Epidemiology and Health

Original article

Association between smoking and the risk of dental implant failure in Korean adults: a nationwide cohort study: Yu-Rin Kim, Minkook Son, hyeon Ji Kim, Seon-Rye Kim; Epidemiol Health. 2026;e2026002. Published online January 14, 2026; DOI: https://doi.org/10.4178/epih.e2026002 [Accepted]

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Abstract Summary PDF: Abstract
OBJECTIVES
We evaluated the associations of smoking status, intensity, duration, and cumulative exposure with the risk of dental implant failure in Korean adults.
METHODS
This retrospective cohort study utilized the National Health Insurance Service–Health Screening Cohort (2016–2019). Overall, 23,573 individuals who had completed the dental implant process were included. Smoking status was categorized as non-smoker, ex-smoker, or current smoker. Smoking intensity, duration, and cumulative exposure were classified using standardized thresholds (>10 cigarettes per day, >10 years, and >10 pack-years). Implant failure was defined as reimplantation or removal. Cox proportional hazards models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for demographic, clinical, and behavioral covariates.
RESULTS
During follow-up, 605 implant failures occurred: 344 in non-smokers, 182 in ex-smokers, and 79 in current smokers. The corresponding incidence rates per 1,000 person-years were 11.6, 16.5, and 22.3, respectively. Current smoking was significantly associated with higher implant failure risk (adjusted HR, 1.59; 95% CI, 1.20 to 2.09), while ex-smokers displayed a non-significant increase (adjusted HR, 1.16; 95% CI, 0.94 to 1.45). A dose–response relationship was observed: smoking more than 10 cigarettes per day, smoking for more than 10 years, or exceeding 10 pack-years was associated with significantly increased risk.
CONCLUSIONS
Smoking is a significant, dose-dependent risk factor for dental implant failure in Korean adults. Current smokers have the highest risk; smoking cessation may reduce adverse outcomes. These findings emphasize the importance of detailed smoking assessments and cessation counseling in implant care and public health strategies.; Summary

Korean summary
본 연구는 치아 임플란트를 시행한 성인들을 대상으로 흡연 상태(현재, 과거, 비흡연)와 흡연 강도, 기간, 누적 노출량에 따른 임플란트 실패 위험의 차이를 분석하였다. 분석 결과, 비흡연자에 비하여 현재 흡연자, 하루 10개피 이상 흡연자, 10년 이상 장기 흡연자, 10갑년 이상 누적 흡연자에서 임플란트 실패 위험이 유의하게 높았다. 특히, 여성의 경우 흡연이 임플란트 실패에 미치는 영향이 남성보다 크게 나타났다. 반면, 과거흡연자는 통계적으로 유의한 연관성을 보이지 않았다. 이러한 결과는 구강건강 증진과 임플란트의 성공적 예후를 위해 흡연자의 금연지도가 필수적임을 시사한다.

Key Message
This study examined differences in implant failure risk according to smoking status (current, former, never) and smoking intensity, duration, and cumulative exposure among adults who underwent dental implant placement. Compared with never-smokers, the risk of implant failure was significantly higher in current smokers, those who smoked ≥10 cigarettes/day, long-term smokers (≥10 years), and individuals with ≥10 pack-years of cumulative smoking exposure. Notably, the adverse impact of smoking on implant failure was greater in women than in men. In contrast, former smoking was not statistically associated with implant failure. These findings underscore the need for structured smoking-cessation counseling to improve oral health and optimize implant prognosis.

Methods

Plan and operations of the 10th Korea National Health and Nutrition Examination Survey (2025–2027): Sun-Ja Kim, Sihyun Park, Sunja Kim, Suyeon Park, Yoonjung Kim, Yunjung Choi, Sungha Yun, Kyungwon Oh; Epidemiol Health. 2026;48:e2026001. Published online January 2, 2026; DOI: https://doi.org/10.4178/epih.e2026001

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Abstract Summary PDF: Abstract
The Korea National Health and Nutrition Examination Survey (KNHANES) is a national health survey mandated by Article 16 of the National Health Promotion Act to assess the health and nutritional status of the Korean population. Over the past 2 decades, the survey has continuously introduced timely survey components while strengthening its survey methodology and operational systems to enhance both the policy relevance and scientific utility of its findings. The 10th KNHANES (2025–2027) preserves the statistical representativeness of its sampling design while expanding the use of web-based self-administered questionnaires to improve participant convenience. In response to Korea’s transition into a super-aged society, the 10th KNHANES incorporates enhanced older-adult health surveys, including osteoporosis assessment and older adults’ life functioning, and newly introduces items addressing social support as part of the social determinants of health. In addition, a longitudinal follow-up survey system has been established to monitor long-term changes in population health. Collectively, these changes are expected to improve understanding of aging-related health issues, support evidence-based national health policy development, and expand the applicability of KNHANES data for academic research.; Summary

Korean summary
국민건강영양조사는 국민건강증진법 제16조에 근거하여 1998년부터 우리 국민의 건강 및 영양 수준을 파악해 온 국가 단위 건강조사이다. 제10기(2025–2027) 국민건강영양조사는 통계적 대표성을 유지하면서 온라인 조사로의 지속적인 개선·확대, 초고령 사회 등 사회·보건환경 변화에 대응한 신규 조사항목 도입, 추적조사 체계 구축을 통해 국가 건강정책 및 만성질환 예방·관리 전략 수립을 위한 근거 생산을 강화하고자 한다.

Key Message
The Korea National Health and Nutrition Examination Survey (KNHANES) is a national health survey mandated by Article 16 of the National Health Promotion Act that has assessed the health and nutritional status of the Korean population since 1998. The 10th KNHANES (2025–2027) maintains statistical representativeness while further improving and expanding web-based self-administered surveys, incorporating new survey components in response to social and public health changes such as the transition to a super-aged society, and establishing a longitudinal follow-up system to strengthen the evidence base for national health policy development and chronic disease prevention and management.

Original Article

Cardiovascular disease risk disparities between immigrants and native Koreans: a population-based study in Gwangju, Korea: Jung-Ho Yang, Yerin Choi, Ran Lee, Seong Eun Kim, Kyung-Hwa Park, Seong-Woo Choi, BongKyu Sun, Kyunghak Kim, Sun-Seog Kweon; Epidemiol Health. 2025;47:e2025067. Published online December 8, 2025; DOI: https://doi.org/10.4178/epih.e2025067

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Korea is becoming a multiethnic society, with immigrants comprising nearly 5% of the population. Evidence on cardiovascular disease (CVD) risk among immigrants remains limited.
METHODS
We conducted a population-based study of 582 immigrants in Gwangju and 2,328 age-matched and gender-matched native Koreans (2022-2023). Immigrant data were obtained from direct health assessments, while native Korean data were drawn from the Korea National Health and Nutrition Examination Survey. CVD risk was estimated using the Framingham risk score (FRS) and pooled cohort equations (PCE). Logistic regression was employed to compare the odds of elevated risk (10-year CVD risk ≥7.5%), adjusting for socio-demographic and behavioral factors.
RESULTS
Immigrants had a higher prevalence of hypertension (37.3 vs. 16.1%), diabetes (11.5 vs. 5.6%), poor self-rated health (69.6 vs. 61.3%), and unmet medical needs (30.9 vs. 8.9%), as well as lower rates of health checkups and cancer screening (all p<0.001), compared to native Koreans. Elevated CVD risk was more frequent in immigrants (FRS, 31.4 vs. 20.8%; PCE, 33.6 vs. 22.8%). The adjusted odds ratios (95% confidence intervals) were 1.47 (1.14 to 1.88) for FRS and 1.49 (1.07 to 2.08) for PCE. Disparities were greatest among women, adults ≥40 years, uninsured people, low-income groups, and migrants from Central Asia, Russia, and Africa.
CONCLUSIONS
Immigrants in Korea face substantially higher CVD risk than native Koreans, particularly within socioeconomically vulnerable subgroups. Targeted prevention and policies addressing structural barriers are urgently needed.; Summary

Korean summary
국내 거주 이민자는 한국인보다 불리한 건강 상태와 더 높은 심혈관질환 위험을 보였다. 특히 여성, 고령자, 저소득층 등 취약 집단에서 격차가 두드러졌으며, 이는 구조적·사회경제적 요인이 이민자 건강 불평등에 기여함을 보여준다. 이러한 결과는 포용적 보건의료 정책과 맞춤형 예방 전략 마련의 필요성을 시사한다.

Key Message
Immigrants in South Korea face unmet healthcare needs, such as limited screening access, low disease awareness, and undertreatment of dyslipidemia. Our study shows consistently higher cardiovascular risk among immigrants compared with native Koreans, especially among women, older adults, uninsured individuals, and Central Asian migrants. These findings underscore the epidemiological importance of structural and socioeconomic disadvantages in shaping immigrant health disparities and emphasize the need for culturally tailored interventions and inclusive health policies to achieve cardiovascular health equity.

Cohort Profile

Study protocol for the Korean Human Exposure Safety Survey (KoHESS): a national biomonitoring program for food and consumer product safety: Hyeon-Jeong Lim, Sang-Yong Eom, Sun-Haeng Choi, Seonmi Hong, Byung-Sun Choi, Young-Seoub Hong, Kwan Lee, Won-Ju Park, Jae-Seok Song, Nam-Jun Kim, Hyo-Jeong Hwang, Rihwa Choi, Hosub Im, Youn-Seok Kang, Hye-Young Lee, Mi-Ran Kim, Hyunjin Son, Yong-Dae Kim; Epidemiol Health. 2025;47:e2025060. Published online October 29, 2025; DOI: https://doi.org/10.4178/epih.e2025060

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This protocol paper describes the design and methodology of the Korean Human Exposure Safety Survey (KoHESS), a three-year national biomonitoring program (2023-2025). Korea’s Act on Risk Assessment of Products for Human Use necessitates scientific evidence for aggregate exposure assessment and cumulative risk evaluation of hazardous substances in food and consumer products. Existing biomonitoring programs primarily focus on environmental exposures, limiting comprehensive assessment of products regulated by the Ministry of Food and Drug Safety. KoHESS employs repeated cross-sectional surveys targeting approximately 5,000 Koreans aged 3-79 years per cycle, using complex stratified multistage sampling for national representativeness. Data collection includes standardized anthropometric measurements, biological samples (blood, urine), comprehensive exposure source surveys, and 2-day 24-hour dietary recalls. Chemical analyses using liquid chromatography-tandem mass spectrometry and inductively coupled plasma mass spectrometry measure 24 perfluoroalkyl and polyfluoroalkyl substances compounds, 25 phthalate metabolites, and 7 heavy metals, with quality assurance through certified reference materials. KoHESS will provide scientifically robust data for establishing safety standards, enable advanced exposure modeling, facilitate risk assessments reflecting cumulative exposures, support targeted protection for vulnerable populations, and contribute to international biomonitoring networks while promoting preventive hazardous substance management systems.; Summary

Korean summary
- 식품의약품안전처(MFDS)가 주관하는 KoHESS (2023-2025)는 한국을 대표하는 5,000명의 국민(3~79세)을 대상으로 3년간 반복 수행되는 전국 규모의 인체 모니터링 프로그램이다. - 기존 환경 노출 데이터의 한계를 보완하여 식품 및 소비재 유래 유해 물질(PFAS 24종, 프탈레이트 25종, 중금속 7종)의 인체 노출 수준을 측정한다. - 수집된 과학적 데이터는 유해 물질의 통합 노출 평가, 누적 위해성 평가 및 제품 안전 기준 설정을 위한 핵심 근거 자료로 활용될 것으로 기대된다.

Key Message
- KoHESS (2023-2025) is a national, repeated cross-sectional biomonitoring program led by the Ministry of Food and Drug Safety (MFDS), targeting 5,000 Koreans (3-79 years) per cycle. - It measures 24 PFAS, 25 phthalate metabolites, and 7 heavy metals, specifically focusing on hazardous substances from food and consumer products, filling gaps in existing environmental data. - The data provides robust scientific evidence crucial for aggregate exposure assessment, cumulative risk evaluation, and establishing safety standards for regulated products.

Original Articles

Personal, community, and societal factors associated with mukbang viewing among adolescents: findings from the Korea Youth Risk Behavior Survey: Cynthia Yursun Yoon, Seungha Shin, Haemi Jun, Hyeeun Park, Minseo Kim; Epidemiol Health. 2025;47:e2025055. Published online September 30, 2025; DOI: https://doi.org/10.4178/epih.e2025055

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Mukbang refers to livestreamed videos in which hosts consume large amounts of energy-dense, nutrient-poor foods while interacting with viewers. Mukbang is widely viewed by Korean adolescents and has been associated with adverse health outcomes. To inform efforts to prevent excessive engagement with mukbang content among Korean adolescents, this study examined personal, community, and societal factors associated with excessive mukbang viewing (≥7 times/wk) and explored gender differences in these associations.
METHODS
Data were drawn from the 2022 Korea Youth Risk Behavior Survey (n=36,990; mean age, 15.1±1.7 years; 48.6% girls; 53.2% attending middle school). Self-reported measures included personal (e.g., perceived health, weight, stress, depression, anxiety), community (e.g., living arrangement), and societal factors (e.g., socioeconomic status) and mukbang viewing frequency. Logistic and modified Poisson regression models were used to examine associations with excessive mukbang viewing and to evaluate differences by gender.
RESULTS
Intrapersonal factors—namely perceived health, weight, stress, depression, and anxiety—were associated with excessive mukbang viewing (adjusted prevalence ratios, 1.18 to 1.44), with more pronounced relationships among girls. A community-level factor—living arrangement—displayed a significant association in boys but not in girls. Boys living on campus had 1.42 times the prevalence of excessive mukbang viewing than boys residing with family members (95% confidence interval, 1.08 to 1.88) after adjustment. Further mutual adjustment attenuated estimates toward the null. Societal factors were not significantly associated with excessive mukbang viewing among adolescents.
CONCLUSIONS
Personal and community factors were associated with excessive mukbang viewing. Future research should investigate the mechanisms underlying these associations.; Summary

Korean summary
- 건강 인식 저하, 스트레스, 우울, 불안 등 개인적인 요인은 과도한 먹방 시청과 관련이 있었으며, 특히 여학생에게서 두드러져, 정서적 어려움이 먹방을 정서 조절이나 사회적 연결의 수단으로 활용할 가능성을 시사한다 - 기숙사에 거주하는 남학생이 가족과 거주하는 남학생보다 과도하게 먹방을 시청할 가능성이 높았으며, 이는 또래 영향과 지역사회의 환경이 먹방 시청에 중요한 역할을 함을 보여준다 - 사회경제적 수준은 과도한 먹방 시청과 유의한 관련은 없었으며, 이는 모든 청소년을 대상으로 정서적 건강과 건강한 미디어 사용을 촉진하는 보편적 예방 전략이 필요함을 시사한다

Key Message
- Personal factors such as poor perceived health, stress, depression, and anxiety were strongly related to excessive mukbang viewing, particularly among girls, suggesting that emotional distress may drive girls to engage with mukbang as a form of coping or personal connection - Among boys, those living on campus were more likely to view mukbang excessively than those living with family, indicating that community environment and peer influence may contribute to higher engagement in mukbang - Socioeconomic status was not significantly associated with excessive mukbang viewing, implying that prevention efforts should address emotional well-being and healthy media use across all adolescents, regardless of the background

Association between psychosocial safety climate and depression risk among Korean workers: Soo Kyung Cho, Seong-Sik Cho, Maureen F. Dollard, May Young Loh, Mo-Yeol Kang; Epidemiol Health. 2025;47:e2025044. Published online August 13, 2025; DOI: https://doi.org/10.4178/epih.e2025044

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Abstract Summary PDF: Abstract
OBJECTIVES
Psychosocial safety climate (PSC) reflects an organization’s commitment to safeguarding workers’ psychological health and safety. While international evidence links low PSC to poor mental health outcomes, its association with depression has not been well established in Korea. This study aimed to examine the relationship between PSC and depression among Korean workers, utilizing a large-scale, population-based survey.
METHODS
We analyzed data from 5,337 wage employees who participated in the fifth wave of the Korean Work, Sleep, and Health Study. Depression was measured using the 9-item Patient Health Questionnaire, and PSC was assessed with a validated 4-item scale. Participants were classified into low-risk, intermediate-risk, and high-risk groups based on their PSC scores. Multivariable logistic regression was conducted to estimate the association between PSC and depression, with stratified analyses performed according to gender, age, and occupational characteristics.
RESULTS
The prevalence of depression increased as PSC scores decreased. Compared to the low-risk group, the intermediate-risk and high-risk PSC groups exhibited 1.19 times and 2.69 times higher risks of depression, respectively, suggesting a clear exposure-response relationship. Stratified analyses indicated that associations were stronger among individuals without union representation or access to occupational health and safety resources.
CONCLUSIONS
These findings underscore the critical role of PSC in workplace mental health. Promoting a high PSC may help reduce depression risk and support mental well-being among workers. Interventions considering vulnerable subgroups are warranted to create psychologically safer work environments in Korea.; Summary

Korean summary
-본 연구에서는 한국 근로자에서 심리사회적 안전풍토(PSC) 점수가 낮을수록 우울 위험이 유의하게 높아짐을 확인하였다. -PSC 중간위험군과 고위험군의 우울 위험은 저위험군에 비해 각각 1.19배, 2.69배 높았다. -연구 결과는 근로자의 정신건강 증진과 국가적 정책 수립을 위해 직장에서의 PSC 강화를 강조한다.

Key Message
-This study demonstrates that lower psychosocial safety climate (PSC) scores are associated with a significantly higher risk of depression among Korean workers. -The risk of depression was 1.19 times higher in the intermediate-risk PSC group and 2.69 times higher in the high-risk PSC group compared with the low-risk group. -Findings highlight the importance of strengthening PSC in workplaces to improve employee mental health and guide national policies.

Can resident registration expiration statistics due to death be used for near-real-time mortality tracking? A validation study using 2023 data from Korea: Jin-Hwan Kim; Epidemiol Health. 2025;47:e2025042. Published online August 3, 2025; DOI: https://doi.org/10.4178/epih.e2025042

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Abstract Summary PDF: Abstract
OBJECTIVES
Real-time mortality tracking is essential for public health surveillance, especially during emergencies such as the coronavirus disease 2019 (COVID-19) pandemic. In Korea, delayed availability of vital statistics (VS) data has hindered timely mortality monitoring. This study evaluates whether National Administrative Data (NAD) on resident registration expiration due to death, provided by the Ministry of Interior and Safety, could serve as a reliable alternative for near real-time mortality surveillance.
METHODS
We compared mortality counts between VS and NAD for 2023 at multiple geographic levels (county, province, and nation) and across demographic strata (sex and age groups). The analysis was conducted in 3 stages: comparing overall mortality counts, analyzing county-level distributions, and assessing equivalence through correlation analyses, scatter plots, and density plots.
RESULTS
NAD showed strong agreement with VS at the national level, reporting only 0.4% more deaths overall (0.2% for male, 0.6% for female). Notable differences were observed in early childhood mortality, with NAD showing 16.8% fewer deaths for neonates (age 0) and 14.8% more for ages 1-4, as well as in monthly variations (5-9%). Correlation analyses indicated extremely high consistency between the 2 data sources across all geographic levels (correlation coefficients ≥0.999), especially at the national and provincial levels.
CONCLUSIONS
NAD provides a reliable alternative to VS for real-time mortality surveillance in Korea, providing comparable accuracy with much-improved timeliness. Although some variations are present in specific age groups and monthly trends, these can be addressed through appropriate analytical strategies. The recent availability of sex-specific and age-specific data in NAD since 2023 establishes it as a valuable infrastructure for mortality surveillance.; Summary

Korean summary
- 행정자료(NAD)는 통계청 사망통계(VS)와 높은 일치도를 보여 신속한 사망 감시체계 구축에 활용할 수 있다. - 2023년부터 NAD에 성별·연령별 정보가 포함됨에 따라, 한국의 공중보건 위기 대응을 위한 핵심적인 사망 감시 인프라로 발전할 수 있게 되었다.

Key Message
- National Administrative Data (NAD) demonstrates high concordance with Vital Statistics (VS), making it applicable for establishing rapid mortality surveillance systems. - With the inclusion of sex- and age-specific information since 2023, NAD has evolved into a critical mortality surveillance infrastructure for South Korea's public health emergency response.

Sugar-sweetened beverage consumption and metabolic dysfunction-associated steatotic liver disease: a beverage type-specific analysis using Korea National Health and Nutrition Examination Survey: Hong Jae Jeon, Woo Sun Rou, Seok Hyun Kim, Byung Seok Lee, Ha Neul Kim, Hei-Gwon Choi, Jaehee Seo, Hyuk Soo Eun, Sukyoung Jung; Epidemiol Health. 2025;47:e2025038. Published online July 21, 2025; DOI: https://doi.org/10.4178/epih.e2025038

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent liver disease. Evidence indicates a relationship between sugar-sweetened beverage (SSB) consumption and MASLD development; however, the effects of specific SSB types on MASLD remain underexplored. This study investigated the association between consumption of 3 distinct types of SSBs and MASLD in Korean adults.
METHODS
We analyzed data from the Korea National Health and Nutrition Examination Survey 2012-2016, including 8,310 participants aged 40-64 years. SSB consumption (soft drinks, fruit drinks, and Korean traditional drinks) was assessed using a food frequency questionnaire. MASLD was defined as a hepatic steatosis index ≥36 in the presence of any cardiometabolic risk factor. Logistic regression models were used to estimate odds ratios (ORs) with 95% confidence intervals (CIs), adjusting for relevant covariates.
RESULTS
Compared to non-drinkers, consumption of soft drinks (≥3 serving/wk) was associated with higher odds of MASLD (OR, 1.36; 95% CI, 1.02 to 1.81; p for trend=0.03), while consumption of Korean traditional drinks (≥3 serving/wk) was associated with lower odds of MASLD (OR, 0.63; 95% CI, 0.45 to 0.89; p for trend=0.01). No association was found between fruit drink consumption and MASLD. In sex-stratified analysis (p-interaction=0.38), an inverse association between Korean traditional drinks and MASLD was observed in male (OR, 0.57; 95% CI, 0.34 to 0.95; p for trend=0.03), but not in female (OR, 0.72; 95% CI, 0.45 to 1.14; p for trend=0.17).
CONCLUSIONS
Consuming soft drinks at least 3 times per week was positively associated with MASLD, whereas an equivalent intake of Korean traditional drinks was inversely associated with MASLD.; Summary

Korean summary
-본 연구는 국민건강영양조사에 참여한 40-64세 한국 성인 8,310명을 대상으로 가당 음료와 새롭게 정의된 대사기능장애 연관 지방간질환(MASLD) 간 연관성을 음료 유형별로 비교 분석하였다. - 주 3회 이상의 탄산음료 섭취는 MASLD 유병 가능성이 증가한 반면, 동일한 빈도의 한국 전통음료 섭취는 유병 가능성을 낮췄다. - 음료 유형에 따른 MASLD 유병 차이는 향후 식이 지침 개발에 중요한 근거가 될 수 있으며, 향후 개인이 건강을 위해 보다 선택적인 음료 섭취를 위한 정책 수립에 기여할 수 있다.

Key Message
Among 8,310 Korean adults aged 40-64 years, soft drink consumption (≥3 servings/week) increased the odds of MASLD, while the same intake of Korean traditional drinks decreased the odds. These findings suggest that beverage type may be an important dietary factor associated with MASLD. Given the differential associations observed, our findings may help inform dietary recommendations that enable individuals to make more selective beverage choices for better liver health.

Health literacy in Korea: findings from the 2023 Korea National Health and Nutrition Examination Survey: Sunhye Choi, Yukyeong Kang, Hyejin Kim, Kyungwon Oh; Epidemiol Health. 2025;47:e2025037. Published online July 9, 2025; DOI: https://doi.org/10.4178/epih.e2025037

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Abstract Summary PDF

Abstract

OBJECTIVES
This study aimed to assess health literacy and identify vulnerable groups, providing a basis for developing health policies aimed at improving health literacy, using data from the 2023 Korea National Health and Nutrition Examination Survey (KNHANES).

METHODS

The health literacy measurement tool used in the 2023 KNHANES comprised a total of 10 items spanning the domains of disease prevention, health promotion, healthcare, and technology and resources. Health literacy was analyzed in relation to socio-demographic characteristics and major health behaviors among 5,906 adults aged 19 years or older, using the SAS program.

RESULTS

As of 2023, the overall prevalence of adequate health literacy among adults was 60.4%. Adequate health literacy was higher in women (62.2%) than in men (58.6%). Younger individuals exhibited higher levels of health literacy, with those aged 19–64 years at 65.9%, compared to only 40.3% among those aged 65 or older. Higher income and education levels were also associated with greater health literacy. Regarding health behavior characteristics, individuals practicing healthy lifestyles, such as non-smoking, engaging in physical activity, and undergoing health checkups, demonstrated higher health literacy than those who did not engage in such behaviors.

CONCLUSIONS

Six out of 10 Korean adults demonstrated adequate health literacy, but significant differences were observed according to socio-demographic characteristics (e.g., age and education) and health behaviors (e.g., smoking and physical activity). Tailored education and policy initiatives are necessary to improve health literacy, particularly targeting older adults, low-income groups, individuals with lower education, and those who do not practice healthy lifestyles.

Summary

Korean summary
2023년 국민건강영양조사를 통해 우리 국민의 건강정보이해능력을 처음으로 조사한 결과, 우리나라 성인 10명 중 6명은 적절한 건강정보이해능력을 갖고 있었다. 건강정보이해능력은 고령, 낮은 교육수준, 건강생활 비실천 등에서 낮아 취약군의 건강정보이해능력 향상을 위한 맞춤형 교육과 정보 제공 등 다양한 방안 모색이 필요하다.

Key Message
According to the results of the 2023 KNHANES—the first nationwide assessment of health literacy in Korea—6 out of 10 Korean adults had adequate health literacy. Diverse strategies—including targeted education and information provision—are needed to improve health literacy among vulnerable groups such as older adults, those with low education and individuals who do not practice healthy lifestyles.

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The Effects of Health Literacy, Social Support, and Health-Promoting Behaviors on Metabolic Syndrome Among Middle-Aged and Older Women Living in Rural Areas of Republic of Korea
Eun-Kyung Lee, Yong-Sook Eo
Healthcare.2025; 13(24): 3279. CrossRef

Socioeconomic inequality in organized and opportunistic screening for breast cancer: results from the Korean National Cancer Screening Survey, 2009-2021: Yejin Ha, Xuan Quy Luu, Woorim Kim, Jae Kwan Jun, Mina Suh, Kui Son Choi; Epidemiol Health. 2025;47:e2025031. Published online May 30, 2025; DOI: https://doi.org/10.4178/epih.e2025031

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Breast cancer screening rates have increased since the introduction of the National Cancer Screening Program (NCSP) in Korea. However, it remains unclear whether socioeconomic inequalities have improved, particularly according to screening type. This study investigated inequalities in organized (government-led) and opportunistic (individually initiated) screening, stratified by education and income levels.
METHODS
Data were obtained from the Korean National Cancer Screening Survey, conducted annually from 2009 to 2021, involving approximately 1,700 women each year except in 2009. Trends were analyzed using joinpoint regression to calculate average annual percent changes (AAPCs). Socioeconomic inequalities were assessed using the slope index of inequality (SII) and relative index of inequality (RII).
RESULTS
Organized screening rates increased from 42.0% in 2009 to 60.2% in 2021 (AAPC, 1.9; 95% confidence interval [CI], 0.7 to 3.4), whereas opportunistic screening rates declined from 13.3% to 11.2% (AAPC, -5.4; 95% CI, -8.7 to -2.3). For organized screening, individuals with lower education levels exhibited higher participation, resulting in negative inequality indices (SII, -5.37%; RII, 0.80). No significant income-based inequality was found (SII, 1.60%; RII, 1.07). However, opportunistic screening demonstrated significant inequalities by both education (SII, 5.37%; RII, 1.92) and income (SII, 5.90%; RII, 1.96), with higher participation rates among more advantaged groups.
CONCLUSIONS
The NCSP has improved breast cancer screening rates and reduced income-related inequality in organized screening. However, educational and income-based inequalities persist in opportunistic screening. To reduce screening inequities, policy efforts are needed to further promote the NCSP, including improving program quality and providing financial support for follow-up examinations.; Summary

Korean summary
본 연구는 한국의 유방암 검진에서 검진 유형에 따른 사회경제적 불평등을 분석하였다. 국가 검진에서는 전체 수검률이 증가하고 소득 관련 불평등이 감소한 반면 개인 검진에서는 사회경제적 불평등이 여전히 존재하였다. 유방암 검진의 불평등을 줄이기 위해 지속적이고 집중적인 정책 노력이 필요하다.

Key Message
This study examined socioeconomic inequality in breast cancer screening in Korea by screening type. While organized screening has improved overall participation and reduced income-related inequality, socioeconomic inequalities remain in opportunistic screening. Continued and targeted policy efforts for the NCSP are necessary to further reduce inequality in breast cancer screening.

Adherence to the Korean National Code Against Cancer and mortality: a prospective cohort study from the Health Examinees-Gem study: Jeeyoo Lee, Aesun Shin, Woo-Kyoung Shin, Ji-Yeob Choi, Daehee Kang; Epidemiol Health. 2025;47:e2025026. Published online May 9, 2025; DOI: https://doi.org/10.4178/epih.e2025026

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
The Korean National Code Against Cancer was released in 2006. These guidelines aimed to promote a healthy lifestyle to prevent cancer risk through 10 recommendations. The objective of this study was to investigate the associations between adherence to the Korean National Code Against Cancer and the risk of all-cause, cancer, and cardiovascular disease (CVD) mortality among Koreans.
METHODS
This prospective cohort study included 109,160 Korean adults aged 40 years to 69 years, recruited from 2004 to 2013 in the population-based Health Examinees-Gem Study. The adherence total score was calculated based on 6 items from the Korean National Code Against Cancer: smoking, consuming vegetables and fruits, limiting salty foods, restricting alcohol intake, engaging in physical activity, and maintaining a healthy weight. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations of adherence scores with mortality risk were estimated using a Cox proportional hazards regression model.
RESULTS
During a mean follow-up period of 12.0 years, 3,799 deaths were recorded. According to the multivariable-adjusted model, males in the highest tertile of adherence scores had a lower risk of all-cause, cancer, and CVD mortality compared to those in the lowest tertile (all-cause: HR, 0.67; 95% CI, 0.60 to 0.74; cancer: HR, 0.63; 95% CI, 0.54 to 0.74; CVD: HR, 0.56, 95% CI, 0.43 to 0.73). A similar association was observed among females for all-cause and CVD mortality (all-cause: HR, 0.85; 95% CI, 0.76 to 0.96; CVD: HR, 0.70; 95% CI, 0.51 to 0.97).
CONCLUSIONS
Adherence to the Korean National Code Against Cancer was associated with a reduced risk of all-cause, cancer, and CVD mortality.; Summary

Korean summary
한국인 대규모 집단에서 암예방 수칙 준수도가 높을수록 전체 사망, 암 사망, 심혈관질환 사망 위험이 감소함을 확인하였으며, 암예방수칙의 보급과 준수가 암뿐만 아니라 다른 만성질환으로 인한 사망을 예방하는 데 중요함을 시사한다.

Key Message
We found that greater adherence to the Korean National Code Against Cancer was associated with reduced risks of all-cause, cancer, and cardiovascular disease mortality in a large Korean population, highlighting the importance of promoting this code for public health.

Effects of student human rights ordinances on mental health among middle and high school students in South Korea: a difference-in-differences analysis: Sang Jun Eun; Epidemiol Health. 2025;47:e2025011. Published online March 1, 2025; DOI: https://doi.org/10.4178/epih.e2025011

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
To actively protect and enhance students’ human rights, student human rights ordinances (SHROs) have been enforced in seven provinces in South Korea at different times since 2010. Although human rights are closely linked to mental health, there has been no research on the effectiveness of human rights legislation on adolescent mental health. This study evaluated the effects of SHROs on the mental health of middle and high school students.
METHODS
Repeated cross-sectional data were used, including 1,148,257 respondents from the Korea Youth Risk Behavior Web-based Survey between 2006 and 2023. Probabilities of perceived stress, sleep insufficiency, depressive mood, suicide ideation, and suicide attempt in treated provinces were estimated through a difference-in-differences approach that accounts for treatment effect heterogeneity across groups over time.
RESULTS
SHROs had no consistently significant effects on any mental health outcomes, except for slightly increased suicide ideation in total students (0.7%, 95% confidence interval 0.3% to 1.1%). Suicide attempts in total and male students and perceived stress and sleep insufficiency in female students tended to decrease, while other mental health outcomes tended to increase. Uncertainty in the effect estimates of SHROs increased for all mental health outcomes with possible violations of parallel trends, rendering originally significant effects insignificant.
CONCLUSIONS
SHROs failed to improve mental health of middle and high school students in treated provinces, possibly due to the absence of enforcement mechanisms. Further research is needed on the effectiveness of and effect mechanisms for legal measures to improve human rights on adolescent mental health.; Summary

Korean summary
학생의 인권을 포괄적으로 보장하기 위해 학생인권조례가 시행되었지만 학생인권조례 시행 지역에서 중고등학생의 정신건강은 향상되지 않았는데, 이는 조례에 벌칙 조항 같은 강제성 기전이 없었기 때문이었을 수 있다. 학생인권조례는 중고등학생의 정신건강에 대해 효과가 없었지만 이 연구는 인권 법제의 청소년 정신건강에 대한 효과를 처음으로 평가했다. 인권증진을 위한 법적 수단의 청소년 정신건강에 대한 효과성과 효과 기전에 관하여 추가 연구가 필요하다.

Key Message
Although student human rights ordinances have been enforced in South Korea to comprehensively guarantee human rights for students, they failed to improve the mental health of middle and high school students in treated provinces, possibly due to the absence of enforcement mechanisms such as penalty provisions. Despite the ineffectiveness of student human rights ordinances, this study first estimated the effects of human rights legislation on adolescent mental health. Further research is needed on the effectiveness of and effect mechanisms for legal measures to improve human rights on adolescent mental health.

Preventable cancer cases and deaths attributable to alcohol consumption in Korea from 2015 to 2030: Soseul Sung, Jihye An, Jeehi Jung, Hyeon Sook Lee, Sungji Moon, Inah Kim, Jung Eun Lee, Aesun Shin, Sun Ha Jee, Sun-Seog Kweon, Min-Ho Shin, Sangmin Park, Seungho Ryu, Sun Young Yang, Seung Ho Choi, Jeongseon Kim, Sang-Wook Yi, Yoon-Jung Choi, Youjin Hong, Sangjun Lee, Woojin Lim, Kyungsik Kim, Sohee Park, Jeong-Soo Im, Hong Gwan Seo, Kwang-Pil Ko, Sue K. Park; Epidemiol Health. 2025;47:e2025009. Published online February 27, 2025; DOI: https://doi.org/10.4178/epih.e2025009

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Alcohol consumption is causally linked to several cancers, and major health organizations classify it as a carcinogen. This study assessed the impact of alcohol consumption on cancer incidence and mortality in Korea in 2015 and 2020, projected trends up to 2030, and compared results based on different criteria.
METHODS
The relative risk of cancer associated with alcohol consumption in Korea was determined through a meta-analysis of alcohol-related relative risks for specific cancers, using primary data from the Korean Cohort Study within the Korean Cohort Consortium. The population-attributable fraction (PAF) was calculated using Levin’s formula, incorporating drinking prevalence and the number of cancer cases and deaths, with a 15-year latency period assumed.
RESULTS
In Korea, the PAF for alcohol consumption, based on ever/never drinking criteria, was higher than that calculated using other criteria, except for the PAF based on past and current/never drinking criteria. Alcohol consumption contributed to 3.58% of all cancer cases and 3.28% of cancer deaths in 2015. It accounted for 4.58% of new cancer cases in male and 2.08% in female, with a higher contribution to incidence than mortality (4.00 and 2.25% of cancer deaths in male and female, respectively). Projections indicate that alcohol-related cancer PAF will decrease by 17.2% in male but increase by 70.2% in female by 2030.
CONCLUSIONS
This study highlights the impact of alcohol consumption on cancer in Korea, emphasizing the need for sex-specific regulations to address sex differences.; Summary

Korean summary
2015년 알콜 섭취는 한국에서 전체 암 발생의 3.58%, 암 사망의 3.28%를 차지했으며, 남성(4.58%)이 여성(2.08%)보다 더 큰 영향을 받았음. 2030년까지 남성의 알콜 관련 암 발생률은 감소할 것으로 예상되지만, 여성에서는 급증할 것으로 보임. 이러한 결과는 특히 여성에서 증가하는 추세를 반영하여 성별 맞춤형 공공 보건 정책의 필요성을 시사함.

Key Message
In 2015, alcohol consumption was responsible for 3.58% of all cancer cases and 3.28% of cancer deaths in Korea, with a more significant impact on males (4.58% of new cases) than females (2.08%). Projections indicate a decrease in alcohol-related cancer cases among males but a sharp increase in females by 2030. These findings highlight the need for sex-specific public health measures to address the growing impact of alcohol on cancer, particularly the increasing trend in female cases.

Preventable cancer cases and deaths attributable to tobacco smoking in Korea from 2015 to 2030: Soseul Sung, Jihye An, Jeehi Jung, Hyeon Sook Lee, Sungji Moon, Inah Kim, Jung Eun Lee, Aesun Shin, Sun Ha Jee, Sun-Seog Kweon, Min-Ho Shin, Sangmin Park, Seungho Ryu, Sun Young Yang, Seung Ho Choi, Jeongseon Kim, Sang-Wook Yi, Yoon-Jung Choi, Youjin Hong, Sangjun Lee, Woojin Lim, Kyungsik Kim, Daehee Kang, Keun-Young Yoo, Sohee Park, Jeong-Soo Im, Hong Gwan Seo, Hai-Rim Shin, Kwang-Pil Ko, Sue K. Park; Epidemiol Health. 2025;47:e2025008. Published online February 27, 2025; DOI: https://doi.org/10.4178/epih.e2025008

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Tobacco smoking is a major public health concern worldwide. This study aimed to assess its impact on cancer incidence and mortality by estimating the population attributable fraction (PAF) in the Korean population for 2015 and 2020 and by projecting future trends until 2030.
METHODS
The Korean relative risk (RR) was calculated via a meta–analysis of RRs for individual cancers attributed to tobacco smoking, based on primary data analysis from the Korean Cohort Consortium. The PAF was estimated using the Levin formula with past and current prevalence rates and the number of cancer cases and deaths, assuming a 15-year latency period.
RESULTS
The proportions of cancer cases and deaths in Korea attributable to tobacco smoking were similar to those calculated using Asian and global RRs for both male and female. In 2015 and 2020, tobacco smoking contributed to 14.32% and 13.17% of cancer cases and 21.70% and 20.69% of cancer deaths in adults, respectively. Among Koreans, smoking was responsible for 25.83% of new cancer cases in male in 2015, 23.49% in male in 2020, 1.46% in female in 2015, and 1.68% in female in 2020. In both years, smoking impacted mortality more strongly than incidence in Korean male and female (incidence in male: 25.83% and 23.49%; mortality in male: 32.09% and 30.41%; incidence in female: 1.46% and 1.68%; and mortality in female: 4.70% and 4.96%, respectively).
CONCLUSIONS
Tobacco smoking causes cancers and deaths in Korea, however, it is preventable. Effective control policies that consider trends and vulnerabilities among female are required.; Summary

Korean summary
한국에서 흡연으로 인한 암 부담은 2015년 발생 14.32%, 사망 21.70%였고 2020년에는 발생 13.17%, 사망 20.69%로 나타남. 두 해 모두 남성에서 부담이 훨씬 컸음(남성: 발생 2015년 25.83%, 2020년 23.49%; 사망 2015년 32.09%, 2020년 30.41% / 여성: 발생 2015년 1.46%, 2020년 1.68%; 사망 2015년 4.70%, 2020년 4.96%). 흡연은 예방 가능한 주요 원인이므로, 여성의 취약성과 추세를 고려한 보다 강력한 금연·규제 정책 강화가 필요함.

Key Message
In Korea, tobacco smoking accounted for 14.32% of incident cancers and 21.70% of cancer deaths in 2015, and 13.17% of incidence and 20.69% of mortality in 2020. The burden was much greater in men than in women in both years (men: incidence 25.83% in 2015 and 23.49% in 2020; mortality 32.09% in 2015 and 30.41% in 2020; women: incidence 1.46% in 2015 and 1.68% in 2020; mortality 4.70% in 2015 and 4.96% in 2020). Smoking remains a preventable driver of substantial cancer incidence and mortality, calling for stronger control policies that also address emerging vulnerabilities among women.

Preventable cancer cases and deaths attributable to deficit of physical activity in Korea from 2015 to 2030: Soseul Sung, Sungji Moon, Jihye An, Jeehi Jung, Hyeon Sook Lee, Youjin Hong, Sangjun Lee, Woojin Lim, Kyungsik Kim, Inah Kim, Jung Eun Lee, Sun Ha Jee, Aesun Shin, Ji-Yeob Choi, Sun-Seog Kweon, Min-Ho Shin, Sangmin Park, Seungho Ryu, Sun Young Yang, Seung Ho Choi, Jeongseon Kim, Sang-Wook Yi, Yoon-Jung Choi, Jeong-Soo Im, Hong Gwan Seo, Sohee Park, Kwang-Pil Ko, Sue K. Park; Epidemiol Health. 2025;47:e2025010. Published online January 27, 2025; DOI: https://doi.org/10.4178/epih.e2025010

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study aimed to determine the population-attributable fractions (PAFs) of cancers using various calculation methods and to estimate the PAFs of cancer incidence and mortality resulting from deficit in physical activity (DPA) from 2015 to 2030, based on data on prevalence rates.
METHODS
The PAF of cancer was estimated using a cohort study-based meta-analysis of relative risk (RR), national prevalence rates of DPA from 2000 to 2015, and national cancer statistics from 2015 to 2030, with a latency of 15 years.
RESULTS
In 2015, DPA contributed to 909 cancer cases and 548 deaths, accounting for 0.42% and 0.68% of new cancer cases and deaths, respectively. By 2030, the PAF values are expected to increase to 1.31% of incidence and 1.80% of mortality, with a continual increase from 2015 to 2030. When the low metabolic equivalent of task (MET) criteria were selected, the PAF values decreased for both incidence and mortality. The PAF calculated with <900 MET-min/wk for the sex-specific MET criterion was higher than that calculated with <900 MET-min/wk for both incidence and mortality.
CONCLUSIONS
The risk of cancer associated with DPA is expected to rise in both male and female. Future research and strategies should emphasize the promotion of physical activity for cancer prevention, considering its significant implications for public health.; Summary

Korean summary
2015년 신체활동 부족(deficit in physical activity, DPA)에 의한 인구집단기여분율(population-attributable fraction, PAF)은 암 발생 0.42%(909건), 암 사망 0.68%(548건)였으며 2030년에는 각각 1.31%, 1.80%로 증가할 것으로 예측됨. 남녀 모두에서 DPA로 인한 암 부담이 증가하고 있으므로, 암 예방을 위한 신체활동 증진 전략을 강화할 필요가 있음.

Key Message
In 2015, deficit in physical activity (DPA) accounted for 0.42% of incident cancers (909 cases) and 0.68% of cancer deaths (548 deaths), with population-attributable fraction (PAF) values projected to rise to 1.31% for incidence and 1.80% for mortality by 2030. The cancer burden attributable to DPA is increasing in both sexes, underscoring the need to strengthen population-level physical-activity promotion for prevention.

Gender differences in awareness and practices of cancer prevention recommendations in Korea: a cross-sectional survey: Yoonjoo Choi, Naeun Kim, Jin-Kyoung Oh, Yoon-Jung Choi, Bohyun Park, Byungmi Kim; Epidemiol Health. 2025;47:e2025003. Published online January 15, 2025; DOI: https://doi.org/10.4178/epih.e2025003

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Gender is a major determinant of health behaviors that influences cancer prevention awareness and practices. This study investigated the relationship of the awareness and practice rates of cancer prevention recommendations with gender and socioeconomic status.

METHODS

We used data from the Korean National Cancer Prevention Awareness and Practice Survey (2023). The sample included 4,000 men and women aged 20-74 years. We conducted multiple logistic regression analyses to evaluate associations with the awareness and practices of cancer prevention, and a joinpoint regression analysis using age-standardized rates to analyze trends in awareness and practice rates from 2007 to 2023.

RESULTS

The awareness rates were 79.4% and 81.2% for men and women, respectively. The overall practice rates were substantially lower (43.1% for men and 48.9% for women). For men, awareness rates did not differ significantly by socio-demographic characteristics, but practice rates increased with age (20-29: 15.9%; 60-74: 53.8%). For women, both awareness (20-29: 73.0%; 60-74: 85.7%) and practice (20-29: 16.8%; 60-74: 67.5%) rates increased with age. The easiest recommendations to follow were “reducing salt intake and avoiding burnt or charred foods” (men: 29.9%; women: 28.4%), whereas the most difficult recommendation was “engaging in regular physical activity” (men: 32.5%; women: 34.4%).

CONCLUSIONS

While awareness of cancer prevention recommendations was high, the practice of these recommendations was low. Gender influenced changes in awareness and practice rates over time, reflecting a large gap in practice. Future research should explore appropriate intervention points for cancer prevention practices and the development of more effective cancer prevention policies.

Summary

Korean summary
암 예방에 대한 인식은 남녀 모두 높은 수준이었으나, 실천에서는 성별 차이가 크게 나타났다. 효과적인 암 예방 정책 수립을 위해 성별에 따른 실천 격차를 고려한 전략이 필요하다.

Key Message
Many factors influence cancer prevention awareness and practice, and gender is a crucial determinant of health behaviour in general. This study found that while awareness was reasonably high among both men and women, there was a signifi- cant gender gap in practice. Given the variation in health behaviours by gender, further evaluation of gender effects is nec- essary to inform future policy interventions aimed at improving cancer prevention practices.

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The Korean National Codes Against Cancer: background of their establishment and the revision process
Yoonjoo Choi, Jin-Kyoung Oh, Ayoung Byeon, Byungmi Kim
Epidemiology and Health.2025; 47: e2025027. CrossRef

An outbreak of Clostridium perfringens infection on a training ship anchored in Busan, Korea: Seonmi Kim, Hyunjin Son; Epidemiol Health. 2024;46:e2024086. Published online November 7, 2024; DOI: https://doi.org/10.4178/epih.e2024086

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Abstract Summary PDF

Abstract

OBJECTIVES
In September 2023, an outbreak of food-borne disease occurred among students on a training ship docked in Busan. This was an epidemiological investigation with the aim of improving infection prevention activities and group meal service practices on board ships.

METHODS

In this study, a case was defined as an individual who experienced diarrhea more than twice a day during their training period aboard the training ship. A total of 171 exposed individuals including 6 food handlers was well-defined; therefore, a retrospective cohort study was conducted. We administered a questionnaire and conducted laboratory tests including 38 rectal swab samples. Relative risk (95% confidence interval) for each food item was calculated.

RESULTS

Of the 165 students and school staff members, 41 met the case definition, resulting in an attack rate of 24.8%; all cases were students. The shape of the epidemic curve was unimodal, with the peak from 00:00 to 06:00 on September 7, 2023. Clostridium perfringens was detected in 9 cases, and no other pathogens were found. Significant relative risk was shown in 11 different food items.

CONCLUSIONS

C. perfringens was the causative pathogen of this outbreak on the training ship. Due to the lack of preserved food samples, the exact source of infection could not be confirmed. Ships are not classified as collective dining facilities, leaving them in a management blind spot. Therefore, specialized guidelines, voluntary inspections by the operating entities, and continuous education for managers and staff are necessary.

Summary

Korean summary
부산의 훈련선에서 발생한 식중독은 Clostridium perfringens에 감염되어 발생한 것으로 확인되었으며, 165명 중 24.8%가 감염되었고, 2023년 9월 7일 0시에서 6시 사이에 유행곡선의 정점을 기록했다. 본 연구는 선박이 집단 급식시설로 분류되지 않아 관리의 사각지대에 놓인 점을 감안하여, 전문적인 가이드라인과 지속적인 교육, 자발적인 점검이 필요함을 제언하고 있다.

Key Message
A food-borne disease outbreak occurred on a training ship in Busan, affecting a significant number of people with Clostridium perfringens infection. Among the 165 people, the attack rate was 24.8%, with the epidemic peak occurring between 0:00 and 06:00 on September 7, 2023. This study recommends implementing specialized guidelines, voluntary inspections, and continuous education to improve infection prevention practices on ships, which are not classified as collective dining facilities and thus remain in a management blind spot.

Citations

Citations to this article as recorded by

Antimicrobial Resistance on Ships: A Narrative Review
Yusuff Adebayo Adebisi, Adeola Bamisaiye, Don Eliseo-Lucero Prisno
Infectious Diseases Now.2025; 55(2): 105027. CrossRef
Significant reduction in norovirus outbreaks and secondary transmission of acute gastroenteritis in Seoul schools following the COVID-19 pandemic: a retrospective epidemiological study
Euncheol Son, Young-Hoon Kim
Journal of Yeungnam Medical Science.2025; 42: 65. CrossRef

Sex-specific associations between dietary legume subtypes and type 2 diabetes in a prospective cohort study: Hye Won Woo, Sangmo Hong, Min-Ho Shin, Sang Baek Koh, Hyeon Chang Kim, Yu-Mi Kim, Mi Kyung Kim; Epidemiol Health. 2024;46:e2024083. Published online October 17, 2024; DOI: https://doi.org/10.4178/epih.e2024083

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Dietary soy, known for its high phytoestrogen content, has been suggested to exhibit a sex-specific association with type 2 diabetes. However, evidence regarding the sex-specific associations of different legume subtypes with type 2 diabetes remains scarce. We aimed to evaluate whether habitual consumption of soy and non-soy legumes (beans and peanuts) was prospectively and sex-specifically associated with the risk of type 2 diabetes incidence, taking into considering significant sex-specific genetic factors beyond legume consumption.

METHODS

A total of 16,666 participants (96,945 person-years) were followed and 945 incident cases were observed. Cumulative intake of legume subtypes was calculated using a food frequency questionnaire administered at baseline and during the revisit surveys.

RESULTS

Non-soy legumes are inversely associated with type 2 diabetes in both men and women. Dietary soy intake, however, demonstrated a unilaterally interacting sex-specific association with type 2 diabetes risk (pinteraction for sex=0.017). Specifically, there was a significant inverse association with type 2 diabetes risk in women (incidence rate ratio, 0.66; 95% confidence interval, 0.48 to 0.80; ptrend=0.007), but no such association was observed in men. This sex-specific association persisted and even appeared antagonistic in minor allele carriers of 2 novel single nucleotide polymorphisms, rs10196939 (LRRTM4) and rs11750158 (near GFPT2) (pinteraction for sex=0.001 and 0.011, respectively).

CONCLUSIONS

Habitual consumption of legumes shows protective impacts against type 2 diabetes, although these benefits vary by sex. Non-soy legumes provide health advantages for both men and women, whereas soy consumption seems to be beneficial exclusively for women.

Summary

Korean summary
콩류 섭취는 제2형 당뇨병 예방에 도움이 되는데, 대두를 제외한 콩류와 땅콩은 남녀 모두에게 건강상의 이점이 있는 반면, 대두는 여성에게만 보호적 이점이 있는 것으로 관찰되었다. 대두 섭취는 남성과 여성에서 서로 다른 영향을 미치는 것으로 관찰되었으며, 이는 대두 섭취의 건강상의 영향이 성별에 따라 다르게 나타날 수 있음을 시사하였다.

Key Message
Our findings showed that while legume consumption was protective against type 2 diabetes, beans and peanuts demonstrated health benefits in both sexes, whereas soy's protective benefits were observed only in women. Soy consumption was observed to have different effects between men and women, suggesting that the health impact of soy intake may differ by sex.

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Differential Network-Based Dietary Structure and Type 2 Diabetes Risk: A Prospective Cohort Study Using Food Co-Consumption Networks
Hye Won Woo, Yu-Mi Kim, Min-Ho Shin, Sang Baek Koh, Hyeon Chang Kim, Mi Kyung Kim
Nutrients.2026; 18(3): 506. CrossRef

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

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.

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Bezdomność w Polsce. Epidemiologiczne spojrzenie na przyczyny zgonów i implikacje zdrowotne (2015–2022)
Jadwiga Duda, Igor Popiela, Karolina Dudzik, Aleksandra Adamus, Maciej Przygoda, Andrzej Kościsz, Tomasz Konopka
Zdrowie Publiczne i Zarządzanie.2025; 23(1): 29. CrossRef

Contrasting income-based inequalities in incidence and mortality of breast cancer in Korea, 2006-2015: Jinwook Bahk, Hee-Yeon Kang, Young-Ho Khang, Kyunghee Jung-Choi; Epidemiol Health. 2024;46:e2024074. Published online September 11, 2024; DOI: https://doi.org/10.4178/epih.e2024074

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Abstract

OBJECTIVES
Breast cancer incidence and mortality rates in Korea are increasing. This study analyzed income-based inequalities in the incidence and mortality of women breast cancer from 2006 to 2015, using national data that covered all Korean women.

METHODS

We used the National Health Information Database from 2006 to 2015. For women aged 20 and older, the age-standardized incidence and mortality rates of breast cancer per 100,000 by income quintile per year were calculated using the direct method. The rate ratio and rate difference (RD) of the age-standardized incidence and mortality rates of breast cancer per 100,000 between the top and bottom income quintiles were calculated as relative and absolute measures for inequalities.

RESULTS

When comparing 2006 and 2015, both the incidence and mortality rates of breast cancer increased. The lowest income quintile experienced higher mortality rates despite having lower incidence rates. In 2015, the income-based RD in incidence and mortality rates between the highest and lowest income quintiles (Q1-Q5) was -19.9 (95% confidence interval [CI], -24.3 to -15.5) and 4.4 (95% CI, 2.9 to 5.8), respectively. Throughout this period, there was no statistically significant trend in income-based disparities in breast cancer incidence and mortality. The age-specific contributions to the absolute magnitude of inequality (RD) in incidence and mortality were more pronounced among middle-aged women than among older women.

CONCLUSIONS

This study found that breast cancer in Korea exhibited pro-rich inequalities in mortality despite pro-poor inequalities in incidence. More equitable policies for screening and treatment of breast cancer are needed.

Summary

Korean summary
2006년부터 2015년 한국의 유방암 불평등 추세를 분석하면, 소득수준이 낮은 여성의 발생률은 상대적으로 낮음에도 불구하고 사망률은 높은 양상을 보였다. 유방암 검진과 치료에 있어 보다 형평성을 고려한 정책이 요구된다.

Key Message
This study found that breast cancer in Korea exhibited pro-rich inequalities in mortality despite pro-poor inequalities in incidence. More equitable policies for screening and treatment of breast cancer are needed.

Citations

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Impact of fragmented care on cancer outcomes among korean women with breast and cervical cancer: a focus on regional and economic disparities
Sun Jung Kim, Noorhee Son, Woo-Ri Lee, Dong-Woo Choi, Seojin Park, Kyu-Tae Han
International Journal for Equity in Health.2025;[Epub] CrossRef

Development and validation of the Health Literacy Index for the Community for the Korean National Health and Nutrition and Examination Survey: Junghee Yoon, Soo Jin Kang, Mangyeong Lee, Juhee Cho; Epidemiol Health. 2024;46:e2024061. Published online July 10, 2024; DOI: https://doi.org/10.4178/epih.e2024061

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Abstract

OBJECTIVES
We developed and validated the Health Literacy Index for the Community (HLIC) to assess the health literacy of the Korean population within the framework of the Korean National Health and Nutrition and Examination Survey.

METHODS

The HLIC was developed through (1) defining the conceptual framework and generating the item pool and (2) finalizing the items and identifying the cut-off value. Interviews were conducted to examine items’ face validity, and a cross-sectional survey was performed to analyze the item-response theory and Rasch models to investigate the instrument’s psychometric properties.

RESULTS

In this study of 1,041 participants, most had no difficulty understanding health information; however, 67.9% struggled to assess the reliability of health information from the Internet or media. A 4-factor structure was identified through factor analysis, leading to the exclusion of some items. This resulted in 10 items across 4 domains: (1) disease prevention, (2) health promotion, (3) health care, and (4) technology and resources. The HLIC demonstrated good internal consistency, with a Cronbach’s α of 0.87. It also showed high test-retest reliability and correlations with other health literacy instruments. A socio-demographic analysis of the HLIC revealed disparities in health literacy across various age groups, education levels, and income brackets.

CONCLUSIONS

The HLIC was developed to systematically measure health literacy in Korea’s general population. Its simplicity and conciseness ensure reliability and validity and improve its accessibility, making it particularly suitable for the broader Korean population, including those with lower literacy levels.

Summary

Korean summary
본 연구는 한국인의 건강 문해력을 평가하기 위해 지역사회 건강정보 이해능력 측정도구(Health Literacy Index for the Community, HLIC)를 개발하고 검증하였다. 그 결과, 많은 사람들이 인터 넷이나 미디어에서 얻은 정보의 신뢰성을 평가하는 데 어려움을 겪고 있으며, 연령, 교육 수준, 소 득에 따라 건강정보 이해능력 격차가 존재함을 확인하였다. 특히 본 도구는 높은 신뢰도와 타당성 을 입증하였으며, 이를 통해 한국인의 격차를 파악하고 맞춤형 개입을 위한 중요한 정보를 제공하 는 도구로서의 유용성을 확인하였다.

Key Message
This study developed and validated the Health Literacy Index for the Community (HLIC) to assess the health literacy of Koreans, finding that many had difficulties to assess its reliability from Internet or media sources, and disparities in health literacy were observed across age, education level, and income. The HLIC demonstrated strong reliability and validity, highlighting its utility for identifying health literacy gaps and informing targeted interventions in Korea.

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Seong-Uk Baek, Jin-Ha Yoon
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Validation of health literacy competencies for healthcare professionals in Korea: a psychometric evaluation study
Soo Jin Kang, Won Ju Hwang, Chanho Park, Hae-Ra Han
BMC Medical Education.2026;[Epub] CrossRef
Health literacy by occupation in Korea
In Cheol Hwang, Hong-Yup Ahn
Journal of Epidemiology and Community Health.2025; 79(12): 963. CrossRef
Health literacy and its relationship with mental health: A nationwide Korean survey
Yoo Jeong Lee, Ki Dong Ko, In Cheol Hwang, Hong Yup Ahn
Asian Journal of Psychiatry.2025; 111: 104628. CrossRef
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Junghee Yoon, Seongwoo Yang, Soo Jin Kang, Mangyeong Lee, Dokyoon Kim, Joungwon Park, Su Jin Kim, Jiyoon Han, Jungin Joo, Juhee Cho
Journal of Medical Internet Research.2025; 27: e67780. CrossRef
Cross-sectional analysis of sociodemographic factors associated with self-reported and knowledge-based health literacy in Korea using data from KNHANES 2023
Ki Young Huh, Ildae Song
Scientific Reports.2025;[Epub] CrossRef
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Sunhye Choi, Yukyeong Kang, Hyejin Kim, Kyungwon Oh
Epidemiology and Health.2025; 47: e2025037. CrossRef
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Gaeun Kim, Moonhee Gang
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Special Article

Nutrition survey methods and food composition database update of the Korean Genome and Epidemiology Study: Seon-Joo Park, Jieun Lyu, Kyoungho Lee, Hae-Jeung Lee, Hyun-Young Park; Epidemiol Health. 2024;46:e2024042. Published online April 2, 2024; DOI: https://doi.org/10.4178/epih.e2024042

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Abstract

This study presents the nutrition survey methods and the updated food composition database for the Korean Genome and Epidemiology Study (KoGES). The KoGES, which is the largest and longest cohort study in Korea, aims to identify genetic and environmental factors associated with chronic diseases. This study has collected dietary data using a validated semi-quantitative food frequency questionnaire and/or the 24-hour recall method. However, these dietary survey methods use different food composition databases, and their nutritional values are out of date. Therefore, it became necessary to update the food composition database by revising nutrient analysis values to reflect improvements in the performance of food ingredient analysis equipment, revising international values to analysis values of Korean agricultural products, adjusting nutrient units, and adding newly reported nutrients related to chronic diseases. For this purpose, we integrated the different food composition databases used in each nutrition survey, updated 23 nutrients, and expanded 48 new nutrients for 3,648 food items using the latest reliable food composition databases published by national and international institutions. This revised food composition database may help to clarify the relationship between various nutrients and chronic diseases. It could serve as a valuable resource for nutritional, epidemiological, and genomic research and provide a basis for determining public health policies.

Summary

Korean summary
한국인유전체역학조사사업은 우리나라에서 가장 크고 오래된 코호트로 만성질환과 영양과의 관련성을 밝히기 위하여 사용되고 있다. 이 논문에서는 영양조사에 대한 자세한 방법론과 현재 공개하고 있는 23개 영양소의 업데이트 및 48개 새로운 영양소의 확대에 대한 내용을 소개하였다. 이러한 개선을 통해 KoGES 영양 데이터의 활용도가 더욱 높아질 것으로 기대된다.

Key Message
The Korean Genome and Epidemiology Study (KoGES) is the largest and longest-running cohort study in South Korea aimed at identifying the relationship between chronic diseases and nutrient intake. This paper provides a detailed methods of the nutritional surveys and introduces updates to the existing 23 nutrients and the addition of 48 new nutrients. These enhancements are expected to significantly increase the utility of the KoGES nutritional data.

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Jaca Maison Lailo, Jiae Shin, Giulia Menichetti, Sang-Ah Lee
Nutrients.2025; 17(10): 1605. CrossRef
Quality of plant-based diets and healthy aging: A community-based prospective cohort study
Boeun Han, Chaeyoung Park, Yujin Lee
Clinical Nutrition.2025; 52: 124. CrossRef
The association between iodine intake and thyroid disease in iodine-replete regions: the Korean Genome and Epidemiology Study
Seon-Joo Park, Lulu Chen, Taylor C Wallace, Hae-Jeung Lee
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Plant-Based Dietary Patterns and the Risk of Cardiovascular Disease in Middle-Aged Korean Adults: A Community-Based Prospective Cohort Study
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Original Articles

A prospective association between dietary mushroom intake and the risk of type 2 diabetes: the Korean Genome and Epidemiology Study–Cardiovascular Disease Association Study: Yu-Mi Kim, Hye Won Woo, Min-Ho Shin, Sang Baek Koh, Hyeon Chang Kim, Mi Kyung Kim; Epidemiol Health. 2024;46:e2024017. Published online January 8, 2024; DOI: https://doi.org/10.4178/epih.e2024017

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Abstract

OBJECTIVES
Mushrooms, known for their nutritious and functional components, are considered healthy and medicinal. This study investigated the prospective association between dietary mushroom consumption and the incidence of type 2 diabetes among Korean adults aged ≥40 years.

METHODS

In total, 16,666 participants who were not taking anti-diabetic medication or insulin and had normal fasting blood glucose (FBG; <126 mg/dL) were included. We used the cumulative average dietary consumption of mushrooms as an exposure metric, calculated from food frequency questionnaires at every follow-up, along with covariates collected during a baseline survey. To estimate incidence rate ratios (IRRs) for type 2 diabetes, a modified Poisson regression model with a robust error estimator was applied.

RESULTS

In multivariable models, dietary mushroom consumption was inversely associated with type 2 diabetes incidence in both genders (men: IRR, 0.65; 95% confidence interval [CI], 0.47 to 0.90; plinearity=0.043 in the highest quartile (Q4) vs. the lowest quartile (Q1); women: IRR, 0.70; 95% CI, 0.54 to 0.93; plinearity=0.114 in Q4 vs. Q1). The inverse association remained after adjustment for dietary factors instead of dietary quality index, the baseline FBG, and the exclusion of incidence within the first year. Additionally, no significant interaction was found regarding the risk of type 2 diabetes between dietary mushroom consumption and participants’ gender or other factors.

CONCLUSIONS

Dietary mushroom consumption was inversely linked with the risk of type 2 diabetes incidence in both genders, indicating the beneficial role of mushrooms in preventing the disease.

Summary

Korean summary
- 흔히 사용하는 버섯의 식이 섭취량이 증가함에 따라 한국 40세 이상 성인에서 제2형 당뇨병 발생 위험이 낮았다. - 이러한 역관계는 성별과 다양한 식이 배경에서도 일관성을 유지하였고, 이는 버섯이 제2형 당뇨병 예방에 있어 잠재적인 식이요소로서의 가능성을 보여주는성을 보여주는 보여주는 결과이다.

Key Message
• Increased dietary consumption of commonly used mushrooms is associated with a lower risk of type 2 diabetes incidence among adults aged 40 years or older in Korea. • This inverse relationship remains consistent across genders and various dietary backgrounds, underscoring the potential of mushrooms as a preventive dietary component against.

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Integrative Roles of Functional Foods, Microbiotics, Nutrigenetics, and Nutrigenomics in Managing Type 2 Diabetes and Obesity
Hong Nhung Lam, Shih-Ping Lin, Dang Hien Ngan Nguyen, Chiao-Ming Chen, Chien-Tien Su, Te-Chao Fang, Sing-Chung Li
Nutrients.2025; 17(4): 608. CrossRef
Protective Properties of the White Button Mushroom, Agaricus bisporus, in a Mouse Model of Colitis
Elaine Dempsey, Aaron M. Walsh, Supriya Yadav, Jude Wilson, Frederick J. Sheedy, Sinead C. Corr
Molecular Nutrition & Food Research.2025;[Epub] CrossRef
Underappreciated Health Benefits of Edible Mushrooms in the Dietary Management of Chronic Kidney Disease
Mona S. Calvo, Jaime Uribarri
Journal of Renal Nutrition.2025;[Epub] CrossRef

Determinants of unhealthy living by gender, age group, and chronic health conditions across districts in Korea using the 2010-2017 Community Health Surveys: Thi Tra Bui, Thi Huyen Trang Nguyen, Jinhee Lee, Sun Young Kim, Jin-Kyoung Oh; Epidemiol Health. 2024;46:e2024014. Published online January 4, 2024; DOI: https://doi.org/10.4178/epih.e2024014

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We investigated the prevalence and determinants of unhealthy living by gender, age, and comorbidities across Korean districts.

METHODS

For 806,246 men and 923,260 women from 245 districts who participated in the 2010-2017 Korean Community Health Surveys, risk scores were calculated based on obesity, physical inactivity, smoking, and high-risk alcohol consumption, each scored from 0 (lowest risk) to 2 (highest risk). A risk score ≥4 was defined as indicating unhealthy living, and weighted proportions were calculated for each district. Using multivariate regression, an ecological model including community socioeconomic, interpersonal, and neighborhood factors was examined by gender, age, and comorbidities.

RESULTS

The mean age-standardized rate of unhealthy living was 24.05% for men and 4.91% for women (coefficients of variation, 13.94% and 29.51%, respectively). Individuals with chronic diseases more frequently exhibited unhealthy lifestyles. Unhealthy lifestyles were associated with educational attainment (β-coefficients: men, -0.21; women, -0.15), high household income (β=0.08 and 0.03, respectively), pub density (β=0.52 and 0.22, respectively), and fast-food outlet density (β=2.81 and 1.63, respectively). Negative associations were observed with manual labor, social activity participation, and hospital bed density. Unhealthy living was positively associated with living alone among women and with being unemployed among middle-aged men. Access to parks was negatively associated with unhealthy living among young men and women. The ecological model explained 32% of regional variation in men and 41% in women.

CONCLUSIONS

Improving the neighborhood built and socioeconomic environment may reduce regional disparities in lifestyle behaviors; however, the impacts may vary according to socio-demographic traits and comorbidities.

Summary

Korean summary
- 시군구 지역단위의 불건강생활(흡연, 음주, 비만, 신체활동 부족 각 0-2점, 합 4점 이상 불건강) 유병률은 여자보다 남자에서 높고, 연령이 높아지면서 감소한다. - 지역사회 환경개선(술집 개수, 패스트푸드점 밀도, 공원 면적, 병상밀도)과 사회경제적 수준 강화(교육수준, 가구소득, 고용)를 통해 생활습관적 건강행태의 지역 격차를 줄일 수 있다. - 이러한 향상 노력의 효과는 지역의 건강상태 수준이나 사회인구학적 특성에 따라 다를 수 있다.

Key Message
• District prevalence rates of unhealthy living were higher among men than women and decreased with advancing age. • Efforts to reduce regional disparities in lifestyle behaviors could benefit from enhancements to the neighborhood environment and the socioeconomic status of the area. • The effectiveness of such improvements may vary based on socio-demographic characteristics and health conditions.

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A Community-Based, Lifestyle Behavioral Intervention Based on the Extended Theory of Planned Behavior for Postmenopausal Women at Cardiometabolic Risk: A Randomized Controlled Trial
Sooyeon Park, Jina Choo
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Han-Nah Kim, Nam-Hee Kim
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Folate, vitamin B12, and homocysteine status in the Korean population: data from the 2013-2015 Korea National Health and Nutrition Examination Survey: Sihan Song, Bo Mi Song, Hyun-Young Park; Epidemiol Health. 2024;46:e2024007. Published online December 11, 2023; DOI: https://doi.org/10.4178/epih.e2024007

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We aimed to assess the serum folate, vitamin B12, and homocysteine status in Korean adolescents and adults using national data.

METHODS

Blood samples were collected from participants aged ≥10 years in the Korea National Health and Nutrition Examination Survey 2013-2015. The stored serum samples were used to measure folate, vitamin B12, and homocysteine concentrations. A total of 8,016 participants were included in this analysis. Unweighted descriptive statistics and adjusted geometric means of the B vitamins and homocysteine concentrations were estimated.

RESULTS

Females had higher serum folate and vitamin B12 concentrations and lower serum homocysteine concentrations than males. Folate deficiency (<6.8 nmol/L) and hyperhomocysteinemia (>15 μmol/L) were found in 8.6% and 11.8% of males, respectively. Approximately 3% of males had low or marginally low vitamin B12 status (≤221 pmol/L). Folate and vitamin B12 deficiencies and hyperhomocysteinemia were found in <2% of females. Suboptimal folate status was prevalent among adolescents and young adults, while suboptimal vitamin B12 status and hyperhomocysteinemia were relatively higher in older adults. Adjusted mean homocysteine concentrations were sharply decreased from the first to second decile of serum folate in males.

CONCLUSIONS

In the Korean population, the proportion of males who achieved desirable folate and homocysteine concentrations were lower than those of females. Although most Koreans have adequate vitamin B12, a suboptimal folate status is common, particularly among adolescents and young adults. These findings could establish a foundation for public health initiatives aimed at improving folate levels in the Korean population.

Summary

Korean summary
엽산과 비타민B12는 전 생애에 걸쳐 건강에 영향을 미치는 필수 비타민이다. 그러나 해당 비타민 상태에 대한 국내 자료는 부족한 실정이다. 본 연구는 국민건강영양조사 참여자로부터 수집된 혈청으로부터 엽산, 비타민B12, 그리고 이들의 기능성 지표인 호모시스테인 농도를 측정하였고 성별과 연령별 분포와 적합 상태를 평가하였다. 엽산 결핍과 고호모시스테인혈증은 남성에서 높은 유병률을 가졌다. 적정 엽산 상태를 충족하지 못하는 비율은 청소년과 젊은 성인에서 흔하게 관찰되었다. 대부분의 한국인은 충분한 비타민B12 수준을 가졌으나, 노인의 경우 정기적인 평가가 필요하다. 본 연구는 한국인이 최적의 엽산과 비타민B12 상태를 유지하기 위한 기반적 근거를 제공한다.

Key Message
Folate and vitamin B12 have significant health impacts throughout the life cycle. However, national-level data on B vitamins in Korea are limited. Serum folate, vitamin B12, and homocysteine concentrations were measured from samples stored during the national survey. In our study, the proportions of folate deficiency and hyperhomocysteinemia were higher in men than in women.Suboptimal folate status was common among adolescents and young adults. Most Koreans had adequate levels of vitamin B12; however, regular monitoring is warranted, especially in the older population. The current data provide a future direction for achieving optimal B vitamin status in the Korean population.

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Systematic Review

Dietary intake and cancer incidence in Korean adults: a systematic review and meta-analysis of observational studies: Ji Hyun Kim, Shinyoung Jun, Jeongseon Kim; Epidemiol Health. 2023;45:e2023102. Published online November 30, 2023; DOI: https://doi.org/10.4178/epih.e2023102

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Abstract

Cancer is a major health burden in Korea, and dietary factors have been suggested as putative risk factors for cancer development at various sites. This study systematically reviewed the published literature investigating the associations between dietary factors and cancer incidence among Korean adults, following the Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines. We focused on the 5 most studied cancer sites (stomach, colorectum, breast, thyroid, and cervix) as outcomes and dietary exposures with evidence levels greater than limited-suggestive according to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) panel’s judgment for any of the cancer sites. This resulted in the inclusion of 72 studies. Pooled estimates of the impact of dietary factors on cancer risk suggested protective associations of fruits and vegetables with risks for gastric cancer (GC), colorectal cancer (CRC), and breast cancer (BC) and dietary vitamin C with the risk of GC, as well as a harmful association between fermented soy products and the risk of GC. Despite the limited number of studies, we observed consistent protective associations of dietary fiber with GC and dietary fiber, coffee, and calcium with CRC. These findings are largely consistent with the WCRF/AICR expert report. However, pooled estimates for the associations of other salt-preserved foods with GC, meat with CRC, and dietary carotenoids and dairy products with BC did not reach statistical significance. Further studies with prospective designs, larger sample sizes, and diverse types of dietary factors and cancer sites are necessary.

Summary

Korean summary
한국 성인을 대상으로 주요 암종 발생과 관련된 식이 요인을 탐색한 72개 역학연구들을 체계적으로 리뷰하고 메타 분석한 결과, 과일 및 채소는 위암, 대장암, 유방암에 대한 보호 효과가 있으며, 식이 비타민 C는 위암 예방에 도움이 된다는 결과가 확인되었다. 반면, 염장 식품 중 발효 대두 제품은 위암 발생 위험을 증가시킬 수 있다. 향후 식이 섭취와 밀접하게 관련되었으나 기존 국내 연구가 부족한 암종과 다양한 식이 요인의 영향을 탐색하는 대규모 전향적 코호트 연구가 요구된다.

Key Message
We conducted a systematic review and meta-analysis on the associations between dietary factors and cancer incidence among Korean adults. Pooled estimates suggested protective associations of fruits and vegetables with risks for gastric cancer (GC), colorectal cancer (CRC), and breast cancer (BC) and dietary vitamin C with the risk of GC, as well as a harmful association between fermented soy products and GC risk. Further research is warranted, emphasizing longitudinal designs, larger sample sizes, and a comprehensive exploration of dietary factors, with a specific focus on anatomical sites with a substantial burden of disease but understudied in the context of diet.

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Original Articles

Risk factors for early-onset lung cancer in Korea: analysis of a nationally representative population-based cohort: Jihun Kang, Taeyun Kim, Kyung-Do Han, Jin-Hyung Jung, Su-Min Jeong, Yo Hwan Yeo, Kyuwon Jung, Hyun Lee, Jong Ho Cho, Dong Wook Shin; Epidemiol Health. 2023;45:e2023101. Published online November 21, 2023; DOI: https://doi.org/10.4178/epih.e2023101

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Abstract

OBJECTIVES
We examined the associations of socioeconomic factors, health behaviors, and comorbidities with early-onset lung cancer.

METHODS

The study included 6,794,287 individuals aged 20-39 years who participated in a Korean national health check-up program from 2009 to 2012. During the follow-up period, 4,684 participants developed lung cancer. Multivariable Cox regression analysis was used to estimate the independent associations of potential risk factors with incident lung cancer.

RESULTS

Older age (multivariable hazard ratio [mHR], 1.13; 95% confidence interval [CI], 1.12 to 1.14) and female sex (mHR, 1.62; 95% CI, 1.49 to 1.75) were associated with increased lung cancer risk. Current smoking was also associated with elevated risk (<10 pack-years: mHR, 1.12; 95% CI, 1.01 to 1.24; ≥10 pack-years: mHR, 1.30; 95% CI, 1.18 to 1.45), but past smoking was not. Although mild alcohol consumption (<10 g/day) was associated with lower lung cancer risk (mHR, 0.92; 95% CI, 0.86 to 0.99), heavier alcohol consumption (≥10 g/day) was not. Higher income (highest vs. lowest quartile: mHR, 0.86; 95% CI, 0.78 to 0.94), physical activity for at least 1,500 metabolic equivalent of task-min/wk (vs. non-exercisers: mHR, 0.83; 95% CI, 0.69 to 0.99) and obesity (vs. normal weight: mHR, 0.89; 95% CI, 0.83 to 0.96) were associated with lower lung cancer risk, whereas metabolic syndrome was associated with increased risk (mHR, 1.13; 95% CI, 1.03 to 1.24).

CONCLUSIONS

In young adults, age, female sex, smoking, and metabolic syndrome were risk factors for early-onset lung cancer, while high income, physical activity, and obesity displayed protective effects.

Summary

Korean summary
나이, 여성, 흡연, 그리고 대사 증후군은 조기 발생 폐암의 위험도 증가와 연관이 있었다. 반면에 높은 소득, 신체 활동, 비만은 젊은 성인에서 폐암 발생의 위험도 감소와 연관성을 나타내었다.

Key Message
Age, female sex, smoking, and metabolic syndrome were risk factors for early-onset lung cancer. While, high income, physical activity, and obesity displayed protective effects on the development of lung cancer in young adults.

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Comprehensive characterization of early-onset lung cancer, in Chinese young adults
Ye Tian, Rui Ma, Wenchang Zhao, Shumin Wang, Chuanjiang Zhou, Weibing Wu, Bo Yang, Hua Xin, Hongyan Wang, Pengfei Li, Ranhua Li, Changhong Liu, Yao Lu, Qian Yu, Chengyang Song, Han Zhang, Ruipu Liang, Lei Zhang, Di Zhou, Xitong Zhao, Zhuo Wu, Yafei Qi, Ru
Nature Communications.2025;[Epub] CrossRef
Early-onset lung cancer in Asia: a narrative review
Roselle B. De Guzman
Frontiers in Oncology.2025;[Epub] CrossRef
Emerging Trends in Global Lung Cancer Burden
Lynn Y.-W. Shong, David C.-L. Lam
Seminars in Respiratory and Critical Care Medicine.2025; 46(05): 409. CrossRef
Association between long-term exposure to a mixture of ambient air pollutants and the incidences of bladder and kidney cancers
Chung Ho Kim, Seyoung Kim, Yoon-Hee Kang, Soontae Kim, Byungmi Kim, Bomi Park
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Age-specific findings on lifestyle and trajectories of cognitive function from the Korean Longitudinal Study of Aging: Seungju lim, Eunyoung Yoo, Ickpyo Hong, Ji-Hyuk Park; Epidemiol Health. 2023;45:e2023098. Published online November 2, 2023; DOI: https://doi.org/10.4178/epih.e2023098

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Abstract

OBJECTIVES
Few longitudinal studies have explored age-related differences in the relationship between lifestyle factors and cognitive decline. This study investigated lifestyle factors at baseline that slow the longitudinal rate of cognitive decline in young-old (55-64 years), middle-old (65-74 years), and old-old (75+ years) individuals.

METHODS

We conducted an 11-year follow-up that included 6,189 older adults from the Korean Longitudinal Study of Aging, which is a cohort study of community-dwelling older Koreans. Lifestyle factors, including physical activity, social activity (SA), smoking, and alcohol consumption were assessed at baseline. Cognitive function was measured at 2-year intervals over 11 years. Latent growth modeling and multi-group analysis were performed.

RESULTS

The influence of lifestyle factors on the rate of cognitive decline differed by age. Smoking at baseline (-0.05; 95% confidence interval [CI], -0.11 to -0.00, per study wave) accelerated cognitive decline in young-old individuals, whereas frequent participation in SA at baseline (0.02; 95% CI, 0.01 to 0.03, per study wave) decelerated cognitive decline in middle-old individuals. None of the lifestyle factors in this study decelerated cognitive decline in old-old individuals.

CONCLUSIONS

Cognitive strategies based on modifiable lifestyle factors such as smoking cessation in young-old individuals and frequent SA participation in middle-old age individuals may have great potential for preventing cognitive decline. Because the influence of lifestyle factors varied by age group, age-specific approaches are recommended to promote cognitive health.

Summary

Korean summary
본 연구는 국내 노인인구를 연령대별로 구분하여 연소노인(55-64세), 중고령노인(65-74세), 고령노인(75세+)의 인지저하 기울기를 가속 혹은 감속시키는 라이프스타일 요인을 파악하였다. '흡연'은 연소노인의 인지저하를 가속, '사회활동 참여 빈도'는 중고령노인의 인지저하를 감속시키는 것으로 나타났으며, 고령노인의 경우 유의미한 변수가 나타나지 않았다. 본 결과는 노인의 인지건강에 있어 연령대별 차별화된 라이프스타일 전략이 필요할 것을 시사한다.

Key Message
This study aimed to identify lifestyle factors that accelerate or decelerate the cognitive decline slope in the older population in South Korea, categorized by age groups: young-old adults (55-64), middle-old adults (65-74), and old-old adults (75+). The findings indicated that 'smoking' accelerates cognitive decline in young-old adults, while 'frequency of social activity participation' decelerates cognitive decline in middle-old adults. However, no significant lifestyle variables were identified for old-old adults. These results suggest the necessity of differentiated lifestyle strategies based on age groups for promoting cognitive health in the older population.

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Aoqiang Zhai, Ruiqi Zou, Tianrun Lv, Siqi Yang, Yanjie Zhong, Yang Xiong, Fuyu Li, Haijie Hu
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Regional disparities in major cancer incidence in Korea, 1999-2018: Eun Hye Park, Mee Joo Kang, Kyu-Won Jung, Eun Hye Park, E Hwa Yun, Hye-Jin Kim, Hyun-Joo Kong, Chang Kyun Choi, Jeong-Soo Im, Hong Gwan Seo, The Community of Population-Based Regional Cancer Registries; Epidemiol Health. 2023;45:e2023089. Published online October 12, 2023; DOI: https://doi.org/10.4178/epih.e2023089

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study investigated regional disparities in the incidence of 8 major cancers at the municipal level in Korea during 1999-2018 and evaluated the presence or absence of hot spots of cancer clusters during 2014-2018.

METHODS

The Korea National Cancer Incidence Database was used. Age-standardized incidence rates were calculated by gender and region at the municipal level for 4 periods of 5 years and 8 cancer types. Regional disparities were calculated as both absolute and relative measures. The possibility of clusters was examined using global Moran’s I with a spatial weight matrix based on adjacency or distance.

RESULTS

Regional disparities varied depending on cancer type and gender during the 20-year study period. For men, the regional disparities of stomach, colon and rectum, lung, and liver cancer declined, and those of thyroid and prostate cancer recently decreased, despite an overall increasing incidence. For women, regional disparities in stomach, colon and rectum, lung, liver, and cervical cancer declined, that of thyroid cancer recently decreased, despite an overall increasing incidence, and that of breast cancer steadily increased. In 2014-2018, breast cancer (I, 0.61; 95% confidence interval [CI], 0.53 to 0.70) showed a high probability of cancer clusters in women, and liver cancer (I, 0.48; 95% CI, 0.40 to 0.56) showed a high probability of cancer clusters in men.

CONCLUSIONS

Disparities in cancer incidence that were not seen at the national level were discovered at the municipal level. These results could provide important directions for planning and implementing local cancer policies.

Summary

Korean summary
이 연구는 한국 시군구 단위에서 지난 20년(1999-2018)간 주요 8개 암 발생률의 지역 간 격차를 조사하고, 최근 5년(2014-2018)의 암 발생 군집 가능성을 평가했습니다. 지역 간 격차는 여성에서 갑상선암, 남성에서는 폐암이 가장 큰 격차를 보였습니다. 군집 가능성은 여성의 경우 유방암, 남성의 경우 간암에서 가장 높았습니다. 전국 단위에서는 볼 수 없었던 지역 간 격차 및 군집 발생 가능성이 시군구 단위에서 발견되었고, 이러한 결과는 지역에 맞는 암 정책을 기획하고 실행하는 데 중요한 방향을 제시할 수 있을 것입니다.

Key Message
This study investigated regional disparities in the incidence of eight major cancers in Korea at the municipal level during 1999-2018 and assessed the possibility of cancer clusters during 2014-2018. Thyroid cancer in women and lung cancer in men showed the most significant regional disparities. Breast cancer in women and liver cancer in men displayed the highest possibility of clustering. Regional disparities and cancer clusters were identified locally, which were not detected nationally. These findings could provide valuable guidance for developing and implementing cancer policies that are tailored to local needs.

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Trends in the effects of socioeconomic position on physical activity levels and sedentary behavior among Korean adolescents: Hunju Lee, Hyowon Choi, Sang Baek Koh, Hyeon Chang Kim; Epidemiol Health. 2023;45:e2023085. Published online September 8, 2023; DOI: https://doi.org/10.4178/epih.e2023085

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Abstract

OBJECTIVES
We examined trends in physical activity and sedentary behavior in Korean adolescents, and their association with socioeconomic position (SEP).

METHODS

We used data from the Korea Youth Risk Behavior Survey, a nationwide study involving students aged 12-19 conducted between 2009 and 2021. SEP was assessed based on economic status, parental education attainment, and urbanization. Physical activity was categorized into vigorous physical activity, moderate physical activity, and muscle training, and sedentary time was also measured. We conducted the log-binomial regression to calculate prevalence ratios (PRs) and prevalence differences.

RESULTS

Our analysis included a total of 593,896 students. We observed an increasing trend in physical activity, but a worsening trend in sedentary behavior. A positive association was found between an adolescent’s physical activity and SEP indicators, except for urbanization. Adolescents with higher economic status engaged in more vigorous physical activity (high: PR, 1.26; 95% confidence interval [CI], 1.25 to 1.28; middle: PR, 1.03; 95% CI, 1.02 to 1.04). Similar associations were observed for father’s education (tertiary or above: PR, 1.11; 95% CI, 1.09 to 1.13; upper secondary: PR, 1.05; 95% CI, 1.03 to 1.07) and mother’s education (tertiary or above: PR, 1.17; 95% CI, 1.15 to 1.20; upper secondary: PR, 1.06; 95% CI, 1.04 to 1.08). Adolescents with higher economic status also showed a higher compliance rate with the guideline restricting sedentary time to 2 hours per day (high: PR, 1.28; 95% CI, 1.25 to 1.30; middle: PR, 1.03; 95% CI, 1.01 to 1.05).

CONCLUSIONS

Adolescents with higher SEP exhibited more physical activity and less sedentary time than those with lower SEP.

Summary

Korean summary
본 연구는 2009년부터 2021년까지 청소년의 사회경제적 지위가 신체활동과 좌식생활습관에 미치는 영향을 분석하였다. 청소년의 경제적 상태, 아버지와 어머니의 교육수준이 높을수록 청소년의 신체활동이 증가하고 좌식생활이 감소하였다. 그러나 청소년이 사는 지역의 도시화 정도는 영향을 미치지 않았다.

Key Message
This article analyzes the effects of an adolescent's socio-economic position on their physical activity and sedentary behavior from 2009 to 2021. The higher the adolescent's economic status, father's education, or mother's education, the more they engaged in physical activity and the less time they spent in sedentary behaviors. However, the level of urbanization in the area where the adolescent resided had no effect.

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Suin Park, Heesoo Lee, Wanhyung Lee, Mi-Jeong Lee
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Kyong Sil Park
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Using structural equation modeling to explore the influences of physical activity, mental health, well-being, and loneliness on Douyin usage at bedtime
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Nutrients.2024; 17(1): 64. CrossRef

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

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.

Citations

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Avoidable Mortality in its Economic Impact in Almaty City, Kazakhstan
Rauan Kastey, Ermek Dyussembekov, Kuanysh Nikatov, Yevgeniy Zhukov, Arimantas Tamasauskas, Oryngul Jumagaziyeva, Madiyar Umirbayev, Kamila Faizullina
Asian Journal of Social Health and Behavior.2025; 8(3): 141. CrossRef
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

Adherence to the World Cancer Research Fund/American Institute for Cancer Research and Korean Cancer Prevention Guidelines and cancer risk: a prospective cohort study from the Health Examinees-Gem study: Jeeyoo Lee, Aesun Shin, Woo-Kyoung Shin, Ji-Yeob Choi, Daehee Kang, Jong-Koo Lee; Epidemiol Health. 2023;45:e2023070. Published online August 1, 2023; DOI: https://doi.org/10.4178/epih.e2023070

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The purpose of this study was to explore the association between adherence to 2 cancer prevention recommendations and cancer risk.

METHODS

In total, 104,386 individuals aged 40-69 years old who were recruited between 2004 and 2013 in the Health Examinees-Gem study were included. Adherence scores were constructed based on 8 items from the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations, including body weight, physical activity, diet, alcohol consumption and breastfeeding, and on 6 items from the Korean cancer prevention guidelines (smoking status, eating vegetables and fruits, salty foods, alcohol intake, physical activity, and body weight). A Cox proportional hazards model was used to estimate the associations between adherence scores and the risk of total and 5 major cancers.

RESULTS

The multivariable hazard ratio (HR) for total cancer with the high adherence score versus the lowest score (4.25-7.00 vs. 0.00-3.25) for the WCRF/AICR guidelines was 0.91 (95% confidence interval [CI], 0.82 to 1.00) in men. A reduced breast cancer risk was observed among women with the highest score. Men within the highest category of the Korean cancer prevention guideline score (3.25-6.00) had an HR of 0.80 (95% CI, 0.73 to 0.88) for developing total cancer compared to men within the lowest score (0.00-2.50). The higher adherence group among men showed lower risks of developing stomach, colorectal, and lung cancers.

CONCLUSIONS

Adhering to guidelines for cancer prevention can help to reduce the risk of developing cancer in Korean men. The association might differ by cancer type and gender.

Summary

Korean summary
- 암예방 가이드라인 준수가 실제로 암 발생을 예방하는지에 대한 해외 연구들이 다수 있으나 한국을 포함한 아시아 국가에서 수행된 연구는 없다. - 국제암연구재단 암예방수칙과 한국 암예방수칙을 준수하는 한국인 남성에서 암 발생 감소가 관찰되었다. 이러한 관련성은 암종에 따라 다르게 나타났다.

Key Message
- The adherence to the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) guidelines on cancer prevention has been addressed in several studies in Western countries. -Among the Korean population, adherence to WCRF/AICR cancer prevention guidelines as well as the Korean cancer prevention guidelines helps prevent cancer in men. Association varies by gender and type of cancer.

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Heterogeneous Clustering of Multiomics Data for Breast Cancer Subgroup Classification and Detection
Joseph Pateras, Musaddiq Lodi, Pratip Rana, Preetam Ghosh
International Journal of Molecular Sciences.2025; 26(4): 1707. CrossRef
Adherence to the Korean National Code Against Cancer and mortality: a prospective cohort study from the Health Examinees-Gem study
Jeeyoo Lee, Aesun Shin, Woo-Kyoung Shin, Ji-Yeob Choi, Daehee Kang
Epidemiology and Health.2025; 47: e2025026. CrossRef
Association between adherence to cancer prevention guidelines and cancer risk: a comprehensive systematic review and dose-response meta-analysis of cohort studies
Jialei Fu, Li-Juan Tan, Shang Lou, Woo-Kyoung Shin, Daehee Kang, Sangah Shin
eClinicalMedicine.2025; 89: 103569. CrossRef
Compliance with the WCRF/AICR Recommendations in Qualitative Adaptation and the Occurrence of Breast Cancer: A Case-Control Study
Beata Stasiewicz, Lidia Wadolowska, Maciej Biernacki, Malgorzata Anna Slowinska, Ewa Stachowska
Cancers.2024; 16(2): 468. CrossRef
Transforming public health and economic outcomes by reducing risky behaviors: the potential for South Korea
Joan E. Madia, Ji Yoon Baek, Aesun Shin
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Alcoholic beverage consumption and female breast cancer risk: A systematic review and meta‐analysis of prospective cohort studies
Ivneet Sohi, Jürgen Rehm, Marian Saab, Lavanya Virmani, Ari Franklin, Gonzalo Sánchez, Mihojana Jhumi, Ahmed Irshad, Hiya Shah, Daniela Correia, Pietro Ferrari, Carina Ferreira‐Borges, Beatrice Lauby‐Secretan, Gauden Galea, Susan Gapstur, Maria Neufeld, H
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Adherence to the Cancer Prevention Recommendations from World Cancer Research Fund/American Institute for Cancer Research After Cancer Diagnosis on Mortality in South Korea
Donghyun Won, Jeeyoo Lee, Sooyoung Cho, Ji Yoon Baek, Daehee Kang, Aesun Shin
Nutrients.2024; 16(23): 4049. CrossRef

Trends in dietary intake and food sources of long-chain polyunsaturated fatty acids among Korean adults between 2007 and 2018: Jae Eun Shim, Youngmi Lee, SuJin Song; Epidemiol Health. 2023;45:e2023069. Published online August 1, 2023; DOI: https://doi.org/10.4178/epih.e2023069

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Abstract PDF

Abstract

OBJECTIVES
This study examined trends in the dietary intake and food sources of long-chain polyunsaturated fatty acids (LC-PUFAs) in Korean adults from 2007 to 2018.

METHODS

In total, 46,307 adults (aged 19-64 years) were selected from the 2007-2018 Korea National Health and Nutrition Examination Surveys. Dietary data were obtained using 24-hour dietary recall. Intake levels and food sources of LC-PUFAs, including alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and linoleic acid (LA), were evaluated across the survey years and assessed based on compliance with dietary recommendations over the 2007-2018 period. Linear trends in LC-PUFAs intake levels over time were examined through multiple linear regression analysis.

RESULTS

From 2007 to 2018, ALA and LA consumption increased from 1.1 g (0.5% of energy) to 1.4 g (0.6% of energy) and from 8.6 g (3.9% of energy) to 10.0 g (4.5% of energy), respectively. EPA intake decreased from 0.14 g to 0.12 g, and EPA+DHA intake showed a decreasing trend. The proportion of individuals who did not meet the recommended intake of EPA+DHA (250 mg/day) increased (64.4 to 68.4%). Regarding changes in food sources of ALA and LA, the contributions from mayonnaise, eggs, and bread increased, while those from plant food sources decreased. Among food sources of EPA and DHA, anchovy, saury, and Atka mackerel showed lower contributions over time.

CONCLUSIONS

Our findings suggest that strategies to encourage the consumption of EPA and DHA from healthy food sources are necessary to improve cardiovascular health in the Korean population.

Summary

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Dietary intake and food sources of essential fatty acids among Korean adolescents: a cross-sectional study based on the 2016–2021 KNHANES data
Enkhgerel Erdenetsetseg, Hye Ran Shin, SuJin Song
Korean Journal of Community Nutrition.2024; 29(2): 144. CrossRef

Effect of trajectory of employment status on all-cause mortality in the late middle-aged and older population: results of the Korea Longitudinal Study of Aging (2006-2020): Jeong Min Yang, Jae Hyun Kim; Epidemiol Health. 2023;45:e2023056. Published online June 8, 2023; DOI: https://doi.org/10.4178/epih.e2023056

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study conducted a longitudinal analysis of the effect of trajectory of employment status (TES) on all-cause mortality in late middle-aged and older Koreans based on the Korean Longitudinal Study of Aging (KLoSA).

METHODS

After excluding missing values, data on 2,774 participants were analyzed using the chi-square test and the group-based trajectory model (GBTM) for data from the first to fifth KLoSA and the chi-square test, log-rank test, and Cox proportional hazard regression for data from the fifth to eighth KLoSA.

RESULTS

The GBTM analysis identified 5 TES groups: sustained white collar (WC; 18.1%), sustained standard blue collar (BC; 10.8%), sustained self-employed BC (41.1%), WC to job loss (9.9%), and BC to job loss (20.1%). Compared to the sustained WC group, the WC to job loss group had higher mortality at 3 years (hazard ratio [HR], 4.04, p=0.044), 5 years (HR, 3.21, p=0.005), and 8 years (HR, 3.18, p<0.001). The BC to job loss group had higher mortality at 5 years (HR, 2.57, p=0.016) and 8 years (HR, 2.20, p=0.012). Those aged 65 years and older and males in the WC to job loss and BC to job loss groups had an increased risk of death at 5 years and 8 years.

CONCLUSIONS

There was a close association between TES and all-cause mortality. This finding highlights the need for policies and institutional measures to reduce mortality within vulnerable groups with an increased risk of death due to a change in employment status.

Summary

Korean summary
본 연구는 제 1차~8차 한국고령화연구패널을 활용하여 중고령층의 근로활동 궤적과 사망 간의 연관성을 분석하였다. 근로활동 궤적을 파악하기 위하여 집단중심추세모형을 활용하였으며, 총 5가지의 근로활동 궤적을 도출하였다. 도출된 궤적을 바탕으로 카이제곱 검정과 콕스 비례위험모형을 통해 근로활동 궤적과 사망률 간의 연관성을 분석하였다. 연구 결과 화이트칼라에서 실업으로 변화하는 집단과 블루칼라에서 실업으로 변화하는 두 집단에서 사망 간의 유의한 결과를 발견하였으며, 특히, 65세 이상 집단과 남성 집단에서 강한 연관성이 존재하였다. 본 연구 결과를 바탕으로 근로활동 변화로 인해 사망 위험이 증가하는 취약 집단을 위한 정책적, 제도적 방안의 기초자료로서 활용되기를 기대한다.

Key Message
Compared with the sustained White Collar (WC) trajectory group, changed WC to job loss trajectory group and changed BC to job loss trajectory had higher mortality. The over 65 years group and the male group, a strong association between change in employment status and mortality was observed. This study emphasizes the need for policy and institutional measures to reduce mortality for vulnerable groups who are at increased risk of death due to changes in employment status.

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The predictive power of employment trajectories on cognition of older adults: Evidence from Chile
Magdalena Delaporte
Social Science & Medicine.2025; 380: 118281. CrossRef

The association of dietary patterns with incident chronic kidney disease and kidney function decline among middle-aged Korean adults: a cohort study: Jialei Fu, Sangah Shin; Epidemiol Health. 2023;45:e2023037. Published online March 21, 2023; DOI: https://doi.org/10.4178/epih.e2023037

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study assessed the association of dietary patterns with the incidence of chronic kidney disease (CKD) and kidney function decline among Korean adults.

METHODS

Data were collected from the records of 20,147 men and 39,857 women who participated in the Health Examinees study. Principal component analysis was used to identify 3 dietary patterns (prudent, flour-based food and meat, and white rice-based), and CKD risk was defined using the Epidemiology Collaboration equation for estimated glomerular filtration rate: (eGFR) <60 mL/min/1.73 m2. A kidney function decline was defined as a >25% decrease in eGFR from baseline.

RESULTS

During the 4.2-year follow-up, 978 participants developed CKD and 971 had a 25% decline in kidney function. After adjusting for potential impact variables, compared with the lowest quartile of the prudent dietary pattern, participants in the highest quartile had a 37% lower risk of kidney function decline among men (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.47 to 0.85); while higher adherence to the flour-based food and meat dietary pattern was associated with an increased risk of CKD in both men (HR, 1.63; 95% CI, 1.22 to 2.19) and women (HR, 1.47; 95% CI, 1.05 to 2.05) as well as a decline in kidney function in both men (HR, 1.49; 95% CI, 1.07 to 2.07) and women (HR, 1.77; 95% CI, 1.33 to 2.35).

CONCLUSIONS

Although a higher adherence to the prudent dietary pattern was inversely associated with the risk of kidney function decline in men, there was no association with CKD risk. In addition, a higher adherence to the flour-based food and meat dietary pattern increased the risk of CKD and kidney function decline. Further clinical trials are needed to confirm these associations.

Summary

Korean summary
건강한 식이패턴(prudent dietary pattern)은 한국 남성의 신장기능 저하 위험을 감소와 관련성이 있었다. 반면, 밀가루 음식과 육류 위주의 식이패턴(Flour-based food and meat dietary pattern)은 남성과 여성 모두에서 신장 기능 저하 위험뿐만 아니라, 만성신장질환(CKD) 위험의 증가와 관련이 있었다. 본 연구의 결과는 한국 성인에서 식사패턴이 신장 기능 및 만성 신장 질환의 발생에 미치는 영향을 확인하였다.

Key Message
1. Better adherence to the prudent dietary pattern may lower the risk of kidney function decline in Korean man. 2. A higher adherence to the flour-based food and meat dietary pattern may higher the risk of chronic kidney disease and kidney function decline.

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Planetary Health Diet Index and Risk of Chronic Kidney Disease in Middle-Aged and Older Adults: Insights From Two Large Prospective Cohorts
Danni Yang, Yeqing Gu, Hongmei Wu, Ge Meng, Qing Zhang, Li Liu, Shaomei Sun, Xing Wang, Qiyu Jia, Kun Song, Shunming Zhang, Tao Huang, Kaijun Niu
Mayo Clinic Proceedings.2026; 101(2): 237. CrossRef
Adherence to a Planetary Health Diet and Risk of Chronic Kidney Disease: A Longitudinal Cohort Study From the UK Biobank
Mercedes Gómez-Cao, Javier Maroto-Rodriguez, Rosario Ortolá, Adrián Carballo-Casla, Fernando Rodriguez-Artalejo, Mercedes Sotos-Prieto
Mayo Clinic Proceedings.2026; 101(2): 224. CrossRef
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Yinghong Zhai, Fangyuan Hu, Lei Yuan, Yang Cao, Xiaofei Ye, Chao Xue, Feng Xu
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Dietary patterns associated with the new onset of chronic kidney disease using clustering algorithm
Dougho Park, Jinmi Kim, Da Woon Kim, Donghyun Lee, Taeyeon Kim, Dahyeon Koo, Youjin Lee, Won Hwa Kim, Hyo Jin Kim
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Suyeon Lee, Dayeon Shin
Nutrition Research and Practice.2024; 18(5): 721. CrossRef

Physical activity, sedentary behavior, and cardiovascular disease risk in Korea: a trajectory analysis: Jina Han, Yeong Jun Ju, Soon Young Lee; Epidemiol Health. 2023;45:e2023028. Published online February 22, 2023; DOI: https://doi.org/10.4178/epih.e2023028

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Abstract PDF

Abstract

OBJECTIVES
To identify the distinct trajectories of sedentary behavior (SB) and explore whether reduced cardiovascular disease (CVD) risk was associated with a distinct trajectory of physical activity (PA).

METHODS

We analyzed data from 6,425 people who participated in the Korean Health Panel Survey over a period of 10 years. The participants’ self-reported SB and PA were assessed annually, and trajectory groups were identified using a group-based trajectory model for longitudinal data analysis. Logistic regression analysis was performed to assess the association between CVD risk (10-year cumulative incidence) and the trajectories of SB and PA. The adjusted variables included socio-demographic factors, the predisposing diseases of CVD, and baseline health behaviors.

RESULTS

Trajectory analysis identified 4 SB trajectory groups: SB group 1 (low and slightly increasing trend, 53.1%), SB group 2 (high and rapidly decreasing trend, 14.7%), SB group 3 (high and slightly decreasing trend, 9.9%), and SB group 4 (low and rapidly increasing trend, 22.2%). The 3 PA trajectory groups were PA group 1 (moderate and slightly decreasing trend, 32.1%), PA group 2 (low and slightly decreasing trend, 57.3%), and PA group 3 (maintained inactivity, 10.7%). By the 10-year follow-up, 577 cases of incident CVD had occurred. We also noted a 50% reduction in the risk of CVD when SB group 4 was accompanied by PA group 1 (odds ratio, 0.50; 95% confidence interval, 0.28 to 0.90).

CONCLUSIONS

Despite increased time spent in SB, maintaining PA about 2 days to 3 days per week reduced the occurrence of CVD.

Summary

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Li-Hua Yu, Ge-Lin Zhang
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Ye Seul Yang, Eu Jeong Ku, Seung-Hyun Ko, Eun-Jung Rhee, Sang-Hyun Ihm, Sung Hee Choi, Won-Young Lee
The Korean Journal of Internal Medicine.2025; 40(5): 696. CrossRef
Physical activity for prevention of cardiovascular disease: a consensus statement of the Korean Society of Cardio-cerebrovascular Disease Prevention
Ye Seul Yang, Eu Jeong Ku, Seung-Hyun Ko, Eun-Jung Rhee, Sang-Hyun Ihm, Sung Hee Choi, Won-Young Lee
Cardiovascular Prevention and Pharmacotherapy.2025; 7(4): 120. CrossRef
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COVID-19: Health Statistics

Changes in food and nutrient intakes in Korean adults before and during the COVID-19 pandemic: data from the 2011-2020 Korea National Health and Nutrition Examination Survey: Kyungwon Oh, Suyeon Park, Sihyun Park, Sungha Yun, Hongseok Choi, Eun Kyeong Jeong; Epidemiol Health. 2023;45:e2023015. Published online February 1, 2023; DOI: https://doi.org/10.4178/epih.e2023015

22,390 View
331 Download
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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study was to examine the changes in dietary habits and food and nutrient intakes between before (2019) and during (2020) the coronavirus disease 2019 (COVID-19) pandemic from the Korea National Health and Nutrition Examination Survey (KNHANES).

METHODS

A total of 54,995 participants aged ≥19 years who participated in the 2011-2020 KNHANES were included. The 10-year trend (2011-2020) and differences between 2019 and 2020 for dietary habits and food and nutrient intakes were estimated using SAS.

RESULTS

In the past 10 years (2011-2020), the dietary habits (increase in skipping meals and eating out), food intake (increase in meats and decrease in fruits and vegetables), and nutrient intake (increase in fat and decrease in sodium) in adults have changed. When comparing between 2019 and 2020, there were 4.6%p decrease in the eating out more than once a day. On the other hand, there were no significant differences in the intakes of food, energy and most of nutrients between 2019 and 2020, except for the proportion of energy intake from fat (1.0%p increase) and carbohydrate (1.0%p decrease).

CONCLUSIONS

Although a change in dietary habits from before to during the COVID-19 pandemic was observed, food and nutrient intakes have not deteriorated markedly and appear similar to the trends in the past 10 years. Throughout the COVID-19 pandemic, it is necessary to monitor the effects of changes in dietary habits on health as well as food and nutrient intakes.

Summary

Korean summary
코로나19 유행 전, 후 비교 시, 외식 감소, 가정식 섭취 증가 등 식생활은 변화가 있었으나 주요 식품 및 영양소 섭취는 큰 변화없이 최근 10년간의 추이가 지속되고 있었다.

Key Message
Although a change in dietary habits from before to during the COVID-19 pandemic was observed, food and nutrient intakes have not deteriorated markedly and appear similar to the trends in the past 10 years in Korean adults.

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Yong-Seok Kwon, Ye-Jun Kim, Eun-Kyung Kim, Jin-Young Lee, Yangsuk Kim, Sohye Kim
Nutrients.2026; 18(2): 240. CrossRef
Association between dietary quality and health-related quality of life among older adults: a cross-sectional study
Shinyoung Jun
BMC Geriatrics.2026;[Epub] CrossRef
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Dasom Son, Yeeun Seo, Kyoung Hwa Ha, Hyeok-Hee Lee, Hyeon Chang Kim, Hokyou Lee
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Original Articles

Decreased birth weight after prenatal exposure to wildfires on the eastern coast of Korea in 2000: En-Joo Jung, Ah-Young Lim, Jong-Hun Kim; Epidemiol Health. 2023;45:e2023003. Published online December 9, 2022; DOI: https://doi.org/10.4178/epih.e2023003

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
In April 2000, a series of wildfires occurred simultaneously in five adjacent small cities located on the eastern coast of Korea. These wildfires burned approximately 23,794 hectares of forestland over several days. We investigated the effects of prenatal exposure to the by-products generated by wildfire disasters on birth weight.

METHODS

Birth weight data were obtained for 1999-2001 from the birth registration database of the Korean National Statistical Office and matched with the zip code and exposed/unexposed pregnancy week for days of the wildfires. Generalized linear models were then used to assess the associations between birth weight and exposure to wildfires after adjusting for fetal sex, gestational age, parity, maternal age, maternal education, paternal education, and average exposed atmospheric temperature.

RESULTS

Compared with unexposed pregnancies before and after the wildfires, mean birth weight decreased by 41.4 g (95% confidence interval [CI], -72.4 to -10.4) after wildfire exposure during the first trimester, 23.2 g (95% CI, -59.3 to 13.0) for exposure during the second trimester, and 27.0 g (95% CI, -63.8 to 9.8) during the third trimester. In the adjusted model for infants exposed in utero during any trimester, the mean birth weight decreased by 32.5 g (95% CI, -53.2 to -11.7).

CONCLUSIONS

We observed a 1% reduction in birth weight after wildfire exposure. Thus, exposure to by-products generated during a wildfire disaster during pregnancy may slow fetal growth and cause developmental delays.

Summary

Korean summary
산불로 인한 연소 부산물에 대한 태아기 노출이 출생 체중에 미치는 영향을 조사하였다. 산불 발생 전후로 연소 부산물에 노출되지 않았던 신생아와 비교하였을 때, 노출된 신생아의 평균 출생 체중은 32.5g (-53.2~-11.7g) 감소하였다. 임신 중 산불로 인한 연소 부산물에 대한 노출은 태아 성장을 느리게 하거나 발달 지연을 일으킬 수 있다.

Key Message
The study investigated the effects of prenatal exposure to by-products generated by wildfire disasters on birth weight. Compared to newborns who were not prenatally exposed to wildfire byproducts, exposed newborns had a 32.5 g (-53.2 to -11.7 g) reduction in birth weight. Exposure to wildfire by-products during pregnancy can slow fetal growth or cause developmental delays.

Citations

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Epidemiological profile of the natural hazards-related disasters in Asia from 2000 to 2021
Andrea Fernández García, Rick Kye Gan, José Antonio Cernuda Martínez, Pedro Arcos González
Journal of Public Health Policy.2025; 46(3): 617. CrossRef
Impact of climate change and environmental adversities on maternal and fetal health: the role of clinical practices and providers in mitigating effects and prioritising women's health in the UK
Athina Samara, Thomas Hanton, Ranee Thakar, Eric Jauniaux, Asma Khalil
Frontiers in Global Women's Health.2025;[Epub] CrossRef
Wildfire Smoke: Health Effects, Mechanisms, and Mitigation
Ying Lei, Tze-Huan Lei, Chan Lu, Xue Zhang, Faming Wang
Environmental Science & Technology.2024; 58(48): 21097. CrossRef
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Emily W. Harville, Bianka Northland
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Effect of socioeconomic disparities on the risk of COVID-19 in 8 metropolitan cities in the Korea: a community-based study: Myung-Jae Hwang, Shin Young Park, Tae-Ho Yoon, Jinhwa Jang, Seon-Young Lee, Myeongsu Yoo, Yoo-Yeon Kim, Hae-Kwan Cheong, Donghyok Kwon, Jong-Hun Kim; Epidemiol Health. 2022;44:e2022107. Published online November 15, 2022; DOI: https://doi.org/10.4178/epih.e2022107

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Socioeconomic disparities have been reported as major risk factors contributing to the spread of coronavirus disease 2019 (COVID-19) at the community level. We conducted an epidemiological study on COVID-19 incidence risk using area-based deprivation indices (DIs) reflecting the characteristics of the susceptible population.

METHODS

A database of the confirmed COVID-19 cases in 8 metropolitan cities in Korea from January 20, 2020 to December 31, 2021 was combined with area-based DI scores and standardized prevalence rates of diabetes and hypertension from the Korean Community Health Survey. Relative risk (RR) levels were estimated using a generalized linear model with a Poisson distribution by age group.

RESULTS

The risk of COVID-19 incidence generally increased with increasing age, especially in patients aged ≥75 years. The RR of COVID-19 incidence per interquartile range increment of the composite deprivation index (composite DI) was 1.54 (95% confidence interval [CI], 1.34 to 1.70). Notably, in the first wave, the risk of COVID-19 incidence was approximately 3 times higher in the region with the lowest socioeconomic status than in the region with the highest status (RR, 3.08; 95% CI, 2.42 to 3.78 based on the the composite DI and RR, 3.13; 95% CI, 2.53 to 3.83 based on the social deprivation index).

CONCLUSIONS

This study provides scientific evidence that socioeconomic deprivation is an important risk factor for the spread of COVID-19. This finding suggests that a mid-term to long-term strategy is needed to protect susceptible populations and reduce the burden of COVID-19 in the community.

Summary

Korean summary
한국의 COVID-19 발생 위험은 지역박탈수준이 높은 지역에서 증가하였고, 특히 유행 초기 75세이상 연령층에서 뚜렷하게 증가하는 것으로 나타났다. 따라서 지역사회수준에서 사회경제적 여건을 고려하여 취약집단에서의 발생위험을 감소시키기 위해 중장기 전략을 세워야 한다는 것을 시사한다.

Key Message
There is a need to develop long-term strategies to reduce the risk of COVID-19 outbreaks in vulnerable populations in areas with poor socioeconomic conditions

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Item non-response imputation in the Korea National Health and Nutrition Examination Survey: Serhim Son, Hyemi Moon, Hyonggin An; Epidemiol Health. 2022;44:e2022096. Published online October 28, 2022; DOI: https://doi.org/10.4178/epih.e2022096

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The Korea National Health and Nutrition Examination Survey (KNHANES) is a public health survey that assesses individuals’ health and nutritional status and monitors the prevalence of major chronic diseases. In general, sampling weights are adjusted for unit non-responses and imputation is conducted for item non-responses. In this study, we proposed strategies for imputing item non-responses in the KNHANES in order to improve the usefulness of data, minimize bias, and increase statistical power.

METHODS

After applying logical imputation, we adopted 2 separate imputation methods for each variable type: unweighted sequential hot-deck imputation for categorical variables and sequential regression imputation for continuous variables. For variance estimation, multiple imputations were applied to the continuous variables. To evaluate the performance of the proposed strategies, we compared the marginal distributions of imputed variables and the results of multivariable regression analysis for the complete-case data and the expanded data with imputed values, respectively.

RESULTS

When comparing the marginal distributions, most non-responses were imputed. The multivariable regression coefficients presented similar estimates; however, the standard errors decreased, resulting in statistically significant p-values. The proposed imputation strategies may cope with the loss of precision due to missing data, thus enhancing statistical power in analyses of the KNHANES by providing expanded data with imputed values.

CONCLUSIONS

The proposed imputation strategy may enhance the utility of data by increasing the number of complete cases and reducing the bias in the analysis, thus laying a foundation to cope with the occurrence of item non-responses in further surveys.

Summary

Korean summary
본 연구는 국민건강영양조사에서 발생한 항목무응답의 대체방법에 대해 연구한다. 본 논문에서 제시된 논리적 대체와 무응답 대체법을 이용해 대체된 데이터를 제공함으로써 결과의 편향 감소와 통계적 검정력 향상을 기대할 수 있다. 또한, 본 연구의 결과는 추후 데이터 수집시 발생하는 무응답 발생의 최소화를 위한 대책마련에 사용될 수 있다.

Key Message
The proposed logical imputation and item non-response imputation strategy may enhance the utility of data by increasing the number of complete cases and reducing the bias in the analysis, thus laying a foundation to cope with the occurrence of item non-responses in further surveys.

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Associations of mediterranean diet score and age-related macular degeneration in Korean elderly
Won Jang, Jungeun Choi, Hyesook Kim
BMC Public Health.2024;[Epub] CrossRef

Effect of mammography screening on the long-term survival of breast cancer patients: results from the National Cancer Screening Program in Korea: Xuan Quy Luu, Kyeongmin Lee, Jae Kwan Jun, Mina Suh, Kyu-Won Jung, Kui Son Choi; Epidemiol Health. 2022;44:e2022094. Published online October 26, 2022; DOI: https://doi.org/10.4178/epih.e2022094

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Abstract PDF Supplementary Material

Abstract

OBJECTIVES
This study investigated the effect of mammography screening on the long-term survival of breast cancer (BC) patients aged 40 years or older according to their screening history and duration since screening.

METHODS

The study cohort was organized from 3 nationwide databases of the Korean National Cancer Screening Program, the Korean Central Cancer Registry, and death certificates. We included 24,387 women diagnosed with invasive BC or ductal carcinoma in situ in 2008 and 2009 and followed up until December 31, 2019. Cox proportional-hazards regression was used to investigate the effect of BC screening on the risk of death.

RESULTS

Overall, 20,916 of 24,387 patients (85.8%) were alive at the end of the follow-up period (median: 10.5 years). The long-term survival rate was significantly lower in the never-screened group (80.3%) than in the screened group (88.9%) (p<0.001). A 35% reduction in the risk of BC death (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.60 to 0.70) from screening was observed. A subgroup analysis according to the cancer stage showed 62%, 36%, and 24% lower risks of BC death for the localized stage, regional stage, and distant stage, respectively. Women aged 40-49 years received the least benefit from BC screening (HR, 0.71; 95% CI, 0.62 to 0.81).

CONCLUSIONS

Mammography screening was effective in reducing the risk of BC-specific death in Asian women across all cancer stages. However, this effect was relatively small among women in their 40s, suggesting that more detailed and specialized screening strategies are needed for that age group.

Summary

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Supplemental automated breast ultrasound in negative screening mammography: early-stage cancer detection in dense breasts with limited yield in non-dense breasts
Soo-Yeon Kim, Sung Eun Song, Min Sun Bae, Kyu Ran Cho, Bo Kyoung Seo, Ok Hee Woo
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Determining risk‐adapted starting age and interval for breast cancer screening based on reproductive and hormonal factors
Tung Hoang, Jeonghee Lee, So‐Youn Jung, Jeongseon Kim
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Current Status of the National Cancer Screening Program in Korea: History, Achievements, and Future Directions
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Vitória Martins Granja De Moura, Janaína Alvarenga Aragão, Luciano Silva Figueiredo, Ana Paula Rodrigues de Sousa Araújo De Moura, Marcos Rocha Luz
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Incidence of edentulism among older adults using the Korean National Health Insurance Service database, 2013-2018: Hyeonjeong Go, Eun-Kyong Kim, Hoi-In Jung, Song Vogue Ahn, Hosung Shin, Atsuo Amano, Youn-Hee Choi; Epidemiol Health. 2022;44:e2022091. Published online October 17, 2022; DOI: https://doi.org/10.4178/epih.e2022091

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Abstract PDF

Abstract

OBJECTIVES
Population aging is rapidly accelerating worldwide. Oral diseases related to aging are also on the rise. This study examined trends in the incidence of edentulism among the older Korean population using data from the Korean National Health Insurance Service (KNHIS).

METHODS

Data on older adults, aged ≥75 years of age, were obtained from the KNHIS for the period 2013-2018. Edentulism was defined as a treatment history of complete dentures in the KNHIS database. The exclusion criteria consisted of both disease codes and treatment codes related to conservative dental treatment, including periodontal and extraction treatment afterward. Crude incidence rates (CIRs) and age-standardized incidence rates (AIRs) with 95% confidence intervals were calculated and reported per 100,000 person-years by the direct method. Trends were tested by Cochrane Armitage models.

RESULTS

Statistically significant increasing trends in both CIRs and AIRs were found among the older Korean population registered in the KNHIS (CIRs, 707.92 to 895.92; AIRs, 705.11 to 889.68; p<0.01). The incidence tended to increase in both genders (p<0.01). Both CIRs and AIRs in specific regions also showed slight but significant annual increases except for Jeju Island (p<0.01 or <0.05). The incidence showed increasing trends (p<0.01) in all income quintiles apart from the highest quintile. The edentulism incidence was highest in the lowest income group (the first quintile).

CONCLUSIONS

Our data showed that the incidence of edentulism among the elderly showed an increasing trend from 2013 to 2018. This result provides a basis for future epidemiological studies on the incidence of edentulism in the older Korean population.

Summary

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

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

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

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

Inequitable distribution of excess mortality during the COVID-19 pandemic in Korea, 2020: Jin-Hwan Kim, Saerom Kim, Eunhye Park, Chang-yup Kim; Epidemiol Health. 2022;44:e2022081. Published online September 26, 2022; DOI: https://doi.org/10.4178/epih.e2022081

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Abstract PDF Supplementary Material

Abstract

OBJECTIVES
This study analyzed inequities in excess mortality according to region and socioeconomic position to explain the distribution of excess mortality in Korea in 2020.

METHODS

We acquired weekly all-cause mortality data from January 2015 to December 2020 from (1) the National Health Insurance Database and (2) Vital Statistics. Excess mortality for 2020 was calculated by comparing the weekly observed and expected deaths from the same period (2015-2019) using quasi-Poisson regression.

RESULTS

An inequitable distribution of excess mortality was identified. The estimated excess mortality in Korea was -29,112 (95% confidence interval, -29,832 to -28,391), corresponding to -55 per 100,000, and the ratio of observed deaths to expected deaths was 0.91. Negative excess mortality was observed except for females in the 0-14 age group. Male Medical Aid beneficiaries showed positive excess mortality, while non-disabled and disabled groups showed similar negative values. When the standardized mortality ratio was calculated for the top 10 causes of death, deaths from Alzheimer’s disease and septicemia increased, whereas those from diabetes mellitus and cerebrovascular disease decreased. The decrease in mortality was primarily concentrated in older adults, while the mortality of young females increased due to increased intentional self-harm.

CONCLUSIONS

This study adds essential evidence regarding the overall performance of Korea. The observed inequalities according to various socioeconomic variables indicate that the results of strict measures to control coronavirus disease 2019 were not distributed equitably. Efforts should be made to properly evaluate the current and future problems related to the pandemic.

Summary

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Awareness of and practice toward cancer prevention recommendations: results of the Korean National Cancer Prevention Awareness and Practice Survey in 2021: Jin-Kyoung Oh, Eunjung Park, Byungmi Kim, Yoon-Jung Choi, E Hwa Yun, Min Kyung Lim, Jeong-Soo Im, Eun Young Park; Epidemiol Health. 2022;44:e2022068. Published online August 26, 2022; DOI: https://doi.org/10.4178/epih.e2022068

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study reports data regarding the awareness and practice of cancer prevention among Koreans in 2021 and behavioral changes during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

We collected Cancer Prevention Awareness and Practice Survey data through face-to-face interview surveys using a structured questionnaire completed by 4,000 randomly selected men and women aged between 20 years and 74 years in 17 provinces. We examined the awareness and practice of 10 cancer prevention recommendations and evaluated their associations with potential risk factors through multiple logistic regression analysis adjusted for age, gender, residence, marital status, education, and income.

RESULTS

Eighty percent of participants knew that cancer is preventable, while 45% practiced cancer prevention. Cancer prevention practice tended to be more common among older participants (adjusted odds ratio [aOR], 1.39 per 10-year increment; 95% confidence interval [CI], 1.29 to 1.49) and less common among rural inhabitants (aOR, 0.66; 95% CI, 0.51 to 0.86) than among urban residents and among single people (aOR, 0.55; 95% CI, 0.45 to 0.66) than among married people. Practices were the highest for avoiding burned or charred foods (87.6%) and lowest for vaccination against human papillomavirus (14.5%). Refusal to follow recommendations was most common for avoiding alcohol consumption (7.9%). The most difficult recommendations to follow were (1) regular exercise (57.7%); (2) maintaining a healthy body weight (46.1%); and (3) avoiding alcohol (40.1%). The most significant COVID-19-related changes were less exercise (32.5%) and increased body weight (25.6%).

CONCLUSIONS

The awareness of cancer prevention was high, but the practice was low. Recommendations targeting awareness and practice need to be further promoted.

Summary

Korean summary
2021년 국민 암예방 인식 및 실천행태 조사에 따르면, 국민의 80%는 암이 예방 가능하다는 사실을 알고 있으나, 45%만이 암예방을 위한 건강생활을 실천하고 있음. 암예방수칙 중 가장 지키기 어려운 항목으로는 ‘운동하기’(57.7%)를 꼽았고, 그 다음으로 ‘건강체중 유지하기’(46.1%)와 ‘소량음주도 피하기’(40.1%)순으로 나타났음. 코로나19 유행으로 인한 가장 흔한 변화는 운동 감소(32.5%)와 체중 증가(25.6%)로 나타났음.

Key Message
According to the data collected from the Cancer Prevention Awareness and Practice Survey in 2021, 80% of participants knew that cancer is preventable, while 45% practiced cancer prevention. The most difficult recommendations to follow were (1) regular exercise (57.7%); (2) maintaining a healthy body weight (46.1%); and (3) avoiding alcohol (40.1%). The most significant COVID-19-related changes were less exercise (32.5%) and increased body weight (25.6%).

Citations

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A comparative study of health behaviors in adult male cancer survivors and the general male population in Korea: from the Korea national health and nutrition examination survey VII-VIII (2016–2021)
Hyein Jung, Yoonjoo Choi, Byungmi Kim
Supportive Care in Cancer.2025;[Epub] CrossRef
Gender differences in awareness and practices of cancer prevention recommendations in Korea: a cross-sectional survey
Yoonjoo Choi, Naeun Kim, Jin-Kyoung Oh, Yoon-Jung Choi, Bohyun Park, Byungmi Kim
Epidemiology and Health.2025; 47: e2025003. CrossRef
Longitudinal assessment of smoking‐related knowledge, attitude, and practice for cancer prevention: an analysis of data from the Korean National Cancer Prevention Awareness and Practice Survey
Jeoung A Kwon, Naeun Kim, Jin-Kyoung Oh, Bohyun Park, Yoon-Jung Choi, Yoonjoo Choi, Byungmi Kim
BMC Public Health.2025;[Epub] CrossRef
Awareness and Practice of Global Cancer Prevention Dietary Guidelines among Koreans
Ahyoung Yun, Yoonjoo Choi, Hyein Jung, Byungmi Kim
Journal of Cancer Prevention.2025; 30(1): 32. CrossRef
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Sunhee Park, Jeoung A Kwon, Byungmi Kim, Naeun Kim, Yejin Ha, Mark Parascandola, YoonJoo Choi
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The Korean National Codes Against Cancer: background of their establishment and the revision process
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Trends and disparities in avoidable, treatable, and preventable mortalities in South Korea, 2001-2020: comparison of capital and non-capital areas: Sang Jun Eun; Epidemiol Health. 2022;44:e2022067. Published online August 16, 2022; DOI: https://doi.org/10.4178/epih.e2022067

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aimed to describe the regional avoidable mortality trends in Korea and examine the trends in avoidable mortality disparities between the Seoul Capital Area and non-Seoul-Capital areas, thereby exploring the underlying reasons for the trend changes.

METHODS

Age-standardized mortality rates from avoidable causes between 2001-2020 were calculated by region. Regional disparities in avoidable mortality were quantified on both absolute and relative scales. Trends and disparities in avoidable mortality were analyzed using joinpoint regression models.

RESULTS

Avoidable, treatable, and preventable mortalities in Korea decreased at different rates over time by region. The largest decreases were in the non-Seoul-Capital non-metropolitan area for avoidable and preventable mortality rates and the non-Seoul- Capital metropolitan area for treatable mortality rates, despite the largest decline being in the Seoul Capital Area prior to around 2009. Absolute and relative regional disparities in avoidable and preventable mortalities generally decreased. Relative disparities in treatable mortality between areas widened. Regional disparities in all types of mortalities tended to improve after around 2009, especially among males. In females, disparities in avoidable, treatable, and preventable mortalities between areas improved less or even worsened.

CONCLUSIONS

Trends and disparities in avoidable mortality across areas in Korea seem to have varied under the influence of diverse social changes. Enhancing health services to underserved areas and strengthening gender-oriented policies are needed to reduce regional disparities in avoidable mortality.

Summary

Korean summary
2001년부터 2020년까지 회피가능, 예방가능 사망률의 수도권과 비수도권 대도시, 비수도권 비대도시 지역 간 절대적, 상대적 격차는 대체로 감소했지만, 치료가능 사망률의 상대적 격차는 커졌다. 회피가능, 치료가능, 예방가능 사망률의 지역 간 격차는 2009년경 이후에 특히 남성에서 개선됐지만, 여성의 경우 덜 개선되거나 오히려 악화되기도 했다.

Key Message
Regional disparities in avoidable, treatable, and preventable mortalities tended to improve after around 2009, especially among males, but, in females, disparities in all types of mortalities between areas improved less or even worsened.

Citations

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Children.2026; 13(2): 217. CrossRef
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The impact of COVID-19 on cancer care in a tertiary hospital in Korea: possible collateral damage to emergency care: Shin Hye Yoo, Jin-Ah Sim, Jeongmi Shin, Bhumsuk Keam, Jun-Bean Park, Aesun Shin; Epidemiol Health. 2022;44:e2022044. Published online May 1, 2022; DOI: https://doi.org/10.4178/epih.e2022044

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We investigated the impact of the COVID-19 pandemic on cancer care in a tertiary hospital in Korea without specific lockdown measures.

METHODS

A retrospective cohort of cancer patients from one of the largest tertiary hospitals in Korea was used to compare healthcare utilization in different settings (outpatient cancer clinic, the emergency department [ED], and admissions to the hematology/oncology ward) between January 1 and December 31, 2020 and the same time period in 2019. The percent changes in healthcare utilization between the 2 periods were calculated.

RESULTS

A total of 448,833 cases from the outpatient cohort, 26,781 cases from the ED cohort, and 14,513 cases from the admission cohort were reviewed for 2019 and 2020. The total number of ED visit cases significantly decreased from 2019 to 2020 by 18.04%, whereas the proportion of cancer patients remained stable. The reduction in ED visits was more prominent in patients with symptoms suspicious for COVID-19, high-acuity cases, and those who lived in non-capital city areas. There were no significant changes in the number of total visits, new cases in the outpatient clinic, or the total number of hospitalizations between the 2 periods.

CONCLUSIONS

During the pandemic, the number of ED visits significantly decreased, while the use of the outpatient clinic and hospitalizations were not affected. Cancer patients’ ED visits decreased after the COVID-19 outbreak, suggesting the potential for collateral damage outside the hospital if patients cannot reach the ED in a timely manner.

Summary

Korean summary
코로나19 이전인 2019년에 비해 코로나19 유행 첫 해인 2020년에 암환자의 1개 상급종합병원 응급실 방문이 유의하게 감소하였고, 특히 코로나19 의심 증상이 있거나, 중증도가 높거나, 비수도권 지역에 거주하는 환자에서 응급실 방문의 감소가 뚜렷하였다. 코로나19 이전과 코로나19 유행 시 외래 방문 암환자의 수, 신환 수는 큰 차이가 없었고, 입원한 암환자의 수 역시 유의한 차이가 없었다. 코로나19 대유행 시 암환자의 응급실 방문 감소는 병원 밖에서 적시에 응급실에 방문하지 못하는 부수적 피해의 가능성을 시사하여, 이에 대한 관심이 필요하다.

Key Message
The study identified a significant decrease in the emergency department visits of the cancer patients at a tertiary hospital in Korea during the COVID-19 pandemic. There were no significant changes in the number of total visits, new cases in the outpatient clinic, or the total number of hospitalizations between pre-COVID-19 and during-COVID-19 periods.

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COVID-19: Special Article

Mental health of Korean adults before and during the COVID-19 pandemic: a special report of the 2020 Korea National Health and Nutrition Examination Survey: Hyunsuk Jeong, Suyeon Park, Jihee Kim, Kyungwon Oh, Hyeon Woo Yim; Epidemiol Health. 2022;44:e2022042. Published online April 25, 2022; DOI: https://doi.org/10.4178/epih.e2022042

32,989 View
590 Download
24 Web of Science
25 Crossref

Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Coronavirus disease 2019 (COVID-19) and the associated social distancing, limited freedom, and fear of an uncertain future are expected to have substantial mental health effects. We investigated mental health responses in the community during the first year of the COVID-19 pandemic in Korea.

METHODS

We used 2016-2019 and 2020 data from the Korea National Health and Nutrition Examination Survey (KNHANES) to assess pre-pandemic and pandemic mental health status, respectively, in terms of perceived severe stress, depression, and suicidal plans. All analyses were gender-stratified. Pre-specified subgroup analyses were performed according to age, employment status, and household income.

RESULTS

The percentage of Korean adults with suicidal plans increased significantly from 1.3%p (95% confidence interval [CI], 1.1 to 1.5) in 2016-2019 to 1.8%p (95% CI, 1.4 to 2.1) in 2020. Individuals in their 20s and 40s showed a marked increase in suicidal plans (1.2%p; 95% CI, 0.0 to 2.3 and 0.9%p; 95% CI, 0.0 to 1.8, respectively). In men, depression and perceived severe stress increased significantly from pre-COVID-19 to 2020. There was a 2.4%p (95% CI, 0.8 to 4.0) increase in depression among standard workers and a 2.9%p increase in depression in individuals in the second-highest quintile of household income from 2016 and 2018 to 2020.

CONCLUSIONS

As COVID-19 continued, mental health issues such as suicidal plans, depression, and severe stress increased significantly in young men and people in the second-highest quintile of household income. Proactive community mental health efforts are needed to prevent increases in the suicide rate resulting from prolonged exposure to the COVID-19 pandemic.

Summary

Korean summary
코로나19 이전에 비해 코로나19 유행 첫 해 동안에 전체 인구에서 자살 계획 유병율이 유의하게 증가하였고 특히 20대-40대에서 증가 비율이 높았다. PHQ-9으로 측정한 우울증 유병율은 전체 남성에서 증가하였고 특히 30대 남성에서 증가 비율이 높았다. 코로나19 영향으로 자살 계획과 우울증과 같은 정신 건강 문제가 젊은 성인에서 크게 증가하였기 때문에 이러한 정신건강 문제가 자살률 증가로 이어지는 것을 방지하기 위해 국가적 차원의 체계적인 정책과 적극적인 지역사회 정신건강 중재가 필요하다.

Key Message
There was a significant increase in the prevalence of suicidal plan in the overall population during the first year of COVID-19 pandemic compared to pre-COVID-19. In particular, suicide plans increased among those in their 20s and 40s. The prevalence of PHQ-9 detected depression increased in all men, especially among men in their 30s. As mental health problems such as suicide planning and depression have significantly increased among young adults due to the impact of COVID-19, systematic policies at the national level and active community mental health interventions are needed to prevent these mental health problems from leading to an increase in suicide rates.

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Epidemiology and Health.2022; 44: e2022101. CrossRef

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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705 Download
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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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Brief Communication

Occupational inequalities in mortality in Korea: an analysis using nationally representative mortality follow-up data from the late 2000s and after: Eunjeong Noh, Young-Ho Khang; Epidemiol Health. 2022;44:e2022038. Published online April 6, 2022; DOI: https://doi.org/10.4178/epih.e2022038

17,216 View
375 Download
2 Web of Science
2 Crossref

Abstract Summary PDF Supplementary Material

Abstract

Many Korean and international studies have found higher mortality rates and poorer health conditions among manual workers than among non-manual workers. However, a recent study using unlinked data argued that since the economic crisis in Korea in the late 2000s, the mortality estimates of male Korean non-manual workers have been higher than those of manual workers. Our work using individually linked data from the late 2000s and after aimed to examine mortality inequality by occupational class. We analyzed Korea National Health and Nutrition Examination Survey data that were individually linked to cause-of-death data. Cox regression analysis was used to identify the hazard ratios for mortality by occupational class. Of 11,766 males aged between 35 and 64, 397 died between 2007 and 2018: 142 died from cancer, 68 from cardiovascular disease, 88 from external causes, and 99 from other causes. After controlling for age, the mortality estimates for manual workers were 1.85 times higher than those for upper non-manual workers (p<0.05). We observed no evidence of reversed mortality inequality among occupational classes in Korea since the 2000s; this previously reported finding might have been due to numerator-denominator bias arising from the use of unlinked data.

Summary

Korean summary
개인 단위 연계자료가 아닌 분모(센서스)-분자(사망신고) 집합 자료를 사용하여 2000년대 후반 경제위기 이후 한국 남성 비육체직의 사망률이 육체직보다 높게 나타난다고 기존의 한 연구가 주장했다. 이 연구는 2000년대 이후 개인 단위로 연계된 코호트 자료를 활용하여 여전히 한국에서 육체직의 사망위험이 비육체직보다 높다는 점을 보임으로써, 기존 연구가 비연계자료의 사용으로 인한 분자-분모 바이어스(numerator-denominator bias) 때문에 그와 같은 결과를 보였다고 지적하였다.

Key Message
This paper using individually linked data from the late 2000s and after observed no evidence of reversed mortality inequality among occupational classes in Korea since the 2000s. The previously reported finding showing reversed occupational mortality inequality might have been due to numerator-denominator bias arising from the use of unlinked data.

Citations

Citations to this article as recorded by

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