Medication Adherence for Hypertensive Patients in Korea / 보건행정학회지

Background@#Medication adherence in hypertension is the most important to control blood pressure and prevent major complications. The purpose of this study was to identify factors affecting medication adherence and to examine the relationship between medication adherence and blood pressure control in Korea. @*Methods@#This study used data from the 7th Korea national health and nutrition examination survey (2016–2018) of the Korea Disease Control and Prevention Agency. We selected 4,063 hypertensive patients from the data. And we choose socio-demographic, health behavior, healthcare utilization, and severity characteristics as hypertensive patient characteristics. @*Results@#Of the patients with hypertension, 92.3% had shown adherence to medication as of 2016–2018 and shows variation according to the characteristic of patients. The cases with male, under 50 years old, urban area, single household, unmet medical services, less than 5 years of hypertension duration, no comorbidities (diabetes mellitus, myocardial infarction) showed significantly low medication adherence. After adjusting for confounders, adherent patients tended to have lower current systolic blood pressure (β=-10.846, p<0.001) and diastolic blood pressure (β=-5.018, p<0.001) than nonadherent patients. And, adherent patients increased the control odds of blood pressure compared with nonadherent patients (odds ratio, 3.02; 95% confidence interval, 2.21-4.12). @*Conclusion@#This study confirmed that adherence to antihypertensive drugs was effective in controlling blood pressure. In order to more actively manage hypertensive patients at the national level, it is necessary to make an effort to improve the medication compliance of nonadherent groups, such as early-diagnosis patients, young patients under 50 years of age, and patients living alone.

A Study of Factors Related to the Subjective Health Status of Elderly Population in Korea / 보건행정학회지

Background@#Despite the high life expectancy, the subjective health status of the elderly people in Korea is reported to be the lowest as compared to other age groups. The purpose of the conducted study was to identify the factors related to the subjective health status of elderly people aged over 65 in Korea. @*Methods@#This study used data from the 7th Korea National Health and Nutrition Examination Survey (2016–2017) of the Korea Disease Control and Prevention Agency. The subjects of the study were selected to be 2,904 elderly people aged over 65. The factors that were selected related to subjective health status were socio-demographics, perceived diseases, health behaviors, and mental health. @*Results@#As a result of the examination of the subjective health status according to the characteristics of the subjects of study, the subjective health status was high in males (β=0.144, p=0.011), urban dwellers (β=0.107, p=0.015), employed persons (β=0.139, p=0.001), college graduates (β=0.322, p<0.001), persons with high household income (β=0.226, p<0.001), persons without chronic disease, nonsmokers (β=0.146, p=0.009), drinkers (β=0.111, p=0.003), persons who practiced aerobic physical activity (β=0.150, p<0.001), persons without depression (β=0.286, p<0.001), and persons who rarely had stress (β=0.837, p<0.001). @*Conclusion@#More attention should be paid to those with low subjective health to improve health for elderly people. Expanding policy supports are required for elderly people with low socioeconomic status, chronic disease or depression, or unhealthy behaviors (smoking or lack of physical activity).

A Study of Factors Related to the Subjective Health Status of Elderly Population in Korea / 보건행정학회지

Background@#Despite the high life expectancy, the subjective health status of the elderly people in Korea is reported to be the lowest as compared to other age groups. The purpose of the conducted study was to identify the factors related to the subjective health status of elderly people aged over 65 in Korea. @*Methods@#This study used data from the 7th Korea National Health and Nutrition Examination Survey (2016–2017) of the Korea Disease Control and Prevention Agency. The subjects of the study were selected to be 2,904 elderly people aged over 65. The factors that were selected related to subjective health status were socio-demographics, perceived diseases, health behaviors, and mental health. @*Results@#As a result of the examination of the subjective health status according to the characteristics of the subjects of study, the subjective health status was high in males (β=0.144, p=0.011), urban dwellers (β=0.107, p=0.015), employed persons (β=0.139, p=0.001), college graduates (β=0.322, p<0.001), persons with high household income (β=0.226, p<0.001), persons without chronic disease, nonsmokers (β=0.146, p=0.009), drinkers (β=0.111, p=0.003), persons who practiced aerobic physical activity (β=0.150, p<0.001), persons without depression (β=0.286, p<0.001), and persons who rarely had stress (β=0.837, p<0.001). @*Conclusion@#More attention should be paid to those with low subjective health to improve health for elderly people. Expanding policy supports are required for elderly people with low socioeconomic status, chronic disease or depression, or unhealthy behaviors (smoking or lack of physical activity).

Agent Orange Exposure and Prevalence of Self-reported Diseases in Korean Vietnam Veterans / 예방의학회지

OBJECTIVES: The aim of this study was to evaluate the association between Agent Orange exposure and self-reported diseases in Korean Vietnam veterans. METHODS: A postal survey of 114 562 Vietnam veterans was conducted. The perceived exposure to Agent Orange was assessed by a 6-item questionnaire. Two proximity-based Agent Orange exposure indices were constructed using division/brigade-level and battalion/company-level unit information. Adjusted odds ratios (ORs) for age and other confounders were calculated using a logistic regression model. RESULTS: The prevalence of all self-reported diseases showed monotonically increasing trends as the levels of perceived self-reported exposure increased. The ORs for colon cancer (OR, 1.13), leukemia (OR, 1.56), hypertension (OR, 1.03), peripheral vasculopathy (OR, 1.07), enterocolitis (OR, 1.07), peripheral neuropathy (OR, 1.07), multiple nerve palsy (OR, 1.14), multiple sclerosis (OR, 1.24), skin diseases (OR, 1.05), psychotic diseases (OR, 1.07) and lipidemia (OR, 1.05) were significantly elevated for the high exposure group in the division/brigade-level proximity-based exposure analysis, compared to the low exposure group. The ORs for cerebral infarction (OR, 1.08), chronic bronchitis (OR, 1.05), multiple nerve palsy (OR, 1.07), multiple sclerosis (OR, 1.16), skin diseases (OR, 1.05), and lipidemia (OR, 1.05) were significantly elevated for the high exposure group in the battalion/company-level analysis. CONCLUSIONS: Korean Vietnam veterans with high exposure to Agent Orange experienced a higher prevalence of several self-reported chronic diseases compared to those with low exposure by proximity-based exposure assessment. The strong positive associations between perceived self-reported exposure and all self-reported diseases should be evaluated with discretion because the likelihood of reporting diseases was directly related to the perceived intensity of Agent Orange exposure.

Serum 2,3,7,8-Tetrachlorodibenzo-p-dioxin Levels and Their Association With Age, Body Mass Index, Smoking, Military Record-based Variables, and Estimated Exposure to Agent Orange in Korean Vietnam Veterans / 예방의학회지

OBJECTIVES: The aim of this study was to examine the levels of serum 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and evaluate their association with age, body mass index, smoking, military record-based variables, and estimated exposure to Agent Orange in Korean Vietnam veterans. METHODS: Serum levels of TCDD were analyzed in 102 Vietnam veterans. Information on age, body mass index, and smoking status were obtained from a self-reported questionnaire. The perceived exposure was assessed by a 6-item questionnaire. Two proximity-based exposures were constructed by division/brigade level and battalion/company level unit information using the Stellman exposure opportunity index model. RESULTS: The mean and median of serum TCDD levels was 1.2 parts per trillion (ppt) and 0.9 ppt, respectively. Only 2 Vietnam veterans had elevated levels of TCDD (>10 ppt). The levels of TCDD did not tend to increase with the likelihood of exposure to Agent Orange, as estimated from either proximity-based exposure or perceived self-reported exposure. The serum TCDD levels were not significantly different according to military unit, year of first deployment, duration of deployment, military rank, age, body mass index, and smoking status. CONCLUSIONS: The average serum TCDD levels in the Korean Vietnam veterans were lower than those reported for other occupationally or environmentally exposed groups and US Vietnam veterans, and their use as an objective marker of Agent Orange exposure may have some limitations. The unit of deployment, duration of deployment, year of first deployment, military rank, perceived self-reported exposure, and proximity-based exposure to Agent Orange were not associated with TCDD levels in Korean Vietnam veterans. Age, body mass index and smoking also were not associated with TCDD levels.

Continuity of Care for Elderly Patients with Diabetes Mellitus, Hypertension, Asthma, and Chronic Obstructive Pulmonary Disease in Korea

We sought to assess continuity of care for elderly patients in Korea and to examine any association between continuity of care and health outcomes (hospitalization, emergency department visits, health care costs). This was a retrospective cohort study using the Korea National Health Insurance Claims Database. Elderly people, 65-84 yr of age, who were first diagnosed with diabetes mellitus (n=268,220), hypertension (n=858,927), asthma (n=129,550), or chronic obstructive pulmonary disease (COPD, n=131,512) in 2002 were followed up for four years, until 2006. The mean of the Continuity of Care Index was 0.735 for hypertension, 0.709 for diabetes mellitus, 0.700 for COPD, and 0.663 for asthma. As continuity of care increased, in all four diseases, the risks of hospitalization and emergency department visits decreased, as did health care costs. In the Korean health care system, elderly patients with greater continuity of care with health care providers had lower risks of hospital and emergency department use and lower health care costs. In conclusion, policy makers need to develop and try actively the program to improve the continuity of care in elderly patients with chronic diseases.

Long-Term Trend in the Incidence of Acute Myocardial Infarction in Korea: 1997-2007

BACKGROUND AND OBJECTIVES: Information about disease incidence is indispensable for the active prevention and control of acute myocardial infarction (AMI). The purpose of this study was to provide basic information for the establishment of policy related to AMI by examining the long-term trends in incidence of AMI. SUBJECTS AND METHODS: This study identified the trend in disease incidence during between 1997 and 2007 using the Korean National Health Insurance Database that includes AMI {the 10th International Classification of Disease (ICD-10) code: I21, I22, I23, I250, I251} as a primary or secondary disease. RESULTS: The attack and incidence rates for AMI in 2007 were 118.4 and 91.8 per 100,000 persons, respectively, and the rates more than doubled for the 11 years. Both rates were higher among males than females and increased more in the older age groups. Incidence cases accounted for most of the total attack cases every year; however, in recent years the proportion of relapse cases was on the rise. The case fatality rate was highest (14.5%) in 2000, and declined rapidly to 9.8% in 2007. The case fatality rate was higher among females than males and the older age groups; in particular, female patients > or=65 years of age had the highest fatality rate. CONCLUSION: This study showed that AMI has been on the rise in Korea for 11 years. Therefore, the establishment of policy for intensive control of the incidence of AMI is necessary by building a continuous monitoring and surveillance system.

An epidemiologic review of Japanese Encephalitis with a special focus on incidence and methods of control for South Korea / 한국역학회지

Japanese encephalitis(JE) is the leading viral cause of encephalitis and disability in Asia. The disease primarily infects children under the age of 15, leaving up to 70% of these who develop illness either dead or with a long-term neurological disability. We reviewed not only JE disease burden, etiology, vector, mode of transmission, reservoir but also geographic distribution and incidence of the disease in Asia, with a focus on the South Korea. A special comment on the methods of control JE and perspective for South Korea also included.

Pilot Study on Recruiting Medical Checkup Participants by Mail Survey among Korean Vietnam Veterans / 예방의학회지

OBJECTIVE: The aim of this study was to identify the validity of recruiting medical checkup participants of Vietnam veterans using a mail survey, and to identify the 'Vietnam service related characteristics' and `general characteristics' of Vietnam veterans groups. METHOD: In this study, a total 900 veterans were randomly selected from the list of Vietnam veterans from 1964 to 1973. The veterans were classified into 5 groups, taking into consideration their registered status in the Ministry of Patriots and Veterans Affairs; the VRD (veterans who have agent orange-related diseases), VSD (veterans who have agent orange-suspected disease), VM (veterans who performed meritorious deeds during the war), VR (veterans who were registered with the Ministry of Patriots and Veterans Affair) and OV (other veterans) groups. By means of postal surveys, the veterans' intention to participate in the medical checkup for our research, and their socioeconomic and general characteristics were investigated. 52 surveys were returned due to the subjects not residing at the listed address, and were excluded from the analysis. RESULT: 699 of the 848 veterans (82.4%) responded to the survey, of which 619 (88.6%) intended to participate in the medical checkup for our research. The 5 veterans groups all had similar ages, Vietnam service period, Agent Orange exposure, troop characteristic and wartime class, with the exception of VM, who were older, and with a greater number of officers than the other 4 groups. There was a big difference in the health statius among the Vietnam veterans group. The VM and OV were much healthier than VRD, VSD and VR groups. The socioeconomic stati of the VRD, VSD and VR groups were lower than those of the VM and OV groups. CONCLUSION: Although there were some limitations, the recruitment, by mail, of medical checkup participants from Vietnam veterans is a valid and feasible method. The VM and OV groups were much healthier, and with higher socioeconomic stati, than the VRD, VSD, and VR groups.

A Proposal of Study Designs and Methods for Evaluating the Adverse Health Effects of Agent Orange among Korean Vietnam Veterans / 예방의학회지

OBJECTIVES: To propose a feasible, valid and appropriate study designs and epidemiologic methods for evaluating the adverse health effects of Agent Orange-chemical defoliants used in Vietnam- in Korea. METHODS: A literature study was performed on Agent Orange, herbicides, pesticides and dioxins. The study subjects, study design, exposure assessment and health outcomes assessment were examined in each study. The potential data sources for the study subjects, study design, exposure assessment and health outcomes assessment in Korea were investigated. RESULTS AND CONCLUSION: In earlier Korean studies, research subjects for studying the effects of Agent Orange were identified from the patients or persons who claimed to have Agent Orange-related diseases due to the difficulties in identifying the entire population of Vietnam veterans in Korea. In this study, an attempt was made to identify the total number of Vietnam veterans in Korea. As a result, the addresses of 20,000 Vietnam veterans were obtained. It is proposed that a retrospective cohort design on a sample of the total number of Vietnam veterans is a feasible and appropriate study design. Self report questionnaires and military records were proposed to assess the exposure level. It is believed that measuring the plasma or tissue TCDD should be used only for a validation study assessing the level of exposure. For the health outcomes assessment, it is possible to obtain the mortality, cancer frequency, physical examination, screening and medical insurance record data.

Cohort Study on Age at Menopause and Mortality- Kangwha Cohort Study - / 예방의학회지

OBJECTIVE: To examine the association between age at menopause and mortality in a population-based sample of women in Kangwha, Korea. METHODS: From the Kangwha Cohort, followed-up from 1985 to 1999, the data of the over 55 year old female group(n=3,596) was used in this study to examine the association between age at menopause and mortality. We calculated the all causes mortality risk ratio and the cancer mortality risk ratio by age at menopause grouping using the Cox Proportional Hazards Model with adjustments for age, BMI, smoking, education, chronic disease, self-rated health status, alcohol consumption and age at first birth. RESULT AND CONCLUSION: Compared to women who had menopause at 45-49 years, the all causes mortality risk ratio was 1.24 for women with menopause at less than 40 years(95% CI=1.01-1.53) and 1.05 for women with menopause at over 50 years(95% CI=0.92-1.20). Also, compared to women who had menopause at 45-49 years, the cancer mortality risk ratio was 1.53 for women with menopause at less than 40 years(95% CI=0.78-2.98) and 1.17 for women with menopause at over 50 years(95% CI=0.77-1.80).