Epidemiology and Health

Original articles

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

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

Spatial patterns of laboratory-confirmed leptospirosis in northeastern Peninsular Malaysia, 2016–2023: Hazlienor Mohd Hatta, Kamarul Imran Musa, Nik Mohd Hafiz Mohd Fuzi, Paula Moraga; Epidemiol Health. 2025;e2025030. Published online May 29, 2025; DOI: https://doi.org/10.4178/epih.e2025030 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Leptospirosis presents significant public health challenges in endemic regions such as north-eastern Peninsular Malaysia. Spatial analysis is essential for visualising disease incidence and distribution, assessing vulnerability based on geographical and socio-economic factors, and ultimately informing targeted interventions, optimising resource allocation, and enhancing surveillance strategies. This study aimed to determine the incidence and characterise the spatial distribution of leptospirosis in Kelantan, Malaysia.
METHODS
All laboratory-confirmed leptospirosis cases reported in Kelantan between 2016 and 2023 were extracted from the Communicable Disease Control Information System (CDCIS) e-Notifikasi online database. Spatial analyses were performed using the spatstat, spdep, and ggplot2 packages within the RStudio integrated development environment.
RESULTS
The analysis encompassed 1534 laboratory-confirmed leptospirosis cases. The average crude annual incidence of leptospirosis cases per 1000 population from 2016 to 2023 was 0.101 (95% CI: 0.038, 0.164). Incidence varied considerably across districts and subdistricts, initially higher in the north but declining over time, while consistently high and increasing incidence was observed in the southern region. Significant clustering of leptospirosis cases occurred throughout the studied years, except during the COVID-19 pandemic. Hotspots were initially prevalent in northern areas but later emerged in south-eastern and southern regions. Significant spatial autocorrelation evolved from high-low to high-high clusters, particularly evident in central and southern regions.
CONCLUSIONS
This study provides valuable local epidemiological and spatial insights into the endemicity of leptospirosis. The findings highlight the need for targeted interventions and continued surveillance to effectively mitigate the leptospirosis burden in endemic areas.; Summary

Safety of combination therapy of azilsartan medoxomil and amlodipine: a population-based cohort study: Hyesung Lee, Bin Hong, Chris Tzu-Ting Su, Sungho Bea, Han Eol Jeong, Kyungyeon Jung, Michael Chun-Yuan Cheng, Zoe Chi-Jui Chang, Edward Chia-Cheng Lai, Jongyoung Lee; Epidemiol Health. 2025;e2025029. Published online May 28, 2025; DOI: https://doi.org/10.4178/epih.e2025029 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
This study investigated the safety of azilsartan and amlodipine combination therapy versus other angiotensin receptor blockers (ARBs) and amlodipine in patients with hypertension.
METHODS
We conducted a cohort study utilizing healthcare databases from South Korea and Taiwan. Patients aged between 18 and 75 years who were newly prescribed both an ARB and amlodipine within 6 months of hypertension diagnosis were included. Safety outcomes assessed were hypotension, angioedema, acute pancreatitis, hyperkalemia, hypokalemia, toxic liver disease, hepatic failure, nausea and vomiting, and fall-related injury. Hazard ratios (HRs) with 95% confidence intervals (CIs) for each safety outcome associated with azilsartan medoxomil and amlodipine versus other ARBs combined with amlodipine were calculated within a 1:1 propensity score (PS)-matched cohort. Summary HRs across databases were computed using random-effects meta-analysis.
RESULTS
We identified 2,472 eligible patients (1,521 from Korea, 951 from Taiwan) initiating treatment with azilsartan medoxomil and amlodipine, and 671,468 patients (312,322 from Korea, 355,409 from Taiwan) initiating other ARBs with amlodipine. After PS matching, baseline characteristics were well-balanced between treatment groups. During the 180-day follow-up, most adverse outcomes did not occur even once in either group, thus precluding the calculation of HRs. The risk of acute pancreatitis was not significantly different between the azilsartan medoxomil and amlodipine group and the other ARB and amlodipine groups (summary HR, 0.86 [95% CI, 0.14–5.37]).
CONCLUSIONS
In this population-based cohort study, azilsartan medoxomil combined with amlodipine was not associated with an increased risk of adverse outcomes compared to other ARBs combined with amlodipine.; Summary

Mortality burden attributable to long-term exposure to fine particulate matter among older adults in South Korea: Jongmin Oh, Jisun Myung, Changwoo Han, Hyun Joo Bae, Soontae Kim, Yun-Chul Hong, Dong-Wook Lee, Youn-Hee Lim; Epidemiol Health. 2025;e2025028. Published online May 28, 2025; DOI: https://doi.org/10.4178/epih.e2025028 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
This study aimed to evaluate the association between long-term exposure to fine particulate matter (PM2.5) and cause-specific mortality among older adults in South Korea, providing insights into the evolving public health burden in an aging society.
METHODS
We analyzed national insurance claims data from the Republic of Korea spanning 2010–2019. Modeled PM2.5 concentrations were assigned to participants according to their residential districts. We employed time-varying Cox proportional hazard models, using age as the time scale, adjusted for potential confounders. Six cause-specific mortalities were considered: ischemic heart disease (IHD), stroke, chronic obstructive pulmonary disease (COPD), acute lower respiratory infection (ALRI), lung cancer (LC), and type 2 diabetes mellitus (T2DM). Annual excess deaths attributable to long-term PM2.5 exposure were calculated.
RESULTS
A total of 5,360,032 older adults were followed from 2010 to 2019. Hazard ratios (HRs) per 10 μg/m³ increase in 12-month PM2.5 concentration were as follows: IHD, 1.068 (95% CI, 1.040–1.097); stroke, 1.023 (95% CI, 1.003–1.043); ALRI, 1.050 (95% CI, 1.026–1.076); COPD, 1.114 (95% CI, 1.072–1.157); T2DM, 1.046 (95% CI, 1.007–1.086); and LC, 0.972 (95% CI, 0.948–0.996). Excess deaths attributable to long-term PM2.5 exposure were estimated at 4,888 (95% CI, 2,304–7,323) in 2010 and 5,179 (95% CI, 2,585–7,648) in 2019.
CONCLUSIONS
Although PM2.5 levels in South Korea have shown a declining trend over the past decade, mortality among older adults associated with long-term PM2.5 exposure has not significantly decreased, likely due to the rapid aging of the population.; Summary

Special article

The Korean National Codes Against Cancer: background of their establishment and the revision process: Yoonjoo Choi, Jin-Kyoung Oh, Ayoung Byeon, Byungmi Kim; Epidemiol Health. 2025;e2025027. Published online May 14, 2025; DOI: https://doi.org/10.4178/epih.e2025027 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
The Korean National Codes Against Cancer provide guidelines for cancer prevention. The inaugural edition was published in 2006, followed by a major revision in 2016. This study aimed to describe the historical context, scientific rationale, and revision process of these guidelines.
METHODS
With rising cancer incidence in the early 2000s, the Korean government recognized the need for national cancer prevention guidelines, prompting the National Cancer Center to initiate their formulation. The Division of Cancer Prevention reviewed global literature on cancer trends and Korea-specific studies on cancer risk factors. The final set of 10 recommendations comprising the Korean National Codes Against Cancer was approved by the National Cancer Control Committee after achieving expert consensus on cancer prevention.
RESULTS
The finalized guidelines are firmly grounded in scientific evidence. The 10 current recommendations include: (1) no smoking and avoidance of secondhand smoke; (2) consuming sufficient fruits and vegetables as part of a balanced diet; (3) reducing salt intake and avoiding burnt or charred foods; (4) limiting alcohol consumption; (5) engaging in regular physical activity (at least 30 minutes a day, 5 days a week); (6) maintaining a healthy body weight; (7) receiving immunization against hepatitis B virus and human papillomavirus; (8) practicing safe sex by maintaining a single sexual partner and using condoms; (9) following health and safety guidelines to avoid exposure to occupational carcinogens; and (10) undergoing regular cancer screening.
CONCLUSIONS
This study detailed the sources and procedures involved in formulating and revising the Korean National Codes Against Cancer.; Summary

Original articles

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

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

Social capital and regional influences: key predictors of unmet dental care needs among older adults in South Korea: Ji-Yeon Lim, Ju-Mi Lee, Hae-Sung Nam; Epidemiol Health. 2025;e2025025. Published online May 7, 2025; DOI: https://doi.org/10.4178/epih.e2025025 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Access to dental services is essential for improving quality of life, and social capital plays a key role in facilitating that access. This study aimed to identify individual- and regional-level factors, including social capital, that predict unmet dental care needs among older adults.
METHODS
We analyzed data from 59,414 older adults obtained from the 2023 Korea Community Health Survey and the Korean Statistical Information Service, employing a 2-level multilevel model. The dependent variables comprised 3 types of unmet dental care needs: overall, due to lack of acceptability, and due to economic reasons. Twelve independent variables, including social capital and other individual and regional factors, were examined.
RESULTS
The prevalence of unmet needs was 14.15% overall, 8.70% for acceptability reasons, and 4.85% for economic reasons. Lower individual social capital was associated with higher odds of unmet dental care needs, whereas regional social capital factors demonstrated no significant association. Residing in regions with higher fiscal independence ratios was related to an increased likelihood of economic unmet needs (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.09 to 1.52). In contrast, a greater density of dentists per 10,000 population was inversely associated with overall and acceptability-related unmet needs (OR, 0.82 for both; 95% CI, 0.73 to 0.92 and 0.73 to 0.93, respectively).
CONCLUSIONS
Individual social capital and specific regional factors—namely, fiscal independence and density of dentists—may represent important determinants of unmet dental care needs among older adults. Policy interventions aimed at reducing unmet needs should consider these variables.; Summary

Risk of new-onset seizures following immunization against COVID-19: a self-controlled case-series study: Hwa Yeon Ko, Dongwon Yoon, Ju Hwan Kim, Han Eol Jeong, Seung Bong Hong, Won Chul Shin, JU YOUNG SHIN; Epidemiol Health. 2025;e2025024. Published online May 2, 2025; DOI: https://doi.org/10.4178/epih.e2025024 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Despite emerging reports of new-onset seizures (NOS) following COVID-19 vaccination, safety evidence regarding the risk of NOS after vaccination remains limited. We aimed to investigate the potential association between NOS and COVID-19 vaccination.
METHODS
We conducted a self-controlled case series study utilizing a nationwide database linking the COVID-19 vaccination registry and the National Health Information Database (from February 2021 to October 2022). We identified adults (≥18 years) who received COVID-19 vaccination (BNT162b2, ChAdOx1 nCoV-19, mRNA-1273, NVX-CoV2373, or Ad26.COV2.S) and had a diagnosis of NOS accompanied by prescriptions of anti-seizure drugs. The observation period was defined as 240 days following vaccination. We evaluated the risk of NOS during a risk window of 28 days after vaccination compared to the control window (the remaining observation period excluding the risk window). Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were estimated using a conditional Poisson regression model.
RESULTS
Among 42,155,198 COVID-19 vaccine recipients, we identified 1,849 and 4,217 patients with NOS in the risk and control windows, respectively. There was no increased risk of NOS within the 28-day period following vaccination (IRR, 0.99; 95% CI, 0.94–1.05). Although results from subgroup analyses by vaccine type were largely consistent with the main findings (IRR, 0.95; 95% CI, 0.88–1.03 for BNT162b2; IRR, 0.95; 95% CI, 0.77–1.16 for ChAdOx1 nCoV-19; IRR, 1.58; 95% CI, 0.52–4.83 for Ad26.COV2.S), a marginally elevated risk was observed for mRNA-1273 (IRR, 1.21; 95% CI, 1.04–1.42).
CONCLUSIONS
There was no evidence of an increased risk of NOS following COVID-19 vaccination. These findings can be used as safety evidence in clinical decision-making and to bolster public confidence in COVID-19 vaccines.; Summary

Association between humidifier disinfectant use duration and lung cancer development in the Republic of Korea: Sungchan Kang, Jeong-In Hwang, Su Hwan Kim, Hyungryul Lim, Dong-wook Lee, Woojoo Lee, Jong Hun Kim, Sol Yu, Jungyun Lim, Younghee Kim, Kyoung-Nam Kim; Epidemiol Health. 2025;e2025023. Published online May 2, 2025; DOI: https://doi.org/10.4178/epih.e2025023 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
This study was conducted to assess the association between the duration of humidifier disinfectant use and lung cancer development.
METHODS
We analyzed data from 3,605 applicants registered for compensation from the Korean government due to health conditions related to humidifier disinfectant exposure. Among these individuals, 121 were diagnosed with lung cancer at least 4 years after their initial exposure (through December 2021). Hazard ratios (HRs) and 95% confidence intervals (CIs) for lung cancer incidence were estimated according to the duration of disinfectant use using Cox proportional hazards models.
RESULTS
Compared with <5 months of use, the HRs for lung cancer were 1.81 (95% CI, 0.41 to 7.97) for 5–14 months, 2.45 (95% CI, 0.58 to 10.41) for 15–29 months, and 4.61 (95% CI, 1.12 to 18.91) for ≥30 months. Using never smokers with <15 months of use as the reference category, the HRs were 2.97 (95% CI, 1.34 to 6.56) for never smokers with ≥15 months of use, 2.73 (95% CI, 0.94 to 7.95) for current or former smokers with <15 months of use, and 4.74 (95% CI, 1.94 to 11.61) for current or former smokers with 15 months of use.
CONCLUSIONS
Our study provides some of the first robust epidemiological evidence that prolonged humidifier disinfectant use contributes to lung cancer development. Future studies—particularly those including unexposed populations—are needed to confirm these findings.; Summary

Inequality in mortality according to regional deprivation during the COVID-19 pandemic: Min Hui Moon, Min-Hyeok Choi, Young Gyu Ko; Epidemiol Health. 2025;e2025022. Published online April 29, 2025; DOI: https://doi.org/10.4178/epih.e2025022 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Vulnerability to coronavirus disease 2019 (COVID-19) is significantly greater in regions with lower socioeconomic status. However, detailed analyses of regional socioeconomic disparities have rarely been conducted in South Korea. This study aimed to identify and compare mortality inequalities associated with regional socioeconomic status across different areas of South Korea during the COVID-19 pandemic.
METHODS
Using cause-of-death statistics from 2020 to 2022, we calculated age-standardized mortality rates (ASMRs) for total mortality, COVID-19 mortality, and pneumonia mortality. The socioeconomic status of each region was assessed using the regional deprivation index. Additionally, we calculated the rate difference (RD), rate ratio (RR), slope index of inequality (SII), and relative index of inequality (RII) for each socioeconomic level to examine the extent of mortality inequality and its temporal changes. These analyses were stratified by sex and urban-rural classification.
RESULTS
The total mortality rate, as well as COVID-19-specific and pneumonia-specific mortality rates, increased during the COVID-19 pandemic. The ASMR for COVID-19 was higher in rural areas (ASMR, 27.79), which have lower healthcare accessibility, compared to urban areas (ASMR, 26.63). However, mortality inequality indicators for COVID-19 were more pronounced in urban areas compared to rural areas (SII [urban: 2.72; rural: -0.05], RII [urban: 0.10; rural: 0.00]). Notably, significant inequalities were observed among men residing in urban areas.
CONCLUSIONS
In disaster situations such as the COVID-19 pandemic, it is essential to implement strategies aimed at reducing overall mortality rates and addressing regional socioeconomic inequalities.; Summary

Geospatial analysis of neonatal mortality in North-eastern India: a multilevel Bayesian approach: Vidhi Jain, Kh. Jitenkumar Singh, Deboshree Das, Shefali Gupta, Gunjan Singh; Epidemiol Health. 2025;e2025021. Published online April 27, 2025; DOI: https://doi.org/10.4178/epih.e2025021 [Accepted]

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OBJECTIVES
Neonatal mortality remains a significant public health issue in India. This study investigates spatial patterns and contributing factors to neonatal mortality in the north-eastern states, identifying hotspot regions and spatial variations.
METHODS
A sample of 34,222 mothers from NFHS-5 (2019–21) in the north-eastern states was analysed. Descriptive and bivariate analyses were conducted alongside Bayesian multilevel logistic regression using Integrated Nested Laplace Approximation (INLA) to model neonatal mortality. Spatial hotspot analysis using Getis-Ord Gi* statistics identified clusters of high neonatal mortality, while geographically weighted regression (GWR) was used to examine spatial variations in the relationships between neonatal mortality and contributing factors.
RESULTS
The neonatal mortality rate in the north-eastern states declined from 45 to 21 per 1,000 live births (NFHS-1 to NFHS-5) but remains higher than the national average. Assam reported the highest mortality (42.16%), whereas Sikkim had the lowest (0.87%). Higher mortality was observed among male infants, mothers with advanced age, low maternal education, and mothers who attended less than 5 antenatal care (ANC) visits. Spatial analysis identified hotspots in Assam, Meghalaya, and Tripura. GWR indicated that areas with less than 5 ANC visits had the strongest association with neonatal mortality. Bayesian multilevel analysis highlighted spatial variations of up to 51% across districts in northeast India.
CONCLUSIONS
This study underscores spatial disparities in neonatal mortality across north-eastern India. Addressing childcare practices and healthcare access in hotspot regions is essential for improving new-born health outcomes. The findings provide critical insights for policymakers to develop targeted interventions aimed at reducing neonatal mortality in these underserved areas.; Summary

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

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Abstract Summary 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.

Impact of hypertension-related avoidable hospitalization on all-cause mortality in older patients with hypertension: a nationwide retrospective cohort study in Korea: Yehrhee Son, Noorhee Son, Sungyoun Chun, Ki-Bong Yoo, Jung Hyun Chang, Woo-Ri Lee; Epidemiol Health. 2025;47:e2025019. Published online April 18, 2025; DOI: https://doi.org/10.4178/epih.e2025019

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
The prevalence of hypertension is increasing as a result of rapid population aging, which elevates the societal burden of the disease. In Korea, the hospitalization rate for hypertension-related admissions exceeds the average reported by the Organization for Economic Cooperation and Development; however, the impact of these hospitalizations has not been evaluated. Therefore, this study investigates the association between hypertension-related avoidable hospitalizations and all-cause mortality.
METHODS
We included patients aged ≥60 years diagnosed with hypertension, identified using data from the National Health Insurance Services Senior Cohort spanning 2008 to 2019. The primary outcome was all-cause mortality measured at 3 years and 5 years after the hypertension diagnosis. The key independent variable was the incidence of hypertension-related avoidable hospitalizations within the first year following the initial hypertension diagnosis. Cox proportional hazards regression analysis was employed to assess these associations. To ensure robust findings and minimize selection bias, several sensitivity analyses were conducted.
RESULTS
Out of 65,686 participants, 397 (0.6%) experienced hypertension-related avoidable hospitalizations within 1 year of their initial hypertension diagnosis. Individuals who experienced such hospitalizations had a significantly higher risk of all-cause mortality compared to those who did not (3-year: hazard ratio [HR], 2.12; 95% confidence interval [CI], 1.53 to 2.94; 5-year: HR, 2.13; 95% CI, 1.68 to 2.68).
CONCLUSIONS
Hypertension-related avoidable hospitalizations among older adults are associated with an increased risk of both short-term and long-term all-cause mortality. These findings underscore the importance of timely hypertension management to prevent such hospitalizations.; Summary

Korean summary
- 고혈압 관련 회피가능한 입원은 한국의 노인 고혈압 환자의 3년 및 5년 사망률과 유의미한 연관성을 보인다. - 사회경제적 및 지역적 건강 격차가 관찰되었으며, 저소득층과 대도시 이외 지역에 거주하는 환자의 사망 위험이 더 높았다. - 약물 복용을 포함한 조기 및 지속적인 고혈압 관리는 회피가능한 입원을 예방하고 장기 생존 결과를 개선하는데에 도움이 될 수 있다.

Key Message
- Hypertension-related avoidable hospitalizations are significantly associated with both 3-year and 5-year all-cause mortality among older patients with hypertension in Korea. - Socioeconomic and regional disparities were observed, with greater mortality risks among patients from low-income groups and non-metropolitan areas. - Early and consistent hypertension management—including medication adherence—may help prevent avoidable hospitalizations and improve long-term survival outcomes.

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

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

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

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

Association of dietary inflammatory index with mortality risk: a prospective analysis of the Korea National Health and Nutrition Examination Survey: Dahyun Park, Hee Ju Jun, Garam Jo, Soyoung Kwak, Min-Jeong Shin; Epidemiol Health. 2025;47:e2025017. Published online April 9, 2025; DOI: https://doi.org/10.4178/epih.e2025017

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Abstract Summary PDF: Abstract
OBJECTIVES
The energy-adjusted dietary inflammatory index (E-DII), a tool developed based on comprehensive research and literature reviews, is used to assess the inflammatory potential of specific diets. Although previous research has demonstrated an association between E-DII and mortality, longitudinal studies investigating a causal relationship in Asian populations are lacking. This study aimed to explore the prospective association between E-DII and the risk of all-cause, cancer, and cardiovascular disease (CVD) mortality using a population-based Korean cohort.
METHODS
The analysis included data from 40,596 individuals who participated in the Korea National Health and Nutrition Examination Survey between 2007 and 2015. The exclusion criteria encompassed the diagnosis of cancer or CVD at baseline, pregnancy at baseline, and death within the first 2 years after baseline. The E-DII was calculated using data from 24-hour dietary recall interviews. Cox proportional hazard regression models were employed to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for mortality risk across E-DII tertiles.
RESULTS
Over an 8.2-year follow-up period, 2,070 deaths were recorded. Compared with the lowest E-DII, a higher index was associated with an increased risk of mortality from all causes (HR, 1.45; 95% CI, 1.25 to 1.69), cancer (HR, 1.41; 95% CI, 1.09 to 1.81), and CVD (HR, 1.53; 95% CI, 1.07 to 2.18). The association between E-DII and all-cause mortality was particularly pronounced among individuals with metabolic conditions.
CONCLUSIONS
Our findings suggest a strong positive association between high E-DII and increased mortality in Korean adults, especially those with metabolic disorders.; Summary

Korean summary
본 연구는 2007–2015년 국민건강영양조사-사망원인통계 연계 데이터를 바탕으로 한국 성인을 대상으로 식이염증지수(E-DII)와 전체, 암, 심혈관질환 사망률 간의 연관성을 분석하였음. 높은 식이염증지수는 전체 사망(HR, 1.45; 95% CI, 1.25–1.69), 암 사망(HR, 1.41; 95% CI, 1.09–1.81), 심혈관질환 사망(HR, 1.53; 95% CI, 1.07–2.18) 위험 증가와 유의하게 관련되었으며, 특히 대사질환 보유자에서 그 연관성이 두드러졌음.

Key Message
This prospective cohort study analyzed nationally representative data from the Korea National Health and Nutrition Examination Survey (2007–2015) to examine the association between the energy-adjusted Dietary Inflammatory Index (E-DII) and mortality risk. A higher E-DII was significantly associated with increased risks of all-cause (HR, 1.45; 95% CI, 1.25–1.69), cancer mortality (HR, 1.41; 95% CI, 1.09–1.81), and cardiovascular mortality (HR, 1.53; 95% CI, 1.07–2.18), particularly among individuals with metabolic disorders.

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