• Journal of Preventive Medicine and Public Health
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• v.39 no.2
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• pp.123-129
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• 2006

Objectives : The incidence of colorectal cancer increased greatly among the elderly in Korea, but the relationship between smoking and colon cancer remains controversial. Few studies have targeted Asian elderly people. We analyzed the smoking status, the amount smoked, and the smoking duration as risk factors of colorectal cancer to determine their association and causality. Methods: The cohort members (n=14, 103) consisted of 4,694 males and 9,409 females, and they were derived from the Korea Elderly Phamacepidemilogic Cohort (KEPEC), which was a population-based dynamic cohort. They were aged 65 years or more and they lived in Busan Metropolitan City between from 1993-1998; they were beneficiaries of the Korean Medical Insurance Corporation (KMIC). The baseline information was surveyed by a self-administered mailed questionnaire; after 8.7 person-years of mean follow up period, 100 cases of colorectal cancer occurred. The adjusted relative ratio (aRR) of smoking status, the smoking amount and the smoking duration were calculated from the Cox's proportional hazard model with the never-smokers as a reference group and the Cox model controlled for age, gender, precancerous lesions of CRC, medication history of NSAIDs & antibiotics, the alcohol drinking status and BMI. Results : Compared with the never smokers, the aRRs were 2.03 (95% CI=1.02-4.03) and 1.36 (95% CI=0.80-2.32) for the ex-smokers and current smokers, respectively. Statistical significant trends were not observed for the dose-relationship among the elderly, either for the mean daily amount smoked (p for trend=0.28) or for the total amount (p for trend=0.15). Still, the aRRs were 1.51 (95% CI=0.97-2.34) for the elderly who smoked less than 40 years and 2.35 (95% CI=1.16-4.74) for the elderly who had 40 years or more of smoking (p for trend=0.06). Smokers who started smoking before the age 20 had an increased aRR of 2.15 (95% CI=1.17-3.93) compared to the never smokers. Conclusions : After controlling for age, gender, precancerous lesion of CRC, medication history of NSAIDs & antibiotics, the alcohol drinking status and BMI, smoking increases the risk of colorectal cancer among elderly people. The age when starting smoking is also important.

• Journal of Preventive Medicine and Public Health
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• v.41 no.1
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• pp.23-29
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• 2008

Objectives : We examined the association between alcohol consumption and incidence of colorectal cancer in elderly Koreans. Methods : The cohort members (n=14,304) consisted of 4,834 males and 9,470 females derived from the Korea Elderly Pharmacoepidemiologic Cohort (KEPEC), a population-based dynamic cohort. They were aged 65 years old or older and lived in Busan between 1993-1998; they were beneficiaries of the Korean Medical Insurance Corporation (KMIC). Baseline information was surveyed by a self-administered, mailed questionnaire. This study population was restricted to 14,304 participants who reported alcohol drinking habits on the questionnaire and had not been diagnosed with colorectal cancer at baseline. The adjusted hazard ratios (aHR) of status, type, frequency and daily average amount of alcohol consumption were computed with Cox's proportional hazard model, with the never-drinkers as a reference group and controlling for age and gender. Results : After 4.82 person-years of mean follow-up 112 cases of colorectal cancer occurred. The incidence densities of colorectal cancer were 161 (95% CI=123-200) for never-drinkers, 219 (95% CI=125-339) for ex-drinkers, and 137 (95% CI=84-189) for current-drinkers per 100,000 person-year. The status, type, frequency, and daily average amount of alcohol consumption were not significantly related to the incidence of colorectal cancer after controlling for age and gender. Conclusions : There was no significant association between alcohol consumption and colorectal cancer among elderly people after controlling for age and gender.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.2
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• pp.421-425
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• 2012

Cancer can be a major cause of poverty. This may be due either to the costs of treating and managing the illness as well as its impact upon people's ability to work. This is a concern that particularly affects countries that lack comprehensive social health insurance systems and other types of social safety nets. The ACTION study is a longitudinal cohort study of 10,000 hospital patients with a first time diagnosis of cancer. It aims to assess the impact of cancer on the economic circumstances of patients and their households, patients' quality of life, costs of treatment and survival. Patients will be followed throughout the first year after their cancer diagnosis, with interviews conducted at baseline (after diagnosis), three and 12 months. A cross-section of public and private hospitals as well as cancer centers across eight member countries of the Association of Southeast Asian Nations (ASEAN) will invite patients to participate. The primary outcome is incidence of financial catastrophe following treatment for cancer, defined as out-of-pocket health care expenditure at 12 months exceeding 30% of household income. Secondary outcomes include illness induced poverty, quality of life, psychological distress, economic hardship, survival and disease status. The findings can raise awareness of the extent of the cancer problem in South East Asia and its breadth in terms of its implications for households and the communities in which cancer patients live, identify priorities for further research and catalyze political action to put in place effective cancer control policies.

• KDI Journal of Economic Policy
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• v.31 no.1
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• pp.139-167
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• 2009

A new public insurance for long-term care was introduced in July 2008 to provide for the rising demand for long-term care as the population is aging rapidly. The demand for long-term care is expected to rise further because more and more elderly are living alone or in households with only other elderly, such as his/her spouse, without informal care of their adult children. Even when the elderly are living together with their adult children, daughters and daughters in law, once the main informal care-givers, are not available because they choose to become economically active and work more over time. Experiences of countries such as Japan and Germany with similar public long-term care insurance scheme highlight the importance of detailed analysis on the demand for long-term care for the financial stability of the insurance scheme. Countries which had underestimated the demand for long-term care at the time of adopting the scheme went through financial instability of insurance schemes. This study analyzes the determinants of the demand for long-term care using data from the second demonstration project (April 2006~April 2007) of the long-term care insurance scheme for the elderly in Korea. Taking full advantage of detailed data on the long-term care, this paper analyzes the eligibility for the long-term care insurance scheme and its use. According to study results, even when common diseases among the elderly such as cancer, diabetes, arthritis, dementia, hypertension, etc. are controlled together with other individual and socioeconomic factors, limitations the elderly are faced with in their twelve activities of daily living significantly affect the eligibility for the Korean Long-term Care Insurance Scheme. This means that limitations in daily living activities are more critical than common diseases among the elderly are to the eligibility for the Korean Long-term Care Insurance Scheme. Bathing and toileting problems have been found to be the most important factor affecting the eligibility for the insurance scheme, followed by eating, dressing and moving around inside the house. Moreover, the choices of whether to use long-term care and which to use between home care and institutional care are found to be significantly influenced by health status and various socioeconomic factors of the elderly. In particular, those with more limitations in daily living activities and the female elderly are more likely to use long-term care and institutional care rather than home care. As for home care users, those living alone or with adult children and those with monthly household income of more than 500,000 won are more likely to use home care. Most importantly, even when the monthly household income of the elderly is controlled, the elderly recipients of the National Basic Living Security, who are not charged for long-term care, are more likely to choose home care. This implies that price as well as income is a critical factor for the decision to use long-term care. Further study on the duration of long-term care use will surely enhance the long-term care policy, when panel data is available for simultaneous analysis of the likelihood of long-term care use and its use duration.

• The Journal of the Korea Contents Association
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• v.22 no.6
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• pp.712-728
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• 2022

World-widely, there has never been a greater need for people to access high-quality expertise about the effective and safe use of medications. Therefore, the profession of pharmacy should meet these needs of the times, as the demographic shifts have led to a situation where older adults now outnumber children, and polypharmacy is also a commonplace. However, the reimbursement system covered by the National Health Insurance (NHI) in Korea is still limited to the traditional dispensing and compounding role of pharmacist. To provide a take-home message to Korean pharmacy reimbursement system, we aimed to review and analyze the international trends in pharmacy remuneration systems. This is a comparative study between Korea, Japan, the United Kingdom, and the United States. Comparison was conducted by reviewing each country's policy and enforcement programs, as well as the related literature. Japan, the UK and the US systems remunerate diverse patient-centered pharmaceutical care services. The Korean pharmacy service fee is, however, narrowly focused on the traditional product-oriented pharmacy services. This study discussed the future direction of improving pharmacist reimbursement systems in Korea, by expanding professional pharmacy service coverage and diversifying fee schedule.

• Korean Journal of Health Education and Promotion
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• v.21 no.4
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• pp.121-135
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• 2004

This study aims to analyze the oral health status of the elderly. Study subjects were 9,340 elderly aged over 65 who took the health examination (the first) for the local insured when the National Health Insurance Corporation carried out its survey from January to December, 2002. The subjects took an oral examination and filled in the questionnaire. Major results from the analysis are as follows: 1. Analysis of Oral Health Behavior For oral health behavior, 38.2％ of total subjects had visited a dental hospital (or clinic) in the last one year in the order of the elderly of big cities (48.3％), the elderly of medium cities (43.9％), and the elderly of rural areas (29.0％)(P<0.001). Elderly men had a higher rate than elderly women, and the younger age had a higher rate(P<0.01). For experience of oral prophylaxis, 12.3％ of the total elderly had experienced it in the order of the elderly of big cities (18.8％), the elderly of medium cities (16.0％), and the elderly of rural areas (6.4％) (P<0.001). For elderly men, the younger age had a higher rate of oral prophylaxis. The number of toothbrushing in order was twice(47.5％), once (26.7％), three times (25.0％), and none (0.7％). The younger age brushed their teeth more often (P<0.001). 2. Analysis of Oral Health Status The rate of caries was 10.6％ of the elderly surveyed. By area, the elderly of rural areas had a higher rate of caries than the elderly of cities (p<0.001) and elderly men were higher than elderly women (p<0.001). By age, many elderly aged over 80 had more than two caries. For missing teeth, the elderly of rural areas had a higher rate than the elderly of cities (p<0.001) and the older age had a higher rate(p<0.001). The rate of periodontal disease was 43.2％ of the total elderly. By area, the elderly of big cities (46.2％) had a higher rate of periodontal disease than the elderly of medium cities (39.4％) and rural areas (43.6％)(p<0.001), and elderly men (46.4％) were higher than elderly women (40.2％)(p<0.001). By age, the lower age had a higher rate of peridontal disease (p<0.001). Dental abrasion was observed in 16.9％ of the total elderly. The elderly of cities (21.0％) had a higher rate than the elderly of rural areas (12.0％)(p<0.001) and elderly men (21.3％) were higher than elderly women (12.8％)(p<0.001). Also the lower age had more dental abrasion symptoms (p<0.001). For needing a denture, the rate among the elderly was 48.5％ and was higher for the elderly of rural areas(20.9％), than the elderly of big cities(7.0％) and medium cities (10.5％)(p<0.001). For the rate of denture wearing, the elderly of rural areas(41.8％) were higher than the elderly of big cities (27.7％) and medium cities (28.2％ )(p<0.001). For the relation of drinking and smoking to oral health, the elderly who had a higher frequency of drinking, had a higher rate of caries (p<0.001)periodontal disease(p<0.001) and missing teeth(p<0.001) Smokers had a higher rate of caries (p<0.001), periodontal disease (p<0.05), and missing teeth (p<0.001) than nonsmokers.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.30 no.1
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• pp.34-38
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• 2019

Background and Objectives : The aim of this study is verify the correlation between benign laryngeal mucosal disease and metabolic syndrome. Materials and Method : Data for patients diagnosed with benign laryngeal mucosal disease and metabolic syndrome from 2006 to 2015 were selected for analysis from the National Health Insurance Service database. Results : The prevalence of Metabolic syndrome was 2,179,785 out of 6,437,051 patients (33.86%). The prevalence of benign laryngeal mucosal disease was 516,594 out of 6,437,051 patients (8.03%). Metabolic syndrome was a risk factor for benign laryngeal mucosal disease [hazard ratio: 0.99, 95% confidence interval: 0.984-0.997] after adjusting for age and other variables including age, gender, smoking status, alcohol intake, exercise, body mass index, and diabetes. The number of metabolic syndrome components was also risk factor. Conclusion : Metabolic syndrome was related to the incidence of benign laryngeal mucosal disease. However this correlation did not seem to be high.

• Journal of the Korean housing association
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• v.11 no.1
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• pp.57-68
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• 2000

This study has been performed to review critical issues affecting continuous residence in profit(self-paid) assistant living facilities for the elderly in the United States. There are three factors influencing continuous residence of frail elderly in the facilities as long as they want without involuntary discharge : Financial ability, behavioral aspects, and facility management situation. Regarding financial ability, income, purchase of insurance policy, cashable assets, willingfulness to pay, and health status were found to be crucial determinants of continuous residence. Overall, 40-50% of those aged 65+ are financially able to stay in the assistant facilities as long as they want, without involuntary discharge. As for behavioral aspects, extroversions, congeniality, culture & life style, conscientiousness, preference for person, and physiological habits were found to be crucial determinants of continuous residence. As for the management situation, it is essential that facilities reach nature level of self-governing rights of the older residents and good local images, and conflicts among the residents and managing parties be resolved on the agreeable standards of inspectors. finally in this study, it is proposed that in Korea, national pension authority offer a liability package for assistant residence, for the case of individual bankruptcy.

• Health Policy and Management
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• v.23 no.4
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• pp.427-433
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• 2013

Background: This study was conducted to evaluate the factors affecting adherence in patients with hypertension and type 2 diabetes mellitus before and after a clinic based patient incentive program in Incheon. Methods: An observational follow-up study was done for 28,355 patients in one registered group and 245,598 patients in a non-registered group from March 16th 2009 to December 31th 2010 in Incheon. The registration, mandatory laboratory tests and number of clinic visits were collected by merging the Incheon Chronic Disease Management System data and the National Health Insurance Corporation (NHIC) data. As a measure of patient adherence, we used a variable of prescription days from the NHIC and defined above 80% of average prescription days as an appropriate patient adherence. Repeated measures analysis of variance and logistic regression were used to analyze the differences in patient adherence and factors affecting adherence. Results: The changes in prescription days for the registered group are larger than for the non-registered group. In the logistic regression model, including the variables with sex, age, income status and number of clinic visits, the registered group exhibited a higher Odds ratio in the patient adherence. Conclusion: This study revealed the association between registration and appropriate patient adherence in patients with hypertension or type 2 diabetes mellitus.

• The Korean Journal of Pain
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• v.34 no.3
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• pp.288-303
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• 2021

Background: Complex regional pain syndrome (CRPS) is an intractable pain disease with various symptoms. Here, we investigated the disease status, work life, sleep problems, medical insurance, economic status, psychological problems, and quality of life (QOL) of CRPS patients. Methods: CRPS patients from 37 university hospitals in South Korea were surveyed. The survey questionnaire consisted of 24 questions on the following aspects of CRPS patients: sex, age, occupation, cause of injury, activities of daily living (ADL), pain severity, sleep disturbance, level of education, economic status, therapeutic effect, and suicidal ideation. Additionally, the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, consisting of 26 questions, was used to identify the status of QOL. Results: A total of 251 patients completed the questionnaire. According to the survey, 54.2% patients could not perform ADL on their own. Over the previous week, the mean pain score was 7.15 ± 1.78 (out of a total of 10 points); 92.1% of patients had sleep disorders and 80.5% had suicidal ideation, with most patients suffering from psychological problems. The average for each domain of WHOQOL-BREF was as follows: 21.74 ± 14.77 for physical, 25.22 ± 17.66 for psychological, 32.02 ± 22.36 for social relationship, and 30.69 ± 15.83 for environmental (out of a total of 100 points each). Occupation, ADL, sleep time, therapeutic effect, and suicidal ideation were statistically correlated with multiple domains. Conclusions: Most patients had moderate to severe pain, economic problems, limitations of their ADL, sleep problems, psychological problems, and a low QOL score.