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INTRODUCTION:New terminologies of metabolic dysfunction-associated steatotic liver disease (MASLD) have been developed. We assessed hepatocellular carcinoma (HCC) risk across MASLD and/or alcohol intake.METHODS:We included participants aged 40-79 years receiving a national health checkup from 2009 to 2010 in the Republic of Korea, classified as follows: non-MASLD, MASLD, MASLD with increased alcohol intake (MetALD; weekly alcohol 210-420 g for male and 140-350 g for female individuals), and alcohol-associated liver disease (ALD; excessive alcohol intake with weekly alcohol ≥420 g for male or ≥350 g for female individuals). The primary outcome was HCC incidence. HCC risk was estimated using multivariable Cox proportional hazard models.RESULTS:Among 6,412,209 participants, proportions of non-MASLD, MASLD, MetALD, and ALD cases were 59.5%, 32.4%, 4.8%, and 3.4%, respectively. During follow-up (median 13.3 years), 27,118 had newly developed HCC. Compared with non-MASLD, the HCC risk increased from MASLD (adjusted hazard ratio [aHR] 1.66, 95% confidence interval [CI] 1.62-1.71) and MetALD (aHR 2.17, 95% CI 2.08-2.27) to ALD (aHR 2.34, 95% CI 2.24-2.45) in a stepwise manner. Furthermore, the older and non-cirrhosis subgroups were more vulnerable to detrimental effects of MASLD and/or alcohol intake, concerning HCC risk. Among the older, female, and cirrhosis subgroups, MetALD poses similar HCC risks as ALD.DISCUSSION:HCC risk increased from MASLD and MetALD to ALD in a stepwise manner, compared with non-MASLD. For an effective primary prevention of HCC, a comprehensive approach should be required to modify both metabolic dysfunction and alcohol intake habit.

Discrimination is associated with depressive symptoms and other negative health effects, but little is known about the mental health risks of workplace gender discrimination. We aimed to investigate the association of workplace gender discrimination and depressive symptoms among employed women in South Korea. The 6.sup.th wave (2016) survey datasets of the Korean Longitudinal Survey of Women and Family (KLoWF) were analyzed for 2,339 respondents who are identified as wage workers. Depressive symptoms were evaluated by the short-form (10-item) Center for Epidemiological Studies-Depression scale. Association of workplace gender discrimination and depressive symptoms was assessed using multivariate logistic regression, adjusted for potential confounding variables including age, income satisfaction, education level, marital status, and currently diagnosed disease. We then measured the age effect using age stratification multivariate logistic regression model. Women who experienced gender discrimination at workplace had higher odds of depressive symptoms regardless of the type of the discrimination including hiring, promotion, work assignments, paid wages, and firing. These associations were consistent in younger women below 40 years of age in regard to hiring, promotion, paid wages and firing, whereas inconsistent among older women above 40 years of age. Workplace gender discrimination was found to be significantly associated with depressive symptoms after adjustment for socio-demographic factors. Further, women under 40 years of age were especially vulnerable to workplace gender discrimination.

Despite the overall association of aspirin on reduced hepatocellular carcinoma (HCC) risk, there have been few studies on its benefit according to specific clinical conditions among hepatitis B virus (HBV)-infected patients. This study aimed to identify subgroups which benefit from long-term aspirin use. Nationwide data covering the HBV-infected population in the Republic of Korea from 2010 to 2011 were analyzed. Patients who had been taking Aspirin for ≥3 years were classified as aspirin users. The primary outcome was HCC development. The multivariable Fine and Gray competing risk regression model was used to estimate the adjusted hazard ratio (HR) in the entire cohort. Propensity score matching at a 1:4 ratio was also performed. Among 161,673 patients, 7,083 newly developed HCC during follow-up (mean: 7.5 years). After adjusting for age, sex, hypertension, diabetes mellitus, dyslipidemia, cirrhosis, antivirals, metformin, statin, smoking, alcohol consumption, and obesity, aspirin users (n = 9,837) were less likely to develop HCC; the adjusted HR was 0.84 (P = 0.002) in the entire cohort and 0.87 (P = 0.010) in the matched cohort. Association of aspirin use with all-cause mortality was not significant (HR = 0.93; P = 0.192), whereas association with liver-related mortality was significant (HR = 0.79; P = 0.019). A significant association was observed in the subgroups with cirrhosis, both sexes, hypertension, non-diabetes mellitus, nonantivirals against chronic hepatitis B, nonmetformin use, nonstatin use, both smoking histories, and obesity (all P < 0.05). Long-term aspirin use is significantly associated with reduced risk of HCC in chronic HBV patients. More comprehensive studies should be implemented to clarify the causal relationship.

This study aimed to examine the longitudinal relationship between disability and depressive symptoms, by comparing four types of disability in community-dwelling individuals with disabilities in South Korea. A total of 3347 South Koreans with disabilities from the second wave of the Panel Survey of Employment for the Disabled was utilized. Depressive symptomatology was assessed by whether the participant had experienced depressive symptoms for more than two weeks during the past year. A multivariate logistic regression model was used to calculate the odds ratio (OR) for depressive symptoms, and a Cox proportional hazards model to calculate the hazard ratio (HR) for two-year survival analysis. Persons who acquired mental disability from accident or industrial disaster and persons with congenital physical-internal disability were at higher risk for depressive symptoms. Maintaining employment was found to be an effective way to decrease the risk of depressive symptoms in persons with physical-external disability, sensory/speech disability, or mental disability. In contrast, in physical-internal disability, retaining normal ability to work seemed to be the key to reduce the risk of depressive symptoms. Predictors of depressive symptoms were found to differ depending on the type of disability. Such differences should be reflected in clinical and policy-level interventions to address the specific psychiatric needs of persons with different disabilities.

ObjectivesTo investigate the association between subelements of physical job demands and cognitive impairment risk in middle-aged and older workers in Korea.DesignLongitudinal study using eight waves (2006–2020) of the Korean Longitudinal Study of Aging.SettingNationally representative sample of the Korean population aged 45 years and older.Participants2170 workers aged 45 and older at baseline.Primary outcome measuresCognitive function was evaluated using the Korean version of the Mini-Mental State Examination and cognitive impairment was defined as a score below 24.ResultsHigh physical strength demands were inversely associated with cognitive impairment (OR 0.31, 95% CI 0.14 to 0.68 for ‘always’ vs ‘never’ category). Conversely, frequent heavy lifting (OR 2.67, 95% CI 1.36 to 5.26) and bending, kneeling or squatting (OR 1.69, 95% CI 0.82 to 3.47) tasks were associated with increased impairment risk. Dose–response relationships were observed between all physical job demands and cognitive impairment, persisting among those with lower education but not among those with higher education.ConclusionsDifferent types of physical job demands have varying relationships with cognitive impairment in middle-aged and older workers. Tasks requiring high physical strength may protect against cognitive impairment while tasks involving heavy lifting and bending, kneeling or squatting may increase the risk. These findings highlight the need for tailored interventions that consider the type of physical job demands and workers’ educational levels to mitigate cognitive impairment risks. Further research is needed to explore the underlying mechanisms and validate these findings.

Chronic systemic inflammation is a hallmark of obesity. This cross-sectional study aimed to investigate the association between metabolic obesity phenotypes and inflammatory markers in Korean adults (N = 21,112; mean age: 50.9 ± 16.6). Metabolic obesity phenotypes were categorized into metabolically healthy non-obesity (MHNO), metabolically unhealthy non-obesity (MUNO), metabolically healthy obesity (MHO), and metabolically unhealthy obesity (MUO) based on body mass index and the presence of any metabolic abnormalities. High-sensitivity C-reactive protein (hs-CRP) levels were measured. Multiple linear regression was used to determine the association between obesity phenotypes and hs-CRP levels. In the male sample, compared to the MHNO type, the MUNO, MHO, and MUO types were associated with a 22.3% (95% confidence interval; CI: 14.7–30.3%), 15.8% (95% CI: 2.6–30.7%), and 12.5% (95% CI: 3.0–22.9%) increase in the hs-CRP levels, respectively. The association between metabolic obesity types and hs-CRP levels was stronger among the female sample; compared to the MHNO type, the MUNO, MHO, and MUO types were associated with a 30.2% (95% CI: 22.8–38.2%), 16.0% (95% CI: 6.5–26.4%), and 22.8% (95% CI: 13.6–32.8%) increase in the hs-CRP levels, respectively. Our findings indicate a varying profile of systemic inflammation across different metabolic obesity phenotypes.

Background The burden of rare diseases on society and patients’ families has increased in Korea. However, because of the infrequency of rare diseases, there is a lack of resources and information to address these cases and inadequate funding for the management of these patients. We investigated the average annual cumulative incidence of rare diseases and the trends in annual cumulative incidence from 2011 to 2015 in Korea by using nationwide administrative data from the Korean National Health Insurance Service (NHIS) database for patients registered with the co-payment assistance policy for rare and incurable diseases. Annual cumulative incidence per 10,000,000 was calculated as the total number of newly enrolled patients with the Korean Standard Classification of Diseases (KCD)-7 code in the register, divided by the number of residents with health insurance coverage during each year. We employed simple linear regression analysis to evaluate the trends in annual cumulative incidence/10,000,000 population per year for each rare disease. Results Overall, national support was provided for patients with 415 KCD codes listed among the targeted rare diseases. The total number of newly enrolled patients with rare diseases was 53,831 in 2011, 52,658 in 2012, 52,955 in 2013, 71,530 in 2014, and 70,559 in 2015. The number of rare diseases with an average annual cumulative incidence of 100/10,000,000 and above was 22 (5.30%), while there were 227 (54.70%) and 148 (35.66%) with an average cumulative incidence between 1/10,000,000 and 100/10,000,000 and less than 1/10,000,000, respectively. The trends in the annual cumulative incidence for 43 rare diseases were statistically significant ( p -value < 0.05). The rare diseases for which the incremental trend per year was statistically significant were sarcoidosis (D86, D86.0, D86.1, D86.2, D86.3, D86.8, D86.9), Parkinson’s disease (G20), Guillain-Barré syndrome (G61.0), primary biliary cirrhosis (K74.3) and Sjogren’s syndrome (M35.0). Conclusions The number of rare diseases showing an increasing trend in annual cumulative incidence was higher than the number of diseases showing a decreasing trend in annual cumulative incidence. Given that the definition and diagnosis vary based on country and that there is difficulty in identifying valid cases, further detection strategies are needed to establish the incidence of each rare disease considering the importance of establishing a health policy based on the actual incidence of the targeted diseases.

Background Suicide is a serious public health concern worldwide, and the fourth leading cause of death in Korea. Few studies have focused on risk factors for suicide attempt among people with suicidal ideation. The aim of the present study was to investigate the risk factors and develop prediction models for suicide attempt among people with suicidal ideation in the Korean population. Method This study included 1567 men and 3726 women aged 20 years and older who had suicidal ideation from the Korea National Health and Nutrition Examination Survey from 2007 to 2012. Among them, 106 men and 188 women attempted suicide. Multivariate logistic regression analysis with backward stepwise elimination was performed to find risk factors for suicide attempt. Sub-group analysis, dividing participants into under 50 and at least 50 years old was also performed. Results Among people with suicidal ideation, age, education, cancer, and depressive disorder were selected as risk factors for suicide attempt in men. Age, education, national basic livelihood security, daily activity limitation, depressive disorder, stress, smoking, and regular exercise were selected in women. Area under curves of our prediction models in men and women were 0.728 and 0.716, respectively. Conclusions It is important to pay attention to populations with suicidal ideation and the risk factors mentioned above. Prediction models using the determined risk factors could be useful to detect high-risk groups early for suicide attempt among people with suicidal ideation. It is necessary to develop specific action plans for these high-risk groups to prevent suicide.

Background: Ageism and age-related discrimination are growing public health concerns that can have detrimental effects on the health of older adults. However, their association with nutritional health remains unexplored. This study explored the association between age discrimination and nutritional risk among older adults in Republic of Korea. Methods: This study is a cross-sectional analysis of the 2023 National Survey of Older Korean. 9951 adults aged ≥ 65 years from the 2023 National Survey of Older Koreans. Age discrimination was assessed based on the reported experiences in six everyday settings: public transportation; commercial facilities; public institutions; healthcare facilities; workplaces; and family. Nutritional status was measured using the Nutrition Screening Initiative and categorized into low; moderate; and high nutritional risk groups. Multinomial logistic regression models were used to determine the association between age discrimination and nutritional risk and estimate odds ratios and 95% confidence intervals (CIs). Results: The mean age of participants was 74.0 years. Among the participants, 73.7% reported no age discrimination, whereas 15.4%, 6.0%, and 4.9% experienced age discrimination in one; two; and three or more settings, respectively. After adjusting for socio-demographic characteristics and health factors, compared to individuals who did not experience age discrimination, those who experienced discrimination in one, two, or three or more dimensions had 1.40-fold (95% CI: 1.17–1.69), 1.46-fold (95% CI: 1.13–1.89), and 1.89-fold (95% CI: 1.44–2.48) higher odds of being at high nutritional risk, respectively. Conclusion: Age discrimination exposure may be a risk factor for poor nutritional health in older adults. Policy efforts are needed to reduce age-related discrimination and stigmatization and promote equitable conditions for healthy aging.