A longitudinal study of learning difficulties in adolescence and biomarkers of cardiometabolic risk in adulthood: A gendered pathways approach.

OBJECTIVES: Little is known about the relationship between learning difficulties (LD) in adolescence and physical health in adulthood. This study investigates the gender-specific pathways through which LD is longitudinally associated with cardiometabolic risk in adulthood. STUDY DESIGN: We used data from the National Longitudinal Study of Adolescent to Adult Health (N = 11,342). To assess cardiometabolic risk, 11 biomarkers related to cardiovascular functioning, glucose metabolism, lipid metabolism, and inflammation were utilized. METHODS: We first estimated the association between LD in adolescence and cardiometabolic risk in adulthood. Then, we examined whether this association is mediated by educational attainment and body mass index (BMI). Finally, we employed a moderated mediation model to determine whether gender moderates these mediation patterns. RESULTS: LD in adolescence was positively associated with cardiometabolic risk in adulthood (b = 0.165, p < 0.001). LD also predicted lower educational attainment (b = -0.724, p < 0.001) and higher BMI (b = 0.589, p < 0.05). Educational attainment and BMI explained 18 and 25 percent of the positive association between LD and cardiometabolic risk, respectively. A moderated mediation model revealed that indirect effects of LD on cardiometabolic risk via educational attainment and BMI were more pronounced among women than men. CONCLUSION: LD in adolescence is a significant predictor of cardiometabolic risk in adulthood. Interventions focusing on the academic and health behaviors of girls with LD may be effective in improving their adult physical health.

Association between a Marine Healing Program and Metabolic Syndrome Components and Mental Health Indicators.

Background and Objectives: Metabolic syndrome is a growing health concern globally, and its prevalence continues to increase. This study investigated whether a marine healing program could improve metabolic syndrome indicators and mental health in adults with a metabolic syndrome and those at risk of developing it. Materials and Methods: This study enrolled 30 participants who were assigned to either the experimental or control groups. The duration of the study was set at 4 weeks. Both groups received metabolic syndrome management education, and the experimental group additionally participated in two marine healing programs. Anthropometric indicators, biochemical indicators, and mental health indicators were collected before and after the intervention. Results: The findings indicate that the experimental group had significantly lower systolic blood pressure, triglycerides, and body weight, as well as higher levels of high-density lipoprotein (HDL-C) and uric acid. Mental health indicators (Hospital Anxiety and Depression Scale and quality of life measures) additionally showed improvement. Pre-post comparisons between the experimental group and the control group showed that the experimental group had significantly decreased by 1.05 kg in body weight, whereas the control group increased by 0.29 kg in body weight. In addition, HDL-C decreased by 0.91 mg/dL in the control group and increased by 3.7 mg/dL in the experimental group. Conclusions: Overall, these results suggest that marine healing programs could improve metabolic syndrome indicators such as body weight and HDL-C better than the control treatment.

Who loses more? Identifying the relationship between hospitalization and income loss: prediction of hospitalization duration and differences of gender and employment status.

BACKGROUND: The major determinants of health and well-being include wider socio-economic and political responses to poverty alleviation. To data, however, South Korea has no related social protection policies to replace income loss or prevent non-preferable health conditions for workers. In particular, there are several differences in social protection policies by gender or occupational groups. This study aimed to investigate how hospitalization affects income loss among workers in South Korea. METHODS: The study sample included 4876 Korean workers who responded to the Korean Welfare Panel Study (KoWePS) for all eight years from 2009 to 2016. We conducted a receiver operating characteristics (ROC) analysis to determine the cut-off point for the length of hospitalization that corresponded to the greatest loss of income. We used panel multi-linear regression to examine the relationship between hospitalization and income loss by gender and employment arrangement. RESULTS: The greatest income loss for women in non-standard employment and self-employed men was observed when the length of hospitalization was seven days or less. When they were hospitalized for more than 14 days, income loss also occurred among men in non-standard employment. In addition, when workers were hospitalized for more than 14 days, the impact of the loss of income was felt into the subsequent year. CONCLUSION: Non-standard and self-employed workers, and even female standard workers, are typically excluded from public insurance coverage in South Korea, and social security is insufficient when they are injured. To protect workers from the vicious circle of the poverty-health trap, national social protections such as sickness benefits are needed.

Relationship between Precarious Employment and Unmet Dental Care Needs among Korean Workers: A Longitudinal Panel Study.

Background and Objectives: Precarious workers experience certain conditions, such as low income, instability in employment, and lack of social security. Precarious employment has increased barriers to the use of dental care services, resulting in more unmet dental care needs. The aim of this study was to identify unmet dental care needs among precarious workers in Korea's labor market, using data from the Korea Health Panel Survey (2011-2017). Materials and Methods: Based on job and income security criteria, four groups were formed: Group A (individuals with job and income security), Group B (individuals reporting job security with income insecurity), Group C (individuals reporting job insecurity with income security), and Group D (individuals with job and income insecurity). We measured self-reported unmet dental need or the inability to receive necessary dental care owing to the past economic burdens. Panel logistic regression analyses were performed to determine the effect of precarious employment on unmet dental care needs for all participants. Results: Approximately 16% of the respondents reported having unmet dental care needs. Unmet dental care needs owing to economic reasons were higher among male workers in groups C and D than among male workers in Group A. In particular, male workers aged 50 years and above in Group B were 3.36 times more likely to have unmet dental care needs than those in Group A. In Group D, female workers showed a high probability of having dental care needs owing to economic reasons. Moreover, female workers aged 18-49 years witnessed an increase in unmet dental care needs. Conclusions: Korean workers with unstable employment and/or income are at a higher risk of having unmet dental care needs owing to financial factors. The findings suggest an urgent need to implement robust national health insurance policies to improve efforts aimed at reducing unmet dental care needs that potentially decreases the disparity in oral health among precariously employed workers. Furthermore, it is necessary to implement comprehensive labor market policies such as sickness benefits for those in precarious employment.

The Influence of Exposure to Smoking in Movies on Cigarette Cravings among Adolescents: A Contextual Quasi-Experimental Model.

This study explored the socio-contextual characteristics of adolescents that led them to have increased cigarette cravings when exposed to smoking scenes in films. We analyzed online survey data collected from a representative sample of 955 Korean adolescents. Our dependent variable was change in cigarette cravings after watching a smoking scene; independent variables included sex, age, school type, allowance, smoking experience, and parental smoking. We used paired t-tests to identify the differences in cigarette cravings modified by individual characteristics, and we performed logistic regression to explore the influences on these changes in cravings. The high school students investigated herein had significantly stronger cigarette cravings after they watched smoking scenes than they did prior to watching these scenes (t = -5.039, p < 0.001). The cravings were significantly higher after watching the clips among non-smokers (t = -4.264, p < 0.001) and participants who had at least one parent who smoked (t = -2.114, p < 0.05); non-smoking adolescents were also more likely to crave cigarettes after they watched smoking scenes than were smokers (odds ratio = 6.90, p < 0.001). Korean adolescents who did not smoke and those who had at least one parent who smoked showed the strongest cigarette cravings after being exposed to smoking in films. Consequently, more effective prevention strategies should be developed that recognize this tendency when regulating smoking scenes in movies or implementing related campaigns among adolescents.

Association of social deprivation and outdoor air pollution with pulmonary tuberculosis in spatiotemporal analysis.

The objective of this study was to identify the association between social deprivation, outdoor air pollution, and tuberculosis (TB) incidence rate or mortality rate. The study sample comprised 25 districts in Seoul, Korea. We used two public data derived from the Community Health Survey and Seoul Statistics. The geographic information system analysis and random effects Poisson regression were applied to explore the association of social deprivation and air pollution with TB incidence and mortality. An 1 ppb increase in sulfur dioxide (SO2) concentration was significantly associated with the risk of TB incidence (risk ratio [RR] = 1.046, 95% confidence interval [CI]: 1.028, 1.065). An 1 unit increase in the deprivation index was significantly related to a6% increase in the mortality of TB (RR = 1.063, 95% CI: 1.031, 1.097). : Our results imply that social deprivation and air pollution may affect the different TB outcomes. Effective policy-making for TB control should reflect the differing outcomes between TB incidence and mortality.

Effects of Maternal Decisional Authority and Media Use on Vaccination for Children in Asian Countries.

Background and objectives: It is now accepted that vaccination is a critical public health strategy in preventing child morbidity and mortality. Understanding factors that promote vaccination is a critical first step. The objective of this study was to investigated associations of maternal decisional authority and media use on vaccination for children in six South and Southeast Asian countries. Materials and Methods: Data come from demographic and health surveys conducted in Bangladesh, Cambodia, Indonesia, Nepal, Pakistan, and the Philippines between 2011 and 2014 (N = 45,168 women). Main outcome variables were four types of basic vaccination for children. Independent variables were maternal decisional authority and media use. Hierarchical multivariable regression analyses were performed to examine associations. Results: Children of mothers who had more decisional authority were more likely to be vaccinated compared to those participants who did not have such authority. The likelihood to have their children vaccinated was higher among women who frequently used media than those who did not use media. Conclusions: Maternal decisional authority and media use are related to improved vaccination for children. To increase vaccination rates in developing countries in South and Southeast Asia, programs and policies that promote maternal decisional authority and the use of media for health need to be implemented to help families and local communities.

Sitting Time and Obesity or Abdominal Obesity in Older South Koreans: Korean National Health and Nutrition Examination Survey 2013.

We examined relationships between sitting time and obesity or abdominal obesity according to sex and socioeconomic status in elderly people. We analyzed data from the Korean National Health and Nutrition Examination Survey 2013, and 1565 participants were included in the study. Multivariate logistic regression analysis was used to examine relationships between sitting time and obesity or abdominal obesity according to sex and socioeconomic status. Sitting time was positively correlated with body mass index in men and women and waist circumference in men. When considering socioeconomic factors, men who sat for 5 hours or longer and fell within the lowest income were more likely to have obesity and abdominal obesity relative to men who sat for 5 hours or shorter and earned higher incomes (odds ratio [95% confidence interval] = 1.80 [1.14-2.84] and 1.63 [1.02-2.61] respectively), and women who sat for 5 hours or longer and fell within the lowest educational level were more likely to have obesity relative to women who sat for 5 hours or less and were educated to a higher level (1.24 [1.01-1.85]). Strategies to reduce sedentary behavior would help to prevent obesity in older men who earn low incomes and women with lower levels of educational attainment.

Conflicting Online Health Information and Rational Decision Making: Implication for Cancer Survivors.

Although people in the social media age can access health information easier, they have difficulty judging conflicting rational information or summarizing the large amounts of health information available. Conflicting health information occurs when contrary assertions or information about a certain health issue comes from different information sources. This study examined the background knowledge and the current phenomenon of why conflicting health information occurs in real-world conditions. We also reviewed causes and solutions by reviewing the literature. In particular, we recommend a method that solves problems that patients have including cancer survivors who cannot themselves be active in seeking health information. Thus, we categorized the specific types of conflicting health information and analyzed the sociodemographic factors and information carrier factors that have an impact on the health information-seeking behavior of individuals.

Effects of public and private health insurance on medical service utilization in the National Health Insurance System: National panel study in the Republic of Korea.

BACKGROUND: Moral hazard or utilization hazard refers to the phenomenon during which patients overuse medical services under national health insurance (NHI) because the services are free or the patients are required to pay only a portion of the utilization costs. The aim of this study is to investigate how NHI and private health insurance (PHI) systems influence increases in health care utilization rates. METHODS: We designed a longitudinal study to examine the utilization of healthcare services between those insured with NHI or PHI and uninsured Koreans using nationally representative four-year panel data from 13,798 participants. This study was conducted using hierarchical multivariate Poisson regression analyses in which covariates and interaction terms are applied after adjusting for the heterogeneous treatment effect. RESULTS: After adjusting covariates including disease status, lower income Koreans who were covered by medical aid were respectively 2.26 and 1.23 times more likely to receive inpatient care and outpatient care than those who were covered by NHI. When the interaction term of type of insurance was included in the model, those were covered by both medical aid and PHI were respectively 2.38 and 1.25 times more likely to receive inpatient care and outpatient care than those who were covered by only NHI. CONCLUSIONS: The moral hazard behind insurance membership, depending on how NHI maintains policies to confer benefits, may give rise to differences in medical utilization. This phenomenon must be closely monitored to find a way to reform NHI when the rights of medical service consumers are solidified through PHI.

Spa Goers' Repeated Visits for Health and Wellness and the Influential Factors: An Exploratory Study of the UK Spa Goers.

Dissemination of spa services across the globe and its market saturation drive demand for differentiated communication methods. This study aims to explore the influential factors on spa goers' repeated visits and their practical applications in the health and wellness spa industry. The identified factors were used as the measurement variables to examine the relation with spa goers' repeated visits. The proposed concept was tested by a mixed method combining a self-administered questionnaire and semistructured interview with 54 survey participants and 6 interviewees. It was meaningful to use a sample of the UK spa goers from the southwest region since global spa trends stem from the EU spas, and the United Kingdom is one of the market leaders. The data were analyzed using frequency, percentage, multiple logistic regression analysis, and coding process. The survey findings demonstrated that the most significant influential factor on the repeated spa visits is a memorable experience of which showed 13.7 times higher probability than the reference up-to-date facility. The details of memorable experiences were discovered throughout the interviews that include the rediscovery of self, feeling of connectedness, recharge for positive emotions, self-reward through escapism, and experience of noncommercialized local products and attractions. Therefore, using experiential marketing methods can be effective spa service marketing.

Unmet healthcare needs and the local extinction index: an analysis of regional disparities impacting South Korea's older adults.

Background: This study examines the factors affecting unmet healthcare experiences by integrating individual-and community-level extinction indices. Methods: Using spatial autocorrelation and multilevel modeling, the study utilizes data from the Community Health Survey and Statistics Korea for 218 local government regions from 2018 to 2019. Results: The analysis identifies significant clustering, particularly in non-metropolitan regions with a higher local extinction index. At the individual level, some factors affect unmet medical needs, and unmet healthcare needs increase as the local extinction index at the community level increases. Conclusion: The findings underscore the need for strategic efforts to enhance regional healthcare accessibility, particularly for vulnerable populations and local infrastructure development.

The effect of public hospital closure on the death of long-term inpatients in Korea.

OBJECTIVES: This study aimed to examine the changes in health outcomes and the patterns of medical institution utilization among patients with long-term stays in public hospitals following the closure of a public medical center. It also sought to present a proposal regarding the role of public hospitals in countries with healthcare systems predominantly driven by private entities, such as Korea. METHODS: To assess the impact of a public healthcare institution closure on health outcomes in a specific region, we utilized nationally representative health insurance claims data. A retrospective cohort study was conducted for this analysis. RESULTS: An analysis of the medical utilization patterns of patients after the closure of Jinju Medical Center showed that 67.4% of the total medical usage was redirected to long-term care hospitals. This figure is notably high in comparison to the 20% utilization rate of nursing hospitals observed among patients from other medical facilities. These results indicate that former patients of Jinju Medical Center may have experienced limitations in accessing necessary medical services beyond nursing care. After accounting for relevant mortality factors, the analysis showed that the mortality rate in closed public hospitals was 2.47 (95% confidence interval, 0.85 to 0.96) times higher than in private hospitals. CONCLUSIONS: The closure of public medical institutions has resulted in unmet healthcare needs, and an observed association was observed with increased mortality rates. It is essential to define the role and objectives of public medical institutions, taking into account the distribution of healthcare resources and the conditions of the population.

Effects of Future Subjective Expectations on Cognitive Decline and Dementia among Middle-Aged and Older Adults.

This study investigated the impact of subjective expectations of the future (e.g., income, life expectancy, and national policies) on the onset of dementia and mild cognitive impairment by sex and age in middle-aged and older adults. The Korean Longitudinal Study of Aging (KLoSA) data from 2008 to 2020, comprising 4116 people above 45 years, were used. A time-series analysis and multiple panel logistic regression were conducted to highlight subjective expectation trends and their effect on dementia and mild cognitive impairment, respectively. Low subjective expectations of the future negatively affected cognitive impairment (total: odds ratio [OR] = 1.02, 95% confidence interval [CI] = 1.01-1.03) and dementia (total: OR = 1.05, 95% CI = 1.03-1.06), and those of national policies were the biggest risk factors for cognitive impairment (total: OR = 1.17, 95% CI = 1.12-1.22) and dementia (total: OR = 1.10, 95% CI = 1.07-1.13). Individuals about to retire and with low expectations of workability were more likely to develop cognitive impairment (total: OR = 1.03, 95% CI = 1.02-1.06). Subjective expectations of economic downturn also caused cognitive impairment, especially in women (OR = 1.04, 95% CI = 1.01-1.07) and early stage older adults (OR = 1.06, 95% CI = 1.02-1.10). Policymakers must consider the impact of changes in national policies and living environments on cognitive impairment and dementia in older adults.

Regional disparities in health literacy for chronic diseases: focusing on healthcare resources and local extinction index.

Objective: This study compared disparities between community health characteristics and health literacy levels for hypertension and diabetes by combining community-level characteristics, such as the local extinction index and healthcare resources, with individual-level characteristics based on the Andersen healthcare utilization model. Method: Data obtained from the 2017, 2019, and 2021 Community Health Surveys, Korean Statistical Information Service, and National Health Insurance Service were analyzed. The analyses included spatial analysis, propensity score matching, and cross-analysis. Results: Twenty-five extinction-risk regions (ERRs) were identified in 2017, 26 in 2019, and 29 in 2021, indicating a high risk of extinction and insufficient healthcare resources in non-metropolitan regions. Based on analyses of demographic changes and unmet medical needs at the individual level, we observed increased age and economic activity, decreased healthcare access, and lower education levels in ERRs compared to non-extinction-risk regions (NERRs). No significant differences were found between the regions regarding diagnosis or medication use concerning the health literacy gap for hypertension and diabetes. However, individuals in ERRs were significantly less likely than those in NERRs to be aware of such diseases or educated about their management. Discussion: Given that healthcare services in ERRs focus on chronic disease management rather than prevention, we propose two directions to reduce health disparities in ERRs. First, the government should encourage cooperation with private healthcare organizations to ensure the provision of health education programs in vulnerable areas. Second, improvements in awareness and education regarding chronic disease management can be achieved through digital healthcare and telemedicine. This study identifies regional disparities in chronic disease prevention and management, providing a basis for policies to ensure healthier communities with health equity.

Metabolic syndrome clustering patterns and the association with cardiovascular disease among post-menopausal Korean women.

The metabolic syndrome (MetS) is a group of diseases conceptualized as a clustering of risk factors, with the risks of developing MetS in women varying significantly before and after menopause. This study investigated MetS clustering patterns and their association with cardiovascular disease (CVD) risk among post-menopausal women (n = 2479) using data from the Korean Genome Epidemiology Study. Using latent class analysis, three groups emerged: diabetic (5.6%), hypertensive (35.2%), and low-risk (59.2%). Relative to the low-risk group, the diabetic group demonstrated associations with older age, a family history of chronic disease, an increased Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), an elevated white blood cell (WBC) count, experience with hysterectomy, being a non-drinker, more physical activity, and excessive sleep. The hypertensive group was associated with older age, lower monthly income, a family history of chronic disease, increased HOMA-IR, a higher WBC count, more physical activity, and excessive sleep. The diabetic and hypertensive groups had a significantly higher CVD risk than the low-risk group (diabetic: odds ratio [OR] = 2.41 [1.11, 5.27]; hypertensive: OR = 2.46 [1.33, 4.55]). This study identified potential markers for MetS screening in post-menopausal women, highlighting the need for early intervention and personalized healthcare for middle-aged women to reduce CVD risk following menopause.

Digital healthcare for dementia and cognitive impairment: A scoping review.

BACKGROUND: Cognitive disorders, such as Alzheimer's disease, are a global health problem. Digital healthcare technology is an innovative management tool for delaying the progression of dementia and mild cognitive impairment. Thanks to digital technology, the possibility of safe and effective care for patients at home and in the community is increasing, even in situations that threaten the continuity of care, such as the COVID-19 pandemic. However, it is difficult to select appropriate technology and alternatives due to the lack of comprehensive reviews on the types and characteristics of digital technology for cognitive impairment, including their effects and limitations. OBJECTIVE: This study aims to identify the types of digital healthcare technology for dementia and mild cognitive impairment and comprehensively examine how its outcome measures were constructed in line with each technology's purpose. METHODS: According to the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews guidelines, a literature search was conducted in August 2021 using Medline (Ovid), EMBASE, and Cochrane library. The search terms were constructed based on Population-Concept-Context mnemonic: 'dementia', 'cognitive impairment', and 'cognitive decline'; digital healthcare technology, such as big data, artificial intelligence, virtual reality, robots, applications, and so on; and the outcomes of digital technology, such as accuracy of diagnosis and physical, mental, and social health. After grasping overall research trends, the literature was classified and analysed in terms of the type of service users and technology. RESULTS: In total, 135 articles were selected. Since 2015, an increase in literature has been observed, and various digital healthcare technologies were identified. For people with mild cognitive impairment, technology for predicting and diagnosing the onset of dementia was studied, and for people with dementia, intervention technology to prevent the deterioration of health and induce significant improvement was considered. Regarding caregivers, many studies were conducted on monitoring and daily living assistive technologies that reduce the burden of care. However, problems such as data collection, storage, safety, and the digital divide persisted at different intensities for each technology type. CONCLUSIONS: This study revealed that appropriate technology options and considerations may differ depending on the characteristics of users. It also emphasises the role of humans in designing and managing technology to apply digital healthcare technology more effectively.

The Gendered Pathways Through Which Intimate Partner Violence Affects Health: Exploring the Role of Unmet Healthcare Needs.

The aim of this study was to examine the relationships between intimate partner violence (IPV), gender, unmet healthcare needs, and health. Specifically, this study identified how unmet healthcare needs mediate the relationship between IPV and health, and how this mediation is moderated by gender. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) (N = 15,425), we first estimated ordinary least squares regression models to investigate the association between IPV and self-rated health. Then, we used structural equation models to examine how unmet healthcare needs mediate this relationship. Lastly, we conducted a moderated mediation model to investigate whether gender moderates these mediation patterns. The results of this study showed that experiencing IPV was associated with a decrease in self-rated health and an increase in the unmet need for medical care (but not in unmet need for routine health check-ups). Unmet need for medical care explained about one-quarter of the negative association between IPV and self-rated health. A moderated mediation model revealed that indirect effects of IPV on health via unmet medical care needs were more pronounced among victimized women than victimized men. This study filled knowledge gaps about the mechanisms underlying the association between IPV and poor health status. Unmet healthcare needs partially mediated the relationship between IPV victimization and health. This mechanism was more salient for the health of victimized women than victimized men. Interventions designed to improve the health of IPV victims may focus on addressing unmet healthcare needs and could be tailored according to the gender of patients.

Unmet dental care needs of homeless adults in South Korea: Findings from a national survey.

This study identifies the key factors underlying the unmet dental care needs of South Korean homeless adults that obstructed their dental service access. We analysed data from 551 Korea Homeless Survey respondents (17 years and older) who reported having an oral disease in the previous 12 months. We conducted multiple logistic regression analyses to examine the factors associated with homeless individuals' unmet dental care needs, using weights to make the data nationally representative. Approximately 43% of the homeless people reported having unmet dental care needs. Housing type (living in the street) was significantly associated with an increased odds ratio of unmet dental care needs. However, when social protection programs (housing benefits and Medical Aid [MA]) were included in the model, the statistical significance of the housing type disappeared. Homeless MA recipients were less likely to have unmet needs than those not covered by MA. On the other hand, homeless people who received housing benefits were more likely to receive dental care than people who do not receive these benefits. Consequently, policy makers should develop social protection programs influencing homeless individuals' access to dental care and ensure the sustainable implementation of integrated community-based dental services for homeless adults.

Suicide among Older Adults with Dementia: Effects of Korea's Long-Term Care Insurance System.

South Korea recently expanded its coverage rate of long-term care insurance (LTCI) by adding a "dementia special grade" in 2014 to improve care service accessibility and extend health life for older adults with dementia. In this study, we propose a multifaceted policy to reduce the suicide risk among older adults with dementia by evaluating the effectiveness of using the long-term care services (LTCS). A sample of 62,282 older adults was selected from the "Older Adults Cohort DB" of the National Health Insurance Service. We conducted Kaplan-Meier and Cox regression to represent the yearly survival curve from 2002 to 2015 according to the individual characteristics. Difference-in-difference estimation was conducted to identify the effect of LTCS on suicide rates by using LTCS before and after 2014. The suicide risk of older adults using LTCS was about 0.256-times lower than those who did not use it (OR = 0.296, 95% CI = 0.183-0.478), whereas it increased after the expansion of the dementia grading (OR = 2.131, 95% CI = 1.061-4.280). To prevent the risk of suicide among older adults with dementia, not only did the mortality rate vary depending on the sex, activities of daily living (ADL), and type of caregiver at the individual level but appropriate national intervention and management, such as improving the accessibility of LTCS, are also needed.