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Causal effect of fasting serum glucose on atherosclerotic cardiovascular disease: a multivariable Mendelian randomization
Su Hyun Lee, Heejin Kimm, Byung-Wan Lee, Chung Mo Nam, So Young Kim, Sunmi Lee, Sun Ha Jee
Epidemiol Health. 2024;46:e2024096.   Published online December 6, 2024
DOI: https://doi.org/10.4178/epih.e2024096
  • 979 View
  • 61 Download
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Observational studies have reported that diabetes is a risk factor that increases the risk of atherosclerotic cardiovascular disease (ASCVD). However, the causal relationship remains a matter of debate. This study aimed to analyze the relationship between fasting serum glucose (FSG) and ASCVD.
METHODS
This study used data from the Korean Cancer Prevention Study-II (KCPS-II) Biobank, consisting of 159,844 people recruited with consent from 18 health examination centers from 2004 to 2013. Outcomes were confirmed based on diagnoses on hospital discharge summaries from National Health Insurance System. We used linear and non-linear Mendelian randomization (MR) methods. The outcome data were obtained from KCPS-II, and the exposure data were derived from the Korean Genome Epidemiology Study.
RESULTS
First, a prospective cohort study estimated that for each 10 mg/dL increase in FSG level, the risk of ASCVD increased by 4% (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.03 to 1.05). Second, the 2-sample MR study showed that every 10 mg/dL increase in FSG influenced the risk of ASCVD (odds ratio [OR], 1.11; 95% CI, 1.04 to 1.18). Third, the multivariable MR study showed that the OR per 10 mg/dL increase in FSG on ASCVD was 1.14 (p<0.001). Similar results were found for a 10 mg/dL increase in FSG and ischemic heart disease (IHD), but a significant relationship with stroke was not found. When performing non-linear MR, a linear relationship was observed between fasting blood sugar and ASCVD, including IHD and stroke.
CONCLUSIONS
FSG showed a linear and causal association with IHD, but not with stroke.
Summary
Korean summary
그동안 당뇨병이 심뇌혈관질환 발생에 위험요인이라는 역학적인 관찰연구는 많이 발표되었지만, 이러한 관련성에 대한 인과적 관련성에 대부분 연구는 서양인을 대상으로 발표되었고, 한국인 자료를 통해 발표된 적은 없었다. 이 연구는 관찰연구의 제한점으로 부각되는 혼란변수와 측정오류에 덜 영향을 받는 새로운 방법론으로써 다변수 멘델리언 무작위화 방법을 사용하여 공복혈당과 심뇌혈관질환의 인과성을 분석하였다. 분석결과, 공복혈당은 허혈성 심질환 발생위험에 인과적인을 관련성을 보였고 뇌졸중에 대해서는 인과적이지 않았다.
Key Message
Over the years, numerous epidemiological observational studies have reported that diabetes is a risk factor for cardiovascular and cerebrovascular diseases. However, most of these studies examining this association were conducted on Western populations, and no studies have been published using Korean data. This study employed a new methodology—multivariable Mendelian randomization—which is less affected by confounding factors and measurement errors, often highlighted as limitations of observational studies, to analyze the causal relationship between fasting glucose levels and cardiovascular and cerebrovascular diseases. The analysis revealed a causal relationship between fasting glucose levels and the risk of ischemic heart disease, while no causal association was observed with stroke.
Smoking-attributable mortality among Korean adults in 2019
Yeun Soo Yang, Keum Ji Jung, Heejin Kimm, Sunmi Lee, Sun Ha Jee
Epidemiol Health. 2024;46:e2024011.   Published online December 19, 2023
DOI: https://doi.org/10.4178/epih.e2024011
  • 3,614 View
  • 132 Download
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Tobacco use ranks among the leading preventable causes of death worldwide. This study was conducted to calculate the mortality rate attributable to smoking in Korea for 2019 and to highlight the importance of tracking and monitoring smoking-related deaths for public health purposes.
METHODS
Population attributable risk (PAR) was used to estimate the number of deaths related to smoking in 2019. PAR percentages were applied to the estimated mortality figures for various diseases, with PAR determined based on relative risk (RR). Levin’s formula was used to calculate PAR, and RR was adjusted for age and alcohol consumption using Cox proportional hazards regression model to derive disease-specific regression coefficients. The analysis incorporated previously determined smoking rates from 1985, and use rates of novel tobacco products were not considered.
RESULTS
The findings revealed a total of 67,982 smoking-attributable deaths in Korea in 2019, 56,993 of which occurred in men and 11,049 in women. The PAR of smoking for various causes of death in adult men was highest for lung cancer at 74.9%, followed by pneumonia (29.4%), ischemic heart disease (42.3%), and stroke (30.2%). For women, the PAR for smoking-related death was highest for lung cancer (19.9%), followed by stroke (7.6%), pneumonia (5.7%), and ischemic heart disease (9.1%).
CONCLUSIONS
In countries experiencing rapid fluctuations in smoking rates, including Korea, regular studies on smoking-related mortality is imperative. Furthermore, it is necessary to investigate smoking-related deaths, including the prevalence of novel tobacco product use, to accurately gauge the risks associated with emerging tobacco products.
Summary
Korean summary
이 연구는 2019년 한국에서 흡연으로 인한 사망률을 계산하고 공중 보건 목적을 위한 흡연 관련 사망추적 및 모니터링의 중요성을 강조합니다. 연구 결과, 2019년 한국에서 흡연으로 인해 총 67,982명이 사망했으며, 이 중 남성이 56,993명, 여성이 11,049명이었습니다. 특히 남성의 경우 폐암(74.9%), 여성의 경우 폐암(19.9%)에서 흡연으로 인한 사망 위험이 가장 높게 나타났습니다.
Key Message
This study analyzed deaths attributable to smoking in Korea in 2019, revealing that a total of 67,982 individuals lost their lives due to smoking. Among these, 56,993 were men and 11,049 were women, with the highest smoking-related mortality rate observed in men due to lung cancer at 74.9%, and in women due to lung cancer at 19.9%. Through these findings, this research emphasizes the importance of tracking and monitoring smoking-related deaths for public health.
Prediction of cancer survivors’ mortality risk in Korea: a 25-year nationwide prospective cohort study
Yeun Soo Yang, Heejin Kimm, Keum Ji Jung, Seulji Moon, Sunmi Lee, Sun Ha Jee
Epidemiol Health. 2022;44:e2022075.   Published online September 13, 2022
DOI: https://doi.org/10.4178/epih.e2022075
  • 7,784 View
  • 175 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study aimed to investigate the factors affecting cancer survival and develop a mortality prediction model for Korean cancer survivors. Our study identified lifestyle and mortality risk factors and attempted to determine whether health-promoting lifestyles affect mortality.
METHODS
Among the 1,637,287 participants in the Korean Cancer Prevention Study (KCPS) cohort, 200,834 cancer survivors who were alive after cancer diagnosis were analyzed. Discrimination and calibration for predicting the 10-year mortality risk were evaluated. A prediction model was derived using the Cox model coefficients, mean risk factor values, and mean mortality from the cancer survivors in the KCPS cohort.
RESULTS
During the 21.6-year follow-up, the all-cause mortality rates of cancer survivors were 57.2% and 39.4% in men and women, respectively. Men, older age, current smoking, and a history of diabetes were high-risk factors for mortality, while exercise habits and a family history of cancer were associated with reduced risk. The prediction model discrimination in the validation dataset for both KCPS all-cause mortality and KCPS cancer mortality was shown by C-statistics of 0.69 and 0.68, respectively. Based on the constructed prediction models, when we modified exercise status and smoking status, as modifiable factors, the cancer survivors’ risk of mortality decreased linearly.
CONCLUSIONS
A mortality prediction model for cancer survivors was developed that may be helpful in supporting a healthy life. Lifestyle modifications in cancer survivors may affect their risk of mortality in the future.
Summary
Korean summary
현재 암 생존자의 사망 위험을 평가하는 데 유용한 한국형 암 생존자 사망률 예측 모델은 없습니다. 본 연구에서는 고령, 남성, 현재 흡연, 당뇨병 병력을 포함한 생활양식 요인이 사망의 고위험 요인인 반면, 운동 습관 및 암의 가족력은 사망 위험을 감소시키는 것으로 나타났습니다. 현재 흡연과 운동 습관은 사망 위험에 영향을 미치는 수정 가능한 두 가지 요소로써, 이러한 생활습관 요인으로 구성된 예측모형은 생활습관 교정을 통해 우리나라 암 생존자의 사망률을 낮출 수 있음을 시사합니다.
Key Message
Currently, there is no Korean mortality prediction model for cancer survivors that would be useful in evaluating their risk of mortality. The present study showed that lifestyle factors, including older age, male sex, current smoking, and history of diabetes were high-risk factors for mortality, while exercise habits and a family history of cancer reduced the risk of mortality. Current smoking and exercise habits are the two modifiable factors that affected the risk of mortality. The prediction model comprising these lifestyle factors implies that the risk of mortality of cancer survivors in Korea can be reduced through lifestyle modification.

Citations

Citations to this article as recorded by  
  • COVID-19 Mortality and Severity in Cancer Patients and Cancer Survivors
    Jae-Min Park, Hye Yeon Koo, Jae-ryun Lee, Hyejin Lee, Jin Yong Lee
    Journal of Korean Medical Science.2024;[Epub]     CrossRef
  • Weight maintenance and gain were significantly associated with lower risk of all-cause and cancer-related mortality in Korean adults who were newly diagnosed with cancer based on the Korean NHIS-HEALS cohort
    Yong-June Kim, Seung Park, Won Tae Kim, Yoon-Jong Bae, Yonghwan Kim, Hee-Taik Kang
    Medicine.2023; 102(47): e36184.     CrossRef

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