Journal of Preventive Medicine and Public Health

Volume 39(6); November 2006

English Abstracts

The Usefulness of Obesity Indices for the Coronary Risk Factors in an Urban Inhabitants.: Sung Kyeong Park, Kwang Hwan Kim, Young Chae Cho; J Prev Med Public Health. 2006;39(6):447-454.

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To determine obesity for the screening of individuals at high risk of coronary heart disease in urban areas. METHODS: Data were obtained from 4,137 adults between 19 and 85 years of age (2,372 males, 1,765 females), not recognized as taking medicines for cardiovascular diseases, who underwent a health check-up at the health promotion center of university hospitals in cities between Jan. 2003 and Dec. 2004. The variables studied were divided into two broad categories, and their relationships examined: obesity indices and risk factors for coronary heart disease. To reveal the relation between each of the obesity indices and the proportion of individuals at risk of coronary heart disease, the obesity indices were stratified and odds ratios obtained after age adjustment. RESULTS: From a gender comparison of anthropometric measures, men were found to have significantly greater heights, weights, and waist and hip circumferences than women. From a gender comparison by the obesity indices, women were found to have significantly higher BMI, %Fat, waist to hip and waist to stature ratios than men. As obesity indices, the waist to stature ratio and the waist circumference were strongly correlated with coronary risk factors, both in men and women. The age-adjusted odds ratio of coronary risk factors increased significantly with increasing waist circumference, BMI, %fat, waist to hip and waist to stature ratios, and were highest specifically for the waist to stature ratio and the waist circumference. CONCLUSIONS: The study results showed that the waist to stature ratio and the waist circumference, as obesity indices, were most closely correlated with coronary risk factors. It is suggested that the waist to stature ratio and, specifically, the waist circumference can be effectively used in the field of health management for screening those with high levels of coronary risk factors.; Summary

Relationship between Corrected QT Interval and Cardiovascular Risk Factors in Young Healthy Adults: The Kangwha Study.: Song Vogue Ahn, Hyeon Chang Kim, Nam Wook Hur, Kyoung Soo Ha, Hoo Sun Jang, Jin Bae Kim, Il Suh; J Prev Med Public Health. 2006;39(6):455-461.

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Prolongation of the heart rate-corrected QT (QTc) interval has been reported to be associated with cardiovascular morbidity and mortality. However, few studies have examined the relationship between the QTc interval and cardiovascular risk factors in young healthy people. The aim of this study was to examine the associations between the QTc interval and cardiovascular risk factors in young healthy adults. METHODS: This study was performed as part of the Kangwha study, which started in 1986, and is an on-going follow-up study on blood pressure and related cardiovascular risk factors. In follow-up examinations during 2005, cardiovascular risk factors, including anthropometrics, blood pressure, blood chemistry and carotid ultrasonography, were measured, and questionnaires on health behaviors completed by 127 men and 149 women aged 25 years. The QTc interval was measured on the resting 12-lead electrocardiogram using an automatic analysis program. RESULTS: The mean QTc interval was significantly longer in women (419+/-17ms) than in men (405+/-17ms) (p<0.001). A significant positive correlation was found between the QTc interval and waist-hip ratio (p=0.030) in men. Women showed a positive correlation between the QTc interval and systolic blood pressure (p=0.017). On a multiple regression analysis, the QTc interval was positively associated with the waist-hip ratio in men (p=0.012) and with the systolic blood pressure (p=0.020) in women. CONCLUSIONS: In young healthy Korean adults, the QTc interval was independently associated with the waist-hip ratio in men and with the systolic blood pressure in women.; Summary

The Effect of Exercise Type on Cardiovascular Disease Risk Index Factors in Male Workers.: Nam Jin Kim, Suk In Lee; J Prev Med Public Health. 2006;39(6):462-468.

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The purpose of this study was to gain an understanding of the effects of three exercise types on anthropometric and serum lipids and physiological index factors, which are known to be the three risk factors of cardiovascular disease in male workers. METHODS: The experimental study period was 12 weeks. In this study, 30-40's males (N=31) were assigned to 3 experimental groups: regular aerobic(treadmill walking) exercise group, regular anaerobic(muscular endurance) exercise group, irregular aerobic & anaerobic exercise group and a control group using a stratified random assignment method. RESULTS: In relation to anthropometric factors, the regular aerobic & anaerobic exercise groups showed significant decreases in Weight, Broca's index, WC, BMI, WHtR, WHpR and HRrest. With regard to the serum lipid factors, the TC was decreased, but the HDL-c increased among the regular aerobic & anaerobic exercise groups. However, no significant difference was found between the other groups in respect to the LDL-c and TG. Considering the physiological factors, the TC/HDL-c, TC-HDL/HDL-c, LDLc/HDL-c and NON-HDL-c ratios were decreased, but the HDL-c/TC ratio increased among the regular aerobic & anaerobic exercise groups. The TG/HDL-c and HDL-c/LDLc ratios showed no significant differences between the groups. These results indicated that the positive change for each factor is much larger in the regular exercise groups, especially in the anaerobic exercise group. CONCLUSIONS: The results indicate that not only regular aerobic exercise, but also regular anaerobic(muscular endurance) exercise could be utilized in lessening the deleterious effects of the risk index factors for cardiovascular disease.; Summary

The Effects of the Parents' Social Class on Infant and Child Death among 1995-2004 Birth Cohort in Korea.: Mia Son, Juhwan Oh, Yong Jun Choi, Jeong Ok Kong, Jisook Choi, Eunjeong Jin, Sung Tae Jung, Se Jin Park; J Prev Med Public Health. 2006;39(6):469-476.

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To investigate the effect of parents' social class on infant and child mortality rates among the birth cohort, for the period of transition to and from the Koran economic crisis 1995-2004. METHODS: All births reported to between 1995 and 2004 (n=5,711,337) were analyzed using a Cox regression model, to study the role of the social determinants of parents in infant and child mortality. The results were adjusted for the parents' age, education and occupation, together with mother's obstetrical history. RESULTS: The crude death rate among those under 10 was 3.71 per 1000 births (21,217 deaths among 5,711,337 births) between 1995 and 2004. The birth cohorts from lower educated parents less than elementary school showed higher mortality rates compared with those from higher educated parents over university level (HR:3.0 (95%CI:2.8-3.7) for father and HR:3.4 (95%CI:3.3-4.5) for mother). The mother's education level showed a stronger relationship with mortality among the birth cohort than that of the fathers'. The gaps in infant mortality rates by parents' social class, and educational level became wider from 1995 to 2004. In particular, the breadth of the existing gap between higher and lower parents' social class groups has dramatically widened since the economic crisis of 1998. DISCUSSIONS: This study shows that social differences exist in infant and child mortality rates. Also, the gap for the infant mortality due to social class has become wider since the economic crisis of 1998.; Summary

Associations between Carotid Intima-media Thickness, Plaque and Cardiovascular Risk Factors.: Young Hoon Lee, Lian Hua Cui, Min Ho Shin, Sun Seog Kweon, Kyeong Soo Park, Seul Ki Jeong, Eun Kyung Chung, Jin Su Choi; J Prev Med Public Health. 2006;39(6):477-484.

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This study was conducted to examine the association between the carotid artery intima-media thickness (IMT), plaque and cardiovascular risk factors according to gender and age. METHODS: The data used for this study were obtained from 1,507 subjects (691 men, 816 women), aged 20-74 years, who participated in 'Prevalence study of thyroid diseases' in two counties of Jeollanam-do Province during July and August of 2004. The body mass index (BMI) and waist hip ratio (WHR) were calculated by anthropometry. The blood pressure, pulse rate, pulse pressure, total cholesterol, triglyceride, HDL cholesterol and fasting blood sugar level were also measured. Ultrasonography was used to measure the carotid artery IMT and plaque. IMT measurements were performed at 6 sites, including both common carotid arteries, and the bulb and internal carotid arteries. The definition of the 'mean IMT' was mean value obtained from these 6 sites. RESULTS: The mean+/-standard deviation IMT values were 0.65+/-0.14 and 0.60+/-0.13 mm in men and women (p<0.001), respectively. The data were analyzed according to gender and the 50 year age groups.In a multiple linear regression analysis, age and hypertension were positively associated with the mean IMT in both men and women, aged<50 years. Age, total cholesterol and smoking (current) were positively associated with the mean IMT in men (> of =50 years). Age was positively associated with the mean IMT in women (> of =50 years), but the HDL cholesterol level was negatively associated. The prevalence of plaques was 44.2%(196/443) in men and 19.4%(89/459) in women, for those greater than 50 years of age. In a multiple logistic regression analysis, age (OR=1.090, 95%CI=1.053-1.129), HDL cholesterol (OR=0.964, 95%CI=0.944-0.984), total cholesterol (OR=1.009, 95%CI=1.002-1.017) and BMI (OR=0.896, 95%CI=0.818-0.983) were independently associated with plaques in men; whereas, age (OR=1.057, 95%CI=1.012-1.103), HDL cholesterol (OR=0.959, 95%CI=0.932-0.986), pulse pressure (OR=1.029, 95%CI=1.007-1.050) and triglycerides (OR=0.531, 95%CI=0.300-0.941) were independently associated with plaques in women. CONCLUSIONS: There were significant gender and aging differences in the association between the IMT, plaque and cardiovascular risk factors. Therefore, for the prevention of atherosclerosis, selective approaches should be considered with regard to gender and age factors.; Summary

The Resting Electrocardiographic ST Segment Depression and Related Factors at a Rural Adult Community, Korea.: Yu Mi Kim, Mi Kyung Kim, Jin Ho Shin, Heon Kil Lim, Do Myung Paek, Bo Youl Choi; J Prev Med Public Health. 2006;39(6):485-492.

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To measure the distribution of electrocardiographic ST segment depression, and evaluate its relationships with cardiovascular risk factors based on the cross-sectional studies within a rural Korean community. METHODS: This study analyzed 1,343 persons, over 40 years old, who participated in a baseline survey during 2002~2005; the exclusion criteria included: a past history of myocardial infarction and angina pectoris, and specific conduction abnormalities. A Standard 12 leads ECG was recorded using an FCP-2101 (Fukuda Denshi Co.). The ST segment depression was retrospectively measured by a physician, according to the Minnesota code classification. RESULTS: ST segment depression was found in 3.6 and 6.4% of male and female participants, respectively. After adjusting for age, gender, smoking, physical activity and obesity differences, high blood pressure showed significant relations with ST depression in females (male ORs=2.67, 95% CI=0.85-8.50; female ORs=2.62, 95% CI=1.29-5.32) CONCLUSIONS: As an ischemic ECG sign, ST depression was related to hypertension in female participants. This relationship remained significant, even after cases with left ventricular hypertrophy were removed.; Summary

Fasting Serum Glucose Level and Gastric Cancer Risk in a Nested Case-control Study.: Jae Kwan Jun, Jin Gwack, Sue Kyung Park, Yun Hee Choi, Yeonju Kim, Aesun Shin, Soung Hoon Chang, Hai Rim Shin, Keun Young Yoo; J Prev Med Public Health. 2006;39(6):493-498.

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Diabetes has been reported as a risk factor for several cancers. However, the association between diabetes and gastric cancer has been inconsistent. The aim of this study was to evaluate the association between the fasting serum glucose level and gastric cancer risk in Korea. METHODS: Among the members of the Korean Multi-Center Cancer Cohort (KMCC) from 1993 to 2004, a total of 100 incident gastric cancer cases were ascertained until December 31, 2002 and 400 controls were matched according to age, sex, and year and area of enrollment. Of the eligible subjects, those without fasting serum glucose level information were excluded, with a total of 64 cases and 236 controls finally selected. On enrollment, all subjects completed a baseline demographic and lifestyle characteristics questionnaire, and had their fasting serum glucose level measured. The Helicobacter pylori infection status was determined by an immunoblot assay using longterm stored serum. The odds ratios (ORs) were estimated using conditional and unconditional logistic regression models adjusted for the H. pylori infection status, smoking, drinking, education, follow-up period and matching variables. RESULTS: The ORs for risk of gastric cancer according to the serum glucose level were 1.33 [95% CI=0.50-3.53] and 1.66 [95% CI=0.55-5.02] for the categories of 100-125 and 126 mg/dL or greater, respectively, compared to the category of less than 100 mg/dL. No increased risk of gastric cancer according to the serum glucose level was found (p-trend=0.337). CONCLUSIONS: This study provides no evidence for an association of the serum glucose level with gastric cancer.; Summary

The Socioeconomic Cost of Diseases in Korea.: Young Ho Jung, Sukja Ko; J Prev Med Public Health. 2006;39(6):499-504.

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The aim of the study was to estimate the annual socioeconomic cost of diseases in Korea. METHODS: We estimate both the direct and indirect costs of diseases in Korea during 2003 using a prevalence-based approach. The direct cost estimates included medical expenditures, traffic costs and caregiver's cost, and the indirect costs, representing the loss of production, included lost workdays due to illness and lost earnings due to premature death, which were estimated based on the human capital theory. The cost estimates were reported at three different discount rates (0, 3 and 5%). RESULTS: The cost of diseases in Korea during 2003 was 38.4 trillion won based on 0% discount rate. This estimate represents approximately 5.3% of GDP. The direct and indirect costs were estimated to be 22.5 trillion (58.5% of total cost) and 15.9 trillion won (41.5%), respectively. It was also found that the cost for those aged 40~49 accounted for the largest proportion (21.7%) in relation to age groups. The cost of diseases for males was 23.5% higher than that for females. For major diseases, the total socioeconomic costs were 16.0, 13.4, 11.3 and 11.19% for neoplasms, and diseases of the digestive, respiratory and circulatory systems, respectively. CONCLUSIONS: This study can be expected to provide valuable information for determining intervention and funding priorities, and for planning health policies.; Summary

The Relationship between ACE I/D Polymorphism and HDL Cholesterol.: Chang Hun You, Young Seoub Hong, Jong Young Kwak, Na Young Kim, Mee Sook Roh, Kap Yeol Jung, Yong Hwan Lee, Jung Man Kim, Joon Youn Kim; J Prev Med Public Health. 2006;39(6):505-510.

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The purpose of this study is to evaluate the association of the angiotensin converting enzyme (ACE) insertion/deletion (I/D) polymorphism with cardiovascular disease risk factors. METHODS: Out of a total of 608 middle-aged adults who visited local health centers, 424 subjects (104 male, 320 female) who had not been diagnosed with hypertension, diabetes mellitus, or hyperlipidemia were included in this study. ACE genotypes were determined in all subjects by polymerase chain reaction methods. RESULTS: Statistical differences in high-density lipoprotein (HDL) cholesterol levels according to ACE genotype were observed using ANOVA (p<0.05), but no differences were found in other cardiovascular risk factors. Specifically, men with the DD and DI genotypes had significantly lower HDL cholesterol levels than those with the II genotype based on the LSD multi-comparison test (p<0.05). CONCLUSIONS: In men, the D-allele of the ACE I/D polymorphism was significantly associated with reduced HDL cholesterol levels. In the future, larger studies are needed to confirm this relationship between ACE I/D polymorphism and HDL cholesterol.; Summary

Factors Affecting National Health Insurance Mass Screening Participation in the Disabled.: Jong Hyock Park, Jin Seok Lee, Jin Yong Lee, Ji Young Hong, So Young Kim, Seong Ok Kim, Byong Hee Cho, Yong Ik Kim, Youngsoo Shin, Yoon Kim; J Prev Med Public Health. 2006;39(6):511-519.

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As the disabled have higher prevalence rates and earlier onsets of chronic diseases than the nondisabled, their participation in mass screening is important for the early detection and intervention of chronic diseases. Nevertheless, in Korea, the disabled have lower participation rates in mass screening services than the nondisabled. The purpose of the study was to find determinants for the participation in the National Health Insurance (NHI) mass screening program among the disabled. METHODS: In this study, the NHI mass screening data of 423,076 disabled people, which were identified using the National Disability Registry (2003), were analyzed. Of the factors affecting the participation rates in mass screenings, the following variables were included for the analysis: socioeconomic stati, such as sex, age, category of health insurance program, region and income; disability characteristics, such as disability type, and severity. A multiple logistic regression analysis was used to evaluate the association between the participation rates, disability characteristics variables and demographic variables. RESULTS: The participation rate in mass screening of the disabled was 41.3%, but was lower in females, an age of more than 70 years, self-employed and for those with an average monthly insurance premium over 133,500 Won and in metropolitan regions. The participation rate was 1.31 times lower in females than males (95% CI=1.29-1.33); 3.50 times lower in the elderly (more than 70 years) than the younger (95% CI=3.33-3.67); 1.43 times lower in those who live in metropolitan areas (95% CI=1.40-1.46); 2.59 times lower for those in a health insurance program for the self-employed than for employees (95% CI=2.56-2.63); 1.19 times lower for the higher income (more than 133,500) than the lower income group (4,400-22,000) for the average monthly insurance premium (95% CI=1.15-1.23); 2.04 times lower for those with brain palsy and stroke disabilities than with auditory impairments (95% CI= 1.97-2.11) and 3.27 times for those with severe compared to mild disabilities (95% CI=3.15-3.40). CONCLUSIONS: The disabled with high severity, and locomotive and communication disabilities have lower participation rates in mass screening services in Korea.; Summary

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