3.Sleep Duration, Mortality, and High-Risk Populations: A Nationwide Study in the United States
Minjeong KIM ; Hyejung LEE ; Seoyeong AHN ; Whanhee LEE
Journal of Sleep Medicine 2024;21(3):150-161
Both insufficient and excessive sleep durations have been recognized as important risk factors for mortality. Nevertheless, the impact of sleep duration on cause-specific mortality and potential effect modifiers has not been investigated extensively. Therefore, this study aimed to assess the association between sleep duration and mortality categorized by cause of death and potential effect modifiers using data from the National Health and Nutrition Examination Survey (NHANES). Methods: We established a prospective cohort based on NHANES participants aged 50 years or older, linked to the National Death Index (NDI) in the United States between 2009 and 2018. The NDI included all-cause, cardiovascular, and respiratory deaths. Sleep duration was assessed during the NHANES examination period. A survey-weighted Cox proportional hazards model was used to evaluate the association between sleep and mortality. Results: A total of 13,947 participants with available NHANES data were included in this study. A U-shaped association between sleep duration and mortality was observed for all-cause and cardiovascular mortality, meanwhile, respiratory mortality was linked to moderately short sleep (>5 and <7 hours). For total mortality, the association with severe short sleep (5 hours or less; p<0.01) was generally stronger than the association with long sleep (>8 hours; p=0.029), with the effect of severe short sleep being significantly prominent in males (p<0.01), non-Hispanic White (0.001), high-income (0.056), and those with a body mass index ≥23.0 kg/m2 (0.001) than those in their counterparts. Conclusions: This study suggests that sleep duration is associated with the mortality risk. Our results provide evidence for a more targeted allocation of public health resources to improve sleep and health.
5.Sleep Duration, Mortality, and High-Risk Populations: A Nationwide Study in the United States
Minjeong KIM ; Hyejung LEE ; Seoyeong AHN ; Whanhee LEE
Journal of Sleep Medicine 2024;21(3):150-161
Both insufficient and excessive sleep durations have been recognized as important risk factors for mortality. Nevertheless, the impact of sleep duration on cause-specific mortality and potential effect modifiers has not been investigated extensively. Therefore, this study aimed to assess the association between sleep duration and mortality categorized by cause of death and potential effect modifiers using data from the National Health and Nutrition Examination Survey (NHANES). Methods: We established a prospective cohort based on NHANES participants aged 50 years or older, linked to the National Death Index (NDI) in the United States between 2009 and 2018. The NDI included all-cause, cardiovascular, and respiratory deaths. Sleep duration was assessed during the NHANES examination period. A survey-weighted Cox proportional hazards model was used to evaluate the association between sleep and mortality. Results: A total of 13,947 participants with available NHANES data were included in this study. A U-shaped association between sleep duration and mortality was observed for all-cause and cardiovascular mortality, meanwhile, respiratory mortality was linked to moderately short sleep (>5 and <7 hours). For total mortality, the association with severe short sleep (5 hours or less; p<0.01) was generally stronger than the association with long sleep (>8 hours; p=0.029), with the effect of severe short sleep being significantly prominent in males (p<0.01), non-Hispanic White (0.001), high-income (0.056), and those with a body mass index ≥23.0 kg/m2 (0.001) than those in their counterparts. Conclusions: This study suggests that sleep duration is associated with the mortality risk. Our results provide evidence for a more targeted allocation of public health resources to improve sleep and health.
7.Sleep Duration, Mortality, and High-Risk Populations: A Nationwide Study in the United States
Minjeong KIM ; Hyejung LEE ; Seoyeong AHN ; Whanhee LEE
Journal of Sleep Medicine 2024;21(3):150-161
Both insufficient and excessive sleep durations have been recognized as important risk factors for mortality. Nevertheless, the impact of sleep duration on cause-specific mortality and potential effect modifiers has not been investigated extensively. Therefore, this study aimed to assess the association between sleep duration and mortality categorized by cause of death and potential effect modifiers using data from the National Health and Nutrition Examination Survey (NHANES). Methods: We established a prospective cohort based on NHANES participants aged 50 years or older, linked to the National Death Index (NDI) in the United States between 2009 and 2018. The NDI included all-cause, cardiovascular, and respiratory deaths. Sleep duration was assessed during the NHANES examination period. A survey-weighted Cox proportional hazards model was used to evaluate the association between sleep and mortality. Results: A total of 13,947 participants with available NHANES data were included in this study. A U-shaped association between sleep duration and mortality was observed for all-cause and cardiovascular mortality, meanwhile, respiratory mortality was linked to moderately short sleep (>5 and <7 hours). For total mortality, the association with severe short sleep (5 hours or less; p<0.01) was generally stronger than the association with long sleep (>8 hours; p=0.029), with the effect of severe short sleep being significantly prominent in males (p<0.01), non-Hispanic White (0.001), high-income (0.056), and those with a body mass index ≥23.0 kg/m2 (0.001) than those in their counterparts. Conclusions: This study suggests that sleep duration is associated with the mortality risk. Our results provide evidence for a more targeted allocation of public health resources to improve sleep and health.
8.Greenness and kidney? A review of epidemiological studies on the association between green space and kidney disease
Jiwoo PARK ; Hyewon YUN ; Whanhee LEE
Kidney Research and Clinical Practice 2024;43(1):63-70
Recent accumulating epidemiological evidence underlines the important role of environmental exposures on kidney diseases. Among environmental exposures, this study addresses “Green space,” which has been recognized as one of the major environmental exposures at the population level. We review a total of seven epidemiological studies currently published on greenness and kidney disease. We also discuss knowledge gaps in the epidemiological evidence in relation to study design, greenness exposure index, emerging kidney outcomes, and inequalities. With an increase in public attention regarding environmental risks and climate change, an improved understanding of the beneficial effects of green space can play an important role in promoting kidney health.
9.Interrupting Effect of Social Distancing on Ischemic Heart Disease, Asthma, Stroke, and Suicide Attempt Patients by PM 2.5 Exposure
Minseo CHOI ; Mia SON ; Sanghyuk BAE ; Whanhee LEE ; Kyung-Nam KIM ; Jung K HYUN
Yonsei Medical Journal 2024;65(5):302-313
Purpose:
This study aimed to examine the interrupting effect of social distancing (SD) on emergency department (ED) patients with ischemic heart disease (IHD), stroke, asthma, and suicide attempts by PM 2.5 exposure in eight Korean megacities from 2017 to 2020.
Materials and Methods:
The study used National Emergency Department Information System and AirKorea data. A total of 469014 patients visited EDs from 2017 to 2020. Interrupted time series analysis was employed to examine changes in the level and slope of the time series, relative risk, and confidence intervals (CIs) by PM 2.5 exposure. The SD level was added to the sensitivity analysis.
Results:
The interrupted time series analysis demonstrated a significant increase in the ratio of relative risk (RRR) of IHD patients in Seoul (RRR=1.004, 95% CI: 1.001, 1.006) and Busan (RRR=1.007, 95% CI: 1.002, 1.012) post-SD. Regarding stroke, only patients in Seoul exhibited a significant decrease post-SD (RRR=0.995, 95% CI: 0.991, 0.999). No significant changes were observed for asthma in any of the cities. In the case of suicide attempts, Ulsan demonstrated substantial pre-SD (RR=0.827, 95% CI: 0.732, 0.935) and post-SD (RRR=1.200, 95% CI: 1.057, 1.362) differences.
Conclusion
While the interrupting effect of SD was not as pronounced as anticipated, this study did validate the effectiveness of SD in modifying health behaviors and minimizing avoidable visits to EDs in addition to curtailing the occurrence of infectious diseases.
10.A Proactive Testing Strategy to COVID-19 for Reopening University Campus during Omicron Wave in Korea: Ewha Safe Campus (ESC) Project
Whanhee LEE ; Kyunghee JUNG-CHOI ; Hyunjin PARK ; Seunghee JUN ; Nackmoon SUNG ; Sun-Hwa LEE ; Misun CHANG ; Hee Jung CHOI ; Chung-Jong KIM ; Hyesook PARK ; Eunhee HA
The Ewha Medical Journal 2023;46(3):e7-
Objectives:
Ewha Womans University launched an on-campus Coronavirus disease-19 (COVID-19) response system called Ewha Safety Campus (ESC) Project in collaboration with the Seegene Inc. RTPCR diagnostic tests for COVID-19 were proactively provided to the participants. This study examines the effectiveness of the on-campus testing strategy in controlling the reproduction number (Rt ) and identifying student groups vulnerable to infection.
Methods:
The ESC project was launched on March 2, 2022, with a pilot period from Feb 22 to March 1, 2022—the peak of the Omicron variant wave. We collected daily data on the RT-PCR test results of the students of Ewha Womans University from Mar 2 to Apr 30, 2022. We daily calculated Rt and compared it with that of the general population of Korea (women, people aged 20–29 years, and Seoul residents). We also examined the students vulnerable to the infection based on the group-specific Rt and positivity rate.
Results:
A lower Rt was observed about 2 weeks after the implementation of the ESC Project than that of the general population. The lower Rt persisted during the entire study period. Dormitory residents had a higher Rt . The positivity rate was higher in students who did not comply with quarantine guidelines and did not receive the second dose of the vaccine.
Conclusion
The study provides scientific evidence for the effectiveness of the on-campus testing strategy and different infection vulnerabilities of students, depending on dormitory residence, compliance with the quarantine guidelines, and vaccination.

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