Journal of Preventive Medicine and Public Health

  • 제57권3호
  • /
  • Pages.260-268
  • /
  • 2024
  • /
  • 1975-8375(pISSN)
  • /
  • 2233-4521(eISSN)
대한예방의학회 (The Korean Society for Preventive Medicine)
권호 표지
DOI QR코드

DOI QR Code

Trends in Regional Disparities in Cardiovascular Surgery and Mortality in Korea: A National Cross-sectional Study

  • Dal-Lae Jin (Department of Public Health, Graduate School of Korea University) ;
  • Kyoung-Hoon Kim (Department of Health Administration, College of Nursing and Health, Kongju National University) ;
  • Euy Suk Chung (Department of Thoracic and Cardiovascular Surgery, Kangbuk Samsung Hospital) ;
  • Seok-Jun Yoon (Department of Preventive Medicine, Korea University College of Medicine)
  • 투고 : 2024.01.30
  • 심사 : 2024.04.01
  • 발행 : 2024.05.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objectives: Regional disparities in cardiovascular care in Korea have led to uneven patient outcomes. Despite the growing need for and access to procedures, few studies have linked regional service availability to mortality rates. This study analyzed regional variation in the utilization of major cardiovascular procedures and their associations with short-term mortality to provide better evidence regarding the relationship between healthcare resource distribution and patient survival. Methods: A cross-sectional study was conducted using nationwide claims data for patients who underwent coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), stent insertion, or aortic aneurysm resection in 2022. Regional variation was assessed by the relevance index (RI). The associations between the regional RI and 30-day mortality were analyzed. Results: The RI was lowest for aortic aneurysm resection (mean, 26.2; standard deviation, 26.1), indicating the most uneven regional distribution among the surgical procedures. Patients undergoing this procedure in regions with higher RIs showed significantly lower 30-day mortality (adjusted odds ratio [aOR], 0.73; 95% confidence interval, 0.55 to 0.96; p=0.026) versus those with lower RIs. This suggests that cardiovascular surgery regional availability, as measured by RI, has an impact on mortality rates for certain complex surgical procedures. The RI was not associated with significant mortality differences for more widely available procedures like CABG (aOR, 0.96), PCI (aOR, 1.00), or stent insertion (aOR, 0.91). Conclusions: Significant regional variation and underutilization of cardiovascular surgery were found, with reduced access linked to worse mortality for complex procedures. Disparities should be addressed through collaboration among hospitals and policy efforts to improve outcomes.

키워드

과제정보

This research was supported by a grant from the Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (grant No. HC21C0114).

참고문헌

  1. Statistics Korea. 2022 Cause of death statistics results; 2023 [cited 2023 Nov 28]. Available from: https://kostat.go.kr/board.es?mid=a10301060200&bid=218&act=view&list_no=427216 (Korean). 
  2. Kim HC. Epidemiology of cardiovascular disease and its risk factors in Korea. Glob Health Med 2021;3(3):134-141. https://doi.org/10.35772/ghm.2021.01008 
  3. Jeong JO. Regional cardiocerebrovascular center project in the treatment of acute myocardial infarction. Korean J Med 2013;85(3):272-274 (Korean). https://doi.org/10.3904/kjm.2013.85.3.272 
  4. Wang JM, Kim BO, Bae JW, Oh DJ. Implementation of national health policy for the prevention and control of cardiovascular disease in South Korea: regional-local cardio-cerebrovascular center and nationwide registry. Korean Circ J 2021;51(5):383-398. https://doi.org/10.4070/kcj.2021.0001 
  5. Kim C, Sung J, Han JY, Jee S, Lee JW, Lee JH, et al. Current status of cardiac rehabilitation in the regional cardiocerebrovascular centers in Korea. J Clin Med 2021;10(21):5079. https://doi.org/10.3390/jcm10215079 
  6. Mehra R. Global public health problem of sudden cardiac death. J Electrocardiol 2007;40(6 Suppl):S118-S122. https://doi.org/10.1016/j.jelectrocard.2007.06.023 
  7. McClellan M, Brown N, Califf RM, Warner JJ. Call to action: urgent challenges in cardiovascular disease: a presidential advisory from the American Heart Association. Circulation 2019; 139(9):e44-e54. https://doi.org/10.1161/CIR.0000000000000652 
  8. Zhao D. Epidemiological features of cardiovascular disease in Asia. JACC Asia 2021;1(1):1-13. https://doi.org/10.1016/j.jacasi.2021.04.007 
  9. Enyeji AM, Barengo NC, Ramirez G, Ibrahimou B, Arrieta A. Regional variation in health care utilization among adults with inadequate cardiovascular health in the USA. Cureus 2023;15(8):e44121. https://doi.org/10.7759/cureus.44121 
  10. Kim M, Yoon SJ, Choi JS, Kim MJ, Sim SB, Lee KS, et al. Imbalance in cardiovascular surgery medical service use between regions. Korean J Thorac Cardiovasc Surg 2016;49(Suppl 1):S14-S19. https://doi.org/10.5090/kjtcs.2016.49.S1.S14 
  11. Fairfield KM, Black AW, Lucas FL, Siewers AE, Cohen MC, Healey CT, et al. Behavioral risk factors and regional variation in cardiovascular health care and death. Am J Prev Med 2018;54(3):376-384. https://doi.org/10.1016/j.amepre.2017.11.011 
  12. Kim E, Baek J, Kim M, Lee H, Bae JW, Kim HC. Trends in regional disparity in cardiovascular mortality in Korea, 1983-2019. Korean Circ J 2022;52(11):829-843. https://doi.org/10.4070/kcj.2022.0156 
  13. Do YK. Development of a medical usage prediction model for health insurance subscribers (phase 2). Wonju: Health Insurance Review & Assessment Service; 2021 (Korean). 
  14. Parcha V, Kalra R, Suri SS, Malla G, Wang TJ, Arora G, et al. Geographic variation in cardiovascular health among American adults. Mayo Clin Proc 2021;96(7):1770-1781. https://doi.org/10.1016/j.mayocp.2020.12.034 
  15. Shin H, Seo J, Roh Y. The relationship between accessibility to local cardio-cerebrovascular disease centers and mortality ratio. Health Soc Welf Rev 2023;43(1):85-100 (Korean). https://doi.org/10.15709/HSWR.2023.43.1.85 
  16. Lee HY, Park MY. Analysis of the emergency medical service area using GIS: the case of Seoul. J GIS Assoc Korea 2004;12(2):193-209 (Korean). 
  17. Kim YE, Pyo J, Lee H, Jeong H, Park YK, Seo JW, et al. Relevance index regional variation by each disease and its essential medical field: a retrospective data analysis from 2016-2020 in Korea. J Korean Med Sci 2023;38(16):e130. https://doi.org/10.3346/jkms.2023.38.e130 
  18. Lim K, Moon H, Park JS, Cho YR, Park K, Park TH, et al. The Busan Regional CardioCerebroVascular Center project's experience over a decade in the treatment of ST-segment elevation myocardial infarction. J Prev Med Public Health 2022;55(4):351-359. https://doi.org/10.3961/jpmph.22.071 
  19. Han SJ, Kim KH. Adjusting for confounders in outcome studies using the Korea National Health Insurance claim database: a review of methods and applications. J Prev Med Public Health 2024;57(1):1-7. https://doi.org/10.3961/jpmph.23.250 
  20. Park YK, Pyo J, Kim YE, Ock M, Yoon SJ. Analysis of relevance index by essential medical service field: a preliminary study on Ulsan metropolitan city. Korean Public Health Res 2021;47(2):133-148 (Korean). https://doi.org/10.22900/kphr.2021.47.2.012 
  21. Korean Law Information Center. Enforce-ment Rules of the Emergency Medical Services Act: Article 13 (standards, methods and procedures for designation of re-gional emergency medical centers) [cited 2024 May 20]. Available from: https://www.law.go.kr/LSW/lsInfoP.do?lsiSeq=260645#0000 (Korean). 
  22. Levaillant M, Marcilly R, Levaillant L, Michel P, Hamel-Broza JF, Vallet B, et al. Assessing the hospital volume-outcome relationship in surgery: a scoping review. BMC Med Res Methodol 2021;21(1):204. https://doi.org/10.1186/s12874-021-01396-6 
  23. Moon SJ, Kim KH, Lee JC, Park JH, Lim SM. Research on policy measures to revitalize essential medical care. Seoul: KMA Research Institute Health Care Policy; 2023 (Korean). 
  24. Go MH. Essential medical resident recruitment rate plummets from 95% to 78.5% in six years, leading to longer wait times for treatment. Yonhapnews; 2023 Jan 12 [cited 2023 Nov 28]. Available from: https://www.yna.co.kr/view/AKR20230112109700530 (Korean). 
  25. Park E. Severe medical staff shortage in gangwon province: no doctors in emergency rooms and health centers [cited 2023 Nov 28]. Available from: https://www.medipana.com/article/view.php?page=1&sch_menu=1&sch_cate=B&news_idx=308161 
  26. Lee SM. Essential health care. J Korean Med Assoc 2019;62(4): 231-237 (Korean). https://doi.org/10.5124/jkma.2019.62.4.231 
  27. National Health Insurance Service. Statistical yearbook on the usage of medical services by region 2022; 2023 [cited 2023 Nov 28]. Available from: https://www.nhis.or.kr/nhis/together/wbhaec06900m01.do?mode=view&articleNo=10839502&article.offset=0&articleLimit=10 (Korean). 
  28. Ministry of Health and Welfare. The 2nd comprehensive plan for prevention and management of cerebrovascular and cardiovascular diseases (2023-2027) [cited 2023 Nov 28]. Available from: https://www.mohw.go.kr/board.es?mid=a10107010100&bid=0043&act=view&list_no=1479239&tag=&cg_code=&list_depth=1 (Korean). 
  29. Ministry of Health and Welfare. Enhancing timely treatment for severe and emergency cardiovascular and cerebrovascular diseases through networks: announcement of the second comprehensive plan for cardiovascular and cerebrovascular disease management, '23-'27; 2023 [cited 2023 Nov 28]. Available from: https://www.mohw.go.kr/board.es?mid=a10503010300&bid=0027&act=view&list_no=377529&tag=&nPage=1 (Korean). 
  30. Park EH, Hwang SS, Oh J, Kim BJ, Bae HJ, Yang KH, et al. Annual endovascular thrombectomy case volume and thrombectomy-capable hospitals of Korea in acute stroke care. J Prev Med Public Health 2023;56(2):145-153. https://doi.org/10.3961/jpmph.22.318 
  31. Health Insurance Review & Assessment Service. 2020 (8th) coronary artery bypass surgery appropriateness evaluation report. Wonju: Health Insurance Review & Assessment Service; 2023 (Korean). 
  32. Jang JS, Han KR, Moon KW, Jeon DW, Shin DH, Kim JS, et al. The current status of percutaneous coronary intervention in Korea: based on year 2014 cohort of Korean percutaneous coronary intervention (K-PCI) registry. Korean Circ J 2017;47(3):328-340. https://doi.org/10.4070/kcj.2017.0071