Epidemiology and Health

COVID-19: Special Article

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

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Abstract Summary PDF Supplementary Material

Abstract

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Summary

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

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

Citations

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COVID-19: Original Article

The medium-term consequences of a COVID-19 lockdown on lifestyle among Spanish older people with hypertension, pulmonary disease, cardiovascular disease, musculoskeletal disease, depression, and cancer: Irene Rodríguez-Gómez, Coral Sánchez-Martín, Francisco J. García-García, Esther García-Esquinas, Marta Miret, Germán Vicente-Rodriguez, Narcís Gusi, Asier Mañas, José A. Carnicero, Marcela Gonzalez-Gross, José L. Ayuso-Mateos, Fernando Rodríguez-Artalejo, Leocadio Rodríguez-Mañas, Ignacio Ara; Epidemiol Health. 2022;44:e2022026. Published online February 21, 2022; DOI: https://doi.org/10.4178/epih.e2022026

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Abstract PDF Supplementary Material: Abstract
OBJECTIVES
This study investigated the associations of chronic diseases with changes in lifestyle and health behaviours in older people following the coronavirus disease 2019 (COVID-19) lockdown in Spain and compared the differences in changes over time.
METHODS
1,092 participants (80.3±5.6 years; 66.5% female) from 2 Spanish cohorts were included. Telephone-based questionnaires were conducted to evaluate lifestyle and health risk behaviours at the end of lockdown and 7 months post-lockdown. Participants were classified as having physician-diagnosed chronic diseases based on self-reported data. Cox proportional models adjusted for major confounders were used.
RESULTS
Compared to those without the corresponding chronic diseases, older people with hypertension were less likely to report increased alcohol consumption (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.55 to 0.99). Pulmonary diseases were associated with lower risks of increased sedentary time (HR, 0.58; 95% CI, 0.39 to 0.86) and worsened sleep quality (HR, 0.56; 95% CI, 0.36 to 0.87), while cardiovascular diseases were associated with a lower risk of decreased sedentary time (HR, 0.58; 95% CI, 0.38 to 0.88). Depression was linked to a higher likelihood of improved diet quality (HR, 1.53; 95% CI, 1.00 to 2.36). Cancer pacients were less likely to have worsened sleep quality (HR, 0.44; 95% CI, 0.22 to 0.89) but more likely to have reduced their frequency of social contact (HR, 2.05; 95% CI, 1.05 to 3.99).
CONCLUSIONS
Older people with chronic diseases showed beneficial changes in lifestyle and health risk behaviours after the COVID-19 lockdown. In particular, older people with hypertension, pulmonary disease, and cancer tended to make beneficial lifestyle and health behaviour changes. However, older people with cardiovascular disease and depression engaged in more health risk behaviours.; Summary

Korean summary

Key Message
Although the majority of older people with chronic diseases showed beneficial changes in lifestyle and health risk behaviors after the COVID-19 lockdown, public health interventions should be developed to prevent the dangerous long-term effects that COVID-19 pandemic-type situations may have on the health of older people, with a particular focus on older people with CVD and depression that seem to have experienced more health risk behaviors during the COVID-19 pandemic than older people with other chronic diseases.

Editorial

Spatiotemporal analyses of the epidemiological characteristics of diabetes mellitus: Sang Youl Rhee; Epidemiol Health. 2021;43:e2021102. Published online December 16, 2021; DOI: https://doi.org/10.4178/epih.e2021102

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Abstract Summary PDF

Abstract

Research based on spatiotemporal analysis has been conducted to identify various factors that can affect an individual’s or community’s degree of health and disease. These spatiotemporal studies can effectively illustrate patterns in disease frequency, features, and temporal flow in different parts of a country. Furthermore, identifying these regional characteristics can aid in the development of disease prevention or intervention strategies.

Summary

Korean summary
1. 시공간 분석은 국가 혹은 지역의 질병 빈도, 특징 및 시간 흐름의 패턴을 효과적으로 설명할 수 있다. 2. 시공간 분석은 질병의 예방 또는 중재 전략 개발에 도움이 될 수 있다.

Key Message
1. Spatiotemporal analyses can effectively illustrate patterns in disease frequency, features, and temporal flow in different parts of a country. 2. Spatiotemporal analysis can aid in disease prevention or development of intervention strategies.

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Methods

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

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31 Citations

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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Obesity, hypertension, diabetes mellitus, and hypercholesterolemia in Korean adults before and during the COVID-19 pandemic: a special report of the 2020 Korea National Health and Nutrition Examination Survey
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Original Articles

Effects of adults’ health behaviors and combinations thereof on health outcomes: an analysis using National Health Insurance Service of Korea cohort data: Hyun-Jung Park, Eun-Jung Kim; Epidemiol Health. 2019;41:e2019042. Published online October 8, 2019; DOI: https://doi.org/10.4178/epih.e2019042

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Abstract Summary PDF

Abstract

OBJECTIVES
The purpose of this study was to estimate the effects of health-risk behaviors, alone and in combination, on health outcomes.

METHODS

This study used sample cohort data provided by the National Health Insurance Service focusing on the use of hospital services, direct medical expenses, length of stay, and re-entry rate according to health-risk behaviors. A frequency analysis and the chi-square test were used to investigate associations between the demographic characteristics of study subjects and their health-risk behaviors. The strength of the association of each factor was calculated as the odds ratio in a crossover analysis.

RESULTS

Obesity had the largest effect, especially in combination with smoking and drinking. In particular, significant associations were shown with the duration of hospitalization and direct medical expenses. After adjustment for sex, age, economic status, and pre-existing medical conditions, the duration of hospitalization was 7.37 times longer and that of medical expenses was 5.18 times higher in the obese group relative to the non-obese group. Drinking showed a statistically significant association with the number of days of hospitalization. After adjusting for the control variables, the number of hospital days was 1.24 longer in the drinking group than in the non-drinking group.

CONCLUSIONS

An analysis of combinations of health risk factors showed obesity had the largest effect.

Summary

Korean summary
본 연구에서는 건강위해행동이 건강결과에 미치는 영향을 추정하고, 건강위해행동 간 상호작용을 분석하여 보다 다차원적 측면에서 건강위해행동과 건강결과 간 관계를 다루었다. 그 결과, 흡연, 비만, 음주 중 1개의 위해행위를 가지고 있는 경우, 흡연 집단에서 모든 건강결과와의 관련성이 통계적으로 유의미하지 않았으나, 비만의 경우, 입원일수와 직접의료비간의 관련성이 유의미하였고, 특히, 비만한 집단의 경우, 성별, 연령, 경제적 수준 및 기저 질환을 보정한 후, 그렇지 않은 집단과 비교하여 입원일수와 의료비의 유의미한 증가가 확인되었다. 건강위험행태요인의 조합을 조사하여, 어떤 경우 건강행태에 영향을 크게 미치는지를 분석한 결과, 비만의 영향이 가장 큰 것으로 분석되었으며, 흡연과 음주, 단일의 건강위험행태보다, 비만과 함께 건강위험행태가 동반되었을 때 그 영향이 증가하였다.

Key Message

Citations

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R.B.N. de Carvalho, F. Rauber, R.M. Claro, R.B. Levy
Public Health.2021; 195: 7. CrossRef

The coverage rates for influenza vaccination and related factors in Korean adults aged 50 and older with chronic disease: based on 2016 Community Health Survey data: Kyeong Hyang Byeon, Jaiyong Kim, Boyoung Choi, Bo Youl Choi; Epidemiol Health. 2018;40:e2018034. Published online July 24, 2018; DOI: https://doi.org/10.4178/epih.e2018034

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aims to identify the coverage rates for influenza vaccination and related factors depending on chronic disease in Korean adults aged 50 and older.

METHODS

The 2016 Korea Community Health Survey was used for analysis. Chi-square test was performed to investigate the coverage rates for influenza vaccination depending on chronic disease, and a multiple logistic regression analysis was used to identify the factors associated with influenza vaccination, by chronic disease.

RESULTS

In men with ≥1 chronic disease, 39.8% of 50-64 years of age, and 86.8% of elderly (over 65 years of age) received influenza vaccination. In women with ≥1 chronic disease, 58.7% of 50-64 years of age, and 89.9% of elderly (over 65 years of age) received influenza vaccination (p<0.001). The chronic diseases associated with influenza vaccination were hypertension (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.19 to 1.37), diabetes (OR, 1.41; 95% CI, 1.28 to 1.55) in men aged 50-64, hypertension (OR, 1.34; 95% CI, 1.20 to 1.49), diabetes (OR, 1.17; 95% CI, 1.02 to 1.33), chronic cardiovascular disease (OR, 1.31; 95% CI, 1.07 to 1.60) in elderly (over 65 years of age). In women aged 50-64, hypertension (OR, 1.39; 95% CI, 1.30 to 1.49), diabetes (OR, 1.51; 95% CI, 1.35 to 1.68), chronic cardiovascular disease (OR, 1.31; 95% CI, 1.05 to 1.64), and hypertension (OR, 1.55; 95% CI, 1.40 to 1.71), diabetes (OR, 1.27; 95% CI, 1.12 to 1.43) in elderly (over 65 years of age).

CONCLUSIONS

Populations in aged 50-64 are recommendation subject for vaccination or classified as high-risk group in case with chronic disease. Though subject over 60 years old is age close to the elderly, the coverage rates for vaccination was low. It is necessary to devise strategies to raise the coverage rates for vaccination.

Summary

Korean summary
매년 인플루엔자 환자수는 증가하는 추세이며 인플루엔자로 인한 의료이용의 질병부담은 커질 것으로 생각된다. 국내에서는 우선접종 권장대상자들에게 예방접종을 받도록 권고하고 있으며, 예방접종은 인플루엔자를 예방할 수 있는 비용 효과적인 방법이다. 65세 이상 대상자는 국가 무료 예방접종 사업 대상으로 인해 예방접종률이 높은 것으로 확인되었다. 50-64세 인구는 예방접종 권고 대상자임에도 불구하고 낮은 것으로 나타났고, 50-64세 연령에서 만성질환을 동반할 경우 고위험군이지만 여전히 낮은 예방접종률을 보였다. 또한 50-64세 연령에서 1개 이상 만성질환을 동반할 경우 대도시, 중소도시에 거주하는 것보다 군지역에 거주할 경우 높은 예방접종률을 확인함으로써 대도시 및 중소도시에 거주하는 50-64세 연령에 대해 예방접종률을 올릴 수 있는 적극적인 예방접종 홍보가 필요할 것으로 생각한다.

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Journal of Korean Medical Science.2023;[Epub] CrossRef
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Prevalence, awareness, treatment, control, and risk factors of hypertension among adults: a cross-sectional study in Iran: Maryam Eghbali, Alireza Khosravi, Awat Feizi, Asieh Mansouri, Behzad Mahaki, Nizal Sarrafzadegan; Epidemiol Health. 2018;40:e2018020. Published online May 18, 2018; DOI: https://doi.org/10.4178/epih.e2018020

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Abstract PDF

Abstract

OBJECTIVES
Hypertension (HTN) is an important risk factor for cardiovascular disease. Considering the importance of this disease for public health, this study was designed in order to determine the prevalence, awareness, treatment, control, and risk factors of HTN in the Iranian adult population.

METHODS

This cross-sectional study was conducted among 2,107 residents of Isfahan, Iran. Samples were selected through multi-stage random cluster sampling in 2015-2016. The outcome variable was HTN, determined by measuring blood pressure in the right arm via a digital arm blood pressure monitor. Awareness, treatment, and control of HTN were assessed by a validated and reliable researcher-developed questionnaire. Other demographic and clinical variables were assessed via a demographic questionnaire.

RESULTS

The overall prevalence of HTN was 17.3% (18.9 and 15.5% in men and women, respectively). The prevalence of HTN increased in both genders with age. The prevalence of awareness of HTN among people with HTN was 69.2%, of whom 92.4 and 59.9% were taking medication for HTN and had controlled HTN, respectively. Logistic regression identified age, body mass index, having diabetes and hyperlipidemia, and a positive family history of HTN as determinants of awareness of HTN.

CONCLUSIONS

The results showed that HTN was highly prevalent in the community, especially in men and in middle-aged and older adults. Approximately 30.8% of patients were unaware of their disease, and there was less awareness among younger adults. Despite the high frequency of taking medication to treat HTN, it was uncontrolled in more than 40.1% of patients. Health policy-makers should therefore consider appropriate preventive and therapeutic strategies for these high-risk groups.

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Bahareh Karami, Azam Azimi, Zohreh Rahimi, Sousan Mahmoudi, Nazanin Jalilian
Biochemical Genetics.2023;[Epub] CrossRef
Prevalence and incidence of pre-hypertension and hypertension (awareness/control) in Iran: findings from Kerman coronary artery diseases risk factors study 2 (KERCADRS)
Hamid Najafipour, Hamid Reza Nasri, Farzaneh Rostamzadeh, Raheleh Amirzadeh, Mitra Shadkam, Ali Mirzazadeh
Journal of Human Hypertension.2022; 36(5): 461. CrossRef
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Editorial

Monitoring targets and indicators for the prevention and control of non-communicable diseases in Korea: Soon Young Lee; Epidemiol Health. 2015;37:e2015023. Published online May 4, 2015; DOI: https://doi.org/10.4178/epih/e2015023

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Abstract PDF: Abstract
In order to respond to the increasing burden of non-communicable diseases (NCDs) worldwide, the World Health Organization developed the global action plan (GAP), which included nine targets and 25 indicators to monitor the targets. Owing to space constraints, the article reviewed the status of 17 indicators for seven targets out of nine targets in the GAP in Korea. Most of these 17 indicators required additional analysis with existing national data to evaluate the status in Korea. Based on the result from evaluating indicators, the current NCD policy strategy and resources in Korea seemed unlikely to reach the GAP goals, unless innovative policy changes was planned to reduce NCD risk factors particularly focusing on smoking, excessive drinking, and insufficient physical activity.; Summary

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Original Article

Dietary Factors Related to the Chronic Diseases Assessed by Semiquantitaive Food Frequency Questionnaire in Korean Adults Living in Rural Area.: J E Shim, J Y Ryu, H Y Paik, C S Shin, H K Lee, Y S Park; Korean J Epidemiol. 1997;19(1):42-57.

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Abstract PDF: Abstract
This study was conducted to assess dietary intake of adults in rural ares and to determine the dietary factors associated with the development of chronic diseases. A cross sectional dietary survey using semiquantitative food frequency questionnaire was conducted together with a health survey including health questionnaire, physical examination and glucose tolerance test. Mean dairy energy intake of subjects was 1872.5kcal and mean percent of RDA for energy intake was 88.4%. Nutrients of average intake below 75% of RDA were vitamine A, vitamin B2, calcium. Older subjects tend to have lower nutrient intake. Intakes of most nutrients and proportion of energy from alcohol were signifi-cantly higher in men than in woman. Newly diagnosed diabetic patients and hypertensives had higher age, BMI, blood pressure, fasting serum glucose levels and serum lipid levels compared with subjects without the diseases, respectively. After adjusted for age and sex, newly-diagnosed hypertencives had more intakes of charbohydrate and niacin, and higher proportion of energy from fat. The odds ratio(OR) for hypertension in higher quartile of subjects compared with subjects in the lowest quartile of intake increased significantly for energy, fat,protein, carbohydrate, vitamin B1, vitamin B2 and niacin after adjusted for age and sex. Also, compared with subjects consumed nutrients in 75-125% of RDA, the OR for hypertension in subjects with intake levels above 125% of RDA were 0.75 for energy, 1.69 for calcium and 0.68 for niacin, and those in below 75% of RDA were 1.33 for energy 1.42 for calcium, 1.23 for vitamin B1, 1.41 for vitamin B2. These inverse associations suggest that the development of hypertension in rural area of Korea is partialey attributed to the intake of several nutrients, generally of undernu-trition. Therefore these results suggests that dietary factors related to chronic diseases in Korea are different from those in the Western society.; Summary

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