Epidemiology and Health最新文献

Objectives: Muscle strength is a key indicator of overall health, and its decline has been linked to increased morbidity and mortality. Socioeconomic factors may contribute to disparities in this decline. Therefore, this study aimed to examine trends in muscle strength and to identify groups with lower muscle strength according to socioeconomic variables.

Methods: We analyzed data from the cross-sectional Korea National Health and Nutrition Examination Survey (KNHANES), including 34,080 adults. Multivariable linear regression analyses were conducted, adjusting for socioeconomic and health-related covariates, and KNHANES survey weights were applied to obtain nationally representative estimates that accounted for the complex sampling design.

Results: Overall, mean grip strength significantly decreased from 2014 to 2022 in both males (from 43.45±0.24 to 41.59± 0.29 kg) and females (from 26.48±0.15 to 24.94±0.13 kg). This trend was consistently observed across all covariate strata, except for individuals aged over 70 years and those in the green-collar occupational group. In 2022, grip strength was lower among individuals with the lowest education level (26.45±0.34 vs. 34.75±0.32 kg in the undergraduate group) and the lowest household income level (29.59±0.45 vs. 34.53±0.35 kg in the highest income group), as well as among unemployed individuals (29.36± 0.30 vs. 37.00±0.47 kg in the blue-collar group), compared with their higher socioeconomic counterparts.

Conclusions: These findings provide descriptive evidence of grip strength trends and socioeconomic disparities in Korea. They may serve as baseline information to guide future longitudinal studies and inform public health strategies.

Objectives: Korea is becoming a multiethnic society, with immigrants comprising nearly 5% of the population. Evidence on cardiovascular disease (CVD) risk among immigrants remains limited.

Methods: We conducted a population-based study of 582 immigrants in Gwangju and 2,328 age-matched and gender-matched native Koreans (2022-2023). Immigrant data were obtained from direct health assessments, while native Korean data were drawn from the Korea National Health and Nutrition Examination Survey. CVD risk was estimated using the Framingham risk score (FRS) and pooled cohort equations (PCE). Logistic regression was employed to compare the odds of elevated risk (10-year CVD risk ≥7.5%), adjusting for socio-demographic and behavioral factors.

Results: Immigrants had a higher prevalence of hypertension (37.3 vs. 16.1%), diabetes (11.5 vs. 5.6%), poor self-rated health (69.6 vs. 61.3%), and unmet medical needs (30.9 vs. 8.9%), as well as lower rates of health checkups and cancer screening (all p<0.001), compared to native Koreans. Elevated CVD risk was more frequent in immigrants (FRS, 31.4 vs. 20.8%; PCE, 33.6 vs. 22.8%). The adjusted odds ratios (95% confidence intervals) were 1.47 (1.14 to 1.88) for FRS and 1.49 (1.07 to 2.08) for PCE. Disparities were greatest among women, adults ≥40 years, uninsured people, low-income groups, and migrants from Central Asia, Russia, and Africa.

Conclusions: Immigrants in Korea face substantially higher CVD risk than native Koreans, particularly within socioeconomically vulnerable subgroups. Targeted prevention and policies addressing structural barriers are urgently needed.

Objectives: This study investigated the associations between usual source of care (USC) characteristics, which incorporate primary care functions, and medication adherence and healthy behaviors in Korean adults with diabetes.

Methods: We used data from 1,543 adults with diabetes in the 2020 Korea Health Panel Survey. USC was categorized into 5 types based on whether a regular doctor was identified and whether that provider fulfilled comprehensiveness and coordination functions. Multivariable logistic regression was used to assess associations with medication adherence and healthy behaviors.

Results: A significant difference in medication adherence was observed by USC type, although no significant associations emerged for healthy behaviors (smoking, drinking, exercise). Compared to the group without a USC, patients whose regular doctor fulfilled either function were 2.38 times more likely to adhere (odds ratio [OR], 2.38; 95% confidence interval [CI], 1.70 to 3.32), and those whose doctor fulfilled both functions were 1.84 times more likely to adhere (OR, 1.84; 95% CI, 1.31 to 2.59). This association was particularly strong for adherence to medication dosage, frequency, and timing.

Conclusions: The findings underscore that the functional quality of the USC, particularly the fulfillment of comprehensiveness and coordination, is crucial in improving medication adherence. Simply having a USC is insufficient. The lack of association with healthy behaviors suggests that physicians may focus more on pharmacological control, highlighting the need for multifaceted interventions.

Objectives: The American Heart Association (AHA) recently defined cardiovascular-kidney-metabolic (CKM) syndrome to better characterize the associations among cardiovascular, kidney, and metabolic diseases. Although about 9 in 10 United States adults have at least 1 risk factor for CKM syndrome, its prevalence in other populations is less understood. To fill this gap, we examined the prevalence of CKM syndrome in Korea and its association with demographic and socioeconomic status (SES).

Methods: Using data from the Korean National Health and Nutrition Examination Survey between 2011 and 2021, we calculated the prevalence of CKM syndrome across the following stages: stage 0 (no risk factors), stage 1 (excess or dysfunctional adiposity), stage 2 (other metabolic risk factors or chronic kidney disease), and stages 3-4 (subclinical/clinical cardiovascular diseases) among adults aged ≥20 years. Weighted analyses were used to estimate prevalence and 95% confidence intervals (CIs) for each CKM syndrome stage, stratified by age, gender, and SES factors.

Results: Among 54,994 Korean adults, the prevalence of CKM syndrome was as follows: stage 0 (25.2%; 95% CI, 24.7 to 25.8), stage 1 (19.3%; 95% CI, 18.9 to 19.7), stage 2 (51.6%; 95% CI, 51.1 to 52.2), and stages 3-4 (3.9%; 95% CI, 3.7 to 4.0). The prevalence of stages 2 and 3-4 was higher in men than in women. In addition, stages 3-4 were more prevalent among rural residents and those with lower education or income.

Conclusions: About 3 out of 4 Koreans are at risk for CKM syndrome. These findings highlight that CKM syndrome is a global health problem and that interventions are urgently needed to prevent further progression.

This study compares biomarker levels among environmentally vulnerable residents in Korea, the general Korean population, and Asians in the United States. We selected 953 exposed residents and 204 controls from the Forensic Research via Omics Markers in Environmental Health Vulnerable Areas (FROM) study (2021-2023), 4,239 participants from the fourth Korean National Environmental Health Survey (2018-2020), and 996 Asians from the U.S. National Health and Nutrition Examination Survey (2017-March 2020). The analyzed biomarkers included blood and urinary metals, urinary metabolites of polycyclic aromatic hydrocarbons, nicotine, volatile organic compounds, and serum perfluorocarbon metabolites. The highest median biomarker levels varied by pollution source among older adults. In refineries, blood lead and cadmium (Cd), as well as urinary Cd and 2-hydroxyfluorene, were highest. Abandoned metal mines exhibited the highest blood and urinary mercury, urinary Cd, total arsenic (As), 2-naphthol, and cotinine levels. Coal-fired power plants showed the highest urinary 1- hydroxyphenanthrene levels, while cement factories had the highest urinary As3+ levels. Sprawls demonstrated the highest urinary monomethylarsonic acid, 1-hydroxypyrene, and phenylglyoxylic acid levels, and industrial areas recorded the highest levels of trans, trans-muconic acid, benzylmercapturic acid, and 2-methylhippuric acid. In general, biomarker levels were higher among exposed residents in the FROM study than in the general population; however, urinary 2-hydroxyfluorene and As5+ levels did not differ significantly. Exposure to pollution sources in environmentally vulnerable areas may elevate biomarker levels in residents.

Objectives: This study investigated regional disparities in adult oral health examination rates in Korea, despite free oral health screenings by the National Health Insurance Service (NHIS). It focused on the impact of provider factors, such as the availability of dental clinics and non-dental institutions.

Methods: A cross-sectional analysis of 2022 data from 229 districts was conducted. The dependent variable was the adult oral health examination rate, while independent variables included provider factors, community health status, lifestyle, demographic, and socioeconomic characteristics. Descriptive statistics, Pearson's correlation, and multiple regression analyses identified significant predictors.

Results: Non-metropolitan areas had higher oral health examination rates (27.4%) than metropolitan areas (25.3%). Correlation analysis showed the general health examination rate (r=0.583) and the number of screening institutions (r=0.234) were the strongest predictors (p<0.001). Regression analysis showed a 1% increase in general health examination rates led to a 1.44% rise in oral health examination rates (p<0.001).

Conclusions: Despite NHIS policies, significant regional disparities persist, showing that providing screenings alone is insufficient. Integrating oral health screenings with general health examinations is necessary. Policymakers must promote collaboration between dental and non-dental providers to ensure equitable, integrated health services, enhancing preventive care and reducing disparities.

Objectives: This study investigated the safety of azilsartan and amlodipine combination therapy versus other angiotensin receptor blockers (ARBs) and amlodipine in patients with hypertension.

Methods: We conducted a cohort study utilizing healthcare databases from Korea and Taiwan. Patients aged between 18 years and 75 years who were newly prescribed both an ARB and amlodipine within 6 months of hypertension diagnosis were included. Safety outcomes assessed were hypotension, angioedema, acute pancreatitis, hyperkalemia, hypokalemia, toxic liver disease, hepatic failure, nausea and vomiting, and fall-related injury. Hazard ratios (HRs) with 95% confidence intervals (CIs) for each safety outcome associated with azilsartan medoxomil and amlodipine versus other ARBs combined with amlodipine were calculated within a 1:1 propensity score (PS)-matched cohort. Summary HRs across databases were computed using random-effects meta-analysis.

Results: We identified 2,472 eligible patients (1,521 from Korea, 951 from Taiwan) initiating treatment with azilsartan medoxomil and amlodipine, and 671,468 patients (312,322 from Korea, 355,409 from Taiwan) initiating other ARBs with amlodipine. After PS matching, baseline characteristics were well-balanced between treatment groups. During the 180-day follow-up, most adverse outcomes did not occur even once in either group, thus precluding the calculation of HRs. The risk of acute pancreatitis was not significantly different between the azilsartan medoxomil and amlodipine group and the other ARB and amlodipine groups (summary HR, 0.86; 95% CI, 0.14 to 5.37).

Conclusions: In this population-based cohort study, azilsartan medoxomil combined with amlodipine was not associated with an increased risk of adverse outcomes compared to other ARBs combined with amlodipine.

Objectives: This study aimed to evaluate the association between long-term exposure to particulate matter with an aerodynamic diameter <2.5 μm (PM2.5) and cause-specific mortality among older adults in Korea, providing insights into the evolving public health burden in an aging society.

Methods: We analyzed national insurance claims data spanning 2010-2019. Modeled PM2.5 concentrations were assigned to participants according to their residential districts. We employed time-varying Cox proportional hazard models, using age as the time scale, adjusted for potential confounders. Six cause-specific mortalities were considered: ischemic heart disease (IHD), stroke, chronic obstructive pulmonary disease (COPD), acute lower respiratory infection (ALRI), lung cancer (LC), and type 2 diabetes mellitus (T2DM). Annual excess deaths attributable to long-term PM2.5 exposure were calculated.

Results: A total of 5,360,032 older adults were followed from 2010 to 2019. Hazard ratios (HRs) per 10 μg/m3 increase in 12-month PM2.5 concentration were as follows: IHD, 1.068 (95% CI, 1.040 to 1.097); stroke, 1.023 (95% CI, 1.003 to 1.043); ALRI, 1.050 (95% CI, 1.026 to 1.076); COPD, 1.114 (95% CI, 1.072 to 1.157); T2DM, 1.046 (95% CI, 1.007 to 1.086); and LC, 0.972 (95% CI, 0.948 to 0.996). Excess deaths attributable to long-term PM2.5 exposure were estimated at 4,888 (95% CI, 2,304 to 7,323) in 2010 and 5,179 (95% CI, 2,585 to 7,648) in 2019.

Conclusions: Although PM2.5 levels in Korea have shown a declining trend over the past decade, mortality among older adults associated with long-term PM2.5 exposure has not significantly decreased, likely due to the rapid aging of the population.

The Cardiovascular Metabolic Etiological Research Center COVID-19 Mental Health Survey (CC-MHS) is a comprehensive longitudinal cohort study investigating the mental health impact of the coronavirus disease 2019 pandemic by utilizing pre-existing baseline data from the Cardiovascular Metabolic Etiological Research Center cohort (2013-2018). This study assesses physical health, lifestyle changes, and mental health using validated tools, including the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and the PTSD Checklist for DSM-5, and evaluates a population of urban and suburban Korean participants across multiple dimensions. Through online surveys, the research identified gender-specific social support mechanisms, showing that men benefit from larger social networks, whereas women derive protective effects from stronger emotional connections. Key findings underscore complex interactions among demographic factors, psychological variables, and public health responses, especially in the context of vaccination attitudes and trust in pandemic management. The CC-MHS delivers critical insights into mental health trajectories during global health crises, offering valuable evidence for developing adaptive public health strategies and for understanding the intricate relationships between individual psychological resilience and broader societal health challenges.

Objectives: This study aimed to assess health literacy and identify vulnerable groups, providing a basis for developing health policies aimed at improving health literacy, using data from the 2023 Korea National Health and Nutrition Examination Survey (KNHANES).

Methods: The health literacy measurement tool used in the 2023 KNHANES comprised a total of 10 items spanning the domains of disease prevention, health promotion, healthcare, and technology and resources. Health literacy was analyzed in relation to socio-demographic characteristics and major health behaviors among 5,906 adults aged 19 years or older, using the SAS program.

Results: As of 2023, the overall prevalence of adequate health literacy among adults was 60.4%. Adequate health literacy was higher in women (62.2%) than in men (58.6%). Younger individuals exhibited higher levels of health literacy, with those aged 19-64 years at 65.9%, compared to only 40.3% among those aged 65 or older. Higher income and education levels were also associated with greater health literacy. Regarding health behavior characteristics, individuals practicing healthy lifestyles, such as non-smoking, engaging in physical activity, and undergoing health checkups, demonstrated higher health literacy than those who did not engage in such behaviors.

Conclusions: Six out of 10 Korean adults demonstrated adequate health literacy, but significant differences were observed according to socio-demographic characteristics (e.g., age and education) and health behaviors (e.g., smoking and physical activity). Tailored education and policy initiatives are necessary to improve health literacy, particularly targeting older adults, low-income groups, individuals with lower education, and those who do not practice healthy lifestyles.