Taiwan National Health Interview Survey Research Articles

Obesity/overweight reduces the risk of active tuberculosis: a nationwide population-based cohort study in Taiwan.

Obesity affects immune function by increasing the number of T helper lymphocytes, which may reduce the risk of tuberculosis (TB) infection. However, the effect of obesity on TB development has not been extensively studied. This nationwide population-based cohort study investigated the effect of obesity on TB development in Taiwanese adults. We included 46 028 adult participants (age ⩾18 years) from three rounds (2001, 2005 and 2009) of the Taiwan National Health Interview Survey. Obesity and overweight were defined as a body mass index (BMI) ⩾27 and 24-26.9 (kg/m2), respectively. Data on BMI and other covariates at baseline were collected by in-person interviews. Incident cases of active TB were identified from the National Health Insurance database. Multivariable logistic regression was used to estimate the associations of obesity and overweight with active TB, with adjustment for age, sex, smoking, alcohol consumption, socioeconomic status and other covariates. In total, 241 new cases of active TB occurred during the study period. Obesity (adjusted odds ratio [AOR], 0.43; 95% confident interval [CI], 0.28-0.67) and overweight (AOR, 0.67; 95% CI, 0.49-0.91) were associated with lower risk of incident TB, after adjusting for demographic characteristics and comorbidities. There was a linear dose-response relation of BMI with active TB incidence (AOR per unit change in BMI, 0.92; 95% CI, 0.88-0.95; P <0.001). Obesity and overweight are associated with lower risk of active TB. Future studies should investigate the underlying mechanisms and clinical and epidemiological consequences of these findings.

Physical activity, smoking, and the incidence of clinically diagnosed insomnia

ObjectiveThis study was designed to examine the independent and combined associations of physical activity and smoking on the incidence of doctor-diagnosed insomnia using a nationally representative sample over seven years, taking into account other relevant covariates. MethodsParticipants aged 18 years or older in the 2005 Taiwan National Health Interview Survey (NHIS) with links to National Health Insurance (NHI) claim data between 2005 and 2012 and without diagnosed insomnia before 2005, were selected into this study (n = 12,728). Participants were classified as having insomnia with International Classification of Diseases, Ninth Revision (ICD-9) CM codes 307.41, 307.42, or 780.52. Self-reported smoking status and frequency, duration, and types of leisure-time and non−leisure-time physical activities were collected. Metabolic equivalent (MET) intensity levels for each activity were assigned, and weekly energy expenditure of each activity was calculated and summed. ResultsInactive participants had a higher risk of incident insomnia [hazard ratio (HR) = 1.22, 95% confidence interval (CI) = 1.06–1.42, p = 0.007] than the active group, and ever-smokers were more likely to have incident insomnia than never smokers (HR = 1.45, 95% CI = 1.20–1.76, p < 0.001). Compared with the nonsmoker/active group, the ever-smoker/inactive group had a higher risk of incident insomnia (HR = 1.78, 95% CI = 1.41–2.25, p < 0.001). Sensitivity analyses excluding individuals diagnosed with other sleep disorders or mental disorders yielded similar results, with the ever-smoker/inactive group having the highest risk of insomnia. ConclusionsInactive adults and smokers are at higher risk for incident insomnia, highlighting the importance of a healthy lifestyle and pointing to strategies such as encouraging smoking cessation and physical activity to avoid insomnia among adults.

Differences Between Men and Women Aged 65 and Older in the Relationship Between Self-Reported Sleep and Cognitive Impairment: A Nationwide Survey in Taiwan.

To examine the prevalence of self-reported sleep disturbances and cognitive impairment in men and women aged 65 and older and to determine sex-specific effects on the relationship between self-reported sleep and cognitive impairment. A secondary data analysis from the 2009 Taiwan National Health Interview Survey. Individuals aged 65 and older (N = 2,413, n = 1,094 men, n = 1,319 women). Subjective sleep characteristics including sleep duration, difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, daytime sleepiness, difficulty breathing during sleep, habitual snoring, and daytime napping were measured using survey questions. The Mini-Mental State Examination was used to identify cognitive impairment. The prevalence of cognitive impairment was 16.3% for men and 27.1% for women. Men and women with cognitive impairment had higher prevalence of self-reported sleep disturbances than those without. There was a significant effect of the interaction between sex and difficulty breathing during sleep on cognitive impairment (adjusted odds ratio (aOR) = 0.39, 95% confidence interval (CI) = 0.20-0.77). In men, difficulty breathing during sleep (aOR = 2.31, 95% CI = 1.39-3.84), habitual snoring (aOR = 2.30, 95% CI = 1.49-3.54), and prolonged sleep duration (> 8.5 hours) (aOR = 1.95, 95% CI = 1.11-3.43) correlated significantly with cognitive impairment. In women, only prolonged sleep duration (>8.5 hours) was associated with higher likelihood of cognitive impairment (aOR = 2.32, 95% CI = 1.33-4.03). This nationwide survey confirmed sex differences in the association between various self-reported sleep disturbances and cognitive impairment in people aged 65 and older.

Predictors of Internet use for health information among male and female Internet users: Findings from the 2009 Taiwan National Health Interview Survey

BackgroundThe Internet is an increasingly important source of health information for the general population. Both preventive health behavior and Internet use are known to be different between men and women. However, few studies have compared predictors of Internet use for health information between the sexes. ObjectivesTo investigate the prevalence and predictors of Internet use for health information among male and female adult Internet users using data from a population-based survey in Taiwan. MethodsRespondents between the ages of 20–65 years were identified from the dataset of the 2009 Taiwan National Health Interview Survey. The outcome variable of the study, the utilization of the Internet for health information, was ascertained by asking whether the respondent had ever used the Internet to search for health information or obtain health services. Univariate and multivariate logistic regression analyses were conducted separately for men and women to evaluate factors associated with the use of Internet for health information. ResultsOf the 2741 adults aged 20–65 years who had ever used the Internet, 1766 (64.4%) of them had used it for health information or services. Multivariate logistic regression analyses showed that a higher educational level (adjusted odds ratio [AOR]=3.60, P<0.001), living alone (AOR=1.77, P=0.019), had exercised in the past two weeks (AOR=2.41, P<0.001), residing in city or urban district (AOR=1.28, P=0.049), with a perceived health status of extremely good, very good, or good (AOR=1.34, P=0.022), and had used Western medicine services in the past month (AOR=1.51, P=0.005) were significantly associated with health information use in male Internet users. On the other hand, age between 20–44.9 years (AOR=1.87, P<0.001), a higher educational level (AOR=3.57, P<0.001), being married (AOR=1.68, P=0.001), had exercised in the past two weeks (AOR=1.56, P<0.001), and had a mean monthly personal income of NT$ 20,000 and above were significant factors in female Internet users. ConclusionsThis secondary data analysis of a representative sample of Taiwan population revealed that a similar but not identical set of independent factors was associated with the use of Internet for health information between male and female Internet users.

The Effect of Free Adult Preventive Care Services on Subsequent Utilization of Inpatient Services in Taiwan.

The objective of this article is to investigate the relationship between the utilization of free adult preventive care services and subsequent utilization of inpatient services among elderly people under the National Health Insurance program in Taiwan. The study used secondary data from the 2005 Taiwan National Health Interview Survey and claim data from the 2006 Taiwan National Health Insurance Research Database for the elderly aged 65 or over. A bivariate probit model was used to avoid the possible endogeneity in individuals' utilization of free adult preventive care and inpatient services. This study finds that, when individuals had utilized the preventive care services in 2005, the probability that they utilized inpatient services in 2006 was significantly reduced by 13.89%. The findings of this study may provide a good reference for policy makers to guide the efficient allocation of medical resources through the continuous promotion of free adult preventive care services under the National Health Insurance program.

Predictive factors for accuracy of perception of parents regarding their overweight or obese children in Taiwan.

Predictive factors for parental accuracy in perception of their children's weight and state of health have been unknown in Taiwan. Data were obtained on children aged 3-12 years from the 2005 Taiwan National Health Interview Survey (NHIS). The comparison of measured BMI and parents' perception of their children's weight operationalized "weight perception". A structured questionnaire ascertained demographic characteristics, and logistic regression determined demographic variables associated with a weight misperception. The prevalence of parental misperception of children who were overweight or obese was 50%; the ratio was higher in younger parents, parents with younger children, and those with overweight or obese children. In fact, only 1.7% of children whose parents misperceived overweight or obesity were engaged in weight management. Most parents viewed excessive weight in their children as better health than normal weight. Parental age, children's age, and weight loss management may be predictive factors in parents' perceptive accuracy regarding children who are overweight or obese.

Daytime sleepiness is independently associated with falls in older adults with dementia.

To examine whether elderly people with dementia have a higher prevalence of falls and sleep disturbances than those without dementia, and to determine the subjective sleep characteristics associated with falls in older adults with dementia. This was a cross-sectional, population-based study derived from the data in the 2009 Taiwan National Health Interview Survey. A total of 123 older adults with dementia (aged 65 years or older), and 246 older adults without dementia who were randomly selected from the database were included. The occurrence of falls and subjective sleep characteristics (e.g. sleep hours, insomnia symptoms, daytime sleepiness, difficulty in breathing during sleep and daytime naps) were evaluated using the responses to the survey questions. The prevalence of falls in older adults with dementia were approximately twofold higher than that for those without dementia (27.6% vs 15.3%, P = 0.006). Older adults with dementia had longer sleep hours, and increased daytime sleepiness, daytime naps and difficulty in breathing during sleep (all P < 0.05) than those without dementia. Among older adults with dementia, daytime sleepiness was the only sleep characteristic that was significantly correlated to an increased risk of falls (adjusted odds ratio 5.56, 95% confidence interval 1.95-15.91) despite controlling for possible risk factors. Older adults with dementia had a higher prevalence of falls and sleep disturbances than that observed for those without dementia. Daytime sleepiness was an independent risk factor of falls in elderly people, with dementia after accounting for a range of covariates. Geriatr Gerontol Int 2016; 16: 850-855.

The effect of benzodiazepine and nonbenzodiazepine prescriptions for diabetes mellitus type 2 in elderly Taiwanese with depressive symptoms.

This study examined the relationship between depression, benzodiazepine (BZD)/nonbenzodiazepine hypnotics (non-BZD), and other risk factors in a national sample of Taiwan's elderly diabetic patients. Data were drawn from the 2005 Taiwan National Health Interview Survey and adults aged 65 years and older. A total of 1331 subjects were included in this study. The Chinese version of Center for Epidemiologic Studies Depression Scale was used to evaluate patients' depression symptoms. The rates of depression in the diabetes mellitus (DM) and non-DM groups were 13.5% (39/288) and 9.8% (102/1043) and the average ages were 73.7 and 73.4 years, respectively. In multivariate regression, the odds ratio of depression was 1.66-fold higher among BZD/non-BZD users (95% confidence interval: 1.10-2.51, model 2) than among those without BZD/non-BZD use. In addition, hyperlipidaemia, poor physical function, and antidepressant use were associated with a higher risk of depressive symptoms. Meanwhile, a monthly household income of NT$30 000-NT$49 999, exercise, and betel chewing were associated with a lower risk of depression. We performed an additional logistic analysis for which the odds ratio of depression significantly increased to 1.52 in non-DM elderly patients (95% confidence interval: 1.06-2.19) who were prescribed BZD/non-BZD. In contrast, there was no significant difference in the odds ratio of depression in the DM elderly regardless of BZD/non-BZD use, although there was a slight tendency for depression among those who used BZD/non-BZD. Depression in non-DM Taiwanese elderly patients was found to be associated with BZD/non-BZD use, whereas depression in DM Taiwanese elderly patients was not found to be associated with BZD/non-BZD use.

Validity of EQ-5D in general population of Taiwan: results of the 2009 National Health Interview and Drug Abuse Survey of Taiwan.

The aim of this study was to examine the validity of the EuroQOL five dimensions questionnaire (EQ-5D) using a nationally representative data from the National Health Interview Survey (NHIS) through comparison with short-form 36 (SF-36). Data for this study came from the 2009 NHIS in Taiwan. The study sample was the 4007 participants aged 20-64 years who completed the survey. We used SUDAAN 10.0 (SAS-Callable) to carry out weighed estimation and statistical inference. The EQ index was estimated using norm values from a Taiwanese study as well as from Japan and the United Kingdom (UK). The SF-36 score was standardized using American norm values. In terms of concurrent validity, the EQ-5D met the five hypotheses. The results did not fulfill hypothesis that women would have lower visual analogue scale (EQ-VAS) scores. In terms of discriminant validity, the EQ-5D fulfilled two hypotheses. Our results approached but did not fulfill hypothesis that there would be a weak association between the physical and psychological dimensions of the EQ-5D and the mental component summary score of the SF-36. Results were comparable regardless of whether the Japanese or UK norm value sets were used. We were able to fulfill many, not all of our validity hypotheses regardless of whether the established Japanese or UK norm value sets or the Taiwanese norm values were used. The EQ-5D is an effective and simple instrument for assessing health-related quality of life of general population in Taiwan.

Concordance between Patient Self-Reports and Claims Data on Clinical Diagnoses, Medication Use, and Health System Utilization in Taiwan

PurposeThe aim of this study was to evaluate the concordance between claims records in the National Health Insurance Research Database and patient self-reports on clinical diagnoses, medication use, and health system utilization.MethodsIn this study, we used the data of 15,574 participants collected from the 2005 Taiwan National Health Interview Survey. We assessed positive agreement, negative agreement, and Cohen's kappa statistics to examine the concordance between claims records and patient self-reports.ResultsKappa values were 0.43, 0.64, and 0.61 for clinical diagnoses, medication use, and health system utilization, respectively. Using a strict algorithm to identify the clinical diagnoses recorded in claims records could improve the negative agreement; however, the effect on positive agreement and kappa was diverse across various conditions.ConclusionWe found that the overall concordance between claims records in the National Health Insurance Research Database and patient self-reports in the Taiwan National Health Interview Survey was moderate for clinical diagnosis and substantial for both medication use and health system utilization.

Benzodiazepine & nonbenzodiazepine prescriptions for Taiwanese elderly with type 2 diabetes contributes to cognitive dysfunction.

This study examined the relationship of cognitive function and benzodiazepine/nonbenzodiazepine hypnotics (BZD/nonBZD) and other risk factors in a national sample of Taiwan's elderly diabetic patients. Data were drawn from the "2005 Taiwan National Health Interview Survey (NHIS)", a population-based study of a national sample of adults aged 65 years and older. A total of 653 participants were included in this study. The Mini-Mental State Examination (MMSE) was used to evaluate patient's cognitive function for which the cut-off score is education-adjusted. There were 130 participants left in the diabetic group and 523 participants in the control group. The average age was 74.2 and 73.3 respectively. The rate of cognitive dysfunction in DM and non DM participants was 11.5% (15/130) and 8.4% (44/523). Compared with those without diabetes in multivariate logistic regression, the odds ratio of cognitive impairment was 1.87-fold higher for diabetic patients (95% CI 1.04-3.61) after adjusting for sociodemographic characteristics, comorbidities, and BZD/nonBZD. Other factors were not significant. We performed an additional logistic analysis for which the odds ratio of cognitive impairment in diabetic patients with BZD/nonBZD was significantly increased to 2.41 (95% CI 1.08-5.40) than for patients without diabetes and BZD/nonBZD. In our research, cognitive dysfunction was associated with diabetes. BZD/nonBZD may have conferred additional risk of cognitive impairment in our elderly diabetic patients. We should consider examining the mental function of DM patients regularly and try our best to avoid potentially inappropriate medications (PIMs).

Geriatric conditions as predictors of increased number of hospital admissions and hospital bed days over one year: Findings of a nationwide cohort of older adults from Taiwan

The main aim of the present study was to determine whether geriatric conditions independently predict hospital utilizations after controlling for chronic diseases and disability among community dwelling older adults. We analyzed data from a nationally representative sample of older adults aged 65 years and above by linkage of 2005 Taiwan National Health Interview Survey data (including demographic characteristics, chronic diseases, disability, and geriatric conditions such as depressive symptoms, cognitive impairment, falls, and urinary incontinence), and 2006 National Health Insurance (NHI) claims data (including hospital admissions and hospital bed days). A total of 1598 participants who consented to data linkage, were successfully linked to NHI data, and had complete data for geriatric conditions were eligible for analysis. The prevalence of depressive symptoms, cognitive impairment, falls, and urinary incontinence were 20.6%, 26.1%, 21.3% and 23.9%, respectively. Overall, 18.2% (291/1598) of participants had at least one hospital admission during 2006. After adjustment for demographics, prior hospitalization, chronic diseases and functional disability, participants with geriatric conditions had significantly more hospital admissions (incidence rate ratio=1.34; 95% confidence interval=[1.02–1.75]) and more hospital bed days (incidence rate ratio=1.72; 95% confidence interval=[1.11–2.66]) than participants without geriatric conditions. Our results highlight the high prevalence (56.3%) of one or more geriatric conditions and their independent association with excess hospital utilizations. Thus, it is of critical importance to develop programs aimed at preventing or improving these conditions to reduce hospital use in this population.

Exposure to secondhand smoke and risk of tuberculosis: prospective cohort study.

BackgroundProspective evidence on the association between secondhand-smoke exposure and tuberculosis is limited.MethodsWe included 23,827 never smokers from two rounds (2001 and 2005) of Taiwan National Health Interview Survey. Information on exposure to secondhand smoke at home as well as other sociodemographic and behavioral factors was collected through in-person interview. The participants were prospectively followed for incidence of tuberculosis through cross-matching the survey database to the national tuberculosis registry of Taiwan.ResultsA total of 85 cases of active tuberculosis were identified after a median follow-up of 7.0 years. The prevalence of exposure to secondhand smoke at home was 41.8% in the study population. In the multivariable Cox proportional hazards analysis, secondhand smoke was not associated with active tuberculosis (adjusted hazard ratio [HR], 1.03; 95% CI, 0.64 to 1.64). In the subgroup analysis, the association between secondhand smoke and tuberculosis decreased with increasing age; the adjusted HR for those <18, > = 18 and <40, > = 40 and <60, and > = 60 years old was 8.48 (0.77 to 93.56), 2.29 (0.75 to 7.01), 1.33 (0.58 to 3.01), and 0.66 (0.35 to 1.23) respectively. Results from extensive sensitivity analyses suggested that potential misclassification of secondhand-smoke exposure would not substantially affect the observed associations.ConclusionsThe results from this prospective cohort study did not support an overall association between secondhand smoke and tuberculosis. However, the finding that adolescents might be particularly susceptible to secondhand smoke's effect warrants further investigation.

Gender Differences in Traditional Chinese Medicine Use among Adults in Taiwan

ObjectivesThe increasing use of complementary, alternative medicine (CAM) and traditional Chinese medicine (TCM) has attracted attention. We report on the gender difference in TCM use among the general population in Taiwan in a population-based, cross-sectional study.MethodsWe collected data on socio-demographic factors, lifestyle and health behavior from the 2001 Taiwan National Health Interview Survey. The medical records of interviewees aged 20–69 years were obtained from National Health Insurance claims data with informed consent. The prevalence of TCM use and the average frequency of TCM use were compared between women and men.ResultsAmong 14,064 eligible participants, the one-year prevalence of TCM use for women and men was 31.8% and 22.4%, respectively. Compared with men, women had a higher average TCM use frequency (1.55 visits vs. 1.04 visits, p<0.001). This significant difference remained evident after excluding gender-specific diseases (1.43 visits vs. 1.03 visits, p<0.001). The average TCM use frequency was significantly higher in women than in men across all age groups. TCM use correlates differed for women and men. Marital status (odds ratio [OR] = 1.55, 95% confidence interval [CI] = 1.30–1.85), family income and unhealthy lifestyle (OR = 1.50, 95% CI = 1.30–1.74) were factors associated with TCM use in men but not in women.ConclusionsIn Taiwan, women used more TCM services than men and the gender differences in the TCM use profile persisted across age groups.

Self-reported myopia in Taiwan: 2005 Taiwan National Health Interview Survey

To determine the prevalence of self-reported myopia nationwide in Taiwan and its association with degrees of urbanization and education levels. Data were obtained from the 2005 Taiwan National Health Interview Survey, a nationwide survey using multistage stratified systematic sampling. The presence of myopia, current residential areas, and education levels were ascertained by a structured questionnaire in participants ≥ 12 years of age. A total of 20,609 eligible persons were included in this study. The overall weighted prevalence of myopia in Taiwan was 46.7% (95% confidence interval: 45.9, 47.5%). The prevalence of myopia for persons aged 12-19, 20-39, 40-64, and ≥ 65 years was 70.3%, 65.4%, 30.4%, and 5.6%, respectively. Women had significantly higher rates of myopia than men for persons younger than 40 years of age (P<0.001). Myopia was significantly associated with both higher degrees of urbanization of current residential areas and higher education levels (both P<0.001). In young adult and adult groups, the effect of education levels on myopia was stronger than that of degrees of urbanization. The study provides a nation-wide prevalence data on myopia in Taiwan. Both degrees of urbanization and education levels are risk factors for myopia.

Which Domain of Self-Rated Health Best Predicts Medical Care Utilization Among Taiwanese Adults?

BackgroundWe attempted to identify the domain of self-rated health (SRH) that best predicts medical care utilization among Taiwanese adults. In addition, we examined the association between SRH and different measure of medical care utilization.MethodsWe analyzed data on 11 987 community-dwelling adults aged 18 to 64 years from the 2005 Taiwan National Health Interview Survey (NHIS). NHIS data were linked to the 2006 National Health Insurance (NHI) administrative database. Then, medical care utilization in 2006, including all outpatient visits, hospitalizations, and mental health outpatient visits, was identified. Domain-specific health ratings were measured by using the Short Form-36 (SF-36) health survey questionnaire. Negative binominal models were used to estimate the contribution of the health domains to medical care utilization. Incidence rate ratios (IRRs) are presented.ResultsThe IRR for the physical component scale showed that those with the highest scores had 77% of the outpatient visits of those with the lowest scores. The importance of mental health domains was markedly higher in estimating mental health outpatient visits. Those with mental health scores above the median had only 61% of mental health outpatient visits of those with scores below the median.ConclusionsA person’s medical care utilization is reflected in the different domains of general health. Domain-specific measures of subjective health are not interchangeable with global general health ratings, because different domains have independent effects on medical care utilization. Our results are potentially important for medical resource allocation because they identify different health domain experiences that require improvement.

Relationships of leisure-time and non-leisure-time physical activity with depressive symptoms: a population-based study of Taiwanese older adults

BackgroundLimited research has explored the relationship between non-leisure-time physical activity (NLTPA), including domestic and work-related physical activities, with depressive symptoms. This study was designed to elucidate independent associations between leisure-time physical activity (LTPA), NLTPA, and specific parameters of physical activity (frequency, duration and intensity) with depressive symptoms in older adults.MethodsA total of 2,727 persons aged ≥ 65 years participating in the 2005 Taiwan National Health Interview Survey were studied. Depressive symptoms were measured by the Center for Epidemiological Studies Depression Scale. Information regarding energy parameters for each type of LTPA and NLTPA during the past 2-week period was analyzed. After adjusting for socio-demographic variables, lifestyle behaviors and health status, multivariate logistic regression models were used to compute adjusted odds ratios (AOR) for LTPA and NLTPA for predicting depressive symptoms.ResultsLTPA but not NLTPA was significantly associated with depressive symptoms. Compared with participants expending 2000+ kcal/week through LTPA, the risk of experiencing depressive symptoms was significantly higher for those expending 1-999 kcal/week (AOR = 2.06, 95% CI: 1.25-3.39), and those who expending 0 kcal/week (AOR = 3.72, 95%CI: 2.28-6.06). Among the three parameters of LTPA (intensity, duration and frequency) examined, only intensity was independently associated with depressive symptoms.ConclusionsThese findings imply that exercise recommendations for older adults should emphasize the importance of higher intensity activity, rather than frequency or duration, for improved mental well-being. However, well-designed prospective cohort studies or intervention trials are needed to confirm these findings.

The association between physical disability and eye care utilization among elderly population in Taiwan: A nationwide cohort study

Medical utilization by elderly population is influenced by a number of factors, and physical disabilities may play an important role. Despite the fact that extensive studies have been carried evaluating medical utilization by older individuals, little is known regarding the impact of physical disabilities on eye care utilization. Using datasets from the Taiwan National Health Interview Survey and National Health Insurance (NHI) system, a sample of 1726 elderly people was obtained for analysis. Older persons with worse Activity of Daily Living (ADL) disabilities were less likely to have eye care (odds ratio (OR): 0.39, 95% confidence interval (CI): 0.25–0.62), but elderly who had Instrumental Activity of Daily Living (IADL) disabilities alone were not associated with lower odds (OR=0.86, 95% CI=0.61–1.20). In addition to the above, female individuals (OR=1.91, 95% CI=1.44–2.53), those with poorer vision (OR=1.89, 95% CI=1.36–2.62), those having eye discomfort (OR=1.66, 95% CI=1.26–2.18 and OR=2.14, 95% CI=1. 32–3.46 respectively for mild and more than moderate eye discomfort), and those with severe eye disease (OR=1.96, 95% CI=1.23–3.10) were more likely to undergo eye care. In conclusion, physical disability is a strong risk factor for lack of eye care utilization among older Taiwanese. The barriers associated with low eye care utilization among individuals with ADL disabilities should be explored in order to facilitate effective policy implementation among those elderly with disabilities so that they are able to receive appropriate eye care.

J-030 RELATIONSHIP BETWEEN UNEMPLOYMENT RATE AND INCIDENCE OF HYPERTENSION AND THE NUMBER OF OUTPATIENT AND INPATIENT VISITS BETWEEN 2001 AND 2005

Background Social economic status has been found associated with cardiovascular diseases. This study investigates the effects of unemployment rate on the incidence of hypertension, and the outpatient and inpatient visits due to hypertension. Methods Data were from the 2001 Taiwan National Health Interview Survey (NHIS). With the informed consent of NHIS respondents, we obtained their medical utilization from National Health Insurance (NHI) claims data. Then the biomarkers of NHIS respondents were collected from the Taiwanese Survey on Hypertension, Hyperglycemia, and Hyperlipidemia (TwSHHH). County unemployment rate was used as an area-level socioeconomic variable. Hypertension was defined according to ICD-9-CM: 401–405. Multilevel model for survival analysis with a time-dependent covariate was used. Multilevel logistic regression and multilevel Poisson regression were performed to estimate effects on the outpatient and inpatient visits. Results There were 5,361 individuals included in the analysis. During 2001 to 2005, the unemployment rate increased the chance of hypertension of females living in metropolitan areas (hazard ratio (HR):1.21, 95%CI:1.01∼1.46) given other risk factors. Unemployment rate reduced the utilization of health care services, such as outpatient or inpatient services. After controlling for other factors, the rate ratio of unemployment rate (RR) was 0.81 (95%CI:0.71∼0.93) and 0.77 (95%CI:0.67∼0.88) for males and females respectively. Older age, living with spouse, with larger BMI, higher values of triglycerides or waist-to-hip ration increased the chance of utilization of health care due to hypertension. Similar pattern was found in number of visits. Conclusion After controlling age, education, marital status, smoking, alcohol drinking, monthly income, body mass index, triglycerides and waist to hip ratio, unemployment rate increased the incidence of hypertension in females living in metropolitan areas. However, the unemployment rate decreased the utilization of health care systems for hypertension.

Psychosocial problems in children with allergic diseases: a population study in Taiwan

A few studies had pointed out the relationship between a single allergic disease and children's psychosocial problems; however, all of these researchers considered the allergic diseases separately. Therefore, this study aimed to investigate the relationship between collective allergic diseases and psychosocial problems among 4- to 12-year-old children in Taiwan. The data were generated from the 2005 Taiwan National Health Interview Survey. A total of 2955 parents or guardians completed the answers for their 4- to 12-year-old children. We used logistic regressions to investigate the association of allergic diseases and the psychosocial problems. About 40.62% children had at least one allergic disease in the past year, and 17.75% children had a score of psychosocial problems higher than or equal to the 75th percentile. After controlling for demographic factors, the risk of having high-level psychosocial problem for children with any allergic disease was 1.84 times of those without allergy. For those who had one, two or more than two allergic diseases, the risks of having psychosocial problems were 1.56, 2.20 and 3.39 times of those had no allergy disease respectively. Children with asthma, dermatitis and rhinitis simultaneously had the highest psychosocial impact (odds ratio = 5.10). Collective allergic diseases were associated with psychosocial problems in children, and the effect was gradient. Parents and paediatricians should pay attention to psychosocial problems in children with allergic diseases and vice versa.