Social Inequities in the Survival of Liver Cancer: A Nationwide Cohort Study in Korea, 2007-2017.

BACKGROUND: To analyze the effects of socioeconomic status (type of insurance and income level) and cancer stage on the survival of patients with liver cancer in Korea. METHODS: A retrospective cohort study was constructed using data from the Healthcare Big Data Platform project in Korea between January 1, 2007, and December 31, 2017. A total of 143,511 patients in Korea diagnosed with liver cancer (International Classification of Diseases, 10th Revision [ICD-10] codes C22, C220, and C221) were followed for an average of 11 years. Of these, 110,443 died. The patient's insurance type and income level were used as indicators of socioeconomic status. Unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using a Cox proportional hazards regression model to analyze the relationship between the effects of sex, age, and cancer stage at first diagnosis (Surveillance, Epidemiology, and the End Results; SEER), type of insurance, and income level on the survival of patients with liver cancer. The interactive effects of the type of insurance, income level, and cancer stage on liver cancer death were also analyzed. RESULTS: The lowest income group (medical aid) showed a higher risk for mortality (HR (95% CI); 1.37 (1.27-1.47) for all patients, 1.44 (1.32-1.57) for men, and 1.16 (1.01-1.34) for women) compared to the highest income group (1-6) among liver cancer (ICD-10 code C22) patients. The risk of liver cancer death was also higher in the lowest income group with a distant cancer stage (SEER = 7) diagnosis than for any other group. CONCLUSION: Liver cancer patients with lower socioeconomic status and more severe cancer stages were at greater risk of death. Reducing social inequalities is needed to improve mortality rates among patients in lower social class groups who present with advanced cancer.

Widening Social Inequalities in Cancer Mortality of Children Under 5 Years in Korea.

BACKGROUND: To investigate the effect of parental social class on cancer mortality in children under 5 in Korea, two birth cohorts were constructed by linking national birth data to under-5 death data from the Statistics Korea for 1995-1999 (3,323,613 births) and 2010-2014 (2,297,876 births). METHODS: The Cox proportional hazards model adjusted for covariates was used in this study. RESULTS: Social inequalities of under-5 cancer mortality risk in paternal education and paternal employment status were greater in 2010-2014 than in 1995-1999. The gap of hazard ratio (HR) of under-5 cancer mortality between lower (high school or below) and higher (university or higher) paternal education increased from 1.23 (95% confidence interval, 1.041.46) in 1995-1999 to 1.45 (1.11-1.97) in 2010-2014; the gap of HR between parents engaged in manual work and non-manual work increased from 1.32 (1.12-1.56) in 1995-1999 to 1.45 (1.12-1.89) in 2010-2014 for fathers, and from 1.18 (0.7-1.98) to 1.69 (1.03-2.79) for mothers. When the parental social class was lower, the risk of under-5 cancer mortality was higher in not only adverse but normal births. CONCLUSION: Social inequalities must be addressed to reduce the disparity in cancer mortality of children under 5 years old.

Exposure to Crude Oil-Related Volatile Organic Compounds Associated with Lung Function Decline in a Longitudinal Panel of Children.

BACKGROUND: Children in the affected area were exposed to large amounts of volatile organic compounds (VOCs) from the Hebei Spirit oil spill accident. OBJECTIVES: We investigated the lung function loss from the exposure to VOCs in a longitudinal panel of 224 children 1, 3, and 5 years after the VOC exposure event. METHODS: Atmospheric estimated concentration of total VOCs (TVOCs), benzene, toluene, ethylbenzene, and xylene for 4 days immediately after the accident were calculated for each village (n = 83) using a modeling technique. Forced expiratory volume in 1 s (FEV1) as an indicator of airway status was measured 1, 3, and 5 years after the exposure in 224 children 4~9 years of age at the exposure to the oil spill. Multiple linear regression and linear mixed models were used to evaluate the associations, with adjustment for smoking and second-hand smoke at home. RESULTS: Among the TVOCs (geometric mean: 1319.5 mg/m3·4 d), xylene (9.4), toluene (8.5), ethylbenzene (5.2), and benzene (2.0) were dominant in the order of air concentration level. In 224 children, percent predicted FEV1 (ppFEV1), adjusted for smoking and second-hand smoke at home, was 100.7% after 1 year, 96.2% after 3 years, and 94.6% after 5 years, and the loss over the period was significant (p < 0.0001). After 1 and 3 years, TVOCs, xylene, toluene, and ethylbenzene were significantly associated with ppFEV1. After 5 years, the associations were not significant. Throughout the 5 years' repeated measurements in the panel, TVOCs, xylene, toluene, and ethylbenzene were significantly associated with ppFEV1. CONCLUSIONS: Exposure to VOCs from the oil spill resulted in lung function loss among children, which remained significant up to 5 years after the exposure.

Income Disparity in Breast Cancer Incidence and Stage at Presentation: A National Population Study of South Korea.

PURPOSE: This study aims to explore income-based disparities in breast cancer (BC) incidence and stage at presentation in a national population in South Korea, where a National Cancer Screening Program (NCSP) has been implemented. METHODS: In 2007, new patients with BC were identified using the Korea Central Cancer Registry database. We calculated adjusted odds ratios (aORs) to evaluate the association between individual income level and the risk of distant stage BC at presentation, adjusting for women's age, body mass index, disability registration, employment, region of residence, and year of diagnosis. RESULTS: The cumulative age-standardized incidence of BC in the 11 years was highest among women in the richest quintile (2,040 per 100,000 women for 11 years), whereas the proportion of distant stage at presentation was the highest (10.2%) among the medical aid beneficiaries. The aOR of distant stage diagnosis at presentation was higher for lower-income quintiles, and the risk was the highest in the medical aid beneficiaries (aOR, 2.25; 95% confidence interval, 1.97-2.58) than in the richest quintile. The income-based gradient in aORs for distant stage did not differ between younger (< 40 years) and older patients. CONCLUSION: A higher risk of distant stage BC at presentation among the lower-income and medical aid groups in the context of a NCSP was observed. A more focused approach toward women in lower-income groups is necessary to alleviate the disparity in the risk of advanced BC.

Income-based disparities in the risk of distant-stage cervical cancer and 5-year mortality after the introduction of a National Cancer Screening Program in Korea.

OBJECTIVES: This study assessed the socioeconomic gradient in the risk of distant-stage cervical cancer (CC) at presentation and 5-year mortality for new CC patients after the introduction of a national Cancer Screening Program (NCSP) in Korea. METHODS: All new CC cases from 2007 to 2017 were retrieved from the Korea Central Cancer Registry database linked with the National Health Information Database of the National Health Insurance Service. The age-standardized cumulative incidence of CC, adjusted odds ratios (ORs) of distant metastasis at presentation, and adjusted all-cause mortality hazard ratios (HRs) within 5 years post-diagnosis were assessed according to the income gradient. RESULTS: The 11-year age-standardized cumulative incidence of CC ranged from 48.9 to 381.5 per 100,000 women, with the richest quintile having the highest incidence. Of 31,391 new cases, 8.6% had distant metastasis on presentation, which was most frequent among Medical Aid beneficiaries (9.9%). Distant-stage CC was more likely when the income level was lower (OR, 1.46; 95% confidence interval [CI]), 1.28 to 1.67 for the lowest compared to the richest) and among Medical Aid beneficiaries (OR, 1.50; 95% CI, 1.24 to 1.82). The 5-year mortality was greater in the lower-income quintiles and Medical Aid beneficiaries than in the richest quintile. CONCLUSIONS: The incidence of CC was higher in the richest quintile than in the lower income quintiles, while the risk of distant-stage CC and mortality was higher for women in lower income quintiles in the context of the NCSP. A more focused approach is needed to further alleviate disparities in the timely diagnosis and treatment of CC.

What Activities in Forests Are Beneficial for Human Health? A Systematic Review.

Over the past decade, clinical trials of forest-based interventions have increased, leading to their recognition as preventive medicine. However, little is known about the differences in health effects according to the activity characteristics of interventions. This study aimed to understand the types of activities and their associated health effects to identify differences in health effects between activities. PubMed, PsycINFO, Web of Science, and Scopus databases were searched, and methodological quality was assessed using Cochrane ROB2. A total of 32 randomized controlled trials (RCTs) met the eligibility criteria. Health outcomes were collected from 6264 participants aged 6-98 years, and the sample size was 12-585. The Interventions were walking (n = 21), staying (n = 7), exercise (n = 4), indirect exposure (n = 4), and the activity time was between 10 and 240 min. Overall, walking showed consistent positive health effects, and there were differences in effects on anxiety and depression, cognitive function, stress hormone, and inflammation according to the activity. However, most of the included studies had a high risk of bias, and interventions were limited to specific activities, durations, and frequencies. Although a few limitations remain, the findings in this study are of great significance in providing the basis for the design of forest-based interventions.

Environmental exposure to asbestos and the risk of lung cancer: a systematic review and meta-analysis.

Asbestos is a carcinogen associated with lung cancer, but few studies have examined the increased risk of lung cancer due to environmental asbestos exposure. We performed a systematic review and meta-analysis to evaluate the association between environmental asbestos exposure and lung cancer. We searched for articles on non-occupational or environmental asbestos exposure and lung cancer in PubMed, EMBASE, CINAHL and Web of Science databases. Our review included 15 studies, and except studies on ingestion exposure we performed a meta-analysis for 13 studies with respect to the type of exposure (neighbourhood and domestic/household exposure). Subgroup analyses and meta-regression were also performed. A significant increase in the risk of lung cancer was found for neighbourhood exposure (1.48, 95% CI 1.18 to 1.86), while the risk was not significantly increased for domestic/household exposure (1.04, 95% CI 0.85 to 1.27). With regard to neighbourhood exposure, naturally occurring asbestos and women were both associated with a higher risk of lung cancer; however, such an increase was not significantly greater compared with that associated with other sources of asbestos exposure and men. Although cautious interpretation is needed due to the large degree of heterogeneity and the small number of included studies, our findings imply that living near the source of asbestos increases the risk of lung cancer.

Evidence-Based Status of Forest Healing Program in South Korea.

Various effects of forest healing on health have been reported, but a certification system to assess the effectiveness of forest healing programs does not exist. In this study, a systematic review (SR) on the "health benefits of forests" and "meta-analysis of forest therapy" was conducted after analyzing the status and level of evidence of 75 forest healing programs that were conducted post-certification in South Korea. The SR for "health benefits of forests" distinguished between activities and time, resulting in 90.9% of walking activities for more than an hour under psychological health, and 100.0% of exercise activities for less than an hour under physiological health. However, the effect of indirect activities performed for more than an hour was unknown. Thus, we confirmed that many indoor activities in the field had low effect size or no established basis regarding the feasibility of its operation. The SR on "meta-analysis of forest therapy" to check whether the program was effective. The highest number of healing effects were obtained for blood pressure (32), followed by psychological depression (24). The findings of this can serve as baseline data to facilitate future development and dissemination of evidence-based forest healing programs.

Physiological and Psychological Assessments for the Establishment of Evidence-Based Forest Healing Programs.

This study aimed to establish a health and medical foundation for forest healing programs and provide a basis for developing an evaluation system for such programs. While the number of visitors to forests and interest in forest healing effects are increasing, few studies have examined the various indicators of the persistent changes in forest healing effects. Therefore, this study conducted pre-, post-, and follow-up experiments on 87 health and clinical indicators in a sample of 88 adolescent participants. The relationships between pre-, post-, and follow-up experiment results for each indicator were analyzed. Of the 87 indicators, 46 showed significant changes, including systolic blood pressure, diastolic blood pressure, cholesterol, serotonin, vitamin D, CD16+CD56 count, interferon-γ, resilience, and self-esteem. The findings are significant for studying diverse participants and indicators and lay the foundation for developing forest healing programs by clarifying aspects such as the indicators suitable for short-term observation versus the indicators requiring long-term observation. Based on these analyses, the results of this study are expected to be useful when conducting research to establish an evidence-based forest healing program in the future.

Future Incidence of Malignant Mesothelioma in South Korea: Updated Projection to 2038.

Malignant mesothelioma (MM) is a cancer that is largely caused by exposure to asbestos. Although asbestos is no longer used in South Korea, the incidence of MM continues to increase due to its long latent period. We aimed to update the previous prediction of MM incidence until 2038. We predicted the incidence of MM over the next 20 years (2019-2038) in South Korea using Møller's age-period-cohort (APC) model and a Poisson regression model based on asbestos consumption. The APC model predicted that the crude incidence rate would increase sharply in men and slowly in women. Despite the sex discrepancy in the rate of increase, the incidence rate for both sexes is expected to continue increasing until 2038. In the Poisson model, the crude incidence rate was predicted to increase continuously until 2038, and far more cases of MM were predicted to occur compared with the results of the APC model. When compared with actual incidence data, the APC model was deemed more suitable than the Poisson model. The APC model predicted a continuous increase over the next 20 years with no peak, suggesting that the incidence of MM will continue to rise far into the future.

Incidence of Cancer and Asbestos-Related Diseases among Residents Living near Abandoned Asbestos Mines in South Korea: A Retrospective Cohort Study Using National Health Insurance Database.

The use of asbestos has been banned since 2009 in South Korea. However, there is still a risk of exposure to environmental asbestos originating from abandoned asbestos mines. We constructed a retrospective dynamic cohort using the National Health Insurance Database of South Korea. We determined the risk of developing asbestos-related diseases (ARDs) among residents living near asbestos mines compared with those living in the control area and the general population. The risks of asbestosis (adjusted hazards ratio [HR] 65.40, 95% CI = 35.02-122.12) and pleural plaques (adjusted HR 3.55, 95% CI = 1.96-6.41) were significantly increased among residents living near the asbestos mines compared with the control area. The risk of malignant mesothelioma was increased near asbestos mines compared with the control area; however, it was not significant (adjusted HR 1.83, 95% CI = 0.61-5.47). When a separate analysis according to sex was conducted, the risk of mesothelioma among male residents was statistically significant (adjusted HR 8.30, 95% CI = 1.04-66.63), and the standardized incidence ratio (SIR) was significantly increased (SIR 3.48, 95% CI = 1.50-6.85). The risk of ARDs was increased due to environmental asbestos exposure near abandoned asbestos mines in South Korea.

A review on four different paths to respiratory arrest from brain injury in children; implications for child abuse.

Child abuse was suspected in a case of out-of-hospital arrest with minor brain injuries. Confronted with continued disputes on pathophysiologic correlates even after autopsy, to assist the differentiation of potential causes of sudden cardiopulmonary arrest in children, we tried to identify the mechanism of cardiopulmonary arrest in brain injuries from different causes. Systematic review was carried out in two stages. First, major external causes of cardiopulmonary arrest among children and infants were identified from Pubmed and Google Scholar search, and then the exact sequence of cardiopulmonary arrest, and their pathophysiologic features were identified based on articles of animal models of brain injury. From the review, we have identified four major groups of external circumstances for rather sudden cardiopulmonary arrest from brain damage in children, after excluding congenital and other unrelated diseases; 1) impact brain apnea, 2) anoxic insults, 3) drug or other substance induced central nervous system depression, and 4) traumatic brain damage. Each group has different features in the course of cardiac and respiratory arrests. Based on this review of pathophysiologic features of cardio-respiratory responses from external causes, we have presented a suspected, but unlikely, child abuse case of respiratory arrest from brain injury. The social consequences of both unknowingly missing, and falsely incriminating the abuse can be grave, and the identification of the mechanisms of cardiopulmonary arrest from brain injury can be important for the differentiation of various potential causes.

Occupational exposure to formaldehyde and risk of lung cancer: A systematic review and meta-analysis.

BACKGROUND: Formaldehyde exposure is associated with nasopharyngeal cancer and leukemia. Previously-described links between formaldehyde exposure and lung cancer have been weak and inconsistent. We performed a systematic review and meta-analysis to evaluate quantitatively the association between formaldehyde exposure and lung cancer. METHODS: We searched for articles on occupational formaldehyde exposure and lung cancer in PubMed, EMBASE, Web of Science, and CINAHL databases. In total, 32 articles were selected and 31 studies were included in a meta-analysis. Subgroup analyses and quality assessments were also performed. RESULTS: The risk of lung cancer among workers exposed to formaldehyde was not significantly increased, with an overall pooled risk estimate of 1.04 (95% confidence interval [CI], 0.97-1.12). The pooled risk estimate of lung cancer was increased when higher exposure studies were considered (1.19; 95% CI, 0.96-1.46). More statistically robust results were obtained when high quality (1.13; 95% CI, 1.08-1.19) and recent (1.13; 95% CI, 1.07-1.19) studies were used in deriving pooled risk estimates. CONCLUSIONS: No significant increase in the risk of lung cancer was evident in the overall pooled risk estimate; even in higher formaldehyde exposure groups. Our findings do not provide strong evidence in favor of formaldehyde as a risk factor for lung cancer. However, since risk estimates were significantly increased for high-quality and recent studies, the possibility that exposure to formaldehyde can increase the risk of lung cancer might still be considered.

Influence of combined exposure to perceived risk at work and unstable employment on self-rated health: a comparison of two cross-sectional surveys in Europe and Korea.

OBJECTIVES: The purpose of this study was to investigate the combined effect of exposure to perceived risk at work and unstable employment on self-rated health in both Korea and the European Union. DESIGN: Cross-sectional study. SETTING: We conducted the analyses using employees data from the third Korean Working Conditions Survey (KWCS) conducted in 2011 and the fifth European Working Conditions Survey (EWCS) conducted in 2010. PARTICIPANTS: Employees of the third KWCS and the fifth EWCS from 35 European countries were the participants of the study. PRIMARY OUTCOME MEASURES: Employment status was divided into two categories: stable and unstable employment. Perceived risk regarding safety and health at work were assessed. Primary health outcomes were poor or moderate self-rated health. Exposures and health status were assessed via a questionnaire. RESULTS: Among Korean employees, the OR of poor self-rated health was 2.00 (95% CI: 1.80 to 2.22) for those with perceived risk at work, 1.18 (95% CI: 1.09 to 1.28) for those with unstable employment and 3.22 (95% CI: 2.72 to 3.81) for those with both perceived risk at work and unstable employment. Relative excess risk due to interaction (RERI) was 1.03 (95% CI: 0.48 to 1.58). Among European employees, the OR for poor self-rated health was 3.20 (95% CI: 2.93 to 3.49) for those with perceived risk at work, 1.04 (95% CI: 0.97 to 1.13) for those with unstable employment and 3.41 (95% CI: 2.93 to 3.98) for those with both perceived risk at work and unstable employment. The RERI was 0.18 (95% CI: -0.36 to 0.71). CONCLUSIONS: Among Korean employees, a supra-additive interaction between perceived risk at work and unstable employment on poor self-rated health was observed. Conversely, a supra-additive interaction was not observed among European employees.

Changes of 30 years in the recognized occupational diseases of Korea: Lessons from the system change perspective.

Thirty years ago, in 1988 of Korea, street demonstrations for the recognition of a 15-year-old boy's death as occupational mercury poisoning had shattered the taboo against occupational disease, and since then, the volume and contents of recognized diseases had changed a lot. Here we tried to ascertain and explain the changes from the system viewpoint. The system of risk management at work was analyzed in narrative terms of what, how, who, and why of the occupational disease managements, then and now, and we conclude the system of last 30 years was to manage the benevolent benefit to the victims for politico-economic purposes. Despite a big shift in outer appearance, the changes in the inner operation were small, and we propose to adopt newer approaches of more health and safety oriented together with human rights.

Association of discrimination and presenteeism with cardiovascular disease: the Fourth Korean Working Conditions Survey.

BACKGROUND: Discrimination is a representative social determinant of health. Presenteeism is defined as presenting to work despite of illness and is an indicator of group health. We investigated the association of discrimination and presenteeism with cardiovascular disease using Korean data. METHODS: This study used the fourth Korea Working Conditions Survey (2014) data of 27,662 wage workers (employees). Presenteeism and discrimination related to age, sex, education, birth region, and employment type were ascertained. Self-reported cardiovascular disease was also assessed using the survey questionnaire. General and occupational characteristics found to be significant in univariate analyses were entered into a multivariate logistic regression analysis of the association of discrimination and presenteeism with cardiovascular disease. We also calculated the odds ratios of multiple discriminations and/or presenteeism for cardiovascular disease. RESULTS: In the univariate analyses, sex, age, education, monthly income, employment type, occupation, hours worked per week, workplace scale, and shift work were significantly associated with cardiovascular disease. A multivariate logistic regression analysis adjusted for general and occupational characteristics showed that discrimination and presenteeism were significantly associated with cardiovascular disease. Finally, the association with cardiovascular disease was strongest when both multiple discriminations and presenteeism were present. CONCLUSIONS: Discrimination and presenteeism are associated with cardiovascular disease, and this association was stronger in the presence of multiple types of discrimination and presenteeism.

Exposure to asbestos and the risk of colorectal cancer mortality: a systematic review and meta-analysis.

Asbestos exposure is associated with mesothelioma and cancer of the lung, larynx and ovary. However, the association between asbestos exposure and colorectal cancer is controversial despite several systematic reviews of the literature, including a number of meta-analyses. We performed a systematic review and meta-analysis to evaluate quantitatively the association between exposure to asbestos and colorectal cancer. We searched for articles on occupational asbestos exposure and colorectal cancer in PubMed, EMBASE and Web of Science published before April 2018. In total, 44 articles were selected and 46 cohort studies were analysed. The overall pooled risk estimates and corresponding 95% CIs of the association between occupational asbestos exposure and colorectal cancer were calculated using a random-effects model. Subgroup analyses and sensitivity tests were also performed. There was a significantly increased risk of colorectal cancer mortality among workers exposed to asbestos occupationally, with an overall pooled SMR of 1.16 (95% CI: 1.05 to 1.29). The pooled SMR for colorectal cancer was elevated in studies in which the asbestos-associated risk of lung cancer was also elevated (1.43; 95% CI: 1.30 to 1.56). This implies that the risk of colorectal cancer mortality increases as the level of asbestos exposure rises. A sensitivity analysis showed robust results and there was no publication bias. Although the effect size was small and the heterogeneity among studies was large, our findings indicate that occupational exposure to asbestos is a risk factor for colorectal cancer.

Association between organizational justice and depressive symptoms among securities company workers.

BACKGROUND: The organizational justice model can evaluate job stressor from decision-making process, attitude of managerial or senior staff toward their junior workers, and unfair resource distribution. Stress from organizational injustice could be harmful to workers' mental health. The purpose of this study is to explore the association between organizational justice and depressive symptoms in a securities company. METHODS: To estimate organizational justice, a translated Moorman's organizational justice evaluation questionnaire (Korean) was employed. Cronbach's α coefficient was estimated to assess the internal consistency of the translated questionnaire. To assess depressive symptoms, the Center for Epidemiologic Studies Depression (CES-D) scale was used. The link between the sub-concepts of the organizational justice model and depressive symptoms was assessed utilizing multiple logistic regression models. RESULTS: The risk of depressive symptoms was significantly higher among workers with higher levels of all subcategory of organizational injustice. In the full adjusted model odds ratio (OR) of higher level of procedural injustice 2.79 (95% confidence interval [CI], 1.58-4.90), OR of the higher level of relational injustice 4.25 (95% CI, 2.66-6.78), OR of higher level of distributional injustice 4.53 (95% CI, 2.63-7.83) respectively. Cronbach's α coefficient of the Korean version was 0.93 for procedural justice, 0.93 for relational justice, and 0.95 for distributive justice. CONCLUSIONS: A higher level of organizational injustice was linked to higher prevalence of depressive symptoms among workers in a company of financial industry.

Urinary phthalate metabolite and bisphenol A levels in the Korean adult population in association with sociodemographic and behavioral characteristics: Korean National Environmental Health Survey (KoNEHS) 2012-2014.

BACKDGROUND: Phthalates and bisphenol A (BPA) have been used in a variety of consumer products and are detected widely in both humans and the environment. Demographic and socio-economic characteristics that affect exposure to these chemicals have been investigated among several general populations; however, nationally-representative population-based studies are limited to Canada, Germany, and the USA. Moreover, relatively little is known about the socio-demographic characteristics that influence exposure to these chemicals among nationally representative populations of Asia. METHODS: Data are obtained from the Korean National Environmental Health Survey (2012-2014). In total, 6,478 adults (aged 19 and older) were recruited and sampled for urinary levels of major phthalate metabolites and bisphenol A. In addition, demographic and socio-economic parameters were determined from questionnaire data and the characteristics associated with urinary concentrations of the target chemicals were assessed. RESULTS: Urinary levels of bis(2-ethylhexyl) phthalate (DEHP) and dibutyl phthalate (DBP) metabolites of Korean adults were generally higher, but those of mono-benzyl phthalate (MBzP) were lower, and BPA were similar or higher than those reported from national biomonitoring programs in the United States and Canada. Similar to other nationally representative populations, females and older adults showed higher creatinine-adjusted phthalate metabolite and BPA levels among the Korean population. Meanwhile, monthly household income and education were negatively associated with urinary phthalate metabolites. Among personal care products, nail polish use was positively associated with both phthalate metabolites and BPA concentrations in urine. CONCLUSION: Our observations based on a nationally representative population of Korea show that socio-demographic determinants for these urinary chemicals vary by country, and should be considered for developing appropriate mitigation measures and policies.