Epidemiology and Health

Original Article

Age-period-cohort analysis of dietary sodium, potassium, and sodium-to-potassium ratio in Korea: Hee Ju Jun, Shieon Kim, Garam Jo; Epidemiol Health. 2025;47:e2025062. Published online November 4, 2025; DOI: https://doi.org/10.4178/epih.e2025062

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OBJECTIVES
Excessive sodium and insufficient potassium consumption are major dietary contributors to hypertension (HTN) and cardiovascular diseases. The sodium-to-potassium ratio is a known predictor of blood pressure (BP) and HTN. This study evaluated 16-year-trends in dietary sodium, potassium, and the sodium-to-potassium ratio, and their associations with BP and HTN in Korea.
METHODS
Data from 76,484 participants aged 19-79 years were obtained from the Korea National Health and Nutrition Examination Survey conducted in 2007-2022. Sodium and potassium intake were assessed using 24-hour recalls, and the sodium- to-potassium ratio was calculated. All values were energy-adjusted using the residual method. Age-period-cohort (APC) models were used to analyze temporal trends. Associations with BP and HTN were examined using multivariate linear and logistic regression models, adjusting for confounders.
RESULTS
Energy-adjusted sodium intake decreased across all age groups, and potassium slightly increased in the recent 5 years, though both remained suboptimal relative to recommendations. APC analyses showed increasing potassium intake with age and a reversed U-shape cohort pattern. The sodium-to-potassium ratio decreased with age and calendar year but increased in recent cohorts. A higher sodium-to-potassium ratio was strongly associated with elevated systolic (β=0.028, p<0.001) and diastolic BP (β=0.036, p<0.001), and increased odds of HTN (odds ratio, 1.19; 95% confidence interval, 1.07 to 1.33). A linear association appeared when the sodium-to-potassium ratio exceeded 1.00 in the spline model.
CONCLUSIONS
Despite improvements, sodium intake remains excessive, and potassium insufficient, particularly in younger adults and recent cohorts. Public health interventions should prioritize reducing sodium and promoting potassium-rich foods to reduce cardiovascular risk.; Summary

Korean summary
한국 성인의 나트륨 섭취는 지난 16년간 감소했지만 여전히 과도한 수준이고, 칼륨 섭취는 최근 증가했으나 권장량에 미치지 못했습니다. 연령·기간·코호트(APC) 분석 결과, 나트륨-칼륨 비율이 최근 출생 코호트에서 높아지는 경향을 보였습니다. 나트륨-칼륨 비율이 높을수록 혈압 상승과 고혈압 위험 증가가 유의하게 연관되는 만큼, 공중보건적 관리가 필요합니다.

Key Message
Over the past 16 years, sodium intake among Korean adults has decreased but remains high, while potassium intake has recently increased yet still falls below recommended levels. Age-period-cohort (APC) analyses showed that the sodium-to-potassium ratio has tended to increase in more recent cohorts. Because a higher sodium-to-potassium ratio is significantly associated with elevated blood pressure and a higher risk of hypertension, targeted public health efforts are needed.

Cohort Profiles

The 2019 Rio Grande birth cohort: profile of a Brazilian 5-year study on mental health conditions: Rafaela Costa Martins, Francine dos Santos Costa, Cauane Blumenberg, Thais Martins-Silva, Romina Buffarini, Juraci Almeida Cesar, Christian Loret de Mola; Epidemiol Health. 2025;47:e2025039. Published online July 21, 2025; DOI: https://doi.org/10.4178/epih.e2025039

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Abstract

We established the 2019 Rio Grande birth cohort to investigate the life course epidemiology of mental health and its intergenerational transmission. In 2019, we systematically identified all hospital births in the city of Rio Grande, located in Southern Brazil. Mothers who delivered a singleton liveborn child were administered a standardized, face-to-face questionnaire. In 2020, we conducted 2 follow-up assessments (WebCOVID-19 1 and 2), a third in 2021-22 (WebCOVID-19-3), and a fourth in 2023-24 (WebPOST-COVID). Across these follow-ups, we collected data on socio-demographic, environmental, and behavioral factors pertaining to both mother and child, as well as maternal mental health. Child mental health and development were specifically evaluated during the fourth follow-up. At baseline, 2,051 mothers were interviewed. Response rates for the online follow-ups were 54.1%, 51.1%, 48.7%, and 34.6%, respectively. In WebCOVID-19-3, the highest prevalence rates for depression (34.7%) and anxiety (33.1%) were observed. This cohort provides novel insights into maternal mental health, child development, and post-coronavirus disease 2019 behaviors, emphasizing culturally specific risk factors. Our findings are based on both published and ongoing studies. Data may be requested upon reasonable request.

Summary

Key Message
The 2019 Rio Grande Birth Cohort is a prospective study that has been following over 2,000 mothers and their children since 2019. It is designed specifically to understand the intergenerational transmission of mental health problems. The cohort's unique design combines detailed face-to-face questionnaires at baseline with remote, web-based follow-ups, and serves as a comprehensive overview of the cohort's methodology, data collection instruments, and study design, demonstrating its potential to generate valuable insights into maternal and child health.

Citations

Citations to this article as recorded by

Changes in habits among mothers during the period of social isolation due to COVID-19 in the municipality of Rio Grande, Rio Grande do Sul, Brazil
Jefferson Sales da Silva, Pâmela Moraes Volz, Rafaela Costa Martins, Francine dos Santos Costa, Cauane Blumenberg, Thais Martins Silva, Romina Buffarini, Lorena Goulart Vieira, Patricia Cota Lima, Zulema Mamani Condori, Caroline Lisset Dominguez Herido, C
Revista Brasileira de Epidemiologia.2025;[Epub] CrossRef

Cohort profile: the Kisalaya cohort of mother-infant dyads in rural south India (2008-2012): Smitha Chandrashekarappa, Krupa Modi, Karl Krupp, Kavitha Ravi, Anisa Khan, Vijaya Srinivas, Poornima Jaykrishna, Anjali Arun, Murali Krishna, Purnima Madhivanan; Epidemiol Health. 2020;42:e2020010. Published online March 11, 2020; DOI: https://doi.org/10.4178/epih.e2020010

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Abstract

The Kisalaya cohort was established in 2008, providing integrated antenatal care (ANC) and human immunodeficiency virus (HIV) testing in order to reduce adverse birth outcomes and pediatric HIV infections. The program used a mobile clinic model to deliver health education, ANC, and HIV/sexually transmitted infection testing and management to pregnant women in rural communities in southern India. This cohort includes pregnant women residing in 144 villages of the Mysuru taluk (a rural region) who received ANC through the mobile clinic and delivered their infants between 2008 and 2011. Of the 1,940 women registered for ANC at primary healthcare centers during this time period, 1,675 (75.6%) were enrolled in the Kisalaya cohort. Once women enrolled in the Kisalaya cohort gave birth, the cohort expanded to include the mother-infant dyads with a retention rate of 100% at follow-up visits at 15 days and at 6 months post-delivery. The baseline data collected during the Kisalaya study included both questionnaire-based data and laboratory-based investigations. Presently, a study entitled “Early life influences on adolescent mental health: a life course study of the Kisalaya birth cohort in south India” is in the process of data collection (2019-2020).

Summary

Citations

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Vulnerability to Sexually Transmitted Infections (STI) / Human Immunodeficiency Virus (HIV) among adolescent girls and young women in India: A rapid review
Sohini Paul, Anupam Sharma, Radhika Dayal, Mahika Mehta, Sudeshna Maitra, Kuhika Seth, Monal Nagrath, Sowmya Ramesh, Niranjan Saggurti, Ajoke Basirat Akinola
PLOS ONE.2024; 19(2): e0298038. CrossRef

Methods

The unrealized potential: cohort effects and age-period-cohort analysis: Jongho Heo, Sun-Young Jeon, Chang-Mo Oh, Jongnam Hwang, Juhwan Oh, Youngtae Cho; Epidemiol Health. 2017;39:e2017056. Published online December 5, 2017; DOI: https://doi.org/10.4178/epih.e2017056

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Abstract

This study aims to provide a systematical introduction of age-period-cohort (APC) analysis to South Korean readers who are unfamiliar with this method (we provide an extended version of this study in Korean). As health data in South Korea has substantially accumulated, population-level studies that explore long-term trends of health status and health inequalities and identify macrosocial determinants of the trends are needed. Analyzing long-term trends requires to discern independent effects of age, period, and cohort using APC analysis. Most existing health and aging literature have used cross-sectional or short-term available panel data to identify age or period effects ignoring cohort effects. This under-use of APC analysis may be attributed to the identification (ID) problem caused by the perfect linear dependency across age, period, and cohort. This study explores recently developed three APC models to address the ID problem and adequately estimate the effects of A-P-C: intrinsic estimator-APC models for tabular age by period data; hierarchical cross-classified random effects models for repeated cross-sectional data; and hierarchical APC-growth curve models for accelerated longitudinal panel data. An analytic exemplar for each model was provided. APC analysis may contribute to identifying biological, historical, and socioeconomic determinants in long-term trends of health status and health inequalities as well as examining Korean’s aging trajectories and temporal trends of period and cohort effects. For designing effective health policies that improve Korean population’s health and reduce health inequalities, it is essential to understand independent effects of the three temporal factors by using the innovative APC models.

Summary

Korean summary
-건강수준 및 건강불평등의 장기적인 추이에 미치는 연령, 기간, 출생 코호트의 독립적인 영향을 분해하는 방법인 연령-기간-코호트 분석법(Age-Period-Cohort analysis)을 국내 보건의료 연구자들에게 체계적으로 소개함 -APC 분석법은 건강수준 및 건강행태, 건강불평등의 추세 분석 및 고령화, 만성질환, 생애주기 연구 등에 있어서 널리 활용될 수 있음 -APC 연구 결과를 바탕으로 향후 보건의료 정책에 있어서도 기간 또는 연령에 따른 정책뿐 아니라 코호트에 특정한 정책들도 고려되어야 할 필요가 있음

Citations

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Original Article

Mortality Trends in Colorectal Cancer and Breast Cancer in Korea: Birth Cohort Effects?.: Jae Kwan Jun, Yeon Ju Kim, Jin Gwack, Yunhee Choi, Yun Chul Hong, Keun Young Yoo; Korean J Epidemiol. 2005;27(1):154-162.

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Abstract PDF: Abstract
PURPOSE
Cancer has been the leading cause of deaths since 1980s in Korea. Among them, colorectal cancer and breast cancer shows steadily increasing pattern, being the fourth and the fifth common site of cancer death in Korea, respectively. This analysis aimed to evaluate potential contribution of birth cohort effects to the recent increases in mortality of colorectal cancer and breast cancer since 1983 in Korea.
METHODS
Mortality statistics on deaths of both cancers for the past 20 years of 1983~2002 were obtained from the National Statistical Office. The age-standardized mortality rates were calculated based on the census population of 1992 as a standard.
RESULTS
Age-standardized mortality rate for colorectal cancer increased 4.7-fold in men and 3.6-fold in women, whereas 2.1-fold increase in breast cancer mortality during 1983~2002. Age-specific mortality rates for colorectal cancer were steadily increasing by age before 1991 in both genders. However, the mortality rates showed an exponentially increasing pattern for the age group of 70 and over during 1993~2001, which was more prominent in female. The birth cohort curves showed that there were 2- to 3-fold increases in the mortality rates of people who were born in 1931 for colorectal cancer compared to those of people who were born in 1921. Differences in mortality for breast cancer by birth cohort were 1.7-fold among age group of 45~49 and 50~54 between 1936 and 1946.
CONCLUSIONS
This analysis suggests that recent increases in mortality of colorectal cancer and breast cancer could potentially be due to birth cohort effects, i.e. rapid changes in life-style in younger generation. The quantitative approach using age-period-cohort model should be pursued.; Summary

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