• 제목/요약/키워드: poisson regression

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척추전문병원과 비전문병원의 의료이용 비교분석 (Comparative Analysis of Medical Use of Spine Specialty Hospitals and Nonspecialty Hospitals)

  • 이영노;정윤지;이광수
    • 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.

영-과잉 회귀모형을 활용한 폭염자료분석 (Heat-Wave Data Analysis based on the Zero-Inflated Regression Models)

  • 김성태;박만식
    • Journal of the Korean Data Analysis Society
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    • 제20권6호
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    • pp.2829-2840
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    • 2018
  • 음이 아닌(non-negative) 측정값을 가지는 확률변수에 있어서, 영(0)이 과도하게 측정되는 자료를 반연속형(semi-continuous) 자료와 영-과잉(zero-inflated) 자료로 구분한다. 이러한 자료에서는 특정 확률 분포(probability distribution) 하에서의 확률보다 훨씬 큰 확률로 0을 관측하게 되는데, 연속형(continuous) 확률분포를 고려하는 경우에는 반연속형으로, 이산형(discrete) 확률분포를 고려하는 경우에는 영-과잉이라고 한다. 본 연구에서는 경계값(0)의 측정 여부에 관한 모형과 0보다 큰 확률변수에 대한 확률분포를 활용한 모형 등 두 개의 부문으로 이루어진 모형, 즉 2-부문 모형(two-part model)을 소개하고자 한다. 특히, 이산형 확률분포 중 포아송 분포와 음이항 분포를 고려한 영-과잉 회귀모형(regression model)을 설명하고 그 특성을 파악하고자 한다. 실증연구에서는 이러한 영-과잉 회귀모형을 활용하여 지난 10년(2009년부터 2018년) 간 한국의 여름철(6-8월) 폭염주의보(heat-wave advisory) 및 폭염경보(heat-wave warning) 발생일수를 적합하였다. 또한 공간예측기법 중 하나인 범용크리깅(universal kriging)을 이용하여 적합결과를 바탕으로 한 폭염 발생일수에 대한 예측지도를 작성하였다.

축력이 재하된 원형 콘크리트 충전강관 기둥의 최대 저항능력 (Ultimate Resisting Capacity of Axially Loaded Circular Concrete-Filled Steel Tube Columns)

  • 곽효경;곽지현
    • 콘크리트학회논문집
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    • 제24권4호
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    • pp.423-433
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    • 2012
  • 콘크리트 충전 강관 기둥은 축하중 재하시 콘크리트에 구속응력이 발생함에 따라 콘크리트의 강도가 증가한다. 콘크리트의 강도 증가분은 발생된 구속응력의 크기에 종속되므로 비선형 해석을 통하여 원형 콘크리트 충전 강관의 축방향 하중에 대한 최대 저항능력을 산정하였다. 콘크리트의 포아송비 및 응력-변형률 관계와 같은 비선형 재료 특성을 고려하였으며, 강관의 다축 항복조건을 기준으로 최대 구속응력을 산정하였다. 실험 결과와의 비교를 통하여 제안된 모델을 검증하였으며, 회귀분석을 통하여 D/t 비율 및 재료성질에 따른 최대 구속응력 산정법을 단순화하였다. Eurocode 4 설계 기준 및 기존에 제안된 다양한 경험식과의 비교를 통하여 제안된 회귀분석식의 타당성을 검증하였다.

서울지역 미세먼지 농도가 호흡기계 및 심혈관계의 외래 방문 및 입원과 진료비에 미치는 영향 (Hospital Visits, Admissions and Hospital Costs among Patients with Respiratory and Cardiovascular Diseases according to Particulate Matter in Seoul)

  • 이형숙
    • 한국환경보건학회지
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    • 제42권5호
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    • pp.324-332
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    • 2016
  • Objectives: The annual average of PM10 in Seoul was $45{\mu}/m^3$, which surpasses the WHO annual guidelines ($20{\mu}/m^3$). Most previous analyses of the effects of PM exposure have been retrospective studies using single hospital data, and fewer studies have attempted to address the relationship of PM10 and hospital costs. This study was conducted to investigate the effects of the concentration of PM10 on hospital visits, admissions and hospital costs in patients with respiratory and cardiovascular diseases. Methods: Medical data from the National Health Insurance Service and the monthly average of PM10 from National Institute of Environmental Research were used to identify the effects of PM10 on hospital visits, admissions and hospital costs. We applied Poisson regression and linear regression to perform the analysis. Results: The relative risks for admissions per $10{\mu}/m^3$ increase in PM10 were 23.11%, 10.2% and 6.9% increases for acute bronchiolitis, asthma and bronchitis, respectively. The relative risk for hospital visits per $10{\mu}/m^3$ increase in PM10 were 10.4%, 6.7% and 5.9% for chronic obstructive pulmonary disease, asthma and chronic sinusitis, respectively. For cardiovascular disease, the relative risk for admissions per $10{\mu}/m^3$ increase in PM10 were 2.2% and 2.1% increases in angina and acute myocardial infarction, respectively. A $10{\mu}/m^3$ increase in the monthly average of PM10 corresponded to 170,723,000 won (95% CI: 125,587,000-215,860,000 won), 123,636,000 won (95% CI: 47,784,000-199,487,000 won) and 78,571,000 won (95% CI: 29,062,000-128,081,000 won) increases in hospital costs for asthma, acute tonsillitis and chronic sinusitis, respectively. Conclusion: Hospital admissions for respiratory and cardiovascular disease were associated with PM10 levels. PM10 exposure is also associated with increased costs for respiratory diseases.

간이 폐기능측정기 (mini-Wright)와 비강세척액 (Nasal Lavage)을 이용한 대기오염물질과 호흡기 건강영향 분석 (Effects of Ambient Air Pollution on Respiratory Health of Workers at Highway Tollgate)

  • 이종태;정용;현연주;조혜련
    • Environmental Analysis Health and Toxicology
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    • 제14권1_2호
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    • pp.21-33
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    • 1999
  • A large number of studies have indicated associations between the impairment of respiratory health and exposure to ambient air pollutants such as ozone (O$_3$) , nitrogen dioxide (NO$_2$) , sulfur dioxide(SO$_2$) , particulate matters (PM$\_$10/). To evaluate this associations, we used the pulmonary function tests (peak expiratory flow rate : PEFR) by mini-wright peak flow meter and counting neutrophils in the nasal lavage (NL) as biomarker. From 15 June to 16 July 1998, for the workers in the highway tollgates, PEFR and NL were measured three times daily and twice per week. and association between the level of air pollutants and PEFR and NL were analyzed using the multiple regression model and the poisson regression model respectively. The results indicated that the effects of all measured air pollutants (SO$_2$, NO$_2$, O$_3$, PM$\_$10/) were not significantly associated with the value of PEFR. On the other side, SO$_2$, NO$_2$, PM$\_$10/ were significantly associated with the number of neutrophils in NL. The increase in SO$_2$, NO$_2$of 10ppb and in PM$\_$10/ of 10$\mu\textrm{g}$/m$^3$was associated with 24%, 21%, 35% increases in neutrophil counts. But the ozone exposure was not associated with NL.

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Estimation of Time Trends of Incidence of Prostate Canner - an Indian Scenario

  • Lalitha, Krishnappa;Suman, Gadicherla;Pruthvish, Sreekantaiah;Mathew, Aleyamma;Murthy, Nandagudi S.
    • Asian Pacific Journal of Cancer Prevention
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    • 제13권12호
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    • pp.6245-6250
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    • 2012
  • Background: With increase in life expectancy, adoption of newer lifestyles and screening using prostate specific antigen (PSA), the incidence of prostate cancer is on rise. Globally prostate cancer is the second most frequently diagnosed cancer and sixth leading cause of cancer death in men. The present communication makes an attempt to analyze the time trends in incidence for different age groups of the Indian population reported in different Indian registries using relative difference and regression approaches. Materials and Methods: The data published in Cancer Incidence in Five Continents for various Indian registries for different periods and/or publications by the individual registries served as the source materials. Trends were estimated by computing the mean annual percentage change (MAPC) in the incidence rates using the relative difference between two time periods (latest and oldest) and also by estimation of annual percentage change (EAPC) by the Poisson regression model. Results: Age adjusted incidence rates (AAR) of prostate cancer for the period 2005-2008 ranged from 0.8 (Manipur state excluding Imphal west) to 10.9 (Delhi) per $10^5$ person-years. Age specific incidence rates (ASIR) increased in all PBCRs especially after 55 years showing a peak incidence at +65 years clearly indicating that prostate cancer is a cancer of the elderly. MAPC in crude incidence rate(CR) ranged from 0.14 (Ahmedabad) to 8.6 (Chennai). Chennai also recorded the highest MAPC of 5.66 in ASIR in the age group of 65+. Estimated annual percentage change (EAPC) in the AAR ranged from 0.8 to 5.8 among the three registries. Increase in trend was seen in the 55-64 year age group cohort in many registries and in the 35-44 age group in Metropolitan cities such as Delhi and Mumbai. Conclusions: Several Indian registries have revealed an increasing trend in the incidence of prostate cancer and the mean annual percentage change has ranged from 0.14-8.6.

Effects of Smoking on Cost of Hospitalization and Length of Stay among Patients with Lung Cancer in Iran: a Hospital-Based Study

  • Sari, Ali Akbari;Rezaei, Satar;Arab, Mohammad;Majdzadeh, Reza;Matin, Behzad Karami;Zandian, Hamed
    • Asian Pacific Journal of Cancer Prevention
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    • 제17권9호
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    • pp.4421-4426
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    • 2016
  • Background: Smoking is recognized as a main leading preventable cause of mortality and morbidity worldwide. It is responsible for a considerable financial burden both on the health system and in society. This study aimed to examine the effect of smoking on cost of hospitalization and length of stay (LoS) among patients with lung cancer in Iran in 2014. Materials and Methods: A total of 415 patients were included in the study. Data on age, sex, insurance status, type of hospitals, type of insurance, geographic local, length of stay and cost of hospitalization was extracted by medical records and smoking status was obtained from a telephone survey. To compare cost of hospitalization and LoS for different smoking groups, current smokers, former smokers, and never smokers, a gamma regression model and zero-truncated poisson regression were used, respectively. Results: Compared with never smokers, current and former smokers showed a 48% and 35% increase in hospitalization costs, respectively. Also, hospital LoS for current and former smokers was 72% and 31% higher than for never smokers, respectively. Conclusions: Our study indicated that cigarette smoking imposes a significant financial burden on hospitals in Iran. It is, however, recommended that more research should be done to implement and evaluate hospital based smoking cessation interventions to better increase cessation rates in these settings.

High Incidence of Breast Cancer in Light-Polluted Areas with Spatial Effects in Korea

  • Kim, Yun Jeong;Park, Man Sik;Lee, Eunil;Choi, Jae Wook
    • Asian Pacific Journal of Cancer Prevention
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    • 제17권1호
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    • pp.361-367
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    • 2016
  • We have reported a high prevalence of breast cancer in light-polluted areas in Korea. However, it is necessary to analyze the spatial effects of light polluted areas on breast cancer because light pollution levels are correlated with region proximity to central urbanized areas in studied cities. In this study, we applied a spatial regression method (an intrinsic conditional autoregressive [iCAR] model) to analyze the relationship between the incidence of breast cancer and artificial light at night (ALAN) levels in 25 regions including central city, urbanized, and rural areas. By Poisson regression analysis, there was a significant correlation between ALAN, alcohol consumption rates, and the incidence of breast cancer. We also found significant spatial effects between ALAN and the incidence of breast cancer, with an increase in the deviance information criterion (DIC) from 374.3 to 348.6 and an increase in $R^2$ from 0.574 to 0.667. Therefore, spatial analysis (an iCAR model) is more appropriate for assessing ALAN effects on breast cancer. To our knowledge, this study is the first to show spatial effects of light pollution on breast cancer, despite the limitations of an ecological study. We suggest that a decrease in ALAN could reduce breast cancer more than expected because of spatial effects.

Impact of the Outpatient Prescription Incentive Program on Reduction of Pharmaceutical Costs of Clinics in South Korea

  • Kwon, Seong Hee;Han, Kyu-Tae;Park, Sohee;Moon, Ki Tae;Park, Eun-Cheol
    • 보건행정학회지
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    • 제27권3호
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    • pp.247-255
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    • 2017
  • Background: South Korea has experienced problems with excessive pharmaceutical expenditures. In 2010, the South Korean government introduced an outpatient prescription incentive program to effectively manage pharmaceutical expenditures. Therefore, we examined the relationship between the outpatient prescription incentive program and pharmaceutical expenditures. Methods: We used data from the Korean National Health Insurance claims database, which included medical claims filed for 22,732 clinics from 2011-2014 to evaluate associated pharmaceutical expenditures. We performed multiple regression analysis and Poisson regression analysis using generalized estimating equation models to examine the associations between outpatient prescription incentives and the outcome variables. Results: The data used in this study consisted of 123,392 cases from 22,372 clinics (average 5.4 periods follow-up). Clinics that had received outpatient prescription incentives in the last period had better cost saving and Outpatient Prescribing Costliness Index (OPCI) (received: proportion of cost saving, ${\beta}=6.8179$; p-value < 0.0001; OPCI, ${\beta}=-0.0227$; p-value < 0.0001; reference = non-received). Moreover, these clinics had higher risk in the provision of outpatient prescription incentive (relative risk, 2.772; 95% confidence interval, 2.720 to 2.824). The associations were higher in clinics that had separate prescribing and dispensing programs, or had professional staff. Conclusion: The introduction of an outpatient prescription incentive program for clinics effectively managed problems with rapid increases of pharmaceutical expenditures in South Korea. However, the pharmaceutical expenditures still increased in spite of the positive impact of the outpatient prescription incentive program. Therefore, healthcare professionals and health policy makers should develop more effective alternatives (i.e., for clinics without separate prescribing and dispensing programs) based on our results.

청주시 4지 신호교차로의 후미추돌사고 분석 (Analysis of Rear-End Accidents at 4-legged Signalized Intersections in Cheongju)

  • 박병호;박정순
    • 대한교통학회지
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    • 제25권5호
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    • pp.57-66
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    • 2007
  • 본 연구는 청주시 4지 신호교차로의 후미추돌사고를 다루고 있다. 연구의 목적은 후미추돌사고의 특성을 분석하고, 교통사고, 교통량 및 기하구조 사이의 관계를 설명하는 모형을 개발하는데 있다. 이를 위해 본 연구는 2004년 106개 교차로에서 발생한 308건의 후미추돌사고 자료를 이용한다. 분석된 주요 결과는 다음과 같다. 첫째, 후미추돌사고 중 심각사고는 77.6%로 매우 심각한 것으로 분석되었다. 둘째, 주간보다는 야간에 그리고 교차로 유입부에서 더 많은 후미추돌사고가 발생하였다. 특히, 대형 선행차량의 사고가 더 심각한 것으로 분석되었다. 마지막으로, 본 연구에서 개발된 다중회귀모형과 포아송회귀모형 모두 통계적 신뢰성이 매우 높은 것으로 분석되었다.