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1.
Artigo em Inglês | MEDLINE | ID: mdl-34360285

RESUMO

The association of short-term particulate matter concentration with cardiovascular disease (CVD) among cancer survivors is yet unclear. Using the National Health Insurance Service database from South Korea, the study population consisted of 22,864 5-year cancer survivors with CVD events during the period 2015-2018. Using a time-stratified case-crossover design, each case date (date of incident CVD) was matched with three or four referent dates, resulting in a total of 101,576 case and referent dates. The daily average particulate matter 10 (PM10), 2.5 (PM2.5), and 2.5-10 (PM2.5-10) on the day of case or referent date (lag0), 1-3 days before the case or referent date (lag1, lag2, and lag3), and the mean value 0-3 days before the case or referent date (lag0-3) were determined. Conditional logistic regression was conducted to calculate the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for CVD according to quartiles of PM10, PM2.5, and PM2.5-10. Compared to the 1st (lowest) quartile of lag0-3 PM10, the 4th (highest) quartile of lag0-3 PM10 was associated with higher odds for CVD (aOR 1.13, 95% CI 1.06-1.21). The 4th quartiles of lag1 (aOR 1.12, 95% CI 1.06-1.19), lag2 (aOR 1.09, 95% CI 1.03-1.16), lag3 (aOR 1.06, 95% CI 1.00-1.12), and lag0-3 (aOR 1.11, 95% CI 1.05-1.18) PM2.5 were associated with higher odds for CVD compared to the respective 1st quartiles. Similarly, the 4th quartile of lag0-3 PM2.5-10 was associated with higher CVD events (aOR 1.11, 95% CI 1.03-1.19) compared to the 1st quartile. Short-term exposure to high levels of PM may be associated with increased CVD risk among cancer survivors.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Sobreviventes de Câncer , Doenças Cardiovasculares , Neoplasias , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Doenças Cardiovasculares/epidemiologia , Estudos Cross-Over , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Humanos , Neoplasias/epidemiologia , Material Particulado/efeitos adversos , Material Particulado/análise
2.
Cancer Res Treat ; 2021 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-34353000

RESUMO

Purpose: This study aimed to assess the feasibility of operational definitions of cancer patients in conducting cancer-related studies using the claims data from the National Health Insurance Service (NHIS). Materials and Methods: Cancer incidence data were obtained from The Korean Central Cancer Registry (KCCR), NHIS primary diagnosis, and from the rare and intractable disease (RID) registration program. Results: The operational definition with higher sensitivity for cancer patient verification was different by cancer type. Using primary diagnosis, the lowest sensitivity was found in colorectal cancer (91.5%; 95% confidence interval [CI], 91.7 to 92.0) and the highest sensitivity was found in breast cancer (97.9%; 95% CI, 97.8 to 98.0). With RID, sensitivity was the lowest in liver cancer (91.9%; 95% CI, 91.7 to 92.0) and highest in breast cancer (98.1%; 95% CI, 98.0 to 98.2). In terms of the difference in the date of diagnosis in the cancer registration data, > 80% of the patients showed a < 31-day difference from the RID definition. Conclusion: Based on the health claims data, the operational definition of cancer incidence is more accurate when using the RID registration program claims compared to using the primary diagnosis despite the relatively less concordance by cancer type requires additional definitions such as treatment.

3.
J Cancer Surviv ; 2021 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-34138453

RESUMO

PURPOSE: Cancer survivors are currently considered high-risk populations for cardiovascular disease. However, no studies have directly evaluated risks and benefits of physical activity for stroke among long-term colorectal cancer survivors. METHODS: This large-scale observational cohort study used data from the Korean National Health Insurance Service database. Newly diagnosed colorectal cancer patients diagnosed between 2006 and 2013 who survived at least 5 years were studied. The primary outcome was stroke, including ischemic stroke and hemorrhage stroke. All patients were followed up to the date of stroke, death, or December 2018, whichever occurred earliest. RESULTS: Of 20,674 colorectal cancer survivors with a median age of 64 years, stroke occurred in 601 patients (2.9%). Moderate-to-vigorous physical activity lowered stroke risk in 5-9 time/week group (adjusted hazard ratio [aHR], 0.72; 95% confidence interval [CI], 0.57-0.93; P=0.010), but not in ≥10 time/week group (aHR, 0.85; 95% CI, 0.62-1.17; P=0.327). Walking also lowered stroke risk in 4-5 time/week group (aHR, 0.75; 95% CI, 0.58-0.97; P=0.028), but not in ≥6 time/week group (aHR, 0.96; 95% CI, 0.78-1.18; P=0.707). In addition, benefits of physical activity were maximized when carried out both moderate-to-vigorous physical activity and walking with moderate frequency (aHR, 0.77; 95% CI, 0.60-0.97; P=0.027). CONCLUSIONS: Moderate frequency of moderate-to-vigorous physical activity (5-9 time/week) and walking (4-5 time/week) significantly lowers the risk of stroke, whereas high-frequency physical activity reduces the benefits of physical activity. IMPLICATIONS FOR CANCER SURVIVORS: Physical activity with moderate frequency is important in the prevention of stroke for long-term colorectal cancer survivors.

4.
BMC Cancer ; 21(1): 710, 2021 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-34134651

RESUMO

BACKGROUND: There is no evidence whether it is best to stop drinking alcohol at all or whether it is okay to drink a little in that light-to-moderate alcohol use was associated with low cardiovascular disease (CVD) compared to non-drinker among colorectal cancer (CRC) survivors, who are regarded as vulnerable to CVD. Therefore, we evaluated the association between alcohol consumption and incident CVD among long-term survivors of CRC. METHODS: This population-based, retrospective cohort study utilized data from the Korean National Insurance Service of 20,653 long-term survivors of CRC diagnosed between 2006 and 2012. Participants were followed up to the date of CVD, death, or December 31, 2018. All patients were categorized according to their daily alcohol consumption (g/day). The outcomes were incident CVD, including ischemic heart disease (IHD) and ischemic and hemorrhagic stroke, analyzed using the Cox proportional hazards regression after adjusting for cardiovascular risk factors and history of chemotherapy and radiotherapy. RESULTS: There was no association between alcohol consumption and incident CVD among long-term survivors of CRC. Additionally, hazardous alcohol consumption (≥ 40 g/day in male patients and ≥ 20 g/day in female patients) was associated with increased CVD, ischemic stroke, and hemorrhagic stroke (adjusted hazard ratio [95% confidence interval]: 1.51 [1.15-1.97], 1.60 [1.03-2.48], and 2.65 [1.25-5.62], respectively) compared with non-drinkers. CONCLUSION: No discernable protective association was found between alcohol consumption and incident CVD for even light-to-moderate drinking among long-term survivors of CRC. Alcohol consumption ≥40 g/day in male patients and ≥ 20 g/day in female patients was associated with an increased risk of stroke compared with non-drinkers. These novel results provide useful evidence when advising survivors of CRC regarding alcohol use.

5.
Sci Rep ; 11(1): 11794, 2021 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-34083714

RESUMO

Nutrient intake for adult cancer survivors is of clinical importance for managing metabolic health. Whether dietary fiber intake is associated with metabolic syndrome (MetS) or not in adult cancer survivors is uncertain. We aim to investigate the association between dietary fiber intake and MetS in adult cancer survivors using a population-based cross-sectional study. A study sample of 1301 adult cancer survivors aged more than 20 years from the sixth and seventh Korea Nutrition Examination Survey (KNHANES) from 2013 to 2018 was identified. Odds ratio (OR) and 95% confidence intervals (95% CI) were estimated from multiple logistic regression adjusted for sociodemographic factors, health behavior, and nutritional status. Among 1,301 adult cancer survivors identified from the KNHANES 2013-2018, the mean dietary fiber intake was 28.1 g/day (standard error, 0.54). Compared to the first quintile of dietary fiber intake, the adjusted ORs and 95% CIs for MetS in the second, third, fourth, and fifth quintiles of dietary fiber intake were 0.84 (0.27-2.61), 0.77 (0.16-3.74), 0.55 (0.14-2.22), and 0.26 (0.05-1.39), respectively (p value for trend = 0.0007). Our findings suggest that high dietary fiber intake is marginally associated with reduced odds of MetS in adult cancer survivors.

6.
Sci Rep ; 11(1): 10152, 2021 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-33980955

RESUMO

The association of fluctuations in body mass index with cardiovascular risk in long-term is not well understood. This study aimed to investigate cardiovascular outcomes of weight fluctuation. Total of 67,101 obese adults from the Korean National Health Insurance Service who received health examinations in three separate biennial periods were included. Participants were followed up from January 1, 2008 to the date of cardiovascular disease, death, or December 31, 2015, and categorized into 9 distinctive groups according to the BMI. Continuous weight gain showed an increased risk of overall cardiovascular disease (hazard ratio [HR], 2.36; P = 0.007), whereas weight loss after weight maintenance (HR, 0.91; P = 0.016) and weight maintenance after weight loss (HR, 0.91; P = 0.004) were ameliorative compared to the no weight change group. As for coronary heart disease, weight maintenance after weight gain was unfavorable (HR, 1.25; P = 0.004) while weight loss after weight maintenance (HR, 0.82; P < 0.001), weight cycling (HR, 0.83; P = 0.043), and weight maintenance after weight loss (HR, 0.88; P = 0.012) were beneficial. Weight maintenance after weight loss is beneficial for obese adults in terms of cardiovascular risks. In addition, weight loss is in part related to reduced risk of coronary heart disease despite weight cycling.

7.
BMJ Open ; 11(4): e045375, 2021 04 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827840

RESUMO

OBJECTIVES: To evaluate the association between incident cardiovascular disease (CVD) and initiation and adherence to statin treatment for primary prevention of CVD in patients with newly diagnosed hypercholesterolaemia. DESIGN: A population-based retrospective cohort study. SETTING: This study used National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) from Republic of Korea. PARTICIPANTS: This study included 11 320 participants without previous history of CVD aged between 40 and 79 years who had elevated total cholesterol level (more than 240 mg/dL) and had initiated statin treatment within 24 months of the national health screening from 2004 to 2012 identified in the NHIS-HEALS. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome, CVD, was defined as first-ever admission or death due to ischaemic heart disease, acute myocardial infarction, revascularisation or stroke, or December 31 2013. The HRs of CVD according to statin adherence were calculated according to stratification by Systematic COronary Risk Evaluation. RESULTS: Early statin initiation significantly lowered risk of CVD outcomes compared with late initiation (HR of late statin user, 1.24; 95% CI 1.02 to 2.51). Among early initiators, statin discontinuers had a significantly higher risk for CVD compared with persistent users (HR, 1.71; 95% CI 1.10 to 2.67), while statin reinitiators had an attenuated risk increase (HR 1.34, 95% CI 0.79 to 2.30). CONCLUSIONS: Among statin users with newly diagnosed hypercholesterolaemia, early statin initiation is associated with lower CVD risk compared with late initiation. Furthermore, statin discontinuation is associated with increased risk of CVD, but reinitiation attenuated the risk.


Assuntos
Doenças Cardiovasculares , Inibidores de Hidroximetilglutaril-CoA Redutases , Hipercolesterolemia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Criança , Pré-Escolar , Estudos de Coortes , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipercolesterolemia/tratamento farmacológico , Hipercolesterolemia/epidemiologia , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco
8.
Eur Heart J ; 42(25): 2487-2497, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33780974

RESUMO

AIMS: Little is known about the trade-off between the health benefits of physical activity (PA) and the potential harmful effects of increased exposure to air pollution during outdoor PA. We examined the association of the combined effects of air pollution and changes in PA with cardiovascular disease (CVD) in young adults. METHODS AND RESULTS: This nationwide cohort study included 1 469 972 young adults aged 20-39 years. Air pollution exposure was estimated by the annual average cumulative level of particulate matter (PM). PA was calculated as minutes of metabolic equivalent tasks per week (MET-min/week) based on two consecutive health examinations from 2009 to 2012. Compared with the participants exposed to low-to-moderate levels of PM2.5 or PM10 who continuously engaged in ≥1000 MET-min/week of PA, those who decreased their PA from ≥1000 MET-min/week to 1-499 MET-min/week [PM10 adjusted hazard ratio (aHR) 1.22; 95% confidence interval (CI) 1.00-1.48] and to 0 MET-min/week (physically inactive; PM10 aHR 1.38; 95% CI 1.07-1.78) had an increased risk of CVD (P for trend <0.01). Among participants exposed to high levels of PM2.5 or PM10, the risk of CVD was elevated with an increase in PA above 1000 MET-min/week. CONCLUSION: Reducing PA may lead to subsequent elevation of CVD risk in young adults exposed to low-to-moderate levels of PM2.5 or PM10, whereas a large increase in PA in a high-pollution environment may adversely affect cardiovascular health.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Doenças Cardiovasculares , Exercício Físico , Adulto , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos de Coortes , Exposição Ambiental/análise , Humanos , Material Particulado/efeitos adversos , Material Particulado/análise , Adulto Jovem
9.
Artigo em Inglês | MEDLINE | ID: mdl-33560298

RESUMO

OBJECTIVE: The primary objective is to investigate adverse effects of ambient particulate matter (PM) in various size on the incidence of prevalent autoimmune rheumatic diseases (AIRDs): Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS), and Systemic Lupus Erythematosus (SLE). METHODS: We investigated 230,034 participants in three metropolitan cities of South Korea from the National Health Insurance Service-National Sample Cohort (NHIS-NSC). Starting from January 2010, subjects were followed up until the first event of prevalent AIRDs, death, or December 2013. 2008-2009 respective averages of PM2.5 (< 2.5µm) and PMcoarse (2.5µm to 10µm) were linked with participants' administrative district codes. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were estimated using Cox regression analysis in one- and two-pollutant model. RESULTS: Adjusted for age, sex, region, and household income in two-pollutant model, RA incidence was positively associated with 10µg/m³ increment of PM2.5 (aHR = 1.74, 95% CI: 1.06-2.86), but not with PMcoarse (aHR = 1.27, 95% CI: 0.87-1.85). In one-pollutant model, an elevated incidence rate of RA was slightly attenuated (PM2.5 aHR = 1.61, 95% CI: 0.99-2.61; PMcoarse aHR = 1.13, 95% CI: 0.80-1.61), with marginal statistical significance of PM2.5. RA incidence was also higher in 4th quartile group of PM2.5 compared to 1st quartile group (aHR = 1.83, 95% CI: 1.07-3.11). No adverse effects of PM were found on AS or SLE in one- and two-pollutant models. CONCLUSION: Important components of PM10 associated with RA incidence were fine fractions (PM2.5), while no positive association was found between PM and AS or SLE.

10.
Breast Cancer Res Treat ; 188(1): 203-214, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33599866

RESUMO

PURPOSE: To examine the association of physical activity among long-term breast cancer survivors on the occurrence of subsequent cardiovascular disease (CVD). METHODS: We investigated the risk of CVD among 39,775 breast cancer patients who were newly diagnosed in 2006 and survived until 2011 within the Korean National Health Insurance Service database. Patients were followed up from 5 years after breast cancer diagnosis to the date of CVD event, death, or December 31, 2018, whichever came earliest. Every 500 MET-mins/week correspond to 152, 125, and 62.5 min per week of light-, moderate-, and vigorous-intensity physical activity, respectively. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for CVD were calculated using Cox proportional hazards regression by physical activity levels. RESULTS: Compared with those with physical activity of 0 MET-min/week, those with 1-499 (aHR 0.82, 95% CI 0.69-0.98), 500-999 (aHR 0.75, 95% CI 0.63-0.90), and ≥ 1,000 (aHR 0.76, 95% CI 0.63-0.93) MET-min/week of PA had lower risk of CVD. Higher levels of PA were associated with lower risk of stroke (p for trend = 0.016). The benefits of PA on obese and overweight breast cancer survivors were smaller than those in normal weight survivors. The frequency of moderate-to-vigorous physical activity (MVPA) showed a reverse J-curve association with CVD, and the best benefit occurred in the 3-4 times MVPA per week group (aHR 0.59, 95% CI 0.46-0.74). CONCLUSIONS: The study showed that even small amounts of PA may be beneficial in potentially decreasing the risk of CVD, CHD, and stroke in breast cancer survivors. Our result will be useful to prescribe and delivery exercise among long-term breast cancer survivors.


Assuntos
Neoplasias da Mama , Sobreviventes de Câncer , Doenças Cardiovasculares , Exercício Físico , Feminino , Humanos , Fatores de Risco
11.
Sci Rep ; 11(1): 2453, 2021 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-33510332

RESUMO

Association between body mass index (BMI) and coronary heart disease (CHD) in cancer survivors is not clearly established. This study analyzed the prediagnosis BMI-CHD association by examining 13,500 cancer survivors identified from the National Health Insurance Service-Health Screening Cohort from January 1, 2004 to December 31, 2009 including the patients who were free of cardiovascular disease at enrollment. The Cox proportional hazards model (adjusted for socioeconomic, health behavior, health status, and medical characteristics) was used for calculating hazard ratios (HR) and 95% confidence intervals (95% CI) for CHD in each prediagnosis BMI category among cancer survivors. Compared to cancer survivors with a prediagnosis BMI between 18.5 and 22.9 kg/m2, those with a prediagnosis BMI of 23.0-24.9 kg/m2 and ≥ 25.0 kg/m2 had significantly higher CHD risk (HR = 1.51; 95% CI: 1.13-2.01 and HR = 1.38; 95% CI: 1.04-1.84, respectively). Cancer survivors with a low prediagnosis BMI (< 18.5 kg/m2) also had significantly higher CHD risk (HR = 1.97; 95% CI: 1.20-3.24) compared to those with a BMI of 18.5-22.9 kg/m2. Similar associations were found after stratifying analyses based on first cancer site and sociodemographic and medical characteristic subgroups. Our study suggests that prediagnosis underweight among patients with cancer is a predictor of CHD risk.


Assuntos
Índice de Massa Corporal , Sobreviventes de Câncer , Doença das Coronárias/diagnóstico , Doença das Coronárias/epidemiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
12.
Eur J Cancer Prev ; 30(3): 211-219, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32925510

RESUMO

Risk of hepatocellular carcinoma (HCC) in young adults might be clinically overlooked for future HCC risk. Thus, we examined the association between weight change and future risk of developing HCC in young adults. We collected a nationwide and population-based cohort data of more than 2.2 million men and women aged between 20 and 39 who were without previous cancer diagnosis and underwent two consecutive biennial national health screening between 2002 and 2005 from the National Health Insurance Service database. The individuals were categorized as weight loss (≥5.0 kg and 2.0-4.9 kg), stable weight (weight gain or loss <2.0 kg), and weight gain (2.0-4.9 kg and ≥5.0 kg) and were followed-up for incident HCC from 1 January 2006 to 31 December 2018. During 12 years of follow-up, there were 2694 HCCs in men and 306 HCCs in women. In the multivariable Cox proportional hazards model adjusted for socioeconomic, health behavior, medical characteristics, and family history, weight gain of more than 5.0 kg and between 2.0 and 4.9 kg were associated with significantly increased risk in young men [hazard ratio (HR) 1.16, 95% confidence intervals (95% CI) 1.01-1.32] and young women (HR 1.34, 95% CI 1.01-1.77), respectively. Protective association of weight loss with HCC was not observed. The association of weight gain and HCC risk was stronger in young adults with underlying liver diseases compared to those without any liver disease (Pheterogeneity < 0.001). Weight gain during young adulthood should not be clinically overlooked for future HCC risk, especially among those with underlying liver diseases.

13.
BMC Public Health ; 20(1): 1844, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-33261608

RESUMO

BACKGROUND: Although social capital has been shown to be one of the important social determinants of health, the association between social trust and the risk of cardiovascular disease (CVD) is not clear yet. We aimed to investigate the association of social trust with CVD risk using a large Korean population based data. METHODS: The data of this study was derived from the Korean National Health Insurance Service database. Community-level social trust was determined from the Korean Community Health Survey. The study population consisted of 2,156,829 participants. According to social trust index measured in the area of residence during 2011, participants were followed-up from 1 January 2012 to 31 December 2016. Multivariate Cox proportional hazards regression was used to determine the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for CVD risk according to quintiles of social trust. RESULTS: Compared to participants with the lowest quintile of social trust, those within the highest quintile had lower risk for CVD (aHR 0.91, 95% CI = 0.89 to 0.93), CHD (aHR 0.92, 95% CI = 0.89 to 0.95), and stroke (aHR 0.90, 95% CI = 0.87 to 0.93). The risk-reducing association of high social trust on CVD risk was preserved after additional adjustments for lifestyle behaviors including smoking, alcohol consumption, and physical activity. CONCLUSION: Higher social trust was associated with reduced risk of CVD even after considering lifestyle behaviors. Social trust in a community level is an important determinant of CVD and enhancing social trust may lead to reduced risk of CVD.


Assuntos
Doenças Cardiovasculares/epidemiologia , Confiança , Idoso , Exercício Físico , Feminino , Inquéritos Epidemiológicos , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Estudos Retrospectivos , Risco , Fatores de Risco , Comportamento de Redução do Risco , Fumar
14.
J Clin Psychiatry ; 82(1)2020 12 29.
Artigo em Inglês | MEDLINE | ID: mdl-33378140

RESUMO

OBJECTIVE: The role of sociodemographic factors, health behaviors, and biological indicators as potential risk factors for suicide is relatively understudied among young adults. The aim of this study is to explore the association of these variables with the risk of death by suicide among young adults. METHODS: The study population consisted of 15,534,438 individuals aged 20-39 years from the Korean National Health Insurance Service. Sociodemographic factors associated with death by suicide during 2006-2015 were evaluated. 3,396,353 individuals who underwent health examinations between 2002 and 2005 were separately assessed for health behaviors and biological indicators associated with death by suicide. Cox proportional hazards regression analysis was used to determine the hazard ratios (HRs) and 95% confidence intervals (CIs) for suicide mortality according to sociodemographic factors (age, household income, job status, residence, and Charlson comorbidity index score), health behaviors (physical activity, smoking, and alcohol consumption), and biological indicators (blood pressure, total cholesterol level, body mass index, and fasting serum glucose level). RESULTS: Low household income, self- and non-employment, increased comorbidity, smoking, and normal weight elevated the risk of death by suicide among young adults. While older age was associated with elevated risk for death by suicide among men (adjusted HR [aHR] = 2.11; 95% CI, 2.02-2.20 for men aged 35-39 years), older age reduced the risk for death by suicide among women (aHR = 0.72; 95% CI, 0.69-0.75 for women aged 35-39 years). Elevated blood pressure and fasting serum glucose level were associated with increased risk for death by suicide among men (aHR = 1.16; 95% CI, 1.05-1.28 and aHR = 1.48; 95% CI, 1.26-1.75, respectively). Finally, high total cholesterol levels were associated with increased risk for death by suicide among women (aHR = 1.59; 95% CI, 1.19-2.13). CONCLUSIONS: Sociodemographic factors, health behaviors, and biological indicators were associated with suicide mortality among young adults.


Assuntos
Suicídio/estatística & dados numéricos , Adulto , Biomarcadores/sangue , Bases de Dados Factuais , Demografia , Feminino , Comportamentos Relacionados com a Saúde , Indicadores Básicos de Saúde , Humanos , Masculino , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Fatores de Risco , Fatores Socioeconômicos , Suicídio/economia , Suicídio/psicologia , Adulto Jovem
15.
BMC Public Health ; 20(1): 1793, 2020 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-33239007

RESUMO

BACKGROUND: Whether community level social capital is associated with mortality within an Asian population is yet unclear. METHODS: The study population was derived from the Korean National Health Insurance Service-National Sample Cohort. A total of 636,055 participants were followed-up during 2012-2013 for deaths from all causes, cardiovascular disease (CVD), cancer, and other causes. Community level social trust and reciprocity at the administrative district level were derived from the Korean Community Health Survey. Cox proportional hazards regression was used to determine the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for mortality according to levels of community level social trust and reciprocity. RESULTS: Compared to participants who reside in areas within the lower half of community level social trust, those who reside in areas within the upper half had lower risk of death from all causes (aHR 0.84, 95% CI 0.78-0.89), CVD (aHR 0.82, 95% CI 0.67-0.99), and cancer (aHR 0.85, 95% CI 0.73-0.98). Similarly, residing in areas in the upper half of community level social reciprocity was associated with reduced risk for all-cause mortality (aHR 0.80, 95% CI 0.75-0.86). The protective association of high community level social trust and reciprocity on mortality remained after additional adjustments for smoking, alcohol intake, and physical activity. CONCLUSIONS: Residing in areas with high community level social trust and reciprocity may be associated with better population health status.


Assuntos
Mortalidade/tendências , Características de Residência , Capital Social , Confiança , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estudos Retrospectivos , Adulto Jovem
16.
Sci Rep ; 10(1): 19991, 2020 11 17.
Artigo em Inglês | MEDLINE | ID: mdl-33203931

RESUMO

Several previous studies have noted benefits of maintaining continuity of care (COC), including improved patient compliance, decreased health care cost, and decreased incidence of hospitalization. However, the association of COC in hypertension patients with subsequent cardiovascular disease (CVD) risk is yet unclear. Therefore, we aimed to investigate the impact of COC on CVD risk among newly-diagnosed hypertension patients. We conducted a cohort with a study population consisted of 244,187 newly-diagnosed hypertension patients in 2004 from the Korean National Health Insurance Service database. The participants were then divided into approximate quartiles of COC index, and followed from 1 January 2007 until 31 December 2017. Cox proportional hazards models were used to evaluate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for CVD risk according to quartiles. Compared to patients within the lowest quartile of COC index, those within the highest quartile of COC index had reduced risk for CVD (aHR 0.76, 95% confidence interval; CI 0.73-0.79), CHD (aHR 0.66, 95% CI 0.62-0.69) and stroke (aHR 0.84, 95% CI 0.80-0.88). COC among hypertension patients was associated with improved medication compliance and reduced risk of stroke and CVD. The importance of maintaining COC should be emphasized to reduce the risk of CVD among hypertension patients.


Assuntos
Doenças Cardiovasculares/etiologia , Hipertensão/complicações , Estudos de Coortes , Continuidade da Assistência ao Paciente , Feminino , Hospitalização , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Modelos de Riscos Proporcionais , Medição de Risco/métodos , Fatores de Risco
17.
Environ Int ; 145: 106161, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33035891

RESUMO

BACKGROUND: Physical activity (PA), especially outdoor PA, may have twofold effects on diabetes risk: the health benefits of PA and the potential detrimental effects caused by augmented exposure to air pollution. We examined the association of combined effects of PA and air pollution with diabetes in older adults. METHODS: The study participants consisted of 1,259,871 older adults aged 58 years or more from the Korean National Health Insurance Service database. The exposure to air pollution was estimated by the average ambient levels of particulate matter (PM) of the participants' residence area. Cox proportional hazards models were used to evaluate the adjusted hazard ratios and 95% confidence intervals of developing diabetes according to the combined effect of moderate to vigorous physical activity (MVPA) and air pollution exposure. RESULTS: Engaging in 5 or more times of MVPA/week was associated with decreased risk of diabetes within groups with both high and low/moderate levels of exposure to PM10 (low/moderate PM10 aHR 0.91, 95% CI 0.89-0.93; high PM10 aHR 0.97, 95% CI 0.94-0.99) or PM2.5 (low/moderate PM2.5 aHR 0.88, 95% CI 0.85-0.90; high PM10 aHR 0.95, 95% CI 0.91-0.99) exposure. The risk-reducing effects upon MVPA tended to be slightly attenuated, which showed the reverse J-shaped association, but still significant, among those who were exposed to a high level of air pollution. The association was consistent among stratified analyses according to the possible confounders. CONCLUSION: MVPA may be inversely associated with the risk of diabetes development within groups with both high and low/moderate levels of exposure to PM10 or PM2.5 in older adults. Future studies are necessary to validate whether the positive health effects of MVPA outweigh the potential detrimental effects due to augmented exposure to air pollution during MVPA.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Diabetes Mellitus , Idoso , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etiologia , Exposição Ambiental/análise , Exercício Físico , Humanos , Pessoa de Meia-Idade , Material Particulado/efeitos adversos , Material Particulado/análise
18.
Diabetologia ; 63(11): 2305-2314, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32820349

RESUMO

AIMS/HYPOTHESIS: The increasing incidence of diabetes among young adults is a disease burden; however, the effects of early-onset diabetes, prediabetes and glycaemic recovery on CVD or mortality remain unclear. We aimed to investigate the association of these factors with 10 year all-cause mortality, CVD mortality and CVD incidence in Korean young adults. METHODS: This large and longitudinal cohort study included data from the Korean National Health Insurance Service-National Health Information Database; 2,502,375 young adults aged 20-39 years without diabetes mellitus and CVD at baseline were included. Glycaemic status was measured twice, first in 2002-2003 and second in 2004-2005. Changes in fasting glucose levels were evaluated according to fasting glucose status: normal fasting glucose (NFG; <5.5 mmol/l), impaired fasting glucose (IFG; 5.5-6.9 mmol/l), and diabetic fasting glucose (DFG; ≥7.0 mmol/l). Primary outcomes were all-cause and CVD mortality risk. The secondary outcome was incidence of CVD, including acute myocardial infarction and stroke. All outcomes arose from the 10 year follow-up period 1 Jan 2006 to 31 December 2015. RESULTS: Individuals with NFG at baseline, who were subsequently newly diagnosed with diabetes and prediabetes (IFG), had increased all-cause mortality (HR [95% CI] 1.60 [1.44, 1.78] and 1.13 [1.09, 1.18], respectively) and CVD incidence (1.13 [1.05, 1.23] and 1.04 [1.01, 1.07], respectively). In those with DFG at baseline, early recovery to NFG and IFG was associated with decreased all-cause mortality (0.57 [0.46, 0.70] and 0.65 [0.53, 0.81], respectively) and CVD incidence (0.70 [0.60, 0.81] and 0.78 [0.66, 0.91], respectively). Among patients with IFG at baseline, early recovery to NFG was associated with decreased CVD mortality (0.74 [0.59, 0.93]). CONCLUSIONS/INTERPRETATION: Early-onset diabetes or prediabetes increased CVD risks and all-cause mortality after the 10 year follow-up. Furthermore, recovery of hyperglycaemia could reduce the subsequent 10 year risk for CVD incidence and all-cause mortality. Graphical abstract.

19.
J Bone Miner Metab ; 38(6): 839-847, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32507945

RESUMO

INTRODUCTION: Air particulate matter (PM) is an environmental exposure associated with oxidation and inflammation. Whether particulate matter is associated with risk of osteoporotic bone fracture is unclear. We investigated the association between exposure to PM and risk of bone fractures. MATERIALS AND METHODS: We collected data of 44,602 participants living in three metropolitan cities in Republic of Korea from National Health Insurance Service database. We examined the association of 2 year averaged concentrations of PM and osteoporotic fracture over 4 years. Exposure to 2-year averaged air pollution [PM2.5 (< 2.5 µm in aerodynamic diameter), PM10 [< 10 µm in aerodynamic diameter], PM coarse (PM ranging from 2.5 µm to 10 µm)] concentrations were estimated from 2008 to 2009 in Air Korea data. The adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for osteoporotic fractures were calculated using the multivariate Cox proportional hazards model. RESULTS: After adjusting for age, household income, and Charlson Comorbidity Index, PM 2.5 in one pollutant model increased the risk of osteoporotic fractures, compared to the first quartile group (4th quartile group aHR = 1.13, 95% CI 1.02-1.24). Also, PM 2.5 increased the risk of spine and non-spine fractures compared to the first quartile group (4th quartile group aHR = 1.17, 95% CI 1.00-1.38, aHR = 1.16, 95% CI 1.01-1.33). We found no association between PM10/PM coarse and osteoporotic fractures. CONCLUSION: We found that PM2.5 is a risk factor for osteoporotic bone fractures.


Assuntos
Poluição do Ar/efeitos adversos , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/etiologia , Idoso , Exposição Ambiental/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Material Particulado/efeitos adversos , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Fatores de Risco
20.
Asian J Psychiatr ; 52: 102161, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32454424

RESUMO

BACKGROUND: The effect of antipsychotics adherence on the risk of cardiovascular disease (CVD) among schizophrenia patients has not been studied. While antipsychotic adherence is favorable for all-cause mortality, its association with CVD incidence is unclear due to the potential risk of CVD caused by antipsychotics. METHODS: Using the Korean National Health Insurance Service Database, we constructed a case-cohort of 80,581 newly-diagnosed schizophrenia patients between 2004 and 2013 from a cohort of all Koreans 20-40 years old. Patients were divided into quartiles by adherence determined by their two-year medication possession ratio. Patients were followed from two years following the diagnosis of schizophrenia until Dec. 31st, 2017 for the primary outcome of incident CVD and secondary outcomes of stroke, myocardial infarction, and all-cause mortality. Cox proportional hazards analysis was performed adjusting for conventional risk factors. OUTCOMES: Newly diagnosed schizophrenia patients were followed for a median of 7.0 years resulting in 1396 incident CVD cases over 5.73 × 105 person-years. When adjusted for potential confounders, the best adherence quartile group had significantly lower risk of CVD (HR, 95%CI; 0.78, 0.66-0.92; p-trend, 0.003), stroke (HR, 95%CI; 0.79, 0.66-0.94; p-trend, 0.015), and all-cause mortality (HR, 95%CI; 0.86, 0.78-0.95; p-trend, 0.003) compared to the worst adherent quartile group. Subgroup analysis by antipsychotics generation, concurrent medication, and comorbidities did not significantly alter results. INTERPRETATION: Among newly diagnosed schizophrenia patients, better adherence to antipsychotics lowered the risk CVD incidence despite previously suggested antipsychotic-associated CVD risk. Thus, efforts to improve antipsychotics adherence may improve CVD outcomes in schizophrenia patients.


Assuntos
Antipsicóticos , Doenças Cardiovasculares , Esquizofrenia , Adulto , Antipsicóticos/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Humanos , Adesão à Medicação , República da Coreia/epidemiologia , Fatores de Risco , Esquizofrenia/tratamento farmacológico , Esquizofrenia/epidemiologia , Adulto Jovem
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