Insurance Association Research Articles

Is AIT worth your while? Economic evaluation of allergen-specific immunotherapy (AIT) for otorhinolaryngologists in private practice

The burden of allergic diseases is significant for patients, payers in the healthcare system, and the political economy. Numerous studies have demonstrated the efficacy and cost-effectiveness of allergen immunotherapy (AIT) compared to symptomatic treatments. However, allergic patients in Germany often do not receive adequate treatment. This study aims to investigate the reimbursement of allergy diagnostics and AIT for ear, nose, and throat (ENT) physicians in private practice. Amodel calculation was conducted to assess the reimbursement of allergology services across 12statutory health insurance associations (Kassenärztliche Vereinigungen, KV) based on the Physician Fee Schedule (Einheitlicher Bewertungsmaßstab, EBM) and KV-specific regulations for the year 2022 [20, 22]. Reimbursement was calculated according to EBM values and with areduced point value. Quarterly reimbursement for a3-year therapy and hourly rates for subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) were analyzed and compared with the average reimbursement per case (durchschnittlicher Honorarumsatz je Behandlungsfall, DHPB). Adherence to the budget resulted in ENT physicians being reimbursed above the DHPB for SCIT in every KV. This remained true for most KVs, even when the excess to the case value was only rewarded at 15%. Reimbursement for a3-year SLIT was lower than the DHPB across all KVs. Allergy diagnostics and AIT represent economically advantageous options for ENT practices. Maintenance therapy demonstrates apositive cost-benefit ratio, supporting the call for aconsistent 3‑year treatment regimen.

Quality of Life in Adults with Atopic Dermatitis in Relation to Disease Severity: Nationwide Data in Japan.

The impact of atopic dermatitis (AD) on daily life and different levels of quality of life (QOL) according to AD severity has not been fully elucidated. This study aimed to assess QOL in relation to the AD severity in Japan. This observational study used anonymized data of health insurance association members and their families registered to a mobile health app. The QOL measures included the Dermatology Life Quality Index (DLQI), EuroQol five-dimensional five-level descriptive system (EQ-5D-5L), Work Productivity and Activity Impairment (WPAI), and sleep disturbance Numerical Rating Scale (NRS). The data were assessed according to AD severity: the Patient-Oriented Eczema Measure (POEM: 0-2, "clear/almost clear"; 3-7, "mild"; 8-16, "moderate"; 17-24, "severe"; 25-28, "very severe"); and itch NRS (0-10). Of 1507 adults with AD symptoms or undergoing treatments, 882 were identified with AD diagnosis records. Of those, 229 (26.0%), 242 (27.4%), 273 (31.0%), and 138 (15.6%) were included in the clear/almost clear, mild, moderate, and severe/very severe POEM groups, with mean ± standard deviation DLQI scores of 2.0 ± 2.7, 3.6 ± 3.3, 6.1 ± 4.4, and 10.4 ± 5.7, respectively. Higher DLQI scores were observed with increasing POEM severity and itch NRS (Spearman's rank correlation coefficient 0.629 and 0.615, respectively). EQ-5D-5L scores slightly lowered with increasing POEM severity, whereas WPAI percentage slightly increased. Sleep disturbance NRS increased with increasing AD severity in terms of POEM and itch NRS. Adults identified with AD diagnosis records (n = 882) yielded higher WPAI percentages than those without (n = 1204) in all four domains (Wilcoxon rank sum test, p < 0.001 for all). This study, using real-world data in Japan, presented valuable data on the relationship between AD severity and various aspects of QOL. The data suggested greater QOL impairment with increasing AD severity; even at lower severity levels, QOL was impacted to some extent. The results highlight the need for careful consideration during clinical practice.

Influence of Innovation Orientation on Performance of Non-Life Insurance in Kenya

The insurance industry plays crucial role in the social and economic development of every economy. However, the non-life insurance sub-sector in Kenya has had performance downturn in the past ten years. This study sought to examine the effect of innovation orientation on the performance of non-life insurance in Kenya. The study was anchored on the Schumpeter’s theory. The target population of the study was 35 non-life insurance companies licensed by the insurance regulatory authority and members of the association of Kenya insurers. The study adopted survey research design and used questionnaires to collect primary data. A pilot study was done to test the reliability and validity of the research instrument. The study used Cronbach’s alpha (α) coefficient to test reliability, while construct and content validity were used to check the validity of the research instrument. The data was analyzed using quantitative and qualitative analysis statistics with the help of SSPS version 24. The study used correlation analysis, regression analysis and analysis of variance (ANOVA) to establish the relationship between the variables, strength and direction of the variables and to test hypotheses. The results were presented in tables and models. The study revealed that innovation orientation significantly influenced the performance of non-life insurance companies in Kenya. This meant that non-life insurance companies that prioritize innovation in their products, services, and processes are likely to achieve better performance outcomes. Given the significant impact of innovation orientation on performance, non-life companies should allocate more resources on research to increase gross written premium, insurance penetration and improve underwriting profits. The study recommends future research in other financial services sectors to establish the role of innovation orientation on performance of those sectors. The study focused on non-life insurance in Kenya which limits its application to a fast growing sub-sector of micro-insurance and recommends that a study be conducted on micro-insurance. The findings of such a study may be useful in aiding review of insurance regulations and policy

BMI trajectory of 8,155,894 Japanese adults from exhaustive health checkup data: the contributions of age-related changes in height and weight.

This study aimed to clarify the trajectory of BMI alongside age-related changes in height and weight among Japanese adults. Data from annual health checkups between 2015 and 2020 by the Japan Health Insurance Association were retrospectively analyzed. A total of 4,777,891 men and 3,378,003 women (age 35-69 years) were stratified into 14 subgroups based on sex and 5-year age categories. We used linear mixed-effects model to estimate values for each outcome, with six-time points (2015-2020) as the independent variable. Mean BMI changes were positive across all subgroups, indicating a trend of increasing BMI (men, 0.02 to 0.14 kg/m2/year; women, 0.05 to 0.16 kg/m2/year). In younger subgroups, the changed were relatively large, with the weight transitions mirroring those of BMI. However, the mean changes were negative (men, -0.06 kg/year; women, -0.01 kg/year) in the oldest subgroups. Height reduction increased with age across subgroups (men, -0.14 to -0.03 cm/year; women, -0.18 to -0.01 cm/year). In conclusion, BMI tended to increase with age in both sexes across all age groups of Japanese adults. The increase in BMI appeared to be influenced by weight gain in young to middle age, whereas height reduction influenced increased BMI in older age groups.

Factors associated with awareness of chronic kidney disease, and impact of awareness on renal prognosis.

Chronic kidney disease (CKD) awareness could help prevent disease progression through modifiable risk factors. However, few patients with CKD are aware of their disease. We aimed to investigate the factors associated with CKD awareness and impact of CKD awareness on renal prognosis. We investigated the proportion of participants with CKD who answered 'aware of CKD' in the questionnaire among those undergoing health check-ups from 2013 to 2022. Participants included working-age employees and their dependents covered by health insurance associations for large and medium-sized companies. The outcome was defined as the change from 'unaware' to 'aware' of CKD; multivariable logistic regression analysis assessed the association of urine tests or nutritional guidance with CKD awareness. A control group was randomly selected from the unaware group and matched for age, sex, estimated glomerular filtration rate (eGFR), urinary protein categories, and follow-up period. Changes in eGFR slopes before and after awareness were compared using linear mixed-effects models. Of the 13,489 participants, 2.8% were aware of CKD at baseline; of the 1,614 with CKD-related disease codes, only 19.6% were aware. The odds ratios of urine tests or nutritional guidance in relation to awareness occurrence were 1.98 (1.29-3.05) and 3.01 (1.38-6.53), respectively. The difference in the eGFR slope improvement from before to after CKD awareness was + 0.92mL/min/1.73m2 per year (0.18-1.67; P = 0.015) in the aware group. Our findings suggest that urine tests and nutritional guidance may promote CKD awareness, which may help slow its progression.

The Effect of Health Insurance on Racial Disparities in Patients With Isolated Colorectal Liver Metastases.

Although resection of colorectal liver metastases (CRLM) improves survival, factors including race and health insurance are associated with disparities in care. The aim of this study was to evaluate the effect of health insurance on racial disparities in CRLM resection. A retrospective study of patients with CRC with synchronous CRLM was performed using the National Cancer Database (2004-2020). The primary outcome was resection liver resection. Multivariable logistic regression (MVR) was performed to evaluate the association of race and insurance with the odds of resection. Forty-four thousand and six hundred sixteen patients were included. Resection rates were lower among Blacks compared to White patients (12.9% vs. 17.3%). By MVR, Black patients (OR 0.76 vs. White), uninsured and Medicaid-insured patients (OR 0.49 and OR 0.71 vs. private insurance) were less likely to undergo resection. On MVR of race stratified by insurance, Black patients with private and Medicare insurance had decreased odds of resection compared to White (OR 0.71 and OR 0.64). Although Black patients with CRLM have lower odds of hepatic resection compared to White, when stratified by insurance, this was only present among private- and Medicare-insured. Further investigation is warranted to understand other factors associated with racial disparities in this population.

Diabetes and suicide: a nationwide longitudinal cohort study among the Japanese working-age population

BackgroundAlthough the mental health burden of diabetes has received substantial attention, there is limited evidence on whether the risk of suicide—a severe consequence of mental health problems—increases among individuals with...

Post-COVID in healthcare workers and its consequences on quality of life, activities, participation, need for rehabilitation and care experiences: protocol of a cohort study

IntroductionHealthcare workers (HCWs) have been of particular relevance for overcoming the SARS-CoV-2 pandemic. At the same time they have been affected by SARS-CoV-2 infections with above average probability. Around 6.5% of the overall infected persons are likely to develop persistent symptoms resulting from the infection, known as long-COVID or post-COVID syndrome (PCS). The aim of this study is (1) to investigate the prevalence, course and characteristics of PCS in German HCWs, (2) to examine its effects on psychosocial variables, (3) to identify rehabilitation and healthcare needs and (4) to analyse treatment experiences.Methods and analysisIn a cohort study with a randomised selection of participants (N=20 000) from the Employer’s Liability Insurance Association for Health and Welfare Care, the health status of HCWs, who had COVID-19 in their professional context will be examined. There will be two measurement points: baseline (T1) and a 12-month follow-up (T2). The outcome measures are the health status with a particular focus on persistent or newly occurring symptoms after a SARS-CoV-2 infection, health-related quality of life, functional capacity, the subjective need for and utilisation of healthcare services. Pre-existing conditions, the course of the acute infection and sociodemographic factors are considered as predictors. An advisory board made up of affected HCWs supports the study by contributing to the surveys’ contents.Ethics and disseminationThe study has been approved by the Local Ethics Committee of the Center for Psychosocial Medicine at the University Hospital Hamburg-Eppendorf (LPEK-0518). For dissemination, the results will be published in peer-reviewed journals, presented at conferences and communicated to relevant stakeholders in general and rehabilitation medicine.Trail registration numberhttps://drks.de/search/de/trial/DRKS00029314

Estimating the prevalence of chronic kidney disease in the older population using health screening data in Japan.

In aging societies, the prevalence of chronic kidney disease (CKD) is expected to increase but may be underestimated because many asymptomatic patients remain undiagnosed. This study aimed to estimate the CKD prevalence among the general older population in Japan. This cross-sectional study used health screening data from the Japan Health Insurance Association collected between April 2014 and March 2023. Data from older people aged 65-90years who underwent renal function screening for estimated glomerular filtration rate (eGFR) and urine protein tests were analyzed. CKD was defined as eGFR < 60mL/min/1.73m2 or proteinuria ≥ 1 + . Inverse probability weighting was used to account for the selection bias. The variables used for weighting were age, sex, insurance status, and the number of previous screenings. Among 2.98 million older individuals, 588,809 (19.7%) had undergone screening (median [IQR] age, 69.9 [67.9-76.2] years, 337,862 women [57.4%]). Regarding the weighted CKD prevalence, 25.3% of the individuals aged 65-90years had CKD; 11.8% of those aged 65-75years and 34.6% of those aged 75years and over showed an increase in prevalence with age. Among the patients with CKD, over half exhibited mild renal dysfunction without proteinuria. Hypertension and diabetes were common comorbidities in older patients with CKD. This cross-sectional study revealed that the weighted prevalence of CKD in the older population aged 65-90years was high (one in four individuals), indicating that it increases with age. Further studies are required to examine the clinical significance of these findings.

Stroke Research Using Administrative Claims Database in Japan: A Narrative Review

Although administrative claims databases have recently been used for clinical research in Japan, no detailed description of their utilization in stroke research is available. We reviewed stroke studies using the Diagnosis Procedure Combination (DPC), the National Database of Health Insurance Claims and Specific Health Checkups (NDB), and several commercial databases sourced from social health insurance associations, focusing on their applications and limitations. Original articles on stroke published by April 2024 using the DPC, NDB, and commercial databases were identified in Ovid MEDLINE. The characteristics of each database were compared in terms of comprehensiveness, traceability, baseline information, and outcome assessment in stroke research. A total of 114 studies were included (83 for DPC, 6 for NDB, and 25 for commercial databases). The number of stroke studies using administrative databases in Japan is still approximately 10 per year, although there is a slowly increasing trend. The DPC database was utilized for short-term outcome studies because of its detailed baseline and outcome information, although the inability to track patients once they changed facilities limits their use in long-term studies. The NDB database is potentially useful for long-term studies because of its comprehensiveness and traceability, but difficulties in data access restrict its usage. The most commonly used commercial database utilizes baseline information on lifestyle and blood test data, although the lack of coverage for those over 75 years old may limit its generalizability. Administrative claims databases are beginning to be used in stroke research in Japan but are not yet fully utilized. Researchers need to understand their applications and limitations.

The Effect of Financial Soundness Level on Premium Growth of Companies Listed in AASI

Analyze how the effect of financial health level as measured by liquidity ratio, investment balance ratio with liabilities, investment income ratio, claim expense ratio, tabarru' fund change ratio, and risk-based capital ratio on premium growth of Islamic insurance companies listed in the Indonesian Sharia Insurance Association (AASI) for the period 2018-2022. Quantitative research using panel data regression analysis with SPSS 26 program.There is a significant influence between the variable ratio of investment income on the growth of premiums of Islamic insurance companies indicated by a partial significance test value of 0.044 &lt;0.05 and there is also an influence between the variable ratio of changes in tabarru's funds on the growth of Islamic insurance premiums indicated by a partial significance test value of 0.007 &lt;0.05. Meanwhile, there is no influence between the variables of liquidity ratio, investment balance ratio with liabilities, claim expense ratio, and risk-based capital (RBC) ratio on the growth of premiums of Islamic insurance companies.

ENSURING SUSTAINABLE WAQF-ZAKAT MICROTAKAFUL PROTECTION THROUGH A SYSTEM DYNAMICS APPROACH

The Islamic financial ecosystems, such as zakat and waqf, have roles in tackling poverty and can be integrated into providing financial protection, such as death benefits to the poor through microtakaful. However, unpredictable payouts and irregular contributions can hinder the implementation of microtakaful, affecting cash flows. This paper employs a system dynamics approach to simulate the cash flows of microtakaful funds, emphasizing the influence of three key factors: the rate of new participants, the mortality rate, and the contribution rate. Note that this approach is chosen for its ability to model complex systems and predict the behavior of microtakaful funds over time. The data collected were from various institutions, including the Life Insurance Association of Malaysia (LIAM), the Central Bank of Malaysia (BNM), and the Department of Statistics Malaysia (DOSM) from 2018 to 2020. The model indicates a minimum contribution rate of RM130 per year, with a 2% mortality rate and 0.8% annual increase in the new participants. The model serves as a foundation for designing a simple and understandable non-profit microtakaful product.

Adherence to national guidelines for colorectal, breast, and cervical cancer screenings in Japanese workplaces: a survey-based classification of enterprises’ practices into “overscreening,” “underscreening,” and “guideline-adherence screening”

BackgroundWorkplace cancer screening programs are determined as part of an employee’s benefits package and health checkups are perceived positively. However, the current status of workplace cancer screening programs in Japan is unavailable. This study aimed to assess the adherence to national guidelines for colorectal, breast, and cervical cancer screenings in the workplace among Japanese enterprises and identify factors associated with excessive or inadequate screenings.MethodsA cross-sectional study design was employed. Data were obtained from a survey conducted by the “Corporate Action to Promote Cancer Control” between November and December 2022 among registered partner enterprises in Japan. The survey included questions on background characteristics, cancer screening practices, and intervention approaches. The analysis included 432 enterprises that provided complete responses regarding colorectal, breast, and cervical cancer screenings.ResultsThe guideline-adherence rates for colorectal, breast, and cervical cancer screenings in the workplace were 12.7%, 3.0%, and 8.8%, respectively. Enterprises had lower adherence to screening guidelines than local governments. Colorectal (70.8%) and breast (67.1%) cancer screenings were predominantly categorized as “overscreening” and cervical (60.6%) cancer screening, as “underscreening.” Factors such as enterprise scale, health insurance associations, and the number of interventional approaches were significantly associated with increased “overscreening” (101–1000: β = 0.13, p = 0.01; ≥ 1000: β = 0.17, p < 0.01; health insurance association: β = 0.23, p < 0.01; and approaches: β = 0.42, p < 0.01) and reduced “underscreening” (101–1000: β = -0.13, p = 0.01; ≥ 1000: β = -0.17, p < 0.01; health insurance association: β = -0.18, p < 0.01; and approaches: β = -0.48, p < 0.01).ConclusionAdherence to national guidelines for colorectal, breast, and cervical cancer screenings in the workplace was suboptimal among Japanese enterprises. Therefore, appropriate cancer screening measures and interventions to ensure guideline adherence and optimization of screening benefits while minimizing potential harms should be expeditiously implemented.

Factors Related to Diagnosis of Diabetes After Detecting High Blood Glucose Levels Through Screening: One-Year Follow-up Among Publicly Insured Adults in Gunma, Japan.

This study aimed to assess the diagnosis of diabetes after detecting high blood glucose levels through screening among insured individuals in Gunma, Japan. Data for men and women 35 to 74 years of age were provided by Japan Health Insurance Association, and 4133 individuals with high blood glucose levels while not currently being treated for diabetes were included in the study. About 13% received a diagnosis of diabetes at a subsequent physician visit, and individuals who were under treatment for hypertension were less likely to receive the added diagnosis of diabetes compared with those not being treated for hypertension (odds ratio = 0.42 from a logistic regression model). Fasting blood glucose levels were significantly improved in the next year only among individuals with a confirmed diagnosis of diabetes.

ASO Visual Abstract: Association of Race, Ethnicity, Language and Insurance and Time to Treatment Initiation Among Women with Breast Cancer at an Urban, Academic, Safety-Net Hospital.

ASO Visual Abstract: Association of Race, Ethnicity, Language and Insurance and Time to Treatment Initiation Among Women with Breast Cancer at an Urban, Academic, Safety-Net Hospital.

Routine Electrocardiogram Screening and Cardiovascular Disease Events in Adults

The resting electrocardiogram (ECG) is commonly performed for cardiovascular disease (CVD) screening purposes in Japan. However, evidence is limited regarding the prognostic significance of ECG in clinical practice settings. To investigate the association between ECG abnormalities and CVD outcomes in a working-age population. This nationwide cohort study included individuals aged 35 to 65 years from the Japan Health Insurance Association database, which covers approximately 40% (30 million) of the working-age population in Japan. Data from April 1, 2015, to March 31, 2022, were included, and analysis was conducted from October 1, 2022, to April 11, 2024. Baseline ECG status (normal, 1 minor abnormality, ≥2 minor abnormalities, or major abnormality). The primary outcome was a composite of overall death and CVD hospital admission due to myocardial infarction, stroke, or heart failure. The secondary outcome was developing a new major ECG abnormality over the years of screening. Of 3 698 429 individuals enrolled in the nationwide annual health check program (mean [SD] age, 47.1 [8.5] years; 66.6% male), 623 073 (16.8%) had 1 minor ECG abnormality, 144 535 (3.9%) had 2 or more minor ECG abnormalities, and 56 921 (1.5%) had a major ECG abnormality. During a median follow-up of 5.5 (IQR, 3.4-5.7) years, baseline ECG abnormality was independently associated with an increased incidence of the composite end points of overall death and CVD admission compared with normal ECG (incidence rates per 10 000 person-years: 92.7 [95% CI, 92.2-93.2] for normal ECG, 128.5 [95% CI, 127.2-129.9] for 1 minor ECG abnormality, 159.7 [95% CI, 156.6-162.9] for ≥2 minor ECG abnormalities, and 266.3 [95% CI, 259.9-272.3] for a major ECG abnormality; adjusted hazard ratios: 1.19 [95% CI, 1.18-1.20] for 1 minor ECG abnormality, 1.37 [95% CI, 1.34-1.39] for ≥2 minor ECG abnormalities, and 1.96 [95% CI, 1.92-2.02] for a major ECG abnormality). Furthermore, the presence and number of minor ECG abnormalities were associated with an increased incidence of developing new major ECG abnormalities (incidence rates per 10 000 person-years: 85.1 [95% CI, 84.5-85.5] for normal ECG, 217.2 [95% CI, 215.5-219.0] for 1 minor ECG abnormality, and 306.4 [95% CI, 302.1-310.7] for ≥2 minor ECG abnormalities; and adjusted hazard ratios: 2.52 [95% CI, 2.49-2.55] for 1 minor ECG abnormality and 3.61 [95% CI, 3.55-3.67] for ≥2 minor ECG abnormalities). Associations were noted regardless of baseline CVD risk. The findings of this study suggest that the potential role of routine ECG screening for early prevention of CVD events, along with the optimal follow-up strategy, should be examined in future studies.

Association of race, ethnicity and insurance status with outcomes for patients with acute pulmonary embolism treated by PERT: a retrospective observational study

BackgroundManagement of PE has become streamlined with the implementation of PE Response Teams (PERT). Race, ethnicity and insurance status are known to influence the outcomes of patients with acute PE. However, whether the implementation of PERT-based care mitigates these racial and ethnic disparities remains unknown. Our aim was to assess the association of race, ethnicity and insurance with outcomes for patients with acute PE managed by PERT.MethodsWe performed a retrospective chart review of 290 patients with acute PE, who were admitted to one of three urban teaching hospitals in the Mount Sinai Health System (New York, NY) from January 2021 to October 2023. A propensity score-weighted analysis was performed to explore the association of race, ethnicity and insurance status with overall outcomes.ResultsMedian age of included patients was 65.5 years and 149 (51.4%) were female. White, Black and Asian patients constituted 56.2% (163), 39.6% (115) and 3.5% [10] of the cohort respectively. Patients of Hispanic or Latino ethnicity accounted for 8.3% [24] of the sample. The 30-day rates of mortality, major bleeding and 30-day re-admission were 10.3%, 2.1% and 12.8% respectively. Black patients had higher odds of major bleeding (odds ratio [OR]: 1.445; p < 0.0001) when compared to White patients. Patients of Hispanic or Latino ethnicity had lower odds of receiving catheter-directed thrombolysis (OR: 0.966; p = 0.0003) and catheter-directed or surgical embolectomy (OR: 0.906; p < 0.0001) when compared to non-Hispanic/Latino patients. Uninsured patients had higher odds of receiving systemic thrombolysis (OR: 1.034; p = 0.0008) and catheter-directed thrombolysis (OR: 1.059; p < 0.0001), and lower odds of receiving catheter-directed or surgical embolectomy (OR: 0.956; p = 0.015) when compared to insured patients, although the odds of 30-day mortality and 30-day major bleeding were not significantly different.ConclusionWithin a cohort of PE patients managed by PERT, there were significant associations between race, ethnicity and overall outcomes. Hispanic or Latino ethnicity and uninsured status were associated with lower odds of receiving catheter-directed or surgical embolectomy. These results suggest that disparities related to ethnicity and insurance status persist despite PERT-based care of patients with acute PE.

Association of immune checkpoint inhibitor introduction and changes in survival disparities by health insurance coverage among individuals newly diagnosed with advanced cancers in the US.

1580 Background: First approved by the US Food and Drug Administration (FDA) in 2011, immune checkpoint inhibitors (ICIs) have transformed treatment options for many cancers. Unfortunately, due to their high cost, individuals without health insurance coverage may not be able to afford them. Therefore, the introduction of ICIs may lead to greater disparities in cancer survival between patients with and without health insurance. This study examined the association of health insurance with changes in survival disparities associated with the introduction of ICIs. Methods: We identified individuals newly diagnosed at age 18-64 years at stage IV with any one of the following cancers with FDA approval for ICI treatment, including melanoma (first approved 03/25/2011, n=9992); HR+ HER- female breast cancer (02/03/2015, n=13632); non-small cell lung cancer (NSCLC; 03/04/2015, n=113866); and renal cell carcinoma (RCC; 11/23/2015, n=15403) from the National Cancer Database. Individuals with private health insurance or who were uninsured at the time of the cancer diagnosis were included. For each cancer, we applied a difference-in-differences (DD) approach to examine the changes in two-year overall survival before and after the ICI FDA approval date among individuals without health insurance compared to those with private health insurance, using flexible parametric survival models and controlling for key sociodemographic factors. Results: As shown (Table), among patients diagnosed with melanoma, 2-year survival rate increased from 16.33% pre-ICI approval to 27.04% after ICI approval among patients who were uninsured and increased from 28.22% to 45.45% among patients with private health insurance, with the disparity by health insurance status widened by 4.58 (95% confidence interval [CI] = 0.02 to 9.14) percentage points (ppt) after adjusting for sociodemographic factors. For patients diagnosed with stage IV NSCLC, the disparity by health insurance widened by 1.58 (95% CI = 0.52 to 2.64) ppt. Conclusions: The introduction of ICIs increased disparities in survival by health insurance status. Policies to improve health insurance coverage options or make new treatments more affordable to uninsured patients are needed. [Table: see text]

자율주행자동차 상용화에 대비한 자동차보험제도 연구

On May 7, 2016, in the state of Florida, USA, a fatal accident occurred involving an autonomous vehicle and a large truck, leading to the death of the driver. This incident heightened interest in autonomous vehicles and sparked discussions on their implications, including the challenges and liability issues in the event of accidents during autonomous operation. The application of existing legal frameworks, such as Article 750 of the Civil Code on tort liability and Article 3 of the Automobile Damage Compensation Guarantee Act on operator liability, to accidents involving autonomous vehicles raises questions about identifying responsible parties and compensating victims. This study examines the applicability of these legal principles to accidents occurring during autonomous driving and proposes the introduction of a No-Fault insurance system as a novel automotive insurance mechanism to address these issues. The analysis revealed that the No-Fault insurance system, a solution to the problems posed by the current fault-based liability system and already implemented in several advanced countries since the early 2000s, was considered but ultimately not adopted in South Korea due to challenges in amending existing legislation, limitations in calculating insurance rates, and concerns over moral hazard, among other issues. However, as autonomous vehicles are poised to integrate into our lives more rapidly than anticipated, and the social concerns regarding traffic accidents during autonomous operation deepen, it is imperative to form a task force comprising the Ministry of Land, Infrastructure, and Transport, the Financial Supervisory Service, the General Insurance Association, among others, before it's too late. This task force should engage in research and discussions, while building a consensus among the public, to prepare for the new automotive market driven by the autonomous vehicle industry.

Heightened Prevalence of Common Hospital-Treated Infections Preceding Dementia Diagnosis with Accelerated Dementia Onset after Influenza

BackgroundSince the beginning of Alzheimer’s disease research, the hypothesis that infections are to some extent associated with neurodegenerative processes has been tested repeatedly. Epidemiological studies on the associations between infections and dementia have reported conflicting results.ObjectivesThis study analyses common hospital-treated infections (herpes, influenza, intestinal infections, pneumonia, sepsis, urinary tract infections) and their association with subsequent dementia and time until dementia onset.Design, Setting, and ParticipantsFor this nationwide population-based case-control study, the dataset of the Austrian National Health Insurance Association was used, including dementia patients (dementia cohort) and age- and gender-matched non-demented individuals (control cohort). Only subjects with data availability of at least 10 years prior to the index date (date of dementia diagnosis or date of censoring) were included.MeasurementsThe incidence of six common infections in older adults (herpes, influenza, intestinal infections, pneumonia, sepsis, and urinary tract infections) was analyzed over a period of 10 years before the censoring date.ResultsThe study population consists of 58208 subjects (29104 per study cohort), mean age: 81 years, 54% females. Patients of the dementia cohort had suffered from infections significantly more often than patients of the control cohort (6002, 20.6% vs. 4826, 16.6%; p < 0.001). Influenza, urinary tract infections, intestinal infections, and sepsis showed independent positive associations with subsequent dementia diagnosis, irrespective of other comorbidities (odds ratios: 1.26 (95% CI: 1.06–1.49), 1.23 (95% CI: 1.16–1.30), 1.16 (95% CI: 1.07–1.27), 1.17 (95% CI: 1.01–1.37), respectively). Time from infection to dementia diagnosis was shorter after influenza compared to all other infections (median: 3.4 years (95% CI: 3.1–3.7) vs. 6.6 years (95% CI: 6.4–6.8); p < 0.001).ConclusionThis is the first study to assess the association between infections and dementia over such a long minimum reporting period. These results, supported by consistent data from other epidemiological studies, emphasize the critical importance of infection prevention measures, especially for older adults. Further research is crucial to better understand the nature of the relationship between infections and dementia.