• Journal of Korean Neurosurgical Society
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• v.65 no.5
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• pp.741-750
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• 2022

Objective : In March 2020, World Health Organization declared a global pandemic caused by a novel coronavirus (SARS-CoV-2). The disease caused by this virus is called COVID-19. Due to its high contagiousness, many changes have occurred in overall areas of our daily life including hospital use by patients. The aim of this study was to investigate the impact of COVID-19 on volume of spine surgery in South Korea using the National Health Insurance database and compare it with the volume of a homologous period before the pandemic. Methods : Data of related to spine surgery from January 2019 to April 2021 were obtained from the National Health Insurance and Health Insurance Review and Assessment Service database. Primary outcomes were total number of patients, rate of patients per 100000 population, and total number of procedures. The number of patients by hospital size was also analyzed. Results : COVID-19 outbreaks occurred in South Korea in March, August, and December of 2020. Compared to the previous year, the total number of patients who underwent spinal surgery showed a decrease for 2-3 months after the first and second outbreaks. However, it showed an increasing trend after the third outbreak. The same pattern was observed in terms of the ratio of the number of patients per 100000 population. Between 2019 and 2021, the mean number of spine surgeries per month tended to increase. Mean annual medical expenses increased over the years (p=0.001). When the number of spine surgeries was analyzed by hospital size, proportion of tertiary general hospital in 2021 increased compared to those in 2019 and 2020 (vs. 2019, p=0.012; vs. 2020, p=0.016). The proportion of general hospital was significantly decreased in 2020 compared to that in 2019 (p=0.037). Conclusion : After the COVID-19 outbreak, patients tended to postpone spinal surgery temporarily. The number of spinal surgeries decreased for 2-3 months after the first and second outbreaks. However, as the ability to respond to the COVID-19 pandemic at the hospital and society-wide level gradually increased, the number of spine surgeries did not decrease after the third outbreak in December 2020. In addition, the annual number of spine surgeries continued to increase. However, it should be noted that patients tend to be increasingly concentrated in tertiary hospitals for spinal surgery.

• Journal of Preventive Medicine and Public Health
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• v.49 no.4
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• pp.230-239
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• 2016

Objectives: We aimed to evaluate the effect of geographic units of analysis on measuring geographic variation in medical services utilization. For this purpose, we compared geographic variations in the rates of eight major procedures in administrative units (districts) and new areal units organized based on the actual health care use of the population in Korea. Methods: To compare geographic variation in geographic units of analysis, we calculated the age-sex standardized rates of eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee-replacement surgery, caesarean section, hysterectomy, computed tomography scan, and magnetic resonance imaging scan) from the National Health Insurance database in Korea for the 2013 period. Using the coefficient of variation, the extremal quotient, and the systematic component of variation, we measured geographic variation for these eight procedures in districts and new areal units. Results: Compared with districts, new areal units showed a reduction in geographic variation. Extremal quotients and inter-decile ratios for the eight procedures were lower in new areal units. While the coefficient of variation was lower for most procedures in new areal units, the pattern of change of the systematic component of variation between districts and new areal units differed among procedures. Conclusions: Geographic variation in medical service utilization could vary according to the geographic unit of analysis. To determine how geographic characteristics such as population size and number of geographic units affect geographic variation, further studies are needed.

• Radiation Oncology Journal
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• v.37 no.1
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• pp.13-21
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• 2019

Purpose: Glioblastoma (GBM) carries a high propensity for in-field failure despite trimodality management. Past studies have failed to show outcome improvements with dose-escalation. Herein, we examined trends and outcomes associated with dose-escalation for GBM. Materials and Methods: The National Cancer Database was queried for GBM patients who underwent surgical resection and external-beam radiation with chemotherapy. Patients were excluded if doses were less than 59.4 Gy; dose-escalation referred to doses ≥66 Gy. Odds ratios identified predictors of dose-escalation. Univariable and multivariable Cox regressions determined potential predictors of overall survival (OS). Propensity-adjusted multivariable analysis better accounted for indication biases. Results: Of 33,991 patients, 1,223 patients received dose-escalation. Median dose in the escalation group was 70 Gy (range, 66 to 89.4 Gy). The use of dose-escalation decreased from 8% in 2004 to 2% in 2014. Predictors of escalated dose were African American race, lower comorbidity score, treatment at community centers, decreased income, and more remote treatment year. Median OS was 16.2 months and 15.8 months for the standard and dose-escalated cohorts, respectively (p = 0.35). On multivariable analysis, age >60 years, higher comorbidity score, treatment at community centers, decreased education, lower income, government insurance, Caucasian race, male gender, and more remote year of treatment predicted for worse OS. On propensity-adjusted multivariable analysis, age >60 years, distance from center >12 miles, decreased education, government insurance, and male gender predicted for worse outcome. Conclusion: Dose-escalated radiotherapy for GBM has decreased over time across the United States, in concordance with guidelines and the available evidence. Similarly, this large study did not discern survival improvements with dose-escalation.

• Therapeutic Science for Rehabilitation
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• v.12 no.1
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• pp.51-63
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• 2023

Objective : This study aimed to analyze the association between lifestyle and medical expenses of older adults with mental illness using claims data. Methods : We conducted secondary data analysis using the older adult cohort database provided by the Korea National Health Insurance Service. The lifestyle and medical expense variables were extracted from the cohort database. We used a generalized linear model to examine the association between lifestyle and medical expenses. Results : In total, 32,853 records were extracted. The results showed that smokers had medical expenses (estimate = -218,255, p = .037). As the number of days of walking increased, medical expenses significantly decreased (estimate = -58,843, p < .0001). Furthermore, as the number of days of drinking decreased, medical expenses increased (estimate = 692,289, p < .0001). Conclusion : This study analyzed the estimates of medical expenses according to lifestyle among older adults with mental illness. Smoking and exercise were negatively associated with medical expenses. These results suggest the importance of a healthy lifestyle for older adults with mental illness. In addition, this study can be used as clinical evidence for lifestyle management programs to improve physical and mental health.

• Journal of Preventive Medicine and Public Health
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• v.31 no.4 s.63
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• pp.592-603
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• 1998

This study was conducted to estimate incidence rate of female breast cancer in a defined area of Chungchongbuk-do in Korea. The presumptive breast cancer cases were selected from two different sources, i.e., medical utilization database of the National Health Insurance Corporation and the database from the National Cancer Registry. Medical students visited each hospital where the presumptive cases had been treated as a breast cancer patient, and made a dictation of medical record of each patient based on the claims stored in the Insurance Corporation from January to December 1995. The diagnoses in the claims included one of the following diagnostic codes; ICD-9 174-175(malignant neoplasms of the breast), 233(carcinoma in situ of the breast and genito-urinary system)or ICD-10 C50(malignant neoplasms of the breast), D05(carcinoma in situ of the breast and genito-urinary system). Each case has been confirmed as having a breast cancer by a breast surgeon through a medical record review. Age-standardized incidence rate of female breast cancer to the Korean population was estimated to be 10.5(95%confidence interval : 8.1-12.9)per 100,000 persons in 1995. Age-standardized rate to the world population was 9.8 per 100,000 persons, and the truncated rate for ages 35-64 was 27.2 per 100,000 persons. Validity of these estimates is discussing in comparison with previous methods of incidence estimation in Korea.

• Journal of Society of Preventive Korean Medicine
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• v.25 no.3
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• pp.25-37
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• 2021

Objectives : To investigate the effectiveness of Korean Medicine services use on the all-cause mortality and incidence of Parkinson's disease(PD) in elderly patients with chronic disease based on the National Health Insurance Service Corhort Database (elderly), called as the NHIS-senior. Methods : This study was a retrospective cohort analysis conducted using the NHIS-senior. Patients with chronic diseases over 65 years old who were not diagnosed PD during 2007-2009 were identified. The case group was defined as patients who used both Korean Medicine and Western Medicine services and the control group consisted of patients who used Western Medicine service only. The all-cause mortality and incidence of PD was analyzed using the Cox proportional hazard model after a propensity score matching(PSM) with a 1:1 ratio. Results : After PSM, the cohort included 47,546 subjects (23,773 in the case group, 23,773 in the control group). Sex, age, comorbidity, severity of disability, and neurology medical service utilization were adjusted in both groups. The mortality was 0.668 times (95% C.I.: 0.646-0.690) lower in the case group than the control group, which was statistically significant (p<0.001). The incidence of PD was 1.051 times (95% C.I.: 0.962-1.148) higher in the case group than the control group, which was not statistically significant(p=0.272). Conclusion : It was not obvious that the use of both Korean Medicine service and Western Medicine services for prevention of PD is benefitial than using only Western Medicine. But it would be possible that using both Korean Medicine and Western Medicine services decreases the mortality than using Western Medicine alone.

• Korean Journal of Schizophrenia Research
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• v.24 no.2
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• pp.60-67
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• 2021

Objectives: The optimal duration of maintenance treatment for patients with first-episode schizophrenia (FES) remains unclear. We examined the first antipsychotic treatment duration and its association with re-initiation of treatment using a nationwide claim database. Methods: Data from the Health Insurance Review and Assessment Service database in South Korea for 2007-2016 were used. Linear regression analysis and Cox proportional hazard models were used to evaluate the associations between the duration of the first antipsychotic treatment, time to re-initiation of treatment, and occurrence of treatment re-initiation. Results: Of 30,143 patients with FES, 80.4% (n=24,231) received <2 years of the first antipsychotic treatment. In patients who discontinued treatment (n=23,030), the rate of treatment re-initiation was 74.2% (n=17,086). As the duration of the first antipsychotic treatment increased, the time to re-initiation of treatment decreased (β=-0.146, p<0.001); however, the rate of treatment reinitiation was relatively constant (hazard ratio=1.001, p<0.001). Conclusion: Long-term antipsychotic treatment was not significantly associated with the rate of treatment re-initiation but showed a negative association with the time to re-initiation of treatment. Further research is needed to better understand the optimal treatment duration for FES.

• Industrial Engineering and Management Systems
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• v.13 no.4
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• pp.449-453
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• 2014

Chronic diseases including hypertension and its complications are major sources causing the national medical expenditures to increase. We aim to predict the risk of hypertension complications for hypertension patients, using the sample national healthcare database established by Korean National Health Insurance Corporation. We apply classification techniques, such as logistic regression, linear discriminant analysis, and classification and regression tree to predict the hypertension complication onset event for each patient. The performance of these three methods is compared in terms of accuracy, sensitivity and specificity. The result shows that these methods seem to perform similarly although the logistic regression performs marginally better than the others.

• Health Policy and Management
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• v.31 no.1
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• pp.125-139
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• 2021

Background: In Korea, the health gap widens due to the number of medical resources and access to medical services between metropolitan and rural. The purpose of this study is to identify the impact of residential migration on medical utilization and accessibility. Methods: This study extracted 528,516 claimed cases in the National Health Insurance Service-Cohort Sample Database from 2006 to 2015. Subjects were classified into two groups by the magnitude of the region, the metropolitan and the rural. The inversed probability weights were calculated for each group. And coefficients of the two-part model were estimated by generalized estimation equation. Results: Those who moved region from metropolitan to rural tend to increase the length of stay and inpatients with ambulatory care sensitive conditions (ACSC) disease. Contrariwise, those who moved areas from rural to metropolitan tend to decrease the total medical cost, the adjusted patient days, the number of outpatients and the number of outpatients and inpatients with ACSC disease. Conclusion: This study identified that between the residents who continued to reside in the region and the migrants, there were significant differences in the medical accessibility, quality of primary care, and unmet medical need.

• Journal of Preventive Medicine and Public Health
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• v.49 no.3
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• pp.143-152
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• 2016

Objectives: Metabolic syndrome is a cluster of risk factors for type 2 diabetes mellitus and cardiovascular disease. Associations between metabolic syndrome and several types of cancer have recently been documented. Methods: We analyzed the sample cohort data from the Korean National Health Insurance Service from 2002, with a follow-up period extending to 2013. The cohort data included 99 565 individuals who participated in the health examination program and whose data were therefore present in the cohort database. The metabolic risk profile of each participant was assessed based on obesity, high serum glucose and total cholesterol levels, and high blood pressure. The occurrence of cancer was identified using Korean National Health Insurance claims data. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models, adjusting for age group, smoking status, alcohol intake, and regular exercise. Results: A total of 5937 cases of cancer occurred during a mean follow-up period of 10.4 years. In men with a high-risk metabolic profile, the risk of colon cancer was elevated (HR, 1.40; 95% CI, 1.14 to 1.71). In women, a high-risk metabolic profile was associated with a significantly increased risk of gallbladder and biliary tract cancer (HR, 2.05; 95% CI, 1.24 to 3.42). Non-significantly increased risks were observed in men for pharynx, larynx, rectum, and kidney cancer, and in women for colon, liver, breast, and ovarian cancer. Conclusions: The findings of this study support the previously suggested association between metabolic syndrome and the risk of several cancers. A high-risk metabolic profile may be an important risk factor for colon cancer in Korean men and gallbladder and biliary tract cancer in Korean women.