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Alcohol Consumption and Mortality in the Korean Multi-center Cancer Cohort Study.

En Joo JUNG ; Aesun SHIN ; Sue K PARK ; Seung Hyun MA ; In Seong CHO ; Boyoung PARK ; Eun Ha LEE ; Soung Hoon CHANG ; Hai Rim SHIN ; Daehee KANG ; Keun Young YOO

Journal of Preventive Medicine and Public Health.2012;45(5):301-308.

OBJECTIVES: To examine the association between alcohol consumption habit, types of beverages, alcohol consumption quantity, and overall and cancer-specific mortality among Korean adults. METHODS: The alcohol consumption information of a total of 16 320 participants who were 20 years or older from the Korean Multi-center Cancer Cohort were analyzed to examine the association between alcohol consumption habit and mortality (median follow-up of 9.3 years). The Cox proportional hazard model was used to estimate the hazard ratio (HR) of alcohol consumption to mortality adjusting for age, sex, geographic areas, education, smoking status, and body mass index. RESULTS: Alcohol drinkers showed an increased risk for total mortality compared with never drinkers (HR, 1.72; 95% confidence interval [CI], 1.38 to 2.14 for past drinkers; HR, 1.21; 95% CI, 1.06 to 1.39 for current drinkers), while past drinkers only were associated with higher risk for cancer deaths (HR, 1.84; 95% CI, 1.34 to 2.53). The quantity of alcohol consumed per week showed a J-shaped association with risk of mortality. Relative to light drinkers (0.01 to 90 g/wk), never drinkers and heavy drinkers (>504 g/wk) had an increased risk for all-cause and cancer deaths: (HR, 1.18; 95% CI, 0.96 to 1.45) and (HR, 1.39; 95% CI, 1.05 to 1.83) for all-cause mortality; and (HR, 1.55; 95% CI, 1.15 to 2.11) and (HR, 2.07; 95% CI, 1.39 to 3.09) for all cancer mortality, respectively. Heavy drinkers (>504 g/wk) showed an elevated risk for death from stomach and liver cancers. CONCLUSIONS: The present study supports the existence of a J-shaped association between alcohol consumption quantity and the risk of all-cause and cancer deaths. Heavy drinkers had an increased risk of death from cancer overall and liver and stomach cancer.
Adult ; Age Factors ; Aged ; Alcohol Drinking/adverse effects/*mortality ; Analysis of Variance ; Cohort Studies ; Female ; Humans ; Male ; Middle Aged ; Neoplasms/etiology/*mortality ; Proportional Hazards Models ; Republic of Korea/epidemiology ; Risk Factors ; Sex Factors ; Young Adult

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The Socioeconomic Burden of Coronary Heart Disease in Korea.

Hoo Sun CHANG ; Han Joong KIM ; Chung Mo NAM ; Seung Ji LIM ; Young Hwa JANG ; Sera KIM ; Hye Young KANG

Journal of Preventive Medicine and Public Health.2012;45(5):291-300.

OBJECTIVES: We aimed to estimate the annual socioeconomic burden of coronary heart disease (CHD) in Korea in 2005, using the National Health Insurance (NHI) claims data. METHODS: A prevalence-based, top-down, cost-of-treatment method was used to assess the direct and indirect costs of CHD (International Classification of Diseases, 10th revision codes of I20-I25), angina pectoris (I20), and myocardial infarction (MI, I21-I23) from a societal perspective. RESULTS: Estimated national spending on CHD in 2005 was 2.52 billion dollar . The majority of the spending was attributable to medical costs (53.3%), followed by productivity loss due to morbidity and premature death (33.6%), transportation (8.1%), and informal caregiver costs (4.9%). While medical cost was the predominant cost attribute in treating angina (74.3% of the total cost), premature death was the largest cost attribute for patients with MI (66.9%). Annual per-capita cost of treating MI, excluding premature death cost, was 3183 dollar, which is about 2 times higher than the cost for angina (1556 dollar). CONCLUSIONS: The total insurance-covered medical cost (1.13 billion dollar) of CHD accounted for approximately 6.02% of the total annual NHI expenditure. These findings suggest that the current burden of CHD on society is tremendous and that more effective prevention strategies are required in Korea.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Angina Pectoris/economics/epidemiology ; Coronary Disease/*economics/epidemiology ; *Cost of Illness ; Female ; Health Care Costs/statistics & numerical data ; Humans ; Insurance, Health/statistics & numerical data ; Male ; Middle Aged ; Myocardial Infarction/economics/epidemiology ; Prevalence ; Republic of Korea/epidemiology ; Sex Factors ; Socioeconomic Factors ; Young Adult

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Effect of Preexisting Musculoskeletal Diseases on the 1-Year Incidence of Fall-related Injuries.

Won Kyung LEE ; Kyoung Ae KONG ; Hyesook PARK

Journal of Preventive Medicine and Public Health.2012;45(5):283-290.

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

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The Singapore Field Epidemiology Service: Insights Into Outbreak Management.

Peng Lim OOI ; Theresa SEETOH ; Jeffery CUTTER

Journal of Preventive Medicine and Public Health.2012;45(5):277-282.

Field epidemiology involves the implementation of quick and targeted public health interventions with the aid of epidemiological methods. In this article, we share our practical experiences in outbreak management and in safeguarding the population against novel diseases. Given that cities represent the financial nexuses of the global economy, global health security necessitates the safeguard of cities against epidemic diseases. Singapore's public health landscape has undergone a systemic and irreversible shift with global connectivity, rapid urbanization, ecological change, increased affluence, as well as shifting demographic patterns over the past two decades. Concomitantly, the threat of epidemics, ranging from severe acute respiratory syndrome and influenza A (H1N1) to the resurgence of vector-borne diseases as well as the rise of modern lifestyle-related outbreaks, have worsened difficulties in safeguarding public health amidst much elusiveness and unpredictability. One critical factor that has helped the country overcome these innate and man-made public health vulnerabilities is the development of a resilient field epidemiology service, which includes our enhancement of surveillance and response capacities for outbreak management, and investment in public health leadership. We offer herein the Singapore story as a case study in meeting the challenges of disease control in our modern built environment.
Disease Outbreaks/*prevention & control ; Ecology ; Environment ; Humans ; Life Style ; Pandemics/prevention & control ; Public Health Administration ; *Public Health Practice ; Singapore/epidemiology ; World Health

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Effects of the Exposure to Polycyclic Aromatic Hydrocarbons or Toluene on Thiobarbituric Acid Reactive Substance Level in Elementary School Children and the Elderly in a Rural Area.

Dae Seon KIM ; Chul Ho LEE ; Sang Yong EOM ; Tackshin KANG ; Yong Dae KIM ; Heon KIM

Journal of Preventive Medicine and Public Health.2008;41(1):61-67. doi:10.3961/jpmph.2008.41.1.61

OBJECTIVES: Polycyclic aromatic hydrocarbons (PAH) and toluene have been reported to induce reactive oxygen species and oxidative stress. This study was performed to investigate the effects of low level exposure to PAHs or toluene on the lipid peroxidation level in elementary school children and the elderly in a rural area. METHODS: Forty seven elementary school children and 40 elderly people who were living in a rural area and not occupationally exposed to PAH or toluene were the subjects of this study. Information about active or passive smoking and diet was obtained using a self-administered questionnaire. The urinary 1-hydroxypyrene (1-OHP), 2-naphthol, hippuric acid and thiobarbituric acid reactive substance (TBARS) concentrations were measured, and these values were corrected with the urinary creatinine concentration. RESULTS: In school children, the geometric means of the urinary 1-OHP, 2-naphthol, hippuric acid and TBARS levels were 0.02 ymol/mol creatinine, 0.47 micron mol/mol creatinine, 0.14 g/g creatinine and 0.95 micron mol/g creatinine, respectively. Those values for the elderly were 0.07 micron mol/mol creatinine, 1.87 micron mol/mol creatinine, 0.11 g/g creatinine and 1.18 micron mol/g creatinine, respectively. The mean levels of urinary 1-OHP, 2-naphthol and TBARS were significantly higher in the elderly subjects than in the children. The urinary TBARS level was not correlated with the urinary 1-OHP, 2-naphthol and hippuric acid, but they were correlated with the age of the subjects. CONCLSIONS: These results suggest that low level inhalation exposure to PAH or toluene does not markedly increase lipid peroxidation, and age is a significant determinant of lipid peroxidation.
Child ; Environmental Exposure/*adverse effects ; Environmental Pollutants/*toxicity ; Female ; Humans ; Male ; Middle Aged ; Polycyclic Hydrocarbons, Aromatic/*toxicity ; *Rural Population ; Thiobarbituric Acid Reactive Substances/*analysis ; Toluene/*toxicity ; Urinalysis

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Effect of Sociodemographic Factors, Cancer, Psychiatric Disorder on Suicide: Gender and Age-specific Patterns.

Jae Young PARK ; Ki Tae MOON ; Yoo Mi CHAE ; Sang Hyuk JUNG

Journal of Preventive Medicine and Public Health.2008;41(1):51-60. doi:10.3961/jpmph.2008.41.1.51

OBJECTIVES: We examined the effect of sociodemographic factors, cancer, and psychiatric disorders on suicide by gender and age-specific patterns in South Korea. METHODS: The study is a case-control study. Claim data was obtained from the national health insurance database and national death registration database. The number of people who committed suicide was 11,523, which was matched with a control group consisting of ten times as many people at 115,230 selected from the national health insurance and medical aids beneficiaries. The medical utilization of the case group was one year before death and that of the control group was from July 1,2003 to June 30, 2004. Four variables-address, economic status, presence of a psychiatric disease, and cancer-were used in multiple logistic regression analyses. RESULTS: Living in cities or in rural areas showed a greater risk for suicide than living in a metropolitan city. Low economic status, the presence of a psychiatric disorder, and cancer were also statistically meaningful risk factors for suicide. The three major psychiatric diseases, schizophrenia, alcohol abuse, and bipolar disorder, were meaningful in all age groups, but the scale of the odds ratio differed by the age group. Only the psychiatric disorder variable was meaningful in the adolescent group, whereas a psychiatric disorder and economic status were meaningful for the young adult group, and all variables were meaningful for the middle-aged group. A psychiatric disorder and cancer were meaningful in the elderly group, economic status was meaningful for male subjects, and address was meaningful for female subjects. CONCLSIONS: Factors such as living in city or rural areas, low economic status, the presence of a psychiatric disorder, and cancer were statistically meaningful risk factors in suicide. These factors also differed by age group. Therefore, policymakers should establish policies for suicide prevention that are relevant for each age group.
Adolescent ; Adult ; Age Distribution ; Aged ; Case-Control Studies ; Child ; Female ; Health Surveys ; Humans ; Male ; Mental Disorders/*epidemiology ; Middle Aged ; Neoplasms/*epidemiology ; Residence Characteristics ; Sex Distribution ; Socioeconomic Factors ; Suicide/*statistics & numerical data

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A Prospective Cohort Study of Exercise and the Incidence of Type 2 Diabetes in Impaired Fasting Glucose Group.

Hong Dae UM ; Duck Chul LEE ; Sang Yi LEE ; Yeon Soo KIM

Journal of Preventive Medicine and Public Health.2008;41(1):45-50. doi:10.3961/jpmph.2008.41.1.45

OBJECTIVES: To determine the relationship between exercise and the incidence of type 2 diabetes in an impaired fasting glucose group. METHODS: This prospective cohort study was conducted in 19,440 men and 4,297 women, aged 30-69 years, with impaired fasting glucose at baseline who had undergone biennial medical evaluation through the National Health Insurance Corporation from 2000 to 2004. Impaired fasting glucose was defined as fasting glucose of 100 to 125 mg/dl and the subjects were divided into 3 groups depending on weekly exercise frequency. Multivariate logistic regression analysis was used to evaluate the association between the baseline exercise status and incidence of type 2 diabetes. RESULTS: During the 4-year follow-up, a total of 3,239 men and 283 women developed type 2 diabetes, a cumulative incidence of 16.6% for men, and 6.5% for women. Also, 1,688 men (21.2%) and 127 women (15.2%) developed type 2 diabetes in the obese group. The adjusted relative risk (RR) of developing type 2 diabetes in non-exercising men was significantly higher than exercising men regularly (RR= 1.375, 95% CI=1.236-1.529)(p<0.0001), and the RR for non-exercising women was higher than exercising women regularly (RR=1.124, 95% CI=0.711-1.778). The RR for non-exercise men/women in the obese group was 1.571 (95% CI=1.351-1.827)(p<0.0001)/1.869(95% CI=0.846-4.130). CONCLSIONS: Regular exercise is effective in preventing type 2 diabetes in people with impaired fasting glucose, and particularly in obese people. People with risk factors for diabetes should participate in a regular exercise program.
Adult ; Aged ; *Blood Glucose ; Diabetes Mellitus, Type 2/*epidemiology/prevention & control ; *Exercise ; Female ; Glucose Tolerance Test ; Humans ; Incidence ; Male ; Middle Aged ; Prospective Studies ; Risk Factors ; Sex Factors

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Associations of Non Alcoholic Fatty Liver with the Metabolic Syndrome and Serum Carotenoids.

Sun kyun PARK ; Hyun Jung LEE ; Duk Hee LEE ; Sung Kook LEE ; Byung Yeol CHUN ; Sung Ae KIM ; Hye Sung LEE ; Hyo Kyung SON ; Sung Hi KIM

Journal of Preventive Medicine and Public Health.2008;41(1):39-44. doi:10.3961/jpmph.2008.41.1.39

OBJECTIVES: This study was conducted to investigate the associations of non alcoholic fatty liver with metabolic syndrome and the serum carotenoids. METHODS: This study was conducted in a general hospital in South Korea from November, 2004 to August, 2005. The study subjects were 350 sampled persons who were aged from 40 years and older (males: 180, females: 170). They were grouped into the normal, mild and severe groups according to fat accumulation in their livers, as determined by ultrasonography. We analyzed the association between non alcoholic fatty liver and metabolic syndrome by multiple logistic regression analysis and we analyzed the association between non alcoholic fatty liver and the serum carotenoids by a general linear model(ANCOVA). RESULTS: After adjustment for the effect of potential covariates, the prevalence of metabolic syndrome was associated with fat accumulation in the liver (p trend <0.001). If the odds ratio of normal group is 1.00, then that of the mild group is 2.80 (95% C.I=1.17-6.71) and that of the severe group is 7.29 (95% C.I=2.76-19.30). The prevalence of metabolic alterations fitting the criteria of metabolic syndrome, according to the class of fat accumulation in the liver, was significantly increased, except for criteria of high blood pressure, a large waist circumference and low HDL (high density lipoprotein) cholesterol level (p trend <0.001). The level of serum beta-carotene was decreased according to the class of fat accumulation in the liver (p trend=0.036), but the levels of serum alpha-carotene, lycopene, bata-cryptoxanthin and lutein were not decreased. CONCLSIONS: This study shows that non alcoholic fatty liver was associated with metabolic syndrome and with the serum beta-carotene level.
Adult ; Carotenoids/*blood ; Fatty Liver/*complications ; Female ; Health Behavior ; Humans ; Male ; Metabolic Syndrome X/*complications ; Middle Aged ; Prevalence ; Regression Analysis

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Job Satisfaction, Subjective Class Identification and Associated Factors of Professional Socialization in Korean Physicians.

Hyung Gon YOON ; Seok Jun YOON ; In Kyoung HWANG ; Yeong Bae MUN ; Hee Young LEE

Journal of Preventive Medicine and Public Health.2008;41(1):30-38. doi:10.3961/jpmph.2008.41.1.30

OBJECTIVES: The aim of this study was to determine the relationship between the core properties of professional socialization and social status satisfaction, economic reward satisfaction, and subjective class identification. METHODS: Medical knowledge and skill, autonomy, and professional value factors were used as essential properties of professional socialization to determine the association with job satisfaction and subjective class identification. The authors used a self-administered questionnaire survey and collected nationwide data between July and August 2003, with 211 responses used for final analysis. RESULTS: 'Age' and 'trust and respect' were positively associated with social status satisfaction, and 'occupation' was negatively associated. 'Income' and 'trust and respect' were positively related to economic reward satisfaction, and 'practicing for oneself', and 'a sense of duty and attendance' were negatively related. 'Practicing for oneself', 'not believing explanations', and 'a sense of duty and attendance' had a positive relationship with subjective class identification. 'Income', 'knowledge system', 'medical mistakes', 'treating like goods', 'meaning and joy', and 'trust and respect' had a negative relationship. CONCLSIONS: The core property variables of professional socialization had a different relationship with social status satisfaction, economic reward satisfaction and subjective class identification. In particular, many core property variables were associated with subjective class identification positively or negatively. The development of professional socialization would help promote job satisfaction and subjective class identification.
Adult ; Age Factors ; Aged ; Female ; Humans ; Income ; *Job Satisfaction ; Korea ; Male ; Middle Aged ; Physicians/*psychology ; Professional Autonomy ; *Social Class ; Trust

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Cohort Study on the Association between Alcohol Consumption and the Risk of Colorectal Cancer in the Korean Elderly.

Hoi Jeong LIM ; Byung Joo PARK

Journal of Preventive Medicine and Public Health.2008;41(1):23-29. doi:10.3961/jpmph.2008.41.1.23

OBJECTIVES: We examined the association between alcohol consumption and incidence of colorectal cancer in elderly Koreans. METHODS: The cohort members (n=14,304) consisted of 4,834 males and 9,470 females derived from the Korea Elderly Pharmacoepidemiologic Cohort (KEPEC), a population-based dynamic cohort. They were aged 65 years old or older and lived in Busan between 1993-1998; they were beneficiaries of the Korean Medical Insurance Corporation (KMIC). Baseline information was surveyed by a self-administered, mailed questionnaire. This study population was restricted to 14,304 participants who reported alcohol drinking habits on the questionnaire and had not been diagnosed with colorectal cancer at baseline. The adjusted hazard ratios (aHR) of status, type, frequency and daily average amount of alcohol consumption were computed with Cox's proportional hazard model, with the never-drinkers as a reference group and controlling for age and gender. RESULTS: After 4.82 person-years of mean follow-up 112 cases of colorectal cancer occurred. The incidence densities of colorectal cancer were 161 (95% CI=123-200) for never-drinkers, 219 (95% CI=125-339) for ex-drinkers, and 137 (95% CI=84-189) for current-drinkers per 100,000 person-year. The status, type, frequency, and daily average amount of alcohol consumption were not significantly related to the incidence of colorectal cancer after controlling for age and gender. CONCLSIONS: There was no significant association between alcohol consumption and colorectal cancer among elderly people after controlling for age and gender.
Age Distribution ; Aged ; Alcohol Drinking/*epidemiology ; Cohort Studies ; Colorectal Neoplasms/*epidemiology ; Female ; Humans ; Korea/epidemiology ; Male ; Proportional Hazards Models ; Questionnaires ; Sex Distribution

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