AIMS:We investigated the impact of aerobic exercise on clinical outcomes in patients with diabetes undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS:We analyzed a nationwide prospective population database from the Korean National Health Insurance System. We included 8225 patients with diabetes who had undergone PCI and documented their aerobic exercise habits before and after the procedure (mean interval: 2.0 years). The patients were categorized into four groups: persistent non-exercisers, new exercisers, exercise discontinuers, and exercise maintainers. The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause death, myocardial infarction, revascularization, and heart failure. We assessed the risk of clinical events using inverse probability-weighted Cox proportional hazards models. During a mean follow-up of 4.9 years, exercise maintainers, discontinuers, and new exercisers were associated with a significantly lower risk of MACE compared to non-exercisers. The lowest risk was observed in exercise maintainers (maintainers: aHR, 0.78; 95% CI: 0.71-0.86; discontinuers: aHR, 0.88; 95% CI: 0.79-0.98; new exercisers: aHR, 0.89; 95% CI: 0.80-1.00). A J-curve relationship between the amount of aerobic exercise and adverse clinical outcomes was observed, with the lowest risk identified at 1000-1499 MET-min/week. Benefits diminished with exercise intensity ≥1500 MET-min/week. CONCLUSION:Aerobic exercise maintenance after PCI was associated with a reduced risk of cardiovascular events in patients with diabetes, with a moderate amount of exercise providing maximal benefit. Therefore, aerobic exercise is advisable for patients with diabetes undergoing PCI, and the optimal exercise dosage warrants further research. LAY SUMMARY:This large-scale prospective population study, based on the Korean National Health Insurance System, demonstrated that maintaining aerobic exercise in patients with diabetes undergoing percutaneous coronary intervention is significantly associated with a lower risk of cardiovascular events.A J-curve relationship was observed between the amount of aerobic exercise and clinical outcomes, with the lowest risk observed at 1000-1499 MET-min/week for both new exercisers and the entire study population.However, exercising beyond 1500 MET-min/week offers diminishing returns, highlighting the need for balanced exercise intensity.

The relationship between steatotic liver disease (SLD) and dementia remains unclear, particularly regarding alcohol consumption patterns. We investigated the risk of dementia across SLD subtypes classified by alcohol consumption. We analyzed 3,071,829 adults without baseline dementia who underwent health examinations in 2012. Participants were classified into No SLD, metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction-associated alcohol-related liver disease (MetALD), and ALD groups. Primary outcomes were newly diagnosed all-cause dementia, Alzheimer’s disease (AD), and vascular dementia (VD). Over a median follow-up of 5.4 years, 72,545 all-cause dementia, 56,999 ad, and 8923 VD cases occurred. The risk of dementia significantly increased across all dementia outcomes in SLD (all p < 0.05). Across the SLD subtypes, ALD showed the highest risk of dementia, followed by MASLD, whereas MetALD showed largely neutral associations except for a modestly increased risk of VD. When MASLD was further stratified by alcohol consumption, the MASLD–no alcohol group showed consistently increased risk of all dementia outcomes (all p < 0.05). In contrast, MASLD with within-threshold alcohol intake showed heterogeneous associations across dementia outcomes. The association between SLD and dementia differed according to SLD phenotype and alcohol consumption pattern. These findings should be interpreted as observational associations and warrant further validation in studies with longitudinal assessment of SLD status and alcohol exposure.

Purpose:Helicobacter pylori is the single most important risk factor for gastric cancer (GC). However, H. pylori eradication (HPE) does not eliminate risk of GC. To clarify the association of lifestyle factors with GC risk after HPE. Materials and Methods:Using the Korean National Health Insurance Services (NHIS) database, adult individuals who claimed HPE between 2010 and 2016 were analyzed. The adjusted hazard ratios (aHR) for GC were analyzed according to the lifestyle status including smoking (never; light [<10PY]; moderate [10-20PY]; heavy [≥20PY]), alcohol (none; mild [<30g/day]; heavy [30g/day]), and abdominal obesity by using Cox proportional hazard model. Results:During a median follow-up period of 6.7 years, 9,754 individuals were newly diagnosed with GC among the total of 1,282,702 subjects. Compared with never smokers, moderate (aHR 1.12 [95%CI 1.04-1.20]) and heavy smokers (1.34 [1.27-1.42]) had greater risks of post-HPE GC with dose-response manner. Heavy drinkers had increased risk of GC (1.23 [1.15-1.32]) compared with non-drinkers, and those with abdominal obesity had slightly elevated GC risk compared with those without that (1.11 [1.06-1.15]). In subgroup analyses, those who had HPE at age ≥ 55 were shown to be more affected by the unhealthy lifestyles (smoking [p-for-interaction <0.01], alcohol [0.03], and abdominal obesity [0.03]). Also, male showed greater risk increase by smoking habit [p-for-interaction 0.02] than female. Conclusion:Unhealthy lifestyles like smoking, alcohol, and abdominal obesity were shown as risk factors for post-HPE GC. Those with late HPE were more likely to be affected by unhealthy lifestyles.

We investigated the association between income parameters and the risk of type 2 diabetes (T2D) influenced by obesity. We analyzed the Korean National Health Insurance Service data (2002–2022), including 3,462,002 adults (aged ≥ 30 years) without diabetes who underwent health examinations in 2012. Income status was assessed annually from 2008 to 2012, and sustained income status was defined as maintaining the same income category for all five consecutive years. Hazard ratios (HRs) for incident T2D were estimated according to income parameters, and stratified by obesity status and BMI categories. During a mean follow-up of 8.73 years, 447,688 T2D cases were identified. Individuals with sustained very low-income (multivariable adjusted HR: 1.599; 95

ObjectiveThis study aimed to investigate association between steatotic liver disease (SLD) subtype and thyroid cancer in women using a nationwide population-based cohort.MethodsThis nationwide population-based cohort study included 2,089,609 women aged more than 40 years who participated in the 2009 health screening program and were followed up until 2022. Participants were divided into four groups based on their SLD status: no SLD, metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol-related liver disease (MetALD), and alcohol-related liver disease (ALD).ResultsDuring a mean follow-up of 12.27 years, 40,072 (1.92%) women were newly diagnosed with thyroid cancer. Compared with the no SLD group, women with MASLD had a higher risk of thyroid cancer (hazard ratio [HR]: 1.19, 95% confidence interval [CI]: 1.16-1.22), whereas those with MetALD and ALD did not have a higher risk. The risk of thyroid cancer was higher in women with MASLD, including both premenopausal (HR: 1.21, 95% CI: 1.16-1.26) and postmenopausal women (HR: 1.17, 95% CI: 1.14-1.21). Women in the MetALD group showed no risk elevation of thyroid cancer regardless of their menopausal status. Postmenopausal women in the ALD group had a higher risk of thyroid cancer than those in the no SLD group (HR: 1.31, 95% CI: 1.05-1.64), whereas premenopausal women did not have a higher risk.ConclusionsThyroid cancer risk was modestly increased in women with MASLD, whereas no significant associations were observed for MetALD or ALD.

INTRODUCTION:Pancreatitis causes substantial morbidity and may increase suicide risk, but population-based evidence remains limited. This study investigated the association between pancreatitis and suicide death in a nationwide cohort. METHODS:This study included 2,732,294 individuals aged ≥40 years who received a national health check-up in 2009 after excluding those with insufficient data or who died within one year of enrollment. Participants were classified according to a history of acute or chronic pancreatitis and followed for suicide death until December 31, 2021. RESULTS:Individuals with pancreatitis had higher suicide death rates than those without pancreatitis (0.82% vs. 0.35%, P < 0.0001). When analyzed separately, suicide death rates were higher in chronic pancreatitis versus without chronic pancreatitis (1.10% vs. 0.35%, P < 0.0001) and in acute pancreatitis versus without acute pancreatitis (0.89% vs. 0.35%, P < 0.0001). In multivariable cause-specific Cox proportional hazard models adjusted for s for demographic factors, health behaviors, comorbidities, and depression, the hazard ratios were 2.04 (95% confidence interval [CI]: 1.42-2.92) for chronic pancreatitis and 1.69 (95% CI:1.17-2.45) for acute pancreatitis. The suicide death risk was comparable to that of the non-pancreatitis population, excluding chronic pancreatitis cases from the acute pancreatitis group (1.03; 95% CI: 0.60-1.78). CONCLUSION:Chronic pancreatitis was independently associated with an increased risk of suicide death, whereas acute pancreatitis without progression to chronic disease did not show a clear increase in risk. Effective management of pancreatitis-related complications and proactive psychiatric care may be reduce suicide resk in this population.

Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant plasma cell disorder with a risk of progression to multiple myeloma. Metabolic syndrome (MetS) is implicated in cancer development, yet its association with MGUS remains unclear. We examined MetS as a risk factor for MGUS in a large Korean cohort. In a retrospective cohort study using the National Health Information Database, we analyzed 4,453,504 adults undergoing health checkups in 2012, followed through up to 2022. MetS was defined by NCEP-ATP III criteria. Over a median 9.3-year follow-up, 1,241 MGUS cases were identified. MetS was associated with a 28% increased MGUS risk (hazard ratio [HR]=1.28; 95% confidence interval [CI]: 1.14- 1.44). Risk escalated with more MetS components, peaking at 76% for five components (HR=1.76; 95% CI: 1.35-2.30). Low high-density lipoprotein cholesterol, hypertension, and central obesity were key risk factors, with higher risks in males and younger adults (range, 20-39 years). Longitudinal analysis showed MetS onset (HR=1.25; 95% CI: 1.06-1.47) or persistence (HR=1.25; 95% CI: 1.06-1.48) increased MGUS risk compared to persistent MetS absence, whereas MetS resolution showed no significant risk increase over persistent MetS absence. MetS increases MGUS risk, particularly in males and younger individuals. Resolving MetS may mitigate MGUS risk, supporting targeted metabolic interventions.

Low muscle mass (LMM) is a risk factor for adverse health outcomes, but its prognostic relevance in cancer remains insufficiently studied. We investigated the independent and combined effects of LMM and obesity on mortality in cancer patients. This cohort study included 635,867 cancer patients. LMM was defined as the lowest quartile on the appendicular skeletal muscle mass index (ASMI). Obesity was defined as body mass index ≥25 kg/m2 and abdominal obesity as waist circumference ≥90 cm (males) and ≥85 cm (females). Patients were classified into four groups based on muscle mass and obesity status. Cox proportional hazards models calculated adjusted hazard ratios (HRs) and 95

Objective:We examined the distribution of low-density lipoprotein cholesterol (LDL-C) levels and compared the hazards of myocardial infarction (MI), stroke, and their composite according to LDL-C concentration in young adults. Methods:This was a nationwide, population-based study. From the Korean National Health Insurance Service database (2002-2022), we identified adults aged 20-39 years without prior MI or stroke who underwent at least 1 health examination between 2009 and 2012 (n=6,458,006). The hazards of MI, stroke, and their composite were evaluated across LDL-C levels. Results:During a median follow-up of 12.6 years, 47,107 MIs, 28,536 strokes, and 73,897 composite events occurred. The hazard of outcomes showed a J-shaped association with LDL-C levels, with the lowest hazard observed around 90-110 mg/dL. Above this range, the hazard increased progressively with rising LDL-C levels. In analyses based on LDL-C categories, levels ≥130 mg/dL were associated with significantly increased hazards of outcomes, with the highest hazards observed at ≥160 mg/dL. The elevated hazards in the higher LDL-C categories were more pronounced in individuals with abdominal obesity and current smokers for all 3 outcomes, and in those with higher body mass index categories, low high-density lipoprotein-cholesterol, and hypertriglyceridemia for MI and the composite outcome. Conclusion:Among young adults, cardiovascular risk demonstrated a J-shaped association with LDL-C levels. Risks increased progressively beyond approximately 90-110 mg/dL, especially in the presence of other cardiometabolic risk factors. These findings underscore the importance of lipid monitoring and cardiovascular risk assessment even in young adults, particularly those with concurrent risk factors.

To evaluate whether menopausal status modifies the association between migraine and cardiovascular disease (CVD) risk in women, using both relative and absolute risk measures. We conducted a nationwide cohort study using Korean National Health Insurance Service data. Women aged ≥ 40 years who underwent the 2009 health screening and had no prior CVD (myocardial infarction or stroke) were included. Migraine was defined by using ICD-10 diagnostic codes. Menopausal status was determined from questionnaire-based reproductive history and prespecified as an effect modifier. Incident CVD and cardiovascular death were ascertained. Multivariable Cox models were used to estimate hazard ratios (HRs). Among 2,156,733 women, 923,517 were premenopausal and 1,233,216 postmenopausal. In premenopausal women, CVD incidence was higher in those with migraine than in those without migraine (2.22 vs. 1.38 per 1,000 person-years), with a higher risk after multivariable adjustment (HR 1.53, 95

OBJECTIVE:Cardiovascular health (CVH), assessed through Life's Essential 8 (LE8), has been widely studied in relation to physical health outcomes. However, its association with mental health, including psychological distress, suicidal behavior, and mental health service utilization, remains underexplored. This study examined whether better CVH is associated with reduced risk of mental health problems and greater engagement with mental health services. METHODS:We conducted a cross-sectional analysis using data from 4,106 Korean adults aged ≥19 years from the 2021 Korea National Health and Nutrition Examination Survey. CVH was measured using LE8 and categorized into low (0-49), moderate (50-79), and high (80-100) groups. Mental health outcomes included perceived stress, depressive mood, suicidal ideation, suicide planning, suicide attempts, and mental health service utilization. RESULTS:Higher LE8 scores were significantly associated with lower stress (p=0.041) and reduced odds of suicidal ideation (p=0.001). Compared to the low CVH group, adjusted odds ratios (ORs) for stress perception were 0.748 (95% confidence interval [CI]: 0.587-0.953) in the moderate group and 0.685 (95% CI: 0.491-0.956) in the high group. For suicidal ideation, the ORs were 0.517 (95% CI: 0.329-0.813) and 0.199 (95% CI: 0.078-0.507), respectively. LE8 health behaviors, not health factors, were significantly associated with stress perception and suicidal ideation. CONCLUSION:Better CVH is associated with lower psychological distress and suicidal behavior, with health behaviors in LE8 showing stronger associations with mental health outcomes than health factors. Further longitudinal studies are needed to confirm causality and underlying mechanisms.

Splenectomy compromises bone health by disrupting the immune–bone axis. In this nationwide cohort study, splenectomy was associated with increased risk of fractures, particularly hip fractures, with the strongest association observed after traumatic splenectomy. These findings support the need for bone quality monitoring and preventive strategies in post-splenectomy patients. Splenectomy may interfere with immune-mediated bone remodeling, potentially compromising bone quality and strength. However, large-scale, long-term evidence linking splenectomy to bone health remains limited. We aimed to investigate the association between splenectomy and fracture incidence using a nationwide cohort. The analysis included 3,125,549 individuals who participated in national health screenings conducted by the Korean National Health Insurance Service, of which 769 had undergone splenectomy. The primary outcome was the incidence of new-onset fractures (hip, vertebral, or other fractures). Multivariable Cox proportional hazards models were used to assess fracture risk, adjusting for potential confounders. Over a median follow-up of 10.3 years, the splenectomy group exhibited a significantly increased risk for any fracture (hazard ratio [HR] 1.61, 95

OBJECTIVE:To evaluate the long-term risk of pulmonary aspergillosis among tuberculosis (TB) survivors and identify risk factors associated with its development. METHODS:Using data from Korea's Healthcare Big Data platform, which integrates information from the Korea National Health Insurance Service and the Korea Centers for Disease Control and Prevention, we conducted a retrospective cohort study including 13 653 TB survivors and 40 959 matched controls without a history of TB. RESULTS:During a median follow-up of 5.4 years, the incidence of pulmonary aspergillosis was markedly higher among TB survivors than controls (0.89 vs. 0.09 per 1000 person-years; P < 0.001), corresponding to an adjusted hazard ratio (aHR) of 6.84 (95% confidence interval [CI], 3.89-12.1). Among TB survivors, low body mass index (aHR, 2.06; 95% CI, 1.11-3.82), diabetes mellitus (aHR, 4.45; 95% CI, 2.56-7.73), connective tissue disease (aHR, 23.19; 95% CI, 2.99-179.63), and bronchiectasis (aHR, 2.55; 95% CI, 1.08-6.04) were independently associated with pulmonary aspergillosis. CONCLUSIONS:TB survivors are at a substantially increased risk of pulmonary aspergillosis compared with individuals without a history of TB. Long-term surveillance and risk-based management strategies should be considered for this high-risk population.

BACKGROUND:This study aimed to examine the cumulative effect of income on hepatocellular carcinoma (HCC) risk in individuals with type 2 diabetes (T2D). METHODS:A nationwide cohort of 1,516,897 adults with T2D and no history of cancer (2015-2016 baseline) from the Korean National Health Insurance Service was analyzed. Annual income was categorized into quartiles based on health insurance premiums, designating the highest quartile and lowest quartile as high- and low-income groups, respectively. Cumulative income status was assessed over 5 years, including the 4 years preceding and the baseline year. Incident HCC was identified via International Classification of Diseases, Tenth Revision (ICD-10) code. RESULTS:The hazard ratio (HR) for 5-year consistent high-income status was 0.68 [95% confidence interval (CI), 0.65-0.72] compared with those never classified as the high-income group, whereas the HR for 5-year consistent low-income status was 1.34 (95% CI, 1.26-1.43) compared with those never classified as the low-income group. The HCC risk showed a significant duration-dependent trend in relation to cumulative exposure to low or high income, respectively (Ptrend < 0.0001). The association was stronger in those without chronic liver disease or major cancer risk factors and remained robust after adjusting for diabetes-related factors. CONCLUSIONS:Prolonged low- or high-income status was independently associated with HCC risk among individuals with T2D, with a clear duration-dependent pattern. IMPACT:These findings emphasize how income stability independently affects the incidence risk of HCC in individuals with T2D.

KEY POINTS:Four-year worsening of cardiovascular-kidney-metabolic stage was independently associated with higher all-cause mortality, showing a stepwise risk gradient in 2.81 million adults. Early worsening of cardiovascular-kidney-metabolic health was associated with higher mortality, whereas stage improvement lowered the risk, highlighting the value of monitoring changes. The association between cardiovascular-kidney-metabolic progression and mortality was stronger in older adults, highlighting prevention targets. BACKGROUND:Cardiovascular-kidney-metabolic (CKM) syndrome represents the progressive interplay among metabolic dysfunction, kidney impairment, and cardiovascular disease, ultimately contributing to higher mortality. We investigated how changes across CKM stages correlate with subsequent all-cause mortality in a nationwide population-based cohort. METHODS:We analyzed data from 2,812,170 adults aged ≥20 years who underwent two general health screenings 4 years apart through the Korean National Health Insurance Service, with CKM stages classified according to clinical criteria reflecting progressive metabolic, kidney, and cardiovascular risk. Stage-specific CKM stage change (improve, sustain, or progress) and its association with all-cause mortality were evaluated using multivariable Cox regression analysis, adjusted for clinicodemographic variables. RESULTS:During the 4-year exposure assessment period, 674,465 adults (24%) experienced CKM stage progress, 1,802,489 (64%) sustained their CKM stage, and 335,216 (12%) improved. Over a subsequent 6.4-year follow-up, CKM stage progress was significantly associated with a higher risk of all-cause mortality (adjusted hazard ratio [HR], 1.38 [1.36 to 1.41]), whereas CKM stage improvement was associated with a lower risk (adjusted HR, 0.93 [0.90 to 0.95]). Notably, even early-stage progression (from stage 0 to stage 1) was linked to a higher mortality risk (adjusted HR, 1.08 [1.01 to 1.15]), with a stepwise higher risk observed with progression to more advanced follow-up CKM stages. The association between CKM stage progress and mortality was more pronounced in older adults. CONCLUSIONS:Worsening of CKM stage is associated with higher all-cause mortality from early to advanced stages, whereas CKM stage improvement is associated with lower mortality risk. These findings provide epidemiologic real-world evidence supporting the importance of monitoring and intervening on CKM progression across its full spectrum to lower long-term mortality risk.

Background:The triglyceride-glucose (TyG) index, a simple marker of insulin resistance, is associated with chronic kidney disease and end-stage kidney disease (ESKD). However, its association with ESKD in young adults remains unexplored. Objective:This study aimed to investigate whether the TyG index increases the risk of ESKD in the young adult population. Methods:This nationwide retrospective, population-based cohort study analyzed data from 6,555,863 individuals aged 20-39 years between January 2009 and December 2012 using the Korean National Health Insurance Database. Participants were categorized into quartiles and deciles based on the TyG index. The cumulative incidence and adjusted hazard ratios for ESKD were assessed. Results:Over a median follow-up period of 10.61 years, 4910 (0.75%) participants developed ESKD. The incidence of ESKD increased with a higher TyG index in quartiles and deciles. The adjusted hazard ratio for ESKD in the highest quartile was 3.438 (95% CI 3.096-3.818) compared to the lowest quartile, and that in the highest decile was 5.944 (95% CI 5.022-7.035) compared to the lowest decile. These associations remained consistent across subgroup analyses by age, sex, obesity, dyslipidemia, and chronic kidney disease. Conclusions:The TyG index is significantly associated with ESKD risk in young adults.

IntroductionThe association between hypertension identified in early adulthood and uterine fibroid development in young women remains poorly understood. Therefore, we aimed to evaluate the association between hypertension identified in early adulthood and uterine fibroid development in reproductive-age women.MethodsIn this nationwide population-based cohort study, we used data from the Korean National Health Insurance Service, health screening and claims database. A total of 2,558,659 women aged 20–39 years without a prior diagnosis of uterine fibroids were enrolled between 2009–2012 and followed for a mean duration of 11.54 years until December 31, 2023. The main outcome measures were incident uterine fibroids and adjusted hazard ratios (HRs) according to blood pressure categories. Blood pressure was categorized as normotension, elevated/stage 1 hypertension, stage 2 hypertension, or treated hypertension according to national guidelines. Incident uterine fibroids were identified using International Classification of Disease 10th revision code D25. Cox proportional hazards models were used to estimate HRs and 95% confidence intervals (CIs), adjusting for demographic factors, lifestyle behaviors, body mass index (BMI), metabolic comorbidities, and healthcare utilization.ResultsDuring follow-up, 373,379 women (14.59%) developed uterine fibroids. Compared with normotensive women, elevated/stage 1 hypertension (adjusted HR 1.04; 95% CI 1.03–1.05) and stage 2 hypertension (adjusted HR 1.06; 95% CI 1.04–1.09) were associated with a progressively increased risk of incident uterine fibroids (all P < 0.001). Women receiving antihypertensive medication exhibited the highest risk (adjusted HR 1.10; 95% CI 1.06–1.14; P < 0.001). These associations were stronger among women with BMI < 25 kg/m² compared with those with BMI ≥ 25 kg/m² (P for interaction < 0.0001), and among women with waist circumference < 85 cm compared with those with waist circumference ≥ 85 cm (P for interaction = 0.0005). No association was observed according to antihypertensive medication class.ConclusionsHypertension identified in early adulthood was independently and progressively associated with incident uterine fibroids in reproductive-age women. These findings suggest that blood pressure dysregulation during early adulthood may be relevant to uterine fibroid risk in young women.

Prior research has established a positive correlation between blood pressure (BP) and ischemic stroke in the general population; however, this association has not been investigated in dementia patients. A population-based cohort of 73,130 individuals with newly diagnosed dementia who underwent a Korean national health checkup after diagnosis was followed up until the end of 2019. Individuals were classified according to their systolic (SBP) and diastolic BP (DBP) during health checkups. Multivariable Cox proportional hazards regression was performed, calculating the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident ischemic stroke. During a mean follow-up of 3.6 years, 4446 (6.1%) patients developed ischemic stroke. In all-cause dementia patients, the risk of ischemic stroke increased after SBP/DBP exceeded 130/90 mmHg compared with SBP 120-129 mmHg and DBP 70-79 mmHg (reference) (both P for trend <0.001). Similar trends were observed in patients with Alzheimer's disease and vascular dementia. In particular, SBP/DBP ≥ 140/90 mmHg and SBP 100-109 mmHg were associated with incrementally higher risks of ischemic stroke and a decreased risk of Alzheimer's disease, respectively (both P for trend <0.001). The positive linear association of SBP and DBP with ischemic stroke in all-cause dementia remained after stratification by sex and antihypertensive medication use, and the association between SBP and ischemic stroke was greater among younger individuals (40-79 years old). In conclusion, both SBP and DBP showed positive linear relationships with the risk of incident ischemic stroke in dementia patients. Achievement of the target BP may be important for stroke prevention in individuals with dementia.

Background: Hypertension is more prevalent among individuals with disabilities than in the general population. This study analyzed long-term trends in disparities in hypertension care quality and the incidence of hypertensive complications among individuals with and without disabilities. Methods: This retrospective cohort study followed 52,743 hypertensive patients aged 20 or older with disabilities newly diagnosed in 2010, along with 47,564 age-and sex-matched patients without disabilities, from 2011 to 2019. Hypertension care quality was assessed using indicators of medication adherence and the completion of three complication-monitoring tests at recommended frequency: blood test, urine test, and electrocardiogram (ECG). Hypertensive complications included major cardiovascular and cerebrovascular events, kidney diseases, and all-cause mortality. Logistic regression was repeated annually to assess hypertension care quality, and Cox-proportional model was used to estimate the risk of hypertension-related complications. Results: Hypertensive patients with disabilities consistently demonstrated lower medication adherence throughout the study period (adjusted odds ratio [aOR], 0.90-0.96, depending on the year), but a higher likelihood of undergoing screenings at recommended frequency (e.g., aOR for blood test, 1.31-1.39, for urine test, 1.24-1.33, and for ECG, 1.30-1.37). The risk of complications remained significantly higher among hypertensive patients with disabilities, even after adjusting for care quality indicators (e.g., adjusted hazard ratio for cardiovascular events: 1.36, 95% confidence interval: 1.31-1.41). Subgroup analyses revealed that the excess risks for complications varied across different sociodemographic groups. Conclusion: These findings underscore the need for comprehensive strategies to enhance medication adherence among hypertensive patients with disabilities. Additionally, other factors beyond medication adherence and monitoring test completion that contribute to the increased risk of complications require further exploration.

Objective: This study aimed to evaluate the associations of baseline income, cumulative income exposure, and income volatility with the incidence of pancreatic and biliary tract cancers in a nationwide Korean cohort. Methods: We analyzed 3,361,091 adults aged 30-65 years who underwent the 2012 National Health Insurance Service (NHIS) health screening. Income level was derived from insurance premium data assessed over the five years preceding baseline (2008-2012) and categorized into baseline income quartiles, cumulative exposure to low or high income, and income volatility based on annual percentage changes. Incident pancreatic and biliary tract cancers were identified using diagnostic codes and the copayment reduction registry. Associations were evaluated using Cox proportional hazards models with adjustment for demographic, lifestyle, and clinical covariates, and cumulative incidence was compared using Kaplan-Meier curves. Results: During a median follow-up of 9.6 years, 14,469 pancreatic cancers and 6,647 biliary tract cancers were newly diagnosed. Lower baseline income was associated with a higher risk of pancreatic and biliary tract cancers, whereas sustained high-income exposure was associated with reduced risk. Cumulative low-income exposure showed a positive linear trend with pancreatic cancer incidence. Income volatility was modestly associated with pancreatic cancer and was positively associated with biliary tract cancer in the fully adjusted model. These associations were generally consistent across subgroups, with a stronger inverse association between prolonged high-income exposure and pancreatic cancer among individuals without diabetes. Conclusions: Income level and income stability were significantly associated with the incidence of pancreatic and biliary tract cancers. Lower baseline income was associated with higher risk, whereas sustained high-income exposure was protective. Income volatility was associated with increased cancer risk, particularly for biliary tract cancer. These findings highlight the importance of incorporating income dynamics into cancer prevention strategies and addressing socioeconomic instability among vulnerable populations.