Impact of age and gender differences in the prevalence and patterns of multimorbidity in the Thai Cohort Study.

BACKGROUND: The study aims to identify the common patterns of multimorbidity and their distribution by age and gender. METHOD: This cross-sectional study collected self-reported data from 42 785 Thai Cohort Study members through mailed questionnaires. Employing prevalence-based analysis, it identified common multimorbidity (coexistence of two or more chronic conditions) patterns, analysing the three most common patterns stratified by age and sex. P for trend (p-trend) was used to test the linear trend for associations between age and prevalence of these chronic conditions in the multimorbidity patterns. RESULTS: Chronic conditions with the highest prevalence were related to metabolic syndromes: obesity (28.5%), hyperlipidaemia (13.2%) and hypertension (7.2%). A positive linear age-multimorbidity association was observed (p-trend = 0.0111). The 60+ participants averaged 1.20 diseases, with 33.7% multimorbidity prevalence. Hyperlipidaemia + obesity was most prevalent in the under-40 multimorbid group (38.7%). Men exhibited a higher prevalence of multimorbidity and associated patterns involving hypertension, hyperlipidaemia and obesity than women. CONCLUSION: Metabolic syndrome components were the prominent factors driving multimorbidity. Significant age and gender differences were also revealed in multimorbidity prevalence. People aged 60+ faced high risk of multimorbidity, while younger individuals tended towards the multimorbidity pattern of obesity and hyperlipidaemia. Men were more susceptible to multimorbidity patterns associated with metabolic syndromes. Future studies for metabolic-related multimorbidity should consider these differences, addressing age and gender issues.

The Impact of Multimorbidity on All-Cause Mortality: A Longitudinal Study of 87,151 Thai Adults.

Objectives: To investigate associations between multimorbidity, socio-demographic and health behaviour factors, and their interactions (multimorbidity and these factors) with all-cause mortality among Thai adults. Methods: Associations between multimorbidity (coexistence of two + chronic diseases) and mortality between 2005 and 2019 were investigated among Thai Cohort Study (TCS) participants (n = 87,151). Kaplan-Meier survival curves estimated and compared survival times. Multivariate Cox proportional hazards models examined associations between risk factors, and interactions between multimorbidity, these factors, and survival. Results: 1,958 cohort members died between 2005 and 2019. The risk of death was 43% higher for multimorbid people. In multivariate Cox proportional hazard models, multimorbidity/number of chronic conditions, age, long sleep duration, smoking and drinking were all independent factors that increased mortality risk. Women, urbanizers, university education, over 20,000-baht personal monthly income and soybean products consumption lowered risk. The interactions between multimorbidity and these variables (except for female, urbanizers and soybeans intake) also had significant (p < 0.05) impact on all-cause mortality. Conclusion: The results emphasise the importance of healthy lifestyle and reduced intake of alcohol and tobacco, in reducing premature mortality, especially when suffering from multimorbidity.

Reviewing Publicly Available Reports on Child Health Disparities in Indigenous and Remote Communities of Australia.

Developing programs that ensure a safe start to life for Indigenous children can lead to better health outcomes. To create effective strategies, governments must have accurate and up-to-date information. Accordingly, we reviewed the health disparities of Australian children in Indigenous and remote communities using publicly available reports. A thorough search was performed on Australian government and other organisational websites (including the Australian Bureau of Statistics [ABS] and the Australian Institute of Health and Welfare [AIHW]), electronic databases [MEDLINE] and grey literature sites for articles, documents and project reports related to Indigenous child health outcomes. The study showed Indigenous dwellings had higher rates of crowding when compared to non-Indigenous dwellings. Smoking during pregnancy, teenage motherhood, low birth weight and infant and child mortality were higher among Indigenous and remote communities. Childhood obesity (including central obesity) and inadequate fruit consumption rates were also higher in Indigenous children, but Indigenous children from remote and very remote areas had a lower rate of obesity. Indigenous children performed better in physical activity compared to non-Indigenous children. No difference was observed in vegetable consumption rates, substance-use disorders or mental health conditions between Indigenous and non-Indigenous children. Future interventions for Indigenous children should focus on modifiable risk factors, including unhealthy housing, perinatal adverse health outcomes, childhood obesity, poor dietary intake, physical inactivity and sedentary behaviours.

Association between greenness and cardiovascular risk factors: Results from a large cohort study in Thailand.

BACKGROUND: The risk of cardiovascular diseases may be reduced by residing in green environments. However, there are relatively few longitudinal cohort studies, especially in Southeast Asia, that focused on the health benefits of long-term greenness exposure in young adults. The present study examined the association between long-term exposure to residential greenness and self-reported morbidities in participants of the Thai Cohort Study (TCS) in Thailand from 2005 to 2013. METHODS: The self-reported outcomes, including high blood pressure, high blood cholesterol, and diabetes, were reported in 2005, 2009, and 2013, where the study participants provided the exact year of disease occurrence. Greenness was assessed by the satellite-based Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI), with a spatial resolution of 250 m. Long-term exposure to NDVI and EVI of each participant's sub-district was averaged over the period of person-time. We used Cox proportional hazards models to examine the association between greenness and health outcomes. Associations with self-reported morbidity were measured using hazard ratios (HRs) per interquartile range (IQR) increase in NDVI and EVI. RESULTS: After adjusting for potential confounders, we observed that an IQR increase in NDVI was associated with lower incidence of high blood pressure (HR = 0.92, 95% CI: 0.89, 0.97) and high blood cholesterol (HR = 0.89, 95%CI: 0.87, 0.92), but not significantly associated with diabetes (HR = 0.93, 95%CI: 0.85, 1.01). EVI was also inversely associated with self-reported high blood pressure (HR = 0.92, 95%CI: 0.88, 0.96), high blood cholesterol (HR = 0.89, 95%CI: 0.87, 0.91), and diabetes (HR = 0.92, 95%CI: 0.85, 0.99). CONCLUSIONS: Long-term exposure to residential greenness was inversely associated with self-reported high blood pressure, high blood cholesterol, and diabetes in participants of TCS. Our study provides evidence that greenness exposure may reduce cardiovascular disease risk factors in adult population.

How do cohabitation and marital status affect mortality risk? Results from a cohort study in Thailand.

OBJECTIVE: To examine the relationship between baseline union status (ie, including marriage and cohabitation) and mortality, paying attention to gender differentials, through an 11-year follow-up of a large cohort in Thailand. DESIGN: Cohort data from Thai Cohort Study (TCS) were linked official death records over an 11-year follow-up period. SETTING: Community-based adults in Thailand. PARTICIPANTS: 87 151 Thai adults participated in TCS cohort. METHOD: Cox regression models measured longitudinal associations between union status and 11-year mortality. RESULTS: From 2005 (baseline) to 2016, persons who cohabited and lived with a partner, married persons but not living with a partner and separated/divorced/widowed people were more likely to die compared with those married and living together with a partner. Those who did not have good family support had a higher death risk than those having good family support.Single or cohabiting women had higher risks of mortality than women who were married and living together with a partner throughout follow-up, while separated/divorced/widowed men had higher risks of mortality than counterpart males. CONCLUSIONS: Our study reveals the protective effect of marriage and living together on mortality in Thailand, an understudied setting where institutionalisation of cohabitation is low leading to a limited mortality protection. Public policies for moderating mortality should thus be gender nuanced, culturally and institutionally specific. Also, we demonstrate that in settings such as Thailand, where marital status is not always defined in the same way as in western cultures, the need to measure cohabitation in locally relevant terms is important.

Long-term air pollution exposure and self-reported morbidity: A longitudinal analysis from the Thai cohort study (TCS).

BACKGROUND: Several studies have shown the health effects of air pollutants, especially in China, North American and Western European countries. But longitudinal cohort studies focused on health effects of long-term air pollution exposure are still limited in Southeast Asian countries where sources of air pollution, weather conditions, and demographic characteristics are different. The present study examined the association between long-term exposure to air pollution and self-reported morbidities in participants of the Thai cohort study (TCS) in Bangkok metropolitan region (BMR), Thailand. METHODS: This longitudinal cohort study was conducted for 9 years from 2005 to 2013. Self-reported morbidities in this study included high blood pressure, high blood cholesterol, and diabetes. Air pollution data were obtained from the Thai government Pollution Control Department (PCD). Particles with diameters ≤10 µm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), and carbon monoxide (CO) exposures were estimated with ordinary kriging method using 22 background and 7 traffic monitoring stations in BMR during 2005-2013. Long-term exposure periods to air pollution for each subject was averaged as the same period of person-time. Cox proportional hazards models were used to examine the association between long-term air pollution exposure with self-reported high blood pressure, high blood cholesterol, diabetes. Results of self-reported morbidity were presented as hazard ratios (HRs) per interquartile range (IQR) increase in PM10, O3, NO2, SO2, and CO. RESULTS: After controlling for potential confounders, we found that an IQR increase in PM10 was significantly associated with self-reported high blood pressure (HR = 1.13, 95% CI: 1.04, 1.23) and high blood cholesterol (HR = 1.07, 95%CI: 1.02, 1.12), but not with diabetes (HR = 1.05, 95%CI: 0.91, 1.21). SO2 was also positively associated with self-reported high blood pressure (HR = 1.22, 95%CI: 1.08, 1.38), high blood cholesterol (HR = 1.20, 95%CI: 1.11, 1.30), and diabetes (HR = 1.21, 95%CI: 0.92, 1.60). Moreover, we observed a positive association between CO and self-reported high blood pressure (HR = 1.07, 95%CI: 1.00, 1.15), but not for other diseases. However, self-reported morbidities were not associated with O3 and NO2. CONCLUSIONS: Long-term exposure to air pollution, especially for PM10 and SO2 was associated with self-reported high blood pressure, high blood cholesterol, and diabetes in subjects of TCS. Our study supports that exposure to air pollution increases cardiovascular disease risk factors for younger population.

Dietary patterns associated with hypertension risk among adults in Thailand: 8-year findings from the Thai Cohort Study.

OBJECTIVE: Dietary intake is a leading risk factor for hypertension. We aimed to assess longitudinal associations between overall dietary patterns and incident hypertension among adults in Thailand. DESIGN: Prospective large Thai Cohort Study (TCS) conducted nationwide from 2005 to 2013. Dietary patterns were identified using factor analysis based on usual intake of fourteen food groups. Multivariable logistic regression assessed associations between dietary patterns and hypertension prevalence and incidence. SETTING: Emerging hypertension and changing diets in Thailand. SUBJECTS: TCS participants who were normotensive at baseline in 2005. RESULTS: Among 36293 participants without hypertension at baseline, 1831 reported incident hypertension (5·1 % incidence) at follow-up. Two dietary patterns were identified: 'Modern' and 'Prudent'. The Modern dietary pattern (high intakes of roasted/smoked foods, instant foods, canned foods, fermented fruits/vegetables, fermented foods, soft drinks, deep-fried foods) was associated with increased incident hypertension (comparing extreme quartiles, OR for incident hypertension=1·51; 95 % CI 1·31, 1·75 in 2013). The Prudent dietary pattern (high intakes of soyabean products, milk, fruits, vegetables) was not associated with incident hypertension in a fully adjusted model. The association between the Modern dietary pattern and hypertension was attenuated by BMI. CONCLUSIONS: Modern dietary pattern was positively associated with hypertension among Thai adults. BMI had a great impact on the relationship between the Modern dietary pattern and incidence of hypertension. Reduction of Modern diets would be expected to prevent and control hypertension. Such a strategy would be worth testing.

HEALTH RISK TRANSITION AND LOW MORTALITY PATTERNS AMONG A NATIONAL COHORT OF ASPIRATIONAL THAI OPEN UNIVERSITY STUDENTS.

In the last 50 years Thailand has achieved advanced demographic and health transitions. Many infectious diseases are controlled and infant and maternal mortality rates are among the lowest in the region. Within such a low mortality setting, however, substantial variations in health persist, with education being a major driver. This paper assesses the ongoing mortality transition in Thailand, examining relationships between risk factors and mortality outcomes among a large nationwide cohort of distance-learning Open University students, as well as examining the differential mortality benefit enjoyed by this educated group when compared with the general Thai population. The cohort comprised 87,151 participants, who in 2005 completed a questionnaire collecting detailed information on socio-demographics, health behaviours and health outcomes. Participants were aged 15-87 at baseline and lived in all regions of the country. Cohort members' citizen identification numbers were matched with official death registration records to identify mortality among participants. A total of 1401 deaths were identified up to November 2016. Results show cohort study participants experiencing mortality at approximately one-third of the rate of the general population in the same age and sex groups. The gap between the mortality rates in the two groups widened with increased age. Differential risk factor prevalence among the two populations, particularly lower overweight and obesity prevalence and lower cigarette smoking rates in the cohort, can explain some of this variation. The largely unmeasurable effect of aspiration for life improvement through distance education while embedded in their communities is shown by this study to have a powerful effect on mortality risk. With overall education levels, including higher education, rising in Thailand this growing group of educated aspirational Thais may represent future trends in Thai mortality. Identifying the drivers and characteristics of this mortality variation can help inform policies to provide health services and to help reduce mortality in the whole population.

Nutrition label experience, obesity, high blood pressure, and high blood lipids in a cohort of 42,750 Thai adults.

INTRODUCTION: Nutrition labels have been promoted for nearly two decades in Thailand to educate people about healthy eating and to combat nutrient-related non-communicable diseases (NCDs). But little is known about how nutrition labels are experienced and whether they are linked with better health. Our objective was to investigate the associations between nutrition label experience, obesity and nutrient-related NCDs in Thai consumers. METHODS: A cross-sectional study was undertaken with a nationwide cohort of 42,750 distance learning Thai adult students enrolled in an Open University in 2013. We measured exposure as nutrition label experience (read, understand, use). Health outcomes were high blood pressure, high blood lipids, and high Body Mass Index (overweight at risk and obesity). Multivariate logistic regression was used to determine the association between nutrition label experience and health outcome adjusting for sociodemographic attributes, physical activity, smoking, and alcohol intake. RESULTS: Frequent nutrition label use varied by cohort attributes and health outcomes and was least for those with low physical activity and high blood pressure. Being male, older, an urban resident or with low physical activity was associated with increasing high blood pressure and high blood lipids. Compared to those who read, understand and use nutrition labels, participants who did not (read, understand, and use), were more likely to report high blood pressure (Adjusted Odds Ratio 1.33; 1.17-1.51), high blood lipids (AOR 1.26; 1.14-1.39), and obesity (AOR 1.23; 1.13-1.33), but were not more likely to be overweight at risk (AOR 1.06; 0.97-1.16). CONCLUSIONS: We found cross-sectional associations between low nutrition label experience and increased likelihood of high blood pressure, high blood lipids, and obesity among Thai adults. Nutrition label education should be promoted as part of a public health approach to appropriate food choices and better lifestyles to reduce obesity and nutrient-related NCDs.

Social Demography of Transitional Dietary Patterns in Thailand: Prospective Evidence from the Thai Cohort Study.

In recent decades, a health-risk transition with changes in diet and lifestyle in low and middle-income countries (LMICs) led to an emergence of chronic diseases. These trends in Southeast Asian LMICs are not well studied. Here, we report on transitional dietary patterns and their socio-demographic predictors in Thai adults. Dietary data in 2015 were from a random sub-sample (N = 1075) of 42,785 Thai Cohort Study (TCS) members who completed all three TCS surveys (2005, 2009, 2013). Principle Component Analysis identified dietary patterns and multivariable linear regression assessed associations (Beta estimates (ß) and confidence intervals (CIs)) between socio-demographic factors and dietary intake pattern scores. Four dietary patterns emerged: Healthy Transitional, Fatty Western, Highly Processed, and Traditional. In women, higher income (≥30,001 Baht/month vs. ≤10,000) and managerial work (vs. office assistant) was associated with lower scores for Traditional (ß = -0.67, 95% CI -1.15, -0.19) and Fatty Western diets (ß = -0.60, 95% CI -1.14, -0.05), respectively. University education associated with lower Highly Processed (ß = -0.57, 95% CI -0.98, -0.17) and higher Traditional diet scores (ß = 0.42, 95% CI 0.03, 0.81). In men and women, urban residence associated with higher Fatty Western and lower Traditional diets. Local policy makers should promote healthy diets, particularly in urban residents, in men, and in low-SEP adults.

Body mass index and type 2 diabetes in Thai adults: defining risk thresholds and population impacts.

BACKGROUND: Body mass index (BMI) cut-off values (>25 and >30) that predict diabetes risk have been well validated in Caucasian populations but less so in Asian populations. We aimed to determine the BMI threshold associated with increased type 2 diabetes (T2DM) risk and to calculate the proportion of T2DM cases attributable to overweight and obesity in the Thai population. METHODS: Participants were those from the Thai Cohort Study who were diabetes-free in 2005 and were followed-up in 2009 and 2013 (n = 39,021). We used multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the BMI-T2DM association. We modelled non-linear associations using restricted cubic splines. We estimated population attributable fractions (PAF) and the number of T2DM incident cases attributed to overweight and obesity. We also calculated the impact of reducing the prevalence of overweight and obesity on T2DM incidence in the Thai population. RESULTS: Non-linear modelling indicated that the points of inflection where the BMI-T2DM association became statistically significant compared to a reference of 20.00 kg/m2 were 21.60 (OR = 1.27, 95% CI 1.00-1.61) and 20.03 (OR = 1.02, 95% CI 1.02-1.03) for men and women, respectively. Approximately two-thirds of T2DM cases in Thai adults could be attributed to overweight and obesity. Annually, if prevalent obesity was 5% lower, ~13,000 cases of T2DM might be prevented in the Thai population. CONCLUSIONS: A BMI cut-point of 22 kg/m2, one point lower than the current 23 kg/m2, would be justified for defining T2DM risk in Thai adults. Lowering obesity prevalence would greatly reduce T2DM incidence.

Relationship between 8-year weight change, body size, and health in a large cohort of adults in Thailand.

BACKGROUND: Overweight and obesity have been shown to be risk factors for a range of non-communicable diseases, especially cardio-metabolic conditions, worldwide. But less is known about the effects of weight change on adults' overall health and wellbeing, particularly in transitional low- and middle-income countries. This study aimed to assess the relationship between 8-year weight change and measures of self-assessed health among Thai adults. METHODS: Data were collected from Thai adults aged 25-40 years (n = 27,003) enrolled in the Thai cohort Study and surveyed in 2005, 2009, and 2013. We used self-reported weight and height measurements at baseline and 2013, as well as three standard health questions regarding overall health, energy, and emotion asked at the two time points, to investigate the effects of weight change on health. RESULTS: Between 2005 and 2013, 6.0% of participants lost more than 5% of their baseline weight; 38.5% were stable (<5% loss to 5% gain); 23.0% slightly gained weight (>5%-10%); 22.8% gained moderate weight (>10%-20%); and 9.4% had heavy weight gain (>20%). Moderate (>10%-20%) and heavy weight gain (>20%) were both associated with an increased risk of reporting 'poor or very poor' overall health in 2013 among participants who had a normal body mass index (BMI) (adjusted odds ratio [AOR] 1.39; 95% confidence interval [CI], 1.13-1.71 and AOR 1.44; 95% CI, 1.09-1.90, respectively), were overweight (AOR 1.53; 955 CI, 1.01-2.29 and AOR 1.82; 95% CI, 1.04-3.19, respectively) or had obesity (AOR 2.47; 95% CI, 1.74-3.51 and AOR 3.20; 95% CI, 2.00-5.16, respectively) in 2005. Weight gain of over 20% also had a negative impact on energy level among cohort members with a normal BMI in 2005 (AOR 1.36; 95% CI, 1.11-1.65) and among participants with obesity in 2005 (AOR 1.93; 95% CI, 1.38-2.71). For those who were underweight, had a normal BMI, or had obesity at baseline, weight loss of more than 5% was associated with reporting emotional problems. Excessive weight gain adversely impacted participants who were underweight or had obesity at baseline. CONCLUSION: Our study found that weight change, in particular weight gain, was associated with negative health outcomes, and this effect appeared to increase at higher levels of body size. The present findings may be useful to promote weight maintenance and healthy lifestyles.

Nutrition label experience and consumption of transitional foods among a nationwide cohort of 42,750 Thai adults.

PURPOSE: The purpose of this paper is to assess the usefulness of nutrition labels in Thailand during nutrition transition from traditional to modern diets that increase salt, sugar, and calorie intake and to note socio-demographic interactions and associations with consumption of transitional processed foods. DESIGN/METHODOLOGY/APPROACH: The authors studied 42,750 distance learning Open University adults aged 23-96 years in 2013 residing nationwide and participating in an ongoing community-based prospective cohort study. The authors used multivariable logistic regression to relate nutrition label experiences ("read", "good understand", "frequent use"), socio-demographic factors, and consumption of four transitional foods. These foods included "unhealthy" instant foods, carbonated soft drinks, and sweet drinks, or "healthy" milk. FINDINGS: Overall, two-thirds reported good understanding and frequent use of nutrition labels. Unhealthy transition-indicator processed foods were frequently consumed: instant foods (7 per cent), (carbonated) soft drinks (15 per cent), and sweet drinks (41 per cent). Frequent users of nutrition labels (e.g. females, older persons, professionals) were less likely to consume unhealthy indicator foods. Those with the most positive overall nutrition label experience ("read" + "good understanding" + "frequent use") had the best indicator food profiles: instant foods (odds ratio (OR) 0.63; 95%CI, 0.56-0.70); soft drinks (OR 0.56; 95%CI, 0.52-0.61); sweet drinks (OR 0.79; 95%CI, 0.74-0.85); milk (OR 1.87; 95%CI, 1.74-2.00). ORIGINALITY/VALUE: Knowledge protected - those with most nutrition label experience were least likely to consume unhealthy foods. Results support government regulated nutrition labels, expanding to include sweet drinks. The study is remarkable for its large size and nationwide footprint. Study subjects were educated, represent Thais of the future, and show high awareness of transition-indicator foods.

Low back pain and limitations of daily living in Asia: longitudinal findings in the Thai cohort study.

BACKGROUND: Low back pain (LBP) is a major cause of disability throughout the world. However, longitudinal evidence to relate low back pain and functional limitations is mostly confined to Western countries. In this study, we investigate the associations between low back pain and functional limitations in a prospective cohort of Thai adults. METHODS: We analysed information from the Thai Cohort Study of adult Open University adults which included 42,785 participants in both 2009 and 2013, with the majority aged 30 to 65 years and residing nationwide. We used multivariate logistic regression to explore the longitudinal associations between LBP in 2009 and 2013 ('never': no LBP in 2009 or 2013; 'reverting': LBP in 2009 but not in 2013; 'incident': no LBP in 2009 but LBP in 2013; and 'chronic': reporting LBP at both time points) and the outcome of functional limitations relating to Activities of Daily Living (ADL) in 2013. RESULTS: Low back pain was common with 30% of cohort members reporting low back pain in both 2009 and 2013 ('chronic LBP'). The 'chronic LBP' group was more likely than the 'never' back pain group to report functional limitations in 2013: adjusted odds ratios 1.60 [95% Confidence Interval: 1.38-1.85] for difficulties getting dressed; 1.98 [1.71-2.30] for walking; 2.02 [1.71-2.39] for climbing stairs; and 3.80 [3.38-4.27] for bending/kneeling. Those with 'incident LBP' or 'reverting LBP' both had increased odds of functional limitations in 2013 but the odds were not generally as high. CONCLUSIONS: Our nationwide data from Thailand suggests that LBP is a frequent public health problem among economically productive age groups with adverse effects on the activities of daily living. This study adds to the limited longitudinal evidence on the substantial impact of low back pain in Southeast Asia.

Caregiving and mental health among workers: Longitudinal evidence from a large cohort of adults in Thailand.

BACKGROUND: As people in middle and lower income countries live longer, more people become sick, disabled, and frail and the demand for family caregiving grows. Thailand faces such challenges. This study investigates the relationship between caregiving and mental health among workers drawn from a large longitudinal cohort of Thai adults. METHODS: Participants were drawn from the Thai Health-Risk Transition Study, a cohort study since 2005 of distance-learning adult Open University students residing nationwide. Caregiving status and binary psychological distress outcome (score 19-30 on Kessler 6) were recorded in 2009 and 2013 among cohort members who were paid workers at both years (n=33,972). Multivariate logistic regression was used to estimate the relationship between four-year longitudinal caregiving status and psychological distress in 2013, adjusting for potential covariates. RESULTS: Longitudinal analyses revealed the transitional nature of care with 25% exiting and 10% entering the caring role during the four-year follow-up. Based on multivariate logistic regression, 2009-2013 caregiving status was significantly associated with psychological distress. Cohort members transitioning into caregiving and those who were caregivers in both 2009 and 2013 had a higher risk for psychological distress than non-caregivers (Adjusted Odds Ratios 1.40 [1.02-1.96] and 1.64 [1.16-2.33], respectively). CONCLUSION: Our findings provide evidence on caregiving and associated risk for psychological distress among working Thais. This adds to the limited existing literature in middle-income countries and highlights the potential pressure among caregivers in balancing work and care while preserving their own mental health.

Incidence and risk factors for type 2 diabetes mellitus in transitional Thailand: results from the Thai cohort study.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is increasingly prevalent in countries undergoing rapid development, including Thailand. We assessed T2DM incidence over an 8-year period in a nationwide cohort of Thai adults. METHODS: Thai Cohort Study participants were surveyed in 2005, 2009 and 2013. The analysed cohort members were aged (15-88), did not have diabetes in 2005 and were followed up by questionnaire in 2013 (n=39 507). T2DM was ascertained using self-report, which has been validated using physician interviews. We calculated the 8-year cumulative incidence of T2DM. Multivariable logistic regression assessed associations between potential risk factors and T2DM incidence. RESULTS: 8-year cumulative incidence of T2DM (2005 to 2013) was 177 per 10 000 (95% CI 164 to 190). Crude and age-standardised cumulative incidences of T2DM by sex were 249 per 10 000 (95% CI 226 to 272) and 222 per 10 000 (95% CI 219 to 225) for men; and 119 per 10 000 (95% CI 105 to 133) and 96 per 10 000 (95% CI 94 to 98) for women, respectively. T2DM increased significantly for both sexes with increasing age and body mass index (BMI) (p trend <0.001 for both). Residence in an urban area as a child associated with T2DM among men and women (OR=1.4, 95% CI 1.1 to 1.7 and OR=1.4, 95% CI 1.01 to 1.79); this was no longer statistically significant after adjusting for BMI. Among men, smoking (OR=1.7, 95% CI 1.3 to 2.2) and alcohol intake (OR=1.8, 95% CI 1.1 to 3.0) were associated with T2DM. CONCLUSIONS: This study found that the sociodemographic and lifestyle changes that have accompanied Thailand's economic development are associated with T2DM risk in a large cohort of Thai adults. Our findings highlight the need to address these transitions to prevent a further increase in the national incidence of T2DM, particularly among Thai men.

Psychological Distress following Injury in a Large Cohort of Thai Adults.

INTRODUCTION: Injury and psychological distress are public health priorities because of their high occurrence in the population. This study examines the longitudinal effects of injury characteristics on psychological distress. METHODS: Study participants were enrolled distance learning Thai adults (N = 42,785 at 2013 follow-up) residing nationwide. We analysed 2009 and 2013 data. Injury questions included injury prevalence, causes and levels of severity. Distress was measured using the standard Kessler-6. To assess the risk for post-injury distress, we used multinomial logistic regression investigating psychological distress in 2013 as an outcome including injury categories in both 2009 and 2013 as predictors, adjusted for sociodemographic factors. RESULTS: Overall injury was predictive of psychological distress. Both types of injury (traffic and non- traffic) associated with increasing psychological distress. Those that had experienced both types of injuries in the previous year had higher odds of developing psychological distress compared to those who experienced just one type. In 2013, adjusted psychological distress odds ratios were 1.46 [95% Confidence Interval 1.14-1.87] for traffic injury only; 1.26 [1.13-1.40] for non-traffic injury only; and 2.71 [2.19-3.35] for both traffic and non-traffic injuries. Increasing frequency of injury and increasing injury severity were also linked to elevated psychological distress among our Thai cohort members. CONCLUSIONS: Our results revealed a significantly high risk of psychological distress following injury. With increasing occurrence of injury, especially traffic injuries in low and middle income countries such as Thailand, future policies should not only focus on physical care but also address psychological distress as an important consequence of injury.

Non-Fatal Injury in Thailand From 2005 to 2013: Incidence Trends and Links to Alcohol Consumption Patterns in the Thai Cohort Study.

BACKGROUND: We analyzed population-based injury trends and the association between injury and alcohol consumption patterns in Thailand, a middle-income country undergoing rapid social change. METHODS: A nationwide cohort of 42 785 Thai adult Open University students, who were aged 15 to 87 years at enrolment, participated in cross-sectional assessments at baseline (2005) and 8 years later (2013). Incident non-fatal traffic and non-traffic injuries were recorded. Alcohol consumption patterns were categorized as follows: non-drinkers, occasional light drinkers, occasional heavy drinkers, regular drinkers, and ex-drinkers. Logistic regression was used to assess associations in 2005 and 2013 between injuries and alcohol consumption. We adjusted odds ratios (ORs) for socio-demographic factors, stress, health behaviors, and risk-taking behaviors. RESULTS: Incidence estimates in 2013 were standardized to the age structure of 2005: the standardized rates were 10% (95% confidence interval [CI], 9.32-9.89) for participants with at least one non-traffic injury and 5% (95% CI, 4.86-5.29) for those with at least one traffic injury. Both standardized incidences for non-traffic and traffic injuries were significantly lower than corresponding rates in 2005 (20% and 6%, respectively). Alcohol consumption was significantly associated with non-traffic injury in 2005, but the association disappeared in 2013. For example, non-traffic injury was associated with regular drinking (adjusted OR 1.17; 95% CI, 1.01-1.40) in 2005, but not in 2013 (adjusted OR 0.89; 95% CI, 0.73-1.10). In both survey years, traffic injury was not associated with occasional heavy drinking when adjusted for health and risk-taking behavior. CONCLUSIONS: We examined non-fatal injury and the health-risk transition in Thailand in 2005 and 2013. Our data revealed decreases in alcohol consumption and non-fatal injury in the Thai Cohort between 2005 and 2013. Alcohol-related injury in Thailand today could be amenable to preventive intervention.

Alcohol consumption patterns in Thailand and their relationship with non-communicable disease.

BACKGROUND: Heavy alcohol consumption is an established risk factor for non-communicable diseases (NCDs) but few studies have investigated drinking and disease risk in middle income, non-western countries. We report on the relationship between alcohol consumption and NCDs in Thailand. METHODS: A nationwide cross sectional survey was conducted of 87,151 Thai adult open university students aged 15 to 87 years (mean age 30.5 years) who were recruited into the Thai Cohort Study. Participants were categorized as never having drunk alcohol (n = 22,527), as being occasional drinkers who drank infrequently but heavily (4+ glasses/occasion - occasional heavy drinkers, n = 24,152) or drank infrequently and less heavily (<4 glasses/occasion - occasional light drinkers, n = 26,861). Current regular drinkers were subdivided into those who either drank heavily (4 + glasses per occasion - regular heavy drinkers, n = 3,675) or those who drank less (<4 glasses/occasion -regular light drinkers, n = 490). There were 7,548 ex-drinkers in the study. Outcomes were lifetime diagnoses of self-reported NCDs and obesity (body mass index ≥ 25). RESULTS: Most women were never drinkers (40 % among females) or occasional light drinkers (39 %), in contrast to men (11 % and 22 %, respectively). Alcohol consumption was associated with urban in-migration and other recognized risks for NCDs (sedentary lifestyle and poor diet). After adjustment for these factors the odds ratios (ORs) for several NCDs outcomes - high cholesterol, hypertension, and liver disease - were significantly elevated among both occasional heavy drinkers (1.2 to 1.5) and regular heavy drinkers (1.5 to 2.0) relative to never drinkers. CONCLUSIONS: Heavy alcohol consumption of 4 or more glasses per occasion, even if the occasions were infrequent, was associated with elevated risk of NCDs in Thailand. These results highlight the need for strategies in Thailand to reduce the quantity of alcohol consumed to prevent alcohol-related disease. Thailand is fortunate that most of the female population is culturally protected from drinking and this national public good should be endorsed and supported.

Environmental tobacco smoke exposure and health disparities: 8-year longitudinal findings from a large cohort of Thai adults.

BACKGROUND: In rich countries, smokers, active or passive, often belong to disadvantaged groups. Less is known of tobacco patterns in the developing world. Hence, we seek out to investigate mental and physical health consequences of smoke exposure as well as tobacco-related inequality in transitional middle-income Thailand. METHODS: We studied a nationwide cohort of 87,151 middle-aged and older adults that we have been following for eight years (2005-2013) for emerging chronic diseases. Logistic regression was used to identify attributes associated with passive smoke exposure. Longitudinal associations between smoke exposure and wellbeing (SF-8) or psychological distress (Kessler 6) were investigated with multiple linear regression or multivariate logistic regression analysis. RESULTS: A high proportion of cohort members, especially females, were passive smokers at home and at public transport stations; males were more exposed at workplace and recreational places. We observed a social gradient with more passive smoking in poorer people. We also observed a dose response relationship linking graded smoke exposures (current, former, passive, non-exposed) to less wellbeing and more psychological distress (p-trend < 0.001). Female smokers in general had less wellbeing and more distress. CONCLUSION: Our findings add to current knowledge on the impact of active and passive smoking on health in a transitional economy. Promotion of smoking cessation programs both in public and at home could also potentially reduce adverse disparities in health and wellbeing in middle and lower income settings such as Thailand.