• Journal of Preventive Medicine and Public Health
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• 제24권3호
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• pp.390-399
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• 1991

The purpose of this study is to examine the relationship between pesticide use and mortality, and cancer mortality which are recognized as health hazards of pesticides. Data were analyzed from a cohort of 6,066 people aged fifty-five or over and who have been residing in the main island of Kangwha county. Death certificates, computerized citizenship registers searches, and household interview survey lead to get more than ninety-seven percents follow-up rate for the first five year observation period. Important findings are as follows : 1. Age specific mortality rates of pesticide users are significantly lower than those of pesticides nonusers. The SMR of male is 0.80, and 0.58 for females respectively probably due to healthy worker effects. But, age specific cancer mortality rates are significantly higher than those of pesticide nonusers (SMR=1.59) in males. This finding is not observed in females (SMR=0.85), however. 2. Logistic regression analyses showed that self-reported health status, drinking, and smoking histories in male are significantly associated with total mortality rate. The histories of pesticide use are also calculated to be highly associated with cancer mortality as in univariate analyses in males. In female, self-reported health status, age of first delivery are found to be significantly related to total mortality rate. Only drinking history is calculated to be associated with cancer mortalities in females. Data from further observation of 'Kangwha cohort' and indepth analyses of these are highly expected.

• Asian Pacific Journal of Cancer Prevention
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• 제14권10호
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• pp.5681-5685
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• 2013

Background: To compare breast cancer incidence and mortality trends in Central Serbia between males and females in the period 1999-2009. Materials and Methods: In this descriptive study, mortality data were obtained from the National Statistics Institute and morbidity data were derived from Institute of Public Health of Serbia for the period of interest. Results: Breast cancer is a leading cancer in the female population of Central Serbia, whereas in male population it is not on the list of 10 leading localizations, concerning both incidence as well as mortality. In the period 1999-2009 the average standardized incidence rates of breast cancer were 60.5/100,000 in women and 1.4/100,000 in men, while average standardized mortality rates were 20.4/100,000 and 0.4/100,000. The average standardized incidence and mortality rates were about 45 times higher in females than males. Male breast cancer comprises approximately 2.1% of all breast cancer cases. The average age-specific mortality and incidence rates increased with age in both sexes. In the observed period standardized mortality rates of breast cancer increased significantly only in men ($y=0.320+0.0215{\times}$, p=0.044). Conclusions: The increase of breast cancer incidence in both sexes and mortality in men, indicate an urgent need for Serbian health professionals to apply existing cancer control and preventive measures. Male breast cancer is more present than in other world regions, with an outstanding increase of mortality, which demands a timely identification (screening) and adequate treatment. A national policy including mammography should be considered in the light of the newest findings.

• Tuberculosis and Respiratory Diseases
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• 제83권4호
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• pp.268-275
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• 2020

Background: It is not evident that the attributable risk of smoking on mortality in Korea has decreased. We investigated the impact of smoking on all-cause mortality and estimated the attributable risk of smoking in Korean adults. Methods: Those aged ≥20 years with smoking history in the Korean National Health and Nutrition Examination Surveys (KNHANES) 2007-2015 were enrolled. We categorized the participants into three groups as follows: never smoker, <20 pack-years (PY) smokers, and ≥20 PY smokers. We applied inverse probability weighting using propensity scores to control various confounders between the groups. All-cause mortality risks were compared between the groups using the Kaplan-Meier log-rank test. The effects of smoking-attributable risks (ARs) on mortality were also calculated. Results: A total of 50,458 participants were included. Among them, 19,334 (38.3%) were smokers and 31,124 (61.7%) were never smokers. Those with a smoking history of 20 PY or more (≥20 PY smokers), those with a smoking history of less than 20 PY (<20 PY smokers), and never smokers were 18.1%, 20.2%, and 61.7%, respectively, of the study population. Smokers had a higher risk of all-cause mortality compared to never smokers (log-rank test p<0.01). The ARs of smoking were 21.8% (95% confidence interval [CI], 5.7%-37.9%) and 9.0% (95% CI, 6.1%-12.0%) in males and females, respectively. ARs decreased from 24.2% to 19.5% in males and from 9.5% to 4.1% in females between 2007-2010 and 2011-2015. Conclusion: Our study using KNHANES IV-VI data demonstrated that smoking increased the risk of all-cause mortality in a dose-response manner and the ARs of smoking on mortality were 21.8% in males and 9.0% in females during 2007-2015. This suggests that the ARs of smoking on mortality have decreased since around 2010.

• 보건행정학회지
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• 제24권3호
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• pp.271-282
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• 2014

Background: Although the mortality rate in cancers has been decreased recently, it is still one of the leading causes of death in most of the countries. This study analyzed the relationship between surgery volume and in hospital mortality of cancer patients. The purpose of this study is to investigate the relationship in Korean healthcare environment and to provide information for the policy development in reducing cancer mortality. Methods: The study sample was the 20,517 cancer patients who underwent surgery and discharged during a month period between 2008-2011. The data were collected in Patient Survey by Korean Institute of Social Affairs. Logistic regression was used to analyse a comprehensive analytic model that includes a binary dependent variable indicating death discharge and independent variables such as surgery volume, organizational characteristics of hospitals, socio-economical characteristics of the patients, and severity of disease indicators. Results: In chi-square test, as the surgery volume increases, the in-hospitals mortality showed a downward trends. In regression analysis, the relationship between surgery volume and mortality showed significant negative associations in all types of cancer except for pancreatic cancer. Conclusion: In the absence of other information patients undergoing cancer surgery can reduce their risk of operative death by selecting a high-volume hospital. Therefore, policies to enhance centralization of cancer surgery services should be considered.

• Journal of Preventive Medicine and Public Health
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• 제39권2호
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• pp.115-122
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• 2006

Objectives : This study was conducted to examine the relationships of the several socioeconomic position indicators with the mortality risk in a representative longitudinal study of South Korea. Methods : The 1998 National Health and Nutrition Examination Survey was conducted on a cross-sectional probability sample of South Korean households, and it contained unique 13-digit personal identification numbers that were linked to the data on mortality from the National Statistical Office of Korea. Of 5,607 males and females, 264 died between 1999 and 2003. Cox's regression was used to estimate the relative risks (RR) and their 95% confidence intervals (CI) of mortality. Results: Socioeconomic differences in mortality were observed after adjustments were made for gender and age. Compared with those people having college or higher education, those people without any formal education had a greater mortality risk (RR=2.21, 95% CI=1.12-4.40). The mortality risk among manual workers was significantly greater than that for the non-manual workers (RR=2.73, 95% CI=1.47-5.06). A non-standard employment status was also associated with an increase in mortality: temporary or daily workers had a greater mortality risk than did the full-time workers (RR=3.01, 95% CI=1.50-6.03). The mortality risk for the low occupational class was 3.06 times greater than that of the high and middle occupational classes (95% CI=1.75-5.36). In addition, graded mortality differences according to equivalized monthly household income were found. A reduction of monthly household income by 500 thousand Korean Won (about 400 US dollars) was related with a 20% excess risk of mortality. Self-reported poor living standards were also associated with an increased risk of mortality. Those without health insurance had a 3.63 times greater risk of mortality than the insured (95% CI=1.61-8.19). Conclusions: This study showed the socioeconomic differentials in mortality in a national longitudinal study of South Korea. The existence of socioeconomic mortality inequalities requires increased social discussion on social policies in Korean society. Furthermore, the mechanisms for the socioeconomic inequalities of mortality need to be explored in future studies.

• Asian Pacific Journal of Cancer Prevention
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• 제14권4호
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• pp.2259-2263
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• 2013

Background: Public use National Health and Nutrition Examination Survey (NHANES III) and NHANES III linked mortality data were here applied to investigate the association between health insurance coverage and all cause and all cancer mortality in adults. Patients and Methods: NHANES III household adult, laboratory and mortality data were merged. Only patients examined in the mobile examination center (MEC) were included in this study. The sampling weight employed was WTPFEX6, SDPPSU6 being used for the probability sampling unit and SDPSTRA6 to designate the strata for the survey analysis. All cause and all cancer mortalities were used as binary outcomes. The effect of health insurance coverage status on all cause and all cancer mortalities were analyzed with potential socioeconomic, behavioral and health status confounders. Results: There were 2398 sample persons included in this study. The mean age was 40 years and the mean (S.E.) follow up was 171.85 (3.12) person months from the MEC examination. For all cause mortality, the odds ratios (significant p-values) of the covariates were: age, 1.0095 (0.000); no health insurance coverage (using subjects with health insurance), 1.71 (0.092); black race (using non-Hispanic white subjects as the reference group) 1.43, (0.083); Mexican-Americans, 0.60 (0.089); DMPPIR, 0.82, (0.000); and drinking hard liquor, 1.014 (0.007). For all cancer mortality, the odds ratio (significant p-values) of the covariates were: age, 1.0072 (0.00); no health insurance coverage, using with health coverage as the reference group, 2.91 (0.002); black race, using non-Hispanic whites as the reference group, 1.64 (0.047); Mexican Americans, 0.33 (0.008) and smoking, 1.017 (0.118). Conclusion: There was a 70% increase in risk of all cause death and almost 300% of all cancer death for people without any health insurance coverage.

• Asian Pacific Journal of Cancer Prevention
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• 제16권15호
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• pp.6413-6416
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• 2015

Colorectal cancer incidence and mortality in Kazakhstan are relatively high but exact statistics have hitherto been lacking and trends over time are unclear. The present study was therefore undertaken to retrospectively assess data for East Kazakhstan, accessed from the central registration office, for the period 2004-2013. Approximate age standardized data for incidence and mortality were generated and compared across age groups, gender and year. It was determined that during the studied period 3,417 new cases of colorectal cancer were registered and 2,259 died of this pathology. Average cancer cancer incidence and mortality over the ten years were $24.1/10^5$ and $15.9/10^5$ respectively, and the overall ratio of mortality/incidence (M/I) was 0.69:1 (range 0.58-0.73). Both incidence and mortality tended to remain constant in both males and females. The male to female ratios also did not significantly vary over time but a trend for improvement of the mortality to incidence ratio was observed, especially for rectum. Whether this might be related to screening remains unclear. These preliminary data indicate that whereas colorectal cancer continues to be important, change in environmental factors are not having a great impact on incidence in East Kazakhstan.

• Hip & pelvis
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• 제34권3호
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• pp.150-160
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• 2022

Purpose: The purpose of this study is to determine risk factors that affect mortality following osteoporotic hip fracture in patients 50 years or older using the National Health Insurance Service (NHIS) sample cohort 2.0 database. Materials and Methods: Data from 2,533 patients who satisfied the inclusion criteria for the NHIS sample cohort 2.0 database were used in this study. Data from patients who suffered osteoporotic hip fractures between 2002-2015 were used. An analysis of correlations between the incidence of osteoporotic hip fractures and various factors (sex, age, underlying diseases, etc.) was performed. Analysis of the associations between the mortality of osteoporotic hip fracture and the various factors with hazard ratio (HR) was performed using Cox regression models. Results: Patient observation continued for an average of 38.12±32.09 months. During the observation period, a higher incidence of hip fracture was observed in women; however, higher mortality following the fracture was observed in men (HR=0.728; 95% confidence interval [CI], 0.635-0.836). The incidence and mortality of fractures increased when there were increasing age, more than three underlying diseases (HR=1.945; 95% CI, 1.284-2.945), cerebrovascular diseases (HR=1.429; 95% CI, 1.232-1.657), and renal diseases (HR=1.248; 95% CI, 1.040-1.497). Also, higher mortality was observed in patients who were underweight (HR=1.342; 95% CI, 1.079-1.669), current smokers (HR=1.338; 95% CI, 1.104-1.621), and inactivity (HR=1.379; 95% CI, 1.189-1.601). Conclusion: Male gender, the presence of cerebrovascular or kidney disease, a more than three underlying diseases, underweight, a current smoker, and inactivity were risk factors that increased mortality.

• 한국인구학
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• 제26권2호
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• pp.33-62
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• 2003

이 연구의 목적은 사망수준의 저하에 영향을 미치는 세 요소-사회경제적 발전, 공공 보건의 발달, 사회경제적 발달의 균등상태-의 상대적 중요성을 분석하는 것이다. 종속변수인 사망 수준의 지표로는 영아사망률과 출생시 기대수명 등 두 변수가 사용되었다. 국민총생산(GNP)은 사회 경제적 발달지표로 여성의 초등학교 취학률과 기니계수(GINI index)는 사회경제적 균등상태 지표로 병원침대당 인구수는 공공보건 지표로 간주되었다. 변수들에 대한 자료는 두 시점에 걸쳐 수집되었다. 하나는 1970년 이전 53개국에서. 다른 하나는 1970-80년대 55개국에서 수집되었다. 탐색적 자료 분석 방법이 통계 분석 방법으로 사용되었다. 이 기법은 종속변수와 독립변수와의 관계가 선형인지 아닌지, 그리고 우리 모형에서 어느 것이 유력 사례인지를 파악할 수 있는 장점이 있다. 분석결과에 따르면, 첫째로 영아 사망률과 세 요소의 관계가 선형이 아니라 비선형임이 밝혀졌다. 영아 사망률 저하에 국민총생산이 가장 많이, 여성의 초등학교 취학률이 두 번째, 기니계수가 그 다음으로 영향을 미치는 것으로 나타났다. 반면 병원침대당 인구수는 통계적으로 유의미한 영향을 보여주지 않았다. 둘째, 출생시 기대수명은 여성의 취학률, 기니계수 등과 같은 변수와는 선형 관계를 가지는 반면 국민총생산 변수와는 비선형 관계를 가진다. 영아사망률 변수와는 달리 출생시 기대수명의 변이에는 여성의 초등학교 취학률이 국민총생산보다 더 커다란 영향을 미쳤다.

• 디지털융복합연구
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• 제11권5호
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• pp.371-384
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• 2013

본 연구에서는 한국 및 미국의 퇴원환자 자료를 이용하여 한국 및 미국의 중증도 보정 사망 모형을 개발하고 개발된 중증도 보정 사망모형에 따라 중증도 보정 사망률 지표를 산출 및 비교한 다음 이를 통해 국내 의료기관 사망률 관리 방안을 제시하고자 하였다. 한국 및 미국 의료기관의 중증도 보정 사망 모형은 데이터마이닝기법인 다중 로지스틱회귀분석 기법, 의사결정나무분석 기법을 이용하여 개발하였다. 개발된 의료기관의 중증도 보정 사망모형에 따라 한국 및 미국 의료기관의 중증도 보정 사망률을 산출한 결과 한국은 매년 증가하고 있는 반면 미국은 매년 감소하고 있는 것으로 나타나 한국과 미국간에 차이가 있었다. 의료기관의 병상규모별 중증도 보정 사망률의 변이 또한 한국이 미국보다 높았다. 국내 의료기관의 사망률 관리를 위해서는 의료기관 자체내에서 사망환자 관리가 가능한 대형 의료기관들의 경우 의료기관 중증도 보정 사망률 평가 결과 공개를 통해 지속적으로 사망률 관리를 유도하고, 의료기관 자체내에서 사망률 관리가 힘든 중소병원들은 국가 차원에서 파악한 국내 의료기관 사망환자 관리의 문제점 및 이를 개선할 수 있는 개선방안을 토대로 사망률 관리 컨설팅을 시행하는 등 의료기관 사망환자 관리 사업을 진행하여야 한다.