Change in Denture Procedures after Implementation of National Health Insurance Coverage for the Elderly in Korea: A Nationwide Database.

BACKGROUND: Dental health is an important factor in daily life routines and is closely associated with maintaining a health-related quality of life. This study examined denture procedure changes after implementation of the National Health Insurance (NHI) Coverage of Dentures for the elderly. METHODS: We used the "Korean Community Health Survey (KCHS)" developed by the Korea Centers for Diseases Control and Prevention. We analyzed the association between policy implementation and dental health-related outcomes using difference-in-differences (DID) analysis to compare patients aged ≥75 with those 65-74 years before and after coverage. RESULTS: A comparison of age groups and coverage periods showed that patients aged ≥75 years had higher (OR: 1.038, 95% CI: 1.021-1.055) procedure rates after coverage. In particular, elderly patients on medical aid had significantly higher denture procedure rates, while those without oral health screening were more likely to have denture procedures. CONCLUSIONS: This study determined the impact of the NHI Coverage of Denture procedure policy for the elderly and found increased denture treatments in the elderly. This policy appeared to positively affect older patients by increasing denture procedures for low-income and medical aid beneficiaries. Hence, the government needs to increase oral health examination and dental health policies for the elderly.

Implementation of the Chronic Disease Care System and its association with health care costs and continuity of care in Korean adults with type 2 diabetes mellitus.

BACKGROUND: The Chronic Disease Care System (CDCS) has been implemented in Korea to encourage treatment continuity in chronic disease patients. This study investigated the effect of the introduction of the CDCS on health care costs and continuity of care in individuals with type 2 diabetes mellitus (T2DM). METHODS: The National Health Insurance data from August, 2010 to March, 2012 (pre-policy) and from May, 2012 to December, 2013 (post-policy) were used. Introduction of the CDCS was defined as the intervention. The intervention group consisted of T2DM patients participating in the program and the control group patients not participating in the program. The Difference-in-Differences (DID) method was used to estimate the differences in total health care costs for outpatient services and continuity of care between the intervention and the control group before and after the intervention period. RESULTS: Implementation of the CDCS was associated with decreased health care costs (ß = - 46,877 Korean Won, P < 0.0001) and improved continuity of care (ß = 0.0536, P < 0.0001) in the intervention group with adjustment for covariates. CONCLUSION: Findings confirm an association between the adoption of the CDCS and reduced health care costs and improved continuity of care. The results reveal the potential benefits of reinforcing effective chronic disease management strategies in reducing health care costs and improving treatment continuity.

The effect of continuity of care on the incidence of end-stage renal disease in patients with newly detected type 2 diabetic nephropathy: a retrospective cohort study.

BACKGROUND: Diabetic nephropathy requires periodic monitoring, dietary modification, and early intervention to prevent the disease severity within limited resource settings. To emphasize the importance of continuous care for chronic diseases, various studies have focused on the association between continuity of care (COC) and common adverse outcomes. However, studies aimed at understanding the effect of COC on the incidence of chronic diseases, such as end-stage renal disease (ESRD), are few. The aim of this study was to determine whether there is an association between COC and the incidence of ESRD among patients with diabetic nephropathy. Moreover, we identified individual- and hospital-level factors associated with the incidence of ESRD among diabetic nephropathy patients. METHODS: We conducted a retrospective cohort study using the administrative National Health Insurance claims data from 2005 to 2012 in the Republic of Korea. The dependent variable, a binary variable, was the incidence of ESRD due to diabetic renal complication. In addition, using the COC index as a binary variable with a cutoff point of 0.75, we divided patients into a 'Good COC group' (COC index≥0.75) and a 'Bad COC group' (COC index< 0.75). The survival analysis was performed using the Cox proportional hazards models. RESULTS: Among 3565 diabetic renal complication patients, ESRD occurred among 83 diabetes mellitus patients (2.3%). Nephropathy patients with lower COC level (< 0.75) had 1.99 times higher risk of ESRD incidence (95% confidence interval [CI]:1.27-3.12). In addition, the lowest income level patients had higher hazard ratio (HR) of ESRD than the highest income level patients (HR: 1.69 95% CI: 0.95-2.98), while patients with disabilities had 2.70 higher HR of ESRD than patients without disabilities (95% CI: 0.64-43). CONCLUSIONS: Among patients with diabetic renal complication, higher continuity of care was associated with lower risk of ESRD. It is therefore recommended that continuous follow-up be encouraged to prevent ESRD among diabetic renal complication patients. Moreover, disparities in health outcomes between socially vulnerable groups including patients with disabilities and those in the lowest income level should be addressed.

Association between Parents' Country of Birth and Adolescent Depressive Symptoms: the Early Stages of Multicultural Society.

BACKGROUND: This study aims to determine whether significant associations exist between the parents' country of birth and adolescent depressive symptoms in the early stages of a multicultural society. METHODS: We used data from the 2012-2016 Korea Youth Risk Behavior Web-based Survey, which included responses from 327,357 individuals. Participants were classified into groups according to their parent's country of birth. Logistic regression analysis was used to examine the significance of the associations. RESULTS: Adolescents whose parents were born abroad are more likely to have depressive symptoms (odds ratio [OR] = 1.68; 95% confidence interval [CI], 1.33-2.12) than adolescents whose parents were native Koreans. Respondents whose father was born in North Korea or Japan or Taiwan show greater odds of depressive symptoms than respondents whose parents were native Korean. CONCLUSION: Adolescents whose parents were born abroad are more likely to have depressive symptoms. Multicultural family support policies should be implemented in consideration of the characteristics of the parents' country of birth.

Effects of Physician Volume on Readmission and Mortality in Elderly Patients with Heart Failure: Nationwide Cohort Study.

PURPOSE: Readmission and mortality rates of patients with heart failure are good indicators of care quality. To determine whether hospital resources are associated with care quality for cardiac patients, we analyzed the effect of number of physicians and the combined effects of number of physicians and beds on 30-day readmission and 1-year mortality. MATERIALS AND METHODS: We used national cohort sample data of the National Health Insurance Service (NHIS) claims in 2002-2013. Subjects comprised 2345 inpatients (age: >65 years) admitted to acute-care hospitals for heart failure. A multivariate Cox regression was used. RESULTS: Of the 2345 patients hospitalized with heart failure, 812 inpatients (34.6%) were readmitted within 30 days and 190 (8.1%) had died within a year. Heart-failure patients treated at hospitals with low physician volumes had higher readmission and mortality rates than high physician volumes [30-day readmission: hazard ratio (HR)=1.291, 95% confidence interval (CI)=1.020-1.633; 1-year mortality: HR=2.168, 95% CI=1.415-3.321]. Patients admitted to hospitals with low or middle bed and physician volume had higher 30-day readmission and 1-year mortality rates than those admitted to hospitals with high volume (30-day readmission: HR=2.812, 95% CI=1.561-5.066 for middle-volume beds & low-volume physicians, 1-year mortality: HR=8.638, 95% CI=2.072-36.02 for middle-volume beds & low-volume physicians). CONCLUSION: Physician volume is related to lower readmission and mortality for heart failure. Of interest, 30-day readmission and 1-year mortality were significantly associated with the combined effects of physician and institution bed volume.

Projection of Breast Cancer Burden due to Reproductive/Lifestyle Changes in Korean Women (2013-2030) Using an Age-Period-Cohort Model.

PURPOSE: The aim of this study was to estimate the burden of breast cancer that can be attributed to rapid lifestyle changes in South Korea in 2013-2030. MATERIALS AND METHODS: An age-period-cohort model was used to estimate the incidence and mortality. The Global Burden of Disease Study Group methodwas used to calculate the years of life lost and years lived with disability in breast cancer patients using a nationwide cancer registry. The population attributable riskswere calculated using meta-analyzed relative risk ratios and by assessing the prevalence of risk factors. RESULTS: Women's reproductive/lifestyle changes, including advanced maternal age at first childbirth (from 37 to 85 disability-adjusted life years [DALYs] per 100,000 person-years), total period of breastfeeding (from 22 to 46 DALYs per 100,000 person-years), obesity (from 37 to 61 DALYs per 100,000 person-years), alcohol consumption (from 19 to 39 DALYs per 100,000 person-years), oral contraceptive use (from 18 to 27 DALYs per 100,000 person-years), and hormone replacement therapy use (from 2 to 3 DALYs per 100,000 person-years) were identified as factors likely to increase the burden of breast cancer from 2013 to 2030. Approximately, 34.2% to 44.3% of the burden of breast cancer could be avoidable in 2030 with reduction in reproductive/lifestyle risk factors. CONCLUSION: The rapid changes of age structure and lifestyle in South Korea during the last decade are expected to strongly increase the breast cancer burden over time unless the risk factors can be effectively modified.

Association between secondhand smoke and glycemic control in adult diabetes patients.

Diabetes is a major chronic disease, and many studies have shown an association between diabetes with severe complications and certain causes of diabetes, including secondhand smoke. Smoking has been considered a significant issue around the world, and research has been conducted on its relationship with diseases including diabetes. However, previous studies have focused on the onset of diabetes, rather than glycemic control in patients with diabetes. Thus, this study aims to provide evidence of a relationship between secondhand smoke and glycemic control. We conducted a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey (2007-2014). We included 1168 male and 1248 female survey participants. Exposure to secondhand smoke at home and/or at workplaces was considered the primary independent variable, and glycemic control was represented by HbA1c levels. Chi-squared tests and logistic regression analysis were performed to evaluate the association. A significant association was found between secondhand smoke and glycemic control (male at home, odds ratio [OR]: 0.36, 95% confidence interval [CI]: 0.14-0.90; female at both locations, OR: 0.29, 95% CI: 0.11-0.74). The sub-group analysis showed a negative association of diabetes management with secondhand smoke in both sexes, regardless of income status or healthy/unhealthy behaviors. Exposure to secondhand smoke at home was revealed as a risk factor for poor glycemic control. Thus, healthcare providers should help diabetes patients to avoid secondhand smoke by educating them on the dangers of secondhand smoke.