National Health Insurance Service-Senior Cohort Research Articles

Increased Risk of New-Onset Parkinson's Disease Following a Diagnosis of Retinal Vascular Occlusion: A 14-Year Cohort Study.

Although the role of the vascular component in the pathophysiology of Parkinson's disease is widely accepted and retinal vascular abnormalities are commonly observed in Parkinson's disease patients, evidence connecting retinal vascular disorders with the risk of developing Parkinson's disease is limited. We aimed to investigate the association between retinal vascular occlusion (RVO) and the risk of developing Parkinson's disease in people over 60 years using a nationwide cohort. From the 14-year South Korean National Health Insurance Service-Senior cohort, 11210 incident RVO patients and 11210 propensity scores, risk-matched controls were included. The incidence of Parkinson's disease was estimated with a Poisson regression. A Cox proportional hazards regression model was used to investigate the associations between RVO and the risk of Parkinson's disease. The incidence of Parkinson's disease was 664.4 cases per 100000 person-years (95% confidence interval [CI], 599.7-736.0) in the RVO cohort. Individuals with RVO had an increased incidence of Parkinson's disease (hazard ratio [HR], 1.28; 95% CI: 1.10-1.49). Increased PD risk was predominantly observed in retinal artery occlusion patients (HR, 1.53; 95% CI: 1.11-2.12), male patients (HR, 1.67; 95% CI: 1.29-2.17), and 5 years after diagnosis (HR, 1.46; 95% CI: 1.10-1.93). Our findings suggest that a common pathophysiological pathway, such as vasculature changes, may exist between RVO and Parkinson's disease. RVO may be one of the risk factors associated with future development of Parkinson's disease. The nature of this association warrants further investigation.

Cost-utility analysis of transitional care services for older inpatients with chronic obstructive pulmonary disease (COPD) in Korea

BackgroundChronic obstructive pulmonary disease (COPD) is associated with a high readmission rate and poses a significant disease burden. South Korea initiated pilot projects on transitional care services (TCS) to reduce readmissions. However, evidence from cost-effectiveness analyses remains undiscovered. This study aimed to evaluate the cost-effectiveness of TCS in patients with COPD from the healthcare system’ perspective.MethodA cost-utility analysis was conducted using a Markov model containing six components of possible medical use after discharge. Transition probabilities and medical costs were extracted from the National Health Insurance Service Senior Cohort (NHIS-SC), and utility data were obtained from published literature. Sensitivity analyses were performed to test the robustness of the results.ResultsConducting TCS produced an incremental quality-adjusted life years gain of 0.231, 0.275, 0.296 for those in their 60s, 70s, and 80s, respectively, and cost savings of $225.16, $1668, and $2251.64 for those in their 60s, 70s, and 80s, respectively, per patient over a 10-year time horizon. The deterministic sensitivity analysis indicated that the TCS cost and the cost of readmission by other diseases immensely impact the results. The probabilistic sensitivity analyses showed that the probability that the incremental cost-effectiveness ratio is below $23,050 was over 85%, 93%, and 97% for those in the 60s, 70s, and 80s, respectively.ConclusionsTCS was the dominant option compared to usual care. However, it is advantageous to the healthcare budget preferentially consider patients aged over 70 years with severe TCS symptoms. In addition, it is essential to include the management of underlying comorbidities in TCS intervention.Trial registrationClinical Research Information Service (CRIS), KCT0007937. Registered on 24 November 2022

Impact of obesity on renal function in elderly Korean adults: a national population-based cohort study.

Obesity is a well-known risk factor for chronic kidney disease and its progression. However, the impact of obesity on the renal function of the elderly population is uncertain. We investigated the association between obesity and renal outcomes in the elderly. We analyzed 130,504 participants from the Korean National Health Insurance Service-Senior cohort. Obesity was classified according to body mass index (BMI), sex-specific waist circumference (WC), and the presence of metabolic syndrome. The primary outcome was renal function decline, defined as a decline in the estimated glomerular filtration rate (eGFR) of at least 50% from baseline or new-onset end-stage renal disease. During a follow-up period of 559,531.1 person-years (median, 4.3 years), 2,486 participants (19.0%; incidence rate of 4.44 per 1,000 person-years) showed renal function decline. A multivariate Cox proportional hazards model revealed that BMI/WC was not associated with renal function decline. However, the group with metabolic syndrome had a significantly increased risk of renal function decline compared to the group without metabolic syndrome (adjusted hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.13-1.36). Compared with the non-metabolic syndrome group, the adjusted HRs (95% CI) for participants with one through five components were 0.96 (0.84-1.11), 1.10 (0.96-1.27), 1.24 (1.06-1.45), 1.37 (1.12-1.66), and 1.99 (1.42-2.79), respectively (p for trend < 0.001). In elderly Korean adults, metabolic syndrome and the number of its components were associated with a higher risk of renal function decline, but BMI or WC was not significant.

Increased Risk of Dementia Following a Diagnosis of Hearing Impairment: A South Korean Nationwide Cohort Study.

Among the older adults, hearing impairment is a common problem and may contribute to dementia. Therefore, we aimed to examine the association between hearing impairment and the risk of dementia among older adults in South Korea. Using the Korean National Health Insurance Service-Senior Cohort from 2005 to 2019, we collected data of 44,728 patients. Hearing impairment was determined using the national disability registry. Propensity score matching (1:1) was performed to match patients with and without hearing impairment (case: 22,364, control: 22,364). A Cox proportional hazards regression model was built to analyze the association between hearing impairment and dementia. Patients with hearing impairment had a higher risk of dementia than those without hearing impairment (hazard ratio [HR] = 1.28, 95% confidence interval [CI] = 1.23-1.34). Assessing the degree of disability, both severe (HR = 1.25, 95% CI = 1.16-1.35) and mild conditions (HR = 1.29, 95% CI = 1.23-1.35) had an increased risk of dementia, respectively. Older patients with hearing impairment exhibit an increased risk of dementia, thereby warranting a new approach to dementia care among these patients regardless of the degree of hearing impairment.

Duration of osteoporosis treatment to reduce the risk of subsequent osteoporotic fracture and all-cause mortality in elderly hip fracture patients in a Korean real-world study

SummaryThis study aimed to evaluate the association between treatment duration of osteoporosis medications and clinical outcomes of patients with hip fracture. We found that the risk of subsequent osteoporotic fractures and all-cause mortality showed a decreasing trend as the treatment duration of osteoporosis medications increased.PurposeTo assess the risk of subsequent osteoporotic fracture (SOF) and all-cause mortality (ACM) in elderly patients with hip fracture in South Korea and to evaluate the potential reduction in the risk of SOF and ACM with varying durations of osteoporosis treatment.MethodsNewly diagnosed patients with hip fracture (age ≥ 60 years) who initiated osteoporosis medication within 3 months after the hip fracture from 2003–2014 were identified from the National Health Insurance Service-Senior cohort. The risk of SOF and ACM was estimated after the 1-year exposure-measurement period. Adjusted hazard ratios (aHRs) were calculated for treatment duration of osteoporosis medications categorized as short-term treatment (ST, < 3 months), early discontinuation (ED, ≥ 3– < 6 months), late discontinuation (LD, ≥ 6– < 12 months), and treatment continuation (TC, ≥ 12 months).ResultsA total of 4,421 patients were included in the analysis. The 3-year cumulative incidence of SOF was 22.4%, 22.0%, 23.9%, and 21.6%, and that of 3-year ACM was 29.8%, 27.0%, 19.7%, and 18.9% in the ST, ED, LD, and TC groups, respectively. Compared with the ST group, the risk of SOF showed a decreasing trend in the TC group (aHR [95% CI], 0.77 [0.58–1.00]). The risk of ACM was significantly reduced in the LD (aHR 0.68 [0.57–0.82]) and TC (aHR 0.65 [0.50–0.84]) groups.ConclusionThese findings underscore the importance of early and continuous osteoporosis treatment for elderly patients with hip fracture to improve health outcomes. The benefits of long-term osteoporosis treatment should be discussed in clinical practice to improve overall health outcomes.

Association between timed up-and-go test and subsequent pneumonia: A cohort study.

Sarcopenia is a risk factor for pneumonia in the elderly, and the timed up-and-go test (TUG) can be used as a screening tool for sarcopenia in this population. This study aimed to evaluate the association between TUG test results and future pneumonia or ventilator care. From the National Health Insurance Service-Senior Cohort database, we identified 19,804 people without neurological diseases who underwent the TUG test in the National Screening Program for Transitional Ages at the age of 66 years during 2007-2008. Gait abnormality was defined as taking 10 s or longer to perform the TUG test. Pneumonia occurrence was defined using the International Classification of Diseases 10th Revision (ICD-10) code for pneumonia (J12-J18, J69), and ventilator care was defined by procedure codes (M5830, M5850, M5867, M5858, M5860, M5859) according to the Healthcare Common Procedure Coding system codes from 2007 to 2015. The mean follow-up period was 7.4 years (standard error, SE 0.02). The incidence rates of pneumonia in the normal and slow TUG groups were 38 and 39.5/1000 person-years, respectively. The slow TUG group did not show a higher risk of pneumonia (adjusted hazard ratio [aHR], 1.042; 95% confidence interval [95% CI], 0.988-1.107]). Regarding ventilator care, the incidence was 4.7 and 5.2 cases per 1,000 person-years in the normal and slow TUG groups, respectively. Slow TUG groups also did not show an increased risk of ventilator occurrence (aHR, 1.136, [95% CI = 0.947-1.363]). The TUG test result was not associated with future pneumonia or ventilator care and may not be useful for predicting pneumonia in community-dwelling elderly individuals. Further studies are needed to identify additional functional tools for sarcopenia associated with future pneumonia occurrences.

Lower-Body Fractures and the Risk of Dementia: A Nationwide Population-Based Study.

The association between physical activity and dementia has been shown in various observational studies. We aimed to determine the risk of dementia in the elderly with lower-body fractures. We reconstructed a population-based matched cohort from the National Health Insurance Service-Senior Cohort data set that covers 511,953 recipients of medical insurance in South Korea. Overall 53,776 subjects with lower-body fractures were identified during 2006-2012, and triplicate control groups were matched randomly by sex, age, and years from the index date for each subject with a fracture. There were 3,573 subjects (6.6%) with and 7,987 subjects (4.9%) without lower-body fractures who developed dementia from 2008 up to 2015. Lower-body fractures were independently associated with a subsequent dementia diagnosis with a higher adjusted hazard ratio (aHR) (1.55, 95% confidence interval [CI]=1.49-1.62) compared with upper-body fractures (aHR=1.19, 95% CI=1.14-1.23). These results support the protective role of physical activity against dementia and highlight the importance of promoting fracture prevention in the elderly.

Risk of dementia in the elderly with non-alcoholic fatty liver disease: A nested case-control study in the Republic of Korea

Introduction: Non-alcoholic fatty liver disease (NAFLD) is known to be associated with metabolic syndrome of which diabetes is an important component. Although diabetes is a known risk factor for dementia, studies on the association between NAFLD and dementia still produce conflicting results. This study aimed to determine whether NAFLD would be a risk factor for the development of dementia in an elderly population. Method: This study included 107,369 subjects aged ≥60 years in the Korean National Health Insurance Service-Senior cohort, entered in 2009 and followed up until 2015. NAFLD was diagnosed by calculating fatty liver index (FLI). Subjects were screened for dementia at baseline using a Korean Dementia Screening Questionnaire, and dementia was diagnosed using ICD-10 codes. Controls were randomly selected at a ratio of 1:5 from individuals who were at risk of becoming the case subjects at the time of selection. Results: From 107,369 subjects, 65,690 stroke- and dementia-free subjects without chronic hepatitis B or C or excessive alcohol drinking were selected for evaluation. Having NAFLD, determined by FLI, was associated with increased risk of dementia development (adjusted odds ratio [AOR] 1.493; 95% confidence interval [CI] 1.214–1.836). The increased risk of dementia in NAFLD subjects was independent of type 2 diabetes (AOR 1.421; 95% CI 1.013–1.994, in subjects with diabetes: AOR 1.540; 95% CI 1.179–2.010, in subjects without diabetes). Conclusion: In this population-based nested case-control study, having NAFLD increased the risk of dementia in elderly individuals, independent of accompanying diabetes.

Association between Sudden Sensorineural Hearing Loss and the Risk of Cardio Cerebrovascular Disease.

This study investigated the association between sudden sensorineural hearing loss (SSNHL) and the risk of cardio-cerebrovascular disease (CCVD) among older adults in South Korea. Data from 38,426 patients in the Korean National Health Insurance Service-Senior Cohort from 2002 to 2019 were collected. The risk of CCVD includes both stroke and acute myocardial infarction. Propensity score matching (1:1) was used to identify pairs of individuals with and without SSNHL (n = 19,213 for cases and controls). Cox proportional hazards regression models were used to analyze the associations between variables. Patients with SSNHL had a higher risk of CCVD (hazard ratio [HR] = 1.17, 95% confidence interval [CI] = 1.11-1.24) compared to those without. The risk of CCVD was higher among those who experienced a stroke than those who did not (HR = 1.17 95% CI = 1.10-1.25). Compared to their matched controls, patients with SSNHL were 1.69 times (HR = 1.69 CI = 1.46-1.94) more likely to have CCVD during the first 12 months of the follow-up period. Older patients with SSNHL are at an increased risk of CCVD. Hence, a more attentive approach featuring aggressive monitoring of patients with SSNHL is required to lessen their risk of CCVD. 3 Laryngoscope, 134:2372-2376, 2024.

Chronic periodontitis and risk of cerebro-cardiovascular diseases among older Koreans.

There is a relative lack of evidence from observational studies of older populations investigating the association between chronic periodontitis and cerebro-cardiovascular diseases. Accordingly, we investigated the risk of cerebro-cardiovascular diseases according to the severity of chronic periodontitis among older adults. Data on older adults with chronic periodontitis were extracted from the Korea National Health Insurance Service-Senior Cohort Database using diagnosis codes and dental procedures. Participants were divided into two exposure groups. Among 46 737 participants eligible for inclusion, 21 905 (46.9%) had newly diagnosed mild chronic periodontitis, and 24 832 (53.1%) had newly diagnosed severe chronic periodontitis. To determine the risk of cerebro-cardiovascular diseases, including ischemic stroke, haemorrhagic stroke, and myocardial infarction, multivariable-adjusted Cox proportional hazards modelling was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) in this retrospective follow-up study. A total of 3453 (7.4%) outcomes were identified during a mean follow-up of 6.1 years. Kaplan-Meier analysis revealed that disease-free probability was lower in the severe group than in the mild group (log-rank P < .001). In the multivariable-adjusted model, the HR for cerebro-cardiovascular diseases in the severe group (relative to the mild group) was 1.16 (95% CI: 1.09-1.25). In individual outcome analysis, ischemic stroke and myocardial infarction were associated with chronic periodontitis severity, but haemorrhagic stroke was not. The severity of chronic periodontitis could be associated with the risk of cerebro-cardiovascular diseases in older adults.

Age- and dose-dependent effect of statin use on the risk of osteoporotic fracture in older adults.

Previous studies have revealed the protective effects of statins on bone but the association of statins use with osteoporotic fractures has shown controversial results. In this study with Korean National Health Insurance Service-Senior cohort database, a total of 365,656 elderly without previous history of osteoporosis and who were started on statin since January 1 2004 were included and observed until December 31 2012. Hazard rations (HR) for major osteoporotic fractures were calculated using the weighted Cox proportional hazards model with inverse-probability of treatment weighting method. During 6.27years of follow-up period, 54,959 osteoporotic fractures occurred and the majority of fractures (69.5%) were vertebral fractures. Compared with non-users, statin use was associated with a decreased risk of all outcomes with adjusted HR (95% CI) of 0.77 (0.72-0.83; P < 0.001) for major osteoporotic fractures, 0.49 (0.38-0.62; P < 0.001) for hip fractures, and 0.70 (0.64-0.77; P < 0.001) for vertebral fractures. When outcomes were examined separately by sex, the results were broadly comparable in terms of patterns of risk reduction by statin use. The patients with statin initiated at age≥ 80years had the highest risk reduction for most outcomes relative to non-users. Higher cumulative dose of statin was negatively associated with the osteoporotic fracture risk; 0.97 (0.91-1.02) for 30-364 cumulative daily defined dose (cDDD), 0.45 (0.40-0.51) for 365-1,094 cDDD, and 0.22 (0.15-0.33) for ≥ 1,095 cDDD. Our results showed that statin use was associated with significant reduction in the risk of osteoporotic fractures in general older population.

Association of Depressive Mood and Frailty With Mortality and Health Care Utilization: Korean National Cohort Study.

To investigate the association of depressive mood and frailty with mortality and health care utilization (HCU) and identify the coexisting effect of depressive mood and frailty in older adults. A retrospective study using nationwide longitudinal cohort data. A total of 27,818 older adults age 66 years from the National Screening Program for Transitional Ages between 2007 and 2008, part of the National Health Insurance Service-Senior cohort. Depressive mood and frailty were measured by the Geriatric Depression Scale and Timed Up and Go test, respectively. Outcomes were mortality and HCU, including long-term care services (LTCS), hospital admissions, and total length of stay (LOS) from the index date to December 31, 2015. Cox proportional hazards regression and zero-inflated negative binomial regression were performed to identify differences in outcomes by depressive mood and frailty. Participants with depressive mood and frailty represented 50.9% and 2.4%, respectively. The prevalence of mortality and LTCS use in the overall participants was 7.1% and 3.0%, respectively. More than 3 hospital admissions (36.7%) and total LOS above 15days (53.2%) were the most common. Depressive mood was associated with LTCS use [hazard ratio (HR) 1.22, 95% confidence interval (CI) 1.05-1.42] and hospital admissions [incidence rate ratio (IRR) 1.05, 95% CI 1.02-1.08]. Frailty had associations with mortality risk (HR 1.96, 95% CI 1.44-2.68), LTCS use (HR 4.86, 95% CI 3.45-6.84), and LOS (IRR 1.30, 95% CI 1.06-1.60). The coexistence of depressive mood and frailty was associated with increased LOS (IRR 1.55, 95% CI 1.16-2.07). Our findings highlight the need to focus on depressive mood and frailty to reduce mortality and HCU. Identifying combined problems in older adults may contribute to healthy aging by reducing adverse health outcomes and the burden of health care costs.

Association Between Hearing Impairment and Incident Depression: A Nationwide Follow-up Study.

Accumulating evidence suggests that hearing impairment is associated with the onset of depression. However, large-scale epidemiological studies are required to define this association more clearly. We aimed to investigate the risk of new-onset depression in Korean older adults with and without hearing impairment. From the National Health Insurance Service-Senior Cohort, which is a retrospective-prospective hybrid database, we analyzed data for 254,466 older adults enrolled in the Korea National Health Insurance Service-Senior Cohort who underwent at least one health screening between 2003 and 2019. A Cox proportional hazards regression model was used to evaluate the association between hearing impairment and the risk of incident depression, which was presented as adjusted hazard ratios (aHR) with 95% confidence intervals (CIs). All participants were followed up until the date of incident depression, death, or December 31, 2019. During 3,417,682 person-years of follow-up investigation, hearing impairment was associated with a higher risk of incident depression (vs. no hearing impairment) in the final adjusted model (aHR, 1.11; 95% CI, 1.01-1.21; p=0.033). Stratified analyses revealed a significant interaction among age, hearing impairment, and the risk of depression. Participants aged <65 years had a higher risk of depression (aHR, 1.29; 95% CI, 1.12-1.50; p < 0.001) than those aged 65 or above (aHR, 1.15; 95% CI, 1.01-1.30; p=0.032). Hearing impairment is independently associated with a higher risk of depression among older adults. The prevention and treatment of hearing impairment may aid in mitigating the risk of incident depression. Level 3 Laryngoscope, 133:3144-3151, 2023.

Association Between Proton Pump Inhibitor Exposure and Acute Kidney Injury After Cardiac Surgery

ObjectiveTo evaluate the association of preoperative proton pump inhibitor (PPI) exposure with incident acute kidney injury (AKI) after cardiac surgery. Patients and MethodsThe Severance cardiac surgery cohort included 9860 cardiac surgery patients aged 18 years or older. The National Health Insurance Service-senior cohort included 2933 patients aged 60 years or older who underwent cardiac surgery. Preoperative PPI exposure was defined as a PPI prescription within 3 weeks prior to cardiac surgery. Primary outcomes were postoperative AKI and AKI requiring dialysis (AKI-dialysis). ResultsIn the Severance cardiac surgery cohort after propensity score matching for PPI exposure, incident AKI (44.0% [472 of 1073] vs 40.5% [1304 of 3219]) and AKI-dialysis (5.8% [62 of 1073] vs 3.7% [119 of 3219]) were more common in patients exposed to PPI than in those who were not. Hospital and intensive care unit stay durations were longer among PPI-exposed than PPI-nonexposed patients. Multivariable conditional logistic analyses revealed that PPI exposure was significantly associated with incident AKI (adjusted odds ratio [AOR], 1.21; 95% CI, 1.03 to 1.42; P=.02) and AKI-dialysis (AOR, 1.74; 95% CI, 1.15 to 2.63; P=.009). The National Health Insurance Service–Senior cohort had similar results, revealing a significant association between PPI exposure and incident AKI-dialysis (AOR, 1.87; 95% CI, 1.25 to 2.81; P=.003). Discontinuation of PPI prior to operation was associated with a lower odds of AKI development in both cohorts. ConclusionPreoperative PPI exposure may be a modifiable risk factor for AKI among patients undergoing cardiac surgery.

Association between depressive mood and chronic periodontitis among senior residents using the National Health Insurance Service-Senior Cohort Database.

Bacteria involved in chronic periodontal disease induce inflammatory cytokines. These cytokines can enter the brain through systemic circulation and cause depression. In this study, we investigated the association between depressed mood and chronic periodontitis in older adults in Korea. This study used data from the Life-changing Period Health Checkup (2007-2008), performed only at 66 years of age, which is available from the National Health Insurance Service-Senior Cohort Database. The depressed mood status was evaluated by three questions in the mental health examination. The definition of chronic periodontitis was determined based on the diagnosis and treatment codes for chronic periodontitis. Based on the three questions, we investigated the association between depressive mood and chronic periodontal disease by dividing the study population into 9622 depressed mood subjects (DMS) and 9091 non-depressed mood subjects (NDMS). Multivariable-adjusted logistic regression analysis was performed, and odds ratios (ORs) with 95% confidence intervals (95% CIs) were presented. Among the NDMS, 5390 patients with chronic periodontitis were identified, and among the DMS, 5964 patients with chronic periodontitis were identified. The crude OR (95% CI) for chronic periodontitis in DMS compared to NDMS was 1.12 (1.06-1.19). The adjusted OR (95% CI) for chronic periodontitis was 1.12 (1.06-1.19). As a result of confirming the effect of sex and comorbidity on the association between depressed mood and chronic periodontitis, a significant association was observed for women at 1.15 (1.07-1.25). In addition, the adjusted OR (95% CI) for depressive mood and chronic periodontitis was 1.15 (1.07-1.25) for patients with hypertension, 1.13 (1.03-1.25) for patients with diabetes, 1.12 (1.02-1.22) for patients with dyslipidemia, and 1.18 (1.04-1.34) for patients with heart disease. This study confirmed the relationship between depressed mood and chronic periodontitis in older adults. Therefore, education to strengthen the emotional management of older adults, especially with respect to depression, would play an auxiliary role in preventing and treating periodontitis.

Association of Balance Impairment with Risk of Incident Dementia among Older Adults.

A growing body of data suggests that balance impairment may be linked to the onset of dementia. However, a large-scale epidemiologic investigation is needed to clarify its association in older adults. A retrospective-prospective hybrid database. Cox proportional hazards regression model was used to assess the relationship between balance impairment and the risk of incident dementia, and the results were provided as adjusted hazard ratios (aHR) with 95% confidence intervals (CI). All participants were tracked until the date of incident dementia, death, or 31 December 2019 whichever came first. We analyzed 143,788 older adults who had at least one health screening between 2009 and 2019 from the Korea National Health Insurance Service-Senior Cohort. A total of 3,774 cases of dementia were discovered throughout 850,425 person-years of follow-up investigation. Balance impairment was associated with a risk of dementia compared to those without balance impairment (adjusted hazard ratio [aHR] 1.83; 95% CI, 1.69-2.00; P value <0.001). Risks of the Alzheimer's disease (aHR, 1.80; 95% CI, 1.65-1.96; P for trend <0.001) and the vascular dementia (aHR, 2.94; 95% CI, 1.89-4.58; P for trend <0.001) showed comparable trends and findings. Balance impairment was found to be independently associated with an increased risk of dementia in older adults.

Effect Modification on Death by Age and Sex in Elderly Hip Fracture.

This study compared the effects of hip fractures on mortality according to sex and age in a nationwide cohort of elderly patients with hip fractures and controls. Patients with hip fractures and matched controls were selected from the National Health Insurance Service-Senior cohort. Time-dependent propensity score matching was estimated from a Cox proportional hazards model with January 1, 2005, as the baseline and hip fracture as an event. Patients were matched by age and sex to participants at risk of developing a hip fracture at time zero. The effect size is presented as hazard ratio (HR) using a Cox proportional hazards model with a robust variance estimator that accounts for clustering within the matched pairs. Altogether, 14,283 patients with incident hip fractures and 28,566 matched controls were identified. The HR of male sex in hip fractures was 1.31 (95% confidence interval [CI], 1.22-1.40; Pinteraction<0.01). Moreover, the HR of age group in hip fractures was 0.73 (95% CI, 0.66-0.80; Pinteraction<0.01) between the 65 to 74 and 75 to 84 years groups, 0.76 (95% CI, 0.71-0.81; Pinteraction<0.01) between the 75 to 84 and ≥85 years groups, and 0.55 (95% CI, 0.50-0.61; Pinteraction<0.01) between the 65 to 74 and ≥85 years groups. Male sex increases the risk of death in elderly patients with hip fractures versus matched controls, but the increased risk of death with age in hip fractures was decreased compared to that in matched controls.

ODP087 Dose-dependent effect of long-term statin use on risk of osteoporotic fracture in elderly patients

Abstract Introduction Studies have been conducted to assess the association between the use of statin and risk of new onset osteoporosis or osteoporotic fractures, however, they have shown conflicting results. We aimed to investigate the association between statin use and the risk of major osteoporotic fractures in elderly population. Methods In this population cohort study with Korean National Health Insurance Service-Senior Cohort database, a total of 365,656 elderly (≥60 years) without previous history of osteoporosis were included. The patients who did not have a history of statin use in year 2003 were followed from January 2004 to December 2012. Incidences of major osteoporotic fractures and site specific fractures were compared using the Cox proportional hazards model with use the inverse probability weighting method. Results During years follow-up period, 54,959 major osteoporotic fractures occurred; the risk of major osteoporotic fractures was significantly reduced (OR,0.769; 95% CI,0.716-0.826) in statin users compared with that in non-users. Among subtypes of major osteoporotic fracture, a risk reduction with statin therapy was significant for both vertebral fracture (OR,0.701; 95% CI,0.641-0.767) and non-vertebral fracture (OR,0.807; 95% CI,0.726-0.898). Longer duration and higher cumulative dose of statin, defined by cumulative daily defined dose, were negatively associated with the risk of major osteoporotic fracture. Conclusion In this population-based cohort study, the use of statin was associated with significant reduction in the risk of osteoporotic fractures in elderly patients without previous history of osteoporosis. Presentation: No date and time listed

Risk of dementia according to the severity of chronic periodontitis in Korea: a nationwide retrospective cohort study.

We investigated the risk of dementia in older adults with chronic periodontitis according to the severity of periodontitis. Data on patients with chronic periodontitis were extracted from the National Health Insurance Service-Senior cohort database from 2002 to 2014. Among 52,728 subjects eligible for inclusion, 11,953 subjects had newly diagnosed mild chronic periodontitis (MCP), and 40,775 subjects had newly diagnosed severe chronic periodontitis (SCP). Two 1:1 propensity score matched cohorts were created with 8,624 patients each in the MCP and SCP groups. To analyze the risk of dementia, a Cox proportional-hazard model was used to calculate hazard ratios with 95% confidence intervals (CIs). In the Kaplan-Meier curve, the disease-free probability was significantly lower in the SCP group than in the MCP group (p for log-rank=0.001). In the multivariable-adjusted model, the HR for the occurrence of dementia in the SCP group compared to the MCP group was 1.15 (95% CI, 1.04 to 1.27; p=0.009). A subgroup analysis revealed a significant association between dementia and the severity of periodontitis, especially in subjects who were male, aged ≥70 years, and had comorbidities. Reducing the severity of chronic periodontitis can help to reduce the risk of dementia. Therefore, it is necessary to aggressively conduct early dementia-prevention programs for males under the age of 70 that include dental health to prevent the progression of periodontitis from mild to severe.

Association of late-life body mass index with the risk of Alzheimer disease: a 10-year nationwide population-based cohort study

Existing data for the association between late-life body mass index (BMI) and the risk of Alzheimer’s disease (AD) in the underweight population are limited with conflicting results. A large population-based cohort study of 148,534 individuals aged ≥ 65 years who participated in the national health screening program from 2002 to 2005 was performed using the Korean National Health Insurance Service-Senior cohort database 2006–2015. The risk of AD according to BMI category (kg/m2) in Asians was evaluated using a multivariable Cox regression model, after adjustments for age, sex, lifestyle, low-income status, and comorbidities. To evaluate the association between BMI and AD risk, the underweight population was further subdivided according to the degree of thinness. During the 10-year follow-up period, 22,279 individuals developed AD. Relative to the normal-weight population, the estimated adjusted hazard ratio (HR) for incident AD in the underweight, overweight, and obese populations was 1.17 (95% confidence interval [CI], 1.09–1.24), 0.90 (0.87–0.93), and 0.83 (0.80–0.85), respectively. In the underweight population, AD risk increased as the degree of thinness increased (p for the trend, < .001). Late-life BMI showed a significant inverse relationship with AD risk, especially in the underweight population. Public health strategies to screen for AD more actively in the underweight population and improve their weight status may help reduce the burden of AD.