Journal of Preventive Medicine and Public Health

Original Article

Decomposition of Socioeconomic Inequality in Cardiovascular Disease Prevalence in the Adult Population: A Cohort-based Cross-sectional Study in Northwest Iran: Farhad Pourfarzi, Telma Zahirian Moghadam, Hamed Zandian; J Prev Med Public Health. 2022;55(3):297-306. Published online May 3, 2022; DOI: https://doi.org/10.3961/jpmph.22.051

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Abstract PDF Supplementary Material: Objectives
The incidence of cardiovascular disease (CVD) mortality is increasing in developing countries. This study aimed to decompose the socioeconomic inequality of CVD in Iran.
Methods
This cross-sectional population-based study was conducted on 20 519 adults who enrolled in the Ardabil Non-Communicable Disease cohort study. Principal component analysis and multivariable logistic regression were used, respectively, to estimate socioeconomic status and to describe the relationships between CVD prevalence and the explanatory variables. The relative concentration index, concentration curve, and Blinder-Oaxaca decomposition model were used to measure and decompose the socioeconomic inequality.
Results
The overall age-adjusted prevalence of CVD was 8.4% in northwest Iran. Multivariable logistic regression showed that older adults, overweight or obese adults, and people with hypertension and diabetes were more likely to have CVD. Moreover, people with low economic status were 38% more likely to have CVD than people with high economic status. The prevalence of CVD was mainly concentrated among the poor (concentration index, -0.077: 95% confidence interval, -0.103 to -0.060), and 78.66% of the gap between the poorest and richest groups was attributed to differences in the distribution of the explanatory variables included in the model.
Conclusions
The most important factors affecting inequality in CVD were old age, chronic illness (hypertension and diabetes), marital status, and socioeconomic status. This study documented stark inequality in the prevalence of CVD, wherein the poor were more affected than the rich. Therefore, it is necessary to implement policies to monitor, screen, and control CVD in poor people living in northwest Iran.; Summary

Special Articles

General Factors of the Korean Exposure Factors Handbook: Jae-Yeon Jang, So-Yeon Kim, Sun-Ja Kim, Kyung-Eun Lee, Hae-Kwan Cheong, Eun-Hye Kim, Kyung-Ho Choi, Young-Hee Kim; J Prev Med Public Health. 2014;47(1):7-17. Published online January 29, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.1.7

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Risk assessment considers the situations and characteristics of the exposure environment and host. Various physiological variables of the human body reflects the characteristics of the population that can directly influence risk exposure. Therefore, identification of exposure factors based on the Korean population is required for appropriate risk assessment. It is expected that a handbook about general exposure factors will be used by professionals in many fields as well as the risk assessors of the health department. The process of developing the exposure factors handbook for the Korean population will be introduced in this article, with a specific focus on the general exposure factors including life expectancy, body weight, surface area, inhalation rates, amount of water intake, and soil ingestion targeting the Korean population. The researchers used national databases including the Life Table and the 2005 Time Use Survey from the National Statistical Office. The anthropometric study of size in Korea used the resources provided by the Korean Agency for Technology and Standards. In addition, direct measurement and questionnaire surveys of representative samples were performed to calculate the inhalation rate, drinking water intake, and soil ingestion.

Summary

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Activity Factors of the Korean Exposure Factors Handbook: Jae-Yeon Jang, Soo-Nam Jo, So-Yeon Kim, Kyung-Eun Lee, Kyung-Ho Choi, Young-Hee Kim; J Prev Med Public Health. 2014;47(1):27-35. Published online January 29, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.1.27

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Abstract PDF

Exposure factors based on the Korean population are required for making appropriate risk assessment. It is expected that handbooks for exposure factors will be applied in many fields, as well as by health department risk assessors. The present article describes the development of an exposure factors handbook that specifically focuses on human activities in situations involving the possible risk of exposure to environmental contaminants. We define majour exposure factors that represent behavioral patterns for risk assessment, including time spent on routine activities, in different places, on using transportation, and engaged in activities related to water contact including swimming, bathing and washing. Duration of residence and employment are also defined. National survey data were used to identify recommended levels of exposure factors in terms of time spent on routine activities and period of residence and employment. An online survey was conducted with 2073 subjects who were selected using a stratified random sampling method in order to develop a list of exposure factors for the time spent in different places and in performing water-related activities. We provide the statistical distribution of the variables, and report reference levels of average exposure based on the reliable data in our exposure factors handbook.

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Food Ingestion Factors of the Korean Exposure Factors Handbook: Jae-Yeon Jang, Soo-Nam Jo, Sun-Ja Kim, Hyung-Nam Myung, Cho-Il Kim; J Prev Med Public Health. 2014;47(1):18-26. Published online January 29, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.1.18

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Abstract PDF

The purpose of this study was to establish food ingestion factors needed to assess exposure to contaminants through food ingestion. The study reclassified the raw data of the Korean National Health and Nutrition Examination Survey in 2001 into 12 subcategories including grain products, meat products, fish and shellfish, and vegetables for international comparability of exposure evaluation. The criteria for food intake calculation were unified according to the characteristics of food groups, and recommended values for food ingestion factors were calculated through moisture correction and recategorization of cooked, processed, and mixed foods for each group. The average intake rate for grain and grain products was 6.25 g/kg-d per capita and the men's intake rate was approximately 8% higher than that of the women. The average intake rate of meat and meat products was 1.62 g/kg-d per capita and the men's intake rate was 30% higher than that of the women, on average. The average intake rate of fish and shellfish was 1.53 g/kg-d per capita, and the age groups of 1 to 2 and 3 to 6 recorded higher capita intake rates than other age groups, 2.62 g/kg-d and 2.25 g/kg-d, respectively. The average intake rate of vegetables was 6.47 g/kg-d per capita, with the age group of 1 to 2 recording the highest per capita intake rate of 9.79 g/kg-d and that of 13 to 19 recording the lowest mean. The study also offers recommended values for food ingestion factors of other food groups by gender, age, and region. The food ingestion exposure factors will need future updates in consideration of ongoing changes in food consumption behavior.

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Overview of the Development of the Korean Exposure Factors Handbook: Jae-Yeon Jang, Soo-Nam Jo, So-Yeon Kim, Hyung-Nam Myung; J Prev Med Public Health. 2014;47(1):1-6. Published online January 29, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.1.1

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Abstract PDF

A set of exposure factors that reflects the characteristics of individual behavior capable of influencing exposure is essential for risk and exposure assessment. In 2007, the Korean Exposure Factors Handbook was, therefore, issued, driven by the need to develop reliable exposure factors representing the Korean population. The purpose of this study was to overview the development process of the Korean Exposure Factors Handbook and major recommended exposure values for the Korean population to allow information exchanges and comparison of recommended values among nations. The researchers reviewed the domestic data that could be used in the development of exposure factors, confirmed a knowledge gap, and set a priority of development by phases. A methodology to measure exposure factors was established to develop measuring techniques and test their validity. Data were processed or a survey was conducted according to the availability of data. The study thus produced recommended values for 24 exposure factors grouped by general exposure factors, food ingestion factors, and activity factors by setting up a database of exposure factors and carrying out statistical analysis. The study has significantly contributed to reducing the potential uncertainty of the risk and exposure assessment derived by the application of foreign data or research findings lacking representativeness or grounds by developing a set of exposure factors reflecting the characteristics of the Korean people. It will be necessary to conduct revisions in light of the changing statistical values of national data and the exposure factors based on Korean characteristics.

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Review

Risk Assessment and Pharmacogenetics in Molecular and Genomic Epidemiology.: Sue K Park, Ji Yeob Choi; J Prev Med Public Health. 2009;42(6):371-376.; DOI: https://doi.org/10.3961/jpmph.2009.42.6.371

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Abstract PDF

In this article, we reviewed the literature on risk assessment (RA) models with and without molecular genomic markers and the current utility of the markers in the pharmacogenetic field. Epidemiological risk assessment is applied using statistical models and equations established from current scientific knowledge of risk and disease. Several papers have reported that traditional RA tools have significant limitations in decision-making in management strategies for individuals as predictions of diseases and disease progression are inaccurate. Recently, the model added information on the genetic susceptibility factors that are expected to be most responsible for differences in individual risk. On the continuum of health care, from diagnosis to treatment, pharmacogenetics has been developed based on the accumulated knowledge of human genomic variation involving drug distribution and metabolism and the target of action, which has the potential to facilitate personalized medicine that can avoid therapeutic failure and serious side effects. There are many challenges for the applicability of genomic information in a clinical setting. Current uses of genetic markers for managing drug therapy and issues in the development of a valid biomarker in pharmacogenetics are discussed.

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Original Articles

Risk-Based Damage Cost Estimation on Mortality Due to Environmental Problems.: Ye Shin Kim, Yong Jin Lee, Hoa Sung Park, Dong Chun Shin; Korean J Prev Med. 2003;36(3):230-238.

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Abstract PDF: OBJECTIVES
To estimate the value of statistical life (VSL) and health damage cost on theoretical mortality estimates due to environmental pollution. METHODS: We assessed the health risk on three environmental problems and eight sub-problems. Willingness to pay (WTP) was elucidated from a questionnaire survey with dichotomous contingent valuation method and VSL (which is the division of WTP by the change of risk reduction) calculated from WTP. Damage costs were estimated by multiplying VSL by the theoretical mortality estimates. RESULTS: VSLs from death caused by air pollution, indoor air pollution and drinking water contamination were about 0.3, 0.5 and 0.3 billion won, respectively. Damage costs of particulate matters (PM10) and radon were higher in the sub-problems and were above 100 billion won. Because damage cost depends on theoretical mortality estimate and WTP, its uncertainty is reduced in the estimating process. CONCLUSION: Health damage cost or risk benefit should be considered as one scientific criterion for decision making in environmental policy.; Summary

Risk Assessment on Carcinogenic Pesticides of Vegetables in Korea.: Jae Hong Yoon, Jong Tae Lee, Yong Chung, Dongchun Shin; Korean J Prev Med. 1999;32(2):155-161.

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Abstract PDF: OBJECTIVES
The study was conducted to estimate the carcinogenic risks from the ingestion of some carcinogenic pesticides (CPs) in vegetables sampled at a local agricultural product market in Seoul. METHODS: After applying a hazard identification step, we selected four pesticides, such as DDT, dieldrin, folpet, and heptachlor epoxide, for this risk assessment. Concentrations of each pesticide were measured from randomly sampled vegetables. In order to estimate the human exposure levels, we combined the concentration of pesticides in the vegetables with consumption rate of those vegetables. Three scenarios were hypothesized for human exposure assessment. Scenario I was the most conservative which supposed the undetected CPs would be the detection limit values. Scenario II was assumed that the undetected CPs would be a half of the detection limit values, and finally scenario III merely considered only values greater than the detection limit values. We finally presented the estimated carcinogenic risks on the basis of the traditional risk assessment procedure suggested by U.S. EPA. RESULTS: Pesticides including DDT, dieldrin, folpet and heptachlor epoxide were detected in 9 samples (6%) in the range of 0.0006~0.09ppm. The daily intake levels of carcinogenic pesticides were estimated in the range of 0.0009~0.0079 microgram/day. As we expected, excess cancer risks based on scenario I was also the highest (1.1x10-8~ 5.5x10-5). CONCLUSIONS: We found that the estimated risks from the pesticides we investigated were not serious. We, however, propose that a continuos monitoring is needed to make sure for the protection of public health.; Summary

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