Disability-Related Mortality Inequity in South Korea: Comparison in Terms of Seoul Metropolitan/Non-Metropolitan Areas and Income Levels.

Despite the improved living standards in South Korea, people with disabilities still experience health disparities. Therefore, we analyzed differences in mortality rates among people with disabilities according to income level and residential area using representative data from the National Health Insurance Service in South Korea. Descriptive statistics and Cox proportional risk models were used to identify the risk factors for mortality affecting people with disabilities stratified by income level and residential area. Those living in non-metropolitan areas and low-income households had high mortality risks, suggesting that income level and residential area were related to mortality risk. The mortality risk of those with a high-income level was 1.534 times higher in non-metropolitan areas than in Seoul metropolitan areas (95% confidence interval [CI] = 1.44-1.63). Among people with low income living in non-metropolitan areas, the crude hazard ratios of mortality risk were 1.26 (95% CI = 1.14-1.39), 1.44 (95% CI = 1.34-1.54), and 1.39 (95% CI = 1.20-1.61) for those with brain lesions, sensory impairment (visual/hearing/speech impairment), and kidney failure, respectively. No significant differences were observed between people with autism in non-metropolitan and Seoul metropolitan areas and those with low- and high-income levels. Health issues and countermeasures are crucial to reduce mortality risk among people with disabilities.

Effects of gastroesophageal reflux disease treatment with proton pump inhibitors on the risk of acute exacerbation and pneumonia in patients with COPD.

BACKGROUND: Gastroesophageal reflux disease (GERD) has been suggested as a risk factor for acute exacerbation of chronic obstructive pulmonary disease (COPD). However, it remains undetermined whether proton pump inhibitor (PPI) treatment reduces the risk of exacerbation or affects the risk of pneumonia. This study aimed to evaluate the risks of both exacerbation and pneumonia following PPI treatment for GERD in patients with COPD. METHODS: This study used a reimbursement database of the Republic of Korea. Patients aged ≥ 40 years with COPD as a main diagnosis and who received PPI treatment for GERD at least for 14 consecutive days between January 2013 and December 2018 were included in the study. A self-controlled case series analysis was conducted to calculate the risk of moderate and severe exacerbation and pneumonia. RESULTS: A total of 104,439 patients with prevalent COPD received PPI treatment for GERD. The risk of moderate exacerbation was significantly lower during the PPI treatment than at baseline. The risk of severe exacerbation increased during the PPI treatment but significantly decreased in the post-treatment period. Pneumonia risk was not significantly increased during the PPI treatment. The results were similar in patients with incident COPD. CONCLUSIONS: The risk of exacerbation was significantly reduced after PPI treatment compared with the non-treated period. Severe exacerbation may increase due to uncontrolled GERD but subsequently decrease following PPI treatment. There was no evidence of an increased risk of pneumonia.

Assessing Mental Illness Risk Among North Korean Refugees and Immigrants Resettled in South Korea.

Importance: The global increase in the numbers of refugees and immigrants has made mental health a major public concern. Although they are divided, North and South Korea share a common ethnic heritage. Objective: To investigate mental illness risk among North Korean immigrants living in South Korea and compare it with that of the general South Korean population. Design, Setting, and Participants: This retrospective, population-based cohort study was based on National Health Insurance claims data from 2007 to 2019, and North Korean immigrants and refugees (NKIRs) and age-matched and sex-matched members of the general population (GP) were included with a 1:3 ratio. Data were analyzed from March 2022 to August 2022. Exposure: Emigration from North Korea to South Korea. Main Outcomes and Measures: Mental illness incidence and risk through a Cox proportional risk model adjusted for sex, age, disability, region, Charlson Comorbidity Index score, and insurance premium percentile. Results: A total of 37 209 NKIRs and 111 627 members of the GP were enrolled. The final analysis examined 112 851 individuals (73 238 [64.9%] female, median [IQR] age 34 [19-47] years), with 90 235 (80.0%) in the GP and 22 616 (20.0%) in the NKIR group. The propensity score-matching population numbered 24 532 in total, with 12 266 each in the NKIR and GP groups. NKIR patients had a higher mental illness risk than the GP (hazard ratio [HR], 2.12; 95% CI, 2.04-2.21). The multivariable adjusted HRs (95% CI) for developing mental disorders were 4.91 (3.59-6.71) for posttraumatic stress disorder, 3.10 (2.90-3.30) for major depressive disorder, 2.27 (2.11-2.44) for anxiety and panic disorder, 2.03 (1.58-2.60) for bipolar affective disorder, 1.85 (1.53-2.24) for alcohol use disorder, and 1.89 (1.46-2.45) for schizophrenia. Conclusions and Relevance: In this study, NKIR individuals showed a significantly higher risk of developing most mental disorders. Interventional strategies can prevent psychiatric morbidity and ensure adequate care for this population.

Association between height loss and cardiovascular disease in the Korean elderly.

Shorter people are at risk for cardiovascular disease (CVD), but data remain limited. This study sought to determine whether height loss is associated with an increased incidence of CVD. From the Korean National Health Insurance Service-Senior database (2002-2015), data of 134,952 individuals with available information on height loss was obtained. Height loss as percentages was measured 3-5 years from the baseline height. To assess hazard ratios for CVD incidence, multivariable Cox proportional hazard regression models were used before and after applying propensity score matching. The unmatched cohort consisted of 109,546 participants without height loss (< 1%): 20,208 participants with 1-2% height loss, and 5126 participants with ≥ 2% height loss. During a median follow-up period of 6.5 years (interquartile range, 3.7-8.5 years), 21,921 were newly diagnosed with CVD. Adults with height loss of > 2% had a greater risk of incident CVD than those with no height loss. This finding was statistically significant both in the original- and propensity score-matched cohorts. The increased risk for ischemic stroke was significant in the male subgroups, in line with degree of height loss. Overall, height loss is associated with an increased risk of subsequent ischemic stroke in Korean men.

Measuring Trends in the Socioeconomic Burden of Disease in Korea, 2007-2015.

This study estimated the direct and indirect socioeconomic costs of 238 diseases and 22 injuries from a social perspective in Korea from 2007 to 2015. The socioeconomic cost of each disease group was calculated based on the Korean Standard Disease Classification System. Direct costs were estimated using health insurance claims data provided by the National Health Insurance Service. The numbers of outpatients and inpatients with the main diagnostic codes for each disease were selected as a proxy indicator for estimating patients' medical use behavior by disease. The economic burden of disease from 2007 to 2015 showed an approximately 20% increase in total costs. From 2007 to 2015, communicable diseases (including infectious, maternal, pediatric, and nutritional diseases) accounted for 8.9-12.2% of the socioeconomic burden, while non-infectious diseases accounted for 65.7-70.7% and injuries accounted for 19.1-22.8%. The top 5 diseases in terms of the socioeconomic burden were self-harm (which took the top spot for 8 years), followed by cirrhosis of the liver, liver cancer, ischemic heart disease, and upper respiratory infections in 2007. Since 2010, the economic burden of conditions such as low back pain, falls, and acute bronchitis has been included in this ranking. This study expanded the scope of calculating the burden of disease at the national level by calculating the burden of disease in Koreans by gender and disease. These findings can be used as indicators of health equality and as useful data for establishing community-centered (or customized) health promotion policies, projects, and national health policy goals.

Overweight and Obesity are Risk Factors for Coronavirus Disease 2019: A Propensity Score-Matched Case-Control Study.

Although obesity is a risk factor for infection, whether it has the same effect on coronavirus disease 2019 (COVID-19) need confirming. We conducted a retrospective propensity score matched case-control study to examine the association between obesity and COVID-19. This study included data from the Nationwide COVID-19 Registry and the Biennial Health Checkup database, until May 30, 2020. We identified 2,231 patients with confirmed COVID-19 and 10-fold-matched negative test controls. Overweight (body mass index [BMI] 23 to 24.9 kg/m2; adjusted odds ratio [aOR], 1.16; 95% confidence interval [CI], 1.1.03 to 1.30) and class 1 obesity (BMI 25 to 29.9 kg/m2; aOR, 1.27; 95% CI, 1.14 to 1.42) had significantly increased COVID-19 risk, while classes 2 and 3 obesity (BMI ≥30 kg/m2) showed similar but non-significant trend. Females and those <50 years had more robust association pattern. Overweight and obesity are possible risk factors of COVID-19.

Association of prescribed medications with the risk of COVID-19 infection and severity among adults in South Korea.

OBJECTIVES: Concerns have been expressed that some drugs may increase susceptibility to SARS-CoV-2 infection. In contrast, other drugs have generated interest as potential therapeutic agents. METHODS: All adults aged ≥18 years who were tested for COVID-19 were included. Exposure was defined as a prescription of study drugs which would have been continued until 7 days prior to test for COVID-19 or later. The outcome measures were the diagnosis of COVID-19 and severe COVID-19. Disease risk score matching and multiple logistic regression was used. RESULTS: Matched claims and testing results were available for 219,961 subjects, of whom 7,341 (3.34%) were diagnosed with COVID-19. Patients were matched to 36,705 controls, and the subset of 878 patients of severe COVID-19 also matched with 1,927 mild-to-moderate patients. Angiotensin receptor blockers were not associated with either the diagnosis of COVID-19 (adjusted OR [aOR], 1.02; 95% confidence interval [CI], 0.90-1.15) or severe disease (aOR, 1.11; 95% CI, 0.87-1.42). The use of hydroxychloroquine was not associated with a lower risk for COVID-19 (aOR, 0.94; 95% CI, 0.53-1.66) or severe disease (aOR, 3.51; 95% CI, 0.76-16.22). CONCLUSIONS: In this national claims data-based case-control study, no commonly prescribed medications were associated with risk of COVID-19 infection or COVID-19 severity.

Impact of obesity, fasting plasma glucose level, blood pressure, and renal function on the severity of COVID-19: A matter of sexual dimorphism?

AIMS: This study aimed to assess whether body mass index (BMI), fasting plasma glucose (FPG) levels, blood pressure (BP), and kidney function were associated with the risk of severe disease or death in patients with COVID-19. METHODS: Data on candidate risk factors were extracted from patients' last checkup records. Propensity score-matched cohorts were constructed, and logistic regression models were used to adjust for age, sex, and comorbidities. The primary outcome was death or severe COVID-19, defined as requiring supplementary oxygen or higher ventilatory support. RESULTS: Among 7,649 patients with confirmed COVID-19, 2,231 (29.2%) received checkups and severe COVID-19 occurred in 307 patients (13.8%). A BMI of 25.0-29.9 was associated with the outcome among women (aOR, 2.29; 95% CI, 1.41-3.73) and patients aged 50-69 years (aOR, 1.64; 95% CI, 1.06-2.54). An FPG ≥ 126 mg/dL was associated with poor outcomes in women (aOR, 2.06; 95% CI, 1.13-3.77) but not in men. Similarly, estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 was a risk factor in women (aOR, 3.46; 95% CI, 1.71-7.01) and patients aged < 70 years. CONCLUSIONS: The effects of BMI, FPG, and eGFR on outcomes associated with COVID-19 were prominent in women but not in men.

Effect of Underlying Comorbidities on the Infection and Severity of COVID-19 in Korea: a Nationwide Case-Control Study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is an emerging threat worldwide. It remains unclear how comorbidities affect the risk of infection and severity of COVID-19. METHODS: This is a nationwide retrospective case-control study of 219,961 individuals, aged 18 years or older, whose medical costs for COVID-19 testing were claimed until May 15, 2020. COVID-19 diagnosis and infection severity were identified from reimbursement data using diagnosis codes and on the basis of respiratory support use, respectively. Odds ratios (ORs) were estimated using multiple logistic regression, after adjusting for age, sex, region, healthcare utilization, and insurance status. RESULTS: The COVID-19 group (7,341 of 219,961) was young and had a high proportion of female. Overall, 13.0% (954 of 7,341) of the cases were severe. The severe COVID-19 group had older patients and a proportion of male ratio than did the non-severe group. Diabetes (odds ratio range [ORR], 1.206-1.254), osteoporosis (ORR, 1.128-1.157), rheumatoid arthritis (ORR, 1.207-1.244), substance use (ORR, 1.321-1.381), and schizophrenia (ORR, 1.614-1.721) showed significant association with COVID-19. In terms of severity, diabetes (OR, 1.247; 95% confidential interval, 1.009-1.543), hypertension (ORR, 1.245-1.317), chronic lower respiratory disease (ORR, 1.216-1.233), chronic renal failure, and end-stage renal disease (ORR, 2.052-2.178) were associated with severe COVID-19. CONCLUSION: We identified several comorbidities associated with COVID-19. Health care workers should be more careful while diagnosing and treating COVID-19 when patients have the abovementioned comorbidities.