Annals of Occupational and Environmental Medicine

Original Article

Association between delivery-food consumption frequency and urinary bisphenol concentrations among Korean adults: a nationally representative study (Korean National Environmental Health Survey cycle 5, 2021–2023): Gwisang Park, Hyeyun Lee, Inchul Jeong, Eunhee Ha, Kihun Kim; Ann Occup Environ Med 2026;38:e37. Published online July 30, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e37

Abstract Abstract in Korean PDF Supplementary Material: Background
Bisphenol exposure remains a public health concern, particularly as the use of bisphenol analogues such as bisphenol S (BPS) has increased. In the post-pandemic period, delivery-food consumption has become routine in South Korea and may represent an important behavioral pathway for bisphenol exposure. This study examined whether delivery-food consumption in plastic containers is associated with urinary bisphenols among Korean adults.
Methods
This study used adult data from the Korean National Environmental Health Survey (KoNEHS) cycle 5 (2021–2023). Delivery-food consumption frequency (nine categories) was modeled per 1-time-per-month increase. Outcomes were urinary bisphenol A (BPA), BPS, and bisphenol F (BPF). Creatinine-adjusted concentrations were analyzed on the natural log scale using multivariable regression models. Model 1 adjusted for sociodemographic factors, and model 2 additionally adjusted for plastic-related behavioral variables.
Results
Among 4,275 adults with complete bisphenol and urinary creatinine data, delivery-food consumption frequency was positively associated with creatinine-adjusted urinary BPS concentrations (1.49% increase per 1-time-per-month increase; 95% confidence interval [CI]: 0.74–2.24; p < 0.001) after sociodemographic adjustment, whereas associations with BPA (0.32% increase; 95% CI, −0.45 to 1.09; p = 0.416) and BPF (−0.14% change; 95% CI: −1.18 to 0.90; p = 0.787) were not statistically significant. After additional adjustment for plastic-related behavioral variables in model 2, the association remained statistically significant for BPS (1.54%; 95% CI, 0.76–2.33; p < 0.001), whereas the associations with BPA and BPF remained non-significant.
Conclusions
More frequent consumption of delivery foods packaged in plastic containers was independently associated with higher creatinine-adjusted urinary BPS concentrations. Given that common delivery container polymers in Korea are generally bisphenol-free, this association suggests that delivery-related behavior serves as a behavioral surrogate for a bundled exposure scenario. The observed BPS signal may partly reflect cumulative exposure from ancillary materials, such as thermal receipts and labels. Future studies should identify specific delivery-associated sources and migration pathways of bisphenols.; 배달음식 섭취 빈도와 소변 비스페놀 농도의 관련성: 국민환경보건기초조사 제5기(2021–2023)를 이용한 전국 대표성 성인 연구
목적
비스페놀 노출은 여전히 중요한 공중보건 문제이며, 최근 비스페놀 S(BPS) 등 비스페놀 유사체의 사용이 증가하고 있다. 코로나19 이후 국내에서 배달음식 섭취가 일상화되면서, 이러한 섭취 행동은 비스페놀 노출의 중요한 행동학적 경로가 될 수 있다. 본 연구는 플라스틱 용기에 포장된 배달음식 섭취가 국내 성인의 소변 비스페놀과 관련되는지 평가하였다.
방법
본 연구는 국민환경보건기초조사 5기(2021–2023) 성인 자료를 이용하였다. 배달음식 섭취 빈도(9개 범주)는 월 1회 증가 단위로 모델링하였다. 결과변수는 소변 비스페놀 A(BPA), BPS, 비스페놀 F(BPF)였으며, 크레아티닌 보정 농도를 자연로그 변환하여 다변량 회귀분석을 시행하였다. 모델 1은 사회인구학적 요인을 보정하였고, 모델 2는 플라스틱 관련 행동 변수를 추가로 보정하였다.
결과
비스페놀 및 소변 크레아티닌 자료가 모두 있는 성인 4,275명을 분석하였다. 배달음식 섭취 빈도는 사회인구학적 요인 보정 후 크레아티닌 보정 소변 BPS 농도와 유의한 양의 관련성을 보였으며, 월 1회 증가당 1.49% 증가하였다(95% 신뢰구간, 0.74–2.24; p < 0.001). 반면 BPA(0.32%; 95% 신뢰구간, −0.45–1.09; p = 0.416)와 BPF(−0.14%; 95% 신뢰구간, −1.18–0.90; p = 0.787)는 유의한 관련성을 보이지 않았다. 모델 2에서 플라스틱 관련 행동 변수를 추가로 보정한 후에도 BPS와의 관련성은 통계적으로 유의하게 유지되었으며(1.54%; 95% 신뢰구간, 0.76–2.33; p < 0.001), BPA와 BPF는 여전히 유의하지 않았다.
결론
플라스틱 용기에 포장된 배달음식을 더 자주 섭취하는 행동은 크레아티닌 보정 소변 BPS 농도 증가와 독립적으로 관련되었다. 국내 주요 배달용기 재질이 일반적으로 비스페놀을 포함하지 않는다는 점을 고려할 때, 이러한 관련성은 배달 관련 행동이 복합 노출 시나리오의 행동학적 대리 지표로 작용할 수 있음을 시사한다. 관찰된 BPS 신호는 감열지 영수증이나 라벨과 같은 부속 재료로부터의 누적 노출을 일부 반영할 수 있다. 향후 연구에서는 배달 관련 비스페놀 노출원과 이행 경로를 구체적으로 규명할 필요가 있다.

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Review

A work-relatedness assessment in epidemiological case investigation of occupational cancers: II. Practice: an upper urinary tract cancer in a dyer: Kihun Kim, Hyeoncheol Oh, Jungwon Kim; Ann Occup Environ Med 2020;32:e31. Published online September 1, 2020; DOI: https://doi.org/10.35371/aoem.2020.32.e31

Abstract PDF: An epidemiological case investigation of occupational cancer is conducted to determine the causation between the cancer and the worker's job. This review describes the overall process of work-relatedness assessment of the epidemiological case investigation through a case of upper urinary tract cancer (UUTC) in benzidine exposed worker in dyeing industry. Medical referrals, occupational history, material safety data sheet, and working environment monitoring submitted by the Korea Workers' Compensation and Welfare Service were reviewed. We further investigated literatures about the cotton dyeing industry, the domestic law and working environment monitoring reports. Benzidine was listed as an International Agency for Research on Cancer risk factor only for bladder cancer among urinary tract cancers, requiring different logical grounds for establishing causation. A literature review was conducted on the metabolic pathways of benzidine to establish biological plausibility. In addition, several papers were investigated that UUTC and bladder cancer share risk factors to extrapolate the epidemiological studies of bladder cancer. Epidemiologic studies of benzidine and bladder cancer were investigated. The worker is a 71-year-old man and performed dyeing and transporting at several dyeing factories for 29 years. The worker was diagnosed with UUTC based on radiologic and histologic results. It was critical to consider that he worked as a dyer for 3 years. The cancer was diagnosed in 2018, with a latent period of approximately 35 years. The worker performed cotton dyeing, and benzidine-based dye was mainly used. The quantitative exposure level of benzidine was reported from non-detection to 397.4 µg/m³. In biological metabolisms, N-acetylhydroxylamine changes DNA structure of urothelium. As a result of reviewing 4 epidemiological studies, the standardized incidence ratio and standardized mortality ratio were significantly high with 3 years of exposure. Work-relatedness was finally assessed as probable based on biological mechanisms and epidemiological evidence. This review will help solutions for work-relatedness assessment processes.

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Review

A work-relatedness assessment in epidemiological case investigation of occupational cancers: I. Principles: Kihun Kim, Jungwon Kim; Ann Occup Environ Med 2020;32:e30. Published online September 1, 2020; DOI: https://doi.org/10.35371/aoem.2020.32.e30

Abstract PDF

It is important to identify the causal relationship between occupational exposure and the disease in the area of compensation because most cancers have long latent period. This review presents the principles that should be considered when evaluating the work-relatedness. We reviewed reports on occupational cancers published by the International Agency for Research on Cancer, American Conference of Governmental Industrial Hygienists, National Toxicology Program, Environmental Protection Agency, European Union, which are the world's most prestigious organizations. In addition, we reviewed relevant papers and books published in Korea. The process is conducted in the order of cancer diagnosis, exposure assessment for carcinogens, and work-relatedness assessment. The probability of causation is determined stochastically rather than deterministically. There is no absolute standard for accreditation criteria and results may vary according to expert opinions and in each country or organization. Revealing the causal relationship of occupational cancers is a difficult process owing to inconsistency in relevant epidemiological studies, lack of well-established biological mechanisms, loss of objective occupational historical data, and other complexity of individual cases. Causation is unclear in many cases. Nevertheless, the data should be reviewed in detail for each case suspected of work-related cancers, and an assessment should be made through valid and plausible logic and literature evidences.

Citations

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Research Article

Effects of job stress on symptoms of bipolar spectrum disorder in an electronic parts manufacturing company: Hyeonchoel Oh, Kihun Kim, Taewoong Ha, Jungwon Kim; Ann Occup Environ Med 2020;32:e25. Published online July 13, 2020; DOI: https://doi.org/10.35371/aoem.2020.32.e25

Abstract PDF

Background

Mental illness is known to be caused by genetic, biological, and environmental risk factors. Although previous studies have established the link between mental illness and job stress, most of them are limited to major depression disorder. Therefore, this study examined the relationship between job stress and bipolar spectrum disorder (BSD).

Methods

This is a cross-sectional study based on a survey conducted in April 2017 at an electronic parts manufacturing company in Busan. In a total of 441 workers, the degree of BSD was identified using the Korean version of the Mood Disorder Questionnaire, and the degree of job stress was identified using the Korean Occupational Stress Scale Short Form. This study also identified general characteristics of workers and job-related factors. The χ² test and Fisher's exact test was conducted to determine the differences among the variables, based on BSD. Multiple logistic regression analysis was conducted to determine the influence of independent variables on BSD.

Results

Cross-analysis showed significant differences between the BSD high-risk and low-risk groups regarding age, sex, occupation, smoking, problem drinking, job stress total score, occupational climate, and major depression disorder symptom. In addition, the significant differences between the BSD high-risk and low-risk groups about job stress were observed in terms of job demand, job insecurity, and occupational climate. A multiple logistic regression analysis revealed that the high-risk group in the job stress group had a higher effect on BSD than the low-risk group (odds ratio [OR]: 2.32, 95% confidence interval [CI]: 1.10–4.88). Among the categories of job stress, high-risk groups in 3 areas—job demand (OR: 2.56, 95% CI: 1.27–5.17), job insecurity (OR: 4.42, 95% CI: 1.19–16.42), and occupational climate (OR: 2.55, 95% CI: 1.29–5.05)—were more likely to have an impact on BSD than the low-risk groups.

Conclusions

This study demonstrated that the high-risk groups of job stress total score, job demand, job insecurity, and occupational climate had a more significant effect on BSD than the low-risk groups. As workers with BSD may have difficulties in their work and personal lives, there is a need to manage job stress to prevention of BSD.

Citations

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Scandinavian Journal of Psychology.2023; 64(2): 171. CrossRef
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