Epidemiology and Health

Systematic Review

Effectiveness of community-based interventions for older adults living alone: a systematic review and meta-analysis: Inhye Kim, Hyunseo An, Sohyeon Yun, Hae Yean Park; Epidemiol Health. 2024;46:e2024013. Published online January 3, 2024; DOI: https://doi.org/10.4178/epih.e2024013

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study examined the effectiveness of community-based interventions designed for older adults living alone through a systematic review and meta-analysis.
METHODS
The study incorporated 4 randomized controlled trials (RCTs) and 5 non-RCTs to evaluate various interventions. The methodological quality of these studies was assessed using the Downs and Black checklist, while Q-statistic and I-square tests were performed to examine statistical heterogeneity. Additionally, visual inspection of funnel plots and the trim-and-fill method were employed to investigate potential publication bias. Of the 2,729 identified studies, 9 met the criteria for inclusion in this review. Independent variables were categorized into 5 groups (physical activity, nutrition, social relationships, social participation, and combined intervention) to examine their effects. Dependent variables were similarly classified into 5 subgroups to identify the specific effects of the interventions.
RESULTS
Interventions focusing on nutrition and combined approaches were the most effective, yielding effect sizes of 0.96 (95% confidence interval [CI], 0.66 to 1.25) and 0.43 (95% CI, 0.26 to 0.60), respectively. The interventions had the greatest impacts on the health behavior and mental health of the participants, with effect sizes of 0.98 (95% CI, 0.73 to 1.22) for health behavior and 0.67 (95% CI, 0.19 to 1.16) for mental health.
CONCLUSIONS
This study suggests a direction for the development of community-based interventions tailored to the needs of older adults living alone. Additionally, it provides evidence to inform policy decisions concerning this demographic.; Summary

Korean summary
본 연구는 독거 노인들 대상으로 한 지역사회 기반 중재의 효과에 대하여 탐색하고 그 효과 크기를 확인하기 위하여 체계적고찰 및 메타분석을 실시하였다. 영양 및 복합 중재가 특히 효과적이었으며, 이는 건강 행동과 정신건강에 있어 중요한 긍정적 효과를 나타내어 추후 개별적 맞춤 중재의 잠재적 효과성을 나타낸다. 이러한 발견은 독거노인 집단의 웰빙 향상을 위한 프로그램과 정책 입안에 근거로 활용될 수 있다.

Key Message
This systematic review and meta-analysis evaluated the impact of community-based interventions for older adults living alone, incorporating 9 studies to assess effectiveness in areas like nutrition and combined strategies. Results indicated significant benefits, particularly in health behavior and mental health, demonstrating the potential of tailored interventions. These findings support the development of targeted programs and policy decisions aimed at improving the well-being of this demographic.

Original Articles

Identifying pregnancy episodes and estimating the last menstrual period using an administrative database in Korea: an application to patients with systemic lupus erythematosus: Yu-Seon Jung, Yeo-Jin Song, Jihyun Keum, Ju Won Lee, Eun Jin Jang, Soo-Kyung Cho, Yoon-Kyoung Sung, Sun-Young Jung; Epidemiol Health. 2024;46:e2024012. Published online December 19, 2023; DOI: https://doi.org/10.4178/epih.e2024012

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study developed an algorithm for identifying pregnancy episodes and estimating the last menstrual period (LMP) in an administrative claims database and applied it to investigate the use of pregnancy-incompatible immunosuppressants among pregnant women with systemic lupus erythematosus (SLE).
METHODS
An algorithm was developed and applied to a nationwide claims database in Korea. Pregnancy episodes were identified using a hierarchy of pregnancy outcomes and clinically plausible periods for subsequent episodes. The LMP was estimated using preterm delivery, sonography, and abortion procedure codes. Otherwise, outcome-specific estimates were applied, assigning a fixed gestational age to the corresponding pregnancy outcome. The algorithm was used to examine the prevalence of pregnancies and utilization of pregnancy-incompatible immunosuppressants (cyclophosphamide [CYC]/mycophenolate mofetil [MMF]/methotrexate [MTX]) and non-steroidal anti-inflammatory drugs (NSAIDs) during pregnancy in SLE patients.
RESULTS
The pregnancy outcomes identified in SLE patients included live births (67%), stillbirths (2%), and abortions (31%). The LMP was mostly estimated with outcome-specific estimates for full-term births (92.3%) and using sonography procedure codes (54.7%) and preterm delivery diagnosis codes (37.9%) for preterm births. The use of CYC/MMF/MTX decreased from 7.6% during preconception to 0.2% at the end of pregnancy. CYC/MMF/MTX use was observed in 3.6% of women within 3 months preconception and 2.5% during 0-7 weeks of pregnancy.
CONCLUSIONS
This study presents the first pregnancy algorithm using a Korean administrative claims database. Although further validation is necessary, this study provides a foundation for evaluating the safety of medications during pregnancy using secondary databases in Korea, especially for rare diseases.; Summary

Korean summary
임산부의 약물 사용 안전성에 대한 근거 제공을 위해 실제 인구집단에서의 임신 중 약물 치료 안전성을 평가하는 청구자료 기반 연구가 중요하다. 본 연구에서는 국내 청구자료에 적용할 수 있는 임신 정의 및 임신 결과 조작적 정의 알고리즘을 개발하였다. 본 알고리즘은 임신 결과 간의 우선순위를 고려한 계층 구조를 활용하며, 조기 분만 및 초음파 검사 코드 등을 통해 최종 월경 기간을 추정하였다. 또한 알고리즘을 전신홍반루푸스 환자에 적용하여 유산, 사산 등의 유병률을 산출하고 임신 중 잠재적으로 부적절한 면역억제제 사용을 파악하여 국내 청구자료의 특성을 고려한 임신 중 약물 사용 연구의 기반을 마련하였다.

Key Message
Limited safety data for pregnant women prompted recent studies on medication during pregnancy using real-world databases. This study developed a tailored algorithm for Korean healthcare claims database, employing a hierarchy of pregnancy outcomes and incorporating pre-term delivery and sonography codes for last menstrual period estimation. Applied to systemic lupus erythematosus (SLE) patients, this study presented the prevalence and drug utilization pattern of pregnancy-incompatible immunosuppressants from preconception to pregnancy end, laying a foundation for further claims database studies on medication pregnancy safety.

Decrease in household secondhand smoking among Korean adolescents associated with smoke-free policies: grade-period-cohort and interrupted time series analyses: Hana Kim, Heewon Kang, Sung-il Cho; Epidemiol Health. 2024;46:e2024009. Published online December 13, 2023; DOI: https://doi.org/10.4178/epih.e2024009

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Smoke-free areas have expanded and related campaigns have been implemented since 1995 in Korea. As a result, household secondhand smoke (SHS) exposure has decreased over the past 15 years. We assessed the cohort effect, the effect of a 2008 campaign on household SHS exposure, and the impact of a complete smoking ban in public places along with increased penalties, as implemented in December 2011.
METHODS
Nationally representative cross-sectional 15-wave survey data of Korean adolescents were used. The 810,516 participants were classified into 6 grade groups, 15 period groups, and 20 middle school admission cohorts. An age-period-cohort analysis, conducted with the intrinsic estimator method, was used to assess the cohort effect of household SHS exposure, and interrupted-time series analyses were conducted to evaluate the effects of the smoke-free policy and the campaign.
RESULTS
For cohorts who entered middle school from 2002 to 2008, the risk of household SHS exposure decreased among both boys and girls. Immediately after implementation of the smoke-free policy, the prevalence of household SHS exposure by period decreased significantly for boys (coefficient, -8.96; p<0.05) and non-significantly for girls (coefficient, -6.99; p=0.07). After the campaign, there was a significant decrease in household SHS exposure by cohort among boys, both immediately and post-intervention (coefficient, -4.84; p=0.03; coefficient, -1.22; p=0.02, respectively).
CONCLUSIONS
A school-admission-cohort effect was found on household SHS exposure among adolescents, which was associated with the smoke-free policy and the campaign. Anti-smoking interventions should be implemented consistently and simultaneously.; Summary

Korean summary
지난 15년 동안 한국 청소년의 가정 내 간접흡연 노출은 감소했다. 가정 내 간접흡연 노출에 대하여 중학교 입학 코호트 효과가 존재하였다. 또한, 청소년의 가정 내 간접흡연 노출 감소는 2011년 12월 공공장소에서의 금연구역 규제와 2008년 시행된 캠페인과 연관되어 있었다.

Key Message
Household secondhand smoke (SHS) exposure among Korean adolescents has decreased over the past 15 years. There was a school admission cohort effect on household SHS exposure. A complete smoking ban in public space with increased penalties in December 2011 and a campaign in 2008 to avoid SHS exposure were associated with reduced household SHS exposure among adolescents.

Folate, vitamin B12, and homocysteine status in the Korean population: data from the 2013-2015 Korea National Health and Nutrition Examination Survey: Sihan Song, Bo Mi Song, Hyun-Young Park; Epidemiol Health. 2024;46:e2024007. Published online December 11, 2023; DOI: https://doi.org/10.4178/epih.e2024007

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
We aimed to assess the serum folate, vitamin B12, and homocysteine status in Korean adolescents and adults using national data.
METHODS
Blood samples were collected from participants aged ≥10 years in the Korea National Health and Nutrition Examination Survey 2013-2015. The stored serum samples were used to measure folate, vitamin B12, and homocysteine concentrations. A total of 8,016 participants were included in this analysis. Unweighted descriptive statistics and adjusted geometric means of the B vitamins and homocysteine concentrations were estimated.
RESULTS
Females had higher serum folate and vitamin B12 concentrations and lower serum homocysteine concentrations than males. Folate deficiency (<6.8 nmol/L) and hyperhomocysteinemia (>15 μmol/L) were found in 8.6% and 11.8% of males, respectively. Approximately 3% of males had low or marginally low vitamin B12 status (≤221 pmol/L). Folate and vitamin B12 deficiencies and hyperhomocysteinemia were found in <2% of females. Suboptimal folate status was prevalent among adolescents and young adults, while suboptimal vitamin B12 status and hyperhomocysteinemia were relatively higher in older adults. Adjusted mean homocysteine concentrations were sharply decreased from the first to second decile of serum folate in males.
CONCLUSIONS
In the Korean population, the proportion of males who achieved desirable folate and homocysteine concentrations were lower than those of females. Although most Koreans have adequate vitamin B12, a suboptimal folate status is common, particularly among adolescents and young adults. These findings could establish a foundation for public health initiatives aimed at improving folate levels in the Korean population.; Summary

Korean summary
엽산과 비타민B12는 전 생애에 걸쳐 건강에 영향을 미치는 필수 비타민이다. 그러나 해당 비타민 상태에 대한 국내 자료는 부족한 실정이다. 본 연구는 국민건강영양조사 참여자로부터 수집된 혈청으로부터 엽산, 비타민B12, 그리고 이들의 기능성 지표인 호모시스테인 농도를 측정하였고 성별과 연령별 분포와 적합 상태를 평가하였다. 엽산 결핍과 고호모시스테인혈증은 남성에서 높은 유병률을 가졌다. 적정 엽산 상태를 충족하지 못하는 비율은 청소년과 젊은 성인에서 흔하게 관찰되었다. 대부분의 한국인은 충분한 비타민B12 수준을 가졌으나, 노인의 경우 정기적인 평가가 필요하다. 본 연구는 한국인이 최적의 엽산과 비타민B12 상태를 유지하기 위한 기반적 근거를 제공한다.

Key Message
Folate and vitamin B12 have significant health impacts throughout the life cycle. However, national-level data on B vitamins in Korea are limited. Serum folate, vitamin B12, and homocysteine concentrations were measured from samples stored during the national survey. In our study, the proportions of folate deficiency and hyperhomocysteinemia were higher in men than in women.Suboptimal folate status was common among adolescents and young adults. Most Koreans had adequate levels of vitamin B12; however, regular monitoring is warranted, especially in the older population. The current data provide a future direction for achieving optimal B vitamin status in the Korean population.

Food literacy and its relationship with food intake: a comparison between adults and older adults using 2021 Seoul Food Survey data: Seulgi Lee, Sohyun Park, Kirang Kim; Epidemiol Health. 2023;45:e2023062. Published online July 3, 2023; DOI: https://doi.org/10.4178/epih.e2023062

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Abstract Summary PDF

Abstract

OBJECTIVES
This study was conducted to examine the differences in food literacy between adults and older adults and the association of food literacy with food group intake.

METHODS

In total, 4,039 participants from the 2021 Survey for Food Consumption in Seoul were included in this study. The intake of whole grains, high-protein foods, total vegetables, vegetables excluding kimchi and pickles, fresh fruits, and milk and dairy products was assessed using a simple food frequency questionnaire. Food literacy was measured using a food literacy measurement questionnaire.

RESULTS

With the exception of milk and dairy, adults had a significantly higher proportion of insufficient food intake than older adults (p<0.001). Both adults and older adults with sufficient food group consumption had higher food literacy scores. Notably, the difference in food literacy scores by level of food intake was highest for fresh fruits (p<0.001). After adjusting for confounding factors affecting food literacy scores, a higher score was associated with a lower probability of having insufficient food intake in all food groups for both adults and older adults. Specifically, those in the highest food literacy score quartile were less likely to have insufficient intake of vegetables (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.28 to 0.43) and fresh fruits (OR, 0.32; 95% CI, 0.24 to 0.43), compared to the lowest quartile.

CONCLUSIONS

Improving food literacy is an important factor for promoting healthy food intake in older adults as well as adults. Therefore, it is necessary to develop intervention programs to work toward this goal.

Summary

Korean summary
건강정보 이해능력(health literacy)은 노인에서 만성질환이나 인지능력과의 관련성이 보고되고 있으나 영양정보 이해능력(food literacy)에 대한 연구는 미비하다. 급변하는 식이 환경에서 식사 및 영양과 관련된 정보를 올바르게 이해하고 판단할 수 있는 영양정보 이해능력은 노인성 질환 예방에 중요하다. 본 연구에서 영양정보 이해능력과 식품군 섭취와의 상관성을 분석한 결과 영양정보 이해능력이 높은 노인이 건강한 식품 섭취 부족 위험이 낮았다. 특히 과일 섭취 부족 위험은 영양정보 이해능력이 높은 노인에서 뚜렷하게 낮았다. 국내 영양정보 이해능력 연구는 초기 단계로 주로 성인 대상으로 연구가 이루어져서 본 연구에서의 결과는 그 의의가 크며, 영양정보 이해능력 향상은 성인과 마찬가지로 노인에서도 건강한 식품 섭취를 위한 중요한 요인으로서 이를 위한 프로그램 개발이 필요할 것으로 사료된다.

Key Message
The study on food literacy among older adults in Korea is significant as previous research has mostly focused on adults. The results showed that older adults with higher food literacy score had lower risk of insufficient food intake as compared with those with lower food literacy score. Specifically, the risk of insufficient fresh fruits intake was the lowest among older adults with higher food literacy score. Therefore, improving food literacy is an important factor for promoting healthy food consumption among older adults.

Citations

Citations to this article as recorded by

Self-perceived food literacy in relation to the quality of overall diet and main meals: A cross-sectional study in Japanese adults
Kentaro Murakami, Nana Shinozaki, Tsuyoshi Okuhara, Tracy A. McCaffrey, M. Barbara E. Livingstone
Appetite.2024; 196: 107281. CrossRef

Non-linear relationship between body mass index and self-rated health in older Korean adults: body image and sex considerations: Seok-Joon Yoon, Jin-Gyu Jung, Soon-Ki Ahn, Jong-Sung Kim, Jang-Hee Hong; Epidemiol Health. 2023;45:e2023061. Published online June 20, 2023; DOI: https://doi.org/10.4178/epih.e2023061

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
The purpose of this study was to investigate the association between body mass index (BMI) and self-rated health (SRH) in older adults aged over 65 years while examining the influence of self-perceived body image (SBI) and sex.
METHODS
Raw data were obtained from the Korea Community Health Survey, which included BMI measurements of Koreans aged over 65 years (n=59,628). Non-linear relationships between BMI and SRH were analyzed separately for each sex using restricted cubic splines while controlling for SBI and other confounding variables.
RESULTS
Men showed a reverse J-shaped association, while women showed a J-shaped association between BMI and poor SRH. However, including SBI in the model changed this association for men to an inverted U-shape showing a negative direction, with the highest risk of poor SRH observed in the underweight to overweight range. For women, a nearly linear positive relationship was observed. Regardless of BMI, those who perceived their weight as not “exactly the right weight” had a higher risk of poor SRH than those who perceived their weight as “exactly the right weight” in both men and women. Older men who thought they were much too fat or too thin had similar highest risks of poor SRH, whereas older women who thought they were too thin had the highest risk of poor SRH.
CONCLUSIONS
The findings of this study emphasize the importance of considering sex and body image perceptions when assessing the relationship between BMI and SRH in older adults, especially in men.; Summary

Korean summary
자가 평가 건강 상태 (self-rated health, SRH)와 체질량지수는 각각 건강에 많은 관련이 있는 것으로 밝혀져 있다. 하지만 둘 사이의 관계는 연구마다 다양하게 나타나 있고, 노인들을 대상으로 한 연구도 많지 않다. 노인들은 본인들의 체중을 낮게 평가하는 경향이 있어 둘 사이 관계를 살펴볼 때 자기 인지 체형에 대한 고려가 필요하며, 성별에 따른 영향도 역시 고려해봐야 한다. 본 연구에서는 체질량지수로 파악한 비만의 정도에 관계없이 남성과 여성 모두에서 자기 인지 체형이 정상인 경우에 좋지 않은 SRH를 가질 위험성이 낮았다. 남성에서는 체질량지수와 SRH의 관계가 불분명하게 나타났고 자기 인지 체형이 더 중요한 요인으로 보인다. 한편 여성에서는 체질량지수가 증가함에 따라 SRH도 나빠지는 경향을 보였다. 이에 노인들의 비만과 관련된 교육에 있어서는 자가 인지 체형과 체질량지수를 이용한 비만의 기준에 대해 포함하는 것이 중요하다.

Key Message
Previous research has not fully explored the relationship between BMI, SBI, and SRH in older adults. Our study, using big data, found that the relationships differed between men and women. Those who perceived their weight as ‘exactly the right weight’ had the lowest risk of poor SRH. In men, BMI had a weak effect on SRH, while in women, the risk of poor SRH increased as BMI increased. We recommend that healthcare providers should educate older adults about BMI standards and help them identify their SBI for effective obesity counseling.

A comparison of methods for the measurement of adherence to antihypertensive multidrug therapy and the clinical consequences: a retrospective cohort study using the Korean nationwide claims database: Minji Jung, Eunjung Choo, Sukhyang Lee; Epidemiol Health. 2023;45:e2023050. Published online May 1, 2023; DOI: https://doi.org/10.4178/epih.e2023050

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
In observational studies, the methods used to measure medication adherence may affect assessments of the clinical outcomes of drug therapy. This study estimated medication adherence to multidrug therapy in patients with hypertension using different measurement methods and compared their impacts on clinical outcomes.
METHODS
This was a retrospective cohort study using the Korean National Health Insurance Service–National Sample Cohort database (2006-2015). Adults diagnosed with hypertension who initiated multidrug antihypertensive therapy in the index year 2007 were included. Adherence was defined as over 80% compliance. Adherence to multidrug antihypertensive therapy was measured in 3 ways using the proportion of days covered (PDC) with 2 approaches to the end-date of the study observations: PDC with at least one drug (PDC<sub>with≥1</sub>), PDC with a duration weighted mean (PDC<sub>wm</sub>), and the daily polypharmacy possession ratio (DPPR). The primary clinical outcome was a composite of cardiovascular and cerebrovascular disease-specific hospitalizations or all-cause mortality.
RESULTS
In total, 4,226 patients who initiated multidrug therapy for hypertension were identified. The mean adherence according to the predefined measurements varied from 72.7% to 79.8%. Non-adherence was associated with an increased risk of a primary outcome. The hazard ratios (95% confidence intervals, CIs) primary outcomes varied from 1.38 (95% CI, 1.19 to 1.59) to 1.44 (95% CI, 1.25 to 1.67).
CONCLUSIONS
Non-adherence to multidrug antihypertensive therapy was significantly associated with an increased risk of a primary clinical outcome. Across the varying estimates based on different methods, medication adherence levels were similar. These findings may provide evidence to support decision-making when assessing medication adherence.; Summary

Korean summary
- 여섯 가지 다중약물 순응도 평가 방법을 적용했을 때, 고혈압제 병용 요법 순응도는 70~80%으로 유사한 결과값을 보였다. - 순응군 대비 비순응군에서 심혈관질환 관련 입원 및 전체 사망 위험 증가가 1.4배 높았다.

Key Message
-In Korea, adherence to multidrug antihypertensive therapy was approximately 70~80% across the six measurements. -Similar impacts of adherence to multidrug antihypertensive therapy upon the clinical consequences with a 4-folds increased risk across the six measurements. -We provide evidence for decision-making of applying adherence measurement in observational analysis.

Impaired pulmonary function mediates the impact of preterm birth on later-life stroke: a 2-step, multivariable Mendelian randomization study: Xingzhi Guo, Peng Tang, Chen Hou, Yue Liu, Rui Li; Epidemiol Health. 2023;45:e2023031. Published online March 3, 2023; DOI: https://doi.org/10.4178/epih.e2023031

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Observational studies have suggested an association between preterm birth and stroke in late adulthood, but it remains unclear whether the association is causal. The purpose of this study was to evaluate the causal effects of gestational age on stroke and to determine the pathophysiological mechanisms underlying the causal associations.

METHODS

Two-sample Mendelian randomization (MR) was performed to assess the causal effects of fetal gestational duration, early preterm birth (EPB), preterm birth, or postterm birth on stroke and its subtypes. Two-step Mendelian randomization (TSMR) and multivariable Mendelian randomization (MVMR) were additionally used to determine the role of common stroke risk factors, including cardiovascular diseases, hypertension, pulmonary impairment, inflammation, and metabolic diseases, in mediating the causal associations between gestational age and stroke and its subtypes.

RESULTS

Genetically predicted EPB increased the risk of cardioembolic stroke (CES; odds ratio [OR], 1.115; 95% confidence interval [CI], 1.036 to 1.200; p=0.004) and large artery stroke (LAS; OR, 1.131; 95% CI, 1.031 to 1.241; p=0.009). The TSMR results showed that EPB was associated with a lower forced expiratory volume in the first second and forced vital capacity ratio (FEV1/FVC) (β=-0.020; 95% CI, -0.035 to -0.005; p=0.009), which increased the risk of CES and LAS. Further MVMR analysis showed that the associations between EPB and stroke disappeared after adjustment for FEV1/FVC.

CONCLUSIONS

Our data demonstrate that EPB is causally associated with an elevated risk of CES and LAS, and that pulmonary dysfunction mediates the causal impact of EPB on CES and LAS.

Summary

Key Message
Genetically predicted early preterm birth (EPB) is significantly associated with an increased risk of cardioembolic stroke (CES) and large artery stroke (LAS). Further multivariable Mendelian randomization analysis demonstrates that pulmonary impairment mediates the causal impact of EPB on CES and LAS in adulthood.

Citations

Citations to this article as recorded by

Causal associations of circulating Helicobacter pylori antibodies with stroke and the mediating role of inflammation
Xingzhi Guo, Peng Tang, Xin Zhang, Rui Li
Inflammation Research.2023; 72(6): 1193. CrossRef
Methodological approaches, challenges, and opportunities in the application of Mendelian randomisation to lifecourse epidemiology: A systematic literature review
Grace M. Power, Eleanor Sanderson, Panagiota Pagoni, Abigail Fraser, Tim Morris, Claire Prince, Timothy M. Frayling, Jon Heron, Tom G. Richardson, Rebecca Richmond, Jessica Tyrrell, Nicole Warrington, George Davey Smith, Laura D. Howe, Kate M. Tilling
European Journal of Epidemiology.2023;[Epub] CrossRef

Clinical traits and systemic risks of familial diabetes mellitus according to age of onset and quantity: an analysis of data from the community-based KoGES cohort study: Ju-Yeun Lee, Kyungsik Kim, Sangjun Lee, Woo Ju An, Sue K. Park; Epidemiol Health. 2023;45:e2023029. Published online February 23, 2023; DOI: https://doi.org/10.4178/epih.e2023029

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
The aim of this study was to clarify the clinical trait of familial diabetes mellitus (DM) by analyzing participants’ risk of DM according to the age of DM onset in parents and siblings, and to evaluate individuals’ risk of DM-associated cardiometabolic diseases.
METHODS
Altogether, 211,173 participants aged ≥40 years from the Korean Genome and Epidemiology Study were included in this study. The participants were divided into groups based on the number (1 or 2 relatives) and age of onset (no DM and early, common, or late onset) of familial DM. Participants’ risk of DM was assessed using a Cox regression model with hazard ratios and 95% confidence intervals (CIs). A logistic regression model with odds ratios was used to evaluate associations among the participants’ likelihood of acquiring cardiometabolic diseases such as hypertension, chronic kidney disease (CKD), and cardiovascular disease.
RESULTS
The risk of developing DM was 2.02-fold (95% CI, 1.88 to 2.18) and 2.88-fold (95% CI, 2.50 to 3.33) higher, respectively, in participants with 1 and 2 family members diagnosed with familial DM. It was 2.72-fold (95% CI, 2.03 to 3.66) higher in those with early-onset familial DM. In the early-onset group, the respective risks of hypertension and CKD were 1.87-fold (95% CI, 1.37 to 2.55) and 4.31-fold (95% CI, 2.55 to 7.27) higher than in the control group.
CONCLUSIONS
The risk of DM and related cardiometabolic diseases was positively associated with the number of family members diagnosed with DM and an early diagnosis in family members with DM.; Summary

Korean summary
본 연구는 한국인유전체역학조사사업 역학자료를 이용하여, 당뇨병을 진단받은 가족 구성원 (부모 및 형제)의 수가 많고 당뇨병이 조기에 발생할수록 개인의 당뇨발생 위험도가 높아짐을 보고하였습니다. 또한 당뇨병이 조기에 발생한 가족구성원이 있을 경우 개인의 일부 심대사질환과의 연관성이 있을 수 있음을 설명하였습니다.

Key Message
This study demonstrated that the risk of diabetes in individuals was significantly associated with the quantity and the onset of family members diagnosed with diabetes. We also explained that having a family member with early-onset diabetes can be associated with some cardiometabolic diseases in individuals.

COVID-19: Brief Communication

Prevalence of SARS-CoV-2 infection among urban cleaning and solid waste management workers during transmission of the Omicron variant in Brazil: Paulo Ricardo Martins-Filho, Joyce Thayane da Conceição dos Santos, Márcia Santos Rezende, Fernanda Oliveira de Carvalho, Érica Santos dos Reis, Waneska de Souza Barboza, Taise Ferreira Cavalcante, Cliomar Alves dos Santos, Lucindo José Quintans-Júnior, Renata Grespan, Cristiane Bani Corrêa, Tatiana Rodrigues de Moura, Dulce Marta Schimieguel, Jullyana de Souza Siqueira Quintans, Adriano Antunes de Souza Araújo; Epidemiol Health. 2023;45:e2023025. Published online February 16, 2023; DOI: https://doi.org/10.4178/epih.e2023025

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Abstract Summary PDF: Abstract
This study estimated the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in urban cleaning and solid waste management workers during the transmission of the Omicron variant in one of the poorest regions of Brazil (the state of Sergipe). Nasopharyngeal swabs were collected from 494 workers, and the presence of SARS-CoV-2 RNA was tested by quantitative reverse-transcriptase polymerase chain reaction. Data on socio-demographic characteristics, comorbidities, vaccination status, mask use, and use of public transport to commute to the workplace were collected. The prevalence with a 95% confidence interval (CI) was calculated from the proportion of SARS-CoV-2 positive cases among the total number of individuals tested. The prevalence ratio (PR) with a 95% CI was the measure of association used to evaluate the relationship between SARS-CoV-2 infection and the exposure variables. The prevalence of SARS-CoV-2 infection was 22.5% (95% CI, 19.0 to 26.4). Individuals under the age of 40 had a higher prevalence of infection (PR, 1.53; 95% CI, 1.03 to 2.30) as well as those who did not believe in the protective effect of vaccines (PR, 1.78; 95% CI, 1.05 to 2.89). Our results indicate the need for better guidance on preventive measures against coronavirus disease 2019 among urban cleaning and solid waste management workers.; Summary

Key Message
Urban cleaning and waste management workers in Brazil faced a significant risk of SARSCoV-2 infection during the Omicron variant transmission, with higher rates observed among younger individuals and those skeptical about vaccine protection.

Original Articles

Health-adjusted life expectancy according to lifestyle classified by the Yonsei Lifestyle Profile-BREF: Sanghun Nam, Kang-Hyun Park, Ji-Hyuk Park, Ickpyo Hong; Epidemiol Health. 2022;44:e2022095. Published online October 28, 2022; DOI: https://doi.org/10.4178/epih.e2022095

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study aimed to investigate health-adjusted life expectancy (HALE) by demographic characteristics (sex, educational achievement, and residential area) according to the lifestyle classifications of the Yonsei Lifestyle Profile-BREF (YLP-BREF).
METHODS
This study included 569 participants aged 55 years or older living in Korea. The YLP-BREF domains were physical activity, activity participation, and nutrition.
RESULTS
Females had a longer HALE (mean±standard deviation, 8.90±5.06 years) in the physical activity domain, while males had a longer HALE in the nutrition domain (9.44±5.91 years). People living in rural areas had longer HALE in physical activity (12.02±5.60 years), activity participation (8.58±4.21 years), and nutrition (11.33±6.43 years). There were no significant differences according to sex or residential area. High school graduates showed the longest HALE (physical activity: 10.38± 6.89; activity participation: 7.64±4.29; nutrition: 9.59±6.40 years). There was a significant difference in educational achievement.
CONCLUSIONS
As people age, the demand for a healthy lifestyle increases. This study attempted to calculate HALE by demographic characteristics according to lifestyle. The results of this study will help inform future research directions for providing a healthy lifestyle.; Summary

Korean summary
본 연구는 Yonsei Lifestyle Profile-BREF(YLP-BREF)의 라이프스타일 분류에 따른 인구통계학적 특성(성별, 주거지역, 학력)에 따른 건강조정수명(Health-Adjusted Life Expectancy; HALE)을 알아보고자 하였다. 본 연구에서 사용한 자료는 한국에 거주하는 55세 이상의 569명이 포함되었으며, YLP-BREF는 신체활동, 활동참여, 영양으로 총 세 영역으로 구성되어 있다. 본 연구 결과, 성별에 따른 건강조정수명은 영양에서 9.44세로 남성이 가장 높았으며, 거주지역은 따른 건강조정수명은 신체활동 영역에서 농촌이 12.02세로 가장높았고, 학력에 따른 건강조정수명은 신체활동 영역에서 고등학교 졸업자가 10.38세로 가장 높았다. 본 연구 결과는 건강한 라이프스타일을 인구통계학적 특성에 따라 제공하기 위한 향후 연구 방향을 제시하는 데 도움이 될 것으로 사료된다.

Key Message
This study investigated Health-Adjusted Life Expectancy (HALE) according to demographic characteristics (sex, residence, educational achievement) according to lifestyle classification of Yonsei Lifestyle Profile-BREF. As a result of this study, the HALE by gender was the highest in nutrition at 9.44 years, and the HALE by residential area was the highest in physical activity at 12.02 years in rural areas, and the HALE by education was in physical activity. , high school graduates had the highest age at 10.38. The results of this study are considered to be helpful in suggesting future research directions for providing a healthy lifestyle.

The associations of the national health and productivity management program with corporate profits in Japan: Yuichiro Yano, Hiroshi Kanegae, Koichi Node, Atsushi Mizuno, Akira Nishiyama, Hiromi Rakugi, Hiroshi Itoh, Kaori Kitaoka, Naoki Kashihara, Fumiaki Ikeno, Ichiro Tsuji, Kunio Okada; Epidemiol Health. 2022;44:e2022080. Published online September 23, 2022; DOI: https://doi.org/10.4178/epih.e2022080

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Using a dataset from a survey on national health and productivity management, we identified health and productivity factors associated with organizational profitability.

METHODS

The Ministry of Economy, Trade and Industry conducted an annual survey on Health and Productivity Management between 2014 and 2021. We assessed the associations of organizational health and productivity management using survey questions collected in 2017 and 2018, with the rate of change in profits from 2017 and 2018 to 2020. We identified factors associated with organizational profitability using eXtreme Gradient Boosting, and calculated SHapley Additive exPlanation (SHAP) values for each factor.

RESULTS

Among 1,593 companies (n= 4,359,834 employees), the mean age of employees at baseline was 40.3 years and the proportion of women was 25.8%. A confusion matrix for evaluating model performance had an accuracy of 0.997, precision of 0.993, recall of 0.997, and area under the precision-recall curve of 0.999. The most important factors related to an increase in corporate profits were the percentage of current smokers (SHAP value, 0.121), per-employee cost of health services (0.084) and medical services (0.050); the percentage of full-time employees working in sales departments (0.074) and distribution or customer service departments (0.054); the percentage of employees who slept well (0.055); and the percentage of employees within a company who regularly exercised (0.043).

CONCLUSIONS

Employees’ lifestyle-related health risk factors and organizations’ management systems were associated with organizational profitability. Lifestyle medicine professionals may demonstrate a significant return on investment by creating a healthier and more productive workforce.

Summary

Key Message
Lifestyle medicine professionals may demonstrate a significant return on investment by creating a healthier and more productive workforce

Citations

Citations to this article as recorded by

Role and Value of the Corporate Medical Director
Gregg M. Stave, Wayne N. Burton, Richard J.L. Heron, T. Warner Hudson, J. Brent Pawlecki, David Roomes, Martin J. Sepulveda, Michael Rendel, Pamela A. Hymel
Journal of Occupational & Environmental Medicine.2023; 65(12): e797. CrossRef

Systematic Review

The prevalence of functional disability and its impact on older adults in the ASEAN region: a systematic review and meta-analysis: Phei Nie Yau, Clairen Jia Ern Foo, Nicholas Li Jie Cheah, Kar Foong Tang, Shaun Wen Huey Lee; Epidemiol Health. 2022;44:e2022058. Published online July 12, 2022; DOI: https://doi.org/10.4178/epih.e2022058

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Functional disability is a common consequence of the ageing process and can lead to poor health outcomes due to the inability to perform activities of daily living (ADL) and instrumental activities of daily living (IADL) independently. However, the prevalence of functional disability among older adults in the Association of Southeast Asian Nations (ASEAN) region is poorly documented. This study aimed to assess the prevalence of functional disability and its impact on older adults in the ASEAN region.

METHODS

A systematic literature search was performed on 4 databases from inception until March 2021 to identify studies examining individuals aged 60 years and above reporting functional disabilities in the ASEAN region. Information on the prevalence and impact of functional disability was extracted, assessed for bias, summarised, and analysed using a random-effects meta-analysis.

RESULTS

Thirty-four studies with 59,944 participants were included. The pooled prevalence of ADL disability was 21.5% (95% confidence interval [CI], 16.2 to 27.3) and that of IADL disability was 46.8% (95% CI, 35.5 to 58.3). Subgroup analyses showed higher prevalence among those of advanced age and women. Adverse impacts included increased years of life with disability and poor health-related quality of life.

CONCLUSIONS

Nearly a quarter of the older adult population in the ASEAN region experience functional disability. These findings highlight the need for further research on the burden and impact of functional disability within this region to allow decision-makers to gauge the severity of the issue, develop policies to reduce the risk of developing functional disabilities, and foster healthy ageing.

Summary

Key Message
Highly common and disabling among older adults in ASEAN region, functional disability limits the ability to carry out activities of daily living, and markedly reduces life quality.

Citations

Citations to this article as recorded by

Association of objectively measured physical activity with incidence disability in older adults with/without social isolation
Masanori Morikawa, Kenji Harada, Satoshi Kurita, Kazuya Fujii, Chiharu Nishijima, Daisuke Kakita, Hiroyuki Shimada
Archives of Gerontology and Geriatrics.2024; 120: 105338. CrossRef
Sedentary behavior and the combination of physical activity associated with dementia, functional disability, and mortality: A cohort study of 90,471 older adults in Japan
Zhen Du, Koryu Sato, Taishi Tsuji, Katsunori Kondo, Naoki Kondo
Preventive Medicine.2024; 180: 107879. CrossRef
Concentrated disadvantage and functional disability: a longitudinal neighbourhood analysis in 100 US cities
Daniel Semenza, Ian Silver, Richard Stansfield, Courtney Boen
Journal of Epidemiology and Community Health.2023; 77(10): 676. CrossRef
Functional disability and associated factors in older adults seen at a primary health care unit
Paulo José Cortez, Paulo Eduardo Aliaga da Silveira, Beatriz Carvalho, João Vitor Medeiros de Abreu, Yan Lyncon, Gerson Souza Santos, Luciano Magalhães Vitorino
Geriatrics Gerontology and Aging.2023;[Epub] CrossRef
Suitable ultrasound screening method for older adults with disability to identify low muscle mass
Huaying Ding, Xia Lin, Sha Huang, Jie Liao, Zhouyu Li, Lanlan Chen, Li Zhu, Yukuan Xie, Qian Nie, Xiaoyan Chen
Frontiers in Medicine.2023;[Epub] CrossRef
Unmet needs for care for activities of daily living among older adults with functional disabilities in Vietnam
Phong Manh Phi, Long Thanh Giang, Tham Thi Hong Pham
Frontiers in Public Health.2023;[Epub] CrossRef
Frailty but not low muscle quality nor sarcopenia is independently associated with mortality among previously hospitalized older adults: A prospective study
Jarson Pedro da Costa Pereira, Alcides da Silva Diniz, Maria Conceição Chaves de Lemos, Cláudia Porto Sabino Pinho Ramiro, Poliana Coelho Cabral
Geriatrics & Gerontology International.2023; 23(10): 736. CrossRef
A cross-sectional study for assessment of activity of daily living and health-related quality of life among adults with physical disabilities in the Wardha district
Aditi Nath, Dr. Sonali Choudhari
F1000Research.2023; 12: 1565. CrossRef
Mental distress and incident functional disability among a rural ageing population in South Africa
Supa Pengpid, Karl Peltzer
International Journal of Geriatric Psychiatry.2022;[Epub] CrossRef
Bidirectional association between functional disability and multimorbidity among middle-aged and older adults in Thailand
Supa Pengpid, Karl Peltzer, Dararatt Anantanasuwong
Frontiers in Public Health.2022;[Epub] CrossRef

Original Articles

The risk of stroke according to statin medication compliance in older people with chronic periodontitis: an analysis using the Korea National Health Insurance Service-Senior Cohort Database: Seon-Rye Kim, Minkook Son, Yu-Rin Kim; Epidemiol Health. 2022;44:e2022055. Published online July 5, 2022; DOI: https://doi.org/10.4178/epih.e2022055

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We investigated the risk of stroke according to statin medication compliance in older people with chronic periodontitis.

METHODS

Chronic periodontitis patients were extracted from the National Health Insurance Service-Senior Cohort Database from 2002 to 2014. Among 255,056 chronic periodontitis patients, 41,412 patients with statin prescriptions for 28 days or more were included. The study population was divided into the top 25% of medication compliance group (TSG) and the lower 25% of medication compliance group (BSG). After 1:1 propensity score matching was performed, the final number of patients in the BSG and TSG was 6,172 each. To analyze the risk of stroke, a Cox proportional hazard model was performed to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) after adjusting for age, sex, income level, hypertension, diabetes, and Charlson comorbidity index.

RESULTS

In the Kaplan-Meier curve, the disease-free probability was prominently lower in the BSG than in the TSG (p for log-rank= 0.001). The HR in the multivariable-adjusted model for stroke occurrence in the TSG compared to the BSG was 0.79 (95% CI, 0.67 to 0.92; p= 0.002). Subgroup analyses showed significant associations between compliance to statin medication and stroke, especially in female, people 85 years or older, and patients with comorbidities.

CONCLUSIONS

Increasing compliance to statins may reduce stroke risk in older adults with chronic periodontitis. Therefore, in order to increase medication compliance among older people with chronic periodontitis, it is necessary for medical staff to make efforts to provide effective medication guidance.

Summary

Korean summary
만성치주질환을 가진 노인에서 스타틴 복용순응도가 낮은 그룹에 비해 높은 그룹이 뇌졸증 발생위험이 낮았다. 특히 여성과 후기 노인 (85세 이상), 동반 질환을 가진 그룹에서 유의한 차이가 있었다. 따라서 스타틴 복용 순응도를 증대시키기 위한 의료진의 노력이 필요할 것이다.

Key Message
The stroke risk of chronic periodontal disease patients was related to statin medication compliance, and the effect of stroke risk was different in women, the elderly, and comorbidities.

Citations

Citations to this article as recorded by

Association between statin compliance and risk of dementia among patients with chronic periodontitis
Yu‐Rin Kim, Minkook Son, Seon‐Rye Kim
Oral Diseases.2023;[Epub] CrossRef
Impact of statin treatment on cardiovascular events in patients with retinal vein occlusion: a nested case-control study in Korea
Joonsang Yoo, Joo Youn Shin, Jimin Jeon, Jinkwon Kim
Epidemiology and Health.2023; 45: e2023035. CrossRef

The vaccination coverage rate in under-5 children in Nasiriyah, Iraq before and during the COVID-19 pandemic: Ali Rifaat Alhaddad, Elham Ahmadnezhad, Akbar Fotouhi; Epidemiol Health. 2022;44:e2022035. Published online March 14, 2022; DOI: https://doi.org/10.4178/epih.e2022035

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Abstract Summary PDF

Abstract

providOBJECTIVES: This study compared the vaccination coverage rate (VCR) in children under 5 years old in Nasiriyah, Iraq before and during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

This cross-sectional study was conducted in the city of Nasiriyah in southeastern Iraq, with data collected from 79 primary healthcare facilities. This study evaluated the VCR in 3 periods (2018, 2019, and 2020) using multi-level random sampling. Pertinent data were extracted from the vaccination records of 598 children for Bacillus Calmette-Guérin (BCG); pentavalent 1, 2, and 3; measles; and activated oral poliovirus vaccine 1 and 2. Missing data were completed by telephone calls to participants’ parents. Logistic regression was applied to compare and estimate the odds ratios (ORs) with 95% confidence intervals (CIs) for the association between VCR and related factors.

RESULTS

The data showed the greatest decline in the studied vaccines in 2020. Among the vaccines studied, BCG had the highest rate in all 3 periods (100% VCR) and measles had the lowest rate (83.7%), reaching 63.6% in 2020 (p<0.001). The highest OR among all types of vaccine were found for the pentavalent-3 vaccine among city dwellers and those born in 2020 (OR, 2.67; 95% CI, 1.39 to 5.10 and OR, 2.34; 95% CI, 1.28 to 4.28, respectively).

CONCLUSIONS

The VCR for children decreased during the COVID-19 pandemic in Iraq, and new health policies are needed to increase the coverage rate. Improving the knowledge and attitudes of parents, as well as removing barriers or risk factors, can also be effective in improving the VCR.

Summary

Key Message
Vaccination is one of the most important essential health services. COVID-19 pandemic has reduced the coverage of vaccination among under five.

Citations

Citations to this article as recorded by

Current Impact and Long-Term Influence of the COVID-19 Pandemic on Iraqi Healthcare Systems: A Case Study
Taysir Al Janabi, Sunny Chung
Epidemiologia.2022; 3(4): 412. CrossRef
Dropout of Vaccination Among Iraqi Children
Maha. A. Kadim, Anees Flayyih Abdulhasan, Zainab Abdulameer Abdulrasol, Ali Fadhil Obaid
South Asian Journal of Social Sciences and Humanities.2022; 3(6): 163. CrossRef

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