Journal of Preventive Medicine and Public Health

Jong-Myon Bae

26 Articles

Statin Intake and Gastric Cancer Risk: An Updated Subgroup Meta-analysis Considering Immortal Time Bias: Jong-Myon Bae; J Prev Med Public Health. 2022;55(5):424-427. Published online August 18, 2022; DOI: https://doi.org/10.3961/jpmph.22.209

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A retrospective record-linkage study (RLS) based on medical records containing drug prescription histories involves immortal time bias (ITB). Thus, it is necessary to control for this bias in the research planning and analysis stages. Furthermore, a summary of a metaanalysis including RLSs that did not control for ITB showed that specific drugs had a preventive effect on the occurrence of the disease. Previous meta-analytic results of three systematic reviews evaluating the association between statin intake and gastric cancer risk showed that the summary hazard ratio (sHR) of the RLSs was lower than 1 and was statistically significant. We should consider the possibility of ITB in the sHR of RLSs and interpret the results carefully.

Summary

Korean summary
이차자료를 활용하여 구축한 코호트 추적연구는 immortal time bias가 개입될 개연성을 염두에 두어야 한다. 이들 연구결과들을 제외한 메타분석 결과 스타닌 복용에 따른 위암발생 위험 감소는 관련성이 없다는 결과를 도출하였다.

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Sodium-glucose cotransporter-2 inhibitors use and the risk of gout: a systematic review and meta-analysis
Shih-Wei Lai, Bing-Fang Hwang, Yu-Hung Kuo, Chiu-Shong Liu, Kuan-Fu Liao
Frontiers in Endocrinology.2023;[Epub] CrossRef

Sources of Infection Among Confirmed Cases of COVID-19 in Jeju Province, Korea: Moonkyong Hwang, Jong-Myon Bae; J Prev Med Public Health. 2021;54(4):245-250. Published online June 30, 2021; DOI: https://doi.org/10.3961/jpmph.21.286

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Abstract Summary PDF Supplementary Material

Objectives
Jeju Province in Korea reported 627 coronavirus disease 2019 (COVID-19) cases between January 20, 2020, and March 31, 2021. This study analyzed the sources of infection among confirmed cases in Jeju Province, a self-governed island.
Methods
The sources of infection were broadly categorized as follows: (1) infections from overseas (confirmed patients who reported travel overseas or contact with overseas travelers); (2) infections from outside Jeju Province (confirmed patients who had visited other provinces or had contact with individuals who had traveled to other provinces in Korea); and (3) unknown sources of infection (confirmed patients who were infected following contact with an infected person whose source of infection was unknown). The chi-square test was used to analyze the differences in the distributions of related variables for each source of infection.
Results
Of the 627 confirmed cases, 38 (6.1%) were infections from overseas sources, 199 (31.7%) were from outside of Jeju Province, and 390 (62.2%) were from unknown sources. Jeju Province had no cases with an unknown source of infection during the first and second waves of the nationwide outbreak.
Conclusions
Infections from overseas sources could be blocked from spreading to local communities in Jeju Province by conducting screening at the airport, along with the preemptive suspension of visa-free entry. In addition, considering the scale of the nationwide outbreak, measures must be established to delay outbreaks from unknown sources of infection caused by sources outside Jeju Province.

Summary

Korean summary
제주도 COVID-19 확진지의 감염원은 다음의 3가지로 대분할 수 있었다. (1) 해외유입 감염원: 해외 방문력이 있거나 해외 방문력이 있는 확진자와 접촉한 적이 있는 확진자; (2) 도외유입 감염원: 국내 타시도 방문력이 있거나 타시도 확진자와 접촉한 적이 있는 확진자; (3) 감염원 미상: 감염경로를 특정할 수 없는 도내 확진자와 이들과 접촉하여 확진자가 된 경우. 이중 해외유입군에 대하여는 선제적인 무비자 중지 결정과 함께 공항만에서의 선별검사를 시행하여 해외유입에 의한 지역사회 전파 가능성을 막을 수 있음을 확인하였다. 반면, 전국의 유행 크기와 맞물러, 도외 유입군으로 인한 감염미상군 발생 시점을 최대한 미룰 수 있는 방안들을 개발할 필요가 있겠다.

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The Impact of the South Korean Local Government's Public Health and Healthy Urban Planning Policies in Combating COVID-19
Fatih ULAŞAN
Kent Akademisi.2023;[Epub] CrossRef
Clinical Characteristics and Risk Factors for Severe Disease of Coronavirus Disease 2019 in a Low Case Fatality Rate Region in Korea
Misun Kim, Jeong Rae Yoo, Sang Taek Heo, Hyang Ran Lee, Hyunjoo Oh
Infection & Chemotherapy.2021; 53(4): 718. CrossRef

A Chinese Case of Coronavirus Disease 2019 (COVID-19) Did Not Show Infectivity During the Incubation Period: Based on an Epidemiological Survey: Jong-Myon Bae; J Prev Med Public Health. 2020;53(2):67-69. Published online March 2, 2020; DOI: https://doi.org/10.3961/jpmph.20.048

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Abstract Summary PDF

Controversy remains over whether the coronavirus disease 2019 (COVID-19) virus may have infectivity during the incubation period before the onset of symptoms. The author had the opportunity to examine the infectivity of COVID-19 during the incubation period by conducting an epidemiological survey on a confirmed patient who had visited Jeju Island during the incubation period. The epidemiological findings support the claim that the COVID-19 virus does not have infectivity during the incubation period.

Summary

Korean summary
잠복기 동안 제주도를 방문했던 중국인 COVID-19 확진자에 대한 역학조사를 수행하였다. 환자와 직접 접촉한 11명을 14일간 격리조치 하였는데, 이들 모두 격리해제까지 COVID-19 감염증상을 보이지 않았다. 이상의 역학조사 결과는 잠복기때는 감염력이 없다는 주장을 뒷받침한다.

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Presymptomatic, asymptomatic and post-symptomatic transmission of SARS-CoV-2: joint British Infection Association (BIA), Healthcare Infection Society (HIS), Infection Prevention Society (IPS) and Royal College of Pathologists (RCPath) guidance
Moira A. Mugglestone, Natasha V. Ratnaraja, Aggie Bak, Jasmin Islam, Jennie A. Wilson, Jennifer Bostock, Samuel E. Moses, James R. Price, Michael Weinbren, Heather P. Loveday, Lucy Rivett, Simon M. Stoneham, A. Peter R. Wilson
BMC Infectious Diseases.2022;[Epub] CrossRef
A case of COVID-19 with an ultralong incubation period
Yujin Wang, Qingwen Wang, Kai Wang, Congkuan Song, ZiXin Guo, Weidong Hu
Infection Control & Hospital Epidemiology.2021; 42(2): 242. CrossRef
Sources of Infection Among Confirmed Cases of COVID-19 in Jeju Province, Korea
Moonkyong Hwang, Jong-Myon Bae
Journal of Preventive Medicine and Public Health.2021; 54(4): 245. CrossRef
Airborne SARS-CoV-2: Weighing the Evidence for Its Role in Community Transmission
Samuel Pecho-Silva, Kovy Arteaga-Livias, Alfonso J. Rodriguez-Morales
Journal of Preventive Medicine and Public Health.2020; 53(3): 178. CrossRef

Author Response: Coronavirus Disease 2019 (COVID-19), Infectivity, and the Incubation Period: Jong-Myon Bae; J Prev Med Public Health. 2020;53(2):71-71. Published online March 31, 2020; DOI: https://doi.org/10.3961/jpmph.20.066

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PDF: Summary

Introduction of Vaccinomics to Develop Personalized Vaccines in Light of Changes in the Usage of Hantaan Virus Vaccine (Hantavax^®) in Korea: Jong-Myon Bae; J Prev Med Public Health. 2019;52(5):277-280. Published online August 7, 2019; DOI: https://doi.org/10.3961/jpmph.19.018

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Abstract Summary PDF Supplementary Material

The Ministry of Food and Drug Safety of Korea made an official announcement in March 2018 that the total number of inoculations of Hantaan virus vaccine (Hantavax^®) would change from 3 to 4. Some aspects of this decision remain controversial. Based on the characteristics of Hantaan virus (HTNV) and its role in the pathogenesis of hemorrhagic fever with renal syndrome, it might be difficult to develop an effective and safe HTNV vaccine through the isolate-inactivate-inject paradigm. With the development of high-throughput ‘omics’ technologies in the 21st century, vaccinomics has been introduced. While the goal of vaccinomics is to develop equations to describe and predict the immune response, it could also serve as a tool for developing new vaccine candidates and individualized approaches to vaccinology. Thus, the possibility of applying the innovative field of vaccinomics to develop a more effective and safer HTNV vaccine should be considered.

Summary

Korean summary
신증후출혈열 (Hemorrhagic fever with renal syndrome, HFRS)를 예방하기 위한 백신들이 여러 가지로 개발 중에 있지만, 한탄 바이러스 (Hantaan virus) 의 병원체 특성과 HFRS의 임상적 특성으로 효과적이고 안전한 백신 개발을 어렵게 하고 있다. 투여할 백신에 대한 ‘면역과정을 이해하고 백신효능을 예측하여’ 백신개발에 활용하는 백신체학의 적용을 적극 강구할 필요가 있다.

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Safety and Immunogenicity of an Andes Virus DNA Vaccine by Needle-Free Injection: A Randomized, Controlled Phase 1 Study
Grant C Paulsen, Robert Frenck, Kay M Tomashek, Rodolfo M Alarcon, Elizabeth Hensel, Ashley Lowe, Rebecca L Brocato, Steve A Kwilas, Matthew D Josleyn, Jay W Hooper
The Journal of Infectious Diseases.2024; 229(1): 30. CrossRef
Zoonotic Hantaviridae with Global Public Health Significance
Rui-Xu Chen, Huan-Yu Gong, Xiu Wang, Ming-Hui Sun, Yu-Fei Ji, Su-Mei Tan, Ji-Ming Chen, Jian-Wei Shao, Ming Liao
Viruses.2023; 15(8): 1705. CrossRef
Current Challenges in Vaccinology
Richard B. Kennedy, Inna G. Ovsyannikova, Peter Palese, Gregory A. Poland
Frontiers in Immunology.2020;[Epub] CrossRef
Association between predator species richness and human hantavirus infection emergence in Brazil
Kyung-Duk Min, Maria Cristina Schneider, Sung-il Cho
One Health.2020; 11: 100196. CrossRef

Proposal to Revise the Screening Test for Latent Tuberculosis Infection in Close Contacts at Elementary Schools in Korea: Jong-Myon Bae; J Prev Med Public Health. 2019;52(4):272-275. Published online May 8, 2019; DOI: https://doi.org/10.3961/jpmph.19.043

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Abstract Summary PDF Supplementary Material: The 2018 National Guideline for Tuberculosis Control, which was published by the Korea Centers for Diseases Prevention and Control (KCDC), mandates conducting an epidemiological survey among close contacts of active tuberculosis patients at public institutions such as schools. In the procedure for these surveys, the tuberculin skin test (TST) is mandated as the screening test for latent tuberculosis infection in elementary school students. However, several guidelines recommend using the interferon-gamma releasing assay (IGRA) for contacts aged over 5 years with a Bacillus Calmette–Guérin vaccination history. The main reason for this is that IGRA has a higher specificity and lower false positive rate than TST. In addition, IGRA requires only a single visit to draw blood and the results are available within 24 hours. These advantages could promote cooperation from both parents and students in conducting these surveys. Thus, these findings regarding the benefits of IGRA for surveys of close contacts at elementary schools should be incorporated into the KCDC guideline.; Summary

Korean summary
집단시설에서의 결핵환자 발생시 수행하는 역학조사 지침에는 잠복결핵감염자의 검진을 위해 초등학생에게 투베르쿨린 피부반응검사 (TST)를 시행하도록 되어 있다. 그러나, 6세 이상의 초등학생들은 필수적으로 BCG 예방접종을 받았다는 점과, 역학조사 수행의 협조 등을 고려할 때 TST 대신 인터페론감마 분비검사 (Interferon-gamma releasing assay, IGRA)를 우선 시행하는 것이 보다 더 근거중심적, 가치중심적 으로 타당하다.

Epidemiological and Clinical Characteristics of Confirmed Cases of Severe Fever With Thrombocytopenia Syndrome in Jeju Province, Korea, 2014-2018: Jinhee Kim, Jong-Myon Bae; J Prev Med Public Health. 2019;52(3):195-199. Published online April 3, 2019; DOI: https://doi.org/10.3961/jpmph.18.289

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Abstract Summary PDF Supplementary Material

Objectives
Jeju Province is well known as the region showing the highest incidence of severe fever with thrombocytopenia syndrome (SFTS) in South Korea. The aim of this study was to evaluate the epidemiological and clinical characteristics of SFTS patients in Jeju Province.
Methods
The primary data for this study were obtained from the Integrated Diseases and Health Control System of the Korea Centers for Disease Control and Prevention (KCDCIS). The selection criteria were confirmed cases of SFTS with a residence listed in Jeju Province at the time of diagnosis, reported to the KCDCIS between July 16, 2014 and November 30, 2018.
Results
Of 55 confirmed cases of SFTS, the case fatality rate was 10.9% (95% confidence interval [CI], 4.1 to 22.2). The most common presenting symptoms at diagnosis of severe fever, myalgia, and diarrhea had incidences of 83.6% (95% Cl, 71.2 to 92.2), 45.5% (95% Cl, 32.0 to 59.5), and 40.0% (95% CI, 27.0 to 54.1), respectively.
Conclusions
Compared to SFTS patients nationwide in 2013-2015, the subjects of this study exhibited a lower case fatality rate and had a lower incidence of severe fever, myalgia, and confusion.

Summary

Korean summary
2014-2018년 제주도 SFTS 환자의 치명률은 10.9% (95%CI: 4.1-22.2)로, 2014-2017년 전국 SFTS 환자의 치명률 19.3% (95%CI: 16.1-22.8)와 유사한 수준이다. 중국환자에 비하여 제주도 환자는 고열, 근육통, 혼수 발현률이 상대적으로 낮으며, 설사는 유사한 수준이었다

Citations

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Seroprevalence of severe fever with thrombocytopenia syndrome using specimens from the Korea National Health & Nutrition Examination Survey
Choon-Mee Kim, Mi Ah Han, Na Ra Yun, Mi-Seon Bang, You Mi Lee, Beomgi Lee, Dong-Min Kim, Eric H. Y. Lau
PLOS Neglected Tropical Diseases.2023; 17(3): e0011097. CrossRef
Analysis of fatal cases of severe fever with thrombocytopenia syndrome in Jiangsu province, China, between 2011 and 2022: A retrospective study
Shuyi Liang, Wei Xie, Zhifeng Li, Nan Zhang, Xiaochen Wang, Yuanfang Qin, Changjun Bao, Jianli Hu
Frontiers in Public Health.2023;[Epub] CrossRef
Epidemiological and spatiotemporal analysis of severe fever with thrombocytopenia syndrome in Eastern China, 2011–2021
Shuyi Liang, Zhifeng Li, Nan Zhang, Xiaochen Wang, Yuanfang Qin, Wei Xie, Changjun Bao, Jianli Hu
BMC Public Health.2023;[Epub] CrossRef
Genetic Diversity, Regional Distribution, and Clinical Characteristics of Severe Fever with Thrombocytopenia Syndrome Virus in Gangwon Province, Korea, a Highly Prevalent Region, 2019–2021
Mi-Young Moon, Hyeon Kyu Kim, Se-Jin Chung, Jae Hwan Byun, Ha-Na Kim, Woan Lee, Soon-Won Lee, Sezim Monoldorova, Sungkyeong Lee, Bo-Young Jeon, Eun-Joo Lim
Microorganisms.2023; 11(9): 2288. CrossRef
Clinical symptoms associated with fatality of severe fever with thrombocytopenia syndrome: A systematic review and meta-analysis
Yao Wang, Zexuan Song, Xiaoying Xu, Xuemin Wei, Haowen Yuan, Hao Liang, Hongling Wen
Acta Tropica.2022; 232: 106481. CrossRef
Clinical manifestations of death with severe fever and thrombocytopenia syndrome: A meta‐analysis and systematic review
Xiankun Wang, Xingxiang Ren, Ziruo Ge, Shuping Cui, Lin Wang, Zhihai Chen, Di Tian
Journal of Medical Virology.2021; 93(6): 3960. CrossRef
Severe fever with thrombocytopenia syndrome virus: a highly lethal bunyavirus
Jing Li, Shen Li, Li Yang, Pengfei Cao, Jianhong Lu
Critical Reviews in Microbiology.2021; 47(1): 112. CrossRef
A new emerging pandemic of severe fever with thrombocytopenia syndrome (SFTS)
Divya Sharma, Mohit Kamthania
VirusDisease.2021; 32(2): 220. CrossRef
Application of a decision tree model in the early identification of severe patients with severe fever with thrombocytopenia syndrome
Bohao Wang, Zhiquan He, Zhijie Yi, Chun Yuan, Wenshuai Suo, Shujun Pei, Yi Li, Hongxia Ma, Haifeng Wang, Bianli Xu, Wanshen Guo, Xueyong Huang, Sam R. Telford
PLOS ONE.2021; 16(7): e0255033. CrossRef
Spatial-temporal characteristics of severe fever with thrombocytopenia syndrome and the relationship with meteorological factors from 2011 to 2018 in Zhejiang Province, China
Haocheng Wu, Chen Wu, Qinbao Lu, Zheyuan Ding, Ming Xue, Junfen Lin, Elvina Viennet
PLOS Neglected Tropical Diseases.2020; 14(4): e0008186. CrossRef
Hazardous alcohol consumption and aging synergistically increase the risk of death in patients with severe fever with thrombocytopenia syndrome
Yang-yang Zhang, Dong-xiao Liu, Wen-bo Fan, Jin-hong Yu, Li Liu, Wen-jun Du, Qiang Li
Ticks and Tick-borne Diseases.2020; 11(6): 101505. CrossRef
Severe fever with thrombocytopenia syndrome virus: a systematic review and meta-analysis of transmission mode
X. Y. Huang, Z. Q. He, B. H. Wang, K. Hu, Y. Li, W. S. Guo
Epidemiology and Infection.2020;[Epub] CrossRef
Four Year Surveillance of the Vector Hard Ticks for SFTS, Ganghwa-do, Republic of Korea
Myung-Deok Kim-Jeon, Seung Jegal, Hojong Jun, Haneul Jung, Seo Hye Park, Seong Kyu Ahn, Jinyoung Lee, Young Woo Gong, Kwangsig Joo, Mun Ju Kwon, Jong Yul Roh, Wook-Gyo Lee, Young Yil Bahk, Tong-Soo Kim
The Korean Journal of Parasitology.2019; 57(6): 691. CrossRef

Incidence of Scarlet Fever in Children in Jeju Province, Korea, 2002-2016: An Age-period-cohort Analysis: Jinhee Kim, Ji-Eun Kim, Jong-Myon Bae; J Prev Med Public Health. 2019;52(3):188-194. Published online April 24, 2019; DOI: https://doi.org/10.3961/jpmph.18.299

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Abstract Summary PDF Supplementary Material

Objectives
Outbreaks of scarlet fever in Mexico in 1999, Hong Kong and mainland China in 2011, and England in 2014-2016 have received global attention, and the number of notified cases in Korean children, including in Jeju Province, has also increased since 2010. To identify relevant hypotheses regarding this emerging outbreak, an age-period-cohort (APC) analysis of scarlet fever incidence was conducted among children in Jeju Province, Korea.
Methods
This study analyzed data from the nationwide insurance claims database administered by the Korean National Health Insurance Service. The inclusion criteria were children aged ≤14 years residing in Jeju Province, Korea who received any form of healthcare for scarlet fever from 2002 to 2016. The age and year variables were categorized into 5 groups, respectively. After calculating the crude incidence rate (CIR) for age and calendar year groups, the intrinsic estimator (IE) method was applied to conduct the APC analysis.
Results
In total, 2345 cases were identified from 2002 to 2016. Scarlet fever was most common in the 0-2 age group, and boys presented more cases than girls. Since the CIR decreased with age between 2002 and 2016, the age and period effect decreased in all observed years. The IE coefficients suggesting a cohort effect shifted from negative to positive in 2009.
Conclusions
The results suggest that the recent outbreak of scarlet fever among children in Jeju Province might be explained through the cohort effect. As children born after 2009 showed a higher risk of scarlet fever, further descriptive epidemiological studies are needed.

Summary

Korean summary
제주도 아동의 성홍열 발생건수의 증가는 출생코호트 효과에 기인한 것으로, 특히 2009년도 이후 출생자의 발생률 증가가 있었다. 기존 연구와 다른 점은, 성홍열 환자 발생률이 가장 높은 연령대가 0-2세라는 점이다. 이에 대한 추가적인 기술역학연구가 필요하다.

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Epidemiological analysis of Group A streptococcus infection diseases among children in Beijing, China under COVID-19 pandemic
Hongxin Li, Lin Zhou, Yong Zhao, Lijuan Ma, Haihua Zhang, Yan Liu, Xiaoyan Liu, Jin Hu
BMC Pediatrics.2023;[Epub] CrossRef
Outbreaks of scarlet fever in kindergartens in Belgrade
Sonja Giljača, Slavica Maris, Nataša Rančić, Milutin Mrvaljević, Zorica Mrvaljević
Zdravstvena zastita.2022; 51(1): 57. CrossRef
Forecasting the monthly incidence of scarlet fever in Chongqing, China using the SARIMA model
W. W. Wu, Q. Li, D. C. Tian, H. Zhao, Y. Xia, Y. Xiong, K. Su, W. G. Tang, X. Chen, J. Wang, L. Qi
Epidemiology and Infection.2022;[Epub] CrossRef
Recent increase in pertussis incidence in Korea: an age-period-cohort analysis
Chanhee Kim, Seonju Yi, Sung-il Cho
Epidemiology and Health.2021; 43: e2021053. CrossRef
Analysis of Epidemiological Characteristics of Scarlet Fever in Zhejiang Province, China, 2004–2018
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Notified Incidence of Tuberculosis in Foreign-born Individuals in Jeju Province, Republic of Korea: Dae Soon Kim, Jong-Myon Bae; J Prev Med Public Health. 2019;52(1):66-70. Published online December 21, 2018; DOI: https://doi.org/10.3961/jpmph.18.246

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Abstract Summary PDF Supplementary Material: Objectives
In the Republic of Korea (ROK), the notified incidence of tuberculosis in foreign-born individuals (NITFBI) has increased recently, as has the rate of multidrug-resistant (MDR) and rifampicin-resistant (RR) tuberculosis in foreigners staying in the ROK. As Jeju Province in ROK has a no-visa entry policy, control programs for NITFBI should be consolidated. The aim was to evaluate the status of NITFBI, with a focus on the distribution of MDR/RR tuberculosis by nationality.
Methods
Data on tuberculosis incidence in individuals born in Jeju Province and in foreign-born individuals were extracted from the Korean Statistical Information Service of Statistics Korea, and the Infectious Disease Surveillance Web Statistics of the Korea Centers for Disease Control and Prevention, respectively.
Results
Among all notified incident cases of tuberculosis, the proportion of NITFBI increased from 1.46% in 2011 to 6.84% in 2017. China- and Vietnam-born individuals accounted for the greatest proportion of the 95 cases of NITFBI. Seven cases of MDR/RR tuberculosis were found, all involving patients born in China.
Conclusions
In Jeju Province, ROK, NITFBI might become more common in the near future. Countermeasures for controlling active tuberculosis in immigrants born in high-risk nations for tuberculosis should be prepared in Jeju Province, since it is a popular tourist destination.; Summary

Korean summary
제주도는 국제자유도시를 천명하면서, 30일 무비자 입국을 허용하고 있다. 이에 따라 외국인 결핵환자가 증가하고 있다. 제주도 결핵 신환자 신고 중 외국인의 분율은 2011년 1.46%에서 2017년 6.84%로 증가했으며, 약제 내성에 있어서는 총 7건이었다. 향후 제주도내 외국인 결핵환자 신고수가 증가하는 가운데 약제내성 결핵환자도 증가할 수 있음을 예측하고, 외국인에 대한 활동성 결핵관리 정책을 보완하고 지침을 강화할 필요가 있다.

Introduction of Phylodynamics for Controlling the HIV/AIDS Epidemic in Korea: Jong-Myon Bae; J Prev Med Public Health. 2018;51(6):326-328. Published online October 22, 2018; DOI: https://doi.org/10.3961/jpmph.18.150

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Abstract Summary PDF Supplementary Material: As over 1000 new cases of HIV/AIDS occur in Korea annually, preventive health programs against HIV/AIDS are urgently needed. Since phylodynamic studies have been suggested as a way to understand how infectious diseases are transmitted and evolve, phylodynamic inferences can be a useful tool for HIV/AIDS research. In particular, phylodynamic models are helpful for dating the origins of an epidemic and estimating its basic reproduction number. Thus, the introduction of phylodynamics would be a highly valuable step towards controlling the HIV/AIDS epidemic in Korea.; Summary

Korean summary
국내 HIV/AIDS 신환자가 지속적으로 발생하고 있는 상황에서, 다른 나라에서는 HIV 감염관리에 계통역동학을 적용하고 있다. 이는 감염원과 감염경로를 알아내고, 기본재생산지수를 산출하도록 해주기 때문이다. 따라서 국내 HIV/AIDS 관리를 위해 계통역동학 적용을 적극 제안한다.”

Necessity of Epigenetic Epidemiology Studies on the Carcinogenesis of Lung Cancer in Never Smokers: Jong-Myon Bae; J Prev Med Public Health. 2018;51(5):263-264. Published online July 8, 2018; DOI: https://doi.org/10.3961/jpmph.18.076

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Abstract PDF Supplementary Material: Based on epidemiological and genomic characteristics, lung cancer in never smokers (LCNS) is a different disease from lung cancer in smokers. Based on current research, the main risk factor for LCNS may be air pollution. A recent case-control study in Koreans reported that nitrogen dioxide (NO2) may be a risk factor for LCNS. Additionally, a cohort study showed that exposure to NO2 was associated with significant hypomethylation. Thus, epigenetic epidemiology studies are needed in the near future to evaluate the carcinogenesis of LCNS according to chronic exposure to air pollution and/or viral infections.; Summary

Horses as a Potential Reservoir of Lyme Borreliosis in Jeju-do, Korea: Jong-Myon Bae; J Prev Med Public Health. 2018;51(4):213-214. Published online June 7, 2018; DOI: https://doi.org/10.3961/jpmph.18.081

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Lyme borreliosis (LB) is the most common tick-borne infectious disease in North America, and it was designated as a national notifiable infectious disease in Korea in December 2010. While no cases in Jeju-do were recorded from 2012 to 2016, a recent survey reported that the seroprevalence of Borrelia burgdorferi using enzyme-linked immunosorbent assays in horses in Jeju-do was 19.0% (95% confidence interval, 12.0 to 28.3%). This fact suggests that horses may be a potential reservoir of LB in Jeju-do and that individuals in close contact with horses may be a high-risk group. Thus, a serological study in this high-risk group is urgently needed.

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Detection of Borrelia burgdorferi sensu-lato-Specific Antibodies in Sera of Canine and Equine Origin—A Comparative Study with Two Line Immunoassays
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Veterinary Sciences.2022; 9(11): 633. CrossRef
Molecular Identification of Selected Tick-Borne Protozoan and Bacterial Pathogens in Thoroughbred Racehorses in Cavite, Philippines
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Researches of Epigenetic Epidemiology for Infections and Radiation as Carcinogen: Jong-Myon Bae; J Prev Med Public Health. 2018;51(4):169-172. Published online July 2, 2018; DOI: https://doi.org/10.3961/jpmph.18.070

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Abstract PDF Supplementary Material

In recent years, a number of studies have been reported on the various types of cancer arising from epigenetic alterations, including reports that these epigenetic alterations occur as a result of radiation exposure or infection. Thyroid cancer and breast cancer, in particular, have high cancer burden, and it has been confirmed that radiation exposure or onco-viral infection are linked to increased risk of development of these two types of cancer, respectively. Thus, the environment-epigenetic alteration-cancer occurrence (EEC) hypothesis has been suggested. This paper reviews the trends in research supporting this hypothesis for radiation exposure and onco-viral infection. If more evidences accumulate for the EEC hypothesis from future research, those findings may greatly aid in the prevention, early diagnosis, treatment, and prognosis of the thyroid cancer and breast cancer.

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Expression level and function analysis of serum miRNAs in workers with occupational exposure to benzene series
Kai Dai, Chen Wang, Wu Yao, Changfu Hao
Chemosphere.2023; 313: 137460. CrossRef
HDAC1 and HDAC2 Double Knockout Triggers Cell Apoptosis in Advanced Thyroid Cancer
Ching-Ling Lin, Ming-Lin Tsai, Chun-Yu Lin, Kai-Wen Hsu, Wen-Shyang Hsieh, Wei-Ming Chi, Li-Chi Huang, Chia-Hwa Lee
International Journal of Molecular Sciences.2019; 20(2): 454. CrossRef

Strategies for Appropriate Patient-centered Care to Decrease the Nationwide Cost of Cancers in Korea: Jong-Myon Bae; J Prev Med Public Health. 2017;50(4):217-227. Published online June 16, 2017; DOI: https://doi.org/10.3961/jpmph.17.069

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In terms of years of life lost to premature mortality, cancer imposes the highest burden in Korea. In order to reduce the burden of cancer, the Korean government has implemented cancer control programs aiming to reduce cancer incidence, to increase survival rates, and to decrease cancer mortality. However, these programs may paradoxically increase the cost burden. For examples, a cancer screening program for early detection could bring about over-diagnosis and over-treatment, and supplying medical services in a paternalistic manner could lead to defensive medicine or futile care. As a practical measure to reduce the cost burden of cancer, appropriate cancer care should be established. Ensuring appropriateness requires patient-doctor communication to ensure that utility values are shared and that autonomous decisions are made regarding medical services. Thus, strategies for reducing the cost burden of cancer through ensuring appropriate patient-centered care include introducing value-based medicine, conducting cost-utility studies, and developing patient decision aids.

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A Systematic Review of Economic Evaluation of Thyroid Cancer
Mijin Kim, Woojin Lim, Kyungsik Kim, Ja Seong Bae, Byung Joo Lee, Bon Seok Koo, Eun Kyung Lee, Eu Jeong Ku, June Young Choi, Bo Hyun Kim, Sue K. Park
International Journal of Thyroidology.2022; 15(2): 74. CrossRef
Ethical, pedagogical, socio-political and anthropological implications of quaternary prevention
Marc Jamoulle, Michel Roland, Jong-Myon Bae, Bruno Heleno, Giorgio Visentin, Gustavo Diniz Ferreira Gusso, Maciek Godycki-Ćwirko, Miguel Pizzanell, Patrick Ouvrard, Ricardo La Valle, Luis Filipe Gomes, Daniel Widmer, Jorge Bernstein, Mariana Mariño, Hamil
Revista Brasileira de Medicina de Família e Comunidade.2018; 13(40): 1. CrossRef

Primary Care Physicians’ Action Plans for Responding to Results of Screening Tests Based on the Concept of Quaternary Prevention: Jong-Myon Bae, Marc Jamoulle; J Prev Med Public Health. 2016;49(6):343-348. Published online October 13, 2016; DOI: https://doi.org/10.3961/jpmph.16.059

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Since noncommunicable diseases (NCDs) are generally controllable rather than curable, more emphasis is placed on prevention than on treatment. For the early detection of diseases, primary care physicians (PCPs), as well as general practitioners and family physicians, should interpret screening results accurately and provide screenees with appropriate information about prevention and treatment, including potential harms. The concept of quaternary prevention (QP), which was introduced by Jamoulle and Roland in 1995, has been applied to screening results. This article summarizes situations that PCPs encounter during screening tests according to the concept of QP, and suggests measures to face such situations. It is suggested that screening tests be customized to fit individual characteristics instead of being performed based on general guidelines. Since screening tests should not be carried out in some circumstances, further studies based on the concept of prevention levels proposed by Jamoulle and Roland are required for the development of strategies to prevent NCDs, including cancers. Thus, applying the concept of QP helps PCPs gain better insights into screening tests aimed at preventing NCDs and also helps improve the doctor-patient relationship by helping screenees understand medical uncertainties.

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Healthy lifestyle status related to alcohol and food addiction risk among college students: a logistic regression analysis
Cheong Hoon Kim, Kyung-Ah Kang, Sunhwa Shin
Journal of American College Health.2023; 71(3): 775. CrossRef
Quaternary prevention: reviewing the concept
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Breast Density and Risk of Breast Cancer in Asian Women: A Meta-analysis of Observational Studies: Jong-Myon Bae, Eun Hee Kim; J Prev Med Public Health. 2016;49(6):367-375. Published online October 21, 2016; DOI: https://doi.org/10.3961/jpmph.16.054

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Abstract PDF

Objectives
The established theory that breast density is an independent predictor of breast cancer risk is based on studies targeting white women in the West. More Asian women than Western women have dense breasts, but the incidence of breast cancer is lower among Asian women. This meta-analysis investigated the association between breast density in mammography and breast cancer risk in Asian women.
Methods
PubMed and Scopus were searched, and the final date of publication was set as December 31, 2015. The effect size in each article was calculated using the interval-collapse method. Summary effect sizes (sESs) and 95% confidence intervals (CIs) were calculated by conducting a meta-analysis applying a random effect model. To investigate the dose-response relationship, random effect dose-response meta-regression (RE-DRMR) was conducted.
Results
Six analytical epidemiology studies in total were selected, including one cohort study and five case-control studies. A total of 17 datasets were constructed by type of breast density index and menopausal status. In analyzing the subgroups of premenopausal vs. postmenopausal women, the percent density (PD) index was confirmed to be associated with a significantly elevated risk for breast cancer (sES, 2.21; 95% CI, 1.52 to 3.21; I²=50.0%). The RE-DRMR results showed that the risk of breast cancer increased 1.73 times for each 25% increase in PD in postmenopausal women (95% CI, 1.20 to 2.47).
Conclusions
In Asian women, breast cancer risk increased with breast density measured using the PD index, regardless of menopausal status. We propose the further development of a breast cancer risk prediction model based on the application of PD in Asian women.

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Helicobacter pylori Infection and Risk of Gastric Cancer in Korea: A Quantitative Systematic Review: Jong-Myon Bae, Eun Hee Kim; J Prev Med Public Health. 2016;49(4):197-204. Published online July 7, 2016; DOI: https://doi.org/10.3961/jpmph.16.024

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Abstract PDF

Objectives
In the context of the global decrease in mortality due to gastric cancer, previous studies have reported that the effect of chronic Helicobacter pylori (H. pylori) infection on the incidence of gastric cancer varies among regions. This systematic review was conducted to investigate H. pylori as a risk factor for gastric cancer in Korea, where the incidence of gastric cancer is among the highest in the world.
Methods
A search strategy was established to identify articles published in Korean as well as in English. Ultimately, we included observational studies conducted among Korean patients that designed with an age-matched and sex-matched control group that reported the odds ratio associated with H. pylori. Gastric cancer cases were subdivided into overall (OGC), cardia (CGC), non-cardia (NGC), early (EGC), advanced, intestinal (IGC), and diffuse forms of gastric cancer. Summary odds ratios (SORs) with 95% confidence intervals (CIs) were calculated in the meta-analysis using a random-effect model.
Results
Eleven case-control studies were ultimately selected. H. pylori was associated with an SOR of 1.81 (95% CI, 1.29 to 2.54) for OGC. Additionally, statistically significant risks were observed for CGC, NGC, EGC, and IGC.
Conclusions
Chronic H. pylori infection was found to raise the risk of gastric cancer among Koreans, with the highest risk observed for CGC and EGC (SOR=2.88 for both). Follow-up clinical epidemiologic studies are needed to assess the effects of current treatments aimed at eradicating H. pylori infections.

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Epstein-Barr Virus and Gastric Cancer Risk: A Meta-analysis With Meta-regression of Case-control Studies: Jong-Myon Bae, Eun Hee Kim; J Prev Med Public Health. 2016;49(2):97-107. Published online March 4, 2016; DOI: https://doi.org/10.3961/jpmph.15.068

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Abstract PDF

Objectives
Research on how the risk of gastric cancer increases with Epstein-Barr virus (EBV) infection is lacking. In a systematic review that investigated studies published until September 2014, the authors did not calculate the summary odds ratio (SOR) due to heterogeneity across studies. Therefore, we include here additional studies published until October 2015 and conduct a meta-analysis with meta-regression that controls for the heterogeneity among studies.
Methods
Using the studies selected in the previously published systematic review, we formulated lists of references, cited articles, and related articles provided by PubMed. From the lists, only case-control studies that detected EBV in tissue samples were selected. In order to control for the heterogeneity among studies, subgroup analysis and meta-regression were performed.
Results
In the 33 case-control results with adjacent non-cancer tissue, the total number of test samples in the case and control groups was 5280 and 4962, respectively. In the 14 case-control results with normal tissue, the total number of test samples in case and control groups was 1393 and 945, respectively. Upon meta-regression, the type of control tissue was found to be a statistically significant variable with regard to heterogeneity. When the control tissue was normal tissue of healthy individuals, the SOR was 3.41 (95% CI, 1.78 to 6.51; I-squared, 65.5%).
Conclusions
The results of the present study support the argument that EBV infection increases the risk of gastric cancer. In the future, age-matched and sex-matched case-control studies should be conducted.

Summary

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Citation Discovery Tools for Conducting Adaptive Meta-analyses to Update Systematic Reviews: Jong-Myon Bae, Eun Hee Kim; J Prev Med Public Health. 2016;49(2):129-133. Published online March 14, 2016; DOI: https://doi.org/10.3961/jpmph.15.074

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Abstract PDF

Objectives
The systematic review (SR) is a research methodology that aims to synthesize related evidence. Updating previously conducted SRs is necessary when new evidence has been produced, but no consensus has yet emerged on the appropriate update methodology. The authors have developed a new SR update method called ‘adaptive meta-analysis’ (AMA) using the ‘cited by’, ‘similar articles’, and ‘related articles’ citation discovery tools in the PubMed and Scopus databases. This study evaluates the usefulness of these citation discovery tools for updating SRs.
Methods
Lists were constructed by applying the citation discovery tools in the two databases to the articles analyzed by a published SR. The degree of overlap between the lists and distribution of excluded results were evaluated.
Results
The articles ultimately selected for the SR update meta-analysis were found in the lists obtained from the ‘cited by’ and ‘similar’ tools in PubMed. Most of the selected articles appeared in both the ‘cited by’ lists in Scopus and PubMed. The Scopus ‘related’ tool did not identify the appropriate articles.
Conclusions
The AMA, which involves using both citation discovery tools in PubMed, and optionally, the ‘related’ tool in Scopus, was found to be useful for updating an SR.

Summary

Citations

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The Author Reply: A Comment on “Quaternary Prevention in Public Health”: Jong-Myon Bae; J Prev Med Public Health. 2016;49(2):141-141. Published online March 31, 2016; DOI: https://doi.org/10.3961/jpmph.16.032

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Primary Care Physicians’ Action Plans for Responding to Results of Screening Tests Based on the Concept of Quaternary Prevention
Jong-Myon Bae, Marc Jamoulle
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Hormonal Replacement Therapy and the Risk of Lung Cancer in Women: An Adaptive Meta-analysis of Cohort Studies: Jong-Myon Bae, Eun Hee Kim; J Prev Med Public Health. 2015;48(6):280-286. Published online November 9, 2015; DOI: https://doi.org/10.3961/jpmph.15.054

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Abstract PDF

Objectives
Approximately 10% to 15% of lung cancer cases occur in never-smokers. Hormonal factors have been suggested to lead to an elevated risk of lung cancer in women. This systematic review (SR) aimed to investigate the association between hormonal replacement therapy (HRT) and the risk of lung cancer in women using cohort studies.
Methods
We first obtained previous SR articles on this topic. Based on these studies we made a list of refereed, cited, and related articles using the PubMed and Scopus databases. All cohort studies that evaluated the relative risk of HRT exposure on lung cancer occurrence in women were selected. Estimate of summary effect size (sES) with 95% confidence intervals (CIs) were calculated.
Results
A total of 14 cohort studies were finally selected. A random effect model was applied due to heterogeneity (I-squared, 64.3%). The sES of the 14 articles evaluating the impact of HRT exposure on lung cancer occurrence in women indicated no statistically significant increase in lung cancer risk (sES, 0.99; 95% CI, 0.90 to 1.09).
Conclusions
These results showed that HRT history had no effect on the risk of lung cancer in women, even though the sES of case-control studies described in previous SR articles indicated that HRT had a protective effect against lung cancer. It is necessary to conduct a pooled analysis of cohort studies.

Summary

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Implementation of Quaternary Prevention in the Korean Healthcare System: Lessons From the 2015 Middle East Respiratory Syndrome Coronavirus Outbreak in the Republic of Korea: Jong-Myon Bae; J Prev Med Public Health. 2015;48(6):271-273. Published online November 24, 2015; DOI: https://doi.org/10.3961/jpmph.15.059

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Abstract PDF

Quaternary prevention should be implemented to minimize harm to patients because the ultimate goal of medicine is to prevent disease and promote health. Primary care physicians have a major responsibility in quaternary prevention, and the establishment of clinical epidemiology as a distinct field of study would create a role charged with minimizing patient harm arising from over-medicalization.

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Contribuições técnicas e socioculturais da prevenção quaternária para a atenção primária à saúde
Fernanda Beatriz Melo Maciel, Hebert Luan Pereira Campos dos Santos, Nilia Maria de Brito Lima Prado
Revista Brasileira de Medicina de Família e Comunidade.2020; 15(42): 2571. CrossRef
The Author Reply: A Comment on “Quaternary Prevention in Public Health”
Jong-Myon Bae
Journal of Preventive Medicine and Public Health.2016; 49(2): 141. CrossRef
A Comment on “Quaternary Prevention in Public Health” by Dr. Jong-Myon Bae
Marc Jamoulle
Journal of Preventive Medicine and Public Health.2016; 49(2): 139. CrossRef

Hormone Replacement Therapy and Risk of Breast Cancer in Korean Women: A Quantitative Systematic Review: Jong-Myon Bae, Eun Hee Kim; J Prev Med Public Health. 2015;48(5):225-230. Published online September 16, 2015; DOI: https://doi.org/10.3961/jpmph.15.046

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Abstract PDF

Objectives
The epidemiological characteristics of breast cancer incidence by age group in Korean women are unique. This systematic review aimed to investigate the association between hormone replacement therapy (HRT) and breast cancer risk in Korean women.
Methods
We searched electronic databases such as KoreaMed, KMbase, KISS, and RISS4U as well as PubMed for publications on Korean breast cancer patients. We also conducted manual searching based on references and citations in potential papers. All of the analytically epidemiologic studies that obtained individual data on HRT exposure and breast cancer occurrence in Korean women were selected. We restricted the inclusion of case-control studies to those that included age-matched controls. Estimates of summary odds ratio (SOR) with 95% confidence intervals (CIs) were calculated using random effect models.
Results
One cohort and five case-control studies were finally selected. Based on the heterogeneity that existed among the six studies (I-squared=70.2%), a random effect model was applied. The summary effect size of HRT history from the six articles indicated no statistical significance in breast cancer risk (SOR, 0.983; 95% CI, 0.620 to 1.556).
Conclusions
These facts support no significant effect of HRT history in the risk of breast cancer in Korean women. It is necessary to conduct a pooled analysis.

Summary

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Attitude, Practices, and Barriers to Menopausal Hormone Therapy Among Physicians in Saudi Arabia
Rayan A Qutob, Abdullah Alaryni, Eysa N Alsolamy, Khalid Al Harbi, Yousef Alammari, Abdulrahman Alanazi, Mohanad Khalid Almaimani, Enad Alsolami, Osamah A Hakami, Asail Ahmed Alammar, Raghad Z Abuthyab, Lana Hesham Alabdulkarim, Razan Khaled Aldeham, Noor
Cureus.2024;[Epub] CrossRef
Menopoz-Sonrası Dönemde Meme Kanseri Gelişiminde Beslenme Alışkanlıkları ve Yaşam Kalitesi Etkili mi?
Burçak ÇUBUKÇU, Fatma TAYHAN KARTAL, Gözde EDE
Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi.2023; 12(3): 1301. CrossRef
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Validating Breast Cancer Risk Prediction Models in the Korean Cancer Prevention Study-II Biobank
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Rates of Change to a Positive Result in Subsequent Screening Mammography in Korean Women: A Retrospective Observational Study: Jong-Myon Bae, Sang Yop Shin, Eun Hee Kim, Yoon-Nam Kim, Chung Mo Nam; J Prev Med Public Health. 2015;48(1):48-52. Published online December 26, 2014; DOI: https://doi.org/10.3961/jpmph.14.042

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Abstract PDF: Objectives
This retrospective cohort study aimed at calculating some parameters of changes in the findings of the subsequent screening mammography (SSM) in female Korean volunteers.
Methods
The study included screenees aged 30 to 79 years who underwent SSM voluntarily after testing negative in the baseline screenings performed between January 2007 and December 2011. A change to a positive result was defined as category 4 or 5 by using the American College of Radiology Breast Imaging Reporting and Data System. The proportion of results that had changed to positive (CP, %) was calculated by dividing the number of cases with results that were positive in the SSM by the total number of study participants. The rate of results that had changed to positive (CR, cases per 100 000 screenee-months) was calculated by dividing the number of cases with results that were positive in the SSM by the total number of months of the follow-up period.
Results
The overall CP and CR in all age groups (n=77 908) were 2.26% and 93.94 cases per 100 000 screenee-months, respectively. The median CP interval in the subjects who had positive SSM results was 30 to 36 months, while that in the age group of 30 to 39 years was shorter.
Conclusions
Different screening intervals should be considered among women aged between 30 and 59 years. In addition, a strategy for a screening program should be developed for the age group of 30 to 39 years, in particular.; Summary

Mean Sojourn Time of Preclinical Gastric Cancer in Korean Men: A Retrospective Observational Study: Jong-Myon Bae, Sang Yop Shin, Eun Hee Kim; J Prev Med Public Health. 2014;47(4):201-205. Published online July 31, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.4.201

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Abstract PDF

Objectives
This retrospective cohort study aimed to estimate the mean sojourn time (MST) of preclinical gastric cancer in Korean men.
Methods
The subjects consisted of voluntary male screenees aged 40 to 69 years who underwent subsequent screening gastroscopies after testing negative at a baseline screening performed between January 2007 and December 2011. A new case was defined if gastric cancer cells were present in the biopsy specimens obtained from gastroscopy. The follow-up period was calculated as the number of person-years between the date of baseline screening gastroscopy and positive findings at a subsequent screening. The MST was calculated using transition rates of gastric cancer to determine the best screening interval.
Results
Of the 171 979 voluntary male screenees, 61 688 (36%) underwent subsequent screening gastroscopies between January 2007 and December 2011. A total of 91 incident cases were found during 19 598 598 person-years of follow-up. The MST of gastric cancer was 2.37 years (95% confidence intervals, 1.92 to 2.96), and those aged 40 to 49 years had a shorter MST than those 50 to 69 years did.
Conclusions
These findings support the 2-year interval of screening recommended by the nationwide gastric cancer screening program in Korea. Further studies for the age-specific MST among women are needed.

Summary

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The Clinical Impact and Cost-Effectiveness of Surveillance of Incidentally Detected Gastric Intestinal Metaplasia: A Microsimulation Analysis
Nikhil R. Thiruvengadam, Shashank Gupta, Seth Buller, Imad Awad, Devika Gandhi, Allison Ibarra, Gonzalo Latorre, Arnoldo Riquelme, Michael L. Kochman, Gregory Cote, Shailja C. Shah, Monica Saumoy
Clinical Gastroenterology and Hepatology.2024; 22(1): 51. CrossRef
Gastric Cancer Incidence and Mortality After Endoscopic Resection of Gastric Adenoma: A Nationwide Cohort Study
Jae Myung Park, Songhee Cho, Ga-Yeong Shin, Jayoun Lee, Minjee Kim, Hyeon Woo Yim
American Journal of Gastroenterology.2023; 118(12): 2166. CrossRef
Effect and cost-effectiveness of national gastric cancer screening in Japan: a microsimulation modeling study
Hsi-Lan Huang, Chi Yan Leung, Eiko Saito, Kota Katanoda, Chin Hur, Chung Yin Kong, Shuhei Nomura, Kenji Shibuya
BMC Medicine.2020;[Epub] CrossRef
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Jeong Seop Moon
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Optimal Interval for Repeated Gastric Cancer Screening in Normal-Risk Healthy Korean Adults: A Retrospective Cohort Study
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Cardiovascular Health Metrics and All-cause and Cardiovascular Disease Mortality Among Middle-aged Men in Korea: The Seoul Male Cohort Study: Ji Young Kim, Young-Jin Ko, Chul Woo Rhee, Byung-Joo Park, Dong-Hyun Kim, Jong-Myon Bae, Myung-Hee Shin, Moo-Song Lee, Zhong Min Li, Yoon-Ok Ahn; J Prev Med Public Health. 2013;46(6):319-328. Published online November 28, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.6.319

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Abstract PDF

Objectives

This study estimated the association of cardiovascular health behaviors with the risk of all-cause and cardiovascular disease (CVD) mortality in middle-aged men in Korea.

Methods

In total, 12 538 men aged 40 to 59 years were enrolled in 1993 and followed up through 2011. Cardiovascular health metrics defined the following lifestyle behaviors proposed by the American Heart Association: smoking, physical activity, body mass index, diet habit score, total cholesterol, blood pressure, and fasting blood glucose. The cardiovascular health metrics score was calculated as a single categorical variable, by assigning 1 point to each ideal healthy behavior. A Cox proportional hazards regression model was used to estimate the hazard ratio of cardiovascular health behavior. Population attributable risks (PARs) were calculated from the significant cardiovascular health metrics.

Results

There were 1054 total and 171 CVD deaths over 230 690 person-years of follow-up. The prevalence of meeting all 7 cardiovascular health metrics was 0.67%. Current smoking, elevated blood pressure, and high fasting blood glucose were significantly associated with all-cause and CVD mortality. The adjusted PARs for the 3 significant metrics combined were 35.2% (95% confidence interval [CI], 21.7 to 47.4) and 52.8% (95% CI, 22.0 to 74.0) for all-cause and CVD mortality, respectively. The adjusted hazard ratios of the groups with a 6-7 vs. 0-2 cardiovascular health metrics score were 0.42 (95% CI, 0.31 to 0.59) for all-cause mortality and 0.10 (95% CI, 0.03 to 0.29) for CVD mortality.

Conclusions

Among cardiovascular health behaviors, not smoking, normal blood pressure, and recommended fasting blood glucose levels were associated with reduced risks of all-cause and CVD mortality. Meeting a greater number of cardiovascular health metrics was associated with a lower risk of all-cause and CVD mortality.

Summary

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