• 자원ㆍ환경경제연구
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• 제16권3호
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• pp.683-699
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• 2007

이 연구는 선택실험법(CE)을 이용하여 다속성 사망 위험 감소와 관련된 선택들로부터 확률적 인간생명 가치(VSL)를 추정하였다. 사망 위험의 네 가지 속성들(사망 원인, 사망위험의 자발성, 사망 시기, 사망 위험 감소의 크기)을 이용하여 선택 대안들의 집합을 설계하였다. 다항 로짓모형의 추정 결과는 10년 동안 1/1,000의 사망 위험을 감소하기 위해 연간 27,930원, 성인의 사망 위험 감소를 위해 연간 116,773원, 자발적 사망 위험 감소를 위해 연간 97,682원, 비자발적 사망 위험 감소를 위해 연간 77,234원을 지불하려고 하였다. 이로부터 얻어진 다양한 확률적 인간생명가치로는 청소년 이하(18세 미만)인 경우 11.65~13.67억 원, 성인(18~59세)은 16.31~18.33억 원, 노인(60세 이상)의 경우는 11.28~13.30억 원으로 추정되었다.

• 응용통계연구
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• 제26권6호
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• pp.1019-1032
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• 2013

최근 급격한 기대수명의 증가에 따라 미래 복지정책 등에 커다란 영향을 주는 장래 사망력의 정확한 예측은 중요한 이슈가 되고 있다. 사망력의 정확한 예측을 위하여 최적의 추정모형의 선택도 중요하지만 사망력에 대한 시계열 적용기간도 매우 중요한 이슈다. 이는 우리나라의 사망률 시계열이 짧고, 특히 1982년 이전 자료가 다소 불완전해서 이에 대한 고려가 필수적이기 때문이다. 본 논문에서는 우리나라 사망력 시계열을 기간에 따라 2개의 그룹(1976~2005년, 1983~2005년)으로 나누어서, 남녀별로 LC모형과 LC 코호트효과 확장모형에 대한 모수 추정값, 사망력지수와 코호트지수의 모형화 및 예측, 장래 기대수명의 예측 적합력을 각각 분석한 후 향후에 장래 기대수명 추계시 고려할 시사점을 제시하고자 한다.

• 한국환경보건학회지
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• 제40권5호
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• pp.346-354
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• 2014

Objectives: Although a number of epidemiologic studies have examined the association between air pollution and mortality, data limitations have resulted in fewer studies of particulate matter with an aerodynamic diameter of ${\leq}2.5{\mu}m$ ($PM_{2.5}$). We conducted a time-series study of the acute effects of particulate matter with an aerodynamic diameter of ${\leq}10{\mu}m$($PM_{10}$) and $PM_{2.5}$ on the increased risk of death for all causes and cardiovascular mortality in Seoul, Korea from 2006 to 2010. Methods: We applied the generalized additive model (GAM) with penalized splines, adjusting for time, day of week, holiday, temperature, and relative humidity in order to investigate the association between risk of mortality and particulate matter. Results: We found that $PM_{10}$ and $PM_{2.5}$ were associated with an increased risk of mortality for all causes and of cardiovascular mortality in Seoul. A $10{\mu}g/m^3$ increase in the concentration of $PM_{10}$ corresponded to 0.44% (95% Confidence Interval [CI]: 0.25-0.63%), and 0.95% (95% CI: 0.16-1.73%) increase of all causes and of cardiovascular mortality. A $10{\mu}g/m^3$ increase in the concentration of $PM_{2.5}$ corresponded to 0.76% (95% CI: 0.40-1.12%), and 1.63% (95% CI: 0.89-2.37%) increase of all causes and cardiovascular mortality. Conclusion: We conclude that $PM_{10}$ and $PM_{2.5}$ have an adverse effect on population health and that this strengthens the rationale for further limiting levels of $PM_{10}$ and $PM_{2.5}$ in Seoul.

• Journal of Trauma and Injury
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• 제21권2호
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• pp.108-114
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• 2008

Purpose: Using a propensity analysis, a recent study reported that blood transfusion might not be an independent predictor of mortality in critically ill patients, which contradicted the results of earlier studies. This study aims to reveal whether or not blood transfusion is an independent predictor of mortality in trauma patients. Methods: A total of three hundred fifty consecutive trauma patients who were admitted to our emergency center from January 2004 to October 2005 and who underwent an arterial blood gas analysis and a venous blood analysis were included in this study. Their medical records were collected prospectively and retrospectively. Using a multivariate logistic analysis, data on the total population and on the propensity-score -matched population were retrospectively analyzed for association with mortality. Results: Of the three hundred fifty patients, one hundred twenty-nine (36.9%) received a blood transfusion. These patients were older (mean age: 48 vs. 44 years; p=0.019) and had a higher mortality rate (27.9% vs. 7.7%; p<0.001). In the total population, the multivariate analysis revealed that the Glasgow coma scale score, the systolic blood pressure, bicarbonate, the need for respiratory support, past medical history of heart disease, the amount of blood transfusion for 24 hours, and hemoglobin were associated with mortality. In thirty-seven pairs of patients matched with a propensity score, potassium, new injury severity score, amount of blood transfusion for 24 hours, and pulse rate were associated with mortality in the multivariate analysis. Therefore, blood transfusion was a significant independent predictor of mortality in trauma patients. Conclusion: Blood transfusion was revealed to be a significant independent predictor of mortality in the total population of trauma patients and in the propensity-score-matched population.

• Journal of Korean Neurosurgical Society
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• 제64권3호
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• pp.460-468
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• 2021

Objective : Extremely low alanine transaminase (ALT) levels are associated with all-cause mortality in frail elderly individuals; the clinical significance of ALT as a reliable biomarker is now being considered. Predicting mortality with routine tests at the time of diagnosis is important for managing patients after intracranial hemorrhage. We aimed to investigate whether an extremely low ALT level is associated with mortality in the elderly after intracranial hemorrhage. Methods : A retrospective review was performed on 455 patients with intracranial hemorrhage admitted to a university-affiliated tertiary care hospital from February 2014 to May 2019. Multivariate Cox regression analysis was performed for all ages and for each age group to determine whether an extremely low ALT level is an independent predictor of mortality only in the elderly. Results : Overall, 294 patients were enrolled, and the mean age of the subjects was 59.1 years, with 99 (33.8%) aged ≥65 years. The variables associated with all-cause mortality in all subjects were age, C-reactive protein (CRP) levels, hemoglobin (Hb) levels (<11 g/dL), and initial Glasgow coma scale (GCS) scores. In young patients, CRP, low Hb levels, and initial GCS scores were significantly associated with all-cause mortality. However, in the elderly (≥65 years), the variables significantly associated with all-cause mortality were extremely low levels of ALT (<10 U/L) (adjusted hazard ratio, 3.313; 95% confidence interval, 1.232-8.909; p=0.018) and initial GCS scores. Conclusion : Extremely low ALT level (<10 U/L) at the time of diagnosis is a significant risk factor for all-cause mortality in the elderly after intracranial hemorrhage.

• Nutrition Research and Practice
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• 제18권4호
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• pp.554-566
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• 2024

BACKGROUND/OBJECTIVES: Urban-rural inequities in health and mortality exist in Korea, a highly centralized developed country. The potential impact of multiple health-related lifestyle behaviors on mortality and difference between urban and rural areas is not fully understood. This study aimed to investigate the effect of high-risk health behaviors on all-cause mortality among residents living in urban and rural in Korea. SUBJECTS/METHODS: Cross-sectional analyses were conducted on 8,298 adults aged 40 yrs and older from the Korea National Health and Nutrition Examination Survey 2013-2015. High-risk behaviors were defined as having poor diet quality, current smoking, high-risk drinking, or insufficient physical activity. Mortality status was linked to the Cause of Death data followed up to December 31, 2019. The associations between all-cause mortality and high-risk behaviors were evaluated using Cox proportional hazard regression models adjusted for age, sex, education, income, and survey year. Population attributable fractions (PAFs) were calculated, and effect modification analysis was conducted. Participants were stratified by residential area (urban or rural). RESULTS: During the follow-up (median: 5.4 yrs), 313 deaths occurred. A higher proportion of rural residents than urban residents engaged in multiple high-risk behaviors (28.9% vs. 22.6%; P < 0.0001). As individual factors, a greater risk of mortality was associated with poor diet quality, current smoking, and inadequate physical activity, and these tendencies persisted in rural residents, especially for diet quality. Multiple high-risk behaviors were positively associated with a higher risk of mortality in Koreans living in urban and rural areas. PAF (95% confidence interval) was 18.5% (7.35-27.9%) and 29.8% (16.1-40.2%) in urban and rural residents, respectively. No additive or multiplicative effect of the region was observed. CONCLUSION: The higher prevalence of multiple high-risk lifestyle behaviors in rural residents may explain the higher mortality in rural areas compared to urban areas. Comprehensive public health policies to improve health-related behaviors in rural populations may be needed.

• 디지털융복합연구
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• 제11권5호
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• pp.371-384
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• 2013

본 연구에서는 한국 및 미국의 퇴원환자 자료를 이용하여 한국 및 미국의 중증도 보정 사망 모형을 개발하고 개발된 중증도 보정 사망모형에 따라 중증도 보정 사망률 지표를 산출 및 비교한 다음 이를 통해 국내 의료기관 사망률 관리 방안을 제시하고자 하였다. 한국 및 미국 의료기관의 중증도 보정 사망 모형은 데이터마이닝기법인 다중 로지스틱회귀분석 기법, 의사결정나무분석 기법을 이용하여 개발하였다. 개발된 의료기관의 중증도 보정 사망모형에 따라 한국 및 미국 의료기관의 중증도 보정 사망률을 산출한 결과 한국은 매년 증가하고 있는 반면 미국은 매년 감소하고 있는 것으로 나타나 한국과 미국간에 차이가 있었다. 의료기관의 병상규모별 중증도 보정 사망률의 변이 또한 한국이 미국보다 높았다. 국내 의료기관의 사망률 관리를 위해서는 의료기관 자체내에서 사망환자 관리가 가능한 대형 의료기관들의 경우 의료기관 중증도 보정 사망률 평가 결과 공개를 통해 지속적으로 사망률 관리를 유도하고, 의료기관 자체내에서 사망률 관리가 힘든 중소병원들은 국가 차원에서 파악한 국내 의료기관 사망환자 관리의 문제점 및 이를 개선할 수 있는 개선방안을 토대로 사망률 관리 컨설팅을 시행하는 등 의료기관 사망환자 관리 사업을 진행하여야 한다.

• 농촌의학ㆍ지역보건
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• 제34권1호
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• pp.1-12
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• 2009

본 연구는 뇌혈관질환 사망에 영향을 미치는 지역의 건강상태 지표를 파악하기 위해 시도되었으며, 연구방법은 2000년 사망 원인 통계를 활용하여 뇌혈관질환으로 인한 사망자 수와 2000년 인구센서스 자료를 이용하여 인구수를 산출하여 뇌혈관질환 표준화 사망률을 산출하였다. 또한 지역사회 건강지표로 지역의 물질적 결핍 지수와 보건의료자원, 도로 포장율, 지방세를 지표로 하였다. 자료는 Excel 2003과 SAS 9.1을 활용하여 분석하였다. GIS 프로그램인 Arcview 9.1을 이용하여 뇌혈관질환 사망률과 지역의 물질적 결핍지수를 시각화하였다. 본 연구의 결과는 다음과 같다. 1. 강원지역에서 뇌혈관질환의 표준화 사망률은 지역, 성별에 따라 차이가 있었다. 남자의 사망률이 가장 높은 지역은 고성군이었고, 가장 낮은 지역은 평창군으로 나타났다. 여자의 사망률이 가장 높은 지역은 고성군이었고, 가장 낮은 지역은 양양군이었다. 2. 강원도의 지역의 물질적 결핍지수는 태백시가 가장 높게 박탈된 지역으로 나타났고, 가장 적게 박탈된 지역은 평창군이었다. 3. 병 의원의 수, 지역의 물질적 결핍지수, 도로포장율. 지방세와 남녀 표준화 사망률과는 관계가 없었다. 본 연구의 의의는 지역의 여러 건강상태를 나타내는 자원들을 지표로 산출하여 뇌혈관질환 사망과 관련지어 분석하고, 또한 소지역인 시 군별 사망률의 차이와 지역사회 건강 지표인 물질적 결핍지수와의 관계를 시각화하였다는 점이다.

• 보험의학회지
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• 제28권1_2호
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• pp.15-18
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• 2009

Background: Recent emergence of drug-resistant tuberculosis such as multidrug-resistant tuberculosis(MDR-TB) or extensively drug-resistant tuberculosis(XDR-TB) has become important health care problems. It has also became grave issues for insurance industries in determining medical risks. We have therefore strived to analyze the comparative mortality rates for drug-resistant tuberculosis through utilization of results from previous articles. Methods: Comparative mortality was calculated from source articles using mortality analysis methods. Results: Mortality ratio of MDR-TB was estimate to 1200%, and excess death rate was 110 per 1,000. Comparative mortality between MDR-TB and XDR-TB by Korean $study^{(1)}$ were 1750, 382, 405, 443, 1025, and 357%, for each 10 months study intervals, respectively. Total mortality ratio was 594% and total excess death rate was 60 per 1,000person. It was determined that the risk of XDR-TB was much greater than MDR-TB. Discussion; Pending the development of a novel anti-tuberculosis drug, it would be prudent to steer clear insuring XDR-TB during underwriting phase due to high medical cost that it creates.

• 보험의학회지
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• 제30권2호
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• pp.12-15
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• 2011

Background: The beneficial effects of implantable cardioverter defibrillators (ICDs) in primary and secondary prevention patients are well established. However, data on potential differences between both groups in mortality are scarce. The aim of this study was to assess extra risk differences between primary and secondary prevention ICD recipients. Methods: Comparative mortality figures were calculated from a source article using mortality analysis methods. Results: Mortality ratio (MR) of primary and secondary prevention ICD recipients were 393% and 373%. Excess death rates (EDR) of both groups were 42 and 38 per 1,000. Discussion: MR and EDR were higher in primary prevention group. But, there was no significant difference.