Cancer Incidence Among Residents Near Coal-Fired Power Plants Based on the Korean National Health Insurance System Data.

BACKGROUND: Cancer is a leading cause of death worldwide, posing a significant threat to human health and life expectancy. Numerous existing studies explored the correlation between coal-fired power plants and cancer development. Currently, Chungcheongnam-do Province hosts 29 coal-fired power plants, constituting half of the total 58 plants across South Korea. METHODS: This study assessed the cancer incidence by proximity to coal-fired power plants in Chungcheongnam-do Province, Korea. In this study, the exposed group comprised individuals residing within a 2-km radius of the coal-fired power plants, whereas the control group comprised individuals who had no prior residency within the 2-km radius of such plants or elsewhere in the province. Standardized incidence ratios were calculated using the cancer incidence cases retrieved from the National Health Insurance System data from 2007 to 2017. RESULTS: The study found that exposed men had a 1.11 (95% confidence interval [CI], 1.09-1.21) times higher risk of developing all cancer types and a 1.15 (95% CI, 1.09-1.22) times higher risk of developing cancers excluding thyroid cancer compared with control men. Exposed women had a 1.05 (95% CI, 1.00-1.14) times higher risk of developing all cancer types and a 1.06 (95% CI, 0.98-1.13) times higher risk of developing cancers excluding thyroid cancer than did control women. The colorectal, liver, prostate, and bladder cancer incidence rates were significantly higher in exposed men than that in all control groups. The incidence of esophageal, stomach, liver, and lung cancers were significantly higher in exposed women compared with all control groups. CONCLUSION: The residents near coal-fired power plants had a higher risk of developing cancer than did those living in other areas. In the future, long-term follow-up investigations in residents living in the vicinity of power plants are warranted.

Associations of active and passive tobacco exposure with elevated blood pressure in Korean adolescents.

OBJECTIVES: To test the hypothesis that tobacco exposure is associated with elevated blood pressure (EBP) in Korean adolescents, and that the association is dose dependent. METHODS: This cross-sectional study used data from the 2011-2020 Korea National Health and Nutrition Survey (KNHANES). Subjects were eligible if they were 13-18 years at the time of participation in KNHANES. Tobacco exposure was defined by urine cotinine level. The main outcomes were EBP and hypertension. Statistical analyses were conducted using SAS version 9.4 with appropriate sampling weights to account for the complex survey design, stratification, and cluster variable. RESULTS: A total of 2,518 adolescents was included in the analysis, representing 2.5 million Korean adolescents. The mean± standard deviation participant age was 15.3±1.7 years, and 55.3% were male. The number of participants with active tobacco smoke exposure was 283 (11.2%), passive tobacco smoke exposure was 145 (5.8%), and no smoke exposure was 2,090 (83.0%). Analysis of the 2,518 urine-cotinine-verified participants showed that tobacco smoke exposure had a significant effect on EBP: with an odds of elevated blood pressure of 3.00 (95% confidence interval [CI], 1.14 to 7.89). The odds of hypertension were 3.61 (95% CI, 1.13 to 11.49) in the active smoking group compared with the no tobacco exposure group after adjustment for potential confounders. CONCLUSIONS: It is necessary to present a range of public health plans to reduce tobacco exposure that affects adolescents' blood pressure, and further research with a larger number of participants using urine cotinine as a biomarker is needed.

Impact of Radiofrequency Exposure From Mobile Phones on the Risk of Developing Brain Tumors in Korean and Japanese Adolescents: A MOBI-Kids Case-control Study.

BACKGROUND: This study aimed to examine the association between risk of brain tumors and radiofrequency (RF) exposure from mobile phones among young people in Korea and Japan. METHODS: This case-control study of brain tumors in young people was conducted in Korea and Japan under the framework of the international MOBI-Kids study. We included 118 patients diagnosed with brain tumors between 2011 and 2015 and 236 matched appendicitis controls aged 10-24 years. Information on mobile phone use was collected through face-to-face interviews. A detailed RF exposure algorithm, based on the MOBI-Kids algorithm and modified to account for the specificities of Japanese and Korean phones and networks, was used to calculate the odds ratios (ORs) for total cumulative specific energy using conditional logistic regression. RESULTS: The adjusted ORs in the highest tertile of cumulative call time at 1 year before the reference date were 1.61 (95% confidence interval [CI], 0.72-3.60) for all brain tumors and 0.70 (95% CI, 0.16-3.03) for gliomas, with no indication of a trend with exposure. The ORs for glioma specifically, were below 1 in the lowest exposure category. CONCLUSION: This study provided no evidence of a causal association between mobile phone use and risk of brain tumors as a whole or of glioma specifically. Further research will be required to evaluate the impact of newer technologies of communication in the future.

Associations of breastfeeding duration and the total number of children breastfed with self-reported osteoarthritis in Korea women 50 years and older: a cross-sectional study.

OBJECTIVES: Osteoarthritis is the most common joint disease, with a higher prevalence among women than men. The present study aimed to examine the associations of breastfeeding duration and the total number of children breastfed with osteoarthritis in Korean women aged 50 years and older. METHODS: In this cross-sectional study, we used representative data from the Korea National Health and Nutrition Examination Survey, phases 5 through 7 (2010-2018). Our analysis included 10,102 women aged ≥50 years. Osteoarthritis experience was defined as whether a physician had ever diagnosed osteoarthritis. Breastfeeding duration was categorized as 1-6 months, 7-24 months, and ≥25 months. The total number of children breastfed was categorized as 1-2, 3-4, and ≥5. The covariates were health behavior characteristics and risks of diseases (smoking, drinking, physical activity, body mass index, diabetes, hypertension, oral contraceptive use, and menopause) as well as socioeconomic characteristics (income, educational level, and occupation). A multiple logistic regression model was used to investigate associations between osteoarthritis and aspects of breastfeeding experience. RESULTS: Compared to the non-breastfeeding group, the breastfeeding group had an odds ratio (OR) of 1.55 (95% confidence interval [CI], 1.18 to 2.03) for osteoarthritis. Those who reported breastfeeding for >25 months had an OR of 1.56 (95% CI, 1.19 to 2.06). CONCLUSIONS: The advantages of breastfeeding are already well known, but the present study suggests that women who breastfeed children for a longer time may have a higher risk of osteoarthritis after middle age.

Associations of daily diet-related greenhouse gas emissions with the incidence and mortality of chronic diseases: a systematic review and meta-analysis of epidemiological studies.

OBJECTIVES: Although the entire process extending from food production to dietary consumption makes a large contribution to total greenhouse gas (GHG) emissions, little and inconsistent evidence exists on the epidemiological associations of daily diet-related GHG emissions with chronic disease risk or all-cause mortality. This systematic review and meta-analysis explored the observational epidemiological relationship between daily diet-related GHG emissions and health outcomes, including the risk of chronic diseases and all-cause mortality. METHODS: Original articles published in English until May 2022 were identified by searching PubMed, Ovid-Embase, Web of Science, CINAHL, and Google Scholar. The extracted data were pooled using both fixed-effects and random-effects meta-analyses and presented as hazard and risk ratios (RRs) with 95% confidence intervals (CIs). RESULTS: In total, 7 cohort studies (21 study arms) were included for qualitative synthesis and meta-analysis. The GHG emissions of dietary consumption showed a significant positive association with the risk of chronic disease incidence and mortality in both fixed-effects and random-effects models (fixed: RR, 1.04; 95% CI, 1.03 to 1.05; random: RR, 1.04; 95% CI, 1.02 to 1.06). This positive association was robust regardless of how daily diet-related GHG emissions were grouped. More strongly animal- based diets showed higher GHG emissions. However, there were only a few studies on specific chronic diseases, and the subgroup analysis showed insignificant results. There was no evidence of publication bias among the studies (Egger test: p=0.79). CONCLUSIONS: A higher GHG-emission diet was found to be associated with a greater risk of all-cause mortality.

Cancer risk in the residents of a town near three industrial waste incinerators in Korea: a retrospective cohort study.

BACKGROUND: Three industrial waste incinerators (IWIs) were built in 1999, 2001, and 2010, within a 3 km radius of a town with a population of around 5000 in Korea. This study evaluated whether residents near these three IWIs had increased cancer incidence than those from other areas in Korea using regional health data. METHODS: Standardized incidence ratios (SIR) were calculated using the frequency of cancer cases in the National Cancer Registry of the exposed area (Buki-myeon), Chungcheongbuk-do (Chungbuk, state including Buki-myeon), and whole Korea from 1999 to 2017. A retrospective cohort was created using National Health Insurance System data from 2002 to 2018. The exposed group was defined as those having a residential history in the exposed area. The control group was defined as those having a residential history in nearby towns or counties in Chungbuk, excluding counties having living and cultural areas in other provinces and cities. Hazard ratio (HR) and 95% confidence intervals (CI) were estimated using the Cox proportional hazard model adjusted for age, level of health insurance fee, and smoking history. RESULTS: In the ecological study using National Cancer Registry data, the risk of all cancers, all cancers excluding thyroid, esophageal, stomach, and lung cancers in the exposed area were 1.13 (95% CI 1.03-1.24), 1.15 (95% CI 1.04-1.26), 1.91 (95% CI 1.13-2.89), 1.39 (95% CI 1.14-1.66), and 1.29 (95% CI 1.03-1.57) times higher than in whole Korea among exposed males, respectively. In the retrospective cohort, 4300 males (26,821 person-years) and 3796 females (24,746 person-years) in exposed group, 150,964 males (1,212,010 person-years) and 134,535 females (1,104,025 person-years) in control group were analyzed. After adjusting for several confounding factors, the risks for gallbladder cancer among males and kidney cancer among females were 2.65 (95% CI 1.38-5.06) and 2.82 (95% CI 1.13-7.03) times higher in the exposed group versus the control group, respectively. CONCLUSIONS: Cancer risk was higher in Koreans having residential history living near IWIs compared to the other areas. Further study warrants nationwide effects and longer follow-up of WIs for cancers in Korea.

Association between long-term exposure to particulate matter and childhood cancer: A retrospective cohort study.

BACKGROUND: Although particulate matter is a known carcinogen, its association with childhood cancer is inconclusive. The present study aimed to examine the association between long-term exposure to particulate matter and childhood cancer. METHODS: A retrospective cohort was constructed from the claims database of the Korea National Health Insurance Service, including children born in seven metropolitan cities in Korea between 2002 and 2012. Monthly mean concentrations of particulate matter with aerodynamic diameter <10 µm (PM10) and other air pollutants (NO2, SO2, CO, and O3) were calculated using data from the AirKorea. Monthly mean concentrations of particulate matter with aerodynamic diameter <2.5 µm (PM2.5) were estimated based on a data fusion approach. Cumulative exposure was assessed by averaging the monthly concentrations accounting for the residential mobility of the children. The occurrence of cancer was identified by the appearance of diagnosis codes in the claims database. Hazard ratios (HR) and 95% confidence intervals (95% CI) were calculated using Cox proportional regression, adjusting for potential confounders and O3 concentrations. RESULTS: During the study period, 1,725 patients were newly diagnosed with cancer among 1,261,855 children. HR of all cancers per 10 µg/m3 increment in annual mean concentrations of PM2.5 and PM10 were 3.02 (95% CI: 1.63, 5.59) and 1.04 (0.74, 1.45), respectively. CONCLUSION: PM2.5 exposure was positively associated with childhood cancer in a large retrospective cohort with exposure assessment accounting for residential mobility.

Mobile Phone Use and Time Trend of Brain Cancer Incidence Rate in Korea.

This study evaluated the time trends in mobile phone subscriber number by mobile network generation (G) and brain cancer incidence by type in Korea. We obtained data from the Information Technology Statistics of Korea (1984-2017) and Korea Central Cancer Registry (1999-2017). The average annual percent change was estimated using Joinpoint regression analysis. We evaluated 29,721 brain cancer cases with an age-standardized incidence rate (ASR) of 2.89/100,000 persons. The glioma and glioblastoma annual ASR significantly increased in 2.6% and 3.9% of males and 3.0% and 3.8% of females, respectively. The ASR for frontal lobe involvement was the highest. The ASR of gliomas of unspecified grade annually increased by 7.8%; those for unspecified topology and histology decreased. The incidence of glioma, glioblastoma, frontal, temporal, and high-grade glioma increased among those aged ≥60 years. No association was observed between the mobile phone subscriber number and brain cancer incidence in Korea. Furthermore, long-term research is warranted because of the latency period of brain cancer. © 2021 Bioelectromagnetics Society.

Latent Tuberculosis Infection Screening and Treatment in Congregate Settings (TB FREE COREA): Demographic Profiles of Interferon-Gamma Release Assay Cohort.

In 2017, the Korean government launched an unprecedentedly large-scaled latent tuberculosis infection (LTBI) screening project which covered more than a million individuals in congregate settings. A total of 1,047,689 participants of source population (n = 2,336,157) underwent LTBI testing from 2017 to 2018. The overall LTBI test uptake rate during this project was 44.8%. Workers in daycare centers (83.5%) and kindergartens (78.9%) showed high participation rate. A total of 1,012,206 individuals with valid results of interferon-gamma release assay (IGRA) were selected to constitute the IGRA cohort. Most of the enrolled participants in the IGRA cohort were in their working age. Approximately, three-quarters of total enrolled population were female. Investigating the LTBI prevalence, stages of LTBI care cascade, natural history of LTBI, efficacy of LTBI treatment and cost-effectiveness of LTBI screening are feasible within this IGRA cohort.

Cancer cluster among small village residents near the fertilizer plant in Korea.

OBJECTIVES: In Jang-jeom, a small village in Hamra-myeon, Iksan-si, Jeollabuk-do, South Korea, residents raised concerns about a suspected cancer cluster that they attributed to a fertilizer plant near the village. We aimed to investigate whether the cancer incidence in the village was higher than that in the general Korean population when the factory was in operation (2001-2017) and whether living in the village was associated with a higher risk of cancer. METHODS: Using national population data and cancer registration data of South Korea, we estimated the standardized incidence ratios (SIRs) in the village to investigate whether more cancer cases occurred in the village compared to other regions. The SIRs were standardized by age groups of 5 years and sex. In order to investigate whether residence in the village increased the risk of cancer, a retrospective cohort was constructed using National Health Insurance Service (NHIS) databases. We estimated the cancer hazard ratios (HRs) using the Cox proportional hazard model, and defined the exposed area as the village of Jang-jeom, and the unexposed or control area as the village neighborhood in Hamra-myeon. We considered potential confounding variables such as age, sex, and income index in the models. Additionally, we measured polycyclic aromatic hydrocarbons (PAHs) and tobacco-specific nitrosamines (TSNAs), suspected carcinogens that may have caused the cancer cluster, in samples collected from the plant and the village. RESULTS: Twenty-three cancer cases occurred in Jang-jeom from 2001 to 2017. Between 2010 and 2016, the incidence rates of all cancers (SIR: 2.05, except thyroid cancer: 2.22), non-melanoma skin cancer (SIR: 21.14, female: 25.41), and gallbladder (GB) and biliary tract cancer in men (SIR: 16.01) in the village were higher than those in the national population in a way that was statistically significant. In our cohort analysis that included only Hamra-myeon residents who have lived there for more than 7 years, we found a statistically significant increase in the risk of all cancers (HR: 1.99, except thyroid cancer: 2.20), non-melanoma skin cancer (HR: 11.60), GB and biliary tract cancer (HR: 15.24), liver cancer (HR: 6.63), and gastric cancer (HR: 3.29) for Jang-jeom residents compared to other Hamra area residents. We identified PAHs and TSNAs in samples of deposited dust and residual fertilizer from the plant and TSNAs in dust samples from village houses. CONCLUSIONS: The results of the SIR calculation and cancer risk analyses of Jang-jeom village residents from the retrospective cohort design showed consistency in the effect size and direction, suggesting that there was a cancer cluster in Jang-jeom. This study would be a good precedent for cancer cluster investigation.

Health Indicators Related to Disease, Death, and Reproduction.

One of the primary goals of epidemiology is to quantify various aspects of a population's health, illness, and death status and the determinants (or risk factors) thereof by calculating health indicators that measure the magnitudes of various conditions. There has been some confusion regarding health indicators, with discrepancies in usage among organizations such as the World Health Organization the, Centers for Disease Control and Prevention (CDC), and the CDC of other countries, and the usage of the relevant terminology may vary across papers. Therefore, in this review, we would like to propose appropriate terminological definitions for health indicators based on the most commonly used meanings and/or the terms used by official agencies, in order to bring clarity to this area of confusion. We have used appropriate examples to make each health indicator easy for the reader to understand. We have included practical exercises for some health indicators to help readers understand the underlying concepts.

Environmental Tobacco Smoke Exposure at Home and Attributable Problem Behaviors in Korean Children and Adolescents for 2012-2014 in a Nationally Representative Survey.

BACKGROUND: This study aimed to examine the environmental tobacco smoke (ETS) exposure at home and associated problem behaviors in Korean children and adolescents. METHODS: Approximately 2,167 children aged 3-18 years were included in the study after excluding 163 active smokers from the Korean Environmental Health Survey in Children and Adolescents (2012-2014). ETS data were obtained using a questionnaire; problem behaviors were measured using the Child Behavior Checklist administered to parents. The relationship between ETS exposure and problem behavior was evaluated using a survey regression model adjusted for region, age, sex, income, and father's education. The population-attributable fraction (PAF%) was calculated based on problem behaviors related to ETS exposure at home. RESULTS: The rates of ETS exposure at home were 20%, 28%, and 39% in children aged 3-5, 6-11, and 12-18 years, respectively; ETS exposure at home was associated with behavioral problems: the exposed group having higher total behavioral problem score (95% confidence interval [CI]) than the non-exposed by 2.46 (0.60-4.32) and 2.74 (0.74-4.74) in children aged 6-11 and 12-18 years, respectively, with no significant association in those aged 3-5 years. The PAF% (95% CI) of total problem behaviors for ETS exposure at home were 2.68 (-10.11-17.78), 10.66 (3.25-17.55), and 11.62 (3.03-18.96) in children aged 3-5, 6-11, and 12-18 years, respectively. Children with externalizing problems had higher PAF% than those with internalizing problems. CONCLUSION: In Korea, ETS exposure at home is associated with problem behaviors in children and adolescents with about more than 10% population attributable fraction.

Health effects of environmental pollution in population living near industrial complex areas in Korea.

Several epidemiological studies have reported an association between environmental pollution and various health conditions in individuals residing in industrial complexes. To evaluate the effects of pollution from industrial complex on human health, we performed a pooled analysis of environmental epidemiologic monitoring data for residents living near national industrial complexes in Korea. The respiratory and allergic symptoms and the prevalence of acute and chronic diseases, including cancer, were used as the outcome variables for health effects. Multiple logistic regression analysis was used to analyze the relationship between exposure to pollution from industrial complexes and health conditions. After adjusting for age, sex, smoking status, occupational exposure, level of education, and body mass index, the residents near the industrial complexes were found to have more respiratory symptoms, such as cough (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.06 to 1.31) and sputum production (OR, 1.13; 95% CI, 1.03 to 1.24), and symptoms of atopic dermatitis (OR, 1.10; 95% CI, 1.01 to 1.20). Among residents of the industrial complexes, the prevalence of acute eye disorders was approximately 40% higher (OR, 1.39; 95% CI, 1.04 to 1.84) and the prevalence of lung and uterine cancer was 3.45 times and 1.88 times higher, respectively, than those among residents of the control area. This study showed that residents living in the vicinity of industrial complexes have a high risk of acute and chronic diseases including respiratory and allergic conditions. These results can be used as basic objective data for developing health management measures for individuals residing near industrial complexes.

Modulation of blood pressure in response to low ambient temperature: The role of DNA methylation of zinc finger genes.

BACKGROUND: Blood pressure rises with a drop in external temperature, but the role of DNA methylation in such blood pressure modulation has not been studied in detail. We evaluated blood pressure and DNA methylation of vascular disease-related genes in association with low temperature. METHODS: To examine changes in blood pressure and DNA methylation associated with low temperature, we conducted repeated measures analysis among 50 participants over 3 repeated visits, and validated the association among another 52 participants. In addition, the mean of methylation changes in the identified CpG sites was evaluated with changes in blood pressure. Mediation analyses were also conducted to model the indirect association between low ambient temperature and blood pressure through changes in DNA methylation. RESULTS: With a 1°C decrease in temperature, increases of 0.6mmHg (standard error (SE), 0.2) in SBP and 0.3mmHg (SE, 0.1) in DBP occurred (P<0.05). Of 24,490 CpG sites in vascular genes, 2 CpG sites of zinc finger (ZNF) genes were significantly associated with temperature after Bonferroni's correction in discovery and replication data. A 10% increase in methylation expression in 2 CpG sites in ZNF genes was associated with a 4-mmHg elevation in DBP (SE, 1.8; P=0.0236). The hypermethylation was attributable to the association of ambient temperature with DBP (proportion of mediation=11.8-20.4%). CONCLUSIONS: Methylation changes in ZNF genes might be involved in the elevation of blood pressure when the body is exposed to cold temperature.

Health Impact Assessment of PM10 and PM2.5 in 27 Southeast and East Asian Cities.

OBJECTIVE: We aimed to evaluate the annual health impacts of particulate matter (PM) less than 10 µm diameter (PM10) and less than 2.5-µm diameter (PM2.5) in 27 cities in Southeast and East Asian countries (Japan, the Philippines, the Republic of Korea, Singapore, and Vietnam) for the year 2009 (n = 50,756,699). METHODS: We estimated the number of cases attributable to long-term exposure. We used a scenario that reduced the annual mean values for PM10 and PM2.5 to 20 and 10 µg/m, respectively. RESULTS: A reduction in long-term exposure to PM10 and PM2.5 would have postponed 8% to 9% of all-cause mortality or about 37,000 deaths. One third of them were associated with cardiopulmonary mortality and one ninth of them were associated with lung cancer mortality. CONCLUSIONS: Current air pollution levels in Southeast and East Asian countries have a nonnegligible public health impact.

Interaction effect of serum 25-hydroxyvitamin D levels and CYP1A1, CYP1B1 polymorphisms on blood pressure in an elderly population.

OBJECTIVE: Hypertension and vitamin D deficiency are prevalent worldwide, especially in the elderly. Considering the possibility of gene-environment contributions to disease development, we evaluated the influence of certain cytochrome P450 polymorphisms and vitamin D levels on blood pressure (BP). METHODS: We measured serum 25-hydroxyvitamin D levels [25(OH)D] and BP in 535 individuals over 60 years old and identified single-nucleotide polymorphisms (SNPs) of CYP1A1 and CYP1B1 in lymphocyte DNA. Repeated measure analyses were used to determine the statistical association. RESULTS: The relationship between 25(OH)D and SBP or DBP was inversely significant, and influence of several CYP1A1 and CYP1B1 SNPs on BP was found across different genotypes. Estimated effect of 25(OH)D levels on BP in the group with higher risky genotype scores of selected SNPs (rs4646421, rs2551188, and rs1056836) was greater (ß = -2.841, P = 0.004 for SBP; ß = -2.035, P = 0.001 for DBP) than the group with lower genotype score (ß = -0.878, P = 0.347 for SBP; ß = 0.037, P = 0.947 for DBP), and synergistic interaction between vitamin D levels and genotype variations was observed (P-interaction = 0.081 for SBP and 0.008 for DBP). When stratified by the hypertension medication status, interaction effect was found only in individuals taking medication (P-interaction = 0.004 for SBP and 0.001 for DBP). CONCLUSION: Genetic variations in CYP1A1 and CYP1B1 and the serum levels of 25(OH)D showed synergistic effect on BP, especially in individuals currently in treatment for hypertension.

[Reliability of covariates in baseline survey of a cohort study: Epidemiological Investigation on Cancer Risk Among Residents Who Reside Near The Nuclear Power Plants in Korea].

OBJECTIVES: We evaluated the reliability of the possible covariates of the baseline survey data collected for the Epidemiological Investigation on Cancer Risk Among Residents Who Reside Near the Nuclear Power Plants in Korea. METHODS: Follow-up surveys were conducted for 477 participants of the cohort at less than 1 year after the initial survey. The mean interval between the initial and follow-up surveys was 282.5 days. Possible covariates were identified by analyzing the correlations with the exposure variable and associations with the outcome variables for all the variables. Logistic regression analysis with stepwise selection was further conducted among the possible covariates to select variables that have covariance with other variables. We considered that these variables can be representing other variables. Seven variables for the males and 3 variables for the females, which had covariance with other possible covariates, were selected as representative variables. The Kappa index of each variable was calculated. RESULTS: For the males, the Kappa indexes were as follow; family history of cancer was 0.64, family history of liver diseases in parents and siblings was 0.56, family history of hypertension in parents and siblings was 0.51, family history of liver diseases was 0.50, family history of hypertension was 0.44, a history of chronic liver diseases was 0.53 and history of pulmonary tuberculosis was 0.36. For females, the Kappa indexes were as follow; family history of cancer was 0.58, family history of hypertension in parents and siblings was 0.56 and family history of hypertension was 0.47. CONCLUSIONS: Most of the possible covariates showed good to moderate agreement.