Skip to main content Accessibility help

Cardiovascular Events after the Sewol Ferry Disaster, South Korea

  • So Yeon Kong (a1), Kyoung Jun Song (a1) (a2), Sang Do Shin (a1) (a3) and Young Sun Ro (a1)



Major incidents affecting large numbers of people may increase the rate of acute cardiovascular events, even among those who are not directly involved in the incident. It is hypothesized that the MV Sewol ferry disaster (South Korea) would increase the incidence of cardiovascular events nation-wide.


Data on all adult patients (>18 years) who were diagnosed with acute cardiovascular events, including acute myocardial infarction (MI), angina, and cardiac arrhythmias, were extracted from the National Emergency Department Information System (NEDIS) from March 15 through June 17, during the years 2011-2014 (four weeks before to eight weeks after the event date). Poisson regression models were used to calculate the incidence rate ratios (IRRs) comparing the weekly changes in the occurrences of cardiovascular events from the week of the Sewol event (April 16-22, 2014) to eight weeks after the disaster (June 11-17, 2014), using the one-month period before Sewol as a reference period (March 15-April 15), adjusting for calendar years (years 2011-2014) and environmental factors.


During the study periods, cardiovascular events were identified in 73,823 patients. Compared to the reference period, the week of the Sewol disaster and the three weeks after the disaster showed a significant increase in the number of acute cardiovascular events, IRRs of 1.09 (95% CI, 1.03-1.15) and 1.08 (95% CI, 1.02-1.15), respectively (P <.01 for both). In particular, there was 21% increase in incidence of arrhythmia (IRR = 1.21; 95% CI, 1.02-1.44; P = .03) during the week of the Sewol disaster compared with the reference period.


This study showed a significant increase in the incidence of acute cardiovascular events during the week of, and the three weeks after, the Sewol ferry disaster in 2014. These additional cardiac emergencies may be triggered by emotional stressors related to the event, highlighting the public health importance of indirect exposure to a tragic catastrophe.

Kong SY, Song KJ, Shin SD, Ro YS. Cardiovascular events after the Sewol ferry disaster, South Korea. Prehosp Disaster Med. 2019;34(2):142–148


Corresponding author

Correspondence: Kyoung Jun Song, MD, PhD, Department of Emergency Medicine, Seoul National University Boramae Medical Center, 20 Boramae-Ro 5 gil, Dongjak-Gu, Seoul, Korea, 07061 E-mail:


Hide All

Conflicts of interest: none



Hide All
1.10.1136/jech.2003.019349Moller, J, Theorell, T, de Faire, U, et al. Work-related stressful life events and the risk of myocardial infarction. Case-control and case-crossover analyses within the Stockholm Heart Epidemiology Program (SHEEP). J Epidemiol Community Health. 2005;59(1):2330.10.1136/jech.2003.019349
2.Strike, PC, Steptoe, A. Behavioral and emotional triggers of acute coronary syndromes: a systematic review and critique. Psychosom Med. 2005;67(2):179186.
3.Leor, J, Kloner, RA. The Northridge earthquake as a trigger for acute myocardial infarction. Am J Cardiol. 1996;77(14):12301232.
4.10.1161/JAHA.114.001354Swerdel, JN, Janevic, TM, Cosgrove, NM, et al. Myocardial Infarction Data Acquisition System Study Group. The effect of Hurricane Sandy on cardiovascular events in New Jersey. J Am Heart Assoc. 2014;3(6):e001354.10.1161/JAHA.114.001354
5.Meisel, SR, Kutz, I, Dayan, KI, et al. Effect of Iraqi missile war on incidence of acute myocardial infarction and sudden death in Israeli civilians. Lancet. 1991;338(8768):660661.
6.10.1093/jurban/jti087Allegra, JR, Mostashari, F, Rothman, J, et al. Cardiac events in New Jersey after the September 11, 2001, terrorist attack. J Urban Health. 2005;82(3):358363.10.1093/jurban/jti087
7.Feng, J, Lenihan, DJ, Johnson, MM, et al. Cardiac sequelae in Brooklyn after the September 11 terrorist attacks. Clin Cardiol. 2006;29(1):1317.
8.Schuster, MA, Stein, BD, Jaycox, L, et al. A national survey of stress reactions after the September 11, 2001, terrorist attacks. N Engl J Med. 2001;345(20):15071512.
9.Kiyohara, K, Kitamura, T, Iwami, T, et al. Impact of the Great East Japan earthquake on out-of-hospital cardiac arrest with cardiac origin in non-disaster areas [corrected]. J Epidemiol Community Health. 2015;69(2):185188.
10.Woo, H, Cho, Y, Shim, E, et al. Public trauma after the Sewol ferry disaster: the role of social media in understanding the public mood. Int J Environ Res Public Health. 2015;12(9):1097410983.
11.Summaries for patients. Omega-3 fatty acids and congestive heart failure in older adults. Ann Intern Med. 2011;155(3):129.
12.Pfefferbaum, B, Seale, TW, McDonald, NB, et al. Posttraumatic stress two years after the Oklahoma City bombing in youths geographically distant from the explosion. Psychiatry. 2000;63(4):358370.
13.Aoki, T, Fukumoto, Y, Yasuda, S, et al. The Great East Japan Earthquake disaster and cardiovascular diseases. Eur Heart J. 2012;33(22):27962803.
14.Ro, YS, Shin, SD, Lee, YJ, et al. Effect of dispatcher-assisted cardiopulmonary resuscitation program and location of out-of-hospital cardiac arrest on survival and neurologic outcome. Ann Emerg Med. 2017;69(1):5261.
15.National Emergency Medical Center. Statistical yearbook of emergency medical service. 2016. Accessed July 2018.
16.Cosselman, KE, Navas-Acien, A, Kaufman, JD. Environmental factors in cardiovascular disease. Nat Rev Cardiol. 2015;12(11):627642.
17.Tsai, CH, Lung, FW, Wang, SY. The 1999 Ji-Ji (Taiwan) earthquake as a trigger for acute myocardial infarction. Psychosomatics. 2004;45(6):477482.
18.Lee, SH, Nam, HS, Kim, HB, et al. Factors associated with complicated grief in students who survived the Sewol ferry disaster in South Korea. Psychiatry Investig. 2018;15(3):254.
19.Lee, SM, Han, H, Jang, KI, et al. Heart rate variability associated with posttraumatic stress disorder in victims’ families of Sewol ferry disaster. Psychiatry Res. 2018;259:277282.
20.Lee, MS, Bhang, SY, Lee, CS, et al. Psychiatric symptoms in teachers from Danwon High School after exposure to the sinking of the motor vessel Sewol. Psychiatry Investig. 2017;14(6):900903.
21.Lee, JY, Kim, SW, Bae, KY, et al. Factors associated with posttraumatic stress disorder symptoms among community volunteers during the Sewol ferry disaster in Korea. Compr Psychiatry. 2017;77:3844.
22.Shedd, OL, Sears, SF Jr., Harvill, JL, et al. The World Trade Center attack: increased frequency of defibrillator shocks for ventricular arrhythmias in patients living remotely from New York City. J Am Coll Cardiol. 2004;44(6):12651267.
23.Holman, EA, Garfin, DR, Silver, RC. Media’s role in broadcasting acute stress following the Boston Marathon bombings. Proc Natl Acad Sci USA. 2014;111(1):9398.
24.Vasterman, P, Yzermans, CJ, Dirkzwager, AJ. The role of the media and media hypes in the aftermath of disasters. Epidemiol Rev. 2005;27:107114.
25.10.1037/0003-066X.62.4.304Marshall, RD, Bryant, RA, Amsel, L, et al. The psychology of ongoing threat: relative risk appraisal, the September 11 attacks, and terrorism-related fears. Am Psychol. 2007;62(4):304316.10.1037/0003-066X.62.4.304
26.Rozanski, A, Blumenthal, JA, Kaplan, J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation. 1999;99(16):21922217.
27.10.1016/j.jacc.2007.12.024Dimsdale, JE. Psychological stress and cardiovascular disease. J Am Coll Cardiol. 2008;51(13):12371246.10.1016/j.jacc.2007.12.024
28.Vale, S. Psychosocial stress and cardiovascular diseases. Postgrad Med J. 2005;81(957):429435.
29.Buckley, T, Hoo, SY, Fethney, J, et al. Triggering of acute coronary occlusion by episodes of anger. Eur Heart J Acute Cardiovasc Care. 2015;4(6):493498.
30.Carroll, D, Ebrahim, S, Tilling, K, et al. Admissions for myocardial infarction and World Cup football: database survey. BMJ. 2002;325(7378):14391442.
31.Wilbert-Lampen, U, Leistner, D, Greven, S, et al. Cardiovascular events during World Cup soccer. N Engl J Med. 2008;358(5):475483.
32.Strike, PC, Perkins-Porras, L, Whitehead, DL, et al. Triggering of acute coronary syndromes by physical exertion and anger: clinical and sociodemographic characteristics. Heart. 2006;92(8):10351040.
33.Tofler, GH, Muller, JE. Triggering of acute cardiovascular disease and potential preventive strategies. Circulation. 2006;114(17):18631872.
34.Coppler, PJ, Rittenberger, JC, Wallace, DJ, et al. Billing diagnoses do not accurately identify out-of-hospital cardiac arrest patients: an analysis of a regional healthcare system. Resuscitation. 2016;98:914.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Prehospital and Disaster Medicine
  • ISSN: 1049-023X
  • EISSN: 1945-1938
  • URL: /core/journals/prehospital-and-disaster-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed