Sex Differences Associated with Weekend Catch-Up Sleep and Waist-to-Height-Ratio among South Korean Adults Using Korea National Health and Nutrition Examination Survey 2016-2021 Data.

The global surge in obesity rates is closely linked to the rise in sleep deprivation and prevalence of sleep disorders. This study aimed to investigate the association between weekend catch-up sleep (CUS) and obesity among Korean adults. Using multiple logistic regression analysis, we analyzed the data of 6790 adults aged >19 years obtained from the Korea National Health and Nutrition Examination Survey 2016-2021. In the subgroup analysis, we conducted multiple logistic regression analysis to determine the association between weekend CUS and obesity, stratified by sex. Women were significantly more likely to be obese than men (odds ratio (OR) = 0.53, 95% confidence interval (CI) = 0.46-0.61). Obesity was associated with 1 ≤ weekend CUS < 2 (OR = 0.86, 95% CI = 0.75-0.99) but not with weekend CUS ≤ 0. Compared to men, women had a lower obesity risk when engaging in weekend supplementary sleep that was 1 ≤ weekend CUS < 2 (OR = 0.78, 95% CI = 0.63-0.97). Our findings revealed that weekend CUS was associated with obesity. Our findings suggest that weekend CUS may offer a form of biological protection against obesity, and they contribute to a better understanding of this association and may serve as a basis for better obesity management.

Association between Delivery during Off-Hours and the Risk of Severe Maternal Morbidity: A Nationwide Population-Based Cohort Study.

This study evaluated the association between off-hour deliveries and the risk of severe maternal morbidity (SMM). Data regarding Korean deliveries between 2005 and 2019 obtained from the National Health Insurance Service were used. SMM was evaluated using an algorithm developed by the United States Centers for Disease Control and Prevention. Modified Poisson regression analyses were conducted to investigate the association between off-hour deliveries and SMM, with stratification by hospital region and the number of beds. Approximately 32.7% of the 3,076,448 nulliparous women in this study delivered during off-hours, including 2.6% who experienced SMM. Patients who delivered at night had the highest risk of SMM (weekday nights, adjusted risk ratio (aRR): 1.41, 95% confidence interval (CI): 1.38-1.44; weekend nights, OR: 1.40, 95% CI: 1.34-1.46). The SMM of night deliveries was higher at hospitals located in small cities and those with 100-499 beds (weekend night: small cities, aRR: 1.49, 95% CI: 1.40-1.59; 100-499 beds, aRR: 1.83, 95% CI: 1.67-2.01; weekday night: small cities, aRR: 1.46, 95% CI: 1.42-1.51; 100-499 beds, aRR: 1.70, 95% CI: 1.62-1.79). Therefore, nighttime deliveries are associated with a higher risk of SMM, especially at hospitals located in small cities and those with 100-499 beds.

Is a change in economic status associated with anxiety, depression and suicide ideation during the COVID-19 pandemic in South Korean adults?

BACKGROUND: Coronavirus disease 2019 (COVID-19) affected global economic changes and mental health outcomes. However, sex differences are unclear regarding the relationship between economic status change and mental health outcomes during the pandemic. Therefore, we investigated whether change in economic status is associated with depression, anxiety and suicidal ideation, based on sex. METHODS: We used data from the COVID-19 National Mental Health Survey 2021 in South Korea. We used the Generalized Anxiety Disorder (GAD) 7-item scale for measuring anxiety, the Patient Health Questionnaire-9 scale for measuring depression and self-reported questionnaires for investigating suicidal ideation and COVID-19-related suicidal ideation. RESULTS: Among 2000 participants, those with a worse economic status change had a 2.7-fold higher risk of GAD (prevalence ratio [PR], 2.70; 95% confidence interval [CI], 2.07-3.51); 2.5-fold higher depression risk (PR, 2.55; 95%CI, 2.05-3.18); 2.1-fold higher risk of suicidal ideation (PR, 2.09; 95%CI, 1.72-2.53); and 4.0-fold higher risk of COVID-19-related suicidal ideation (PR, 4.03; 95%CI, 2.78-5.83). Women whose economic status worsened had a 3.5-fold higher risk of COVID-19-related suicidal ideation (PR, 3.49; 95%CI, 2.01-6.06). CONCLUSION: Worse economic change is associated with negative mental health outcomes during the COVID-19 pandemic; particularly, women experiencing financial hardships during the pandemic had a higher risk of COVID-19-related suicidal ideation.

The impact of assisted reproductive technology treatment coverage on marriage, pregnancy, and childbirth in women of childbearing age: an interrupted time-series analysis.

BACKGROUND: Korea is encountering major challenges related to its declining birth rate and aging population. Various policies have been introduced to prevent further population decrease and boost the birth rate, but their effectiveness has not been verified. Therefore, this study examined the effects of assisted reproductive technology (ART) insurance coverage on marriage, pregnancy, and childbirth in women of childbearing age. METHODS: All information on marriage, pregnancy, childbirth of women of childbearing age was obtained from Statistics Korea and Korean National Health Insurance Service database. During a total follow-up period of 54 months (July 2015 to December 2019), an average of 12,524,214 women of childbearing age per month, and 29,701 live births per month were included in the analysis. An interrupted time series with segmented regression was performed to analyze the time trend and changes in outcomes. RESULTS: The implementation of ART coverage policies had no significant impact on marriage or pregnancy rates. However, it did affect multiple pregnancy and multiple birth rates, which increased by 1.0% (Exp(ß3) = 1.010, P-value = 0.0001) and 1.4% (Exp(ß3) = 1.014, P-value = < 0.0001), respectively, compared to the pre-intervention period. Although the effect of covering ART treatment on total birth rates were not confirmed, a slightly slower decline was observed after the intervention (Exp(ß1) = 0.993, P-value = < 0.0001, Exp(ß1 + ß3) = 0.996 P-value = 0.012). CONCLUSION: This study identified the effects of ART health insurance coverage policy on the rates of multiple pregnancies and births. After the policy implementation, the downward trend in the total birth rate reduced slightly. Our findings suggest that interventions to support infertile couples should be expanded to solve the problem of low fertility rates. To address the intricate problems related to low birth rates, the Korean government introduced a policy that provides financial support and health insurance coverage for assisted reproductive technology (ART) treatment for infertile couples. As a result of evaluating the effectiveness of the ART coverage policy, it led to higher rates of pregnancies and births. In addition, although the total birth rate has been continuously decreasing over time, the decline may have been slowed down slightly by this policy.

Evaluation of Assisted Reproductive Technology Health Insurance Coverage for Multiple Pregnancies and Births in Korea.

Importance: While various policies to support couples experiencing infertility have been introduced due to the fertility rate rapidly dropping in developed countries, few large-scale nationwide cohort studies have evaluated the outcomes of assisted reproductive technology (ART) health insurance coverage policies. Objective: To evaluate ART health insurance coverage for multiple pregnancies and births in Korea. Design, Setting, and Participants: This population-based cohort study used delivery cohort data from the Korean National Health Insurance Service database between July 1, 2015, and December 31, 2019. A total of 1 474 484 women were included after exclusion of those who gave birth at nonmedical institutions and those with missing data. Exposure: Two 27-month periods were examined before and after the Korean National Health Insurance Service had begun covering ART treatment (preintervention period, July 1, 2015, to September 30, 2017; postintervention period, October 1, 2017, to December 31, 2019). Main Outcomes and Measures: Multiple pregnancies and multiple births were identified by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes. Total births were defined as the total number of babies born to each pregnant woman during the follow-up period. An interrupted time series with segmented regression was conducted to analyze the time trend and its change in outcomes. Data analysis was conducted between December 2, 2022, and February 15, 2023. Results: Of the 1 474 484 women eligible for the analysis (mean [SD] age, 33.2 [4.6] years), approximately 1.60% had multiple pregnancies and 1.10% had multiple births. After covering ART treatment, the likelihood of multiple pregnancies and multiple births was estimated to increase by 0.7% (estimate, 1.007; 95% CI, 1.004-1.011; P < .001) and 1.2% (estimate, 1.012; 95% CI, 1.007-1.016; P < .001) compared with before coverage. The probability of an increase in the number of total births per pregnant woman after the intervention was estimated to be 0.5% (estimate, 1.005; 95% CI, 1.005-1.005; P < .001). The relatively high-income class above the median income showed a decreasing trend in multiple births and total births before the intervention, but after the intervention, a significant increase was observed. Conclusions and Relevance: This population-based cohort study found that the possibility of multiple pregnancies and births in Korea significantly increased after the implementation of an ART health insurance coverage policy. These findings suggest that the development and coverage of policies to support couples experiencing infertility may help address low fertility rates.

Advanced maternal age and severe maternal morbidity in South Korea: a population-based cohort study.

To investigate the association between maternal age and severe maternal morbidity (SMM) in a Korean population. Data for cases of delivery between 2003 and 2019 were extracted from the Korean National Health Insurance Service-National Delivery Cohort. The main outcome was SMM, which was determined using the Center for Disease Control and Prevention's algorithm. A generalized estimating equation model with a log link was performed for the relationship between SMM and maternal age adjusted for covariates. SMM occurred in 40,959/2,113,615 (1.9%) of delivery cases. Teenagers and women 35 years and older had an increased risk of SMM in both nulliparous and multiparous cases (ages 15-19: risk ratio (RR) 1.32, 95% confidence interval (CI) 1.15-1.46; ages 35-39: RR 1.24, 95% CI 1.21-1.28; ages 40-44: RR 1.57, 95% CI 1.50-1.64; and ages 45 or older: RR 2.07, 95% CI 1.75-2.44). Women aged 40 years and older had the highest rates of SMM. In singleton births as well as in nulliparous and multiparous cases, teenagers and women aged 35 years and older had a particularly high risk of SMM. Identifying and managing risk factors for SMM in these vulnerable age groups may improve maternal health outcomes.

Do lifestyle risk behaviors affect anxiety, depressive symptoms, and suicidal ideation among adolescents?

Cultivating and maintaining good mental health and a healthy lifestyle during adolescence-the period when physical and psychological development occurs-is important. Further, an unhealthy lifestyle can have long-term effects on health. Few studies have examined the multiple effects of lifestyle risk behavior on mental health, and the behaviors that interact with this relationship remain unclear. This study aimed to explore the associations between anxiety, depressive symptoms, and suicidal ideation and a cumulative unhealthy lifestyle. The study included 54,948 participants from the 2020 Korea Youth Risk Behavior Web-Based Survey. The generalized anxiety disorder-7 scale was used to define the disorder. Depressive symptoms and suicidal ideation were evaluated using a self-reported questionnaire. The relationship between mental health and lifestyle risk scores was examined using multiple logistic regression analysis. There was a significantly positive relationship of a high lifestyle risk score with the risk of generalized anxiety disorder, depressive symptoms, and suicidal ideation. There were interaction effects between sex and academic achievement. Insufficient/prolonged sleep was strongly associated with poor mental health among Korean adolescents. Our findings showed an association between poor mental health and high lifestyle risk scores. Longitudinal studies to identify potential risk behaviors and to reveal causal relationships are warranted.

Effects of assisted reproductive technology on severe maternal morbidity risk in both singleton and multiple births in Korea: A nationwide population-based cohort study.

BACKGROUND: Whether infertility treatment predicts severe maternal morbidity in both singleton and twin pregnancies is controversial. We conducted this nationwide population-based cohort study to compare pregnancies conceived through assisted reproductive technology treatments, such as intrauterine insemination or in vitro fertilization, with unassisted pregnancies. METHODS: This study included 269,930 women who experienced childbirth in 2018, using data of the National Health Insurance Service National Delivery Cohort in Korea. The primary outcome was assessed using a severe maternal morbidity algorithm developed by the Centers for Disease Control and Prevention in the United States. A modified Poisson regression was used to estimate the adjusted risk ratio of severe maternal morbidity. RESULTS: Severe maternal morbidity occurred in 6,333 (2.3%) of 280,612 deliveries investigated. The risk of severe maternal morbidity was approximately 1.5-fold higher among women who received in vitro fertilization (risk ratio: 1.51, 95% confidence interval: 1.36-1.68) than among fertile women. However, no significant association between intrauterine insemination and maternal morbidity was identified. Via subgroup analysis, in vitro fertilization increased the risk of severe maternal morbidity by 1.6- and 1.3-fold in singleton and multiple births, respectively (singleton: risk ratio: 1.62, 95% confidence interval: 1.43-1.83; multiple birth: risk ratio: 1.31, 95% confidence interval: 1.07-1.60). CONCLUSIONS: This study suggested that in vitro fertilization was associated with the risk of severe maternal morbidity in both singleton and multiple births. Further research should identify patient- and treatment-specific factors that may mitigate or prevent adverse maternal health risks.

Health behavior changes and mortality among South Korean cancer survivors.

Considering the rapid growth in the number of cancer survivors, the successful management of their health behaviors requires further attention. However, there are lack of information about cancer survivors' health behaviors and the risk of mortality using Korean cohort data. This study aimed to examine the effects of health behavior changes on mortality among cancer survivors and to develop a validated nomogram. This cohort study was conducted using claims data. Data from adult cancer survivors from the National Health Insurance Service-National Sample Cohort, conducted between 2002 and 2015, were included. Individuals who were alive for five years after their cancer diagnosis were defined as cancer survivors. Cox proportional-hazards regression was used to estimate the target associations. Discrimination (Harrell's C-index) and calibration (Hosmer-Lemeshow test) were employed to validate the nomogram. Data from 9300 cancer survivors were used for analysis. Compared to non-smokers, those who started or quit smoking had a higher risk of all-cause mortality. Those who were physically inactive had a higher risk of all-cause mortality than those who were continuously active. In the nomogram, the C-index value was 0.79 in the training data and 0.81 in the testing data. Hosmer-Lemeshow test was not significant, demonstrating a good fit. We found that individuals with unhealthy behaviors had a higher risk of mortality, thereby highlighting the importance of managing health behaviors among cancer survivors. The development of a validated nomogram may provide useful insights regarding official policies and existing practices in healthcare systems, which would benefit cancer survivors. Our study could provide the evidence to inform the priority of guideline for managing the health behavior among cancer survivors.

Comparison of global indicators for severe maternal morbidity among South Korean women who delivered from 2003 to 2018: a population-based retrospective cohort study.

BACKGROUND: Even though several severe maternal morbidity (SMM) indicators exist globally, indicators that can serve as international standards are needed. Therefore, this study aimed to compare the SMM risk assessment using four international indicators and identify the factors underlying the differences among the risk assessments obtained by the various indicators. METHODS: This study used the National Health Insurance delivery cohort in South Korea from 2003 to 2018. SMM was estimated using four indicators: the United States Centers for Disease Control and Prevention (US-CDC) SMM algorithm, the American College of Obstetricians and Gynecologists (ACOG) gold standard guidelines, Zwart et al.'s indicators for the Netherlands, and the European Network on Severe Acute Maternal Morbidity (EURONET-SAMM) index. Generalized estimating equations models were used to identify the relationships between SMM indicators and risk factors. RESULTS: The SMM incidence rates in 6,421,091 deliveries, were 2.36%, 3.12%, 0.31%, and 1.36% using the US-CDC, ACOG, Zwart et al.'s, and EURONET SAMM indicators, respectively. In sub indicators, hemorrhage-related codes constituted the highest proportion of all SMM indicators. Advanced maternal age was related to high risk in all four SMM indicators (US-CDC: 40-44 years, RR 1.67, 95% CI 1.63-1.71; ACOG's guidelines: 40-44 years, RR 1.52, 95% CI 1.49-1.56; Zwart's indicators: RR 2.72, 95% CI 2.55-2.90; EURONET-SAMM: RR 2.04, 95% CI 1.97-2.11) compared to those aged 25-29 years. In residential area, women who lived in rural area had approximately 1.2- to 1.5-fold higher risk of SMM compared to those who lived in Seoul. Additionally, inadequate prenatal care was associated with a 1.1- to 1.4-fold higher risk of SMM compared to adequate prenatal care. CONCLUSIONS: SMM was associated with maternal age, socioeconomic status, and adverse obstetric factors using various international SMM indicators. Further studies are needed to further determine risk and preventable factors for SMM and to identify more specific causes associated with the frequent sub-indicators of SMM.

There are several indicators of severe maternal morbidity (SMM) globally, but indicators that can serve as international standards are not exist yet. This study compared the SMM risk assessment using four international indicators such as US-CDC's SMM, ACOG's gold standard guidelines, Zwart et al.'s SMM, and EURONET-SAMM, and identify the factors underlying the differences among the risk assessments obtained by the various indicators.This study extracted women who were aged 15­49 years, those who had childbirth in the healthcare institute during 2003 to 2018 in South Korea using the National Health Insurance database.Of the 6,421,091 childbirth cases, the incidence of each SMM indicators were as follow: the US-CDC's SMM: 2.4%; the ACOG's gold standard guidelines: 3.1%; Zwart et al.'s SMM: 0.3%; the EURONET-SAMM: 1.4% indicators. In addition, the highest incidence of each sub-indicators was blood transfusion or obstetric hemorrhage which recorded more than 70% of total SMM cases. In particular, the risk factor on SMM were: advanced maternal age; living rural area; inadequate prenatal care.In conclusion, SMM was associated with maternal age, socioeconomic status, and adverse obstetric factors using various global SMM indicators. Therefore, further studies are needed to identify more specific causes associated with the frequent sub-indicators of SMM and to determine risk and preventable factors for SMM.

Do the Self-Reported Changes in Physical Activity After the Emergence of the COVID-19 Pandemic Associate With Major Depression According to Moderate to Vigorous Physical Activity Status?

BACKGROUND: As the COVID-19 pandemic emerged, and social distancing increased, the physical activity (PA) of people decreased, which increased depression. The purpose of this study was to analyze the relationship between self-reported changes in PA with the COVID-19 pandemic and major depression according to moderate to vigorous physical activity (MVPA) status. METHODS: This study included 228,457 adults and used data from the Korea Community Health Survey 2020. Multiple logistic regression analysis was performed to evaluate the relationship between self-reported changes in PA and major depression stratified by MVPA status. RESULTS: The percentage of participants who reported decreases in PA was 39.5% in men and 44.7% in women compared with the pre-COVID-19 pandemic period. Those who reported decreases in PA after the onset of COVID-19 had major depression (men odds ratio = 1.28; 95% confidence interval, 1.15-1.43 and women odds ratio = 1.35; 95% confidence interval, 1.25-1.46). Women who were moderately or vigorously physically active had higher odds of major depression when they reported decreases in PA (odds ratio = 1.31; 95% confidence interval, 1.06-1.62). CONCLUSIONS: People who reported decreases in PA were associated with major depression compared with the pre-COVID-19 pandemic period. Based on this, the government should encourage exercise to reduce major depression and provide guidelines for PA at home or outdoors.

The Association Between Adequate Prenatal Care and Severe Maternal Morbidity Among Teenage Pregnancies: A Population-Based Cohort Study.

Background: The aim of this study was to examine whether inadequate prenatal care affect the risk of severe maternal morbidity in teenage pregnancies. Methods: We included 23,202 delivery cases among adolescent mothers aged between 13 and 19 years old with ≥ 37 weeks' gestational age. Data were derived from the National Health Insurance Service National Delivery Cohort in Korea between 2003 and 2018. We used a generalized estimating equation model while adjusting for numerous covariates to determine the adjusted relative risk (RR) associated with severe maternal morbidity. The main outcome measures were severe maternal morbidity and the Kessner Adequacy of Prenatal Care Index. Results: Severe maternal morbidity occurred in 723 (3.1%) of the 23,202 investigated delivery cases. The risk of severe maternal morbidity was 1.8-fold higher among adolescent mothers who had received inadequate prenatal care (RR, 1.81, 95% confidence interval [CI], 1.39-2.37) and 1.6-fold higher among those who had received intermediate prenatal care (RR, 1.59, 95% CI, 1.33-1.87) compared to those with adequate prenatal care. Synergistic effects of inadequate prenatal care and maternal comorbidities affected severe maternal morbidity. Conclusion: This study confirmed that inadequate prenatal care is associated with increased risk of severe maternal morbidity among pregnant teenagers. Notably, maternal comorbidity and inadequate prenatal care produced synergistic effects on severe maternal morbidity. Public health policy makers should focus on the development and implementation of programs to ensure that adequate prenatal care and financial/healthcare support is provided to teenage mothers during their pregnancies.

Gender differences in the association between multimorbidity and depression in older Korean adults: an analysis of data from the National Survey of Older Koreans (2011-2017).

OBJECTIVES: Previous studies have shown that people with multimorbidity have a higher risk of depression than those without multimorbidity. However, few studies have examined the association between depression and multimorbidity in men and women separately. Since the rates of depression and multimorbidity are different in men and women, it is necessary to examine whether gender differences affect their association. METHODS: This study included 30,138 participants (aged ≥ 65 years) from the National Survey of Older Koreans (2011-2017). Depression was defined using the Korean version of the Geriatric Depression Scale (SGDS-K). Multimorbidity was defined as people who had 2 or more chronic diseases, including arthritis, diabetes, heart disease, hypertension, pulmonary disease, cancer, stroke, or osteoporosis. Multiple logistic regression analysis was performed to determine the association between depression and multimorbidity. RESULTS: In total, 22.2% and 30.7% of men and women, respectively, had depression. Those with multimorbidity had a higher risk of depression than those without chronic conditions; specifically, the difference in risk among men was greater than that among women. Age was considered a moderator for women. While the effects of pulmonary disease, stroke, and cancer were especially substantial in the integrated analysis, gender differences were observed related to various chronic conditions comorbid with heart disease. CONCLUSIONS: There are gender differences in the association between multimorbidity and depression among older Korean adults. Therefore, gender-specific care should be provided to reduce depression in older adults with multimorbidity.

Effects of Changes in Multiple Chronic Conditions on Medical Costs among Older Adults in South Korea.

This study aims to analyze the relationship between cognitive function and out-of-pocket cost of the state change of multiple chronic conditions in individuals aged 60 or older. Data from the 2014 to 2018 Korean Longitudinal Study of Aging were used for 2202 older adults who were cognitively "normal" at the start of the survey. Four status change groups were established ("Good → Good," "Good → Bad," "Bad → Good," and "Bad → Bad") according to the change in the number of chronic diseases. Generalized estimating equation modeling analyzed the association between these changes and out-of-pocket medical cost. Out-of-pocket cost was significantly higher among older adults with multiple chronic conditions (p < 0.0001). Total out-of-pocket medical cost and out-of-pocket cost for outpatient care and prescription drugs were significantly higher for Bad→ Bad or Good → Bad changes. Older adults with cognitive decline had significantly higher total out-of-pocket medical cost and out-of-pocket cost for prescription drugs. This study demonstrates the need to improve the multiple chronic conditions management construction model to enhance the health of older adults in Korea and secure national health care finances long-term. It provides a foundation for related medical and medical expenses-related systems.

Sex Difference in the Socioeconomic Burden of Osteoporosis among South Koreans.

Background: The prevalence of osteoporosis is increasing with the aging of the population and the socioeconomic burden. The purpose of this study was to determine the socioeconomic burden of osteoporosis in Korea. Methods: The prevalence of osteoporosis was analyzed using 2017 National Patients Sample and Korea National Health and Nutrition Examination Survey data. Direct costs were divided into healthcare and non-healthcare costs, and indirect costs were calculated by assessing the cost of loss of productivity for labor loss due to disease. Results: The prevalence of osteoporosis diagnosis was 1.91% in total, which was 13 times higher in women than in men (3.57% vs. 0.26%). The socioeconomic cost of osteoporosis was 299.1 million USD based on main diagnosis, and the cost was 13 times higher in women than in men (277.6 vs. 21.5 million USD). The total cost based on main and secondary diagnosis was 981.8 million USD. Similarly, the cost was seven times higher in women than in men (862.4 vs. 119.4 million USD). Conclusions: Osteoporosis increases the socioeconomic burden of disease, and it is significantly higher in women than in men. The policy support for the implementation of prevention and management programs would be necessary to reduce the burden of osteoporosis.

The Impact of Sedentary Behavior and Self-Rated Health on Cardiovascular Disease and Cancer among South Korean Elderly Persons Using the Korea National Health and Nutrition Examination Survey (KNHANES) 2014-2018 Data.

Cardiovascular disease and cancer have increased the risk of mortality and morbidity in elderly persons worldwide. The aim of this study was to investigate the association of sedentary behavior and self-rated health with cardiovascular disease or cancer in elderly people. The data of 6785 elderly persons aged above 65 years from the Korea National Health and Nutrition Examination Survey 2014-2018 were examined. Binary logistic regression analyses assessed the association of sedentary behavior, self-rated health, and other risk factors with cardiovascular disease or cancer. Prolonged sedentary behavior in elderly people was associated with a high risk for cardiovascular disease (odds ratio (OR): 1.28, 95% confidence interval (CI): 1.08-1.52). There was a high risk for cardiovascular disease (OR: 2.36, 95% CI: 1.85-3.01) or cancer (OR: 1.48, 95% CI: 1.17-1.88) in elderly people who had poor self-rated health. This study identified the association between prolonged sedentary behavior and cardiovascular disease, and between poor self-rated health and cancer. Since prolonged sedentary behavior is related to cardiovascular disease, efforts are needed to reduce sedentary behavior hours and maintain good self-rated health.

Salivary Immunoglobulin Gamma-3 Chain C Is a Promising Noninvasive Biomarker for Systemic Lupus Erythematosus.

We aimed to characterize the salivary protein components and identify biomarkers in patients with systemic lupus erythematosus (SLE). A proteomic analysis using two-dimensional gel electrophoresis and mass spectrometry was performed to determine the alterations of salivary proteins between patients with SLE and healthy controls, and the concentrations of the candidate proteins were measured through Western blot analysis and the enzyme-linked immunosorbent assay. The 10 differentially expressed protein spots were immunoglobulin gamma-3 chain C region (IGHG3), immunoglobulin alpha-1 chain C region, protein S100A8, lactoferrin, leukemia-associated protein 7, and 8-oxoguanine DNA glycosylase. The patients with SLE exhibited enhanced salivary IGHG3 (3.9 ± 2.15 pg/mL) and lactoferrin (4.7 ± 1.8 pg/mL) levels compared to patients with rheumatoid arthritis (1.8 ± 1.01 pg/mL and 3.2 ± 1.6 pg/mL, respectively; p < 0.001 for both) or healthy controls (2.2 ± 1.64 pg/mL and 2.2 ± 1.7 pg/mL, respectively; p < 0.001 for both). The salivary IGHG3 levels correlated with the erythrocyte sedimentation rate (r = 0.26, p = 0.01), anti-double-stranded DNA (dsDNA) antibody levels (r = 0.25, p = 0.01), and nephritis (r = 0.28, p = 0.01). The proteomic analysis revealed that the salivary IGHG3 levels were associated with SLE and lupus disease activity, suggesting that salivary IGHG3 may be a promising noninvasive biomarker for SLE.

Does Urinary Incontinence and Mode of Delivery Affect Postpartum Depression? A Nationwide Population-Based Cohort Study in Korea.

We investigated the association between urinary incontinence and postpartum depression. Data were extracted from the Korean National Health Insurance Service-National Sample Cohort and included women who delivered between 2004 and 2013. Postpartum depression was determined using diagnostic codes during the six-month postpartum period. Urinary incontinence was identified as having a prescription of incontinence drugs or a diagnosis. Cox proportional hazard models were used to calculate adjusted hazard ratios. Of the 83,066 women, 5393 (6.49%) had urinary incontinence and 691 (0.83%) had postpartum depression. Postpartum depression was higher among women with urinary incontinence, aged 15-19 years, ≥40 years old, the lowest income level, and who underwent cesarean section delivery. In the combined analysis, women with urinary incontinence and cesarean section had an approximately three times higher risk of postpartum depression compared with those without urinary incontinence and with spontaneous delivery. Women without urinary incontinence and cesarean section, and those with urinary incontinence and spontaneous delivery were at higher risk of postpartum depression compared with the reference group. Urinary incontinence and cesarean section delivery were significantly associated with postpartum depression during the first six months after childbirth. Therefore, further research should be conducted to evaluate whether urinary incontinence contributes to postpartum depression.

Socioeconomic Status and Successful Delivery after an Infertility Diagnosis: a Nationwide Health Insurance Cohort Study in Korea Conducted from 2005 to 2013.

BACKGROUND: The global disease burden of infertility is rising and accessibility to infertility treatments and assisted reproduction is a challenging issue. Therefore, we investigated characteristics of successful delivery after an infertility diagnosis among infertile women. METHODS: We designed a retrospective cohort study with the main outcome measure of a delivery medical record after the initial diagnosis of infertility. A total of 10,108 women patients who were diagnosed with infertility between 2005 to 2013 in the National Health Insurance Cooperation Cohort Database of Korea were enrolled. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for subsequent delivery were estimated by applying a Cox proportional-hazard regression model. RESULTS: Approximately 55% of infertile women who reported infertility had a delivery eventually. Infertile women who are aged between 30 to 39 (HR, 0.80; 95% CI, 0.75-0.84), in low income level (HR, 0.77; 95% CI, 0.71-0.84), or diagnosed with diabetes (HR, 0.76; 95% CI, 0.60-0.96) were less likely to report a delivery. CONCLUSION: These findings highlight demographic, socioeconomic, and medical characteristics of reporting a consequent delivery. Although many previous articles reported an association between socioeconomic status and receiving medical evaluation, there were few studies regarding successful delivery after an infertility diagnosis across socioeconomic status. Thus, the maintaining of support for low socioeconomic status infertile women and their family should be considered after the infertility diagnosis in aspects of financial and social approaches.

The Effect of Socioeconomic Status on All-Cause Maternal Mortality: A Nationwide Population-Based Cohort Study.

Improving maternal health is one of the 13 targets of Sustainable Development Goal 3; consequently, preventing maternal death, which usually occurs in women's prime productive years, is an important issue that needs to be addressed immediately. This study examines the association between socioeconomic status and all-cause maternal mortality in South Korea and provides evidence of preventable risk factors for maternal death. For this population-based retrospective cohort study, data on 3,334,663 nulliparous women were extracted from the Korean National Health Insurance Service database between 2003 and 2018. The outcome variables were all-cause maternal mortality within six weeks and a year after childbirth. A log-binomial regression model determined the association between maternal mortality and income-level adjusted covariates. Women with lower income levels had higher risk of maternal death within six weeks (risk ratio (RR) = 2.42, 95% confidence interval (CI) = 1.65-3.53) and within one year (RR = 1.83, 95% CI = 1.47-2.28), especially those who were aged 35-39 years, lived in rural areas, delivered via cesarean section, and had maternal comorbidities. The study identifies a significant relationship between South Korean primiparas' socioeconomic status and maternal death within six weeks or one year after childbirth, suggesting interventions to alleviate the risk of maternal death.