Cold hypersensitivity in the hands and feet (CHHF) is the symptom of sensation of cold in the extremities under conditions that would not typically evoke such a sensation. CHHF is commonly observed in East Asians, especially women, and is a result of the abnormal contraction of blood vessels in the extremities [
CHHF is considered more important in Korean medicine and other types of traditional East Asian medicine (TEAM) than in Western medicine. This is because CHHF is an important diagnostic factor in TEAM and is traditionally known to accompany several chronic symptoms and diseases, such as dyspepsia, menstrual pain, fatigue, and infertility [
Although the prevalence of CHHF and its effects on health-related quality of life (HRQOL) are important with regard to health care and policies, studies related to CHHF are insufficient. In Korea, one study investigated the location (hands, feet, abdomen, knees, etc.) and severity of cold hypersensitivity in 362 women visiting the gynaecology outpatient department of one university-affiliated hospital of Korean medicine [
Hence, this study aimed to investigate the prevalence of cold hypersensitivity by location (hands, feet, abdomen), and its effect on HRQOL, using a nationwide survey conducted over two rounds in 2013 and 2015.
The participants in this study were adult Korean men and women aged 19 years and over. The questionnaire survey was conducted by petition to a specialist organization (Gallup Korea Institute). Registered citizen population statistics were used for random extraction of participants using stratified multistage sampling based on region, sex, and age (95% confidence interval, sampling error ± 3.0%). A total of 1101 participants were surveyed between May 6 and June 14, 2013, and 1100 participants were surveyed between October 1 and October 30, 2015.
The survey was conducted through face-to-face interviews by a trained interviewer. The participants responded to structured questionnaires with the assistance of the interviewer. These questionnaires did not include the participants’ personal information (address, citizen registration number, telephone number, name), and the participants provided verbal consent to participation after receiving an explanation of the objectives of the questionnaires and their use.
This survey did not collect personal information on participants. Participants verbally agreed that the questionnaire results could be used for research purposes. This study was approved by the Institutional Review Board of the Semyung University Korean Medicine Hospital (No. 1707-10).
The questionnaire about cold hypersensitivity required participants to respond to questions about their hands, feet, and abdomen in everyday life. Each question was scored on a 7-point scale, whereby a score closer to 7 indicated a colder condition, and a score closer to 1 indicated a warmer condition. A score of 5–7 points for one location was defined as cold hypersensitivity of that area, a score of 5–7 points in both the hands and the feet was defined as CHHF, while a score of 1–4 points in both the hands and the feet was defined as non-CHHF.
The participants’ HRQOL was assessed using the Short-Form 12 Item Health Survey (SF-12 v2). The SF-12 is a health-related questionnaire with established validity and reliability. It is divided into the physical component summary (PCS) and the mental component summary (MCS) and consists of 8 domains. Scores range from 0 to 100 points, with a higher score indicating better health [
Participants’ general characteristics are expressed as the mean ± SD (standard deviation) and frequency. Chi-square tests and independent
There were 2201 participants in total, comprising 1090 men (49.5%) and 1111 women (50.5%). The mean age of participants was 46.5 ± 15.4 years and the mean BMI was 23.2 ± 2.9 kg/m2. Mean cold hypersensitivity scores were 3.4, 3.5, and 3.6 for the hands, feet, and abdomen, respectively. Other general characteristics are presented in Table
Participants’ general characteristics.
Category | 2013 | 2015 | P-value | Total |
---|---|---|---|---|
Sex | ||||
Male | 545 | 545 | 0.983 | 1090 (49.5) |
Female | 556 | 556 | 1111 (50.5) | |
Age (years) | ||||
20–29 | 183 (16.6) | 194 (17.6) | 0.852 | 377 (17.1) |
30–39 | 224 (20.3) | 204 (18.5) | 428 (19.4) | |
40–49 | 243 (22.1) | 234 (21.3) | 477 (21.7) | |
50–59 | 217 (19.7) | 218 (19.8) | 435 (19.8) | |
60–69 | 120 (10.9) | 130 (11.8) | 250 (11.4) | |
Over 70 | 114 (10.4) | 120 (10.9) | 234 (10.6) | |
Mean | 46.4 ± 15.3 | 46.6 ± 15.6 | 0.731 | 46.5 ± 15.4 |
Body mass index (kg/m2) | 23.2 ± 3.0 | 23.2 ± 2.8 | 0.937 | 23.2 ± 2.9 |
Drinking | ||||
Current drinker | 961 (87.3) | 720 (65.5) | < 0.001 | 1681 (76.4) |
Not drinking | 140 (12.7) | 380 (34.5) | 520 (23.6) | |
Smoking | ||||
Current smoker | 293 (26.6) | 275 (25.0) | 0.387 | 568 (25.8) |
Not smoking | 808 (73.4) | 825 (75.0) | 1633 (74.2) | |
Marital status | ||||
With spouse | 814 (74.0) | 777 (70.6) | 0.078 | 1591 (72.3) |
Without spouse | 286 (26.0) | 323 (29.4) | 609 (27.7) | |
Income | ||||
Under 200 | 199 (18.2) | 142 (12.9) | 0.001 | 341 (15.5) |
200–300 | 219 (20.0) | 187 (17.0) | 406 (18.5) | |
300–400 | 299 (27.3) | 325 (29.5) | 624 (28.4) | |
400–500 | 167 (15.3) | 184 (16.7) | 351 (16.0) | |
Over 500 | 211 (19.3) | 262 (23.8) | 473 (21.5) | |
Occupation | ||||
Office | 219 (19.9) | 253 (23.0) | 0.130 | 472 (21.4) |
Service | 390 (35.4) | 394 (35.8) | 784 (35.6) | |
Others | 492 (44.7) | 453 (41.2) | 945 (42.9) | |
Education | ||||
≤ Middle school | 208 (19.0) | 162 (14.7) | 0.017 | 370 (16.9) |
High school | 420 (38.4) | 466 (42.4) | 886 (40.4) | |
≥ University | 466 (42.6) | 472 (42.9) | 938 (42.8) | |
Hands score | 3.5 ± 1.6 | 3.4 ± 1.5 | 0.413 | 3.4±1.6 |
Feet score | 3.5 ± 1.6 | 3.5 ± 1.5 | 0.973 | 3.5±1.6 |
Abdomen score | 3.6 ± 1.5 | 3.6 ± 1.4 | 0.627 | 3.6±1.4 |
| ||||
Total | 1101 (50.0) | 1100 (50.0) | 2201 (100) |
Data are shown as n (%) or the mean ± standard deviation. P values were calculated by chi-square test or Student’s
Cold hypersensitivity scores in the hands and feet were strongly positively correlated, with correlation coefficients exceeding 0.8 in both men and women; there were also moderate positive correlations between cold sensitivity in the abdomen and the hands, and in the abdomen and the feet (correlation coefficients: 0.597, 0.638, respectively). Age did not correlate with cold hypersensitivity, but BMI was negatively correlated with cold hypersensitivity in the hands and feet. Abdominal cold hypersensitivity and BMI did not show a significant correlation in women or men, individually, but did show a weak negative correlation across all participants combined (Table
Correlations between cold hypersensitivity scores, body mass index, and age, by sex and affected body part.
Hands | Feet | Abdomen | BMI | Age | |
---|---|---|---|---|---|
Men | |||||
Hands | 1 | ||||
Feet | 0.805 | 1 | |||
Abdomen | 0.580 | 0.637 | 1 | ||
BMI | -0.118 | -0.110 | -0.057 | 1 | |
Age | 0.037 | 0.028 | 0.002 | 0.059 | 1 |
| |||||
Women | |||||
Hands | 1 | ||||
Feet | 0.848 | 1 | |||
Abdomen | 0.583 | 0.614 | 1 | ||
BMI | -0.182 | -0.162 | -0.052 | 1 | |
Age | -0.014 | -0.006 | 0.031 | 0.393 | 1 |
| |||||
Total | |||||
Hands | 1 | ||||
Feet | 0.837 | 1 | |||
Abdomen | 0.597 | 0.638 | 1 | ||
BMI | -0.189 | -0.179 | -0.095 | 1 | |
Age | 0.021 | 0.023 | 0.031 | 0.220 | 1 |
BMI, body mass index;
As shown in Figure
Distribution of response to cold hypersensitivity questionnaire by sex.
Cold hypersensitivity of the hands was observed in 21.6%, cold hypersensitivity of the feet was observed in 23.0%, and cold hypersensitivity of the abdomen was observed in 22.5% of participants. Cold hypersensitivity of all three body parts was observed in 17.9% of participants, and 34.2% of participants showed cold hypersensitivity in at least one of the three body parts. The prevalence of cold hypersensitivity was significantly higher in women than in men, irrespective of the body part (Figure
The prevalence of cold hypersensitivity by sex and body part. CHH: cold hypersensitivity in the hands; CHF: cold hypersensitivity in the feet; CHA: cold hypersensitivity in the abdomen; CHHF: cold hypersensitivity in the hands and feet; CHHFA: cold hypersensitivity in the hands, feet, and abdomen; one of HFA: cold hypersensitivity in just one of the three areas (hands, feet, or abdomen).
The two groups showed no difference in age, but weight and BMI were lower in the CHHF group for both men and women. PCS and MCS were significantly lower in the CHHF group than in the non-CHHF group for women. For men, PCS was significantly lower in the CHHF group, but there was no significant difference between these groups in terms of MCS (Table
Difference in general characteristics between CHHF and non-CHHF groups.
CHHF | Non-CHHF | P-value | |
---|---|---|---|
Men | |||
N | 106 | 906 | |
Age | 48.0 ±15.7 | 45.2 ±14.9 | 0.071 |
Height | 172.0 ±5.7 | 172.5 ±5.4 | 0.390 |
Weight | 68.5 ±8.2 | 71.2 ±9.2 | 0.003 |
BMI | 23.1 ±2.4 | 23.9 ±2.6 | 0.004 |
PCS | 51.3 ±6.7 | 52.7±6.1 | 0.024 |
MCS | 50.4 ±7.5 | 51.2 ±7.9 | 0.282 |
Drinking | |||
Current drinker | 93 (87.7) | 789 (87.1) | 0.850 |
Not drinking | 13 (12.3) | 117 (12.9) | |
Smoking | |||
Current smoker | 43 (43.4) | 439 (48.5) | 0.324 |
Not smoking | 60 (56.6) | 467 (51.5) | |
Marital status | |||
With spouse | 77 (72.6) | 636 (70.2) | 0.602 |
Without spouse | 29 (27.4) | 270 (29.8) | |
Income | |||
Under 200 | 23 (21.7) | 121 (13.4) | 0.174 |
200–300 | 19 (17.9) | 180 (19.9) | |
300–400 | 28 (26.4) | 270 (29.8) | |
400–500 | 13 (12.3) | 150 (16.6) | |
Over 500 | 23 (21.7) | 184 (20.3) | |
Occupation | |||
Office | 22 (20.8) | 251 (27.7) | 0.088 |
Service | 36 (34.0) | 339 (37.4) | |
Others | 48 (45.3) | 316 (34.9) | |
Education | |||
≤ Middle school | 17 (16.0) | 96 (10.6) | 0.211 |
High school | 35 (33.0) | 343 (37.9) | |
≥ University | 54 (50.9) | 466 (51.5) | |
Women | |||
N | 289 | 707 | |
Age | 47.1 ±16.2 | 47.6 ±15.3 | 0.688 |
Height | 158.8 ±5.3 | 159.2 ±5.0 | 0.247 |
Weight | 55.3 ±6.9 | 57.5 ±7.4 | < 0.001 |
BMI | 22.0 ±2.9 | 22.7 ±3.0 | < 0.001 |
PCS | 48.1 ±9.4 | 50.6 ±7.7 | < 0.001 |
MCS | 48.2 ±8.7 | 50.8 ±8.3 | < 0.001 |
Drinking | |||
Current drinker | 201 (69.6) | 457 (64.6) | 0.078 |
Not drinking | 88 (30.4) | 250 (35.4) | |
Smoking | |||
Current smoker | 11 (3.8) | 16 (2.3) | 0.127 |
Not smoking | 278 (96.2) | 691 (97.7) | |
Marital status | |||
With spouse | 211 (73.3) | 537 (76.0) | 0.373 |
Without spouse | 77 (26.7) | 170 (24.0) | |
Income | |||
Under 200 | 56 (19.5) | 109 (15.5) | 0.458 |
200–300 | 52 (18.1) | 121 (17.2) | |
300–400 | 74 (25.8) | 200 (28.4) | |
400–500 | 40 (13.9) | 118 (16.7) | |
Over 500 | 65 (22.6) | 157 (22.3) | |
Occupation | |||
Office | 61 (21.1) | 100 (14.1) | 0.025 |
Service | 89 (30.8) | 243 (34.4) | |
Others | 139 (48.1) | 364 (51.5) | |
Education | |||
≤ Middle school | 58 (20.1) | 162 (23.1) | 0.074 |
High school | 112 (38.9) | 306 (43.6) | |
≥ University | 118 (41.0) | 234 (33.3) | |
Total | |||
N | 395 | 1613 | |
Age | 47.3 ± 16.1 | 46.2 ± 15.1 | 0.191 |
Height | 162.3 ± 8.0 | 166.6 ± 8.4 | < 0.001 |
Weight | 58.8 ± 9.3 | 65.2 ± 10.8 | < 0.001 |
BMI | 22.3 ± 2.8 | 23.4 ± 2.9 | < 0.001 |
PCS | 48.9 ± 8.9 | 51.8 ± 6.9 | < 0.001 |
MCS | 48.8 ± 8.4 | 51.1 ± 8.1 | < 0.001 |
Drinking | |||
Current drinker | 294 (74.4) | 1246 (77.2) | 0.235 |
Not drinking | 101 (25.6) | 367 (22.8) | |
Smoking | |||
Current smoker | 57 (14.4) | 455 (28.2) | < 0.001 |
Not smoking | 338 (85.6) | 1158 (71.8) | |
Marital status | |||
With spouse | 288 (73.1) | 1173 (72.7) | 0.881 |
Without spouse | 106 (26.9) | 440 (27.3) | |
Income | |||
Under 200 | 79 (20.1) | 230 (14.3) | 0.035 |
200–300 | 71 (18.1) | 301 (18.7) | |
300–400 | 102 (26.0) | 470 (29.2) | |
400–500 | 53 (13.5) | 268 (16.6) | |
Over 500 | 88 (22.4) | 341 (21.2) | |
Occupation | |||
Office | 83 (21.0) | 351 (21.8) | 0.147 |
Service | 125 (31.6) | 582 (36.1) | |
Others | 187 (47.3) | 680 (42.2) | |
Education | |||
≤ Middle school | 75 (19.0) | 258 (16.1) | 0.295 |
High school | 147 (37.3) | 649 (40.4) | |
≥ University | 172 (43.7) | 700 (43.6) |
CHHF, cold hypersensitivity in the hands and feet; BMI, body mass index; PCS, SF-12 Physical component summary; MCS, SF-12 mental component summary.
In a multiple regression analysis investigating the effects of CHHF on PCS and MCS, CHHF was found to have a statistically significant negative effect on PCS and MCS in all models, including Model 1, which did not use adjustment variables, Model 2, which corrected for age and sex, Model 3, which corrected for age, sex, and BMI, and Model 4, which added sociodemographic variables such as drinking, smoking, marital status, income, occupation, and education (Table
Multiple regression analysis for the association of CHHF and HRQOL.
Models | Dependent variable (SF-12) | |||||||
---|---|---|---|---|---|---|---|---|
PCS | MCS | |||||||
B | SE | | B | SE | Β | | ||
Model 1 | -2.889 | 0.42 | -0.15 | < 0.001 | -2.328 | 0.46 | -0.11 | < 0.001 |
Model 2 | -2.070 | 0.38 | -0.11 | < 0.001 | -2.094 | 0.47 | -0.10 | < 0.001 |
Model 3 | -2.163 | 0.39 | -0.12 | < 0.001 | -2.098 | 0.47 | -0.10 | < 0.001 |
Model 4 | -2.144 | 0.38 | -0.11 | < 0.001 | -2.096 | 0.48 | -0.10 | < 0.001 |
CHHF, cold hypersensitivity in the hands and feet; HRQOL, health-related quality of life; Model 1: unadjusted; Model 2: adjusted for gender and age; Model 3: adjusted for gender, age, and body mass index; Model 4: adjusted for gender, age, body mass index, and all sociodemographic variables, such as drinking, smoking, marital status, income, occupation, and education; B, unstandardized regression coefficients; SE, standard error of unstandardized coefficients;
Here, we investigated the prevalence and characteristics of CHHF among Koreans by administering a self-report questionnaire survey to typical Korean adults. Overall, our results have implications for both basic research and clinical applications and suggest that people with CHHF might have poor health.
CHHF is not only a major factor for diagnosing certain conditions, such as cold syndrome (
In related work, studies in Japan have investigated subjects with a cold disorder called ‘hiesho’, which is a similar concept to CHHF, and reported a higher frequency of symptoms such as shoulder stiffness, fatigue, neck stiffness, eyestrain, knee pain, and abdominal pain [
Therefore, the public health sector is increasingly recognizing the importance of ascertaining the prevalence and distribution of CHHF. In one study of 3067 elderly individuals aged 65 years or older, 28.6% of women and 23.6% of men were reported to have cold feet and/or legs [
In Korea, even though a large number of individuals visit medical institutions for CHHF, few studies have investigated the proportion of Koreans with CHHF or other cold disorders, and on the impact of CHHF on HRQOL. Indeed, the majority of studies of cold disorder or CHHF in Korea have only examined particular subject groups [
As previously mentioned, at an institution of traditional Korean medicine, subjects most frequently complained of cold sensation in their hands, feet, and abdomen [
As shown in Figure
Age showed no correlation with cold hypersensitivity scores in either men or women; this differs from the results of Mozaffarieh and colleagues, who reported a negative correlation between CHHF and age in women [
Using the SF-12, the relationship between CHHF and HRQOL was evaluated in terms of the MCS and PCS. Since previous studies had confirmed a high prevalence of various symptoms and diseases in groups with CHHF, we predicted that similar trends would be observed in the general Korean population [
This study has the following limitations. First, because the questionnaire used in this study only assesses the severity of cold sensation in each body part, participants may have differed in their standards for discomfort related to cold hypersensitivity. A more objective instrument will need to be developed in the future to overcome this problem. In addition, because we were unable to survey the duration of symptoms and the time of onset, it was not possible to evaluate the impact of CHHF duration on HRQOL. Second, it is difficult to directly compare the results of this study with those of previous studies, since previous CHHF studies used different evaluation and diagnostic methods. Third, because CHHF is influenced by race, culture, and the environment [
Despite these limitations, this study differs from previous studies that have largely investigated patients at medical institutions. Specifically, we recruited a sample analogous to the general Korean population by stratifying participants by age, sex, and region. Therefore, our study was able to examine the distribution of cold hypersensitivity in Korea more accurately compared with any previous study, so the data on tendency and distribution of CHHF in Koreans collected through this study can be used as a reliable basis for preparing health policies and medical care guidelines for this symptom in the future. In addition, the results of this study on the relationship between CHHF, BMI, and HRQOL suggest that people with CHHF need management of CHHF in order to improve HRQOL, and one of the ways to improve the HRQOL is to avoid low BMI.
In conclusion, this study elucidated the distribution of cold hypersensitivity among Korean adults by body part and sex and also demonstrated a clear negative correlation between BMI and CHHF. Finally, we confirmed that CHHF had an independent negative effect on PCS and MCS, even after adjusting for age, sex, BMI, and sociodemographic variables.
The data that support the findings of this study are available from the Korean medicine Data Center (KDC,
The authors declare that they have no conflicts of interest.
Kwang-Ho Bae conceived the study design and drafted the manuscript. Su-Jung Kim, Youngseop Lee, and Ho-Yeon Go analysed the questionnaire data and helped with interpretation of the data. Si-woo Lee participated in the design of the study, assisted with the previous study, and reviewed this manuscript. All of the authors contributed to the final manuscript and approved the final version.
This study was supported by grants from the Korea Institute of Oriental Medicine (K18902 and KSN1713092).