Journal of Preventive Medicine and Public Health

Original Article

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

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Abstract Summary PDF Supplementary Material

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

Summary

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

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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

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

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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

Cancer Incidence in Korean Vietnam Veterans During 1992-2003: The Korean Veterans Health Study: Sang-Wook Yi; J Prev Med Public Health. 2013;46(6):309-318. Published online November 28, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.6.309

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Abstract PDF

Objectives

The aim of this study was to investigate the association between Vietnam experience including exposure to military herbicides and cancer incidence in Korean Vietnam War veterans.

Methods

The cancer cases of 185 265 Vietnam veterans from January 1, 1992 to December 31, 2003 were confirmed from the Korea National Cancer Incidence Database. The age-adjusted incidence and standardized incidence ratios (SIRs) were calculated using the male population during 1992 to 2003 as a standard population.

Results

The age-adjusted overall cancer incidence per 100 000 person-years was 455.3 in Vietnam veterans. The overall cancer incidence was slightly yet significantly lower in veterans (SIR, 0.97; 95% confidence interval, 0.95 to 0.99) than in the general population. The overall cancer incidence in enlisted soldiers was not lower (SIR, 1.00), whereas that in officers was significantly lower (SIR, 0.87) than in the general population. The incidences of prostate cancer and T-cell lymphoma in all veterans, and lung cancer and bladder cancer in enlisted soldiers, and colon cancer and kidney cancer in non-commissioned officers, and colon cancer, kidney cancer, and prostate cancer in officers, were higher than in the general population. The SIR for overall cancer among Vietnam veterans rose from 0.92 for 1992-1997 to 0.99 for 1998-2003.

Conclusions

The overall cancer incidence in Vietnam veterans was not higher than in the general male population. Vietnam veterans and military rank subcohorts experienced a higher incidence of several cancers, including prostate cancer, T-cell lymphoma, lung cancer, bladder cancer, kidney cancer, and colon cancer than the general population. The SIR for overall cancer increased over time in Vietnam veterans.

Summary

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Serum 2,3,7,8-Tetrachlorodibenzo-p-dioxin Levels and Their Association With Age, Body Mass Index, Smoking, Military Record-based Variables, and Estimated Exposure to Agent Orange in Korean Vietnam Veterans: Sang-Wook Yi, Heechoul Ohrr, Jong-Uk Won, Jae-Seok Song, Jae-Seok Hong; J Prev Med Public Health. 2013;46(5):226-236. Published online September 30, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.5.226

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Abstract PDF

Objectives

The aim of this study was to examine the levels of serum 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and evaluate their association with age, body mass index, smoking, military record-based variables, and estimated exposure to Agent Orange in Korean Vietnam veterans.

Methods

Serum levels of TCDD were analyzed in 102 Vietnam veterans. Information on age, body mass index, and smoking status were obtained from a self-reported questionnaire. The perceived exposure was assessed by a 6-item questionnaire. Two proximity-based exposures were constructed by division/brigade level and battalion/company level unit information using the Stellman exposure opportunity index model.

Results

The mean and median of serum TCDD levels was 1.2 parts per trillion (ppt) and 0.9 ppt, respectively. Only 2 Vietnam veterans had elevated levels of TCDD (>10 ppt). The levels of TCDD did not tend to increase with the likelihood of exposure to Agent Orange, as estimated from either proximity-based exposure or perceived self-reported exposure. The serum TCDD levels were not significantly different according to military unit, year of first deployment, duration of deployment, military rank, age, body mass index, and smoking status.

Conclusions

The average serum TCDD levels in the Korean Vietnam veterans were lower than those reported for other occupationally or environmentally exposed groups and US Vietnam veterans, and their use as an objective marker of Agent Orange exposure may have some limitations. The unit of deployment, duration of deployment, year of first deployment, military rank, perceived self-reported exposure, and proximity-based exposure to Agent Orange were not associated with TCDD levels in Korean Vietnam veterans. Age, body mass index and smoking also were not associated with TCDD levels.

Summary

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A critical review of the epidemiology of Agent Orange or 2,3,7,8-tetrachlorodibenzo-p-dioxin and lymphoid malignancies
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Agent Orange Exposure and Prevalence of Self-reported Diseases in Korean Vietnam Veterans: Sang-Wook Yi, Heechoul Ohrr, Jae-Seok Hong, Jee-Jeon Yi; J Prev Med Public Health. 2013;46(5):213-225. Published online September 30, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.5.213

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Abstract PDF

Objectives

The aim of this study was to evaluate the association between Agent Orange exposure and self-reported diseases in Korean Vietnam veterans.

Methods

A postal survey of 114 562 Vietnam veterans was conducted. The perceived exposure to Agent Orange was assessed by a 6-item questionnaire. Two proximity-based Agent Orange exposure indices were constructed using division/brigade-level and battalion/company-level unit information. Adjusted odds ratios (ORs) for age and other confounders were calculated using a logistic regression model.

Results

The prevalence of all self-reported diseases showed monotonically increasing trends as the levels of perceived self-reported exposure increased. The ORs for colon cancer (OR, 1.13), leukemia (OR, 1.56), hypertension (OR, 1.03), peripheral vasculopathy (OR, 1.07), enterocolitis (OR, 1.07), peripheral neuropathy (OR, 1.07), multiple nerve palsy (OR, 1.14), multiple sclerosis (OR, 1.24), skin diseases (OR, 1.05), psychotic diseases (OR, 1.07) and lipidemia (OR, 1.05) were significantly elevated for the high exposure group in the division/brigade-level proximity-based exposure analysis, compared to the low exposure group. The ORs for cerebral infarction (OR, 1.08), chronic bronchitis (OR, 1.05), multiple nerve palsy (OR, 1.07), multiple sclerosis (OR, 1.16), skin diseases (OR, 1.05), and lipidemia (OR, 1.05) were significantly elevated for the high exposure group in the battalion/company-level analysis.

Conclusions

Korean Vietnam veterans with high exposure to Agent Orange experienced a higher prevalence of several self-reported chronic diseases compared to those with low exposure by proximity-based exposure assessment. The strong positive associations between perceived self-reported exposure and all self-reported diseases should be evaluated with discretion because the likelihood of reporting diseases was directly related to the perceived intensity of Agent Orange exposure.

Summary

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