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The impact of sunlight exposure on mortality of ESRD patients: Comparison of the results using case-crossover study design
일조시간이 말기신부전(ESRD) 환자의 사망에 미치는 영향: Case-crossover design을 이용한 결과비교

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Authors
윤은아
Advisor
김호
Major
보건대학원 보건학과(보건학전공)
Issue Date
2018-08
Publisher
서울대학교 대학원
Description
학위논문 (석사)-- 서울대학교 대학원 : 보건대학원 보건학과(보건학전공), 2018. 8. 김호.
Abstract
Background



Recent data suggest that reduced sunlight exposure is associated with increased mortality in the general population. To date, the association between sunlight exposure and mortality in dialysis patients has not been examined.



Objective



Among 134,478 dialysis patients in the Korean end-stage renal disease (ESRD) cohort from 2001 to 2014, 31,291 patients were enrolled from seven metropolitan cities, and data were analyzed using bi-directional case-crossover design. We examined the association between short-term sunlight exposure and mortality in ESRD patients. We adjusted for temperature, humidity, and daily concentrations of nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), carbon monoxide (CO), and particle matter (PM10) as confounders.



Method



Among 134,478 dialysis patients in the Korean end-stage renal disease (ESRD) cohort from 2001 to 2014, 31,291 patients were enrolled from seven metropolitan cities, and data were analyzed using bi-directional case-crossover design. We examined the association between short-term sunlight exposure and mortality in ESRD patients. We adjusted for temperature, humidity, and daily concentrations of nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), carbon monoxide (CO), and particle matter (PM10) as confounders.



Result



The characteristics of the study population included age (65.6 ± 12.26 (mean ± standard deviation [SD]) years), sex (male, 59.96%
female, 41.04%), comorbidity (diabetes, 53.58%
hypertension, 40.5%), and kidney dialysis type (hemodialysis, 73.02%
peritoneal dialysis, 26.98 %). The mean ± SD follow-up time was 4.68 ± 4.37 years. The daily sunlight exposure was significantly decreased in the case group compared with the control group (P=0.004). Sunlight exposure was associated with all-cause death overall (ORs [95%CI]: 0.99 [0.98-0.99], P=0.042) in a fully adjusted model. Patients with diabetes (ORs [95%CI]: 0.98 [0.97-0.99], P=0.016) or aged higher than 75 years (ORs [95%CI]
0.97 [0.96 – 0.99], P=0.020) had higher risks of mortality than patients without diabetes or aged below 75 years, respectively.



Conclusion



These findings suggest that sunlight exposure is inversely correlated with all-cause mortality in dialysis patients, especially in high-risk patients with diabetes and older adults.



Keyword : sunlight exposure, mortality, end stage renal disease, ESRD, sunshine vitamin, vitamin D
Language
English
URI
https://hdl.handle.net/10371/144210
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Graduate School of Public Health (보건대학원)Dept. of Public Health (보건학과)Theses (Master's Degree_보건학과)
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