Spatio-temporal Analysis of District-level Life Expectancy from 2004 to 2017 in Korea.

BACKGROUND: Health indicators, such as mortality rates or life expectancy, need to be presented at the local level to improve the health of local residents and to reduce health inequality across geographic areas. The aim of this study was to estimate life expectancy at the district level in Korea through a spatio-temporal analysis. METHODS: Spatio-temporal models were applied to the National Health Information Database of the National Health Insurance Service to estimate the mortality rates for 19 age groups in 250 districts from 2004 to 2017 by gender in Korea. Annual district-level life tables by gender were constructed using the estimated mortality rates, and then annual district-level life expectancy by gender was estimated using the life table method and the Kannisto-Thatcher method. The annual district-level life expectancies based on the spatio-temporal models were compared to the life expectancies calculated under the assumption that the mortality rates in these 250 districts are independent from one another. RESULTS: In 2017, district-level life expectancy at birth ranged from 75.5 years (95% credible interval [CI], 74.0-77.0 years) to 84.2 years (95% CI, 83.4-85.0 years) for men and from 83.9 years (95% CI, 83.2-84.6 years) to 88.2 years (95% CI, 87.3-89.1 years) for women. Between 2004 and 2017, district-level life expectancy at birth increased by 4.57 years (95% CI, 4.49-4.65 years) for men and by 4.06 years (95% CI, 3.99-4.12 years) for women. To obtain stable annual life expectancy estimates at the district level, it is recommended to use the life expectancy based on spatio-temporal models instead of calculating life expectancy using observed mortality. CONCLUSION: In this study, we estimated the annual district-level life expectancy from 2004 to 2017 in Korea by gender using a spatio-temporal model. Local governments could use annual district-level life expectancy estimates as a performance indicator of health policies to improve the health of local residents. The approach to district-level analysis with spatio-temporal modeling employed in this study could be used in future analyses to produce district-level health-related indicators in Korea.

Comparison of three small-area mortality metrics according to urbanity in Korea: the standardized mortality ratio, comparative mortality figure, and life expectancy.

BACKGROUND: This study aimed to compare three small-area level mortality metrics according to urbanity in Korea: the standardized mortality ratio (SMR), comparative mortality figure (CMF), and life expectancy (LE) by urbanity. METHODS: We utilized the National Health Information Database to obtain annual small-area level age-specific numbers of population and deaths in Korea between 2013 and 2017. First, differences in the SMR by urbanity were examined, assuming the same age-specific mortality rates in all small areas. Second, we explored the differences in ranking obtained using the three metrics (SMR, CMF, and LE). Third, the ratio of CMF to SMR by population was analyzed according to urbanity. RESULTS: We found that the age-specific population distributions in urbanized areas were similar, but rural areas had a relatively old population structure. The age-specific mortality ratio also differed by urbanity. Assuming the same rate of age-specific mortality across all small areas, we found that comparable median values in all areas. However, areas with a high SMR showed a strong predominance of metropolitan areas. The ranking by SMR differed markedly from the rankings by CMF and LE, especially in areas of high mortality, while the latter two metrics did not differ notably. The ratio of CMF to SMR showed larger variations in small areas in rural areas, particularly in those with small populations, than in metropolitan and urban areas. CONCLUSIONS: In a comparison of multiple SMRs, bias could exist if the study areas have large differences in population structure. The use of CMF or LE should be considered for comparisons if it is possible to acquire age-specific mortality data for each small area.

Tobacco price increases in Korea and their impact on socioeconomic inequalities in smoking and subsequent socioeconomic inequalities in mortality: a modelling study.

OBJECTIVE: Through a modelling study, we assessed the impact of tobacco price increases on smoking and smoking inequalities by income, and then quantified the subsequent effects on mortality and inequalities in mortality in Korea. METHODS: Eleven-year pooled data from the Korea National Health and Nutrition Examination Survey (KNHANES) (n=65 197) were used to estimate the income group-specific price elasticity. The price elasticity was then used to calculate changes in current smoking prevalence and per capita cigarette consumption resulting from a spectrum of hypothetical tobacco price increases. The mortality risk function from the 10-year mortality follow-up data of the National Health Insurance Service-National Sample Cohort (n=293 858, numbers of deaths=14 953) and the current distributions of smoking-related variables from the KNHANES 2015-2017 were employed to estimate the effect of tobacco price increases on inequality in mortality. RESULTS: Low-income Korean smokers were more responsive to changes in tobacco price. Increasing the tobacco price by 100% would achieve the overall reduction of 2.0% for 10-year mortality. For mortality inequalities by income, the relative index of inequality (slope index of inequality) would be reduced by 3.8% (4.8%) for 10-year mortality. CONCLUSIONS: This modelling study showed that tobacco price increases in Korea can reduce current smoking prevalence and per capita cigarette consumption in the whole population, and especially among the poor, which in turn would reduce the gap in mortality between income groups.

Stress radiography for clinical evaluation of anterior shoulder instability.

BACKGROUND: The purpose of this study was to examine the validity of stress radiography using the Telos GA-IIE as a clinical methodology to evaluate shoulder instability. METHODS: On 36 anterior shoulder dislocators and 23 uninjured volunteers, 4 types of stress radiographs were captured while applying 15 daN of force anteriorly (AER0 and AER60) and posteriorly (PER0 and PER60) at 2 different positions: (1) 90° of abduction combined with 0° external rotation and (2) 90° of abduction combined with 60° external rotation. The results of the anterior drawer test and of the same test under anesthesia were correlated. RESULTS: AER0 and AER60 from the affected shoulder revealed significantly larger displacement than on the normal side (P < .05), and all 4 radiographs from the affected joints demonstrated significantly larger displacement (P < .05) than in the volunteers. Among the 4 types of radiographs, AER0 and AER60 showed significantly higher displacement in the patients (P < .001), whereas there were no differences in the volunteers (P = .167). The results of the anterior drawer test positively correlated to AER60 (Pearson correlation coefficient [PCC] = 0.453; P = .005) and AER0 (PCC = 0.529; P = .001), and those of examination under anesthesia weakly correlated to AER60 (PCC = 0.287; P = .264) but highly correlated to AER0 (PCC = 0.695; P = .002). CONCLUSION: Stress radiographs on the affected shoulder frequently correlated with physical examinations, and the displacement of >3 mm on AER0 suggests anterior instability.

Embryotoxicity assessment of developmental neurotoxicants using a neuronal endpoint in the embryonic stem cell test.

The embryonic stem cell test (EST) is a validated in vitro embryotoxicity test; however, as the inhibition of cardiac differentiation alone is used as a differentiation endpoint in the EST, it may not be a useful test to screen embryotoxic chemicals that affect the differentiation of noncardiac tissues. Previously, methylmercury (MeHg), cadmium and arsenic compounds, which are heavy metals that induce developmental neurotoxicity in vivo, were misclassified as nonembryotoxic with the EST. The aim of this study was to improve the EST to correctly screen such developmental neurotoxicants. We developed a neuronal endpoint (Tuj-1 ID50) using flow cytometry analysis of Tuj-1-positive cells to screen developmental neurotoxicants (MeHg, valproic acid, sodium arsenate and sodium arsenite) correctly using an adherent monoculture differentiation method. Using Tuj-1 ID50 in the EST instead of cardiac ID50, all of the tested chemicals were classified as embryotoxic, while the negative controls were correctly classified as nonembryotoxic. To support the validity of Tuj-1 ID50) , we compared the results from two experimenters who independently tested MeHg using our modified EST. An additional neuronal endpoint (MAP2 ID50), obtained by analyzing the relative quantity of MAP2 mRNA, was used to classify the same chemicals. There were no significant differences in the three endpoint values of the two experimenters or in the classification results, except for isoniazid. In conclusion, our results indicate that Tuj-1 ID50 can be used as a surrogate endpoint of the traditional EST to screen developmental neurotoxicants correctly and it can also be applied to other chemicals.

Stagnation of life expectancy in Korea in 2018: A cause-specific decomposition analysis.

According to the most recent annual report released by Korea Statistics, the life expectancy at birth (for both sexes) in 2018 was 82.7 years, an increase of 0.0 years over 2017, reflecting the first stagnation in life expectancy since 1960. In this study, a time-series analysis was conducted of trends in life expectancy from 2003 to 2018, and causes of death were analyzed using the Kannisto-Thatcher method and the Arriaga decomposition method. The time trend analysis of yearly life expectancy changes indicated that, in Korea, there was a tendency for the yearly increase in life expectancy between 2003 and 2018 to decrease by 0.0211 years per calendar year. The contribution of cardiovascular diseases, the most important contributor to the life expectancy increase in Korea, gradually decreased over this period. The contribution of cardiovascular diseases to the life expectancy increase was 0.506 years in 2003-2006, but this contribution decreased to 0.218 years in 2015-2018. The positive contributions of ill-defined causes and external causes to life expectancy increase detected in previous periods were not evident in 2015-2018. Diseases of the respiratory system made the largest negative contribution both between 2015 and 2018 and between 2017-2018. The life expectancy stagnation in 2018 could be understood as the combined effect of (a) decreasing momentum in the increase of life expectancy and (b) a chance event in 2018 involving life expectancy. Currently, it is difficult to judge whether the stagnation of life expectancy in 2018 is temporary, and further analyses of life expectancy and contributing causes of death in the future are needed.

Educational Inequalities in Self-Rated Health in Europe and South Korea.

While numerous comparative works on the magnitude of health inequalities in Europe have been conducted, there is a paucity of research that encompasses non-European nations such as Asian countries. This study was conducted to compare Europe and Korea in terms of educational health inequalities, with poor self-rated health (SRH) as the outcome variable. The European Union Statistics on Income and Living Conditions and the Korea National Health and Nutrition Examination Survey in 2017 were used (31 countries). Adult men and women aged 20+ years were included (207,245 men and 238,007 women). The age-standardized, sex-specific prevalence of poor SRH by educational level was computed. The slope index of inequality (SII) and relative index of inequality (RII) were calculated. The prevalence of poor SRH was higher in Korea than in other countries for both low/middle- and highly educated individuals. Among highly educated Koreans, the proportion of less healthy women was higher than that of less healthy men. Korea's SII was the highest for men (15.7%) and the ninth-highest for women (10.4%). In contrast, Korea's RII was the third-lowest for men (3.27), and the lowest among women (1.98). This high-SII-low-RII mix seems to have been generated by the high level of baseline poor SRH.

Quantifying the impact of reducing socioeconomic inequalities in modifiable risk factors on mortality and mortality inequalities in South Korea.

OBJECTIVES: We quantified the impact of reducing socioeconomic inequalities in risk factors on mortality and mortality inequalities in South Korea. METHODS: The mortality risk function from the 12-year mortality follow-up data of the National Health Insurance Service-National Health Screening Cohort, the prevalence of major risk factors from the Korea National Health and Nutrition Examination Survey 2013-2015, and the Health Plan 2020 (HP2020) goals for major risk factors were used to estimate the magnitude of reduction in mortality inequalities by changing the magnitude of income-based inequalities in risk factors in various scenarios under gender-specific models among participants aged 40-79 years. RESULTS: The greatest reduction in absolute and relative inequalities in mortality would occur if the low-income group achieved the HP2020 goals earlier than the high-income group. A 10-20% reduction in all-cause mortality inequalities was expected if absolute gaps between income groups in risk factors were halved. CONCLUSIONS: With the practical goal halving the socioeconomic gaps in modifiable risk factors, reducing inequalities in all-cause mortality by 10-20% would be possible. Further reduction in mortality inequalities would need more aggressive policies on social determinants of health.

Impact of the 2015 Middle East Respiratory Syndrome Outbreak on Emergency Care Utilization and Mortality in South Korea.

PURPOSE: In May 2015, South Korea experienced an epidemic of Middle East respiratory syndrome (MERS). This study investigated the impacts of MERS epidemic on emergency care utilization and mortality in South Korea. MATERIALS AND METHODS: A natural experimental study was conducted using healthcare utilization and mortality data of the entire Korean population. The number of monthly emergency room (ER) visits was investigated to identify changes in emergency care utilization during the MERS epidemic; these trends were also examined according to patients' demographic factors, disease severity, and region. Deaths within 7 days after visiting an ER were analyzed to evaluate the impact of the reduction in ER visits on mortality. RESULTS: The number of ER visits during the peak of the MERS epidemic (June 2015) decreased by 33.1% compared to the average figures from June 2014 and June 2016. The decrease was observed in all age, sex, and income groups, and was more pronounced for low-acuity diseases (acute otitis media: 53.0%; upper respiratory infections: 45.2%) than for high-acuity diseases (myocardial infarctions: 14.0%; ischemic stroke: 16.6%). No substantial changes were detected for the highest-acuity diseases, with increases of 3.5% for cardiac arrest and 2.4% for hemorrhagic stroke. The number of deaths within 7 days of an ER visit did not change significantly. CONCLUSION: During the MERS epidemic, the number of ER visits decreased in all age, sex, and socioeconomic groups, and decreased most sharply for low-acuity diseases. Nonetheless, there was no significant change in deaths after emergency care.

Trends in inequality in life expectancy at birth between 2004 and 2017 and projections for 2030 in Korea: multiyear cross-sectional differences by income from national health insurance data.

OBJECTIVES: The current status, time trends and future projections of a national health equity target are crucial elements of national health equity surveillance. This study examined time trends in inequality by income in life expectancy (LE) at birth between 2004 and 2017 and made future projections for the year 2030 in Korea. DESIGN: Using individually linked mortality data, time trends in inequality by income in LE at birth were examined. The LE projection was made with the Lee-Carter model. SETTING: Total Korean population and death data derived from the National Health Information Database of the National Health Insurance Service. PARTICIPANTS: A total of 685 773 157 subjects and 3 486 893 deaths between 2004 and 2017 were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES: Annual LE and the magnitude of inequality by income in LE between 2004 and 2030. RESULTS: Inequality by income in LE among the total Korean population increased during the past 14 years, and this inequality is projected to become even greater in the future. In 2030, the magnitude of inequality by income in LE is projected to increase by 0.25 years in comparison to the magnitude in 2017. The increase in LE inequality was projected to be more prominent among women, with a projected 1.08 year increase in LE inequality between 2017 and 2030. CONCLUSION: Aggressive policies should be developed to close the increasing LE gap in Korea. LE inequalities by income should be considered as a measurable target for health equity in the process of establishing the National Health Plan 2030 in Korea.

Inhibition of aroclor 1254-induced depletion of stored calcium prevents the cell death in catecholaminergic cells.

The relationship between depleting effects of polychlorinated biphenyls (PCBs) on the intracellular calcium store and PCBs-induced cell death in dopaminergic cells has not been fully evaluated. Here, we evaluated the effects of inhibitors of the release of ER-stored calcium on the cytotoxicities induced by 10 microg/ml of Aroclor 1254 (A1254; polychlorinated biphenyl mixture) in a catecholaminergic cell-line, CATH.a cells. Exposure to A1254 produced an elevation in free calcium ([Ca2+]i) in the presence or absence of extracellular calcium and decreased in cell viability. From our results, we deduced that the A1254-induced elevation of [Ca2+]i resulted from the depletion of ER-stored calcium. The [Ca2+)]i elevation was dramatically inhibited by an inositol 1,4,5-triphosphate receptor (IP3R) antagonist, and slightly inhibited by a ryanodine receptor (RyR) blocker. IP3R blockers conferred significant protection against A1254-induced cell death, as did RyR blockers, but calcium chelators or NMDA blockers did not. However, none of these reagents inhibited the depletion of intracellular dopamine by A1254 indicating that the mechanism of PCB-induced dopamine depletion may be independent of calcium alterations. Taken together, these data suggest that agents inhibiting the receptor-mediated depletion of stored calcium can prevent the A1254-induced cell death, but not modulate the A1254-induced intracellular dopamine depletion in CATH.a cells.

Aroclor 1254-induced cytotoxicity in catecholaminergic CATH.a cells related to the inhibition of NO production.

The neuronal nitric oxide synthase (nNOS) specific inhibitor, 7-nitroindazole (7-NI), and the nitric oxide (NO) donor (S-nitroso-N-acetylpenicillarnine, SNAP) were used to study the role of NO in polychlorinated biphenyl (PCB: Aroclor 1254)-induced cytotoxicity in the immortalized dopaminergic cell line (CATH.a cells), derived from the central nervous system of mice. Treatment of the dopaminergic cells with various concentrations of Aroclor 1254 (0.5-10 microg/ml), a commercial PCB mixture, showed significant cytotoxicity as evaluated by lactate dehydrogenase (LDH) release and assessment of cell viability, depending on the concentration used. We also observed that Aroclor 1254 treatment reduced the level of nNOS expression. Furthermore, the cytotoxicity of Aroclor 1254 was augmented by 10 microM of 7-NI, which alone did not produce cytotoxicity, while it was protected by treatment with SNAP. Depending on the concentrations of Aroclor 1254 used, intracellular dopamine and dihydroxyphenylacetic acid (DOPAC) concentrations were significantly decreased. Therefore, these results suggest that PCBs have the potential for dopaminergic neurotoxicity, which may be related with the PCBs-mediated alteration of NO production originating from nNOS at least in part.

Changes of the level of G protein alpha-subunit mRNA by tolerance to and withdrawal from butorphanol.

Butorphanol was infused continuously into cerebral ventricle at a constant rate of 26 nmol/microl/h for 3 days, and the withdrawal from opioid was rendered 7 h after the cessation of infusion. The G-protein alpha-subunit has been implicated in opioid tolerance and withdrawal. The effects of continuous infusion of butorphanol on the modulation of G protein alpha-subunit mRNA were investigated by using in situ hybridization techniques. In situ hybridization showed marked changes in the levels of Galpha s during butorphanol tolerance and withdrawal. Specifically, the level of Galpha s mRNA was significantly decreased in almost all areas of brain except hippocampus during the butorphanol withdrawal. It was also decreased in the septum and cerebellar granule layer in butorphanol tolerant rats. The level of Galpha i mRNA was significantly decreased only in the cerebral cortex of butorphanol tolerant rat. However, no such change was noted during the withdrawal from butorphanol. The level of Galpha o mRNA was not changed either in butorphanol tolerant or in the butorphanol withdrawal rats. No alterations were noted in the level of [3H]forskolin binding to adenylyl cyclase in butorphanol tolerant as well as withdrawing rats. The levels of pCREB were significantly elevated in the hippocampus in the butorphanol withdrawal rats. These results suggest that region-specific changes of G protein alpha-subunit mRNA and pCREB without marked changes in the level of adenylyl cyclase may underlie the tolerance to and withdrawal from butorphanol.