Epidemiology and Health

Original Article

Multimorbidity patterns by health-related quality of life status in older adults: an association rules and network analysis utilizing the Korea National Health and Nutrition Examination Survey: Thi-Ngoc Tran, Sanghee Lee, Chang-Mo Oh, Hyunsoon Cho; Epidemiol Health. 2022;44:e2022113. Published online November 29, 2022; DOI: https://doi.org/10.4178/epih.e2022113

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Abstract

OBJECTIVES
Improved life expectancy has increased the prevalence of older adults living with multimorbidity which likely deteriorates their health-related quality of life (HRQoL). However, relatively little is known about patterns and the relationships of multimorbidity by HRQoL status in older adults.

METHODS

Individuals aged 65 or older from the Korea National Health and Nutrition Examination Survey V-VII (2010-2018) were analyzed. HRQoL was assessed by the EuroQoL-5 dimensions questionnaire and categorized as poor, normal, or good. The impact of multimorbidity on HRQoL was evaluated using logistic regression. The patterns and inter-relationships between multimorbidity, stratified by HRQoL groups, were analyzed using the association rules and network analysis approach.

RESULTS

Multimorbidity was significantly associated with poor HRQoL (3 or more diseases vs. none; adjusted odds ratio, 2.70; 95% confidence interval, 2.10 to 3.46). Hypertension, arthritis, hyperlipidemia, and diabetes were the most prevalent diseases across all HRQoL groups. Complex interrelationships of morbidities, higher prevalence, and node strengths in all diseases were observed in the poor HRQoL group, particularly for arthritis, depression, and stroke, compared to other groups (1.5-3.0 times higher, p<0.05 for all). Apart from hypertension, arthritis and hyperlipidemia had a higher prevalence and stronger connections with other diseases in females, whereas this was the case for diabetes and stroke in males with poor HRQoL.

CONCLUSIONS

Multimorbidity patterns formed complicatedly inter-correlated disease networks in the poor HRQoL group with differences according to sex. These findings enhance the understanding of multimorbidity connections and provide information on the healthcare needs of older adults, especially those with poor HRQoL.

Summary

Korean summary
기대 수명의 증가에 따라 고령인구에서 건강관련 삶의 질을 저하시킬 수 있는 복합질환의 유병률도 함께 증가하고 있다. 본 연구에서는 국민건강영양조사 자료를 이용하여 65세 이상 우리나라 고령인구에서 건강관련 삶의 질 (HRQoL)에 따른 복합만성질환 패턴을 분석하였다. 복합만성질환은 건강관련 삶의 질 저하와 통계적으로 유의하게 연관되어 있으며, 연관성 및 네크워크 분석 결과 건강관련 삶의 질이 낮을수록 복합질환의 패턴이 복잡한 것으로 나타났다. 전체적으로 고혈압, 관절염, 고지혈증, 당뇨병이 가장 높은 발생률을 보였다. 건강관련 삶의 질이 낮은 그룹에서는 관절염, 우울증, 뇌졸중 등의 질병이 높은 발생률과 상호관련성을 보였으며, 이는 성별에 따라 차이가 있었다. 연구 결과는 고령자, 특히 건강관련 삶의 질이 낮은 노인의 의료 서비스 요구에 대해 정보를 제공해 줄 수 있을 것이다,

Key Message
Network analysis of older adults (65 or older) in Korea showed that hypertension, arthritis, hyperlipidemia, and diabetes were the most common multimorbidity regardless of HRQoL status. However, as HRQoL deteriorated, multimorbidity patterns formed complicatedly inter-correlated disease networks; the prevalence and the node strength of arthritis, depression, and stroke increased considerably and be diversified by sex.

Citations

Citations to this article as recorded by

Chronic Disease Patterns and Their Relationship With Health-Related Quality of Life in South Korean Older Adults With the 2021 Korean National Health and Nutrition Examination Survey: Latent Class Analysis
Mi-Sun Lee, Hooyeon Lee
JMIR Public Health and Surveillance.2024; 10: e49433. CrossRef
Health-promoting behavior to enhance perceived meaning and control of life in chronic disease patients with role limitations and depressive symptoms: a network approach
Je-Yeon Yun, Young Ho Yun
Scientific Reports.2023;[Epub] CrossRef

Methods

Meta-analysis for genome-wide association studies using case-control design: application and practice: Sungryul Shim, Jiyoung Kim, Wonguen Jung, In-Soo Shin, Jong-Myon Bae; Epidemiol Health. 2016;38:e2016058. Published online December 18, 2016; DOI: https://doi.org/10.4178/epih.e2016058

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Abstract

This review aimed to arrange the process of a systematic review of genome-wide association studies in order to practice and apply a genome-wide meta-analysis (GWMA). The process has a series of five steps: searching and selection, extraction of related information, evaluation of validity, meta-analysis by type of genetic model, and evaluation of heterogeneity. In contrast to intervention meta-analyses, GWMA has to evaluate the Hardy–Weinberg equilibrium (HWE) in the third step and conduct meta-analyses by five potential genetic models, including dominant, recessive, homozygote contrast, heterozygote contrast, and allelic contrast in the fourth step. The ‘genhwcci’ and ‘metan’ commands of STATA software evaluate the HWE and calculate a summary effect size, respectively. A meta-regression using the ‘metareg’ command of STATA should be conducted to evaluate related factors of heterogeneities.

Summary

Korean summary
오늘날 활발히 수행되고 있는 유전체역학연구는 재현성의 문제, 대상자 크기의 한계 등으로 유전체 메타분석 연구가 요구되고 있다. 유전체 메타분석의 전반적인 수행 단계는 약물, 수술 등의 중개연구의 메타분석처럼 5 단계를 밟아 수행된다. 그러나, 유전체 메타분석은 3번째 과정에서 Hardy–Weinberg equilibrium (HWE) 검정과 4번째 과정에서 5가지 가능한 유전형 모델에 따라 메타분석이 이루어진다는 점에서 중개연구의 메타분석과 차이가 있다.

Citations

Citations to this article as recorded by

Recommendations for Statistical Reporting in Cardiovascular Medicine: A Special Report From the American Heart Association
Andrew D. Althouse, Jennifer E. Below, Brian L. Claggett, Nancy J. Cox, James A. de Lemos, Rahul C. Deo, Sue Duval, Rory Hachamovitch, Sanjay Kaul, Scott W. Keith, Eric Secemsky, Armando Teixeira-Pinto, Veronique L. Roger
Circulation.2021;[Epub] CrossRef
Effects of Arsenic (+3 Oxidation State) Methyltransferase Gene Polymorphisms and Expression on Bladder Cancer: Evidence from a Systematic Review, Meta-analysis and TCGA Dataset
Yuxuan Song, Donghui Jin, Jingyi Chen, Wanfeng Liang, Xiaoqiang Liu
Toxicological Sciences.2020; 177(1): 27. CrossRef
Associations between TLR4 Polymorphisms and Open Angle Glaucoma: A Meta-Analysis
Zhongjing Lin, Shouyue Huang, Jun Sun, Bing Xie, Yisheng Zhong
BioMed Research International.2019; 2019: 1. CrossRef

Brief Communication

Evaluation report on the causal association between humidifier disinfectants and lung injury: Mina Ha, Soon Young Lee, Seung-sik Hwang, Hyesook Park, Seungsoo Sheen, Hae Kwan Cheong, Bo Youl Choi; Epidemiol Health. 2016;38:e2016037. Published online August 18, 2016; DOI: https://doi.org/10.4178/epih.e2016037

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Abstract

OBJECTIVES
As of November 2011, the Korean government recalled and banned humidifier disinfectants (HDs) from the market, because four case-control studies and one retrospective epidemiological study proved the association between HDs and lung injury of unknown cause. The report reviewed the causal role of HDs in lung injury based on scientific evidences.

METHODS

A careful examination on the association between the HDs and lung injury was based on the criteria of causality inference by Hill and the US Surgeon General Expert Committee.

RESULTS

We found that all the evidences on the causality fulfilled the criteria (strength of association, consistency, specificity, temporality, biologic gradient, plausibility, coherence, experiment, analogy, consideration of alternative explanations, and cessation of exposure), which proved the unknown cause lung injury reported in 2011 was caused by the HDs. In particular, there was no single reported case of lung injury since the ban in selling HDs in November 2011 as well as before the HDs were sold in markets.

CONCLUSIONS

Although only a few epidemiological studies in Korea have evaluated the association between lung injury and the use of HDs, those studies contributed to proving the strong association between the use of the HDs and lung injury, based on scientific evidence.

Summary

Korean summary
본 논문에서는 Hill의 기준과 US Surgeon General 전문위원회에서 제시하는 기준에 근거하여 가습기살균제와 폐손상과의 인과성을 검토하였다. 검토결과, 11개 조건(관련성의 강도, 일관성, 특이성, 시간적 선후관계, 생물학적 용량-반응 관계, 개연성, 기존 지식과의 일치성, 실험, 유사성, 다른 가능한 해석에 대한 고려 및 노출의 중단) 을 모두 충족함을 확인하므로 써, 2011년 발생한 원인미상 폐손상의 원인이 가습기살균제 노출로 인한 것임을 알 수 있었다. 무엇보다도 가습기살균제 시판 전에는 원인미상 폐손상이 보고된 바가 없었고, 2011년 11월 가습기살균제 판매중지 이후 폐손상이 한 건도 발생하지 않은 것은 원인미상의 폐손상이 가습기살균제로 인한 것임을 강력하게 지지하는 것으로 판단된다.

Citations

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New-Onset and Exacerbation of Lung Diseases after Short-Term Exposures to Humidifier Disinfectant during Hospitalization
Seula Lee, Kyunghee Han, Jeonggyo Yoon, Eun-Kyung Jo, Wonho Yang, Yoon-Hyeong Choi
Toxics.2022; 10(7): 371. CrossRef
Characterizing Subjects Exposed to Humidifier Disinfectants Using Computed-Tomography-Based Latent Traits: A Deep Learning Approach
Frank Li, Jiwoong Choi, Xuan Zhang, Prathish K. Rajaraman, Chang-Hyun Lee, Hongseok Ko, Kum-Ju Chae, Eun-Kee Park, Alejandro P. Comellas, Eric A. Hoffman, Ching-Long Lin
International Journal of Environmental Research and Public Health.2022; 19(19): 11894. CrossRef
Physical analysis reveals distinct responses of human bronchial epithelial cells to guanidine and isothiazolinone biocides
Tae Yoon Kwon, Jaeseong Jeong, Eunyoung Park, Youngbin Cho, Dongyoung Lim, Ung Hyun Ko, Jennifer H. Shin, Jinhee Choi
Toxicology and Applied Pharmacology.2021; 424: 115589. CrossRef
Need for individual-based evaluation to determine the association between humidifier disinfectants and health injuries
Hyeong-Cheol Kim, Hyunil Kim, Eun-Chan Mun, Yesung Lee, Soyoung Park
Annals of Occupational and Environmental Medicine.2021;[Epub] CrossRef
Strength of Association. Report 1. Graduations of Relative Risk
А. Котеров, A. Koterov, Л. Ушенкова, L. Ushenkova, Э. Зубенкова, E. Zubenkova, А. Вайнсон, A. Vaynson, М. Калинина, M. Kalinina, А. Бирюков, A. Biryukov
Medical Radiology and radiation safety.2019; : 5. CrossRef
Causal inference in environmental epidemiology
Sanghyuk Bae, Hwan-Cheol Kim, Byeongjin Ye, Won-Jun Choi, Young-Seoub Hong, Mina Ha
Environmental Health and Toxicology.2017; 32: e2017015. CrossRef

Original Articles

Relationship Between Earlobe Crease and Brachial-ankle Pulse Wave Velocity in Non-hypertensive, Non-diabetic Adults in Korea: Sang In Choi, Hee Cheol Kang, Choon Ok Kim, Seung Beom Lee, Won Ju Hwang, Dae Ryong Kang; Epidemiol Health. 2009;31:e2009002. Published online October 12, 2009; DOI: https://doi.org/10.4178/epih/e2009002

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Abstract PDF

Abstract

<sec><title>OBJECTIVES</title>Several studies have found a significant association between the presence of earlobe crease (ELC) and cardiovascular disease (CVD). Brachial-ankle Pulse Wave Velocity (baPWV) is a non-invasive and useful measure of arterial stiffness predicting cardiovascular events and mortality. However, few studies have reported the relationship between ELC and baPWV as a new measure of arterial stiffness. The purpose of this study was to determine whether ELC is related to baPWV in non-diabetic, non-hypertensive, and apparently healthy Korean adults.</sec><sec><title>METHODS</title>A cross-sectional study was conducted on 573 non-hypertensive, non-diabetic Korean adults aged 20-80 yr. Subjects were stratified into three groups according to gender and menopausal status. baPWV was measured by an automatic waveform analyser. The association between ELC and baPWV was assessed by multiple linear regression analysis after adjusting for conventional cardiovascular disease risk factors including age, gender, blood pressure, lipid profile, and smoking status etc.</sec><sec><title>RESULTS</title>The overall frequency of ELC was 19.02% and the subjects with ELC showed significantly higher mean baPWV (p<0.0001). Multiple linear regression of subjects revealed that the presence of ELC was independently associated with baPWV (male, p<0.0001; premenopausal female p=0.0162; postmenopausal female p=0.0208).</sec><sec><title>CONCLUSION</title>ELC had a significant correlation with baPWV, independently controlling for other classical cardiovascular risk factors in adults aged 20 yr or older. ELC is an important surrogate marker of increased arterial stiffness as measured by baPWV in Korean adults.</sec>

Summary

Citations

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Diagonal earlobe crease and long-term survival after myocardial infarction
Christian Thilo, Christine Meisinger, Margit Heier, Wolfgang von Scheidt, Inge Kirchberger
BMC Cardiovascular Disorders.2021;[Epub] CrossRef
Association between serum carbohydrate antigen 19-9 levels and leukoaraiosis in middle-aged and older adults: A cross-sectional study
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Atherosclerosis.2020; 292: 188. CrossRef
Association Between the Frank Sign and Cardiovascular Events
Saleh Nazzal, Arnon Blum
Southern Medical Journal.2018; 111(8): 504. CrossRef
Reevaluation of the earlobe types in Koreans
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HOMO.2018; 69(6): 377. CrossRef
The role of diagonal earlobe as evidence of coronary artery disease in a Salahiddin province- Iraqi population
Omar Raheem Khalaf AL-Obaidi, Rasha Abduladheem Yaseen
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Prevalence of Earlobe Creases and Their Association With History of Cardiovascular Disease in Patients Undergoing Hemodialysis: A Cross‐Sectional Study
Minako Wakasugi, Junichiro James Kazama, Kazuko Kawamura, Suguru Yamamoto, Masaaki Nagai, Kentaro Omori, Saori Yokota, Hirokazu Fujikawa, Ikuo Aoike, Tsukasa Omori, Ichiei Narita
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Diagonal Earlobe Crease is a Visible Sign for Cerebral Small Vessel Disease and Amyloid-β
Jin San Lee, Seongbeom Park, Hee Jin Kim, Yeshin Kim, Hyemin Jang, Ko Woon Kim, Hak Young Rhee, Sung Sang Yoon, Kyoung Jin Hwang, Key-Chung Park, Seung Hwan Moon, Sung Tae Kim, Samuel N. Lockhart, Duk L. Na, Sang Won Seo
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Diagonal earlobe crease and coronary artery disease in a Chinese population
Xing-li Wu, Ding-you Yang, Yu-sheng Zhao, Wen-hui Chai, Ming-lei Jin
BMC Cardiovascular Disorders.2014;[Epub] CrossRef
Earlobe Crease May Provide Predictive Information on Asymptomatic Peripheral Arterial Disease in Patients Clinically Free of Atherosclerotic Vascular Disease
Levent Korkmaz, Mustafa Tarık Ağaç, Zeydin Acar, Hakan Erkan, Ismail Gurbak, Ibrahim Halil Kurt, Huseyin Bektas, Erdinc Pelit, Ayca Ata Korkmaz, Şükrü Çelik
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Association Between Earlobe Crease and the Metabolic Syndrome in a Cross-sectional Study
Eun Hee Kang, Hee Cheol Kang
Epidemiology and Health.2012; 34: e2012004. CrossRef
Diagonal Ear Lobe Crease and Coronary Artery Disease
Damir Fabijanić, Viktor Čulić
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Association between Metabolic Syndrome and Alcohol drinking and Smoking histories in a rural area of Korea.: Hee Sung Ha, Hyeon Woo Yim, Yong Moon Park, Jin Hee Lee, Seung Hwan Lee, Hyuk Sang Kwon, Kun Ho Yoon, Ho Young Son, Moo Il Kang, Won Chul Lee; Korean J Epidemiol. 2008;30(2):281-293. Published online December 31, 2008; DOI: https://doi.org/10.4178/kje.2008.30.2.281

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Abstract PDF: Abstract
PURPOSE
Prevalence of metabolic syndrome is increasing markedly in rural area of Korea. Alcohol drinking and smoking are the main risk factors which shows the highest prevalence rate among the risk factors of metabolic syndrome. The aim of this study was to investigate the association between metabolic syndrome and alcohol drinking and smoking histories in a rural area of Korea.
METHODS
Data was obtained from 1,332(507 men, 825 women) individuals aged over 40 years who lived in rural area of Chungju city in 2007. Metabolic syndrome was defined by NCEP ATP III criteria and waist circumference was defined by WHO-APR(Asia Pacific Region). Data analysis was carried out using SAS version 8.02.
RESULTS
In men, adjusted odds ratio for metabolic syndrome was 2.78(1.09-7.05) for current alcohol drinker, 2.75(1.38-5.51) for past alcohol drinker, 3.25(1.58-6.67) for under 21 years old at start of alcohol drinking, 2.62(1.12-6.11) for light alcohol drinker, 6.01(2.65-13.64) for heavy alcohol drinker. In women, all the alcohol related risk factors were not statistically significant with metabolic syndrome. For all the smoking related risk factors were not statistically significant with metabolic syndrome in men and women. Adjusted odds ratio of alcohol drinking habits for each components of diagnostic criteria of metabolic syndrome was significant for high blood pressure, high fasting glucose and hypertriglyceridemia in men and abdominal obesity in women. Adjusted odds ratio of cigarette smoking habits for each components of diagnostic criteria of metabolic syndrome was significant for abdominal obesity in women.
CONCLUSION
Controlling alcohol drinking habits in men should be reinforced in order to prevent the metabolic syndrome in a rural area of Korea.; Summary

The Role of the Epidemiological Causality of the Association between Smoking and Lung Cancer.: Kyung Hwan Lee, Hyun Hee Kang; Korean J Epidemiol. 2005;27(2):28-37.

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Abstract PDF: Abstract
It is generally accepted that acknowledgment of the causality of the association between smoking and lung cancer plays a crucial role in imposing liability on tobacco manufacturers in tobacco-related cases. However, acknowledgment of the epidemiological causality of the association is merely a precondition to putting liability on tobacco manufacturers; it does not play a crucial role. Smokers smoke manufactured tobacco by their right to choose according to their self-decision; therefore, it is not reasonable to place all liability concerning lung cancer on tobacco manufacturers. This paper studies the dual structure of the causality of the association between tobacco manufacturing and smoking as well as smoking and lung cancer. It can be understood that tobacco manufacturers must be held liable for lung cancer caused by smoking when there was intentional concealment or insufficient provision of information on the harmfulness of tobacco and the addictiveness of nicotine. The epidemiological causality of the association is the minimum scientific and legal precondition to placing liability on tobacco manufacturers for lung cancer caused by smoking. However, striving for protection and promotion of national health by, for instance, promoting antismoking programs, the epidemiological causality of the association adequately plays a social role when viewed from a public health perspective.; Summary

A Review Study on Confounding Effect: Case-control Study.: Seonwoo Kim, Minji Kim, Soon Young Lee; Korean J Epidemiol. 1999;21(2):248-253.

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Abstract PDF: Abstract
Confounding is the distortion of a disease/exposure association brought about by other factors which are not considered in the study design or the data analysis. These factors are called confounding factors. We should be cautious in data analysis of observational study of association of disease/exposure, since confounding often occurred in observational study. This study examines confounding effect according to data pattern (the ratio of controls to cases, the ratio of exposures to non-exposures for each level of confounding factor), criteria for treating a variable as a confounding variable, and some notes for the analysis in case-control study.; Summary

Using Mining Association Rules for the Dietary Assessment of Adults in Rural Area.: J E Shim, H Y Paik, W S Shin, K C Kim; Korean J Epidemiol. 1997;19(2):220-230.

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Abstract PDF: Abstract
This study was performed to find out a nutrient which could be used as an index for a quick and easy dietary assessment using mining association rules, the automated and intelligent database analysis. A Dietary survey with 24 hour recall method was conducted to 2037 adults over 30 years of age in rural area of Korea. Daily nutrient intake as the percent of the Recommended Daily Allowances(RDA) was applied to the association rules and nutrient intake over 75% of RDA was considered enough intake. Association rules in nutrient database show relation-ships among nutrients, and they are statements as this form, "50% of person that take protein under 60% of RDA also take calcium." Applying these rules between nutrients over 75% of RDA with 25% level of minimum support, we found that protein, phosphorus, niacin had 7 association rules and association rules of protein had higher level of confidence than the others. Applying between nutrients below 60% of RDA, calcium and vitamin A had the highest number of association rules, however, the levels of confidence were low. Protein had 5 association rules, 2nd higher number, and the levels of confidence were higher than others. From these results protein indicated nutrient intake patterns better than energy did, which is generally used as a representative nutrient. This results could be used in the dietary assessment and nutrition education of korean adults in rural area.; Summary

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