Sarah M. McGhee

Metabolic syndrome increases all‐cause and vascular mortality: the Hong Kong Cardiovascular Risk Factor Study

Objective  The metabolic syndrome has been associated with increased mortality in some Caucasian populations, but data in Asian populations are not available. We present data describing the association of the metabolic syndrome with mortality.

Valuation of the SF-6D Health States Is Feasible, Acceptable, Reliable, and Valid in a Chinese Population.

OBJECTIVES The SF-6D is a preference-based measure of health (PBMH) derived from the SF-36 for economic evaluation. The aim of this study was to find out whether it was feasible, acceptable, reliable, and valid to use the standard gamble (SG) method to generate preference-based values for the SF-6D in a Chinese population. METHODS The SF-6D was translated into Chinese by forward and backward translations. Forty-nine states defined by the SF-6D were selected using an orthogonal design and grouped into seven sets. An age-sex stratified sample of 126 Chinese adults with low education levels valued a set of 7 and the pits (worst) SF-6D health states by the SG method. The data were modeled at the individual and mean levels to predict preference values for all SF-6D states. The quality of data and the predictive power of the models were compared with results from the United Kingdom. RESULTS All respondents completed the interviews with 3% finding the process very difficult and 21% felt some degree of irritation or boredom. A total of 907 SG valuations (90% out of 1008 observations) were useable for econometric modeling. There was no significant change in the test-retest values from 21 subjects. The main mean effect models achieved a good fit with a mean absolute error of 0.054. Some differences between the Chinese and UK preference coefficients were found especially in the physical functioning dimension. The range of SG values predicted by the HK function is slightly longer, with the pits state having a value of 0.152 compared to 0.271 in the UK. CONCLUSION It was feasible, acceptable, reliable, and valid to value the SF-6D with the SG method in a Chinese population with relatively low education levels. The results supported the feasibility and validity of valuing PBMH in Asian populations. Further studies are required to determine whether the differences in the SF-6D scoring algorithms between the British and Chinese populations are important.

Mortality associated with passive smoking in Hong Kong.

Passive smoking can cause death from lung cancer and coronary heart disease, but there is little evidence for associations with other causes of death in never smokers. A recent study showed increased all cause mortality with exposure to secondhand smoke at home but did not examine associations with specific causes of death and dose-response relations.1 We have published estimates of the mortality attributable to active smoking in Hong Kong2 and now present the related findings on passive smoking at home. Details of the sample selection and data collection have been reported.2 Each person who reported a death in 1998 at four death registries was given a questionnaire which asked about the lifestyle 10 years earlier of the decedent and of a living person about the same age who was well known to the informant. Passive smoking was identified in the interview with the question, “Ten years ago, in about 1988, excluding the decedent/control, how many persons who lived with the decedent/control smoked?” Decedents or …

Cost of tobacco-related diseases, including passive smoking, in Hong Kong

Background: Costs of tobacco-related disease can be useful evidence to support tobacco control. In Hong Kong we now have locally derived data on the risks of smoking, including passive smoking. Aim: To estimate the health-related costs of tobacco from both active and passive smoking. Methods: Using local data, we estimated active and passive smoking-attributable mortality, hospital admissions, outpatient, emergency and general practitioner visits for adults and children, use of nursing homes and domestic help, time lost from work due to illness and premature mortality in the productive years. Morbidity risk data were used where possible but otherwise estimates based on mortality risks were used. Utilisation was valued at unit costs or from survey data. Work time lost was valued at the median wage and an additional costing included a value of US

Waiting time, doctor shopping, and nonattendance at specialist outpatient clinics: case-control study of 6495 individuals in Hong Kong.

1.3 million for a life lost. Results: In the Hong Kong population of 6.5 million in 1998, the annual value of direct medical costs, long term care and productivity loss was US

Secondhand smoke and respiratory ill health in current smokers

532 million for active smoking and US

Promoting smoking cessation among the elderly: what are the predictors of intention to quit and successful quitting?

156 million for passive smoking; passive smoking accounted for 23% of the total costs. Adding the value of attributable lives lost brought the annual cost to US

Public opinion on smoke-free policies in restaurants and predicted effect on patronage in Hong Kong

9.4 billion. Conclusion: The health costs of tobacco use are high and represent a net loss to society. Passive smoking increases these costs by at least a quarter. This quantification of the costs of tobacco provides strong motivation for legislative action on smoke-free areas in the Asia Pacific Region and elsewhere.

Air Pollution: Costs and Paths to a Solution in Hong Kong—Understanding the Connections Among Visibility, Air Pollution, and Health Costs in Pursuit of Accountability, Environmental Justice, and Health Protection

Objective. Nonattendance is a major health services research and management issue that has received little attention or systematic study in Asia. We examined the independent associations between waiting time, doctor shopping, and nonattendance in specialist outpatient clinics of 4 large public hospitals in Hong Kong. Research Design. Case-control study. Setting and Participants. A total of 6495 attenders and nonattenders enrolled from July 2000 through October 2001. Pain Outcome Measures. Odds ratios (ORs) and associated 95% confidence intervals (CI) for nonattendance. Results. Longer waiting times (adjusted OR2nd quartile, 1.67; 95% CI, 1.38–2.03; adjusted OR3rd quartile, 1.90; 95% CI, 1.56–2.30; adjusted OR4th quartile, 2.30; 95% CI, 1.91-2.78) and doctor-shopping behavior (adjusted OR, 2.91; 95% CI, 2.51–3.38) were independent risk factors for nonattendance. These effects were robust after multivariate adjustment and testing for effect modification. They also appeared to persist uniformly across hospitals and specialties. There was no demonstrable relationship between waiting time and doctor shopping. Conclusions. This is the largest study of nonattendance at outpatient clinics and the first such study carried out in Asia. Targeted strategies should be implemented and evaluated using these results to reduce waiting time, doctor shopping, and ultimately nonattendance.

Effectiveness and efficiency of opportunistic cervical cancer screening: Comparison with organized screening

Background: Numerous studies have concluded that secondhand smoke (SHS) is harmful to non-smokers but controversy persists regarding its effects on smokers. The impact of SHS exposure on the acute respiratory health of current active smokers was examined using a cross sectional design. Methods: 9923 uniformed staff in the Hong Kong Police Force completed a standardised questionnaire on current and past smoking, SHS exposure at home and at work, acute respiratory symptoms, and recent physician consultation. 3999 male current smokers were included in the analysis. Results: About 5% of the smokers were exposed to SHS at home only, 53% were exposed at work only, and 30% were exposed both at home and at work. The prevalence ratios for respiratory symptoms (throat and nasal problems, cough, phlegm, and wheeze), physician consultation, and self medication were higher for those who were exposed to SHS at home or at work. The odds ratios of reporting one or more respiratory symptoms, for SHS exposures at home or at work, were 1.33 (95% confidence interval (CI) 1.12 to 1.59) and 1.66 (95% CI 1.36 to 2.02) respectively, after adjusting for age, marital status, education, rank and duties, exposure to self perceived dusty or polluted environment in previous job, and total dose of active smoking. The adjusted odds ratios showed significant positive dose–response gradients with SHS exposure at home, at work, and at both places combined. Conclusions: SHS exposure is strongly associated with increased acute respiratory symptoms and recent outpatient service utilisation in current smokers. If the association is causal, public health action to limit SHS exposure could also benefit smokers.