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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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  • 13 Download
AbstractAbstract 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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  • 13 Download
AbstractAbstract 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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AbstractAbstract 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
Original Articles
Causal effect of fasting serum glucose on atherosclerotic cardiovascular disease: a multivariable Mendelian randomization
Su Hyun Lee, Heejin Kimm, Byung-Wan Lee, Chung Mo Nam, So Young Kim, Sunmi Lee, Sun Ha Jee
Epidemiol Health. 2024;46:e2024096.   Published online December 6, 2024
DOI: https://doi.org/10.4178/epih.e2024096
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Observational studies have reported that diabetes is a risk factor that increases the risk of atherosclerotic cardiovascular disease (ASCVD). However, the causal relationship remains a matter of debate. This study aimed to analyze the relationship between fasting serum glucose (FSG) and ASCVD.
METHODS
This study used data from the Korean Cancer Prevention Study-II (KCPS-II) Biobank, consisting of 159,844 people recruited with consent from 18 health examination centers from 2004 to 2013. Outcomes were confirmed based on diagnoses on hospital discharge summaries from National Health Insurance System. We used linear and non-linear Mendelian randomization (MR) methods. The outcome data were obtained from KCPS-II, and the exposure data were derived from the Korean Genome Epidemiology Study.
RESULTS
First, a prospective cohort study estimated that for each 10 mg/dL increase in FSG level, the risk of ASCVD increased by 4% (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.03 to 1.05). Second, the 2-sample MR study showed that every 10 mg/dL increase in FSG influenced the risk of ASCVD (odds ratio [OR], 1.11; 95% CI, 1.04 to 1.18). Third, the multivariable MR study showed that the OR per 10 mg/dL increase in FSG on ASCVD was 1.14 (p<0.001). Similar results were found for a 10 mg/dL increase in FSG and ischemic heart disease (IHD), but a significant relationship with stroke was not found. When performing non-linear MR, a linear relationship was observed between fasting blood sugar and ASCVD, including IHD and stroke.
CONCLUSIONS
FSG showed a linear and causal association with IHD, but not with stroke.
Summary
Korean summary
그동안 당뇨병이 심뇌혈관질환 발생에 위험요인이라는 역학적인 관찰연구는 많이 발표되었지만, 이러한 관련성에 대한 인과적 관련성에 대부분 연구는 서양인을 대상으로 발표되었고, 한국인 자료를 통해 발표된 적은 없었다. 이 연구는 관찰연구의 제한점으로 부각되는 혼란변수와 측정오류에 덜 영향을 받는 새로운 방법론으로써 다변수 멘델리언 무작위화 방법을 사용하여 공복혈당과 심뇌혈관질환의 인과성을 분석하였다. 분석결과, 공복혈당은 허혈성 심질환 발생위험에 인과적인을 관련성을 보였고 뇌졸중에 대해서는 인과적이지 않았다.
Key Message
Over the years, numerous epidemiological observational studies have reported that diabetes is a risk factor for cardiovascular and cerebrovascular diseases. However, most of these studies examining this association were conducted on Western populations, and no studies have been published using Korean data. This study employed a new methodology—multivariable Mendelian randomization—which is less affected by confounding factors and measurement errors, often highlighted as limitations of observational studies, to analyze the causal relationship between fasting glucose levels and cardiovascular and cerebrovascular diseases. The analysis revealed a causal relationship between fasting glucose levels and the risk of ischemic heart disease, while no causal association was observed with stroke.
Causal association between serum bilirubin and ischemic stroke: multivariable Mendelian randomization
Jong Won Shin, Keum Ji Jung, Mikyung Ryu, Jungeun Kim, Heejin Kimm, Sun Ha Jee
Epidemiol Health. 2024;46:e2024070.   Published online August 19, 2024
DOI: https://doi.org/10.4178/epih.e2024070
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Previous research has predominantly focused on total bilirubin levels without clearly distinguishing between direct and indirect bilirubin. In this study, the differences between these forms were examined, and their potential causal relationships with ischemic stroke were investigated.
METHODS
Two-sample multivariable Mendelian randomization (MVMR) analysis was employed, extracting summary data on bilirubin from the Korean Cancer Prevention Study-II (n=159,844) and the Korean Genome and Epidemiology Study (n=72,299). Data on ischemic stroke were obtained from BioBank Japan (n=201,800). Colocalization analysis was performed, focusing on the <i>UGT1A1, SLCO1B1</i>, and <i>SLCO1B3</i> genes, which are the primary loci associated with serum bilirubin levels.
RESULTS
Crude 2-sample Mendelian randomization analysis revealed a significant negative association between total bilirubin levels and ischemic stroke. However, in MVMR analyses, only indirect bilirubin demonstrated a significant negative association with ischemic stroke (odds ratio, 0.76; 95% confidence interval, 0.59 to 0.98). Colocalization analysis did not identify a shared causal variant between the 3 genetic loci related to indirect bilirubin and the risk of ischemic stroke.
CONCLUSIONS
Our study establishes a causal association between higher genetically determined levels of serum indirect bilirubin and reduced risk of ischemic stroke in an Asian population. Future research should include more in-depth analysis of shared genetic variants between indirect bilirubin and ischemic stroke.
Summary
Korean summary
이 연구는 혈청 빌리루빈의 세 가지 형태(총, 직접, 간접 빌리루빈)와 허혈성 뇌졸중 간의 인과적 연관성을 다루었습니다. 다변수 멘델리안 무작위 분석(MVMR)을 통해 간접 빌리루빈이 허혈성 뇌졸중 위험을 유의미하게 감소시키는 것으로 나타났습니다. 이 결과는 빌리루빈의 항산화 역할과 허혈성 뇌졸중 간의 상관관계를 심화 이해하는 데 기여합니다.
Key Message
This study investigated the causal associations between three forms of serum bilirubin (total, direct, and indirect) and ischemic stroke. Multivariable Mendelian randomization (MVMR) analysis revealed a significant inverse association between indirect bilirubin and the risk of ischemic stroke. These findings contribute to a deeper understanding of the relationship between bilirubin's antioxidant role and ischemic stroke.
Smoking-attributable mortality among Korean adults in 2019
Yeun Soo Yang, Keum Ji Jung, Heejin Kimm, Sunmi Lee, Sun Ha Jee
Epidemiol Health. 2024;46:e2024011.   Published online December 19, 2023
DOI: https://doi.org/10.4178/epih.e2024011
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Tobacco use ranks among the leading preventable causes of death worldwide. This study was conducted to calculate the mortality rate attributable to smoking in Korea for 2019 and to highlight the importance of tracking and monitoring smoking-related deaths for public health purposes.
METHODS
Population attributable risk (PAR) was used to estimate the number of deaths related to smoking in 2019. PAR percentages were applied to the estimated mortality figures for various diseases, with PAR determined based on relative risk (RR). Levin’s formula was used to calculate PAR, and RR was adjusted for age and alcohol consumption using Cox proportional hazards regression model to derive disease-specific regression coefficients. The analysis incorporated previously determined smoking rates from 1985, and use rates of novel tobacco products were not considered.
RESULTS
The findings revealed a total of 67,982 smoking-attributable deaths in Korea in 2019, 56,993 of which occurred in men and 11,049 in women. The PAR of smoking for various causes of death in adult men was highest for lung cancer at 74.9%, followed by pneumonia (29.4%), ischemic heart disease (42.3%), and stroke (30.2%). For women, the PAR for smoking-related death was highest for lung cancer (19.9%), followed by stroke (7.6%), pneumonia (5.7%), and ischemic heart disease (9.1%).
CONCLUSIONS
In countries experiencing rapid fluctuations in smoking rates, including Korea, regular studies on smoking-related mortality is imperative. Furthermore, it is necessary to investigate smoking-related deaths, including the prevalence of novel tobacco product use, to accurately gauge the risks associated with emerging tobacco products.
Summary
Korean summary
이 연구는 2019년 한국에서 흡연으로 인한 사망률을 계산하고 공중 보건 목적을 위한 흡연 관련 사망추적 및 모니터링의 중요성을 강조합니다. 연구 결과, 2019년 한국에서 흡연으로 인해 총 67,982명이 사망했으며, 이 중 남성이 56,993명, 여성이 11,049명이었습니다. 특히 남성의 경우 폐암(74.9%), 여성의 경우 폐암(19.9%)에서 흡연으로 인한 사망 위험이 가장 높게 나타났습니다.
Key Message
This study analyzed deaths attributable to smoking in Korea in 2019, revealing that a total of 67,982 individuals lost their lives due to smoking. Among these, 56,993 were men and 11,049 were women, with the highest smoking-related mortality rate observed in men due to lung cancer at 74.9%, and in women due to lung cancer at 19.9%. Through these findings, this research emphasizes the importance of tracking and monitoring smoking-related deaths for public health.
Special Articles
Cancer risk based on alcohol consumption levels: a comprehensive systematic review and meta-analysis
Seunghee Jun, Hyunjin Park, Ui-Jeong Kim, Eun Jeong Choi, Hye Ah Lee, Bomi Park, Soon Young Lee, Sun Ha Jee, Hyesook Park
Epidemiol Health. 2023;45:e2023092.   Published online October 16, 2023
DOI: https://doi.org/10.4178/epih.e2023092
  • 18,346 View
  • 627 Download
  • 10 Web of Science
  • 13 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Alcohol consumption is a well-established risk factor for cancer. Despite extensive research into the relationship between alcohol consumption and cancer risk, the effect of light alcohol consumption on cancer risk remains a topic of debate. To contribute to this discourse, we conducted a comprehensive systematic review and meta-analysis.
METHODS
Our systematic review aimed to investigate the associations between different levels of alcohol consumption and the risk of several cancer types. We focused on analyzing prospective associations using data from 139 cohort studies. Among them, 106 studies were included in the meta-analysis after a quantitative synthesis.
RESULTS
Our analysis did not find a significant association between light alcohol consumption and all-cause cancer risk (relative risk, 1.02; 95% confidence interval, 0.99 to 1.04), but we observed a dose-response relationship. Light alcohol consumption was significantly associated with higher risks of esophageal, colorectal, and breast cancers. Light to moderate drinking was associated with elevated risks of esophageal, colorectal, laryngeal, and breast cancers. Heavy drinking was also found to contribute to the risk of stomach, liver, pancreas, and prostate cancers, thereby increasing the risk of almost all types of cancer. Additionally, females generally had lower cancer risks compared to males.
CONCLUSIONS
Our findings highlight that cancer risks extend beyond heavy alcohol consumption to include light alcohol consumption as well. These findings suggest that there is no safe level of alcohol consumption associated with cancer risk. Our results underscore the importance of public health interventions addressing alcohol consumption to mitigate cancer risks.
Summary
Korean summary
본 연구는 코호트 연구를 기반으로 하여 음주의 수준에 따른 암 위험 연관성에 대해 체계적 문헌고찰(139편)과 메타분석(106편)을 수행하였다. 연구 결과, 음주와 암 위험 사이에 용량-반응 관계가 나타났으며, 소량의 음주는 암 유형에 따라 차이가 있었으나, 식도암, 대장암, 전립선암(남성), 유방암(여성)에서 암 위험과의 연관성이 있음을 발견했다. 따라서, 암 위험 측면에서 음주에 안전한 수준이 없음을 시사하며, 음주와 관련된 잠재적 피해를 완화하기 위해서는 음주 지침 강화와 같은 공중보건개입이 필요하다.
Key Message
The aim of this study was to assess the relationship between different levels of alcohol consumption and the risk of various cancer types through a systematic review and meta-analysis, providing insights into the ongoing debate about alcohol consumption and cancer causality. The findings support a dose-response relationship between alcohol consumption levels and cancer risk and the light alcohol consumption was associated with risks of esophageal, colorectal, prostate (male), and breast (female) cancer. These results emphasize the absence of a safe threshold for alcohol consumption in terms of cancer risk.

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Genetically determined alcohol consumption and cancer risk in Korea
Keum Ji Jung, Ji Woo Baek, Sang Yop Shin, Sun Ha Jee
Epidemiol Health. 2023;45:e2023077.   Published online August 23, 2023
DOI: https://doi.org/10.4178/epih.e2023077
  • 7,988 View
  • 180 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The purpose of this study was to determine the causal relationship between the genetically determined amount of alcohol consumption and the occurrence of major cancers.
METHODS
The data used in this study were from 129,324 people selected from the Korean Cancer Prevention Study-II, the participants of which visited 18 health examination centers between 2004 and 2013. Cancer incidence was confirmed as of 2020 using data from the National Cancer Center. A genome-wide association study (GWAS) on alcohol consumption was performed using PLINK 2.0, and sex, age, chip type, and principal components were adjusted.
RESULTS
From the GWAS, a genetic risk score for alcohol consumption was calculated and genetically determined alcohol consumption (GDAC) was estimated. GDAC was divided into quintile groups and showed significant causal relationships with rectal cancer and liver cancer, but not with other cancers. For liver cancer, an association was shown in the hepatitis B surface antigen (HBsAg)-negative group, and a particularly strong association was found in the over-60-year-old HBsAg-negative group, in which, compared to the GDAC Q1 group, the Q4 group had a 2.35 times higher risk (95% confidence interval [CI], 1.05 to 5.23), and the Q5 group had a 2.40 times higher risk (95% CI, 1.09 to 5.30).
CONCLUSIONS
The results of this study provided evidence that the amount of alcohol consumed is causally related to the occurrence of rectal cancer and liver cancer in HBsAg-negative individuals. Additional studies should be continued for other cancer types through long-term follow-up.
Summary
Korean summary
본 연구는 유전적으로 결정되는 음주량과 주요 암 발생 사이의 인과 관계를 밝히고자 하였다. 그 결과 유전적으로 결정되는 음주량이 증가할수록 직장암 발생 위험이 높아졌고, 특히 HBsAg 음성인 사람에서 간암 발생 위험이 높아지는 것으로 밝혀졌다.
Key Message
The purpose of this study was to reveal the causal relationship between genetically determined alcohol consumption and the incidence of major cancers. As a result, it was found that as the genetically determined amount of alcohol consumed increases, the risk of rectal cancer increases, and especially in people who are HBsAg negative, the risk of liver cancer increases.

Citations

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    Frontiers in Immunology.2024;[Epub]     CrossRef
  • Cancer risk based on alcohol consumption levels: a comprehensive systematic review and meta-analysis
    Seunghee Jun, Hyunjin Park, Ui-Jeong Kim, Eun Jeong Choi, Hye Ah Lee, Bomi Park, Soon Young Lee, Sun Ha Jee, Hyesook Park
    Epidemiology and Health.2023; 45: e2023092.     CrossRef
Original Articles
Prediction of cancer survivors’ mortality risk in Korea: a 25-year nationwide prospective cohort study
Yeun Soo Yang, Heejin Kimm, Keum Ji Jung, Seulji Moon, Sunmi Lee, Sun Ha Jee
Epidemiol Health. 2022;44:e2022075.   Published online September 13, 2022
DOI: https://doi.org/10.4178/epih.e2022075
  • 9,265 View
  • 177 Download
  • 2 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study aimed to investigate the factors affecting cancer survival and develop a mortality prediction model for Korean cancer survivors. Our study identified lifestyle and mortality risk factors and attempted to determine whether health-promoting lifestyles affect mortality.
METHODS
Among the 1,637,287 participants in the Korean Cancer Prevention Study (KCPS) cohort, 200,834 cancer survivors who were alive after cancer diagnosis were analyzed. Discrimination and calibration for predicting the 10-year mortality risk were evaluated. A prediction model was derived using the Cox model coefficients, mean risk factor values, and mean mortality from the cancer survivors in the KCPS cohort.
RESULTS
During the 21.6-year follow-up, the all-cause mortality rates of cancer survivors were 57.2% and 39.4% in men and women, respectively. Men, older age, current smoking, and a history of diabetes were high-risk factors for mortality, while exercise habits and a family history of cancer were associated with reduced risk. The prediction model discrimination in the validation dataset for both KCPS all-cause mortality and KCPS cancer mortality was shown by C-statistics of 0.69 and 0.68, respectively. Based on the constructed prediction models, when we modified exercise status and smoking status, as modifiable factors, the cancer survivors’ risk of mortality decreased linearly.
CONCLUSIONS
A mortality prediction model for cancer survivors was developed that may be helpful in supporting a healthy life. Lifestyle modifications in cancer survivors may affect their risk of mortality in the future.
Summary
Korean summary
현재 암 생존자의 사망 위험을 평가하는 데 유용한 한국형 암 생존자 사망률 예측 모델은 없습니다. 본 연구에서는 고령, 남성, 현재 흡연, 당뇨병 병력을 포함한 생활양식 요인이 사망의 고위험 요인인 반면, 운동 습관 및 암의 가족력은 사망 위험을 감소시키는 것으로 나타났습니다. 현재 흡연과 운동 습관은 사망 위험에 영향을 미치는 수정 가능한 두 가지 요소로써, 이러한 생활습관 요인으로 구성된 예측모형은 생활습관 교정을 통해 우리나라 암 생존자의 사망률을 낮출 수 있음을 시사합니다.
Key Message
Currently, there is no Korean mortality prediction model for cancer survivors that would be useful in evaluating their risk of mortality. The present study showed that lifestyle factors, including older age, male sex, current smoking, and history of diabetes were high-risk factors for mortality, while exercise habits and a family history of cancer reduced the risk of mortality. Current smoking and exercise habits are the two modifiable factors that affected the risk of mortality. The prediction model comprising these lifestyle factors implies that the risk of mortality of cancer survivors in Korea can be reduced through lifestyle modification.

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  • A comparative study of health behaviors in adult male cancer survivors and the general male population in Korea: from the Korea national health and nutrition examination survey VII-VIII (2016–2021)
    Hyein Jung, Yoonjoo Choi, Byungmi Kim
    Supportive Care in Cancer.2025;[Epub]     CrossRef
  • COVID-19 Mortality and Severity in Cancer Patients and Cancer Survivors
    Jae-Min Park, Hye Yeon Koo, Jae-ryun Lee, Hyejin Lee, Jin Yong Lee
    Journal of Korean Medical Science.2024;[Epub]     CrossRef
  • Weight maintenance and gain were significantly associated with lower risk of all-cause and cancer-related mortality in Korean adults who were newly diagnosed with cancer based on the Korean NHIS-HEALS cohort
    Yong-June Kim, Seung Park, Won Tae Kim, Yoon-Jong Bae, Yonghwan Kim, Hee-Taik Kang
    Medicine.2023; 102(47): e36184.     CrossRef
The predictive value of resting heart rate in identifying undiagnosed diabetes in Korean adults: Korea National Health and Nutrition Examination Survey
Dong-Hyuk Park, Wonhee Cho, Yong-Ho Lee, Sun Ha Jee, Justin Y. Jeon
Epidemiol Health. 2022;44:e2022009.   Published online January 3, 2022
DOI: https://doi.org/10.4178/epih.e2022009
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  • 1 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The purpose of this study was (1) to examine whether the addition of resting heart rate (RHR) to the existing undiagnosed diabetes mellitus (UnDM) prediction model would improve predictability, and (2) to develop and validate UnDM prediction models by using only easily assessable variables such as gender, RHR, age, and waist circumference (WC).
METHODS
Korea National Health and Nutrition Examination Survey (KNHANES) 2010, 2012, 2014, 2016 data were used to develop the model (model building set, n=19,675), while the data from 2011, 2013, 2015, 2017 were used to validate the model (validation set, n=19,917). UnDM was defined as a fasting glucose level ≥126 mg/dL or glycated hemoglobin ≥6.5%; however, doctors have not diagnosed it. Statistical package for the social sciences logistic regression analysis was used to determine the predictors of UnDM.
RESULTS
RHR, age, and WC were associated with UnDM. When RHR was added to the existing model, sensitivity was reduced (86 vs. 73%), specificity was increased (49 vs. 65%), and a higher Youden index (35 vs. 38) was expressed. When only gender, RHR, age, and WC were used in the model, a sensitivity, specificity, and Youden index of 70%, 67%, and 37, respectively, were observed.
CONCLUSIONS
Adding RHR to the existing UnDM prediction model improved specificity and the Youden index. Furthermore, when the prediction model only used gender, RHR, age, and WC, the outcomes were not inferior to those of the existing prediction model.
Summary
Korean summary
당뇨병 미인지 또는 미진단은 적절한 치료 시작 시기를 늦추고 당뇨병 합병증 발생의 위험을 높이기 때문에, 각국은 당뇨병 예측 모형을 개발하여 당뇨병을 조기에 예측하고, 치료 시기를 앞당기기 위해 노력하고 있다. 본 연구는 기존의 한국인 당뇨병 예측 모형에 안정시심박수를 추가 변수로 포함시켜, 예측 모형의 성능이 일부개선되는 것을 확인하였고, 더 나아가 나이, 허리 둘레, 그리고 안정시심박수를 포함하여 예측 모형을 개발하고, 그 성능을 확인하였다. 본 연구에서는 간단하게 측정이 가능한 허리 둘레와 안정시심박수 그리고 나이만 포함한 예측 모형이 기존의 예측 모형과 비교해 성능이 열등하지 않은 것을 확인하였다.
Key Message
Higher RHR is associated with increased risk of diabetes. When RHR is added to the Korean undiagnosed diabetes risk score model (Age, Family history of diabetes, Hypertension, Waist circumference, Smoking, Alcohol consumption), the model somewhat increased its predictability of undiagnosed diabetes. Furthermore, the prediction model developed only using age, waist circumference and RHR, which anyone can easily measure or access, had similar predictability to the previous undiagnosed diabetes risk prediction model. The results of this study may help develop future strategies or applications for predicting early undiagnosed diabetes.

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  • Comparisons of the prediction models for undiagnosed diabetes between machine learning versus traditional statistical methods
    Seong Gyu Choi, Minsuk Oh, Dong–Hyuk Park, Byeongchan Lee, Yong-ho Lee, Sun Ha Jee, Justin Y. Jeon
    Scientific Reports.2023;[Epub]     CrossRef
  • Factors related to undiagnosed diabetes in Korean adults: a secondary data analysis
    Bohyun Kim
    Journal of Korean Biological Nursing Science.2023; 25(4): 295.     CrossRef
Bilirubin and risk of ischemic heart disease in Korea: a two-sample Mendelian randomization study
Christina Jeon, Ji-Young Lee, Sun Ju Lee, Keum Ji Jung, Heejin Kimm, Sun Ha Jee
Epidemiol Health. 2019;41:e2019034.   Published online July 12, 2019
DOI: https://doi.org/10.4178/epih.e2019034
  • 15,707 View
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  • 10 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Bilirubin is an endogenous antioxidant that protects cells against oxidative stress. Increased plasma levels of bilirubin have been associated with a reduced risk of ischemic heart disease (IHD) in previous studies. Nonetheless, whether those associations reflect a true protective effect of bilirubin on IHD, rather than confounding or reverse causation, remains unknown. Therefore, we applied two-sample Mendelian randomization to evaluate the causal association between bilirubin levels and IHD risk in a Korean population.
METHODS
A total of 5 genetic variants—TRPM8 (rs10490012), USP40 (rs12993249), ATG16L1 (rs2119503), SLCO1B1 (rs4149014), and SLCO1B3 (rs73233620)—were selected as genetic instruments for serum bilirubin levels using a communitybased cohort, the Korean Genome and Epidemiology Study, comprising 33,598 subjects. We then evaluated their impact on IHD using the Korean Cancer Prevention Study-II cohort.
RESULTS
Among the 5 instrumental variables that showed significant associations with serum bilirubin levels, rs12993249 (USP40) showed the most significant association (p<2.36×10-105). However, we found no significant association between serum bilirubin levels and IHD. Sensitivity analyses demonstrated a consistent association, suggesting that our observations were robust.
CONCLUSIONS
Using two-sample Mendelian randomization, we found no association between serum bilirubin levels and IHD. Further studies that confirm the observed interactions among other ethnicities are warranted.
Summary
Korean summary
이 연구는 대규모 한국인 코호트를 이용하여, 빌리루빈과 허혈성 심장질환의 인과성을 규명한 연구결과이다. 특히 두 가지 자료를 이용한 멘델리안 무작위배정 연구방법을 적용하여, 한국인을 대상으로 빌리루빈과 허혈성 심장질환의 인과성을 처음으로 규명한 점이 큰 시사점을 가진다.

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  • Association of Different Total Bilirubin Levels with Prognosis of Peritoneal Dialysis-Associated Peritonitis
    Yujian He, Jingjing Zhu, Fei Xiao, Qingyun Luo, Pengpeng Wang, Xu Wang, Yan He, Zibo Xiong
    Medicina.2023; 59(10): 1837.     CrossRef
  • Novel prognostic score based on the preoperative total bilirubin-albumin ratio and fibrinogen-albumin ratio in ampullary adenocarcinoma
    Xiao-Jie Zhang, He Fei, Chong-Yuan Sun, Ze-Feng Li, Zheng Li, Chun-Guang Guo, Dong-Bing Zhao
    World Journal of Gastrointestinal Surgery.2023; 15(10): 2247.     CrossRef
  • The Nonlinear Relationship Between Total Bilirubin and Coronary Heart Disease: A Dose-Response Meta-Analysis
    Chaoxiu Li, Wenying Wu, Yumeng Song, Shuang Xu, Xiaomei Wu
    Frontiers in Cardiovascular Medicine.2022;[Epub]     CrossRef
  • Another Reason to Cut Down on Alcohol?
    Hyeon Chang Kim
    Korean Circulation Journal.2022; 52(3): 231.     CrossRef
  • Serum bilirubin and kidney function: a Mendelian randomization study
    Sehoon Park, Soojin Lee, Yaerim Kim, Yeonhee Lee, Min Woo Kang, Kwangsoo Kim, Yong Chul Kim, Seung Seok Han, Hajeong Lee, Jung Pyo Lee, Kwon Wook Joo, Chun Soo Lim, Yon Su Kim, Dong Ki Kim
    Clinical Kidney Journal.2022; 15(9): 1755.     CrossRef
  • Heme Oxygenase-1 and Blood Bilirubin Are Gradually Activated by Oral D-Glyceric Acid
    O. Petteri Hirvonen, Maarit Lehti, Heikki Kyröläinen, Heikki Kainulainen
    Antioxidants.2022; 11(12): 2319.     CrossRef
  • Exploring the causal pathway from bilirubin to CVD and diabetes in the UK biobank cohort study: Observational findings and Mendelian randomization studies
    Lei Hou, Hongkai Li, Shucheng Si, Yuanyuan Yu, Xiaoru Sun, Xinhui Liu, Ran Yan, Yifan Yu, Chuan Wang, Fan Yang, Qing Wang, Fuzhong Xue
    Atherosclerosis.2021; 320: 112.     CrossRef
  • The causal association of bilirubin with cardiovascular disease: Are there still any questions?
    Claudia Lamina, Florian Kronenberg
    Atherosclerosis.2021; 320: 92.     CrossRef
  • Association between Alcohol Consumption and Serum Cortisol Levels: a Mendelian Randomization Study
    Jung-Ho Yang, Sun-Seog Kweon, Young-Hoon Lee, Seong-Woo Choi, So-Yeon Ryu, Hae-Sung Nam, Kyeong-Soo Park, Hye-Yeon Kim, Min-Ho Shin
    Journal of Korean Medical Science.2021;[Epub]     CrossRef
  • SLCO1B1 Variants and The Risk of Antituberculosis Drug-induced Hepatotoxicity: A Systematic Review and Meta-analysis
    Min Zhu, Xinyu Chen, Zhuolu Hao, Yiwen He, Bing Han, Shaowen Tang
    Pharmacogenomics.2009; 24(18): 931.     CrossRef
Relationship between binge drinking experience and suicide attempts in Korean adolescents: based on the 2013 Korean Youth Risk Behavior Web-based Survey
Kyeong Hyang Byeon, Sun Ha Jee, Jae Woong Sull, Bo Young Choi, Heejin Kimm
Epidemiol Health. 2018;40:e2018046.   Published online September 26, 2018
DOI: https://doi.org/10.4178/epih.e2018046
  • 16,645 View
  • 190 Download
  • 11 Web of Science
  • 14 Crossref
AbstractAbstract PDFSupplementary Material
Abstract
OBJECTIVES
Suicide and drinking problems in adolescents are increasing every year, and it is known that suicide is related to drinking. This study aims to identify the relationship between binge drinking experience (BDE) and suicide attempts in Korean adolescents.
METHODS
The Ninth Korean Youth Risk Behavior Web-based Survey (KYRBS), conducted in 2013, was used for analysis. Multiple logistic regression analysis was used to identify the relationship between BDE and suicide attempts, and the relationship between BDE and suicide attempts in middle and high school students was stratified by age.
RESULTS
BDE and suicide attempts were highly related. The odds ratio (OR) of attempted suicide in BDE was 1.63 times (95% confidence interval [CI], 1.28 to 2.09) higher then non-drinking in males. And the OR of attempted suicide in females was 1.21 times (95% CI, 1.07 to 1.37) higher then non-drinking in non-BDE, 1.79 times (95% CI, 1.47 to 2.19) higher in BDE. BDE was associated with suicide attempts in males aged 12 or 13 years (OR, 3.97; 95% CI, 1.57 to 10.03) and in females aged 15 years (OR, 2.66; 95% CI, 1.79 to 3.96).
CONCLUSIONS
BDE is an important factor related to suicide attempts in adolescents. In order to reduce suicide attempts, it is necessary to educate the youth about the regulation of BDE and drinking prevention.
Summary

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Perspective
The effect of smoking on lung cancer: ethnic differences and the smoking paradox
Keum Ji Jung, Christina Jeon, Sun Ha Jee
Epidemiol Health. 2016;38:e2016060.   Published online December 20, 2016
DOI: https://doi.org/10.4178/epih.e2016060
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  • 699 Download
  • 49 Web of Science
  • 39 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
The objectives of this review were to determine whether the smoking paradox still exists and to summarize possible explanations for the smoking paradox. Based on published data, we compared the risk of cigarette smoking for lung cancer in Western and Asian countries. We extracted data from the relevant studies about annual tobacco consumption, lung cancer mortality rates according to smoking status from each country, and possible explanations for the smoking paradox. A significantly greater risk of lung cancer death was found among current smokers in Asian countries than among nonsmokers, with relative risks (RRs) of 4.0 to 4.6 for Koreans, 3.7 to 5.1 for Japanese, and 2.4 to 6.5 for Chinese. Although a significantly greater risk of lung cancer was present among current smokers in Asian countries, the RRs in Asian countries were much lower than those reported in Western countries (range, 9.4 to 23.2). Possible explanations for the smoking paradox included epidemiologic characteristics, such as the smoking amount, age at smoking initiation, and the use of filtered or mild tobacco. The smoking paradox definitely exists, but may be explained by major epidemiologic characteristics. Therefore, the smoking paradox should not be interpreted as indicating that tobacco is safer or less harmful for Asians.
Summary
Korean summary
흡연이 폐암에 미치는 관련성의 인종 차이 흡연은 폐암의 가장 큰 원인으로 알려져 있다. 그러나 흡연이 폐암에 미치는 관련성의 크기는 영국, 미국 등 서양에서 발표된 연구결과에서 10-20배 정도로 보고되고 있으나 한국, 일본, 중국 등 동양에서 발표된 연구에서 3-5배 정도로 낮게 보고되고 있다. 이러한 차이는 흡연유행, 담배성분, 흡연자 특성, 그리고 유전적인 차이로 일부 설명되고 있으나 아직 완전히 이해되어진 상태는 아니다. 이는 공중보건학적으로 매우 중요한 의미를 가지므로 동서양의 직접적인 비교연구가 필요할 것으로 생각된다.

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Original Articles
Impaired fasting glucose, single-nucleotide polymorphisms, and risk for colorectal cancer in Koreans
Keum Ji Jung, Miyong To Kim, Sun Ha Jee
Epidemiol Health. 2016;38:e2016002.   Published online January 6, 2016
DOI: https://doi.org/10.4178/epih.e2016002
  • 19,848 View
  • 153 Download
  • 11 Web of Science
  • 9 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Numerous studies have demonstrated that fasting serum glucose (FSG) levels and certain single-nucleotide polymorphisms (SNPs) are related to an increased risk of colorectal cancer (CRC); however, their combined effects are still unclear.
METHODS
Of a total of 144,527 men and women free of cancer at baseline, 317 developed CRC during 5.3 years of follow-up. A case-cohort study (n=1,691) was used, consisting of participants with a DNA sample available. Three well-known SNPs (rs3802842, rs6983267, rs10795668) were genotyped. Hazard ratios (HR) and 95% confidence intervals (CI) of CRC, colon and rectal cancer were calculated, with the Cox proportional hazard models.
RESULTS
The crude incidence rates per 100,000 person-years were 41.1 overall, 48.4 for men, and 29.3 for women. Among participants with dysglycemia, SNPs rs3802842 and rs6983267 were both associated with an increased risk of CRC (HR, 3.2; 95% CI, 1.9 to 5.5 and HR, 1.8; 95% CI, 1.1 to 3.1, respectively) and rectal cancer (HR, 3.4; 95% CI, 1.8 to 6.6 and HR, 3.3; 95% CI, 1.6 to 7.1, respectively). The interaction effect of dysglycemia and SNPs was positive, that is, resulted in an elevated risk of CRC, but was not statistically significant.
CONCLUSIONS
This study demonstrates that both high FSG and certain SNPs are major risk factors for CRC and rectal cancer but that they did not interact synergistically. The difference in effect size of the SNPs according to CRC subtype (i.e., colon or rectal cancer) and presence of dysglycemia merits further research.
Summary
Korean summary
본 연구에서는 공복혈당농도와 대장암과 관련된 단일염기다형성(SNP)과의 관련성을 살펴 보았다. 높은 공복혈당농도와 단일염기다형성(SNP_rs3802842, rs6983267)은 대장암의 주요한 위험요인이었으나, 두 가지 요인의 상호작용으로 인한 시너지 효과는 없는 것으로 나타났다. 대장암의 아형에 따른 다른 효과 크기와 이상혈당증 유무에 따른 향후 연구가 더 필요할 것으로 생각된다.

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Adiponectin is Associated with Impaired Fasting Glucose in the Non-Diabetic Population
Sang Yeun Kim, Sun Ju Lee, Hyoun Kyoung Park, Ji Eun Yun, Myoungsook Lee, Jidong Sung, Sun Ha Jee
Epidemiol Health. 2011;33:e2011007.   Published online August 20, 2011
DOI: https://doi.org/10.4178/epih/e2011007
  • 20,565 View
  • 112 Download
  • 7 Crossref
AbstractAbstract PDF
Abstract
<sec><title>OBJECTIVES</title><p>Adiponectin is strongly associated with diabetes in the Western population. However, whether adiponectin is independently associated with impaired fasting glucose (IFG) in the non-obese population is unknown.</p></sec><sec><title>METHODS</title><p>The serum adiponectin, insulin resistance (IR), and waist circumference (WC) of 27,549 healthy Koreans were measured. Individuals were then classified into tertile groups by gender. IFG was defined as a fasting serum glucose of 100-125 mg/dL without diabetes. IR was calculated using the homeostasis model assessment of insulin resistance (HOMA-IR). The association of adiponectin and IFG was determined using logistic regression analysis.</p></sec><sec><title>RESULTS</title><p>WC and adiponectin were associated with IFG in both men and women. However, the association of WC with IFG was attenuated in both men and women after adjustment for the HOMA-IR. Adiponectin was still associated with IFG after adjustment for and stratification by HOMA-IR in men and women. Strong combined associations of IR and adiponectin with IFG were observed in men and women. Multivariate adjusted odds ratios (ORs) (95% confidence interval [CI]) among those in the highest tertile of IR and the lowest tertile of adiponectin were 9.8 (7.96 to 12.07) for men and 24.1 (13.86 to 41.94) for women.</p></sec><sec><title>CONCLUSION</title><p>These results suggest that adiponectin is strongly associated with IFG, and point to adiponectin as an additional diagnostic biomarker of IFG in the non-diabetic population.</p></sec>
Summary

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