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1.
Artigo em Inglês | MEDLINE | ID: mdl-34850029

RESUMO

CONTEXT: Although blood pressure variability (BPV) is associated with various health outcomes, only one study suggested that BPV is correlated with hip fractures. As cardiovascular disease and fractures share similar pathophysiology, there might be a link between BPV and fractures. OBJECTIVE: To investigate the association between BPV and the incident fractures. DESIGN: Retrospective cohort study. SETTING: Population-based, using the Korean National Health Insurance System database. PATIENTS OR OTHER PARTICIPANTS: A total of 3,256,070 participants aged 50 and above who participated in ≥3 health examinations within the previous five years, including the index year (2009-2010), were included. Outcome data was obtained through the end of 2016. EXPOSURE: BPV was calculated using variability independent of the mean. High variability was defined as the highest quartile of variability. MAIN OUTCOME MEASURES: Newly diagnosed fractures. RESULTS: During the median follow-up of 7.0 years, there were 337,045 cases of any fracture (10.4%). After adjusting for age, sex, income, lifestyle factors, and comorbidities, a higher risk of fracture was observed with higher quartiles of BPV than the lowest quartile group: the adjusted hazard ratios (95% confidence intervals) for incident any fracture were 1.07 (1.06-1.08) in the higher quartile of systolic BPV, 1.06 (1.05-1.07) in that of diastolic BPV, and 1.07 (1.06-1.08) in that of both systolic and diastolic BPV. Consistent results were noted for vertebral fractures and hip fractures, as well as in various subgroup analyses. CONCLUSIONS: A positive association was noted between higher BPV and fracture incidence. BPV is an independent predictor for developing fracture.

2.
J Cancer Surviv ; 2021 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-34741691

RESUMO

PURPOSE: Caregivers of childhood cancer survivors (CCS) have diverse needs, which should be addressed to provide comprehensive cancer care. We aimed to evaluate the unmet needs of caregivers of CCS. METHODS: The subjects were 700 caregivers recruited at three major hospitals in South Korea. We collected study data using self-administered questionnaires and a thorough review of medical records. We assessed the unmet needs of caregivers using the comprehensive needs assessment tool for cancer caregivers and evaluated factors associated with the highest tertile range of unmet needs by multiple logistic regression analysis. RESULTS: The greatest unmet needs of caregivers had to do with healthcare staff, followed by information. Compared with father-caregivers, mother-caregivers had greater unmet needs related to health and psychological problems, family/social support, and religious/spiritual support, with odds ratios (95% confidence interval) of 3.79 (2.52-5.69), 3.17 (2.09-4.81), and 1.69 (1.14-2.50), respectively. Compared with caregivers of the youngest CCS (< 6 years), caregivers of CCS aged 12-18 years and caregivers of the oldest CCS (≥ 19 years) respectively showed 2.62 (1.24-5.52) and 3.18 (1.34-7.55) times greater unmet needs for information. Caregivers of CCS who received haematopoietic stem-cell transplantation had a 2.01-fold (1.14-3.57) greater need for practical support. CONCLUSION: Caregivers of CCS had substantial unmet needs required for comprehensive care for CCS. Several individual characteristics of caregivers and their children were significantly associated with greater unmet needs of the caregivers. IMPLICATIONS FOR CANCER SURVIVORS: Personalized support based on the characteristics of both CCS and their caregivers is required to provide comprehensive care for CCS.

3.
Diabetes Obes Metab ; 2021 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-34726318

RESUMO

AIM: Nonalcoholic fatty liver disease (NAFLD) is associated with increased risk of cardiovascular diseases (CVDs). Because studies of young adults are limited, we investigated the relationship between NAFLD and cardiovascular events among a nationally representative sample of young adults in Korea. METHODS AND RESULTS: This population-based cohort study from the Korean National Health Insurance Service included adults who were 20-39 years old when they underwent a health examination from 2009-2012. NAFLD was defined as fatty liver index (FLI) ≥60, and participants were divided into three groups according to FLI (<30, 30-59, and ≥60) to investigate the dose-dependent effect of FLI scores. Among 5,324,410 participants, 9.8% had an FLI ≥60. There were 13,051 myocardial infarctions (MI, 0.39%) and 8,573 strokes (0.26%) during a median follow-up of 8.4 years. In multivariable analysis, NAFLD was associated with a higher risk of MI and stroke (hazard ratio [HR]=1.69; 95% confidence interval [CI]: 1.61-1.77 and HR=1.73; 95% CI: 1.63-1.84, respectively). MI and stroke had dose-depended relationships with FLI (HR=1.28 in FLI 30-59 and 1.73 in FLI ≥60 for MI and HR=1.18 in FLI 30-59 and 1.41 in FLI ≥60 for stroke, respectively). CONCLUSIONS: NAFLD was an independent predictor of MI and stroke in young adults. These results suggest that primary prevention of CVD should be emphasized in young adults with NAFLD. This article is protected by copyright. All rights reserved.

4.
Artigo em Inglês | MEDLINE | ID: mdl-34769724

RESUMO

Alcohol consumption is a major risk factor for head and neck cancer (HNC), yet little data exist examining drinking patterns and HNC risk. In this population-based, retrospective cohort study, 11,737,467 subjects were recruited from the Korean National Health Insurance Service database. The risks of overall HNC and HNC subtypes according to average alcohol consumption, drinking frequency, and daily amount were examined using Cox proportional hazard models. Over the median follow-up of 6.4 years, 15,832 HNC cases were identified. HNC risk linearly increased with drinking frequency (p-trend < 0.01; adjusted hazard ratio [aHR] 1.55, 95% confidence interval [CI] 1.45-1.67 in subjects who drank 7 days/week). HNC risk also increased according to daily amount of alcohol consumption (p-trend < 0.01), but plateaued from 5-7 units/occasion (aHR 1.25, 95% CI 1.19-1.31) to >14 units/occasion (aHR 1.26, 95% CI 1.13-1.40). When stratified by average alcohol consumption, drinking frequency, but not daily amount, showed a linear relationship with HNC risk in moderate and heavy drinkers. When comparing the HNC subtypes, similar tendencies were observed in cancers of the oral cavity, pharynx, and larynx, but not in the salivary gland. In conclusion, drinking frequency is a stronger risk factor for HNC, especially for cancer of the oral cavity, pharynx, and larynx, than the daily amount of alcohol consumption.


Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Estudos de Coortes , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/etiologia , Humanos , Estudos Retrospectivos , Fatores de Risco
5.
Parkinsonism Relat Disord ; 93: 19-26, 2021 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-34763304

RESUMO

BACKGROUND: The association between nonalcoholic fatty liver disease (NAFLD) and Parkinson's disease (PD) remains uncertain. This study sought to assess the sex-specific association between NAFLD and PD risk considering that sex is an important factor in both conditions. METHODS: We included 2,651,169 men and 2,998,904 women (≥40 years of age) who underwent health examinations in 2009 using database of the Korean National Health Insurance Service. To define NAFLD, the Fatty Liver Index (FLI) was used and a score of at least 60 points was regarded as suggesting the presence of NAFLD. Cox proportional hazards analyses were performed to evaluate the association between the presence of NAFLD/each component of FLI and the risk of PD. All analyses were stratified by sex. RESULTS: The median follow-up duration was 7.3 years in both men and women. Of the total study population, 23,233 patients with PD (10,578 men and 12,655 women) were identified. Among men, a decreased risk of PD was observed in those with NAFLD [adjusted hazard ratio (aHR): 0.86, 95% confidence interval (CI): 0.82-0.91]. In contrast, among women, an increased risk of PD was observed in those with NAFLD (aHR: 1.09, 95% CI: 1.02-1.16). This different association according to sex was more prominent among younger participants but was not significant in the old age group. CONCLUSIONS: NAFLD defined by FLI is differently associated with the risk of PD by sex (i.e., low risk of PD in men with NAFLD vs. high risk of PD in women with NAFLD).

6.
J Clin Med ; 10(21)2021 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-34768709

RESUMO

Although both obesity and menopause are associated with increased risk of diabetes mellitus (DM), the association between obesity and DM according to menopausal status remains uncertain. Therefore, we conducted a study to examine the relationship between obesity and incidence of diabetes mellitus (DM) in premenopausal and postmenopausal women. Total of 926,196 premenopausal and 1,193,881 postmenopausal women who underwent health examinations from 2009 to 2014 were identified using the database of the Korean National Health Insurance Service. We compared the incidence and risk of DM according to body mass index (BMI) and waist circumference (WC) in the two groups of women. Cox proportional hazards analyses were performed to evaluate the association between the presence of obesity and risk of DM according to menopausal state. During the 7.8-year follow-up period, 37,736 (4.1%) premenopausal women and 121,102 (10.1%) postmenopausal women were diagnosed with DM. Compared to the reference group (BMI 18.5-23), a stronger association between obesity and risk of DM was observed in both pre- and postmenopausal women: multivariable-adjusted hazard ratios and 95% confidence intervals for BMI subgroups <18.5, 23-25, 25-30, and >30 were 0.62 (0.54, 0.70), 1.91 (1.85, 1.97), 3.38 (3.28, 3.47), and 6.25 (6.02, 6.48), respectively (p trend < 0.001) in premenopausal women and 0.87 (0.82, 0.92), 1.44 (1.41, 1.46), 2.00 (1.97, 2.03), and 2.96 (2.89, 3.02) in postmenopausal women (p trend < 0.001, p-interaction < 0.001). A similar trend was observed for WC. Subgroup analyses of women aged 45 to 55 also showed a stronger association with DM in premenopausal than in postmenopausal women. In conclusion, the association between obesity and DM was stronger in premenopausal women than in postmenopausal women. As estrogens are synthesized in adipose tissue by aromatization of androgens after menopause, increased estrogen levels in obese postmenopausal might have a protective effect against DM.

7.
Cancers (Basel) ; 13(19)2021 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-34638244

RESUMO

There have been conflicting results regarding the association between diabetes and the risk of hematologic malignancies, and its interaction with obesity is unknown. This study determined the risk of hematologic malignancies according to the glycemic status in a population-based study involving health screening 9,774,625 participants. The baseline glycemic status of the participants was categorized into no diabetes, impaired fasting glucose (IFG), newly detected diabetes, diabetes duration <5 years, and diabetes duration ≥5 year groups. The risks of overall and specific hematologic malignancies were estimated using a Cox regression analysis. During a median follow up of 7.3 years, 14,733 hematologic malignancies developed. The adjusted hazard ratio (aHR) for the risk of all the hematologic malignancies was 0.99 (95% confidence interval (CI) 0.95-1.02) for IFG, 0.99 (95% CI 0.91-1.08) for newly detected diabetes, 1.03 (95% CI 0.96-1.11) for diabetes duration <5 years, and 1.11 (95% CI 1.03, 1.20) for diabetes duration ≥5 year groups. The association was independent from obesity. The risk of non-Hodgkin's lymphoma (NHL) increased according to the progression of dysglycemia towards a longer diabetes duration, while Hodgkin's lymphoma did not. This study in Korea demonstrated diabetes to be associated with an increased risk of hematologic malignancies independent of obesity. The NHL risk increased with the diabetes duration.

8.
Am J Ophthalmol ; 2021 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-34624247

RESUMO

PURPOSE: To evaluate the association between high-density lipoprotein (HDL) cholesterol levels and the future risk of retinal artery occlusion (RAO). DESIGN: Population-based cohort study. METHODS: This study used data provided by the Korean National Health Insurance Service. A total of 9,316,212 individuals over 40 years of age who participated in the Korean National Health Screening Program in 2013 or 2014 were included. Data on risk factors, including age, sex, income level, systemic comorbidities, behavioral factors, and baseline lipid profiles, were collected from health screening results and claims data. Patients were followed up until December 2018, and incident cases of RAO were identified using registered diagnostic codes from claims data. A prospective association between HDL cholesterol level and incident RAO was investigated using the multivariable-adjusted Cox proportional hazard model. RESULTS: During an average follow-up period of 4.93 years, 9,878 patients were newly diagnosed with RAO. Compared to those with low HDL cholesterol levels (< 40 mg/dL), patients with high HDL cholesterol levels (≥ 60 mg/dL) had a lower risk of future RAO development with a hazard ratio (95% confidence intervals) of 0.78 (0.73-0.83) in the age and sex-adjusted model and 0.88 (0.83-0.95) in the full-adjusted model. The younger subgroup (< 60 years) had an HR of 0.81 in the high HDL cholesterol group compared to the low HDL cholesterol group, while the older subgroup (≥ 60 years) had an HR of 0.93 (p for interaction = 0.012). CONCLUSION: Low HDL cholesterol level is an independent risk factor for the development of RAO.

9.
JAMA Netw Open ; 4(9): e2126099, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34546370

RESUMO

Importance: The risk of tuberculosis (TB) associated with diabetes status, considering impaired fasting glucose or duration of diabetes, has not been well established. Objective: To evaluate the association of diabetes status with the development of TB in the general population. Design, Setting, and Participants: This population-based cohort study used data from the Korean National Health Insurance System database. Adult participants without a history of TB who underwent a health screening in 2009 were included. Eligible participants were followed up for incident TB cases from 1 year after the day of health screening until December 31, 2018. Data analysis was performed from September 2019 to September 2020. Exposures: Five levels of diabetes status were evaluated: normal glucose, impaired fasting glucose (considered as without diabetes), new-onset diabetes, diabetes duration less than 5 years, and diabetes duration 5 years or longer (considered as having diabetes). Main Outcomes and Measures: Newly diagnosed TB. Results: Among 4 423 177 participants, the mean (SD) age was 46.5 (13.9) years, and there were 2 597 142 men (58.7%). A total of 26 458 participants (0.6%) received a diagnosis of TB within a median (interquartile range) of 8.3 (8.1-8.6) years of follow-up. An increased risk of TB was observed in participants with diabetes compared with those without diabetes (adjusted hazard ratio [aHR], 1.48; 95% CI, 1.42-1.53). Although participants with impaired fasting glucose did not show an increased risk of TB incidence (aHR, 0.97; 95% CI, 0.93-1.01), the risk of TB incidence increased with diabetes duration (new-onset diabetes, aHR, 1.32; 95% CI, 1.23-1.42; diabetes duration <5 years, aHR, 1.45; 95% CI, 1.36-1.54; diabetes duration ≥5 years, aHR, 1.57; 95% CI, 1.48-1.66). Among participants with new-onset diabetes, compared with those in the lowest decile (fasting plasma glucose [FPG] level ≥126 but <128 mg/dL), the risk of TB was significantly increased for those in the highest decile (FPG level ≥202 mg/dL, aHR, 1.79; 95% CI, 1.42-2.26). Conclusions and Relevance: These findings suggest that longer diabetes duration is associated with development of TB, showing a dose-response association. Among participants with new-onset diabetes, incident TB was more common among those with FPG levels greater than or equal to 202 mg/dL.

10.
J Clin Med ; 10(17)2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34501279

RESUMO

BACKGROUND: We investigate the incidence and characteristics of IOL dislocation among the pseudophakic population after phacoemulsification. METHODS: National data were collected from the health claims recorded with the Health Insurance Review and Assessment Service of South Korea from 2009 to 2016. Pseudophakic patients aged 40 years or older were included. The incidence estimates of phacoemulsification and IOL dislocation were analyzed, and the cumulative probabilities of IOL dislocation among the pseudophakic population and general population were calculated as a proportion. RESULTS: Of 51,307,821 total subjects, 25,271,917 of whom were aged 40 years or older, 3,906,071 cataract cases in 2,650,104 pseudophakic patients were identified, and 72,309 patients experienced IOL dislocation. The cumulative probability was 2.73% per person and 1.85% per surgery among patients 40 years of age or older. The eight-year incidence rate for IOL dislocation in the pseudophakic population aged 40 years or older was 7671 per 1,000,000 person-years (95% CI: 7616-7727), including 10,341 cases in men and 5814 in women. Incidence peaked in the seventh decade of life for cataract surgery but in the fifth decade of life for IOL dislocation. The cumulative probability of IOL dislocation after phacoemulsification was approximately 2%, and the incidence rate was about 7000 per 1,000,000 pseudophakic patients. CONCLUSIONS: There was a significantly higher incidence of IOL dislocation among young males, even though the higher incidence of cataract surgery was observed among older females. These estimates of the nationwide, population-based incidence of IOL dislocation can help increase understanding of the population vulnerable to IOL dislocation.

11.
Cancer Res Treat ; 2021 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-34583456

RESUMO

Purpose: While renal impairment is one of the first clinical manifestations of multiple myeloma (MM), declined renal function may conversely be a risk factor for cancers including MM. In this study, we investigated the relationship between chronic kidney disease and MM at a population level. Materials and Methods: A total of 9,809,376 adults who participated in a nationwide health screening program and had no MM, cancer or end-stage renal disease at baseline were investigated for incidence of MM. The impact of estimated glomerular filtration rate (eGFR) and random urine dipstick proteinuria, and interactive associations of the two factors on the MM incidence were evaluated. Results: The general incidence of MM was 4.8 per 100,000 person-years (mean follow-up of 8.3 years). Participants with eGFR <60 mL/min/1.73m2 (5.8% of participants) had higher MM incidence than those with eGFR ≥60 mL/min/1.73m2 (adjusted hazard ratio [aHR] = 1.29, 95% confidence interval [CI]: 1.17-1.43). When eGFR was graded into five levels, there was a significant inverse dose-response relationship between eGFR level and MM incidence at the lower eGFR levels (reference: eGFR 60-89 mL/min/1.73m2). A dose-response relationship was also found with degree of dipstick proteinuria and incidence of MM. Conclusion: Adults with decreased renal function indicated either by decreased eGFR or presence of proteinuria are at a higher risk of developing MM compared to those without, and there is a dose-response relationship between the severity of renal impairment and MM incidence.

12.
Nutrients ; 13(9)2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34579084

RESUMO

Although body mass index (BMI) is a potential risk factor for bronchiectasis in young adults, the association between BMI and incident bronchiectasis has not been well elucidated. This study included 6,329,838 individuals aged 20-40 years from the Korean National Health Insurance Service database 2009-2012 who were followed up until the date of the diagnosis of bronchiectasis, death, or 31 December 2018. We evaluated the incidence and risk of bronchiectasis according to the BMI category. The incidence rate of bronchiectasis increased as BMI decreased in a dose-dependent manner (p for trend <0.01). In multivariable Cox regression analysis, being underweight was an independent risk factor for the development of bronchiectasis, with a hazard ratio of 1.24 (95% confidence interval, 1.19-1.30) compared to being normal weight. In subgroup analysis, the effect of being underweight on the development of bronchiectasis was more evident in males and older individuals (30-40 years) than females and younger individuals (20-29 years), respectively (p for interaction <0.01 for both). These results remained significant in subgroup analysis in which subjects with comorbidities related to being underweight were excluded. Being underweight may be a novel risk factor for the development of bronchiectasis in young adults.


Assuntos
Bronquiectasia/epidemiologia , Bronquiectasia/etiologia , Adulto , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Análise Multivariada , República da Coreia/epidemiologia , Fatores de Risco , Adulto Jovem
13.
JAMA Netw Open ; 4(8): e2120382, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34406403

RESUMO

Importance: Although total alcohol consumption is a known risk factor for gastrointestinal (GI) cancers, few studies have attempted to assess the pattern of alcohol drinking in association with GI cancers. Objective: To evaluate the relative association of the frequency of drinking vs the amount of alcohol consumed per occasion with the development of GI cancers. Design, Setting, and Participants: A population-based retrospective cohort study used data from the Korean National Health Insurance System database on 11 737 467 participants without cancer who underwent a national health screening program from January 1, 2009, to December 31, 2010. Participants were followed up from the year after their health screening date until they received a diagnosis of GI cancer, death, or December 31, 2017. The median follow-up duration was 6.4 years (interquartile range, 6.4-7.4 years). Statistical analysis was performed from January 1, 2019, to March 31, 2020. Exposures: Weekly alcohol consumption (nondrinker [0 g/week], mild drinker [0-104 g/week], moderate drinker [105-209 g/week], and heavy drinker [≥210 g/week]), drinking frequency, and amount per occasion. Main Outcomes and Measures: Incident GI cancers at 6 specific sites (esophagus, stomach, colorectal, liver, biliary, and pancreas). Results: Among 11 737 467 participants (6 124 776 women [52.2%]; mean [SD] age, 54.6 [10.4] years), 319 202 (2.7%) developed GI cancer. Compared with nondrinkers, the risk of GI cancer was higher for mild drinkers (adjusted hazard ratio [aHR], 1.04; 95% CI, 1.03-1.05), moderate drinkers (aHR, 1.14; 95% CI, 1.12-1.15), and heavy drinkers (aHR, 1.28; 95% CI, 1.26-1.29). The risk of GI cancer increased linearly with the frequency of drinking in a dose-dependent manner (aHR, 1.39; 95% CI, 1.36-1.41 for individuals who drink every day). In contrast, the risk of GI cancer appeared to increase with consumption up to 5 to 7 units per occasion (aHR, 1.15; 95% CI, 1.14-1.16), and then the HRs were no higher for those with a higher intake per session than 5 to 7 units (8-14 units per occasion: aHR, 1.11; 95% CI, 1.09-1.12; >14 units per occasion: aHR, 1.11; 95% CI, 1.08-1.14). Given similar weekly alcohol consumption levels, the risk of GI cancer increased with a higher frequency of drinking and decreased with a higher amount per occasion. Risk patterns for 6 specific cancers were generally similar to that of all GI cancers. Conclusions and Relevance: In this cohort study, frequent drinking was a more important risk factor for incident GI cancers than the amount of alcohol consumed per occasion. Individuals should be cautioned about regular consumption of small amounts of alcohol in addition to the total amount of alcohol consumption or amount per occasion.

14.
Sci Rep ; 11(1): 16171, 2021 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-34373584

RESUMO

We evaluated the association between aspirin, statins, and metformin use and prostate cancer (PC) incidence and mortality using a large population-based dataset. 388,760 men who participated in national health screening program in Korea during 2002-2003 were observed from 2004 to 2013. Hazard ratios of aspirin, statins, and metformin use for PC incidence and PC mortality were calculated with adjustment for simultaneous drug use. Cumulative use of each drug was inserted as time-dependent variable with 2-year time windows. Aspirin use ≥ 1.5 year (per 2-year) was associated with borderline decrease in PC mortality when compared to non-users (adjusted hazard ratio [aHR] 0.71, 95% confidence interval [CI] 0.50-1.02). Statins use was not associated with either PC incidence or PC mortality. Metformin ever-use was associated with decreased PC incidence compared with non-diabetics (aHR 0.86, 95% CI 0.77-0.96). Diabetics who were not using metformin or using low cumulative doses had higher PC mortality than non-diabetics (aHR 2.01, 95% CI 1.44-2.81, and aHR 1.70, 95% CI 1.07-2.69, respectively). However, subjects with higher cumulative doses of metformin did not show increased PC mortality. In conclusion, metformin use was associated with lower PC incidence. Use of aspirin and that of metformin among diabetic patients were associated with lower PC mortality.


Assuntos
Aspirina/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Metformina/uso terapêutico , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Aspirina/administração & dosagem , Estudos de Coortes , Inquéritos Epidemiológicos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/uso terapêutico , Incidência , Estudos Longitudinais , Masculino , Metformina/administração & dosagem , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Neoplasias da Próstata/prevenção & controle , República da Coreia/epidemiologia
15.
J Affect Disord ; 294: 786-793, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34375203

RESUMO

BACKGROUND: The effect of dynamic changes in metabolic parameters over time on the development of depression has yet to be examined. In this study, we aimed to determine the association between the variability of metabolic parameters and the development of depression using nationally representative data. METHODS: We used health examination data provided by the South Korean National Health Insurance System (NHIS) and included those who underwent the examination ≥ 3 times within five years of enrollment, without a previous history of depression (n = 9,058,424). The variability of each metabolic parameter including weight circumference, blood pressure, fasting blood glucose, high-density lipoprotein cholesterol, and triglyceride levels was estimated using variability independent of mean (VIM) indices. High variability was defined as the highest quartile (Q4) of variability. RESULTS: Each metabolic parameter with high variability was associated with a higher risk of newly diagnosed depression compared to those with low variability, after adjusting for age, sex, smoking, alcohol drinking, regular exercise, income status, baseline diabetes, hypertension, and dyslipidemia. As the number of highly variable metabolic parameters increased, the risk for newly diagnosed depression increased even after adjusting for the aforementioned covariates (hazard ratio (HR) = 1.4, 95% confidence interval (CI): 1.3 - 1.4 in those with five highly variable parameters compared to those with no highly variable parameter). LIMITATIONS: relatively short observation period; no systematic measure of depression severity. CONCLUSIONS: Our results suggest that the variability of metabolic parameters is an independent risk factor for depression.


Assuntos
Glicemia , Depressão , Pressão Sanguínea , Estudos de Coortes , Depressão/diagnóstico , Depressão/epidemiologia , Humanos , República da Coreia/epidemiologia , Fatores de Risco
16.
Sci Rep ; 11(1): 16254, 2021 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-34376753

RESUMO

The association between the total cholesterol level and tuberculosis (TB) risk has been controversial. Our study aimed to evaluate whether total cholesterol level can predict the risk of TB. Data from 5,000,566 subjects who participated in a health screening exam in 2009 were investigated using the Korean National Health Insurance Service database (2009-2018). Cox hazard regression analyses were used to evaluate TB risk according to the quartile of total cholesterol levels. During an average of 8.2 years of follow-up, 32,078 cases of TB occurred. There was a significant inverse association between the total cholesterol level and TB risk. Compared with subjects in the highest quartile, those in the lowest quartile had a 1.35-fold increased TB risk (95% confidence interval = 1.31-1.39). The association between total cholesterol level and TB risk was more apparent in young subjects (age < 65 years), those without diabetes mellitus (DM), and those without obesity (p for interaction < 0.001 for age group, DM, and body mass index). Although there was a significant inverse association between total cholesterol level and TB risk in subjects who did not use a statin, no significant association was observed between the total cholesterol level and TB risk in subjects who used a statin. A low total cholesterol level was significantly associated with an increased risk of TB, even after adjusting for confounders, especially in patients younger than 65 years, those without DM or obesity, and those who did not use a statin.


Assuntos
Colesterol/metabolismo , Bases de Dados Factuais , Tuberculose/epidemiologia , Idoso , Estudos de Casos e Controles , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prognóstico , República da Coreia/epidemiologia , Fatores de Risco , Tuberculose/metabolismo , Tuberculose/microbiologia
17.
Metabolism ; 123: 154866, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34411553

RESUMO

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of diabetes but has been rarely investigated in young adults. In this study, we investigated the relationship between NAFLD and incident diabetes risk in young adults using nationwide Korean population data. METHODS: This population-based cohort study from the Korean National Health Insurance Service included adults aged 20 through 39 years who underwent a health examination from 2009 to 2012. NAFLD was defined as a fatty liver index (FLI) ≥60 in the absence of alcohol consumption of ≥30 g/day. Newly diagnosed diabetes during follow-up was identified using claims data. Cox regression was used to calculate the hazard ratio for incident diabetes after adjusting for classical confounders. FINDINGS: Among the 5,254,786 participants, 9.3% had an FLI ≥60. During the median follow-up of 8.6 years, 91,885 cases of incident diabetes occurred. In multivariable analysis, the risk of incident diabetes was significantly higher in the NAFLD group than the control group (adjusted hazard ratio = 4.97, 95% confidence interval, 4.90-5.05). Stratified analyses showed higher associations in those who were ≥30 years, male, obese, smokers, alcohol consumers, and did not regularly exercise (all P < 0.001). CONCLUSIONS: NAFLD is associated with a five-fold increased risk of incident diabetes in young adults. These results suggest an independent high risk for incident diabetes in young adults and underscore the importance of paying early attention to patients who develop NAFLD before middle age.

18.
Eur Heart J ; 42(40): 4141-4153, 2021 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-34431997

RESUMO

AIMS: The aim of this study was to assess the association of smoking cessation and reduction with risk of cardiovascular disease (CVD). METHODS AND RESULTS: A total of 897 975 current smokers aged ≥40 years who had undergone two consecutive national health examinations (in 2009 and 2011) were included. Participants were classified as quitters (20.6%), reducers I (≥50% reduction, 7.3%), reducers II (20-50% reduction, 11.6%), sustainers (45.7%), and increasers (≥20% increase, 14.5%). During 5 575 556 person-years (PY) of follow-up, 17 748 stroke (3.2/1000 PY) and 11 271 myocardial infarction (MI) (2.0/1000 PY) events were identified. Quitters had significantly decreased risk of stroke [adjusted hazard ratio (aHR) 0.77 95% confidence interval (CI) 0.74-0.81; absolute risk reduction (ARR) -0.37, 95% CI -0.43 to -0.31] and MI (aHR 0.74, 95% CI 0.70-0.78; ARR -0.27, 95% CI -0.31 to -0.22) compared to sustainers after adjustment for demographic factors, comorbidities, and smoking status. The risk of stroke and MI incidence in reducers I (aHR 1.02, 95% CI 0.97-1.08 and aHR 0.99, 95% CI 0.92-1.06, respectively) and reducers II (aHR 1.00, 95% CI 0.95-1.05 and aHR 0.97, 95% CI 0.92-1.04, respectively) was not significantly different from the risk in sustainers. Further analysis with a subgroup who underwent a third examination (in 2013) showed that those who quit at the second examination but had starting smoking again by the third examination had 42-69% increased risk of CVD compared to sustained quitters. CONCLUSIONS: Smoking cessation, but not reduction, was associated with reduced CVD risk. Our study emphasizes the importance of sustained quitting in terms of CVD risk reduction.


Assuntos
Doenças Cardiovasculares , Abandono do Hábito de Fumar , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Humanos , Incidência , Fatores de Risco , Fumar/epidemiologia
19.
Cancers (Basel) ; 13(14)2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34298709

RESUMO

Early detection of lung cancer by screening has contributed to reduce lung cancer mortality. Identifying high risk subjects for lung cancer is necessary to maximize the benefits and minimize the harms followed by lung cancer screening. In the present study, individual lung cancer risk in Korea was presented using a risk prediction model. Participants who completed health examinations in 2009 based on the Korean National Health Insurance (KNHI) database (DB) were eligible for the present study. Risk scores were assigned based on the adjusted hazard ratio (HR), and the standardized points for each risk factor were calculated to be proportional to the b coefficients. Model discrimination was assessed using the concordance statistic (c-statistic), and calibration ability assessed by plotting the mean predicted probability against the mean observed probability of lung cancer. Among candidate predictors, age, sex, smoking intensity, body mass index (BMI), presence of chronic obstructive pulmonary disease (COPD), pulmonary tuberculosis (TB), and type 2 diabetes mellitus (DM) were finally included. Our risk prediction model showed good discrimination (c-statistic, 0.810; 95% CI: 0.801-0.819). The relationship between model-predicted and actual lung cancer development correlated well in the calibration plot. When using easily accessible and modifiable risk factors, this model can help individuals make decisions regarding lung cancer screening or lifestyle modification, including smoking cessation.

20.
J Clin Med ; 10(12)2021 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-34204698

RESUMO

BACKGROUND: In this study, we analyzed the association between antibiotic use and obesity and metabolic syndrome (MS) in a Korean adult population. METHODS: Subjects using the Korean National Health Insurance Service sample cohort were retrospectively analyzed in 2015. The differences in obesity and metabolic syndrome (MS) status were compared and analyzed according to duration of systemic antibiotic treatment in the previous 10 years (non-users, 1st, 2nd, and 3rd tertile). RESULTS: Subjects who used systemic antibiotics for longer periods were older, satisfied more criteria for MS, and had more comorbidities than non-users (non-users vs. 3rd tertile, p < 0.0001 for all). After adjusting for confounding factors, the risk of obesity was higher in subjects who used systemic antibiotics for longer periods than in non-users (non-users vs. 3rd tertile, OR (odds ratio) (95% CI (confidence interval)); 1.20 (1.12-1.38)). The criteria for MS were more satisfied in the 3rd tertile than in non-users. A higher obesity risk was also found in subjects treated with antibiotics targeting Gram-negative organisms than in those targeting Gram-positive organisms. CONCLUSION: The risk of obesity was higher in subjects who took systemic antibiotics more frequently. The risk was more prominent when they took antibiotics targeting Gram-negative bacteria.

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