Health Status Indicators Research Articles

The Increasing Salience of Health in Social Forces Research

Global life expectancy at birth approximately doubled during the 100-year history of Social Forces (Heuveline 2022; Riley 2005). As the average length of life of the individuals and their experiences in the communities and institutions studied in the journal increased, health became more salient to social and economic life. The increasing prominence of health, embodied by an individual’s continuing physical, emotional, mental, and social ability to cope with his or her environment over the life course, is reflected in the trend of health-related articles in Social Forces. A handful of health-related articles appeared during the decades from 1920 to 1960, followed by a small but steady flow of publications from 1970 to 2000, after which there has been more growth and diversity in health-related publications in the twentieth-first-century issues of Social Forces. The trend in health research within Social Forces has been driven by three factors: (1) the substantive relevance of health status, behavior, and healthcare (i) within societal structures and institutional contexts, (ii) in relation to social behavior, and (iii) as influenced by social stratification processes; (2) increasing availability of high-quality health data; and (3) increased attention to measurement of health. While much of the early health research published in Social Forces focused on mental health and mental health systems, over time as new surveys delivered a greater range of health measures, research soon included diverse measures of general health status, health behavior, and physical health indicators and change in them over time.

The changing bacteriological profile of neonatal sepsis in a tertiary care hospital – Emergence of Citrobacter septicemia

Neonatal Mortality Rate (NMR) is one of the indicators of health status of a nation and neonatal sepsis is one of the commonest causes of NMR contributing to 19% of all neonatal deaths in India. All over India, there is a gradually increasing trend of multi-drug resistant (MDR) pathogens in neonatal intensive care units (NICU) and special newborn care units (SNCUs) in tertiary care hospitals.To determine the changing trend in the bacteriological profile of neonatal septicemia and their antibiotic susceptibility pattern (AST).It is a retrospective study conducted on total 452 blood culture samples collected from SNCU over 1-year period from July 2017 to June 2018 in tertiary care government hospital. Organisms were identified by the standard protocol and their antimicrobial susceptibility testing was determined as per latest CLSI guidelines.out of 452 blood culture of neonatal septicemia patients, 138 cases (30.53%) were culture positive Most common isolated gram negative organism was spp. 55/138 (39.85%) followed by spp. 23/138 (16.66%). Most common isolated gram positive organism was 25/138 (18.11%) followed by Coagulase Negative Staphylococcus (CONS) (8.69%). Among gram negative isolates most sensitive antimicrobial was Imipenem (87.6%) followed by Levofloxacin (87.4%) and Piperacillin + Tazobactam (46%) and resistant to, Cotrimoxazole, Amoxicillin + clavulanate and 3rd generation Cephalosporins.spp. is the predominant organism of neonatal sepsis in the Indian subcontinent, although significant rise in proportion of spp. is occurring. High resistance to cephalosporins is a cause of concern, as they are one of the most common prescribed antibiotic groups.

Efficacy of CFTR modulators in clinical practice (6-month follow-up)

Pathogenetic therapy for the treatment of cystic fibrosis (CF) has been developed that modulates the CFTR protein and restores its activity as a chloride channel. This treatment is represented by CFTR modulators for various genotypes covering 85 - 90% of patients with CF.The aim was to analyze the efficacy of two targeted drugs in patients aged 6 - 18 years with CF in clinical practice during a 6-month follow-up.Methods. The study was conducted based on the analysis of the database “CF Patient Registry of the Russian Federation” for 2021 - 2022. The study included 178 patients receiving lumacaftor/ivacaftor and 158 patients receiving elexacaftor/tezacaftor/ivacaftor. Respiratory function indicators (FEV1, FVC), sweat test, and anthropometric data were analyzed.Results. In the group of children treated with lumacaftor/ivacaftor, Me (Q1 - Q3) body weight (kg) increased at 6-month follow-up from 40.0 (28.9 - 48.0) to 44.9 (29.3 - 50.8), p < 0.001, and the height (cm) increased from 156.0 (140.0 - 161.0) to 158.0 (143.0 - 162.0),p < 0.001. Me (Q1 - Q3) FEV1 improved from 63.5 (42.3 - 84.8) to 72.0 (56.9 - 82.4) %,p < 0.045. Sweat test (mmol/l) decreased Me (Q1 - Q3) from 115 (101.0 - 123.0) to 86.5 (79.0 - 103.0), p < 0.001. During therapy with elexacaftor/tezacaftor/ ivacaftor, Me (Q1 - Q3) body weight (kg) increased at 6-month follow-up from 44.4 (36.8 - 50.0) to 49.3 (44.1 - 51.9),p < 0.001, and Me (Q1 -Q3) height (cm) increased from 160.5 (152.3 - 165.1) to 163.0 (155.5 - 166.9),p < 0.001. Me (Q1 - Q3) FVC and FEV1 improved: FVC from 78.5 (60.9 - 91.0) to 90.5 (76.8 - 106.8) %,p < 0.001, FEV1 from 73.5 (60.5 - 82.1) to 95.0 (65.3 - 107.0) %,p < 0.001. Sweat test (mmol/l) decreased from 119 (108 - 126) to 75.5 (65.3 - 88);р < 0.001.Conclusion. Health status indicators of of children with CF aged 6 - 18 years were analyzed for 6 months of targeted therapy (lumacaftor/ivacaftor and elexacaftor/tezacaftor/ivacaftor). Positive changes were observed in weight, height, respiratory function, and sweat test.

Forecasting Infant Mortality Rate using Exponential Smoothing and Moving Averages Techniques

Infant Mortality Rates (IMR) are important indicators of health status of any country. This research presents Time Series Analysis using Exponential Smoothing and Moving Averages (MA). Six years data on infant mortality covering 2016 to 2021 was obtained from Yobe State Specialist Hospital Damaturu. We used Single Exponential Smoothing, which at =2, the model showed a smoothed trend of infant mortality over the period of 72 months. A forecast made based on this smoothed trend indicated a constant rate of infant mortality over the period of 8 months with MAPE = 17.9165, MAD = 4.5133 and MSD = 30.2982. We also studied nature of trend using Moving Averages (MA) and forecast made at length = 4 showed a constant rate of forecast over the period of 8 months with MAPE = 19.3504, MAD = 4.8377, and MSD = 34.1556. Based on the three accuracy measures, single exponential smoothing method presented a better fit to the data. Highest infant mortality was observed in 2021 with total death of 331 which represents 17.08% of the total deaths.

Cannabis use among cancer survivors in 22 states: Results from the Behavioral Risk Factor Surveillance System, 2020.

This study identified factors associated with recent cannabis use and cannabis use for medical purposes among cancer survivors relative to individuals without a history of cancer. Data from the Behavioral Risk Factor Surveillance System were analyzed for the 22 states completing the optional cannabis module in 2020. Weighted multiple logistic regression was performed to explore variables associated with past 30-day cannabis use and cannabis use for medical purposes, stratified by history of cancer. Covariates included state-level cannabis policy, sociodemographic characteristics, health status indicators, and substance use. Cannabis use was lower among cancer survivors compared to individuals with no history of cancer (7.57% vs. 10.83%). However, a higher proportion of cancer survivors reported use for medical purposes (82.23% vs. 62.58%). After adjusting for state-level policy, biological sex, age, educational attainment, self-reported race/ethnicity, home ownership, mental health status and physical health status, current smoking (odds ratio [OR], 5.14 vs. 3.74) and binge drinking (OR, 2.71 vs. 2.69) were associated with cannabis use in both groups. Characteristics associated with medical cannabis use varied for the two groups; however, daily use (20-30days; OR, 1.72 vs. 2.43) was associated with cannabis use for medical purposes in both groups after adjusting for other variables in the model. A high proportion of individuals report cannabis use for medical purposes with higher rates among cancer survivors. Findings support the urgent need for ongoing cannabis research to better understand and inform its use for medical purposes, as well as the development of high-quality standardized education materials and clinical practice guidelines.

Automated Computer Vision System for Urine Color Detection

Urine color analysis is one of the most helpful indicators of health status, and any changes in urine color might be a symptom of serious disease, dehydration of the body, or caused by drugs. To get better assistance for urine color detection in the proposed system, a urine color automatic identification has been developed based on computer vision. The proposed system uses a web camera to capture an image in real-time, analyze it, and then classify the color of urine by using the random forest (RF) algorithm and show the result via the Graphical User Interface (GUI). In addition, the proposed system can send the results to the mobile phone of the patient or care provider by using an Arduino microcontroller and GSM module. Moreover, sending a voice message about the color of urine is related to pathological conditions. The results showed that the proposed system has high accuracy (approximately about 97%) in detecting urine color under different light conditions, with low cost, short time, and easy implementation. In the comparison with the current methods the proposed system has maximum accuracy and minimum error rate. This methodology can pave the way for an additional case study in medical applications, particularly in diagnosis, and patient health monitoring.

A rapid review of patient-reported outcomes investigated in the context of advanced renal cell cancer or advanced hepatocellular cancer.

Patient-reported outcomes (PROs) are key indicators of health status and functioning, coming directly from the patient. Comprehensive monitoring of PROs enables implementation of person-centred care. Currently, the PROs that patients with advanced renal cell carcinoma (RCC) or hepatocellular carcinoma (HCC) consider of greatest importance remains unknown. A rapid literature review was carried out to identify PROs commonly reported in clinical studies of patients with advanced RCC/HCC. We searched MEDLINE, CINAHL & PsycInfo for relevant peer-reviewed publications in the period from 2000 to 2021. Pre-specified selection criteria were applied to all retrieved records. Findings were integrated into a narrative synthesis. Eighty-one studies met our selection criteria and were retained. Most research was on advanced RCC (n=64, 79%); 46 studies (57%) were drug trials. Only twenty-six studies (32%) employed PROs as their primary endpoint. Most PROs concerned physical symptoms (45% RCC, 54% HCC) and emotional wellbeing (19% RCC, 16% HCC). The most common outcome measured was quality of life (65% of the total), followed by fatigue (62%) and pain (54%). Whether selection of these PROs was patient-driven was not reported. A wide range of PROs were assessed. Deficits in PROs often cause patients to seek out help; however, which PROs matter the most to people with advanced RCC/HCC must be further clarified. Targeting, monitoring, and responding to the 'right' PROs can enhance provision of person-centred care in advanced RCC/HCC and augment the clinical efficacy of established and emerging targeted therapies.

Association between electronic device use and health status among a middle-aged and elderly population: a cross-sectional analysis in the UK Biobank.

Few previous studies have investigated the impact of multiple types of electronic devices on health status, and the moderating effects of gender, age, and BMI. Our aim is to examine the relationships between the use of four types of electronics and three health status indicators in a middle-aged and elderly population, and how these relationships varied by gender, age, and BMI. Using data from 376,806 participants aged 40-69 years in the UK Biobank, we conducted a multivariate linear regression to estimate the association between electronic device use and health status. Electronics use was categorized as TV watching, computer use, computer gaming, and mobile phone use, and health status included self-rated health (SRH), multisite chronic pain (MCP), and total physical activity (TPA). Interaction terms were utilized to assess whether the above associations were modified by BMI, gender, and age. Further stratified analysis was performed to explore the role of gender, age, and BMI. Higher levels of TV watching (BSRH = 0.056, BMCP = 0.044, BTPA= -1.795), computer use (BSRH = 0.007, BTPA= -3.469), and computer gaming (BSRH = 0.055, BMCP = 0.058, BTPA= -6.076) were consistently associated with poorer health status (all P < 0.05). Contrastingly, earlier exposure to mobile phones (BSRH = -0.048, BTPA= 0.933, BMCP = 0.056) was inconsistent with health (all P < 0.05). Additionally, BMI (Bcomputer use-SRH= 0.0026, Bphone-SRH= 0.0049, BTV-MCP= 0.0031, and BTV-TPA= -0.0584) exacerbated the negative effects of electronics use, and male (Bphone-SRH = -0.0414, Bphone-MCP = -0.0537, Bphone-TPA= 2.8873) were healthier with earlier exposure to mobile phones (all P < 0.05). Our findings suggest that the adverse health effects associated with watching TV, computer use, and computer gaming were consistent and were moderated by BMI, gender, and age, which advances a comprehensive understanding of the association between multiple types of electronic devices and health status, and provides new perspectives for future research. The online version contains supplementary material available at 10.1007/s10389-023-01886-5.

B-esterase measurements and other blood related biomarkers in loggerhead sea turtles (Caretta caretta) as indicators of health status

The loggerhead sea turtle (Caretta caretta) has been selected as sentinel species by the Marine Strategy Framework Directive (MSFD) descriptor 10 in relation to marine litter. In this, and other protected species, there is a need to develop conservative pollution biomarkers equally informative of chemical exposures to those traditionally carried out in metabolic organs, such as the liver. With this aim, plasma from turtles undergoing rehabilitation at the Fundació Oceanogràfic rescue centre (Arca del Mar) were selected and tested for B-esterase measurements. Hydrolysis rates of acetylcholinesterase (AChE), butyrylcholinesterase (BChE) and carboxylesterases (CEs) using four commercial substrates were undertaken on 191 plasma samples. Results indicated that acetylthiocholine was the most adequate substrate of cholinesterases and butyrate esters for CE measures. The correlation of these parameters with well-established blood biochemistry measurements was analysed. B-esterase measures in wild specimens were discussed in relation to age group, pathology on admission to the rescue centre and season; moreover, contrasts with long-term resident turtles were also made. Although this study provides baseline data on B-esterase measures in a large sample size for this species, more complementary information is still needed in terms of population genetics, chemical exposures, and in relation to other biochemical parameters before they can be confidently applied in wild specimens within the regulatory MSFD.

A Survey of Neck Pain among Dentists of the Lebanese Community.

The majority of participants were between the ages of 25 and 35, and the gender distribution of the demographic distribution was comparable. The prevalence of pain was 86.8% (97/342 dentists). NDI analysis showed that 65.7% had mild disability, 12.8% have a moderate disability, and 1% had severe disability. Bivariate analysis showed that pain was affected by age (p=0.013), orthodontist practices (p=0.031), regular exercise (p < 0.001), using vibrating instruments (p < 0.001), cervical flexion for better vision while working (p < 0.001), knowledge, and experience about ergonomic posture (p < 0.005). Multivariate analysis showed four predictors for pain: age (p=0.017), performing stretching exercises after finishing clinical practice (p=0.022), orthodontist specialty (p=0.029), and performing cervical flexion for better vision while working (p=0.004). This study showed that through the application of some strategies such as stretching, exercising, and being careful in using vibrating instruments, the dentist may be able to relieve the pain.

Is Laser Therapy an Adjuvant in the Treatment of Peri-Implant Mucositis? A Randomized Clinical Trial.

(1) Background: Early diagnosis and treatment of peri-implant mucositis may reduce inflammatory markers and halt the progression of the condition to peri-implantitis. Adjunctive laser treatment may have therapeutic benefits that are not yet well known. The aim of this study was to determine the advantages and limitations of laser therapy as an adjuvant in the treatment of peri-implant mucositis. (2) Methods: A total of 42 patients with at least 2 implants situated in different hemiarches were included in this study and divided into two groups: G1 (received laser therapy) and G2 (no laser therapy). Periodontal health status indices were recorded at the initial moment (T0), and all patients underwent non-surgical debridement therapy accompanied by oral hygiene training. In patients from group G1, one implant site received adjuvant laser therapy (subgroup IL), and the other one did not receive active laser light (IC). The plaque index (PI), probing pocket depth (PPD), and bleeding on probing (BOP) values recorded after 3 months (T1) and 6 months (T2) were analyzed and compared with those at T0. (3) Results: PI values considerably reduced at moment T1 and T2 for both G1 and G2 (p = 0.0031). PPD was also reduced, but the difference between the groups and the three recording moments was not statistically significant. Statistically significant differences were found when comparing the BOP values between G1 IL and G1 IC for T0/T1 (p = 0.0182) and T1/T2 (p < 0.0001), but there was no significant difference between G2 and G1 IL or G1 IC. (4) Conclusions: Laser therapy as an adjunct to conventional treatment of peri-implant mucositis leads to a statistically significant reduction in bleeding on probing at 3-month and 6-month re-evaluations. Moreover, it leads to an evident reduction in probing depth but with no statistical significance. These results should be interpreted with caution, and more in-depth research should be performed to create a complete laser therapy protocol for peri-implant mucositis.

Analysis of patient variables including socioeconomic indicators and their association with recurrence rates and persistence of benign paroxysmal positional vertigo: A retrospective case series.

Analysis of patient variables including socioeconomic indicators and their association with recurrence rates and persistence of benign paroxysmal positional vertigo: A retrospective case series.

Cutaneous angiomatosis‐like presentation in koi carp (Cyprinus carpio koi): Clinical–pathological investigations

The skin represents an indicator of an animal's health status. Causes of cutaneous diseases in fish most often trace back to biological agents. However, fish skin diseases can also arise from a complex interaction of infectious and non-infectious causes, making it more difficult to identify a specific aetiology. In the period between April and September of the years 2019-2022, four koi carp (Cyprinus carpio koi) from two European countries presented with multifocal, irregularly round, few mm to 1cm, variably raised cutaneous reddened areas. The fish displayed good general condition. Cutaneous samples, investigated by microbiological and molecular methods and microscopy, did not indicate a primary pathogenic agent. Gross and histological findings of the cutaneous biopsies were consistent with a multifocal/reactive process centred on dermal vessels. The histological features were reminiscent of angiomatosis, a benign proliferative condition affecting the dermal vessels of mammals, including human patients. The clinical-pathological presentation and the dermatologic condition that affected the koi carp are discussed and compared with the veterinary and human literature.

Senior Health Clinic for 75-year-old home-dwelling Finns – study design, clinic protocol and non-response analysis

BackgroundIn the Finnish policy on older people preventive activities, which maintain functional capacity and independent living, are emphasized. The Turku Senior Health Clinic, aimed at maintaining independent coping of all home-dwelling 75-year-old citizens in the city of Turku, was founded in the beginning of 2020. The aim of this paper is to describe design and protocol of the Turku Senior Health Clinic Study (TSHeC) and provide results of the non-response analysis.MethodsThe non-response analysis used data from 1296 participants (71% of those eligible) and 164 non-participants of the study. Sociodemographic, health status, psychosocial and physical functional ability indicators were included in the analysis. Participants and non-participants were also compared in respect to their neighborhood socioeconomic disadvantage. Differences between participants and non-participants were tested using the Chi squared or Fisher´s exact test for categorical variables and t-test for continuous variable.ResultsThe proportions of women (43% vs. 61%) and of those with only satisfying, poor or very poor self-rated financial status (38% vs. 49%) were significantly lower in non-participants than in participants. Comparison of the non-participants and participants in respect to their neighborhood socioeconomic disadvantage showed no differences. The prevalence of hypertension (66% vs. 54%), chronic lung disease (20% vs. 11%), and kidney failure (6% vs. 3%) were higher among non-participants compared to participants. Feelings of loneliness were less frequent among non-participants (14%) compared to participants (32%). The proportions of those using assistive mobility devices (18% vs. 8%) as well as those having previous falls (12% vs. 5%) were higher in non-participants than in participants.ConclusionsThe participation rate of TSHeC was high. No neighborhood differences in participation were found. Health status and physical functioning of non-participants seemed to be slightly worse than those of the participants, and more women than men participated. These differences may weaken the generalizability of the findings of the study. The differences have to be taken into account when recommendation for the content and implementation of preventive nurse-managed health clinic in primary health care in Finland is going to be given.Trial registrationClinicalTrials.gov Identifier: NCT05634239; registration date; 1st of December 2022. Retrospectively registered.

Thirty-year follow-up of the NICHD Study of Early Child Care and Youth Development (SECCYD): the challenges and triumphs of conducting in-person research at a distance

PurposeThe purpose of the current study, The National Institute of Child Health and Human Development (NICHD) Study of Health in Early and Adult Life (SHINE), was to build on the...

An Overview of Ecological Indicators of Fish to Evaluate the Anthropogenic Pressures in Aquatic Ecosystems: From Traditional to Innovative DNA-Based Approaches

In order to halt the loss of global biodiversity and considering the United Nations Decade for Ocean Conservation Agenda, increasing efforts to improve biomonitoring programs and assessment of ecosystem health are needed. Aquatic environments are among the most complex to monitor, requiring an array of tools to assess their status and to define conservation targets. Although several parameters need to be considered for a comprehensive ecological status assessment, it is important to identify easy-to-apply high-resolution monitoring methods. Shifts in fish composition and abundance are often good indicators of ecosystem health status in relation to anthropogenic activities. However, traditional monitoring methods are strictly related to the habitat under study and cannot be applied universally. This review summarizes the importance of ecological indicators for aquatic environments subjected to anthropogenic stressors, with a particular focus on fish communities and transitional water ecosystems. We describe the main characteristics of both traditional and novel methods for fish monitoring, highlighting their advantages and shortcomings in an attempt to identify simple and reliable ways for a correct evaluation of the dynamics of aquatic ecosystems.

Associations of early-life exposures and socioeconomic status with cognitive development at preadolescence.

The long-term relations of socioeconomic status (SES) and early-life exposures with cognitive development at preadolescence are not fully understood, especially in low SES populations. We examined associations of SES and early-life exposures including feeding practices, physical growth and infections with cognitive development among preadolescents from underprivileged communities. A prospective study was conducted among 146 healthy children from two relatively low SES Arab villages in Israel, who were recruited at age 1-9 weeks and followed until age 18 months. Information was obtained on their feeding practices, health status and growth indicators. Cognitive development at age 10-12 years was assessed using the Wechsler Intelligence Scale, including the full-scale intelligence quotient (FSIQ) and scores of four cognitive domains. Multiple linear regression models were performed. Nearly all the children (98%) were breastfed in infancy. Bivariate correlations were found of SES, growth indices and rates of diarrheal and respiratory illnesses in infancy, but not of feeding practices, with cognitive scores. In multivariable models, SES was positively (p<0.001) associated with all the cognitive domains (beta coefficient ranges 4.3 to 8.2). Birthweight was positively associated with FSIQ (p=0.039) and the perceptual reasoning index (p=0.002). Weight for age Z score at age 10-14 months was positively associated with the verbal comprehension index (p=0.003). The rate of respiratory illnesses was negatively associated with the perceptual reasoning index (p=0.05). SES is strongly associated with cognitive development even in relatively low SES communities. Birthweight, weight indicators and respiratory illness in infancy might affect cognitive development through preadolescence.

Clinical validation of a contactless respiration rate monitor

Respiratory rate (RR) is an often underestimated and underreported vital sign with tremendous clinical value. As a predictor of cardiopulmonary arrest, chronic obstructive pulmonary disease (COPD) exacerbation or indicator of health state for example in COVID-19 patients, respiratory rate could be especially valuable in remote long-term patient monitoring, which is challenging to implement. Contactless devices for home use aim to overcome these challenges. In this study, the contactless Sleepiz One+ respiration monitor for home use during sleep was validated against the thoracic effort belt. The agreement of instantaneous breathing rate and breathing rate statistics between the Sleepiz One+ device and the thoracic effort belt was initially evaluated during a 20-min sleep window under controlled conditions (no body movement) on a cohort of 19 participants and secondly in a more natural setting (uncontrolled for body movement) during a whole night on a cohort of 139 participants. Excellent agreement was shown for instantaneous breathing rate to be within 3 breaths per minute (Brpm) compared to thoracic effort band with an accuracy of 100% and mean absolute error (MAE) of 0.39 Brpm for the setting controlled for movement, and an accuracy of 99.5% with a MAE of 0.48 Brpm for the whole night measurement, respectively. Excellent agreement was also achieved for the respiratory rate statistics over the whole night with absolute errors of 0.43, 0.39 and 0.67 Brpm for the 10th, 50th and 90th percentiles, respectively. Based on these results we conclude that the Sleepiz One+ can estimate instantaneous respiratory rate and its summary statistics at high accuracy in a clinical setting. Further studies are required to evaluate the performance in the home environment, however, it is expected that the performance is at similar level, as the measurement conditions for the Sleepiz One+ device are better at home than in a clinical setting.

Energy poverty, housing conditions, and self-assessed health: evidence from Poland

Energy poverty, i.e., inefficient heating and insufficient access to energy services, can turn a shelter into a health hazard. We find that substandard housing and ineffective heating is associated with a higher risk of poor health in an urban context. We surveyed people living in two middle-sized cities in a coal-dependent region of Poland and used objective and subjective indicators of energy poverty and self-assessed health status. We demonstrate that people who live in substandard housing are more likely to exhibit poor musculoskeletal and cardiovascular outcomes, by 10 and 6 pp, respectively than otherwise similar people living in suitable housing conditions. We show that energy-poor people who use coal or a wood stove have a 24 pp higher likelihood of respiratory disease than the energy-poor who live in flats connected to district heating. We also find that a significant amount of the explained variance in the probability of respiratory disease is attributable to energy poverty. To improve the housing conditions and reduce the risk of poor health outcomes, we recommend two policy instruments: 1) a full subsidy for thermal retrofits and connecting multi-family buildings to the district heating network and 2) a targeted energy voucher for clean heating.

Data resource profile: the Korean Community Health Status Indicators (K-CHSI) database.

Korean Community Health Status Indicators (K-CHSI) is a model-based database containing annual data on health outcomes and determinants at the municipal level (si/gun/gu-level regions, including mid-sized cities, counties, and districts). K-CHSI's health outcomes include overall mortality, disease incidence, prevalence rates, and self-reported health. Health determinants were measured in 5 domains: socio-demographic factors, health behaviors, social environment, physical environment, and the healthcare system. The data sources are 71 public databases, including Causes of Death Statistics, Cancer Registration Statistics, Community Health Survey, Population Census, and Census on Establishments and Statistics of Urban Plans. This dataset covers Korea's 17 metropolitan cities and provinces, with data from approximately 250 municipal regions (si/gun/gu). The current version of the database (DB version 1.3) was built using 12 years of data from 2008 to 2019. All data included in K-CHSI may be downloaded via the Korea Community Health Survey site, with no login requirement (https://chs.kdca.go.kr/chs/recsRoom/dataBaseMain.do). K-CHSI covers extensive health outcomes and health determinants at the municipal level over a period of more than 10 years, which enables ecological and time-series analyses of the relationships among various health outcomes and related factors.