Annals of Occupational and Environmental Medicine

Research Article

Comparison of risk-assessment tools for cardio-cerebrovascular diseases (CVD) in male shipyard workers: a cross-sectional study: Jea Chul Ha, Jun Seok Son, Young Ouk Kim, Chang Ho Chae, Chan Woo Kim, Hyoung Ouk Park, Jun Ho Lee, Young Hoo Shin, Hyun Woo Park; Ann Occup Environ Med 2019;31:e4. Published online May 23, 2019; DOI: https://doi.org/10.35371/aoem.2019.31.e4

Background

Periodic revision of assessment tools is essential to ensure risk assessment reliability and validity. Despite the recent revision of the Korea Occupational Safety and Health Agency (KOSHA) 2018, there is no evidence showing that the revision is superior to other cardio-cerebrovascular diseases (CVDs) risk-assessment tools for workplace health management. We conducted a comparative analysis using the Framingham risk score (FRS) as a gold standard to identify the most relevant CVDs risk-assessment tool for workplace health management.

Methods

We included 4,460 shipyard workers who had undergone a workers' health examination during January–December 2016. Risk levels for CVDs were calculated based on the FRS, KOSHA 2013, KOSHA 2017, KOSHA 2018 (2 methods), National Health Screening Program health risk appraisal (NHS HRA) 2017, and NHS HRA 2018. Study participants were categorized into low-risk, moderate-risk, or high-risk groups. Sensitivity, specificity, correlation, and agreement of each risk-assessment tool were calculated compared with the FRS as a gold standard. For statistical analyses, Spearman's rank correlation coefficient and the linearly weighted kappa coefficient were calculated.

Results

Sensitivity of the risk assessments was highest in the KOSHA 2018 (health risk appraisal [HRA]). The FRS showed correlation coefficients of 0.354 with the KOSHA 2013, 0.396 with the KOSHA 2017, 0.386 with the KOSHA 2018, 0.505 with the KOSHA 2018 (HRA), 0.288 with the NHS HRA 2017, and 0.622 with the NHS HRA 2018. Kappa values, calculated to examine the agreement in relation to the KOSHA 2013, KOSHA 2017, KOSHA 2018, KOSHA 2018 (HRA), NHS HRA 2017, and NHS HRA 2018 with the FRS, were 0.268, 0.322, 0.352, 0.136, 0.221, and 0.559, respectively.

Conclusions

The NHS HRA 2018 risk calculation method is a useful risk-assessment tool for CVDs, but only when appropriate classification criteria are applied. In order to enhance the risk-group identification capability of the KOSHA guideline, we propose to apply the classification criteria set in this study based on the risk group definition of the 2018 Korean Society of Hypertension guidelines for the management of hypertension instead of the current classification criteria of the KOSHA 2018.

Citations

Citations to this article as recorded by

Comparing Korea Occupational Safety & Health Agency and National Health Insurance Service’s cardio-cerebrovascular diseases risk-assessment tools using data from one hospital’s health checkups
Yunrae Cho, Dong Geon Kim, Byung-Chan Park, Seonhee Yang, Sang Kyu Kim
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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.

Citations

Citations to this article as recorded by

Comparing Korea Occupational Safety & Health Agency and National Health Insurance Service’s cardio-cerebrovascular diseases risk-assessment tools using data from one hospital’s health checkups
Yunrae Cho, Dong Geon Kim, Byung-Chan Park, Seonhee Yang, Sang Kyu Kim
Annals of Occupational and Environmental Medicine.2023;[Epub] CrossRef
Comparison of risk-assessment tools for cardio-cerebrovascular diseases (CVD) in male shipyard workers: a cross-sectional study
Jea Chul Ha, Jun Seok Son, Young Ouk Kim, Chang Ho Chae, Chan Woo Kim, Hyoung Ouk Park, Jun Ho Lee, Young Hoo Shin, Hyun Woo Park
Annals of Occupational and Environmental Medicine.2019;[Epub] CrossRef
Cardiovascular Disease According to Job Type and Life Style
Wan-Young Yoon
Journal of Digital Convergence.2016; 14(2): 501. CrossRef
The Assessment of Framingham Risk Score and 10 Year CHD Risk according to Application of LDL Cholesterol or Total Cholesterol
Se Young Kwon, Young Ak Na
Korean Journal of Clinical Laboratory Science.2016; 48(2): 54. CrossRef
10-Year Risk for Cardiovascular Disease Among Male Workers in Small-Sized Industries
Kyongok Park, Seon Young Hwang
Journal of Cardiovascular Nursing.2015; 30(3): 267. CrossRef

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Original Article

Comparison of Cardiovascular Disease Risk Assessment Tools by Using Coronary CT Angiography: Myeong Bo Kim, Won Ju Park, Keun Ho Jang, Dae Kwang Lee, Hong Jae Chae, Jai Dong Moon; Korean Journal of Occupational and Environmental Medicine 2010;22(2):102-113. Published online June 30, 2010; DOI: https://doi.org/10.35371/kjoem.2010.22.2.102

Abstract PDF

OBJECTIVE: The prevalence and mortality rate of cardiovascular disease (CVD) have increased among Koreans over the past 20 years. To manage and control this disease, various CVD risk assessment tools such as KOSHA (Korean Occupational Safety and Health Agent) CVD risk assessment, the presence of metabolic syndrome and the Framingham risk score (FRS) have been developed and applied to employees at the workplace. This study was designed to compare the validity of the CVD risk assessment tools mentioned above with the findings of coronary CT angiography (CCTA).
METHODS
The subjects of this study who were 490 male-workers aged between 31 and 70, and these subjects were selected among those who had visited a University Hospital for a general health examination and who underwent CCTA from January 2007 to June 2009. Chi-square tests and logistic regression analysis were used to compare and analyze the associations between the CVD risk assessment tools and the coronary artery changes such as calcification and stenosis.
RESULTS
Metabolic syndrome (OR=1.90, 95% CI 1.23-2.95) and the Framingham risk score (OR=2.71, 95% CI 1.83-4.01) were the significant and meaningful predictors of coronary artery calcification. On the analysis of the association with coronary artery stenosis, only the Framingham risk score (OR=2.21, 95% CI 1.46-3.36) turned out to be a significant and meaningful predictor.
CONCLUSION
The results suggest that the Framingham risk score is a relatively valid CVD risk assessment tool. Henceforth, to effectively manage cardiovascular diseases in the workplace, advanced tools and indicators for management should be considered and provided based on meaningful study results.

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Original Article

Framingham Risk Scores by Occupational Group: Based on the 3rd Korean National Health and Nutrition Examination Survey: Min Chul Choi, Yoon Hee Song, Sang Youl Rhee, Jeong Taek Woo; Korean Journal of Occupational and Environmental Medicine 2009;21(1):63-75. Published online March 31, 2009; DOI: https://doi.org/10.35371/kjoem.2009.21.1.63

Abstract PDF

OBJECTIVES
To find differences in Framingham risk scores which predict the probable risk of future cardiovascular disease, among three different occupational categories.
METHODS
Subjects were selected from respondents of the 3rd Korean National Health and Nutrition Examination Survey. A total of 2,059 employed people between 20 to 59 years old were selected. The occupational categories were professional and office workers, salespeople and service workers and technicians and elementary occupations. The Framingham risk score was calculated to find the risk of cardiovascular disease within the next 10 years. In addition socio-demographic characteristics, life-styles, the prevalence of chronic disease, and cardiovascular disease were compared among the occupational categories.
RESULTS
The average Framingham risk score was 2.77+/-6.44 for professional and office workers (n=771), 5.95+/-6.10 for salespeople and service workers (n=603) and 7.07+/-5.87 for technician and elementary occupations (n=685) Statistically significant multiple regression equations were derived (p<0.001).
CONCLUSIONS
Framingham risk scores of technicians and elementary occupations were highest which suggests that this occupational group has the highest risk of cardiovascular disease.

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