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.

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.

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 $SO_2$.

흡연, 음주와 운동습관의 군집현상을 통한 건강행태의 고위험군: 국민건강영양 조사

강기원,성주헌,김창엽,Kang, Ki-Won,Sung, Joo-Hon,Kim, Chang-Yup 대한예방의학회 2010 예방의학회지 Vol.43 No.1

Objectives: We investigated the clustering of selected lifestyle factors (cigarette smoking, heavy alcohol consumption, lack of physical exercise) and identified the population characteristics associated with increasing lifestyle risks. Methods: Data on lifestyle risk factors, sociodemographic characteristics, and history of chronic diseases were obtained from 7,694 individuals ${\geq}20$ years of age who participated in the 2005 Korea National Health and Nutrition Examination Survey (KNHANES). Clustering of lifestyle risks involved the observed prevalence of multiple risks and those expected from marginal exposure prevalence of the three selected risk factors. Prevalence odds ratio was adopted as a measurement of clustering. Multiple correspondence analysis, Kendall tau correlation, Man-Whitney analysis, and ordinal logistic regression analysis were conducted to identify variables increasing lifestyle risks. Results: In both men and women, increased lifestyle risks were associated with clustering of: (1) cigarette smoking and excessive alcohol consumption, and (2) smoking, excessive alcohol consumption, and lack of physical exercise. Patterns of clustering for physical exercise were different from those for cigarette smoking and alcohol consumption. The increased unhealthy clustering was found among men 20-64 years of age with mild or moderate stress, and among women 35-49 years of age who were never-married, with mild stress, and increased body mass index (>$30\;kg/m^2$). Conclusions: Addressing a lack of physical exercise considering individual characteristics including gender, age, employment activity, and stress levels should be a focus of health promotion efforts.

체중 잔차를 이용한 12세 아동의 정상 폐기능 예측식

강종원,성주헌,조수헌,주영수,Kang, Jong-Won,Sung, Joo-Hon,Cho, Soo-Hun,Ju, Yeong-Su 대한예방의학회 1999 Journal of Preventive Medicine and Public Health Vol.32 No.1

Objectives. Changes in lung function are frequently used as biological markers to assess the health effects of criteria air pollutants. We tried to formulate the prediction models of pulmonary functions based on height, weight, age and gender, especially for children aged 12 years who are commonly selected for the study of health effects of the air pollution. Methods. The target pulmonary function parameters were forced vital capacity(FVC) and forced expiratory volume in one second(FEV1). Two hundreds and fifity-eight male and 301 female 12-year old children were included in the analysis after excluding unsatisfactory tests to the criteria recommended by American Thoracic Sosiety and excluding more or less than 20% predicted value by previous prediction equations. The weight prediction equation using height as a independent variable was calculated, and then the difference of observed weight and predicted weight (i.e. residual) was used as the independent variable of pulmonary function prediction equations with height. Results. The prediction equations of FVC and FEV1 for male are FVC(ml) = $50.84{\times}height(cm)+7.06{\times}weight$ residual 4838.86, FEV1(ml) = $43.57{\times}height(cm)+3.16{\times}weight$ residual - 4156.66, respectively. The prediction equations of FVC and FEV1 for female are FVC(ml) = $42.57{\times}height(cm)+12.50{\times}weight$ residual - 3862.39, FEV1(ml) = $36.29{\times}height(cm)+7.74{\times}weight$ residual - 3200.94, respectively. 환경오염과 관련된 건강효과 연구에서 흡연, 직업 등 교란변수의 영향을 효과적으로 배제할 수 있으면서 폐기능검사가 제대로 시행될 수 있는 연구대상으로 선호되고 있는 특정 연령층인 12세 학동의 보다 정확한 FVC와 FEV1 예측식을 만 들고자 전국 11개 중학교의 학생들(남자 256명, 여자 301명)을 대상으로 측정된 신장, 체중, 그리고 폐기능검사 값으로 신장-체중의 회귀식을 유도하였고, 이를 통해 12세 인구의 신장별 표준체중을 산출하였다. 이 표준체중과 실측체중의 차이인 잔차를 독립변수로 하여 폐기능 예측 식을 남녀별로 만들었는데, 남자의 경우는, FVC(ml) = 50.84 $\times$ 신장(cm) + 7.06 $\times$ 체중 잔차 - 4838.86, FEV1(m1) = 43.57 $\times$ 신장(cm) + 3.16 $\times$ 체증 잔차 4156.66 이었다. 여자에서는 FVC(ml) = 42.57 $\times$ 신장(cm) + 12.50 $\times$ 체중 잔차 - 3862.39, 그리고 FEV1(ml) = 36.29 $\times$ 신장(cm) + 7.74 $\times$ 체중 잔차 - 3200.94 이었다. 이렇게 얻어진 예측값들의 설명력(R2)은 남자에서 FVC, FEV1가 각각 0.708, 0.670이었고, 여자에서는 FVC, FEV1가 각각 0.580, 0.513이었다.

한국 성인의 수면습관 및 불면증 관련 요인 : 3개 농촌지역주민을 대상으로 한 단시적 연구

정도언,손창호,성주헌,장성훈,이건세,이원진,신해림,이부옥,조수헌,Jeong, Do-Un,Sohn, Chang-Ho,Sung, Joo-Hon,Chang, Song-Hun,Lee, Kun-Sei,Lee, Won-Jin,Shin, Hai-Rim,Lee, Bu-Ok,Cho, Soo-Hun 대한수면의학회 1997 수면·정신생리 Vol.4 No.2

Objectives: We attempted to study sleep habits and insomnia-associated factors in Korean rural adult population. Methods : In 1,441 adult subjects of three rural communities selected by cluster sampling, we administered an epidemiologic survey using questionnaire methods from July 14, 1996 to July 28, 1996. Results : 1) Mean sleep latency and mean time to sleep again after awakening during nocturnal sleep were longer in females than in males. Females suffered more frequently from insomnia symptom, awakening during nocturnal sleep. morning headache, dysphoric mood in the morning, and the feeling of 'not refreshed' on waking-up than males. 2) The older age group (defined as those older than 65 years) was found to have earlier bed-time, longer sleep latency, more frequent nocturia, longer time to sleep again after awakening during nocturnal sleep, and more frequent insomnia symptom. 3) The presence of insomnia symptom more than once a week was significantly associated with suffering from physical illness, being divorced-separated-widowed, frequently feeling depressed, nocturia, or low education level. 4) In multiple logistic regression analysis, old age, being female, low education level, frequently feeling depressed, and nocturia were independently associated with the presence of insomnia symptom more than once a week. Conclusion : We conclude that, in a Korean rural adult population, insomnia symptom increases with age and females usually suffer more from insomnia symptom than males. In addition, low education level, feeling depressed mood frequently, and nocturia are found to be significantly associated independently with the presence of insomnia symptom more than once a week.

한국 성인의 수면무호흡 증상 유병률 및 위험요인 : 3개 농촌지역을 대상으로 한 단시적 연구

손창호,정도언,성주헌,장성훈,이건세,이원진,신해림,이부옥,조수헌,Sohn, Chang-Ho,Jeong, Do-Un,Sung, Joo-Hon,Chang, Song-Hun,Lee, Kun-Sei,Lee, Won-Jin,Shin, Hai-Rim,Lee, Bu-Ok,Cho, Soo-Hun 대한수면의학회 1998 수면·정신생리 Vol.5 No.1

연구배경 및 방법 : 충청북도 충주시의 노운면과 산척면 그리고 경상남도 함안군 여항면에 거주하는 농촌 성인 중에서 집락추출법으로 선정한 총 1,441명을 대상으로 코골이 및 수면무호흡 증상 유병률에 관해 설문조사법을 이용한 역학조사를 1996년 7월 2주간에 걸쳐 실시하였다. 결과 : 대상군의 14.1%에서 거의 매일 코골이가 있었으며, 2.9%에서는 거의 매일 수면무호홉 증상이 있다고 보고하였다. 수면무호흡 증상은 남성, 45 세 - 64 세의 연령대, 비만한 사람, 흡연자, 주 1회 이상 음주자에서 유의하게 흔하였다. 다중 로짓 회귀분석에서 남성, 45 세 - 64 세의 연령대, 비만이 상호독립적으로 코골이와 수면 무호흡증상에 영향을 미치는 인자임을 알 수 있었다. 또한 코골이 및 수면무호흡 증상군에서 코를 골지 않는 군에 비해 헤모글로빈 및 적혈구수치가 정상범위내이기는 하지만 증가되어 있었다. 이완기 혈압의 상승소견도보여서 수면무호흡증상이 심혈관계에 상당한 영향을 준다는 것을 알 수 있었다. 그러나 수면무호홉 증상에 따른 주관적 이차증상의 발생빈도는 수면 무호흡증상군과 코를 골지 않는 군사이에 차이가없었다. 결론 : 국내에서도 상당한 정도의 수면 중 호흡장애가 실재하며 심혈관계 등에 유의한 영향을 끼치고 있음을 알 수 있었다. Objectives : We attempted to study obstructive sleep apnea symptoms prevalence and sleep apnea-associated factors in Korean rural adult population. Methods : In 1,441 adult subjects of three rural communities selected by cluster sampling, we administered an epidemiologic survey using questionnaire methods from July 14, 1996 to July 28, 1996. Results : 1) In 14.1% of the subjects, snoring was reported to occur almost daily and 2.9% of the subjects reported sleep apnea symptoms occurring almost daily. 2) Snoring and sleep apnea symptoms were found more frequently in males or in mid-aged group(45 - 64 years old) than in females or in younger- and older-aged groups, respectively. Compared with the subjects who have no snoring, the subjects who have snoring or sleep apnea symptoms had greater body mass index(BMI), waist-hip ratio, hemoglobin level, RBC count, and higher diastolic blood pressure. 3) Cigarette smoking and alcohol drinking more than once a week were significantly associated with suffering from sleep apnea symptoms. 4) In multiple logistic regression analysis, being male, mid-aged, and greater BMI were independently associated with the presence of snoring and sleep apnea symptoms. Conclusion : We conclude that, in the Korean rural adult population, males or mid-aged group suffers more from snoring and sleep apnea symptoms than females or younger- and older-aged groups. In addition, being male, mid-aged, and greater BMI were significantly associated independently with the presence of snoring and sleep apnea symptoms.

Receiver Operating Characteristic 분석법을 이용한 업무관련성 근골격계질환 설문지 개발

권호장,주영수,조수헌,강대희,성주헌,최성우,최재욱,김재영,김돈규,김재용,Kwon, Ho-Jang,Ju, Yeong-Su,Cho, Soo-Hun,Kang, Dae-Hee,Sung, Joo-Hon,Choi, Seong-Woo,Choi, Jae-Wook,Kim, Jae-Young,Kim, Don-Gyu,Kim, Jai-Yong 대한예방의학회 1999 예방의학회지 Vol.32 No.3

ROC곡선의 AUC는 측전도구의 기준 타당도를 나타내는 가장 일반화된 지표다. 본 연구는 ROC분석법을 이용하여 현행의 근로자건강진단에서 업무관련성 근골격계 질환의 고위험군을 변별하는 표준 설문지를 개발하고자 하였다. 컴퓨터를 이용하는 선박 설계업 종사자 89명, 전화번호 안내원 113명, 일반 직업 여성 79명, 주부 89명 등 총 370명의 일차 연구대상군에 대한 재활의 학과 전문의의 최종 진단결과를 기준으로 1996년에 개발된 '근로자의 신체 증상에 관한 설문지'의 응답결과를 비교하였다. 근골격계 질환과의 관련성이 높은 문항조합을 선정하고 문항별 가중치를 산출하기 위해 로짓회귀분석, 상관분석 등을 실시하였으며, 문항조합 및 가중치 산출방법이 서로 다른 4가지 설문모형에 따른 AUC를 비교 하였다. 또한, 국내 모 자동차조립공장 근로자 225명의 설문결과와 산업의학 전문의의 진단결과 자료를 이용하여 4가지 설문모형의 AUC 재현도를 확인하였다. 분석 결과, 통계적으로 유의 한 차이는 없었으나 문항수를 줄여도 문항별 응답수준별 가중치를 부여하면 AUC가 일관되게 증가함을 확인하였다. 증상문항 4개와 신체부위문항 7개를 통합한 11개 문항에 가중치를 부여하는 모형이 변별력, 재현도, 편의성 측면에서 우수한 것으로 나타나, 이를 기준으로 새로운 업무관련성 근골격계 질환 설문지를 설계할 수 있었다. 문항수가 적으면서도 타당도는 높은 설문지를 개발하고, 상대적인 비교평가에 쓰일 수 있는 정량적 가중치를 제시한 것이 본 연구의 주요성과라 할 수 있다. 본 연구는 전문의 사이의 진단기준 차이를 고려하지 못한 점, 다양한 인구집단에 적용할만한 절대적인 참고치를 제시하지 못한 점 등에서 한계가 있다. 그러나, '측정 도구의 정량적 타당도 검증을 통한 질병 감시용 도구 개발'이라는 본 연구의 기본 취지 및 접근방법은 향후 조직적인 질병 예방활동에 활용될 여지가 있을 것이다. Objectives: Receive Operating Characteristic(ROC) curve with the area under the ROC curve(AUC) is one of the most popular indicator to evaluate the criterion validity of the measurement tool. This study was conducted to develop a standardized questionnaire to discriminate workers at high-risk of work-related musculoskeletal disorders using ROC analysis. Methods: The diagnostic results determined by rehabilitation medicine specialists in 370 persons(89 shipyard CAD workers, 113 telephone directory assistant operators, 79 women with occupation, and 89 housewives) were compared with participant's own replies to 'the questionnair on the worker's subjective physical symptoms'(Kwon, 1996). The AUC's from four models with different methods in item selection and weighting were compared with each other. These 4 models were applied to 225 persons, working in an assembly line of motor vehicle, for the purpose of AUC reliability test. Results: In a weighted model with 11 items, the AUC was 0.8155 in the primary study population, and 0.8026 in the secondary study population(p=0.3780). It was superior in the aspects of discriminability, reliability and convenience. A new questionnaire of musculoskeletal disorder could be constructed by this model. Conclusion: A more valid questionnaire with a small number of items and the quantitative weight scores useful for the relative comparisons are the main results of this study. While the absolute reference value applicable to the wide range of populations was not estimated, the basic intent of this study, developing a surveillance fool through quantitative validation of the measures, would serve for the systematic disease prevention activities.

장애보정손실연수 ( DALY ) 를 이용한 우리나라 주요 심혈관계 질환의 질병부담 측정

이태진(Tae Jin Lee),김재용(Jai Yong Kim),성주헌(Joo Hon Sung) 한국보건경제정책학회(구 한국보건경제학회) 2002 보건경제와 정책연구 Vol.8 No.1

사업장 소음 폭로에 의한 일과성 역치 상승과 회복

조수헌,하미나,한상환,주영수,성주헌,강종원,윤덕로,송동빈,이명학,김선태 大韓産業醫學會 1996 대한직업환경의학회지 Vol.8 No.2

To determine the recovery time from noise-induced temporary threshold shift(TTS), a prospective field study was conducted at three worksites where workers are known to be exposed high level of noise. Subjects were selected according to answers on a questionnaire which inquired about otological history and previous noise exposure, including avocational, military and occupational exposures. After excluding employee with past otologic problems, recent exposure to high level noise, and under medications, total 92 employees participated in the study. Among 92 participants, complete consecutive audiometric examinations were carried out at 0∼2 hours, 5∼7 hours, 14∼16 hours after worktime noise exposure on 26 participants wearing hearing protectors and 22 participants wearing no protective devices. The difference between the hearing level 0∼2 hours after noise exposure and 5∼7 hours is statistically significant by paired t-test(p<0.01). The median recovery times calculated from the data of 22 participants wearing no protective hearing devices are 15.6 hours at 4000Hz, and 7.7 hours, 10.3 hours, 8.4 hours at 1000Hz, 2000Hz and 8000Hz respectively. These data suggest that when measuring the pure tone audiometry for noise exposed workers, at least 16 hours noise-free interval is required.