Epidemiology and Health最新文献

{"title":"Vaccination coverage according to immunosuppression level among adults with non-rheumatoid arthritis rheumatic diseases: a retrospective observational study in South Korea.","authors":"Choseok Yoon, Kiho Jung, Wooyoung Jang, Jinnam Kim, Se Yoon Park, Bongyoung Kim","doi":"10.4178/epih.e2026018","DOIUrl":"https://doi.org/10.4178/epih.e2026018","url":null,"abstract":"<p><p>Patients with autoimmune inflammatory rheumatic diseases are particularly vulnerable to infectious diseases. Accordingly, a broader range of vaccines and, in some cases, additional doses are recommended for these patients compared with the general population. This study investigated the vaccination status of adult patients with non-rheumatoid arthritis rheumatic diseases (NRRDs). This retrospective study was conducted in the rheumatology outpatient department of a tertiary care hospital and included adult patients (aged ≥19 years) with NRRDs who received glucocorticoids and/or disease-modifying antirheumatic drugs from January 2023 to March 2023. Among these patients, we compared vaccination rates between high-level immunosuppression (HLI) and non-HLI groups. HLI was defined as current biologic use or prednisolone equivalent at a dose of ≥20 mg/day for ≥14 days. Of the 4,070 patients with NRRDs, 1,522 (37.4%) were in the HLI group. Overall vaccination rates (complete plus partial vaccination) were significantly lower in the HLI group than in the non-HLI group for influenza (20.2% vs. 31.0%, p<0.001), hepatitis B (59.5% vs. 68.8%, p<0.001), pneumococcal disease (12.9% vs. 26.9%, p<0.001), and herpes zoster (4.3% vs. 10.8%, p<0.001). Overall, vaccination rates were low among patients with NRRDs, with especially low rates in the HLI group. These findings highlight the need for systematic vaccination strategies.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2026018"},"PeriodicalIF":2.2,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cohort profile: The Korean Youth Health Behavior Panel Survey (KYHPS).","authors":"Jun Hyun Hwang, Inho Park, Soon-Woo Park","doi":"10.4178/epih.e2026017","DOIUrl":"https://doi.org/10.4178/epih.e2026017","url":null,"abstract":"<p><p>The identification of factors that predispose adolescents to adopt healthy lifestyles is essential because this developmental stage shapes long-term health trajectories. To address the lack of longitudinal data on adolescent health in Korea, the Korean Youth Health Behavior Panel Survey (KYHPS) was established in 2019. The KYHPS recruited 5,051 sixth-grade students from 260 elementary schools nationwide, excluding Jeju, and follows them annually for 10 years using a stratified multistage probability sampling design. Data were collected using tablet-assisted self-interviews, and the questionnaires were developed on the basis of the ecological model of health behaviors. The survey focused on 4 major domains-tobacco use, alcohol consumption, diet, and physical activity-along with psychosocial and contextual factors at the individual, family, peer, school, and community levels. Panel retention was 93.1% in Wave 2 and 82.0% in Wave 6. The KYHPS is the first national longitudinal survey specifically focused on adolescent health behaviors in Korea and provides a unique opportunity to examine health trajectories and their determinants across adolescence and into early adulthood, with important implications for prevention and policy. .</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2026017"},"PeriodicalIF":2.2,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of chronic lung disease, insufficient sleep, and pain with incident frailty in Chinese middle-aged and older adults.","authors":"Wenyan Hu, Lifang Chen, Tingyan Li, Yongping Gu","doi":"10.4178/epih.e2026016","DOIUrl":"https://doi.org/10.4178/epih.e2026016","url":null,"abstract":"<p><strong>Objectives: </strong>Chronic lung disease, insufficient sleep, and chronic pain are prevalent among middle-aged and older adults and may synergistically accelerate frailty. This study was conducted to examine the independent and combined associations of chronic lung disease, insufficient sleep, and pain with frailty risk among middle-aged and older Chinese adults.</p><p><strong>Methods: </strong>This study used data from the China Health and Retirement Longitudinal Study. Multivariable logistic regression and mediation analyses were used to examine the associations among chronic lung disease, insufficient sleep, pain, and frailty. Pain was categorized into any bodily pain and chest pain, with the latter analyzed separately due to its potential relationship with chronic lung disease. Subgroup analyses stratified by age and sex were also conducted to assess effect modification.</p><p><strong>Results: </strong>Chronic lung disease combined with insufficient sleep (odds ratio [OR], 2.71; 95% confidence interval [CI], 1.70-4.22), pain (OR, 3.04; 95% CI, 1.86-4.86), or chest pain (OR, 2.58; 95% CI, 1.07-5.56) was significantly associated with higher odds of frailty. Subgroup analyses showed an interaction among chronic lung disease, chest pain, and age (p for interaction <0.05). Mediation analysis revealedanalyses indicated that sleep, pain, and chest pain mediated 10.1%, 26.2%, and 14.0% of the association between chronic lung disease and frailty, respectively.</p><p><strong>Conclusion: </strong>The combined presence of chronic lung disease with insufficient sleep or pain was associated with an increased risk of incident frailty. Screening and interventions targeting these factors may help mitigate frailty among middle-aged and older adults.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2026016"},"PeriodicalIF":2.2,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality risk associated with acetylcholinesterase inhibitor use in Parkinson's disease dementia according to sex and age at disease onset: a nationwide cohort study.","authors":"Bora Yoon, Hwa Jung Kim","doi":"10.4178/epih.e2026015","DOIUrl":"https://doi.org/10.4178/epih.e2026015","url":null,"abstract":"<p><strong>Objectives: </strong>Dementia increases mortality risk; however, most studies evaluating acetylcholinesterase inhibitors (AChEIs) have focused on Alzheimer's disease. The survival effects of AChEIs in Parkinson's disease dementia (PDD) remain unclear. This study evaluated the association between AChEI use and mortality in PDD, stratified by sex and age at Parkinson's disease (PD) onset.</p><p><strong>Methods: </strong>This retrospective cohort study used data from the Korean National Health Insurance Service from January 2002 to December 2021. Patients diagnosed with PDD after PD onset were included. Propensity score matching (2:1) was performed to match AChEI users with non-users. Kaplan-Meier survival analyses and subgroup analyses were conducted according to sex and age at PD onset.</p><p><strong>Results: </strong>AChEI use was associated with a 24% reduction in mortality risk (HR = 0.76, 95% CI: 0.74-0.78, p < 0.001). The survival benefit persisted throughout follow-up and was more pronounced in females (HR = 0.71, 95% CI: 0.69-0.74) than in males (HR = 0.83, 95% CI: 0.80-0.86). In late-onset PDD, AChEI use was associated with a 26% reduction in mortality (HR = 0.74, 95% CI: 0.72-0.76), whereas no significant association was observed in young-onset PDD (HR = 1.02, 95% CI: 0.92-1.33, p = 0.665). Survival outcomes were comparable between donepezil and rivastigmine users.</p><p><strong>Conclusion: </strong>AChEI use improved survival in patients with PDD, particularly in females and in those with late-onset PD, with the greatest benefit observed during early and medium-term follow-up periods. These findings suggest that AChEIs may confer a survival advantage in PDD regardless of the specific agent used.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2026015"},"PeriodicalIF":2.2,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Latency period of lung cancer in relation to tobacco smoking in Korea.","authors":"Thi Tra Bui, Hee-Yeon Kang, Eunjung Park, Jin-Kyoung Oh","doi":"10.4178/epih.e2026014","DOIUrl":"https://doi.org/10.4178/epih.e2026014","url":null,"abstract":"<p><strong>Objectives: </strong>This mixed-methods observational study aimed to examine the temporal relationship between trends in cigarette smoking prevalence and lung cancer mortality and incidence rates, and to estimate the latency period between smoking initiation and lung cancer diagnosis among smokers at the individual level.</p><p><strong>Methods: </strong>Smoking prevalence data for 1960-2022 were reconstructed using data from the Korea National Health and Nutrition Examination Survey (1998-2022). Lung cancer mortality data (1983-2022) and incidence data (1999-2022) were obtained from the Korea Central Cancer Registry. The population latency period was estimated using peak comparison and distributed lag non-linear models. The individual latency period was estimated as the average time interval between age at smoking initiation and age at lung cancer diagnosis using individual-level data from the National Health Insurance Service cohort.</p><p><strong>Results: </strong>In men, smoking prevalence peaked around 1985, whereas lung cancer mortality peaked around 2000 during 1960-2022, indicating a lag time of approximately 15 years. In women, lung cancer mortality peaked in 2002, while smoking prevalence peaked around the same time. The population-level latency period between smoking and lung cancer incidence was estimated to be 15 years after adjustment for age, sex, and year of outcome. The individual latency period was estimated to be 42.6 years (standard deviation [SD], 12.5) in men and 34.4 years (SD, 14.2) in women. Smoking intensity and age at initiation did not appear to shorten the individual latency period.</p><p><strong>Conclusion: </strong>Estimates of the smoking-attributable lung cancer burden should account for historical smoking prevalence from approximately 15 years earlier.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2026014"},"PeriodicalIF":2.2,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between the consumption of raw Kudoa septempunctata-infected farmed Paralichthys olivaceus and gastrointestinal symptoms.","authors":"Jihye An, En-Joo Jung, Soon-Ok Lee, Jong-Hoon Choi, Jung Hee Kim, Sung-Jong Hong, Sung-Hee Hong, Jung-Wong Ju, Hyungjun Kim, Kwang-Pil Ko","doi":"10.4178/epih.e2026003","DOIUrl":"https://doi.org/10.4178/epih.e2026003","url":null,"abstract":"<p><strong>Objectives: </strong>Kudoa septempunctata has been identified as the causative agent of food poisoning following the consumption of raw farmed Paralichthys olivaceus. However, cohort studies providing robust evidence for an association between K. septempunctata and gastrointestinal symptoms remain limited. This prospective cohort study investigated the association between the consumption of K. septempunctata-infected farmed P. olivaceus and the occurrence of gastrointestinal symptoms.</p><p><strong>Methods: </strong>Individuals who purchased raw farmed P. olivaceus between 2020 and 2021 were selected as the study population. Study data included 2 rounds of questionnaire surveys administered before and after consumption, 2 muscle specimens obtained from each purchased fish, and human biological specimens collected from individuals who developed gastrointestinal symptoms within 24 hours after consumption. Data were analyzed using the chi-square test and t-test, and the association between consumption of K. septempunctata-infected farmed P. olivaceus and gastrointestinal symptoms was evaluated using relative risk estimates between exposure groups.</p><p><strong>Results: </strong>The relative risk of gastrointestinal symptoms associated with exposure to K. septempunctata-infected P. olivaceus ranged from 71.2 (95% CI, 27.0-178.6) to 124.5 (95% CI, 43.5-355) across the 2 case definitions. A strong and statistically significant association was observed between exposure to K. septempunctata-infected P. olivaceus and the development of acute gastrointestinal symptoms.</p><p><strong>Conclusion: </strong>These findings indicate both an association and a causal relationship between consumption of K. septempunctata-infected farmed P. olivaceus and the onset of gastrointestinal symptoms.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2026003"},"PeriodicalIF":2.2,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between smoking and the risk of dental implant failure in Korean adults: a nationwide cohort study.","authors":"Yu-Rin Kim, Minkook Son, Hyeon Ji Kim, Seon-Rye Kim","doi":"10.4178/epih.e2026002","DOIUrl":"10.4178/epih.e2026002","url":null,"abstract":"<p><strong>Objectives: </strong>We evaluated the associations of smoking status, intensity, duration, and cumulative exposure with the risk of dental implant failure in Korean adults.</p><p><strong>Methods: </strong>This retrospective cohort study utilized the National Health Insurance Service-Health Screening Cohort (2016-2019). Overall, 23,573 individuals who had completed the dental implant process were included. Smoking status was categorized as non-smoker, ex-smoker, or current smoker. Smoking intensity, duration, and cumulative exposure were classified using standardized thresholds (>10 cigarettes per day, >10 years, and >10 pack-years). Implant failure was defined as reimplantation or removal. Cox proportional hazards models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for demographic, clinical, and behavioral covariates.</p><p><strong>Results: </strong>During follow-up, 605 implant failures occurred: 344 in non-smokers, 182 in ex-smokers, and 79 in current smokers. The corresponding incidence rates per 1,000 person-years were 11.56, 16.54, and 22.33, respectively. Current smoking was significantly associated with higher implant failure risk (adjusted HR, 1.59; 95% CI, 1.20 to 2.09), while ex-smokers displayed a non-significant increase (adjusted HR, 1.16; 95% CI, 0.94 to 1.45). A dose-response relationship was observed: smoking more than 10 cigarettes per day, smoking for more than 10 years, or exceeding 10 pack-years was associated with significantly increased risk.</p><p><strong>Conclusions: </strong>Smoking is a significant, dose-dependent risk factor for dental implant failure in Korean adults. Current smokers have the highest risk; smoking cessation may reduce adverse outcomes. These findings emphasize the importance of detailed smoking assessments and cessation counseling in implant care and public health strategies.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2026002"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12946569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of gestational age by pregnancy outcomes and distribution of pregnancy-related codes in Korean claims data.","authors":"Woo-Jung Kim, Yunha Noh, Yongtai Cho, Eun-Young Choi, HyunJoo Lim, Hyesung Lee, Ju-Young Shin","doi":"10.4178/epih.e2026007","DOIUrl":"10.4178/epih.e2026007","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate a fixed-duration algorithm for gestational age (GA) estimation according to pregnancy outcomes and to describe the GA distribution of pregnancy-related codes in Korea.</p><p><strong>Methods: </strong>We included 351,055 pregnancy episodes (2019-2022) from linked data between the National Health Insurance Service and the Korea Immunization Registry Information System (KIRIS). GA from claims data was estimated by subtracting fixed durations from the delivery date (algorithm-based GA), and GA derived from KIRIS was defined as the gold standard. Accuracy was evaluated as the proportion of episodes in which the difference between the estimated GA and the reference standard fell within ±2 weeks. We described the distributions of the GA at which each prenatal test, pregnancy complication, and diagnostic code was recorded.</p><p><strong>Results: </strong>Algorithm-based GA estimation showed high accuracy for live births (92.2% within ±2 weeks) but markedly lower accuracy for non-live birth outcomes, including stillbirth (3.3%), termination (7.2%), spontaneous abortion (45.2%), and ectopic pregnancy (20.0%). In additional analyses aimed at identifying potential indicators for improving GA estimation, most events occurred within clinically expected timeframes, although some individual codes exhibited poor temporal alignment.</p><p><strong>Conclusions: </strong>Algorithm-based GA estimation using claims data performed well for live births but demonstrated limited accuracy for non-live birth outcomes. Incorporating information from prenatal tests and pregnancy complications may enhance GA estimation.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2026007"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13033438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age- and disability-based trends in potentially preventable hospitalizations: evidence from nationwide claims data in Korea.","authors":"Hyejung Yoon, Boyoung Jeon, Seyune Lee, Daesung Choi, Se-Youn Jung, Dong-Min Son, YongJoo Rhee, Juhyeon Moon, So Youn Park, In-Hwan Oh, Young-Il Jung","doi":"10.4178/epih.e2026012","DOIUrl":"10.4178/epih.e2026012","url":null,"abstract":"<p><strong>Objectives: </strong>Individuals with disabilities are at greater risk of hospitalization than the general population. We examined 10-year trends in potentially preventable hospitalizations (PPH) in Korea, comparing individuals with and without disabilities and assessing age-specific patterns.</p><p><strong>Methods: </strong>Using National Health Information Database claims data (2010-2019), we established a fixed cohort of newly registered individuals with disabilities and control subjects statistically matched (1:1.5) at baseline. Annual PPH rates among patients with each condition were calculated and age- and sex-standardized according to Organization for Economic Cooperation and Development Health Care Quality Indicators definitions. Trends and annual percent changes (APCs) were analyzed by disability status and age group (non-older: 30-64; older adults: ≥65 years).</p><p><strong>Results: </strong>Between 2010 and 2019, PPH rates declined significantly in both groups. Among individuals with disabilities, the steepest decline was observed for hypertension (APC, -15.7%; 95% confidence interval [CI], -17.7 to -13.7), whereas congestive heart failure showed the largest reduction among individuals without disabilities (APC, -7.8%; 95% CI, -10.8 to -4.7). Declines were generally greater among non-older adults aged 30-64 years, regardless of disability status. The disparity between disability and non-disability groups narrowed over the decade, primarily due to larger improvements among non-older adults. Older adults with disabilities consistently exhibited the highest PPH rates for most conditions, whereas younger individuals with disabilities had the highest rates for diabetes.</p><p><strong>Conclusions: </strong>PPH rates declined over the decade among both individuals with and without disabilities, particularly for hypertension and among non-older adults. However, older adults with disabilities remain at elevated risk, underscoring the need for targeted strategies to improve access to community-based primary care.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2026012"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147366994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Normal liver enzymes do not indicate safety from alcohol-related liver disease: evidence from a Korean nationwide cohort.","authors":"Yeon Woo Oh, Jun Young Park, Eun-Cheol Park","doi":"10.4178/epih.e2026004","DOIUrl":"10.4178/epih.e2026004","url":null,"abstract":"<p><strong>Objectives: </strong>This study examined whether individuals with consistently normal liver enzyme levels are protected from alcohol-related liver disease and investigated whether heavy drinking increases liver disease risk independent of normal biomarker status.</p><p><strong>Methods: </strong>We conducted a nationwide cohort study using Korean National Health Insurance Service data (2002-2019), including 19,035 participants aged ≥40 years who maintained normal liver enzyme levels (aspartate aminotransferase ≤40 μ/L, alanine aminotransferase ≤40 μ/L, gamma-glutamyl transferase ≤63 μ/L for men and ≤35 μ/L for women) across multiple examinations conducted between 2002 and 2008. Participants were categorized as abstainers (≤1 time/mo), moderate drinkers (≤2 times/wk), and heavy drinkers (≥3 times/wk). Primary outcomes included incident liver disease identified using diagnostic codes. Cox proportional hazards models were used to estimate hazard ratios (HRs), with age-stratified analyses performed.</p><p><strong>Results: </strong>Heavy drinkers demonstrated a significantly higher risk of liver disease than abstainers (HR, 1.73; 95% confidence interval [CI], 1.40 to 2.14), whereas moderate drinkers showed no significant association (HR, 1.06; 95% CI, 0.94 to 1.19). Consistent patterns emerged for middle-aged adults (40-69 years), with attenuated effects among participants aged ≥70 years. When alcoholic liver disease was analyzed specifically, both moderate (HR, 1.29; 95% CI, 1.05 to 1.58) and heavy drinkers (HR, 2.86; 95% CI, 2.09 to 3.91) exhibited significantly increased hazards.</p><p><strong>Conclusions: </strong>Despite normal liver enzyme levels, heavy alcohol consumption was associated with a significantly increased risk of liver disease. These findings challenge current reactive screening paradigms relying solely on biomarker abnormalities and support proactive alcohol counseling regardless of enzyme results. More sensitive strategies are needed for early detection of alcohol-related liver injury.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2026004"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13033442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}