Nationwide Health Insurance Research Articles

Rapid reduction in fracture risk after the discontinuation of long-term oral glucocorticoid therapy: a retrospective cohort study using a nationwide health insurance claims database in Japan.

We investigated changes in fracture risk following discontinuation of long-term oral glucocorticoids (GCs) using Japan's nationwide health insurance claims database (NDBJ). We identified patients aged ≥ 50 years who initiated GC therapy in 2012-2019. Those receiving ≥ 5mg (prednisolone or equivalent, PSL)/day for ≥ 72days in the initial 90days of GC therapy were classified as the GC-exposure group, and those receiving < 5mg PSL/day for < 30days were classified as the reference group. Patients discontinuing GC after 90days of GC therapy were classified as the GC-discontinuation group; all others were classified as the GC-continuation group. We tracked the incidence rates of hip and clinical vertebral fractures for up to 990days, and assessed fracture risk after GC discontinuation by hazard ratios (HR) adjusted by inverse probability weighting using propensity scores for GC discontinuation. There was a total of 52,179 GC-discontinuation, 91,969 GC-continuation, and 43,138 reference group women, and 57,560, 93,736, and 33,696 men in the corresponding groups, respectively. According to adjusted HRs, incidence rates of fractures were significantly lower in the GC-discontinuation group than in the GC-continuation group in the initial 90days after GC discontinuation and remained significant for 360days, except for hip fracture in men. HRs for hip fractures remained significantly higher in the GC-discontinuation group compared to the reference group for 720days post-discontinuation. Fracture risk declines rapidly in the first year after GC discontinuation, but vigilance is necessary as the increased risk persists for two years post-discontinuation.

A 5-Year Mortality Prediction Model for Prostate Cancer Patients Based on the Korean Nationwide Health Insurance Claims Database.

Prostate cancer is the fourth most common cancer and eighth leading cause of cancer-related mortality worldwide. Its incidence is increasing in South Korea. This study aimed to investigate a predictive model for the 5-year survival probability of prostate cancer patients in a Korean primary care setting. This retrospective study used data from the nationwide insurance claims database. The main outcome was survival probability 5 years after the initial diagnosis of prostate cancer. Potential confounding factors such as age, body mass index (BMI), blood pressure, laboratory results, lifestyle behaviors, household income, and comorbidity index were considered. These variables were available in the national health check-up information. A Cox proportional hazards regression model was used to develop the predictive model. The predictive performance was calculated based on the mean area under the receiver operating characteristic curve (AUC) after 10-fold cross-validation. The mean 5-year survival probability was 82.0%. Age, fasting glucose and gamma-glutamyl transferase levels, current smoking, and multiple comorbidities were positively associated with mortality, whereas BMI, alkaline phosphatase levels, total cholesterol levels, alcohol intake, physical activity, and household income were inversely associated with mortality. The mean AUC after 10-fold cross-validation was 0.71. The 5-year survival probability model showed a moderately good predictive performance. This may be useful in predicting the survival probability of prostate cancer patients in primary care settings. When interpreting these results, potential limitations, such as selection or healthy user biases, should be considered.

Changes in Healthcare Utilization After the 2022 Seoul Metropolitan Flood: Applying a Generalized Synthetic Control Approach.

Floods can have adverse health effects and impose a burden on healthcare systems. However, the potential consequences of floods on specific medical causes in densely populated metropolitan cities has not been characterized yet. Therefore, we evaluate the changes in healthcare utilization patterns after the 2022 Seoul flood using nationwide health insurance data. Based on the flood inundation map, districts within the flooded municipalities of Seoul were classified as severe-(n=12), mild-(n=22), or non-(n=38) flood-affected districts. Capitalizing on the timing of the flood as a natural experiment, a generalized synthetic control method was applied to estimate changes in the number of disease-specific hospital visits in flood-affected districts during 2weeks after the flood. We found excess hospital visits for external injuries (20.2 visits, 95% CI: -6.0, 45.2) and fewer visits for pregnancy and puerperium (-3.0 visits, 95% CI: -5.1, -0.5) in residents of flooded districts. When comparing severe- and non-flood districts, the increase in hospital visits for external injuries (56.2 visits, 95% CI: 17.2, 93.2) and a decrease in hospital visits related to pregnancy and puerperium (-5.3 visits, 95% CI: -8.4, -1.6) were prominent in residents living in severe-flood affected districts. Disease specific analysis showed an increase in hospital visits for injuries to the elbow and forearm, ankle and foot injuries, and chronic lower respiratory diseases in severe-flood-affected districts. However, these impacts were not observed when comparing the mild- and non-flood-affected districts. Our study suggests an immediate and substantial change in medical demand following flood exposure, highlighting the importance of public health responses after flood events.

Impact of the 2017 revised Japanese obstetric hemorrhage management guidelines on tranexamic acid use in patients undergoing cesarean delivery: an interrupted time series analysis

BackgroundTranexamic acid is one component of a complex management algorithm for postpartum hemorrhage. In Japan, the 2010 obstetric hemorrhage management guidelines was revised in 2017, adding the recommendation for the administration of tranexamic acid for postpartum hemorrhage. This research aims to delineate the temporal trends in tranexamic acid administration in patients undergoing cesarean deliveries and to examine the impact of the obstetric hemorrhage management guidelines implementation. MethodsAn interrupted time series analysis was conducted on data from patients who underwent cesarean deliveries from April 2012 to August 2021, sourced from Japan’s nationwide health insurance claims database. We examined the trends of tranexamic acid usage and blood transfusion use before and after the implementation of the revised guidelines in 2017. ResultsThe study cohort comprised 91 166 cesarean deliveries. Prior to the guideline implementation, the rate of tranexamic acid usage decreased. Post-guidelines implementation, there was a statistically significant increase in the rate of tranexamic acid use, with a quarterly percentage change of 0.48% (95% confidence interval: 0.36 to 0.60; P < 0.001). The guidelines implementation in 2017 was not significantly associated with a change in the rate of transfusions. ConclusionsThis interrupted time series analysis demonstrated a significant increase in the rate of tranexamic acid administration following the implementation of the revised guidelines, reversing the previously observed downward trend. Our findings could reflect the impact of the revised guideline on the use of tranexamic acid for postpartum hemorrhage, but this did not translate to fewer blood transfusions.

Analyses of Osteogenesis Imperfecta in South Korea Using the Nationwide Health Insurance Service Claim Data: A Propensity Score-Matched Study.

Osteogenesis imperfecta (OI) is the most common inherited form of bone fragility and includes a heterogeneous group of genetic disorders that most commonly result from defects associated with type I collagen. Although genetic analyses have been developed, nationwide research on the incidence and associated fractures in OI is lacking. This study aimed to investigate the patterns of OI prevalence, incidence, fracture rate, etc. in South Korea using National Health Insurance Service (NHIS) claims data. We found 1596 patients newly diagnosed with OI between March 2002 and February 2020. We evaluated the incidence, prevalence, and history of fractures, fracture site, prescription of anti-osteoporosis drugs, etc. To compare medical costs, fracture rates, and scoliosis rates, we created a control group comprising patients without OI using 1:1 propensity score matching. The prevalence of OI increased slightly each year, with an annual incidence of 20.20 per 100,000 live births. Mean fracture frequency in OI patients was 17 (2-32) times per patient and the most frequent fracture site was the lower leg. A total of 21.4% patients were prescribed anti-osteoporosis drugs, and the most popular drug was pamidronate. After 1:1 propensity score matching, in terms of scoliosis, OI patients had a 3.91 times higher prevalence of scoliosis than in healthy patients which was statistically significant. The sum of medical care expenses for patients with OI was 3.5 times higher than that for patients without OI. We identified nationwide trends in OI occurrence, fractures, and medication use. This study also highlighted the real-world data of scoliosis and medical costs compared to the control group.

Health-economic evaluation of orthogeriatric co-management for patients with forearm or humerus fractures: an analysis of insurance claims data from Germany

Orthogeriatric co-management (OGCM) describes a collaboration of orthopedic surgeons and geriatricians for the treatment of fragility fractures in geriatric patients. While its cost-effectiveness for hip fractures has been widely investigated, research focusing on fractures of the upper extremities is lacking. Thus, we conducted a health economic evaluation of treatment in OGCM hospitals for forearm and humerus fractures.In a retrospective cohort study with nationwide health insurance claims data, we selected the first inpatient stay due to a forearm or humerus fracture in 2014–2018 either treated in hospitals that were able to offer OGCM (OGCM group) or not (non-OGCM group) and applied a 1-year follow-up. We included 31,557 cases with forearm (63.1% OGCM group) and 39,093 cases with humerus fractures (63.9% OGCM group) and balanced relevant covariates using entropy balancing. We investigated costs in different health sectors, length of stay, and cost-effectiveness regarding total cost per life year or fracture-free life year gained.In both fracture cohorts, initial hospital stay, inpatient stay, and total costs were higher in OGCM than in non-OGCM hospitals. For neither cohort nor effectiveness outcome, the probability that treatment in OGCM hospitals was cost-effective exceeded 95% for a willingness-to-pay of up to €150,000.We did not find distinct benefits of treatment in OGCM hospitals. Assigning cases to study groups on hospital-level and using life years and fracture-free life years, which might not adequately reflect the manifold ways these fractures affect the patients’ health, as effectiveness outcomes, might have underestimated the effectiveness of treatment in OGCM hospitals.

Potentially Inappropriate End of Life Care and Healthcare Costs in the Last 30 Days of Life in Regions Providing Integrated Palliative Care in the Netherlands: A Registration-based Study.

This study aimed to assess the effect of integrated palliative care (IPC) on potentially inappropriate end- of-life care and healthcare-costs in the last 30 days of life in the Netherlands. Nationwide health-insurance claims data were used to assess potentially inappropriate end-of-life care (≥2 emergency room visits; ≥2 hospital admissions; >14 days hospitalization; chemotherapy; ICU admission; hospital death) and healthcare-costs in all deceased adults in IPC regions pre- and post- implementation and in those receiving IPC compared to a 1:2 matched control group. In regions providing IPC deceased adults (n = 37,468) received significantly less potentially inappropriate end-of-life care post-implementation compared to pre-implementation (26.5% vs 27.9%; p < 0.05). Deceased adults who received IPC (n = 210) also received significantly less potentially inappropriate end-of-life care compared to a matched control group (14.8% vs 28.3%; p < 0.05). Mean hospital costs significantly decreased for deceased adults who received IPC (€2,817), while mean costs increased for general practitioner services (€311) and home care (€1,632). These results highlight the importance of implementation of integrated palliative care and suitable payment. Further research in a larger sample is needed. This study shows less potentially inappropriate end-of-life care and a shift in healthcare costs from hospital to general practitioner and home care with IPC.

P-754 Association between ovarian hyperstimulation syndrome and adverse obstetric and neonatal outcomes in Korea: a nationwide health insurance database study

Abstract Study question Does OHSS affect maternal and neonatal outcomes in perinatal life? Summary answer OHSS is associated with an increased risk of postpartum hemorrhage, large birth weight, neonatal respiratory distress syndrome, and intraventricular hemorrhage. What is known already Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic condition caused by ovulation induction. Golan et al.(1989)’s clinical staging system categorizes OHSS into mild, moderate, and severe based on the clinical characteristics. Among them, severe OHSS is considered potentially fatal and requires hospitalization. In 2021, a systematic review of 3,303 pregnant patients with OHSS and 89,720 pregnant patients without OHSS, drawn from 13 studies, revealed a notable impact of OHSS on preterm birth. However, owing to the characteristics of spontaneous resolution in the relatively early stages of pregnancy, no large-scale study has confirmed the OHSS and pregnancy outcomes. Study design, size, duration This retrospective study utilized a combined dataset from two primary sources: the Korea National Health Insurance (KNHI) claims database and the National Health Screening Program for Infants and Children (NHSP-IC) database. We identified all women who delivered between January 1, 2012, and December 31, 2020 from KNHI claims database. Pregnancy outcomes including preterm birth and PPH were identified from NHSP-IC database and KNHI claims database, respectively. Participants/materials, setting, methods We enrolled all women who delivered between January 1, 2012, and December 31, 2020 (N = 3,446,520). Women diagnosed with multiple pregnancy or had missing data were excluded (N = 2,565,461). The participants were divided into three groups according to the presence or absence of an ovarian hyperstimulation diagnosis code (ICD-10 code N981) and hospitalization within 3 months before pregnancy: non-OHSS group (N = 2,562,562), mild-to-moderate OHSS group (N = 2,293), severe OHSS group (N = 606). Main results and the role of chance In this study, mothers in the ovarian hyperstimulation group had a younger age and a higher rate incidence of primiparity and cesarean section. In the ovarian hyperstimulation group, a significantly high proportion of patients was diagnosed with pre-pregnancy hypertension or diabetes mellitus and gestational hypertension or gestational diabetes. The risk of postpartum hemorrhage was 38.2% higher in the mild-to-moderate OHSS group than in the non-OHSS group (adjusted odds ratio (aOR): 1.382, 95% confidence interval (CI): 1.223–1.562). No difference was found in the average birth weight of newborns according to the presence or absence of OHSS. However, the risk of macrosomia was elevated by 62.4% in the severe OHSS group (aOR: 1.624, 95% CI: 1.168–2.259) than the non-OHSS group. The mild-to-moderate OHSS group had a 36.8% higher risk of respiratory distress syndrome compared with the non-OHSS group (aOR: 1.368, 95% CI: 1.149–1.629). The mild-to-moderate OHSS group had a 2.697-fold increased risk of intraventricular hemorrhage compared with the non-OHSS group (aOR: 2.697, 95% CI: 1.338–5.437). Limitations, reasons for caution A limitation lies in the unknown details of the controlled ovarian stimulation protocol, type and dose of gonadotrophin used, hormone concentration, and embryo transfer method used due to the data structure. Despite the potential variations in the causes of hospitalization, hospitalized patients were classified into the severe OHSS group. Wider implications of the findings Although OHSS occurs during early pregnancy, further research is required to determine its long-term effects. Especially, if the incidence of IVH is significantly higher in the OHSS group, particularly among uncommon full-term neonates, further studies are warranted. Trial registration number Not Applicable

Investigating the impact of tadalafil on progression of age-related macular degeneration: a health insurance claims database analysis

PurposeTo assess the effect of tadalafil use on progression of early/intermediate to advanced exudative or non-exudative age-related macular degeneration (AMD) in a real-world population. DesignRetrospective cohort study utilizing Optum's de-identified Clinformatics® Data Mart Database (CDM). MethodsPatients were included from January 2015 to December 2020 aged 55 and older with an index International Classification of Diseases, Tenth Revision (ICD-10) diagnosis of early or intermediate AMD who had a 2-year period of continuous enrollment prior to the index diagnosis date (lookback period), 5 years of continuous follow-up, and who did not meet any exclusion criteria (claims for a phosphodiesterase-5 (PDE-5) inhibitor other than tadalafil during the study, diagnosis of advanced non-exudative or exudative AMD, or claims for exudative AMD treatment during the lookback period). Treated patients with claims for tadalafil during the study period were matched 1:1 to untreated controls by age, sex, race, and smoking status. We assessed the effect of any tadalafil use, high (≥2700 mg) cumulative dose tadalafil vs. matched untreated controls, high (>2700 mg) vs. low (≤2700 mg) cumulative dose tadalafil, and the 2-year cumulative dose of tadalafil (per 100 mg) as a continuous variable on incidence of progression to exudative or advanced non-exudative AMD during the 2-year follow-up. ResultsThere was no significant difference in odds of progression to exudative AMD or advanced non-exudative AMD in the control vs treated groups (OR = 0.802, 95% CI (0.558–1.152), p = 0.233; OR = 1.326, 95% CI (0.757–2.323), p = 0.323). High (≥2700 mg) cumulative dose tadalafil was not associated with a significant difference in odds of progression to exudative AMD or advanced non-exudative AMD when compared to the matched controls (OR = 0.455, 95% CI (0.202–1.025), p = 0.057; OR = 1.000, 95% CI (0.318–3.142), p = 1.000). There was no significant difference in odds of progression to exudative AMD or advanced non-exudative AMD in the high (>2700 mg) vs. low (≤2700 mg) cumulative dose tadalafil (OR = 0.590, 95% CI (0.296–1.177), p = 0.134; OR = 1.039, 95% CI (0.440–2.460), p = 0.931). Lastly, there was no significant difference in odds of progression to exudative AMD or advanced non-exudative AMD when assessing the 2-year cumulative tadalafil dose (per 100 mg) as a continuous variable (OR = 1.000, 95% CI (1.000–1.000), p = 0.305; OR = 1.000, 95% CI (1.000–1.000), p = 0.878). ConclusionIn a retrospective cohort study of a large nationwide health insurance claims database, tadalafil use was not associated with progression of AMD.

Health-Seeking Patterns of Female North Korean Defectors in South Korea for Mental Health: Evidence from Nationwide Health Insurance Data

Health-Seeking Patterns of Female North Korean Defectors in South Korea for Mental Health: Evidence from Nationwide Health Insurance Data

Annual epidemiological and health insurance disease burden of hip osteoarthritis in Hungary based on nationwide data

BackgroundHealth services utilization related to hip osteoarthritis imposes a significant burden on society and health care systems. Our aim was to analyse the epidemiological and health insurance disease burden of hip osteoarthritis in Hungary based on nationwide data.MethodsData were extracted from the nationwide financial database of the National Health Insurance Fund Administration (NHIFA) of Hungary for the year 2018. The analysed data included annual patient numbers, prevalence, and age-standardized prevalence per 100,000 population in outpatient care, health insurance costs calculated for age groups and sexes for all types of care. Patients with hip osteoarthritis were identified using code M16 of the International Classification of Diseases (ICD), 10th revision. Age-standardised prevalence rates were calculated using the European Standard Population 2013 (ESP2013).ResultsBased on patient numbers of outpatient care, the prevalence per 100,000 among males was 1,483.7 patients (1.5%), among females 2,905.5 (2.9%), in total 2,226.2 patients (2.2%). The age-standardised prevalence was 1,734.8 (1.7%) for males and 2,594.8 (2.6%) for females per 100,000 population, for a total of 2,237.6 (2.2%). The prevalence per 100,000 population was higher for women in all age groups. In age group 30–39, 40–49, 50–59, 60–69 and 70 + the overall prevalence was 0.2%, 0.8%, 2.7%, 5.0% and 7.7%, respectively, describing a continuously increasing trend. In 2018, the NHIFA spent 42.31 million EUR on the treatment of hip osteoarthritis. Hip osteoarthritis accounts for 1% of total nationwide health insurance expenditures. 36.8% of costs were attributed to the treatment of male patients, and 63.2% to female patients. Acute inpatient care, outpatient care and chronic and rehabilitation inpatient care were the main cost drivers, accounting for 62.7%, 14.6% and 8.2% of the total health care expenditure for men, and 51.0%, 20.0% and 11.2% for women, respectively. The average annual treatment cost per patient was 3,627 EUR for men and 4,194 EUR for women.ConclusionsThe prevalence of hip osteoarthritis was 1.96 times higher (the age-standardised prevalence was 1.5 times higher) in women compared to men. Acute inpatient care was the major cost driver in the treatment of hip osteoarthritis. The average annual treatment cost per patient was 15.6% higher for women compared to men.

Thyroid cancer risk in women after hysterectomy: A nationwide cohort study

ObjectivesHysterectomy is commonly performed for benign uterine pathologies but there is some controversy over whether it is associated with an increased risk of thyroid cancer. This study examines the associations of hysterectomy with ovarian conservation or with bilateral salpingo-oophorectomy and thyroid cancer incidence in Taiwan. MethodsWe analyzed data from a nationwide health insurance claims database and identified 29,577 women aged ≥30 years who underwent hysterectomy with ovarian conservation or hysterectomy with bilateral salpingo-oophorectomy between 2000 and 2016. Propensity score-matching analyses were performed at ratios of 1:1 for the hysterectomy and no-hysterectomy groups, to reduce selection bias. We monitored thyroid cancer occurrence in both groups until 2017. Cox regression was used to calculate hazard ratios with 95 % confidence intervals and determine thyroid cancer risk in women who underwent hysterectomy. ResultsThe study comprised 29,577 patients who underwent any hysterectomy and 29,577 participants who did not. The mean follow-up period was 10.03 ± 4.92 years. Patients who underwent hysterectomy had higher thyroid cancer incidence (4.72 per 10,000 person-years) than those who did not (3.06 per 10,000 person-years) and a greater risk of any thyroid cancer (adjusted hazard ratio = 1.40; 95 % confidence interval = 1.08–1.82). However, there was no association between hysterectomy with bilateral salpingo-oophorectomy and thyroid cancer incidence (p > 0.05). ConclusionsOur findings suggest that women who undergo hysterectomy are at a higher risk of developing thyroid cancer than those who do not.

Human Papilloma Virus Typing as a Triage Tool for Women with Postcoital Bleeding: A Retrospective Cohort Study.

Objective: To investigate the performance of human papilloma virus (HPV) typing as a triage tool in the management of patients with postcoital bleeding (PCB). Methods: All patients referred for colposcopy at a cervical pathology clinic of a nationwide health insurance organization, due to PCB and had a preceding high-risk HPV (hrHPV) test between 2018 and 2020, were retrospectively located. Demographic and pathologic data were collected from electronic medical files. Sensitivity, specificity, and negative and positive predictive value of hrHPV test according to final pathology were calculated. Results: Three hundred ninety patients referred for colposcopy due to PCB with a preceding hrHPV test were located. HrHPV-positive patients were significantly younger (33.7 ± 10 vs. 37.2 ± 9, p < 0.006) with a higher proportion of nulliparous, nonmarried, and smokers compared with hrHPV-negative patients (75% vs. 47%, p < 0.001; 75.4% vs. 45.1%, p < 0.001; and 24.6% vs. 12.8%, p < 0.028, respectively). No case of high-grade cervical intraepithelial neoplasia (CIN2/3) was identified among hrHPV-negative patients. The sensitivity and NPV of the hrHPV test for high-grade cervical lesions were both 100%, decreasing to 36% and 95%, respectively, for any cervical dysplasia (CIN1/CIN2/CIN3). Adding cytology to HPV typing had a negligible effect on test performance. At univariate analysis, age, HPV vaccine status, nulliparity, and positive HPV typing were independently associated with cervical dysplasia. At multivariate analysis, only positive HPV typing remained significantly associated with cervical dysplasia (hazard ratio 2.75, confidence interval 1.1-6.5, p = 0.023). Conclusion: A negative HPV test even in the presence of PCB may rule out cervical dysplasia with extremely high accuracy and may save unnecessary colposcopies.

United States Healthcare System

United States Healthcare System

Effect of menopausal hormonal therapy on cardiovascular risks in Korean postmenopausal women: A nationwide cohort study.

To evaluate the association between menopausal hormonal therapy (MHT) and the risk of cardiovascular disease (CVD), according to various regimens, dosages, routes of administration and starting ages of MHT. A population-based cohort study using the Korean National Health Insurance Services database. Nationwide health insurance database. Women who reported entering menopause at an age of ≥40 years with no history of CVD in the national health examination. The study population comprised 1 120 705 subjects enrolled between 2002 and 2019, categorised according to MHT status (MHT group, n = 319 007; non-MHT group, n = 801 698). Incidence of CVD (a composite of myocardial infarction and stroke). The incidence of CVD was 59 266 (7.4%) in the non-MHT group and 17 674 (5.5%) in the MHT group. After adjusting for confounding factors, an increased risk of CVD was observed with the administration of tibolone (hazard ratio, HR 1.143, 95% CI 1.117-1.170), oral estrogen (HR 1.246, 95% CI 1.198-1.295) or transdermal estrogen (HR 1.289, 95% CI 1.066-1.558), compared with the non-MHT group; the risk was based on an increased risk of stroke. The risk trends were consistent regardless of the age of starting MHT or the physicians' specialty. Among tibolone users, a longer period from entering menopause to taking tibolone and the use of any dosage (1.25 or 2.5 mg) were linked with a higher risk of CVD, compared with non-MHT users. This nationwide cohort study demonstrated an increased risk of CVD, driven mainly by an increased risk of stroke, among tibolone and oral or transdermal estrogen users, compared with that of non-MHT users.

Linear IgA Bullous Dermatosis in Korea Using the Nationwide Health Insurance Database.

(1) Background: Linear immunoglobulin A bullous dermatosis (LABD) is a rare autoimmune, subepidermal blistering disease, characterized by linear IgA deposits along the epidermal basement membrane. LABD is idiopathic and is associated with medication and systemic autoimmune diseases. (2) Methods: We investigated the demographic characteristics, disease course, causative agents, and associated diseases in Korean patients with LABD. The Korean Health Insurance Review and Assessment Service database was used to obtain data. We identified 670 LABD cases between 2010 and 2022. (3) Results: The annual incidence of LABD was 1.3 per 100,000 persons, with a higher prevalence in individuals ≥60 years old. The patients were treated with dapsone for 30.7 ± 56.7 days, had 1.3 ± 0.7 hospital visits, and were hospitalized for 19.8 ± 19.7 days. Risk factors, including malignancy, commonly preceded LABD. Antibiotic use, specifically vancomycin and third-generation cephalosporins, was a risk factor. The mean age of LABD diagnosis was 55.9 ± 21.7 years. (4) Conclusion: This is the first published study to assess a nationwide cohort for LABD. The incidence of LABD was higher than that in other studies. Most case reports have linked LABD with the administration of specific antibiotics; however, this study shows there were more associations with other conditions.

Unmet Healthcare Needs and Their Determining Factors: Addressing Inequalities in Access to Healthcare in Myanmar

Myanmar aims to achieve universal health coverage by 2030 through the 2017–2021 National Health Plan while providing nearly cost-free healthcare services at public facilities. Nonetheless, concerns regarding healthcare access persist. This study examined healthcare access in Myanmar by identifying the prevalence, determinants, and reasons behind unmet healthcare needs (UHN), which occur when an individual needs healthcare but cannot access it. Descriptive statistical analysis and binary logistic regression were employed using data obtained from 318 residents of Tat Kon Township, Nay Pyi Taw. Among the participants, 23.6% experienced UHN. Specifically, individuals with low income, daily-waged workers, rural residents, younger individuals, and females reported high UHN. The primary reason was the unavailability of healthcare facilities (46.7%), followed by competing personal priorities (19%) and treatment or transportation costs (14%). The government could consider expanding public healthcare infrastructure and implementing a nationwide health insurance system. Continuing the geographic expansion of health services to address the needs of rural residents and extending service hours to accommodate individuals engaged in daily-waged or full-time employment are recommended. These efforts could be complemented by improving public transportation infrastructure, promoting income security, and supporting gender equity to facilitate access to healthcare services.

Risk Factor Analysis of Complications and Mortality Following Coil Procedures in Patients with Intracranial Unruptured Aneurysms Using a Nationwide Health Insurance Database.

(1) Background: Unruptured intracranial aneurysm (UIA) occurs in 1-2% of the population and is being increasingly detected. Patients with UIA are treated with close observation, endovascular coiling or surgical clipping. The proportion of endovascular coiling has been rising. However, complications such as cerebral infarction (CI), intracranial hemorrhage (ICRH), and death remain crucial issues after coil treatment. (2) Methods: We analyzed the incidence and risk factors of complications after the use of coil in patients with UIA based on the patients' characteristics. We utilized the Health Insurance Review and Assessment (HIRA) database. Patients treated with coils for UIA between 1 January 2015 and 1 December 2021 were retrospectively analyzed. (3) Results: Of the total 35,140 patients, 1062 developed ICRH, of whom 87 died, with a mortality rate of 8.2%. Meanwhile, 749 patients developed CI, of whom 29 died, with a mortality rate of 3.9%. The overall mortality rate was 1.8%. In a univariate analysis of the risk factors, older age, males, a higher Charlson Comorbidity Index (CCI) score, and diabetes increase the risk of CI. Meanwhile, males with higher CCI scores and hemiplegia or paraplegia show increased ICRH risk. Older age, males and metastatic solid tumors relate to increased mortality risk. (4) Conclusions: This study is significant in that the complications based on the patient's underlying medical condition were analyzed.

Use of sodium-glucose cotransporter-2 inhibitors in France: Analysis of French nationwide health insurance database.

Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have been commercialized in France for type 2 diabetes since April 2020 and later for heart and renal diseases. Given the recent developments in treating diabetes and the widening of SGLT-2i indications, we aimed to study changes in the use of glucose-lowering drugs in France and to characterize SGLT-2i new users. We performed a nationwide utilization study using the French health insurance database. Trends in incidence and prevalence of glucose-lowering drug use were assessed by a repeated cross-sectional study in 2019 and 2021. A cohort study of incident SGLT-2i users was then conducted to describe patient characteristics and the strategy for treating diabetes. The prevalence of SGLT-2i use gradually reached 0.1% in the third quarter of 2021 and increased more significantly to 0.2% thereafter. SGLT-2i became the second most prescribed glucose-lowering drug class after metformin at the end of 2021 (0.1%). Among the cohort of 125 387 SGLT-2i new users (mean age 65.0 years; 60.1% of men), 87.6% presented a diabetic comorbidity. The patient profile changed over the study period with an increasing proportion of patients with cardiovascular (28.7% in 2020 vs. 40.2% in 2021) or renal (7.7% in 2020 vs. 11.8% in 2021) comorbidities at initiation. The main combinations used at SGLT-2i initiation were metformin (12.5%) and metformin plus dipeptidyl peptidase-4 inhibitors (8.1%). One-year probability of SGLT-2i persistence was estimated to be 55%. The expansion of indications for SGLT-2i and the broadening of the target population make it essential to assess the reasons for discontinuation and review their safety profile.

Discontinuation of antiplatelet therapy after stent-assisted coil embolisation of cerebral aneurysm: a nationwide cohort study

IntroductionStent-assisted coil embolisation (SACE) for the treatment of unruptured cerebral aneurysms has been increasingly used. Long-term advantages of antiplatelet therapy (APT) post-SACE treatment are still not well understood. We investigated...