Use of Herbal Decoction and Pharmacopuncture in Individuals with Chronic Disease: findings from a nationally representative panel.

Objectives: This study analyzed the Korea Health Panel Annual Data 2019 to investigate factors related to the use of non-insured Korean medicine (KM) treatment in individuals with chronic diseases. The non-insured KM treatments of interest were herbal decoction (HD) and pharmacopuncture (PA). Methods: Among adults aged 19 or older, 6,159 individuals with chronic diseases who received outpatient KM treatment at least once in 2019 were included. They were divided into three groups according to the KM treatment used (1) basic insured KM non-pharmacological treatment (BT) group (n = 629); (2) HD group (n = 256); (3) PA group (n = 184). Logistic regression analysis was used to explore factors associated with favoring HD or PA use over BT. Potentially relevant candidate factors were classified using the Andersen Behavior Model. Results: Compared to BT, the 1st to 3rd quartiles of income compared to the 4th quartile (odds ratio 1.50 to 2.06 for HD; 2.03 to 2.83 for PA), health insurance subscribers compared to medical aid (odds ratio 2.51; 13.43), and presence of musculoskeletal diseases (odds ratio 1.66; 1.91) were significantly positively associated with HD and PA use. Moreover, the presence of cardiovascular disease (odds ratio 1.46) and neuropsychiatric disease (odds ratio 1.97) were also significantly positively associated with HD use. Conclusion: The presence of some chronic diseases, especially musculoskeletal diseases, was significantly positively associated with HD and PA use, while low economic status was significantly negatively associated with HD and PA use, indicating the potential existence of unmet medical needs in this population. Since chronic diseases impose a considerable health burden, the results of this study can be used for reference for future health insurance coverage policies in South Korea.

The Association Between Physical Activity and Health Care Risk Management in Individuals With Disabilities.

Despite the increasing economic burden of people with disabilities (PWDs) over time, the impact of physical activity on PWDs in the Republic of Korea (ROK) remains relatively unexplored. Thus, we examined the association between physical activity and disease risk, health care utilization, and expenditures for PWDs in the ROK. We considered gender differences across eight diseases using the National Health Insurance (NHI) panel data from 2013 to 2019. The sample consisted of PWDs who underwent regular medical check-ups and were aged 40 years and above, aligning with the NHI's health screening program targeting beneficiaries in this age range. The final sample included 281 142 healthy PWDs. Among them, 44.1% (n = 124 061) engaged in physical activity, while the remaining 45.9% (n = 157 081) did not participate in any physical activity. The results show a negative association between physical activity and the incidence of various diseases among both genders. Health care utilization exhibited gender and disease-based variations, with men and women demonstrating higher utilization rates in the absence of physical activity. Health care expenditures also differed based on gender and disease, as men and women displayed higher costs in the absence of physical activity. Consequently, public policymakers should establish tailored activity programs for PWDs, adhering to activity guidelines designed for this population.

Does Maintained Medical Aid Coverage Affect Healthy Lifestyle Factors, Metabolic Syndrome-Related Health Status, and Individuals' Use of Healthcare Services?

Concerns about the moral hazards and usage of universal health insurance require examination. This study aimed to analyze changes in lifestyle, metabolic syndrome-related health status, and individuals' tendency to use healthcare services according to changes in the eligibility status of medical aid recipients. This paper reports a retrospective cohort study that involved analyzing data from 2366 medical aid recipients aged 40 years or older who underwent national health screenings in 2012 and 2014. Of the recipients, 1606 participants continued to be eligible for medical aid (the "maintained" group) and 760 changed from being medical aid recipients to National Health Insurance (NHI) enrollees (the "changed" group). Compared to the "changed" group, the "maintained" group was less likely to quit smoking, more likely to begin smoking, less likely to reduce binge drinking to moderate drinking, and had a significant increase in blood glucose and waist circumference. Annual total medical expenses also increased significantly in the "maintained" group. Since the mere strengthening of healthcare coverage may lead to moral hazards and the failure to link individuals' tendency to use healthcare services and outcomes, establishing mechanisms is necessary to educate people about the health-related outcomes of maintaining a healthy lifestyle and ensure the appropriate use of healthcare services.

Effect of Household Type on the Prevalence of Metabolic Syndrome in Korea: Using Propensity Score Matching.

This study analyzed the effect of the household type on the prevalence of metabolic syndrome in Koreans utilizing data from the sixth, seventh, and eighth Korea National Health and Nutrition Examination Surveys conducted by the Korea Disease Control and Prevention Agency from 2015 to 2019. The demographic characteristics, metabolic syndrome characteristics according to household type, and risk factors of 25,092 subjects were identified using the Rao−Scott χ2−test and weighted multiple logistic regression results. Furthermore, to understand the effect of the household type on prevalence of metabolic syndrome, the selection bias between the groups was eliminated using the propensity score matching method. The average treatment effect for those treated for metabolic syndrome prior to propensity score matching was higher for single-person households, with 0.353 and 0.268 for single- and multi-person households, respectively. The difference was statistically significant (p < 0.0001). However, after propensity score matching, it was observed to be higher for multi-person households, with 0.290 and 0.316 for single- and multi-person households, respectively. However, the difference was not statistically significant (p < 0.1822). Difference was observed regarding the prevalence of metabolic syndrome by individual characteristics, some of which were considered in previous studies. However, the household type alone did not explain the prevalence of metabolic syndrome.

Analysis of risk factors affecting suicidal ideation in South Korea by life cycle stage.

OBJECTIVE: This study analyzed risk factors for suicidal ideation in South Koreans from a life cycle perspective. METHODS: A secondary analysis was conducted of data collected in 2015 as part of the 6th Korea National Health and Nutrition Examination Survey (KNHANES). The participants comprised 5,935 individuals aged 12 years or older. The statistical analysis reflected the complex sampling design of the KNHANES, and the Rao-Scott chi-square test and multiple logistic regression analysis were performed. RESULTS: The prevalence of suicidal ideation was 5.7% in adolescents, 3.7% in young adults, 5.4% in middle-aged adults, and 7.0% in older adults. Depression and stress were risk factors in every stage of the life cycle. In those aged 12 to 19 years, activity restrictions were significantly associated with suicidal ideation. Education and subjective health status were risk factors in adults aged 20 to 39 years, and education, activity restrictions, and quality of life were the major risk factors in those aged 40 to 64 years. For adults 65 years of age or older, the risk of suicidal ideation was higher among those with inappropriate sleep time. CONCLUSION: The risk factors for suicidal ideation were found to be different across stages of the life cycle. This suggests a need for individualized suicide prevention plans and specific government policies that reflect the characteristics of each life cycle stage.

Differences in Function and Healthcare Cost of Older Adults with Dementia by Long-Term Care Service Type: A National Dataset Analysis.

This study aims to analyze the function and cost changes among long-term care insurance (LTCI) beneficiaries with low-severity dementia according to their LTCI service type. Data were collected from the Korean LTCI and national health insurance (NHI) datasets. Participants were 4414 beneficiaries with dementia aged 65 or older who received LTC services continuously for 4 years (2008-2011). LTCI service types were classified into home care (HC), institutional care (IC), and combined care (CC). Activities of daily living (ADL), cognitive function, medical cost, and benefit-cost were assessed. Linear mixed models and multiple regression models were used to analyze the changes in function and costs of the beneficiaries. ADL, cognitive function, medical cost, and benefit-cost differed significantly depending on the service type and time (p < 0.001). LTCI service types affected the degree of changes in ADL, cognitive function, medical cost, and benefit-cost over four years and showed negative changes in IC and CC beneficiaries than HC beneficiaries. HC is a cost-effective way to maintain the function of beneficiaries with low-severity dementia. Thus, efforts are needed to actively promote HC services.

The Prevalence of Metabolic Syndrome and Health-Related Behavior Changes: The Korea National Health Examination Survey.

This study was conducted to investigate the effect of health-related behavior changes on the prevalence of metabolic syndrome (MetS). This study utilized data from the Korea National Health Examination Survey of adults aged 40 or older who underwent health screening in 2011, 2013, and 2015. The prevalence of MetS was analyzed according to sex, age, income, residence location, and health-related behaviors by conducting multiple logistic regression analysis. For health-related behaviors, smoking, drinking, and physical activity were examined, and changes in health-related behaviors over five years from 2011 to 2015 were included in the analysis. The prevalence of MetS in Korea in 2015 was 31.7%. The prevalence showed statistically significant differences according to sex, age, income, location, and health-related behaviors. The prevalence was higher in men than in women and increased with aging. Regarding income, MetS prevalence was slightly higher in the middle-income groups compared with the lowest or the highest. Regarding location, MetS prevalence was lower in metropolitan areas compared to small- to medium-sized cities and farming/fishery rural areas. Regarding health-related behavior, MetS prevalence increased in the smoking, heavy drinking, and passive activity groups compared with the nonsmoking, moderate drinking, and active activity groups. Regarding health-related behavior change, MetS prevalence was higher by 22% in the short-term nonsmoking group (subjects who smoked in the past but not currently) compared to the continuous nonsmoking group. The risk for MetS also increased by 84.9% in the continuous heavy drinking group compared to the continuous moderate drinking group. Finally, the risk for MetS increased by 30.3% in the continuous passive physical activity group compared to the continuous active physical activity group. This study's findings indicate the importance of maintaining healthy lifestyle habits to prevent MetS. In particular, the focus for change should be concentrated on short-term nonsmoking, continuous heavy drinking, and continuous passive physical activities to improve health-related behaviors.

Developing the High-Risk Drinking Scorecard Model in Korea.

OBJECTIVES: This study aimed to develop a high-risk drinking scorecard using cross-sectional data from the 2014 Korea Community Health Survey. METHODS: Data were collected from records for 149,592 subjects who had participated in the Korea Community Health Survey conducted from 2014. The scorecard model was developed using data mining, a scorecard and points to double the odds approach for weighted multiple logistic regression. RESULTS: This study found that there were many major influencing factors for high-risk drinkers which included gender, age, educational level, occupation, whether they received health check-ups, depressive symptoms, over-moderate physical activity, mental stress, smoking status, obese status, and regular breakfast. Men in their thirties to fifties had a high risk of being a drinker and the risks in office workers and sales workers were high. Those individuals who were current smokers had a higher risk of drinking. In the scorecard results, the highest score range was observed for gender, age, educational level, and smoking status, suggesting that these were the most important risk factors. CONCLUSION: A credit risk scorecard system can be applied to quantify the scoring method, not only to help the medical service provider to understand the meaning, but also to help the general public to understand the danger of high-risk drinking more easily.

Effect of medicine adherence on the occurrence of cerebrovascular disorders in diabetes mellitus patients.

OBJECTIVES: To assess the association between the occurrence of cerebrovascular disorders and a medication adherence in diabetes mellitus patients. METHODS: Medical records from 1,114 new patients with diabetes mellitus were collected and the occurrence of cerebrovascular disorders was observed. Data was gathered from the health examination records of diabetes mellitus patients registered at the Korean Metabolic Syndrome Research from 1996 to 2005, medication records from the National Health Insurance Corporation and death data from the National Statistics Office from 1997 to 2007. Hazard ratios were analyzed using the Cox proportional hazard model to test the association between the occurrence of cerebrovascular disorders and the level of medication adherence. Medication adherence was calculated using Continuous measure of Medication Acquisition (CMA). RESULTS: Of 1,114 diabetes mellitus patients, cerebrovascular disorders occurred in 67 cases (6.1%). The mean duration for the development of a cerebrovascular disorder was 3.82 yr. Medication adherence (≥0.8 vs. <0.5: HR, 3.26; 95% CI, 1.47-7.21, ≥0.8 vs. 0.5-0.7 HR, 0.99; 95% CI, 0.33-2.95) was an independent factor associated with the occurrence of cerebrovascular disorders in diabetes mellitus. CONCLUSION: Increased medication adherence is necessary to prevent the occurrence of cerebrovascular disorders in diabetes mellitus patients. Furthermore we propose that CMA be considered as a method for monitoring medication adherence in clinics.

Data mining approach to model the diagnostic service management.

Korea has National Health Insurance Program operated by the government-owned National Health Insurance Corporation, and diagnostic services are provided every two year for the insured and their family members. Developing a customer relationship management (CRM) system using data mining technology would be useful to improve the performance of diagnostic service programs. Under these circumstances, this study developed a model for diagnostic service management taking into account the characteristics of subjects using a data mining approach. This study could be further used to develop an automated CRM system contributing to the increase in the rate of receiving diagnostic services.