National Health Insurance Service Database Research Articles (Page 1)

Background: While early surgical repair in tetralogy of Fallot (TOF) is increasingly favored, the long-term impact of surgical strategy—particularly on extracardiac organs—remains unclear. This study aimed to compare neurologic, pulmonary, renal, hepatic, and developmental outcomes between initial total correction and staged repair in neonates with TOF. Methods: We analyzed data from the Korean National Health Insurance Service database (2005–2021), including all infants diagnosed with TOF within the first year of life. Patients were grouped by surgical strategy: (1) initial total correction within 30 days of diagnosis and (2) staged repair, defined as PDA stent or shunt followed by total correction. Primary outcomes were extracardiac complications identified by ICD-10 codes. Multivariable Cox regression models were used to estimate adjusted hazard ratios (HRs), with subgroup analyses for patients undergoing intervention within 1 and 3 months of diagnosis. Results: Among 2,496 patients who underwent total correction, the staged repair group had significantly higher risks of neurologic (HR 6.08; 95% CI, 3.43–10.78), renal (HR 9.95; 95% CI, 4.79–20.66), and developmental (HR 1.70; 95% CI, 1.42–2.03) complications compared to the initial correction group. These associations persisted across early intervention subgroups. Pulmonary and hepatic complications showed no significant difference. Independent predictors of adverse outcomes included low birth weight and presence of genetic disorders. Conclusions: In this nationwide study, staged repair in TOF was associated with substantially greater long-term risk of renal, neurologic, and developmental complications, even in infants requiring early intervention. These findings support consideration of extracardiac morbidity—not just cardiac survival—when selecting surgical timing in TOF.

BACKGROUND: The association between breast cancer diagnosis, treatment, and the risk of incident ischemic stroke remains unclear. We aimed to investigate ischemic stroke risk among breast cancer survivors and evaluate the association by age, follow-up duration, and cancer treatments. METHODS: Using the Korean National Health Insurance Service database, we studied 113,232 women newly diagnosed with breast cancer (aged ≥18 years) without prior stroke history who underwent breast cancer surgery between January 2010 and December 2016. Each was matched 1:3 by birth year to a cancer-free female population (n=322,818). Subdistribution hazard ratios (sHRs) and 95% confidence intervals (CIs) were estimated, accounting for death as a competing risk and adjusting for sociodemographic factors and cardiovascular and noncardiovascular comorbidities. RESULTS: Over a mean follow-up of 7.2 years, ischemic stroke occurred in 1,155 (1.0%) breast cancer surgery survivors. Overall, breast cancer survivors had a slightly lower risk of stroke than cancer-free women (sHR 0.94; 95% CI 0.88–1.00). However, stroke risk was elevated in the short term following diagnosis (sHR 1.59, 95% CI 1.34–1.89 at 1 year; sHR 1.17, 95% CI 1.05–1.30 at 3 years) across all age groups, with stronger associations observed at 3 and 6 months post-diagnosis. A reduced risk was observed after 1 year in a landmark analysis that included only individuals event-free at the 1-year follow-up (sHR 0.87, 95% CI 0.81–0.93). Among breast cancer survivors, treatment with anthracycline (sHR 1.25) and the combination of tamoxifen and aromatase inhibitors (sHR 1.49) were associated with increased stroke risk, whereas radiation therapy was associated with decreased risk (sHR 0.84). These associations weakened and became nonsignificant after 1 year. Stroke risk was also higher in breast cancer survivors with low income, hypertension, diabetes, or current smoking. CONCLUSION: The association between breast cancer and ischemic stroke risk is time-dependent, with increased short-term risk post-diagnosis and treatment, followed by a decline over time. These findings highlight the importance of proactive stroke risk management, including baseline cardiovascular assessments and ongoing monitoring for thromboembolic events.

Background: Obstructive sleep apnea (OSA) is increasingly recognized as a risk factor for cardiovascular diseases. However, long-term population-based data evaluating its association with a spectrum of cardiovascular outcomes, particularly conduction system disorders, remain limited. Objective: We investigated the 15-year cardiovascular outcomes in patients with OSA using a large-scale nationwide cohort. Methods: We conducted a retrospective cohort study using the Korean National Health Insurance Service database, including 547,749 patients diagnosed with OSA and 2,282,415 matched controls between 2002 and 2020. Following exclusion criteria and 1:1 propensity score matching, 541,812 individuals were included in each group. The primary outcomes were incidence of atrial fibrillation (AF), premature beats, ventricular arrhythmias, atrioventricular block, sinus node dysfunction, heart failure, ischemic heart disease (IHD), and stroke. Cumulative incidence was assessed using Kaplan–Meier survival curves. Hazard ratios (HR) were estimated using Cox proportional hazards models adjusted for relevant covariates. Results: Over a 15-year follow-up period, the OSA group exhibited significantly higher incidence rates of all cardiovascular outcomes than the control group. In the matched cohort, adjusted HR were elevated for AF (1.82 [1.77–1.87]), premature beats (2.25 [2.17–2.34]), ventricular arrhythmias (1.81 [1.64–1.99]), AV block (1.81 [1.64–1.99]), sinus node dysfunction (2.22 [1.96–2.50]), heart failure (1.43 [1.39–1.48]), IHD (1.54 [1.52–1.56]), and stroke (1.20 [1.18–1.22]) (all p < 0.0001). The incidence of conduction disorders, AV block, and sinus node dysfunction nearly doubled in the OSA group. Conclusion: OSA was independently associated with an increased long-term risk of various cardiovascular outcomes, including arrhythmias, ischemic events, and conduction system disorders. This supports the importance of early identification and longitudinal management of cardiovascular risk in this population.

Introduction: Data are scarce regarding the long-term impact of physical activity (PA) change on new and recurrent ischemic events following myocardial infarction (MI). We hypothesized that increased PA was associated with a lower risk of major adverse cardiovascular events (MACE) after MI. Methods: From the Korean National Health Insurance Service database, we identified all incident cases of acute MI in 2009–2019 and included adults aged ≥19 years at first MI who underwent health examinations during a pre-MI look-back and a 2-year post-MI landmark period (Figure A). PA was self-reported at each examination using a modified International PA Questionnaire and was categorized as 0 metabolic equivalent of task (MET)-min/week (inactive), 1–599 MET-min/week (active but not meeting guideline), or ≥600 MET-min/week (active, meeting guideline), or modeled continuously using restricted cubic splines. Primary outcome was the first occurrence of MACE (composite of all-cause death, stroke, or recurrent MI) after the landmark. Secondary outcomes included cardiovascular death, first occurrence of each component of MACE, and total (first and subsequent) occurrence (ie, recurrent event analysis) of MACE. Results: Over a median follow-up of 6.1 years after the 2-year landmark among 62,322 adults who had first MI (median age at landmark, 64 years; 20.3% women), 10,693 primary outcome events occurred. After multivariable adjustment, higher PA levels (1–599 or ≥600 MET-min/week) after first MI were associated with a lower risk of MACE (HR [95% CI]: 0.85 [0.81–0.89] and 0.76 [0.72–0.80], respectively) compared with 0 MET-min/week (Figure B). Participants who increased PA from 0 MET-min/week to 1–599 or ≥600 MET-min/week had a lower risk of MACE than those who remained inactive (HR [95% CI]: 0.85 [0.80–0.91] and 0.81 [0.75–0.87], respectively; Figure C). Conversely, participants who decreased PA from ≥600 MET-min/week to 1–599 or 0 MET-min/week had a higher risk of MACE than those who maintained PA (HR [95% CI]: 1.15 [1.02–1.30] and 1.29 [1.16–1.42], respectively). An inverse dose-response association was observed between PA change and the risk of MACE (Figure D). Findings were consistent for first and total occurrence of secondary outcomes. Conclusions: Increases in PA after MI were associated with a lower risk of MACE, whereas decreases in PA were associated with a higher risk. These findings highlight the importance of promoting PA for long-term secondary prevention after MI.

BackgroundLong-term opioid dependence after critical illness is an emerging concern, yet the incidence and predictors of persistent opioid use among intensive care unit (ICU) survivors remain incompletely characterized. We aimed to estimate the six-month incidence of new persistent opioid use in opioid-naïve ICU survivors and to identify associated risk factors.MethodsWe conducted a retrospective, nationwide cohort study using South Korea’s National Health Insurance Service database. Adults admitted to any ICU between January 1, 2020, and December 31, 2022, were included if they survived to hospital discharge and remained alive for at least six months, with no opioid prescription in the 12 months preceding admission. New persistent opioid use was defined as at least one outpatient opioid prescription within 90 days after discharge and at least one additional prescription between 91 and 180 days. We performed multivariable logistic regression to identify independent predictors.ResultsAmong 567,260 opioid-naïve ICU survivors, 23,945 (4.2%) developed new persistent opioid use within six months. Across the cohort, 22,643 (4.0%) received less-potent opioids (tramadol, dihydrocodeine) and 1,643 (0.3%) received potent opioids (morphine, fentanyl, oxycodone, hydromorphone, methadone). Independent predictors included older age (odds ratio [OR] 1.01 per year; 95% confidence interval [CI], 1.01–1.02; P < 0.001), female sex (OR 1.13; 95% CI, 1.09–1.16; P < 0.001), socioeconomic disadvantage (Medical Aid, OR 1.30; 95% CI, 1.23–1.38; P < 0.001), malignancy (OR 1.05; 95% CI, 1.01–1.09; P = 0.017), metastatic tumor (OR 1.24; 95% CI, 1.15–1.35; P < 0.001), extracorporeal membrane oxygenation (OR 1.80; 95% CI, 1.75–1.89; P < 0.001), and continuous renal replacement therapy (OR 1.24; 95% CI, 1.11–1.37; P < 0.001). The strongest predictor was an early opioid prescription within 30 days of discharge (OR 19.7; 95% CI, 19.1–20.3; P < 0.001). Potency-specific analysis showed potent opioid persistence was largely driven by cancer, while less-potent use was shaped more by demographic and socioeconomic factors.ConclusionsApproximately one in 25 ICU survivors developed new persistent opioid use by six months. Early post-discharge opioid prescription was the dominant risk factor. Risk profiles differed by opioid potency, underscoring the need for early tapering strategies, multimodal non-opioid analgesia, and stewardship programs tailored to patient subgroups and opioid type.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13054-025-05716-w.

The risk of suicide mortality according to income dynamics assessed using health insurance premium data: A nationwide cohort study in Korea.

Association between smoking status and suicide mortality in patients with type 2 diabetes: A nationwide population-based cohort study.

Background/Objectives: Pacemaker-associated heart failure (PaHF) is a recognized complication of chronic ventricular pacing, yet its long-term incidence and prognostic impact remain incompletely defined. Previous studies on PaHF have been largely limited by small sample sizes, single-center designs, and insufficient long-term or time-dependent analyses. We aimed to evaluate the incidence, clinical predictors, and mortality risk of PaHF in a nationwide real-world cohort. Methods: Using the Korean National Health Insurance Service database, we identified 32,216 patients who underwent de novo pacemaker implantation between 2008 and 2019 without prior heart failure. Results: During a median follow-up of 3.8 years, 4170 patients (12.9%) developed new-onset PaHF and 6184 (19.2%) died. PaHF was independently associated with increased all-cause mortality (adjusted hazard ratio [HR]: 3.11, 95% confidence interval [CI]: 2.93–3.32, p &lt; 0.001), even after accounting for immortal-time bias and relevant covariates. The incidence of PaHF and its associated mortality risk both peaked within the first six months post implantation and remained persistently elevated throughout follow-up; notably, PaHF-associated mortality showed a late resurgence. Sensitivity and subgroup analyses consistently demonstrated higher mortality among patients with PaHF across a wide range of clinical characteristics. Conclusions: In this large, nationwide cohort, the development of PaHF was associated with a substantial and sustained increase in mortality risk following pacemaker implantation. Given the persistent and dynamic nature of this risk, longitudinal monitoring of cardiac function and individualized pacing strategies may be warranted to mitigate long-term adverse outcomes. Additionally, these findings provide real-world benchmarks to guide future pacing strategies and surveillance efforts.

Co-prescription of selective serotonin reuptake inhibitors (SSRIs) and second-generation antipsychotics is common in the management of schizophrenia. However, the real-world clinical impact of cytochrome P450 (CYP)-mediated drug-drug interactions (DDIs) remains unclear. We investigated whether the co-prescription of risperidone or aripiprazole with SSRIs that differ in their CYP2D6 inhibition potential is associated with an increased burden of extrapyramidal symptoms (EPS). Using the Korean National Health Insurance Service database (2002-2022), we identified 4100 patients with schizophrenia who were treated with one of four medication combinations: risperidone plus escitalopram (Risp+Esc; n = 1611), risperidone plus fluoxetine/paroxetine (Risp+CYP2D6i; n = 1051), aripiprazole plus escitalopram (Arip+Esc; n = 1025), or aripiprazole plus fluoxetine/paroxetine (Arip+CYP2D6i; n = 413). The primary outcome was the mean proportion of days covered (PDC) by anticholinergic agents, used as a proxy for EPS burden. Groups were compared using multivariate analysis of covariance, adjusting for confounders. The Risp+CYP2D6i group had a significantly higher mean PDC for anticholinergics compared with the Risp+Esc group (56.4% vs. 47.3%; F = 23.98, P<.0001). Conversely, no significant difference was observed between the Arip+CYP2D6i and Arip+Esc groups (26.1% vs. 28.6%; F = 1.47, P= .225). The use of zolpidem and mood stabilizers was also significantly higher in both CYP2D6i groups. Co-prescription of strong CYP2D6-inhibiting SSRIs with risperidone, but not aripiprazole, is associated with a significant increase in anticholinergic use, providing large-scale, real-world evidence of a clinically meaningful DDI. These findings underscore the importance of considering SSRI metabolic profiles to mitigate EPS risk in patients treated with risperidone.

Objective The prevalence of depression is high among patients with end stage kidney disease (ESKD). To date, there has been limited investigation into the comparative effects of antidepressant in patients with ESKD. This study aims to explore the association between type of antidepressant, incidence of all-cause death, and hospitalization for major bleeding in patients with ESKD and depression.Methods This study utilized data obtained from the Korean National Health Insurance Service Database. Patients with ESKD were divided into two groups: those prescribed strong serotonin reuptake inhibitors (SRIs) and those prescribed weak or intermediate SRIs.Results Over a mean follow-up of 2.46 years, the strong SRI group had a lower risk of all-cause death (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.81–0.93) and hospitalization for major bleeding (HR 0.84, 95% CI 0.79–0.90) with no increased risk of bleeding-related death (HR 1.05, 95% CI 0.80–1.37) compared to the weak or intermediate SRI group. The protective effects of strong SRI use for all-cause death and hospitalization for major bleeding remained consistent in those prescribed SSRIs for less than 120 days (death: HR 0.85, 95% CI 0.80–0.92; hospitalization for major bleeding: HR 0.84, 95% CI 0.78–0.90), and in patients aged below 75 years (death: HR 0.83, 95% CI 0.76–0.90; hospitalization for major bleeding: HR 0.81, 95% CI 0.75–0.87).Conclusion In patients with ESKD and depression, the use of strong SRIs was associated with a reduced risk of all-cause death and major bleeding hospitalization compared to the use of weak or intermediate SRIs.

Immunoglobulin G4–related disease (IgG4-RD) is a chronic inflammatory condition that has been suggested to increase cancer risk, but the incidence and types of associated malignancies remain unclear. This study aimed to evaluate the cancer risk in patients with IgG4-RD using a nationwide population-based cohort. We identified 2,150 patients newly diagnosed with IgG4-RD between January 2012 and December 2020 from the Korean National Health Insurance Service database. Patients were followed until the occurrence of cancer, death, or December 31, 2021. Standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated to compare cancer incidence in IgG4-RD patients with that in the general population. Subgroup analyses were conducted based on sex, age at diagnosis, follow-up duration, and use of immunosuppressive agents. Patients with IgG4-RD had a significantly increased risk of overall cancer (SIR 4.12, 95% CI 3.48–4.85), including solid tumors (SIR 3.33, 95% CI 2.74–4.02) and hematologic malignancies (SIR 15.31, 95% CI 10.17–22.13). Among solid tumors, the highest risks were observed for pancreatic cancer (SIR 14.54, 95% CI 8.31–23.62), central nervous system cancer, and biliary tract cancer. Myelodysplastic syndrome and non-Hodgkin lymphoma were the most frequent hematologic cancers. Cancer risk was higher in female patients. The risk peaked within the first year after IgG4-RD diagnosis (SIR 7.13, 95% CI 5.65–8.89). Patients with IgG4-RD have a significantly elevated risk of developing cancer, particularly myelodysplastic syndrome, non-Hodgkin lymphoma, pancreatic cancer, and biliary tract cancer. Close surveillance for malignancy is warranted, especially during the first year after diagnosis. Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-21176-2.

ABSTRACTBackgroundLongitudinal evidence of the relationship between blood pressure (BP) variability and end‐stage kidney disease (ESKD) among individuals with type 2 diabetes is limited. Therefore, we evaluated the association between BP variability and ESKD in Korean adults with type 2 diabetes.MethodsThe study utilized data from the Korean National Health Insurance Service database, comprising health checkups conducted between 2004 and 2015. We enrolled 36 421 adults aged ≥ 19 years with type 2 diabetes who underwent at least two health checkups and were followed up until the end of 2017. BP variability was measured using the coefficient of variation, standard deviation, and variability independent of the mean. Hazard ratios (HRs) and 95% confidence intervals (CIs) for ESKD were determined using multivariate Cox proportional hazards regression analysis.ResultsDuring a median follow‐up of 8.05 years, 290 patients with ESKD were identified. The highest quartile of systolic or diastolic BP variability presented a higher risk of ESKD than did the lowest quartile of systolic or diastolic BP variability. The group with the highest systolic and diastolic BP variability had a 77% higher risk of ESKD than did those in the lowest three quartiles of both systolic and diastolic BP variability. These associations were present in younger individuals without comorbidities.ConclusionsAmong individuals with type 2 diabetes, increased BP variability was associated with an increased risk of ESKD. These associations were similarly observed in younger individuals without comorbidities. Maintaining a consistent BP seems to be important to prevent progression to ESKD in individuals with type 2 diabetes.

PurposeTo explore the association between cumulative exposure to outdoor artificial light at night (O-ALAN) during pregnancy and risk of childhood strabismus.MethodsIn this nationwide population-based case-control study, an entire-South-Korean-population mother-child-pair cohort representing births for the years 2008 to 2011 and residing in urban areas was identified based on the National Health Insurance Service (NHIS) database. Average levels of O-ALAN at the residential addresses of mothers during pregnancy were estimated using time-varying satellite data, providing a composite view of persistent nighttime illumination at approximately a ∼1 km2 scale. The odds ratios (ORs) and 95% confidence intervals (CIs) for the association between O-ALAN and strabismus risk were calculated using maximum likelihood estimation, adjusting for socio-demographic and area-based risk factors (e.g., nighttime traffic noise, particulate matter ≤10 μm).ResultsThe study included 755,796 mother-child pairs (mean [SD] maternal age, 32.4 [3.9] years; 51.9% boys). An interquartile range (IQR) increase in O-ALAN (21.7 nW/cm2/sr) was associated with an OR of 1.159 (95% CI: 1.145, 1.172) for childhood strabismus. The exposure-response curve showed a non-linear pattern, with stronger associations at higher exposure levels (approximately 40 nW/cm2/sr). Sub-analysis revealed a significant association for exotropia (OR: 1.179 [95% CI: 1.158, 1.200]), but not for esotropia (OR: 1.011 [95% CI: 0.977, 1.045]) or vertical strabismus (OR: 1.107 [95% CI: 0.982, 1.250]).ConclusionHigher levels of residential O-ALAN during pregnancy were associated with increased risk of childhood strabismus in this cohort. Further research with more detailed information on exposure and potential mediators is warranted.

IntroductionAlthough the gender differences in suicide and smoking are well-known, studies exploring the impact of gender on the relationship between smoking and suicide are limited. This population-based nationwide cohort study examines the association between smoking and suicide risk among1.8 million depressed patients, analyzed separately by gender.MethodsThis longitudinal cohort study included 1,827,249 adults diagnosed with depression between 2010 and 2015 from the Korean National Health Insurance Service database. Smoking status (never, former, current) was self-reported during health screenings, and suicides were identified via national mortality records. Cox proportional hazards models adjusted for demographic, clinical, and psychiatric covariates assessed hazard ratios (HRs) for suicide risk. Subgroup analyses explored effect modifications by covariates, including age, income, and alcohol use.ResultsOver a median follow-up of 6.8 years, 6,318 individuals (0.35%) died by suicide. Smoking was associated with increased suicide risk in both men and women, with a stronger association in women. Current smoking showed a higher risk in women (HR = 2.646, 95% CI: 2.287-3.062) compared to men (HR = 1.376, 95% CI: 1.277-1.483). In men, factors such as younger age and alcohol consumption intensified this association, whereas in women, low income was a significant modifier; the highest suicide risk was observed in low-income former smokers.ConclusionSmoking is associated with increased suicide risk among individuals with depression, with notable gender differences in risk magnitude and modifying factors. These findings highlight the need for gender-specific suicide prevention strategies. Limitations include reliance on self-reported smoking data and lack of time-varying measures of exposure.

Antibiotic use may alter gut microbiota, which could be associated with various diseases, including cardiovascular disease (CVD). Accordingly, further epidemiological evidence is needed to clarify the potential risk of CVD associated with antibiotic exposure. We evaluated the association between long-term antibiotic exposure and CVD risk in South Korea. This nationwide retrospective cohort study used data from the Korean National Health Insurance Service database. A total of 2 159 965 individuals aged 40 to 79 years who had no history of antibiotic prescriptions from 2004 to 2005 were included and followed through December 31, 2021. Antibiotic exposure was defined as the cumulative days of antibiotic prescriptions from 2006 to 2010. The primary end point was incident CVD with 2 or more days of hospitalization from 2011 to 2021. Adjusted hazard ratios (aHR) and 95% CIs for CVD according to antibiotic exposure were estimated using multivariable Cox proportional hazards models, adjusting for a range of covariates. Longer cumulative antibiotic prescription days were associated with an increased risk of CVD. The aHRs for CVD associated with 1 to 14, 15 to 90, 91 to 180, 181 to 364, and ≥365 days of antibiotic exposure were 0.98 (95% CI, 0.96-1.01), 1.01 (95% CI, 0.99-1.03), 1.05 (95% CI, 1.03-1.08), 1.06 (95% CI, 1.04-1.09), and 1.10 (95% CI, 1.07-1.13) compared with those with no antibiotic prescriptions. In this large population-based cohort study of Korean adults, long-term antibiotic exposure may be associated with a higher risk of CVD. Further research is warranted to establish causality and elucidate the underlying mechanisms for this association.

Abstract Background and Aims The triglyceride glucose (TyG) index has been proposed as a reliable marker of insulin resistance and an independent predictor of cardiovascular (CV) event. However, its prognostic value in chronic kidney disease (CKD) remains unclear. This study aims to assess predictive value of the TyG index for clinical outcomes in CKD population. Method This study was conducted using the Korean National Health Insurance Service database. A total of 123,249 individuals with CKD who underwent a national health examination between 2012 and 2015 were enrolled and divided into four groups based on TyG index quartiles. The primary outcome was a CV event, including myocardial infarction and stroke, and the secondary outcomes were progression to end-stage kidney disease (ESKD) and all-cause mortality. Results During a median follow-up time of 58.6 months, CV event, progression to ESKD, and all-cause mortality occurred in 15,400 (12.5%), 5,668 (4.5%) and 10,245 (8.3%) cases, respectively. The cumulative event rate of cardiovascular events, progression to ESKD, and all-cause mortality was the highest among population with TyG quartile 4 (all P &amp;lt; 0.001). In multivariate Cox-regression analysis, a higher TyG index was associated with an increased risk of CV event. Compared with participants in the lowest quartile of TyG index, hazard ratios (HR) and 95% confidence intervals (CI) for CV event were 1.05 (1.00–1.10), 1.09 (1.04–1.15), 1.29 (1.23–1.36) for those in second, third, and fourth quartile of TyG index. The risk of progression to ESKD was also increased as TyG quartile increased [adjusted HR (95% CI) 1.15 (1.05–1.26), 1.22 (1.10–1.35), and 1.75 (1.60–1.91)] for population with TyG quartile 2, 3, and 4, respectively. The risk of all-cause mortality was significantly elevated in individuals with TyG index quartile 4. Conclusion The TyG index serves as a valuable predictor of CV event, progression to ESKD and all-cause mortality in CKD population.

BackgroundGiven propofol’s antioxidant and anti‑inflammatory properties compared with volatile/inhalational agents, we aimed to evaluate the association between anesthetic technique and both in‑hospital mortality and postoperative complications following spinal surgery.MethodsIn this retrospective, population‑based cohort study, we used South Korea’s National Health Insurance Service database to identify adult patients (≥ 18 years) who underwent spinal surgery between January 1, 2016 and December 31, 2021. Primary outcomes were in‑hospital mortality and postoperative complications. Propensity score (PS) matching (1:1) was employed to balance baseline characteristics between the total intravenous anesthesia (TIVA) and volatile/inhalational anesthesia (INH) groups.ResultsAmong 708,387 patients, 264,728 (37.4%) received TIVA and 443,659 (62.6%) received INH. After PS matching, 460,654 patients remained (230,327 per group). In the PS‑matched cohort, TIVA was associated with significantly lower odds of in‑hospital mortality (OR 0.85; 95% CI 0.80–0.89; P = 0.004) and postoperative complications (11.8% vs. 14.2%; OR 0.81; 95% CI 0.80–0.82; P < 0.001) compared with INH. In the full cohort, multivariable logistic regression confirmed these findings: TIVA remained linked to reduced in‑hospital mortality (OR 0.74; 95% CI 0.63–0.87; P < 0.001) and fewer postoperative complications (OR 0.71; 95% CI 0.70–0.73; P < 0.001).ConclusionsIn this nationwide cohort, propofol‑based TIVA was associated with lower in‑hospital mortality and fewer postoperative complications than volatile/inhalational anesthesia in adult spinal surgery patients. Prospective trials are warranted to confirm these findings.Trial registration: Not applicable.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12871-025-03385-4.

Electronic and conventional cigarette use and risk of spinal disc disorders: a nationwide cohort study.

BackgroundRenal hyperfiltration (RHF) and metabolic syndrome (MetS) share common pathophysiology and are both associated with adverse clinical outcomes. However, their combined impact remains unclear.MethodsIn total, 278,552 propensity score-matched individuals were enrolled in the Korean National Health Insurance Service database (2009–2011). Participants were divided into four groups based on RHF and MetS status, and cardiovascular (CV) events, end-stage kidney disease (ESKD) progression, and all-cause mortality were evaluated.ResultsCompared to non-MetS with normal renal filtration (NRF), MetS with NRF was associated with a significant increase in the risk of CV events, which was further amplified when combined with RHF (adjusted HR = 1.44, 95% CI = 1.35–1.55, P for interaction = 0.047). Patients with RHF exhibited more pronounced increases in the HRs for CV events than those with NRF as the number of dysfunctional metabolic components increased (P for interaction = 0.019). The risk of ESKD progression was not increased in non-MetS with RHF; however, it was significantly higher in patients with MetS alone and highest in those with both MetS and RHF (adjusted HR = 3.23, 95% CI = 1.61–6.47). The risk of all-cause mortality was elevated in patients with RHF or MetS alone and highest in those with both RHF and MetS (adjusted HR = 1.41, 95% CI = 1.31–1.52).ConclusionThe clinical significance of RHF differs based on MetS status, with their coexistence posing the highest risk for CV events, ESKD progression, and all-cause mortality. A synergistic interaction between RHF and MetS was evident in the risk of CV events.

Background/Objectives: Atopic dermatitis (AD) is a chronic inflammatory skin disorder increasingly recognized for its association with psychiatric comorbidities. However, the extent of this association compared to dermatologic controls in Asian populations remains underexplored. We sought to evaluate the prevalence and risk of psychiatric comorbidities in adult patients with AD compared to those with melanocytic naevi using a nationwide population-based cohort. Methods: We conducted a retrospective cohort study utilizing the Korean National Health Insurance Service (NHIS) database, including individuals diagnosed with AD (ICD-10 code L20.0) or melanocytic naevi (ICD-10 code D22, excluding melanoma) between 1 January 2010 and 31 December 2023. Patients were required to have at least five years of diagnostic history and be 25 years or older at the end of the study. Psychiatric comorbidities were identified based on ICD-10 codes. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to compare psychiatric morbidity between groups. Results: Among 1,902,114 individuals (1,813,320 with AD and 88,794 with naevi), psychiatric comorbidities were more prevalent in the AD group (28.2%) compared to the naevi group (27.1%) (adjusted OR 1.04, 95% CI 1.02–1.05). While differences for major depression, bipolar disorder, and personality disorders were not statistically significant, other psychiatric categories suggested significantly higher prevalence in the AD group. Sex-stratified analysis revealed a higher overall psychiatric morbidity in women compared to men; however, the relative risk increase associated with AD was slightly greater in men than in women. Comparison with previous international studies suggests that Korea’s healthcare accessibility and nationwide mental health programs may contribute to the smaller observed difference. Conclusions: This large-scale cohort study highlights a modest but significant association between AD and psychiatric comorbidities in adults. Our findings underscore the importance of integrating mental health assessment into routine dermatologic care for AD patients to improve comprehensive disease management.