Epidemiology and Health

Original Article

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

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

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

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

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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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.

Original Articles

Effect of the human papillomavirus vaccine on the risk of genital warts: a nationwide cohort study of Korean adolescent girls: Jaeyoung Cho, Eun Mi Kim, Jihye Kim, Ju-Young Shin, Eui Hyeok Kim, Jong Heon Park, Seunghyun Lewis Kwon, Geun-Yong Kwon, Soon-Ae Shin, Jaiyong Kim; Epidemiol Health. 2024;46:e2024040. Published online March 18, 2024; DOI: https://doi.org/10.4178/epih.e2024040

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The purpose of this study was to assess the effectiveness of human papillomavirus (HPV) vaccination administered to adolescent girls through Korea’s National Immunization Program.

METHODS

This retrospective cohort study included patients who were 12-13 years old, whether vaccinated or unvaccinated, between July 2016 and December 2017. The incidence of genital warts (GWs) was monitored through 2021. Time-stratified hazard ratios (HRs) were estimated, adjusting for birth year, socioeconomic status, and the level of urbanization of the region, and were presented with 95% confidence intervals (CIs). Data were sourced from the Immunization Registry Integration System, linked with the National Health Information Database.

RESULTS

The study included 332,062 adolescent girls, with an average follow-up period of approximately 4.6 years. Except for the first year, the HRs for the vaccinated group were lower than those for the unvaccinated group. The HRs for specific cut-off years were as follows: year 2, 0.62 (95% CI, 0.31 to 1.13); year 3, 0.58 (95% CI, 0.35 to 0.96); and year 4 and beyond, 0.39 (95% CI, 0.28 to 0.52).

CONCLUSIONS

Our findings indicate that HPV vaccination was associated with a reduction in the risk of GWs among adolescent girls. Notably, this reduction became significant as the incidence of GWs increased with age.

Summary

Korean summary
이 연구는 후향적 코호트 연구로써, HPV 예방접종이 한국의 여자 청소년에서 생식기사마귀 질환의 위험을 감소시키는 것과 연관성이 있다는 것을 보여주었다. 따라서 단기적으로 한국의 국가예방접종 사업은 생식기사마귀 질환에 있어 효과가 있었다고 볼 수 있다. 향후에는 전암성 병변 또는 암 등과 같은 심각한 질환에 대한 백신의 영향을 확인할 필요가 있다.

Key Message
In this retrospective cohort study, our results demonstrated that HPV vaccination is associated with a reduction in the risk of GWs among adolescent girls. In the short term, the NIP of Korea can be considered effective in providing protection against GWs. Future studies need to analyze the impact of vaccines on more serious diseases such as precancerous lesions or cancer.

Citations

Citations to this article as recorded by

Effect of human papillomavirus (HPV) vaccination on HPV infection and recurrence of HPV related disease after local surgical treatment: A systematic review and meta-analysis
Qinxue Cao, Yantao Hou, Chaoyang Wang, Juntao Yin, Mehmet Demirci
PLOS ONE.2024; 19(12): e0312128. CrossRef

The coverage rates for influenza vaccination and related factors in Korean adults aged 50 and older with chronic disease: based on 2016 Community Health Survey data: Kyeong Hyang Byeon, Jaiyong Kim, Boyoung Choi, Bo Youl Choi; Epidemiol Health. 2018;40:e2018034. Published online July 24, 2018; DOI: https://doi.org/10.4178/epih.e2018034

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11 Web of Science
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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aims to identify the coverage rates for influenza vaccination and related factors depending on chronic disease in Korean adults aged 50 and older.

METHODS

The 2016 Korea Community Health Survey was used for analysis. Chi-square test was performed to investigate the coverage rates for influenza vaccination depending on chronic disease, and a multiple logistic regression analysis was used to identify the factors associated with influenza vaccination, by chronic disease.

RESULTS

In men with ≥1 chronic disease, 39.8% of 50-64 years of age, and 86.8% of elderly (over 65 years of age) received influenza vaccination. In women with ≥1 chronic disease, 58.7% of 50-64 years of age, and 89.9% of elderly (over 65 years of age) received influenza vaccination (p<0.001). The chronic diseases associated with influenza vaccination were hypertension (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.19 to 1.37), diabetes (OR, 1.41; 95% CI, 1.28 to 1.55) in men aged 50-64, hypertension (OR, 1.34; 95% CI, 1.20 to 1.49), diabetes (OR, 1.17; 95% CI, 1.02 to 1.33), chronic cardiovascular disease (OR, 1.31; 95% CI, 1.07 to 1.60) in elderly (over 65 years of age). In women aged 50-64, hypertension (OR, 1.39; 95% CI, 1.30 to 1.49), diabetes (OR, 1.51; 95% CI, 1.35 to 1.68), chronic cardiovascular disease (OR, 1.31; 95% CI, 1.05 to 1.64), and hypertension (OR, 1.55; 95% CI, 1.40 to 1.71), diabetes (OR, 1.27; 95% CI, 1.12 to 1.43) in elderly (over 65 years of age).

CONCLUSIONS

Populations in aged 50-64 are recommendation subject for vaccination or classified as high-risk group in case with chronic disease. Though subject over 60 years old is age close to the elderly, the coverage rates for vaccination was low. It is necessary to devise strategies to raise the coverage rates for vaccination.

Summary

Korean summary
매년 인플루엔자 환자수는 증가하는 추세이며 인플루엔자로 인한 의료이용의 질병부담은 커질 것으로 생각된다. 국내에서는 우선접종 권장대상자들에게 예방접종을 받도록 권고하고 있으며, 예방접종은 인플루엔자를 예방할 수 있는 비용 효과적인 방법이다. 65세 이상 대상자는 국가 무료 예방접종 사업 대상으로 인해 예방접종률이 높은 것으로 확인되었다. 50-64세 인구는 예방접종 권고 대상자임에도 불구하고 낮은 것으로 나타났고, 50-64세 연령에서 만성질환을 동반할 경우 고위험군이지만 여전히 낮은 예방접종률을 보였다. 또한 50-64세 연령에서 1개 이상 만성질환을 동반할 경우 대도시, 중소도시에 거주하는 것보다 군지역에 거주할 경우 높은 예방접종률을 확인함으로써 대도시 및 중소도시에 거주하는 50-64세 연령에 대해 예방접종률을 올릴 수 있는 적극적인 예방접종 홍보가 필요할 것으로 생각한다.

Citations

Citations to this article as recorded by

All-Cause and Cause-Specific Mortality Attributable to Seasonal Influenza: A Nationwide Matched Cohort Study
Heeseon Jang, Jaelim Cho, Seong-Kyung Cho, Donghan Lee, Sung-il Cho, Sang-Baek Koh, Dong-Chun Shin, Changsoo Kim
Journal of Korean Medical Science.2023;[Epub] CrossRef
Cost-Effectiveness of Influenza Vaccination Strategies in Adults: Older Adults Aged ≥65 Years, Adults Aged 50–64 Years, and At-Risk Adults Aged 19–64 Years
Min Joo Choi, Gyeongseon Shin, Daewon Kang, Jae-Ok Lim, Yun-Kyung Kim, Won Suk Choi, Jae-Won Yun, Ji Yun Noh, Joon Young Song, Woo Joo Kim, Sang-Eun Choi, Hee Jin Cheong
Vaccines.2022; 10(3): 445. CrossRef
Assessing Vaccine Protection for Older Adults with Diabetes: A Systematic Review
Leena Almasri, Barbara J. Holtzclaw
Western Journal of Nursing Research.2022; 44(6): 582. CrossRef
Drivers of and barriers to routine adult vaccination: A systematic literature review
Amanda L. Eiden, Jane Barratt, Mawuli K. Nyaku
Human Vaccines & Immunotherapeutics.2022;[Epub] CrossRef
Factors associated with influenza vaccination coverage and willingness in the elderly with chronic diseases in Shenzhen, China
Hongbiao Chen, Qiushuang Li, Minyi Zhang, Zihao Gu, Xiaofeng Zhou, He Cao, Fei Wu, Minyi Liang, Liting Zheng, Juxian Xian, Qing Chen, Qihui Lin
Human Vaccines & Immunotherapeutics.2022;[Epub] CrossRef
The role of health determinants in the influenza vaccination uptake among older adults (65+): a scope review
Regina Roller-Wirnsberger, Sonja Lindner, Lea Kolosovski, Elisabeth Platzer, Peter Dovjak, Holger Flick, Chariklia Tziraki, Maddalena Illario
Aging Clinical and Experimental Research.2021; 33(8): 2123. CrossRef
Factors Related to Influenza Vaccination Intention in University Students Based on Theory of Planned Behavior
Yeojoo Chae, Sunjoo Kim, Seungkyoung Yang
Journal of Health Informatics and Statistics.2021; 46(1): 64. CrossRef
Analysis of Epidemiological and Clinical Characteristics of COVID-19 in Northwest Mexico and the Relationship Between the Influenza Vaccine and the Survival of Infected Patients
Uriel A. Angulo-Zamudio, Francisco M. Martínez-Villa, Nidia Leon-Sicairos, Hector Flores-Villaseñor, Jorge Velazquez-Roman, Abraham Campos-Romero, Jonathan Alcántar-Fernández, Francisco Urrea, Secundino Muro-Amador, Julio Medina-Serrano, Jesus J. Martinez
Frontiers in Public Health.2021;[Epub] CrossRef
Influenza Vaccination Coverage among Older Adults with Hypertension in Shenzhen, China: A Cross-Sectional Survey during the COVID-19 Pandemic
Qiushuang Li, Minyi Zhang, Hongbiao Chen, Fei Wu, Juxian Xian, Liting Zheng, Minyi Liang, He Cao, Xiaofeng Zhou, Zihao Gu, Qihui Lin, Qing Chen
Vaccines.2021; 9(10): 1105. CrossRef
A Nationwide Survey on the Hospital Vaccination Policies in Korea
Sun Hee Park, Mi Suk Lee, Sung Ran Kim, Yee Gyung Kwak
Journal of Korean Medical Science.2020;[Epub] CrossRef
Possibilities for Coronavirus (COVID 19) – The Perspectives
Mark Christopher Arokiaraj
SSRN Electronic Journal .2020;[Epub] CrossRef
Correlation of Influenza Vaccination and the COVID-19 Severity
Mark Christopher Arokiaraj
SSRN Electronic Journal .2020;[Epub] CrossRef
Considering Interim Interventions to Control COVID-19 Associated Morbidity and Mortality—Perspectives
Mark Christopher Arokiaraj
Frontiers in Public Health.2020;[Epub] CrossRef
Increasing Influenza Vaccination Rates in People With Chronic Illness
Linda Sanftenberg, Felix Brombacher, Jörg Schelling, Stefanie J. Klug, Jochen Gensichen
Deutsches Ärzteblatt international.2019;[Epub] CrossRef

Occupational Cancer Surveillance System Using Data Linkage Analysis in Korea.: Sang Yun Lee, Jaiyong Kim, Seongwoo Choi, Hyungjun Im, Kijung Yoon, Ho Jang Kwon, Soo Hun Cho, Daehee Kang; Korean J Epidemiol. 1999;21(2):276-282.

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To develop the occupational cancer surveillance system in Korea, data linkage analysis was performed on the subjects of Health-monitoring-pocketbook (the list of subjects who were exposed to selected occupational carcinogens) and the retired workers of a cokes manufacturing factory using the Korean medical insurance data, Korean death certificate data and Korean cancer registry data. Study subjects comprised the 822 retired subjects and the 3101 present-post subjects of Health-monitoring-pocketbook and the 182 retired workers of a cokes manufacturing factory. The incidence of cancer of these study subjects was ascertained by linkage of Korean medical insurance data of year 1995-6, Korean death certificate data of year 1992-8 and Korean cancer registry data of year 1993-5. In the study subjects, Eighty seven percent were males and mean age was 39.3+/-8.9 year-old, Average work duration was 8.0+/-5.5 years. Chrome, asbestos and cokes were the most frequent exposed agents. In the study subjects, total 13 cancer cases were ascertained by data linkage analysis. In the ascertained cancer cases, 8 cases were male and 5 cases were female, and 7 cases were aged 40-49 yr, 5 cases were aged 50-59 yr and 1 cases were aged 30-39 yr. The commonest exposure agent in the ascertained cancer cases was asbestos and cokes. By the site of cancer, 3 stomach cancer cases, 2 hematopoietic cancer cases and 2 biliary tract cancer cases were ascertained. The occupational cancer surveillance system using data linkage analysis on the workers exposed to hazardous agents was the most feasible and efficient method in Korea. And to do this, establishment of occupational history information in several disease registry database is needed with the effort of estimating the proper size of workers exposed hazardous agents.; Summary

The Usefulness of the Secondary Database for Occupational Asthma Surveillance System in Korea.: Hyungjune Im, Sungwoo Choi, Jaiyong Kim, Sang Yun Lee, Kijung Yoon, Youngju Lee, Ho Jang Kwon, Daehee Kang, Soo Hun Cho; Korean J Epidemiol. 1999;21(2):266-275.

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Abstract PDF: Abstract
Occupational asthma is defined as a disease that is characterized by airway narrowing and bronchial hyperresponsiveness caused by specific working environment. It is estimated that occupational asthma cases in Korea have been underreported. This study, using Korean Medical Insurance Data(KMID), examined the distribution of asthma patients' occupations and the frequency of high risk occupations for occupational asthma in Seoul, Korea to evaluate the usefulness of the KMID data as a database for active occupational asthma surveillance system. Six hundreds and forty two(30.7%) of 2093 patients who were finally chosen as a study population by using 1995-year KMID, were contacted by telephone. 296 persons(47.4%) of 642 patients replied that they were diagnosed as asthma. The occupations of 296 asthma patients were classified by Korean standardized industrial classfication (KSIC). The most common occupations included Wholesale and Retail trade(19.5%), Real estate, Renting and Business activities(14.9%), Construction(14.9%), Manufacturing(12.3%). Forty(13.5%) of 296 patients who could be classified by KSIC were working at high risk jobs for occupational asthma. KMID could be used as a useful data for occupational asthma surveillance system if the limitations of KMID, which is the accuracy of diagnosis, data accessibility, difficulty of following up study subjects, would be solved. The prevalence of occupational asthma could be estimated if the follow-up study diagnosing occupational asthma for asthma patients working in high risk jobs would be held.; Summary

Measurement Errors on Normotensive Subjects in Screening Test.: Jong Myon Bae, Dae Sung Kim, Jaiyong Kim, Yoon Ok Ahn; Korean J Epidemiol. 1999;21(1):1-7.

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Abstract PDF: Abstract
BACKGROUND
Blood pressure measurements with a mercury sphygmomanometer serve as the screening test to establish the clinical diagnosis of primary hypertension. But one of the problems of hypertension screening is the variability of blood pressure measurements.
METHODS
In order to identify the measurement error of blood pressure through the biennial health screening program of Korea Insurance Medical Corporation, we compared the blood pressure of screening test with true value which defined as the mean of blood pressures taken from the direct contact and twice check-up among normotensive Seoul Cohort participants.
RESULTS
Three hundred forty-nine participants had both data of screening measurement and survey of direct contact. The means of difference in systolic and diastolic blood pressure between both data were 8.47 mmHg and 6.54 mmHg, respectively. These results showed statistical significance with paired t-test (p=0.001).
CONCLUSION
Our findings indicated that screening measurement of blood pressure had false negative. And if a epidemiologic study about blood pressure used the data of screening test, it should adjust value of systolic and diastolic blood pressure with adding 8 and 7 mmHg, respectively.; Summary

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