Hepatocellular carcinoma, decompensation, and mortality based on hepatitis C treatment: A prospective cohort study.

BACKGROUND: Prospective studies of the long-term outcomes of patients with hepatitis C virus (HCV) infection after treatment with interferon-based therapy (IBT) or direct-acting antivirals (DAA) are limited in many Asian countries. AIM: To elucidate the incidences of hepatocellular carcinoma (HCC) and death/transplantation based on treatment with IBT or DAA, to compare the outcomes of the sustained virologic response (SVR) to IBT and DAA, and to investigate outcome-determining factors after SVR. METHODS: This cohort included 2054 viremic patients (mean age, 57 years; 46.5% male; 27.4% with cirrhosis) prospectively enrolled at seven hospitals between 2007 and 2019. They were classified as the untreated group (n = 619), IBT group (n = 578), and DAA group (n = 857). Outcomes included the incidences of HCC and death/transplantation. The incidences of the outcomes for each group according to treatment were calculated using an exact method based on the Poisson distribution. A multivariate Cox regression analysis was performed to determine the factors associated with HCC or death/transplantation, followed by propensity score matching to confirm the results. RESULTS: During a median of 4.1 years of follow-up, HCC and death/transplantation occurred in 113 and 206 patients, respectively, in the entire cohort. Compared with the untreated group, the incidences of HCC and death/transplantation were significantly lower in the IBT group [adjusted hazard ratio (aHR) 0.47, 95%CI: 0.28-0.80 and aHR 0.28, 95%CI: 0.18-0.43, respectively] and the DAA group (aHR 0.58, 95%CI: 0.35-0.96, and aHR 0.19, 95%CI: 0.20-0.68, respectively). Among 1268 patients who attained SVR with IBT (n = 451) or DAA (n = 816), the multivariable-adjusted analysis showed no differences in the risks of HCC (HR 2.03; 95%CI: 0.76-5.43) and death/transplantation (HR 1.38; 95%CI: 0.55-3.49) between the two groups. This was confirmed by a propensity score-matching analysis. Independent factors for HCC after SVR were age, genotype 1, and the presence of cirrhosis. CONCLUSION: Treatment and achieving SVR with either IBT or DAA significantly reduced the incidences of HCC and mortality in the Asian patients with HCV infection. The risks of HCC and mortality were not significantly different regardless of whether SVR was induced by IBT or DAA.

Increasing trends in mortality and costs of infectious diseases in Korea: trends in mortality and costs of infectious diseases.

OBJECTIVES: In an era when the average life expectancy and overall mortality rate have improved, Korea remains at risk for infectious disease outbreaks that place substantial burdens on the healthcare system. This study investigated trends in mortality and the economic burden of infectious diseases. METHODS: Healthcare data from the Health Insurance Review and Assessment Service (2009-2019) and the Korean Statistics Information Service (1997-2019) were used. We selected 10 infectious disease groups (intestinal infections, tuberculosis, vaccine- preventable diseases, sepsis, viral hepatitis, HIV-related diseases, central nervous system infections, rheumatic heart diseases, respiratory tract infections, and arthropod-borne viral diseases). RESULTS: The age-standardized mortality rate for infectious diseases increased from 27.2 per 100,000 population in 1997 to 37.1 per 100,000 population in 2019 and has had an upward trend since 2004. During this same period, significant increases were seen in respiratory tract infections and among elderly persons, especially those aged ≥85 years. The costs for infectious diseases increased from 4.126 billion US dollar (USD) in 2009 to 6.612 billion USD in 2019, with respiratory tract infections accounting for 3.699 billion USD (69%). The annual cost per patient for visits for medical care due to infectious diseases increased from 131 USD in 2009 to 204 USD in 2019. CONCLUSIONS: Mortality among elderly persons and those with respiratory tract infections increased during the study period. The economic burden of infectious diseases has consistently increased, especially for respiratory tract infections. It is therefore essential to establish effective management policies that considers specific infectious diseases and patient groups.

Costs of viral hepatitis B in the Republic of Korea, 2002-2015.

The Republic of Korea has a high prevalence of hepatitis B virus (HBV) infection, and the policies concerning costly antiviral medication have been revised recently. However, in the past 10 years, no related research on costs has been conducted. The objective of this study was to estimate the economic burden of viral hepatitis B and determine the trend of changes in its costs between 2002 and 2015. Claims data from the National Health Insurance Service were used. To identify viral hepatitis B cases, the ICD-10th code B16, B17.0, B18.0 and B18.1 were used based on a primary diagnosis. This study was conducted from a societal perspective regarding both direct and indirect costs. Annual costs were adjusted for inflation by calculations based on the 2015 costs. The number of patients with viral hepatitis B increased from 213 758 in 2002 to 342 672 in 2015. The total socio-economic costs increased from 127.1 million USD in 2002 to 459.1 million USD in 2015, mainly due to the increase in pharmaceutical costs, which accounted for the largest proportion of total costs since 2009-220.5 million USD in 2015, which was ~15 times higher than that in 2002. The healthcare costs for viral hepatitis B accounted for 0.13% of the national health expenditure in 2002, increasing to 0.31% in 2015. The economic burden of viral hepatitis B has increased in the Republic of Korea. It is therefore essential to reduce the healthcare costs of HBV infection by establishing an effective management policy.

The current status of health data on Korean children and adolescents.

Childhood and adolescence are critical periods that affect adults' health status. Therefore, the factors influencing the health of children and adolescents should be analyzed. In Korea, a wide range of youth-related health data has been obtained, both on the regional level and on the national level. This report summarizes the current status of studies related to the health of Korean children and adolescents. Data for which open access is offered include the Korea Youth Risk Behavior Web-based Study, the Panel Study on Korean Children, the Korean Youth Panel Survey, the Korean Children and Youth Panel Survey, and the Student Health Examination. In addition, the Health Examination of Korean Youth Outside of School, the Korean Children and Adolescents Obesity Cohort Study, the Korean Children's Environmental Health Study, the Korea Youth Media Use and Harmful Environment Survey, the Comprehensive Survey of Korean Youth, and the Multicultural Adolescents Panel Study are summarized.