Health Information Database Research Articles

All-cause and cause-specific mortality risks in individuals with diabetes living alone: A large-scale population-based cohort study

AimsThe rise in one-person households is a global trend. We aimed to investigate mortality risk in individuals with diabetes living alone (IDLA) using a large-scale population-based database. MethodsA total of 2,447,557 adults with type 2 diabetes were identified from the Korean National Health Information Database. One-person households were defined based on the number of registered family members. The risks of all-cause and cause-specific mortalities were estimated using a multivariable Cox proportional hazards regression model. ResultsDuring a median follow-up period of 6.0 years, 191,084 deaths (7.8 %) occurred. IDLA had a higher risk of mortality compared to those not living alone after adjusting for potential confounders (HR 1.20, 95 % CI: 1.18–1.22). This association was more prominent in younger individuals, men, and those with low income, and it was dependent on the duration of living alone. The risks of cause-specific mortality were all significantly higher in the IDLA group compared with the non-IDLA group. Adherence to favorable lifestyle behaviors was associated with a significant reduction in all-cause mortality, particularly in IDLA. ConclusionsThe elevated risk of mortality in IDLA highlights the need for tailored medical interventions and social assistance, particularly for those with unhealthy lifestyles or low income.

Geographical disparities in temporal trends of low birth weight in Saskatchewan from 2002/2003 to 2021/2022: insights from a joinpoint regression analysis.

Low birth weight (LBW) is an important public health indicator that is associated with various negative health outcomes in infants. To effectively implement interventions that would improve health outcomes in children, it is important to understand both the historical trends and current levels of LBW rates. In this study, trends and regional differences in LBW rates in Saskatchewan from 2002/2003 to 2021/2022 were assessed. A joinpoint regression analysis was conducted using historical LBW rates, obtained from the Canadian Institute for Health Information database. Data were analysed using average percent change and average annual percent change. Spatial patterns and trends were identified using a choropleth map. From a provincial and national rate of 5.2% in 2002/2003, the LBW rate in Saskatchewan increased to 6.5% in 2021/2022, approaching the national rate of 6.8%. Over the 20-year period, average annual changes for Canada were 1.4% and 1.0% for Saskatchewan. There was a turning point in the study: 2004/2005 for Canada and 2011/2012 for Saskatchewan. Initially, Saskatchewan had stable LBW rates, increasing yearly by 0.1%, while the national rate was 5.7%. However, in recent years, Saskatchewan's rate increased to 1.8% annually, surpassing the national rate of 0.9%. Geographical differences were also observed within Saskatchewan, with the Far North region having the highest LBW rate (9.2%), and the Central West region having the lowest rate (4.3%) in 2021/2022. The Central East, Regina Qu'Appelle, and southern Saskatchewan saw significant upwards trends in LBW rates between 2015/2016 and 2021/2022. There is an increasing trend in LBW rates in Canada and Saskatchewan, as well as geographical disparities within the province. The geographical disparities in LBW rates underscore the need for tailored interventions in high-risk regions in the province.

Sex-differential effect of waist circumference on new-onset cerebral infarction: a nationwide cohort study.

Excessive abdominal adiposity represents a cardiovascular disease risk factor. Waist circumference (WC) reflects abdominal adiposity and is known as an easy-to-measure indicator of obesity. This study aimed to evaluate the relationship between WC level and the development of cerebral infarction in Koreans. 209,442 Koreans were included among the general population registered in the National Health Information Database. Depending on the degree of WC, the possibility of cerebral infarction was tracked for 4.37 person-years. Identification of patients with cerebral infarction was confirmed through the diagnostic code ICD I63 of inpatient or outpatient. Participants' data were analyzed by sex. The hazard ratios (HRs) and confidence interval (CI) for cerebral infarction were calculated using the Cox proportional hazards model. Between 2009 and 2013, 2,403 cases (1.15%) of cerebral infarction occurred during the follow-up period of 915,223.6 person-years. The HRs (95% CI) for incident cerebral infarction in men was adjusted for multiple covariates, and comparison of WC levels second, third, and fourth quartile with the first quartile showed 1.10 (0.94-1.28), 1.11 (0.95-1.30), and 1.24 (1.07-1.45), respectively (P for trend 0.045). This association was not significant in women (P for trend 0.619). The severity of WC levels in men is significantly associated with the risk of developing cerebral infarction in Koreans. This finding indicates that other measurements for excessive adipose visceral tissue, except abdominal circumference, need to be taken into account to identify the risk of cerebral infarction in women.

Risk for Facial Palsy after COVID-19 Vaccination, South Korea, 2021-2022.

We conducted a self-controlled case series study to investigate the association between COVID-19 vaccination and facial palsy (FP) in South Korea. We used a large immunization registry linked with the national health information database. We included 44,564,345 patients >18 years of age who received >1 dose of COVID-19 vaccine (BNT162b2, mRNA-1273, ChAdOx1 nCoV-19, or Ad.26.COV2.S) and had an FP diagnosis and corticosteroid prescription within 240 days postvaccination. We compared FP incidence in a risk window (days 1-28) with a control window (the remainder of the 240-day observation period, excluding any risk windows). We found 5,211 patients experienced FP within the risk window and 10,531 experienced FP within the control window. FP risk increased within 28 days postvaccination, primarily after first and second doses and was observed for both mRNA and viral vaccines. Clinicians should carefully assess the FP risk-benefit profile associated with the COVID-19 vaccines and monitor neurologic signs after vaccination.

Height and breast cancer risk in premenopausal Korean women aged under 40 years of age.

Taller women are at an increased risk of breast cancer; however, evidence regarding this in younger women is limited. This study investigated the association between body height and breast cancer risk in premenopausal Korean women aged <40 years. Premenopausal women aged <40 years enroled in the Kangbuk Samsung Health Study (KSHS) and National Health Insurance Service-National Health Information Database (NHIS-NHID) were included in the analysis. Trained staff members performed anthropometry, including height measurements. Breast cancer incidence was followed up until December 2019. Cox regression model and restricted cubic- spline regression were applied. The mean (standard deviation [SD]) age was 33.3 (3.6) years and 32.9 (4.2) in KSHS and NHIS-NHID cohorts, respectively. After adjusting for age at baseline and other confounders, every 10 cm of height was associated with a 1.44-fold increased risk of developing breast cancer (adjusted hazard ratio [aHR], 1.44; 95% confidence interval [CI], 1.17-1.78) in the KSHS. The restricted cubic spline regression showed an almost linear association between height and breast cancer risk. Compared to women with height <155 cm, aHRs (95% CI) among those with height 160-165 cm, 165-170 cm, and ≥170 cm were 1.67 (1.07-2.60), 1.75 (1.09-2.81), and 2.31 (1.18-3.86), respectively (P = 0.009). Results were similar in the NHIS-NHID cohort (aHR, 1.20 [95% CI, 1.10-1.31] per 10-cm increase in height). In young Korean women, greater body height was associated with increased breast cancer risk.

6700 Risk Of Dementia According To The Reproductive Factors In Postmenopausal Women With Diabetes

Abstract Disclosure: J. Yu: None. K. Han: None. J. Yun: None. S. Lee: None. Risk of dementia according to the reproductive factors in postmenopausal women with diabetes Jin Yu[1], Kyungdo Han[2], Jae-Seung Yun[3], Seung-Hwan Lee[1],[4] [1]Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea[2]Department of Statistics and Actuarial Science, Soongsil University[3]Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea[4]Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea Background: Previous studies have suggested a possible association between endogenous estrogen exposure and decreased risk of cognitive impairment or dementia. We aimed to investigate the impact of reproductive factors on the risk of dementia in women with diabetes. Methods:166,245 postmenopausal women with type 2 diabetes aged over 40 who underwent health examination in 2009 were identified from the National Health Information Database. Information regarding reproductive factors were collected through self-administered questionnaires. Incident dementia was defined using diagnosis codes and anti-dementia drug prescription. Cox proportional hazards regression analyses were performed to evaluate the risk of all-cause dementia, Alzheimer’s disease, and vascular dementia according to reproductive factors including age at menarche, age at menopause, reproductive lifespan, parity, and use of hormone replacement therapy (HRT). Results: The mean age and reproductive lifespan were 64.5 ± 8.0 and 33.4 ± 4.7 years, respectively. During the median follow-up of 8.3 years, 25,330 cases of any dementia, including 20,817 cases of Alzheimer's disease and 2,756 cases of vascular dementia were developed. The hazard ratios (95% CI) of all-cause dementia were 1.28 (1.06-1.56) for age at menarche &amp;gt;16 years compared with ≤12 years, 0.71 (0.66-0.77) for age at menopause ≥55 years compared with &amp;lt;40 years, and 0.72 (0.68-0.76) for reproductive lifespan ≥40 years compared with &amp;lt;30 years, respectively. The risk of all-cause dementia was decreased by 11% in women with parity ≥2 compared with 0, and by 16% in women with HRT for more than 5 years compared without HRT. Similar findings were observed for Alzheimer’s disease and vascular dementia. Conclusion: Longer reproductive lifespan was associated with lower risk of dementia in postmenopausal women with diabetes. Presentation: 6/2/2024

8297 Risk Of Pancreatic Cancer In Patients With Diabetes Mellitus And Pancreatitis: A Nationwide Nested Case-Control Study

Abstract Disclosure: Y. Kim: None. H. Kim: None. M. Yu: None. C. Nam: None. E. Kang: None. Background: Despite diabetes mellitus and pancreatitis being known risk factors for pancreatic cancer, but because of their low incidence, patients with these conditions are not included in pancreatic cancer screening. This study aimed to determine the high-risk subgroup of patients with diabetes and pancreatitis that would benefit from pancreatic cancer screening. Methods: A nested case-control study was conducted using data from the national health information database of the Korean National Health Insurance Service. Patients were categorized into the following groups: type 2 diabetes only (T2D-only), pancreatitis only (PAN-only), type 2 diabetes followed by pancreatitis (T2D-PAN), post-pancreatitis DM (PPDM), and no diabetes and no pancreatitis (NDNP). Conditional logistic regression was used to determine significant associations of each group with pancreatic cancer development risk. Results: The risk of pancreatic cancer was significantly higher in the T2D-PAN (adjusted odds ratio [AOR], 4.96; 95% confidence interval [CI], 4.48-5.49) and PPDM (AOR, 4.71; 95% CI, 4.12-5.37) groups than in the NDNP group. Furthermore, the T2D-PAN and PPDM groups had a significantly higher risk of pancreatic cancer than the T2D-only and PAN-only groups. Compared to patients in the NDNP group, patients with PPDM using insulin had a 9-fold increased risk (AOR, 9.84; 95% CI, 6.77-14.29), and patients with T2D-PAN using insulin had a 6-fold increased risk (AOR, 6.62; 95% CI, 5.33-8.20). Conclusion: Patients with both diabetes and pancreatitis had a higher risk of pancreatic cancer than those with either alone, regardless of the order of occurrence, and insulin use was associated with an additional increase in pancreatic cancer risk. These results suggest that these subgroups of patients could be considered to benefit from pancreatic cancer screening. Presentation: 6/2/2024

Prescription patterns and symptom relief of antitussives and expectorants in patients with cough: a nationwide study in Korea.

Limited data are available on the prescription patterns and efficacy of antitussives and expectorants for patients with acute and chronic cough. This study examined the use and efficacy of these medications in a nationally representative sample of Korean patients. We examined 4,206,016 individuals from the National Health Insurance Service (NHIS)-National Health Information Database (NHID) between 2015 and 2017. Among them, a sample of 10% (n=420,602) was retrieved for the diagnosis of respiratory diseases using the International Classification of Diseases, 10th edition (ICD-10; J00-J99), or the prescription of antitussives and expectorants for cough (ICD-10; R05). The acute cough group included those who were prescribed medications within 4 weeks of initial diagnosis (prescription within 14 days), whereas the chronic cough group included patients who were prescribed medications within 16 weeks of initial diagnosis (prescription within 56 days). If the prescription was discontinued or not changed to an alternative drug after the initial prescription, these cases were considered to have achieved symptom relief. This study included 288,460 patients (971,065 cases) with acute cough and 5,888 patients (15,399 cases) with chronic cough. 'Expectorants, excluding combinations with cough suppressants' had the highest prescription rates in both groups (acute cough, 63.8%; chronic cough, 61.7%), and showed the highest symptom relief regardless of the number of medications prescribed (acute cough, 84.3%; chronic cough, 70.4%). 'Expectorants, excluding combinations with cough suppressants' were the most prescribed and effective medications for relieving cough symptoms in Korea patients. Further studies are needed to determine the optimal duration for using antitussives and expectorants in cough management.

Cancer Risks of Patients with Graves' Disease Who Received Antithyroid Drugs as Initial Treatment: A Nationwide Population-Based Analysis.

Background: Population-based studies that examine the associations between hyperthyroidism and cancer risk have yielded inconsistent results. It remains unclear whether the risks of different cancers increase in patients with Graves' disease (GD) who received antithyroid drugs (ATDs) as initial treatment. We aimed to determine whether cancer risk increases in patients with GD, compared with controls. Methods: This nationwide retrospective cohort study utilized data from the National Health Information Database of South Korea. We included 29,502 patients aged >20 years with GD, who received ATDs as initial treatment, and 57,173 age- and sex-matched controls. The primary outcome was the incidence of various types of cancers. Hazard ratios (HRs) with confidence intervals (CIs) for cancer risk were estimated using Cox proportional hazards models. We also analyzed HR by follow-up period since the diagnosis of GD, accounting for surveillance effect. Results: The risk of biliary tract and pancreatic cancers (HR: 1.41, CI: 1.24-1.60), thyroid cancer (HR: 15.51, CI: 12.29-19.57), prostate cancer (HR: 1.48, CI: 1.28-1.71), and ovarian cancer (HR: 1.31, CI: 1.13-1.52) was elevated in the GD group than in the control group even after the first year of follow-up was excluded. The increased risk of these cancers persisted after a follow-up period of more than 5 years. The risk of thyroid cancer in patients with GD was higher during the initial follow-up period (1 to <2 years) (HR: 19.35, CI: 7.66-48.87) compared with that in the follow-up period exceeding 2 years. The cancer risk estimates remained significant after excluding patients with GD who underwent subsequent radioactive iodine therapy. Conclusion: In this large-scale population-based study, GD was associated with increased risks of biliary tract and pancreatic, prostate, ovarian, and thyroid cancers. The increased risk of thyroid cancer, particularly during the initial follow-up period, may be a surveillance effect.

Epidemiology of Inherited Retinal Diseases in Korea: A National Health Information Database Analysis (2011-2020)

Purpose: We evaluated the incidence and prevalence of inherited retinal diseases (IRDs) in Korea using a national database.Methods: This retrospective study used the National Health Information Database to enroll patients with IRDs (registration code V209) between January 2011 and December 2020. Incidence and prevalence of IRDs were analyzed and stratified by age, sex, geographic location, and socioeconomic status.Results: During the study period, 10,228 patients were diagnosed with IRD, yielding an annual incidence rate of 1.60–2.35 per 100,000 individuals. In 2020, the prevalence of IRD reached 27.1 cases per 100,000 individuals. Initial diagnoses were primarily concentrated in Seoul (44.4%), metropolitan areas (29.4%), and Gyeonggi province (12.1%). Notably, less than 50% of patients received their initial diagnosis in their home region, except for residents of Seoul (94.0%), metropolitan areas (76.8%), and Jeju Island (70.8%). The incidence of IRDs was higher among the top 25% income bracket, compared to other income levels.Conclusions: Our study provides the first nationwide, population-based estimates of IRD incidence and prevalence in Korea. Our findings reveal significant regional and socioeconomic disparities in IRD healthcare access, emphasizing the need for targeted interventions.

Incidence of Acute Endophthalmitis after Secondary Intraocular Lens Implantation: A Nationwide Cohort Study

Plain Language SummaryIn this study, we analyzed the occurrence of acute endophthalmitis following secondary intraocular lens (IOL) implantation in South Korea. Using data from the National Health Insurance Service (NHIS)-National Health Information Database (NHID), we identified patients who underwent secondary IOL implantation or IOL exchange between 2002 and 2021 due to IOL dislocation or mechanical IOL complications. Postoperative endophthalmitis (POE) was defined as patients having received intravitreal antibiotic injection or vitrectomy for acute endophthalmitis diagnosed within 42 days after the claim for secondary IOL surgeries. Out of 39,364 patients who received secondary IOL implantation during the study period, acute POE was diagnosed in 62 patients, resulting in an overall incidence of 0.16%. The majority of POE cases were identified within the first-week post-surgery. In the univariate analysis, there was a higher incidence of endophthalmitis in patients with pre-existing glaucoma and those who underwent concurrent vitrectomy. Our findings suggest that the incidence of acute endophthalmitis following secondary IOL implantation in South Korea was similar to that of other nations. This study, based on retrospective claims data, represents the largest study of its kind in South Korean patients.

Epidemiologic characteristics and risk factors of Clostridioides difficile infection in patients with active tuberculosis in the Republic of Korea: a nationwide population-based study

The relationship between anti-tuberculosis (TB) agents and Clostridioides difficile infection (CDI) remains unclear. This study aimed to investigate the epidemiological characteristics and risk factors for CDI in patients with TB. This nationwide, population-based cohort study was conducted in the Republic of Korea (ROK) between January 2018 and December 2022. Data were extracted from the National Health Insurance Service (NHIS) National Health Information Database. The risk factors for CDI in patients with TB were identified through multivariate logistic regression analysis using a 1:4 greedy matching method based on age and sex. During the study period, CDI developed in 2,901 of the 131,950 patients with TB who were prescribed anti-TB agents. The incidence of CDI in patients with TB has increased annually in the ROK from 12.31/1000 in 2018 to 33.51/1000 in 2022. Oral metronidazole (81.94%) was the most common first-line treatment for CDI. The in-hospital mortality rate of patients with concomitant CDI and tuberculosis was 9.9% compared with 6.9% in those with TB alone (P<0.0001). Multivariate logistic regression analysis found intensive care unit admission, Charlson Comorbidity Index ≥3, antibiotics exposure, standard regimen, multidrug resistant TB, and extrapulmonary TB as significant risk factors for development of CDI in patients with TB. CDI is uncommon in patients with TB, but it results in a significantly increased mortality rate. Patients being treated for TB should be carefully monitored for the development of CDI. Further clinical research is warranted to identify effective interventions for preventing and controlling CDI during TB treatment.

Association between Exclusive Breastfeeding and the Incidence of Childhood Nephrotic Syndrome

ObjectiveTo assess the relationship between breastfeeding and the risk of developing nephrotic syndrome using a population-based nationwide birth cohort in Korea. Study designThis nationwide cohort study utilized data from the Korean National Health Information Database and the Korean National Health Screening Program for Infants and Children. The study included all children born between January 1, 2010, and December 31, 2018, who underwent their first health screening, which included a specific questionnaire on breastfeeding between 4 and 6 months of age. Associations between nephrotic syndrome and exclusive breastfeeding were estimated using adjusted hazard ratios (aHR) derived from Cox proportional hazards models, adjusted for sociodemographic variables, with follow-up until the occurrence of nephrotic syndrome, eight years post-index date, death, or December 31, 2022, whichever was first. ResultsThe study population comprised 1,787,774 children (median follow-up: 7.96 years; IQR: 6.31–8.00 years), including 612,556 exclusively breastfed and 1,175,218 formula-fed children. Exclusive breastfeeding was associated with a decreased risk of developing nephrotic syndrome (aHR: 0.80; 95% CI: 0.69 – 0.93). Subgroup analysis stratified by sex mirrored the overall findings, although statistical significance was not observed in girls (boys: aHR, 0.75; 95% CI, 0.62–0.92; girls: aHR, 0.87; 95% CI, 0.70 – 1.09). Sensitivity analysis confirmed these results. ConclusionExclusive breastfeeding was associated with a 20% reduced risk of developing nephrotic syndrome up to 8 years of age.

Different Associations between Lipid Levels and Risk for Heart Failure according to Diabetes Progression.

The relationship between circulating lipid levels and the risk for heart failure (HF) is controversial. We aimed to examine this association, and whether it is modified by the duration of diabetes or treatment regimens in people with type 2 diabetes mellitus. Individuals (n=2,439,978) who underwent health examinations in 2015 to 2016 were identified from the Korean National Health Information Database. Subjects were categorized according to the duration of diabetes (new-onset, <5, 5-10, or ≥10 years) and number of antidiabetic medications. Incident HF was defined according to the International Classification of Diseases, 10th Revision (ICD-10) code I50 as the primary diagnosis during hospitalization. The risk for HF was estimated using multivariate Cox proportional hazard analysis. During a median follow-up of 4.0 years, 151,624 cases of HF occurred. An inverse association between low-density lipoprotein cholesterol (LDL-C) levels and incident HF was observed in the new-onset diabetes group, with an approximately 25% lower risk in those with LDL-C levels of 100-129, 130-159, and ≥160 mg/dL, compared to those with levels <70 mg/dL. However, J-shaped associations were noted in the long-standing diabetes group, with a 16% higher risk in those with LDL-C level ≥160 mg/dL, compared to those with levels <70 mg/dL. Similar patterns were observed in the relationship between total cholesterol or non-high-density lipoprotein cholesterol and the risk for HF, and when subjects were grouped according to the number of antidiabetic medications instead of diabetes duration. Different associations between lipid levels and the risk for HF were noted according to disease progression status among individuals with diabetes.

Early Cleft Palate Repair is Associated With Lower Incidence of Velopharyngeal Insufficiency Surgery.

The timing of primary repair in nonsyndromic cleft palate remains controversial. Recent evidence suggests earlier repair is associated with a lower incidence of velopharyngeal insufficiency (VPI). The authors aim to evaluate these findings in a large cohort study using causal inference. All nonsyndromic cleft palate repairs in California were extracted between 2000 and 2021 from the California Health Care Access and Information (HCAI) database. Cases were linked with VPI surgery following cleft palate repair based on unique identifiers. The main outcome measure was incidence of VPI surgery evaluated with propensity score matching. Early cleft palate repair was defined as <7 months of age versus traditional cleft palate repair at >11 months of age. Standardized mean differences (SMD) were measured before and after matching for potential confounders including sex, race, payer, and distance from patient home to hospital. In all, 52,007 cleft palate repairs were included, of which 12,169 (23.3%) were repaired early and 39,838 (76.7%) were repaired traditionally. Early cleft palate repairs underwent VPI surgery in 1.2% (13/1,000) of cases, compared with 6.1% (61/1000) in the traditional repair cohort. Post-matching, the average treatment effect of early repair was a 6.3% reduction in VPI surgery (P<0.001, 95% CI -6.3, -5.4%). All covariate SMDs were <|0.1| after matching. Our cohort study demonstrates a significantly reduced incidence of VPI surgery in children with primary cleft palate repair <7 months of age. Craniofacial centers should consider early cleft palate repair in appropriate patients.

Community Privilege and Unplanned Surgery for Access-Sensitive Surgical Conditions.

We sought to define the association of privilege on rates of unplanned surgery and perioperative outcomes for access-sensitive surgical conditions. Social determinants of health (SDOH) are critical in influencing timely access to healthcare. Privilege represents a right, benefit, advantage, or opportunity that positively influences all SDOH. The California Department of Health Care Access and Information (HCAI) database identified patients who underwent abdominal aortic aneurysm repair, ventral hernia repair, or colectomy for colon cancer between 2017 and 2020 and was merged using ZIP codes with the Index of Concentration of Extremes, a validated measure of racial and economic privilege obtained from the American Community Survey. Clustered multivariable regression was performed to assess the association between privilege and outcomes. Among 185,316 patients who underwent a surgical procedure for one of three access-sensitive surgical conditions, roughly 1 in 5 individuals resided in areas with the highest (Q5; n=37,308; 20.1%) or lowest (Q1; n=36,352, 19.6%) privilege. Nearly one-half of the surgeries were unplanned (n=88,814, 46.9%), and colectomy for colon cancer was the most performed emergent procedure. Patients residing in the lowest privileged areas had higher rates of unplanned surgery compared with those residing in the highest privilege (Q1; 55.4% vs. 39.4%; referent: Q5; adjusted odds ratio [OR], 1.23, 95%CI 1.16-1.31; P<0.001). For each access-sensitive surgical condition, patients in the least privileged areas were more likely to experience higher rates of inpatient mortality (Q1; 3.1% vs. 2.1%; referent: Q5; adjusted OR, 1.41, 95%CI 1.24-1.60; P<0.001), perioperative complications (Q1; 30.4% vs. Q5; 23.8%; referent: Q5; adjusted OR, 1.24, 95%CI 1.18-1.31; P<0.001) and extended hospital stays (Q1; 26.3% vs. 20.1%; referent: Q5; adjusted OR, 1.16, 95%CI 1.09-1.22; P<0.001). Privilege was associated with rates of unplanned surgery and adverse clinical outcomes. This indicates the role privilege as a key SDOH that influences patient access to and quality of surgical care.

Increased Hospital Encounters in Individuals With Spina Bifida Compared to the General Population: Statewide Health Care Utilization in California From 1995 to 2017.

Our goal was to understand health care utilization by comparing hospital encounters among individuals with spina bifida and the general population and to identify the factors associated with utilization. Using the Department of Health Care Access and Information database (1995-2017), individuals with spina bifida were identified and matched to controls by birth year. The primary outcome measures were the number of hospital encounters (stratified as ≤2 vs ≥3 encounters) and the time between the first and second encounters. Univariate, multivariate, and subgroup analyses were performed to identify factors associated with ≥ 3 encounters. When compared to controls, individuals with spina bifida had more ≥ 3 hospital encounters (69% vs 29%), spent more days in the hospital (58 days vs 13 days), and had a higher average charge per hospital stay ($433,537 vs $99,975) (P < .001 for all). After adjusting for covariates, we found that having spina bifida was associated with increased hospital encounters compared to controls (odds ratio 3.95, 95% CI 3.77-4.14, P < .001). Individuals with spina bifida were found to have less time between their first and second encounters (2.5 vs 3.3 years, P < .001). Within the spina bifida population, sex, race, ethnicity, comorbidities, and nonprivate insurance were associated with ≥ 3 encounters. Spina bifida is associated with more hospital encounters and fewer days between first and second encounters compared to the general population. These findings highlight factors driving increased utilization of resources, thereby empowering providers to better support this vulnerable population.

Universal health coverage saves more lives among severely ill COVID-19 patients: A difference-in-differences analysis of individual patient data in South Korea

BackgroundUniversal health coverage (UHC) ensures affordability of a variety of essential health services for the general population. Although UHC could mitigate the harmful effects of coronavirus disease 2019 (COVID-19) on patients and their socioeconomic position, the debate on UHC’s scope and ability to improve health outcomes is ongoing. This study aimed to identify the impact of UHC policy withdrawal on the health outcomes of South Korea’s severely ill COVID-19 patients.MethodsWe used a propensity score matching (PSM) and difference-in-differences combined model. This study’s subjects were 44,552 hospitalized COVID-19 patients contributing towards health insurance claims data, COVID-19 notifications and vaccination data extracted from the National Health Information Database and the Korea Disease Control and Prevention Agency from 1 December 2020 to 30 April 2022. After PSM, 2460 patients were included. This study’s exposures were severity of illness and UHC policy change. The primary outcome was the case fatality rate (CFR) for COVID-19, which was defined as death within 30 days of a COVID-19 diagnosis. There were four secondary outcomes, including time interval between diagnosis and hospitalization (days), length of stay (days), total medical expenses (USD) and the time interval between diagnosis and death (days).ResultsAfter the UHC policy’s withdrawal, the severely ill patients’ CFR increased to 284 per 1000 patients [95% confidence interval (CI) 229.1–338.4], hospitalization days decreased to 9.61 days (95% CI −11.20 to −8.03) and total medical expenses decreased to 5702.73 USD (95% CI −7128.41 to −4202.01) compared with those who were not severely ill.ConclusionsDuring the pandemic, UHC may have saved the lives of severely ill COVID-19 patients; therefore, expanding services and financial coverage could be a crucial strategy during public health crises.

Association of Uterine Leiomyoma with Type 2 Diabetes Mellitus in Young Women: A Population-Based Cohort Study.

We investigated the association between uterine leiomyoma (UL) and incident type 2 diabetes mellitus (T2DM) in young women. A nationwide population-based cohort study of 2,541,550 women aged between 20 and 40 years was performed using the National Health Information Database. Cox proportional hazards models were used to analyze the risk of incident T2DM according to the presence of UL and myomectomy. The mean age was 29.70 years, and mean body mass index was 21.31 kg/m2. Among 2,541,550 participants, 18,375 (0.72%) women had UL. During a median 7.45 years of follow-up, 23,829 women (0.94%) were diagnosed with T2DM. The incidence of T2DM in women with UL (1.805/1,000 person-years) was higher than in those without UL (1.289/1,000 person-years). Compared with women without UL, women with UL had a higher risk of incident T2DM (hazard ratio, 1.216; 95% confidence interval [CI], 1.071 to 1.382). Women with UL who did not undergo myomectomy had a 1.505 times (95% CI, 1.297 to 1.748) higher risk for incident T2DM than women without UL. However, women with UL who underwent myomectomy did not have increased risk for incident T2DM. Young women with UL were associated with a high risk of incident T2DM. In addition, myomectomy seemed to attenuate the risk for incident T2DM in young women with UL.

Socioeconomic disparities in alcohol-related depression: a national cohort study of low-income medical aid beneficiaries and national health insurance beneficiaries in Korea

ObjectiveTo examine the association between patterns of alcohol consumption in the past and the risk of depression among medical aid beneficiaries and National Health Insurance beneficiaries in Korea.MethodsWe used data from the National Health Information Database (NHID) of 1,292,618 participants who underwent health checkups in 2015–16 and 2017–18. We categorized alcohol consumption into four groups: continuous high, increased, decreased, and non-consumers. We followed the participants from 2019 to 2021 and identified new episodes of depression. We calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for depression by alcohol consumption groups and socioeconomic status.ResultsMedical aid beneficiaries had higher risks of depression than National Health Insurance beneficiaries across all alcohol consumption groups. The highest risk was observed among continuous high consumers (aOR, 2.31; 95% CI, 1.36–3.93), followed by increased (aOR, 1.51; 95% CI, 1.17–1.94), decreased (aOR, 1.48; 95% CI, 1.18–1.84), and non-consumers (aOR, 1.37; 95% CI, 1.22–1.54).ConclusionsSocioeconomic status and patterns of alcohol consumption in the past are associated with the risk of depression. Public health interventions should consider both factors to reduce alcohol-related depression and health inequalities.