Health Statistics Data Research Articles

National Center for Health Statistics Data Linkage Program: Generating Synthetic Data to Support Tiered Access

The National Center for Health Statistics (NCHS) has a long-established data linkage program that links NCHS health survey data with vital and other administrative records to expand the analytic potential of both the survey and administrative data. Integrating survey and administrative data provides a powerful mechanism for creating policy-relevant data resources to support the examination of factors that can influence disability, chronic disease, health care utilization, morbidity, and mortality. However, data privacy concerns impact the accessibility of NCHS linked data and thus its utilization. Nearly all NCHS linked data files are available only through the NCHS and Federal Statistical Research Data Centers. To minimize this barrier to access, the NCHS Data Linkage Program is engaged in a pilot project to create NCHS' first public-use fully synthetic data files. This initiative supports Evidence Act requirements, including tiered access to federal data. The talk will include an overview of the steps taken to generate the synthetic linked data and provide a verification process to support its analytic utility. The talk will also include a summary of NCHS’ exploration of other privacy enhancing technologies to increase partnership and data access.

Cost-effectiveness of implementing performance-based financing for improving maternal and child health in Ethiopia.

Performance Based Financing (PBF) supports realization of universal health coverage by promoting bargaining between purchasers and health service providers through identifying priority services and monitoring indicators. In PBF, purchasers use health statistics and information to make decisions rather than merely reimbursing invoices. In this respect, PBF shares certain elements of strategic health purchasing. PBF implementation began in Ethiopia in 2015 as a pilot at one hospital and eight health centers. Prior to this the system predominantly followed input-based financing where providers were provided with a predetermined budget for inputs for service provision. The purpose of the study is to determine whether the implementation of PBF is cost-effective in improving maternal and child health in Ethiopia compared to the standard care. The current study used cost-effectiveness analysis to assess the effects of PBF on maternal and child health. Two districts implementing PBF and two following standard care were selected for the study. Both groups of selected districts share common grounds before initiating PBF in the selected group. The provider perspective costing approach was used in the study. Data at the district level were gathered retrospectively for the period of July 2018 to June 2021. Data from health service statistics were transformed to population level coverages and the Lives Saved Tool method used to compute the number of lives saved. Additionally for purpose of comparison, lives saved were translated into discounted quality-adjusted life years. The number of lives saved under PBF was 261, whereas number of lives saved under standard care was 194. The identified incremental cost per capita due to PBF was $1.8 while total costs of delivering service at PBF district was 8,816,370 USD per million population per year while the standard care costs 9,780,920 USD per million population per year. QALYs obtained under PBF and standard care were 6,118 and 4,526 per million population per year, respectively. The conclusion made from this analysis is that, implementing PBF is cost-saving in Ethiopia compared to the standard care. Due to lack of district-level survey-based data, such as prevalence and effects on maternal and child health, national-level estimates were used into the LiST tool.There may be some central-level PBF start-up costs that were not captured, which may have spillover effects on the existing health system performance that this study has not considered.There may be health statistics data accuracy differences between the PBF and non-PBF districts. The researchers considered using data from records as reported by both groups of districts.

Trends and Variations in Pancreatic Cancer Mortality Among US Metro and Nonmetro Adults, 1999-2020.

Pancreatic cancer is the third leading cause of cancer deaths in the United States. Despite decreasing cancer mortality rates as a whole, pancreatic cancer death rates in the United States remain steady and demonstrate racial/ethnic disparities. Divergent cancer mortality trends have also been observed between metro and nonmetro populations. We therefore aimed to compare metro and nonmetro trends in pancreatic cancer mortality rates in the United States from 1999 to 2020 and investigate potential sex and racial/ethnic differences. We analyzed National Center for Health Statistics data for all pancreatic cancer deaths among individuals aged 25 years or older in the United States. We estimated the average annual percent change (AAPC) in age-standardized pancreatic cancer mortality rates in metro versus nonmetro areas by sex and race/ethnicity. Of the total 810,425 pancreatic cancer-related deaths identified from 1999 to 2020, 668,547 occurred in metro areas and 141,878 in nonmetro areas. Non-Hispanic Black individuals had the highest rates of pancreatic cancer mortality regardless of metropolitan status. In both metro and nonmetro areas, pancreatic cancer mortality rates among non-Hispanic White individuals increased over the study period (AAPC: metro, males, 0.32%; females, 0.27%; nonmetro, males, 0.77%; females, 0.62%). Non-Hispanic Black individuals in metro areas had a decrease in pancreatic cancer mortality (AAPC: males, -0.25%; females, -0.29%), but rates among non-Hispanic Black women in nonmetro areas increased (AAPC, 0.49%). There are variations not only in pancreatic cancer mortality by metro and nonmetro status but also by sex and race/ethnicity within these areas. Individuals who live in nonmetro areas have higher pancreatic cancer mortality rates and increasing death rates compared with their metro counterparts. These findings highlight the need for targeted cancer prevention strategies that are specific to metro or nonmetro populations.

Public health infrastructure and human resources in tribal areas of India: a decadal assessment (2012–2022) with Rural Health Statistics data

PurposeThe recommended public healthcare infrastructure and human resources are essential to deliver healthcare services, particularly in tribal areas, as the country’s tribal population depends mainly on the public healthcare system for their medical needs. India has a substantial share of the tribal population, accounting for approximately 9% of the total population. The paper reviews the state of public healthcare infrastructure and human resources in tribal areas for a period that spreads over a decade.Design/methodology/approachThe paper relied on data from the Government of India’s Rural Health Statistics (RHS) reports (2011–2012 and 2021–2022). From these reports, data on the physical infrastructure and human resources in the tribal areas were extracted. The extracted data were compiled and analyzed using Microsoft Excel.FindingsThe analysis showed that the improvement in public healthcare infrastructure and human resource situation in tribal areas of the country was not commensurate with the tribal population growth seen in the last decade. As a result, the average population covered by a health facility was greater than the prescribed norms in the tribal-dominated geographies. The health worker-population ratio at the primary healthcare level was also higher than the national norms. However, there was a substantial improvement in the doctor-population ratio at the primary health center level. In comparison to tribal-lean states, tribal-dominated states faced the concurrent challenge of a growing population and strained healthcare facilities and human resources. As a result, the healthcare infrastructure and human resource gap continued in the tribal-dominated states of the country. The gaps in health infrastructure and human resources in tribal-dominated states must be addressed as a priority under the health infrastructure strengthening efforts to ensure that the tribal population receives and has access to quality health care from publicly funded health facilities, leading to improved health outcomes in the tribal population and the achievement of the sustainable development goals (SDGs).Originality/valueWe have not come across any paper that has carried out pancountry analysis of healthcare infrastructure and human resources in tribal areas.

Factors of Incomplete Inpatient Medical Records Filling at Dr. H. Slamet Martodirdjo Regional General Hospital Pamekasan

Hospitals have an important role in improving health status by providing quality services, including complete medical record data and information. Complete and accurate medical records can be used for health care and patient treatment, evidence in law enforcement, medical discipline and medical ethics, educational and research purposes, basis of payment for health care costs, and health statistical data. This study aimed to identify the factors causing the incomplete filling of inpatient medical records at Dr. H. Slamet Martodirdjo Regional General Hospital Pamekasan. This research applied the descriptive observational method, with data collected through secondary data analysis using document studies and problem exploration using focus group discussions (FGD). The document study was conducted on 80 samples of inpatient medical records, while the FGD was conducted by inviting the head of the planning department, medical records officer, and 8 heads of inpatient wards to find out the causes and solutions for incomplete medical record files. The study results found that the number of incomplete medical records was 76.25%, with the highest percentage of incompleteness due to doctors, pharmacists, and nurses. The main problem causing the incompleteness of medical records was professional caregivers (PPA) who lacked discipline. The solutions obtained were management meetings and evaluations to professional caregivers, constructing policies that regulate reward and punishment systems, monitoring the checklists of medical record completeness, and routine evaluation of medical record files.

EPIDEMIOLOGY AND HEALTH IN TRANSIT

Traffic is a social phenomenon in which it portrays the structural disposition and positioning of man - machine, in reciprocal interaction and movement with the influences of the social environment, when the dimension of subjectivity breaks with the dichotomies ensnared in modern thought, such as; individual/society, intellectual/emotional, internal/external through a theoretical model on the human psyche from its generative character within the cultural fabric in which people and groups participate. The subject of this study is justified by the fact that, in this social context in which human subjectivities - truck drivers and their risky behaviour - converge, traffic is characterized as an environmental and interdisciplinary phenomenon. To this end, bibliographic sources were searched on various interfaces related to the man-machine dyad, using data sources such as Google Scholar, the Virtual Health Library (VHL), scientific articles and statistical data source platforms. The results related to risk behaviors encompassed the human fact as one of the most impactful (adding other adversities such as fear of dismissal, symptoms of stress, anxiety, competitiveness, homesickness, burnout, psychological and psychiatric illness, victims of violence and traffic accidents, substance abuse); the use of the driver-machine relationship «the house is your truck» and the influences on the issue of driver and passenger vulnerability is a factor that causes numerous accidents. Therefore, in the face of contemporary demands involving pressure and a race against time, a high level of responsibility related to loads and transportation, stressful situations and a lack of healthier psycho-emotional resources is a watershed, determining the life or death of many individuals moving between their worlds. Further research correlating the dimension of human subjectivity is therefore fruitfully suggested, with a view to aligning the profession of truck drivers with safer traffic, promoting the reframing of this phenomenon and safer traffic and preservation of life.

Relationship between metformin use and mortality in tuberculosis patients with diabetes: a nationwide cohort study.

To determine whether metformin, which is considered a host-directed therapy for tuberculosis (TB), is effective in improving the prognosis of patients with TB and diabetes mellitus (DM), who have higher mortality than those without DM. This cohort study included patients who were registered as having TB in the National Tuberculosis Surveillance System. The medical and death records of matched patients were obtained from the National Health Information Database and Statistics Korea, respectively, and data from 2011 to 2017 were collected retrospectively. We classified patients according to metformin use among participants who used diabetes drugs for more than 28 days. The primary outcome was all-cause mortality during TB treatment. Double propensity score adjustment was applied to reduce the effects of confounding and multivariable Cox proportional hazard models were used to estimate adjusted hazard ratio (aHR) with 95% confidence interval (CI). The all-cause mortality rate during TB treatment was lower (9.5% vs. 12.4%, p < 0.01) in the metformin user group. The hazard of death due to all causes after double propensity score adjustment was also lower in the metformin user group (aHR 0.76, 95% CI 0.67-0.86, p < 0.01). There was no significant difference in mortality between metformin users and non-users for TB-related deaths (p = 0.22); however, there was a significant difference in the non-TB-related deaths (p < 0.01). Metformin use in patients with TB-DM co-prevalence is associated with reduced all-cause mortality, suggesting the potential for metformin adjuvant therapy in these patients.

Evaluation of Health Statistics Data Quality in Urumqi Region Based on Analytic Hierarchy Process

Evaluation of Health Statistics Data Quality in Urumqi Region Based on Analytic Hierarchy Process

A Comprehensive 16-Year Analysis of National Center for Health Statistics Data on the Top Three Causes of Death Before Age 75 by Sex, Race, and Hispanic Origin.

This study aimed to conduct a comprehensive 16-year analysis of years of potential life lost (YPLL) due to leading causes of death in the United States, focusing on disparities by sex, race/ethnicity, and specific causes of death using the National Center for Health Statistics (NCHS) data. Data from the NCHS spanning 2000-2016 were included. Age-adjusted YPLL rates per 100,000 population were analyzed, stratified by sex, race/ethnicity, and leading causes of death, including malignant neoplasms, heart disease, and cerebrovascular diseases. Over 16 years, the total YPLL rate was 7,036.2 per 100,000 population. Males had a higher YPLL rate (8,852.5 per 100,000) than females (5,259.9 per 100,000). Among racial/ethnic groups, Black/African Americans had the highest YPLL rate (10,896.8 per 100,000), followed by American Indian/Alaska Natives (7,310.0 per 100,000), Hispanics/Latinos (5,256.8 per 100,000), and Asians/Pacific Islanders (3,279.7 per 100,000). Leading causes included malignant neoplasms (1,451.6 per 100,000), heart diseases (1,055.4 per 100,000), and cerebrovascular diseases (182.3 per 100,000). This analysis spanning 16 years highlights notable disparities in YPLLrates among different demographic groups. These differences are evident in the YPLL rates for males, which are higher than those for females. The YPLL rate is most pronounced among Black/African Americans, followed by American Indian/Alaska Natives, Hispanics/Latinos, and Asians/Pacific Islanders. The primary contributors to YPLL are malignant neoplasms, heart diseases, and cerebrovascular diseases. These findings emphasize the importance of addressing these disparities to enhance public health outcomes and mitigate the premature loss of life.Despite progress, disparities persist, highlighting the need for targeted interventions and further research.

Epidemiology of Current Asthma in Children Under 18: A Two-Decade Overview Using National Center for Health Statistics (NCHS) Data.

This study conducted a comprehensive two-decade analysis of current asthma among children under 18 in the United States using National Center for Health Statistics (NCHS) data. The primary objective was to assess the prevalence of current asthma, evaluate temporal trends, and identify disparities based on gender, age, insurance status, household poverty levels, and race/ethnicity. Data spanning 2003-2019 from NCHS were analyzed, focusing on current asthma prevalence among children under 18. Age-adjusted prevalence rates were calculated and stratified by various factors, including gender, age groups, health insurance status, poverty levels, and race/ethnicity. The study revealed substantial disparities in current asthma prevalence. Over the two-decade period, the overall prevalence of current asthma fluctuated. It increased from 2003 (8.5%) to 2009 (9.6%) and then decreased by 2019 (7.0%). Gender disparities were evident, with males (9.9%) consistently reporting a higher prevalence than females (7.5%). Older children aged between 10-17 years (10.4%) consistently had a higher prevalence of asthma than younger children aged 0-4 (5.3%) and 5-9 years (9.5%). Children with Medicaid insurance (11.2%) had the highest prevalence, followed by insured (8.9%), privately insured (7.7%), and uninsured children (6.1%). Children living below the federal poverty level (FPL) consistently reported the highest prevalence (11.3%), while children above 400% of the FPL (7.1%) had the lowest prevalence. Racial disparities were observed, with Black children (14.3%) having higher asthma prevalence, followed by White (7.6%) and Asian children (5.4%). The study highlights significant disparities in current asthma prevalence over the two-decade period analyzed. While the overall prevalence showed fluctuations, it generally increased from 2003 to 2009 and then decreased by 2019. Gender disparities were evident, with males consistently reporting a higher prevalence compared to females. Older children in the 10-17 age group consistently had a higher asthma prevalence than younger age groups. Moreover, disparities based on insurance status and income levels were also apparent, with children on Medicaid and those living below the FPL reporting higher asthma prevalence. Racial disparities were observed, with Black children having the highest prevalence, followed by White and Asian children. These findings emphasize the importance of addressing these disparities and tailoring interventions to improve asthma management and prevention across different demographic groups.

Health care use and health consequences of geographic lack of access to abortion and maternity care.

Recent years have brought substantial declines in geographic access to abortion facilities and maternity care across the US. The purpose of this study was to identify the reproductive health consequences of living in a county without access to comprehensive reproductive health care services. We analyzed National Center for Health Statistics data on all live births occurring in the US in 2020. We used data on locations of abortion facilities and availability of maternity care in order to classify counties by level of access to comprehensive reproductive health care services and defined comprehensive reproductive health care deserts as counties that did not have an abortion facility in the county or in any neighboring county and did not have any maternity care practitioners. We fit modified Poisson regression models with generalized estimating equations to estimate the degree to which living in a comprehensive reproductive health care desert was associated with receipt of timely and adequate prenatal care and risk of preterm birth, controlling for individual-level and county-level characteristics. In 2020, one third of counties in the US were comprehensive reproductive health care deserts (n = 1082), and 136,272 births occurred in these counties. In adjusted models, there was no difference in prenatal health care use (timeliness or adequacy of care) between persons in comprehensive reproductive health care deserts and those with full access to care, but the risk of preterm birth was significantly elevated (aRR =1.09, 95% CI = 1.06, 1.13). Lack of access to comprehensive reproductive health care services may increase the incidence of preterm birth.

Attention-Deficit Hyperactivity Disorder Among American Youth: A Comprehensive 20-Year Analysis of National Center for Health Statistics (NCHS) Data

Attention-Deficit Hyperactivity Disorder Among American Youth: A Comprehensive 20-Year Analysis of National Center for Health Statistics (NCHS) Data

Modern probiotics in the treatment of sexually transmitted infections. From the problem to its solution

This article is a review of current scientific publications that are devoted to the problem of sexually transmitted infections (STIs) and the importance of probiotics in their treatment. The article also analyzes the data of regulatory documents of the World Health Organization and statistical data of the Center for Medical Statistics of the Ministry of Health of Ukraine and the State Statistics Service of Ukraine, which highlight the problem of the prevalence of STIs in the world and in Ukraine.Sexually transmitted infections have a serious negative impact on sexual and reproductive health worldwide. In the absence of treatment, they can have serious outcomes, including neurological and cardiovascular diseases, infertility, ectopic pregnancy, increased risk of infection with the human immunodeficiency virus. One of the serious factors which prevent the reduction of STDs increased rate in the world is the drug resistance for these infections. Infections caused by resistant strains of microorganisms are characterized by a more severe course, more often require hospitalization of the patient, increase the duration of the patient’s stay in the hospital, require the use of combined antibiotic therapy with the administration of reserve drugs.According to the results of scientific studies, Bacillus probiotics are an alternative for solving problems related to STIs and their outcomes. The innovative combination of the components of the drugs that contain the SirionProbioProtection probiotic formula helps to overcome such a problem as the resistance of STI pathogens to etiotropic antibiotic therapy. The use of alternative methods of exposure to STIs and their consequences add to success in providing obstetric and gynecological services.

Risk of Severe Maternal Morbidity (SMM) in patients with Placenta Accreta Spectrum (PAS) disorders referred from rural communities to a regional PAS center.

The primary objective of this study was to assess the risk of Severe Maternal Morbidity (SMM) experienced by patients residing in rural communities when delivered by a multidisciplinary team within a single urban academic center for Placenta Accreta Spectrum (PAS). Subsequently, we aimed to determine a distance dependent relationship between PAS morbidity and distance travelled by patients in rural communities. This was a retrospective cohort study of patients who had PAS histopathologic confirmation and delivery at our institution from 2005-2022. Our objective was to determine the relationship between patient locations (rural vs. urban) and maternal morbidity associated with PAS delivery. Socio-geographic determination of rurality was determined using the National Center for Health Statistics and most recent national census population data. Distance travelled was calculated by patient zip code to our PAS center using global positioning system data. During the study period, 139 patients were managed by cesarean hysterectomy with confirmed PAS histopathology. Of these, ninety-four (67.6%) were from our urban community and forty-five (32.4%) were from surrounding rural communities. The overall SMM incidence was 85% including blood transfusion and 17% without blood transfusions. Patient from rural communities were more likely to experience SMM (28.9% vs. 12.8%, p=0.03) and this was driven by acute renal failure (1.1 vs 11.1%, p=0.01) and disseminated intravascular coagulopathy (1.1 vs 8.8%, p=0.04). SMM did reveal a a distance-dependent relationship with SMM rates of 13.2%, 33.3%, and 43.8% at 50, 100 and 150 miles, respectively (p=0.005). Patients with PAS experience high rates of SMM. Geographic distance to a PAS center appears to significantly impact the overall morbidity a patient experiences. Further research is warranted to address this disparity and optimize patient outcomes for patients in rural communities.

Analysis of public health-care facilities in rural India

PurposeThis paper aims to analyze the status of infrastructure, workforce and basic amenities at public health-care facilities in rural India and draw a comparison with its urban counterparts.Design/methodology/approachRural Health Statistics data and National Sample Survey Office Report for the period 2019–10 were used to analyze lower-level public health facilities, namely, subcenters, primary health centers and community health centers (CHCs). Selected tracer indicators under World Health Organization’s (WHO) Service Availability and Readiness Assessment (SARA) mechanism such as health center density, core health workforce density and basic amenities were used to carry out the analysis. The extent of facility coverage was measured using the National Rural Health Mission (NRHM) guidelines and the proportion of facilities satisfying the Indian Public Health Standards (IPHS) was measured to assess the service provision quality in rural public health-care facilities.FindingsResults indicated that the density of public health centers is higher in rural areas than in urban areas. Almost all public health-care facilities lack basic amenities in rural areas. Working positions for health specialists in CHCs barely meet the total requirement. Almost all of the public health facilities functioning in rural areas do not meet the IPHS norms.Originality/valueTo the best of the authors’ knowledge, the present paper is the first initiative to assess the status of rural public health-care facilities on the national level using WHO’s SARA indicators as well as NRHM and IPHS guidelines. The study is significant in terms of policy input for achieving universal health coverage in India.

Changes in the Place of Death and Implications for End-of-Life Care Policy: A Population-Based Observational Study.

Background: Death in hospital rather than at home is becoming more prevalent, even among terminally ill patients receiving home-based care. Identifying trends in places of death is crucial to care policy, especially for aging populations as in Taiwan. Aim: To identify changes in the places of natural death of Taiwanese individuals for various causes of death. Design: A population-based observational study was conducted. Setting: Anonymous data for the period 2000-2020 from the Death Database of Taiwan's National Center for Health Statistics Data were obtained and analyzed. Results: In 2000, 60.1% of natural deaths occurred in the home, whereas in 2020, this percentage was only 36.8%; conversely, the percentage of deaths in hospital increased from 34.4% in 2000 to 56.1% in 2020. Deaths in a nursing home or long-term care facility were found to account for only 3.8% of all natural deaths in 2020. Dementia was the cause of death for which the proportion of institutional deaths was highest, although this proportion was <10% for most years. We applied the joinpoint regression model to estimate trend changes in places of death. During the study period, the places of death in Taiwan changed significantly, the average annual percent changes for hospital deaths over the 21-year period was 2.54% (confidence interval [CI]: 2.04 to 3.03), and for home deaths was -2.69% (CI: -3.26 to -2.13). Conclusions: The detailed findings of this national study can offer insight into potential future clinical burdens and lead to better health policy decisions for Taiwan.

Rates Of Preterm Birth And Low Birthweight: An Analysis Of Racial And Ethnic Populations.

Using National Center for Health Statistics data (2016-20), we evaluated variation in low birthweight and prematurity among racial and ethnic subcategories. Disparities as large as 2.3-fold among rates of low birthweight for "multiple race" subcategories underscore the need for granular data stratification and analysis by racial and ethnic subcategories to address the root causes of inequities in infant outcomes.

Suicide Mortality by Place, Gender, and Age Group - China, 2010-2021.

Suicide is an important public health concern in China. We examined suicide mortality by place, sex, and age group from 2010 to 2021 to identify and quantify significant suicide mortality changes in China. We retrieved age-standardized and age-specific suicide mortality rates by place (urban vs. rural) and sex from the Chinese Health Statistical Yearbook and population data from the 2010 and 2020 Chinese National Population Census. Line graphs were used to demonstrate trends in suicide mortality. Joinpoint regression models were fitted to detect the time periods experiencing significant suicide mortality changes, and average annual percent change (AAPC) and annual percent change were reported to quantify changes in suicide mortality from 2010 to 2021. The overall age-standardized suicide mortality rate decreased from 10.88 to 5.25 per 100,000 population between 2010 and 2021 (AAPC=-5.3%, 95% confidence interval: -6.5%, -4.0%). Similar reductions in suicide mortality were observed for both males and females, as well as in urban and rural settings during this period. From 2010 to 2021, significant declines in suicide mortality were observed among the three older age groups (25-44 years, 45-64 years, and 65 years or above), while a substantial increase was noted in the youngest age group (5-14 years). No significant change was found in suicide mortality rates for the 15-24 year age group. Subgroup analyses based on location and sex revealed consistent findings. The findings of this study suggest a probable overall success of suicide prevention efforts in China over the past decade. However, the recent increase in suicide mortality among children aged 5-14 years calls for the attention of injury researchers, policymakers, and public health practitioners.

Effects of Senility on Disease Burden: Panel Analysis Using 2010 to 2019 OECD Health Data.

In this study, the geniatric status of OECD (Organisation for Economic Co-operation and Development) countries was measured, and the effects of aging status on disease patterns in each country were quantitatively assessed. A theoretical model explaining the effects was suggested, and the implications were discussed. Data used in this study were the OECD Health Statistics data and WHO Global Burden of Disease data. The values for each country were paired with disability-adjusted life years (DALYs) presented by the WHO and Institute for Health Metrics and Evaluation (IHME). A cross-country panel analysis was conducted to analyze the effects of senility on the burden of disease in OECD countries. Geniatric status had effects on the burden of disease (P = .048). Total health expenditure significantly reduced the burden of disease (P = .001). In the panel model with YLL (Year of Life Lost) as the outcome variable, geniatric status had twice greater effects on the burden of disease than that in the model with DALY (P = .003). In medical insurance-related policies, the characteristics of the disease should be considered. In particular, chronic diseases have not received much attention compared to their risk. However, the disease that actually affects the burden of disease is a disease that becomes chronic and requires long-term treatment rather than a disease with a high fatality rate. And, as a result of this study, the higher the level of resource consumption for treatment in OECD countries, where aging is progressing, the burden of disease was rather reduced. Therefore, if there is institutional support to receive appropriate treatment, it will be possible to reduce the national burden of disease.

Trends in National Pharmaceutical Expenditure in Korea during 2011 - 2020.

This study aimed to identify the trends in pharmaceutical expenditure (PE), share of PE in health expenditure (HE), and trends in expenditure by pharmacological groups (ATC level 1 classification) in Korea for a 10-year period (2011 - 2020) and compare the data with those of other Organisation for Economic Co-operation and Development (OECD) countries. Using the findings, we determined the current status of pharmaceutical expenditure (PE) management in Korea and derived the implications for establishing future macroscopic policies on PE. We analyzed the OECD Health Statistics and the Korean national health insurance claims database from January 2011 through December 2020. The outcome measures were HE, PE, and pharmaceutical sales data for ATC level 1 medicines from OECD Health Statistics data during 2011 - 2020. As OECD collects limited ATC level 1 data, we used the HIRA health insurance claims data for PEs of ATC level-1 classification, including D, L, P, and S. PE in Korea increased by 38.5% from 19.9 billion USD in 2011 to 27.6 billion USD in 2020, whereas the share of PE in HE decreased by 6.3%p from 26.4% in 2011 to 20.1% in 2020. In 2020, Korea ranked third in PE per capita (760.9 USD PPP) and had the highest share of PE (20.1%) among the 19 OECD countries studied. By ATC level 1 class, the highest PE was A (alimentary tract and metabolism) at 4.3 billion USD, and L (antineoplastic and immunomodulating agents) had the highest increase at 13.4%; in contrast, J (anti-infectives for systemic use) had the lowest increase in annual average PE at -0.2% in 2020 relative to 2011. Among the 17 OECD countries, Korea had the highest and the third-highest expenditures for ATC codes A and J, respectively. PE in Korea has continued to increase between 2011 and 2020, indicating the need for macroscopic management of PE. Our results on PE by ATC code may help health authorities in establishing future policies on PE.