Epidemiology of pediatric inflammatory bowel disease categorized by age subgroups in Korea.

BACKGROUND: Pediatric inflammatory bowel disease (PIBD) affects different age groups and its incidence is increasing worldwide. However, there is a lack of research focusing on age subgroups in Asian countries. In this nationwide population-based study, we investigated the epidemiology of PIBD among different age subgroups in Korea. METHODS: We analyzed Korean health administration data from 2005 to 2016. Data were divided by age at diagnosis as follows: group 1, 0-1 years; group 2, 2-5 years; group 3, 6-9 years; group 4, 10-16 years. We analyzed the overall incidence, temporal changes, and regional differences by age subgroups, using Poisson regression analysis. RESULTS: From 2005 to 2016, 2734 inflammatory bowel disease (IBD) cases were diagnosed among patients under 17 years of age. In the overall population, the incidence rate of PIBD over the entire study period was 2.248/105 person-years (PY), significantly increasing from 1.173/105 PY in 2005-2007 to 3.267/105 PY in 2014-2016. The incidence rates in groups 1 and 2 remained unchanged, whereas those of groups 3 and 4 increased significantly. The same trend was observed when analyzed separately for Crohn's disease (CD) and ulcerative colitis (UC). The incidence rates of CD in groups 3 and 4 showed differences between metropolitan and non-metropolitan areas, whereas those in groups 1 and 2, and UC of all age subgroups showed no difference. CONCLUSIONS: The temporal trend and regional differences of PIBD differed among age subgroups, suggesting that genetic and environmental factors have varying impacts on IBD development across different subgroups.

Prevalence of Inflammatory Bowel Disease Unclassified, as Estimated Using the Revised Porto Criteria, among Korean Pediatric Patients with Inflammatory Bowel Disease.

Purpose: Few studies have reported the prevalence of inflammatory bowel disease unclassified (IBDU) among Korean pediatric IBD (PIBD) population. To address this gap, we used two tertiary centers and nationwide population-based healthcare administrative data to estimate the prevalence of Korean pediatric IBDU at the time of diagnosis. Methods: We identified 136 patients aged 2-17 years with newly diagnosed IBD (94 Crohn's disease [CD] and 42 ulcerative colitis [UC]) from two tertiary centers in Korea between 2005 and 2017. We reclassified these 136 patients using the revised Porto criteria. To estimate the population-based prevalence, we analyzed Korean administrative healthcare data between 2005 and 2016, which revealed 3,650 IBD patients, including 2,538 CD and 1,112 UC. By extrapolating the reclassified results to a population-based dataset, we estimated the prevalence of PIBD subtypes. Results: Among the 94 CD, the original diagnosis remained unchanged in 93 (98.9%), while the diagnosis of one (1.1%) patient was changed to IBDU. Among the 42 UC, the original diagnosis remained unchanged in 13 (31.0%), while the diagnoses in 11 (26.2%), 17 (40.5%), and one (2.4%) patient changed to atypical UC, IBDU, and CD, respectively. The estimated prevalences of CD, UC, atypical UC, and IBDU in the Korean population were 69.5%, 9.4%, 8.0%, and 13.1%, respectively. Conclusion: This study is the first in Korea to estimate the prevalence of pediatric IBDU. This prevalence (13.1%) aligns with findings from Western studies. Large-scale prospective multicenter studies on PIBDU are required to examine the clinical features and outcomes of this condition.

Quality controlled YouTube content intervention for enhancing health literacy and health behavioural intention: A randomized controlled study.

Background: Individuals increasingly turn to the Internet for health information, with YouTube being a prominent source. However, the quality and reliability of the health information vary widely, potentially affecting health literacy and behavioural intentions. Methods: To analyse the impact of health information quality on health literacy and behavioural intention, we conducted a randomized controlled trial using a quality-controlled YouTube intervention. Health information quality on YouTube was evaluated using the Global Quality Score and DISCERN. We randomly allocated (1 : 1) to the intervention group to watch the highest quality-evaluated content and to the control group to watch the lowest quality-evaluated content. Health literacy and health behavioural intention were assessed before and after watching YouTube. The trial was set for two different topics: interpreting laboratory test results from health check-up and information about inflammatory bowel disease (IBD). Results: From 8 April 2022 to 15 April 2022, 505 participants were randomly assigned to watch either high-quality content (intervention group, n = 255) or low-quality content (control group, n = 250). Health literacy significantly improved in the intervention group (28.1 before and 31.8 after; p < 0.01 for health check-up; 28.3 before and 31.3 after; p < 0.01 for IBD). Health behavioural intention significantly improved in the intervention group (3.5 before and 4.1 after; p < 0.01 for health check-up; 3.6 before and 4.0 after; p < 0.01 for IBD). Control groups had no such effect. Conclusion: High-quality health information can enhance health literacy and behavioural intention in both healthy individuals and those with specific conditions like IBD. It stresses the significance of ensuring reliable health information online and calls for future efforts to curate and provide access to high-quality health content.

Association of midlife body-weight variability and cycles with earlier dementia onset: a nationwide cohort study.

BACKGROUND: Given the rising awareness of health-related lifestyle modifications, the impact of changes in body weight (BW) on cognitive function and dementia generates significant concern. This study aimed to investigate the association between BW changes and dementia in a middle-aged Korean population. METHODS: A retrospective, population-based longitudinal study was conducted utilizing data from the National Health Insurance Service (NHIS) database. Participants aged 40 years or older in 2011 who underwent at least five health checkups between 2002 and 2011 were followed-up for dementia until 2020. A total of 3,635,988 dementia-free Korean aged < 65 at baseline were examined. We analyzed the association between BW variability independent of the mean (VIM) with BW cycle, defined as either an upward or a downward direction of BW, and the risk of incident dementia. RESULTS: The results showed an increased risk of dementia in the highest quartile of VIM quartile (hazard ratio [HR] 1.52, 95% confidence interval [CI] 1.47-1.58) compared to the lowest quartile of VIM. Additionally, the results showed an even higher increased risk of dementia in the highest BW cycle (≥ 2 cycles of 10% BW = HR 2.00, 95% CI 1.74-1.29). Notably, the combined concept of VIM with BW cycle showed an even higher dementia risk (highest quartile of VIM with ≥ 2 cycles of 10% BW = HR 2.37, 95% CI 2.05-2.74) compared to the baseline group (lowest quartile of VIM with < 3% BW cycle). CONCLUSIONS: The present study highlights the importance of considering BW changes with BW variability along with the BW cycle to assess dementia risk in detail, providing valuable insights for preventive strategies.

Continual learning framework for a multicenter study with an application to electrocardiogram.

Deep learning has been increasingly utilized in the medical field and achieved many goals. Since the size of data dominates the performance of deep learning, several medical institutions are conducting joint research to obtain as much data as possible. However, sharing data is usually prohibited owing to the risk of privacy invasion. Federated learning is a reasonable idea to train distributed multicenter data without direct access; however, a central server to merge and distribute models is needed, which is expensive and hardly approved due to various legal regulations. This paper proposes a continual learning framework for a multicenter study, which does not require a central server and can prevent catastrophic forgetting of previously trained knowledge. The proposed framework contains the continual learning method selection process, assuming that a single method is not omnipotent for all involved datasets in a real-world setting and that there could be a proper method to be selected for specific data. We utilized the fake data based on a generative adversarial network to evaluate methods prospectively, not ex post facto. We used four independent electrocardiogram datasets for a multicenter study and trained the arrhythmia detection model. Our proposed framework was evaluated against supervised and federated learning methods, as well as finetuning approaches that do not include any regulation to preserve previous knowledge. Even without a central server and access to the past data, our framework achieved stable performance (AUROC 0.897) across all involved datasets, achieving comparable performance to federated learning (AUROC 0.901).

Deep learning-based long-term risk evaluation of incident type 2 diabetes using electrocardiogram in a non-diabetic population: a retrospective, multicentre study.

Background: Diabetes is a major public health concern. We aimed to evaluate the long-term risk of incident type 2 diabetes in a non-diabetic population using a deep learning model (DLM) detecting prevalent type 2 diabetes using electrocardiogram (ECG). Methods: In this retrospective study, participants who underwent health checkups at two tertiary hospitals in Seoul, South Korea, between Jan 1, 2001 and Dec 31, 2022 were included. Type 2 diabetes was defined as glucose ≥126 mg/dL or glycated haemoglobin (HbA1c) ≥ 6.5%. For survival analysis on incident type 2 diabetes, we introduced an additional variable, diabetic ECG, which is determined by the DLM trained on ECG and corresponding prevalent diabetes. It was assumed that non-diabetic individuals with diabetic ECG had a higher risk of incident type 2 diabetes than those with non-diabetic ECG. The one-dimensional ResNet-based model was adopted for the DLM, and the Guided Grad-CAM was used to localise important regions of ECG. We divided the non-diabetic group into the diabetic ECG group (false positive) and the non-diabetic ECG (true negative) group according to the DLM decision, and performed a Cox proportional hazard model, considering the occurrence of type 2 diabetes more than six months after the visit. Findings: 190,581 individuals were included in the study with a median follow-up period of 11.84 years. The areas under the receiver operating characteristic curve for prevalent type 2 diabetes detection were 0.816 (0.807-0.825) and 0.762 (0.754-0.770) for the internal and external validations, respectively. The model primarily focused on the QRS duration and, occasionally, P or T waves. The diabetic ECG group exhibited an increased risk of incident type 2 diabetes compared with the non-diabetic ECG group, with hazard ratios of 2.15 (1.82-2.53) and 1.92 (1.74-2.11) for internal and external validation, respectively. Interpretation: In the non-diabetic group, those whose ECG was classified as diabetes by the DLM were at a higher risk of incident type 2 diabetes than those whose ECG was not. Additional clinical research on the relationship between the phenotype of ECG and diabetes to support the results and further investigation with tracked data and various ECG recording systems are suggested for future works. Funding: National Research Foundation of Korea.

Trends in Childhood Glaucoma Prevalence and Incidence in South Korea, 2002-2019: A Nationwide Population-Based Study.

PRCIS: This nationwide analysis identified the prevalence and incidence of childhood glaucoma for an 18-year period. The prevalence and incidence of primary congenital glaucoma showed increasing trends. Juvenile open angle glaucoma, meanwhile, showed a decreasing tendency. PURPOSE: We aimed to determine the trends in the prevalence and incidence of childhood glaucoma in the entire population of South Korea. PATIENTS AND METHODS: A nationwide retrospective cohort study was performed with an age-specific and sex-specific population of South Korea. The Korean National Health Insurance Service claims database for 2002 to 2019 was accessed to identify cases of ophthalmologist-confirmed primary childhood glaucoma [ie, primary congenital glaucoma (PCG) and juvenile open angle glaucoma (JOAG)]. Incidence for PCG was estimated for a same-birth-year population, while that for JOAG was estimated using age-specific and sex-specific population figures. To verify the glaucoma cases, we also analyzed the diagnostic codes as well as any information on medication prescriptions and/or ocular-surgery history. RESULTS: During the 18-year observational period, totals of 505 and 7538 patients were diagnosed with PCG and JOAG, respectively. The mean prevalences of PCG and JOAG were 3.96±0.72 and 14.17±5.18, respectively. The prevalence of PCG showed an overall increasing trend during the study period, but the pattern was not significant ( ß =0.049, P =0.143); that of JOAG, meanwhile, showed a significant decreasing tendency ( ß =-0.713, P =0.001). PCG prevalence showed no difference between urban and rural areas, but JOAG showed a higher prevalence in rural areas ( P <0.001). As for mean incidence, the rates for PCG and JOAG were 1.54±0.49 and 5.02±1.95 (per 100,000 person-years), respectively, and were higher in males ( P <0.001 and P =0.013). CONCLUSION: This study identified childhood glaucoma prevalence and incidence in a general population of East Asian ethnicity. This data could help to promote a better understanding of the typical epidemiological features and clinical courses of childhood glaucoma patients.

Nighttime Outdoor Artificial Light and Risk of Age-Related Macular Degeneration.

Importance: Light pollution's impact on human health is increasingly recognized, but its link to exudative age-related macular degeneration (EAMD) remains unclear. Objective: To investigate the association between exposure to outdoor artificial light at night (OALAN) and the risk of incident EAMD. Design, Setting, and Participants: In this nationwide population-based case-control study, all individuals 50 years or older with newly diagnosed EAMD between January 1, 2010, and December 31, 2011, were identified with reference to the Korean National Health Insurance Service registration program database for rare and intractable diseases. Birth year- and sex-matched controls (with no EAMD diagnosis until 2020) were selected at a 1:30 ratio. Data were acquired from May 1 to December 31, 2021, and analyzed from June 1 to November 30, 2022. Exposures: Mean levels of OALAN at participants' residential addresses during 2008 and 2009 were estimated using time-varying satellite data for a composite view of persistent nighttime illumination at an approximate scale of 1 km2. Main Outcomes and Measures: The hazard ratios (HRs) and 95% CIs of the association between residential OALAN and risk of incident EAMD were determined based on maximum likelihood estimation after adjusting for sociodemographic characteristics, comorbidities, and area-level risk factors (ie, nighttime traffic noise and particulate matter of aerodynamic diameter ≤10 µm in each participant's administrative district of residence). Results: A total of 126 418 participants were included in the analysis (mean [SD] age, 66.0 [7.9] years; 78 244 men [61.9%]). Of these, 4078 were patients with newly diagnosed EAMD and 122 340 were EAMD-free matched controls. In fully adjusted models, an IQR (55.8 nW/cm2/sr) increase in OALAN level was associated with an HR of 1.67 (95% CI, 1.56-1.78) for incident EAMD. The exposure-response curve demonstrated a nonlinear, concave upward slope becoming more pronounced at higher levels of light exposure (ie, at approximately 110 nW/cm2/sr). In a subgroup analysis, an IQR increase in OALAN was associated with increased risk of incident EAMD in urban areas (HR, 1.46 [95% CI, 1.33-1.61]) but not in rural areas (HR, 1.01 [95% CI, 0.84-1.22]). Conclusions and Relevance: In this nationwide population-based case-control study, higher levels of residential OALAN were associated with an increased risk of incident EAMD. Future studies with more detailed information on exposure, individual adaptive behaviors, and potential mediators are warranted.

Visual Impairment Risk After Alcohol Abstinence in Patients With Newly Diagnosed Open-Angle Glaucoma.

Importance: Recent studies indicate that alcohol consumption is linked to increased intraocular pressure and higher prevalence of open-angle glaucoma (OAG). However, there is insufficient evidence to establish any correlation between alcohol abstinence and improved outcomes in patients with OAG. Objective: To evaluate the association between alcohol consumption status (and its changes) and risk of incident severe visual impairment (VI) or blindness in patients with newly diagnosed OAG. Design, Setting, and Participants: This retrospective, nationwide, population-based cohort study used the Korean National Health Insurance Service's claims and health examination database to enroll patients who were newly diagnosed with OAG between January 1, 2010, and December 31, 2011, and had been alcohol drinkers before their OAG diagnosis. The cohort was followed up until December 2020. The data were analyzed from February to December 2022. Exposures: The patients were categorized into 2 groups based on their post-OAG diagnosis alcohol consumption status: sustainers and abstainers. The risks of severe VI or blindness were compared using weighted Cox proportional hazards regression models along with inverse probability of treatment weighting. Main Outcomes and Measures: Incident severe VI or blindness. Results: Among 13 643 patients with newly diagnosed OAG (mean [SD] age, 53.7 [11.9] years; 12 066 men [88.4%]) who were drinkers, 2866 (21.0%) quit drinking after the diagnosis. During 91 366 person-years of follow-up, patients abstaining from alcohol after their OAG diagnosis had a lower risk of severe VI or blindness than did those who had sustained drinking (adjusted hazard ratio [AHR] after inverse probability of treatment weighting, 0.63; 95% CI, 0.45-0.87). Among the sustained drinkers, both mild consumption (<105 g/wk; AHR, 1.52; 95% CI, 1.01-2.28) and moderate to heavy consumption (≥105 g/wk; AHR, 1.78; 95% CI, 1.11-2.86) after OAG diagnosis were associated with higher risk of severe VI or blindness relative to abstainers. Frequent drinking (≥4 d/wk) also was associated with a higher risk of severe VI or blindness (AHR, 2.56; 95% CI, 1.52-4.33) compared with abstinence. Conclusions and Relevance: In this cohort study of patients with OAG who were drinkers, abstaining from alcohol after an OAG diagnosis was associated with lower risk of severe VI or blindness. These findings suggest that lifestyle interventions, such as alcohol abstinence, could be essential for patients with newly diagnosed OAG.

Implementation of Interoperable Healthcare Standards for Community Healthcare.

Building an integrated data model that includes not only clinical data but also personal health records has become increasingly important. We aimed to build a big data healthcare platform by developing a common data model that can be utilized in the healthcare field. To this end, we acquired health data from various communities to establish community care digital healthcare service models. Further, to improve personal health data interoperability, we ensured conformance to international standards, namely, the Systemized Nomenclature of Medicine Clinical Terms (SNOMED-CT) and transmission standards, namely, Health Level 7 Fast Healthcare Interoperability Resource (HL7 FHIR). Furthermore, FHIR resource profiling was designed to transmit and receive data, following the HL7 FHIR R4 guidelines.

Prediction of incident chronic kidney disease in a population with normal renal function and normo-proteinuria.

Regarding the irreversible clinical course of chronic kidney disease, identifying high-risk subjects susceptible to Chronic Kidney Disease (CKD) has an important clinical implication. Previous studies have developed risk prediction models identifying high-risk individuals within a group, including those who may have experienced minor renal damage, to provide an opportunity for initiating therapies or interventions at earlier stages of CKD. To date, there were no other studies developed a prediction model with quantitative risk factors to detect the earliest stage of CKD that individuals with normal renal function in the general population may experience. We derived 11,495,668 individuals with an estimated glomerular filtration rate (eGFR) ≥90 mL/min/1.73 m2 and normo-proteinuria, who underwent health screening ≥2 times between 2009 and 2016 from the prospective nationwide registry cohort. The primary outcome was the incident CKD, defined by an eGFR <60 mL/min/1.73 m2. Sex-specific multivariate Cox regression models predicting the 8-year incident CKD risk were developed. The performance of developed models was assessed using Harrell's C and the area under the receiver operating characteristics curve (AUROC) with 10-fold cross-validation. Both men and women, who met the definition of incident CKD, were older and had more medical treatment history in hypertension and diabetes. Harrell's C and AUROC of the developed prediction models were 0.82 and 0.83 for men and 0.79 and 0.80 for women. This study developed sex-specific prediction equations with reasonable performance in a population with normal renal function.

Low-dose aspirin in the primary prevention of cardiovascular diseases: A retrospective, propensity score matched study.

BACKGROUND AND AIMS: Although the guidelines have been revised recently, the effect of aspirin for the primary prevention of cardiovascular disease (CVD) is still controversial. Thus, we aimed to evaluate the effect of aspirin on primary prevention in the real world. METHODS: Among the 4,266,268 participants without a history of CVD or previous prescription of aspirin and other antiplatelet agents who were screened between 2002 and 2008, 268,963 persons who were prescribed low-dose aspirin (≤100 mg/day) over 90 days in 2002-2008 and 1,075,852 persons who did not receive aspirin were selected after propensity score matching. A Cox proportional-hazards model was used to evaluate the effect of low-dose aspirin on the development of CVD and bleeding episodes. RESULTS: Aspirin showed a protective effect on total CVD events (hazard ratio (HR); 0.737, 95% confidence interval; 0.729-0.745). The protective effect of aspirin on total CVD events was significant in men, women and even in young participants (<65 years). Aspirin had a protective effect in participants with diabetes or hypertension against all subcategories of CVD. The HR of bleeding risk was 1.4-1.5 in aspirin group. CONCLUSIONS: Low-dose aspirin generally showed a protective effect against CVD regardless of age, sex, and underlying comorbidities in the real world. Though, the effect of aspirin was evident at a young age, the risk of bleeding was also high (1.4-1.5 times), and thus, careful prescription is required.

Association between Sight-Threatening Eye Diseases and Death by Suicide in South Korea: A Nationwide Population-based Cohort Study.

PURPOSE: Although associations between visual impairment (VI) and suicide are posited, specific risks across the sight-threatening eye disease (STED) spectrum remain to be assessed. We determined whether individuals with STED die more often by suicide than do other people and assessed the temporal associations. DESIGN: A nationwide, population-based cohort study. PARTICIPANTS: All persons aged 40 years or older in South Korea from 2010 to 2020. METHODS: Persons diagnosed with STEDs (i.e., glaucoma, exudative age-related macular degeneration [AMD], or diabetic retinopathy [DR]) were identified in the Korean National Health Insurance (NHI) service database. Both NHI health checkup records and the National Disability Registration were used for coexisting severe VI. Death by suicide was defined as diagnostic codes as recorded in the Korea National Statistical Office. Incidence rate ratios (IRRs) were estimated by quasi-Poisson regressions and adjusted for sociodemographics, comorbidity, psychiatric diagnoses, and VI. The temporal relationship between time since first STED diagnosis and suicide risk was determined by identifying patients with STED newly diagnosed during the period from 2010 to 2011. MAIN OUTCOME MEASURES: The IRR of death by suicide in people with STED relative to those without. RESULTS: Of the 2.8 million people (45% male) observed for 24 300 969 person-years, 13 205 died by suicide. Among them, 34% (n = 4514) had a STED diagnosis, for a suicide rate of 69 per 100 000 person-years (95% confidence interval [CI], 67-72), relative to 51 per 100 000 person-years (95% CI, 50-52) for non-STED individuals. People with STED had an adjusted IRR of 1.33 (95% CI, 1.26-1.41) relative to those without. The largest excess adjusted IRR of suicide mortality was that for DR (1.40, 95% CI, 1.29-1.52). For exudative AMD, the adjusted IRR was 1.20 (95% CI, 1.04-1.39), whereas for glaucoma, the corresponding value was 1.09 (95% CI, 1.02-1.17). With coexisting severe VI, the IRR for any STED was 1.49 (95% CI, 1.29-1.73). The highest suicide hazard ratio was between 3 and 6 months postdiagnosis (5.33; 95% CI, 4.59-6.20). CONCLUSIONS: In South Korea between 2010 and 2020, a higher suicide rate was evident among those with diagnosed STED than for persons not so diagnosed. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Effect of Ambient Air Pollutants on the Medical Costs of Allergic Rhinitis in Seoul, Korea.

BACKGROUND: Ambient air pollutants are considered significant factors that influence allergic diseases. This study aimed to evaluate the effect of ambient air pollution on the medical costs of allergic rhinitis (AR) through a time-series analysis. METHODS: We used data from the Korean National Health Insurance Database from January 2016 to December 2019. The total cost for medical management and outpatient prescriptions for AR, estimated by the National Health Insurance Service for 25 districts, was summed as the total medical costs. The monthly concentrations of PM10 , PM2.5 , NO2 , CO, O3 , and SO2 were calculated, and time-series analysis was performed to evaluate the effect of ambient air pollutants on the medical cost of AR using the seasonal autoregressive integrated moving average (SARIMA) model. RESULTS: Time-series analysis revealed that the concentrations of PM10 , NO2 , and CO were significantly associated with an increased medical cost of AR when adjusting for monthly differences and seasonality (p = 0.048, p = 0.001, and p = 0.001 respectively). The increase in medical costs of AR was 6.22% (95% confidence interval [CI]: 0.0%-12.37%), 11.27% (95% CI: 6.03%-16.50%), and 11.05% (95% CI: 7.09%-15.01%) per one standard deviation increase in PM10 , NO2, and CO respectively. CONCLUSIONS: The monthly concentrations of PM10 , NO2 , and CO were significantly associated with the increased medical costs of AR when adjusting for monthly differences and seasonality. This analysis provides a better understanding of the health and economic effects of ambient air pollutants on AR. LEVEL OF EVIDENCE: N/A Laryngoscope, 133:1828-1833, 2023.

Incidence of Sturge-Weber Syndrome and Risk of Secondary Glaucoma: A Nationwide Population-based Study Using a Rare Disease Registry.

PURPOSE: To determine Sturge-Weber syndrome (SWS) incidence and secondary glaucoma risk. DESIGN: Nationwide retrospective cohort study. METHODS: The Korean National Health Insurance (NHI) claims database from 2002 to 2019 along with the registration-program database for rare intractable diseases (ie, the rare disease registry) were accessed to identify ophthalmologist/neurologist-confirmed SWS patients. SWS incidence was estimated in a same-birth-year population (ie, a birth cohort) from 2002 to 2009. Among the SWS patients born between 2002 and 2019, the incidence of SWS-associated glaucoma was estimated. RESULTS: During the 18-year observational period, a total of 1049 patients were registered as SWS. The mean birth-cohort SWS incidence was 3.08 (95% CI 2.52-3.64) per 100 000 people per year, with an approximate female-to-male ratio of 0.97:1. Among the 217 SWS patients born between 2002 and 2019, secondary glaucoma arose in 18 (8.3%) cases, including 12 males (66.7%). Among these 18 SWS-associated glaucoma cases, 15 (83.3%) were diagnosed before 1 year of age, and the other 3 (16.7%) between age 1 and 2 years. Among the 660 SWS patients under age 40 years during the study period, SWS-associated glaucoma was identified in 79 (12.0%) cases. Neurologic manifestations such as epilepsy, hemiparesis, and mental retardation did not significantly differ between SWS patients with and those without secondary glaucoma. CONCLUSIONS: This study identified birth-cohort SWS incidence and determined secondary-glaucoma risk in a population of East Asian ethnicity. These data could help to promote better understanding of the epidemiologic features of SWS patients.

Distinct Endotypes of Pediatric Rhinitis Based on Cluster Analysis.

PURPOSE: Despite the wide spectrum of pediatric rhinitis, endotyping of rhinitis based on type 2 inflammation and bronchial hyper-responsiveness (BHR) is lacking. This study aimed to investigate endotypes of pediatric rhinitis using cluster analysis. METHODS: Cluster analysis was performed on data from 241 children with rhinitis by using 12 variables reflecting clinical characteristics of skin prick, laboratory, and pulmonary function tests. After extracting clusters, between-cluster differences in clinical features, such as nasal symptom scores and asthma comorbidity, were assessed to investigate the association between the endotypes and clinical features. RESULTS: Four clusters were extracted by hierarchical cluster analysis. Cluster 1 (n = 32 [13.3%]) was the non-allergic rhinitis dominant cluster with low type 2 inflammation and the lowest rate of BHR. Patients in cluster 1 had the mildest nasal symptoms and no asthma comorbidity. Cluster 2 (n = 114 [47.3%]) was the largest cluster and exhibited intermediate type 2 inflammation and low BHR. Cluster 3 (n = 65 [27.0%]) showed high type 2 inflammation and intermediate BHR. However, the severity of nasal symptoms and asthma comorbidity in this cluster were comparable with those in cluster 2. Cluster 4 (n = 30 [12.4%]) revealed high type 2 inflammation and BHR with potential functional airway impairment. Additionally, cluster 4 displayed the most severe nasal symptoms and frequent asthma comorbidity. CONCLUSIONS: Four distinct endotypes of pediatric rhinitis based on allergen sensitization, type 2 inflammation, and BHR correlate to symptoms and asthma comorbidity. These endotypes may aid clinicians in understanding the wide spectrum of pediatric rhinitis.

Spatial autocorrelation may bias the risk estimation: An application of eigenvector spatial filtering on the risk of air pollutant on asthma.

Air pollutants are major risk factors for respiratory diseases, particularly asthma, socially and spatially correlated. Many existing environment-asthma-related studies, however, have evaluated the impact of crude trends at the largest district level, which accounts only for temporal effects and may produce biased results with spatial autocorrelation. This study aimed to investigate how the spatial autocorrelation affects the air pollution effect estimations (sulfur dioxide [SO2], nitrogen dioxide [NO2], carbon monoxide [CO], and particulate matter [PM10]) on daily asthma emergency department (ED) visits in two metropolitan areas in Korea (Seoul Metropolitan Area [SMA] and Busan Metropolitan City, Ulsan Metropolitan City, Gyeongsangnamdo [BUG]). We applied eigenvector spatial filter (ESF) to the spatio-temporal model to remove spatial autocorrelation and distributed lag nonlinear model (DLNM) to explore nonlinear patterns between air pollutant concentration and lagged days on the three models including aggregated model (a temporal model), spatial model without ESF, and spatial model with ESF (both are spatio-temporal models). The effect of SO2 was not statistically significant for asthma ED visits in the aggregated model for SMA (cumulative relative risks [CRR] = 0.99, confidence intervals [CI]: 0.93-1.05), while the effect was statistically significant in the spatial model with ESF (CRR = 1.10, CI: 1.08-1.12). NO2 and CO were positively correlated to asthma ED visits in the spatial model without ESF (CRR = 0.84, CI: 0.81-0.86; 0.91, 0.89-0.94, respectively), but the spatial model with ESF showed significant risks (CRR = 1.21, CI: 1.18-1.24; 1.13, 1.11-1.16). Moreover, the spatial model with ESF successfully removed spatial autocorrelation (P-values for Moran's I 0.83-0.98) and demonstrated the highest model fit (McFadden's pseudo R2 0.42-0.43 for SMA and 0.26-0.27 for BUG) among the three models. Our findings demonstrate how ESF can be introduced into spatial correlation to remove bias and construct more reliable models.

The association between diabetes and hypertension with the number and extent of weight cycles determined from 6 million participants.

The purpose of this study was to elucidate the association between weight cycling and clinical outcomes such as type 2 diabetes and hypertension with differential effects of baseline age and obesity. Nationwide data from 6,132,569 healthy adults who underwent five or more health screenings between 2002 and 2011 were analyzed and followed until December 2019 for type 2 diabetes and hypertension. Weight cycling was defined as a change in body weight followed by another change in the opposite direction. Through the Cox proportional hazards model, the number and degree of weight cycles were positively associated with increased risk of type 2 diabetes and hypertension. The hazard ratios (HRs) of weight cycling for type 2 diabetes and hypertension were as high as 1.263 (1.213-1.315) and 1.175 (1.144-1.207) at two or more weight cycles of 10% of body weight (BW), respectively. The association was stronger for females, individuals with normal body weight/BMI, and older individuals. Weight cycling was significantly associated with an increased risk of adverse health outcomes and was stronger in individuals with normal BMI and females, indicating that these people should be informed about the potential risk of weight cycling.

Association between higher variability in kidney function and long-term mortality.

AIM: We evaluated whether estimated glomerular filtration rate variability in the general population could be associated with all-cause mortality. METHODS: Health examination data from 7842 individuals aged >20 years who visited for health check-ups at least thrice at ≥6-month intervals between May 1, 1995 and November 30, 2010 were collected. Estimated glomerular filtration rate variability was defined as the coefficient of variation of the estimated glomerular filtration rate, that is, standard deviation/mean value multiplied by 100. The study population was divided into three groups based on the coefficient of variation tertiles, and the mortality risks were compared across groups. RESULTS: The mean duration from the final visit to the outcome was 10.3 ± 2.9 years. The mean coefficient of variations of estimated glomerular filtration rate variability from the lowest to the highest variability group were 5.1 ± 1.8%, 9.0 ± 1.0%, and 14.4 ± 3.9%, respectively. There was a 1.3 times higher risk of mortality in the group with the highest variability (hazard ratio: 1.300, 95% confidence interval: 1.013-1.669) after adjustment. The findings were similar in patients with diabetes and those >60 years old (hazard ratio: 1.635, 95% confidence interval: 1.076-2.483; hazard ratio: 1.585, 95% confidence interval: 1.107-2.269). CONCLUSION: Higher estimated glomerular filtration rate variability was associated with increased 10-year mortality in the general population. This variability was very small, but considering the patients' long-term prognoses, it was significant.