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21 "Daehee Kang"
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Original Articles
Sleep Duration, Comorbidities, and Mortality in Korean Health Examinees: A Prospective Cohort Study
Sukhong Min, Woo-Kyoung Shin, Katherine De la Torre, Dan Huang, Hyung-Suk Yoon, Aesun Shin, Ji-Yeob Choi, Daehee Kang
J Prev Med Public Health. 2023;56(5):458-466.   Published online September 26, 2023
DOI: https://doi.org/10.3961/jpmph.23.311
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AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
The association between long sleep duration and mortality is frequently attributed to the confounding influence of comorbidities. Nevertheless, past efforts to account for comorbidities have yielded inconsistent outcomes. The objective of this study was to evaluate this relationship using a large prospective cohort in Korea.
Methods
The study included 114 205 participants from the Health Examinees Study, who were followed for a median of 9.1 years. A composite comorbidity score was developed to summarize the effects of 21 diseases. Using Cox proportional hazards regression, hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause, cancer, and cardiovascular mortality associated with sleep duration were estimated. These estimates were adjusted for socio-demographic factors, lifestyle factors, body mass index, and comorbidity score. Additionally, a stratified analysis by subgroups with and without comorbidities was conducted.
Results
Throughout the follow-up period, 2675 deaths were recorded. After all adjustments, an association was observed between a sleep duration of 8 hours or more and all-cause mortality (HR, 1.10; 95% CI, 1.01 to 1.20). However, no such association was detected in the stratified analysis for the subgroups based on comorbidity status.
Conclusions
Long sleep duration was found to be associated with all-cause mortality among Koreans, even after adjusting for comorbidities. Additional studies are required to explore the mechanism underlying the association between sleep duration and major causes of mortality.
Summary
Korean summary
- 한국의 대규모 코호트 자료를 이용, 긴 수면 시간과 사망률 간의 연관성이 동반 상병으로 인한 교란 효과로 인한 것인지를 검토하였다. - 수면 시간과 총 사망률, 암 사망률, 심혈관질환 사망률 간의 연관성을 확인하였고, 이 중 총 사망률과 긴 수면 시간이 동반 상병 지수로 보정 한 뒤에도 유의한 연관성을 보였다.
Key Message
Using a large prospective cohort in Korea, the association between long sleep duration and mortality was evaluated, after adjusting for the confounding influence of comorbidities. When 114,205 participants from the Health Examinees Study were followed for a median of 9.1 years, sleep duration of 8 hours or more were found to be associated with all-cause mortality (HR, 1.10; 95% CI, 1.01 to 1.20). Additional studies are required to explore the mechanism underlying the association between sleep duration and major causes of mortality.
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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  • 136 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary 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.

Citations

Citations to this article as recorded by  
  • A Comparison of Green, Delta, and Monte Carlo Methods to Select an Optimal Approach for Calculating the 95% Confidence Interval of the Population-attributable Fraction: Guidance for Epidemiological Research
    Sangjun Lee, Sungji Moon, Kyungsik Kim, Soseul Sung, Youjin Hong, Woojin Lim, Sue K. Park
    Journal of Preventive Medicine and Public Health.2024; 57(5): 499.     CrossRef
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Validity of Self-reported Stroke and Myocardial Infarction in Korea: The Health Examinees (HEXA) Study
Sunho Choe, Joonki Lee, Jeeyoo Lee, Daehee Kang, Jong-Koo Lee, Aesun Shin
J Prev Med Public Health. 2019;52(6):377-383.   Published online November 12, 2019
DOI: https://doi.org/10.3961/jpmph.19.089
  • 5,886 View
  • 95 Download
  • 8 Crossref
AbstractAbstract PDF
Objectives
Self-reported disease history is often used in epidemiological studies. In this study, we acquired the hospital records of subjects who self-reported stroke or myocardial infarction (MI) and evaluated the validity of the participants’ self-reported disease history. We also determined the level of agreement between specialists and non-specialists.
Methods
Among the participants in the Health Examinees study, 1488 subjects self-reported stroke or MI during 2012-2017, and medical records were acquired for the 429 subjects (28.8%) who agreed to share their medical information. Each record was independently assigned to 2 medical doctors for review. The records were classified as ‘definite,’ ‘possible,’ or ‘not’ stroke or MI. If the doctors did not agree, a third doctor made the final decision. The positive predictive value (PPV) of self-reporting was calculated with the doctors’ review as the gold standard. Kappa statistics were used to compare the results between general doctors and neurologists or cardiologists.
Results
Medical records from 208 patients with self-reported stroke and 221 patients with self-reported MI were reviewed. The PPV of self-reported disease history was 51.4% for stroke and 32.6% for MI. If cases classified as ‘possible’ were counted as positive diagnoses, the PPV was 59.1% for stroke and 33.5% for MI. Kappa statistics showed moderate levels of agreement between specialists and non-specialists for both stroke and MI.
Conclusions
The validity of self-reported disease was lower than expected, especially in those who reported having been diagnosed with MI. Proper consideration is needed when using these self-reported data in further studies.
Summary

Citations

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Risk Reduction of Breast Cancer by Childbirth, Breastfeeding, and Their Interaction in Korean Women: Heterogeneous Effects Across Menopausal Status, Hormone Receptor Status, and Pathological Subtypes
Seok Hun Jeong, Yoon Suk An, Ji-Yeob Choi, Boyoung Park, Daehee Kang, Min Hyuk Lee, Wonshik Han, Dong Young Noh, Keun-Young Yoo, Sue K. Park
J Prev Med Public Health. 2017;50(6):401-410.   Published online November 10, 2017
DOI: https://doi.org/10.3961/jpmph.17.152
  • 9,405 View
  • 264 Download
  • 11 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
The purpose of this study was to examine the associations of childbirth, breastfeeding, and their interaction with breast cancer (BC) risk reduction, and to evaluate the heterogeneity in the BC risk reduction effects of these factors by menopause, hormone receptor (HR) status, and pathological subtype.
Methods
BC patients aged 40+ from the Korean Breast Cancer Registry in 2004-2012 and controls from the Health Examinee cohort participants were included in this study after 1:1 matching (12 889 pairs) by age and enrollment year. BC risk according to childbirth, breast-feeding, and their interaction was calculated in logistic regression models using odds ratios (ORs) and 95% confidence intervals (CIs).
Results
BC risk decreased with childbirth (3+ childbirths relative to 1 childbirth: OR, 0.66; 95% CI, 0.56 to 0.78 and OR, 0.80; 95% CI, 0.68 to 0.95 in postmenopausal and premenopausal women, respectively); and the degree of risk reduction by the number of children was heterogeneous according to menopausal status (p-heterogeneity=0.04), HR status (p-heterogeneity<0.001), and pathological subtype (p-heterogeneity<0.001); whereas breastfeeding for 1-12 months showed a heterogeneous association with BC risk according to menopausal status, with risk reduction only in premenopausal women (p-heterogeneity<0.05). The combination of 2 more childbirths and breastfeeding for ≥13 months had a much stronger BC risk reduction of 49% (OR, 0.51; 95% CI, 0.45 to 0.58).
Conclusions
This study suggests that the combination of longer breastfeeding and more childbirths reduces BC risk more strongly, and that women who experience both 2 or more childbirths and breastfeed for ≥13 months can reduce their BC risk by about 50%.
Summary

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Review
The Effect of Breastfeeding Duration and Parity on the Risk of Epithelial Ovarian Cancer: A Systematic Review and Meta-analysis
Ho Kyung Sung, Seung Hyun Ma, Ji-Yeob Choi, Yunji Hwang, Choonghyun Ahn, Byoung-Gie Kim, Yong-Man Kim, Jae Weon Kim, Sokbom Kang, Jaehoon Kim, Tae Jin Kim, Keun-Young Yoo, Daehee Kang, Suekyung Park
J Prev Med Public Health. 2016;49(6):349-366.   Published online September 8, 2016
DOI: https://doi.org/10.3961/jpmph.16.066
  • 15,811 View
  • 302 Download
  • 52 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
We conducted a systematic review and meta-analysis to summarize current evidence regarding the association of parity and duration of breastfeeding with the risk of epithelial ovarian cancer (EOC).
Methods
A systematic search of relevant studies published by December 31, 2015 was performed in PubMed and EMBASE. A random-effect model was used to obtain the summary relative risks (RRs) and 95% confidence intervals (CIs).
Results
Thirty-two studies had parity categories of 1, 2, and ≥3. The summary RRs for EOC were 0.72 (95% CI, 0.65 to 0.79), 0.57 (95% CI, 0.49 to 0.65), and 0.46 (95% CI, 0.41 to 0.52), respectively. Small to moderate heterogeneity was observed for one birth (p<0.01; Q=59.46; I2=47.9%). Fifteen studies had breastfeeding categories of <6 months, 6-12 months, and >13 months. The summary RRs were 0.79 (95% CI, 0.72 to 0.87), 0.72 (95% CI, 0.64 to 0.81), and 0.67 (95% CI, 0.56 to 0.79), respectively. Only small heterogeneity was observed for <6 months of breastfeeding (p=0.17; Q=18.79, I2=25.5%). Compared to nulliparous women with no history of breastfeeding, the joint effects of two births and <6 months of breastfeeding resulted in a 0.5-fold reduced risk for EOC.
Conclusions
The first birth and breastfeeding for <6 months were associated with significant reductions in EOC risk.
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
  • 10,716 View
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  • 18 Crossref
AbstractAbstract PDFSupplementary 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; ORSevere 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 A1c 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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Association of Selected Medical Conditions With Breast Cancer Risk in Korea
Sun Jae Jung, Minkyo Song, Ji-Yeob Choi, Nan Song, Sue Kyung Park, Keun-Young Yoo, Daehee Kang
J Prev Med Public Health. 2013;46(6):346-352.   Published online November 28, 2013
DOI: https://doi.org/10.3961/jpmph.2013.46.6.346
  • 10,474 View
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  • 13 Crossref
AbstractAbstract PDF
Objectives

To estimate the effect of medical conditions in the population of Korea on breast cancer risk in a case-control study.

Methods

The cases were 3242 women with incident, histologically confirmed breast cancer in two major hospitals interviewed between 2001 and 2007. The controls were 1818 women each admitted to either of those two hospitals for a variety of non-neoplastic conditions. Information on each disease was obtained from a standardized questionnaire by trained personnel. Odds ratios (ORs) for each disease were derived from multiple logistic regression adjusted for age, age of menarche, pregnancy, age of first pregnancy, and family history of breast cancer.

Results

Among all of the incident breast cancer patients, pre-existing diabetes (OR, 1.33; 95% confidence interval [CI], 0.99 to 1.78), hypertension (OR, 1.46; 95% CI, 1.18 to 1.83), thyroid diseases (OR, 1.26; 95% CI, 1.00 to 1.58), and ovarian diseases (OR, 1.70; 95% CI, 1.23 to 2.35) were associated with an increased risk of breast cancer when other factors were adjusted for. In a stratified analysis by menopausal status, pre-existing hypertension (pre-menopause OR, 0.80; 95% CI, 0.48 to 1.34 vs. post-menopause OR, 1.87; 95% CI, 1.44 to 2.43; p-heterogeneity <0.01) and ovarian disease (pre-menopause OR, 4.20; 95% CI, 1.91 to 9.24 vs. post-menopause OR, 1.39; 95% CI, 1.02 to 1.91; p-heterogeneity 0.01) showed significantly different risks of breast cancer.

Conclusions

Our results suggest the possibility that medical conditions such as hypertension affect breast cancer development, and that this can differ by menopausal status. Our study also indicates a possible correlation between ovarian diseases and breast cancer risk.

Summary

Citations

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A Prospective Cohort Study on the Relationship of Sleep Duration With All-cause and Disease-specific Mortality in the Korean Multi-center Cancer Cohort Study
Yohwan Yeo, Seung Hyun Ma, Sue Kyung Park, Soung-Hoon Chang, Hai-Rim Shin, Daehee Kang, Keun-Young Yoo
J Prev Med Public Health. 2013;46(5):271-281.   Published online September 30, 2013
DOI: https://doi.org/10.3961/jpmph.2013.46.5.271
  • 13,657 View
  • 169 Download
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AbstractAbstract PDF
Objectives

Emerging evidence indicates that sleep duration is associated with health outcomes. However, the relationship of sleep duration with long-term health is unclear. This study was designed to determine the relationship of sleep duration with mortality as a parameter for long-term health in a large prospective cohort study in Korea.

Methods

The study population included 13 164 participants aged over 20 years from the Korean Multi-center Cancer Cohort study. Information on sleep duration was obtained through a structured questionnaire interview. The hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality were estimated using a Cox regression model. The non-linear relationship between sleep duration and mortality was examined non-parametrically using restricted cubic splines.

Results

The HRs for all-cause mortality showed a U-shape, with the lowest point at sleep duration of 7 to 8 hours. There was an increased risk of death among persons with sleep duration of ≤5 hours (HR, 1.21; 95% CI, 1.03 to 1.41) and of ≥10 hours (HR, 1.36; 95% CI, 1.07 to 1.72). In stratified analysis, this relationship of HR was seen in women and in participants aged ≥60 years. Risk of cardiovascular disease-specific mortality was associated with a sleep duration of ≤5 hours (HR, 1.40; 95% CI, 1.02 to 1.93). Risk of death from respiratory disease was associated with sleep duration at both extremes (≤5 and ≥10 hours).

Conclusions

Sleep durations of 7 to 8 hours may be recommended to the public for a general healthy lifestyle in Korea.

Summary

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Interaction of Body Mass Index and Diabetes as Modifiers of Cardiovascular Mortality in a Cohort Study
Seung Hyun Ma, Bo-Young Park, Jae Jeong Yang, En-Joo Jung, Yohwan Yeo, Yungi Whang, Soung-Hoon Chang, Hai-Rim Shin, Daehee Kang, Keun-Young Yoo, Sue Kyung Park
J Prev Med Public Health. 2012;45(6):394-401.   Published online November 29, 2012
DOI: https://doi.org/10.3961/jpmph.2012.45.6.394
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AbstractAbstract PDF
Objectives

Diabetes and obesity each increases mortality, but recent papers have shown that lean Asian persons were at greater risk for mortality than were obese persons. The objective of this study is to determine whether an interaction exists between body mass index (BMI) and diabetes, which can modify the risk of death by cardiovascular disease (CVD).

Methods

Subjects who were over 20 years of age, and who had information regarding BMI, past history of diabetes, and fasting blood glucose levels (n=16 048), were selected from the Korea Multi-center Cancer Cohort study participants. By 2008, a total of 1290 participants had died; 251 and 155 had died of CVD and stroke, respectively. The hazard for deaths was calculated with hazard ratio (HR) and 95% confidence interval (95% CI) by Cox proportional hazard model.

Results

Compared with the normal population, patients with diabetes were at higher risk for CVD and stroke deaths (HR, 1.84; 95% CI, 1.33 to 2.56; HR, 1.82; 95% CI, 1.20 to 2.76; respectively). Relative to subjects with no diabetes and normal BMI (21 to 22.9 kg/m2), lean subjects with diabetes (BMI <21 kg/m2) had a greater risk for CVD and stroke deaths (HR, 2.83; 95% CI, 1.57 to 5.09; HR, 3.27; 95% CI, 1.58 to 6.76; respectively), while obese subjects with diabetes (BMI ≥25 kg/m2) had no increased death risk (p-interaction <0.05). This pattern was consistent in sub-populations with no incidence of hypertension.

Conclusions

This study suggests that diabetes in lean people is more critical to CVD deaths than it is in obese people.

Summary

Citations

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Alcohol Consumption and Mortality in the Korean Multi-center Cancer Cohort Study
En-Joo Jung, Aesun Shin, Sue K. Park, Seung-Hyun Ma, In-Seong Cho, Boyoung Park, Eun-Ha Lee, Soung-Hoon Chang, Hai-Rim Shin, Daehee Kang, Keun-Young Yoo
J Prev Med Public Health. 2012;45(5):301-308.   Published online September 28, 2012
DOI: https://doi.org/10.3961/jpmph.2012.45.5.301
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AbstractAbstract PDF
Objectives

To examine the association between alcohol consumption habit, types of beverages, alcohol consumption quantity, and overall and cancer-specific mortality among Korean adults.

Methods

The alcohol consumption information of a total of 16 320 participants who were 20 years or older from the Korean Multi-center Cancer Cohort were analyzed to examine the association between alcohol consumption habit and mortality (median follow-up of 9.3 years). The Cox proportional hazard model was used to estimate the hazard ratio (HR) of alcohol consumption to mortality adjusting for age, sex, geographic areas, education, smoking status, and body mass index.

Results

Alcohol drinkers showed an increased risk for total mortality compared with never drinkers (HR, 1.72; 95% confidence interval [CI], 1.38 to 2.14 for past drinkers; HR, 1.21; 95% CI, 1.06 to 1.39 for current drinkers), while past drinkers only were associated with higher risk for cancer deaths (HR, 1.84; 95% CI, 1.34 to 2.53). The quantity of alcohol consumed per week showed a J-shaped association with risk of mortality. Relative to light drinkers (0.01 to 90 g/wk), never drinkers and heavy drinkers (>504 g/wk) had an increased risk for all-cause and cancer deaths: (HR, 1.18; 95% CI, 0.96 to 1.45) and (HR, 1.39; 95% CI, 1.05 to 1.83) for all-cause mortality; and (HR, 1.55; 95% CI, 1.15 to 2.11) and (HR, 2.07; 95% CI, 1.39 to 3.09) for all cancer mortality, respectively. Heavy drinkers (>504 g/wk) showed an elevated risk for death from stomach and liver cancers.

Conclusions

The present study supports the existence of a J-shaped association between alcohol consumption quantity and the risk of all-cause and cancer deaths. Heavy drinkers had an increased risk of death from cancer overall and liver and stomach cancer.

Summary

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Research Support, Non-U.S. Gov't
Reliability and Data Integration of Duplicated Test Results Using Two Bioelectrical Impedence Analysis Machines in the Korean Genome and Epidemiology Study.
Boyoung Park, Jae Jeong Yang, Ji Hyun Yang, Jimin Kim, Lisa Y Cho, Daehee Kang, Chol Shin, Young Seoub Hong, Bo Youl Choi, Sung Soo Kim, Man Suck Park, Sue K Park
J Prev Med Public Health. 2010;43(6):479-485.
DOI: https://doi.org/10.3961/jpmph.2010.43.6.479
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AbstractAbstract PDF
OBJECTIVES
The Korean Genome and Epidemiology Study (KoGES), a multicenter-based multi-cohort study, has collected information on body composition using two different bioelectrical impedence analysis (BIA) machines. The aim of the study was to evaluate the possibility of whether the test values measured from different BIA machines can be integrated through statistical adjustment algorithm under excellent inter-rater reliability. METHODS: We selected two centers to measure inter-rater reliability of the two BIA machines. We set up the two machines side by side and measured subjects' body compositions between October 2007 and December 2007. Duplicated test values of 848 subjects were collected. Pearson and intra-class correlation coefficients for inter-rater reliability were estimated using results from the two machines. To detect the feasibility for data integration, we constructed statistical compensation models using linear regression models with residual analysis and R-square values. RESULTS: All correlation coefficients indicated excellent reliability except mineral mass. However, models using only duplicated body composition values for data integration were not feasible due to relatively low R2 values of 0.8 for mineral mass and target weight. To integrate body composition data, models adjusted for four empirical variables that were age, sex, weight and height were most ideal (all R2>0.9). CONCLUSIONS: The test values measured with the two BIA machines in the KoGES have excellent reliability for the nine body composition values. Based on reliability, values can be integrated through algorithmic statistical adjustment using regression equations that includes age, sex, weight, and height.
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    Jae-Moon Bae
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Multicenter Study
Cigarette Smoking and Mortality in the Korean Multi-center Cancer Cohort (KMCC) Study.
Eun Ha Lee, Sue K Park, Kwang Pil Ko, In Seong Cho, Soung Hoon Chang, Hai Rim Shin, Daehee Kang, Keun Young Yoo
J Prev Med Public Health. 2010;43(2):151-158.
DOI: https://doi.org/10.3961/jpmph.2010.43.2.151
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AbstractAbstract PDF
OBJECTIVES
The aim of this study was to evaluate the association between cigarette smoking and total mortality, cancer mortality and other disease mortalities in Korean adults. METHODS: A total of 14 161 subjects of the Korean Multi-center Cancer Cohort who were over 40 years of age and who were cancer-free at baseline enrollment reported their lifestyle factors, including the smoking status. The median follow-up time was 6.6 years. During the follow-up period from 1993 to 2005, we identified 1159 cases of mortality, including 260 cancer mortality cases with a total of 91 987 person-years, by the national death certificate. Cox proportional hazard regression model was used to estimate the hazard ratio (HR) of cigarette smoking for total mortality, cancer mortality and disease-specific mortality, as adjusted for age, gender, the geographic area and year of enrollment, the alcohol consumption status, the education level and the body mass index (BMI). RESULTS: Cigarette smoking was significantly associated with an increased risk of total mortality, all-cancer mortality and lung cancer mortality (p-trend, <0.01, <0.01, <0.01, respectively). Compared to non-smoking, current smokers were at a higher risk for mortality [HR (95% CI)=1.3 (1.1-1.5) for total mortality; HR (95% CI)=1.6 (1.1-2.2) for all-cancer mortality; HR (95% CI)=3.9 (1.9-7.7) for lung cancer mortality]. CONCLUSIONS: This study's results suggest that cigarette smoking might be associated with total mortality, all-cancer mortality and especially lung cancer mortality among Korean adults.
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Review
Identification and Application of Biomarkers in Molecular and Genomic Epidemiologic Research.
Kyoung Mu Lee, Sohee Han, Woong Yang Park, Daehee Kang
J Prev Med Public Health. 2009;42(6):349-355.
DOI: https://doi.org/10.3961/jpmph.2009.42.6.349
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AbstractAbstract PDF
Biomarkers are characteristic biological properties that can be detected and measured in a variety of biological matrices in the human body, including the blood and tissue, to give an indication of whether there is a threat of disease, if a disease already exists, or how such a disease may develop in an individual case. Along the continuum from exposure to clinical disease and progression, exposure, internal dose, biologically effective dose, early biological effect, altered structure and/or function, clinical disease, and disease progression can potentially be observed and quantified using biomarkers. While the traditional discovery of biomarkers has been a slow process, the advent of molecular and genomic medicine has resulted in explosive growth in the discovery of new biomarkers. In this review, issues in evaluating biomarkers will be discussed and the biomarkers of environmental exposure, early biologic effect, and susceptibility identified and validated in epidemiological studies will be summarized. The spectrum of genomic approaches currently used to identify and apply biomarkers and strategies to validate genomic biomarkers will also be discussed.
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    Bensu Karahalil, Ayşe Başak Engin, Erdem Coşkun
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Evaluation Studies
Stability and Intra-Individual Variation of Urinary Malondialdehyde and 2-Naphthol.
Kyoung Ho Lee, Daehee Kang
J Prev Med Public Health. 2008;41(3):195-199.
DOI: https://doi.org/10.3961/jpmph.2008.41.3.195
  • 5,534 View
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AbstractAbstract PDF
OBJECTIVES
Malondialdehyde (MDA), a lipid peroxidation by-product, has been widely used as an indicator of oxidative stress. Urinary 2-naphthol, a urinary PAH metabolite, is used as a marker of ambient particulate exposure and is associated with lung cancer and chronic obstructive pulmonary disease. However, the stability and intra-individual variation associated with urinary MDA and 2-naphthol have not been thoroughly addressed. The objective of this study was to assess the stability and intraindividual variation associated with urinary MDA and 2-naphthol. METHODS: Urine samples were collected from 10 healthy volunteers (mean age 34, range 27~42 years old). Each sample was divided into three aliquots and stored under three different conditions. The levels of urinary MDA and 2-naphthol were analyzed 1) just after sampling, 2) after storage at room temperature (21degrees C) for 16 hours, and 3) after storage in a -20degrees C freezer for 16 hours. In addition, an epidemiological study was conducted in 44 Chinese subjects over a period of 3 weeks. The urinary MDA and 2-naphthol were measured by HPLC three times. RESULTS: There was no difference in the levels of urinary MDA and 2-naphthol between the triplicate measurements (n=10, p=0.84 and p=0.83, respectively). The intra-class correlation coefficients (ICC) for urinary MDA and 2-naphthol were 0.74 and 0.42, respectively. However, the levels of PM2.5 in the air were well correlated with the levels of both MDA and 2-naphthol in the epidemiological study. CONCLUSIONS: These results suggest that urinary MDA and 2-naphthol remain stable under variable storage conditions, even at room temperature for 16 hours, and indicate that these markers can be used in epidemiological studies involving various sample storage conditions. The intra-CC of urinary 2-naphthol and MDA were acceptable for application to epidemiological studies.
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    Kyoung-Ho Lee, Xiao-Ou Shu, Yu-Tang Gao, Bu-Tian Ji, Gong Yang, Aaron Blair, Nathaniel Rothman, Wei Zheng, Wong-Ho Chow, Daehee Kang
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Multicenter Study
Cigarette Smoking and Gastric Cancer Risk in a Community-based Cohort Study in Korea.
Yeonju Kim, Aesun Shin, Jin Gwack, Jae Kwan Jun, Sue Kyung Park, Daehee Kang, Hai Rim Shin, Soung Hoon Chang, Keun Young Yoo
J Prev Med Public Health. 2007;40(6):467-474.
DOI: https://doi.org/10.3961/jpmph.2007.40.6.467
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AbstractAbstract PDF
OBJECTIVES
Gastric cancer is the most common incident cancer in Korea. Although Helicobacter pylori infection is the most important risk factor for the development of gastric cancer, cigarette smoking has also been suggested to play an important role in the development of gastric cancer. The objective of this study is to evaluate the relationship between cigarette smoking and gastric cancer risk in a Korean population. METHODS: The study population consisted of 13,785 subjects who had been enrolled in the Korean Multi-Center Cancer Cohort between 1993 and 2002. As of December 2002, 139 incident gastric cancer cases were ascertained through the Korea Central Cancer Registry and the National Death Certificate Database. Relative risks (RR) and 95% confidence intervals (CI) for gastric cancer were estimated using CoxZs proportional hazard model adjusted for age, education, alcohol drinking status and history of gastritis or ulcer. RESULTS: Significant dose-response relationships were observed between the duration of smoking and the risk of gastric cancer among the male subjects in comparison to non-smokers: men who smoked for 20-39 years had a 2.09- fold (95% CI 1.00-4.38) increase, and those who smoked for more than 40 years had a 3.13-fold (95% CI 1.59-6.17) increase in the risk of gastric cancer (Ptrend<0.01). CONCLUSIONS: This study suggests that a longer duration of cigarette smoking may increase the risk of gastric cancer development in a dose-response manner in Korean men. The association between smoking and gastric cancer risk in women should be verified in future studies with a larger number of cases.
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