• 한국임상약학회지
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• 제29권3호
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• pp.186-192
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• 2019

Background: Diabetes is associated with cancer risk in the aging population. Observational studies have indicated the beneficial effects of metformin against breast cancer, making studies on the anticancer potential of antidiabetic drugs worthwhile. This study investigated cancer incidence in patients on antidiabetic monotherapy. Methods: Using National Health Insurance Service data (2002-2013), a retrospective cohort study that included type 2 diabetes mellitus (T2DM) patients was conducted. Study subjects were enrolled if they were ${\geq}30$ years old, on monotherapy for diabetes, and cancer-free. They were followed up for cancer occurrence or death, until December 31st, 2013. A Cox proportional hazard model analysis was conducted between metformin and sulfonylurea (including meglitinide) users, to determine cancer risk, with adjustment for age, gender, comorbidity index, dyslipidemia, hypertension, and T2DM duration. Results: The number of antidiabetic monotherapy-treated T2DM patients without a history of cancer was 9,554 (metformin, n = 5,825; sulfonylurea, n = 3,225; others, n = 504). During the follow-up period (mean, 2.04; IQR, 3.18 years), the cancer incidence rate was 5.48/100 and 5.45/100 patient-years for metformin and sulfonylurea, respectively. The hazard ratio (HR) for risk of cancer incidence in the metformin group was 0.74 (95% confidence interval [CI], 0.66-0.83; p < 0.0001), compared with sulfonylurea. Additionally, the HRs for risks of lung, liver, and stomach cancer were respectively 0.46 (95% CI, 0.31-0.66; p < 0.0001), 0.41 (95% CI, 0.31-0.54; p < 0.0001), and 0.51 (95% CI, 0.35-0.73; p = 0.0003). Conclusion: Antidiabetic therapy with metformin reduces cancer risk by 26%, specifically for lung, liver, and stomach cancer.

• 한국병원경영학회지
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• 제27권1호
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• pp.1-10
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• 2022

Background: This study aims to empirically compare and evaluate the current status of medical accessibility and health inequality between people with disabilities and without. We calculated the ACSC hospitalization rate, which is a medical accessibility index, for hypertension, a major risk factor for cardiovascular disease that accounts for more than 20% of deaths among people with disabilities using the 2016 National Health Insurance Big Data. Methods: The subjects of the study were a total of 601,520, including 64,018 people with disabilities and 537,501 people without. Logistic regression was performed to analyze the differences in hypertension hospitalization rates adjusted for demographic and sociological characteristics and disease characteristics using SAS 9.4 program. Results: Before adjusting for the characteristics, the hypertension hospitalization rate of people with disabilities was 1.55%, and the people without disabilities were 0.49%. After adjusting, it was found that people with disabilities were 2.11 times higher than people without disabilities, and it was statistically significant. Conclusion: The preventable hospitalization rate of people with disabilities is higher than that of people without, suggesting that the disabled have problems with access to medical care and health inequality. Therefore, the government's policy improvement is required to close the medical gap for the disabled.

• Journal of Preventive Medicine and Public Health
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• 제57권1호
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• pp.65-72
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• 2024

Objectives: Protecting people against financial hardship caused by illness stands as a fundamental obligation within healthcare systems and constitutes a pivotal component in achieving universal health coverage. The objective of this study was to analyze the prevalence and determinants of catastrophic health expenditures (CHE) in Iran, over the period of 2013 to 2019. Methods: Data were obtained from 7 annual national surveys conducted between 2013 and 2019 on the income and expenditures of Iranian households. The prevalence of CHE was determined using a threshold of 40% of household capacity to pay for healthcare. A binary logistic regression model was used to identify the determinants influencing CHE. Results: The prevalence of CHE increased from 3.60% in 2013 to 3.95% in 2019. In all the years analyzed, the extent of CHE occurrence among rural populations exceeded that of urban populations. Living in an urban area, having a higher wealth index, possessing health insurance coverage, and having employed family members, an employed household head, and a literate household head are all associated with a reduced likelihood of CHE (p<0.05). Conversely, the use of dental, outpatient, and inpatient care, and the presence of elderly members in the household, are associated with an increased probability of facing CHE (p<0.05). Conclusions: Throughout the study period, CHE consistently exceeded the 1% threshold designated in the national development plan. Continuous monitoring of CHE and its determinants at both household and health system levels is essential for the implementation of effective strategies aimed at enhancing financial protection.

• PNF and Movement
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• 제22권2호
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• pp.257-266
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• 2024

Purpose: The aim of this study was to determine the influence of psychological and other risk factors on the recurrence of nonspecific neck pain. To achieve this, a nationwide cohort provided by the National Health Insurance Service in South Korea, with a three-year follow-up, was used. Methods: The study included patients who did not experience neck pain for the first year but were diagnosed with nonspecific neck pain (ICD-10 code: M54.2) in the second year. The progress of their neck pain recurrence was followed up for the next two years. Medical records, including age, gender, health insurance premium quintile, regional health vulnerability index score, initial onset duration, total hospitalization duration, and secondary diagnosis at onset, were extracted for analysis. Multivariate logistic regression analysis was performed to analyze the recurrence rate and risk factors for nonspecific neck pain recurrence. Results: Among a total of 591,215 patients, 29.2% experienced recurrence within two years. Patients with psychological disorders had a higher recurrence rate (30.6-33.8%) than those without psychological disorders (29.2%). Specifically, mood disorders (OR = 1.16) and stress-related disorders (OR = 1.06) were identified as risk factors for the recurrence of nonspecific neck pain. Older age (OR = 1.16-1.43), being female (OR = 1.17), being employed (OR = 1.23), and using medial aids (OR = 1.41) were also identified as risk factors. Conclusion: This study provides evidence for a high recurrence rate of nonspecific neck pain and highlights the need to consider psychological factors as well as personal factors in comprehensive interventions to prevent recurrent nonspecific neck pain.

• 한국산학기술학회논문지
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• 제11권6호
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• pp.2161-2168
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• 2010

본 연구는 행정자료인 건강보험 및 의료급여비용 청구자료를 이용하였으며, 일개지역(2개도, 남 북)에 개설 되어있는 전체 의료기관을 대상으로 진료일 기준 '08.7월~'08.12월(184일)동안 외래 방문이 1회 이상인 30세 이상의 수진자 485,953명을 대상으로 하였다. 진료지속성과 영향 요인을 분석한 결과 다음과 같다. 우리나라 성인 고혈압 환자의 평균 진료지속성 수준은 MMCI, $0.96{\pm}0.13$, MFPC $0.96{\pm}0.12$으로 높게 나타났다. 외래진료 지속성에 영향을 미치는 요인으로는 여성일수록, 55세~64세 이상 연령일수록, 동반상병이 있을수록 통계적으로 유의하게 낮았으며, 주이용기관이 상위 종별일수록 통계적으로 유의하게 MMCI와 MFPC 모두 높게 나타났다. 이 연구에서는 우리나라 성인 고혈압환자의 평균 진료지속성 수준은 높은 것으로 나타났으며, 여성, 64세 이상 연령 등 진료지속성이 낮은 대상자에 대한 관리가 필요할 것으로 보인다. 이 연구 결과는 우리나라 고혈압환자들의 건강관리 행태를 모니터하는 지표 및 국가의 고혈압관리사업의 성과지표로써 활용할 수 있을 것이다.

• 보건행정학회지
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• 제28권1호
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• pp.3-14
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• 2018

Background: Both objective body shape and perceived body image have been known to influence the mental health. The purpose of this study was to explore the relationship of a combination between actual body mass index (BMI) status and perceived body image with anxiety depressive condition (ADC) in Korean men and women. Methods: This cross-sectional study analyzed data of 26,239 subjects ${\geq}20$ years old from the National Health and Nutrition Examination Survey (2010-2014). This study performed a Rao-Scott chi-square and multivariate logistic regression analyses reflecting survey characteristics and used a variety of independent variables such as socio-demographics and health behavior factors. Results: With all independent variables considered, people with normal weight who perceived themselves as overweight were more likely associated with ADC than a referent group with normal weight who perceived themselves as normal weight, as shown for both men (odds ratio [OR], 1.52; confidence interval [CI], 1.07-2.15) and women (OR, 1.25; CI, 1.06-1.48). Meanwhile, compared to the referent group, men with underweight who perceived themselves as underweight showed a lower association with ADC (OR, 0.63; CI, 0.41-0.97), whereas women with underweight who perceived themselves as underweight showed its higher association (OR, 1.47; CI, 1.10-1.96). Conclusion: A certain group of people categorized as a combination between actual BMI status and perceived body image showed a relatively high likelihood of having ADC, and the gender difference in the likelihood of having the condition for a group was clear. Therefore, this study suggests the need to identify the group at a high risk of ADC on the basis of actual BMI status and perceived body image and to develop an appropriate mental health management program for the group.

• 보건행정학회지
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• 제34권1호
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• pp.26-37
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• 2024

연구배경: 본 연구의 목적은 척추전문병원과 비전문병원의 건당 진료비 및 재원일수 차이를 비교 분석하고, 이에 영향을 미치는 요인을 파악하는 것이다. 방법: 본 연구는 2021년 1월부터 2022년 12월까지의 입원 환자 진료비를 포함한 건강보험심사평가원의 청구 데이터를 사용했다. 의료기관 현황 데이터는 연구대상 병원의 특성을 파악하는 데 사용되었다. 다수준분석을 통해 건당 진료비와 관련된 요인을 파악하고, 포아송 회귀분석을 통해 척추전문병원과 비전문병원 간 재원일수를 분석했다. 분석대상은 척추전문병원 32,015건, 비전문병원 17,555건이었다. 결과: 다빈도 척추 수술 5건 중 4건의 경우, 전문병원이 비전문병원보다 재원일수가 더 긴 것으로 나타났다. 다수준분석 및 포아송 회귀분석 결과, 수술유형에 관계없이 연령이 높고, Charlson comorbidity index 점수가 높을수록 건당 진료비와 재원일수 모두 유의하게 증가하는 것으로 나타났다(p<0.05). 그러나 병원이 대도시에 위치한 경우에는 유의미하게 감소하였다(p<0.05). 결론: 본 연구에서는 기존 연구결과와 달리 전문병원의 건당 진료비와 재원일수가 더 긴 것으로 나타났다. 향후 이러한 차이의 원인을 찾기 위해 추가적인 연구가 필요하다.

• 보건행정학회지
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• 제24권1호
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• pp.56-70
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• 2014

Background: Korea shows rapid population aging and increase in healthcare service use and expenditure. Also, this would be accelerated because of the baby boomers who will be 65 years old and more in 2020. Chronic disease is another reason that increases the use of healthcare service and expenditure of the middle- and old-aged households. Catastrophic health expenditure (CHE) is the index which can indicate the households' burden of health spending. Despite the importance, there are few studies on CHE of middle- and old-aged households and especially no panel study yet. This is the reason that this study is carried out. Methods: This study used 3-year data from the Korea Welfare Panel Study conducted from 2009 to 2011. We defined CHE if a household's health expenditure is equal or greater than the threshold value if income remaining after subsistence needs has been met. We used 4 different threshold values which are 10%, 20%, 30%, and 40%. In order to look at the households which experienced CHE, we conducted panel logit analysis after correspondence analysis and conditional transition probability analysis. Results: This study showed three notable results. First, there has been a difference among age groups, which implies that the older people are, the more easily they can experience CHE. Second, the households with no private insurance are shown to have a higher CHE occurrence rate. Lastly, there has been a significant difference among the kinds of chronic diseases. The households which have cancer, cerebrovascular disease, and heart disease have a higher CHE occurrence rate. However, the households with diabetes have no significant effects to CHE occurrence. Also, hypertension has a negative effect to the occurrence. Conclusion: With the results, it can be implied that elderly people with chronic disease are more needed in medical coverage and healthcare. Also, private insurance can play its role in protecting households from CHE. Therefore, it needs to conduct studies on CHE especially about different age groups, private insurance, and chronic disease.

• 대한예방한의학회지
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• 제22권3호
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• pp.1-10
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• 2018

Backgrounds : In 2017, National Health Insurance implemented the pilot insuring project for Chuna manual therapy(CMT). 65 Korean Medicine(KM) hospitals and clinics were selected in the project to monitor the provision of insured CMT. Objectives : This study aimed to evaluate the effectiveness of CMT for low back pain provided in the real world setting. Methods : Patients with low back pain who agreed to participated in the study were enrolled and requested to complete questionnaires. Patients who received CMT regardless of receiving other KM therapies were classified to Chuna group, and patient who received KM therapies without CMT to KM group. Pain(pain-VAS) and back function(KODI, Oswestry disability index-Korean version), quality of life were assessed at baseline, 4 weeks, and 8 weeks. Additionally, patients who received CMT twice and more, and who's pain-VAS 20 and over were included, and patients who used pain injection were excluded in the analysis. Results : Of 371 patients who completed all questionnaire (mean age=42.6years, SD=12.45; 61% female), 96 were excluded, 170 were in Chuna group, and 105 were in KM group. Proportions of patients who had low back pain for more than twelve weeks in the Chuna group and KM group were 57.7% and 24.8%, respectively. Pain and back function were significantly improved on 4weeks and 8weeks in both groups, but there was no difference between two groups. For the patients in the sub-acute and chronic stage(>=12 weeks), change of total KODI scores in the Chuna group was higher than KM group(p=0.013) at 4weeks. Conclusions : CMT with other KM therapies can improve back function in the sub-acute and chronic patients. For insurance policy decision, economic evaluation of CMT is needed.

• Tuberculosis and Respiratory Diseases
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• 제85권1호
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• pp.74-79
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• 2022

Background: The effect of underlying chronic obstructive pulmonary disease (COPD) on coronavirus disease 2019 (COVID-19) during a pandemic is controversial. The purpose of this study was to examine the prognosis of COVID-19 according to the underlying COPD. Methods: COVID-19 patients were assessed using nationwide health insurance data. Comorbidities were evaluated using the modified Charlson Comorbidity Index (mCCI) which excluded COPD from conventional CCI scores. Baseline characteristics were assessed. Univariable and multiple logistic and linear regression analyses were performed to determine effects of variables on clinical outcomes. Ages, sex, mCCI, socioeconomic status, and underlying COPD were selected as variables. Results: COPD patients showed older age (71.3±11.6 years vs. 47.7±19.1 years, p<0.001), higher mCCI (2.6±1.9 vs. 0.8±1.3, p<0.001), and higher mortality (22.9% vs. 3.2%, p<0.001) than non-COPD patients. The intensive care unit admission rate and hospital length of stay were not significantly different between the two groups. All variables were associated with mortality in univariate analysis. However, underlying COPD was not associated with mortality unlike other variables in the adjusted analysis. Older age (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.11-1.14; p<0.001), male sex (OR, 2.29; 95% CI, 1.67-3.12; p<0.001), higher mCCI (OR, 1.30; 95% CI, 1.20-1.41; p<0.001), and medical aid insurance (OR, 1.55; 95% CI, 1.03-2.32; p=0.035) were associated with mortality. Conclusion: Underlying COPD is not associated with a poor prognosis of COVID-19.