대기오염에 의한 폐암 및 만성폐색성호흡기질환 -개인 흡연력을 보정한 만성건강영향평가-

성주헌,조수헌,강대희,유근영,Sung, Joo-Hon,Cho, Soo-Hun,Kang, Dae-Hee,Yoo, Keun-Young 대한예방의학회 1997 예방의학회지 Vol.30 No.3

Background : Although there are growing concerns about the adverse health effect of air pollution, not much evidence on health effect of current air pollution level had been accumulated yet in Korea. This study was designed to evaluate the chronic health effect of ai. pollution using Korean Medical Insurance Corporation (KMIC) data and air quality data. Medical insurance data in Korea have some drawback in accuracy, but they do have some strength especially in their national coverage, in having unified ID system and individual information which enables various data linkage and chronic health effect study. Method : This study utilized the data of Korean Environmental Surveillance System Study (Surveillance Study), which consist of asthma, acute bronchitis, chronic obstructive pulmonary diseases (COPD), cardiovascular diseases (congestive heart failure and ischemic heart disease), all cancers, accidents and congenital anomaly, i. e., mainly potential environmental diseases. We reconstructed a nested case-control study wit5h Surveillance Study data and air pollution data in Korea. Among 1,037,210 insured who completed? questionnaire and physical examination in 1992, disease free (for chronic respiratory disease and cancer) persons, between the age of 35-64 with smoking status information were selected to reconstruct cohort of 564,991 persons. The cohort was followed-up to 1995 (1992-5) and the subjects who had the diseases in Surveillance Study were selected. Finally, the patients, with address information and available air pollution data, left to be 'final subjects' Cases were defined to all lung cancer cases (424) and COPD admission cases (89), while control groups are determined to all other patients than two case groups among 'final subjects'. That is, cases are putative chronic environmental diseases, while controls are mainly acute environmental diseases. for exposure, Air quality data in 73 monitoring sites between 1991 - 1993 were analyzed to surrogate air pollution exposure level of located areas (58 areas). Five major air pollutants data, TSP, $O_3,\;SO_2$, CO, NOx was available and the area means were applied to the residents of the local area. 3-year arithmetic mean value, the counts of days violating both long-term and shot-term standards during the period were used as indices of exposure. Multiple logistic regression model was applied. All analyses were performed adjusting for current and past smoking history, age, gender. Results : Plain arithmetic means of pollutants level did not succeed in revealing any relation to the risk of lung cancer or COPD, while the cumulative counts of non-at-tainment days did. All pollutants indices failed to show significant positive findings with COPD excess. Lung cancer risks were significantly and consistently associated with the increase of $O_3$ and CO exceedance counts (to corrected error level -0.017) and less strongly and consistently with $SO_2$ and TSP. $SO_2$ and TSP showed weaker and less consistent relationship. $O_3$ and CO were estimated to increase the risks of lung cancer by 2.04 and 1.46 respectively, the maximal probable risks, derived from comparing more polluted area (95%) with cleaner area (5%). Conclusions : Although not decisive due to potential misclassication of exposure, these results wert drawn by relatively conservative interpretation, and could be used as an evidence of chronic health effect especially for lung cancer. $O_3$ might be a candidate for promoter of lung cancer, while CO should be considered as surrogated measure of motor vehicle emissions. The control selection in this study could have been less appropriate for COPD, and further evaluation with another setting might be necessary.

한국 유전체 코호트 구축의 전략적 고려사항

성주헌,조성일,Sung, Joo-Hon,Cho, Sung-Il 대한예방의학회 2007 예방의학회지 Vol.40 No.2

Focusing on complex diseases of public health significance, strategic issues regarding the on-going Korean Genome Cohort were reviewed: target size and diseases, measurements, study design issues, and follow-up strategy of the cohort. Considering the epidemiologic characteristics of Korean population as well as strengths and drawbacks of current research environment, we tried to tailor the experience of other existing cohorts into proposals for this Korean study. Currently 100,000 individuals have been participating the new Genome Cohort in Korea. Target size of de novo collection is recommended to be set as between 300,000 to 500,000. This target size would allow acceptable power to detect genetic and environmental factors of moderate effect size and possible interactions between them. Family units and/or special subgroups are recommended to parallel main body of adult individuals to increase the overall efficiency of the study. Given that response rate to the conventional re-contact method may not be satisfactory, successful follow-up is the main key to the achievement of the Korean Genome Cohort. Access to the central database such as National Health Insurance data can provide enormous potential for near-complete case detection. Efforts to build consensus amongst scientists from broad fields and stakeholders are crucial to unleash the centralized database as well as to refine the commitment of this national project.

한 자동차공장의 1주연속 12시간주야맞교대근무 노동자들의 심박동수변이

성주헌,염명걸,공정옥,이혜은,김인아,김정연,손미아,Sung, Ju-Hon,Yum, Myung-Gul,Kong, Jung-Ok,Lee, Hye-Un,Kim, In-A,Kim, Jung-Yeon,Son, Mi-A 대한예방의학회 2004 예방의학회지 Vol.37 No.2

Objectives : The objective of this study is to compare the circadian patterns of heart rate variability assessed by 24-hour ambulatory electrocardiographic (ECG) recordings during day shift and night shift among the workers in the 5 days-concecutive-12-hour shift in an automobile factory in Korea. Methods : The study population consisted 300 workers, who were randomly selected among the 8700 total workers in one car factory. To analyse circadian variation, the 24-hour ECG recordings (Marquette) were measured during day shift (08:00-20:00 h) and night shift (20:00-08:00 h). Analysis was performed for all time and frequency domain measures of HRV. 233 workers completed taking 24-hour ECG recordings. Results : This study shows that the 24 hourcircadian variation mainly follows work/sleep cycle rather than day/night cycle among shift workers. This study also shows that among the night shift, the circadian variation between work and sleep cycle decreased compared to the work/sleep cycle among day shift workers. All time and frequency domain parameters (except LF/HF ratio) show significantly different between work and sleep in the day shift and night shift. Conclusion : These changes in heart rate variability circadian rhythms reflect significant reductions in cardiac parasympathetic activity with the most marked reduction in normal vagal activity among the shift workers. Especially, it suggests the circadian rhytm has blunted among the night workers. The quantification of the circadian variation in HRV can be a surrogates of workers' potential health risk, as well as suggests possible mechanisms through which the shift works compromise workers' health.

한국인 쌍둥이-가족 코호트와 심혈관계질환 및 대사성증후군관련 유전체 자료원 소개

성주헌 한국지질동맥경화학회(구 한국지질학회) 2009 한국지질동맥경화학회 추계학술발표논문집 Vol.2009 No.-

Dietary Restraint Is Non-Genetically Associated with Change in Body Mass Index: The Healthy Twin Study

성주헌,이가영,송윤미 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.4

Purpose: We aimed to examine if past and more recent body mass index (BMI) changes are associated with eating behavior (EB) traits and whether these associationsare due to non-genetic factors. Materials and Methods: In 1321 Korean twins and family members, recent and past BMI change groups were defined using quartiles of BMI change between first and second visits over 2.4±0.9 years and BMI change between 20 years old and second visit, respectively. We applied linear mixed analysis for relationships of past or recent BMI change groups and each EB (restrained, external, and emotional EB using the Dutch Eating Behavior Questionnaire)assessed at second visit after adjusting for household effect and covariates (age, gender, education, medical history of diabetes, hypertension, and dyslipidemia,alcohol use, physical activity, smoking habit, and calorie intake). In monozygotictwin pairs, paired t-test for within-pair comparison and conditional logistic regressionanalysis were conducted regarding EB. Results: Greater past BMI change was associated with higher restrained eating scores (P for trend=0.031), whereas greater recent BMI change was associated with higher external eating scores (P for trend=0.046). In co-twin-control analysis, twins with greater past BMI change were more likely to have higher restrained eating scores as compared with their co-twins with lower past BMI change (odds ratio 1.80; 95% confidence interval 1.13--2.87), whereas there were no associations between recent BMI change and external eating scores. Conclusion: Greater BMI change since 20 years old is associated with higher dietary restraint, and non-genetic factors explain this relationship.

1994년 하절기의 심혈관계 및 호흡기계 초과사망 - 이상고온 및 대기오염의 영향을 중심으로 -

성주헌,김호,조수헌,Sung, Joo-Hon,Kim, Ho,Cho, Soo-Hun 대한예방의학회 2001 예방의학회지 Vol.34 No.4

Objectives : To explore the possible effect of an interaction between summertime heat waves and ozone on cardiopulmonary mortality during the 1994 heat wave in Korea. Methods : The unusually hot summer of 1994 in Korea was defined as the heat wave in this study. We examined the associations of air pollutants with daily cardiopulmonary deaths between 1991-1995, considering the product term of the heat wave and each pollutant, weather and time trends. Results : During the heat wave, while temperatures were uniformly higher than those of other summers, the within-heat-wave difference in mortality paralleled that in the regional ozone levels. In terms of the influence of the heat wave, the results of ozone were different to those of total suspended particles (TSP) and sulfur dioxide $(SO_2)$. The ozone association (relative risk (RR) : 1.036; 95% confidence interval (CI) = 1.018-1.054) was observed only under heat wave conditions, while the TSP (RR : 1.006, 95% CI = 0.999-1.012) and the $SO_2$ (RR = 1.018, 95% CI : 1.011-1.024) associations were found under normal weather conditions (per interquartile increase of each pollutant; results of three pollutants model). The ozone association under heat wave was attributable to the statistical interaction between the heat wave and ozone. Conclusions : These results support the possibility of a biological synergy between the heat wave and ozone, one that is not evident between the heat wave and other major pollutants like particles or $SO_2$.

수명손실연수에 의한 한국인의 주요 건강문제

성주헌 한국역학회 1997 Epidemiology and Health Vol.19 No.2

특수건강진단 자료를 이용한 소음성난청 판정기준의 비교

한상환,조수헌,주영수,하미나,윤덕로,권호장,강대희,성주헌 大韓産業醫學會 1996 대한직업환경의학회지 Vol.8 No.3

Although noise-induced hearing loss (NIHL) is the most prevalent occupational disease in Korea, only 10% of the diagnosed cases are compensated. Old (1989-94) and current diagnostic criteria, criteria for workers' compensation of NIHL in Korea, compensation formulas of American Medical Association/American association of Ophthalmology and Otolaryngology (AMA/AAOO), the Committee on Hearing, Bio-Acoustics, Biomechanics (CHABA), American Academy of Otolaryngology (AAO) recommendation were compared. Each criterion was applied on the audiomety data of 4044 workers (8023 ears), who had received the second line screening test of Special Periodic Health Examination Program for noise-exposed workers during 1991-2. First, the resulting proportions of NIHL cases by employing each criterion were compared and strength of agreement was measured using kappa value. Temporary Threshold Shift (TTS) was corrected by noise free interval, and the reduction ratio of NIHL cases was calculated. Theoretical progression model of NIHL was reconstructed from previous studies on the natural course of NIHL to evaluate the change of diagnosis result of each criterion in the model. The kappa value between old and current criteria was 0.19, 0.55 for current criteria and workers' com. criteria, ranging from 0.08 to 0.78, highest coincidence was observed between current criteria and CHABA formula. The current criteria produce most similar results with CHABA formula. If TTS is corrected for NFI, there is about 14% reduction of NIHL cases. The results of applying on NIHL progression model divided the formulas roughly into 3 groups, of which compensation criteria was the most, old criteria and AAO the least conservative. In conclusion, the result of 4 ㎑ audiometry should be excluded in evaluation of hearing level and a new hearing conservation program should be set out. Current diagnostic criteria has an ambiguity in that managerial concept for prevention and purpose of compensation is mixed up. The current diagnostic criteria and compensation criteria could be incorporated into a new formula which is based on the state of the art test for estimating everyday hearing disability.

한국여성에서 혈중 콜레스테롤치와 사망의 연관성

송윤미,성주헌외3명 한국역학회 1997 Epidemiology and Health Vol.19 No.2

생활화학물질의 건강영향평가 방안 제언

성주헌(Joohon Sung) 서울대학교 보건환경연구소 2017 보건학논집 Vol.54 No.2