Korean National Health Information Database Research Articles

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.

Low household income increases risks for chronic obstructive pulmonary disease in young population: a nationwide retrospective cohort study in South Korea

BackgroundLow socioeconomic status is a risk factor for chronic obstructive pulmonary disease (COPD); however, the association between low household income and COPD in young populations remains unclear.MethodsWe screened individuals aged...

Trends in commonly used and potentially inappropriate medications in older Korean patients with polypharmacy

BackgroundPolypharmacy is a global public health concern. This study aimed to determine the prevalence of polypharmacy and trends in the use of commonly used and potentially inappropriate medications among older Korean patients.MethodsIndividuals aged ≥ 65 years who were prescribed any medication between 2014 and 2018 were selected from the Korean National Health Information Database. Joinpoint regression analyses were used to determine trends in the age-adjusted polypharmacy rates by age group. The prescription rates of the most commonly used medications and the most commonly used potentially inappropriate medications were analysed by year or age group for patients with polypharmacy using the chi-square and proportion difference tests.ResultsThis study included 1,849,968 patients, 661,206 (35.7%) of whom had polypharmacy. Age-adjusted polypharmacy rates increased significantly between 2014 and 2018 (P = 0.046). Among patients with polypharmacy, the most commonly prescribed medications were aspirin (100 mg), atorvastatin, metformin, glimepiride, and rosuvastatin. The most commonly prescribed and potentially inappropriate medications were alprazolam, diazepam, amitriptyline, zolpidem, and dimenhydrinate. There was a significant decrease in the prescription rates for each of these drugs in 2018 compared with 2014 among patients with polypharmacy (all P < 0.001), whereas there was a significant increase in alprazolam prescription among patients aged ≥ 85 years when analysed by age group (P < 0.001).ConclusionsThis study revealed an increasing prevalence of polypharmacy among older adults. Additionally, it highlighted that the utilisation of commonly prescribed potentially inappropriate medications, such as benzodiazepines and tricyclic antidepressants, has remained persistent, particularly among patients aged ≥ 85 years who practiced polypharmacy. These findings provide evidence-based guidance for the development of robust polypharmacy management strategies to ensure medication safety among older adults.

Comparison of the impact of longitudinal body mass index changes on cardiac arrest risk between normal and overweight populations.

Being overweight is a key modifiable risk factor for cardiovascular disease. However, the impact of longitudinal changes in body mass index (BMI) on the risk of out-of-hospital cardiac arrests (OHCA) remains unclear, especially among overweight populations. This nested case-control study utilized data from the Korean National Health Information Database between 2009 and 2018. A total of 23453 OHCA patients, who underwent national health check-ups within 1 and 2-4years before OHCA occurrence, and 31686 controls, who underwent similar national health check-ups, were included. The study population was matched for sex, age and survival status. Conditional logistic regression was employed to analyse the odds ratios (ORs) and 95% confidence intervals (CIs) of each BMI per cent change in assessing the risk of OHCA occurrence within 1year. A reverse J-shaped association between BMI per cent change and OHCA risk was observed, even among overweight populations. Among the overweight populations, weight loss significantly increased OHCA risk, with ORs (95% CI) of 4.10 (3.23-5.20) for severe weight loss (BMI decrease>15%), 2.72 (2.33-3.17) for moderate weight loss (BMI decrease 10-15%) and 1.46 (1.35-1.59) for mild weight loss (BMI decrease 5-10%). Conversely, mild weight gain (BMI increase 5-10%) did not significantly increase OHCA risk. The impact of weight changes on the occurrence of OHCA differed by sex, being more prominent in males. Significant weight changes within a 4-year period increase the risk of OHCA with a reverse J-shaped association, even among overweight and obese individuals. Maintaining a stable weight could be a reliable public health strategy irrespective of the weight status, particularly for males.

417-P: Diabetic Foot Ulcer Amputation Increases the Risk of Severe Renal and Retinal Microvascular Complications—A Korean National Health Information Database Study

417-P: Diabetic Foot Ulcer Amputation Increases the Risk of Severe Renal and Retinal Microvascular Complications—A Korean National Health Information Database Study

Association of obstructive sleep apnea with risk of lung cancer: a nationwide cohort study in Korea

Current knowledge regarding the relationship between obstructive sleep apnea (OSA) and the risk of lung cancer is limited. This study aimed to evaluate associations between OSA and the incidence of lung cancer based on the Korean National Health Information Database. The study outcome was the incidence of newly diagnosed lung cancer, and a Cox proportional hazards model was used for analysis. A total of 181,070 adult patients newly diagnosed with OSA between 2011 and 2018 were matched with those without OSA by up to 1:5 propensity score matching based on age and sex. During follow-up over (mean ± standard deviation) 9.1 ± 2.0 years, 2614 incident cases of lung cancer were identified. The incidence rate was 39.51 per 100,000 person-years in the OSA group, and 24.93 per 100,000 person-years in the control group. After adjusting for income and the presence of comorbidities, the association remained significant (hazard ratio [HR] 1.95, 95% confidence interval [CI] 1.74–2.18, p-value < 0.001). The adjusted HR for incident lung cancer was 2.14 (95% CI 1.69–2.70) in female patients with OSA, and 1.90 (95% CI 1.67–2.16) in male patients with OSA. The risk of incident lung cancer increased with age, with a HR of 2.99 (95% CI 2.46–3.64) in those aged ≥ 65 years. This nationwide study showed an independent association between OSA and an increased risk of lung cancer in the Korean population.

The risk of open angle glaucoma in young adults with allergic diseases: a Nationwide cohort study

This study investigated the potential associations between allergic diseases (asthma, allergic rhinitis, and atopic dermatitis) and the development of primary open-angle glaucoma. We utilized authorized data from the Korean National Health Information Database (KNHID), which provides comprehensive medical claims data and information from the National Health Screening Program. We compared the baseline characteristics of subjects with and without allergic diseases and calculated the incidence and risk of glaucoma development. Cox proportional hazard regression analysis was used to determine the risk of glaucoma development in subjects with allergic diseases. A total of 171,129 subjects aged 20–39 with or without allergic diseases who underwent a general health examination between 2009 and 2015 were included. Subjects with allergic diseases exhibited a higher incidence of glaucoma compared to the control group. The hazard ratio (HR) of glaucoma onset was 1.49 and 1.39 in subjects with at least one allergic disease before and after adjusting for potential confounding factors, respectively. Among allergic diseases, atopic dermatitis showed the highest risk for glaucoma development (aHR 1.73) after adjusting for confounders. Allergic rhinitis showed an increased risk for incident glaucoma after adjustment (aHR 1.38). Asthma showed the lowest but still increased risk for glaucoma (aHR 1.22). The associations were consistent in all subgroup analyses stratified by sex, smoking, drinking, exercise, diabetes, hypertension, dyslipidemia, or history of steroid. In conclusion, allergic diseases are associated with increased risk of glaucoma development. Among allergic diseases, atopic dermatitis showed the highest risk for glaucoma development followed by allergic rhinitis and asthma.

Influenza epidemiology and treatment in people with a visual disability: A retrospective cohort study

BackgroundVisual disabilities (VD) are expected to rise with an aging population. Persons with VD experience a higher prevalence of chronic and acute diseases. Despite the significance of influenza to this population, there is limited data comparing influenza care disparities between those with VD and those without. ObjectiveThe study aimed to determine the influenza burden and associated healthcare utilization in individuals with VD compared to those without disabilities. MethodsA retrospective cohort study was conducted using the Korean National Health Information Database, encompassing three influenza seasons (2011–2012 to 2013–2014). The influenza incidence and incidence rate ratio (IRR) was calculated. Adjusted IRRs were calculated using a zero-inflated Poisson model. We assessed the risk of admissions and 30-day post-influenza mortality, employing logistic regression or survival analysis. ResultsA total of 504,374 patients (252,964 patients with VD and 251,410 controls) were followed for 1,471,480 person-years. The influenza incidence was higher in the VD cohort than in the control (8.8 vs. 7.8 cases per 1000 person-years). VD cohort had a higher influenza IRR (adjusted IRR 1·13, 95% confidence interval [CI] 1·02–1·25). Severe VD exhibited higher hospitalization risk (adjusted odds ratio [OR] 1·29, 95% CI 1·10–1·20) and increased medical costs. Severe VD was a significant risk factor for mortality (adjusted Hazard Ratio 1·89, 95% CI 1·04–3·45). ConclusionsPeople with VD have a higher influenza incidence, while their outcomes are comparable to those without. Nevertheless, severe VD significantly contributes more to hospitalization, mortality, and medical costs than controls.

Patterns of follow-up mental health care after hospitalization for suicide-related behaviors among older adults in South Korea

ObjectiveThis study aimed to investigate the sociodemographic and clinical factors associated with receiving follow-up mental healthcare within 7 days and 30 days after hospitalization for suicide-related behaviors (SRB) among older adults in South Korea. MethodsData from the Korean National Health Information Database were used, including information on sociodemographic variables and healthcare utilization. The study cohort consisted of individuals born in 1950 or before with a prior hospitalization record for suicide attempts or probable suicide attempts. Logistic regression analysis was conducted to predict the odds of receiving follow-up care within 7 days and 30 days, adjusting for covariates. ResultsAmong the 37,595 older adults discharged from hospitalization for SRB, 29.13 % and 37.86 % received follow-up care within 7 days and 30 days, respectively. Follow-up care was more common among younger individuals, women, those with higher socio-economic status (SES), urban residents, and individuals with comorbidities. ConclusionThe provision of mental health follow-up care for older adults after hospitalization for suicide attempts is inadequate in South Korea. Increasing access to follow-up care among those with lower income, residing in rural areas, and older age is crucial. Public awareness campaigns, stigma reduction training for healthcare providers, and system-level changes, such as telemedicine and integrated care pathways, can help bridge the healthcare gap and reduce suicide mortality among older adults.

No increased risk of osteonecrosis of the jaw in osteoporotic patients with dental implants: a nationwide cohort study.

The occurrence of implant-associated osteonecrosis of the jaw (ONJ) has been reported in osteoporotic patients, particularly in association with bisphosphonate therapy. This study aimed to investigate the risk of implant surgery and implant presence for ONJ occurrence in osteoporotic patients longitudinally. Based on Korean National Health Information Database, subjects over the age of 65 who were diagnosed with osteoporosis between July 2014 and December 2016 were included. The implant group included subjects who had undergone dental implant surgery between January 2017 and December 2017, while the control group included those who had no history of dental implants. The primary outcome was the occurrence of ONJ, and the date of final follow-up was December 2020. A total of 332,728 subjects with osteoporosis were included in the analysis: 83,182 in the implant group and 249,546 in the control group. The risk of ONJ among those who had undergone implant surgery (risk of implant surgery-associated ONJ) was not higher than that among those without implant surgery. The risk of ONJ among those with implants (risk of implant presence-associated ONJ) was lower than that among those without implants. Even in subjects with a history of bisphosphonates, steroids, periodontitis, or tooth extraction, those who had undergone implant surgery or had implants did not have a higher ONJ risk than those who had not undergone surgery or did not have implants; rather, they showed a lower risk. The results may suggest that dental implants are not associated with an increased risk of ONJ. A further study on whether dental implants are associated with lower ONJ risk is needed. Dental implants did not increase the risk of ONJ development in osteoporotic patients, even with a history of bisphosphonates. This may suggest that the risk profiles for ONJ occurrence between selective insertion of dental implants and other dentoalveolar surgery associated with infectious conditions are different.

Clinical Characteristics of Patients With Statin Discontinuation in Korea: A Nationwide Population-Based Study.

To investigate the clinical characteristics of patients with statin discontinuation in Korea, using a nationwide database. We analyzed 1,308,390 patients treated with statin for the first time in their life between 2016 and 2017 using the Korean National Health Information Database. The patients participated in the Korean National Health Screening Program within two years before taking statin. Patients with statin discontinuation were defined as those who were not prescribed statin between 365 days and 730 days after the initial statin prescription. The overall prevalence of statin discontinuation was 39.44%. Patients with statin discontinuation were younger, had lower body mass index (BMI), included a higher number of smokers and drinkers, did not exercise regularly, with fewer cases of hypertension and diabetes mellitus than those without statin discontinuation (p<0.001). Compared with patients aged 20-29 years, the risk of statin discontinuation showed a U-shaped relationship with age (odds ratios [ORs]: 0.619 in 30-39 years; 0.454 in 40-49 years; 0.345 in 50-59 years; 0.307 in 60-69 years; 0.324 in 70-79 years; and 0.415 in ≥80 years). In addition, increased BMI was associated with decreased risk of statin discontinuation (ORs: 0.969 with 25.0-29.9 kg/m2, and 0.890 with ≥30.0 kg/m2). Patients with hypertension and diabetes mellitus were at a lower risk of statin discontinuation (OR: 0.414 for hypertension; 0.416 for diabetes mellitus). The prevalence of patients with statin discontinuation in Korea was 39.44% at 1 to 2 years after initial statin treatment.

Risk of Neurodegenerative Diseases in Elderly Koreans with an Initial Diagnosis of Type 2 Diabetes: A Nationwide Retrospective Cohort Study.

Type 2 diabetes (T2D) and neurodegenerative diseases (NDs) are common among elderly individuals. Growing evidence has indicated a strong link between T2D and NDs, such as Alzheimer's disease. However, previous studies have limitations in exploring the epidemiological relationship among these diseases as a group of NDs rather than as a specific type of ND. We aimed to investigate the risk of NDs in elderly Koreans who were first diagnosed with T2D and determine the association between T2D and NDs. We conducted a retrospective longitudinal cohort study of patients with who were initially diagnosed with T2D using the Korean National Health Information Database. The study participants were categorized into a T2D group (n = 155,459) and a control group (n = 155,459), aged 60-84 years, that were matched for age, sex, and comorbidities. We followed the participants for 10 years to investigate the incidence of NDs. The Cox proportional hazards regression model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for NDs. The numbers of patients diagnosed with ND at the end of follow-up were as follows: 51,096/155,459 (32.9%) in the T2D group and 44,673/155,459 (28.7%) in the control group (χ2 = 622.53, p < 0.001). The incidences of NDs in the T2D and control groups were 44.68 (95% CI: 44.29, 45.07) and 36.89 (95% CI: 36.55, 37.24) cases per 1,000 person-years at risk, respectively. The overall incidence of NDs was higher in the T2D group than that in the control group (HR: 1.23, 95% CI: 1.22, 1.25, p < 0.001). This study revealed a higher incidence of NDs in elderly Koreans who were initially diagnosed with T2D. This suggests that T2D is a risk factor for NDs in elderly Koreans.

Assessing examination equipment accessibility for the disabled using non-fidelity of checkup items

Abstract Background Even after arriving at the hospital for a health checkup, access to equipment of the disabled is often limited. However, there is a lack of investigation on accessibility of health examination equipment due to difficulty in appropriate evaluation. Methods The Korean national health information database was analyzed to assess the non-fidelity of health checkup screening items for the disabled and non-disabled. Health checkup items included height, weight, BMI, visual acuity, audiometry, blood pressure, urinary protein, hemoglobin and chest X-ray. To analyze the non-fidelity of health checkup items according to the characteristics of the disabled, a chi-square analysis was conducted. Logistic regression analysis was performed to non-fidelity the influencing factors for non-fidelity of each health checkup item for the disabled and non-disabled. Results Among all health checkup participants, women's non-fidelity rate of checkup items was twice higher than men's (OR 2.20, 95% CI 2.18-2.21). The disabled were more twice times higher non-fidelity rate than the non-disabled(OR 2.49, 95% CI 2.47-2.52). It was evident in the case of women disabled, severely disabled or elderly disabled(&amp;lt;.001). Conclusions The non-fidelity rate of the disabled was high, especially for women disabled, severly disabled or elderly disabled. Even if the disabled visit a hospital for health checkup, access to the equipment may be limited. To increase accessibility to diagnostic equipment and improve access to essential health services, it is important to monitor and support the non-fidelity of each checkup item. Key messages • The disabled are more than twice as likely to have higher non-fidelity rates of health checkup items than the non-disabled. • Especially it was high among women disabled, severely disabled or elderly disabled.

Risk of Depression in Patients with Acromegaly in Korea (2006-2016): A Nationwide Population-Based Study.

An increased prevalence of depression has been reported in patients with acromegaly. However, most studies included a relatively small sample size owing to the rarity of acromegaly. We aimed to investigate the risk of depression in patients with acromegaly using the Korean National Health Information Database (NHID). The data of patients with acromegaly in 2006-2016 were collected from the rare incurable disease registry of the NHID. Patients with acromegaly were matched with control participants without acromegaly for age and sex in a 1:5 ratio. Patients who did not receive treatment for acromegaly had a significantly increased risk of depression [hazard ratio (HR): 1.43, 95% confidence interval (CI): 1.12-1.82]. However, the risk of depression did not increase in patients who received treatment for acromegaly. The multiple Cox regression analysis showed that the risk of depression was significantly higher in the untreated group than in the control group during the first three years of observation (HR: 1.829; 95% CI: 1.305-2.563). However, after a time lag of over 3 years, the risk of depression decreased in the untreated group, which is similar to that in the control group. Our nationwide study suggests that patients who did not receive treatment for acromegaly have a higher risk of depression compared with controls. The untreated acromegaly patients should be monitored for the development of depression, especially in the early years after diagnosis. These results could serve as a basis for developing screening strategies to mitigate depression in acromegaly patients.

Effect of smoking on the development of chronic obstructive pulmonary disease in young individuals: a nationwide cohort study.

Cigarette smoking is an important risk factor for developing chronic obstructive pulmonary disease (COPD). However, the effect of smoking on the development of COPD in young individuals remains unclear. We aimed to evaluate the effect of smoking on COPD development in young individuals. Using the Korean National Health Information Database, we screened individuals aged 20-39 years who participated in the national health check-up between 2009 and 2012. We defined physician-diagnosed COPD based on health insurance claims and searched the database until December 2019. We identified 6,307,576 eligible individuals, and 13,789 had newly developed COPD. We used multivariate Cox proportional hazards models to estimate the adjusted hazard ratio (aHR) of risk factors for COPD. The incidence rate for developing COPD was 0.26/1000 person-year. The risk of developing COPD was significantly higher in current smokers [aHR 1.46, 95% confidence interval (CI) 1.39-1.53] and former smokers (aHR 1.21, 95% CI 1.14-1.29) than in non-smokers. Furthermore, the risk increased with increasing smoking amounts (≥20 pack-years, aHR 2.24; 10-20 pack-years, aHR 1.55; <10 pack-years, aHR 1.27). Female participants had a higher relative risk of developing COPD due to smoking, compared with their male counterparts. Cigarette smoking increased the risk of developing COPD in young individuals. Current and heavy smokers had higher risks of developing COPD than non-smokers. Female smokers were more likely to develop COPD than male smokers.

Pre-aspirin use has no benefit on the neurological disability and mortality after cardiovascular events: A nation-wide population-based cohort study.

To evaluate the effects of aspirin in the primary prevention, we evaluated disability grades and mortality after ischemic/hemorrhagic stroke and myocardial infarction (MI). A retrospective nation-wide propensity score-matched cohort study was performed using the Korean National Health Information Database. From 3,060,639 subjects who were older than 55 and performed national health examinations in 2004 and 2005, we selected the aspirin group (N = 8770) was composed of patients who had received aspirin prior to cardiovascular events. Cox proportional hazards model was used to compare the acquisition times for neurologic disability grades and survival times between the aspirin and control groups. Only in hemorrhagic stroke, the severe neurologic disability risk was higher in the aspirin group (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.02-1.42). The aspirin group was associated with higher 90-day (HR, 1.33; 95% CI, 1.23-1.44) and long-term mortality risk (HR, 1.06; 95% CI, 1.03-1.10) after pooling 3 events. The old age was a strong risk factor for 90-day mortality in hemorrhagic stroke (50s: reference; 60s: HR 2.21, 95% CI 1.50-3.25; 70s: HR 3.63, 95% CI 2.48-5.30; 80s: HR 6.69, 95% CI 4.54-9.65; >90s: HR 11.28, 95% CI 6.46-19.70). Pre-aspirin use in cardiovascular events has detrimental effects on severe neurological disability in hemorrhagic stroke and short-/long-term mortality in 3 cardiovascular events. The use of aspirin for the primary prevention especially in the elderly should be very cautious because the old age is a strong risk factor for 90-day mortality after hemorrhagic stroke.

40-LB: The Association between Changes in Physical Activity Before and After Thyroidectomy and Incident Type 2 Diabetes in Patients with Thyroid Cancer

Background: Thyroid cancer patients who underwent thyroid-stimulating hormone suppression therapy after thyroidectomy is increased a risk for type 2 diabetes mellitus (T2DM). However, whether the changes in physical activity (PA) before and after thyroidectomy in patients with thyroid cancer are associated with T2DM has not been evaluated yet. We investigated the association between changes in PA before and after thyroidectomy and incident T2DM in patients with thyroid cancer. Methods: An observational cohort study of 69,526 thyroid cancer patients who underwent thyroidectomy between 2010 and 2016 was performed using the Korean National Health Information Database. PA was defined as mid-term or vigorous exercise at least 1 day in a week. PA changes over time were divided into four groups: persistent non-exercisers (n = 18,441), new exercisers (n = 14,599), exercise dropouts (n = 11,023), and exercise maintainers (n = 25,463). Results: During mean 4.5 years of follow-up, the incidences per 1,000 person years of T2DM were lower in patients who performed PA before or after thyroidectomy than persistent non-exercisers (10.77 in persistent non-exerciser group, 8.28 in new exerciser group, 8.59 in exercise dropout group, and 7.61 in exercise maintainer group). Compared with the persistent non-exerciser group, the exercise dropout group (adjusted hazard ratio [aHR] 0.81, 95% confidence interval [CI], 0.72-0.91), new exerciser group (aHR 0.87, 95% CI 0.78-0.97), and the exercise maintainer group (aHR 0.84, 95% CI 0.76-0.93) had lower risks of incident T2DM. When we stratified patients according to energy expenditure, PA with &amp;lt; 1,500 metabolic equivalent of task (MET)-min/week in exercise maintainers was associated with lower risk of incident T2DM than non-exercisers, but PA with ≥ 1,500 MET-min/week was not. Conclusion: In patients with thyroid cancer, PA before or after thyroidectomy was associated with lower risk of incident T2DM. Disclosure J. Park: None. H. Park: None. S. Kim: None. Y. Cho: None. K. Han: None. K. Kim: None.

Mortality risk according to smoking trajectories after cancer diagnosis among Korean male cancer survivors: A population-based cohort study.

Previous research on post-diagnosis smoking among cancer survivors mainly relied on smoking status, which may not fully reflect the impact of changes in smoking levels. This study aimed to evaluate mortality risk according to smoking trajectories among Korean male cancer survivors, using a trajectory approach to comprehensively capture smoking patterns. The study included 110555 men diagnosed with cancer between 2002 and 2018 from the Korean National Health Information Database. Group-based trajectory modelling was used to identify post-diagnosis smoking trajectories among pre-diagnosis current smokers (n=45331). Cox hazards models were fitted to evaluate mortality risk according to smoking trajectories for pooled cancers, pooled smoking-related cancers, smoking-unrelated cancers, and gastric, colorectal, liver, and lung cancers. Smoking trajectories included light-smoking quitters, heavy-smoking quitters, consistent moderate smokers, and decreasing heavy smokers. Smoking significantly increased all-cause and cancer mortality risks in cancer patients for pooled cancers, pooled smoking-related cancers, and pooled smoking-unrelated cancers. Compared to non-smokers, all-cause mortality risk for pooled cancers significantly increased according to smoking trajectories:(AHR=1.33; 95% CI: 1.27-1.40), (AHR=1.39; 95% CI: 1.34-1.44), (AHR=1.44; 95% CI: 1.34-1.54), and (AHR=1.47; 95% CI: 1.36-1.60), respectively. Smoking increased all-cause and cancer mortality risks in gastric and colorectal cancer patients and cancer-specific mortality in lung cancer patients. The significant associations of smoking trajectories with all-cause and cancer mortality risks were primarily observed in 5-year survivors but not in short-term survivors. Among heavy smokers, smoking cessation significantly reduced all-cause mortality risk in the long-term. The post-diagnosis smoking trajectory independently predicts cancer prognosis among male cancer patients. Proactive cessation support should be strengthened, particularly for those who smoke heavily.

Anti-seizure medication prescription in epilepsy patients in South Korea: A seven-year population-based retrospective cohort study

Background and ObjectivesThis study aimed to explore the natural history of patients with epilepsy using overall antiseizure-medication (ASM) treatment patterns on a nationwide scale in South Korea. MethodsWe investigated a retrospective longitudinal cohort of patients with epilepsy in South Korea using nationwide data from the Korean National Health Information Database of the Health Insurance and Review Assessment Service between January 1st, 2009, and December 31st, 2018. Histories of each patient's ASM prescription were followed for up to 7 years from the index date, the first observed date of ICD-10 epilepsy diagnosis codes with at least one ASM prescription. ResultsOf 82,390 incident patients analyzed, ten thousand and fifty-nine were followed up to seven years, and nearly 60% of them discontinued the ASM(s). The proportion of patients with possible drug-resistant epilepsy (DRE), who experience three or more types of ASMs, gradually increased, reaching approximately 8.8% of the total number of patients in the seventh year (6.45% for adults, 21.8% for children). The duration of progression for half of the patients with possible DRE was 1.29 years for children, 1.79 years for adults, and 1.62 years for mixed-age patients. However, even in the sixth year, 72 cases progressed to possible DRE, and 6 cases with possible DRE discontinued ASMs in the next year, showing a dynamic process. DiscussionOur population-based study showed the dynamic changes of anti-seizure medication prescription in epilepsy patients with real-world data, which slowly stabilizes over years after the first diagnosis of epilepsy.