Epidemiology and Health最新文献

{"title":"Sex differences in personal, community, and societal factors associated with mukbang among adolescents: korea youth risk behavior survey.","authors":"Cynthia Yursun Yoon, Seungha Shin, Haemi Jun, Hyeeun Park, Minseo Kim","doi":"10.4178/epih.e2025055","DOIUrl":"https://doi.org/10.4178/epih.e2025055","url":null,"abstract":"<p><strong>Objectives: </strong>Mukbang refers to live-streamed videos in which hosts consume large amounts of energy-dense, nutrient-poor foods while interacting with viewers. Mukbang is concerning, as it is commonly viewed by Korean adolescents and has shown to associate with adverse health outcomes. To inform efforts to prevent excessive engagement in mukbang among Korean adolescents, this study examined personal, community, and societal-level factors associated with excessive mukbang viewing (≥ 7 times/week) among Korean adolescents and the sex differences in such associations.</p><p><strong>Methods: </strong>Data were drawn from the 2022 Korea Youth Risk Behavior Survey (N=36,990, Mage=15.1±1.7, girls=48.6%, 53.2% attending middle-school). Self-reported data included personal (e.g., perceived health, weight, stress, depression, anxiety), community (e.g., living arrangement), and societal-level factors (e.g., socioeconomic status) and mukbang viewing. Logistic and modified Poisson regressions were used to examine associations of factors associated with excessive mukbang viewing among Korean adolescents and how it differs by sex.</p><p><strong>Results: </strong>Intrapersonal factors-specifically perceived health, weight, stress, depression, and anxiety- were associated with excessive mukbang viewing among adolescents (aPR range=1.18-1.44) and were more pronounced among girls. A community level factor-living arrangement-was associated with mukbang in boys but not in girls. Boys living on campus had 1.42 times the prevalence of mukbang viewing than boys living with family members (95% CI=1.08-1.88) after adjustments. Further mutual adjustment attenuated point estimates toward the null. Societal-level factors were not associated with mukbang among adolescents.</p><p><strong>Conclusion: </strong>Personal and community-level factors were associated with excessive mukbang viewing. Future research should explore the underlying mechanisms of these associations.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2025055"},"PeriodicalIF":2.2,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The delayed cancer treatment and economic inequality in Korea : results of common cancers by the time-to-surgery.","authors":"Noorhee Son, Woo-Ri Lee, Dong-Woo Choi, Kyu-Tae Han","doi":"10.4178/epih.e2025056","DOIUrl":"https://doi.org/10.4178/epih.e2025056","url":null,"abstract":"<p><strong>Objectives: </strong>Growing concerns regarding the concentration of cancer treatment in the capital city in South Korea have raised questions about equitable access to timely and optimal patient care. In this study, we evaluated the impact of time-to-surgery (TTS) on healthcare utilization and outcomes, with the goal of providing policy recommendations for effective quality assessment of cancer care.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed data from 2011 to 2021 obtained from National Health Insurance Service claims. A generalized estimating equation and a Cox proportional hazards model were applied to assess the effects of TTS on length of hospital stay (LOS), medical costs, and 5-year mortality among patients diagnosed with lung, liver, and colorectal cancers. Subgroup analyses were conducted based on patients' baseline economic status.</p><p><strong>Results: </strong>Among patients who underwent surgical treatment for lung, liver, or colorectal cancer, 20.4%, 11.4%, and 11.4% experienced treatment delays, respectively. Regardless of cancer type, longer TTS was associated with prolonged LOS and higher medical costs. Moreover, patients with extended TTS demonstrated an increased risk of 5-year mortality. Disparities by income level were evident, with greater differences observed in the lower-income group.</p><p><strong>Conclusion: </strong>This study highlights the importance of timely surgical treatment for patients with cancer, particularly in relation to income-based disparities. These findings emphasize the need to improve Korea's concentrated cancer care delivery system to enhance healthcare efficiency and address health literacy gaps affecting treatment by income level.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2025056"},"PeriodicalIF":2.2,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Explainable SHAP-XGBoost models for identifying important social factors associated with the atherosclerotic cardiovascular disease risk score using the LASSO feature selection technique.","authors":"Jungtae Choi, Jooeun Jeon, Hyoeun An, Hyeon Chang Kim","doi":"10.4178/epih.e2025052","DOIUrl":"https://doi.org/10.4178/epih.e2025052","url":null,"abstract":"<p><strong>Objectives: </strong>Extensive evidence indicates that social factors play an essential role in explaining atherosclerotic cardiovascular disease (ASCVD). This study aimed to examine which social factors are associated with the estimated 10-year ASCVD risk score among male and female adults, incorporating both multifaceted social network components and conventional risk factors.</p><p><strong>Methods: </strong>Using data from 4368 middle-aged Korean adults, we explored factors most likely to explain ASCVD risk with interpretable machine learning algorithms. The ASCVD risk was determined using the 10-year ASCVD risk score, as calculated using pooled cohort equations. Social network components were assessed through the name generator module. A total of 52 variables were included in the model.</p><p><strong>Results: </strong>For male participants (area under the receiver operating characteristic curve [AUC] = 0.65), the average years known for network members contributed most to ASCVD risk prediction (mean Shapley additive explanations [SHAP] value = 0.31), followed by spouse's education level (0.22), medical history with diagnosis (0.18), and snoring frequency (0.14). By contrast, for female participants (AUC = 0.60), medical history with diagnosis was the strongest predictor (0.47), followed by logged income (0.21), education level (0.19), and the average number of years known in network members (0.17).</p><p><strong>Conclusion: </strong>Several important social factors were associated with the ASCVD risk score in both male and female adults. However, longitudinal research is needed to determine whether these factors predict future ASCVD events.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2025052"},"PeriodicalIF":2.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Probiotics for preventing neonatal sepsis in preterm neonates: a systematic review and meta-analysis for clinical practice.","authors":"Rizka Maulida, Radhian Amandito, Rinawati Rohsiswatmo, Amarila Malik","doi":"10.4178/epih.e2025051","DOIUrl":"https://doi.org/10.4178/epih.e2025051","url":null,"abstract":"<p><strong>Objectives: </strong>Late-onset sepsis (LOS), occurring after 72 hours of birth, is a significant cause of morbidity and mortality especially in preterm neonates. Probiotics have been proposed as a preventive strategy to enhance gut health, modulate immune responses, and reduce the incidence of neonatal sepsis. We aimed to evaluate the effectiveness of probiotics in preventing neonatal sepsis in preterm neonates, with particular attention to the impact of different strains and dosage regimens.</p><p><strong>Methods: </strong>Eligible studies included preterm neonates (≤36 weeks gestational age) with culture-proven LOS and focused on probiotic supplementation. Comprehensive searches were conducted in MEDLINE via PubMed, Cochrane CENTRAL, Scopus, and ProQuest up to July 28, 2024. The Revised Cochrane Risk of Bias Tool (RoB 2.0) was applied to assess study quality, and a random-effects meta-analysis was performed using Review Manager (RevMan) version 5.4. Additionally, the certainty of the body of evidence was evaluated using the GRADE approach (Grading of Recommendations Assessment, Development, and Evaluation).</p><p><strong>Results: </strong>Thirty-one studies including 8,040 preterm neonates were reviewed. Meta-analysis demonstrated that probiotics significantly reduced the incidence of LOS (pooled risk ratio [RR], 0.83; 95% CI, 0.72-0.95). Greater efficacy was observed with multistrain formulations (RR, 0.76; 95% CI, 0.72-0.95) and low-dose regimens (RR, 0.72; 95% CI, 0.56-0.91). Probiotic supplementation was also associated with shorter hospital stays and a trend toward lower mortality, although the latter did not reach statistical significance.</p><p><strong>Conclusion: </strong>To effectively reduce LOS in preterm neonates, specific combinations of multistrain probiotics and optimized dosing strategies may provide the most benefit.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2025051"},"PeriodicalIF":2.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic factors affecting breast and cervical cancer screening compliance in Asian National Cancer Centers Alliance countries: a systematic review.","authors":"Seowoo Bae, Ye Ji Kang, Jeonghoon Ahn, Bo-Hyoung Jang, Kui Son Choi, Hyeon Ji Lee, Mina Suh","doi":"10.4178/epih.e2025050","DOIUrl":"https://doi.org/10.4178/epih.e2025050","url":null,"abstract":"<p><strong>Objectives: </strong>Breast and cervical cancers are the most frequently diagnosed cancers in women. The Asian National Cancer Centers Alliance (ANCCA) has strengthened cancer control efforts in the Asia region; however, only a few countries have achieved sufficient participation rates. This systematic review aimed to synthesize the existing evidence on socioeconomic factors influencing women's compliance with breast and cervical cancer screening in ANCCA countries.</p><p><strong>Methods: </strong>This study was conducted as a systematic review, with studies collected from PubMed, Cochrane Library, Scopus, and Embase. All included studies employed cross-sectional designs to identify socioeconomic factors affecting compliance with breast or cervical cancer screening. Study selection, quality assessment, and data extraction were carried out by 2 independent reviewers with cross-checking.</p><p><strong>Results: </strong>In total, 48 studies were reviewed. Education level and family history were associated with participation in breast cancer screening, while education level, household income, marital status, and medical insurance were linked with cervical cancer screening. When stratified by Human Development Index (HDI) level or by the presence of a National Cancer Screening Program, differences were observed in the factors influencing screening compliance. Nevertheless, higher education consistently correlated with higher screening rates for both cancer types, regardless of HDI level.</p><p><strong>Conclusion: </strong>This systematic review identified multiple socioeconomic factors that shape breast and cervical cancer screening compliance in Asian countries. To reduce disparities in participation, tailored multi-strategy approaches adapted to each country's specific context are required. These findings may provide useful evidence for future research and policy initiatives aimed at addressing health equity issues.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2025050"},"PeriodicalIF":2.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decentralized pandemic response and health equity: an analysis of socioeconomic disparities in COVID-19 mortality in Japan.","authors":"Hasan Jamil, Aminu Abubakar Kende, Shuhei Nomura, Fumiya Inoue, Takao Suzuki, Stuart Gilmour","doi":"10.4178/epih.e2025049","DOIUrl":"https://doi.org/10.4178/epih.e2025049","url":null,"abstract":"<p><strong>Objectives: </strong>Global data often link greater socioeconomic deprivation to higher COVID-19 mortality. However, whether decentralized governance can mitigate this disparity by enabling tailored, equitable local responses remains unclear. We assessed whether Japan's decentralized pandemic response moderated the association between area-level socioeconomic deprivation and COVID-19 mortality across municipalities.</p><p><strong>Methods: </strong>We analyzed 20,760 COVID-19 deaths from all Japanese municipalities during 2020-2021. We computed standardized mortality ratios using national age- and sex-specific rates to derive expected counts. We then fit a Bayesian spatial Poisson regression model with the log of expected counts as an offset to estimate smoothed relative risks (RRs). The Area Deprivation Index (ADI) represented the primary predictor; structured and unstructured random effects captured spatial correlation and residual variability.</p><p><strong>Results: </strong>Mapping of smoothed RRs, categorized into quintiles, revealed higher mortality risk in northern, central, and western municipalities, with lower risk in southern and scattered central regions. Contradicting global trends, deprivation and COVID-19 mortality demonstrated an inverse association (ADI coefficient, -0.095; 95% credible interval, -0.173 to -0.018), indicating that more deprived municipalities exhibited lower RRs for COVID-19 mortality (9.1% reduction per 1-unit increase in ADI).</p><p><strong>Conclusion: </strong>The inverse relationship between area deprivation and COVID-19 mortality in Japan contrasts with global patterns. Although Japan's decentralized health system ensured equitable access to COVID-19 treatment, lower mortality in more deprived areas likely reflects additional protective factors, including population density patterns and community-specific adaptations. These findings underscore the complex interplay between socioeconomic conditions and health outcomes during global health emergencies.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2025049"},"PeriodicalIF":2.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a telemedicine pilot project for hypertension in Korea: a nationwide real-world data study.","authors":"Jeong-Yeon Kim, Yeryeon Jung, Seongwoo Seo, Youseok Kim, Min Jung Ko, Hun-Sung Kim","doi":"10.4178/epih.e2025048","DOIUrl":"https://doi.org/10.4178/epih.e2025048","url":null,"abstract":"<p><strong>Objectives: </strong> A telemedicine pilot project has received temporary authorization in Korea. The clinical effectiveness of telemedicine is well established; however, ongoing research must assess medical utilization, sustainability, prescription continuity, and safety.</p><p><strong>Methods: </strong> This study evaluated medical utilization, sustainability, prescription continuity, and safety before and after the implementation of a telemedicine pilot project between June 2022 and December 2023. Data were obtained from the Korean National Health Insurance Service (NHIS), and participants were divided into those who received non-face-to-face hypertension treatment at least once and those who did not.</p><p><strong>Results: </strong> This study included 124,210 patients diagnosed with hypertension who received telemedicine (the Tele_G group) and 124,210 propensity score-matched control individuals. The difference-in-difference (DID) for medical utilization between the Tele_G and control groups was 0.10 (-0.03 vs. -0.12, p<0.001). The DID for the Modified Modified Continuity Index was -0.005 (-0.003 vs. 0.002, p<0.001), while that for Most Frequent Provider Continuity was -0.006 (-0.004 vs. 0.002, p<0.001). The DID for the prescription day rate was 0.41 (-0.61 vs. -1.02, p<0.001), and that for the appropriate prescription continuation rate was 0.52 (-1.23 vs. -1.75, p<0.005).</p><p><strong>Conclusion: </strong> Telemedicine did not fully achieve the same standard as face-to-face treatment for hypertension management; however, it showed comparable safety, suggesting potential as secondary care. As the first NHIS-based study on this topic in Korea, this research highlights the benefits of telemedicine when appropriately utilized for patients with hypertension. Nevertheless, due to limitations regarding long-term continuity and policy design, cautious interpretation is required, and further prospective studies are warranted.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2025048"},"PeriodicalIF":2.2,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behavioral and psychosocial factors associated with sugar-sweetened beverage consumption among Korean adolescents: a path analysis using the 2022 Korea Youth Risk Behavior Survey.","authors":"Hye-Young Park, Soo Rack Ryu, Hoon-Ki Park, Hwan-Sik Hwang, Kye-Yeung Park","doi":"10.4178/epih.e2025047","DOIUrl":"https://doi.org/10.4178/epih.e2025047","url":null,"abstract":"<p><strong>Objectives: </strong>Rising obesity rates among adolescents are a major global health concern and are closely linked to the consumption of sugar-sweetened beverages (SSBs). This study aimed to identify key behavioral and psychosocial factors influencing SSB consumption among adolescents.</p><p><strong>Methods: </strong>This cross-sectional study analyzed data from the 2022 Korea Youth Risk Behavior Web-based Survey, which included 49,548 participants aged 12-18 years. Information on SSB consumption frequency, sociodemographic characteristics, eating habits, sedentary behaviors, and other health-related factors was collected through self-administered questionnaires. Path analysis was used to model SSB consumption and estimate the direct and indirect effects of modifiable factors.</p><p><strong>Results: </strong>Male students, current alcohol drinkers, those with higher frequencies of fast-food or late-night snack consumption, and heavy smartphone users were more likely to frequently consume SSBs. Fast-food intake had the strongest direct effect on SSB consumption (B = 0.3884), while nighttime eating showed a substantial direct effect (B = 0.1437) and mediated 21.7% of the relationship between fast-food intake and SSB consumption. Leisure sitting time exerted both direct (B = 0.0741) and indirect effects on SSB intake, mediated through watching mukbang, smartphone use, fast-food consumption, and nighttime eating. Self-perceived health status was negatively associated with SSB consumption (B = -0.0619), with indirect effects mediated by fast-food intake and nighttime eating.</p><p><strong>Conclusion: </strong>Among Korean adolescents, SSB consumption was strongly associated with unhealthy eating patterns and prolonged leisure sitting time. Increased fast-food consumption, nighttime eating, watching mukbang, smartphone use, and negative self-perceived health status not only directly influenced SSB intake, but also acted as mediating factors.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2025047"},"PeriodicalIF":2.2,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for Q fever incidence in South Korea: a comparative analysis using frequentist and Bayesian methods.","authors":"Ji-Hyun Son, Sung-Dae Park","doi":"10.4178/epih.e2025046","DOIUrl":"https://doi.org/10.4178/epih.e2025046","url":null,"abstract":"<p><strong>Objectives: </strong>This study investigated the principal determinants of human Q fever incidence and explored regional variation between metropolitan cities and provinces in South Korea.</p><p><strong>Methods: </strong>Panel data on human Q fever incidence, livestock populations, and facility metrics were collected across 17 metropolitan cities and provinces from 2017 to 2024. Analytical approaches included frequentist models (ordinary least squares [OLS], random effects, fixed effects) and Bayesian models.</p><p><strong>Results: </strong>Frequentist panel analysis indicated that slaughterhouse count was positively associated with Q fever incidence in both pooled OLS (β=1.20, p<0.001) and random effects models (β=1.03, p<0.001), but not in the fixed effects model (β=0.14, p=0.65). After correcting for serial correlation using Driscoll-Kraay standard errors, livestock population (β=0.55, p<0.01), livestock market count (β=-2.01, p<0.05), and livestock Q fever cases (β=-0.11, p<0.01) were significantly associated with human incidence. A Bayesian fixed effects model confirmed a significant relationship between slaughterhouses and human Q fever incidence (posterior mean: 0.87, 95% credible interval [CrI], 0.21-1.42), providing more stable inference with limited samples and allowing probabilistic uncertainty estimation. A Bayesian hierarchical model revealed a stronger association in metropolitan cities (posterior mean, 1.46; 95% CrI, 0.34-2.57) than in provinces (1.22), while livestock population remained significant in provinces (0.94, 95% CrI, 0.15-1.74).</p><p><strong>Conclusion: </strong>In South Korea, slaughterhouse density was the main determinant of Q fever in metropolitan areas and livestock density was the primary risk factor in provinces. These findings underscore the need for region-specific preventive strategies and reinforce the value of a One Health approach.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2025046"},"PeriodicalIF":2.2,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in sustainable dietary patterns in United States adults, 2007-2018.","authors":"Sukyoung Jung, Heather Young, Barbara Braffett, Samuel Simmens, Eunice Hong Lim Lee, Cynthia Ogden","doi":"10.4178/epih.e2025045","DOIUrl":"https://doi.org/10.4178/epih.e2025045","url":null,"abstract":"<p><strong>Objectives: </strong>Adopting sustainable diets is essential for improving both human and planetary health, and such diets should be evaluated from a multidimensional perspective. We characterized trends in sustainable dietary patterns, quantified by the Sustainable Diet Index for US adults (SDI-US), along with trends in diet quality, diet-related environmental impacts, food affordability, and food practices.</p><p><strong>Methods: </strong>This study analyzed data from the National Health and Nutrition Examination Survey (2007-2018) for adults aged ≥20 years (n = 25,543). The SDI-US (range: 4-20 points), with higher scores indicating more sustainable diets, was calculated using 24-hour dietary recall data and responses to consumer and dietary behavior questionnaires. Mean total SDI-US scores, sub-indices, and 12 individual indicators were estimated for each survey cycle. Trends were assessed using orthogonal polynomial contrasts in regression models.</p><p><strong>Results: </strong>From 2007 to 2018, total SDI-US scores showed no significant overall trend (overall mean = 13.1). Nutritional and sociocultural indicators remained relatively stable, whereas the economic indicator (food expenditures) worsened from 21.4% to 26.4% (p<0.05, linear trend) between 2007-2008 and 2017-2018. Environmental impacts initially worsened between 2007-2008 and 2013-2014 but improved through 2017-2018 (all p<0.05, quadratic trend). When stratified by age (p for interaction <0.0001), a slight decline in SDI-US was observed among adults aged ≥60 years (14.1 to 13.9, p<0.0001).</p><p><strong>Conclusion: </strong>From 2007 to 2018, total SDI-US scores largely remained unchanged, although declines occurred among adults ≥60 years and scores remained lower among adults aged 20-39 years. Ongoing monitoring and coordinated improvements across all dimensions are needed to advance sustainable diets in all age groups.</p>","PeriodicalId":48543,"journal":{"name":"Epidemiology and Health","volume":" ","pages":"e2025045"},"PeriodicalIF":2.2,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}