Epidemiology and Health

Original Articles

Age at first childbirth and the risk of hypertriglyceridemia among Korean women: Hye Rin Choi, Hyeon Chang Kim; Epidemiol Health. 2023;45:e2023010. Published online December 29, 2022; DOI: https://doi.org/10.4178/epih.e2023010

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Abstract Summary PDF: Abstract
OBJECTIVES
We aimed to investigate the association of age at first childbirth with the risk of hypertriglyceridemia among Korean women.
METHODS
This study used data from the Korean Genome and Epidemiology Study–Cardiovascular Disease Association Study. In total, 16,747 women were included in the cross-sectional analysis, and 6,250 women were included in the longitudinal analysis. The participants were divided based on their age at first childbirth (<20, 20-24, 25-29, and ≥30 years). Hypertriglyceridemia was defined as triglyceride levels of ≥150 mg/dL.
RESULTS
The multivariable-adjusted odds ratio for prevalent hypertriglyceridemia was 1.19 (95% confidence interval [CI], 1.01 to 1.40) in women whose first childbirth was before 20 years of age, compared to those whose first childbirth was at 25-29 years of age, after adjustment for age, study site, body mass index, blood pressure, diabetes, alcohol consumption, carbohydrate intake, income, marital status, education, parity, usage of oral contraceptives, and hormone replacement status. During a median follow-up of 5.2 years, 1,770 women developed hypertriglyceridemia. Compared with women who gave birth to their first child between 25 years and 29 years of age, those giving birth to their first child before 20 years of age had a higher risk for incident hypertriglyceridemia in later life (adjusted hazard ratio, 1.25; 95% CI, 0.99 to 1.57).
CONCLUSIONS
Giving birth to one’s first child before the age of 20 years was associated with an increased risk of hypertriglyceridemia among Korean women.; Summary

Korean summary
한국인유전체역학조사사업의 농촌기반 코호트 자료를 분석한 결과, 20세 이전에 초산을 경험한 한국 여성에서 25-29세에 경험한 군에 비해 고중성지방혈증에 걸릴 위험이 증가하였음 폐경 후 여성을 한정하여 보았을 때도 20세 이전 초산과 고중성지방혈증 간의 유의한 관련성을 보였음 여성의 출산 등 여성력이 심혈관계 질환 발생의 위험요인으로 작용할 수 있으며, 출산력에 따른 혈중 중성지방수치 관리 전략 마련이 필요함

Key Message
Among Korean women, having their first child before the age of 20 was associated with an increased risk of hypertriglyceridemia. Targeted preventive actions should be developed for those women who give birth at an early age in order to manage their blood triglyceride levels.

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

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Abstract Summary PDF: Abstract
OBJECTIVES
Occupational stress management is particularly important for successful business operations, since occupational stress adversely affects workers’ health, eventually lowering their productivity. Therefore, this study aimed to investigate the correlation between occupational stress and health-related productivity loss (HRPL) among Korean workers.
METHODS
In 2021, 1,078 workers participated in a web-based questionnaire survey. HRPL was measured using the Work Productivity and Activity Impairment Questionnaire, and occupational stress was measured using the Korean Occupational Stress Scale-Short Form. The occupational stress level was divided into tertiles (low, intermediate, and high), and the low occupational stress group was used as the reference group. Using a generalised linear model, differences in labour productivity loss according to the level of occupational stress were tested after adjusting for demographic characteristics such as age, gender, education level, household income, occupation, and underlying medical conditions.
RESULTS
Non-parametric regression analysis of HRPL according to occupational stress showed a direct association between occupational stress and HRPL. A statistically significant difference was observed in HRPL between participants with intermediate and high occupational stress and those with low occupational stress.
CONCLUSIONS
Our results support the hypothesis that high occupational stress is associated with decreased labour productivity.; Summary

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

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

Brief communication

Self-reported Adverse events following the second dose of COVID-19 Vaccines in the Republic of Korea: Recipient survey, February to December 2021: Yunhyung Kwon, Insob Hwang, Mijeong Ko, Hyungjun Kim, Seontae Kim, Soon-Young Seo, Enhi Cho, Lee Yeon-Kyeng; Epidemiol Health. 2022;e2023006. Published online December 26, 2022; DOI: https://doi.org/10.4178/epih.e2023006 [Accepted]

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Abstract PDF: Abstract
Objectives
The national coronavirus disease 2019(COVID-19) vaccination program was implemented with four vaccines against COVID-19 in the Republic of Korea. A text-based survey, in addition to a passive adverse event reporting system, was launched to report unusual symptoms after vaccination quickly. This study aims to compare the frequency of adverse events caused by COVID-19 vaccines based on the vaccine type and the homologous and heterologous 2-dose regimen.
Methods
The self-reported adverse symptoms of vaccination were collected through a text message survey for 7 days after each vaccination. This study included 50,950 vaccine recipients who responded the survey at least once. Informed consent about receiving text surveys was obtained from the vaccine recipients on the day of the first vaccination.
Results
The recipients of mRNA vaccines expressed 1.6 to 2.8 times more local and systemic reactions after dose 2 than after dose 1(p<0.0001), whereas ChAdOx1-S recipients reported significantly fewer local and systemic reactions after dose 2 than after dose 1(p<0.0001). Local and systemic reactions were approximately 1.3 and 2 times higher for heterologous vaccination than for BNT162b2/BNT162b2 and ChAdOx1-S/ChAdOx1-S, respectively. Young individuals, females, and heterologous vaccine regimens with ChAdOx1-S/BNT162b2 vaccines reported more adverse symptoms than older, males and homologous vaccine regimens.
Conclusions
Though heterologous schedules, young and female were associated with higher risk of solicited reactions after CVODI-19 vaccination, no critical issues have been rose. Actively considering heterologous schedules based on evidence of efficacy and safety seems desirable.; Summary

Korean summary

Key Message

Original article

Viral shedding patterns of the symptomatic SARS-CoV-2 infection according to virus-type dominant periods and vaccination status in Gyeonggi Province, Korea: Gawon Choi, Ah-Young Lim, Sojin Choi, Kunhee Park, Soon Young Lee, Jong-Hun Kim; Epidemiol Health. 2022;e2023008. Published online December 21, 2022; DOI: https://doi.org/10.4178/epih.e2023008 [Accepted]

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Abstract PDF: Abstract
Objectives
We compared the viral cycle threshold (Ct) value of infected patients to better understand the viral kinetics during the dominant period in which a specific virus type according to the vaccination status in Gyeonggi Province, Republic of Korea.
Methods
We obtained case-specific data from the COVID-19 surveillance system, Gyeonggi in-depth epidemiologic report system, and Health Insurance Review & Assessment (HIRA) Service from January 2020 to January 2022. We defined the dominant periods according to the viral sequencing test result and explored Ct values. Using a generalized additive model, we performed a nonlinear regression analysis to determine viral kinetics over time.
Results
Cases in the delta variant dominant period had higher viral shedding patterns than cases in other periods. The temporal change of virus shedding did not differ according to the vaccination status in the omicron variant dominant period but decreased in patients who completed the third vaccination in the delta variant dominant period. The time from symptom onset to peak viral shedding based on the E gene in the case of the omicron and delta variant dominant periods was approximately 2.4 days (95% CI: 2.2-2.5) and 2.1 days (95% CI: 95% CI: 2.0-2.1), respectively.
Conclusions
In the one-time tests conducted to diagnose SARS-CoV-2 infection in a large population, although individual characteristics were not adjusted, it was confirmed that the viral shedding differed according to the dominant strain and vaccination history. These analysis results give utilization value for hundreds of thousands of test data produced at SARS-CoV-2 screening test centers.; Summary

Korean summary

Key Message

Brief Communication

Clinical severity according to the primary infection variant in patients with suspected SARS-CoV-2 reinfection in Korea: Myung-Jae Hwang, Insob Hwang, Chungmin Park, Hanul Park, Taejong Son, Jong-Hun Kim; Epidemiol Health. 2023;45:e2023007. Published online December 21, 2022; DOI: https://doi.org/10.4178/epih.e2023007

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Abstract PDF: Abstract
OBJECTIVES
We aimed to evaluate the severity of suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection according to variants of concern in Gyeongsangbuk-do and Daegu, Korea.
METHODS
The database of coronavirus disease 2019 (COVID-19) cases reported from epidemiological investigations through the integrated system operated by the Korea Disease Control and Prevention Agency, from January 20, 2020 to May 7, 2022 was combined with data from the Health Insurance Review and Assessment Service system. The severity odds ratio (SOR) in secondary infection episodes compared with primary infection was estimated using a generalized linear model with a binomial distribution.
RESULTS
In all patients, the SOR of SARS-CoV-2 reinfection was 0.89 (95% confidence interval [CI], 0.82 to 0.95), and the severity was lower than in the first infection. Patients who had been vaccinated within 91 days showed a more attenuated SOR (0.85; 95% CI, 0.74 to 0.98). However, despite vaccination, in patients with both primary and secondary infections caused by the Omicron variant, the severity was reduced to a lesser extent than in patients primarily infected with other variants.
CONCLUSIONS
We could make efforts to relieve the severity of COVID-19 in vulnerable populations, in which death is more likely, by recommending booster vaccinations in case of a resurgence.; Summary

Korean summary

Key Message

Original Article

The associations of tobacco use, sexually transmitted infections, HPV vaccination, and screening with the global incidence of cervical cancer: an ecological time series modeling study: Luyan Zheng, Yushi Lin, Jie Wu, Min Zheng; Epidemiol Health. 2023;45:e2023005. Published online December 13, 2022; DOI: https://doi.org/10.4178/epih.e2023005

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Abstract PDF: Abstract
OBJECTIVES
We aimed to quantify the temporal associations between cervical cancer incidence and cervical cancer-related factors and to predict the number of new cervical cancer cases averted under counterfactual scenarios compared to the status quo scenario.
METHODS
We described temporal trends in cervical cancer and associated factors globally from 1990 to 2019. We then used generalized linear mixed models to explore the impact of tobacco use, sexually transmitted infections (STIs), human papillomavirus (HPV) vaccination, and cervical screening on cervical cancer incidence. A counterfactual analysis was performed to simulate the most effective scenario for reducing cervical cancer incidence.
RESULTS
The worldwide incidence of cervical cancer showed a downward trend over the past 3 decades (estimated annual percentage change, -0.72%), although the incidence remained high (>30 cases per 100,000 persons) in sub-Saharan Africa, Latin America, and the Caribbean. Higher smoking and STI prevalence showed significant direct associations with the incidence of cervical cancer, whereas HPV vaccination and screening coverage showed significant inverse associations. If the strategic goals for accelerating the elimination of cervical cancer and tobacco control programs had been achieved in 2019, the largest decrease in the number of new cervical cancer cases would have been observed, with 54,169 fewer new cases of cervical cancer in 2019.
CONCLUSIONS
Our counterfactual analysis found that a comprehensive intervention program emphasizing scaled-up cervical screening coverage (70%), HPV vaccination coverage (90%), and tobacco control (30% relative reduction) would be the most effective program for reducing cervical cancer incidence.; Summary

Korean summary

Key Message

Original article

Parental concerns on COVID-19 vaccine safety and hesitancy in Korea: Implications for vaccine communication: Hye-Kyung Cho, Hyunju Lee, Young June Choe, Shinkyeong Kim, Sujin Seo, Jiwon Moon, Eun Hwa Choi, Geun-Yong Kwon, Jee Yeon Shin, Sang-Yoon Choi, Mi Jin Jeong, Myoungsoon You; Epidemiol Health. 2022;e2023004. Published online December 13, 2022; DOI: https://doi.org/10.4178/epih.e2023004 [Accepted]

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Abstract PDF: Abstract
Objectives
Vaccination is one of the most important strategies to contain the spread of COVID-19. As vaccination in children is dependent on parents, it is important to understand parents’ awareness and attitudes toward vaccines in order to devise strategies to raise vaccination rates in children.
Methods
A web-based nationwide survey was conducted among Korean parents of 7–18- year-old children in August 2021 to estimate parents’ intention to vaccinate their children against COVID-19 and identify key factors affecting parental acceptance and hesitancy using regression analysis.
Results
Approximately 56.4% (575/1,019) were willing to vaccinate their children against COVID-19. Contributing factors to COVID-19 vaccine hesitancy were mothers (aOR 0.36, 95% CI 0.25–0.52), parents with lower education (aOR 0.83, 95% CI 0.70–0.97), hesitancy to other childhood vaccines (aOR 0.78, 95% CI 0.64–0.96), and refusal to vaccinate themselves (aOR 0.08, 95% CI 0.02–0.20). Children of older age (aOR 1.2, 95% CI 1.13–1.28), trust to child’s doctor (aOR 1.19, 95% CI 1.07–1.32),parents who showed positive perception about the effectiveness of the COVID-19 (aOR 2.6, 95% CI 1.9–3.57), and those who reported low risk of COVID-19 vaccine (aOR 1.68, 95% CI 1.27–2.24) were associated with COVID-19 vaccine acceptance. The most common cause of hesitancy was a concern about experiencing adverse reactions.
Conclusions
Providing parents with accurate and reliable information on vaccine effectiveness and safety is important to increase uptake of COVID-19 vaccine in children. Differential or targeted approaches to parents according to gender, age and age of children are necessary for effective communication on the vaccination in children.; Summary

Korean summary

Key Message

Original Article

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

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
In April 2000, a series of wildfires occurred simultaneously in five adjacent small cities located on the eastern coast of Korea. These wildfires burned approximately 23,794 hectares of forestland over several days. We investigated the effects of prenatal exposure to the by-products generated by wildfire disasters on birth weight.
METHODS
Birth weight data were obtained for 1999-2001 from the birth registration database of the Korean National Statistical Office and matched with the zip code and exposed/unexposed pregnancy week for days of the wildfires. Generalized linear models were then used to assess the associations between birth weight and exposure to wildfires after adjusting for fetal sex, gestational age, parity, maternal age, maternal education, paternal education, and average exposed atmospheric temperature.
RESULTS
Compared with unexposed pregnancies before and after the wildfires, mean birth weight decreased by 41.4 g (95% confidence interval [CI], -72.4 to -10.4) after wildfire exposure during the first trimester, 23.2 g (95% CI, -59.3 to 13.0) for exposure during the second trimester, and 27.0 g (95% CI, -63.8 to 9.8) during the third trimester. In the adjusted model for infants exposed in utero during any trimester, the mean birth weight decreased by 32.5 g (95% CI, -53.2 to -11.7).
CONCLUSIONS
We observed a 1% reduction in birth weight after wildfire exposure. Thus, exposure to by-products generated during a wildfire disaster during pregnancy may slow fetal growth and cause developmental delays.; Summary

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

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

Original article

Evaluation of the accessibility and its equity of the national public-private mix (PPM) program for tuberculosis in South Korea: a multilevel analysis: Hyunjin Son, Changhoon Kim; Epidemiol Health. 2022;e2023002. Published online December 7, 2022; DOI: https://doi.org/10.4178/epih.e2023002 [Accepted]

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Abstract PDF: Abstract
Objectives
To examine the effect of area and individual level characteristics on the probability of getting the support for TB treatment by PPM program (PPM coverage) in the early stage of the program.
Methods
A retrospective cohort study based on the national TB notification data in South Korea. 137,865 drug-susceptible new TB patients were followed up. Odds ratios (ORs) of PPM support and PPM coverage were estimated through multilevel logistic regression and empirical Bayesian estimation according to individual, area, and cross level.
Results
The case of 0-29 years old age group, female, Korean nationality, treatment at a general hospital, and a one-time notified were higher for ORs of PPM support. Urbanicity and less deprivation showed a higher PPM coverage. Due to the cross-level interaction, PPM coverage in the urban areas (slope=-0.048, p0.001) was higher but steeper negative deprivation gradient than in rural areas (slope=-0.015, p0.001), and only negative deprivation gradient at general hospital (slope=-0.047, p0.001) according to healthcare facility. In the rural areas. PPM coverage also has a negative deprivation gradient at general hospital (slope=-0.031, p0.001) but a positive deprivation gradient at hospitals and clinics (respectively, 0.046(p0.001), 0.063(p0.001)). Nevertheless, the PPM coverage level in rural areas was generally lower than in urban areas.
Conclusions
The PPM program had created a large disparity in PPM coverage between urban-rural areas and type of healthcare facility according to deprivation. Considering the high risk of tuberculosis incidence in regions with higher deprivation, institutional improvement and program redesign is needed to improve accessibility and its equity.; Summary

Korean summary

Key Message

Original Article

Long-term association of pericardial adipose tissue with incident diabetes and prediabetes: the Coronary Artery Risk Development in Young Adults Study: Minsuk Oh, Wonhee Cho, Dong Hoon Lee, Kara M. Whitaker, Pamela J. Schreiner, James G. Terry, Joon Young Kim; Epidemiol Health. 2023;45:e2023001. Published online December 3, 2022; DOI: https://doi.org/10.4178/epih.e2023001

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Abstract Summary PDF: Abstract
OBJECTIVES
We examined whether pericardial adipose tissue (PAT) is predictive of prediabetes and type 2 diabetes over time.
METHODS
In total, 2,570 adults without prediabetes/diabetes from the Coronary Artery Risk Development in Young Adults Study were followed up over 15 years. PAT volume was measured by computed tomography scans, and the new onset of prediabetes/diabetes was examined 5 years, 10 years, and 15 years after the PAT measurements. Multivariable Cox regression models were used to examine the association between the tertile of PAT and incident prediabetes/diabetes up to 15 years later. The predictive ability of PAT (vs. waist circumference [WC], body mass index [BMI], waist-to-height ratio [WHtR]) for prediabetes/diabetes was examined by comparing the area under the receiver operating characteristic curve (AUC).
RESULTS
The highest tertile of PAT was associated with a 1.56 times (95% confidence interval [CI], 1.03 to 2.34) higher rate of diabetes than the lowest tertile; however, no association was found between the highest tertile of PAT and prediabetes in the fully adjusted models, including additional adjustment for BMI or WC. In the fully adjusted models, the AUCs of WC, BMI, WHtR, and PAT for predicting diabetes were not significantly different, whereas the AUC of WC for predicting prediabetes was higher than that of PAT.
CONCLUSIONS
PAT may be a significant predictor of hyperglycemia, but this association might depend on the effect of BMI or WC. Additional work is warranted to examine whether novel adiposity indicators can suggest advanced and optimal information to supplement the established diagnosis for prediabetes/diabetes.; Summary

Korean summary
본 연구는 심장 내 축적되는 내장지방과 5년에서 15년 뒤의 당뇨병 전조 단계 및 당뇨병의 발생률과 연관성이 있음을 제안한다. 또한, 본 연구는 심장 내 내장지방과 당뇨병 발생률의 관계는 체질량 지수 또는 허리둘레의 영향에 따라 상이할 수 있음을 제안한다.

Key Message
Pericardial adipose tissue may be a significant predictor of future hyperglycemia in adults, but this association might depend on the effect of body mass index or waist circumference.

Original article

Multimorbidity patterns by health-related quality of life status in older adults: An association rules and network analysis utilizing Korean National Health and Nutrition Examination Survey: Thi-Ngoc Tran, Sanghee Lee, Chang-Mo Oh, Hyunsoon Cho; Epidemiol Health. 2022;e2022113. Published online November 29, 2022; DOI: https://doi.org/10.4178/epih.e2022113 [Accepted]

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Abstract PDF: Abstract
Objectives
Improved life expectancy has increased the prevalence of older adults living with multimorbidity, which likely deteriorates their health-related quality of life (HRQoL). However, less is known about patterns and the relationships of multimorbidity by HRQoL status in older adults.
Methods
Individuals aged 65 or older from the Korean National Health and Nutrition Examination Survey V-VII (2010-2018) were analyzed. HRQoL was assessed by the EQ-5D questionnaire and categorized into three groups: poor, normal, and good. The impact of multimorbidity on HRQoL was evaluated using logistic regression. The patterns and inter-relationships between multimorbidities, stratified by the HRQoL groups, were analyzed using the association rule and network analysis approach.
Results
Multimorbidity status was significantly associated with poor HRQoL (3 or more diseases vs. none: aOR = 2.70, 95% CI, 2.10–3.46). Hypertension, arthritis, hyperlipidemia, and diabetes were the most prevalent diseases across all HRQoL groups. The complex interrelationships of morbidities, higher prevalence, and node strengths in all diseases were observed in the poor HRQoL group, particularly arthritis, depression, and stroke, compared to other groups (1.5~3 times higher, all p-values <.05). Apart from hypertension, arthritis and hyperlipidemia had a higher prevalence and stronger connections with other diseases in women, whereas diabetes and stroke in men with poor HRQoL.
Conclusions
Our study revealed that multimorbidity patterns were complicatedly inter-correlated disease networks in the poor HRQoL group and diversed by sex. These findings enhance the understanding of multimorbidity connections and help inform health care needs for older adults, especially those with poor HRQoL.; Summary

Korean summary

Key Message

Original Article

Mediation analysis of leisure activities on the association between cognitive function and mortality: a longitudinal study of 42,942 Chinese adults 65 years and older: Xingxing Chen, Wenfan Wu, Xian Zhang, Tingxi Long, Wenyu Zhu, Rundong Hu, Xurui Jin, Lijing L. Yan, Yao Yao; Epidemiol Health. 2022;44:e2022112. Published online November 27, 2022; DOI: https://doi.org/10.4178/epih.e2022112

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Abstract PDF: Abstract
study aimed to evaluate whether leisure activities causally mediate these associations.
METHODS
This longitudinal study included 42,246 participants aged over 65 years from the Chinese Longitudinal Healthy Longevity Survey. The Mini-Mental State Examination and a self-reported scale were used to measure cognitive status and leisure activities, respectively. We examined the associations of cognitive function and leisure activities with mortality using Cox proportional hazards models. Causal mediation analysis was used to assess whether leisure activities mediated the association between cognitive function and mortality.
RESULTS
Cognitive function and leisure activities were inversely associated with mortality. Leisure activities accounted for 28.3% (95% confidence interval [CI], 25.6 to 31.1) of the total effect of cognitive function and mortality. A higher mediated proportion (PM) was observed for physical leisure activities (PM, 20.1%; 95% CI, 18.0 to 22.3) than for social leisure activities (PM, 17.7%; 95% CI, 15.7 to 19.7). The mediating effect was higher among participants at younger ages (PM, 41.5%; 95% CI, 21.3 to 65.4), those with higher education levels (PM, 30.5%; 95% CI, 25.3 to 36.2), and residents of rural China (PM, 42.5%; 95% CI, 25.4 to 62.5).
CONCLUSIONS
Cognitive function was associated with inverse mortality. Leisure activities significantly mediated this association. Participation in leisure activities at the early stages of mild cognitive impairment could reduce the risk of mortality, which has a major impact on interventional strategies for healthy aging.; Summary

Korean summary

Key Message
Both cognitive function and leisure activities were associated with inverse mortality. Leisure activities were an important mediator of the association between cognitive function and mortality. A planned intervention for leisure activities, at an early stage of mild cognitive impairment, could promote health outcomes and optimally reduce the risk of mortality.

Original article

Trends in breast cancer screening rates among Korean women: results from the Korean National Cancer Screening Survey (KNCSS), 2005-2020: Soo Yeon Song, Yun Yeong Lee, Hye Young Shin, Bomi Park, Mina Suh, Kui Son Choi, Jae Kwan Jun; Epidemiol Health. 2022;e2022111. Published online November 24, 2022; DOI: https://doi.org/10.4178/epih.e2022111 [Accepted]

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Abstract PDF: Abstract
Objectives
Since 2002, the Korean government has provided breast cancer screening as part of the National Cancer Screening Program. This study reported the screening rate trends among Korean women from 2005 to 2020, including organized and opportunistic screening for breast cancer.
Methods
Data from the Korean National Cancer Screening Survey, an annual cross-sectional nationwide survey, was collected using a structured questionnaire between 2005 and 2020. The study population included 23,702 women aged 40–74 years with no history of cancer. We estimated the screening rate with the current recommendation of biennial mammographic screening for breast cancer. In addition, a joinpoint trend analysis was performed for breast cancer screening rates using subgroup analysis.
Results
In 2020, the breast cancer screening rate was 63.5%, which showed an annual increase of 7.72% (95% confidence interval 5.53% to 9.95%) between 2005 and 2012, followed by non-significant trends thereafter. In particular, a significant decrease in the breast cancer screening rate was observed in the subgroups aged 50–59 years old, with 12–15 years of education, and living in rural areas.
Conclusions
Although there has been substantial improve in breast cancer screening rates in Korean women, the recent trend has flattened. Therefore, efforts are continually required to find out unmet subgroups and solve barriers for uptake of breast cancer screening.; Summary

Korean summary

Key Message

COVID-19: Original Article

Cause-specific mortality in Korea during the first year of the COVID-19 pandemic: Jinwook Bahk, Kyunghee Jung-Choi; Epidemiol Health. 2022;44:e2022110. Published online November 23, 2022; DOI: https://doi.org/10.4178/epih.e2022110

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Abstract Summary PDF: Abstract
OBJECTIVES
This study aimed to examine the trends in total mortality between 1998 and 2020 and to compare the changes in a wide range of detailed causes of death between 2020 (i.e., during the coronavirus disease 2019 [COVID-19] pandemic) and the previous year in Korea.
METHODS
We used registered population and mortality data for the years 1998-2020 obtained from Statistics Korea. The age-standardized all-cause mortality rate and the annual percent change between 1998 and 2020 were determined. The rate ratio and rate difference of the age-standardized mortality rate between 2019 and 2020 were calculated.
RESULTS
The age-standardized all-cause mortality rate in Korea has been on a downward trend since 1998, and the decline continued in 2020. In 2020, 950 people died from COVID-19, accounting for 0.3% of all deaths. Mortality decreased for most causes of death; however, the number of deaths attributed to sepsis and aspiration pneumonia increased between 2019 and 2020 for both men and women. Age-specific mortality rates decreased or remained stable between 2019 and 2020 for all age groups, except women aged 25-29. This increase was mainly attributed to a higher number of suicide deaths.
CONCLUSIONS
This study shed light on the issues of sepsis and aspiration pneumonia despite the successful response to COVID-19 in Korea in 2020. Cases of death from sepsis and aspiration pneumonia should be identified and monitored. In addition, it is necessary to develop a proactive policy to address suicide among young people, especially young women.; Summary

Korean summary
1998년 이래 한국의 연령표준화 총사망률은 지속적으로 감소하였고, 이러한 경향은 코로나19 대유행 첫해인 2020년에도 관찰되었다. 대부분 사망원인별 사망률이 코로나19 대유행이후에도 감소하였으나, 패혈증 및 흡인성 폐렴으로 인한 사망자가 남성과 여성 모두에서 증가했다. 연령별 사망률에서는 25-29세 여성을 제외한 모든 연령대에서 2019년에 비해 2020년 사망률이 감소하거나 유지되었고, 25-29세 여성의 사망률 증가는 주로 자살 사망의 증가에 기인했다.

Key Message
During 1988-2020, the age-standardized all-cause mortality rate in Korea has been on a downward trend and the decline continued in 2020. In 2020, mortality decreased for most causes of death, however, the number of deaths attributed to sepsis and aspiration pneumonia increased between 2019 and 2020. Age-specific mortality rates decreased or remained stable between 2019 and 2020 for all age groups, except women aged 25-29. This was mainly attributed to increased suicide deaths.

Systematic review

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

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Firefighters are occupationally exposed to hazardous factors which may increase their risk of disease. Non-cancer disease risk in firefighters has not been systematically examined. This systematic review aimed at identifying non-cancer disease risk in firefighters and determining whether a risk difference exists according to job characteristics. We searched the Cochrane Library, Embase, PubMed, and KoreaMed databases using relevant keywords from their inception to April 30, 2021. The Risk of Bias Assessment Tool for Non-randomized Studies version 2.0 was used to assess the quality of evidence. Because of study heterogeneity, a narrative synthesis was presented. The systematic literature search yielded 2491 studies, of which 66 met the selection and quality criteria. We confirmed that the healthy worker effect is strong in firefighters as compared to the general population. We also displayed a significant increase in the incidence of lumbar disc herniation, lower back pain, angina pectoris, acute myocardial infarction, and post-traumatic stress disorder in firefighters compared to other occupational groups. Contradicting results around PTSD and anxiety disorders risks related to rank were reported. Sufficient evidence for increased risk of lumbar disc herniation, lower back pain, angina pectoris, acute myocardial infarction, and post-traumatic stress disorder was available. There was a difference in the risk of non-cancer disease depending on job type, years of service, and rank. However, caution should be exercised when interpreting the results because the classification criteria for firefighters' jobs and ranks differ by country.; Summary

Korean summary

Key Message

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