• 한국임상약학회지
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• 제28권3호
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• pp.194-203
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• 2018

Background: Bone fractures are high in elderly patients with type 2 diabetes mellitus (T2DM). Hyperglycemia and chronic kidney disease may increase the risk of fracture prevalence via altered bone metabolism, but whether glycemic control and kidney function are associated with the risk of fracture prevalence remains unclear. This study evaluated the relationship between glycemic control and baseline estimated glomerular filtration rate (eGFR) and risk of fracture prevalence in older and middle-aged patients with T2DM. Methods: Patients who underwent a general medical check-up between 2009 and 2013 were selected from the Korean National Health Insurance Sharing Service records. Chi-square test and multiple logistic regression analysis were used to assess the relationship between glycemic control and eGFR and risk of fracture prevalence. Results: Cumulative fracture prevalence were higher in patients with T2DM, irrespective of whether they had tight or less stringent glycemic control (fasting blood glucose [FBG] ${\geq}110mg/dL$). After adjustment for baseline age and FBG, tight and less stringent glycemic control was significantly associated with increased adjusted risk of fracture prevalence in middle-aged patients with T2DM (OR=1.13, 95% CI, 1.05-1.21, p=0.0005 vs OR=1.13, 95% CI, 1.06-1.20, p=0.0001), but not in older patients. Baseline eGFR was not significantly related to fracture prevalence in either older or middle-aged patients. Conclusion: Less stringent glycemic control significantly increased the adjusted risk of fracture prevalence in middle-aged patients with T2DM. Further studies are needed to confirm the effect of tight glycemic control on fracture prevalence.

• Journal of Korean Medical Science
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• 제33권49호
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• pp.310.1-310.11
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• 2018

Background: Acute pyelonephritis (APN) is one of the most common community-acquired bacterial infections. Recent increases of antimicrobial resistance in urinary pathogens might have changed the other epidemiologic characteristics of APN. The objective of this study was to describe the current epidemiology of APN in Korea, using the entire population. Methods: From the claims database of the Health Insurance Review and Assessment Service in Korea, the patients with International Classification of Diseases, 10th Revision codes N10 (acute tubulo-interstitial nephritis) or N12 (tubulo-interstitial nephritis, neither acute nor chronic) as the primary discharge diagnosis during 2010-2014 were analyzed, with two or more claims during a 14-day period considered as a single episode. Results: The annual incidence rate of APN per 10,000 persons was 39.1 and was on the increase year to year (35.6 in 2010; 36.7 in 2011; 38.9 in 2012; 40.1 in 2013; 43.8 in 2014, P = 0.004). The increasing trend was observed in both inpatients (P = 0.014) and outpatients (P = 0.004); in both men (P = 0.042) and women (P = 0.003); and those aged under 55 years (P = 0.014) and 55 years or higher (P = 0.003). Eleven times more women were diagnosed and treated with APN than men (men vs. women, 6.5 vs. 71.3), and one of every 4.1 patients was hospitalized (inpatients vs. outpatients, 9.6 vs. 29.4). The recurrence rate was 15.8%, and the median duration from a sporadic episode (i.e., no episode in the preceding 12 months) to the first recurrence was 44 days. The recurrence probability increased with the number of previous recurrences. The average medical cost per inpatient episode was USD 1,144, which was 12.9 times higher than that per outpatient episode (USD 89). Conclusion: The epidemiology of APN in Korea has been changing with an increasing incidence rate.

• 한국임상약학회지
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• 제29권3호
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• pp.186-192
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• 2019

Background: Diabetes is associated with cancer risk in the aging population. Observational studies have indicated the beneficial effects of metformin against breast cancer, making studies on the anticancer potential of antidiabetic drugs worthwhile. This study investigated cancer incidence in patients on antidiabetic monotherapy. Methods: Using National Health Insurance Service data (2002-2013), a retrospective cohort study that included type 2 diabetes mellitus (T2DM) patients was conducted. Study subjects were enrolled if they were ${\geq}30$ years old, on monotherapy for diabetes, and cancer-free. They were followed up for cancer occurrence or death, until December 31st, 2013. A Cox proportional hazard model analysis was conducted between metformin and sulfonylurea (including meglitinide) users, to determine cancer risk, with adjustment for age, gender, comorbidity index, dyslipidemia, hypertension, and T2DM duration. Results: The number of antidiabetic monotherapy-treated T2DM patients without a history of cancer was 9,554 (metformin, n = 5,825; sulfonylurea, n = 3,225; others, n = 504). During the follow-up period (mean, 2.04; IQR, 3.18 years), the cancer incidence rate was 5.48/100 and 5.45/100 patient-years for metformin and sulfonylurea, respectively. The hazard ratio (HR) for risk of cancer incidence in the metformin group was 0.74 (95% confidence interval [CI], 0.66-0.83; p < 0.0001), compared with sulfonylurea. Additionally, the HRs for risks of lung, liver, and stomach cancer were respectively 0.46 (95% CI, 0.31-0.66; p < 0.0001), 0.41 (95% CI, 0.31-0.54; p < 0.0001), and 0.51 (95% CI, 0.35-0.73; p = 0.0003). Conclusion: Antidiabetic therapy with metformin reduces cancer risk by 26%, specifically for lung, liver, and stomach cancer.

• Journal of Korean Neurosurgical Society
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• 제62권1호
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• pp.46-52
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• 2019

Objective : The aim of this nationwide study was to analyze the current state of patients with newly diagnosed metastatic spine tumors according to surgical methods. Methods : Data was extracted from the Korean Health Insurance Review and Assessment Service database. Surgery was categorized into three methods : fusion, decompression, and vertebroplasty. Data included patient age, sex, health insurance type, and co-morbidities. Survival rates of metastatic spine tumor patients according to each surgical method were evaluated. Results : Among 1677 patients who had an operation, 823 patients were treated by fusion, 141 patients underwent decompression, and 713 patients were treated by vertebroplasty. The three most prevalent primary tumor sites were the lung, breast, and liver & biliary. On the other hand, the three most prevalent primary tumor sites of patients who underwent surgery were the lung, liver & biliary, and the prostate. The median survival periods for each surgical method in the metastatic spine tumor patients were 228 days for those who underwent surgery, 249 days for decompression, and 154 days for vertebroplasty. Age, sex, and comorbidities significantly affected survival rate. Conclusion : For every primary tumor site, decompression was the least common surgical method during the study period. Although the three surgical methods did not significantly affect the survival period, patients with a poor prognosis tended to undergo vertebroplasty.

• Journal of Preventive Medicine and Public Health
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• 제52권3호
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• pp.188-194
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• 2019

Objectives: Outbreaks of scarlet fever in Mexico in 1999, Hong Kong and mainland China in 2011, and England in 2014-2016 have received global attention, and the number of notified cases in Korean children, including in Jeju Province, has also increased since 2010. To identify relevant hypotheses regarding this emerging outbreak, an age-period-cohort (APC) analysis of scarlet fever incidence was conducted among children in Jeju Province, Korea. Methods: This study analyzed data from the nationwide insurance claims database administered by the Korean National Health Insurance Service. The inclusion criteria were children aged ${\leq}14years$ residing in Jeju Province, Korea who received any form of healthcare for scarlet fever from 2002 to 2016. The age and year variables were categorized into 5 groups, respectively. After calculating the crude incidence rate (CIR) for age and calendar year groups, the intrinsic estimator (IE) method was applied to conduct the APC analysis. Results: In total, 2345 cases were identified from 2002 to 2016. Scarlet fever was most common in the 0-2 age group, and boys presented more cases than girls. Since the CIR decreased with age between 2002 and 2016, the age and period effect decreased in all observed years. The IE coefficients suggesting a cohort effect shifted from negative to positive in 2009. Conclusions: The results suggest that the recent outbreak of scarlet fever among children in Jeju Province might be explained through the cohort effect. As children born after 2009 showed a higher risk of scarlet fever, further descriptive epidemiological studies are needed.

• 한국임상약학회지
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• 제32권3호
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• pp.155-165
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• 2022

Background: Chronic obstructive pulmonary disease (COPD) is not completely reversible and requires long-term management with appropriate treatment. This study aimed to analyze trends in treatment regimens and medication costs for COPD patients using a national claims database. Methods: We conducted this analysis using National Patient Sample data from the Health Insurance Review and Assessment Service covering the period from 2015 to 2018. We have constructed a dataset comprising COPD disease classification codes J43.x and J44.x (based on KCD-7 code, J43.0 was excluded) and compiled a list of drugs fitting current guidelines. To identify trends, we calculated frequency, ratio, and compound annual growth rate (CAGR) using the numbers of prescriptions and patients. Results: The number of COPD patients was 7,260 in 2018, slightly decreased from 2015. Most of these COPD patients were aged 60 or older and included a high proportion of males (72.2%; 2018). The number of patients prescribed inhaled medications increased gradually from 2015 to 2018 (9,227 (47.1%); 2015, 9,285 (51.5%); 2018), while the number of patients prescribed systemic beta-agonists and Xanthines has decreased since 2015 (CAGR -14.7; systemic beta-agonist, -5.8; Xanthines). The per capita cost of medication has increased by 0.4% (KRW 206,667; 2018, KRW 204,278; 2015) annually during the study period. Conclusion: This study showed that treatment with inhaled medications had continuously increased in accord with changing guidelines, but oral medications were still widely used. It is necessary to emphasize the importance of inhaled medications in treating COPD to reduce additional economic burden through appropriate medication use.

• Korean Circulation Journal
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• 제53권5호
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• pp.313-327
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• 2023

Background and Objectives: Pulmonary arterial hypertension (PAH) is a rare but fatal disease. Recent advances in PAH-specific drugs have improved its outcomes, although the healthcare burden of novel therapeutics may lead to a discrepancy in outcomes between developing and developed countries. We analyzed how the epidemiology and clinical features of PAH has changed through the rapidly advancing healthcare infrastructure in South Korea. Methods: PAH was defined according to a newly devised 3-component algorithm. Using a nationwide health insurance claims database, we delineated annual trends in the prevalence, incidence, medication prescription pattern, and 5-year survival of PAH in Korea. Cumulative survival and potential predictors of mortality were also assessed among 2,151 incident PAH cases. Results: Between 2002 or 2004 and 2018, the prevalence and incidence of PAH increased 75-fold (0.4 to 29.9 per million people) and 12-fold (0.5 to 6.3 per million person-years), respectively. The proportion of patients on combination PAH-specific drug therapy has also steadily increased up to 29.0% in 2018. Among 2,151 incident PAH cases (median [interquartile range] age, 50 [37-62] years; 67.2% female), the 5-year survival rate and median survival duration were 71.8% and 13.1 years, respectively. Independent predictors of mortality were age, sex, etiology of PAH, diabetes, dyslipidemia, and chronic kidney disease. Conclusions: This nationwide study delineated that the prevalence and incidence of PAH have grown rapidly in Korea since the early 2000s. The use of combination therapy has also increased, and the 5-year survival rate of PAH in Korea was similar to those in western countries.

• 중환자간호학회지
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• 제17권2호
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• pp.25-41
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• 2024

Purpose : This study aimed to investigate changes in critical nursing activities from 2009 to 2020 and explore the relationship between nurse staffing and such activities in intensive care units. Methods : A total of 446,445 adult patients admitted to intensive care units in tertiary and general hospitals from 2009 to 2020 were identified using the National Health Insurance claims database. The Critical Nursing Activities Index was calculated based on the following critical nursing activities: ventilator, extracorporeal membrane oxygenation (ECMO), and continuous renal replacement therapy (CRRT). Trend analysis was performed to analyze changes in critical nursing activities over 12 years and to assess linear trends across different staffing levels. Results : The annual utilization days for ventilators, ECMO, and CRRT, as well as the Critical Nursing Activities Index significantly increased over the study period (p-for-trend<.001) in tertiary and general hospitals, except for ventilator use in general hospitals. Ventilator, ECMO, and CRRT utilization exhibited a significant upward trend with higher nurse staffing levels (Bonferroni adjusted p-for-trend<.001). The Critical Nursing Activities Index was significantly higher in hospitals with higher staffing levels compared to those with lower staffing levels (Bonferroni adjusted p <.05). Conclusion : The findings underscore the need for improved nurse staffing levels in intensive care units. Government policies should ensure that staffing levels align with critical nursing activities among critically ill patients to uphold the quality of care.

• The Korean journal of internal medicine
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• 제39권3호
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• pp.469-476
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• 2024

Background/Aims: The reimbursement policy for cryptogenic stroke (CS) was expanded in November 2018 from recurrent strokes to the first stroke episode. No reports have demonstrated whether this policy change has affected trends in implantable loop recorder (ILR) utilization. Methods: We identified patients who received an ILR implant using the Korea Health Insurance Review and Assessment Service database between July 2016 and October 2021. Patients meeting all the following criteria were considered to have CS indication: 1) prior stroke history, 2) no previous history of atrial fibrillation or flutter (AF/AFL), and 3) no maintenance of oral anticoagulant for ≥4 weeks within a year before ILR implant. AF/AFL diagnosed within 3 years after ILR implant or before ILR removal was considered ILR-driven. Results: Among 3,056 patients, 1,001 (32.8%) had CS indications. The total ILR implant number gradually increased for both CS and non-CS indications and the number of CS indication significantly increased after implementing the expanded reimbursement policy. The detection rate for AF/AFL was 26.3% in CS patients over 3 years, which was significantly higher in patients implanted with an ILR within 2 months after stroke than those implanted later. Conclusions: The expanded coverage policy for CS had a significant impact on the number of ILR implantation for CS indication. The diagnostic yield of ILR for AF/AFL detection seems better when ILR is implanted within 2 months than later. Further investigation is needed to demonstrate other clinical benefits and the optimal ILR implantation timing.

• Journal of Preventive Medicine and Public Health
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• 제30권1호
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• pp.195-207
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• 1997

High price equipment is one of the major factors that increases national health expenditure in developed countries. Computerized Tomography(CT), one of the important high price equipment, has been concerns of health service researchers and policy makers in many countries. In Korea, CT, first introduced in 1984, have spreaded nationwide with rapid speed. Though the Committee for Approving Import of High Price Medical Equipment, founded in 1981, tried to regulate the introduction of high price medical equipment including CT, the effort resulted in failure. The exact situation of diffusion of the high price equipment, however, was not yet investigated. We aimed at the description of the diffusion of CT in Korea and analysis of influencing factors on hospitals for the adoption of CT. We mainly used the database of CT, made in 1996 by the National Federation of Medical Insurance for the purpose of insurance payment for CT. Also characteristics of hospitals were gathered from yearbooks published by the central and local governments and by the Korean Hospital Association. We calculated the cumulative number of the CT per one million population year by year. In turn, multiple linear logistic regression was done to find out the contributing factors for the adoption of CT by each hospital. In the logistic regression model, it is regarded as dependent factor whether a hospital retained CT or not in 1988 and 1993. The major categories of the independent factors were hospital characteristics, environmental factors and competitive conditions of hospitals at the period of the adoption. The results are as follows: Number of CT scanners per one million persons in Korea marked more higher level compared with those of most OECD countries. Major influencing factors on the adoption of CT scanners were hospital characteristics, such as hospital referral level, and competitive condition of hospitals, such as number of CT scanners per 10,000 persons in each district where the hospital was located. In Korea, CT diffused with rather rapid speed, comparable with those of the United States and Japan. The major factors contributing on the adoption of CT for hospitals were competitive condition and hospital characteristics rather than regional health care need for CT. In conclusion, a kind of regulating mechanism would be necessary for the prevention of the indiscreet adoption and inefficient use of high price equipment including CT.