Epidemiology and Health

Volume 47; 2025

Erratum

Characteristics of imported and domestic malaria cases in Gyeonggi Province, Korea: Sunghee Hong, Jihye Kim, Soo-Nam Jo, Jong-Hun Kim, Boyoung Park, Bo Youl Choi; Epidemiol Health. 2025;47:e2024087.E. Published online March 17, 2025; DOI: https://doi.org/10.4178/epih.e2024087.E; Corrects: Epidemiol Health 2024;46:e2024087

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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 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.

Cohort Profile

The 2019 Rio Grande birth cohort: profile of a Brazilian 5-year study on mental health conditions: Rafaela Costa Martins, Francine dos Santos Costa, Cauane Blumenberg, Thais Martins-Silva, Romina Buffarini, Juraci Almeida Cesar, Christian Loret de Mola; Epidemiol Health. 2025;47:e2025039. Published online July 21, 2025; DOI: https://doi.org/10.4178/epih.e2025039

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We established the 2019 Rio Grande birth cohort to investigate the life course epidemiology of mental health and its intergenerational transmission. In 2019, we systematically identified all hospital births in the city of Rio Grande, located in Southern Brazil. Mothers who delivered a singleton liveborn child were administered a standardized, face-to-face questionnaire. In 2020, we conducted 2 follow-up assessments (WebCOVID-19 1 and 2), a third in 2021-22 (WebCOVID-19-3), and a fourth in 2023-24 (WebPOST-COVID). Across these follow-ups, we collected data on socio-demographic, environmental, and behavioral factors pertaining to both mother and child, as well as maternal mental health. Child mental health and development were specifically evaluated during the fourth follow-up. At baseline, 2,051 mothers were interviewed. Response rates for the online follow-ups were 54.1%, 51.1%, 48.7%, and 34.6%, respectively. In WebCOVID-19-3, the highest prevalence rates for depression (34.7%) and anxiety (33.1%) were observed. This cohort provides novel insights into maternal mental health, child development, and post-coronavirus disease 2019 behaviors, emphasizing culturally specific risk factors. Our findings are based on both published and ongoing studies. Data may be requested upon reasonable request.; Summary

Key Message
The 2019 Rio Grande Birth Cohort is a prospective study that has been following over 2,000 mothers and their children since 2019. It is designed specifically to understand the intergenerational transmission of mental health problems. The cohort's unique design combines detailed face-to-face questionnaires at baseline with remote, web-based follow-ups, and serves as a comprehensive overview of the cohort's methodology, data collection instruments, and study design, demonstrating its potential to generate valuable insights into maternal and child health.

Original Articles

Sugar-sweetened beverage consumption and metabolic dysfunction-associated steatotic liver disease: a beverage type-specific analysis using Korea National Health and Nutrition Examination Survey: Hong Jae Jeon, Woo Sun Rou, Seok Hyun Kim, Byung Seok Lee, Ha Neul Kim, Hei-Gwon Choi, Jaehee Seo, Hyuk Soo Eun, Sukyoung Jung; Epidemiol Health. 2025;47:e2025038. Published online July 21, 2025; DOI: https://doi.org/10.4178/epih.e2025038

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent liver disease. Evidence indicates a relationship between sugar-sweetened beverage (SSB) consumption and MASLD development; however, the effects of specific SSB types on MASLD remain underexplored. This study investigated the association between consumption of 3 distinct types of SSBs and MASLD in Korean adults.
METHODS
We analyzed data from the Korea National Health and Nutrition Examination Survey 2012-2016, including 8,310 participants aged 40-64 years. SSB consumption (soft drinks, fruit drinks, and Korean traditional drinks) was assessed using a food frequency questionnaire. MASLD was defined as a hepatic steatosis index ≥36 in the presence of any cardiometabolic risk factor. Logistic regression models were used to estimate odds ratios (ORs) with 95% confidence intervals (CIs), adjusting for relevant covariates.
RESULTS
Compared to non-drinkers, consumption of soft drinks (≥3 serving/wk) was associated with higher odds of MASLD (OR, 1.36; 95% CI, 1.02 to 1.81; p for trend=0.03), while consumption of Korean traditional drinks (≥3 serving/wk) was associated with lower odds of MASLD (OR, 0.63; 95% CI, 0.45 to 0.89; p for trend=0.01). No association was found between fruit drink consumption and MASLD. In sex-stratified analysis (p-interaction=0.38), an inverse association between Korean traditional drinks and MASLD was observed in male (OR, 0.57; 95% CI, 0.34 to 0.95; p for trend=0.03), but not in female (OR, 0.72; 95% CI, 0.45 to 1.14; p for trend=0.17).
CONCLUSIONS
Consuming soft drinks at least 3 times per week was positively associated with MASLD, whereas an equivalent intake of Korean traditional drinks was inversely associated with MASLD.; Summary

Korean summary
-본 연구는 국민건강영양조사에 참여한 40-64세 한국 성인 8,310명을 대상으로 가당 음료와 새롭게 정의된 대사기능장애 연관 지방간질환(MASLD) 간 연관성을 음료 유형별로 비교 분석하였다. - 주 3회 이상의 탄산음료 섭취는 MASLD 유병 가능성이 증가한 반면, 동일한 빈도의 한국 전통음료 섭취는 유병 가능성을 낮췄다. - 음료 유형에 따른 MASLD 유병 차이는 향후 식이 지침 개발에 중요한 근거가 될 수 있으며, 향후 개인이 건강을 위해 보다 선택적인 음료 섭취를 위한 정책 수립에 기여할 수 있다.

Key Message
Among 8,310 Korean adults aged 40-64 years, soft drink consumption (≥3 servings/week) increased the odds of MASLD, while the same intake of Korean traditional drinks decreased the odds. These findings suggest that beverage type may be an important dietary factor associated with MASLD. Given the differential associations observed, our findings may help inform dietary recommendations that enable individuals to make more selective beverage choices for better liver health.

Health literacy in Korea: findings from the 2023 Korea National Health and Nutrition Examination Survey: Sunhye Choi, Yukyeong Kang, Hyejin Kim, Kyungwon Oh; Epidemiol Health. 2025;47:e2025037. Published online July 9, 2025; DOI: https://doi.org/10.4178/epih.e2025037

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Abstract Summary PDF: Abstract
OBJECTIVES
This study aimed to assess health literacy and identify vulnerable groups, providing a basis for developing health policies aimed at improving health literacy, using data from the 2023 Korea National Health and Nutrition Examination Survey (KNHANES).
METHODS
The health literacy measurement tool used in the 2023 KNHANES comprised a total of 10 items spanning the domains of disease prevention, health promotion, healthcare, and technology and resources. Health literacy was analyzed in relation to socio-demographic characteristics and major health behaviors among 5,906 adults aged 19 years or older, using the SAS program.
RESULTS
As of 2023, the overall prevalence of adequate health literacy among adults was 60.4%. Adequate health literacy was higher in women (62.2%) than in men (58.6%). Younger individuals exhibited higher levels of health literacy, with those aged 19–64 years at 65.9%, compared to only 40.3% among those aged 65 or older. Higher income and education levels were also associated with greater health literacy. Regarding health behavior characteristics, individuals practicing healthy lifestyles, such as non-smoking, engaging in physical activity, and undergoing health checkups, demonstrated higher health literacy than those who did not engage in such behaviors.
CONCLUSIONS
Six out of 10 Korean adults demonstrated adequate health literacy, but significant differences were observed according to socio-demographic characteristics (e.g., age and education) and health behaviors (e.g., smoking and physical activity). Tailored education and policy initiatives are necessary to improve health literacy, particularly targeting older adults, low-income groups, individuals with lower education, and those who do not practice healthy lifestyles.; Summary

Korean summary
2023년 국민건강영양조사를 통해 우리 국민의 건강정보이해능력을 처음으로 조사한 결과, 우리나라 성인 10명 중 6명은 적절한 건강정보이해능력을 갖고 있었다. 건강정보이해능력은 고령, 낮은 교육수준, 건강생활 비실천 등에서 낮아 취약군의 건강정보이해능력 향상을 위한 맞춤형 교육과 정보 제공 등 다양한 방안 모색이 필요하다.

Key Message
According to the results of the 2023 KNHANES—the first nationwide assessment of health literacy in Korea—6 out of 10 Korean adults had adequate health literacy. Diverse strategies—including targeted education and information provision—are needed to improve health literacy among vulnerable groups such as older adults, those with low education and individuals who do not practice healthy lifestyles.

Associations of self-rated health, depression, and work ability with employee control over working time: Heejoo Ko, Seong-Sik Cho, Jaesung Choi, Mo-Yeol Kang; Epidemiol Health. 2025;47:e2025036. Published online July 8, 2025; DOI: https://doi.org/10.4178/epih.e2025036

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Abstract Summary PDF: Abstract
OBJECTIVES
Work-time control (WTC), defined as employees’ ability to influence their work schedules, is a crucial determinant of work-life balance and well-being. This study aims to evaluate the associations between WTC and health-related outcomes among Korean workers and examine potential effect modifications by working hours and shift work status.
METHODS
This study analyzed data from the 2024 wave of the Korean Work, Sleep, and Health Study, a nationwide panel study of workers aged 19 years to 70 years (n=5,195). WTC was measured using a 6-item scale, and participants were categorized into low (≤12) or high (>12) WTC groups. Outcomes included self-rated health (SRH), depression (measured by the Patient Health Questionnaire-9), and work ability (WA; measured by the Work Ability Index). Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for poor SRH, moderate-to-severe depression, and poor WA, adjusting for demographic and occupational variables. Subgroup analyses assessed effect modifications by working hours and shift work.
RESULTS
Higher WTC was associated with lower odds of poor SRH (OR, 0.73; 95% CI, 0.62 to 0.86), moderate-to-severe depression (OR, 0.71; 95% CI, 0.61 to 0.83), and poor WA (OR, 0.62; 95% CI, 0.46 to 0.84). These associations were significant among daytime workers but not shift workers. The protective effects of WTC were attenuated among workers whose working hours exceeding 52 hr/wk.
CONCLUSIONS
Higher WTC is associated with better health and work outcomes, emphasizing its importance for employee well-being. However, its benefits may be limited among shift workers and employees working excessive hours.; Summary

Korean summary
- 근로시간 통제권(WTC)이 높은 근로자는 주관적 건강상태가 더 좋고, 우울 위험이 낮으며, 근로능력이 높은 것으로 나타났다. - 이러한 보호 효과는 주간 근로자에서만 유의하였으며, 근로시간이 주 52시간을 초과할 경우 효과가 약화되었다.

Key Message
- Higher work-time control (WTC) was associated with better self-rated health, lower risk of depression, and improved work ability among Korean workers. - The protective effects of WTC were significant for daytime workers but not for shift workers, and benefits diminished when weekly working hours exceeded 52.

Occurrence rate and estimated economic burden of pulp and periapical disease treatment among Korean older adults: a national population-based retrospective study: Hyeonjeong Go, Masae Kuboniwa, Youn-Hee Choi; Epidemiol Health. 2025;47:e2025035. Published online July 3, 2025; DOI: https://doi.org/10.4178/epih.e2025035

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Abstract Summary PDF: Abstract
OBJECTIVES
Maintaining healthy dentition is essential for the overall health of older adults. Treatment of pulp and periapical disease (PPD) is crucial for preserving teeth. This study assessed the occurrence rate and economic burden of PPD treatment in an older Korean population.
METHODS
Data were obtained for adults aged ≥65 years from the Korean National Health Insurance Services from 2014 to 2018. The occurrence rate was defined as the proportion of individuals who received ≥1 PPD treatment. The economic burden was estimated using both direct and indirect expenditures, calculated from a societal perspective. Regression analysis was performed to evaluate yearly trends in occurrence rate and economic burden.
RESULTS
Direct costs, which included insured and non-insured medical expenses, ranged from US$13.79 million to US$10.47 million. Indirect costs, comprising transportation and time costs, ranged from US$0.89 million to US$0.80 million. Total costs declined from US$14.68 million to US$11.36 million. The occurrence rate of PPD treatment decreased significantly from 1.24% to 0.91% (p<0.05). The economic burden also demonstrated a statistically significant downward trend, with total PPD costs decreasing from 0.00099% to 0.00066% of Korea’s GDP, and from 0.63% to 0.30% of the annual total dental care benefit costs between 2014 and 2018 (p<0.05).
CONCLUSIONS
The occurrence rate and estimated economic burden of PPD treatment significantly decreased among older Korean adults from 2014 to 2018. Conservative approaches to tooth preservation contribute to more effective oral health policies and help reduce the economic burden of oral disease treatments in an aging society.; Summary

Korean summary
· 한국 노년층에서 치수 및 치근단 질환 치료의 발생률과 경제적 부담은 연구 기간 동안 통계적으로 유의미하게 감소했습니다. · 이러한 연구 결과는 보존적 치과 치료가 고령화 사회에서 구강 질환으로 인한 경제적 부담을 줄이는 효과적인 구강 보건 정책이 될 수 있음을 시사합니다.

Key Message
· The occurrence rate and economic burden of pulp and periapical disease (PPD) treatment among older Korean adults have shown a statistically significant decrease over the study period. · These findings suggest that conservative dental treatment can serve as an effective oral health policy for reducing the economic burden of oral diseases in an aging society.

Identifying adverse reactions following COVID-19 vaccination in Korea using data from active surveillance: a text mining approach: Hye Ah Lee, Bomi Park, Chung Ho Kim, Yeonjae Kim, Hyunjin Park, Seunghee Jun, Hyelim Lee, Seunghyun Lewis Kwon, Yesul Heo, Hyungmin Lee, Hyesook Park, COVID-19 Vaccine Safety Research Committee; Epidemiol Health. 2025;47:e2025034. Published online June 30, 2025; DOI: https://doi.org/10.4178/epih.e2025034

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Unstructured text data collected through vaccine safety surveillance systems can identify previously unreported adverse reactions and provide critical information to enhance these systems. This study explored adverse reactions using text data collected through an active surveillance system following coronavirus disease 2019 (COVID-19) vaccination.
METHODS
We performed text mining on 2,608 and 2,054 records from 2 survey seasons (2023-2024 and 2024-2025), in which participants reported health conditions experienced within 7 days of vaccination using free-text responses. Frequency analysis was conducted to identify key terms, followed by subgroup analyses by sex, age, and concomitant influenza vaccination. In addition, semantic network analysis was used to examine terms reported together.
RESULTS
The analysis identified several common (≥1%) adverse events, such as respiratory symptoms, sleep disturbances, lumbago, and indigestion, which had not been frequently noted in prior literature. Moreover, less frequent (≥0.1 to <1.0%) adverse reactions affecting the eyes, ears, and oral cavity were also detected. These adverse reactions did not differ significantly in frequency based on the presence or absence of simultaneous influenza vaccination. Co-occurrence analysis and estimation of correlation coefficients further revealed associations between frequently co-reported symptoms.
CONCLUSIONS
This study utilized text mining to uncover previously unrecognized adverse reactions associated with COVID-19 vaccination, thereby broadening our understanding of the vaccine’s safety profile. The insights obtained may inform future investigations into vaccine-related adverse reactions and improve the processing of text data in surveillance systems.; Summary

Korean summary
* 본 연구는 COVID-19 백신 접종 후 자가 보고된 증상을 텍스트 마이닝으로 분석하여, 이전에 알려지지 않았던 부작용을 확인하였습니다. * 본 연구 결과는 백신 부작용에 대한 이해를 높이고, 향후 연구 및 감시 체계 개선에 중요한 통찰력을 제공합니다.

Key Message
* This study used text mining of self-reported symptoms following COVID-19 vaccination to identify previously unrecognized adverse reactions. * Our findings enhance the understanding of vaccine side effects and provide valuable insights for future research and surveillance system improvement.

COVID-19: Cohort Profile

Cohort profile: Cardiovascular Metabolic Etiological Research Center COVID-19 Mental Health Survey (CC-MHS): Sun Jae Jung, Dongkyu Lee, Ji Su Yang, Sunghyuk Kang, Hyejin Kim, Jeong Hyun Ahn, Yunseong Heo, Jieun Noh, Changhyun Kim, Hyeon Chang Kim; Epidemiol Health. 2025;47:e2025033. Published online June 30, 2025; DOI: https://doi.org/10.4178/epih.e2025033

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Abstract Summary PDF: Abstract
The Cardiovascular Metabolic Etiological Research Center COVID-19 Mental Health Survey (CC-MHS) is a comprehensive longitudinal cohort study investigating the mental health impact of the coronavirus disease 2019 pandemic by utilizing pre-existing baseline data from the Cardiovascular Metabolic Etiological Research Center cohort (2013-2018). This study assesses physical health, lifestyle changes, and mental health using validated tools, including the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and the PTSD Checklist for DSM-5, and evaluates a population of urban and suburban Korean participants across multiple dimensions. Through online surveys, the research identified gender-specific social support mechanisms, showing that men benefit from larger social networks, whereas women derive protective effects from stronger emotional connections. Key findings underscore complex interactions among demographic factors, psychological variables, and public health responses, especially in the context of vaccination attitudes and trust in pandemic management. The CC-MHS delivers critical insights into mental health trajectories during global health crises, offering valuable evidence for developing adaptive public health strategies and for understanding the intricate relationships between individual psychological resilience and broader societal health challenges.; Summary

Korean summary
본 CC-MHS 코호트는 팬데믹 이전 4,060명 대상 CMERC 기초자료 활용하였다 본 CC-MHS 코호트는 우울, 불안, PTSD 등 정신건강 평가를 7차례 추적조사하였다. 본 코호트에서는 성별 보호요인과 사회적 지지·신뢰의 중요성 규명하였다.

Key Message
In CC-MHS, we utilized pre-pandemic baseline data from 4,060 adults in the CMERC cohort. We conducted 7 waves of mental health surveys assessing depression, anxiety, PTSD, and resilience. In this cohort, we identified gender-specific protective factors and emphasized the importance of social support and trust.

Original Articles

Being trans in Korea: key milestones and stigmatization across life stages in a nationwide survey of 585 transgender and non-binary young adults: Sungsub Choo, Ranyeong Kim, Hyemin Lee, Horim Yi, Rockli Kim, Seung-Sup Kim; Epidemiol Health. 2025;47:e2025032. Published online June 27, 2025; DOI: https://doi.org/10.4178/epih.e2025032

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Understanding the experiences of transgender and non-binary (TGNB) individuals from a life-course perspective is essential. This article aims to identify ages at key milestones related to transgender identity and assess experiences of stigmatization among TGNB individuals across different life stages.
METHODS
We analyzed data from a nationwide longitudinal survey of 585 TGNB adults in Korea collected in 2020 and 2021. Analysis of variance and chi-square test were used to compare mean ages at transgender identity developmental milestones and experiences of anti-transgender stigma across transgender identities.
RESULTS
On average, TGNB Koreans realized their transgender identity at age 13, accepted it at age 20, and came out to others at age 21. Regarding experiences of stigmatization across different life stages, 67.4% reported hearing homophobic and transphobic remarks from teachers in secondary school. Among TGNB individuals assigned male at birth (AMAB) who served mandatory military service, 29.0% were classified as maladjusted soldiers, and 12.1% experienced sexual harassment or violence. When asked about the job application process, 57.0% reported discontinuing their job search due to their transgender identity. Financial burden represented the primary barrier to psychiatric evaluations, hormone treatment, and gender-affirming surgery.
CONCLUSIONS
Our study identifies key milestone ages related to transgender identity and experiences of stigmatization across life stages among TGNB adults in Korea. With 97.6% of participants under 40 years old, these findings primarily reflect the experiences of TGNB young adults. Further research is necessary to better understand the experiences of middle-aged and elderly TGNB individuals in Korea.; Summary

Korean summary
한국에서 트랜스젠더 당사자들은 평균적으로 13살에 트랜스젠더 정체성을 자각하고, 20살에 트랜스젠더로서의 자신을 수용하며, 21살에 처음으로 트랜스젠더 정체성을 타인에게 알린다. 시스젠더 이성애자의 몸을 표준으로 구성된 한국 사회에서, 트랜스젠더는 청소년기와 성인기를 거치며 고등학교, 군 복무, 취업, 의료 이용 등에서 차별과 낙인을 경험한다.

Key Message
The average age of developmental milestones related to transgender identity include realizing their transgender identity at age 13, accepting it at age 20, and first coming out at age 21. TGNB individuals faced stigma and discrimination in key set- tings and situations such as secondary school, the military, and job applications from their adolescence and onwards.

Socioeconomic inequality in organized and opportunistic screening for breast cancer: results from the Korean National Cancer Screening Survey, 2009-2021: Yejin Ha, Xuan Quy Luu, Woorim Kim, Jae Kwan Jun, Mina Suh, Kui Son Choi; Epidemiol Health. 2025;47:e2025031. Published online May 30, 2025; DOI: https://doi.org/10.4178/epih.e2025031

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Breast cancer screening rates have increased since the introduction of the National Cancer Screening Program (NCSP) in Korea. However, it remains unclear whether socioeconomic inequalities have improved, particularly according to screening type. This study investigated inequalities in organized (government-led) and opportunistic (individually initiated) screening, stratified by education and income levels.
METHODS
Data were obtained from the Korean National Cancer Screening Survey, conducted annually from 2009 to 2021, involving approximately 1,700 women each year except in 2009. Trends were analyzed using joinpoint regression to calculate average annual percent changes (AAPCs). Socioeconomic inequalities were assessed using the slope index of inequality (SII) and relative index of inequality (RII).
RESULTS
Organized screening rates increased from 42.0% in 2009 to 60.2% in 2021 (AAPC, 1.9; 95% confidence interval [CI], 0.7 to 3.4), whereas opportunistic screening rates declined from 13.3% to 11.2% (AAPC, -5.4; 95% CI, -8.7 to -2.3). For organized screening, individuals with lower education levels exhibited higher participation, resulting in negative inequality indices (SII, -5.37%; RII, 0.80). No significant income-based inequality was found (SII, 1.60%; RII, 1.07). However, opportunistic screening demonstrated significant inequalities by both education (SII, 5.37%; RII, 1.92) and income (SII, 5.90%; RII, 1.96), with higher participation rates among more advantaged groups.
CONCLUSIONS
The NCSP has improved breast cancer screening rates and reduced income-related inequality in organized screening. However, educational and income-based inequalities persist in opportunistic screening. To reduce screening inequities, policy efforts are needed to further promote the NCSP, including improving program quality and providing financial support for follow-up examinations.; Summary

Korean summary
본 연구는 한국의 유방암 검진에서 검진 유형에 따른 사회경제적 불평등을 분석하였다. 국가 검진에서는 전체 수검률이 증가하고 소득 관련 불평등이 감소한 반면 개인 검진에서는 사회경제적 불평등이 여전히 존재하였다. 유방암 검진의 불평등을 줄이기 위해 지속적이고 집중적인 정책 노력이 필요하다.

Key Message
This study examined socioeconomic inequality in breast cancer screening in Korea by screening type. While organized screening has improved overall participation and reduced income-related inequality, socioeconomic inequalities remain in opportunistic screening. Continued and targeted policy efforts for the NCSP are necessary to further reduce inequality in breast cancer screening.

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