Journal of Preventive Medicine and Public Health

Original Articles

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.

Citations

Citations to this article as recorded by

Risk of all-cause mortality by various cigarette smoking indices: A longitudinal study using the Korea National Health Examination Baseline Cohort in South Korea
Heewon Kang, Eunsil Cheon, Jieun Hwang, Suyoung Jo, Kyoungin Na, Seong Yong Park, Sung-il Cho
Tobacco Induced Diseases.2025; 23(January): 1. CrossRef
The economic cost of direct smoking in South Korea
Kristine Namhee Kwon, Kangyeon Lee, Wankyo Chung
Preventive Medicine Reports.2024; 46: 102865. CrossRef

Causes of Child Mortality (1 to 4 Years of Age) From 1983 to 2012 in the Republic of Korea: National Vital Data: Seung Ah Choe, Sung-Il Cho; J Prev Med Public Health. 2014;47(6):336-342. Published online November 7, 2014; DOI: https://doi.org/10.3961/jpmph.14.024

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Abstract PDF

Objectives
Child mortality remains a critical problem even in developed countries due to low fertility. To plan effective interventions, investigation into the trends and causes of child mortality is necessary. Therefore, we analyzed these trends and causes of child deaths over the last 30 years in Korea.
Methods
Causes of death data were obtained from a nationwide vital registration managed by the Korean Statistical Information Service. The mortality rate among all children aged between one and four years and the causes of deaths were reviewed. Data from 1983-2012 and 1993-2012 were analyzed separately because the proportion of unspecified causes of death during 1983-1992 varied substantially from that during 1993-2012.
Results
The child (1-4 years) mortality rates substantially decreased during the past three decades. The trend analysis revealed that all the five major causes of death (infectious, neoplastic, neurologic, congenital, and external origins) have decreased significantly. However, the sex ratio of child mortality (boys to girls) slightly increased during the last 30 years. External causes of death remain the most frequent origin of child mortality, and the proportion of mortality due to child assault has significantly increased (from 1.02 in 1983 to 1.38 in 2012).
Conclusions
In Korea, the major causes and rate of child mortality have changed and the sex ratio of child mortality has slightly increased since the early 1980s. Child mortality, especially due to preventable causes, requires public health intervention.

Summary

Citations

Citations to this article as recorded by

Child mortality of twins and singletons among late preterm and term birth: a study of national linked birth and under-five mortality data of Korea
Young Shin Kim, Minku Kang, Young June Choe, Joohon Sung, Ji Yeon Lee, Seung-Ah Choe
European Journal of Pediatrics.2022; 181(5): 2109. CrossRef

Accuracy of the Registered Cause of Death in a County and its Related Factors.: Eun Kyung Chung, Hee Young Shin, Jun Ho Shin, Hae Sung Nam, So Yeon Ryu, Jeong Soo Im, Jung Ae Rhee; Korean J Prev Med. 2002;35(2):153-159.

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Abstract PDF: OBJECTIVES
To evaluate the accuracy of the registered cause of death in a county and its related factors. METHODS: The data used in this study was based on 504 cases, in a county of Chonnam province, registered between January and December 1998. Study subjects consisted of 388 of the 504 cases, and their causes of death were established by an interview survey of the next of kin or neighbor and medical record surveys. We compared the registered cause of death with the confirmed cause of death, determined by surveys and medical records, and evaluated the factors associated with the accuracy of the registered cause of death. RESULTS: 62.6% of the deaths were concordant with 19 Chapters classification of cause of death. external causes of mortality, endocrine, nutritional and metabolic diseases, neoplasms and diseases of the circulatory system showed the good agreement between the registered cause of death and the confirmed cause of death. The factors relating to the accuracy of the registered cause of death were the doctors' diagnosis for the cause of death (adjusted Odds Ratio: 2.67, 95% Confidence Interval: 1.21-5.89) and the grade of the public officials in charge of the death registry (adjusted Odds Ratio: 0.30, 95% CI= 0.12-0.78). CONCLUSIONS: The accuracy of the registered cause of death was not high. It could be improved by using the doctors' diagnosis for death and improving the job specification for public officials who deal with death registration.; Summary

Burden of Disease in Korea: Years of Life Lost due to Premature Deaths.: Hyejung Chang, Jae Il Myoung, Youngsoo Shin; Korean J Prev Med. 2001;34(4):354-362.

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Abstract PDF: OBJECTIVES
The aim of this study was to estimate the burden of disease through an analysis of Years of Life Lost due to premature deaths, one component of the Disability-Adjusted Life Years (DALY). In addition, the cause of death statistics were adjusted to improve validity, and the results were compared with those of the Global Burden of Disease (GBD). METHODS: In closely following the approach taken in the original GBD study, most of the explicit assumptions and the value judgments were not changed. However, the statistics for some problematic concerns such as deaths of infants or those due to senility, were adjusted. Deaths, standard expected years of life lost (SEYLL), and potential years of life lost (PYLL) were computed using vital registration data compiled by the National Statistical Office. RESULTS: The burden for males is 1.8 and 2.3 times higher than that for females, according to SEYLL and PYLL, respectively. The proportions of deaths due to Group I, II, and III causes are 5.4%, 80.4%, and 14.3%, respectively, for PYLL, but in a major shift from Group II to III they are 6.3%, 66.2%, and 27.5%, respectively, for SEYLL. The proportion of Group III causes in Korea, 27.5%, is extremely high when compared to 10.1% for the world, 7.6% for developed countries, and 10.7% for developing countries. CONCLUSIONS: Estimation results showed that the total burden due to premature deaths is smaller than that for the entire world but larger than that for developed countries. The disease structure of Korea has changed to resemble that of developed countries. Also, an overly large portion of the total burden in Korea stems from injuries arising from car accidents.; Summary

A Study of the Cause-of-Death reported on Official Death Registry in a Rural Area.: Hae Sung Nam, Kyeong Soo Park, Byeong Hwan Sun, Jun Ho Shin, Seok Joon Sohn, Jin Su Choi, Byong Woo Kim; Korean J Prev Med. 1996;29(2):227-238.

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Abstract PDF: This study was conducted to evaluate the accuracy of the official death registry in rural area. The base data used for the study was 379 deaths registered during the period of 1993 and 1994 in 4 rural townships of Chonnam Province. The interview survey for cause-of-death was performed on the next of kin and/or neighbor. Additional medical informations were collected from hospitals and medical insurance associations for the purpose of verification. The underlying cause-of-death of 278 cases presumed by the survey was compared to the cause on official death registry. There was a prominent disagreement of cause-of-death between the survey data and the registry data(agreement rate: 38.9~44.6%%, according to disease classification method). These results may be caused by extremely low rates of physicians' certification, which were mostly confined to the poisoning and injury. Symptoms, signs, and ill defined conditions on death registry could be classified into circulatory disease(32.3%), neoplasm(21.2%), digestive disease(7.l%), injury and poisoning(7.l%) and so on. These results suggest that careful attention and verification be required on utilization of death registry data in rural area.; Summary

English Abstract

Mortality among Medical Doctors Based on the Registered Cause of Death in Korea 1992-2002.: You Cheol Shin, Jae Heon Kang, Cheol Hwan Kim; J Prev Med Public Health. 2005;38(1):38-44.

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Abstract PDF: OBJECTIVE
To compare the mortality rate of Korean medical doctors to that of the general Korean population for the period 1992-2002. METHODS: The membership records of the Korean Medical Association were linked to the 1992-2002 death certificate data of Korea's National Statistical Office using 13-digit unique personal identification numbers. The study population consisted of 61, 164 medical doctors with a follow-up period of 473, 932 person-years. Standardized mortality ratios (SMRs) were calculated to compare cause-specific mortality rates of medical doctors to those of the general population. RESULTS: We confirmed 1, 150 deaths at ages from 30 to 75 years from 1 January 1992 to 31 December 2002. The SMR for all-cause of death was 0.47 (95% CI : 0.44~0.50). The SMRs for smoking-related diseases such as cerebrovascular accidents and chronic obstructive pulmonary disease were smaller than the SMR of all-cause of death. However, the SMRs for colorectal and pancreatic cancers were not significantly lower than those of the general population. Transport accidents and suicides accounted for 72% (94 of 131) of external causes of death. The SMR for suicide was 0.51 (95% CI : 0.38~0.68). CONCLUSIONS: The mortality rate of South Korean medical doctors was less than 50% that of the general population of South Korea. Cause-specific analysis showed that mortality rates in leading causes of death were lower among medical doctors although differences in mortality rates between medical doctors and the general population varied with the causes of death. These health benefits found among medical doctors may be attributable to the lower level of health damaging behaviors (e.g., lower smoking rates) and better working conditions.; Summary

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