• Journal of dental hygiene science
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• v.24 no.1
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• pp.22-28
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• 2024

Background: Particulate matter (PM) has been extensively observed due to its negative association with human health. Previous research revealed the possible negative effect of air pollutant exposure on oral health. However, the predictive model between air pollutant exposure and the prevalence of periodontitis has not been observed yet. Therefore, this study aims to propose a predictive model for the number of patients with periodontitis exposed to PM and atmospheric factors in South Korea using deep learning. Methods: This study is a retrospective cohort study utilizing secondary data from the Korean Statistical Information Service and the Health Insurance Review and Assessment database for air pollution and the number of patients with periodontitis, respectively. Data from 2015 to 2022 were collected and consolidated every month, organized by region. Following data matching and management, the deep neural networks (DNN) model was applied, and the mean absolute percentage error (MAPE) value was calculated to ensure the accuracy of the model. Results: As we evaluated the DNN model with MAPE, the multivariate model of air pollution including exposure to PM_2.5, PM₁₀, and other atmospheric factors predict approximately 85% of the number of patients with periodontitis. The MAPE value ranged from 12.85 to 17.10 (mean±standard deviation=14.12±1.30), indicating a commendable level of accuracy. Conclusion: In this study, the predictive model for the number of patients with periodontitis is developed based on air pollution, including exposure to PM_2.5, PM₁₀, and other atmospheric factors. Additionally, various relevant factors are incorporated into the developed predictive model to elucidate specific causal relationships. It is anticipated that future research will lead to the development of a more accurate model for predicting the number of patients with periodontitis.

• Tuberculosis and Respiratory Diseases
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• v.78 no.4
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• pp.349-355
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• 2015

Background: The tuberculin skin test (TST) is the standard tool to diagnose latent tuberculosis infection (LTBI) in mass screening. The aim of this study is to find an optimal cut-off point of the TST+ rate within tuberculosis (TB) contacts to predict the active TB development among adolescents in school TB outbreaks. Methods: The Korean National Health Insurance Review and Assessment database was used to identify active TB development in relation to the initial TST (cut-off, 10 mm). The 7,475 contacts in 89 schools were divided into two groups: Incident TB group (43 schools) and no incident TB group (46 schools). LTBI treatment was initiated in 607 of the 1,761 TST+ contacts. The association with active TB progression was examined at different cut-off points of the TST+ rate. Results: The mean duration of follow-up was $3.9{\pm}0.9years$. Thirty-three contacts developed active TB during the 4,504 person-years among the TST+ contacts without LTBI treatment (n=1,154). The average TST+ rate for the incident TB group (n=43) and no incident TB group (n=46) were 31.0% and 15.5%, respectively. The TST+ rate per group was related with TB progression (odds ratio [OR], 1.025; 95% confidence interval [CI], 1.001-1.050; p=0.037). Based on the TST+ rate per group, active TB was best predicted at TST+ ${\geq}$ 16% (OR, 3.11; 95% CI, 1.29-7.51; area under curve, 0.64). Conclusion: Sixteen percent of the TST+ rate per group within the same grade students can be suggested as an optimal cut-off to predict active TB development in middle and high schools TB outbreaks.

• Journal of Preventive Medicine and Public Health
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• v.45 no.4
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• pp.219-226
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• 2012

Objectives: To evaluate the risk of fractures related with zolpidem in elderly insomnia patients. Methods: Health claims data on the entire South Korean elderly population from January 2005 to June 2006 were extracted from the Health Insurance Review and Assessment Service database. We applied a case-crossover design. Cases were defined as insomnia patients who had a fracture diagnosis. We set the hazard period of 1 day length prior to the fracture date and four control periods of the same length at 5, 10, 15, and 20 weeks prior to the fracture date. Time independent confounding factors such as age, gender, lifestyle, cognitive function level, mobility, socioeconomic status, residential environment, and comorbidity could be controlled using the case-crossover design. Time dependent confounding factors, especially co-medication of patients during the study period, were adjusted by conditional logistic regression analysis. The odds ratios and their 95% confidence intervals (CIs) were estimated for the risk of fracture related to zolpidem. Results: One thousand five hundred and eight cases of fracture were detected in insomnia patients during the study period. In our data, the use of zolpidem increased the risk of fracture significantly (adjusted odds ratio [aOR], 1.72; 95% CI, 1.37 to 2.16). However, the association between benzodiazepine hypnotics and the risk of fracture was not statistically significant (aOR, 1.00; 95% CI, 0.83 to 1.21). Likewise, the results were not statistically significant in stratified analysis with each benzodiazepine generic subgroup. Conclusions: Zolpidem could increase the risk of fracture in elderly insomnia patients. Therefore zolpidem should be prescribed carefully and the elderly should be provided with sufficient patient education.

• Journal of Preventive Medicine and Public Health
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• v.47 no.1
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• pp.36-46
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• 2014

Objectives: To evaluate the association between fracture risk and levothyroxine use in elderly women with hypothyroidism, according to previous osteoporosis history. Methods: We conducted a cohort study from the Korean Health Insurance Review and Assessment Service claims database from January 2005 to June 2006. The study population comprised women aged ${\geq}65$ years who had been diagnosed with hypothyroidism and prescribed levothyroxine monotherapy. We excluded patients who met any of the following criteria: previous fracture history, hyperthyroidism, thyroid cancer, or pituitary disorder; low levothyroxine adherence; or a follow-up period <90 days. We categorized the daily levothyroxine doses into 4 groups: ${\leq}50{\mu}g/d$, 51 to $100{\mu}g/d$, 101 to $150{\mu}g/d$, and > $150{\mu}g/d$. The hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated with the Cox proportional hazard model, and subgroup analyses were performed according to the osteoporosis history and osteoporosis-specific drug prescription status. Results: Among 11 155 cohort participants, 35.6% had previous histories of osteoporosis. The adjusted HR of fracture for the > $150{\mu}g/d$ group, compared with the 51 to $100{\mu}g/d$ group, was 1.56 (95% CI, 1.03 to 2.37) in osteoporosis subgroup. In the highly probable osteoporosis subgroup, restricted to patients who were concurrently prescribed osteoporosis-specific drugs, the adjusted HR of fracture for the > $150{\mu}g/d$ group, compared with the 51 to 100 ${\mu}g/d$ group, was 1.93 (95% CI, 1.14 to 3.26). Conclusions: While further studies are needed, physicians should be concerned about potential levothyroxine overtreatment in elderly osteoporosis patients.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.12 no.3
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• pp.1234-1243
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• 2011

Our study was carried out to develop the severity-adjustment model for length of stay in hospital for community-acquired pneumonia so that we analysed the factors on the variation in length of stay(LOS). The subjects were 5,353 community-acquired pneumonia inpatients of the Korean National Hospital Discharge In-depth Injury Survey data from 2004 through 2006. The data were analyzed using t-test and ANOVA and the severity-adjustment model was developed using data mining technique. There are differences according to gender, age, type of insurance, type of admission, but there is no difference of whether patients died in hospital. After yielding the standardized value of the difference between crude and expected length of stay, we analysed the variation of length of stay for community-acquired pneumonia. There was variation of LOS in regional differences and insurance type, though there was no variation according whether patients receive their care in their residences. The variation of length of stay controlling the case mix or severity of illness can be explained the factors of provider. This supply factors in LOS variations should be more studied for individual practice style or patient management practices and healthcare resources or environment. We expect that the severity-adjustment model using administrative databases should be more adapted in other diseases in practical.

• Journal of Preventive Medicine and Public Health
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• v.43 no.6
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• pp.523-534
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• 2010

Objectives: We assessed impact of performance reporting information about the readmission rate, length of stay and cost of hip hemiarthroplasty. Methods: The data are from a nationwide claims database, National Quality Improvement Project database, of Health Insurance Review & Assessment Service in Korea. From January 2006 to April 2008, we received information of length of stay, readmission within 30 days, cost of 22 851 hip hemiarthroplasty episodes. Each episodes has retained the diagnoses of comorbidities and demographics. We used time-series analysis to assess the shifting of patients selections, between high volume (over 16 operations in a year) and low volume institutions, after performance reporting (December 2007). The changes of quality (readmission, length of stay) and cost were evaluated by multilevel analysis with adjustment of patient's factors and institutional factors after performance reporting. Results: As compared with the before performance reporting, the proportion of patients who choose the high volume institution, increased 3.45% and the trends continued 4 months at marginal significance (p = 0.059). After performance reporting, national average readmission rate, length of stay were decreased by 0.49 OR (95% CI=0.25 - 0.95) and 10% (${\beta}$=-0.102, p<0.01) and cost was not changed (${\beta}$=-0.01, p=0.27). The high volume institutions were more decreased than low volume in length of stay. Conclusions: After performance reporting, readmission rate, length of stay were decreased and the patient selections were marginally shifted from low volume institutions to high volume institutions.

• Health Policy and Management
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• v.26 no.2
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• pp.135-147
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• 2016

Background: The voluntary diagnosis-related groups (DRG)-based payment system was introduced in 2002 and the government mandated participation in the DRG for all hospitals from July 2013. The main purpose of this study is to examine the independent effect of mandatory participation in DRG on various outcomes of patients. Methods: This study collected 1,809,948 inpatient DRG data from the Health Insurance Review and Assessment database which contains medical information for all patients for the period 2007 to 2014 and examined patient outcomes such as length of stay (LOS), total medical cost, spillover, and readmission rate according to hospital size. Results: LOS of patients decreased after DRGs (large hospitals: adjusted odds ratio [aOR], 0.87; 95% confidence interval [CI], 0.78-0.97; small hospitals: aOR, 0.91; 95% CI, 0.91-0.92). The total medical cost of patients increased after DRGs (large hospitals: aOR, 1.22; 95% CI, 1.14-1.30; small hospitals: aOR, 1.22; 95% CI, 1.21-1.23). The results reveals that spillover of patients increased after DRGs (large hospitals: aOR, 1.27; 95% CI, 0.70-2.33; small hospitals: aOR, 1.18; 95% CI, 1.16-1.20). Finally, we found that readmission rates of patients decreased significantly after DRGs (large hospitals: aOR, 0.28; 95% CI, 0.26-0.29; small hospitals: aOR, 0.59; 95% CI, 0.56-0.63). Conclusion: The DRG payment system compared to fee-for-service payment in South Korea may be an alternative medical price policy which can reduce the LOS. However, government need to monitor inappropriate changes such as spillover increase. Since this study also is the results based on relatively simple surgery, insurer needs to compare or review bundled payment like new DRG for expansion of various inpatient-related diseases including internal medicine.

• Journal of Acupuncture Research
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• v.27 no.2
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• pp.43-49
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• 2010

Objectives : Among young generation, the prevalence of spinal disorders is known to be increasing. This study aimed to analyze the clinical data of spinal disorder in young ages in Korea. Methods : Number of patient, kinds of disorder, and medical cost were analyzed for patients(7~18 years) underwent spinal disorders using computerized database of Health Insurance Review and Assessment Service(HIRAS) from 2004 to 2008. We included dorsopathies as spinal disorder according to Korean Classification of Diseases(KCD) and excluded spinal disorder caused by trauma. We compared the data of traditional Korean medicine treatment with that of western medical care. Results : 4.8% of the children and adolescents had medical treatment with spinal disorder in 2008. The claim number and medical cost for both traditional Korean medicine and western medicine treatment are increasing 1.8 and 1.3 times respectively over 5 years. Total medical spent of western clinic was 2.1 times than those of traditional Korean clinic. The most common spinal disorder was dorsalgia(31.8%) and scoliosis(13.5%) in western clinics while back pain(29.0%) and neck pain(10.8%) in oriental clinic. Conclusions : We first reported the clinical tendency of spinal disorder in Korean children adolescents from 2004 to 2008. This study will support the development of a strategy for traditional Korean medicine-based prevention or treatment of spinal disorders in young generation.

• Annals of Coloproctology
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• v.34 no.6
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• pp.299-305
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• 2018

Purpose: Inflammatory bowel disease (IBD) in Korea has been increasing in recent years, but accurate statistics about operations for IBD are lacking. The purpose of this study was to investigate the trends and current status of IBD surgeries in Korea. Methods: Using a national database from the Korea Health Insurance Review and Assessment Service, we analyzed data from patients who underwent surgery for Crohn disease and ulcerative colitis from January 2009 to October 2016. Results: The mean number of patients who underwent surgery for Crohn disease was 791.8 per year. Colorectal surgery, small bowel surgery, and anal surgery were performed fairly often (31.2%, 29.4%, 39.4%, respectively), and laparoscopic surgery continued to increase, recently exceeding 30%. About 50% of Crohn patients used biologics before and after surgery, and those patients also underwent a relatively high rate of anal surgeries (44.2%). The mean number of patients who underwent surgery for ulcerative colitis was 247.6 per year. Colorectal surgery accounted for more than half of all operations, and laparoscopic surgery has been increasing rapidly, having been performed in about 60% of patients in recent years. The incidence of colorectal cancer in patients with ulcerative colitis was very high and increased rapidly during the study period, reaching about 80%. Conclusion: The number of patients undergoing laparoscopic surgery for IBD in Korea has increased significantly. Biologics are actively used by patients with Crohn disease, with a high proportion of anal surgeries required. Many of the surgical indications for ulcerative colitis have shifted into colorectal cancer.

• Journal of the korean academy of Pediatric Dentistry
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• v.49 no.2
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• pp.206-216
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• 2022

This study aimed to investigate the frequency of dental visits after coronavirus disease 2019 (COVID-19) in children and adolescents in comparison to that of adults. The data on the number of dental visits on the basis of different classification and treatment codes for all the age groups were provided by the Health Insurance Review and Assessment Service from January 2017 to December 2020. To reduce the impact of the population change, dental visits per 1000 people was used. After the start of the pandemic, dental visits per 1000 people decreased in all age groups when analyzed for the diseases of pulp and periapical tissues classification code and dental visits per 1000 people decreased over 5 years age groups when analyzed for the pulp treatment code. Regarding the restorative treatment code, visits in the 0 - 19 years age group decreased after the pandemic. Based on the comparison of the number of confirmed COVID-19 cases to that of monthly dental visits by treatment codes, the change rate of pulp and restorative treatments gradually decreased after the waves of the pandemic in February and August 2020 in Korea. Furthermore, dental visits per 1000 people for gingivitis and periodontal disease classification code increased after the pandemic in all age groups. The rate of decrease in dental visits per 1000 people for restorative treatments in children and adolescents was higher than that in adults. The rate of decrease in the number of dental visits for multi-visit pulp treatments showed a rapid decrease as compared to that of 1-visit pulp treatments after the pandemic. This study identified changes in the number of dental visits of children and adolescents after COVID-19 transmission in comparison to that observed in adults.