Heejin Kimm

Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States

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Publications (37)96.35 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the performance of the American College of Cardiology/American Heart Association (ACC/AHA) 2013 Pooled Cohort Equations in the Korean Heart Study (KHS) population and to develop a Korean Risk Prediction Model (KRPM) for atherosclerotic cardiovascular disease (ASCVD) events. The KHS cohort included 200,010 Korean adults aged 40-79 years who were free from ASCVD at baseline. Discrimination, calibration, and recalibration of the ACC/AHA Equations in predicting 10-year ASCVD risk in the KHS cohort were evaluated. The KRPM was derived using Cox model coefficients, mean risk factor values, and mean incidences from the KHS cohort. In the discriminatory analysis, the ACC/AHA Equations' White and African-American (AA) models moderately distinguished cases from non-cases, and were similar to the KRPM: For men, the area under the receiver operating characteristic curve (AUROCs) were 0.727 (White model), 0.725 (AA model), and 0.741 (KRPM); for women, the corresponding AUROCs were 0.738, 0.739, and 0.745. Absolute 10-year ASCVD risk for men in the KHS cohort was overestimated by 56.5% (White model) and 74.1% (AA model), while the risk for women was underestimated by 27.9% (White model) and overestimated by 29.1% (AA model). Recalibration of the ACC/AHA Equations did not affect discriminatory ability but improved calibration substantially, especially in men in the White model. Of the three ASCVD risk prediction models, the KRPM showed best calibration. The ACC/AHA Equations should not be directly applied for ASCVD risk prediction in a Korean population. The KRPM showed best predictive ability for ASCVD risk. Copyright © 2015. Published by Elsevier Ireland Ltd.
    Atherosclerosis 07/2015; 242(1):367-375. DOI:10.1016/j.atherosclerosis.2015.07.033 · 3.97 Impact Factor
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    ABSTRACT: To evaluate the association between serum prostate-specific antigen (PSA) concentration from a screening test and prostate cancer mortality in an Asian population. We included 118,665 men in the Korean Heart Study, a large prospective cohort study of participants who voluntarily underwent private health examinations that included PSA-based prostate cancer screening. The baseline visit occurred between January 1994 and December 2004, and follow-up was through December 2011. Deaths from prostate cancer were ascertained from the underlying cause of death from a computerized search of death certificate data from the National Statistical Office in Korea. We used the Cox proportional hazards regression to estimate the association between serum PSA and risk of prostate cancer death adjusting the baseline age, cigarette smoking status, and body mass index. During 1,381,901 person-years of follow-up, 6036 men died of any cause, and of these, 56 men died of prostate cancer. The multivariate-adjusted hazard ratio for prostate cancer death statistically significantly increased across PSA concentrations (P trend <.0001). The hazard ratio increased 7% per 1-ng/mL increase in PSA. The association between PSA concentration and death from prostate cancer was stronger in younger than in older men and in heavier than leaner men. In conclusion, an increased screening PSA level is associated with an increased risk of prostate cancer death in Korean men. Our findings may have implications for the development of targeted PSA cutpoints for biopsy recommendation. Copyright © 2015 Elsevier Inc. All rights reserved.
    Urology 05/2015; 85(5). DOI:10.1016/j.urology.2015.02.014 · 2.13 Impact Factor
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    ABSTRACT: Acute kidney injury (AKI) is a serious global public health problem. We aimed to quantify the risk of AKI associated with estimated glomerular filtration rate (eGFR), albuminuria (albumin-creatinine ratio [ACR]), age, sex, and race (African American and white). Collaborative meta-analysis. 8 general-population cohorts (1,285,049 participants) and 5 chronic kidney disease (CKD) cohorts (79,519 participants). Available eGFR, ACR, and 50 or more AKI events. Age, sex, race, eGFR, urine ACR, and interactions. Hospitalized with or for AKI, using Cox proportional hazards models to estimate HRs of AKI and random-effects meta-analysis to pool results. 16,480 (1.3%) general-population cohort participants had AKI over a mean follow-up of 4 years; 2,087 (2.6%) CKD participants had AKI over a mean follow-up of 1 year. Lower eGFR and higher ACR were strongly associated with AKI. Compared with eGFR of 80mL/min/1.73m(2), the adjusted HR of AKI at eGFR of 45mL/min/1.73m(2) was 3.35 (95% CI, 2.75-4.07). Compared with ACR of 5mg/g, the risk of AKI at ACR of 300mg/g was 2.73 (95% CI, 2.18-3.43). Older age was associated with higher risk of AKI, but this effect was attenuated with lower eGFR or higher ACR. Male sex was associated with higher risk of AKI, with a slight attenuation in lower eGFR but not in higher ACR. African Americans had higher AKI risk at higher levels of eGFR and most levels of ACR. Only 2 general-population cohorts could contribute to analyses by race; AKI identified by diagnostic code. Reduced eGFR and increased ACR are consistent strong risk factors for AKI, whereas associations of AKI with age, sex, and race may be weaker in more advanced stages of CKD. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
    American Journal of Kidney Diseases 05/2015; DOI:10.1053/j.ajkd.2015.02.337 · 5.76 Impact Factor
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    ABSTRACT: Caste- and ethnicity-based inequalities are major obstacles to achieving health equity. The authors investigated whether there is any association between caste- and ethnicity-based inequalities and HIV-related knowledge within caste and ethnic populations. They used the 2011 Nepal Demographic and Health Survey, a nationally represented cross-sectional study data set. The study sample consisted of 11,273 women between 15 and 49 years of age. Univariate and logistic regression models were used to examine the relationship between caste- and ethnicity-based inequalities and HIV-related knowledge. The study sample was divided into high Hindu caste (47.9 percent), “untouchable” caste (18.4 percent), and indigenous populations (33.7 percent). Within the study sample, the high-caste population was found to have the greatest knowledge of the means by which HIV is prevented and transmitted. After controlling for socioeconomic and demographic characteristics, untouchables were the least knowledgeable. The odds ratio for incomplete knowledge about transmission among indigenous populations was 1.27 times higher than that for high Hindu castes, but there was no significant difference in knowledge of preventive measures. The findings suggest the existence of a prevailing HIV knowledge gap. This in turn suggests that appropriate steps need to be implemented to convey complete knowledge to underprivileged populations.
    Health & social work 02/2015; 40(2). DOI:10.1093/hsw/hlv010 · 0.94 Impact Factor
  • Hyejin Lim · Heejin Kimm · In Han Song
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    ABSTRACT: The purpose of the study reported in this article was to investigate the relationship between employment status and self-rated health (SRH) and the moderating effect of household income among wage workers in South Korea. This research analyzed the Korean Labor and Income Panel Study, 2005 to 2008. Of the 10,494 respondents participating in the survey during the period, a total of 1,548 people whose employment status had remained either precarious or nonprecarious were selected. A moderated multiple regression model was used to examine the main effect of employment status on SRH and the moderating effect of total household income on the relationship between employment status and SRH. Among 343 precarious workers and 1,205 nonprecarious workers, after controlling for gender, age, education, smoking, and drinking, employment status was associated with SRH of wage workers, and household income was found to have a moderating effect on SRH in that higher income buffers the link between unstable employment status and low SRH. Unstable employment, combined with low income, was significantly related to precarious wage workers’ perceived health. To promote public health, efforts may be needed to secure not only people's employment, but also their income.
    Health & social work 02/2015; 40(1):26-33. DOI:10.1093/hsw/hlu042 · 0.94 Impact Factor
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    Jung-Eun Lim · Heejin Kimm · Sun Ha Jee
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    ABSTRACT: Background Smoking is a major risk factor for lung cancer. Bilirubin, an antioxidant, is inversely associated with the risk of diseases related to oxidative stress. This study was conducted to determine the influence of smoking and bilirubin levels on the risk of lung cancer in the Severance cohort study. Methods This study included 68,676 Korean who received a health examination at Severance Health Promotion Center from 1994 to 2004. Serum bilirubin measurements within normal range were divided into tertiles whereas smoking states were divided as never-smokers, former smokers and current smokers. A diagnosis of lung cancer was coded as occurring based on the report from the National Cancer Registry. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated using Cox proportional hazards model. Results At the end of the study period, 240 patients (men: 181, women: 59) developed lung cancer. Compared to those with bilirubin levels ≥1.0 mg/dL, HRs (95% CI) for lung cancer were 2.8 (1.8–4.2) for subjects having bilirubin levels from 0.2 to 0.7 mg/dL in men. When we stratified our analysis by smoking status, bilirubin consistently showed a protective effect on the risk of lung cancer on both never- and current smokers. Current smokers having bilirubin levels from 0.2 to 0.7 mg/dL had a risk of lung cancer by 6.0-fold higher than never-smokers with bilirubin levels ≥1.0 mg/dL in men. Conclusion In this large prospective study, higher baseline bilirubin level in the normal range was associated with low risk of lung cancer. Smoking and low bilirubin levels were cumulatively associated with a higher risk of lung cancer.
    PLoS ONE 08/2014; 9(8):e103972. DOI:10.1371/journal.pone.0103972 · 3.23 Impact Factor
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    ABSTRACT: Women with greater autonomy have higher HIV-related knowledge and condom use. Inability to negotiate safer sex in high-risk situations might increase HIV infection. This study examined the relationship between women's autonomy and ability to negotiate safer sex practices among married women. The 2011 Nepal Demographic and Health Survey data were used. The data were collected by two-stage stratified cluster sampling and face-to-face interviews. Autonomy was measured in Decision-Making Participation and Assets Ownership, while ability to negotiate safer sex consists of Refusal of Sex and Ask for Condom Use. Among 12,674 women of 15-49 years, married women were analyzed (n = 8,896). Women with greater autonomy in decision-making participation were more likely to negotiate safer sex. After controlling for socio-demographic factors, odds ratios (OR) for refusal of sex was 2.70 (95% CI [2.14, 3.40]) in women with the highest decision-making participation. These women showed higher OR for 'ask for condom use' in high risk situations (2.10, 95% CI [1.81, 2.44]). Assets ownership also demonstrated a positive statistical relationship with asking for a condom use (OR 1.31, 95% CI [1.10, 1.56]). The results point to the importance of women's autonomy on sexual health. It emphasizes women's empowerment-based approach to curbing HIV/AIDS in developing countries.
    AIDS education and prevention: official publication of the International Society for AIDS Education 02/2014; 26(1):1-12. DOI:10.1521/aeap.2014.26.1.1 · 1.51 Impact Factor
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    ABSTRACT: Objective: The objectives of this study were to develop a coronary heart disease (CHD) risk model among the Korean Heart Study (KHS) population and compare it with the Framingham CHD risk score. Design: A prospective cohort study within a national insurance system. Setting: 18 health promotion centres nationwide between 1996 and 2001 in Korea. Participants: 268 315 Koreans between the ages of 30 and 74 years without CHD at baseline. Outcome measure: Non-fatal or fatal CHD events between 1997 and 2011. During an 11.6-year median follow-up, 2596 CHD events (1903 non-fatal and 693 fatal) occurred in the cohort. The optimal CHD model was created by adding high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol and triglycerides to the basic CHD model, evaluating using the area under the receiver operating characteristic curve (ROC) and continuous net reclassification index (NRI). Results: The optimal CHD models for men and women included HDL-cholesterol (NRI=0.284) and triglycerides (NRI=0.207) from the basic CHD model, respectively. The discrimination using the CHD model in the Korean cohort was high: the areas under ROC were 0.764 (95% CI 0.752 to 0.774) for men and 0.815 (95% CI 0.795 to 0.835) for women. The Framingham risk function predicted 3-6 times as many CHD events than observed. Recalibration of the Framingham function using the mean values of risk factors and mean CHD incidence rates of the KHS cohort substantially improved the performance of the Framingham functions in the KHS cohort. Conclusions: The present study provides the first evidence that the Framingham risk function overestimates the risk of CHD in the Korean population where CHD incidence is low. The Korean CHD risk model is well-calculated alternations which can be used to predict an individual's risk of CHD and provides a useful guide to identify the groups at high risk for CHD among Koreans.
    BMJ Open 01/2014; 4(5):e005025. DOI:10.1136/bmjopen-2014-005025 · 2.06 Impact Factor
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    ABSTRACT: Studies on factors which may predict the risk of diabetes are scarce. This prospective cohort study was conducted to determine the association between adiponectin and type 2 diabetes among Korean men and women. A total of 42,845 participants who visited one of seven health examination centers located in Seoul and Gyeonggi province, Republic of Korea between 2004 and 2008 were included in this study. The incidence rates of diabetes were determined through December 2011. To evaluate the effects of adiponectin on type 2 diabetes, the Cox proportional hazard model was used. Of the 40,005 participants, 959 developed type 2 diabetes during a 6-year follow-up. After the adjustment for age, body mass index (BMI), and waist circumference, the risks for type 2 diabetes in participants with normoglycemia had a 1.70-fold (95% confidence interval [CI], 1.21 to 2.38) increase in men and a 1.83-fold (95% CI, 1.17 to 2.86) increase in women with the lowest tertile of adiponectin when compared to the highest tertile of adiponectin. For participants with impaired fasting glucose (IFG), the risk for type 2 diabetes had a 1.46-fold (95% CI, 1.17 to 1.83) increase in men and a 2.52-fold (95% CI, 1.57 to 4.06) increase in women with the lowest tertile of adiponectin. Except for female participants with normoglycemia, all the risks remained significant after the adjustment for fasting glucose and other confounding variables. Surprisingly, BMI and waist circumference were not predictors of type 2 diabetes in men or women with IFG after adjustment for fasting glucose and other confounders. A strong association between adiponectin and diabetes was observed. The use of adiponectin as a predictor of type 2 diabetes is considered to be useful.
    Diabetes & metabolism journal 08/2013; 37(4):252-61. DOI:10.4093/dmj.2013.37.4.252
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    Keum Ji Jung · Heejin Kimm · Ji Eun Yun · Sun Ha Jee
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    ABSTRACT: Background Thigh circumference is associated with diabetes risk; however, the role of obesity as a potential effect modifier has not been well studied. Methods We examined the association between thigh circumference and diabetes in a cross-sectional study of 384 612 Koreans aged 30 to 79 years. The association between diabetes and thigh circumference in relation to body mass index (BMI) was analyzed among 315 628 participants, using multivariate logistic regression. Thigh circumference was categorized into 9 percentile categories—namely, the 2.5th, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 97.5th percentiles—and the 50th percentile was used as the reference value for thigh circumference. Separate analyses were performed for men and women. Results The association of thigh circumference with diabetes showed contradictory patterns before and after adjustment for BMI and waist circumference. Small thigh circumference was associated with greater risk of diabetes among men and women. This relationship was stronger among participants younger than 50 years, although age was not a significant effect modifier. BMI was a significant effect modifier among men with a BMI of less than 25 kg/m2. Among women, diabetes risk increased with smaller thigh circumference. Conclusions Small thigh circumference was associated with diabetes, and this association was stronger among participants with a BMI of less than 25 kg/m2. Thigh circumference might be a useful diabetes marker in lean populations.
    Journal of Epidemiology 07/2013; 23(5). DOI:10.2188/jea.JE20120174 · 2.86 Impact Factor
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    ABSTRACT: To describe the rationale, objectives, protocol, and preliminary results for a new prospective cohort study of cardiovascular disease (CVD) risk factors in South Korea. Study members were recruited from participants in routine health assessments at health promotion centres across South Korea. Established and emerging CVD risk factors were measured. Eighteen centres holding electronic health records agreed to linkage of participants' records to future health insurance claims for monitoring of disease events. The recruitment of 430,920 participants (266,782 men, 164,138 women), aged 30-74 years, provides broad geographical reach across South Korea. Risk factor prevalence was more favourable in women than men, and, in general, in the younger rather than older study members. There was also close similarity between the characteristics of the present sample and the Korean National Health and Nutrition Examination Survey. The expected associations between risk factors and both CVD and death were also apparent. Data from the present sample, based on data linkage, show close agreement with South Korea-wide surveys (for risk factor prevalence) and the extant literature (for risk factor associations). These findings gives confidence in future results anticipated from this cohort study of east Asians - a group that has been traditionally under-researched.
    07/2013; 21(12). DOI:10.1177/2047487313497602
  • Heejin Kimm · Jaeseong Jo · Sun Ha Jee
    03/2013; DOI:10.1530/endoabs.32.P361
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    ABSTRACT: Objective To assess for the presence of a sex interaction in the associations of estimated glomerular filtration rate and albuminuria with all-cause mortality, cardiovascular mortality, and end stage renal disease. Design Random effects meta-analysis using pooled individual participant data. Setting 46 cohorts from Europe, North and South America, Asia, and Australasia. Participants 2 051 158 participants (54% women) from general population cohorts (n=1 861 052), high risk cohorts (n=151 494), and chronic kidney disease cohorts (n=38 612). Eligible cohorts (except chronic kidney disease cohorts) had at least 1000 participants, outcomes of either mortality or end stage renal disease of ≥50 events, and baseline measurements of estimated glomerular filtration rate according to the Chronic Kidney Disease Epidemiology Collaboration equation (mL/min/1.73 m2) and urinary albumin-creatinine ratio (mg/g). Results Risks of all-cause mortality and cardiovascular mortality were higher in men at all levels of estimated glomerular filtration rate and albumin-creatinine ratio. While higher risk was associated with lower estimated glomerular filtration rate and higher albumin-creatinine ratio in both sexes, the slope of the risk relationship for all-cause mortality and for cardiovascular mortality were steeper in women than in men. Compared with an estimated glomerular filtration rate of 95, the adjusted hazard ratio for all-cause mortality at estimated glomerular filtration rate 45 was 1.32 (95% CI 1.08 to 1.61) in women and 1.22 (1.00 to 1.48) in men (Pinteraction<0.01). Compared with a urinary albumin-creatinine ratio of 5, the adjusted hazard ratio for all-cause mortality at urinary albumin-creatinine ratio 30 was 1.69 (1.54 to 1.84) in women and 1.43 (1.31 to 1.57) in men (Pinteraction<0.01). Conversely, there was no evidence of a sex difference in associations of estimated glomerular filtration rate and urinary albumin-creatinine ratio with end stage renal disease risk. Conclusions Both sexes face increased risk of all-cause mortality, cardiovascular mortality, and end stage renal disease with lower estimated glomerular filtration rates and higher albuminuria. These findings were robust across a large global consortium.
    BMJ (online) 01/2013; 346:f324. DOI:10.1136/bmj.f324 · 16.38 Impact Factor
  • Eunhae Chung · Heejin Kimm · In Han Song
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    ABSTRACT: Background: As a result of flexibility of labor market, the number of temporary workers has been increasing, and their unstable employment status threatens their economic status in Korea. Both job instability and economic status have been reported as risk factors for depression. However, little is known about the interaction between the two, particularly in longitudinal studies. We investigated the interaction between the effects of employment stability during 3 years in combination with economic status on depression. Methods: Based on the 1st(2005) through 4th(2008) wave data from KOWEPS(Korea WElfare Panel Study), data of 1,963 workers was analyzed. Employment instability was classified with four categories according to the employment status changes. Economic status was defined using disposable income and depression level was measured by CES-D. Results: Groups of employment instability consisted maintaining regular worker(n=1,094), downward(n=135), upward,(n=368), and maintaining temporary worker(n=366). The result showed that (1) compared to the group of maintaining regular worker(13.254.20), the depressive level by CES-D was worse in the maintaining temporary worker group(15.07.15, p<0.001). (2) As the disposable income was higher, the depressive level got lower(correlation coefficient -0.149, p<0.0001). (3) Statistically significant interaction effect was detected between employment instability and economic status(disposable income) on depression. Workers in downward group(β=-0.050, p<0.01) and maintaining temporary worker group(β=-0.079, p<0.001) showed decreasing depression level than maintaining stable workers as their disposable income increased. Conclusion: These findings suggest that it is necessary to understand the severity of depression caused by unstable employment, and mental health policy should address those with unstable employment status and low economic situation.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
  • In Han Song · Sewon Kwon · Danbi Park · Heejin Kimm
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    ABSTRACT: Background: Suicide, one of the most serious social problems in current Korea, has been known to negatively influence other people. Especially, in the adolescent period when sensitively influenced by peer group members, friends' suicide-related behaviors may have a serious impact on adolescents. Therefore, this study is to investigate the influence of friends' suicide attempts on adolescents' suicidal ideation, and to examine the moderating effect of social support on the relationship between friends' suicide attempts and adolescents' suicidal ideation. Methods: Data were collected from 549 middle school students of 5 schools selected from each regional districts of Seoul and Incheon metropolitan areas. Multiple regression analysis was used for analysis. Results: First, it is found that friends' suicidal attempts statistically significantly increases adolescents' suicidal ideation(β=.16, p<.001). Second, social support has a moderating effect on the relationship between friends' suicide attempts and adolescents' suicidal ideation(β=-.09, p<.05). In other words, students who have friends with suicide attempts reported a greater level of suicidal ideation; and having social support resources reduced the effects of friends' suicide attempts resulting in lowered level of suicidal ideation. Conclusions: These findings suggest that, at the crisis occurrence of suicidal-related behaviors among adolescents, prompt crisis intervention should be made to prevent from increasing the negative influence on peer members, and efforts should be directed at constructing social support systems in families, schools, and communities.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
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    ABSTRACT: Abdominal obesity increases mortality and morbidity from cardiovascular disease and there is a possibility that smoking effects obesity. However, previous studies concerning the effects of smoking on obesity are inconsistent. The objective of this study was to examine whether smoking is positively related to abdominal obesity in men with type 2 diabetes. Subjects consisted of 2197 type 2 diabetic patients who visited Huh's Diabetes Center from 2003 to 2009. Indices of abdominal obesity were defined as visceral fat thickness (VFT) measured by ultrasonography and waist circumference (WC). Overall obesity was defined as body mass index (BMI). Statistically significant differences in WC and VFT by smoking status were identified. However, there was no statistical difference in BMI according to smoking status. Means of WC and VFT were not significantly higher in heavy smokers and lower in mild smokers. Compared to nonsmokers, the BMI confounder adjusted odds ratio and 95% confidence interval for VFT in ex-smokers and current-smokers were 1.70 (1.21 to 2.39) and 1.86 (1.27 to 2.73), respectively. Smoking status was positively associated with abdominal obesity in type 2 diabetic patients.
    09/2012; 45(5):316-22. DOI:10.3961/jpmph.2012.45.5.316
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    ABSTRACT: Colorectal cancer (CRC) is among the leading causes of cancer deaths and can be caused by environmental factors as well as genetic factors. Therefore, we developed a prediction model of CRC using genetic risk scores (GRS) and evaluated the effects of conventional risk factors, including family history of CRC, in combination with GRS on the risk of CRC in Koreans. This study included 187 cases (men, 133; women, 54) and 976 controls (men, 554; women, 422). GRS were calculated with most significantly associated single-nucleotide polymorphism with CRC through a genomewide association study. The area under the curve (AUC) increased by 0.5% to 5.2% when either counted or weighted GRS was added to a prediction model consisting of age alone (AUC 0.687 for men, 0.598 for women) or age and family history of CRC (AUC 0.692 for men, 0.603 for women) for both men and women. Furthermore, the risk of CRC significantly increased for individuals with a family history of CRC in the highest quartile of GRS when compared to subjects without a family history of CRC in the lowest quartile of GRS (counted GRS odds ratio [OR], 47.9; 95% confidence interval [CI], 4.9 to 471.8 for men; OR, 22.3; 95% CI, 1.4 to 344.2 for women) (weighted GRS OR, 35.9; 95% CI, 5.9 to 218.2 for men; OR, 18.1, 95% CI, 3.7 to 88.1 for women). Our findings suggest that in Koreans, especially in Korean men, GRS improve the prediction of CRC when considered in conjunction with age and family history of CRC.
    09/2012; 10(3):175-83. DOI:10.5808/GI.2012.10.3.175
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    Ji Eun Yun · Soyoung Won · Heejin Kimm · Sun Ha Jee
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    ABSTRACT: Background Most studies that have evaluated the association between combined lifestyle factors and mortality outcomes have been conducted in populations of Caucasian origin. The objective of this study was to examine the association between combined lifestyle scores and the risk of mortality in Korean men and women. Methods The study population included 59,941 Koreans, 30–84 years of age, who had visited the Severance Health Promotion Center between 1994 and 2003. Cox regression models were fitted to establish the association between combined lifestyle factors (current smoker, heavy daily alcohol use, overweight or obese weight, physical inactivity, and unhealthy diet) and mortality outcomes. Results During 10.3 years of follow-up, there were 2,398 cases of death from any cause. Individual and combined lifestyle factors were found to be associated with the risk of mortality. Compared to those having none or only one risk factor, in men with a combination of four lifestyle factors, the relative risk for cancer mortality was 2.04-fold, for non-cancer mortality 1.92-fold, and for all-cause mortality 2.00-fold. In women, the relative risk was 2.00-fold for cancer mortality, 2.17-fold for non-cancer mortality, and 2.09-fold for all-cause mortality. The population attributable risks for all-cause mortality for the four risk factors combined was 44.5% for men and 26.5% for women. Conclusion This study suggests that having a high (unhealthy) lifestyle score, in contrast to a low (healthy) score, can substantially increase the risk of death by any cause, cancer, and non-cancer in Korean men and women.
    BMC Public Health 08/2012; 12(1):673. DOI:10.1186/1471-2458-12-673 · 2.32 Impact Factor
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    ABSTRACT: Background Physical activity decreases deaths from cardiovascular disease and other causes; however, it is unclear whether physical activity is associated with cancer incidence and death in Asian populations. Methods Data from 59 636 Koreans aged 30 to 93 years were collected using a questionnaire and medical examination at the Severance Hospital Health Promotion Center between 1994 and 2004. Study participants were followed for a mean duration of 10.3 years. Results In the exercising group, the multivariate Cox proportional hazards model showed a lower risk of cancer death (hazard ratio [HR] = 0.72, 95% CI = 0.62–0.85) in men but not in women. Those who exercised, as compared with those who did not, had lower risks of all-cause death (men: HR = 0.68, 95% CI = 0.60–0.76; women: HR = 0.65, 95% CI = 0.53–0.79) and noncancer death (men: 0.63, 0.53–0.75; women: 0.52, 0.39–0.69). Physical activity was inversely associated with risk of noncancer death among men and women. Conclusions Physical activity was associated with lower risks of cancer death and noncancer death.
    Journal of Epidemiology 07/2012; 22(6). DOI:10.2188/jea.JE20110110 · 2.86 Impact Factor
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    Jaeseong Jo · Heejin Kimm · Ji Eun Yun · Kyu Jang Lee · Sun Ha Jee
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    ABSTRACT: Cigarette smoking is a modifiable risk factor for cardiovascular disease. Bilirubin is a potent antioxidant and its concentration decreases in smokers. However, studies about the association between cigarette smoking and bilirubin are scarce and most are limited to total bilirubin. Additionally, bilirubin is highly related to hemoglobin. Therefore, this study evaluates the association between bilirubin subtypes and cigarette smoking in healthy Korean men independently of hemoglobin. This study included 48 040 Korean men aged 30 to 87 years who visited the Korea Medical Institute for routine health examinations from January to December, 2007. The association of smoking with total, direct, and indirect bilirubin was assessed by logistic regression analysis taking into consideration differences in subjects and smoking characteristics. Current smokers had lower bilirubin concentrations than never-smokers and ex-smokers. Smoking amount and duration were inversely significantly associated with total, direct, and indirect bilirubin. In a multivariable adjusted model, compared to never-smokers, the odds ratios (ORs) and 95% confidence intervals (CIs) of current smokers with the highest number of pack-years were 1.7 (1.6 to 1.9) for total, 1.5 (1.4 to 1.6) for direct, and 1.7 (1.6 to 1.9) for indirect bilirubin. After further adjustment for hemoglobin, this association became stronger (OR [95% CI], 2.1 [1.9 to 2.2] for total; 1.9 [1.8 to 2.0] for direct; 2.0 [1.9 to 2.2] for indirect bilirubin). In this study, bilirubin subtypes are inversely associated with smoking status, smoking amount, and smoking duration in healthy Korean men independently of hemoglobin. Further studies are needed to investigate this association in healthy Korean women.
    03/2012; 45(2):105-12. DOI:10.3961/jpmph.2012.45.2.105

Publication Stats

381 Citations
96.35 Total Impact Points

Institutions

  • 2015
    • Johns Hopkins Bloomberg School of Public Health
      • Department of Epidemiology
      Baltimore, Maryland, United States
  • 2009–2015
    • Yonsei University
      • Graduate School of Public Health
      Sŏul, Seoul, South Korea