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      Anemia and health-related quality of life in South Korea: data from the Korean national health and nutrition examination survey 2008–2016

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          Abstract

          Background

          Anemia is associated with impaired quality of life (QoL). We examined the relationship between anemia and QoL in the Korean population using the EuroQol five-dimensional (EQ-5D) questionnaire.

          Methods

          Data of 30,526 subjects were included from the Korean National Health and Nutrition Examination Survey (2008–2016). The QoL was assessed using three-levels of the EQ-5D questionnaire (G1, G2, and G3). Analysis of variance was used to compare the prevalence of anemia according to the three levels of health status in each of the five dimensions of EQ-5D. Multiple linear regression analysis was used to evaluate the association between hemoglobin level and QoL, and multivariable logistic regression analysis was used to evaluate the odds ratios (ORs) and 95% confidence intervals (CIs) for low levels of each of the five dimensions of EQ-5D.

          Results

          As the level of EQ-5D was worse (from G1 to G3), the prevalence of anemia increased (p for trend < 0.001). Hemoglobin level and EQ-5D showed positive association after adjusting for all covariates such as age, sex, smoking, alcohol drinking, exercise, education, income, marital status, urban living, diabetes mellitus, hypertension, hypercholesterolemia, chronic kidney disease, total calorie intake, and protein intake. Subjects with anemia had increased ORs for low levels (G2 + G3) of each dimension of EQ-5D compared to subjects without anemia. ORs and 95% CIs for mobility, self-care, and usual activities were 1.208(1.078, 1.353), 1.161(0.98, 1.376), and 1.331(1.173, 1.51), respectively, after adjusting for all covariates. Pain/discomfort and anxiety/depression were not associated with increased ORs for low levels of EQ-5D.

          Conclusions

          In South Korea, low QoL was associated with anemia, particularly in the mobility, self-care, and usual activities dimensions of EQ-5D.

          Electronic supplementary material

          The online version of this article (10.1186/s12889-019-6930-y) contains supplementary material, which is available to authorized users.

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          Most cited references21

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          The Global Burden of Anemia.

          Anemia is an important cause of health loss. We estimated levels and trends of nonfatal anemia burden for 23 distinct etiologies in 188 countries, 20 age groups, and both sexes from 1990 to 2013. All available population-level anemia data were collected and standardized. We estimated mean hemoglobin, prevalence of anemia by severity, quantitative disability owing to anemia, and underlying etiology for each population using the approach of the Global Burden of Disease, Injuries and Risk Factors 2013 Study. Anemia burden is high. Developing countries account for 89% of all anemia-related disability. Iron-deficiency anemia remains the dominant cause of anemia.
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            South Korean time trade-off values for EQ-5D health states: modeling with observed values for 101 health states.

            This study establishes the South Korean population-based preference weights for EQ-5D based on values elicited from a representative national sample using the time trade-off (TTO) method. The data for this paper came from a South Korean EQ-5D valuation study where 1307 representative respondents were invited to participate and a total of 101 health states defined by the EQ-5D descriptive system were directly valued. Both aggregate and individual level modeling were conducted to generate values for all 243 health states defined by EQ-5D. Various regression techniques and model specifications were also examined in order to produce the best fit model. Final model selection was based on minimizing the difference between the observed and estimated value for each health state. The N3 model yielded the best fit for the observed TTO value at the aggregate level. It had a mean absolute error of 0.029 and only 15 predictions out of 101 had errors exceeding 0.05 in absolute magnitude. The study successfully establishes South Korean population-based preference weights for the EQ-5D. The value set derived here is based on a representative population sample, limiting the interpolation space and possessing better model performance. Thus, this EQ-5D value set should be given preference for use with the South Korean population.
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              Epidemiology of anemia in older adults.

              Anemia is a common, multifactorial condition among older adults. The World Health Organization (WHO) definition of anemia (hemoglobin concentration <12 g/dL in women and <13 g/dL in men) is most often used in epidemiologic studies of older adults. More than 10% of community-dwelling adults age 65 years and older has WHO-defined anemia. After age 50 years, prevalence of anemia increases with advancing age and exceeds 20% in those 85 years and older. In nursing homes, anemia is present in 48% to 63% of residents. Incidence of anemia in older adults is not well characterized. Among older adults with anemia, approximately one third have evidence of iron, folate, and/or vitamin B(12) deficiency, another third have renal insufficiency and/or chronic inflammation, and the remaining third have anemia that is unexplained. Several studies demonstrate that anemia is associated with poorer survival in older adults. This review details the distribution and consequences of anemia in older adults and identifies future epidemiologic research needs.
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                Author and article information

                Contributors
                ped99@cmcnu.or.kr
                hkd917@naver.com
                vornfree@gmail.com
                mrchir@naver.com
                +82-2-2258-7226 , ygpark@catholic.ac.kr
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                13 June 2019
                13 June 2019
                2019
                : 19
                Affiliations
                [1 ]ISNI 0000 0004 0470 4224, GRID grid.411947.e, Department of Medical Lifescience, , The Catholic University College of Medicine, ; 222, Banpo-daero, Seocho-gu, Seoul 137-701 South Korea
                [2 ]ISNI 0000 0004 0470 4224, GRID grid.411947.e, Department of Medical Statistics, , The Catholic University College of Medicine, ; 222, Banpo-daero, Seocho-gu, Seoul 137-701 South Korea
                [3 ]ISNI 0000 0001 0840 2678, GRID grid.222754.4, Department of Family Medicine, , Korea University College of Medicine, ; 73 Inchon-ro, Seoungbuk-Gu, Seoul 136-705 South Korea
                Article
                6930
                10.1186/s12889-019-6930-y
                6567528
                31196013
                d4e9fa23-3571-498a-837b-4252e742521a
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funding
                Funded by: Ministry of Science and ICT
                Award ID: 2017-0-00588
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Public health
                anemia,quality of life,euroqol five-dimensional questionnaire,korean national health and nutrition examination survey

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