ABSTRACT
To contain the surge of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the South Korean government has implemented non-pharmacological interventions as well as border restrictions. The efficacy of entry restrictions should be evaluated to facilitate their preparation for new variants of SARS-CoV-2. This study explored the impact of border policy changes on overseas entrants and local cases of SARS-CoV-2 variants. Data from the Korea Disease Control and Prevention Agency randomly collected between April 11, 2021 and August 20, 2022 were evaluated using the Granger causality model. The results showed that the outbreak gap of delta variants between international and domestic cases was 10 weeks, while that of omicron variants was approximately 2 weeks, meaning that the quarantine policy helped contain delta variants rather than more transmissible variants. It is recommended that countries implement quarantine policies based on particular purposes accounting for the specific features of different variants to avoid potential negative impacts on the economy.
ABSTRACT
Purpose@#The incidence of gallstone disease and cholecystectomy is increasing worldwide. The aim of this study was to determine trends in the incidence of cholecystectomy in Korea. @*Methods@#The National Health Insurance Services database was used to determine patterns in proportion of cholecystectomy and cholecystostomy in the total population of Korea from 2003 to 2017. The age-standardized rate (ASR) was calculated to compare the cholecystectomy and cholecystostomy according to changes in the population structure over time. The ASR was investigated according to patient age, sex, socioeconomic status, use of computed tomography, and type of hospital to identify trends. @*Results@#The ASR per 100,000 based on the 2010 population of cholecystectomy cases increased markedly from 67.7 to 211.4 between 2003 and 2017. The ASR was consistently higher in female than male (71.9 vs. 63.6 in 2003, 221.8 vs. 201.8 in 2017). Furthermore, the ASR for cholecystectomy increased with age, and surgery for gallstone disease was performed more often at a specialized center than at other medical facilities. The length of hospital stay of cholecystectomy decreased steadily from 10.6 days in 2003 to 6.9 days in 2017. @*Conclusion@#This study shows that the incidence of cholecystectomy and cholecystostomy has steadily increased over the years in Korea, with a trend toward older age and higher socioeconomic status in patients undergoing cholecystectomy. Increasing use of computed tomography investigations could be a primary cause for this trend. An integrated strategy is needed to manage the increase in older patients undergoing cholecystectomy and shorten their hospital stay with medical safety.
ABSTRACT
Background@#Advances in medicine and changes in the medical environment can affect the diagnosis and treatment of diseases. The main purpose of the present study was to investigate whether the difference in accessibility to diagnosis and treatment facilities influenced the occurrence of appendectomy in Korea. @*Methods@#We collected data on 183,531 appendectomy patients between 2003 and 2017 using the National Health Insurance Services claims. Retrospective analysis of relationship between the age-standardized rate (ASR) of appendectomy and clinical variables affecting medical accessibility was performed. Pearson’s correlation analyses were used. @*Results@#The incidence of appendectomy decreased from 30,164 cases in 2003 to 7,355 cases in 2017. The rate of computerized tomography (CT) scans for diagnosis of appendicitis increased from 4.73% in 2003 to 86.96% in 2017. The ASR of appendectomy in uncomplicated and complicated appendicitis decreased from 48.71 in 2005 to 13.40 in 2010 and 8.37 in 2005 to 2.96 in 2009, respectively. The ASR of appendectomy was higher in the high-income group.The proportion and ASR of appendectomy in older age group increased steadily with years.The total admission days continued to decrease from 6.02 days in 2003 to 4.96 days in 2017. @*Conclusion@#The incidence of appendectomy was seemingly associated with the rate of CT scan. In particular, the incidence of appendectomy in uncomplicated appendicitis was markedly reduced. Through enhanced accessibility to CT scans, accurate diagnosis and treatment of appendicitis can be facilitated.
ABSTRACT
BackgroundThe coronavirus disease (COVID-19) pandemic is an emerging threat worldwide. It is still unclear how comorbidities affect the risk of infection and severity of COVID-19. MethodsA nationwide retrospective case-control study of 65,149 individuals, aged 18 years or older, whose medical cost for COVID-19 testing were claimed until April 8, 2020. The diagnosis of COVID-19 and severity of COVID-19 infection were identified from the reimbursement data using diagnosis codes and based on whether respiratory support was used, respectively. Odds ratios were estimated using multiple logistic regression, after adjusting for age, sex, region, healthcare utilization, and insurance status. ResultsThe COVID-19 group (5,172 of 65,149) was younger and showed higher proportion of females. 5.6% (293 of 5,172) of COVID-19 cases were severe. The severe COVID-19 group had older patients and a higher male ratio than the non-severe group. Cushing syndrome (Odds ratio range (ORR) 2.059-2.358), chronic renal disease (ORR 1.292-1.604), anemia (OR 1.132), bone marrow dysfunction (ORR 1.471-1.645), and schizophrenia (ORR 1.287-1.556) showed significant association with infection of COVID-19. In terms of severity, diabetes (OR 1.417, 95% CI 1.047-1.917), hypertension (OR 1.378, 95% CI 1.008-1.883), heart failure (ORR 1.562-1.730), chronic lower respiratory disease (ORR 1.361-1.413), non-infectious lower digestive system disease (ORR 1.361-1.418), rheumatoid arthritis (ORR 1.865-1.908), substance use (ORR 2.790-2.848), and schizophrenia (ORR 3.434-3.833) were related with severe COVID-19. ConclusionsWe identified several comorbidities associated with COVID-19. Health care workers should be more careful when diagnosing and treating COVID-19 when the patient has the above-mentioned comorbidities. Take Home messageComorbidities that might be associated with COVID-19 infection and severe clinical course were identified, which could assist in formulating public health measures to mitigate the risk in groups with increased risk.
ABSTRACT
BackgroundIdentifying the association between medications taken prior to the infection of coronavirus disease (COVID-19) might be useful during the current pandemic until a proven treatment is developed. We aimed to determine whether the risk of developing COVID-19 was associated with the use of various drugs that may increase or decrease susceptibility to severe acute respiratory syndrome coronavirus 2 infection and COVID-19. Methods and FindingsA case-control study was performed using a nationwide claims database of South Korea, where a large testing capacity has been available throughout the pandemic. Exposure was defined as the prescription of study drugs that would have been continued until [≤]7 days before the testing for COVID-19. Adults were considered eligible if they were [≥]18 years old and tested for COVID-19. Among the 65,149 eligible subjects (mean age, 48.3 years; 49.4% male), 5,172 (7.9%) were diagnosed with COVID-19. Hydroxychloroquine was not significantly associated with the risk of COVID-19 (adjusted odds ratio [aOR], 1.48; 95% CI, 0.95-2.31). In the overall population, lower risks of COVID-19 were associated with the use of camostat (aOR, 0.45; 95% CI, 0.20-1.02) and amiodarone (aOR, 0.54; 95% CI, 0.33-0.89), although the differences were not significant in the subgroup analyses. Angiotensin receptor blockers were also associated with a slightly increased risk of COVID-19 (aOR, 1.13; 95% CI, 1.01-1.26), which was also not observed in the subgroup analysis. The study limitations include potential bias regarding the controls characteristics, inability to determine prescription compliance, and a lack of information regarding the severity of underlying conditions. ConclusionsNo medications were consistently associated with increased or decreased risks of COVID-19. These findings suggest that a more cautious approach is warranted for the clinical use of re-purposed drugs until the results are available from clinical trials.
ABSTRACT
Background@#The coronavirus disease 2019 (COVID-19) pandemic is an emerging threat worldwide. It remains unclear how comorbidities affect the risk of infection and severity of COVID-19. @*Methods@#This is a nationwide retrospective case-control study of 219,961 individuals, aged 18 years or older, whose medical costs for COVID-19 testing were claimed until May 15, 2020. COVID-19 diagnosis and infection severity were identified from reimbursement data using diagnosis codes and on the basis of respiratory support use, respectively. Odds ratios (ORs) were estimated using multiple logistic regression, after adjusting for age, sex, region, healthcare utilization, and insurance status. @*Results@#The COVID-19 group (7,341 of 219,961) was young and had a high proportion of female. Overall, 13.0% (954 of 7,341) of the cases were severe. The severe COVID-19 group had older patients and a proportion of male ratio than did the non-severe group. Diabetes (odds ratio range [ORR], 1.206–1.254), osteoporosis (ORR, 1.128–1.157), rheumatoid arthritis (ORR, 1.207–1.244), substance use (ORR, 1.321–1.381), and schizophrenia (ORR, 1.614–1.721) showed significant association with COVID-19. In terms of severity, diabetes (OR, 1.247; 95% confidential interval, 1.009–1.543), hypertension (ORR, 1.245–1.317), chronic lower respiratory disease (ORR, 1.216–1.233), chronic renal failure, and end-stage renal disease (ORR, 2.052–2.178) were associated with severe COVID-19. @*Conclusion@#We identified several comorbidities associated with COVID-19. Health care workers should be more careful while diagnosing and treating COVID-19 when patients have the abovementioned comorbidities.
