Health impact assessment (HIA) system has been listed in the Outline of the Healthy China 2030 Plan and the Law of Basic Health Care and Health Promotion of the People's Republic of China, however, the technique guideline of HIA needs to be established and improved. This paper summarizes the applications of different epidemiological methods in HIA and focus on the introduction of the application of ecology model of health social determinants as theory basis in the establishment of HIA system along with the introduction of HIA cases in the world. The applications of epidemiological methods in domestic HIA research are limited. Therefore, appropriate applications of epidemiological methods should be strengthened in HIA guideline and system development, especially the applications of big health data, mobile health techniques, systems epidemiology and implementation science, to facilitate data collection and potential health hazard evaluation and surveillance for HIA, establishment and improvement of HIA system and the implementation of Healthy China Strategy.
China/epidemiology* ; Epidemiologic Methods ; Health Impact Assessment ; Health Promotion ; Humans

OBJECTIVE: To investigate the epidemiology of sepsis in Korea and identify risk factors for death in sepsis.METHODS: We conducted a longitudinal, population-based epidemiological study of sepsis in Korea from 2005 to 2012 using the National Health Insurance Service-National Sample Cohort, a population-based cohort representing 2.2% of the Korean population. The primary objective was to assess the incidence, mortality and cost of sepsis. The secondary objective was to identify the risk factors for death in sepsis. Claim records of admitted adult patients (aged ≥15 years) were analyzed. Sepsis was defined as 1) bacterial or fungal infection or the conditions they often complicate, 2) prescription of intravenous antibiotics, and 3) presence of any organ dysfunction. Comorbidities were defined using the Charlson/Deyo method. Risk factors for 6-month mortality were assessed using multivariable logistic regression.RESULTS: A total of 22,882 cases were identified. Both incidence and 6-month mortality increased from 265.7 (95% confidence interval [CI], 254.7 to 277.1) to 453.1 (95% CI, 439.0 to 467.5) per 100,000 person-years (P-trend <0.001) and from 26.5% (95% CI, 24.4% to 28.8%) to 30.1% (95% CI, 28.4% to 31.9%), respectively. After standardization, the increasing trend of incidence was slower but still significant (P-trend <0.001), while that for mortality was not (P-trend 0.883). The average cost increased by 75.5% (P-trend <0.001). Multivariable logistic regression identified various risk factors for mortality.CONCLUSION: The burden of sepsis in Korea was high and is expected to increase considering the aging population. Proactive measures to curtail this increase should be sought and implemented.
Adult ; Aging ; Anti-Bacterial Agents ; Cohort Studies ; Comorbidity ; Epidemiologic Studies ; Epidemiology ; Humans ; Incidence ; Korea ; Logistic Models ; Methods ; Mortality ; National Health Programs ; Prescriptions ; Risk Factors ; Sepsis

Adult ; China ; Cross-Sectional Studies ; Epidemiologic Methods ; Epidemiology ; education ; Female ; Humans ; Male

OBJECTIVES: Ecological momentary assessment (EMA) methods are known to have validity for capturing momentary changes in variables over time. However, data quality relies on the completion rates, which are influenced by both participants' characteristics and study designs. This study applied an EMA method using a mobile application to assess momentary moods and stress levels in patients with Moyamoya disease to examine variables associated with EMA completion rates. METHODS: Adults with Moyamoya disease were recruited from a tertiary hospital in Seoul. Patients with cognitive impairment were excluded. The EMA survey was loaded as a mobile application onto the participants' personal smartphones. Notifications were sent at semi-random intervals four times a day for seven consecutive days. Daily completion rates were calculated as the percentage of completed responses per day; overall completion rates were calculated as the proportion of completed responses per total of the 28 scheduled measures in the study and assessed through a descriptive analysis, t-test, ANOVA, and regression analysis, with mixed modeling to identify the point at which the daily completion rate significantly decreased. RESULTS: A total of 98 participants responded (mean age, 41.00 ± 10.30 years; 69.4% female; 75.5% married). The overall completion rate was 70.66%, with no gender or age differences found. The daily completion rate decreased significantly after day 5 (p = 0.029). CONCLUSIONS: Obtaining a good completion rate is essential for quality data in EMA methods. Strategic approaches to a study design should be established to encourage participants throughout a study to improve completion rates.
Adult ; Cognition Disorders ; Data Accuracy ; Epidemiologic Factors ; Female ; Guideline Adherence ; Humans ; Methods ; Mobile Applications ; Moyamoya Disease ; Seoul ; Smartphone ; Tertiary Care Centers

OBJECTIVES: Outbreaks of scarlet fever in Mexico in 1999, Hong Kong and mainland China in 2011, and England in 2014-2016 have received global attention, and the number of notified cases in Korean children, including in Jeju Province, has also increased since 2010. To identify relevant hypotheses regarding this emerging outbreak, an age-period-cohort (APC) analysis of scarlet fever incidence was conducted among children in Jeju Province, Korea. METHODS: This study analyzed data from the nationwide insurance claims database administered by the Korean National Health Insurance Service. The inclusion criteria were children aged ≤14 years residing in Jeju Province, Korea who received any form of healthcare for scarlet fever from 2002 to 2016. The age and year variables were categorized into 5 groups, respectively. After calculating the crude incidence rate (CIR) for age and calendar year groups, the intrinsic estimator (IE) method was applied to conduct the APC analysis. RESULTS: In total, 2345 cases were identified from 2002 to 2016. Scarlet fever was most common in the 0-2 age group, and boys presented more cases than girls. Since the CIR decreased with age between 2002 and 2016, the age and period effect decreased in all observed years. The IE coefficients suggesting a cohort effect shifted from negative to positive in 2009. CONCLUSIONS: The results suggest that the recent outbreak of scarlet fever among children in Jeju Province might be explained through the cohort effect. As children born after 2009 showed a higher risk of scarlet fever, further descriptive epidemiological studies are needed.
Child ; China ; Cohort Effect ; Delivery of Health Care ; Disease Outbreaks ; England ; Epidemiologic Studies ; Exotoxins ; Female ; Hong Kong ; Humans ; Incidence ; Insurance ; Korea ; Methods ; Mexico ; National Health Programs ; Scarlet Fever ; Streptococcus pyogenes

OBJECTIVES: We reviewed digital epidemiological studies to characterize how researchers are using digital data by topic domain, study purpose, data source, and analytic method. METHODS: We reviewed research articles published within the last decade that used digital data to answer epidemiological research questions. Data were abstracted from these articles using a data collection tool that we developed. Finally, we summarized the characteristics of the digital epidemiological studies. RESULTS: We identified six main topic domains: infectious diseases (58.7%), non-communicable diseases (29.4%), mental health and substance use (8.3%), general population behavior (4.6%), environmental, dietary, and lifestyle (4.6%), and vital status (0.9%). We identified four categories for the study purpose: description (22.9%), exploration (34.9%), explanation (27.5%), and prediction and control (14.7%). We identified eight categories for the data sources: web search query (52.3%), social media posts (31.2%), web portal posts (11.9%), webpage access logs (7.3%), images (7.3%), mobile phone network data (1.8%), global positioning system data (1.8%), and others (2.8%). Of these, 50.5% used correlation analyses, 41.3% regression analyses, 25.6% machine learning, and 19.3% descriptive analyses. CONCLUSIONS: Digital data collected for non-epidemiological purposes are being used to study health phenomena in a variety of topic domains. Digital epidemiology requires access to large datasets and advanced analytics. Ensuring open access is clearly at odds with the desire to have as little personal data as possible in these large datasets to protect privacy. Establishment of data cooperatives with restricted access may be a solution to this dilemma.
Cell Phones ; Communicable Diseases ; Data Collection ; Dataset ; Epidemiologic Studies* ; Epidemiological Monitoring ; Epidemiology* ; Geographic Information Systems ; Humans ; Information Storage and Retrieval ; Internet ; Life Style ; Machine Learning ; Mental Health ; Methods ; Privacy ; Public Health Surveillance ; Social Media

The overall details of causality frames in the objective world remain obscure, which poses difficulty for causality research. Based on the temporality of cause and effect, the objective world is divided into three time zones and two time points, in which the causal relationships of the variables are parsed by using Directed Acyclic Graphs (DAGs). Causal DAGs of the world (or causal web) is composed of two parts. One is basic or core to the whole DAGs, formed by the combination of any one variable originating from each time unit mentioned above. Cause effect is affected by the confounding only. The other is an internal DAGs within each time unit representing a parent-child or ancestor-descendant relationship, which exhibits a structure similar to the confounding. This paper summarizes the construction of causality frames for objective world research (causal DAGs), and clarify a structural basis for the control of the confounding in effect estimate.
Causality ; Computer Graphics ; Confounding Factors, Epidemiologic ; Data Interpretation, Statistical ; Epidemiologic Methods ; Humans

One of the commonly accepted merits of cohort studies (CSs) refers to the exposure precedes outcome superior to other observational designs. We use Directed Acyclic Graphs to construct a causal graph among research populations under CSs. We notice that the substitution of research population in place of a susceptible one can be used for effect estimation. Its correctness depends on the outcome-free status of the substituted population and the performance of both screening and diagnosis regarding the outcomes under study at baseline. The temporal precedence of exposure over outcome occurs theoretically, despite the opposite happens in realities. Correct effect estimate is affected by both the suitability of population substitution and the validities of outcome identification and exclusion.
Causality ; Cohort Studies ; Confounding Factors, Epidemiologic ; Epidemiologic Methods ; Mass Screening ; Research Design

BACKGROUND AND OBJECTIVES: Whether using both traditional risk factors and genetic variants for stroke as opposed to using either of the 2 alone improves the prediction of stroke risk remains unclear. The purpose of this study was to compare the predictability of stroke risk between models using traditional risk score (TRS) and genetic risk score (GRS). METHODS: We used a case-cohort study from the Korean Cancer Prevention Study-II (KCPS-II) Biobank (n=156,701). We genotyped 72 single nucleotide polymorphisms (SNPs) identified in genome-wide association study (GWAS) on the KCPS-II sub-cohort members and stroke cases. We calculated GRS by summing the number of risk alleles. Prediction models with or without GRS were evaluated in terms of the area under the receiver operating characteristic curve (AUROC). RESULTS: Sixteen out of 72 SNPs identified in GWAS showed significant associations with stroke, with an odds ratio greater than 2.0. For participants aged < 40 years, AUROCs for incident stroke were 0.58, 0.65, and 0.67 in models using modifiable TRS only, GRS only, and TRS plus GRS, respectively, showing that GRS only model had better prediction than TRS only. For participants aged ≥40 years, however, TRS only model had better prediction than GRS only model. Favorable levels of traditional risk were associated with significantly lower stroke risks within each genetic risk category. CONCLUSIONS: TRS and GRS were both independently associated with stroke risk. Using genetic variants in addition to traditional risk factors may be the most accurate way of predicting stroke risk, particularly in relatively younger individuals.
Alleles ; Epidemiologic Methods ; Genetics ; Genome-Wide Association Study ; Korea ; Odds Ratio ; Polymorphism, Single Nucleotide ; Risk Factors ; ROC Curve ; Stroke

PURPOSE: The purpose of this study was to test the mediating effect of depression on the relationship between gambling severity and cognitive distortion in Koreans with a gambling disorder. METHODS: Secondary data from a comprehensive assessment of problematic gambling between 2015 and 2017 on Korea Center on Gambling Problems were used. The subjects in this study were 254 Koreans with that gambling disorder. Data were collected with self-report structured questionnaires which included individual characteristics, the Korean version of Problem Gambling Severity Index, the Center for the Epidemiologic Studies Depression, and the Gambling Related Cognitions Scale. Data were analyzed by using descriptive statistics, independent t-test, one-way ANOVA with the Scheffé test, Pearson's correlation coefficients, and a mediation analysis of the Baron and Kenny method with the SPSS 22.0 program. RESULTS: Significant correlations emerged among the three variables, gambling severity, depression, and cognitive distortion. Depression exerted a partial mediating effect (β=.20, p < .001) on the relationship between gambling severity and cognitive distortion (Sobel test: z=2.33, p=.012). CONCLUSION: Based on this study's findings, nursing intervention programs focused on managing gambling severity and decreasing depression are highly recommended to alleviate cognitive distortion in people with a gambling disorder.
Cognition ; Depression ; Epidemiologic Studies ; Gambling ; Korea ; Methods ; Negotiating ; Nursing ; Statistics as Topic