Annals of Occupational and Environmental Medicine

Original Article

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; Ann Occup Environ Med 2023;35:e35. Published online August 21, 2023; DOI: https://doi.org/10.35371/aoem.2023.35.e35

Abstract Abstract in Korean PDF PubReader ePub: Background
Cardio-cerebrovascular diseases (CVDs) are the most common cause of death worldwide. Various CVD risk assessment tools have been developed. In South Korea, the Korea Occupational Safety & Health Agency (KOSHA) and the National Health Insurance Service (NHIS) have provided CVD risk assessments with health checkups. Since 2018, the KOSHA guide has stated that NHIS CVD risk assessment tool could be used as an alternative of KOSHA assessment tool for evaluating CVD risk of workers. The objective of this study was to determine the correlation and agreement between the KOSHA and the NHIS CVD risk assessment tools.
Methods
Subjects of this study were 17,485 examinees aged 20 to 64 years who had undergone medical examinations from January 2021 to December 2021 at a general hospital. We classified subjects into low-risk, moderate-risk, high-risk, and highest-risk groups according to KOSHA and NHIS’s CVD risk assessment tools. We then compared them with cross-analysis, Spearman correlation analysis, and linearly weighted kappa coefficient.
Results
The correlation between KOSHA and NHIS tools was statistically significant (p-value < 0.001), with a correlation coefficient of 0.403 and a kappa coefficient of 0.203. When we compared risk group distribution using KOSHA and NHIS tools, CVD risk of 6,498 (37.1%) participants showed a concordance. Compared to the NHIS tool, the KOSHA tool classified 9,908 (56.7%) participants into a lower risk category and 1,079 (6.2%) participants into a higher risk category.
Conclusions
In this study, KOSHA and NHIS tools showed a moderate correlation with a fair agreement. The NHIS tool showed a tendency to classify participants to higher CVD risk group than the KOSHA tool. To prevent CVD more effectively, a higher estimation tool among verified CVD risk assessment methods should be selected and managements such as early intervention and treatment of risk factors should be performed targeting the high-risk group.; 일개 병원 건강검진 자료를 이용한 한국산업안전보건공단과 건강보험공단의 심뇌혈관질환 위험도 평가의 비교
목적
심뇌혈관질환은 전 세계적으로 가장 많은 사망원인으로, 국내외에서 다양한 위험도 예측모형이 개발되었다. 국내에서는 한국산업안전보건공단의 뇌심혈관계질환 발병위험도 평가와 건강보험공단의 심뇌혈관질환 위험 평가가 있으며, 국가건강검진과 함께 제공되고 있다. 한국산업안전보건공단은 2018년부터 건강보험공단의 심뇌혈관질환 위험 평가의 결과를 평가에 이용할 수 있도록 하고 있어, 두가지 위험도 평가도구를 비교하고 그 상관관계와 일치도를 확인하고자 하였다.
방법
이 연구는 경주의 일개 종합병원에서 2021년 1월부터 12월까지 건강검진을 시행한 17,485명의 수검자를 대상으로 하였다. 건강검진 결과를 이용하여 한국산업안전보건공단와 건강보험공단의 지침에 따라 위험도 평가를 실시하였으며, 저위험군, 중등도위험군, 고위험군, 최고위험군으로 분류하였다. 이후 각각의 위험도 평가에 따른 위험군에 대하여 교차분석 및 스피어만 상관분석, 그리고 선형가중카파를 이용한 일치도 분석을 실시하였다.
결과
한국산업안전보건공단과 건강보험공단의 위험도 평가도구의 상관관계와 일치도는 통계적으로 유의하게 나타났고(p-value < 0.001), 상관계수는 0.403, 카파계수는 0.203으로 나타났다. 두가지 도구의 위험군 분포를 비교하였을 때, 6,498명(37.2%)는 동일한 위험군으로 평가되었다. 건강보험공단의 도구에서 더 높은 위험군으로 평가한 경우는 9,908명(56.7%), 한국산업안전보건공단의 도구에서 더 높은 위험군으로 평가한 경우는 1,079명(6.2%)로 나타났다.
결론
이 연구에서 한국산업안전보건공단과 건강보험공단의 위험도 평가도구는 중간정도의 상관관계와 어느정도의 일치도를 보였다. 두가지 도구 중 한가지만 사용할 경우에는 도구와 수검자의 특성에 따른 신중한 선택이 필요하다. 두가지 도구 중 건강보험공단의 도구가 더 높은 위험군으로 평가하는 경향을 보였다. 검증된 두가지 도구 중 더 높은 위험군으로 평가하는 쪽을 선택함으로써 위험요인을 조기에 발견하고 관리한다면 심뇌혈관질환의 효과적인 예방에 도움이 될 것이다.

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Original Article

Risk assessment of heavy metals in tuna from Japanese restaurants in the Republic of Korea: Seong-Jin Bae, Kyu-Sik Shin, Chulyong Park, Kiook Baek, So-Young Son, Joon Sakong; Ann Occup Environ Med 2023;35:e3. Published online February 9, 2023; DOI: https://doi.org/10.35371/aoem.2023.35.e3

Abstract Abstract in Korean PDF Supplementary Material PubReader ePub

Background

Studies on the risk of mercury (Hg) in Korean fishery products focus primarily on total Hg levels as opposed to methylmercury (MeHg) levels. None of the few studies on MeHg in tuna investigated tuna from Japanese restaurants. Few have evaluated lead (Pb), cadmium (Cd) and arsenic (As) in tuna. Thus, this study aimed to conduct a risk assessment by evaluating heavy metal concentrations in tuna from Japanese restaurants.

Methods

Thirty-one tuna samples were collected from Japanese restaurants in the Republic of Korea. They were classified according to region and species. The concentration of heavy metals in the samples was analyzed using the Ministry of Food and Drug Safety Food Code method. The rate of exceedance of maximum residue levels (MRLs) and the risk compared to the provisional tolerable weekly intake (PTWI) set by the Joint Food and Agriculture Organization/World Health Organization Expert Committee on Food Additives (%PTWI) were evaluated for risk assessment.

Results

The mean of MeHg, Pb, Cd and As concentrations were 0.56 ± 1.47 mg/kg, 33.95 ± 3.74 μg/kg, 14.25 ± 2.19 μg/kg and 1.46 ± 1.89 mg/kg, respectively. No sample exceeded the MRLs of Pb and Cd, but 9.7% of the samples exceeded the MRL of MeHg. The %PTWIs of MeHg, Pb, Cd and As were 4.2037, 0.0162, 0.0244 and 1.1627, respectively. The %PTWI of MeHg by age group and sex was highest among men aged 19–29 years (10.6494), followed by men aged 30–49 years (7.2458) and women aged 19–29 years (4.8307).

Conclusions

We found that 3 out of 31 samples exceeded the MRL of MeHg. The %PTWI of MeHg showed significant differences based on age and sex, and the value was likely to exceed a safe level depending on individuals’ eating behaviors. Therefore, improved risk management for MeHg is required.

한국의 일식집 유통 참치의 중금속(4종) 위해성평가
목적
국내 수산물의 수은에 관한 위해성 연구는 주로 메틸수은이 아닌 총 수은을 대상으로 이루어졌다. 소수의 참치의 메틸수은에 대한 연구들 중 일식점 유통 참치에 대한 연구는 없었다. 참치의 납, 카드뮴 및 비소에 대한 연구도 거의 이루어지지 않았다. 따라서 본 연구에서는 일식점 유통 참치의 중금속 농도를 평가하여 위해성평가를 실시하고자 하였다.
방법
참치는 한국의 일식집에서 총 31개의 시료가 수집되었다. 지역과 참치의 종에 따라서 분류하였다. 시료의 중금속 농도는 식품의약품안전처의 식품공전에 따라 분석했다. 위해성평가를 위해서 식품의 잔류허용기준을 초과하는 비율과 FAO/WHO합동식품첨가물 전문가위원회가 설정한 잠정주간섭취허용과 비교한 위험도(%PTWI)를 산출하였다.
결과
메틸수은, 납, 카드뮴 및 비소 농도의 기하평균은 각각 0.56 ± 1.47 mg/kg, 33.95 ± 3.74 μg/kg, 14.25 ± 2.19 μg/kg 및 1.46 ± 1.89 mg/kg이었다. 납과 카드뮴의 경우 잔류허용기준을 초과하는 시료가 없었으나 메틸수은의 경우 시료의 9.7%가 초과했다. 메틸수은, 납, 카드뮴 및 비소의 %PTWI는 4.2037, 0.0162, 0.0244 및 1.1627이었다. 메틸수은의 %PTWI는 19-29세의 남성, 30-49세의 남성, 19-29세의 여성 순으로 높았으며, 그 값은 10.6494, 7.2458, 4.8307이었다.
결론
총 31개의 시료 중 3개에서 메틸수은의 잔류허용기준을 초과하는 것으로 나타났다. 메틸수은의 %PTWI는 연령과 성별에 따라 상당한 차이를 보였고, 그리고 그 값은 섭취행태에 따라서 안전 수준을 초과할 가능성을 보였다. 따라서, 메틸수은에 대한 개선된 안전성 관리 방안이 필요할 것으로 보인다.

Citations

Citations to this article as recorded by

Metal Load of Potentially Toxic Elements in Tuna (Thunnus albacares)—Food Safety Aspects
József Lehel, Zita Papp, András Bartha, Péter Palotás, Rita Szabó, Péter Budai, Miklós Süth
Foods.2023; 12(16): 3038. CrossRef

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Research Article

A global, cross cultural study examining the relationship between employee health risk status and work performance metrics: Ana Howarth, Jose Quesada, Peter R. Mills; Ann Occup Environ Med 2017;29:17. Published online June 12, 2017; DOI: https://doi.org/10.1186/s40557-017-0172-1

Abstract PDF Supplementary Material PubReader ePub

Background

Health risk assessments (HRA) are used by many organisations as a basis for developing relevant and targeted employee health and well-being interventions. However, many HRA’s have a western-centric focus and therefore it is unclear whether the results can be directly extrapolated to those from non-western countries. More information regarding the differences in the associations between country status and health risks is needed along with a more global perspective of employee health risk factors and well-being overall. Therefore we aimed to i) quantify and compare associations for a number of health risk factors based on country status, and then ii) explore which characteristics can aid better prediction of well-being levels and in turn workplace productivity globally.

Methods

Online employee HRA data collected from 254 multi-national companies, for the years 2013 through 2016 was analysed (n = 117,274). Multiple linear regression models were fitted, adjusting for age and gender, to quantify associations between country status and health risk factors. Separate regression models were used to assess the prediction of well-being measures related to productivity.

Results

On average, the developing countries were comprised of younger individuals with lower obesity rates and markedly higher job satisfaction compared to their developed country counterparts. However, they also reported higher levels of anxiety and depression, a greater number of health risks and lower job effectiveness. Assessment of key factors related to productivity found that region of residency was the biggest predictor of presenteeism and poor pain management was the biggest predictor of absenteeism.

Conclusions

Clear differences in health risks exist between employees from developed and developing countries and these should be considered when addressing well-being and productivity in the global workforce.

Electronic supplementary material

The online version of this article (doi:10.1186/s40557-017-0172-1) contains supplementary material, which is available to authorized users.

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Case Report

Risk assessment of gastric cancer associated with asbestosis: a case report: Soo-Hong Park, Dong-Mug Kang, Bon-Hak Koo, Young-Ki Kim, Jong-Eun Kim; Ann Occup Environ Med 2015;27:9. Published online March 13, 2015; DOI: https://doi.org/10.1186/s40557-015-0061-4

Abstract PDF PubReader ePub

Background

The International Agency for Research on Cancer classifies asbestos as belonging to Carcinogen Group 2A for gastric cancer. We herein report a case of gastric cancer associated with asbestosis and describe the work-related and risk assessments of asbestos exposure for gastric cancer.

Case presentation

The 66-year-old male patient in our case worked in asbestos spinning factories. His level of cumulated asbestos fiber exposure was estimated to be 38.0–71.0 f-yr/cc. Thus, the Excess Life Cancer Risk for lung cancer associated with asbestos exposure was 9,648×10⁻⁵, almost 9,600 times the value recommended by the United States of America Environmental Protection Agency (1 × 10⁻⁵). The relative risk of developing lung cancer for this patient was more than 25 f-yr/cc, a well-known criterion for doubling the risk of lung cancer.

Conclusion

The patient’s exposure to high-dose asbestos was sufficient to increase his risk of gastric cancer because as the risk of lung cancer increased, the risk of gastric cancer was due to increase as well. Therefore, occupational asbestos fiber exposure might be associated with gastric cancer in this case.

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Review

Work-related Musculoskeletal Disorders in Korea Provoked by Workers’ Collective Compensation Claims against Work Intensification: Dongmug Kang, Youngki Kim, Young-Il Lee, Sangbaek Koh, Inah Kim, Hoonkoo Lee; Ann Occup Environ Med 2014;26:19-19. Published online July 29, 2014; DOI: https://doi.org/10.1186/2052-4374-26-19

Abstract PDF PubReader ePub

This article presents the process of workers’ problems with work related musculoskeletal disorders (WMSDs), the introduction of risk assessments (RA) for their prevention, and the consequences of this process in Korea. In 1997, economic crisis caused a rapid increase of massive layoffs, worker dispatch system introduction, job insecurity, and use of irregular workers resulting in work intensification. Work intensification increased WMSDs, which created massive workers’ compensation collective claims. Workers argued for the reduction of work intensity. The RAs introduced as a consequence of the workers’ struggle is unique in the world. Whereas these RAs were expected to play a pivotal role in WMSDs prevention, they dis not due to workers’ lack of engagement after the compensation struggle. In fact, changes in the compensation judgment system and criteria have resulted in lower compensation approval rates leading to lower workers’ compensation claims. The Korean experience provides insight into WMSDs causes in a globalized world. In such a the globalized world, work intensification as the result of work flexibility could be an international trend.

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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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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

The Concentration of Cadmium in Urine, and Its Role in Health-risk Assessment of Residents in the Vicinity of Abandoned Mines in Gyeongsangbuk-do, Korea: Sung Ho Yun, Chang Yoon Kim, Tae Yoon Hwang, Kyu Chang Won, Jun Young Do, Se Jin Lee, Yeong Mog Park, Kwan Soo Jun, Gae Ho Lee, Do Young Lee, Kwang Seub Park, Joon Sakong; Korean Journal of Occupational and Environmental Medicine 2010;22(3):251-261. Published online September 30, 2010; DOI: https://doi.org/10.35371/kjoem.2010.22.3.251

Abstract PDF

OBJECTIVES
This study was conducted to assess the concentration of urine cadmium and health risks of residents in the vicinity of abandoned metal mines in Gyeongsangbuk-do.
METHODS
The concentration of cadmium in the soil, water, and agricultural crops was measured in Gyeongsangbuk-do, Butdeun and Suksan, which have abandoned metal mines. We measured the concentration of cadmium in the urine of residents from the following areas: 78 from village A, 99 from village C and 147 from control areas. Other health-risk assessments were performed on each resident, such as measuring the concentration of beta2-MG and a bone density test.
RESULTS
In abandoned mine areas, the mean concentration of cadmium was higher in agricultural soil and in the crops than in that of control areas. The concentration of cadmium in the stream exceeded the guideline level. In regard to provisional tolerable daily intake (PTDI) of cadmium, the actual intake rate through crops was 33.81%, 72.74% in abandoned mine areas and 5.03%, 6.16% in control areas. Residents in abandoned mine areas, A village and C village had a geometric mean of urine Cd of 1.90 microgram/g cr and 1.45 microgram/g cr. These measurements were significantly higher than those of residents in control areas, B village and D village, 0.59 microgram/g cr and 0.65 microgram/g cr (p<0.01). Following adjustments for age, sex, smoking habit, and occupational history, the concentration of urine cadmium of residents in the Butdeun abandoned meta mine was higher by 1.62 microgram/g cr as compared with the control group (p<0.01). Residents from the Suksan abandoned metal mine also had a higher concentration by 1.07 microgram/g cr (p<0.01). A multiple linear regression analysis was performed for the factors associated with T-score, and this showed that the concentration of urine cadmium was not an influential factor.
CONCLUSIONS
Based on these measurements, areas with abandoned metal mines contaminated streams, agricultural soil, and crops of the adjacent areas, with cadmium. Because residents in the adjacent areas intake contaminated crops, their urine cadmium was increased. Despite a lack of evidence demonstrating the detrimental effect of increased urine cadmium in residents, an additional study is needed to assess the health risks of residents in the vicinity of abandoned metal mines.

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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

A Comparison of KOSHA's Cardiovascular Disease Risk Assessment and the Predicted 10-year Risk of Cardiovascular Disease Developed by Jee for a Male Workers at a Wallpaper and Floor Covering Manufacturer: Kyungjin Yi, Hyeontaeck Heo, Dongwon Kim, Inah Kim, Sooyoung Kim, Junrae Rho, Jehyeok Mun; Korean Journal of Occupational and Environmental Medicine 2009;21(2):174-183. Published online June 30, 2009; DOI: https://doi.org/10.35371/kjoem.2009.21.2.174

Abstract PDF

OBJECTIVES
This study was conducted to evaluate the relationship between KOSHA's cardiovascular disease risk assessment and the predicted 10-year risk of cardiovascular disease developed by Jee. SUBJECTS AND METHODS: Data were obtained from a structured questionnaire survey and medical examination of 509 male workers aged 30-59 years employed at a wallpaper and floor covering workplace in May 2008. We calculated KOSHA's cardiovascular disease risk assessment and Jee's predicted 10-year risk of cardiovascular disease. A high risk of cardiovascular disease was defined as the upper 10th percentile of Jee's predicted 10-year risk of cardiovascular disease. Statistical analysis was conducted using the Wilcoxon rank sum test, Kruskal Wallis test and a logistic regression model.
RESULTS
Jee's predicted 10-year risk of cardiovascular disease significantly increased as KOSHA's cardiovascular disease risk increased. Logistic regression analysis indicated that the group with 3 or more cardiovascular disease risk factors according to KOSHA's model was more likely to experience cardiovascular disease within 10 years(OR=34.4, 95% C.I.=4.4-267.2).
CONCLUSIONS
KOSHA's cardiovascular disease risk assessment was fairly well associated with Jee's predicted 10-year risk of cardiovascular disease and was believed to be a practical and convenient method of preventing cardiovascular disease at the workplace.

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Annals of Occupational and Environmental Medicine.2022;[Epub] CrossRef

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Original Article

Development of a Baseline Checklist for CTD Risk Assessment: Donghyun Park, Sang Hwan Han, Dong Bin Song; Korean Journal of Occupational and Environmental Medicine 1998;10(2):251-266. Published online May 31, 1998; DOI: https://doi.org/10.35371/kjoem.1998.10.2.251

Abstract PDF: Today, CTDs (Cumulative Trauma Disorders) are one of major hazards in the US and European Industries disrupting work schedules, productivity and increasing workers compensation costs. The increase in injuries and their associated costs has led companies to form committees and implement programs to address this problem. Therefore, it is important that quantitative analysis tools help identify and assess industrial tasks that pose risk to workers. However, the process of quantifying risk in upper limb tasks is still in its infancy stage and calls for better measurement techniques are not going unheard. As the first work of quantification, baseline CTD checklist for risk assessment was developed in this study. It was mainly based on previous literature regarding CTDs. The checklist was unique in that its expected user was industrial hygienist who did not have much ergonomic background and in that it was targeted to Korean workers in various types of industries. As the first application of the checklist, some jobs in two industries (VDT, heavy Industry) were evaluated, and compared with the medical data. Eighteen out of thirty items in the checklist was univariately significant (p<0.05) on the results of medical examinations. The correlation between medical data and total risk score from the checklist was 0.62. The feasibility of its use by an industrial hygienist was also checked by comparing with the results by an ergonomist. Their correlation (on the basis of Kendall's tau-b) in terms of total risk score was 0.74. The checklist in this study shows reasonably good performance for the first trial. Further research will have to include continuous refinement and validation for many more industries and many more jobs.

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