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Original Articles
Exploring cognitive trajectories and their association with physical performance: evidence from the China Health and Retirement Longitudinal Study
Jingdong Suo, Xianlei Shen, Jinyu He, Haoran Sun, Yu Shi, Rongxin He, Xiao Zhang, Xijie Wang, Yuandi Xi, Wannian Liang
Epidemiol Health. 2023;45:e2023064.   Published online July 9, 2023
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AbstractAbstract AbstractSummary PDF
The long-term trends of cognitive function and its associations with physical performance remain unclear, particularly in Asian populations. The study objectives were to determine cognitive trajectories in middle-aged and elderly Chinese individuals, as well as to examine differences in physical performance across cognitive trajectory groups.
Data were extracted from the China Health and Retirement Longitudinal Study. A total of 5,701 participants (47.7% male) with a mean age of 57.8 (standard deviation, 8.4) years at enrollment were included. A group-based trajectory model was used to identify cognitive trajectory groups for each sex. Grip strength, repeated chair stand, and standing balance tests were used to evaluate physical performance. An ordered logistic regression model was employed to analyze differences in physical performance across cognitive trajectory groups.
Three cognitive trajectory groups were identified for each sex: low, middle, and high. For both sexes, higher cognitive trajectory groups exhibited smaller declines with age. In the fully adjusted model, relative to the low trajectory group, the odds ratios (ORs) of better physical performance in the middle cognitive group were 1.37 (95% confidence interval [CI], 1.17 to 1.59; p<0.001) during follow-up and 1.40 (95% CI, 1.20 to 1.64; p<0.001) at the endpoint. The ORs in the high trajectory group were 1.94 (95% CI, 1.61 to 2.32; p<0.001) during follow-up and 2.04 (95% CI, 1.69 to 2.45; p<0.001) at the endpoint.
Cognitive function was better preserved in male participants and individuals with higher baseline cognitive function. A higher cognitive trajectory was associated with better physical performance over time.
Key Message
Three cognitive trajectory groups were identified for each sex in middle-aged and elderly Chinese people. Cognitive function was found to be better preserved in male participants and individuals with higher baseline cognitive function. Better cognitive trajectory was associated with better physical performance over time.
Association of the dietary inflammatory index with phenotypic age in the United States adults
Mengzi Sun, Jiaxin Fang, Wenhui Gao, Yue He, Yanan Ma, Lina Jin
Epidemiol Health. 2023;45:e2023051.   Published online May 4, 2023
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  • 171 Download
AbstractAbstract AbstractSummary PDF
One of the underlying mechanisms of aging is chronic inflammation, which has been closely associated with daily diet. Phenotypic age (PhenoAge) has been used as an index to track the aging process before diseases show clinical symptoms. The present study aimed to explore the association between the dietary inflammatory index (DII) and PhenoAge.
In total, 9,275 adults aged 20 years old and over in the National Health and Nutrition Examination Survey were involved in this study. Dietary patterns were classified as pro-inflammatory or anti-inflammatory according to the DII. PhenoAge was regarded as a continuous variable, and linear regression was used to explore its association with dietary inflammation. Stratified analyses by sex, age, race, physical exercise, smoking status, drinking status, and body mass index were used to test the sensitivity of these associations.
The median value of PhenoAge was 38.60 years and 39.76 years for the participants with anti-inflammatory and pro-inflammatory diets, respectively. A pro-inflammatory diet was positively associated with PhenoAge (β=0.73; 95% confidence interval, 0.31 to 1.14), compared with participants who had an anti-inflammatory diet. There was an interaction between dietary inflammation and age for PhenoAge (pinteraction<0.001). The strength of the association between a pro-inflammatory diet and PhenoAge was stronger as age increased.
A pro-inflammatory diet was associated with a higher PhenoAge, and the association was strongest in the elderly. We recommended reducing dietary inflammation to delay phenotypic aging, especially for the elderly.
Key Message
One of the underlying mechanisms of aging is chronic inflammation, which has been closely associated with daily diet, and phenotypic age (PhenoAge) has been used as an index to track the aging process before diseases show clinical symptoms. The present study found that a pro-inflammatory diet was associated with a higher PhenoAge, and the association was strongest in the elderly. We recommended reducing dietary inflammation to delay phenotypic aging, especially for the elderly.
Association of multiple anthropometric indices with in 944,760 elderly Chinese people
Lirong Dong, Yuanyuan Wang, Jinshui Xu, Yang Zhou, Guiju Sun, Dakang Ji, Haijian Guo, Baoli Zhu
Epidemiol Health. 2023;45:e2023046.   Published online April 17, 2023
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  • 104 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
The aims of this study were to update the latest data on the prevalence of hypertension (HTN) in the elderly Chinese population and to assess relationships between new anthropometric indices and HTN.
Data were obtained from the Basic Public Health Service (BPHS) survey for Jiangsu Province, China. A total of 944,760 people aged 65 years and older were included in this study. Blood pressure was measured by trained investigators. Body weight, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WtHR), conicity index (COI), body roundness index (BRI), and a body shape index (ABSI) were included in the analysis as anthropometric indices. Logistic regression analysis and restricted cubic splines were used to evaluate the association of anthropometric indices with HTN.
The prevalence of HTN among elderly residents of Jiangsu Province was 64.7% (95% confidence interval, 64.6 to 64.8). After adjusting for multiple covariates, all anthropometric indices except ABSI showed significant non-linear positive dose-response associations with HTN across sex (pnonlinear<0.001). Among participants with BMI <28 kg/m2, abnormal weight, WC, WtHR, BRI, COI, and ABSI were positively associated with HTN.
The prevalence of HTN in the elderly in Jiangsu Province is gradually increasing. It is necessary to consider the combination of ABSI and COI with BMI for screening elderly individuals for HTN in follow-up prospective studies.
Key Message
We have conducted a comprehensive review of the supplementary material and have implemented the necessary modifications. We would like to extend our sincere apologies for any inconvenience that may have been caused during your work. Additionally, we have taken note of the fact that certain fields within the Author Contribution and ORCID sections were not previously verified. To rectify this situation and eliminate any potential ambiguity, we have diligently re-entered the information in question.
No evidence of delay in colorectal cancer diagnosis during the COVID-19 pandemic in Gwangju and Jeonnam, Korea
Hye-Yeon Kim, Min-Gyeong Kim, Mi-Ran Kang, Jeong-Ho Yang, Min-Ho Shin, Sun-Seog Kweon
Epidemiol Health. 2022;44:e2022092.   Published online October 17, 2022
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AbstractAbstract AbstractSummary PDF
We evaluated whether the coronavirus disease 2019 (COVID-19) pandemic caused delays in the diagnosis and treatment of colorectal cancer (CRC) in Korea, where there have been no regional or hospital lockdowns during the pandemic period.
Data on CRC patients (n=1,445) diagnosed in Gwangju Metropolitan City and Jeonnam Province between January 2019 and December 2021 were assessed. The stage at the time of CRC diagnosis, route to diagnosis, time to initial cancer treatment, and length of hospital admission were compared before and during the COVID-19 pandemic. Logistic regression was also performed to identify factors associated with the risk for diagnosis in an advanced stage.
No negative effects indicating a higher CRC stage at diagnosis or delayed treatment during the pandemic were observed. Instead, the risk for an advanced stage at diagnosis (TNM stage III/IV) decreased in CRC patients diagnosed during the pandemic (odds ratio, 0.768; 95% confidence interval, 0.647 to 0.911). No significant differences in the interval from diagnosis to operation or chemotherapy were observed.
No negative effects on CRC diagnosis and treatment were found until the end of 2021, which may be related to the small magnitude of the COVID-19 epidemic, the absence of a lockdown policy in Korea, and the rebound in the number of diagnostic colonoscopy procedures in 2021.
Korean summary
COVID-19 판데믹 시기에 진단된 대장암환자에서 진단병기의 지연과 치료의 지연이 발생한 증거는 찾을 수 없었다. 이것은 2021년까지 한국에서는 유행규모가 크지 않았고, 의료기관 또는 지역단위의 봉쇄정책이 거의 없었기 때문일 것으로 추정된다.
Key Message
No evidence of delayed diagnosis and treatment of colorectal cancer was found during the COVID-19 pandemic period (2020-2021) in Gwangju-Jeonnam, Korea. It may be related to the small magnitude of the COVID-19 epidemic, the absence of a lockdown policy in Korea.
Exploring the relationships between anthropometric indices of adiposity and physical performance in middle-aged and older Brazilian women: a canonical correlation analysis
Rafaela Andrade do Nascimento, Mariana Carmem Apolinário Vieira, Juliana Fernandes, Ingrid Guerra Azevedo, Mayle Andrade Moreira, José Vilton Costa, Saionara Maria Aires da Câmara, Álvaro Campos Cavalcanti Maciel
Epidemiol Health. 2022;44:e2022074.   Published online September 13, 2022
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AbstractAbstract AbstractSummary PDF
This study analyzed the influence of anthropometric indices of adiposity on the physical performance of middle-aged and older women.
A cross-sectional study was conducted among 368 women from 50 years to 80 years old. Anthropometric and biochemical characteristics were analyzed, and physical performance was evaluated. The statistical analysis used measures of central tendency and dispersion for descriptive data, Pearson correlations to demonstrate the initial associations between the variables, and canonical correlation (CC) to evaluate the relationship between the set of anthropometric adiposity indices and performance-related variables.
The participants had a mean age of 58.57±8.21 years, a visceral adiposity index of 7.09±4.23, a body mass index of 29.20±4.94 kg/m2, and a conicity index of 1.33±0.07. The average handgrip strength was 25.06±4.89 kgf, gait speed was 1.07±0.23 m/s, and the mean Short Physical Performance Battery (SPPB) score was 10.83±1.36. The first canonical function presented the highest shared variance, CC, and redundancy index (cumulative percentage of variance, 82.52; Wilks’ lambda, 0.66; CC, 0.532; p<0.001). From the analysis of this canonical function, the conicity index (-0.59) displayed inverse correlations with handgrip strength (0.84) and the SPPB (0.68), as well as a direct correlation with gait speed (-0.43).
In middle-aged and older women, there was an inverse relationship between the conicity index and muscle strength and power, while a direct relationship was found between the same index and gait speed.
Key Message
In aging process there is an increase in body adiposity and reduction in muscle size, mainly in women, due to the consequences of menopause and lower level of physical activity. This study analyzed the influence of anthropometric indices of adiposity on the physical performance of middle-aged and older women (50-80 years old), using canonical correlation analysis. The findings showed an inverse relationship between the conicity index and muscle strength and power, while a direct relationship between the same index and gait speed. Therefore, physical performance is influenced by changes in body composition that occur with age in this population group
Cohort Profile
Cohort profile: the Environmental-Pollution-Induced Neurological EFfects (EPINEF) study: a multicenter cohort study of Korean adults
Heeseon Jang, Woojin Kim, Jaelim Cho, Jungwoo Sohn, Juhwan Noh, Gayoung Seo, Seung-Koo Lee, Young Noh, Sung Soo Oh, Sang-Baek Koh, Hee Jin Kim, Sang Won Seo, Ho Hyun Kim, Jung Il Lee, Sun-Young Kim, Changsoo Kim
Epidemiol Health. 2021;43:e2021067.   Published online September 16, 2021
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  • 4 Citations
AbstractAbstract AbstractSummary PDFSupplementary Material
The general population is exposed to numerous environmental pollutants, and it remains unclear which pollutants affect the brain, accelerating brain aging and increasing the risk of dementia. The Environmental-Pollution-Induced Neurological Effects study is a multi-city prospective cohort study aiming to comprehensively investigate the effect of different environmental pollutants on brain structures, neuropsychological function, and the development of dementia in adults. The baseline data of 3,775 healthy elderly people were collected from August 2014 to March 2018. The eligibility criteria were age ≥50 years and no self-reported history of dementia, movement disorders, or stroke. The assessment included demographics and anthropometrics, laboratory test results, and individual levels of exposure to air pollution. A neuroimaging sub-cohort was also recruited with 1,022 participants during the same period, and brain magnetic resonance imaging and neuropsychological tests were conducted. The first follow-up environmental pollutant measurements will start in 2022 and the follow-up for the sub-cohort will be conducted every 3-4 years. We have found that subtle structural changes in the brain may be induced by exposure to airborne pollutants such as particulate matter 10 μm or less in diameter (PM10), particulate matter 2.5 μm or less in diameter (PM2.5) and Mn10, manganese in PM10; Mn2.5, manganese in PM2.5. PM10, PM2.5, and nitrogen dioxide in healthy adults. This study provides a basis for research involving large-scale, long-term neuroimaging assessments in community-based populations.
Korean summary
EPINEF 코호트는 환경유해인자에 의한 신경계 질환의 위해성을 평가하고, 환경유해인자로 유발되는 신경심리학적 기능 저하 또는 뇌 노화에 대한 근거를 제공하기 위해 2014년부터 50세 이상의 건강한 성인을 대상으로 시작되었습니다. 본 코호트는 뇌 영상학적 표지자와 인지 기능과 관련된 환경유해인자를 광범위하게 조사한 한국 최초의 장기 추적관찰 연구로, 대기 오염 물질 또는 다환방향족탄화수소 노출이 대뇌 영상표지자 및 신경심리학적 기능, 노인의 우울 증상에 대한 악화 요인으로서의 대기오염물질 노출과 결혼 상태의 교호작용 등의 연구결과들을 발표하였습니다. 또한, 추후에도 코호트의 지속적인 추적을 통해 환경유해인자 노출에 따른 신경학적 건강영향을 연구하여, 신경계 질환 관리를 위한 보건 정책 개선에 기여할 수 있을 것으로 기대됩니다.
Key Message
The EPINEF cohort was started in 2014 to assess the risk of neurological diseases caused by environmental harmful factors and to provide evidence for neuropsychological dysfunction or brain aging induced by these factors. This cohort is the first long-term follow-up study in Korea to extensively investigate brain imaging markers and environmental harmful factors related to cognitive function, and several related research results have been published. In addition, the follow-up survey will be continued in the future, and we expect that the results of the study will contribute to improving health policies for the management of neurological diseases.


Citations to this article as recorded by  
  • Associations of Particulate Matter Exposures With Brain Gray Matter Thickness and White Matter Hyperintensities: Effect Modification by Low-Grade Chronic Inflammation
    Jaelim Cho, Heeseon Jang, Young Noh, Seung-Koo Lee, Sang-Baek Koh, Sun-Young Kim, Changsoo Kim
    Journal of Korean Medical Science.2023;[Epub]     CrossRef
  • Polycyclic aromatic hydrocarbons and changes in brain cortical thickness and an Alzheimer's disease-specific marker for cortical atrophy in adults: A longitudinal neuroimaging study of the EPINEF cohort
    Jaelim Cho, Jungwoo Sohn, Sung Hee Yang, Seung-Koo Lee, Young Noh, Sung Soo Oh, Sang-Baek Koh, Changsoo Kim
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Original Article
Association between body temperature and leukocyte telomere length in Korean middle-aged and older adults
Carolina García-García, Chol Shin, Inkyung Baik
Epidemiol Health. 2021;43:e2021063.   Published online September 8, 2021
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  • 1 Citations
AbstractAbstract AbstractSummary PDFSupplementary Material
Data on associations between body temperature (BT) and leukocyte telomere length (LTL), which has been widely used as a biomarker of cellular senescence in recent epidemiological studies, are limited. Therefore, this study aimed to explore the associations between a normal BT range (35.0-37.5°C) and LTL via 6-year longitudinal observations of 2,004 male and female adults aged 50 or older.
BT was obtained by measuring the tympanic temperature, and relative LTL was determined by real-time polymerase chain reaction. Robust regression analysis was used to evaluate the association between the baseline and follow-up LTL values and their differences.
A significant inverse association was found between BT and LTL at baseline. The regression coefficient estimate was -0.03 (95% confidence interval, -0.07 to -0.001; p<0.05). This association was stronger in participants with a body mass index >25 kg/m2 and males (p<0.01). However, there were no associations between BT and LTL at follow-up or BT and 6-year longitudinal differences in LTL.
These findings suggest that having a high BT between 35°C and 37.5°C (95°F and 99°F) may be detrimental for obese individuals in terms of biological aging.
Korean summary
본 역학 연구는 한국 성인 2,004명을 연구대상자로 하여 2011-2012년에 고막 체온을 측정하고 전혈을 채취하여 백혈구 텔로미어 길이를 분석하였으며 이러한 분석을 2017-2018년에 반복하여 6년 동안의 백혈구 텔로미어 길이 변화를 계산하였다. 고막 체온과 초기 텔로미어 길이의 관련성을 분석한 결과, 정상 체온 범위 내 체온이 높을수록 텔로미어 길이가 유의적으로 짧아지는 생리적 노화 상태와 관련된 것으로 나타났으며, 이러한 결과는 비만할 경우 더욱 분명하게 나타났다. 본 연구 결과를 통해 비만 시 체내 열발생과 관련된 노화 진행이 체중 감소를 통해 지연될 수 있는 가능성이 제시되었다.
Key Message
In an epidemiological study including Korean adults, a relatively higher normal body temperature between 35°C to 37.5°C was found to be associated with shorter leukocyte telomere length, a cellular senescence biomarker. In particular, this association was observed to be stronger among obese participants, suggesting that attaining normal body weight may be beneficial for anti-aging.


Citations to this article as recorded by  
  • Higher Daily Air Temperature Is Associated with Shorter Leukocyte Telomere Length: KORA F3 and KORA F4
    Wenli Ni, Kathrin Wolf, Susanne Breitner, Siqi Zhang, Nikolaos Nikolaou, Cavin K. Ward-Caviness, Melanie Waldenberger, Christian Gieger, Annette Peters, Alexandra Schneider
    Environmental Science & Technology.2022; 56(24): 17815.     CrossRef
A systematic review of barriers and motivators to physical activity in elderly adults in Iran and worldwide
Soudabeh Yarmohammadi, Hossein Mozafar Saadati, Mohtasham Ghaffari, Ali Ramezankhani
Epidemiol Health. 2019;41:e2019049.   Published online November 29, 2019
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  • 378 Download
  • 40 Citations
AbstractAbstract PDFSupplementary Material
This study was conducted to identify and characterize the barriers and motivations to physical activity (PA) for elderly adults in Iran and other countries.
We searched 6 databases (PubMed, Embase, Scopus, Web of Science, Magiran, and the Scientific Information Database) from 2000 to the November 2017, using “aged 60 and over,” “physical activity” or “exercise,” and “motivator” and “barrier” as keywords. Two reviewers independently performed the search, screening, and quality assessment of the studies.
In total, 34 papers were finally included in the study. The most important barriers, based on the frequency of factors, included physical problems, having no companions, and physical barriers to walking. The motivators included improving one’s physical condition, being social, and suitability of the physical environment.
Important motivators and barriers to PA were more closely related to intrapersonal factors than to the interpersonal and environmental domains. The barriers and motivators to PA in the elderly were not markedly different between Iran and other countries. Therefore, a general strategy could be designed to improve PA in the elderly.


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Original Articles
The Relationship between Height and Cognitive Function among Community-dwelling Elderly: Hallym Aging Study
Shan Ai Quan, Jin-Young Jeong, Dong-Hyun Kim
Epidemiol Health. 2013;35:e2013002.   Published online April 30, 2013
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  • 7 Citations
AbstractAbstract PDF

Height is known as an index that reflects the environment of the fetal, childhood, and adolescent periods, which affect adult health. This study was conducted to elucidate whether height is associated with cognitive impairment in community-dwelling elders in Korea.


The study subjects were recruited among community dwelling elderly individuals aged 65 or over who participated in the 2004 Hallym Aging Study. They were invited to a general hospital and were evaluated for socioeconomic status, smoking history, and various clinical measures. Cognitive function measurement was performed using the Korean-Mini Mental State Examination. Logistic regression was used to evaluate the association between height and cognitive function.


After adjusting for potential covariates such as age and education, the smallest group was associated with higher risk of cognitive impairment compared with the tallest group among elderly men (odds ratio [OR], 4.20; 95% confidence interval [CI], 1.02-17.36), but not among elderly women (OR,1.65; 95% CI, 0.62-4.40).


The reason for this difference according to sex may be explained by the differential effects of education on cognitive function by sex. A larger population-based prospective cohort study is needed to examine the association between height and cognitive function according to sex.



Citations to this article as recorded by  
  • Taller adult height is associated with better performance of cognitive trajectories in Chinese over 45 years old: Evidence from the China Health and Retirement Longitudinal Study
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    Geriatrics & Gerontology International.2021; 21(8): 732.     CrossRef
  • Sex-related associations between body height and cognitive impairment among low-income elderly adults in rural China: a population-based cross-sectional study
    Dongwang Qi, Chanhong Shi, Rongyan Mao, Xuewei Yang, Jinhui Song, Yanjia Wang, Jun Tu, Jinghua Wang, Xianjia Ning, Yi Wu
    Biology of Sex Differences.2021;[Epub]     CrossRef
  • Book-Oriented Environment in Childhood and Current Cognitive Performance among Old-Aged Europeans
    Galit Weinstein, Ella Cohn-Schwartz, Noam Damri
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  • Host and disease factors are associated with cognitive function in European HIV-infected adults prior to initiation of antiretroviral therapy
    A Winston, W Stöhr, A Antinori, A Arenas-Pinto, JM Llibre, H Amieva, A Cabié, I Williams, G Di Perri, MJ Tellez, J Rockstroh, A Babiker, A Pozniak, F Raffi, L Richert
    HIV Medicine.2016; 17(6): 471.     CrossRef
  • Adult Body Height Is a Good Predictor of Different Dimensions of Cognitive Function in Aged Individuals: A Cross-Sectional Study
    Vitor H. Pereira, Patrício S. Costa, Nadine C. Santos, Pedro G. Cunha, Margarida Correia-Neves, Joana A. Palha, Nuno Sousa
    Frontiers in Aging Neuroscience.2016;[Epub]     CrossRef
  • Associations among height, body mass index and intelligence from age 11 to age 78 years
    Mathew A. Harris, Caroline E. Brett, Ian J. Deary, John M. Starr
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  • Body Mass Index, Height and Socioeconomic Position in Adolescence, Their Trajectories into Adulthood, and Cognitive Function in Midlife
    Irit Cohen-Manheim, Glen M. Doniger, Ronit Sinnreich, Ely S. Simon, Havi Murad, Ronit Pinchas-Mizrachi, Jeremy D. Kark
    Journal of Alzheimer's Disease.2016; 55(3): 1207.     CrossRef
Development of Risk Prediction Model for Cardiovascular Disease Using Intima Media Thickness of Carotid Artery Among Community-Dwelling Elderly.
Jin Young Jeong, Kyung Soon Hong, Soong Nang Jang, Young Ho Choi, Moon Gi Choi, Sang Kon Lee, Hyun Ah Kim, Seok Won Park, Na Rae Hong, Dong Hyun Kim
Korean J Epidemiol. 2007;29(2):187-199.
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  • 24 Download
AbstractAbstract PDF
This study was performed to develop risk prediction model for cardiovascular disease using intima-media thickness (IMT) of carotid artery among the community dwelling elderly.
Follow-up survey was conducted in 2007 to measure the IMT of carotid artery, which is known as a preclinical marker of atherosclerotic change, among participants at the baseline survey of Hallym Aging Study (HAS) in 2004. They were categorized into two groups; increased IMT > or = 0.9 mm and normal IMT < 0.9 mm. To evaluate which factors are independently related with the increased IMT, multiple logistic regression analysis was done. Based on the regression coefficients of these factors weighed by the magnitude of the effect estimates, we calculated the risk scores for increased IMT for every participants. ROC curve was plotted for the each cutoff point of risk scores and its fitness was tested using Area Under the Curve (AUC). Finally, we calculated risk ratios for the increased IMT according to the level of risk based on the risk scores.
Several factors were found as related factors for the increased IMT in the multiple logistic regression: age (beta=0.15), cholesterol (beta=0.01), insulin (beta=0.13), and pulse pressure (beta=0.90) for men, and age (beta=0.08), family history of diabetes mellitus (beta=0.94) and stroke (beta=0.79), alcohol drinking (beta=0.39), and high cholesterol (beta=0.77) for women. We assigned the weighed value for each factors. The average risk scores were 14.48 (range 9.69-18.76) for men and 4.59 (range 2.41-7.48) for women. The Area Under the Curve (AUC) were 0.77 for men and 0.71 for women. We also observed the higher risk of increased IMT as the risk scores increased.
Based on the results, we expect to predict the level of the risk for the increased IMT, which is preclinical marker for atherosclerotic change, among the elderly.

Epidemiol Health : Epidemiology and Health