Epidemiology and Health

Original articles

Sex differences in personal, community, and societal factors associated with mukbang among adolescents: korea youth risk behavior survey: Cynthia Yursun Yoon, Seungha Shin, Haemi Jun, Hyeeun Park, Minseo Kim; Epidemiol Health. 2025;e2025055. Published online September 30, 2025; DOI: https://doi.org/10.4178/epih.e2025055 [Accepted]

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Abstract PDF: Abstract
Objectives
Mukbang refers to live-streamed videos in which hosts consume large amounts of energy-dense, nutrient-poor foods while interacting with viewers. Mukbang is concerning, as it is commonly viewed by Korean adolescents and has shown to associate with adverse health outcomes. To inform efforts to prevent excessive engagement in mukbang among Korean adolescents, this study examined personal, community, and societal-level factors associated with excessive mukbang viewing (≥ 7 times/week) among Korean adolescents and the sex differences in such associations.
Methods
Data were drawn from the 2022 Korea Youth Risk Behavior Survey (N=36,990, Mage=15.1±1.7, girls=48.6%, 53.2% attending middle-school). Self-reported data included personal (e.g., perceived health, weight, stress, depression, anxiety), community (e.g., living arrangement), and societal-level factors (e.g., socioeconomic status) and mukbang viewing. Logistic and modified Poisson regressions were used to examine associations of factors associated with excessive mukbang viewing among Korean adolescents and how it differs by sex.
Results
Intrapersonal factors-specifically perceived health, weight, stress, depression, and anxiety- were associated with excessive mukbang viewing among adolescents (aPR range=1.18-1.44) and were more pronounced among girls. A community level factor-living arrangement-was associated with mukbang in boys but not in girls. Boys living on campus had 1.42 times the prevalence of mukbang viewing than boys living with family members (95% CI=1.08-1.88) after adjustments. Further mutual adjustment attenuated point estimates toward the null. Societal-level factors were not associated with mukbang among adolescents.
Conclusions
Personal and community-level factors were associated with excessive mukbang viewing. Future research should explore the underlying mechanisms of these associations.; Summary

The delayed cancer treatment and economic inequality in Korea : results of common cancers by the time-to-surgery: Noorhee Son, Woo-Ri Lee, Dong-Woo Choi, Kyu-Tae Han; Epidemiol Health. 2025;e2025056. Published online September 27, 2025; DOI: https://doi.org/10.4178/epih.e2025056 [Accepted]

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OBJECTIVES
Growing concerns regarding the concentration of cancer treatment in the capital city in South Korea have raised questions about equitable access to timely and optimal patient care. In this study, we evaluated the impact of time-to-surgery (TTS) on healthcare utilization and outcomes, with the goal of providing policy recommendations for effective quality assessment of cancer care.
METHODS
This retrospective cohort study analyzed data from 2011 to 2021 obtained from National Health Insurance Service claims. A generalized estimating equation and a Cox proportional hazards model were applied to assess the effects of TTS on length of hospital stay (LOS), medical costs, and 5-year mortality among patients diagnosed with lung, liver, and colorectal cancers. Subgroup analyses were conducted based on patients’ baseline economic status.
RESULTS
Among patients who underwent surgical treatment for lung, liver, or colorectal cancer, 20.4%, 11.4%, and 11.4% experienced treatment delays, respectively. Regardless of cancer type, longer TTS was associated with prolonged LOS and higher medical costs. Moreover, patients with extended TTS demonstrated an increased risk of 5-year mortality. Disparities by income level were evident, with greater differences observed in the lower-income group.
CONCLUSIONS
This study highlights the importance of timely surgical treatment for patients with cancer, particularly in relation to income-based disparities. These findings emphasize the need to improve Korea’s concentrated cancer care delivery system to enhance healthcare efficiency and address health literacy gaps affecting treatment by income level.; Summary

Correspondences

Authors’ Reply: Safety of combination therapy of azilsartan medoxomil and amlodipine: a population-based cohort study: Hyesung Lee, Bin Hong, Chris Tzu-Ting Su, Sungho Bea, Han Eol Jeong, Kyungyeon Jung, Michael Chun-Yuan Cheng, Zoe Chi-Jui Chang, Edward Chia-Cheng Lai, Jongyoung Lee; Epidemiol Health. 2025;47:e2025054. Published online September 20, 2025; DOI: https://doi.org/10.4178/epih.e2025054

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Letter to the Editor: Safety of combination therapy of azilsartan medoxomil and amlodipine: a population-based cohort study: Zhanyi Zhou; Epidemiol Health. 2025;47:e2025053. Published online September 20, 2025; DOI: https://doi.org/10.4178/epih.e2025053

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Original article

Explainable SHAP-XGBoost models for identifying important social factors associated with the atherosclerotic cardiovascular disease risk score using the LASSO feature selection technique: Jungtae Choi, Jooeun Jeon, Hyoeun An, Hyeon Chang Kim; Epidemiol Health. 2025;e2025052. Published online September 10, 2025; DOI: https://doi.org/10.4178/epih.e2025052 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Extensive evidence indicates that social factors play an essential role in explaining atherosclerotic cardiovascular disease (ASCVD). This study aimed to examine which social factors are associated with the estimated 10-year ASCVD risk score among male and female adults, incorporating both multifaceted social network components and conventional risk factors.
METHODS
Using data from 4368 middle-aged Korean adults, we explored factors most likely to explain ASCVD risk with interpretable machine learning algorithms. The ASCVD risk was determined using the 10-year ASCVD risk score, as calculated using pooled cohort equations. Social network components were assessed through the name generator module. A total of 52 variables were included in the model.
RESULTS
For male participants (area under the receiver operating characteristic curve [AUC] = 0.65), the average years known for network members contributed most to ASCVD risk prediction (mean Shapley additive explanations [SHAP] value = 0.31), followed by spouse’s education level (0.22), medical history with diagnosis (0.18), and snoring frequency (0.14). By contrast, for female participants (AUC = 0.60), medical history with diagnosis was the strongest predictor (0.47), followed by logged income (0.21), education level (0.19), and the average number of years known in network members (0.17).
CONCLUSIONS
Several important social factors were associated with the ASCVD risk score in both male and female adults. However, longitudinal research is needed to determine whether these factors predict future ASCVD events.; Summary

Systematic reviews

Probiotics for preventing neonatal sepsis in preterm neonates: a systematic review and meta-analysis for clinical practice: Rizka Maulida, Radhian Amandito, Rinawati Rohsiswatmo, Amarila Malik; Epidemiol Health. 2025;e2025051. Published online September 3, 2025; DOI: https://doi.org/10.4178/epih.e2025051 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Late-onset sepsis (LOS), occurring after 72 hours of birth, is a significant cause of morbidity and mortality especially in preterm neonates. Probiotics have been proposed as a preventive strategy to enhance gut health, modulate immune responses, and reduce the incidence of neonatal sepsis. We aimed to evaluate the effectiveness of probiotics in preventing neonatal sepsis in preterm neonates, with particular attention to the impact of different strains and dosage regimens.
Methods
Eligible studies included preterm neonates (≤36 weeks gestational age) with culture-proven LOS and focused on probiotic supplementation. Comprehensive searches were conducted in MEDLINE via PubMed, Cochrane CENTRAL, Scopus, and ProQuest up to July 28, 2024. The Revised Cochrane Risk of Bias Tool (RoB 2.0) was applied to assess study quality, and a random-effects meta-analysis was performed using Review Manager (RevMan) version 5.4. Additionally, the certainty of the body of evidence was evaluated using the GRADE approach (Grading of Recommendations Assessment, Development, and Evaluation).
RESULTS
Thirty-one studies including 8,040 preterm neonates were reviewed. Meta-analysis demonstrated that probiotics significantly reduced the incidence of LOS (pooled risk ratio [RR], 0.83; 95% CI, 0.72–0.95). Greater efficacy was observed with multistrain formulations (RR, 0.76; 95% CI, 0.72–0.95) and low-dose regimens (RR, 0.72; 95% CI, 0.56–0.91). Probiotic supplementation was also associated with shorter hospital stays and a trend toward lower mortality, although the latter did not reach statistical significance.
CONCLUSIONS
To effectively reduce LOS in preterm neonates, specific combinations of multistrain probiotics and optimized dosing strategies may provide the most benefit.; Summary

Socioeconomic factors affecting breast and cervical cancer screening compliance in Asian National Cancer Centers Alliance countries: a systematic review: Seowoo Bae, Ye Ji Kang, Jeonghoon Ahn, Bo-Hyoung Jang, Kui Son Choi, Hyeon Ji Lee, Mina Suh; Epidemiol Health. 2025;e2025050. Published online August 28, 2025; DOI: https://doi.org/10.4178/epih.e2025050 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Breast and cervical cancers are the most frequently diagnosed cancers in women. The Asian National Cancer Centers Alliance (ANCCA) has strengthened cancer control efforts in the Asia region; however, only a few countries have achieved sufficient participation rates. This systematic review aimed to synthesize the existing evidence on socioeconomic factors influencing women’s compliance with breast and cervical cancer screening in ANCCA countries.
METHODS
This study was conducted as a systematic review, with studies collected from PubMed, Cochrane Library, Scopus, and Embase. All included studies employed cross-sectional designs to identify socioeconomic factors affecting compliance with breast or cervical cancer screening. Study selection, quality assessment, and data extraction were carried out by 2 independent reviewers with cross-checking.
RESULTS
In total, 48 studies were reviewed. Education level and family history were associated with participation in breast cancer screening, while education level, household income, marital status, and medical insurance were linked with cervical cancer screening. When stratified by Human Development Index (HDI) level or by the presence of a National Cancer Screening Program, differences were observed in the factors influencing screening compliance. Nevertheless, higher education consistently correlated with higher screening rates for both cancer types, regardless of HDI level.
CONCLUSIONS
This systematic review identified multiple socioeconomic factors that shape breast and cervical cancer screening compliance in Asian countries. To reduce disparities in participation, tailored multi-strategy approaches adapted to each country’s specific context are required. These findings may provide useful evidence for future research and policy initiatives aimed at addressing health equity issues.; Summary

Original articles

Decentralized pandemic response and health equity: an analysis of socioeconomic disparities in COVID-19 mortality in Japan: Hasan Jamil, Aminu Abubakar Kende, Shuhei Nomura, Fumiya Inoue, Takao Suzuki, Stuart Gilmour; Epidemiol Health. 2025;e2025049. Published online August 28, 2025; DOI: https://doi.org/10.4178/epih.e2025049 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Global data often link greater socioeconomic deprivation to higher COVID-19 mortality. However, whether decentralized governance can mitigate this disparity by enabling tailored, equitable local responses remains unclear. We assessed whether Japan’s decentralized pandemic response moderated the association between area-level socioeconomic deprivation and COVID-19 mortality across municipalities.
METHODS
We analyzed 20,760 COVID-19 deaths from all Japanese municipalities during 2020–2021. We computed standardized mortality ratios using national age- and sex-specific rates to derive expected counts. We then fit a Bayesian spatial Poisson regression model with the log of expected counts as an offset to estimate smoothed relative risks (RRs). The Area Deprivation Index (ADI) represented the primary predictor; structured and unstructured random effects captured spatial correlation and residual variability.
RESULTS
Mapping of smoothed RRs, categorized into quintiles, revealed higher mortality risk in northern, central, and western municipalities, with lower risk in southern and scattered central regions. Contradicting global trends, deprivation and COVID-19 mortality demonstrated an inverse association (ADI coefficient, –0.095; 95% credible interval, –0.173 to –0.018), indicating that more deprived municipalities exhibited lower RRs for COVID-19 mortality (9.1% reduction per 1-unit increase in ADI).
CONCLUSIONS
The inverse relationship between area deprivation and COVID-19 mortality in Japan contrasts with global patterns. Although Japan’s decentralized health system ensured equitable access to COVID-19 treatment, lower mortality in more deprived areas likely reflects additional protective factors, including population density patterns and community-specific adaptations. These findings underscore the complex interplay between socioeconomic conditions and health outcomes during global health emergencies.; Summary

Evaluation of a telemedicine pilot project for hypertension in Korea: a nationwide real-world data study: Jeong-Yeon Kim, Yeryeon Jung, Seongwoo Seo, Youseok Kim, Min Jung Ko, Hun-Sung Kim; Epidemiol Health. 2025;e2025048. Published online August 25, 2025; DOI: https://doi.org/10.4178/epih.e2025048 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
A telemedicine pilot project has received temporary authorization in Korea. The clinical effectiveness of telemedicine is well established; however, ongoing research must assess medical utilization, sustainability, prescription continuity, and safety.
METHODS
This study evaluated medical utilization, sustainability, prescription continuity, and safety before and after the implementation of a telemedicine pilot project between June 2022 and December 2023. Data were obtained from the Korean National Health Insurance Service (NHIS), and participants were divided into those who received non-face-to-face hypertension treatment at least once and those who did not.
RESULTS
This study included 124,210 patients diagnosed with hypertension who received telemedicine (the Tele_G group) and 124,210 propensity score-matched control individuals. The difference-in-difference (DID) for medical utilization between the Tele_G and control groups was 0.10 (−0.03 vs. −0.12, p<0.001). The DID for the Modified Modified Continuity Index was −0.005 (−0.003 vs. 0.002, p<0.001), while that for Most Frequent Provider Continuity was −0.006 (−0.004 vs. 0.002, p<0.001). The DID for the prescription day rate was 0.41 (−0.61 vs. −1.02, p<0.001), and that for the appropriate prescription continuation rate was 0.52 (−1.23 vs. −1.75, p<0.005).
CONCLUSIONS
Telemedicine did not fully achieve the same standard as face-to-face treatment for hypertension management; however, it showed comparable safety, suggesting potential as secondary care. As the first NHIS-based study on this topic in Korea, this research highlights the benefits of telemedicine when appropriately utilized for patients with hypertension. Nevertheless, due to limitations regarding long-term continuity and policy design, cautious interpretation is required, and further prospective studies are warranted.; Summary

Behavioral and psychosocial factors associated with sugar-sweetened beverage consumption among Korean adolescents: a path analysis using the 2022 Korea Youth Risk Behavior Survey: Hye-Young Park, Soo Rack Ryu, Hoon-Ki Park, Hwan-Sik Hwang, Kye-Yeung Park; Epidemiol Health. 2025;e2025047. Published online August 21, 2025; DOI: https://doi.org/10.4178/epih.e2025047 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Rising obesity rates among adolescents are a major global health concern and are closely linked to the consumption of sugar-sweetened beverages (SSBs). This study aimed to identify key behavioral and psychosocial factors influencing SSB consumption among adolescents.
METHODS
This cross-sectional study analyzed data from the 2022 Korea Youth Risk Behavior Web-based Survey, which included 49,548 participants aged 12–18 years. Information on SSB consumption frequency, sociodemographic characteristics, eating habits, sedentary behaviors, and other health-related factors was collected through self-administered questionnaires. Path analysis was used to model SSB consumption and estimate the direct and indirect effects of modifiable factors.
RESULTS
Male students, current alcohol drinkers, those with higher frequencies of fast-food or late-night snack consumption, and heavy smartphone users were more likely to frequently consume SSBs. Fast-food intake had the strongest direct effect on SSB consumption (B = 0.3884), while nighttime eating showed a substantial direct effect (B = 0.1437) and mediated 21.7% of the relationship between fast-food intake and SSB consumption. Leisure sitting time exerted both direct (B = 0.0741) and indirect effects on SSB intake, mediated through watching mukbang, smartphone use, fast-food consumption, and nighttime eating. Self-perceived health status was negatively associated with SSB consumption (B = –0.0619), with indirect effects mediated by fast-food intake and nighttime eating.
CONCLUSIONS
Among Korean adolescents, SSB consumption was strongly associated with unhealthy eating patterns and prolonged leisure sitting time. Increased fast-food consumption, nighttime eating, watching mukbang, smartphone use, and negative self-perceived health status not only directly influenced SSB intake, but also acted as mediating factors.; Summary

Risk factors for Q fever incidence in South Korea: a comparative analysis using frequentist and Bayesian methods: Ji-hyun Son, Sung-dae Park; Epidemiol Health. 2025;e2025046. Published online August 20, 2025; DOI: https://doi.org/10.4178/epih.e2025046 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
This study investigated the principal determinants of human Q fever incidence and explored regional variation between metropolitan cities and provinces in South Korea.
METHODS
Panel data on human Q fever incidence, livestock populations, and facility metrics were collected across 17 metropolitan cities and provinces from 2017 to 2024. Analytical approaches included frequentist models (ordinary least squares [OLS], random effects, fixed effects) and Bayesian models.
RESULTS
Frequentist panel analysis indicated that slaughterhouse count was positively associated with Q fever incidence in both pooled OLS (β=1.20, p<0.001) and random effects models (β=1.03, p<0.001), but not in the fixed effects model (β=0.14, p=0.65). After correcting for serial correlation using Driscoll–Kraay standard errors, livestock population (β=0.55, p<0.01), livestock market count (β=–2.01, p<0.05), and livestock Q fever cases (β=–0.11, p<0.01) were significantly associated with human incidence. A Bayesian fixed effects model confirmed a significant relationship between slaughterhouses and human Q fever incidence (posterior mean: 0.87, 95% credible interval [CrI], 0.21-1.42), providing more stable inference with limited samples and allowing probabilistic uncertainty estimation. A Bayesian hierarchical model revealed a stronger association in metropolitan cities (posterior mean, 1.46; 95% CrI, 0.34-2.57) than in provinces (1.22), while livestock population remained significant in provinces (0.94, 95% CrI, 0.15-1.74).
CONCLUSIONS
In South Korea, slaughterhouse density was the main determinant of Q fever in metropolitan areas and livestock density was the primary risk factor in provinces. These findings underscore the need for region-specific preventive strategies and reinforce the value of a One Health approach.; Summary

Trends in sustainable dietary patterns in United States adults, 2007-2018: Sukyoung Jung, Heather Young, Barbara Braffett, Samuel Simmens, Eunice Hong Lim Lee, Cynthia Ogden; Epidemiol Health. 2025;e2025045. Published online August 18, 2025; DOI: https://doi.org/10.4178/epih.e2025045 [Accepted]

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Abstract Summary PDF: Abstract
OBJECTIVES
Adopting sustainable diets is essential for improving both human and planetary health, and such diets should be evaluated from a multidimensional perspective. We characterized trends in sustainable dietary patterns, quantified by the Sustainable Diet Index for US adults (SDI-US), along with trends in diet quality, diet-related environmental impacts, food affordability, and food practices.
METHODS
This study analyzed data from the National Health and Nutrition Examination Survey (2007–2018) for adults aged ≥20 years (n = 25,543). The SDI-US (range: 4–20 points), with higher scores indicating more sustainable diets, was calculated using 24-hour dietary recall data and responses to consumer and dietary behavior questionnaires. Mean total SDI-US scores, sub-indices, and 12 individual indicators were estimated for each survey cycle. Trends were assessed using orthogonal polynomial contrasts in regression models.
RESULTS
From 2007 to 2018, total SDI-US scores showed no significant overall trend (overall mean = 13.1). Nutritional and sociocultural indicators remained relatively stable, whereas the economic indicator (food expenditures) worsened from 21.4% to 26.4% (p<0.05, linear trend) between 2007–2008 and 2017–2018. Environmental impacts initially worsened between 2007–2008 and 2013–2014 but improved through 2017–2018 (all p<0.05, quadratic trend). When stratified by age (p for interaction <0.0001), a slight decline in SDI-US was observed among adults aged ≥60 years (14.1 to 13.9, p<0.0001).
CONCLUSIONS
From 2007 to 2018, total SDI-US scores largely remained unchanged, although declines occurred among adults ≥60 years and scores remained lower among adults aged 20–39 years. Ongoing monitoring and coordinated improvements across all dimensions are needed to advance sustainable diets in all age groups.; Summary

Korean summary
- 본 연구는 미국 국민건강영양조사에 참여한 20세 성인 25,543명을 대상으로 세계식량기구의 다차원적 지속가능한 식이 지수(SDI-US)를 활용하여 12년간의 추이를 분석하였다. - 전체 SDI-US 점수는 전체적으로 큰 변화가 없었으나, 경제적 지표는 악화되고 환경 지표는 최근 개선을 보였고, 60세 이상 성인에서는 SDI-US 점수가 감소하였으며, 20-39세 성인에서는 낮은 수준이 유지되었다. - 지속가능한 식이로의 전환을 위해 지속적 모니터링과 연령대별 맞춤형 정책이 필요하다.

Key Message
Among 25,543 US adults aged 20 years and older, overall sustainable diet index (SDI-US) scores showed no significant change between 2007 and 2018. While food expenditure share worsened and environmental indicators recently improved, declines were observed among older adults (≥60 years) and lower scores persisted among younger adults (20–39 years). These findings highlight the need for ongoing monitoring and tailored strategies to promote sustainable diets across age groups.

Original Articles

Association between psychosocial safety climate and depression risk among Korean workers: Soo Kyung Cho, Seong-Sik Cho, Maureen F. Dollard, May Young Loh, Mo-Yeol Kang; Epidemiol Health. 2025;47:e2025044. Published online August 13, 2025; DOI: https://doi.org/10.4178/epih.e2025044

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Abstract Summary PDF: Abstract
OBJECTIVES
Psychosocial safety climate (PSC) reflects an organization’s commitment to safeguarding workers’ psychological health and safety. While international evidence links low PSC to poor mental health outcomes, its association with depression has not been well established in Korea. This study aimed to examine the relationship between PSC and depression among Korean workers, utilizing a large-scale, population-based survey.
METHODS
We analyzed data from 5,337 wage employees who participated in the fifth wave of the Korean Work, Sleep, and Health Study. Depression was measured using the 9-item Patient Health Questionnaire, and PSC was assessed with a validated 4-item scale. Participants were classified into low-risk, intermediate-risk, and high-risk groups based on their PSC scores. Multivariable logistic regression was conducted to estimate the association between PSC and depression, with stratified analyses performed according to gender, age, and occupational characteristics.
RESULTS
The prevalence of depression increased as PSC scores decreased. Compared to the low-risk group, the intermediate-risk and high-risk PSC groups exhibited 1.19 times and 2.69 times higher risks of depression, respectively, suggesting a clear exposure-response relationship. Stratified analyses indicated that associations were stronger among individuals without union representation or access to occupational health and safety resources.
CONCLUSIONS
These findings underscore the critical role of PSC in workplace mental health. Promoting a high PSC may help reduce depression risk and support mental well-being among workers. Interventions considering vulnerable subgroups are warranted to create psychologically safer work environments in Korea.; Summary

Korean summary
-본 연구에서는 한국 근로자에서 심리사회적 안전풍토(PSC) 점수가 낮을수록 우울 위험이 유의하게 높아짐을 확인하였다. -PSC 중간위험군과 고위험군의 우울 위험은 저위험군에 비해 각각 1.19배, 2.69배 높았다. -연구 결과는 근로자의 정신건강 증진과 국가적 정책 수립을 위해 직장에서의 PSC 강화를 강조한다.

Key Message
-This study demonstrates that lower psychosocial safety climate (PSC) scores are associated with a significantly higher risk of depression among Korean workers. -The risk of depression was 1.19 times higher in the intermediate-risk PSC group and 2.69 times higher in the high-risk PSC group compared with the low-risk group. -Findings highlight the importance of strengthening PSC in workplaces to improve employee mental health and guide national policies.

Individual- and neighborhood-level factors influencing diet quality: a multilevel analysis using Korea National Health and Nutrition Examination Survey data, 2010-2019: Dahyun Park, Min-Jeong Shin, S V Subramanian, Clara Yongjoo Park, Rockli Kim; Epidemiol Health. 2025;47:e2025043. Published online August 4, 2025; DOI: https://doi.org/10.4178/epih.e2025043

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Abstract Summary PDF: Abstract
OBJECTIVES
Although environmental factors influence lifestyle choices, few studies have examined how individual-level and neighborhood-level socio-demographic factors interact to affect diet quality in Korea. We investigated the associations between multilevel factors and diet quality among Korean adults and explored potential interactions by gender and age.
METHODS
We conducted a cross-sectional analysis of 42,035 adults from 1,671 towns using data from the Korea National Health and Nutrition Examination Survey (2010-2019) and the Population and Housing Census of Korea (2010-2019). Individual-level variables included gender, age, education, income, number of household members, smoking, drinking, physical activity, and subjective health status. Neighborhood-level variables included residential area, housing type, number of restaurants per capita, population size, and the proportion of low-income households and older adults. Associations with the Korean Healthy Eating Index (KHEI) were assessed using 2-level hierarchical models.
RESULTS
Of the total variance in KHEI, 5.2% was attributable to neighborhood-level differences. Individual-level factors explained 48.1% of variance at the neighborhood-level, while neighborhood-level factors accounted for an additional 12.4%. Individuals living in rural areas, non-apartment housing, neighborhoods with higher proportions of low-income households and older adults, or in areas with smaller populations, had lower KHEI scores than their counterparts. In random slope models with cross-level interaction terms, diet quality among adults aged 70 years and older varied significantly according to neighborhood- level characteristics.
CONCLUSIONS
Both individual-level and neighborhood-level factors influence diet quality in Korea, with older adults being especially vulnerable to neighborhood characteristics. Multilevel approaches are needed to identify at-risk populations and improve dietary outcomes.; Summary

Korean summary
한국에서 식이 질은 개인적 요인 뿐 만 아니라 지역사회 수준 요인에 의해서도 유의하게 영향을 받는다. 농촌 거주, 비아파트 주거, 저소득층 또는 고령 인구 비율이 높은 지역에 거주하는 경우 한국 건강식이 지수(KHEI) 점수가 낮게 나타났다. 특히 노인은 불리한 지역사회 환경에 더욱 취약하여, 젊은 성인보다 더 강한 교차 수준 상호작용을 보였다.

Key Message
Both individual- and neighborhood-level factors significantly influence diet quality in Korea. Rural residence, non-apartment housing, and neighborhoods with higher proportions of low-income or elderly residents were associated with lower Korean Healthy Eating Index (KHEI) scores. Older adults were especially vulnerable to adverse neighborhood environments, show- ing stronger cross-level interactions than younger adults.

Can resident registration expiration statistics due to death be used for near-real-time mortality tracking? A validation study using 2023 data from Korea: Jin-Hwan Kim; Epidemiol Health. 2025;47:e2025042. Published online August 3, 2025; DOI: https://doi.org/10.4178/epih.e2025042

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Abstract Summary PDF: Abstract
OBJECTIVES
Real-time mortality tracking is essential for public health surveillance, especially during emergencies such as the coronavirus disease 2019 (COVID-19) pandemic. In Korea, delayed availability of vital statistics (VS) data has hindered timely mortality monitoring. This study evaluates whether National Administrative Data (NAD) on resident registration expiration due to death, provided by the Ministry of Interior and Safety, could serve as a reliable alternative for near real-time mortality surveillance.
METHODS
We compared mortality counts between VS and NAD for 2023 at multiple geographic levels (county, province, and nation) and across demographic strata (sex and age groups). The analysis was conducted in 3 stages: comparing overall mortality counts, analyzing county-level distributions, and assessing equivalence through correlation analyses, scatter plots, and density plots.
RESULTS
NAD showed strong agreement with VS at the national level, reporting only 0.4% more deaths overall (0.2% for male, 0.6% for female). Notable differences were observed in early childhood mortality, with NAD showing 16.8% fewer deaths for neonates (age 0) and 14.8% more for ages 1-4, as well as in monthly variations (5-9%). Correlation analyses indicated extremely high consistency between the 2 data sources across all geographic levels (correlation coefficients ≥0.999), especially at the national and provincial levels.
CONCLUSIONS
NAD provides a reliable alternative to VS for real-time mortality surveillance in Korea, providing comparable accuracy with much-improved timeliness. Although some variations are present in specific age groups and monthly trends, these can be addressed through appropriate analytical strategies. The recent availability of sex-specific and age-specific data in NAD since 2023 establishes it as a valuable infrastructure for mortality surveillance.; Summary

Korean summary
- 행정자료(NAD)는 통계청 사망통계(VS)와 높은 일치도를 보여 신속한 사망 감시체계 구축에 활용할 수 있다. - 2023년부터 NAD에 성별·연령별 정보가 포함됨에 따라, 한국의 공중보건 위기 대응을 위한 핵심적인 사망 감시 인프라로 발전할 수 있게 되었다.

Key Message
- National Administrative Data (NAD) demonstrates high concordance with Vital Statistics (VS), making it applicable for establishing rapid mortality surveillance systems. - With the inclusion of sex- and age-specific information since 2023, NAD has evolved into a critical mortality surveillance infrastructure for South Korea's public health emergency response.

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