Epidemiology and Health

Associations between usual source of care characteristics and health outcomes in diabetes mellitus: a focus on medication adherence and healthy behaviors
Lee SE, Kim CW, Bae JE and Choi JH
This study investigated the associations between usual source of care (USC) characteristics, which incorporate primary care functions, and medication adherence and healthy behaviors in Korean adults with diabetes.
Age-Period-Cohort Analysis of dietary sodium, potassium, and sodium-to-potassium ratio in Korea
Jun HJ, Kim S and Jo G
Excessive sodium and insufficient potassium consumption are major dietary contributors to hypertension (HTN) and cardiovascular diseases. The sodium-to-potassium ratio is a known predictor of blood pressure (BP) and HTN. This study evaluated 16-years trends in dietary sodium, potassium, and the sodium-to-potassium ratio, and their associations with BP and HTN in Korea.
Prospective associations between psychosocial stress and the risk of type 2 diabetes in middle-aged adults: findings from the KoGES_CAVAS
Kim JE, Woo HW, Kim YM, Shin MH, Koh SB and Kim MK
Psychosocial stress is a potential risk factor for type 2 diabetes (T2D); however, the influence of the timing of stress exposure remains uncertain. We examined the prospective associations of baseline, cumulative average, and recent psychosocial stress with the risk of incident T2D in middle-aged adults.
Study Protocol for the Korean Human Exposure Safety Survey (KoHESS): A National Biomonitoring Program for Food and Consumer Product Safety
Lim HJ, Eom SY, Choi SH, Hong S, Choi BS, Hong YS, Lee K, Park WJ, Song JS, Kim NJ, Hwang HJ, Choi R, Im H, Kang YS, Lee HY, Kim MR, Son H and Kim YD
This protocol paper describes the design and methodology of the Korean Human Exposure Safety Survey (KoHESS), a three-year national biomonitoring program (2023-2025). Korea's Act on Risk Assessment of Products for Human Use necessitates scientific evidence for aggregate exposure assessment and cumulative risk evaluation of hazardous substances in food and consumer products. Existing biomonitoring programs primarily focus on environmental exposures, limiting comprehensive assessment of products regulated by the Ministry of Food and Drug Safety. KoHESS employs repeated cross-sectional surveys targeting approximately 5,000 Koreans aged 3-79 years per cycle, using complex stratified multistage sampling for national representativeness. Data collection includes standardized anthropometric measurements, biological samples (blood, urine), comprehensive exposure source surveys, and 2-day 24-hour dietary recalls. Chemical analyses using liquid chromatography-tandem mass spectrometry and inductively coupled plasma mass spectrometry measure 24 PFAS compounds, 25 phthalate metabolites, and 7 heavy metals, with quality assurance through certified reference materials. KoHESS will provide scientifically robust data for establishing safety standards, enable advanced exposure modeling, facilitate risk assessments reflecting cumulative exposures, support targeted protection for vulnerable populations, and contribute to international biomonitoring networks while promoting preventive hazardous substance management systems.
Validation of the Korean Pubertal Development Scale (PDS-K): a non-invasive self-report tool for epidemiological use
Kim J, Kim D, Pyun H, Jeong WK, Cheon YM, Lee SJ and Sung J
As the average age of pubertal onset continues to decline, the need for reliable and culturally appropriate tools to assess pubertal development has become increasingly important. However, no validated, non-invasive, self-report instrument has been available for use in Korea. This study aimed to translate, culturally adapt, and evaluate the Korean version of the Pubertal Development Scale (PDS-K). The original PDS was translated using a forward-backward translation procedure and reviewed by experts to ensure cultural relevance. The PDS-K was administered to a total of 217 elementary school students (grades 4-6). Internal consistency and test-retest reliability were evaluated using Cronbach's α, item-total correlations, Cohen's kappa, and intraclass correlation coefficients (ICC). The PDS-K demonstrated acceptable internal consistency (Cronbach's α: boys = 0.79, girls = 0.74) and good test-retest reliability (ICCs: 0.77 for boys, 0.87 for girls). Sex-specific patterns of pubertal progression were also observed. Although further validation across broader age groups and against clinical benchmarks is warranted, the PDS-K provides a practical and culturally adapted tool for the non-invasive assessment of pubertal development and holds promise for large-scale epidemiological research.
Socioeconomic factors affecting breast and cervical cancer screening compliance in Asian National Cancer Centers Alliance countries: a systematic review
Bae S, Kang YJ, Ahn J, Jang BH, Choi KS, Lee HJ and Suh M
Breast and cervical cancers are the most frequently diagnosed cancers in women. The Asian National Cancer Centers Alliance (ANCCA) has strengthened cancer control efforts in the Asia region; however, only a few countries have achieved sufficient participation rates. This systematic review aimed to synthesize the existing evidence on socioeconomic factors influencing women's compliance with breast and cervical cancer screening in ANCCA countries. This study was conducted as a systematic review, with studies collected from PubMed, Cochrane Library, Scopus, and Embase. All included studies employed cross-sectional designs to identify socioeconomic factors affecting compliance with breast or cervical cancer screening. Study selection, quality assessment, and data extraction were carried out by 2 independent reviewers with cross-checking. In total, 48 studies were reviewed. Education level and family history were associated with participation in breast cancer screening, while education level, household income, marital status, and medical insurance were linked with cervical cancer screening. When stratified by Human Development Index (HDI) level or by the presence of a National Cancer Screening Program, differences were observed in the factors influencing screening compliance. Nevertheless, higher education consistently correlated with higher screening rates for both cancer types, regardless of HDI level. This systematic review identified multiple socioeconomic factors that shape breast and cervical cancer screening compliance in Asian countries. To reduce disparities in participation, tailored multi-strategy approaches adapted to each country's specific context are required. These findings may provide useful evidence for future research and policy initiatives aimed at addressing health equity issues.
Decentralized pandemic response and health equity: an analysis of socioeconomic disparities in COVID-19 mortality in Japan
Jamil H, Kende AA, Nomura S, Inoue F, Suzuki T and Gilmour S
Global data often link greater socioeconomic deprivation to higher coronavirus disease 2019 (COVID-19) mortality. However, whether decentralized governance can mitigate this disparity by enabling tailored, equitable local responses remains unclear. We assessed whether Japan's decentralized pandemic response moderated the association between area-level socioeconomic deprivation and COVID-19 mortality across municipalities.
Probiotics for preventing neonatal sepsis in preterm neonates: a systematic review and meta-analysis for clinical practice
Maulida R, Amandito R, Rohsiswatmo R and Malik A
Late-onset sepsis (LOS), occurring after 72 hours of birth, is a significant cause of morbidity and mortality especially in preterm neonates. Probiotics have been proposed as a preventive strategy to enhance gut health, modulate immune responses, and reduce the incidence of neonatal sepsis. We aimed to evaluate the effectiveness of probiotics in preventing neonatal sepsis in preterm neonates, with particular attention to the impact of different strains and dosage regimens. Eligible studies included preterm neonates (≤36 weeks gestational age) with culture-proven LOS and focused on probiotic supplementation. Comprehensive searches were conducted in MEDLINE via PubMed, Cochrane CENTRAL, Scopus, and ProQuest up to July 28, 2024. The Revised Cochrane Risk of Bias Tool (RoB 2.0) was applied to assess study quality, and a random-effects meta-analysis was performed using Review Manager version 5.4. Additionally, the certainty of the body of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Thirty-one studies including 8,040 preterm neonates were reviewed. Meta-analysis demonstrated that probiotics significantly reduced the incidence of LOS (pooled risk ratio [RR], 0.83; 95% confidence interval [CI], 0.72 to 0.95). Greater efficacy was observed with multistrain formulations (RR, 0.76; 95% CI, 0.72 to 0.95) and low-dose regimens (RR, 0.72; 95% CI, 0.56 to 0.91). Probiotic supplementation was also associated with shorter hospital stays and a trend toward lower mortality, although the latter did not reach statistical significance. To effectively reduce LOS in preterm neonates, specific combinations of multistrain probiotics and optimized dosing strategies may provide the most benefit.
Authors' Reply: Safety of combination therapy of azilsartan medoxomil and amlodipine: a population-based cohort study
Lee H, Hong B, Tzu-Ting Su C, Bea S, Jeong HE, Jung K, Cheng MC, Chang ZC, Lai EC and Lee J
Trends in sustainable dietary patterns in United States adults, 2007-2018
Jung S, Young HA, Braffett BH, Simmens SJ, Lee EHL and Ogden CL
Adopting sustainable diets is essential for improving both human and planetary health, and such diets should be evaluated from a multidimensional perspective. We characterized trends in sustainable dietary patterns, quantified by the sustainable diet index for United States (SDI-US) adults, along with trends in diet quality, diet-related environmental impacts, food affordability, and food practices.
Individual- and neighborhood-level factors influencing diet quality: a multilevel analysis using Korea National Health and Nutrition Examination Survey data, 2010-2019
Park D, Shin MJ, Subramanian SV, Park CY and Kim R
Although environmental factors influence lifestyle choices, few studies have examined how individual-level and neighborhood-level socio-demographic factors interact to affect diet quality in Korea. We investigated the associations between multilevel factors and diet quality among Korean adults and explored potential interactions by gender and age.
Explainable SHAP-XGBoost models for identifying important social factors associated with the atherosclerotic cardiovascular disease risk score using the LASSO feature selection technique
Choi J, Jeon J, An H and Kim HC
Extensive evidence indicates that social factors play an essential role in explaining atherosclerotic cardiovascular disease (ASCVD). This study aimed to examine which social factors are associated with the estimated 10-year ASCVD risk score among male and female adults, incorporating both multifaceted social network components and conventional risk factors.
A large-scale norovirus outbreak associated with kimchi consumption across multiple schools in a Korean city in 2024
Park E, Cho S, Kim E, Park JI, Lee JH and Gwack J
Norovirus is a major global concern for foodborne outbreaks. We investigated a large-scale norovirus outbreak in a Korean city to identify the source of infection and implement control measures.
Data profile: cancer sample cohorts (stomach, breast, colorectal, and liver) in Korea
Pak D, Jang SY, Yoon JH, Kim DW, Noh JW, Choi DW, Guk M, Kim H, Oh JW, Chae H, Kong HJ, Kim GH, Nam JW, Lee GR, Park D, Jeon J, Yun B, Yoo KB and Choi KS
Cancer Public Library Database (CPLD) links data from four major population-based public sources: the Korea National Cancer Incidence Database in the Korea Central Cancer Registry, cause-of-death data in Statistics Korea, the National Health Information Database in the National Health Insurance Service, and the National Health Insurance Research Database in the Health Insurance Review & Assessment Service. The National Cancer Data Center has developed a new nationally representative sample cohort dataset from Korean Clinical Data Utilization for Research Excellence project (K-CURE) CPLD: Stomach Cancer Sample Cohort, Breast Cancer Sample Cohort, Colorectal Cancer Sample Cohort, and Liver Cancer Sample Cohort. The sample populations consisted of approximately 21% of all cancer patients from 2012 to 2019. The populations of the Stomach Cancer Sample Cohort, Breast Cancer Sample Cohort, Colorectal Cancer Sample Cohort, and Liver Cancer Sample Cohort were 51,951, 39,586, 53,485, and 27,375 patients, respectively. The dataset included cancer incidence information, demographics, socioeconomic variables, health utilization data (procedures, diagnoses, and medications), general health checkup data, cancer screening data before and after the cancer incidence, as well as death information. These cohorts could help researchers analyze time-to-event data on mortality, treatment outcomes, comorbid conditions following a cancer diagnosis, and cancer incidence risk factors. The data can be accessed through the K-CURE portal (https://k-cure.mohw.go.kr/).
Behavioral and psychosocial factors associated with sugar-sweetened beverage consumption among Korean adolescents: a path analysis using the 2022 Korea Youth Risk Behavior Survey
Park HY, Ryu SR, Park HK, Hwang HS and Park KY
Rising obesity rates among adolescents are a major global health concern and are closely linked to the consumption of sugar-sweetened beverages (SSBs). This study aimed to identify key behavioral and psychosocial factors influencing SSB consumption among adolescents.
Evaluation of a telemedicine pilot project for hypertension in Korea: a nationwide real-world data study
Kim JY, Jung Y, Seo S, Kim Y, Ko MJ and Kim HS
 A telemedicine pilot project has received temporary authorization in Korea. The clinical effectiveness of telemedicine is well established; however, ongoing research must assess medical utilization, sustainability, prescription continuity, and safety.
Personal, community, and societal factors associated with mukbang viewing among adolescents: findings from the Korea Youth Risk Behavior Survey
Yoon CY, Shin S, Jun H, Park H and Kim M
Mukbang refers to livestreamed videos in which hosts consume large amounts of energy-dense, nutrient-poor foods while interacting with viewers. Mukbang is widely viewed by Korean adolescents and has been associated with adverse health outcomes. To inform efforts to prevent excessive engagement with mukbang content among Korean adolescents, this study examined personal, community, and societal factors associated with excessive mukbang viewing (≥7 times/wk) and explored gender differences in these associations.
Association between psychosocial safety climate and depression risk among Korean workers
Cho SK, Cho SS, Dollard MF, Loh MY and Kang MY
Psychosocial safety climate (PSC) reflects an organization's commitment to safeguarding workers' psychological health and safety. While international evidence links low PSC to poor mental health outcomes, its association with depression has not been well established in Korea. This study aimed to examine the relationship between PSC and depression among Korean workers, utilizing a large-scale, population-based survey.
The delayed cancer treatment and economic inequality in Korea: results of common cancers by the time-to-surgery
Son N, Lee WR, Choi DW and Han KT
Growing concerns regarding the concentration of cancer treatment in the capital city in Korea have raised questions about equitable access to timely and optimal patient care. In this study, we evaluated the impact of time-to-surgery (TTS) on healthcare utilization and outcomes, with the goal of providing policy recommendations for effective quality assessment of cancer care.
Risk factors for Q fever incidence in Korea: a comparative analysis using frequentist and Bayesian methods
Son JH and Park SD
This study investigated the principal determinants of human Q fever incidence and explored regional variation between metropolitan cities and provinces in Korea.
Letter to the Editor: Safety of combination therapy of azilsartan medoxomil and amlodipine: a population-based cohort study
Zhou Z