Association between antidepressants and the risk of diabetic foot ulcers and amputation in antidepressant-naïve type 2 diabetes mellitus patients: A nested case-control study.

AIMS: Antidepressants are widely used by individuals with type 2 diabetes mellitus (T2DM). This study aimed to explore the correlation between antidepressant use, considering specific antidepressant subclasses or cumulative doses, and diabetic foot ulcer (DFU) risk. METHODS: This nested case-control study was conducted using a representative population-based Korean cohort database from 2002 to 2019. Participants with DFUs were matched with participants without DFUs based on age, sex, date of T2DM diagnosis, and follow-up duration. In total, 791 DFUs and 3900 controls were included. The association between antidepressant use or cumulative dose of each antidepressant subclass, DFU risk and amputation risk was examined using a conditional logistic regression model. RESULTS: Antidepressant ever-use was associated with an increased incidence of DFUs compared with non-use. Furthermore, an increase in DFU risk was evident with increasing cumulative antidepressant dosage, particularly among tricyclic antidepressant (TCA) ever-users and selective serotonin reuptake inhibitors (SSRIs) ever-users. Additionally, antidepressant ever-users displayed a higher risk of DFUs requiring amputation, which was consistently observed when the cumulative dosages of overall antidepressants and TCAs were considered. CONCLUSION: Caution is advised when administering TCAs and SSRIs in antidepressant-naïve T2DM patients to reduce DFU and the consequent amputation risk.

Risk of Pancreatic Cancer After Acute Pancreatitis: A Retrospective Analysis of the Korean National Sample Cohort.

BACKGROUND: Acute pancreatitis may increase the risk of pancreatic cancer, although this association remains unclear. Therefore, we aimed to investigate this association. METHODS: We retrospectively analyzed the 2002-2019 Korean National Health Insurance Service-National Sample Cohort using 1:3 propensity score matching for sex and age (acute pancreatitis, n = 4,494; matched controls, n = 13,482). We calculated the hazard ratio (HR) for pancreatic cancer risk in patients with acute pancreatitis using Cox proportional hazards regression. RESULTS: Acute pancreatitis was significantly associated with an increased risk of pancreatic cancer throughout the study period (adjusted HR, 7.56 [95% confidence interval, 5.00-11.41]), which persisted for 2, 2-5, and > 5 years post-diagnosis (19.11 [9.60-38.05], 3.46 [1.35-8.33], and 2.73 [1.21-6.15], respectively). This pancreatitis-related pancreatic cancer risk became insignificant beyond 10 years of follow-up (1.24 [0.24-6.49]). Furthermore, this risk notably increased as the number of recurrent acute pancreatitis episodes increased (1 episode: 5.25 [3.31-8.33], 2 episodes: 11.35 [6.38-20.19], ≥ 3 episodes: 24.58 [13.66-44.26]). CONCLUSION: Following an acute pancreatitis diagnosis, the risk of pancreatic cancer increases significantly in the initial years, with a rapid increase further accentuated with recurrent acute pancreatitis episodes. Additional study is needed to evaluate whether this increased risk of carcinogenesis is attributed to accumulated inflammation.

Effect of the peripartum depressive symptoms on the Internet use disorder of their offspring in late childhood: retrospective longitudinal study.

Internet use disorder (IUD) is an emerging social and mental health concern. This study aimed to analyze the relative risk of IUD in late childhood among children whose mothers experienced peripartum depressive symptoms. This study included 762 participants (397 boys and 365 girls) and was conducted in 2017 (aged 9) and 2019 (aged 11). We analyzed the adjusted relative risk of being at high risk for IUD based on whether the mother experienced depressive symptoms during pregnancy or one month after delivery. We also considered the persistence of depressed mood for 4 months after delivery and the severity of peripartum depressive symptoms. From 2017, 20.7% of boys and 14.0% of girls were at high risk of developing IUD. Compared to the non-peripartum depressive group, girls whose mothers experienced peripartum depressive symptoms and those that persisted for 4 months were 1.084 and 1.124 times more likely to be at high risk of IUD (95% confidence interval = 1.005-1.170 and 1.013-1.248), respectively. There were no statistically significant differences among boys. Peripartum depressed mood could be one of risk factors of IUD. IUD needs to be monitored in children whose mothers experienced peripartum depressive symptoms.

Association between Sudden Sensorineural Hearing Loss and the Risk of Cardio Cerebrovascular Disease.

OBJECTIVES: This study investigated the association between sudden sensorineural hearing loss (SSNHL) and the risk of cardio-cerebrovascular disease (CCVD) among older adults in South Korea. METHODS: Data from 38,426 patients in the Korean National Health Insurance Service-Senior Cohort from 2002 to 2019 were collected. The risk of CCVD includes both stroke and acute myocardial infarction. Propensity score matching (1:1) was used to identify pairs of individuals with and without SSNHL (n = 19,213 for cases and controls). Cox proportional hazards regression models were used to analyze the associations between variables. RESULTS: Patients with SSNHL had a higher risk of CCVD (hazard ratio [HR] = 1.17, 95% confidence interval [CI] = 1.11-1.24) compared to those without. The risk of CCVD was higher among those who experienced a stroke than those who did not (HR = 1.17 95% CI = 1.10-1.25). Compared to their matched controls, patients with SSNHL were 1.69 times (HR = 1.69 CI = 1.46-1.94) more likely to have CCVD during the first 12 months of the follow-up period. CONCLUSION: Older patients with SSNHL are at an increased risk of CCVD. Hence, a more attentive approach featuring aggressive monitoring of patients with SSNHL is required to lessen their risk of CCVD. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:2372-2376, 2024.

Increased Risk of Dementia Following a Diagnosis of Hearing Impairment: A South Korean Nationwide Cohort Study.

BACKGROUND: Among the older adults, hearing impairment is a common problem and may contribute to dementia. OBJECTIVE: Therefore, we aimed to examine the association between hearing impairment and the risk of dementia among older adults in South Korea. METHODS: Using the Korean National Health Insurance Service-Senior Cohort from 2005 to 2019, we collected data of 44,728 patients. Hearing impairment was determined using the national disability registry. Propensity score matching (1:1) was performed to match patients with and without hearing impairment (case: 22,364, control: 22,364). A Cox proportional hazards regression model was built to analyze the association between hearing impairment and dementia. RESULTS: Patients with hearing impairment had a higher risk of dementia than those without hearing impairment (hazard ratio [HR] = 1.28, 95% confidence interval [CI] = 1.23-1.34). Assessing the degree of disability, both severe (HR = 1.25, 95% CI = 1.16-1.35) and mild conditions (HR = 1.29, 95% CI = 1.23-1.35) had an increased risk of dementia, respectively. CONCLUSIONS: Older patients with hearing impairment exhibit an increased risk of dementia, thereby warranting a new approach to dementia care among these patients regardless of the degree of hearing impairment.

Association between stress-related disorders and the risk of dementia using the Korean National Sample Cohort: a matched cohort study.

Post-traumatic stress disorder (PTSD) is associated with the development of dementia; however, the association of dementia risk with overall stress-related disorders is less known. This study investigated the association between stress-related disorders and the risk of dementia in a Korean nationwide sample cohort. The data analyzed in this study were acquired from the Korean National Health Insurance Service National Sample Cohort between 2002 and 2013. Using a 1:3 propensity score matching, 8906 patients with stress-related disorders and 26,718 control participants were included in the analysis. Patients with stress-related disorders had a higher risk of developing dementia after adjusting for covariates (hazard ratio [HR] = 1.15; 95% confidence interval [CI] 1.01-1.30) than control participants. Patients with PTSD showed the highest risk of increase (HR = 1.78) than those with other types of stress-related disorders. Patients with stress-related disorders showed the highest and significantly increased risk for Alzheimer's dementia (HR = 1.22, 95% CI 1.04-1.56). These results indicated an association between a history of stress-related disorders and the risk of dementia in the South Korean population. Further research investigating the causal mechanisms is needed.

Association between smoking and obstructive sleep apnea based on the STOP-Bang index.

Smoking is a risk factor for respiratory diseases, and it worsens sleep quality due to nicotine stimulation and sudden nicotine withdrawal during sleep. This can increase the severity of OSA through alterations upper airway inflammation and neuromuscular function, arousal mechanisms, and sleep architecture. Therefore, it may lead to sleep-disrupted breathing, particularly obstructive sleep apnea (OSA). Herein, this study aims to research the association between smoking and OSA through the STOP-Bang index. In this study, total sample of 3442 participants (1465 men and 1977 women) were analyzed. We used data from the Korea National Health and Nutrition Examination Survey in 2020 by classifying adults into current, ex-, and non-smokers. A multiple logistic regression analysis was used to investigate the association between smoking and OSA. Furthermore, multinomial regression analysis was used to investigate the effect of smoking cessation. For males, compared to the non-smokers, the odds ratios (OR) for the OSA were significantly higher in the ex-smokers (OR: 1.53, 95% confidence interval(CI) 1.01-2.32) and current smokers (OR: 1.79, 95% CI 1.10-2.89). In females, higher ORs were observed for OSA risk, similar to the non-smokers, smoking cessation, and pack-years. Among men, OSA was significantly associated with a moderate risk for ex-smokers (OR: 1.61, 95% CI 1.05-2.48) and a severe risk for current smokers (OR: 1.88, 95% CI 1.07-3.29). This study observed that smoking might contribute to OSA risk among adults. Smoking cessation can help to manage sleep quality properly.

Association between changes in having of cancer patients in the family and depression: A longitudinal panel study.

BACKGROUND: Cancer diagnosis can cause considerable stress among patients and their families. Both may experience clinical depression and severe anxiety. Therefore, this study investigated the association between the occurrence of cancer patients in the family and the depression among family members. METHODS: Data from the Korean Longitudinal Study of Aging (2006-2020) were used. A total of 6251 participants who completed the short-form Center for Epidemiologic Studies Depression Scale (CESD-10-D) questionnaire were included. General estimating equations were used to assess the temporal effects of changes on depression in the presence of cancer patients in the family. RESULTS: Having cancer patients in the family was associated with a high risk of depression among both men and women (men, Odds Ratio (OR):1.78, 95 % Confidence Intervals (CI) 1.13-2.79; women, OR:1.53, 95 % CI 1.06-2.22). Depressive symptoms were particularly high in women, especially when cancer symptoms were more severe than previous surveys (OR: 2.48, 95 % CI 1.18-5.20). LIMITATIONS: First, non-responders were excluded but this could be affected by underestimation bias. Second, depression was defined as the CESD-10-D score, and the biological risk factors of depression could not be identified because of survey-based database. Third, due to the retrospective design study, confirming the causal relationship clearly is difficult. Finally, residual scheming effects of unmeasured variables could not be eliminated. CONCLUSION: Our findings support efforts to diagnose and manage depression in the families of cancer patients. Accordingly, healthcare services and supportive interventions to reduce the psychological factors of cancer patients' families are needed.

Association between sedentary behavior and chronic kidney disease in Korean adults.

BACKGROUND: Chronic kidney disease (CKD) is a significant health care burden, with a worldwide prevalence of approximately 11%. The general population spends over 50% of the awake time sedentary activities. However, to the best of our knowledge, no study has evaluated the association between sedentary time and CKD, with a focus on both kidney damage and kidney function, in the South Korean population. Accordingly, the present study aimed to address this gap in the knowledge. METHOD: We used data from the 8th Korea National Health and Nutrition Examination Survey. The analysis included 9,534 participants, especially excluded those who had been diagnosed with kidney disease or who were currently undergoing treatment. Sedentary behavior was self-reported by the participants. An estimated glomerular filtration rate (eGFR) and/or albuminuria were used as measures for detection of CKD according to the guidelines of the Kidney Disease Improving Global Outcomes. We analyzed the data using multiple logistic regression. RESULTS: Among the women, the risk of CKD was significantly greater among those who sat for ≥ 12 h/d relative to those who sat for < 6 h/d, after adjusting for physical activity and other covariates (odds ratio [OR]: 1.45, 95% confidence interval [CI]: 1.01-2.06). Similarly, among those who sat over 12 h/d, those who engaged in low levels of physical activity had a higher risk of CKD than those who engaged in high levels of activity (OR: 1.65, 95% CI: 1.04-2.61). No statistically significant results were found for men. CONCLUSION: Excessive sedentary behavior was associated with an increased risk of CKD, especially albuminuria, regardless of the level of physical activity, only in women. These findings emphasize the importance of avoiding excessive sitting for a long time and increasing overall physical activity levels.

Association between weekend catch-up sleep and dyslipidemia among Korean workers.

Within competitive sociocultural environments, most Korean workers are likely to shorten their sleep duration during the weekday. Short sleep duration is associated with dyslipidemia; however, studies on the correlation between various sleep patterns and dyslipidemia are still lacking. In hence this study aimed to investigate the association between weekend catch-up sleep (CUS) and dyslipidemia among South Korean workers. Our study used data from the 8th Korea National Health and Nutrition Examination Survey (KNHANES). The analysis covered 4,085 participants, excluding those who were diagnosed with dyslipidemia and not currently participating in economic activities. Weekend CUS was calculated as the absolute difference between self-reported weekday and weekend sleep duration. Dyslipidemia was diagnosed based on the levels of total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides in blood samples collected after 9-12 h of fasting. After adjusting for sociodemographic, economic, health-related, and sleep-related factors, a negative association of weekend CUS with dyslipidemia was observed in male workers (odds ratio: 0.76, 95% confidence interval: 0.61-0.95). Further, workers with total sleep duration of 7-8 h, night workers, and white-collar workers with CUS were at relatively low risk of dyslipidemia compared to the non-CUS group. Less than 2 h of weekend CUS was negatively related to dyslipidemia in Korean workers, especially males. This suggests that sleeping more on weekends for workers who had a lack of sleep during the week can help prevent dyslipidemia.

Association between serum lipid levels over time and risk of Parkinson's disease.

The role of serum lipids in Parkinson's disease (PD) remains controversial. We aimed to evaluate the association between time-varying serum lipid levels and the risk of PD. This study included an assessment of the complete lipid profiles of 200,454 individuals from the 2002-2019 Korean National Health Insurance Health Screening Cohort. Time-dependent Cox proportional hazard regression models were used to evaluate the association between serum lipid levels over time and the risk of PD. Individuals in the lowest tertile of total cholesterol and low-density lipoprotein cholesterol had a 1.17 times [hazard ratio (HR) 1.17; 95% confidence interval (CI) 1.04-1.31] and 1.19 times (HR 1.19; 95% CI 1.06-1.34) higher risk of PD than those in middle tertile, respectively. Individuals in the highest high-density lipoprotein cholesterol tertile had a 0.89 times (HR 0.89; 95% CI 0.79-1.00) lower risk of PD than those in middle tertile, but the association was less robust in sensitivity analyses. Serum triglyceride levels were not related to the risk of PD. Our results suggest that the serum total and low-density lipoprotein cholesterol levels over time are inversely associated with the risk of PD. Further research is warranted to confirm these findings and reveal the underlying mechanisms.

The risk of osteoporotic fractures after gastrectomy: Findings from the Korean national sample cohort database (2002-2019).

Objective: This study used a national sample cohort database to investigate the risk of osteoporotic fractures after gastrectomy is performed for gastric cancer. Materials and Methods: We used data from the Korea National Health Insurance Service-National Sample Cohort between 2002 and 2019. After performing 1:3 propensity score matching, 28,328 individuals were analysed in the final study (7, 082 cases; 21, 246 controls). Gastrectomy data were extracted from the coded claims data, and osteoporotic fractures were defined as the occurrence of fractures in any of the vertebrae, distal radius, humerus, or hip, according to the 10th version of the International Classification of Diseases. A Cox proportional hazards regression model was generated to investigate the association between gastrectomy and risk of osteoporotic fractures. Results: Patients with gastric cancer who underwent a gastrectomy had a higher risk of osteoporotic fractures as compared to the general population (men, hazard ratio [HR]: 1.13, 95% confidence interval [CI]: 1.00-1.27; women, HR: 1.18, 95% CI: 1.06-1.30). A significantly higher risk of osteoporotic fractures was observed with surgical resection than with endoscopic resection (men, surgical, HR: 1.28, 95% CI: 1.08-1.52, endoscopic, HR: 1.04, 95% CI: 0.90-1.21; women, surgical, HR: 1.34, 95% CI: 1.11-1.62, endoscopic, HR: 1.13, 95% CI: 1.01-1.27). In men, the risk of hip fracture was the highest among the four fracture sites (HR: 1.18, 95% CI:0.89-1.56), while in women, the risk of vertebral fracture after gastrectomy was the highest (HR: 1.16, 95% CI: 0.99-1.35). Conclusion: Patients with gastric cancer who underwent gastrectomy had a higher risk of osteoporotic fractures as compared to the general population. This suggests the need for bone metabolism management in patients with gastric cancer to prevent post-gastrectomy complications.

Increased risk of all-cause, Alzheimer's, and vascular dementia in adults with migraine in Korea: a population-based cohort study.

BACKGROUND: Studies investigating the association between migraine and dementia have reported inconsistent findings. This study aimed to evaluate whether patients with migraine have an increased risk of dementia compared to individuals without migraine. METHODS: We obtained data from the 2002-2019 Korean National Health Insurance Health Screening Cohort. Non-migraine controls were selected using a 1:1 risk-set matching with a time-dependent propensity score. The main outcome was the development of all-cause dementia, and the secondary outcome was the development of each cause of dementia (Alzheimer's, vascular, mixed or other specified, and unspecified dementia). The incidence rate of dementia was calculated using Poisson regression, and the association between migraine and dementia was evaluated using Cox proportional hazards regression. RESULTS: Among 88,390 participants, 66.1% were female, and the mean baseline age was 55.3 ± 9.4 years. During the study period, dementia cases were identified in 4,800 of the 44,195 patients with migraine and 3,757 of the 44,915 matched controls. The incidence rate of dementia was 139.6 (95% confidence interval [CI], 135.7-143.5) and 107.7 (95% CI, 104.3-111.1) cases per 10,000 person-years in patients with migraine and matched controls, respectively. Patients with migraine had a 1.30 (hazard ratio [HR], 1.30; 95% CI, 1.25-1.35), 1.29 (HR, 1.29; 95% CI, 1.23-1.35), 1.35 (HR, 1.35; 95% CI, 1.19-1.54), 1.36 (HR, 1.36; 95% CI, 1.00-1.83), and 1.30 (HR, 1.30; 95% CI, 1.17-1.45) times higher risk of developing all-cause dementia, Alzheimer's dementia, vascular dementia, mixed or other specified dementias, and unspecified dementia than their matched controls, respectively. CONCLUSION: Our results suggest that migraine is associated with an increased risk of subsequent dementia. Further research is warranted to confirm these findings and to reveal the underlying mechanisms.

Association between smoking cessation and obstructive spirometry pattern among Korean adults aged 40-79 years.

Smoking cessation aids in restoring lung function. However, whether long-term cessation can fully restore lung function has not been studied thoroughly, especially in Asian countries. This study aimed to evaluate the association between smoking cessation status and obstructive spirometry pattern among Koreans aged 40-79 years. In total, 6298 men and 8088 women aged 40-79 years from the Korea National Health and Nutrition Examination Survey (2015-2019) were analyzed for smoking cessation status, including the duration after quitting. Current-smokers showed a higher likelihood of having an obstructive spirometry pattern than never-smokers among both men (odds ratio [OR]: 3.15, 95% confidence interval [CI]: 2.32-4.29) and women (OR: 2.60, 95% CI: 1.59-4.23). In men, the effect tended to decrease with longer duration after cessation, but male ex-smokers who had quit smoking ≥ 20 years ago still showed a higher likelihood of having an obstructive spirometry pattern than male never-smokers (OR: 1.40, 95% CI: 1.05-1.89). In female ex-smokers, there was no significant association with the obstructive spirometry pattern, compared to that in female never-smokers. This study emphasizes the benefits of smoking cessation, possibility of long-lasting harm to lung function due to tobacco smoking, and importance of smoking prevention.

Synergistic associations of visual and self-reported hearing acuity with low handgrip strength in older adults: a population-based cross-sectional study.

BACKGROUND: It is unclear whether visual and hearing acuity are independently or synergistically associated with muscle strength. We aimed to examine the associations of visual and self-reported hearing acuity with low handgrip strength and the additive interaction between visual and hearing acuity on low handgrip strength in people over 60 years. METHOD: Data of 3,075 individuals aged over 60 years from the 2017 and 2018 Korea National Health and Nutrition Examination Survey were used for this cross-sectional study. Low handgrip strength was defined based on the 20th percentile of the study population (< 30.4 kg for male and < 17.7 kg for female). Visual and self-reported hearing acuity were each divided into three categories: good, moderate, and impaired. Multiple logistic regression and relative excess risk due to interaction (RERI) were performed. RESULTS: Of the 3,075 participants, 993 (32.3 %) demonstrated low handgrip strength. Low handgrip strength was more prevalent in participants with moderate (adjusted odds ratio [AOR] = 1.54, 95 % confidence interval [CI] = 1.12-2.12) and impaired visual acuity (AOR = 2.00, 95 % CI = 1.34-2.96). Both moderate and impaired self-reported hearing acuity were significantly associated with low handgrip strength (moderate: AOR = 1.25, 95 % CI = 1.01-1.55; impaired: AOR = 1.66, 95 % CI = 1.15-2.38). The more severe the sensory function decline, the higher the association with muscle weakness. Moreover, combined sensory impairments were associated with deteriorating low handgrip strength (AOR = 8.38), with significantly strong additive interactions (RERI = 2.61, 95 % CI = 2.52-2.70). CONCLUSIONS: Awareness is needed regarding the risk of reduced muscle strength in individuals with moderate and impaired sensory function. Older people with sensory function decline in clinical settings may benefit from programs such as exercise prescription to prevent muscle weakness.

Associations of Handgrip Strength and Handgrip Strength Asymmetry With Depression in the Elderly in Korea: A Cross-sectional Study.

OBJECTIVES: Recent studies have suggested that assessing handgrip strength (HGS) asymmetry together with HGS may be helpful for evaluating problems in geriatric patients. This study aimed to identify whether HGS asymmetry, weakness, or both were associated with depression in Korean older adults. METHODS: This study included 4274 subjects from the sixth and seventh Korea National Health and Nutrition Examination Survey. Depression was measured using the Patient Health Questionnaire-9. The maximum HGS of the dominant hand was used as a representative value. HGS symmetry was categorized by the ratio of the HGS of the dominant hand to that of non-dominant hand. The odds ratio (OR) for depression was calculated according to the HGS and its symmetry. RESULTS: In total, 240 (12.5%) men and 534 (22.7%) women had depression. HGS or HGS asymmetry showed no statistically significant associations with depression in elderly men. Elevated odds of depression were observed in elderly women with low HGS (OR, 1.93; 95% confidence interval [CI], 1.33 to 2.81) or prominent HGS asymmetry (OR, 1.46; 95% CI, 1.02 to 2.08). There was a positive additive interaction between asymmetric HGS and weakness, as women with low and prominently asymmetric HGS showed higher odds of depression (OR, 3.77; 95% CI, 2.16 to 6.59) than women with high and symmetric HGS. CONCLUSIONS: Depression in elderly Korean women was associated with both low and asymmetric HGS. Our findings support the potential value of HGS asymmetry as an indicator of HGS.

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.