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Jeong SM, Jung KW, Park J, Lee HJ, Shin DW, Suh M. Disparities in Overall Survival Rates for Cancers across Income Levels in the Republic of Korea. Cancers (Basel) 2024; 16:2923. [PMID: 39199693 PMCID: PMC11352955 DOI: 10.3390/cancers16162923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 08/16/2024] [Accepted: 08/20/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND The overall survival rates among cancer patients have been improving. However, the increase in survival is not uniform across socioeconomic status. Thus, we investigated income disparities in the 5-year survival rate (5YSR) in cancer patients and the temporal trends. METHODS This study used a national cancer cohort from 2002 to 2018 that was established by linking the Korea Central Cancer Registry and the National Health Insurance Service (NHIS) claim database to calculate the cancer survival rate by income level in the Republic of Korea. Survival data were available from 2002 onward, and the analysis was based on the actuarial method. We compared the survival of the earliest available 5-year period of 2002-2006 and the latest available 5-year period of 2014-2018, observing until 31 December 2021. Income level was classified into six categories: Medical Aid beneficiaries and five NHIS subtypes according to insurance premium. The slope index of inequality (SII) and relative index of inequality were used to measure absolute and relative differences in 5YSR by income, respectively. RESULTS The 5YSR between the 2002-2006 and 2014-2018 periods for all cancers improved. A significant improvement in 5-year survival rates (5YSR) over the study period was observed in lung, liver, and stomach cancer. The SII of survival rates for lung (17.5, 95% confidence interval (CI) 7.0-28.1), liver (15.1, 95% CI 10.9-19.2), stomach (13.9, 95% CI 3.2-24.7), colorectal (11.4, 95% CI 0.9-22.0), and prostate (10.7, 95% CI 2.5-18.8) cancer was significantly higher, implying higher survival rates as income levels increased. The SII for lung, liver, and stomach cancer increased, while that of thyroid, breast, cervical, prostate, and colorectal cancer decreased over the study period. CONCLUSIONS Although substantial improvement in the 5YSR was observed across cancer types and income levels from 2002 to 2018, this increase was not uniformly distributed across income levels. Our study revealed persistent income disparities in the survival of cancer patients, particularly for lung and liver cancer.
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Affiliation(s)
- Su-Min Jeong
- Department of Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
- Department of Family Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Kyu-Won Jung
- National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea; (K.-W.J.); (J.P.); (H.J.L.)
| | - Juwon Park
- National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea; (K.-W.J.); (J.P.); (H.J.L.)
| | - Hyeon Ji Lee
- National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea; (K.-W.J.); (J.P.); (H.J.L.)
| | - Dong Wook Shin
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Department of Family Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea
- Supportive Care Center, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea; (K.-W.J.); (J.P.); (H.J.L.)
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Shin J, Bae YJ, Kang HT. Insurance Types and All-Cause Mortality in Korean Cancer Patients: A Nationwide Population-Based Cohort Study. J Pers Med 2024; 14:861. [PMID: 39202052 PMCID: PMC11355516 DOI: 10.3390/jpm14080861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/05/2024] [Accepted: 08/12/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND Economic deprivation is expected to influence cancer mortality due to its impact on screening and treatment options, as well as healthy lifestyle. However, the relationship between insurance type, premiums, and mortality rates remains unclear. This study investigated the relationship between insurance type and mortality in patients with newly diagnosed cancer using data from the Korean National Health Insurance Database. METHODS this retrospective cohort study included 111,941 cancer patients diagnosed between 1 January 2007 and 31 December 2008, with a median follow-up period of 13.41 years. The insurance types were categorized as regional and workplace subscribers and income-based insurance premiums were divided into tertiles (T1, T2, and T3). RESULTS Cox proportional hazards regression analysis adjusted for age, lifestyle factors, health metrics, and comorbidities showed workplace subscribers (n = 76,944) had a lower all-cause mortality hazard ratio (HR) (95% confidence interval [CI]: 0.940 [0.919-0.961]) compared to regional subscribers (n = 34,997). Higher income tertiles (T2, T3) were associated with lower mortality compared to the T1 group, notably in male regional and workplace subscribers, and female regional subscribers. CONCLUSION The study identified that insurance types and premiums significantly influence mortality in cancer patients, highlighting the necessity for individualized insurance policies for cancer patients.
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Affiliation(s)
- Jinyoung Shin
- Department of Family Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea;
| | - Yoon-Jong Bae
- Department of Data Science, Hanmi Pharm. Co., Ltd., Seoul 05545, Republic of Korea;
| | - Hee-Taik Kang
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Kim SY, Kang HJ, Kim KH, Kim DU, Nam SJ, Yang JK, Jang DK, Choi HS, Ryu DG, Lee JW, Lee JY, Park S, Lee HJ. Cardiovascular disease risk and associated physical activity factors in gastrointestinal cancer survivors. BMC Public Health 2024; 24:1656. [PMID: 38902653 PMCID: PMC11191341 DOI: 10.1186/s12889-024-19097-2] [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: 12/03/2023] [Accepted: 06/11/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION Although the risk of CVD is increased in cancer survivors, few studies have investigated the CVD risk in survivors of gastrointestinal (GI) cancer. Therefore, we evaluated the CVD risk using the 10-year atherosclerotic cardiovascular disease (ASCVD) risk score for GI cancer survivors and associated physical activity factors. METHODS Using the 2014-2019 Korean National Health and Nutrition Examination Surveys, data were collected for 262 GI cancer survivors and 1,310 cancer-free controls matched at a 1:5 ratio based on age and sex. The International Physical Activity Questionnaire Short-Form was used to assess physical activity, and the Euro QoL Questionnaire 5-Dimensional Classification (EQ-5D) was used to assess the health-related quality of life. RESULTS A multiple logistic regression analysis demonstrated a lower risk of ASCVD in GI cancer survivors than in controls (adjusted odds ratio [aOR] = 0.73, 95% confidence interval [CI] = 0.55-0.97). Moreover, the risk of having a high ASCVD score was significantly lower in individuals who performed sufficient aerobic physical activity (aOR = 0.59, 95% CI = 0.47-0.75) and those with an EQ-5D score 1 or 2 (aOR = 0.36, 95% CI = 0.20-0.65 and aOR = 0.31, 95% CI = 0.16-0.58, respectively). CONCLUSIONS This population-based study demonstrated that engaging in sufficient physical activity can reduce the ASCVD risk among GI cancer survivors.
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Affiliation(s)
- Su Young Kim
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Hye Jung Kang
- Department of Health Informatics and Biostatistics, Graduate School of Public Health, Yonsei University, 50-1 Yonsei-Ro, Sodeamun-Gu, Seoul, 03722, Republic of Korea
| | - Ki-Hyun Kim
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Dong Uk Kim
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Republic of Korea
| | - Seung-Joo Nam
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Jae Kook Yang
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Dong Kee Jang
- Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dae Gon Ryu
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jung Wook Lee
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Jong Yoon Lee
- Division of Gastroenterology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, 49201, Republic of Korea
| | - Sohee Park
- Department of Health Informatics and Biostatistics, Graduate School of Public Health, Yonsei University, 50-1 Yonsei-Ro, Sodeamun-Gu, Seoul, 03722, Republic of Korea.
| | - Hyun Jung Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
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Tran TXM, Kim S, Cha C, Park B. Temporal Trend in Uptake of the National General Health Checkups and Cancer Screening Program among Korean Women with Breast Cancer. Cancer Res Treat 2024; 56:522-530. [PMID: 37905311 PMCID: PMC11016641 DOI: 10.4143/crt.2023.729] [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: 06/07/2023] [Accepted: 10/28/2023] [Indexed: 11/02/2023] Open
Abstract
PURPOSE This study assessed the temporal trends of uptake of national general health and cancer screening among women with breast cancer in Korea between 2009 and 2016. MATERIALS AND METHODS We retrospectively analyzed the claims data from the Korean National Health Insurance Service database. Participants included 101,403 breast cancer patients diagnosed between 2009 and 2016. Information on participation in national screening programs, including breast cancer screening, general health, and gastric, colorectal, and cervical cancers, up to 2020 was collected. Screening participation rates within the first 2 and 5 years postdiagnosis were calculated by diagnosis year and fitted with joinpoint regression models to assess temporal trends. RESULTS Overall, the participation rate in breast cancer screening within 2 years postdiagnosis increased from 10.9% to 14.0% from 2009-2016, with an annual percentage change (APC) of 3.7% (p < 0.05). The participation rate in breast cancer screening was lower than that in general health checkup and screening for other cancers within 2 and 5 years postdiagnosis. A steady increase in screening trends was also observed for general health, gastric, colorectal, and cervical cancers, with APC of 5.3%, 5.7%, 6.9%, and 7.6% in the 2-year postdiagnosis rate, and APC of 3.6%, 3.7%, 3.7%, and 4.4% in 5-year postdiagnosis rate, respectively. The screening rate was highest among age groups 50-59 and 60-69 in 2009 and significant upward trends were observed in all age groups for general health checkup and gastric, colorectal, and cervical cancer screening. CONCLUSION Among female breast cancer survivors in Korea, the uptake rate of screenings for general health and various cancers, including breast, gastric, colorectal, and cervical cancers, has shown a gradual increase in recent years.
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Affiliation(s)
- Thi Xuan Mai Tran
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
- Institute for Health and Society, Hanyang University, Seoul, Korea
| | - Soyeoun Kim
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
- Institute for Health and Society, Hanyang University, Seoul, Korea
| | - Chihwan Cha
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Boyoung Park
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
- Hanyang Institute of Bioscience and Biotechnology, Hanyang University, Seoul, Korea
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Yan M, Fraser B, McArthur E, Mehrabi M, Brode SK, Marras TK. External Validation of the BACES Score in Canadian Patients With Nontuberculous Mycobacterial Pulmonary Disease. Chest 2024; 165:521-528. [PMID: 37827237 DOI: 10.1016/j.chest.2023.10.006] [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: 06/09/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND The clinical course of nontuberculous mycobacterial pulmonary disease (NTM-PD) can be variable and difficult to predict. Recently, the BACES score was developed as a tool to predict all-cause mortality in patients with NTM-PD. This score is calculated based on five patient characteristics (BMI, age, cavity, erythrocyte sedimentation rate, and sex), and higher scores portend worse prognosis. Although the BACES score has been validated in a cohort of South Korean patients, it has not yet been validated in other settings or ethnic groups. RESEARCH QUESTION How well does the BACES mortality score perform in a cohort of Canadian patients with NTM-PD? STUDY DESIGN AND METHODS We performed a single-center retrospective chart review. Patients who were seen between July 2003 and June 2021 were eligible for inclusion if they met guideline-based diagnostic criteria for NTM-PD and were excluded if any component of the BACES score was missing. To assess the model's discriminatory performance, we compared Kaplan-Meier curves between risk groups and calculated Harrell's C index. To assess calibration, we used a graphical calibration curve. RESULTS The cohort included 435 patients with a median follow-up of 5.8 years. The median age was 64 years and 74% were female. Based on the BACES scores, patients were classified into three risk groups: low, moderate, or high. Survival curves showed clear separation of the risk groups. Harrell's C index was 0.733 in the study cohort, indicating moderate to good discriminatory performance, although this was lower than the value reported in the derivation cohort (0.812). The graphical calibration curve showed a tendency of the BACES model to underpredict mortality. INTERPRETATION The BACES model was evaluated in a multicultural cohort of Canadian patients and demonstrated good discriminatory performance but suboptimal calibration, which may be due to population differences, the use of dichotomized variables in model construction, or both.
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Affiliation(s)
- Marie Yan
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Brooke Fraser
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Matty Mehrabi
- Division of Respirology, Toronto Western Hospital, Toronto, ON, Canada
| | - Sarah K Brode
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Respirology, Toronto Western Hospital, Toronto, ON, Canada
| | - Theodore K Marras
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Respirology, Toronto Western Hospital, Toronto, ON, Canada.
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Yoo TK, Han KD, Rhee EJ, Lee WY. Risk of Cardiovascular Disease according to Baseline Low-Density Lipoprotein Cholesterol Level in Different Age Groups in Korean Diabetes Population: A Cohort Study. Diabetes Metab J 2024; 48:265-278. [PMID: 38403889 PMCID: PMC10995493 DOI: 10.4093/dmj.2022.0443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 12/16/2023] [Indexed: 02/27/2024] Open
Abstract
BACKGRUOUND The association between low-density lipoprotein (LDL-C) levels and cardiovascular disease (CVD) risk in different age groups within the diabetes mellitus (DM) population remains unclear. The cohort study was conducted to investigate this relationship. METHODS We assessed the 2009 to 2012 Korean National Health Screening and National Health Insurance Service records, with follow-up to the primary outcome (myocardial infarction [MI] or stroke) or December 2018. After excluding the participants with a history of MI or stroke, 2,227,394 participants with DM were included and categorized according to baseline LDL-C levels and age. Cox proportional hazards modeling was conducted. The CVD risk of age <40 years and LDL-C <70 mg/dL was set as the reference. In each age group, LDL-C <70 mg/dL was used as a reference for the subgroup analysis. RESULTS The cut-off LDL-C value for increased MI risk in each age group varied (<40 years old, LDL-C ≥160 mg/dL: hazard ratios [HR], 2.03; 95% confidence interval [CI], 1.644 to 2.506) (40-49-year-old, LDL-C <115 mg/dL: HR, 1.245; 95% CI, 1.04 to 1.489) (50-59-year-old, LDL-C <115 mg/dL: HR, 1.21; 95% CI, 1.014 to 1.445) (60-69-year-old, LDL-C <145 mg/dL: HR, 1.229; 95% CI, 1.022 to 1.479) (≥70 years old group, LDL-C <100 mg/dL: HR, 1.238; 95% CI, 1.018 to 1.504). The cut-off LDL-C values for increased stroke risk varied in each age subgroup (<40 years old, LDL-C ≥160 mg/dL: HR, 1.395; 95% CI, 1.094 to 1.779) (40-49-year-old, LDL-C <145 mg/dL: HR, 1.13; 95% CI, 1.019 to 1.253) (50-59-year-old, LDL-C <160 mg/dL: HR, 1.079; 95% CI, 1.008 to 1.154) (60-69-year-old, LDL-C <130 mg/dL: HR, 1.07; 95% CI, 1.022 to 1.119) (≥70 years old, LDL-C <115 mg/dL: HR, 1.064; 95% CI, 1.019 to 1.112). CONCLUSION The effect of LDL-C on the risk of CVD differs depending on the age of the population with DM.
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Affiliation(s)
- Tae Kyung Yoo
- Department of Medicine, MetroWest Medical Center, Framingham, MA, USA
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Eun-Jung Rhee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won-Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
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Baek SU, Lee YM, Yoon JH. Association between long working hours and engagement in preventive healthcare services in Korean workers: Findings from the Korean National Health and Nutrition Examination Survey. Prev Med 2024; 180:107849. [PMID: 38185224 DOI: 10.1016/j.ypmed.2024.107849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/09/2024]
Abstract
BACKGROUND Engagement in preventive healthcare services is crucial for preventing diseases. We explored how working hours are associated with engagement in preventive healthcare services, with a focus on gender differences. METHODS This cross-sectional study used data from the 2007-2012 Korean National Health and Nutrition Examination Survey. The dependent variable was engagement in each of the five preventive healthcare services (health check-ups, influenza vaccination, and stomach, breast, and cervical cancer screenings). We estimated the prevalence ratios (PRs) and 95% confidence intervals (CIs) using robust Poisson regression. RESULTS The study analyzed 19,819 workers (9119 women). The adjusted PRs (95% CI) of the association between working ≥55 h per week and engagement in preventive healthcare services among men were 0.95 (0.90-1.00) for health check-ups, 0.86 (0.77-0.96) for influenza vaccination, and 0.95 (0.87-1.03) for stomach cancer screening compared to working 35-40 h per week. Among women, the adjusted PRs (95% CI) of the association between working ≥55 h per week and engagement in preventive healthcare services were 0.84 (0.78-0.91) for health check-ups, 0.82 (0.73-0.92) for influenza vaccination, and 0.88 (0.80-0.97) for stomach, 0.85 (0.78-0.94) for breast, and 0.82 (0.74-0.91) for cervical cancer screenings. CONCLUSION Long working hours were negatively associated with engagement in preventive healthcare services, and the association was pronounced among female workers. Efforts to promote preventive healthcare participation among individuals with long working hours are necessary, and it is essential to consider the unique vulnerabilities of women when developing such policies.
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Affiliation(s)
- Seong-Uk Baek
- Department of Occupational and Environmental Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Republic of Korea; Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yu-Min Lee
- Department of Occupational and Environmental Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Ha Yoon
- The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Kim JY, Hong J, Yoon J, Park J, Kim TH. Regularity of cervical cancer screening in Korea: analysis using national public data for 12 years. J Gynecol Oncol 2024; 35:e18. [PMID: 37921602 PMCID: PMC10948977 DOI: 10.3802/jgo.2024.35.e18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/04/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE To assess the frequency of regular uptake of national cervical cancer screening (CCS) program and identify associated factors among Korean women. METHODS This study is a fundamental investigation that employs openly accessible public data of Korea through secondary data analysis. A cohort of 4,663 women from the 2007-2012 Korean National Health and Nutrition Examination Survey, was followed up for up to 12 years (2007-2018) to obtain the frequency of national CCS. Compliance level with CCS was categorized, and an ordinal logistic regression model was employed to investigate the contributing factors. RESULTS The regular uptake of CCS in South Korea was low at 18.9%. The trend of regular screening showed significant association with various factors, including age (40-59 years), household income (100%-150% bracket), occupation (service workers), place of residence (small to medium sized cities), education level (middle school graduates), marital status (married), and possession of private insurance. Moreover, individuals with a history of non-cervical cancer or carcinoma in situ of the cervix, a family history of cervical cancer, or a higher frequency of general check-ups demonstrated a stronger adherence to regular CCS uptake. CONCLUSION Our findings revealed that regular participation in CCS in Korea was lower than anticipated, with factors such as socioeconomic status, personal history of gynecologic issue, and frequency of general health check-ups playing influential roles. However, further research, including an exploration of unexamined psychological barriers to screening, is necessary to gain a better understanding the reasons behind the reduced rates of regular CCS among Korean women.
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Affiliation(s)
- Jong-Yeup Kim
- Department of Biomedical Informatics, Konyang University College of Medicine, Daejeon, Korea
| | - Jeeyoung Hong
- Department of Biomedical Informatics, Konyang University College of Medicine, Daejeon, Korea
| | - Juhee Yoon
- Department of Obstetrics and Gynecology, Konyang University College of Medicine, Daejeon, Korea
| | - Jinsol Park
- Department of Obstetrics and Gynecology, Konyang University College of Medicine, Daejeon, Korea
| | - Tae-Hyun Kim
- Department of Obstetrics and Gynecology, Konyang University College of Medicine, Daejeon, Korea.
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Chon YE, Park SJ, Park MY, Ha Y, Lee JH, Lee KS, Yoon EL, Jun DW. Extrahepatic Malignancies Are the Leading Cause of Death in Patients with Chronic Hepatitis B without Cirrhosis: A Large Population-Based Cohort Study. Cancers (Basel) 2024; 16:711. [PMID: 38398102 PMCID: PMC10886555 DOI: 10.3390/cancers16040711] [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: 01/12/2024] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: Accurate statistics on the causes of death in patients with chronic hepatitis B (CHB) are lacking. We investigated mortality rates and causes of death over time. (2) Methods: Data on patients newly diagnosed with CHB from 2007 to 2010 (cohort 1, n = 223,424) and 2012 to 2015 (cohort 2, n = 177,966) were retrieved from the Korean National Health Insurance Service. Mortality data were obtained from Statistics Korea. The causes of death were classified as liver-related (hepatic decompensation or hepatocellular carcinoma [HCC]) or extrahepatic (cardiovascular-related, cerebrovascular-related, or extrahepatic malignancy-related). (3) Results: Over a 10-year follow-up period of 223,424 patients (cohort 1) with CHB, the overall mortality was 1.54 per 100 person-years. The mortality associated with HCC was the highest (0.65 per 100 person-years), followed by mortality related to extrahepatic malignancies (0.26 per 100 person-years), and cardio/cerebrovascular diseases (0.18 per 100 person-years). In the non-cirrhotic CHB (87.4%), 70% (11,198/15,996) of patients died due to non-liver-related causes over ten years. The 10-year overall mortality was 0.86 per 100 person-years. Among these, mortality due to extrahepatic malignancies had the highest rate (0.23 per 100 person-years), followed by mortality related to HCC (0.20 per 100 person-years), and cardio/cerebrovascular diseases (0.16 per 100 person-years). The 5-year mortality associated with extrahepatic malignancies increased from 0.36 per 100 person-years (cohort 1) to 0.40 per 100 person-years (cohort 2). (4) Conclusions: Mortality related to HCC decreased, whereas mortality related to extrahepatic malignancies increased in the antiviral era. Extrahepatic malignancies were the leading cause of death among patients with CHB without cirrhosis.
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Affiliation(s)
- Young Eun Chon
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam 13496, Republic of Korea; (Y.E.C.); (Y.H.); (J.H.L.); (K.S.L.)
| | - Sung Jun Park
- Department of Gastroenterology, CHA Gumi Medical Center, CHA University, Seongnam 39295, Republic of Korea;
| | - Man Young Park
- Department of Digital Clinical Research, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea;
| | - Yeonjung Ha
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam 13496, Republic of Korea; (Y.E.C.); (Y.H.); (J.H.L.); (K.S.L.)
| | - Joo Ho Lee
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam 13496, Republic of Korea; (Y.E.C.); (Y.H.); (J.H.L.); (K.S.L.)
| | - Kwan Sik Lee
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam 13496, Republic of Korea; (Y.E.C.); (Y.H.); (J.H.L.); (K.S.L.)
| | - Eileen L. Yoon
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea;
| | - Dae Won Jun
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea;
- Hanyang Institute of Bioscience and Biotechnology, Seoul 04763, Republic of Korea
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Jeong SM, Jung KW, Park J, Kim N, Shin DW, Suh M. Disparities in Cancer Incidence across Income Levels in South Korea. Cancers (Basel) 2023; 15:5898. [PMID: 38136441 PMCID: PMC10741676 DOI: 10.3390/cancers15245898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Recent nationwide studies of disparities in cancer incidence by income are scarce in Korea. This study investigated such disparities in cancer incidence and the stage at cancer diagnosis across income groups in Korea. METHODS This study utilized data from a national cancer database, specifically focusing on cases recorded in the year 2018. Income levels were categorized into quintiles according to the insurance premium paid in addition to the Medicaid benefit. The slope index of inequality (SII) and relative index of inequality (RII) were used to measure absolute and relative differences in cancer incidence by income. A multivariable logistic regression was performed to estimate the risk of a distant stage at cancer diagnosis. RESULTS The total number of cases of incident cancer was 223,371 (men: 116,320, women: 107,051) with shares of the total of 29.5% (5Q), 20.4% (4Q), 16.0% (3Q), 13.5% (2Q), 15.6% (1Q), and 5% (Medicaid). The most common cancer type was thyroid cancer, followed by gastric and colorectal cancers. The age-standardized incidence rate for all cancers was lowest in the highest income group, but the SII was not statistically significant (SII: -35.7), and the RII was -0.07. Colorectal and cervical cancers had lower incidence rates for higher income groups, while thyroid and prostate cancers had higher incidence rates for higher income groups. The odds ratio for a distant stage at diagnosis for all cancers increased for lower income groups relative to 5Q. CONCLUSIONS Disparities in cancer incidence in a Korean population differed by cancer type, and lower income was a significant predictor of a distant stage at diagnosis for cancers overall. These results emphasize the need for further study of the underlying causes of disparities in cancer incidence and the stage at diagnosis, as well as the need for interventions to mitigate these disparities.
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Affiliation(s)
- Su-Min Jeong
- Department of Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
- Department of Family Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Kyu-Won Jung
- National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea; (K.-W.J.); (J.P.); (N.K.)
| | - Juwon Park
- National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea; (K.-W.J.); (J.P.); (N.K.)
| | - Nayeon Kim
- National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea; (K.-W.J.); (J.P.); (N.K.)
| | - Dong Wook Shin
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, School of Medicine, Sungkyunkwan University, Seoul 16419, Republic of Korea
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea; (K.-W.J.); (J.P.); (N.K.)
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11
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Kim YJ, Park S, Kim WT, Bae YJ, Kim Y, Kang HT. Weight maintenance and gain were significantly associated with lower risk of all-cause and cancer-related mortality in Korean adults who were newly diagnosed with cancer based on the Korean NHIS-HEALS cohort. Medicine (Baltimore) 2023; 102:e36184. [PMID: 38013342 PMCID: PMC10681573 DOI: 10.1097/md.0000000000036184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/27/2023] [Indexed: 11/29/2023] Open
Abstract
The burden of malignant neoplasms is increasing worldwide. Healthy lifestyles such as maintaining a healthy body weight are important to improve survival rate in cancer patients. This study was aimed to test the hypothesis that weight change affects mortality in patients newly diagnosed with cancer. This study was retrospectively designed based on the National Health Insurance Service-National Health Screening Cohort. A total of 1856 subjects aged at least 40 years who received a national health checkup within 6 months before cancer diagnosis was included. Study subjects were classified into 3 categories based on weight change before and after cancer diagnosis: weight loss, maintenance, and gain. Cox proportional hazards regression models were adopted to examine the association between weight change and mortality after adjusting for confounders. Compared to those experiencing weight loss, the adjusted hazards ratios (HRs) (95% confidence intervals [CIs]) for those experiencing weight maintenance were 0.327 (0.189-0.568) for all-cause mortality and 0.431 (0.215-0.867) for cancer-related mortality. The adjusted HRs (95% CIs) for those experiencing weight gain were 0.149 (0.044-0.505) for all-cause mortality and 0.289 (0.080-1.045) for cancer-related mortality. After stratifying according to baseline body mass index (BMI), weight maintenance and gain were negatively associated with all-cause mortality (0.286 [0.138-0.592] for weight maintenance and 0.119 [0.027-0.533] for weight gain) among those with a BMI < 25 kg/m2. Weight maintenance and gain reduced the risk of all-cause mortality in patients newly diagnosed with any cancer. In addition, weight maintenance was significantly related to cancer-related mortality.
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Affiliation(s)
- Yong-June Kim
- Department of Urology, Chungbuk National University Hospital, Cheongju, Chungbuk, South Korea
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Chungbuk, South Korea
| | - Seung Park
- Department of Biomedical Engineering, Chungbuk National University Hospital, Cheongju, Chungbuk, South Korea
| | - Won Tae Kim
- Department of Urology, Chungbuk National University Hospital, Cheongju, Chungbuk, South Korea
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Chungbuk, South Korea
| | - Yoon-Jong Bae
- Department of Information & Statistics, Chungbuk National University College of Science, Cheongju, Chungbuk, South Korea
| | - Yonghwan Kim
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Chungbuk, South Korea
| | - Hee-Taik Kang
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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12
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Park G, Kim J, Lee SH, Kim Y. Large gastric hamartomatous inverted polyp accompanied by advanced gastric cancer: A case report. World J Clin Cases 2023; 11:6967-6973. [PMID: 37901034 PMCID: PMC10600841 DOI: 10.12998/wjcc.v11.i28.6967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 08/31/2023] [Accepted: 09/12/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Gastric hamartomatous inverted polyps (GHIPs) are benign polyps of the gastric submucosal layer. Currently there are 52 reported cases in the English literature. According to a literature review, approximately 27% of GHIPs show a coexisting carcinoma. CASE SUMMARY A 66-year-old man was referred to our institution with ulcerative lesions detected on esophagogastroduodenoscopy (EGD) during a regular check-up. Other medical findings were nonspecific. The lesions had borderline histologic features that could not exclude malignancy and were followed up with three EGDs and biopsies at intervals of 3 mo. The latest biopsy was revealed as an adenocarcinoma. A total gastrectomy was performed to remove the tumor. The surgical specimen revealed a 6.9 cm × 4.5 cm sized GHIP with a coexisting 1.6 cm sized well-differentiated adenocarcinoma which extended to the muscularis propria. The malignancy did not originate from the GHIP but showed an overlap. CONCLUSION A large GHIP, which was unusually presented as an ulcerative lesion, was surgically removed, and was accompanied by advanced gastric cancer. Regular follow-up and thorough examinations of ulcerative lesions with equivocal biopsy have resulted in appropriate diagnosis and treatment. Therefore, aggressive intervention may be beneficial if GHIP is suspected.
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Affiliation(s)
- Gyerim Park
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
| | - Jihye Kim
- Department of Internal Medicine, CHA Gangnam Medical Center, CHA University, Seoul 06135, South Korea
- Center for Health Promotion and Optimal Aging, Seoul National University Hospital, Seoul 03080, South Korea
| | - Sung Hak Lee
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
| | - Younghoon Kim
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
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13
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Jin EH, Han K, Shin CM, Lee DH, Kang SJ, Lim JH, Choi YJ. Sex and Tumor-Site Differences in the Association of Alcohol Intake With the Risk of Early-Onset Colorectal Cancer. J Clin Oncol 2023; 41:3816-3825. [PMID: 37315287 PMCID: PMC10419447 DOI: 10.1200/jco.22.01895] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 03/28/2023] [Accepted: 05/03/2023] [Indexed: 06/16/2023] Open
Abstract
PURPOSE Given the increasing incidence of early-onset colorectal cancer (CRC; diagnosed before age 50 years) worldwide, it is important to identify modifiable risk factors. We investigated whether alcohol consumption in the young population correlated with an increased early-onset CRC risk that differed by tumor location and sex. PATIENTS AND METHODS We investigated the association between average daily alcohol consumption and the risk of early-onset CRC among 5,666,576 individuals age 20-49 years using data from the Korean National Health Insurance Service (2009-2019). Alcohol consumption levels of nondrinker, light (reference), moderate, and heavy drinker were defined as 0, <10, 10 to <30, and ≥30 g/d for men and 0, <10, 10 to <20, and ≥20 g/d for women, respectively. Multivariate Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) with 95% CIs. RESULTS We identified 8,314 incident early-onset CRC cases during the follow-up period. Moderate and heavy drinkers showed an increased risk of early-onset CRC compared with light drinkers (aHR, 1.09 [95% CI, 1.02 to 1.16] and aHR, 1.20 [95% CI, 1.11 to 1.29], respectively). Subgroup analysis by tumor location showed positive dose-response significance for early-onset distal colon and rectal cancers, but not for proximal colon cancer. The dose-response association between drinking frequency and risk of early-onset CRC was significant, with a 7%, 14%, and 27% increased risk for 1-2, 3-4, and ≥5 d/wk compared with nondrinkers, respectively. CONCLUSION Excessive alcohol consumption increases the risk of CRC onset before age 50 years. Thus, effective interventions are required to discourage alcohol consumption among young people and to tailor CRC screening approaches for high-risk individuals.
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Affiliation(s)
- Eun Hyo Jin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seung Joo Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Joo Hyun Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Yoon Jin Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
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Chang Y, Jeon J, Song TJ, Kim J. Association of triglyceride/high-density lipoprotein cholesterol ratio with severe complications of COVID-19. Heliyon 2023; 9:e17428. [PMID: 37366523 PMCID: PMC10275776 DOI: 10.1016/j.heliyon.2023.e17428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus can lead to serious complications such as respiratory failure, requiring mechanical ventilation or ICU care, and can even result in death, especially in older patients with comorbidities. The ratio of triglyceride to high-density lipoprotein cholesterol (TG/HDL), a biomarker of atherosclerotic dyslipidemia and insulin resistance, is related to cardiovascular mortality and morbidity. We aimed to evaluate the link between serious complications of COVID-19 and TG/HDL in the general population. Methods We conducted a comprehensive analysis of 3,933 COVID-19 patients from a nationwide cohort in Korea spanning from January 1 to June 4, 2020. TG/HDL ratio was calculated from the national health screening examination data underwent before the COVID-19 infection. Serious complications of COVID-19 were defined as a composite of high-flow oxygen therapy, mechanical ventilation, admission to the intensive care unit (ICU), and mortality. We employed logistic regression analysis to investigate the relationship between the TG/HDL ratio and the likelihood of developing severe complications within 2 months of the diagnosis. To visualize this association, we used a smoothing spline plot based on the generalized additive regression model. Multivariate analysis was performed with adjustment for age, gender, body mass index, lifestyle measures, and comorbidities. Results Among the 3,933 COVID-19 patients, the proportion of serious complications was 7.53%. Regarding individual outcomes, the number of patients who received high-flow oxygen therapy, mechanical ventilation, ICU care, and died was 84 (2.14%), 122 (3.10%), 173 (4.40%), and 118 (3.00%), respectively. In the multivariable logistic regression, a positive association was found between TG/HDL ratio and serious complications of COVID-19 (adjusted OR, 1.09; 95% CI [1.03-1.15], p = 0.004). Conclusion Our study revealed a significant positive association between TG/HDL ratio and the risk of developing severe complications in COVID-19-infected patients. While this finding provides valuable insight into the potential prognostic role of TG/HDL ratio in COVID-19, further studies are needed to fully elucidate the underlying mechanisms behind this relationship.
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Affiliation(s)
- Yoonkyung Chang
- Department of Neurology, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Jimin Jeon
- Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Jinkwon Kim
- Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Republic of Korea
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15
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Park M, Lee JS, Kim YH. Association of physical activity, smoking, and socioeconomic factors on health checkup participation in community-dwelling stroke survivors aged 50 years or older. BMC Public Health 2023; 23:502. [PMID: 36922771 PMCID: PMC10015660 DOI: 10.1186/s12889-023-15403-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/08/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND We investigated the sociodemographic and health-related factors associated with health checkup participation in community-dwelling stroke survivors. METHODS Among participants of the Korea National Health and Nutrition Examination Survey, 642 stroke survivors were included. We investigated the sociodemographic, medical, and health-related quality of life factors-evaluated by the EuroQol 5-Dimension Questionnaire (EQ-5D)-associated with participation in any type of health checkup. To explore the associations between multiple variables and health checkup participation, a multivariable complex-sample logistic regression model was used. RESULTS One-third of the community-dwelling stroke survivors did not receive a health checkup in the past two years. Insufficient physical activity (OR: 0.5, 95% CI: 0.3-0.9), current smoking (OR: 0.4, 95% CI: 0.2-0.8), low education level (OR: 0.5, 95% CI: 0.3-0.9), living alone (OR: 0.5, 95% CI: 0.3-0.998), and no occupation (OR: 0.5, 95% CI: 0.3-0.9) showed independent negative associations with health checkup participation. Among the five EQ-5D dimensions, mobility, self-care, usual activities, and pain/discomfort dimensions were associated with health checkup participation rate. CONCLUSION Policies and further research are needed to promote health checkups for stroke survivors who are physically inactive, currently smoking, living alone, unemployed, less educated, or having extreme problems in their daily lives.
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Affiliation(s)
- Mina Park
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Soo Lee
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeo Hyung Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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16
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Disparities in the first-ever diagnosed liver cancers between the emergency department and outpatient department in Taiwan: a population-based study. BMC Public Health 2023; 23:283. [PMID: 36755232 PMCID: PMC9906857 DOI: 10.1186/s12889-023-15218-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Liver cancer is ranked fifth in incidence and second in mortality among cancers in Taiwan. Nevertheless, the Taiwan government does not screen for liver cancer in its free cancer screening and preventive health examination service. This study compared the differences in cancer stage and survival between patients who received an initial liver cancer diagnosis in outpatient departments (OPDs) and those who received such a diagnosis in emergency departments (EDs). METHODS This retrospective cohort study used the 2000-2016 National Health Insurance Database to obtain a sample from 2 million Taiwanese residents. To evaluate the effect of the utilization of the adult health examination offered to people aged ≥ 40 years, patients aged ≥ 40 years who received an initial liver cancer diagnosis between 2003 and 2015 were followed up until December 31, 2016. RESULTS In total, 2,881 patients were included in this study. A greater proportion of cancer cases in the OPD group were non-advanced than those in the ED group (75.26% vs. 54.23%). Having stage C or D cancer, having a low monthly salary, and a Charlson comorbidity index score ≥ 8, not having hepatitis B, being divorced, and attending a non-public hospital as the primary care institution were risk factors for initial ED diagnosis. The risk of liver cancer-specific death among the ED group patients was 1.38 times that among the OPD group patients (adjusted hazard ratio = 1.38, 95% confidence interval [CI] = 1.14-1.68, P < 0.001). However, the use of health examination did not exert a significant effect on the likelihood of liver cancer diagnosis in an ED (adjusted odds ratio = 0.86, 95% CI = 0.61-1.21, P = 0.381). CONCLUSION Government-subsidized health examinations are insufficient to prevent first-ever diagnosed liver cancers in EDs. Patients with liver cancers diagnosed in EDs had a higher risk of advanced stage and mortality. For early detection and treatment, the government may consider implementing liver cancer screening for high-risk and low-socioeconomic people.
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Jeong YW, Jung Y, Jeong H, Huh JH, Sung KC, Shin JH, Kim HC, Kim JY, Kang DR. Prediction Model for Hypertension and Diabetes Mellitus Using Korean Public Health Examination Data (2002–2017). Diagnostics (Basel) 2022; 12:diagnostics12081967. [PMID: 36010317 PMCID: PMC9407141 DOI: 10.3390/diagnostics12081967] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/29/2022] [Accepted: 08/13/2022] [Indexed: 11/21/2022] Open
Abstract
Hypertension and diabetes mellitus are major chronic diseases that are important factors in the management of cardiovascular disease. In order to prevent the occurrence of chronic diseases, proper health management through periodic health check-ups is necessary. The purpose of this study is to determine the incidence of hypertension and diabetes mellitus according to the health check-up, and to develop a predictive model for hypertension and diabetes according to the health check-up. We used the National Health Insurance Corporation database of Korea and checked whether hypertension or diabetes occurred from that date according to the number of health check-ups over the past 10 years. Compared to those who underwent five health check-ups, those who participated in the first screening had hypertension (OR = 2.18, 95% CI = 2.14–2.22), diabetes mellitus (OR = 1.33, 95% CI = 1.30–1.35) and both diseases (OR = 2.46, 95% CI = 2.39–2.53); individuals who underwent 10 screenings had hypertension (OR = 0.86, 95% CI = 0.83–0.88), diabetes mellitus (OR = 0.83, 95% CI = 0.81–0.85) and both diseases (OR = 0.83, 95% CI = 0.79–0.87). Individuals who attended fewer than five screenings compared with individuals who attended five or more screenings had hypertension (OR = 1.61, 95% CI = 1.59–1.62; AUC = 0.66), diabetes mellitus (OR = 1.21, 95% CI = 1.20–1.22; AUC = 0.59) and both diseases (OR = 1.75, 95% CI = 1.72–1.78, AUC = 0.63). The machine learning-based prediction model using XGBoost showed higher performance in all datasets than the conventional logistic regression model in predicting hypertension (accuracy, 0.828 vs. 0.628; F1-score, 0.800 vs. 0.633; AUC, 828 vs. 0.630), diabetes mellitus (accuracy, 0.707 vs. 0.575; F1-score, 0.663 vs. 0.576; AUC, 0.710 vs. 0.575) and both diseases (accuracy, 0.950 vs. 0.612; F1-score, 0.950 vs. 0.614; AUC, 0.952 vs. 0.612). It was found that health check-up had a great influence on the occurrence of hypertension and diabetes, and screening frequency was more important than other factors in the variable importances.
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Affiliation(s)
- Yong Whi Jeong
- Department of Biostatistics, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
| | - Yeojin Jung
- Department of Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
| | - Hoyeon Jeong
- Department of Biostatistics, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
| | - Ji Hye Huh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea
| | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul 04763, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Jang Young Kim
- Division of Cardiology, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
| | - Dae Ryong Kang
- Department of Biostatistics, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
- Department of Precision Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
- Correspondence: ; Tel.: +82-33-0391
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