Journal of Preventive Medicine and Public Health

Original Articles

Sex-specific Associations Between Serum Hemoglobin Levels and the Risk of Cause-specific Death in Korea Using the National Health Insurance Service-National Health Screening Cohort (NHIS HEALS): Yoonsuk An, Jieun Jang, Sangjun Lee, Sungji Moon, Sue K. Park; J Prev Med Public Health. 2019;52(6):393-404. Published online November 1, 2019; DOI: https://doi.org/10.3961/jpmph.19.146

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Abstract Summary PDF Supplementary Material

Objectives
The purpose of this study was to determine the associations between blood hemoglobin (Hgb) levels and the risk of death by specific causes.
Methods
Using the National Health Insurance Services-National Health Screening Cohort (n=487 643), we classified serum Hgb levels into 6 sex-specific groups. Cox regression analysis was used to analyze the associations between Hgb levels and the risk of cause-specific death.
Results
Hgb levels in male population showed a U-shaped, J-shaped, or inverse J-shaped association with the risk of death from ischemic heart disease, acute myocardial infarction, liver cancer, cirrhosis and chronic obstructive pulmonary disease (COPD) (all non-linear p<0.05; hazard ratio [HR]; 95% confidence interval [CI]) for the lowest and the highest Hgb levels for the risk of each cause of death in male population: HR, 1.14; 95% CI, 0.98 to 1.34; HR, 2.87; 95% CI, 1.48 to 5.57; HR, 1.16; 95% CI, 0.96 to 1.40; HR, 3.05; 95% CI, 1.44 to 6.48; HR, 1.36; 95% CI, 1.18 to 1.56; HR, 2.11; 95% CI, 1.05 to 4.26; HR, 3.64; 95% CI, 2.49 to 5.33; HR, 5.97; 95% CI, 1.44 to 24.82; HR, 1.62; 95% CI, 1.14 to 2.30; HR, 3.84; 95% CI, 1.22 to 12.13, respectively), while in female population, high Hgb levels were associated with a lower risk of death from hypertension and a higher risk of death from COPD (overall p<0.05; HR, 1.86; 95% CI, 1.29 to 2.67 for the lowest Hgb levels for hypertension; overall p<0.01, HR, 6.60; 95% CI, 2.37 to 18.14 for the highest Hgb levels for COPD). For the risk of lung cancer death by Hgb levels, a linear negative association was found in male population (overall p<0.01; the lowest Hgb levels, HR, 1.17; 95% CI, 1.05 to 1.33) but an inverse J-shaped association was found in female population (non-linear p=0.01; HR, 1.25; 95% CI, 0.96 to 1.63; HR, 2.58; 95% CI, 1.21 to 5.50).
Conclusions
Both low and high Hgb levels were associated with an increased risk of death from various causes, and some diseases showed different patterns according to sex.

Summary

Korean summary
본 연구는 2002년 및 2003년 한국 국민건강보험공단 건강검진 수검자 코호트(NHIS-HEALS)를 이용하여 총 487,643명을 대상으로 2013년 말일까지의 통계청 사망자료 추적관찰 기반 혈중 헤모글로빈과 전체, 심뇌혈관, 암, 기타 질환의 (만성 폐쇄성 폐질환, 간경화증) 사망위험 간 상관관계를 성별 층화하여 콕스회귀모형으로 분석하였음. 연구 결과 남성에서는 낮은 헤모글로빈 및 높은 헤모글로빈 농도와 허혈성 심질환, 심근경색, 간암, 간경화증, 그리고 만성 폐쇄성 폐질환 사망위험이 통계적으로 유의하게 증가함을 보인 반면, 여성에서는 낮은 헤모글로빈 농도에서는 고혈압, 높은 헤모글로빈 농도에서는 만성 폐쇄성 폐질환 사망위험도가 통계적으로 유의하게 증가하였음.결과적으로 낮은 그리고 높은 헤모글로빈 농도가 기존에 알려져 있던 심혈관질환의 사망위험에 영향을 주었을 뿐만 아니라 암 질환 및 기타 다른 질환들의 사망위험에도 영향을 주는 것으로 나타났기에 혈중 헤모글로빈 농도가 사망위험도의 잠재적인 예측인자로써의 가능성을 보였음. 주요 단어: 헤모글로빈, 빈혈, 사망, 성별, 한국인

Citations

Citations to this article as recorded by

Cross-phenotype association analysis of gastric cancer: in-silico functional annotation based on the disease–gene network
Sangjun Lee, Han-Kwang Yang, Hyuk-Joon Lee, Do Joong Park, Seong-Ho Kong, Sue K. Park
Gastric Cancer.2023; 26(4): 517. CrossRef
1H-NMR metabolomics-based surrogates to impute common clinical risk factors and endpoints
D. Bizzarri, M.J.T. Reinders, M. Beekman, P.E. Slagboom, BBMRI-NL, E.B. van den Akker
eBioMedicine.2022; 75: 103764. CrossRef
Coronary Atherosclerotic Disease and Cancer: Risk Factors and Interrelation
Jinjing Li, Jieqiong Zhao, Yonghong Lei, Yan Chen, Miaomiao Cheng, Xiaoqing Wei, Jing Liu, Pengyun Liu, Ruirui Chen, Xiaoqing Yin, Lei Shang, Xue Li
Frontiers in Cardiovascular Medicine.2022;[Epub] CrossRef
Binary cutpoint and the combined effect of systolic and diastolic blood pressure on cardiovascular disease mortality: A community-based cohort study
Ju-Yeun Lee, Ji Hoon Hong, Sangjun Lee, Seokyung An, Aesun Shin, Sue K. Park, Tariq Jamal Siddiqi
PLOS ONE.2022; 17(6): e0270510. 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

7,135 View
134 Download
3 Crossref

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.

Citations

Citations to this article as recorded by

Binary cutpoint and the combined effect of systolic and diastolic blood pressure on cardiovascular disease mortality: A community-based cohort study
Ju-Yeun Lee, Ji Hoon Hong, Sangjun Lee, Seokyung An, Aesun Shin, Sue K. Park, Tariq Jamal Siddiqi
PLOS ONE.2022; 17(6): e0270510. CrossRef
Hypertension, the renin–angiotensin system, and the risk of lower respiratory tract infections and lung injury: implications for COVID-19
Reinhold Kreutz, Engi Abd El-Hady Algharably, Michel Azizi, Piotr Dobrowolski, Tomasz Guzik, Andrzej Januszewicz, Alexandre Persu, Aleksander Prejbisz, Thomas Günther Riemer, Ji-Guang Wang, Michel Burnier
Cardiovascular Research.2020; 116(10): 1688. CrossRef
Prevalence of hypertension, levels of lipids and blood glucose in patients with acute pancreatitis, chronic pancreatitis and pancreatic cancer
I. N. Grigorieva, O. V. Efimova, T. S. Suvorova, N. L. Tov, T. I. Romanova
Russian Journal of Cardiology.2020; 25(6): 3823. CrossRef

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