Exploring determinants of flourishing: a comprehensive network analysis of retirees in Taiwan.

BACKGROUND: Human flourishing is an emerging concept, extending beyond the conventional boundaries of subjective well-being and evolving into a comprehensive capture of the diverse dimensions of human life within complex societal structures. Therefore, moving away from traditional approaches centered on the single latent construct, this study aims to explore the multiple aspects of human flourishing and the intricate interplay of their contributing factors. METHODS: Data were collected from the Health and Living Environments Survey of Taiwanese Retirees during 2023 (valid sample n = 1,111). Human flourishing was measured using the Secure Flourish Index developed by Harvard University, which includes 12 indicators: (1) life satisfaction, (2) happiness, (3) mental health, (4) physical health, (5) meaning in life, (6) sense of purpose, (7) promoting good, (8) delaying gratification, (9) content relationships, (10) satisfying relationships, (11) financial stability, and (12) material stability. A mixed graphical network analysis was employed to analyze the related determinants, divided into four groups: (a) sociodemographic factors, (b) physical functions and health status, (c) social and family engagement, and (d) community environmental characteristics as nodes. RESULTS: We analyzed 31 variables and identified 133 nonzero edges out of 465 potential connections in the comprehensive network. Results showed that happiness and promoting good were the two most critical indicators influencing retirees' overall flourishing. Different flourishing indicators were also associated with various influential factors. For instance, personal characteristics, especially gender and education, emerged as central factors. Family caregiving negatively affected happiness and financial stability, whereas social engagement was positively associated with life satisfaction and meaning in life. Employment status had mixed effects, negatively associated with life satisfaction but positively associated with mental health. Community environments, such as a sense of community and neighborhood safety, generally enhanced flourishing. However, the accessibility of neighborhood resources was paradoxically associated with material stability, pointing to the complexity of environmental factors in human flourishing. CONCLUSION: This study provides a comprehensive network analysis that reveals intricate connections between personal, behavioral, and environmental factors, offering profound insights for targeted interventions to foster human flourishing.

Working retirees in Taiwan: examining determinants of different working status after retirement.

This study aims to investigate the factors influencing the work status of retirees after retirement, especially focusing on self-employment and unpaid work. Data was taken and analyzed from the "Taiwan Health and Retirement Study," a nationally representative sample of retired personnel aged 50-74 in 2015-2016. Four types of work status were classified after retirement: Fully retired, Paid work, Self-employment, and Unpaid work. Multinomial regression analysis was used to explore the factors related to participation in paid, self-employed, and unpaid work. Results show that pre-retirement occupation was significantly associated with paid work after retirement. For example, retirees in Taiwan who were employed by private enterprises or self-employed before retirement were more likely to engage in paid work after retirement than civil servants before retirement. Two other factors, namely pre-retirement job stress and work flexibility, prolong the careers of retired workers, especially in self-employment and unpaid work after retirement. Gender also significantly affects the choice of work after retirement. These findings can be used as a reference for future policies on the aging labor force.

Prevalence and Determinants of Multiple Forms of Malnutrition among Adults with Different Body Mass Index: A Population-Based Survey in the Philippines.

Background: The multiple forms of malnutrition, including overnutrition, undernutrition, and diet-related noncommunicable diseases, are emerging crises in Asian countries. Past studies have focused more on malnutrition among overweight/obese individuals; however, limited research has examined chronic energy-deficient adults. Therefore, this study is aimed at investigating the prevalence and determinants of different forms of malnutrition among adults with different body mass index, using the Philippines as an example. Findings from this study will guide the development and implementation of public health nutrition programs and policies. Methods: A representative dataset from the 2013 Philippine National Nutrition Survey was used in the study. Adults aged ≥20 years (n = 16,826) were included in the analysis after excluding those with missing values. Six phenotypes of malnutrition were assessed, including three in overweight/obese adults (overweight/obese with metabolic syndrome; those with micronutrient deficiency-anemia, vitamin A deficiency, and iodine insufficiency; and those with both metabolic syndrome and micronutrient deficiency) and three in chronic energy-deficient (CED) adults (CED with either metabolic syndrome or micronutrient deficiency and with both metabolic syndrome and micronutrient deficiency). Sociodemographic and lifestyle factors were examined as the determinants of different forms of malnutrition, and multinomial logistic regression analyses were performed. Results: The prevalence of the six phenotypes of malnutrition ranged from 0.4% to 10.2%, where overweight/obese with metabolic syndrome was the most predominant type. The multinomial logistic regression models indicated that older age was the major risk factor across all phenotypes. Sex was associated with the outcomes in the overweight/obesity group, whereas employment status was correlated with CED adults. Furthermore, higher educational levels, being married, living in affluent households, and not smoking were protective factors for conditions related to CED but not overweight/obese individuals. Conclusion: Malnutrition in all its forms is a significant public health concern that must be understood and addressed. Policymakers should implement appropriate intervention programs to control these nutritional problems considering the specific risk factors for the adult population.

Retirement planning and types of healthy lifestyle after retirement: a Nationwide Survey in Taiwan.

Limited research has examined the components of retirement planning and the effects on retirees' health behaviors. This study aims to explore whether retirement planning is associated with different types of healthy lifestyles after retirement. We conducted a nationwide Health and Retirement Survey in Taiwan and analyzed the data from 2015 to 2016. A total of 3128 retirees aged 50-74 years were included in the analysis. Twenty items on retirement planning from five categories were administered, and 20 health-related behaviors were used for measuring healthy lifestyles. Results showed that five types of healthy lifestyles were found from the 20 health behaviors by factor analysis. After controlling for all covariates, various components of retirement planning were associated with different types of lifestyles. Retirees having any item of retirement planning would significantly increase the score of 'healthy living'. Those with 1-2 items were also associated with the total score and the type of 'no unhealthy food'. However, those with ≥ 6 items were the only group positively related to the type of 'regular health checkups' but negatively to the type of 'good medication'. In conclusion, retirement planning offers a 'window of opportunity' for promoting healthy lifestyles after retirement. Pre-retirement planning should be advocated in the workplace to improve health-related behaviors, especially for those upcoming retired workers. In addition, a friendly environment and continuous programs should also be incorporated for better retirement life.

Associations of Urban Residence and Wealth Index With Various Sources of Contraceptives Among Young Women Aged 15-24 Years in 25 Sub-Saharan African Countries.

PURPOSE: Appreciating user differences in contraceptive sources is essential for improving contraceptive access and safeguarding an equitable and sustainable future. Therefore, this study explored whether urban residence and individual wealth are associated with where women access contraception (e.g., government, private, or nongovernmental organization provider) and assessed whether these associations are modified by the income level in the respondents' country of residence. METHODS: We analyzed the cross-sectional data of Demographic Health Surveys conducted between 2009 and 2020 in 25 countries. The final data set included 25,081 young women aged between 15 and 24 years who are using contraceptives. Multinomial logistic regression models were established to assess the associations of our outcome variable, namely, various contraceptive sources, with our main independent variables, namely, urban residence and wealth index. We also assessed the potential effect modification by country income level on the above associations. RESULTS: We observed obvious urban-rural and rich-poor disparities in odds of using contraceptive sources. Generally, living in urban residences and being wealthy were positively associated with all sources of contraceptives. However, these associations were mostly modified by country income level. People living in urban residences utilized more private sources, especially in low-income (beta coefficient, B = 0.973) and upper-middle-income countries (B = 1.361). Young women in urban areas across all analyzed countries were also more likely to use contraceptives from other sources (B = 0.267). In addition, women from poor households were less likely to use private sources (B = -1.166) and other sources (B = -0.547). DISCUSSION: Even though young women may prefer private sources of contraceptives due to their confidentiality and flexible hours, these sources carry more benefits for rich and urban young women than for poor and rural women. The differential accessibility and affordability may account for the observed urban-rural and rich-poor disparities in using contraceptive sources, respectively, and the income level of a country is likely to modify such disparities.

A Review on Dietary Patterns and Double Burden of Malnutrition: Knowledge Gaps for Future Research.

Nutrition transition is characterized by shifts in dietary patterns (DPs) and is one of the factors associated with the double burden of malnutrition (DBM). Evidence indicates correlations between DPs and obesity, diabetes, and cardiovascular diseases. However, little is known on how DP influences DBM. This mini-review examined DP-DBM relationship among adults along with different DP approaches and DBM definitions. A structured search of peer-reviewed articles was performed from Web of Science. Keywords related to "dietary patterns," "double burden of malnutrition," and "adults" were used. A total of 133 studies were included. Results showed that factor analysis was the predominant DP analysis method. DBM was frequently assessed at the national level and defined as the coexistence of overweight/obesity and underweight. From the 133 studies, only four articles investigated DP-DBM association and suggested that healthier DPs positively improved DBM. Significant knowledge gaps remain, including (1) application of a combination of DP approaches, (2) evaluation of individual-level and household-level DBM, and (3) inconsistency of micronutrient deficiencies and non-communicable disease indicators in DBM definition. This review revealed paucity of studies on the nexus of DPs and DBM. Future research is imperative to establish evidence on the link between food patterns and multiple burdens of malnutrition.

The long-term effects of dual caregiving on the caregivers' well-being among middle-aged and older adults in Taiwan.

OBJECTIVES: As life expectancy is prolonged, older people may face increased burdens related to supporting multi-generational family members. This study is aimed toward examining the effects of such an emerging type of informal care on the well-being of caregivers. METHODS: Participants aged 50 and over from the Taiwan Longitudinal Study on Aging (1996-2007, n = 4,217) were analyzed. We categorized caregiving status according to different care recipients: 1) older adults only, 2) grandchildren only, 3) both older adults and grandchildren (dual caregiving), and 4) non-caregivers. Well-being was measured based on depressive symptoms and degree of life satisfaction. Generalized Estimation Equation models were used to examine the association between types of caregiving and the caregivers' state of well-being. RESULTS: After adjusting for all covariates, caregivers of older adults had significantly more depressive symptoms and less life satisfaction than non-caregivers, especially when caregiving for adults with ADL problems. In contrast, caregivers of grandchildren were not significantly affect either depression or life satisfaction as compared with non-caregivers. Interestingly, caregiving for both older adults and grandchildren had no significant effect on depression but positively affected the degree of life satisfaction. CONCLUSION: Our findings highlight that simultaneously taking care of both older adults and grandchildren can buffer negative feelings in caregivers or even improve their mental health.

The changes in feeling of loneliness after retirement among baby boomers and pre-boomers in Taiwan: Do work-family conflict before retirement and social engagement after retirement matter?

Significance: Few studies have analyzed how loneliness-related factors differ across generations for older adults in non-Western societies. Building upon the stress process model, this study aimed to explore the relationships between work-family conflict before retirement, social engagement after retirement and changes in loneliness after retirement among retirees across two birth cohorts (Baby Boomers and pre-Boomers) in Taiwan. Methods: Data from the Taiwan Health and Retirement Study, a nationwide retired cohort sample collected from two waves between 2015/2016 and 2018/2019, was analyzed. A total of 2370 retirees aged 50-74 years were included in the analysis after excluding those who died or were lost to follow-up. Multivariate multinomial logistic models were used to estimate four types of changes in loneliness: (1) remaining not lonely, (2) becoming not lonely, (3) becoming lonely, and (4) remaining lonely. Results: About two-thirds of the retirees remained not lonely, and less than 10% maintained their feelings of loneliness across two waves. Multinomial logit models showed that both cohorts who experienced work-family conflict before retirement and stressful life events after retirement had higher odds of remaining lonely than those who remained not lonely. However, an increase in social engagement, especially social contact, appeared to be a protective factor against becoming and remaining lonely for both cohorts. Yet, work-related characteristics before retirement were significantly related to the changes in loneliness among pre-Boomers rather than Baby Boomers. Conclusions: The results suggest that work-family conflict before retirement produces an exacerbating effect; in contrast, social engagement after retirement is beneficial to not feeling lonely across two birth cohorts in Taiwan. This investigation highlights the importance of social stressors occurring before retirement because these have an effect on retirees' feelings of loneliness beyond individual socioeconomic status.

Sex Differences in Dietary Patterns of Adults and Their Associations with the Double Burden of Malnutrition: A Population-Based National Survey in the Philippines.

A dietary pattern transition is a risk factor for the double burden of malnutrition (DBM), but related information is limited. This study aimed to identify sex differences in dietary patterns of adults in a low-middle income country and to examine their association with DBM. A total of 8957 adults (4465 men and 4492 non-pregnant and non-lactating women) who participated in the 2013 Philippine National Nutrition Survey were included in the analysis. Logistic regression models were formulated to investigate the relationship between dietary patterns and DBM. The factor analysis derived seven dietary patterns for males and six patterns for females. Results showed that approximately 30% of Filipino adults suffered from DBM. The rice pattern was associated with lower odds of DBM for males only. The meat and sugar pattern in males and the protein-rich foods, cereal, and sugar pattern in females decreased DBM likelihood. An inverse relationship was observed for the vegetables and corn patterns, wherein females had an increased risk for DBM. Our findings suggest that rice-based and meat-containing patterns could play protective roles in DBM development among adults in the Philippines. Understanding sex-specific dietary patterns can be utilized to guide public health nutrition interventions in the prevention of malnutrition in all its forms.

A new approach to generating virtual samples to enhance classification accuracy with small data-a case of bladder cancer.

In the medical field, researchers are often unable to obtain the sufficient samples in a short period of time necessary to build a stable data-driven forecasting model used to classify a new disease. To address the problem of small data learning, many studies have demonstrated that generating virtual samples intended to augment the amount of training data is an effective approach, as it helps to improve forecasting models with small datasets. One of the most popular methods used in these studies is the mega-trend-diffusion (MTD) technique, which is widely used in various fields. The effectiveness of the MTD technique depends on the degree of data diffusion. However, data diffusion is seriously affected by extreme values. In addition, the MTD method only considers data fitted using a unimodal triangular membership function. However, in fact, data may come from multiple distributions in the real world. Therefore, considering the fact that data comes from multi-distributions, in this paper, a distance-based mega-trend-diffusion (DB-MTD) technique is proposed to appropriately estimate the degree of data diffusion with less impacts from extreme values. In the proposed method, it is assumed that the data is fitted by the triangular and trapezoidal membership functions to generate virtual samples. In addition, a possibility evaluation mechanism is proposed to measure the applicability of the virtual samples. In our experiment, two bladder cancer datasets are used to verify the effectiveness of the proposed DB-MTD method. The experimental results demonstrated that the proposed method outperforms other VSG techniques in classification and regression items for small bladder cancer datasets.

Dietary Patterns and Their Association with Sociodemographic and Lifestyle Factors in Filipino Adults.

Recent studies have investigated dietary patterns to assess the overall dietary habits of specific populations. However, limited epidemiological research has been conducted to explore the unique dietary intakes in low and middle-income countries. This study aims to examine the dietary patterns of Filipino adults and their association with sociodemographic and lifestyle factors. A total of 10,025 adults (≥20 years old) who participated in the 2013 Philippine National Nutrition Survey were included in the analysis. Dietary patterns were derived using factor analysis of 18 food groups from the dietary survey component. Six dietary patterns were identified, namely (1) rice; (2) cereal, milk, sugar, and oil; (3) fruits and miscellaneous food; (4) fish; (5) vegetables and corn; and (6) meat and beverage. Generalized ordered logistic regression analysis indicated that the dietary patterns were associated with different factors, specifically sex, age, educational attainment, marital status, employment status, household size, wealth quintile, smoking status, alcohol consumption, and physical activity. Our findings showed distinct dietary patterns among Filipino adults that were influenced by various sociodemographic and lifestyle parameters. The results of this study have valuable public health implications and the dietary patterns generated can further be used to analyze the link between diet and health outcomes.

The public-sector family planning program impact scores in association with long-acting reversible contraceptive use among young women in 22 Sub-Saharan African countries: A pooled multi-level analysis.

OBJECTIVE: The objective of this study was to evaluate the role of public-sector family planning program impact scores and other country-level factors on LARC use among young women aged 15 to 24. STUDY DESIGN: We conducted this research using a large population database covering several decades' worth of multi-wave cross-sectional samples of the demographic health survey (DHS) and the World Bank website data. We carried out a multi-level analysis on data from 1990 to 2019 from 22 Sub-Saharan African countries, with 163,242 participants. RESULTS: We found LARC use was at 3.1% of all young women under study. Sierra Leone, 2019 survey had the highest LARC use at 21,961 per 100,000. A 10% increase in public-sector family planning program impact scores was positively associated with LARC use with odds ratio of 1.44, 95% CI, 1.43-1.45). We also noted that a 1% increase in HIV prevalence was associated with a reduced odds ratio of LARC use at 0.75 (95% CI, 0.70-0.81). CONCLUSIONS: Findings from this study provide empirical evidence highlighting the importance of country-level factors in influencing LARC use among young women in sub-Saharan Africa IMPLICATIONS: For young women in Africa, policymakers need to increase their effort on national family planning programs especially in the public sector. Broader societal level interventions to improve LARC use are required. Specific interventions must address the complexities of HIV prevention and LARC use to benefit young women living in countries with a high HIV prevalence.

The Double Burden of Malnutrition at the Individual Level Among Adults: A Nationwide Survey in the Philippines.

Introduction: Double burden of malnutrition (DBM) is a fast-evolving public health challenge. The rising prevalence of obesity and diet-related non-communicable diseases alongside persistent nutritional deficiencies are compelling problems in many developing countries. However, there is limited evidence on the coexistence of these conditions in the same individual among community-dwelling adults. This cross-sectional study describes the various forms of DBM and examines the determinants of DBM at the individual level among adults in the Philippines. Materials and Methods: A nationwide dataset from the 2013 Philippine National Nutrition Survey was used. The final study sample consisted of 17,157 adults (8,596 men and 8,561 non-pregnant and non-lactating women). This study focused on three DBM types within adults: (#1) Underweight and at least one cardiometabolic risk factor (Uw + ≥1 CMRF), (#2) Anemia and at least one cardiometabolic risk factor (An + ≥1 CMRF), (#3) Vitamin A deficiency or iodine insufficiency and at least one cardiometabolic risk factor (Other MND + ≥1 CMRF). The total double burden of malnutrition was also evaluated as the sum of the aforementioned three types. Logistic regression models were used to assess associations between socio-demographic and lifestyle factors and DBM. Results: The prevalence of the three types of DBM were: type #1, 8.1%; type #2, 5.6%; type #3, 20.6%, and the total DBM prevalence was 29.4%. Sex, age, educational attainment, employment status, wealth quintile, and alcohol drinking were the risk factors for DBM. In contrast, marital status, smoking, and physical activity were associated with the different DBM types. Conclusion: The study findings contribute to the current state of knowledge on the broad spectrum of individual-level DBM. Understanding the disparities of this phenomenon could guide integrated actions directed to the concomitance of malnutrition in various forms and cardiometabolic disease risks.

Prevalence and Determinants of the Co-Occurrence of Overweight or Obesity and Micronutrient Deficiencies among Adults in the Philippines: Results from a National Representative Survey.

The double burden of malnutrition (DBM) affects many low- and middle-income countries. However, few studies have examined DBM at the individual level, or undernutrition and overnutrition co-occurring within the same person. This study aims to investigate the prevalence and determinants of DBM among adults in the Philippines. Data from the 2013 National Nutrition Survey were used. The sample size in the analysis was 17,010 adults aged ≥20 years old, after excluding pregnant and lactating women. DBM was defined as the co-occurrence of overweight/obesity and anemia (definition #1), overweight/obesity and anemia or vitamin A deficiency (definition #2), and overweight/obesity and anemia or vitamin A deficiency or iodine insufficiency (definition #3). Anthropometric measurements and biochemical markers were used for DBM assessment. Data were analyzed using descriptive statistics, the chi-square test, and logistic regression by R software. Results showed that definition #3 is the predominant type of DBM (7.0%) in the general population, whereas the prevalence of DBM has increased to 23.7% in overweight/obese persons. Sex, age, educational attainment, marital status, household size, wealth quintile, and smoking status were the determinants of DBM. This study revealed that Filipino adults experience malnutrition critically and must be addressed through food and nutrition interventions.

Social-Economic Environments and Depressive Symptoms in Community-Dwelling Adults: A Multi-Level Analysis for Two Nationwide Datasets in Taiwan.

Most studies have focused on factors associated with depression at the individual level, and evidence on ecological models linking social-economic features with depression is rare in Taiwan. This study aimed to use multi-level analysis to explore the effects of social-economic environments on depressive symptoms among Taiwanese adults. The 2009 National Health Interview Survey (NHIS) and the Age-Friendly Environments database were linked in this study. A total of 6602 adults aged 20 years and older were included in the analysis. A Chinese version of the 10-item CESD was used as the outcome measure. Three social indicators (population density, divorce rate, and crime rate) and three economic indicators (unemployment rate, per capita disposable income, and per capita government expenditures) at the ecological level were examined. Results showed that two social environments and two economic features were significantly associated with depressive symptoms. However, the effects of these factors were different by gender and age groups. The economic environments were critical for males and young adults aged 20-44 years old, whereas the social environments were significant for females and middle-aged and older adults. Intervention efforts for depression prevention should integrate ecological approaches into the effects of social-economic environments on depressive symptoms.

The Optimal Timing for Using Capsule Endoscopy for Patients with Gastrointestinal Bleeding.

OBJECTIVES: Capsule endoscopy (CE) is a useful diagnostic modality for patients with occult gastrointestinal (GI) bleeding. However, most previous studies utilizing CE have focused on techniques, patient characteristics, safety and feasibility, and case analyses. Studies evaluating the optimal timing for utilizing CE, which is an essential factor for obtaining a better diagnostic yield, remain scarce in the literature. Considering that a CE examination is expensive, we, therefore, undertook this study to evaluate, analyze, and determine the optimal time for performing CE in patients with occult GI bleeding. METHODS: Seventy-five patients were initially recruited, but finally, sixty patients with significant GI bleeding with an unknown etiology after traditional endoscopic examinations were included in the study. All data were collected from a local hospital in Taiwan, encompassing the period from 2010 to 2018. The relationship between the timing of CE examination and the diagnostic correction rate (DCR) was then analyzed statistically. RESULTS: More female (58.3%) and older adult (68.3%) patients were in our study. Based on the four analytical models used in the study, the results showed that the most optimal time to perform CE is within three days after GI bleeding occurs.

Opportunity for HiAP through a Healthy Cities initiative in Taiwan: a multiple streams analysis.

Health in All Policies (HiAP) is an effective approach to promote population health through addressing comprehensive social determinants of health. In 1997, the World Health Organization designed a 20-step protocol for developing a Healthy Cities (HC) project to build healthy public policies. Taiwan adopted the concept of HC in 2002 and established the first demonstration project in Tainan City in 2003. This study explores the impact of the HC initiative on the development of HiAP, as well as how a window of opportunities for HiAP was opened through the HC movement, using Tainan City as an example. Tainan was selected as the case for this study because of its relative maturity in the development of an HC initiative. A theory-driven thematic analysis was conducted in the study with archived documents between 2003 and 2010. We first adopted a Multiple Streams Approach to examine how the city government opened a window for HiAP through the HC initiative and then drew on the Maturity Model to evaluate the stage of HiAP in the Tainan HC project. After analyzing all related documents, we concluded that HiAP in the Tainan HC project had reached Stage V Institutionalization after 7 years. Key contexts, factors, challenges and strategies were identified. This study suggests that the HC initiative can indeed contribute to the development of HiAP and that the window was opened for HiAP through a concurrence of the three streams of problem, policy and politics along with the HC movement process.

Exploring the role of built environments and depressive symptoms in community-dwelling older adults: A case of Taiwan.

OBJECTIVES: Depression in older adults is a growing public health concern. However, limited research has focused on the issues of physical environments and depression in the elderly in Asia. The purpose of the study is to examine the relationship between the built environments and depressive symptoms in older adults using Taiwan as an example. METHODS: Two national datasets were used in this study, including the 2009 National Health Interview Survey and the 2006 National Land Use Investigation in Taiwan. A total of 2,155 older adults were recruited, and eight built environments were examined among 161 townships. Depressive symptoms were measured using a 10-item CES-D scale, and four sophisticated models were built using a multi-level analysis. RESULTS: Five types of built environments were found to be significantly associated with depressive symptoms in older adults. Among them, two types of built environments, 'health and medical services' and 'schools' were highly related to a lower CES-D score and lower odds of being depressed, whereas the other three built environments, 'cultural and historical facilities,' 'recreational and amusement areas,' and 'playgrounds and sports venues' were significantly associated with an increasing risk of being depressed. CONCLUSIONS: Different built environments had different effects on depression and some even showed a dose-response relationship. These results can help urban planners or city designers reconsider how to facilitate the construction of built environments in neighborhoods that will improve the mental health of older adults.

Effects of physical and social environments on the risk of dementia among Taiwanese older adults: a population-based case-control study.

BACKGROUND: Physical and social environments may influence cognition health in older adults. However, evidence regarding physical and social environments linked to dementia is lacking, especially in Asia. This study aims to explore the influence of physical and social environments on the incidence of dementia through a population-based case-control design in Taiwan. METHODS: We identified 26,206 incident cases with dementia aged≧65 years in 2010, with the same no. of controls from National Health Insurance claims. Environmental measures were collected from government statistics including three physical environments and three social environments. Multilevel logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CI) of the association between dementia incidence and the environmental measures at the township level. RESULTS: We observed a significant reduction of 12% in the odds ratios of dementia in areas with higher availability of playgrounds and sport venues (OR 0.88, 95% CI 0.81-0.95), after controlling for individual and other environmental characteristics. Community center availability was also significantly associated with an 8% decreased odds for dementia (OR 0.92, 95% CI 0.87-0.99), but the association was not significant after further consideration of individual-level characteristics. Although higher odds of dementia were found in areas with high median annual family income (OR 1.14, 95% CI 1.04-1.25), such a significant relationship did not appear in the full model. CONCLUSIONS: Our study suggests that specific physical and social environmental features have different influences on the risk of dementia. Public health interventions may consider these environmental aspects for preventing dementia incidence.