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Systematic review
The Effectiveness of Protein Supplementation Combined with Resistance Exercise Program Among Community-Dwelling Older Adults with Sarcopenia: A Systematic Review and Meta-analysis
Phatcharaphon Whaikid, Noppawan Piaseu
Epidemiol Health. 2024;e2024030.   Published online February 14, 2024
DOI: https://doi.org/10.4178/epih.e2024030    [Accepted]
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AbstractAbstract PDF
Abstract
OBJECTIVES
ImprovingThe combination of protein supplementation and resistance exercise shows promise for improving and maintaining muscle mass, strength, and performance through protein supplementation combined with resistance exercise is promising in older adults with sarcopenia. The objective of the presentThis systematic review isaimed to examineevaluate the effects of protein supplementation combined with resistance exercisethis combination on muscle mass, muscle strength, and physical performance amongin community-dwelling older adults with sarcopenia.
METHODS
ComprehensiveWe conducted a comprehensive search across fourof 4 electronic databases,includes: PubMed, Scopus, Embase, and the Medline library, spanningMEDLINE Library. The search covered literature from January 2013 to January 2023, following and followed the Preferred Reporting Items for Systematic ReviewReviews and Meta-AnalysisAnalyses (PRISMA) guidelines. Two independent reviewers evaluateassessed the methodological quality and individualof each study using the standard critical appraisal instrumenttool from the Johanna Briggs Institute (JBI. The meta). Meta-analysis was performed usingwith the JBI Sumari program.
RESULTS
A total of The review included 7 randomized controlled trials and 1 quasi -experimental study consisting, encompassing a total of 854 older adultsparticipants aged 60 years and above were included in this review. The duration of the studies. The study durations ranged from 10 to 24 weeks. TheAn analysis using aof standardized mean difference (SMD) revealeddifferences (SMDs) showed that protein supplementation combined with resistance exercise significantly increased muscle mass (SMD=0.95 (; 95% CI:, 0.13,-1.78),; p< 0.05),) and muscle strength (SMD=0.32 (; 95% CI: 0.08, 0.08-0.56),; p< 0.05).
CONCLUSIONS
The smallAlthough the limited number of RCTs constrains the strengthrandomized controlled trials restricts the robustness of our conclusions. Nevertheless, our findings indicate, the evidence suggests that protein supplementation combined with resistance exercise effectively enhancesis effective in enhancing muscle mass and strength amongin community-dwelling older adults with sarcopenia.
Summary
Original articles
Impact of electronic cigarette use on the increased risk of diabetes: the Korean Community Health Survey
Wonseok Jeong, Seungju Kim
Epidemiol Health. 2024;e2024029.   Published online February 13, 2024
DOI: https://doi.org/10.4178/epih.e2024029    [Accepted]
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Abstract
OBJECTIVES
Only a few studies have solely investigated the health impacts of electronic cigarettes on diabetes while considering the impact of conventional cigarettes. Therefore, this study aimed to examine the effect of electronic cigarette smoking on diabetes in South Korean dual-, electronic cigarette-, conventional cigarette-, and non-smokers.
METHODS
Data were obtained from the 2021 and 2022 Korean Community Health Surveys of 460,603 Korean adults. The main independent variable was smoking behavior. Participants were categorized according to their smoking behavior, as dual smokers, electronic cigarette smokers, conventional cigarette smokers, and non-smokers. The dependent variable, the presence of diabetes, was defined by a doctor’s diagnosis. Multiple logistic regression analysis was performed to examine the association between smoking behavior and diabetes. Subgroup analyses were also performed to investigate the associations among different socio-economic groups.
RESULTS
Conventional cigarette smokers had a higher risk of diabetes than did non-smokers (odds ratio [OR] = 1.22, 95% confidence interval [CI] = 1.19–1.26). More importantly, those who only vaped electronic cigarettes were at high risk of diabetes (OR = 1.15, 95% CI = 1.01–1.32). Lastly, dual smokers had the highest OR for diabetes among other smoking behavior groups (OR = 1.39, 95% CI = 1.22–1.58). Dual smoking was associated with the highest risk of diabetes in most subgroups.
CONCLUSIONS
This study suggests that conventional cigarette use and smoking electronic cigarettes negatively impact diabetes, and using both types leads to worse health outcomes. Therefore, cessation of all types of smoking is necessary for a healthy life.
Summary
Associations of active and passive tobacco exposure with elevated blood pressure in Korean adolescents
Hyerin Park, Hyunsuk Jeong, Hyeon Woo Yim, Sanghyuk Bae
Epidemiol Health. 2024;e2024028.   Published online February 13, 2024
DOI: https://doi.org/10.4178/epih.e2024028    [Accepted]
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AbstractAbstract PDF
Abstract
OBJECTIVES
To test the hypothesis that tobacco exposure is associated with elevated blood pressure in Korean adolescents, and that the association is dose dependent.
METHODS
This cross-sectional study used data from the 2011–2020 Korea National Health and Nutrition Survey (KNHANES). Subjects were eligible if they were 13–18 years at the time of participation in KNHANES. Tobacco exposure was defined by urine cotinine level. The main outcomes were elevated blood pressure (EBP) and hypertension. Statistical analyses were conducted using SAS 9.4 with appropriate sampling weights to account for the complex survey design, stratification, and cluster variable.
RESULTS
A total of 2518 adolescents was included in the analysis, representing 2.5 million Korean adolescents. The mean (SD) participant age was 15.3 (1.7) years, and 55.3% were male. The number of participants with active tobacco smoke exposure was 283 (11.2%), passive tobacco smoke exposure was 145 (5.8%), and no smoke exposure was 2090 (83.0%). Analysis of the 2518 urine-cotinine-verified participants showed that tobacco smoke exposure had a significant effect on EBP: with an elevated odds of BP of 3.00 (95% CI: 1.14–7.89). The odds of hypertension were 3.61 (95% CI: 1.13–11.49) in the active smoking group compared with the no tobacco exposure group after adjustment for potential confounders.
CONCLUSIONS
It is necessary to present a range of public health plans to reduce tobacco exposure that affects adolescents' blood pressure, and further research with a larger number of participants using urine cotinine as a biomarker is needed.
Summary
Mediating effect of lower extremity muscle on the relationship between obesity and osteoarthritis in middle-aged and elderly women in Korea: Based on the 2009–2011 Korea National Health and Nutrition Examination Survey
Minjun Kim, Joonwoong Kim, Inhwan Lee
Epidemiol Health. 2024;e2024027.   Published online February 2, 2024
DOI: https://doi.org/10.4178/epih.e2024027    [Accepted]
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Abstract
OBJECTIVES
This study investigated whether the lower extremity muscle mass index (LMI) mediates the relationship between general obesity, central obesity, and knee osteoarthritis in middle-aged and elderly women in Korea.
METHODS
Data of 2,843 women aged ≥50 years were collected from the Korean National Health and Nutrition Examination Survey conducted between 2009 and 2011. General obesity and central obesity were evaluated based on body mass index (BMI) and waist circumference (WC), calculated through anthropometric measurements and body composition assessments. LMI was calculated by dividing the muscle mass in both legs—measured using the dual-energy X-ray absorptiometry—by body weight. Knee osteoarthritis was defined as a Kellgren-Lawrence scale (KL) grade of ≥2 as assessed through radiographic images.
RESULTS
Knee osteoarthritis prevalence, indicated by KL grades, was significantly higher in the general obesity and central obesity groups compared to the normal group, and conversely, lower with varying LMI levels. Using mediation analysis with bootstrapping and adjusting for covariates, we found that LMI mediated the relationship between BMI and KL (β: 0.005; 95% CI: 0.000–0.010) and WC and KL grade (β: 0.002; 95% CI: 0.001–0.003), explaining 4.8% and 6.7% of the total effects of BMI and WC on KL grade, respectively.
CONCLUSIONS
The study suggested that LMI partially mediates the link between general obesity and/or central obesity and knee osteoarthritis, proposing that a higher proportion of lower limb muscle mass relative to body weight can alleviate the increased risk of knee osteoarthritis caused by obesity.
Summary
Adherence to the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Survivors and Biomarkers of Inflammation among Breast Cancer Survivors
Minji Kang, Sihan Song, Hyun Jeong Cho, Zisun Kim, Hyun Jo Youn, Jihyoung Cho, Jun Won Min, Yoo Seok Kim, Sang-Woon Choi, Jung Eun Lee
Epidemiol Health. 2024;e2024026.   Published online January 25, 2024
DOI: https://doi.org/10.4178/epih.e2024026    [Accepted]
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AbstractAbstract PDF
Abstract
OBJECTIVES
This study investigated whether adherence to the overall lifestyle recommendations in the American Cancer Society (ACS) guidelines on nutrition and physical activity for cancer survivors was associated with inflammation in breast cancer survivors.
METHODS
The study included 409 women who had undergone breast cancer surgery at least 1 year before enrollment. A generalized linear model was used to estimate the least square mean and 95% confidence interval of plasma levels of inflammatory markers according to lifestyle factors defined in terms of adherence to the ACS guidelines.
RESULTS
Higher overall adherence scores were associated with lower levels of high-sensitivity C-reactive protein (hs-CRP) (p for trend=0.0153) and higher levels of adiponectin (p for trend=0.0095). Similar significant associations of hs-CRP (p for trend=0.0040) and adiponectin (p for trend=0.0097) levels were observed with the score for the body mass index (BMI) component of the adherence score. A higher diet component score was associated with a higher adiponectin level (p for trend=0.0198), but there was no significant association for the physical activity component score.
CONCLUSIONS
The present study's findings suggest that maintaining a healthy lifestyle according to the ACS guidelines was associated with beneficial effects on inflammatory marker levels, especially hs-CRP and adiponectin, among breast cancer survivors. Among the 3 components of lifestyle guidelines, the BMI component exhibited the most similar tendency to the overall adherence score in relation to inflammatory indicators. Further prospective and intervention studies are needed to investigate longitudinal associations between lifestyle factors and inflammatory markers among breast cancer survivors.
Summary
Public holidays increased the transmission of COVID-19 in Japan, 2020–2021: a mathematical modelling study
Jiaying Qiao, Hiroshi Nishiura
Epidemiol Health. 2024;e2024025.   Published online January 22, 2024
DOI: https://doi.org/10.4178/epih.e2024025    [Accepted]
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AbstractAbstract PDF
Abstract
OBJECTIVES
Although the role of specific holidays in modifying transmission dynamics of infectious diseases has received some research attention, the epidemiological impact of public holidays on the transmission of coronavirus disease 2019 (COVID-19) remains unclear.
METHODS
To assess the extent of increased transmission frequency during public holidays, we collected COVID-19 incidence and mobility data in Hokkaido, Tokyo, Aichi, and Osaka from 15 February 2020 to 30 September 2021. Models linking the estimated effective reproduction number (Rt) with raw or adjusted mobility, public holidays, and the state of emergency declaration were developed. The best-fit model included public holidays as an essential input variable, and was used to calculate counterfactuals of Rt in the absence of holidays.
RESULTS
During public holidays, on average, Rt increased by 5.71%, 3.19%, 4.84%, and 24.82% in Hokkaido, Tokyo, Aichi, and Osaka, respectively, resulting in a total increase of 580 (95% confidence interval [CI], 213–954), 2,209 (95% CI, 1,230–3,201), 1,086 (95% CI, 478–1,686), and 5,211 (95% CI, 4,554–5,867) cases that were attributable to the impact of public holidays.
CONCLUSIONS
Public holidays intensified the transmission of COVID-19, highlighting the importance of considering public holidays in designing appropriate public health and social measures in the future.
Summary
Comparison of all-cause mortality associated with non-alcoholic fatty liver disease and metabolic dysfunction-associated fatty liver disease
Wei-Chun Cheng, Hua-Fen Chen, Hsiu-Chi Cheng, Chung-Yi Li
Epidemiol Health. 2024;e2024024.   Published online January 21, 2024
DOI: https://doi.org/10.4178/epih.e2024024    [Accepted]
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Abstract
OBJECTIVES
The global burden of non-alcoholic fatty liver disease (NAFLD) is rising. An alternative term, metabolic dysfunction-associated fatty liver disease (MAFLD), instead highlights the associated metabolic risks. This cohort study examined patient classifications under NAFLD and MAFLD criteria and their associations with all-cause mortality.
METHODS
Participants who attended a paid health checkup (2012-2015) were included. Hepatic steatosis (HS) was diagnosed ultrasonographically. NAFLD was defined as HS without secondary causes, while MAFLD involved HS with overweight/obesity, type 2 diabetes mellitus, or ≥2 metabolic dysfunctions. Mortality was tracked via the Taiwan Death Registry until November 30, 2022.
RESULTS
Of 118,915 participants, 36.9% had NAFLD, 40.2% had MAFLD, and 32.9% met both definitions. Participants with NAFLD alone had lower mortality, and those with MAFLD alone had higher mortality, than individuals with both conditions. After adjustment for potential confounders, the hazard ratios (HRs) for all-cause mortality were 1.08 (95% confidence interval [CI], 0.78-1.48) for NAFLD alone and 1.26 (95% CI, 1.09-1.47) for MAFLD alone, relative to both conditions. Advanced fibrosis conferred greater mortality risk, with HRs of 1.93 (95% CI, 1.44-2.58) and 2.08 (95% CI, 1.61-2.70) for advanced fibrotic NAFLD and MAFLD, respectively. Key mortality risk factors for NAFLD and MAFLD included older age, unmarried status, higher body mass index, smoking, diabetes mellitus, chronic kidney disease, and advanced fibrosis.
CONCLUSIONS
All-cause mortality in NAFLD and/or MAFLD was linked to cardiometabolic covariates, with risk attenuated after multivariable adjustment. A high Fib-4 score, indicating fibrosis, could identify FLD cases involving elevated mortality risk.
Summary
Association between dietary and behavioral-based oxidative balance score and phenotypic age acceleration: a cross-sectional study
Dongzhe Wu, Yulin Shen, Chaoyi Qu, Peng Huang, Xue Geng, Jianhong Zhang, Zhijian Rao, Qiangman Wei, Shijie Liu, Jiexiu Zhao
Epidemiol Health. 2024;e2024023.   Published online January 18, 2024
DOI: https://doi.org/10.4178/epih.e2024023    [Accepted]
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Abstract
OBJECTIVES
In light of the rise in the global aging population, this study investigated the potential of the oxidative balance score (OBS) as an indicator of phenotypic age acceleration (PhenoAgeAccel) to better understand and potentially slow down aging.
METHODS
Utilizing data from the National Health and Nutrition Examination Survey (NHANES) collected between 2001 and 2010, including 13,142 U.S. adults (48.75% female and 51.25% male) aged 20 and above, OBS and PhenoAgeAccel were calculated. Weighted generalized linear regression models were employed to explore the associations between OBS and PhenoAgeAccel, including a sex-specific analysis.
RESULTS
The OBS demonstrated significant variability across various demographic and health-related factors. There was a clear negative correlation observed between the higher OBS quartiles and PhenoAgeAccel, which presented sex-specific results: the negative association between OBS and PhenoAgeAccel was more pronounced in men than in women. An analysis using restricted cubic splines revealed no significant nonlinear relationships. Interaction effects were noted solely in the context of sex and hyperlipidemia.
CONCLUSIONS
A higher OBS was significantly associated with a slower aging process, as measured by lower PhenoAgeAccel. These findings underscore the importance of OBS as a biomarker in the study of aging and point to sex and hyperlipidemia as variables that may affect this association. Additional research is required to confirm these results and to investigate the biological underpinnings of this relationship.
Summary
The Effect of Public Hospital Closure on the Death of Long-term Inpatients
Taeuk Kang, Munsung Sohn, Changwoo Shon
Epidemiol Health. 2024;e2024022.   Published online January 17, 2024
DOI: https://doi.org/10.4178/epih.e2024022    [Accepted]
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Abstract
OBJECTIVES
This study aimed to examine the changes in health outcomes and the patterns of medical institution utilization among patients with long-term stays in public hospitals following the closure of a public medical center. It also sought to present a proposal regarding the role of public hospitals in countries with healthcare systems predominantly driven by private entities, such as Korea.
METHODS
To assess the impact of a public healthcare institution closure on health outcomes in a specific region, we utilized nationally representative health insurance claims data. A retrospective cohort study was conducted for this analysis.
RESULTS
An analysis of the medical utilization patterns of patients after the closure of Jinju Medical Center showed that 67.4% of the total medical usage was redirected to long-term care hospitals. This figure is notably high in comparison to the 20% utilization rate of nursing hospitals observed among patients from other medical facilities. These results indicate that former patients of Jinju Medical Center may have experienced limitations in accessing necessary medical services beyond nursing care. After accounting for relevant mortality factors, the analysis showed that the mortality rate in closed public hospitals was 2.67 times higher (95% CI, 0.85-0.96) than in private hospitals.
CONCLUSIONS
The closure of public medical institutions has resulted in unmet healthcare needs, and an observed association was observed with increased mortality rates. It is essential to define the role and objectives of public medical institutions, taking into account the distribution of healthcare resources and the conditions of the population.
Summary
Associations of depressive symptoms with lower extremity function and balance in older adults
Bong Jo Kim, Kyupin Ha, Hyun Soo Kim, Hye Ran Bae, Minkook Son
Epidemiol Health. 2024;e2024021.   Published online January 15, 2024
DOI: https://doi.org/10.4178/epih.e2024021    [Accepted]
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AbstractAbstract PDF
Abstract
OBJECTIVES
The relationship of depressive symptoms to lower extremity function and balance, especially in older adults without a depression diagnosis, remains unclear. Therefore, our study analyzed this relationship using a large sample of Korean older adults.
METHODS
We used data from the Korean National Health Insurance Service’s Health Screening Program database. Individuals aged 66 years who had undergone the National Screening Program for Transitional Ages in Korea and were without a diagnosis of depressive disorder were included. The lower extremity function and balance were evaluated using 2 physical tests, while depressive symptoms were assessed using a 3-question survey. Multivariable-adjusted logistic regression analysis was used to examine the association between depressive symptoms and lower extremity function and balance.
RESULTS
Among 66,041 individuals, those with depressive symptoms showed significantly higher rates of abnormal lower extremity function and abnormal balance. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the association of depressive symptoms to abnormal lower extremity function and abnormal balance were (OR=1.34; 95% CI, 1.25–1.44) and (OR=1.38; 95% CI, 1.29–1.48), respectively. Assessment of the relationship based on depressive symptom scores revealed that higher scores were associated with higher ORs (p for trend <0.001). Subgroup analyses further confirmed this relationship, especially among patients with cerebrovascular disease or dementia.
CONCLUSIONS
This study revealed an association between depressive symptoms and the abnormal lower extremity function and balance of 66-year-old individuals without a diagnosis of depressive disorder.
Summary
Associations of the magnesium depletion score and magnesium intake with diabetes among US adults: an analysis of the National Health and Nutrition Examination Survey 2011-2018
Zhong Tian, Shifang Qu, Chen Yana, Jiaxin Fang, Xingxu Song, Kai He, Kexin Jiang, Xiaoyue Sun, Jianyang Shi, Yuchun Tao, Lina Jin
Epidemiol Health. 2024;e2024020.   Published online January 10, 2024
DOI: https://doi.org/10.4178/epih.e2024020    [Accepted]
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AbstractAbstract PDF
Abstract
OBJECTIVES
The magnesium depletion score (MDS) is considered more reliable than traditional approaches for predicting magnesium deficiency in humans. We explored the associations of MDS and dietary magnesium intake with diabetes.
METHODS
We obtained data from 18,853 participants in the National Health and Nutrition Examination Survey 2011-2018. Using multivariate regression and stratified analysis, we investigated the relationships of both MDS and magnesium intake with diabetes. To compute prevalence ratios (PRs), we employed modified Poisson or log-binomial regression. We characterized the nonlinear association between magnesium intake and diabetes using restricted cubic spline analysis.
RESULTS
Participants with MDS ≥2 exhibited a PR of 1.26 (95% confidence interval [CI], 1.19 to 1.34) for diabetes. Per-SD increase in dietary magnesium intake was associated with a lower prevalence of diabetes (PR=0.91; 95% CI, 0.87 to 0.96). Subgroup analyses revealed a positive association between MDS ≥2 and diabetes across all levels of dietary magnesium intake, including the lowest (PR=1.35; 95% CI, 1.18 to 1.55), middle (PR=1.23; 95% CI, 1.12 to 1.35), and highest tertiles (PR=1.25; 95% CI, 1.13 to 1.37; pinteraction<0.001). Per-SD increase in magnesium intake was associated with lower diabetes prevalence in participants with MDS <2 (PR=0.92; 95% CI, 0.87 to 0.98) and those with MDS ≥2 (PR=0.91; 95% CI, 0.84 to 0.98; pinteraction=0.030).
CONCLUSIONS
MDS is associated with diabetes, particularly among individuals with low magnesium intake. Adequate dietary magnesium intake may reduce diabetes risk, especially in those with high MDS.
Summary
Association of plain water intake with self-reported depression and suicidality among Korean adolescents
Jung Woo Lee, Yookyung Kim
Epidemiol Health. 2024;e2024019.   Published online January 9, 2024
DOI: https://doi.org/10.4178/epih.e2024019    [Accepted]
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AbstractAbstract PDF
Abstract
OBJECTIVES
Adolescent depression and suicidality are serious health problems worldwide. Lower plain water intake has been proposed as a risk factor for depression in adults. This study investigated the association of daily plain water intake with self-reported depression and suicidality among Korean adolescents.
METHODS
We used nationwide data from 112,250 students aged 12-18 years who participated in the Korean Youth Risk Behavior Web-based Surveys in 2019 and 2020. Daily plain water intake was categorized as <1, 1-2, and ≥3 glasses. The adjusted odds ratios (AORs) with 95% confidence intervals (CIs) for self-reported depression and suicidality were calculated using multiple regression analyses.
RESULTS
The weighted prevalence rates of self-reported depression, suicidal ideation, suicide planning, and suicide attempts were 26.7%, 12.0%, 3.8%, and 2.5%, respectively. Of the participants, 3.9%, 18.5%, and 77.7% were categorized into the <1, 1-2, and ≥3 glasses/day groups, respectively. Compared to the reference group (≥3 glasses/day), the lowest level of water intake (<1 glass/day) was associated with higher odds of self-reported depression (AOR=1.30; 95% CI, 1.20-1.39), suicidal ideation (AOR=1.39; 95% CI, 1.27-1.55), suicide planning (AOR=1.46; 95% CI, 1.25-1.69), and suicide attempts (AOR=1.38; 95% CI, 1.15-1.67). Moderately lower water intake (1-2 glasses/day) showed slightly increased odds of self-reported depression (AOR=1.05; 95% CI, 1.01-1.10) and suicidal ideation (AOR=1.08; 95% CI, 1.03-1.14).
CONCLUSIONS
Lower plain water intake was significantly associated with a higher risk of self-reported depression and suicidality among Korean adolescents. Since this cross-sectional study is unable to establish a causal relationship, it underscores the need for additional longitudinal research.
Summary
Socioeconomic inequality in health-related quality of life among Korean adults with chronic disease: an analysis of the Korean Community Health Survey
Thi Huyen Trang Nguyen, Thi Tra Bui, Jinhee Lee, Kui Son Choi, Hyunsoon Cho, Jin-Kyoung Oh
Epidemiol Health. 2024;e2024018.   Published online January 8, 2024
DOI: https://doi.org/10.4178/epih.e2024018    [Accepted]
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AbstractAbstract PDF
Abstract
OBJECTIVES
Health-related quality of life is crucial for people dealing with chronic illness. This study investigated the quality of life in individuals with 5 common chronic conditions in Korea. We also analyzed socioeconomic factors such as education, income, occupation, and urbanization to identify determinants of inequality.
METHODS
Using 2016 Community Health Survey data, we examined individuals aged 30 or older with chronic diseases (diabetes, hypertension, cardiovascular disease, hyperlipidemia, arthritis) using the EQ-5D-3L tool. We analyzed the associations between socioeconomic factors (education, income, occupation, urbanization) and quality of life using descriptive statistics and regression analysis. Inequality indices (RII, SII) were used to measure inequality in quality of life.
RESULTS
Individuals with higher income levels showed a 1.95-fold higher likelihood of a better quality of life than those with the lowest income. The lowest income group had higher odds of mobility (adjusted odds ratio [aOR]=2.2), self-care (aOR=2.1), activity limitations (aOR=2.4), pain/discomfort (aOR=1.8), and anxiety/depression (aOR=2.3). Educational disparities included a 3-fold increase in mobility and daily activity problems for those with elementary or lower education. Well-educated participants had a 1.94 times higher quality of life, with smaller differences in anxiety/depression and self-management. The income gap accounted for 14.1% of variance in quality-of-life disparities.
CONCLUSIONS
Addressing socioeconomic disparities in the quality of life for individuals with chronic diseases necessitates tailored interventions and targeted health policies. This research informs policymakers in developing focused initiatives to alleviate health inequities. It emphasizes the importance of mental health support and ensuring affordable, accessible healthcare services.
Summary
A prospective association between dietary mushroom intake and the risk of type 2 diabetes: the Korean Genome and Epidemiology Study–Cardiovascular Disease Association Study
Yu-Mi Kim, Hye Won Woo, Min-Ho Shin, Sang Baek Koh, Hyeon Chang Kim, Mi Kyung Kim
Epidemiol Health. 2024;e2024017.   Published online January 8, 2024
DOI: https://doi.org/10.4178/epih.e2024017    [Accepted]
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AbstractAbstract PDF
Abstract
OBJECTIVES
Mushrooms, known for their nutritious and functional components, are considered healthy and medicinal. This study investigated the prospective association between dietary mushroom consumption and the incidence of type 2 diabetes among Korean adults aged ≥ 40 years.
METHODS
In total, 16,666 participants who were not taking anti-diabetic medication or insulin and had normal fasting blood glucose (FBG) (< 126 mg/dL) were included. We used the cumulative average dietary consumption of mushrooms as an exposure metric, calculated from food frequency questionnaires at every follow-up, along with covariates collected during a baseline survey. To estimate incidence rate ratios (IRRs) for type 2 diabetes, a modified Poisson regression model with a robust error estimator was applied.
RESULTS
In multivariable models, dietary mushroom consumption was inversely associated with type 2 diabetes incidence in both sexes (men: IRR, 0.65; 95% CI, 0.47 to 0.90; plinearity = 0.0427 in the highest quartile (Q4) vs. the lowest quartile (Q1); women: IRR, 0.70; 95% CI, 0.54 to 0.93; plinearity = 0.1145 in Q4 vs. Q1). The inverse association remained after adjustment for dietary factors instead of dietary quality index, the baseline FBG, and the exclusion of incidence within the first year. Additionally, no significant interaction was found regarding the risk of type 2 diabetes between dietary mushroom consumption and participants’ sex or other factors.
CONCLUSIONS
Dietary mushroom consumption was inversely linked with the risk of type 2 diabetes incidence in both sexes, indicating the beneficial role of mushrooms in preventing the disease.
Summary
The bounds of meta-analytics and an alternative method
Ramalingam Shanmugam, Mohammad Tabatabai, Derek Wilus, Karan P Singh
Epidemiol Health. 2024;e2024016.   Published online January 7, 2024
DOI: https://doi.org/10.4178/epih.e2024016    [Accepted]
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AbstractAbstract PDF
Abstract
OBJECTIVES
Meta-analysis is a statistical appraisal of the data analytic implications of published articles (Y), estimating parameters including the odds ratio and relative risk. This information is helpful for evaluating the significance of the findings. The Higgins I2 index is often used to measure heterogeneity among studies. The objectives of this article are to amend the Higgins I2 index score in a novel and innovative way and to make it more useful in practice. METHODS: Heterogeneity among study populations can be affected by many sources, including the sample size and study design. They influence the Cochran Q score and, thus, the Higgins I2 score. In this regard, the I2 score is not an absolute indicator of heterogeneity. Q changes by bound as Y increases unboundedly. An innovative methodology is devised to show the conditional and unconditional probability structures.
RESULTS
Various properties are derived, including showing that a zero correlation between Q and Y does not necessarily mean that they are independent. A new alternative statistic, S2, is derived and applied to mild cognitive impairment and COVID-19 vaccination for meta-analysis. CONCLUSIONS: A hidden shortcoming of the Higgins I2 index is overcome in this article by amending the Higgins I2 score. The usefulness of the proposed methodology is illustrated using 2 examples. The findings have potential health policy implications.
Summary

Epidemiol Health : Epidemiology and Health