Journal of Preventive Medicine and Public Health

Methods

Health Indicators Related to Disease, Death, and Reproduction: Jeoungbin Choi, Moran Ki, Ho Jang Kwon, Boyoung Park, Sanghyuk Bae, Chang-Mo Oh, Byung Chul Chun, Gyung-Jae Oh, Young Hoon Lee, Tae-Yong Lee, Hae Kwan Cheong, Bo Youl Choi, Jung Han Park, Sue K. Park; J Prev Med Public Health. 2019;52(1):14-20. Published online January 23, 2019; DOI: https://doi.org/10.3961/jpmph.18.250

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Abstract Summary PDF Supplementary Material

One of the primary goals of epidemiology is to quantify various aspects of a population’s health, illness, and death status and the determinants (or risk factors) thereof by calculating health indicators that measure the magnitudes of various conditions. There has been some confusion regarding health indicators, with discrepancies in usage among organizations such as the World Health Organization the, Centers for Disease Control and Prevention (CDC), and the CDC of other countries, and the usage of the relevant terminology may vary across papers. Therefore, in this review, we would like to propose appropriate terminological definitions for health indicators based on the most commonly used meanings and/or the terms used by official agencies, in order to bring clarity to this area of confusion. We have used appropriate examples to make each health indicator easy for the reader to understand. We have included practical exercises for some health indicators to help readers understand the underlying concepts.

Summary

Korean summary
본 논문에서는 질병과 사망, 출생 관련 지표들의 개념과 종류를 설명하고, 특히 연구자들이 흔히 혼동하여 사용하는 지표들에 대한 적절한 정의를 제시하였다. 또한 지표들의 예시를 부록으로 수록하여 독자들이 지표의 개념을 보다 쉽게 습득하도록 돕고자 하였다.

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Correspondence

Author Response: The Increasing Hepatitis A Incidence in Korea: Is It Possible Within a Limited Time?: Joo Youn Seo, Moran Ki, Bo Youl Choi; J Prev Med Public Health. 2012;45(5):331-332. Published online September 28, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.5.331

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PDF: Summary

Original Article

Pattern of Hepatitis A Incidence According to Area Characteristics Using National Health Insurance Data: Joo Youn Seo, Jae Hee Seo, Myoung Hee Kim, Moran Ki, Hee Suk Park, Bo Youl Choi; J Prev Med Public Health. 2012;45(3):164-173. Published online May 31, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.3.164

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Abstract PDF

Objectives

Over the past several years, the incidence of hepatitis A infection has been increasing rapidly in the young-adult population in Korea. We examined the effects of area-level socioeconomic status and environmental hygiene on the incidence of hepatitis A.

Methods

This study is based on the registered national population of Korea and the national health insurance data from 2004 to 2008. A total of 73 459 individuals were confirmed to have had hepatitis A. The standardized incidences of hepatitis A in 232 districts adjusted for sex and age of people were calculated for each year, and the rate ratios of the incidence rates were estimated according to area-level socioeconomic status and environmental hygiene using multiple Poisson regression models.

Results

The incidence rates of hepatitis A infection were 15.6 (per 100 000) in 2004, 19.0 (per 100 000) in 2005, 27.2 (per 100 000) in 2006, 25.1 (per 100 000) in 2007, and 61.7 (per 100 000) in 2008. The analysis of the area-level effects showed that residential areas of the less deprived than other regions, areas with higher levels of education, and heavily populated areas were significantly associated with increased risk.

Conclusions

There is a very strong possibility that both area-level socioeconomic status and environmental hygiene play a role in increasing the risk of hepatitis A infection in Korea. Therefore, to reduce hepatitis A infection, we need a nationwide strategy that considers these area-level characteristics.

Summary

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English Abstract

Mumps Transmission Control Status and Inapparent Infection Rate among Middle and High School Students during the 2007-2008 Mumps Outbreak in Daegu.: Kyo Hyun Kim, Chang Hwi Kim, Bo Youl Choi, Un Yeong Go, Dong Han Lee, Moran Ki; J Prev Med Public Health. 2009;42(6):408-415.; DOI: https://doi.org/10.3961/jpmph.2009.42.6.408

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Abstract PDF

OBJECTIVES
This study was performed to investigate the mumps transmission control status and inapparent infection rate among middle and high school students in Daegu City during a mumps outbreak. METHODS: Nine schools (two middle schools and seven high schools), which reported a number of mumps cases between 2007 and 2008 were selected for investigation. During March-May 2008, a standard questionnaire was distributed to gather information about case identification, instructed isolation measure, isolation status of mumps cases and related factors, and outdoor activities of non-isolated mumps case. Inapparent infection rate was estimated by serum mumps IgM and IgG antibodies status and self-reported mumps symptoms in three of the nine schools. RESULTS: Among 2,560 respondents, more than half of students answered that they did not receive instructions in mumps transmission control measures during the outbreak. Among the 327 mumps cases identified by the questionnaire, 131 cases (40.1%) were considered as isolated and the isolation rates were significantly different among schools, grades, and gender. Of the non-isolated cases, 88.3% continued attending school. Inapparent mumps infection rates were between 56.3% and 70.2%. CONCLUSIONS: Mumps transmission control was inadequate to control the mumps outbreak. Although high inapparent infection rate would mitigate the transmission control effect of case isolation, this measure is fundamental for infection control. The reasons of this inadequate status need to be explored to develop an effective intervention strategy.

Summary

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Original Articles

Assessment of the Availability of Health Insurance Data for Epidemiologic Study of Childhood Aseptic Meningitis.: Sue Kyung Park, Hae Kwan Cheong, Moran Ki, Young Mo Son, Ho Kim; Korean J Prev Med. 2003;36(4):349-358.

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Abstract PDF: OBJECTIVES
Aseptic meningitis is a major cause of Korean childhood morbidity late spring and early summer. However, the nationwide incidences of the disease have not been reported. This study was conducted to evaluate the availability of National Health Insurance data (NHID) for the study of an epidemiological trend in the surveillance of aseptic meningitis in children. METHODS: All the claims, under A87, A87.8, and A87.9 by ICD-10, among children below 15 years of age, to the National Health Insurance Corporation, between January and December 1998, were extracted. A survey of the medical record of 3, 874 cases from 136 general hospitals was performed. The availability of the NHID was evaluated by the three following methods: 1) The diagnostic accuracy (the positive predictive value = proportion of the confirmed aseptic meningitis among the subjects registered as above disease-codes in NHID) was evaluated through a chart review, and according to age, gender, month and region of disease-occurrence. 2) The distribution of confirmed cases was compared with the distribution of total subjects from the NHID, for subjects in General hospitals, or the subjects surveyed. 3) The proportion of confirmed CSF test was confirmed, and the relating factor, which was the difference in CSF-test rate, analyzed. RESULTS: Among 3, 874 cases, CSF examinations were performed on 1, 845 (47.6%), and the CSF-test rates were different according to the medical utility (admission vs. OPD visit) and the severity of the symptoms and signs. The diagnostic accuracy for aseptic meningitis, and during the epidemic (May-Aug) and sporadic (Sept-Apr) periods, were 85.0 (1, 568/1, 845), 86.0 (1, 239/1, 440) and 81.2% (329/405), respectively. The distributions by age, sex, month or period (epidemic/sporadic) and region, in the confirmed cases, were similar to those in the NHID, in both the subjects at General hospitals and in those surveyed, to within +/-7%. CONCLUSIONS: In this paper, the NHID for the subjects registered with an aseptic meningitis disease-code might be available for an epidemiological study on the incidence-estimation of childhood aseptic meningitis, as the NHID could include both the probable and definite cases. On the basis of this result, further studies of time-series and secular trend analyses, using the NHID, will be performed.; Summary

An Epidemiologic Investigation on Mumps Outbreak in Cheju-do, 1998.: Myounghee Kim, Moran Ki, Youngjoo Hur, Boyoul Choi; Korean J Prev Med. 2001;34(1):89-99.

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Abstract PDF: OBJECTIVES
To describe the characteristics of a mumps epidemic in Cheju-do, 1998 and to identify the risk factors associated with mumps infection. METHODS: To estimate attack rate, previously collected data from the Nationally Notifiable Communicable Disease Reporting System and School Health Reporting System, temporarily administered by Division of Education, as well as additional surveillance data were used. In order to identify the clinical characteristics and risk factors associated with mumps, we conducted a questionnaire survey in 17 schools (9 elementary, 4 middle, and 4 high schools) among a population that included healthy students. RESULTS: From March 3 to August 31, 2,195 cases of mumps were identified, and patients under 20 years of age accounted for 2,162 cases (attack rate 13.2, 95% CI 12.6-13.7/1,000). The attack rate for the population under 20 years of age was the highest in Nam county (44.7/1,000), and in the 7-12 years old sub-group(>20.0/1,000). There was no sexual difference. 80.9% and 59.7% of patients presented periauricular and submandibular swelling respectively. Aseptic meningitis was a complication in 2.9% of cases, orchitis in 1.3%, epididymitis in 0.9% and oophoritis in 0.6% respectively. The overall MMR vaccination rate was 59.1% and it decreased in accordance with increasing age. In students aged 10 years old or below, household contact and MMR vaccination status was significantly associated with infection, and only among students with household contact, the risk of one dose MMR(OR=10.22, 95% CI 2.92-35.78) and non-vaccination (OR=11.62, 95% CI 1.96-68.96) was significantly greater when compared with that of two dose vaccination. Among students aged 11 years old or above, household contact history was significantly associated and MMR vaccination status was not associated. CONCLUSIONS: Low vaccination rate and vaccine failure were thought to predispose the population for this large outbreak. To prevent sustained mumps outbreaks, a second MMR vaccination should be encouraged and catch up vaccinations should be given to elderly children who remain susceptible.; Summary

Lipid Profiles and Related Factors in Adolescent.: Moran Ki, Boyoul Choi, Mi Kyung Kim, Ki Rang Kim, Jin Nu Fang, Yun Ju Kang; Korean J Prev Med. 2000;33(1):83-90.

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Abstract PDF: OBJECTIVES
To assess the prevalence rate of dyslipidemia and the level of related factors in adolescents groups in Seoul and Yangpyong area. METHODS: Design; School based survey during May-Jun 1996 in Seoul and Yangpyong county. Subject; 2,453 boys and girls, aged 13 to 19 years; 1,137 Seoul and 1,316 Yangpyong county. Main Outcome Measures; Prevalence rates of raised serum total cholesterol, triglycerides, LDL-cholesterol, decreased HDL-cholesterol, obesity, and levels of energy intake and expenditure RESULTS: Energy intake and fat intake of boys were higher than those of girls and they were higher in Seoul. Energy expenditure per day of boys was bigger than that of girls too. Prevalence rate of obesity was higher in boys of Seoul(15.2%) and girls in Yangpyong county(14.0%). Serum lipid profiles(total cholesterol, triglycerides, LDL-cholesterol) were higher among girls and all prevalence rates of dyslipidemia were higher in boys in Seoul and in girls in Yangpyong county. Especially, girls(29.1%) in Yangpyong had raised serum cholesterol level(> or =170 mg/dl). In contrast, boys in Seoul had higher level of decreased HDL-cholesterol(46.8%) compared to Yangpyong(23.6%). The relationships between serum lipid profiles and relative weights and sex are highly significant. And the relationship between triglycerides and energy intake is significant(p=0.038). But, the associations between serum lipid profiles and energy expenditure had borderline significances. CONCLUSIONS: Hypercholesterolemia rates in girls were higher. Obesity prevalence rate was highest in boys of Seoul. Relative weight and sex are significantly related to lipid profiles. Therefore, Korea is in need of preventive strategies for different obesity and gender groups.; Summary

Relationship between Adolescent Obesity and Socioeconomic Status of Parents: In Seoul, Yangpyong, and Yanbian Area.: Moran Ki, Bo Youl Choi, Mi Kyoung Kim, Jin Nu Fang, Chun Ying Xu, Dong Hyon Ahn, Yun Ju Kang; Korean J Prev Med. 1999;32(1):9-16.

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Abstract PDF: OBJECTIVES
Few studies have attempted to explain the association between socioeconomic status (SES) and obesity in Korea. Especially the studies on same race with different SES at same time are good for SES influence estimation. The present study highlights the influence of SES of parents on adolescent obesity. The subjects are the same race, but live in different areas, with different SES, Seoul and Yangpung in Korea, and Yanbian in China. METHODS: The cross-sectional study was conducted in Mar-Jun 1996. We carried out anthropometry, 24 hour-recall diet survey, self-reported questionnaire about sociodemographic characteristics and physical activity. For SES indicators, we used income and education of parents. RESULTS: The relationship between SES of parents, defined as educational status, and obesity in boys in Korea and China is direct, but not significant. The relationship is inverse and non-significant among Korean girls. However, for the Korean girls in severe obesity, the relationship is significant. For the Korean-Chinese girls, there is an inverse relationship between the education level and obesity but a direct relationship between the income level of parents and obesity. For the Korean adolescent, there are a direct association between the SES of parents and the nutrients factors such as energy, protein, and fat intake. The energy expenditure of adolescent has no relationship with SES of parents. CONCLUSION: Among boys, the higher the SES, the greater the risk of obese. Among girls in Korea and Korean-Chinese, on the other hand, the lower the educational status of parents, the greater the risk of obese.; Summary

A Seroepidemiologic Study on Rubella Antibody in Pregnant Women in Kyonggi Do.: Moran Ki, Boyoul Choi, Young Jeon Shin, Hung Bae Park, Bae Joong Youn, Joong Surk Hahn; Korean J Prev Med. 1997;30(2):279-292.

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Abstract PDF: The vaccinations of susceptible children and postpubertal females are the major means to prevent congenital rubella syndrome(CRS). Another means for reducing the CRS is therapeutic abortion or fetal monitoring for women who are infected in the first four months of pregnancy. We couldnt estimate the incidence of CRS in Korea, because there was no surveillance system for rubella and CRS. Nationwide vaccination program for 15months infant had been started early 1980s. So, most women at childbearing age during study period were not received rubella vaccination. We set forth CRS management system for pregnant women in two rural county of Kyonggi province, Korea. In this system, the presence of rubella IgG and IgM antibodies for early pregnant women were examined with MEIA(Microparticle Enzyme Immunoassay) method by IMx automated analyzer Abbott. The infected pregnant women followed up in order to confirm their children CRS. This study was carried out from Mar.1993 to Jun.1994, and pregnant women examined were 874 persons. The results were summarized as follows. The overall positive rate of rubella IgG antibody was 94.5%(826/874). The positive rate was significantly increase as the age increased, and reached 100% in pregnant women who were over 35 years old. This results suggest that a meaningful number of women are infected during childbearing years. The geometric mean titer of IgG of sero-positive subjects was significantly declined as the age increased. On the question about history of URI symptoms and rash in pregnancy, 20.7% of respondents checked on URI symptoms with rash, 13.5% only URI symptoms without rash, and 65.8% no symptoms. However there was no demonstrable association between the rubella like infection history in pregnancy and the rubella IgG and IgM antibody status. Rubella infection rate in pregnant women was 0.9%(95% CI 0.4-1.8%). Two of these 8 infected pregnancies were terminated by therapeutic abortion. One of them was not followed. Five babies had no gross anomalies at birth. In Dec.1996, three of five babies were normal appeared infants. Two of them were not followed. Throughout this study results, we confirmed the need of CRS management system for pregnant women, in Korea.; Summary

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