Journal of Preventive Medicine and Public Health

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; : 1. CrossRef

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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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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The relationship between regional inequalities in the provision of emergency health services and other health services
Erkan Boğa
Medicine.2023; 102(45): e35930. CrossRef

Special Article

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.

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A Quasi-experimental Study on the Effect of Pre-entry Tuberculosis Screening for Immigrants on Treatment Outcomes in South Korea: A Difference-in-Differences Analysis
Sarah Yu, Dawoon Jeong, Hee-Yeon Kang, Young Ae Kang, Gyeong In Lee, Hongjo Choi
Journal of Epidemiology and Global Health.2024;[Epub] CrossRef
Relationship between metformin use and mortality in tuberculosis patients with diabetes: a nationwide cohort study
Eunki Chung, Dawoon Jeong, Jeongha Mok, Doosoo Jeon, Hee-Yeon Kang, Heejin Kim, Heesun Kim, Hongjo Choi, Young Ae Kang
The Korean Journal of Internal Medicine.2024; 39(2): 306. CrossRef
Sex differences in the impact of diabetes mellitus on tuberculosis recurrence: a retrospective national cohort study
Dararat Eksombatchai, Dawoon Jeong, Jeongha Mok, Doosoo Jeon, Hee-Yeon Kang, Hee Jin Kim, Hee-Sun Kim, Hongjo Choi, Young Ae Kang
International Journal of Infectious Diseases.2023; 127: 1. CrossRef
Nationwide Treatment Outcomes of Patients With Multidrug/Rifampin-Resistant Tuberculosis in Korea, 2011–2017: A Retrospective Cohort Study (Korean TB-POST)
Hongjo Choi, Jeongha Mok, Young Ae Kang, Dawoon Jeong, Hee-Yeon Kang, Hee Jin Kim, Hee-Sun Kim, Doosoo Jeon
Journal of Korean Medical Science.2023;[Epub] CrossRef
Prevalence and associated factors of diabetes mellitus among patients with tuberculosis in South Korea from 2011 to 2018: a nationwide cohort study
Dawoon Jeong, Jeongha Mok, Doosoo Jeon, Hee-Yeon Kang, Hee Jin Kim, Hee-Sun Kim, Jeong Mi Seo, Hongjo Choi, Young Ae Kang
BMJ Open.2023; 13(3): e069642. CrossRef
Impact of Anti-Tuberculosis Drug Use on Treatment Outcomes in Patients with Pulmonary Fluoroquinolone-Resistant Multidrug-Resistant Tuberculosis: A Nationwide Retrospective Cohort Study with Propensity Score Matching
Hongjo Choi, Dawoon Jeong, Young Ae Kang, Doosoo Jeon, Hee-Yeon Kang, Hee Jin Kim, Hee-Sun Kim, Jeongha Mok
Tuberculosis and Respiratory Diseases.2023; 86(3): 234. CrossRef
Retreatment after loss to follow-up reduces mortality in patients with multidrug/rifampicin-resistant tuberculosis
Hongjo Choi, Jeongha Mok, Young Ae Kang, Dawoon Jeong, Hee-Yeon Kang, Hee Jin Kim, Hee-Sun Kim, Doosoo Jeon
ERJ Open Research.2023; 9(4): 00135-2023. CrossRef
Association between diabetes mellitus and cause of death in patients with tuberculosis: A Korean nationwide cohort study
Se Hyun Kwak, Dawoon Jeong, Jeongha Mok, Doosoo Jeon, Hee-Yeon Kang, Hee Jin Kim, Hee-Sun Kim, Hongjo Choi, Young Ae Kang, Frederick Quinn
PLOS ONE.2023; 18(12): e0295556. CrossRef

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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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

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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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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.

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Relationship between bisphenol A and autoimmune thyroid disease in women of childbearing age
Ning Yuan, Jianbin Sun, Xin Zhao, Wei Li
Frontiers in Endocrinology.2024;[Epub] CrossRef
Temporal trends in risk of bisphenol A, benzophenone-3 and triclosan exposure among U.S. children and adolescents aged 6–19 years: Findings from the National Health and Nutrition Examination Survey 2005–2016
Ruiqiang Li, Wenqiang Zhan, Jingyi Ren, Fan Zhang, Xin Huang, Yuxia Ma
Environmental Research.2023; 216: 114474. CrossRef
A case-control study of urinary concentrations of bisphenol A, bisphenol F, and bisphenol S and the risk of papillary thyroid cancer
Lei Zhang, Jiahuai Zhang, Sai Fan, Yuxin Zhong, Jingguang Li, Yunfeng Zhao, Song Ni, Jiaying Liu, Yongning Wu
Chemosphere.2023; 312: 137162. CrossRef
Transient developmental exposure to low doses of bisphenol F negatively affects neurogliogenesis and olfactory behaviour in adult mice
Pieter Vancamp, Lucile Butruille, Anni Herranen, Anita Boelen, Jean-Baptiste Fini, Barbara A. Demeneix, Sylvie Remaud
Environment International.2023; 172: 107770. CrossRef
Risk Assessment of Bisphenol A in the Korean General Population
Myungsil Hwang, Seon-Joo Park, Hae-Jeung Lee
Applied Sciences.2023; 13(6): 3587. CrossRef
The Joint Effects of Bisphenols and Iodine Exposure on Thyroid during Pregnancy
Wei Lu, Zhuo Sun, Zhengyuan Wang, Mengying Qu, Zehuan Shi, Qi Song, Liping Shen, Shupeng Mai, Yuan Wang, Xinyu Hong, Jiajie Zang
Nutrients.2023; 15(15): 3422. CrossRef
Associations of exposure to bisphenol A and its substitutes with neurodevelopmental outcomes among infants at 12 months of age: A cross-sectional study
Zhuanning Xia, Cheng Lv, Yan Zhang, Rong Shi, Qi Lu, Ying Tian, Xiaoning Lei, Yu Gao
Chemosphere.2023; 341: 139973. CrossRef
Association of urinary bisphenols with thyroid function in the general population: a cross-sectional study of an industrial park in China
Yang Hu, Shiming Lai, Ying Li, Xiaodong Wu, Mingluan Xing, Xueqing Li, Dandan Xu, Yuan Chen, Jie Xiang, Ping Cheng, Xiaofeng Wang, Zhijian Chen, Hao Ding, Peiwei Xu, Xiaoming Lou
Environmental Science and Pollution Research.2023; 30(49): 107517. CrossRef
Associations of Urinary Bisphenol a, Bisphenol F, and Bisphenol S with the Risk of Papillary Thyroid Cancer: A Case-Control Study
Lei Zhang, Jiahuai Zhang, Sai Fan, Yuxin Zhong, Jingguang Li, Yunfeng Zhao, Song Ni, Jiaying Liu, Yong-Ning Wu
SSRN Electronic Journal .2022;[Epub] CrossRef
The Impact of Bisphenol A on Thyroid Function in Neonates and Children: A Systematic Review of the Literature
Diamanto Koutaki, George Paltoglou, Aikaterini Vourdoumpa, Evangelia Charmandari
Nutrients.2021; 14(1): 168. CrossRef

Relationship Between Non-alcoholic Fatty Liver Disease and Decreased Bone Mineral Density: A Retrospective Cohort Study in Korea: Jisun Sung, Seungho Ryu, Yun-Mi Song, Hae-Kwan Cheong; J Prev Med Public Health. 2020;53(5):342-352. Published online July 17, 2020; DOI: https://doi.org/10.3961/jpmph.20.089

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Abstract PDF

Objectives
The aim of this retrospective cohort study was to investigate whether non-alcoholic fatty liver disease (NAFLD) was associated with incident bone mineral density (BMD) decrease.
Methods
This study included 4536 subjects with normal BMD at baseline. NAFLD was defined as the presence of fatty liver on abdominal ultrasonography without significant alcohol consumption or other causes. Decreased BMD was defined as a diagnosis of osteopenia, osteoporosis, or BMD below the expected range for the patient’s age based on dual-energy X-ray absorptiometry. Cox proportional hazards models were used to estimate the hazard ratio of incident BMD decrease in subjects with or without NAFLD. Subgroup analyses were conducted according to the relevant factors.
Results
Across 13 354 person-years of total follow-up, decreased BMD was observed in 606 subjects, corresponding to an incidence of 45.4 cases per 1000 person-years (median follow-up duration, 2.1 years). In the model adjusted for age and sex, the hazard ratio was 0.65 (95% confidence interval, 0.51 to 0.82), and statistical significance disappeared after adjustment for body mass index (BMI) and cardiometabolic factors. In the subgroup analyses, NAFLD was associated with a lower risk of incident BMD decrease in females even after adjustment for confounders. The direction of the effect of NAFLD on the risk of BMD decrease changed depending on BMI category and body fat percentage, although the impact was statistically insignificant.
Conclusions
NAFLD had a significant protective effect on BMD in females. However, the effects may vary depending on BMI category or body fat percentage.

Summary

Citations

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Maria Eleni Chondrogianni, Ioannis Kyrou, Theodoros Androutsakos, Christina-Maria Flessa, Evangelos Menenakos, Kamaljit Kaur Chatha, Yekaterina Aranan, Athanasios G. Papavassiliou, Eva Kassi, Harpal S. Randeva
Frontiers in Endocrinology.2024;[Epub] CrossRef
Association between body fat and bone mineral density in Korean adults: a cohort study
Hyunjung Yoon, Eunju Sung, Jae-Heon Kang, Cheol-Hwan Kim, Hocheol Shin, Eunsol Yoo, Minyoung Kim, Mi Yeon Lee, Sujeong Shin
Scientific Reports.2023;[Epub] CrossRef
Liver fibrosis is associated with impaired bone mineralization and microstructure in obese individuals with non-alcoholic fatty liver disease
Ilaria Barchetta, Carla Lubrano, Flavia Agata Cimini, Sara Dule, Giulia Passarella, Arianna Dellanno, Alberto Di Biasio, Frida Leonetti, Gianfranco Silecchia, Andrea Lenzi, Maria Gisella Cavallo
Hepatology International.2023; 17(2): 357. CrossRef
Non-Alcoholic Fatty Liver Disease and Bone Tissue Metabolism: Current Findings and Future Perspectives
Oxana M. Drapkina, Anastasia Yu. Elkina, Anna F. Sheptulina, Anton R. Kiselev
International Journal of Molecular Sciences.2023; 24(9): 8445. CrossRef
Nonalcoholic Fatty Liver Disease Is Associated With Decreased Bone Mineral Density in Adults: A Systematic Review and Meta‐Analysis
Ying‐Hao Su, Kuo‐Liong Chien, Shu‐Hua Yang, Wei‐Tso Chia, Jen‐Hau Chen, Yen‐Ching Chen
Journal of Bone and Mineral Research.2023; 38(8): 1092. CrossRef
The National Consensus statement on the management of adult patients with non-alcoholic fatty liver disease and main comorbidities
Marina V. Maevskaya, Yulia V. Kotovskaya, Vladimir T. Ivashkin, Olga N. Tkacheva, Ekaterina A. Troshina, Marina V. Shestakova, Valeriy V. Breder, Natalia I. Geyvandova, Vladimir L. Doshchitsin, Ekaterina N. Dudinskaya, Ekaterina V. Ershova, Khava B. Kodzo
Terapevticheskii arkhiv.2022; 94(2): 216. CrossRef
Nonalcoholic fatty liver disease and osteoporosis: A potential association with therapeutic implications
Ilias D. Vachliotis, Athanasios D. Anastasilakis, Antonis Goulas, Dimitrios G. Goulis, Stergios A. Polyzos
Diabetes, Obesity and Metabolism.2022; 24(9): 1702. CrossRef
Hepatic fibrosis is associated with an increased rate of decline in bone mineral density in men with nonalcoholic fatty liver disease
Ji Won Yoon, Min Joo Kim, Goh-Eun Chung, Jong In Yang, Jeong Yoon Yim, Jin Ju Kim, Sun Mie Kim, Min-Sun Kwak
Hepatology International.2021; 15(6): 1347. CrossRef
NAFLD Associated Comorbidity
L. B. Lazebnik, S. V. Turkina
Experimental and Clinical Gastroenterology.2021; (10): 5. CrossRef

Blood Pressure and the Risk of Death From Non-cardiovascular Diseases: A Population-based Cohort Study of Korean Adults: Jeoungbin Choi, Jieun Jang, Yoonsuk An, Sue K. Park; J Prev Med Public Health. 2018;51(6):298-309. Published online November 14, 2018; DOI: https://doi.org/10.3961/jpmph.18.212

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Abstract Summary PDF Supplementary Material

Objectives
The objective of this study was to assess the relationship between systolic and diastolic blood pressure (SBP, DBP) and the risk of death from specific causes other than cardiovascular diseases.
Methods
We calculated the risk of specific death by SBP and DBP categories for 506 508 health examinees in 2002-2003 using hazard ratios (HRs) and 95% confidence intervals (CIs) in a Cox proportional hazards model.
Results
Compared to normal levels (SBP <120 or DBP <90 mmHg), stage I systolic and diastolic hypertension (SBP 140-159, DBP 85- 89 mmHg, respectively) were associated with an increased risk of death from diabetes mellitus, alcoholic liver disease, and renal failure (HR, 1.83; 95% CI, 1.51 to 2.22; HR, 1.24; 95% CI, 1.06 to 1.46; HR, 2.30; 95% CI, 1.64 to 3.21; HR, 1.67; 95% CI, 1.27 to 2.20; HR, 1.99; 95% CI, 1.41 to 2.81; HR, 1.31; 95% CI, 0.99 to 1.73, respectively), but a decreased risk of death from intestinal pneumonia (HR, 0.64; 95% CI, 0.42 to 0.98; HR, 0.59; 95% CI, 0.39 to 0.91). Only stage II systolic hypertension (SBP ≥160 mmHg) was associated with an increased risk of death from pneumonia, liver cirrhosis, and intestinal ischemia (HR, 1.54; 95% CI, 1.19 to 1.98; HR, 1.46; 95% CI, 1.00 to 2.15; HR, 3.77; 95% CI, 1.24 to 11.40, respectively), and stage I and II diastolic hypertension (SBP 140-159 and ≥160 mmHg) were associated with an increased risk of death from intestinal ischemia (HR, 3.07; 95% CI, 1.27 to 7.38; HR, 4.39; 95% CI, 1.62 to 11.88, respectively).
Conclusions
An increase in blood pressure levels may alter the risk of death from certain causes other than cardiovascular diseases, a well-known outcome of hypertension, although the mechanism of these associations is not well documented.

Summary

Korean summary
2002년 및 2003년 한국 국민건강보험공단 건강검진 수검자 코호트(NHIS-HEALS) 중 506,508명을 대상으로 2013년 말일까지의 통계청 사망자료 기반 심뇌혈관질환을 제외한 기타 사망원인으로의 사망위험을 콕스회귀모형으로 분석한 결과에서 1단계 수축기 고혈압 군과 1단계 이완기 고혈압 군에서 당뇨, 알코올성 간질환, 콩팥부전 사망의 위험도가 통계적으로 유의하게 증가함을 보인 반면, 간질성 폐렴의 사망위험은 유의하게 감소함을 보였다. 2단계 수축기 고혈압 군에서는 폐렴, 간경화 및 허혈성 장질환의 사망위험이 증가하는 것을 보였다. 혈압의 증가가 기존에 알려진 심뇌혈관 질환 이외의 사망위험도에도 연관된 것으로 보이며, 고혈압의 질병부담 연구 및 보건정책 수립시 이 같은 점에 대한 고려가 필요하다.

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The Risk of Colorectal Cancer After Cholecystectomy or Appendectomy: A Population-based Cohort Study in Korea: Joonki Lee, Sunho Choe, Ji Won Park, Seung-Yong Jeong, Aesun Shin; J Prev Med Public Health. 2018;51(6):281-288. Published online October 29, 2018; DOI: https://doi.org/10.3961/jpmph.18.105

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Abstract Summary PDF Supplementary Material

Objectives
We investigated the association between cholecystectomy or appendectomy and the subsequent risk of colorectal cancer (CRC) in the Korean population.
Methods
A retrospective cohort study was conducted with the National Health Insurance Service–National Sample Cohort of Korea; this sample was followed up from January 1, 2002, until the date of CRC incidence, loss to follow-up, or December 31, 2015. The exposure status of cholecystectomy and appendectomy was treated as a time-varying covariate. The calculated risk of CRC was stratified by follow-up period, and the association between these surgical procedures and CRC was investigated by a Cox regression model applying appropriate lag periods.
Results
A total of 707 663 individuals were identified for analysis. The study population was followed up for an average of 13.66 years, and 4324 CRC cases were identified. The hazard ratio (HR) of CRC was elevated in the first year after cholecystectomy (HR, 1.71; 95% confidence interval [CI], 1.01 to 2.89) and in the first year and 2-3 years after appendectomy (HR, 4.22; 95% CI, 2.87 to 6.20; HR, 2.34; 95% CI, 1.36 to 4.03, respectively). The HRs of CRC after applying 1 year of lag after cholecystectomy and 3 years of lag after appendectomy were 0.80 (95% CI, 0.57 to 1.13) and 0.77 (95% CI, 0.51 to 1.16), respectively.
Conclusions
The risk of CRC increased in the first year after cholecystectomy and appendectomy, implying the possibility of bias. When appropriate lag periods after surgery were applied, no association was found between cholecystectomy or appendectomy and CRC.

Summary

Korean summary
본 연구는 담낭절제술, 충수돌기절제술 후 대장암의 발생위험에 관한 연구로 국민건강보험공단 표본코호트자료를 사용한 후향적코호트 연구이다. 총 707 663명을 대상으로 연구를 진행하였으며, 담낭절제술을 시행한 환자들은 수술 후 1년 이내에서 대장암의 위험도가 유의하게 증가하였으나 이후 관련성을 보이지 않았고, 충수돌기절제술을 시행한 환자들은 수술 후 1년, 2~3년에서 유의하게 위험도가 증가하였으나, 이후에는 관련성을 보이지 않았다. 이 결과는 역인과관계의 가능성을 시사하며 이것을 고려하였을 때, 담낭절제술과 충수돌기절제술은 대장암의 발생위험과의 연관성을 보이지 않았다.

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Effect of Uric Acid on the Development of Chronic Kidney Disease: The Korean Multi-Rural Communities Cohort Study: Kwang Ho Mun, Gyeong Im Yu, Bo Youl Choi, Mi Kyung Kim, Min-Ho Shin, Dong Hoon Shin; J Prev Med Public Health. 2018;51(5):248-256. Published online September 7, 2018; DOI: https://doi.org/10.3961/jpmph.18.112

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Abstract PDF

Objectives
Several studies have investigated the effects of serum uric acid (SUA) levels on chronic kidney disease (CKD), with discrepant results. The effect of SUA levels on CKD development was studied in the Korean rural population.
Methods
A total of 9695 participants aged ≥40 years were recruited from 3 rural communities in Korea between 2005 and 2009. Of those participants, 5577 who participated in the follow-up and did not have cerebrovascular disease, myocardial infarction, cancer, or CKD at baseline were studied. The participants, of whom 2133 were men and 3444 were women, were grouped into 5 categories according to their quintile of SUA levels. An estimated glomerular filtration rate of <60 mL/min/1.73 m2 at the time of follow-up was considered to indicate newly developed CKD. The effects of SUA levels on CKD development after adjusting for potential confounders were assessed using Cox proportional hazard models.
Results
Among the 5577 participants, 9.4 and 11.0% of men and women developed CKD. The hazard ratio (HR) of CKD was higher in the highest quintile of SUA levels than in the third quintile in men (adjusted HR, 1.60; 95% confidence interval [CI], 1.02 to 2.51) and women (adjusted HR, 1.56; 95% CI, 1.14 to 2.15). Furthermore, CKD development was also more common in the lowest quintile of SUA levels than in the third quintile in men (adjusted HR, 1.83; 95% CI, 1.15 to 2.90). The effect of SUA was consistent in younger, obese, and hypertensive men.
Conclusions
Both high and low SUA levels were risk factors for CKD development in rural Korean men, while only high levels were a risk factor in their women counterparts.

Summary

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Metabolic Risk Profile and Cancer in Korean Men and Women: Seulki Ko, Seok-Jun Yoon, Dongwoo Kim, A-Rim Kim, Eun-Jung Kim, Hye-Young Seo; J Prev Med Public Health. 2016;49(3):143-152. Published online May 18, 2016; DOI: https://doi.org/10.3961/jpmph.16.021

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Abstract PDF

Objectives
Metabolic syndrome is a cluster of risk factors for type 2 diabetes mellitus and cardiovascular disease. Associations between metabolic syndrome and several types of cancer have recently been documented.
Methods
We analyzed the sample cohort data from the Korean National Health Insurance Service from 2002, with a follow-up period extending to 2013. The cohort data included 99 565 individuals who participated in the health examination program and whose data were therefore present in the cohort database. The metabolic risk profile of each participant was assessed based on obesity, high serum glucose and total cholesterol levels, and high blood pressure. The occurrence of cancer was identified using Korean National Health Insurance claims data. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models, adjusting for age group, smoking status, alcohol intake, and regular exercise.
Results
A total of 5937 cases of cancer occurred during a mean follow-up period of 10.4 years. In men with a high-risk metabolic profile, the risk of colon cancer was elevated (HR, 1.40; 95% CI, 1.14 to 1.71). In women, a high-risk metabolic profile was associated with a significantly increased risk of gallbladder and biliary tract cancer (HR, 2.05; 95% CI, 1.24 to 3.42). Non-significantly increased risks were observed in men for pharynx, larynx, rectum, and kidney cancer, and in women for colon, liver, breast, and ovarian cancer.
Conclusions
The findings of this study support the previously suggested association between metabolic syndrome and the risk of several cancers. A high-risk metabolic profile may be an important risk factor for colon cancer in Korean men and gallbladder and biliary tract cancer in Korean women.

Summary

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Brief Report

Depressive Symptoms on the Geriatric Depression Scale and Suicide Deaths in Older Middle-aged Men: A Prospective Cohort Study: Sang-Wook Yi; J Prev Med Public Health. 2016;49(3):176-182. Published online April 12, 2016; DOI: https://doi.org/10.3961/jpmph.16.012

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Abstract PDF

Objectives
Prospective evaluations of the associations between depressive symptoms and suicide deaths have been mainly performed in high-risk populations, such as individuals with psychiatric disorders or histories of self-harm. The purpose of this study was to prospectively examine whether more severe depressive symptoms assessed using the Geriatric Depression Scale (GDS) were associated with a greater risk of death from suicide in a general-risk population.
Methods
A total of 113 478 men from the Korean Veterans Health Study (mean age, 58.9 years) who participated in a postal survey in 2004 were followed up for suicide mortality until 2010.
Results
Over 6.4 years of follow-up, 400 men died by suicide (56.7 deaths per 100 000 person-years). More severe depressive symptoms were associated with greater risk of suicide death (p for trend <0.001). The unadjusted hazard ratios (HRs) in comparison to the absence of depression were 2.18 for mild depression, 2.13 for moderate depression, 3.33 for severe depression, and 3.67 for extreme depression. After adjusting for potential confounders, men with a potential depressive disorder had an approximate 90% higher mortality from suicide (adjusted HR, 1.92; 95% confidence interval [CI], 1.38 to 2.68; p<0.001) than men without depression. Each five-point increase in the GDS score was associated with a higher risk of death by suicide (adjusted HR, 1.22; p<0.001). The value of the area under the receiver operating characteristics curve of GDS scores for suicide deaths was 0.61 (95% CI, 0.58 to 0.64).
Conclusions
Depressive symptoms assessed using the GDS were found to be a strong independent predictor of future suicide. However, the estimate of relative risk was weaker than would be expected based on retrospective psychological autopsy studies.

Summary

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Original Articles

Determinants of Poor Self-rated Health in Korean Adults With Diabetes: Hwi-Won Lee, Minkyo Song, Jae Jeong Yang, Daehee Kang; J Prev Med Public Health. 2015;48(6):287-300. Published online October 23, 2015; DOI: https://doi.org/10.3961/jpmph.15.048

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Abstract PDF Supplementary Material

Objectives
Self-rated health is a measure of perceived health widely used in epidemiological studies. Our study investigated the determinants of poor self-rated health in middle-aged Korean adults with diabetes.
Methods
A cross-sectional study was conducted based on the Health Examinees Study. A total of 9759 adults aged 40 to 69 years who reported having physician-diagnosed diabetes were analyzed with regard to a range of health determinants, including sociodemographic, lifestyle, psychosocial, and physical variables, in association with self-rated health status using multivariate logistic regression models. A p-value <0.05 was considered to indicate statistical significance.
Results
We found that negative psychosocial conditions, including frequent stress events and severe distress according to the psychosocial well-being index, were most strongly associated with poor self-rated health (odds ratio [OR]_{Frequent stress events}, 5.40; 95% confidence interval [CI], 4.63 to 6.29; OR_{Severe distress}, 11.08; 95% CI, 8.77 to 14.00). Moreover, younger age and being underweight or obese were shown to be associated with poor self-rated health. Physical factors relating to participants’ medical history of diabetes, such as a younger age at diagnosis, a longer duration of diabetes, insulin therapy, hemoglobin A_1c levels of 6.5% or more, and comorbidities, were other correlates of poor reported health.
Conclusions
Our findings suggest that, in addition to medical variables, unfavorable socioeconomic factors, and adverse lifestyle behaviors, younger age, being underweight or obese, and psychosocial stress could be distinc factors in predicting negative perceived health status in Korean adults with diabetes.

Summary

Citations

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A Scoping Review of Possible Solutions for Decreasing Socioeconomic Inequalities in Type 2 Diabetes Mellitus
Laleh Gharacheh, Mostafa Amini-Rarani, Amin Torabipour, Saeed Karimi
International Journal of Preventive Medicine.2024;[Epub] CrossRef
Exploring factors associated with self‐rated health in individuals with diabetes and its impact on quality of life: Evidence from the Survey of Health, Ageing, and Retirement in Europe
Rosa Marie Brückner, Aline Schönenberg, Rebecca Wientzek, Mandy Schreiber, Tino Prell
Journal of Diabetes.2024;[Epub] CrossRef
Gender Disparities in Healthy Aging: A Cross-National Comparative Study in the United States and South Korea from 2006 to 2016
Lanlan Chu, Anjelynt Lor, Mary-Genevieve Moisan, Kieu My Phi
The International Journal of Aging and Human Development.2023; 96(1): 33. CrossRef
People with Diabetes Have Poorer Self-Rated Health (SRH) and Diabetes Moderates the Association between Age and SRH
Weixi Kang, Antonio Malvaso
Diseases.2023; 11(2): 73. CrossRef
The Relationship between Self-Perceived Health and Physical Activity in the Mental Health of Korean Cancer Survivors
Sungjung Kwak, Jieun Shin, Jong-Yeup Kim
Healthcare.2023; 11(11): 1549. CrossRef
Sleep Duration, Sleep Quality, and Insomnia in Association With Self-Rated Health: A Systematic Review and Meta-Analysis
Sohrab Amiri
Sleep Medicine Research.2023; 14(2): 66. CrossRef
Diabetes Moderates the Link between Personality Traits and Self-Rated Health (SRH)
Weixi Kang
Healthcare.2023; 11(15): 2149. CrossRef
Low Social Support and Risk for Depression in People With Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis
Akhmad Azmiardi, Bhisma Murti, Ratih Puspita Febrinasari, Didik Gunawan Tamtomo
Journal of Preventive Medicine and Public Health.2022; 55(1): 37. CrossRef
Self-rated health and perceived environmental quality in Brunei Darussalam: a cross-sectional study
Evi Nurvidya Arifin, Chang-Yau Hoon, Ly Slesman, Abby Tan
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Obesity, Disability and Self-Perceived Health Outcomes in Australian Adults: A Longitudinal Analysis Using 14 Annual Waves of the HILDA Cohort
Syed Afroz Keramat, Khorshed Alam, Bright Opoku Ahinkorah, Md Sariful Islam, Md Irteja Islam, Md Zobayer Hossain, Sazia Ahmed, Jeff Gow, Stuart JH Biddle
ClinicoEconomics and Outcomes Research.2021; Volume 13: 777. CrossRef
Factors Associated with Poor Self-Rated Health in Cancer Patients
Hyo Rim Ju, Ye Rim Jeon, Seo Young Kang, Jung Ah Lee, Young Sik Kim
Korean Journal of Family Practice.2021; 11(5): 385. CrossRef
Physical Exercise, Social Interaction, Access to Care, and Community Service: Mediators in the Relationship Between Socioeconomic Status and Health Among Older Patients With Diabetes
Qingwen Deng, Wenbin Liu
Frontiers in Public Health.2020;[Epub] CrossRef
Self-rated health and the risk of incident type 2 diabetes mellitus: A cohort study
Jin-Won Noh, Yoosoo Chang, Minsun Park, Young Dae Kwon, Seungho Ryu
Scientific Reports.2019;[Epub] CrossRef
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Razak M. Gyasi, David R. Phillips, Roman David
Women & Health.2019; 59(10): 1089. CrossRef
Gender, self-rated health and functional decline among community-dwelling older adults
Razak M. Gyasi, David R. Phillips
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Self‐reported oral health predicts tooth loss after five and ten years in a population‐based study
Peter Meisel, Birte Holtfreter, Henry Völzke, Thomas Kocher
Journal of Clinical Periodontology.2018; 45(10): 1164. CrossRef
Body mass index and self-rated health in East Asian countries: Comparison among South Korea, China, Japan, and Taiwan
Jin-Won Noh, Jinseok Kim, Youngmi Yang, Jumin Park, Jooyoung Cheon, Young Dae Kwon, Clemens Fürnsinn
PLOS ONE.2017; 12(8): e0183881. CrossRef
Self-rated health predicts decline in instrumental activities of daily living among high-functioning community-dwelling older people
Kimiko Tomioka, Norio Kurumatani, Hiroshi Hosoi
Age and Ageing.2016;[Epub] 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; J Prev Med Public Health. 2015;48(2):105-110. Published online March 11, 2015; DOI: https://doi.org/10.3961/jpmph.15.003

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Abstract PDF

Objectives
Recently, low systolic blood pressure (SBP) was found to be associated with an increased risk of death from vascular diseases in a rural elderly population in Korea. However, evidence on the association between low SBP and vascular diseases is scarce. The aim of this study was to prospectively examine the association between low SBP and mortality from all causes and vascular diseases in older middle-aged Korean men.
Methods
From 2004 to 2010, 94 085 Korean Vietnam War veterans were followed-up for deaths. The adjusted hazard ratios (aHR) were calculated using the Cox proportional hazard model. A stratified analysis was conducted by age at enrollment. SBP was self-reported by a postal survey in 2004.
Results
Among the participants aged 60 and older, the lowest SBP (<90 mmHg) category had an elevated aHR for mortality from all causes (aHR, 1.9; 95% confidence interval [CI], 1.2 to 3.1) and vascular diseases (International Classification of Disease, 10th revision, I00-I99; aHR, 3.2; 95% CI, 1.2 to 8.4) compared to those with an SBP of 100 to 119 mmHg. Those with an SBP below 80 mmHg (aHR, 4.5; 95% CI, 1.1 to 18.8) and those with an SBP of 80 to 89 mmHg (aHR, 3.1; 95% CI, 0.9 to 10.2) also had an increased risk of vascular mortality, compared to those with an SBP of 90 to 119 mmHg. This association was sustained when excluding the first two years of follow-up or preexisting vascular diseases. In men younger than 60 years, the association of low SBP was weaker than that in those aged 60 years or older.
Conclusions
Our findings suggest that low SBP (<90 mmHg) may increase vascular mortality in Korean men aged 60 years or older.

Summary

Citations

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Relationship between systolic blood pressure and all-cause mortality: a prospective study in a cohort of Chinese adults
Chunsheng Li, Youren Chen, Qiongbing Zheng, Weiqiang Wu, Zhichao Chen, Lu Song, Shasha An, Zhifang Li, Shuohua Chen, S. L. Wu
BMC Public Health.2018;[Epub] CrossRef
Baseline and longitudinal change in blood pressure and mortality in a Chinese cohort
Jian-Bing Wang, Qiu-Chi Huang, Shu-Chang Hu, Pei-Wen Zheng, Peng Shen, Die Li, Huai-Chu Lu, Xiang Gao, Hong-Bo Lin, Kun Chen
Journal of Epidemiology and Community Health.2018; 72(12): 1083. CrossRef
Low Systolic Blood Pressure and Vascular Mortality Among More Than 1 Million Korean Adults
Sang-Wook Yi, Yejin Mok, Heechoul Ohrr, Jee-Jeon Yi, Young Duk Yun, Jihwan Park, Sun Ha Jee
Circulation.2016; 133(24): 2381. CrossRef

Serum Uric Acid Level and the Incidence of Metabolic Syndrome in Middle-aged Korean Men: A 5-Year Follow-up Study: Jong-Keun Lee, Jae-Hong Ryoo, Joong-Myung Choi, Sung Keun Park; J Prev Med Public Health. 2014;47(6):317-326. Published online November 4, 2014; DOI: https://doi.org/10.3961/jpmph.14.028

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89 Download
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Abstract PDF

Objectives
Elevated serum uric acid (UA) has been known to be associated with the prevalence of metabolic syndrome (MetS). However, no prospective studies have examined whether serum UA levels are actually associated with the development of MetS. We performed a prospective study to evaluate the longitudinal effects of baseline serum UA levels on the development of MetS.
Methods
A MetS-free cohort of 14 906 healthy Korean men, who participated in a medical check-up program in 2005, was followed until 2010. MetS was defined according to the Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention. Cox proportional hazards models were performed.
Results
During 52 466.1 person-years of follow-up, 2428 incident cases of MetS developed between 2006 and 2010. After adjusting for multiple covariates, the hazard ratios (95% confidence intervals) for incident MetS for the second, the third, and the fourth quartile to the first quartile of serum UA levels were 1.09 (0.92-1.29), 1.22 (1.04-1.44), and 1.48 (1.26-1.73), respectively (p for trend <0.001). These associations were also significant in the clinically relevant subgroup analyses.
Conclusions
Elevated serum UA levels were independently associated with future development of MetS in Korean men during the 5-year follow-up period.

Summary

Citations

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Which Clusters of Metabolic Syndrome Are the Most Associated with Serum Uric Acid?
Jurgita Mikolaitytė, Jolita Badarienė, Roma Puronaitė, Alma Čypienė, Irma Rutkauskienė, Jolanta Dadonienė, Aleksandras Laucevičius
Medicina.2022; 58(2): 297. CrossRef
Association between serum uric acid and metabolic syndrome: a cross-sectional study in Bangladeshi adults
Nurshad Ali, Rakib Miah, Mahmudul Hasan, Zitu Barman, Ananya Dutta Mou, Jaasia Momtahena Hafsa, Aporajita Das Trisha, Akibul Hasan, Farjana Islam
Scientific Reports.2020;[Epub] CrossRef
Association between uric acid and metabolic syndrome in elderly women
Hui-Juan Wang, Lei-Zhi Shi, Cun-Fei Liu, Shi-Min Liu, Song-Tao Shi
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Cuiling Zhu, Ran Cui, Mingming Gao, Sharvan Rampersad, Hui You, Chunjun Sheng, Peng Yang, Hui Sheng, Xiaoyun Cheng, Le Bu, Shen Qu
International Journal of Endocrinology.2017; 2017: 1. CrossRef
Association between Serum Uric Acid and Mortality among Chinese Patients with Coronary Artery Disease
Qing Li, Yuan Zhang, Ding Ding, Yunou Yang, Qian Chen, Chaoqun Liu, Xinrui Li, Changjiang Hong, Wenhua Ling
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Levothyroxine Dose and Fracture Risk According to the Osteoporosis Status in Elderly Women: Young-Jin Ko, Ji Young Kim, Joongyub Lee, Hong-Ji Song, Ju-Young Kim, Nam-Kyong Choi, Byung-Joo Park; J Prev Med Public Health. 2014;47(1):36-46. Published online January 29, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.1.36

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171 Download
23 Crossref

Abstract PDF

Objectives

To evaluate the association between fracture risk and levothyroxine use in elderly women with hypothyroidism, according to previous osteoporosis history.

Methods

We conducted a cohort study from the Korean Health Insurance Review and Assessment Service claims database from January 2005 to June 2006. The study population comprised women aged ≥65 years who had been diagnosed with hypothyroidism and prescribed levothyroxine monotherapy. We excluded patients who met any of the following criteria: previous fracture history, hyperthyroidism, thyroid cancer, or pituitary disorder; low levothyroxine adherence; or a follow-up period <90 days. We categorized the daily levothyroxine doses into 4 groups: ≤50 µg/d, 51 to 100 µg/d, 101 to 150 µg/d, and >150 µg/d. The hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated with the Cox proportional hazard model, and subgroup analyses were performed according to the osteoporosis history and osteoporosis-specific drug prescription status.

Results

Among 11 155 cohort participants, 35.6% had previous histories of osteoporosis. The adjusted HR of fracture for the >150 µg/d group, compared with the 51 to 100 µg/d group, was 1.56 (95% CI, 1.03 to 2.37) in osteoporosis subgroup. In the highly probable osteoporosis subgroup, restricted to patients who were concurrently prescribed osteoporosis-specific drugs, the adjusted HR of fracture for the >150 µg/d group, compared with the 51 to 100 µg/d group, was 1.93 (95% CI, 1.14 to 3.26).

Conclusions

While further studies are needed, physicians should be concerned about potential levothyroxine overtreatment in elderly osteoporosis patients.

Summary

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