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Ramamoorthy V, Chan K, Roy M, Saxena A, Ahmed MA, Zhang Z, Appunni S, Thomas R, McGranaghan P, McDermott M, La Rosa FDLR, Rubens M. Healthcare expenditure trends among adult stroke patients in the United States, 2011-2020. J Stroke Cerebrovasc Dis 2023; 32:107333. [PMID: 37659191 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107333] [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: 02/28/2023] [Revised: 08/12/2023] [Accepted: 08/28/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND In the US, between 2018 and 2019, approximately $57 billion were expended on stroke and related conditions. The aim of this study was to understand trends in direct healthcare expenditures among stroke patients using novel cost estimation methods and a nationally representative database. METHODS This study was a retrospective analysis of 193,003 adults, ≥18 years of age, using the Medical Expenditure Panel Survey during 2009-2016. Manning and Mullahy's two-part model were used to calculate adjusted mean and incremental medical expenditures after adjusting for covariates. RESULTS The mean (Standard Deviation) direct annual healthcare expenditure among stroke patients was $16,979.0 ($16,222.0- $17,736.0) and was nearly 3 times greater than non-stroke participants which were $5,039.7 ($4,951.0-$5,128.5) and were mainly spent on inpatient services, prescription medications, and office-based visits. Stroke patients had an additional healthcare expenditure of $4096.0 (3543.9, 4648.1) per person per year, compared to participants without stroke after adjusting for covariates (P<0.001). The total mean annual direct healthcare expenditure for stroke survivors increased from $16,142.0 (15,017.0-17,267.0) in 2007-2008 to $16,979.0 (16,222.0-17,736.0) in 2015-2016. CONCLUSION Our study showed that stroke survivors had significantly greater healthcare expenses, compared to non-stroke individuals, mainly due to higher expenditures on inpatient services, prescription drugs, and office visits. These findings are concerning because the prevalence of stroke is projected to increase due to aging population and increased survival rates.
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Affiliation(s)
| | - Kelvin Chan
- Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - Mukesh Roy
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Anshul Saxena
- Center for Advanced Analytics, Baptist Health South Florida, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Md Ashfaq Ahmed
- Center for Advanced Analytics, Baptist Health South Florida, Miami, FL 33176, USA
| | - Zhenwei Zhang
- Center for Advanced Analytics, Baptist Health South Florida, Miami, FL 33176, USA
| | | | | | - Peter McGranaghan
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany
| | - Michael McDermott
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; Baptist Health South Florida, Miami Neuroscience Institute, Miami, Florida 33176, USA
| | - Felipe De Los Rios La Rosa
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; Baptist Health South Florida, Miami Neuroscience Institute, Miami, Florida 33176, USA
| | - Muni Rubens
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; Universidad Espíritu Santo, Ecuador.
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Kim J, Park EC. Associations of stroke with all-cause and cause-specific mortality: A population-based matched cohort study. J Public Health (Oxf) 2023; 45:66-74. [PMID: 35220438 DOI: 10.1093/pubmed/fdac011] [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: 02/13/2020] [Revised: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aimed to assess the specific associations between stroke and all-cause and cause-specific mortality among Korean adults. METHODS We used data extracted from the Korean National Health Insurance claims database from 2002 to 2013, including information on individuals with or without stroke aged 20 years and older. Patients with intracerebral hemorrhage, ischemic stroke or unspecified stroke were classified as stroke patients, while a reference population matched in terms of sex and age were also selected. The outcomes were all-cause mortality, natural causes of death (i.e. all natural causes, death by stroke and death by other diseases) and suicide. Survival analysis was performed using the Cox proportional hazards model. RESULTS Of the 73 150 eligible participants-including 14 630 stroke patients and 58 520 age- and sex-matched controls-11 121 (15.2%) died during the study period. Of them, 10 513 participants (94.5%) died of natural causes, including 1653 (14.5%) who died due to stroke and 8860 (79.7%) who died due to other diseases. Two hundred and fifty patients (2.2%) died by suicide. Stroke patients showed higher adjusted hazard ratios (HR) for all-cause (HR = 6.48, 95% CI, 3.87-10.86), all-natural-cause (HR = 2.68, 95% CI, 2.53-2.84), stroke (HR = 21.16, 95% CI, 17.49-25.61), other disease (HR = 1.69, 95% CI, 1.58-1.81) and suicide mortality (HR = 3.34, 95% CI, 2.24-4.98) than those without stroke. The effect size of stroke for suicide mortality was greater than that for other causes of mortality (except stroke mortality). CONCLUSIONS Stroke was associated with a higher risk of all-cause, natural cause and suicide mortality; stroke was more strongly associated with risk of suicide mortality than with any mortality for any other causes. From a policy standpoint, these results suggest the need for greater supportive care to prevent unnatural deaths among stroke patients.
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Affiliation(s)
- Juyeong Kim
- Department of Public Health, Sahmyook University, Seoul 01795, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul 03722, Republic of Korea.,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 10711, Republic of Korea
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Jeong Y, Jung YJ, Noh E, Ha S, Hwang J, Cho GJ, Oh MJ, Kim YH. The risk for future cerebrovascular disease in pregnant women with Moyamoya disease: a nationwide population-based study in South Korea. BMC Pregnancy Childbirth 2022; 22:433. [PMID: 35610618 PMCID: PMC9128146 DOI: 10.1186/s12884-022-04718-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 04/22/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Physiologic changes during pregnancy affect the development of postpartum cerebrovascular disease (CVD) in women with Moyamoya disease. Due to the rare prevalence of Moyamoya disease and its large regional variations, large-scale based studies on the risk of CVD after delivery have not been conducted. This study aimed to evaluate whether women with Moyamoya disease have an increased risk of CVD after delivery. METHODS Research data was collected from the National Health Insurance Claims Database of the Health Insurance Review and Assessment Service. Patients who delivered in Korea from 2007 to 2014 were enrolled in this study. We classified women as having CVD if they were diagnosed with any of the following conditions between delivery and December 31, 2016; cerebral infarction (I63.X in the International Classification of Diseases-10th Revision [ICD-10]) and/or intracranial hemorrhage (I61.X, I62.X in ICD-10) and/or subarachnoid hemorrhage (I60.X in ICD-10). Women with Moyamoya disease were identified as having I67.5 in ICD-10. We matched the study cohort by the ratio of 1:10 to analyze the risk CVD occurrence. The matching technique applied in this study was based on the variables of age and parity. To evaluate the adjusted hazard ratio (HR) for CVD in women with Moyamoya disease, we used multivariate Cox proportional hazard regression. RESULTS Among a total of 3,611,216 Korean women who underwent delivered, we identified 412 women with Moyamoya disease diagnosis and 1420 age- and parity-matched women without Moyamoya disease (control). Compared to the control group, women with Moyamoya disease had a significantly higher rate of Cesarean section, overt DM, and essential hypertension (all p < 0.0001). Among women with Moyamoya disease, 55 (13.35%) women developed CVD within the follow-up postpartum period. The presence of Moyamoya disease was associated with an increased risk of CVD after delivery (adjusted HR 37.42; 95% confidence interval (CI) 17.50-80.02 within 2.3 years) after adjusting for pregnancy-induced hypertension, gestational diabetes mellitus, pregestational diabetes, chronic hypertension. CONCLUSION This population based study showed that the occurrence rate of CVD after delivery was higher in women with Moyamoya disease than in those without. Therefore, careful and long-term postpartum surveillance is required for women with Moyamoya disease.
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Affiliation(s)
- Yeonseong Jeong
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Yun Ji Jung
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Eunjin Noh
- Korea University Guro Hospital Smart Healthcare Center, Seoul, Republic of Korea
| | - Sungyeon Ha
- Graduate School of Statistics, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jeongeun Hwang
- Department of Biomedical Research Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young-Han Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea.
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Kim JY, Cho SM, Yoo Y, Lee T, Kim JK. Association between Stroke and Abdominal Obesity in the Middle-Aged and Elderly Korean Population: KNHANES Data from 2011-2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106140. [PMID: 35627679 PMCID: PMC9141436 DOI: 10.3390/ijerph19106140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 01/27/2023]
Abstract
Obesity and overweight status are primary risk factors for stroke. A relative small number of studies has analyzed the association of abdominal obesity, a crucial indicator for insulin resistance with stroke, compared to general obesity. We aimed to reveal 31,490 records from the Korea National Health and Nutrition Examination Survey (KNHANES). Logistic regression was used to identify the association of abdominal obesity with the risk of stroke. For the multivariate model, covariates were determined based on the cardio-cerebro vascular prediction models. In the sex-specific multivariate logistic regression analysis (including age, antihypertensive drug, diabetes, current smoking, and systolic blood pressure as confounders), the elevated waist circumference (WC) in women was significantly associated with the increased risk for stroke. In case of the categorized form of WC, we discerned the non-linear relationships between WC and the stroke status. The sex-specific associations between the abdominal obesity and stroke status were shown and their relationship pattern exhibited non-linear relationships.
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Affiliation(s)
- Jong Yeon Kim
- Department of Neurosurgery, Yonsei University Wonju College of Medicine, Wonju 26426, Korea; (J.Y.K.); (S.M.C.)
| | - Sung Min Cho
- Department of Neurosurgery, Yonsei University Wonju College of Medicine, Wonju 26426, Korea; (J.Y.K.); (S.M.C.)
| | - Youngmin Yoo
- Department of Medicine, Graduate School, Yonsei University Wonju College of Medicine, Wonju 26426, Korea;
| | - Taesic Lee
- Department of Family Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea;
- The Study of Obesity and Metabolic Syndrome, Korean Academy of Family Medicine, Daejeon 35365, Korea
| | - Jong Koo Kim
- Department of Family Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea;
- Institute of Global Health Care and Development, Wonju 26426, Korea
- Correspondence:
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Zhang S, Wang A, Zhu W, Qiu Z, Zhang Z. Meta-analysis of risk factors associated with suicidal ideation after stroke. Ann Gen Psychiatry 2022; 21:1. [PMID: 34986853 PMCID: PMC8734070 DOI: 10.1186/s12991-021-00378-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 12/23/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Over the past decade, increasing attention has been paid on post stroke suicide (PSS), which is one of complications of stroke. The rates of stroke and suicide are relatively high, especially in Asian populations. Thus, a deeper understanding of the prevalence and epidemiological impact of suicide after stroke is urgently needed. Clinical diagnosis and prevention of PSS are at the incipient stage, but the risk factors responsible for the occurrence of PSS in different regions and stages of the disease remain largely unknown. The present meta-analysis aimed to determine the incidence of PSS at different stages and time courses, and to identify the underlying risk factors for PSS. METHODS We systematically searched the Cochrane library, Embase, PubMed, CNKI and Web of Science databases from their inception until April 2019.The research articles reporting on the risk factor for PSS were screened and included in the meta-analysis. The data from the included studies were extracted according to the predefined criteria. RESULTS A total of 12 studies (n = 2,693,036) were included for meta-analyses. Of these studies, 7 reporting suicide prevalence were meta-analyzed. The pooled estimate of suicidal ideation rates after stroke was 12%, which could be influenced by multiple risk factors, including sex, smoking, depression, sleep disorders, previous stroke and low household income. Studies conducted in Asia demonstrated higher suicide prevalence (approximately 15%) compared to other regions. Smoking, low family income, depression, heart disease and sleep disorders were important risk factors for PSS. When compared to PSS of more than 1 year, the incidence of suicide within 1 year after stroke was more likely to be statistically significant. It was found that 4 out of every 1000 stroke survivors tended to commit suicide. The results of this meta-analysis showed that depression (OR = 2.32; p < 0.01) was significantly associated with suicidal ideation, regardless of stroke duration. CONCLUSION PSS is one of the common complications of stroke. Despite some limitations, we successfully identified the risk factors associated with suicidal ideation after stroke. Notably, depression was significantly associated with suicidal ideation, regardless of stroke duration. Targeting this risk factor may be helpful to improve stroke patient care and prevent suicidal ideation after stroke. Future research will be carried out to assess whether suicidal ideation or thoughts and actual suicide attempts are strongly predictive of suicide deaths after stroke (Registration No. CRD42019128813).
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Affiliation(s)
- Shuangmei Zhang
- Department of Rehabilitation, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, China
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, China
| | - Anrong Wang
- Science and Technology Innovation Center Affiliated To Guangzhou, University of Traditional Chinese Medicine, Guangzhou, 510145, China
| | - Weifeng Zhu
- Department of Neurology, Affiliated Chinese Medicine Hospital of Guangzhou Medical University, Guangzhou, 510145, China
| | - Zhaoyang Qiu
- Department of Neurology, First College of Clinical Medicine Affiliated to Shandong University of Traditional Chinese Medicine, Jinan, 250014, China
| | - Zhaoxu Zhang
- Department of Neurology, Peking University People's Hospital, Beijing, 100044, China.
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Oh SH, Ku H, Park KS. Prevalence and socioeconomic burden of diabetes mellitus in South Korean adults: a population-based study using administrative data. BMC Public Health 2021; 21:548. [PMID: 33743612 PMCID: PMC7980668 DOI: 10.1186/s12889-021-10450-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/16/2021] [Indexed: 01/22/2023] Open
Abstract
Background Diabetes leads to severe complications and imposes health and financial burdens on the society. However, currently existing domestic public health studies of diabetes in South Korea mainly focus on prevalence, and data on the nationwide burden of diabetes in South Korea are lacking. The study aimed to estimate the prevalence and economic burden of diabetes imposed on the South Korean society. Methods A prevalence-based cost-of-illness study was conducted using the Korean national claims database. Adult diabetic patients were defined as those aged ≥20 years with claim records containing diagnostic codes for diabetes (E10-E14) during at least two outpatient visits or one hospitalization. Direct costs included medical costs for the diagnosis and treatment of diabetes and transportation costs. Indirect costs included productivity loss costs due to morbidity and premature death and caregivers’ costs. Subgroup analyses were conducted according to the type of diabetes, age (< 65 vs. ≥65), diabetes medication, experience of hospitalization, and presence of diabetic complications or related comorbidities. Results A total of 4,472,133 patients were diagnosed with diabetes in Korea in 2017. The average annual prevalence of diabetes was estimated at 10.7%. The diabetes-related economic burden was USD 18,293 million, with an average per capita cost of USD 4090 in 2019. Medical costs accounted for the biggest portion of the total cost (69.5%), followed by productivity loss costs (17.9%), caregivers’ costs (10.2%), and transportation costs (2.4%). According to subgroup analyses, type 2 diabetes, presence of diabetic complications or related comorbidities, diabetes medication, and hospitalization represented the biggest portion of the economic burden for diabetes. As the number of complications increased from one to three or more, the per capita cost increased from USD 3991 to USD 11,965. In inpatient settings, the per capita cost was ~ 10.8 times higher than that of outpatient settings. Conclusions South Korea has a slightly high prevalence and economic burden of diabetes. These findings highlight the need for effective strategies to manage diabetic patients and suggest that policy makers allocate more health care resources to diabetes. This is the first study on this topic, conducted using a nationally representative claims database in South Korea. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10450-3.
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Affiliation(s)
- Sung-Hee Oh
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daehak-ro 80, Buk-gu, Daegu, 41566, Republic of Korea
| | - Hyemin Ku
- NDnex, Saebitgongwon-ro 67, Gwangmyeong-si, Gyeonggi-do, 14348, Republic of Korea
| | - Kang Seo Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Deajeon Eulji Medical Center, Eulji University, Dusanseo-ro 95, Seo-gu, Daejeon, 35233, Republic of Korea.
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Comparative Study on the Outcome of Stroke Patients Transferred by Doctor Helicopters and Ground Ambulances in South Korea: A Retrospective Controlled Study. Emerg Med Int 2020; 2020:8493289. [PMID: 33224530 PMCID: PMC7670300 DOI: 10.1155/2020/8493289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/22/2020] [Accepted: 09/27/2020] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study was to analyze the effectiveness of helicopter emergency medical services (HEMS) for its economic operations in South Korea. This study targeted stroke patients who were transported via HEMS or ground emergency medical services (GEMS) from the scene of an accident to a regional emergency medical center. From this patient population, stroke patients who traveled at least 50 km from the scene of the cerebral infarction to the hospital with analyzable outcome data were extracted and included in this study. This study included 26 HEMS and 102 GEMS stroke patients from a pool of 183 potential patients. The survival-to-discharge rate of patients transported via HEMS (96.2%; 25/26) was significantly higher than that of patients transported via GEMS (83.2%; 104/128) (P=0.001). The HEMS transfer was quicker with respect to the decision-making process because the emergency physician actively evaluates and communicates on-site and during in-transit travel to request an appointment immediately upon arrival at the emergency room. These results indicate that using HEMS increased discharge and survival rates and reduced in-hospital mortality of HEMS of stroke patients with a reduced admission time. This result association leads to reasonable cost-effectiveness and efficient estimates overall. In conclusion, HEMS indicate reduced time taken for stroke patients to be hospitalized and treated and decreased mortality after 24 hours. According to this result, HEMS transport can be more effective than GEMS in long-distance delivery of stroke patients.
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Lifetime risks and health impacts of hemorrhagic and ischemic stroke in South Korea. Sci Rep 2020; 10:14544. [PMID: 32884001 PMCID: PMC7471302 DOI: 10.1038/s41598-020-71439-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 08/13/2020] [Indexed: 12/12/2022] Open
Abstract
This study is aimed toward estimating the lifetime risks, life expectancy, expected years of life lost (EYLL), and lifetime costs related to different subtypes of stroke in South Korea. We included 13,994 patients diagnosed with stroke (ICD-10, I60-I63) in the National Health Insurance Service-National Sample Cohort of Korea between 2006 and 2015. Lifetime risks were calculated using the cumulative incidence rate for patients aged 18–84. Lifetime survival data were obtained through the Kaplan–Meier method and extrapolated with a rolling-over extrapolation algorithm. The lifetime costs were estimated by multiplying the average monthly expenditures with the survival probabilities and adding the values over lifetime. The lifetime risks of stroke in Korea have been decreasing consistently over the last decade with the exception of subarachnoid hemorrhage in females, which appears to have slightly increased. The EYLL is higher in hemorrhagic stroke than in ischemic stroke (6–9.7 vs. 4.7). Expected lifetime costs reimbursed by the NHIS would amount to about $71,406 accompanied with $14,921 copayment from the patients for hemorrhagic stroke, and $50,551 and $11,666, respectively, for ischemic stroke. Further studies are warranted to combine survival with quality of life and functional disability to obtain a more detailed outcome assessment of the potential impact of the prevention of stroke.
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Yoo JS, Choe EY, Kim YM, Kim SH, Won YJ. Predictive costs in medical care for Koreans with metabolic syndrome from 2009 to 2013 based on the National Health Insurance claims dataset. Korean J Intern Med 2020; 35:936-945. [PMID: 31422650 PMCID: PMC7373977 DOI: 10.3904/kjim.2016.343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 08/16/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND/AIMS Although metabolic syndrome has been associated with increasing medical costs worldwide, there have been no studies using a nationwide and longitudinal South Korean dataset. We investigated trends in subsidized medical costs among Korean adults with metabolic syndrome. METHODS This study was based on the National Sample Cohort database of South Korea. We used data of national health checkups in 2009 as well as data of subsidized prescription drugs and the Korean Classification of Disease diagnosis codes from claims in 2007 to 2008 to identify underlying diseases. We calculated the direct medical costs, which were subsidized by the Korean National Health Insurance, among 204,768 individuals older than 20 years from 2009 to 2013. RESULTS The proportion of subjects with metabolic syndrome was 27.2%. Direct medical costs for 5 years differed by a magnitude of 2.16 between subjects with and without metabolic syndrome. The costs increased by approximately 41.8% in the metabolic syndrome group in 5 years. Direct medical costs increased with every additional risk factor, even if a subject had less than three risk factors of metabolic syndrome. Metabolic syndrome per se and all of its components, except low serum high-density lipoprotein cholesterol level, resulted in a significant increase in medical costs. CONCLUSION The medical costs of subjects with metabolic syndrome were higher than that of those without metabolic syndrome and it increased with the number of risk factors. Further research using cumulative data of more than 10 years, including unsubsidized and indirect costs, is needed in the future.
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Affiliation(s)
- Jeong Seon Yoo
- Department of Internal Medicine, Seobuk Hospital, Seoul Metropolitan Government, Seoul, Korea
- Graduate School, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Yeong Choe
- Graduate School, Yonsei University College of Medicine, Seoul, Korea
| | - Yoo Mee Kim
- Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Se Hwa Kim
- Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Young Jun Won
- Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
- Correspondence to Young Jun Won, M.D. Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, 25 Simgok-ro 100beon-gil, Seogu, Incheon 22711, Korea Tel: +82-32-290-3963 Fax: +82-32-290-3879 E-mail:
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Ahn Y, Jee D. Socioeconomic Costs of Age-related Macular Degeneration in Korea. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.8.765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yongsun Ahn
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Suncheon Public Health Center, Suncheon, Korea
| | - Donghyun Jee
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kim YS, Lee DH, Chae HS, Han K. Changing Disease Trends in the Northern Gyeonggi-do Province of South Korea from 2002 to 2013: A Big Data Study Using National Health Information Database Cohort. Osong Public Health Res Perspect 2018; 9:248-254. [PMID: 30402380 PMCID: PMC6202018 DOI: 10.24171/j.phrp.2018.9.5.06] [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] [Indexed: 12/01/2022] Open
Abstract
Objectives To investigate the chronological patterns of diseases in Northern Gyeonggi-do province, South Korea, and compare these with national data. Methods A National Health Insurance cohort based on the National Health Information Database (NHID Cohort 2002–2013) was used to perform a retrospective, population-based study (46,605,433 of the target population, of which 1,025,340 were randomly sampled) to identify disease patterns from 2002 to 2013. Common diseases including malaria, cancer (uterine cervix, urinary bladder, colon), diabetes mellitus, psychiatric disorders, hypertension, intracranial hemorrhage, bronchitis/bronchiolitis, peptic ulcer, and end stage renal disease were evaluated. Results Uterine cervix cancer, urinary bladder cancer and colon cancer had the greatest rate of increase in Northern Gyeonggi-do province compared with the rest of the country, but by 2013 the incidence of these cancers had dropped dramatically. Acute myocardial infarction and end stage renal disease also increased over the study period. Psychiatric disorders, diabetes mellitus, hypertension and peptic ulcers showed a gradual increase over time. No obvious differences were found for intracranial hemorrhage or bronchitis/bronchiolitis between the Northern Gyeonggi-do province and the remaining South Korean provinces. Malaria showed a unique time trend, only observed in the Northern Gyeonggi province, peaking in 2004, 2007 and 2009 to 2010. Conclusion This study showed that the Northern Gyeonggi-do province population had a different disease profile over time, compared with collated data for the remaining provinces in South Korea. “Big data” studies using the National Health Insurance cohort database can provide insight into the healthcare environment for healthcare providers, stakeholders and policymakers.
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Affiliation(s)
- Young Soo Kim
- Epidemiology Study Cluster of Uijeongbu St. Mary's Hospital, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Dong-Hee Lee
- Epidemiology Study Cluster of Uijeongbu St. Mary's Hospital, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Hiun Suk Chae
- Epidemiology Study Cluster of Uijeongbu St. Mary's Hospital, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Kyungdo Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Cha YJ. The Economic Burden of Stroke Based on South Korea's National Health Insurance Claims Database. Int J Health Policy Manag 2018; 7:904-909. [PMID: 30316242 PMCID: PMC6186466 DOI: 10.15171/ijhpm.2018.42] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 04/21/2018] [Indexed: 12/04/2022] Open
Abstract
Background: This study was conducted to determine the scale and the nature of the economic burden caused by strokes and to use the results as an evidential source for determining the allocation of South Korea stroke cases in 2015.
Methods: For research subjects, the study analyzed demographic characteristics and economic burden based on data from national health insurance (NHI) claims for inpatient and outpatient cases of ischemic stroke and hemorrhagic stroke in 2015 through the Health Insurance Review and Assessment Service (HIRA) and statistical data regarding cause of death from the Korea National Statistical Office (KNSO). This study, in order to estimate economic burden due to stroke, deduced the direct and indirect costs of illness caused by stroke, using cost-of-illness (COI) methods. The economic burden is divided into direct and indirect costs, and indirect cost is estimated by summing lost productivity measured in opportunity cost lost by medical disposition due to a specific disease and lost productivity due to premature death.
Results: The total economic burden in Korea due to stroke was US$6.855 billion, that due to ischemic stroke was US$3.658 billion, and that due to hemorrhagic stroke was US$3.197 billion. The average economic burden per stroke case was about US$7247.
Conclusion: The results of estimating the annual economic burden in all of Korea due to stroke will be used as an evidential source for preparing medical insurance policies, priorities, and plans for arranging medical resources for stroke as well as for determining effective prevention of the disease and related priorities in national health care policies.
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Affiliation(s)
- Yu-Jin Cha
- Department of Occupational Therapy, Semyung University, Jecheon, Republic of Korea
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13
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Hong I, Kim YJ, Sonnenfeld ML, Grattan E, Reistetter TA. Disability Measurement for Korean Community-Dwelling Adults With Stroke: Item-Level Psychometric Analysis of the Korean Longitudinal Study of Ageing. Ann Rehabil Med 2018; 42:336-345. [PMID: 29765888 PMCID: PMC5940611 DOI: 10.5535/arm.2018.42.2.336] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 07/27/2017] [Indexed: 11/24/2022] Open
Abstract
Objective To investigate the psychometric properties of the activities of daily living (ADL) instrument used in the analysis of Korean Longitudinal Study of Ageing (KLoSA) dataset. Methods A retrospective study was carried out involving 2006 KLoSA records of community-dwelling adults diagnosed with stroke. The ADL instrument used for the analysis of KLoSA included 17 items, which were analyzed using Rasch modeling to develop a robust outcome measure. The unidimensionality of the ADL instrument was examined based on confirmatory factor analysis with a one-factor model. Item-level psychometric analysis of the ADL instrument included fit statistics, internal consistency, precision, and the item difficulty hierarchy. Results The study sample included a total of 201 community-dwelling adults (1.5% of the Korean population with an age over 45 years; mean age=70.0 years, SD=9.7) having a history of stroke. The ADL instrument demonstrated unidimensional construct. Two misfit items, money management (mean square [MnSq]=1.56, standardized Z-statistics [ZSTD]=2.3) and phone use (MnSq=1.78, ZSTD=2.3) were removed from the analysis. The remaining 15 items demonstrated good item fit, high internal consistency (person reliability=0.91), and good precision (person strata=3.48). The instrument precisely estimated person measures within a wide range of theta (−4.75 logits < θ < 3.97 logits) and a reliability of 0.9, with a conceptual hierarchy of item difficulty. Conclusion The findings indicate that the 15 ADL items met Rasch expectations of unidimensionality and demonstrated good psychometric properties. It is proposed that the validated ADL instrument can be used as a primary outcome measure for assessing longitudinal disability trajectories in the Korean adult population and can be employed for comparative analysis of international disability across national aging studies.
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Affiliation(s)
- Ickpyo Hong
- Department of Occupational Therapy, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Young Joo Kim
- Department of Occupational Therapy, College of Allied Health Science, East Carolina University, Greenville, NC, USA
| | - Mandi L Sonnenfeld
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Emily Grattan
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Timothy A Reistetter
- Department of Occupational Therapy, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
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Abstract
Objectives This study aims to estimate the annual economic cost per hemiplegic patient in Turkey. Patients and methods Between September 2014 and December 2014, a total of 84 hemiplegic patients (53 males, 31 females; mean age 61.4±13.5 years; range 28-89 years) with stroke for 12 months were included in the study. Type of cerebrovascular accident and complications were evaluated. Hospital records and data from the relatives of the patients were used to calculate the cost. Annual costs were evaluated starting from first hospitalization. Direct costs were calculated with the sum of hospital care (acute care, diagnostic investigations, treatment and rehabilitation), medications, medical visits, outpatient rehabilitation and orthopedic aids. Indirect costs were calculated by taking the income loss due to absence from work into consideration. Prices of medical resources were obtained from the 2014 Healthcare Implementation Notification payment list. Results At the end of the study, the average direct cost and indirect cost per patient were calculated respectively as 10,594.90±6,554.20 Turkish liras and 9,357.10±10,195.60 Turkish liras (4,606.47±2,849.65 USD and 4,068.30±4,432.86 USD). We found a negative correlation between total cost and age (p=0.001), and a positive correlation with duration of hospitalization (p=0.001) and number of complications (p=0.049). We were unable to find any relation of cost with sex and cerebrovascular accident type. Spasticity (p=0.028) and epilepsy (p=0.037) being among the complications were observed to increase the cost. Conclusion Stroke is an important economic burden for Turkish population. Preventive social measures are necessary to reduce this cost.
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Kim J, Kim YS, Kim K, Oh YM, Yoo KH, Rhee CK, Lee JH. Socioeconomic impact of asthma, chronic obstructive pulmonary disease and asthma-COPD overlap syndrome. J Thorac Dis 2017; 9:1547-1556. [PMID: 28740668 DOI: 10.21037/jtd.2017.05.07] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is defined as having both features of asthma and COPD, which are airway hyper-responsiveness and incompletely reversible airway obstruction. However, socioeconomic impact of ACOS have not been well appreciated. METHODS Adults with available wheezing history and acceptable spirometry were selected from the fourth Korean National Health and Nutrition Examination Survey (KNHANES IV) in 2007-2009. Their data were merged with the Korean National Health Insurance claim data. 'Asthma group' was defined as having self-reported wheezing history and FEV1/FVC ≥0.7, 'COPD group' was defined as having FEV1/FVC <0.7 and no wheezing, 'ACOS group' was defined as having both wheezing and FEV1/FVC <0.7, and 'no airway disease (NAD) group' was defined as having no wheezing and FEV1/FVC ≥0.7. RESULTS Among a total of 11,656 subjects, ACOS comprise 2.2%; COPD, 8.4%; asthma, 5.8% and NAD, 83.6%. Total length of healthcare utilization and medical costs of ACOS group was the top among four groups (P<0.001), though inpatient medical cost was the highest in COPD group (P=0.025). Multiple linear regression analyses showed that ACOS group (β=12.63, P<0.001) and asthma group (β=6.14, P<0.001) were significantly associated with longer duration of healthcare utilization and ACOS group (β=350,475.88, P=0.008) and asthma group (β=386,876.81, P<0.001) were associated with higher medical costs. CONCLUSIONS This study demonstrated that ACOS independently influences healthcare utilization after adjusting several factors. In order to utilize limited medical resources efficiently, it may be necessary to find and manage ACOS patients.
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Affiliation(s)
- Jinhee Kim
- Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea
| | - Young Sam Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyungjoo Kim
- Department of Clinical Research Support, National Strategic Coordinating Center for Clinical Research, Seoul, Korea
| | - Yeon-Mok Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kwang Ha Yoo
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Chin Kook Rhee
- Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - Jin Hwa Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
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Sohn S, Kim J, Chung CK, Lee NR, Sohn MJ, Kim SH. A Nation-Wide Epidemiological Study of Newly Diagnosed Primary Spine Tumor in the Adult Korean Population, 2009-2011. J Korean Neurosurg Soc 2017; 60:195-204. [PMID: 28264240 PMCID: PMC5365297 DOI: 10.3340/jkns.2016.0505.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 11/29/2016] [Accepted: 12/09/2016] [Indexed: 12/21/2022] Open
Abstract
Objective This 2009–2011 nation-wide study of adult Koreans was aimed to provide characteristics, medical utilization states, and survival rates for newly diagnosed patients with primary nonmalignant and malignant spine tumors. Methods Data for patients with primary spine tumors were selected from the Korean Health Insurance Review and Assessment Service database. The data included their age, sex, health insurance type, co-morbidities, medical cost, and hospital stay duration. Hospital stay duration and medical costs per person occurring in one calendar year were used. In addition, survival rates of patients with primary malignant spine tumors were evaluated. Results The incidence rate of a primary spine tumor increased with age, and the year of diagnosis (p≤0.0001). Average annual medical costs ranged from 1627 USD (pelvis & sacrum & coccyx tumors) to 6601 USD (spinal cord tumor) for primary nonmalignant spine tumor and from 12137 USD (spinal meningomas) to 20825 USD (pelvis & sacrum & coccyx tumors) for a primary malignant spine tumor. Overall survival rates for those with a primary malignant spine tumor were 87.0%, 75.3%, and 70.6% at 3, 12, and 24 months, respectively. The Cox regression model results showed that male sex, medicare insurance were significantly positive factors affecting survival after a diagnosis of primary malignant spine tumor. Conclusion Our study provides a detailed view of the characteristics, medical utilization states, and survival rates of patients newly diagnosed with primary spine tumors in Korea.
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Affiliation(s)
- Seil Sohn
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.,Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea.,Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.,Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jinhee Kim
- Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.,Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea.,Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea
| | - Na Rae Lee
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Moon Jun Sohn
- Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea
| | - Sung Hwan Kim
- Department of Radiation Oncology, St. Vincent's Hospital, School of Medicine, The Catholic University of Korea, Suwon, Korea
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Chung JH, Kim JB, Kim JH. Suicidal ideation and attempts in patients with stroke: a population-based study. J Neurol 2016; 263:2032-8. [DOI: 10.1007/s00415-016-8231-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/02/2016] [Accepted: 07/04/2016] [Indexed: 12/22/2022]
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Park TH, Choi JC. Validation of Stroke and Thrombolytic Therapy in Korean National Health Insurance Claim Data. J Clin Neurol 2015; 12:42-8. [PMID: 26365022 PMCID: PMC4712285 DOI: 10.3988/jcn.2016.12.1.42] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/08/2015] [Accepted: 06/10/2015] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose The claims data of the Korean National Health Insurance (NHI) system can be useful in stroke research. The aim of this study was to validate the accuracy of hospital discharge data used for NHI claims in identifying acute stroke and use of thrombolytic therapy. Methods The hospital discharge data of 1,811 patients with stroke-related diagnosis codes were obtained from Jeju National University Hospital (JNUH) and Seoul Medical Center (SMC). Three algorithms were tested to identify discharges with acute stroke [ischemic stroke (IS), intracranial hemorrhage (ICH), or subarachnoid hemorrhage (SAH)]: 1) all diagnosis codes up to nine positions, 2) one primary diagnosis and one secondary diagnosis, and 3) only one primary diagnosis code. Reviews of medical records were considered the gold standards. Results Overall, the degree of agreement (κ) was higher for algorithms 1 and 2 than for algorithm 3, and the sensitivity and specificity of the first two algorithms for IS and SAH were both >90%, with almost perfect agreement (κ=0.83-0.84) in the JNUH data set. Regarding ICH, only algorithm 1 yielded an almost perfect agreement (κ=0.82). In the SMC data set, almost perfect agreement was found for both ICH and SAH in all three algorithms. In contrast, the three algorithms yielded a range of agreement levels, though all substantial, for IS. Almost perfect agreement was obtained for use of thrombolytic therapy in both data sets (κ=0.91-0.99). Conclusions Discharge with hemorrhagic stroke and use of thrombolytic therapy were identified with high reliability in administrative discharge data. A substantial level of agreement was also obtained for IS, despite variation between the algorithms and data sets.
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Affiliation(s)
- Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Jay Chol Choi
- Department of Neurology, School of Medicine, Jeju National University, Jeju, Korea.
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Ng CS, Toh MPHS, Ng J, Ko Y. Direct medical cost of stroke in Singapore. Int J Stroke 2015; 10 Suppl A100:75-82. [PMID: 26179153 DOI: 10.1111/ijs.12576] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 06/01/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Globally, stroke is recognized as one of the main causes of long-term disability, accounting for approximately 5·7 million deaths each year. It is a debilitating and costly chronic condition that consumes about 2-4% of total healthcare expenditure. AIMS To estimate the direct medical cost associated with stroke in Singapore in 2012 and to determine associated predictors. METHODS The National Healthcare Group Chronic Disease Management System database was used to identify patients with stroke between the years 2006 and 2012. Estimated stroke-related costs included hospitalizations, accident and emergency room visits, outpatient physician visits, laboratory tests, and medications. RESULTS A total of 700 patients were randomly selected for the analyses. The mean annual direct medical cost was found to be S$12 473·7, of which 93·6% were accounted for by inpatient services, 4·9% by outpatient services, and 1·5% by A&E services. Independent determinants of greater total costs were stroke types, such as ischemic stroke (P = 0·005), subarachnoid hemorrhage (P < 0·001) and intracerebral haemorrhage (P < 0·001), shorter poststroke period, more than one complications (P = 0·045), and a greater number of comorbidities (P = 0·001). CONCLUSION There is a considerable economic burden associated with stroke in Singapore. The type of stroke, length of poststroke period, and stroke complications and comorbidities are found to be associated with the total costs. Efforts to reduce inpatient costs and to allocate health resources to focus on the primary prevention of stroke should become a priority.
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Affiliation(s)
- Charmaine Shuyu Ng
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Matthias Paul Han Sim Toh
- Information Management, Central Regional Health Office, National Healthcare Group, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Jiaying Ng
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Yu Ko
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
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Chen CH, Chen MC, Gibbs H, Kwon SU, Lo S, On YK, Rosman A, Suwanwela NC, Tan RS, Tirador LS, Zirlik A. Antithrombotic treatment for stroke prevention in atrial fibrillation: The Asian agenda. Int J Cardiol 2015; 191:244-53. [DOI: 10.1016/j.ijcard.2015.03.369] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
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Shon C, Choi HY, Shim JJ, Park SY, Lee KS, Yoon SJ, Oh IH. The Economic Burden of Hepatitis A, B, and C in South Korea. Jpn J Infect Dis 2015; 69:18-27. [PMID: 25971325 DOI: 10.7883/yoken.jjid.2014.499] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The prevalence of hepatitis in South Korea is relatively high compared to that in other high-income countries. For this reason, viral hepatitis infection not only affects the population's health, but also impacts national healthcare costs. This study was performed in order to estimate the individual economic costs of the hepatitis A, B, and C viruses as well as to determine, using nationally representative data, the trends in South Korea with respect to these viruses during the 2008-2011 period. The study found that the prevalence of hepatitis A had decreased, but those of hepatitis B and C had increased overall. The mortality rate of hepatitis C was higher than that of the other two types. The mortality rate of hepatitis B had changed little, whereas that of hepatitis C had risen. The total cost of hepatitis A had decreased, from US $62.2 million to US $45.7 million, although a notable exception occurred in 2009, when the cost was US $126.6 million. Conversely, the total cost of hepatitis B had increased rapidly during the same period, from US $501.4 million to US $607.8 million. Finally, the total cost of hepatitis C had also increased from US $63.9 million to US $90.7 million. The direct costs of hepatitis A, B, and C were estimated to account for approximately 35.5%, 46.6%, and 58.0% of the total, respectively. These findings demonstrate the economic burden associated with hepatitis A, B, and C, and demonstrate the need to establish an effective prevention and management policy for future planning in South Korea.
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Sohn S, Kim J, Chung CK, Lee NR, Park E, Chang UK, Sohn MJ, Kim SH. Nationwide epidemiology and healthcare utilization of spine tumor patients in the adult Korean population, 2009-2012. Neurooncol Pract 2015; 2:93-100. [PMID: 31386022 DOI: 10.1093/nop/npv006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Indexed: 11/13/2022] Open
Abstract
Background The aim of this nationwide study was to describe the incidence and health care utilization of adult Korean patients with primary malignant, primary nonmalignant, and metastatic spine tumors between 2009 and 2012. Methods Patients with primary and metastatic spine tumors were identified from the Korean Health Insurance Review and Assessment Service database between January 1, 2009, and December 31, 2012. Demographics, incidence rate, annual medical cost, and annual hospital stay of each new patient were reviewed. Results Of 1600 primary spine tumors diagnosed from 2009 to 2012, 373 (23.3%) were malignant, and 1227 (76.7%) were nonmalignant. The most common tumor type was neoplasm of spinal cord among primary malignant (C72.0, 51.5%) and primary nonmalignant (D33.4, 66.2%) spine tumors. Differences in primary malignant, primary nonmalignant, and metastatic spine tumor incidence by sex were significant (P = .004, <.001, and <.001, respectively). The annual incidence rate of primary nonmalignant and metastatic spine tumors increased significantly over the study period (P = .005 and <.001, respectively). Lung, liver/biliary, and breast were the most prevalent original tumor sites for metastatic spine tumors. In 2011, average annual medical costs associated with treatment of primary malignant, primary nonmalignant, and metastatic tumors were US $15 223, $6502, and $16 038, respectively. Average annual hospital stay durations for primary malignant, primary nonmalignant, and metastatic spine tumors in 2011 were 103.4, 61.7, and 79.6 days, respectively. Conclusions This is the first nationwide analysis of spine tumors, including metastatic spine tumors, in Asia.
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Affiliation(s)
- Seil Sohn
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea (S.S., C.K.C.); Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea (S.S., C.K.C.); Clinical Research Institute, Seoul National University Hospital, Seoul, Korea (S.S., C.K.C.); Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea (C.K.C.); Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea (J.K.); National Evidence-based Healthcare Collaborating Agency, Seoul, Korea (N.-R.L., E.P.); Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science, Seoul, Korea (U.-K.C.); Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Gimhae, Korea (M.J.S.); Department of Radiation Oncology, St. Vincent's Hospital, School of Medicine, The Catholic University of Korea, Suwon, Korea (S.H.K.)
| | - Jinhee Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea (S.S., C.K.C.); Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea (S.S., C.K.C.); Clinical Research Institute, Seoul National University Hospital, Seoul, Korea (S.S., C.K.C.); Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea (C.K.C.); Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea (J.K.); National Evidence-based Healthcare Collaborating Agency, Seoul, Korea (N.-R.L., E.P.); Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science, Seoul, Korea (U.-K.C.); Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Gimhae, Korea (M.J.S.); Department of Radiation Oncology, St. Vincent's Hospital, School of Medicine, The Catholic University of Korea, Suwon, Korea (S.H.K.)
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea (S.S., C.K.C.); Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea (S.S., C.K.C.); Clinical Research Institute, Seoul National University Hospital, Seoul, Korea (S.S., C.K.C.); Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea (C.K.C.); Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea (J.K.); National Evidence-based Healthcare Collaborating Agency, Seoul, Korea (N.-R.L., E.P.); Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science, Seoul, Korea (U.-K.C.); Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Gimhae, Korea (M.J.S.); Department of Radiation Oncology, St. Vincent's Hospital, School of Medicine, The Catholic University of Korea, Suwon, Korea (S.H.K.)
| | - Na-Rye Lee
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea (S.S., C.K.C.); Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea (S.S., C.K.C.); Clinical Research Institute, Seoul National University Hospital, Seoul, Korea (S.S., C.K.C.); Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea (C.K.C.); Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea (J.K.); National Evidence-based Healthcare Collaborating Agency, Seoul, Korea (N.-R.L., E.P.); Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science, Seoul, Korea (U.-K.C.); Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Gimhae, Korea (M.J.S.); Department of Radiation Oncology, St. Vincent's Hospital, School of Medicine, The Catholic University of Korea, Suwon, Korea (S.H.K.)
| | - Eunjung Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea (S.S., C.K.C.); Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea (S.S., C.K.C.); Clinical Research Institute, Seoul National University Hospital, Seoul, Korea (S.S., C.K.C.); Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea (C.K.C.); Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea (J.K.); National Evidence-based Healthcare Collaborating Agency, Seoul, Korea (N.-R.L., E.P.); Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science, Seoul, Korea (U.-K.C.); Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Gimhae, Korea (M.J.S.); Department of Radiation Oncology, St. Vincent's Hospital, School of Medicine, The Catholic University of Korea, Suwon, Korea (S.H.K.)
| | - Ung-Kyu Chang
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea (S.S., C.K.C.); Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea (S.S., C.K.C.); Clinical Research Institute, Seoul National University Hospital, Seoul, Korea (S.S., C.K.C.); Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea (C.K.C.); Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea (J.K.); National Evidence-based Healthcare Collaborating Agency, Seoul, Korea (N.-R.L., E.P.); Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science, Seoul, Korea (U.-K.C.); Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Gimhae, Korea (M.J.S.); Department of Radiation Oncology, St. Vincent's Hospital, School of Medicine, The Catholic University of Korea, Suwon, Korea (S.H.K.)
| | - Moon Jun Sohn
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea (S.S., C.K.C.); Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea (S.S., C.K.C.); Clinical Research Institute, Seoul National University Hospital, Seoul, Korea (S.S., C.K.C.); Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea (C.K.C.); Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea (J.K.); National Evidence-based Healthcare Collaborating Agency, Seoul, Korea (N.-R.L., E.P.); Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science, Seoul, Korea (U.-K.C.); Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Gimhae, Korea (M.J.S.); Department of Radiation Oncology, St. Vincent's Hospital, School of Medicine, The Catholic University of Korea, Suwon, Korea (S.H.K.)
| | - Sung Hwan Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea (S.S., C.K.C.); Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea (S.S., C.K.C.); Clinical Research Institute, Seoul National University Hospital, Seoul, Korea (S.S., C.K.C.); Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea (C.K.C.); Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea (J.K.); National Evidence-based Healthcare Collaborating Agency, Seoul, Korea (N.-R.L., E.P.); Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science, Seoul, Korea (U.-K.C.); Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Gimhae, Korea (M.J.S.); Department of Radiation Oncology, St. Vincent's Hospital, School of Medicine, The Catholic University of Korea, Suwon, Korea (S.H.K.)
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The epidemiology and economic burden of Clostridium difficile infection in Korea. BIOMED RESEARCH INTERNATIONAL 2015; 2015:510386. [PMID: 25821807 PMCID: PMC4363506 DOI: 10.1155/2015/510386] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 01/26/2015] [Indexed: 01/05/2023]
Abstract
The prevalence of Clostridium difficile infection and the associated burden have recently increased in many countries. While the main risk factors for C. difficile infection include old age and antibiotic use, the prevalence of this infection is increasing in low-risk groups. These trends highlight the need for research on C. difficile infection. This study pointed out the prevalence and economic burden of C. difficile infection and uses the representative national data which is primarily from the database of the Korean Health Insurance Review and Assessment Service, for 2008–2011. The annual economic cost was measured using a prevalence approach, which sums the costs incurred to treat C. difficile infection. C. difficile infection prevalence was estimated to have increased from 1.43 per 100,000 in 2008 to 5.06 per 100,000 in 2011. Moreover, mortality increased from 69 cases in 2008 to 172 in 2011. The economic cost increased concurrently, from $2.4 million in 2008 to $7.6 million, $10.5 million, and $15.8 million in 2009, 2010, and 2011, respectively. The increasing economic burden of C. difficile infection over the course of the study period emphasizes the need for intervention to minimize the burden of a preventable illness like C. difficile infection.
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Koo BK, Lee CH, Yang BR, Hwang SS, Choi NK. The incidence and prevalence of diabetes mellitus and related atherosclerotic complications in Korea: a National Health Insurance Database Study. PLoS One 2014; 9:e110650. [PMID: 25329714 PMCID: PMC4199756 DOI: 10.1371/journal.pone.0110650] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 09/20/2014] [Indexed: 11/19/2022] Open
Abstract
AIMS/INTRODUCTION The incidence and prevalence of type 2 diabetes mellitus (T2DM) and related macrovascular complications in Korea were estimated using the Health Insurance Review and Assessment (HIRA) database from 2007-2011, which covers the claim data of 97.0% of the Korean population. MATERIALS AND METHODS T2DM, coronary artery disease (CAD), cerebrovascular disease (CVD), and peripheral artery disease (PAD) were defined according to ICD-10 codes. We used the Healthcare Common Procedure Coding System codes provided by HIRA to identify associated procedures or surgeries. When calculating incidence, we excluded cases with preexisting T2DM within two years before the index year. A Poisson distribution was assumed when calculating 95% confidence intervals for prevalence and incidence rates. RESULTS The prevalence of T2DM in Korean adults aged 20-89 years was 6.1-6.9% and the annual incidence rates of T2DM ranged from 9.5-9.8/1,000 person-year (PY) during the study period. The incidence rates of T2DM in men and women aged 20-49 years showed decreasing patterns from 2009 to 2011 (P<0.001); by contrast, the incidence in subjects aged 70-79 years showed increased patterns from 2009 to 2011 (P<0.001). The incidence rates of CAD and CVD in patients newly diagnosed with T2DM were 18.84/1,000 PY and 11.32/1,000 PY, respectively, in the year of diagnosis. Among newly diagnosed individuals with T2DM who were undergoing treatment for PAD, 14.6% underwent angioplasty for CAD during the same period. CONCLUSIONS Our study measured the national incidences of T2DM, CAD, CVD, and PAD, which are of great concern for public health. We also confirmed the relatively higher risk of CAD and CVD newly detected T2DM patients compared to the general population in Korea.
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Affiliation(s)
- Bo Kyung Koo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - Chang-Hoon Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bo Ram Yang
- Division of Clinical Epidemiology, Medical Research Collaborating Center, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung-sik Hwang
- Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Nam-Kyong Choi
- Division of Clinical Epidemiology, Medical Research Collaborating Center, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
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Kim K, Jeong BG, Ki M, Park M, Park JK, Choi BY, Yoo WS. The costs of hepatitis A infections in South Korea. Epidemiol Health 2014; 36:e2014011. [PMID: 25139060 PMCID: PMC4154348 DOI: 10.4178/epih/e2014011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 07/08/2014] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES: The incidence of hepatitis A infections among young adults has recently increased in South Korea. Although universal vaccination has often been suggested to mitigate the problem, its rationale has not been well-understood. Estimating the societal costs of hepatitis A infections might support the development of intervention strategies. METHODS: We classified hepatitis A infections into eight clinical pathways and estimated the number of occurrences and cost per case for each clinical pathway using claim data from National Health Insurance and several national surveys as well as assumptions based on previous studies. To determine the total costs of a hepatitis A infection, both direct and indirect costs were estimated. Indirect costs were estimated using the human-capital approach. All costs are adjusted to the year 2008. RESULTS: There were 30,240 identified cases of hepatitis A infections in 2008 for a total cost of 80,873 million won (2.7 million won per case). Direct and indirect costs constituted 56.2% and 43.8% of the total costs, respectively. People aged 20-39 accounted for 71.3% of total cases and 74.6% of total costs. Medical costs per capita were the lowest in the 0-4 age group and highest in the 20-29 age group. CONCLUSIONS: This study could provide evidence for development of cost-effective interventions to control hepatitis A infections. But the true costs including uncaptured and intangible costs of hepatitis A infections might be higher than our results indicate.
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Affiliation(s)
- Kyohyun Kim
- Research Institute, Health Insurance Review & Assessment Service, Seoul, Korea
| | - Baek-Geun Jeong
- Department of Preventive Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Moran Ki
- Department of Cancer Control and Policy, Graduated School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Mira Park
- Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, Korea
| | | | - Bo Youl Choi
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Weon-Seob Yoo
- Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea
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Jung HK, Kim YH, Park JY, Jang BH, Park SY, Nam MH, Choi MG. Estimating the burden of irritable bowel syndrome: analysis of a nationwide korean database. J Neurogastroenterol Motil 2014; 20:242-52. [PMID: 24840377 PMCID: PMC4015204 DOI: 10.5056/jnm.2014.20.2.242] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 01/23/2014] [Accepted: 01/23/2014] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Management of irritable bowel syndrome (IBS) imposes a heavy economic burden. This study was to estimate the epidemiologic features of IBS and to report the IBS burden for the first time in the Korean population. Methods A cross-sectional study was conducted using the National Health Insurance (NHI) system database, which covers the entire population of Korea. IBS was defined as diagnostic code −10 in adults with any outpatient clinic visits or hospitalization related to IBS. We excluded diseases that mimic IBS symptoms. Results A total of 2.42 million (58.2% female) individuals were identified as patients with IBS, yielding an age- and gender-adjusted prevalence of 5.1% in males and 6.9% in females. The prevalence of IBS increased proportionally with age, with higher medical costs in middle-aged patients. Outpatient clinics were visited by 98.6% of IBS patients, and 1.9% were treated upon admission. Of these patients, 87.6% were given a prescription. Co-morbidities that commonly accompanied IBS included upper gastrointestinal (36.1%), respiratory (12.3%), musculoskeletal (8.0%) disease, somatoform (4.3%) and depression/anxiety disorders (3.1%). The NHI costs of IBS, which include the NHI covered cost and beneficiary copayment charges, were estimated to be 155 million USD, which accounts for 0.46% of the total NHI costs for the entire Korean population. Conclusions According to the Korean national claims database, about 6% of the Korean population seeks medical care for IBS at least once per year. This high prevalence places a large economic burden on the Korean healthcare system, accounting for 0.46% of overall national medical expenditure.
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Affiliation(s)
- Hye-Kyung Jung
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Youn Hee Kim
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Joo Yeon Park
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Bo Hyoung Jang
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea and College of Korean Medicine, Kyung Hee University, Seoul, Korea
| | - Sun-Young Park
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea and School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, Korea
| | - Mi-Hee Nam
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Myung-Gyu Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea and Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Ho RCM, Mak KK, Chua ANC, Ho CSH, Mak A. The effect of severity of depressive disorder on economic burden in a university hospital in Singapore. Expert Rev Pharmacoecon Outcomes Res 2014; 13:549-59. [PMID: 23977979 DOI: 10.1586/14737167.2013.815409] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Depressive disorder is treatable but costly, thus influencing quality of life of people. AIM Determine direct and indirect costs incurred by depressive disorder in Singapore. METHODS A 1-year prospective naturalistic study was conducted in a university mood disorder center between 2007 and 2008. Patients with primary International Classification of Disease-10 diagnosis of depressive disorder were recruited. Disease costs between mild, moderate and severe depression, and cost predictors were analyzed and determined. RESULTS Forty nine patients completed the study. Mean annual total costs per patient were US$7638. Indirect costs (81%) dominated the total costs. Approximately 50% of indirect costs were associated with loss of productivity and unemployment. Higher education level, higher mean Hamilton Rating Scale for Depression score and number of suicide attempts were independent variables associated with increased direct costs while mean Hamilton Rating Scale for Depression scale score was an independent variable for indirect costs. CONCLUSION Medical cost saving strategies should focus on indirect costs.
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Affiliation(s)
- Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 5 Lower Kent Ridge Road, 119074, Singapore.
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Kim J, Kim K, Kim Y, Yoo KH, Lee CK, Yoon HK, Kim YS, Park YB, Lee JH, Oh YM, Lee SD, Lee SW. The association between inhaled long-acting bronchodilators and less in-hospital care in newly-diagnosed COPD patients. Respir Med 2014; 108:153-61. [DOI: 10.1016/j.rmed.2013.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 06/26/2013] [Accepted: 08/06/2013] [Indexed: 11/27/2022]
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Kim DW, Lee SY, Chung SE, Cheong HK, Jung KY. Clinical characteristics of patients with treated epilepsy in Korea: a nationwide epidemiologic study. Epilepsia 2013; 55:67-75. [PMID: 24299173 DOI: 10.1111/epi.12469] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Although a number of epidemiologic studies have been conducted on the prevalence and incidence of epilepsy around the world, only a few studies have investigated the clinical characteristics of patients with epilepsy in a population-based sample. The purpose of the present study was to describe the clinical characteristics of treated patients with epilepsy in Korea via a nationwide medical records survey. METHODS The study population was obtained through a nationwide database registered to the Health Insurance Review and Assessment service. Patients were recruited from clinics and hospitals in each cluster according to region and referral level by random selection from a preallocated sample of patients. All patients were being treated with antiepileptic drug medication with or without a diagnosis code for epilepsy or seizure between January 2009 and December 2009. Among the 6,436 selected patients, 2,150 met the diagnostic criteria for epilepsy and were included in our survey on the clinical characteristics of patients who were with treated epilepsy. RESULTS The proportion of male patients with epilepsy in this study was higher (1,226; 57.0%) than that of female patients. In addition, 10.6% of patients were first diagnosed with epilepsy in 2009, and 53.6% of patients experienced at least one seizure over the course of 2009; 78.1% were classified as having localization-related epilepsy, whereas 7.3% were considered to have generalized epilepsy. Thirty-five percent of patients were thus classified as idiopathic or cryptogenic cases. The most common cause of symptomatic epilepsy was trauma (10.0%), followed by stroke (9.6%), central nervous system (CNS) infection (5.7%), and hippocampal sclerosis (4.9%). SIGNIFICANCE This is the first nationwide study of the clinical characteristics of treated epilepsy in Korea using a national database validated by medical records survey. The etiologies of epilepsy and epilepsy syndrome classifications were comparable to those previously reported in other developed countries.
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Affiliation(s)
- Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea
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Rhee CK, Yoon HK, Yoo KH, Kim YS, Lee SW, Park YB, Lee JH, Kim Y, Kim K, Kim J, Oh YM, Lee SD. Medical utilization and cost in patients with overlap syndrome of chronic obstructive pulmonary disease and asthma. COPD 2013; 11:163-70. [PMID: 24111662 DOI: 10.3109/15412555.2013.831061] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Little information is available regarding medical utilization and cost in patients with overlap syndrome of chronic obstructive pulmonary disease (COPD) and asthma. The purpose of this study is to analyze medical utilization and cost in patients with overlap syndrome and to compare them to COPD patients without asthma. METHODS Using the 2009 Korean National Health Insurance (NHI) database, COPD patients were identified. Medical utilization and costs were also analyzed. RESULTS Of a total of 185,147 patients identified with COPD, 101,004 patients were classified with overlap syndrome of COPD and asthma and 84,143 patients with COPD without asthma. In 2009, the percentages of emergency room visits, admissions, and intensive care unit admissions were 14.6%, 30.5%, and 0.5%, respectively, in the patients with overlap syndrome group and 5.0%, 14.1%, and 0.2%, respectively, in the COPD patients without asthma group (p < 0.05 for all comparisons). The cost of medical utilization was 790 ± 71 US dollars per person and 3,373 ± 4,628 dollars per person for outpatient and inpatient services, respectively, in the patients with overlap syndrome and 413 ± 512 and 3,010 ± 5,013, respectively, in the COPD patients without asthma (p < 0.05 for all comparisons). Multiple linear regression showed that age, sex, overlap syndrome, hospitalization in the last year, low socioeconomic status, and type of hospital use were significant factors affecting medical utilization and cost. CONCLUSIONS In patients with overlap syndrome, both medical utilization and cost were higher than in COPD patients without asthma.
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Affiliation(s)
- Chin Kook Rhee
- 1Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic University of Korea , Seoul , Republic of Korea
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Hong KS, Bang OY, Kang DW, Yu KH, Bae HJ, Lee JS, Heo JH, Kwon SU, Oh CW, Lee BC, Kim JS, Yoon BW. Stroke statistics in Korea: part I. Epidemiology and risk factors: a report from the korean stroke society and clinical research center for stroke. J Stroke 2013; 15:2-20. [PMID: 24324935 PMCID: PMC3779679 DOI: 10.5853/jos.2013.15.1.2] [Citation(s) in RCA: 221] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 12/27/2012] [Accepted: 12/27/2012] [Indexed: 01/28/2023] Open
Abstract
The aim of the Part I of Stroke Statistics in Korea is to summarize nationally representative data of the epidemiology and risk factors of stroke in a single document. Every year, approximately 105,000 people experience a new or recurrent stroke and more than 26,000 die of stroke, which indicates that every 5 minutes stroke attacks someone and every 20 minutes stroke kills someone in Korea. Stroke accounts for roughly 1 of every 10 deaths. The estimated stroke prevalence is about 795,000 in people aged ≥30 years. The nationwide total cost for stroke care was 3,737 billion Korean won (US$3.3 billion) in 2005. Fortunately, the annual stroke mortality rate decreased substantially by 28.3% during the first decade of the 21th century (53.2/100,000 in 2010). Among OECD countries, Korea had the lowest in-hospital 30-day case-fatality rate for ischemic stroke and ranked third lowest for hemorrhagic stroke in 2009. The proportion of ischemic stroke has steadily increased and accounted for 76% of all strokes in 2009. According to hospital registry studies, the 90-day mortality rate was 3-7% for ischemic stroke and 17% for intracerebral hemorrhage. For risk factors, among Korean adults ≥30 years of age, one in 3-4 has hypertension, one in 10 diabetes, and one in 7 hypercholesterolemia. One in 3 Korean adults ≥19 years of age is obese. Over the last 10 years, the prevalence of hypertension slightly decreased, but the prevalence of diabetes, hypercholesterolemia, and obesity increased. Smoking prevalence in men has decreased, but is still as high as 48%. This report could be a valuable resource for establishing health care policy and guiding future research directions.
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Affiliation(s)
- Keun-Sik Hong
- Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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Chang HS, Kim HJ, Nam CM, Lim SJ, Jang YH, Kim S, Kang HY. The socioeconomic burden of coronary heart disease in Korea. J Prev Med Public Health 2012; 45:291-300. [PMID: 23091654 PMCID: PMC3469811 DOI: 10.3961/jpmph.2012.45.5.291] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 06/07/2012] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES We aimed to estimate the annual socioeconomic burden of coronary heart disease (CHD) in Korea in 2005, using the National Health Insurance (NHI) claims data. METHODS A prevalence-based, top-down, cost-of-treatment method was used to assess the direct and indirect costs of CHD (International Classification of Diseases, 10th revision codes of I20-I25), angina pectoris (I20), and myocardial infarction (MI, I21-I23) from a societal perspective. RESULTS Estimated national spending on CHD in 2005 was $2.52 billion. The majority of the spending was attributable to medical costs (53.3%), followed by productivity loss due to morbidity and premature death (33.6%), transportation (8.1%), and informal caregiver costs (4.9%). While medical cost was the predominant cost attribute in treating angina (74.3% of the total cost), premature death was the largest cost attribute for patients with MI (66.9%). Annual per-capita cost of treating MI, excluding premature death cost, was $3183, which is about 2 times higher than the cost for angina ($1556). CONCLUSIONS The total insurance-covered medical cost ($1.13 billion) of CHD accounted for approximately 6.02% of the total annual NHI expenditure. These findings suggest that the current burden of CHD on society is tremendous and that more effective prevention strategies are required in Korea.
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Affiliation(s)
- Hoo-Sun Chang
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
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Rha JH, Koo J, Cho KH, Kim EG, Oh GS, Lee SJ, Cha JK, Oh JJ, Ham GR, Seo HS, Kim JS. Two-year direct medical costs of stroke in Korea: a multi-centre incidence-based study from hospital perspectives. Int J Stroke 2012; 8:186-92. [PMID: 22568522 DOI: 10.1111/j.1747-4949.2012.00815.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Despite increasing socio-economic burden of stroke, few studies have investigated the costs associated with the stroke care in Korea. We estimated the two-year direct medical costs associated with stroke. METHODS This was a multi-centre, incidence-based, retrospective observational study. We examined the records of all adult patients who were admitted in eight large hospitals throughout Korea due to acute stroke [I60: sub-arachnoid haemorrhage; I61: intracerebral haemorrhage; I62: other nontraumatic haemorrhage; I63: cerebral infarction, by The International Statistical Classification of Diseases and Related Health Problems (ICD)-10] between 1 November and 31 December 2006. Direct medical inpatient and outpatient cost of each patient was extracted from the medical record and the reimbursement claim data of the hospital. RESULTS Out of 908 studied patients (14% diagnosed as I60, 18% as I61, 3% as I62, and 65% as I63), 460 (50.7%) were assessed for more than one-year. The annual average direct medical costs were Korean 8,114,471 US$8732) for the first year, and Korean 431,527 for the second year. The first year costs for haemorrhagic stroke (I60-I62) (Korean 13,090,179) were significantly higher than those associated with cerebral infarction (I63) (Korean 5,460,459), whereas the second year costs were not different. Factors independently associated with high cost were female gender, young age, and first stroke. CONCLUSIONS Direct medical costs for stroke in Korea were determined, which seem to be lower than those of other developed countries. Female gender, young age, and first stroke were factors related to higher stroke cost.
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Park KS. [How much amount of socioeconomic loss is caused by digestive diseases?]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 58:297-9. [PMID: 22299172 DOI: 10.4166/kjg.2011.58.6.297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Yoon SS, Chang H, Kwon YD. Itemized hospital charges for acute cerebral infarction patients influenced by severity in an academic medical center in Korea. J Clin Neurol 2012; 8:58-64. [PMID: 22523514 PMCID: PMC3325433 DOI: 10.3988/jcn.2012.8.1.58] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 09/14/2011] [Accepted: 09/14/2011] [Indexed: 11/19/2022] Open
Abstract
Background and Purpose Stroke imposes a major burden on patients, their families, and the national healthcare system. The purpose of this study was to determine the itemized hospital charges in acute ischemic stroke patients according to their severity by partitioning the charges in detail and then examining whether stroke severity was a significant contributor to these charges. Methods This study analyzed data of first-time acute ischemic stroke patients who had been admitted to an academic medical center between September 2003 and April 2009. The patients' demographic and clinical characteristics were analyzed descriptively, and then eight categorized hospital charges as well as the total charge were compared among patients grouped according to stroke severity, using analysis of variance. Multiple regression analyses were conducted to test the influence of stroke severity on itemized hospital charges as well as the total charge, while controlling for other related factors. Results More-severe strokes were associated with a higher total charge. Significantly higher charges were associated with patients with more-severe strokes regarding all charged items except imaging studies. The charges for imaging studies were similar across all severities of stroke. While controlling for other factors, a significant impact of stroke severity was found in both the total hospital charge and most itemized charges. Conclusions Itemized hospital charges for inpatients with acute ischemic stroke varied according to stroke severity. Stroke severity was a significant factor influencing the itemized charges of acute hospitalization of ischemic stroke patients.
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Affiliation(s)
- Sung Sang Yoon
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
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Jung HK, Jang B, Kim YH, Park J, Park SY, Nam MH, Choi MG. [Health care costs of digestive diseases in Korea]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 58:323-31. [PMID: 22198230 DOI: 10.4166/kjg.2011.58.6.323] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Gastrointestinal (GI) diseases impose a heavy economic burden. We aimed to provide the first report on the health care utilization and costs of GI diseases in Korea. METHODS We collected the data from all insurance claims database of National Health Insurance Corporation in Korea and the cause of death database in 2007 of Korea National Statistical Office. We compiled information about all digestive disease as a primary diagnosis on clinic visits, hospitalization, and cause of death from these databases. RESULTS Seventeen million people (35.6%) had a diagnosis of GI diseases during the year 2007. Among them, the proportion of patients with upper GI diseases was prevalent in 54.9% (9.5 million patients/year). The 1/4 patients in out-patients clinic had any one of gastroesophageal reflux disease, irritable bowel syndrome and constipation. Thirteen percent of the total direct cost in 2007 was attributed to all GI diseases, which was 3,649 billion won (0.4% of GDP). The patients with hospitalization occupied by 5% of all patients with GI diseases, however, attributed to 58.9% of GI-related direct costs. GI malignancy was the major cause of medical expenses in hospitalization. Stomach cancer continues to be the leading cause of GI-related death in Korea. CONCLUSIONS GI diseases causes a heavy socioeconomic burden with high morbidity of functional GI disorders in outpatients care and high mortality of GI malignancy in inpatient care. This report highlights the healthcare utilization burden of GI diseases for researchers and public health policy maker to create new directions of integrated researches and health care plan.
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Affiliation(s)
- Hye-kyung Jung
- Department of Internal Medicine, Ewha Womans University School of Medicine, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
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Lee SY, Jung KY, Lee IK, Yi SD, Cho YW, Kim DW, Hwang SS, Kim S. Prevalence of treated epilepsy in Korea based on national health insurance data. J Korean Med Sci 2012; 27:285-90. [PMID: 22379340 PMCID: PMC3286776 DOI: 10.3346/jkms.2012.27.3.285] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 12/21/2011] [Indexed: 12/03/2022] Open
Abstract
The Korean national health security system covers the entire population and all medical facilities. We aimed to estimate epilepsy prevalence, anticonvulsant utilization pattern and the cost. We identified prevalent epilepsy patients by the prescription of anticonvulsants under the diagnostic codes suggesting seizure or epilepsy from 2007 Korean National Health Insurance databases. The information of demography, residential area, the kind of medical security service reflecting economic status, anticonvulsants, and the costs was extracted. The overall prevalence of treated epilepsy patients was 2.41/1,000, and higher for men than women. The age-specific prevalence was the lowest in those in their thirties and forties. Epilepsy was more prevalent among lower-income individuals receiving medical aid. The regional prevalence was the highest in Jeju Island and lowest in Ulsan city. New anticonvulsants were more frequently used than old anticonvulsants in the younger age group. The total annual cost of epilepsy or seizure reached 0.46% of total medical expenditure and 0.27% of total expenditure on health. This is the first nationwide epidemiological report issued on epilepsy in Korea. Epilepsy prevalence in Korea is comparable to those in developed countries. Economic status and geography affect the prevalence of epilepsy.
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Affiliation(s)
- Seo-Young Lee
- Department of Neurology, Kangwon National University, Chuncheon, Korea
| | - Ki-Young Jung
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | | | - Sang Do Yi
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Yong Won Cho
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University Medical Center, Seoul, Korea
| | - Seung-Sik Hwang
- Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea
| | - Sejin Kim
- Department of Research and Statistics, Health Insurance Review & Assessment Service, Seoul, Korea
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Lee MH, Kim HC, Ahn SV, Hur NW, Choi DP, Park CG, Suh I. Prevalence of Dyslipidemia among Korean Adults: Korea National Health and Nutrition Survey 1998-2005. Diabetes Metab J 2012; 36:43-55. [PMID: 22363921 PMCID: PMC3283826 DOI: 10.4093/dmj.2012.36.1.43] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 06/01/2011] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Dyslipidemia is a disorder of lipid metabolism, including elevated total cholesterol, elevated triglyceride, elevated low density lipoprotein cholesterol (LDL-C), and decreased high density lipoprotein cholesterol (HDL-C). The objective of this study was to investigate recent changes in the prevalence of dyslipidemia and also the rates of awareness, treatment, and control of dyslipidemia among Korean adults. METHODS Dyslipidemia is defined according to the National Cholesterol Education Program-Adult Treatment Panel III as total cholesterol ≥240 mg/dL, LDL-C ≥160 mg/dL, HDL-C <40 mg/dL, and triglyceride ≥200 mg/dL. The prevalence of dyslipidemia was estimated for adults aged ≥20 years using the Korea National Health and Nutrition Survey (KNHANES) in 1998 (n=6,923), 2001 (n=4,882), and 2005 (n=5,323). Rates of awareness, treatment and control of dyslipidemia were calculated for adults aged ≥30 years using the KNHANES in 2005 (n=4,654). RESULTS The prevalence of dyslipidemia (aged ≥20 years) increased from 32.4% in 1998 to 42.6% in 2001 and 44.1% in 2005. Compared with the KNHANES in 1998, the prevalence of dyslipidemia was 47% (95% confidence interval [CI], 35% to 59%) higher in 2001 and 61% (95% CI, 49% to 75%) higher in 2005. In 2005, only 9.5% of people with dyslipidemia were aware of the disease, 5.2% used lipid-lowering medication, and 33.2% of patients with treatment reached treatment goals. CONCLUSION The prevalence of dyslipidemia in Korea gradually increased between 1998 and 2005. These findings suggest that more intense efforts for the prevention and treatment of dyslipidemia may lead to further improvement in the management of dyslipidemia.
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Affiliation(s)
- Myung Ha Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea
| | - Song Vogue Ahn
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Nam Wook Hur
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Phil Choi
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Gyu Park
- Department of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Il Suh
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
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Kim HJ, Kim YA, Seo HY, Kim EJ, Yoon SJ, Oh IH. The economic burden of stroke in 2010 in Korea. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2012. [DOI: 10.5124/jkma.2012.55.12.1226] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hyun-Jin Kim
- Department of Public Health, Graduate School, Korea University, Seoul, Korea
| | - Young-Ae Kim
- Department of Public Health, Graduate School, Korea University, Seoul, Korea
| | - Hye-Young Seo
- Department of Health Policy and Hospital Management, Graduate School of Public Health, Korea University, Seoul, Korea
| | - Eun-Jung Kim
- Department of Nursing, Cheju Halla College, Jeju, Korea
| | - Seok-Jun Yoon
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | - In-Hwan Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
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Jung IY, Lim JY, Kang EK, Sohn HM, Paik NJ. The Factors Associated with Good Responses to Speech Therapy Combined with Transcranial Direct Current Stimulation in Post-stroke Aphasic Patients. Ann Rehabil Med 2011; 35:460-9. [PMID: 22506160 PMCID: PMC3309227 DOI: 10.5535/arm.2011.35.4.460] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 03/22/2011] [Indexed: 11/17/2022] Open
Abstract
Objective To determine factors associated with good responses to speech therapy combined with transcranial direct current stimulation (tDCS) in aphasic patients after stroke. Method The language function was evaluated using Korean version of Western aphasia battery (K-WAB) before and after speech therapy with tDCS in 37 stroke patients. Patients received speech therapy for 30 minutes over 2 to 3 weeks (10 sessions) while the cathodal tDCS was performed to the Brodmann area 45 with 1 mA for 20 minutes. We compared the improvement of aphasia quotient % (AQ%) between two evaluation times according to age, sex, days after onset, stroke type, aphasia type, brain lesion confirmed by magnetic resonance image and initial severity of aphasia. The factors related with good responses were also checked. Results AQ% improved from pre- to post-therapy (14.94±6.73%, p<0.001). AQ% improvement was greater in patients with less severe, fluent type of aphasia who received treatment before 30 days since stroke was developed (p<0.05). The adjusted logistic regression model revealed that patients with hemorrhagic stroke were more likely to achieve good responses (odds ratio=4.897, p<0.05) relative to infarction. Initial severity over 10% in AQ% was also found to be significantly associated with good improvement (odds ratio=8.618, p<0.05). Conclusion Speech therapy with tDCS was established as a treatment tool for aphasic patients after stroke. Lower initial severity was associated with good responses.
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Affiliation(s)
- Il-Young Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea
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Wang X, Kong Y, Chen H, Zhang JH, Wang Y. Characteristics of acute cerebral hemorrhage with regard to lipid metabolism and glycometabolism among different age groups. ACTA NEUROCHIRURGICA. SUPPLEMENT 2011; 111:367-371. [PMID: 21725784 DOI: 10.1007/978-3-7091-0693-8_62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE This study investigated the lipid metabolism and glycometabolism of patients with acute cerebral hemorrhage from 2006-2008 in order to find a possible association among lipid metabolism, glycometabolism and different age groups of adults in the Chinese Chongqing population. METHODS Data on levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C) and fasting serum glucose (GLU) were obtained from records of patients (548) from the Department of Neurology of the First Affiliated Hospital of Chongqing Medical University. Participants ranging in age from 21-94 years were divided into three groups; the first group was the young group in which all participants were 21-44 years old; the second group was the middle-age group in which all participants were 45-59 years old, and the last group was the elderly group in which all participants were 60-94 years old. RESULTS Levels of TC, TG, HDL-C, LDL-C and GLU were not significantly different among the three groups (P>0.05). Proportions of hypercholesterolemia high LDL-C, low HDL-C, impaired fasting glucose and diabetes mellitus were not different among the three groups (P>0.05). Only the proportion of hypertriglyceridemia patients was significantly different. The risk of being diagnosed with hypertriglyceridemia in the middle-age group was increased 2.371 times (95% CI: 1.542-3.645) and in the young group increased 2.281 times (95% CI: 1.211 -4.296). CONCLUSION Age and hypertriglyceridemia are risk factors associated with an increased incidence rate of acute cerebral hemorrhage in the Chongqing population in China.
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Affiliation(s)
- Xiaolin Wang
- The Medical Examination Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Wei JW, Heeley EL, Jan S, Huang Y, Huang Q, Wang JG, Cheng Y, Xu E, Yang Q, Anderson CS. Variations and determinants of hospital costs for acute stroke in China. PLoS One 2010; 5. [PMID: 20927384 PMCID: PMC2946911 DOI: 10.1371/journal.pone.0013041] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 08/31/2010] [Indexed: 12/04/2022] Open
Abstract
Background The burden of stroke is high and increasing in China. We modelled variations in, and predictors of, the costs of hospital care for patients with acute stroke in China. Methods and Findings Baseline characteristics and hospital costs for 5,255 patients were collected using the prospective register-based ChinaQUEST study, conducted in 48 Level 3 and 14 Level 2 hospitals in China during 2006–2007. Ordinary least squares estimation was used to determine factors associated with hospital costs. Overall mean cost of hospitalisation was 11,216 Chinese Yuan Renminbi (CNY) (≈US$1,602) per patient, which equates to more than half the average annual wage in China. Variations in cost were largely attributable to stroke severity and length of hospital stay (LOS). Model forecasts showed that reducing LOS from the mean of 20 days for Level 3 and 18 days for Level 2 hospitals to a duration of 1 week, which is common among Western countries, afforded cost reductions of 49% and 19%, respectively. Other lesser determinants varied by hospital level: in Level 3 hospitals, health insurance and the occurrence of in-hospital complications were each associated with 10% and 18% increases in cost, respectively, whilst treatment in a teaching hospital was associated with approximately 39% decrease in cost on average. For Level 2 hospitals, stroke due to intracerebral haemorrhage was associated with a 19% greater cost than for ischaemic stroke. Conclusions Changes to hospital policies to standardise resource use and reduce the variation in LOS could attenuate costs and improve efficiencies for acute stroke management in China. The success of these strategies will be enhanced by broader policy initiatives currently underway to reform hospital reimbursement systems.
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Affiliation(s)
- Jade W Wei
- The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia.
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