Korean National Health Insurance Claims Research Articles

Effect of the Presence of Emergency Departments with 300 or More Hospital Beds in Health Service Areas on 30-Day Mortality in Korea: A Nationwide Retrospective Cross-sectional Study.

Disparities in emergency care accessibility exist between health service areas (HSAs). There is limited evidence on whether the presence of an emergency department (ED) that exceeds a certain hospital bed capacity is associated with emergency patient outcomes at the regional level. The objective of this study was to evaluate the effect of HSAs with or without of regional or local emergency centers with 300 or more hospital beds (EC300 or nEC300, respectively) by comparing the 30-day mortality of patients with severe emergency diseases (SEDs) admitted to the hospital through the ED. The study retrospectively evaluated data from the Korean National Health Insurance Claims database and enrolled patients who were admitted from the ED for SEDs. SEDs were defined using ICD-10 codes for 28 disease categories with high severity, and 56 HSAs were designated as published by the Korean National Health Insurance Service. We performed hierarchical logistic regression analysis using multilevel models with the generalized linear mixed model (GLIMMIX) procedure to evaluate whether EC300 was associated with the 30-day mortality of SED patients, adjusting for patient-level, prehospital-level, hospital-level, and HSA-level variables. In total, 662,478 patients were analyzed, of whom 54,839 (8.3%) died within 30 days after hospital discharge. Of the 56 HSAs, 46 (82.1%) were included in the EC300 group. After adjustment for patient-level, prehospital-level, hospital-level and HSA-level variables, nEC300 was significantly associated with increased 30-day mortality in SED patients (AOR: 1.33, 95% CI: 1.137-1.153). In addition, patients who visited EDs with fewer annual SED admissions were associated with higher 30-day mortality. nEC300 had a greater risk of 30-day mortality in patients treated with SEDs than EC300. The results indicate that not only the number of EDs in each HSA is important for ensuring adequate patient outcomes but also the presence of EDs with adequate receiving capacity.

Treatment compliance, treatment patterns, and healthcare utilization in epilepsy patients with first add-on antiepileptic drugs: A nationwide cohort study

ObjectiveThis study aimed to assess the treatment compliance, patterns, healthcare resource utilization (HCRU), and costs of anti-epilepsy drugs (AEDs) as the first add-on therapy in patients with epilepsy. MethodsWe conducted a retrospective population-based cohort study using Korean National Health Insurance claims data from 2016 to 2020. Patients with epilepsy who newly received AED add-on therapy were identified and followed for up to 12 months to evaluate persistence, adherence, treatment patterns, HCRU, and costs. ResultsAmong 6,746 patients who initiated AED add-on therapy, 65.5% were persistent on their index AED add-on from the index date until the end of the follow-up period, and the mean persistent time on the index add-on was 307.3 ± 92.3 days. A total of 76.8% patients were adherent, with a medication possession ratio (MPR) ≥80%, and the mean MPR was 88.9 ± 25.4%. Persistence and adherence to the index AED add-on were relatively higher among patients prescribed lamotrigine, levetiracetam, oxcarbazepine, and perampanel than those prescribed carbamazepine, topiramate, or valproate. A total of 41.0% of the patients changed their index AED add-on during the follow-up period. The carbamazepine, topiramate, and valproate groups had higher rates of change than the other AED groups. HCRU and costs tended to be lower in the lamotrigine, levetiracetam, oxcarbazepine, and perampanel groups. Furthermore, perampanel showed the lowest HCRU and costs for all-cause cases as well as the lowest length of stay and outpatient visits for epilepsy-related cases. ConclusionIn this population-based study, the use of lamotrigine, levetiracetam, oxcarbazepine, or perampanel as the first add-on therapy in patients with epilepsy contributed to better treatment compliance and lower HCRU and costs than that of carbamazepine, topiramate, or valproate.

Cost-effectiveness of improving patients’ adherence to tuberculosis treatment in South Korea using discrete event simulation

BackgroundPoor adherence to tuberculosis (TB) treatment is an obstacle to controlling the disease. The Korean government’s national TB control plan includes a program on adherence to TB treatment to manage patients with TB. This study aimed to assess the cost-effectiveness of a national TB program for improving patient adherence. MethodsA discrete event simulation (DES) model was developed to estimate the costs and quality-adjusted life-years (QALYs) of adherent and non-adherent patients. In this model, we considered treatment completion, loss to follow-up, recurrence, death, and treatment changes from drug-susceptible to multidrug-resistant TB as clinical events. We obtained input parameters such as costs, probability of events, and time distributions for each event from the Korean National Health Insurance claims data. We estimated the costs and QALYs before implementation of the program (adherence rate = 79%) and at present (current adherence rate = 94%). The incremental cost-effectiveness ratio (ICER) was used to evaluate whether the program was cost-effective given the willingness-to-pay threshold. ResultsIn the simulation, the program increasing the proportion of adherent patients gained 0.018 QALY/patient while spending $162/patient. The ICER of the TB program was $8790/QALY. Given a willingness-to-pay threshold of $20,000, the national TB program was considered cost-effective. ConclusionImprovements in adherence to TB treatment through the current TB program were cost-effective. The DES model accurately reflected the real world. Commitment programs to improve patient adherence may help manage TB nationwide.

Comparison of the Efficacy of Ezetimibe Combination Therapy and High-Intensity Statin Monotherapy in Type 2 Diabetes.

Low-density lipoprotein cholesterol (LDL-C)-lowering therapy is considerably important in preventing cardiovascular disease (CVD) among patients with diabetes. Studies comparing CVD, stroke, and mortality outcomes of low- or moderate-intensity statins with ezetimibe combination therapy and high-intensity statin monotherapy in patients with diabetes remain lacking. This study compared the primary prevention effect of myocardial infarction (MI), stroke, and all-cause death between combination therapy of low- or moderate-intensity statins and ezetimibe and high-intensity statin monotherapy in patients with diabetes using the Korean National Health Insurance claims database. Patients aged ≥20 years with type 2 diabetes and dyslipidemia were enrolled. The combination therapy of low- or moderate-intensity statin and ezetimibe was compared with high-intensity statin monotherapy after a propensity score-matched analysis. The incidence of composite outcomes consisting of MI, stroke, and all-cause death and each component were analyzed. In moderate-intensity statin therapy with ezetimibe combination therapy, LDL-C (74 ± 37.9 mg/dL vs 80.8 ± 38.8 mg/dL, P < .001) and the incidence of composite outcomes were lower (hazard ratio 0.85, 95% CI 0.74-0.98) than those in high-intensity statin monotherapy. Meanwhile, no significant difference was observed in the LDL-C levels and composite outcomes between low-intensity statins with ezetimibe combination therapy and high-intensity statin monotherapy. Adding ezetimibe to a moderate-intensity statin in patients with type 2 diabetes has a greater LDL-C-lowering effect and greater primary prevention of composite outcomes than that of high-intensity statin monotherapy.

Antimicrobial Use and Carbapenem-Resistant Enterobacterales in Korea: A Nationwide Case-Control Study With Propensity Score Matching.

Nationwide research on the association between carbapenem-resistant Enterobacterales (CREs) and antibiotic use is limited. This nested case-control study analyzed Korean National Health Insurance claims data from April 2017 to April 2019. Based on the occurrence of CRE, hospitalized patients aged ≥ 18 years were classified into CRE (cases) and control groups. Propensity scores based on age, sex, modified Charlson comorbidity score, insurance type, long-term care facility, intensive care unit stay, and acquisition of vancomycin-resistant Enterococci were used to match the case and control groups (1:3). After matching, the study included 6,476 participants (1,619 cases and 4,857 controls). Multivariable logistic regression analysis revealed that the utilization of broad-spectrum antibiotics, such as piperacillin/tazobactam (adjusted odds ratio [aOR], 2.178; 95% confidence interval [CI], 1.829-2.594), third/fourth generation cephalosporins (aOR, 1.764; 95% CI, 1.514-2.056), and carbapenems (aOR, 1.775; 95% CI, 1.454-2.165), as well as the presence of comorbidities (diabetes [aOR, 1.237; 95% CI, 1.061-1.443], hemiplegia or paraplegia [aOR, 1.370; 95% CI, 1.119-1.679], kidney disease [aOR, 1.312; 95% CI, 1.105-1.559], and liver disease [aOR, 1.431; 95% CI, 1.073-1.908]), were significantly associated with the development of CRE. Additionally, the CRE group had higher mortality (8.33 vs. 3.32 incidence rate per 100 person-months, P < 0.001) and a total cost of healthcare utilization per person-month (15,325,491 ± 23,587,378 vs. 5,263,373 ± 14,070,118 KRW, P < 0.001) than the control group. The utilization of broad-spectrum antibiotics and the presence of comorbidities are associated with increasing development of CRE. This study emphasizes the importance of antimicrobial stewardship in reducing broad-spectrum antibiotic use and CRE disease burden in Korea.

Seasonality and Association With Climate Factors of Epiglottitis in South Korea: A Nationwide Population-Based Study

Background and Objectives The seasonality and climatic relevance of epiglottitis have not yet been fully investigated in a population-based cohort. This study aimed to examine the seasonality of epiglottitis and explore associated climatic factors.Materials and Method In a retrospective cohort study using the Korean National Health Insurance claims database from January 2010 to December 2019, we identified patients with epiglottitis who claimed the following diagnostic codes as a principal or first additional diagnosis: International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes J0510, J0510.001 (acute epiglottitis without obstruction, epiglottitis not otherwise specified), and J0511 (acute epiglottitis with obstruction). We calculated the seasonal ratio as the ratio of the highest to the lowest number of patients per month to compare the degree of seasonality. In addition, the climate data points corresponding to each month were obtained. Thus, we analyzed the correlations between the monthly patient numbers for each disease and various climatic factors.Results There were seasonal variations in the number of patients with epiglottitis, which were highest from winter to spring and lowest in summer. The prevalence of epiglottitis was strongly correlated with the average temperature, ground temperature, relative humidity, precipitation, daily temperature range, and sunlight rate. Additionally, epiglottitis was most prevalent in the &lt;9 age group before 2013, but after 2013, it was most prevalent in the 30–39 age group.Conclusion This large population-based study demonstrated clear seasonality and climatic association in patients with epiglottitis. Further studies exploring the detailed demographic factors affecting epiglottitis are required to address similar diseases more effectively.

Carotid artery stenting has a lower risk of severe acute kidney injury than percutaneous coronary intervention: Based on Korean national health insurance claims database

Carotid artery stenting has a lower risk of severe acute kidney injury than percutaneous coronary intervention: Based on Korean national health insurance claims database

Association Between Three Atopic Triad and Retinal Vein Occlusion Risk: A Nationwide Population-Based Study

ABSTRACT Purpose To evaluate the association between three allergic diseases (allergic dermatitis, allergic rhinitis, and asthma) and the development of retinal vein occlusion (RVO), a major retinal disease that causes visual impairment. Method This study used data obtained from the Korean National Health Insurance Claims database between 2009 and 2018. The association between the three atopic triads (allergic dermatitis, allergic rhinitis, and asthma) and the occurrence of sight-threatening RVO, as determined by diagnostic and treatment codes, were analyzed. Multivariate adjusted Cox regression analysis was used to determine the hazard ratios (HRs) and 95% confidence intervals for RVO development in the presence of allergic disease. Results In this population-based study, 2,160,195 (54.6%) individuals were male, 1,794,968 (45.4%) were female, and 620,938 (15.7%) were diagnosed with allergic diseases. Patients with either asthma or allergic rhinitis had a greater risk of RVO (adjusted hazard ratio (aHR) = 1.101, 95% confidence interval [CI] = 1.029–1.178 for asthma; aHR = 1.181, 95% CI = 1.147–1.215 for allergic rhinitis) compared to those without asthma or allergic rhinitis; however, patients with atopic dermatitis did not show a significant association with RVO (aHR = 1.071, 95% CI = 0.889–1.290), after adjusting for other risk factors. Conclusion Our study revealed that allergic rhinitis, asthma, and coexisting multiple allergic conditions were associated with an increased risk of RVO. Thus, it may be advisable to suggest an ophthalmological examination for patients with allergies due to the increased possibility of the occurrence of retinal vascular disease.

The Transfer Patterns of Vulnerable Populations with Acute Cardio-Cerebrovascular Diseases

Abstract Background In Korea, cardio-cerebrovascular diseases (CCDs) are the second leading cause of death. As providing appropriate treatment within the golden hour is crucial for managing acute onset CCDs, health outcomes vary depending on the accessibility of hospital. This study aimed to investigate the healthcare accessibility of vulnerable populations based on the transfer patterns with acute CCDs. Methods We analyzed the transfer times to final treatment hospital using the Korean National Health Insurance claim database from 2016 to 2021. We used multivariate logistic regression analysis on whether patients were transferred between hospitals after adjusting for age, gender, income level, and residence. Results The risk of transfer between hospitals was lower in socially vulnerable groups (elderly, low-income groups, and people with disabilities) compared to other groups (adjusted Odds Ratio [aOR]=0.65; 95% Confidence Interval [CI] 0.64-0.67 for people with disabilities vs people without disabilities), while it was higher in geographically vulnerable groups (rural) compared to other groups (aOR=2.05; [CI] 2.01-2.09 for rural vs metropolitan). Additionally, people with mild disabilities and those with visual, hearing, language, or physical disabilities showed higher transfer risk compared to other groups. Conclusions The risk of transfer showed opposite patterns between the two vulnerable groups with high mortality rates. The geographically vulnerable group had a higher risk due to absence treatable hospitals, while the socially vulnerable group might not have transferred even when it was necessary due to economic and physical constraints. The possibility of transfer was higher among the high-income group, which was assumed to be transferred to hospitals with better medical services. In fact, among patients hospitalized at teaching hospitals, 40% belong to the top 20% of income level. Efforts to improve accessibility for all in medical services should be continued. Key messages • The risk of being transferred between hospitals showed opposite patterns between socially vulnerable and geographically vulnerable groups with high mortality rates. • Measures are needed to improve access to quality hospitals, and monitoring is necessary for situations where necessary transfers are not carried out.

Disparities in cardiovascular mortality after diagnosed depression among people with disability

Abstract Background Persons with depression are more likely to eventually develop CVD or CVD related deaths. Depression history could be said a predictor or marker of cardiometabolic risk. However, potential disparities in cardiovascular mortality after diagnosis depression among people with and without disability rarely haven't been investigated. Methods We conducted a retrospective cohort study with a data set linking the National Disability Database, the Korean National Health Insurance Claims Database, and Cause of Death Database. To identify cases of depression and cardiovascular mortality, we used the ICD-10 code. Results Even after excluding people with brain injury and heart problems, people with disabilities had a 2.82 times higher cardiovascular specific mortality than the non-disabled (6.5 vs 2.3 people per 1000), especially in those with severe disabilities (7.5 vs 2.3 people per 1000). In survival analysis, the median survival time was 78.6 months and 71.6 months in the non-disabled and those with severe disability, respectively (Log-rank, p&amp;lt;.0001). This higher likelihood was more evident for people with severe disability(aHR=2.02, p&amp;lt;.0001), disability due to renal failure (aHR=3.43, p&amp;lt;.0001), speech and language disabilities (aHR=2.67, p&amp;lt;.0001), and hearing disabilities (aHR=2.29, p&amp;lt;.0001). Conclusions Although people with disabilities were known to be in poor health, disparities were found in cardiovascular mortality after depression history, especially in severe disabilities, renal failure, speech and language, and/or hearing disabilities. This emphasizes the importance of regular screening for cardiovascular risk factors in the disabled with depression, and we should do more efforts to develop policies supporting mental and cardiovascular health. Key messages • Patients with disabilities had a higher cardiovascular diseases specific mortality, and had a shorter survival time than the non-disabled. • Patients with severe disabilities, renal failure, speech and language, and/or hearing disabilities had a higher cardiovascular diseases specific mortality.

Impact of Periodontal Treatment and Demographic and Socioeconomic Factors on Tooth Loss in Persons with Disabilities: An Analysis of Korean National Health Insurance Claims Data

Impact of Periodontal Treatment and Demographic and Socioeconomic Factors on Tooth Loss in Persons with Disabilities: An Analysis of Korean National Health Insurance Claims Data

Diagnostic trends of preoperative venous thromboembolism and its clinical implications in patients who underwent surgery for degenerative spinal diseases

BACKGROUND CONTEXTAlthough the risk of postoperative venous thromboembolism (VTE) in patients who undergo surgery for degenerative spinal disease has received attention, patients experiencing prolonged pain and disability while awaiting or considering surgery have not received adequate attention regarding the risk of VTE. PURPOSETo investigate the epidemiology of preoperative VTE in patients undergoing surgery for degenerative spinal disease. DESIGNRetrospective cohort study using a nationwide database. PATIENT SAMPLEPatients who underwent surgery for degenerative spinal disease. OUTCOME MEASURESPreoperative occurrence of VTE. METHODSData from 2014 to 2018 were obtained from the Korean National Health Insurance claims database. The occurrence of preoperative VTE within a 1-year period divided into 12 time intervals of 30 days each was investigated. The patients were categorized into two groups based on the presence of preoperative VTE. Multivariable logistic regression analysis was conducted to identify the factors associated with preoperative VTE. To validate the relationship between degenerative spinal disease and preoperative VTE, the diagnostic trends of preoperative VTE were analyzed in accordance with the identified risk factors. RESULTSThe overall incidence of preoperative VTE was 50 per 10,000 individuals. Multivariable analysis revealed that VTE occurred more frequently in older patients with specific medical comorbidities, particularly in those with a lumbar spinal lesion accompanied by arthritis of the hip, knee, or shoulder. We also found that the incidence rates of preoperative VTE, as well as the gradient of their increase, began to rise approximately 2 to 3 months prior to the index surgery, peaking just before the index surgery. This diagnostic trend was consistently observed in all patients irrespective of the presence of other risk factors. CONCLUSIONSThe incidence of preoperative VTE in patients with degenerative spinal disease exhibited a sharp increase immediately before surgery, with similar rates to those of postoperative VTE. Clinicians managing patients with degenerative spinal disease should be vigilant for preoperative as well as postoperative VTE.

Association between cardio-cerebrovascular disease and systemic antipsoriatic therapy in psoriasis patients using population-based data: A nested case-control study.

The effect of antipsoriatic therapy on cardio-cerebrovascular disease (CCVD) is not well described. Thus, we performed a population-based nested case-control study to investigate the effect of systemic antipsoriatic therapy on CCVD in psoriasis patients. Using nationwide cohort data from the Korean National Health Insurance Claims database, newly diagnosed psoriasis patients were identified. Among the enrolled participants, postenrollment development of CCVD events (ischemic heart disease, myocardial infarction, cerebral infarction, and cerebral hemorrhage) was investigated. To evaluate the effect of systemic antipsoriatic therapy on CCVD risk, we calculated the proportion of the treatment period with systemic antipsoriatic therapy during the study period (PTP [%]: the sum of all systemic antipsoriatic therapy durations divided by total observation period). Among 251 813 participants, 6262 experienced CCVD events during the study period (CCVD group). Controls included 245 551 patients without CCVD history during the study period (non-CCVD group). The non-CCVD group had greater PTP than the CCVD group (CCVD 2.12 ± 7.92, non-CCVD 2.64 ± 9.64; P < 0.001). In multiple logistic regression analysis, PTP was inversely associated with the CCVD risk after adjusting for age, sex, diabetes, hypertension, and dyslipidemia. A 10% increase in PTP reduced CCVD risk by 0.96 (95% confidence interval 0.93 to 0.99). Reduced CCVD risk was robust for both conventional antipsoriatic therapy and biologics. Our study found that systemic antipsoriatic therapy use was inversely associated with CCVD risk in psoriasis patients. These findings suggested that systemic antipsoriatic therapy could reduce CCVD development in patients with psoriasis.

Incidence and Features of Lymphoid Proliferation and Lymphomas after Solid Organ or Hematopoietic Stem Cell Transplantation in a National Database Cohort.

Post-transplantation lymphoproliferative disorders (PTLDs) after hematopoietic stem transplantation (HCT) or solid organ transplantation (SOT) result in poorer outcomes, including death. There are limited large cohort data on the incidence and natural course of PTLD in Asians. We investigated PTLD using Korean national health insurance claims data of 47,518 patients who underwent HCT or SOT in 2008-2020. Patient demographics, time and type of PTLD diagnosis, type of PTLD treatment, and death data were collected. We used Fine and Gray subdistribution hazard models to calculate the cumulative incidence and risk factors for PTLD. During median follow-up of 5.32 years, PTLD occurred in 294 of 36,945 SOT patients (0.79%) and 235 of 10,573 HCT patients (2.22%). Cumulative incidence of PTLD were 0.49% at 1 year, 1.02% at 5 years, and 1.50% at 10 years post-transplantation. Age < 20 years (subdistribution hazard ratio [SHR] of 1.67 in age 10-19, SHR 1.51 in age 0-9), HCT (SHR 3.02), heart transplantation (SHR 2.27), and liver transplantation (SHR 1.47) were significant risk factors for PTLD. The presence of PTLD was associated with an increased risk of death (hazard ratio of 2.84). Overall, 5-year survival of PTLD patients was 68.9% (95% confidence interval, 64.9 to 73.2). We observed a steady increase in PTLD over 10 years after HCT or SOT in this large cohort study. Pediatric age group, HCT, liver transplantation, and heart transplantation were suggested to be risk factors for PTLD, and PTLD was associated with a higher risk of death.

Association of physical activity with total and cause-specific mortality in patients with diabetes: A nationwide population-based cohort study

AimsPhysical inactivity is a modifiable risk factor for cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM); however, little is known about its association with mortality due to other causes. Herein, we investigated the association between physical activity (PA) and cause-specific mortality in patients with T2DM. MethodsWe analyzed data from the Korean National Health Insurance Service and claims database of adults with T2DM aged >20 years at baseline (n = 2,651,214). Each participant’s PA volume was measured as the metabolic equivalent of tasks (METs)-min per week, and hazard ratios of all-cause and cause-specific mortality relative to PA levels were estimated. ResultsDuring the 7.8 years of follow-up, all-cause, CVD, respiratory, cancer, and other causes of mortality were lowest in patients engaged in vigorous PA. MET-min/week was inversely associated with mortality after adjusting for covariates. The reduction in total and cause-specific mortality was greater in patients aged ≥65 years than in those aged <65 years. ConclusionsIncreasing PA may facilitate a reduction in mortality from various causes, especially among older patients with T2DM. Clinicians should encourage such patients to increase their daily PA levels to reduce their risk of mortality.

Disparity of Bladder Cancer Incidence Among Male Workers Across Industries: A Population Based Cohort Study From South Korea.

This study aimed to investigate the bladder cancer risk across workers' industries. This study was conducted using Korean National Health Insurance claims data. Workers were included in this study to build a retrospective cohort of the entire working population. Workers' industries were divided into 77 industries according to the Korean Standard Industry Classification division category. The standardized incidence ratio was calculated by comparing 77 industries according to the Korean Standard Industry Classification with the educational public officer. Bladder cancer risk was particularly high in the following industrial sectors: passenger land transport, except transport via railways; sea and coastal water transport; restaurants and mobile food service activities; telecommunications; and computer programming, consultancy, and related activities. Our result provides evidence regarding the disparity of bladder cancer incidence among male workers across industries.

Elevated risk of cervical cancer in elderly women with incident ulcerative colitis in South Korea

The association between ulcerative colitis (UC) and uterine cervical cancer is still unclear. To investigate cervical cancer risk in South Korean women with UC, we analyzed the Korean National Health Insurance claims data. UC was defined using both ICD-10 codes and UC-specific prescriptions. We analyzed incident cases of UC diagnosed between 2006 and 2015. Age-matched women without UC (control group) were randomly selected from the general population (1:3 ratio). Hazard ratios were calculated using multivariate Cox proportional hazard regression, and the event was defined as occurrence of cervical cancer. A total of 12,632 women with UC and 36,797 women without UC were enrolled. The incidence of cervical cancer was 38.8 per 100,000 women per year in UC patients and 25.7 per 100,000 women per year in controls, respectively. The adjusted HR for cervical cancer was 1.56 (95% CI 0.97–2.50) in the UC group with reference to the control group. When stratified by age, the adjusted HR for cervical cancer was 3.65 (95% CI 1.54–8.66) in elderly UC patients (≥ 60 years) compared to elderly control group (≥ 60 years). Within UC patients, increased age (≥ 40 years) and low socioeconomic status were associated with an increased risk of cervical cancer. The incidence of cervical cancer was found to be higher among elderly patients (≥ 60 years) with newly diagnosed UC in South Korea, compared to age-matched controls. Therefore, regular cervical cancer screening is recommended for elderly patients who have recently been diagnosed with UC.

Risk of adverse obstetric outcomes in patients with a history of endometrial cancer: A nationwide population-based cohort study.

To evaluate adverse obstetric outcomes in women with a history of endometrial cancer (EC). Population-based cohort study. The Korean National Health Insurance (KNHI) claims database. Women who gave birth between 2009 and 2016, with a history of EC prior to pregnancy. The KNHI database was used to compare obstetric outcomes of women with and without a history of EC, using the ICD-10 codes. Multivariable logistic regression models were used to determine the associations between a history of EC and adverse obstetric outcomes. Adverse obstetric outcomes. Overall, 248 and 3 335 359 women with and without a history of EC, respectively, gave birth. When adjusted for age, primiparity and comorbidities, an increased risk of multiple gestations (odds ratio [OR] 4.925, 95% confidence interval [CI] 3.394-7.147), caesarean delivery (OR 2.005, 95% CI 1.535-2.62) and preterm birth (OR 1.941, 95% CI 1.107-3.404) was observed among women with a history of EC. We were unable to demonstrate significant differences in the risk of pre-eclampsia, gestational diabetes, vacuum delivery, placenta praevia, placenta accreta spectrum, placental abruption and postpartum haemorrhage between the groups. In the sensitivity analyses excluding multiple gestations, an increased risk of preterm birth was not observed among women with a history of EC (OR 1.276, 95% CI 0.565-2.881). There is no convincing evidence of an increased risk of adverse obstetric outcomes among women with a history of EC. Our findings would be useful in counselling of patients with EC who are undergoing fertility-sparing treatment.

Comparison of pneumonia incidence between long-acting muscarinic antagonist and inhaled corticosteroid plus long-acting beta agonist in patients with COPD

Few studies have directly compared the incidence of pneumonia in patients on common chronic obstructive pulmonary disease (COPD) treatments such as long-acting muscarinic antagonists (LAMA) with those on inhaled corticosteroids and long-acting β2-agonist (ICS/LABA). Moreover, risk factors for pneumonia in COPD are still unclear. We aimed to compare the incidence of pneumonia in COPD patients on LAMA and those on ICS/LABA and explored the risk factors associated with pneumonia. This nationwide cohort study used Korean National Health Insurance claim data from January 2002 to April 2016. Patients who received COPD medication, either LAMA or ICS/LABA, with the COPD diagnostic code, were selected. We enrolled patients with good compliance (medication possession ratio ≥ 80%). The primary outcome was pneumonia in COPD patients initiating LAMA or ICS/LABA. We investigated the risk factors associated with pneumonia, including the sub-types of ICS treatments. After propensity score matching, the incidence rate per 1000 person-years of pneumonia was 93.96 for LAMA (n = 1003) and 136.42 for ICS/LABA (n = 1003) patients (p < 0.001). The adjusted hazard ratio (HR) for pneumonia in patients on fluticasone/LABA was 1.496 (95% confidence interval [CI] 1.204–1.859) compared with LAMA (p < 0.001). In multivariable analysis, a history of pneumonia was a risk factor associated with pneumonia (HR 2.123; 95% CI 1.580–2.852; p < 0.001). The incidence of pneumonia was higher in COPD patients on ICS/LABA compared with those on LAMA. It is recommended that ICS use be avoided in COPD patients with high pneumonia risk.

Longitudinal trends in direct costs and healthcare utilization ascribable to inflammatory bowel disease in the biologic era: a nationwide, population-based study.

Biologic-era data regarding the direct cost and healthcare utilization of inflammatory bowel disease at the population level are limited, especially in Asia. Thus, we aimed to investigate the nationwide prevalence, direct cost, and healthcare utilization of inflammatory bowel disease in Korea in a recent 10-year period. Using the Korean National Health Insurance claim data from 2008 to 2017, we investigated all prescription medications and their associated direct costs, hospitalizations, and outpatient visits. We also estimated the nationwide prevalence of inflammatory bowel disease using population census data. The estimated inflammatory bowel disease prevalence significantly increased from 108.8/100 000 in 2008 to 140.4/100 000 in 2017. The overall annual costs for inflammatory bowel disease and the healthcare cost per capita increased from $24.5 million (in US dollars) to $105.1 million and from $458.4 to $1456.6 million, respectively (both P<0.001). Whereas the ratio of outpatient costs increased from 35.3% to 69.4%, that of outpatient days remained steady. The total annual medication cost and proportion rose from $13.3 million to $76.8 million and from 54.2% to 73.3%, respectively, mainly due to the increasing antitumor necrosis factor cost, from $1.5 million to $49.3 million (from 11.1% to 64.1% of the total annual drug cost and from 6.3% to 46.9% of the total annual cost). We observed increasing trends in the prevalence, direct costs, and healthcare utilization of inflammatory bowel disease in Korea in recent years. The attributable cost was mainly driven by rising expenditures on antitumor necrosis factor medications.