OBJECTIVES: We conducted a comorbidity network analysis using data from the seventh Korea National Health and Nutrition Examination Survey to systematically quantify obesity-related comorbidities. METHODS: The study included 11,712 subjects aged 45 to 80 (5,075 male and 6,637 female). A prevalent disease was defined as a specific disease for which a subject had been diagnosed by a doctor and was being treated. Comorbidity network analysis was performed for diseases with a prevalence of 1% or more, including overweight and obesity. We estimated the observed-to-expected ratio of all possible disease pairs with comorbidity strength and visualized the network of obesity-related comorbidities. RESULTS: In subjects over 45 years old, 37.3% of people had a body mass index over 25.0 kg/m2. The most common prevalent disease was hypertension (42.3%), followed by dyslipidemia (17.4%) and diabetes (17.0%). Overweight and obese subjects were 2.1 times (95% confidence interval, 1.9 to 2.3) more likely to have a comorbidity (i.e., 2 or more diseases) than normal-weight subjects. Metabolic diseases such as hypertension, dyslipidemia, diabetes, and osteoarthritis were directly associated with overweight and obesity. The probability of coexistence for each of those 4 diseases was 1.3 times higher than expected. In addition, hypertension and dyslipidemia frequently coexisted in overweight and obese female along with other diseases. In obese male, dyslipidemia and diabetes were the major diseases in the comorbidity network. CONCLUSIONS Our results provide evidence justifying the management of metabolic components in obese individuals. In addition, our results will help prioritize interventions for comorbidity reduction as a public health goal.

OBJECTIVES: We conducted a comorbidity network analysis using data from the seventh Korea National Health and Nutrition Examination Survey to systematically quantify obesity-related comorbidities. METHODS: The study included 11,712 subjects aged 45 to 80 (5,075 male and 6,637 female). A prevalent disease was defined as a specific disease for which a subject had been diagnosed by a doctor and was being treated. Comorbidity network analysis was performed for diseases with a prevalence of 1% or more, including overweight and obesity. We estimated the observed-to-expected ratio of all possible disease pairs with comorbidity strength and visualized the network of obesity-related comorbidities. RESULTS: In subjects over 45 years old, 37.3% of people had a body mass index over 25.0 kg/m2. The most common prevalent disease was hypertension (42.3%), followed by dyslipidemia (17.4%) and diabetes (17.0%). Overweight and obese subjects were 2.1 times (95% confidence interval, 1.9 to 2.3) more likely to have a comorbidity (i.e., 2 or more diseases) than normal-weight subjects. Metabolic diseases such as hypertension, dyslipidemia, diabetes, and osteoarthritis were directly associated with overweight and obesity. The probability of coexistence for each of those 4 diseases was 1.3 times higher than expected. In addition, hypertension and dyslipidemia frequently coexisted in overweight and obese female along with other diseases. In obese male, dyslipidemia and diabetes were the major diseases in the comorbidity network. CONCLUSIONS Our results provide evidence justifying the management of metabolic components in obese individuals. In addition, our results will help prioritize interventions for comorbidity reduction as a public health goal.

Objectives: This study investigated the association between exacerbated economic hardship during the coronavirus disease 2019 (COVID-19) pandemic and changes in the health behaviors of Korean adolescents. Methods: We analyzed data from the 2021 Korea Youth Risk Behavior Survey and included 44 908 students (22 823 boys and 22 085 girls) as study subjects. The dependent variables included changes in health behaviors (breakfast habits, physical activity, and alcohol use) that occurred during the COVID-19 pandemic. The aggravation of economic hardship by COVID-19 and the subjective economic status of the family were used as exposure variables. Multiple logistic regression analysis was utilized to calculate the prevalence odds ratios (PORs). Results: Severe exacerbation of a family’s economic hardship due to COVID-19 was negatively associated with the health behaviors of adolescents, including increased breakfast skipping (POR, 1.85; 95% confidence interval [CI], 1.55 to 2.21 for boys and POR, 1.56; 95% CI, 1.27 to 1.92 for girls) and decreased physical activity (POR, 1.37; 95% CI, 1.19 to 1.57 for boys and POR, 1.38; 95% CI, 1.19 to 1.60 for girls). These negative changes in health behaviors were further amplified when combined with a low subjective family economic status. Conclusions The experience of worsening household hardship can lead to negative changes in health behavior among adolescents. It is crucial to implement measures that address the economic challenges that arise from stressful events such as COVID-19 and to strive to improve the lifestyles of adolescents under such circumstances.

Studies conducted to evaluate temporal trends of heat-related mortality have not considered the effects of heat waves; although it is known they can affect mortality and act as a modifying factor. After adjusting for long-term trends and seasonality, the effects of temperature on non-accidental deaths in Seoul and Busan (inland and coastal cities, respectively) were analyzed using a generalized additive model of Poisson distribution. We evaluated temporal trends of heat-related mortalities in four periods (1991-1995, 1996-2000, 2001-2005, and 2006-2012). The effects of temperature on mortality were evaluated according to the occurrence of a heat wave and results were compared in the two cities. The effect of temperature on mortality was the greatest in 1991-1995 in Seoul; no significant change was observed in Busan. When we stratified the study period by heat wave status, the risk increase in mortality was 15.9% per 1℃ during years with a heat wave in Seoul, which was much higher than 0.31% increase observed during years without a heat wave. On the other hand, Busan showed a linear relationship between temperature and mortality and no significant difference between years with or without a heat wave. Variations in the relationship between temperature and mortality could be misunderstood if heat waves are not considered. Furthermore, heterogeneity was found in the modifying effect of heat waves on heat-related mortality in inland and coastal cities. The findings of this study help understand relations between temperature and mortality.
Cause of Death/*trends ; Cities ; Humans ; Temperature

A system for assessing the burdens imposed by disease and injury was developed to meet healthcare, priority setting, and policy planning needs. The first such system, the Global Burden of Disease (GBD), was implemented in 1990. However, problems associated with limited data and assumed disability weightings remain to be resolved. The purpose of the present study was to estimate national burdens of injuries in Korea using more reliable data and disability weightings. The incidences of injuries were estimated using the Korean National Hospital Discharge Survey and the mortality data from the Korean National Statistical Office in 2010. Additionally, durations of injuries and age at injury onset were used to calculate disability-adjusted life years (DALY) using disability weightings derived from the Korean Burden of Disease (KBD) study. Korea had 1,581,072 DALYs resulting from injuries (3,170 per 100,000), which was 22.9% higher than found by the GBD 2010 study. Males had almost twice as heavy an injury burden as females. Road injury, fall, and self-harm ranked 1st, 2nd, and 3rd in terms of burden of injury in 2010. Total injury burden peaked in the forties, while burden per person declined gradually from early adulthood. We hope that this study contributes to the reliable evaluation of injury burden and a better understanding of injury-related health status using nation-specific, dependable data.
Death Certificates* ; Delivery of Health Care ; Female ; Health Care Surveys ; Hope ; Humans ; Incidence ; Korea ; Male ; Mortality

The purpose of this study was to estimate the national burden of mental substance disorders on medical care utilization in Korea using National Health Insurance System (NHIS) data and updated disability weight, in terms of disability-adjusted life years (DALYs). For each of the 24 disorders, the incident years lived with disability (YLDs) was calculated, using NHIS data to estimate prevalence and incidence rates. The DisMod-II software program was used to model duration and remission. The years of life lost (YLLs) due to premature death were calculated from causes of death statistics. DALYs were computed as the sum of YLDs and YLLs, and time discounting and age weighting were applied. The year examined was 2012, and the subjects were divided into 9 groups according to age. In 2012, the Korean burden of mental and substance use disorders was 945,391 DALYs. More than 98% of DALYs were from YLDs, and the burden in females was greater than that in males, though the burden in males aged less than 19 years old was greater than that in females. Unipolar depressive disorders, schizophrenia, and anxiety disorders were found to be major diseases that accounted for more than 70% of the burden, and most DALYs occurred in their 30–59. Mental and substance use disorders accounted for 6.2% of the total burden of disease and were found to be the 7th greatest burden of disease. Therefore, mental and substance use disorders need to be embraced by mainstream health care with resources commensurate with the burden.
Anxiety Disorders ; Cause of Death ; Delivery of Health Care ; Depressive Disorder ; Female ; Humans ; Incidence ; Korea ; Male ; Mortality, Premature ; National Health Programs ; Prevalence ; Schizophrenia ; Substance-Related Disorders*

OBJECTIVES: People who have chronic diseases, as well as gait imbalance or psychiatric drug use, may be susceptible to injuries from falls and slips. The purpose of this study was to evaluate the effect of musculoskeletal diseases on incidental fall-related injuries among adults in Korea. METHODS: We analyzed data from the 4th Korea National Health and Nutrition Examination Survey (2007-2009), which are national data obtained by a rolling survey sampling method. The 1-year incidence of fall-related injuries was defined by health service utilization within the last year due to injury occurring after a slip and fall, and musculoskeletal diseases included osteoarthritis, rheumatoid arthritis, osteoporosis, and back pain. To evaluate the effects of preexisting musculoskeletal diseases, adults diagnosed before the last year were considered the exposed group, and adults who had never been diagnosed were the unexposed group. RESULTS: The weighted lifetime prevalence of musculoskeletal disease was 32 540 per 100 000 persons. Musculoskeletal diseases were associated with a higher risk of fall-related injury after adjustment for sex, age, residence, household income, education, occupation, visual disturbance, paralysis due to stroke, and medication for depression (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.03 to 1.93). As the number of comorbid musculoskeletal diseases increased, the risk of fall-induced injuries increased (p-value for trend <0.001). In particular, patients who had any musculoskeletal condition were at much higher risk of recurrent fall-related injuries (OR, 6.20; 95% CI, 1.06 to 36.08). CONCLUSIONS: One must take into account the risk of fall-related injuries and provide prevention strategies among adults who have musculoskeletal diseases.
Accidental Falls/*statistics & numerical data ; Adolescent ; Adult ; Age Factors ; Aged ; Arthritis, Rheumatoid/complications/epidemiology ; Back Pain/complications/epidemiology ; Female ; Health Surveys ; Humans ; Incidence ; Male ; Middle Aged ; Musculoskeletal Diseases/*complications ; Osteoarthritis/complications/epidemiology ; Osteoporosis/complications/epidemiology ; Republic of Korea/epidemiology ; Risk Factors ; Sex Factors ; Socioeconomic Factors ; Young Adult

Obesity during childhood is a dominant risk factor for noncommunicable diseases (NCDs), and is itself considered a disease that needs to be treated. Recently, the growth in childhood obesity in Korea has become stagnant; however, two in every ten children are still overweight. In addition, 60% or more of overweight children have at least one metabolic syndrome risk factor. Thus, childhood obesity should be controlled through lifestyle modification. This paper reviews studies of the modifiable risk factors of obesity in Korean children. According to the life-course approach, preschool-aged children (<5 years) are influenced by their parents rather than individual habits because they are under mostly parental care. Elementary school-aged children (6 to 11 years) are affected by overlapping individual and parental effects. This may mean that the establishment of individual behavior patterns begins during this period. The conditions of poor eating habits such as skipping meals, eating out, and high fat intake, along with low physical activity, facilitate increased obesity among adolescents (12 to 18 years). Notably, adolescent girls show high rates of both underweight and obesity, which may lead to the development of NCDs in their offspring. Therefore, the problem of NCDs is no longer limited to adults, but is also prevalent among children. In addition, early intervention offers cost-effective opportunities for preventing NCDs. Thus, children need primary consideration, adequate monitoring, diagnosis, and treatment to reduce the burden of NCDs later in adulthood.
Adolescent ; Child ; Chronic Disease/*epidemiology ; Diet ; Female ; Humans ; Life Style ; Male ; Metabolic Syndrome X/epidemiology/*etiology/*prevention & control ; Obesity/*complications/epidemiology/*prevention & control ; Parent-Child Relations ; Prevalence ; Republic of Korea/epidemiology ; Risk Factors ; Sedentary Lifestyle

OBJECTIVES: Economic growth and development of medical technology help to improve the average life expectancy, but the western diet and rapid conversions to poor lifestyles lead an increasing risk of major chronic diseases. Coronary heart disease mortality in Korea has been on the increase, while showing a steady decline in the other industrialized countries. An age-period-cohort analysis can help understand the trends in mortality and predict the near future. METHODS: We analyzed the time trends of ischemic heart disease mortality, which is on the increase, from 1985 to 2009 using an age-period-cohort model to characterize the effects of ischemic heart disease on changes in the mortality rate over time. RESULTS: All three effects on total ischemic heart disease mortality were statistically significant. Regarding the period effect, the mortality rate was decreased slightly in 2000 to 2004, after it had continuously increased since the late 1980s that trend was similar in both sexes. The expected age effect was noticeable, starting from the mid-60's. In addition, the age effect in women was more remarkable than that in men. Women born from the early 1900s to 1925 observed an increase in ischemic heart mortality. That cohort effect showed significance only in women. CONCLUSIONS: The future cohort effect might have a lasting impact on the risk of ischemic heart disease in women with the increasing elderly population, and a national prevention policy is need to establish management of high risk by considering the age-period-cohort effect.
Adult ; Age Factors ; Aged ; Female ; Humans ; Male ; Middle Aged ; Myocardial Ischemia/*mortality ; Republic of Korea/epidemiology ; Risk Factors ; Sex Factors

Background and Objectives: To evaluate mismatches between pure-tone audiometry (PTA) and auditory steady-state response (ASSR) tests in non-auditory neuropathy adults and investigate brain lesions that may explain the mismatches, especially in cases where the ASSR threshold was worse than the estimated PTA threshold.Subjects and Method PTA, speech audiometry, auditory brainstem response, ASSR, and neuroimaging tests were carried out on individuals selected. Among them, medical records of 30 subjects (16 males, 14 females; mean age=54.4±13.2 years) with significant mismatches between PTA and estimated ASSR thresholds were analyzed retrospectively. All neuroimaging tests were reviewed to identify any neurologic abnormalities. Results: Pathologic brain lesions were found in 19 cases (63.3%) in the study group, all of which showed significant mismatch in hearing threshold between PTA and ASSR. Seven case of ischemic brain lesions (23.3%), five tumorous lesions (16.6%), and four brain vessel anomalies (13.3%) were found. Brain hemorrhage due to trauma were found in two cases (6.6%) as well as one case (3.3%) of unruptured aneurysm. Central auditory pathway disorder was suspected in two cases. The 11 cases showing normal results in the imaging studies included one mental retardation, one brain concussion, and seven cases (23.3%) with no specific causes. Six tinnitus cases included two subjects showing discrepancies between frequency matching in the tinnitogram. Conclusion In adults with a mismatch between PTA thresholds and estimated ASSR thresholds, especially for those with moderate to profound hearing loss, additional neuroimaging tests and other audiologic tests may reveal other possible causes of hearing loss.