Epidemiology and Health

Original Article

Association of work-time control with burnout and turnover intention: a cross-sectional analysis of a general working population in Korea: Hye-Eun Lee, Seong-Sik Cho, Mo-Yeol Kang; Epidemiol Health. 2026;48:e2026011. Published online February 21, 2026; DOI: https://doi.org/10.4178/epih.e2026011

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OBJECTIVES
For employees, work-time control (WTC) may protect against burnout and turnover. However, evidence from Korean workplaces is limited. This study aimed to examine whether WTC is associated with burnout and turnover intention and to test whether burnout mediates this relationship.
METHODS
We analyzed data from 4,745 wage workers in the 2024 wave of the Korean Work, Sleep, and Health Study. WTC was assessed across 6 domains, burnout was measured using the Korean Burnout Syndrome Scale, and turnover intention was assessed using a validated 4-item scale. Logistic regression was used to estimate the associations of WTC quartile with burnout and turnover intention, and mediation analysis was used to decompose the association between WTC and turnover intention through burnout.
RESULTS
Among 4,745 workers, the prevalence of burnout was 3.9% and turnover intention was 34.5%; both increased stepwise across lower WTC quartiles. In adjusted models, workers in the lowest WTC quartile had higher odds of burnout (odds ratio [OR], 3.95; 95% confidence interval [CI], 2.41 to 6.47) and turnover intention (OR, 2.24; 95% CI, 1.85 to 2.71) than those in the highest quartile. Mediation analysis showed that burnout explained 36.6% (95% CI, 22.3 to 51.0) of the association between WTC and turnover intention.
CONCLUSIONS
Lower WTC was linked to higher burnout and turnover intention, with burnout explaining more than one-third of this relationship.; Summary

Korean summary
근로시간 통제(work-time control, WTC)가 낮을수록 한국 노동자에서 번아웃과 이직 의도가 더 높게 나타났다. WTC가 가장 낮은 집단은 가장 높은 집단에 비해 번아웃 위험이 약 4배, 이직 의도는 약 2배 이상 높았다. 번아웃은 WTC와 이직 의도 사이 연관성의 약 36.6%를 매개하여, 근로시간 자율성을 높이는 것이 번아웃을 줄이고 이직 의도를 낮추는 데 기여할 수 있음을 시사한다.

Key Message
Lower work-time control (WTC) was associated with higher burnout and greater turnover intention among Korean workers. Workers in the lowest WTC quartile had nearly four times higher odds of burnout and more than twice the odds of turnover intention compared with those in the highest quartile. Burnout mediated about 36.6% of the association between WTC and turnover intention, suggesting that improving schedule control may reduce turnover partly by preventing burnout.

Systematic Review

Confounding and the healthy worker survivor effect in studies of medical radiation workers: a systematic review of methodological approaches: Eun Jung Park, Kyoungyeol Yuk, Jaeho Jeong, Won Jin Lee; Epidemiol Health. 2026;48:e2026009. Published online February 4, 2026; DOI: https://doi.org/10.4178/epih.e2026009

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Confounding and the healthy worker survivor effect (HWSE) represent major methodological challenges in epidemiology, particularly in studies of low-dose exposures, where effect sizes are small and risk estimates can be readily distorted by bias. This systematic review aimed to summarize the methods used to adjust for confounding and the HWSE in studies of medical radiation workers. We systematically searched PubMed and Embase for studies of medical radiation workers from inception through June 30, 2025. Studies reporting excess risk estimates for any health outcomes associated with occupational radiation exposure were included. Study selection followed the PECO (Population, Exposure, Comparator, Outcome) criteria, and data were synthesized descriptively. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in PROSPERO (CRD42024589851). Sixteen eligible studies from 3 countries were identified, all of which were rated as high quality. To control for confounding, regression was used in all studies, followed by stratification (62.5%) and restriction (18.8%). Age, sex, and birth year were adjusted for in all models, with smoking being the next most frequently controlled variable. To mitigate the HWSE, only a single approach, adjustment for employment characteristics, was identified, and it was applied in 3 studies (18.8%). No other approaches, including restriction or g-methods, were employed. Although confounding is generally addressed using conventional analytical approaches, the HWSE has rarely been considered in studies of medical radiation workers. More comprehensive strategies that explicitly account for the HWSE are needed to improve the validity of risk estimates, particularly in low-dose occupational studies.; Summary

Korean summary
교란 및 건강근로자 생존효과는 역학 연구에서 해결해야 할 중요한 과제이며, 특히 저노출 연구에서는 효과 크기가 상대적으로 작아 이러한 영향에 더욱 취약하다. 연구 결과, 의료방사선종사자 연구에서 교란은 회귀분석 및 층화와 같은 전통적인 방법을 통해 적절히 보정되고 있지만, 건강근로자 생존효과를 줄이기 위한 방법은 대부분의 연구에서 적용되지 않고 있다. 향후 역학 연구에서는 보다 정확한 위험도 평가를 위해 건강근로자 생존효과를 줄이기 위한 다양한 방법의 적용이 필요하다.

Key Message
Confounding and the healthy worker survivor effect (HWSE) are major methodological challenges in epidemiology, particu- larly in studies involving low-dose exposure. Although confounding is generally considered to have only a limited impact in occupational epidemiology, a variety of analytical methods have nonetheless been applied to control it. In contrast, the HWSE, despite being widely recognized as a major source of bias, has rarely been mitigated in practice. More comprehensive strat- egies that explicitly account for the HWSE are needed to improve the validity of risk estimates.

Original Articles

Parents’ employment and non-chromosomal congenital anomalies in Korea: a national population cohort study: Kyuwon Kim, Hoyol Jhang, Erdenetuya Bolormaa, Chae Bong Kim, Seung-Ah Choe; Epidemiol Health. 2025;47:e2025018. Published online April 10, 2025; DOI: https://doi.org/10.4178/epih.e2025018

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OBJECTIVES
We assessed the association between parents’ employment status, including industrial classification, and non-chromosomal congenital anomalies in offspring.
METHODS
We analyzed data from mothers who delivered live births between 2020 and 2022, linking their records with those of their neonates from the National Health Information Service (NHIS) database. Our analysis focused on common industrial classifications representing at least 6% of the total workforce. Congenital anomalies were identified based on neonates’ diagnostic codes. We conducted logistic regression to estimate odds ratios (ORs) of congenital anomalies by the industrial classification of mothers and their partners, adjusting for individual risk factors, with the financial industry serving as the reference category.
RESULTS
Among 338,637 women with a live birth, 148,818 (43.9%) were employed at the time of pregnancy. Employment was associated with a higher risk of congenital anomalies (OR, 1.08; 95% confidence interval [CI], 1.04 to 1.12). Within the common industrial classifications, health and social work exhibited the highest risk (OR, 1.11; 95% CI, 1.06 to 1.22) compared to the financial industry. Women employed in general hospitals showed particularly elevated risks (OR, 1.19; 95% CI, 1.04 to 1.37). Among male partners, the risk estimates were generally imprecise.
CONCLUSIONS
The study indicates that certain industries are linked with a higher risk of congenital anomalies among women workers. These findings underscore the need for enhanced safety measures in high-risk industrial settings to reduce the occurrence of congenital anomalies.; Summary

Korean summary
- 2020~2022년 출산 여성 338,637명 중 43.9%가 임신 중 고용 상태였으며, 고용된 상태는 비염색체성 선천 기형 위험 증가와 연관됨(오즈비=1.08; 95% 신뢰구간[CI] 1.04–1.12). - 산업별 분석에서 금융업을 참조 기준으로 할 때, 보건·사회복지업이 가장 높은 위험을 보였고(1.11; 95% CI 1.06–1.22), 특히 종합병원에 근무하는 여성에서 위험이 특히 높았음(1.19; 95% CI 1.04–1.37). - 남성 파트너에서는 선천 기형 위험을 높이는 산업 분류는 뚜렷하지 않았으며 위험 추정치의 신뢰 구간이 전반적으로 넓고 정밀도가 낮았음.

Key Message
- Among 338,637 women who delivered between 2020 and 2022, 43.9% were employed during pregnancy, and employment status was associated with an increased risk of non-chromosomal congenital anomalies (OR 1.08; 95% confidence interval [CI] 1.04–1.12). - Compared to the financial industry, health and social work showed the highest risk (OR 1.11; 95% CI 1.06–1.22), with women working in general hospitals exhibiting an even greater elevated risk (OR 1.19; 95% CI 1.04–1.37). - Risk estimates by industrial classification for male partners were generally imprecise, with wide confidence intervals.

Association between the safety climate and occupational injury in the Korean working population: a cross-sectional study: Jeehee Min, Tae-Won Jang, Hye-Eun Lee, Mo-Yeol Kang, Seong-Sik Cho; Epidemiol Health. 2024;46:e2024082. Published online October 1, 2024; DOI: https://doi.org/10.4178/epih.e2024082

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Preventing occupational injuries remains a significant challenge in Korea. A positive safety climate can contribute to reducing workplace injuries. However, the impact of safety climate on preventing occupational injuries among the Korean workforce has not been adequately explored. Therefore, this study aimed to investigate the relationship between the perceived safety climate and occupational injuries within the Korean working population.

METHODS

This study used baseline data from the Korean Work, Sleep, and Health Study (KWSH). The safety climate was measured using the brief version of the Nordic Safety Climate Questionnaire. Occupational injury was determined by whether injuries or accidents had occurred at workplaces in the past year. Logistic regression analysis was performed to examine the association between the safety climate and occupational injury.

RESULTS

Participants who reported an unfavorable workplace safety climate were more likely to experience occupational injuries. Multiple logistic regression analysis revealed that the adjusted odds ratio (OR) for occupational injuries in an unfavorable safety climate was 2.20 (95% confidence interval [CI], 1.38 to 3.51) compared to a favorable safety climate. Specifically, factors such as “not encouraging employees to follow safety rules when on a tight schedule” (OR, 2.02; 95% CI, 1.25 to 3.24) and “not helping each other work safely” (OR, 1.98; 95% CI, 1.17 to 3.25) were significantly associated with occupational injuries.

CONCLUSIONS

An unfavorable safety climate was associated with increased occupational injuries among Korean workers. Improving the safety climate in the workplace may reduce occupational injuries in Korea.

Summary

Korean summary
한국 노동인구집단에서도 안전풍토는 직업성 손상과 관련성이 관찰되었다. 이 같은 결과는 작업장의 안전풍토를 개선함으로써 직업성 손상을 예방할 수 있음을 시사한다.

Key Message
Safety climate was related to occupational injuries in the Korean working population. This result may indicate that occupational injuries can be prevented by improving the workplace safety climate. Workplace safety should be a high priority goal for management, and workers need to help each other for workplace safety.

Citations

Citations to this article as recorded by

Data profile: Korean Work, Sleep, and Health Study (KWSHS)
Seong-Sik Cho, Jeehee Min, Heejoo Ko, Mo-Yeol Kang
Ann Occup Environ Med.2025; 37: e3. CrossRef
Safety Climate and Occupational Injuries in the Iron and Steel Industries in Tanzania
Saumu Shabani, Bente Elisabeth Moen, Teferi Abegaz, Simon Henry Mamuya
International Journal of Environmental Research and Public Health.2025; 22(9): 1372. CrossRef
Association between safety climate, safety participation, safety compliance, and occupational injuries among workers in large-scale building construction projects in Ethiopia
Teferi Abegaz, Wakgari Deressa, Bente E. Moen
International Archives of Occupational and Environmental Health.2025; 98(7): 685. CrossRef

Data Profile

Data profile: the Korean Workers’ Compensation-National Health Insurance Service (KoWorC-NHIS) cohort: Jeehee Min, Eun Mi Kim, Jaiyong Kim, Jungwon Jang, Youngjin Choi, Inah Kim; Epidemiol Health. 2024;46:e2024071. Published online August 19, 2024; DOI: https://doi.org/10.4178/epih.e2024071

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Abstract Summary PDF

Abstract

The Korean Workers’ Compensation-National Health Insurance Service (KoWorC-NHIS) cohort was established to investigate the longitudinal health outcomes of Korean workers who have been compensated for occupational injuries or diseases. This cohort study, which utilized data spanning from 2004 to 2015, merged workers’ compensation insurance claim data with the National Health Insurance Database (NHID), encompassing 858,793 participants. The data included socio-demographic factors such as age, sex, income, address, insurance type, and disability grade. It also covered the types of occupational accidents, International Classification of Diseases, 10th revision codes for diseases or accidents, work tenure, industry, occupation code, and company size. Additional details such as the occupational hire date, date of claim, date of recognition, and affected body parts were recorded. The cohort predominantly consisted of male workers (80.0%), with the majority experiencing their first occupational accident in their 40s (27.6%) or 50s (25.3%). Notably, 93.1% of the cases were classified as occupational injuries. By integrating this data with that from the NHID, updates on health utilization, employment status, and income changes were made annually. The follow-up period for this study is set to conclude in 2045.

Summary

Korean summary
KoWorC-NHIS Cohort (산재보험-국민건강보험공단 코호트) 는 2004년부터 2015년까지 산업재해를 경험한 근로자들의 장기적인 건강 결과를 추적 조사하기 위해 구축된 코호트이다. 이 코호트에는 총 858,793명의 근로자가 등록되었으며, 대다수는 남성 (80%)이었고, 업무상 사고 (93.1%)를 경험한 것으로 나타났다. 이 코호트를 활용하여 산업재해 피해 근로자들의 장기적인 건강영향을 분석할 수 있으며, 취약 계층 근로자의 건강을 보호하기 위한 예방 정책 수립의 근거로 활용할 수 있다.

Key Message
The KoWorC-NHIS Cohort (Workers' Compensation Insurance-National Health Insurance Service Cohort) was established to track the long-term health outcomes of workers who experienced occupational injuries and illnesses from 2004 to 2015. The cohort includes a total of 858,793 workers, with the majority being male (80%) and having experienced occupational accidents (93.1%). This cohort can be used to analyze the long-term health effects on workers who have suffered occupational injuries, and can serve as evidence for establishing preventive policies to protect the health of vulnerable workers.

Citations

Citations to this article as recorded by

Machine learning-based prediction of dissatisfaction after occupational injury: a retrospective cohort study using the nationwide Korean workers’ compensation insurance database
Youjin Lee, Taeyeon Kim, Dahyeon Koo, Dougho Park
BMJ Open.2025; 15(11): e103321. CrossRef

Original Articles

Does the father’s job matter? Parental occupation and preterm birth in Korea: Taemi Kim, Eunseon Gwak, Bolormaa Erdenetuya, Jeong-Won Oh, Jung-won Yoon, Myoung-Hee Kim, Jia Ryu, Seung-Ah Choe; Epidemiol Health. 2023;45:e2023078. Published online August 24, 2023; DOI: https://doi.org/10.4178/epih.e2023078

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Limited evidence is available regarding the impact of paternal occupation and its combined effect with maternal occupation on preterm birth. Therefore, we assessed the association of maternal and paternal occupations with preterm birth.

METHODS

We used the national birth data of Korea between 2010 and 2020. Parental occupations were divided into 5 categories: (1) managers; (2) professionals, technicians, and related workers; (3) clerks and support workers; (4) service and sales workers; and (5) manual workers. A multinomial logistic regression model was used to calculate the adjusted odds ratios (aORs) of extremely, very, and moderate-to-late preterm births per occupational category considering individual risk factors.

RESULTS

For the 4,004,976 singleton births, 40.2% of mothers and 95.5% of fathers were employed. Compared to non-employment, employment was associated with a lower risk of preterm birth. Among employed mothers, service and sales occupations were associated with a higher risk of preterm birth than managerial occupations (aOR, 1.06; 95% confidence interval [CI], 1.01 to 1.10 for moderate-to-late preterm births). The father’s manual occupation was associated with a higher risk of preterm birth (aOR, 1.09; 95% CI, 1.05 to 1.13 for moderate-to-late preterm) than managerial occupations. When both parents had high-risk occupations, the risk of preterm birth was higher than in cases where only the mother or neither of the parents had a high-risk occupation.

CONCLUSIONS

Paternal occupation was associated with preterm birth regardless of maternal employment and occupation and modified the effect of maternal occupation. Detailed occupational environment data are needed to identify the paternal exposures that increase the risk.

Summary

Korean summary
본 연구는 2010년부터 2020년까지 출생신고자료를 활용하여 부모의 직업이 조산에 미치는 영향에 대해 살펴보았다. 어머니의 경우 서비스 및 판매직종에서 근무할 경우 관리자 직종에 비해 조산 위험이 높았고, 아버지의 경우 육체노동자일 경우 조산의 위험이 높아졌다. 특히 부모 모두 고위험 직업을 가질수록 한쪽만 고위험 직업을 가졌을 때보다 조산 위험이 더 높았다.

Key Message
This study explored the association between parental occupation and preterm birth using Korean national birth data from 2010 to 2020. The analysis revealed that employment was associated with a lower preterm birth risk. Among employed mothers, service and sales occupations exhibited a higher risk than managerial occupations and paternal manual occupations were associated with increased preterm birth risk. When both parents were employed in high-risk occupations, the probability of preterm birth was greater compared to cases where only one of them had such an occupation.

Citations

Citations to this article as recorded by

Adolescent sports participation and social-class health inequalities: evidence from CHNS
Jie Yu, Yao Lu, Lunan Zhao
Frontiers in Public Health.2026;[Epub] CrossRef
Association Between the Occupation of Pregnant Women’s Partners and Risks of Infant Low Birth Weight and Preterm Birth in a Prospective Birth Cohort
Sumitaka Kobayashi, Yasuaki Saijo, Hiroyoshi Iwata, Takeshi Yamaguchi, Naomi Tamura, Mariko Itoh, Maki Tojo, Yoshiya Ito, Reiko Kishi
Journal of Occupational & Environmental Medicine.2025; 67(3): 161. CrossRef
Perinatal health inequalities between Canadian-born and foreign-born women in Canada: a decomposition analysis
Melia Alcantara, Sam B Harper, Gabriel D Shapiro, Tracey Bushnik, Jay S Kaufman, Zoua Vang, Angela Mashford-Pringle, Seungmi Yang
BMJ Public Health.2025; 3(2): e001231. CrossRef
Beyond Genes: Mechanistic and Epidemiological Insights into Paternal Environmental Influence on Offspring Health
Ran Shmuel Rotem, Sonia Hernández-Díaz, Russ Hauser, Marc G. Weisskopf
Current Environmental Health Reports.2025;[Epub] CrossRef
Neurodevelopmental Outcomes of Moderate to Late Preterm Infants: A Population at Risk
Rachel H. Goode, Kendell R. German, Dennis Z. Kuo
NeoReviews.2025; 26(11): e743. CrossRef
Narrative Review of National Health Insurance Claims Data for Gestational Age Calculation and Vaccine Safety Evaluation in Pregnancy
Taemi Kim, Seung-Ah Choe
Health Insurance Review & Assessment Service Research.2025; 5(2): 98. CrossRef

Cancer incidence among male construction workers in Korea: a standardized incidence ratio analysis, 2009-2015: Soonsu Shin, Woo-Ri Lee, Jin-Ha Yoon, Wanhyung Lee; Epidemiol Health. 2023;45:e2023060. Published online June 19, 2023; DOI: https://doi.org/10.4178/epih.e2023060

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Construction workers face an elevated risk for several types of cancer. Nevertheless, there is a lack of large-scale epidemiological studies examining the risk of all cancers in construction workers. This study aimed to investigate the risk of various cancers in male construction workers using the Korean National Health Insurance Service (NHIS) database.
METHODS
We used data from the NHIS database from 2009 to 2015. Construction workers were identified using the Korean Standard Industrial Classification code. We calculated the age-standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) for cancer occurrence in male construction workers compared to all male workers.
RESULTS
Compared to all male workers, the SIRs for esophageal cancer (SIR, 1.24; 95% CI, 1.07 to 1.42) and malignant neoplasms of the liver and intrahepatic bile ducts (SIR, 1.18; 95% CI, 1.13 to 1.24) were significantly higher in male construction workers. The SIRs for malignant neoplasms of the urinary tract (SIR, 1.19; 95% CI, 1.05 to 1.35) and non-Hodgkin lymphoma (SIR, 1.21; 95% CI, 1.02 to 1.43) were significantly elevated in building construction workers. The SIR for malignant neoplasms of the trachea, bronchus, and lung (SIR, 1.16; 95% CI, 1.03 to 1.29) was significantly higher in heavy and civil engineering workers.
CONCLUSIONS
Male construction workers have an increased risk for esophageal cancer, liver cancer, lung cancer, and non-Hodgkin’s cancer. Our results indicate that tailored strategies for cancer prevention should be developed for construction workers.; Summary

Korean summary
건설 노동자는 작업환경에서 수많은 유해 인자에 노출되지만, 건설 노동자에서 암의 연령 표준화 발생비를 조사한 역학 연구는 부족하다. 이번 연구에서 식도암과 간담도암의 연령 표준화 발생비는 전체 남성 근로자에 비해 남성 건설 근로자에게서 증가하였다. 이러한 결과는 건설 근로자에서 암 위험이 증가했음을 나타내며, 이 직업군에서 암 예방을 위한 추가 연구와 정책이 필요함을 의미한다.

Key Message
Despite the exposure of construction workers to numerous hazardous substances at workplace, epidemiological studies investigating the risk of all cancers in this occupational group are lacking. In this study, the age-standardized incidence ratio of esophageal cancer and hepatobiliary cancers increased in male construction workers compared to all male workers. Our results underscore the increased several cancer risks faced by male construction workers, necessitating the development of tailored strategies for cancer prevention in this occupational group.

Estimated trends in hospitalizations due to occupational injuries in Korea based on the Korean National Hospital Discharge In-depth Injury Survey (2006-2019): Seong-Uk Baek, Won-Tae Lee, Min-Seok Kim, Myeong-Hun Lim, Jin-Ha Yoon; Epidemiol Health. 2023;45:e2023042. Published online April 5, 2023; DOI: https://doi.org/10.4178/epih.e2023042

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
In recent years, occupational injuries have sparked a huge social and political debate. Thus, in this study, we focused on the characteristics and trends of occupational injuries requiring hospitalization in Korea.

METHODS

The Korea National Hospital Discharge In-depth Injury Survey was designed to estimate the annual number and characteristics of all injury-related hospitalizations in Korea. The annual number of hospitalizations due to occupational injuries and the age-standardized rates (ASRs) were estimated from 2006 to 2019. The annual percentage change (APC) and average annual percentage change (AAPC) of ASRs and their 95% confidence intervals (CIs) were calculated using joinpoint regression. All analyses were stratified by gender.

RESULTS

In men, the APC of the ASRs of all-cause occupational injuries was -3.1% (95% CI, -4.5 to -1.7) in 2006-2015. However, a non-significant upward trend was observed after 2015 (APC, 3.3%; 95% CI, -1.6 to 8.5). In women, the APC of all-cause occupational injuries was -8.6% (95% CI, -12.1 to -5.1) in 2006-2012. However, a non-significant upward trend was observed after 2012 (APC, 2.1%; 95% CI, -0.9 to 5.2). A recent upward trend in stabbing injuries was observed after 2012 (APC, 4.7%; 95% CI, -1.8 to 11.8) in women. A non-significant overall increasing trend was also observed for occupational injuries caused by exposure to extreme temperatures (AAPC, 3.7%; 95% CI, -1.1 to 8.7) in women.

CONCLUSIONS

A recent upward trend in all-cause injury hospitalizations and hospitalizations caused by stabbing injuries was observed. Therefore, active policy interventions are required to prevent occupational injuries.

Summary

Korean summary
본 연구는 퇴원환자 심층조사를 사용하여 2006년부터 2019년까지 우리나라에서 발생한 업무상 손상의 추세를 연령표준화발생률을 구함으로써 분석하였다. 남녀 모두에서 2010년대 초반 까지는 발생률이 유의하게 감소하는 추세를 보였지만, 2013-2015년 이후부터는 통계적으로 유의하지 않은 점진적 상승 추세가 관찰되었다. 이러한 연구 결과는 업무상 손상을 예방하기 위해 적극적인 정책적 개입이 필요하다는 것을 시사한다.

Key Message
This study analyzed the trends in work-related injury occurrences in South Korea from 2006 to 2019 based on a nationally representative, repeated cross-sectional dataset. Age-standardized rates were calculated and their annual trend was estimated using a JointPoint regression. While both males and females exhibited a significant decline in occupational injury rates until the early 2010s, a non-significant but gradual upward trend has been observed since 2013-2015. These findings underscore the need for active policy interventions to prevent work.

Citations

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Factors Affecting Mortality and Distribution of Co-morbidities in Chronic Obstructive Pulmonary Disease
Sung-Soo Kim
Journal of Health Informatics and Statistics.2024; 49(1): 35. CrossRef

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

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Abstract

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Summary

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

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

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Eun KIM, Hyoung-Ryoul KIM, Sangjun CHOI, Hyun A CHO, Seong-Sik CHO, Mo-Yeol KANG
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Association between work from home and health-related productivity loss among Korean employees
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Annals of Occupational and Environmental Medicine.2024;[Epub] CrossRef
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Akihiro Koreki, Mitsuhiro Sado, Yasue Mitsukura, Hisateru Tachimori, Anna Kubota, Yoshiaki Kanamori, Manae Uchibori, Shiyori Usune, Akira Ninomiya, Ryutaro Shirahama, Akihiro Fujimoto, Kanako Inabe, Hiroaki Miyata, Masaru Mimura
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Journal of Occupational Health.2024;[Epub] CrossRef

Systematic Review

Non-cancer health risks in firefighters: a systematic review: Jeong Ah Kim, Soo Yeon Song, Wonjeong Jeong, Jae Kwan Jun; Epidemiol Health. 2022;44:e2022109. Published online November 16, 2022; DOI: https://doi.org/10.4178/epih.e2022109

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Abstract

osFirefighters are occupationally exposed to hazardous factors that may increase their risk of disease. However, non-cancer disease risk in firefighters has not been systematically examined. This systematic review aimed to identify non-cancer disease risk in firefighters and determine whether the risk differs according to job characteristics. We searched the Cochrane Library, Embase, PubMed, and KoreaMed databases using relevant keywords from their inception to April 30, 2021. The Risk of Bias Assessment Tool for Non-randomized Studies version 2.0 was used to assess the quality of evidence. Due to study heterogeneity, a narrative synthesis was presented. The systematic literature search yielded 2,491 studies, of which 66 met the selection and quality criteria. We confirmed that the healthy worker effect is strong in firefighters as compared to the general population. We also identified a significant increase in the incidence of lumbar disc herniation, lower back pain, angina pectoris, acute myocardial infarction, and post-traumatic stress disorder (PTSD) in firefighters compared to other occupational groups. Contradictory results for the risk of PTSD and anxiety disorders related to rank were reported. Sufficient evidence for increased risk of lumbar disc herniation, lower back pain, angina pectoris, acute myocardial infarction, and PTSD was available. The risk of non-cancer diseases varied depending on job type, years of service, and rank. However, caution should be exercised when interpreting the results because the classification criteria for firefighters’ jobs and ranks differ by country.

Summary

Korean summary
본 연구는 소방관과 비암성 질환과의 직업관련성을 파악하기 위해 체계적 문헌고찰을 수행하였다. 소방관은 근골격계 질환, 협심증, 심근경색, 외상후 스트레스 장애 등 일부 질환에서 일관된 직업관련성이 보고되었다. 하지만 대부분의 연구에서 연구결과가 건강근로자효과의 영향을 보정하지 못하였고 근무형태, 근무조건, 근무강도 등에 따라 일관되지 못한 결과를 보고하고 있다.

Key Message
In firefighters, risks of lumbar disc herniation, lower back pain, angina pectoris, acute myocardial infarction, and post-traumatic stress disorder were increased constantly. Due to the failure to avoid the healthy-worker effect, consistent relationship between firefighters and non-cancerous diseases has not been reported.

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Organizational health culture in the Korean firefighter intervention studies: a scoping review
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Alexis Descatha, Hugues Dousseau, Sabrina Pitet, Francis Magnolini, Neil McMillan, Neil Mangelsdorf, Rick Swan, Jean-Marie Steve, Didier Pourret, Marc Fadel
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Occupational and Environmental Medicine.2025; 82(9): 423. CrossRef
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Original Article

The associations of job strain and leisure-time physical activity with the risk of hypertension: the population-based Midlife in the United States cohort study: Xinyue Liu, Timothy A. Matthews, Liwei Chen, Jian Li; Epidemiol Health. 2022;44:e2022073. Published online September 7, 2022; DOI: https://doi.org/10.4178/epih.e2022073

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306 Download
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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Job strain is positively associated with incident hypertension, while increasing leisure-time physical activity (LTPA) can reduce incident hypertension. However, the joint associations of job strain and LTPA with incident hypertension among United States workers have yet to be investigated. This study examined the independent and joint associations of job strain and LTPA with incident hypertension.

METHODS

This prospective cohort study (n=1,160) utilized data from the population-based Midlife in the United States study. The associations of job strain and LTPA at baseline with incident hypertension during follow-up were examined using Cox proportional hazards models. High job strain was derived from a combination of high job demands and low job control, and high LTPA was defined as engagement in moderate or vigorous LTPA at least once per week.

RESULTS

During 9,218 person-years of follow-up, the hypertension incidence rate was 30.6 (95% confidence interval [CI], 27.3 to 34.3) per 1,000 person-years. High job strain was associated with a higher risk for hypertension than low job strain (adjusted hazard ratio [aHR], 1.29; 95% CI, 1.00 to 1.67). High LTPA was associated with lower hypertension risk than low LTPA (aHR, 0.77; 95% CI, 0.60 to 0.98). Hypertension risk was higher among workers with high job strain and low LTPA than among those with low job strain and high LTPA (aHR, 1.70; 95% CI, 1.18 to 2.43).

CONCLUSIONS

Job strain and LTPA showed positive and inverse associations, respectively, with incident hypertension. The combination of high job strain and low LTPA was associated with the highest risk for hypertension.

Summary

Key Message
High job strain and low leisure-time physical activity are independent risk factors for hypertension among workers, and those with high job strain and low leisure-time physical activity are at the highest risk, so it is critical that policy interventions target job strain and leisure-time physical activity to reduce hypertension.

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Ethan Siu Leung Cheung, David S. Curtis, Sara Grineski, Yehua Dennis Wei, Ming Wen
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Workplace discrimination and risk of alcohol abuse: a prospective cohort study in the United States
Adrian Loerbroks, Liwei Chen, Chunqing Lin, Kira Schmidt Stiedenroth, Jian Li
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Alternative Formulations of Job Strain and Sleep Disturbances: A Longitudinal Study in the United States
Yijia Sun, Megan Guardiano, Mayumi Saiki, Jian Li
American Journal of Industrial Medicine.2025; 68(3): 264. CrossRef
Dose–response relationship between leisure-time physical activity and metabolic syndrome in short sleep US adults: evidence from a nationwide investigation
Yanwei You, Hao Ding, Meihua Tang, Weizhao Wang, Ning Yan, Leizi Min, Yuquan Chen, Xindong Ma
Applied Physiology, Nutrition, and Metabolism.2025; 50: 1. CrossRef
Physical activity lowers hypertension risk: A 2-sample Mendelian randomization study
Chenlu Zhang, Sicong Chen, Wei Song
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Prospective associations of occupational and leisure-time physical activity with risk of diabetes: a cohort study from the United States
Timothy A Matthews, Xinyue Liu, Liwei Chen, Jian Li
Annals of Work Exposures and Health.2024; 68(6): 581. CrossRef
The association between leisure‐time physical activity and cardiorespiratory and muscular fitness and job strain—Study with a Northern Finland birth cohort of 1966
Heli Kiema‐Junes, Aino Saarinen, Raija Korpelainen, Leena Ala‐Mursula, Maisa Niemelä, Vahid Farrahi, Mirka Hintsanen
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2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension
Giuseppe Mancia, Reinhold Kreutz, Mattias Brunström, Michel Burnier, Guido Grassi, Andrzej Januszewicz, Maria Lorenza Muiesan, Konstantinos Tsioufis, Enrico Agabiti-Rosei, Engi Abd Elhady Algharably, Michel Azizi, Athanase Benetos, Claudio Borghi, Jana Br
Journal of Hypertension.2023; 41(12): 1874. CrossRef
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Timothy A. Matthews, Yifang Zhu, Wendie Robbins, Mary Rezk-Hanna, Paul M. Macey, Yeonsu Song, Jian Li
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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

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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.

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Following the power: social-class inequities in mortality from accidental poisonings, suicide, and chronic liver disease in the United States
Jerzy Eisenberg-Guyot, Candace M. Cosgrove, Alex Azan, Samuel R. Friedman, Seth J. Prins, Audrey Renson
Social Science & Medicine.2026; 392: 118991. CrossRef
Insurance Types and All-Cause Mortality in Korean Cancer Patients: A Nationwide Population-Based Cohort Study
Jinyoung Shin, Yoon-Jong Bae, Hee-Taik Kang
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Mortality of Suicide and Cerebro-Cardiovascular Diseases by Occupation in Korea, 1997–2020
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COVID-19: Perspective

Magnifying the importance of collecting race, ethnicity, industry, and occupation data during the COVID-19 pandemic: Sai Krishna Gudi, Sophia M. George, Komal Krishna Tiwari; Epidemiol Health. 2021;43:e2021095. Published online November 6, 2021; DOI: https://doi.org/10.4178/epih.e2021095

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Abstract Summary PDF

Abstract

The contagiousness of coronavirus disease-2019 (COVID-19) led to the imposition of historical lockdowns in various countries. No scientific mind could have made accurate projections of the tremendous impact that COVID-19 would have on nations, communities, and the global-wide economy. Meanwhile, millions of workers have lost their jobs, while healthcare workers are overwhelmed and are reaching a state of mental and physical exhaustion. With the uncontrollable spread, researchers have been working to identify factors associated with COVID-19. In this regard, race, ethnicity, industry, and occupation have been found to be predominant factors of interest. However, unfortunately, the unavailability of such information has been a difficult reality. Since race, ethnicity, and employment are essential social determinants of health and could serve as potential risk-factors for COVID-19, collecting such information may offer important context for prioritising vulnerable groups. Thus, this perspective aims to highlight the importance and need for collecting race, ethnicity, and occupation-related data to track and treat the racial/ethnic groups that have been most strongly affected by the COVID-19 pandemic. Collecting such data will provide valuable insights and help public health officials recognise workplace-related outbreaks and evaluate the odds of various ethnic groups and professions contracting COVID-19.

Summary

Key Message
As essential social determinants of health, collecting and recording the race/ethnicity, occupation and industry information will provide valuable insights and help public health officials identify workplace-related outbreaks and evaluate the odds of various ethnic groups and professions contracting COVID-19.

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COVID-19: Original Article

Estimation of the number of working population at high-risk of COVID-19 infection in Korea: Juyeon Lee, Myounghee Kim; Epidemiol Health. 2020;42:e2020051. Published online July 9, 2020; DOI: https://doi.org/10.4178/epih.e2020051

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We aimed to identify occupational groups at high-risk of coronavirus disease 2019 (COVID-19) infection in Korea, to estimate the number of such workers, and to examine the prevalence of protective resources by employment status.

METHODS

Based on the sixth Standard Occupational Classification codes, 2015 census data were linked with data from the fifth Korean Working Conditions Survey, which measured how frequently workers directly come into contact with people other than fellow employees in the workplace.

RESULTS

A total of 30 occupational groups, including 7 occupations from the healthcare and welfare sectors and 23 from other sectors, were classified as high-risk occupational groups involving frequent contact with people other than fellow employees in the workplace (more than half of the working hours). Approximately 1.4 million (women, 79.1%) and 10.7 million workers (46.3%) are employed in high-risk occupations. Occupations with a larger proportion of women are more likely to be at a high-risk of infection and are paid less. For wage-earners in high-risk occupations, protective resources to deal with COVID-19 (e.g., trade unions and health and safety committees) are less prevalent among temporary or daily workers than among those with permanent employment.

CONCLUSIONS

Given the large number of Koreans employed in high-risk occupations and inequalities within the working population, the workplace needs to be the key locus for governmental actions to control COVID-19, and special consideration for vulnerable workers is warranted.

Summary

Korean summary
코로나바이러스감염증-19 (코로나19) 유행 상황에서 감염 고위험 직업군 종사자는 보건의료복지 업종에서 총 140만 명, 그 외 업종에서 총 1,073만 명으로 추정된다. 고위험 사업장에 대해 정부가 안전보건 관리·감독·규제 및 지원 체계를 수립하고, 방역대책의 중심에 노동자의 안전과 건강 보호를 두는 관점의 전환이 필요하다. 우선 당장 역학조사 과정에서 직업관련 요소를 자세히 확인하고, 직업관련 감염에 대한 모니터링과 그에 걸맞는 대책을 마련해야 한다.

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Original Article

Factors associated with health-related quality of life in a working population in Singapore: Dhiya Mahirah, Charlotte Sauter, Thuan-Quoc Thach, Gerard Dunleavy, Nuraini Nazeha, George I. Christopoulos, Chee Kiong Soh, Josip Car; Epidemiol Health. 2020;42:e2020048. Published online June 30, 2020; DOI: https://doi.org/10.4178/epih.e2020048

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Abstract

OBJECTIVES
This study aimed to evaluate the determinants of health-related quality of life (HRQoL) among workers in Singapore.

METHODS

We analysed data from a cross-sectional study of 464 participants from 4 companies in Singapore. Physical and mental components of HRQoL were assessed using the Short-Form 36 version 2.0 survey. A generalized linear model was used to determine factors associated with the physical component summary (PCS) and mental component summary (MCS) scores of HRQoL.

RESULTS

The overall mean PCS and MCS scores were mean±standard deviation 51.6±6.7 and 50.2±7.7, respectively. The scores for subscales ranged from 62.7±14.7 for vitality to 83.5±20.0 for role limitation due to emotional problems. Ethnicity, overweight/obesity, and years working at the company were significantly associated with physical HRQoL, and age and stress at work were significantly associated with mental HRQoL. Moreover, sleep quality was significantly associated with both physical and mental HRQoL.

CONCLUSIONS

These findings could help workplaces in planning strategies and initiatives for employees to maintain a worklife balance that encompasses their physical, emotional, and social well-being.

Summary

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COVID-19: Perspective

Prevention of exposure to and spread of COVID-19 using air purifiers: challenges and concerns: Seunghon Ham; Epidemiol Health. 2020;42:e2020027. Published online April 17, 2020; DOI: https://doi.org/10.4178/epih.e2020027

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Abstract PDF

Abstract

Coronavirus disease 2019 (COVID-19) is now a pandemic. The Korean government has declared a red alert, which is the highest level of the national infectious disease alert system, and the World Health Organization has similarly declared its highest-level pandemic alert (phase 6). The spread of COVID-19 is an unprecedented worldwide public health problem that governments and individuals must work to overcome. Recently, an infection cluster arose in a call center in Seoul. To support call center companies, the Korean Ministry of Employment and Labor has proposed covering the costs of installing partitions and air purifiers, providing hand sanitizers, and supplying masks to prevent droplet and aerosol infections. Air purifiers are expected to be installed on the floor with the exhaust outlets at a higher level, such as the level of the desks or breathing zones of workers. When a worker coughs or releases droplets near a colleague’s respiratory system, the droplets may spread throughout the call center via air flow from air purifier. In this fashion, a single infected person can give rise to an infection cluster. Attempts to prevent infection must not lead to new infections, and the installation of air purifiers may cause new problems. Therefore, using air purifiers to control the spread of COVID-19 should be approached with caution.

Summary

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Original Article

Analysis of the severity of occupational injuries in the mining industry using a Bayesian network: Mostafa Mirzaei Aliabadi, Hamed Aghaei, Omid kalatpuor, Ali Reza Soltanian, Asghar Nikravesh; Epidemiol Health. 2019;41:e2019017. Published online May 11, 2019; DOI: https://doi.org/10.4178/epih.e2019017

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Abstract PDF

Abstract

OBJECTIVES
Occupational injuries are known to be the main adverse outcome of occupational accidents. The purpose of the current study was to identify control strategies to reduce the severity of occupational injuries in the mining industry using Bayesian network (BN) analysis.

METHODS

The BN structure was created using a focus group technique. Data on 425 mining accidents was collected, and the required information was extracted. The expectation-maximization algorithm was used to estimate the conditional probability tables. Belief updating was used to determine which factors had the greatest effect on severity of accidents.

RESULTS

Based on sensitivity analyses of the BN, training, type of accident, and activity type of workers were the most important factors influencing the severity of accidents. Of individual factors, workers’ experience had the strongest influence on the severity of accidents.

CONCLUSIONS

Among the examined factors, safety training was the most important factor influencing the severity of accidents. Organizations may be able to reduce the severity of occupational injuries by holding safety training courses prepared based on the activity type of workers.

Summary

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Editorial

Lessons from radiation epidemiology: Won Jin Lee; Epidemiol Health. 2018;40:e2018057. Published online November 14, 2018; DOI: https://doi.org/10.4178/epih.e2018057

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Abstract Summary PDF Supplementary Material

Abstract

Radiation epidemiology has developed as a specialized field and has unique characteristics compared to the other fields of epidemiology. Radiation exposure assessment is highly quantified and health risk assessment can yield precise risks per unit dose in each organ. At the same time, radiation epidemiology also emphasizes the uncertainty of the estimated doses and risks. More radiation epidemiologists work in radiation societies rather than those of epidemiology. This specialization deepens the research of radiation studies but also results in fragmentation from general epidemiology. In addition to continued involvement with radiation-related sciences, therefore, more efforts to communicate with the other fields of epidemiology are necessary for radiation epidemiology.

Summary

Korean summary
방사선 역학은 역학의 세부 전공분야로서 다른 역학 분야와 구별되는 특성들이 있다. 노출 및 건강영향 평가에서의 정량화된 접근방법을 비롯하여 방사선 역학의 많은 장점들은 다른 역학분야에서도 응용될 필요가 있다. 이러한 전문화는 역학 연구의 내용을 깊게 발전시키는데 큰 역할을 하고 있는 반면, 일반 역학 분야와 분열되는 단점도 있다. 따라서 기존 방사선 관련 학문들과의 지속적인 교류뿐 아니라 다른 역학분야와의 활발한 교류를 통해 방사선 역학 및 전체 역학분야를 발전시키는 것이 중요하다.

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Review

Occupational risk factors among Iranian farmworkers: a review of the available evidence: Mahin Ghafari, Zahra Cheraghi, Amin Doosti-Irani; Epidemiol Health. 2017;39:e2017027. Published online July 2, 2017; DOI: https://doi.org/10.4178/epih.e2017027

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Abstract PDF

Abstract

Farming is one of the most important components of most economies. No comprehensive picture exists of the health status of Iranian farmers and the work-related hazards that affect them. We aimed to determine the gaps in the current knowledge regarding the occupational health of Iranian farmworkers. Electronic databases including Medline, Web of Science, Scopus, and Embase, as well as national databases including the Scientific Information Database, MagIran, and Barakat Knowledge System, were searched for articles published through March 2017. All epidemiologic studies regarding the occupational health of farmworkers in Iran were reviewed, regardless of their design, language, time of publication, and location. Of the 86 retrieved articles, 39 studies were ultimately analyzed. Most studies were conducted in Fars, Kerman, and Mazandaran provinces. According to the results of this review, chemical, physical, and biological hazards, along with work-related injuries, may be the main factors threatening the health of farmworkers. The unsafe use of pesticides was related to male infertility, eye and digestive complications, pesticide poisoning, pesticide absorption, hematological changes, non-Hodgkin lymphoma, and multiple myeloma. Chemical hazards (e.g., the unsafe use of pesticides), physical hazards, injuries, and biological hazards (e.g., work-related infectious diseases) threaten the health of Iranian farmworkers. Moreover, farmworkers lack adequate knowledge about the occupational hazards they face and the relevant risk factors.

Summary

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Original Articles

A Comparison of Occupation, Education, and Cause of Death from National Death Certificates and Deaths Data Due to Workplace Injuries from WELCO in Korea.: Mia Son; Korean J Epidemiol. 2001;23(2):44-51.

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Abstract PDF: Abstract
PURPOSE
The variables (occupation, education, cause of death, age, and sex) on death certificates can be used for health related studies, however, there has been little research on health related studies using death certificates in Korea. Also, the validity of the values of these variables on death certificates is questionable in Korea. Therefore, we compared occupation, data obtained from WELCO(Korea Labour Welfare Corporation) between 1995 and 1997.
METHODS
WELCO data on deaths due to workplace injury between 1995-1997 were merged with data from NSO on deaths occurring during the same period, using social security numbers. Out of a total of 7,698 deaths due to workplace injury reported to WELCO between 1995 and 1997, final study population are linked to 6,513 deaths among aged 20-64 between 1995 and 1997. On linking the data sets, two different sources of data are cross-tabulated to determine the percentage of agreement. Expected agreement and Kappa index are also calculated.
RESULTS
The results are as follows : Some manual workers are promoted into the non-manual group in the national death data from the National Statistics Office. Educational groups are promoted or demoted between NSO and WELCO death data. The Kappa index for occupational group is 0.49 when the occupational groups are categorised as manual and non-manual workers. The Kappa index is 0.50 in the two-category classification for education : beyond and below university levels; 0.32 in the three-category classification : university, high-school and less than middle-school; 0.25 in the four category classification : university, high-school, middle-school and less than elementary school. The Kappa index is 0.69 for the three-category disease classification : injury, poisoning and certain other consequences of external causes (S00-T98, ICD10), disease of the circulatory system(I00-I99, ICD10) and other disease categories except the two-category classification. The Kappa index for the 5-year age band is 0.99. There is no disagreement for the sex.
CONCLUSIONS
The comparison between national workplace injury data and national death data and tells us that occupational and educational variables are not in the range of 'excellent agreement' suggested by Koch(1997). Our comparison study suggests strong prediction of random errors as well as systemic errors. As for the cause of death, injury and cardiovascular disease from the NSO data are well-matched with those from the WELCO workplace injury death data. However, this comparison may have a limitation as the present study is confined to comparing only the categories of infury and cardiovascular disease. This study suggests that national death data as well as workplace injury data need to be improved for use as health indicators in studies relating socio-economic factors and working conditions to mortality in Korea.; Summary

Correlation Study on Clinical Laboratory Findings with Occupational Exposure to Low Dose Ionizing Radiation in Nuclear Workers in Korea.: Young Khi Lim, Keun Young Yoo; Korean J Epidemiol. 2001;23(2):8-18.

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PURPOSE
Even though atomic energy and radioisotope had been made for a peaceful purpose, some of the public do't feel safe possibly due to potential exposure to ionizing radiation. While health effects of high level radiation are almost deterministic, the stochastic effects of the 'low-dose radiation' have not come to a correct conclusion. This correlation study was conducted to assess the health effect due to potential exposure th low-dose radiation in the nuclear power plants workers in Korea.
METHODS
The study subjects was selected among the nuclear workers. Among those who attend the epidemiologic survey for screening of any malignancies done by the study group of Seoul National University Hospital during 1992-1993, 1) those who had undertaken both the physical examination with clinical laboratory tests and the direct interview with questionnaire, 2) male workers, and 3) those with record on radiation dosimetry as well as employment records in the company. Correlation analysis with Pearson's correlation coefficients and quantitative analysis with normal ranges of various tests were done by the PC-SAS for window.
RESULTS
Total cumulative radiation doses was relatively low, ranging 1 mSv at the lowest to 391 mSv at the highest. Moreover, mostly 68.7% of the subjects was within lower limit of total cumulative doses under 10 mSv. Among the clinical laboratory test, statistical significant correlation was see in hemoglobin(HGB), creatinine(CRE), and carcinoembryonic antigen(CEA).
CONCLUSION
This study concluded that health effect of occupational exposure to low-dose ionizing radiation is minimal or, if any, extremely lower than expected in the nuclear power plants workers in Korea. Major limitation of this study is that the healthy worker effect could not excluded. A large-scale prospective epidemiologic study on the relationship between radiation exposure and health hazard is needed to draw a more valid conclusion.; Summary

Occupational Cancer Surveillance System Using Data Linkage Analysis in Korea.: Sang Yun Lee, Jaiyong Kim, Seongwoo Choi, Hyungjun Im, Kijung Yoon, Ho Jang Kwon, Soo Hun Cho, Daehee Kang; Korean J Epidemiol. 1999;21(2):276-282.

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To develop the occupational cancer surveillance system in Korea, data linkage analysis was performed on the subjects of Health-monitoring-pocketbook (the list of subjects who were exposed to selected occupational carcinogens) and the retired workers of a cokes manufacturing factory using the Korean medical insurance data, Korean death certificate data and Korean cancer registry data. Study subjects comprised the 822 retired subjects and the 3101 present-post subjects of Health-monitoring-pocketbook and the 182 retired workers of a cokes manufacturing factory. The incidence of cancer of these study subjects was ascertained by linkage of Korean medical insurance data of year 1995-6, Korean death certificate data of year 1992-8 and Korean cancer registry data of year 1993-5. In the study subjects, Eighty seven percent were males and mean age was 39.3+/-8.9 year-old, Average work duration was 8.0+/-5.5 years. Chrome, asbestos and cokes were the most frequent exposed agents. In the study subjects, total 13 cancer cases were ascertained by data linkage analysis. In the ascertained cancer cases, 8 cases were male and 5 cases were female, and 7 cases were aged 40-49 yr, 5 cases were aged 50-59 yr and 1 cases were aged 30-39 yr. The commonest exposure agent in the ascertained cancer cases was asbestos and cokes. By the site of cancer, 3 stomach cancer cases, 2 hematopoietic cancer cases and 2 biliary tract cancer cases were ascertained. The occupational cancer surveillance system using data linkage analysis on the workers exposed to hazardous agents was the most feasible and efficient method in Korea. And to do this, establishment of occupational history information in several disease registry database is needed with the effort of estimating the proper size of workers exposed hazardous agents.; Summary

The Usefulness of the Secondary Database for Occupational Asthma Surveillance System in Korea.: Hyungjune Im, Sungwoo Choi, Jaiyong Kim, Sang Yun Lee, Kijung Yoon, Youngju Lee, Ho Jang Kwon, Daehee Kang, Soo Hun Cho; Korean J Epidemiol. 1999;21(2):266-275.

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Occupational asthma is defined as a disease that is characterized by airway narrowing and bronchial hyperresponsiveness caused by specific working environment. It is estimated that occupational asthma cases in Korea have been underreported. This study, using Korean Medical Insurance Data(KMID), examined the distribution of asthma patients' occupations and the frequency of high risk occupations for occupational asthma in Seoul, Korea to evaluate the usefulness of the KMID data as a database for active occupational asthma surveillance system. Six hundreds and forty two(30.7%) of 2093 patients who were finally chosen as a study population by using 1995-year KMID, were contacted by telephone. 296 persons(47.4%) of 642 patients replied that they were diagnosed as asthma. The occupations of 296 asthma patients were classified by Korean standardized industrial classfication (KSIC). The most common occupations included Wholesale and Retail trade(19.5%), Real estate, Renting and Business activities(14.9%), Construction(14.9%), Manufacturing(12.3%). Forty(13.5%) of 296 patients who could be classified by KSIC were working at high risk jobs for occupational asthma. KMID could be used as a useful data for occupational asthma surveillance system if the limitations of KMID, which is the accuracy of diagnosis, data accessibility, difficulty of following up study subjects, would be solved. The prevalence of occupational asthma could be estimated if the follow-up study diagnosing occupational asthma for asthma patients working in high risk jobs would be held.; Summary

Occupational Relationship of Cancer Patients Diagnosed in Two University Hospitals.: Geun Ryang Bae, Hyun Sul Lim, Doohie Kim; Korean J Epidemiol. 1999;21(1):64-71.

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OBJECTIVES
This study was performed to evaluate the occupational relationship on 190 cases of cancer selected out of 622 cases of cancer registered in two university hospitals from January 1, 1996 to December 31, 1997.
METHODS
The selection criteria was for the patient to be more than 40 years old with lung, liver, urinary bladder, nasal cavity and skin cancer or leukemia. We reviewed the medical records to update the missing data and occupational histories. Telephone interviews were used to obtain complete occupational histories on the subjects.
RESULTS
The sites of cancer in the order of relative frequency was lung (51.0%), followed by liver (32.9%), urinary bladder (14.1%) and skin (2.0%) in male, liver (41.5%), followed by lung (31.7%), skin (19.5%) and urinary bladder (7.3%) in female. The occupational histories of 190 cases with suspected cancer-causing occupations were recorded 5.8% on the doctor's medical records and 33.2% on the nursing records. The response rates of the telephone interviews were 87.4%. The distribution of occupation according to the telephone interviews was farmer (47.7%), office worker (16.1%), salesman (12.8%), production worker (6.7%), simple laborer (3.4%) and unknown (13.4%) in male, housewife (63.4%), farmer (17.1%), saleswoman (9.8%) and unknown (9.8%) in female. And there were two cases of suspected occupational relationships in the lung cancer cases.
CONCLUSIONS
We could not discover definite cases of occupational cancer but found out two cases of suspected occupational relationships. Occupational cancer is likely to increase in the near future, so the efforts to detect occupational relationships with cancer should be continued.; Summary

Incidence Density and Risk Factors of Low Back Pain among the Workers in a Welding Material Manufacturing Factory.: Ju Tae Park, Hyun Sul Lim; Korean J Epidemiol. 1999;21(1):36-52.

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This study was performed to understand the incidence density and detect the risk factors of occupational low back pain. A cross-sectional study was conducted with a questionnaire in a welding material manufacturing factory in October, 1993. Therefore, we selected 140 workers who had never complained of low back pain as cohorts. Also, we added 236 newly entered persons who had never complained of low back pain. The total number of cohorts were 376 workers. And then we continued with a questionnaire survey in October, 1996 and with a questionnaire survey and medical examinations by a specialist in October, 1997. Follow-ups were done for 337 workers. The number of newly developed low back pain among workers were 127. The characteristics of low back pain were as follows. The durations of pain were less than or equal to 2 days (42.6%), from 3 days to less than 1 week (8.7%), from 1 week to less than 1 month (11.0%), 1 month or more (6.2%). The frequency was everyday (7.9%), once per week (21.3%), once per month (14.2%), once per 2-3 months (9.4%), once per 5 months (11.0%). The severity of pain was slight (9.4%), mild (33.1%), moderate (13.4%), severe (10.2%) and very severe (1.6%). The onset of most low back pain was insidious (41.7%). The diagnosis of low back pain was muscle strain (37.8%), lumbar sprain (23.6%) and myofacial pain syndrome (3.9%). The number of newly developed low back pain among workers were 127, their incidence density was 15.7 per 100 person-years. In univariate analysis, age, marital status, educational level, smoking habit, category of job, tenures and frequency of stretching exercises showed a statistical significance. The multivariate logistic regression analysis confirmed that category of job and tenures (p<0.05) were independent risk factors for low back pain among workers. The number of newly developed occupational low back pain among production workers were 71, their incidence density was 11.3 per 100 person-years. In univariate analysis, age, marital status, educational level, regular exercise, tenures, posture of waist and lifting of heavy materials showed a statistical significance. The multivariate logistic regression analysis confirmed that posture of waist (p<0.05) and lifting of heavy materials (p<0.1) were independent risk factors for occupational low back pain among production workers.; Summary

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