Risk of Cerebro-Cardiovascular Diseases among Police Officers and Firefighters:A Nationwide Retrospective Cohort Study

Purpose@#Police officers and firefighters are exposed to risk factors for cerebro-cardiovascular diseases, and the actual risk is expected to increase compared with other occupational groups. The present study aimed to estimate the risks of cerebro-cardiovascular diseases in police officers and firefighters compared to other occupational groups. @*Materials and Methods@#Using the National Health Insurance Service data, we constructed a retrospective cohort of public officers. Three-year consecutive health insurance registration data were used to identify police officers and firefighters. Cerebro-cardiovascular diseases consisted of acute myocardial infarction, other ischemic heart disease, cardiac arrhythmia, and stroke. We compared the incidences of cerebro-cardiovascular diseases between each of the two occupational groups (police officers and firefighters) and other public officers by calculating standardized incidence ratios (SIRs). @*Results@#SIRs and 95% confidence intervals of all cerebro-cardiovascular diseases for police officers and firefighters were 1.71 (1.66–1.76) and 1.22 (1.12–1.31), respectively, as compared with all public officers. The incidence ratios remained significantly higher compared to general and education officers. Subgroup analyses for myocardial infarction, stroke, and cardiac arrhythmia exhibited significant increases in incidence ratios among police officers and firefighters. @*Conclusion@#This study suggests that both police officers and firefighters are at high risk of cerebro-cardiovascular diseases.Therefore, medical protection measures for these occupational groups should be improved.

The Effect of Residential Migration on the Utilization and Accessibility of Medical Care / 보건행정학회지

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.

The Effect of Residential Migration on the Utilization and Accessibility of Medical Care / 보건행정학회지

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.

Factors Affecting the Healthcare Utilization of Spinal and Joint Surgery in Elderly Patients / 보건행정학회지

Background@#The purpose of this study is to analyze the current status and factors of elderly patients’ hospitalization for hip replacement, knee replacement, and general spine surgery. @*Methods@#National health insurance data in 2018 was provided by the National Health Insurance Service. We used multiple regression to analyze factors associated with the medical utilization of hip replacement, knee replacement, and general spine surgery in elderly patients over 65 years old. The dependent variables are the length of stay and total health expenditure. The independent variables are the demographic-social factors (sex, age, region, insurance type, income level) and surgery-related factors (institution type, location of the hospital, surgery classification). @*Results@#The most common factor affecting surgery was the location of medical institutions. Compared with the medical institutions located in metropolitan, the length of stay in rural medical institutions was higher and total health expenditure was lower. The lower quartile of income, the higher the length of stay and total health expenditure. In addition, the variables of age, type of health insurance, and type of medical institution were statistically significant. @*Conclusion@#In this study, we confirmed the effect of sociodemographic factors and medical institution factors on the Healthcare Utilization of spinal and joint surgery.

Analyses of Factors Related to the Incurrence of Catastrophic Health Expenditure: Does Elderly in Households Matter? / 보건행정학회지

Background@#The purpose of this study is to explain the factors influencing the incurrence of catastrophic health expenditure of national health insurance households using panel data observed over a long period. @*Methods@#The study targeted 3,652 households who had no censoring during the 11-year survey period (2007–2017) and householders whose insurance type was consistently maintained as national health insurance. Generalized estimating equations were adopted to identify factors affecting the occurrence of catastrophic health expenditure at 20%, 30%, and 40% threshold levels. A subgroup analysis was conducted by categorizing groups depending on the existence of the elderly in the household. @*Results@#For the last 11 years, the incidence of catastrophic health expenditure in the households without the elderly decreased slightly at all threshold levels, but the households with the elderly seemed to be increased. At baseline, household type showed a statistically significant relationship with all other variables. The results of generalized estimating equations analyses show that household income was not significant at all threshold levels in the households without elderly. On the other hand, in the households with the elderly, the 2nd (odds ratio [OR], 1.33–2.05) and 3rd quintile groups (OR, 1.25–2.55) were more likely to have catastrophic health expenditure compared to the 1st quintile of household income group. @*Conclusion@#As the amount of health expenditures relative to the ability to pay is increasing in households with the elderly, the application of an intervention followed by consistent monitoring is needed. This study found that there were differences in influencing factors according to the presence of the elderly in the households. In particular, in households with the elderly, interesting results have been drawn regarding the occurrence of catastrophic health expenditure in the near-poor, so additional research is required.

Analyses of Factors Related to the Incurrence of Catastrophic Health Expenditure: Does Elderly in Households Matter? / 보건행정학회지

Background@#The purpose of this study is to explain the factors influencing the incurrence of catastrophic health expenditure of national health insurance households using panel data observed over a long period. @*Methods@#The study targeted 3,652 households who had no censoring during the 11-year survey period (2007–2017) and householders whose insurance type was consistently maintained as national health insurance. Generalized estimating equations were adopted to identify factors affecting the occurrence of catastrophic health expenditure at 20%, 30%, and 40% threshold levels. A subgroup analysis was conducted by categorizing groups depending on the existence of the elderly in the household. @*Results@#For the last 11 years, the incidence of catastrophic health expenditure in the households without the elderly decreased slightly at all threshold levels, but the households with the elderly seemed to be increased. At baseline, household type showed a statistically significant relationship with all other variables. The results of generalized estimating equations analyses show that household income was not significant at all threshold levels in the households without elderly. On the other hand, in the households with the elderly, the 2nd (odds ratio [OR], 1.33–2.05) and 3rd quintile groups (OR, 1.25–2.55) were more likely to have catastrophic health expenditure compared to the 1st quintile of household income group. @*Conclusion@#As the amount of health expenditures relative to the ability to pay is increasing in households with the elderly, the application of an intervention followed by consistent monitoring is needed. This study found that there were differences in influencing factors according to the presence of the elderly in the households. In particular, in households with the elderly, interesting results have been drawn regarding the occurrence of catastrophic health expenditure in the near-poor, so additional research is required.

Association between Possibility of Purchasing Cigarettes and E-cigarette Experience among Korean Adolescent Smokers / 가정의학회지

BACKGROUND: To aim of this study was to examine the association between perceived possibility of purchasing cigarettes and e-cigarette experience among adolescents who currently smoke cigarettes. METHODS: Data were derived from the Korea Youth Risk Behavior Web-Based Survey; a total of 29,169 current smokers participated. The dependent variable was e-cigarette experience in the previous month. Analyses included χ2 test and survey logistic regression. RESULTS: A perceived easy possibility of purchasing cigarettes increased the odds of e-cigarette experience (odds ratio, 1.19; 95% confidence interval, 1.07–1.33) compared to when it was perceived as impossible. An easy possibility of purchasing cigarettes increased the odds of e-cigarettes experience among males aged 12–15 or 17 years compared to when it was impossible to purchase cigarettes. CONCLUSION: A perceived easy possibility of purchasing cigarettes was more likely to increase e-cigarette experience among adolescents. Laws restricting adolescents' access to e-cigarettes must be strengthened.

New Alert Override Codes for the Drug Utilization Review System Derived from Outpatient Prescription Data from a Tertiary Teaching Hospital in Korea / 대한의료정보학회지

OBJECTIVES: This paper proposes new alert override reason codes that are improvements on existing Drug Utilization Review (DUR) codes based on an analysis of DUR alert override cases in a tertiary medical institution. METHODS: Data were obtained from a tertiary teaching hospital covering the period from April 1, 2012 to January 15, 2013. We analyzed cases in which doctors had used the 11 overlapping prescription codes provided by the Health Insurance Review and Assessment Service (HIRA) or had provided free-text reasons. RESULTS: We identified 27,955 alert override cases. Among these, 7,772 (27.8%) utilized the HIRA codes, and 20,183 (72.2%) utilized free-text reasons. According to the free-text content analysis, 8,646 cases (42.8%) could be classified using the 11 HIRA codes, and 11,537 (57.2%) could not. In the unclassifiable cases, we identified the need for codes for "prescription relating to operation" and "emergency situations." Two overlapping prescription codes required removal because they were not used. Codes A, C, F, H, I, and J (for drug non-administration cases) explained surrounding situations in too much detail, making differentiation between them difficult. These 6 codes were merged into code J4: "patient was not taking/will not take the medications involved in the DDI." Of the 11 HIRA codes, 6 were merged into a single code, 2 were removed, and 2 were added, yielding 6 alert override codes. We could codify 23,550 (84.2%) alert override cases using these codes. CONCLUSIONS: These new codes will facilitate the use of the drug-drug interactions alert override in the current DUR system. For further study, an appropriate evaluation should be conducted with prescribing clinicians.

Association of Demographic and Socioeconomic Factors With Risk Factors for Chronic Kidney Disease / 예방의학회지

OBJECTIVES: The goal of this study was to examine the association of various demographic and socioeconomic factors with risk factors for chronic kidney disease (CKD). METHODS: We used nationally representative pooled data from the Korea National Health and Nutrition Examination Survey (KNHANES), 2007-2013. We estimated the glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease equation. We defined CKD as a GFR <60 mL/min/1.73 m2, and 1304 of the 45 208 individuals included in the KNHANES were found to have CKD by this definition. The outcome variable was whether individual subjects adhered to the CKD prevention and management guidelines recommended by the Korea Centers for Disease Control and Prevention. The guidelines suggest that individuals maintain a normal weight, abstain from alcohol consumption and smoking, manage diabetes and hypertension, and engage in regular exercise in order to prevent and manage CKD. RESULTS: This study found that individuals with CKD were more likely to be obese and have hypertension or diabetes than individuals without CKD. In particular, male and less-educated CKD patients were less likely to adhere to the guidelines. CONCLUSIONS: Although the prevalence of CKD, as indicated by the KNHANES data, decreased from 2007 to 2013, the prevalence of most risk factors associated with CKD fluctuated over the same time period. Since a variety of demographic and socioeconomic factors are related to the successful implementation of guidelines for preventing and managing CKD, individually tailored prevention activities should be developed.

Does Home Oxygen Therapy Slow Down the Progression of Chronic Obstructive Pulmonary Diseases? / 한국호스피스완화의료학회지

PURPOSE: As the National Health Insurance Service (NHIS) began to cover home oxygen therapy (HOT) services from 2006, it is expected that the new services have contributed to overall positive outcome of patients with chronic obstructive pulmonary disease (COPD). We examined whether the usage of HOT has helped slow down the progression of COPD. METHODS: We examined hospital claim data (N=10,798) of COPD inpatients who were treated in 2007~2012. We performed chi2 tests to analyze the differences in the changes to respiratory impairment grades. Multiple logistic regression analysis was used to identify factors that are associated with the use of HOT. Finally, a generalized linear mixed model was used to examine association between the HOT treatment and changes to respiratory impairment grades. RESULTS: A total of 2,490 patients had grade 1 respiratory impairment, and patients with grades 2 or 3 totaled 8,308. The OR for use of HOT was lower in grade 3 patients than others (OR: 0.33, 95% CI: 0.30~0.37). The maintenance/mitigation in all grades, those who used HOT had a higher OR than non-users (OR: 1.41, 95% CI: 1.23~1.61). CONCLUSION: HOT was effective in maintaining or mitigating the respiratory impairment in COPD patients.

Effects of Disease Detection on Changes in Smoking Behavior

PURPOSE: This study was conducted to investigate the effect that detection of chronic disease via health screening programs has on health behaviors, particularly smoking. MATERIALS AND METHODS: We analyzed national health insurance data from 2007 and 2009. Subjects who were 40 years of age in 2007 and eligible for the life cycle-based national health screening program were included. The total study population comprised 153518 individuals who participated in the screening program in 2007 and follow-up screening in 2009. Multiple logistic regression analyses were conducted by sex, with adjustment for health insurance type, socioeconomic status, body mass index, diabetes, hypertension, hyperlipidemia, and family history of cardiovascular and/or neurovascular disease. RESULTS: Among men with smoking behavior changes, those newly diagnosed with hyperlipidemia were more likely to show a positive health behavior change, such as smoking cessation, and were less likely to have a negative behavior change (e.g., smoking initiation). Additionally, men newly diagnosed with diabetes showed lower rates of negative health behavior changes compared to those without disease. Body mass index (BMI)> or =25, compared to BMI<23, showed higher rates of positive health behavior changes and lower rates of negative health behavior changes. Newly diagnosed chronic disease did not influence smoking behavior in women. CONCLUSION: Smoking behavior changes were only detected in men who participated in health screening programs. In particular, those newly diagnosed with hyperlipidemia were more likely to stop smoking and less likely to start smoking.

The Adoption of Electronic Medical Records and Decision Support Systems in Korea / 대한의료정보학회지

OBJECTIVES: To examine the current status of hospital information systems (HIS), analyze the effects of Electronic Medical Records (EMR) and Clinical Decision Support Systems (CDSS) have upon hospital performance, and examine how management issues change over time according to various growth stages. METHODS: Data taken from the 2010 survey on the HIS status and management issues for 44 tertiary hospitals and 2009 survey on hospital performance appraisal were used. A chi-square test was used to analyze the association between the EMR and CDSS characteristics. A t-test was used to analyze the effects of EMR and CDSS on hospital performance. RESULTS: Hospital size and top management support were significantly associated with the adoption of EMR. Unlike the EMR results, however, only the standardization characteristic was significantly associated with CDSS adoption. Both EMR and CDSS were associated with the improvement of hospital performance. The EMR adoption rates and outsourcing consistently increased as the growth stage increased. The CDSS, Knowledge Management System, standardization, and user training adoption rates for Stage 3 hospitals were higher than those found for Stage 2 hospitals. CONCLUSIONS: Both EMR and CDSS influenced the improvement of hospital performance. As hospitals advanced to Stage 3, i.e. have more experience with information systems, they adopted EMRs and realized the importance of each management issue.