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Association between hospital characteristics and 30-day mortality after acute stroke: a multilevel study in Korea
Joo Won Park, Myoung-Hee Kim
Epidemiol Health. 2026;48:e2026030.   Published online June 12, 2026
DOI: https://doi.org/10.4178/epih.e2026030
  • 2,320 View
  • 67 Download
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Stroke is the fourth leading cause of death in Korea and shows substantial regional variation in mortality. Although timely medical care can reduce premature death and disability, few studies have examined hospital-level factors associated with stroke outcomes. This study aimed to identify hospital-level factors associated with acute stroke mortality and to determine optimal resource levels for high-quality care.
METHODS
This nationwide retrospective cohort study analyzed patients with acute stroke in Korea from 2018 to 2020 using the National Health Insurance Service claims database and Medical Resource Report data. The outcome was all-cause mortality within 30 days of admission. Individual-level variables included socio-demographic characteristics, the Charlson comorbidity index, and the stroke severity index. Hospital-level variables included the number of beds, specialists, neurologists/neurosurgeons, and nurses, as well as accreditation level and stroke center designation status. Hierarchical logistic regression using generalized linear mixed models and change-point analysis were used to determine optimal resource thresholds.
RESULTS
Change-point analysis identified critical thresholds associated with reduced mortality: 600 hospital beds, 25 specialists, 8 neurologists and neurosurgeons, and 540 nurses. Multilevel analysis showed that patients treated in hospitals with fewer than 600 beds (odds ratio [OR], 1.13; p=0.013), fewer than 8 neurologists and neurosurgeons (OR, 1.15; p=0.004), and no stroke intervention capacity (OR, 1.05; p=0.037) had a significantly higher risk of 30-day mortality.
CONCLUSIONS
The identified thresholds provide baseline data that may guide development of medical systems tailored to local characteristics and support the timely delivery of high-quality medical services. These findings suggest that each health service areas should include hospitals that meet minimum resource standards to improve stroke outcomes.
Summary
Korean summary
전국 급성 뇌졸중 환자 315,762명을 분석한 결과, 30일 사망률 감소와 관련된 병원 자원 임계값은 병상 600개, 전문의 25명, 신경과·신경외과 전문의 8명, 간호사 540명이었다. 환자 특성을 보정한 후에도 병상 600개 미만, 신경과·신경외과 전문의 8명 미만, 급성기 시술 역량이 없는 병원에서 치료받은 환자의 사망 위험이 유의하게 높았다. 이는 각 진료권마다 최소 자원 기준을 충족하는 병원 확보가 뇌졸중 사망률의 지역 간 불평등 해소를 위한 정책 기준이 될 수 있음을 시사한다.
Key Message
In this nationwide study of 315,762 acute stroke patients in Korea, change-point analysis identified hospital resource thresholds associated with reduced 30-day mortality: 600 beds, 25 specialists, 8 neurologists/neurosurgeons, and 540 nurses. After adjusting for patient characteristics, mortality risk was significantly higher in hospitals with fewer than 600 beds, fewer than 8 neurologists/neurosurgeons, or no acute intervention capacity. These thresholds may serve as policy benchmarks for ensuring adequate stroke care capacity within each health service area.
Original Articles
Association between regular dental scaling and stroke risk in patients with periodontal diseases: evidence from a Korean nationwide database
Yu-Rin Kim, Minkook Son, Seon-Rye Kim
Epidemiol Health. 2025;47:e2025020.   Published online April 19, 2025
DOI: https://doi.org/10.4178/epih.e2025020
  • 11,870 View
  • 159 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
This study aimed to evaluate the association between the frequency of dental scaling and the risk of stroke among individuals with moderate-to-severe periodontal diseases and verify the effect of regular dental scaling on stroke risk in this population.
METHODS
In this retrospective study, 25,758 subjects with moderate-to-severe periodontal diseases were selected from the Korean National Health Insurance Service-National Health Screening Cohort database. Based on the frequency of dental scaling, the subjects were divided into three groups: regular, occasional, and infrequent. Restricted cubic splines were used to evaluate hazard ratios (HRs) with 95% confidence intervals (CIs) for stroke. Additionally, landmark analysis was conducted to strengthen the reliability of the results.
RESULTS
There were 293, 111, and 38 stroke cases in the infrequent, occasional, and regular group, respectively. The adjusted HR for stroke in the regular group, compared to that in the infrequent group, was 0.40 (95% CI, 0.29 to 0.57). In the landmark analysis with follow-up after 1 year and after 2 years, the adjusted HR in the regular group compared to that in the infrequent group was 0.41 (95% CI, 0.28 to 0.60) and 0.50 (95% CI, 0.33 to 0.76), respectively.
CONCLUSIONS
Regular dental scaling was significantly associated with a reduced risk of stroke in patients with moderate-to-severe periodontal diseases. These findings may suggest a potential preventive role of dental scaling beyond oral health. Further studies are needed to explore the underlying biological mechanisms linking periodontal care to stroke prevention and to explore causal relationships between dental scaling and stroke risk.
Summary
Korean summary
중등도 이상의 치주염을 가진 성인을 대상으로 분석한 결과, 정기적으로 치석 제거(스케일링)를 시행한 집단은 비정기적 또는 미시행 집단에 비해 뇌졸중 발생 위험이 통계적으로 유의하게 낮은 것으로 나타났다. 이러한 보호 효과는 특히 남성 및 65세 이상 고령층에서 더욱 뚜렷하게 관찰되었다. 본 결과는 정기적인 구강건강관리가 뇌혈관질환 예방에 있어 잠재적인 기여 요인임을 시사한다.
Key Message
Among adults with moderate to severe periodontitis, those who underwent regular dental scaling had a significantly lower risk of stroke compared to those without routine scaling. This protective effect was especially evident in males and individuals aged 65 and older. These results suggest that regular oral healthcare may serve as a potential contributing factor in the prevention of cerebrovascular diseases.

Citations

Citations to this article as recorded by  
  • Dental Interventions for Stroke Prevention—A Narrative Review of Literature
    Anita Siewko, Szymon J. Jurga, Maksymilian A. Brzezicki, Izabela Wojtasz, Anita Nowak, Gabriel Slonina, Iwona Towpik, Lukasz Dzieciuchowicz, Radoslaw Kazmierski
    Neurology and Clinical Neuroscience.2026; 14(5): 345.     CrossRef
  • Cost-effectiveness analysis of non-surgical periodontal treatment to prevent strokes and myocardial infarctions in the United Kingdom
    Edward Coote, Nitesh Patel, Rajesh Vijayanarayanan
    Cost Effectiveness and Resource Allocation.2026;[Epub]     CrossRef
  • Reduced Total Subgingival Bacterial Load in Patients with Ischaemic Stroke: A Case–Control Study of the Subgingival Microbiome and Carotid Atherosclerosis
    Anita Siewko, Szymon J. Jurga, Maksymilian Aleksander Brzezicki, Izabela Wojtasz, Anita Nowak, Filip Czop, Maja Jurga, Iwona Towpik, Lukasz Dzieciuchowicz, Jaroslaw Piskorski, Radoslaw Kazmierski
    Journal of Clinical Medicine.2026; 15(17): 6703.     CrossRef
  • Periodontitis and risk of stroke: a systematic review and meta-analysis of observational studies
    Xinyu Meng, Xiaohua Chen
    Frontiers in Neurology.2025;[Epub]     CrossRef
Miscarriage, stillbirth, and mortality risk from stroke in women: findings from the PLCO study
Hui Tang, Zhou Li, Yuan Zhang, Mingjun Dai, Xiaoya Wang, Chuan Shao
Epidemiol Health. 2024;46:e2024093.   Published online November 25, 2024
DOI: https://doi.org/10.4178/epih.e2024093
  • 11,611 View
  • 162 Download
AbstractAbstract PDFSupplementary Material
Abstract
OBJECTIVES
Existing evidence suggests that miscarriage and stillbirth are associated with an increased risk of stroke in women. However, the impact of these events on stroke mortality remains unclear. This study aimed to elucidate the potential association between miscarriage and stillbirth and stroke mortality in women.
METHODS
We employed a competing risk model using data from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial to assess the relationship between miscarriage/stillbirth and stroke death. Death from other causes was considered as a competing risk, and we conducted a subgroup analysis to explore the potential impact.
RESULTS
Our study included 68,629 women for miscarriage and 65,343 women for stillbirth. No significant association was observed between miscarriage and stroke mortality (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.84 to 1.10; p=0.58). While a single stillbirth did not show a significant association (HR, 0.81; 95% CI, 0.57 to 1.15; p=0.23), recurrent stillbirth (≥2) was associated with a significantly increased risk of stroke mortality compared to women with no stillbirths (HR, 2.24; 95% CI, 1.45 to 3.46; p<0.001).
CONCLUSIONS
Our findings suggest that recurrent stillbirth, but not single events, is associated with an elevated risk of stroke mortality in women. Further research is warranted to clarify the underlying mechanisms and potential long-term health implications of recurrent pregnancy loss.
Summary
Causal association between serum bilirubin and ischemic stroke: multivariable Mendelian randomization
Jong Won Shin, Keum Ji Jung, Mikyung Ryu, Jungeun Kim, Heejin Kimm, Sun Ha Jee
Epidemiol Health. 2024;46:e2024070.   Published online August 19, 2024
DOI: https://doi.org/10.4178/epih.e2024070
  • 16,700 View
  • 139 Download
  • 9 Web of Science
  • 8 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Previous research has predominantly focused on total bilirubin levels without clearly distinguishing between direct and indirect bilirubin. In this study, the differences between these forms were examined, and their potential causal relationships with ischemic stroke were investigated.
METHODS
Two-sample multivariable Mendelian randomization (MVMR) analysis was employed, extracting summary data on bilirubin from the Korean Cancer Prevention Study-II (n=159,844) and the Korean Genome and Epidemiology Study (n=72,299). Data on ischemic stroke were obtained from BioBank Japan (n=201,800). Colocalization analysis was performed, focusing on the <i>UGT1A1, SLCO1B1</i>, and <i>SLCO1B3</i> genes, which are the primary loci associated with serum bilirubin levels.
RESULTS
Crude 2-sample Mendelian randomization analysis revealed a significant negative association between total bilirubin levels and ischemic stroke. However, in MVMR analyses, only indirect bilirubin demonstrated a significant negative association with ischemic stroke (odds ratio, 0.76; 95% confidence interval, 0.59 to 0.98). Colocalization analysis did not identify a shared causal variant between the 3 genetic loci related to indirect bilirubin and the risk of ischemic stroke.
CONCLUSIONS
Our study establishes a causal association between higher genetically determined levels of serum indirect bilirubin and reduced risk of ischemic stroke in an Asian population. Future research should include more in-depth analysis of shared genetic variants between indirect bilirubin and ischemic stroke.
Summary
Korean summary
이 연구는 혈청 빌리루빈의 세 가지 형태(총, 직접, 간접 빌리루빈)와 허혈성 뇌졸중 간의 인과적 연관성을 다루었습니다. 다변수 멘델리안 무작위 분석(MVMR)을 통해 간접 빌리루빈이 허혈성 뇌졸중 위험을 유의미하게 감소시키는 것으로 나타났습니다. 이 결과는 빌리루빈의 항산화 역할과 허혈성 뇌졸중 간의 상관관계를 심화 이해하는 데 기여합니다.
Key Message
This study investigated the causal associations between three forms of serum bilirubin (total, direct, and indirect) and ischemic stroke. Multivariable Mendelian randomization (MVMR) analysis revealed a significant inverse association between indirect bilirubin and the risk of ischemic stroke. These findings contribute to a deeper understanding of the relationship between bilirubin's antioxidant role and ischemic stroke.

Citations

Citations to this article as recorded by  
  • Sex-specific associations of creatinine and antioxidant biomarkers with lung cancer risk by drinking and smoking behavior: A prospective cohort study
    Jong Won Shin, Jae Woong Sull, Nguyen Thien Minh, Sun Ha Jee
    Cancer Epidemiology.2026; 101: 102993.     CrossRef
  • Sex-specific in the nonlinear associations of hemoglobin glycation index and all-cause mortality in the general US adult population: results from NHANES 1999–2018
    Chaolan Wang, Ke Lin, Hong Zhang, Tianbao Liu, Zhen Zeng, Wanpei Luo, Yan Jiang, Xiang Zhang, Shuang Du
    Nutrition & Metabolism.2026;[Epub]     CrossRef
  • Associations of bilirubin, albumin, and the ALBI index with gastric cancer risk: a smoking-stratified prospective cohort study in men
    Jong Won Shin, Ji-Won Lee, Nguyen Thien Minh, Sun Ha Jee
    BMC Gastroenterology.2026;[Epub]     CrossRef
  • Association Between Creatinine and Lung Cancer Risk in Men Smokers: A Comparative Analysis with Antioxidant Biomarkers from the KCPS-II Cohort
    Jong-Won Shin, Thien-Minh Nguyen, Sun-Ha Jee
    Antioxidants.2025; 14(5): 584.     CrossRef
  • Sex-Specific Associations of Total Bilirubin, ALBI, and PALBI with Lung Cancer Risk: Interactions with Smoking and Alcohol
    Jong Won Shin, Nguyen Thien Minh, Sun Ha Jee
    Healthcare.2025; 13(11): 1321.     CrossRef
  • Bilirubin Metabolism and Thyroid Cancer: Insights from ALBI and PALBI Indices
    Jong Won Shin, Jae Woong Sull, Nguyen Thien Minh, Sun Ha Jee
    Biomolecules.2025; 15(7): 1042.     CrossRef
  • Toward Precision Post-Stroke Rehabilitation Medicine: Integrating Molecular, Imaging, and Computational Biomarkers for Functional Outcome Prediction
    Roxana Nartea, Simona Savulescu, Claudia Gabriela Potcovaru, Daniela Poenaru
    Journal of Clinical Medicine.2025; 14(22): 8077.     CrossRef
  • Association between De Ritis ratio and mortality in individuals with diabetes or prediabetes: evidence from NHANES (1999–2018)
    Hui-Dong Long, Ruo-Yue Guo, Jing-Yu Zhou, Yi-Peng Du, Guang-Cheng Liu, Xiu-Di Pan, Zhao-Hua Zeng, Yun-En Lin
    European Journal of Medical Research.2025;[Epub]     CrossRef
Special Articles
Incidence and case fatality of stroke in Korea, 2011-2020
Jenny Moon, Yeeun Seo, Hyeok-Hee Lee, Hokyou Lee, Fumie Kaneko, Sojung Shin, Eunji Kim, Kyu Sun Yum, Young Dae Kim, Jang-Hyun Baek, Hyeon Chang Kim
Epidemiol Health. 2024;46:e2024003.   Published online December 26, 2023
DOI: https://doi.org/10.4178/epih.e2024003
  • 31,114 View
  • 337 Download
  • 16 Web of Science
  • 14 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Stroke remains the second leading cause of death in Korea. This study was designed to estimate the crude, age-adjusted and age-specific incidence rates, as well as the case fatality rate of stroke, in Korea from 2011 to 2020.
METHODS
We utilized data from the National Health Insurance Services from January 1, 2002 to December 31, 2020, to calculate incidence rates and 30-day and 1-year case fatality rates of stroke. Additionally, we determined sex and age-specific incidence rates and computed age-standardized incidence rates by direct standardization to the 2005 population.
RESULTS
The crude incidence rate of stroke hovered around 200 (per 100,000 person-years) from 2011 to 2015, then surged to 218.4 in 2019, before marginally declining to 208.0 in 2020. Conversely, the age-standardized incidence rate consistently decreased by 25% between 2011 and 2020. When stratified by sex, the crude incidence rate increased between 2011 and 2019 for both sexes, followed by a decrease in 2020. Age-standardized incidence rates displayed a downward trend throughout the study period for both sexes. Across all age groups, the 30-day and 1-year case fatality rates of stroke consistently decreased from 2011 to 2019, only to increase in 2020.
CONCLUSIONS
Despite a decrease in the age-standardized incidence rate, the total number of stroke events in Korea continues to rise due to the rapidly aging population. Moreover, 2020 witnessed a decrease in incidence but an increase in case fatality rates.
Summary
Key Message
This nationwide study using Korean National Health Insurance System data reveals a decade-long downward trend in overall stroke incidence rates. While the crude incidence rate showed a temporary increase from 2016 to 2019 before a slight decline in 2020, the age-standardized incidence rate consistently decreased over the study period. The study emphasizes the significance of continuous monitoring and preventive strategies to address stroke as a public health concern in Korea

Citations

Citations to this article as recorded by  
  • Nationwide Trends in the Incidence and Fatality of Acute Myocardial Infarction and Stroke in Korea, 2011–2023
    Jaewon Khil, Sojung Shin, Seojeong Shin, Jaeyong Lee, Minsung Cho, Na Yeon Ahn, Sang Gyeong Lee, Yeongchang Jo, Seng Chan You, Yeonhee Yoo, Seung-Jun Lee, Jang-Whan Bae, Min Kim, Kyu Sun Yum, Jang-Hyun Baek, Hokyou Lee, Hyeon Chang Kim
    Korean Circulation Journal.2027;[Epub]     CrossRef
  • Perceptions of Integrated Medical Service Among Stroke Patients in South Korea: Self-Reported Web-Based Survey Study
    Han-Gyul Lee, Woo-Sang Jung, Ho Geol Woo, Seungwon Kwon, Sung Hyuk Heo
    Journal of Multidisciplinary Healthcare.2026; Volume 19: 1.     CrossRef
  • Trends in Acute Care and Rehabilitation for First-Ever Stroke Patients: A 12-Year Perspective, the KOSCO Study
    Dae Hyun Kim, Min Kyun Sohn, Jongmin Lee, Deog Young Kim, Yong-Il Shin, Gyung-Jae Oh, Yang-Soo Lee, Min Cheol Joo, So Young Lee, Min-Keun Song, Junhee Han, Jeonghoon Ahn, Ho Seok Lee, Yun-Hee Kim, Won Hyuk Chang
    Journal of Korean Medical Science.2026;[Epub]     CrossRef
  • Herbal medicine evaluation for reimbursement-based post-stroke sequelae (HERB-PSS): a retrospective analysis using Korean health insurance claim data, 2020–2024
    Soo-Dam Kim, Man Young Park, Jiyun Cha, Changsop Yang, Eunbyul Cho, Sungha Kim
    Frontiers in Neurology.2026;[Epub]     CrossRef
  • Time-Dependent Association Between Breast Cancer and Risk of Ischemic Stroke
    Yong-Moon Mark Park, Wonyoung Jung, Bong-sung Kim, Minwoo Lee, Michael G. Fradley, Sindhu J. Malapati, Tasneem Z. Naqvi, Ronda S. Henry-Tillman, Jawahar L. Mehta, Kyungdo Han, Dong Wook Shin
    Neurology.2026;[Epub]     CrossRef
  • Effects of Physical Activity on the Incidence of Stroke with Polygenic Risk Score
    Yun Seo Cho, Tae Yeon Kim, Kihoon Yuk, Ji Eun Lee, Joo Hee Park, Yeon Soo Kim, Min-Chul Lee, Jin Pyeong Jeon, In Cheol Jeong, Kumpei Tanisawa, Hyo Youl Moon
    Exercise Science.2026; 35(3): 256.     CrossRef
  • Effect of regular exercise on stroke prevention: an instrumental variables approach
    Wonseok Jeong
    BMC Public Health.2025;[Epub]     CrossRef
  • A Study on the Healthcare Workforce and Care for Acute Stroke: Results From the Survey of Hospitals Included in the National Acute Stroke Quality Assessment Program
    Jong Young Lee, Jun Kyeong Ko, Hak Cheol Ko, Hae-Won Koo, Hyon-Jo Kwon, Dae-Won Kim, Kangmin Kim, Myeong Jin Kim, Hoon Kim, Keun Young Park, Kuhyun Yang, Jae Sang Oh, Won Ki Yoon, Dong Hoon Lee, Ho Jun Yi, Heui Seung Lee, Jong-Kook Rhim, Dong-Kyu Jang, Yo
    Journal of Korean Medical Science.2025;[Epub]     CrossRef
  • Confidence-linked and uncertainty-based staged framework for phenotype validation using large language models
    Sumin Lee, Hyeok-Hee Lee, Hokyou Lee, Kyu Sun Yum, Jang-Hyun Baek, Jaewon Khil, Jaeyong Lee, Sojung Shin, Minsung Cho, Na Yeon Ahn, Seng Chan You, Hyeon Chang Kim
    Journal of the American Medical Informatics Association.2025; 32(8): 1320.     CrossRef
  • Association between triglyceride glucose-waist-adjusted waist index and incident stroke in Chinese adults: a prospective cohort study
    Yaqin Ye, Zhenyi He, Jingguo Wu, Junlin Wu, Yanbing Liang
    Frontiers in Nutrition.2025;[Epub]     CrossRef
  • G20 stroke burden 1990–2035: trends, projections and precision health insights
    Rongrong Chen, Xiangwen Li, Ruonan Zhao, Xufei Zhao, Lin Ma, Qi Miao, Rongqiang Zhang
    Neurological Sciences.2025; 46(11): 5863.     CrossRef
  • The Importance of Cost-Effectiveness in New Drug Approval: Stroke Burden and Tenecteplase Efficacy
    Hyuk Sung Kwon, Byung-Jo Kim
    Journal of Clinical Neurology.2025; 21(5): 363.     CrossRef
  • Clinical Practice Guideline for Stroke Rehabilitation in Korea—Part 2: Rehabilitation for Motor and Sensory Function (2024)
    Hyun Haeng Lee, Yong Wook Kim, Hyoung Seop Kim, Seung Nam Yang, Sun Im, Woo-Kyoung Yoo, Joon-Ho Shin, Min-Kyun Oh, Won-Seok Kim, Da-Sol Kim, Won Kee Chang, Seyoung Shin, Sekwang Lee, Doo Young Kim, Sung-Hwa Ko, Yeo Jun Yun, Yookyung Lee, Miyoung Choi, Suk
    Brain & Neurorehabilitation.2025;[Epub]     CrossRef
  • Explainable SHAP-XGBoost models for identifying important social factors associated with the atherosclerotic cardiovascular disease risk score using the LASSO feature selection technique
    Jungtae Choi, Jooeun Jeon, Hyoeun An, Hyeon Chang Kim
    Epidemiology and Health.2025; 47: e2025052.     CrossRef
Identification of acute myocardial infarction and stroke events using the National Health Insurance Service database in Korea
Minsung Cho, Hyeok-Hee Lee, Jang-Hyun Baek, Kyu Sun Yum, Min Kim, Jang-Whan Bae, Seung-Jun Lee, Byeong-Keuk Kim, Young Ah Kim, JiHyun Yang, Dong Wook Kim, Young Dae Kim, Haeyong Pak, Kyung Won Kim, Sohee Park, Seng Chan You, Hokyou Lee, Hyeon Chang Kim
Epidemiol Health. 2024;46:e2024001.   Published online December 26, 2023
DOI: https://doi.org/10.4178/epih.e2024001
  • 28,681 View
  • 319 Download
  • 14 Web of Science
  • 12 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The escalating burden of cardiovascular disease (CVD) is a critical public health issue worldwide. CVD, especially acute myocardial infarction (AMI) and stroke, is the leading contributor to morbidity and mortality in Korea. We aimed to develop algorithms for identifying AMI and stroke events from the National Health Insurance Service (NHIS) database and validate these algorithms through medical record review.
METHODS
We first established a concept and definition of “hospitalization episode,” taking into account the unique features of health claims-based NHIS database. We then developed first and recurrent event identification algorithms, separately for AMI and stroke, to determine whether each hospitalization episode represents a true incident case of AMI or stroke. Finally, we assessed our algorithms’ accuracy by calculating their positive predictive values (PPVs) based on medical records of algorithm-identified events.
RESULTS
We developed identification algorithms for both AMI and stroke. To validate them, we conducted retrospective review of medical records for 3,140 algorithm-identified events (1,399 AMI and 1,741 stroke events) across 24 hospitals throughout Korea. The overall PPVs for the first and recurrent AMI events were around 92% and 78%, respectively, while those for the first and recurrent stroke events were around 88% and 81%, respectively.
CONCLUSIONS
We successfully developed algorithms for identifying AMI and stroke events. The algorithms demonstrated high accuracy, with PPVs of approximately 90% for first events and 80% for recurrent events. These findings indicate that our algorithms hold promise as an instrumental tool for the consistent and reliable production of national CVD statistics in Korea.
Summary
Key Message
In this study, we developed algorithms to identify acute myocardial infarction (AMI) and stroke events from the Korean National Health insurance Service database. To validate them, we conducted retrospective review of medical records across 24 hospitals throughout Korea. The overall positive predictive values for the first and recurrent AMI events were around 92% and 78%, respectively, while those for the first and recurrent stroke events were around 88% and 81%, respectively.

Citations

Citations to this article as recorded by  
  • Nationwide Trends in the Incidence and Fatality of Acute Myocardial Infarction and Stroke in Korea, 2011–2023
    Jaewon Khil, Sojung Shin, Seojeong Shin, Jaeyong Lee, Minsung Cho, Na Yeon Ahn, Sang Gyeong Lee, Yeongchang Jo, Seng Chan You, Yeonhee Yoo, Seung-Jun Lee, Jang-Whan Bae, Min Kim, Kyu Sun Yum, Jang-Hyun Baek, Hokyou Lee, Hyeon Chang Kim
    Korean Circulation Journal.2027;[Epub]     CrossRef
  • Cardiovascular Risk Among Stroke Survivors With Combustible and Electronic Cigarettes: A Nationwide Study in Korean Men
    Joonsang Yoo, Jimin Jeon, Minyoul Baik, Yun Young Choi, Jinkwon Kim
    Journal of the American Heart Association.2026;[Epub]     CrossRef
  • Blood pressure status and risk of cardiovascular disease in older adults aged 75+ without prior cardiovascular events: a nationwide cohort study
    Sangwon Choi, Kyung-Do Han, Kyung-Ho Yu, Byung-Chul Lee, Mi Sun Oh, Dae Young Cheon, Minwoo Lee
    European Journal of Preventive Cardiology.2026;[Epub]     CrossRef
  • Geographic disparities in EVT access and stroke mortality under universal health coverage in South Korea
    Jeehye Lee
    BMC Health Services Research.2026;[Epub]     CrossRef
  • Postacute sequelae of SARS-CoV-2 infection on ophthalmic diseases: a binational cohort study
    Jee Myung Yang, Hayeon Lee, Jaeyu Park, Min Kim, Ho-Seok Sa, Joo Yong Lee, Kyung Rim Sung, Francesco Branda, Krishna Prasad Acharya, Dong Keon Yon
    British Journal of Ophthalmology.2026; : bjo-2025-328412.     CrossRef
  • Effect of a ≥50% Reduction in Low-Density Lipoprotein Cholesterol From Baseline in Patients With Ischemic Stroke
    Minyoul Baik, Jimin Jeon, Joonsang Yoo, Jinkwon Kim
    Neurology.2026;[Epub]     CrossRef
  • Constipation and risk of death and cardiovascular events in patients on hemodialysis
    Sang Cheol Park, Juyoung Jung, Young Eun Kwon, Song In Baeg, Dong-Jin Oh, Do Hyoung Kim, Young-Ki Lee, Hye Min Choi
    Kidney Research and Clinical Practice.2025; 44(1): 155.     CrossRef
  • Body Mass Index Changes and Femur Fracture Risk in Parkinson's Disease: National Cohort Study
    Sung‐Ho Ahn, Hye Sun Lee, Jun‐Hyuk Lee
    Journal of Cachexia, Sarcopenia and Muscle.2025;[Epub]     CrossRef
  • Confidence-linked and uncertainty-based staged framework for phenotype validation using large language models
    Sumin Lee, Hyeok-Hee Lee, Hokyou Lee, Kyu Sun Yum, Jang-Hyun Baek, Jaewon Khil, Jaeyong Lee, Sojung Shin, Minsung Cho, Na Yeon Ahn, Seng Chan You, Hyeon Chang Kim
    Journal of the American Medical Informatics Association.2025; 32(8): 1320.     CrossRef
  • Cardiovascular risk across blood pressure categories defined by the 2024 ESC and 2023 ESH hypertension guidelines: insights from a Korean nationwide cohort study
    Dae young Cheon, Kyung-do Han, Yeon Jung Lee, Jeen Hwa Lee, Myung Soo Park, Sook Jin Lee, Seongwoo Han, Jae Hyuk Choi, Minwoo Lee
    European Journal of Preventive Cardiology.2025;[Epub]     CrossRef
  • Cumulative Cardiovascular Health Score Through Young Adulthood and Cardiovascular and Kidney Outcomes in Midlife
    Jong Hyun Jhee, Kyoung Hwa Ha, Dasom Son, Hyeok-Hee Lee, Eun-Jin Kim, Hyeon Chang Kim, Hokyou Lee
    JAMA Cardiology.2025; 10(11): 1207.     CrossRef
  • Incidence and case fatality of stroke in Korea, 2011-2020
    Jenny Moon, Yeeun Seo, Hyeok-Hee Lee, Hokyou Lee, Fumie Kaneko, Sojung Shin, Eunji Kim, Kyu Sun Yum, Young Dae Kim, Jang-Hyun Baek, Hyeon Chang Kim
    Epidemiology and Health.2023; 46: e2024003.     CrossRef
Original Articles
The mediating role of atrial fibrillation in causal associations between risk factors and stroke: a Mendelian randomization study
Shanmei Qin, Mengmeng Wang, Dipender Gill, Zhizhong Zhang, Xinfeng Liu
Epidemiol Health. 2024;46:e2024005.   Published online December 6, 2023
DOI: https://doi.org/10.4178/epih.e2024005
  • 18,420 View
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Atrial fibrillation (AF) contributes to stroke development and progression. We aimed to quantify the mediating role of AF in the causal associations between a wide range of risk factors and stroke via a Mendelian randomization (MR) framework.
METHODS
We assessed the associations of 108 traits with stroke and its subtypes in a 2-sample univariable MR approach, then conducted a bidirectional MR analysis between these 108 traits and AF to evaluate the presence and direction of their causal associations. Finally, to further investigate the extent to which AF mediated the effects of eligible traits on stroke, we applied multivariable and 2-step MR techniques in a mediation analysis where outcomes were restricted to stroke types causally affected by AF (any stroke [AS], any ischemic stroke [AIS], and cardioembolic stroke [CES]).
RESULTS
Among 108 traits, 42 were putatively causal for at least 1 stroke type; of these 42 traits, 20 that had no bidirectional relationship with AF were retained. Finally, 33 associations of 15 eligible traits were examined in the mediation analysis. The mediation analyses for AS, AIS, and CES each included 11 eligible traits. After AF adjustment, the direct effects of all traits on CES were attenuated to null (all p>0.05), while the associations with AS and AIS persisted for most traits (AF-mediated proportion: from 6.6% [95% confidence interval, 2.7 to 0.6] to 52.0% [95% confidence interval, 39.8 to 64.3]).
CONCLUSIONS
The causal associations between all eligible traits and CES were largely mediated through AF, while most traits affected AS and AIS independently of AF.
Summary
Key Message
Previous studies have not systematically detected and quantified the mediating role of AF in causal associations between a wide range of risk factors and stroke types. This study, using several MR approaches, found that the causal associations between risk factors and stroke, and the role of AF in mediating these associations, varied across stroke types. Although AF largely mediated the trait-CES associations, most traits affected AS and AIS independently of AF, highlighting the need for accurate disease classification in clinical practice and trials.

Citations

Citations to this article as recorded by  
  • Mendelian randomization studies on ischemic stroke: a field synopsis and systematic review
    Junyi Yang, Chen Han, Yue Zhang, Shutong Tan, Qian Wu, Yumei Ma, Yuanjie Duan, Yaxin Wang, Jinke Wang, Binhui Liu, Changqing Mu, Ruixia Zhu, Xiaoqian Zhang, Jian Zhang, Xu Liu
    Journal of Translational Medicine.2025;[Epub]     CrossRef
Impact of statin treatment on cardiovascular events in patients with retinal vein occlusion: a nested case-control study in Korea
Joonsang Yoo, Joo Youn Shin, Jimin Jeon, Jinkwon Kim
Epidemiol Health. 2023;45:e2023035.   Published online March 15, 2023
DOI: https://doi.org/10.4178/epih.e2023035
  • 23,959 View
  • 189 Download
  • 9 Web of Science
  • 10 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Retinal vein occlusion (RVO) is associated with an increased risk of future cardiovascular events. Statin therapy is a key cornerstone in prevention for patients at high cardiovascular risk. However, little is known about the role of statin therapy for patients with RVO. This study evaluated whether statin treatment in patients with RVO was associated with a lower risk of cardiovascular events.
METHODS
A population-based, nested case-control study was conducted with a cohort of newly diagnosed RVO patients without prior cardiovascular disease between 2008 and 2020 using a nationwide health claims database in Korea. From this cohort of RVO patients, we identified cases of cardiovascular events (stroke or myocardial infarction) after RVO and matched controls based on sex, age, insurance type, antiplatelet use, and underlying comorbidities using 1:2 incidence density sampling.
RESULTS
Using a cohort of 142,759 patients with newly diagnosed RVO, we selected 6,810 cases and 13,620 matched controls. A significantly lower risk of cardiovascular events (adjusted odds ratio, 0.604; 95% confidence interval, 0.557 to 0.655) was observed in RVO patients with statin treatment than in those without statin treatment. Statin treatment was associated with a reduced risk for both stroke and myocardial infarction after RVO. Longer statin treatment after RVO was associated with a lower risk for cardiovascular events.
CONCLUSIONS
Statin treatment was associated with a lower risk for future cardiovascular events in patients with newly diagnosed RVO. Further studies are warranted to clarify the potential cardiovascular preventive role of statins in patients with RVO.
Summary
Korean summary
· 망막정맥폐색 환자들은 심뇌혈관질환의 발생 위험이 높다고 알려져 있다. · 이번 연구를 통해 망막정맥폐색의 발생 이후 스타틴을 복용한 환자들에서 심근경색 및 뇌졸중 발생 위험도가 감소함을 확인하였다. · 고위험군인 망막정맥폐색 환자들에서 적극적인 스타틴의 사용이 심뇌혈관질환의 예방에 도움이 될 수 있을 것이다.
Key Message
· Statin was associated with a lower risk of cardiovascular events in RVO patients. · The reduced risk was observed in both stroke and myocardial infarction after RVO. · Statins might be a good candidate for cardiovascular prevention in RVO patients.

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  • Artificial intelligence based retinal imaging for cardiovascular risk and statin guidance in retinal vein occlusion
    Dongjin Nam, Yong-Hwan Jang, So Jung Ryu, Sahil Thakur, Simon Nusinovici, Junseok Park, Moonsu Kim, Sunjin Hwang
    American Journal of Preventive Cardiology.2026; 26: 101427.     CrossRef
  • Oculomics of lipid metabolism: A scoping review across anterior and posterior segment diseases
    Heesuk Kim, Byung-Hyun Joe, Dongjin Nam, Tae Keun Yoo
    Science Progress.2026;[Epub]     CrossRef
  • The Impact of PCSK9 Inhibitors on Development of Retinal Vascular Occlusions
    Isabella H. Yazji, Nadia J. Abbass, David C. Kaelber, Katherine E. Talcott, Rishi P. Singh
    American Journal of Ophthalmology.2026; 290: 298.     CrossRef
  • Potential protective associations of antidiabetic and lipid-lowering therapies with retinal vein occlusion risk: a systematic review and meta-analysis
    Anas Alamoudi, Ahmed Alnabihi, Sultan Al-Qahtani, Waleed K. Alsarhani, Peter J. Kertes
    Eye.2026;[Epub]     CrossRef
  • Retinal Imaging as a Window into Cardiovascular Health: Towards Harnessing Retinal Analytics for Precision Cardiovascular Medicine
    Jay Bharatsingh Bisen, Hayden Sikora, Anushree Aneja, Sanjiv J. Shah, Rukhsana G. Mirza
    Journal of Cardiovascular Development and Disease.2025; 12(6): 230.     CrossRef
  • Exploring the role of oxidative stress in retinal vein occlusion: an updated and comprehensive review on the pathophysiology and treatment perspectives
    Jiaqi Zhang, Xuejun Xie, Ya Mo
    International Ophthalmology.2025;[Epub]     CrossRef
  • Oclusión venosa de retina y su asociación con la enfermedad vascular aterosclerótica
    María Larrousse Morellón, Yéssica López Loureiro, Susana Ruiz Bilbao
    Medicina Clínica.2024; 163(4): 199.     CrossRef
  • Zerumbone Inhibits the Viability, Motility, and Angiogenesis of Human Retinal Microvascular Endothelial Cells (HRCECs) by Inhibiting Vascular Endothelial Growth Factor
    Jiexin Yu, Shule Jiang, Yanli Liu
    Current Eye Research.2024; 49(11): 1201.     CrossRef
  • Retinal venous occlusion and its association with atherosclerotic vascular disease
    María Larrousse Morellón, Yéssica López Loureiro, Susana Ruiz Bilbao
    Medicina Clínica (English Edition).2024; 163(4): 199.     CrossRef
  • Retinal Findings and Cardiovascular Risk: Prognostic Conditions, Novel Biomarkers, and Emerging Image Analysis Techniques
    Joseph Colcombe, Rusdeep Mundae, Alexis Kaiser, Jacques Bijon, Yasha Modi
    Journal of Personalized Medicine.2023; 13(11): 1564.     CrossRef
Impaired pulmonary function mediates the impact of preterm birth on later-life stroke: a 2-step, multivariable Mendelian randomization study
Xingzhi Guo, Peng Tang, Chen Hou, Yue Liu, Rui Li
Epidemiol Health. 2023;45:e2023031.   Published online March 3, 2023
DOI: https://doi.org/10.4178/epih.e2023031
  • 21,624 View
  • 204 Download
  • 8 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Observational studies have suggested an association between preterm birth and stroke in late adulthood, but it remains unclear whether the association is causal. The purpose of this study was to evaluate the causal effects of gestational age on stroke and to determine the pathophysiological mechanisms underlying the causal associations.
METHODS
Two-sample Mendelian randomization (MR) was performed to assess the causal effects of fetal gestational duration, early preterm birth (EPB), preterm birth, or postterm birth on stroke and its subtypes. Two-step Mendelian randomization (TSMR) and multivariable Mendelian randomization (MVMR) were additionally used to determine the role of common stroke risk factors, including cardiovascular diseases, hypertension, pulmonary impairment, inflammation, and metabolic diseases, in mediating the causal associations between gestational age and stroke and its subtypes.
RESULTS
Genetically predicted EPB increased the risk of cardioembolic stroke (CES; odds ratio [OR], 1.115; 95% confidence interval [CI], 1.036 to 1.200; p=0.004) and large artery stroke (LAS; OR, 1.131; 95% CI, 1.031 to 1.241; p=0.009). The TSMR results showed that EPB was associated with a lower forced expiratory volume in the first second and forced vital capacity ratio (FEV1/FVC) (β=-0.020; 95% CI, -0.035 to -0.005; p=0.009), which increased the risk of CES and LAS. Further MVMR analysis showed that the associations between EPB and stroke disappeared after adjustment for FEV1/FVC.
CONCLUSIONS
Our data demonstrate that EPB is causally associated with an elevated risk of CES and LAS, and that pulmonary dysfunction mediates the causal impact of EPB on CES and LAS.
Summary
Key Message
Genetically predicted early preterm birth (EPB) is significantly associated with an increased risk of cardioembolic stroke (CES) and large artery stroke (LAS). Further multivariable Mendelian randomization analysis demonstrates that pulmonary impairment mediates the causal impact of EPB on CES and LAS in adulthood.

Citations

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  • From Neonatal History to Adult Cardiovascular Risk: Preterm Birth as a Lifelong Risk Enhancer
    Mohamedanas Mohamedfaruk Patni, Malek Nasrallah, Dana Ja’afer Al Tarawneh, Mohamed El-Tanani, Khalid Ahmed Ibrahim, Abdullah Mohamad Hajjo, Mhd Munzer Zaher Hussin Alali, Ibrahim Alabid, Wasim Iyad Alghoul, Sakina Abdeali Sehrawala, Imran Rangraze, Ramya
    Medical Sciences.2026; 14(5): 543.     CrossRef
  • Unveiling the Role of Immune Cells and Plasma Metabolites in Breast Cancer Risk: A Mendelian Randomization and Mediation Analysis
    Yiran Li, Yinfu Zhu, Kunxiang Gong, Yi Wang, Yinger Huang, Wenbo Hao
    Current Pharmaceutical Biotechnology.2026; 27(9): 1140.     CrossRef
  • Association between triglyceride glucose-waist-adjusted waist index and incident stroke in Chinese adults: a prospective cohort study
    Yaqin Ye, Zhenyi He, Jingguo Wu, Junlin Wu, Yanbing Liang
    Frontiers in Nutrition.2025;[Epub]     CrossRef
  • Causal associations of mood swings with preterm birth: a Mendelian randomization analysis
    Yuting Xia, Jianan Zhang, Yun Shang
    The Journal of Maternal-Fetal & Neonatal Medicine.2025;[Epub]     CrossRef
  • Methodological approaches, challenges, and opportunities in the application of Mendelian randomisation to lifecourse epidemiology: A systematic literature review
    Grace M. Power, Eleanor Sanderson, Panagiota Pagoni, Abigail Fraser, Tim Morris, Claire Prince, Timothy M. Frayling, Jon Heron, Tom G. Richardson, Rebecca Richmond, Jessica Tyrrell, Nicole Warrington, George Davey Smith, Laura D. Howe, Kate M. Tilling
    European Journal of Epidemiology.2024; 39(5): 501.     CrossRef
  • Tumor necrosis factor mediates the impact of PM2.5 on bone mineral density: Inflammatory proteome Mendelian randomization and colocalization analyses
    Mingzheng Li, Peng Shi, Huajie Yang, Suyuan Tong, Nianfeng Qiu, Fan Yao, Yuan Du, Shuhua Xi, Fei Wang
    Ecotoxicology and Environmental Safety.2024; 270: 115896.     CrossRef
  • Causal associations of circulating Helicobacter pylori antibodies with stroke and the mediating role of inflammation
    Xingzhi Guo, Peng Tang, Xin Zhang, Rui Li
    Inflammation Research.2023; 72(6): 1193.     CrossRef
  • Causal relationship between Helicobacter pylori antibodies and gastroesophageal reflux disease (GERD): A mendelian study
    Jiaqin Chen, Junning Zhang, Xiaolu Ma, Yuehan Ren, Yi Tang, Zhongmian Zhang, Wangyu Ye, Xiyan Zhang, Zili Lin, Lan Wang, Zhihong Li, Yasin Sahin
    PLOS ONE.2023; 18(12): e0294771.     CrossRef
The risk of stroke according to statin medication compliance in older people with chronic periodontitis: an analysis using the Korea National Health Insurance Service-Senior Cohort Database
Seon-Rye Kim, Minkook Son, Yu-Rin Kim
Epidemiol Health. 2022;44:e2022055.   Published online July 5, 2022
DOI: https://doi.org/10.4178/epih.e2022055
  • 25,101 View
  • 345 Download
  • 7 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
We investigated the risk of stroke according to statin medication compliance in older people with chronic periodontitis.
METHODS
Chronic periodontitis patients were extracted from the National Health Insurance Service-Senior Cohort Database from 2002 to 2014. Among 255,056 chronic periodontitis patients, 41,412 patients with statin prescriptions for 28 days or more were included. The study population was divided into the top 25% of medication compliance group (TSG) and the lower 25% of medication compliance group (BSG). After 1:1 propensity score matching was performed, the final number of patients in the BSG and TSG was 6,172 each. To analyze the risk of stroke, a Cox proportional hazard model was performed to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) after adjusting for age, sex, income level, hypertension, diabetes, and Charlson comorbidity index.
RESULTS
In the Kaplan-Meier curve, the disease-free probability was prominently lower in the BSG than in the TSG (p for log-rank= 0.001). The HR in the multivariable-adjusted model for stroke occurrence in the TSG compared to the BSG was 0.79 (95% CI, 0.67 to 0.92; p= 0.002). Subgroup analyses showed significant associations between compliance to statin medication and stroke, especially in female, people 85 years or older, and patients with comorbidities.
CONCLUSIONS
Increasing compliance to statins may reduce stroke risk in older adults with chronic periodontitis. Therefore, in order to increase medication compliance among older people with chronic periodontitis, it is necessary for medical staff to make efforts to provide effective medication guidance.
Summary
Korean summary
만성치주질환을 가진 노인에서 스타틴 복용순응도가 낮은 그룹에 비해 높은 그룹이 뇌졸증 발생위험이 낮았다. 특히 여성과 후기 노인 (85세 이상), 동반 질환을 가진 그룹에서 유의한 차이가 있었다. 따라서 스타틴 복용 순응도를 증대시키기 위한 의료진의 노력이 필요할 것이다.
Key Message
The stroke risk of chronic periodontal disease patients was related to statin medication compliance, and the effect of stroke risk was different in women, the elderly, and comorbidities.

Citations

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  • Oral Diseases and Brain Pathologies: A Systematic Review with Narrative Synthesis of Clinical, Neuroimaging, and Mechanistic Evidence
    Marines Vega Sanchez, Francisco Córdova, Maria Rodríguez Tatés, Luis Chauca Bajaña, Diego Quiguango Farías, María Flores Araque, Byron Velásquez Ron
    Biomedicines.2026; 14(4): 768.     CrossRef
  • Periodontal Procedure Intensity and Incident Tinnitus in Korean Adults: A Nationwide Cohort Study
    Yu-Rin Kim, Minkook Son, Seon-Rye Kim, Byung-Jun Cho
    Medicina.2026; 62(8): 1578.     CrossRef
  • Association between regular dental scaling and stroke risk in patients with periodontal diseases: evidence from a Korean nationwide database
    Yu-Rin Kim, Minkook Son, Seon-Rye Kim
    Epidemiology and Health.2025; 47: e2025020.     CrossRef
  • Significance of IL-8 and HMGB1 expression in peripheral blood and gingival sulcus fluid of patients with chronic periodontitis
    Peng Liu
    American Journal of Translational Research.2025; 17(11): 9167.     CrossRef
  • Association between statin compliance and risk of dementia among patients with chronic periodontitis
    Yu‐Rin Kim, Minkook Son, Seon‐Rye Kim
    Oral Diseases.2024; 30(5): 3440.     CrossRef
  • The association between dental caries, periodontal diseases, and tooth loss with diabetes mellitus among the elderly population
    Mohammad-Hossein Heydari, Farshad Sharifi, Shayan Sobhaninejad, Ali Sharifi, Leili Alizadeh, Soheila Darmiani, Shima Bijari, Parvin Parvaie, Soheila Bakhshandeh, Shervan Shoaee, Mohammad-Hossein Khoshnevisan
    Journal of Diabetes & Metabolic Disorders.2024; 23(1): 1371.     CrossRef
  • Impact of statin treatment on cardiovascular events in patients with retinal vein occlusion: a nested case-control study in Korea
    Joonsang Yoo, Joo Youn Shin, Jimin Jeon, Jinkwon Kim
    Epidemiology and Health.2023; 45: e2023035.     CrossRef
Associations between dietary risk factors and ischemic stroke: a comparison of regression methods using data from the Multi-Ethnic Study of Atherosclerosis
Seyed Saeed Hashemi Nazari, Yaser Mokhayeri, Mohammad Ali Mansournia, Soheila Khodakarim, Hamid Soori
Epidemiol Health. 2018;40:e2018021.   Published online May 21, 2018
DOI: https://doi.org/10.4178/epih.e2018021
  • 30,168 View
  • 276 Download
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AbstractAbstract PDF
Abstract
OBJECTIVES
We analyzed dietary patterns using reduced rank regression (RRR), and assessed how well the scores extracted by RRR predicted stroke in comparison to the scores produced by partial least squares and principal component regression models.
METHODS
Dietary data at baseline were used to extract dietary patterns using the 3 methods, along with 4 response variables: body mass index, fibrinogen, interleukin-6, and low-density lipoprotein cholesterol. The analyses were based on 5,468 males and females aged 45-84 years who had no clinical cardiovascular disease, using data from the Multi-Ethnic Study of Atherosclerosis.
RESULTS
The primary factor derived by RRR was positively associated with stroke incidence in both models. The first model was adjusted for sex and race and the second model was adjusted for the variables in model 1 as well as smoking, physical activity, family and sibling history of stroke, the use of any lipid-lowering medication, the use of any anti-hypertensive medication, hypertension, and history of myocardial infarction (model 1: hazard ratio [HR], 7.49; 95% confidence interval [CI], 1.66 to 33.69; p for trend=0.01; model 2: HR, 6.83; 95% CI, 1.51 to 30.87 for quintile 5 compared with the reference category; p for trend=0.02).
CONCLUSIONS
Based primarily on RRR, we identified that a dietary pattern high in fats and oils, poultry, non-diet soda, processed meat, tomatoes, legumes, chicken, tuna and egg salad, and fried potatoes and low in dark-yellow and cruciferous vegetables may increase the incidence of ischemic stroke.
Summary

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  • Trimethylamine N-oxide, β-alanine, tryptophan index, and vitamin B6-related dietary patterns in association with stroke risk
    Dong Liu, Siyue Tan, Zhengyuan Zhou, Shujun Gu, Hui Zuo
    Nutrition, Metabolism and Cardiovascular Diseases.2024; 34(5): 1179.     CrossRef
  • A comparison of principal component analysis, reduced-rank regression, and partial least–squares in the identification of dietary patterns associated with cardiometabolic risk factors in Iranian overweight and obese women
    Fatemeh Gholami, Ahmadreza Hajiheidari, Bahareh Barkhidarian, Neda Soveid, Mir Saeid Yekaninejad, Zahra Karimi, Niki Bahrampour, Seyed Ali Keshavarz, Gholamali Javdan, Khadijeh Mirzaei
    BMC Medical Research Methodology.2024;[Epub]     CrossRef
  • Comparison of data-driven identified hypertension-protective dietary patterns among Chinese adults: based on a nationwide study
    Yuxiang Yang, Wei Piao, Shuya Cai, Kun Huang, Changzheng Yuan, Xue Cheng, Ling Zhang, Yuge Li, Liyun Zhao, Dongmei Yu
    European Journal of Nutrition.2023; 62(7): 2805.     CrossRef
  • Associations between dietary patterns and cardiovascular disease risk in Canadian adults: a comparison of partial least squares, reduced rank regression, and the simplified dietary pattern technique
    Svilena V Lazarova, Mahsa Jessri
    The American Journal of Clinical Nutrition.2022; 116(2): 362.     CrossRef
  • Association Between Dietary Quality Indices and Atherosclerosis Risk: A Case-Control Study
    Mahsa Samadani, Anahita Mansoori, Habib Haybar, Fatemeh Haidari, Majid Mohammadshahi
    Nutrition and Metabolic Insights.2022;[Epub]     CrossRef
  • Visceral adiposity-related dietary patterns and the risk of cardiovascular disease in Iranian adults: A population-based cohort study
    Nazanin Moslehi, Fatemeh Rahimi Sakak, Maryam Mahdavi, Parvin Mirmiran, Fereidoun Azizi
    Frontiers in Nutrition.2022;[Epub]     CrossRef
  • Dietary patterns derived by reduced rank regression and non-communicable disease risk
    Carmen Piernas, Min Gao, Susan A. Jebb
    Proceedings of the Nutrition Society.2022; : 1.     CrossRef
  • Dietary patterns related to cardiovascular disease based on reduced rank regression analysis of healthy middle-aged Koreans: data from the community-based Korean Genome and Epidemiology Study (KoGES) cohort
    Hye Ah Lee, Hyoin An, EunJin Lee
    The American Journal of Clinical Nutrition.2020; 111(6): 1159.     CrossRef
  • Interaction between an ATP-Binding Cassette A1 (ABCA1) Variant and Egg Consumption for the Risk of Ischemic Stroke and Carotid Atherosclerosis: a Family-Based Study in the Chinese Population
    Jing Song, Xia Jiang, Yaying Cao, Juan Juan, Tao Wu, Yonghua Hu
    Journal of Atherosclerosis and Thrombosis.2019; 26(9): 835.     CrossRef
Review
Registry-based stroke research in Taiwan: past and future
Cheng-Yang Hsieh, Darren Philbert Wu, Sheng-Feng Sung
Epidemiol Health. 2018;40:e2018004.   Published online February 4, 2018
DOI: https://doi.org/10.4178/epih.e2018004
  • 41,126 View
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AbstractAbstract PDF
Abstract
Stroke registries are observational databases focusing on the clinical information and outcomes of stroke patients. They play an important role in the cycle of quality improvement. Registry data are collected from real-world experiences of stroke care and are suitable for measuring quality of care. By exposing inadequacies in performance measures of stroke care, research from stroke registries has changed how we manage stroke patients in Taiwan. With the success of various quality improvement campaigns, mortality from stroke and recurrence of stroke have decreased in the past decade. After the implementation of a nationwide stroke registry, researchers have been creatively expanding how they use and collect registry data for research. Through the use of the nationwide stroke registry as a common data model, researchers from many hospitals have built their own stroke registries with extended data elements to meet the needs of research. In collaboration with information technology professionals, stroke registry systems have changed from web-based, manual submission systems to automated fill-in systems in some hospitals. Furthermore, record linkage between stroke registries and administrative claims databases or other existing databases has widened the utility of registry data in research. Using stroke registry data as the reference standard, researchers have validated several algorithms for ascertaining the diagnosis of stroke and its risk factors from claims data, and have also developed a claims-based index to estimate stroke severity. By making better use of registry data, we believe that we will provide better care to patients with stroke.
Summary

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    Phyo-Wai Thu, Yu-Ping Yu, Jen-Hung Wang, Chooi-Lan Liew
    Tzu Chi Medical Journal.2025; 37(3): 311.     CrossRef
  • Exploring Face Perception Efficiency in Patients with Lacunar Stroke: A Study with Familiar and Unfamiliar Face Recognition
    Chi-Yu Lin, Mary Wen-Reng Ho, Sarina Hui-Lin Chien
    Brain Sciences.2025; 15(10): 1072.     CrossRef
  • Predicting ischemic stroke patients’ prognosis changes using machine learning in a nationwide stroke registry
    Ching-Heng Lin, Yi-An Chen, Jiann-Shing Jeng, Yu Sun, Cheng-Yu Wei, Po-Yen Yeh, Wei-Lun Chang, Yang C. Fann, Kai-Cheng Hsu, Jiunn-Tay Lee
    Medical & Biological Engineering & Computing.2024; 62(8): 2343.     CrossRef
  • Urban–Rural Disparity in Socioeconomic Status, Green Space and Cerebrovascular Disease Mortality
    Wen-Yu Lin, Ping-Yi Lin, Chih-Da Wu, Wen-Miin Liang, Hsien-Wen Kuo
    Atmosphere.2024; 15(6): 642.     CrossRef
  • Maximising the Quality of Stroke Care: Reporting of Data Collection Methods and Resourcing in National Stroke Registries: A Systematic Review
    Agnes Jonsson, Nicole Cosgrave, Anna Healy, Lisa Mellon, David J. Williams, Anne Hickey
    Journal of Medical Systems.2024;[Epub]     CrossRef
  • Data source profile reporting by studies that use routinely collected health data to explore the effects of drug treatment
    Wen Wang, Mei Liu, Qiao He, Mingqi Wang, Jiayue Xu, Ling Li, Guowei Li, Lin He, Kang Zou, Xin Sun
    BMC Medical Research Methodology.2023;[Epub]     CrossRef
  • Registry Studies of Stroke in Japan
    Ryu Matsuo
    Journal of Atherosclerosis and Thrombosis.2023; 30(9): 1095.     CrossRef
  • TREAT‐AIS: A Multicenter National Registry
    Sung‐Chun Tang, Yi‐Chen Hsieh, Chun‐Jen Lin, Yu‐Wei Chen, Kuan‐Hung Lin, Pi‐Shan Sung, Meng‐Tsang Hsieh, Chih‐Wei Tang, Hai‐Jui Chu, Kun‐Chang Tsai, Chao‐Liang Chou, Cheng‐Yu Wei, Shang‐Yih Yen, Po‐Lin Chen, Hsu‐Ling Yeh, Lung Chan, Sheng‐Feng Sung, Hon‐M
    Stroke: Vascular and Interventional Neurology.2023;[Epub]     CrossRef
  • Risk of Incident Epilepsy After a Middle Cerebral Artery Territory Infarction
    Cheng-Yang Hsieh, Chien-Chou Su, Edward Chia-Cheng Lai, Yu-Shiue Chen, Tzu-Hsin Huang, Yea-Huei Kao Yang, Chih-Hung Chen, Sheng-Feng Sung, Chin-Wei Huang
    Frontiers in Neurology.2022;[Epub]     CrossRef
  • Clinical registries data quality attributes to support registry-based randomised controlled trials: A scoping review
    Khic-Houy Prang, Bill Karanatsios, Ebony Verbunt, Hui-Li Wong, Justin Yeung, Margaret Kelaher, Peter Gibbs
    Contemporary Clinical Trials.2022; 119: 106843.     CrossRef
  • Hypoperfusion Index Ratio as a Surrogate of Collateral Scoring on CT Angiogram in Large Vessel Stroke
    Chun-Min Wang, Yu-Ming Chang, Pi-Shan Sung, Chih-Hung Chen
    Journal of Clinical Medicine.2021; 10(6): 1296.     CrossRef
  • The Riga East University Hospital Stroke Registry—An Analysis of 4915 Consecutive Patients with Acute Stroke
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Original Article
Evaluation of risk prediction model for stroke risk based on Cox's and Weibull model in Korea.
Youn Nam Kim, Ur Rin Cho, Byung Ho Nam, Il Soo Park, Sun Ha Jee
Korean J Epidemiol. 2008;30(1):41-48.   Published online June 30, 2008
DOI: https://doi.org/10.4178/kje.2008.30.1.41
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AbstractAbstract PDF
Abstract
OBJECTIVE: The objective was to compare Cox proportional hazards model and Weibull model for predicting long-term probabilities for stroke risk in the Korean Cancer Prevention Study(KCPS).
METHODS
The subjects comprised of 385,279 Korean aged 55 to 64 years who received health insurance from the National Health Insurance Corporation and who had medical examinations in 1992 and 1995. 70% of the subjects were used for model building and the rest for model evaluation. The final prediction model for stroke includes age, systolic blood pressure, diabetes, total cholesterol and smoking. Subjects were follow-up for identification of incident stroke cases between 1993 and 2005. Comparisons included predicted coefficients of stroke risk factors, incidence probabilities over 10 years, and the area under a receiver operating characteristics (ROC) curve for both Cox's proportional hazard model and Weibull model.
RESULTS
The average age of study population was 55.5 years in men and 56.3 years in women, respectively. Percentage of men and women in study population were 58.0% and 42.0%, respectively. The study findings satisfied proportionality according to the two models. There was no significant difference in coefficients between the two models of prediction models in men and in women. Moreover, there was no difference in incidence probabilities of stroke and c-statistics. C-statistics were 0.68 for men as same as for women.
CONCLUSION
There was no difference for the prediction of the stroke risk in the Korean population using Cox's proportional hazard model and Weibull model, thus the two models were found to be efficient for this purpose.
Summary

Citations

Citations to this article as recorded by  
  • Systematic Review of Cardiovascular Risk Prediction Models for the Korean Population
    Jaeyong Lee, Sojung Shin, Dasom Son, Hyeok-Hee Lee, Hyeon Chang Kim, Hokyou Lee
    Korean Circulation Journal.2027;[Epub]     CrossRef
Review
Studies on the Association between Phenylpropanolamine (PPA) and Hemorrhagic Stroke in Other Countries.
Seung Mi Lee, Byung Woo Yoon, Byung Joo Park
Korean J Epidemiol. 2004;26(2):1-7.
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AbstractAbstract PDF
Abstract
OBJECTIVES
Phenylpropanolamine (PPA) had been used widely as cold remedies or appetite suppressants. However, products containing PPA were withdrawn in sequence in the US, Japan, and Korea due to the increased risk of hemorrhagic stroke. The purpose of this paper was to review safety issues related with the PPA use and hemorrhagic stroke in view of pharmacoepidemiology and pharmacovigilance.
METHODS
AND MATERIALS: Researches conducted for evaluating the association between the PPA use and hemorrhagic stroke in other countries were reviewed, which involved case reports, case series, case-control studies, and cohort studies.
RESULTS
In terms of pharmacologic and clinical features, PPA may increase the risk of hemorrhagic stroke through increased blood pressure, heart rate, or vasculitis. The association between the PPA use and hemorrhagic stroke among young women was suggested by case reports from spontaneous adverse events reporting systems or medical journals. The cohort study, using the large prescription database in the US and published in 1984, failed to reveal the association in the population aged below 65. The case-control study conducted as the Yale Hemorrhagic Stroke Project, published in 2000, was the first study to find the association between the PPA as appetite suppressants and hemorrhagic stroke among women ages 18-49 years by well-designed analytic epidemiological research. It led to withdrawal of all products containing PPA in the US and many other countries since 2000. However, the association between PPA and cerebral hemorrhage could not be confirmed by the case-control study conducted in Mexico due to inappropriate recruitment of control group.
CONCLUSIONS
During several years case reports have suggested that hemorrhagic stroke could be induced by PPA, and the Yale Hemorrhagic Stroke Project revealed the association by case-control study and provided a useful model for pharmacovigilance. Nevertheless, their finding could not be applied to other population such as elderly women and male population. And they could not provide any evidence on the association between PPA and stroke when PPA was used as cold remedy taken daily dose below 100mg.
Summary
Original Articles
Prevalence of Stroke in Pyongchang County.
Jong Ku Park, Kyung Sook Cho, Chun Bae Kim, Jin Back Kim, Ha Ja Song, Kee Ho Park, Seong Gyu Ko
Korean J Epidemiol. 2001;23(1):69-79.
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AbstractAbstract PDF
Abstract
PURPOSE
The purpose of this study was to identify the prevalence of stroke in Pyongchang county, Kangwon do.
METHODS
The presumptive stroke patients of Pyongchang county were identified with a key-person method in October 2000. And then, medical records of these patients were reviewed by well-trained two students who major in the science of medical record.
RESULTS
In the year 2000, there were 92 males and 68 females of self-diagnosed stroke. Of these, stroke patients based on physician's diagnosis were 102, and stroke patients based on CT/MRI findings or Minnesota criteria were 93. Prevalence rate of self-reported stroke, stroke based on physician's diagnosis, and stroke based on CT/MRI findings or Minnesota criteria were 0.33%, 0.29%, and 0.26% respectively.
CONCLUSION
We conclude that verifying process of diagnosis is needed to estimate the prevalence of stroke in community.
Summary
The Relationship Between Cholesterol Level and Mortality in Korean Women.
Yun Mi Song, Joo Hon Sung, Jai Jun Byeon, Joung Soon Kim, Oh Young Park
Korean J Epidemiol. 1997;19(2):131-146.
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AbstractAbstract PDF
Abstract
BACKGROUND
There were many efforts to evaluate the relationship between cholesterol and mortality. But almost all of them have been performed on male western people who have higher mean cholesterol concentration than oriental people and have different disease pattern from women's. So, upto now, the relationship of cholesterol to mortality in women with low cholesterol concentration was not well known. We carried out this study to investigate the relationship in Korea women whose mean cholesterol level was lower than that of western people and men.
METHOD
Study subjects included in were 100,363 Korean women aged 30-65 years. They undertook multiphasic health examination provided by Korea Medical Insurance Corporation between March 1990 and July 1990, and had no history of cancer and no significant medical illnesses which could change blood cholesterol level. Study subjects were followed for 5.5 years until December 1995 and it was determined whether each subject was dead or alive using the mortality data from the Korea National Statistical office and the Korea Medical Insurance Corporation. Nonlinear ralationship between serum total cholesterol and mortality was investigated with the use of quadratic regression and with dummy variables using the 158-180mg/dl group as the comparison group. To analyzing the relationship between cholesterol concentra-tion and mortality with controlling for age, smoking, alcohol drinking, exercise, diastolic blood pressure, body mass index, pay level, Cox propor-tional hazard model was used.
RESULT
During the follow-up period, there were 369 deaths. Mean cholesterol concentration of study subjects was 182.8mg/dl There was no significant association between serum cholesterol and total mortality, but women with cholesterol concentrations below 130mg/dl showed slightly increased risk of death(RR=1.20). Cholesterol had an inverse relationship with mortality from stroke, and women with cholesterol concentrations below 130mg/dl had higher risk of death from stroke(RR=3.28). Although there was no statistical significance,risk of mortality from hemorrhagic stroke in women with very low cholesterol concentration was markedly higher than in women with cholesterol concentrations above 130mg/dl. Mortality relationship with cholesterol. And women with cholesterol concentrations higher than 203mg/dl had abruply increased risk for death from ischemic heart disease.
CONCLUSION
Through this study, we could observe an inverse J shaped relationship between cholesterol concentration and mortality in Korean women. The increased risk of mortality from hemorrhagic stroke in people with very low cholesterol concentration supports the previous report which proposed low cholesterol level as a significant risk factor of hemorrhagic stroke. In spite of the lack of statistical signi-ficance, greately increased risk of mortality from ischemic heart disease in people with cholesterol higher than 203mg/dl suggests that cholesterol concentration at the upper end of distribution can be a significant risk factor of ischemic heart disease in women.
Summary
Epidemiol Health : Epidemiology and Health
© Korean Society of Epidemiology.
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