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.

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.

Cancer care patterns in South Korea: Types of hospital where patients receive care and outcomes using national health insurance claims data.

BACKGROUND: Although strengthening coverage has improved cancer care, there are concerns related to medical distortion. Previous studies have only examined whether patients visit a specific hospital, and not the continuum of patients with cancer, resulting in a lack of evidence in South Korea. This study aimed to investigate the patterns in hospital type for cancer care and analyze their association with outcomes. METHODS: The data for this study were obtained from the National Health Insurance Services Sampled Cohort database. This study included patients with four types of cancer (top four cancer incidence in 2020): gastric (3353), colorectal (2915), lung (1351), and thyroid (5158) cancer. The latent class mixed model was used to investigate cancer care patterns, and multiple regression or survival analysis was performed to examine medical cost, length of stay (LOS), and mortality. RESULTS: The patterns in each cancer type were classified into two to four classes, namely, mainly visited clinics or hospitals, mainly visited general hospitals, mainly visited tertiary hospitals (MT), and tertiary to general hospitals through trajectory modeling based on the utilization of cancer care. Compared to the MT pattern, other patterns were generally associated with higher cost, LOS, and mortality. CONCLUSION: The patterns found in this study may be a more realistic way of defining patients with cancer in South Korea compared to previous studies, and its association-related outcomes may be used as a basis to address problems in the healthcare system and prepare alternatives for patients with cancer. Future studies should review cancer care patterns related to other factors such as regional distribution.

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.

Non-cancer health risks in firefighters: a systematic review.

osFirefighters are occupationally exposed to hazardous factors that may increase their risk of disease. However, non-cancer disease risk in firefighters has not been systematically examined. This systematic review aimed to identify non-cancer disease risk in firefighters and determine whether the risk differs according to job characteristics. We searched the Cochrane Library, Embase, PubMed, and KoreaMed databases using relevant keywords from their inception to April 30, 2021. The Risk of Bias Assessment Tool for Non-randomized Studies version 2.0 was used to assess the quality of evidence. Due to study heterogeneity, a narrative synthesis was presented. The systematic literature search yielded 2,491 studies, of which 66 met the selection and quality criteria. We confirmed that the healthy worker effect is strong in firefighters as compared to the general population. We also identified a significant increase in the incidence of lumbar disc herniation, lower back pain, angina pectoris, acute myocardial infarction, and post-traumatic stress disorder (PTSD) in firefighters compared to other occupational groups. Contradictory results for the risk of PTSD and anxiety disorders related to rank were reported. Sufficient evidence for increased risk of lumbar disc herniation, lower back pain, angina pectoris, acute myocardial infarction, and PTSD was available. The risk of non-cancer diseases varied depending on job type, years of service, and rank. However, caution should be exercised when interpreting the results because the classification criteria for firefighters' jobs and ranks differ by country.

Health behavior changes and mortality among South Korean cancer survivors.

Considering the rapid growth in the number of cancer survivors, the successful management of their health behaviors requires further attention. However, there are lack of information about cancer survivors' health behaviors and the risk of mortality using Korean cohort data. This study aimed to examine the effects of health behavior changes on mortality among cancer survivors and to develop a validated nomogram. This cohort study was conducted using claims data. Data from adult cancer survivors from the National Health Insurance Service-National Sample Cohort, conducted between 2002 and 2015, were included. Individuals who were alive for five years after their cancer diagnosis were defined as cancer survivors. Cox proportional-hazards regression was used to estimate the target associations. Discrimination (Harrell's C-index) and calibration (Hosmer-Lemeshow test) were employed to validate the nomogram. Data from 9300 cancer survivors were used for analysis. Compared to non-smokers, those who started or quit smoking had a higher risk of all-cause mortality. Those who were physically inactive had a higher risk of all-cause mortality than those who were continuously active. In the nomogram, the C-index value was 0.79 in the training data and 0.81 in the testing data. Hosmer-Lemeshow test was not significant, demonstrating a good fit. We found that individuals with unhealthy behaviors had a higher risk of mortality, thereby highlighting the importance of managing health behaviors among cancer survivors. The development of a validated nomogram may provide useful insights regarding official policies and existing practices in healthcare systems, which would benefit cancer survivors. Our study could provide the evidence to inform the priority of guideline for managing the health behavior among cancer survivors.

Association between gastric cancer and the risk of depression among South Korean adults.

OBJECTIVES: The diagnosis and treatment of cancer are stressful events that could trigger psychological distress in a large number of cancer patients. The aim of this study was to examine the association between gastric cancer and the risk of new onset of depression among South Korean adults. METHODS: Data from 12,664 participants aged over 40 years was derived from the National Health Service National Sample Cohort (2002-2013). The case cohort consists of patients who received a diagnosis of gastric cancer between 2002 and 2009, and the corresponding control group was selected through 1:1 propensity score matching (case: 6332, control: 6332). The new onset of depression was considered as the dependent variable. A Cox proportional hazards regression model was built to analyze the associations between variables in consideration. RESULTS: Individuals with gastric cancer had a higher risk of new onset of depression than those without cancer (hazard ratio [HR] = 1.28, 95% confidence interval [CI] = 1.13-1.45.) Female gastric patients had a higher risk of depression compared to male patients (Female; HR = 1.89, 95% CI = 1.66-2.16, Male; HR = 1.25, 95% CI = 1.10-1.41). Gastric cancer patients in their 60s had the highest risk of new onset of depression compared to other age groups and no cancer group (HR = 1.61, 95% CI = 1.40-1.85). Gastric cancer patients who were previously diagnosed with depression prior to their diagnosis of cancer had a higher risk of new onset of depression than gastric cancer patients without antecedent diagnosis of depression (Past Depression (Yes); HR = 5.17, 95% CI = 4.10-6.51, Past Depression (No); HR = 1.35, CI = 1.21-1.51). CONCLUSIONS: The study identified a significant relationship between gastric cancer and depression among South Korean adults, suggesting that the diagnosis and treatment of gastric cancer increases the risk of new onset of depression, especially among female patients between 60 and 69 years old of high income and living in metropolitan regions. Pre-existing health conditions also appeared to be a risk factor. Thus, in consideration of treatment efficacy and patients' quality of life, the results of the study emphasizes the need for attentive intervention, while distinguishing the most vulnerable groups.

Increasing disparities in the proportions of active treatment and 5-year overall survival over time by age groups among older patients with gastric cancer in Korea.

Purpose: As older patients with gastric cancer increase in Korea, no consensus indicative of anti-cancer treatment exists for the oldest old (age 85+). We investigated potential disparities in the proportion of surgery-including active treatment and the degree of survival improvement over time by age groups, and whether heterogeneity exists in the protective effect of time period on overall survival (OS) by age at diagnosis clusters. Materials and methods: A nationwide cohort (N = 63,975) of older patients with gastric cancer (age at diagnosis 70+) in 2005-2012 were followed until the end of 2018. Patients were categorized into four time period groups by their year of diagnosis. Cancer treatment patterns and 5-year OS were analyzed accordingly, and a random coefficients Cox model with random intercepts and random slopes of time period by age at diagnosis clusters was employed. Results: The mean age of patients was 76.4, and 60.4% were males. Most patients had 0-1 comorbidities (73.3%) and low-risk frailty scores (74.2%). Roughly two-thirds of patients received some form of anti-cancer treatment (62.4%), and while the number of comorbidities and the proportion of high-risk frailty scores trended toward an increase, the proportion of patients receiving anti-cancer treatment increased from 58% in 2005-2006 to 69.6% in 2011-2012. The proportion of surgery-including active treatment increased to over 70% in the 70-74 years old group, while stagnating at 10% in the 90+ years old group. Differences in the slope of 5-year OS improvement resulted in a widening survival gap between the old (age 70-84) and the oldest old. The protective effect of time period on OS hazard in the oldest old was not monotonically reduced with increasing "chronological" age but varied quite randomly, especially among female patients. Conclusion: Our study showed no upper age limit in terms of benefiting from the advances in the detection and treatment of gastric cancer over time. Thus, "functional" age rather than "chronological" age should be the criterion for anti-cancer screening and treatment, and actual implementation of proven treatments in the oldest old patients to reduce their non-compliance with treatment in clinical practice is needed to improve gastric cancer survival for all.

Association between healthy lifestyle score changes and quality of life and health-related quality of life: a longitudinal analysis of South Korean panel data.

OBJECTIVES: We aimed to determine the influence of changes in the aggregate score of healthy lifestyle factors on health-related quality of life (HRQOL) and overall quality of life (QOL) in the Korean older adult population. DESIGN: This study used a longitudinal design. SETTING AND PARTICIPANTS: Data on 9474 participants aged 45 years or older were extracted from the Korean Longitudinal Study on Aging for the period 2006-2016. A composite score of four lifestyle factors (smoking, drinking, physical activity and body mass index) was calculated, and biennial changes in aggregate score were computed. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcomes were HRQOL and QOL. RESULTS: Generalised estimating equation analysis results showed that those with healthy lifestyle score changes from 'Low-High' (ß =-0.987, p=0.002; ß =-1.288, p<0.0001), 'High-Low' (ß =-1.281, p<0.0001; ß =-1.952, p<0.0001) and 'Low-Low' (ß =-1.552, p<0.0001; ß =-2.398, p<0.0001) groups were more likely to be have lower HRQOL and QOL estimates than those in 'High-High' group. Female gender, older age and depression had a more negative impact on HRQOL, while male gender and younger age had a more negative impact on QOL, especially in the Low-Low group. The relationship between changes in scores and HRQOL and QOL varied across different elements of healthy lifestyle scores. Changes in physical activity, drinking and smoking status were significantly associated with lower HRQOL and QOL. CONCLUSION: The findings suggest an association between a low healthy lifestyle score and poor quality of life, in both general and health-related aspects. Strategies targeting the Korean ageing demographic to promote a healthier lifestyle should be encouraged.

The effect of depression status change on daily cigarette smoking amount according to sex: an eleven-year follow up study of the Korea Welfare Panel Study.

BACKGROUND: In the past decade, the Korean smoking rate has only decreased by 3%, despite several smoking control policies. There is a need for such policies to take smokers' psychological characteristics into account. Depression is a well-known contributor to failed smoking cessation. This study aimed to examine the effect of smokers' depression status changes on their daily cigarette smoking amount (DCA). METHODS: This study used a sample drawn from the Korea Welfare Panel Study (KoWePS) waves 3 (2008) to 13 (2018). The DCA refers to the number of the cigarettes smoked per day at the time of the survey. Depression was measured using an 11-item version of the Center for Epidemiologic Studies Depression Scale (CESD-11). A generalized estimating equation (GEE) model was employed to analyse the effect of change of depression status on DCA. RESULTS: The 2008 baseline included a total of 1821 participants: 1645 males and 176 females. The Yes→No male depression status group had lower DCA (ß = - 0.631, p-value = 0.0248) than the No→No group. The Yes→No male depression status group that began smoking before age 19 had lower DCA (ß = - 0.881, p-value: 0.0089) than the No→No group that started smoking before 19. CONCLUSIONS: We found that a change from depressed to non-depressed and non-depressed to depressed status is associated with decreasing and increasing DCA among men, respectively. Also, for smokers who began smoking before 19 years of age, the subgroup that went from depressed to non-depressed had much a lower DCA than general smokers. Thus, when treating people participating in smoking cessation programs, counsellors should check for depression symptoms and encourage individuals to pursue depression treatment simultaneously.

Association between depression and risk of Parkinson's disease in South Korean adults.

BACKGROUND: Depression is considered a predictive factor for cognitive impairments. At the same time, Parkinson's disease (PD) is a growing public health problem. The aim of this study is to examine the association between depression and PD risk among South Korean adults. METHODS: Data from 21,766 participants aged over 40, derived from the National Health Insurance Service National Sample Cohort (2002-2013), were included. Propensity score matching (1:1) was used to match participants with and without depression (case: 10,875, control: 10,875). The dependent variable was PD risk. A Cox proportional hazards regression model was built to analyze the associations between variables. RESULTS: People with depression had a higher risk of PD than those without depression (hazard ratio (HR) = 1.61, 95% confidence interval (CI) = 1.26-2.06). Among individuals with disabilities, those with depression had a higher risk of PD (HR = 2.31, 95% CI = 1.08-4.94). According to the Charlson Comorbidity Index (CCI) score, those with depression had a higher risk of PD than their counterparts (CCI score ≥ 5: HR = 1.63, 95% CI = 1.21-2.20). LIMITATIONS: The limitations include the inability to 1) explore factors such as smoking and drinking status, which could be related to PD risk and 2) identify undiagnosed PD that already existed at the time of diagnosis of depression. CONCLUSIONS: The results suggest that having depression places individuals at a higher risk of PD. Interventions to alleviate the risk of PD should focus on adequate depression management.

Association Between the Location of Secondhand Smoke Exposure and Depressive Symptoms among South Korean Adolescents.

The incidence of depression among adolescents has gradually increased, leading to adult psychological outcomes and suicide. Although the rate of secondhand smoke exposure (SHSE) has recently decreased, SHSE remains high in children. We aimed to determine the association between depressive symptoms in adolescents and the locations of SHSE using an extensive population survey. Using data from the 14th Korea Youth Risk Behavior Web-based Survey, we assessed self-reported data of depressive symptoms and SHSE among non-smokers. SHSE locations were classified into four groups: only at school, only at home, at both school and home, and other places. Multiple logistic regression analysis was performed to identify the associations between SHSE locations and depressive symptoms. The relationship between SHSE and depressive symptoms was the highest in the "SHSE at home and school" group (boys: odds ratio [OR] = 1.61, 95% confidence interval [CI] = 1.44-1.80; girls: OR = 1.72, 95% CI = 1.54-1.91), followed by the "school" (boys: OR = 1.53, 95% CI = 1.39-1.67; girls: OR = 1.36, 95% CI = 1.25-1.48) and "home" groups (boys: OR = 1.23, 95% CI = 1.12-1.35; girls: OR = 1.30, 95% CI = 1.20-1.40). These results emphasize the importance of stricter smoking regulations not only in public places, but also in households. Adolescents and their families should be educated on the dangers of smoking and the effects of SHSE on mental health.

The Association of Smoking Exposure at Home with Attempts to Quit Smoking and Cessation Success: A Survey of South Korean Adolescents Who Smoke.

This study aimed to examine the association of smoking exposure at home with attempts to quit smoking and the success or failure of such attempts among South Korean adolescents. We utilized the data of 28,652 South Korean adolescents who smoked from the 2015-2017 Korea Youth Risk Behavior Web-based Survey, including demographic variables (age, sex, and family structure), socioeconomic variables (allowance per week, household income level, and grade), and health-related characteristics (alcohol consumption, intensity of physical activity, stress level, self-reported health status, attendance in smoking cessation programs, and smoking onset). A multiple logistic regression analysis revealed that attempting to quit smoking was less likely among those exposed to smoking at home every day compared to those without such exposure (boys exposed to smoking every day: OR = 0.52, CI = 0.45-0.60; girls exposed to smoking every day: OR = 0.48, CI = 0.38-0.61); cessation success showed similar results (boys exposed to smoking every day: OR = 0.51, CI = 0.46-0.58; girls exposed to smoking every day: OR = 0.56, CI = 0.47-0.66). These findings highlight the impacts of smoking exposure at home and the importance of considering this exposure when supporting adolescents to quit.

Associations of electronic and conventional cigarette use with periodontal disease in South Korean adults.

BACKGROUND: The aim of this study was to examine the association of conventional cigarette smoking and electronic cigarette vaping with periodontal disease in South Korean adults. METHODS: For this study, data from 13,551 participants, a subset derived from the Korean National Health and Nutrition Examination Survey conducted between 2013 and 2015, were examined. Participants were divided into four categories: electronic cigarettes vapers, conventional cigarettes smokers, ex-users, and non-users. Periodontal status was measured by the Community Periodontal Index. Multiple logistic regression analysis was performed to examine the association of periodontal disease with smoking and vaping individually. RESULTS: Out of 187 men and 35 women who vape electronic cigarette, 67 (35.8%) men and 10 (28.6%) women had periodontal diseases. Out of 1,957 men and 363 women who smoke conventional cigarettes, 861 (44.0%) men and 121 (35.3%) women had periodontal diseases. Periodontal disease was more prevalent in each vapers and smokers than non-users in men (electronic cigarettes: odds ratio [OR] = 2.34, 95% confidence interval [CI] = 1.52 to 3.59, conventional cigarettes: OR = 2.17, 95% CI = 1.76 to 2.68). Furthermore, both vaping and smoking had significant relation to dental caries, toothache, and dental damages. CONCLUSIONS: Electronic and conventional cigarette use was each significantly associated with increased periodontal disease rates. After adjusting for demographic, socioeconomic, and health-related characteristics, both vaping and smoking each had significant association with periodontal diseases. Therefore, this study suggests that vaping may not be a safe alternative to smoking. Cessation of both types of cigarettes is necessary for maintaining oral health.