Factors affecting treatment compliance in new hypertensive patients in Korea.

This study aims to analyze continuity of care according to complications and examine the relationship between the continuity of care and health outcomes (hospitalization, emergency department visits, and complications) using data of new hypertensive patients from Korea's National Health Insurance Claims database. There were a total of 715,053 new hypertensive patients followed up for three years until 2011. Indices of continuity of care were Continuity of Care Index (COC), Modified, Modified Continuity Index (MMCI), and Most Frequent Provider Continuity (MFPC). The mean values of COC, MMCI, and MFPC were 0.79, 0.77, and 0.87, respectively, in new hypertensive patients with complications, and 0.80, 0.79, and 0.87, respectively, in those without complications. The factors affecting the continuity of care were sex, ambulatory care visits, number of providers, main medical institution, and Charlson's comorbidity score. Following analysis of the correlation between the treatment compliance and health outcomes, the low COC group had a higher association with hospitalization, the emergency department visit, and complications as compared with the high COC group. COC and medication adherence were associated with a reduction of hospitalization, emergency department visits, and complications. This indicates it would be mandatory to manage the patients' continuity of care.

Disability-Adjusted Life Years for Communicable Disease in the Korean Burden of Disease Study 2012.

Globally, the incidence of communicable diseases has decreased compared to non-communicable diseases. However, chronic communicable diseases such as HIV/AIDS and tuberculosis persist worldwide. Furthermore, emerging new infections such as H1N1 influenza pose a new threat to public health. However, most studies have focused on non-communicable diseases because of their increasing incidence, with fewer studies investigating communicable diseases. Therefore, we estimated the burden of communicable diseases in Korea using national representative 2012 data. To estimate the disability-adjusted life years (DALY), we used cause of death data from the Statistics Korea to estimate the years of life lost (YLL), applied the Korean garbage code algorithm, and used national claims data from the National Health Insurance Service (NHIS) to estimate years lived with disability (YLD). In 2012, the total DALYs of communicable disease were 445 per 100,000, with 129 YLLs per 100,000 and 316 YLDs per 100,000. The total DALYs in men were 468 per 100,000, greater than the 422 per 100,000 DALYs seen in women. The DALYs of lower respiratory infections were the highest value among communicable diseases at 143/100,000 DALYs followed by tuberculosis and upper respiratory infections. The 40-49 years old age group had the largest number of total DALYs. In contrast, the over 80 years old age group had the largest number of total DALYs per 100,000 followed by the 70-79 and 0-9 years old age groups. These results enable the prioritization of interventions related to communicable diseases and can be used for evidence-based public health policies.

The association between alcohol consumption and left ventricular diastolic function and geometry change in general Korean population.

Aims: The adverse effect of heavy alcohol intake on cardiovascular disease is well established. However, there is only limited information about the risk of subclinical left ventricular (LV) abnormality according to alcohol consumption. Thus, this study was to investigate the association between alcohol consumption and LV functional and structural abnormality. Methods and results: Study participants were 49 714 Korean adults received echocardiogram as an item of health check-up program. They were stratified into 6 groups according to alcohol consumption; non (life time never drinker), occasional (<1 g/day), light (1-15 g/day), moderate (15-30 g/day), heavy (30-60 g/day), and very heavy (>60 g/day) drinker. Multiple logistic regression analysis was used to assess the odd ratios (ORs) for LV hypertrophy (LVH), increased relative wall thickness (RWT) and impaired LV diastolic (LVD) function with a reference of non-drinker. Additionally, the adjusted mean values of echocardiographic parameters were evaluated to assess LV diastolic function and structure. In logistic regression analysis, very heavy alcohol drinker had the highest adjusted ORs for LVH, increased RWT and impaired LVD function in all participants and male subgroup (P < 0.05). The dose dependent relationship was found between alcohol consumption and impaired LVD function in all participants and gender subgroups. There was no specific pattern of relationship to suggest the favourable effect of light alcohol drinking on heart. Conclusion: Increased alcohol intake had the adverse effect on LV function and structure. However, potential favourable effect of light alcohol intake was not observed. Prospective studies are required to investigate long-term effect of alcohol consumption on subclinical LV change.

The optimal cut-off of blood pressure related to left ventricular diastolic dysfunction and remodeling in Asian diabetic patients.

BACKGROUND: Although a recent randomized trial found no difference between intensive and standard blood pressure (BP) control in patients with diabetes mellitus (DM), the debate over the optimal BP target continues. Thus, the present study investigated the effect of BP on the subclinical left ventricular (LV) function and structural changes in diabetic patients. METHOD: A total of 2649 patients with DM who received echocardiography were enrolled in this study. Study population was stratified by three groups according to BP and presence of hypertension (normal, <130/80mmHg; prehypertension, ≥130/80mmHg without hypertension; hypertension, ≥140/90mmHg or history of hypertension). The odds ratios (ORs) of impaired LV diastolic function and LV remodeling were analyzed using multivariate logistic regression analysis. The adjusted mean values of echocardiographic parameters related to LV diastolic function and remodeling were also evaluated. RESULT: When normal group was set as reference, the adjusted ORs [95% confidential interval (CI)] for impaired LV diastolic function was 2.45 (95% CI 1.84-3.24) in prehypertension, 3.51 (95% CI 2.57-4.80) in hypertension group. Adjusted ORs for LV remodeling only showed significant result in hypertension group [1.82 (95% CI 1.23-2.69)]. The adjusted mean value of LV diastolic function and structure also demonstrated LV deterioration in prehypertension and hypertension groups. CONCLUSION: Our study showed the adverse influence of prehypertension and hypertension on subclinical LV deterioration. This finding suggested the potential clinical benefits of intensive BP control (<130/80mmHg) in patients with DM.

Utilization Patterns of Korean Medicine: An Analysis of the National Health Insurance Cohort Database from 2002 to 2013.

OBJECTIVES: Although Korean Medicine (KM) is an important part of the Korean healthcare system and plays a significant role in chronic and incurable diseases, there is insufficient information about KM utilization. The aim of the study was to identify KM utilization patterns using a national representative sample data. METHODS: KM users aged 0-80 years and older from the nationally representative sample in the National Health Insurance Service-National Sample Cohort of 778,506 KM users between 2002 and 2013 (were analyzed. Annual changes in utilization patterns were analyzed by sex, nine age groups, five income levels, and numbers of visits and hospitalizations. Utilization patterns by the type of healthcare institution and the top 10 major diseases were studied. RESULTS: Frequencies of KM use differed according to analyses of patients and claims. Women used KM 1.5 times more than did men. Patients in their 40s and 50s made up one third of KM users. In contrast to other studies, high-income groups used KM more than did low-income groups. More than 96% of ambulatory patients used mostly KM clinics, and more than 76% of inpatients used KM hospitals. Musculoskeletal disorders were the main disease treated, which conformed to the results of previous studies. CONCLUSION: The results suggest that women, people in their 40s and 50s, and people with a relatively high income use KM more often than other patients. Further comparison studies of both Western medicine in Korea and other countries should be conducted.