DOI QR코드

DOI QR Code

Comparing Korea Occupational Safety & Health Agency and National Health Insurance Service's cardio-cerebrovascular diseases risk-assessment tools using data from one hospital's health checkups

  • Yunrae Cho (Department of Occupational and Environmental Medicine, Dongguk University Gyeongju Hospital) ;
  • Dong Geon Kim (Department of Occupational and Environmental Medicine, Dongguk University Gyeongju Hospital) ;
  • Byung-Chan Park (Department of Occupational and Environmental Medicine, Dongguk University Gyeongju Hospital) ;
  • Seonhee Yang (Department of Occupational and Environmental Medicine, Dongguk University Gyeongju Hospital) ;
  • Sang Kyu Kim (Department of Preventive Medicine, Dongguk University College of Medicine)
  • Received : 2023.01.25
  • Accepted : 2023.05.25
  • Published : 2023.12.31

Abstract

Background: Cardio-cerebrovascular diseases (CVDs) are the most common cause of death worldwide. Various CVD risk assessment tools have been developed. In South Korea, the Korea Occupational Safety & Health Agency (KOSHA) and the National Health Insurance Service (NHIS) have provided CVD risk assessments with health checkups. Since 2018, the KOSHA guide has stated that NHIS CVD risk assessment tool could be used as an alternative of KOSHA assessment tool for evaluating CVD risk of workers. The objective of this study was to determine the correlation and agreement between the KOSHA and the NHIS CVD risk assessment tools. Methods: Subjects of this study were 17,485 examinees aged 20 to 64 years who had undergone medical examinations from January 2021 to December 2021 at a general hospital. We classified subjects into low-risk, moderate-risk, high-risk, and highest-risk groups according to KOSHA and NHIS's CVD risk assessment tools. We then compared them with cross-analysis, Spearman correlation analysis, and linearly weighted kappa coefficient. Results: The correlation between KOSHA and NHIS tools was statistically significant (p-value < 0.001), with a correlation coefficient of 0.403 and a kappa coefficient of 0.203. When we compared risk group distribution using KOSHA and NHIS tools, CVD risk of 6,498 (37.1%) participants showed a concordance. Compared to the NHIS tool, the KOSHA tool classified 9,908 (56.7%) participants into a lower risk category and 1,079 (6.2%) participants into a higher risk category. Conclusions: In this study, KOSHA and NHIS tools showed a moderate correlation with a fair agreement. The NHIS tool showed a tendency to classify participants to higher CVD risk group than the KOSHA tool. To prevent CVD more effectively, a higher estimation tool among verified CVD risk assessment methods should be selected and managements such as early intervention and treatment of risk factors should be performed targeting the high-risk group.

Keywords

Acknowledgement

This work was supported by the Dongguk University Research Fund, 2019.

References

  1. World Health Organization. The top 10 causes of death. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death. Updated 2020. Accessed September 7, 2022. 
  2. Korean Statistical Information Service. Cause of death statistics. https://kosis.kr/index/index.do. Updated 2021. Accessed September 7, 2022. 
  3. Statistics Korea. 2022 Elderly Statistics. Daejeon, Korea: Statistics Korea; 2022. 
  4. Health Insurance Review and Assessment Service (KR); National Health Insurance Service (KR). 2020 National Health Insurance Statistical Yearbook. Wonju, Korea: National Health Insurance Service; 2020. 
  5. Hwang IS, Kim EY, Lee KH, Cho BL. Improvement of the health risk appraisal model and report form of the national health screening program. Public Health Wkly Rep 2018;11(14):433-7. 
  6. Kannel WB, McGee D, Gordon T. A general cardiovascular risk profile: the Framingham Study. Am J Cardiol 1976;38(1):46-51. https://doi.org/10.1016/0002-9149(76)90061-8
  7. Yun JM, Yoo TG, Oh SW, Cho BL, Kim E, Hwang I. Prediction of cardiovascular disease in Korean population: based on health risk appraisal of national health screening program. J Korean Med Assoc 2017;60(9):746-52. https://doi.org/10.5124/jkma.2017.60.9.746
  8. Whitworth JA; World Health Organization, International Society of Hypertension Writing Group. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 2003;21(11):1983-92. https://doi.org/10.1097/00004872-200311000-00002
  9. Korea Occupational Safety and Health Agency. Risk Assessment for the Prevention of Cardio-Cerebrovascular Disease at Workplace (KOSHA Code H-200-2018). Ulsan, Korea: Korea Occupational Safety and Health Agency; 2018. 
  10. Korea Centers for Disease Control and Prevention. Improvement of Health Risk Appraisal (HRA). Cheongju, Korea: Korea Centers for Disease Control and Prevention; 2017. 
  11. Um IY, Choi WJ, Lee D, Oh JS, Yi MK, Yoon JW, et al. Risk assessment for cardiovascular diseases in male workers: comparing KOSHA guidelines and the Framingham risk score system. Korean J Occup Environ Med 2012;24(4):365-74. https://doi.org/10.35371/kjoem.2012.24.4.365
  12. Ha JC, Son JS, Kim YO, Chae CH, Kim CW, Park HO, et al. Comparison of risk-assessment tools for cardio-cerebrovascular diseases (CVD) in male shipyard workers: a cross-sectional study. Ann Occup Environ Med 2019;31(1):e4.
  13. Yi KJ, Heo HT, Kim DW, Kim IA, Kim SY, Rho JR, et al. A comparison of KOSHA's cardiovascular disease risk assessment and the predicted 10-year risk of cardiovascular disease developed by Jee for a male workers at a wallpaper and floor covering manufacturer. Korean J Occup Environ Med 2009;21(2):174-83. https://doi.org/10.35371/kjoem.2009.21.2.174
  14. Levey AS, Greene T, Kusek JW, Beck GJ. A simplified equation to predict glomerular filtration rate from serum creatinine. J Am Soc Nephrol 2000;11:155A. 
  15. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European guidelines on cardiovascular disease prevention in clinical practice: the sixth joint task force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts): developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016;37(29):2315-81. https://doi.org/10.1093/eurheartj/ehw106
  16. Yang J, Biery DW, Singh A, Divakaran S, DeFilippis EM, Wu WY, et al. Risk factors and outcomes of very young adults who experience myocardial infarction: the partners YOUNG-MI registry. Am J Med 2020;133(5):605-612.e1. https://doi.org/10.1016/j.amjmed.2019.10.020
  17. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee. JAMA 2014;311(5):507-20. https://doi.org/10.1001/jama.2013.284427
  18. Guirguis-Blake JM, Evans CV, Webber EM, Coppola EL, Perdue LA, Weyrich MS. Screening for hypertension in adults: updated evidence report and systematic review for the US preventive services task force. JAMA 2021;325(16):1657-69. https://doi.org/10.1001/jama.2020.21669
  19. Kimura K, Nagata T, Ohtani M, Nagata M, Kajiki S, Fujino Y, et al. Cardiovascular and cerebrovascular diseases risk associated with the incidence of presenteeism and the costs of presenteeism. J Occup Health 2020;62(1):e12167.
  20. Luengo-Fernandez R, Leal J, Gray A, Petersen S, Rayner M. Cost of cardiovascular diseases in the United Kingdom. Heart 2006;92(10):1384-9. https://doi.org/10.1136/hrt.2005.072173
  21. Shin J, Park SH, Kim JH, Ihm SH, Kim KI, Kim WS, et al. Discordance between ambulatory versus clinic blood pressure according to global cardiovascular risk group. Korean J Intern Med 2015;30(5):610-9. https://doi.org/10.3904/kjim.2015.30.5.610
  22. Stergiou GS, Asayama K, Thijs L, Kollias A, Niiranen TJ, Hozawa A, et al. Prognosis of white-coat and masked hypertension: International Database of Home blood pressure in relation to Cardiovascular Outcome. Hypertension 2014;63(4):675-82. https://doi.org/10.1161/HYPERTENSIONAHA.113.02741
  23. Korean Society of Hypertension. 2018 Korean Society of Hypertension Guidelines for the Management of Hypertension. Seoul, Korea: Korean Society of Hypertension; 2018. 
  24. Cho BL. Evaluation of the Validity of Current National Health Screening Program and Plan to Improve the System. Seoul, Korea: Seoul National University College of Medicine; 2013. 
  25. Park S, Park EC, Nam JM, Lee SH, Kim TH, Lee GS, et al. Cost-Effectiveness Analysis for National Lipid Disorders Screening Program. Cheongju, Korea: Korea Disease Control and Prevention Agency; 2014.