Epidemiology and Health

Original articles

Preventable cancer cases and deaths attributable to deficit of physical activity in Korea from 2015 to 2030: Soseul Sung, Sungji Moon, Jihye An, Jeehi Jung, Hyeon Sook Lee, Youjin Hong, Sangjun Lee, Woojin Lim, Kyungsik Kim, Inah Kim, Jung Eun Lee, Sun Ha Jee, Aesun Shin, Ji-Yeob Choi, Sun-Seog Kweon, Min-Ho Shin, Sangmin Park, Seung-Ho Ryu, Sun Young Yang, Seung Ho Choi, Jeongseon Kim, Sang-Wook Yi, Yoon-Jung Choi, Jeong-Soo Im, Hong Gwan Seo, Sohee Park, Kwang-Pil Ko, Sue K. Park; Epidemiol Health. 2025;e2025010. Published online February 27, 2025; DOI: https://doi.org/10.4178/epih.e2025010 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
This study aimed to determine the population–attributable fractions (PAFs) of cancers using various calculation methods and to estimate the PAFs of cancer incidence and mortality resulting from deficit in physical activity (DPA) from 2015 to 2030, based on data on prevalence rates.
METHODS
The PAF of cancer was estimated using a cohort study–based meta–analysis of relative risk (RR), national prevalence rates of DPA from 2000 to 2015, and national cancer statistics from 2015 to 2030, with a latency of 15 years.
RESULTS
In 2015, DPA contributed to 909 cancer cases and 548 deaths, accounting for 0.42% and 0.68% of new cancer cases and deaths, respectively. By 2030, the PAF values are expected to increase to 1.31% of incidence and 1.80% of mortality, with a continual increase from 2015 to 2030. When the low metabolic equivalent of task (MET) criteria were selected, the PAF values decreased for both incidence and mortality. The PAF calculated with <900 MET–min/week for the sex–specific MET criterion was higher than that calculated with <900 MET–min/week for both incidence and mortality.
CONCLUSIONS
The risk of cancer associated with DPA is expected to rise in both men and women. Future research and strategies should emphasize the promotion of physical activity for cancer prevention, considering its significant implications for public health.; Summary

Preventable cancer cases and deaths attributable to alcohol consumption in Korea from 2015 to 2030: Soseul Sung, Jihye An, Jeehi Jung, Hyeon Sook Lee, Sungji Moon, Inah Kim, Jung Eun Lee, Aesun Shin, Sun Ha Jee, Sun-Seog Kweon, Min-Ho Shin, Sangmin Park, Seung-Ho Ryu, Sun Young Yang, Seung Ho Choi, Jeongseon Kim, Sang-Wook Yi, Yoon-Jung Choi, Youjin Hong, Sangjun Lee, Woojin Lim, Kyungsik Kim, Sohee Park, Jeong-Soo Im, Hong Gwan Seo, Kwang-Pil Ko, Sue K. Park; Epidemiol Health. 2025;e2025009. Published online February 27, 2025; DOI: https://doi.org/10.4178/epih.e2025009 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Alcohol consumption is causally linked to several cancers, and major health organizations classify it as a carcinogen. This study assessed the impact of alcohol consumption on cancer incidence and mortality in Korea in 2015 and 2020, projected trends up to 2030, and compared results based on different criteria.
METHODS
The relative risk of cancer associated with alcohol consumption in Korea was determined through a meta–analysis of alcohol–related relative risks for specific cancers, using primary data from the Korean Cohort Study within the Korean Cohort Consortium. The population–attributable fraction (PAF) was calculated using Levin's formula, incorporating drinking prevalence and the number of cancer cases and deaths, with a 15–year latency period assumed.
RESULTS
In Korea, the PAF for alcohol consumption, based on ever/never drinking criteria, was higher than that calculated using other criteria, except for the PAF based on past and current/never drinking criteria. Alcohol consumption contributed to 3.58% of all cancer cases and 3.28% of cancer deaths in 2015. It accounted for 4.58% of new cancer cases in men and 2.08% in women, with a higher contribution to incidence than mortality (4.00% and 2.25% of cancer deaths in men and women, respectively). Projections indicate that alcohol–related cancer PAF will decrease by 17.2% in men but increase by 70.2% in women by 2030.
CONCLUSIONS
This study highlights the impact of alcohol consumption on cancer in Korea, emphasizing the need for sex–specific regulations to address sex differences.; Summary

Preventable cancer cases and deaths attributable to tobacco smoking in Korea from 2015 to 2030: Soseul Sung, Jihye An, Jeehi Jung, Hyeon Sook Lee, Sungji Moon, Inah Kim, Jung Eun Lee, Aesun Shin, Sun Ha Jee, Sun-Seog Kweon, Min-Ho Shin, Sangmin Park, Seung-Ho Ryu, Sun Young Yang, Seung Ho Choi, Jeongseon Kim, Sang-Wook Yi, Yoon-Jung Choi, Youjin Hong, Sangjun Lee, Woojin Lim, Kyungsik Kim, Daehee Kang, Keun-Young Yoo, Sohee Park, Jeong-Soo Im, Hong Gwan Seo, Hai-Rim Shin, Kwang-Pil Ko, Sue K. Park; Epidemiol Health. 2025;e2025008. Published online February 27, 2025; DOI: https://doi.org/10.4178/epih.e2025008 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Tobacco smoking is a major public health concern worldwide. This study aimed to assess its impact on cancer incidence and mortality by estimating the population attributable fraction (PAF) in the Korean population for 2015 and 2020 and by projecting future trends until 2030.
METHODS
The Korean relative risk (RR) was calculated via a meta–analysis of RRs for individual cancers attributed to tobacco smoking, based on primary data analysis from the Korean Cohort Consortium. The PAF was estimated using the Levin formula with past and current prevalence rates and the number of cancer cases and deaths, assuming a 15–year latency period.
RESULTS
The proportions of cancer cases and deaths in Korea attributable to tobacco smoking were similar to those calculated using Asian and global RRs for both men and women. In 2015 and 2020, tobacco smoking contributed to 14.32% and 13.17% of cancer cases and 21.70% and 20.69% of cancer deaths in adults, respectively. Among Koreans, smoking was responsible for 25.83% of new cancer cases in men in 2015, 23.49% in men in 2020, 1.46% in women in 2015, and 1.68% in women in 2020. In both years, smoking impacted mortality more strongly than incidence in Korean men and women (incidence in men: 25.83% and 23.49%; mortality in men: 32.09% and 30.41%; incidence in women: 1.46% and 1.68%; and mortality in women: 4.70% and 4.96%, respectively).
CONCLUSIONS
Tobacco smoking causes cancers and deaths in Korea, however, it is preventable. Effective control policies that consider trends and vulnerabilities among women are required.; Summary

Cohort Profile

Cohort study profile: a cohort of Korean atomic bomb survivors and their offspring: Hamin Lee, Jin-Wu Nam, Mi Kyung Kim, Inah Kim, Yu-Mi Kim, Boyoung Park; Epidemiol Health. 2024;46:e2024089. Published online November 18, 2024; DOI: https://doi.org/10.4178/epih.e2024089

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Abstract Summary PDF: Abstract
The Korean Atomic Bomb Survivor Cohort (K-ABC) study was designed to investigate the health impacts of atomic bomb exposure on Korean survivors and to explore whether these effects are passed down genetically to their descendants. This paper outlines the study’s design, data collection methods, baseline socio-demographic characteristics, exposure status, and disease prevalence among the participants, based on survey responses and health examinations. From 2020 to 2024, a total of 2,544 individuals, comprising 1,109 atomic bomb survivors (G1), 1,193 children of G1 (G2), and 242 grandchildren of G1 (G3), consented to participate in the study. Of these, 1,828 participants (659 in G1, 927 in G2, and 242 in G3) completed the survey and underwent health examinations, representing a participation rate of 71.9%. Exposure information was gathered using a questionnaire and verified through records from the Korean Red Cross and a handbook issued by the Japanese government. Disease prevalence was determined based on participants’ self-reported physician diagnoses. This study presents details about the K-ABC study and provides baseline data on the participants recruited. These data will be valuable for interpreting the results of future K-ABC studies.; Summary

Korean summary
한국인 원폭피해자 코호트 연구는 1945년 일본에서 원자폭탄에 피폭된 원폭 피해자 1세와 이들의 자녀인 2세, 3세의 건강과 질병 위험도을 장기적으로 조사한다. 이를 위해 2020년부터 2023년까지 설문조사를 통해 정보를 수집하였고, 이후 설문조사와 함께 건강보험공단, 국립암센터, 통계청 등 공공 기관에서 보유하고 있는 데이터를 연계하여 추적관찰을 수행해 나갈 예정이다.

Key Message
The Korean atomic bomb survivor’s cohort study investigates the long-term health and disease risks of first generation atomic bomb survivors exposed in Japan in 1945, as well as their second generation and third generations. From 2020 to 2023, information was collected through surveys. Follow-up will be conducted through surveys and secondary data linkage from public institutions such as the National Health Insurance Service, the Korea Central Cancer Registry, and Statistics Korea.

Data Profile

Data profile: the Korean Workers’ Compensation-National Health Insurance Service (KoWorC-NHIS) cohort: Jeehee Min, Eun Mi Kim, Jaiyong Kim, Jungwon Jang, Youngjin Choi, Inah Kim; Epidemiol Health. 2024;46:e2024071. Published online August 19, 2024; DOI: https://doi.org/10.4178/epih.e2024071

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Abstract Summary PDF: Abstract
The Korean Workers’ Compensation-National Health Insurance Service (KoWorC-NHIS) cohort was established to investigate the longitudinal health outcomes of Korean workers who have been compensated for occupational injuries or diseases. This cohort study, which utilized data spanning from 2004 to 2015, merged workers’ compensation insurance claim data with the National Health Insurance Database (NHID), encompassing 858,793 participants. The data included socio-demographic factors such as age, sex, income, address, insurance type, and disability grade. It also covered the types of occupational accidents, International Classification of Diseases, 10th revision codes for diseases or accidents, work tenure, industry, occupation code, and company size. Additional details such as the occupational hire date, date of claim, date of recognition, and affected body parts were recorded. The cohort predominantly consisted of male workers (80.0%), with the majority experiencing their first occupational accident in their 40s (27.6%) or 50s (25.3%). Notably, 93.1% of the cases were classified as occupational injuries. By integrating this data with that from the NHID, updates on health utilization, employment status, and income changes were made annually. The follow-up period for this study is set to conclude in 2045.; Summary

Korean summary
KoWorC-NHIS Cohort (산재보험-국민건강보험공단 코호트) 는 2004년부터 2015년까지 산업재해를 경험한 근로자들의 장기적인 건강 결과를 추적 조사하기 위해 구축된 코호트이다. 이 코호트에는 총 858,793명의 근로자가 등록되었으며, 대다수는 남성 (80%)이었고, 업무상 사고 (93.1%)를 경험한 것으로 나타났다. 이 코호트를 활용하여 산업재해 피해 근로자들의 장기적인 건강영향을 분석할 수 있으며, 취약 계층 근로자의 건강을 보호하기 위한 예방 정책 수립의 근거로 활용할 수 있다.

Key Message
The KoWorC-NHIS Cohort (Workers' Compensation Insurance-National Health Insurance Service Cohort) was established to track the long-term health outcomes of workers who experienced occupational injuries and illnesses from 2004 to 2015. The cohort includes a total of 858,793 workers, with the majority being male (80%) and having experienced occupational accidents (93.1%). This cohort can be used to analyze the long-term health effects on workers who have suffered occupational injuries, and can serve as evidence for establishing preventive policies to protect the health of vulnerable workers.

Methods

Validation of self-reported morbidities in the Korean Atomic Bomb Survivor Cohort: Ansun Jeong, Somin Jeon, Seong-geun Moon, Mi Kyung Kim, Inah Kim, Yu-Mi Kim, Boyoung Park; Epidemiol Health. 2024;46:e2024058. Published online June 28, 2024; DOI: https://doi.org/10.4178/epih.e2024058

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study aimed to evaluate the agreement of disease status collected through a survey of the Korean Atomic Bomb Survivor Cohort (K-ABC), compared with medical claim records from the Korean National Health Insurance Service (NHIS) database and the Korean Central Cancer Registry (KCCR).
METHODS
Data on the lifetime physician-diagnosed morbidities of 1,215 K-ABC participants were collected through an interviewer-administered questionnaire between 2020 and 2022. Survey data were linked to the NHIS and KCCR databases. Eleven diseases were included for validation. We evaluated the following indicators: sensitivity, specificity, positive predictive value, negative predictive value, accuracy, the area under the curve, and the kappa coefficient.
RESULTS
The mean±standard deviation age was 62.1±18.7 years, and 42.6% of the participants were aged ≥70 years. Hypertension and cataracts showed the highest prevalence rates (33.8 and 28.8%, respectively). Hypertension, diabetes, and cancer demonstrated high sensitivity (>0.8) and specificity (>0.9), whereas diabetes, cancer, myocardial infarction, angina pectoris, and asthma exhibited high accuracy (>0.9). In contrast, arthritis, allergic rhinitis, and asthma showed low sensitivity (<0.4) and kappa values (<0.3). In the participants aged ≥70 years, the kappa value was ≥0.4 for all diseases except arthritis, allergic rhinitis, and asthma.
CONCLUSIONS
The results from this initial analysis showed relatively high agreement between the survey and NHIS/KCCR databases, especially for hypertension, diabetes, and cancer. Our findings suggest that the information on morbidities collected through the questionnaires in this cohort was valid for both younger and older individuals.; Summary

Korean summary
한국인 원폭피해자 코호트에서 설문으로 조사한 질병 과거력과 국민건강보험공단/암등록자료와의 일치도는 높은 편이었으며, 특히 고혈압, 당뇨, 암에서 높았다. 설문으로 조사한 질병 과거력은 젊은 대상자와 고령 대상자 모두에서 높았다.

Key Message
High agreement between the survey and NHIS/KCCR databases, especially for hypertension, diabetes, and cancer in the Korean Atomic Bomb Survivor Cohort was observed. The information on morbidities collected through the questionnaires in this cohort was valid for both younger and older individuals.

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