Sun A Kim

Risk factors for falls in older Korean adults: the 2011 Community Health Survey.

Falls are a major health problem for elderly populations worldwide. We analyzed data from the 2011 Korean Community Health Survey to identify potential risk factors for falls in a representative population-based sample of community-dwelling older Korean adults. Risk factors for falls were assessed by multivariate survey logistic regression models. The prevalence of falls was 36.5% in males and 63.5% in females. Age and female sex were associated with a higher risk of falls. Similarly, living alone, living in an urban area, poor self-rated health, and high stress were associated with a high risk of falls. Subjects with diabetes mellitus, stroke, osteoarthritis, osteoporosis, urinary incontinence, cataracts, or depression had a high risk of falls. However, subjects with hypertension were at low risk for falls. In conclusion, age, female sex, marital status, residence location, self-rated health, stress, and several chronic conditions were significantly associated with the risk for falls in the older Korean adults. Our findings suggest that these risk factors should be addressed in public health policies for preventing falls. Graphical Abstract

Household and area income levels are associated with smoking status in the Korean adult population

BackgroundSome previous studies have suggested that area-level characteristics have effects on smoking. The aim of this study was to evaluate the associations between household income and area income on smoking in Korean adults.MethodsThis study was based on the Korean Community Health Survey (KCHS) performed in South Korea, between September and November 2009. In total, 222,242 subjects (103,124 men and 119,118 women) were included in the analysis. Information on smoking status was collected using a standardized questionnaire. Income status was determined by monthly household income. Household income was categorized as: <1 million won; <2 million won; <3 million won; and ≥3 million won. Area-level income categorized as quartiles. Data were analyzed using multilevel regression models. The analysis was conducted separately urban and rural, by sex.ResultsThe lowest household income group had a higher risk of smoking than the highest household income group in both urban and rural areas for both men and women after adjusting for individual characteristics (urban men: odds ration [OR], 1.44; 95% confidence interval [CI], 1.36–1.53; rural men: OR, 1.33; 95% CI, 1.25–1.42; urban women: OR, 2.38; 95% CI, 2.06–2.76; rural women: OR, 1.51; 95% CI, 1.25–1.83). In men, the lowest area-level income group had a higher risk for smoking than the highest area-level income group in urban areas after adjusting for individual characteristics and household income (OR, 1.17; 95% CI, 1.02–1.33). In women, the lowest area-level income group had a lower risk for smoking than the highest area-level income group in rural areas after adjusting for individual characteristics and household income (OR, 0.52; 95% CI, 0.39–0.70). However, no association was observed between area-level income and smoking in rural areas for men or in urban areas for women.ConclusionsThe results showed that smoking is strongly associated with household income status in both men and women, and area-level income is partly associated with smoking. Effects of area-level income on smoking differed by sex and region. These findings suggest that area characteristics have contextual effects on health related behavior independent of individual characteristics.

Association between Serum 25-hydroxyvitamin D Levels and Type 2 Diabetes in Korean Adults

Previous studies have suggested that a vitamin D deficiency increases the risk of type 2 diabetes. This study evaluated the association between serum vitamin D levels and type 2 diabetes in Korean adults. This study included 9,014 subjects (3,600 males and 5,414 females) aged ≥50 years who participated in the Dong-gu Study. The subjects were divided into groups in whom the serum vitamin D level was severely deficient (<10 ng/mL), deficient (10 to <20 ng/mL), insufficient (20 to <30 ng/mL) and sufficient (≥30 ng/mL). Type 2 diabetes was defined by a fasting blood glucose level of ≥126 mg/dL and/or an HbA1c proportion of ≥6.5% and/or self-reported current use of diabetes medication. Multiple logistic regression was performed to evaluate the association between vitamin D status and type 2 diabetes. The age- and sex-adjusted prevalence of type 2 diabetes was 22.6%, 22.5% and 18.4% and 12.7% for severely deficient, deficient, insufficient, and sufficient, respectively. Multivariate modeling revealed that subjects with insufficient or sufficient vitamin D levels were at a lower risk of type 2 diabetes than were subjects with deficient vitamin D levels [odds ratio (OR), 0.82; 95% confidence interval (CI), 0.71–0.94 and OR, 0.51; 95% CI, 0.35–0.74, respectively]. Higher serum vitamin D levels were associated with a reduced risk of diabetes in Korean adults, suggesting that vitamin D may play a role in the pathogenesis of diabetes.

Parathyroid Hormone Levels Are Independently Associated with eGFR and Albuminuria: The Dong-gu Study

Increased parathyroid hormone (PTH) was associated with cardiovascular mortality and morbidity in CKD patients. Our aim was to investigate the associations among estimated glomerular filtration rate (eGFR), albumin/creatinine ratio (ACR) and PTH independent of 25-hydroxyvitamin D (25(OH)D). This study included 9,162 individuals who completed the baseline survey of the Dong-gu Study, which was conducted in Korea from 2007 to 2010. The eGFR, ACR, PTH and 25(OH)D were measured in participants who met the detailed inclusion criteria. After being adjusting for covariates (sex, age, waist circumference, smoking, alcohol intake, physical activity, hypertension medications, diabetes medication, total cholesterol, triglyceride, HDL cholesterol) and log-ACR, the PTH value stratified by 25(OH)D level significantly decreased with increasing eGFR levels in each 25(OH)D stratum. Moreover, after adjustment for the same covariates and log-eGFR, the PTH value stratified by 25(OH)D level significantly increased with increasing ACR levels in each 25(OH)D stratum. In conclusion, the PTH values significantly decreased with increasing eGFR levels and increased with increasing ACR levels independently of 25(OH)D in an adult Korean population ≥50 y of age.

Association between Smoking and Unintentional Injuries among Korean Adults

Using a cross-sectional representative national survey, we evaluated the relationship between cigarette smoking and unintentional injuries among Korean adults. We used data from the 2009 Korean Community Health Survey. Smoking status was defined as never smokers, ex-smokers, and current smokers. Current smokers were categorized into light daily smokers (1–10 cigarettes/day), moderate daily smokers (11–20 cigarettes/day), or heavy daily smokers (≥21 cigarettes/day). We used the Poisson regression model with a robust variance estimation to estimate prevalence rate ratios (PRR) and corresponding 95% confidence interval (95% CI). After adjusting for demographic characteristics, socioeconomic variables, lifestyle variables, and health status variables, former smokers (PRR, 1.19, 95% CI 1.11–1.28), light daily smokers (PRR 1.22, 95% CI 1.13–1.32), moderate daily smokers (PRR 1.33, 95% CI 1.24–1.42), and heavy daily smokers (PRR 1.40, 95% CI 1.25–1.57) had an increased risk for unintentional injuries compared with non-smokers. In conclusion, cigarette smoking is associated with unintentional injuries in a dose-response manner in Korean adults. The findings suggest that community smoking cessation programs may reduce morbidity and mortality from unintentional injuries.

Association of Coffee and Tea with Ferritin: Data from the Korean National Health and Nutrition Examination Survey (IV and V)

There have been few studies that have evaluated the association between coffee intake and iron in Korean population. Data from the Korean National Health and Nutrition Examination Survey (IV and V; 2007–2012) was used to investigate the association between coffee and green tea intake and serum ferritin levels in Korean adults. Beverage intake was assessed using a food frequency questionnaire. Multivariate linear regression was performed to evaluate the relationship between coffee and tea intake and serum ferritin levels, after adjusting for age, body mass index, education level, smoking status, alcohol consumption, physical activity, hypertension, diabetes mellitus, and daily iron intake. Coffee intake was negatively related to serum ferritin levels in both sexes. The multivariate-adjusted geometric mean of serum ferritin level was 100.7 ng/mL (95% confidence interval [CI]: 98.2–103.4) in men drinking <1 coffee/day, and 92.2 ng/mL (95% CI: 89.7–94.8) in those drinking ≥3 coffees/day. In women, the equivalent serum ferritin levels were 35.6 ng/mL (95% CI: 34.8–36.4) and 28.9 ng/mL (95% CI: 27.8–30.1). However, green tea intake was not related to serum ferritin levels. In conclusion, coffee consumption was associated with lower serum ferritin levels in Korean adults.

Glycated Hemoglobin and All-Cause Mortality in Korean Type 2 Diabetes

The purpose of this study was to evaluate the association between glycated hemoglobin (HbA1c) and all-cause mortality in type 2 diabetes mellitus. We conducted a community-based prospective cohort study of 352 type 2 diabetic patients aged 30-92 who participated in a community diabetes complications screening program in Gokseng-gun, Jeollanamdo, Korea. HbA1c levels were categorized as <6.5%, 6.5-6.9%, 7.0-7.9%, 8.0-8.9% and ≥9.0%. Patients were followed up on for a mean of 6.9 years. The Cox proportional hazards model was used to evaluate the relationship between HbA1c levels and all-cause mortality. During the mean follow-up period of 6.9 years, 77 patients (21.9%) died. A J-shaped association was found between HbA1c and all-cause mortality, with the lowest mortality at 6.5-6.9% of HbA1c levels. Compared to patients with HbA1c of 6.5-6.9%, patients with <6.5%, 7.0-7.9%, 8.0-8.9% and ≥9.0% had an adjusted hazard ratio (95% confidence interval) for all-cause mortality of 1.71 (0.76-3.84), 1.23 (0.53-2.82), 1.32(0.51-3.44) and 2.66 (1.01-7.02), respectively. We found a J-shaped association between glycated hemoglobin and all-cause mortality in Korean type 2 diabetic patients.

Association of APOE Genotype with Bone Mineral Density in Men and Women: The Dong-gu and Namwon Studies

Many studies have investigated relationships between APOE genotype and bone mineral density (BMD). However, the results of these studies have been inconsistent. Few studies have been carried out in Asian populations. We studied the relationship of the APOE gene polymorphism and BMD in two large population-based studies. The datasets included the Dong-gu Study (3575 men and 5335 women) and the Namwon Study (2310 men, 3512 women). Lumbar spine and femoral neck BMD were measured by dual-energy X-ray absorptiometry. APOE genotypes were analyzed by polymerase chain reaction–restriction fragment length polymorphism. The APOE genotypes were classified into APOE E2 (E2/E2 and E2/E3), APOE E3 (E3/E3), and APOE E4 (E3/E4 and E4/E4). The genotype distribution of the study population was in Hardy-Weinberg equilibrium. There were no significant differences among APOE genotype groups in lumbar and femoral neck BMD in either cohort. Our data do not support the hypothesis that the APOE genotype is associated with BMD.

Erratum: correction of prevalence of falls by sex in article 'risk factors for falls in older korean adults: the 2011 community health survey'.

[This corrects the article on p. 1482 in vol. 29, PMID: 25408578.].

The Relationship between Socioeconomic Status and Gastric Cancer Screening in the Population of a Metropolitan Area

Objectives: Socioeconomic status plays an important role in health care and disease prevention. This study aimed to examine the association between socioeconomic status, measured by education levels and household income, and gastric cancer screening. Methods: A total of 21,220 community-dwelling adults aged 40 to 69 years within a defined geographic area participated in a community health survey in 2009 and 2010. The survey was conducted using a structured questionnaire by trained investigators who visited the subjects` households directly. Logistic regression analysis was used to determine the relationship between self-reported participation in gastric cancer screening and socioeconomic variables (education and household income). Results: The gastric cancer screening rate was 52.1% for subjects in their forties, 63.7% for those in their fifties, and 67.3% for those in their sixties. In multivariate analysis, higher education and income levels were associated with higher rates of gastric cancer screening (high school vs. elementary school: odds ratio [OR] 1.41, 95 % confidence interval [CI] 1.26-1.58; highest income quartile vs. lowest income quartile: OR 1.62, 95% CI 1.44-1.84). The gradient between income and screening rate was more pronounced in the population aged 40 to 49 years than in the other age groups. Conclusions: This study demonstrates that lower socioeconomic status is associated with decreased participation in gastric cancer screening. Our findings suggest that the screening program should be focused on low-income and less-educated populations, especially among younger adults, to reduce health disparities.