Journal of Preventive Medicine and Public Health

Volume 46(5); September 2013

Original Articles

Agent Orange Exposure and Prevalence of Self-reported Diseases in Korean Vietnam Veterans: Sang-Wook Yi, Heechoul Ohrr, Jae-Seok Hong, Jee-Jeon Yi; J Prev Med Public Health. 2013;46(5):213-225. Published online September 30, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.5.213

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153 Download
34 Crossref

Objectives

The aim of this study was to evaluate the association between Agent Orange exposure and self-reported diseases in Korean Vietnam veterans.

Methods

A postal survey of 114 562 Vietnam veterans was conducted. The perceived exposure to Agent Orange was assessed by a 6-item questionnaire. Two proximity-based Agent Orange exposure indices were constructed using division/brigade-level and battalion/company-level unit information. Adjusted odds ratios (ORs) for age and other confounders were calculated using a logistic regression model.

Results

The prevalence of all self-reported diseases showed monotonically increasing trends as the levels of perceived self-reported exposure increased. The ORs for colon cancer (OR, 1.13), leukemia (OR, 1.56), hypertension (OR, 1.03), peripheral vasculopathy (OR, 1.07), enterocolitis (OR, 1.07), peripheral neuropathy (OR, 1.07), multiple nerve palsy (OR, 1.14), multiple sclerosis (OR, 1.24), skin diseases (OR, 1.05), psychotic diseases (OR, 1.07) and lipidemia (OR, 1.05) were significantly elevated for the high exposure group in the division/brigade-level proximity-based exposure analysis, compared to the low exposure group. The ORs for cerebral infarction (OR, 1.08), chronic bronchitis (OR, 1.05), multiple nerve palsy (OR, 1.07), multiple sclerosis (OR, 1.16), skin diseases (OR, 1.05), and lipidemia (OR, 1.05) were significantly elevated for the high exposure group in the battalion/company-level analysis.

Conclusions

Korean Vietnam veterans with high exposure to Agent Orange experienced a higher prevalence of several self-reported chronic diseases compared to those with low exposure by proximity-based exposure assessment. The strong positive associations between perceived self-reported exposure and all self-reported diseases should be evaluated with discretion because the likelihood of reporting diseases was directly related to the perceived intensity of Agent Orange exposure.

Summary

Citations

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Suzanne M. de la Monte, Ming Tong
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Seung-Hoon Lee, Changsu Han, Junhyung Kim, Hyun-Ghang Jeong, Moon-Soo Lee, Jin Hee Choi, Hayun Choi
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Ake Pugkhem, Supot Kamsa‐ard, Siriporn Kamsa‐ard, Vor Luvira, Varisara Luvira, Vajarabhongsa Bhudhisawasdi
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Exposures and Bladder Cancer Risk Among Military Veterans: A Systematic Review and Meta-analysis
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Urology.2024;[Epub] CrossRef
Cancer risk in Vietnam war veterans from the Korean Vietnam war veterans’ health study cohort
Wanhyung Lee, Soyoung Park, Seong-Kyu Kang, Seunghon Ham, Jin-Ha Yoon, Won-Jun Choi
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Body Mass Index and Cancer Mortality Among Korean Older Middle-Aged Men
Jae-Seok Hong, Sang-Wook Yi, Jee-Jeon Yi, Seri Hong, Heechoul Ohrr
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Karen T. Le, Mark P. Sawicki, Marilene B. Wang, Jerome M. Hershman, Angela M. Leung
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Sang-Wook Yi, Jae-Seok Hong, Jee-Jeon Yi, Heechoul Ohrr
Medicine.2016; 95(39): e4876. CrossRef
Herbicide Exposure, Vietnam Service, and Hypertension Risk in Army Chemical Corps Veterans
Yasmin S. Cypel, Amii M. Kress, Stephanie M. Eber, Aaron I. Schneiderman, Victoria J. Davey
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Kamran Khan, Susan E Wozniak, JoAnn Coleman, Mukund S Didolkar
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Shen-Miao Yang, Jian-Yong Li, Robert Peter Gale, Xiao-Jun Huang
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Authors' response to: ME Ginevan et al. Exposure estimates in epidemiological studies of Korean veterans of the Vietnam War
S.-W. Yi, S.-Y. Ryu
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Association of persistent organic pollutants and non-persistent pesticides with diabetes and diabetes-related health outcomes in Asia: A systematic review
Lindsay M. Jaacks, Lisa R. Staimez
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A critical review of the epidemiology of Agent Orange or 2,3,7,8-tetrachlorodibenzo-p-dioxin and lymphoid malignancies
Ellen T. Chang, Paolo Boffetta, Hans-Olov Adami, Jack S. Mandel
Annals of Epidemiology.2015; 25(4): 275. CrossRef
Low Systolic Blood Pressure and Mortality From All Causes and Vascular Diseases Among Older Middle-aged Men: Korean Veterans Health Study
Sang-Wook Yi, Heechoul Ohrr
Journal of Preventive Medicine and Public Health.2015; 48(2): 105. CrossRef
Agent Orange exposure and disease prevalence in Korean Vietnam veterans: The Korean veterans health study
Sang-Wook Yi, Jae-Seok Hong, Heechoul Ohrr, Jee-Jeon Yi
Environmental Research.2014; 133: 56. CrossRef
A critical review of the epidemiology of Agent Orange/TCDD and prostate cancer
Ellen T. Chang, Paolo Boffetta, Hans-Olov Adami, Philip Cole, Jack S. Mandel
European Journal of Epidemiology.2014; 29(10): 667. CrossRef
Agent Orange exposure and cancer incidence in Korean Vietnam veterans: A prospective cohort study
Sang‐Wook Yi, Heechoul Ohrr
Cancer.2014; 120(23): 3699. CrossRef
Agent Orange exposure and risk of death in Korean Vietnam veterans: Korean Veterans Health Study
Sang-Wook Yi, So-Yeon Ryu, Heechoul Ohrr, Jae-Seok Hong
International Journal of Epidemiology.2014; 43(6): 1825. CrossRef

Serum 2,3,7,8-Tetrachlorodibenzo-p-dioxin Levels and Their Association With Age, Body Mass Index, Smoking, Military Record-based Variables, and Estimated Exposure to Agent Orange in Korean Vietnam Veterans: Sang-Wook Yi, Heechoul Ohrr, Jong-Uk Won, Jae-Seok Song, Jae-Seok Hong; J Prev Med Public Health. 2013;46(5):226-236. Published online September 30, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.5.226

11,493 View
87 Download
12 Crossref

Abstract PDF

Objectives

The aim of this study was to examine the levels of serum 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and evaluate their association with age, body mass index, smoking, military record-based variables, and estimated exposure to Agent Orange in Korean Vietnam veterans.

Methods

Serum levels of TCDD were analyzed in 102 Vietnam veterans. Information on age, body mass index, and smoking status were obtained from a self-reported questionnaire. The perceived exposure was assessed by a 6-item questionnaire. Two proximity-based exposures were constructed by division/brigade level and battalion/company level unit information using the Stellman exposure opportunity index model.

Results

The mean and median of serum TCDD levels was 1.2 parts per trillion (ppt) and 0.9 ppt, respectively. Only 2 Vietnam veterans had elevated levels of TCDD (>10 ppt). The levels of TCDD did not tend to increase with the likelihood of exposure to Agent Orange, as estimated from either proximity-based exposure or perceived self-reported exposure. The serum TCDD levels were not significantly different according to military unit, year of first deployment, duration of deployment, military rank, age, body mass index, and smoking status.

Conclusions

The average serum TCDD levels in the Korean Vietnam veterans were lower than those reported for other occupationally or environmentally exposed groups and US Vietnam veterans, and their use as an objective marker of Agent Orange exposure may have some limitations. The unit of deployment, duration of deployment, year of first deployment, military rank, perceived self-reported exposure, and proximity-based exposure to Agent Orange were not associated with TCDD levels in Korean Vietnam veterans. Age, body mass index and smoking also were not associated with TCDD levels.

Summary

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Determinants of exposure to polychlorinated biphenyls in the Italian population in the last decades
Anna Maria Ingelido, Vittorio Abate, Annalisa Abballe, Stefania Paola De Filippis, Elena Dellatte, Silvia De Luca, Fabiola Ferri, Anna Rita Fulgenzi, Nicola Iacovella, Anna Laura Iamiceli, Valentina Marra, Roberto Miniero, Silvia Valentini, Elena De Felip
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Serum dioxin concentrations in military workers at three dioxin-contaminated airbases in Vietnam
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Karen T. Le, Mark P. Sawicki, Marilene B. Wang, Jerome M. Hershman, Angela M. Leung
Endocrine Practice.2016; 22(6): 699. CrossRef
Herbicide Exposure, Vietnam Service, and Hypertension Risk in Army Chemical Corps Veterans
Yasmin S. Cypel, Amii M. Kress, Stephanie M. Eber, Aaron I. Schneiderman, Victoria J. Davey
Journal of Occupational & Environmental Medicine.2016; 58(11): 1127. CrossRef
Authors' response to: ME Ginevan et al. Exposure estimates in epidemiological studies of Korean veterans of the Vietnam War
S.-W. Yi, S.-Y. Ryu
International Journal of Epidemiology.2015; 44(1): 359. CrossRef
A critical review of the epidemiology of Agent Orange or 2,3,7,8-tetrachlorodibenzo-p-dioxin and lymphoid malignancies
Ellen T. Chang, Paolo Boffetta, Hans-Olov Adami, Jack S. Mandel
Annals of Epidemiology.2015; 25(4): 275. CrossRef
A critical review of the epidemiology of Agent Orange/TCDD and prostate cancer
Ellen T. Chang, Paolo Boffetta, Hans-Olov Adami, Philip Cole, Jack S. Mandel
European Journal of Epidemiology.2014; 29(10): 667. CrossRef
Challenges in investigating the association between Agent Orange and cancer: Site‐specific cancer risk and accuracy of exposure assessment
Thomas H. Sinks
Cancer.2014; 120(23): 3595. CrossRef
Agent Orange exposure and cancer incidence in Korean Vietnam veterans: A prospective cohort study
Sang‐Wook Yi, Heechoul Ohrr
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Agent Orange exposure and risk of death in Korean Vietnam veterans: Korean Veterans Health Study
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Has Income-related Inequity in Health Care Utilization and Expenditures Been Improved? Evidence From the Korean National Health and Nutrition Examination Survey of 2005 and 2010: Eunkyoung Kim, Soonman Kwon, Ke Xu; J Prev Med Public Health. 2013;46(5):237-248. Published online September 30, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.5.237

12,534 View
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10 Crossref

Abstract PDF

Objectives

The purpose of this study is to examine and explain the extent of income-related inequity in health care utilization and expenditures to compare the extent in 2005 and 2010 in Korea.

Methods

We employed the concentration indices and the horizontal inequity index proposed by Wagstaff and van Doorslaer based on one- and two-part models. This study was conducted using data from the 2005 and 2010 Korean National Health and Nutrition Examination Survey. We examined health care utilization and expenditures for different types of health care providers, including health centers, physician clinics, hospitals, general hospitals, dental care, and licensed traditional medical practitioners.

Results

The results show the equitable distribution of overall health care utilization with pro-poor tendencies and modest pro-rich inequity in the amount of medical expenditures in 2010. For the decomposition analysis, non-need variables such as income, education, private insurance, and occupational status have contributed considerably to pro-rich inequality in health care over the period between 2005 and 2010.

Conclusions

We found that health care utilization in Korea in 2010 was fairly equitable, but the poor still have some barriers to accessing primary care and continuing to receive medical care.

Summary

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Differences in Cigarette Use Behaviors by Age at the Time of Diagnosis With Diabetes From Young Adulthood to Adulthood: Results From the National Longitudinal Study of Adolescent Health: Jisuk Bae; J Prev Med Public Health. 2013;46(5):249-260. Published online September 30, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.5.249

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Abstract PDF

Objectives

Previous observations propose that risk-taking behaviors such as cigarette smoking are prevailing among young people with chronic conditions including diabetes. The purpose of this study was to examine whether cigarette smoking is more prevalent among diabetics than non-diabetics and whether it differs by age at the time of diagnosis with diabetes from young adulthood (YAH) to adulthood (AH).

Methods

We used US panel data from the National Longitudinal Study of Adolescent Health (Add Health Study) during the years 2001 to 2002 (Wave III, YAH) and 2007 to 2008 (Wave IV, AH). Multivariate logistic regression models were applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of cigarette use behaviors according to age at the time of diagnosis with diabetes, after adjusting for demographic and selected behavioral factors.

Results

Of 12 175 study participants, 2.6% reported having been diagnosed with diabetes up to AH. Early-onset diabetics (age at diagnosis <13 years) were more likely than non-diabetics to report frequent cigarette smoking (smoking on ≥20 days during the previous 30 days) in YAH (OR, 3.34; 95% CI, 1.27 to 8.79). On the other hand, late-onset diabetics (age at diagnosis ≥13 years) were more likely than non-diabetics to report heavy cigarette smoking (smoking ≥10 cigarettes per day during the previous 30 days) in AH (OR, 1.54; 95% CI, 1.03 to 2.30).

Conclusions

The current study indicated that diabetics are more likely than non-diabetics to smoke cigarettes frequently and heavily in YAH and AH. Effective smoking prevention and cessation programs uniquely focused on diabetics need to be designed and implemented.

Summary

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Socio-demographic Characteristics and Leading Causes of Death Among the Casualties of Meteorological Events Compared With All-cause Deaths in Korea, 2000-2011: Kyung Eun Lee, Hyung-Nam Myung, Wonwoong Na, Jae-Yeon Jang; J Prev Med Public Health. 2013;46(5):261-270. Published online September 30, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.5.261

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Abstract PDF

Objectives

This study investigated the socio-demographic characteristics and medical causes of death among meteorological disaster casualties and compared them with deaths from all causes.

Methods

Based on the death data provided by the National Statistical Office from 2000 to 2011, the authors analyzed the gender, age, and region of 709 casualties whose external causes were recorded as natural events (X330-X389). Exact matching was applied to compare between deaths from meteorological disasters and all deaths.

Results

The total number of deaths for last 12 years was 2 728 505. After exact matching, 642 casualties of meteorological disasters were matched to 6815 all-cause deaths, which were defined as general deaths. The mean age of the meteorological disaster casualties was 51.56, which was lower than that of the general deaths by 17.02 (p<0.001). As for the gender ratio, 62.34% of the meteorological event casualties were male. While 54.09% of the matched all-cause deaths occurred at a medical institution, only 7.6% of casualties from meteorological events did. As for occupation, the rate of those working in agriculture, forestry, and fishery jobs was twice as high in the casualties from meteorological disasters as that in the general deaths (p<0.001). Meteorological disaster-related injuries like drowning were more prevalent in the casualties of meteorological events (57.48%). The rate of amputation and crushing injury in deaths from meteorological disasters was three times as high as in the general deaths.

Conclusions

The new information gained on the particular characteristics contributing to casualties from meteorological events will be useful for developing prevention policies.

Summary

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Su-Mi Chae, Daeeun Kim
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A Prospective Cohort Study on the Relationship of Sleep Duration With All-cause and Disease-specific Mortality in the Korean Multi-center Cancer Cohort Study: Yohwan Yeo, Seung Hyun Ma, Sue Kyung Park, Soung-Hoon Chang, Hai-Rim Shin, Daehee Kang, Keun-Young Yoo; J Prev Med Public Health. 2013;46(5):271-281. Published online September 30, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.5.271

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164 Download
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Abstract PDF

Objectives

Emerging evidence indicates that sleep duration is associated with health outcomes. However, the relationship of sleep duration with long-term health is unclear. This study was designed to determine the relationship of sleep duration with mortality as a parameter for long-term health in a large prospective cohort study in Korea.

Methods

The study population included 13 164 participants aged over 20 years from the Korean Multi-center Cancer Cohort study. Information on sleep duration was obtained through a structured questionnaire interview. The hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality were estimated using a Cox regression model. The non-linear relationship between sleep duration and mortality was examined non-parametrically using restricted cubic splines.

Results

The HRs for all-cause mortality showed a U-shape, with the lowest point at sleep duration of 7 to 8 hours. There was an increased risk of death among persons with sleep duration of ≤5 hours (HR, 1.21; 95% CI, 1.03 to 1.41) and of ≥10 hours (HR, 1.36; 95% CI, 1.07 to 1.72). In stratified analysis, this relationship of HR was seen in women and in participants aged ≥60 years. Risk of cardiovascular disease-specific mortality was associated with a sleep duration of ≤5 hours (HR, 1.40; 95% CI, 1.02 to 1.93). Risk of death from respiratory disease was associated with sleep duration at both extremes (≤5 and ≥10 hours).

Conclusions

Sleep durations of 7 to 8 hours may be recommended to the public for a general healthy lifestyle in Korea.

Summary

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A New Disability-related Health Care Needs Assessment Tool for Persons With Brain Disorders: Yoon Kim, Sang June Eun, Wan Ho Kim, Bum-Suk Lee, Ja-Ho Leigh, Jung-Eun Kim, Jin Yong Lee; J Prev Med Public Health. 2013;46(5):282-290. Published online September 30, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.5.282

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Abstract PDF: Objectives
This study aimed to develop a health needs assessment (HNA) tool for persons with brain disorders and to assess the unmet needs of persons with brain disorders using the developed tool.
Methods
The authors used consensus methods to develop a HNA tool. Using a randomized stratified systematic sampling method adjusted for sex, age, and districts, 57 registered persons (27 severe and 30 mild cases) with brain disorders dwelling in Seoul, South Korea were chosen and medical specialists investigated all of the subjects with the developed tools.
Results
The HNA tool for brain disorders we developed included four categories: 1) medical interventions and operations, 2) assistive devices, 3) rehabilitation therapy, and 4) regular follow-up. This study also found that 71.9% of the subjects did not receive appropriate medical care, which implies that the severity of their disability is likely to be exacerbated and permanent, and the loss irrecoverable.
Conclusions
Our results showed that the HNA tool for persons with brain disorders based on unmet needs defined by physicians can be a useful method for evaluating the appropriateness and necessity of medical services offered to the disabled, and it can serve as the norm for providing health care services for disabled persons. Further studies should be undertaken to increase validity and reliability of the tool. Fundamental research investigating the factors generating or affecting the unmet needs is necessary; its results could serve as basis for developing policies to eliminate or alleviate these factors.; Summary

Erratums

Corrigendum: Trends in Reports on Climate Change in 2009-2011 in the Korean Press Based on Daily Newspapers' Ownership Structure: Jihye Lee, Yeon-pyo Hong, Hyunsook Kim, Youngtak Hong, Weonyoung Lee; J Prev Med Public Health. 2013;46(5):291-291. Published online September 30, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.5.291; Corrects: J Prev Med Public Health 2013;46(2):105

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Erratum: Burden of Noncommunicable Diseases and National Strategies to Control Them in Korea: Young-Ho Khang; J Prev Med Public Health. 2013;46(5):292-292. Published online September 30, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.5.292; Corrects: J Prev Med Public Health 2013;46(4):155

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