Gender Differences in Relations of Smoking Status, Depression, and Suicidality in Korea: Findings from the Korea National Health and Nutrition Examination Survey 2008-2012

Associations of Alcohol Consumption and Smoking Behaviors with Depressed Mood According to Gender in Korean Young Adults

BACKGROUND

Recent studies have reported that chronic mental health problems often emerge in young adulthood. This study elucidated the independent effects of smoking and drinking on depressed mood in young adults by sex.

METHODS

We used Data from the Korea National Health and Nutrition Examination Surveys conducted in 2014, 2016, and 2018. A total of 3,391 participants aged 19-35 years, without serious chronic diseases, were recruited for this study. Depression was evaluated using the Patient Health Questionnaire (PHQ-9).

RESULTS

Smoking behavior, current smoking, and number of days smoked were significantly associated with higher PHQ-9 scores in both men and women (all P<0.05). However, past and ever smoking were positively associated with PHQ-9 scores only in women (all P<0.001). Regarding alcohol consumption, the age at which drinking first began was negatively associated with PHQ-9 scores in both men and women (all P<0.001), but the amount of alcohol consumed at 1 time was positively associated with PHQ-9 scores only in women (P=0.013). Men who drank 2-4 times a month and women who had not drunk during the past year had the lowest PHQ-9 scores.

CONCLUSION

Smoking and alcohol consumption were independently associated with depressed mood in young Korean adults, which was more pronounced in women, and exhibited sex-specific characteristics.

A retrospective analysis of substance use among female psychiatric patients in Saudi Arabia

Objective

This study investigated the prevalence of substance use (SU), and its risk factors, among women attending psychiatric outpatients center in Saudi Arabia.

Design

A retrospective cross-sectional design.

Materials and methods

We reviewed outpatients' records of 200 female patients with a history of SU from a psychiatric unit in Jeddah, Saudi Arabia from December 2018 to February 2019. The researchers developed the pro forma, and 2 psychiatrists and a family medicine physician validated the form.

Results

The most common and widely used were psychoactive substances (58%), followed by central nervous system (CNS) depressants (22%), and finally cannabinols (9.5%). Overall, the highest substance use was the amphetamine-cannabis-nicotine (ACN) representing nearly half of the illicit items (46.6%), followed by heroine-alcohol-benzodiazepine (16.4%), and with the lowest being benzodiazepine-nicotine (1.7%). There was a significant difference between the single substance and multiple substance use in terms of age (p = 0.001), smoking behavior (p = 0.001), patients past history (p = 0.005), and age of the patient at the start of drug use (p = 0.005).

Conclusion

Although the prevalence of substance use among women is low in Saudi Arabia, screening of substance use disorders risks and building a rehabilitation program to control drug dependence are needed.

Use of electronic vaping products and mental health among adolescent high school students in the United States: The moderating effect of sex

Although studies have investigated the association between conventional tobacco smoking and mental health outcomes among adolescents in the United States, few studies have examined the association between electronic vaping products (EVPs) and mental health among adolescents. This study aimed to investigate the cross-sectional association between EVPs use, symptoms of depression, and suicidal behaviors among adolescents. Data were pooled from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 14,285 adolescents (50.3% female) was analyzed using binary logistic regression. The outcome variables investigated were symptoms of depression, suicidal ideation, suicide plan, and suicide attempts, and the main explanatory variable was EVPs use. Of the 14,285 adolescents, 22.2%, 19.2%, and 58.8% were current, former and never users of EVPs, respectively. Controlling for other factors, current users of EVPs were significantly more likely to report having symptoms of depression (AOR = 1.82, 95% CI = 1.58-2.09), having suicidal ideation (AOR = 1.55, 95% CI = 1.30-1.86), making a suicide plan (AOR = 1.62, 95% CI = 1.34-1.97), or attempting suicide (AOR = 1.75, 95% CI = 1.41-2.18) when compared to never users of EVPs. Gender moderated the association between EVPs use, symptoms of depression, suicidal ideation, and suicide plan. Racial minority identity, sexual minority identity, sexual violence victimization, victim of school and cyberbullying, alcohol use, and cigarette smoking were all significantly associated with depression and suicidal behaviors. Study findings support the association between EVPs use and adolescent mental health. Future studies that employ longitudinal designs may offer more insight into the mechanisms underlying this association.

The relationship between lifestyle risk factors and depression in Korean older adults: a moderating effect of gender

Background

Little is known regarding the role of gender as a possible modulator in determining the associations between lifestyle risk factors and depression in older adults.

Objectives

This study examined whether gender modulates the relationship between depression and lifestyle risk factors in Korean adults aged 65 years and older (n = 3700).

Methods

Data were obtained from the 2016 and 2018 Korea National Health and Examination Survey. The primary outcome was depression, assessed with the patient health questionnaire-9. As exposures, smoking habits, at-risk alcohol consumption, and physical inactivity were assessed with a standardized questionnaire. In addition, mean adequacy ratio (MAR) as an indicator of overall nutritional inadequacy was assessed with dietary intakes of macro- and micronutrients.

Results

In men only, either two or three and more risk factors were significantly associated with higher depression risk (OR (95% confidence interval, CI) = 2.886 (1.003–8.299) and OR (95% CI) = 3.109 (1.064–9.097), respectively). In women only, either two or three and more risk factors were also significantly associated with higher depression risk (OR (95% CI) = 1.505 (1.067–2.124) and OR (95% CI) = 2.828 (1.527–5.239), respectively). In particular, the presence of smoking habits and MAR were the major determinants of depression (OR (95% CI) = 1.835 (1.09–3.10) and OR (95% CI) = 1.585 (1.125–2.233), respectively) in women only. Finally, a moderation analysis with the Hayes PROCESS Macro showed a significant moderating effect of gender (β (95% CI) = 0.633 (0.206 ~ 1.060)) on the relationship between risk factors and depression. In addition, the slope of the relationship was much steeper in women than in men.

Conclusion

Current findings suggest that lifestyle risk factors are more closely associated with depression risk in women than in men.

Effect of parental smoking on their children's urine cotinine level in Korea: A population-based study

BACKGROUND

Children may be exposed to tobacco products in multiple ways if their parents smoke. The risks of exposure to secondhand smoke (SHS) are well known. This study aimed to investigate the association between parental smoking and the children's cotinine level in relation to restricting home smoking, in Korea.

METHODS

Using the Korea National Health and Nutrition Health Examination Survey data from 2014 to 2017, we analyzed urine cotinine data of parents and their non-smoking children (n = 1,403), in whose homes parents prohibited smoking. We performed linear regression analysis by adjusting age, sex, house type, and household income to determine if parent smoking was related to the urine cotinine concentration of their children. In addition, analysis of covariance and Tukey's post-hoc tests were performed according to parent smoking pattern.

FINDING

Children's urine cotinine concentrations were positively associated with those of their parents. Children of smoking parents had a significantly higher urine cotinine concentration than that in the group where both parents are non-smokers (diff = 0.933, P < .0001); mothers-only smoker group (diff = 0.511, P = 0.042); and fathers-only smoker group (diff = 0.712, P < .0001). In the fathers-only smoker group, the urine cotinine concentration was significantly higher than that in the group where both parents were non-smoker (diff = 0.221, P < .0001), but not significantly different compared to the mothers-only smoker group (diff = - -0.201, P = 0.388). Children living in apartments were more likely to be exposed to smoking substances.

CONCLUSION

This study showed a correlation between parents' and children's urine cotinine concentrations, supporting the occurrence of home smoking exposure due to the parents' smoking habit in Korea. Although avoiding indoor home smoking can decrease the children's exposure to tobacco, there is a need to identify other ways of smoking exposure and ensure appropriate monitoring and enforcement of banning smoking in the home.

The prevalence of depression symptoms after smoking cessation: a systematic review and meta-analysis

Objectives: Smoking cessation can have positive effects on people's health, especially mental health. This study aimed to address the prevalence of depression in the smoking cessation population. Methods: In the present meta-analysis study, PRISMA protocol was used. Two databases, PubMed and Scopus, were selected. Articles in these two databases in English were targeted and the search was limited to July 2020. First, the results related to the prevalence of depression were calculated. The results were pooled. Results: Forty-nine articles with different designs were eligible for meta-analysis. The prevalence of depression in the smoking cessation population was 18% and the confidence interval was 14-22%. The highest depression prevalence was in Asia and Europe, followed by America. The prevalence of major depression in the smoking cessation population was 15% and the prevalence of depressive symptoms was 17%. The smoking cessation population had a lower odds of depression than current smokers (OR= 0.63 CI = 0.54-0.75; I2 83.9%). There was little evidence for publication bias. Discussion: The status of depression in the smoking cessation population is different from that of nonsmokers and current smokers. Therefore, in terms of health policy and encouraging people to smoking cessation, the issue of its positive effects on mental health should be emphasized.

Factors associated with poor sleep quality in the Korean general population: Providing information from the Korean version of the Pittsburgh Sleep Quality Index

BACKGROUND

Recently, studies have been conducted to address the research gap in the understanding of poor-quality sleep and its relationship to health outcomes, through the evaluation of sleep quality. The aim of this study was to provide information regarding poor sleep quality based on a nationwide general population sample in Korea.

METHODS

We conducted a cross-sectional study using data from a nationwide sample of 165,193 individuals (males: 44%) aged 19 years or older from the 2018 Korea Community Health Survey. The age range of the participants was 19-107 years (mean: 55.3 ± 17.5). The Korean version of the Pittsburgh Sleep Quality Index (PSQI) was used for assessing sleep quality. Poor sleep quality was defined as a total PSQI score of >5.

RESULTS

The overall prevalence of poor sleepers was 41.0% (males: 35.6%; females: 46.2%). Poor sociodemographic status (illiteracy, low income, and unemployment), poor health behaviors (smoking, high-risk drinking, diabetes, hypertension, non-participation in walking, and obesity), and poor mental health (perceived poor health status, stress, depressive symptoms, and subjective cognitive decline) were all associated with poor sleep quality in both males and females.

LIMITATIONS

As this study relies on self-reported and cross-sectional data, causal inferences cannot be made.

CONCLUSIONS

Poor sleep quality is highly prevalent in females. In addition, poor socio-demographic status, poor health behaviors, and poor mental health were associated with poor sleep quality. The mechanisms underlying sex differences in sleep quality remain to be elucidated, and further studies are required to address this.

Association between Occupational Noise and Vibration Exposure and Insomnia among Workers in Korea

Background: The effect of noise and vibration exposure on disturbed sleep has been investigated in the past. However, this study was carried out to investigate the relationship between workplace noise and vibration exposure with insomnia amongst representative Korean workers, both simultaneously and separately. Methods: Our research analyzed an overall population of 30,837 workers aged 15 years or older using data derived from the 5th Korean Working Conditions Survey (KWCS) conducted in 2017. Chi-squared tests and logistic regression were performed to investigate baseline characteristics and to quantify the association between workplace exposure to noise and vibration with insomnia. Relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S) were calculated to measure interactions between simultaneous noise and vibration exposure with insomnia. Results: The prevalence of those who reported insomnia was 18.3% of the general population. Among men and women, insomnia in those who were exposed to noise only was 13.9% and 18.3%, respectively, and in those who were exposed to vibration only, it was 23.9% in males and 26.4% in females. Insomnia in those who were exposed to both noise and vibration simultaneously was 20.5% and 41.2% in men and women, respectively. The odds ratio (OR) of insomnia due to noise exposure was 1.10 and 1.07 in men and women, respectively. OR of vibration exposure was 1.84 in men and 1.58 in women. For noise plus vibration exposure OR was 1.83 in men and 3.14 in female workers, where the synergistic effect of noise and vibration exposure could be seen. The association between the varying degree of simultaneous noise plus vibration exposure with insomnia showed a dose–response relationship. The interaction measures showed a synergistic effect of simultaneous exposure in women but not in men. Conclusion: Our study revealed an association between occupational noise and vibration exposure and insomnia, both individually and simultaneously. Additional studies and research are required to further comprehend this relationship.

Gender Differences in Harmful Use of Alcohol Among Korean Adults

Objectives

Harmful alcohol consumption is associated with considerable social and economic damage to individuals and society. Because gender and ethnic background influence alcohol intake differently, examining gender specific factors influencing harmful drinking is necessary. This study investigated gender differences in alcohol consumption, harmful drinking, and the associated factors among Korean adults.

Methods

We analyzed the data from the 2012–2015 Korean National Health and Nutrition Examination Survey. Data from survey participants aged 20–64 years (N = 18,581) were included. The Alcohol Use Disorders Identification Test was used for alcohol dependence, and pooled weights were used. Chi-squared tests and multiple logistic regression analyses were conducted.

Results

The prevalence of harmful alcohol use (Alcohol Use Disorders Identification Test score ≥ 16) was 10.7% in the total sample; 18.4% in men and 3.4% in women, which constituted a significant difference. Education, marital status, smoking, perceived stress, and depressive feeling were associated with harmful drinking in both genders. However, household income, occupation, and perceived health status were associated with harmful drinking only in men.

Conclusion

Since there are gender differences in harmful drinking and alcohol dependence, gender tailored prevention and intervention strategies for alcohol dependence are necessary including consideration of smoking, stress, and depressive feeling.

The Relationship between Electronic Cigarette Use with or without Cigarette Smoking and Alcohol Use among Adolescents: Finding from the 11th Korea Youth Risk Behavior Web-based Survey

BACKGROUND

Electronic cigarette (EC) consumption ('vaping') is rapidly increasing, not only in adults but also in adolescents. Little is known about the association between vaping and problem behaviors such as drinking.

METHODS

We used data from the 11th Korea Youth Risk Behavior Web-based Survey, which was conducted in 2015 and included 68,043 participants who were Korean middle and high school students. The survey assessed EC, cigarette, and alcohol use. Multiple regression analysis was used to examine risk of current drinking and problem drinking across the following categories of users: never user (never used either product), former user (use of EC or cigarettes in the past, but not currently), vaping only, smoking only, and dual user (current use of both products).

RESULTS

EC only users were 1.2% in males, and 0.3% in females. Dual user of both conventional cigarettes and ECs were 5.1% in males, and 1.2% in females. Drinking frequency, drinking quantity per once, and problem drinking were higher among vapers than non-vapers and former-vapers, moreover, were higher among daily vapers than intermittent vapers. Compared to never users, EC only users were higher on risk of current drink and problem drink. The dual users were highest on risk of current drink.

CONCLUSION

Vaping is independently associated with alcohol use problems in Korean students, even those not currently smoking. Moreover, dual use of cigarettes and ECs is strongly associated with alcohol use problems. Therefore, vaping students should be concerned about their hidden alcohol use problems.

Shared and unique risk factors for depression and diabetes mellitus in a longitudinal study, implications for prevention: an analysis of a longitudinal population sample aged ⩾45 years

OBJECTIVE

The objective of this study was to examine shared and unique risk factors for incident depression and diabetes mellitus in a national longitudinal population-based survey.

METHODS

Canadian National Population Health Survey (NPHS) longitudinal study was used. A subsample of the initial NPHS sample (n = 4845), free of depression or diabetes mellitus at baseline was tracked over a 10-year period. Univariate and multivariate modified Poisson regression models were used to estimate the relative risk (RR). Stratified analyses by sex were conducted to measure its moderating role. The goodness-of-fit of the various models was tested.

RESULTS

The cumulative incidence rate of major depressive disorder and incident diabetes mellitus at 10-year follow-up were 4.1% and 10.1% respectively. Hypertension, daily smoking, physical inactivity and being overweight or obese were shared risk factors for major depressive episode and diabetes mellitus. Being female, family stress, traumatic events, having any chronic disease or heart disease were uniquely associated with depression while increasing age and ethnicity (non-white) were unique risk factors for diabetes mellitus. Also, underweight, family stress, chronic disease, and heart disease were risk factors for major depressive disorder in both sexes. Six risk factors, age, ethnicity (non-white), high blood pressure, daily smoking, physical inactivity, and body mass index were associated with incident diabetes mellitus in both sexes.

CONCLUSION

We found common risk behaviors/conditions not specific to either diabetes mellitus or depression. These risks have also been implicated in the development of a variety of chronic diseases. These findings underline the importance of public health prevention programs targeting generic risk behaviors.

Smoking among adults with serious psychological distress: Analysis of anonymized data from a national cross-sectional survey in Japan

BACKGROUND

Smoking behavior among people with serious psychological distress (SPD) has not been fully investigated in Asia, although smoking has become a public health concern worldwide. Many Western population-based studies indicate that people with psychological distress are more likely to smoke.

METHODS

This study used a national representative data set from the 2010 Comprehensive Survey of Living Conditions of Japan. SPD was defined as scores ≥13 or greater on the Kessler Psychological Distress Scale (K6). Multivariate logistic regression analyses were conducted to analyze the association between SPD and current smoking in Japanese adults.

RESULTS

In both men (n = 27,937) and women (n = 30,786), SPD was significantly associated with current smoking (adjusted odds ratios [95% confidence intervals]: 1.169 [1.030-1.328] for men and 1.677 [1.457-1.931] for women). Among men, SPD was significantly associated with current smoking only in people aged ≥50 years (1.519 [1.232-1.874]) and married (1.456 [1.228-1.728]). SPD was significantly associated with current smoking in women of all ages. SPD had a greater impact on current smoking for women aged 20-49 years than for those aged ≥50 years (1.832 [1.552-2.162] and 1.445 [1.099-1.900], respectively).

LIMITATIONS

The cross-sectional design precludes assumptions about the direction of causality. In addition, smoking status was self-reported.

CONCLUSIONS

SPD was significantly associated with current smoking in Japan and the association was much stronger for younger women. Clinical strategies are needed to reduce the prevalence of smoking among people with SPD to reduce excess mortality in this population.

Use patterns of over-the-counter (OTC) medications and perspectives on OTC medications among Korean adult patients with chronic diseases: gender and age differences

BACKGROUND

A number of symptomatic patients tend to use over-the-counter (OTC) medications and prescription medications. OTC medications can be easily obtained in pharmacies for self-treatment, but using OTC medications is not always safe and beneficial for patients. The aims of this study were to examine the use patterns of OTC medications and assess patients' perspectives regarding the use of OTC medications in Korean patients with chronic diseases.

PATIENTS AND METHODS

A descriptive, cross-sectional survey was carried out with Korean patients who visited the community pharmacy, located at the southern region of South Korea, during September 2015.

RESULTS

A total of 345 patients participated in this survey. Approximately 64% of Korean survey respondents reported that they had used OTC drugs. The most commonly used OTC medications were antipyretics, analgesics and anti-inflammatory drugs. The perception level of Korean consumers on adverse drug reactions and drug-drug interactions from OTC medications was relatively low. Although OTC package leaflets are a main source of information about OTC medications, Korean consumers' level of reading OTC package leaflets was relatively low.

CONCLUSION

Based on these results, this study can serve as a meaningful starting point for interventions of health care professionals regarding OTC medications in South Korea. In particular, pharmacists should inform their consumers of drug-related problems from OTC drugs during consultation with the consumers; however, information about OTC drugs should be tailored to consumer information needs with the consideration of his or her circumstance. It is somewhat difficult to generalize the results from this study to other regions of South Korea since most of the respondents were probably residents of a small rural city located in the southern region of South Korea.

Characteristics of hardcore smokers in South Korea from 2007 to 2013

Background

As the prevalence of smoking decreased in western countries, a significant proportion of smokers appeared to be particularly resistant to quitting- “hardcore” smokers. This study examines the characteristics of hardcore smokers in South Korea.

Methods

We used the data from 2007 to 2013 from the Korea National Health and Nutrition Examination Survey. Hardcore smoking was defined as (1) smoking >15 cigarettes per day, (2) having no plans of quitting, and (3) having made no attempts to quit. Multiple logistic regression analyses were used to investigate the association between various sociodemographic variables and hardcore smoking.

Results

The proportion of hardcore smokers among smokers did not change significantly from 23.1% in 2007 to 23.0% in 2013. None of the three characteristics of hardcore smokers for either gender showed a significant change from 2007 to 2013. Multiple logistic regression analysis showed that hardcore smokers were 1.64 times (95% confidence interval [CI], 1.28–2.11) greater among those aging 40–49 years than among those aging 19–29 years, and four times greater among men than women. Never-married smokers were less likely to be hardcore smokers than married ones (odds ratio 0.79; 95% CI, 0.66–0.96). Household income and education level did not have any significant association with the likelihood of a hardcore smoker.

Conclusions

Hardcore smoking was more prevalent among men, unmarried men and those aging 40–49 years.

Sex-based Association between Depression and Metabolic Syndrome in Korean Middle-aged and Older Adults

OBJECTIVES

This study aimed to identify the sex-based association between depression and the development of metabolic syndrome (Mets) among middle-aged and older Korean adults.

METHODS

A cross-sectional design was used for the secondary analysis of the 2010-2014 Korean National Health and Nutrition Examination Survey. Data from 1,938 men and 2,404 women were analyzed. Mets was defined in accordance with the criteria used for clinical diagnosis. Depression was assessed with a question about having clinical depression. The association between depression and the development of Mets with or without adjustment for covariates was identified by conducting logistic regression analysis on weighted data using a complex sample procedure.

RESULTS

More women than men had depression. Before covariate adjustment, depression was significantly associated with the development of Mets among women (odds ratio [OR], 1.586; 95% confidence interval [CI], 1.152-2.183) and with a higher triglyceride level among men (OR, 1.679; 95% CI, 1.001-2.818). After covariate adjustment; depression was significantly associated with higher waist circumference among women (adjusted OR [AOR], 1.532; 95% CI, 1.046-2.245) and higher triglyceride level (AOR, 1.511; 95% CI, 1.029-2.219) than was Mets. Conversely, depression did not have significant effects on the development of Mets among men.

CONCLUSION

Depression was associated with the development of Mets among middle-aged and older Korean women. Healthcare providers in communities should assess women with depression for the presence of Mets components. Interventions for relieving depressive symptoms should also be provided to women at risk for Mets.

Dietary vitamin C intake protects against COPD: the Korea National Health and Nutrition Examination Survey in 2012

BACKGROUND

Vitamin C, as an antioxidant, has recently been suggested to provide protection against COPD; however, only few national cohort studies have investigated these effects. We aimed to confirm the protective effects of vitamin C against COPD in Korean patients.

PATIENTS AND METHODS

We analyzed the data of 3,283 adults aged ≥40 years (representing 23,541,704 subjects) who underwent pulmonary function tests and responded to questionnaires on smoking history and vitamin C intake, with stratification variables and sampling weight designated by the Korea 2012 National Health and Nutrition Examination Survey.

RESULTS

Among all the subjects, 512 (representing 3,459,679 subjects; 15.6%) were diagnosed as having COPD based on pulmonary function test results. Male gender, old age, residence in suburban/rural regions, low household income, low educational level, an occupation in agriculture or fisheries, and heavy smoking were significantly associated with COPD. Low intake of nutrients, including potassium, vitamin A, carotene, retinol, and vitamin C, was significantly associated with COPD. The prevalence of COPD in heavy smokers with the lowest quartile (Q1, <48.50 mg; 63.0%) and low-middle quartile (Q2, 48.50-84.38 mg; 56.4%) of vitamin C intake was significantly higher than that in subjects with the high-middle quartile (Q3, 84.38-141.63 mg; 29.5%) and highest quartile (Q4, >141.63 mg; 32.6%) of vitamin C intake (P=0.015). In multivariate analysis, male gender, old age, heavy smoking, and a low intake of vitamin C were significant independent risk factors for COPD. A significant reduction of 76.7% in COPD risk was observed with a Q3 vitamin C intake compared to Q1 vitamin C intake (odds ratio, 0.233; 95% confidence interval, 0.094-0.576) in heavy smokers.

CONCLUSION

This large-scale national study suggests that dietary vitamin C provides protection against COPD, independent of smoking history, in the general Korean population.

The health-related quality of life of ankylosing spondylitis patients assessed by SF-36: a systematic review and meta-analysis

PURPOSE

The main purpose of this meta-analysis was to evaluate the impact of ankylosing spondylitis on the health-related quality of life assessed by the Medical Outcomes Short-Form-36 questionnaire (SF-36).

METHODS

A systematic literature search was performed on PubMed and Web of Science until January 22, 2016 to obtain eligible studies. Random effect model was performed to summarize the scores of each domain. The radar chart was used to compare the scores of AS patients with other health conditions. Spearman's correlation analysis and meta-regression were used to explore the related factors. STATA (version 11.0) and SPSS (version 13.0) were adopted in this meta-analysis.

RESULTS

Thirty-eight studies were included in this study, which were all reliable to summarize the scores of the SF-36. Pooled mean scores of the physical health domains ranged from 45.93 to 58.17, with the RP and PF domains being the lowest and the highest, respectively. Pooled mean scores of the mental health domains ranged from 47.49 to 62.52, with the VT and SF domains being the lowest and the highest, respectively. Besides, the physical component summary was lower than the mental component summary. BASDAI and BASFI were negatively associated with some domains of the SF-36 significantly. Patients with AS had a substantial impaired HRQoL in comparison with the general population.

CONCLUSIONS

AS could adversely affect the HRQoL of patients. Measuring HRQoL should be considered as an essential part of the overall assessment of health status of AS patients, which would provide valuable clues for improving the management of disease and making decisions regarding treatment.