• 한국임상약학회지
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• 제29권2호
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• pp.109-114
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• 2019

Background: Rheumatoid arthritis (RA) is a systemic inflammatory disease that manifests as joint damage or athletic disability via sustained inflammation of the synovial membrane. The risk of cardiovascular disease (CVD) is higher in RA patients. This study aimed at evaluating the association between CVD comorbidities and RA by comparing a pharmacotherapy group with a non-pharmacotherapy group. Methods: Patient sample data from the Health Insurance Review and Assessment Service (HIRA-NPS-2016) were used. Inverse probability of treatment weighting (IPTW) using the propensity score was used to minimize the differences in patient characteristics. Logistic regression analysis was used to evaluate the risk of CVD comorbidities. Results: The analyses included 1,207,213 patients, of which 33,122 (2.8%) had RA. The odds ratios (OR) of CVD comorbidities were increased in RA patients; ischemic heart disease (IHD: OR 1.75; 95% CI 1.73, 1.77), cerebral infarction (CERI: OR 1.28; 95% CI 1.26, 1.30), hypertension (HTN: OR 1.44; 95% CI 1.43, 1.45), diabetes mellitus (DM: OR 2.04; 95% CI 2.03, 2.06), and dyslipidemia (DL: OR 3.49; 95% CI 3.47, 3.51). The ORs of IHD, CERI, HTN, and DM in the traditional DMARD and biologic treatment groups were decreased, compared with those in the non-pharmacotherapy group. Conclusions: Thus, CVD risk was higher in RA patients, considering age, sex, and socioeconomic status. Appropriate pharmacotherapy could decrease the risk of CVD comorbidities in RA patients.

• 한국임상약학회지
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• 제32권3호
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• pp.178-184
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• 2022

Background: Migraine is one of the leading causes of poor quality of life and disability, and migraine incidences in pediatrics are increasing. Proper medication is important for the preventive and acute treatment of migraine. This study aimed to identify the current status of prescribed medication in pediatric patients with migraine. Methods: We used data from a sample of pediatric patients from the Health Insurance Review and Assessment Service (HIRA-PPS-2018) and analyzed the status of prescription drugs and frequency of visits to medical institutions with migraine diagnoses in pediatric patients. Results: A total of 12,228 pediatric patients diagnosed with migraine during 2018 were analyzed. Among these patients, 7,170 (58.64%) were girls and 9,510 (77.77%) were adolescents. Additionally, 9,157 patients (74.89%) received acute treatment, and 592 patients (4.84%) received combination therapy with analgesics and triptans. Acetaminophen for acute treatment and flunarizine for preventive treatment were the most commonly prescribed. In most children and adolescents, acute treatment drugs were prescribed for less than 14 days. Conclusion: Analgesics, such as acetaminophen or non-steroidal anti-inflammatory drugs, were prescribed frequently for acute treatment in pediatric patients with migraine. The drug prescription duration was within the recommended range, indicating a low risk of overdose. For preventive treatment, clinically studied medication for pediatric patients with migraine was used.

• 보건행정학회지
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• 제26권4호
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• pp.359-372
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• 2016

Background: The purpose of this study was to develop risk-adjustment models for acute stroke mortality that were based on data from Health Insurance Review and Assessment Service (HIRA) dataset and to evaluate the validity of these models for comparing hospital performance. Methods: We identified prognostic factors of acute stroke mortality through literature review. On the basis of the avaliable data, the following factors was included in risk adjustment models: age, sex, stroke subtype, stroke severity, and comorbid conditions. Survey data in 2014 was used for development and 2012 dataset was analysed for validation. Prediction models of acute stroke mortality by stroke type were developed using logistic regression. Model performance was evaluated using C-statistics, $R^2$ values, and Hosmer-Lemeshow goodness-of-fit statistics. Results: We excluded some of the clinical factors such as mental status, vital sign, and lab finding from risk adjustment model because there is no avaliable data. The ischemic stroke model with age, sex, and stroke severity (categorical) showed good performance (C-statistic=0.881, Hosmer-Lemeshow test p=0.371). The hemorrhagic stroke model with age, sex, stroke subtype, and stroke severity (categorical) also showed good performance (C-statistic=0.867, Hosmer-Lemeshow test p=0.850). Conclusion: Among risk adjustment models we recommend the model including age, sex, stroke severity, and stroke subtype for HIRA assessment. However, this model may be inappropriate for comparing hospital performance due to several methodological weaknesses such as lack of clinical information, variations across hospitals in the coding of comorbidities, inability to discriminate between comorbidity and complication, missing of stroke severity, and small case number of hospitals. Therefore, further studies are needed to enhance the validity of the risk adjustment model of acute stroke mortality.

• 대한소아치과학회지
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• 제47권3호
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• pp.277-292
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• 2020

유치 및 미성숙영구치의 치수치료는 소아 및 청소년 영역에서 빈번하게 행하지는 치료이며, 임상 양상과 치수 진단 뿐만 아니라 환아 및 보호자, 술자의 환경에 영향을 받는다. 이 연구의 목적은 실제 임상에서 행해지는 치수치료의 현황에 대한 조사와 더불어 치료방법을 선택하게 된 배경에 대해 조사하는 것이다. 이 연구는 소아치과학회 회원을 대상으로 총 153명의 설문조사 결과지를 바탕으로 시행되었으며, 2010년부터 2018년까지의 건강보험심사평가원의 통계자료를 함께 분석하였다. 설문조사 결과와 건강보험심사평가원의 통계자료 모두 유치의 1-visit pulpectomy가 가장 활발하게 시행되고 있는 술식으로 나타났으며, 유치열기 또는 혼합치열기 어린이에서 Ni-Ti file의 사용 빈도가 증가하였다. 미성숙영구치의 치료에서는 개인치과의원에서 치수재생치료의 시행 빈도가 대학병원보다 낮은 것으로 나타났다.

• 응용통계연구
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• 제33권5호
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• pp.627-637
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• 2020

본 논문에서는 건강보험심사평가원에서 제공한 약 120만명의 2014년 고령환자의료자료(HIRA-APS-2014-0053)과 기상자료를 일반화추정방정식(generalized estimating equation; GEE) 모형과 long short term memory (LSTM) 기반 순환신경망(recurrent neural network; RNN) 모형으로 분석하여 기상 조건에 따른 주요 주상병의 발생 빈도를 예측한다. 이를 위해 환자가 의료 서비스를 받은 기관의 지역을 이용하여 환자의 거주지를 추정하고 해당 지역의 주별 기상 관측소 자료와 의료자료를 병합하였다. 질병 발생 상태를 세 개의 범주(질병에 걸리지 않음, 관심 주상병 발생, 다른 질병 방생)로 나누었으며 각 범주에 속할 확률을 GEE 모형과 RNN 모형으로 추정하였다. 각 범주별 발생 건수는 해당 범주의 속할 추정확률의 합으로 계산하였으며 비교분석결과 RNN을 이용한 예측이 GEE를 이용한 예측보다 정확도가 높은 것으로 나타났다.

• Tuberculosis and Respiratory Diseases
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• 제73권1호
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• pp.48-55
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• 2012

Background: The epidemiology of tuberculosis (TB) has been assessed based on the data of the analysis of TB patients notified to the surveillance system in Korea. However, the national status of TB is not validated through this surveillance system. The objective is to determine the epidemiology of TB and to understand the accurate status of TB patients treated in private institutions. Methods: Medical records of 53,579 patients who had been diagnosed with TB in 2008 were analyzed. Results: Among 53,579 patients, the number of sputum smear positive cases was 15,639(29.2%) and the number of new cases was 39,191 (73.1%). The drug resistance rate of new cases was 5.3%, while the rate stood at 13.3% for TB patients with treatment history. The number of multi-drug resistant TB (MDR-TB) patients was 2,472 (4.6%), which consists of 2.9% of new cases and 9.3% of TB patients with prior treatment history. The number of extensively drug-resistant TB patients was 749 (1.4%), consisting of 1.1% of new cases and 2.2% of TB patients with prior treatment history. In terms of treatment outcomes, 66.4% of all TB patients, 70.5% of new cases, 64.4% of relapse cases, and 46.8% of MDR-TB cases were cured or completed. It was inferred that in 2008, the total number of TB patients reached 70,767, 145.6 per 100,000 people (95% confidence interval, 145.5~145.7). Conclusion: We conclude that the medical records review of the Health Insurance Review and Assessment Service (HIRA) data can be very effective in promoting the understanding of the current status of TB in private institutions.

• 한국임상약학회지
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• 제30권4호
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• pp.264-269
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• 2020

Background: Inflammatory diseases can increase the prevalence of anemia. Recent studies confirmed that the prevalence of anemia is increased by atopic dermatitis (AD), a chronic inflammatory disease. Therefore, we aimed to elucidate the correlation between AD severity and prevalence of anemia. Methods: We used data of pediatric patients from the Health Insurance Review and Assessment Service (HIRA-PPS-2016). We included pediatric patients (<18 years) with AD diagnosis who were prescribed medications for AD. We applied a propensity score method with inverse probability of treatment weighting (IPTW) adjusting for differences in prevalence of confounders and performed IPTW logistic regression to evaluate associations between the anemia and severity of AD. Results: In total, 91,501 patients (mild AD: 47,054 patients; moderate-to-severe AD: 44,447 patients) <18 years who were prescribed drugs for AD were analyzed. Analysis of the probability of patients with mild AD and prevalence of anemia as a reference revealed an odds ratio (OR) of 1.159 (95% CI, 1.109-1.212; p<0.001) in moderate-to-severe AD patients, indicating a correlation between anemia prevalence and AD severity. Subgroup analysis according to gender, age group, and type of health insurance revealed there was an association between AD severity and anemia except in patients equal or older than 7 years. Conclusion: The prevalence of anemia increased with AD severity despite adjusting for confounding factors. Our results support the hypothesis that AD can cause anemia, and anemia prevalence could be increased in severe AD patients. Further studies are needed to establish a pathological basis.

• 한국임상약학회지
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• 제32권3호
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• pp.155-165
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• 2022

Background: Chronic obstructive pulmonary disease (COPD) is not completely reversible and requires long-term management with appropriate treatment. This study aimed to analyze trends in treatment regimens and medication costs for COPD patients using a national claims database. Methods: We conducted this analysis using National Patient Sample data from the Health Insurance Review and Assessment Service covering the period from 2015 to 2018. We have constructed a dataset comprising COPD disease classification codes J43.x and J44.x (based on KCD-7 code, J43.0 was excluded) and compiled a list of drugs fitting current guidelines. To identify trends, we calculated frequency, ratio, and compound annual growth rate (CAGR) using the numbers of prescriptions and patients. Results: The number of COPD patients was 7,260 in 2018, slightly decreased from 2015. Most of these COPD patients were aged 60 or older and included a high proportion of males (72.2%; 2018). The number of patients prescribed inhaled medications increased gradually from 2015 to 2018 (9,227 (47.1%); 2015, 9,285 (51.5%); 2018), while the number of patients prescribed systemic beta-agonists and Xanthines has decreased since 2015 (CAGR -14.7; systemic beta-agonist, -5.8; Xanthines). The per capita cost of medication has increased by 0.4% (KRW 206,667; 2018, KRW 204,278; 2015) annually during the study period. Conclusion: This study showed that treatment with inhaled medications had continuously increased in accord with changing guidelines, but oral medications were still widely used. It is necessary to emphasize the importance of inhaled medications in treating COPD to reduce additional economic burden through appropriate medication use.

• Parasites, Hosts and Diseases
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• 제60권4호
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• pp.261-271
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• 2022

This study provides an overview of the current status of clonorchiasis and cholangiocarcinoma (CCA), and their relationship in Korea during 2012-2020. Data were obtained from the Health Insurance Review & Assessment Service of Korea. Cluster, trend, and correlation analyses were performed. Gyeongsangnam-do and Seoul had the highest average number of cases (1,026 and 4,208) and adjusted rate (306 and 424) for clonorchiasis and CCA, respectively. The most likely clusters (MLC) for clonorchiasis and CCA were Busan/Gyeongsangnam-do/Ulsan/Daegu/Gyeongsangbuk-do (Relative Risk; RR=4.55, Likelihood Ratio; LLR=9,131.115) joint cluster and Seoul (RR=2.29, LLR=7,602.472), respectively. The MLC for clonorchiasis was in the southeastern part of Korea, while that for CCA was in the southern part. Clonorchiasis showed a decreasing trend in the southeastern districts, while increased in the southwestern districts. Cities in the central region had a decreasing trend, while the western districts had an increasing trend. In most adults (30-59), infection rate of clonorchiasis showed a significant decrease until 2018, while thereafter increased, although not significant. CCA showed a sharply decreasing tendency. The incidence of clonorchiasis and CCA were positively correlated. In general, the correlation was weak (r=0.39, P<0.001), but it was strongly positive around the 4 river basins (r=0.74, P<0.001). This study might provide an analytic basis for developing an effective system against clonorchiasis and CCA.

• 한방재활의학과학회지
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• 제31권4호
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• pp.105-116
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• 2021

Objectives Lumbar herniated intervertebral disc (L-HIVD) is common disease in which Western-Korean collaborative treatment is performed in Korea. This study aimed to analyze Western-Korean collaborative treatment utilization of Korean patients with L-HIVD using Health Insurance Review & Assessment Service's Patients Sample Data. Methods This study used the Health Insurance Review & Assessment Service-National Patient Sample (HIRA-NPS) in 2018. Claim data of L-HIVD patients were extracted. The claim data were rebuilt with the operational concept of 'episode of care' and divided into Korean medicine episode group (KM), Western medicine episode group (WM) and collaborative treatment episode group (CT). General characteristics, medical expenses and healthcare utilization were analyzed. In addition, the difference of average visit day and average medical expenses between non-collaborative group (KM plus WM) and CT were analyzed by the propensity score matching method. Results A Total of 64,333 patients and 365,745 claims were extracted. The number of episodes of WM, KM and CT was 69,383 (92.97%), 3,903 (5.23%), and 1,341 (1.80%) respectively. The frequency of collaborative treatment episode was higher in women and the age of 50s. The most frequently described treatment in CT was acupuncture therapy. As a result of the propensity score matching, the number of visit days and medical expenses in the collaborative treatment group was higher than in the non-collaborative group. Conclusions The analysis of healthcare utilization of Korean-Western collaborative treatment may be used as basic data for establishing medical policies and systematic collaborative treatment model in the future.