National Health Insurance Service-Health Screening Research Articles

PO-01-226 RACIAL DIFFERENCES AND SIMILARITIES IN ATRIAL FIBRILLATION EPIDEMIOLOGY, RISK FACTORS, AND MORTALITY IN COMMUNITY-BASED COHORTS: RESULTS FROM THE KOREAN NHIS-HEALS AND UK BIOBANK STUDIES

Atrial fibrillation (AF) is associated with mortality, morbidity, and medical costs. Despite the increasing public health importance of AF, race-specific disease distributions and associations between clinical risk factors and AF have received limited attention. This study aimed to compare established associations between risk factors and AF in white Europeans from the UK Biobank and Asian subjects from the Korean NHIS-HEALS (National Health Insurance Service-Health Screening) study. This study included 402,229 and 484,406 patients without a diagnosis of nonvalvular AF from the Korean NHIS-HEALS cohort and UK Biobank, respectively. The incidence of AF, its associations with mortality, common risk factors, biomarkers, prevalent cardiovascular disease, and their attributable risk by race were examined. The median follow-up time was 11.8 years (interquartile range [IQR] 11.1–12.6) in the UK Biobank and 7.6 years (IQR 7.0–8.2) in the Korean NHIS-HEALS. Fewer AF cases were observed in Korean NHIS-HEALS (N=9182; 2.3%) than in the UK Biobank (N=25312; 5.2%). Cardiovascular risk factors, comorbidities, and glucose levels were associated with an increased risk of new-onset AF in both cohorts, with significant interactions by country for associations with body mass index (BMI), economic status, smoking history, history of heart failure, and cholesterol level. BMI was more strongly related to new-onset AF in UK Biobank [hazard ratio (HR), 1.31; 95% confidence interval (CI), 1.29–1.33] compared to Korean NHIS-HEALS (HR, 1.11; 95% CI, 1.09–1.14), with a relative risk ratio of 1.18 (95% CI, 1.15–1.21). Total cholesterol was inversely associated with incident AF in both cohorts (HR, 0.86; 95% CI, 0.85–0.87 versus 0.91; 95% CI, 0.89–0.93 in Korean NHIS-HEALS), relative risk ratio 0.95 (95% CI, 0.92–0.97). Attributable risk proportion of most classical risk factors were similar in both the studies. In this first large-scale comparison of Caucasian and Asian populations, the cumulative risk of developing AF was higher in the UK than in Korea over most of their lifespan. Higher BMI, smoking, history of heart failure, and lower total cholesterol levels were associated with a higher risk of AF in the UK than in Asians.

PO-05-196 MODIFIABLE LIFESTYLE FACTORS AND LIFETIME RISK OF ATRIAL FIBRILLATION: COHORT STUDY BASED ON LONGITUDINAL DATA FROM THE KOREA NHIS-HEALS AND UK BIOBANK

Reasons for the higher incidence of AF among Europeans compared to Asians are yet to be fully understood. We aimed to examine the association between modifiable lifestyle factors and the lifetime risk of atrial fibrillation (AF) in Europe and East Asia, along with race/ethnic similarities and disparities. We used longitudinal cohort study data from the Korea National Health Insurance Service-Health Screening cohort (K-NHIS-HealS) and UK Biobank. Individuals free of AF at baseline were assessed. Modifiable lifestyle factors included blood pressure, body mass index, cigarette smoking, diabetes, alcohol consumption, and physical activity. Each modifiable lifestyle factor was categorized as optimal (no borderline or adverse lifestyle factor), borderline (at least one borderline and no adverse lifestyle factor), or adverse (at least one adverse lifestyle factor) levels. We estimated lifetime risk of AF at index age 45 years to attained age 85 years, accounting for the competing risk of death. From the K-NHIS-HealS and UK Biobank datasets, we compared 383,048 East Asian (75.8% elevated, 19.3% borderline) and 292,499 White European (70.8% elevated, 28.2% borderline) subjects. The overall lifetime risk of AF was 16.5% and 19.5% in East Asian and White Europeans, respectively (p<0.001). The lifetime risk of AF was similar between the two races with optimal (9.6% East Asian vs 9.1 % White European, p=0.773), higher in East Asian with borderline (15.0% vs 12.0%, p<0.001), and higher in White European with adverse lifestyle factor profiles (17.1% vs 20.6%, p<0.001). Compared to East Asians, the relative risk of AF in White Europeans was 14% higher (hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.09-1.20, p<0.001) for two adverse lifestyle factors and 40% higher (HR 1.40, 95% CI 1.31-1.50, p<0.001) for ≥3 adverse lifestyle factors. The overall lifetime risk of AF was about 1 in 6 in East Asians whereas 1 in 5 in White Europeans. The overall higher lifetime risk of AF in White Europeans compared to East Asians might be attributable to adverse lifestyle factors. Adherence to optimal lifestyle factors reduced the lifetime risk of AF to about 1 in 10 regardless of race/ethnicity.

PO-01-137 RACIAL DIFFERENCES IN ATRIAL FIBRILLATION-RELATED ISCHEMIC AND HEMORRHAGIC STROKES AND MORTALITY. A PATIENT-LEVEL COMPARATIVE ANALYSIS OF UK BIOBANK AND KOREAN NATIONWIDE DATA

Adverse outcomes associated with atrial fibrillation (AF) in Asians have not yet been fully elucidated, although reported event rates from Asia appear higher than non-Asians. In a patient-level comparative analysis of two national cohort data, we evaluated the race-specific associations of AF with stroke and mortality. The Korean National Health Insurance Service-Health Screening and UK Biobank are prospective, observational cohorts. From 2005 through 2012, follow-up health examinations were conducted regularly. The main outcomes were total, ischemic, and hemorrhagic strokes and all-cause death. This study enrolled 425,805 Asians (mean [SD] age, 56.0 [9.3] years; 55.3% of men) and 372,851 Whites (mean [SD] age, 57.1 [8.0] years; 47.6% of men). During the follow-up period (mean [SD], 7.3 [1.4] years in Asians; 11.7 [1.5] years in Whites), the incident rates (IR) of AF per 1000 person-years were 2.6 (95% CI, 2.5–2.7) in Asians and 4.4 (95% CI, 4.3–4.5) in Whites. The IR of total, ischemic, and hemorrhagic strokes were greater in Asians with AF than in Whites with AF. The rate difference (difference in IR of the outcome between those with and without AF) for total stroke was 15.2 (95% CI, 13.4–17.0) in Asians and 4.5 (95% CI, 4.0–5.0) in Whites. For ischemic and hemorrhagic strokes, the rate differences were 2.5- to 3.5-fold higher in Asians than in Whites. Consistently, the identical trend was observed for all-cause death In the K-NHIS-HealS and UK Biobank Study, the outcomes of AF-related rates of total, ischemic, and hemorrhagic strokes and all-cause death was greater in Asians than Whites. Despite the higher incidence of AF in Whites, there was a much poorer prognosis in Asians with AF.

Inverse association between changes in systolic and diastolic blood pressure and risk of depression: A nationally representative cohort study

BackgroundDepression is one of complex mental disorders with diverse etiological factors but the association between blood pressure (BP) and depression is unknown. We aimed to investigate the association between changes in BP (systolic and diastolic) and incident depression. MethodsFrom the National Health Insurance Service-Health Screening Cohort (NHIS-HEALS), 224,192 participants who underwent biennial health screenings from period I (2004–05) and II (2006–07) were included in the study. Systolic BP (SBP) and diastolic BP (DBP) categories were defined as follows: SBP into 5 categories (<90 mmHg, 90 mmHg −119 mmHg, 120 mmHg −129 mmHg, 130 mmHg −139 mmHg, ≥140 mmHg) and DBP into 4 categories (<60 mmHg, 60 mmHg −79 mmHg, 80 mmHg −89 mmHg, ≥90 mmHg). Also, BP levels were classified into 5 groups: normal, elevated BP, stage 1 BP, stage 2 BP, hypotension. Using the Cox proportional hazards regression, changes in SBP and DBP between two screening periods and the risk of depression were calculated by adjusted hazard ratio (aHR) and 95 % confidence interval (CI). ResultsThere were 17,780 depression events during 1.5 million person-year of follow-up. Compared to the participants with SBP ≥ 140 mmHg or DBP ≥ 90 mmHg from both periods, those who decreased SBP from ≥140 mmHg to 120 mmHg–129 mmHg (aHR 1.13; 95 % CI 1.04–1.24; P = 0.001) and those who decreased DBP from ≥90 mmHg to 60 mmHg–79 mmHg (aHR 1.10; 95 % CI 1.02–1.20; P = 0.020) showed a higher risk of depression, respectively. ConclusionsChanges in SBP and DBP showed an inverse relationship with depression risk.

The Risk of Type 2 Diabetes Mellitus according to Changes in Obesity Status in Late Middle-Aged Adults: A Nationwide Cohort Study of Korea.

Although obesity is a well-known risk factor of type 2 diabetes mellitus (T2DM), there is scant data on discriminating the contribution of previous obesity and recent weight gain on developing T2DM. We analyzed the Korean National Health Insurance Service-Health Screening Cohort data from 2002 to 2015 where Korean residents underwent biennial health checkups. Participants were classified into four groups according to their obesity status (body mass index [BMI] ≥25 kg/m2) before and after turning 50 years old: maintaining normal (MN), becoming obese (BO), becoming normal (BN), and maintaining obese (MO). Cox proportional hazards regression model was used to estimate the risk of T2DM factoring in the covariates age, sex, BMI, presence of impaired fasting glucose or hypertension, family history of diabetes, and smoking status. A total of 118,438 participants (mean age, 52.5±1.1 years; men, 45.2%) were prospectively evaluated for incident T2DM. A total of 7,339 (6.2%) participants were diagnosed with T2DM during a follow-up period of 4.8±2.6 years. Incidence rates of T2DM per 1,000 person-year were 9.20 in MN, 14.81 in BO, 14.42 in BN, 21.38 in MO. After factoring in covariates, participants in the groups BN (adjusted hazard ratio [aHR], 1.15; 95% confidence interval [CI], 1.04 to 1.27) and MO (aHR, 1.14; 95% CI, 1.06 to 1.24) were at increased risk of developing T2DM compared to MN, whereas BO (hazard ratio, 1.06; 95% CI, 0.96 to 1.17) was not. Having been obese before 50 years old increased the risk of developing T2DM in the future, but becoming obese after 50 did not. Therefore, it is important to maintain normal weight from early adulthood to prevent future metabolic perturbations.

Possible Incidental Parkinson's Disease following Asthma: A Nested Case-Control Study in Korea.

A connection between asthma and the occurrence of Parkinson's disease (PD) has been suggested, but the findings have been contentious and require verification. In this nested case-control study using data from the Korean National Health Insurance Service-Health Screening Cohort (2002-2019), which comprised 9029 participants with PD and 36,116 matched controls, we explored the relationship between asthma and incident PD. An overlap-weighted logistic regression model was used to measure the probability of asthma and PD. After adjusting for various covariates, we found that asthma was related to a 1.11-fold greater probability of PD (95% confidence interval: 1.06-1.16). A subgroup analysis showed that this effect was independent of age, sex, residential area, or alcohol consumption, and that it was still noticeable even among patients with a high income; those with a normal weight or obesity; those who were non-smokers or current smokers; and those with no history of chronic obstructive pulmonary disease, hypertension, hyperglycemia, hyperlipidemia, or anemia. Thus, these findings may indicate that asthma may slightly augment the likelihood of PD in the Korean adult population regardless of demographic or lifestyle factors, making it difficult to predict PD in asthma patients.

Waist Circumference and Cardiovascular Risk Profiles after Autologous Breast Reconstruction: A Nationwide Population-Based Cohort Study.

To date, few studies have examined changes in waist circumference and cardiovascular risk profile (CVRP) after autologous breast reconstruction. Therefore, this study aimed to investigate the effect of flap surgery using autologous tissue on waist circumference and CVRP through a nationwide population-based cohort study. In total, 6926 patients who underwent autologous breast reconstruction between 2015 and 2019 were considered. Of them, we evaluated 3444 patients who underwent the complete Korean National Health Insurance Service Health Screening (NHIS-HealS) before and after surgery. Body measurements, including waist circumference, weight, and body mass index; and CVRP, including blood pressure, fasting blood glucose, and cholesterol levels, were analyzed by type of surgery up to 3-4 years postoperatively. The body measurements of patients who underwent abdominal-based breast reconstruction were reduced 1-2 years after surgery, but returned to preoperative values 3-4 years after surgery. Regardless of the type of surgery, CVRP was worsened at both 1-2 years and 3-4 years after surgery, except for low-density lipoprotein values. Autologous breast reconstruction did not ameliorate the deterioration of CVRP over time. In addition, the abdominoplasty effect of abdominal-based breast reconstruction disappeared 1-2 years after surgery.

Changes in high-density lipoprotein cholesterol with risk of Cardiovascular Disease among initially high-density lipoprotein-high participants

BackgroundHigh-density lipoprotein cholesterol’s (HDL-C) long-held status as a cardiovascular disease (CVD) preventative has been called into question. Most of the evidence, however, focused on either the risk of death from CVD, or on single time point level of HDL-C. This study aimed to determine the association between changes in HDL-C levels and incident CVD in individuals with high baseline HDL-C levels (≥ 60 mg/dL).Methods77,134 people from the Korea National Health Insurance Service-Health Screening Cohort were followed for 517,515 person-years. Cox proportional hazards regression was used to evaluate the association between change in HDL-C levels and the risk of incident CVD. All participants were followed up until 31 December 2019, CVD, or death.ResultsParticipants with the greatest increase in their HDL-C levels had higher risks of CVD (adjusted hazard ratio [aHR], 1.15; 95% confidence interval [CI], 1.05–1.25) and CHD (aHR 1.27, CI 1.11–1.46) after adjusting for age, sex, household income, body mass index, hypertension, diabetes mellitus, dyslipidemia, smoking, alcohol consumption, moderate-to-vigorous physical activity, Charlson comorbidity index, and total cholesterol than those with the lowest increase in HDL-C levels. Such association remained significant even among participants with decreased low-density lipoprotein cholesterol (LDL-C) levels for CHD (aHR 1.26, CI 1.03–1.53).ConclusionsIn people with already high HDL-C levels, additional increases in HDL-C levels may be associated with an increased risk of CVD. This finding held true irrespective of the change in their LDL-C levels. Increasing HDL-C levels may lead to unintentionally elevated risk of CVD.

Associations of high-normal blood pressure and impaired fasting glucose with atrial fibrillation

ObjectiveTo investigate the association of high-normal blood pressure (BP) and impaired fasting glucose (IFG) with the risk of atrial fibrillation (AF) in two cohorts.MethodsThe Korean National Health Insurance Service-Health Screening...

Exercise Frequency Reduction Is Associated With Higher Risk of Infection in Newly Diagnosed Diabetes: A Nationally Representative Cohort Study.

Exercise is an important method to control the progression of diabetes. Since diabetes compromises immune function and increases the risk of infectious diseases, we hypothesized that exercise may affect the risk of infection by its immunoprotective effects. However, population-based cohort studies regarding the association between exercise and the risk of infection are limited, especially regarding changes in exercise frequency. The aim of this study was to determine the association between the change in exercise frequency and the risk of infection among patients with newly diagnosed diabetes. Data of 10,023 patients with newly diagnosed diabetes were extracted from the Korean National Health Insurance Service-Health Screening Cohort. Self-reported questionnaires for moderate-to-vigorous physical activity (MVPA) were used to classify changes in exercise frequency between two consecutive two-year periods of health screenings (2009-2010 and 2011-2012). The association between changes in exercise frequency and the risk of infection was evaluated using multivariable Cox proportional-hazards regression. Compared with engaging in ≥ 5 times of MVPA/week during both periods, a radical decrease in MVPA (from ≥ 5 times of MVPA/week to physical inactivity) was associated with a higher risk of pneumonia (adjusted hazard ratio [aHR], 1.60; 95% confidence interval [CI], 1.03-2.48) and upper respiratory tract infection (aHR, 1.15; 95% CI, 1.01-1.31). In addition, a reduction of MVPA from ≥ 5 to < 5 times of MVPA/week was associated with a higher risk of pneumonia (aHR, 1.52; 95% CI, 1.02-2.27), whereas the risk of upper respiratory tract infection was not higher. Among patients with newly diagnosed diabetes, a reduction in exercise frequency was related to an increase in the risk of pneumonia. For patients with diabetes, a modest level of physical activity may need to be maintained to reduce the risk of pneumonia.

Changes of Body Mass Index and the Incidence of Hypertension in Late Middle Age: A Nationwide Cohort Study in South Korea

Background: Previous studies revealed weight gain is an independent risk factor for hypertension. Hypertension in late middle age increases the risks of dementia and cardiovascular diseases. We aimed to analyze the difference in the risk of hypertension in the late middle age according to the change of body mass index (BMI) using nationwide cohort data of South Korea.Methods: We used 64,136 individuals from National Health Insurance Service-Health Screening Cohort in South Korea. The primary endpoint is newly diagnosed hypertension after observation start date, which was defined as the date of first examination after 50. BMI changes were measured between two consecutive health examinations before and after 50. Cox proportional hazard regression analysis was performed to evaluate the association between the change of BMI and the risk of hypertension.Results: During the mean follow-up period of 3.4±1.9 years, 8,676 individuals were diagnosed with hypertension. Both normal-to-obese group and obese-to-obese group had 19% higher risk for hypertension, and obese-to normal group had 10% higher risk for hypertension in late middle age, compared to normal-to-normal group.Conclusions: We confirmed becoming obese and maintaining obese increase the risk of hypertension in late middle age. Thus, clinicians need to assess obese patients regularly for the possibility of new onset hypertension and take preventive measure to reduce the risk by losing weights before late middle age.

Potential Association of Osteoporosis and Not Osteoporotic Fractures in Patients with Gout: A Longitudinal Follow-Up Study.

Health issues associated with gout and increased occurrence of osteoporosis or fractures have been raised; however, the results are elusive. Herein, we explored the possible link between gout and incident osteoporosis/osteoporotic fractures based on long-term follow-up nationwide data. This study enrolled 16,305 patients with gout and 65,220 controls who were matched by propensity score at a 1:4 ratio on the basis of sex, age, income, and residence from the Korean National Health Insurance Service-Health Screening Cohort database (2002−2015). A Cox proportional hazard model was employed to identify the relevance between gout and incident osteoporosis/fractures, following adjustment for various covariates. In the follow-up period, osteoporosis developed in 761 individuals with gout and 2805 controls (incidence rates: 8.0 and 7.3/1000 person-years, respectively), and each osteoporotic fracture in the distal radius (2.8 vs. 2.7/1000 person-years), hip (1.3 vs. 1.3/1000 person-years), and spine (4.5 vs. 4.5/1000 person-years) occurred in gout and control groups, respectively. After adjustment, the gout group presented an 11% higher development of osteoporosis (95% confidence interval = 1.02−1.20) than the controls (p = 0.011). Subgroup analyses maintained the augment of incident osteoporosis in sufferers with gout, particularly in either men or <60 years. However, no such relevance was identified between gout and incident osteoporotic fractures at any site. In conclusion, gout may result in a slightly elevated likelihood of developing osteoporosis, and not osteoporotic fractures, in the Korean population.

Increased risk of cataract surgery in patients with allergic disease: a population based cohort study.

We investigated the association between cataract and allergic diseases, including atopic dermatitis (AD), allergic rhinitis (AR), and asthma using 2,631,015 subjects' data from the 2009 National Health Insurance Service-Health Screening Cohort in Korea. Each allergic disease was defined as three or more occasions of diagnosis within 1year with dedicated ICD-10 codes. The primary endpoint was newly received cataract surgery during the follow-up period. In total, 447,883 subjects had at least one allergic disease. During the mean follow-up of 7.8 ± 1.7years, newly developed cataract surgery was observed in 301,693 subjects (allergic group, n = 69,321; non-allergic group, n = 232,372). After adjusting for demographic characteristics (age, sex), systemic and ocular comorbidities, socioeconomic status, and lifestyle factors (smoking, drinking, regular exercise), the allergic group had a higher hazard ratio (HR) for cataract development compared with the non-allergic group. We further performed a subgroup analysis for patients regarding sex and age. In the subgroup analysis of subjects with AD, men aged < 50years had a higher HR compared to women of the same age group. In conclusion, subjects with allergic diseases had a higher risk of cataract surgery than their counterparts, and the combination of AD and AR resulted in the highest risk. Particularly, the association was more evident in male than female patients with AD aged < 50years.

Trends of Blood Transfusion According to Diseases in Korea: A 10-Year Nationwide Cohort Study

Introduction: Recent guidelines recommend restrictive red blood cell transfusion; therefore, hospitals have started introducing and implementing patient blood management programs. This is the first study to analyze changes in the trends of blood transfusions in the whole population over the past 10 years according to sex, age group, blood component, disease, and hospital type. Methods: This cohort study analyzed blood transfusion records for 10 years, from January 2009 to December 2018, using nationwide population-based data from the Korean National Health Insurance Service-Health Screening Cohort database. Results: The proportion of transfusion procedures conducted in the total population has increased constantly for 10 years. Although its proportion in the age group of 10–79 years decreased, the total number of transfusions increased significantly due to the increase in the population and proportion of transfusions in those aged 80 years or older. Furthermore, the proportion of multicomponent transfusion procedures increased in this age group, which was greater than that of transfusions. The most common disease among transfusion patients in 2009 was cancer, of which gastrointestinal (GI) cancer accounted for more than half, followed by trauma and hematologic diseases (GI cancers > trauma > other cancers > hematologic diseases). The proportion of patients with GI cancer decreased, whereas that of trauma and hematologic diseases increased over the 10 years, with trauma becoming the most common disease type in 2018 (trauma > GI cancers > hematologic diseases > other cancers). Although transfusion rates per hospitalization decreased, the total number of inpatients increased, thus increasing the number of blood transfusions in all types of hospitals. Discussion/Conclusions: The proportion of transfusion procedures in the total population increased owing to the increase in the total number of transfusions in patients aged 80 years or older. The proportion of patients with trauma and hematologic diseases has also increased. Moreover, the total number of inpatients has been increasing, which subsequently increases the number of blood transfusions performed. Specific management strategies targeting these groups may improve blood management.

Association between Osteoporosis and Meniere's Disease: Two Longitudinal Follow-Up Cohort Studies.

A high rate of Meniere's disease (MD) in patients with osteoporosis has been suggested. This research intended to estimate the bidirectional association of MD with osteoporosis. The ≥40-year-old population in the Korean National Health Insurance Service-Health Screening Cohort 2002-2019 was examined. In study I, 9529 patients with MD and 38,116 control I participants were analyzed for a previous history of osteoporosis. In study II, 65,858 patients with osteoporosis and 65,858 control II participants were analyzed for a previous history of MD. Stratified Cox proportional hazard models were applied to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) of MD for osteoporosis in study I and of osteoporosis for MD in study II. The rate of a prior history of osteoporosis was 13.3% for the MD group and 11.3% for the control I group. The patients with MD had a 1.12 times higher HR for previous osteoporosis (95% CI = 1.04-1.20). In study II, the rate or a prior history of MD was 3.7% for patients with osteoporosis and 2.0% for the control II group. The patients with osteoporosis had a 1.50 times higher HR for previous MD (95% CI = 1.40-1.61). Most subgroups according to age, sex, and comorbid conditions demonstrated consistent bidirectional associations between MD and osteoporosis. Adult patients with MD had a greater risk of osteoporosis. In addition, adult patients with osteoporosis also showed a higher risk of MD.

Machine learning based risk prediction for Parkinson's disease with nationwide health screening data

Although many studies have been conducted on machine learning (ML) models for Parkinson’s disease (PD) prediction using neuroimaging and movement analyses, studies with large population-based datasets are limited. We aimed to propose PD prediction models using ML algorithms based on the National Health Insurance Service-Health Screening datasets. We selected individuals who participated in national health-screening programs > 5 times between 2002 and 2015. PD was defined based on the ICD-code (G20), and a matched cohort of individuals without PD was selected using a 1:1 random sampling method. Various ML algorithms were applied for PD prediction, and the performance of the prediction models was compared. Neural networks, gradient boosting machines, and random forest algorithms exhibited the best average prediction accuracy (average area under the receiver operating characteristic curve (AUC): 0.779, 0.766, and 0.731, respectively) among the algorithms validated in this study. The overall model performance metrics were higher in men than in women (AUC: 0.742 and 0.729, respectively). The most important factor for predicting PD occurrence was body mass index, followed by total cholesterol, glucose, hemoglobin, and blood pressure levels. Smoking and alcohol consumption (in men) and socioeconomic status, physical activity, and diabetes mellitus (in women) were highly correlated with the occurrence of PD. The proposed health-screening dataset-based PD prediction model using ML algorithms is readily applicable, produces validated results, and could be a useful option for PD prediction models.

Antihypertensive Use and the Risk of Cataract in Patients with Hypertension: A Nationwide Case-control Study

ABSTRACT Purpose This study aims to investigate the association between antihypertensive use and the risk of cataract in a matched case-control study. Methods We analysed the Korean National Health Insurance Service-Health Screening Cohort database from 2002 to 2013. We defined ‘cases’ as patients prescribed antihypertensives and underwent their first eye cataract surgery between 2010 and 2013. ‘Controls’ were patients prescribed antihypertensives and no history of cataract surgery or diagnosis between 2002 and 2013. Four controls were matched to each case by several variables. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated for cataract risk using a conditional logistic regression model after adjustment. Results The analyses comprised 12,166 cases and 48,664 controls. The adjusted ORs for cataracts were 1.18 (95% CI: 1.12–1.24) in thiazide diuretics, 1.12 (95% CI: 1.07–1.18) in beta-blockers, 0.94 (95% CI: 0.90–1.00) in calcium channel blockers, 1.22 (95% CI: 1.14–1.30) in angiotensin-converting enzyme (ACE) inhibitors, and 0.97 (95% CI: 0.91–1.03) in angiotensin II receptor blockers compared to ‘non-use’ of each antihypertensive. Conclusion In a nationwide case-control study, the use of thiazide diuretics, beta-blockers, or ACE inhibitors do not represent minimal clinical important difference in the risk of cataract and the use of calcium channel blockers or angiotensin II receptor blockers is not associated with an increased risk of cataracts compared to non-use of each antihypertensive. Given the benefits of treating hypertension, such as the reduction in further complications, we suggest there is no need to change current clinical practice for antihypertensives.

Association between Migraines and Prior Proton Pump Inhibitor Use: A Nested Case-Control Study Using a National Health Screening Cohort.

The effect of proton pump inhibitor (PPI) use on migraine risk remains controversial. We explored the odds of migraines in relation to prior PPI use and treatment duration. Data from the Korean National Health Insurance Service-Health Screening Cohort (2002-2015) were analyzed in this nested case-control study involving 28,159 participants with incident migraines and 112,636 controls (1:4 matched by sex, age, income, and residential region). The baseline covariates were balanced by performing propensity score overlap weighting-based adjustments, and the effect of prior PPI use (past vs. current) and treatment duration (&lt;30 and 30-365 days vs. ≥365 days) on incident migraines was evaluated using logistic regression. In past and current PPI users, prior PPI use raised the likelihood of migraines (adjusted odds ratio [95% confidence interval]: 2.56 [2.36-2.79] and 4.66 [4.29-5.06], respectively). Participants who used PPI for &lt;30, 30-365, or ≥365 days exhibited high odds of migraines (2.49 [2.29-2.72], 4.41 [4.05-4.79], and 4.14 [3.77-4.54], respectively). Incident migraines with or without aura also increased independently of PPI use history or duration. In summary, prior PPI use, irrespective of the elapsed time since use and the duration of use, is possibly associated with incident migraines with or without aura.

Abstract 13938: Metabolically Healthy Obese and Incident Coronary Heart Disease in Adult Cancer Survivors

Introduction: There is a paucity of data on the combined association of metabolic health status and obesity with coronary heart disease (CHD) in adult cancer survivors who are at excess risk of CHD associated with potentially harmful side effects from some cancer therapies. Long-term cardiovascular health among adult cancer survivors who are metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUN), and metabolically unhealthy obese (MUO) as compared to those who are metabolically healthy non-obese (MHN) remains uncertain. Hypothesis: The hypothesis of this study was that adult cancer survivors who are MHO, MUN, MUO would have higher risk of CHD as compared to those who are MHN. Methods: Data on metabolic health status and incident CHD among adult cancer survivors (n=2,336) were abstracted from the National Health Insurance Service-Health Screening Cohort, 2002-2019 along with information on confounding variables (sociodemographic factors, health status, health behavior, and family history of heart disease). Obesity was defined as body mass index≥25.0 kg/m 2 and the participants were considered metabolically unhealthy if they met more than three out of the five (fasting serum glucose, blood pressure, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol) criteria for worsened metabolic health. Cox proportional hazards model adjusted for the confounding variables was used to compute hazard ratios (HR) and 95% confidence intervals (95% CI) for incident CHD according to the metabolic health and obesity categories. Results: Among adult cancer survivors, those who are MHO (HR=2.80; 95% CI: 1.65-4.76), MUN (HR=2.58; 95%: 1.12-5.97), and MUO (HR=4.88; 95% CI: 2.27-10.5) had higher risk of incident CHD as compared to those who are MHN. Conclusions: Adult cancer survivors who are MHO should also be of a clinical concern. Excess body weight and metabolic health status should be concurrently managed to reduce the risk of developing CHD among adult cancer survivors.

The Reciprocal Relationship between Osteoporosis and Renal Stones.

Previous studies have proposed an association between osteoporosis and renal stones. The current analyses intended to investigate the bidirectional relationship between osteoporosis and renal stones. The ≥40-year-old population in the National Health Insurance Service-Health Screening cohort (2002-2015) was analyzed. In study I, 67,811 patients with osteoporosis and 67,811 control I participants were matched. The hazard ratio (HR) of osteoporosis for renal stones was calculated using stratified Cox proportional hazard models. In study II, 25,261 patients with renal stones and 101,044 control II participants were matched. The HR of renal stones for osteoporosis was estimated using stratified Cox proportional hazard models. In study I, 3.4% (2276/67,811) of osteoporosis patients and 2.5% (1696/67,811) of control I participants had renal stones. Osteoporosis patients had a 1.36 times higher HR for renal stones than control I participants (95% confidence intervals [CI] = 1.28-1.45). In study II, 9.2% (2319/25,261) of renal stone patients and 7.6% (7658/101,044) of control II participants had osteoporosis. Renal stone patients had a 1.26 times higher HR for osteoporosis than control II participants (95% CI = 1.21-1.32). Adults with osteoporosis had a higher risk of renal stones. Moreover, adults with renal stones had a higher risk of osteoporosis.