Currently, more than 57 million people live with dementia worldwide, and this number is expected to increase to more than 152 million by 2050.¹ Alcohol consumption is generally considered as a potential modifiable risk factor for dementia, but the results in the literature are not completely consistent.² Several longitudinal studies^3-6 reported an association of mild to moderate alcohol consumption with a reduced risk of dementia, whereas others showed no association.^7-10 Notably, most studies assessed alcohol consumption only once at baseline. Only a few studies considered a change of alcohol consumption during the study period and its association with the incidence of dementia (eTable 1 in Supplement 1). Sabia et al⁴ examined the link between 17-year trajectories of alcohol consumption and the risk of dementia in the UK. The authors concluded that the risk of dementia was increased in those with long-term abstinence, decreased alcohol consumption, and long-term consumption greater than 14 units per week compared with participants with long-term consumption of 1 to 14 units per week.⁴ However, that study did not conduct stratified analyses considering the initial amount of alcohol consumption level (eg, mild, moderate, or heavy). Mukamal et al⁵ examined alcohol consumption in 2 separate assessments. In that study, however, the participants were simply categorized according to the average level of alcohol consumption between 2 measurements (eg, <1 drinks per week) without reflecting changes in the pattern (eg, decreased or increased) of alcohol consumption between the measurements.⁵ In addition, that study used only the abstainers, but not the sustainers, as a reference, making it difficult to accurately reflect the effect of changes in the pattern of alcohol consumption on the risk of dementia.

Importance: Several observational studies have reported that smoking cessation is associated with a lower risk of dementia. However, no studies have examined the association between change in smoking intensity and risk of dementia.Objective: To investigate the association between a change in smoking intensity, including smoking reduction and smoking cessation, and risk of all dementia.Design, Setting, and Participants: This cohort study used data from the National Health Insurance Service database of Korea. The cohort included participants 40 years or older who underwent biennial health examinations (2009 and 2011) and had current smoking status at the first health examination. The cohort was followed up until December 31, 2018, and statistical analysis was performed between July and December 2021.Exposures: Change in smoking intensity from baseline was defined operationally as follows: quitters (stopped smoking), reducers I (decreased number of cigarettes smoked per day by ≥50%), reducers II (decreased number of cigarettes smoked per day by 20%-50%), sustainers (maintained [decreased or increased] number of cigarettes smoked per day by less than 20%), or increasers (increased number of cigarettes smoked per day by ≥20%).Main Outcomes and Measures: The primary outcome was newly diagnosed dementia, which was identified by prescribed antidementia medications with concomitant International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes for dementia. Adjusted hazard ratios and 95% CIs were used to determine the association between change in smoking intensity and incidence of dementia, including Alzheimer disease (AD) and vascular dementia (VaD).Results: A total of 789 532 participants (756 469 males [95.8%]; mean [SD] age, 52.2 [8.5] years) were included. During a median (IQR) follow-up period of 6.3 (6.1-6.6) years, 11 912 dementia events, including 8800 AD and 1889 VaD events, were identified. Overall, participants in the quitter group had a significantly lower risk of all dementia (adjusted hazard ratio [aHR], 0.92; 95% CI, 0.87-0.97) compared with those in the sustainer group. Those in the reducer I (aHR, 1.25; 95% CI, 1.18-1.33) and increaser (aHR, 1.12; 95% CI, 1.06-1.18) groups had a significantly higher risk of all dementia compared with those in the sustainer group.The patterns for AD and VaD remained consistent with patterns for all dementia.Conclusions and Relevance: The results of this study showed that smoking cessation was associated with a lower risk of dementia compared with sustained smoking intensity, while smoking reduction was associated with a higher risk. Smoking cessation should be emphasized in efforts to reduce the disease burden of dementia.

Among risk factors of developing frailty, dietary factor played an important role as a potentially modifiable risk factor. Eating alone is associated with malnutrition, depression, and social isolation, which are risk factors of frailty. We evaluated the longitudinal association between a change to eating alone and deterioration in frailty status in a cohort of community-dwelling elderly persons. The study subjects were 2072 non-frail Korean elderly persons aged 70-84 years who were recruited for the Korean Frailty and Aging Cohort Study (KFACS). The subjects were divided into 4 groups based on changes in eating with others or alone between the baseline survey (2016-2017) and the follow-up survey (2018-2019): group I (ate with others consistently), group II (ate with others at baseline but ate alone at follow-up), group III (ate alone at baseline but ate with others at follow-up), group IV (ate alone consistently). We assessed physical frailty using the Cardiovascular Health Study (CHS) frailty phenotype. The association between changes in eating with others or alone and frailty progression was assessed by multiple logistic regression analysis after adjusting for covariates. The mean age of the study subjects was 76.2 (SD: 3.8) years old and 50.8 % were female. At follow-up, 364 new cases (34.5 %) of pre-frailty (n = 348) and frailty (n = 16) were identified among those who were robust at baseline (n = 1056), while 88 new cases (8.7 %) of frailty were identified among those who were pre-frail at baseline (n = 1016). Compared to group I, group II showed an increased risk of deterioration in frailty status after adjustments with multivariables including social isolation and malnutrition (adjusted odds ratio [aOR] = 1.61, 95 % confidence interval [CI]: 1.03-2.50). However, the association disappeared after further adjustment for depression. When we examined the longitudinal association between changes in eating with others or alone and changes in each frailty domain, group II showed an increased risk for the weight loss (aOR = 3.07, 95 % CI: 1.39-6.76) compared to group I. Group IV showed an increased risk for the weight loss (aOR = 2.39, 95 % CI: 0.95-6.00) and weakness (aOR = 2.07, 95 % CI: 1.16-3.68). A change from eating with others to eating alone was found to significantly increase the risk of deterioration in frailty status in elderly people, and the association seemed to be mediated by depression. These findings suggest that interventions to maintain eating partners and manage depression are needed to prevent frailty progression in elderly people.

BACKGROUND: Stroke survivors face physical and cognitive challenges, leading to an increased dependency and a higher fall risk. We aimed to investigate the impact of poststroke disability and stroke type on fracture risk at various sites compared with matched controls. METHODS: This retrospective cohort study used data from the Korean National Health Insurance System database (2010–2018), including patients with stroke and 1:1 matched controls. Stroke survivors were grouped based on the presence and severity of their poststroke disability and stroke type. The primary outcome was a newly diagnosed fracture, analyzed by Cox proportional hazard regression analyses adjusting for potential confounders. RESULTS: Among 223 358 stroke survivors (mean age, 64.8±10.9 years; 61.2% men), 16 344 fractures occurred during a mean follow-up of 3.7±2.5 years. In matched controls (n=322 161; mean age, 65.4±11.2 years; 61.3% men), 20 398 fractures were identified. Stroke survivors had increased overall fracture risk compared with matched controls (adjusted hazard ratio [aHR], 1.40 [95% CI, 1.37–1.43]). Specifically, hip fracture risk was even greater in stroke survivors (incidence rate per 1000 person-years, 4.7 [95% CI, 4.5–4.8]; aHR, 2.42 [95% CI, 2.30–2.55]) than controls (incidence rate, 2.2 [95% CI, 2.1–2.3]). The risk of vertebral fractures (aHR, 1.29 [95% CI, 1.25–1.34]) and other fractures (aHR, 1.19 [95% CI, 1.15–1.23]) was also higher than that of the control group. Hip fracture risk was the highest among stroke survivors with severe poststroke disability (aHR, 4.82 [95% CI, 4.28–5.42]), although vertebral or other fracture risk was the highest among those with mild poststroke disability. No significant difference in fracture risk was found between hemorrhagic and ischemic stroke survivors when stratified by disability status. CONCLUSIONS: Our findings showed increased subsequent fracture risk among stroke survivors, particularly those with poststroke disability and for hip fracture. Bone health assessment and treatment should be emphasized as an essential part of stroke management.

Background: Age‐related macular degeneration (AMD) is the leading cause of visual disability. AMD shares some risk factors with the pathogenesis of cardiovascular disease (CVD). However, previous studies examining the association between AMD and the risk of CVD provide conflicting results. Hence, we investigated the association between AMD, visual disability, and the risk of CVD. Methods and Results: This is a nationwide cohort study using data from the Korean National Health Insurance System database (2009–2019) on subjects who underwent a national health screening program in 2009. A total of 3 789 963 subjects were categorized by the presence of AMD and visual disability. Visual disability was defined as a best‐corrected visual acuity of ≤20/100 by validated documentation from a specialist physician. Cox regression hazard model was used to examine the hazard ratios (HRs) of CVD, including myocardial infarction and ischemic stroke, after adjusting for potential confounders. During a mean 9.77 years of follow‐up, AMD was associated with a 5% higher risk of myocardial infarction (adjusted HR [aHR], 1.05 [95% CI, 1.01–1.10]) but not associated with increased risk of overall CVD (aHR, 1.02 [95% CI, 1.00–1.05]) or ischemic stroke (aHR, 1.02 [95% CI, 0.98–1.06]). However, when AMD was accompanied by visual disability, there was increased risk of CVD (aHR, 1.17 [95% CI, 1.06–1.29]), myocardial infarction (aHR, 1.18 [95% CI, 1.01–1.37]), and ischemic stroke (aHR, 1.20 [95% CI, 1.06–1.35]). These trends were more evident in women and subjects with cardiometabolic comorbidities. Conclusions: AMD with visual disability, but not all AMD, was associated with an increased risk of CVD. Patients with AMD who have visual disability should be targeted for CVD prevention.

Postoperative gastrointestinal bleeding (PGIB) is a serious complication with expensive medical costs and a high mortality rate. This study aims to analyze the incidence of PGIB and its associated factors, including its relationship with postoperative analgesic use. Patients aged ≥20 years who received various kinds of surgery from 2013 to 2017 were included (n = 1,319,807). PGIB was defined by admission with ICD-10 codes of gastrointestinal bleeding plus transfusion within 2 months after surgery. A total of 3505 (0.27%) subjects had PGIB, and the incidence was much higher for those who underwent major gastrointestinal and major cardiovascular surgery (1.9% for both), followed by major head and neck (0.7%), major genitourinary (0.5%), and orthopedic surgery (0.45%). On multivariate analysis, older age, male sex, lower income, comorbidities, peptic ulcer disease, and congestive heart failure were associated with a higher risk of gastrointestinal bleeding. Among analgesics, steroid use was associated with increased postoperative bleeding risk (adjusted OR: 1.36, 95% CI: 1.25–1.48). Acetaminophen/nonsteroidal anti-inflammatory drugs, cyclooxygenase 2 inhibitors, anticonvulsants, antidepressants, and opioids were not associated with increased risk. PGIB is considerable for major surgeries, and its risk should be considered, especially for patients with older age and comorbidities and use of steroids.