Annals of Occupational and Environmental Medicine

Original Article

Overall and cardiovascular mortality according to 10-year cardiovascular risk of the general health checkup: the Kangbuk Samsung Cohort Study: Youshik Jeong, Yesung Lee, Eunchan Mun, Eunhye Seo, Daehoon Kim, Jaehong Lee, Jinsook Jeong, Woncheol Lee; Ann Occup Environ Med 2022;34:e40. Published online November 23, 2022; DOI: https://doi.org/10.35371/aoem.2022.34.e40

Abstract Abstract in Korean PDF PubReader ePub

Background

According to the occupational accident status analysis in 2020, of 1,180 occupational deaths, 463 were caused by cardiovascular disease (CVD). Workers should be assessed for CVD risk at regular intervals to prevent work-related CVD in accordance with the rules on occupational safety and health standards. However, no previous study has addressed risk and mortality. Therefore, this longitudinal study was conducted to evaluate the relationship between 10-year cardiovascular risk of the general health checkup and mortality.

Methods

The study included 545,859 participants who visited Kangbuk Samsung Total Healthcare Centers from January 1, 2002, to December 31, 2017. We performed 10-year cardiovascular risk assessment for the participants and the risk was divided into 4 groups (low, moderate, high, and very high). The study used death data from the Korea National Statistical Office for survival status as an outcome variable by December 31, 2019, and the cause of death based on the International Classification of Diseases, 10^th Revision (ICD-10) was identified. Statistical analysis was performed using Cox proportional hazards regression analysis, and the sum of the periods from the first visit to the date of death or December 31, 2019, was used as a time scale. We also performed a stratified analysis for age at baseline and sex.

Results

During 5,253,627.9 person-years, 4,738 overall deaths and 654 cardiovascular deaths occurred. When the low-risk group was set as a reference, in the multivariable-adjusted model, the hazard ratios (HRs) (95% confidence interval [CI]) for overall mortality were 3.36 (2.87–3.95) in the moderate-risk group, 11.08 (9.27–13.25) in the high-risk group, and 21.20 (17.42–25.79) in the very-high-risk group, all of which were statistically significant. In cardiovascular deaths, the difference according to the risk classification was more pronounced. The HRs (95% CI) were 8.57 (4.95–14.83), 38.95 (21.77–69.69), and 78.81 (42.62–145.71) in each group. As a result of a subgroup analysis by age and sex, the HRs of all-cause mortality and cardiovascular mortality tended to be higher in the high-risk group.

Conclusions

This large-scale longitudinal study confirmed that the risk of death increases with the 10-year cardiovascular risk of general health checkup.

일반건강검진 10년 심뇌혈관질환 발병 위험도에 따른 사망률: 강북삼성 코호트 연구
목적
한국산업안전보건공단(KOSHA)의 2020년도 산업재해 현황 분석에 따르면 2020년도 업무상 질병 사망자 1,180명 중 심뇌혈관질환으로 인한 사망자는 463명으로 높은 비중을 차지하였다. 근로자는 산업안전보건기준에 관한 규칙에 의거하여 작업 관련 심뇌혈관질환 예방을 위해 정해진 주기에 따라 뇌심혈관질환 발병 위험도 평가 및 사후 관리를 받아야 한다. 하지만 발병 위험도와 사망률에 대한 기존 연구는 없었다. 따라서 이번 종단 연구는 일반건강검진 10년 심뇌혈관질환 발병 위험도와 사망률 간의 관계를 평가하기 위해 수행되었다.
방법
연구는 2002년 1월 1일부터 2017년 12월 31일까지 강북삼성병원 종합건진센터에 방문한 545,859명의 수검자들을 대상으로 이루어졌다. 연구 대상자들은 KOSHA 가이드라인에 따라 저위험군, 중등도위험군, 고위험군, 최고위험군 총 4개의 군으로 분류되었다. 연구는 강북삼성병원 코호트 자료와 연계된 통계청 사망자료를 이용하여 사망 여부와 사망원인을 확인하였다. 2019년 12월 31일까지의 사망 여부를 확인하여 결과변수로 정했고, 사망원인은 국제질병분류(ICD-10)를 기반으로 확인하였다. 통계 분석은 Cox 회귀 분석으로 하였고, 첫 방문부터 사망일 혹은 2019년 12월 31일까지의 기간들의 합산을 시간 척도로 사용하였다. 또한 나이와 성별에 대해 층화분석을 시행하였다.
결과
추적 관찰 기간 중앙값 9.07년 및 총 5,253,627.9인년 동안 발생한 전체 사망자는 4,738명, 심뇌혈관계 사망자는 654명이었다. 저위험군을 기준으로 하였을 때, 다변수 보정 모형에서 전체 사망의 위험비(HR)(95% 신뢰구간)는 중등도위험군에서 3.36 (2.87-3.95), 고위험군에서 11.08 (9.27-13.25), 최고위험군에서 21.20 (17.42-25.79)으로 통계적으로 유의했다. 심뇌혈관계 사망의 위험비는 각각의 군에서 8.57 (4.95-14.83), 38.95 (21.77-69.69), 78.81 (42.62-145.71)로 차이가 더 두드러지는 것으로 관찰되었다. 또한 나이와 성별의 층화분석을 시행하였을 때도 고위험군에서 전체 사망률과 심뇌혈관계 사망률이 더 높은 경향을 보였다.
결론
이번 대규모 종단 연구를 통해서 일반건강검진 10년 심뇌혈관질환 발병 위험도가 높을수록 실제 사망 위험이 증가한다는 것을 확인할 수 있었다.

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Eunyoung Park, Suwhan Kim, Seunghyeon Cho, Hyeonjun Kim, Inho Jung, Jai-Dong Moon, Won-Ju Park
Journal of Korean Medical Science.2023;[Epub] CrossRef

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Research Article

Association between depression and cardiovascular disease risk in general population of Korea: results from the Korea National Health and Nutrition Examination Survey, 2016: Jinho Song, Tae Hwan Koh, One Park, Daeil Kwon, Seonghoon Kang, Kyeongmin Kwak, Jong-Tae Park; Ann Occup Environ Med 2019;31:e10. Published online June 20, 2019; DOI: https://doi.org/10.35371/aoem.2019.31.e10

Abstract PDF Supplementary Material PubReader ePub

Background

Depression is considered as a risk factor for cardiovascular disease (CVD) and associated with changes in individuals' health status that might influence CVD risk. However, most studies have scrutinized this relationship on a rather narrower and specific study population. By focusing on general population of Korea, we sought to inspect the association of depression with CVD risk and cardiovascular risk factors.

Methods

The data from the first year (2016) of the 7th Korea National Health and Nutrition Examination Survey was used. Participants were classified by the Patient Health Questionnaire-9 (PHQ-9) score as such: normal group (PHQ-9 score 0–4), mild depression (MD) group (PHQ-9 score 5–9) and moderate and severe depression (MSD) group (PHQ-9 score 10–27). General linear model was used to analyze differences and the trend of mean CVD risk according to depression level. Adjusted odds ratios (AORs) were calculated by logistic regression to identify the association between depression and cardiovascular risk factors after adjusting for age.

Results

Mean CVD risk of MSD group was higher than that of normal group (p < 0.05). There was a tendency of CVD risk to increase as depression worsened (p < 0.01). Among men, MSD group was associated with current smoking (AOR, 2.97; 95% confidence interval [CI], 1.78–4.97), taking antihypertensive medications (AOR, 2.42; 95% CI, 1.26–4.66), increased fasting blood sugar (> 125 mg/dL; AOR, 2.37; 95% CI, 1.25–4.50) and taking diabetes medications (AOR, 3.08; 95% CI, 1.65–5.72). MD group was associated with current smoking (AOR, 1.60; 95% CI, 1.18–2.17). Among women, MSD group was associated with high body mass index (≥ 25 kg/m²; AOR, 1.61; 95% CI, 1.11–2.32), large waist circumference (≥ 85 cm; AOR, 1.63; 95% CI, 1.12–2.37), current smoking (AOR, 5.11; 95% CI, 3.07–8.52) and taking diabetes medications (AOR, 2.62; 95% CI, 1.68–4.08). MD group was associated with current smoking (AOR, 1.86; 95% CI, 1.18–2.93).

Conclusions

We suggest that depression is associated with increased risk for CVD occurrence in general population of Korea.

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Research Article

Cardiovascular Disease Risk of Bus Drivers in a City of Korea: Seung Yong Shin, Chul Gab Lee, Han Soo Song, Sul Ha Kim, Hyun Seung Lee, Min Soo Jung, Sang Kon Yoo; Ann Occup Environ Med 2013;25:34-34. Published online November 11, 2013; DOI: https://doi.org/10.1186/2052-4374-25-34

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Objective

To prevent the occurrence of CV events such as MI and stroke among professional drivers in Korea, bus drivers were compared to other occupations through the Framingham risk scoring system (FRS) or metabolic syndrome (MS) of cardiovascular disease (CVD) risk assessment methods.

Methods

In October 2012, a health examination survey was conducted for 443 male bus drivers in a big city. Their CVD risk factors were compared to those of a ‘total employed’ (A group) and ‘crafts and machine operators’ (B group) extracted from Fifth Korea National Health and Nutrition Examination Survey (KNHANES, 2010) data by using FRS and MS. We calculated proportions of the CVD risk factors distribution between bus drivers and the A, B groups by the bootstrapping method. The Odds ratio (OR) between CV event risk combining MS with CHD equivalent risk of FRS and occupational factors like shift patterns and professional driving duration/age ratios (PDAR) of bus drivers was calculated through multinominal logistic regression.

Results

The proportion of BMI ≥ 25 kg/m² was 53.9% and waist circumference ≥ 90cm was 40.9% among bus drivers. Hypertension and MS prevalence of bus drivers was 53.3%, 49.9% which is higher than 17.6%, 22.6% in the A group and 19.7%, 23.8% in the B group respectively. OR of high CV event risk in alternate shift was 2.58 (95% CI 1.33~5.00) in comparison with double shift pattern and OR in PDAR ≥ 0.5 was 2.18 (95% CI 1.15~4.14).

Conclusion

Middle aged male drivers in a big city of Korea stand a higher chance of developing CV event than other professions of the same age.

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Original Article

Risk Assessment for Cardiovascular Diseases in Male Workers: Comparing KOSHA Guidelines and the Framingham Risk Score System: In Yong Um, Won Jun Choi, Deul Lee, Jae Seok Oh, Min Kee Yi, Jong Wan Yoon, Sang Hwan Han; Korean Journal of Occupational and Environmental Medicine 2012;24(4):365-374. Published online December 31, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.4.365

Abstract PDF

OBJECTIVES
This study aimed to investigate the 10-year risk of cardiovascular disease (CVD) by Framingham risk score (FRS) who classified as "healthy group" by Korean Occupational Safety and Health Agent (KOSHA)' s cardiovascular risk assessment.
METHODS
The subjects of this study were 1,781 male workers in a large steel company. Health status was obtained periodically through medical examinations and questionnaires. We assessed cardiovascular risk using KOSHA guidelines and calculated the 10-year risk of cardiovascular disease using the Framingham risk score for those categorized to the "healthy group" by KOSHA guideline. A closer examination of cardiovascular risk factors was performed in 62 subjects paradoxically placed in the "healthy group" by KOSHA guidelines and the "high-risk group" by FRS.
RESULTS
Among the "healthy group" by KOSHA's cardiovascular risk assessment, 230(15.8%) subjects had more than 3 CVD risk factors and 62(4.2%) subjects were high risk group (more than 20%) in 10-years risk of CVD by Framingham risk score. Modifiable risk factors included cigarette smoking (96.8%), high serum total cholesterol (82.3%), high serum triglyceride (66.1%), insufficient physical activity (66.1%), and obesity (58.1%).
CONCLUSIONS
Among subjects with normal blood pressure, it seems that KOSHA guidelines underestimate CVD risk, identified by the Framingham risk score. For the effective prevention and management of CVD, modifiable risk factors, such as cigarette smoking, dyslipidemia, and obesity, need to be constructively controlled.

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Original Article

The Correlation of Cardiovascular Risk Factors and Hearing Loss: Sung Pil Jung, Soo Young Kim, Tae Yong Lee, Young Chae Cho, Dong Bae Lee; Korean Journal of Occupational and Environmental Medicine 1998;10(2):189-202. Published online May 31, 1998; DOI: https://doi.org/10.35371/kjoem.1998.10.2.189

Abstract PDF

To investigate the effects of cardiovascular risk factors on hearing loss, hearing threshold and cardiovascular risk factors such as blood pressure, hematologic values, and serum lipid levels of 3,827 persons who visited the Health Center of a University Hospital in Kumi for health examination from January 1, 1995 to July 31, 1997 were analysed. The results were summarized as follows ; 1. Hearing threshold was shifted highly in both sex groups with age increased. Smoking did not influence increase of hearing loss, but drinking alcohol amount increased hearing threshold when sex was adjusted. The most highly increased hearing threshold showed among farmers group, but next was blue collars group. Hearing threshold increasing basis with BMI increased. 2. Systolic and diastolic blood pressure and hematocrit value increased the hearing threshold in both sex groups, but hemoglobin value did not related to the hearing threshold. 3. Total cholesterol, LDL-cholesterol, triglyceride, and atherosclerosis index were significantly increased with the grade of hearing lose increased, when age was adjusted. 4. In the logistic regression analysis, the atherosclerosis index, age, and hematocrit value revealed risk factors which contributed in that orders, though the values were small they showed statistical significances, but the risks were lowered when hemoglobin values increased, in both sex groups. Consequently, hyperlipidemia was significantly related to the hearing loss when age was adjusted.

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Spatio-temporal Characteristics of the Frequency of Weather Types and Analysis of the Related Air Quality in Korean Urban Areas over a Recent Decade (2007-2016)
Hyeong-Sik Park, Sang-Keun Song, Seung-Beom Han, Seongbin Cho
Journal of Environmental Science International.2018; 27(11): 1129. CrossRef

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Original Article

The Effect of Day and Night Shift on Risk Factors of Cardiovascular Disease in Automobile: Manufacturing Plant Workers: Jae Haek Shin, Jung Jeung Lee, Kyeong Soo Lee, Joon Sakong, Chang Yoon Kim, Jong Hak Chung; Korean Journal of Occupational and Environmental Medicine 1995;7(1):28-45. Published online February 28, 1995; DOI: https://doi.org/10.35371/kjoem.1995.7.1.28

Abstract PDF: An investigation of effects of shift work on cardiovascular risk factors has been carried out on workers of a motor company in Ulsan, for 2 months from 20 April to 20 June,1993. This cross-sectional survey was designed to compare the shift workers (n=420) with day workers (n=88). The study subjects were drawn from workers who were employed in twelve hour shift system. A control group who never experienced shift work was drawn from different sections of the factory. Each worker completed a medical and occupational questionnaire and cardiovascular risk factors such as blood pressure, total cholesterol, triglyceride, apolipoprotein A-1 and B were measured. In univariate analysis, apolipoprotein B and the ratio of apolipoprotein B to apolipoprotem A-1 increased in shift workers. In multiple regression analysis for the systolic blood pressure, shift work was significant independent variable (p=0.059). In multiple regression analysis for the cholesterol, age and body mass index were significant independent variables(p<0.01), but shift work was not a statistically significant independent variable. In multiple regression analysis for the ratio of apolipoprotein B to apolipoprotein A-1, shift work was significant independent variable (p<0.05). Shift workers who have engaged in shift work more than 5 years have an excess of total cholesterol, apolipoprotein B and ratio of apolipoprotein B to apolipoprotein A-1 than those who have engaged in shift work less than 5 years (p<0.05). In multiple regression analysis for the cholesterol, duration of shift work was a significant independent variable (p=0.012). In multiple regression analysis for the apolipoprotein B and ratio of apolipoprotein B to apolipoprotein A-1, duration of shift work was not a significant independent variable.

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