Health Insurance Service Research Articles

Long-Term Risk of Autoimmune and Autoinflammatory Connective Tissue Disorders Following COVID-19.

Few studies have investigated the association between COVID-19 and autoimmune and autoinflammatory connective tissue disorders; however, research with long-term observation remains insufficient. To investigate the long-term risk of autoimmune and autoinflammatory diseases after COVID-19 over an extended observation period. This retrospective nationwide population-based study investigated the Korea Disease Control and Prevention Agency-COVID-19-National Health Insurance Service (K-COV-N) cohort. Individuals with confirmed COVID-19 from October 8, 2020, to December 31, 2022, and controls identified among individuals who participated in the general health examination in 2018 were included in the analysis. Confirmed COVID-19. Incidence and risk of autoimmune and autoinflammatory connective tissue disorders in patients after COVID-19. Various covariates, such as demographic characteristics, general health data, socioeconomic status, and comorbidity profiles, were balanced using inverse probability weighting. A total of 6 912 427 participants (53.6% male; mean [SD] age, 53.39 [20.13] years) consisting of 3 145 388 with COVID-19 and 3 767 039 controls with an observational period of more than 180 days were included. Alopecia areata (adjusted hazard ratio [AHR], 1.11 [95% CI, 1.07-1.15]), alopecia totalis (AHR, 1.24 [95% CI, 1.09-1.42]), vitiligo (AHR, 1.11 [95% CI, 1.04-1.19]), Behçet disease (AHR, 1.45 [95% CI, 1.20-1.74]), Crohn disease (AHR, 1.35 [95% CI, 1.14-1.60]), ulcerative colitis (AHR, 1.15 [95% CI, 1.04-1.28]), rheumatoid arthritis (AHR, 1.09 [95% CI, 1.06-1.12]), systemic lupus erythematosus (AHR, 1.14 [95% CI, 1.01-1.28]), Sjögren syndrome (AHR, 1.13 [95% CI, 1.03-1.25]), ankylosing spondylitis (AHR, 1.11 [95% CI, 1.02-1.20]), and bullous pemphigoid (AHR, 1.62 [95% CI, 1.07-2.45]) were associated with higher risk in the COVID-19 group. Subgroup analyses revealed that demographic factors, including male and female sex, age younger than 40 years, and age 40 years and older, exhibited diverse associations with the risk of autoimmune and autoinflammatory outcomes. In addition, severe COVID-19 infection requiring intensive care unit admission, the Delta period, and not being vaccinated were associated with higher risk. This retrospective cohort study with an extended follow-up period found associations between COVID-19 and the long-term risk of various autoimmune and autoinflammatory connective tissue disorders. Long-term monitoring and care of patients is crucial after COVID-19, considering demographic factors, disease severity, and vaccination status, to mitigate these risks.

Prevalence of self-reported symptoms of diabetic autonomic dysfunction in the North Denmark Region: a population-based survey.

Diabetic autonomic neuropathy is a severe complication of diabetes, estimated to affect up to 44% in type 1 diabetes (T1D) and 73% in type 2 diabetes (T2D) based on clinical studies. Currently, the assessment of diabetic autonomic neuropathy is not implemented in Denmark's clinical guidelines, complicating the estimation of the true prevalence. Thus, this study investigated the prevalence of self-reported symptoms of autonomic dysfunction in people living with diabetes in the North Denmark Region using the Composite Autonomic Symptoms Score (COMPASS)-31 questionnaire. In 2022, all adults with T1D or T2D in the North Denmark Region (n = 29,155) were identified using The National Health Insurance Service Registry and invited to an online survey including the Danish version of COMPASS-31. The prevalence and associated 95% confidence intervals (CI) for symptomatic autonomic dysfunction were determined using a cut-off value of 16. In total, 7,377 completed COMPASS-31, of which 82.4% reported having T2D and 13.7% T1D. The prevalence of symptomatic autonomic dysfunction was 36.8% (95% CI: 34-40) after a median of 26 years with diabetes for T1D and 44.2% (95% CI: 43-45) after a median of 10 years for T2D. Pupillary and orthostatic intolerance were the most frequent moderate to severe symptoms, respectively (38.4% and 24.0% in T1D and 32.8% and 26.3% in T2D). Symptoms of autonomic dysfunction are very common in individuals with diabetes living in the North Denmark Region, emphasizing the unmet need for regular testing to increase awareness and allow for adequate management, ultimately reducing the morbidity of diabetes.

Early onset and increasing disparities in neurodevelopmental delays from birth to age 6 in children from low socioeconomic backgrounds.

To analyze the complex relationship between socioeconomic status (SES) and neurodevelopmental achievements by investigating the temporal dynamics of these associations from birth to age 6. This retrospective cohort study was conducted over 6 years using population-based data from the National Health Insurance Service and integrated data from the National Health Screening Program for Infants and Children. Participants were children born between 2009 and 2011 in Korea without neurodevelopmental delays with potential developmental implications. We analyzed results from the Korean Developmental Screening Test, administered at age 6, which covered overall assessment and six domains of gross and fine motor function, cognition, language, sociality, and self-care. The secondary outcome was to determine when neurodevelopmental outcomes began after birth and how these differences changed over time. Of 276,167 individuals (49.2% males), 66,325, 138,980, and 60,862 had low, intermediate, and high SES, respectively. Neurodevelopmental delays observed across all developmental domains were more prevalent in the low-SES group than in the high-SES group. Disparities in neurodevelopment according to these statuses were apparent as early as age 2 and tended to increase over time (interaction, P < 0.001). The cognition and language domains exhibited the most substantial disparities between SES levels. These disparities persisted in subgroup analyses of sex, birthweight, head circumference, birth data, and breastfeeding variables. Low SES was significantly associated with an increased risk of adverse neurodevelopmental outcomes in preschool children, particularly those affecting cognitive and language domains. These differences manifested in early childhood and widened over time.

Elevated risk of end-stage kidney disease in stroke patients: A population-based observational study.

Estimating the incidence of end-stage kidney disease (ESKD) in stroke survivors is important to assess and predict clinical course, improve post-stroke quality of life, and ultimately reduce health burden. Our objective was to assess the risk of ESKD in patients compared to a matched stroke-free control cohort. A nationwide retrospective cohort study was conducted in 315,326 stroke subjects and 390,781 matched stroke-free control subjects. Health examination results and claims data were collected from the Korean National Health Insurance Service during 2010-2018. Cox proportional hazard models were used to assess the risk of ESKD in the stroke cohort. During a mean follow-up period of 4.3 years, the incidence of ESKD was 1.83 per 100,000 person-years in the stroke cohort versus 0.57 per 100,000 person-years in the control cohort. The stroke cohort exhibited a significantly higher risk of developing ESKD compared to the matched control, with an adjusted hazard ratio (aHR) of 1.79 (95% confidence interval (CI) = 1.67-1.93). Stroke survivors were associated with a higher risk of developing ESKD, regardless of the severity of disability (aHRs of 1.93, 95% CI = 1.69-2.21 for severe disability; 1.71, 95% CI = 1.41-2.07 for mild disability; and 1.78, 95% CI = 1.65-1.92 for no disability), compared to the matching control cohort. The elevated risk was observed in both hemorrhagic stroke (aHR = 1.96, 95% CI = 1.73-2.23) and ischemic stroke (aHR = 1.75, 95% CI = 1.62-1.89). This study demonstrates that stroke patients have a significantly higher risk of incident ESKD. This highlights the need for heightened clinical awareness and improved monitoring of kidney function in this population.

Cholecystectomy Increases the Risk of Chronic Kidney Disease: A Nationwide Longitudinal Cohort Study

Background/Objectives: Growing evidence suggests that cholecystectomy is associated with adverse health outcomes, including the development of metabolic diseases. However, data on the association between cholecystectomy and kidney disease are limited. The present study aimed to investigate the association between cholecystectomy and chronic kidney disease (CKD) using a nationwide longitudinal cohort. Methods: Participants aged ≥20 years with cholecystectomy between 2010 and 2014 (n = 116,748) and age- and sex-matched control participants without cholecystectomy (n = 116,748) were analyzed using the Korea National Health Insurance Service data. The adjusted hazard ratios (aHRs) were calculated for incident CKD in the cholecystectomy group compared with the nonoperative controls. Results: A total of 233,496 participants were included (mean age, 54.7 ± 12.7 years; 52.6% men). During the mean follow-up period of 4.8 ± 1.7 years, 6450 patients (5.5%) were newly diagnosed with CKD in the cholecystectomy group. Cholecystectomy was an independent risk factor for the development of CKD after adjustment for confounders, including age, sex, income, health behaviors, and comorbidities. The risk of CKD was 21% higher in the cholecystectomy group compared to the non-cholecystectomy group (aHR, 1.21; 95% CI, 1.17–1.26). The increased risk of CKD in the cholecystectomy group was consistently significant when a stratified analysis by age, sex, and presence or absence of comorbidities was conducted. Conclusions: Cholecystectomy was independently associated with an increased risk of developing CKD in a nationwide population-based study. Therefore, careful and long-term monitoring of the risk of CKD after cholecystectomy is necessary.

Spatial associations of daily PM2.5 concentration with cardiovascular and pulmonary morbidity in Korea

Air pollution, particularly fine particulate matter less than 2.5 micrometers in diameter (PM2.5), contributes to respiratory and cardiovascular diseases and poses significant public health risks worldwide. This study evaluated the short-term effects of PM2.5 on hospital admissions for cardiovascular and respiratory diseases, with additional analyses to identify vulnerable populations based on regional characteristics. The present study analyzed data from 249 Korean communities between 2006 and 2021. Data on daily hospital admissions for cardiovascular and respiratory diseases were obtained from the National Health Insurance Service. Data on PM2.5 concentrations were sourced from air quality modeling. Additional data on regional characteristics, including the regional deprivation index, proportion of elderly residents, education levels, and greenness levels, were also collected. We used case time series analysis to assess the associations between PM2.5 concentrations and hospital admissions for cardiovascular and respiratory diseases and explored effect modification by regional characteristics with stratified analyses. The mean numbers of daily cardiovascular admissions and respiratory admissions were 5.68 ± 5.46 and 6.46 ± 8.03, respectively. The mean PM2.5 concentrations were 23.58 ± 13.66 μg/m3. A10 μg/m³ increment in daily PM2.5 concentration was associated with increase of cardiovascular and respiratory hospitalization by 0.94% (95% CI: 0.84%, 1.04%) and 1.43% (95% CI: 1.34%, 1.52%), respectively. Regional characteristics analysis showed significant disparities, with higher risks for hospital admissions in areas with lower deprivation and low greenness. This study highlights the significant short-term health impacts of PM2.5 on respiratory and cardiovascular hospital admissions in Korean communities. The findings underscore the critical role of regional and demographic factors in modulating these effects, identifying socio-economic areas, age structure of the population, lower education levels, and low greenness as key vulnerability factors.

Implementation of the Indonesian Food and Drug Authority Agency's (BPOM) Health Service Policy on the Sale of Non- Prescribed Prescription Drugs at Pharmacies in Makassar

Implementation of the Indonesian Food and Drug Authority Agency's (BPOM) Health Service Policy on the Sale of Non- Prescribed Prescription Drugs at Pharmacies in Makassar

Smoking Cessation and Incident Cardiovascular Disease

The association between smoking cessation and cardiovascular disease (CVD) risk in relation to cumulative smoking exposure remains poorly understood. To evaluate the associations among smoking cessation, lifetime smoking burden, and CVD risk according to the number of years elapsed after smoking cessation. This retrospective cohort study of the Korean National Health Insurance Service database investigated smoking duration and intensity between January 2006 and December 2008. Participants were categorized by self-reported smoking habits as current, ex-, or never-smokers. Smoking records were updated every 2 years until December 2019, with participants whose smoking status changed or whose smoking status was unclear excluded. Data analysis was performed between June and December 2022. Time-updated self-reported smoking status, years since quitting, and cumulative smoking amount (pack-years [PY]). The primary outcome was incidence and hazard ratio of CVD (composite of cardiovascular death, myocardial infarction, stroke, and heart failure). Overall, 5 391 231 participants (39.9% male; mean [SD] age, 45.8 [14.7] years; 853 756 [15.8%] current smokers, 104 604 [1.9%] ex-smokers, and 4 432 871 [82.2%] never smokers) were followed up for a mean (SD) of 4.2 (4.4) years. The median (IQR) baseline cumulative smoking amounts were 14.0 (7.5-20.0) PY in current smokers and 10.5 (5.3-20.0) PY in ex-smokers. The median (IQR) duration of smoking cessation was 4 (2-8) years for ex-smokers. Regardless of continued smoking, a dose-dependent association was evident between smoking and incident CVD. Compared with current smokers, ex-smokers with a lifetime smoking burden of less than 8 PY (light ex-smokers) experienced a significant reduction in CVD risk within 10 years of cessation, with a CVD risk similar to that of never-smokers. Conversely, ex-smokers with at least 8 PY (heavy ex-smokers) exhibited a slower decline in CVD risk than light ex-smokers, requiring more than 25 years for the residual CVD risk to disappear. In this cohort study, smoking and CVD risk exhibited a dose-dependent association, with light ex-smokers having a CVD risk similar to that of never-smokers relatively soon after smoking cessation. For heavy ex-smokers, greater than 25 years might be required for the residual CVD risk to align with that of never-smokers.

Analysis of the utilization rate of claimed dental implants and related factors.

Purpose: This study aims to identify the utilization of claimed dental implants and the related factors in South Korea using the Anderson behavioral model.Materials and Methods: This study used the Health Checkup Cohort DB, claimed data from the National Health Insurance Service (NHIS), to identify changes in the utilization of dental implants and related factors. The study population was selected as 75 years old because they were covered by NHIS since the first year, 2014. Finally, the sample subjects in the analysis were 63,880. The data was analyzed using IBM SPSS Statistics for Windows, version 26.0 (Statistical Package for the Social Sciences 26.0. SPSS Inc. Chicago, IL, USA).Results: The dental implant utilization rate of the study population increased continuously, from 3.4% in Phase 1 to 6.3% and 7.0% in Phase 2 and 3, respectively. The significant differences by region, insurance type, and disability were shown in Phases 1 and 2 (p&lt;0.05), but it was insignificant in Phase 3 (p&gt;0.05). In the fully adjusted logistic regression model, the probability of using dental implants was 1.9 times higher in the higher Phase than the others. The people who had annual oral examinations showed a two times higher possibility of having dental implant surgery.Conclusions: It is necessary to review the recent claiming trends and related factors before the decision-making for coverage, especially dental coverage with huge effects, such as dental implants.

Comparing ischemic cardiovascular effectiveness and safety between individual SGLT-2 inhibitors and DPP-4 inhibitors in patients with type 2 diabetes: a nationwide population-based cohort study

ObjectivesThis study compared the ischemic cardiovascular events (iCVEs) effectiveness and safety of initiating empagliflozin or dapagliflozin with those of dipeptidyl peptidase-4 inhibitors (DPP-4is), as well as the comparative effects between empagliflozin and dapagliflozin.MethodsUsing data from the National Health Insurance Service in Korea, patients with type 2 diabetes mellitus (T2DM) who were newly prescribed empagliflozin, dapagliflozin, or DPP-4is from 2016 to 2019 and who did not have a recent CVE history were included. A Cox proportional hazards regression model was used to estimate the adjusted hazard ratio (aHR) with 95% confidence intervals (CIs) for iCVEs and safety events.ResultsEmpagliflozin and dapagliflozin significantly reduced the risks of ischemic stroke (aHR 0.568, 95% CI 0.408–0.791; aHR 0.612, 95% CI 0.476–0.786, respectively) and all-cause mortality (aHR 0.590, 95% CI 0.442–0.788; aHR 0.730, 95% CI 0.603–0.884, respectively) compared with DPP-4is. Initiating dapagliflozin or empagliflozin was associated with significantly lower incidence of severe hypoglycemia, bone fracture, urinary tract infection, and acute kidney injury than that of DPP-4is. No significant differences were observed between empagliflozin and dapagliflozin in iCVEs and most safety outcomes.ConclusionEmpagliflozin and dapagliflozin showed significant preventive effects on ischemic stroke and all-cause mortality compared with DPP-4is in patients with T2DM, and their protective effects were similar. Both empagliflozin and dapagliflozin were not related to the harmful effects on most safety events. These results suggest that it may be beneficial to initiate empagliflozin or dapagliflozin for ischemic stroke prevention in patients with T2DM. However, further validation studies, such as randomized controlled trials, are needed to generalize these results.

Predicting mid- and late-life dementia risk in primary care: A prognostic study from a national health screening cohort

The objective of this study is to develop and validate dementia risk prediction models for mid- and late-life individuals that are based on accessible variables within a primary care setting. Using the Korean National Health Insurance Service database (2010–2019), we analyzed 6,696,073 individuals aged 40 and older who participated in a national health screening program over a mean follow-up of 8.95 years. Potential predictors were selected based on a literature review and the available data. Dementia cases were identified using claim-based codes and validated by corresponding prescription information. 5-year dementia risk prediction models for mid-life (40–59 years), and late-life (60+ years) stages were developed using the Cox proportional hazards model. Model performance was assessed through discrimination and calibration. Both models included age, sex, body mass index, smoking, alcohol consumption, physical activity, diabetes, hypertension, dyslipidemia, and chronic kidney disease. The models’ AUROCs were 0.764 for mid-life and 0.743 for late-life. The impact of predictors on dementia risk was consistently stronger in mid-life than in late-life stages. Our models showed good calibration with low-risk estimates in mid-life and overall in late-life. These findings underscore the crucial role of managing modifiable risk factors, particularly during mid-life to reduce dementia risk.

Changes in physical activity and all-cause mortality among individuals with dementia: a cohort study using the National Health Insurance Service Database in Korea.

To examine associations between the amount and changes in regular physical activity (PA) before and after diagnosis of dementia and all-cause mortality risk, and whether these associations differ by PA intensity (light, moderate or vigorous). This retrospective cohort study used data from the Korean National Health Insurance Service Database, including 60 252 individuals newly diagnosed with dementia between 2010 and 2016 who underwent health examinations both before and after diagnosis. PA was assessed using the International Physical Activity Questionnaire-Short Form. Multivariable Cox proportional hazards regression models were used to analyse the associations between PA (amount and changes) and all-cause mortality risk. During a mean follow-up of 3.7 years, 16 431 (27.3%) deaths occurred. Higher PA levels after dementia diagnosis were associated with a dose-dependent decrease in mortality risk (p for trend <0.001). Maintaining regular PA, compared with remaining inactive, was associated with the lowest mortality risk (HR=0.71, 95% CI 0.65 to 0.79). Sustained engagement in PA of any intensity was associated with decreased mortality risk: light (HR=0.70, 95% CI 0.67 to 0.75), moderate (HR=0.74, 95% CI 0.64 to 0.86) and vigorous PA (HR=0.70, 95% CI 0.61 to 0.79). Initiating any PA intensity after dementia diagnosis was associated with at least 20% reduced mortality risk. These associations were consistent in Alzheimer's disease. Maintaining or initiating regular PA, regardless of intensity, after dementia diagnosis was associated with a reduced risk of all-cause mortality. Lifestyle modifications promoting PA might offer survival benefits for individuals with dementia.

Assessment of healthy worker survivor bias among middle-aged manufacturing employees in Korea

Abstract Background Healthy Worker Survivor Bias (HWSB) describes a selection bias where those continuously employed tend to exhibit superior health outcomes compared to their unemployed counterparts. This bias challenges for adjustments due to its time-dependent nature. This study aims to evaluate the extent of HWSB related to changes in employment status among middle-aged manufacturing workers using comprehensive national data from Korea. Methods The study analyzed data from the National Health Insurance Service, targeting individuals aged 40-49 who maintained consistent insurance coverage-either as manufacturing employees or non-employees (self-employed or unemployed)-from 2008 to 2010. The observation period spanned from January 2011 to December 2022, with all-cause mortality as the primary outcome. We employed landmark analysis to quantify HWSB related to employment status by comparing age-standardized mortality ratios between employees and the general population from the initial assessment to the last landmark period (up to 7 years), calculating 95% confidence intervals (CI) using Poisson distribution. Results The cohort included 4,621,983 participants (726,616 manufacturing employees and 3,895,367 (84.3%) non-employees). Throughout an average follow-up of 10.9 years (43.1% male; median age of 44), there were 116,418 deaths (11,530 (1.6%) among manufacturing employees and 104,888 (2.7%) among non-employees). Analysis revealed a consistent linear increase in HWSB over time. Notably, the bias was more pronounced among females (7-year HWSB-ES [95% CI]: 0.27 [0.17-0.37]) compared to males (7-year HWSB-ES [95% CI]: 0.18 [0.14-0.22]). Conclusions This study quantifies the extent of HWSB among middle-aged manufacturing workers in Korea, highlighting its significant impact, notably in females. These findings are vital for occupational health research, emphasizing the necessity to consider HWSB to prevent the underestimation of health risks associated with hazardous exposures. Key messages • Findings suggest HWSB is more pronounced in female manufacturing workers, indicating the need for targeted occupational health interventions. • The study underscores the importance of accounting for HWSB in occupational health studies to avoid underestimating health risks associated with workplace exposures.

Proteinuria and the risk of incident atrial fibrillation according to diabetes stage in patients with diabetes: a nationwide population-based cohort study

Abstract Background Proteinuria and diabetes mellitus (DM) are established cardiovascular risk factors, both independently associated with an increased risk of atrial fibrillation (AF). Despite previous findings correlating proteinuria amount with incident AF, regardless of DM diagnosis, the nuanced association at different stages of DM warrants further investigation. Purpose This study aimed to delve into and compare the relationship between proteinuria amount and the risk of incident AF in patients across various stages of DM. Methods A cohort of 3,866,428 individuals without prior AF and type 1 DM, who underwent the 2009 health checkup provided by the National Health Insurance Service in Korea, were categorized into five DM stages: normal, prediabetes, new-onset DM, early DM (diagnosed &amp;lt; 5 years), and late DM (diagnosed ≥ 5 years). Proteinuria was graded using the urine dipstick test, ranging from negative to 3+ or more. AF incidence was tracked until December 31, 2020. Results The cohort, with an average age of 47.0 ± 13.9 years and 45.4% females, demonstrated escalating annual AF incidence rates from 1.90 to 6.45 per 1000 person-years across DM stages (p&amp;lt;0.001) (Figure). Similarly, the rates increased from 2.28 to 7.28 per 1000 person-years by proteinuria levels (p&amp;lt;0.001) (Figure). Adjusted Cox regression models revealed a heightened risk of incident AF associated with higher proteinuria amounts in all DM stages (adjusted hazard ratios for urine dipstick 3+ or more: 1.57, 1.76, 1.44, 2.32, and 2.23, respectively). Notably, the association between proteinuria and incident AF was more pronounced in individuals with early and late DM compared to those with prediabetes and new-onset DM (Figure). Conclusions At each DM stage, from prediabetes to late DM, a higher level of proteinuria corresponds to an increased risk of AF development. Furthermore, a stronger association was observed in patients with longer DM duration compared to those with prediabetes or new-onset DM. These findings underscore the significance of monitoring proteinuria levels across DM stages to assess AF risk comprehensively.

Impact of changes in proteinuria on the risk of atrial fibrillation in patients with diabetes mellitus: a nationwide population-based study

Abstract Background Diabetes mellitus (DM) is a well-known risk factor for atrial fibrillation (AF). Proteinuria is also considered as an independent predictor for AF. However, there is limited data on whether the changes in proteinuria severity can impact the risk of AF among patients with DM. Purpose We aimed to evaluate the association between changes in proteinuria over time detected using a urine dipstick test and the risk of AF among patients with DM. Methods A total of 1,605,495 patients with DM who underwent two biennial health checkups provided by the National Health Insurance Service (NHIS) between January 2013 and December 2016 were included. All patients had two consecutive urine dipstick tests during the checkups. We divided the study population into four groups based on their glomerular filtration rate (GFR): &amp;gt; 90 ml/min, 60-90 ml/min, &amp;lt; 60 ml/min, and those with end-stage renal disease (ESRD). We evaluated the association between the changes in proteinuria over time detected using a urine dipstick test and the risk of AF and their changes by GFR. Results During a median 4.0-year follow-up, AF occurred in 32,391 persons (5.22 per 1,000 person-years). Among 1,605,495 patients who underwent two consecutive urine dipstick tests, 1,453,116 (90.51%) patients had a negative proteinuria on both tests (negative or trace result on both urine dipstick tests), and 68,979 (4.3%) patients had an aggravated proteinuria (from negative to more than 1+ result on subsequent urine dipstick test). While 48,357 (3.01%) patients had a resolved proteinuria (from positive to negative results on subsequent tests) and 35,043 (2.18%) patients had a persistent proteinuria (positive result on both tests). Those with aggravated or resolved or persistent proteinuria showed an increased risk of AF (HR 1.39, 95% CI 1.33-1.46; HR 1.37, 95% CI 1.30-1.45; HR 1.95, 95% CI 1.85-2.06) compared with most subjects who showed subsequent negative results on proteinuria. This result was consistent within every GFR group. However, the tendency of increment of AF risk by changes in proteinuria was more prominent in lower GFR groups (Table). In subgroup analysis, there was no significant difference between male and female. However, the younger aged (&amp;lt; 65 years) group had a more prominent tendency of increased AF risk by changes in proteinuria. Conclusion Changes in proteinuria showed a significant association with the risk of AF in patients with DM. This tendency was prominent in patients with lower GFR. Therefore, careful monitoring of AF risk based on proteinuria changes could be beneficial for those with DM.

Clopidogrel versus aspirin monotherapy for secondary prevention after percutaneous coronary intervention - a nationwide population-based study

Abstract Background After percutaneous coronary intervention (PCI), patients are maintained on single antiplatelet therapy (SAPT) for secondary cardiovascular prevention after completing the guideline-recommended duration of DAPT for a period of time. We sought to compare the efficacy and safety of clopidogrel versus aspirin monotherapy for secondary prevention in patients who undergoing PCI in a population-based cohort study using the database from the National Health Insurance Service (NHIS) in Korea. Methods Of those who underwent PCI from 2009 to 2020, 133,343 patients were selected for analysis. (aspirin 65,802 patients, clopidogrel 67,653 patients). To balance between aspirin and clopidogrel users for the comparison of efficacy and safety, we applied the inverse probability of treatment weighting (IPTW) of propensity score method. The primary effectiveness outcome was major cardiovascular events (MACEs) as the composite of cardiovascular death, myocardial infarction (MI) or stroke. The primary safety outcome was any bleeding. We divided the short DAPT user (&amp;lt; 6 months of DAPT in patients with CCS or &amp;lt; 12 months of DAPT in patients with ACS) and long DAPT user (≥ 6 months of DAPT in patients with CCS or ≥ 12 months of DAPT in patients with ACS) by DAPT duration. Results After IPTW matching, overall the mean age of participants was 63.8±16.3 and the median SAPT duration was 3.3 (1.3 – 6.2). During period, the overall primary effectiveness outcome occurred in 4.1% in aspirin group and 2.8% in clopidogrel group (hazard ratio [HR], 0.684; 95% CI, 0.656 – 0.712; p-value &amp;lt;0.0001) (Figure 1-A). the overall primary safety outcome occurred in 2.4% in aspirin group and 2.1% in clopidogrel group (HR, 0.945; 95% CI, 0.899 – 0.994; p-value, 0.0287) (Figure 1-B). In short DAPT group, clopidogrel reduced the risk of MACE (HR, 0.761; 95% CI, 0.715 – 0.811; p-value, &amp;lt;0.0001) but did not reduce the risk of bleeding (HR, 0.973; 95% CI, 0.893 – 1.056; p-value, 0.5067) comaped with aspirin. However, in the long DAPT group, clopdiogrel reduced both MACE (HR, 0.633; 95% CI, 0.600 – 0.669; p-value &amp;lt;0.0001) and bleeding risk (HR, 0.931; 95% CI, 0.873 – 0.992; p-value, 0.028) compared with aspirin. (Figure 2) Conclusion Clopidogrel monotherapy, compared with aspirin monotherapy during the chronic maintenance period after PCI reduced the risk of MACEs and bleeding. As shown in randomized controlled trials, clopidogrel monotherapy was superior to aspirin monotherapy in preventing future clinical adverse events in real-world bid database.

Interaction between alcohol intake and employment status changes on mortality among young workers

Abstract Background To investigate the impact of changes in employment status and their interaction with alcohol consumption on health outcomes among young workers. This study aims to explore how employment fluctuations, periodic unemployment, and economic activity levels influence the health of economically active individuals, focusing particularly on the synergistic effects that these employment changes may have when combined with alcohol consumption. Methods We conducted a retrospective cohort study using data from the Korean National Health Insurance Service database. The study included individuals aged 25-44 years who underwent health check-ups between 2009 and 2010. We categorized changes in employment status into three groups: continuously employed, economically active with employment fluctuations, and periodically unemployed. We estimated adjusted hazard ratios and 95% confidence intervals using multivariable Cox proportional hazard models to assess the impact of changes in employment status on the risk of all-cause mortality. The relative excess risk due to interaction, a widely accepted indicator of additive interaction, was used to assess the interaction between alcohol consumption and changes in employment status. Results Changes in employment status significantly increased the risk of all-cause mortality in both men and women in the economically active with employment fluctuations and periodically unemployed groups compared with the continuously employed group. The synergistic effect of alcohol consumption and changes in employment status on the risk of all-cause mortality was significant only among men. Conclusions The findings of this study indicate that changes in employment status, particularly when combined with alcohol consumption, significantly affect all-cause mortality among young workers. Key messages • Employment status fluctuations combined with alcohol consumption significantly increase all-cause mortality risks among young workers, especially men. • This study emphasizes the urgent need for targeted interventions that address the combined impact of employment and lifestyle factors on public health.

Disparities in the Incidence and Prevalence of Psychotic Disorders Between With and Without Disabled

Abstract Background Numerous epidemiological studies on psychotic disorders have been conducted, however, most of the studies were conducted from an etiological perspective, and conducted with small sample sizes relatively few focused on all types of disabled, especially with a long observation period. Moreover, no study has included the whole adult population of a country. Methods This study was conducted using a data set linking the Korean National Health Insurance Service database, and disability registration data. Age-standardized incidence or prevalence rates were calculated during 2008-2017 according to the presence, severity, and type of the disability. Factors associated with psychotic disorders were examined by multivariate logistic regression. Results The age-standardized incidence and prevalence of psychotic disorders was higher among the disabled than among those without disabled across all years, especially those with severe disabled, and intellectual disabled. The gap in the prevalence of psychotic disorders between the disabled and the non-disabled has widened over time. The severe disabled and intellectual disabled showed the strongest associations with the incidence(aOR=3.04,95% CI = 2.93-3.15;aOR=6.18, 95% CI = 5.90-6.47) and prevalence(aOR=7.64,95% CI = 7.58-7.69;aOR=53.62, 95% CI = 53.04-54.22) of psychotic disorders. Conclusions The incidence and prevalence of psychotic disorders were higher in people with disabled, especially those with severe disabled, and intellectual disabled. The government must increase effort to narrow the gap between the non-disabled and disabled. Financial support: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education (No. 2022R1I1A3070074, and 2022R1I1A1A01068449), and a grant of Patient-Centered Clinical Research Coordinating Center funded by the Ministry of Health &amp; Welfare, Republic of Korea (No. HC23C016500). Key messages • The incidence and prevalence of psychotic disorders were higher in the disabled, especially severe disabled, and intellectual disabled. • Important reasons for these finding may be the ‘low socioeconomic status’ and ‘mental health’ of the disabled.

Early rhythm control of atrial fibrillation in cancer survivors: a nationwide population-based cohort study

Abstract Background Though early rhythm control (ERC) in patients with atrial fibrillation (AF) is effective in reducing stroke, the benefit of ERC has not been well-elucidated in cancer survivors. This study aimed to compare the risk of ischemic stroke between ERC and usual care in cancer survivors with AF and cancer. Methods This nationwide observational study was conducted using the Korean National Health Insurance Service database. Patients aged 20 years or older with newly diagnosed AF between 2009 and 2018 were included. Patients who received rhythm control therapy within 1-year of AF diagnosis were defined as the ERC group, while the remaining patients were defined as the usual care group. The risk of ischemic stroke in the ERC group compared to the usual care group was evaluated in long-term cancer survivors (cancer diagnosis ≥5 years) and the non-cancer group. Results A total of 591,692 patients were included in the study (18,747 patients [3.2 %] with cancer, mean age 65.7±14.6 years, 53.7% men, mean CHA2DS2-VASc score 3.3±2.0). The proportion of patients receiving ERC was slightly higher in cancer survivors compared to the non-cancer group (28.0% vs 25.3%, p&amp;lt;0.001). During a mean 4-year follow-up, incident stroke occurred in 52,500 patients (1,338 in cancer survivors, 51,182 in non-cancer). The ERC group showed a lower risk of stroke than the usual care group, regardless of the presence of cancer history(Figure); adjusted hazard ratio [95% confidence interval] 0.67 [0.58-0.76] in cancer survivors, 0.76 [0.74-0.78] in the non-cancer group (p-for-interaction=0.125). The effect of ERC on the risk of ischemic stroke in cancer group was consistent across all subgroups, including different cancer types or use of chemotherapy. Conclusion ERC was associated with a lower risk of ischemic stroke among long-term cancer survivors. An integrated approach incorporating appropriate rhythm control strategies should be considered for cancer survivors with newly diagnosed AF.

Effect of catheter ablation vs medical therapy on cardiovascular outcomes in hypertrophic cardiomyopathy with atrial fibrillation

Abstract Background Atrial fibrillation (AF) increases the risks of stroke and mortality. AF ablation in patients with heart failure (HF) was associated with a lower risk of death and hospitalisation for worsening HF. Whether AF ablation is beneficial to improve cardiovascular outcomes in patients with concomitant hypertrophic cardiomyopathy (HCM) and AF remains unclear. Objective To investigate whether AF ablation is more effective than conventional medical therapy for improving outcomes in HCM. Methods 2,281 patients with HCM and AF undergoing catheter ablation or medical therapy (antiarrhythmic drugs or rate control drugs) in 2005–2015 were identified from the Korean National Health Insurance Service database. The primary composite outcome of death from cardiovascular causes, ischaemic stroke, hospitalization for worsening HF, or acute myocardial infarction was compared between catheter ablation and medical therapy using propensity score overlap weighting. The time-at-risk was counted from the first medical therapy, and catheter ablation was analysed as a time-varying exposure. Results Of the included (41.1% female; median age: 66 years), 145 (6.1%) underwent catheter ablation for AF during the study period. During a mean follow-up of 3.1 (IQR 1.3–5.8) years, a total of 831 composite outcomes occurred including 292 cardiovascular deaths and 401 strokes. Catheter ablation, compared with medical therapy, was associated with lower risks of the primary composite outcome (weighted incidence rate: 3.84 vs. 6.43 per 100 person-years; weighted HR 0.61, 95% CI 0.38–0.96) and ischaemic stroke (weighted HR 0.43, 95% CI 0.19–0.97). The association between ablation and a lower risk of composite outcome was more pronounced in cases of ablation success whereas no significant difference was observed in cases of ablation failure. Conclusions In patients with AF and HCM, catheter ablation was associated with a lower risk of adverse cardiovascular outcomes than medical therapy.