna Burke, Trish Tucker, Jason Gilliland
The Journal of Nutrition.2024; 154(4): 1376. CrossRef
Perceived Familial Financial Insecurity and Obesity Among Korean Adolescents During the COVID-19 Pandemic
Fumie Kaneko, Eunji Kim, Hokyou Lee, Kokoro Shirai, Ryo Kawasaki, Hyeon Chang Kim
Journal of Epidemiology.2024; 34(12): 587. CrossRef
Intake of energy and macronutrients according to household income among elementary, middle, and high school students before and during the COVID-19 pandemic: a cross-sectional study
Chae-Eun Jeong, Heejin Lee, Jung Eun Lee
Korean Journal of Community Nutrition.2024; 29(3): 234. CrossRef
Analysis of health behavior, mental health, and nutritional status among Korean adolescents before and after COVID-19 outbreak: based on the 2019–2020 Korea National Health and Nutrition Examination Survey
Misun Lee, Sarang Jeong, Chong-Su Kim, Yoon Jung Yang
Journal of Nutrition and Health.2023; 56(6): 667. CrossRef

Original Articles

Multimorbidity adjusted years lost to disability rates calculated through Monte-Carlo simulation in Korea: Yoonhee Shin, Eun Jeong Choi, Bomi Park, Hye Ah Lee, Eun-Kyung Lee, Hyesook Park; Epidemiol Health. 2022;44:e2022090. Published online October 17, 2022; DOI: https://doi.org/10.4178/epih.e2022090

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
To efficiently utilize limited health and medical resources, it is necessary to accurately measure the level of health, which requires estimating the multimorbidity-corrected burden of disease.
METHODS
This study used 2015 and 2016 data from the National Health Insurance Service, and employed the list of diseases defined in a Korean study of the burden of disease, the criteria for prevalence, and the “cause–sequelae–health state” disease system. When calculating the years lost to disability (YLD), multimorbidity was corrected using Monte-Carlo simulation.
RESULTS
Correcting for multimorbidity changed YLD at all ages in Korea by -1.2% (95% confidence interval [CI], -24.1 to 3.6) in males and -12.4% (95% CI, -23.0 to 0.3) in females in 2015, and by -10.8% (95% CI, -24.1 to 4.6) in males and -11.1% (95% CI, -22.8 to 1.7) in females in 2016. The YLD rate for non-communicable diseases in males decreased more than that of other disease groups in both years, by -11.8% (95% CI, -19.5 to 3.6) and -11.5% (95% CI, -19.3 to -3.0), respectively. The overall YLD rate changed by -1.3% in the 5-year to 9-year age group, and the magnitude of this change remained similar until the 10-19-year age group, gradually decreased after 20 years of age, and steeply increased to more than 10% in those aged 60 and older.
CONCLUSIONS
Calculations of YLD should adjust for multimorbidity, as the disease burden can otherwise be overestimated for the elderly, who tend to exhibit a high prevalence of multimorbidity.; Summary

Korean summary
복합질환 유병률이 증가됨에 따라 인구의 건강수준 측정 시 복합질환을 고려하는 것은 중요하다. 이에 본 연구에서는 복합질환 유병상태를 고려한 YLD(장애로 인한 손실년수)를 산출하고, 복합질환 유병상태를 고려하지 않고 산출한 YLD값과 비교하여 질병부담 산출 시 복합질환 유병상태를 보정하는 것의 효과 크기를 추정하였다. 복합질환의 유병률이 높은 노령층에서 복합질환을 고려하지 않고 YLD를 계산 할 경우 질병부담이 과대 추정될 수 있어, 복합질환을 보정하여 YLD를 산출하는 것이 필요하다.

Key Message
For the elderly whose disease burden can be overestimated, the multimorbidity should be adjusted during YLD calculations.

Employment status and mortality among Korean men over a 13-year period: Dohee Lim, Kyoung Ae Kong, Hyesook Park, Kyunghee Jung-Choi; Epidemiol Health. 2021;43:e2021055. Published online August 18, 2021; DOI: https://doi.org/10.4178/epih.e2021055

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study explored the effect of employment status on mortality over a 13-year period in Korean men.

METHODS

Data were used from the Korean Labor and Income Panel Study from 1999 to 2012. This study started with 2,737 subjects and included employed men in good health, aged 30-69 years. Deaths were tracked for 13 years from 2000 to 2012. Employment status classifications were: (1) regular employees, (2) precarious employees, (3) petty bourgeoisie, and (4) employers. Hazard ratios (HRs) were calculated using a Cox proportional hazards model, and were adjusted for age, education, income, and occupation, with regular employees as the reference category. To examine the effect of employment status and include employment history, the risk ratios of mortality were measured using the Poisson regression model, considering the duration of each employment and using 0 years as the reference category.

RESULTS

Over the course of the 13-year study, being a precarious employee (HR, 1.84) or petty bourgeoisie (HR, 1.87) at a particular point in time had a negative effect on mortality when compared with regular employees. Furthermore, working as precarious employees or petty bourgeoisie had no positive effect on mortality. A positive effect was observed, however, on the overall mortality risk for regular employees.

CONCLUSIONS

These results suggest that a healthy social policy is needed for precarious employees and petty bourgeoisie to avoid disadvantages in the workplace and the social safety net.

Summary

Korean summary
13년간 추적한 결과, 비정규직 노동자와 고용원이 없는 자영업자가 정규직 노동자에 비해 사망위험이 유의하게 높았다. 정규직 노동자에서는 일하는 것이 사망위험을 낮추는 긍정적인 효과를 관찰할 수 있었으나, 비정규직 노동자나 고용원이 없는 자영업자에서는 일하는 것의 긍정적인 효과를 관찰할 수 없었다. 이는 비정규직 노동자와 고용원이 없는 자영업자에 대한 건강한 사회 정책이 필요함을 시사한다.

Key Message
Over the course of the 13-year study, being a precarious employee or petty bourgeoisie had a negative effect on mortality when compared with regular employees. No positive effect of working was found for precarious employees or petty bourgeoisie, whereas cumulative work as a regular employee was observed to have a positive effect on mortality. These results suggest that a healthy social policy is needed for precarious employees and petty bourgeoisie to avoid disadvantages in the workplace and the social safety net.

Citations

Citations to this article as recorded by

Temporary Employment Is Associated with Poor Dietary Quality in Middle-Aged Workers in Korea: A Nationwide Study Based on the Korean Healthy Eating Index, 2013–2021
Seong-Uk Baek, Myeong-Hun Lim, Yu-Min Lee, Jong-Uk Won, Jin-Ha Yoon
Nutrients.2024; 16(10): 1482. CrossRef
Inequality in Mortality and Cardiovascular Risk Among Young, Low-Income, Self-Employed Workers: Nationwide Retrospective Cohort Study
Byungyoon Yun, Heejoo Park, Jaesung Choi, Juyeon Oh, Juho Sim, Yangwook Kim, Jongmin Lee, Jin-Ha Yoon
JMIR Public Health and Surveillance.2024; 10: e48047. 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

29,380 View
425 Download
28 Web of Science
27 Crossref

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

28,207 View
452 Download
30 Web of Science
37 Crossref

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.

Citations

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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

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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

55,519 View
760 Download
217 Web of Science
237 Crossref

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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Nutrients.2026; 18(2): 360. CrossRef
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Nutrition Research.2026; 149: 13. CrossRef
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The Journal of Nutrition.2026; 156(5): 101459. CrossRef
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Epidemiology and Health.2026; 48: e2026001. CrossRef
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Preventive Medicine Reports.2026; 65: 103445. CrossRef
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Diabetes & Metabolism Journal.2026; 50(2): 255. CrossRef
Diabetes Fact Sheet 2025: Comparative Epidemiology and Clinical Features of Obese and Non-Obese Diabetes in Korea
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Diabetes & Metabolism Journal.2026; 50(2): 267. CrossRef
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Frontiers in Public Health.2025;[Epub] CrossRef
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The Journal of Clinical Endocrinology & Metabolism.2025; 110(3): e717. CrossRef
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Exposure and Health.2025; 17(1): 153. CrossRef
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Thomas Kocher, Peter Meisel, Sebastian Baumeister, Birte Holtfreter
Periodontology 2000.2025; 98(1): 65. CrossRef
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Kayoung Lee
Maturitas.2025; 191: 108147. CrossRef
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Byungmi Kim, Yejin Ha, Juyeon Hwang, Hyun-Jin Kim
Chemosphere.2025; 370: 144002. CrossRef
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Sleep and Breathing.2025;[Epub] CrossRef
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Environment International.2025; 195: 109190. CrossRef
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International Journal of Older People Nursing.2025;[Epub] CrossRef
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Donghee Kim, Won Kim, Aijaz Ahmed
Clinical and Molecular Hepatology.2025; 31(1): e5. CrossRef
Diabetes Fact Sheets in Korea 2024
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Diabetes & Metabolism Journal.2025; 49(1): 24. CrossRef
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Journal of Korean Medical Science.2025;[Epub] CrossRef
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Biomedicines.2025; 13(2): 336. CrossRef
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Annals of Epidemiology.2025; 103: 1. CrossRef
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Clinical Hypertension.2025;[Epub] CrossRef
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Nutrition Journal.2025;[Epub] CrossRef
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Social Science & Medicine.2025; 373: 117972. CrossRef
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Diabetes & Metabolism Journal.2025; 49(2): 172. CrossRef
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Asia-Pacific Journal of Oncology Nursing.2025; 12: 100684. CrossRef
Life’s Essential 8 and All-Cause and Cardiovascular Disease Mortality Among Korean Adults
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Circulation Journal.2025; 89(8): 1238. CrossRef
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Journal of Public Health.2025; 47(3): 610. CrossRef
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The Journal of Nutrition.2025; 155(10): 3517. CrossRef
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CardioMetabolic Syndrome Journal.2025; 5(2): 87. CrossRef
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Nutrients.2025; 17(14): 2372. CrossRef
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Journal of Psychosomatic Research.2025; 196: 112340. CrossRef
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Journal of Lipid and Atherosclerosis.2025; 14(3): 298. CrossRef
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Nutrients.2025; 17(15): 2411. CrossRef
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Diseases.2025; 13(8): 239. CrossRef
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BMC Public Health.2025;[Epub] CrossRef
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Journal of Clinical Medicine.2025; 14(16): 5835. CrossRef
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The Korean Journal of Internal Medicine.2025; 40(6): 1017. CrossRef
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Scientific Reports.2025;[Epub] CrossRef
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American Journal of Epidemiology.2025; 194(12): 3520. CrossRef
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Clinical Nutrition Research.2025; 14(4): 284. CrossRef
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British Journal of Nutrition.2024; 131(5): 894. CrossRef
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Preventive Medicine.2024; 180: 107849. CrossRef
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Preventive Medicine.2024; 180: 107890. CrossRef
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PLOS ONE.2024; 19(3): e0300295. CrossRef
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Journal of Affective Disorders.2024; 350: 544. CrossRef
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Clinical Hypertension.2024;[Epub] CrossRef
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Nutrients.2024; 16(5): 724. CrossRef
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Journal of the American Heart Association.2024;[Epub] CrossRef
The Phenomenon, Influence and Coping Strategies of Overweight and Obesity in the Elderly
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Four modeling approaches to study restrictions on everyday life and social activities due to chronic diseases with consequences of suicidal behavior
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Model-Based Economic Evaluations of Interventions for Dementia: An Updated Systematic Review and Quality Assessment
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Temporary Employment Is Associated with Poor Dietary Quality in Middle-Aged Workers in Korea: A Nationwide Study Based on the Korean Healthy Eating Index, 2013–2021
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Exploring Disparities for Obesity in Korea Using Hierarchical Age-Period-Cohort Analysis With Cross-Classified Random Effect Models
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Tuberculosis and Respiratory Diseases.2024; 87(3): 357. CrossRef
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Sex differences in the association between social jetlag and hazardous alcohol consumption in Korean workers: A nationwide cross-sectional study
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Sleep Medicine.2024; 119: 549. CrossRef
Association between Dietary Quality and Non-Alcoholic Fatty Liver Disease in Korean Adults: A Nationwide, Population-Based Study Using the Korean Healthy Eating Index (2013–2021)
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Nutrients.2024; 16(10): 1516. CrossRef
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The mediating role of sugar and lipid metabolism and systemic inflammation in the association between breakfast skipping and periodontitis: A population‐based study
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Nationwide Prevalence of Video Head Impulse Test Abnormality and its Risk Factors in South Korea
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Otolaryngology–Head and Neck Surgery.2024; 171(4): 1172. CrossRef
Milk Consumption and Its Association with Dental Caries: Gender-Specific Insights from the Korea National Health and Nutrition Examination Survey (2013–2015)
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Lifestyle Behaviors in Patients With Gastric Cancer: Continuous Need for Alcohol Abstinence and Muscle Strength Training Education
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Enhancing Familial Hypercholesterolemia Detection in South Korea: A Targeted Screening Approach Integrating National Program and Genetic Cascade Screening
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Exploring the impact of age and socioeconomic factors on health-related unemployment using propensity score matching: results from Korea National Health and Nutrition Examination Survey (2015–2017)
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Impact of Education as a Social Determinant on the Risk of Type 2 Diabetes Mellitus in Korean Adults
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Healthcare.2024; 12(14): 1446. CrossRef
Estimated GFR in the Korean and US Asian Populations Using the 2021 Creatinine-Based GFR Estimating Equation Without Race
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Kidney Medicine.2024; 6(10): 100890. CrossRef
Long working hours and preventive oral health behaviors: a nationwide study in Korea (2007–2021)
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Experimental and Clinical Transplantation.2024;[Epub] CrossRef
Efficacy of Daily Walking as a Potential Predictor of Improved Health-Related Quality of Life in Patients with Type 2 Diabetes in Korea
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Healthcare.2024; 12(16): 1644. CrossRef
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A national cross-sectional study on breakfast skipping-related factors and comparison of nutritional status according to breakfast skipping in older adults based on the 8th Korea National Health and Nutrition Examination Survey (KNHANES, 2020)
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Health-Related Quality of Life and Associated Comorbidities in Community-Dwelling Women with Breast Cancer
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Korean Journal of Clinical Laboratory Science.2024; 56(3): 248. CrossRef
Association between exposure to ambient particulate matter and high sensitivity C-reactive protein: A nationwide study in South Korea, 2015–2018
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Sex-Specific Trends in the Prevalence of Osteoarthritis and Rheumatoid Arthritis From 2005 to 2021 in South Korea: Nationwide Cross-Sectional Study
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Hazardous alcohol use is associated with food insecurity in adults living alone: Findings from a nationwide study in Korea
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Social Science & Medicine.2024; 362: 117468. CrossRef
Association Between Frequency of Away-From-Home Meals and Prevalence of Inflammatory Sinonasal Diseases: A Population-Based Cross-Sectional Study
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Cardiovascular Disease & Diabetes Statistics in Korea: Nationwide Data 2010 to 2019
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Development and validation of the Health Literacy Index for the Community for the Korean National Health and Nutrition and Examination Survey
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Association between Obstructive Sleep Apnea and Chronic Kidney Disease According to Sex, Long Working Hours: The Korean National Health and Nutrition Examination Survey (2019–2020)
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Impact of the COVID-19 Pandemic on Gender Differences in Depression Based on National Representative Data
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Identifying the Group Vulnerable to Unmet Medical Needs Due to Food Security: According to Children in the Household
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Healthcare.2023; 11(3): 423. CrossRef
Food Insecurity Is Associated with Dietary Consumption during the COVID-19 Pandemic: Data from the Korea National Health and Nutrition Examination Survey 2019–2020
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Nutrients.2023; 15(3): 772. CrossRef
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Obesity Research & Clinical Practice.2023; 17(2): 116. CrossRef
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Archives of Gerontology and Geriatrics.2023; 110: 104987. CrossRef
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Sleep and Breathing.2023; 27(6): 2199. CrossRef
Self-Reported Reasons for Activity Limitations According to Age and Sex in Community-Dwelling Stroke Survivors
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Healthcare.2023; 11(10): 1420. CrossRef
Relationships of neck circumference and abdominal obesity with insulin resistance considering relative handgrip strength in middle-aged and older individuals
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Archives of Gerontology and Geriatrics.2023; 114: 105097. CrossRef
Temporal Trends of the Prevalence of Abdominal Obesity and Metabolic Syndrome in Korean Children and Adolescents between 2007 and 2020
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Journal of Obesity & Metabolic Syndrome.2023; 32(2): 170. CrossRef
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Healthcare.2023; 11(13): 1974. CrossRef
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Healthcare.2023; 11(16): 2303. CrossRef
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Preventive Medicine.2023; 175: 107691. CrossRef
Public Awareness of Dyslipidemia Among the Korean Population: A Survey Study
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Journal of Lipid and Atherosclerosis.2023; 12(3): 307. CrossRef
Standardized protocol of blood pressure measurement and quality control program for the Korea National Health and Nutrition Examination Survey
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Journal of Cachexia, Sarcopenia and Muscle.2023; 14(6): 2747. CrossRef
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COPD Risk Factor Profiles in General Population and Referred Patients: Potential Etiotypes
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International Journal of Chronic Obstructive Pulmonary Disease.2023; Volume 18: 2509. CrossRef
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Frontiers in Medicine.2023;[Epub] CrossRef
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Inverse Association of Serum Folate Level with Metabolic Syndrome and Its Components in Korean Premenopausal Women: Findings of the 2016–2018 Korean National Health Nutrition Examination Survey
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Nutrients.2022; 14(4): 880. CrossRef
Lower Dietary Calcium Intake is Associated with a Higher Risk of Mortality in Korean Adults
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Journal of the Academy of Nutrition and Dietetics.2022; 122(11): 2072. CrossRef
Association between exposure to fine particulate matter and kidney function: Results from the Korea National Health and Nutrition Examination Survey
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Environmental Research.2022; 212: 113080. CrossRef
Cardiovascular Implications of the 2021 KDIGO Blood Pressure Guideline for Adults With Chronic Kidney Disease
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Journal of the American College of Cardiology.2022; 79(17): 1675. CrossRef
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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
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Diabetes Fact Sheet in Korea 2021
Jae Hyun Bae, Kyung-Do Han, Seung-Hyun Ko, Ye Seul Yang, Jong Han Choi, Kyung Mook Choi, Hyuk-Sang Kwon, Kyu Chang Won
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Korean Journal of Clinical Laboratory Science.2022; 54(2): 149. CrossRef
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International Journal of Environmental Research and Public Health.2022; 19(14): 8242. CrossRef
Smoking in the workplace: A study of female call center employees in South Korea
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PLOS ONE.2022; 17(7): e0267685. CrossRef
Alterations in Glomerular Filtration Rates Using Different Algorithms in the Korean Population Visiting Local Clinics and Hospitals
Rihwa Choi, Sang Gon Lee, Eun Hee Lee
Journal of Clinical Medicine.2022; 11(18): 5339. CrossRef
Prevalence Trends of Metabolic Syndrome among Korean Children and Adolescents from a Population-Based Cross-Sectional Survey
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Life.2022; 12(9): 1404. CrossRef
The Association of Mercury and ALT with Obesity in Korean Adults: Using Data from the Korea National Health and Nutrition Examination Survey for 11 Years (KNHANES 2005, 2008~2017)
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Korean Journal of Clinical Laboratory Science.2022; 54(3): 192. CrossRef
Low relative hand grip strength is associated with a higher risk for diabetes and impaired fasting glucose among the Korean population
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Menstrual and Reproductive Factors for Gastric Cancer in Postmenopausal Women: The 2007–2020 Korea National Health and Nutrition Examination Survey
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International Journal of Environmental Research and Public Health.2022; 19(21): 14468. CrossRef
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Journal of the Korean Medical Association.2022; 65(10): 633. CrossRef
One-year prevalence and clinical characteristics in chronic dizziness: The 2019–2020 Korean National Health and Nutrition Examination Survey
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Frontiers in Neurology.2022;[Epub] CrossRef
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Clinical Hypertension.2022;[Epub] CrossRef
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Original Article

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

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Abstract Summary PDF

Abstract

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Summary

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

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

Citations

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Cohort Profile

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

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Abstract Summary PDF Supplementary Material

Abstract

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

Summary

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

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

Citations

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Epidemiology and Health.2025; 47: e2025001. CrossRef
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BMC Public Health.2025;[Epub] CrossRef
Keun Lee (October 10, 1942 – May 14, 2024): a pioneering pediatrician in the field of developmental screening tests in Korea and a beloved teacher at Ewha Womans University College of Medicine
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BMI trajectory and inflammatory effects on metabolic syndrome in adolescents
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Brief Communication

Evaluation report on the causal association between humidifier disinfectants and lung injury: Mina Ha, Soon Young Lee, Seung-sik Hwang, Hyesook Park, Seungsoo Sheen, Hae Kwan Cheong, Bo Youl Choi; Epidemiol Health. 2016;38:e2016037. Published online August 18, 2016; DOI: https://doi.org/10.4178/epih.e2016037

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
As of November 2011, the Korean government recalled and banned humidifier disinfectants (HDs) from the market, because four case-control studies and one retrospective epidemiological study proved the association between HDs and lung injury of unknown cause. The report reviewed the causal role of HDs in lung injury based on scientific evidences.

METHODS

A careful examination on the association between the HDs and lung injury was based on the criteria of causality inference by Hill and the US Surgeon General Expert Committee.

RESULTS

We found that all the evidences on the causality fulfilled the criteria (strength of association, consistency, specificity, temporality, biologic gradient, plausibility, coherence, experiment, analogy, consideration of alternative explanations, and cessation of exposure), which proved the unknown cause lung injury reported in 2011 was caused by the HDs. In particular, there was no single reported case of lung injury since the ban in selling HDs in November 2011 as well as before the HDs were sold in markets.

CONCLUSIONS

Although only a few epidemiological studies in Korea have evaluated the association between lung injury and the use of HDs, those studies contributed to proving the strong association between the use of the HDs and lung injury, based on scientific evidence.

Summary

Korean summary
본 논문에서는 Hill의 기준과 US Surgeon General 전문위원회에서 제시하는 기준에 근거하여 가습기살균제와 폐손상과의 인과성을 검토하였다. 검토결과, 11개 조건(관련성의 강도, 일관성, 특이성, 시간적 선후관계, 생물학적 용량-반응 관계, 개연성, 기존 지식과의 일치성, 실험, 유사성, 다른 가능한 해석에 대한 고려 및 노출의 중단) 을 모두 충족함을 확인하므로 써, 2011년 발생한 원인미상 폐손상의 원인이 가습기살균제 노출로 인한 것임을 알 수 있었다. 무엇보다도 가습기살균제 시판 전에는 원인미상 폐손상이 보고된 바가 없었고, 2011년 11월 가습기살균제 판매중지 이후 폐손상이 한 건도 발생하지 않은 것은 원인미상의 폐손상이 가습기살균제로 인한 것임을 강력하게 지지하는 것으로 판단된다.

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Association of respiratory diseases with humidifier disinfectants exposure and its latency: A study of health damage reporter cohort in South Korea
Jaiyong Kim, Kyoung Sook Jeong, Seungyeon Heo, Youngmee Lee, Taksoo Kim, Hye-Jin Kim, Suejin Kim, Hae-Kwan Cheong, Mina Ha
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Risk of non-cancer respiratory diseases attributed to humidifier disinfectant exposure in Koreans: age-period-cohort and differences-in-difference analyses
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New-Onset and Exacerbation of Lung Diseases after Short-Term Exposures to Humidifier Disinfectant during Hospitalization
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Need for individual-based evaluation to determine the association between humidifier disinfectants and health injuries
Hyeong-Cheol Kim, Hyunil Kim, Eun-Chan Mun, Yesung Lee, Soyoung Park
Annals of Occupational and Environmental Medicine.2021;[Epub] CrossRef
Strength of Association. Report 1. Graduations of Relative Risk
А. Котеров, A. Koterov, Л. Ушенкова, L. Ushenkova, Э. Зубенкова, E. Zubenkova, А. Вайнсон, A. Vaynson, М. Калинина, M. Kalinina, А. Бирюков, A. Biryukov
Medical Radiology and radiation safety.2019; : 5. CrossRef
Causal inference in environmental epidemiology
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Environmental Health and Toxicology.2017; 32: e2017015. CrossRef

Original Articles

The effect of community-level smoke-free ordinances on smoking rates in men based on Community Health Surveys: Hye Ah Lee, Hyesook Park, Ho Kim, Kyunghee Jung-Choi; Epidemiol Health. 2014;36:e2014037. Published online December 26, 2014; DOI: https://doi.org/10.4178/epih/e2014037

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162 Download
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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
As one of smoke-free policies, communities have established the smoke-free ordinances since August 2010. Thus, this study aimed to evaluate the effects of community-level smoke-free ordinances (SFO) on smoking rates in men using multiyear Community Health Survey (CHS) data.

METHODS

Data on community-level SFO were collected from a website on Enhanced Local Laws and Regulation Information System. Regional smoking-related data were obtained from CHS data from 2008 to 2012 and the age-standardized rates of current smoking in men, attempts to quit smoking, and smoke-free campaign experiences including the mean number of cigarettes smoked (smoking amount) were calculated. Repeated measures analysis of variance was performed to evaluate the effects of regional implementation of SFO and the duration on change of smoking rates.

RESULTS

Overall current smoking rates and daily mean cigarettes smoked were lower in community where SFO had been implemented compared to those without implementation, and there was a significant difference in smoking rates between 2010 and 2008. Cross-sectional analysis of the effects of regional SFO revealed clear difference in rate of current smoking, but longitudinal analysis showed no significant differences. Stratifying by age groups, however, showed that groups less than 30 years of age had low smoking rates in community with ordinance compared to those without SFO since 2010. Yearly surveys measuring the number of cigarettes smoked, attempts to quit smoking, and experiences of smoke-free campaigns showed regional differences in the duration of implementation, but these differences were not significant in longitudinal analysis. Furthermore, there was a difference in regional socioeconomic characteristics between community with and without SFO implementation.

CONCLUSIONS

For effective smoking control, it is necessary to evaluate current policies and develop indices to evaluate the practical implementation of ordinances. As more communities to pass the SFO, long-term observation and assessments required.

Summary

Korean summary
2008년부터 2012년까지 조사된 지역사회건강조사 자료를 이용하여, 지역별 금연 조례 시행에 대한 효과를 평가한 연구 결과로, 종단적 분석을 통해 접근하였을 때 시간에 따른 흡연율 감소 폭은 조례 시행/미시행 지역간에 차이를 보이지 않았으며, 지역의 사회경제적 특성 요인에 차이가 존재하는 것으로 나타났다. 효과적인 흡연 규제를 위해, 현 시행중인 정책에 대한 효과 평가 및 장기적인 평가가 필요하다.

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The Associations between Social Support, Health-Related Behaviors, Socioeconomic Status and Depression in Medical Students: Yoolwon Jeong, Jin Young Kim, Jae Seon Ryu, Ko eun Lee, Eun Hee Ha, Hyesook Park; Epidemiol Health. 2010;32:e2010009. Published online November 24, 2010; DOI: https://doi.org/10.4178/epih/e2010009

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Abstract PDF

Abstract

<sec><title>OBJECTIVES</title>The objective of this study was to estimate the prevalence of depression in medical students and to evaluate whether interpersonal social support, health-related behaviors, and socio-economic factors were associated with depression in medical students.</sec><sec><title>METHODS</title>The subjects in this study were 120 medical students in Seoul, Korea who were surveyed in September, 2008. The subjects were all women and over the age of 20. Their age, body mass index (BMI), quality of sleep, diet, household income, smoking, alcohol consumption, exercise levels, and self-reported health status were surveyed. The degree of perceived social support was measured using the interpersonal support evaluation list (ISEL). Depression was evaluated using the center for epidemiology studies depression scale (CES-D).</sec><sec><title>RESULTS</title>The mean CES-D score was 14.1±8.6 and 37.1% of the participants appeared to suffer from depression. Low levels of perceived interpersonal support increased the risk of depression by more than 10 times and having higher household income did not necessarily decrease the risk of depression.</sec><sec><title>CONCLUSION</title>Medical students have a relatively high level of depression. Efforts should be made to encourage social support in order to promote mental health in medical students.</sec>

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Effects of Exposure-Confounder Misclassification and Criteria of Model Choice in Ecologic Studies.: Sun Hee Lee, Chung Mo Nam, Hung Wok Park; Korean J Epidemiol. 1996;18(2):142-150.

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Abstract PDF: Abstract
Ecologic studies are widely used in all fields of public health on account of accesibility of data. However, two problems related to these studies have been brought up. The first is ecological fallacy occurred in the course of interpreting the ecologic level of exposure-disease associations into individual level. The second is exposure isclassification which leads to serious bias. Nevertheless there is few methodologic study dealing joint effects of the two problems in ecologic study. This study was conducted to suggest an ecologic model not having an ecologic fallacy due to model linkage failure and a methodology for correcting the misclassification bias due to exposure-confounder misclassification. Finally, we suggest a criteria for the ecologic model selection. Main results are as follows: 1. A linear ecologic regression model has a serious ecological fallacy due to model linkage failure and the misclassification bias due to the exposure-confounder misclassification. 2. An interaction ecologic regression model has no ecological fallacy due to model linkage failure, but it is affected seriously by the exposure misclassification. However misclassification bias could be removed mathematically if the information related to the misclassification was known. 3. A log-linear ecologic regression model has an ecological fallacy due to model linkage failure. It is seriously biased as the individual risk ratio are increased, but relatively less affected by the exposure misclassification than interaction ecologic regression model. 4. One of the two ecologic regression model-interaction ecologic regression model and log-linear ecologic regression model- would be selected according to the information of individual risk ratio and exposure misclassification. But using a linear ecologic regression model should be avoided in any circumstance. The above results are only valid in case that there is no other source of ecological fallacy except model linkage failure. Also exposure and confounder are independent each other, measured binary, and having nondifferential misclassification. Since the above assumptions are somewhat strong in considering the real situations of ecologic studies, it is necessary to extend the scope of this study.; Summary

The Comparison of the Somatization and Hypochondriacal Trends Between Labor Workers and Managerial Workers.: Chul Lee, Hee Sook Park, Won Chul Lee, Kwang Ho Meng; Korean J Epidemiol. 1995;17(2):225-234.

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Abstract PDF: Abstract
This study was designed to investigate the difference of somatization and hypochondriacal trends between labor workers and managerial workers. The subjects consisted of 302 workers who were employed at 13 small scale industries in a city of Kyung Kee province. Data collection was done from February 25, 1993 to March 10, 1993. Symptom Check List-90-Somatization(SCL) and Illness Attitude Scale(IAS) which are composed of self-report questionnares were used as measuring instruments. The results were as follows: 1. Mean scores of SCL-90-R-Somatization in labor workers were significantly higher than those in managerial workers and there were significant differences in 7 subscales (pain in heart or chest, nausea of upset stomach, muscle soreness, trouble breathing, hot or cold spells, numbness, lump sensation in throat between to two groups. 2. There was no significant difference in mean scores of illness attitude Scales between labor workers and managerial workers. However, among the subscale of IAS mean scores of "hypochondriacal beliefs" and "effects of symptom" in labor workers, the mean scores of IAS in labor workers were significantly higher than those in managerial workers. 3. When compared by educational level, middle school graduates and college graduates of labor workers showed significantly higher mean scores of SCL than those of managerial workers. 4. When compared by employment duration, labor workers who worked less than 5 years showed significantly higher mean of SCL and IAS than those of managerial workers. 5. There were no significant differences in mean scores of SCL and IAS between the levels of subjectively evaluated environmental conditions by the workers themselves of the illumination, organic solvent, noise and dust.; Summary

The association between insulin resistance and Framingham risk score among type 2 diabetes.: Hee Sook Park, Ji Eun Yun, Soo Jin Yoon, Eurin Cho, Kyung A Ahn, Seok Won Park, Chul Woo Ahn, Dae Jung Kim, Young Duk Song, Young Ju Choi, Mi Ae Cho, Eun Jig Lee, Kap Bum Huh, Sun Ha Jee; Korean J Epidemiol. 2007;29(1):46-58.

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Abstract PDF: Abstract
BACKGROUND
AND PURPOSE: Insulin resistance has been known to be associated with the risk of cardiovascular diseases. However, the relationship with Framingham risk score among type 2 diabetes has not been well known. We investigated the relationship between insulin resistance (IR) and the Framingham risk score(FRS) among type 2 diabetes in Korea.
METHODS
We estimated the 5-year risk of ischemic heart disease(IHD) based on Framingham equation among 1,941 diabetes patients(1,294 men and 647 women), who visited Huh's clinic, enrolled from January 2003 to June 2006. IR, which was measured by insulin tolerance test (ITT), was divided into five groups(Q1 to Q5). High risk of IHD was defined as upper 10 percentile of FRS. Multivariate regression and logistic regression models were used to see independent association of higher quintiles of IR level, compared with lowest quintile(Q1) for the risk of IHD.
RESULTS
Mean (+/-standard deviation) 5-year FRS of study subjects were 8.40%(+/-6.89) for men and 5.92%(+/-5.23) for women. There were significant correlation between IR, body mass index, HbA1C, fasting glucose, triglyceride, LDL-cholesterol, C-peptide and FRS in both men and women. After adjusting for triglyceride, LDL-cholesterol, C-peptide, multivariate regression model analysis showed that IR was independently associated with the FRS. A positive association between IR and high risk of IHD was observed in men: highest versus lowest quintile of IR (odds ratio 5.45 in men and 4.71 in women).
CONCLUSION
Increased IR level was independently associated with risk of IHD measured by FRS among type 2 diabetes in Korea.; Summary

Surveillance System for Communicable Disease in Korea.: Ok Park; Korean J Epidemiol. 2006;28(1):22-27.

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Abstract PDF: Abstract
Korea has experienced sporadic cases or outbreaks of emerging and reemerging infectious diseases since the 1980s. Confirmed outbreaks have included leptospirosis and legionellosis in 1984, HIV infection in 1985, enterohemorrhagic E-coli infection in 1998, staphylococcus aureus infection with decreased vancomycin susceptibility in 1999, brucellosis in 2002, and botulism in 2003. Korea has also suffered from reemerging diseases such as vivax malaria along the Demilitarized Zone (DMZ) since 1993. Owing to globalization, imported cases of diarrheal diseases, malaria, and dengue have been increasing. In addition, the overall incidence of acute infectious diseases such as shigellosis, scrub typhus, and mumps, which had been decreasing since 1970 until the late 1990s, began to increase again after the late 1990s. The range of emerging and reemerging diseases poses serious public health threats to the public. The Korean government has been striving to build capacity to detect and respond to these infectious disease threats in a timely manner since the late 1990s. For this, the government revised the Communicable Disease Prevention Law, reorganized the government structure for communicable disease control, and developed human resources through field epidemiology and various other training programs. SARS and highly pathogenic avian influenza provided momentum to accelerate these endeavors. Korea has thus far achieved significant improvements in the field of infectious disease surveillance. There are, however, gaps that need to be addressed including insufficient capacity for disease surveillance and response for emerging infectious disease at the local government level, inadequate operation of various surveillance systems, insufficient integration among surveillance systems, and low participation rate for notification among physicians. Therefore, the Korean government plans to improve infectious disease surveillance by implementing the following procedures: establishment of a web-based reporting system, integration of EDI and laboratory surveillance systems, extension of the electronic reporting system to the private sector, continuous development of human resources to build capacity, and enhancement of collaboration with the private sector.; Summary

Sentinel Surveillance System for Pediatric Communicable Diseases.: Young Ohk Yoo, Eun Kyeong Jeong, Ok Park, Byung Chul Chun; Korean J Epidemiol. 2004;26(2):32-42.

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Abstract PDF: Abstract
PURPOSE
The purpose of this study is to review the process for establishing a pediatric communicable diseases sentinel surveillance system, and the results of operation based on the accumulated data to understand the descriptive epidemiologic characteristics of pediatric communicable diseases.
METHODS
A sentinel surveillance system for pediatric communicable diseases was developed in May 2001 with the 202 doctors in pediatric clinics who participated voluntarily. The target diseases for sentinel surveillance were measles, mumps, rubella, chicken pox and aseptic meningitis. The case definitions of those diseases for surveillance were divided into confirmed cases and suspected cases by the diseases definitions of national notifiable diseases system. The participants should report as soon as possible when they diagnosed measles, mumps, rubella cases including suspected ones. But chicken pox and aseptic meningitis cases were reported once a week in regular base including zero report. We collected the data from May 2001 to December 2003 and showed the descriptive epidemiologic characteristics of each disease.
RESULTS
The average reporting proportion among survellance doctors has been increased, about 88% in 2003. For measles, 206 cases were reported in 2001, 10 cases in 2002, and 2 cases in 2003. Children under the age of 2 (53.4 %) showed the highest. Among the measles cases, 86.4% had no previous vaccination history. In case of mumps, 246 cases in 2001, 241 in 2002, and 566 cases in 2003 were reported. Mumps showed seasonality, highest from April to June in each year. The sex ratio was about 1.5(M:F = 6:4). Among the reported cases, 76.9 % had previous MMR immunization history at least one time. For Rubella, 9 cases in 2001, 3 in 2002, and no case were reported in 2003. The chicken pox case proportion per 100 pediatric consultations showed peak in from May to June and from November to January. 3-5 year-old children (45.7%) were showed high proportion by age.
CONCLUSION
This study described the process of establishing and operating a system for the pediatric communicable disease sentinel surveillance. We analyzed the desriptive epidemiologic characteristic of the reported data from May 2001 to December 2003. These data maybe useful to build the policy of public health management for communicable diseases control system and vaccine preventable diseases.; Summary

A Trial for Association between Oxidative Stress in Midterm Pregnancy and Postnatal Growth during the First Year of Life.: Hyesook Park, Young Ju Kim, Hwa Young Lee, Eun Ae Park, Nam Soo Chang, Eun Hee Ha, Bo Hyun Park, Bo Eun Lee, Ju Hee Hong; Korean J Epidemiol. 2004;26(1):17-26.

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Abstract PDF: Abstract
OBJECTIVES
We aims to construct Infant Growth Cohort for evaluating whether oxidative stress in midterm pregnancy has an adverse effect on postnatal growth.
METHODS
AND MATERIALS: From September 2001 to April 2004, we constructed an Ewha Infant Growth Cohort connected with the Ewha Pregnant Women Cohort. We excluded mother-and-child pairs in which the mother had experienced hypertension or diabetes during pregnancy and had multiple births for this study, which gave us 233 mother-and-child pairs for analysis. We measured maternal serum homocysteine and urinary 8-hydroxyguanosine (8-OHdG) and malondialdehyde (MDA) at 24~28 weeks of pregnancy, and infant weights at birth and at 6 and 12 months postnatally. We applied repeated measures ANOVA with PROC MIXED to assess the significance of differences.
RESULTS
We followed 64 and 85 infants at 6 and 12 months respectively. The mean body weights were 3146.4 g at birth, 8229.7 g at 6 months, and 1006.47 g at 12 months. The mean birth weight of infants was lower in mothers with higher homocysteine levels (third and fourth quartiles), but body weights from the first- and fourth-quartile groups of maternal homocysteine levels were lower than the others even though it was not statistically significant. Body weights at birth and at 6 months in third- and fourth-quartile groups of 8-OHdG levels were lower than the others. The body weights in the fourth quartile MDA group were significantly lower than the others at all time points.
CONCLUSIONS
Maternal oxidative stress in midterm pregnancy may cause postnatal growth retardation. But, there were high rate of follow up loss and various measurement errors. Therefore, we need to have efforts for compete follow up and valid and reliable measurements.; Summary

Indigenous Malaria Surveillance in Korea.: Dae Seong Kim, Soon Duck Kim, Yong Tae Yum, Chae Seung Lim, Kab Ro Lee, Mi Sook Park, Bae Jung Yoon; Korean J Epidemiol. 1997;19(2):180-189.

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Abstract PDF: Abstract
Malaria, one of the compulsory notifiable diseases, has been diappeared from Korea based on that fact no notification on malaria case was received from local health agencies during the last decade or so. Recently, Indigenous malaria has been re-emerged since 1993 and 549 cases was notificated till 1996. We conducted a surveillance system on the resurgent malaria outbreaks in the northern area of Kyonggi Province around the Imjin River. Malaria Surveillance Networks(MSNs) were established in Paju and Yoncheon between August 1996 and December 1996. When a febrile patient visits a clinic or a hospital, clinician takes a blood sample and refer to district malaria laboratory for the sample. The blood sample is examined in the malaria laboratory(public health center), and if malaria parasites are found, a radical or curative treatment is offered to patients. MSNs took 94 febrile cases and identified 23 malaria cases(24.5%). All malaria cases were infected by the indigenous vivax malaria. In Paju, 14 of 62 febrile cases(22.6%) were malaria outbreaks and 9 of 32 febrile cases(28.1%) in Yoncheon. In Korea resurgent malaria, malaria surveillance system should be operated for a program based on the district public health center with the coupled laboratory and dispensary.; Summary

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