- Medical Expenses by Site of Cancer and Survival Time among Cancer Patients in the Last One Year of Life.
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Jee Jeon Yi, Won Kon Yoo, So Yoon Kim, Kwang Ki Kim, Sang Wook Yi
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J Prev Med Public Health. 2005;38(1):9-15.
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To analyze medical expenses by cancer site and survival time among cancer patients in their last year of life. METHOD: The study subjects were 45, 394 people that had died of cancers in 2002, were registered by the Korea Central Cancer Registry and received National Health Insurance benefit in the last year (360 days) of life. Personal identification data, general characteristics, dates of death and cancer incidence, and site of cancer were collected from the National Statistical Office and the Korea Central Cancer Registry, and merged with the data of the individual medical expenses of the Health Insurance Review Agency. RESULTS: Average monthly cost curves were U-shaped with high costs near the time of diagnosis and death, and lower costs in between. Medical expenses in the last year of life were around 30.3, 16.7, 13.0, and 12.1 million won among leukemia, lymphoma, ovarian cancer, and breast cancer patients, respectively. Digestive organ cancers including stomach, esophagus, liver, pancreas, and colorectal cancers had relatively low medical expenses. Medical expenses in the last year of life were inverse U-shaped with high expenses near one year of survival. Average monthly cost in the 12 months before death among the patients who had survived 10~15 years were more than two-fold greater than the cost before diagnosis among those who had survived for less than one year. CONCLUSIONS: Leukemia was the most expensive cancer. It is possible that once diagnosed as cancer, medical expenses do not return to the level before diagnosis. Further research will be needed to understand the magnitude and change of the medical expenses among cancer patients with long term follow up data.
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- A Relationship of Care Time with Functional Status and Patients Characteristics among Patients in Long-term Care Hospitals.
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Jee Jeon Yi, Sang Wook Yi, Jeong In Kim, Seung Hm Yu, Hyeong Sik Yoo
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J Prev Med Public Health. 2004;37(3):282-291.
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The aim of this study was to investigate the functional status variables related to the care time of health professionals for patients in long-term care facilities. METHODS: The functional stati of 1001 patients in 8 longterm care hospitals were examined by the Resident Assessment Instrument for Long-term Care Facility Version 2.0. The care time of health professionals for patients was calculated using data from a self-reported task survey by nurses, auxiliary nurses, private aides, doctors, physiotherapists and social workers. RESULTS: The average care time per diem was 240.6 minutes. The care time by doctors, nurses and private aides were 11.0, 71.0 and 139.5 minutes, respectively. The lower the function of activities of daily living (ADL) and the greater the symptoms of extensive services, special care and clinical complexity, the more care time was served. On the contrary, the greater the symptoms of nursing rehabilitation, depression, cognitive disorder, behavior problem and psychiatry/mood disorder, the less care time was served. Age and gender were not significantly related to the care time. CONCLUSIONS: Developing a case mix classification system for elderly long term care patients may be helpful for both of patients and health care providers. The ADL, extensive services, special care and clinical complexity of variables should be considered in the development of a case mix system for the long term care of patients in Korea.
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- A Study on the Cost and Proportion of Complementary and Alternative Medicine in Total Healthcare Cost among Elderly in the Last 6 Months of Life.
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Jee Jeon Yi, Heechoul Ohrr, Sang Wook Yi
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J Prev Med Public Health. 2004;37(2):141-149.
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- OBJECTIONS: To evaluate the cost and proportion of complementary and alternative medicines (CAM) in the total healthcare costs among the elderly in the last 6 months of life. METHODS: The care-giving families of 301 persons older than 65 years, who died between July 1st and December 31st of 2001, and were also registered in Self-Employed Health Insurance Programs in Seoul, were interviewed. RESULTS: The cost of CAM was 1.09 million Won, which as a proportion of the total healthcare cost was 38.1%. The elderly aged between 65 and 69 year-old, male, living with their spouse, Buddhist and having cancers had higher CAM costs in an ANOVA and simple regression analysis. After controlling of various factors, age was the only significant factor associated with the cost of CAM. The elderly above 80 years old, female, bereaved and Buddhist had higher proportional CAM costs, and the elderly having cancers or cardiovascular diseases had lower proportional CAM costs in an ANOVA and simple regression analysis. After adjusting for various factors, the elderly above 85 years old, female and Buddhist had higher proportional CAM costs, and the elderly having cancers had lower proportional CAM costs. CONCLUSION: The very old and Buddhist, and/or the ill with no clear diagnosis, may depend more on CAM. Further research will be needed on the meaning and impact of CAM and their costs to public health and the total healthcare system.
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- Association of Drinking Patterns and Health Characteristics with Beverage Preference.
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Jee Jeon Yi, Heechoul Ohrr, Sang Wook Yi, Woo Jin Chung
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J Prev Med Public Health. 2004;37(2):133-140.
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To investigate the association between the type of preferred alcoholic beverage and drinking pattern and health characteristics. METHODS: A Cross-sectional study was conducted from 22 April to 3 May in 2002. 301 females and 699 males aged 13 to 59 were personally interviewed. Data on sociodemographic characteristics, drinking pattern and health characteristics were collected. 735 drinkers who were 19 year-old or over were included in analysis. Beverage preference was classified 3 categories: Beer drinker, wine drinker (including wine, makguly, chungju and yakju) and soju drinker (including soju and spirits). RESULTS: Beer drinkers were likely to be females. Compared to wine or soju drinkers, beer drinkers were less frequently drank, and consumed less total alcohol per week and less alcohol per 1 drinking among both male and female. Controlling for various confounders, beer drinker had significantly less total alcohol consumption per week, and alcohol consumption per 1 drinking than wine and soju drinker. CONCLUSION: Beer drinking were associated with less smoking in males and healthy drinking pattern in both gender than soju drinking.
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- Association between Alcohol Drinking and Cardiovascular Disease Mortality and All-cause Mortality: Kangwha Cohort Study.
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Sang Wook Yi, Sang Hyun Yoo, Jae Woong Sull, Heechoul Ohrr
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J Prev Med Public Health. 2004;37(2):120-126.
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- OBJECTIONS: This study sought to examine relationships between alcohol drinking and cardiovascular disease mortality and all-cause mortality. METHODS: From March 1985 through December 1999, 2, 696 males and 3, 595 females aged 55 or over as of 1985 were followed up for their mortality until 31 December 1999. We calculated the mortality risk ratios by level of alcohol consumption. Among the drinker, the level of alcohol consumption was calculated by the frequency of alcohol comsumption and the type of alcohol. Cox proportional hazard model was used to adjust for confounding factors. RESULTS: Among males, compared to abstainer, heavy drinker had significantly higher mortality in all cause (Risk ratio=1.35), cardiovascular disease (Risk ratio=1.52) and cerebrovascular disease (Risk ratio =1.66). Although not significant, moderate drinker had lower ischemic heart disease mortality (Risk ratio =0.38). Among females, there was no statistically significant association between alcohol comsumption and mortality. CONCLUSION: The results of this study suggest that alcohol drinking has harmful effect on all-cause mortality, cardiovascular disease mortality and cerebrovascular disease mortality among males, especially in heavy drinker among males. Minimal evidence on protective effect for cardiovascular disease mortality in low or moderate drinker is observed.
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- A Study on the Association Between Ginseng Intake and Incidences of Cancer: Kangwha Cohort Study.
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Joo Sun Byun, Heechoul Ohrr, Sang Wook Yi, Jae Suk Hong, Tae Yong Sohn
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Korean J Prev Med. 2003;36(4):367-372.
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There are many concerns about ginseng as a cancer chemopreventive substance, but there have been few epidemiological studies on ginseng. This study sought to examine the relationships between ginseng intake and cancer incidence in the Kangwha cohort. METHODS: Between March 1985 and December 1999, 2697 males, aged 55 or over, as of 1985, were followed up for their cancer incidence. The cancer incidence rate, standardized incidence ratio and risk ratios were calculated according to ginseng intake. A Cox proportional hazard model was used to adjust for age at entry, smoking, alcohol intake, hypertension, and body mass index. RESULTS & CONCLUSIONS: The ginseng intake group had the same cancer (C00-C97) incidences (Standardized Incidence Ratio: SIR=1.11, 95% Confidence Interval = 0.97-1.27) and the same risk ratio (RR=1.09, 95% Confidence Interval = 0.85-1.41) as the no-intake group. Analyzing the subjects that had followed up from 1990, however, the ginseng intake group had lower cancer incidences at all sites (RR = 0.79, 95% Confidence Interval = 0.58-1.09). This was a cohort study to try and evaluate the association between ginseng intake and the incidences of cancer. The results of this study provide no clear conclusions on the cancer preventive effects of ginseng. Therefore, further study is needed in the future.
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- A Study on the Association between Healthcare Utilization and the Burden of Families Caring for the Elderly in the Last 6 Months of Life.
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Jee Jeon Yi, Hee Na Lee, Heechoul Ohrr, Hye Young Jung, Sang Wook Yi
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Korean J Prev Med. 2003;36(4):332-338.
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To investigate the relationship between medical expenses and the burden of families caring for the elderly in the last 6 months of life, and to evaluate the factors relating to the burden of family caregivers. METHODS: The families of 301 persons older than 65 years, who died between 1 July and 31 December 2001, and were registered in Resident-based- Health Insurance Programs in Seoul, were interviewed. The medical expenses and length of stay among the elderly were collected from Korean Health Insurance Corporations. RESULTS: 31 percents of the elderly had no medical expenses in the last 6 months of life. On average, the objective burden (4.92) was higher than the subjective burden (3.35). Families caring for male elderly had a higher burden. With increasing age at death, the objective burden was significantly increased. The burden on a family seemed to be influenced more by the family income than the property of the elderly. With increasing total health care costs, the objective burden on the family caregivers was significantly increased, but with increasing medical expenses, the subjective burden was significantly decreased. CONCLUSION: An association between healthcare utilization and burden on families was observed. The reason for the decreasing subjective burden when medical expenses were decreased was unclear. Further research will be needed.
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- Medical Service Utilization and Trends among Korean Elderly in the Last One Year of Life.
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Jee Jeon Yi, Ki Soon Park, Seung Hum Yu, Jeong In Kim, Jae Yong Park, Wang Kun Yoo, Sang Wook Yi
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Korean J Prev Med. 2003;36(4):325-331.
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To analyze medical service utilization and trends among the elderly in the last year of life. METHOD: The subjects of this study were people that had died at the age sixty-five and above between January 1st and June 30th 2000 The names of the deceased and their dates of death were collected from the data of the funeral-expenses-receivers of the National Health Insurance Corporation (NHIC). This data was merged with that of the individual medical expenses of the NHIC. RESULTS: In the first half of 2000, 84.2% of the funeral-expenses-receivers (53, 063) utilized medical services during the year prior to their death; 51.0% (27, 042) were female and 49.0% (26, 021) male. In the last twelve months of life, the medical fees, the number of days receiving medical services and the number of days receiving medicine were 3, 107, 935 Won, 47.88 and 153.21, respectively, for each person. As the age of the groups increased, the level of medical service utilization decreased; the change was more obvious in female group. The level of medical service utilization during the twelve months prior to death drastically increased around the time of death. CONCLUSIONS: This study, from an analysis of the level of medical service utilization prior to death, shows a concentrated volume of medical services during a certain time period prior to death.
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- Pilot Study on Recruiting Medical Checkup Participants by Mail Survey among Korean Vietnam Veterans.
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Sang Wook Yi, Jae Seok Hong, Heechoul Ohrr
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Korean J Prev Med. 2003;36(2):171-178.
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The aim of this study was to identify the validity of recruiting medical checkup participants of Vietnam veterans using a mail survey, and to identify the 'Vietnam service related characteristics' and `general characteristics' of Vietnam veterans groups. METHOD: In this study, a total 900 veterans were randomly selected from the list of Vietnam veterans from 1964 to 1973. The veterans were classified into 5 groups, taking into consideration their registered status in the Ministry of Patriots and Veterans Affairs; the VRD (veterans who have agent orange-related diseases), VSD (veterans who have agent orange-suspected disease), VM (veterans who performed meritorious deeds during the war), VR (veterans who were registered with the Ministry of Patriots and Veterans Affair) and OV (other veterans) groups. By means of postal surveys, the veterans' intention to participate in the medical checkup for our research, and their socioeconomic and general characteristics were investigated. 52 surveys were returned due to the subjects not residing at the listed address, and were excluded from the analysis. RESULT: 699 of the 848 veterans (82.4%) responded to the survey, of which 619 (88.6%) intended to participate in the medical checkup for our research. The 5 veterans groups all had similar ages, Vietnam service period, Agent Orange exposure, troop characteristic and wartime class, with the exception of VM, who were older, and with a greater number of officers than the other 4 groups. There was a big difference in the health statius among the Vietnam veterans group. The VM and OV were much healthier than VRD, VSD and VR groups. The socioeconomic stati of the VRD, VSD and VR groups were lower than those of the VM and OV groups. CONCLUSION: Although there were some limitations, the recruitment, by mail, of medical checkup participants from Vietnam veterans is a valid and feasible method. The VM and OV groups were much healthier, and with higher socioeconomic stati, than the VRD, VSD, and VR groups.
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- Cigarette Smoking, Alcohol and Cancer Mortality in Men: The Kangwha Cohort Study.
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Sang Gyu Lee, Chung Mo Nam, Sang Wook Yi, Hee Chul Ohrr
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Korean J Prev Med. 2002;35(2):123-128.
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To examine the relationship between cigarette smoking, alcohol and cancer mortality in men in the Kangwha cohort after 12 years and 10 months of follow up. METHODS: The subjects consisted of 2,681 men in the Kangwha cohort aged over 55 in 1985. Number of deaths and the time to death from all cancers and other cause were measured and the data for the smoking and drinking habits were obtained from the baseline survey data in 1985. All subjects were categorized into four groups according to their smoking habits: non-smokers, ex-smokers, moderate-smokers (1-19 cigarettes per day), heavy-smokers (> or =20 cigarettes per day). In addition, they were also categorized according to their drinking habits: non-drinkers, light-drinkers (< or =1 drink per week), moderate-drinkers (<3 drinks per day), heavy-drinkers (> or =3 drinks per day). The cancer specific death rates were calculated according to their smoking and drinking status. The adjusted risk ratio for all cancer deaths according to their smoking and drinking status were estimated using the Cox's proportional hazard regression model. RESULTS: Using nonsmokers as the reference category, the adjusted risk ratio for all cancer deaths were 1.573(95% CI=1.003-2.468) for heavy-smokers. For lung cancer deaths, the adjusted risk ratios were 3.540(95% CI=1.251-10.018) for moderate-smoker and 4.114(95% CI=1.275-13.271) for heavy-smokers. Compared to non-drinkers, the adjusted risk ratio for stomach cancer was 2.204(95% CI=1.114-4.361) for light-drinkers. CONCLUSION: Smoking is the most significant risk factor for cancer deaths particularly lung cancer.
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- Pesticides and Cancer Incidence: The Kangwha Cohort Study.
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Jae Woong Sull, Sang Wook Yi, Tae Yong Sohn, Sun Ha Jee, Chung Mo Nam, Heechul Ohrr
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Korean J Prev Med. 2002;35(1):24-32.
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Few studies have examined the relationship between the risk of cancer and exposure to pesticides in Korea or in other East Asian that have until recently used chlorophenoxy herbicides. The aim of this study was to evaluate the relationship between the exposure to pesticides and cancer incidence. METHODS: We conducted a prospective cohort study with a follow-up period of 13 years (1985-1998). The subjects included 2,687 male and 3,589 female Kangwha Island residents, Koreans aged fifty-five or more as of March 1985, who received a personal health interview and completed a health examination survey. A Cox proportional hazards models were used to estimate relative risks (RR). RESULTS: At baseline, the mean age of the study participants in 1985 was 66.4 for males and 67.1 for females. During the 13 years follow-up, a total of 300 incidents of cancer in males and 146 in females developed. In males, the total cancer incidence in the highest group was RR, 1.4 (95% CI=1.0-1.9), p for trend=0.041, for digestive organ cancer incidence in the highest group, RR, 1.5 (95% CI=1.0-2.3), p for trend=0.057, for stomach cancer incidence in the highest group, RR, 1.6 (95% CI=0.9-2.8), p for trend=0.094, for gallbladder cancer incidence in the highest group, RR, 9.1 (95% CI=1.1-77.0), p for trend=0.014 were elevated according to the higher frequency of pesticide use per year. In particular, the risk of gallbladder cancer was very high. Although not significant, the risk of liver cancer was higher than in the non-exposed group (in the highest group, RR, 2.0 (95% CI=0.7-5.9)). In females, although not significant, breast cancer incidence in the highest exposure group was higher than in the non-exposed group (in the highest group, RR, 4.7 (95% CI=0.8-27.9)). CONCLUSIONS: This study demonstrates that Korean farmers who use pesticides, particularly males, have a significantly higher total cancer incidence, particularly from digestive organ cancers such as, stomach, gallbladder, and liver cancer. In particular, the risk of gallbladder cancer was very high.
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- Cohort Study on Age at Menopause and Mortality- Kangwha Cohort Study -.
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Jae Seok Hong, Sang Wook Yi, Sun Ha Jee, Tae Yong Sohn, Heechoul Ohrr
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Korean J Prev Med. 2001;34(4):323-330.
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To examine the association between age at menopause and mortality in a population-based sample of women in Kangwha, Korea. METHODS: From the Kangwha Cohort, followed-up from 1985 to 1999, the data of the over 55 year old female group(n=3,596) was used in this study to examine the association between age at menopause and mortality. We calculated the all causes mortality risk ratio and the cancer mortality risk ratio by age at menopause grouping using the Cox Proportional Hazards Model with adjustments for age, BMI, smoking, education, chronic disease, self-rated health status, alcohol consumption and age at first birth. RESULT AND CONCLUSION: Compared to women who had menopause at 45-49 years, the all causes mortality risk ratio was 1.24 for women with menopause at less than 40 years(95% CI=1.01-1.53) and 1.05 for women with menopause at over 50 years(95% CI=0.92-1.20). Also, compared to women who had menopause at 45-49 years, the cancer mortality risk ratio was 1.53 for women with menopause at less than 40 years(95% CI=0.78-2.98) and 1.17 for women with menopause at over 50 years(95% CI=0.77-1.80).
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- A Proposal of Study Designs and Methods for Evaluating the Adverse Health Effects of Agent Orange among Korean Vietnam Veterans.
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Sang Wook Yi, Jong Uk Won, Jae Seok Hong, Heechoul Ohrr
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Korean J Prev Med. 2001;34(3):228-236.
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To propose a feasible, valid and appropriate study designs and epidemiologic methods for evaluating the adverse health effects of Agent Orange-chemical defoliants used in Vietnam- in Korea. METHODS: A literature study was performed on Agent Orange, herbicides, pesticides and dioxins. The study subjects, study design, exposure assessment and health outcomes assessment were examined in each study. The potential data sources for the study subjects, study design, exposure assessment and health outcomes assessment in Korea were investigated. RESULTS AND CONCLUSION: In earlier Korean studies, research subjects for studying the effects of Agent Orange were identified from the patients or persons who claimed to have Agent Orange-related diseases due to the difficulties in identifying the entire population of Vietnam veterans in Korea. In this study, an attempt was made to identify the total number of Vietnam veterans in Korea. As a result, the addresses of 20,000 Vietnam veterans were obtained. It is proposed that a retrospective cohort design on a sample of the total number of Vietnam veterans is a feasible and appropriate study design. Self report questionnaires and military records were proposed to assess the exposure level. It is believed that measuring the plasma or tissue TCDD should be used only for a validation study assessing the level of exposure. For the health outcomes assessment, it is possible to obtain the mortality, cancer frequency, physical examination, screening and medical insurance record data.
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- Association between BMI and Mortality: Kangwha cohort study.
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Soo Jin Yoon, Sang Wook Yi, Soh Yoon Kim, Heechoul Ohrr, Yun Hee Park, Soon Young Lee, Tae Yong Sohn
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Korean J Prev Med. 2000;33(4):459-468.
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To investigate the association between BMI and Mortality. METHODS: This study was based on the analysis and assembly of the 'Kangwha Cohort Study', previously conducted by the Department of Preventive Medicine, Yonsei University. A total of 2,696 males and 3,595 females were followed for almost ten years and ten months from March 1985 to January 1996, a total of whom 2,420 died during this period. The Cox's proportional hazards regression model was used to analyze this data. RESULTS: We found a U-shaped relationship between BMI and mortality among the aged men in the Kangwha cohort. The hazard ratio of dying was adjusted for age, marital status, occupation, self cognitive health level, chronic disease, smoking, and alcohol frequency, then sorted by body mass index into the following groups; less than 18.5, 18.5 to less than 21.0, 21.0 to less than 23.5, 23.5 to less than 26.0 and greater than or equal to 26. The corresponding ratios for men were 1.81(1.50-2.19, 95%CI), 1.31(1.14-1.51, 95%CI), 1.0(referent), 1.05(0.87-1.26, 95%CI) and 1.39(1.09-1.76, 95%CI), respectively. And for women, 1.46(1.19-1.78), 1.12(0.95-1.31, 95%CI), 1.0(referent), 1.00(0.84-1.20, 95%CI) and 1.09(0.89-1.34, 95%CI), respectively. CONCLUSIONS: The risk of death among aged men in Kangwha increased in the under and overweight groups. The relationship between BMI and mortality has been well studied in Western populations, but little is known about the association between BMI and mortality in our country. So, on the basis of this study, it is apparent that more studies of the relationship between BMI and mortality will be needed for future work.
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- Cancer Incidence in Kangwha County(1986 - 1992).
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Soh Yoon Kim, Heechoul Ohrr, Hyung Gon Kang, Suk Il Kim, Sang Wook Yi
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Korean J Prev Med. 1999;32(4):482-490.
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This paper presents the information on the incidence of cancer from the population-based cancer resistry in Kangwha County. Material and METHODS: This investigation is based on Kangwha cancer registry. The data included cases of cancer diagnosed from 1986 through 1992. The diagnosis of cancer was confirmed by a team of physicians and nurses with the medical records kept in the clinics and hospitals based on the diagnostic criteria recommended by WHO. Home visitings were also made to cancer patients confirmed in every 6 months for the follow up and for the collection of relevant information directly from the patients. RESULTS: A total of 992 cancer cases were registered during 1986 - 1992. The age-adjusted cancer incidence rate of all site is 201.7 in men and 110.7 in women. The most common cancer is the stomach cancer in both sexes. The age-adjusted incidence rate of the stomach cancer is 65.9 in men and 25.0 in women per 100,000 population. The lung cancer(33.8) and liver cancer(27.7) are next common cancers in men. The cervical cancer(21.8) and lung cancer(8.4) are next in women. CONCLUSION: The most common cancer is the stomach cancer in both sexes. The annual age-adjusted incidence rate of the stomach cancer is 65.9 in men and 25.0 in women per 100,000 population.
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- The Prevalence of Cancer in Kangwha County.
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Sang Wook Yi, Heechoul Ohrr, Kang Hee Lee, Suk Il Kim, Hyung Gon Kang, Sun Ha Jee
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Korean J Prev Med. 1999;32(3):333-342.
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Most descriptive studies of cancer have focused either on cancer incidence or mortality. Cancer prevalence has rarely been estimated. Cancer prevalence data can be used as a measure of the economic and social burden of cancer and are also useful for health care planning. This study attempts to estimate cancer prevalence in Kangwha county. METHODS: This investigation is based on data of Kangwha cancer registry. The data include all cases of cancer diagnosed from 1983 through 1992. We define "prevalent cases" as cancer patients who is alive as of January 1, 1993. For each five-year age group, the number of "known prevalent cases" is added to the number of "estimated prevalent cases". Prevalence is calculated by dividing these sums by the populations of Kangwha County on December 31, 1992(derived from Kangwha Statistics Annual). RESULTS: Crude prevalence of cancer among males and females are 536.7 and 601.1 per 100,000 respectively. Gastric cancer is the most common malignant neoplasm(213.2 per 100,000, crude prevalence) among males. It is followed by lung cancer(45.1 per 100,000), liver cancer(32.8 per 100,000), rectal cancer(25.4 per 100,000) and colon cancer(25.4 per 100,000). Cervical cancer is the most common cancer(201.9 per 100,000, crude prevalence) and is followed by gastric cancer(91.5 per 100,000), thyroid cancer(64.8 per 100,000), breast cancer(57.2 per 100,000) and rectal cancer(32.7 per 100,000) among females. CONCLUSIONS: We tried to estimate cancer prevalence based on the Kangwha cancer registry for the first time in Korea. The estimation of cancer prevalence based on a population-based cancer registry will be more correct and useful as the data accumulate. We will make another estimation in the near future.
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