Nationwide trends in prevalence of underweight, overweight, and obesity among people with disabilities in South Korea from 2008 to 2017

The extent to which family doctors have the ability to deal with patients with disabilities

Lack of training of health workers presents a unique challenge in meeting the needs of patients with disabilities (PWD). Therefore, the current study aimed to determine the level of medical students' ability to deal with PWD in hospitals by knowing the IFD 'attitudes and the challenges they face while working with this group. Additionally, the study sought to understand the intern family doctors' (IFD) perspectives on problem-solving strategies. To achieve the study objectives, a questionnaire was designed to measure trends, challenges, and solutions to the problems facing IFD. The study sample comprised 152 doctors from various medical colleges in Riyadh. At this point, the data underwent descriptive analysis, and the ordinal alpha indicated a reliability of 0.71 for the internal consistency measure. The study found that IFD have a median ability to deal with PWD, with a median score of 2.37. IFD have positive attitudes, with a median score of 2.27. However, trainee IFD face difficulties in communication, proficiency, implementing rights and legislation, and attending special education training workshops (a median 2.21). The study found a positive correlation between solutions to these problems and the enhancement of medical students' understanding of PWD characteristics and strategies, with a median score of 2.63. However, the multiplicity of areas in the Kingdom of Saudi Arabia (KSA) hinders the generalization of the results. Finally, participants recommended establishing special education diplomas and curricula for IFD', ensuring the presence of a PWD specialist in clinics to address doctors' challenges, and providing periodic training workshops for doctors to attend.

[Disability status and consumption of sugar-sweetened beverages: analysis of a Colombian population survey]

Introduction

Introduction: according to the World Health Organization (WHO), obesity has tripled in the world as a result of high caloric intake. People with disabilities are more likely to be overweight and obese. Objectives: this study aimed to estimate the association between disability status and consumption of sugar-sweetened beverages in the population aged 18 years and older in Colombia in 2017. Methods: we conducted a secondary analysis of data from Colombia's 2017 National Quality of Life Survey (ECV). The dependent variable was the consumption of sugar-sweetened beverages, and the independent variable was the disability status. Additionally, confounding variables were incorporated. An ordinal logistic regression was performed to estimate the magnitude of the association. The complex sample design of the 2017 LCS was considered in all results. Results: we included data from 18,957 persons aged 18 years and older; 7.9 % had a disability, and 64.4 % consumed sugar-sweetened beverages. People with moderate and severe disability were 18 % and 41 %, respectively, less likely to have a higher consumption of sugar-sweetened beverages compared to people without disability (OR: 0.82; 95 % CI: 0.72-0.95 and OR: 0.59; 95 % CI: 0.39-0.90). When stratified by age group, this association remained only in those older than 45. Conclusions: in Colombia, in 2017, people with disabilities older than 45 years consumed fewer sugar-sweetened beverages than people without disabilities.

The relationships between obesity and epilepsy: A systematic review with meta-analysis

OBJECTIVE

There is ongoing debate regarding the association between epilepsy and obesity. Thus, the aim of this study was to examine the correlation between epilepsy and obesity.

METHOD

This study adhered to the PRISMA guidelines for systematic reviews and meta-analyses. On The Prospero website, this study has been successfully registered (CRD42023439530), searching electronic databases from the Cochr-ane Library, PubMed, Web of Sciences and Embase until February 10, 2024.The search keywords included "Epilepsy", "Obesity", "Case-Control Studies", "cohort studies", "Randomized Controlled Trial" and "Cross-Sectional Studies". The medical subject headings(MeSH) of PubMed was utilized to search for relevant subject words and free words, and a comprehensive search strategy was developed. Two reviewers conducted article screening, data extraction and bias risk assessment in strict accordance with the predefined criteria for including and excluding studies. The predefined inclusion criteria were as follows: 1) Inclusion of case-control, cohort, randomized controlled trial, and cross-sectional studies; 2) Segregation of subjects into epileptic patients and healthy controls; 3)Obesity as the outcome measure; 4) Availability of comprehensive data; 5) Publication in English. The exclusion criteria were as follows: 1) Exclusion of animal experiments, reviews, and other types of studies; 2) Absence of a healthy control group; 3) Incomplete data; 4) Unextractable or unconvertible data; 5) Low quality, indicated by an Agency for Healthcare Research and Quality(AHRQ) score of 5 or lower,or a Newcastle-Ottawa Scale (NOS) score less than 3. The subjects included in the study included adults and children, and the diagnostic criteria for obesity were used at different ages. In this study, obesity was defined as having a body mass index(BMI) of 25 kg/m2 or higher in adults and being above the 85th percentile of BMI for age in children. We used obesity as an outcome measure for meta-analysis using RevMan, version 5.3.

RESULTS

A meta-analysis was conducted on a total of 17 clinical studies, which involved 5329 patients with epilepsy and 480837 healthy controls. These studies were selected from a pool of 1497 articles obtained from four electronic databases mentioned earlier. Duplicate studies were removed based on the search strategies employed. No significant heterogeneity was observed in the outcome measure of obesity in epileptic patients compared with healthy controls(p = 0.01,I2 = 49%). Therefore, a fixed effects model was utilized in this study. The findings revealed a significant difference in obesity prevalence between patients with epilepsy and healthy controls(OR = 1.28, 95%CI: 1.20-1.38, p<0.01).

CONCLUSION

The results of this meta-analysis indicate that epilepsy patients are more prone to obesity than healthy people, so we need to pay attention to the problem of post-epilepsy obesity clinically. Currently, there is a scarcity of largescale prospective studies. Additional clinical investigations are warranted to delve deeper into whether obesity is a comorbidity of epilepsy and whether obesity can potentially trigger epilepsy.

Trends in underweight and severe underweight disparities in Korean adults and older adults: a nationwide, repeated cross-sectional study

OBJECTIVES

Little is known about the disparities in underweight prevalence among the general population in high-income countries. We investigated the trends in underweight prevalence and disparities across sociodemographic groups among Korean adults and older adults.

SETTING AND PARTICIPANTS

A series of cross-sectional data on Korean national health checkups for adults aged ≥20 years were analyzed from 2005 to 2016.

MEASUREMENTS

Based on body mass index (kg/m2), underweight was graded as mild (17.0-18.49), moderate (16.0-16.9), and severe (<16.0). Underweight prevalence was compared across sociodemographic subgroups in 2015-2016. Trends in underweight disparities were examined from 2005-2006 to 2015-2016. Multivariable-adjusted odds ratios (ORs; 95% confidence intervals, CIs) were calculated using logistic regression.

RESULTS

Approximately 11-22 million adults were included in each wave. In 2015-2016, the overall prevalence of underweight was 3.6% (men 2.0%, women 5.2%); severe underweight was 0.2% (men 0.1%, women 0.3%). The prevalence of underweight varied by sex and age groups. In men, those aged ≥80 years had the highest prevalence (overall 7.33%, severe underweight 0.84%). In women, those aged 20-29 years had the highest prevalence of overall underweight (14.57%), whereas those aged ≥80 years had the highest prevalence of severe underweight (1.38%). Compared with individuals in the lowest income quartile, men in the highest income had lower ORs of overall (0.59, 95% CI 0.59-0.60) and severe underweight (0.46, 95% CI 0.44-0.48); women in the highest income quartile had a higher OR of overall (1.12, 95% CI 1.12-1.13) but a lower OR of severe underweight (0.89, 95% CI 0.86-0.92). From 2005-2006 to 2015-2016, severe underweight consistently declined in older men but remained constant in women aged ≥80 years, widening sex disparities among older adults. Severe underweight decreased or leveled off in the highest income quartile but steadily increased in the lowest quartile, worsening income disparities.

CONCLUSION

In this nationwide study, underweight was more prevalent among women, older adults aged ≥80 years, and low-income individuals. Disparities in severe underweight widened across sociodemographic subgroups over time.

Widening disparities in the national prevalence of diabetes mellitus for people with disabilities in South Korea

OBJECTIVES

In Korea, diabetes mellitus has a high disease burden, based on disability-adjusted life years. However, the disease burden is disproportionately distributed, with people with disabilities (PWD) experiencing higher rates of health disparities. Our study investigated long-term trends in diabetes prevalence and risk according to disability status, grade, and type.

STUDY DESIGN

Retrospective cohort study.

METHODS

Approximately 10 million individuals aged ≥30 years were included yearly from the National Health Information Database (NHID) and national disability registration data in Korea between 2008 and 2017, corresponding to 40 % of those aged ≥30 years in Korea. In 2017, 12, 975, 757 individuals were included; 5.5 % had disabilities. We estimated annual diabetes age-standardized prevalence and used multiple logistic regression analyses to estimate the odds of having diabetes in 2017, according to disability status, severity, and type.

RESULTS

Diabetes age-standardized prevalence consistently increased over 2008-2017 in PWD and people without disabilities. However, the prevalence increased more rapidly and was higher in all years among PWD, with widening disparities based on disability status. Additionally, diabetes prevalence was high in all years for specific subgroups, including women, individuals with intellectual or mental disabilities or autism, and individuals with severe disabilities, suggesting further disparities among PWD.

CONCLUSIONS

Our findings reveal health disparities between those with and without disabilities and among PWD subgroups. In addition to timely prevention, diabetes screening and management among PWD is vital. Public investment in improving disparities in the root causes of diabetes is essential, including health behaviours, healthcare utilization, and self-care.

Increased Risk of New-Onset Asthma After COVID-19: A Nationwide Population-Based Cohort Study

BACKGROUND

Previous studies have suggested that respiratory virus infections may be associated with new-onset asthma. However, whether coronavirus disease 2019 (COVID-19) is associated with an increased risk of new-onset asthma remains unclear.

OBJECTIVE

We aimed to evaluate whether recent COVID-19 increases the risk of new-onset asthma and whether COVID-19 vaccination could mitigate this risk.

METHODS

We constructed 3 different study designs using the Korean National Health Insurance claim-based database: study 1: COVID-19-diagnosed subjects (COVID-19 cohort) and their matched controls; study 2: COVID-19-vaccinated subjects (vaccination cohort) and their matched controls; and study 3: vaccination cohort and their matched controls, excluding subjects diagnosed with COVID-19.

RESULTS

In study 1, 1.6% of the COVID-19 cohort and 0.7% of the matched cohort developed new-onset asthma, with incidences of 31.28 and 14.55 per 1,000 person-years, respectively (P < .001). The COVID-19 cohort had a higher risk of new-onset asthma (adjusted hazard ratio [aHR] 2.14; 95% CI 1.88-2.45) than matched controls. In study 2, the vaccination cohort had a lower risk of new-onset asthma than the matched controls (aHR 0.82; 95% CI 0.76-0.89). However, among subjects without a COVID-19 diagnosis, COVID-19 vaccination was not associated with a reduced risk of new-onset asthma in study 3 (aHR 0.95; 95% CI 0.87-1.04). In subgroup analysis, the risk of new-onset asthma was significantly lower in fully vaccinated subjects and higher in older subjects and in those with diabetes mellitus than in their counterparts.

CONCLUSIONS

The COVID-19 was associated with a higher incidence of new-onset asthma, which might be preventable by COVID-19 vaccination.

Regional-level Indicators for Chronic Diseases of People with Disabilities: Findings from a Modified Delphi Study

Maintaining health cannot be achieved individually; it is influenced by social, legal, and institutional factors surrounding the individuals. This study aimed to identify regional-level factors that may influence the occurrence of chronic diseases among people with disabilities. To achieve this, we conducted a Delphi survey with experts to identify a set of regional indicators required for studying the health status of people with disabilities, particularly for predicting the occurrence of chronic diseases. Through the process of the Delphi survey, 24 indicators were finally selected. The major categories of the indicators were demographic factors (4 indicators), health behaviors (6 indicators), healthcare resources and utilization (11 indicators), and local community policies (3 indicators). Each category and subcategory of indicators plays a crucial role in understanding and improving the health and well-being of people with disabilities at the regional level. By addressing these factors comprehensively, policymakers and healthcare providers can develop more effective and targeted interventions, ultimately fostering a more inclusive and supportive environment for people with disabilities. The findings underscore the importance of a holistic approach to health assessment and the need for continued monitoring and evaluation to inform policy and practice.

Socioeconomic Disparities in the Association Between All-Cause Mortality and Health Check-Up Participation Among Healthy Middle-Aged Workers: A Nationwide Study

BACKGROUND

This study assessed the relationship between non-participation in health check-ups and all-cause mortality and morbidity, considering socioeconomic status.

METHODS

Healthy, middle-aged (35-54 years) working individuals who maintained either self-employed or employee status from 2006-2010 were recruited in this retrospective cohort study from the National Health Insurance Service in Korea. Health check-up participation was calculated as the sum of the number of health check-ups in 2007-2008 and 2009-2010. Adjusted hazard ratio (HR) and 95% confidence interval (CI) of all-cause mortality were estimated for each gender using multivariable Cox proportional hazard models, adjusting for age, income, residential area, and employment status. Interaction of non-participation in health check-ups and employment status on the risk of all-cause mortality was further analyzed.

RESULTS

Among 4,267,243 individuals with a median 12-year follow-up (median age, 44; men, 74.43%), 89,030 (2.09%) died. The proportion (number) of deaths of individuals with no, one-time, and two-time participation in health check-ups was 3.53% (n = 47,496), 1.66% (n = 13,835), and 1.33% (n = 27,699), respectively. The association between health check-up participation and all-cause mortality showed a reverse J-shaped curve with the highest adjusted HR (95% CI) of 1.575 (1.541-1.611) and 1.718 (1.628-1.813) for men and women who did not attend any health check-ups, respectively. According to the interaction analysis, both genders showed significant additive and multiplicative interaction, with more pronounced additive interaction among women who did not attend health check-ups (relative excess risk due to interaction, 1.014 [0.871-1.158]).

CONCLUSION

Our study highlights the significant reverse J-shaped association between health check-up participation and all-cause mortality. A pronounced association was found among self-employed individuals, regardless of gender.

Early-onset stroke among people with disabilities: a national database study in South Korea from 2008 to 2017

Background

This study investigated 10-year trend in the incidence and prevalence of ischemic, hemorrhagic, and overall strokes according to the severity and type of disability between people with and without disabilities.

Methods

This serial cross-sectional analysis was conducted using national health information data during a 10-year period from 2008 to 2017. Age-standardized incidence and prevalence were analyzed for each year, according to the presence, severity, and type of disability. The odds ratio (OR) of stroke was examined using multivariable logistic regression after adjusting for socio-demographic and clinical variables collected in 2017.

Findings

In total, 413,398,084 people were enrolled between 2008 and 2017. In 2017, 43,552,192 people aged 19 or older were included and 5.8% was disabled. For 10 years, age-standardized incidence of ischemic and hemorrhagic stroke decreased significantly regardless of the presence of disability. However, age-standardized incidence of stroke in disabled were almost 2.5 times higher than the non-disabled in 2017. Stroke occurs 20 years earlier in people with disabilities than in those without disabilities. In 2017, people with disabilities had higher odds of stroke compared to those without disability (OR = 4.11, 95% confidence interval [CI]: 4.06-4.16), particularly among those with severe disabilities (OR = 4.75, 95% CI: 4.67-4.84). People with major internal organ impairment showed the highest incidence of stroke (OR = 5.95, 95% CI: 5.73-6.17). The main risk factors for stroke presented in this study were disability factors, chronic diseases, and advanced age.

Interpretation

People with disabilities are at a greater risk of developing stroke incidence. Developing a public health policy and identifying the risk factors for stroke in people with disabilities would be beneficial.

Funding

This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Ministry of Education (No. 2022R1I1A3070074).

Growing disparity in the prevalence of chronic obstructive pulmonary disease between people with and without disabilities: a Korean nationwide serial cross-sectional study

Few studies have examined the association between disability and chronic obstructive pulmonary disease (COPD). We compared the trends in the annual COPD prevalence between people with and without disabilities, and examined the association between disability and COPD. We linked the National Health Information Database (2008-2017) with the National Disability Registration Database, which includes more than 2 million people with disabilities every year. In the 2017 dataset, people with disabilities had a higher prevalence of COPD than those without disabilities (30.6% vs. 12.5%, P < 0.001). The age-standardized prevalence rate of COPD among people without disabilities increased from 4.2 in 2008 to 10.9% in 2017 (change of 6.7%), whereas that among those with disabilities increased from 7.0 to 17.1% (change of 10.1%). In multivariate analysis, compared to people without disabilities, those with disabilities had a higher probability of having COPD (adjusted odds ratio, 1.42; 95% confidence interval 1.42-1.43). The results of subgroup analysis by disability characteristics suggested that disabilities due to failure of an organ, such as the kidney, lung, heart, or liver, and severe disabilities were particularly vulnerable to COPD. In conclusion, people with disabilities are more likely to have COPD compared to people without disabilities. Further longitudinal studies that examine cause-and-effect relationship between disability and COPD are needed to clarify this relationship and to further investigate any potential negative effects associated with the coexistence of these conditions.

The Korea National Disability Registration System

The Korea National Disability Registration System (KNDRS) was established in 1989 to provide social welfare benefits based on predefined criteria for disability registration and an objective medical assessment using a disability grading system. Disability registration requires (1) a medical examination by a qualified specialist physician and (2) a medical advisory meeting to review the degree of disability. Medical institutions and specialists for the diagnosis of disabilities are legally stipulated, and medical records for a specified period are required to support the diagnosis. The number of disability types has gradually expanded, and 15 disability types have been legally defined. As of 2021, 2.645 million people were registered as disabled, accounting for approximately 5.1% of the total population. Among the 15 disability types, disabilities of the extremities account for the largest proportion (45.1%). Previous studies have investigated the epidemiology of disabilities using data from the KNDRS, combined predominantly with data from the National Health Insurance Research Database (NHIRD). Korea has a mandatory public health insurance system that covers the entire Korean population, and the National Health Insurance Services manages all eligibility information, including disability types and severity ratings. In short, the KNDRS-NHIRD is a significant data resource for research on the epidemiology of disabilities.

Fact Sheet of Amputee 10-Year Trends in Korea: From 2011 to 2020

This fact sheet was used to analyze the trends in the number of amputees within the population and changes in their health-related behaviors since 2011. Data from the National Survey of Disabled Persons in Korea from 2011 to 2020 were used in this study. The cases of amputation among people with disabilities have increased. Although there were more upper extremity amputations than lower extremity amputations, as amputations below the wrist account for a greater proportion in South Korea than in other countries, the number of upper extremity amputations decreased and lower extremity amputations increased. The most common cause of amputation is accidents, followed by diseases and congenital anomalies. The majority of the amputees were male; however, the number of females showed a gradual increase, and the average age also increased. The proportion of amputated patients with chronic diseases, such as diabetes and hypertension, is increasing, and medical services are relatively limited. In this review study, through the 10-year trend change in the prevalence of amputee, it was possible to infer the impact of personal, social, and environmental changes. Based on these amputee statistics, it is expected that they can be used to plan health and medical policies for the disabled.