Epidemiology and Health

Original Articles

Homelessness and mortality: gender, age, and housing status inequity in Korea: Gum-Ryeong Park, Dawoon Jeong, Seung Won Lee, Hojoon Sohn, Young Ae Kang, Hongjo Choi; Epidemiol Health. 2024;46:e2024076. Published online September 12, 2024; DOI: https://doi.org/10.4178/epih.e2024076

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
We compared mortality rates among various housing statuses within the homeless population and investigated factors contributing to their deaths, including housing status, gender, and age.
METHODS
Using a comprehensive multi-year dataset (n=15,445) curated by the National Tuberculosis Screening and Case Management Programs, matched with the 2019-2021 Vital Statistics Death Database and National Health Insurance claims data, we calculated age-standardized mortality rates and conducted survival analysis to estimate differences in mortality rates based on housing status.
RESULTS
The mortality rate among the homeless population was twice as high as that of the general population, at 1,159.6 per 100,000 compared to 645.8 per 100,000, respectively. Cancer and cardiovascular diseases were the primary causes of death. Furthermore, individuals residing in shelter facilities faced a significantly higher risk of death than those who were rough sleeping, with an adjusted hazard ratio of 1.70 (95% confidence interval, 1.37 to 2.11). This increased risk was especially pronounced in older adults and women.
CONCLUSIONS
The study highlights the urgent need for targeted interventions, as the homeless population faces significantly higher mortality rates. Older adults and women in shelter facilities are at the highest risk.; Summary

Korean summary
전체 인구의 사망률은 큰 폭으로 줄어들면서 홈리스와 전체 인구 간의 사망 불평등이 1.3배에서 1.8배로 증가했다. 특히 쪽방주민이나 거리 홈리스보다 시설 거주 홈리스의 사망 위험이 더 높았으며, 동일 조건하에서 거리 홈리스 대비 약 1.7배 높은 사망 위험을 보였다. 본 연구는 홈리스의 탈시설화를 촉진하는 정책 전환의 필요성을 시사한다.

Key Message
The mortality rate of the general population has significantly declined, leading to an increase in mortality inequality between the homeless and the general population from 1.3 to 1.8 times. In particular, the mortality risk for homeless individuals in facilities was higher than that of those living in jjokbang or on the streets. This study highlights the need for a policy shift to promote deinstitutionalization for the homeless population.

Comparative analysis of body mass index and obesity-related anthropometric indices for mortality prediction: a study of the Namwon and Dong-gu cohort in Korea: Ye Rim Kim, Min-Ho Shin, Young-Hoon Lee, Seong-Woo Choi, Hae-Sung Nam, Jeong-Ho Yang, Sun-Seog Kweon; Epidemiol Health. 2024;46:e2024066. Published online July 17, 2024; DOI: https://doi.org/10.4178/epih.e2024066

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Abstract

OBJECTIVES
This study investigated the associations between several obesity-related anthropometric indices and mortality in middle-aged and elderly populations to compare the indices’ predictive ability with that of the body mass index (BMI).

METHODS

We analyzed data on 12 indices calculated from 19,805 community-based cohort participants (average age, 63.27 years; median follow-up, 13.49 years). Each index was calculated using directly measured values of height, weight, waist circumference (WC), and hip circumference (HC). We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for each index using Cox regression and evaluated mortality prediction with the Harrell concordance index (c-index).

RESULTS

Adding anthropometric indices to the basic mortality model (c-index, 0.7723; 95% CI, 0.7647 to 0.7799) significantly increased the predictive power of BMI (c-index, 0.7735; 95% CI, 0.7659 to 0.7811), a body shape index (ABSI; c-index, 0.7735; 95% CI, 0.7659 to 0.7810), weight-adjusted waist index (WWI; c-index, 0.7731; 95% CI, 0.7656 to 0.7807), and waist to hip index (WHI; c-index, 0.7733; 95% CI, 0.7657 to 0.7809). The differences between the BMI model and the other 3 models were not statistically significant.

CONCLUSIONS

In predicting all-cause mortality, the ABSI, WWI, and WHI models based on WC or HC had stronger predictive power than conventional risk factors but were not significantly different from the BMI model.

Summary

Korean summary
- 다수의 비만관련 신체계측지표들이 사망률을 유의하게 예측하였지만 체질량지수보다 통계적으로 우월하지는 않았다. - 복부둘레가 고려된 비만지표들이 사망률예측에 더 유용할 것으로 추정된다.

Key Message
- Several obesity indices provided predictive value for all-cause mortality but were not superior to body mass index - Obesity indices that take abdominal circumference into account are likely to be more useful for predicting mortality.

Citations

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Accumulated subcutaneous fat in abdomen is associated with long COVID-19 symptoms among non-hospitalized patients: a prospective observational study
Tingxin Li, Baoming He, Yuping Liu, Chen Wang
Frontiers in Medicine.2024;[Epub] CrossRef

Toxicological evidence integration to confirm the biological plausibility of the association between humidifier disinfectant exposure and respiratory diseases using the AEP-AOP framework: Ha Ryong Kim, Jun Woo Kim, Jong-Hyeon Lee, Younghee Kim, Jungyun Lim, Yong-Wook Baek, Sunkyoung Shin, Mina Ha, Hae-Kwan Cheong, Kyu Hyuck Chung, Review Committee for the Epidemiological Correlations between Humidifier Disinfectants Exposure and Health Effects; Epidemiol Health. 2024;46:e2024060. Published online July 7, 2024; DOI: https://doi.org/10.4178/epih.e2024060

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Exposure to humidifier disinfectants has been linked to respiratory diseases, including interstitial lung disease, asthma, and pneumonia. Consequently, numerous toxicological studies have explored respiratory damage as both a necessary and sufficient condition for these diseases. We systematically reviewed and integrated evidence from toxicological studies by applying the evidence integration method established in previous research to confirm the biological plausibility of the association between exposure and disease.
METHODS
We conducted a literature search focusing on polyhexamethylene guanidine phosphate (PHMG) and chloromethylisothiazolinone/methylisothiazolinone (CMIT/MIT), the primary ingredients in humidifier disinfectants. We selected relevant studies based on their quality and the population, exposure, comparator, outcome (PECO) statements. These studies were categorized into three lines of evidence: hazard information, animal studies, and mechanistic studies. Based on a systematic review, we integrated the evidence to develop an aggregate exposure pathway–adverse outcome pathway (AEP-AOP) model for respiratory damage. The reliability and relevance of our findings were assessed by comparing them with the hypothesized pathogenic mechanisms of respiratory diseases.
RESULTS
By integrating toxicological evidence for each component of the AEP-AOP framework for PHMG and CMIT/MIT, we developed an AEP-AOP model that elucidates how disinfectants released from humidifiers expose target sites, triggering molecular initiating events and key events that ultimately lead to respiratory damage. This model exhibits high reliability and relevance to the pathogenesis of respiratory diseases.
CONCLUSIONS
The AEP-AOP model developed in this study provides strong evidence, based on evidence-based toxicology, that exposure to humidifier disinfectants causes respiratory diseases. This model demonstrates the pathways leading to respiratory damage, a hallmark of these conditions.; Summary

Korean summary
- PHMG와 CMIT/MIT에 대한 AEP-AOP 프레임워크와 독성학적 근거종합 방법에 의해 가습기살균제의 호흡기계 손상 AEP-AOP 모델을 개발하였다. - 이 모델은 가습기살균제 복합 노출과 호흡기계 질환 간의 인과성을 규명하는 과학적 근거를 제공하며, 향후 다양한 살균제 성분의 호흡기계 건강영향을 예측하는데 활용할 수 있다.

Key Message
• The AEP-AOP model for humidifier disinfectant-induced respiratory damage developed by the AEP-AOP frameworks for PHMG and CMIT/MIT, along with the toxicological evidence integration method. • This model provides a scientific basis for establishing causality between mixed exposure to humidifier disinfectants and respiratory diseases, and can be used in the future to predict the health effects of various disinfectant ingredients.

Methods

Expansion of a food composition database for the food frequency questionnaire in the Korean Genome and Epidemiology Study (KoGES): a comprehensive database of dietary antioxidants and total antioxidant capacity: Jiseon Lee, Ji-Sook Kong, Hye Won Woo, Mi Kyung Kim; Epidemiol Health. 2024;46:e2024050. Published online May 10, 2024; DOI: https://doi.org/10.4178/epih.e2024050

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study constructed a comprehensive database of dietary antioxidants and total antioxidant capacity (TAC) to facilitate the estimation of daily antioxidant intake using a food frequency questionnaire (FFQ). This database was applied to 3 general population-based cohorts (n=195,961) within the Korean Genome and Epidemiology Study (KoGES).

METHODS

To establish a database of 412 foods derived from recipes of a 106-item FFQ, we followed a pre-established standardized protocol. This included the selection of source databases, matching of foods, substitution of unmatched items with identical foods and input of values, and assessment of coverage. For each food, the TAC was estimated by summing the individual antioxidant capacities, calculated by multiplying the amount of each antioxidant by its vitamin C equivalent antioxidant capacity.

RESULTS

We identified 48 antioxidants across 5 classes: retinol, carotenoids, vitamins C and E, and flavonoids, with flavonoids divided into 7 subclasses. TAC values were then established. Coverage exceeded 90.0% for retinol, carotenoids, vitamin C, and vitamin E, while coverage for flavonoids was 60.9%. The daily intakes of 4 antioxidant classes—all but vitamin E—were higher in women than in men. The Ansan-Ansung cohort exhibited the highest levels of dietary TAC, vitamin E, and flavonoids, while the Health Examinees Study cohort displayed the highest values for retinol, carotenoids, and vitamin C.

CONCLUSIONS

We customized a comprehensive antioxidant database for the KoGES FFQ, achieving relatively high coverage. This expansion could support research investigating the impact of dietary antioxidants on the development of chronic diseases targeted by the KoGES.

Summary

Korean summary
본 연구는 한국인유전체역학조사사업(KoGES) 식품섭취빈도조사(FFQ)에 특화된 항산화 데이터베이스를 확장하여 개발한 첫 번째 연구로, 48종의 항산화제와 TAC 값을 포함하여 기존 연구의 부족한 부분을 채웠습니다. 코호트 별로 식이 항산화제 섭취량에서 큰 차이가 나타났으며, 지역사회 기반 코호트에서는 비타민 E와 플라보노이드 섭취가 가장 높았고, 도시 기반 코호트에서는 레티놀, 카로티노이드, 비타민 C 섭취에서 가장 높았습니다. 반면, 농촌 기반 코호트에서는 대부분의 항산화제 섭취량이 가장 낮았습니다. 또한 성별, 연령, 및 교육 수준에 따른 섭취량의 차이도 확인되었으며, 주로 여성, 젊은 연령층, 그리고 교육 수준이 높은 사람들이 더 많은 항산화제를 섭취한 반면, 고령자와 흡연자는 섭취량이 적게 나타났습니다.

Key Message
This study is the first to develop an expanded antioxidant database specifically for the Korean Genome and Epidemiology Study (KoGES) FFQ, addressing a critical gap in research by including a broad range of 48 antioxidants and total antioxidant capacity (TAC). Significant differences in dietary antioxidant intake were observed across different cohorts, with participants in the Ansan and Ansung (ASAS) study consuming the most vitamin E and flavonoids, while those in the Health Examinee (HEXA) study had the highest intake of retinol, carotenoids, and vitamin C. In contrast, the Cardiovascular Disease Association Study (CAVAS) showed the lowest intake of most antioxidants. Demographic differences were also evident, with women, younger individuals, and those with higher education levels consuming more antioxidants, while older adults and smokers consumed less.

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Diet-Wide Association Study for the Incidence of Type 2 Diabetes in Three Population-Based Cohorts
Hye Won Woo, Manh Thang Hoang, Min-Ho Shin, Sang Baek Koh, Hyeon Chang Kim, Yu-Mi Kim, Mi Kyung Kim
Nutrients.2024; 16(22): 3798. CrossRef

Original Articles

Association of decreased estimated glomerular filtration rate with lung cancer risk in the Korean population: Soonsu Shin, Min-Ho Kim, Chang-Mo Oh, Hyejin Chun, Eunhee Ha, Hyo Choon Lee, Seong Ho Moon, Dong-Young Lee, Dosang Cho, Sangho Lee, Min Hyung Jung, Jae-Hong Ryoo; Epidemiol Health. 2024;46:e2024041. Published online March 20, 2024; DOI: https://doi.org/10.4178/epih.e2024041

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Inconsistent results are available regarding the association between low estimated glomerular filtration rate (eGFR) and lung cancer risk. We aimed to explore the risk of lung cancer according to eGFR category in the Korean population.

METHODS

We included 358,293 adults who underwent health checkups between 2009 and 2010, utilizing data from the National Health Insurance Service-National Sample Cohort. Participants were categorized into 3 groups based on their baseline eGFR, as determined using the Chronic Kidney Disease Epidemiology Collaboration equation: group 1 (eGFR ≥90 mL/min/1.73 m2), group 2 (eGFR ≥60 to <90 mL/min/1.73 m2), and group 3 (eGFR <60 mL/min/1.73 m2). Incidences of lung cancer were identified using the corresponding codes from the International Classification of Diseases, 10th revision. Multivariate Cox proportional hazard models were employed to calculate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for lung cancer incidence up to 2019.

RESULTS

In multivariate analysis, group 2 exhibited a 26% higher risk of developing lung cancer than group 1 (HR, 1.26; 95% CI, 1.19 to 1.35). Furthermore, group 3 demonstrated a 72% elevated risk of lung cancer relative to group 1 (HR, 1.72; 95% CI, 1.58 to 1.89). Among participants with dipstick proteinuria of 2+ or greater, group 3 faced a significantly higher risk of lung cancer than group 1 (HR, 2.93; 95% CI, 1.37 to 6.24).

CONCLUSIONS

Low eGFR was significantly associated with increased lung cancer risk within the Korean population. A particularly robust association was observed in individuals with severe proteinuria, emphasizing the need for further investigation.

Summary

Korean summary
이번 연구에서는 한국인 인구집단에서 단백뇨와 동반된 낮은 사구체 여과율이 페암의 발생 위험을 증가시켰다. 이는 신장기능의 저하가 폐암의 위험을 증가시킬 수 있음을 시사한다. 신장기능이 저하된 환자들의 면밀한 추적관찰이 필요할 수 있다.

Key Message
Our research found that lower estimated glomerular filtration rate with proteinuria increased the risk of lung cancer in a Korean population. These findings suggest that decreased kidney function may increase the risk of lung cancer, indicating the need for careful observation of patients with impaired kidney function.

Citations

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Mendelian randomization study of the relationship between blood and urine biomarkers and lung cancer
Haihua Huang, Haijun Zheng
Frontiers in Oncology.2024;[Epub] CrossRef

Identifying pregnancy episodes and estimating the last menstrual period using an administrative database in Korea: an application to patients with systemic lupus erythematosus: Yu-Seon Jung, Yeo-Jin Song, Jihyun Keum, Ju Won Lee, Eun Jin Jang, Soo-Kyung Cho, Yoon-Kyoung Sung, Sun-Young Jung; Epidemiol Health. 2024;46:e2024012. Published online December 19, 2023; DOI: https://doi.org/10.4178/epih.e2024012

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study developed an algorithm for identifying pregnancy episodes and estimating the last menstrual period (LMP) in an administrative claims database and applied it to investigate the use of pregnancy-incompatible immunosuppressants among pregnant women with systemic lupus erythematosus (SLE).

METHODS

An algorithm was developed and applied to a nationwide claims database in Korea. Pregnancy episodes were identified using a hierarchy of pregnancy outcomes and clinically plausible periods for subsequent episodes. The LMP was estimated using preterm delivery, sonography, and abortion procedure codes. Otherwise, outcome-specific estimates were applied, assigning a fixed gestational age to the corresponding pregnancy outcome. The algorithm was used to examine the prevalence of pregnancies and utilization of pregnancy-incompatible immunosuppressants (cyclophosphamide [CYC]/mycophenolate mofetil [MMF]/methotrexate [MTX]) and non-steroidal anti-inflammatory drugs (NSAIDs) during pregnancy in SLE patients.

RESULTS

The pregnancy outcomes identified in SLE patients included live births (67%), stillbirths (2%), and abortions (31%). The LMP was mostly estimated with outcome-specific estimates for full-term births (92.3%) and using sonography procedure codes (54.7%) and preterm delivery diagnosis codes (37.9%) for preterm births. The use of CYC/MMF/MTX decreased from 7.6% during preconception to 0.2% at the end of pregnancy. CYC/MMF/MTX use was observed in 3.6% of women within 3 months preconception and 2.5% during 0-7 weeks of pregnancy.

CONCLUSIONS

This study presents the first pregnancy algorithm using a Korean administrative claims database. Although further validation is necessary, this study provides a foundation for evaluating the safety of medications during pregnancy using secondary databases in Korea, especially for rare diseases.

Summary

Korean summary
임산부의 약물 사용 안전성에 대한 근거 제공을 위해 실제 인구집단에서의 임신 중 약물 치료 안전성을 평가하는 청구자료 기반 연구가 중요하다. 본 연구에서는 국내 청구자료에 적용할 수 있는 임신 정의 및 임신 결과 조작적 정의 알고리즘을 개발하였다. 본 알고리즘은 임신 결과 간의 우선순위를 고려한 계층 구조를 활용하며, 조기 분만 및 초음파 검사 코드 등을 통해 최종 월경 기간을 추정하였다. 또한 알고리즘을 전신홍반루푸스 환자에 적용하여 유산, 사산 등의 유병률을 산출하고 임신 중 잠재적으로 부적절한 면역억제제 사용을 파악하여 국내 청구자료의 특성을 고려한 임신 중 약물 사용 연구의 기반을 마련하였다.

Key Message
Limited safety data for pregnant women prompted recent studies on medication during pregnancy using real-world databases. This study developed a tailored algorithm for Korean healthcare claims database, employing a hierarchy of pregnancy outcomes and incorporating pre-term delivery and sonography codes for last menstrual period estimation. Applied to systemic lupus erythematosus (SLE) patients, this study presented the prevalence and drug utilization pattern of pregnancy-incompatible immunosuppressants from preconception to pregnancy end, laying a foundation for further claims database studies on medication pregnancy safety.

Citations

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Utilisation patterns of immunomodulators and pregnancy outcomes in systemic lupus erythematosus: Insights from Korean national data
Yu-Seon Jung, Yeo-Jin Song, Hyeon Ji Lee, Eunji Kim, Soo-Kyung Cho, Yoon-Kyoung Sung, Sun-Young Jung
Lupus.2025;[Epub] CrossRef

Validation of the Korean Academy of Geriatric Dentistry screening questionnaire and oral frailty diagnostic criteria in community-dwelling older adults: Jeong-Hyun Kang, Seong-Chan Park, Hoi-In Jung, Sun Jae Jung, Hye-Jin Park, Soo-Min Kim, Min-Ji Jo, Yun-Seon Lee, Sun-Young Han; Epidemiol Health. 2024;46:e2024008. Published online December 11, 2023; DOI: https://doi.org/10.4178/epih.e2024008

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study aimed to establish the validity—specifically, the sensitivity and specificity—of the screening questionnaire and diagnostic criteria for oral frailty proposed by the Korean Academy of Geriatric Dentistry (KAGD) among community-dwelling older adults.
METHODS
This study enrolled 100 participants. Among various definitions of oral frailty, this study used the criteria proposed by Tanaka as the reference test. The screening questionnaire consisted of 11 items for screening physical frailty, chewing ability, swallowing difficulties, oral dryness, and tongue and lip motor function. Each question had a different scoring weight, and if the total score was 1 or higher, an oral frailty diagnostic examination proposed by the KAGD would be recommended. The diagnostic test was the oral frailty diagnostic criteria proposed by the KAGD including 6 measures: chewing ability, occlusal force, tongue pressure, oral dryness, swallowing difficulty, and oral hygiene. If a participant exhibited 2 or more positive measures, this participant was classified as “oral frail.” The screening questionnaire was analyzed using a cut-off value of 1 or higher, while the diagnostic criteria utilized a cut-off of 2 or more positive measures. Sensitivity and specificity were calculated.
RESULTS
The screening questionnaire showed significant power for screening oral frailty (area under the receiver operating characteristic curve, 0.783; sensitivity, 87.8%; specificity, 52.5%). The diagnostic accuracy of the newly proposed diagnostic criteria was acceptable (sensitivity, 95.1%; specificity, 42.4%).
CONCLUSIONS
The newly proposed screening questionnaire and diagnostic criteria in Korea appear to be a useful tool to identify oral frailty in community-dwelling older adults.; Summary

Korean summary
본 연구는 지역사회에 거주하는 노인들의 구강 노쇠에 대한 선별검사 설문지와 진단 기준을 검증하는 것을 목표로 했습니다. 민감도와 특이도가 계산되었으며, 스크리닝 설문지는 구강 노쇠를 식별하는 데 상당한 힘을 보여주었고(민감도 87.8%, 특이도 52.5%), 진단 기준은 수용 가능한 정확도(민감도 95.1%, 특이도 42.4%)를 나타냈습니다. 연구 결과는 제안된 선별 설문지와 진단 기준이 한국 지역사회에 거주하는 노인들의 구강 노쇠를 식별하는 데 유용한 도구임을 시사합니다.

Key Message
This study aimed to validate a screening questionnaire and diagnostic criteria for oral frailty among older adults living in the community. Sensitivity and specificity were calculated, with the screening questionnaire demonstrating a significant power for identifying oral frailty (sensitivity 87.8%, specificity 52.5%) and the diagnostic criteria showing acceptable accuracy (sensitivity 95.1%, specificity 42.4%). The findings suggest that the proposed screening questionnaire and diagnostic criteria are valuable tools for identifying oral frailty in community-dwelling older adults in Korea.

Changes in proteinuria and the associated risks of ischemic heart disease, acute myocardial infarction, and angina pectoris in Korean population: Sung Keun Park, Ju Young Jung, Min-Ho Kim, Chang-Mo Oh, Eunhee Ha, Eun Hye Yang, Hyo Choon Lee, Soonsu Shin, Woo Yeon Hwang, Sangho Lee, So Youn Shin, Jae-Hong Ryoo; Epidemiol Health. 2023;45:e2023088. Published online September 30, 2023; DOI: https://doi.org/10.4178/epih.e2023088

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Proteinuria is widely used to predict cardiovascular risk. However, there is insufficient evidence to predict how changes in proteinuria may affect the incidence of cardiovascular disease.
METHODS
The study included 265,236 Korean adults who underwent health checkups in 2003-2004 and 2007-2008. They were categorized into 4 groups based on changes in proteinuria (negative: negative → negative; resolved: proteinuria ≥1+ → negative; incident: negative → proteinuria ≥1+; persistent: proteinuria ≥1+ → proteinuria ≥1+). We conducted 6 years of follow-up to identify the risks of developing ischemic heart disease (IHD), acute myocardial infarction (AMI), and angina pectoris according to changes in proteinuria. A multivariate Cox proportional-hazards model was used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for incident IHD, AMI, and angina pectoris.
RESULTS
The IHD risk (expressed as HR [95% CI]) was the highest for persistent proteinuria, followed in descending order by incident and resolved proteinuria, compared with negative proteinuria (negative: reference, resolved: 1.211 [95% CI, 1.104 to 1.329], incident: 1.288 [95% CI, 1.184 to 1.400], and persistent: 1.578 [95% CI, 1.324 to 1.881]). The same pattern was associated with AMI (negative: reference, resolved: 1.401 [95% CI, 1.048 to 1.872], incident: 1.606 [95% CI, 1.268 to 2.035], and persistent: 2.069 [95% CI, 1.281 to 3.342]) and angina pectoris (negative: reference, resolved: 1.184 [95% CI, 1.065 to 1.316], incident: 1.275 [95% CI, 1.160 to 1.401], and persistent: 1.554 [95% CI, 1.272 to 1.899]).
CONCLUSIONS
Experiencing proteinuria increased the risks of IHD, AMI, and angina pectoris even after proteinuria resolved.; Summary

Korean summary
- 본 연구의 목적은 요 시험지 검사를 통해 확인된 단백뇨의 3-5년간의 변화 수준에 따른 허혈성 심질환, 급성 심근 경색, 협심증의 발생 위험을 평가하는 것이다. - 지속적으로 단백뇨가 음성인 집단에 (negative proteinuria) 비해서, 단백뇨가 있었다 사라진 집단 (resolved proteinuria), 새로이 단백뇨가 생긴 집단 (incident proteinuria), 지속적으로 단백뇨가 존재하는 집단 (persistent proteinuria)은 유의하게 증가한 허혈성 심질환, 급성 심근 경색, 협심증의 발생 위험을 나타내었다. - 이러한 결과는 단백뇨가 일단 발생한 사람은, 나중에 사라지더라도, 관상 동맥 질환에 대한 위험이 높으며, 이에 대한 관리와 주의가 필요하다는 것을 시사한다.

Key Message
- The present study was to evaluate the risk of incident ischemic heart disease, acute myocardial infarction, and angina pectoris according to changes in urine dipstick proteinuria over 3-5 years. - Compared with persistently negative proteinuria (negative → negative), resolved proteinuria (positive → negative), incident proteinuria (negative → positive), and persistent proteinuria (positive → positive) had the increased risk of ischemic heart disease, acute myocardial infarction, and angina pectoris. - These results suggest that once manifested proteinuria lead to the increased risk of coronary artery disease, regardless of changes in proteinuria.

Did the socioeconomic inequalities in avoidable and unavoidable mortality worsen during the first year of the COVID-19 pandemic in Korea?: Rora Oh, Myoung-Hee Kim, Juyeon Lee, Rangkyoung Ha, Jungwook Kim; Epidemiol Health. 2023;45:e2023072. Published online August 3, 2023; DOI: https://doi.org/10.4178/epih.e2023072

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study examined changes in socioeconomic inequalities in mortality in Korea before and after the outbreak of coronavirus disease 2019 (COVID-19).

METHODS

From 2017 to 2020, age-standardized mortality rates were calculated for all-cause deaths, avoidable deaths (preventable deaths, treatable deaths), and unavoidable deaths using National Health Insurance claims data and Statistics Korea’s cause of death data. In addition, the slope index of inequality (SII) and the relative index of inequality (RII) by six income levels (Medical Aid beneficiary group and quintile of health insurance premiums) were computed to analyze the magnitude and change of mortality inequalities.

RESULTS

All-cause and avoidable mortality rates decreased steadily between 2017 and 2020, whereas unavoidable mortality remained relatively stable. In the case of mortality inequalities, the disparity in all-cause mortality between income classes was exacerbated in 2020 compared to 2019, with the SII increasing from 185.44 to 189.22 and the RII increasing from 3.99 to 4.29. In particular, the preventable and unavoidable mortality rates showed an apparent increase in inequality, as both the SII (preventable: 91.31 to 92.01, unavoidable: 69.99 to 75.38) and RII (preventable: 3.42 to 3.66, unavoidable: 5.02 to 5.89) increased.

CONCLUSIONS

In the first year of the COVID-19 pandemic, mortality inequality continued to increase, although there was no sign of exacerbation. It is necessary to continuously evaluate mortality inequalities, particularly for preventable and unavoidable deaths.

Summary

Korean summary
이 연구는 COVID-19 발생 전후 한국에서의 사망률 추이와 사망률 불평등 변화를 조사했다. 2017~2020년 사이에 총사망률과 회피가능사망률은 줄어들었지만, 사망률의 사회경제적 불평등은 더 커지는 경향을 보였다. 특히 예방가능사망과 회피불가능사망에서 불평등이 커져 지속적인 추적과 평가가 필요하다.

Key Message
This study examined the trends in mortality rates and changes in mortality inequality in Korea before and after the onset of COVID-19. Between 2017 and 2020, while the all-cause and avoidable mortality rates decreased, there was a growing trend of inequality in mortality rates based on income levels. Particularly, inequalities in preventable and unavoidable deaths have increased, emphasizing the need for ongoing evaluation.

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Incidence and Influencing Factors of Avoidable Mortality in Korea From 2013-2022: Analysis of Cause-of-death Statistics
Jeong Min Yang, Jieun Hwang
Journal of Preventive Medicine and Public Health.2024; 57(6): 540. CrossRef

Associations of cumulative average dietary total antioxidant capacity and intake of antioxidants with metabolic syndrome risk in Korean adults aged 40 years and older: a prospective cohort study (KoGES_CAVAS): Ji-Sook Kong, Jiseon Lee, Youngjun Kim, Hye Won Woo, Min-Ho Shin, Sang Baek Koh, Hyeon Chang Kim, Yu-Mi Kim, Mi Kyung Kim; Epidemiol Health. 2023;45:e2023067. Published online July 28, 2023; DOI: https://doi.org/10.4178/epih.e2023067

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Limited and inconsistent prospective evidence exists regarding the relationship of dietary total antioxidant capacity (dTAC) and antioxidant intake with metabolic syndrome (MetS) risk. We evaluated the associations of the cumulative averages of dTAC and antioxidant intake (in 5 classes: retinol, vitamin C, vitamin E, carotenoids, and flavonoids, as well as 7 flavonoid subclasses) with the risk of MetS.

METHODS

This study included 11,379 participants without MetS, drawn from the Korean Genome and Epidemiology Study_CArdioVascular disease Association Study (KoGES_CAVAS). The cumulative average consumption was calculated using repeated food frequency questionnaires. Incidence rate ratios were estimated using a modified Poisson regression model with a robust error estimator.

RESULTS

The median follow-up period was 5.16 years, and 2,416 cases of MetS were recorded over 58,750 person-years. In men, significant inverse associations were observed in all 5 antioxidant classes, except for the highest quartile of dTAC. In women, dTAC and total flavonoids were not significantly associated with MetS; however, significant L-shaped associations were found for the remaining 4 antioxidant classes. Of the 7 flavonoid subclasses, only flavones in the highest quartile for men and flavan-3-ols in women lacked significant associations with MetS. The inverse associations were not sex-specific, but they were particularly pronounced among participants with a body mass index (BMI) of 23 kg/m2 or higher.

CONCLUSIONS

The findings suggest that most antioxidant classes and flavonoid subclasses, unlike dTAC, exhibit a clear beneficial association with MetS in an L-shaped pattern in both men and women, particularly those with a high BMI.

Summary

Korean summary
농촌코호트 조사 참여자를 대상으로 식이 총항산화능, 총항산화능 하위분류, 플라보노이드 하위분류와 대사증후군 발생 위험의 전향적 연관성을 평가한 결과, 대부분의 항산화물(5개항산화물 분류:4개 항산화 비타민과 플라보노이드; 플라보노이드 7개 하부분류)에서 대사증후군과 음의 상관성을 확인할 수 있었으며 총항산화능(남자와 여자)과 플라보노이드(여자)에서 약한 연관성을 보였다. 남녀간 유의한 상호작용은 없었고 특히 BMI가 높은 집단에서 두드러졌다. 이 연구의 결과는 특히 식이 총항산화능을 구성하는 하위 유형을 적절히 섭취하는 것이 특히 비만한 성인에서 대사증후군 위험을 낮추는 예방전략으로 효과가 있을 수 있음을 시사한다.

Key Message
We observed that the cumulative average of dietary antioxidant vitamins and most flavonoids may be have pivotal roles in prevention of MetS, although there may be weak associations of dTAC and flavonoids in women. Moreover, these inverse associations were more pronounced in high BMI individuals. Our results suggest that the consumption of antioxidants and flavonoid may mitigate the MetS risk, particularly in overweight/obese individuals at high risk of developing chronic diseases.

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The association of dietary total flavonoids and their subclasses with the risk of type 2 diabetes: a prospective cohort study
Hye Won Woo, Mi Kyung Kim, Kong Ji-Sook, Jiseon Lee, Min-Ho Shin, Sang Baek Koh, Hyeon Chang Kim, Yu-Mi Kim
European Journal of Nutrition.2024; 63(4): 1339. CrossRef
A Systematized Review of the Relationship Between Obesity and Vitamin C Requirements
Julia K Bird, Edith JM Feskens, Alida Melse-Boonstra
Current Developments in Nutrition.2024; 8(5): 102152. CrossRef
Expansion of a food composition database for the food frequency questionnaire in the Korean Genome and Epidemiology Study (KoGES): a comprehensive database of dietary antioxidants and total antioxidant capacity
Jiseon Lee, Ji-Sook Kong, Hye Won Woo, Mi Kyung Kim
Epidemiology and Health.2024; 46: e2024050. CrossRef

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

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Abstract Summary PDF Supplementary Material

Abstract

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Summary

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

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

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Multicenter evaluation of tofacitinib retention and safety in rheumatoid arthritis – why cardiovascular risk factors do not equate to overt risk
Anna Felis-Giemza, Mateusz Moskal, Krzysztof Proc, Zbigniew Guzera, Marcin Stajszczyk, Karolina Palej, Kornelia Chmurzyńska, Piotr Wiland, Krzysztof Batko, Bogdan Batko
Rheumatology.2024; 61(6): 414. CrossRef
Biologics Versus JAK Inhibitors. Part I: Cancer Risk. A Narrative Review
Miguel Mansilla-Polo, Daniel Morgado-Carrasco
Dermatology and Therapy.2024; 14(6): 1389. CrossRef
JAK inhibitor selectivity: new opportunities, better drugs?
Anniina Virtanen, Francesca Romana Spinelli, Jean Baptiste Telliez, John J. O’Shea, Olli Silvennoinen, Massimo Gadina
Nature Reviews Rheumatology.2024; 20(10): 649. CrossRef
Safety and Effectiveness of Baricitinib in Chinese Patients with Moderate-to-Severe Rheumatoid Arthritis: 24-Week Results from a Post-Marketing Safety Study
Chan-yuan Wu, Qian Wang, Jian Shi, Xiu-ying Zhang, Rong Du, Jie-ruo Gu, Qi-huan Liu, Jiao Yu, Jia-wei Xu, Yan-jie Zhang, Hao Zhu, Meng-tao Li, Xiao-feng Zeng
Rheumatology and Therapy.2023; 10(6): 1609. CrossRef
Comparative cardiovascular safety with janus kinase inhibitors and biological disease-modifying antirheumatic drugs as used in clinical practice: an observational cohort study from Sweden in patients with rheumatoid arthritis
Hannah Bower, Thomas Frisell, Daniela di Giuseppe, Benedicte Delcoigne, Johan Askling
RMD Open.2023; 9(4): e003630. CrossRef
Are JAKis more effective among elderly patients with RA, smokers and those with higher cardiovascular risk? A comparative effectiveness study of b/tsDMARDs in Sweden
Hannah Bower, Thomas Frisell, Daniela di Giuseppe, Benedicte Delcoigne, Ulf Lindström, Carl Turesson, Katerina Chatzidionysiou, Elisabet Lindqvist, Ann Knight, Helena Forsblad-d'Elia, Johan Askling
RMD Open.2023; 9(4): e003648. CrossRef

The association between occupational stress level and health-related productivity loss among Korean employees: Jonghee Chung, Jin-Hyo Kim, Jae Yoon Lee, Hee Seok Kang, Dong-wook Lee, Yun-Chul Hong, Mo-Yeol Kang; Epidemiol Health. 2023;45:e2023009. Published online December 28, 2022; DOI: https://doi.org/10.4178/epih.e2023009

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Abstract Summary PDF

Abstract

OBJECTIVES
Occupational stress management is particularly important for successful business operations, since occupational stress adversely affects workers’ health, eventually lowering their productivity. Therefore, this study aimed to investigate the correlation between occupational stress and health-related productivity loss (HRPL) among Korean workers.

METHODS

In 2021, 1,078 workers participated in a web-based questionnaire survey. HRPL was measured using the Work Productivity and Activity Impairment Questionnaire, and occupational stress was measured using the Korean Occupational Stress Scale-Short Form. The occupational stress level was divided into tertiles (low, intermediate, and high), and the low occupational stress group was used as the reference group. Using a generalised linear model, differences in labour productivity loss according to the level of occupational stress were tested after adjusting for demographic characteristics such as age, gender, education level, household income, occupation, and underlying medical conditions.

RESULTS

Non-parametric regression analysis of HRPL according to occupational stress showed a direct association between occupational stress and HRPL. A statistically significant difference was observed in HRPL between participants with intermediate and high occupational stress and those with low occupational stress.

CONCLUSIONS

Our results support the hypothesis that high occupational stress is associated with decreased labour productivity.

Summary

Korean summary
직무스트레스가 건강에 미치는 영향은 잘 알려져 있으나, 노동생산성에 대해 분석한 결과는 그동안 부족하였다. 한국 노동자 1078명을 분석한 결과, 직무스트레스가 낮은 군에 비해서 중등도이거나 높은 경우, 결근이나 프리젠티즘과 같은 건강관련 노동생산성 손실이 약 20%p 정도 높은 것으로 분석되었다.

Key Message
As a result of analyzing 1078 Korean workers, it was revealed that health-related labor productivity losses such as absenteeism and presenteeism were about 20%p higher when occupational stress was moderate or high compared to the low occupational stress group.

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Association between work from home and health-related productivity loss among Korean employees
Hyo Jeong Kim, Dong Wook Lee, Jaesung Choi, Yun-Chul Hong, Mo-Yeol Kang
Annals of Occupational and Environmental Medicine.2024;[Epub] CrossRef
The association between salivary IL-6 and poor sleep quality assessed using Apple watches in stressed workers in Japan
Akihiro Koreki, Mitsuhiro Sado, Yasue Mitsukura, Hisateru Tachimori, Anna Kubota, Yoshiaki Kanamori, Manae Uchibori, Shiyori Usune, Akira Ninomiya, Ryutaro Shirahama, Akihiro Fujimoto, Kanako Inabe, Hiroaki Miyata, Masaru Mimura
Scientific Reports.2024;[Epub] CrossRef
The association of emotional labor and workplace violence with health-related productivity loss
Heejoo Ko, Dohwan Kim, Seong-Sik Cho, Dong-Wook Lee, Jaesung Choi, Minseok Kim, Min Young Park, Mo-Yeol Kang
Journal of Occupational Health.2024;[Epub] CrossRef

Long-term association of pericardial adipose tissue with incident diabetes and prediabetes: the Coronary Artery Risk Development in Young Adults Study: Minsuk Oh, Wonhee Cho, Dong Hoon Lee, Kara M. Whitaker, Pamela J. Schreiner, James G. Terry, Joon Young Kim; Epidemiol Health. 2023;45:e2023001. Published online December 3, 2022; DOI: https://doi.org/10.4178/epih.e2023001

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
We examined whether pericardial adipose tissue (PAT) is predictive of prediabetes and type 2 diabetes over time.
METHODS
In total, 2,570 adults without prediabetes/diabetes from the Coronary Artery Risk Development in Young Adults Study were followed up over 15 years. PAT volume was measured by computed tomography scans, and the new onset of prediabetes/diabetes was examined 5 years, 10 years, and 15 years after the PAT measurements. Multivariable Cox regression models were used to examine the association between the tertile of PAT and incident prediabetes/diabetes up to 15 years later. The predictive ability of PAT (vs. waist circumference [WC], body mass index [BMI], waist-to-height ratio [WHtR]) for prediabetes/diabetes was examined by comparing the area under the receiver operating characteristic curve (AUC).
RESULTS
The highest tertile of PAT was associated with a 1.56 times (95% confidence interval [CI], 1.03 to 2.34) higher rate of diabetes than the lowest tertile; however, no association was found between the highest tertile of PAT and prediabetes in the fully adjusted models, including additional adjustment for BMI or WC. In the fully adjusted models, the AUCs of WC, BMI, WHtR, and PAT for predicting diabetes were not significantly different, whereas the AUC of WC for predicting prediabetes was higher than that of PAT.
CONCLUSIONS
PAT may be a significant predictor of hyperglycemia, but this association might depend on the effect of BMI or WC. Additional work is warranted to examine whether novel adiposity indicators can suggest advanced and optimal information to supplement the established diagnosis for prediabetes/diabetes.; Summary

Korean summary
본 연구는 심장 내 축적되는 내장지방과 5년에서 15년 뒤의 당뇨병 전조 단계 및 당뇨병의 발생률과 연관성이 있음을 제안한다. 또한, 본 연구는 심장 내 내장지방과 당뇨병 발생률의 관계는 체질량 지수 또는 허리둘레의 영향에 따라 상이할 수 있음을 제안한다.

Key Message
Pericardial adipose tissue may be a significant predictor of future hyperglycemia in adults, but this association might depend on the effect of body mass index or waist circumference.

The association between metabolic syndrome and heart failure in middle-aged male and female: Korean population-based study of 2 million individuals: Tae-Eun Kim, Hyeongsu Kim, JiDong Sung, Duk-Kyung Kim, Myoung-Soon Lee, Seong Woo Han, Hyun-Joong Kim, Sung Hea Kim, Kyu-Hyung Ryu; Epidemiol Health. 2022;44:e2022078. Published online September 21, 2022; DOI: https://doi.org/10.4178/epih.e2022078

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Abstract PDF

Abstract

OBJECTIVES
Although an association is known to exist between metabolic syndrome (MetS) and heart failure (HF) risk, large longitudinal studies are limited. We investigated metabolic status as a risk factor for HF in middle-aged male and female and considered sex differences in various risk factors for HF using nationwide real-world data.

METHODS

Data obtained from the Korean National Health Insurance Service from 2009 to 2016 were analyzed. A total of 2,151,597 middle-aged subjects (between 50 and 59 years old) were enrolled. Subjects were divided into 3 groups (normal, pre‐ MetS, and MetS). Cox proportional hazard models were used to estimate the association between MetS and incident HF after adjusting for clinical risk factors.

RESULTS

At baseline, MetS existed in 23.77% of male and 10.58% of female. Pre-MetS and MetS increased the risk of HF: the hazard ratios of pre-MetS for incident HF were 1.508 (95% confidence interval [CI], 1.287 to 1.767) in male and 1.395 (95% CI, 1.158 to 1.681) in female, and those of MetS were 1.711 (95% CI, 1.433 to 2.044) in male and 2.144 (95% CI, 1.674 to 2.747) in female. Current smoking, a low hemoglobin level, underweight (body mass index < 18.5 kg/m2), a high creatinine level, and acute myocardial infarction were also predictors of HF in both sexes.

CONCLUSIONS

Pre-MetS and MetS were identified as risk factors for HF in middle-aged male and female. The effect of MetS on the occurrence of HF was stronger in female than in male. Pre-MetS was also a predictor of HF, but was associated with a lower risk than MetS.

Summary

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Integrating machine learning and nontargeted plasma lipidomics to explore lipid characteristics of premetabolic syndrome and metabolic syndrome
Xinfeng Huang, Qing He, Haiping Hu, Huanhuan Shi, Xiaoyang Zhang, Youqiong Xu
Frontiers in Endocrinology.2024;[Epub] CrossRef
Association between metabolic syndrome and kidney cancer risk: a prospective cohort study
Lin Wang, Han Du, Chao Sheng, Hongji Dai, Kexin Chen
Lipids in Health and Disease.2024;[Epub] CrossRef
The Impact of Metabolic Syndrome on Heart Failure in Young Korean Population: A Nationwide Study
Tae-Eun Kim, Do Young Kim, Hyeongsu Kim, Jidong Sung, Duk-Kyung Kim, Myoung-Soon Lee, Seong Woo Han, Hyun-Joong Kim, Hyun Kyun Ki, Sung Hea Kim, Kyu-Hyung Ryu
Metabolites.2024; 14(9): 485. CrossRef
Do Sex and Gender-Related Differences Account to Different Risk of Developing Heart Failure in Middle-Aged People with Metabolic Syndrome?
Stefano Bonapace, Alessandro Mantovani
Metabolites.2024; 14(10): 528. CrossRef
Sex and Age Differences in the Impact of Metabolic Syndrome on Heart Failure Development
Tae-Eun Kim, Do Young Kim, Hyeongsu Kim, Sung Hea Kim
Metabolites.2024; 14(12): 653. CrossRef
17-year follow-up of association between telomere length and all-cause mortality, cardiovascular mortality in individuals with metabolic syndrome: results from the NHANES database prospective cohort study
Lijiao Xiong, Guangyan Yang, Tianting Guo, Zhaohao Zeng, Tingfeng Liao, Yanchun Li, Ying Li, Fujuan Chen, Shu Yang, Lin Kang, Zhen Liang
Diabetology & Metabolic Syndrome.2023;[Epub] CrossRef
Modifications of long-term heart rate variability produced in an experimental model of diet-induced metabolic syndrome
W. M. Lozano, J. E. Ortiz-Guzmán, O. Arias-Mutis, A. Bizy, P. Genovés, L. Such-Miquel, A. Alberola, F. J. Chorro, M. Zarzoso, C. J. Calvo
Interface Focus.2023;[Epub] CrossRef
Different Impact of Metabolic Syndrome on the Risk of Incidence of the Peripheral Artery Disease and the Venous Thromboembolism: A Nationwide Longitudinal Cohort Study in South Korea
Myung Soo Park, Jong Sun Ok, JiDong Sung, Duk-Kyung Kim, Seong Woo Han, Tae-Eun Kim, Bum Sung Kim, Hyun-Joong Kim, Sung Hea Kim, Hyeongsu Kim
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Predictors of COVID-19 booster vaccine hesitancy among fully vaccinated adults in Korea: a nationwide cross-sectional survey: Yunha Noh, Ju Hwan Kim, Dongwon Yoon, Young June Choe, Seung-Ah Choe, Jaehun Jung, Sang-Won Lee, Ju-Young Shin; Epidemiol Health. 2022;44:e2022061. Published online July 22, 2022; DOI: https://doi.org/10.4178/epih.e2022061

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study explored predictors of coronavirus disease 2019 (COVID-19) booster hesitancy among fully vaccinated young adults and parental COVID-19 vaccine hesitancy for their children.

METHODS

This cross-sectional study administered an online survey from December 2 to December 20, 2021. We enrolled participants aged 18-49 years, for whom ≥2 weeks had passed after their initial COVID-19 vaccination. We estimated odds ratios (ORs) with 95% confidence intervals (CIs) using multivariate logistic regression to evaluate factors associated with booster/vaccine hesitancy.

RESULTS

Among the 2,993 participants, 48.8% showed hesitancy (wait and see: 40.2%; definitely not: 8.7%). Booster hesitancy was more common among women (OR, 1.25; 95% CI, 1.05 to 1.50), younger people (OR, 1.44; 95% CI, 1.17 to 1.77), those with a lower education level (OR, 2.05; 95% CI, 1.10 to 3.82), those who received the mRNA-1273 vaccine type (OR, 2.01; 95% CI, 1.65 to 2.45), and those who experienced serious adverse events following previous COVID-19 vaccination (OR, 2.03; 95% CI, 1.47 to 2.80). The main reasons for booster hesitancy were concerns about safety (54.1%) and doubts about efficacy (29.8%). Among the 1,020 respondents with children aged <18 years, 65.8% were hesitant to vaccinate their children against COVID-19; hesitancy was associated with younger parental age, education level, the type of vaccine the parent received, and a history of COVID-19 infection.

CONCLUSIONS

Concerns about the efficacy and safety of COVID-19 vaccines were the major barrier to booster acceptance. The initial COVID-19 vaccine type (mRNA-1273), young age, gender (women), a low education level, and adverse events after the first COVID-19 vaccine were key predictors of booster hesitancy.

Summary

Korean summary
본 연구는 국내 19-49세 성인을 대상으로, 코로나19 3차접종 의향과 그들의 18세 미만 자녀에 대한 코로나19 기초접종 의향을 조사하고, 코로나19 백신접종 기피와 관련된 요인을 파악하고자 하였다. 2021년 12월 2일부터 20일까지 온라인 설문조사를 통하여 자료를 수집하였으며, 연구대상자는 코로나19 기초접종을 완료한 후 2주 경과한 19-49세 성인으로, 전국 대표성을 확보하기 위해 성별, 연령, 지역별로 층화하여 모집하였다. 코로나19 3차접종 기피율은 약 48.8%로 나타났으며, 접종 기피 관련 영향요인으로는 젊은 연령층, 여성, 낮은 교육수준, 기초접종 백신 종류, 기초접종 후 중증 이상반응 경험이 포함되었으며, 18세 미만 자녀에 대한 코로나19 기초접종 기피율은 65.8%로, 관련 영향요인으로는 젊은 부모 연령, 교육수준, 부모의 기초접종 백신 종류, 코로나19 감염 과거력이 포함되었다.

Key Message
Concerns about the safety and efficacy of COVID-19 vaccines were the major barrier to booster acceptance; the initial COVID-19 vaccine type (mRNA-1273), younger age, gender (women), a low education level, and adverse events after the first COVID-19 vaccine were key predictors of booster hesitancy.

Citations

Citations to this article as recorded by

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