• 대한예방한의학회지
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• 제28권1호
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• pp.69-87
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• 2024

Objectives : This study is to investigate the current National Health Insurance Database cohort studies related to complications of Parkinson's Disease (PD) and suggest the design of Korean medical epidemiological studies of PD. Methods : Nationwide longitudinal studies of PD patients in South Korea were collected through Pubmed and the Korea Citation Index (KCI). We selected cohort studies that used the National Health Insurance Database in Korea and targeted Parkinson's disease patients. Studies published before February 2024 were categorized according to study designs. We examined variables and covariates, enroll dates and matching methods. Results : Of a total of 536 studies, 18 studies met the inclusion criteria. All studies used the National Health Insurance (NHI) Research Database and among them, 5 used sample data and one senior database. Studies can be classified into two types. 11 cohort studies were comparing PD patients and non-PD patients. Another type was 4 PD patients cohort studies. Most studies used two diagnostic codes (G20 and V124) for inclusion criteria. Enroll periods were from 2002 to 2017, and follow-up periods were from 7 to 14 years. 16 studies considered age and sex as covariates. 15 studies used the propensity score matching method to increase the level of causality. There was only one study related to the Korean medical treatment. Conclusion : In future cohort studies on Korean medical treatment, more attempts should be made to reveal the effect of the treatments on PD patients by defining inclusion criteria for patient groups, covariates, exposure variables, and assessment indicators more operatively.

• Annals of Occupational and Environmental Medicine
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• 제35권
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• pp.26.1-26.15
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• 2023

Background: The objective of this study is to investigate the differences in incidence rates of targeted diseases by classification of occupations among construction workers in Korea. Methods: In a subject-based cohort of the Korean Construction Worker's Cohort, we surveyed a total of 1,027 construction workers. As occupational exposure, the classification of occupations was developed using two axes: construction business and job type. To analyze disease incidence, we linked survey data with National Health Insurance Service data. Eleven target disease categories with high prevalence or estimated work-relatedness among construction workers were evaluated in our study. The average incidence rates were calculated as cases per 1,000 person-years (PY). Results: Injury, poisoning, and certain other consequences of external causes had the highest incidence rate of 344.08 per 1,000 PY, followed by disease of the musculoskeletal system and connective tissue for 208.64 and diseases of the skin and subcutaneous tissue for 197.87 in our cohort. We especially found that chronic obstructive pulmonary disease was more common in construction painters, civil engineering welders, and civil engineering frame mold carpenters, asthma in construction painters, landscape, and construction water proofers, interstitial lung diseases in construction water proofers. Conclusions: This is the first study to systematically classify complex construction occupations in order to analyze occupational diseases in Korean construction workers. There were differences in disease incidences among construction workers based on the classification of occupations. It is necessary to develop customized occupational safety and health policies for high-risk occupations for each disease in the construction industry.

• Journal of Preventive Medicine and Public Health
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• 제27권1호
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• pp.117-134
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• 1994

대구직할시 남구 1 개동 주민을 대상으로 도시 지역의료보험 실시 전후(이하 실시 전후)의 의료 이용양상을 파악하기 위하여 실시 6개월 전인 1989년 1월에 1차조사를 하였고, 실시 1년 6개월 후인 1991년 1월에 2차조사를 하였다. 1차조사의 대상자는 1,230가구 4,939명이 었으나, 2차추적조사가 가능했던 인구는 519가구 2,277명 (추적률:46.1%)이었다. 2차조사까지 추적이 가능했던 2,277명 중 1차 조사시 보험에 가입되지 않았던 240가구 1,033명을 코호트 I군(이하 I군)으로 하였고, 1차조사시 보험에 가입되었던 279가구 1,244명을 코흐트 II군(이하 II군)으로 구분하여 조사자료를 분석하였다. 인구 1,000명당 급성이환으로 인한 의사방문율의 변화는 실시 후에 I군에서 16.5 증가한 반면, II에서는 2.4만 증가하였으며, 만성이환에서도 I군이 13.5 증가하였으나 II군은 7.2만 증가하였다. 이환 및 활동제한 의료필요 충족률도 I군에서 실시 후 뚜렷히 증가하였다. 월가구소득별 급성이환에 의한 의료필요충족률은 I군에서 40만원미만군이 1.6으로 $40{\sim}99$만원군의 4.0과 100만원이상군의 49.3에 비해 월등히 낮았다. 이러한 소견은 나머지 조사대상군과 만성이환에서도 동일하였다. 급성과 만성이환자의 병원이용 이유는 유용성, 의원의 경우는 지리적 접근성이 실시전후모두에서 가장 많았고 약국이용 이유 중 실시 전에는 접근성과 의료비지불성이 중요하였으나, 실시 후에는 의료비지불성의 중요성은 상대적으로 감소하였다. 최근 15일간 의사방문여부를 종속변수로한 multiple logistic regression analysis에서 급성이환(+), 만성이환(+) 그리고 월가구소득(+)이 실시전후 모두에서 유의한 변수였다. 실시 후 부과된 보험료에 대한 불만족률이 두군 모두 지역의료보험 가입자에서 각각 81.0%와 74.1%로 타 의료보험가입자에 비해 월등히 높았다. 실시 후 병원과 의원의 의료비와 서어비스에 불만족스럽다고 응답한 사람이 I군에 비해 II군에서 더 많았다. 이상의 소견으로 의료보험이 실시됨으로 미충족의료수요를 감소시키는 효과를 가져왔으나 실시 후에도 저소득층의 의료이용률이 고소득층에 비해 여전히 낮아 의료보험실시로 경제적 장애가 감소하였음에도 불구하고 본인부담금 등으로 인한 경제적 장애와 의료기관을 방문하는데 소요되는 시간, 대기시간 등 의료이용을 저해하는 요인이 남아있어 의료이용의 형평이 사회계층들간에 완전히 이루어지지는 않았다. 특히 만성이환의 경우, 불균형이 심하였다. 또한, 부과된보험료에 대한 불만족도가 높아 현행 보험료선정기준의 재평가 및 공정성을 향상시킬 필요성이 제기되었다.

• 대한지리학회지
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• 제46권2호
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• pp.212-232
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• 2011

이 연구의 목적은 이지역 코호트 요인법에 의한 인구 추계 방법론을 정립하고, 그것을 부산광역시의 장래 인구 추계에 적용하는 것이다. 우선 시도와 같은 지역 인구의 추계에 있어 우리나라의 공식적인 방법인 순이동 코호트-요인법이 갖는 한계를 예증하였다. 대안으로 지역간 코호트-요인법 중 전체 지역을 두 지역으로 구분한 후 지역 간의 전입과 전출을 분리하여 추계하는 이지역 코호트-요인법을 정립하였다. 이를 바탕으로 부산광역시의 2005~2030년에 대한 인구 추계를 3가지 시나리오 하에서 실행하였다. 순이동 방식을 취한 인구 추계와 이지역 방식을 취한 인구 추계 간에는 상당한 차이가 나타났는데, 전출 초과 지역인 부산의 경우 순이동 방식에서 더 빠른 인구 감소가 나타났다. 이지역 방식에 의한 부산 및 전국추계의 인구 변화 추세를 검토한 결과 추계가 상당히 합리적으로 이루어짐을 확인할 수 있었다. 결론적으로 본 연구에서 제시된 이지역 코호트-요인법은 순이동 코호트-요인법에 비해 논리적으로 더 정연하면서도 실제 추계에 있어서도 높은 유용성을 보여 주었다.

• Korean Journal of Radiology
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• 제24권4호
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• pp.274-283
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• 2023

Objective: To compare the outcomes of digital breast tomosynthesis (DBT) screening combined with ultrasound (US) with those of digital mammography (DM) combined with US in women with dense breasts. Materials and Methods: A retrospective database search identified consecutive asymptomatic women with dense breasts who underwent breast cancer screening with DBT or DM and whole-breast US simultaneously between June 2016 and July 2019. Women who underwent DBT + US (DBT cohort) and DM + US (DM cohort) were matched using 1:2 ratio according to mammographic density, age, menopausal status, hormone replacement therapy, and a family history of breast cancer. The cancer detection rate (CDR) per 1000 screening examinations, abnormal interpretation rate (AIR), sensitivity, and specificity were compared. Results: A total of 863 women in the DBT cohort were matched with 1726 women in the DM cohort (median age, 53 years; interquartile range, 40-78 years) and 26 breast cancers (9 in the DBT cohort and 17 in the DM cohort) were identified. The DBT and DM cohorts showed comparable CDR (10.4 [9 of 863; 95% confidence interval {CI}: 4.8-19.7] vs. 9.8 [17 of 1726; 95% CI: 5.7-15.7] per 1000 examinations, respectively; P = 0.889). DBT cohort showed a higher AIR than the DM cohort (31.6% [273 of 863; 95% CI: 28.5%-34.9%] vs. 22.4% [387 of 1726; 95% CI: 20.5%-24.5%]; P < 0.001). The sensitivity for both cohorts was 100%. In women with negative findings on DBT or DM, supplemental US yielded similar CDRs in both DBT and DM cohorts (4.0 vs. 3.3 per 1000 examinations, respectively; P = 0.803) and higher AIR in the DBT cohort (24.8% [188 of 758; 95% CI: 21.8%-28.0%] vs. 16.9% [257 of 1516; 95% CI: 15.1%-18.9%; P < 0.001). Conclusion: DBT screening combined with US showed comparable CDR but lower specificity than DM screening combined with US in women with dense breasts.

• 응용통계연구
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• 제28권4호
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• pp.703-719
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• 2015

본 논문은 평균회귀 2요인 사망률 모형에 코호트 효과를 반영한 개선된 확률론적 사망률 모형을 제시한다. 한국 남자의 사망률 자료를 바탕으로 가중평균최소제곱법과 메트로폴리스 알고리듬을 이용하여 사망률 모형을 추정한 결과 코호트 효과를 반영하는 것이 모형 적합도를 향상시킴을 발견하였다. 국민연금공단과 같은 연금사업자가 자신의 장수위험을 금융시장에 순차적으로 전가하는 수단으로서 옵션방식 이자지급 장수채권의 활용을 제안하고 발행채권의 가격 산출방법을 제시하는 것이 본 논문이 기여하는 점이다. 특히 생존지수에 의해 이자지급 현금흐름이 결정되는 장수채권 가격산출을 위하여 코호트 효과가 매우 중요한 요소임을 강조하였다.

• Journal of Preventive Medicine and Public Health
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• 제48권6호
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• pp.280-286
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• 2015

Objectives: Approximately 10% to 15% of lung cancer cases occur in never-smokers. Hormonal factors have been suggested to lead to an elevated risk of lung cancer in women. This systematic review (SR) aimed to investigate the association between hormonal replacement therapy (HRT) and the risk of lung cancer in women using cohort studies. Methods: We first obtained previous SR articles on this topic. Based on these studies we made a list of refereed, cited, and related articles using the PubMed and Scopus databases. All cohort studies that evaluated the relative risk of HRT exposure on lung cancer occurrence in women were selected. Estimate of summary effect size (sES) with 95% confidence intervals (CIs) were calculated. Results: A total of 14 cohort studies were finally selected. A random effect model was applied due to heterogeneity (I-squared, 64.3%). The sES of the 14 articles evaluating the impact of HRT exposure on lung cancer occurrence in women indicated no statistically significant increase in lung cancer risk (sES, 0.99; 95% CI, 0.90 to 1.09). Conclusions: These results showed that HRT history had no effect on the risk of lung cancer in women, even though the sES of case-control studies described in previous SR articles indicated that HRT had a protective effect against lung cancer. It is necessary to conduct a pooled analysis of cohort studies.

• Asian Pacific Journal of Cancer Prevention
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• 제14권10호
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• pp.6185-6187
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• 2013

Cervical cancer has emerged as a major public health problem in Lucknow and New York in the $21^{st}$ century. Cancer genetic studies are essential to identify/stratify disease-susceptible individuals in a population-based cohort. Sample size homogeneity and North Indian caste in female urology genetic-studies are significant issues in meaningful interpretation of data. A review of scientific literature using Pubmed database was conducted, including an assessment of cervical cancer genetic studies conducted as part of the author's doctoral dissertation at a premier Lucknow-based medical research Institute. Sample size numbers and caste criteria in the North Indian cohort ($N{\leq}400$ subjects) were evaluated with homogeneity in the sample cohort data set(s). Subgroup caste-stratification of North Indian cohort is equally essential, for instance, Brahmin (e.g. Pandey), Vaishya (e.g. Mittal), Rajput (e.g. Singh) and Kshudra (e.g. Yadav) during the conception and design of genetics-based studies. Sample size homogeneity in histopathologically confirmed case and control numbers and caste-based stratification in a North Indian cohort is essential in single nucleotide polymorphism (SNP) studies in cervical cancer susceptible populations to draw more definitive conclusions.

• 농촌의학ㆍ지역보건
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• 제31권2호
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• pp.119-144
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• 2006

The Korea rural health study, a large prospective cohort study, the objectives of this study are exploration for potential causes of agricultural injuries and diseases among farmers. Current medical research suggests that they may have higher rates of some traumatic injuries, pesticide poisoning, infectious diseases, musculoskeletal diseases, asthma and other respiratory diseases. This study is designed to identify occupational, lifestyle, and environmental factors of workplace that may affect the rate of diseases in farming population. Round 1, initial cohort recruitment, will begin in 2006 and conclude in 2009. Round 2, follow-up will begin in 2010 and conclude in 2014. Approximately 54,000 persons will be selected to study population. Nested case-control studies and case-crossover studies will be conducted for getting to the bottom of agriculture-related diseases. Recruitment and follow-up are conducted in collaboration with multi-centers. As data on the exposures and health outcomes of this study population are collected and analyzed in 2014. This study will be evaluated by public health experts for effort, achievement, adequacy of performance, efficacy, process of study and so on. The author expects that this cohort study may reduce agricultural injuries and diseases and will provide information that agricultural workers can use in making decisions about their health. Also, this study will be significant basis for strengthening the competitiveness of agriculture in Korea.

• 한국음향학회지
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• 제22권5호
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• pp.383-387
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• 2003

본 논문에서는 기존의 고정크기의 코호트 집단을 기반으로 한 화자검증 방법을 다룬다. 특히, 본 논문에서는 고정크기의 코호트 대신에 화자모델들 사이의 거리를 이용하는 가변크기의 새로운 코호트를 제안한다: 제안된 새로운 방식에서는 각 화자로부터 일정한 거리 내에 있는 주변 화자모델들의 밀집도가 고려된다. 그 화자주변의 밀집도가 높으면 코호트의 크기가 자동적으로 증가되어 화자검증률이 개선되고, 반면 밀집도가 적으면 코호트의 크기가 감소되어 계산량이 줄어든다 실험결과 제안된 방법이 기존의 방식에 비하여 EER (Equal Error Rate)을 감소시킴을 확인할 수 있었다.