• Journal of Preventive Medicine and Public Health
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• 제56권1호
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• pp.31-40
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• 2023

Objectives: This study investigated the effect of cognitive impairment on the association between social network properties and mortality among older Korean adults. Methods: This study used data from the Korean Social Life, Health, and Aging Project. It obtained 814 older adults' complete network maps across an entire village in 2011-2012. Participants' deaths until December 31, 2020 were confirmed by cause-of-death statistics. A Cox proportional hazards model was used to assess the risks of poor social network properties (low degree centrality, perceived loneliness, social non-participation, group-level segregation, and lack of support) on mortality according to cognitive impairment. Results: In total, 675 participants (5510.4 person-years) were analyzed, excluding those with missing data and those whose deaths could not be verified. Along with cognitive impairment, all social network properties except loneliness were independently associated with mortality. When stratified by cognitive function, some variables indicating poor social relations had higher risks among older adults with cognitive impairment, with adjusted hazard ratios (HRs) of 2.12 (95% confidence interval [CI], 1.34 to 3.35) for social nonparticipation, 1.58 (95% CI, 0.94 to 2.65) for group-level segregation, and 3.44 (95% CI, 1.55 to 7.60) for lack of support. On the contrary, these effects were not observed among those with normal cognition, with adjusted HRs of 0.73 (95% CI, 0.31 to 1.71), 0.96 (95% CI, 0.42 to 2.21), and 0.95 (95% CI, 0.23 to 3.96), respectively. Conclusions: The effect of social network properties was more critical among the elderly with cognitive impairment. Older adults with poor cognitive function are particularly encouraged to participate in social activities to reduce the risk of mortality.

• The Korean journal of internal medicine
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• 제39권2호
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• pp.306-317
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• 2024

Background/Aims: To determine whether metformin, which is considered a host-directed therapy for tuberculosis (TB), is effective in improving the prognosis of patients with TB and diabetes mellitus (DM), who have higher mortality than those without DM. Methods: This cohort study included patients who were registered as having TB in the National Tuberculosis Surveillance System. The medical and death records of matched patients were obtained from the National Health Information Database and Statistics Korea, respectively, and data from 2011 to 2017 were collected retrospectively. We classified patients according to metformin use among participants who used diabetes drugs for more than 28 days. The primary outcome was all-cause mortality during TB treatment. Double propensity score adjustment was applied to reduce the effects of confounding and multivariable Cox proportional hazard models were used to estimate adjusted hazard ratio (aHR) with 95% confidence interval (CI). Results: The all-cause mortality rate during TB treatment was lower (9.5% vs. 12.4%, p < 0.01) in the metformin user group. The hazard of death due to all causes after double propensity score adjustment was also lower in the metformin user group (aHR 0.76, 95% CI 0.67-0.86, p < 0.01). There was no significant difference in mortality between metformin users and non-users for TB-related deaths (p = 0.22); however, there was a significant difference in the non-TB-related deaths (p < 0.01). Conclusions: Metformin use in patients with TB-DM co-prevalence is associated with reduced all-cause mortality, suggesting the potential for metformin adjuvant therapy in these patients.

• 보건행정학회지
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• 제24권2호
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• pp.143-152
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• 2014

Background: Previous studies showed that the characteristics of population and regions were related to the suicide rates. This study purposed to analyze the relationships between regional factors and suicide rates with spatial analysis model. Methods: This is a cross sectional study based on the statistics of 2011 which was extracted from the 229 City Gun Gu administrative districts in Korea. Cause of death statistics on each district was used to produce the age-, sex-adjusted mortality rates resulting from suicide. Regional characteristics were measured by the number of doctors engaged in medical institutions per 1,000 population, divorced people's rate per 1,000 population, number of marriages per 1,000 population, and percent of welfare budget in general accounting. Statistical analysis was performed by using SAS ver. 9.3 and ArcGIS ver. 10.2 was used for geographically weighted regression (GWR). Results: In ordinary least square (OLS) regression, divorced people's rate per 1,000 population had a significant positive relationship with the standardized mortality rate per 100,000 population. Marriages per 1,000 population and the proportion of welfare budget in the general accounting had significant negative relationships with the mortality rates. Meanwhile, GWR provided that the directions of variable, divorced people's rate per 1,000 population, were varied depending on regions. The adjusted $R^2$ was improved from the 0.32 in OLS to the 0.46 in GWR. Conclusion: Results of GWR showed that regional factors had different effects on the suicide rates depending on locations. It suggested that policy interventions for reducing the suicide rate should consider the regional characteristics in obtaining policy objectives.

• Journal of the Korean Data and Information Science Society
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• 제26권1호
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• pp.101-109
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• 2015

행정구역상 읍/면/동 단위의 소지역 (small area)별로 질병위험의 차이에 대한 분석을 위해, 2005년 기준 서울 행정동을 기준으로 2005년부터 2008년까지 질병, 사고, 암 사망자료에 대한 표준화 사망률 (SMR; standardized mortality rate)을 고려하였다. 소지역 단위로 질병사망률을 직접 추정하는 것은 소지역 내 표본수가 작아, 개발 소지역 단위에서의 직접 계산된 SMR은 그 추정치의 정도 (precision) 확보가 어려운 문제점이 발생한다. 따라서, 본 연구에서는 각 소지역간 효과 추정을 위해 공간적 상관성 (spatial correlation)을 가지는 다단계 일반화 선형모형 (HGLM; hierarchical generalized linear models)을 고려하였다. 이를 통해, 서울지역 동별 주요 사망원인에 따른 공변량의 효과 및 추정된 SMR을 근거로 질병지도 결과를 제시하였다.

• 대한지리학회지
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• 제51권3호
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• pp.367-380
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• 2016

본 연구에서는 우리나라에서 발생한 저체중아 출생 집계 자료를 공간적으로 지도화하기 위한 기법들을 검토 비교하고, 이를 기반으로 우리나라의 LBW 지도를 작성하였다. 표준화사망률이나 조사망률 등은 역학 분야에서 지속적으로 광범위하게 사용되고 있는 지표이다. 그러나 이러한 표준화사망률은 집계 단위의 샘플 수에 영향을 많이 받는다는 단점을 가지고 있다. 이에, 본 연구에서는 베이지언 기법을 활용하여 샘플 수에 따른 통계적 변동성을 감소시키고자 하였다. 이를 위해 경험적 베이지언 기법과 풀 베이지언 기법을 모두 활용하였고, 결과적으로 유사한 통계량을 산출한 것을 확인할 수 있었다. 반면, SMR 기반의 통계량은 높은 분산을 가지고 있음을 확인하였다. 연구의 결과에 따른 통계 지도는 우리나라 저체중아 출생의 높은 위험도를 가지는 지역들을 파악할 수 있도록 한다.

• Journal of the Korean Data and Information Science Society
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• 제22권6호
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• pp.1257-1264
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• 2011

Delirium is a neuropsychiatric disorder accompanying symptoms of hallucination, drowsiness, and tremors. It has high occurrence rates among elders, heart disease patients, and burn patients. It is a medical emergency associated with increased morbidity and mortality rates. That s why early detection and prevention of delirium ar significantly important. And This mental illness like delirium occurred by complex interaction between risk factors. In this paper, we identify risk factors and interactions between these factors for delirium using multi-factor dimensionality reduction (MDR) method.

• Journal of the Korean Data and Information Science Society
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• 제22권2호
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• pp.137-148
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• 2011

본 논문에서는 최근 중요한 문제로 대두되고 있는 손상으로 인한 사망 중 운수사고, 자살, 낙상사고에 의한 사망률에 대한 시 군 구 별 차이를 체계적으로 파악하고자 한다. 2008년 사망원인통계 원시 자료 중 19세 이상이면서, 국제사인분류에 따른 사인이 운수사고, 자살, 낙상사고에 의한 자료만을 추출하여 분석대상으로 고려하였다. 분석모형으로 성별, 연령, 1인당 주민세를 고정효과로 보정하고, 사망자수가 포아송분포를 따른다는 가정 하에 지역효과를 변량효과로 둔 포아송 HGLM 모형을 고려하여 시 군 구 소지역별 효과의 차이를 질병지도로 나타내었다. 분석결과 운수사고, 자살사고로 인한 사망률은 시 군 구 소지역별로 유의한 차이가 나타났지만, 낙상사고로 인한 사망률은 시 군 구 지역별로 유의한 차이가 없는 것으로 나타났다.

• Journal of Gastric Cancer
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• 제22권3호
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• pp.160-168
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• 2022

This study investigated the trends of gastric cancer in Korea by adding the latest updated gastric cancer data from 2019. Gastric cancer incidence between 1999 and 2019 was reviewed using data from the Korea Central Cancer Registry. The study period was divided into 3 periods: period I (1999-2005), period II (2006-2012), and period III (2013-2019). The incidence, mortality, tumor location, histology, stage, and treatment were analyzed. Between 1999 and 2019, 577,502 patients were newly diagnosed with gastric cancer in Korea, accounting for 33.2% of patients aged ≥ 70 years. The age-standardized incidence rate (per 100,000) significantly decreased from 2011 (43.0) to 2019 (29.6), with an annual percent change of -4.50. Additionally, the age-standardized mortality rate (per 100,000) markedly decreased from 1999 (23.9) to 2019 (6.7). The proportions of patients with cardia and fundus cancers remained consistent. The proportion of localized stage cases increased, while those of regional and distant stages decreased. The rate of surgical treatment increased in localized and regional stages from 2006 to 2019. The overall 5-year relative survival (5YRS) rate of gastric cancer (per 100,000) increased from 55.7% in period I to 77.0% in period III. From 2013 to 2019, the 5YRS rates of patients (per 100,000) who underwent surgical treatment were 100.6% and 70.5% in the localized and regional stages, respectively. The results of this study demonstrated several changes in the epidemiology of gastric cancer in Korea. This study provides information to help understand the current trends in gastric cancer in Korea.

• 응용통계연구
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• 제33권4호
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• pp.421-437
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• 2020

본 논문은 최근에 널리 사용되고 있는 R 프로그램으로 출산율, 사망률, 국제이동률을 예측하고 이들 결과를 Leslie 행렬에 대입해 인구추계 산출하는 방법을 소개한다. 특히 Kaneko (2003)가 제안한 출산율의 일반화로그감마모형, Li 등 (2013)의 사망률 LC-ER 모형, Ramsay와 Silverman (2005)가 제안한 국제이동률의 함수적데이터모형을 시현할 수 있도록 하였다. 최근 R로 구현된 대표적인 인구추계 패키지로 demography, bayesPop가 소개되고 있으나, 이는 Human Mortality Database (HMD), Human Fertility Database (HFD)에 업로드된 자료에 한에서만 분석이 가능하고 기타 데이터를 적용하기 위해서는 자료 변경과 수정이 요구된다. 특히 우리나라의 경우 HMD에 단기 간의 자료로만 제공되어 있어 이 패키기를 적용하기에는 한계점이 있다. 이에 본 논문은 이런 실정과 한국의 저출산, 고령화, 내국인, 외국인 국제이동률 상이패턴을 반영할 수 있는 R 프로그램을 소개하고, 2117년까지의 인구추계를 도출하였다.

• Journal of Preventive Medicine and Public Health
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• 제47권4호
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• pp.206-215
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• 2014

Objectives: The hospital standardized mortality ratio (HSMR) has been widely used because it allows for robust risk adjustment using administrative data and is important for improving the quality of patient care. Methods: All inpatients discharged from hospitals with more than 700 beds (66 hospitals) in 2008 were eligible for inclusion. Using the claims data, 29 most responsible diagnosis (MRDx), accounting for 80% of all inpatient deaths among these hospitals, were identified, and inpatients with those MRDx were selected. The final study population included 703 571 inpatients including 27 718 (3.9% of all inpatients) in-hospital deaths. Using logistic regression, risk-adjusted models for predicting in-hospital mortality were created for each MRDx. The HSMR of individual hospitals was calculated for each MRDx using the model coefficients. The models included age, gender, income level, urgency of admission, diagnosis codes, disease-specific risk factors, and comorbidities. The Elixhauser comorbidity index was used to adjust for comorbidities. Results: For 26 out of 29 MRDx, the c-statistics of these mortality prediction models were higher than 0.8 indicating excellent discriminative power. The HSMR greatly varied across hospitals and disease groups. The academic status of the hospital was the only factor significantly associated with the HSMR. Conclusions: We found a large variation in HSMR among hospitals; therefore, efforts to reduce these variations including continuous monitoring and regular disclosure of the HSMR are required.