Ya-Hui Chang

Background: On July 1, 2017, Taiwan introduced a mandatory license renewal policy for older drivers, which was gradually implemented among drivers aged ≥ 75 years. However, the benefits of this regulation remain uncertain. This study examined the effects of the license renewal policy on collision and case fatality rates among older drivers.Methods: We conducted a controlled interrupted time-series analysis using monthly national police-reported motor vehicle collision data from January 2013 to December 2021. Drivers aged ≥75 years comprised the age group subject to the policy, and drivers aged 65–74 years served as the comparison group. Collision rates were modeled using negative binomial regression with age-group-specific population as the offset. Case fatality rates were modeled using Poisson regression with monthly collision counts as the offset. Estimates were expressed as rate ratios and ratios of rate ratios (RRRs).Results: The immediate post-policy level change in collision rates among drivers aged ≥75 years did not differ significantly from that among drivers aged 65–74 years (RRR, 1.061; 95% CI, 0.992–1.134). However, the post-policy monthly trend was significantly greater among drivers aged ≥75 years than among drivers aged 65–74 years (RRR, 1.004; 95% CI, 1.001–1.007). For case fatality rates, neither the immediate level change nor the post-policy monthly trend differed significantly between groups.Conclusion: The introduction of the license renewal policy was not associated with clear evidence of a population-level road safety benefit among drivers aged ≥75 years.

Background: Metabolic syndrome (MetS) is a multifaceted health condition influenced by physiological and lifestyle factors, leading to increased risks of cardiovascular disease and other chronic health issues. Lifestyle behaviors often manifest in various clustering patterns, and evidence of their impact on MetS remains limited. Objective: This study explores the relationship of latent classes of lifestyle behaviors with the risk of MetS and its components. Methods: This cross-sectional study used data from Taiwan’s 2020‐2022 Adult Preventive Health Services Database, which was linked to 2020‐2022 National Health Insurance claim data. The study included 241,156 adults aged 40 years and older who participated in adult preventive health services between 2020 and 2022. Lifestyle behaviors were assessed through smoking, alcohol consumption, betel quid chewing, and physical activities. Latent class analysis was used to identify lifestyle behavior patterns, while binary logistic regression examined the association of these patterns with MetS risk and its components. Results: The latent class analysis identified 5 distinct lifestyle behavior patterns, with an overall MetS prevalence of 35.72% (86,143/241,156). Compared to the “healthy lifestyle” group (27,465/241,156, 11.39% prevalence), the “insufficiently physically active (IPA)” group (182,101/241,156, 75.51%, adjusted odds ratio [aOR] 1.41, 95% CI 1.37‐1.45; P<.001), the “occasional drinking but physically active” group (18,244/241,156, 7.57%, aOR 1.27, 95% CI 1.21‐1.32; P<.001), the “occasional drinking and regular smoking with IPA” group (9539/241,156, 3.96%, aOR 2.38, 95% CI 2.26‐2.50; P<.001), and the “unhealthy in all behaviors” group (3807/241,156, 1.58%, aOR 2.38, 95% CI 2.22‐2.55; P<.001) showed significantly higher odds of developing MetS. Compared to the “healthy lifestyle” group, all other lifestyle patterns were also associated with significantly higher odds of central obesity (P<.001), elevated blood pressure (P<.001), elevated fasting blood glucose (P<.001), elevated fasting triglycerides (P<.001), and reduced high-density lipoprotein cholesterol (P<.001), with the most potent effects observed in the “occasional drinking and regular smoking with IPA” group and the “unhealthy in all behaviors” group. An exception was noted for the “occasional drinking but physically active” group, which showed a significantly lower likelihood of reduced high-density lipoprotein cholesterol (aOR 0.90, 95% CI 0.85‐0.94; P<.001). Conclusions: Engaging in sufficient physical activity and adopting multibehavior interventions tailored to specific lifestyle patterns are crucial for effectively preventing MetS in adults.

Background: Monitoring and improving intrinsic capacity (IC) and well-being are essential for older adults to maintain functional abilities. However, evidence of effective interventions to improve IC and happiness is scarce. This study examined the effects of multicomponent interventions in the Healthy Longevity and Ageing in Place (HOPE) randomised controlled trial on IC and happiness among rural community-dwelling older adults. Methods: This cluster randomised trial was conducted in rural communities in Taiwan (NCT05104034). Participants aged ≥50 were enrolled from September 2021 to April 2022 and randomly assigned by community level to one of three groups: multicomponent integrated care (MIC), osteoporosis care (OC) and usual care (UC). MIC included osteoporosis, sarcopenia and polypharmacy care, along with exercise and nutritional support. OC was a resource-conservative, focusing on osteoporosis screening and treatment alone. IC and happiness were measured at baseline and 12 months after follow-up. IC was assessed across cognition, locomotion, vitality, sensory and psychological domains per World Health Organization Integrated Care for Older People (ICOPE) guidelines. Happiness was measured using the 10-item Chinese Happiness Inventory. Generalised estimating equations were used to estimate the effect of the intervention. Results: 567 residents were recruited from 30 congregate meal service centres. Mean IC score increased across all the groups, though the happiness score decreased. Compared to UC, the MIC group exhibited a significantly greater improvement in IC scores (adjusted estimate = 0.30, standard error (SE) = 0.11, P = .01), whereas OC did not show significant effects. Smaller reductions in happiness scores were observed in both the MIC (adjusted estimate = 1.46, SE = 0.48, P = .003) and OC groups (adjusted estimate = 0.95, SE = 0.48, P = .05). Conclusion: MIC, including osteoporosis and pharmaceutical care, along with exercise and nutritional support, is an effective strategy to enhance IC and happiness compared to osteoporosis treatment alone and UC. This underscores the importance of comprehensive strategies for promoting healthy ageing in rural communities.

Sugar-sweetened beverages (SSBs) are drinks that contain added sugar or sweeteners and provide calories with no additional nutrients, and some countries have imposed additional taxes on the SSBs to reduce consumption, which is considered an SSB tax policy. This study used a cross-sectional online survey to examine the patterns of public support for an SSB tax in Taiwan. The sample included 1617 adults aged ≥ 20 years, who answered the survey questionnaire between May 2020 and April 2021. The respondents were recruited using convenience sampling, but sampling weights were applied to represent the Taiwanese population. Generalized ordered logit models with sampling weights were used to examine the correlates of public support for an SSB tax. Results showed that ~60% of the respondents supported the SSB tax and 47% perceived the tax to be effective. The respondents who were aware of the perceived health risks of SSBs or those who believed that one should be partly responsible for the health impact of SSBs were more likely to show support for the SSB tax. In adjusted regression models, both one’s perceived risk and perceived responsibility of SSBs were positively associated with the perceived effectiveness of the SSB tax after sociodemographic characteristics were controlled. These research findings show evidence that there is public support for implementing an SSB tax to reduce SSB consumption in Taiwan.

OBJECTIVES: Limited information is available on whether diabetes increases the severity of injuries from motor vehicle crashes (MVCs). This study aimed to investigate the association of type 2 diabetes with injury severity among driver victims of MVCs.METHODS: This cohort study involved 75,737 adult driver victims with type 2 diabetes from Taiwan’s Police-Reported Traffic Accident Registry in 2015-2017, along with 150,911 sex-, age-, and calendar year-matched controls. The severity level of non- fatal injuries was derived from the International Classification of Diseases Programs for Injury Categorization based on the diagnostic codes of National Health Insurance claims within 3 days after an MVC. Information on fatal injuries within 3 days after an MVC was obtained from the Taiwan Death Registry. Logistic regression models were used to estimate the odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) of injury severity in association with type 2 diabetes.RESULTS: After adjusting for potential confounders, driver victims with type 2 diabetes experienced significantly higher risks of mild and severe non-fatal injuries than their counterparts without diabetes, with covariate-adjusted ORs of 1.08 (95% CI, 1.05 to 1.11) and 1.28 (95% CI, 1.20 to 1.37), respectively. By contrast, the adjusted OR for fatal injuries was not significantly elevated, at 1.02 (95% CI, 0.89 to 1.18). Similar results were found when car and scooter driver victims were analyzed separately.CONCLUSIONS: Type 2 diabetes was found to moderately increase the severity of non-fatal injuries from MVCs among car and scooter driver victims.

Background: Visit-to-visit variability (VVV) of glycated hemoglobin (HbA1c) levels have been found to be associated with prognosis of diabetes. However, little is known about whether or to what extent sex and age may modify the effects of VVV. Methods: To investigate age- and sex-specific rates of mortality from all causes and relative hazards of mortality in association with VVV of HbA1c levels, 47,145 patients with diabetes and prescription of any antidiabetic agents >6 months were identified from outpatient visits of a tertiary medical center in northern Taiwan during 2003–2018. VVV of HbA1c was measured by quartiles of standard deviation (SD), coefficient of variation (CV), and average real variability (ARV), respectively. The study subjects were linked to Taiwan’s National Death Registry to identify all-cause mortality. The person-year approach with the Poisson assumption was used to assess the all-cause mortality rates, and Cox proportional hazard regression model was used to evaluate the relative hazards of all-cause mortality concerning various levels of VVV of HbA1c. Results: The lowest all-cause mortality rate was found in either the first or second quartile of various measures for VVV of HbA1c, but the highest mortality rate was consistently observed in the fourth quartile of VVV, regardless of SD, CV, or ARV across ages and sexes. Increased hazards of overall all-cause mortality were noticed from the second to fourth quartile of VVV of HbA1c. In detailed age- and sex-stratified analyses, elevated risk of mortality was seen in the fourth quartile of those aged 69 years, increased risk of mortality was noticed in the third and fourth quartiles of any VVV of HbA1c irrespective of sex. In those aged 50–69 years, incremental increased hazards of mortality were consistently observed in the second to fourth quartiles of VVV of HbA1c. Conclusion: HbA1c variability whether it was SD, CV, or ARV could strongly predict the risks of all-cause mortality. The extent of the relationship between VVV of HbA1c and all-cause mortality in different age groups was comparable between both sexes. Given the importance of long-term glucose fluctuation, the inclusion of HbA1c variability calculated from the standardized method should be considered by clinical guideline policymakers as part of the biochemical panel in daily diabetes management.

The aim of the study was to provide a systematic review and meta-analysis of studies examining the association between mortality risk and motor vehicle crashes (MVCs) in pregnant women compared with nonpregnant women. We used relevant MeSH terms to identify epidemiological studies of mortality risk in relation to MVCs from PubMed, Embase, and MEDLINE databases. The Newcastle–Ottawa Scale (NOS) was used for quality assessment. For comparison of mortality from MVCs between pregnant and nonpregnant women, the pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random effects model. The eight studies selected met all inclusion criteria. These studies included 14,120 injured victims who were pregnant at the time of the incident and 207,935 victims who were not pregnant. Compared with nonpregnant women, pregnant women had a moderate but insignificant decrease in mortality risk (pooled OR = 0.68, 95% CI = 0.38–1.22, I² = 88.71%). Subgroup analysis revealed that the pooled OR significantly increased at 1.64 (95% CI = 1.16–2.33, I² < 0.01%) for two studies with a similar difference in the mean injury severity score (ISS) between pregnant and nonpregnant women. Future studies should further explore the risk factors associated with MVCs in pregnant women to reduce maternal mortality.

Objective Large clinical trials have proved the efficacy of Covid-19 vaccine, and the number of literature about the effectiveness is rapidly growing in the first half of year after mass vaccination was administrated globally. This rapid review aims to provide evidence syntheses as a means to complement the current evidence on the vaccine effectiveness (VE) against various outcomes in real-world settings. Methods This review is conducted based on the updated guideline of PRISMA 2020. Databases (PubMed, EMBASE, and MedRxiv) were searched up to 30 June 2021, (PROSPERO ID: 266866). The studies that assessed the VE of the 6 WHO-authorized vaccines (BNT162b2, ChAdOx1, Ad26.COV2.S, mRNA-1273, BBIBP-CorV, and CoronaVac) were eligible to be included. Quality assessment was performed based on ROBINS-I by 2 independent reviewers. Findings A total of 39 studies were included, covering over 15 million of participants from 11 nations. Among the general population after 2 doses of vaccination, the VE against symptomatic SARS-CoV-2 infection was estimated at 89%–97%, 92% (95% CI, 78%–97%) and 94% (95% CI, 86%–97%) for BNT162b2, ChAdOx1 and mRNA-1273, respectively. As for the protective effects against B.1.617.2 related symptomatic infection, the VE was 88% (95% CI, 85.3%–90.1%) by BNT162b2 and 67.0% (95% CI, 61.3%–71.8%) by ChAdOx1 after fully vaccination. Conclusion This review revealed a consistently high effectiveness of vaccines among the general population in real-world settings. Further studies are needed to provide the information on different races/ethnicity, the effects against SARS-CoV-2 variants, and the duration of protection with longer study time.