Journal of Preventive Medicine and Public Health

Yangho Kim

5 Articles

Inappropriate Survey Design Analysis of the Korean National Health and Nutrition Examination Survey May Produce Biased Results: Yangho Kim, Sunmin Park, Nam-Soo Kim, Byung-Kook Lee; J Prev Med Public Health. 2013;46(2):96-104. Published online March 28, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.2.96

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Objectives

The inherent nature of the Korean National Health and Nutrition Examination Survey (KNHANES) design requires special analysis by incorporating sample weights, stratification, and clustering not used in ordinary statistical procedures.

Methods

This study investigated the proportion of research papers that have used an appropriate statistical methodology out of the research papers analyzing the KNHANES cited in the PubMed online system from 2007 to 2012. We also compared differences in mean and regression estimates between the ordinary statistical data analyses without sampling weight and design-based data analyses using the KNHANES 2008 to 2010.

Results

Of the 247 research articles cited in PubMed, only 19.8% of all articles used survey design analysis, compared with 80.2% of articles that used ordinary statistical analysis, treating KNHANES data as if it were collected using a simple random sampling method. Means and standard errors differed between the ordinary statistical data analyses and design-based analyses, and the standard errors in the design-based analyses tended to be larger than those in the ordinary statistical data analyses.

Conclusions

Ignoring complex survey design can result in biased estimates and overstated significance levels. Sample weights, stratification, and clustering of the design must be incorporated into analyses to ensure the development of appropriate estimates and standard errors of these estimates.

Summary

Citations

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The Association of Central Obesity with Type 2 Diabetes among Koreans according to the Serum Gamma-Glutamyltransferase Level: Korean Genome and Epidemiology Study.: Ji Yeon Shin, Jun Hyun Hwang, Jin Young Jeong, Sung Hi Kim, Jai Dong Moon, Sang Chul Roh, Young Wook Kim, Yangho Kim, Jong Han Leem, Young Su Ju, Young Seoub Hong, Eun Hee Ha, Yong Hwan Lee, Duk Hee Lee, Dong Hyun Kim; J Prev Med Public Health. 2009;42(6):386-391.; DOI: https://doi.org/10.3961/jpmph.2009.42.6.386

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Abstract PDF

OBJECTIVES
This cross-sectional study was performed to examine if the serum gamma-glutamyltransferase (GGT) level that is within its normal range is associated with the risk of type 2 diabetes and if the association between the waist hip ratio (WHR) and type 2 diabetes is different depending on the serum GGT levels. METHODS: The study subjects were 23,436 persons aged 40 years or older and who participated in regular health check-ups at 11 hospitals (males: 5,821, females: 17,615). The gender-specific quintiles of the serum GGT and WHR were used to examine the associations with type 2 diabetes. RESULTS: The serum GGT levels within their normal range were positively associated with type 2 diabetes only in women. The adjusted odds ratios (ORs) were 1.0, 1.0, 1.4, 2.1, and 2.5 according to the quintiles of the serum GGT (p(trend)<0.01). The WHR was more strongly associated with the prevalence of diabetes among the women with a high-normal serum GGT level as compared with those with a low-normal serum GGT level (p for interaction=0.02). For example, the adjusted ORs for women with a low normal serum GGT level were 1.0, 1.2, 1.5, 2.2, and 2.4 according to the quintiles of the WHR, while those figures were 1.0, 2.4, 3.6, 5.0, and 8.3 among the women with a high normal serum GGT level. However, in men, the serum GGT was very weakly associated with type 2 diabetes and the association between the WHR and type 2 diabetes was not different depending on the serum GGT level. CONCLUSIONS: Serum GGT within its normal range was positively associated with type 2 diabetes, and central obesity was more strongly associated with the prevalence of type 2 diabetes when the serum GGT level was high-normal. However, these associations were observed only in women, which is different from the previous findings. The stronger relation between central obesity and type 2 diabetes among women with a high-normal serum GGT level can be useful for selecting a group that is at high risk for type 2 diabetes irregardless of whatever the underlying mechanism is.

Summary

Citations

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Serum gamma-glutamyl transferase and risk of type 2 diabetes in the general Korean population: a Mendelian randomization study
Youn Sue Lee, Yoonsu Cho, Stephen Burgess, George Davey Smith, Caroline L. Relton, So-Youn Shin, Min-Jeong Shin
Human Molecular Genetics.2016; 25(17): 3877. CrossRef
Different associations between obesity and impaired fasting glucose depending on serum gamma-glutamyltransferase levels within normal range: a cross-sectional study
Nam Soo Hong, Jeong-Gook Kim, Yu-Mi Lee, Hyun-Woo Kim, Sin Kam, Keon-Yeop Kim, Ki-Su Kim, Duk-Hee Lee
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Trend of the Changes in the Level of Blood Lead, Urinary Arsenic and Urinary Cadmium of Children in Ulsan: 3-year Follow-up Study.: Choong Ryeol Lee, Cheol In Yoo, Ji Ho Lee, Hun Lee, Yangho Kim; Korean J Prev Med. 2001;34(2):166-174.

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Abstract PDF: OBJECTIVES
To obtain basic data on blood lead level and urinary level of arsenic and cadmium of children living near a petrochemical estate and a suburban area in Ulsan, Korea and to observe the trend of the changes in the level of these metals in these children. METHODS: The study subjects comprised 626 children living near a petrochemical estate and 299 children living in a suburban area of Ulsan. We analyzed the level of lead, arsenic and cadmium using atomic absorption spectrometer. RESULTS: The mean levels of blood lead in children living near the petrochemical estate were 5.25 microgram/dl, 5.24 microgram/dl, and 7.24 microgram/dl in the years 1997, 1999, and 2000, respectively, whereas those of children living in the suburban area were 3.81 microgram/dl, 4.75 microgram/dl, and 7.19 microgram/dl respectively. The mean levels of urinary arsenic in children living near the petrochemical estate were 4.57 microgram/g creatinine, 4.78 microgram/g creatinine, and 6.02 microgram /g creatinine in the year 1997, 1999, and 2000 respectively, whereas those of children living in suburban area were 2.35 microgram/g creatinine, 4.75 microgram/g creatinine, and 7.07 microgram/g creatinine, respectively. The mean levels of urinary cadmium in children living near the petrochemical estate were 1.15 microgram/g creatinine, 1.05 microgram/g creatinine, and 1.71 microgram/g creatinine in the year 1997, 1999, and 2000, respectively, whereas those of the children living in the suburban area were 0.74 microgram/g creatinine, 1.29 microgram/g creatinine, and 1.48 microgram/g creatinine, respectively. There were increasing trends in the level of blood lead, urinary arsenic and cadmium of children in Ulsan, and the differences in the level of these metals were disappearing between the children living in other areas year by year. CONCLUSIONS: These results suggest that the amount of exposure to lead, arsenic, and cadmium is increasing from year to year, and there is a need for periodic biological and atmospheric monitoring of these metals in Ulsan.; Summary

Respiratory Health of the Children Living near the Petrochemical Estate in Ulsan.: Choong Ryeol Lee, Cheol In Yoo, Ji Ho Lee, Yangho Kim; Korean J Prev Med. 2000;33(2):174-183.

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Abstract PDF: OBJECTIVES
To evaluate the effect of low-level exposure of air pollutants on the respiratory tract of the children living near the petrochemical estate in Ulsan. METHODS: The study design was cross-sectional, and the study subjects consisted of 150 children(76 boys, 74 girls) living near the petrochemical estate and 100 children(53 boys, 47 girls) living in a suburban area. We investigated respiratory health using self-administered questionnaires(ATS-DLD-78), radiological examination, and pulmonary function test such as FVC and FEV1. RESULTS: There were higher prevalence rates of respiratory symptoms in the children living near the petrochemical estate than the children living in a suburban area. And the results of FVC and FEV1 of 11-years old children living near the petrochemical estate were lower than those of the children living in a suburban area. CONCLUSIONS: Chronic exposure of low-level air pollutants would affect respiratory health of the children. Therefore, further a longitudinal study of respiratory health will be needed for children living near the petrochemical estate in Ulsan.; Summary

Evaluation of Puretone Threshold Using Periodic Health Examination Data on Noise-exposed Workers in Korea .: Kyoo Sang Kim, Yangho Kim, Jung Keun Choi, Jung Sun Park, Young Han Moon; Korean J Prev Med. 1999;32(1):30-39.

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Abstract PDF: OBJECTIVES
This study was carried out to evaluate hearing impairment judgement and to investigate the differences in various diagnostic criteria for noise-induced hearing loss (NIHL) among workers who required for close observation (C). METHODS: Out of 731,029 workers who had taken the specific periodic health examination in 1994, we used the audiometric data on 37,999 workers (C) eliminating the employees who had previous otologic problems. Many investigators have being using different criteria for the evaluation of hearing impairment. In this study, we used the criteria of early (1989-1994), current, compensation for NIHL in Korea, 2-, 3-, 4-divided classification and hearing loss at 4,000 Hz and compared the evaluation results. RESULTS: The prevalences of C and workers who had occupational disease (D1) diagnosed for NIHL were 11.1 % and 0.44 %. There were significant difference in the prevalences of C and D1 depending on different province of Korea. Pure tone averages (PTAs) were not appropriately applied in their evaluation. 97% of workers whom we studied on were below the level of mild hearing loss judged by ISO standard. However, there were wide variations in the prevalence rate of mild hearing loss by diagnostic criteria. Thus, there were different judgements in determining the degree of NIHL depending on which diagnostic criteria were utilized. PTAs were found 20.54 (Rt) and 20.74 (Lt) when the method of 3-divided classification was applied for audiometric data. The degree of hearing impairment of the left ear was more severe than that of right ear. The prevalence of normal hearing threshold below 20 dB was 75.4% and the range of difference in both ear was below 10 dB. Right sided hearing threshold levels were 21.08 dB (500 Hz), 18.44 dB (1,000 Hz), 22.09 (2,000 Hz) and 52.36 dB (4,000 Hz). There was typical high frequency loss (C5-dip at 4,000 Hz) above 30 - 40 dB in normal hearing level. The increasing trend in hearing threshold level was gradually decreased by the increase of PTAs. The difference between PTAs and threshold at 4,000 Hz was about 10 dB. CONCLUSIONS: We could found that PTAs in the previous examination were not appropriately evaluated. This study revealed that they did not use unique criteria for managing the workers of NIHL. For the prevention of NIHL, it was found that the quality control on diagnosis and comprehensive management program were required, especially for those of hearing loss (C).; Summary

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