[Show abstract][Hide abstract] ABSTRACT: Health related quality of life (HRQoL) is an important dimension of individuals' well-being, and especially in chronic diseases like diabetes and hypertension. The objective of this study was to evaluate the contributions of disease process, comorbidities, medication or awareness of the disease to HRQoL in diabetes mellitus, hypertension and dyslipidemia.
This was a cross-sectional study of 3514 respondents from the general community in Singapore, assessed for HRQoL, disease and comorbid conditions through self-report, clinical and laboratory investigations. HRQoL was assessed using SF-36 health survey version 2. For each condition, participants were categorized as having 1) no disease, 2) undiagnosed, 3) diagnosed, not taking medication, and 4) diagnosed, taking medication. Analysis used one-way ANOVA and multiple linear regression.
Diagnosed disease was associated with lower physical health component summary (PCS) scores across all three conditions. After adjustment for comorbidities, this association remained significant only for those not on medication in diabetes (-2.7±1.2 points, p = 0.03) and dyslipidemia (-1.3±0.4 points, p = 0.003). Diagnosed hypertension (no medication -2.6±0.9 points, p = 0.002; medication -1.4±0.5 points, p = 0.004) and dyslipidemia (no medication -0.9±0.4 points, p = 0.03; medication -1.9±0.5 points, p<0.001) were associated with lower mental health component summary (MCS) scores. Undiagnosed disease was associated with higher MCS in diabetes (2.4±1.0 points, p = 0.01) and dyslipidemia (0.8±0.4 points, p = 0.045), and PCS in hypertension (1.2±0.4 points, p = 0.004).
Disease awareness was associated with lower HRQoL across the diseases studied, with PCS associations partially mediated by comorbidities. Equally importantly, undiagnosed disease was not associated with HRQoL deficits, which may partly explain why these individuals do not seek medical care.
PLoS ONE 11/2014; 9(11):e113802. DOI:10.1371/journal.pone.0113802 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Context: Hemoglobin A1c (HbA1c) ≥6.5% (47.5 mmol/mol) has recently been included as a criterion for the diagnosis of diabetes mellitus. It is unclear whether this criterion is appropriate in Asians. Objective: To examine the relationship between HbA1c and diabetes-specific moderate-retinopathy in Asian ethnic groups. Design, setting and participants: Four independent population: based cross-sectional studies (2004-2011) in Singapore representing the three major Asian ethnic groups (n=13,170 adults aged ≥25 years, Chinese =5,834, Malays=3,596, and Indians=3,740). Main outcome: Moderate-retinopathy was assessed from digital retinal photographs and defined as level >43 using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. Sensitivity, specificity, positive and negative predictive values (PPV, NPV), and the area under the receiver operating characteristic curve (AUC) for detecting moderate-retinopathy were compared across ethnic groups at different HbA1c cut-points. Results: HbA1c levels were higher in Indians and Malays compared to Chinese (p<0.001). The prevalence of moderate-retinopathy below HbA1c <6.5% was <1% in all ethnic groups. At HbA1c ≥6.5%, the sensitivity for detecting moderate-retinopathy was lower in Chinese compared to Indians and Malays (75.8% vs. 86.0%, 85.3%), but specificity (89.7% vs. 71.9%, 76.3%) was higher; however, PPV and NPV were similar among Chinese, Indians, and Malays (10.5%, 12.3%, 12.4%; 99.6%, 99.1%, 99.2%). The AUCs were similar across all three ethnic groups (0.861, 0.851 and 0.853). Conclusions: Our study supports the use of HbA1c for diagnosing diabetes in Asians. Despite some inter-ethnic variation in the relationship of HbA1c and retinopathy, a cut-point of 6.5% performs reasonably well in the three major Asian ethnic groups.
[Show abstract][Hide abstract] ABSTRACT: Objectives: The relationship between disability and comorbidity on mortality is widely perceived as additive in clinical models of frailty. Design: National data were retrospectively extracted from medical records of community hospital. Data Sources: There were of 12,804 acutely-disabled patients admitted for inpatient rehabilitation in Singapore rehabilitation community hospitals from 1996 through 2005 were followed up for death till 31 December 2011. Outcome Measure: Cox proportional-hazards regression to assess the interaction of comorbidity and disability at discharge on all-cause mortality. Results: During a median follow-up of 10.9 years, there were 8,565 deaths (66.9%). The mean age was 73.0 (standard deviation: 11.5) years. Independent risk factors of mortality were higher comorbidity (p<0.001), severity of disability at discharge (p<0.001), being widowed (adjusted hazard ratio [aHR]: 1.38, 95% confidence interval [CI]:1.25-1.53), low socioeconomic status (aHR: 1.40, 95%CI:1.29-1.53), discharge to nursing home (aHR: 1.14, 95%CI:1.05-1.22) and re-admission into acute care (aHR: 1.54, 95%CI:1.45-1.65). In the main effects model, those with high comorbidity had an aHR = 2.41 (95%CI:2.13-2.72) whereas those with total disability had an aHR = 2.28 (95%CI:2.12-2.46). In the interaction model, synergistic interaction existed between comorbidity and disability (p<0.001) where those with high comorbidity and total disability had much higher aHR = 6.57 (95%CI:5.15-8.37). Conclusions: Patients with greater comorbidity and disability at discharge, discharge to nursing home or re-admission into acute care, lower socioeconomic status and being widowed had higher mortality risk. Our results identified predictive variables of mortality that map well onto the frailty cascade model. Increasing comorbidity and disability interacted synergistically to increase mortality risk.
PLoS ONE 08/2014; 9(8):e106248. DOI:10.1371/journal.pone.0106248 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To compare the prevalence of common medical conditions (including mental health and self-rated health) and lifestyle risk factors for disease of the Singapore workforce with the nonworking population, and evaluate the association of these factors with occupation class.
Data were obtained from a population-representative cross-sectional survey in 2010. Adjusted prevalence ratios (PRs) were obtained by modified Breslow-Cox proportional hazards regression model.
Within the workforce, after adjustment for age, sex, and ethnicity, daily smoking (PR = 1.87; 95% confidence interval [CI], 1.40 to 2.51; P < 0.001), no regular exercise (PR = 1.13; 95% CI, 1.07 to 1.20; P < 0.001), and poor self-rated health (PR = 1.46, 95% CI, 1.22 to 1.76; P < 0.001) were more prevalent in the lower-skilled occupation classes.
Lower-skilled occupation classes in Singapore are associated with lifestyle risk factors, and tailored workplace health promotion programs addressing their specific health needs are needed.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 05/2014; 56(5):498-509. DOI:10.1097/JOM.0000000000000131 · 1.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction:
The aim of this study is to report normative data for the Short-Form 36 version 2 (SF-36v2) for assessing health-related quality of life, in the Singapore general population.
Materials and methods:
Data for English and Chinese-speaking participants of the Singapore Prospective Study Programme were analysed. The SF-36v2 scores were norm-based with the English-speaking Singapore general population as reference and reported by age (in decades), gender and ethnicity as well as for the 5 most prevalent chronic medical conditions. Scores were reported separately for the English and Chinese language versions.
A total of 6151 English-speaking (61.5% Chinese and 19.2% Malay) and 1194 Chinese-speaking participants provided complete data. Mean (SD) age of all participants was 49.6 (12.58) years with 52.4% being women. In both languages, women reported lower scores than men on all scales. Among the chronic medical conditions, stroke had the largest impact on all English SF-36v2 scales and on 3 Chinese SF-36v2 scales (role-physical, general health and social functioning).
We have provided detailed normative data for the Singapore English and Chinese SF-36v2, which would be valuable in furthering HRQoL research in Singapore and possibly the region.
Annals of the Academy of Medicine, Singapore 02/2014; 43(1):15-23. · 1.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective:
The primary aim of this article was to evaluate measurement equivalence of the English and Chinese versions of the Short Form 36 version 2 (SF-36v2) and Short Form 6D (SF-6D).
Study design and setting:
In this cross-sectional study, health-related quality of life (HRQoL) was measured from 4,973 ethnic Chinese subjects using the SF-36v2 questionnaire. Measurement equivalence of domain and utility scores for the English- and Chinese-language SF-36v2 and SF-6D were assessed by examining the score differences between the two languages using linear regression models, with and without adjustment for known determinants of HRQoL. Equivalence was achieved if the 90% confidence interval (CI) of the differences in scores, due to language, fell within a predefined equivalence margin.
Compared with English-speaking Chinese, Chinese-speaking Chinese were significantly older (47.6 vs. 55.5 years). All SF-36v2 domains were equivalent after adjusting for known HRQoL. SF-6D utility/items had the 90% CI either fully or partially overlap their predefined equivalence margin.
The English- and Chinese-language versions of the SF-36v2 and SF-6D demonstrated equivalence.
[Show abstract][Hide abstract] ABSTRACT: Purpose:
We aimed to evaluate the measurement properties of the Singapore English and Chinese versions of the Short-Form 36 version 2 (SF-36v2) Questionnaire, an improved version of the widely used SF-36, for assessing health-related quality of life (HRQoL) in a multi-ethnic urban Asian population in Singapore.
SF-36v2 scores and data on medical history, demographic and lifestyle factors from the Singapore Prospective Study Programme were analyzed. Convergent and divergent validity, internal consistency, floor and ceiling effects, known group validity and factor structure of the SF-36v2 were assessed for the English and Chinese versions, respectively.
Complete data for 4,917 participants (45.8 %) out of 10,747 eligible individuals were analyzed (survey language: 4,115 English and 802 Chinese). Item-scale correlations exceeded 0.4 for all items of the English SF-36v2 and for all except one item of the Chinese SF-36v2 (bathe and dress: item-scale correlation: 0.36). In the English SF-36v2, Cronbach's alpha exceeded 0.70 for all scales. In the Chinese SF-36v2, Cronbach's alpha exceeded 0.7 on all scales except social functioning (Cronbach's alpha: 0.68). For known groups validity, respondents with chronic medical conditions expectedly reported lower SF-36v2 score on most English and Chinese SF-36v2 scales. In confirmatory factor analysis, the Singapore three-component model was favored over the United States two-component and Japan three-component models.
The English and Chinese SF-36v2 are valid and reliable for assessing HRQoL among English and Chinese-speaking Singaporeans. Test-retest reliability and responsiveness of the English and Chinese SF-36v2 in Singapore remain to be evaluated.
Quality of Life Research 03/2013; 22(9). DOI:10.1007/s11136-013-0381-1 · 2.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: All-cause mortality risk persisted for 5 years after hip fractures in both men and women. There may be gender-specific differences in effect and duration of excess risk for cause-specific mortality after hip fracture. INTRODUCTION: To determine all-cause and cause-specific mortality risk in the first 5 years after hip fracture in an Asian Chinese population. METHODS: The Singapore Chinese Health Study is a population-based cohort of 63,257 middle-aged and elderly Chinese men and women in Singapore recruited between 1993 and 1998. This cohort was followed up for hip fracture and death via linkage with nationwide hospital discharge database and death registry. As of 31 December 2008, we identified 1,166 hip fracture cases and matched five non-fracture cohort subjects by age and gender for each fracture case. Cox proportional hazards and competing risks regression models with hip fracture as a time-dependent covariate were used to determine all-cause and cause-specific mortality risk, respectively. RESULTS: Increase in all-cause mortality risk persisted till 5 years after hip fracture (adjusted hazard ratio, aHR = 1.58 [95 % CI, 1.35-1.86] for females and aHR = 1.64 [95 % CI, 1.30-2.06] for males). Men had higher mortality risk after hip fracture than women for deaths from stroke and cancer up to 1 year post-fracture but women with hip fracture had higher coronary artery mortality risk than men for 5 years post-fracture. Men had higher risk of death from pneumonia while women had increased risk of death from urinary tract infections. There was no difference in mortality risk by types of hip fracture surgery. CONCLUSIONS: All-cause mortality risk persisted for 5 years after hip fractures in men and women. There are gender-specific differences in effect size and duration of excess mortality risk from hip fractures between specific causes of death.
Osteoporosis International 12/2012; 24(7). DOI:10.1007/s00198-012-2183-7 · 4.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Type 2 diabetes and associated complications adversely affect health-related quality of life (HRQoL). However, it is unclear whether different complications have the same or different associations with HRQoL. We examined associations between retinopathy, nephropathy, peripheral neuropathy (microvascular), coronary heart disease, stroke and peripheral arterial disease (macrovascular) in diabetes and HRQoL.
This study was a follow-up examination between 2004 and 2007 of participants from four previous cross-sectional population-based studies in Singapore.
Health-related quality of life was assessed through self-administered SF-36 health survey version 2. Diabetes and complications status were assessed through self-report, clinical and laboratory examinations. About 2601 individuals, 2205 healthy and 396 with diabetes, were studied.
Lower physical component scores (PCS) were associated with microvascular (2·96 points, P < 0·001) and both macro- and microvascular complications (4·67 points, P < 0·001), but not diabetes alone. Coronary heart disease (3·86 points, P = 0·007), peripheral neuropathy (11·46 points, P < 0·001) and severe retinopathy (4·46 points, P < 0·001) were associated with lower PCS. The greatest reduction in scores was seen in peripheral neuropathy.
Quality of life in patients with diabetes is affected mainly by presence of complications, and not diabetes per se. Peripheral neuropathy was associated with the greatest reduction in quality of life. Improved management to prevent or delay onset of complications may reduce the effect on quality of life in patients with diabetes.
[Show abstract][Hide abstract] ABSTRACT: Purpose Obesity adversely affects health-related quality of life (HRQoL). Most studies have used body mass index (BMI) to measure obesity. Other measures of obesity, such as waist circumference (WC) or waist-to-hip ratio (WHR), may be better predictors of cardiovascular disease and mortality. We, therefore, examined the associations between other anthropometric measures and HRQoL in a multi-ethnic Asian population. Methods In this follow-up study from four previous crosssectional surveys, HRQoL was measured, at follow-up, using the Short-Form 36 version 2 (SF-36v2) questionnaire. Linear regression was used to assess the relationship between anthropometric measures [BMI, WC, waist residuals (WR) (generated by regressing WC on BMI), WHR, waist-toheight ratio (WHtR) and height (Ht)] and HRQoL. We compared the models' R2, Akaike's information criteria (AIC), and Schwarz Bayesian information criteria (BIC) from the different models. Results Among 4,981 subjects, 47.6 % were men aged 50.6 ± 12.2 and women aged 49.3 ± 11.6 years. All gender-specific anthropometric measures were significantly correlated with BMI, except WR. After adjusting for known determinants of HRQoL, we found significant associations between BMI, WC and WHtR with SF-36v2 Physical Component Summary (PCS) scores in women but not men. In contrast, after adjusting for known determinants of HRQoL, WR and WHR were significantly associated with SF-36v2 Mental Component Summary (MCS) scores in men, but not women. R2, AIC and BIC were similar for all anthropometric measures in the final model. Conclusions The associations between measures of central obesity and HRQoL differed between men and women. In women, associations were seen with SF-36v2 PCS, but measures of central obesity did not have significant associations with HRQoL after controlling for BMI. In men, an association between WC and SF-36v2 MCS was statistically significant independent of BMI. These gender differences require further investigation.
Quality of Life Research 05/2012; 22(4). DOI:10.1007/s11136-012-0193-8 · 2.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Identification of high-risk individuals is crucial for effective implementation of type 2 diabetes mellitus prevention programs. Several studies have shown that multivariable predictive functions perform as well as the 2-hour post-challenge glucose in identifying these high-risk individuals. The performance of these functions in Asian populations, where the rise in prevalence of type 2 diabetes mellitus is expected to be the greatest in the next several decades, is relatively unknown.
Using data from three Asian populations in Singapore, we compared the performance of three multivariate predictive models in terms of their discriminatory power and calibration quality: the San Antonio Health Study model, Atherosclerosis Risk in Communities model and the Framingham model.
The San Antonio Health Study and Atherosclerosis Risk in Communities models had better discriminative powers than using only fasting plasma glucose or the 2-hour post-challenge glucose. However, the Framingham model did not perform significantly better than fasting glucose or the 2-hour post-challenge glucose. All published models suffered from poor calibration. After recalibration, the Atherosclerosis Risk in Communities model achieved good calibration, the San Antonio Health Study model showed a significant lack of fit in females and the Framingham model showed a significant lack of fit in both females and males.
We conclude that adoption of the ARIC model for Asian populations is feasible and highly recommended when local prospective data is unavailable.
BMC Medical Research Methodology 04/2012; 12(1):48. DOI:10.1186/1471-2288-12-48 · 2.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We assessed the seroepidemiology of pertussis, diphtheria and poliovirus antibodies in a cohort of highly immunized children, together with the burden of these diseases in Singapore.
Hospital residual sera collected between August 2008 and July 2010 from 1200 children aged 1-17 years were tested for the prevalence of IgG antibodies against Bordetella pertussis, diphtheria toxoid, and all three poliovirus types by enzyme-linked immunosorbent assays.
We found an overall seroprevalence of 99.4% (95% CI 98.8-99.7%) for diphtheria, and 92.3% (95% CI 90.6-93.6%) for poliomyelitis, along with no indigenous cases of these diseases since 1993. However, the seroprevalence for pertussis was 60.8% (95% CI 58.0-63.5%) only. Among the subjects who had completed three doses of pertussis vaccination by the age of 2 years (n=1092), the pertussis seroprevalence was 85.0% (95% CI 79.7-89.2%) in those who received the last vaccination within a year before the study, and it decreased to 75.0% (95% CI 64.5-83.2%) and 63.1% (95% CI 50.9-73.8%) in those who had the last vaccination 1 year and 2 years before the study, respectively. The seroprevalence remained at about 50% for those whose last pertussis vaccination was administered 4 years and longer before the study.
The high seroprevalence for poliomyelitis and diphtheria confer solid herd immunity to eliminate these diseases in Singapore. In contrast, immunity against pertussis waned considerably over time, and routine boosters should be given to adolescents to ensure sustained immunity against pertussis.
[Show abstract][Hide abstract] ABSTRACT: To study whether HbA(1c) , and its relationship with fasting plasma glucose, was significantly different among Chinese, Malays and Indians in Singapore.
A sample of 3895 individuals without known diabetes underwent detailed interview and health examination, including anthropometric and biochemical evaluation, between 2004 and 2007. Pearson's correlation, analysis of variance and multiple linear regression analyses were used to examine the influence of ethnicity on HbA(1c) .
As fasting plasma glucose increased, HbA(1c) increased more in Malays and Indians compared with Chinese after adjustment for age, gender, waist circumference, serum cholesterol, serum triglyceride and homeostasis model assessment of insulin resistance (P-interaction < 0.001). This translates to an HbA(1c) difference of 1.1 mmol/mol (0.1%, Indians vs. Chinese), and 0.9 mmol/mol (0.08%, Malays vs. Chinese) at fasting plasma glucose 5.6 mmol/l (the American Diabetes Association criterion for impaired fasting glycaemia); and 2.1 mmol/mol (0.19%, Indians vs. Chinese) and 2.6 mmol/mol (0.24%, Malays vs. Chinese) at fasting plasma glucose 7.0 mmol/l, the diagnostic criterion for diabetes mellitus.
Using HbA(1c) in place of fasting plasma glucose will reclassify different proportions of the population in different ethnic groups. This may have implications in interpretation of HbA(1c) results across ethnic groups and the use of HbA(1c) for diagnosing diabetes mellitus.
Diabetic Medicine 01/2012; 29(7):911-7. DOI:10.1111/j.1464-5491.2012.03599.x · 3.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis and is associated with increased cardiovascular morbidity and mortality. We describe the prevalence and risk factors of PAD in a multi-ethnic Asian population (Chinese, Malays and Indians) in Singapore. The Singapore Prospective Study Program recruited 4132 individuals between 2004 and 2006 in which the ankle-brachial index (ABI) was measured using the Smartdop™ 20EX bi-directional blood flow detector. PAD was defined as ≤ 0.9 and a high ABI > 1.4, with ABI 1.11-1.20 as reference. The mean age (SD) of individuals in the study was 49.9 (11.8) years, with 51.8% females. PAD was present in 4.3% of the population and a high ABI (> 1.4) was rare. Malays and Indians had a higher risk (especially in females). Compared to those with an ABI between 1.11 and 1.20, those with PAD were more likely to be of Malay and Indian ethnicity, female sex, with higher systolic blood pressure and pulse pressure, with increased prevalence of diabetes mellitus, hypertension, albuminuria and renal impairment, and with a past history of stroke. In conclusion, in this large multi-ethnic Asian population, we document the distribution and risk factor associations for PAD. PAD shows an ethnic distribution similar to that of coronary artery disease in Singapore, with differences in sex distribution. Apart from traditional vascular risk factors, pulse pressure, renal impairment and a past history of stroke are important determinants of PAD.
Vascular Medicine 03/2011; 16(2):87-95. DOI:10.1177/1358863X11400781 · 1.79 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Asian populations are documenting rapid increases in the rates of diabetes and hip fracture, but there are no prospective data linking both diseases in Asian studies. We investigated this association among a cohort of Chinese in Singapore.
A prospective cohort of 63,257 Chinese in the Singapore Chinese Health Study, established between 1993 and 1998, was followed up for a mean duration of 12 years. Diabetes status was ascertained by baseline interviews, and incidence of hip fracture post-enrollment was identified through a nationwide hospital discharge database.
The risk of hip fracture, after adjustment for other risk factors, was almost double among people with diabetes compared with people without diabetes (relative risk 1.98, 95% CI 1.71-2.29). When stratified by BMI, the increase in risk of hip fracture among people with diabetes relative to people without diabetes was similar in all four strata. There was a very strong dose-dependent relationship between duration of diabetes and risk of hip fracture (P for trend <0.0001). Compared with people without diabetes, the relative risk (95% CI) among subjects with diabetes for <5 years at recruitment was 1.40 (1.08-1.82), and this risk increased to 2.66 (2.04-3.47) among individuals with diabetes for >or=15 years.
Asians with diabetes, like their Western counterparts, experience an increased risk of hip fracture. Early assessment for osteoporosis and increased fracture risk, as well as prevention of falls, should be part of the management of diabetes.
Diabetes care 08/2010; 33(8):1766-70. DOI:10.2337/dc10-0067 · 8.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To examine the changes in weight and waist circumference of adult Singaporeans between 1998 and 2005-2007, and the associations of these changes with demographic and socio-economic factors.
A prospective study, which followed up participants aged 18-69 years from the 1998 National Health Survey. Analysis was performed on data from 2483 individuals (53% of original sample) who returned for follow-up in 2005-2007. Body weight and waist circumference were measured both at baseline and follow-up. Logistic regression was used to examine factors associated with being overweight and obese at baseline. Linear regression was used to examine changes in weight and waist circumference over time. The variables examined were age, gender, ethnicity, marital status, educational level, housing and employment status, smoking, alcohol consumption and sports activities.
Mean weight for the population increased over the follow-up period by 1.48 kg (s.d.=4.95) and mean waist circumference increased by 3.32 cm (s.d.=7.92). Cross-sectionally, those who were overweight or obese were more likely to be Malays or Indians, married, homemakers and have lower educational level. Prospectively, individuals who gained the most weight were younger, more likely to be ethnic minority groups and have the lowest body mass index (BMI) at baseline. They also appeared to be of higher socio-economic status (SES) based on housing type. These associations were statistically significant even after adjusting for other variables.
Obesity prevention should start early in the younger age. Preventive programs need to reach out to Malay and Indian ethnic groups and those with higher SES. These findings should be used in designing messaging of preventive strategies.
International journal of obesity (2005) 10/2009; 33(11):1299-308. DOI:10.1038/ijo.2009.173 · 5.00 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although there is some epidemiologic evidence that soy may reduce risk of osteoporotic fracture in women, it is not known whether this risk reduction also occurs for men. The authors examined gender-specific associations between soy intake and hip fracture risk in the Singapore Chinese Health Study, a prospective cohort of 63,257 Chinese living in Singapore. At recruitment between 1993 and 1998, each subject was administered a food frequency questionnaire and questions on medical history and lifestyle factors. As of December 31, 2006, 276 incident cases of hip fracture in men and 692 cases in women were identified via linkage with hospital discharge databases. For both genders, hip fracture risk was positively associated with cigarette smoking and was inversely associated with body mass index. There was a statistically significant association of tofu equivalents, soy protein, and isoflavones with hip fracture risk among women but not among men. Compared with women in the lowest quartile of intakes for tofu equivalents (<49.4 g/day), soy protein (<2.7 g/day), and isoflavones (<5.8 mg/1,000 kcal/day), those in the second-fourth quartiles exhibited 21%-36% reductions in risk (all P < 0.036). Risk levels were comparable across the second, third, and fourth quartiles of soy intake categories.
American journal of epidemiology 08/2009; 170(7):901-9. DOI:10.1093/aje/kwp220 · 5.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Singapore Burden of Disease (SBoD) Study 2004 provides a comprehensive and detailed assessment of the size and distribution of health problems in Singapore. It is the first local study to use disability-adjusted life years (DALYs) to quantify the total disease burden.
The SBoD study applied the methods developed for the original Global Burden of Disease study to data specific to Singapore to compute the DALYs. DALY is a summary measure of population health that combines time lost due to premature mortality (years of life lost [YLL]) with time spent in ill-health (broadly-termed disability) arising from incident cases of disease or injury (years of life lost due to disability [YLD]). DALYs, stratified by gender and age group, were calculated for more than 130 specific health conditions for the Singapore resident population for the year 2004.
In 2004, diabetes mellitus, ischaemic heart disease and stroke were the top three leading causes of premature death and ill-health in Singapore, and together accounted for more than one-quarter (28 percent) of the total disease burden (in DALYs). Morbidity burden (YLD) was responsible for 52 percent of the total DALYs, with diabetes mellitus, anxiety and depression, and Alzheimer's disease and other dementias being the main sources of the total YLDs. Ischaemic heart disease, stroke and lung cancer were the major contributors to the premature mortality burden (YLL).
This study provides an objective and systematic assessment of the fatal and nonfatal health conditions in Singapore to support priority setting in public health policies and research.
Singapore medical journal 06/2009; 50(5):468-78. · 0.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Recent studies suggest that no distinct glycemic threshold consistently differentiates individuals with or without retinopathy. The authors sought to determine whether the same was true for other microvascular complications. They studied 5,094 participants with fasting plasma glucose values and concurrent microvascular complications from 4 previous cross-sectional surveys carried out in Singapore (1982-1998) who attended a follow-up examination in 2004-2007. Peripheral neuropathy was diagnosed based on abnormal responses to a 10-g monofilament or neurothesiometer test. Chronic kidney disease was defined in various ways by using albuminuria (urine albumin:creatinine ratio >30 microg/mg) and estimated glomerular filtration rate, alone and in combination. Prevalence of peripheral neuropathy was 7.5%. For chronic kidney disease, prevalence of albuminuria only was 10.5%, estimated glomerular filtration rate of <60 mL/minute per 1.73 m(2) only was 4.1%, and both was 2.1%. Prevalence of peripheral neuropathy and chronic kidney disease gradually increased in relation to fasting plasma glucose, beginning at levels below the existing diagnostic threshold for diabetes mellitus of 7.0 mmol/L (126 mg/dL). For chronic kidney disease, these associations persisted after adjustment for age, gender, ethnic group, and hypertension. Current diagnostic thresholds for diabetes mellitus have limited sensitivity for identifying individuals with these microvascular complications. Ascertaining these individuals may require development and application of novel screening strategies.
American journal of epidemiology 04/2009; 169(12):1454-62. DOI:10.1093/aje/kwp076 · 5.23 Impact Factor