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Kim SH, Park HE. Investigating Factors Influencing the National Cancer Screening Program among Older Individuals in Republic of Korea-Data from the Korea National Health and Nutrition Examination Survey VIII. Healthcare (Basel) 2024; 12:1237. [PMID: 38921351 PMCID: PMC11203246 DOI: 10.3390/healthcare12121237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/07/2024] [Accepted: 06/13/2024] [Indexed: 06/27/2024] Open
Abstract
This study aims to determine the influencing factors of the participation of older individuals aged 65 years and above in South Korea's National Cancer Screening Program (NCSP) using data from the eighth wave (2019-2021) of the Korea National Health and Nutrition Examination Survey (KNHANES VIII), and discuss potential problems and coping strategies. Variables were selected based on Andersen's healthcare utilization model. "Participation in the NSCP" was considered the dependent variable, with independent variables including sociodemographic characteristics (sex, marital status, residence, education level, income level, economic activity, medical coverage type, and private insurance), health conditions (subjective health status, hypertension, and diabetes), and health behaviors (physical activity, monthly alcohol consumption, and current smoking status). The analysis revealed that higher participation rates correlated with being married, having an education level beyond elementary school, being employed, subscribing to private insurance, perceiving oneself as having average or poor health, engaging in physical activity, and not smoking. Sex, residence, income, medical coverage type, hypertension, diabetes, and monthly alcohol consumption were found to be insignificantly correlated. These findings underscore the importance of tailored promotion and health education for older individuals to boost NCSP participation rates, which could ultimately elevate public health standards.
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Affiliation(s)
- Seok Hwan Kim
- Department of Health Information, Dongguk University Wise Campus, 123 Dongdae-ro, Gyeongju-si 38066, Gyeongsangbuk-do, Republic of Korea;
| | - Hyo Eun Park
- Department of Nursing, Suwon Women’s University, 72 Onjeong-ro, Gwonseon-gu, Suwon-si 16632, Gyeonggi-do, Republic of Korea
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Choi J, Lee SR, Choi EK, Lee KY, Ahn HJ, Kwon S, Han KD, Oh S, Lip GYH. Effect of physical activity on incident atrial fibrillation in individuals with varying duration of diabetes: a nationwide population study. Cardiovasc Diabetol 2024; 23:115. [PMID: 38555442 PMCID: PMC10981812 DOI: 10.1186/s12933-024-02194-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/10/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Diabetes mellitus (DM) duration affects incident atrial fibrillation (AF) risk; the effect of physical activity on mitigating AF risk related to varying DM duration remains unknown. We assessed the effect of physical activity on incident AF in patients with DM with respect to known DM duration. METHODS Patients with type 2 DM who underwent the Korean National Health Insurance Service health examination in 2015-2016 were grouped by DM duration: new onset and < 5, 5-9, and ≥ 10 years. Physical activity was classified into four levels: 0, < 500, 500-999, 1,000-1,499, and ≥ 1,500 metabolic equivalent task (MET)-min/week, with the primary outcome being new-onset AF. RESULTS The study enrolled 2,392,486 patients (aged 59.3 ± 12.0 years, 39.8% female) with an average follow-up of 3.9 ± 0.8 years and mean DM duration of 5.3 ± 5.1 years. Greater physical activity was associated with a lower AF risk. Lowering of incident AF risk varied with different amounts of physical activity in relation to known DM duration. Among patients with new-onset DM, DM duration < 5 years and 5-9 years and 1,000-1,499 MET-min/week exhibited the lowest AF risk. Physical activity ≥ 1,500 MET-min/week was associated with the lowest incident AF risk in patients with DM duration ≥ 10 years (by 15%), followed DM duration of 5-9 years (12%) and < 5 years (9%) (p-for-interaction = 0.002). CONCLUSIONS Longer DM duration was associated with a high risk of incident AF, while increased physical activity generally reduced AF risk. Engaging in > 1,500 MET-min/week was associated with the greatest AF risk reduction in patients with longer DM duration, highlighting the potential benefits of higher activity levels for AF prevention.
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Affiliation(s)
- JungMin Choi
- Division of cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Division of cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Eue-Keun Choi
- Division of cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Kyung-Yeon Lee
- Division of cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo-Jeong Ahn
- Division of cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soonil Kwon
- Division of cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Do Han
- Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Seil Oh
- Division of cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Gregory Y H Lip
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Liverpool Center for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Chest & Heart Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Eun Y, Kim H, Lee J. Reply. Arthritis Rheumatol 2023; 75:1081-1082. [PMID: 36575803 DOI: 10.1002/art.42432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022]
Affiliation(s)
- Yeonghee Eun
- Division of Rheumatology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Hyungjin Kim
- Department of Medicine and Department of Medical Humanities, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jaejoon Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Kim Y, Park J, Park JH. Regional differences in health screening participation between before and during COVID-19 pandemic. Environ Health Prev Med 2023; 28:8. [PMID: 36697026 PMCID: PMC9884562 DOI: 10.1265/ehpm.22-00239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Health screening is a preventive and cost-effective public health strategy for early detection of diseases. However, the COVID-19 pandemic has decreased health screening participation. The aim of this study was to examine regional differences in health screening participation between before and during COVID-19 pandemic and vulnerabilities of health screening participation in the regional context. METHODS Administrative data from 229 districts consisting of 16 provinces in South Korea and health screening participation rate of each district collected in 2019 and 2020 were included in the study. Data were then analyzed via descriptive statistics and geographically weighted regression (GWR). RESULTS This study revealed that health screening participation rates decreased in all districts during COVID-19. Regional vulnerabilities contributing to a further reduction in health screening participation rate included COVID-19 concerns, the population of those aged 65+ years and the disabled, lower education level, lower access to healthcare, and the prevalence of chronic disease. GWR analysis showed that different vulnerable factors had different degrees of influence on differences in health screening participation rate. CONCLUSIONS These findings could enhance our understanding of decreased health screening participation due to COVID-19 and suggest that regional vulnerabilities should be considered stringent public health strategies after COVID-19.
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Affiliation(s)
- Yeaeun Kim
- Department of Health Care Management, Catholic University of Pusan, Busan, South Korea
| | - Jongho Park
- Division of Health Administration, Gwangju University, Gwangju, South Korea
| | - Jae-Hyun Park
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, South Korea
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Jeong YW, Jung Y, Jeong H, Huh JH, Sung KC, Shin JH, Kim HC, Kim JY, Kang DR. Prediction Model for Hypertension and Diabetes Mellitus Using Korean Public Health Examination Data (2002–2017). Diagnostics (Basel) 2022; 12:diagnostics12081967. [PMID: 36010317 PMCID: PMC9407141 DOI: 10.3390/diagnostics12081967] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/29/2022] [Accepted: 08/13/2022] [Indexed: 11/21/2022] Open
Abstract
Hypertension and diabetes mellitus are major chronic diseases that are important factors in the management of cardiovascular disease. In order to prevent the occurrence of chronic diseases, proper health management through periodic health check-ups is necessary. The purpose of this study is to determine the incidence of hypertension and diabetes mellitus according to the health check-up, and to develop a predictive model for hypertension and diabetes according to the health check-up. We used the National Health Insurance Corporation database of Korea and checked whether hypertension or diabetes occurred from that date according to the number of health check-ups over the past 10 years. Compared to those who underwent five health check-ups, those who participated in the first screening had hypertension (OR = 2.18, 95% CI = 2.14–2.22), diabetes mellitus (OR = 1.33, 95% CI = 1.30–1.35) and both diseases (OR = 2.46, 95% CI = 2.39–2.53); individuals who underwent 10 screenings had hypertension (OR = 0.86, 95% CI = 0.83–0.88), diabetes mellitus (OR = 0.83, 95% CI = 0.81–0.85) and both diseases (OR = 0.83, 95% CI = 0.79–0.87). Individuals who attended fewer than five screenings compared with individuals who attended five or more screenings had hypertension (OR = 1.61, 95% CI = 1.59–1.62; AUC = 0.66), diabetes mellitus (OR = 1.21, 95% CI = 1.20–1.22; AUC = 0.59) and both diseases (OR = 1.75, 95% CI = 1.72–1.78, AUC = 0.63). The machine learning-based prediction model using XGBoost showed higher performance in all datasets than the conventional logistic regression model in predicting hypertension (accuracy, 0.828 vs. 0.628; F1-score, 0.800 vs. 0.633; AUC, 828 vs. 0.630), diabetes mellitus (accuracy, 0.707 vs. 0.575; F1-score, 0.663 vs. 0.576; AUC, 0.710 vs. 0.575) and both diseases (accuracy, 0.950 vs. 0.612; F1-score, 0.950 vs. 0.614; AUC, 0.952 vs. 0.612). It was found that health check-up had a great influence on the occurrence of hypertension and diabetes, and screening frequency was more important than other factors in the variable importances.
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Affiliation(s)
- Yong Whi Jeong
- Department of Biostatistics, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
| | - Yeojin Jung
- Department of Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
| | - Hoyeon Jeong
- Department of Biostatistics, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
| | - Ji Hye Huh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea
| | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul 04763, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Jang Young Kim
- Division of Cardiology, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
| | - Dae Ryong Kang
- Department of Biostatistics, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
- Department of Precision Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
- Correspondence: ; Tel.: +82-33-0391
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Ko Y, Min J, Kim HW, Koo HK, Oh JY, Jeong YJ, Kang HH, Kang JY, Kim JS, Lee SS, Park JS, Kwon Y, Yang J, Han J, Jang YJ. Time delays and risk factors in the management of patients with active pulmonary tuberculosis: nationwide cohort study. Sci Rep 2022; 12:11355. [PMID: 35790866 PMCID: PMC9255533 DOI: 10.1038/s41598-022-15264-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022] Open
Abstract
Estimating the time delay and identifying associated factors is essential for effective tuberculosis control. We systemically analysed data obtained from the Korea Tuberculosis Cohort in 2019 by classifying delays as presentation and healthcare delays of pulmonary tuberculosis (PTB). Of 6593 patients with active PTB, presentation and healthcare delays were recorded in 4151 and 5571 patients, respectively. The median presentation delay was 16.0 (5.0-40.0) days. Multivariable logistic regression analysis showed that longer presentation delays were associated with neuropsychiatric disease [adjusted odds ratio (OR) 2.098; 95% confidence interval (CI) 1.639-2.687; p < 0.001] and heavy alcohol intake (adjusted OR 1.505; 95% CI 1.187-1.907; p < 0.001). The median healthcare delay was 5.0 (1.0-14.0) days. A longer healthcare delay was associated with malignancy (adjusted OR 1.351; 95% CI 1.069-1.709; p = 0.012), autoimmune disease (adjusted OR 2.445; 95% CI 1.295-4.617; p = 0.006), and low bacterial burden manifested as an acid-fast bacillus smear-negative and tuberculosis polymerase chain reaction-negative status (adjusted OR 1.316; 95% CI 1.104-1.569; p = 0.002). Active case-finding programmes need to focus on patients with heavy alcoholism or neuropsychiatric diseases. To ensure early PTB detection, healthcare providers must carefully monitor patients with malignancy, autoimmune disease, or a high index of suspicion for PTB.
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Affiliation(s)
- Yousang Ko
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Sung-an ro 150, Kangdonggu, Seoul, 05355, Republic of Korea.
| | - Jinsoo Min
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyung Woo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyeon-Kyoung Koo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Jee Youn Oh
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yun-Jeong Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Hyeon Hui Kang
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Republic of Korea
| | - Ji Young Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ju Sang Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Soon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Jae Seuk Park
- Division of Pulmonary Medicine, Department of Internal Medicine, Dankook University College of Medicine, 119 Dandae-ro, Dongnam-gu, Cheonan, 31116, Republic of Korea.
| | - Yunhyung Kwon
- Division of Tuberculosis Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Jiyeon Yang
- Division of Tuberculosis Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Jiyeon Han
- Division of Tuberculosis Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - You Jin Jang
- Division of Tuberculosis Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
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Shin J, Kim J, Lee C, Yoon JY, Kim S, Song S, Kim HS. Development of Various Diabetes Prediction Models Using Machine Learning Techniques. Diabetes Metab J 2022; 46:650-657. [PMID: 35272434 PMCID: PMC9353566 DOI: 10.4093/dmj.2021.0115] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/14/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There are many models for predicting diabetes mellitus (DM), but their clinical implication remains vague. Therefore, we aimed to create various DM prediction models using easily accessible health screening test parameters. METHODS Two sets of variables were used to develop eight DM prediction models. One set comprised 62 easily accessible examination results of commonly used variables from a tertiary university hospital. The second set comprised 27 of the 62 variables included in the national routine health checkups. Gradient boosting and random forest algorithms were used to develop the models. Internal validation was performed using the stratified 10-fold cross-validation method. RESULTS The area under the receiver operating characteristic curve (ROC-AUC) for the 62-variable DM model making 12-month predictions for subjects without diabetes was the largest (0.928) among those of the eight DM prediction models. The ROC-AUC dropped by more than 0.04 when training with the simplified 27-variable set but still showed fairly good performance with ROC-AUCs between 0.842 and 0.880. The accuracy was up to 11.5% higher (from 0.807 to 0.714) when fasting glucose was included. CONCLUSION We created easily applicable diabetes prediction models that deliver good performance using parameters commonly assessed during tertiary university hospital and national routine health checkups. We plan to perform prospective external validation, hoping that the developed DM prediction models will be widely used in clinical practice.
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Affiliation(s)
- Juyoung Shin
- Health Promotion Center, Seoul St. Mary’s Hospital, Seoul, Korea
- Department of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | | | | | | | | | - Hun-Sung Kim
- Department of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Corresponding author: Hun-Sung Kim https://orcid.org/0000-0002-7002-7300 Department of Medical Informatics, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea E-mail:
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Shin DW, Cho J, Park JH, Cho B. National General Health Screening Program in Korea: history, current status, and future direction: A scoping review. PRECISION AND FUTURE MEDICINE 2022. [DOI: 10.23838/pfm.2021.00135] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Ye BJ, Kim JY, Suh C, Choi SP, Choi M, Kim DH, Son BC. Development of a Chatbot Program for Follow-Up Management of Workers' General Health Examinations in Korea: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042170. [PMID: 33672158 PMCID: PMC7926907 DOI: 10.3390/ijerph18042170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 12/02/2022]
Abstract
(1) Background: Follow-up management of workers’ general health examination (WGHE) is important, but it is not currently well done. Chatbot, a type of digital healthcare tool, is used in various medical fields but has never been developed for follow-up management of WGHE in Korea. (2) Methods: The database containing results and explanations related to WGHE was constructed. Then, the channel, which connects users with the database was created. A user survey regarding effectiveness was administered to 23 healthcare providers. Additionally, interviews on applicability for occupational health services were conducted with six nurses in the agency of occupational health management. (3) Results: Chatbot was implemented on a small scale on the Amazon cloud service (AWS) EC2 using KaKaoTalk and Web Chat as user channels. Regarding the effectiveness, 21 (91.30%) rated the need for chatbots as very high; however, 11 (47.83%) rated the usability as not high. Of the 23 participants, 14 (60.87%) expressed overall satisfaction. Nurses appreciated the chatbot program as a method for resolving accessibility and as an aid for explaining examination results and follow-up management. (4) Conclusions: The effectiveness of WGHE and the applicability in the occupational health service of the chatbot program for follow-up management can be confirmed.
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Affiliation(s)
- Byeong Jin Ye
- Department of Occupational and Environmental Medicine & Institute of Environmental and Occupational Medicine, Busan Paik Hospital, Inje University, Busan 47392, Korea; (B.J.Y.); (C.S.); (S.P.C.); (M.C.); (D.H.K.)
| | | | - Chunhui Suh
- Department of Occupational and Environmental Medicine & Institute of Environmental and Occupational Medicine, Busan Paik Hospital, Inje University, Busan 47392, Korea; (B.J.Y.); (C.S.); (S.P.C.); (M.C.); (D.H.K.)
| | - Seong Pil Choi
- Department of Occupational and Environmental Medicine & Institute of Environmental and Occupational Medicine, Busan Paik Hospital, Inje University, Busan 47392, Korea; (B.J.Y.); (C.S.); (S.P.C.); (M.C.); (D.H.K.)
| | - Maro Choi
- Department of Occupational and Environmental Medicine & Institute of Environmental and Occupational Medicine, Busan Paik Hospital, Inje University, Busan 47392, Korea; (B.J.Y.); (C.S.); (S.P.C.); (M.C.); (D.H.K.)
| | - Dong Hyun Kim
- Department of Occupational and Environmental Medicine & Institute of Environmental and Occupational Medicine, Busan Paik Hospital, Inje University, Busan 47392, Korea; (B.J.Y.); (C.S.); (S.P.C.); (M.C.); (D.H.K.)
| | - Byung Chul Son
- Department of Occupational and Environmental Medicine & Institute of Environmental and Occupational Medicine, Busan Paik Hospital, Inje University, Busan 47392, Korea; (B.J.Y.); (C.S.); (S.P.C.); (M.C.); (D.H.K.)
- Correspondence: ; Tel.: +82-51-890-6142; Fax: +82-51-893-3523
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Park BH, Lee BK, Ahn J, Kim NS, Park J, Kim Y. Association of Participation in Health Check-ups with Risk Factors for Cardiovascular Diseases. J Korean Med Sci 2021; 36:e19. [PMID: 33463093 PMCID: PMC7813587 DOI: 10.3346/jkms.2021.36.e19] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/27/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND We compared the risk factors for cardiovascular diseases (CVDs) among Koreans who did and did not participate in national periodic health check-ups, after adjustment for demographic factors, socioeconomic status, and lifestyle factors. METHODS This cross-sectional study used data from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2007 to 2018. Study subjects were classified as participants or non-participants in health check-ups, based on attendance at national periodic health check-ups during the previous two years. RESULTS Comparison of participants and non-participants in health check-ups indicated statistically significant differences in age, gender, region, education level, monthly income, employment status, obesity, smoking, alcohol consumption, exercise, and marital status. After adjustment for demographic, socioeconomic factors, and health-related behaviors, woman non-participants were more likely to have metabolic syndrome, pre-hypertension, hypertension, prediabetes, and diabetes, and man non-participants were more likely to have pre-diabetes and diabetes. CONCLUSION Subjects who participated in periodic health check-ups had fewer CVD-related risk factors than non-participants. Thus, health care providers should encourage non-participants to attend periodic health check-ups so that appropriate interventions can be implemented and decrease the risk for CVDs in these individuals.
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Affiliation(s)
- Bok Hyun Park
- Department of Environmental Health, Daejeon Health Institute of Technology, Daejeon, Korea
| | - Byung Kook Lee
- Department of Preventive Medicine, Soonchunhyang University, Asan, Korea
| | - Jaeouk Ahn
- Department of Medical IT Engineering, College of Medical Sciences, Soonchunhyang University, Asan, Korea
| | - Nam Soo Kim
- Institute of Occupational and Environmental Medicine, Soonchunhyang University, Asan, Korea
| | - Jungsun Park
- Department of Occupational Health, Daegu Catholic University, Gyeongsan, Korea.
| | - Yangho Kim
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
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Yun JM, Choi S, Kim K, Kim SM, Son JS, Lee G, Jeong SM, Park SY, Kim YY, Park SM. All-cause mortality, cardiovascular mortality, and incidence of cardiovascular disease according to a screening program of cardiovascular risk in South Korea among young adults: a nationwide cohort study. Public Health 2020; 190:23-29. [PMID: 33338899 DOI: 10.1016/j.puhe.2020.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 08/03/2020] [Accepted: 10/29/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We aimed to determine whether there are any differences in all-cause and cause-specific mortality with cardiovascular disease (CVD) risk between health screening attenders and non-attenders among young adults. STUDY DESIGN We performed a retrospective cohort study using claim data from the Korean National Health Insurance Service database. METHODS Individuals aged 20-39 years who had received health screening at least once between 2002 and 2005 were classified as attenders, and the others were classified as non-attenders. After propensity score matching according to attendance of health screening, 2,060,409 attenders and 2,060,409 non-attenders were included. We estimated adjusted hazard ratios (HRs) and 95% confidence interval (CI) for all-cause mortality, cause-specific mortality, and hospitalization of CVD from 2006 to 2015. RESULTS Survival from all-cause mortality was greater among attenders than among non-attenders (log rank P < 0.001). Similarly, death from CVD (log rank P = 0.007) and CVD events (log rank P < 0.001) were less likely among attenders. The risk for all-cause mortality in attenders was significantly lower than that in non-attenders (HR = 0.83, 95% CI = 0.81 to 0.84). The risk for CVD mortality (HR = 0.80, 95% CI = 0.73 to 0.87) and hospitalization of CVD (HR = 0.92, 95% CI = 0.91 to 0.94) were lower in attenders. In stratified analyses, the risk for all-cause and cause-specific mortalities was lower among attenders regardless of insurance type. CONCLUSIONS Among young adults, the risk for all-cause mortality, CVD mortality, and hospitalization of CVD were lower for those who underwent health screenings. Future studies that evaluate the cost-effectiveness of health screening with additional consideration of psychosocial aspects are needed.
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Affiliation(s)
- J M Yun
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
| | - S Choi
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - K Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - S M Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - J S Son
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
| | - G Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
| | - S-M Jeong
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
| | - S Y Park
- Big Data Steering Department, National Health Insurance Service, Wonju, South Korea
| | - Y-Y Kim
- Big Data Steering Department, National Health Insurance Service, Wonju, South Korea
| | - S M Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea.
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12
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Min J, Chung C, Jung SS, Park HK, Lee SS, Lee KM. Clinical profiles of subclinical disease among pulmonary tuberculosis patients: a prospective cohort study in South Korea. BMC Pulm Med 2020; 20:316. [PMID: 33267859 PMCID: PMC7709260 DOI: 10.1186/s12890-020-01351-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/17/2020] [Indexed: 11/17/2022] Open
Abstract
Background Subclinical tuberculosis (TB) is a potential target for public health intervention because its early identification may reduce TB transmission. We aimed to describe the clinical and laboratory findings of subclinical disease among pulmonary TB patients and compared treatment outcomes for subclinical and active diseases.
Methods In this prospective cohort study, we enrolled adult patients aged ≥ 19 years with pulmonary TB between 2016 and 2018. Subclinical TB was defined as radiographic or microbiologic test results consistent with TB without clinical symptoms. We implemented a two-stage symptom assessment using a predefined TB symptom checklist. Demographic, clinical, and laboratory data were compared between subclinical and active diseases using multivariable binary logistic regression analysis. We evaluated treatment outcomes in the drug-susceptible cohort. Results Among 420 enrolled patients, 81 (19.3%) had subclinical TB. Multivariable analysis showed that age < 65 years was the only variable significantly associated with subclinical disease. Subclinical disease had a significantly lower proportion of acid-fast bacilli smear and culture positivity and multiple lobe involvement compared to active disease. The white blood cell counts, platelet counts, and C-reactive protein levels were significantly higher among patients with active disease than among those with subclinical disease. Among 319 patients with treatment success in the drug-susceptible cohort, six (1.9%) recurrent cases were identified, and all were active disease. Patients with subclinical disease had a higher proportion of favourable outcomes; however, its odds ratio was insignificant. Conclusions Nearly one-fifth of tuberculosis cases were subclinical in South Korea. Despite its milder clinical presentation and lower level of inflammatory markers, the treatment outcomes of subclinical TB were not significantly different from that of active disease.
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Affiliation(s)
- Jinsoo Min
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chaeuk Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Sung Soo Jung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Hye Kyeong Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Sung-Soon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Ki Man Lee
- Department of Internal Medicine, Chungbuk National University College of Medicine, 1, Chungdae-ro, Seowon-gu, Cheongju, 28644, Republic of Korea. .,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea.
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13
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Heo HC, Byun YS, Sohn SH, Jo SM, Park SK, Sakong J. Validity assessment of self-reported smoking status in firefighters using the urine cotinine test. Ann Occup Environ Med 2020; 32:e2. [PMID: 32082584 PMCID: PMC7008589 DOI: 10.35371/aoem.2020.32.e2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In firefighters, smoking management is important because they are exposed to various harmful substances in their occupational environment. Accurate surveys of smoking status are essential to control tobacco use. The main disadvantage of self-report questionnaires, which are commonly used for investigating smoking status, is the possibility that the subjects' response are invalid. If the validity of firefighters' answers on smoking questionnaires is not adequate, different methods will be needed for investigating smoking status in firefighters. METHODS This study was conducted on 445 male firefighters from 9 fire stations in Daegu (the city in South Korea) who visited a medical institution for medical checkup in 2016. The urine cotinine test strip (DCT-102; CLIAwaived Inc., cut-off value = 200 ng/mL) was used to classify the actual smoking status and to assess the validity of self-reported smoking status on questionnaires. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the smoking questionnaires were analyzed. Subjects testing positive in the urine cotinine test (assumed the actual current smokers) were selected. The frequency at which actual current smokers were misclassified as current non-smokers by the questionnaire was calculated. Subjects' characteristics were analyzed for possible association with any discrepancy between self-reported smoking status and urine cotinine test results. RESULTS The smoking rates among firefighters surveyed using the smoking questionnaire and the urine cotinine test were 22.47% and 51.24%, respectively. Of the all subjects, 29.66% (n = 132) were misclassified. The sensitivity of the smoking questionnaire was 42.98%, the specificity was 99.08%, the PPV was 98.00%, and the NPV was 62.32%. In the 228 subjects classified as current actual smokers by the urine cotinine test, 57.02% (n = 130) were misclassified on the questionnaire. The misclassification rate increased with age. The degree of misclassification also increased when subjects had a history of disease. CONCLUSIONS In present study, the validity of the smoking questionnaire for firefighters was not suitable for investigating smoking status due to low sensitivity. To increase the validity of smoking status monitoring in firefighters, consideration of the various factors like survey environment, subjects' characteristics, and occupational factors is needed.
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Affiliation(s)
- Han Cheol Heo
- Department of Occupational and Environmental Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Young Seok Byun
- Department of Occupational and Environmental Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Soo Ho Sohn
- Department of Occupational and Environmental Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Seong Min Jo
- Department of Occupational and Environmental Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Sung Kyu Park
- Department of Occupational and Environmental Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Joon Sakong
- Department of Occupational and Environmental Medicine, Yeungnam University Hospital, Daegu, Korea
- Department of Preventive Medicine and Public Health, College of Medicine, Yeungnam University, Daegu, Korea
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Park KY, Hwang HS, Cho KH, Han K, Nam GE, Kim YH, Kwon Y, Park YG. Body Weight Fluctuation as a Risk Factor for Type 2 Diabetes: Results from a Nationwide Cohort Study. J Clin Med 2019; 8:jcm8070950. [PMID: 31261984 PMCID: PMC6678837 DOI: 10.3390/jcm8070950] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/19/2019] [Accepted: 06/26/2019] [Indexed: 12/23/2022] Open
Abstract
We aimed to investigate how body weight fluctuation affects the risk of developing type 2 diabetes by conducting a nationwide cohort study. A total of 3,855,884 participants from the National Health Insurance System health check-up data from 2012 were included in this study, and follow-up continued until 2016. Body weight was measured at least thrice between 2009 and 2012. Body weight variability (BWV) was estimated using average successive variability (ASV) indices. Cox proportional hazards regression models were used to evaluate the association of BWV with the risk of type 2 diabetes using hazard ratios (HRs) and 95% confidence intervals (CIs). Body weight fluctuation was associated with a higher risk of incident diabetes after adjustment for confounders (HR 1.10, 95% CI 1.07, 1.12 in the highest BWV quartile compared to the lowest). Regardless of the weight change status, the highest ASV quartile of BWV increased the risk for diabetes. Even subjects with a normal glucose tolerance status and those aged under 65 years had a higher risk of diabetes if their body weight highly fluctuated during the follow-up years. Our results suggest that body weight variability is an independent risk factor for diabetes. It is important to pay attention to frequent body weight fluctuations.
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Affiliation(s)
- Kye-Yeung Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul 04763, Korea
| | - Hwan-Sik Hwang
- Department of Family Medicine, Hanyang University College of Medicine, Seoul 04763, Korea.
| | - Kyung-Hwan Cho
- Department of Family Medicine, Korea University College of Medicine, Seoul 02841, Korea
| | - Kyungdo Han
- Department of Biostatistics, the Catholic University of Korea College of Medicine, Seoul 06591, Korea
| | - Ga Eun Nam
- Department of Family Medicine, Korea University College of Medicine, Seoul 02841, Korea
| | - Yang Hyun Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul 02841, Korea
| | - Yeongkeun Kwon
- Department of Family Medicine, Korea University College of Medicine, Seoul 02841, Korea
| | - Yong-Gyu Park
- Department of Medical Statistics, the Catholic University of Korea College of Medicine, Seoul 06591, Korea.
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15
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Lee M, Shin J. Change in Waist Circumference With Continuous Use of a Smart Belt: An Observational Study. JMIR Mhealth Uhealth 2019; 7:e10737. [PMID: 31045500 PMCID: PMC6521184 DOI: 10.2196/10737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 11/27/2018] [Accepted: 12/12/2018] [Indexed: 11/13/2022] Open
Abstract
Background Health insurers and policymakers are trying to prevent and reduce cardiovascular diseases due to obesity. A smart belt that monitors activity and waist circumference is a new concept for conquering obesity and may be a promising new strategy for health insurers and policymakers. Objective This preliminary study evaluated whether the use of a smart belt was associated with a decrease in waist circumference. Methods In the manufacturer’s database, there were data on a total of 427 men at baseline. A total of 223, 81, and 27 users kept using the smart belt for 4, 8, and 12 weeks, respectively. Paired t tests and repeated measures analysis of variance (ANOVA) were used to identify the change in waist circumference at specified time intervals (at 4, 8, and 12 weeks). In addition, a linear mixed model was used to incorporate all users’ waist circumference data at each time point. Preexisting data on waist circumference and self-reported demographics were obtained from the manufacturer of the smart belt (WELT Corporation, South Korea). Results Compared with baseline, the waist circumference (cm) decreased significantly at all time points: –0.270 for week 4, –0.761 for week 8, and –1.972 for week 12 (all P<.01). Although each paired t test had a different sample size because of loss to follow-up, the differences between baseline and each subsequent week increased. Equal continuous reduction in waist circumference was observed with the ANOVA and mixed model analysis (beta=–0.158 every week). Conclusions The smart belt is a newly developed, wearable device that measures real-time steps, sedentary time, and waist circumference. In this study, we showed that wearing the smart belt was associated with reducing waist circumference over 12 weeks. This direct-to-consumer smart health device may contribute toward reducing the risk of obesity and related conditions and controlling increasing health costs for health insurers.
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Affiliation(s)
- Myeonggyun Lee
- Division of Biostatistics, Department of Population Health and Environmental Medicine, New York University School of Medicine, New York City, NY, United States
| | - Jaeyong Shin
- Department of Preventive Medicine, Ajou University School of Medicine, Suwon, Republic of Korea.,Institute of Health Services, Graduate School, Yonsei University, Seoul, Republic of Korea.,Department of Policy Analysis and Management, College of Human Ecology, Cornell University, Ithaca, NY, United States
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16
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Kim HB, Lee SA, Lim W. Knowing is not half the battle: Impacts of information from the National Health Screening Program in Korea. JOURNAL OF HEALTH ECONOMICS 2019; 65:1-14. [PMID: 30877903 DOI: 10.1016/j.jhealeco.2019.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/21/2018] [Accepted: 01/21/2019] [Indexed: 06/09/2023]
Abstract
Health screening provides information on disease risk and diagnosis, but whether this promotes health is unclear. We estimate the impacts of information provided by Korea's National Health Screening Program by applying a regression discontinuity design around different biomarker thresholds of diabetes, obesity, and hyperlipidemia risk using administrative data that includes medical claims, biomarkers, and behavioral surveys over four years after screening. Generally, we find limited responses to disease risk information alone. However, we find evidence for weight loss around the high risk threshold for diabetes, where information is combined with active prompting for a secondary examination for diagnosis and treatment.
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Affiliation(s)
- Hyuncheol Bryant Kim
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY 14853, United States.
| | - Suejin A Lee
- Department of Economics, Cornell University, Ithaca, NY 14853, United States
| | - Wilfredo Lim
- Mathematica Policy Research, Oakland, CA 94612, United States
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17
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Min J, Kwon SK, Jeong HW, Han JH, Kim YJ, Kang M, Kang G. End-stage Renal Disease and Risk of Active Tuberculosis: a Nationwide Population-Based Cohort Study. J Korean Med Sci 2018; 33:e341. [PMID: 30595682 PMCID: PMC6306323 DOI: 10.3346/jkms.2018.33.e341] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/09/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The converging epidemics of tuberculosis (TB) and end-stage renal disease (ESRD) have generated a significant public health burden, however, previous studies have been limited to a small number of patients. This nationwide cohort study aimed to assess the rate of developing active TB among patients receiving dialysis for ESRD. METHODS The Korean national health insurance database was used to identify patients receiving dialysis for new-onset ESRD during 2004-2013, who were propensity score matched to an equivalent number of non-dialysis subjects from the general population. The incidences of active TB in the ESRD and control cohorts were calculated for 2004-2013, and multivariable Cox proportional hazards model was used to evaluate the ESRD-related risk of active TB. RESULTS During 2004-2013, 59,584 patients received dialysis for newly diagnosed ESRD. In the dialysis and control cohorts, 457 (0.8%) and 125 (0.2%) cases of active TB were detected, respectively. Patients with ESRD were associated with a significantly higher risk of active TB compared to the controls (incidence rate ratio, 4.80). The ESRD cohort had an independently elevated risk of active TB (adjusted hazard ratio, 4.39; 95% confidence interval, 3.60-5.37). CONCLUSION We found that patients receiving dialysis for ESRD had an elevated risk of active TB. These results highlight the need for detailed and well-organised guidelines for active TB screening among patients with ESRD.
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Affiliation(s)
- Jinsoo Min
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Soon Kil Kwon
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hye Won Jeong
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Joung-Ho Han
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Yeonkook Joseph Kim
- Graduate School of Health Science Business Convergence, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Minseok Kang
- Department of Health Information and Management, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Gilwon Kang
- Department of Health Information and Management, Chungbuk National University College of Medicine, Cheongju, Korea
- Chungbuk Regional Cardiovascular Center, Chungbuk National University Hospital, Cheongju, Korea
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18
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Jeong SM, Choi S, Kim K, Kim SM, Lee G, Park SY, Kim YY, Son JS, Yun JM, Park SM. Effect of Change in Total Cholesterol Levels on Cardiovascular Disease Among Young Adults. J Am Heart Assoc 2018; 7:e008819. [PMID: 29899019 PMCID: PMC6220545 DOI: 10.1161/jaha.118.008819] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/16/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Although high serum cholesterol in young adults is known to be a predictor for cardiovascular events, there is not enough evidence for the association of cholesterol level change with cardiovascular disease (CVD). This study aimed to evaluate whether the change in cholesterol is associated with incidence of CVD among young adults. METHODS AND RESULTS We examined 2 682 045 young adults (aged 20-39 years) who had undergone 2 consecutive national health check-ups provided by Korean National Health Insurance Service between 2002 and 2005. Cholesterol levels were classified into low (<180 mg/dL), middle (180-240 mg/dL) and high (≥240 mg/dL). CVD events were defined as ≥2 days hospitalization attributable to CVD for 10 years follow-up. Increased cholesterol levels were significantly associated with elevated ischemic heart disease risk (adjusted hazard ration [aHR]=1.21; 95% confidence interval [CI]=1.03-1.42 in low-high group and aHR=1.21; 95% CI=1.15-1.27 in middle-high group) and cerebrovascular disease (CEVD) risk (aHR=1.24; 95% CI=1.05-1.47 in low-high group and aHR=1.09; 95% CI=1.02-1.16 in middle-high group). Decreased cholesterol levels were associated with reduced ischemic heart disease risk (aHR=0.91; 95% CI=0.88-0.95 in middle-low group, aHR=0.65; 95% CI=0.56-0.75 in high-low group and aHR=0.68; 95% CI=0.65-0.73 in high-middle group). Furthermore, lower cerebrovascular disease risk (aHR=0.76; 95% CI=0.62-0.92) was observed in the high-low group compared with patients with sustained high cholesterol. CONCLUSIONS The findings of our study indicate that increased cholesterol levels were associated with high CVD risk in young adults. Furthermore, young adults with decreased cholesterol levels had reduced risk for CVD.
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Affiliation(s)
- Su-Min Jeong
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seulggie Choi
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
| | - Kyuwoong Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
| | - Sung Min Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
| | - Gyeongsil Lee
- Department of Family Medicine, Health Promotion Center, Chung-Ang University Hospital, Seoul, Korea
| | - Seong Yong Park
- Big Data Steering Department, National Health Insurance Service, Wonju, Korea
| | - Yeon-Yong Kim
- Big Data Steering Department, National Health Insurance Service, Wonju, Korea
| | - Joung Sik Son
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae-Moon Yun
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang Min Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
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Jeong SM, Choi S, Kim K, Kim SM, Lee G, Son JS, Yun JM, Park SM. Association of change in total cholesterol level with mortality: A population-based study. PLoS One 2018; 13:e0196030. [PMID: 29672595 PMCID: PMC5908176 DOI: 10.1371/journal.pone.0196030] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/05/2018] [Indexed: 11/18/2022] Open
Abstract
Background Hypercholesterolemia is a well-established risk factor for coronary heart disease, but the association between cholesterol level change and mortality is not fully understood. We aimed to investigate the association of 2 year (2002–2003 to 2004–2005) change in cholesterol with all-cause and cause-specific mortality in a population-based cohort study. Methods and findings The study population consisted of 269,391 participants aged more than 40 years who were free of myocardial infarction, stroke and cancer using the Korean National Health Insurance Service—National Health Screening Cohort. Cholesterol levels were classified into 1st, 2nd and 3rd tertiles during each of the first and second health examinations, respectively. The participants were followed-up for all-cause and cause-specific mortality from 1 January 2006 to 31 December 2013. Compared to participants who stayed within the 2nd tertile group for cholesterol during both the first and second examinations, participants who became or maintained cholesterol levels to the 1st tertile during the second examination had increased risk of all-cause mortality [adjusted hazard ratio (aHR) with 95% confidence interval (95% CI) = 1.28 (1.18–1.38) in 1st/1st, 1.16 (1.07–1.26) in 2nd/1st and 1.47 (1.32–1.64) in 3rd/1st tertile levels, respectively]. In addition, increased or persistent high cholesterol levels to the 3rd tertile was associated with elevated risk for all-cause mortality [aHR (95% CI) = 1.10 (1.01–1.20) in 1st/2nd, 1.16(1.03–1.31) in 1st/3rd and 1.15(1.05–1.25) in 3rd/3rd tertile levels]. Conclusions Changes in cholesterol levels in either direction to low cholesterol or persistently low cholesterol levels were associated with higher risk of mortality. Particularly, spontaneous decline in cholesterol levels may be a marker for worsening health conditions.
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Affiliation(s)
- Su-Min Jeong
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seulggie Choi
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Kyuwoong Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Sung-Min Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Gyeongsil Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joung Sik Son
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae-Moon Yun
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang Min Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Republic of Korea
- * E-mail:
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20
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Lee SW, Lee HY, Ihm SH, Park SH, Kim TH, Kim HC. Status of hypertension screening in the Korea National General Health Screening Program: a questionnaire survey on 210 screening centers in two metropolitan areas. Clin Hypertens 2017; 23:23. [PMID: 29225914 PMCID: PMC5716058 DOI: 10.1186/s40885-017-0075-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/11/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The purpose of this survey was to evaluate the performance of hypertension screening in medical institutions conducting the national general health screening program of the Republic of Korea. METHODS We contacted 700 medical institutions of Seoul and Incheon areas which performed the national general health screening program in 2016, and 210 of them completed telephone survey. The questions asked in the survey include equipment, environment, personnel and quality control procedures for blood pressure (BP) measurement, and interpretation of the measurements. RESULTS A majority of the responding screening centers used oscilloscope sphygmomanometers (51.9%), had only one-sized cuff (65.2%), and measured BP in open space (54.3%). BP levels were measured mainly by nurses (62.0%) and doctors (25.0%), after a 1 to10 minutes (84.9%) of resting period. A 75.2% of screening centers regularly calibrated sphygmomanometers, 81.4% had a manual for BP measurement, and 59.0% had a training program. A 80.0% of respondents answered that they used averages of multiple BP measurements to determine an individual's BP level, and 82.9% answered that criteria for hypertension was systolic BP ≥140 mmHg and/or diastolic BP ≥ 90 mmHg. If a screening finds an individual with hypertension, 82.9% of centers recommend revisiting for a second BP measurement rather than start medication immediately. CONCLUSION In most medical institutions performing general health screening program, certified medical personnel measure BP and interpret the results according to established protocols. However, there is room for improvement in the equipment, environment and quality control procedures for BP measurement.
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Affiliation(s)
- Seung Won Lee
- Cardiovascular and Metabolic Diseases Etiology Research Center, Yonsei University College of Medicine, Seoul, South Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, 03722 South Korea
| | - Hae-Young Lee
- Department of internal medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Hyun Ihm
- Division of Cardiology, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Sung Ha Park
- Department of internal medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae Hyun Kim
- Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Hyeon Chang Kim
- Cardiovascular and Metabolic Diseases Etiology Research Center, Yonsei University College of Medicine, Seoul, South Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, 03722 South Korea
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Eom H, Myong JP, Kim EA, Choi B, Park SW, Kang YJ. Effectiveness of workers' general health examination in Korea by health examination period and compliance: retrospective cohort study using nationwide data. Ann Occup Environ Med 2017; 29:2. [PMID: 28239481 PMCID: PMC5316150 DOI: 10.1186/s40557-017-0160-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 02/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our study evaluated the effectiveness of the Workers' General Health Examination by health examination period and compliance. METHODS A retrospective cohort of the health examination participants in 2006 (baseline year: N = 6,527,045) was used. We identified newly occurring cardio-cerebrovascular disease over 7 years (from 2007 to 2013). After stratification by age, sex, and national health insurance type, we identified 7 years' cumulative incidence of cardio-cerebrovascular disease by health examination compliance and estimated its relative risk by health examination period and compliance. RESULTS The compliant group presented a lower cumulative incidence of cardio-cerebrovascular disease than the non-compliant group; this result was consistent across sex, working age (40s and 50s), and workplace policyholder. Relative risk of cardio-cerebrovascular disease by health examination period (1 and 2 years) showed statistically significant results in ischemic heart disease for male participants. Of men in their 40s, office workers (over a 2-year period) presented statistically higher relative risk of ischemic heart disease than non-office workers (over a 1-year period: 1.03; 95% confidence interval, 1.02-1.03). However, there were no consistent results in ischemic cerebrovascular disease and hemorrhagic cerebrovascular disease for men or cardio-cerebrovascular disease for women. CONCLUSION A 1-year period of Workers' General Health Examinations in non-office workers had a more significant prevention effect on ischemic heart disease than a 2-year period in office workers among working age (40s-50s) men. It is, however, necessary to consider that prevention of cardio-cerebrovascular disease can be partially explained by their occupational characteristics rather than by health examination period.
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Affiliation(s)
- Huisu Eom
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, 400, Jongga-ro, Ulsan, 44419 Jung-gu Republic of Korea
| | - Jun-Pyo Myong
- Department of Occupational and Environmental Medicine, Seoul St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Eun-A Kim
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, 400, Jongga-ro, Ulsan, 44419 Jung-gu Republic of Korea
| | - Bohwa Choi
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, 400, Jongga-ro, Ulsan, 44419 Jung-gu Republic of Korea
| | - Soon Woo Park
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, 400, Jongga-ro, Ulsan, 44419 Jung-gu Republic of Korea
| | - Young Joong Kang
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, 400, Jongga-ro, Ulsan, 44419 Jung-gu Republic of Korea
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Kim EA. The First Evaluation of Workers' General Health Examination in Korea. Ann Occup Environ Med 2017; 29:1. [PMID: 28203379 PMCID: PMC5301339 DOI: 10.1186/s40557-017-0158-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 02/08/2017] [Indexed: 12/04/2022] Open
Affiliation(s)
- Eun-A Kim
- Occupational Safety and Health Search Institute, Korea Occupational Safety and Health Agency, Ulsan, Republic of Korea
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23
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Woo H, Lee J, Lee J, Park JW, Park S, Kim J, Oh JH, Shin A. Diabetes Mellitus and Site-specific Colorectal Cancer Risk in Korea: A Case-control Study. J Prev Med Public Health 2017; 49:45-52. [PMID: 26841884 PMCID: PMC4750510 DOI: 10.3961/jpmph.15.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 12/22/2015] [Indexed: 12/28/2022] Open
Abstract
Objectives: Previous large-scale cohort studies conducted in Korea have found a positive association between diabetes mellitus (DM) and colorectal cancer (CRC) in men only, in contrast to studies of other populations that have found significant associations in both men and women. Methods: A total of 1070 CRC cases and 2775 controls were recruited from the National Cancer Center, Korea between August 2010 and June 2013. Self-reported DM history and the duration of DM were compared between cases and controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by binary and polytomous logistic regression models. Results: DM was associated with an elevated risk of CRC in both men (OR, 1.47; 95% CI, 1.13 to 1.90) and women (OR, 1.92; 95% CI, 1.24 to 2.98). This association remained when we controlled for age, body mass index, alcohol consumption, and physical activity level. In sub-site analyses, DM was associated with distal colon cancer risk in both men (multivariate OR, 2.04; 95% CI, 1.39 to 3.00) and women (multivariate ORs, 1.99; 95% CI, 1.05 to 3.79), while DM was only associated with rectal cancer risk in women (multivariate OR, 2.05; 95% CI, 1.10 to 3.82). No significant association was found between DM and proximal colon cancer risk in either men (multivariate OR, 1.45; 95% CI, 0.88 to 2.41) or women (multivariate OR, 1.79; 95% CI, 0.78 to 4.08). Conclusions: Overall, DM was associated with an increased risk of CRC in Koreans. However, potential over-estimation of the ORs should be considered due to potential biases from the case-control design.
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Affiliation(s)
- Hyeongtaek Woo
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jeeyoo Lee
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jeonghee Lee
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Won Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sungchan Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jeongseon Kim
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hwan Oh
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
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24
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Abstract
PURPOSE This study was conducted to investigate the effect that detection of chronic disease via health screening programs has on health behaviors, particularly smoking. MATERIALS AND METHODS We analyzed national health insurance data from 2007 and 2009. Subjects who were 40 years of age in 2007 and eligible for the life cycle-based national health screening program were included. The total study population comprised 153,518 individuals who participated in the screening program in 2007 and follow-up screening in 2009. Multiple logistic regression analyses were conducted by sex, with adjustment for health insurance type, socioeconomic status, body mass index, diabetes, hypertension, hyperlipidemia, and family history of cardiovascular and/or neurovascular disease. RESULTS Among men with smoking behavior changes, those newly diagnosed with hyperlipidemia were more likely to show a positive health behavior change, such as smoking cessation, and were less likely to have a negative behavior change (e.g., smoking initiation). Additionally, men newly diagnosed with diabetes showed lower rates of negative health behavior changes compared to those without disease. Body mass index (BMI)≥25, compared to BMI<23, showed higher rates of positive health behavior changes and lower rates of negative health behavior changes. Newly diagnosed chronic disease did not influence smoking behavior in women. CONCLUSION Smoking behavior changes were only detected in men who participated in health screening programs. In particular, those newly diagnosed with hyperlipidemia were more likely to stop smoking and less likely to start smoking.
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Affiliation(s)
- Jeoung A Kwon
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Wooman Jeon
- National Health Insurance Services, Seoul, Korea
| | - Eun-Cheol Park
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.; Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Hyun Kim
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea.; Department of Public Health, Graduate School, Yonsei University, Seoul, Korea
| | - Sun Jung Kim
- Department of Health Administration, Namseoul University, Cheonan, Korea
| | - Ki-Bong Yoo
- Department of Healthcare Management, Eulji University, Seongnam, Korea
| | - Minjee Lee
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sang Gyu Lee
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea.; Department of Hospital Management, Graduate School of Public Health, Yonsei University, Seoul, Korea.
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25
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Lee HH, Park JY. The Association between Health Examination and Personal Medical Cost through Panel Survey. HEALTH POLICY AND MANAGEMENT 2014. [DOI: 10.4332/kjhpa.2014.24.1.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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26
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Yang HK, Shin DW, Hwang SS, Oh J, Cho BL. Regional factors associated with participation in the national health screening program: a multilevel analysis using national data. J Korean Med Sci 2013; 28:348-56. [PMID: 23487573 PMCID: PMC3594596 DOI: 10.3346/jkms.2013.28.3.348] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 01/11/2013] [Indexed: 11/20/2022] Open
Abstract
High participation rates are important for maximizing the effects of a health screening program. Previous studies have suggested that individual or regional characteristics have effects on health behaviors. In this study, we investigated the determinants of participation in the National Screening Program for Transitional Ages by simultaneously analyzing individual and area-level factors by multilevel analysis. A total of 1,081,216 subjects, aged 40 and 66 yr and nested in 254 areas, were included. There was a significant variation in participation rates across the areas even after adjusting for individual and area-level variables. Among the individual-level variables, increasing age, sex, higher income, and mild disability grade were associated with a higher participation rate. In urban areas, the 40-yr-old group had higher participation rates than the 66-yr-old group. Deprived areas had significantly high participation rates for both age groups. The number of screening centers per 1,000 inhabitants had no significant effect on participation in the screening program. In conclusion, regional characteristics are associated with participation rates independent of personal features and regional factors have differential effects with respect to age. A multi-dimensional approach is recommended to promote participation in health screening programs.
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Affiliation(s)
- Hyung-Kook Yang
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong-Wook Shin
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung-Sik Hwang
- Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea
| | - Juwhan Oh
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea
| | - Be-Long Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
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27
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Kim HS, Shin DW, Lee WC, Kim YT, Cho B. National screening program for transitional ages in Korea: a new screening for strengthening primary prevention and follow-up care. J Korean Med Sci 2012; 27 Suppl:S70-5. [PMID: 22661875 PMCID: PMC3360178 DOI: 10.3346/jkms.2012.27.s.s70] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 02/23/2012] [Indexed: 12/24/2022] Open
Abstract
Screening can effectively reduce mortality and morbidity in some diseases. In Korea, a practical national screening program for chronic disease was launched in 1995 and several problems were discussed. The program focused primarily on disease detection without follow-up care. In addition, the test items were uniform regardless of subject's age, sex, or risk factors; and people with low socioeconomic status were excluded. To improve the quality of program, a new national screening program called the "National Screening Program for Transitional Ages (NSPTA)" was initiated in 2007. It targeted two age groups, ages 40 and 66, because these ages are important transition periods in one's lifecycle. Follow-up care and education for lifestyle modification has been intensified; screening tests for mental health problems and osteoporosis have been introduced. The pool of eligible participants has been expanded to include people supported by Medicaid. This review aimed to describe the contents, process, and characteristics of the NSPTA and to compare it with the previous program. In addition, some preliminary results from 2007 to 2009 were presented. Lastly, we suggest several points that need to be considered to improve the program such as enhancement of participation rates, necessity of specialized committee and research for current screening program to be supported by evidence.
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Affiliation(s)
- Hyun Su Kim
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Wook Shin
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Won Chul Lee
- Department of Preventive Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Young Taek Kim
- Division of Chronic Disease Control, Korea Centers for Disease Control and Prevention, Osong, Korea
| | - Belong Cho
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
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28
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Lim SH, Lee SB. Analysis of Inpatients with Bacterial Keratitis Over a 12-Year Period: Pathogenic Organisms and Antibiotic Resistance. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.3.372] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Su-Ho Lim
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Sang-Bumm Lee
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
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29
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Cho B, Lee CM. Current situation of national health screening systems in Korea. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2011. [DOI: 10.5124/jkma.2011.54.7.666] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Belong Cho
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Cheol Min Lee
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
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