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

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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Research Article

Risk factors associated with mortality from pneumonia among patients with pneumoconiosis: Bum Seak Jo, Jongin Lee, YounMo Cho, Junsu Byun, Hyoung Ryoul Kim, Jung Wan Koo, Jun Pyo Myong; Ann Occup Environ Med 2016;28:19. Published online April 7, 2016; DOI: https://doi.org/10.1186/s40557-016-0103-6

Abstract PDF

Background

The aim of this study was to evaluate factors associated with increased risk of mortality from pneumonia among patients with pneumoconiosis.

Methods

Medical records of 103 pneumoconiosis patients hospitalized for pneumonia were investigated. Seven patients who had lung cancer or other malignancy and 13 patients with insufficient medical record were excluded. Two female patients were excluded due to small number to analyze. The subjects were divided into two groups by clinical outcome of pneumonia, the deceased group and the survival group. The two groups were compared in terms of age, smoking history, episode of recent pneumonia, concomitancy of interstitial fibrosis or fungal ball infection, extent of small opacities, grade of large opacities and results of spirometry. Multiple logistic regression was applied to determine the association between these variables and mortality from pneumonia.

Results

The deceased group showed more frequent history of recent pneumonia (p = 0.006), higher prevalence of interstitial fibrosis (p = 0.007) and longer hospitalization period (p = 0.044). The proportion of subjects who had decreased FVC, less than 70 % of predicted value, was higher in the deceased group (p < 0.001). In multiple logistic regression, after adjusting age, smoking history, recent pneumonia, fungal ball, large opacity, profusion and FVC (or FEV₁) less than 70 % of predicted value, history of recent pneumonia, concomitancy of interstitial fibrosis, type of pneumoconiosis and fungal ball presented statistically significant association with mortality from pneumonia.

Conclusions

The concomitancy of fungal ball or interstitial fibrosis, history of recent pneumonia within last 90 days, type of pneumoconiosis, FVC less than 70 % of predicted value, FEV₁ less than 70 % of predicted value presented statistically significant association with mortality from pneumonia. More attention should be given to patients who have such factors when treating pneumonia with pneumoconiosis.

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Research Article

Public-health impact of outdoor air pollution for 2^nd air pollution management policy in Seoul metropolitan area, Korea: Jong Han Leem, Soon Tae Kim, Hwan Cheol Kim; Ann Occup Environ Med 2015;27:7. Published online February 27, 2015; DOI: https://doi.org/10.1186/s40557-015-0058-z

Abstract PDF

Objectives

Air pollution contributes to mortality and morbidity. We estimated the impact of outdoor air pollution on public health in Seoul metropolitan area, Korea. Attributable cases of morbidity and mortality were estimated.

Methods

Epidemiology-based exposure-response functions for a 10 μg/m3 increase in particulate matter (PM_2.5 and PM₁₀) were used to quantify the effects of air pollution. Cases attributable to air pollution were estimated for mortality (adults ≥ 30 years), respiratory and cardiovascular hospital admissions (all ages), chronic bronchitis (all ages), and acute bronchitis episodes (≤18 years). Environmental exposure (PM_2.5 and PM₁₀) was modeled for each 3 km × 3 km.

Results

In 2010, air pollution caused 15.9% of total mortality or approximately 15,346 attributable cases per year. Particulate air pollution also accounted for: 12,511 hospitalized cases of respiratory disease; 20,490 new cases of chronic bronchitis (adults); 278,346 episodes of acute bronchitis (children). After performing the 2^nd Seoul metropolitan air pollution management plan, the reducible death number associated with air pollution is 14,915 cases per year in 2024. We can reduce 57.9% of death associated with air pollution.

Conclusion

This assessment estimates the public-health impacts of current patterns of air pollution. Although individual health risks of air pollution are relatively small, the public-health consequences are remarkable. Particulate air pollution remains a key target for public-health action in the Seoul metropolitan area. Our results, which have also been used for economic valuation, should guide decisions on the assessment of environmental health-policy options.

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Original Article

Mortality Patterns among Korean Vietnam Veterans: Sang Wook Yi, Hee Choul Ohrr; Korean Journal of Occupational and Environmental Medicine 2011;23(3):279-286. Published online September 30, 2011; DOI: https://doi.org/10.35371/kjoem.2011.23.3.279

Abstract PDF

OBJECTIVES
A total of 320,000 Korean soldiers in three combat units and four supporting units participated in the Vietnam War. The aim of this study was to investigate the association between Vietnam experience and mortality by comparing mortalities in Korean Vietnam War veterans to the general population.
METHODS
The deaths of 185,760 Vietnam veterans from January 1, 1992 to December 31, 2005 were confirmed by matching the veterans' information to death records from the National Statistical Office. Crude death rate, age adjusted rate and Standardized mortality ratios (SMRs) were calculated 95% confidence. Age was standardized to the total male population during 1992-2005 with the age of 36 to 83 years old.
RESULTS
The age adjusted death rate per 100,000 was 868.1 among veterans and 1226.5 among the general population. Mortality of all causes was significantly lower among veterans (SMR=0.83, 95% CI: 0.82-0.84). Mortalities from neoplasms (SMR=0.87), circulatory diseases (SMR=0.79), and external causes of deaths (SMR=0.92) were significantly lower among veterans. Mortalities from several external causes of deaths including Intentional self-harm (X60-X84), assault and accidental poisoning, angina pectoris, chronic ischemic heart diseases, prostate cancer, and malignant neoplasms of hematopoietic system including multiple myeloma, non-Hodgkin's lymphoma, and leukemia were not different between veterans and the general population.
CONCLUSIONS
Mortality among Vietnam veterans was lower than that among the general population. It would be explained mainly by healthy veteran effect.

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Original Article

Suicide Trend of Standardized Mortality Ratio and Age Standardized Proportion Mortality Ratio According to Occupational Groups in Korea: 1993-2007: Jin Ha Yoon, Ki Hyun Lee, Kyu Yeon Hahn, Sei Jin Chang, Bong Suk Cha, Seong Ho Min, Kyung Suk Lee, Hye Seon Chae, Aeyong Eom, Sang Baek Koh; Korean Journal of Occupational and Environmental Medicine 2011;23(2):173-182. Published online June 30, 2011; DOI: https://doi.org/10.35371/kjoem.2011.23.2.173

Abstract PDF

OBJECTIVES
A number of studies on the trends of socioeconomic differences in suicide mortality have indicated that these inequality gaps have widened over time and highlight that certain occupations have more suicide risk than others. However suicide rates according to occupation based socioeconomic position have not been frequently studied in Korea. The purpose of this study is to report trends and inequality of suicide according to occupation based social class during 1993-2007 in Korea and to identify occupations with significantly high standardized mortality ratios (SMRs) and proportional mortality ratios (PMRs) for both men and women.
METHODS
Korean census records for the years 1995, 2000, and 2005 were linked with the cause of death records from Korean National Statistical Office (KNSO) for the periods 1993-1997, 1998-2003, and 2004-2007 respectively. This data was used to calculate age adjusted proportional mortality ratios (PMRs) and standardized mortality ratios (SMRs) for both men and women aged 25~54 years according to five occupation based socioeconomic positions.
RESULTS
Among men, the agricultural-fishery-forestry group had the greatest suicide rate (SMR: 341) with a high PMR (113) and the manual labor group showed the highest PMR (118), while the managers-professional occupation group showed the lowest sPMR (78) and SMR (21). Among women, the agricultural-fishery group had the highest score in SMR (316) and PMR (130), and the technical-artificer group showed the lowest sPMR (71) and SMR (27). The inequality gaps in the suicide mortality rate according to occupation had widened during 1998-2002, but showed a recovery trend plot after 2003.
CONCLUSIONS
Although the occupation based socioeconomic inequalities show a recovery trend after 2003, the excess inequality from suicide remains as high as it was prior to the 2002 year in some occupational groups. The results of the current study indicate that the manual and agricultural-fishery-forestry groups were high risk groups of suicide.

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Original Article

Effect of air pollution on daily mortality in Daegu (1993~1997): Mi Young Lee, Choong Won Lee, Suk Kwon Suh; Korean Journal of Occupational and Environmental Medicine 2000;12(2):235-248. Published online June 30, 2000; DOI: https://doi.org/10.35371/kjoem.2000.12.2.235

Abstract PDF

OBJECTIVES
In order to evaluate the relationship between daily mortality and air pollution in Deagu for the period by the data from January 1993 to December 1997.
METHODS
Deaths from accident(International Classification of Disease, Revision 9; 800-999 and Revision 10; V01- Y89) were excluded, Daily counts of deaths were analysed by general additive poisson model on the current day to 5 days before death, with controlling for effects of year, season, weather, weekday and holiday. The air pollutants examined included total suspended particulate (TSP), sulfur dioxide (SO,), nitrogen dioxide (NO,), carbon monoxide (CO) and ozone (03).
RESULTS
Mortality was associated with NO, SO and CO in the air. Total mortality was estimated to increase by 1. 6 % (95 % CI 0. 3-3 %) with each 10 ppb rise in NOy on the current day and the preceding 1 day, 9. 4 % (95 % CI 7 13 %) with each 100 ppb rise in SOy and 2. 7 % (95 % CI 0. 1 5 %) with each 1 ppm rise in CO on the current day. The NO was more evident for the elderly who were 65 years and more. Cardiovascular-specific mortality was associated with the levels of CO on the current day. Respiratory-specific mortality was associated with the levels of TSP and NO 5 days before death. Excess mortality risk is clearly evident in the upper range of NO levels and increased monotonically with NO.
CONCLUSIONS
This study suggested that the air pollution status below the current Korean ambient air quality standard might have an adverse effect on daily mortality. Then, it is impertive that the strategy for control of the air pollution-related daily mortality should be developed.

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Kyoung-Mu Lee, Moon-Young Park
Journal of Environmental Health Sciences.2022; 48(3): 138. CrossRef

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