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1.
Washington; Organización Panamericana de la Salud; jul. 30, 2020. 4 p.
Non-conventional in Spanish | LILACS (Americas) | ID: biblio-1116084

ABSTRACT

Varios países de América Latina son el epicentro de la pandemia de COVID-19. La región, la más desigual del mundo, es especialmente vulnerable a la COVID-19 por sus altos niveles de informalidad laboral, urbanización y débiles sistemas de salud y protección social.


Subject(s)
Pneumonia, Viral/economics , Health Systems/economics , Coronavirus Infections/economics , Economics , Pandemics/economics , Betacoronavirus , Sustainable Development/economics , National Health Programs/economics , Caribbean Region , Public Health Policy , Latin America
2.
RECIIS (Online) ; 14(2): 515-519, abr.-jun. 2020. ilus
Article in Portuguese | LILACS (Americas) | ID: biblio-1102937

ABSTRACT

Em 2018, o Sistema Único de Saúde (SUS) completou 30 anos de sua criação no Brasil. Embora reúna muitas conquistas nessas três décadas, o SUS hoje enfrenta novos desafios, impostos pela agenda liberal e conservadora em curso no país. Nesse contexto, o documentário O Espírito de 45 (2013), dirigido por Ken Loach, que destaca a criação do Serviço Nacional de Saúde (National Health Service - NHS), no Reino Unido, é um filme salutar. Tendo a cidadania e o bem comum como grandes temas, a obra mostra como é possível, revisitando o passado, despertar o espírito combativo em defesa de uma sociedade mais justa e solidária, que privilegie o bem-estar da população em lugar do lucro e que aponte caminhos para a defesa do SUS, enquanto uma conquista do povo brasileiro.


In 2018, the SUS ­ Sistema Unificado de Saúde (Unified Health System) celebrated the 30th anniversary of its setting up in Brazil. Despite its many achievements in these three decades, nowadays SUS faces new challenges which were imposed by a liberal and conservative agenda ongoing in the country. In this context, the documentary The Spirit of '45 (2013), directed by Ken Loach, which highlights the creation of the National Health Service (NHS) in the United Kingdom, is a very important film. Addressing citizenship and the common good as major themes, the movie shows how it is possible by revisiting the past to awaken the combative spirit in favour of a fairer and more solidary society, in order to prioritize the population's wellbeing instead of the profit and to point out ways to defend SUS as an achievement of the Brazilian people.


En 2018, el SUS ­ Sistema Único de Saúde (Sistema Único de Salud) completó 30 años de su creación en Brasil. Aunque haya tenido muchos logros en estas tres décadas, el SUS enfrenta hoy nuevos desafíos, impuestos por la agenda liberal y conservadora en curso en el país. En este contexto, la película documental The Spirit of '45 (2013), en la versión brasileña, O Espírito de 45, de Ken Loach, que destaca la creación del Servicio Nacional de Salud (National Health Service ­ NHS); en el Reino Unido, es un buen ejemplo. Con la ciudadanía y el bien común como temas principales, la producción muestra como es posible, reviviendo el pasado, despertar el espíritu combativo en defensa de una sociedad más justa y solidaria, que privilegie el bienestar de la población en lugar de losbeneficios lucrativos, y señale formas de defender el SUS, como un logro del pueblo brasileño.


Subject(s)
Humans , Social Welfare , Unified Health System , Health Care Reform , Documentaries and Factual Films , National Health Programs , Brazil , Narration , Universal Health Coverage , United Kingdom , Health Policy
3.
Article in English | WPRIM (Western Pacific) | ID: wprim-786209

ABSTRACT

BACKGROUND AND OBJECTIVES: We aim to explore the additional discriminative accuracy of a deep learning (DL) algorithm using repeated-measures data for identifying people at high risk for cardiovascular disease (CVD), compared to Cox hazard regression.METHODS: Two CVD prediction models were developed from National Health Insurance Service-Health Screening Cohort (NHIS-HEALS): a Cox regression model and a DL model. Performance of each model was assessed in the internal and 2 external validation cohorts in Koreans (National Health Insurance Service-National Sample Cohort; NHIS-NSC) and in Europeans (Rotterdam Study). A total of 412,030 adults in the NHIS-HEALS; 178,875 adults in the NHIS-NSC; and the 4,296 adults in Rotterdam Study were included.RESULTS: Mean ages was 52 years (46% women) and there were 25,777 events (6.3%) in NHIS-HEALS during the follow-up. In internal validation, the DL approach demonstrated a C-statistic of 0.896 (95% confidence interval, 0.886–0.907) in men and 0.921 (0.908–0.934) in women and improved reclassification compared with Cox regression (net reclassification index [NRI], 24.8% in men, 29.0% in women). In external validation with NHIS-NSC, DL demonstrated a C-statistic of 0.868 (0.860–0.876) in men and 0.889 (0.876–0.898) in women, and improved reclassification compared with Cox regression (NRI, 24.9% in men, 26.2% in women). In external validation applied to the Rotterdam Study, DL demonstrated a C-statistic of 0.860 (0.824–0.897) in men and 0.867 (0.830–0.903) in women, and improved reclassification compared with Cox regression (NRI, 36.9% in men, 31.8% in women).CONCLUSIONS: A DL algorithm exhibited greater discriminative accuracy than Cox model approaches.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02931500


Subject(s)
Adult , Artificial Intelligence , Cardiovascular Diseases , Cohort Studies , Female , Follow-Up Studies , Humans , Insurance, Health , Learning , Male , Mass Screening , National Health Programs
4.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-787240

ABSTRACT

The Big Data Research Committee of the Korean Society of Gastroenterology conducted activities and researches with three goals. First, it provides the basis for proper and cost-effective treatment of digestive diseases in Korea. Second, it carries out population-level global research by establishing a system of big data analysis related to gastroenterology. Third, it provides the members of the Korean Society of Gastroenterology with the opportunity to plan and assess the public interest related to big data. The studies published by the committee members in this paper were carried out under these objectives, and the findings are believed to have achieved the public interest goals that may be helpful in the current medical and health policy. The construction of the big data infrastructure for digestive drugs is also underway, and we expect to see meaningful results pertaining to important digestive drugs. Research using public health medical big data, such as the National Health Insurance Corporation data base, should ultimately provide a basis for reflecting public messages and policies for the public. To this end, it is necessary for Korean researchers to lead efforts to lower the barriers and to approach relevant information and opportunities using big data research.


Subject(s)
Committee Membership , Gastroenterology , Health Policy , Korea , National Health Programs , Public Health , Statistics as Topic
5.
Korean Circulation Journal ; : 267-277, 2020.
Article in English | WPRIM (Western Pacific) | ID: wprim-811351

ABSTRACT

BACKGROUND AND OBJECTIVES: Nationwide social inequalities of oral anticoagulation (OAC) usage after the introduction of non-vitamin K antagonist oral anticoagulants (NOACs) have not been well identified in patients with atrial fibrillation (AF). This study assessed overall rate and social inequalities of OAC usage after the introduction of NOAC in Korea.METHODS: Between January 2002 and December 2016, we identified 888,540 patients with AF in the Korea National Health Insurance system database. The change of OAC rate in different medical systems after the introduction of NOAC were evaluated.RESULTS: In all population, overall OAC use increased from 13.2% to 23.4% (p for trend <0.001), and NOAC use increased from 0% to 14.6% (p for trend <0.001). Compared with pre-reimbursement (0.48%), the annual increase of OAC use was significantly higher after partial (1.16%, p<0.001), and full reimbursement of OAC (3.72%, p<0.001). Full reimbursement of NOAC (adjusted odds ratio, 2.10; 95% confidence interval, 2.04–2.15) was independently associated with higher OAC use. However, the difference of overall OAC usage between tertiary referral hospitals and nursing or public health centers increased from 17.9% in 2010 to 36.8% in 2016. Moreover, usage rate of NOAC was significantly different among different medical systems from 37.2% at the tertiary referral hospital and 5.5% at nursing or public health centers.CONCLUSIONS: Introduction of NOACs in routine practice for stroke prevention in AF was associated with improved rates of overall OAC use. However, significant practice-level variations in OAC and NOAC use remain producing social inequalities of OAC despite full reimbursement.


Subject(s)
Anticoagulants , Atrial Fibrillation , Humans , Insurance , Korea , National Health Programs , Nursing , Odds Ratio , Public Health , Socioeconomic Factors , Stroke , Tertiary Care Centers
6.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-811302

ABSTRACT

Due to technological advances and the establishment of evidence-based medicine, radiological examinations are playing a crucial role in modern medicine, as a result of which they have been steadily increasing, and the rate of increase has intensified in the 2000s. Although this is a global phenomenon, the increase of radiological examinations in Korea is also high due to the introduction of the National Health Insurance Coverage Expansion Policy, so-called Moon Jae-in Care, for ultrasonography and magnetic resonance imaging. For accurate and rapid diagnosis of diseases, it is necessary for doctors to order appropriate radiological studies. However, the increase in radiological examination has created many problems, such as increased medical costs, decreased diagnostic accuracy due to radiologist burnout, and increased patient exposure to radiation. To reduce unnecessary imaging studies, a number of measures could be deployed including the development of clinical guidelines to select appropriate radiological examinations for each clinical situation.


Subject(s)
Diagnosis , Evidence-Based Medicine , History, Modern 1601- , Humans , Insurance, Health , Korea , Magnetic Resonance Imaging , Moon , National Health Programs , Ultrasonography
7.
Article in English | WPRIM (Western Pacific) | ID: wprim-811269

ABSTRACT

OBJECTIVES: This study aimed to understand the nationwide patterns of antibiotic prescription after tooth extraction in adult patients.MATERIALS AND METHODS: This study analyzed dental records from the National Health Insurance Service–National Sample Cohort (NHIS–NSC) database on 503,725 tooth extractions performed in adults (≥19 years) during 2011–2015. Patient sex, age, household income, systemic disease (diabetes mellitus and hypertension), type of dental institution, region of dental institution, year of prescription, and type of tooth extraction procedure were considered. The antibiotic prescription rate and broad-spectrum antibiotic prescription frequency were analyzed using chi-squared tests. Factors affecting the prescription of broad-spectrum antibiotics were evaluated using multivariate logistic regression analysis.RESULTS: The rate of antibiotic prescription after tooth extraction was 81.85%. Penicillin was most commonly prescribed (45.25%), followed by penicillin with beta-lactamase inhibitors (18.76%), metronidazole (12.29%), and second- to fourth-generation cephalosporins (11.52%). The proportion of broad-spectrum antibiotics used among all prescribed antibiotics was 45.88%.CONCLUSION: The findings of this study demonstrate that the rate of antibiotic prescription after tooth extraction is higher in Korea than in other countries. Furthermore, broad-spectrum antibiotics are used more frequently, which may indicate unnecessary drug prescription, an important contributor to antibiotic resistance.


Subject(s)
Adult , Anti-Bacterial Agents , beta-Lactamase Inhibitors , Cephalosporins , Cohort Studies , Dental Records , Drug Prescriptions , Drug Resistance, Microbial , Family Characteristics , Humans , Korea , Logistic Models , Metronidazole , National Health Programs , Penicillins , Prescriptions , Tooth Extraction , Tooth
8.
Article in English | WPRIM (Western Pacific) | ID: wprim-811143

ABSTRACT

BACKGROUND: Diabetes mellitus is associated with an increased risk of dementia. We aimed to comprehensively analyze the incidence and risk factors for dementia and young-onset dementia (YOD) in diabetic patients in Korea using the National Health Insurance Service data.METHODS: Between January 1, 2009 and December 31, 2012, a total of 1,917,702 participants with diabetes were included and followed until the date of dementia diagnosis or until December 31, 2015. We evaluated the incidence and risk factors for all dementia, Alzheimer's disease (AD), and vascular dementia (VaD) by Cox proportional hazards analyses. We also compared the impact of risk factors on the occurrence of YOD and late-onset dementia (LOD).RESULTS: During an average of 5.1 years of follow-up, the incidence of all types of dementia, AD, or VaD was 9.5, 6.8, and 1.3/1,000 person-years, respectively, in participants with diabetes. YOD comprised 4.8% of all dementia occurrence, and the ratio of AD/VaD was 2.1 for YOD compared with 5.5 for LOD. Current smokers and subjects with lower income, plasma glucose levels, body mass index (BMI), and subjects with hypertension, dyslipidemia, vascular complications, depression, and insulin treatment developed dementia more frequently. Vascular risk factors such as smoking, hypertension, and previous cardiovascular diseases were more strongly associated with the development of VaD than AD. Low BMI and a history of stroke or depression had a stronger influence on the development of YOD than LOD.CONCLUSION: The optimal management of modifiable risk factors may be important for preventing dementia in subjects with diabetes mellitus.


Subject(s)
Alzheimer Disease , Blood Glucose , Body Mass Index , Cardiovascular Diseases , Dementia , Dementia, Vascular , Depression , Diabetes Mellitus , Diabetes Mellitus, Type 2 , Diagnosis , Dyslipidemias , Follow-Up Studies , Humans , Hypertension , Incidence , Insulin , Korea , National Health Programs , Risk Factors , Smoke , Smoking , Stroke
9.
Article in English | WPRIM (Western Pacific) | ID: wprim-811142

ABSTRACT

BACKGROUND: Type 2 diabetes mellitus (T2DM) is associated with an increased risk for dementia. The effects of hypoglycemia on dementia are controversial. Thus, we evaluated whether hypoglycemia increases the risk for dementia in senior patients with T2DM.METHODS: We used the Korean National Health Insurance Service Senior cohort, which includes >10% of the entire senior population of South Korea. In total, 5,966 patients who had ever experienced at least one episode of hypoglycemia were matched with those who had not, using propensity score matching. The risk of dementia was assessed through a survival analysis of matched pairs.RESULTS: Patients with underlying hypoglycemic events had an increased risk for all-cause dementia, Alzheimer's dementia (AD), and vascular dementia (VaD) compared with those who had not experienced a hypoglycemic event (hazard ratio [HR], 1.254; 95% confidence interval [CI], 1.166 to 1.349; P<0.001 for all-cause dementia; HR, 1.264; 95% CI, 1.162 to 1.375; P<0.001 for AD; HR, 1.286; 95% CI, 1.110 to 1.490; P<0.001 for VaD). According to number of hypoglycemic episodes, the HRs of dementia were 1.170, 1.201, and 1.358 in patients with one hypoglycemic episode, two or three episodes, and more than three episodes, respectively. In the subgroup analysis, hypoglycemia was associated with an increased risk for dementia in both sexes with or without T2DM microvascular or macrovascular complications.CONCLUSION: Our findings suggest that patients with a history of hypoglycemia have a higher risk for dementia. This trend was similar for AD and VaD, the two most important subtypes of dementia.


Subject(s)
Cohort Studies , Dementia , Dementia, Vascular , Diabetes Mellitus, Type 2 , Humans , Hypoglycemia , Korea , National Health Programs , Propensity Score
10.
Annals of Dermatology ; : 115-121, 2020.
Article in English | WPRIM (Western Pacific) | ID: wprim-811087

ABSTRACT

BACKGROUND: Recently, the number of nationwide medical researches on psoriasis using the National Health Insurance Service database has been on the rise. However, identification of psoriasis using diagnostic codes alone can lead to misclassification. Accuracy of the diagnostic codes and their concordance with medical records should be validated first to identify psoriasis patients correctly.OBJECTIVE: To validate the diagnostic codes of psoriasis (International Classification of Diseases, 10th Revision L40) and to find the algorithm for the identification of psoriasis.METHODS: We collected medical records of patients who received their first diagnostic codes of psoriasis during 5 years from five hospitals. Fifteen percent of psoriasis patients were randomly selected from each hospital. We performed a validation by reviewing medical records and compared 5 algorithms to identify the best algorithm.RESULTS: Total of 538 cases were reviewed and classified as psoriasis (n=368), not psoriasis (n=159), and questionable (n=11). The most accurate algorithm was including patients with ≥1 visits with psoriasis as primary diagnostic codes and prescription of vitamin D derivatives. Its positive predictive value was 96.5% (95% confidence interval [CI], 93.9%~98.1%), which was significantly higher than those of the algorithm, including patients with ≥1 visits with psoriasis as primary diagnostic codes or including ≥1 visits with diagnostic codes of psoriasis (primary or additional) (91.0% and 69.8%). Sensitivity was 90.8% (95% CI, 87.2%~93.4%) and specificity was 92.5% (95% CI, 86.9%~95.9%).CONCLUSION: Our study demonstrates a validated algorithm to identify psoriasis, which will be useful for the nationwide population-based study of psoriasis in Korea.


Subject(s)
Classification , Electronic Health Records , Humans , International Classification of Diseases , Korea , Medical Records , National Health Programs , Prescriptions , Psoriasis , Sensitivity and Specificity , Vitamin D
11.
Article in English | WPRIM (Western Pacific) | ID: wprim-811065

ABSTRACT

PURPOSE: The prevalence of asthma is increasing globally as the world population increases; however, and the prevalence and mortality of asthma have not been extensively investigated. Also, the effects of severity and aging on asthma prevalence and mortality are unknown. We aimed to investigate trends of the prevalence and mortality of asthma as well as health care uses and costs over 14 years according to disease severity by using real-world data in Korea.METHODS: Using the National Health Insurance Sharing Service database, we extracted asthmatic patients having diagnosis codes of asthma and prescription records of antiasthmatic medications from 2002 to 2015 and categorized them according to asthma exacerbation and regular treatment. We defined asthma-associated death in terms of patients' prescription records within 3 months before all-cause death, then linked with the Cause of Death Statistics. The annual asthma-related health care uses and costs were analyzed.RESULTS: The prevalence rates of asthma (1.6% to 2.2%) and severe asthma (SA; 3.5% to 6.1% among total asthmatics) have increased steadily over the decade in Korea, where the proportion of elderly asthmatics having increased. The asthma-related health care uses and costs had increased during the study period with the highest uses/costs in SA. The asthma mortality had a steady rising trend from 16.2 to 28.0 deaths per 100,000 with the highest mortality in SA.CONCLUSIONS: The prevalence and mortality of asthma as well as SA increases along with the burden of health care uses/costs. More active interventions, including changes in health care policies, are needed to reduce the prevalence and mortality of asthma, especially SA.


Subject(s)
Aged , Aging , Asthma , Cause of Death , Delivery of Health Care , Diagnosis , Health Care Costs , Humans , Korea , Mortality , National Health Programs , Prescriptions , Prevalence
12.
Article in English | WPRIM (Western Pacific) | ID: wprim-810957

ABSTRACT

Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.


Subject(s)
Abdomen , Budgets , Chest Pain , Critical Care , Dyspnea , Emergencies , Heart , Heart Arrest , Insurance Coverage , Insurance , Insurance, Health , Korea , Medical Records , National Health Programs , Patient Care , Point-of-Care Systems , Prescriptions , Shock , Thorax , Ultrasonography
13.
Article in English | WPRIM (Western Pacific) | ID: wprim-810956

ABSTRACT

BACKGROUND: The big data provided by Health Insurance Review and Assessment (HIRA) contains data from nearly all Korean populations enrolled in the National Health Insurance Service. We aimed to identify the incidence of facial fractures and its trends in Korea using this big data from HIRA.METHODS: We used the Korean Standard Classification of Disease and Cause of Death 6, 7 for diagnosis codes. A total of 582,318 patients were included in the final analysis. All statistical analyses were performed using SAS software and SPSS software.RESULTS: The incidence of facial fractures consistently declined, from 107,695 cases in 2011 to 87,306 cases in 2016. The incidence of facial fractures was the highest in June 2011 (n = 26,423) and lowest in January 2014 (n = 10,282). Nasal bone fractures were the most common, followed by orbit and frontal sinus fractures. The percentage of nasal bone fractures declined, whereas those of orbital fractures increased from 2011 to 2016 (P < 0.001). Among orbital fractures, inferior wall fractures were the most common, followed by medial wall fractures. Among mandibular fractures, angle fractures were the most common, followed by condylar process and symphysis fractures. Although it was difficult to predict the most common type of zygomatic and maxilla fractures, their incidence consistently declined since 2011.CONCLUSION: We observed trends in facial fractures in Korea using big data including information for nearly all nations in Korea. Therefore, it is possible to predict the incidence of facial fractures. This study is meaningful in that it is the first study that investigated the incidence of facial fractures by specific type.


Subject(s)
Cause of Death , Classification , Diagnosis , Facial Bones , Fractures, Bone , Frontal Sinus , Humans , Incidence , Insurance, Health , Korea , Mandibular Fractures , Maxilla , Nasal Bone , National Health Programs , Orbit , Orbital Fractures
14.
Article in English | WPRIM (Western Pacific) | ID: wprim-810949

ABSTRACT

BACKGROUND: Statistical data of undiagnosed people living with human immunodeficiency virus (PLHIV) are of great importance to human immunodeficiency virus (HIV) infection control. This study estimated the total number of PLHIV using nationwide claims data.METHODS: This study used data of the incident HIV cases identified by the National Health Insurance System between 2009 and 2015. The number of patients with acquired immune deficiency syndrome (AIDS) was identified by diagnoses or prescription records. The estimated number of PLHIV and the time to diagnosis were calculated from the incident numbers of HIV and AIDS cases using the HIV Modeling Tool of the European Center for Disease Prevention and Control.RESULTS: Between 2009 and 2015, a total of 7,033 PLHIV and 2,899 AIDS patients were diagnosed. In 2009, the number of incident HIV cases was 873 (460 AIDS patients), increasing to 995 (337 AIDS patients) in 2015. Besides, the estimated number of prevalent cases was 10,753 in 2009, compared to 14,880 in 2015. Patients visiting health facilities accounted for 42.9% (4,616/10,753) in 2009 and 64.1% (9,544/14,880) in 2015. In 2009, there were 8,363 (77.8%) undiagnosed HIV cases, experiencing a decline to 6,215 (41.8%) in 2015. It took a mean of 6.96 years to diagnose after HIV infection.CONCLUSION: This study estimates the total burden of HIV infection in Korea for the first time using an internationally recognized HIV modeling tool. Claims data can be used to estimate the number of undiagnosed cases by identifying the total number of PLHIV and AIDS patients visiting health facilities.


Subject(s)
Acquired Immunodeficiency Syndrome , Diagnosis , Health Facilities , HIV Infections , HIV , Humans , Infection Control , Korea , National Health Programs , Prescriptions
15.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-820821

ABSTRACT

OBJECTIVES: This study aimed to estimate the financial budget of fluoride application in the National Health Insurance.METHODS: The amount of fluoride application was calculated by using the sealant rate (utilization rate 1), dental examination rate (utilization rate 2), and the average rate of these two (utilization rate 3) in children and adolescents. For the next five years, 100% of the existing fees were applied to estimate the financial budget.RESULTS: The total budget for children and adolescents was estimated to be 22.0 billion won minimum and 83.5 billion won maximum in the first year, and 104.8 billion won minimum and 398.5 billion won maximum up to the next five years. Moreover, in high risk groups, the total budget was estimated to be 4.2 billion won minimum and 16.1 billion won maximum in the first year, and 18.6 billion won minimum and 70.8 billion won maximum up to the next five years.CONCLUSIONS: The financial budget of fluoride application coverage for children and adolescents was similar or lower than that of the current dental sealants. It needs to implement promptly with the reason of financial saving over the long-term point of view. Based on this evidence, it is affordable and necessary to begin to promote oral health for children and adolescents.


Subject(s)
Adolescent , Budgets , Child , Fees and Charges , Fluorides , Humans , Insurance, Health , National Health Programs , Oral Health , Pit and Fissure Sealants
16.
Article in English | WPRIM (Western Pacific) | ID: wprim-816626

ABSTRACT

Korea is currently an aged society and is on the cusp of becoming a superaged society in a few years. The health burden of cardiovascular diseases increases with age, and the increasing prevalence of cardiovascular risk factors, such as obesity, hypertension, diabetes mellitus, and dyslipidemia, may be linked to increased population-level cardiovascular risk. In 2018, the prevalence of obesity in Korea was 35.7% (men, 45.4%; women, 26.5%) according to the Obesity Fact Sheet 2019, based on National Health Insurance Corporation medical checkup data. In 2016, the prevalence of diabetes was 14.4% in Koreans older than 30 years according to the Diabetes Fact Sheet published by the Korean Diabetes Association, based on data from the Korean National Health and Nutrition Examination Survey. The prevalence of hypertension in the total population of Korea in 2018 was 28.3% according to the Korean Hypertension Fact Sheet produced by the Korean Society of Hypertension. Lastly, the prevalence of dyslipidemia in 2018 was 40.5% according to the Dyslipidemia Fact Sheet published by the Korean Society of Lipid and Atherosclerosis. In this article, I would like to review the prevalence and current management of cardiovascular risk factors in Korea according to the fact sheets released by various associations.


Subject(s)
Adult , Atherosclerosis , Cardiovascular Diseases , Diabetes Mellitus , Dyslipidemias , Female , Humans , Hypertension , Korea , National Health Programs , Nutrition Surveys , Obesity , Prevalence , Risk Factors
17.
Article in English | WPRIM (Western Pacific) | ID: wprim-816617

ABSTRACT

BACKGROUND: Pheochromocytomas and paragangliomas (PPGLs) are rare endocrine tumors originating from chromaffin cells. PPGLs are associated with a high mortality rate and several complications. To date, no epidemiological studies have been conducted on PPGLs in Asia. This study aimed to investigate the epidemiology and prognosis of PPGLs in Korea using nationwide data.METHODS: Using the National Health Insurance Service Database, subjects with a principal diagnosis of PPGLs on two or more occasions between 2003 and 2014 who satisfied the operational definition of PPGLs were included. Incidence, prevalence, complications, metastasis, and mortality were investigated.RESULTS: In total, 1048 subjects with a mean age of 47.6±16.1 years were included. There was no sex preponderance. The overall prevalence of PPGLs was 2.13 per 100,000 persons, and the overall age-standardized incidence rate was 0.18 per 100,000 person-years. Malignant PPGLs accounted for 17.7% (185 of 1,048) of cases, and 94 subjects exhibited metastasis at the time of diagnosis. Among initially non-metastatic PPGLs, 9.5% (nine of 954) eventually metastasized after a mean duration of 78.1±41.4 months. The 5-year survival rates for non-metastatic and metastatic PPGLs at diagnosis were 97% and 84%, respectively. Multivariable Cox regression models adjusted for covariates showed that metastatic PPGLs were associated with a 2.40-fold higher risk of mortality than non-metastatic PPGLs (95% confidence interval, 1.38 to 4.17; P=0.002).CONCLUSION: PPGLs are rare in Korea, and the prognosis of these endocrine tumors varies depending on whether they are benign or malignant. This epidemiological study paves the way for further research on PPGLs.


Subject(s)
Asia , Chromaffin Cells , Diagnosis , Epidemiologic Studies , Epidemiology , Humans , Incidence , Korea , Mortality , National Health Programs , Neoplasm Metastasis , Paraganglioma , Pheochromocytoma , Prevalence , Prognosis , Survival Rate
18.
Article in English | WPRIM (Western Pacific) | ID: wprim-782492

ABSTRACT

BACKGROUND: This study aimed to evaluate the association between baseline results of the Timed Up and Go (TUG) test and subsequent functional dependency occurrence.METHODS: From the National Health Insurance Service-Senior Cohort database, we identified 39,519 people who participated in the National Screening Program for Transitional Ages at the age of 66 during 2007–2008. Impaired mobility was defined as taking 10 seconds or longer to perform the TUG test. Functional dependency occurrence was defined as the initiation of receiving national Long-Term Care Insurance services—home care or admission to long-term care facilities. Cox proportional hazard regression models were used to assess the hazard ratios (HRs) for dependency occurrence according to baseline TUG test results.RESULTS: The mean follow-up period was 5.7 years. Occurrence rates of dependency were 2.0 and 3.4 cases per 1,000 person-years in the normal and impaired TUG groups, respectively. Impaired mobility was associated with a higher risk of functional dependency occurrence (adjusted HR [aHR], 1.65; 95% confidence interval [CI], 1.40–1.95; P < 0.001). Additionally, in the subgroup analysis for the participants with intact baseline activities of daily living, impaired mobility was associated with a higher risk of dependency occurrence (aHR, 1.65; 95% CI, 1.33–2.04; P < 0.001).CONCLUSION: The TUG test might be a useful predictive marker of subsequent functional dependency occurrence. Intervention to prevent functional dependency may be helpful for older adults with impairment on the TUG test.


Subject(s)
Activities of Daily Living , Adult , Cohort Studies , Follow-Up Studies , Gait , Geriatric Assessment , Humans , Insurance, Long-Term Care , Long-Term Care , Mass Screening , National Health Programs
19.
Article in English | WPRIM (Western Pacific) | ID: wprim-782489

ABSTRACT

BACKGROUND: The purposes of this study were 1) to investigate the incidence of pneumonia during hospitalization in elderly hip fracture patients, 2) to evaluate the effect of pneumonia on 30 day to 1 year mortality and 3) to analyze the impact of age and gender on the mortality rate in the pneumonia patients using a nationwide cohort of Korea.METHODS: The Korean National Health Insurance Service (NHIS) database included approximately 5.5 million Korean enrollees > 60 years of age. A total of 588,147 participants were randomly selected for senior cohort using 10% simple random sampling. We identified senile (> 65 years old) patients who underwent hip fracture surgery from January 2005 to December 2014 and those who developed pneumonia during hospitalization from the NHIS-Senior cohort. The index date of hip fracture occurrence was defined as the date of admission to the acute care hospital. The last date of follow-up was defined as the date of death or 31 December 2015, whichever came first. A multivariable-adjusted Cox proportional hazards model was used to investigate the effects of pneumonia on all-cause mortality.RESULTS: During the enrollment period, a total of 14,736 patients, who were older than 65 years, underwent hip fracture surgeries. Among them, 1,629 patients (11.05%) developed pneumonia during the hospitalization. The pneumonia incidence was 16.39% (601/3,666) in men patients and 9.29% (1,028/10,042) in women patients. Compared to 13,107 non-pneumonia patients, adjusted relative risk (aRR) of death in pneumonia patients was 2.69 (95% confidence interval [CI], 2.14–3.38; P < 0.001) within postoperative 30-day, 3.40 (95% CI, 3.01–3.83; P < 0.001) within postoperative 90-day, 2.86 (95% CI, 2.61–3.15; P < 0.001) within postoperative 180-day and 2.31 (95% CI, 2.14–2.50; P < 0.001) within postoperative 1-year. According to patient's age, the aRR of death in pneumonia patients was 5.75 (95% CI, 2.89–11.43) in adults aged < 70 years, 5.14 (95% CI, 4.08–6.46) in those aged 70–79 years, 3.29 (95% CI, 2.81–3.86) in those aged 80–89 years and 2.02 (95% CI, 1.52–2.69) in those aged ≥ 90 years. The aRR was 3.63 (95% CI, 3.01–4.38) in men pneumonia patients, and 3.27 (95% CI, 2.80–3.83) in women pneumonia patients.CONCLUSION: The prevalence of pneumonia in elderly hip fracture patients was 11.05%. Men had higher incidence (16.39%) than women (9.29%). Compared to non-pneumonia patients, the pneumonia patients had higher 30-day to 1-year mortalities with aRR of 2.31 to 3.40. They had increased mortality in all age groups older than 65 years with aRR of 1.52 to 4.08. Both genders of pneumonia patients had higher risk of mortality (aRR, 3.63 in men and 3.27 in women) compared to non-pneumonia patients.


Subject(s)
Adult , Aged , Cohort Studies , Female , Follow-Up Studies , Hip , Hospitalization , Humans , Incidence , Korea , Male , Mortality , National Health Programs , Pneumonia , Prevalence , Proportional Hazards Models
20.
Article in English | WPRIM (Western Pacific) | ID: wprim-782275

ABSTRACT

BACKGROUND: Firefighters are exposed to many dangerous working conditions. Many studies have identified the risk of disease for firefighters, but only a few studies have addressed the medical expenses of firefighters, which represents a concrete scale of disease. Our purpose in this study was to determine the medical expenditures of firefighters to assess the overall scale of disease in Korea. We focused on cancer, mental disorders, cardio-cerebrovascular disease, and musculoskeletal disease, the prevalence of which was expected to be high in firefighters.METHODS: This study utilized National Health Insurance Service data. We targeted firefighters, police officers, and government officials. We classified disease based on the 10th revision of the International Statistical Classification of Diseases and Related Health Problems codes. We compared prevalence by the age-standardized prevalence rate, considering standard distribution of the population. Medical expenditure of disease was defined as outpatient fees, hospitalization fees, and drug costs. Total medical expenditures were calculated by the sum of those 3 categories.RESULTS: The age-standardized prevalence of cancer, mental disorders, and cardiovascular disease in firefighters was slightly higher than or similar to that of government officials and police officers (no significant difference). However, medical expenditures for stomach cancer, mental disorders, and most cardio-cerebrovascular diseases were higher in firefighters than in others. In particular, firefighters spent 12 times more money for ischemic heart disease than did government officials. Of musculoskeletal diseases, lumbar disc disorder had the highest expenditures among firefighters.CONCLUSIONS: The age-standardized prevalence of most of diseases of firefighters was not as high as in the other groups, but the medical expenses of firefighters were much higher than those of government officials and police officers.


Subject(s)
Cardiovascular Diseases , Drug Costs , Fees and Charges , Firefighters , Health Expenditures , Hospitalization , Humans , International Classification of Diseases , Korea , Mental Disorders , Musculoskeletal Diseases , Myocardial Ischemia , National Health Programs , Occupational Groups , Outpatients , Police , Prevalence , Stomach Neoplasms
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