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Volume 46; 2024
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Original Article
Causal effect of serum matrix metalloproteinase levels on venous thromboembolism: a Mendelian randomization study
Deheng Han, Fangcong Yu, Liangrong Zheng
Epidemiol Health. 2024;46:e2024046.   Published online April 24, 2024
DOI: https://doi.org/10.4178/epih.e2024046
  • 1,368 View
  • 125 Download
AbstractAbstract PDF
Abstract
OBJECTIVES
Serum matrix metalloproteinase (MMP) levels are associated with cardiovascular diseases. However, the causal associations between serum levels of specific MMPs and venous thromboembolism (VTE) remain unclear. The present study sought to explore the causal relationship between serum MMP levels and VTE by using the Mendelian randomization (MR) method.
METHODS
In this study 2-sample MR study, the exposure data on serum MMP levels were derived from genome-wide association studies involving 21,758 individuals from 13 cohorts of European descent. The outcome data on VTE, including deep vein thrombosis and pulmonary embolism, were derived from the FinnGen research project. The primary method used was the inverse-variance weighting method. The MR-Egger intercept test and the Cochran Q test were used to evaluate pleiotropy and heterogeneity.
RESULTS
Using the inverse-variance weighting method, higher serum MMP-12 levels were found to be associated with an increased risk of VTE (odds ratio, 1.04; 95% confidence interval, 1.01 to 1.07; p=0.001). Moreover, there was a weak association between the levels of certain MMPs and VTE. Sensitivity analyses revealed no significant heterogeneity and pleiotropy in our study, and the Steiger directionality test did not reveal a significant reverse causation association.
CONCLUSIONS
There is a causal association between MMP-12 levels and VTE, which may have substantial implications for the diagnostic and therapeutic strategies used for VTE.
Summary
Special Article
Nutrition survey methods and food composition database update of the Korean Genome and Epidemiology Study
Seon-Joo Park, Jieun Lyu, Kyoungho Lee, Hae-Jeung Lee, Hyun-Young Park
Epidemiol Health. 2024;46:e2024042.   Published online April 2, 2024
DOI: https://doi.org/10.4178/epih.e2024042
  • 1,456 View
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AbstractAbstract AbstractSummary PDF
Abstract
This study presents the nutrition survey methods and the updated food composition database for the Korean Genome and Epidemiology Study (KoGES). The KoGES, which is the largest and longest cohort study in Korea, aims to identify genetic and environmental factors associated with chronic diseases. This study has collected dietary data using a validated semi-quantitative food frequency questionnaire and/or the 24-hour recall method. However, these dietary survey methods use different food composition databases, and their nutritional values are out of date. Therefore, it became necessary to update the food composition database by revising nutrient analysis values to reflect improvements in the performance of food ingredient analysis equipment, revising international values to analysis values of Korean agricultural products, adjusting nutrient units, and adding newly reported nutrients related to chronic diseases. For this purpose, we integrated the different food composition databases used in each nutrition survey, updated 23 nutrients, and expanded 48 new nutrients for 3,648 food items using the latest reliable food composition databases published by national and international institutions. This revised food composition database may help to clarify the relationship between various nutrients and chronic diseases. It could serve as a valuable resource for nutritional, epidemiological, and genomic research and provide a basis for determining public health policies.
Summary
Korean summary
한국인유전체역학조사사업은 우리나라에서 가장 크고 오래된 코호트로 만성질환과 영양과의 관련성을 밝히기 위하여 사용되고 있다. 이 논문에서는 영양조사에 대한 자세한 방법론과 현재 공개하고 있는 23개 영양소의 업데이트 및 48개 새로운 영양소의 확대에 대한 내용을 소개하였다. 이러한 개선을 통해 KoGES 영양 데이터의 활용도가 더욱 높아질 것으로 기대된다.
Key Message
The Korean Genome and Epidemiology Study (KoGES) is the largest and longest-running cohort study in South Korea aimed at identifying the relationship between chronic diseases and nutrient intake. This paper provides a detailed methods of the nutritional surveys and introduces updates to the existing 23 nutrients and the addition of 48 new nutrients. These enhancements are expected to significantly increase the utility of the KoGES nutritional data.
Original Articles
Association of decreased estimated glomerular filtration rate with lung cancer risk in the Korean population
Soonsu Shin, Min-Ho Kim, Chang-Mo Oh, Hyejin Chun, Eunhee Ha, Hyo Choon Lee, Seong Ho Moon, Dong-Young Lee, Dosang Cho, Sangho Lee, Min Hyung Jung, Jae-Hong Ryoo
Epidemiol Health. 2024;46:e2024041.   Published online March 20, 2024
DOI: https://doi.org/10.4178/epih.e2024041
  • 1,558 View
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Inconsistent results are available regarding the association between low estimated glomerular filtration rate (eGFR) and lung cancer risk. We aimed to explore the risk of lung cancer according to eGFR category in the Korean population.
METHODS
We included 358,293 adults who underwent health checkups between 2009 and 2010, utilizing data from the National Health Insurance Service-National Sample Cohort. Participants were categorized into 3 groups based on their baseline eGFR, as determined using the Chronic Kidney Disease Epidemiology Collaboration equation: group 1 (eGFR ≥90 mL/min/1.73 m<sup>2</sup>), group 2 (eGFR ≥60 to <90 mL/min/1.73 m<sup>2</sup>), and group 3 (eGFR <60 mL/min/1.73 m<sup>2</sup>). Incidences of lung cancer were identified using the corresponding codes from the International Classification of Diseases, 10th revision. Multivariate Cox proportional hazard models were employed to calculate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for lung cancer incidence up to 2019.
RESULTS
In multivariate analysis, group 2 exhibited a 26% higher risk of developing lung cancer than group 1 (HR, 1.26; 95% CI, 1.19 to 1.35). Furthermore, group 3 demonstrated a 72% elevated risk of lung cancer relative to group 1 (HR, 1.72; 95% CI, 1.58 to 1.89). Among participants with dipstick proteinuria of 2+ or greater, group 3 faced a significantly higher risk of lung cancer than group 1 (HR, 2.93; 95% CI, 1.37 to 6.24).
CONCLUSIONS
Low eGFR was significantly associated with increased lung cancer risk within the Korean population. A particularly robust association was observed in individuals with severe proteinuria, emphasizing the need for further investigation.
Summary
Korean summary
이번 연구에서는 한국인 인구집단에서 단백뇨와 동반된 낮은 사구체 여과율이 페암의 발생 위험을 증가시켰다. 이는 신장기능의 저하가 폐암의 위험을 증가시킬 수 있음을 시사한다. 신장기능이 저하된 환자들의 면밀한 추적관찰이 필요할 수 있다.
Key Message
Our research found that lower estimated glomerular filtration rate with proteinuria increased the risk of lung cancer in a Korean population. These findings suggest that decreased kidney function may increase the risk of lung cancer, indicating the need for careful observation of patients with impaired kidney function.
Effect of the human papillomavirus vaccine on the risk of genital warts: a nationwide cohort study of Korean adolescent girls
Jaeyoung Cho, Eun Mi Kim, Jihye Kim, Ju-Young Shin, Eui Hyeok Kim, Jong Heon Park, Seunghyun Lewis Kwon, Geun-Yong Kwon, Soon-Ae Shin, Jaiyong Kim
Epidemiol Health. 2024;46:e2024040.   Published online March 18, 2024
DOI: https://doi.org/10.4178/epih.e2024040
  • 1,372 View
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The purpose of this study was to assess the effectiveness of human papillomavirus (HPV) vaccination administered to adolescent girls through Korea’s National Immunization Program.
METHODS
This retrospective cohort study included patients who were 12-13 years old, whether vaccinated or unvaccinated, between July 2016 and December 2017. The incidence of genital warts (GWs) was monitored through 2021. Time-stratified hazard ratios (HRs) were estimated, adjusting for birth year, socioeconomic status, and the level of urbanization of the region, and were presented with 95% confidence intervals (CIs). Data were sourced from the Immunization Registry Integration System, linked with the National Health Information Database.
RESULTS
The study included 332,062 adolescent girls, with an average follow-up period of approximately 4.6 years. Except for the first year, the HRs for the vaccinated group were lower than those for the unvaccinated group. The HRs for specific cut-off years were as follows: year 2, 0.62 (95% CI, 0.31 to 1.13); year 3, 0.58 (95% CI, 0.35 to 0.96); and year 4 and beyond, 0.39 (95% CI, 0.28 to 0.52).
CONCLUSIONS
Our findings indicate that HPV vaccination was associated with a reduction in the risk of GWs among adolescent girls. Notably, this reduction became significant as the incidence of GWs increased with age.
Summary
Korean summary
이 연구는 후향적 코호트 연구로써, HPV 예방접종이 한국의 여자 청소년에서 생식기사마귀 질환의 위험을 감소시키는 것과 연관성이 있다는 것을 보여주었다. 따라서 단기적으로 한국의 국가예방접종 사업은 생식기사마귀 질환에 있어 효과가 있었다고 볼 수 있다. 향후에는 전암성 병변 또는 암 등과 같은 심각한 질환에 대한 백신의 영향을 확인할 필요가 있다.
Key Message
In this retrospective cohort study, our results demonstrated that HPV vaccination is associated with a reduction in the risk of GWs among adolescent girls. In the short term, the NIP of Korea can be considered effective in providing protection against GWs. Future studies need to analyze the impact of vaccines on more serious diseases such as precancerous lesions or cancer.
Worsening of health disparities across COVID-19 pandemic stages in Korea
Hyejin Lee, Hyunwoo Nam, Jae-ryun Lee, Hyemin Jung, Jin Yong Lee
Epidemiol Health. 2024;46:e2024038.   Published online March 13, 2024
DOI: https://doi.org/10.4178/epih.e2024038
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
With the end of the coronavirus disease 2019 (COVID-19) pandemic, the health outcomes of this disease in Korea must be examined. We aimed to investigate health outcomes and disparities linked to socioeconomic status during the COVID-19 pandemic in Korea and to identify risk factors for hospitalization and mortality.
METHODS
This nationwide retrospective study incorporated an analysis of individuals with and without COVID-19 in Korea between January 1, 2020 and December 31, 2022. The study period was divided into 4 stages. Prevalence, hospitalization, mortality, and case-fatality rates were calculated per 100,000 population. Multivariate logistic regression was performed to identify risk factors for COVID-19 hospitalization and mortality.
RESULTS
Overall, the incidence rate was 40,601 per 100,000 population, the mortality rate was 105 per 100,000 population, and the case-fatality rate was 259 per 100,000 cases. A total of 12,577,367 new cases (24.5%) were recorded in stage 3 and 8,979,635 cases (17.5%) in stage 4. Medical Aid recipients displayed the lowest 3-year cumulative incidence rate (32,737 per 100,000) but the highest hospitalization (5,663 cases per 100,000), mortality (498 per 100,000), and case-fatality (1,521 per 100,000) rates. Male sex, older age, lower economic status, non-metropolitan area of residence, high Charlson comorbidity index, and disability were associated with higher risk of hospitalization and death. Vaccination was found to reduce mortality risk.
CONCLUSIONS
As the pandemic progressed, surges were observed in incidence, hospitalization, and mortality, exacerbating disparities associated with economic status and disability. Nevertheless, Korea has maintained a low case-fatality rate across all economic groups.
Summary
Korean summary
국민건강보험공단 자료를 이용하여 2020-2022년 후향적 코호트를 구축하여 시기별 코로나19 유병률, 입원률, 사망률, 치명률과 장애, 소득에 따른 건강격차를 확인하였을 때, 코로나19 대유행이 진행됨에 따라 발병률, 입원률, 사망률이 급증하고 건강 격차가 확대되었다. 그러나 이러한 격차에도 불구하고 한국은 다른 국가들과 비교하여 모든 소득수준에서 낮은 치명률을 유지하였다.
Key Message
Using data from the National Health Insurance Service, a retrospective cohort for the years 2020-2022 was established. By examining the COVID-19 prevalence rate, hospitalisation rate, mortality rate, and case-fatality rate, along with health disparities based on disability and economic status, as the pandemic progressed, there was a surge in incidence, hospitalisation, and mortality, widening disparities related to economic status and disability. Despite these disparities, Korea has maintained a low case-fatality rate across all economic groups.
Epidemiologic Investigation
Salmonellosis outbreaks linked to eggs at 2 gimbap restaurants in Korea
Jun Suk Eun, Joohyun Han, Ji-Hyun Lim, Eunkyung Shin, Junyoung Kim, Da-Jung Ko, Jaeil Yoo, Sungil Kim, Jin Sook Kim, Jung Sub Park, Ji-Hyuk Park
Epidemiol Health. 2024;46:e2024036.   Published online March 7, 2024
DOI: https://doi.org/10.4178/epih.e2024036
  • 1,217 View
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Salmonellosis outbreaks occurred at 2 restaurants 2 days apart, and an epidemiological investigation was conducted to determine whether the outbreaks were connected.
METHODS
Case studies were conducted for both outbreaks. Stool samples were collected from individuals, and food samples were collected from the restaurants. Pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing analyses were performed on outbreak-related <i>Salmonella enterica</i> serovar Enteritidis (<i>Salmonella Enteritidis</i>) isolates. Traceback investigations were also conducted for the ingredients from gimbap restaurants A and B.
RESULTS
In total, 106 people from gimbap restaurant A and 5 from gimbap restaurant B met the case definition. Salmonella Enteritidis was detected in samples from 2 food handlers, 22 patients, and 1 food (iceberg lettuce) at gimbap restaurant A and from 1 patient at gimbap restaurant B. According to PFGE, all isolates were identified as SEGX01.089. The molecular typing of all isolates showed the same pattern, and the genetic distance was close according to phylogenetic analysis. Eggs were the only food ingredient that was supplied to both gimbap restaurants.
CONCLUSIONS
The outbreaks were caused by <i>Salmonella</i> Enteritidis, and the source of infections was suspected to be contaminated eggs. To prevent foodborne outbreaks of <i>Salmonella</i>, restaurants should heat eggs sufficiently, and egg farms need to establish management systems that prevent <i>Salmonella</i> infections.
Summary
Korean summary
동일한 도시의 두 식당에서 2일 간격으로 살모넬라감염증 유행이 발생하여, 원인을 확인하고 두 유행 간에 연관이 있는지를 규명하기 위해 역학조사를 시행하였다. 병원체에 대한 유전자형 분석과 식재료 역추적조사 결과를 바탕으로 두 유행은 Salmonella Enteritidis에 의해 발생하였고, 감염원은 동일한 농장에서 공급된 오염된 계란으로 추적하였다.
Key Message
Salmonellosis outbreaks occurred at 2 restaurants in the same city 2 days apart, and epidemiological investigations were conducted to identify the causes and determine whether the outbreaks were connected. Based on the genetic characterization of the pathogens and traceback investigation of the food ingredients, the outbreaks were caused by Salmonella Enteritidis and the source of infection was traced to contaminated eggs, which were supplied from the same farm.
Original Articles
Association between plant-based diets and the risk of coronary heart disease predicted using the Framingham Risk Score in Korean men: data from the HEXA cohort study
Khongorzul Ganbat, Bayarmaa Nasan Ulzii, Sangah Shin
Epidemiol Health. 2024;46:e2024035.   Published online February 28, 2024
DOI: https://doi.org/10.4178/epih.e2024035
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study investigated the potential correlation between 4 plant-based diet indices and the predicted risk of coronary heart disease (CHD) in Korean men using the Framingham Risk Score.
METHODS
The study included 12,356 men participants (aged ≥40 years) from the Health Examinees Study. Dietary intake was estimated using a validated food frequency questionnaire. Four plant-based diet indices were measured, including the overall plant-based diet index, the healthy plant-based diet index (hPDI), the unhealthy plant-based diet index (uPDI), and the pro-vegetarian diet index. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for the predicted 10-year risk of CHD.
RESULTS
The study found that individuals in the highest hPDI quintile had a 19% lower risk score for CHD based on the Framingham Risk Score (model 3: HR, 0.80; 95% CI, 0.69 to 0.93; p for trend=0.010). In stratified analyses, the highest pro-vegetarian diet index was associated with a lower risk score for CHD in physically active individuals (HR, 0.74; 95% CI, 0.59 to 0.93; p for interaction=0.020). Conversely, the highest uPDI was associated with the highest risk score for CHD in those with a body mass index of ≥25 kg/m2 and a waist circumference ≥90 cm.
CONCLUSIONS
This prospective cohort study highlights the positive role of adhering to a high hPDI diet in the prevention of CHD in Korean men. Further prospective studies are needed to determine the association between various plant-based diet indices and the risk of CHD in Asian populations with different dietary habits.
Summary
Korean summary
본 연구는 한국 남성의 관상 동맥 심장 질환(CHD) 위험을 줄이는데 있어서 식이 패턴, 특히 건강한 식물성 식이 지수의 역할이 중요함을 강조한다. 높은 hPDI지수를 가진 사람이 CHD 위험이 유의미하게 19% 감소하는 것은 건강한 식물성 기반 식단 선택이 심혈관 건강에 미칠 수 있는 잠재된 영향력을 강조한다.
Key Message
The study highlights the important role of dietary patterns, especially healthy plant-based diet index (hPDI), in reducing the risk of coronary heart disease (CHD) among Korean men. A significant 19% reduction in CHD risk associated with the highest hPDI underscores the potential impact of dietary choices on cardiovascular health.
Predictive ability of the Chinese visceral adiposity index for incident hypertension in working-aged Koreans
Ju Young Jung, Chang-Mo Oh, Hyun chul Jo, Sung Keun Park
Epidemiol Health. 2024;46:e2024034.   Published online February 27, 2024
DOI: https://doi.org/10.4178/epih.e2024034
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  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The Chinese visceral adiposity index (CVAI) was developed to assess visceral adipose tissue in the Asian population. This study evaluated the predictive ability of the CVAI for incident hypertension in Korean adults.
METHODS
The study participants included 128,577 Koreans without hypertension. They were grouped in quartiles according to body mass index (BMI), waist circumference (WC), visceral adipose index (VAI), and CVAI values. The Cox proportional hazard assumption was used to evaluate the hazard ratio (HR) and 95% confidence interval (CI) for incident hypertension (adjusted HR [95% CI]) according to quartile level across a follow-up period of 6.9 years. Subgroup analyses were conducted by gender and obesity. The area under the curve was calculated to compare the predictive abilities of all indices (BMI, WC, VAI, and CVAI) for incident hypertension.
RESULTS
The CVAI was proportionally associated with the risk of hypertension in all participants (quartile 1: reference; quartile 2: 1.71 [95% CI, 1.59 to 1.82]; quartile 3: 2.41 [95% CI, 2.25 to 2.58]; and quartile 4: 3.46 [95% CI, 3.23 to 3.71]). Time dependent receiver operating characteristic curve analysis indicated that the CVAI was superior to BMI, WC, and VAI in predicting hypertension at the 2-year, 4-year, 6-year, and 8-year follow-ups. This finding was also observed in the gender and obesity subgroups. The predictive ability of the CVAI was greater in the women and non-obese subgroups than in the men and obese subgroups.
CONCLUSIONS
The CVAI was a stronger predictor of hypertension than BMI, WC, and VAI.
Summary
Korean summary
고혈압은 심혈관 질환의 주요 원인이다. 내장 지방은 비만에서 고혈압의 병태 생리에 중요한 역할을 한다. 최근의 연구는 Chinese visceral adiposity index (CVAI)가 다른 비만 지표 보다 아시아 인에서 심혈관 질환의 고 위험군을 더욱 잘 구분해 낸다는 것을 보고하였다. 우리는 체질량 지수, 허리 둘레, visceral adiposity index, CVAI의 고혈압에 대한 예측력을 비교 하였다. 우리의 연구는 CVAI가 고혈압을 예측하는데 있어 다른 지표 보다 우월하다는 것을 보여주었다.
Key Message
Hypertension is a leading risk factor for cardiovascular disease. It is known that visceral adiposity has an important role in the pathogenesis of hypertension in obesity. Recent studies have demonstrated that Chinese visceral adiposity index (CVAI) is more discriminative the high risk group for cardiovascular disease in Asians than other obesity indices. We compared the predictive ability for the development hypertension among body mass index, waist circumference, visceral adiposity index, and CVAI. Our study showed that CVAI is superior to predict hypertension than other indices.

Citations

Citations to this article as recorded by  
  • Association of traditional and novel obesity indicators with stroke risk: Findings from the Rural Chinese cohort study
    Dongdong Zhang, Weifeng Huo, Weiling Chen, Xi Li, Pei Qin, Ming Zhang, Jing Li, Xizhuo Sun, Yu Liu, Dongsheng Hu
    Nutrition, Metabolism and Cardiovascular Diseases.2024;[Epub]     CrossRef
Influence of practice location on prescribing, diabetes care, and colorectal cancer screening among Czech general practitioners during the COVID-19 pandemic
Jan Bělobrádek, Luděk Šídlo, Tom Philipp
Epidemiol Health. 2024;46:e2024033.   Published online February 23, 2024
DOI: https://doi.org/10.4178/epih.e2024033
  • 2,113 View
  • 73 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The provision of primary health care was not interrupted during the coronavirus disease 2019 (COVID-19) pandemic in Czechia, although the capacity and resources of providers changed. We examined how the pandemic affected individual general practices throughout 2017-2021, focusing on differences between urban and rural practices.
METHODS
We analysed data from the largest health insurance company in Czechia, which provides care to 4.5 million people (60% of the population). We evaluated the prescription volume, diabetes care procedures, and faecal immunochemical test (FIT) in preventive care and new pandemic-related procedures (remote consultations, testing, and vaccinations). For the spatial distribution of practices, we adapted the Organisation for Economic Cooperation and Development typology.
RESULTS
We observed minimal declines in 2020 in the rate of prescribing (-1.0%) and diabetes care (-5.1%), with a rapid resumption in 2021, but a substantial decline in FIT (-17.8% in 2020) with slow resumption. Remote consultations were used by 94% of all practices regardless of location, with testing and vaccinations more commonly performed by rural general practitioners (GPs).
CONCLUSIONS
Primary care in Czechia rose to the challenge of the COVID-19 pandemic, as shown by the finding that the volume of healthcare services provided through primary care did not decrease across most of the monitored parameters. This study also confirmed that rural GPs provide more care in-house, both in terms of prescribing and procedures performed in their practices. Future studies will need to focus on preventive care, which the pandemic has dampened in GP practices in Czechia.
Summary
Key Message
Primary care in Czechia has effectively adapted to the changes brought about by the COVID-19 pandemic. Minimal impact was observed in prescribtions and diabetic patient care. There was a significant decline in colorectal cancer screening, with a slow restitution after the pandemic subsided. Rural GPs consistently provided in-house treatment and have higher shares of both prescribing and diabetes care, as well as performing more COVID-19 specific procedures.
Brief Communication
Assessing the impact and implications of the revised Act on the Aggravated Punishment of Specific Crimes in preventing child traffic injuries in school zones in Korea: an interrupted time series analysis
Hong Jin Ku, Jin-Hwan Kim, Young June Choe, Seung Ah Choe, Mark R. Zonfrillo
Epidemiol Health. 2024;46:e2024032.   Published online February 21, 2024
DOI: https://doi.org/10.4178/epih.e2024032
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  • 93 Download
AbstractAbstract AbstractSummary PDF
Abstract
In 2019, a child’s death in Korea led to legislation that imposed stricter penalties for school zone traffic violations. We assessed the impact of that legislation using 2017-2022 Traffic Accident Analysis System data. Adjusted analyses revealed a significant decline in severe injuries in school zones, decreasing from 11 cases to 8 cases per month (p=0.017). The legislation correlated with a reduced risk of all child traffic injuries (risk ratio, 0.987; 95% confidence interval, 0.977 to 0.997; p=0.002), indicating its efficacy in curbing accidents.
Summary
Korean summary
2019년 민식이법 도입 후 소아 교통사고에 미치는 영향을 평가하고자 하였다. 2017-2022 교통사고 분석 시스템 데이터를 통해 그 효과를 평가했고, 학군지역에서 심각한 부상이 월 평균 11건에서 8건으로 감소했다(p=0.017). 또한, 모든 어린이 교통사고 위험 비율도 감소했고(risk ratio, 0.987, 95% CI, 0.977-0.997; p=0.002), 사고 예방에 효과적임을 입증했다. 이 연구는 학군지역 어린이 안전에 법 조치의 긍정적 영향을 강조하며, 지속적인 도로 안전 강화의 중요성을 강조한다.
Key Message
Revised legislation in Korea, following a child’s tragic death, enforced stricter penalties for school zone traffic violations. Analysis of 2017-2022 data showed a significant decrease in severe injuries from 11 to 8 cases monthly (p=0.017). The legislation also reduced the risk of all child traffic injuries (risk ratio, 0.987; 95% CI, 0.977 to 0.997; p=0.002), demonstrating its effectiveness in preventing accidents. This study underscores the legislation’s positive impact on child safety in school zones, emphasizing the importance of ongoing enforcement efforts for road safety.
Original Article
Association of insomnia and daytime napping with metabolic syndrome and its components in a Korean population: an analysis of data from the Korean Genome and Epidemiology Study
Da-Been Lee, Dae-Wui Yoon, Inkyung Baik
Epidemiol Health. 2024;46:e2024031.   Published online February 20, 2024
DOI: https://doi.org/10.4178/epih.e2024031
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
We investigated the association between metabolic syndrome (MetS) and the coexistence of insomnia and daytime napping, because limited data have been reported regarding this association.
METHODS
The study population was 8,440 participants aged 40-65 years, who were from the Korean Genome and Epidemiology Study. Self-reported information on insomnia symptoms and nap duration was used to define exposure variables. Data on waist circumference (WC), blood pressure (BP), and fasting blood glucose (FBG), triglyceride (TG), and high-density lipoprotein cholesterol levels in blood were used to define MetS. Multivariate logistic regression analysis was performed to obtain odds ratio (OR) and 95% confidence interval (CI).
RESULTS
In multivariate logistic regression analysis, the coexistence of insomnia and napping was not significantly associated with MetS. However, the insomnia and non-napping group showed higher ORs of high TG (OR, 1.19; 95% CI, 1.02 to 1.39) and high BP (OR, 1.28; 95% CI, 1.10 to 1.49) than the non-insomnia and non-napping group. The combination of non-insomnia and napping and that of insomnia and napping showed higher ORs of high TG (OR, 1.13; 95% CI, 1.00 to 1.29) and high FBG (OR, 1.59; 95% CI, 1.14 to 2.21), respectively. In analyses of insomnia symptoms, only the combination of difficulty in maintaining sleep (DMS) and non-napping showed a higher OR for MetS (OR, 1.25; 95% CI, 1.03 to 1.52) than the non-DMS and non-napping group.
CONCLUSIONS
Individuals with insomnia, particularly those who do not take naps, were disproportionately likely to have MetS components, especially TG or BP. Information on these variables may help predict individuals’ vulnerability to specific MetS components.
Summary
Korean summary
- 불면증과 대사증후군 구성요소와의 유의한 연관성은 낮잠의 유무에 따라 달라진다. - 낮잠을 자지 않는 불면증 환자는 대사증후군의 구성요소 중 특히 고중성지방이나 고혈압의 위험성이 높아진다.
Key Message
• The significant association of insomnia with MetS components varies with the presence or absence of napping. • Individuals with insomnia who do not take naps were likely to have MetS components, especially TG or BP.
Systematic Review
The effectiveness of protein supplementation combined with resistance exercise programs among community-dwelling older adults with sarcopenia: a systematic review and meta-analysis
Phatcharaphon Whaikid, Noppawan Piaseu
Epidemiol Health. 2024;46:e2024030.   Published online February 14, 2024
DOI: https://doi.org/10.4178/epih.e2024030
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The combination of protein supplementation and resistance exercise shows promise for improving and maintaining muscle mass, strength, and performance in older adults with sarcopenia. This systematic review aimed to evaluate the effects of this combination on muscle mass, muscle strength, and physical performance in community-dwelling older adults with sarcopenia.
METHODS
We conducted a comprehensive search of 4 electronic databases: PubMed, Scopus, Embase, and the MEDLINE Library. The search covered literature from January 2013 to January 2023 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent reviewers assessed the methodological quality of each study using the standard critical appraisal tool from the Joanna Briggs Institute (JBI). Meta-analysis was performed with the JBI Sumari program.
RESULTS
The review included 7 randomized controlled trials and 1 quasi-experimental study, encompassing a total of 854 participants aged 60 years and above. The study durations ranged from 10 weeks to 24 weeks. An analysis of standardized mean differences (SMDs) showed that protein supplementation combined with resistance exercise significantly increased muscle mass (SMD, 0.95; 95% confidence interval [CI], 0.13 to 1.78; p<0.05) and muscle strength (SMD, 0.32; 95% CI, 0.08 to 0.56; p<0.05).
CONCLUSIONS
Although the limited number of randomized controlled trials restricts the robustness of our conclusions, the evidence suggests that protein supplementation combined with resistance exercise is effective in enhancing muscle mass and strength in community-dwelling older adults with sarcopenia.
Summary
Key Message
Sarcopenia is a significant health concern. Given the contextual variations and the diverse factors that contribute to the prevalence of sarcopenia, delivering precision interventions to older adults diagnosed with sarcopenia who still reside in the community poses unique challenges. Therefore, precision interventions are vital for proper and feasible treatment planning, especially for early management actions, to reduce the impact of sarcopenia and its associated adverse effects in older adults. Our systematic review and meta-analysis showed that protein supplementation combined with resistance exercise is effective in enhancing muscle mass and strength in community-dwelling older adults with sarcopenia.
Original Articles
Impact of electronic cigarette use on the increased risk of diabetes: the Korean Community Health Survey
Wonseok Jeong, Seungju Kim
Epidemiol Health. 2024;46:e2024029.   Published online February 13, 2024
DOI: https://doi.org/10.4178/epih.e2024029
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Only a few studies have solely investigated the health impacts of electronic cigarettes on diabetes while considering the impact of conventional cigarettes. Therefore, this study aimed to examine the effect of electronic cigarette smoking on diabetes in Korean dual smokers, electronic cigarette smokers, conventional cigarette smokers, and non-smokers.
METHODS
Data were obtained from the 2021 and 2022 Korean Community Health Surveys of 460,603 Korean adults. The main independent variable was smoking behavior. Participants were categorized according to their smoking behavior, as dual smokers, electronic cigarette smokers, conventional cigarette smokers, and non-smokers. The dependent variable, the presence of diabetes, was defined by a doctor’s diagnosis. Multiple logistic regression analysis was performed to examine the association between smoking behavior and diabetes. Subgroup analyses were also performed to investigate the associations among different socioeconomic groups.
RESULTS
Conventional cigarette smokers had a higher risk of diabetes than did non-smokers (adjusted odds ratio [aOR], 1.22; 95% confidence interval [CI], 1.19 to 1.26). More importantly, those who only vaped electronic cigarettes were at high risk of diabetes (aOR, 1.15; 95% CI, 1.01 to 1.31). Lastly, dual smokers had the highest aOR for diabetes among other smoking behavior groups (aOR, 1.39; 95% CI, 1.22 to 1.58). Dual smoking was associated with the highest risk of diabetes in most subgroups.
CONCLUSIONS
This study suggests that conventional cigarette use and smoking electronic cigarettes negatively impact diabetes, and using both types leads to worse health outcomes. Therefore, cessation of all types of smoking is necessary for a healthy life.
Summary
Korean summary
이 연구는 한국의 이중 흡연자, 전자담배 흡연자, 일반 담배 흡연자 및 비흡연자들 사이에서 전자담배가 당뇨병에 미치는 영향을 조사하였다. 데이터는 460,603명의 한국 성인을 대상으로 한 2021년과 2022년 한국 지역사회 건강 조사를 사용하였다. 우리는 일반 담배나 전자담배 사용이 당뇨병에 부정적인 영향을 미친다는 것을 발견했으며, 두 가지를 함께 사용하면 건강 상태가 더욱 악화될 수 있다. 이에, 건강한 삶을 유지하기 위해서는 모든 형태의 흡연을 중단하는 것이 필수적이다.
Key Message
This study investigated how smoking electronic cigarettes affects diabetes among Korean dual smokers, electronic cigarette smokers, conventional cigarette smokers, and non-smokers. Data were obtained from the 2021 and 2022 Korean Community Health Surveys of 460,603 Korean adults. We found that using traditional cigarettes or electronic cigarettes adversely affects diabetes, and the combined use of both can lead to worse health outcomes. Therefore, quitting all forms of smoking is essential for maintaining a healthy life.
Associations of active and passive tobacco exposure with elevated blood pressure in Korean adolescents
Hyerin Park, Hyunsuk Jeong, Hyeon Woo Yim, Sanghyuk Bae
Epidemiol Health. 2024;46:e2024028.   Published online February 13, 2024
DOI: https://doi.org/10.4178/epih.e2024028
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
To test the hypothesis that tobacco exposure is associated with elevated blood pressure (EBP) in Korean adolescents, and that the association is dose dependent.
METHODS
This cross-sectional study used data from the 2011-2020 Korea National Health and Nutrition Survey (KNHANES). Subjects were eligible if they were 13-18 years at the time of participation in KNHANES. Tobacco exposure was defined by urine cotinine level. The main outcomes were EBP and hypertension. Statistical analyses were conducted using SAS version 9.4 with appropriate sampling weights to account for the complex survey design, stratification, and cluster variable.
RESULTS
A total of 2,518 adolescents was included in the analysis, representing 2.5 million Korean adolescents. The mean± standard deviation participant age was 15.3±1.7 years, and 55.3% were male. The number of participants with active tobacco smoke exposure was 283 (11.2%), passive tobacco smoke exposure was 145 (5.8%), and no smoke exposure was 2,090 (83.0%). Analysis of the 2,518 urine-cotinine-verified participants showed that tobacco smoke exposure had a significant effect on EBP: with an odds of elevated blood pressure of 3.00 (95% confidence interval [CI], 1.14 to 7.89). The odds of hypertension were 3.61 (95% CI, 1.13 to 11.49) in the active smoking group compared with the no tobacco exposure group after adjustment for potential confounders.
CONCLUSIONS
It is necessary to present a range of public health plans to reduce tobacco exposure that affects adolescents’ blood pressure, and further research with a larger number of participants using urine cotinine as a biomarker is needed.
Summary
Korean summary
청소년기의 고혈압은 성인기의 다양한 질병을 초래할 수 있는 주요 원인이다. 흡연과 고혈압의 관계에 관한 다수의 연구들이 있으나 상반된 결과들이 보고되었고 국내 청소년의 직 간접적 담배 연기 노출과 혈압과의 연관성은 명확하게 밝혀지지 않았다. 따라서 본 연구에서는 한국 청소년에서 담배 연기 노출과 혈압 상승과의 연관성을 확인해 보고자 하였다. 연구 결과 직접 흡연을 하는 청소년들은 비흡연군에 비하여 3배 이상 혈압이 증가하는 것으로 나타났다.
Key Message
Hypertension during adolescence is a leading cause of disease in adults. The relationship between smoking and hypertension has been studied, but findings between studies are conflicting. Nicotine is a known toxin, but the relationship between active and passive smoking and blood pressure in adolescents is not clear. So that we tested and found adolescents in Korea who were active smokers showed over 3-fold increased risk of elevated blood pressure.
Mediating effect of lower extremity muscle on the relationship between obesity and osteoarthritis in middle-aged and elderly women in Korea: based on the 2009-2011 Korea National Health and Nutrition Examination Survey
Minjun Kim, Joonwoong Kim, Inhwan Lee
Epidemiol Health. 2024;46:e2024027.   Published online February 2, 2024
DOI: https://doi.org/10.4178/epih.e2024027
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study investigated whether the lower extremity muscle mass index (LMI) mediates the relationship between general obesity, central obesity, and knee osteoarthritis in middle-aged and elderly women in Korea.
METHODS
Data of 2,843 women aged ≥50 years were collected from the Korean National Health and Nutrition Examination Survey conducted between 2009 and 2011. General obesity and central obesity were evaluated based on body mass index (BMI) and waist circumference (WC), calculated through anthropometric measurements and body composition assessments. LMI was calculated by dividing the muscle mass in both legs—measured using the dual-energy X-ray absorptiometry—by body weight. Knee osteoarthritis was defined as a Kellgren-Lawrence scale (KL) grade of ≥2 as assessed through radiographic images.
RESULTS
Knee osteoarthritis prevalence, indicated by KL grades, was significantly higher in the general obesity and central obesity groups compared to the normal group, and conversely, lower with varying LMI levels. Using mediation analysis with bootstrapping and adjusting for covariates, we found that LMI mediated the relationship between BMI and KL (β, 0.005; 95% confidence interval [CI], 0.000 to 0.010) and WC and KL grade (β, 0.002; 95% CI, 0.001 to 0.003), explaining 4.8% and 6.7% of the total effects of BMI and WC on KL grade, respectively.
CONCLUSIONS
The study suggested that LMI partially mediates the link between general obesity and/or central obesity and knee osteoarthritis, proposing that a higher proportion of lower limb muscle mass relative to body weight can alleviate the increased risk of knee osteoarthritis caused by obesity.
Summary
Korean summary
본 연구는 한국의 50세 이상 여성들을 대상으로 비만 및 복부비만과 무릎골관절염의 관계에 대한 다리근육비율의 매개 효과를 분석한 결과, 다리근육비율은 비만의 진단하는 사용되는 체질량지수, 복부비만의 진단에 사용되는 허리둘레와 무릎 골관절염의 진단에 사용되는 KL등급의 관계를 부분적으로 매개하는 것으로 나타났다. 이러한 결과는 다리근육의 강화가 비만 및 복부비만으로 인한 무릎골관절염의 위험을 완화할 수 있음을 시사하며, 건강한 생활습관과 규칙적인 근력운동의 병행을 통해 다리 근육을 강화하는 것이 무릎 골관절염의 예방을 위한 전략으로 권장되어야 함을 시사한다.
Key Message
Research examining the mediating effect of lower extremity muscle mass on the relationships of knee osteoarthritis to general and central obesity is scarce. Herein, we demonstrate the mediating effect of lean mass index on the relationships of knee osteoarthritis with body mass index and waist circumference in Korean women aged 50 years or older. We propose that strengthening leg muscles may mitigate, to some extent, the risk of knee osteoarthritis associated with general and central obesity. We recommend a regimen for strengthening leg muscles through healthy lifestyle habits and regular strength training, in conjunction with weight and abdominal fat management.

Epidemiol Health : Epidemiology and Health