The Health Examinees (HEXA) Study: Rationale, Study Design and Baseline Characteristics

  • Health Examinees (HEXA) Study Group (Health Examinees (HEXA) Study Group)
  • Published : 2015.03.09


Background: Korea has experienced rapid economic development in a very short period of time. A mixture of traditional and modern risk factors coexists and the rapid change in non-genetic factors interacts with genetic constituents. With consideration of these unique aspects of Korean society, a large-scale genomic cohort study-the Health Examinees (HEXA) Study-has been conducted to investigate epidemiologic characteristics, genomic features, and gene-environment interactions of major chronic diseases including cancer in the Korean population. Materials and Methods: Following a standardized study protocol, the subjects were prospectively recruited from 38 health examination centers and training hospitals throughout the country. An interview-based questionnaire survey was conducted to collect information on socio-demographic characteristics, medical history, medication usage, family history, lifestyle factors, diet, physical activity, and reproductive factors for women. Various biological specimens (i.e., plasma, serum, buffy coat, blood cells, genomic DNA, and urine) were collected for biorepository according to the standardized protocol. Skilled medical staff also performed physical examinations. Results: Between 2004 and 2013, a total of 167,169 subjects aged 40-69 years were recruited for the HEXA study. Participants are being followed up utilizing active and passive methods. The first wave of active follow-up began in 2012 and it will be continued until 2015. The principal purpose of passive follow-up is based on data linkages with the National Death Certificate, the National Cancer Registry, and the National Health Insurance Claim data. Conclusions: The HEXA study will render an opportunity to investigate biomarkers of early health index and the chronological changes associated with chronic diseases.


Epidemiology;chronic disease;cohort study;health examinees;Korea


  1. Ahn Y, Kwon E, Shim JE, et al (2007). Validation and reproducibility of food frequency questionnaire for Korean genome epidemiologic study. Eur J Clin Nutr, 61, 1435-41.
  2. Alavanja MC, Sandler DP, McMaster SB, et al (1996). The Agricultural Health Study. Environ Health Perspect, 104, 362-9.
  3. Cho KH, Park S, Lee KS, et al (2013). A single measure of cancer burden in Korea from 1999 to 2010. Asian Pac J Cancer Prev, 14, 5249-55.
  4. Cho LY, Kim CS, Li L, et al (2009). Validation of self-reported cancer incidence at follow-up in a prospective cohort study. Ann Epidemiol, 19, 644-6.
  5. Cho SH, Kim KD, Kim SR, et al (1999). Adolescent menstrual disorders: Comparison Between 1988 and 1998. Korean J Obstet Gynecol, 42, 2043-7.
  6. Han MA, Choi KS, Park JH, et al (2011). Midcourse evaluation of the second-term 10-year plan for cancer control in Korea. Asian Pac J Cancer Prev, 12, 327-33.
  7. Hong KS, Bang OY, Kang DW, et al (2013). Stroke statistics in Korea: part I. Epidemiology and risk factors: a report from the korean stroke society and clinical research center for stroke. J Stroke, 15, 2-20.
  8. Kim S, Moon S, Popkin BM (2000). The nutrition transition in South Korea. Am J Clin Nutr., 71, 44-53.
  9. KNSO. 2009. Korean Statistical Information System (KOSIS). On-Line Statistics Database. [Online]. Korea National Statistical Office. Available:
  10. Konishi M, Kondou H, Okada K (2001). Health status, life habits, and social background among the JPHC study participants at baseline survey. Japan Public Health Center-based Prospective Study on Cancer and Cardiovascular Diseases. J Epidemiol, 11, 57-74.
  11. Langenberg C, Kuh D, Wadsworth ME, et al (2006). Social circumstances and education: life course origins of social inequalities in metabolic risk in a prospective national birth cohort. Am J Public Health, 96, 2216-21.
  12. Okasha M, McCarron P, McEwen J, et al (2001). Age at menarche: secular trends and association with adult anthropometric measures. Ann Human Biol, 28, 68-78.
  13. Park MJ, Lee IS, Shin EK, et al (2006). The timing of sexual maturation and secular trends of menarchial age in Korean adolescents. Korean J Ped, 49, 610-6.
  14. Park YS, Lee DH, Choi JM, et al (2004). Trend of obesity in school age children in Seoul over the past 23 years. Korean J Ped, 47, 247-57.
  15. Riboli E, Kaaks R (1997). The EPIC Project: rationale and study design. European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol, 26, 6.
  16. Seo HJ, Oh IH, Yoon SJ (2012). A comparison of the cancer incidence rates between the national cancer registry and insurance claims data in Korea. Asian Pac J Cancer Prev, 13, 6163-8.
  17. Slimani N, Kaaks R, Ferrari P, et al (2002). European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study: rationale, design and population characteristics. Public Health Nutr, 5, 1125-45.
  18. Tsugane S, Sobue T (2001). Baseline survey of JPHC study--design and participation rate. Japan Public Health Centerbased Prospective Study on Cancer and Cardiovascular Diseases. J Epidemiol, 11, S24-9.
  19. Watanabe S, Tsugane S, Sobue T, et al (2001). Study design and organization of the JPHC study. Japan Public Health Centerbased Prospective Study on Cancer and Cardiovascular Diseases. J Epidemiol, 11, 3-7.
  20. WHO. 2009. Global health risks: mortality and burden of disease attributable to selected major risks. [Online]. Available: [Accessed June 30 2014].
  21. WHO. 2011. The Fact Sheet : The Top Ten Causes of Death [Online]. Available: [Accessed June 30 2014].
  22. Woo HD, Kim J (2011). Nutritional epidemiology of cancer in Korea: recent accomplishments and future directions. Asian Pac J Cancer Prev, 12, 2377-83.
  23. Yoo KY, Kim Y, Park SK, et al (2006). Lifestyle, genetic susceptibility and future trends of breast cancer in Korea. Asian Pac J Cancer Prev, 7, 679-82.
  24. Yoo KY, Shin HR, Chang SH, et al (2005). Genomic epidemiology cohorts in Korea: present and the future. Asian Pac J Cancer Prev, 6, 238-43.
  25. You CH, Kang S, Kwon YD, et al (2013). Time trend of outof-pocket expenditure among cancer inpatients: evidence from Korean tertiary hospitals. Asian Pac J Cancer Prev, 14, 6985-9.
  26. Zheng W, Chow WH, Yang G, et al (2005). The Shanghai Women's Health Study: rationale, study design, and baseline characteristics. Am J Epidemiol, 162, 1123-31.

Cited by

  1. Risk Prediction Using Genome-Wide Association Studies on Type 2 Diabetes vol.14, pp.4, 2016,
  2. Associations of sleep duration with metabolic syndrome and its components in adult Koreans: from the Health Examinees Study vol.14, pp.4, 2016,
  3. Frequency of Loud Snoring and Metabolic Syndrome among Korean Adults: Results from the Health Examinees (HEXA) Study vol.14, pp.11, 2017,
  4. Relationship between coffee consumption and stroke risk in Korean population: the Health Examinees (HEXA) Study vol.16, pp.1, 2017,
  5. Association Between Health Behaviors and Family History of Cancer in Cancer Survivors: Data From the Korean Genome and Epidemiology Study vol.22, pp.3, 2017,
  6. Egg Consumption and Risk of Metabolic Syndrome in Korean Adults: Results from the Health Examinees Study vol.9, pp.7, 2017,
  7. Association between Milk Consumption and Metabolic Syndrome among Korean Adults: Results from the Health Examinees Study vol.9, pp.10, 2017,
  8. An association between diet quality index for Koreans (DQI-K) and total mortality in Health Examinees Gem (HEXA-G) study vol.12, pp.3, 2018,
  9. Weight change after smoking cessation and incident metabolic syndrome in middle-aged Korean men: an observational study vol.9, pp.1, 2019,