Asia Pac J Public Health
· 2026 Jul · PMID 42394628
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The COVID-19 pandemic disrupted health care utilization worldwide, followed by uneven recovery patterns. South Korea also experienced this recovery disruption due to the nationwide medical strike in 2024. Especially, thi...The COVID-19 pandemic disrupted health care utilization worldwide, followed by uneven recovery patterns. South Korea also experienced this recovery disruption due to the nationwide medical strike in 2024. Especially, this medical strike raised concerns about the vulnerability and instability of the national health care system amid supply-side shocks during the post-crisis recovery. Its impacts and aftermaths need to be analyzed and evaluated for the latter response. In this article, we investigated changes in health care utilization and costs using National Health Insurance claims data across 6 phases: pre-COVID (2018-2019), early COVID (2020), mid-COVID (2021), late COVID (2022), recovery (2023), and the 2024 medical strike. In this work, we found that health care utilization declined during the COVID-19 pandemic, partially rebounded in 2023, and declined again during the 2024 strike. On the contrary, aggregate and per-patient health care expenditures increased during the recovery period and remained elevated during the strike despite reduced patient volumes. Per-patient expenditures rose most prominently in surgical and emergency-related specialties. We confirmed our results, suggesting that health care recovery may remain fragile and susceptible to subsequent supply-side disruptions. They also highlighted the need for specialty-sensitive monitoring and policy responses to support system resilience and patient financial protection.
Mat Rifin H, Wan KS, Robert Lourdes TG
… +3 more, Ismail H, Amali KH, Riyadzi MR
Asia Pac J Public Health
· 2026 Jun · PMID 42370526
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Obesity is a risk factor for hypercholesterolemia; however, evidence of obesity among Orang Asli (OA) adults remains limited. Lifestyle changes, including unhealthy diets and sedentary behavior, may increase vulnerabilit...Obesity is a risk factor for hypercholesterolemia; however, evidence of obesity among Orang Asli (OA) adults remains limited. Lifestyle changes, including unhealthy diets and sedentary behavior, may increase vulnerability to noncommunicable diseases. This study examined the sex-specific associations between body mass index (BMI) and hypercholesterolemia using data from the OA Health Survey 2022. A total of 8160 adults aged ≥18 years with complete questionnaires, anthropometric data, and blood data were analyzed. The prevalence of hypercholesterolemia among OA adults was 47.6%; of these, 41.5% were previously undiagnosed. Compared with normal BMI, overweight and obesity were associated with a higher odds of hypercholesterolemia in both sexes. Older age, Senoi tribe affiliation, and diabetes were associated with hypercholesterolemia in both sexes. These findings highlight the need for culturally tailored interventions to strengthen obesity prevention and cholesterol testing in primary care and outreach services to reduce cardiovascular risk in OA communities.
Habib K, Sethi SM, Khanum I
… +3 more, Babar R, Farooqi H, Nasir N
Asia Pac J Public Health
· 2026 Jun · PMID 42333786
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Long COVID has emerged as an important post-pandemic health challenge, yet physician awareness in low- and middle-income countries remains limited. This multicenter cross-sectional study assessed the knowledge, attitudes...Long COVID has emerged as an important post-pandemic health challenge, yet physician awareness in low- and middle-income countries remains limited. This multicenter cross-sectional study assessed the knowledge, attitudes, and practices of physicians in Pakistan regarding COVID-19 and Long COVID using an online survey conducted in 2024. A total of 117 physicians participated. While knowledge of acute COVID-19 was generally adequate, with 74.4% achieving good scores, knowledge of Long COVID was considerably lower, with only 30.8% demonstrating adequate understanding. Although most participants recognized common Long COVID symptoms (94.9%), fewer correctly identified its formal definition (37.6%). Attitudes toward COVID-19 prevention and management were largely positive (86.3%), and most participants reported appropriate clinical practices (97.4%). Female physicians had higher odds of adequate Long COVID knowledge, whereas those with more than 10 years of experience had significantly lower knowledge levels. These findings highlight a substantial gap in physician awareness of Long COVID despite strong preparedness for acute COVID-19. Targeted educational interventions are needed to improve recognition and management of post-COVID conditions, particularly in resource-limited settings.
Qu X, Wang Q, Xue H
… +4 more, Li M, Du W, Shen A, Fan L
Asia Pac J Public Health
· 2026 Jun · PMID 42332888
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Despite its prevalence, the health care burden of co-occurring physical, psychological, and cognitive (PPC) disorders remains unclear. This study examines impact of different PPC-multimorbidity patterns on health care ut...Despite its prevalence, the health care burden of co-occurring physical, psychological, and cognitive (PPC) disorders remains unclear. This study examines impact of different PPC-multimorbidity patterns on health care utilization and costs among 12 643 middle-aged and older Chinese adults using longitudinal data (China Health and Retirement Longitudinal Study 2011-2020). We measured outpatient/inpatient utilization (any visit/number of visits) and out-of-pocket (OOP) costs via self-reports. Binary, count, and censored outcomes were analyzed using mixed-effects logistic, negative binomial, and Tobit regressions, respectively. Results showed that PPC-multimorbidity significantly increased outpatient/inpatient utilization and OOP costs (OR = 1.43, IRR = 1.41, OR = 1.73, IRR = 1.53, IRR = 1.71, β = 24.96, β = 353.02; < .001). Increasing coexisting PPC types progressively amplified health care burden (dose-response -trend < .001). Pattern-specific analyses demonstrated heterogeneous impacts, with nearly all PPC-multimorbidity combinations elevating health care demands. In conclusion, PPC-multimorbidity imposes a substantial health care burden. These findings advance multimorbidity conceptualization beyond simple disease counts, emphasizing the need to address distinct multimorbidity patterns and their complex interactions.
Asia Pac J Public Health
· 2026 Jun · PMID 42318742
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Public health crises may disrupt health behaviors and socioeconomic conditions that influence suicide risk. This study examined associations between COVID-19-related daily life disruptions and suicidal ideation and suici...Public health crises may disrupt health behaviors and socioeconomic conditions that influence suicide risk. This study examined associations between COVID-19-related daily life disruptions and suicidal ideation and suicide attempts among Korean adults. We analyzed nationally representative data from 149 950 adults aged 19 to 64 years from the 2021 Korea Community Health Survey. Weighted multivariable logistic regression models assessed associations between changes in health behaviors (physical activity, smoking, alcohol use, instant food consumption) and socioeconomic conditions (household income, employment, work environment) and suicidal behaviors during the past 12 months. Both behavioral and socioeconomic disruptions were associated with higher odds of suicidal ideation. Increased smoking and alcohol consumption showed the strongest associations with both suicidal ideation and suicide attempts. Decreased household income, job loss, and worsened work environments were significantly associated with suicide attempts. Behavioral instability in either direction was also linked to elevated suicidal ideation. Behavioral and socioeconomic instability may serve as early population-level indicators of suicide vulnerability during public health crises.
Huang J, Yang J, Song Y
… +5 more, Zhai H, Guo K, Zhou F, Hu X, Xu Z
Asia Pac J Public Health
· 2026 Jun · PMID 42318658
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This study explored how different multimorbidity patterns impact transitions between cognitive stages in the elderly in China using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The data included 8...This study explored how different multimorbidity patterns impact transitions between cognitive stages in the elderly in China using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The data included 8778 dementia-free participants aged ≥60 years (21 500 observations). At baseline, K-Means clustering identified 3 multimorbidity patterns: cardiovascular, sensory, and multisystem. A multistate Markov model estimated transition probabilities. Results showed that compared with the sensory pattern, the cardiovascular pattern (hazard ratio [HR] 0.45, 95% CI [0.34, 0.60]) and the multisystem pattern (HR 0.48, 95% CI [0.37, 0.63]) were associated with a lower risk of progression from normal cognition to cognitive impairment. The sojourn time for normal cognition in the sensory pattern is shorter than that in cardiovascular and multisystem patterns. At age 80, the sojourn time for cognitive impairment in the sensory pattern is longer (1.96 years) than that in others (1.42 and 1.55 years) but converged with other patterns at ages 90 and 100. Different multimorbidity patterns exhibit distinct transitions between cognitive stages. Targeted interventions based on risk factors may mitigate cognitive decline in the elderly.
Asia Pac J Public Health
· 2026 Jun · PMID 42294545
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Deafblindness or difficulty seeing and hearing even with correction or hearing aids affects an estimated 7.4% (about 295 000) of New Zealanders, with prevalence rising sharply among older adults. Analysis of 2023 Census...Deafblindness or difficulty seeing and hearing even with correction or hearing aids affects an estimated 7.4% (about 295 000) of New Zealanders, with prevalence rising sharply among older adults. Analysis of 2023 Census data using the Washington Group Short Set (WGSS) highlights not only the scale of this issue but also its inequitable distribution: gender-diverse people, Māori, Pacific peoples, and rural communities experience higher rates and earlier onset of sensory difficulties. However, the WGSS's Western, individualistic framing often undercounts deafblindness in Indigenous and collectivist cultures, risking invisibility for those most affected. Geographic disparities further compound inequity, with rural regions facing greater barriers to care. These findings reveal that current measurement tools and policies may not fully capture the lived realities of deafblind people, limiting access to services and perpetuating disadvantage. Addressing these gaps requires culturally responsive data collection, co-design with affected communities, and integrated, holistic support systems. Recognising deafblindness as a distinct disability and aligning policy with Te Tiriti o Waitangi and the United Nations Convention on the Rights of Persons with Disabilities are essential steps towards equity and inclusion.
Asia Pac J Public Health
· 2026 Jun · PMID 42267499
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Climate change is a major factor influencing cardiovascular health, yet its impact on diverse cardiac conditions in East Asia remains insufficiently explored. This study investigated associations between meteorological f...Climate change is a major factor influencing cardiovascular health, yet its impact on diverse cardiac conditions in East Asia remains insufficiently explored. This study investigated associations between meteorological factors and cardiac morbidity in 3 South Korean cities-Seoul, Busan, and Daejeon-using monthly administrative data from 2010 to 2023. Generalized additive models were employed to assess the effects of temperature, precipitation, and extreme weather indicators on acute pericarditis and heartbeat abnormalities. The results revealed distinct city-specific sensitivities: in Seoul, heatwave days were positively associated with increased pericarditis visits, while in Busan, more frequent precipitation days were linked to higher risks of heartbeat abnormalities. Furthermore, relative humidity emerged as a significant factor, with lower humidity levels correlating with increased pericarditis in Seoul and Daejeon, and higher humidity associated with elevated heartbeat abnormality risks in Seoul. Our results indicate that urban cardiovascular vulnerability involves a complex interplay of thermal and hygrometric stressors that varies by city. These findings highlight the importance of weather factors beyond temperature alone, suggesting the necessity of considering city-specific climate patterns in epidemiological monitoring.
Ho Huu T, Lai Duc T, Nguyen Van Vinh C
… +5 more, Nguyen Ngoc Thuy D, Ho The N, Dang Thai B, Nhu NDP, Dang Van C
Asia Pac J Public Health
· 2026 Jun · PMID 42240223
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Depression is a global public health concern; however, access to adequate care remains limited, particularly in low-resource settings. This single-arm community-based intervention implemented in Vietnam aimed to enhance...Depression is a global public health concern; however, access to adequate care remains limited, particularly in low-resource settings. This single-arm community-based intervention implemented in Vietnam aimed to enhance primary health care staff's (PHS) capacity to deliver non-pharmacological treatment. Mental health specialists trained PHS and village health collaborators (VHCs) in screening and group counseling based on behavioral activation (BA) therapy. Village health collaborators screened 2000 purposively selected adults using the Patient Health Questionnaire-2 (PHQ-2) and subsequently referred individuals with scores ≥2 for further assessment with the Patient Health Questionnaire-9 (PHQ-9). Those scoring ≥10 were enrolled in an 8-week group counseling program. Patient Health Questionnaire-9 scores were measured biweekly and analyzed using mixed-effects models. Of 2000 individuals screened, 172 (8.6%) were identified as at risk, 85% of whom were female. Following the intervention, the mean PHQ-9 score decreased from 12.9 to 5.5, with an average weekly reduction of 0.89 points. These findings highlight the potential role of primary health care stations in community-based mental health care.
Dong X, Wu B, Chen S
… +3 more, Zhu Z, Chen Y, Fu C
Asia Pac J Public Health
· 2026 Jun · PMID 42240208
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Older adults shoulder the greatest influenza burden, yet vaccination coverage in China remains low, especially in rural counties. Using community data from Deqing County, Zhejiang (2018-2022), we built a decision tree-Ma...Older adults shoulder the greatest influenza burden, yet vaccination coverage in China remains low, especially in rural counties. Using community data from Deqing County, Zhejiang (2018-2022), we built a decision tree-Markov model with 2-week cycles to evaluate a five-year free vaccination program for older adults under the current policy for residents aged ≥60 years and in two additional subgroup-based scenario analyses, one restricted to adults aged ≥70 years and the other to older adults with chronic diseases. From health care and societal perspectives, incremental cost-effectiveness ratios (ICERs) for the current program were US$10 535 and US$9657 per quality-adjusted life-year, respectively, both below the willingness-to-pay threshold of 1.5× local per capita Gross Domestic Product (GDP) (US$25 887). In subgroup-based scenario analyses, the policy showed greater cost-effectiveness and larger reductions in severe influenza when evaluated in the oldest old and in older adults with chronic conditions. Because decisions are anchored to locally scaled thresholds and routine data, findings may provide policy-relevant evidence for similar county- and district-level settings, although transferability should be interpreted with caution.
Asia Pac J Public Health
· 2026 May · PMID 42218635
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High-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) are widely used strategies for managing type 2 diabetes mellitus (T2DM), but evidence on their comparative effects and practical f...High-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) are widely used strategies for managing type 2 diabetes mellitus (T2DM), but evidence on their comparative effects and practical feasibility is limited. A systematic search of CNKI, Wanfang, PubMed, Web of Science, and EBSCO-SPORTDiscus was conducted up to January 31, 2026, to identify randomized controlled trials enrolling adults with T2DM. Twenty studies (n = 981; 49.6% male; mean age 58.04 ± 10.08 years; mean body mass index 28.03 ± 4.43 kg/m) with interventions lasting ≥8 weeks reporting fasting blood glucose (FBG), fasting insulin (FINS), homeostatic model assessment of insulin resistance (HOMA-IR), glycated hemoglobin (HbA1c), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG), or total cholesterol (TC) were included. Data were extracted using standardized spreadsheets. Statistical analysis included standardized mean differences (SMDs) with 95% confidence intervals, heterogeneity assessment, and Egger's test for publication bias. Compared with routine pharmacological treatment, HIIT significantly improved FBG (SMD = -1.24), HbA1c (-1.40), HOMA-IR (-1.03), FINS (-0.97), HDL (0.86), and TG (-0.55) (all < .05), while no significant differences were observed for LDL, TC, or between HIIT and MICT. A 12-week, thrice-weekly HIIT protocol was most effective for glycemic control. High-intensity interval training's time efficiency and motivational appeal may enhance adherence and support implementation in clinical practice and public health programs.
Abdul Rani F, Nik Farid ND, Yahya A
… +6 more, Ismail SS, Suboh S, Limon MIH, Johari Chan M, R Selvasingam R, Tan CV
Asia Pac J Public Health
· 2026 May · PMID 42212911
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The household double burden of malnutrition (DBM), where maternal overnutrition coexists with child undernutrition, is a concern in Malaysia, as adult obesity rises alongside child undernutrition. Local evidence focused...The household double burden of malnutrition (DBM), where maternal overnutrition coexists with child undernutrition, is a concern in Malaysia, as adult obesity rises alongside child undernutrition. Local evidence focused on rural and indigenous populations, lacking studies in vulnerable urban communities. This study determined the prevalence, subtypes, and factors associated with household DBM among residents of low-cost housing communities in Kuala Lumpur. A cross-sectional survey was conducted from April to July 2024 among 346 households of children attending public early childhood education centres, using cluster random sampling. Data on sociodemographics, food security, dietary diversity, and anthropometry were collected and analysed with SPSS 29. Household DBM prevalence was 11.0%, predominantly among underweight children. Risk was higher with maternal short stature (aOR 2.80, 95% CI [1.01-7.76]) and higher child birth order (aOR 2.03, 95% CI [1.15-3.59]), while older maternal age was protective (aOR 0.84, 95% CI [0.74-0.96]). These findings support the need for integrated maternal and child nutrition strategies, guided by local data.
Beh HC, Ng WL, Beh YC
… +4 more, Wong CZY, Chin YS, A A, A H H
Asia Pac J Public Health
· 2026 May · PMID 42212893
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COVID-19 significantly disrupted health care services. This study aimed to evaluate the impact of appointment deferment during pandemic on patient outcomes. This was a retrospective cohort study where we traced the clini...COVID-19 significantly disrupted health care services. This study aimed to evaluate the impact of appointment deferment during pandemic on patient outcomes. This was a retrospective cohort study where we traced the clinical parameters for patients where their appointment being scheduled to 6 months later. A total of 577 patients were included, mean age was 67.0 years (±11.8). Patients (7.8%, n = 45) made unscheduled visits, hospitalizations (3.1%, n = 18) while (0.5%, n = 3) deceased. Low-density lipoprotein and estimated glomerular filtration rate showed slightly improved post deferment but might not be clinically significant. Further sub-analyses found that patients with hypertension and heart diseases had nearly twice the odd of having poorer outcome (adjusted odds ratio: 1.991, 95% CI [1.023, 3.876], = .043). Understanding these patterns would help identify patient groups at higher risk of poor outcomes and inform future strategies for triaging and managing care during public health emergencies.
Asia Pac J Public Health
· 2026 May · PMID 42153911
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Sarcopenia contributes substantially to disability and mortality in older adults, and vitamin D plays an important role in muscle health. Using nationally representative data from the 2022 to 2023 Korea National Health a...Sarcopenia contributes substantially to disability and mortality in older adults, and vitamin D plays an important role in muscle health. Using nationally representative data from the 2022 to 2023 Korea National Health and Nutrition Examination Survey (KNHANES), this study examined the association between dietary vitamin D intake and sarcopenia among adults aged ≥65 years and evaluated whether regional socioeconomic deprivation, measured by the Area Deprivation Index (ADI), moderates this relationship. Sarcopenia was defined using sex-specific cutoffs of appendicular skeletal muscle mass relative to body weight. Vitamin D intake was assessed using a 24-hour dietary recall, and ADI was constructed from regional socioeconomic indicators. Analyses accounted for the complex survey design and included multivariable and moderated logistic regression analyses. Higher vitamin D intake was associated with lower odds of sarcopenia, whereas higher ADI was associated with increased odds. A significant vitamin D intake × ADI interaction indicated that the protective association of vitamin D intake was attenuated in more socioeconomically deprived regions. These findings highlight the importance of incorporating regional socioeconomic context into nutrition policies and public health strategies aimed at preventing sarcopenia among older adults in South Korea.
Fadzil SS, Yahya A, Daliana Nik Farid N
… +1 more, Kamaruzzaman SB
Asia Pac J Public Health
· 2026 May · PMID 42112936
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Dementia is a major public health concern, and accurate dementia knowledge assessment using locally appropriate tools is very important. This study aimed to cross-culturally adapt and test the psychometric properties of...Dementia is a major public health concern, and accurate dementia knowledge assessment using locally appropriate tools is very important. This study aimed to cross-culturally adapt and test the psychometric properties of the 27-item Malay-Singapore version of Dementia Knowledge Assessment Scale (DKAS) among the general public in Malaysia. A total of 491 Malaysian adults attending the MOH primary care health services in Selangor, Malaysia, were included in this study. Some phrases were revised after face validation to ensure items' readability. Items 7 and 8 (I-CVI<0.78) were dropped following content validation. Pilot and test-retest revealed a good internal consistency (Cronbach's alpha = 0.89) and reproducibility (ICC 0.66-0.94). The data collected was then randomly split for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). In EFA, five items were removed due to low factor loadings (<0.4). The 20 items from EFA accounted for 51.0% of total variance. Following CFA, the original structures of DKAS were reduced to 16 items in a 4-factor model with strong model fit (χ/df = 1.99, RMSEA = 0.05, GFI = 0.93, AGFI = 0.91, TLI = 0.93, and CFI = 0.94) and reliability indices. In summary, the Malaysian version of DKAS (DKAS-My) is a valid and reliable instrument that can be used to assess dementia knowledge among the general public in Malaysia.
Widyaningrum R, Ambarwati K, Kuntari T
… +2 more, Putri TA, Kusumaninrum PD
Asia Pac J Public Health
· 2026 May · PMID 42104831
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Breastfeeding has been shown to provide numerous benefits for mothers and babies in the short and long term. During the COVID-19 pandemic, breastfeeding support, which was traditionally provided offline, shifted to onlin...Breastfeeding has been shown to provide numerous benefits for mothers and babies in the short and long term. During the COVID-19 pandemic, breastfeeding support, which was traditionally provided offline, shifted to online platforms. Although these remote services were available before the pandemic began, online interventions emerged as an alternative and proved effective in helping mothers breastfeed during that period. We aimed to explore the existing literature on the experiences of mothers and health care professionals with remote one-to-one synchronous breastfeeding support and to identify the unmet support needs of mothers regarding this type of support. We systematically searched seven literature databases: MEDLINE, CINAHL Plus, MIDIRS, Web of Science, ASSIA, WHO Global Index, and Google Search. Articles published before 2010 and in languages other than English and Bahasa were excluded. A thematic approach was used to synthesise the data. Twenty-one studies were included in this review. Three themes generated from the synthesis: (1) mothers' acceptance of one-to-one synchronous telelactation, (2) benefit of one-to-one synchronous telelactation, and (3) challenges faced in one-to-one synchronous telelactation. In conclusion, mothers generally accepted one-to-one synchronous breastfeeding support as an alternative to in-person sessions, although some challenges remain. Further improvements are needed to address accessibility and scheduling issues.