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Jiang Y, Li L. Projections of functional dependence among the late middle-aged and older population from 2018-2048 in China: a dynamic microsimulation. Glob Health Res Policy 2024; 9:15. [PMID: 38679749 PMCID: PMC11057077 DOI: 10.1186/s41256-024-00357-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/23/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND The population of China is aging rapidly. However, the long-term trajectories of functionally dependent late middle-aged and older Chinese people are currently absent. The present study aimed to estimate the population size and proportion of late middle-aged and older adults with difficulties and dependence on activities of daily living (ADL) and instrumental activities of daily living (IADL) in China from 2018 to 2048. METHODS We constructed a dynamic microsimulation model to project the population size and proportions of late middle-aged and older Chinese people who have difficulty and dependence in ADL and IADL from 2018-2048. The model was populated with a representative sample of the target population and allowed individual-level interaction between risk factors, diseases, and health outcomes. Analyses by socioeconomic subgroups were also conducted. RESULTS Almost 25% and 38% of late middle-aged and older people in China will become ADL- and IADL-dependent by 2048, respectively. Also, 17% of the target population will be severely ADL-disabled by 2048. The inequity in functional status across subgroups by sex, educational level, and urban/rural residency will become substantial. CONCLUSIONS The numbers and percentages of China's functionally difficult and dependent late middle-aged and older population will increase by magnitudes as of the mid-21st century, the pressure of which is compounded by its disproportionate distribution across subgroups. To alleviate the overwhelming challenge, efforts to improve the functional status of the underserved subpopulation should also be iterated.
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Affiliation(s)
- Yawen Jiang
- School of Public Health (Shenzhen), Sun Yat-sen University, Room 533, #1 West Wing of Medical Complex, 66 Gongchang Road, Guangming District, Shenzhen, Guangdong, China.
| | - Limin Li
- School of Public Health (Shenzhen), Sun Yat-sen University, Room 533, #1 West Wing of Medical Complex, 66 Gongchang Road, Guangming District, Shenzhen, Guangdong, China
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Hu L, Wu S, Zhang Y, Xia X, Shu Y, He Q, Manshan H, Kuo Z, Zhao Y, Wang P, Li Y, Wang C, Su K, Han H, Yuan J, Xiang J, Xia B. Associations of maternal and personal smoking with all-cause and cause-specific mortality risk and life expectancy: a prospective cohort study. Public Health 2024; 229:144-150. [PMID: 38442596 DOI: 10.1016/j.puhe.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/18/2024] [Accepted: 02/04/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVES The aim of this study was to evaluate the individual and combined effects of maternal smoking during pregnancy (MSDP) and personal smoking on mortality and life expectancy. STUDY DESIGN A prospective cohort study based on the UK Biobank, with a median follow-up of 12.47 years. METHODS This study employed multivariate Cox regression to determine the relative risks of mortality from all causes and specific diseases according to maternal and/or personal smoking status and pack-years of smoking (0, 1-20, 21-30, >30). Additionally, this study estimated the additive interaction between the two exposures. Life table analyses were performed using the estimated age-specific mortality rates to forecast life expectancy. RESULTS Results indicated that MSDP elevated the risk of all-cause mortality (HR = 1.12, 95% CI: 1.09-1.15) and mortality due to neoplasms (HR = 1.10, 95% CI: 1.06-1.12), circulatory (HR = 1.13, 95% CI: 1.06-1.19), respiratory (HR = 1.27, 95% CI: 1.16-1.40) and digestive system diseases (HR = 1.22, 95% CI: 1.08-1.38). Notably, both multiplicative and additive interactions were observed between maternal and personal smoking, with Relative Excess Risk due to Interaction (RERI) values for mortality from all causes, neoplasms, circulatory, and respiratory diseases being 0.21, 0.22, 0.16, and 0.76, respectively. This study also found a trend towards shorter gained life expectancy when maternal smoking and increasing pack-years of personal smoking were combined. CONCLUSIONS In this cohort study of UK Biobank, MSDP was associated with an increased risk of all-cause mortality and reduced life expectancy, suggesting that quitting smoking during pregnancy might have health and longevity benefits for both generations.
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Affiliation(s)
- Linmin Hu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China
| | - Siqing Wu
- School of Medicine, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China
| | - Yunhui Zhang
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China
| | - Xuedan Xia
- Clinical Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China
| | - Yuelong Shu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China; Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Pekina Union Medical School, Beijing, China
| | - Qiangsheng He
- Clinical Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China; Big Data Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China; Chinese Health Risk Management Collaboration (CHRIMAC), Shenzhen, Guangdong 518107, China
| | - Huang Manshan
- Department of Stomatology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China
| | - Zicong Kuo
- Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China; Center for Digestive Disease, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China
| | - Yingya Zhao
- Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pengpeng Wang
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China
| | - Yanfei Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Chunliang Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China
| | - Kai Su
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China
| | - Hengyi Han
- School of Medicine, Tsinghua University, Beijing, China
| | - Jinqiu Yuan
- Clinical Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China; Big Data Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China; Chinese Health Risk Management Collaboration (CHRIMAC), Shenzhen, Guangdong 518107, China; Center for Digestive Disease, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China.
| | - Jianbang Xiang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China.
| | - Bin Xia
- Clinical Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China; Big Data Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China; Chinese Health Risk Management Collaboration (CHRIMAC), Shenzhen, Guangdong 518107, China.
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Palacios A, Alcaraz A, Casarini A, Rodriguez Cairoli F, Espinola N, Balan D, Perelli L, Augustovski F, Bardach A, Pichon-Riviere A. The health, economic and social burden of smoking in Argentina, and the impact of increasing tobacco taxes in a context of illicit trade. HEALTH ECONOMICS 2023; 32:2655-2672. [PMID: 37525366 DOI: 10.1002/hec.4741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 03/15/2023] [Accepted: 06/12/2023] [Indexed: 08/02/2023]
Abstract
Tobacco tax increases, the most cost-effective measure in reducing consumption, remain underutilized in low and middle-income countries. This study estimates the health and economic burden of smoking in Argentina and forecasts the benefits of tobacco tax hikes, accounting for the potential effects of illicit trade. Using a probabilistic Markov microsimulation model, this study quantifies smoking-related deaths, health events, and societal costs. The model also estimates the health and economic benefits of different increases in the price of cigarettes through taxes. Annually, smoking causes 45,000 deaths and 221,000 health events in Argentina, costing USD 2782 million in direct medical expenses, USD 1470 million in labor productivity loss costs, and USD 1069 million in informal care costs-totaling 1.2% of the national gross domestic product. Even in a scenario that considers illicit trade of tobacco products, a 50% cigarette price increase through taxes could yield USD 8292 million in total economic benefits accumulated over a decade. Consequently, raising tobacco taxes could significantly reduce the health and economic burdens of smoking in Argentina while increasing fiscal revenue.
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Affiliation(s)
- Alfredo Palacios
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- Centre for Health Economics (CHE), University of York, York, UK
| | - Andrea Alcaraz
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Agustín Casarini
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | | | - Natalia Espinola
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Dario Balan
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Lucas Perelli
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Federico Augustovski
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- CONICET (National Scientific and Technical Research Council, Argentina), Buenos Aires, Argentina
- School of Public Health, University of Buenos Aires (UBA), Buenos Aires, Argentina
| | - Ariel Bardach
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- CONICET (National Scientific and Technical Research Council, Argentina), Buenos Aires, Argentina
| | - Andrés Pichon-Riviere
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- CONICET (National Scientific and Technical Research Council, Argentina), Buenos Aires, Argentina
- School of Public Health, University of Buenos Aires (UBA), Buenos Aires, Argentina
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Depression with Chronic Disease Is Associated with Increased Use of Medical Services and Medical Expenses in Hardcore Smokers. Healthcare (Basel) 2022; 10:healthcare10081405. [PMID: 36011061 PMCID: PMC9407839 DOI: 10.3390/healthcare10081405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/11/2022] [Accepted: 07/19/2022] [Indexed: 11/17/2022] Open
Abstract
We aimed to investigate the association of chronic disease and depression with medical service use and expenses in hardcore smokers and provide basic data for health management system of hardcore smokers. This was a secondary data study involving 1735 smokers. Propensity score matching (PSM) was conducted to match hardcore smokers with regular smokers, and a two part model (TPM) was used based on the matched groups. In the case of general smokers, subjects with both depression and chronic disease had a significant relation to medical service use. In the case of hardcore smokers, subjects without depression and with chronic disease or with both depression and chronic disease had increased the use of medical services. The depression and chronic disease of general smokers did not affect the use of medical services. In the case of hardcore smokers, subjects who do not have depression and have only chronic disease (β = 0.20, p = 0.002) or with depression and chronic disease (β = 0.20, p = 0.014) significantly related the use of medical services. Conclusion: It is necessary to establish a health management system that considers both emotional states and chronic disease for hardcore smokers.
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May P, Normand C, Matthews S, Kenny RA, Romero-Ortuno R, Tysinger B. Projecting future health and service use among older people in Ireland: an overview of a dynamic microsimulation model in The Irish Longitudinal Study on Ageing (TILDA). HRB Open Res 2022; 5:21. [PMID: 36262382 PMCID: PMC9554695 DOI: 10.12688/hrbopenres.13525.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 10/14/2023] Open
Abstract
Background: Demographic ageing is a population health success story but poses unprecedented policy challenges in the 21st century. Policymakers must prepare health systems, economies and societies for these challenges. Policy choices can be usefully informed by models that evaluate outcomes and trade-offs in advance under different scenarios. Methods: We developed a dynamic demographic-economic microsimulation model for the population aged 50 and over in Ireland: the Irish Future Older Adults Model (IFOAM). Our principal dataset was The Irish Longitudinal Study on Ageing (TILDA). We employed first-order Markovian competing risks models to estimate transition probabilities of TILDA participants to different outcomes: diagnosis of serious diseases, functional limitations, risk-modifying behaviours, health care use and mortality. We combined transition probabilities with the characteristics of the stock population to estimate biennial changes in outcome state. Results: IFOAM projections estimated large annual increases in total deaths, in the number of people living and dying with serious illness and functional impairment, and in demand for hospital care between 2018 and 2040. The most important driver of these increases is the rising absolute number of older people in Ireland as the population ages. The increasing proportion of older old and oldest old citizens is projected to increase the average prevalence of chronic conditions and functional limitations. We deemed internal validity to be good but lacked external benchmarks for validation and corroboration of most outcomes. Conclusion: We have developed and validated a microsimulation model that projects health and related outcomes among older people in Ireland. Future research should address identified policy questions. The model enhances the capacity of researchers and policymakers to quantitatively forecast health and economic dynamics among older people in Ireland, to evaluate ex ante policy responses to these dynamics, and to collaborate internationally on global challenges associated with demographic ageing.
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Affiliation(s)
- Peter May
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, Dublin, D2, Ireland
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Pearse Street, Dublin, D2, Ireland
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, Dublin, D2, Ireland
- Cicely Saunders Institute, King's College London, Denmark Hill, London, SE1 1UL, UK
| | - Soraya Matthews
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, Dublin, D2, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Pearse Street, Dublin, D2, Ireland
| | - Roman Romero-Ortuno
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Pearse Street, Dublin, D2, Ireland
- Global Brain Health Institute, Trinity College Dublin, Lloyd Institute, Dublin, D2, Ireland
| | - Bryan Tysinger
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, 90007, USA
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Maldonado N, Llorente B, Reynales-Shigematsu LM, Saenz-de-Miera B, Jha P, Shannon G. Tobacco Taxes as the Unsung Hero: Impact of a Tax Increase on Advancing Sustainable Development in Colombia. Int J Public Health 2022; 67:1604353. [PMID: 35431761 PMCID: PMC9006985 DOI: 10.3389/ijph.2022.1604353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/16/2022] [Indexed: 11/25/2022] Open
Abstract
Objective: Tobacco taxes are a well-established cost-effective policy to prevent Noncommunicable Diseases. This paper evaluates the expected effects of a tobacco tax increase on the Sustainable Development Goals in Colombia. Methods: We use microsimulation to build an artificial society that mimics the observed characteristics of Colombia's population, and from there we simulate the behavioral response to a tax increase of COP$4,750 (an increase that has been discussed by policy makers and legislators) and the subsequent effects in all SDGs. Results: The tobacco tax hike reduces the number of smokers (from 4.51 to 3.45 MM smokers) and smoking intensity, resulting in a drop in the number of cigarettes smoked in Colombia (from 332.3 to 215.5 MM of 20-stick packs). Such reduction is expected to decrease premature mortality, healthcare costs, poverty and people facing catastrophic expenditure on healthcare, to increase health, income and gender equity, and to strengthen domestic resource mobilization even in the presence of illicit cigarettes. Conclusion: Tobacco taxes are an effective intervention for public health and a powerful instrument to advance on the 2030 Sustainable Development Agenda. Relevance: A comprehensive analysis of the impact of tobacco taxes on all areas of Sustainable Development is missing in the empirical literature. Such perspective is needed to break the barriers for further tobacco tax increases by gathering wider societal support, especially from stakeholders and key decision makers from development areas other than health. SDG Nr: SDG3 (health), SDG 1 (no poverty), SDG 4 (education), SDG 5 (gender equality), SDG6 (water), SDG10 (inequality), SDG12 (responsible production and consumption), SDG17 (partnerships).
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Affiliation(s)
- Norman Maldonado
- Research Center on Health Economics and Social Protection (PROESA), Universidad ICESI, Cali, Colombia
- Global Tobacco Economics Consortium (GTEC), Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Blanca Llorente
- Global Tobacco Economics Consortium (GTEC), Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Fundación Anáas, Bogotá, Colombia
| | - Luz Myriam Reynales-Shigematsu
- Global Tobacco Economics Consortium (GTEC), Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Belen Saenz-de-Miera
- Global Tobacco Economics Consortium (GTEC), Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Universidad Autónoma de Baja California Sur, La Paz, México
| | - Prabhat Jha
- Global Tobacco Economics Consortium (GTEC), Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Centre for Global Health Research, University of Toronto, Toronto, ON, Canada
| | - Geordan Shannon
- Global Tobacco Economics Consortium (GTEC), Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Institute for Global Health, University College London, London, United Kingdom
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May P, Normand C, Matthews S, Kenny RA, Romero-Ortuno R, Tysinger B. Projecting future health and service use among older people in Ireland: an overview of a dynamic microsimulation model in The Irish Longitudinal Study on Ageing (TILDA). HRB Open Res 2022; 5:21. [PMID: 36262382 PMCID: PMC9554695 DOI: 10.12688/hrbopenres.13525.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Demographic ageing is a population health success story but poses unprecedented policy challenges in the 21st century. Policymakers must prepare health systems, economies and societies for these challenges. Policy choices can be usefully informed by models that evaluate outcomes and trade-offs in advance under different scenarios. Methods:
We developed a dynamic demographic-economic microsimulation model for the population aged 50 and over in Ireland: the Irish Future Older Adults Model (IFOAM). Our principal dataset was The Irish Longitudinal Study on Ageing (TILDA). We employed first-order Markovian competing risks models to estimate transition probabilities of TILDA participants to different outcomes: diagnosis of serious diseases, functional limitations, risk-modifying behaviours, health care use and mortality. We combined transition probabilities with the characteristics of the stock population to estimate biennial changes in outcome state.
Results: IFOAM projections estimated large annual increases in total deaths, in the number of people living and dying with serious illness and functional impairment, and in demand for hospital care between 2018 and 2040. The most important driver of these increases is the rising absolute number of older people in Ireland as the population ages. The increasing proportion of older old and oldest old citizens is projected to increase the average prevalence of chronic conditions and functional limitations. We deemed internal validity to be good but lacked external benchmarks for validation and corroboration of most outcomes. Conclusion:
We have developed and validated a microsimulation model that predicts future health and related outcomes among older people in Ireland. Future research should address identified policy questions. The model enhances the capacity of researchers and policymakers to quantitatively forecast future health and economic dynamics among older people in Ireland, to evaluate ex ante policy responses to these dynamics, and to collaborate internationally on global challenges associated with demographic ageing.
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Affiliation(s)
- Peter May
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, Dublin, D2, Ireland
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Pearse Street, Dublin, D2, Ireland
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, Dublin, D2, Ireland
- Cicely Saunders Institute, King's College London, Denmark Hill, London, SE1 1UL, UK
| | - Soraya Matthews
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, Dublin, D2, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Pearse Street, Dublin, D2, Ireland
| | - Roman Romero-Ortuno
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Pearse Street, Dublin, D2, Ireland
- Global Brain Health Institute, Trinity College Dublin, Lloyd Institute, Dublin, D2, Ireland
| | - Bryan Tysinger
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, 90007, USA
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Lee TH, Kim W. Differences in electronic cigarette use among adolescents in Korea: A nationwide analysis. J Subst Abuse Treat 2021; 131:108554. [PMID: 34187709 DOI: 10.1016/j.jsat.2021.108554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/16/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The use of electronic cigarettes (e-cigarettes) has increased among adolescents. This study aimed to investigate the relationship between e-cigarette use and different sociodemographic factors among Korean adolescents. METHODS The study used the 2017 to 2019 Korea Youth Risk Behavior Web-based Survey (KYRBS) data. The study measured sociodemographic status based on living arrangement, economic status, and parental birthplace. We used a Chi-square test to investigate the general characteristics of the study population. We applied multiple logistic regression analysis to analyze the association between e-cigarette use and sociodemographic status. Model 1 included electronic cigarettes only as the outcome variable and model 2 included electronic cigarettes plus combustible cigarettes. The study expressed results as odds ratios (OR) and their 95% confidence interval (95% CI). RESULTS A total of 2.4% of adolescents used e-cigarettes only and 6.5% e-cigarettes and/or conventional cigarettes. In e-cigarettes users (model 1), compared to individuals living with their parents, those living with their relatives (OR 3.23, 95% CI 2.45-4.24) and in protective facilities (OR 4.36, 95% CI 2.98-6.39) were more likely to smoke. The "middle" showed lower odds than the "low" economic status group (OR 0.78, 95% CI 0.69-0.87). Adolescents with both parents born abroad (OR 2.92, 95% CI 1.78-4.82) also had a higher likelihood of smoking than those with both native Korean parents. The study found similar trends in model 2, which accounted for both electronic and combustible cigarettes. CONCLUSION E-cigarette use among adolescents was associated with living arrangement, economic status, and parental birthplace. E-cigarettes use among adolescents should be monitored, particularly in the vulnerable groups of adolescents that this study identified.
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Affiliation(s)
- Tae Hoon Lee
- Medical Cost Analysis Division, Health Insurance Review & Assessment Service, Wonju-si, Republic of Korea
| | - Woorim Kim
- Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang-si, Republic of Korea.
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