The Effect of Additional Private Health Insurance on Mortality in the Context of Universal Public Health Insurance.

(1) Background: Korea operates its national health insurance (NHI) system as a form of public health insurance, and is commonly regarded as having achieved universal health coverage (UHC). However, many Korean households register for additional private health insurance (PHI) programs. Typically, registration rates for PHI are higher for individuals with a higher socioeconomic status (SES). A difference in mortality between those with and without additional PHI would indicate that there are health inequalities within the Korean NHI system under UHC. Therefore, this study aimed to confirm whether additional PHI affects mortality under the Korean NHI system. (2) Methods: We conducted a longitudinal study using the Korean Longitudinal Study of Aging data from the first to the sixth wave. The analysis included 8743 participants, who were divided into two groups: those who only had NHI and those who had both NHI and PHI. Differences in mortality between the two groups were compared using the Cox proportional hazard regression. (3) Results: The group with both NHI and PHI had lower mortality than the group with only NHI (hazard ratio = 0.53, 95% confidence interval: 0.41, 0.9). (4) Conclusions: The results of this study reveal that there are health disparities according to SES and PHI within the Korean NHI system under UHC. Therefore, relevant government institutions and experts should further improve the NHI system to reduce health disparities.

Association between rotating night shift work and metabolic syndrome in Korean workers: differences between 8-hour and 12-hour rotating shift work.

This study aimed to analyze the association between the shift work schedule and metabolic syndrome (MetS). This is a retrospective longitudinal study based on the 2015 health checkup data of 2,090 workers evaluated for MetS in 2010 at a general hospital in Korea. The participants were divided according to their shift work schedule into daytime, three-shift (8-h rotation), and two-shift (12-h rotation) workers. The index that indicates the association between the shift work schedule and MetS is the odds ratio (OR) calculated using multivariate logistic regression. The analysis for the entire group of workers indicated that there was positive association between two-shift rotation and MetS (OR=1.58, 95% confidence interval [CI]: 1.09, 2.29). In the analysis of rotating night-shift workers, the years of rotating night shifts, frequency of night-shift work, and sleep disturbance were added to the confounding variables, and two-shift work remained positively associated with MetS (OR=1.72, 95% CI: 1.10, 2.70). The risk of MetS differs based on the shift work schedules they engage in. Hence, structural changes to the shift work schedules are required to prevent MetS in night-shift workers.

Prognostic impact of concordant and discordant cytomorphology of bone marrow involvement in patients with diffuse, large, B-cell lymphoma treated with R-CHOP.

BACKGROUND: Bone marrow involvement confers a poor prognosis in patients with diffuse, large, B-cell lymphoma (DLBCL). However, the prognostic significance of concordant and discordant bone marrow involvement in these cases differs. We analysed this further in patients treated with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone) at a single institute. DESIGN AND METHODS: The cytomorphology of bone marrow involvement was evaluated in 632 patients who were diagnosed with DLBCL in primary tissues and had received R-CHOP therapy. Bone marrow trephine biopsies and clot sections were analysed, along with the immunohistochemical analysis of CD20, CD79a and CD3. RESULTS: Bone marrow involvement was identified in 80 of our DLBCL patient subjects (12.7%). Of these, 32 (40%) showed discordant bone marrow involvement, and 48 (60%) showed concordant involvement. Kaplan-Meier survival analysis showed that progression-free survival and overall survival was poorer in the concordant group (p<0.001). Multivariate analysis, adjusted for the International Prognostic Index score, showed that concordant involvement was an independent predictor of progression-free survival (p<0.001) and overall survival (p=0.011). Discordant involvement was not a negative prognostic factor independent of the International Prognostic Index. CONCLUSIONS: Prognostication based on bone marrow involvement cytomorphology is a useful indicator of progression-free survival and overall survival, independent of the International Prognostic Index score, in DLBCL patients. Accurate staging based on morphology should thus be included in bone marrow examinations of such cases.