Epidemiology and Health

Most-download articles are from the articles published in 2023 during the last three month.

Original Article

Geospatial analysis of neonatal mortality in north-eastern India: a multilevel Bayesian approach: Vidhi Jain, Kh. Jitenkumar Singh, Deboshree Das, Shefali Gupta, Gunjan Singh; Epidemiol Health. 2025;47:e2025021. Published online April 27, 2025; DOI: https://doi.org/10.4178/epih.e2025021

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Abstract PDF: Abstract
OBJECTIVES
Neonatal mortality remains a significant public health issue in India. This study investigates spatial patterns and contributing factors to neonatal mortality in the north-eastern states, identifying hotspot regions and spatial variations.
METHODS
A sample of 34,222 mothers from India’s National Family Health Survey (NFHS-5, 2019-21) in the north-eastern states was analysed. Descriptive and bivariate analyses were conducted alongside Bayesian multilevel logistic regression using integrated nested Laplace approximation to model neonatal mortality. Spatial hotspot analysis using Getis-Ord Gi* statistics identified clusters of high neonatal mortality, while geographically weighted regression (GWR) was used to examine spatial variations in the relationships between neonatal mortality and contributing factors.
RESULTS
The neonatal mortality rate in the north-eastern states declined from 45 to 21 per 1,000 live births (NFHS-1 to NFHS-5) but remains higher than the national average. Assam reported the highest mortality (42.16%), whereas Sikkim had the lowest (0.87%). Higher mortality was observed among male infants, mothers with advanced age, low maternal education, and mothers who attended less than 5 antenatal care (ANC) visits. Spatial analysis identified hotspots in Assam, Meghalaya, and Tripura. GWR indicated that areas with less than 5 ANC visits had the strongest association with neonatal mortality. Bayesian multilevel analysis highlighted spatial variations of up to 51% across districts in northeast India.
CONCLUSIONS
This study underscores spatial disparities in neonatal mortality across north-eastern India. Addressing childcare practices and healthcare access in hotspot regions is essential for improving new-born health outcomes. The findings provide critical insights for policymakers to develop targeted interventions aimed at reducing neonatal mortality in these underserved areas.; Summary

Special Article

Cancer risk based on alcohol consumption levels: a comprehensive systematic review and meta-analysis: Seunghee Jun, Hyunjin Park, Ui-Jeong Kim, Eun Jeong Choi, Hye Ah Lee, Bomi Park, Soon Young Lee, Sun Ha Jee, Hyesook Park; Epidemiol Health. 2023;45:e2023092. Published online October 16, 2023; DOI: https://doi.org/10.4178/epih.e2023092

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24 Web of Science
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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Alcohol consumption is a well-established risk factor for cancer. Despite extensive research into the relationship between alcohol consumption and cancer risk, the effect of light alcohol consumption on cancer risk remains a topic of debate. To contribute to this discourse, we conducted a comprehensive systematic review and meta-analysis.

METHODS

Our systematic review aimed to investigate the associations between different levels of alcohol consumption and the risk of several cancer types. We focused on analyzing prospective associations using data from 139 cohort studies. Among them, 106 studies were included in the meta-analysis after a quantitative synthesis.

RESULTS

Our analysis did not find a significant association between light alcohol consumption and all-cause cancer risk (relative risk, 1.02; 95% confidence interval, 0.99 to 1.04), but we observed a dose-response relationship. Light alcohol consumption was significantly associated with higher risks of esophageal, colorectal, and breast cancers. Light to moderate drinking was associated with elevated risks of esophageal, colorectal, laryngeal, and breast cancers. Heavy drinking was also found to contribute to the risk of stomach, liver, pancreas, and prostate cancers, thereby increasing the risk of almost all types of cancer. Additionally, females generally had lower cancer risks compared to males.

CONCLUSIONS

Our findings highlight that cancer risks extend beyond heavy alcohol consumption to include light alcohol consumption as well. These findings suggest that there is no safe level of alcohol consumption associated with cancer risk. Our results underscore the importance of public health interventions addressing alcohol consumption to mitigate cancer risks.

Summary

Korean summary
본 연구는 코호트 연구를 기반으로 하여 음주의 수준에 따른 암 위험 연관성에 대해 체계적 문헌고찰(139편)과 메타분석(106편)을 수행하였다. 연구 결과, 음주와 암 위험 사이에 용량-반응 관계가 나타났으며, 소량의 음주는 암 유형에 따라 차이가 있었으나, 식도암, 대장암, 전립선암(남성), 유방암(여성)에서 암 위험과의 연관성이 있음을 발견했다. 따라서, 암 위험 측면에서 음주에 안전한 수준이 없음을 시사하며, 음주와 관련된 잠재적 피해를 완화하기 위해서는 음주 지침 강화와 같은 공중보건개입이 필요하다.

Key Message
The aim of this study was to assess the relationship between different levels of alcohol consumption and the risk of various cancer types through a systematic review and meta-analysis, providing insights into the ongoing debate about alcohol consumption and cancer causality. The findings support a dose-response relationship between alcohol consumption levels and cancer risk and the light alcohol consumption was associated with risks of esophageal, colorectal, prostate (male), and breast (female) cancer. These results emphasize the absence of a safe threshold for alcohol consumption in terms of cancer risk.

Citations

Citations to this article as recorded by

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Liwei Ma, Edwin C. K. Tan, Benjamin Goudey, Liang Jin, Yijun Pan
Alzheimer's & Dementia.2025;[Epub] CrossRef
Associations of lifestyle factors with oral cancer risk: An umbrella review
Haobo Xu, Zhonglan Gao, Hairong Liu, Liya An, Ting Yang, Bojun Zhang, Guobin LIU, Dali Sun
Journal of Stomatology Oral and Maxillofacial Surgery.2025; 126(3): 102234. CrossRef
Estudio bibliométrico de las publicaciones sobre cirugía pancreática realizadas por cirujanos españoles
Juan Jesús Rubio-García, Celia Villodre Tudela, Cándido Alcázar López, Silvia Carbonell Morote, Mariano Franco Campello, Paola Melgar Requena, Adrián Paredes Segura, José Manuel Ramia Ángel
Cirugía Española.2025; 103(4): 201. CrossRef
Personalized Lifestyle Interventions for Prevention and Treatment of Obesity-Related Cancers: A Call to Action
Mohamad Motevalli, Fatima Cody Stanford
Cancers.2025; 17(8): 1255. CrossRef
Bibliometric study of publications on pancreatic surgery carried out by spanish surgeons
Juan Jesús Rubio-García, Celia Villodre Tudela, Cándido Alcázar López, Silvia Carbonell Morote, Mariano Franco Campello, Paola Melgar Requena, Adrián Paredes Segura, José Manuel Ramia Ángel
Cirugía Española (English Edition).2025; 103(4): 201. CrossRef
Alcohol consumption and breast lesions: targets for risk-based screening in high-risk Italian women
Sonia Cerrai, Alessio Lachi, Michela Franchini, Stefania Pieroni, Giada Anastasi, Marco Scalese, Anna Odone, Silvano Gallus, Luc Smits, Sabrina Molinaro
Breast Cancer.2025;[Epub] CrossRef
Design and Optimization of Surface Plasmon Resonance-Based Non-Invasive Refractive Index Biosensor Using Ag-SiO2 Materials for Alcoholic Beverages Compound Detection
Trupti Kamani, Shobhit K. Patel, Sana Ben Khalifa, Pankaj Pathak, Saleh Chebaane, Marouan Kouki
Plasmonics.2025;[Epub] CrossRef
Invisible foes: how air pollution and lifestyle conspire in the rise of colorectal cancer
Di Zhao, Meng Zhu
QJM: An International Journal of Medicine.2025;[Epub] CrossRef
Wine Consumption and Lung Cancer Risk: A Systematic Review and Meta-Analysis
Carlotta Bertola, Camilla Gobbetti, Gaia Baccarini, Roberto Fabiani
Nutrients.2025; 17(8): 1322. CrossRef
A narrative review on alcohol and alimentary tract cancer with special emphasis on acetaldehyde and oxidative stress
Helmut Karl Seitz
Zeitschrift für Gastroenterologie.2025;[Epub] CrossRef
Association of Cigarette Smoking and Alcohol Drinking With Risk of 12 Common Cancers Among Low-Income American Adults in the Southeastern United States
Jiajun Shi, Wanqing Wen, Qiuyin Cai, Martha J. Shrubsole, Xiao-Ou Shu, Wei Zheng
Cancer Control.2025;[Epub] CrossRef
Identification of MMP14 and MKLN1 as colorectal cancer susceptibility genes and drug-repositioning candidates from a genome-wide association study
Dabin Yun, Jung-Ho Yang, Jin-ah Sim, Minjung Kim, Ji Won Park, Seung Yong Jeong, Aesun Shin, Sun-Seog Kweon, Nan Song
Journal of Translational Medicine.2025;[Epub] CrossRef
Research Progress on Risk Factors and Endoscopic Diagnosis of Gastric Mucosal Intestinal Metaplasia
思妤刘
Advances in Clinical Medicine.2025; 15(05): 1135. CrossRef
Global Cancer Burden Forecast for 204 Countries and Territories, 2022–2050: A Predictive Analysis from the Global Burden of Disease Study 2021
Jinghao Liang, Yijian Lin, Wenxi Wang, Jingchun Ni, Hongmiao Lin, Zishan Huang, Jihao Qi, Zhaofeng Tan, Hengrui Liang, Jianxing He
Cancer Letters.2025; 629: 217883. CrossRef
Global burden of breast cancer attributable to alcohol consumption: a multi-regional observational analysis (1990–2021)
Fangfang Cui, Yuntian Chu, Weiyi Wang, Meihao Ji, Sidong Zhang, Zhengyu Wu, Yadong Song
Addictive Behaviors.2025; 170: 108426. CrossRef
Patterns of cigarette, e-cigarette, heated tobacco, and alcohol use in solid organ transplant recipients, a pre- versus posttransplant comparison: Survey results from a transplantation center in Poland
Zuzanna Marczak, Bartosz Olkowski, Olga Maria Rostkowska, Dorota Miszewska-Szyszkowska, Olga Kozińska-Przybył, Tomasz Warężak, Magdalena Durlik
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Analysis of Novel DNA Adducts Derived from Acetaldehyde
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Granulocyte function in response to acute alcohol consumption: temporal shifts from proinflammatory activation to antiinflammatory modulation in healthy volunteers
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The Impact of Tobacco Smoking and Alcohol Consumption on the Development of Gastric Cancers
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Genetic Heterogeneity Across Dimensions of Alcohol Use Behaviors
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To Drink or Not to Drink? Investigating Alcohol’s Impact on Prostate Cancer Risk
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Factors associated with acquiring exercise habits through health guidance for metabolic syndrome among middle-aged Japanese workers: A machine learning approach
Jiawei Wan, Kyohsuke Wakaba, Takeshi Onoue, Kazuyo Tsushita, Yoshio Nakata
Preventive Medicine Reports.2024; 48: 102915. CrossRef
Development of an algorithm for identifying paraneoplastic ischemic stroke in association with lung, pancreatic, and colorectal cancer
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Alcohol consumption and its association with cancer, cardiovascular, liver and brain diseases: a systematic review of Mendelian randomization studies
Naouras Bouajila, Cloé Domenighetti, Henri-Jean Aubin, Mickael Naassila
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Prévention et dépistage des cancers dans les rhumatismes inflammatoires chroniques
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Global, regional, and national trends in gastric cancer burden: 1990-2021 and projections to 2040
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Alcohol Consumption and Breast and Ovarian Cancer Development: Molecular Pathways and Mechanisms
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Original Articles

Inequality in mortality according to regional deprivation during the COVID-19 pandemic: Min Hui Moon, Young Gyu Ko, Min Hyeok Choi; Epidemiol Health. 2025;47:e2025022. Published online April 29, 2025; DOI: https://doi.org/10.4178/epih.e2025022

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Abstract Summary PDF: Abstract
OBJECTIVES
Vulnerability to coronavirus disease 2019 (COVID-19) is significantly greater in regions with lower socioeconomic status (SES). However, detailed analyses of regional socioeconomic disparities have rarely been conducted in Korea. This study aimed to identify and compare mortality inequalities associated with regional SES across different areas of Korea during the COVID-19 pandemic.
METHODS
Using cause-of-death statistics from 2020 to 2022, we calculated age-standardized mortality rates (ASMRs) for total mortality, COVID-19 mortality, and pneumonia mortality. The SES of each region was assessed using the regional deprivation index. Additionally, we calculated the rate difference, rate ratio, slope index of inequality (SII), and relative index of inequality (RII) for each socioeconomic level to examine the extent of mortality inequality and its temporal changes. These analyses were stratified by gender and urban-rural classification.
RESULTS
The total mortality rate, as well as COVID-19-specific and pneumonia-specific mortality rates, increased during the COVID-19 pandemic. The ASMR for COVID-19 was higher in rural areas (ASMR, 27.79), which have lower healthcare accessibility, compared to urban areas (ASMR, 26.63). However, mortality inequality indicators for COVID-19 were more pronounced in urban areas compared to rural areas (SII: urban, 2.72; rural, -0.05, RII: urban, 0.10; rural, 0.00). Notably, significant inequalities were observed among men residing in urban areas.
CONCLUSIONS
In disaster situations such as the COVID-19 pandemic, it is essential to implement strategies aimed at reducing overall mortality rates and addressing regional socioeconomic inequalities.; Summary

Korean summary
COVID-19 팬데믹 기간 동안, 지역의 사회경제적 수준은 한국의 사망률에 중요한 영향을 미쳤다. 총사망률, COVID-19 사망률, 폐렴 사망률에 대한 연령표준화사망률(ASMR)은 의료 접근성이 낮고 박탈 수준이 높은 농촌 지역에서 더 높게 나타났으나, 상대적인 사망 불평등은 특히 남성을 중심으로 도시 지역에서 더 두드러지게 나타났다. 이러한 결과는 공중보건 위기 상황에서 건강 불평등이 지역의 사회경제적 수준과 맥락에 따라 복합적으로 작용함을 보여준다. 정책 입안자들은 지역 간 사회경제적 수준에 따른 절대적 불평등과 상대적 불평등을 모두 고려한 맞춤형 개입 전략을 수립하고, 형평한 의료 접근성을 확보함으로써 향후 팬데믹에서의 사망 위험을 줄이기 위한 노력을 강화해야 한다.

Key Message
During the COVID-19 pandemic, regional socioeconomic disparities significantly influenced mortality in Korea. Mortality rates were higher in deprived rural areas, while relative inequalities were more evident in urban men. Tailored policies addressing both absolute and relative inequalities are essential to ensure equitable healthcare access in future crises.

Association between regular dental scaling and stroke risk in patients with periodontal diseases: evidence from a Korean nationwide database: Yu-Rin Kim, Minkook Son, Seon-Rye Kim; Epidemiol Health. 2025;47:e2025020. Published online April 19, 2025; DOI: https://doi.org/10.4178/epih.e2025020

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Abstract Summary PDF: Abstract
OBJECTIVES
This study aimed to evaluate the association between the frequency of dental scaling and the risk of stroke among individuals with moderate-to-severe periodontal diseases and verify the effect of regular dental scaling on stroke risk in this population.
METHODS
In this retrospective study, 25,758 subjects with moderate-to-severe periodontal diseases were selected from the Korean National Health Insurance Service-National Health Screening Cohort database. Based on the frequency of dental scaling, the subjects were divided into three groups: regular, occasional, and infrequent. Restricted cubic splines were used to evaluate hazard ratios (HRs) with 95% confidence intervals (CIs) for stroke. Additionally, landmark analysis was conducted to strengthen the reliability of the results.
RESULTS
There were 293, 111, and 38 stroke cases in the infrequent, occasional, and regular group, respectively. The adjusted HR for stroke in the regular group, compared to that in the infrequent group, was 0.40 (95% CI, 0.29 to 0.57). In the landmark analysis with follow-up after 1 year and after 2 years, the adjusted HR in the regular group compared to that in the infrequent group was 0.41 (95% CI, 0.28 to 0.60) and 0.50 (95% CI, 0.33 to 0.76), respectively.
CONCLUSIONS
Regular dental scaling was significantly associated with a reduced risk of stroke in patients with moderate-to-severe periodontal diseases. These findings may suggest a potential preventive role of dental scaling beyond oral health. Further studies are needed to explore the underlying biological mechanisms linking periodontal care to stroke prevention and to explore causal relationships between dental scaling and stroke risk.; Summary

Korean summary
중등도 이상의 치주염을 가진 성인을 대상으로 분석한 결과, 정기적으로 치석 제거(스케일링)를 시행한 집단은 비정기적 또는 미시행 집단에 비해 뇌졸중 발생 위험이 통계적으로 유의하게 낮은 것으로 나타났다. 이러한 보호 효과는 특히 남성 및 65세 이상 고령층에서 더욱 뚜렷하게 관찰되었다. 본 결과는 정기적인 구강건강관리가 뇌혈관질환 예방에 있어 잠재적인 기여 요인임을 시사한다.

Key Message
Among adults with moderate to severe periodontitis, those who underwent regular dental scaling had a significantly lower risk of stroke compared to those without routine scaling. This protective effect was especially evident in males and individuals aged 65 and older. These results suggest that regular oral healthcare may serve as a potential contributing factor in the prevention of cerebrovascular diseases.

Risk of non-cancer respiratory diseases attributed to humidifier disinfectant exposure in Koreans: age-period-cohort and differences-in-difference analyses: Jaiyong Kim, Kyoung Sook Jeong, Seungyeon Heo, Younghee Kim, Jungyun Lim, Sol Yu, Suejin Kim, Sun-Kyoung Shin, Hae-Kwan Cheong, Mina Ha, Epidemiology Expert Committee for Reviewing the Epidemiological Correlations between Humidifier Disinfectant Exposure and Health Effects; Epidemiol Health. 2025;47:e2025006. Published online February 22, 2025; DOI: https://doi.org/10.4178/epih.e2025006

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Humidifier disinfectants (HDs) were sold in Korea from 1994 until their recall in 2011. We examined the incidence patterns of 8 respiratory diseases before and after the HD recall and estimated the attributable risk in the Korean population.
METHODS
Using National Health Insurance data from 2002 to 2019, we performed age–cohort–period and differences-in-diffference analyses (comparing periods before vs. after the recall) to estimate the population-attributable fraction and the excess number of episodes. The database comprised 51 million individuals (99% of the Korean population). The incidence of 8 diseases—acute upper respiratory infection (AURI), acute lower respiratory infection (ALRI), asthma, pneumonia, chronic sinusitis (CS), interstitial lung disease (ILD), bronchiectasis, and chronic obstructive pulmonary disease (COPD)—was defined by constructing episodes of care based on patterns of medical care and the clinical characteristics of each disease.
RESULTS
The relative risks (RRs) for AURI, ALRI, asthma, pneumonia, CS, and ILD were elevated among younger individuals (with an RR as high as 82.18 for AURI in males), whereas chronic conditions such as bronchiectasis, COPD, and ILD showed higher RRs in older individuals. During the HD exposure period, the population-attributable risk percentage ranged from 4.6% for bronchiectasis to 25.1% for pneumonia, with the excess number of episodes ranging from 6,218 for ILD to 3,058,861 for CS. Notably, females of reproductive age (19-44 years) experienced 1.1-9.2 times more excess episodes than males.
CONCLUSIONS
This study provides epidemiological evidence that inhalation exposure to HDs affects the entire respiratory tract and identifies vulnerable groups.; Summary

Korean summary
- 2002년부터 2012년까지 가습기살균제 흡입 노출은 한국 인구의 호흡기 질환 중 4~25%에 기여했으며, 특히 천식, 폐렴, 간질성폐질환이 젊은 연령층에서 더 큰 영향을 보였다. - 기관지확장증과 간질성폐질환 같은 만성질환에서는 고령층에서 초과 발생 사례 수가 더 많았다. - 어린이, 노인, 가임기 여성이 취약집단으로 확인되었다.

Key Message
- From 2002 to 2012, humidifier disinfectant inhalation exposure contributed to 4–25% of respiratory diseases in Korea, with greater effects among younger people, especially for asthma, pneumonia, and interstitial lung disease. - Older individuals showed more excess episodes for chronic conditions like bronchiectasis and interstitial lung disease. - The young, the elderly, and reproductive-age women were identified as vulnerable groups in association with humidifier disinfectant exposure.

Erratum

Characteristics of imported and domestic malaria cases in Gyeonggi Province, Korea: Sunghee Hong, Jihye Kim, Soo-Nam Jo, Jong-Hun Kim, Boyoung Park, Bo Youl Choi; Epidemiol Health. 2025;47:e2024087.E. Published online March 17, 2025; DOI: https://doi.org/10.4178/epih.e2024087.E; Corrects: Epidemiol Health 2024;46:e2024087

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Original Article

Prevalence of cardiovascular-kidney-metabolic syndrome in Korea: Korea National Health and Nutrition Examination Survey 2011-2021: Sung-Bin Hong, Ji-Eun Kim, Seung Seok Han, Joseph J. Shearer, Jungnam Joo, Ji-Yeob Choi, Véronique L. Roger; Epidemiol Health. 2025;47:e2025005. Published online February 14, 2025; DOI: https://doi.org/10.4178/epih.e2025005

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1 Crossref

Abstract Summary PDF Supplementary Material

Abstract

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.

Summary

Korean summary
최근, 심장-신장-대사 증후군을 하나로 묶어 관리하는 것의 필요성이 대두되고 있다. 본 연구 결과 20세 이상의 한국 성인들의 74.8%가 심장-신장-대사 증후군의 위험군에 속해 있었다. 또한 그 정도가 증가하는 추세로 나타나 적절한 관리가 필요해 보인다.

Key Message
Recently, the need for an integrated approach to managing cardiovascular-kidney-metabolic (CKM) syndrome has been emphasized. This study found that 74.8% of Korean adults aged 20 and older had a risk for CKM syndrome. Moreover, the prevalence is increasing, highlighting the necessity of proper management.

Citations

Citations to this article as recorded by

Relationship between estimated pulse wave velocity trajectories and cardiovascular disease risk in patients with cardiovascular-kidney-metabolic syndrome stages 0–3
Tingting Chen, Huangyi Yin, Yubo Zhou, Min Liang
Nutrition, Metabolism and Cardiovascular Diseases.2025; : 104192. CrossRef

Original article

Safety of combination therapy of azilsartan medoxomil and amlodipine: a population-based cohort study: Hyesung Lee, Bin Hong, Chris Tzu-Ting Su, Sungho Bea, Han Eol Jeong, Kyungyeon Jung, Michael Chun-Yuan Cheng, Zoe Chi-Jui Chang, Edward Chia-Cheng Lai, Jongyoung Lee; Epidemiol Health. 2025;e2025029. Published online May 28, 2025; DOI: https://doi.org/10.4178/epih.e2025029 [Accepted]

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Abstract PDF: Abstract
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 South Korea and Taiwan. Patients aged between 18 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, 0.14–5.37]).
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.; Summary

Original Articles

Effects of student human rights ordinances on mental health among middle and high school students in South Korea: a difference-in-differences analysis: Sang Jun Eun; Epidemiol Health. 2025;47:e2025011. Published online March 1, 2025; DOI: https://doi.org/10.4178/epih.e2025011

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
To actively protect and enhance students’ human rights, student human rights ordinances (SHROs) have been enforced in seven provinces in South Korea at different times since 2010. Although human rights are closely linked to mental health, there has been no research on the effectiveness of human rights legislation on adolescent mental health. This study evaluated the effects of SHROs on the mental health of middle and high school students.
METHODS
Repeated cross-sectional data were used, including 1,148,257 respondents from the Korea Youth Risk Behavior Web-based Survey between 2006 and 2023. Probabilities of perceived stress, sleep insufficiency, depressive mood, suicide ideation, and suicide attempt in treated provinces were estimated through a difference-in-differences approach that accounts for treatment effect heterogeneity across groups over time.
RESULTS
SHROs had no consistently significant effects on any mental health outcomes, except for slightly increased suicide ideation in total students (0.7%, 95% confidence interval 0.3% to 1.1%). Suicide attempts in total and male students and perceived stress and sleep insufficiency in female students tended to decrease, while other mental health outcomes tended to increase. Uncertainty in the effect estimates of SHROs increased for all mental health outcomes with possible violations of parallel trends, rendering originally significant effects insignificant.
CONCLUSIONS
SHROs failed to improve mental health of middle and high school students in treated provinces, possibly due to the absence of enforcement mechanisms. Further research is needed on the effectiveness of and effect mechanisms for legal measures to improve human rights on adolescent mental health.; Summary

Korean summary
학생의 인권을 포괄적으로 보장하기 위해 학생인권조례가 시행되었지만 학생인권조례 시행 지역에서 중고등학생의 정신건강은 향상되지 않았는데, 이는 조례에 벌칙 조항 같은 강제성 기전이 없었기 때문이었을 수 있다. 학생인권조례는 중고등학생의 정신건강에 대해 효과가 없었지만 이 연구는 인권 법제의 청소년 정신건강에 대한 효과를 처음으로 평가했다. 인권증진을 위한 법적 수단의 청소년 정신건강에 대한 효과성과 효과 기전에 관하여 추가 연구가 필요하다.

Key Message
Although student human rights ordinances have been enforced in South Korea to comprehensively guarantee human rights for students, they failed to improve the mental health of middle and high school students in treated provinces, possibly due to the absence of enforcement mechanisms such as penalty provisions. Despite the ineffectiveness of student human rights ordinances, this study first estimated the effects of human rights legislation on adolescent mental health. Further research is needed on the effectiveness of and effect mechanisms for legal measures to improve human rights on adolescent mental health.

Gender differences in awareness and practices of cancer prevention recommendations in Korea: a cross-sectional survey: Yoonjoo Choi, Naeun Kim, Jin-Kyoung Oh, Yoon-Jung Choi, Bohyun Park, Byungmi Kim; Epidemiol Health. 2025;47:e2025003. Published online January 15, 2025; DOI: https://doi.org/10.4178/epih.e2025003

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Gender is a major determinant of health behaviors that influences cancer prevention awareness and practices. This study investigated the relationship of the awareness and practice rates of cancer prevention recommendations with gender and socioeconomic status.
METHODS
We used data from the Korean National Cancer Prevention Awareness and Practice Survey (2023). The sample included 4,000 men and women aged 20-74 years. We conducted multiple logistic regression analyses to evaluate associations with the awareness and practices of cancer prevention, and a joinpoint regression analysis using age-standardized rates to analyze trends in awareness and practice rates from 2007 to 2023.
RESULTS
The awareness rates were 79.4% and 81.2% for men and women, respectively. The overall practice rates were substantially lower (43.1% for men and 48.9% for women). For men, awareness rates did not differ significantly by socio-demographic characteristics, but practice rates increased with age (20-29: 15.9%; 60-74: 53.8%). For women, both awareness (20-29: 73.0%; 60-74: 85.7%) and practice (20-29: 16.8%; 60-74: 67.5%) rates increased with age. The easiest recommendations to follow were “reducing salt intake and avoiding burnt or charred foods” (men: 29.9%; women: 28.4%), whereas the most difficult recommendation was “engaging in regular physical activity” (men: 32.5%; women: 34.4%).
CONCLUSIONS
While awareness of cancer prevention recommendations was high, the practice of these recommendations was low. Gender influenced changes in awareness and practice rates over time, reflecting a large gap in practice. Future research should explore appropriate intervention points for cancer prevention practices and the development of more effective cancer prevention policies.; Summary

Korean summary
암 예방에 대한 인식은 남녀 모두 높은 수준이었으나, 실천에서는 성별 차이가 크게 나타났다. 효과적인 암 예방 정책 수립을 위해 성별에 따른 실천 격차를 고려한 전략이 필요하다.

Key Message
Many factors influence cancer prevention awareness and practice, and gender is a crucial determinant of health behaviour in general. This study found that while awareness was reasonably high among both men and women, there was a signifi- cant gender gap in practice. Given the variation in health behaviours by gender, further evaluation of gender effects is nec- essary to inform future policy interventions aimed at improving cancer prevention practices.

Association between humidifier disinfectant use duration and lung cancer development in Korea: Sungchan Kang, Jeong-In Hwang, Su Hwan Kim, Hyungryul Lim, Dong-wook Lee, Woojoo Lee, Jong Hun Kim, Sol Yu, Jungyun Lim, Younghee Kim, Kyoung-Nam Kim; Epidemiol Health. 2025;47:e2025023. Published online May 2, 2025; DOI: https://doi.org/10.4178/epih.e2025023

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Abstract Summary PDF: Abstract
OBJECTIVES
This study was conducted to assess the association between the duration of humidifier disinfectant use and lung cancer development.
METHODS
We analyzed data from 3,605 applicants registered for compensation from the Korean government due to health conditions related to humidifier disinfectant exposure. Among these individuals, 121 were diagnosed with lung cancer at least 4 years after their initial exposure (through December 2021). Hazard ratios (HRs) and 95% confidence intervals (CIs) for lung cancer incidence were estimated according to the duration of disinfectant use using Cox proportional hazards models.
RESULTS
Compared with <5 months of use, the HRs for lung cancer were 1.81 (95% CI, 0.41 to 7.97) for 5-14 months, 2.45 (95% CI, 0.58 to 10.41) for 15-29 months, and 4.61 (95% CI, 1.12 to 18.91) for ≥30 months. Using never smokers with <15 months of use as the reference category, the HRs were 2.97 (95% CI, 1.34 to 6.56) for never smokers with ≥15 months of use, 2.73 (95% CI, 0.94 to 7.95) for current or former smokers with <15 months of use, and 4.74 (95% CI, 1.94 to 11.61) for current or former smokers with ≥15 months of use.
CONCLUSIONS
Our study provides some of the first robust epidemiological evidence that prolonged humidifier disinfectant use contributes to lung cancer development. Future studies—particularly those including unexposed populations—are needed to confirm these findings.; Summary

Korean summary
* 장기간의 가습기 살균제 사용과 폐암 발생의 위험 간에는 정량적 연관성을 발견할 수 있었습니다. * 가습기살균제를 30개월 이상 사용했다고 응답한 사람들은, 가습기살균제를 5개월 미만 사용했다고 응답한 사람들과 비교하여 폐암 발생 위험이 4배 높았습니다.

Key Message
* There is a quantitative association between prolonged humidifier disinfectants use and the risk of lung cancer incidence. * Individuals reported they used humidifier disinfectants for more than 30 months had more than four times higher risk of lung cancer than those of individuals who reported they used humidifier disinfectants for less than five months.

Identifying factors associated with mental health status following climate-related disasters: a nationwide longitudinal panel study in Korea: Eunjin Oh, Jaelim Cho, Changsoo Kim, Hyungryul Lim, Kyoung-Nam Kim; Epidemiol Health. 2025;47:e2025014. Published online March 27, 2025; DOI: https://doi.org/10.4178/epih.e2025014

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Despite the increasing frequency and intensity of climate-related disasters, identifying factors associated with mental health status remains challenging. This study aimed to determine the factors linked to symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) following heavy rainfall and typhoons.
METHODS
National data on climate-related disaster victims (n=825 for heavy rainfall and n=1,220 for typhoon) from a longitudinal panel in Korea (“Long-term Survey on the Change of Life of Disaster Victims”) and data from individuals unaffected by disasters (n=893) were used. Generalized linear mixed models were employed to evaluate the factors associated with mental health status following climate-related disasters.
RESULTS
Greater disaster severity (e.g., experiencing casualties or asset loss) was associated with higher scores for depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and PTSD (Impact Event Scale-Revised). The association between casualty experience and anxiety score was more pronounced among individuals over 65 years (β [log-transformed score], 1.39; standard error [SE], 0.26; p<0.001), female respondents (β, 1.20; SE, 0.20; p<0.001), those with a low education level (β, 1.18; SE, 0.25; p<0.001), and those with a low income (β, 1.45; SE, 0.26; p<0.001) compared to their counterparts.
CONCLUSIONS
These findings may help guide targeted interventions and shape public health policies and disaster management strategies that prioritize mental health support for the most at-risk populations, ultimately increasing community resilience to climate-related challenges.; Summary

Korean summary
본 연구는 기후 관련 재난 후 우울증, 불안, PTSD와 관련된 요인을 파악하였다. 재난의 심각도가 클수록 정신 건강 악화는 더 심각하였으며 특히 노인, 여성, 낮은 교육 수준과 소득을 가진 취약한 그룹이 더 큰 위험에 처해 있었다. 이 결과는 향후 재난 대응에서 이러한 인구집단을 지원하기 위한 맞춤형 정신 건강 개입과 정책의 필요성을 시사한다.

Key Message
We identified factors associated with depression, anxiety, and PTSD following climate-related disasters, highlighting that greater disaster severity correlates with worse mental health outcomes. Vulnerable groups, such as older adults, women, those with lower education and income, are at higher risk. The findings suggest the need for targeted mental health interventions and policies to support these populations in future disaster responses.

Impact of hypertension-related avoidable hospitalization on all-cause mortality in older patients with hypertension: a nationwide retrospective cohort study in Korea: Yehrhee Son, Noorhee Son, Sungyoun Chun, Ki-Bong Yoo, Jung Hyun Chang, Woo-Ri Lee; Epidemiol Health. 2025;47:e2025019. Published online April 18, 2025; DOI: https://doi.org/10.4178/epih.e2025019

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
The prevalence of hypertension is increasing as a result of rapid population aging, which elevates the societal burden of the disease. In Korea, the hospitalization rate for hypertension-related admissions exceeds the average reported by the Organization for Economic Cooperation and Development; however, the impact of these hospitalizations has not been evaluated. Therefore, this study investigates the association between hypertension-related avoidable hospitalizations and all-cause mortality.
METHODS
We included patients aged ≥60 years diagnosed with hypertension, identified using data from the National Health Insurance Services Senior Cohort spanning 2008 to 2019. The primary outcome was all-cause mortality measured at 3 years and 5 years after the hypertension diagnosis. The key independent variable was the incidence of hypertension-related avoidable hospitalizations within the first year following the initial hypertension diagnosis. Cox proportional hazards regression analysis was employed to assess these associations. To ensure robust findings and minimize selection bias, several sensitivity analyses were conducted.
RESULTS
Out of 65,686 participants, 397 (0.6%) experienced hypertension-related avoidable hospitalizations within 1 year of their initial hypertension diagnosis. Individuals who experienced such hospitalizations had a significantly higher risk of all-cause mortality compared to those who did not (3-year: hazard ratio [HR], 2.12; 95% confidence interval [CI], 1.53 to 2.94; 5-year: HR, 2.13; 95% CI, 1.68 to 2.68).
CONCLUSIONS
Hypertension-related avoidable hospitalizations among older adults are associated with an increased risk of both short-term and long-term all-cause mortality. These findings underscore the importance of timely hypertension management to prevent such hospitalizations.; Summary

Korean summary
- 고혈압 관련 회피가능한 입원은 한국의 노인 고혈압 환자의 3년 및 5년 사망률과 유의미한 연관성을 보인다. - 사회경제적 및 지역적 건강 격차가 관찰되었으며, 저소득층과 대도시 이외 지역에 거주하는 환자의 사망 위험이 더 높았다. - 약물 복용을 포함한 조기 및 지속적인 고혈압 관리는 회피가능한 입원을 예방하고 장기 생존 결과를 개선하는데에 도움이 될 수 있다.

Key Message
- Hypertension-related avoidable hospitalizations are significantly associated with both 3-year and 5-year all-cause mortality among older patients with hypertension in Korea. - Socioeconomic and regional disparities were observed, with greater mortality risks among patients from low-income groups and non-metropolitan areas. - Early and consistent hypertension management—including medication adherence—may help prevent avoidable hospitalizations and improve long-term survival outcomes.

Adherence to the Korean National Code Against Cancer and mortality: a prospective cohort study from the Health Examinees-Gem study: Jeeyoo Lee, Aesun Shin, Woo-Kyoung Shin, Ji-Yeob Choi, Daehee Kang; Epidemiol Health. 2025;47:e2025026. Published online May 9, 2025; DOI: https://doi.org/10.4178/epih.e2025026

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Abstract Summary PDF: Abstract
OBJECTIVES
The Korean National Code Against Cancer was released in 2006. These guidelines aimed to promote a healthy lifestyle to prevent cancer risk through 10 recommendations. The objective of this study was to investigate the associations between adherence to the Korean National Code Against Cancer and the risk of all-cause, cancer, and cardiovascular disease (CVD) mortality among Koreans.
METHODS
This prospective cohort study included 109,160 Korean adults aged 40 years to 69 years, recruited from 2004 to 2013 in the population-based Health Examinees-Gem Study. The adherence total score was calculated based on 6 items from the Korean National Code Against Cancer: smoking, consuming vegetables and fruits, limiting salty foods, restricting alcohol intake, engaging in physical activity, and maintaining a healthy weight. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations of adherence scores with mortality risk were estimated using a Cox proportional hazards regression model.
RESULTS
During a mean follow-up period of 12.0 years, 3,799 deaths were recorded. According to the multivariable-adjusted model, males in the highest tertile of adherence scores had a lower risk of all-cause, cancer, and CVD mortality compared to those in the lowest tertile (all-cause: HR, 0.67; 95% CI, 0.60 to 0.74; cancer: HR, 0.63; 95% CI, 0.54 to 0.74; CVD: HR, 0.56, 95% CI, 0.43 to 0.73). A similar association was observed among females for all-cause and CVD mortality (all-cause: HR, 0.85; 95% CI, 0.76 to 0.96; CVD: HR, 0.70; 95% CI, 0.51 to 0.97).
CONCLUSIONS
Adherence to the Korean National Code Against Cancer was associated with a reduced risk of all-cause, cancer, and CVD mortality.; Summary

Korean summary
한국인 대규모 집단에서 암예방 수칙 준수도가 높을수록 전체 사망, 암 사망, 심혈관질환 사망 위험이 감소함을 확인하였으며, 암예방수칙의 보급과 준수가 암뿐만 아니라 다른 만성질환으로 인한 사망을 예방하는 데 중요함을 시사한다.

Key Message
We found that greater adherence to the Korean National Code Against Cancer was associated with reduced risks of all-cause, cancer, and cardiovascular disease mortality in a large Korean population, highlighting the importance of promoting this code for public health.

Association of dietary inflammatory index with mortality risk: a prospective analysis of the Korea National Health and Nutrition Examination Survey: Dahyun Park, Hee Ju Jun, Garam Jo, Soyoung Kwak, Min-Jeong Shin; Epidemiol Health. 2025;47:e2025017. Published online April 9, 2025; DOI: https://doi.org/10.4178/epih.e2025017

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Abstract Summary PDF: Abstract
OBJECTIVES
The energy-adjusted dietary inflammatory index (E-DII), a tool developed based on comprehensive research and literature reviews, is used to assess the inflammatory potential of specific diets. Although previous research has demonstrated an association between E-DII and mortality, longitudinal studies investigating a causal relationship in Asian populations are lacking. This study aimed to explore the prospective association between E-DII and the risk of all-cause, cancer, and cardiovascular disease (CVD) mortality using a population-based Korean cohort.
METHODS
The analysis included data from 40,596 individuals who participated in the Korea National Health and Nutrition Examination Survey between 2007 and 2015. The exclusion criteria encompassed the diagnosis of cancer or CVD at baseline, pregnancy at baseline, and death within the first 2 years after baseline. The E-DII was calculated using data from 24-hour dietary recall interviews. Cox proportional hazard regression models were employed to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for mortality risk across E-DII tertiles.
RESULTS
Over an 8.2-year follow-up period, 2,070 deaths were recorded. Compared with the lowest E-DII, a higher index was associated with an increased risk of mortality from all causes (HR, 1.45; 95% CI, 1.25 to 1.69), cancer (HR, 1.41; 95% CI, 1.09 to 1.81), and CVD (HR, 1.53; 95% CI, 1.07 to 2.18). The association between E-DII and all-cause mortality was particularly pronounced among individuals with metabolic conditions.
CONCLUSIONS
Our findings suggest a strong positive association between high E-DII and increased mortality in Korean adults, especially those with metabolic disorders.; Summary

Korean summary
본 연구는 2007–2015년 국민건강영양조사-사망원인통계 연계 데이터를 바탕으로 한국 성인을 대상으로 식이염증지수(E-DII)와 전체, 암, 심혈관질환 사망률 간의 연관성을 분석하였음. 높은 식이염증지수는 전체 사망(HR, 1.45; 95% CI, 1.25–1.69), 암 사망(HR, 1.41; 95% CI, 1.09–1.81), 심혈관질환 사망(HR, 1.53; 95% CI, 1.07–2.18) 위험 증가와 유의하게 관련되었으며, 특히 대사질환 보유자에서 그 연관성이 두드러졌음.

Key Message
This prospective cohort study analyzed nationally representative data from the Korea National Health and Nutrition Examination Survey (2007–2015) to examine the association between the energy-adjusted Dietary Inflammatory Index (E-DII) and mortality risk. A higher E-DII was significantly associated with increased risks of all-cause (HR, 1.45; 95% CI, 1.25–1.69), cancer mortality (HR, 1.41; 95% CI, 1.09–1.81), and cardiovascular mortality (HR, 1.53; 95% CI, 1.07–2.18), particularly among individuals with metabolic disorders.

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