Journal of Preventive Medicine and Public Health

Original Articles

Frailty Index Predicts Future All-cause Mortality and Quality of Life: A 2-Year Follow-up Study Among Korean Older Adults From a Population-based Cohort Study: Woolim Ko, Hyunsuk Jeong, Hyeon Woo Yim; J Prev Med Public Health. 2025;58(6):572-580. Published online November 10, 2025; DOI: https://doi.org/10.3961/jpmph.25.210

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Abstract Summary PDF Supplementary Material: Objectives
The frailty index (FI), a proxy measure of accelerated biological aging, predicts adverse outcomes in older adults. We investigated whether the FI predicts mortality in a community-based Korean older adult population and its association with subjective health status over 2 years.
Methods
This prospective cohort study included 936 community-dwelling individuals aged ≥60 years. The FI, calculated from 28 self-reported baseline variables, was scored on a scale from 0 to 1 (<0.25: non-frail; 0.25-0.34: mildly frail; ≥0.35: moderately to severely frail). The primary outcome was 2-year all-cause mortality. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated. Quality of life was assessed using the European Quality of Life Five-Dimension Three-Level (EQ-5D-3L), with the proportions reporting extreme problems and prevalence ratios of problems across frailty groups. Analyses were conducted using the GENMOD procedure in SAS version 9.4.
Results
Of the 936 participants, 111 (11.9%) were non-frail, 230 (24.6%) were mildly frail, and 595 (63.6%) were moderately to severely frail. The prevalence of moderate to severe frailty increased with age. The moderate-severe frailty group had a ≥5-fold increased risk of mortality compared to the non-frail group (adjusted RR, 5.79; 95% CI, 1.39 to 24.07). Among those completing follow-up, the moderate-severe frailty group reported more problems across all EQ-5D-3L domains at 2 years.
Conclusions
Frail older adults are at increased risk of mortality, but this risk was significant only for those in the moderate-to-severe frailty category at 2-year follow-up. The FI is a valuable predictor of premature death and health challenges in older adults.; Summary

Korean summary
2년의 추적 관찰 기간 동안, 기저 시점의 중등도에서 중증의 노쇠 상태에 있던 노인은 노쇠하지 않은 노인에 비해 사망 위험이 5배 이상 높았으며, EQ-5D-3L로 평가한 다양한 삶의 질 영역에서도 더 큰 어려움을 겪는 것으로 나타났다. 이러한 결과는 특히 중등도에서 중증의 노쇠 상태가 임상적 위험뿐만 아니라 주관적 삶의 질을 개선하기 위한 우선적 개입이 필요할 수 있음을 시사한다. 본 연구는 노인의 건강 결과를 향상시키기 위해서는 개별 질환 관리뿐 아니라 노쇠 상태를 체계적으로 평가하고 관리하는 것이 중요함을 제안한다.

Key Message
During the two-year follow-up period, older adults who were moderately to severely frail at baseline had a more than fivefold higher risk of death compared with those who were non-frail, and they also experienced greater difficulties across various quality-of-life domains as measured by the EQ-5D-3L. These findings suggest that moderate to severe frailty may require high-priority interventions to improve not only clinical risks but also subjective quality of life. This study indicates that, to improve health outcomes in older adults, it is important to systematically assess and manage frailty in addition to addressing individual diseases.

Smoking-attributable Mortality in Korea, 2020: A Meta-analysis of 4 Databases: Eunsil Cheon, Yeun Soo Yang, Suyoung Jo, Jieun Hwang, Keum Ji Jung, Sunmi Lee, Seong Yong Park, Kyoungin Na, Soyeon Kim, Sun Ha Jee, Sung-il Cho; J Prev Med Public Health. 2024;57(4):327-338. Published online July 3, 2024; DOI: https://doi.org/10.3961/jpmph.23.471

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Abstract Summary PDF Supplementary Material

Objectives
Estimating the number of deaths caused by smoking is crucial for developing and evaluating tobacco control and smoking cessation policies. This study aimed to determine smoking-attributable mortality (SAM) in Korea in 2020.
Methods
Four large-scale cohorts from Korea were analyzed. A Cox proportional-hazards model was used to determine the hazard ratios (HRs) of smoking-related death. By conducting a meta-analysis of these HRs, the pooled HRs of smoking-related death for 41 diseases were estimated. Population-attributable fractions (PAFs) were calculated based on the smoking prevalence for 1995 in conjunction with the pooled HRs. Subsequently, SAM was derived using the PAF and the number of deaths recorded for each disease in 2020.
Results
The pooled HR for all-cause mortality attributable to smoking was 1.73 for current men smokers (95% confidence interval [CI], 1.53 to 1.95) and 1.63 for current women smokers (95% CI, 1.37 to 1.94). Smoking accounted for 33.2% of all-cause deaths in men and 4.6% in women. Additionally, it was a factor in 71.8% of men lung cancer deaths and 11.9% of women lung cancer deaths. In 2020, smoking was responsible for 53 930 men deaths and 6283 women deaths, totaling 60 213 deaths.
Conclusions
Cigarette smoking was responsible for a significant number of deaths in Korea in 2020. Monitoring the impact and societal burden of smoking is essential for effective tobacco control and harm prevention policies.

Summary

Korean summary
한국의 흡연율은 상당 수준 감소하였지만 흡연의 장기적인 건강영향은 지속적으로 나타나고 있다. 4개의 대규모 코호트와 1995년 흡연율을 사용하여 2020년 한국의 흡연기인 사망자수를 산출한 결과 남성 53,930명, 여성 6283명으로 총 60,213명이였다. 효과적인 담배규제와 금연 정책을 위하여 장기적인 사망자수 모니터링이 필요할 것이다.

Key Message
Despite the significant decrease in smoking rates in South Korea, the long-term health effects of smoking continue to manifest. Our analysis using four large-scale cohorts and 1995 smoking prevalence revealed that in 2020, the number of smoking-attributable death in South Korea was 53,930 for men and 6,283 for women, totaling 60,213. Long-term monitoring is necessary for effective tobacco control and smoking cessation policies.

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Risk of all-cause mortality by various cigarette smoking indices: A longitudinal study using the Korea National Health Examination Baseline Cohort in South Korea
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Special Article

Cohort Study Protocol: A Cohort of Korean Atomic Bomb Survivors and Their Offspring: Seong-geun Moon, Ansun Jeong, Yunji Han, Jin-Wu Nam, Mi Kyung Kim, Inah Kim, Yu-Mi Kim, Boyoung Park; J Prev Med Public Health. 2023;56(1):1-11. Published online January 31, 2023; DOI: https://doi.org/10.3961/jpmph.22.469

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Abstract Summary PDF Supplementary Material

In 1945, atomic bombs were dropped on Hiroshima and Nagasaki. Approximately 70 000 Koreans are estimated to have been exposed to radiation from atomic bombs at that time. After Korea’s Liberation Day, approximately 23 000 of these people returned to Korea. To investigate the long-term health and hereditary effects of atomic bomb exposure on the offspring, cohort studies have been conducted on atomic bomb survivors in Japan. This study is an ongoing cohort study to determine the health status of Korean atomic bomb survivors and investigate whether any health effects were inherited by their offspring. Atomic bomb survivors are defined by the Special Act On the Support for Korean Atomic Bomb Victims, and their offspring are identified by participating atomic bomb survivors. As of 2024, we plan to recruit 1500 atomic bomb survivors and their offspring, including 200 trios with more than 300 people. Questionnaires regarding socio-demographic factors, health behaviors, past medical history, laboratory tests, and pedigree information comprise the data collected to minimize survival bias. For the 200 trios, whole-genome analysis is planned to identify de novo mutations in atomic bomb survivors and to compare the prevalence of de novo mutations with trios in the general population. Active follow-up based on telephone surveys and passive follow-up with linkage to the Korean Red Cross, National Health Insurance Service, death registry, and Korea Central Cancer Registry data are ongoing. By combining pedigree information with the findings of trio-based whole-genome analysis, the results will elucidate the hereditary health effects of atomic bomb exposure.

Summary

Korean summary
해당 연구는 한국인 원폭피해 생존자 및 그 후손에서 피폭이 건강에 미치는 영향과 그것의 유전적 영향 유무를 밝히고자 계획된 연구이다. 이 연구는 연구대상자들에 대한 건강 설문 조사, 신체계측, 가계도 조사, 유전체 조사 뿐 아니라 2차 자료 연계를 통해 폭넓고 정확한 건강 정보를 수집하고 있다. 이 연구를 통해 연구대상자들의 건강 상태 파악 및 개선에 도움이 되고자 한다.

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Intergenerational effects of ionizing radiation: review of recent studies from human data (2018–2021)
A. Amrenova, C. Baudin, E. Ostroumova, J. Stephens, R. Anderson, D. Laurier
International Journal of Radiation Biology.2024; 100(9): 1253. CrossRef
Cohort study profile: a cohort of Korean atomic bomb survivors and their offspring
Hamin Lee, Jin-Wu Nam, Mi Kyung Kim, Inah Kim, Yu-Mi Kim, Boyoung Park
Epidemiology and Health.2024; 46: e2024089. CrossRef
Validation of self-reported morbidities in the Korean Atomic Bomb Survivor Cohort
Ansun Jeong, Somin Jeon, Seong-geun Moon, Mi Kyung Kim, Inah Kim, Yu-Mi Kim, Boyoung Park
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Original Article

The Korea Cohort Consortium: The Future of Pooling Cohort Studies: Sangjun Lee, Kwang-Pil Ko, Jung Eun Lee, Inah Kim, Sun Ha Jee, Aesun Shin, Sun-Seog Kweon, Min-Ho Shin, Sangmin Park, Seungho Ryu, Sun Young Yang, Seung Ho Choi, Jeongseon Kim, Sang-Wook Yi, Daehee Kang, Keun-Young Yoo, Sue K. Park; J Prev Med Public Health. 2022;55(5):464-474. Published online September 12, 2022; DOI: https://doi.org/10.3961/jpmph.22.299

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Abstract Summary PDF Supplementary Material

Objectives
We introduced the cohort studies included in the Korea Cohort Consortium (KCC), focusing on large-scale cohort studies established in Korea with a prolonged follow-up period. Moreover, we also provided projections of the follow-up and estimates of the sample size that would be necessary for big-data analyses based on pooling established cohort studies, including population-based genomic studies.
Methods
We mainly focused on the characteristics of individual cohort studies from the KCC. We developed “PROFAN”, a Shiny application for projecting the follow-up period to achieve a certain number of cases when pooling established cohort studies. As examples, we projected the follow-up periods for 5000 cases of gastric cancer, 2500 cases of prostate and breast cancer, and 500 cases of non-Hodgkin lymphoma. The sample sizes for sequencing-based analyses based on a 1:1 case-control study were also calculated.
Results
The KCC consisted of 8 individual cohort studies, of which 3 were community-based and 5 were health screening-based cohorts. The population-based cohort studies were mainly organized by Korean government agencies and research institutes. The projected follow-up period was at least 10 years to achieve 5000 cases based on a cohort of 0.5 million participants. The mean of the minimum to maximum sample sizes for performing sequencing analyses was 5917-72 102.
Conclusions
We propose an approach to establish a large-scale consortium based on the standardization and harmonization of existing cohort studies to obtain adequate statistical power with a sufficient sample size to analyze high-risk groups or rare cancer subtypes.

Summary

Korean summary
한국 코호트 컨소시엄(KCC)은 “2015년 한국의 생활 습관 및 환경 요인에 따른 암 기여분율” 프로젝트의 3단계 과업으로써, 본 프로젝트에 참여한 기존의 구축된 개인 코호트 연구의 연구자들을 주도로 다수의 대규모 한국 코호트 연구를 기반으로 구성되었다. 따라서 본 연구는 KCC에 포함된 한국 코호트 연구를 소개하는 것을 목표로 하였다. 또한 여러 기 확립된 국제 컨소시엄을 기반으로 빅데이터 기반 코호트 풀링 연구의 중요성을 제시하였다.

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Special Articles

The KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD): A Korean Chronic Kidney Disease Cohort: Kook-Hwan Oh, Sue K. Park, Jayoun Kim, Curie Ahn; J Prev Med Public Health. 2022;55(4):313-320. Published online July 1, 2022; DOI: https://doi.org/10.3961/jpmph.22.031

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Abstract Summary PDF Supplementary Material

The KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) was launched in 2011 with the support of the Korea Disease Control and Prevention Agency. The study was designed with the aim of exploring the various clinical features and characteristics of chronic kidney disease (CKD) in Koreans, and elucidating the risk factors for CKD progression and adverse outcomes of CKD. For the cohort study, nephrologists at 9 tertiary university-affiliated hospitals participated in patient recruitment and follow-up. Biostatisticians and epidemiologists also participated in the basic design and structuring of the study. From 2011 until 2016, the KNOW-CKD Phase I recruited 2238 adult patients with CKD from stages G1 to G5, who were not receiving renal replacement therapy. The KNOW-CKD Phase II recruitment was started in 2019, with an enrollment target of 1500 subjects, focused on diabetic nephropathy and hypertensive kidney diseases in patients with reduced kidney function who are presumed to be at a higher risk of adverse outcomes. As of 2021, the KNOW-CKD investigators have published articles in the fields of socioeconomics, quality of life, nutrition, physical activity, renal progression, cardiovascular disease and outcomes, anemia, mineral bone disease, serum and urine biomarkers, and international and inter-ethnic comparisons. The KNOW-CKD researchers will elaborate a prediction model for various outcomes of CKD such as the development of end-stage kidney disease, major adverse cardiovascular events, and death.

Summary

Korean summary
KNOW-CKD 코호트 연구는 전국적 규모의 다기관 만성콩팥병 장기 추적 코호트 연구로서 2011년 질병관리청의 후원으로 시작된 연구이다. 이 연구는 우리나라 만성콩팥병의 임상적인 경과와 합병증, 신기능 악화 정도와 심혈관계 사건, 사망 등 주요 사건의 발생 위험 요인들을 규명하고자 기획되었다. 궁극적으로 KNOW-CKD 연구는 말기신부전으로의 진행과 사망, 심혈관계 주요 사건 등 만성콩팥병의 예후 예측 모델을 구축하는 것을 목표로 한다.

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Cohort Profile: Korean Tuberculosis and Post-Tuberculosis Cohort Constructed by Linking the Korean National Tuberculosis Surveillance System and National Health Information Database: Dawoon Jeong, Hee-Yeon Kang, Jinsun Kim, Hyewon Lee, Bit-Na Yoo, Hee-Sun Kim, Hongjo Choi; J Prev Med Public Health. 2022;55(3):253-262. Published online April 22, 2022; DOI: https://doi.org/10.3961/jpmph.21.635

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We aimed to review the current data composition of the Korean Tuberculosis and Post-Tuberculosis Cohort, which was constructed by linking the Korean Tuberculosis Surveillance System (KNTSS; established and operated by the Korean Disease Control and Prevention Agency since 2000) and the National Health Information Database (NHID; established by the National Health Insurance Service in 2012). The following data were linked: KNTSS data pertaining to patients diagnosed with tuberculosis between 2011 and 2018, NHID data of patients with a history of tuberculosis and related diseases between 2006 and 2018, and data (obtained from the Statistics Korea database) on causes of death. Data from 300 117 tuberculosis patients (177 206 men and 122 911 women) were linked. The rate of treatment success for new cases was highest in 2015 (86.7%), with a gradual decrease thereafter. The treatment success rate for previously treated cases showed an increasing trend until 2014 (79.0%) and decreased thereafter. In total, 53 906 deaths were confirmed among tuberculosis patients included in the cohort. The Korean Tuberculosis and Post-Tuberculosis Cohort can be used to analyze different measurement variables in an integrated manner depending on the data source. Therefore, these cohort data can be used in future epidemiological studies and research on policy-effect analysis, treatment outcome analysis, and health-related behaviors such as treatment discontinuation.

Summary

Korean summary
TB Post 코호트(Korean Tuberculosis and Post-Tuberculosis Cohort)는 한국의 결핵 모니터링 및 관리에 대한 인구집단 수준에서의 새로운 근거를 마련하고자 구축한 우리나라 결핵 환자 코호트입니다. 국가 결핵감시체계의 일환으로 구축된 질병관리청의 결핵신고자료와 국민건강보험공단의 국민건강정보DB 자료, 통계청 사망원인 자료의 연계로 구축되었으며, 각 자료원이 보유한 정보를 활용하여 통합적인 결핵 환자 연구가 가능할 것으로 기대하고 있습니다. 결핵의 정책 효과 연구뿐만 아니라, 치료 성공, 실패, 중단 등 치료결과에 대한 영향 요인 및 환자들의 건강 관련 행태에 대한 역학 연구 등 향후 다양한 연구에 활용될 수 있을 것으로 기대됩니다.

Citations

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ANÁLISE ESPACIAL DOS CASOS DE TUBERCULOSE EM UM ESTADO DA AMAZÔNIA OCIDENTAL BRASILEIRA: ESTUDO CLÍNICO-EPIDEMIOLÓGICO
Waleska Thicyara Cândida dos Santos, Mário Sérgio Monteiro Fonseca
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Brief Report

Reliability and Validity of a Life Course Passive Smoke Exposure Questionnaire in an Australian Cohort From Childhood to Adulthood: Chigozie Ezegbe, Costan G. Magnussen, Amanda Louise Neil, Marie-Jeanne Buscot, Terence Dwyer, Alison Venn, Seana Gall; J Prev Med Public Health. 2021;54(2):153-159. Published online March 10, 2021; DOI: https://doi.org/10.3961/jpmph.20.559

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Abstract PDF Supplementary Material

Objectives
Life course exposure to passive smoke may predict health, but there are few validated measures. We tested the reliability and validity of a retrospective life course passive smoking questionnaire.
Methods
Participants from the third follow-up of the Childhood Determinants of Adult Health study (2014-2019, ages 36-49 years) retrospectively reported mother/father/other household member smoking when living at home during childhood, including duration (years) and smoking location (never/sometimes/always inside house). The severity of exposure index (SEI; sum of mother/father/other years smoked multiplied by smoking location), cumulative years of exposure (CYE; sum of mother/father/other years), and total household smokers (THS) were derived. The reliability of retrospective passive smoking reports was examined with intraclass correlation coefficients (ICCs) using household smoking reported 34 years earlier in 1985 by participants when aged 7-15 years. Construct validity was examined by correlating retrospective passive smoking with participants’ smoking in adulthood and lung function in childhood and adulthood.
Results
Among 2082 participants (mean±standard deviation [SD], 45.0±2.5 years; 55.2% females), THS ranged from 0 to 5 (mean± SD, 0.9±1.0), CYE ranged from 0 to 106 (mean±SD, 10.5±13.9), and SEI ranged from 0 to 318 (mean±SD, 24.4±36.0). Retrospective measures showed moderate agreement with total household smokers reported in childhood (ICC, 0.58 to 0.62). The retrospective measures were weakly but significantly (p<0.05) correlated with participants’ smoking (r=0.13 to 0.15) and lung function (r= -0.05 to -0.06).
Conclusions
The retrospective passive smoking questionnaire showed reasonable reliability and validity. This measure may be useful for epidemiological studies.

Summary

Citations

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Childhood secondhand smoke exposure and respiratory disease mortality among never-smokers: the Japan collaborative cohort study for evaluation of cancer risk
Haruna Kawachi, Masayuki Teramoto, Isao Muraki, Kokoro Shirai, Kazumasa Yamagishi, Akiko Tamakoshi, Hiroyasu Iso
Journal of Public Health.2023; 45(3): 604. CrossRef

Original Articles

Associations Between Thyroid Hormone Levels and Urinary Concentrations of Bisphenol A, F, and S in 6-Year-old Children in Korea: Yoonyoung Jang, Yoon-Jung Choi, Youn-Hee Lim, Kyung-Shin Lee, Bung-Nyun Kim, Choong Ho Shin, Young Ah Lee, Johanna Inhyang Kim, Yun-Chul Hong; J Prev Med Public Health. 2021;54(1):37-45. Published online November 23, 2020; DOI: https://doi.org/10.3961/jpmph.20.310

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Abstract Summary PDF Supplementary Material

Objectives
Bisphenol A (BPA) is used in the electrical, mechanical, medical, and food industries. Previous studies have suggested that BPA is an endocrine disruptor. Regulation of BPA has led to increased use of bisphenol F (BPF) and bisphenol S (BPS). However, few studies have investigated the associations of BPF and BPS with thyroid dysfunction in children. Our study investigated the associations of prenatal BPA and early childhood BPA, BPF, and BPS exposure with thyroid function in 6-year-old children.
Methods
Prenatal BPA concentrations were measured during the second trimester of pregnancy in an established prospective birth cohort. We measured urinary BPA, BPF, and BPS concentrations and thyroid hormone levels (thyroid-stimulating hormone, total T₃, and free T₄) in 6-year-old children (n=574). We examined the associations between urinary bisphenol concentrations and percentage change of thyroid hormone concentrations using multivariate linear regression. We also compared thyroid hormone levels by dividing the cohort according to BPA, BPF, and BPS concentrations.
Results
The associations between prenatal BPA and total T₃ levels were statistically significant in all models, except for girls when using a crude model. The associations between urinary BPA and BPS concentrations and levels of all thyroid hormones were not statistically significant. However, we observed that lower free T₄ levels (-1.94%; 95% confidence interval, -3.82 to -0.03) were associated with higher urinary BPF concentrations in girls only.
Conclusions
Our findings identified significant associations between prenatal BPA exposure and total T₃ levels in all children and between BPF exposure and free T₄ levels in girls only.

Summary

Korean summary
비스페놀 A의 건강위해성에 대한 역학적 근거들이 축적되어 비스페놀 A 대신 BPF와 BPS와 같은 대체물질이 사용되고 있다. 본 논문에서는 어머니의 산전 비스페놀 A 노출과 6세 어린이의 비스페놀 A, 비스페놀 F, 비스페놀 S 노출 정도에 따라 어린이의 갑상선호르몬 농도에 어떠한 영향을 미치는가 보고자 하였다. 어머니의 산전 비스페놀 A 노출은 어린이의 total T3 농도에 유의하게 영향을 미쳤으며, 특히 여자아이에게서 비스페놀 F 노출이 한 단위 증가할수록 free T4 농도가 유의하게 감소하는 것을 관찰하였다. 본 논문의 의의는 비스페놀 F, S가 어린이의 갑상선기능에 어떠한 영향을 미치는지 역학적 근거를 제시하였다는 점이나, 인과적 연관성을 위해서는 시간적 선후관계를 고려한 더 많은 연구가 필요하다.

Citations

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Age-period-cohort Analysis of Healthy Lifestyle Behaviors Using the National Health and Nutrition Survey in Japan: Tasuku Okui; J Prev Med Public Health. 2020;53(6):409-418. Published online August 13, 2020; DOI: https://doi.org/10.3961/jpmph.20.159

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