Association of polypharmacy with all-cause mortality and adverse events among elderly colorectal cancer survivors.

BACKGROUND: The risk of inappropriate drug exposure in elderly colorectal cancer (CRC) survivors after the initial cancer treatment has not been well studied. This study investigated the association of polypharmacy (PP) with overall survival, hospitalization, and emergency room (ER) visits among older CRC survivors. METHODS: A retrospective cohort study was conducted using the Korean National Health Insurance claims data follow-up from 2002 to 2017. Participants comprised those aged ≥65 years who were hospitalized with a diagnosis of CRC received cancer treatment and survived at least 2 years from the initial CRC diagnosis between 2003 and 2012. PP was defined based on the number of individual drugs during the third year, after 2 years of survival since the initial cancer treatment. PP was categorized as follows: non-PP (zero to four prescribed drugs); PP (five to nine drugs), and excessive PP (≥10 drugs). Main outcomes are all-cause mortality, hospitalization, and ER visits. RESULTS: Of the 55,228 participants, 44.5% died, 83.1% were hospitalized, and 46.1% visited the ER. The PP and excess PP groups showed increased risk of all-cause mortality, hospitalization, and ER visit compared with the low PP group, and was highly associated among groups including patients aged 65 to 74 years and those in low-level frailty groups. CONCLUSIONS: These risks can be minimized by increasing awareness and enhancing behaviors among health care professionals, especially clinician and pharmacists, to be aware of potential drug interactions, review, and ongoing monitoring. PLAIN LANGUAGE SUMMARY: The risk of inappropriate drug exposure in older colorectal cancer (CRC) survivors after the initial cancer treatment has not been well studied. Polypharmacy was associated with adverse outcomes, including all-cause mortality, hospitalization, and emergency room visits among older CRC survivors and it was particularly associated with those who were 65 to 75 years and those with low risk of frailty. When prescribing drugs, physicians should be mindful of finding a balance between adequate treatment of diseases and avoiding adverse drug effects in survivors of CRC.

The effects of hospice care on healthcare expenditure among cancer patients.

PURPOSE: It is necessary to estimate the hospice usage and hospice-related cost for entire cancer patients using nationwide cohort data to establish a suitable ethical and cultural infrastructure. This study aims to show the effects of hospital hospice care on healthcare expenditure among South Korean cancer patients. METHODS: This study is a retrospective cohort study using customized health information data provided by the National Health Insurance Service. Individuals who were diagnosed with stomach, colorectal, or lung cancer between 2003 and 2012 were defined as new cancer patients, which included 7,176 subjects. Patients who died under hospital-based hospice care during the follow-up period from January 2016 to December 2018 comprised the treatment group. Healthcare expenditure was the dependent variable. Generalized estimating equations was used. RESULTS: Among the subjects, 2,219 (30.9%) had used hospice care at an average total cost of 948,771 (± 3,417,384) won. Individuals who had used hospice care had a lower odds ratio (EXP(ß)) of healthcare expenditure than those who did not (Total cost: EXP(ß) = 0.27, 95% confidence intervals (CI) = 0.25-0.30; Hospitalization cost: EXP(ß) = 0.32, 95% CI = 0.29-0.35; Outpatient cost: EXP(ß) = 0.02, 95% CI = 0.02-0.02). CONCLUSION: Healthcare expenditure was reduced among those cancer patients in South Korea who used hospice care compared with among those who did not. This emphasizes the importance of using hospice care and encourages those hesitant to use hospice care. The results provide useful insights into both official policy and the existing practices of healthcare systems.

Association of institutional transition of cancer care with mortality in elderly patients with lung cancer: a retrospective cohort study using national claim data.

BACKGROUND: Although survival based outcomes of lung cancer patients have been well developed, institutional transition of cancer care, that is, when patients transfer from primary visiting hospitals to other hospitals, and mortality have not yet been explored using a large-scale representative population-based sample. METHODS: Data from the Korean National Elderly Sampled Cohort survey were used to identify patients with lung cancer who were diagnosed during 2005-2013 and followed up with for at least 1 year after diagnosis (3738 patients with lung cancer aged over 60 years). First, the authors examined the distribution of the study population by mortality, and Kaplan-Meier survival curves/log-rank test were used to compare mortality based on institutional transition of cancer care. Survival analysis using the Cox proportional hazard model was conducted after controlling for all other variables. RESULTS: Results showed that 1-year mortality was higher in patients who underwent institutional transition of cancer care during 30 days after diagnosis (44.2% vs. 39.7%, p = .027); however, this was not associated with 5-year mortality. The Cox proportional hazard model showed that patients who underwent institutional transition of cancer care during 30 days after diagnosis exhibited statistically significant associations with high mortality for 1 year and 5 years (1-year mortality, Hazard ratio [HR]: 1.279, p = .001; 5-year mortality, HR: 1.158, p = .002). CONCLUSION: This study found that institutional transition of cancer care was associated with higher mortality among elderly patients with lung cancer. Future consideration should also be given to the limitation of patients' choice when opting for institutional transition of care since there are currently no control mechanisms in this regard. Results of this study merit health policymakers' attention.

Does fragmented cancer care affect survival? Analysis of gastric cancer patients using national insurance claim data.

BACKGROUND: We aimed to investigate the association between fragmented cancer care in the early phase after cancer diagnosis and patient outcomes using national insurance claim data. METHODS: From a nationwide sampled cohort database, we identified National Health Insurance beneficiaries diagnosed with gastric cancer (ICD-10: C16) in South Korea during 2005-2013. We analyzed the results of a multiple logistic regression analysis using the generalized estimated equation model to investigate which patient and institution characteristics affected fragmented cancer care during the first year after diagnosis. Then, survival analysis using the Cox proportional hazard model was conducted to investigate the association between fragmented cancer care and five-year mortality. RESULTS: Of 2879 gastric cancer patients, 11.9% received fragmented cancer care by changing their most visited medical institution during the first year after diagnosis. We found that patients with fragmented cancer care had a higher risk of five-year mortality (HR: 1.310, 95% CI: 1.023-1.677). This association was evident among patients who only received chemotherapy or radiotherapy (HR: 1.633, 95% CI: 1.005-2.654). CONCLUSIONS: Fragmented cancer care was associated with increased risk of five-year mortality. Additionally, changes in the most visited medical institution occurred more frequently in either patients with severe conditions or patients who mainly visited smaller medical institutions. Further study is warranted to confirm these findings and examine a causal relationship between fragmented cancer care and survival.

Pioglitazone use associated with reduced risk of the first attack of ischemic stroke in patients with newly onset type 2 diabetes: a nationwide nested case-control study.

BACKGROUND: Pioglitazone use is known to be associated with a reduced risk of recurrent stroke in patients with diabetes mellitus (DM) who have a history of stroke. However, it is unclear whether this benefit extends to patients without a history of stroke. We aimed to evaluate the association between pioglitazone use and development of first attack of ischemic stroke in patients with newly diagnosed type 2 DM. METHODS: Using longitudinal nationwide data from the 2002-2017 Korean National Health Insurance Service DM cohort, we analyzed the association between pioglitazone use and incidence of primary ischemic stroke using a nested case-control study. Among 128,171 patients with newly onset type 2 DM who were stroke-free at the time of DM diagnosis, 4796 cases of ischemic stroke were identified and matched to 23,980 controls based on age, sex, and the onset and duration of DM. The mean (standard deviation) follow-up time was 6.08 (3.34) years for the cases and controls. Odds ratios (ORs) and 95% confidence intervals (CIs) for the association between ischemic stroke and pioglitazone use were analyzed by multivariable conditional logistic regression analyses adjusted for comorbidities, cardiometabolic risk profile, and other oral antidiabetic medications. RESULTS: Pioglitazone use was associated with a reduced risk of first attack of ischemic stroke (adjusted OR [AOR] 0.69, 95% CI 0.60-0.80) when compared with non-use. Notably, pioglitazone use was found to have a dose-dependent association with reduced rate of ischemic stroke emergence (first cumulative defined daily dose [cDDD] quartile AOR 0.99, 95% CI 0.74-1.32; second quartile, AOR 0.77, 95% CI 0.56-1.06; third quartile, AOR 0.51, 95% Cl 0.36-0.71; highest quartile, AOR 0.48, 95% CI 0.33-0.69). More pronounced risk reduction was found in patients who used pioglitazone for more than 2 years. A further stratified analysis revealed that pioglitazone use had greater protective effects in patients with risk factors for stroke, such as high blood pressure, obesity, and current smoking. CONCLUSIONS: Pioglitazone use may have a preventive effect on primary ischemic stroke in patients with type 2 DM, particularly in those at high risk of stroke.

Regional and income disparities in treatment and drug adherence of patients with dyslipidemia: a retrospective cohort study in South Korea, 2003-2015.

BACKGROUNDS: Health disparities represent a major public health problem that needs to be addressed, and a variety of factors, including geographical location and income, can contribute to these disparities. Although previous studies have suggested that health differs by region and income, evidence on the difference in treatment rate is relatively insufficient. To identify differences in prescription rates by region and income in patients with dyslipidemia. METHODS: Using data from the National Health Insurance Service senior cohort, we included older adults who were diagnosed with dyslipidemia in Korea from 2003 to 2015. Overall prescription rate was determined for patients with dyslipidemia. In addition, medication possession ratio and a defined daily dose were analyzed in patients who were prescribed statins. A generalized estimating equation Poisson model was used to assess differences in prescription rates. RESULTS: Patients living in rural areas (Chungcheong-do, Jeolla-do, and Gyeongsang-do) had a significantly higher prescription rate than those in metropolitan cities. Unlike the prescription rate, the drug adherence was significantly higher in Seoul, Gyeonggi-do, and Gangwon-do but lower in Jeolla-do and Gyeongsang-do than in metropolitan cities. Patients with low income had lower prescription rates than those with high income, but this difference was not statistically significant. CONCLUSION: Our findings demonstrate differences in the treatment rates of patients with dyslipidemia by region and income. Appropriate interventions are needed in vulnerable regions and groups to increase the treatment rate for patients with dyslipidemia.

Association between changes in economic activity and catastrophic health expenditure: findings from the Korea Health Panel Survey, 2014-2016.

BACKGROUND: The rate of catastrophic health expenditure (CHE) continues to rise in South Korea. This study examined the association between changes in economic activity and CHE experiences in South Korea. METHODS: This study analyzed the Korea Health Panel Survey data using a logistic regression analysis to study the association between changes in economic activity in 2014-2015 and the participants' CHE experiences in 2015. The study included a total of 12,454 individuals over the age of 19. The subgroup analyses were organized by sex, age, health-related variables, and household level variables, and the reasons for leaving economic activity. RESULTS: Those who quit economic activities were more likely to experience CHE than those who continued to engage in economic activities (OR [odds ratio] = 2.10; 95% CI [confidence interval]: 1.31-3.36). The subgroup analysis results, according to health-related variables, showed that there is a tendency to a higher Charlson comorbidity index, a higher OR, and, in groups that quit their economic activities, people with disabilities were more likely to experience CHE than people without disabilities (OR = 5.63; 95% CI 1.71-18.59, OR = 1.82; 95% CI 1.08-3.08, respectively). Another subgroup analysis found that if the reason for not participating in economic activity was a health-related issue, the participant was more likely to experience CHE (active → inactive: OR = 2.40; 95% CI 0.61-9.43, inactive → inactive OR = 1.65; 95% CI 1.01-2.68). CONCLUSIONS: Those individuals who became unemployed were more likely to experience CHE, especially if health problems precipitated the job loss. Therefore, efforts are needed to expand coverage for those people who suffer from high medical expenses.

Association between family conflict resolution methods and depressive symptoms in South Korea: a longitudinal study.

We investigated the relationship between family conflict resolution and depression, focusing on each component of family conflict resolution to determine which factors have stronger associations with depression. We used data from 2008 to 2015 of the Korea Welfare Panel Study. Our final sample included 3565 participants. For each participant, we included at least 2-8 years of follow-up data with a mean follow-up time of 4.05 ± 2.52 years. To identify the relationship between new-onset depressive symptoms and participants' family conflict resolution styles, we performed generalized estimating equation analysis with autoregressive working correlations to estimate adjusted odds ratios for new-onset depressive symptoms adjusted for covariates. Compared with positive family conflict resolution, negative family conflict resolution had a higher odds ratio for depressive symptoms (aOR 1.80, 95% CI 1.42-2.29). This relationship was strongly founded on participants who were women (aOR 2.35, 95% CI 1.55-3.94) with experience of verbal aggression (aOR 1.84, 95% CI 1.42-2.37) and threatening behaviors (aOR 1.89, 95% CI 1.25-2.85). Negative family conflict resolution has long-term associations with an elevated risk of depressive symptoms. In particular, we observed higher risks of depression with verbal and psychological conflict than with physical conflict. Health care providers and health policymakers should support the management and development of methods for dealing with family conflict to improve mental health at a family level, as well as an individual level.

Association between change in lifestyle and cognitive functions among elderly Koreans: findings from the Korean longitudinal study of aging (2006-2016).

BACKGROUND: South Korea is an aged society that continues to age rapidly. Therefore, the purpose of this study was to investigate the association between changes in lifestyle and cognitive functions in the South Korean elderly using a nationally representative survey. METHODS: We analyzed data from the Korean Longitudinal Study of Aging (KLoSA) 2006-2016, a biannual panel survey. Multiple linear regression analysis was performed with repeated measurements data to examine the association between lifestyle change and cognitive functions over 2 years. Lifestyle combined the scores of four factors (smoking status, alcohol drinking status, body weight, and exercise), and then categorized them into four groups (Good→Good, Bad→Good, Good→Bad, and Bad→Bad) according to the two-year change. Cognitive functions were set according to the scores measured through the Korean Mini-Mental State Examination (K-MMSE). RESULTS: Among females, the K-MMSE score was the highest in the Bad→Good group compared to the reference group, Bad→Bad (ß = 0.914; SD = 3.744; p < .0001). The next highest scores were in the Good→Good group (ß = 0.813; SD = 4.654; p = 0.0005) and the Good→Bad group (ß = 0.475; SD = 4.542; p = 0.0481). Among males, only the K-MMSE of the Good→Good group was statistically significant (ß = 0.509; SD = 3.245; p = 0.0077). The results of subgroup analysis showed that the K-MMSE scores of females who did not participate in any social activities were more affected by their lifestyle (Good-Good: ß = 1.614; SD = 4.270; p = 0.0017, Bad-Good: ß = 1.817; SD = 3.945; p < .0001). Subgroup analysis showed that females who started drinking more than a moderate amount of alcohol had lower K-MMSE scores (Good-Bad: ß = - 2.636; SD = 2.915; p = 0.0011). Additionally, in both sexes, exercising, among the four lifestyle options, had a strong and significant association with higher K-MMSE scores. CONCLUSIONS: Following a healthy lifestyle or improving an unhealthy lifestyle can help people prevent or slow down cognitive decline. Regularly engaging in an adequate amount of exercise can help the cognitive function of the elderly. Females, specifically, can experience positive effects on their cognitive function if they participate in social activities while maintaining healthy lifestyles, in particular not drinking too much alcohol.

The effect of shifting medical coverage from National Health Insurance to Medical Aid type I and type II on health care utilization and out-of-pocket spending in South Korea.

BACKGROUND: This study examines the effects of a shift in medical coverage, from National Health Insurance (NHI) to Medical Aid (MA), on health care utilization (measured by the number of outpatient visits and length of stay; LOS) and out-of-pocket medical expenses. METHODS: Data were collected from the Korean Welfare Panel Study (2010-2016). A total of 888 MA Type I beneficiaries and 221 MA Type II beneficiaries who shifted from the NHI were included as the case group and 2664 and 663 consecutive NHI holders (1:3 propensity score-matched) were included as the control group, respectively. We used the 'difference-in-differences' (DiD) analysis approach to assess changes in health care utilization and medical spending by the group members. RESULTS: Differential average changes in outpatient visits in the MA Type I panel between the pre- and post-shift periods were significant, but differential changes in LOS were not found. Those who shifted from NHI to MA Type I had increased number of outpatient visits without changes in out-of-pocket spending, compared to consecutive NHI holder who had similar characteristics. However, this was not found for MA Type II beneficiaries. CONCLUSION: Our research provides evidence that the shift in medical coverage from NHI to MA Type I increased the number of outpatient visits without increasing the out-of-pocket spending. Considering the problem of excess medical utilization by Korean MA Type I beneficiaries, further researches are required to have in-depth discussions on the appropriateness of the current cost-sharing level on MA beneficiaries.

Association between night work and dyslipidemia in South Korean men and women: a cross-sectional study.

BACKGROUND: Previous studies have reported that an irregular work schedule, particularly nighttime work, is associated with an altered lipid profile. Additionally, a mismatch in circadian rhythm can affect sleeping and eating habits, leading to poor health. This study aimed to examine the association between night work and dyslipidemia among South Korean adults aged ≥30 years. METHODS: For this study, the data of 5813 participants in the 2013-2016 Korea National Health and Nutrition Examination Survey were analyzed. Diagnoses of dyslipidemia were based on blood sampling tests of total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL) cholesterol, and triglyceride levels. Night work was defined as that conducted during evening (6 P.M.-12 A.M.) and overnight hours (12 A.M.-8 A.M.). The association between night work hours and dyslipidemia in South Korean men and women was investigated using a logistic regression analysis. RESULTS: After adjusting for sociodemographic, economic, health-related, and nutritional factors, an association of night work with dyslipidemia was observed in male participants (odds ratio = 1.53, 95% confidence interval: 1.05-2.24). In subset analyses of male participants, night workers who skipped meals were more likely to have dyslipidemia than their day-working counterparts. Among men who slept < 7 h, night workers had a higher probability of dyslipidemia than day workers. In contrast, no statistically significant association between night work and dyslipidemia was observed in female participants, although the probability of dyslipidemia appeared to increase with advancing age. Furthermore, when women with dyslipidemia were subdivided by occupational categories, night workers in white collar positions were more likely to have dyslipidemia than their day-working counterparts. CONCLUSION: Our study observed an association of night work with dyslipidemia, particularly in men. Although these findings may support interventions for South Korean night workers, further studies are needed for validation.

Correction to: Depressive symptoms in individuals with family members requiring ADL assistance.

Following publication of the original article [1], the authors reported an error in Table 2 in their paper. The table entry "Men's P value" was mistakenly included under the table heading "Women". The original article [1] has been updated.

Depressive symptoms in individuals with family members requiring ADL assistance.

BACKGROUND: The number of patients with depressive symptoms worldwide is increasing steadily, and the prevalence of depression among caregivers is high. Therefore, the present study aimed to identify the effects of individuals' caregiving status with respect to their family members requiring activities of daily living (ADLs) assistance on depressive symptoms among those aged 45 or over. METHODS: Data were collected from the 2006-2016 using the Korean Longitudinal Study of Aging surveys. Participants were categorized into three groups based on their caregiving status with respect to family members requiring ADL assistance: whether they provided the assistance themselves, whether the assistance was provided by other caregivers, or whether no assistance was required. We analyzed the generalized estimating equation model and subgroups. RESULTS: A total of 3744 men and 4386 women were included for the analysis. Men who cared for family members requiring ADL assistance had higher depressive symptoms than those with family members who did not require ADL assistance. Among women, participants who had family members requiring ADL assistance that they themselves or others were providing had higher depressive symptoms than those without family members requiring ADL assistance. Subgroup analysis was conducted based on age, job status, regular physical activities, participation status in social activities, and the number of cohabiting generations. CONCLUSIONS: The study results indicated higher depressive symptoms among those with family members requiring ADL assistance and those who care for such family members themselves. This suggests that an alternative to family caregiving is necessary, especially for the elderly, regardless of caregiver sex.

Association of self-reported sedentary time with insulin resistance among Korean adults without diabetes mellitus: a cross-sectional study.

BACKGROUND: A more sedentary lifestyle can result in insulin resistance. However, few research studies have assessed the association between insulin resistance and sedentary lifestyle in Asian populations. Therefore, this study aimed to investigate the association of sedentary time with insulin resistance. In addition, we also investigate the moderate effect of employment status, moderate-to-vigorous physical activity (MVPA), and body mass index (BMI) in this association. METHODS: Data from 2573 individuals who participated in the 2015 Korean National Health and Nutrition Examination Survey were analyzed. Sedentary time was measured using self-administered questionnaires, and IR data were estimated using the homeostasis model assessment-insulin resistance index (HOMA-IR). Adjusted odds ratio (OR) and 95% confidence intervals (CIs) from a multivariable logistic regression model were generated for all participants. Subgroup analysis was only performed between sedentary time and HOMA-IR stratified by employment status, because moderate effects were not significant in the tests for interaction for MVPA and BMI. For all analyses, the individuals were categorized as having high or normal HOMA-IR values (> 1.6 and ≤ 1.6, respectively). RESULTS: A HOMA-IR > 1.6 was observed in 40.3% of the sedentary time Q1 (low) group (< 5.0 h/day), 41.4% of the sedentary time Q2 (middle-low) group, 44.2% of the sedentary time Q3 (middle-high) group, and 48.4% of the sedentary time Q4 (high) group (≥10.0 h/day). When the low level sedentary time group was used as the reference group, the high level sedentary time group was significantly associated with high IR value (HOMA-IR > 1.6) (OR = 1.40, 95% CI: 1.060-1.838). However, this association was not significant across the other sedentary time groups. Moreover, participants reporting a high sedentary time and were employed had 1.67 times the odds of having a high IR value (HOMA-IR > 1.6) compared to those who reported having a low sedentary time and were employed (OR = 1.67, 95% CI: 1.184-2.344). In the unemployed participants, sedentary time was not associated with IR. CONCLUSIONS: High sedentary time (≥10.0 h/day) was associated with elevated HOMA-IR among Korean adults without diabetes mellitus. Furthermore, the association between high sedentary time and HOMA-IR values was more pronounced in the employed population.

The association between parental depression and adolescent's Internet addiction in South Korea.

BACKGROUND: A number of risk factors for Internet addiction among adolescents have been identified to be associated with their behavior, familial, and parental factors. However, few studies have focused on the relationship between parental mental health and Internet addiction among adolescents. Therefore, we investigated the association between parental mental health and children's Internet addiction by controlling for several risk factors. METHODS: This study used panel data collected by the Korea Welfare Panel Study in 2012 and 2015. We focused primarily on the association between Internet addiction which was assessed by the Internet Addiction Scale (IAS) and parental depression which was measured with the 11-item version of the Center for Epidemiologic Studies Depression Scale. To analyze the association between parental depression and log-transformed IAS, we conducted multiple regression analysis after adjusting for covariates. RESULTS: Among 587 children, depressed mothers and fathers comprised 4.75 and 4.19%, respectively. The mean IAS score of the adolescents was 23.62 ± 4.38. Only maternal depression (ß = 0.0960, p = 0.0033) showed higher IAS among children compared to nonmaternal depression. Strongly positive associations between parental depression and children's Internet addiction were observed for high maternal education level, adolescents' gender, and adolescent's academic performance. CONCLUSIONS: Maternal depression is related to children's Internet addiction; particularly, mothers who had graduated from the university level or above, male children, and children's normal or better academic performance show the strongest relationship with children's Internet addiction.

What is the relationship between the local population change and cancer incidence in patients with dyslipidemia: Evidence of the impact of local extinction in Korea.

BACKGROUND: Changes in the local population are intricately linked to healthcare infrastructure, which subsequently impacts the healthcare sector. A decreasing local population can result in lagging health infrastructure, potentially leading to adverse health outcomes as patients may be at risk of not receiving optimal care and treatment. While some studies have explored the relationship between chronic diseases and local population decline, evidence regarding cancer is insufficient. In this study, we focused on how deteriorating management of chronic diseases such as dyslipidemia could influence the risk of cancer. We investigated the relationship between changes in the local population and cancer incidence among patients with dyslipidemia. METHODS: This cohort study was conducted using claims data. Data from adult patients with dyslipidemia from the National Health Insurance Service-National Sample Cohort conducted between 2002 and 2015 were included. Population changes in each region were obtained from the Korean Statistical Information Service and were used to link each individual's regional code. Cancer risk was the dependent variable, and Cox proportional hazards regression was used to estimate the target associations. RESULTS: Data from 336,883 patients with dyslipidemia were analyzed. Individuals who resided in areas with a decreasing population had a higher risk of cancer than those living in areas with an increasing population (decrease: hazard ratio (HR) = 1.06, 95% CI = 1.03-1.10; normal: HR = 1.05, 95% CI = 1.02-1.09). Participants living in regions with a low number of hospitals had a higher risk of cancer than those in regions with a higher number of hospitals (HR = 1.20, 95% CI = 1.12-1.29). CONCLUSION: Patients in regions where the population has declined are at a higher risk of cancer, highlighting the importance of managing medical problems caused by regional extinction. This could provide evidence for and useful insights into official policies on population decline and cancer risk.

Relationship between patient outcomes and patterns of fragmented cancer care in older adults with gastric cancer: A nationwide cohort study in South Korea.

INTRODUCTION: Fragmented cancer care, defined as receipt of care from multiple hospitals, has been shown to be associated with poor patient outcomes and high expense. However, evidence regarding the effects of hospital choice by patients with cancer on overall survival are lacking. Thus, we investigated the relationship between patterns of fragmented care and five-year mortality in patients with gastric cancer. MATERIALS AND METHODS: Using the Korean National Health Insurance senior cohort of adults aged ≥60 years, we identified patients with gastric cancer who underwent gastrectomy during 2007-2014. We examined the distribution of the study population by five-year mortality, and used Kaplan-Meier survival curves/log-rank test and Cox proportional hazard model to compare five-year mortality with fragmented cancer care. RESULTS: Among the participants, 19.5% died within five years. There were more deaths among patients who received fragmented care, especially those who transferred to smaller hospitals (46.6%) than to larger ones (40.0%). The likelihood of five-year mortality was higher in patients who received fragmented cancer care upon moving from large to small hospitals than those who did not transfer hospitals (hazard ratio, 1.28; 95% confidence interval, 1.10-1.48, P = .001). Moreover, mortality was higher among patients treated in large hospitals or in the capital area for initial treatment, and this association was greater for patients from rural areas. DISCUSSION: Fragmentation of cancer care was associated with reduced survival, and the risk of mortality was higher among patients who moved from large to small hospitals.

Data Resource Profile: The Cancer Public Library Database in South Korea.

This paper provides a comprehensive overview of the Cancer Public Library Database (CPLD), established under the Korean Clinical Data Utilization for Research Excellence project (K-CURE). The CPLD links data from four major population-based public sources: the Korea National Cancer Incidence Database in the Korea Central Cancer Registry, cause-of-death data in Statistics Korea, the National Health Information Database in the National Health Insurance Service, and the National Health Insurance Research Database in the Health Insurance Review & Assessment Service. These databases are linked using an encrypted resident registration number. The CPLD, established in 2022 and updated annually, comprises 1,983,499 men and women newly diagnosed with cancer between 2012 and 2019. It contains data on cancer registration and death, demographics, medical claims, general health checkups, and national cancer screening. The most common cancers among men in the CPLD were stomach (16.1%), lung (14.0%), colorectal (13.3%), prostate (9.6%), and liver (9.3%) cancers. The most common cancers among women were thyroid (20.4%), breast (16.6%), colorectal (9.0%), stomach (7.8%), and lung (6.2%) cancers. Among them, 571,285 died between 2012 and 2020 owing to cancer (89.2%) or other causes (10.8%). Upon approval, the CPLD is accessible to researchers through the K-CURE portal. The CPLD is a unique resource for diverse cancer research to investigate medical use before a cancer diagnosis, during initial diagnosis and treatment, and long-term follow-up. This offers expanded insight into healthcare delivery across the cancer continuum, from screening to end-of-life care.

Effects of ranitidine and nizatidine on the risk of gastrointestinal cancer.

Purpose: Gastrointestinal (GI) cancer occurs in digestive organs such as the stomach, colon, liver, esophagus, and pancreas. About 83,034 cases occurred in Korea alone in 2020. Dietary factors, alcohol consumption, Helicobacter pylori (H. pylori), and lifestyle factors increase the incidence of diseases such as gastritis, peptic ulcer, pancreatitis, and gastroesophageal reflux disease (GERD), which can develop into GI cancer. However, in 2019, the US Food and Drug Administration announced that the drugs ranitidine and nizatidine, which are used for digestive disorders, contain carcinogens. In this study, we investigated the effects of ranitidine and nizatidine on the development of GI cancer. Materials and methods: In this study, using National Health Insurance Service-National Sample Cohort (NHIS-NSC) version 2.5 (updated from 2002 to 2019), subjects who developed GI cancer were enrolled in the case group, and those who were at risk of, but did not develop, cancer were enrolled in the control group. Thereafter, risk-set matching was performed (1:3 ratio) by sex and age at the time of diagnosis of cancer in the case group. Through this procedure, 22,931 cases and 68,793 controls were identified. The associations of ranitidine and/or nizatidine with GI cancer were confirmed by adjusted odds ratios (aORs) and 95% confidence intervals (CIs) calculated through conditional logistic regression analysis. Results: The aORs of ranitidine and/or nizatidine users were lower than those of nonusers in all average prescription days groups (< 30 days/year: aOR [95% CI] = 0.79 [0.75-0.82]; 30-59 days/year: aOR [95% CI] = 0.66 [0.59-0.73]; 60-89 days/year: aOR [95% CI] = 0.69 [0.59-0.81]; ≥ 90 days/year: aOR [95% CI] = 0.69 [0.59-0.79]). Sensitivity analyses were conducted with different lag periods for the onset of GI cancer after drug administration, and these analyses yielded consistent results. Additional analyses were also performed by dividing subjects into groups based on cancer types and CCI scores, and these analyses produced the same results. Conclusion: Our study, using nationwide retrospective cohort data, did not find evidence suggesting that ranitidine and nizatidine increase the risk of GI cancer. In fact, we observed that the incidence of GI cancer was lower in individuals who used the drugs compared to nonusers. These findings suggest a potential beneficial effect of these drugs on cancer risk, likely attributed to their ability to improve digestive function.

Pioglitazone Use and Reduced Risk of Dementia in Patients With Diabetes Mellitus With a History of Ischemic Stroke.

BACKGROUND AND OBJECTIVES: Previous studies have reported the protective effect of pioglitazone on dementia in patients with type 2 diabetes mellitus (DM). Recent studies have shown that pioglitazone also lowers the risk of primary and recurrent stroke. Understanding the characteristics of patients particularly associated with the benefits of pioglitazone would facilitate its personalized use by specifying subpopulations during routine clinical care. The aim of this study was to examine the effects of pioglitazone use on dementia in consideration of stroke occurrence. METHODS: Using nationwide longitudinal data of patients with DM from the Korean National Health Insurance Service DM cohort (2002-2017), we investigated the association of pioglitazone use with incident dementia in patients with new-onset type 2 DM. The heterogeneity of the treatment effect was examined using exploratory analyses. Using a multistate model, we assessed the extent to which incident stroke affects the association between pioglitazone use and dementia. RESULTS: Pioglitazone use was associated with a reduced risk of dementia, compared with nonuse (adjusted hazard ratio [aHR] = 0.84, 95% CI 0.75-0.95); the risk reduction in dementia was greater among patients with a history of ischemic heart disease or stroke before DM onset (aHR = 0.46, 95% CI 0.24-0.90; aHR = 0.57, 95% CI 0.38-0.86, respectively). The incidence of stroke was also reduced by pioglitazone use (aHR = 0.81, 95% CI 0.66-1.00). However, when the stroke developed during the observation period of pioglitazone use, such lowered risk of dementia was not observed (aHR = 1.27, 95% CI 0.80-2.04). DISCUSSION: Pioglitazone use is associated with a lower risk of dementia in patients with DM, particularly in those with a history of stroke or ischemic heart disease, suggesting the possibility of applying a personalized approach when choosing pioglitazone to suppress dementia in patients with DM.