Epidemiology and Health最新文献

{"title":"Comorbidity network of post-traumatic stress and depressive symptoms during the COVID-19 pandemic in Korea.","authors":"Yujin Lee, Ji Su Yang, Alexander C Tsai, Jee In Kang, Hearan Koo, Hyeon Woo Yim, Hyeon Chang Kim, Sun Jae Jung","doi":"10.4178/epih.e2026006","DOIUrl":"10.4178/epih.e2026006","url":null,"abstract":"<p><strong>Objectives: </strong>The coronavirus disease 2019 (COVID-19) pandemic had direct effects on population health through infection and morbidity, as well as indirect effects on population mental health. We estimated the network structure of post-traumatic stress symptoms (PTSS) and depressive symptoms throughout the pandemic in Korea and aimed to identify the most central and bridging symptoms.</p><p><strong>Methods: </strong>Participants aged 30-64 years completed mental health surveys across 3 phases of the COVID-19 pandemic: March 2020 (n=1,925), February-March 2021 (n=1,754), and December 2021-January 2022 (n=1,595). Using PTSS and depressive symptom data, we conducted network analyses, and the primary measures of symptom importance (centrality) were expected influence and bridge expected influence.</p><p><strong>Results: </strong>In the comorbidity network, although the most central symptoms fluctuated over the course of the pandemic, sleep problems were consistently identified as the most influential bridge symptoms throughout. The symptom network structure differed between the subacute and chronic phases of the pandemic.</p><p><strong>Conclusions: </strong>We found evidence of changes in the network structure of PTSS and depressive symptoms, even as sleep problems retained a consistent role as a bridging symptom. Although overall network structures varied across phases of the pandemic, the bridging role of sleep-related symptoms remained consistently strong, suggesting that sleep problems may represent a general and enduring mechanism underlying PTSS-depression comorbidity. During future pandemics, prompt screening for sleep problems may help prevent the development of comorbidity between PTSS and depressive symptoms.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2026006"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13034016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087680","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":"Confounding and the healthy worker survivor effect in studies of medical radiation workers: a systematic review of methodological approaches.","authors":"Eun Jung Park, Kyoungyeol Yuk, Jaeho Jeong, Won Jin Lee","doi":"10.4178/epih.e2026009","DOIUrl":"10.4178/epih.e2026009","url":null,"abstract":"<p><p>Confounding and the healthy worker survivor effect (HWSE) represent major methodological challenges in epidemiology, particularly in studies of low-dose exposures, where effect sizes are small and risk estimates can be readily distorted by bias. This systematic review aimed to summarize the methods used to adjust for confounding and the HWSE in studies of medical radiation workers. We systematically searched PubMed and Embase for studies of medical radiation workers from inception through June 30, 2025. Studies reporting excess risk estimates for any health outcomes associated with occupational radiation exposure were included. Study selection followed the PECO (Population, Exposure, Comparator, Outcome) criteria, and data were synthesized descriptively. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in PROSPERO (CRD42024589851). Sixteen eligible studies from 3 countries were identified, all of which were rated as high quality. To control for confounding, regression was used in all studies, followed by stratification (62.5%) and restriction (18.8%). Age, sex, and birth year were adjusted for in all models, with smoking being the next most frequently controlled variable. To mitigate the HWSE, only a single approach, adjustment for employment characteristics, was identified, and it was applied in 3 studies (18.8%). No other approaches, including restriction or g-methods, were employed. Although confounding is generally addressed using conventional analytical approaches, the HWSE has rarely been considered in studies of medical radiation workers. More comprehensive strategies that explicitly account for the HWSE are needed to improve the validity of risk estimates, particularly in low-dose occupational studies.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2026009"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13033441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146126985","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":"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":"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 Statistics Korea and 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, gender, 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>Conclusions: </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":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219974/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond cohort versus case-control: the primacy of exposure assessment over study design in occupational cancer epidemiology.","authors":"Yangwoo Kim, Dong-Uk Park","doi":"10.4178/epih.e2026026","DOIUrl":"10.4178/epih.e2026026","url":null,"abstract":"<p><p>In occupational cancer epidemiology, prospective cohort studies are conventionally ranked above case-control studies. However, exposure assessment quality-central to occupational risk estimation-receives less methodological attention than study design. This review argues that divergent cohort and case-control risk estimates reflect exposure assessment limitations rather than study design. Three findings support this. First, variance decomposition demonstrates that group-level exposure assignment attenuates effect estimates by a reliability ratio approaching zero as within-worker variability becomes dominant. Second, Berkson error in job-exposure matrices, combined with model non-linearity, biases estimates toward the null. Third, the healthy worker effect, immortal time bias, and left truncation compound misclassification and shift cohort estimates further toward the null. Two case studies illustrate this pattern. For night shift work and breast cancer, the case-control odds ratio (OR) of 1.34 contrasted with the cohort relative risk (RR) of 0.98; at 30 years' cumulative exposure, these estimates were 1.88 and 1.13. For welding fumes and lung cancer, the pooled cohort RR of 1.29 contrasted with a case-control OR of 1.87; Sørensen's cohort, using individual breathing-zone measurements, recovered a hazard rate ratio of 2.34 at the highest cumulative exposure. Thus, an occupational cancer study's inferential value depends on its exposure assessment method rather than its design label. Group-level assignment attenuates effect estimates and may compromise etiological inference regardless of nominal design. Individual exposure reconstruction-through occupational interviews, industrial hygiene assessment, or personal monitoring-supports precise dose-response estimation. Quality assessment tools and meta-analyses should stratify evidence by exposure assessment method rather than design label.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2026026"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266829","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":"Temporal generalized linear mixed models for monitoring national health behavior in the United States using subnational observational data.","authors":"Floe Foxon, Mark A Sembower, Saul Shiffman","doi":"10.4178/epih.e2026035","DOIUrl":"10.4178/epih.e2026035","url":null,"abstract":"<p><strong>Objectives: </strong>Since 2025, administrative changes have resulted in the dismissal of federal workers responsible for implementing United States national health surveys. While national data are crucial to understanding trends at the national level, it may be possible to complement such data sources using state-level observational data by using the latter to predict the former in statistical models. This study presents a proof-of-concept approach for estimating the national prevalence of health behaviors in the United States based on partial state-level prevalence estimates.</p><p><strong>Methods: </strong>Focusing on United States adolescent e-cigarette use, the prevalence of which informs regulatory efforts by the U.S. Food and Drug Administration's Center for Tobacco Products, we implemented temporal generalized linear mixed models (GLMMs; with binomial or beta response distributions, a logit link function, and a spatial power covariance structure to account for autocorrelation). Models were fitted to national e-cigarette use prevalence from the National Youth Tobacco Survey and state-level e-cigarette use prevalence from 38 state-specific surveys administered by state health and education departments and other organizations from 2011 to 2025.</p><p><strong>Results: </strong>Beta models performed similarly to binomial models in year-level predictive performance, with modest mean absolute error (MAE) for in-sample predictions (beta: 1.5-1.8 percentage points [pp]; binomial: 1.4-2.6 pp) and out-of-sample predictions (beta: 2.3 pp; binomial: 2.2 pp). MAEs were generally higher for simpler comparator models: time-trend extrapolation models, 4.7-5.5 pp; 1-year-lag persistence models, 4.1-4.7 pp; and naïve mean models, 1.8-2.0 pp.</p><p><strong>Conclusions: </strong>Temporal GLMMs may be useful tools for monitoring national trends in substance use behaviors when subnational data, but not national data, are available.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2026035"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622103","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 of work-time control with burnout and turnover intention: a cross-sectional analysis of a general working population in Korea.","authors":"Hye-Eun Lee, Seong-Sik Cho, Mo-Yeol Kang","doi":"10.4178/epih.e2026011","DOIUrl":"10.4178/epih.e2026011","url":null,"abstract":"<p><strong>Objectives: </strong>For employees, work-time control (WTC) may protect against burnout and turnover. However, evidence from Korean workplaces is limited. This study aimed to examine whether WTC is associated with burnout and turnover intention and to test whether burnout mediates this relationship.</p><p><strong>Methods: </strong>We analyzed data from 4,745 wage workers in the 2024 wave of the Korean Work, Sleep, and Health Study. WTC was assessed across 6 domains, burnout was measured using the Korean Burnout Syndrome Scale, and turnover intention was assessed using a validated 4-item scale. Logistic regression was used to estimate the associations of WTC quartile with burnout and turnover intention, and mediation analysis was used to decompose the association between WTC and turnover intention through burnout.</p><p><strong>Results: </strong>Among 4,745 workers, the prevalence of burnout was 3.9% and turnover intention was 34.5%; both increased stepwise across lower WTC quartiles. In adjusted models, workers in the lowest WTC quartile had higher odds of burnout (odds ratio [OR], 3.95; 95% confidence interval [CI], 2.41 to 6.47) and turnover intention (OR, 2.24; 95% CI, 1.85 to 2.71) than those in the highest quartile. Mediation analysis showed that burnout explained 36.6% (95% CI, 22.3 to 51.0) of the association between WTC and turnover intention.</p><p><strong>Conclusions: </strong>Lower WTC was linked to higher burnout and turnover intention, with burnout explaining more than one-third of this relationship.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2026011"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13033437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147311321","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":"Childhood mortality from acute diarrheal disease in Paraguay and vaccination impact: a 31-year ecological study.","authors":"María Eugenia Galeano, Magaly Martínez, Anibal Francisco Espínola, Eliana Andrea Alvarenga, Margarita Samudio","doi":"10.4178/epih.e2026010","DOIUrl":"10.4178/epih.e2026010","url":null,"abstract":"<p><strong>Objectives: </strong>Acute diarrheal disease (ADD) remains a leading cause of morbidity and mortality in children under 5 worldwide. In Paraguay, the introduction of the rotavirus vaccine in 2010 aimed to reduce the burden of ADD in infants and young children. This study analyzed 31 years of public data on ADD morbidity and mortality in Paraguayan children under 5 and evaluated the impact of rotavirus vaccination.</p><p><strong>Methods: </strong>Annual ADD incidence, total deaths, and mortality rates from 1993 to 2023 were obtained from public databases. Proportionate mortality due to ADD, cause-specific mortality rates, absolute risk reduction (ARR) and relative risk reduction (RRR), and joinpoint regression were calculated using EPIDAT 4.2 and Joinpoint 5.3.0 software, with data stratified by age group and vaccination period.</p><p><strong>Results: </strong>Between 1993 and 2021, pediatric mortality in Paraguay declined steadily across all age groups. Following the introduction of Rotarix in 2010, infant mortality dropped from 2.36 to 0.19 deaths per 1,000 live births (ARR, 0.83; RRR, 81.4%). Joinpoint analysis showed a decline in under-5 mortality between 2009 and 2012 (annual percentage change=-35.2%, p<0.05), followed by stabilization. ADD incidence increased until 2019 and then declined, while vaccine coverage exceeded 70%.</p><p><strong>Conclusions: </strong>Paraguay has sustained declines in infant and childhood mortality over 3 decades through improvements in healthcare and immunization, with the 2010 introduction of Rotarix reducing the mortality rate by 43 deaths per 100,000 infants under 12 months. These results underscore the impact of vaccination and health system strengthening, while highlighting the need to monitor emerging threats.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2026010"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147311308","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":"Inequalities in facility-based delivery in Indonesia: evidence from the 2023 Indonesian Health Survey based on Andersen's health services utilization framework.","authors":"Legina Anggraeni, Lia Nurdini, Maryuni, Evi Martha, Sabarinah","doi":"10.4178/epih.e2026032","DOIUrl":"10.4178/epih.e2026032","url":null,"abstract":"<p><strong>Objectives: </strong>Facility-based delivery is essential for reducing maternal and infant mortality, particularly in low-income and middle-income countries. However, evidence remains limited on how structural and socioeconomic inequalities shape access to delivery services in Indonesia. Based on Andersen's health services utilization framework, this study examined structural and individual determinants of facility-based delivery in Indonesia using nationally representative data, with particular attention to access-related and socioeconomic inequalities.</p><p><strong>Methods: </strong>This cross-sectional study analyzed nationally representative data from the 2023 Indonesian Health Survey and included 68,884 women aged 10-54 years who had given birth. Predisposing, enabling, and need factors were analyzed according to Andersen's framework. Univariate, bivariate, and multivariate analyses were performed, and multiple logistic regression was used to identify factors associated with non-facility delivery.</p><p><strong>Results: </strong>Substantial inequalities in facility-based delivery were observed. Overall, 7.2% of women in Indonesia delivered outside a health facility. After adjustment, rural residence (adjusted odds ratio [aOR], 1.98; 95% confidence interval [CI], 1.71 to 2.29), lower education (aOR, 2.24; 95% CI, 2.01 to 2.55), longer travel time to health facilities (aOR, 2.29; 95% CI, 2.00 to 2.63), lack of health insurance (aOR, 2.25; 95% CI, 1.98 to 2.56) , and inadequate antenatal care (aOR, 2.79; 95% CI, 2.46 to 3.15) were strong predictors of non-facility delivery.</p><p><strong>Conclusions: </strong>Facility-based delivery in Indonesia was shaped by contextual and enabling factors, rather than by individual characteristics alone. Integrated policies are needed to improve geographic access, increase health insurance coverage, strengthen community-based health education, and improve antenatal care programs, particularly in rural areas, to expand access to delivery services at health facilities.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2026032"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377544","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, JungHee Kim, Sung-Jong Hong, Sung-Hee Hong, Jung-Won Ju, Hyungjun Kim, Kwang-Pil Ko","doi":"10.4178/epih.e2026003","DOIUrl":"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% confidence interval [CI], 27.0 to 178.6) to 124.5 (95% CI, 43.5 to 355.0) 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>Conclusions: </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":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219975/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of health behavior trajectories on all-cause and cause-specific mortality: an analysis using the National Health Insurance Service-National Health Screening Cohort in Korea.","authors":"Jeong Min Yang, Jieun Hwang","doi":"10.4178/epih.e2026029","DOIUrl":"10.4178/epih.e2026029","url":null,"abstract":"<p><strong>Objectives: </strong>Non-communicable diseases account for approximately 75% of global deaths and nearly 80% of deaths in Korea. Although the World Health Organization emphasizes the long-term management of multiple health behaviors (HBs), most studies have examined individual behaviors over short periods, thereby overlooking behavioral changes and their long-term effects. This study assessed how combined health behavior trajectories (HBTs) were associated with mortality risk, with consideration of sex-specific and age-specific differences.</p><p><strong>Methods: </strong>Using the National Health Insurance Service-National Health Screening Cohort in Korea, we analyzed 167,343 Korean adults aged 40-79 years, including 95,226 male participants and 72,117 female participants. The mean follow-up duration was 10.34 years for male participants and 10.65 years for female participants. Group-based multi-trajectory modeling was used to identify trajectories of tobacco use, alcohol consumption, physical activity, and body mass index. Associations with all-cause, cancer, and cardiovascular disease (CVD) mortality were examined using time-dependent Cox proportional hazards models stratified by sex and age.</p><p><strong>Results: </strong>Six distinct HBTs were identified in each sex, including a decreasing-risk trajectory that reflected improvements across multiple behaviors. Among male participants, the higher severe-risk group had markedly elevated all-cause mortality (hazard ratio [HR], 2.02; 95% confidence interval [CI], 1.63 to 2.51) and CVD mortality (HR, 3.17; 95% CI, 2.01 to 4.99). Among female participants, the severe-risk group had significantly higher risks of all-cause mortality (HR, 1.83; 95% CI, 1.43 to 2.34), cancer mortality (HR, 1.91; 95% CI, 1.20 to 3.05), and CVD mortality (HR, 2.68; 95% CI, 1.77 to 4.05). The decreasing-risk trajectory was associated with lower all-cause mortality in both sexes, particularly among individuals aged ≥65 years (male participants: HR, 0.87; 95% CI, 0.80 to 0.94; female participants: HR, 0.88; 95% CI, 0.79 to 0.98).</p><p><strong>Conclusions: </strong>Distinct sex-specific HBTs were strongly associated with mortality. Sustained improvements across multiple HBs were associated with substantially lower long-term mortality. These findings support preventive health policies that target middle-aged and older populations.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2026029"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266908","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}