RESUMEN
Long-term exposure to ambient PM2.5 is known associated with cardiovascular and respiratory health effects. However, the heterogeneous concentrationresponse function (CRF) between PM2.5 exposure across different concentration range and cardiopulmonary disease and diabetes mellitus (DM) incidence, and their implications on attributable years lived with disability (YLD) and regulation policy has not been well-studied. In this retrospective longitudinal cohort study, disease-free participants (approximately 170,000 individuals, aged ≥ 30 years) from the MJ Health Database were followed up (2007-2017) regarding incidents of coronary heart disease (CHD), ischemic stroke, chronic obstructive pulmonary disease (COPD), lower respiratory tract infections (LRIs), and DM. We used a time-dependent nonlinear weight-transformation Cox regression model for the CRF with an address-matched 3-year mean PM2.5 exposure estimate. Town/district-specific PM2.5-attributable YLD were calculated by multiplying the disease incidence rate, population attributable fraction, disability weight, and sex-age group specific subpopulation for each disease separately. The estimated CRFs for cardiopulmonary diseases were heterogeneously with the hazard ratios (HRs) increased rapidly for CHD and ischemic stroke at PM2.5 concentration lower than 10 µg/m3, whereas the HRs for DM (LRIs) increased with PM2.5 higher than 15 (20) µg/m3. Women had higher HRs for ischemic stroke and DM but not CHD. Relative to the lowest observed PM2.5 concentration of 6 µg/m3 of the study population, the PM2.5 level with an extra risk of 0.1 % (comparable to the disease incidence) for CHD, ischemic stroke, DM, and LRIs were 8.59, 11.85, 22.09, and 24.23 µg/m3, respectively. The associated attributable YLD decreased by 51.4 % with LRIs reduced most (83.6 %), followed by DM (63.7 %) as a result of PM2.5 concentration reduction from 26.10 to 16.82 µg/m3 during 2011-2019 in Taiwan. The proportion of YLD due to CHD and ischemic stroke remained dominant (56.4 %-69.9 %). The cost-benefit analysis for the tradeoff between avoidable YLD and mitigation cost suggested an optimal PM2.5 exposure level at 12 µg/m3. CRFs for cardiopulmonary diseases, attributable YLD, and regulation level, may vary depending on the national/regional background and spatial distribution of PM2.5 concentrations, as well as demographic characteristics.
Asunto(s)
Contaminantes Atmosféricos , Diabetes Mellitus , Exposición a Riesgos Ambientales , Material Particulado , Humanos , Material Particulado/análisis , Incidencia , Femenino , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Exposición a Riesgos Ambientales/estadística & datos numéricos , Adulto , Contaminantes Atmosféricos/análisis , Diabetes Mellitus/epidemiología , Anciano , Estudios Longitudinales , Taiwán/epidemiología , Enfermedades Cardiovasculares/epidemiología , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/inducido químicamente , Contaminación del Aire/estadística & datos numéricos , Contaminación del Aire/efectos adversosRESUMEN
Background: Electrical storm (ES) has profound psychological effects and is associated with a higher mortality in patients with implantable cardioverter-defibrillator (ICD). Assessing the incidence and features of ES, is vital. Previous studies have shown winter peaks for ventricular tachyarrhythmia (VTA) in ICD patients. However, the effects of heat with a high relative humidity remain unclear. Thus, this study aimed to assess the nonlinear and lagged effects of apparent temperature [or heat index (HI)] on VTA among patients with and without ES after ICD implantation. Methods: Of 626 consecutive patients who had ICDs implanted from January 2004 to June 2017 at our hospital, 172 who experienced sustained VTAs in ICD recording were analyzed, and their clinical records were abstracted to assess the association between VTA incidence and HI by time-stratified case-crossover analysis. Cubic splines were used for the nonlinear effect of HI, with adjustment for air pollutant concentrations. Results: A significant seasonal effect for ES patients was noted. Apparent temperature, but not ambient temperature, was associated with VTA occurrences. The low and high HI thresholds for VTA incidence were <15° and >30°C, respectively, with a percentage change in odds ratios of 1.06 and 0.37, respectively, per 1°C. Lagged effects could only be demonstrated in ES patients, which lasted longer for low HI (in the next 4 days) than high HI (in the next 1 day). Conclusion: VTA occurrence in ICD patients was strongly associated with low HI and moderately associated with high HI. Lagged effects of HI on VTA were noted in patients with ES. Furthermore, patients with ES were more vulnerable to heat stress than those without ES. Patients with ICD implantation, particularly in those with ES, should avoid exposure to low and high HI to reduce the risk of VTAs, improve quality of life and possibly reduce mortality.
RESUMEN
Type 2 diabetes mellitus (DM) is known to be closely associated with lifestyle and obesity and has a prevalence that increases with age. This study aimed to assess the short-term composite effect of diet, physical activity, psychosocial health, and waist circumference (WC) on the incidence of DM in the elderly and to provide a lifestyle-based predictive index.We used baseline measurements (2009-2013) of 5349 community-dwelling participants (aged 55 years and older, 52% female) of the Healthy Aging Longitudinal Study in Taiwan (HALST) for fasting plasma glucose, HbA1C, serum cholesterol, triglycerides, blood pressures, WC, and outcomes of home-visit questionnaire. Principal component analysis (PCA) was used to identify participants with a healthy lifestyle (HLF: higher diet, physical activity, and psychosocial scores) and a lower WC, with cutoffs determined by the receiver-operating characteristics. A Cox regression model was applied to 3424 participants without DM at baseline by linking to their National Health Insurance records (median follow-up of 3.1 years).In total, 247 new DM cases (7.2%) were identified. The HLF and lower WC group had a relative risk (RR) of DM of 0.54 (95% CI 0.35-0.82) compared to the non-HLF and higher WC group. When stratified by the presence of impaired glucose tolerance (IGT) or metabolic syndrome (MS), only participants with IGT/MS showed significant risks (RR 0.55; 95% CI 0.33-0.92). However, except for WC, the individual lifestyle factors were nonsignificant in the overall model without PCA.A composite protective effect of HLF and normal WC on DM within 5 years was observed, especially in those with IGT or MS. Psychosocial health constituted an important lifestyle factor in the elderly. The cutoffs identified could be used as a lifestyle-based risk index for DM. Maintaining an HLF to prevent DM is especially important for the elderly.
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Envejecimiento/fisiología , Diabetes Mellitus Tipo 2/epidemiología , Estilo de Vida Saludable , Circunferencia de la Cintura , Anciano , Anciano de 80 o más Años , Glucemia , Índice de Masa Corporal , Estudios Transversales , Dieta , Ejercicio Físico , Femenino , Intolerancia a la Glucosa/epidemiología , Hemoglobina Glucada , Humanos , Incidencia , Estilo de Vida , Lípidos/sangre , Estudios Longitudinales , Masculino , Síndrome Metabólico/epidemiología , Persona de Mediana Edad , Obesidad/epidemiología , Prevalencia , Factores de Riesgo , Taiwán/epidemiologíaRESUMEN
By using the data from the 2001 National Health Interview Survey and the National Heath Insurance database in Taiwan, this study aims at investigating the socioeconomic and demographic factors associated with different health care choices. This study incorporated hierarchical cluster analysis into multiple correspondent analysis to determine 5 attribute clusters of socioeconomic and demographic factors associated with different health care choices. This study found that older women with higher education levels were more likely to choose multiple sources of health care and that low- to middle-income people were more likely to use over-the-counter medications in pharmacies. In addition, people's self-reported health care choices were inconsistent with their observed health care seeking behavior. The health policy authority may need to provide more health promotion education programs, especially for older women with higher educational levels, and funding incentives for quality of care provided rather than relying solely on reimbursements for episodic care.
Asunto(s)
Conducta de Elección , Atención a la Salud , Aceptación de la Atención de Salud/estadística & datos numéricos , Adulto , Factores de Edad , Análisis por Conglomerados , Terapias Complementarias/estadística & datos numéricos , Demografía , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Medicina Tradicional China/estadística & datos numéricos , Persona de Mediana Edad , Medicamentos sin Prescripción , Aceptación de la Atención de Salud/psicología , Factores Sexuales , Factores Socioeconómicos , Taiwán , Adulto JovenRESUMEN
BACKGROUND & AIMS: Obesity-related metabolic disorders such as hypertension, diabetes mellitus, hypercholesterolemia, hypertriglyceridemia, and hyperuricemia are major risk factors for cardiovascular disease. The aim was to compare body mass index, waist circumference, and waist-to-hip ratio as predictors of these metabolic disorders. METHODS: We evaluated 1625 men and 1779 women, aged 35-64 y who participated in the 2001 National Health Interview Survey and 2002 Taiwan Three High Prevalence Survey. Their anthropometric measurements were analyzed as predictors of metabolic disorders using empirical receiver-operating characteristic curves and logistic regression models. RESULTS: Overall, waist circumference performed well as a predictor of metabolic disorders. Body mass index was the best predictor for men who smoked, whereas waist circumference and waist-to-hip ratio were better alternatives for non-smoking men and women. Anthropometric measures had higher predictabilities for those aged 35-44 y but relatively weak associations with diabetes mellitus for men aged 45-64 y and hypercholesterolemia for men and women. CONCLUSIONS: The associations between anthropometric measures and the metabolic disorders varied with comorbidity, gender, age groups, and smoking status. Waist-to-hip ratio was the best predictor for diabetes mellitus, especially for participants aged 45-64 y. The anthropometric measures did not predict hypercholesterolemia well.
Asunto(s)
Índice de Masa Corporal , Enfermedades Metabólicas/epidemiología , Obesidad/complicaciones , Circunferencia de la Cintura , Relación Cintura-Cadera , Adulto , Envejecimiento , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Modelos Logísticos , Masculino , Enfermedades Metabólicas/complicaciones , Persona de Mediana Edad , Prevalencia , Curva ROC , Factores de Riesgo , Factores Sexuales , Fumar , TaiwánRESUMEN
BACKGROUND: Invasive fungal infections, such as candidemia, caused by Candida species have been increasing. Candidemia is not only associated with a high mortality (30% to 40%) but also extends the length of hospital stay and increases the costs of medical care. Sepsis caused by Candida species is clinically indistinguishable from bacterial infections. Although, the clinical presentations of the patients with candidemia caused by Candida albicans and non-albicans Candida species (NAC) are indistinguishable, the susceptibilities to antifungal agents of these species are different. In this study, we attempted to identify the risk factors for candidemia caused by C. albicans and NAC in the hope that this may guide initial empiric therapy. METHODS: A retrospective chart review was conducted during 1996 to 1999 at the Veterans General Hospital-Taipei. RESULTS: There were 130 fatal cases of candidemia, including 68 patients with C. albicans and 62 with NAC. Candidemia was the most likely cause of death in 55 of the 130 patients (42.3 %). There was no significant difference in the distribution of Candida species between those died of candidemia and those died of underlying conditions. Patients who had one of the following conditions were more likely to have C. albicans, age > or = 65 years, immunosuppression accounted to prior use of steroids, leukocytosis, in the intensive care unit (ICU), and intravascular and urinary catheters. Patients who had undergone cancer chemotherapy often appeared less critically ill and were more likely to have NAC. CONCLUSION: Clinical and epidemiological differences in the risk factors between candidemia caused by C. albicans and NAC may provide helpful clues to initiate empiric therapy for patients infected with C. albicans versus NAC.