1
|
Hwang YH, Yoo TK, Lee SB, Kim J, Ko BS, Kim HJ, Lee JW, Son BH, Chung IY. Implementation of BRCA Test among Young Breast Cancer Patients in South Korea: A Nationwide Cohort Study. Cancer Res Treat 2024; 56:802-808. [PMID: 38374698 PMCID: PMC11261184 DOI: 10.4143/crt.2023.1186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/18/2024] [Indexed: 02/21/2024] Open
Abstract
PURPOSE This study aimed to investigate the frequency of BRCA testing and related factors among young breast cancer patients (age < 40 years) in South Korea. MATERIALS AND METHODS We conducted a nationwide retrospective cohort study using data from the Health Insurance Review and Assessment claims. Newly diagnosed breast cancer patients younger than 40 were included. Annual BRCA testing ratios (number of BRCA test recipients/the number of patients undergoing breast cancer surgery in each year) were analyzed by region and health care delivery system. We investigated the location of breast cancer diagnosis and BRCA testing. RESULTS From January 2010 to December 2020, there were 25,665 newly diagnosed young breast cancer patients, of whom 12,186 (47.5%) underwent BRCA testing. The BRCA testing ratios increased gradually from 0.084 (154/1,842) in 2010 to 0.961 (1,975/2,055) in 2020. Medical aid (vs. health insurance) and undergoing surgery in metropolitan cities or others (vs. Seoul), general hospitals, and clinics (vs. tertiary hospitals) were associated with a lower likelihood of BRCA testing. While 97.8% of the patients diagnosed in Seoul underwent BRCA testing in Seoul, 22.9% and 29.2% of patients who were diagnosed in metropolitan areas and other regions moved to Seoul and underwent BRCA testing, respectively. CONCLUSION The frequency of BRCA testing has increased over time in South Korea, with Seoul showing a particularly high rate of testing. About one-quarter of patients diagnosed with breast cancer outside of Seoul moved to Seoul and underwent BRCA testing.
Collapse
Affiliation(s)
- Yung-Huyn Hwang
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Kyung Yoo
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sae Byul Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jisun Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom Seok Ko
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Won Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Ho Son
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Il Yong Chung
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
2
|
Lim WH, Kim HL, Joh HS, Seo JB, Kim SH, Zo JH, Kim MA. The Prognostic Value of Arterial Stiffness According to Socioeconomic Status. J Clin Med 2023; 12:6943. [PMID: 37959408 PMCID: PMC10647441 DOI: 10.3390/jcm12216943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 10/31/2023] [Accepted: 11/04/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Individuals of low socioeconomic status (SES) often exhibit increased cardiovascular risk factors and a worse prognosis. We conducted this study to ascertain whether brachial-ankle pulse wave velocity (baPWV), a straightforward and reliable measure of arterial stiffness, can hold prognostic value for people with low SES. METHODS We retrospectively analyzed a total of 1266 subjects (mean age 64.6 ± 11.6 years; 47.2% female) without documented cardiovascular disease who had undergone baPWV measurement. The subjects included 633 National Health Insurance Beneficiaries (NHIB) and 633 Medical Aid Beneficiaries (MAB), matched for major clinical features through a 1:1 propensity score matching method. Major adverse cardiovascular events (MACE), such as death, non-fatal myocardial infarction, non-fatal ischemic stroke, coronary revascularization, and heart failure necessitating admission, were assessed during the clinical follow-up. RESULTS During a median follow-up period of 4.2 years (interquartile range, 2.2-5.7 years), there were 77 MACE cases (6.1%). In multivariable Cox regression analyses, baPWV was identified as a significant predictor of MACE in both groups, regardless of the use of three different baPWV criteria (median value, Asian consensus recommendation, and cut-off value obtained by receiver operating characteristic [ROC] curve analysis). In both groups, the baPWV value obtained using ROC curve analysis emerged as the best predictor of MACE. This predictive value was stronger in the NHIB group (hazard ratio, 5.80; 95% confidence interval, 2.30-14.65; p < 0.001) than in the MAB group (hazard ratio, 3.30; 95% confidence interval, 1.57-6.92; p = 0.002). CONCLUSIONS baPWV was associated with future MACE incidence in both NHIB and MAB groups. Since baPWV is simple and cost-effective to measure, it could be efficiently used as a risk stratification tool for individuals with low SES.
Collapse
Affiliation(s)
| | - Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Republic of Korea; (W.-H.L.); (H.S.J.); (J.-B.S.); (S.-H.K.); (J.-H.Z.); (M.-A.K.)
| | | | | | | | | | | |
Collapse
|
3
|
Lee CH, Lee YB, Moon H, Chung JW, Cho EJ, Lee JH, Yu SJ, Kim YJ, Lee J, Yoon JH. Association between daily aspirin therapy and risk of hepatocellular carcinoma according to metabolic risk factor burden in non-cirrhotic patients with chronic hepatitis B. Aliment Pharmacol Ther 2023; 58:704-714. [PMID: 37461332 DOI: 10.1111/apt.17643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/22/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Several studies have demonstrated chemopreventive effects of aspirin against hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). AIMS To investigate the associations of aspirin use with risks of HCC, liver-related mortality, and major bleeding according to metabolic risk factor burden among non-cirrhotic patients with CHB METHODS: Using the Korean National Health Insurance Service database, we identified 282,611 non-cirrhotic adults with CHB. Data on obesity, diabetes, high blood pressure, and hypercholesterolemia were collected. Subjects were stratified into lower and higher metabolic risk groups (≤2 and ≥3 risk factors, respectively). Propensity score-matched cohorts of aspirin users and non-users were generated. Risks of HCC, liver-related death and major bleeding were analyzed. RESULTS During the median follow-up of 7.4 years, positive associations between metabolic risk factor burden and outcomes were verified (all ptrend < 0.001). In the lower metabolic risk group (13,104 pairs), the association between aspirin use and HCC risk was not significant after multivariable adjustment (adjusted subdistribution hazard ratio [aSHR]: 0.93; 95% CI: 0.84-1.03); however, aspirin use was associated with elevated major bleeding risk (aSHR: 1.22; 95% CI: 1.08-1.39). In the higher metabolic risk group (2984 pairs), aspirin use was associated with reduced risks of HCC (aSHR: 0.72; 95% CI: 0.57-0.91) and liver-related mortality (aSHR: 0.69; 95% CI: 0.50-0.96) without an increase in risk of major bleeding (aSHR: 1.02; 95% CI: 0.79-1.32). CONCLUSIONS Aspirin therapy was associated with reduced risks of HCC and liver-related death without excess risk of major bleeding, in non-cirrhotic patients with CHB who had a higher metabolic risk factor burden.
Collapse
Affiliation(s)
- Cheol-Hyung Lee
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yun Bin Lee
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyemi Moon
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Ju Cho
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Su Jong Yu
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoon Jun Kim
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Juneyoung Lee
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
4
|
Choi M, Sempungu JK, Lee EH, Lee YH. Changes in contributions of age- and cause-specific mortality to the widening life expectancy gap between North and South Korea, 1990-2019: An analysis of the Global Burden of Disease Study 2019. SSM Popul Health 2023; 23:101445. [PMID: 37334332 PMCID: PMC10276181 DOI: 10.1016/j.ssmph.2023.101445] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/08/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023] Open
Abstract
Background Life expectancy gaps between North and South Korea have increased but contributions to these gaps remain poorly understood. Using data from the Global Burden of Disease Study (GBD) 2019, we examined how much death from specific diseases contributed to these gaps in different age groups over three decades. Methods Data for death numbers and population by sex and 5-year age groups in both North and South Korea from 1990 to 2019 were extracted from the GBD 2019 to calculate life expectancy. Joinpoint regression analysis was conducted to investigate changes in life expectancy in North and South Korea. We used decomposition analysis to partition differences in life expectancy within and between the two Koreas into changes in age- and cause-specific death contributions. Results Life expectancy increased in two Koreas from 1990 to 2019, but North Korea experienced a marked decline in life expectancy during the mid-1990s. The life expectancy gaps between the two Koreas were greatest in 1999, with a difference of 13.3 years for males and 14.9 years for females. The main contributors to these gaps were higher under-5 mortality from nutritional deficiencies for males (4.62 years) and females (4.57 years) in North Korea, accounting for about 30% of the total gap in life expectancy. After 1999, the life expectancy gaps reduced but persisted with differences of about ten years by 2019. Notably, chronic diseases contributed to about 8 out of 10 years of life expectancy gap between the two Koreas in 2019. Differential cardiovascular disease mortality in the older groups was the main contributor to the life expectancy gap. Conclusions The contributors to this gap have shifted from nutritional deficiencies in children younger than five years to cardiovascular disease among elderly people. Efforts for strengthening social and healthcare systems are needed to curb this large gap.
Collapse
Affiliation(s)
- Minjae Choi
- Institute for Future Public Health, Graduate School of Public Health, Korea University, Seoul, Republic of Korea
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Joshua Kirabo Sempungu
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- Program in Public Health, Graduate School, Korea University, Seoul, Republic of Korea
| | - Eun Hae Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- Program in Public Health, Graduate School, Korea University, Seoul, Republic of Korea
| | - Yo Han Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
5
|
Oh S, Joo HJ, Sohn JW, Park S, Jang JS, Seong J, Park KJ, Lee SH. Cloud-based digital healthcare development for precision medical hospital information system. Per Med 2023; 20:435-444. [PMID: 37811595 DOI: 10.2217/pme-2023-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Aim: This study aims to develop a cloud-based digital healthcare system for precision medical hospital information systems (P-HIS). Methods: In 2020, international standardization of P-HIS clinical terms and codes was performed. In 2021, South Korea's first tertiary hospital cloud was established and implemented successfully. Results: P-HIS was applied at Korea's first tertiary general hospital. Common data model-compatible precision medicine/medical service solutions were developed for medical support. Ultrahigh-quality medical data for precision medicine were acquired and built using big data. Joint global commercialization and dissemination/spreading were achieved using the P-HIS consortium and global common data model-based observational medical outcome partnership network. Conclusion: To provide personalized precision medical services in the future, establishing and using big medical data is essential.
Collapse
Affiliation(s)
- SeJun Oh
- Human Behavior & Genetic Institute, Associate Research Center, Korea University, Seoul, 02841, Republic of Korea
| | - Hyung Joon Joo
- Division of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University of College of Medicine, Seoul, 02841, Republic of Korea
| | - Jang Wook Sohn
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Sangsoo Park
- Division of Global Sport Studies, Korea University Sejong Campus, Sejong, 30019, Republic of Korea
| | - Jin Su Jang
- Human Behavior & Genetic Institute, Associate Research Center, Korea University, Seoul, 02841, Republic of Korea
| | - Jiwon Seong
- Korea University Medicine Center, Seoul, Biomedical Research Institute, Seoul, 02841, Republic of Korea
- Huniverse, Seoul, 02566, Republic of Korea
| | | | - Sang Heon Lee
- Department of Physical Medicine and Rehabilitation, Korea University Medical Center, Seoul, 02841, Republic of Korea
| |
Collapse
|
6
|
Chuck KW, Hong S, Lee Y. Underuse of Gastric Cancer Screening Services among Koreans with Type 2 Diabetes. Healthcare (Basel) 2023; 11:healthcare11070927. [PMID: 37046854 PMCID: PMC10093844 DOI: 10.3390/healthcare11070927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
We aimed to compare the gastric cancer screening rates between participants with diabetes and those without diabetes in the Korean population. The data of 4284 participants from the Korea National Health and Nutrition Examination Survey 2019 were used. Cancer-free people aged ≥40 years were included, and cancer screening rates in diabetes and non-diabetes participants were analyzed. Baseline characteristics and screening rates were calculated using weighted frequencies and multivariable regression at a 95% confidence interval in both groups. Screening for gastric cancer was significantly lower (odd ratio [OR]: 0.77, 95% CI: 0.64-0.95) in patients with diabetes than in those without diabetes. The odds of performing the recommended gastric cancer screening were also lower (OR: 0.72, 95% CI: 0.58-0.90) in participants with diabetes than in those without diabetes. After adjusting for socio-demographic factors, the multivariable logistics regression analysis also showed lower odds for gastric cancer screening participation in diabetic patients than in non-diabetes participants. Conclusively, people with diabetes were less likely to have ever had or been recommended screening compared with those without diabetes. Greater efforts need to be made by health specialists to increase the awareness and the need of long-term preventive care including gastric cancer screening in high-risk groups.
Collapse
Affiliation(s)
- Kumban Walter Chuck
- Department of Medical Sciences, Ajou University, 206 World cup-ro, Yeongtong-gu, Suwon-si 16499, Republic of Korea
| | - Seri Hong
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, 164-World cup-ro, Yeongtong-gu, Suwon-si 16499, Republic of Korea
| | - Yunhwan Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, 164-World cup-ro, Yeongtong-gu, Suwon-si 16499, Republic of Korea
| |
Collapse
|
7
|
Shin HR, Kim YS, Park YK, Koo SK, Son WH, Han JW, Son EH, Kang HJ, Choi KH, Han JS, Lee HS, Lim HS. Nutritional Status and Frailty Improvement through Senior-Friendly Diet among Community-Dwelling Older Adults in South Korea. Nutrients 2023; 15:nu15061381. [PMID: 36986111 PMCID: PMC10051771 DOI: 10.3390/nu15061381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/15/2023] Open
Abstract
Considering that Korea’s aging population is rapidly increasing, health serves as an indicator of older adults’ quality of life, and dietary life directly affects their health. For health maintenance and improvement, preventive healthcare measures including safe food selection and nutritional supply are needed. This study aimed to evaluate the effect of senior-friendly diet on nutrition and health status improvement in older adults receiving community care. A total of 180 older adults were analyzed, with 154 and 26 in the senior-friendly diet intervention group and the general diet group, respectively. Surveys, blood tests, and frailty evaluations were conducted before and after the study. After 5 months of intervention, the blood status, nutrient intake, and frailty level were evaluated. The participants’ mean age was 82.7 years, and 89.4% of them were living alone. In both groups, energy, protein, vitamin A, vitamin D, vitamin C, calcium, and magnesium intake were insufficient initially but generally improved after the intervention. Especially in the intervention group, energy, protein, vitamin D, vitamin C, and folic acid intake significantly increased. The frailty level also slightly improved, and the malnutrition rate was reduced. Even after the passage of time, the improvement effect size significantly differed between the groups. Therefore, resolving and supporting meals corresponding to the physiological needs of the older adults has a great impact on improving their quality of life, and such special consideration is a reasonable way to respond to a super-aged society.
Collapse
Affiliation(s)
- Hye-Ri Shin
- Department of Gerontology, AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Republic of Korea; (H.-R.S.); (Y.-S.K.)
| | - Young-Sun Kim
- Department of Gerontology, AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Republic of Korea; (H.-R.S.); (Y.-S.K.)
| | - Yoo-Kyung Park
- Department of Medical Nutrition, AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Republic of Korea; (Y.-K.P.)
| | - Seul-Ki Koo
- Department of Gerontology, AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Republic of Korea; (H.-R.S.); (Y.-S.K.)
| | - Woo-Hyun Son
- Department of Gerontology, AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Republic of Korea; (H.-R.S.); (Y.-S.K.)
| | - Jae-Won Han
- Department of Gerontology, AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Republic of Korea; (H.-R.S.); (Y.-S.K.)
| | - Eun-Ha Son
- Department of Gerontology, AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Republic of Korea; (H.-R.S.); (Y.-S.K.)
| | - Hae-Jin Kang
- Department of Medical Nutrition, AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Republic of Korea; (Y.-K.P.)
| | - Kyeong-Hee Choi
- The Food Industry Promotional Agency of Korea, Iksan 54576, Republic of Korea
| | - Jin-Soo Han
- The Food Industry Promotional Agency of Korea, Iksan 54576, Republic of Korea
| | - Hyun-Sun Lee
- The Food Industry Promotional Agency of Korea, Iksan 54576, Republic of Korea
| | - Hee-Sook Lim
- Department of Gerontology, AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Republic of Korea; (H.-R.S.); (Y.-S.K.)
- Correspondence: ; Tel.: +82-31-201-2936
| |
Collapse
|
8
|
Kang CR, Yang SJ. Risk factors for depressive symptoms by age group among human immunodeficiency virus-infected adults in Korea. AIDS Care 2022; 34:1522-1529. [PMID: 34612099 DOI: 10.1080/09540121.2021.1981225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We identified factors associated with depressive symptoms according to age group. We used data from a city-wide, cross-sectional survey conducted by the Seoul Metropolitan Government in 2014. Multivariable logistic regression analyses were performed to explore factors related to depressive symptoms. Depressive symptoms were assessed using a single item from the Korea National Health and Nutrition Examination Survey. Of the 370 subjects, 37.3% had depressive symptoms during the past 12 months. Compared to an age of ≥50 years, being 20-39 (adjusted odds ratio, 2.45; 95% confidence interval, 1.26-4.75) or 40-49 years (2.58; 1.32-5.06) of age was positively associated with depressive symptoms. In addition, a history of acquired immune deficiency syndrome-defining opportunistic disease (3.29; 1.09-9.92) and perceived discrimination (1.93; 1.16-3.20) in subjects aged 20-39 years, and poor subjective health (4.97; 1.42-17.32) in subjects aged 40-49 years, were associated with depressive symptoms, but no factor exhibited a significant association in subjects aged ≥ 50 years. In conclusion, a screening program that considers the factors identified in this study to prioritize patients with depression should be implemented.
Collapse
Affiliation(s)
- Cho Ryok Kang
- Division of Nursing Science, Ewha Womans University, Seoul, Korea.,Infectious Disease Control Division, Seoul Metropolitan Government, Seoul, Korea
| | - Sook Ja Yang
- Division of Nursing Science, Ewha Womans University, Seoul, Korea
| |
Collapse
|
9
|
Shin WY, Go TH, Kang DR, Lee SY, Lee W, Kim S, Lee J, Kim JH. Patterns of patients with polypharmacy in adult population from Korea. Sci Rep 2022; 12:18073. [PMID: 36302935 PMCID: PMC9613698 DOI: 10.1038/s41598-022-23032-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 10/25/2022] [Indexed: 01/15/2023] Open
Abstract
Polypharmacy and its rising global prevalence is a growing public health burden. Using a large representative nationwide Korean cohort (N = 761,145), we conducted a retrospective cross-sectional study aiming to identify subpopulations of patients with polypharmacy and characterize their unique patterns through cluster analysis. Patients aged ≥ 30 years who were prescribed at least one medication between 2014 and 2018 were included in our study. Six clusters were identified: cluster 1 mostly included patients who were hospitalized for a long time (4.3 ± 5.3 days); cluster 2 consisted of patients with disabilities (100.0%) and had the highest mean number of prescription drugs (7.7 ± 2.8 medications); cluster 3 was a group of low-income patients (99.9%); cluster 4 was a group of high-income patients (80.2%) who frequently (46.4 ± 25.9 days) visited hospitals/clinics (7.3 ± 2.7 places); cluster 5 was mostly elderly (74.9 ± 9.8 years) females (80.3%); and cluster 6 comprised mostly middle-aged (56.4 ± 1.5 years) males (88.6%) (all P < 0.001). Patients in clusters 1-5 had more prescribed medications and outpatient visit days than those in cluster 6 (all P < 0.001). Given limited health care resources, individuals with any of the identified phenotypes may be preferential candidates for participation in intervention programs for optimal medication use.
Collapse
Affiliation(s)
- Woo-young Shin
- grid.254224.70000 0001 0789 9563Department of Family Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hwa Go
- grid.15444.300000 0004 0470 5454Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Dae Ryong Kang
- grid.15444.300000 0004 0470 5454Department of Precision Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sei Young Lee
- grid.254224.70000 0001 0789 9563Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Won Lee
- grid.254224.70000 0001 0789 9563Department of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Seonah Kim
- grid.411651.60000 0004 0647 4960Department of Family Medicine, Health Promotion Center, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jiewon Lee
- grid.254224.70000 0001 0789 9563Department of Family Medicine, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973 Republic of Korea
| | - Jung-ha Kim
- grid.254224.70000 0001 0789 9563Department of Family Medicine, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973 Republic of Korea
| |
Collapse
|
10
|
Bahk J, Kang HY, Khang YH. Disability type–specific mortality patterns and life expectancy among disabled people in South Korea using 10-year combined data between 2008 and 2017. Prev Med Rep 2022; 29:101958. [PMID: 36161125 PMCID: PMC9501987 DOI: 10.1016/j.pmedr.2022.101958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/13/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
People with any disabilities accounted for a quarter of total deaths. People with disabilities had higher average ages and poor economic conditions. All disability types presented higher mortality rates and lower life expectancy. The major causes of death differed according to the type of disability.
People with disabilities have a higher mortality risk than non-disabled people. However, mortality patterns and life expectancy according to disability types are under-researched. This study investigated the sociodemographic characteristics and compared mortality and life expectancy among people with disabilities according to disability type in Korea using 10-year combined data between 2008 and 2017. The National Health Information Database from the National Health Insurance Service covering the total Korean population between 2008 and 2017 was obtained. This study described the age and income distributions of people with disabilities and calculated the mortality rate, proportional mortality ratio, and life expectancy according to disability type. Most disability subgroups had higher average ages than were found for non-disabled people. The proportion of the bottom 20% household income group was also higher in all types of disabilities than in non-disabled people. The crude mortality rate, age-standardized mortality rate, and life expectancy were all worse in people with all types of disabilities than in their non-disabled counterparts, but variations according to disability type were found. The composition of causes of death also varied across disability types. Although all types of disabilities were associated with higher mortality rates and lower life expectancy, the sociodemographic characteristics and mortality and life expectancy patterns differed across types of disability. People with disabilities experienced various health-related problems and financial burdens. Public assistance needs to be strengthened to guarantee adequate income and health care services for people with disabilities, considering their sociodemographic characteristics and mortality patterns.
Collapse
Affiliation(s)
- Jinwook Bahk
- Department of Public Health, Keimyung University, 1095, Dalgubeol-daero, Dalseo-gu, Daegu, Korea
| | - Hee-Yeon Kang
- Department of Health Policy and Management, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Korea
- Institute of Health Policy and Management, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Young-Ho Khang
- Department of Health Policy and Management, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Korea
- Institute of Health Policy and Management, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, Korea
- Corresponding author at: Department of Health Policy and Management, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea.
| |
Collapse
|
11
|
Validation of Operational Definition to Identify Patients with Osteoporotic Hip Fractures in Administrative Claims Data. Healthcare (Basel) 2022; 10:healthcare10091724. [PMID: 36141336 PMCID: PMC9498336 DOI: 10.3390/healthcare10091724] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 08/31/2022] [Indexed: 11/18/2022] Open
Abstract
As incidences of osteoporotic hip fractures (OHFs) have increased, identifying OHFs has become important to establishing the medical guidelines for their management. This study was conducted to develop an operational definition to identify patients with OHFs using two diagnosis codes and eight procedure codes from health insurance claims data and to assess the operational definition’s validity through a chart review. The study extracted data on OHFs from 522 patients who underwent hip surgeries based on diagnosis codes. Orthopedic surgeons then reviewed these patients’ medical records and radiographs to identify those with true OHFs. The validities of nine different algorithms of operational definitions, developed using a combination of three levels of diagnosis codes and eight procedure codes, were assessed using various statistics. The developed operational definition showed an accuracy above 0.97 and an area under the receiver operating characteristic curve above 0.97, indicating excellent discriminative power. This study demonstrated that the operational definition that combines diagnosis and procedure codes shows a high validity in detecting OHFs and can be used as a valid tool to detect OHFs from big health claims data.
Collapse
|
12
|
Jang H, Lee YB, Moon H, Chung JW, Nam JY, Cho EJ, Lee JH, Yu SJ, Kim YJ, Lee J, Yoon JH. Aspirin use and risk of hepatocellular carcinoma in patients with chronic hepatitis B with or without cirrhosis. Hepatology 2022; 76:492-501. [PMID: 35100447 DOI: 10.1002/hep.32380] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/14/2022] [Accepted: 01/26/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Studies on differential effect of aspirin therapy on HCC risk across the spectrum of liver diseases are lacking. We investigated the association between aspirin use and risks of HCC, liver-associated death, and major bleeding in chronic hepatitis B (CHB) patients with or without cirrhosis. APPROACH AND RESULTS We identified 329,635 eligible adults with CHB from 2007 through 2017, using the Korean National Health Insurance Service database, including patients who received aspirin for ≥90 consecutive days (n = 20,200) and patients who never received antiplatelet therapy (n = 309,435). Risks of HCC, liver-associated mortality, and major bleeding were estimated in a propensity-score-matched cohort (19,003 pairs), accounting for competing risks. With a median follow-up of 6.7 years, 10-year cumulative incidence of HCC was 9.5% in the aspirin-treated group and 11.3% in the untreated group (adjusted subdistribution hazard ratio [aSHR], 0.85; 95% CI, 0.78-0.92). However, among patients with cirrhosis (2479 pairs), an association of aspirin use with HCC risk was not evident (aSHR, 1.00; 95% CI, 0.85-1.18). Cirrhosis status had a significant effect on the association between aspirin use and HCC risk (pinteraction , n = 0.04). Aspirin use was also associated with lower liver-associated mortality (aSHR, 0.80; 95% CI, 0.71-0.90). Moreover, aspirin use was not associated with major bleeding risk (aSHR, 1.09; 95% CI, 0.99-1.21). CONCLUSIONS Aspirin use was associated with reduced risks of HCC and liver-associated mortality in adults with CHB. Cirrhosis status had a substantial effect on the association between aspirin use and HCC risk.
Collapse
Affiliation(s)
- Heejoon Jang
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Yun Bin Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyemi Moon
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joon Yeul Nam
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Ju Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Su Jong Yu
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Juneyoung Lee
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
13
|
Lee WR, Yoo KB, Lee GM, Koo JH, Kim LH. Is Avoidable Hospitalization Experienced Prior to Infection Associated With COVID-19-Related Deaths? Int J Public Health 2022; 67:1604426. [PMID: 35795099 PMCID: PMC9252312 DOI: 10.3389/ijph.2022.1604426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 05/18/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives: This study aimed to determine the effect of the presence or absence of avoidable hospitalization before acquiring coronavirus disease (COVID-19) on COVID-19-related deaths. Methods: This study used the total NHIS-COVID-19 dataset comprising domestic COVID-19 patients, provided by the National Health Insurance Service (NHIS) in South Korea. We conducted logistic regression and double robust estimation (DRE) to confirm the effect of avoidable hospitalization on COVID-19-related deaths. Results: Logistic regression analysis confirmed that the odds ratio (OR) of death due to COVID-19 was high in the group that experienced avoidable hospitalization. DRE analysis showed a higher OR of death due to COVID-19 in the group that experienced avoidable hospitalization compared to the group that did not experience avoidable hospitalization, except in the subgroup aged ≤69 years. Conclusion: The effect of avoidable hospitalization on COVID-19-related deaths was confirmed. Therefore, continued health care, preventive medicine, and public health management are essential for reducing avoidable hospitalizations despite the COVID-19 pandemic. Clinicians need to be informed about the importance of continuous disease management.
Collapse
Affiliation(s)
- Woo-Ri Lee
- Department of Health Administration, Yonsei University, Wonju, South Korea
| | - Ki-Bong Yoo
- Department of Health Administration, Yonsei University, Wonju, South Korea
- *Correspondence: Ki-Bong Yoo,
| | - Gyeong-Min Lee
- Department of Health Administration, Yonsei University, Wonju, South Korea
| | - Jun Hyuk Koo
- Yonsei University Wonju Industry-Academic Cooperation Foundation, Wonju, South Korea
| | - Li-Hyun Kim
- Department of Health Administration, Yonsei University, Wonju, South Korea
| |
Collapse
|
14
|
Sex and Economic Disparity Related to Reperfusion Therapies for Patients with Acute Ischemic Stroke in South Korea across a 10-Year Period: A Nationwide Population-Based Study Using the National Health Insurance Database. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053050. [PMID: 35270741 PMCID: PMC8910261 DOI: 10.3390/ijerph19053050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/25/2022] [Accepted: 03/03/2022] [Indexed: 12/10/2022]
Abstract
A complete enumeration study was conducted to evaluate trends related to reperfusion therapies (intravenous thrombolysis (IVT) and endovascular treatment (EVT)) in acute ischemic stroke (AIS) in South Korea, according to sex, economic status, and age, over a 10-year period retrospectively, using the National Health Information Database (NHIS-2020-1-481). This study included AIS patients aged ≥20 years who were hospitalized in a general hospital or tertiary hospital for ≥4 days and underwent brain imaging during the same period. Study participants were classified by sex, economic status (Medical Aid beneficiaries and National Health Insurance beneficiaries) and age (20-44, 45-64, 65-79, and ≥80 years). Women showed a significantly lower OR (Odds ratio) than men in IVT (OR: 0.75; 95% CI: 0.73-0.77), EVT (OR: 0.96; 95% CI: 0.93-0.99), and any therapy (OR: 0.82; 95% CI: 0.80-0.84). The Medical Aid beneficiaries showed significantly lower OR in IVT (OR 0.91, 95% CI 0.88-0.95), EVT (OR 0.93, 95% CI 0.89-0.98), and either therapy (OR 0.92, 95% CI 0.90-0.95) than the National Health Insurance beneficiaries. This study showed sex and economic disparity related to reperfusion therapies in patients with AIS in Korea.
Collapse
|
15
|
Song EY, Shin S, Park H, Kim N, Yoon JH, Roh EY. Differences in the diagnosis and treatment of hematologic malignancies attributable to health insurance coverage. Medicine (Baltimore) 2022; 101:e29020. [PMID: 35244084 PMCID: PMC8896484 DOI: 10.1097/md.0000000000029020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/17/2022] [Indexed: 01/04/2023] Open
Abstract
Medical care should be equally provided to the public regardless of their financial capability. In the real world, expenditures directly out from the patient sector decide the medical journey, even in a country with national health insurance. The aim of this study was to investigate whether there are differences in the diagnostic and treatment processes in hematologic malignancies based on patient characteristics, such as health insurance status.Through the review of 5614 "CBCs with differential count" results with abnormal cells from 358 patients from January 2010 to June 2017, 238 patients without past medical histories of hematologic malignancies were enrolled. Excluding reactive cases, 206 patients with hematologic malignancy were classified into 8 disease categories: acute leukemia, myelodysplastic syndrome, myeloproliferative neoplasm (MPN), myelodysplastic syndrome/MPN, lymphoid neoplasm, plasma cell neoplasm, r/o hematologic malignancy, and cancer.The patients' age, sex, disease categories and follow-up durations showed associations with the clinical course. The "refusal of treatment" group was the oldest and had a relatively higher percentage of females, whereas those who decided to transfer to a tertiary hospital were younger. The age, clinical course, and follow-up durations were different across health insurance statuses. The medical aid group was the oldest, and the group whose status changed from a medical insurance subscriber to a medical aid beneficiary during treatment was the youngest. The majority of patients who refused treatment or wished to be transferred to a tertiary hospital were medical insurance subscribers. The percentage of patients who were treated in this secondary municipal hospital was higher in the medical-aid beneficiaries group than in the medical insurance group. Follow-up durations were longest in the status change group and shortest in the medical insurance group.Almost all medical aid beneficiaries with hematologic malignancies opted to continue treatment at this secondary/municipal hospitals, indicating that this category of medical institutions provides adequate levels and qualified healthcare services to those patients. The secondary municipal hospital provides qualified healthcare services for medical aid beneficiaries with hematologic malignancies.
Collapse
Affiliation(s)
- Eun Young Song
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sue Shin
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Laboratory Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hyunwoong Park
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Laboratory Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Namhee Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Laboratory Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jong Hyun Yoon
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Laboratory Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Eun Youn Roh
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Laboratory Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| |
Collapse
|
16
|
Yoo W, Kim S, Kim S, Jeong E, Lee K. Association between the National Health Insurance coverage benefit extension policy and clinical outcomes of ventilated patients: a retrospective study. Acute Crit Care 2022; 37:53-60. [PMID: 35279977 PMCID: PMC8918707 DOI: 10.4266/acc.2021.01389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background This study aimed to investigate the association between the Korean National Health Insurance coverage benefit extension policy and clinical outcomes of patients who were ventilated owing to various respiratory diseases. Methods Data from 515 patients (male, 69.7%; mean age, 69.8±12.1 years; in-hospital mortality rate, 28.3%) who were hospitalized in a respiratory intensive care unit were retrospectively analyzed over 5 years. Results Of total enrolled patients, 356 (69.1%) had one benefit items under this policy during their hospital stay. They had significantly higher medical expenditure (total: median, 23,683 vs. 12,742 U.S. dollars [USD], P<0.001), out-of-pocket (median, 5,932 vs. 4,081 USD; P<0.001), and a lower percentage of out-of-pocket medical expenditure relative to total medical expenditure (median, 26.0% vs. 32.2%; P<0.001). Patients without benefit items associated with higher in-hospital mortality (hazard ratio [HR], 2.794; 95% confidence interval [CI], 1.980–3.941; P<0.001). In analysis of patients with benefit items, patients with three items (“cancer,” “tuberculosis,” and “disability”) had significantly lower out-of-pocket medical expenditure (3,441 vs. 6,517 USD, P<0.001), and a lower percentage of out-of-pocket medical expenditure relative to total medical expenditure (17.2% vs. 27.7%, P<0.001). They were associated with higher in-hospital mortality (HR, 3.904; 95% CI, 2.533–6.039; P<0.001). Conclusions Our study showed patients with benefit items had more medical resources and associated improved in-hospital survival. Patients with the aforementioned three benefit items had lower out-of-pocket medical expenditure due to the implementation of this policy, but higher in-hospital mortality.
Collapse
|
17
|
Noh Y, Choe SA, Kim WJ, Shin JY. Discontinuation and re-initiation of antidepressants during pregnancy: A nationwide cohort study. J Affect Disord 2022; 298:500-507. [PMID: 34728291 DOI: 10.1016/j.jad.2021.10.069] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 10/08/2021] [Accepted: 10/23/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Women tend to discontinue antidepressants during pregnancy. We examined the rate of and factors associated with antidepressant discontinuation and re-initiation during pregnancy. METHODS We conducted a nationwide cohort study using Korea's healthcare database. The study cohort included women who were aged 15-50 years, gave birth during 2013-2017, had ≥1 depression diagnosis, ≥2 antidepressant prescriptions within 6 months (one within one month of preconception). Cox proportional hazards model was used to evaluate factors associated with antidepressant discontinuation and re-initiation during pregnancy. RESULTS Among 5207 pregnancies, 4954 (95.1%) discontinued antidepressants during pregnancy, which included 4657 (89.4%) in the first trimester, 1810 (38.9%) of whom re-initiated them during pregnancy or postpartum period. The risk of antidepressant discontinuation increased in women with substance-related disorders (HR 1.17, 95% CI 1.01-1.35), but decreased in women receiving medical aid (0.53, 0.46-0.62) and patients suggestive of severe depression, such as psychiatric comorbidities and long-term antidepressant use before pregnancy. Antidepressant re-initiation occurred frequently in medical aid recipients (1.25, 1.06-1.47), nulliparous women (1.11, 1.01-1.22), and women with severe symptoms. CONCLUSIONS We found high rates of antidepressant discontinuation and re-initiation during pregnancy. Although women suggestive of severe symptoms were less likely to discontinue antidepressants during pregnancy, they were more likely to re-initiate them during their perinatal period, which warrants more detailed guidelines on perinatal depression.
Collapse
Affiliation(s)
- Yunha Noh
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeong gi-do 16419, Republic of Korea
| | - Seung-Ah Choe
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo Jung Kim
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeong gi-do 16419, Republic of Korea; Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea; Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, Republic of Korea.
| |
Collapse
|
18
|
Park SC, Won SY, Kim NH, Choi H, Youk TM, Lee HJ, Jeon HH. Risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections: a nationwide population-based study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:211. [PMID: 33708838 PMCID: PMC7940880 DOI: 10.21037/atm-20-5958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) has rapidly turned into a public health emergency worldwide; however, the risk factors for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have not been well-described. We aimed to identify the clinical risk factors for SARS-CoV-2 infections in Korea, where social distancing and face masks have been strongly recommended. Methods The data of individuals who underwent the reverse transcription polymerase chain reaction test for SARS-CoV-2 between January 3 and May 31, 2020 were retrieved from the Health Insurance Review and Assessment Service dataset. We used multivariable logistic regression models to identify the risk factors for SARS-CoV-2 infections in the population. Results We retrieved the results of 219,729 SARS-CoV-2 tests, of which 7,333 were positive results. In the multivariable analysis, female sex was associated with a higher risk of testing positive for SARS-CoV-2 [odds ratio (OR) =1.30, 95% confidence interval (CI): 1.24–1.37, P<0.0001]. Additionally, populations living in areas that had large outbreaks of COVID-19 were at an increased risk of testing positive for SARS-CoV-2 (OR =6.87, 95% CI: 6.55–7.21, P<0.0001). The odds of a positive test were greater for the Medical Aid beneficiaries (OR =1.99, 95% CI: 1.82–2.18, P<0.0001) than for the National Health Insurance beneficiaries. Individuals with diabetes mellitus (DM) were more likely to test positive (OR =1.15, 95% CI: 1.07–1.24, P=0.0002). Conclusions Women, individuals living in areas with large outbreaks of COVID-19, Medical Aid beneficiaries, and individuals with DM might have greater risks of contracting SARS-CoV-2 infections despite practicing social distancing and using face masks.
Collapse
Affiliation(s)
- Seon Cheol Park
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Sun Young Won
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Na Hye Kim
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Heun Choi
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Tae Mi Youk
- Research Institute, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.,Department of Statistics, Korea University, Seoul, Republic of Korea
| | - Hyun Jung Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic Korea
| | - Han Ho Jeon
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| |
Collapse
|
19
|
Jeong HE, Lee J, Shin HJ, Shin JY. Socioeconomic disparities in Korea by health insurance type during the COVID-19 pandemic: a nationwide study. Epidemiol Health 2021; 43:e2021007. [PMID: 33445821 PMCID: PMC8060526 DOI: 10.4178/epih.e2021007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/13/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES This study explored socioeconomic disparities in Korea using health insurance type as a proxy during the ongoing coronavirus disease 2019 (COVID-19) pandemic. METHODS We conducted a retrospective cohort study using Korea's nationwide healthcare database, which contained all individuals who received a diagnostic test for COVID-19 (n=232,390) as of May 15, 2020. We classified our cohort by health insurance type into beneficiaries of the National Health Insurance (NHI) or Medicaid programs. Our study outcomes were infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19-related outcomes, a composite of all-cause death, intensive care unit admission, and mechanical ventilation use. We estimated age-, sex-, and Charlson comorbidity index score-adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using a multivariable logistic regression analysis. RESULTS Of the 218,070 NHI and 14,320 Medicaid beneficiaries who received COVID-19 tests, 7,777 and 738 tested positive, respectively. The Medicaid beneficiaries were older (mean age, 57.5 vs. 47.8 years), more likely to be males (47.2 vs. 40.2%), and had a higher comorbidity burden (mean CCI, 2.0 vs. 1.7) than NHI beneficiaries. Compared to NHI beneficiaries, Medicaid beneficiaries had a 22% increased risk of SARS-CoV-2 infection (aOR, 1.22; 95% CI, 1.09 to 1.38), but had no significantly elevated risk of COVID-19-related outcomes (aOR 1.10, 95% CI 0.77 to 1.57); the individual events of the composite outcome yielded similar findings. CONCLUSIONS As socioeconomic factors, with health insurance as a proxy, could serve as determinants during the current pandemic, pre-emptive support is needed for high-risk groups to slow its spread.
Collapse
Affiliation(s)
- Han Eol Jeong
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Jongseong Lee
- Columbia School of Social Work, Columbia University, New York, NY, USA
| | - Hyun Joon Shin
- Lemuel Shattuck Hospital, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea.,Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| |
Collapse
|
20
|
Pak JE, Kim KH, Shin SD, Song KJ, Hong KJ, Ro YS, Park JH. Association between chronic liver disease and clinical outcomes in out-of-hospital cardiac arrest. Resuscitation 2020; 158:1-7. [PMID: 33189806 DOI: 10.1016/j.resuscitation.2020.10.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/27/2020] [Accepted: 10/18/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Out-of-hospital cardiac arrest (OHCA) and chronic liver disease (CLD) are global health issues. The purpose of this study is to evaluate the association between chronic liver disease and clinical outcomes in OHCA. METHODS A retrospective observation study, using a nationwide population-based OHCA registry, was conducted. Adult patients with cardiac OHCAs who were treated by emergency medical service (EMS) providers between January 2013 and December 2015 were screened. The main exposure was the status of chronic liver disease that had been diagnosed before OHCA, categorized into three groups: no CLD, CLD without cirrhosis, and CLD with cirrhosis. Multivariable logistic regression analysis for survival and neurologic recovery were conducted to calculate the adjusted odds ratio (AOR) and confidence intervals (CIs). Interaction analysis for age, gender were performed and sensitivity analysis by imputation for main exposure missing was also. RESULT A total of 8844 eligible OHCA patients were enrolled. There were 361 (4.1%) patients in the CLD without cirrhosis group and 1323 (15%) patients in the CLD with cirrhosis group. Compared to no CLD group, CLD with cirrhosis group was less likely to have favorable outcomes for good neurological recovery and survival to discharge. Patients with CLD but without cirrhosis showed similar associations in neurologic recovery and survival with those without CLD. In multivariable logistic regression analysis, the AOR and 95% CIs for good neurological outcome and survival to discharge were as below; good neurological outcome - 1.07 (0.70-1.64) for CLD without cirrhosis, 0.08 (0.04-0.16) for CLD with cirrhosis, survival to discharge - 1.01 (0.70-1.45) for CLD without cirrhosis, 0.13 (0.08-0.20) for CLD with cirrhosis. Same trends of association were demonstrated in interaction and imputation analysis. CONCLUSION OHCA patients with liver cirrhosis showed poor clinical outcomes and CLD had no negative association unless they progressed to cirrhotic status.
Collapse
Affiliation(s)
- Ji Eun Pak
- Department of Emergency Medicine, Seoul National University Hospital, Republic of Korea.
| | - Ki Hong Kim
- Department of Emergency Medicine, Seoul National University Hospital, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Boramae Medical Center, Republic of Korea.
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University Hospital, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Young Sun Ro
- Department of Emergency Medicine, Seoul National University Hospital, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Jeong Ho Park
- Department of Emergency Medicine, Seoul National University Hospital, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| |
Collapse
|
21
|
Bahk J, Kang HY, Khang YH. Age- and cause-specific contributions to the life expectancy gap between Medical Aid recipients and National Health Insurance beneficiaries in Korea, 2008-2017. PLoS One 2020; 15:e0241755. [PMID: 33141849 PMCID: PMC7608888 DOI: 10.1371/journal.pone.0241755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022] Open
Abstract
Recipients of Medical Aid, a government-funded social assistance program for the poor, have a shorter life expectancy than National Health Insurance beneficiaries in Korea. This study aims to explore the contributions of age and major causes of death to the life expectancy difference between the two groups. We used the National Health Information Database provided by the National Health Insurance Service individually linked to mortality registration data of Statistics Korea between 2008 and 2017. Annual abridged life tables were constructed and Arriaga’s life expectancy decomposition method was employed to estimate age- and cause-specific contributions to the life expectancy gap between National Health Insurance beneficiaries and Medical Aid recipients. The life expectancy difference between National Health Insurance beneficiaries and Medical Aid recipients was 14.5 years during the period of 2008–2017. The age groups between 30 and 64 years accounted for 78.7% and 67.5% of the total life expectancy gap in men and women, respectively. Cancer was the leading cause of death contributing to excess mortality among Medical Aid recipients compared to National Health Insurance beneficiaries. More specifically, alcohol-attributable deaths (such as alcoholic liver disease, liver cancer, liver cirrhosis, and alcohol/substance abuse), suicide, and cardiometabolic risk factor–related deaths (such as cerebrovascular disease, ischemic heart disease, and diabetes) were the leading contributors to the life expectancy gap. To decrease excess deaths in Medical Aid recipients and reduce health inequalities, effective policies for tobacco and alcohol regulation, suicide prevention, and interventions to address cardiometabolic risk factors are needed.
Collapse
Affiliation(s)
- Jinwook Bahk
- Department of Public Health, Keimyung University, Daegu, South Korea
| | - Hee-Yeon Kang
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea
| | - Young-Ho Khang
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea
- * E-mail:
| |
Collapse
|
22
|
Kim HL, Lee JY, Lim WH, Seo JB, Kim SH, Zo JH, Kim MA. Relationship of Socioeconomic Status to Arterial Stiffness: Comparison Between Medical Aid Beneficiaries and National Health Insurance Beneficiaries. Am J Hypertens 2020; 33:718-725. [PMID: 32391565 DOI: 10.1093/ajh/hpaa075] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 04/22/2020] [Accepted: 05/06/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND There is no general agreement on underlying pathophysiology explaining the high burden of cardiovascular disease on people at low socioeconomic status (SES). This study was conducted to investigate the association between healthcare systems and arterial stiffness. METHODS A total of 8,929 subjects (60 years old and 55% were male) who underwent brachial-ankle pulse wave velocity (baPWV) measurement were retrospectively analyzed. There were 8,237 National Health Insurance (NHI) beneficiaries (92.2%) and 692 medical aid (MA) beneficiaries (7.8%). The median value of baPWV was 1,540 cm/s. RESULTS Subjects with higher baPWV values (≥1,540 cm/s) were older, and more frequently had cardiovascular risk factors and unfavorable laboratory findings than those with lower values baPWV (<1,540 cm/s). The baPWV values were significantly higher in MA beneficiaries than in NHI beneficiaries (1,966 ± 495 vs. 1,582 ± 346 cm/s, P < 0.001). The proportion of MA beneficiaries was significantly higher in subjects with higher baPWV than those with lower baPWV (13.1% vs. 2.3%, P < 0.001). In multivariable analysis, MA beneficiaries were significantly associated with higher baPWV values even after controlling for potential confounders (odds ratio, 5.41; 95% confidence intervals, 4.02-7.27; P < 0.001). CONCLUSIONS The baPWV values were significantly higher in MA beneficiaries than in NHI beneficiaries. The result of this study provides additional evidence on the association between low SES and arterial stiffening.
Collapse
Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Yong Lee
- Department of Public Health and Community Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Woo-Hyun Lim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Bin Seo
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joo-He Zo
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myung-A Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
23
|
Bahk J, Kang HY, Khang YH. Inequality in Life Expectancy in Korea according to Various Categorizations of the National Health Insurance Premiums as a Marker of Income. Yonsei Med J 2020; 61:640-643. [PMID: 32608209 PMCID: PMC7329743 DOI: 10.3349/ymj.2020.61.7.640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 11/28/2022] Open
Abstract
The purpose of this study was to examine the degree to which the magnitude of income inequality in life expectancy according to different categorization across beneficiary types under the National Health Insurance Service (NHIS) in Korea. We used population and death data in 2017 from the National Health Information Database of the NHIS. Income quintile groups were classified in four ways according to beneficiary type (employee insured, self-employed insured, and Medical Aid beneficiaries). Standard life table procedures were used to calculate life expectancy. The life expectancy gap between the lowest and highest income quintiles was the largest when the entire population was divided into quintiles without distinguishing among types of beneficiaries. In conclusion, we suggest that income quintile indicators in NHIS data, measured without distinguishing among types of beneficiaries, may best represent the magnitude of health inequalities in Korean society. This indicator could be used for future research on health inequalities, as well as for monitoring health inequalities in Korea.
Collapse
Affiliation(s)
- Jinwook Bahk
- Department of Public Health, Keimyung University, Daegu, Korea
| | - Hee Yeon Kang
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ho Khang
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea.
| |
Collapse
|
24
|
Park CH, Ahn KO, Shin SD, Park JH, Lee SY. Association between health insurance status and transfer of patients with return of spontaneous circulation after out-of-hospital cardiac arrest. Resuscitation 2020; 149:143-149. [PMID: 32114072 DOI: 10.1016/j.resuscitation.2020.02.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/04/2020] [Accepted: 02/21/2020] [Indexed: 12/11/2022]
Abstract
AIM To explore the factors related to the probability of inter-hospital transfer to a heart attack centre in patients with return of spontaneous circulation after out-of-hospital cardiac arrest (OHCA) in the Republic of Korea. METHODS This cross-sectional observational study used data from a Korean national emergency medical service OHCA database for cases between 2015 and 2017. Adult OHCA patients with a presumed cardiac origin who initially presented at a non-heart-attack centre were included in the analysis. The main exposure variable was health insurance type (national health insurance versus medical aid), which was used as a proxy measure of individual socioeconomic status. The primary outcome was emergency department disposition (transfer to a heart attack centre versus no transfer). A multivariate logistic analysis using propensity score matching was conducted. We also analysed the associations between patient transfer and neurologic recovery as well as survival to discharge. RESULTS Of 7804 eligible OHCA patients, 1804 23.0%) were transferred to a heart attack centre. Patients on medical aid were less likely to be transferred (adjusted odds ratio [OR], 0.75; 95% confidence interval [CI], 0.59-0.95 in a matched cohort) compared with patients with national health insurance. Transfer to a heart attack centre was significantly associated with a lower risk of death (adjusted OR, 0.38; 95% CI, 0.33-0.45) and better neurologic recovery (adjusted OR, 0.46; 95% CI, 0.38-0.56). CONCLUSION Socioeconomic status appears likely to influence the probability of transfer to a heart attack centre after resuscitation.
Collapse
Affiliation(s)
- Chi Ho Park
- Department of Emergency Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea.
| | - Ki Ok Ahn
- Department of Emergency Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea.
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Jeong Ho Park
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Sun Young Lee
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; National EMS Control Center, National Fire Agency, Sejong, Republic of Korea.
| |
Collapse
|