Population-based Health Survey Research Articles

Diagnostic validity of self-reported oral health outcomes in population surveys: literature review.

Population-based health surveys are increasingly including self-reported oral health measures. However, their validity is frequently questioned. This study aimed to review the diagnostic validity of self-reported oral health measures - regarding periodontal conditions, number of remaining teeth and use and need of prostheses - and to present prototypes of oral health items to assess periodontal conditions. Papers published between 1991 and 2011 were identified through PubMed database. The sample profile, the sample size and the methods used in each study were analyzed, as well as the sensitivity, specificity, positive and negative predictive values of the oral health items. Periodontists were contacted, using a standardized text, sent by e-mail, which asked them to provide self-reported items regarding periodontal conditions. We reviewed 19 studies; 13 assessed periodontal conditions; five, the number of remaining teeth and four, the use and need of prosthesis - some studies evaluated two or more conditions simultaneously. Five of the eight periodontists suggested questions to assess periodontal conditions. The maximum and the minimum sensitivity values to assess periodontal conditions, number of remaining teeth and use and need of prosthesis were 100 and 2%; 91 and 21%; 100 and 100%; respectively; the maximum and the minimum specificity values were 100 and 18%; 97 and 96%; 93 and 93%; respectively. In conclusion, there are acceptable sensitivity and specificity values for number of remaining teeth and use and need of prosthesis only. Finally, we consider there is the need for further studies in the national context, in order to assess the impact of the questions about self-reported oral health conditions in epidemiological analyses. Therefore, it will be possible to empirically verify if self-reported questions can be used in such studies.

Menstrual Cycle Abnormalities in Healthy Women With Low Physical Activity: The North-Trøndelag Population-based Health Study

Menstrual dysfunctions are often found in athletic women. This study evaluated the association between leisure time physical activity (LTPA) and menstrual function in healthy nonathletic women. During 1984-1986, a population-based health survey (HUNT 1) was conducted in Nord-Trøndelag, Norway, with follow-up (HUNT 2) in 1995-1997. Women < 45 years old in HUNT 2 were included in the current study. LTPA was assessed by questionnaire in HUNT 1 and HUNT 2, and menstrual function by questionnaire in HUNT 2. Adjusted odds ratios (OR's) for long cycles were increased in women who reported < 1 hour of light LTPA (OR = 1.4, 95% CI = 1.0-2.0) and 1-2 hours (OR = 1.3, 95% CI = 1.0-1.8) per week compared with women with ≥ 3 hours/week. Adjusted OR for irregular cycles was decreased in women constantly in the lowest tertile of LTPA index in HUNT 1 and HUNT 2 (OR = 0.4, 95% CI = 0.2-0.9). Adjusted OR for prolonged bleeding was 2.6 (95% CI = 1.3-5.4) for women with < 1 hour/week of light LTPA and 2.3 (95% CI = 1.3-4.3) for women with 1-2 hours, compared with ≥ 3 hours/week. Very low physical activity may increase the risk of menstrual cycle disruptions. Moderate PA should be encouraged for optimum reproductive health.

Psychiatric history of women who have had an abortion

Prior research has focused primarily on the mental health consequences of abortion; little is known about mental health before abortion. In this study, the psychiatric history of women who have had an abortion is investigated. 325 Women who recently had an abortion were compared with 1902 women from the population-based Netherlands Mental Health Survey and Incidence Study (NEMESIS-2). Lifetime prevalence estimates of various mental disorders were measured using the Composite International Diagnostic Interview 3.0. Compared to the reference sample, women in the abortion sample were three times more likely to report a history of any mental disorder (OR = 3.06, 95% CI = 2.36–3.98). The highest odds were found for conduct disorder (OR = 6.97, 95% CI = 4.41–11.01) and drug dependence (OR = 4.96, 95% CI = 2.55–9.66). Similar results were found for lifetime-minus-last-year prevalence estimates and for women who had first-time abortions only. The results support the notion that psychiatric history may explain associations that have been found between abortion and mental health. Psychiatric history should therefore be taken into account when investigating the mental health consequences of abortion.

Role of Metabolic Factors in the Association Between Osteocalcin and Testosterone in Chinese Men

Osteocalcin can regulate energy metabolism and increase testosterone production. Although previous studies have shown the positive association between osteocalcin and testosterone, the effect of metabolic factors in the association is unclear. Osteocalcin, testosterone, and metabolic factors were accessed in 2400 men aged 20 to 69 years, who participated in the population-based Fangchenggang Area Male Health and Examination Survey in Guangxi province of China from September 2009 to December 2009. Metabolic syndrome was defined based on the updated report of National Cholesterol Education Program Adult Treatment Panel III criteria. Serum total osteocalcin, total testosterone (TT), and sex hormone binding globulin (SHBG) were measured, whereas free testosterone (FT) and bioavailable testosterone (BT) were calculated based on Vermeulen's formula. The multivariable linear regression analysis was used. Osteocalcin was positively associated with TT, FT, and BT in the unadjusted model (all P < .001). After adjusting for age, the positive association between osteocalcin and TT remained statistically significant (β = .17, 95% confidence interval = 0.14-0.20) and was not attenuated in each MetS subgroup including hypertriglyceridemia, hyperglycemia, elevated blood pressure, and low high-density lipoprotein cholesterol, while in the group of central obesity (waist circumstance ≥90 cm), the association appeared significantly stronger (β = 0.21, 95% confidence interval = 0.12-0.30). After further adjusting for SHBG, osteocalcin was positively associated with TT, FT, and BT in men with central obesity or men with any two MetS components (all P < .05). Serum total osteocalcin is positively associated with testosterone, which is probably modified by SHBG and central obesity.

Both total testosterone and sex hormone‐binding globulin are independent risk factors for metabolic syndrome: results from Fangchenggang Area Male Health and Examination Survey in China

Metabolic syndrome is often beneficial from testosterone replacement therapy. Although testosterone and sex hormone-binding globulin (SHBG) are inversely associated with the risk of metabolic syndrome, it is controversial whether the association between testosterone and metabolic syndrome is independent of SHBG. Testosterone, SHBG and metabolic syndrome were evaluated in 2361 men aged 20-73 years, who participated in the population-based Fangchenggang Area Male Health and Examination Survey. Total testosterone, SHBG and other biochemical profiles were measured. Free testosterone and bioavailable testosterone were calculated on the basis of Vermeulen's formula. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria for Asian population. The independent associations with metabolic syndrome were determined by multivariate logistic regression analysis. Men with metabolic syndrome had a lower level of total testosterone, bioavailable testosterone, free testosterone, or SHBG than those without metabolic syndrome (all p < 0.001). Both total testosterone and SHBG were inversely correlated with body mass index or homeostasis model assessment of insulin resistance (all age-adjusted p < 0.001). Men within the lowest quartile of total testosterone [odds ratio (OR) = 4.86, 95% confidence interval (CI) = 2.72-8.68], bioavailable testosterone (OR = 3.04, 95% CI = 1.81-5.10), free testosterone (OR = 3.08, 95% CI = 1.81-5.27) or SHBG (OR = 4.28, 95% CI = 2.52-7.27) had a risk of metabolic syndrome after adjusting for age, smoking, homeostasis model assessment of insulin resistance and body mass index. Total testosterone remained inversely associated with metabolic syndrome after further adjusting for SHBG (OR = 0.95, 95% CI = 0.92-0.99), while SHBG remained inversely associated with metabolic syndrome after further adjusting for total testosterone (OR = 0.99, 95% CI = 0.97-1.00). Total testosterone and SHBG are independent risk factors of metabolic syndrome. Prospective studies are needed to explore whether the association between sex hormones and metabolic syndrome was mediated by insulin resistance or obesity.

Population-based health survey in Eastern region of Saudi Arabia

A community health survey was conducted to describe the current health status and preventive health practices of National Guard military employees and their dependants residing in the Eastern region of Saudi Arabia. In a cross-sectional survey in 2010, data were collected via a questionnaire interview and direct physical measurements. A total of 1339 adults aged 14 years completed the survey [mean age 30.7 (SD 12.7) years]. About two-thirds of the sample had problems of overweight and obesity, while 50% had high serum lipids and psychiatric disorders. Hypertension and diabetes were detected in 9.0% and 9.1% of the participants respectively and 15.8% were smokers. The rates of complete immunization and breastfeeding of children were 88.9% and 80.2% respectively and 21.7% of the women had ever used oral contraceptives. However, only 6.5% of the women had ever had a mammogram and 13.4% a cervical smear. The survey results provide a baseline from which to strengthen many oublic health nolicies and orogrammes.

Risk of incident diabetes in relation to long-term exposure to fine particulate matter in Ontario, Canada.

Background: Laboratory studies suggest that fine particulate matter (≤ 2.5 µm in diameter; PM2.5) can activate pathophysiological responses that may induce insulin resistance and type 2 diabetes. However, epidemiological evidence relating PM2.5 and diabetes is sparse, particularly for incident diabetes.Objectives: We conducted a population-based cohort study to determine whether long-term exposure to ambient PM2.5 is associated with incident diabetes.Methods: We assembled a cohort of 62,012 nondiabetic adults who lived in Ontario, Canada, and completed one of five population-based health surveys between 1996 and 2005. Follow-up extended until 31 December 2010. Incident diabetes diagnosed between 1996 and 2010 was ascertained using the Ontario Diabetes Database, a validated registry of persons diagnosed with diabetes (sensitivity = 86%, specificity = 97%). Six-year average concentrations of PM2.5 at the postal codes of baseline residences were derived from satellite observations. We used Cox proportional hazards models to estimate the associations, adjusting for various individual-level risk factors and contextual covariates such as smoking, body mass index, physical activity, and neighborhood-level household income. We also conducted multiple sensitivity analyses. In addition, we examined effect modification for selected comorbidities and sociodemographic characteristics.Results: There were 6,310 incident cases of diabetes over 484,644 total person-years of follow-up. The adjusted hazard ratio for a 10-µg/m3 increase in PM2.5 was 1.11 (95% CI: 1.02, 1.21). Estimated associations were comparable among all sensitivity analyses. We did not find strong evidence of effect modification by comorbidities or sociodemographic covariates.Conclusions: This study suggests that long-term exposure to PM2.5 may contribute to the development of diabetes.

Association between testosterone levels and risk of future rheumatoid arthritis in men: a population-based case–control study

ObjectivesRheumatoid arthritis (RA) is less common among men than women, and sex hormones have been suggested to play a part in the pathogenesis. Lower levels of testosterone have been demonstrated...

Trends in low-density lipoprotein cholesterol goal achievement in high risk United States adults: longitudinal findings from the 1999-2008 National Health and Nutrition Examination Surveys.

BackgroundPrevious studies have demonstrated gaps in achievement of low-density lipoprotein-cholesterol (LDL-C) goals among U.S. individuals at high cardiovascular disease risk; however, recent studies in selected populations indicate improvements.ObjectiveWe sought to define the longitudinal trends in achieving LDL-C goals among high-risk United States adults from 1999–2008. Methods We analyzed five sequential population-based cross-sectional National Health and Nutrition Examination Surveys 1999–2008, which included 18,656 participants aged 20–79 years. We calculated rates of LDL-C goal achievement and treatment in the high-risk population.ResultsThe prevalence of high-risk individuals increased from 13% to 15.5% (p = 0.046). Achievement of LDL-C <100 mg/dL increased from 24% to 50.4% (p<0.0001) in the high-risk population with similar findings in subgroups with (27% to 64.8% p<0.0001) and without (21.8% to 43.7%, p<0.0001) coronary heart disease (CHD). Achievement of LDL-C <70 mg/dL improved from 2.4% to 17% (p<0.0001) in high-risk individuals and subgroups with (3.4% to 21.4%, p<0.0001) and without (1.7% to 14.9%, p<0.0001) CHD. The proportion with LDL-C ≥130 mg/dL and not on lipid medications decreased from 29.4% to 18% (p = 0.0002), with similar findings among CHD (25% to 11.9% p = 0.0013) and non-CHD (35.8% to 20.8% p<0.0001) subgroups.ConclusionThe proportions of the U.S. high-risk population achieving LDL-C <100 mg/dL and <70 mg/dL increased over the last decade. With 65% of the CHD subpopulation achieving an LDL-C <100 mg/dL in the most recent survey, U.S. LDL-C goal achievement exceeds previous reports and approximates rates achieved in highly selected patient cohorts.

The Costs Associated with Antidepressant Use in Depression and Anxiety in Community-Living Older Adults

To determine the costs associated with antidepressant (AD) use by depression and anxiety status in a public-managed health care system. Data were obtained from a population-based health survey of 1869 older adults. Depression and anxiety were based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria and measured at 2 time points 1 year apart. AD and health service use and costs were identified from provincial administrative databases and included hospitalizations, physician fees, outpatient medications, and ambulatory visits. Patient costs considered were related to drug copayments, transportation, and time spent seeking medical care. Annual costs associated with AD use were studied as a function of mental health status at baseline and follow-up interviews (persistence, incidence, remission, or no illness). Generalized linear models with a gamma distribution were used to control for individual factors. The costs incurred by participants using ADs as a whole (17.8%) reached $6678 (95% CI $5449 to $8182), significantly more than in participants not using ADs ($4698; 95% CI $3710 to $5949). AD use was associated with greater total adjusted costs among respondents with no depression (adjusted difference = $1769; 95% CI $236 to $3702) and no anxiety (adjusted difference = $1845; 95% CI $203 to $3486). The results showed that AD use was not associated with cost savings in any group, and indeed with greater costs among participants who were neither depressed nor anxious at any time point. Future cost studies may consider the analyses of different AD classes regarding the different clinical mental health profiles in older adults.

Physical activity and cardiovascular risk factors at menopause: The Nord-Trøndelag health study

Background Lowered physical activity levels may partially explain changes in metabolic risk factors in women after menopause.Objectives To evaluate the association between physical activity and metabolic risk factors at baseline and after 11 years, as well as the change in that association over time in women who were premenopausal and ≥ 40 years at baseline.Methods Subjects in a Norwegian population-based health survey answered questionnaires and had body and serum measurements during 1995–1997 (HUNT 2) and in a follow-up study during 2006–2008 (HUNT 3). Repeated-measures analyses were used to estimate the association between physical activity and metabolic factors, adjusting for age, smoking status, education, alcohol intake, and parity. Adjustment for hormonal treatment and medication was made, as appropriate.Results In women remaining premenopausal, a higher physical activity score in HUNT 3 was associated with lower weight (p < 0.01) and waist–hip ratio (p < 0.01) and higher high density lipoprotein (HDL) cholesterol in HUNT 3 (p < 0.01). In women that were postmenopausal by the time of follow-up, a higher physical activity score in HUNT 3 was associated with lower weight (p < 0.01), waist–hip ratio (p < 0.01), triglycerides (p < 0.01), and higher total cholesterol (p < 0.05), HDL cholesterol (p < 0.01), and diastolic blood pressure (p < 0.05) in HUNT 3. The association of total physical activity score with weight and waist–hip ratio was stronger in HUNT 3 than in HUNT 2 (p < 0.01).Conclusion Increased physical activity may reduce the risk of adverse outcomes and use of pharmacological management in women of menopausal age.

The Excess Healthcare Costs Associated With Depression and Anxiety in Elderly Living in the Community

To estimate the excess healthcare costs attributable to depression and anxiety in a public managed care system. The data were retained from a population-based health survey on 2,494 community-dwelling older adults age 65years or more participating in the ESA (Étude sur la Santé des Aînés) study. Depression and anxiety were assessed using Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria and measured at two time points 1 year apart. Annual healthcare costs considered included hospitalizations, emergency and outpatient visits, physician fees, and outpatient medications. Health service use and costs were identified from provincial administrative databases. Costs were studied as a function of the presence (yes/no) of depression and anxiety, and as persistence, incidence/remission, and no illness. Generalized linear models with a gamma distribution (log link) were used to control for a number of factors. Participants with depression had higher outpatient mental health-related costs. Participants with anxiety had higher total healthcare costs and specifically outpatient costs and inpatient costs. As opposed to people without depression and anxiety, persistent cases had higher mean costs followed by people with the disorders for only part of the year. Most of these differences were explained by sociodemographic and clinical factors. The excess annual adjusted healthcare costs of depression, anxiety, and comorbid depression and anxiety reached $27.4, $80.0, and $119.8 million per 1,000,000 population of elderly, respectively. The excess costs of depression and anxiety in community-dwelling elderly are just as significant as those observed for adults even when productivity losses are not considered. Adequately managing depression and anxiety in the older adult population may lead to important healthcare cost savings for society.

The sixth survey of the Tromsø Study (Tromsø 6) in 2007–08: Collaborative research in the interface between clinical medicine and epidemiology: Study objectives, design, data collection procedures, and attendance in a multipurpose population-based health survey

To provide a synopsis of the sixth survey of the Tromsø Study, Tromsø 6, objectives and new target areas, study design, follow-up studies, data collection, attendance, and participant characteristics. The Tromsø Study, initiated in 1974, is an epidemiological, prospective study of health conditions and chronic diseases, and a resource for the surveillance of disease risk factors. The purpose of Tromsø 6 (2007-08) was to collect novel and repeated measurements of exposure data and to assess levels of disease risk factors. Tromsø 6 included a main study that comprised two screening visits and several follow-up studies. Main study data collection: First visit (n=12,984): questionnaires, interviews, measurements of height, weight, hip and waist circumference, heart rate, blood pressure, forearm bone density, grip strength, pain sensitivity measurements, and blood and hair samples and nose and throat swab cultures. Second visit (n=7307): sampling of biological specimens (blood, urine, nose and throat swab cultures) and clinical examinations (12-lead electrocardiography, cognitive tests, visual acuity test, retinal photography, carotid ultrasound, spirometry, dual-energy X-ray absorptiometry, and echocardiography. A total of 12,984 participants aged 30-87 years were examined. The attendance rate was 66%, lower than in previous Tromsø Study surveys. The attendance was lowest in the youngest and oldest, those invited for the first time, and lower in men than women. The completion of the survey with this comprehensive data collection went satisfactorily. The decreasing attendance rate calls for new recruitment strategies and optimisation of the study organisation to facilitate attendance.

DRD4Genotype Predicts Longevity in Mouse and Human

Longevity is influenced by genetic and environmental factors. The brain's dopamine system may be particularly relevant, since it modulates traits (e.g., sensitivity to reward, incentive motivation, sustained effort) that impact behavioral responses to the environment. In particular, the dopamine D4 receptor (DRD4) has been shown to moderate the impact of environments on behavior and health. We tested the hypothesis that the DRD4 gene influences longevity and that its impact is mediated through environmental effects. Surviving participants of a 30-year-old population-based health survey (N = 310; age range, 90-109 years; the 90+ Study) were genotyped/resequenced at the DRD4 gene and compared with a European ancestry-matched younger population (N = 2902; age range, 7-45 years). We found that the oldest-old population had a 66% increase in individuals carrying the DRD4 7R allele relative to the younger sample (p = 3.5 × 10(-9)), and that this genotype was strongly correlated with increased levels of physical activity. Consistent with these results, DRD4 knock-out mice, when compared with wild-type and heterozygous mice, displayed a 7-9.7% decrease in lifespan, reduced spontaneous locomotor activity, and no lifespan increase when reared in an enriched environment. These results support the hypothesis that DRD4 gene variants contribute to longevity in humans and in mice, and suggest that this effect is mediated by shaping behavioral responses to the environment.

Alveolar Bone Loss Associated With Age‐Related Macular Degeneration in Males

The aim of this study is to examine the relationship of selected systemic and oral health parameters and the salivary presence of six periodontal pathogens to age-related macular degeneration (AMD). The present cross-sectional study includes data on 1,751 individuals (≥30 years old). General health information was obtained by questionnaires and interviews, including self-reported diagnosis of AMD, as well as by the general and oral health examination, including panoramic radiography and laboratory analyses. Fifty-four individuals with degenerative fundus changes formed the AMD group, and the other 1,697 formed the non-AMD group. Pearson χ(2) and analysis of variance tests were used for comparisons of categorical parameters and continuous parameters between the participant groups, respectively. A logistic regression analysis was performed to study the association of AMD with alveolar bone loss and the number of teeth by controlling for age, diabetic status, systolic blood pressure, education, and smoking, and also for the carriage of salivary bacteria. Advanced age, systolic blood pressure, and diabetes were associated with AMD (P <0.001), whereas the carriage rates of the examined periodontal pathogens were not. In the whole study population, the participants with AMD had fewer teeth (P <0.001) and more alveolar bone loss (P = 0.004) compared with non-AMD participants. In a logistic regression model adjusted for age, smoking, and diabetes, alveolar bone loss was associated with AMD in males with an odds ratio of 4.3 (95% confidence interval = 1.3 to 14.6, P = 0.013). In this population-based health survey, alveolar bone loss is independently associated with AMD in males.

Reference Values of Serum Rheumatoid Factor in Coastal Residents

This study aims to investigate the reference values of serum rheumatoid factor (RF) in coastal residents. We collected 1,762 serum samples from 20 - 69 year-old males who participated in the population-based Fangchenggang Area Male Health and Examination Survey from September 2009 to December 2009. The values of serum RF were measured by immunoturbidimetry. The established normal reference value range of serum RF (< or = 18.90 IU/mL) in healthy adult males who live in coastal areas is lower than the current value that is extensively used (20 IU/mL). Age, ethnicity, and smoking specific reference values were calculated. Differences were found within groups, but no significant difference in drinking was observed. It is suggested that every special region should establish respective normal reference values of serum RF in healthy individuals.

Validade da hipertensão autorreferida associa-se inversamente com escolaridade em brasileiros

Self-reported hypertension is an important piece of information for public health that is available in epidemiological studies. For proper use of this information, such studies should be validated. To validate self-reported hypertension and associated factors in adults and elderly individuals in São Paulo, Brazil. Participants were selected from the sample of a population-based cross-sectional health survey carried out in São Paulo (ISA Capital-2008). Their age was 20 years or older, they were from both genders, and had their blood pressure measured (n = 535). Hypertension was defined as blood pressure > 140/90 mmHg and/or use of medication for hypertension. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Kappa coefficient were calculated. Poisson regression was used to identify factors associated with sensitivity of self-reported hypertension. Sensitivity of self-reported hypertension was 71.1% (95%CI: 64.8 to 76.9), specificity 80.5% (95%CI: 75.6 to 84.8), PPV 73.7% (95%CI: 67.4 to 79.3), and NPV 78.5% (95%CI: 73.5 to 82.9). There was moderate agreement between self-reported hypertension and hypertension as diagnosed by blood pressure measurement (kappa = 0.52, 95%CI: 0.45 to 0.59). Body mass index and level of education were independently associated with sensitivity (body mass index > 25 kg/m²: PR = 1.42, 95% CI: 1.15 to 1.76; schooling > 9 years: PR = 0.71 95%CI: 0.54-0.94). Self-reported hypertension was shown to be valid in adults and the elderly in the city of São Paulo, and is thus an appropriate indicator for the surveillance of hypertension prevalence in the absence of blood pressure measurement. Overweight was positively associated with validity of self-reported hypertension. Further studies are needed to elucidate the inverse association between the validity of self-reported hypertension and level of education.

Incidence of and Risk Factors for Low Birth Weight in Oman: A Population Based Study

The purpose of this study was to provide levels, t rends and determinants of low birth weight (LBW) in Oman using population based health survey data. The data for the study come from the 2000 Nat ional Health Survey of Oman. The sample consists of 977 singleton live births that occurred during five years before the survey date. The survey gathered data on birth weight from child health card. Univariate, bivariate and multivariate statistical techniques and tests were employed for data analysis. The incidence of LBW was observed to be 9% in Oman in 2000. LBW rate shows increasing trends in Oman. The results of both bivariate and mult ivariate analysis revealed that maternal low level of education, low income level, primipara, late and low ANC visits, preterm b irths, pregnancy complications and region of residence in A l-Batinah were significantly associated with the increased risk of LBW in Oman. Consanguinity shows insignificant marginal effect on LBW. In order to reduce the incidence of low b irth weight, health improvement strategies should focus on special care and intervention programs for high risk groups identified in the study.

293 – The costs associated with antidepressant use in depression and anxiety in community living older adults

Objective To determine the costs associated with antidepressant (AD) use and mental health status. Methods Data were obtained from a population-based health survey of 2,004 older adults. Depression and anxiety were based on DSM-IV criteria and measured at two time points 1 year apart. AD use and health service use and costs were identified from provincial administrative databases. Patient costs included drug copayments, transportation and time spent seeking medical care. Costs associated with AD use were studied as a function of mental health status at baseline and follow-up interviews [i.e. persistence, incidence, remission, no illness]. Generalized linear models with a gamma distribution (log link) were used to control for potential confounders such as socio-economic and clinical factors and AD adherence rates. Results The costs incurred by participants using AD (16.6%) reached $6861 (95% CI: $5586, $8426), significantly more than costs for those not using AD: $4662 ($3679, $5908). AD use was associated with increased total adjusted costs in respondents with no depression and anxiety and in respondents with incident anxiety. Increased costs were due to significantly higher hospitalisation and outpatient costs. The results also suggested a negative association between adherence to AD and the persistence of depression. Conclusion The results did not show important cost savings or decreased health service use associated with AD use and this for all depression and anxiety groups. Future cost studies may consider the analyses of different AD classes with respect to the different clinical mental health profiles in older adults.

High Vitamin D Status in Younger Individuals Is Associated with Low Circulating Thyrotropin

Vitamin D is an immunomodulator and may affect autoimmune thyroid diseases. Vitamin D has also been shown to influence thyrocytes directly by attenuating thyrotropin (TSH)-stimulated iodide uptake and cell growth. However, it is unclear how vitamin D status is related to TSH at the population level. The goal of the present study was to investigate the relationship between vitamin D status and TSH levels according to thyroid autoantibodies in a population-based health survey in Thailand. A total of 2582 adults, aged 15-98 years, were randomly selected according to the geographical region from the Thailand 4th National Health Examination Survey sample. By study design, the sexes were equally represented. Serum levels of 25-hydroxyvitamin D [25(OH)D], TSH, the thyroid peroxidase antibody (TPOAb), and the thyroglobulin antibody (TgAb) were measured in all subjects. The mean age was 55.0±0.4 (SE) years. In subjects positive for serum TgAb, serum TSH levels were higher, whereas total serum 25(OH)D levels were lower. In addition, the prevalence of vitamin D insufficiency in TgAb-positive subjects was significantly higher than that observed in TPOAb- and TgAb-negative subjects, whether based on cutoff values of 20 or 30 ng/mL: 8.3% vs. 5.6%, p<0.05; or 47.6% vs. 42.0%, p<0.05, respectively. However, vitamin D status was not associated with positive TPOAb and/or TgAb after controlling for sex and age. To explore the probable interaction between vitamin D status and age on serum TSH, analyses were performed according to age tertiles; it was found that higher 25(OH)D levels were independently associated with lower TSH, but only in subjects in the lowest age tertile. This population-based study showed that high vitamin D status in younger individuals is associated with low circulating TSH.