The indirect impact of the COVID-19 pandemic on people with type 2 diabetes mellitus and without COVID-19 infection: Systematic review and meta-analysis.

BACKGROUND: The effect directly from the coronavirus disease 2019 (COVID-19) infection on health and fatality has received considerable attention, particularly among people with type 2 diabetes mellitus (T2DM). However, evidence on the indirect impact of disrupted healthcare services during the pandemic on people with T2DM is limited. This systematic review aims to assess the indirect impact of the pandemic on the metabolic management of T2DM people without a history of COVID-19 infection. METHODS: PubMed, Web of Science, and Scopus were systematically searched for studies that compared diabetes-related health outcomes between pre-pandemic and during-pandemic periods in people with T2DM and without the COVID-19 infection and published from January 1, 2020, to July 13, 2022. A meta-analysis was performed to estimate the overall effect on the diabetes indicators, including hemoglobin A1c (HbA1c), lipid profiles, and weight control, with different effect models according to the heterogeneity. RESULTS: Eleven observational studies were included in the final review. No significant changes in HbA1c levels [weighted mean difference (WMD), 0.06 (95% CI -0.12 to 0.24)] and body weight index (BMI) [0.15 (95% CI -0.24 to 0.53)] between the pre-pandemic and during-pandemic were found in the meta-analysis. Four studies reported lipid indicators; most reported insignificant changes in low-density lipoprotein (LDL, n = 2) and high-density lipoprotein (HDL, n = 3); two studies reported an increase in total cholesterol and triglyceride. CONCLUSIONS: This review did not find significant changes in HbA1c and BMI among people with T2DM after data pooling, but a possible worsening in lipids parameters during the COVID-19 pandemic. There were limited data on long-term outcomes and healthcare utilization, which warrants further research. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022360433.

Diabetes with poor-control HbA1c is cardiovascular disease 'risk equivalent' for mortality: UK Biobank and Hong Kong population-based cohort study.

INTRODUCTION: Type 2 diabetes mellitus (T2DM) has traditionally been considered a coronary heart disease 'risk equivalent' for future mortality, but significant heterogeneity exists across people with T2DM. This study aims to determine the risk of all-cause mortality of patients with cardiovascular disease (CVD) and T2DM in UK and Hong Kong, with stratifications for hemoglobin A1 (HbA1c) concentrations, compared with those without CVD and diabetes mellitus. RESEARCH DESIGN AND METHODS: This is a retrospective cohort study of 3 839 391 adults from Hong Kong and a prospective cohort study of 497 779 adults from the UK Biobank. Individuals were divided into seven disease groups: (1) no T2DM and CVD, (2) T2DM only with HbA1c <7%, (3) T2DM only with HbA1c 7%-7.9%, (4) T2DM only with HbA1c 8%-8.9%, (5) T2DM only with HbA1c ≥9%, (6) CVD only, and (7) T2DM and CVD. Differences in all-cause mortality between groups were examined using Cox regression. RESULTS: After around 10 years of median follow-up, 423 818 and 19 844 deaths were identified in the Hong Kong cohort and UK Biobank, respectively. Compared with individuals without T2DM and CVD, the adjusted HR for all-cause mortality in the other six disease groups for the Hong Kong cohort was 1.25 (95% CI 1.23 to 1.27) for T2DM only with HbA1c <7%, 1.21 (95% CI 1.19 to 1.23) for T2DM only with HbA1c 7%-7.9%, 1.36 (95% CI 1.33 to 1.39) for T2DM only with HbA1c 8%-8.9%, 1.82 (95% CI 1.78 to 1.85) for T2DM only with HbA1c ≥9%, 1.37 (95% CI 1.36 to 1.38) for CVD only, and 1.83 (95% CI 1.81 to 1.85) for T2DM and CVD, and for the UK Biobank the HR was 1.45 (95% CI 1.33 to 1.58), 1.50 (95% CI 1.32 to 1.70), 1.72 (95% CI 1.43 to 2.08), 2.51 (95% CI 2.05 to 3.08), 1.67 (95% CI 1.59 to 1.75) and 2.62 (95% CI 2.42 to 2.83), respectively. This indicates that patients with T2DM had an increased risk of mortality compared with those without T2DM and CVD, and in those with HbA1c ≥9% an even higher risk than people with CVD. CONCLUSIONS: Patients with T2DM with poor HbA1c control (8%-8.9% and ≥9%) were associated with similar and higher risk of mortality compared with patients with CVD, respectively. Optimal HbA1c, controlled for risk reduction and prevention of mortality and complications in diabetes management, remains important.

Long-term spill-over impact of COVID-19 on health and healthcare of people with non-communicable diseases: a study protocol for a population-based cohort and health economic study.

INTRODUCTION: The COVID-19 pandemic has a significant spill-over effect on people with non-communicable diseases (NCDs) over the long term, beyond the direct effect of COVID-19 infection. Evaluating changes in health outcomes, health service use and costs can provide evidence to optimise care for people with NCDs during and after the pandemic, and to better prepare outbreak responses in the future. METHODS AND ANALYSIS: This is a population-based cohort study using electronic health records of the Hong Kong Hospital Authority (HA) CMS, economic modelling and serial cross-sectional surveys on health service use. This study includes people aged ≥18 years who have a documented diagnosis of diabetes mellitus, hypertension, cardiovascular disease, cancer, chronic respiratory disease or chronic kidney disease with at least one attendance at the HA hospital or clinic between 1 January 2010 and 31 December 2019, and without COVID-19 infection. Changes in all-cause mortality, disease-specific outcomes, and health services use rates and costs will be assessed between pre-COVID-19 and-post-COVID-19 pandemic or during each wave using an interrupted time series analysis. The long-term health economic impact of healthcare disruptions during the COVID-19 pandemic will be studied using microsimulation modelling. Multivariable Cox proportional hazards regression and Poisson/negative binomial regression will be used to evaluate the effect of different modes of supplementary care on health outcomes. ETHICS AND DISSEMINATION: The study was approved by the institutional review board of the University of Hong Kong, the HA Hong Kong West Cluster (reference number UW 21-297). The study findings will be disseminated through peer-reviewed publications and international conferences.

Risk factors associated with tuberculosis recurrence in South Korea determined using a nationwide cohort study.

OBJECTIVE: Prevention of tuberculosis (TB) recurrence is an important issue in TB control. South Korea, a country with a high average income, has been challenged with an intermediate burden of TB. We aimed to estimate the TB recurrence rate after successful completion of the first anti-TB chemotherapy, and to identify the risk factors for the TB recurrence by focusing on co-morbidities and behavioral factors. METHODS: This is a population-based cohort study using data from the National Health Insurance (NHI) database between 2002 and 2013. Newly diagnosed TB patients were identified using the classification of disease codes and prescription records. Final analytical subjects included people who successfully completed the first anti-TB chemotherapy. The primary outcome measure was recurrent TB 6-month after the first treatment completion. A set of associated risk factors, including demographic characteristics, co-morbidities, and health behavior factors were analyzed using Cox regression analysis. RESULTS: Among 5,446 TB patients, 2,226 (40.1%) completed the first anti-TB treatment. During the follow-up period, 150 (6.7%) patients had TB recurrence, and the crude recurrent rate was 22.6 per 1000 person-years. The majority of recurrence cases (89%) occurred within the first 2-year period. The major findings show that participants who are male (adjusted HR (aHR) = 1.81, at a 95% CI, range: 1.11-2.94), older in age (aHR = 1.07, at a 95% CI, range: 1.00-1.14), have a lower income (aHR = 1.96, at a 95% CI, range: 1.10-3.48) and who are underweight (aHR = 1.92, at a 95% CI, range 1.15-3.20) were at higher risks for TB recurrence. CONCLUSION: People who have risk factors for recurrent TB need to improve treatment compliance through more effective TB management, and follow-up observation for one or two years after the treatment completion.

Risk of suicide death in psychiatric patients according to the level of continuity of care and area deprivation: A population-based nested case-control study.

Continuity of care and area deprivation have been implicated as possible risk factors of suicide in psychiatric patients. This nested case-control study aimed to examine the association between continuity of care and area deprivation and suicide death in patients with psychiatric disorders. Data were collected from the Korean National Health Insurance Service National Sample Cohort, 2003-2013. The subjects were 974 patients with psychiatric disorders who completed suicides. Each case was compared to three control cases with propensity score matching by gender, age, and follow-up period with incidence density sampling, comprising the final control group of 2,922 living patients. Hazard ratios (HR) for suicide risk considering continuity of care and area deprivation were analysed using a multiple conditional logistic regression. The average follow-up periods between the case and control groups were not statistically different (case: 277.6 weeks, control: 271.4 weeks, p = .245). Both poor continuity of care and higher area deprivation proved to be associated with increased risk of suicide (poor continuity of care; adjusted HR [AHR]: 3.38, 95% confidence intervals [CI]: 2.58-4.43, highest area deprivation; AHR: 1.93, 95% CI: 1.53-2.44). Poor continuity of care combined with highest area deprivation showed a negative synergistic effect on a highly increased risk of suicide (AHR: 2.88, 95% CI: 1.45-5.74). Age was effect modified between suicide risk and poor continuity of care as well as suicide risk and higher area deprivation. A strong patient-provider relationship with good continuity of care may lead to a lower possibility of suicide in psychiatric patients. Moreover, improving community capacity for suicide prevention as well as appropriate postvention should be addressed.

Disparities in diabetes-related avoidable hospitalization among diabetes patients with disability using a nationwide cohort study.

Diabetes is an ambulatory care sensitive condition that quality of care can prevent complications development and hospitalization needs. However, diabetes patients with disability face greater challenges with receiving quality diabetes care than those without disabilities. This study examined diabetes-related avoidable hospitalizations (DRAH) focusing on the association with disability. We used nationally representative health insurance cohort data from 2002 to 2013. The study population is people who were newly diagnosed with type 2 diabetes. We measured the cumulated number of DRAH using the Prevention Quality Indicators (PQIs). The variables of interest were disability severity and type. We performed a recurrent events analysis using Cox proportional hazard regression model. Among 49,410 type 2 diabetes patients, 12,231 (24.8%) experienced DRAHs at least once during the follow-up period. Among the total population, 5924 (12.0%) diabetes patients were registered as disabled. The findings report that disability severity was significantly associated with higher risks for DRAH, where severely disabled diabetes patients showed the highest hazard ratio of 2.24 (95% CI 1.80-2.79). Among three DRAH indicators, severely disabled diabetes patients showed increased risks for long-term (AHR 2.21, 95% CI 1.89-2.60) and uncontrolled (AHR 2.28, 95% CI 1.80-2.88) DRAH. In addition, intellectual (AHR 5.52, 95% CI 3.78-8.05) and mental (AHR 3.97, 95% CI 2.29-6.89) disability showed higher risks than other types of disability. In conclusion, diabetes patients with disability are at higher risk for DRAH compared to those without disabilities, and those with intellectual and mental disabilities were more likely to experience DRAH compared to those with physical or other types of disability. These findings call for action to find the more appropriate interventions to improve targeted diabetes primary care for patients with disability. Further research is needed to better understand determinants of increasing risks of DRAH.

Association between community deprivation and practising health behaviours among South Korean adults: a survey-based cross-sectional study.

OBJECTIVES: This study aimed to determine the association between community deprivation and poor health behaviours among South Korean adults. DESIGN: This was a survey-based cross-sectional study. SETTING AND PARTICIPANTS: Data of 224 552 participants from 244 communities were collected from the Korea Community Health Survey, conducted in 2015. PRIMARY AND SECONDARY OUTCOME MEASURES: We defined health behaviours by combining three variables: not smoking, not high-risk drinking and walking frequently. Community deprivation was classified into social and economic deprivation. RESULTS: Multilevel logistic analysis was conducted to determine the association of poor health behaviours through a hierarchical model (individual and community) for the 224 552 participants. Among them, 69.9% did not practice healthy behaviours. We found that a higher level of deprivation index was significantly associated with higher odds of not-practising healthy behaviours (Q3, OR: 1.15, 95% CI: 1.00 to 1.31; Q4 (highest), OR: 1.22, 95% CI: 1.06 to 1.39). Economic deprivation had a positive association with not-practising health behaviours while social deprivation had a negative association. CONCLUSION: These findings imply that community deprivation levels may influence individual health behaviours. Accordingly, there is a need for enforcing the role of primary healthcare centres in encouraging a healthy lifestyle among the residents in their communities, developing national health policy guidelines for health equity and providing financial help to people experiencing community deprivation.

Frailty transitions and cognitive function among South Korean older adults.

Frailty is considered a multidimensional geriatric syndrome, manifested by the accumulation of age-associated deficits. The consequences of frailty transitions are still understudied. This study evaluated the influence of frailty transitions on cognitive function in the older adult population. We used data derived from the Korean Longitudinal Study of Aging (KLoSA) (2008-2018) on older adults aged ≥ 65 years. Frailty was assessed using a validated Korean frailty measure known as the frailty instrument (FI), and cognitive function was measured using the Korean version of the Mini-Mental State Examination (K-MMSE). Transitions in frailty and their relationship with cognitive function were investigated using lagged generalized estimating equations (GEE), t-tests, and ANOVA. Respondents who experienced frailty transitions (those with ameliorating frailty), those who developed frailty, and whose frailty remained constant, were more likely to have a lower cognitive function than those who were consistently non-frail. Older age, activities of daily living (ADL) disability, and instrumental ADL disability were more negatively associated with declining cognitive function, especially in the "frail → frail" group. Changes in all individual components of the frailty instrument were significantly associated with impaired cognitive function. The results suggest an association between frailty transitions and cognitive impairment. Over a 2-year span, the remaining frail individuals had the highest rate of cognitive decline in men, while the change from non-frail to frail state in women was significantly associated with the lowest cognitive function values. We recommend early interventions and prevention strategies in older adults to help ameliorate or slow down both frailty and cognitive function decline.

Household income changes and suicidal ideation in South Korea: Findings from a longitudinal study.

INTRODUCTION: This study aimed to provide evidence for the need for social and welfare support in suicide prevention. METHODS: Data were collected from the Korean Welfare Panel Study, 2011-2016. The study sample consisted of 7504 people (male: 3080 and female: 4424; mean age: 54.4 ± 16.6), with annual follow-ups until 2016. A generalized linear mixed-effects model using a logit link function with random intercept for longitudinal binary data was employed to identify the association between household income change and suicidal ideation status. RESULTS: Suicidal ideation was found in 279 (3.7%) people at the baseline year. A drastic reduction in household income was associated with an increased probability of having suicidal ideation (adjusted odds ratio: 2.205, 95% confidence interval: 1.326-3.666). Using interaction analyses, those who had a drastic reduction in household income and were married, males, aged 40-49, and previously in a middle- to high-income group showed a higher probability of having suicidal ideation. CONCLUSION: A drastic reduction in household income was associated with a higher probability of suicidal ideation, with specific differences according to gender, age, previous household income level, and marital status. This study reinforces the need for social and welfare support in suicide prevention policies and programs.

The Impact of Transitions in Caregiving Status on Depressive Symptoms among Older Family Caregivers: Findings from the Korean Longitudinal Study of Aging.

This study identifies the effects of transitions in caregiving status on depressive symptoms among middle-aged or older adults who care for family members with limitations in activities of daily living (ADL). Data were collected from the 2006-2018 Korean Longitudinal Study of Aging. A total of 7817 subjects were included. On the basis of their caregiving status transition, participants were categorized into four groups: started caregiving, continued caregiving, stopped caregiving, and noncaregivers. Depressive symptoms were measured using the 10 item Center for Epidemiologic Studies Depression Scale. Analysis using a generalized estimating equation model and subgroup analyses were conducted. Compared to noncaregivers, women who started caregiving showed more depressive symptoms in the following year (ß 0.761, p < 0.0001). Regardless of sex, older adults who continued caregiving had more depressive symptoms than noncaregivers did (ß 0.616, p < 0.0277 in men, and ß 1.091, p < 0.0001 in women). After relinquishing caregiving responsibilities to other caregivers, participants' depressive symptoms in the following year showed no statistically significant difference from that of noncaregivers. Thus, starting or continuing caregiving was associated with increased depressive symptoms, and those symptoms could be normalized by stopping caregiving. Intervention strategies to reduce family caregivers' depressive symptoms are needed.

Association between social participation and mental health consultation in individuals with suicidal ideation: a cross-sectional study.

BACKGROUND: Suicidal ideation is a significant public health concern worldwide. Although suicides might be preventable through the provision of adequate treatment, mental health consultation is still mostly underutilized. This study thus aimed to examine the association between social participation and utilization of mental health consultations in individuals with suicidal ideation. METHODS: Data were collected from the nationwide Community Health Survey (conducted by the Korea Centers for Disease Control and Prevention, 2017). A total of 17,067 individuals (men: 32.9%, women: 67.1%) who reported experiencing suicidal ideation were included in the analysis. The mean age of the study population was 60.1 (±17.8) years old. This study examined social participation; the number of social activities participated in among leisure, volunteer, social, and religion related activities. Multivariate logistic regression was then used to assess the significance of these associations. RESULTS: Among those experienced suicidal ideation, 1860 (10.9%) reported receiving mental health consultation services (men: 8.8%, women: 11.9%). Overall, an increased social participation was significantly associated with increased odds of using forms of mental health consultation (OR = 1.65, 95% CI: 1.31-2.09). CONCLUSIONS: In this study, significant evidence of the links between social participation and utilization of mental health consultation was discovered among at risk individuals with suicidal ideation. Suicide prevention policies and programs designed to enhance social participation could potentially encourage people at suicide risk to seek the help they need. Further research focusing on social approaches can produce useful information to plan and implement comprehensive and effective strategies.

The impact of poverty transitions on frailty among older adults in South Korea: findings from the Korean longitudinal study of ageing.

BACKGROUND: Frailty is an emerging public health concern among aging populations. Although socioeconomic status is a well-known contributor to frailty, there is limited research investigating the effects of poverty on frailty. This study aimed to examine the association between poverty transitions and frailty prevalence in older adults. METHODS: Data were collected from the six-wave Korean Longitudinal Study of Ageing (2006-2016). A total of 9263 middle-aged and older adults were included in the analysis. Poverty was defined as being below 50% of the median household income based on the equivalized household. Frailty was measured using an instrument comprising items on physical phenotype (grip strength) and psychological (exhaustion) and social aspects (isolation). Analyses using generalized estimating equations were conducted to estimate the relationship between poverty transition and frailty status. RESULTS: Among the 9263 respondents, 9.4% of the male respondents (n = 388) and 13.6% of the female respondents (n = 700) were frail. After controlling for covariates, female participants who transitioned into poverty (OR = 1.31, 95% CI: 1.02-1.69) and persistently remained in poverty (OR = 1.36, 95% CI: 1.10-1.68) showed increased odds of frailty in the follow-up year. We did not find significant results in the male participants. CONCLUSIONS: The findings suggest that those who experience poverty transitions, enter poverty, and remain in poverty persistently are at higher risk of frailty. To improve age-related health status among the elderly, interventions aiming to prevent and reduce frailty among the elderly should target individuals who are more vulnerable to the negative effects of frailty.

Association between community outpatient clinic care accessibility and the uptake of diabetic retinopathy screening: A multi-level analysis.

AIMS: To investigate the uptake rate variance of fundus examination for diabetes-related complications among demographically and geographically diverse communities and examine determinants that influence this rate focusing on outpatient eye care clinic accessibility at community level. METHODS: Data of 20,904 participants with diabetes from 228 communities in 2015 were collected from the nationwide Community Health Survey and Statistics Korea. Outpatient eye care clinic accessibility was measured by the number of eye clinics per 1000 population. Multilevel analysis was conducted to assess the fundus examination uptake rate across communities and examine the association of individual- and community-level determinants with this rate. RESULTS: The uptake rate among patients with diabetes was 34.8% and varied across communities. At the individual level, determinants related to knowledge and awareness were significantly positively associated with fundus examination uptake. At the community level, increases in the number of eye clinics were associated with significant increases in fundus examination uptake (OR 1.21; 95% CI 1.03-1.43). CONCLUSIONS: Based on the result that outpatient eye care clinic accessibility was significantly associated with the uptake rate across communities, improving accessibility may be an important factor and should be considered when developing interventions for promoting regular diabetic retinopathy screening. This will lead to earlier detection of complications and minimize diabetes-related visual impairment.