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Background: Sexual activity in elderly people is a topic of growing interest but the relationships of sexual activity, libido and widowhood to mortality have been barely investigated., Methods: A total of 2,453 subjects enrolled from a nationwide survey on health status of residents aged 65 years or older in Taiwan between 1989 and 1991 were followed up until 31 December 2003 for ascertaining cause of death. Information on the frequency of sexual activity, libido (sexual desire), widowhood, disease status and relevant risk factors for risk of death at baseline were collected., Results: After controlling for age and relevant confounding factors, sexual activity was found to be inversely related to mortality {adjusted hazard ratio (aHR) = 0.67 [95% confidence interval (CI):0.56-0.80] for males, aHR = 0.84 (95% CI:0.65-1.09) for females and aHR = 0.72 (95% CI: 0.62-0.84) for both sexes combined}. Men having libido had lower mortality [aHR = 0.81 (95% CI:0.68-0.97)]. Widowhood status was positively correlated with mortality [aHR = 1.66 (95% CI: 1.25-2.19) for males, aHR = 1.33 (95% CI: 1.09 to -1.62) for females and aHR = 1.43 (95% CI: 1.21-1.68) for both sexes combined]. Sexual activity was also inversely related to mortality from stroke [aHR = 0.64 (95% CI: 0.41-1.00)]., Conclusions: Sexual activity was associated with all-cause and cause-specific mortality independently of other risk factors. This finding was consistent with the elevated risk of death associated with widowhood for both men and women, and by the decreased mortality risk in men having libido.

The major objective of the present study was to identify biologic and behavioral risk factors of cardiovascular disease (CVD) in the elderly population in Taiwan. It is hypothesized that the selected risk factors are significantly associated with the prevalence of CVD. Data came from a nationwide geriatric survey in 1991. Stratified proportional sampling was used to recruit 2,600 subjects. These were evaluated by family physicians working for the Departments of Family Medicine at four medical centers in four major cities in Taiwan. Univariate and multivariate logistic regression analyses were used to examine the associations between risk factors and the prevalence of CVD. The prevalence of CVD was 38.31%. Patients with CVD consistently had higher values for each selected risk factor except high-density lipoprotein-cholesterol (HDL-C) and glucose concentrations. The findings also indicated that hypertension, hypertriglyceridemia, low HDL-C concentration, ex-drinking status, and overweight were significantly associated with the prevalence of CVD among the elderly in Taiwan. The findings not only confirm the risk factors for CVD, but also invite more attention to be given to the importance of biologic and behavioral risk factors in CVD.

Background: Identifying biological measures that are predictive of mortality for elderly people aged over 65 years has not been fully elucidated in oriental studies., Objective: The associations between these biological measures and long-term mortality were therefore investigated, and classifications for risk of death were developed among Taiwanese elderly people, Methods: Data used in this study were derived from a total of 597 apparently healthy subjects aged over 65 years identified from a nationwide survey that was conducted between 1989 and 1991 in Taiwan. Each participant received a physical examination and a wide range of biological measures. These 597 apparently healthy subjects were followed to 31 December 1999 to determine the cause of death. The grouping technique using factor analysis was first used to aggregate similar characteristics of biological measures into reduced components. Risk of death for each subject was classified into four groups: good (A), fair (B), modest (C) and poor (D). Hazard ratios for groups B, C, D against A were calculated., Results: The overall 10-year survival rate was 72% [95% confidence interval (CI) 68-76%]. The adjusted hazard ratios for all-cause death in high and mid-level categories of haematological components versus the lowest group were 0.51 (95% CI 0.33-0.80) and 0.56 (95% CI 0.37-0.85), respectively. Group D had a 6-fold risk of death as compared with group A (relative risk = 6.34, 95% CI 3.85-10.52). The corresponding figures were 2.48 (95% CI 1.43-4.29) and 1.60 (95% CI 2.88-6.89) for groups B and C, respectively., Conclusions: The relationships of biological measures to long-term mortality were elucidated. Information on classification for risk of death may be helpful for elderly people to pay attention to their health status after receiving a health check-up.

Background: In Taiwan, distributions of body composition are usually generated for children, adolescent, and middle-aged groups. This study describes three anthropometric measures (i.e., height, weight, and body mass index [BMI]) of elderly persons in Taiwan., Methods: The data was derived from a prospective cross-sectional, population-based geriatric survey funded by the National Department of Health in Taiwan in 1991. A total of 2,600 subjects were successfully evaluated. A descriptive analysis was performed to generate distributions of height, weight, and BMI of elderly persons. Based on these descriptive data, the prevalence of overweight and obesity was estimated, and a cross-national comparison on the prevalence of obesity was made., Results: Age-group-specific means and standard deviations for height, weight, and BMI of Taiwanese elderly persons were presented. By gender, the elderly men were taller and heavier than the elderly women: however, the women had a higher mean value of BMI (kg/m2). The prevalence of overweight was 27.3% in men and 34.9% in women; the prevalence of obesity was 3.2% in men and 6.4% in women. The prevalence of obesity for the elderly men and women in Taiwan was lower than in Kuwait, Sweden, the United States, and the Native Americans, but higher than in Japan., Conclusions: The comparison indicates cross-cultural differences existing in the prevalence of obesity, which may be due to aging, nutritional status, or environmental factors. For future research, the relationship of anthropometric data to socioeconomic status and behavioral factors will be examined.

Studies of the factors affecting the first recurrence of ischemic stroke have reported inconsistent findings. Types of initial stroke and the racial differences in study samples are among the explanations that may account for this inconsistency. The aims of this study were to estimate the cumulative recurrence rates of noncardioembolic ischemic stroke and identify the factors that influence the first recurrence of noncardioembolic ischemic stroke in the Taiwanese Chinese population. Four hundred and sixty-six patients with noncardioembolic ischemic stroke from thirteen hospitals in Taiwan were followed up in this study to ascertain first recurrence of noncardioembolic ischemic stroke between October 1992 and April 1995. The Kaplan-Meier method was used to estimate the cumulative recurrence rate. The Cox regression model was used to ascertain the significant factors affecting the first recurrence of noncardioembolic ischemic stroke. The overall cumulative recurrence rate was 10.5% (49/466) from the follow-up period of 30 months. After adjustment for age, sex, treatment modes, and variables pertinent to blood pressure, the site of brain lesion remained a significant factor. The relative risk of first recurrence for the basal ganglion vs. the region of middle cerebral artery was 3.06 (95% CI: 1.29-7.26). The brain lesion site was demonstrated to be an independent predictor of risk for the first recurrence of noncardioembolic ischemic stroke among the Taiwanese Chinese population. Whether this finding was also seen in other populations should be corroborated in future research.

In order to study the health status and prevalence of diseases in elderly Chinese people in Taiwan, a hospital-based, physician-conducted epidemiological survey was undertaken. Study subjects were people aged > or = 65 years who were randomly selected from four regions of Taiwan. A total of 2600 subjects were studied. Most of the study subjects visited the hospitals for detailed history taking, physical examination and laboratory tests, including urinalysis, blood chemistry, electrocardiography, and chest and lumbar spine radiography. The cardiovascular data of 2518 subjects (males 1283) comprised this report. The prevalence of hypertension in the aged Chinese in Taiwan was high in both males and females (males 33.2%, females 40.9%, combined 37%). Coronary artery disease was also common (11.4%), but the prevalence was relatively low compared with Western people. Other cardiovascular diseases such as aortic aneurysm and valvular heart disease were rare. About 70% of the electrocardiograms were found abnormal. This well-organized, large-scale epidemiological survey not only presents useful information for local medical care for the elderly but also provides important data for comparison between different people in the world.

Stroke data bank can afford important information regarding risk factors, pathogenesis, prognosis, etc. By means of hospital-based stroke registry, we investigated the risk factors and case-fatality rates in different types of stroke and transient ischemic attack (TIA) patients at the National Taiwan University Hospital in 1995. After excluding ineligible patients, 995 patients aged 1-98 years (575 men and 420 women) were recruited. Men predominated in all age groups for stroke and TIA in general except for cerebral hemorrhage (CH) in patients aged < 35 years and subarachnoid hemorrhage (SAH) in patients aged > or = 45 years. Of these, 676 (67.9%), 41 (4.1%), 228 (22.9%) and 50 (5%) patients were classified in the categories of cerebral infarction (CI), TIA, CH and SAH, respectively. The CI/CH ratio was 2.96. Hypertension remained one of the most important risk factors for CI, CH and TIA patients. Severe extracranial carotid artery stenosis (> or = 50%) was found in 12% of the CI patients and 27% of the TIA patients, but not found in the CH and SAH patients. Of these patients, the 30-day case-fatality rate was 10.9%, highest in SAH (30%), followed by CH (24.1%) and CI (5.6%). There were 41 in-hospital stroke patients who had significantly higher case-fatality rates than the other stroke patients (P<0.001 for all stroke, CI and CH patients by chi2 test). As compared to the previous stroke registries in Taiwan, there is a secular trend of increasing CI/CH ratios. These findings in Taiwan were compared with those in other populations, including other Asian, Caucasian and black populations. The CI/CH ratios in Asian populations, including Chinese, Japanese and Korean, were much lower than those in Caucasian and black populations. Dietary, environmental and genetic factors probably play important roles in these differences.

Background and Purpose: To better understand the clinical pattern and further elucidate the risk factors and outcome in different subtypes of cerebral infarction (CI) of the Chinese in Taiwan, we analyzed the National Taiwan University Hospital Stroke Registry in 1995 and performed an ethnic comparison with similar data banks., Methods: From the National Taiwan University Hospital Stroke Registry in 1995, 676 patients (383 men and 293 women; mean age, 64.9 years; SD, 13.8 years; range, 1 to 98 years) with CI were recruited for this analysis. CI was classified into five subtypes based on clinical manifestations, ultrasonographic studies, and neuroimaging findings: large-artery atherosclerosis, lacunae, cardioembolism, other less common determined causes, and undetermined cause. Vascular risk factors, extracranial carotid artery atherosclerosis, and 30-day case-fatality rates were investigated in each subtype of CI., Results: Of all CI patients, 17%, 29%, 20%, 6%, and 29% were classified as large-artery atherosclerosis, lacunae, cardioembolism, other determined causes, and undetermined cause subtypes, respectively. The present results were compared with those from eight similar Western stroke registries. The relative incidence of lacunar CI in Chinese patients was more common, but large-artery atherosclerotic CI was less common than in whites. Hypertension was frequently seen in CI patients, especially in those with lacunae (85%) and large-artery atherosclerosis (69%). Patients with cardioembolism had a higher percentage of atrial fibrillation (69%), left ventricular hypertrophy, and ischemic heart disease than the other patients. Patients with large-artery atherosclerosis had more vascular risk factors, such as hypertension, diabetes mellitus, smoking, and carotid stenosis. Cardioembolic patients had higher case-fatality rates than other CI patients. Of the cardioembolic patients, 17.3% and 21.8% died within 30 days and during hospitalization, respectively., Conclusions: The proportion of CI subtypes varied in different stroke registries. This may be partly due to applied classification criteria and racial-ethnic differences. Awareness of the risk factors and outcome in each subtype of stroke may afford further insights into the surveillance and treatment of cerebrovascular disease.

The present community-based study was performed to provide predictive equations and lower boundaries of normal values for forced expiratory volume in one second (FEVI), forced vital capacity (FVC), and their percent ratio (FEV1%) in non-smoking, healthy adult men and women residing in communities, using ATS-recommended techniques and equipment. Use was made of data collected cross-sectionally from Nov. 1990 to Dec. 1993 in an ongoing longitudinal study on evolution of cardiovascular disease risk factors in Chinese. The spirometric values in our population reached their peak at around age 20. After age 20, a downward age trend was observed for FVC, FEV1, and FEV1%. Linear and negative relations were found in adults for each of the three spirometric values with age. Linear and positive relations were found between height and FVC or FEV1, but not between height and FEV1%. The age trends of FVC and FEV1 in Chinese adults were similar to those in Caucasians. Mean FVC and FEV1 levels of Chinese in Taiwan were systematically lower than those of Caucasians for a given height and a given age. Age and height specific percentile values of FVC and FEV1 and the age-specific percentile value of FEV1% are provided for adult men and women in this community study.

Background and Purpose: Stroke has been the second leading cause of death for all ages in Taiwan since 1983. However, despite the severity of the threat, stroke prevalence in Taiwan has not yet been addressed in a nationwide survey. In this study, the stroke prevalence in Taiwan was investigated using data from the 1994 National Health Interview Survey., Methods: This nationwide survey sought to obtain a nationally representative sample of households in Taiwan by using three-stage stratified random sampling with a probability proportional to size. In the first stage, 58 townships were selected, from the 359 townships in Taiwan, according to their administrative structure and level of socioeconomic development. In the second stage, 149 basic administrative regions (tsun or li) were selected from the selected 58 townships. Finally, 3814 households were selected from the 149 selected tsuns or lis. Field interviews were carried out between October 1994 and December 1994. Follow-up interviews with families of stroke patients were made 2 years later., Results: Of the selected households 3119, or 81.8%, responded. A total of 11925 persons were interviewed, and 71 of them were stroke patients, with a crude point prevalence rate of 5.95 per 1000. The stroke prevalence increased steadily with age, from 0.51 per 1000 in persons aged 35 to 44 years to 113.6 per 1000 in persons aged 85 years or over. There was a weak association with higher stroke prevalence for persons living in eastern Taiwan or those of lower educational level. The overall male/female prevalence ratio was 1.17. The results of follow-up interviews showed a cumulative mortality rate of 25.4% within the 2-year period and an ischemic/hemorrhagic stroke ratio of 1.33 in 35 patients whose stroke type could be validated., Conclusions: Age was the most important factor correlating to stroke prevalence. On the basis of this result, planning policies and programs for stroke prevention in Taiwan should give a higher priority to (1) aggressive primary prevention for aged people who are apparently at higher risk of stroke and (2) early reduction of stroke risk factors in younger aged people whose immediate risk of stroke is lower but would increase significantly with age.

A cross-sectional study on the correlates of elderly disability was conducted in Taiwan. A total of 400 subjects was randomly selected according to Barthel Index scores from among 2600 subjects, which was a sample of a previous community-based health survey of elderly aged 65 or over. After comprehensive interviews and examinations of the subjects, disability dimensions and its correlates were identified. Results showed elderly with lower Mini-Mental State Examination scores and chronic diseases (such as stroke, pressure sores, hypertension, fracture, etc.) were more physical-functionally and socially disabled. This suggests that prevention and treatment of chronic diseases should be pursued further and that further assessment of cognitive-mental status in the elderly is warranted. In addition, males were more disabled than females in a physical-functional aspect, which may be the consequence of the traditional Chinese cultural effect.

Background and Purpose: We investigated the influence of alcohol consumption and cigarette smoking on all types of stroke and cerebral infarction, in particular among a representative sample of elderly residents in Taiwan., Methods: This study was a component of a nationwide survey of health and living status of residents aged 65 years or older in Taiwan in which subjects received detailed physical, neurological, and laboratory examinations. Inquiries were made about medical history, and information on the amount and duration of drinking and smoking was obtained. Diagnoses of stroke were made according to the results of brain computed tomography at the onset of disease or were based on criteria established by the World Health Organization., Results: Of the 2600 subjects, there were 155 elderly persons with stroke (prevalence, 6%). Excessive drinking of more than 367.6 g/wk of alcohol was associated with a high prevalence of cerebral infarction. Consumption of < or = 367.5 g/wk of alcohol did not have an influence on stroke prevalence. The relationship between duration of alcohol drinking and stroke was equivocal. More than 30 pack-years of cigarette smoking was a significant risk factor for all types of stroke and cerebral infarction in particular. Using multiple logistic regression to control for possible confounders, it was found that smoking was an independent risk factors for all stroke and was of borderline significance for cerebral infarction. Although excessive drinking was a significant risk factor for cerebral infarction in univariate analysis, this effect was lost after adjustment for other confounders., Conclusions: Cigarette smoking was a more important risk factor for stroke and cerebral infarction than excessive drinking of alcohol.

The role of hemostatic factors in the pathogenesis of cardiovascular disease has gained much attention recently. Information about hemostatic factors, and their age patterns is sparse for orientals. With the data collected in the Cardiovascular Disease Risk Factor Two-township Study in Taiwan, this study shows that, in general, the older the age, the stronger the tendency toward thrombosis. With advancing age, prothrombin time, activated partial thromboplastin time, and antithrombin-III level decreased steadily; but mean values of fibrinogen, factor VIIc, and factor VIIIc increased. Gender differences in the age patterns of the above factors are carefully described. Curvilinear relations between hemostatic factors and age were demonstrated for adults aged 18 and above for all hemostatic factors studied. This curvilinearity should be taken into consideration when adjusting for the effect of age in data analysis to avoid residual confounding, particularly when the age range of the study subjects is wide.

In order to estimate the seroprevalence and explore multiple risk factors associated with Helicobacter pylori infection among residents in Taiwan, a total of 823 subjects randomly selected from one metropolitan precinct and three townships were studied. Serum samples were tested for IgG antibodies against H. pylori by enzyme-linked immunosorbent assay using commercial kits. The overall seropositive rate was 54.4% with no gender difference (53.7% for males and 55.2% for females). There was a significant geographical variation with the highest seropositive rate (63.4%) in rural area where aborigines live, and where the age-adjusted stomach cancer mortality is highest and the lowest (40.5%) in urban area where Hakkas live, and where the stomach cancer mortality is lowest. There was also an increasing seropositive rate with age from 27.1% for children younger than 10 years old to 72.3% for adults aged more than 40 years old. Age-specific seroprevalence in Taiwan is higher than that in United States, France, Finland and Australia, and lower than that in Algeria, Ivory Coast and India. No association with H. pylori seropositivity was observed for drinking water source, toilet type, family income and educational level after adjusting for age and area. A dose-response relation between H. pylori seropositivity and sibship size was found. Upon further analysis of seroprevalence for children aged 16 or younger, a positive association was observed for birth order and current number of children in family; there was also an inverse association for current number of adults in family. The early childhood transmission among siblings seems an important determinant of H. pylori seropositivity in Taiwan.

To investigate Helicobacter pylori (H. pylori) infection in subjects with and without gastroduodenal diseases in Taiwan, IgG antibodies to H. pylori were examined in 136 healthy volunteers, 101 patients with non-ulcer dyspepsia, 122 gastric ulcers, 119 duodenal ulcers, and 161 gastric adenocarcinomas. The seropositivity was highest in duodenal ulcers (87.4%) (p < 0.001, as compared to healthy volunteers), followed by gastric ulcers (76.2%) (p < 0.01, as compared to healthy volunteers), but similar among gastric adenocarcinomas (60.3%), healthy volunteers (58.8%), and patients with non-ulcer dyspepsia (55.5%). Higher acquisition of H. pylori in younger patients with duodenal and gastric ulcers suggests a strong association with H. pylori. No ulcer characteristics, including number, location, and activity, were significantly statistically associated with the seropositivity of H. pylori in gastric and duodenal ulcers. Similarly, the location, extent of invasion, and histology of gastric adenocarcinoma was not significantly statistically associated with the seropositivity of H. pylori.

To investigate the association of Helicobacter pylori and gastric ulcer and adenocarcinoma, IgG antibodies against H. pylori were examined in 823 randomly selected subjects, 92 healthy volunteers, 117 patients with gastric ulcer, and 148 with gastric adenocarcinomas in Taiwan, where the prevalence of gastric adenocarcinoma is high. The seropositivity of this population in Taiwan was 54.4%. Gastric ulcer patients had a higher seropositivity (83.8%) than healthy volunteers (62.0%) and gastric adenocarcinoma patients (62.2%) (P < 0.001). Gender difference, blood type, and habit of smoking were not associated with the seroprevalence in any study groups. Gastric ulcer coexistent with duodenal ulcer had a higher seropositivity (94.7%) (P < 0.05). The seropositivity of H. pylori in gastric adenocarcinoma patients was higher than in healthy volunteers only in younger age and was not associated with histologic type, invasion, and location of major tumors. The results reemphasize the association of H. pylori infection with gastric ulcer but not with gastric adenocarcinoma in Taiwan.

Delivery records of public hospitals and local health centers were analyzed to investigate the secular trend of multiple births from 1955 to 1990 in Taiwan. Twinning rates decreased gradually from the late 1950s to 1973, slightly increased and remained stable from 1974 to 1980, and then increased strikingly from 1981 to 1990. During the study period, MZ rates were consistently higher than DZ rates except in 1986 when a higher DZ rate was observed. The highest MZ rate of 7.7 per 1,000 deliveries was observed in 1985, while the highest DZ rate of 4.6 per 1,000 deliveries was observed in 1986. The triplet incidence rate also declined from the early 1960s to 1973 and then increased markedly from 1974 to 1990. A case-control study including 482 MZ and 252 DZ twin pairs and 1,496 singletons was carried out in four teaching hospitals in Taipei City between October 1985 and June 1989 to examine factors related to twinning. The zygosity of twin pairs was determined by sex, placentation and red blood cell antigens. Multiple logistic regression analysis showed that the higher the maternal age, the lower the MZ and DZ rates, while the higher the parity, the higher the rates. There was no association of paternal age or of maternal educational level with twinning rates.

In order to examine perinatal mortality and prevalence of major congenital malformations in twins, deliveries in four teaching hospitals in Taipei City were studied. Among a total of 73,264 deliveries from October 1985 to June 1989, there were 844 pairs of twins. The zygosity of the twin pairs was determined by sex, placentation and 12 red blood cell antigens. There were 482 MZ and 252 DZ twin pairs identified, but the zygosity of a further 110 twin pairs was indeterminable due to lack of information on plancentation and/or blood types. A total of 4,573 singletons delivered in one study hospital from July 1986 to June 1987 were also studied as controls. The perinatal mortality rate was 7.5% for MZ twins, 1.4% for DZ twins, and 0.7% for singletons. The concordance rate of perinatal death was significantly higher in MZ (60%) than in DZ (0%) twins. The prevalence of major congenital malformations was 2.7% for MZ twins, 1.0% for DZ twins, and 0.6% for singletons. The concordance rate of major congenital malformations was 18% for MZ twins, but no DZ pair was concordant in any major congenital malformation. The concordance rate of facial clefts was 29% for MZ twins. There were 2 sets of conjoined twins giving a prevalence rate of 2.7 per 100,000 deliveries. These findings showing the prevalence of perinatal mortality and major congenital malformation to be highest in MZ twins, intermediate in DZ twins and lowest in singletons, suggest the importance of intrauterine environments in the determination of perinatal mortality and congenital malformations.