Association of National Identity and Trust in Government with COVID-19 Vaccination and Brand Choice in Taiwan.

In Taiwan, hesitancy regarding COVID-19 vaccination centered more on the choice of vaccine brand than on the decision to vaccinate. However, there is limited research exploring the factors influencing COVID-19 vaccine brand preferences from a sociopolitical perspective. Thus, we aimed to examine how Taiwanese national identity and trust in government influence vaccination status and vaccine brand choice, using longitudinal data from 2020, 2021, and 2023. This study utilized data from the Taiwan Panel Study of Family Dynamics 2020 survey, and combined it with data from two self-administered surveys conducted in 2021 and 2023. We focused on four vaccines commonly administered in Taiwan: AstraZeneca, Moderna, Pfizer-BioNTech, and the domestically-developed Medigen. Using Poisson regression models with robust standard errors, we assessed the effects of national identity and trust in government on the choice of COVID-19 vaccine brand. By analyzing data from 2361 participants, we found that national identity and trust in government were associated with the likelihood of COVID-19 vaccination, the number of vaccine doses received, and the brand of vaccine taken. Those who identified themselves as Taiwanese were more inclined to receive the Medigen and AstraZeneca vaccines, but less willing to receive Pfizer-BioNTech vaccine. Those who trusted the government were more likely to prefer and receive the Medigen vaccine. Conversely, those who didn't trust the government were less likely to prefer Medigen and AstraZeneca vaccines, but were willing to receive Pfizer-BioNTech vaccine. Vaccine brand preferences and uptake in Taiwan were affected by individuals' national identity and their trust in government. This highlights the critical role of sociopolitical factors in shaping public health strategies.

Sex differences in the association between sugar-sweetened beverages consumption and metabolic risks among the working-age population in Taiwan.

OBJECTIVE: Sugar-sweetened beverages (SSBs) are linked to increased metabolic risk. However, the sex differences in the relationship between SSB intake and adverse health effects remain unclear. Therefore, the present study examined the association between SSB consumption and metabolic risks among working-age males and females from Taiwanese communities. DESIGN: A community-based study utilized data from a comprehensive health screening project conducted by the Public Health Bureau in Changhua County, Taiwan. Metabolic risks included waist circumference, systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL), and fasting glucose level using serum tests. SETTING: Participants were recruited in Changhua County, Taiwan. PARTICIPANTS: Between 2005 and 2014, 92,724 citizens participated in the health screening; our data analysis included 75,278 respondents between 30 and 64. RESULTS: The results showed that the frequency of SSB consumption was associated with abnormal waist circumference and elevated total cholesterol, triglycerides, LDL, and glucose in both men and women. Increased SSB consumption frequency was associated with elevated glucose and hypertension in women. Even a slight increase in SSB intake frequency was related to raising the metabolic risks. Similar patterns were evident when models included body mass index (BMI); however, the associations were attenuated. In the BMI-stratified subgroup analysis, the relationship between SSB consumption and metabolic risks was more pronounced in participants without obesity. CONCLUSION: The present study suggests that SSB consumption carries metabolic risk among working-age Taiwanese, particularly women and those without obesity. Health promotion programs should raise awareness of the health hazards associated with SSBs.

Association of functional, interactive, and critical health literacy with good self-rated health among Taiwanese community-dwelling older adults.

The functional, interactive, and critical domains of health literacy are associated with health. However, studies examining the relationship between health literacy subdomains and health in the Chinese-speaking context are still limited. Thus, we aimed to examine the association of functional, interactive, and critical health literacy with self-rated health among older Taiwanese adults. A total of 1,072 participants aged 60 or older were included in the analysis. Health literacy was measured by the 11-item short-form Mandarin Health Literacy Scale and validated tools. Self-rated health was categorized into good (good/very good), fair, and poor (poor/very poor) status. Multinomial logistic regression revealed that only interactive health literacy was associated with reporting good health status (OR = 2.30; 95% CI = 1.65 to 3.21). Conversely, all health literacy subdomains were not associated with reporting poor health. This study suggested that interactive health literacy was the key determinant of good self-rated health status for community-dwelling older adults.

Validation of the short falls efficacy scale-international for Taiwanese community-dwelling older adults: Associations with fall history, physical frailty, and quality of life.

The FES-I is widely used to measure the fear of falling. However, studies linking the Chinese version of the FES-I to frailty and quality of life among older adults are still limited. Thus, this study examined the association of the full 16-item FES-I and the 7-item short FES-I with fall history, physical frailty, and quality of life among older Taiwanese adults. A total of 751 community-dwelling older adults in Taipei City participated in this study. Data analyses included logistic and linear regression models. The 16-item and the short FES-I were strongly correlated (Spearman rho = 0.963), and both scales are reliable. The 7-item FES-I was positively associated with fall history and physical frailty and negatively associated with the physical (b = -0.65, p < 0.001) and mental (b = -0.59, p < 0.001) components of health-related quality of life, independent of physical frailty. Thus, the short FES-I can be used to increase the feasibility of health screenings of older adults in Chinese-speaking contexts.

Double disadvantage: income inequality, spatial polarization and mortality rates in Taiwan.

Background: Previous studies have suggested that social and economic spatial polarization is associated with various health outcomes. However, few studies have examined the joint effect of income inequality and spatial polarization on health. Methods: Data on mortality in 2008-12 were from the Ministry of Health and Welfare. We constructed economic spatial polarization using the Index of Concentration at the Extremes (ICE) by tax data from the Ministry of Finance. The Gini coefficient was from the Family Income and Expenditure Survey. Using multilevel datasets of 352 townships nested within 20 cities in Taiwan, we examined the association between township-level ICE and mortality, and further examined whether city-level income inequality moderate this association. Results: In 2008-12, the average age-standardized mortality in Taiwan was 470.5 per 100 000 populations. As compared to the highest income-based ICE quintile, the lowest ICE quintile was associated with an excess 171.7 deaths per 100 000 people (95% CI = 116.1, 227.3) after controlling for income inequality and population size. One unit rise in the Gini coefficient further increased 29.9 deaths (95% CI = 12.4, 47.5) for the lowest ICE quintile, as compared to the highest. Conclusion: The joint effect of income inequality and small-scale economic polarization may shed light on how inequalities increase mortality.

County-Level Income Inequality, Social Mobility, and Deaths of Despair in the US, 2000-2019.

Importance: Increasing mortality from suicide, drug overdose, and alcohol-related liver disease (collectively referred to as deaths of despair) is a critical public health crisis. Income inequality and social mobility have been separately associated with all-cause mortality; however, no studies have examined their interaction with these preventable deaths. Objective: To assess the interaction between income inequality and social mobility with deaths of despair among working-age Hispanic, non-Hispanic Black, and non-Hispanic White populations. Design, Setting, and Participants: This cross-sectional study analyzed data from the Centers for Disease Control and Prevention WONDER (Wide-Ranging Online Data for Epidemiologic Research) database on county-level deaths of despair from 2000 to 2019 across racial and ethnic groups. Statistical analysis was performed from January 8 to May 20, 2023. Exposures: The primary exposure of interest was county-level income inequality, measured by the Gini coefficient. Another exposure was race- and ethnicity-specific absolute social mobility. Tertiles for the Gini coefficient and social mobility were created to evaluate the dose-response association. Main Outcomes and Measures: The main outcomes were adjusted risk ratios (RRs) of deaths from suicide, drug overdose, and alcoholic liver disease. The interaction between income inequality and social mobility was formally tested on both the additive and multiplicative scales. Results: The sample included 788 counties for Hispanic populations, 1050 counties for non-Hispanic Black populations, and 2942 counties for non-Hispanic White populations. Over the study period, 152 350, 149 589, and 1 250 156 deaths of despair were recorded for working-age Hispanic, non-Hispanic Black, and non-Hispanic White populations, respectively. Compared with the reference group (counties with low income inequality and high social mobility), counties with greater income inequality (high inequality: RR, 1.26 [95% CI, 1.24-1.29] for Hispanic populations; RR, 1.18 [95% CI, 1.15-1.20] for non-Hispanic Black populations; and RR, 1.22 [95% CI, 1.21-1.23] for non-Hispanic White populations) or less social mobility (low mobility: RR, 1.79 [95% CI, 1.76-1.82] for Hispanic populations; RR, 1.64 [95% CI, 1.61-1.67] for non-Hispanic Black populations; and RR, 1.38 [95% CI, 1.38-1.39] for non-Hispanic White populations) had higher RRs for deaths of despair. In counties with high income inequality and low social mobility, positive interactions were observed on the additive scale for Hispanic populations (relative excess risk due to interaction [RERI], 0.27 [95% CI, 0.17-0.37]), non-Hispanic Black populations (RERI, 0.36 [95% CI, 0.30-0.42]), and non-Hispanic White populations (RERI, 0.10 [95% CI, 0.09-0.12]). In contrast, positive interactions on the multiplicative scale were found only for non-Hispanic Black populations (ratio of RRs, 1.24 [95% CI, 1.18-1.31]) and non-Hispanic White populations (ratio of RRs, 1.03 [95% CI, 1.02-1.05]), but not for Hispanic populations (ratio of RRs, 0.98 [95% CI, 0.93-1.04]). In the sensitivity analyses using continuous Gini coefficient and social mobility, a positive interaction was observed between higher income inequality and lower social mobility with deaths of despair on both the additive and multiplicative scales for all 3 racial and ethnic groups. Conclusions and Relevance: This cross-sectional study found that the joint exposure of unequal income distribution and lack of social mobility was associated with additional risks for deaths of despair, suggesting that addressing the underlying social and economic conditions is crucial in responding to the epidemic of deaths of despair.

Relative deprivation and human flourishing: how do upward income comparisons affect health, happiness and life satisfaction?

BACKGROUND: Relative deprivation induced by social comparisons is hypothesised to deleteriously affect health. Previous work has proposed the [Formula: see text] index as a measure of relative deprivation; however, the performance of this novel index still needs further testing in the working-age population. This study examined the association of three relative deprivation measures (the Yitzhaki Index, income rank and the [Formula: see text] index) with human flourishing outcomes. METHODS: This cross-sectional study analysed data from 2177 working-age adults in Taiwan. We conducted least-squares linear models to investigate the association between relative deprivation measures and health, happiness, life satisfaction, meaning in life, social relationships, and subjective well-being. RESULTS: When using sex and age as the reference group, for each increased SD in the Yitzhaki Index, the six human flourishing outcomes decreased by 0.10-0.20 SD. The results were consistent across various definitions of the reference group. Based on the Akaike information criterion, the Yitzhaki Index generally showed better model fits for health, happiness, life satisfaction and meaning in life, and had comparable model fits with the income rank for social relationships and subjective well-being. In comparing the relative performance of the [Formula: see text] index, positive α parameters (0<α<1) generally showed better model fits, suggesting that individuals were more sensitive to comparisons with those more distant from their own income level. CONCLUSION: Policies to reduce relative deprivation by lowering income inequality could contribute to a higher level of health, happiness, life satisfaction, meaning in life, social relationships and subjective well-being.

Association of Financial Literacy and Risk Preference With Fraud Exposure and Victimization Among Middle-Aged and Older Adults in China.

Fraud jeopardizes older people's physical, mental, and economic well-being, and financial literacy and risk preference have been linked to the risk of fraud experience. Given the inconsistent evidence, we investigated whether financial literacy and risk preferences were associated with fraud exposure and victimization among middle-aged and older adults. We analyzed data from the 2015 China Household Finance Survey, including 22,121 participants aged 50 and older. Poisson regression models were conducted to determine the association of financial literacy and risk preference with fraud experience. We found that financial literacy and risk preference were positively associated with fraud exposure and victimization. The prevalence of fraud victimization among middle-aged and older adults with the highest financial literacy and risk preference levels was 46.5% and 45.8% higher than among those with the lowest levels, respectively. These findings suggested that basic financial knowledge is insufficient to protect older people from fraud exposure and victimization.

Retinal Microvascular Changes in Mild Cognitive Impairment and Alzheimer's Disease: A Systematic Review, Meta-Analysis, and Meta-Regression.

Background: The remarkable increase in prevalence and significant morbidity of neurodegenerative diseases pose a tremendous burden for the health care system. Changes in retinal microvasculature metrics associated with Alzheimer's disease (AD) and mild cognitive impairment (MCI) may provide opportunities for early diagnosis and intervention. However, the role of retinal vascular biomarkers remains controversial. We aim to perform a systematic review, meta-analysis and meta-regression to evaluate the comprehensive retinal microvasculature changes in patients with AD and MCI. Methods: We conducted a literature search on PubMed, MEDLINE, and EMBASE to identify studies published before May 2021 which assessed the measurements of optical coherence tomography angiography (OCTA) between AD, MCI with healthy control eyes, including foveal avascular zone (FAZ), vessel density (VD) of peripapillary, superficial and deep capillary plexus, and choroidal thickness using a random-effect model. We also performed meta-regression and subgroup analysis and assessed heterogeneity and publication bias to evaluate potential sources of bias. Results: Compared with control eyes, VD of superficial capillary plexus was significantly lower in AD [standardized mean difference (SMD): -0.48; 95% CI (-0.70 to -0.27); p = 0.04] and MCI eyes [SMD: -0.42; 95% CI (-0.81 to -0.03); p = 0.03], as well as reduced VD of deep capillary plexus [SMD: -1.19; 95% CI (-2.00 to -0.38]; p < 0.001], [SMD: -0.53; 95% CI (-0.85 to -0.22); p < 0.001]. FAZ was significantly enlarged in AD eyes [SMD: 0.54; 95% CI (0.09 to 0.99); p = 0.02]. The meta-regression analysis showed that the OCTA machine type and macular scan size significantly influenced the variation of VD and FAZ between AD and control eyes (p < 0.05). Conclusion: Our results highlight the potential of OCTA as a biomarker to detect early microvasculature deficits in AD and MCI. Notably, the macular scan size and different OCTA machine type could explain the heterogeneity observed in literatures. This information might be useful for future longitudinal study design to evaluate the role of OCTA in monitoring disease progression and treatment efficacy.

Urban-Rural Disparities in the Incidence of Diabetes-Related Complications in Taiwan: A Propensity Score Matching Analysis.

Although a disparity has been noted in the prevalence and outcome of chronic disease between rural and urban areas, studies about diabetes-related complications are lacking. The purpose of this study was to examine the association between urbanization and occurrence of diabetes-related complications using Taiwan's nationwide diabetic mellitus database. In total, 380,474 patients with newly diagnosed type 2 diabetes between 2000 and 2008 were included and followed up until 2013 or death; after propensity score matching, 31,310 pairs were included for analysis. Occurrences of seven diabetes-related complications of interest were identified. Cox proportional hazards model was used to determine the time-to-event hazard ratio (HR) among urban, suburban and rural groups. We found that the HRs of all cardiovascular events during the five-year follow-up was 1.04 times (95% confidence interval (CI) 1.00-1.07) and 1.15 times (95% CI 1.12-1.19) higher in suburban and rural areas than in urban areas. Patients in suburban and rural areas had a greater likelihood of congestive heart failure, stroke, and end-stage renal disease than those in urban areas. Moreover, patients in rural areas had a higher likelihood of ischemic heart disease, blindness, and ulcer than those in urban areas. Our empirical findings provide evidence for potential urban-rural disparities in diabetes-related complications in Taiwan.

The association between relative deprivation and self-rated health, depressive symptoms, and smoking behavior in Taiwan.

Relative deprivation has been hypothesized as one explanation for the association between income inequality and health. However, few studies have examined the effect of relative deprivation on psychosocial and behavioral outcomes. Using a cross-sectional data from the National Survey on Knowledge, Attitude, and Practice of Health Promotion in Taiwan, this study examined the relationship between relative deprivation and physical health (self-rated health), psychosocial health (depressive symptoms), and behavioral health (smoking) among working-age Taiwanese men and women. We found that higher relative deprivation (measured by the Yitzhaki Index) is significantly associated with a higher prevalence of poor self-rated health, depressive symptoms, and current smoking in both genders. After controlling for demographic variables and absolute income, the prevalence ratios (PRs) of reporting poor health for each 10,000 NT-dollars higher in the Yitzhaki Index are between 1.25 and 1.57, depending on the reference groups. The PRs were between 1.33 and 1.77 for depressive symptoms, and between 1.04 and 1.46 for smoking. Additionally, the depressive symptoms attenuated the association between relative deprivation and self-rated health. The results were consistent with various definitions of reference groups. In conclusion, this study suggests that the psychosocial process of relative deprivation is a crucial mechanism linking income inequality to health. Narrowing the income gap between rich and poor may protect the physical and mental well-being of the population and reduce the prevalence of smoking.