• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제46권1호
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• pp.49-57
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• 2020

Objectives: This study aimed to understand the nationwide patterns of antibiotic prescription after tooth extraction in adult patients. Materials and Methods: This study analyzed dental records from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) database on 503,725 tooth extractions performed in adults (≥19 years) during 2011-2015. Patient sex, age, household income, systemic disease (diabetes mellitus and hypertension), type of dental institution, region of dental institution, year of prescription, and type of tooth extraction procedure were considered. The antibiotic prescription rate and broad-spectrum antibiotic prescription frequency were analyzed using chi-squared tests. Factors affecting the prescription of broad-spectrum antibiotics were evaluated using multivariate logistic regression analysis. Results: The rate of antibiotic prescription after tooth extraction was 81.85%. Penicillin was most commonly prescribed (45.25%), followed by penicillin with beta-lactamase inhibitors (18.76%), metronidazole (12.29%), and second- to fourth-generation cephalosporins (11.52%). The proportion of broad-spectrum antibiotics used among all prescribed antibiotics was 45.88%. Conclusion: The findings of this study demonstrate that the rate of antibiotic prescription after tooth extraction is higher in Korea than in other countries. Furthermore, broad-spectrum antibiotics are used more frequently, which may indicate unnecessary drug prescription, an important contributor to antibiotic resistance.

• 보건의료산업학회지
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• 제14권1호
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• pp.147-159
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• 2020

Objectives: This study is the human factors and disease factors of the copayment system for the elderly (>65 years old) and to identify does the current status and characteristics of the applied elderly and conducted to provide basic data. Methods: Sample cohort data from the National Health Insurance Corporation database, from the years 2012-2015, were analyzed of 21,772 elderly people over the copayment ceiling. Results: The ratio of those who exceeded the copayment ceiling system rose sharply from progressive rates of 3.39% in 2012, 3.69% in 2013 and 5.03% in 2014, to rates of 37.13% from 2013. Factors identified that affect the instances of being over the copayment ceiling were: age, income group, region, severity, disability, sickness distribution, inpatient days, and outpatient days. Conclusions: The reorganization of the copayment ceiling system in 2014 favored low-income families of the elderly, but in 2015, the proportion of elderly was low (only 5.78%). The government's policies needs to change to allow for the amount of the deductible upper limit for low- and middle- income groups to be further subdivided in order for the elderly to receive more deductibles.

• Safety and Health at Work
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• 제11권3호
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• pp.262-265
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• 2020

Coronavirus disease 2019 (Covid-19) poses an important occupational health risk to health workers (HWs) that has attracted global scrutiny. To date, several thousand HWs globally have been reported as infected with the severe acute respiratory syndrome coronavirus 2 virus that causes the disease. It is therefore a public health priority for policymakers to understand risk factors for this vulnerable group to avert occupational transmission. A rapid review was carried out on 20 April 2020 on Covid-19 risk factors among HWs in PubMed, Google Scholar, and EBSCOHost Web (Academic Search Complete, CINAHL Complete, MEDLINE with Full Text, CINAHL with Full Text, APA PsycInfo, Health Source-Consumer Edition, Health Source: Nursing/Academic Edition) and WHO Global Database. We also searched for preprints on the medRxiv database. We searched for reports, reviews, and primary observational studies (case control, case cross-over, cross-sectional, and cohort). The review included studies conducted among HWs with Covid-19 that reported risk factors irrespective of their sample size. Eleven studies met the inclusion criteria. Lack of personal protective equipment, exposure to infected patients, work overload, poor infection control, and preexisting medical conditions were identified as risk factors for Covid-19 among HWs. In the context of Covid-19, HWs face an unprecedented occupational risk of morbidity and mortality. There is need for rapid development of sustainable measures that protect HWs from the pandemic.

• 대한소아치과학회지
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• 제49권2호
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• pp.188-196
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• 2022

이 연구의 목적은 2002년부터 2015년까지 건강보험심사평가원 자료를 이용하여 대한민국 만 20세 미만 소아청소년의 치과를 주소로 응급실 방문 특성과 경향성에 대하여 조사하는 것이다. 연구 대상은 대한민국 전체 인구 중 2%인 약 100만 명을 무작위 표본 추출하여 만 20세 미만의 소아청소년들과 만 20세 이상의 성인들로 나누어 주상병, 성별, 지역, 소득수준 및 요양급여 비용에 대해 비교 분석하였다. 소아청소년에서 응급실 방문 비율은 비외상성 주상병보다 외상성 주상병에서 더 높게 관찰되었다. 비외상성 주상병의 비율은 소아청소년이 성인보다 낮았으며, 특히 입의 연조직염 및 농양(K12.2)과 치은염 및 치주질환(K05)에서 유의미한 차이를 보였다. 고소득 가구의 소아청소년이 저소득 가구의 소아청소년보다 응급실에 더 많이 내원하는 것으로 조사되었다. 소아청소년의 치과 응급 진료의 연도별 경향성은 표본 수가 적어 확인할 수 없었으나 소아청소년의 치과를 주소로 응급실에 내원하는 특성을 성인과 비교 및 분석이 가능하였다. 추후 연구에서 시간에 따른 유의미한 경향성을 파악하기 위해서는 표본 연구 자료가 아닌 맞춤형 자료를 이용한 연구가 필요할 것으로 보인다.

• 보건행정학회지
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• 제28권2호
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• pp.168-177
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• 2018

Background: This study investigates the potential volume and outcome association of coronary heart disease (CHD) patients who have undergone percutaneous coronary intervention (PCI) using a large and representative sample. Methods: We used a National Health Insurance Service-Cohort Sample Database from 2002 to 2013 released by the Korean National Health Insurance Service. A total of 8,908 subjects were analyzed. The primary analysis was based on Cox proportional hazards models to examine our hypothesis. Results: After adjusting for confounders, the hazard ratio of thirty-day and 1-year mortality in hospitals with a low volume of CHD patients with PCI was 2.8 and 2.2 times higher (p=0.00) compared to hospitals with a high volume of CHD patients with PCI, respectively. Thirty-day and 1-year mortality of CHD patients with PCI in low-volume hospitals admitted through the emergency room were 3.101 (p=0.00) and 2.8 times higher (p=0.01) than those in high-volume hospitals, respectively. Only 30-day mortality in low-volume hospitals of angina pectoris and myocardial infarction patients with PCI was 5.3 and 2.4 times those in high-volume hospitals with PCI, respectively. Conclusion: Mortality was significantly lower when PCI was performed in a high-volume hospital than in a low-volume hospital. Among patients admitted through the emergency room and diagnosed with angina pectoris, total PCI volume (low vs. high) was associated with significantly greater cardiac mortality risk of CHD patients. Thus, There is a need for better strategic approaches from both clinical and health policy standpoints for treatment of CHD patients.

• 대한한방소아과학회지
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• 제36권2호
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• pp.1-12
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• 2022

Objectives We analyzed visiting patterns to medical institutions and cost per visit according to the common cold patients aged 0-19 years. We analyzed Korean medical treatment for common cold. Methods Using the Pediatric Patient Sample data of the Health Insurance Review and Assessment Service (HIRA-PPS), we analyzed the data on health insurance claims of approximately 1 million people from 2017 to 2019. The data included the number of patients who visited the hospital due to common cold for the first and second time, the ratio of second visits by type of medical institution, and the status of prescriptions in Korean medical institutions. Results The number of patients visiting healthcare providers for common cold was higher in Western medical institutions than in Korean medical institutions. However, the number of second visits was higher in Korean medical institutions. Acupuncture is the most commonly used medical treatment in Korean medical institutions for common cold. Herbal medicine for common cold was usually prescribed for 2-3 days for children and adolescents. Conclusions Although the average medical cost of Korean medical institutions was higher than that of Western medical institutions, the rate of second visits to Korean medical institutions was higher because of the demand for Korean medical treatment

• 한국임상약학회지
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• 제32권1호
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• pp.37-46
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• 2022

Background: Non-valvular atrial fibrillation (NVAF) is associated with ischemic stroke risk in the aging population. Observational studies have indicated beneficial effects of direct-acting oral anticoagulant (DOAC) against ischemic stroke compared to warfarin. This study aimed to investigate ischemic stroke incidence and bleeding risk in patients on DOAC therapy. Methods: Using the database of Korean Health Insurance Review and Assessment-Aged Patient Sample 2015, we conducted a retrospective cohort study. Study subjects with NVAF diagnosis and prescribed anticoagulants were enrolled. Propensity score (PS) matching by age, sex, comorbidities, and medications were used. The clinical outcomes were major adverse cerebro-cardiovascular events (MACCEs, ischemic stroke/systemic embolism, myocardial infarction, cardiac death) and bleeding events. A cox proportional hazard model analysis was performed to compare the outcomes with hazard ratio (HR) and 95% confidence interval (CI). Results: Total 4,773 elderly patients with NVAF were initially included. Four PS-matched groups including rivaroxaban vs. warfarin-only (n=1,079), dabigatran vs. warfarin-only (n=721), rivaroxaban vs. dabigatran (n=721), and switchers of warfarin to rivaroxaban vs. warfarin-only (n=287) were analyzed. Every group showed statistically similar results of MACCEs and bleeding events, except for the group of rivaroxaban vs. dabigatran. Rivaroxaban users showed higher risks of bleeding events than dabigatran users (HR 2.25, 95% CI 1.01-4.99). Conclusion: In the elderly patients with NVAF, efficacy and safety outcomes among oral anticoagulants including DOACs and warfarin were similar, while rivaroxaban are more likely to have higher bleeding risks than dabigatran. Further research using large size sample is needed.

• 융합정보논문지
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• 제9권6호
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• pp.194-201
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• 2019

서울지역의 호흡기질환으로 입원한 환자를 대상으로 미세먼지 노출에 대한 건강영향을 평가하였다. 건강보험공단의 2002-2010년 동안 표본코호트의 만성폐쇄성 폐 질환(COPD), 천식 및 폐렴과 같은 호흡기 질환으로 입원한 13,974명의 환자를 대상자로 하였다. 추적관찰 기간동안 미세먼지 농도가 50ug/m3 이상에서 10ug/m3 증가할 때 15세 미만의 연령층에서는 1.38%, 65세 이상의 연령층에서는 1.62%, 75세 이상 연령층에서는 2.87% 호흡기질환으로 입원이 증가하였고, 폐렴환자는 1.50%, COPD 환자는 1.51%, 폐렴 및 천식환자는 1.55% 입원이 증가하였다. 또한 미세먼지가 80ug/m3 이상에서는 65세 이상 연령층에서 3.71%, 75세 이상 연령층에서 4.25% 입원환자가 증가하였다. 높은 미세먼지농도와 호흡기 질환으로 입원한 환자들과, 특히 노인에서 관련성이 높게 나타났다. 이미 호흡기 질환이 있었던 사람들, 특히 나이가 많은 환자는 고농도의 미세먼지에 노출되지 않도록 주의해야 한다.

• 대한방사선기술학회지:방사선기술과학
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• 제43권1호
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• pp.23-27
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• 2020

In South Korea, female individuals in their forties show a high rate of incidence, with approximately 13% of the patients being <40 years. This statistic is more than twice as high as that in Western countries. It is therefore necessary to identify the risk factors for breast cancer incidence by age and economic activity participation status. Women aged 30 to 59-whether breast cancer patients or those in the control group and having no breast cancer-were appraised from the sample cohort database. The data were analyzed using the statistical software R36.2. To identify the factors affecting breast cancer incidence, the degree of association was determined with HR and 95% CI by means of cox regression analysis. As for the socio-demographic variables, the older the individual, the higher the risk of breast cancer incidence becomes. As for the economic activity variables, those who were dependents (unemployed) and who had higher income (medium and high) were at higher risk of breast cancer incidence, which was statistically significant. The income-adjusted HR (model 1) for breast cancer development associated with the economic activity was 1.452 (95% CI, 1.19-1.77). The body mass index and alcohol intake-adjusted HR (model 2) was 1.431 (95% CI, 1.18-1.74). One needs to pay attention to policy plans regarding women's quality of life, as well as to the risk of breast cancer incidence by their economic activity. In other words, policies need to give post care, instead of focus on early detection and cancer treatment.

• 한방재활의학과학회지
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• 제27권2호
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• pp.67-75
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• 2017

Objectives The study of the clinical effects of traditional east asian medicine (TEAM) using Taiwan national health insurance claim dataset (NHIRD) is useful in Korean Medicine research. We reviewed the clinical studies of TEAM using NHIRD as a whole through this study. Methods We comprehensively searched PUBMED and NHIRD DB for clinical effects of TEAM study using NHIRD from inception to 17, January 2017. As a result, 40 studies investigating the contribution of TEAM intervention to health benefit have been confirmed. We analyzed publication time, target disease, sample size, outcome measurement and main result of 40 searched studies. Results The number of TEAM studies using NHIRD grdually increasing. The topics of the team study using NHIRD covered a wide range of subjects including cardiovascular disease, tumor, gynecological disease, diabetes and kidney disease. The studies have shown large samples and reported significant effects on severe diseases. Conclusions The results of this study suggest that the study of Korean Medicine using Big data will be useful for decision making related to health care in Korea. However, considering the limited domestic Korean health insurance data, it will be necessary to activate the big data research of Korean Medicine through the establishment of a separate cohort in Korea.