Validation of Cancer Diagnosis Based on the National Health Insurance Service Database versus the National Cancer Registry Database in Korea / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#This study aimed to assess the feasibility of operational definitions of cancer patients in conducting cancer-related studies using the claims data from the National Health Insurance Service (NHIS). @*Materials and Methods@#Cancer incidence data were obtained from the Korean Central Cancer Registry, the NHIS primary diagnosis, and from the rare and intractable disease (RID) registration program. @*Results@#The operational definition with higher sensitivity for cancer patient verification was different by cancer type. Using primary diagnosis, the lowest sensitivity was found in colorectal cancer (91.5%; 95% confidence interval [CI], 91.7 to 92.0) and the highest sensitivity was found in breast cancer (97.9%; 95% CI, 97.8 to 98.0). With RID, sensitivity was the lowest in liver cancer (91.9%; 95% CI, 91.7 to 92.0) and highest in breast cancer (98.1%; 95% CI, 98.0 to 98.2). In terms of the difference in the date of diagnosis in the cancer registration data, > 80% of the patients showed a < 31-day difference from the RID definition. @*Conclusion@#Based on the NHIS data, the operational definition of cancer incidence is more accurate when using the RID registration program claims compared to using the primary diagnosis despite the relatively lower concordance by cancer type requires additional definitions such as treatment.

Prevalence and Predictors of Sustained Smoking after a Cancer Diagnosis in Korean Men / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Although smoking has a significant impact on mortality and morbidity of cancer patients, many patients continue to smoke post-diagnosis. The purpose of this study was to investigate prevalence and predictors of sustained smoking among male cancer survivors. @*Materials and Methods@#The Korean National Health Insurance Service-National Health Screening Cohort database was used for this population-based, retrospective study. Study subjects were 15,141 men who were diagnosed with their first incident cancer between 2004 and 2011. Changes in smoking status before and after a cancer diagnosis were investigated. For patients who were current smokers pre-diagnosis, association between post-diagnosis sustained smoking and demographic, socioeconomic, and clinical variables were examined. @*Results@#Of the 4,657 pre-diagnosis smokers, 2,255 (48%) had quit after cancer diagnosis, while 2,402 (51.6%) continued to smoke. In a multivariate logistic regression analysis, younger age at cancer diagnosis (adjusted odds ratio [aOR], 1.37; 95% confidence interval [CI], 1.21 to 1.55; p < 0.001), low socioeconomic status (aOR, 1.29; 95% CI, 1.15 to 1.45; p ≤ 0.001), pre-diagnosis heavy smoking (aOR, 1.24; 95% CI, 1.09 to 1.41; p=0.001), diagnosis of non-smoking– related cancer (aOR, 1.67; 95% CI, 1.42 to 1.96; p < 0.001), and high serum glucose level (aOR, 1.23; 95% CI, 1.03 to 1.46; p=0.019) were associated with sustained smoking after a cancer diagnosis. @*Conclusion@#Almost half of the male smokers continue to smoke after a cancer diagnosis. Targeted interventions for smoking cessation should be considered for patients with younger age, low socioeconomic status, heavy smoking history, non-smoking–related cancer, and high blood glucose levels.

Association between Change in Alcohol Consumption and Metabolic Syndrome: Analysis from the Health Examinees Study

BACKGROUND: The association between change in alcohol intake and metabolic syndrome is unclear. METHODS: This retrospective cohort consisted of 41,368 males and females from the Health Examinees-GEM study. Participants were divided into non-drinkers (0.0 g/day), light drinkers (male: 0.1 to 19.9 g/day; female: 0.1 to 9.9 g/day), moderate drinkers (male: 20.0 to 39.9 g/day; female: 10.0 to 19.9 g/day), and heavy drinkers (male: ≥40.0 g/day; female: ≥20.0 g/day) for each of the initial and follow-up health examinations. Logistic regression analysis was used to determine the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for developing metabolic syndrome according to the change in alcohol consumption between the initial and follow-up health examinations. Adjusted mean values for the change in waist circumference, fasting serum glucose (FSG), blood pressure, triglycerides, and high density lipoprotein cholesterol (HDL-C) levels were determined according to the change in alcohol consumption by linear regression analysis. RESULTS: Compared to persistent light drinkers, those who increased alcohol intake to heavy levels had elevated risk of metabolic syndrome (aOR, 1.45; 95% CI, 1.09 to 1.92). In contrast, heavy drinkers who became light drinkers had reduced risk of metabolic syndrome (aOR, 0.61; 95% CI, 0.44 to 0.84) compared to persistent heavy drinkers. Increased alcohol consumption was associated with elevated adjusted mean values for waist circumference, FSG, blood pressure, triglycerides, and HDL-C levels (all P<0.05). Reduction in alcohol intake was associated with decreased waist circumference, FSG, blood pressure, triglycerides, and HDL-C levels among initial heavy drinkers (all P<0.05). CONCLUSION: Heavy drinkers who reduce alcohol consumption could benefit from reduced risk of metabolic syndrome.

The Influence of Family History of Hypertension on Hypertension Prevalence, Management and Healthy Behaviors among Korean Adults: Results from the Korea National Health and Nutrition Examination Survey 2014–2016

BACKGROUND@#This study was designed to investigate the influence of family history of hypertension (FH) on hypertension prevalence, management, and healthy behaviors among Korean adults.@*METHODS@#By using data from the Korea National Health and Nutrition Examination Survey 2014–2016, a cross-sectional study was performed. The study population included 8,280 individuals who underwent health examination and food frequency questionnaire were divided into two groups based on FH. Participants with one or more first-degree FH classified as having a FH. Health behaviors analyzed were low sodium intake, weight management, no smoking, non-risky drinking, and sufficient physical activity. Multiple logistic regression analyses were used to compare outcome variables (hypertension prevalence, awareness, treatment, control, and healthy behaviors).@*RESULTS@#Of a total of 8,280 subjects, 3,626 (43.8%) participants had FH. Presence of a FH significantly associated with the risk of hypertension prevalence (adjusted odds ratio [aOR], 2.47; 95% confidence interval [CI], 2.01–3.04), awareness (aOR, 1.97; 95% CI, 1.30–2.99), treatment (aOR, 2.61; 95% CI, 1.71–3.98), and control (aOR, 1.77; 95% CI, 1.19–2.64). In contrast, FH was not significantly associated with healthy behaviors. In the subgroup analyses, the normotensives with FH were even slightly less likely to get health check-ups than those without FH (aOR, 0.84; 95% CI, 0.72–0.99).@*CONCLUSIONS@#Although those with FH showed higher prevalence, awareness, treatment, and control rates, health behaviors of those with FH were not higher than those without FH. More attention should be directed to promote the healthy behaviors for management and prevention of hypertension, especially among those with FH.

The Influence of Family History of Hypertension on Hypertension Prevalence, Management and Healthy Behaviors among Korean Adults: Results from the Korea National Health and Nutrition Examination Survey 2014–2016

BACKGROUND: This study was designed to investigate the influence of family history of hypertension (FH) on hypertension prevalence, management, and healthy behaviors among Korean adults. METHODS: By using data from the Korea National Health and Nutrition Examination Survey 2014–2016, a cross-sectional study was performed. The study population included 8,280 individuals who underwent health examination and food frequency questionnaire were divided into two groups based on FH. Participants with one or more first-degree FH classified as having a FH. Health behaviors analyzed were low sodium intake, weight management, no smoking, non-risky drinking, and sufficient physical activity. Multiple logistic regression analyses were used to compare outcome variables (hypertension prevalence, awareness, treatment, control, and healthy behaviors). RESULTS: Of a total of 8,280 subjects, 3,626 (43.8%) participants had FH. Presence of a FH significantly associated with the risk of hypertension prevalence (adjusted odds ratio [aOR], 2.47; 95% confidence interval [CI], 2.01–3.04), awareness (aOR, 1.97; 95% CI, 1.30–2.99), treatment (aOR, 2.61; 95% CI, 1.71–3.98), and control (aOR, 1.77; 95% CI, 1.19–2.64). In contrast, FH was not significantly associated with healthy behaviors. In the subgroup analyses, the normotensives with FH were even slightly less likely to get health check-ups than those without FH (aOR, 0.84; 95% CI, 0.72–0.99). CONCLUSIONS: Although those with FH showed higher prevalence, awareness, treatment, and control rates, health behaviors of those with FH were not higher than those without FH. More attention should be directed to promote the healthy behaviors for management and prevention of hypertension, especially among those with FH.

Effect of Smoking Cessation and Reduction on the Risk of Cancer in Korean Men: A Population Based Study / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to investigate the effect of smoking habit change on the risk of cancer. MATERIALS AND METHODS: From the Korean National Health Insurance Service database, we determined the change in smoking habit between the first (2002 and 2003) and second (2004 and 2005) health examination periods. A total of 143,071 men were categorized into baseline heavy (≥ 20 cigarettes per day), moderate (10-19 cigarettes per day), light (< 10 cigarettes per day) smokers, quitters, and never smokers, after which the change in smoking status was determined during the second health examination. The participants were then followed up from 2006 to 2013 for all cancer, smoking related cancer, and lung cancer. RESULTS: Compared to heavy continual smokers, heavy smokers who quit had reduced risk of smoking related cancer (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.56 to 0.97) and tended to have reduced risk of all cancer (HR, 0.87; 95% CI, 0.75 to 1.00). Moderate smokers who reduced the amount of smoking to light levels had decreased risk of all cancer (HR, 0.82; 95% CI, 0.72 to 0.94), smoking related cancer (HR, 0.74; 95% CI, 0.59 to 0.93), and lung cancer (HR, 0.55; 95% CI, 0.38 to 0.79) compared to heavy continual smokers. CONCLUSION: Smoking reduction decreases the risk of all cancer, smoking related cancer, and lung cancer. While smoking cessation should be the treatment of choice for smokers, smoking reduction may serve as an alternative strategy for those who cannot quit.