Diabetes Is Positively Associated With High Risk of Depression in Korean Cervical Cancer Patients: Korean National Health and Nutrition Examination Survey 2010–2021
Article information
Abstract
Objective
Objective of this study is to evaluate the association between high risk of depression and metabolic diseases such as hypertension, diabetes, and dyslipidemia in Korean cervical cancer patients.
Methods
A total of 330 women with cervical cancer were included in this study, using data from the Korea National Health and Nutrition Examination Survey from 2010 to 2021. Participants were categorized into two groups—high risk of depression and non-depression—based on their answers to survey items related to depression. A multivariate logistic regression analysis was used to evaluate the influence of metabolic diseases on high risk of depression in patients with cervical cancer.
Results
A total of 78 (23.64%) and 252 (76.36%) women were classified into the high risk of depression and non-depression groups, respectively. In multivariate logistic regression analysis adjusting for age, menopausal status, and smoking status, diabetes was associated with an odds ratio of 2.47 (95% confidence interval: 1.205, 5.071) for high risk of depression in cervical cancer patients. However, among the metabolic diseases, hypertension, and dyslipidemia were not associated with high risk of depression in patients with cervical cancer.
Conclusion
This study suggests that diabetes may be associated with a increased risk of high risk of depression in cervical cancer patients. Therefore, appropriate treatment of diabetes in cervical cancer patients may contribute to lowering the risk of depression in the future.
INTRODUCTION
Globally, the incidence of depression has increased by approximately 49.29%, that is, from 162 million in the 1990s to 241 million in 2017 [1]. The latest statistics released by the World Health Organization in 2023 reported that approximately 280 million people worldwide experience depression, with women being more vulnerable to depression than men [2]. According to statistics conducted by the Korean Centers for Disease Control and Prevention, the percentages of men and women who experienced depression in Seoul, Korea, were 4.8% and 7.7%, respectively, in 2020; 5.2% and 8.6%, respectively, in 2021; and 5.3% and 9.1%, respectively, in 2022. The percentage of both men and women who experience depression is gradually increasing [3]. These data show that the incidence of depression is higher among women than among men in Korea. In general, the incidence of depression in adults over the age of 18 is about 17%, and the incidence of depression in cancer patients is about 25% [4,5], so it can be expected that female cancer patients are particularly vulnerable to and have a significantly higher incidence of depression. A recent retrospective study conducted at Korea University Anam Hospital evaluated the association between depression and cancer outcomes in patients with gynecological cancer and found that the hazard ratio (HR) of cancer aggravation significantly increased to 2.09 in the presence of depression [6]. In other words, the presence of depression in cancer patients can have a significant impact on cancer survival, and there is a need to identify the importance of finding related factor that might influence the depression in cancer patients.
Many factors can contribute to the development of depression, including social and economic factors, sleep quality, family history, and underlying medical conditions [7,8].
In particular, metabolic diseases such as hypertension, diabetes, and dyslipidemia have been constantly reported to be associated with depression based on a variety of physiological and biological backgrounds. Hypertension can lead to arteriosclerosis, small vessel disease, and even ischemic brain damage. Among brain regions, the white matter is closely related to the occurrence of depression; in particular, ischemic brain damage in the white matter may be closely linked to a significant increase in depression [9]. In type 2 diabetes, an insulin-resistant environment induces mitochondrial and dopaminergic dysfunction in the brain, which can lead to anxiety and depressive behaviors [10]. Cholesterol is a major component of the cell membrane and plays a crucial role in cell-to-cell signaling and substance transport. However, in dyslipidemia, which is an environment of cholesterol imbalance, signal transduction through cell membranes is not smoothly transmitted. This results in the dysfunction of serotonin signaling and a decrease in the sensitivity of serotonin receptors in the environment of hypercholesterolemia, leading to depression [11].
Based on these mechanisms, several studies have evaluated the associations between hypertension, diabetes, dyslipidemia, and depression. Some studies have reported a positive association between hypertension and depression [12-14], while others found a negative or no significant relationship [9,15-21]. Similarly, researches on diabetes and depression have shown both positive association [22-25] and no significant relationship [26,27]. For dyslipidemia, finding also vary, with some studies reporting a positive relationship [11,28-33], and others showing no association [11,31,33-35]. Based on the results of these studies, the association between depression and metabolic diseases remains inconsistent. Furthermore, few studies have evaluated the association between high risk of depression and metabolic diseases in patients with cervical cancer, and even fewer studies have been conducted on Korean patients with cervical cancer. We hypothesized that there is a positive relationship between high risk of depression and the prevalence of metabolic diseases, such as hypertension, diabetes, and dyslipidemia, and decided to use the Korea National Health and Nutrition Examination Survey (KNHANES) data to utilize a large scale data representing Korean women. Therefore, this study aimed to evaluate the association between high risk of depression and metabolic diseases such as hypertension, diabetes, and dyslipidemia in Korean patients with cervical cancer.
METHODS
Study participants and design
This cross-sectional study used KNHANES data gathered between 2010 and 2021. All data were available from the KNHANES database (https://knhanes.kdca.go.kr/knhanes/sub03/sub03_02_05.do). The KNHANES has been conducting a survey every three years since 1998 to understand the health levels, health behaviors, diet, and nutrition of the Korean population. All steps in the questionnaire, including height, weight, waist circumference, body mass index (BMI), and health, are conducted by well-trained medical staff. The participants for the KNHANES were selected using the following method. A two stage stratified cluster sampling method was applied, with the primary and secondary sampling units being the survey districts and households, respectively. A total of 192 survey districts were selected annual, amounting to approximately 576 districts over three years. Within each sampled district, 25 households were chosen from appropriate households, excluding those in institutions such as nursing homes, military barracks, prisons, or foreign households. All individuals aged over one year or older within the selected households were included as survey participants.
The inclusion criteria for this study were women aged 20 years and older who responded to the cervical cancer questionnaire and were diagnosed with cervical cancer. Exclusion criteria were male sex, female sex under 20 years of age, non-cervical cancer, and missing values. We excluded 219 women with missing information about cervical cancer, 580 women with missing information about depression and 13,243 missing system data by considering them as missing values. As a result, according to our criteria, 330 participants were selected from the 95,310 individuals surveyed between 2010 and 2021 (Figure 1). In the KNHANES data, there were survey items to determine the mental health status of the participants; we categorized the participants into high risk of depression and non-depression groups based on the results of the following survey items (high risk of depression group, if they answered yes to at least one of the following survey items; non-depression group, if they answered no to any of the following survey items): “Have you ever been diagnosed with depression by a doctor?” or “Are you currently experiencing depression?” or “Have you felt depressed for more than two weeks in a row?” or “Have you had suicidal thoughts in the past year?” or “Have you attempted suicide in the past year?”.
Study variables
The KNHANES includes the results of a health survey on medical use, health examination results, education, economic activities, drinking, smoking, mental health, and women’s health, as well as the results of an examination survey, including blood pressure measurements, blood tests, and body measurements. BMI was calculated based on the measured height and weight (kg/m2); waist circumference was measured at the narrowed part between the rib cage and iliac crest after normal expiration. Personal income levels were categorized into four quartiles based on the average monthly household income ([monthly overall household income][household size]-0.5): Q1, low; Q2, low-intermediate; Q3, upper intermediate; and Q4, high. The degree of education was classified as elementary school, middle school, high school, or college or higher. Drinking was divided into five categories based on drinking frequency: not drinking at all, less than once a month, approximately once a month, approximately once a week, and almost every day. Smokers were classified as non-smokers or smokers based on the contents of a questionnaire that surveyed adults on smoking throughout their lives. For the women’s health questionnaire, those who checked the box stating that they were still menstruating were categorized as menstruating, and those who said they were naturally or artificially menopausal were categorized as menopausal. Those who had a spouse but did not live with them, including those who were divorced or widowed, were included in the not living together group, while those living with a spouse were included in the living together group. Age at first childbirth and number of pregnancies were also included in the questionnaire. Those who were taking oral contraceptives (OC) were included in the yes group, and those who were not were included in the no group.
Blood samples were collected after an overnight fast from the antecubital vein in the morning. Total cholesterol, triglyceride (TG), and plasma glucose levels were measured using a Labospect008AS (Hitachi, Tokyo, Japan). HbA1c levels were measured using a Tosoh G8 (Tosoh, Tokyo, Japan).
Participants were divided into two groups according to their hypertension status: normal and hypertensive. Normal was defined as systolic blood pressure (SBP) <120 mm Hg and diastolic blood pressure (DBP) <80 mm Hg, answering “no” to the question “Have you been diagnosed with hypertension by a doctor?” and answering “no” to the question “Do you currently suffer from hypertension?”. Hypertension was defined as SBP ≥140 mm Hg or DBP ≥90 mm Hg, answering “yes” to the question “Have you been diagnosed with hypertension by a doctor?” or answering “yes” to the question “Do you currently suffer from hypertension?”. Participants were classified into two groups according to their diabetes status: normal and diabetic. Normal was defined as fasting glucose level <100 mg/dL or HbA1c level <5.7%, answering “no” to the question “Have you been diagnosed with diabetes by a doctor?” and answering “no” to the question “Do you currently suffer from diabetes?”. Diabetes was defined as fasting glucose level ≥126 mg/dL or HbA1c ≥6.5%, answering “yes” to the question “Have you been diagnosed with diabetes by a doctor?” or answering “yes” to the question “Do you currently suffer from diabetes?”. No dyslipidemia was defined if the cholesterol level was <240 mg/dL and the TG level was <200 md/dL, if they answered “no” to the question “Have you been diagnosed with dyslipidemia by a doctor?” and if they answered “no” to the question “Do you currently suffer from dyslipidemia?”. Dyslipidemia was defined by if the cholesterol level was ≥240 mg/dL or the TG level was ≥200 mg/dL, if they answered “yes” to the question “Have you been diagnosed with dyslipidemia by a doctor?” or “yes” to the question “Do you currently suffer from dyslipidemia?”.
Statistical analysis
KNHANES data were extracted using a two-stage stratified cluster sampling design rather than a simple random sampling design method. When interpreting results for the target population of Korean using this KNHANES data, the Korean Disease Control and Prevention Agency recommends conducting analyses that account for the complex sampling design, rather than simple analysis. Therefore, statistical analysis was conducted based on the complex sample analysis method. An integrated weight was applied to integrate the 12 years of data, and one data point was produced. Comparisons of continuous variables between the two groups (non-depression group, high risk of depression group) were performed using Student’s t-test, and categorical variables were analyzed using the chi-square test or Fisher’s exact test. Univariate analysis was performed for each investigated variable to analyze the risk of high risk of depression and non-depression. Multivariate logistic regression analysis was performed to evaluate the risk of high risk of depression according to metabolic diseases status such as hypertension, diabetes, and dyslipidemia. We considered three confounding variables (age, menopausal status, and smoking status) that were adjusted for in the multivariate logistic regression analysis. All analyses were performed using SPSS Statistics for Windows version 25.0 (IBM Corp., Armonk, NY, USA). For all analyses, p-values <0.05 were considered statistically significant.
Ethics
We conducted a retrospective study using KNHANES data collected after receiving Institutional Review Board (IRB) approval from the Korea Center for Disease Control and Prevention. The following approval numbers were granted by the IRB of the Korean Center for Disease Control and Prevention from 2010 to 2021; 2010-02CON-21-C, 2011-02CON-06-C, 2012-01EXP-01-2C, 2013-07CON-03-4C, 2013-12EXP-03-5C, 2018-01-03-P-A, 2018-01-03-C-A, 2018-01-03-2C-A, 2018-01-03-5C-A.
RESULTS
The mean age of the participants selected for this study was 60.83±13.34 years. Of the 330 participants, 252 belonged to the non-depression group and 78 to the high risk of depression group. The comparison of characteristics between the two groups and the univariate logistic regression analysis results of the risk for high risk of depression are presented in Table 1. There were no significant differences in demographic factors between the two groups, such as age, weight, height, BMI, waist circumference, individual income, education, alcohol consumption, living status with spouse, age at first childbirth, number of pregnancies, and OC use.

Comparison of characteristics between non-depression and high risk of depression groups and risk assessment of high risk depression compared to non-depression using univariate logistic regression analysis
However, the proportion of smokers (p=0.022) and menstruation status (p=0.015) in the high risk of depression group were significantly higher than those in the non-depression group. When comparing the proportion of metabolic diseases between the two groups, the proportion of cervical cancer patients with diabetes was significantly higher in the high risk of depression group (p=0.016), whereas the proportions of hypertension and dyslipidemia were not significantly different between the two groups. Univariate analysis results were as follows: smoking was significantly associated with the risk of high risk of depression (odds ratio [OR], 2.29; 95% confidence interval [CI], 1.110, 4.738; p=0.025). In contrast, a lower risk of high risk of depression was associated with menopausal status (OR, 0.51; 95% CI, 0.299, 0.880; p=0.015). Among the metabolic diseases, the presence of diabetes was associated with an increased risk of high risk of depression (OR, 2.19; 95% CI, 1.146, 4.181; p=0.018). However, hypertension and dyslipidemia were not associated with an increased risk of high risk of depression. Other detailed baseline characteristics and univariate logistic regression analysis results not included in Table 1 are presented in Supplementary Table 1.
In the multivariate logistic regression analysis, after adjusting for age, smoking status, and menopausal status among the factors that were significant in the univariate logistic regression analysis, diabetes was positively associated with the high risk of depression in patients with cervical cancer (OR, 2.47; 95% CI, 1.205, 5.071; p=0.014) (Table 2); however, hypertension and dyslipidemia were not associated with the high risk of depression group. In addition, the results of the multivariate logistic regression analysis were expressed as a graph in the forest plot to make it easy to see at a glance, which was presented as Figure 2.

Multivariate logistics regression analysis of the risk for high risk depression by metabolic diseases status such as hypertension, diabetes, and dyslipidemia
DISCUSSION
In this retrospective study, we found that patients with cervical cancer had a significant positive relationship between high risk of depression and diabetes, whereas hypertension and dyslipidemia were not associated with high risk of depression. To the best of our knowledge, this study is one of the few to investigate the relationship between high risk of depression and metabolic diseases in Korean patients with cervical cancer.
Hypertension can cause ischemic damage to the white matter in the brain, leading to depression [9]. Consistent with this assumption, a prospective study by Jeon et al. [12] reported a significant increase in the HR of depression with hypertension, and a cross-sectional study by Tokioka et al. [13] found that the presence of masked hypertension significantly increased the OR of depressive symptoms in both men (OR, 1.72; 95% CI, 1.26, 2.34) and women (OR, 1.30; 95% CI, 1.06, 1.59). Furthermore, Eloseily et al. [14] observed higher SBP in depressed adolescents. Based on the above, we assumed that there would be a positive relationship between hypertension and high risk of depression in cervical cancer patients. However, our results revealed no association between high risk of depression and hypertension in patients with cervical cancer. Similar to our findings, a prospective cohort study by Akbaraly et al. [21] found no association between hypertension and depressive symptoms. Other studies have also reported no significant association between depression and hypertension [19,20]. Study using the UK Biobank found no relationship between depression and white matter microstructure [36]. This supports our finding of no association between depression and hypertension, challenging theories that vascular risk factors, such as hypertension, could disrupt white matter tracts, leading to mood dysregulation and depression. In contrast, a German cross-sectional study reported a negative relationship between depressive symptoms and arterial blood pressure [18]. Similarly, a study on Dutch adults found that increased blood pressure was associated with decreased pain sensitivity, anxiety, and negative task perceptions in hypertensive women, but not in men [17]. Other studies have also reported that as blood pressure increases, the stress levels experienced by participants tend to decrease [15,16]. Studies reporting a negative relationship between hypertension and depression support the following mechanism: the baroreceptor, a key peripheral blood pressure sensor, plays a crucial role in the regulation of blood pressure, particularly under hypertensive conditions, by activating it during the elevated systolic phases to stabilize pressure. This activation triggers analgesia and reduces stress responses, thereby facilitating emotional balance by decreasing the perceptions of physical and social discomfort. The relationship between hypertension and depression remains elusive, with inconsistent results across studies, including sex differences. Although the Blöchl et al. [36] study using the UK Biobank supports our findings, they notes as a limitation that, even with a longer-term longitudinal followup, significant changes in brain white matter microstructure were not observed. Therefore, further longitudinal studies are required to confirm this hypothesis.
An association between depression and diabetes has been identified in previous studies. A meta-analysis by Anderson et al. [23] reported a significantly increased risk of depression with diabetes, regardless of the type of diabetes (OR, 2.0; 95% CI, 1.8, 2.2). Additionally, a case-control study comparing type 2 diabetics with normoglycemic individuals revealed significantly higher risks for depressive episodes (OR, 1.8; 95% CI, 1.7, 2.0), recurrent depressive episodes (OR, 2.4; 95% CI, 2.2, 2.6), and suicidal ideation (OR, 3.6; 95% CI, 2.5, 4.8) in those with type 2 diabetes [22]. A cohort study by Meurs et al. [24] found a significantly increased risk of depressive disorders with diabetes (OR adjusted for age and sex, 1.84; 95% CI, 1.48, 2.28) (OR adjusted for comorbidities and anxiety disorder, 1.39; 95% CI, 1.10, 1.76). A meta-analysis by Chen et al. [25] reported an increased risk of depression in those with prediabetes (OR, 1.11; 95% CI, 1.03, 1.19) or previously diagnosed diabetes (OR, 1.80; 95% CI, 1.40, 2.31) compared to those with normal blood glucose levels. Our study also revealed a significant positive relationship between high risk of depression and diabetes. Although the mechanisms linking depression and diabetes are not fully understood, several hypotheses have suggested a connection (Figure 3). In diabetes, the oxidative action of mitochondria is impaired in an environment of insulin resistance. This leads to an increase in reactive oxygen species as well as increased oxidation of proteins and lipids in the basal ganglia of the brain, which play a role in controlling emotions, physical movements, and thoughts. This leads to increased turnover of dopamine, causing dopamine dysfunction [10,37]. In addition, monoamine oxidase (MAO) A, which oxidizes and breaks down neurotransmitters such as serotonin and norepinephrine, and MAO B, which oxidizes and breaks down phenylethylamine, the neurotransmitter responsible for mood and excited feelings in humans, are increased in an environment of elevated blood sugar and increased insulin resistance. As a result, concentrations of serotonin, norepinephrine, and phenylethylamine decrease [10,38]. This decrease in neurotransmitters that contribute to maintaining excited emotions and feelings of well-being in humans can trigger depressive behaviors. Consequently, diabetes contributes to an increased incidence of depression. Animal experiments with brain-specific insulin receptor knockout mice (NIRKO mice) by Kleinridders et al. [10] also confirmed that depression-like behaviors were observed in NIRKO mice artificially induced a diabetic environment. Several studies have investigated the relationship between depression and metabolic diseases in cancer patients. For example, Zhao et al.’s [39] study on Chinese cervical cancer patients who underwent surgery found that diabetes significantly increased the risk of depression, and Han’s [40] study on gastric cancer patients who underwent surgery reported a higher risk of depression in those with diabetes. Notably, these studies, similar to our study, selected hypertension, diabetes, and dyslipidemia as variables to assess their association with depression in cervical cancer pa-tients or gastric cancer patients [39,40]. Both Zhao et al. [39] and Han [40] studies, consistent with our findings, reported no significant association between hypertension or dyslipidemia and depression. However, they observed a significant positive relationship between diabetes and depression. These findings support the results of our study. However, other studies have reported no significant association between depression and diabetes [26,27]. Our study differs from studies conducted in the general population in that we evaluated the association between high risk of depression and diabetes only in cervical cancer patients. It is possible that the specific cellular environment of cervical cancer may have a different effect on the association between diabetes and depression compared to the environment in the general population. Therefore, it is necessary to investigate this issue in further studies.

Schematic representation of the mechanism between diabetes and depressive behaviors. ROS, reactive oxygen species; MAO, monoamine oxidases; NE, norepinephrine.
No significant relationship was found between dyslipidemia and high risk of depression in our study. Similarly, a cross-sectional study from India reported no association between depressive symptoms and cholesterol levels, including low-density lipoprotein (LDL) (OR, 1.00; p=0.19), high-density lipoprotein (OR, 0.99; p=0.76), TG (OR, 1.00; p=0.12), and total cholesterol (OR, 0.99; p=0.84) [34]. Our study, which focused on Korean women with cervical cancer, could not explore sex differences in the relationship between dyslipidemia and high risk of depression. Previous studies have revealed no relationship between dyslipidemia and depression in women; however, significant associations exist for men. For example, a study among Korean adolescents found higher LDL levels associated with an increased depressive mood risk in men (OR, 5.76; 95% CI, 1.06, 31.08) but not in women [11]. Lee et al. [31] research using KNHANES data showed that men with elevated TG levels had a higher risk of depression (OR, 1.535; 95% CI, 1.098, 2.147), with no association in women. Additionally, Han’s [33] and Xu et al.’s [35] studies confirmed a significant relationship between dyslipidemia and depression in men but not in women. A brief explanation of why the association between dyslipidemia and depression may lead to different outcomes in men and women is presented below. Androgenic hormones such as testosterone activate the MAPK-ERK pathway in neurons, leading to neuroprotection. However, in dyslipidemia, where TG levels are elevated, testosterone deficiency inhibits the neuroprotective effects in the nervous system. Consequently, neurotransmitters involved in emotional control become dysfunctional, creating an environment that makes it easier for depression to occur [41,42]. For this reason, dyslipidemia in men may make them more vulnerable to depression than women. Contrary to previous hypotheses, studies by Li et al. [29] and Wu et al. [30] demonstrated that higher TG levels significantly increased the risk of depression across genders. Additionally, Wee et al.’s [32] study found that traumatic brain injury patients with untreated dyslipidemia had a 61% increased risk of depression (HR, 1.61; p=0.0378). A cross-sectional study in Koreans showed increased depression risks at LDL levels below 70 mg/dL (OR, 1.191; 95% CI, 1.073, 1.435), and above 160 mg/dL (OR, 1.241; 95% CI, 1.073, 1.435) [28]. The relationship between dyslipidemia and depression is still unclear. The com-plex interplay between cervical cancer’s unique molecular factors, including metabolic and angiogenic elements and cytokines, must be further explored.
This study had some limitations. First, this was a cross-sectional study, and we were unable to perform a longitudinal follow-up. In addition, since this study was conducted as a cross-sectional study, it is possible to analyze the association by obtaining both the cause and result at one point in time, but there is a limitation that it is difficult to clearly establish a causal relationship through this study. Second, participants were excluded from the study if they did not complete the questionnaire or had systemically missing values. In this study, out of 14,372 participants with cervical cancer, 14,042 were excluded due to missing values, and 330 participants were finally selected. This large number of exclusions can lead to exclusion bias. Third, because the survey responses depended on each individual’s memory, potential recall bias could not be excluded. Fourth, because the KNHANES only provides information on the diagnosis of cervical cancer, information on the cellular type of cervical cancer, such as squamous cell carcinoma or adenocarcinoma, or stage or previous chemotherapy or radiotherapy were unavailable. For this reason, we were unable to assess whether the association between high risk of depression and metabolic disease differed according to the cervical cancer cell type or stage or previous treatment. Fifth, although human papillomavirus (HPV) infection is a known risk factor for cervical cancer, information on HPV infection status was not available in the KNHANES data. For this reason, we could not analyze the relationship between high risk of depression and metabolic diseases in patients with cervical cancer according to their HPV infection status. Nevertheless, the strength of this study is that it is one of the few studies to evaluate the association between high risk of depression and metabolic diseases such as hypertension, diabetes, and dyslipidemia in Korean patients with cervical cancer using over 12 years of large nationally representative sample data. We found a significant positive association between diabetes and depression in Korean patients with cervical cancer. In the future, a longitudinal follow-up study is needed to evaluate how diabetes control contributes to reducing the risk of high risk of depression. Furthermore, although this study only included Korean women, further research is needed to identify whether the association between diabetes and high risk of depression also applies to women of other ethnicities.
In our study, among metabolic diseases such as hypertension, diabetes, and dyslipidemia, diabetes significantly increased the risk of high risk of depression in Korean patients with cervical cancer. Therefore, encouraging proper treatment of diabetes in cervical cancer patients may contribute to lowering the potential risk of depression in the future.
Supplementary Materials
The Supplement is available with this article at https://doi.org/10.30773/pi.2024.0222.
Other characteristics between the two groups and high risk of depression compared to non-depression by univariate logistic regression analysis
Notes
Availability of Data and Material
Date and materials are available on reasonable request. The raw data of KNHANES used in this paper can be accessed through the following website. https://knhanes.kdca.go.kr/knhanes/sub03/sub03_02_05.do.
Conflicts of Interest
The authors have no potential conflicts of interest to disclose.
Author Contributions
Conceptualization: Seon-Mi Lee, Jae-Yun Song. Data curation: Seon-Mi Lee, Aeran Seol, Sanghoon Lee, Hyun-Woong Cho. Formal analysis: Seon-Mi Lee, Aeran Seol, Sanghoon Lee, Kyung-Jin Min. Funding acquisition: Jae-Yun Song. Investigation: Jae-Yun Song, Won Jun Choi. Methodology: Seon-Mi Lee, Daun Shin. Project administration: Seon-Mi Lee, Daun Shin. Resources: Seon-Mi Lee, Jin-Hwa Hong. Software: Seon-Mi Lee, Aeran Seol. Supervision: Jae-Yun Song, Won Jun Choi. Validation: Seon-Mi Lee, Nak-Woo Lee. Visualization: Seon-Mi Lee, Daun Shin, Jin-Hwa Hong, Jae-Kwan Lee, Nak-Woo Lee. Writing—original draft: Seon-Mi Lee. Writing—review & editing: Seon-Mi Lee, Daun Shin, Jae-Yun Song, Won Jun Choi.
Funding Statement
None
Acknowledgements
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