Epidemiology and Health

Systematic Review

The status quo of systematic reviews published in high-impact journals in Korea: a study focused on protocol registration and GRADE use: Mi Ah Han, Seong Jung Kim, Eu Chang Hwang, Jae Hung Jung; Epidemiol Health. 2022;44:e2022108. Published online November 15, 2022; DOI: https://doi.org/10.4178/epih.e2022108

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Abstract Summary PDF: Abstract
RegOBJECTIVES: This study investigated the status quo of systematic reviews published in major journals in Korea from the perspective of protocol registration and adopting the grading of recommendation, assessment, development and evaluation (GRADE) system.
METHODS
We examined systematic reviews published in Korea’s top 15 medical journals from 2018 to 2021. Teams of 2 reviewers assessed the studies’ eligibility criteria and extracted data independently and in duplicate. We collected information on study characteristics, protocol registration, and GRADE use of the included reviews, and reviewed the “Instructions for Authors” of the selected journals to assess any guidance related to systematic reviews.
RESULTS
Out of the 126 identified reviews, 18 (14.3%) reported that they registered or published their protocol. Only 5 (4.0%) rated the certainty of evidence; and all 5 used the GRADE system. Only 6 of 15 journals mentioned systematic reviews in their “Instructions for Authors.” Six journals endorsed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework for systematic review reporting (2 mandatory, 3 recommended, and 1 unclear). None of the journals included mentioned protocol registration or certainty of evidence in their authors’ guidelines.
CONCLUSIONS
Overall, the proportion of systematic reviews that had prior protocol registration or used the GRADE approach to rate the certainty of evidence was very low. Our study highlights the need for adherence to systematic review standards in medical journals in Korea, including prior protocol registration and certainty of evidence assessment. Our review will help improve the quality of systematic reviews in Korea.; Summary

Korean summary
한국 의학 저널에서 계획서를 사전에 등록하거나 근거의 확실성을 평가하기 위해 GRADE 접근 방식을 사용한 체계적 문헌고찰의 분율은 낮았다. 우리의 연구는 계획서 등록 및 근거의 확실성 평가를 포함하여 체계적 문헌고찰의 방법론적 표준 준수의 필요성을 강조한다.

Key Message
The proportion of systematic reviews that had prior protocol registration or used the GRADE approach to rate the certainty of evidence was very low in Korean medical journals, and our study highlights the need for adherence to systematic review standards in medical journals in Korea, including prior protocol registration and certainty of evidence assessment.

Original Articles

Effect of socioeconomic disparities on the risk of COVID-19 in 8 metropolitan cities in the Korea: a community-based study: Myung-Jae Hwang, Shin Young Park, Tae-Ho Yoon, Jinhwa Jang, Seon-Young Lee, Myeongsu Yoo, Yoo-Yeon Kim, Hae-Kwan Cheong, Donghyok Kwon, Jong-Hun Kim; Epidemiol Health. 2022;44:e2022107. Published online November 15, 2022; DOI: https://doi.org/10.4178/epih.e2022107

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Abstract PDF

Abstract

OBJECTIVES
Socioeconomic disparities have been reported as major risk factors contributing to the spread of coronavirus disease 2019 (COVID-19) at the community level. We conducted an epidemiological study on COVID-19 incidence risk using area-based deprivation indices (DIs) reflecting the characteristics of the susceptible population.

METHODS

A database of the confirmed COVID-19 cases in 8 metropolitan cities in Korea from January 20, 2020 to December 31, 2021 was combined with area-based DI scores and standardized prevalence rates of diabetes and hypertension from the Korean Community Health Survey. Relative risk (RR) levels were estimated using a generalized linear model with a Poisson distribution by age group.

RESULTS

The risk of COVID-19 incidence generally increased with increasing age, especially in patients aged ≥75 years. The RR of COVID-19 incidence per interquartile range increment of the composite deprivation index (composite DI) was 1.54 (95% confidence interval [CI], 1.34 to 1.70). Notably, in the first wave, the risk of COVID-19 incidence was approximately 3 times higher in the region with the lowest socioeconomic status than in the region with the highest status (RR, 3.08; 95% CI, 2.42 to 3.78 based on the the composite DI and RR, 3.13; 95% CI, 2.53 to 3.83 based on the social deprivation index).

CONCLUSIONS

This study provides scientific evidence that socioeconomic deprivation is an important risk factor for the spread of COVID-19. This finding suggests that a mid-term to long-term strategy is needed to protect susceptible populations and reduce the burden of COVID-19 in the community.

Summary

Korean summary

Key Message

Citations

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The current state of graphical abstracts and how to create good graphical abstracts
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Science Editing.2023; 10(1): 19. CrossRef

Perceived usefulness of COVID-19 tools for contact tracing among contact tracers in Korea: Seonyeong Gong, Jong Youn Moon, Jaehun Jung; Epidemiol Health. 2022;44:e2022106. Published online November 15, 2022; DOI: https://doi.org/10.4178/epih.e2022106

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Abstract PDF: Abstract
OBJECTIVES
In Korea, contact tracing for coronavirus disease 2019 is conducted using information from credit card records, handwritten visitor logs, KI-Pass (QR code), and the Safe Call system after an interview. We investigated the usefulness of these tools for contact tracing.
METHODS
An anonymous survey was conducted for 2 months (July to September 2021) among contact tracers throughout Korea. The questionnaire consisted of 4 parts: (1) demographic characteristics; (2) the usefulness of each tool for contact tracing; (3) the order in which information was checked during contact tracing; and (4) the match rate between tools for contact tracing, screening test rate, response rate, and helpfulness (rated on a Likert scale).
RESULTS
In total, 190 individuals completed the survey. When asked to rate the usefulness of each tool for contact tracing on a Likert scale, most respondents (86.3%) provided positive responses for credit card records, while the most common responses for handwritten visitor logs were negative. The highest percentage of positive responses for helpfulness was found for KI-Pass (91.1%), followed in descending order by credit card records (82.6%), Safe Call (78.2%), and handwritten visitor logs (22.1%).
CONCLUSIONS
Over 80% of participants provided positive responses for credit card records, KI-Pass, and Safe Call data, while approximately 50% provided negative responses regarding the usefulness of handwritten visitor logs. Our findings highlight the need to unify systems for post-interview contact tracing to increase their convenience for contact tracers, as well as the need to improve tools utilizing handwritten visitor logs for digitally vulnerable groups.; Summary

Korean summary

Key Message

Epidemiologic Investigation

An outbreak of neurologic symptoms among patients exposed to an unknown stench in a high school near an industrial complex: an epidemiological investigation: Kiook Baek, Seongmin Jo, Chulyong Park, Joon Sakong; Epidemiol Health. 2022;44:e2022105. Published online November 9, 2022; DOI: https://doi.org/10.4178/epih.e2022105

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Abstract Summary PDF: Abstract
OBJECTIVES
Seven students at a high school in Korea visited the emergency room with non-specific neurological symptoms after a stench was noticed during a school entrance ceremony. In relation to this incident, 105 patients visited medical institutions over 5 days. A team of environmental and epidemiological experts was assembled to investigate the incident.
METHODS
Our team of experts participated in the investigation 1 month post-incident. Previously, only air samples had been analyzed. We received results of air samples analyzed by other investigators, medical records of some students, and data from police interviews of patients. Additional investigation and interviews were conducted, and the events were reconstructed in spatial and temporal order.
RESULTS
A cluster of patients was observed on the south side and parts of the north side of the upper floor. A stench like that reported during the incident had been noticed for about 2 years near the school. Students consistently described a similar stench occurring frequently in the vicinity of the school. According to student statements, the odor mainly resembled something burning. The carboxyhemoglobin levels of some students were observed to be >1.5%.
CONCLUSIONS
In the investigation, 2 suspected sources were identified: a science room storing chemicals downstairs from the auditorium and various industrial facilities near the school. Combining the scattered evidence, we considered a toxic puff of gas, perhaps from brief incineration or leakage in a specific area, to be the likely cause of the incident. We describe our approach and the limitations encountered during the investigation.; Summary

Korean summary
본 논문은 일개 고등학교에서 원인미상의 악취와 함께 100명 이상의 환자가 발생한 사건에 대한 조사과정을 담은 문헌이다. 본 연구진은 사건 발생 후 약 1달 후에 조사진에 합류하였으며, 발생 당시 환자 분포 점지도 작성, 인근 지역 사업장 및 악취발생 장소 점지도 작성, 사건 전후 시계열적 사건분석, 기상자료, 관계자 인터뷰 자료 분석 등의 역학적 기법을 동원하여 원인을 인근 지역에서 발생한 퍼프 가스의 유입으로 추정하였다. 본 사건의 원인은 결국 미제로 종결되었지만 추후 유사 사례 발생시 본 조사의 방법론을 참고할 수 있을 것이며, 의료진의 조기 개입을 수행하지 못함으로 인한 초기 상세 인터뷰 자료 확보, 생체 시료 수집 등이 이루어지지 못한 본 조사 과정의 한계점을 반면교사로 삼을 수 있을 것이다.

Key Message
This paper presents an investigation of an outbreak of over 100 patients experiencing an unexplained odor in a high school. The research team utilized epidemiological methods, including dot mapping, temporal analysis of events, and interview data analysis. The source of the odor was estimated to be the inflow of puff gas from surrounding areas. Although the toxic puff gas discharge facility was not identified, sharing the experience from this investigation could help with future investigations of similar incidents.

COVID-19: Original Article

Changes in eating behaviors according to household income in adolescents during the COVID-19 pandemic: findings from the Korea National Health and Nutrition Examination Survey: Hye Ah Lee, Ho Jung Lee, Bomi Park, Yoonhee Shin, Hyunjin Park, Hyesook Park; Epidemiol Health. 2022;44:e2022102. Published online November 9, 2022; DOI: https://doi.org/10.4178/epih.e2022102

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OBJECTIVES
To assess social inequalities in changes in dietary behaviors among adolescents during the coronavirus disease 2019 (COVID-19) pandemic, we compared changes in dietary behavior indicators by household income.
METHODS
Using cross-sectional data from the 2019 and 2020 Korea National Health and Nutrition Examination Survey, the prevalence of dietary behaviors in adolescents (12-18 years old) was estimated and changes in dietary behaviors during the COVID-19 pandemic were evaluated. We assessed changes in dietary behaviors with a household income (as a measure of socioeconomic status, SES) disparity.
RESULTS
During the COVID-19 pandemic, the average consumption of vegetables decreased and food insecurity worsened. Adolescents were more likely to skip breakfast than before COVID-19 (33.1 and 37.4%). Soft drink consumption also increased in 2020 from 2019 (7.6 and 14.8%), especially among boys. Average sugar intake and sodium intake showed a tendency to decrease only in girls, but there was no significant difference according to SES level. Skipping breakfast was particularly evident in the low-SES group, and the difference according to household income level (high vs. low) was greater during COVID-19 than before. The prevalence of soft drink consumption increased significantly in the low-SES group, but the rate of increase did not differ by SES level.
CONCLUSIONS
We found that the social disparity in skipping breakfast was further aggravated during the COVID-19 pandemic. To reach a better understanding of the dietary behaviors of adolescents, continuous monitoring is necessary.; Summary

Korean summary
국민건강영양조사 자료를 활용하여, COVID-19 팬데믹 전후 청소년의 식생활 변화 및 가구소득 수준에 따른 차이를 평가하였다. 대체로, 평균 채소 섭취량은 감소하고 탄산음료 소비는 증가한 것으로 나타났으며, 아침식사 결식율도 약간 증가한 것으로 나타났다. 게다가, 가구소득 수준에 따라 평가하였을 때, 아침식사 결식율 증가는 가구소득이 높은 군에 비해 가구소득 수준이 낮은 군에서 두드러진 것으로 나타났다. COVID-19 팬데믹이 장기화됨에 따라, 청소년의 식생활 변화에 대해서는 지속적인 모니터링이 필요하다.

Key Message
Using data from the 2019 and 2020 Korea National Health and Nutrition Examination Survey, changes in dietary behaviors of adolescents (12-18 years old) during the COVID-19 pandemic were evaluated. During the COVID-19 pandemic, average consumption of vegetables decreased and consumption of soft drinks increased in 2020 from 2019 (7.6% and 14.8%). In addition, the social disparity in skipping breakfast among adolescents was further aggravated. To reach a better understanding of the dietary behaviors of adolescents, continuous monitoring is necessary.

Original Articles

Long working hours and the risk of hypothyroidism in healthy Korean workers: a cohort study: Yesung Lee, Woncheol Lee, Hyoung-Ryoul Kim; Epidemiol Health. 2022;44:e2022104. Published online November 8, 2022; DOI: https://doi.org/10.4178/epih.e2022104

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Abstract Summary PDF: Abstract
OBJECTIVES
Long working hours have been reported to cause various health problems, but are currently practiced in many countries. Building upon a previous cross-sectional study, the authors aimed to elucidate the causal relationship between long working hours and hypothyroidism through a longitudinal study.
METHODS
Data were collected at baseline from 45,259 participants without thyroid disease and with consistent weekly working hours (36-40, 41-52, 53-60, and >60 hours) during the follow-up period. Hypothyroidism was defined using the reference limits of serum thyroid-stimulating hormone and free thyroxine levels. By estimating hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazards regression analysis, the risk of incident hypothyroidism was evaluated with 36-40 hours of work per week as the reference.
RESULTS
During 138,261.7 person-years of follow-up, 2,914 participants developed hypothyroidism (incidence density, 2.11/102 person-years). The multivariable-adjusted HRs of incident hypothyroidism for 41-52 hours, 53-60 hours, and >60 hours of work per week were 1.13 (95% CI, 1.03 to 1.24), 2.53 (95% CI, 2.17 to 2.95), and 2.57 (95% CI, 2.09 to 3.15), respectively. In dose-response analyses, long working hours had an approximately linear relationship with hypothyroidism incidence. The risk of incident hypothyroidism in those who worked 53-60 hours and >60 hours per week compared with the reference group was significantly higher among the older age group (≥36 years, stratified by median age), men, and daytime workers.
CONCLUSIONS
This large-scale cohort study demonstrated the association between long working hours and an increased risk of incident hypothyroidism with a dose-response relationship.; Summary

Korean summary
대규모 코호트연구를 통해 장시간노동을 수행한 노동자들에서 갑상선기능저하증의 위험이 높아지는 것을 확인할 수 있었다. 특히 연령, 성, 교대근무 유무에 따라 층화하여 분석한 결과에서 고연령, 남성, 교대근무를 하지 않는 노동자에서 관련성의 크기가 증가하였다.

Key Message
This large-scale cohort study (The Kangbuk Samsung Health Study), which used 45,259 participants without thyroid disease at baseline and estimated hazard ratios (HRs) using Cox proportional hazards regression analysis, demonstrated the association between long working hours and an increased risk of incident hypothyroidism with a dose-response relationship especially in older age group, men, and daytime workers.

Smokeless tobacco consumption and its association with tobacco control factors in the Western Pacific Region: results from the Global Youth Tobacco Survey 2015-2019: Chandrashekhar T. Sreeramareddy, Anusha Manoharan; Epidemiol Health. 2022;44:e2022103. Published online November 8, 2022; DOI: https://doi.org/10.4178/epih.e2022103

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Abstract PDF: Abstract
OBJECTIVES
We estimated the prevalence of smokeless tobacco (ST) consumption and its associations with tobacco control factors among school-going youth in 18 Western Pacific Region (WPR) countries.
METHODS
We analyzed school-based Global Youth Tobacco Survey (2014-2019) microdata from 18 WPR countries and estimated weighted prevalence rates of ST consumption, cigarette smoking, and dual use. We used multilevel binary logistic regression to examine the associations of ST consumption and dual use with demographic variables, exposure to pro-tobacco and anti-tobacco factors, national income, and MPOWER indicators.
RESULTS
Data from 58,263 school-going youth were analyzed. The prevalence of past 30-day ST consumption was highest in Kiribati (42.1%), the Marshall Islands (26.1%), Micronesia (21.3%), Palau (16.0%), and Papua New Guinea (15.2%). In adjusted multilevel models, ST consumption and dual use were significantly associated with sex, age, parental smoking, pro-tobacco factors, national income, and MPOWER score. For each unit increase in score for cessation programs, we observed approximately 1.4-fold increases in the odds of youth ST consumption (adjusted odds ratio [aOR], 1.38; 95% confidence interval [CI], 1.15 to 1.66) and dual use (aOR, 1.47; 95% CI, 1.16 to 1.86). Similarly, for each unit increase in score for health-related warnings, the odds of both ST consumption (aOR, 0.47; 95% CI, 0.42 to 0.53) and dual use (aOR, 0.35; 95% CI, 0.30 to 0.42) decreased by approximately 60%.
CONCLUSIONS
The prevalence of youth ST consumption was substantial in the Pacific Islands, exceeding that of cigarette smoking in some countries. Implementing MPOWER measures for ST products could help reduce ST consumption.; Summary

Korean summary

Key Message

Changes in the prevalence of metabolic syndrome in Korean adults after the COVID-19 outbreak: Ji-Young Kwon, Sang-Wook Song; Epidemiol Health. 2022;44:e2022101. Published online November 5, 2022; DOI: https://doi.org/10.4178/epih.e2022101

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OBJECTIVES
This study sought to reveal changes in the prevalence of metabolic syndrome (MetS) after the start of the coronavirus disease 2019 (COVID-19) pandemic and to identify the groups showing the greatest changes.
METHODS
We compared the prevalence of MetS between 2017–2019 (i.e., the 3-year period before the COVID-19 pandemic) and soon after the initial outbreak of COVID-19 in 2020 among 24,564 adults ≥ 19 years of age using data from the Korea National Health and Nutrition Examination Survey.
RESULTS
The prevalence of MetS increased steadily between 2017 and 2020 (29.4 to 35.3%, p for trend < 0.001), with annual percent changes of 2.0%p, 2.2%p, and 1.7%p, respectively. Compared to 3 years before the COVID-19 pandemic, the prevalence of MetS significantly increased during the COVID-19 pandemic in males (6.2%p; 95% confidence interval [CI], 3.5 to 8.9) compared to females (1.5%p; 95% CI, -1.2 to 4.1). The age groups with the greatest increases in MetS prevalence after the COVID-19 pandemic were those in their 40s (4.6%p; 95% CI, 0.9 to 8.4) and 50s (5.8%p; 95% CI, 2.2 to 9.4). By educational background, the increase in MetS prevalence was greatest among those with a college degree or higher (5.1%p). The prevalence of MetS in high-income (5.3%p) and low-income (4.6%p) groups significantly increased.
CONCLUSIONS
The increasing trend in the overall prevalence of MetS continued during the COVID-19 pandemic. In particular, the prevalence of MetS among adult males in their 40s and 50s increased significantly after the COVID-19 outbreak in Korea.; Summary

Korean summary

Key Message

Maternal pre-pregnancy anemia and childhood anemia in Indonesia: a risk assessment using a population-based prospective longitudinal study: Fadila Wirawan, Dieta Nurrika; Epidemiol Health. 2022;44:e2022100. Published online November 1, 2022; DOI: https://doi.org/10.4178/epih.e2022100

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OBJECTIVES
Anemia in children under 5 years of age is often overlooked despite its detrimental effects. The public health approach to anemia prevention includes the maternal pre-pregnancy phase. This study investigated the association between pre-pregnancy anemia and the risk of anemia in children under 5 years of age.
METHODS
This cohort study included non-pregnant women from the 2007 Indonesian Family Life Survey (IFLS) and their children under 5 in the 2014 IFLS. The anemia status of mothers and children was determined based on hemoglobin (Hb) levels using Hemocue. Mantel-Haenszel adjusted relative risks (aRRs), including risk stratification by covariates, were used for the final risk assessment.
RESULTS
In total, 637 children in the 2014 IFLS were included. The risk of having a child with anemia was 1.71-fold higher in women with pre-pregnancy anemia than in women without pre-pregnancy anemia (aRR, 1.71; 95% confidence interval [CI], 1.03 to 2.85). After risk stratification based on potential confounding variables, maternal pre-pregnancy anemia remained an independent risk factor for anemia in children who still breastfed at the time of data collection (relative risk [RR], 2.11; 95% CI, 1.16 to 3.86), in children who were given water earlier than 6 months of age (RR, 2.08; 95% CI, 1.20 to 3.61), in children of mothers with a normal or underweight pre-pregnancy body mass index (RR, 1.94; 95% CI, 1.20 to 3.14), and in children of mothers without current anemia (RR, 2.20; 95% CI, 1.21 to 3.99).
CONCLUSIONS
Pre-pregnancy anemia increased the risk of childhood anemia. A public health approach emphasizing pre-conception maternal health would enable better maternal and child morbidity risk prevention.; Summary

Korean summary

Key Message
Pre-pregnancy anemia increased the risk of childhood anemia by 1.7 times compared to without pre-pregnancy anemia, and increased when the child was still breastfed, given water before 6 months of age, and the mother had a normal or underweight pre-pregnancy BMI, regardless of the mother’s current no anemia status.

Aspergillus sensitization associated with current asthma in children in the United States: an analysis of data from the 2005-2006 NHANES: Hui-Ju Wen, Shu-Li Wang, Ming-Chieh Li, Yue Leon Guo; Epidemiol Health. 2022;44:e2022099. Published online October 28, 2022; DOI: https://doi.org/10.4178/epih.e2022099

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Abstract PDF: Abstract
OBJECTIVES
This study investigated the association between allergen sensitization and current asthma in children in the United States using data from the 2005-2006 National Health and Nutrition Examination Survey (NHANES).
METHODS
Children who participated in the 2005–2006 NHANES, aged 6 years to 19 years, were included in this study. A structured questionnaire was used to assess asthma status (without asthma, asthma in remission, or current asthma). Nineteen specific immunoglobulin E (sIgE) levels were measured using the Pharmacia Diagnostics ImmunoCAP 1000 System (Kalamazoo, MI, USA). A machine-learning method was applied to select important sIgEs related to childhood asthma. Multivariate regression analysis was used to test this hypothesis.
RESULTS
In total, 2,875 children were recruited. The prevalence of ever having asthma and current asthma was 16.5% and 5.6%, respectively. Six sIgE levels were found to contribute to asthma using bootstrap forest selection. After adjusting for the child’s sex, age, and family income, children with double the sIgE levels of Dermatophagoides farinae, dogs, and Aspergillus were more likely to have current asthma than children without asthma (odds ratio [95% confident interval]: 1.11 [1.04 to 1.19], 1.30 [1.16 to 1.46], and 1.55 [1.39 to 1.72], respectively).
CONCLUSIONS
Our findings suggest that allergen sensitization, especially to Aspergillus, is associated with current asthma in children. Strategies to reduce sensitization may help prevent and manage asthma.; Summary

Korean summary

Key Message

Original article

Nationwide trends in incidence of tuberculosis among people with disabilities in South Korea: a nationwide serial cross-sectional study: Min Jinsoo, Kim So Young, Park Jong Eun, Kim Yeon Yong, Park Jong-Hyock; Epidemiol Health. 2022;e2022098. Published online October 28, 2022; DOI: https://doi.org/10.4178/epih.e2022098 [Accepted]

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Abstract PDF: Abstract
Objectives
Studies on the association between disability and tuberculosis (TB) are scarce. We aimed to assess the risk of active TB disease among people with disabilities.
Methods
We conducted a nationwide serial cross-sectional study using national registry linkage databases from 2008 to 2017. The crude and age, sex-standardized incidence rates of TB were analyzed for each year according to the presence, type, and severity of disabilities. The crude incidence rate and odds of developing TB disease were examined by a multivariable logistic regression model using data in 2017.
Results
The overall incidence of active TB decreased between 2008 and 2017. Age, sex-standardized incidence rates of TB disease among people with disabilities were significantly higher than among those without disabilities throughout all observed years (P < 0.001). As of 2017, the population with disabilities had a higher crude incidence rate of active TB disease than that without disability (119.9/100,000 vs. 48.5/100,000 person-years, P < 0.001), regardless of sex, income level, and place of residence. Compared to those without disability, those with disabilities had higher odds of active TB (adjusted odds ratio [aOR], 1.19; 95% confidence interval [CI], 1.15–1.24). Mental disability (aOR, 1.51; 95% CI, 1.24–1.84) had the highest odds of active TB incidence, followed by developmental disability (aOR, 1.30; 95% CI, 1.09–1.55).
Conclusions
People with disabilities are at a greater risk of developing TB disease. Active screening and care for TB cases would be beneficial for people with disabilities.; Summary

Korean summary

Key Message

Systematic review

The prevalence of Q fever in the Eastern Mediterranean region: a systematic review and meta-analysis: Mozhgan Ahmadinezhad, leila mounesan, Amin Doostiirani, Manijeh Yousefi Behzadi; Epidemiol Health. 2022;e2022097. Published online October 28, 2022; DOI: https://doi.org/10.4178/epih.e2022097 [Accepted]

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Abstract PDF: Abstract
Objectives
Q fever is a main zoonotic disease around the world. This disease is common in the eastern mediterranean region, so we conducted for the first time a systematic review and meta-analysis between humans and animals and ticks in the Eastern Mediterranean region.
Methods
Major national and international databases were searched from 2000 up to 2021. We extracted the prevalence of Q fever in blood sample in animal, milk sample in animal, tick and human as the main outcome. We reported the prevalence of the seropositivity as point and 95% confidence intervals.
Results
In this review, 112 papers were identified. The overall seroprevalence Q fever was 23.42 (95% CI 20.3–26.21).The pooled seroprevalence of Q fever in tick was 42.44% ( 95% CI: 21.13- 63.75%). The prevalence was 25.54%( 95% CI: 16.15-34.92%) in human. The prevalence of Q fever in animal blood samples such as goat, sheep, camel, cattle, dog, cat, buffalo and horse were 28.05%, 25.10%, 25.04%, 19.52 %, 8.45%, 9.80%, 6.33%, 6.51% respectively. Also, the prevalence of Q fever in milk samples of animals was higher in cattle 21.41% than sheep 18.69% and goat 13.85% and camel 3.38%.
Conclusions
Coxiella burnetii infections are common in human and in a wide range of animal populations but they are still not recognized in many countries in the eastern mediterranean region, thus presenting a significant threat to human and animal health in the region.; Summary

Korean summary

Key Message

Original Article

Item non-response imputation in the Korea National Health and Nutrition Examination Survey: Serhim Son, Hyemi Moon, Hyonggin An; Epidemiol Health. 2022;44:e2022096. Published online October 28, 2022; DOI: https://doi.org/10.4178/epih.e2022096

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Abstract PDF: Abstract
OBJECTIVES
The Korea National Health and Nutrition Examination Survey (KNHANES) is a public health survey that assesses individuals’ health and nutritional status and monitors the prevalence of major chronic diseases. In general, sampling weights are adjusted for unit non-responses and imputation is conducted for item non-responses. In this study, we proposed strategies for imputing item non-responses in the KNHANES in order to improve the usefulness of data, minimize bias, and increase statistical power.
METHODS
After applying logical imputation, we adopted 2 separate imputation methods for each variable type: unweighted sequential hot-deck imputation for categorical variables and sequential regression imputation for continuous variables. For variance estimation, multiple imputations were applied to the continuous variables. To evaluate the performance of the proposed strategies, we compared the marginal distributions of imputed variables and the results of multivariable regression analysis for the complete-case data and the expanded data with imputed values, respectively.
RESULTS
When comparing the marginal distributions, most non-responses were imputed. The multivariable regression coefficients presented similar estimates; however, the standard errors decreased, resulting in statistically significant p-values. The proposed imputation strategies may cope with the loss of precision due to missing data, thus enhancing statistical power in analyses of the KNHANES by providing expanded data with imputed values.
CONCLUSIONS
The proposed imputation strategy may enhance the utility of data by increasing the number of complete cases and reducing the bias in the analysis, thus laying a foundation to cope with the occurrence of item non-responses in further surveys.; Summary

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Original article

Health-adjusted life expectancy according to lifestyle classified by the Yonsei Lifestyle Profile-BREF: Sanghun Nam, Kang Hyun Park, Ji Hyuk Park, Ickpyo Hong; Epidemiol Health. 2022;e2022095. Published online October 28, 2022; DOI: https://doi.org/10.4178/epih.e2022095 [Accepted]

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Abstract PDF: Abstract
Objectives
This study aimed to investigate health-adjusted life expectancy (HALE) by demographic characteristics (sex, educational achievement, and residential area) according to the lifestyle classifications of the Yonsei Lifestyle Profile-BREF.
Methods
This study included 569 participants aged 55 years or older living in South Korea. The YLP-BRFE domains were physical activity, activity participation, and nutrition.
Results
Although females had higher HALE (mean=8.90 years, standard deviation (SD)=5.06) in physical activity. Males were more elevated in nutrition (mean=9.44 years, SD=5.91). People living in rural areas had higher HALE in physical activity (mean=12.02 years, SD=5.60), activity participation (mean=8.58 years, SD=4.21), and nutrition (mean=11.33 years, SD=6.43). There was no significant difference between the sexes and residential areas. High school graduates showed the highest HALE (physical activity: mean=10.38 years, SD=6.89, activity participation: mean=7.64 years, SD=4.29, nutrition: mean=9.59 years, SD=6.40). There was a significant difference in educational achievement.
Conclusions
As people age, the demand for a healthy lifestyle increases. This study attempted to calculate HALE by demographic characteristics according to lifestyle. The results of this study are considered helpful for future research directions for providing a healthy lifestyle.; Summary

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Original Article

Effect of mammography screening on the long-term survival of breast cancer patients: results from the National Cancer Screening Program in Korea: Xuan Quy Luu, Kyeongmin Lee, Jae Kwan Jun, Mina Suh, Kyu-Won Jung, Kui Son Choi; Epidemiol Health. 2022;44:e2022094. Published online October 26, 2022; DOI: https://doi.org/10.4178/epih.e2022094

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Abstract PDF Supplementary Material: Abstract
OBJECTIVES
This study investigated the effect of mammography screening on the long-term survival of breast cancer (BC) patients aged 40 years or older according to their screening history and duration since screening.
METHODS
The study cohort was organized from 3 nationwide databases of the Korean National Cancer Screening Program, the Korean Central Cancer Registry, and death certificates. We included 24,387 women diagnosed with invasive BC or ductal carcinoma in situ in 2008 and 2009 and followed up until December 31, 2019. Cox proportional-hazards regression was used to investigate the effect of BC screening on the risk of death.
RESULTS
Overall, 20,916 of 24,387 patients (85.8%) were alive at the end of the follow-up period (median: 10.5 years). The long-term survival rate was significantly lower in the never-screened group (80.3%) than in the screened group (88.9%) (p<0.001). A 35% reduction in the risk of BC death (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.60 to 0.70) from screening was observed. A subgroup analysis according to the cancer stage showed 62%, 36%, and 24% lower risks of BC death for the localized stage, regional stage, and distant stage, respectively. Women aged 40-49 years received the least benefit from BC screening (HR, 0.71; 95% CI, 0.62 to 0.81).
CONCLUSIONS
Mammography screening was effective in reducing the risk of BC-specific death in Asian women across all cancer stages. However, this effect was relatively small among women in their 40s, suggesting that more detailed and specialized screening strategies are needed for that age group.; Summary

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