Natural Menopause and Risk of Stroke in Elderly Women

Although early natural menopause has been postulated to increase stroke risk, studies have not produced convincing results. We examined the associations between stroke risks and age at natural menopause or time since natural menopause. 5,731 naturally postmenopausal women more than 65 yr of age were followed from 1993 to 1998. Information on age at menopause and risk factors were obtained using mailed questionnaires. 186 cases of stroke occurred over a total 27,936 person years. After adjusting for age, hypertension, and physical activity, age at menopause was not found to be significantly associated with stroke or cerebral infarction. However, adjusted relative risks (aRRs) showed a significant increasing tendency of hemorrhagic stroke versus age at menopause (aRRs, 0.66, 0.48, 1.00 and 2.33 for the following age groups at menopause; 40-44, 45-49, 50-54 [reference group], and > or =55 yr). Time since menopause (11-20, 21-30, and > or =31 yr) was not found to be significantly associated with cerebral infarction, or hemorrhagic stroke. Late menopause (menopause age > or =55 yr) showed a tendency of a lower risk of cerebral infarction (aRR, 0.79) and a higher risk of hemorrhagic stroke (aRR, 2.33). Further study is warranted to determine stroke risk in women during the decade following menopause.

Stomach Cancer Incidence, Mortality and Survival Rate in Korean Elderly Pharmacoepidemiologic Cohort (KEPEC) in 1994~1998 / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study was conducted to estimate the incidence, mortality and survival rate of stomach cancer in elderly people in Korea. MATERIALS AND METHODS: The source population was a Korean Elderly Phamacoepidemiologic Cohort (KEPEC), who were 65 years of age or older and living in Busan metropolitan city and Gyeongsangnam province, Korea. A subcohort of 38, 443 persons without stomach cancer were identified before enrolling the KEPEC. The stomach cancer incidence cases were detected from three different sources, the medical claims database of the Korea Medical Insurance Corporation (KMIC), the Korea Central Cancer Registry (KCCR), and the Busan Cancer Registry (BCR). A hospital survey for abstracting the relevant information to confirm the final diagnosis of the potential cases from the medical claims database was conducted. A medical oncologist reviewed the data to confirm the final diagnoses and the date of onset. The mortality cases due to stomach cancer were detected from the mortality database at the National Statistical Office. The incidence rate, the survival rate and the mortality rate of stomach cancer and their 95% confidence intervals were estimated using SAS Windows ver. 8.1. RESULTS: There were 338 confirmed stomach cancer cases in the KEPEC between 1 January 1994 and 31 December 1998. The age-standardized incidence rate of stomach cancer in the Korean elderly population was estimated to be 351.4 per 100, 000 person-years in males and 122.6 per 100, 000 person-years in females. In addition, 272 stomach cancer death cases were detected in the KEPEC between 1 Jan. 1994 and 31 Dec. 1998. The age-standardized mortality rate of stomach cancer to the Korean elderly population was estimated to be 268.5 per 100, 000 person-years in males and 93.7 per 100, 000 person-years in females. The one-year survival rate was 62.1% in males and 63.0% in females, which was considered to be statistically similar. The three-year survival rate was 38.9% in males and 40.9% in females. The five-year survival rate was 34.8% in males and 34.7% in females. CONCLUSION: The age-standardized male stomach cancer incidence rate and mortality rate to the Korean population were approximately three times higher than in female. However, there was little significant difference between males and females in terms of the overall survival rates. These results may be useful for planning a health policy for preventing and managing stomach cancer in Korea.

H2 Receptor Antagonists and Gastric Cancer in the Elderly: A Nested Case-Control Study / 예방의학회지

OBJECTIVE: To test if the intake of H2 receptor antagonists (H2-RAs) increases the risk of gastric cancer in the elderly. METHODS: The source population for this study was drawn from the responders to a questionnaire survey administered to the Korea Elderly Pharmacoepidemiological Cohort (KEPEC), who were beneficiaries of the Korean Medical Insurance Corporation, were at least 65 years old, and residing in Busan in 1993. The information on H2-RAs exposure was obtained from a drug prescription database compiled between Jan. 1993 and Dec. 1994. The cases consisted of 76 gastric cancer patients, as confirmed from the KMIC claims data, the National Cancer Registry and the Busan Cancer Registry. The follow-up period was from Jan. 1993 to Dec. 1998. Cancer free controls were randomly selected by 1:4 individual matching, which took in to consideration the year of birth and gender. Information on confounders was collected by a mail questionnaire survey. The odds ratios, and their 95% confidence intervals, were calculated using a conditional logistic regression model. RESULTS: After adjusting for a history of gastric ulcer symptoms, medication history, and body mass index, the adjusted OR (aOR) was 4.6 (95% CI=1.72-12.49). The odds ratio of long term use (more than 7 days) was 2.3 (95% CI=1.07-4.82). The odds ratio of short term use was 4.6 (95% CI=1.26-16.50). The odds ratio of parenteral use was 4.4 (95% CI=1.16-17.05) and combination use between the oral and parenteral routes (aOR, 16.8; 95% CI=1.21-233.24) had the high risk of gastric cancer. The aOR of cimetidine was 1.7 (95% CI=1.04-2.95). The aOR of ranitidine was 2.0 (95% CI=1.21-3.40). The aOR of famotidine was 1.7 (95% CI=0.98-2.80). CONCLUSION: The intake of H2-RAs might increase the risk of gastric cancer through achlorhydria in the elderly.

Reproductive History and Hip Fracture in the Elderly Women in Korea: A Cohort Study / 예방의학회지

OBJECTIVES: The reproductive history of women has been suggested to have a possible influence on the risk of osteoporotic fractures. The purpose of this study was to assess the association between reproductive history and hip fractures in the elderly women. METHODS: The study subjects were drawn from women members of the Korean Elderly Pharmacoepidemiologic Cohort (KEPEC), aged 65 years or over, whose reproductive histories were available, and who were beneficiaries of the Korea Medical Insurance Corporation (KMIC) in 1993 and lived in Busan city, Korea. The information on reproductive histories, and possible confounders, were collected from mailed questionnaires. Potential hip fracture cases were collected from the claims data obtained between 1993 and 1998, with a hospital survey conducted to confirm the final diagnoses. Rate ratios and their 95% confidence intervals, were calculated using a Cox's proportional hazard model. RESUJLTS: Following up 5,219 women for 6 years, 51 cases were confirmed with hip fractures. When adjusted for age, weight and physical activity, the rate ratio of hip fractures in women who had given birth three or more times was 0.56 (95% CI: 0.25 - 1.25), compared with those who had given birth two or less times. When adjusted for age, number of births, weight and physical activity, the rate ratio in women who first gave birth when younger than 22 years was 0.60 (95% CI: 0.34 - 1.08) compared with those who had giving birth at 22 years or older. CONCLUSIONS: According to these findings, an early age when first giving birth might decrease the risk of hip fractures in elderly Korean women.

Reproductive History and Hip Fracture in the Elderly Women in Korea: A Cohort Study / 예방의학회지

OBJECTIVES: The reproductive history of women has been suggested to have a possible influence on the risk of osteoporotic fractures. The purpose of this study was to assess the association between reproductive history and hip fractures in the elderly women. METHODS: The study subjects were drawn from women members of the Korean Elderly Pharmacoepidemiologic Cohort (KEPEC), aged 65 years or over, whose reproductive histories were available, and who were beneficiaries of the Korea Medical Insurance Corporation (KMIC) in 1993 and lived in Busan city, Korea. The information on reproductive histories, and possible confounders, were collected from mailed questionnaires. Potential hip fracture cases were collected from the claims data obtained between 1993 and 1998, with a hospital survey conducted to confirm the final diagnoses. Rate ratios and their 95% confidence intervals, were calculated using a Cox's proportional hazard model. RESUJLTS: Following up 5,219 women for 6 years, 51 cases were confirmed with hip fractures. When adjusted for age, weight and physical activity, the rate ratio of hip fractures in women who had given birth three or more times was 0.56 (95% CI: 0.25 - 1.25), compared with those who had given birth two or less times. When adjusted for age, number of births, weight and physical activity, the rate ratio in women who first gave birth when younger than 22 years was 0.60 (95% CI: 0.34 - 1.08) compared with those who had giving birth at 22 years or older. CONCLUSIONS: According to these findings, an early age when first giving birth might decrease the risk of hip fractures in elderly Korean women.

Physical Activity and Hip Fracture in Elderly People: A Cohort Study in Korea / 예방의학회지

OBJECTIVE: To evaluate the relationship between physical activity and the risk of hip fracture in the elderly Korean people. METHODS: The study population was a Physical Activity Subcohort (n=8,908) extracted from the Korean Elderly Pharmacoepidemiological Cohort (KEPEC). Physical activity information was obtained from a mailed questionnaire surveys. The outcome data was collected from claims data gathered between Jan. 1993 and Dec. 1998. A hospital survey relating to potential cases was conducted to confirm the final diagnoses. The abstracted data was reviewed by a medical doctor before the final diagnoses were confirmed. A mailing questionnaire survey was performed to obtain information on potentially confounding variables, including alcohol intake, smoking habits, weight, height and postmenopausal duration. There were 79 confirmed cases hospitalized due to hip fractures between Jan. 1993 and Dec. 1998. Relative risk of physical activity scores on the hip fracture, and their 95% confidence intervals, were estimated by a Cox's proportional hazard model using SAS for Windows ver. 6.12. RESUJLTS: Compared to the reference group, the adjusted relative risk of hip fracture associated with the most physical active category; after controlling for age, weight and alcohol intake in the males, and for weight, alcohol intake and postmenopausal duration in the females, were 1.04 (95% CI=0.35-3.06) and 0.44 (95% CI=0.26-0.77), respectively. CONCLUSIONS: Physical activity may protect elderly women from hip fracture.

Physical Activity and Hip Fracture in Elderly People: A Cohort Study in Korea / 예방의학회지

OBJECTIVE: To evaluate the relationship between physical activity and the risk of hip fracture in the elderly Korean people. METHODS: The study population was a Physical Activity Subcohort (n=8,908) extracted from the Korean Elderly Pharmacoepidemiological Cohort (KEPEC). Physical activity information was obtained from a mailed questionnaire surveys. The outcome data was collected from claims data gathered between Jan. 1993 and Dec. 1998. A hospital survey relating to potential cases was conducted to confirm the final diagnoses. The abstracted data was reviewed by a medical doctor before the final diagnoses were confirmed. A mailing questionnaire survey was performed to obtain information on potentially confounding variables, including alcohol intake, smoking habits, weight, height and postmenopausal duration. There were 79 confirmed cases hospitalized due to hip fractures between Jan. 1993 and Dec. 1998. Relative risk of physical activity scores on the hip fracture, and their 95% confidence intervals, were estimated by a Cox's proportional hazard model using SAS for Windows ver. 6.12. RESUJLTS: Compared to the reference group, the adjusted relative risk of hip fracture associated with the most physical active category; after controlling for age, weight and alcohol intake in the males, and for weight, alcohol intake and postmenopausal duration in the females, were 1.04 (95% CI=0.35-3.06) and 0.44 (95% CI=0.26-0.77), respectively. CONCLUSIONS: Physical activity may protect elderly women from hip fracture.

Lung cancer incidence, mortality and survival rate in Korean Elderly Pharmacoepidemiologic Cohort(KEPEC) in 1994-1998 / 한국역학회지

PURPOSE: This study was conducted to estimate incidence, mortality and survival rate of lung cancer in the elderly people in Korea. METHODS: Study population was Korean Elderly Phamacoepidemiologic Cohort (KEPEC). The lung cancer incidence cases were detected from three different sources, medical utilization database of the Korea Medical Insurance Corporation (KMIC), the database from the National Cancer Registry, and the database from the Regional Cancer Registry. The hospital survey to confirm the final diagnosis of the potential cases was conducted. A specialist on lung cancer reviewed the abstracted data to confirm the final diagnoses. The lung cancer death cases were detected from the mortality database at National Statistical Office. Incidence rate, survival rate and mortality rate of lung cancer and their 95% confidence intervals were estimated with SAS Window ver. 8.1. PESULTS: There were 213 confirmed lung cancer cases in KEPEC between Jan. 1994 and Dec. 1998. Age-standardized incidence rate of lung cancer to the Korean population was estimated to be 316.9 per 100,000 person-years in male and 65.2 per 100,000 person-years in female. Age-standardized mortality rate of lung cancer to the Korean population was estimated to be 342.3 per 100,000 person-years in male and 84.8 per 100,000 person-years in female. One year survival rate was 17% in male and 11% in female. Two year survival rate was 2% in male and 4% in female. CONCLUSION: Age-standardized incidence rate, age-standardized mortality rate and survival rate of lung cancer in the elderly Korean may be useful for further study and making health policy for managing lung cancer in the elderly.