Dementia and Neurocognitive Disorders (대한치매학회지)

Korean Dementia Association (대한치매학회)
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Dementia Incidence Rate Before and After Implementing the National Responsibility Policy for Dementia Care in Patients With Vascular Risk Factors in Korea

  • Gihwan Byeon (Department of Psychiatry, Kangwon National University Hospital) ;
  • Sung Ok Kwon (Interdisciplinary Graduate Program in Medical Bigdata Convergence, Kangwon National University) ;
  • JinHyeong Jhoo (Department of Psychiatry, Kangwon National University Hospital) ;
  • Jae-Won Jang (Department of Neurology, Kangwon National University School of Medicine) ;
  • Yeshin Kim (Department of Neurology, Kangwon National University School of Medicine)
  • Received : 2023.02.16
  • Accepted : 2023.03.28
  • Published : 2023.04.30
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Abstract

Background and Purpose: The National Responsibility Policy for Dementia Care was implemented in September 2017 in Korea. This study aimed to compare dementia incidence in Seoul and Gangwon-do before and after the implementation of this policy. Methods: We extracted insurance claim data from the Korean Health Insurance Review and Assessment Service for people diagnosed with diabetes, hypertension, or dyslipidemia for the first time in Seoul and Gangwon-do, Korea. We defined two enrollment groups based on the policy implementation date: 1) January 1, 2015 to December 31, 2016 (Index 1, pre-implementation), and 2) January 1, 2017 to December 31, 2018 (Index 2, post-implementation). Each group was followed up for 1 year from the time of enrollment. Then, we calculated hazard ratios to compare the incidence of dementia between the two groups, and between Seoul and Gangwon-do. Results: In Seoul, the incidence of dementia was significantly lower in Index 2 than in Index 1 (hazard ratio [HR], 0.926; 95% confidence interval [CI], 0.875-0.979). However, the incidence rate did not differ between the 2 groups (HR, 1.113; 95% CI, 0.966-1.281) in Gangwon-do. In Index 1, the incidence of dementia did not differ between Seoul and Gangwon-do (HR, 1.043; 95% CI, 0.941-1.156), but in Index 2, was significantly higher in Gangwon-do than in Seoul (HR, 1.240; 95% CI, 1.109-1.386). Conclusions: After implementing the National Responsibility Policy for Dementia Care, the dementia incidence rate decreased significantly in Seoul, consistent with other studies, but not in Gangwon-do.

Keywords

Acknowledgement

We would like to thank the Health Insurance Review and Assessment Service for assistance in providing and analyzing data.

References

  1. Xu J, Zhang Y, Qiu C, Cheng F. Global and regional economic costs of dementia: a systematic review. Lancet 2017;390:S47.
  2. National Institute of Dementia. Korean dementia observatory 2021 [Internet]. Seoul: National Institute of Dementia; 2021 [cited 2022 Sep 6]. Available from: https://ansim.nid.or.kr/community/pds_view.aspx?bid=243.
  3. Ministry of Health and Welfare in Korea. Press release related to the National Responsibility Policy for Dementia Care [Internet]. Sejong: Ministry of Health and Welfare in Korea; 2017 [cited 2022 Sep 6]. Available from: http://www.mohw.go.kr/react/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&CONT_SEQ=341876.
  4. National Institute of Dementia. Dementia facility information [Internet]. Seoul: National Institute of Dementia; c2023 [cited 2023 Mar 21]. Available from: https://www.nid.or.kr/info/facility_list.aspx.
  5. Lee YJ. A study on the inequality of health care resources distribution affected by regional characteristics. J Crit Soc Welf 2005;21:49-78.
  6. Seoul Metropolitan Center for Dementia. Prevention of dementia and awareness improvement project [Internet]. Seoul: Seoul Metropolitan Center for Dementia; c2023 [cited 2022 Sep 6]. Available from: https://seouldementia.or.kr/business/enterprise.asp.
  7. World Health Organization. International Classification of Disease 10th Revision [Internet]. Geneva: World Health Organization; 2019 [cited 2022 Sep 6]. Available from: https://icd.who.int/browse10/2019/en#/.
  8. Kim L, Kim JA, Kim S. A guide for the utilization of Health Insurance Review and Assessment Service National Patient Samples. Epidemiol Health 2014;36:e2014008.
  9. Kim CT, Myung W, Lewis M, Lee H, Kim SE, Lee K, et al. Exposure to general anesthesia and risk of dementia: a nationwide population-based cohort study. J Alzheimers Dis 2018;63:395-405. https://doi.org/10.3233/JAD-170951
  10. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-383. https://doi.org/10.1016/0021-9681(87)90171-8
  11. Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol 2004;57:1288-1294. https://doi.org/10.1016/j.jclinepi.2004.03.012
  12. Kwon HS, Jeong YW, Kim SH, Park KH, Seo SW, Na HR, et al. Annual incidence of dementia from 2003 to 2018 in Metropolitan Seoul, Korea: a population-based study. J Clin Med 2022;11:819.
  13. Roehr S, Pabst A, Luck T, Riedel-Heller SG. Is dementia incidence declining in high-income countries? A systematic review and meta-analysis. Clin Epidemiol 2018;10:1233-1247. https://doi.org/10.2147/CLEP.S163649
  14. Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, et al. Dementia prevention, intervention, and care. Lancet 2017;390:2673-2734. https://doi.org/10.1016/S0140-6736(17)31363-6
  15. Norton S, Matthews FE, Barnes DE, Yaffe K, Brayne C. Potential for primary prevention of Alzheimer's disease: an analysis of population-based data. Lancet Neurol 2014;13:788-794. https://doi.org/10.1016/S1474-4422(14)70136-X
  16. Lafortune L, Martin S, Kelly S, Kuhn I, Remes O, Cowan A, et al. Behavioural risk factors in mid-life associated with successful ageing, disability, dementia and frailty in later life: a rapid systematic review. PLoS One 2016;11:e0144405.
  17. Wittenberg R, Karagiannidou M, Knapp M; Personal Social Services Research Unit, London School of Economics and Political Science. Primary Prevention of Dementia: Barriers and Facilitators. London: Public Health England, 2017.
  18. Jia J, Wang F, Wei C, Zhou A, Jia X, Li F, et al. The prevalence of dementia in urban and rural areas of China. Alzheimers Dement 2014;10:1-9. https://doi.org/10.1016/j.jalz.2013.01.012
  19. Park JE, Kim BS, Kim KW, Hahm BJ, Sohn JH, Suk HW, et al. Decline in the incidence of all-cause and Alzheimer's disease dementia: a 12-year-later rural cohort study in Korea. J Korean Med Sci 2019;34:e293.
  20. Robb C, Haley WE, Becker MA, Polivka LA, Chwa HJ. Attitudes towards mental health care in younger and older adults: similarities and differences. Aging Ment Health 2003;7:142-152. https://doi.org/10.1080/1360786031000072321
  21. Ministry of Land, Infrastructure and Transport of Korea, National Geographic Information Institute. National territorial monitoring report [Internet]. Suwon: National Geographic Information Institute; 2020 [cited 2022 Sep 6]. Available from: http://map.ngii.go.kr/ms/pblictn/nationalYearBook.do.
  22. Health Insurance Review and Assessment Service of Korea. Data on the number of nursing institutions of Korea [Internet]. Wonju: Health Insurance Review and Assessment Service; 2022 [cited 2022 Sep 6]. Available from: http://opendata.hira.or.kr/op/opc/olapYadmStatInfo.do.
  23. Chen JH, Lin KP, Chen YC. Risk factors for dementia. J Formos Med Assoc 2009;108:754-764. https://doi.org/10.1016/S0929-6646(09)60402-2
  24. Jeon KS, Choi ES, Lee HY. Gender-related difference in the utilization of health care services by Korean adults. J Korean Acad Public Health Nurs 2010;24:182-196.
  25. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, D.C.: American Psychiatric Publishing, Inc., 2013.
  26. Kim SY, Lim JS, Kong IG, Choi HG. Hearing impairment and the risk of neurodegenerative dementia: a longitudinal follow-up study using a national sample cohort. Sci Rep 2018;8:15266.
  27. Paik JS, Ha M, Jung YH, Kim GH, Han KD, Kim HS, et al. Low vision and the risk of dementia: a nationwide population-based cohort study. Sci Rep 2020;10:9109.
  28. Ministry of Health and Welfare of Korea. 2020 Survey on the elderly in Korea [Internet]. Sejong: Ministry of Health and Welfare of Korea; 2022 [cited 2022 Sep 6]. Available from: https://kosis.kr/statHtml/statHtml.do?orgId=117&tblId=DT_117071_018&conn_path=I2.
  29. Takeda S, Rakugi H, Morishita R. Roles of vascular risk factors in the pathogenesis of dementia. Hypertens Res 2020;43:162-167. https://doi.org/10.1038/s41440-019-0357-9
  30. Kaira M, Walia V, Garg M. Role of hypertension and hyperlipidemia in the pathogenesis of dementia. In: Ashraf GM, Uddin MS, editors. Current Thoughts on Dementia: From Risk Factors to Therapeutic Interventions. Singapore: Springer Nature Singapore, 2022; 251-272.
  31. Korea Disease Control and Prevention Agency. Status and issues of chronic disease in 2019 [Internet]. Cheongju: Korea Disease Control and Prevention Agency; 2020 [cited 2022 Sep 6]. Available from: https://knhanes.kdca.go.kr/knhanes/sub04/sub04_04_01.do.