Nationwide Population-based Study In Korea Research Articles

Association between cardiac arrhythmia before pregnancy and gestational diabetes: a nationwide population-based study in Korea.

Given the higher prevalence of cardiac arrhythmias in individuals with diabetes, we investigated the relationship between cardiac arrhythmias and the incidence of gestational diabetes (GDM). This retrospective cohort study utilized data from the Korean Health Insurance Service database, encompassing 1,113,729 women who gave birth between January 2007 and December 2015. After excluding those who did not undergo National Health Screening tests within 1 year prior to pregnancy, those with multifetal pregnancies, and those diagnosed with diabetes, we analyzed 365,880 singleton pregnancies without a history of diabetes. Of these, 3,253 (0.9%) had cardiac arrhythmias, including premature extra beats, supraventricular tachyarrhythmias, and/or atrial flutter/fibrillation. GDM occurred in 31,938 (8.7%) subjects during pregnancy, and was more prevalent in women with cardiac arrhythmia than in those without (14.9% vs. 8.7%, p<0.001). In the multivariate analysis, the association between cardiac arrhythmia and GDM remained statistically significant (adjusted odds ratio, 1.78; 95% CI, 1.615-1.970; p<0.001). Subgroup analysis revealed that the risk of GDM was consistently statistically significant in subjects with cardiac arrhythmia, regardless of age, body mass index, and the presence or absence of chronic hypertension. Therefore, cardiac arrhythmias before and during pregnancy appear to be associated with an increased risk of developing GDM.

Association between cardiac arrhythmia before pregnancy and gestational diabetes: a nationwide population-based study in Korea

Abstract Background Premature extra betas and supraventricular tachyarrhythmias are prevalent in the gestational period. Gestational diabetes mellitus (GDM) complicated a significant proportion of pregnancies worldwide. Purpose Given the high prevalence of cardiac arrhythmia (CA) among patients with diabetes, we aimed to investigate the association of CA with GDM. Methods This is a nationwide cohort study using the Korean Health Insurance database. We identified 1,113,729 women who gave birth between 2007 and 2015. After excluding subjects who did not undergo the national health screening test within a year before pregnancy, multi-pregnancy, and those with fasting blood glucose ≥126 mg/mL and/or diagnosed with diabetes before pregnancy CA was defined as atrial and ventricular premature beats, paroxysmal tachycardia, and atrial fibrillation. The primary outcome was the incidence of GDM. Subgroup analysis stratified by age and body mass index at pregnancy onset, and a history of hypertension before pregnancy were conducted. Results A total of 365,880 women were included in the final analysis. Of them, 3,253 (0.9%) had a diagnosis of CA. Subjects with CA were older at pregnancy onset (mean age 33.3±4.1 vs. 33.0±3.9 years, P&amp;lt;0.001), and had a higher proportion of hypertension (5.2% vs. 1.0%, P &amp;lt;0.001) than in subjects without CA. GDM was detected in 31,938 (8.7%) subjects and more commonly occurred in subjects with CA than those without (14.9% vs. 8.7%, P&amp;lt;0.001). After adjusting for confounding factors, the incidence of GMD was statistically significantly higher in those with CA (adjusted OR 1.78, 95% CI 1.615–1.970, P&amp;lt;0.001). Moreover, the relationship between CA with GDM was statistically significant regardless of age and body mass index (Figure 1). Meanwhile, despite a higher incidence of GDM, the association between CA and GDM was insignificant in subjects with a history of hypertension. Conclusion The risk of gestational diabetes was higher in subjects diagnosed with CA before or during pregnancy compared with those without CA.

The Risk of Venous Thrombosis for Erythropoiesis Stimulating Agents and Blood Transfusions in Cancer Patients: A Nationwide Population-Based Study in Korea

Introduction: Several previous studies have indicated that both erythropoiesis-stimulating agents (ESAs) and blood transfusions elevate the risk of venous thrombosis in cancer patients. Nevertheless, there has been inconsistency in the evidence regarding whether ESAs or blood transfusions are more closely linked to thrombotic complications. To address this, nationwide population data was analyzed to explore the association between the use of ESAs, blood transfusions, and the risk of venous thrombosis in cancer patients. Methods: This study utilized a case-crossover design and analyzed the National Health Insurance Database of Korea. A total of 710,910 patients diagnosed cancer (ICD-10 code: C00.x-C26.x, C30.x-C34.x, C37.x-C41.x, C45.x-C58.x, C60.x-C76.x, C81.x-C85.x, C88.3, C88.7, C88.9, C90.0, C90.1, C91.x-C93.x, C94.0-C94.3, C94.5, C94.7, C95.x, C96.x) between January 1, 2011, and December 31, 2020 were included. Of these, 57,256 (8.03%) identified with venous thrombosis (ICD-10 code: I80.x). The hazard period, starting from the week of thrombosis and going back 12 weeks, was compared to an earlier 12-week control period separated by a 24-week gap. Secondary analyses were conducted with different durations for the hazard/control periods (8 and 4 weeks) to assess the robustness of the results. Patients served as their own controls, and time-dependent covariates such as granulocyte colony-stimulating factor and chemotherapy were evaluated for their association with thrombotic risk. Patients were categorized based on occurrences of inpatient hospitalization, red blood cell transfusion, platelet transfusion, central venous catheter placement, and major surgery during hazard and control periods, and these variables were compared using χ2 tests. Finally, conditional logistical regression was employed to compare the odds of exposure to ESAs, blood transfusions, and other thrombosis risk factors during the hazard period to the exposure odds during the control period. Results: There were similar rates of ESA use during the hazard period and the control period (0.88% vs. 0.28%; P = 0.477). However, red blood cell transfusions (6.85% vs. 1.79%; P &amp;lt;0.001), platelet transfusions (1.92% vs. 0.48%; P = 0.003), insertion of a central venous catheter (3.34% vs. 0.74%; P &amp;lt;0.001), hospitalizations (11.79% vs. 2.77%; P &amp;lt;0.001), and major surgery (5.70% vs. 2.00%; P &amp;lt;0.001) differed significantly between the two exposure periods. All of these factors were more frequent during the hazard period compared to the control period. In the crude conditional logistical regression model, the odds ratio (OR) for ESA use was significantly increased (OR = 3.14; 95% CI: 2.63, 7.75). However, after controlling for other covariates including red blood cell transfusions, platelet transfusions, central venous catheter insertion, hospitalization, and major surgery in an adjusted model, ESA use was found to be non-significant (OR = 1.12; 95% CI: 0.93, 1.36). In contrast to ESA use, red blood cell transfusion was associated with an increased risk of thrombosis in both the crude model (OR = 3.83; 95% CI: 3.58, 4.11) and the adjusted model (OR = 1.44; 95% CI: 1.32, 1.58). This study also investigated whether varying the lengths of the hazard and control periods (8 and 4 weeks) would affect the association between ESA use, red blood cell transfusions, and thrombotic events. The results showed that the association remained consistent regardless of the duration of the periods. Overall, these findings suggest that while there was an increased risk of thrombosis associated with red blood cell transfusions, the use of ESAs did not show a significant association with thrombotic events after adjusting for other relevant factors. Conclusions: This study revealed a stronger association between red blood cell transfusions and thrombotic complications in cancer patients. These findings suggest that red blood cell transfusions may have a higher thrombotic risk compared to ESAs in this particular patient population. Furthermore, the results indicate that the use of ESAs in cancer patients might not increase the risk of thrombotic complications depending on the exposure duration. Further studies are needed to assess the impact of ESAs and blood transfusions on thrombotic risk in different populations.

JAAD Game Changer: “Vitiligo and overt thyroid diseases: A nationwide population-based study in Korea”

JAAD Game Changer: “Vitiligo and overt thyroid diseases: A nationwide population-based study in Korea”

Bidirectional associations between periodontal disease and systemic diseases: a nationwide population-based study in Korea

To evaluate the associations of periodontal disease (PD) with systemic diseases, including diabetes mellitus (DM) and cardiovascular disease (CVD), as well as the reciprocal association. The CVD included the cases of coronary heart disease and heart failure. A prospective study was conducted from 2007 to 2019 using linked data from three databases in Korea. Three separate study groups were formed to individually determine the risks of PD (n = 10,533), DM (n = 14,523) and CVD (n = 14,315). All diseases were confirmed based on physicians’ diagnoses using medical records and self-reports. Cox proportional hazard regression was applied with 95% confidence intervals (CIs) to obtain hazard ratios (HRs). PD was significantly associated with an elevated risk of DM (HR [95% CI]: 1.22 [1.07–1.39]) after full adjustment for age, sex, lifestyle factors, body mass index, dental behaviour and CVD. PD was also found to increase the risk of CVD (1.27 [1.03–1.57]), whereas CVD increased the risk of PD (1.20 [1.09–1.32]) after full adjustment for other covariates including DM. This study found a bidirectional association between PD and CVD, as well as a positive association of PD with DM.

All-Cause and Cause-Specific Mortality among Patients with Vitiligo: A Nationwide Population-Based Study in Korea

Vitiligo is a common autoimmune skin disorder; however, there is limited information about risks of mortality among patients with vitiligo. Therefore, we aimed to investigate the mortality in patients with vitiligo. A population-based cohort study was conducted using the data linkage of the National Health Insurance Service database and the National Death Registry. Patients with incident vitiligo were matched with sociodemographic factors-matched controls without vitiligo in a 1:5 ratio. All-cause and cause-specific mortalities were compared between patients with vitiligo and controls. In total, 107,424 patients with incident vitiligo and 537,120 matched controls were included. The mortality rates were 34.8 and 45.3 per 10,000 person-years in patients and controls, respectively. Patients with vitiligo showed a significantly lower risk of mortality (adjusted hazard ratio= 0.75, 95% confidence interval= 0.72-0.78). The cause-specific mortality from infectious diseases, oncologic diseases, hematologic diseases, endocrine diseases, neurologic diseases, cardiovascular diseases, respiratory diseases, and renal/urogenital disease was significantly lower in patients with vitiligo. Patients with vitiligo were associated with a lower risk of mortality, suggesting that vitiligo-associated autoimmunity might contribute to reduced morbidity and mortality.

Rapid weight gain in early life is associated with central precocious puberty in girls, not in boys - a nationwide population-based study in Korea.

This study aimed to investigate the effect of rapid weight gain (RWG) on the incidence of central precocious puberty (CPP) using nationwide population-based data. A total of 253,967 children (101,841 boys and 152,126 girls) who underwent regular health consultations under the National Health Insurance Service from 2007 to 2010 were followed up until the age of 10 years for boys and 9 years for girls. We calculated differences in the weight Z-scores from 4-6 months to 9-12 months (infancy) and from 9-12 months to 18-24 months or 30-36 months (toddlerhood) using the lambda-mu-sigma method. The population was subdivided into four groups: RWGinf/tod (infancy > + 0.67 standard deviation score [SDS], toddlerhood > 0 SDS), RWGinf (infancy > + 0.67 SDS, toddlerhood < 0 SDS), RWGtod (toddlerhood > + 0.67 SDS), and control (no RWG). The diagnosis of CPP was based on the diagnostic codes of the International Classification of Diseases 10th revision and the prescription of gonadotropin-releasing hormone agonists. The cumulative risk of CPP based on age was analyzed using Kaplan-Meier survival curves, and the association between the RWG groups and CPP was assessed using multivariate logistic regression analysis. CPP was diagnosed in 268 boys and 9,225 girls. For the girls, the CPP-free probability was the highest in the control group, followed by the RWGtod, RWGinf, and RWGinf/tod groups (log-rank p < 0.001). However, the incidence of CPP did not vary significantly for the boys. Compared to the control group, the other groups had a higher risk of CPP in girls (RWGinf/tod: adjusted odds ratio [aOR] 1.35, 95%, confidence interval [95% CI] 1.13-1.62; RWGinf: aOR 1.25, 95% CI 1.13-1.38; and RWGtod: aOR 1.18, 95% CI 1.09-1.28). This nationwide population-based study demonstrated that any RWG from birth to 3 years of age contributed to an increased risk of CPP in girls but not in boys. Girls who experienced RWG during both infancy and toddlerhood had the highest risk of developing CPP. These findings suggest that early detection and appropriate management of excessive weight gain in early life may be important for preventing CPP in girls.

Trends in treatment patterns and survival outcomes in pancreatic cancer: A nationwide population-based study in Korea

BackgroundThe treatment of pancreatic cancer has evolved; however, real-world data on treatment trends remain scarce. This study investigated treatment patterns for pancreatic cancer and patient survival using a nationwide population-based study in Korea. MethodsUsing the National Health Insurance database, data from 78,920 patients diagnosed with pancreatic cancer in Korea between 2006 and 2019 were extracted. Treatment patterns and survival by age group and year of diagnosis were examined. ResultsPrimary treatment was delivered as follows: 16,562 patients (21.0%) underwent surgery, 20,998 patients (26.6%) received chemotherapy, 1332 patients (1.7%) received chemoradiotherapy, and 40,040 patients (50.7%) received supportive care only. The proportion of patients undergoing surgery or chemotherapy increased gradually in all age groups over time. The commonly used anti-cancer drugs have changed from gemcitabine±erlotinib to gemcitabine+nab-paclitaxel and FOLFIRINOX. Survival improved mainly in patients who underwent surgery or chemotherapy. Median overall survival for all patients improved from 5.5 months in 2006–2008 to 9.8 months in 2018–2019, with greater improvement observed in younger age groups: 8.8–18.8 months, age ≤59 years, 6.8–14.6 months, age 60–69 years, 4.2–8.3 months, age 70–79 years and 2.4–3.4 months, age ≥80 years (all p < 0.0001). ConclusionsAn increase in the rates of surgery and chemotherapy for pancreatic cancer was observed. Survival rates for pancreatic cancer have generally improved over the past decade and are greater in patients undergoing surgery or chemotherapy and in younger age groups.

Two-Year Changes in Diabetic Kidney Disease Phenotype and the Risk of Heart Failure: A Nationwide Population-Based Study in Korea.

Diabetic kidney disease (DKD) is a risk factor for hospitalization for heart failure (HHF). DKD could be classified into four phenotypes by estimated glomerular filtration rate (eGFR, normal vs. low) and proteinuria (PU, negative vs. positive). Also, the phenotype often changes dynamically. This study examined HHF risk according to the DKD phenotype changes across 2-year assessments. The study included 1,343,116 patients with type 2 diabetes mellitus (T2DM) from the Korean National Health Insurance Service database after excluding a very high-risk phenotype (eGFR <30 mL/min/1.73 m2) at baseline, who underwent two cycles of medical checkups between 2009 and 2014. From the baseline and 2-year eGFR and PU results, participants were divided into 10 DKD phenotypic change categories. During an average of 6.5 years of follow-up, 7,874 subjects developed HHF. The cumulative incidence of HHF from index date was highest in the eGFRlowPU- phenotype, followed by eGFRnorPU+ and eGFRnorPU-. Changes in DKD phenotype differently affect HHF risk. When the persistent eGFRnorPU- category was the reference, hazard ratios for HHF were 3.10 (95% confidence interval [CI], 2.73 to 3.52) in persistent eGFRnorPU+ and 1.86 (95% CI, 1.73 to 1.99) in persistent eGFRlowPU-. Among altered phenotypes, the category converted to eGFRlowPU+ showed the highest risk. In the normal eGFR category at the second examination, those who converted from PU- to PU+ showed a higher risk of HHF than those who converted from PU+ to PU-. Changes in DKD phenotype, particularly with the presence of PU, are more likely to reflect the risk of HHF, compared with DKD phenotype based on a single time point in patients with T2DM.

Prevalence and incidence of vitiligo and associated comorbidities: a nationwide population-based study in Korea.

The prevalence of vitiligo shows regional variance. Recently, an association between vitiligo and extracutaneous conditions including other autoimmune, metabolic and dermatological disorders has been suggested. Despite its increasing incidence, the epidemiological trends and comorbidities in people with vitiligo have rarely been quantified in Asia. To determine the prevalence and incidence of vitiligo and the disorders associated with vitiligo using the National Health Insurance Service database. We included all patients with vitiligo, classified by the International Classification of Disease, 10th revision (ICD-10) code of L80, with ≥ 3 documented visits from 2003 to 2019. The incidence and prevalence of vitiligo were estimated for the study period. Age-, sex-, insurance type- and income level-matched controls (ratio 1 : 5) were selected to compare comorbidities. The odds ratios between comorbidities and vitiligo were calculated through conditional logistic regression. The incidence and annual prevalence of vitiligo in Korea increased from 2003 to 2019, with incidence peaking in summer. Age-specific incidence showed a bimodal distribution, with the steepest increase in the group aged < 20 years. Many comorbidities, including alopecia areata, psoriasis, rheumatoid arthritis, systemic lupus erythematosus, Crohn disease, ulcerative colitis, Sjögren syndrome, diabetes mellitus, dyslipidaemia, chronic hepatitis, anxiety disorder and mood disorder showed higher odds ratios in patients with vitiligo than controls. The incidence and prevalence of vitiligo are increasing, particularly among younger patients in Korea. In addition, various comorbidities are associated with vitiligo, therefore, if patients with vitiligo present with extracutaneous symptoms, physicians should consider the possibility of other comorbid diseases.

1315. Dental Discoloration and Enamel dysplasia after Tetracyclines Exposure in Children: A Nationwide Population-Based Study in Korea

Abstract Background Tetracycline (TC) is not recommended for pediatric use due to the risk of permanent teeth discoloration and enamel dysplasia. We aimed to assess the incidence of dental abnormality in Korean children and investigate whether the risk was greater in tetracycline-exposed children compared to the general population. Methods This nationwide, population-based study using Health Insurance Review and Assessment service database included children (aged 0-12 years) who were prescribed tetracycline for at least a day between January 2008 and December 2020. We evaluated the incidence rate of children who were inserted diagnosis codes for dental discoloration and enamel dysplasia after at least 6 months after prescription as the primary outcome. Standardized incidence ratio was analyzed to determine whether the risk of dental abnormalities was greater in the exposed group compared to the general population in Korea. Results A total of 56,990 patients with TCs exposure were included, 3% were under the age of 8 (n=1,735) while the majority of 97% were between ages of 8 and 12 (n=55,255). The incidence rate in 0-7 year old age group was 734 cases per 100,000 person-years, which was about five times higher than the 143 cases per 100,000 person-years of the 8-12 year old group with statistical significance (P&amp;lt; 0.001). The 5-year cumulative incidence rate in the 0-7 years old age group was 4.1 % (95% CI, 3.0-5.7%) and 5.7% (95% CI, 4.1–7.8%) in 10-year period. In the 8-12 year old age group, 5-year cumulative incidence was 0.8% (95% CI, 0.7-0.9%) and 1.3% (95% CI, 1.1-1.4%). The risk of dental abnormalities was not significantly increased in the TC-exposed group of 0-7 year old age group compared to the general population (SIR = 1.08; 95% CI, 0.69-1.60). Conclusion The incidence of tooth discoloration and enamel dysplasia was lower than previously suggested, particularly between the ages of 8 and 12 and as low as one-fifth of those under the age of 8, suggesting a reconsideration of limiting use of TCs in children if clinically indicated. Disclosures All Authors: No reported disclosures.

Model for Predicting In-Hospital Mortality of Physical Trauma Patients Using Artificial Intelligence Techniques: Nationwide Population-Based Study in Korea.

Physical trauma-related mortality places a heavy burden on society. Estimating the mortality risk in physical trauma patients is crucial to enhance treatment efficiency and reduce this burden. The most popular and accurate model is the Injury Severity Score (ISS), which is based on the Abbreviated Injury Scale (AIS), an anatomical injury severity scoring system. However, the AIS requires specialists to code the injury scale by reviewing a patient's medical record; therefore, applying the model to every hospital is impossible. We aimed to develop an artificial intelligence (AI) model to predict in-hospital mortality in physical trauma patients using the International Classification of Disease 10th Revision (ICD-10), triage scale, procedure codes, and other clinical features. We used the Korean National Emergency Department Information System (NEDIS) data set (N=778,111) compiled from over 400 hospitals between 2016 and 2019. To predict in-hospital mortality, we used the following as input features: ICD-10, patient age, gender, intentionality, injury mechanism, and emergent symptom, Alert/Verbal/Painful/Unresponsive (AVPU) scale, Korean Triage and Acuity Scale (KTAS), and procedure codes. We proposed the ensemble of deep neural networks (EDNN) via 5-fold cross-validation and compared them with other state-of-the-art machine learning models, including traditional prediction models. We further investigated the effect of the features. Our proposed EDNN with all features provided the highest area under the receiver operating characteristic (AUROC) curve of 0.9507, outperforming other state-of-the-art models, including the following traditional prediction models: Adaptive Boosting (AdaBoost; AUROC of 0.9433), Extreme Gradient Boosting (XGBoost; AUROC of 0.9331), ICD-based ISS (AUROC of 0.8699 for an inclusive model and AUROC of 0.8224 for an exclusive model), and KTAS (AUROC of 0.1841). In addition, using all features yielded a higher AUROC than any other partial features, namely, EDNN with the features of ICD-10 only (AUROC of 0.8964) and EDNN with the features excluding ICD-10 (AUROC of 0.9383). Our proposed EDNN with all features outperforms other state-of-the-art models, including the traditional diagnostic code-based prediction model and triage scale.

Incidence of major depressive disorder over time in patients with liver cirrhosis: A nationwide population-based study in Korea.

There is yet to be a large-scale longitudinal study on the course of depression incidence within the duration of cirrhosis. The aim of this study is to analyze the incidence of depression from before to after diagnosis of cirrhosis over time. Incidence Rate (IR) was defined as the number of newly diagnosed patients with MDD divided by the sum of observation periods by using claims database in Korea. Incidence Rate Ratio (IRR) was defined as the IR in the specific interest period divided by the IR in the control period. The control period was defied as 1 to 2 years before diagnosis of cirrhosis. The IRs before and after cirrhosis diagnosis were 3.56 and 7.54 per 100 person-year, respectively. The IRR was 2.12 (95% confidence Interval: 2.06-2.18). The IRR of developing depression mildly increased before diagnosis of cirrhosis (-360 days to -181 days, IRR 1.14, p < 0.001; -180 days to -90 days, IRR 1.24, p < 0.001; -90 days to -31 days, IRR 1.56, p < 0.001) and rapidly increased immediately after diagnosis of cirrhosis (+30 days to +89 days, IRR 2.12, 95% confidence interval: 2.06-2.18, p < 0.001). The pattern of increasing depression immediately after the diagnosis of cirrhosis was observed equally in all sexes and ages. Thus, clinicians must pay close attention to screening for depression within the first three months of liver cirrhosis diagnosis.

Changes in Alcohol Consumption and Risk of Heart Failure: A Nationwide Population-Based Study in Korea.

Background: The association between alcohol intake and newly developed heart failure remains unclear. We aimed to measure the change in alcohol intake between two timepoints to evaluate the association of alcohol consumption with incident heart failure using a population-based study in Korea. Methods: Using the Korean National Health Insurance database, participants who underwent two subsequent national health examinations in 2009 and 2011 were included. Participants were classified into four groups according to total alcohol intake (none: 0 g alcohol/day; light: <15 g alcohol/day; moderate: 15−30 g alcohol/day; and heavy: ≥30 g alcohol/day), and changes in alcohol consumption between the two health exams were grouped into the following five categories: abstainers, sustainers (those who maintained their first examination drinking level), increasers, reducers, and quitters. After adjustment for age, sex, smoking status, regular exercise, socioeconomic information, and comorbidities, the Charlson Comorbidity Index, systolic blood pressure, and laboratory results, a Cox proportional hazards model was used to find the risk of newly diagnosed heart failure (according to ICD-10 code I50 from claims for the first hospitalization) as the primary endpoint. A subgroup analysis among those with a third examination was conducted to reflect further changes in alcohol consumption. Results: Among 3,842,850 subjects, 106,611 (3.0%) were diagnosed with heart failure during the mean follow-up period of 6.3 years. Increasers to a light level of drinking had a lower HF risk compared with abstainers (aHR = 0.91, 95% CI: 0.89−0.94). Those who increased their alcohol intake to a heavy level had a higher HF risk (from light to heavy (aHR = 1.19, 95% CI: 1.12−1.26) and from a moderate to heavy level (aHR = 1.13, 95% CI: 1.07−1.19). Reducing alcohol from a heavy to moderate level was associated with lower HF risk (aHR = 0.90, 95% CI: 0.86−0.95). Conclusion: This study found that light and moderate sustainers had lower incident heart failure risk compared with abstainers. Increased alcohol consumption from light to moderate to heavy was associated with a higher incident heart failure risk.

Long-term outcomes of preterm infants in the first 6years of life: a nationwide population-based study in Korea.

Lower gestational age was associated with an increase in a wide spectrum of adverse neurodevelopmental and respiratory outcomes in the first 6years of life. Although morbidities were highest at the earliest gestational ages, moderate-to-late preterm children were significantly associated with increased adverse outcomes compared with full-term children. Our findings prove this under-recognized group's long-term follow-up and policy support. •Infants born preterm are at high risk for neurodevelopmental and various medical health problems. • Nationwide research on long-term outcomes for moderate-to-late preterm birth is sparse. •In this nationwide cohort study, lower gestational age at birth was inversely associated with increased adverse neurodevelopmental and respiratory outcomes in the first 6 years of life. • Long-term follow-up and policy support are required for moderate-to-late preterm children who are at risk of increased adverse outcomes compared with full-term births.

Risk for Behçet’s disease gauged via high-density lipoprotein cholesterol: a nationwide population-based study in Korea

Behçet’s disease (BD) is a chronic inflammatory disease. Low levels of plasma high-density lipoprotein cholesterol (HDL-C) are associated with Crohn’s disease, another chronic inflammatory disease. However, the effects of low HDL-C levels on BD are unclear. We investigated the effects of HDL-C levels, and variability therein, on the risk for BD. We used the Korean National Health Insurance System database to identify 5,587,754 adults without a history of BD who underwent ≥ 3 medical examinations between 2010 and 2013. Mean HDL-C levels at each visit were used to calculate variability independent of the mean (VIM) and the coefficient of variation (CV). There were 676 new cases of BD (0.012%). The risk for BD was increased in participants with highly variable and low mean HDL-C levels. In a multivariate-adjusted model, the hazard ratios (95% confidence intervals) for BD incidence were 1.335 (1.058–1.684) in a high mean/high VIM group, 1.527 (1.211–1.925) in a low mean/low VIM group, and 2.096 (1.67–2.63) in a low mean/high VIM group compared to a high mean/low VIM group. Low mean HDL-C levels, and high variability therein, are independent risk factors for BD.

Risk of herpes zoster infection in patients with cirrhosis: a nationwide population-based study in Korea

Risk of herpes zoster infection in patients with cirrhosis: a nationwide population-based study in Korea

Suicide attempt-related emergency department visits among adolescents: a nationwide population-based study in Korea, 2016–2019

BackgroundThe incidence of adolescent suicide in Korea is increasing; however, nationwide data regarding short-term prediction of suicide attempts (SAs) is still limited. Therefore, this study aimed to investigate the incidence of SA-related annual emergency department (ED) visits among adolescents in Korea from 2016 to 2019 and to summarize the corresponding demographic and clinical characteristics based on the dispositions of SA-related ED visits.MethodsMost referral hospitals provide relevant essential ED information to the National Emergency Medical Center through the National Emergency Department Information System (NEDIS). We analyzed NEDIS data on adolescent visits (aged < 20 years) for a 4-year period from 2016 to 2019. Patients were classified into the discharge and hospitalization groups for comparison, and jointpoint regression analysis was used to identify the years in which there was a change in annual percentage change (APC) in age- and sex-standardized incidence rates of SA-related ED visits. The characteristics of patients in the discharge group and hospitalization group subgroups were also compared.ResultsThe APC in the incidence rate of SA-related ED visits in the 4-year study period revealed a 35.61% increase. The incidence rate increase was higher among females (APC: 46.26%) than among males (APC: 17.95%). Moreover, the incidence rate increased faster in mid-adolescence patients (APC: 51.12%) than in late-adolescence patients (APC: 26.98%). The proportion of poisoning as the SA method was 69.7% in the hospitalization group and 34.5% in the discharge group (p < 0.001).DiscussionOur findings suggest that an increase in the number of SA-related ED visits among female and mid-adolescent patients represented the largest increase in SA-related ED visits from 2016 to 2019. Accordingly, evidence-based suicide prevention programs need to be customized based on sex and age, and further diversification of health care systems is needed through analysis of the characteristics of the dispositions of SA-related ED visits.

Dementia in a Hearing-impaired Population According to Hearing Aid Use: A Nationwide Population-based Study in Korea.

Background:Hearing loss is considered a potentially modifiable risk factor for dementia. However, the effect of use of a hearing aid on the development of dementia has not been clearly established. We aimed to assess the incidence of dementia in hearing-impaired individuals according to hearing aid use in a nationwide population-based cohort study with matched controls.Methods:This was a retrospective, longitudinal, cohort study of South Korean national claims data for individuals newly registered with hearing disabilities (better ear ≥40 dBHL with worse ear ≥80 dBHL, or better ear ≥60 dBHL) between 2004 and 2008. The hearing aid cohort comprised individuals who received hearing aid subsidies from the National Health Insurance within a year from disability registration. The comparison cohort comprised individuals without a record of a hearing aid claim during the study period after 1:1 matching for audiologic and sociodemographic factors with the hearing aid cohort. The occurrence of dementia was followed up until 2018.Results:Each cohort comprised 8780 individuals. Overall incidence of dementia in the hearing aid and comparison cohorts were 156.0 and 184.5 per 10,000 person-years, respectively (incidence rate ratio = 0.85, 95% confidence interval 0.79–0.91). In a multivariable analysis of the whole study populations, hearing aid use (hazard ratio = 0.75, 95% confidence interval 0.70–0.81) attenuated the risk of dementia.Conclusions:Dementia incidence in individuals with hearing disabilities was lower in hearing aid users than that in nonusers. Hearing rehabilitation with hearing aids should be encouraged for individuals with hearing loss.

Herbal Medicine Prescriptions for Functional Dyspepsia: A Nationwide Population-Based Study in Korea.

Background Herbal medicine is widely used for the treatment of functional dyspepsia (FD) in East Asian countries. We aimed to analyze the prescription patterns of herbal medicine for patients with FD in Korean medicine clinical settings through the analysis of national health insurance claims data over the past 10 years and to check how herbal medicine has been used for FD within the scope of national health insurance. Methods All prescription data claimed to the Health Insurance Review and Assessment Service with the diagnosis of FD and herbal medicine prescriptions in 2010–2019 were reviewed. We estimated the demographics, clinical characteristics, and annual prescription amount and cost of each herbal medicine. Frequent comorbidities of FD were investigated by analyzing the frequency of the Korean standard classification of diseases codes used together with FD. Results In total, 19,388,248 herbal medicine prescriptions were identified. Herbal medicine prescriptions were mostly claimed by women, the elderly, outpatients at Korean medicine clinics, and national health insurance; the number increased every year. The most frequently prescribed herbal medicine was Pingwei-san (Pyeongwi-san) (31.12%), followed by Xiangshapingwei-san (Hyangsapyeongwi-san) (23.20%), Qiongxia-tang (Gungha-tang) (6.31%), and Banxiaxiexin-tang (Banhasasim-tang) (6.25%). The total cost of herbal medicine prescriptions increased every year, and it was highest for Xiangshapingwei-san (Hyangsapyeongwi-san) (19.37%), followed by Banxiaxiexin-tang (Banhasasim-tang) (17.50%) and then Pingwei-san (Pyeongwi-san) (15.63%). Musculoskeletal and connective tissue diseases including low back pain and myalgia were the commonest comorbidities associated with FD. Conclusion This is the first study to investigate the disease burden and actual prescription pattern of herbal medicine for FD using claim data. Future clinical research and related healthcare policies should be established based on our study.