• 가정과삶의질연구
• /
• 제10권2호
• /
• pp.51-59
• /
• 1992

Previous studies indicated that unmarried persons are subject to higher mortality than the married, and that the differentials are more marked for male than for females. There are two major approaches to explaining the marital status differentials in mortality ; selection function and protection function of marriage. Following protection fucntion, this study develops the new "instrumental / expressive sex-role" hypothesis in order to explain why marriage protects males more against death. The hypothesis expects that male's instrumental role and female's expressive role have direct effect as well as indirect effect through social integration on sex differential mortality by marital status. for the hypothesis testing, Korea and US vital statistics and census data are used to compute age-specific , age-adjusted mortality rates and their ratios for persons in different marital status. Major findings are as follows. 1)For both Korea and US being married is more advantageous to males than females, ad being widowed, divorced, and separated is more disadvantageous to males, while being never-married is more disadvantageous to females, 2) For Korea, the never married men and women have the highest mortality rates, 3) For US the never married women have the highest mortality rate, while the divorced, separated, and widowed men have the highest mortality rate. Fro both Korea and US data, selection function is rejected, but instrumental/expressive sex-role hypothesis succeeds in accounting for the sex and marital status differential in mortality.

• 응용통계연구
• /
• 제31권1호
• /
• pp.41-65
• /
• 2018

우리나라의 경우 선진국에 비해 짧은 기간 동안 사망률 개선이 급속히 이루어짐에 따라 사망률 예측에 있어 모형의 선택뿐만 아니라 시계열 이용기간의 선정 또한 중요한 고려사항이 될 수 있다. 따라서 본 연구에서는 시계열 이용기간의 선택 관점에서 회귀모형을 이용하는 방법을 제안하였다. 또한 Lee-Carter (LC) 모형, LC류 (Lee-Miller (LM), Booth-Maindonald-Smith (BMS)) 그리고 비모수 모형(functional data model (FDM), Coherent FDM)을 토대로 시계열 이용기간을 다르게 적용할 경우 어떠한 문제가 발생되며, 연령별 사망률과 기대수명 예측력에 어떠한 차이를 보이는지 살펴보았다. 분석결과를 바탕으로 5개의 모형별 2030년까지 남녀의 연령별 사망률과 예측기대수명을 작성하고 통계청(Korean Statistical Information Service; KOSIS)에서 제공하는 장래 연령별 사망률과 기대수명과 비교하였다.

• 보험의학회지
• /
• 제26권
• /
• pp.31-39
• /
• 2007

Background and main issue: In the Korean insurance market, an outstanding issue is the decrease of margin of risk ratio. This affects the solvency and profitability of insurance companies. Insurance medicine, which has been developed in Western countries, is so-called medical risk selection or medical underwriting. Medical risk selection is based on clinical follow-up study and mortality analysis methodology. Unfortunately, there have been few clinical follow-up studies, and no intercompany disease analysis system is available in the Korean insurance market. In practice, we use underwriting guidelines, which were developed by some global reinsurance companies. However, these guidelines were developed under clinical follow-up studies performed abroad. So, we cannot rule out underestimation of excess mortality factors such as mortality ratio, excess death rate, and life expectancy. It is necessary to perform medical assessment in claims administration. Comparing the insured's statement by medical records with products' benefit according to this procedure, we can make sound claim decisions and participate in the role of sound underwriting. We can call this scientific procedure as the verification of medical claims review. Another area of medical claims review is medical counsel for claims staff. Result: There is another insurance medicine in addition to medical risk selection. Independent medical assessment by medical records of insured is medical claims review. Medical claims review is composed of verification and counsel.

• Mycobiology
• /
• 제40권2호
• /
• pp.111-116
• /
• 2012

Ten strains of the entomopathogenic fungi Metarhizium anisopliae and Beauveria bassiana were evaluated to find the most effective strain for optimization studies. The first criterion tested for strain selection was the mortality (> 50%) of Spodoptera litura larvae after inoculation of the fungus for 4 days. Results on several bioassays revealed that B. bassiana BNBCRC showed the most virulence on mortality S. litura larvae (80% mortality). B. bassiana BNBCRC also showed the highest germination rate (72.22%). However, its conidia yield ($7.2{\times}10^8$ conidia/mL) was lower than those of B. bassiana B 14841 ($8.3{\times}10^8$ conidia/mL) and M. anisopliae M6 ($8.2{\times}10^8$ conidia/mL). The highest accumulative radial growth was obtained from the strain B14841 (37.10 mm/day) while the strain BNBCRC showed moderate radial growth (24.40 mm/day). M. anisopliae M6 possessed the highest protease activity (145.00 mU/mL) while M. anisopliae M8 possessed the highest chitinase activity (20.00 mU/mL) during 96~144 hr cultivation. Amongst these criteria, selection based on virulence and germination rate lead to the selection of B. bassiana BNBCRC. B. bassiana B14841 would be selected if based on growth rate while M. anisopliae M6 and M8 possessed the highest enzyme activities.

• 보험의학회지
• /
• 제29권2호
• /
• pp.22-28
• /
• 2010

Medical risk selection or mortality analysis is very important in insurance medicine. Among many kind of source articles there have been several limitations. There are few long-term follow-up studies in rare disease, as Romeo's article. We can do mortality analysis of this type using cause of death within the article and assumption of expected mortality q'. In the case of article which is published in foreign country such as Tikkanen et al, we can use comparative group from the control group within source article. It is another way for mortality analysis of limited article. However Retrospective study even performed in Korea, is unusable for estimation of extra-mortality.

• 보험의학회지
• /
• 제28권1_2호
• /
• pp.15-18
• /
• 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.

• 보건행정학회지
• /
• 제17권3호
• /
• pp.87-105
• /
• 2007

The purpose of this study was to analyze whether nonemergency, isolated coronary artery bypass graft (CABG) surgery for high- or low-risk patients biases the assessment of the risk-adjusted mortality rates of hospitals. This study used 2002 National Health Insurance claims data for tertiary hospitals in Korea. The study sample consisted of 1,959 patients from 23 tertiary hospitals. The risk-adjustment model used the patients' biological, admission, and comorbidity data identified in the claims. The subjects were classified into high- and low-risk groups based on predicted surgical risk. The crude mortality rates and risk-adjusted mortality rates for low-risk, high-risk, and all patients in a hospital were compared based on the rank and the four intervals defined by quartile. Also, the crude mortality rates of the three groups were compared with their 95% confidence intervals of predicted mortality rates. The C-statistic (0.83) and Hosmer-Lemeshow test ($X^2$=11.47, p=0.18) indicated that the risk-adjustment model performed well. Presenting crude mortality rates with their 95% confidence intervals of predicted rates showed higher agreements among the three groups than using the rank or intervals of mortality rates defined by quartile in the hospital performance assessment. The crude mortality rates for the low-risk patients in 21 of the 23 hospitals were located on the same side of their 95% confidence intervals compared to that for all patients. High-risk patients and all patients differed at only one hospital. In conclusion, the impact of risk selection by hospital on the assessment results was the smallest when comparing the crude inpatient mortality rates of CABG patients with the 95% confidence intervals of predicted mortality rates. Given the increasing importance of quality improvements in Korean health policy, it will be necessary to use the appropriate method of releasing the hospital performance data to the public to minimize any unwanted impact such as risk-based hospital selection.

• Journal of Preventive Medicine and Public Health
• /
• 제38권3호
• /
• pp.267-275
• /
• 2005

Evidence on the relation of socioeconomic position (SEP) with health and illness is mounting in South Korea. Several unlinked studies and individually linked studies (longitudinal study) showed a graded inverse relationship between SEP and mortality among South Korean males and females. Based on the mortality relative ratios by occupational class reported in the published papers of South Korea and western countries, the magnitude of the socioeconomic inequality in mortality in South Korea seems to be similar to or even greater than that in western industrialized countries. A potential contribution of health related selection, health behaviors and psychosocial factors to explain this socioeconomic inequality in mortality was discussed. It was suggested that early life exposure measures would demonstrate a greater ability to explain socioeconomic inequalities in all-cause mortality than the above pathway variables in South Korea. This is based on the cause-specific structure of mortality among the South Korean population who have a relatively greater proportion of stomach cancer, hemorrhagic stroke, liver cancer and liver disease, and tuberculosis, which share early life exposures as important elements of their etiology, than western countries. However, the relative contribution of early and later life socioeconomic conditions in producing socioeconomic inequality in health may differ according to the outcome, thus remains to be investigated.

• Journal of Gastric Cancer
• /
• 제19권2호
• /
• pp.202-211
• /
• 2019

Purpose: Poor physiological reserve for withstanding major cancer surgery in older adults is an important concern in the selection of patients for oncologic gastrectomy. The present study aimed to analyze mortality patterns among patients who underwent gastrectomy for cancer according to age groups. The primary outcomes of this study were early- and middleterm results: 30-day and 3-, 6-, 12-, and 36-month mortality rates. Materials and Methods: A retrospective review of 288 patients who underwent surgical resection for gastric cancer in two centers was carried out. Patients were stratified into four groups according to age: 29-50 years (group I, n=27), 51-65 years (group II, n=117), 66-75 years (group III, n=81), and 76-92 years (group IV, n=58). Statistical calculations focused on the differences in the survival rates between groups I and II as well as between groups II and IV. Results: The middle-aged patients (group II) had significantly better 3-year survival than either the youngest (group I) or the oldest patients (group IV). The 6-month mortality rates were 16.9% in group III and 29.3% in group IV. Two-thirds of the patients from groups III and IV who died between 2 and 6 months after surgery had an uneventful postoperative course. Conclusions: Age is an important prognostic factor of middle-term survival after gastrectomy for cancer. Geriatric assessment and better patient selection for major surgery for cancer are required to improve the outcome of gastrectomy for cancer in patients aged over 75 years.

• Journal of the Korean Statistical Society
• /
• 제12권1호
• /
• pp.24-35
• /
• 1983

In fitting models to data, selection of the most desirable estimation method and determination of the adequacy of fitted model are the central issues. This paper compares the maximum likelihood estimators and the minimum logit chi-square estimators, both being best asymptotically normal, when logit models are fitted to infant mortality data. Chi-square goodness-of-fit test and likelihood ratio one are also compared. The analysis infant mortality data shows that the outlying observations do not necessarily result in the same impact on goodness-of-fit measures.