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Background/Aims@#The incidence and prognosis of gastric cancer (GC) shows sex difference.This study aimed to evaluate the effect of body mass index (BMI) on GC survival depending on sex. @*Methods@#The sex, age, location, histology, TNM stages, BMI, and survival were analyzed in GC patients from May 2003 to February 2020 at the Seoul National University Bundang Hospital. @*Results@#Among 14,688 patients, there were twice as many males (66.6%) as females (33.4%).However, under age 40 years, females (8.6%) were more prevalent than males (3.1%). Cardia GC in males showed a U-shaped distribution for underweight (9.6%), normal (6.4%), overweight (6.1%), obesity (5.6%), and severe obesity (9.3%) but not in females (p=0.003). Females showed decreased proportion of diffuse-type GC regarding BMI (underweight [59.9%], normal [56.8%], overweight [49.5%], obesity [44.8%], and severe obesity [41.7%]), but males did not (p<0.001). Both sexes had the worst prognosis in the underweight group (p<0.001), and the higher BMI, the better prognosis in males, but not females. Sex differences in prognosis according to BMI tended to be more prominent in males than in females in subgroup analysis of TNM stages I, II, and III and the operative treatment group. @*Conclusions@#GC-specific survival was affected by BMI in a sex-dependent manner. These differences may be related to genetic, and environmental, hormonal factors; body composition; and muscle mass (Trial registration number: NCT04973631).
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Background@#The reliability and validity of the anxiety subscale of the Hospital Anxiety and Depression Scale for Koreans (K-HADS-A) has not been studied in Korean surgical patients. This study aimed to validate the usefulness of K-HADS-A for measuring preoperative anxiety in Korean surgical patients. Additionally, the effect of preoperative anxiety on postoperative quality of recovery was evaluated. @*Methods@#Preoperative anxiety in 126 inpatients with planned elective surgery was measured using the K-HADS-A. The postoperative quality of recovery was measured using the Korean version of the Quality of Recovery-15. The validity and reliability of the K-HADS-A were evaluated. The differences in quality of recovery on the first and seventh day postoperatively were then compared between the anxious and non-anxious groups. @*Results@#There was a statistical correlation between the K-HADS-A and Anxiety Likert Scale. The goodness-of-fit indices of the structural equation model showed how well the data from the K-HADS-A match their concept. The Kaiser-Meyer-Olkin value was 0.848, and the P value of Bartlett’s test of sphericity was < 0.001. Cronbach’s alpha was high at 0.872. The K-HADS-A had an acceptable level of validity and reliability. Postoperative quality of recovery was significantly lower in the anxious group (postoperative day 1: t = 2.058, P = 0.042; postoperative day 7: t = 3.430, P = 0.002). @*Conclusions@#The K-HADS-A is an acceptable tool for appropriately assessing preoperative anxiety in Korean surgical patients. Assessing preoperative anxiety is valuable, because preoperative anxiety affects the postoperative quality of mental and physical recovery.
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Purpose@#This study was conducted to build a direction for government policies regarding strategies for the commercialization of digital therapeutics in Korea, as well as its globalization. @*Materials and Methods@#The study included 37 participants from the Korea Digital Health Industry Association (KODHIA). The data was based on a survey conducted in 2020 targeting employees of companies engaged in the digital health industry in Korea.Participants were asked about their involvement in product development of digital therapeutics and their opinion about the growing motivator for digital therapeutics in Korea and the global market. @*Results@#According to our data, among subjects not involved in making digital therapeutics products, the main reason for not being involved was the lack of experts (73.9%) and difficulty in licensing (73.9%). Responses concerning the priority area in need of national support were R&D funding (43.2%), and the next was licensing guidance and simplifying regulations (24.3%). Possible difficulties of overseas market expansion were the unfamiliarity in digital therapeutics technology verification and licensing structures of foreign countries (73%), and concerns regarding the level of recognition of clinical trials and technology in Korea from overseas (70.3%). Overall, respondents were hesitant in starting a related business due to the lack of government support and the complexity of the regulation process. Moreover, concerns about global market entry were similar. Being unfamiliar with the novel process and worrying about the achievement despite existing challenges were the biggest drawback. @*Conclusion@#For the digital therapeutics industry to evolve domestically and internationally, government support and guidance are essential.
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Background@#Comparison of the prevalence of cardiometabolic disorders (CMDs) and comorbidities in Korea and the United States (US) can be an important indicator for forecasting future risk of cardiovascular events in Korea. This study aimed to estimate and compare the prevalence of hypertension, diabetes mellitus (DM), dyslipidemia, obesity, and metabolic syndrome (MetS) in Korea and the US. @*Methods@#A total of 15,872 individuals from the US National Health and Nutrition Examination Survey (NHANES) 2003–2014 and 26,492 from the Korea NHANES (KNHANES) 2007–2014 were included. Additionally, 164,339 (139,345 from the Health Examinees-Gem Study and 24,994 from the Cardiovascular Disease Association Study) participants enrolled in the Korea Genome and Epidemiology Study were included to investigate the differences of CMDs between urban and rural regions. To estimate the age-standardized prevalence of CMDs in individuals aged 40–69 years, direct standardization using the World Health Organization standard population was performed. @*Results@#The prevalence of CMDs was lower in Korea than the US (hypertension 49.9% vs.56.8%; DM 13.4% vs. 14.3%; hypercholesterolemia 16.8% vs. 17.8%; obesity 36.2% vs. 38.6%; and MetS 29.4% vs. 36.5%). According to the median survey years, dyslipidemia has become more prevalent in Korea than in the US since 2010. The prevalence of CMDs was greater in rural than that in urban areas in Korea. @*Conclusion@#The prevalence of dyslipidemia in Korea exceeded that of the US after 2010, which was associated with increasing burden of cardiovascular events. The present study suggests that further preventive strategies are needed to mitigate the prevalence of CMDs in Korea.
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Background/Aims@#Hypertension (HT) has a significant impact on public health and medical expenses. However, HT is a chronic disease that requires the long-term follow-up of a large number of patients. @*Methods@#The Korean Hypertension Cohort (KHC) study aimed to develop a model for calculating cardiovascular risk in HT patients by linking and utilizing the detailed clinical and longitudinal data from hospitals and the national health insurance claim database, respectively. This cohort had a planned sample size of over 11,000 HT patients and 100,000 non-HT controls. Eligible patients were hypertensive patients, who were presenting for the first time and were diagnosed with HT as a main disease from 2006 to 2011. Long-term survival data over a period of approximately 9 years were obtained from the national health insurance claim and national health examination data. @*Results@#This cohort enrolled 11,083 patients with HT. The mean age was 58.87 ± 11.5 years, 50.5% were male, and 31.4% were never-treated HT. Of the enrolled patients, 32.9% and 37.7% belonged to the high and moderate cardiovascular risk groups, respectively. Initial blood pressures were 149.4 ± 18.5/88.5 ± 12.5 mmHg. During the 2 years hospital data follow-up period, blood pressures lowered to 130.8 ± 14.1/78.0 ± 9.7 mmHg with 1.9 ± 1.0 tablet doses of antihypertensive medication. Cardiovascular events occurred in 7.5% of the overall patients; 8.5%, 8.8%, and 4.7% in the high, moderate, and low risk patients, respectively. @*Conclusions@#The KHC study has provided important information on the long-term outcomes of HT patients according to the blood pressure, comorbid diseases, medication, and adherence, as well as health behaviors and health resource use.
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Background@#In this study, we aimed to investigate the interaction effects of individual socioeconomic status and regional deprivation on the onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients. @*Methods@#Korean National Health Insurance Service National Sample Cohort data from 2002 to 2013 were used. A total of 50,954 patients newly diagnosed with type 2 diabetes from 2004 to 2012 and aged 30 years or above were included. We classified patients into six groups according to individual income level and neighborhood deprivation: ‘high in advantaged,’ ‘high in disadvantaged,’ ‘middle in advantaged,’ ‘middle in disadvantaged,’ ‘low in advantaged,’ and ‘low in disadvantaged.’ We calculated hazard ratios (HR) of onset of diabetes complication and diabetes-related hospitalization using the Cox proportional hazard model, with the reference group as diabetes patients with high income in advantaged regions. @*Results@#In terms of the interaction effects of individual income level and regional socioeconomic level, even with the same low individual income level, the group with a high regional socioeconomic level (low in advantaged) showed low HRs for the onset of diabetes complication (HR, 1.04; 95% confidence interval [CI], 1.00–1.08) compared to the ‘low in disadvantaged’ group (HR, 1.10;95% CI, 1.05–1.16). In addition, the ‘high in advantaged’ group showed slightly higher HRs for the onset of diabetes complication (HR, 1.06; 95% CI, 1.00–1.11) compared to the ‘low in advantaged’ and it appeared to be associated with slight mitigation of the risk of diabetes complication. For the low-income level, the patients in disadvantaged regions showed the highest HRs for diabetes-related hospitalization (HR, 1.29; 95% CI, 1.19–1.41) compared to the other groups. @*Conclusion@#Although we need to perform further investigations to reveal the mechanisms that led to our results, interaction effects individual socioeconomic status and regional deprivation might be associated with on onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients.
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Background/Aims@#Hypertension (HT) has a significant impact on public health and medical expenses. However, HT is a chronic disease that requires the long-term follow-up of a large number of patients. @*Methods@#The Korean Hypertension Cohort (KHC) study aimed to develop a model for calculating cardiovascular risk in HT patients by linking and utilizing the detailed clinical and longitudinal data from hospitals and the national health insurance claim database, respectively. This cohort had a planned sample size of over 11,000 HT patients and 100,000 non-HT controls. Eligible patients were hypertensive patients, who were presenting for the first time and were diagnosed with HT as a main disease from 2006 to 2011. Long-term survival data over a period of approximately 9 years were obtained from the national health insurance claim and national health examination data. @*Results@#This cohort enrolled 11,083 patients with HT. The mean age was 58.87 ± 11.5 years, 50.5% were male, and 31.4% were never-treated HT. Of the enrolled patients, 32.9% and 37.7% belonged to the high and moderate cardiovascular risk groups, respectively. Initial blood pressures were 149.4 ± 18.5/88.5 ± 12.5 mmHg. During the 2 years hospital data follow-up period, blood pressures lowered to 130.8 ± 14.1/78.0 ± 9.7 mmHg with 1.9 ± 1.0 tablet doses of antihypertensive medication. Cardiovascular events occurred in 7.5% of the overall patients; 8.5%, 8.8%, and 4.7% in the high, moderate, and low risk patients, respectively. @*Conclusions@#The KHC study has provided important information on the long-term outcomes of HT patients according to the blood pressure, comorbid diseases, medication, and adherence, as well as health behaviors and health resource use.
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Background@#In this study, we aimed to investigate the interaction effects of individual socioeconomic status and regional deprivation on the onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients. @*Methods@#Korean National Health Insurance Service National Sample Cohort data from 2002 to 2013 were used. A total of 50,954 patients newly diagnosed with type 2 diabetes from 2004 to 2012 and aged 30 years or above were included. We classified patients into six groups according to individual income level and neighborhood deprivation: ‘high in advantaged,’ ‘high in disadvantaged,’ ‘middle in advantaged,’ ‘middle in disadvantaged,’ ‘low in advantaged,’ and ‘low in disadvantaged.’ We calculated hazard ratios (HR) of onset of diabetes complication and diabetes-related hospitalization using the Cox proportional hazard model, with the reference group as diabetes patients with high income in advantaged regions. @*Results@#In terms of the interaction effects of individual income level and regional socioeconomic level, even with the same low individual income level, the group with a high regional socioeconomic level (low in advantaged) showed low HRs for the onset of diabetes complication (HR, 1.04; 95% confidence interval [CI], 1.00–1.08) compared to the ‘low in disadvantaged’ group (HR, 1.10;95% CI, 1.05–1.16). In addition, the ‘high in advantaged’ group showed slightly higher HRs for the onset of diabetes complication (HR, 1.06; 95% CI, 1.00–1.11) compared to the ‘low in advantaged’ and it appeared to be associated with slight mitigation of the risk of diabetes complication. For the low-income level, the patients in disadvantaged regions showed the highest HRs for diabetes-related hospitalization (HR, 1.29; 95% CI, 1.19–1.41) compared to the other groups. @*Conclusion@#Although we need to perform further investigations to reveal the mechanisms that led to our results, interaction effects individual socioeconomic status and regional deprivation might be associated with on onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients.
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Unmet healthcare needs lead to increased disease severity, increased likelihood of complications, and worse disease prognosis. To examine the latest status of unmet healthcare needs in South Korea, the four different data configured with nationally representative sample of South Korean population were used: the Korea Health and Nutrition Examination Survey (KNAHANES, 2007–2018), the Community Health Survey (CHS, 2008–2018), the Korea Health Panel Survey (KHP, 2011–2016), and the Korean Welfare Panel Study (KOWEPS, 2006–2018). The proportion of individuals reporting unmet healthcare needs were 7.8% (KNHANES, 2018), 8.8% (CHS), and 10.8% (KHP, 2016). Annual percentage change which characterizes trend for the follow-up period was -9.1%, -3.2%, and -6.8%, respectively. The proportion of individuals reporting unmet healthcare needs due to cost were 1.2% (KNAHANES, 2018), 1.2% (CHS, 2018), 2.5% (KHP, 2016), and 0.5% (KOWEPS, 2018). Annual percentage change which characterizes trend for the follow-up period was -10.3%, -12.0%, -11.3%, and -18.8, respectively. The low-income population and the elderly population were vulnerable groups reporting the highest rate of unmet health care needs. The rate of unmet healthcare needs has been declining since the past decade, still, the disparity between different income groups and age groups suggests that there are many challenges to address.
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Cancer is a disease which has the huge burden in worldwide, and cancer is the number one cause of death in Korea. At this point, the new framework for cancer monitoring index is required for regional cancer monitoring. Especially, cancer survivors are the important target which is rapidly increasing recently, also cancer survivor’s quality of care should be considered in the cancer monitoring index framework. To develop the Multidimensional Cancer Monitoring Index considering cancer survivor’s quality of care, we took into account cancer continuum which including prevention, detection, diagnosis, treatment, survivorship, assessment of quality of care and monitoring cancer patient, and end-of life care for stage. For target, components of health care delivery system such as patient, family, provider, payer, and policy maker are included. Also, Donabedian model which is a framework for examining health services and evaluating quality of health care such as structure, process, and outcome is applied to contents. This new cancer monitoring framework which includes multidimensional components could help to develop regional cancer monitoring index, and to make national cancer management and prevention policy in the future.
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The digital treatment technology industry is one of the core fostering industries of the Moon Jae-in government along with the global trend. The purpose of this study is to compare and analyze the investment and economic ripple effect on the related industries. To this end, we used the industry-related table, which is the actual measurement data for 2015 that the Bank of Korea actually measured and released every 5 years in 2019. The digital treatment technology industry was not clearly classified within Korea’s industrial classification system, so the contents of the industry-related survey were analyzed, and the digital treatment technology industry was reclassified and then analyzed. As a result of the analysis, it was analyzed that the production induction effect of the digital treatment technology-related industry in 2015 was 1.770, the value-added induction effect was 0.875, and the employment induction effect was 19.128, which was higher than that of other industries in Korea. As a result of the analysis of the economic ripple effect (scenario 1), the production inducing effect was about 370 billion won, the added value inducing effect was about 185 billion won, and the employment inducing effect was 4,044 people. The results of this study are expected to play a large role in economic revitalization as the effect of inducing production, increasing employment, and creating added value through fostering the digital treatment technology industry is expected to play a large role in activating the economy. It is expected to play a large role in providing central medical services. Therefore, it is expected that policy support for revitalizing the digital treatment technology industry through active investment support and tax benefits from the government to foster the digital treatment technology industry is necessary.
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Cancer is a disease which has the huge burden in worldwide, and cancer is the number one cause of death in Korea. At this point, the new framework for cancer monitoring index is required for regional cancer monitoring. Especially, cancer survivors are the important target which is rapidly increasing recently, also cancer survivor’s quality of care should be considered in the cancer monitoring index framework. To develop the Multidimensional Cancer Monitoring Index considering cancer survivor’s quality of care, we took into account cancer continuum which including prevention, detection, diagnosis, treatment, survivorship, assessment of quality of care and monitoring cancer patient, and end-of life care for stage. For target, components of health care delivery system such as patient, family, provider, payer, and policy maker are included. Also, Donabedian model which is a framework for examining health services and evaluating quality of health care such as structure, process, and outcome is applied to contents. This new cancer monitoring framework which includes multidimensional components could help to develop regional cancer monitoring index, and to make national cancer management and prevention policy in the future.
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The digital treatment technology industry is one of the core fostering industries of the Moon Jae-in government along with the global trend. The purpose of this study is to compare and analyze the investment and economic ripple effect on the related industries. To this end, we used the industry-related table, which is the actual measurement data for 2015 that the Bank of Korea actually measured and released every 5 years in 2019. The digital treatment technology industry was not clearly classified within Korea’s industrial classification system, so the contents of the industry-related survey were analyzed, and the digital treatment technology industry was reclassified and then analyzed. As a result of the analysis, it was analyzed that the production induction effect of the digital treatment technology-related industry in 2015 was 1.770, the value-added induction effect was 0.875, and the employment induction effect was 19.128, which was higher than that of other industries in Korea. As a result of the analysis of the economic ripple effect (scenario 1), the production inducing effect was about 370 billion won, the added value inducing effect was about 185 billion won, and the employment inducing effect was 4,044 people. The results of this study are expected to play a large role in economic revitalization as the effect of inducing production, increasing employment, and creating added value through fostering the digital treatment technology industry is expected to play a large role in activating the economy. It is expected to play a large role in providing central medical services. Therefore, it is expected that policy support for revitalizing the digital treatment technology industry through active investment support and tax benefits from the government to foster the digital treatment technology industry is necessary.
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Unmet healthcare needs are being used as an important indicator of the accessibility of healthcare services worldwide. To examine current status and trends of unmet needs in Korea, we used data from four sources: the Korea National Health and Nutrition Examination Survey (KNHANES, 2007–2017); the Community Health Survey (CHS 2008–2017); the Korea Health Panel Survey (KHP 2011–2015); and the Korean Welfare Panel Study (KOWEPS 2006–2017). The proportion of individual reporting unmet healthcare needs as of 2017 was 8.8% (KNHANES), 10.6% (CHS), and 12.4% (KHP as of 2015). The proportion of households reporting unmet healthcare needs due to cost was 0.5% (KOWEPS). Annual percentage change was −19.2%, −13.3%, −5.8%, and −13.3% respectively. Low income populations had more unmet healthcare needs than high income populations. However, unlike the last two studies, the main reason for unmet medical reasons was that there was no time regardless of income level.
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Delivery of Health Care , Family Characteristics , Health Surveys , Korea , Nutrition Surveys , Population Growth , PovertyABSTRACT
BACKGROUND/AIMS: Although there is growing interest in hospice-palliative care, little information is available on the effects of such care in South Korea. Addressing this research gap, i.e., determining the cost-effectiveness of hospice-palliative care in South Korea, will help guide policy. Thus, the aim of this study was to evaluate the cost-effectiveness analysis of hospice-palliative care in adults diagnosed with terminal cancer. METHODS: We used a Markov model to construct a decision tree, for an analysis comparing the general ward with the hospice-palliative ward in terms of patient quality of life and cost-effectiveness. Cost and quality of life were estimated based on published Korean studies. Cost-effectiveness was calculated as the incremental cost relative to the incremental effect. Additionally, a one-way sensitivity analysis was performed to test the robustness of the results. RESULTS: Hospice-palliative ward care was more cost-effective than general ward care. The incremental cost was 290,401 Korean won (KRW) and the incremental effect was −0.25. The incremental cost-effectiveness ratio was −1,174,045 KRW. A similar pattern of results was obtained in the sensitivity analysis. CONCLUSIONS: Our results suggest that hospice-palliative ward care is more cost-effective than general ward care.
Subject(s)
Adult , Humans , Cost-Benefit Analysis , Decision Trees , Hospice Care , Korea , Patients' Rooms , Quality of LifeABSTRACT
OBJECTIVES@#The purpose of this study was to determine the associations between blood hemoglobin (Hgb) levels and the risk of death by specific causes.@*METHODS@#Using the National Health Insurance Services-National Health Screening Cohort (n=487 643), we classified serum Hgb levels into 6 sex-specific groups. Cox regression analysis was used to analyze the associations between Hgb levels and the risk of cause-specific death.@*RESULTS@#Hgb levels in male population showed a U-shaped, J-shaped, or inverse J-shaped association with the risk of death from ischemic heart disease, acute myocardial infarction, liver cancer, cirrhosis and chronic obstructive pulmonary disease (COPD) (all non-linear p<0.05; hazard ratio [HR]; 95% confidence interval [CI]) for the lowest and the highest Hgb levels for the risk of each cause of death in male population: HR, 1.14; 95% CI, 0.98 to 1.34; HR, 2.87; 95% CI, 1.48 to 5.57; HR, 1.16; 95% CI, 0.96 to 1.40; HR, 3.05; 95% CI, 1.44 to 6.48; HR, 1.36; 95% CI, 1.18 to 1.56; HR, 2.11; 95% CI, 1.05 to 4.26; HR, 3.64; 95% CI, 2.49 to 5.33; HR, 5.97; 95% CI, 1.44 to 24.82; HR, 1.62; 95% CI, 1.14 to 2.30; HR, 3.84; 95% CI, 1.22 to 12.13, respectively), while in female population, high Hgb levels were associated with a lower risk of death from hypertension and a higher risk of death from COPD (overall p<0.05; HR, 1.86; 95% CI, 1.29 to 2.67 for the lowest Hgb levels for hypertension; overall p<0.01, HR, 6.60; 95% CI, 2.37 to 18.14 for the highest Hgb levels for COPD). For the risk of lung cancer death by Hgb levels, a linear negative association was found in male population (overall p<0.01; the lowest Hgb levels, HR, 1.17; 95% CI, 1.05 to 1.33) but an inverse J-shaped association was found in female population (non-linear p=0.01; HR, 1.25; 95% CI, 0.96 to 1.63; HR, 2.58; 95% CI, 1.21 to 5.50).@*CONCLUSIONS@#Both low and high Hgb levels were associated with an increased risk of death from various causes, and some diseases showed different patterns according to sex.
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BACKGROUND/AIMS@#Although there is growing interest in hospice-palliative care, little information is available on the effects of such care in South Korea. Addressing this research gap, i.e., determining the cost-effectiveness of hospice-palliative care in South Korea, will help guide policy. Thus, the aim of this study was to evaluate the cost-effectiveness analysis of hospice-palliative care in adults diagnosed with terminal cancer.@*METHODS@#We used a Markov model to construct a decision tree, for an analysis comparing the general ward with the hospice-palliative ward in terms of patient quality of life and cost-effectiveness. Cost and quality of life were estimated based on published Korean studies. Cost-effectiveness was calculated as the incremental cost relative to the incremental effect. Additionally, a one-way sensitivity analysis was performed to test the robustness of the results.@*RESULTS@#Hospice-palliative ward care was more cost-effective than general ward care. The incremental cost was 290,401 Korean won (KRW) and the incremental effect was −0.25. The incremental cost-effectiveness ratio was −1,174,045 KRW. A similar pattern of results was obtained in the sensitivity analysis.@*CONCLUSIONS@#Our results suggest that hospice-palliative ward care is more cost-effective than general ward care.
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PURPOSE: Few studies investigated roles of body mass index (BMI) on gastric cancer (GC) risk according to Helicobacter pylori infection status. This study was conducted to evaluate associations between BMI and GC risk with consideration of H. pylori infection information. MATERIALS AND METHODS: We performed a case-cohort study (n=2,458) that consists of a subcohort, (n=2,193 including 67 GC incident cases) randomly selected from the Korean Multicenter Cancer Cohort (KMCC) and 265 incident GC cases outside of the subcohort. H. pylori infection was assessed using an immunoblot assay. GC risk according to BMI was evaluated by calculating hazard ratios (HRs) and their 95% confidence intervals (95% CIs) using weighted Cox hazard regression model. RESULTS: Increased GC risk in lower BMI group (< 23 kg/m²) with marginal significance, (HR, 1.32; 95% CI, 0.98 to 1.77) compared to the reference group (BMI of 23-24.9 kg/m²) was observed. In the H. pylori non-infection, both lower (< 23 kg/m²) and higher BMI (≥ 25 kg/m²) showed non-significantly increased GC risk (HR, 10.82; 95% CI, 1.25 to 93.60 and HR, 11.33; 95% CI, 1.13 to 113.66, respectively). However, these U-shaped associations between BMI and GC risk were not observed in the group who had ever been infected by H. pylori. CONCLUSION: This study suggests the U-shaped associations between BMI and GC risk, especially in subjects who had never been infected by H. pylori.
Subject(s)
Body Mass Index , Cohort Studies , Helicobacter pylori , Helicobacter , Stomach NeoplasmsABSTRACT
OBJECTIVES: The objective of this study was to assess the relationship between systolic and diastolic blood pressure (SBP, DBP) and the risk of death from specific causes other than cardiovascular diseases. METHODS: We calculated the risk of specific death by SBP and DBP categories for 506 508 health examinees in 2002-2003 using hazard ratios (HRs) and 95% confidence intervals (CIs) in a Cox proportional hazards model. RESULTS: Compared to normal levels (SBP < 120 or DBP < 90 mmHg), stage I systolic and diastolic hypertension (SBP 140-159, DBP 85- 89 mmHg, respectively) were associated with an increased risk of death from diabetes mellitus, alcoholic liver disease, and renal failure (HR, 1.83; 95% CI, 1.51 to 2.22; HR, 1.24; 95% CI, 1.06 to 1.46; HR, 2.30; 95% CI, 1.64 to 3.21; HR, 1.67; 95% CI, 1.27 to 2.20; HR, 1.99; 95% CI, 1.41 to 2.81; HR, 1.31; 95% CI, 0.99 to 1.73, respectively), but a decreased risk of death from intestinal pneumonia (HR, 0.64; 95% CI, 0.42 to 0.98; HR, 0.59; 95% CI, 0.39 to 0.91). Only stage II systolic hypertension (SBP ≥160 mmHg) was associated with an increased risk of death from pneumonia, liver cirrhosis, and intestinal ischemia (HR, 1.54; 95% CI, 1.19 to 1.98; HR, 1.46; 95% CI, 1.00 to 2.15; HR, 3.77; 95% CI, 1.24 to 11.40, respectively), and stage I and II diastolic hypertension (SBP 140-159 and ≥160 mmHg) were associated with an increased risk of death from intestinal ischemia (HR, 3.07; 95% CI, 1.27 to 7.38; HR, 4.39; 95% CI, 1.62 to 11.88, respectively). CONCLUSIONS: An increase in blood pressure levels may alter the risk of death from certain causes other than cardiovascular diseases, a well-known outcome of hypertension, although the mechanism of these associations is not well documented.
Subject(s)
Adult , Humans , Blood Pressure , Cardiovascular Diseases , Cohort Studies , Diabetes Mellitus , Hypertension , Ischemia , Liver Cirrhosis , Liver Diseases, Alcoholic , Pneumonia , Proportional Hazards Models , Renal InsufficiencyABSTRACT
Unmet healthcare needs do not end with the phenomenon itself, but lead to possibilities of increased severity of illness. Missed opportunities for treatment at the right timing increase possibilities of complications, and affect prognosis of disease. To examine current status and trends of unmet needs in Korea, we used data from four sources: the Korea National Health and Nutrition Examination Survey (KNHNES, '2007–2016); the Community Health Survey (CHS '2008–2016); the Korea Health Panel Survey (KHP '2011–2014); and the Korean Welfare Panel Study (KOWEPS '2006–2016). The proportion of individual reporting unmet healthcare needs as of 2016 was 8.8% (KNHNES), 11.5% (CHS), and 12.8% (KHP, as of 2014). Annual percentage change which characterizes trend for the follow-up period was −9.9%, −3.1%, and −1.3%, respectively. The proportion of individuals reporting unmet healthcare needs due to cost was 1.8% (KNHNES), 1.5% (CHS), and 3.0% (KHP). The proportion of households reporting unmet healthcare needs due to cost was 1.0% (KOWEPS). Annual percentage change was −10.0%, −15.2%, −5.4%, and −17.5%, respectively. Low income populations had more unmet healthcare needs than high income populations. Therefore, in order to improve unmet healthcare needs, it is necessary to focus on low income populations.