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1.
Transl Lung Cancer Res ; 13(1): 46-59, 2024 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-38404998

RESUMO

Background: Although various studies have demonstrated that the clinical efficacy of immune checkpoint inhibitors (ICIs) improves the prognosis of patients with non-small cell lung cancer (NSCLC), studies on the financial aspects based on large population-based data are needed. This study aimed to analyze the differences in medical expenses and the effect of ICIs on the prognosis of patients with advanced or metastatic NSCLC. Methods: Patients newly diagnosed with stage IIIB or IV NSCLC who received palliative chemotherapy between 2013 and 2020 were selected from the nationwide database of the population covered by the Korean National Health Insurance Service. Interrupted time-series analysis was performed to evaluate the effects of subsequent ICI use after platinum-based cytotoxic chemotherapy (CC) on overall mortality. Progression-free survival and medical expenditure were also assessed. Results: In the final study population, 2,485 and 4,812 patients were included in the ICI and non-ICI groups, respectively. ICI treatment significantly lowered the risk of death [adjusted hazard ratio, 0.79; 95% confidence interval (CI): 0.75-0.84]. And the ICI-treated patients were less likely to experience disease progression (adjusted odds ratios, 0.92; 95% CI: 0.85-0.99). Furthermore, after the introduction of ICIs, both total and cancer-related medical expenses per capita showed an increasing trend [ß: $4.56K, standard error (SE): $0.27K, P<0.0001 and ß: $4.54K, SE: $0.27K, P<0.0001, respectively]. Conclusions: Subsequent ICI use after platinum-based CC improved the overall survival rate of patients with advanced NSCLC. With the increasing burden of individual medical expenses, further research is required to identify patients for whom ICI treatment may be effective.

2.
J Gastroenterol Hepatol ; 39(1): 74-80, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37855299

RESUMO

BACKGROUND AND AIM: Colorectal cancer (CRC) was the fourth most common cancer in Republic of Korea in 2019. It has a gradually increasing mortality rate, indicating the importance of screening for CRC. Among the various CRC screening test, fecal immunochemical test (FIT) is a simple yet most commonly used. Neverthelss, there have been only few long-term studies on subjects with FIT-positive. Therefore, in this study, we aimed to investigate the risk factors for CRC in FIT-positive patients using the National Health Insurance Service Bigdata database. METHODS: Among 1 737 633 individuals with a FIT screening result for CRC in 2009, 101 143 (5.82%) were confirmed to be FIT positive. The CRC incidence over 10 years (up to 2018) of these participants was investigated using the National Cancer Registry. RESULTS: Out of the 101 143 FIT-positive participants, 4395 (4.35%) were diagnosed with CRC. The FIT-positive patients who underwent a second round of screening showed a 5-year cumulative CRC incidence of approximately 1.25%, whereas those who did not showed an incidence of approximately 3.75%. Among the FIT-positive patients, the CRC incidence in the non-compliance group for the second round of screening was 2.8 times higher than that in the compliance group. CONCLUSIONS: In FIT-positive participants, non-compliance with the second round of screening was identified as a major risk factor for CRC development. It is necessary to establish appropriate strategies for managing risk factors for CRC in FIT-positive patients to increase the rate of compliance with the second round of CRC screening.


Assuntos
Neoplasias Colorretais , Detecção Precoce de Câncer , Humanos , Colonoscopia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Fatores de Risco , Programas Nacionais de Saúde , Programas de Rastreamento , Fezes , Sangue Oculto
3.
BMC Geriatr ; 23(1): 840, 2023 12 12.
Artigo em Inglês | MEDLINE | ID: mdl-38087197

RESUMO

BACKGROUND: This study aimed to identify and select age-related diseases (ARDs) in Korea, which is about to have a super-aged society, and to elucidate patterns in their incidence rates. METHODS: The National Health Insurance Service-National Sample Cohort, comprising 1 million health insurance and medical benefit beneficiaries in Korea from 2002 to 2019, was utilized. We selected 14 diseases with high disease burden and prevalence among Koreans from the 92 diseases defined in the Global Burden of Diseases, Injuries, and Risk Factors Study as ARDs. The annual incidence rate represented the number of patients newly diagnosed with an ARD each year from 2006 to 2019, excluding those with a history of ARD diagnosis from 2002 to 2005. The incidence rate by age was categorized into 10-year units based on age as of 2019. The number of patients with ARDs in each age group was used as the numerator, and the incidence rate for each age group was calculated with the age group as the denominator. RESULTS: Regarding the annual incidence rates of ARDs from 2006 to 2019, chronic obstructive pulmonary disease, congestive heart failure, and ischemic heart disease decreased annually, whereas dyslipidemia, chronic kidney disease, cataracts, hearing loss, and Parkinson's disease showed a significant increase. Hypertension, diabetes, cerebrovascular disease, osteoporosis, osteoarthritis, and age-related macular degeneration initially displayed a gradual decrease in incidence but exhibited a tendency to increase after 2015. Concerning age-specific incidence rates of ARDs, two types of curves emerged. The first type, characterized by an exponential increase with age, was exemplified by congestive heart failure. The second type, marked by an exponential increase peaking between ages 60 and 80, followed by stability or decrease, was observed in 13 ARDs, excluding congestive heart failure. However, hypertension, ischemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, and hearing loss in men belonged to the first type. CONCLUSIONS: From an epidemiological perspective, there are similar characteristics in age-specific ARDs that increase with age, reaching a peak followed by a plateau or decrease in Koreans.


Assuntos
Transtornos Cerebrovasculares , Perda Auditiva , Insuficiência Cardíaca , Hipertensão , Isquemia Miocárdica , Doença Pulmonar Obstrutiva Crônica , Síndrome do Desconforto Respiratório , Masculino , Humanos , Idoso , Incidência , Envelhecimento , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/epidemiologia , Programas Nacionais de Saúde , República da Coreia/epidemiologia
4.
Lung Cancer ; 186: 107412, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37856923

RESUMO

BACKGROUND: South Korea introduced the National Lung Cancer Screening Program (NLCSP) in 2019. This study investigated the effect of the NLCSP on one-year mortality in individuals with a history of lung cancer. METHODS: This study used the 2018-2020 National Health Insurance Service claims data. The difference-in-differences approach was used to investigate the effect of participating in the NLCSP between the case and control groups before and after the intervention period. The case group included individuals aged between 54 and 74 years with a smoking history of ≥ 30 pack-years and the control group those aged between 54 and 74 years with a history of smoking of <30 pack-years and non-smokers. The pre-intervention period was from January 2018 to June 2019 and the post-intervention period from July 2019 to December 2020. RESULTS: The introduction of the NLCSP was related to an overall decrease in one-year mortality (-3.21 % points, 95 % Confidence Interval (CI) -4.84 to -1.58). Specifically, this reduction was significant for lung cancer related mortality (lung cancer: -2.69 % points, 95 % CI -4.24 to -1.13). Furthermore, stronger associations were found in individuals of older age, residing in non-metropolitan areas, and who visited healthcare institutions in non-metropolitan areas. CONCLUSION: The findings confirm a relationship between implementation of the NLCSP and one-year mortality in eligible individuals with a history of lung cancer, which is noteworthy considering that Korea is one of the first countries to include lung cancer into the national cancer screening program.


Assuntos
Neoplasias Pulmonares , Humanos , Pessoa de Meia-Idade , Idoso , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiologia , Detecção Precoce de Câncer , Pulmão , Fumar , República da Coreia/epidemiologia , Programas de Rastreamento
5.
Int J Qual Health Care ; 35(2)2023 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-37098223

RESUMO

The National Cancer Screening Program of South Korea for cervical cancer was expanded from women aged ≥30 years to women aged ≥20 years in 2016. This study investigated the effect of this policy on occurrence rates of cervical dysplasia, carcinoma in situ, and cervical cancer in women in their twenties. The National Health Information Database for the years 2012-19 was used. The outcome measures were monthly occurrence rates of cervical dysplasia, cervical carcinoma in situ, and cervical cancer. An interrupted time series analysis was performed to investigate whether the number of occurrences changed after policy implementation. For cervical dysplasia, a pre-intervention decreasing trend of 0.3243 per month (P-value < .0001) was found. The post-intervention trend did not differ significantly, although the slope increased at a rate of 0.4622 per month (P-value < .0001). For carcinoma in situ, a trend of increase at 0.0128 per month (P-value = .0099) was seen before policy implementation. The post-intervention trend did not escalate, but the slope showed an increasing trend of 0.0217 per month (P-value < .0001). For cervical cancer, no significant trend was present before intervention. Occurrences of cervical cancer escalated at a rate of 0.0406 per month (P-value < .0001) after policy implementation, and the slope also showed an increasing trend at a rate of 0.0394 per month (P-value < .0001). Expanding the target population for cervical cancer screening increased detection rates for cervical cancer in women aged between 20 and 29 years.


Assuntos
Carcinoma in Situ , Displasia do Colo do Útero , Neoplasias do Colo do Útero , Feminino , Humanos , Adulto Jovem , Adulto , Neoplasias do Colo do Útero/diagnóstico , Detecção Precoce de Câncer , Displasia do Colo do Útero/diagnóstico , Displasia do Colo do Útero/epidemiologia , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/epidemiologia , Carcinoma in Situ/patologia , República da Coreia/epidemiologia , Programas de Rastreamento
6.
Gynecol Oncol ; 170: 19-24, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36608383

RESUMO

BACKGROUND: To evaluate the cost-effectiveness of the addition of hyperthermic intraperitoneal chemotherapy (HIPEC) following interval cytoreductive surgery (ICS) for stage III-IV ovarian cancer from a randomized controlled phase III trial. METHODS: A comparative cost-effective analysis was performed using a Markov health-state transition model derived from the current trial cohort (ClinicalTrials.gov Identifier: NCT01091636). The incremental cost-effectiveness ratio (ICER) was evaluated by dividing the incremental costs by incremental quality-adjusted life-years (QALYs) with a time horizon of 10 years. Costs were calculated from the perspective of Korean healthcare, and health utility values were extracted from published sources. RESULTS: Based on data from the trial, the mean QALY in the ICS group was 7.16 compared to 10.8 in ICS followed by the HIPEC group. With an incremental QALY of 3.64, the ICS followed by HIPEC, was estimated to obtain an ICER of KRW 954,598 (USD 708.3) per QALY. CONCLUSION: The findings of the study suggest that ICS followed by HIPEC, is cost-effective with a significant gain in QALYs. These results may support the current reimbursement of HIPEC from Korean insurance services and the management of long-term conditions.


Assuntos
Quimioterapia Intraperitoneal Hipertérmica , Neoplasias Ovarianas , Humanos , Feminino , Análise Custo-Benefício , Procedimentos Cirúrgicos de Citorredução/métodos , Neoplasias Ovarianas/tratamento farmacológico , Carcinoma Epitelial do Ovário/tratamento farmacológico , República da Coreia
7.
J Korean Med Sci ; 37(32): e248, 2022 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-35971762

RESUMO

BACKGROUND: Previous studies have reported an association between pneumonia risk and the use of certain drugs. We investigated the relationship between antihypertensive drugs and pneumonia in the general population. METHODS: This case-crossover study utilized the nationwide data of South Korea. We included participants who were hospitalized for pneumonia. A single case period was defined as 30 days before pneumonia onset, and two control periods were established (90-120 and 150-180 days before pneumonia onset). Further, we performed sensitivity and subgroup analyses (according to the presence of diabetes, documented disability, and whether participants were aged ≥ 70 years). We used conditional logistic regression models adjusted for covariates, such as angiotensin-converting-enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), other antihypertensives, statins, antipsychotics, benzodiazepine, and the number of outpatient visits. RESULTS: In total, 15,463 subjects were included in this study. ACE inhibitors (adjusted odds ratio [aOR], 0.660; 95% confidence interval [CI], 0.558-0.781), ARBs (aOR, 0.702; 95% CI, 0.640-0.770), and other antihypertensive drugs (aOR, 0.737; 95% CI, 0.665-0.816) were significantly associated with reduced pneumonia risk. Subgroup analyses according to the presence of diabetes mellitus, documented disability, and whether participants were aged ≥ 70 years consistently showed the association of antihypertensives with a reduced risk of hospitalization for pneumonia. CONCLUSION: All antihypertensive drug types were related to a lower risk of hospitalization for pneumonia in the general population. Our results implied that frequent medical service usage and protective immunity were primarily related to a reduced risk of pneumonia in the general population of South Korea.


Assuntos
Anti-Hipertensivos , Hospitalização , Hipertensão , Pneumonia , Antagonistas de Receptores de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Anti-Hipertensivos/uso terapêutico , Estudos Cross-Over , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Programas Nacionais de Saúde , Pneumonia/tratamento farmacológico , Pneumonia/epidemiologia , República da Coreia/epidemiologia
8.
J Korean Med Sci ; 37(19): e153, 2022 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-35578585

RESUMO

BACKGROUND: F-18 Fluorodeoxyglucose positron emission tomography (F-18 FDG PET), which can cover the body from the skull base to the thigh in one scan, is beneficial for evaluating distant metastasis. F-18 FDG PET has interested policymakers because of its relatively high cost. This study investigated the effect of the F-18 FDG PET reimbursement criteria amendment on healthcare behavior in breast cancer using an interrupted time series (ITS) analysis. METHODS: We retrospectively analyzed the inpatient and outpatient data from Korea's Health Insurance Review and Assessment Service (HIRA) from January 1, 2013 to December 31, 2018. ITS analysis was performed for the number of each medical imaging modality and the total medical imaging cost of the breast cancer patients. RESULTS: The annual number of breast cancer patients has been increasing steadily since 2013. The trend of F-18 FDG PET increased before the reimbursement criteria was amended, but intensely decreased immediately thereafter. The chest and abdomen computed tomography scans showed a statistically significant increase immediately after the amendment and kept steadily increasing. A change in the total medical imaging cost for the breast cancer patient claimed every month showed an increasing trend before the amendment (ß = 5,475, standard error [SE] = 1,992, P = 0.008) and rapid change immediately after (ß = -103,317, SE = 16,152, P < 0.001). However, there was no significant change in the total medical imaging cost at the long-term follow-up (ß = -912, SE = 1,981, P = 0.647). CONCLUSION: Restriction of health insurance coverage for cancer may affect healthcare behaviors. To compensate for it, the policymakers must consider this and anticipate the impact following implementation.


Assuntos
Neoplasias da Mama , Fluordesoxiglucose F18 , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Atenção à Saúde , Feminino , Humanos , Cobertura do Seguro , Análise de Séries Temporais Interrompida , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , República da Coreia , Estudos Retrospectivos
9.
Medicine (Baltimore) ; 99(25): e20723, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569209

RESUMO

This study aimed to analyze the trends of opioid use disorders, cannabis use disorders, and palliative care among hospitalized patients with gastrointestinal cancer and to identify their associated factors.We analyzed the National Inpatient Sample data from 2005 to 2014 and included hospitalized patients with gastrointestinal cancers. The trends of hospital palliative care and opioid or cannabis use disorders were analyzed using the compound annual growth rates (CAGR) with Rao-Scott correction for χ tests. Multivariate logistic regression analyses were performed to identify the associated factors.From 2005 to 2014, among 4,364,416 hospitalizations of patients with gastrointestinal cancer, the average annual rates of opioid and cannabis use disorders were 0.4% (n = 19,520), and 0.3% (n = 13,009), respectively. The utilization rate of hospital palliative care was 6.2% (n = 268,742). They all sharply increased for 10 years (CAGR = 9.61%, 22.2%, and 21.51%, respectively). The patients with a cannabis use disorder were over 4 times more likely to have an opioid use disorder (Odds ratios, OR = 4.029; P < .001). Hospital palliative care was associated with higher opioid use disorder rates, higher in-hospital mortality, shorter length of hospital stay, and lower hospital charges. (OR = 1.527, 9.980, B = -0.054 and -0.386; each of P < .001)The temporal trends of opioid use disorders and hospital palliative care use among patients with gastrointestinal cancer increased from 2005 to 2014, which is mostly attributed to patients with a higher risk of in-hospital mortality. Cannabis use disorders were associated with opioid use disorders. Palliative care was associated with both reduced lengths of stay and hospital charge.


Assuntos
Neoplasias Gastrointestinais/epidemiologia , Hospitalização/tendências , Abuso de Maconha/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Cuidados Paliativos/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Preços Hospitalares/tendências , Humanos , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia
10.
Diabetes Metab J ; 44(6): 897-907, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33389959

RESUMO

BACKGROUND: This study aimed to determine the infection risk of coronavirus disease 2019 (COVID-19) in patients with diabetes (according to treatment method). METHODS: Claimed subjects to the Korean National Health Insurance claims database diagnosed with COVID-19 were included. Ten thousand sixty-nine patients with COVID-19 between January 28 and April 5, 2020, were included. Stratified random sampling of 1:5 was used to select the control group of COVID-19 patients. In total 50,587 subjects were selected as the control group. After deleting the missing values, 60,656 subjects were included. RESULTS: Adjusted odds ratio (OR) indicated that diabetic insulin users had a higher risk of COVID-19 than subjects without diabetes (OR, 1.25; 95% confidence interval [CI], 1.03 to 1.53; P=0.0278). In the subgroup analysis, infection risk was higher among diabetes male insulin users (OR, 1.42; 95% CI, 1.07 to 1.89), those between 40 and 59 years (OR, 1.66; 95% CI, 1.13 to 2.44). The infection risk was higher in diabetic insulin users with 2 to 4 years of morbidity (OR, 1.744; 95% CI, 1.003 to 3.044). CONCLUSION: Some diabetic patients with certain conditions would be associated with a higher risk of acquiring COVID-19, highlighting their need for special attention. Efforts are warranted to ensure that diabetic patients have minimal exposure to the virus. It is important to establish proactive care and screening tests for diabetic patients suspected with COVID-19 for timely disease diagnosis and management.


Assuntos
COVID-19/economia , COVID-19/epidemiologia , Diabetes Mellitus/economia , Diabetes Mellitus/epidemiologia , Vigilância da População , Classe Social , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/diagnóstico , Bases de Dados Factuais/tendências , Diabetes Mellitus/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/tendências , República da Coreia/epidemiologia , Fatores de Risco , Adulto Jovem
11.
Medicine (Baltimore) ; 98(47): e17739, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764772

RESUMO

To examine trends and contributing factors of opioid, heroin, and cannabis-associated emergency department (ED) visits in Nevada.The 2009 to 2017 Nevada State ED database (n = 7,950,554 ED visits) were used. Use of opioid, heroin, and cannabis, respectively, was identified by the International Classification of Diseases, 9th & 10th Revisions. Three multivariable models, one for each of the 3 dependent variables, were conducted. Independent variables included year, insurance status, race/ethnicity, use of other substance, and mental health conditions.The number of individuals with opioid, heroin, cannabis-associated ED visits increased 3%, 10%, and 23% annually from 2009 to 2015, particularly among 21 to 29 age group, females, and African Americans. Use of other substance (odds ratio [OR] = 3.91; 95% confidence interval [CI] = 3.84, 3.99; reference - no use of other substance), mental health conditions (OR = 2.48; 95% CI = 2.43, 2.53; reference - without mental health conditions), Medicaid (OR = 1.41; 95% CI = 1.38, 1.44; reference - non-Medicaid), Medicare (OR = 1.44; 95% CI = 1.39, 1.49; reference - non-Medicare) and uninsured patients (OR = 1.52; 95% CI = 1.49, 1.56; reference - insured) were predictors of all three substance-associated ED visits.With a steady increase in trends of opioid, heroin, and cannabis-associated ED visits in recent years, the main contributing factors include patient sociodemographic factors, mental health conditions, and use of other substances.


Assuntos
Emergências/epidemiologia , Dependência de Heroína/epidemiologia , Abuso de Maconha/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Adolescente , Adulto , Idoso , Criança , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nevada/epidemiologia , Fatores de Risco , Adulto Jovem
12.
Medicine (Baltimore) ; 98(28): e16169, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305399

RESUMO

We aim to examine temporal trends of orthopedic operations and opioid-related hospital stays among seniors in the nation and states of Oregon and Washington where marijuana legalization was accepted earlier than any others.As aging society advances in the United States (U.S.), orthopedic operations and opioid-related hospital stays among seniors increase in the nation.A serial cross-sectional cohort study using the healthcare cost and utilization project fast stats from 2006 through 2015 measured annual rate per 100,000 populations of orthopedic operations by age groups (45-64 vs 65 and older) as well as annual rate per 100,000 populations of opioid-related hospital stays among 65 and older in the nation, Oregon and Washington states from 2008 through 2017. Orthopedic operations (knee arthroplasty, total or partial hip replacement, spinal fusion or laminectomy) and opioid-related hospital stays were measured. The compound annual growth rate (CAGR) was used to quantify temporal trends of orthopedic operations by age groups as well as opioid-related hospital stays and was tested by Rao-Scott correction of χ for categorical variables.The CAGR (4.06%) of orthopedic operations among age 65 and older increased (P < .001) unlike the unchanged rate among age 45 to 64. The CAGRs of opioid-related hospital stays among age 65 and older were upward trends among seniors in general (6.79%) and in Oregon (10.32%) and Washington (15.48%) in particular (all P < .001).Orthopedic operations and opioid-related hospital stays among seniors increased over time in the U.S. Marijuana legalization might have played a role of gateway drug to opioid among seniors.


Assuntos
Analgésicos Opioides/uso terapêutico , Controle de Medicamentos e Entorpecentes , Artropatias/tratamento farmacológico , Idoso , Estudos Transversais , Custos de Cuidados de Saúde , Hospitalização/tendências , Humanos , Artropatias/economia , Artropatias/cirurgia , Uso da Maconha/legislação & jurisprudência , Pessoa de Meia-Idade , Oregon , Procedimentos Ortopédicos , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Retrospectivos , Washington
13.
Am J Hosp Palliat Care ; 36(12): 1105-1113, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31122031

RESUMO

BACKGROUND: Palliative care services and life-sustaining treatments are provided to dying patients with lung cancer in the United States. However, data on the utilization trends of palliative care services and life-sustaining treatments of dying patients with lung cancer are not available. METHODS: This study was a retrospective analysis of the National Inpatient Sample data (2005-2014) and included patients with lung cancer, aged ≥ 18 years, who died in the hospitals. Claims data of palliative care services and life-sustaining treatments that contained systemic procedures, local procedures, or surgeries were extracted. Compound annual growth rates (CAGRs) using Rao-Scott correction for χ2 tests were used to determine the statistical significance of temporal utilization trends of palliative care services and life-sustaining treatments and their hospital costs. Multilevel multivariate regressions were performed to identify factors associated with hospital costs. RESULTS: A total of 120 144 weighted patients with lung cancer died in the hospitals and 41.9% of them received palliative care services. The CAGRs of systemic procedures, local procedures, surgeries, palliative care services, and hospital cost were 3.42%, 3.48%, 6.08%, 18.5%, and 5.0% (all P < .001), respectively. Increased hospital cost was attributed to systemic procedures (50.6%), local procedures (74.4%), and surgeries (68.5%; all P < .001), respectively. Palliative care services were related to decreasing hospital costs by 28.6% (P < .001). CONCLUSION: The temporal trends of palliative care services indicate that their utilization has increased gradually. Palliative care services were associated with reduced hospital costs. However, life-sustaining treatments were associated with increased hospital costs.


Assuntos
Custos Hospitalares/estatística & dados numéricos , Neoplasias Pulmonares/terapia , Cuidados Paliativos/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Assistência Terminal/estatística & dados numéricos , Idoso , Feminino , Humanos , Tempo de Internação , Neoplasias Pulmonares/economia , Masculino , Cuidados Paliativos/economia , Estudos Retrospectivos , Assistência Terminal/economia , Estados Unidos/epidemiologia
14.
J Palliat Care ; 34(4): 232-240, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30767641

RESUMO

AIM: Pancreas cancer continues to carry a poor prognosis. Hospitalized patients with advanced chronic pancreatic illnesses increasingly receive palliative care due to its perceived clinical benefits. Meanwhile, a growing proportion of elderly patients are reportedly receiving life-sustaining procedures. Temporal trends in the utilization of life-sustaining procedures and palliative care consultation among dying patients with advanced chronic pancreatic illnesses in US hospitals were examined. METHODS AND MATERIALS: A serial, cross-sectional analysis was carried out using the National Inpatient Sample Database. Decedents 18 years and older with a principal diagnosis of pancreas cancer or other advanced chronic pancreatic illnesses from 2005 through 2014. The compound annual growth rates (CAGRs) and Cochrane-Armitage correction of χ2 statistic were used. The receipt of life-sustaining systemic procedures, intra-abdominal local procedures and surgeries, and palliative care consultation were examined. Multilevel multivariate logistic regressions were performed to examine the association of various procedures with the utilization of palliative care consultation. RESULTS: Among 77 394 183 hospitalizations, 29 515 patients were examined. The CAGRs of systemic procedures, intra-abdominal procedures, surgeries, and palliative care were -4.19% (P = .008), 2.17%, -1.40%, and 14.03% (P < .001), respectively. The receipt of systemic procedures (odds ratio [OR] = 2.40, 95% confidence interval [CI], 2.08-2.74), local intra-abdominal procedures (OR = 1.46, 95% CI, 1.27-1.70), and surgeries (OR = 2.51, 95% CI, 2.07-3.05) was associated with palliative care consultation (Ps < .001). CONCLUSIONS: Among adults with pancreatic cancer or other advanced chronic pancreatic illnesses in the US hospitals from 2005 to 2014, the utilization of life-sustaining systemic procedures decreased while the prevalence of palliative care consultation increased.


Assuntos
Hospitais/estatística & dados numéricos , Sistemas de Manutenção da Vida/estatística & dados numéricos , Cuidados Paliativos/estatística & dados numéricos , Pancreatopatias/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Doente Terminal/psicologia , Doente Terminal/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Previsões , Hospitais/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/tendências , Estados Unidos , Adulto Jovem
15.
Artigo em Inglês | MEDLINE | ID: mdl-30650629

RESUMO

Objectives: As the relationship between diabetes mellitus and thyroid dysfunction is well known, it is important to investigate the factors influencing this association. Continuity of care is associated with better quality of care and outcomes, such as reduced complications, among diabetes patients. Therefore, the purpose of this study was to investigate the association between continuity of care and the onset of thyroid dysfunction among diabetes patients. Methods: We used Korean National Health Insurance Service National Sample Cohort data from 2002 to 2013. Our final study population included 16,806 newly diagnosed diabetes patients who were older than 45 years of age. Continuity of care was measured using the Continuity of Care index. The dependent variable was the onset of thyroid disorder. Cox proportional hazard regression models were used for statistical analyses. Results: Diabetes patients with low continuity of care were at increased risk of the onset of thyroid disorder compared with those with high continuity of care (hazard ratio (HR): 1.28, 95% confidence interval (CI): 1.07⁻1.54). Subgroup analyses showed that this association was significant within patients with type 2 diabetes (HR: 1.24, 95% CI: 1.01⁻1.52) or whose main attending site was a local clinic (HR: 1.32, 95% CI: 1.07⁻1.64). Conclusions: Our results show that diabetes patients with low continuity of care are more likely to experience the onset of thyroid disorder. Therefore, improving continuity of care could be a reasonable method of preventing complications or comorbidities, including thyroid disorder, among diabetes patients.


Assuntos
Continuidade da Assistência ao Paciente , Diabetes Mellitus Tipo 2/epidemiologia , Doenças da Glândula Tireoide/epidemiologia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia
16.
Eur J Public Health ; 29(2): 225-231, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30260368

RESUMO

Avoidable hospitalizations can act as an indicator for primary health care quality, in particular ambulatory care sensitive conditions (ACSCs) as hospitalizations for these conditions are generally considered avoidable through successful management. This study aimed to examine whether differences exist between income levels in rates of avoidable hospitalization.The South Korea National Health Insurance claims data from 2002 to 2013 were used. All hospitalizations were included and categorized into avoidable and non-avoidable cases. The independent variable was income level classified into quartiles and the dependent variable rates of avoidable hospitalization. Analysis was conducted using the generalized estimating equation (GEE) Poisson model. Subgroup analysis was performed based on chronic versus acute disease status and urban versus rural region. RESULTS: A total of 1 310 492 cases were included, in which the crude rate of avoidable hospitalizations was 1444.5 per 100 000 person years. Compared to the Q4 highest income group set as reference, the Q3 (RR 1.07, 95% CI 1.04-1.09), Q2 (RR 1.16, 95% CI 1.13-1.19) and Q1 (RR 1.20, 95% CI 1.17-1.24) income groups showed higher rates of avoidable hospitalizations. CONCLUSION: Risks of avoidable hospitalizations for ACSCs was higher in lower than higher income groups, implying that socioeconomic status is related to disparities in avoidable hospitalizations. The findings suggest the importance of monitoring the vulnerable groups identified in managing avoidable hospitalizations.


Assuntos
Hospitalização/estatística & dados numéricos , Renda/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/estatística & dados numéricos , Criança , Pré-Escolar , Estudos de Coortes , Comorbidade , Feminino , Humanos , Lactente , Recém-Nascido , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Indicadores de Qualidade em Assistência à Saúde , República da Coreia , Características de Residência , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
17.
BMC Health Serv Res ; 17(1): 478, 2017 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-28697765

RESUMO

BACKGROUND: We evaluated the effectiveness of a policy allowing for the sale of over-the-counter drugs outside of pharmacies by examining its effect on number of monthly outpatient visits for acute upper respiratory infections, dyspepsia, and migraine. METHOD: We used medical claims data extracted from the Korean National Health Insurance Cohort Database from 2009 to 2013. The Korean National Health Insurance Cohort Database comprises a nationally representative sample of claims - about 2% of the entire population - obtained from the medical record data held by the Korean National Health Insurance Corporation (which has data on the entire nation). The analysis included26,284,706 person-months of 1,042,728 individuals. An interrupted-time series analysis was performed. Outcome measures were monthly outpatient visits for acute upper respiratory infections, dyspepsia, and migraine. To investigate the effect of the policy, we compared the number of monthly visits before and after the policy's implementation in 2012. RESULT: For acute upper respiratory infections, monthly outpatient visits showed a decreasing trend before the policy (ß = -0.0003);after it, a prompt change and increasing trend in monthly outpatient visits were observed, but these were non-significant. For dyspepsia, the trend was increasing before implementation (ß = -0.0101), but this reversed after implementation(ß = -0.007). For migraine, an increasing trend was observed before the policy (ß = 0.0057). After it, we observed a significant prompt change (ß = -0.0314) but no significant trend. CONCLUSION: Deregulation of selling over-the-counter medication outside of pharmacies reduced monthly outpatient visits for dyspepsia and migraine symptoms, but not acute upper respiratory infections.


Assuntos
Política de Saúde , Legislação de Medicamentos , Medicamentos sem Prescrição/uso terapêutico , Pacientes Ambulatoriais , Farmácias , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Comércio , Feminino , Humanos , Revisão da Utilização de Seguros , Análise de Séries Temporais Interrompida , Masculino , Prontuários Médicos , Pessoa de Meia-Idade , Programas Nacionais de Saúde , República da Coreia
18.
BMC Public Health ; 15: 1249, 2015 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-26679934

RESUMO

BACKGROUND: Secondhand Smoking (SHS) has been suggested as a major health problem in the world and is known to cause various negative health effects that have in turn caused the deaths of almost 600,000 people per year. Evidence has suggested that SHS may have an effect on health problems and such findings have influenced the implementation of smoking-free areas. However, few studies have investigated the effects of SHS on stress which is considered major risk factor for mental health. Thus, the purpose of our study was to investigate the association between exposure to SHS and stress. METHODS: We performed a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey (2007-2012). In our study, a total of 33,728 participants were included to evaluate the association between SHS exposure and stress based on smoking status. Association between SHS exposure and stress was examined using logistic regression models. RESULTS: A total of 12,441 participants (42.9 %) were exposed to SHS in the workplace or at home. In our study, exposure to SHS was significantly associated with higher stress compared to non-exposure, regardless of smoking status (smoker odds ratio [OR]: 1.22; ex-smoker OR: 1.25; never-smoker OR: 1.42). Our results showed that the effect of SHS on stress was greater when exposure took place both at home and in the workplace in smokers and never-smokers. CONCLUSIONS: Exposure to SHS in the workplace and at home is considered to be a risk factor for high stress in both smokers and never-smoker. Therefore, strict regulations banning smoke which can smoking ban reduce SHS exposure are recommended in order to improve the populations' health.


Assuntos
Fumar/epidemiologia , Estresse Psicológico/epidemiologia , Poluição por Fumaça de Tabaco/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , República da Coreia , Características de Residência/estatística & dados numéricos , Fatores de Risco , Fatores Socioeconômicos , Local de Trabalho/estatística & dados numéricos , Adulto Jovem
19.
Asian Pac J Cancer Prev ; 16(4): 1415-20, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25743808

RESUMO

BACKGROUND: We compared the health-promoting behavior of long-term cancer survivors with those of the general population to identify necessary behavioral interventions to reduce the health risk among cancer patients. MATERIALS AND METHODS: We used data from the 2007 and 2012 Korea National Health and Nutrition Examination Surveys (KNHANES IV [2007~2009] and KNHANES V [2010~2012]) on smoking status, alcohol use, physical exercise, and disease screening. We compared long-term cancer survivors with members of the general population; the controls were matched by propensity score matching. A multiple logistic regression model was used to investigate the association between cancer status and health-promoting behavior. RESULTS: Long-term cancer survivors had a lower risk of smoking than the general population controls (OR: 0.42, 95%CI: 0.25-0.71). In addition, the long-term cancer survivors had a lower risk of alcohol use than the general population controls (OR: 0.70, 95%CI: 0.50-0.98). However, in terms of physical exercise and disease screening, no statistically significant differences were detected (physical exercise OR: 1.01, 95%CI: 0.75-1.35; disease screening OR: 1.27, 95%CI: 0.93-1.74). All covariates were adjusted. CONCLUSIONS: The long-term cancer survivors had a much lower risk of smoking and alcohol use than the general population controls. However, almost no differences in physical exercise and screening for cancer recurrence or secondary disease were detected between the long-term cancer survivors and general population controls. To reduce the health risks and challenges facing long-term cancer survivors, interventions to encourage physical exercise and screening for cancer recurrence and secondary disease should be implemented.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Exercício Físico/psicologia , Comportamentos Relacionados com a Saúde , Neoplasias/prevenção & controle , Neoplasias/psicologia , Fumar/psicologia , Sobreviventes/psicologia , Idoso , Estudos de Casos e Controles , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Inquéritos Nutricionais , Prognóstico , República da Coreia , Fatores de Risco , Taxa de Sobrevida
20.
Asian Pac J Cancer Prev ; 15(13): 5287-91, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25040990

RESUMO

BACKGROUND: The cancer survival rate in Korea has substantially increased, necessitating the management of not only patients with cancer but also longer term survivors. Although the divorce rate has drastically increased in Korea, there is not sufficient research regarding the relationship between changes in marital status and quality of life (QOL) in cancer patients and survivors. Thus, we aimed to examine the relationship between marital status and QOL in such cases. MATERIALS AND METHODS: This study was performed using the Community Health Survey of 2008 administered by the Korea Centers for Disease Control and Prevention (N=169,328). We used t-tests and Chi-square tests to compare demographic variables between men and women, and analysis of variance (ANOVA) to compare QOL scores among comparison groups. We also performed a multilevel analysis on the relationship between QOL and marital status while accounting for provincial differences. RESULTS: Decline of EuroQOL five dimensions (EQ-5D) in single patients with cancer was greater than in any other marital status group, but there was no statistically significant decline in survivors of cancer with regard to marital status. In the general population, the decline of EQ-5D was higher among single people than married people. Using the EuroQOL visual analog scale (EQ-VAS), single people had higher values than those of other marital status among both patients with cancer and survivors of cancer. In the general population, EQ-VAS values were higher for single people compared to married people. CONCLUSIONS: There may be a significant relationship between marital status and QOL in cancer patients and survivors. Policy interventions to manage patients with cancer who experience a decline in QOL as well as marital problems should be conducted.


Assuntos
Suscetibilidade a Doenças/psicologia , Neoplasias/psicologia , Qualidade de Vida/psicologia , Adulto , Idoso , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Estado Civil , Pessoa de Meia-Idade , República da Coreia , Sobreviventes , Adulto Jovem
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