Comparison of risk-assessment tools for cardio-cerebrovascular diseases (CVD) in male shipyard workers: a cross-sectional study

Jea Chul Ha,Jun Seok Son,Young Ouk Kim,Chang Ho Chae,Chan Woo Kim,Hyoung Ouk Park,Jun Ho Lee,Young Hoo Shin,Hyun Woo Park 대한직업환경의학회 2019 대한직업환경의학회지 Vol.31 No.-

Background: Periodic revision of assessment tools is essential to ensure risk assessment reliability and validity. Despite the recent revision of the Korea Occupational Safety and Health Agency (KOSHA) 2018, there is no evidence showing that the revision is superior to other cardio-cerebrovascular diseases (CVDs) risk-assessment tools for workplace health management. We conducted a comparative analysis using the Framingham risk score (FRS) as a gold standard to identify the most relevant CVDs risk-assessment tool for workplace health management. Methods: We included 4,460 shipyard workers who had undergone a workers" health examination during January–December 2016. Risk levels for CVDs were calculated based on the FRS, KOSHA 2013, KOSHA 2017, KOSHA 2018 (2 methods), National Health Screening Program health risk appraisal (NHS HRA) 2017, and NHS HRA 2018. Study participants were categorized into low-risk, moderate-risk, or high-risk groups. Sensitivity, specificity, correlation, and agreement of each risk-assessment tool were calculated compared with the FRS as a gold standard. For statistical analyses, Spearman"s rank correlation coefficient and the linearly weighted kappa coefficient were calculated. Results: Sensitivity of the risk assessments was highest in the KOSHA 2018 (health risk appraisal [HRA]). The FRS showed correlation coefficients of 0.354 with the KOSHA 2013, 0.396 with the KOSHA 2017, 0.386 with the KOSHA 2018, 0.505 with the KOSHA 2018 (HRA), 0.288 with the NHS HRA 2017, and 0.622 with the NHS HRA 2018. Kappa values, calculated to examine the agreement in relation to the KOSHA 2013, KOSHA 2017, KOSHA 2018, KOSHA 2018 (HRA), NHS HRA 2017, and NHS HRA 2018 with the FRS, were 0.268, 0.322, 0.352, 0.136, 0.221, and 0.559, respectively. Conclusions: The NHS HRA 2018 risk calculation method is a useful risk-assessment tool for CVDs, but only when appropriate classification criteria are applied. In order to enhance the risk-group identification capability of the KOSHA guideline, we propose to apply the classification criteria set in this study based on the risk group definition of the 2018 Korean Society of Hypertension guidelines for the management of hypertension instead of the current classification criteria of the KOSHA 2018.

건강위험요인 상태변화에 따른 고혈압 건강위험평가 모형 개발

박일수 ( Park Il Su ),김유미 ( Kim Yoo Mi ),강성홍 ( Kang Sung Hong ) 한국보건사회연구원 2015 保健社會硏究 Vol.35 No.4

본 연구의 목적은 다년간의 건강검진 및 문진 자료를 이용하여 고혈압 건강위험평가 모형을 개발하기 위한 것이다. 2010년 고혈압 미발생 수검자 11,632명을 대상으로 이들의 2009~2010년 건강행태, 신체계측 및 생화학검사 결과와 같은 건강위험요인상태변화가 2011~2012년 고혈압 발생에 미치는 영향을 파악하기 위해 로지스틱 회귀분석으로서 고혈압 건강위험평가 모형을 개발하였다. 그 결과, 개발된 고혈압 건강위험평가 모형을 통해 연령, 가족력, 음주습관 변화, 허리둘레 변화, 혈압 및 중성지방 수치의 변화가 주요 위험요인으로 선별되었다(C-통계량 =0.81[남=0.78, 여=0.87]). 특히 고혈압전단계(120-139/80-89 mmHg) 수준을 유지하는 경우, 정상 수준을 유지하는 사람에 비해 3-4년 이내 고혈압 발생위험이 16.52배(95% CI, 9.36-29.16) 높았다. 건강행태, 신체계측, 생화학검사의 변화 정도를 위험 요인으로 구성한 고혈압 발생 예측 모형은 환자뿐만 아니라 임상의료인과 보건정책가에게도 유용하게 이용될 수 있을 것이며, 추후 외적 타당도 연구가 수행되어야 할 것이다. This study aimed to develop a health risk appraisal model for predicting hypertension incidence by using measures based on multi-year (2008-2012) data of individuals who underwent a general health examination. A total of 11,632 subjects with a normal blood pressure in 2010 were enrolled to observe changes of health behavior, anthropometric measurements, and laboratory results from 2009 through 2010 affecting hypertension incidence in 2011-2012. A hypertension risk score model was developed using logistic regression. Also, the C-statistic (95% confidence interval) was used to develop the best-fitting prediction model. Hypertension risk model consisted of age, family history of hypertension, and changes in drinking behavior, visceral obesity, blood pressure level, and triglycerides level (C-statistic=0.81[male=0.78, female=0.87]). The incidence rate of hypertension was positively associated with change (◁) in blood pressure level, especially sustaining level of prehypertension (odds ratio [95% CI], 16.52 [9.36-29.16]), independently from other risk factors. The health risk model will be helpful for clinicians and policy makers as well as individuals to prevent hypertension.

Predictive Accuracy of a Health Risk Appraisal Program Using Mortality Risk Age in 116,927 Korean Men

김주영,박병주,김윤,박진호,조비룡 대한의학회 2011 Journal of Korean medical science Vol.26 No.2

Health risk appraisal (HRA) is a tool for determining health risk factors and motivating individuals to maintain a healthy lifestyle. We performed this study to describe the HRA algorithm and evaluate the accuracy of an HRA program for 10-yr mortality prediction in Korean men. We used data derived from periodic health examinations of 116,927 male public officials and school personnel aged 20 or older. Risk age and the difference between risk age and calendar age were calculated. We obtained the hazard ratio (HR) of 10-yr mortality according to the calculated age difference. Of the 116,927 subjects, 1,900(1.6%) died during the 10 yr after the 1992 medical examinations. The HR of 10-yr mortality increased significantly with age difference. Compared with the HR in the reference group (age difference below 2 yr), the HR in the group with a 2- to 6-yr age difference was 1.20 (95% confidence interval [CI]: 1.05 to 1.38) and HR in the group with more than 7-yr age difference was 1.35 (95% CI: 1.14 to 1.75). Risk age is a relatively good predictor of 10-yr mortality in Korean men and may be useful in identifying high-risk middle-aged men for health interventions.

사업장 근로자의 건강위험 평가도구 개발

정규철,이용애,홍윤철,조희숙,박혜숙,임현술,하은희 이화여자대학교 환경문제연구소 1998 이화환경연구 Vol.2 No.-

Health Risk Appraisal(HRA) is usually defined as a process by which we expect of individual's chances of acquiring specific diseases within a defined period of time. The concept of worksite as an area of health maintenance and promotion is newly developing. Our movement for health promotion of employees has been increasingly known in the worksite. The aim of this study is to develop health risk appraisal tools about health promotion at the worksite for employees. We performed this study by two steps: one step was to develop a HRA questionnaire of worksites in Korea, another was to evaluate the reliability of the questionnaire. For developing HRA questionnaire, we reviewed scientific examples at first, and then weighted the score by delphi. To evaluate the reliability of developed questionnaire, we carried out survey by test-retest method. A total of 131 employees completed HRA questionnaire on two times. The results are as follows. The total score of health risk in unhealthy workers was higher than that of healthy workers. The range of test-retest reliability of responses to the questionnaire was 0.57-0.94. Therefore it seems that this questionnaire was very suitable to assess the health behavior of workers. In conclusion, the developed HRA questionnaire can be used as a tool for evaluating health behavior and for providing health counseling materials.

Patient-Level Prediction of Cardio-Cerebrovascular Events in Hypertension Using Nationwide Claims Data

Eysenbach, Gunther,Shin, Soo-Yong,Park, Yurang,Park, Jaram,Kim, Jeong-Whun,Ryu, Borim,Heo, Eunyoung,Jung, Se Young,Yoo, Sooyoung JMIR Publications 2019 Journal of medical Internet research Vol.21 No.2

<P><B>Background</B></P><P>Prevention and management of chronic diseases are the main goals of national health maintenance programs. Previously widely used screening tools, such as Health Risk Appraisal, are restricted in their achievement this goal due to their limitations, such as static characteristics, accessibility, and generalizability. Hypertension is one of the most important chronic diseases requiring management via the nationwide health maintenance program, and health care providers should inform patients about their risks of a complication caused by hypertension.</P><P><B>Objective</B></P><P>Our goal was to develop and compare machine learning models predicting high-risk vascular diseases for hypertensive patients so that they can manage their blood pressure based on their risk level.</P><P><B>Methods</B></P><P>We used a 12-year longitudinal dataset of the nationwide sample cohort, which contains the data of 514,866 patients and allows tracking of patients’ medical history across all health care providers in Korea (N=51,920). To ensure the generalizability of our models, we conducted an external validation using another national sample cohort dataset, comprising one million different patients, published by the National Health Insurance Service. From each dataset, we obtained the data of 74,535 and 59,738 patients with essential hypertension and developed machine learning models for predicting cardiovascular and cerebrovascular events. Six machine learning models were developed and compared for evaluating performances based on validation metrics.</P><P><B>Results</B></P><P>Machine learning algorithms enabled us to detect high-risk patients based on their medical history. The long short-term memory-based algorithm outperformed in the within test (F1-score=.772, external test F1-score=.613), and the random forest-based algorithm of risk prediction showed better performance over other machine learning algorithms concerning generalization (within test F1-score=.757, external test F1-score=.705). Concerning the number of features, in the within test, the long short-term memory-based algorithms outperformed regardless of the number of features. However, in the external test, the random forest-based algorithm was the best, irrespective of the number of features it encountered.</P><P><B>Conclusions</B></P><P>We developed and compared machine learning models predicting high-risk vascular diseases in hypertensive patients so that they may manage their blood pressure based on their risk level. By relying on the prediction model, a government can predict high-risk patients at the nationwide level and establish health care policies in advance.</P>

사업장 근로자의 건강위험 평가도구 개발

홍윤철,임현술,하은희,정규철,조희숙,박혜숙,이용애 大韓産業醫學會 1998 대한직업환경의학회지 Vol.10 No.4

Health Risk Appraisal(HRA) is usually defined as a process by which we expect of individual's chances of death or acquiring specific diseases within a defined period of time. The concept of worksite as an area of health maintenance and promotion is newly developing. Our movement for health promotion of employees has been increasingly known in the worksite. The aim of this study is to develop health risk appraisal tools about health promotion at the worksite for employees. We performed this study by two steps; one step was to develop a HRA questionnaire of worksites in Korea, another was to evaluate the reliability of the questionnaire. For developing HRA questionnaire, we reviewed scientific examples at first, and then weighted the score by delphi. To evaluate the reliability of developed questionnaire, we carried out survey by test-retest method. A total of 131 employees completed HRA questionnaire on two times. The results are as follows. The total score of health risk in unhealthy workers was higher than that of healthy workers. The range of test-retest reliability of responses to the questionnaire was 0.57-0.94. Therefore it seems that this questionnaire was very suitable to assess the health behavior of workers. In conclusion, the developed HRA questionnaire can be used as a tool for evaluating health behavior and for providing health counseling materials.

청주지역 시내버스 운전자의 비만도에 따른 식습관과 건강위험도

김지현(Jihyun Kim),조수현(Suhyeun Cho),여윤재(Yoonjae Yeoh),연미영(Mi-Yong Yon),현태선(Taisun Hyun),한영희(Young-Hee Han) 충북대학교 생활과학연구소 2021 생활과학연구논총 Vol.25 No.2

This study aims to investigate the obesity status, dietary habits, and health risks among city bus drivers in Cheongju. A questionnaire survey and anthropometric measurements were conducted on 159 drivers from November 23 to 28, 2017. The Diet-related Health Risk Appraisal (D-HRA) developed by the Korea Health Industry Development Institute was used to investigate the risks of hypertension, diabetes, and hyperlipidemia. The average body mass index (BMI) was 25.8 kg/m2, and the average body fat percentage was 24.9%. The participants were classified into three groups based on BMI: normal weight group (18.5-22.9 ㎏/㎡, 19.5%), overweight group (23-24.9 ㎏/㎡, 20.2%), and obese group (≥25 ㎏/㎡, 60.3%). There were statistically significant differences in smoking rates (P < 0.01) and perceived health status (P < 0.01), but there were no differences in dietary habits or consumption frequencies of food groups among the three groups. The smoking rate of the normal weight group was 58.1%, which was higher than those of the overweight group (34.4%) and the obese group (35.4%). The percentage of the normal weight group who subjectively assessed their health to be “good” was 41.9%, whereas the percentages were only 12.5% and 15.6% in the overweight group and obese group, respectively. The “high” risks of hypertension, diabetes, and hyperlipidemia, as assessed by the D-HRA, were 88.5%, 77.1%, and 81.3%, respectively, in the obese group, which were significantly higher than those measured in the other two groups (P < 0.001). Our results showed that more than half of the bus drivers participating in this study were obese, and obese drivers had higher risks of chronic diseases. Therefore, in order to prevent chronic diseases among city bus drivers, it is necessary to assess both the risks of chronic diseases using the D-HRA in advance and to provide proper dietary practice information and effective nutrition management services, including nutrition education and counseling, to city bus drivers.

허혈성심질환 예측모형을 이용한 사회경제적 위치와 허혈성심질환 위험도의 연관성

고동희,한순실,지선하,김형렬,Koh, Dong-Hee,Han, Sun-Shil,Jee, Sun-Ha,Kim, Hyoung-Ryoul 대한예방의학회 2006 예방의학회지 Vol.39 No.4

Objectives: The object of this study is to assess the relationship between socioeconomic factors and the predicted 10-year risk of cardiovascular disease by using health risk appraisal of ischemic heart disease. Methods: The study population was taken from The 2001 Korea National Health and Nutrition Survey, and it consisted of 1,566 men and 1,984 women aged 30-59. We calculated 10-year risk using the risk function of ischemic heart disease as developed by Jee. The educational level and equivalized household income were dichotomized by a 12 years education period and the median income level. Occupation was dichotomized into manual/non-manual work. We stratified the population by age(10 years) and sex, and then we rated the risk differences according to socioeconomic factors by performing t-tests for each strata. Results: There were gradients of the predicted 10-year risk of ischemic heart disease with the educational level and the equivalized household income, and thet was an increasing tendency of risk differences with age. Manual workers didn't show significant risk difference from non-manual workers. Conclusions: There was definite relationship between low socioeconomic position and the predicted risk of ischemic heart disease in the future.

Effects of corrective exercises on selective functional movement assessment and health risk appraisal in middle-aged women

( Jae Eun Kim ),( Cheong Kim ),( Sinseop Kim ) 물리치료재활과학회 2016 Physical therapy rehabilitation science Vol.5 No.4

Objective: The purpose of this study was to find the limited patterns of middle-aged women in selective functional movement evaluation and analyze the effects of pattern improvement exercises and general control groups on the Health Risk Appraisal (HRA). Design: Randomized controlled trial. Methods: The 31 subjects were physically healthy middle-aged women aged 40-59 living in Seoul, The subjects were randomly divided into an experimental group and a control group. Forty-three physically healthy women were originally recruited and randomly assigned to either the experimental group (n=22) or the control group (n=21). However, due to lack of participation, a total of seventeen subjects in the exercise group and fourteen subjects in the control group participated in the study. All subjects were tested using Selective Functional Movement Assessment (SFMA) and HRA for the baseline measurement and joined an exercise program of their group for one hour per session, twice a week for four weeks. The experimental group was provided with the corrective exercises and the control group was given the general fitness program. A follow-up test was conducted after eight weeks from the baseline measurement. Results: Both experimental and control group showed significant changes in SFMA and HRA scores (p<0.05). In the experimental group and control groups, the SFMA and HRA showed significant improvement from baseline to 4 weeks (p<0.05). Also, in the experimental group, the SFMA was significantly improved from baseline to 8 weeks (p<0.05). For the experimental group, there was a significant improvement in SFMA after 4 weeks compared to the control group (p<0.05). Conclusions: The corrective exercise in the experimental group had a positive effect on the SFMA score as well as the general squat exercise in the control group. The corrective exercise and general control group had the same positive effect on the HRA score.

일반건강검진의 이상지질혈증 검진주기 변경에 대한 문제점 고찰

이준희 ( June-hee Lee ),이경재 ( Kyung-jae Lee ) 한국보건행정학회 2021 보건행정학회지 Vol.31 No.3

Background: Korea National Health Checkup Programs are aimed at the prevention and early detection of cardiovascular disease in adults. To establish a countermeasure for this tendency, The current Korea National Health Checkup Programs have been providing Health Risk Appraisal (HRA) since 2009, thereby focusing on individual lifestyle correction. However, from 2018, the dyslipidemia screening exam cycle has been changed from 2 to 4 years. Methods: In this study, we try to investigate whether policy decisions are valid based on domestic reports that have influenced policy decisions. First, considering the epidemiology of the domestic cardiovascular disease, dyslipidemia, and metabolic syndrome, the change of the 4-year cycle is appropriate or not. Second, whether the research method that applies came to make policy decisions appropriate or not. Third, our study also investigates whether the direction of policy decision was suitable for the second comprehensive national examination plan. Results: The data that are used in the previous study were that of 10 years ago and there also was a problem in selecting the data, especially the use of one of the research methods to calculate the signal to noise ratio that was aimed at improving health had some problems. This is a research method that does not match with the aim itself. Conclusion: Changing the screening cycle for dyslipidemia does not match the recent trend of general screening to effectively prevent cardiovascular disease in improving individual lifestyles in the national health checkup plan. Studying the relationship with metabolic syndrome, which can be an intermediate stage of cardiovascular disease, could be a policy direction that is more suitable for the national health examination comprehensive plan.