Risk of cancer, cardiovascular disease, thromboembolism, and mortality in patients with rheumatoid arthritis receiving Janus kinase inhibitors: a real-world retrospective observational study using Korean health insurance data.

OBJECTIVES: This study investigated whether Janus kinase inhibitors (JAKis) raise the risk of cardiovascular disease (CVD), venous thromboembolism (VTE), and cancer in patients with rheumatoid arthritis (RA). METHODS: We conducted a real-world retrospective observational study using data obtained from the Korean National Health Insurance Service database. Two data sets were analyzed: tumor necrosis factor inhibitor (TNFi)/JAKi-naive RA patients (set 1) and all RA patients who used TNFis or JAKis (set 2). The incidence rate ratios (IRRs) and hazard ratios (HRs) for acute myocardial infarction (AMI), stroke, cardiovascular (CV)-related mortality, major adverse cardiovascular events (MACE), VTE, arterial thromboembolism (ATE), cancer, and all-cause mortality were compared between the JAKi and TNFi groups. RESULTS: Set 1 included 1,596 RA patients (JAKi group: 645; TNFi group: 951), and set 2 included 11,765 RA patients (JAKi group: 2,498; TNFi group: 9,267). No adverse events (AEs) showed significantly higher IRRs in the JAKi groups than in the TNFi groups of sets 1 and 2. The HRs for MACE in the JAKi groups of sets 1 and 2 were 0.59 (95% confidence [CI], 0.35 to 0.99) and 0.80 (95% CI, 0.67 to 0.97), respectively. The JAKi group of set 2 showed a significantly higher risk of all-cause mortality (HR, 1.71; 95% CI, 1.32 to 2.20), but the other AEs did not demonstrate increased risks in the JAKi groups. CONCLUSIONS: In this study, JAKis did not increase the risk of AMI, stroke, CV-related mortality, MACE, VTE, ATE, or cancer in Korean RA patients relative to TNFis.

Age-Standardized Breast Cancer Detection Rates of Breast Cancer Screening Program by Age Group in Korea; Comparison with Age-Standardized Incidence Rates from the Korea Central Cancer Registry.

To compare the epidemiological characteristics of a breast cancer screening program of patients between 40-69 years of age and ≥70 years of age, we calculated the age-standardized detection rate of the breast cancer screening program and compared it with the age-standardized incidence rate from the Korea Central Cancer Registry. The data of the breast cancer screening program from January 2009 to December 2016 and the data of the health insurance claims from January 2006 to August 2017 were used. In the 40-69 year age group, the age-standardized detection rate of breast cancer increased annually from 106.1 in 2009 to 158.6 in 2015 and did not differ from the age-standardized incidence rate. In the ≥70 year age group, the age-standardized detection rate of breast cancer increased annually from 65.7 in 2009 to 120.3 in 2015 and was 1.9 to 2.7 fold of the age­standardized incidence rate. It shows that the early detection effect of breast cancer screening was greater for patients over 70 years old. Further studies are needed to evaluate the effect of breast cancer detection in the ≥70 year age group on all-cause mortality or breast cancer mortality.

Study on the Relevance of Metabolic Syndrome and Incidence of Gastric Cancer in Korea.

(1) Background: This study aimed to determine the relevance between stages of metabolic syndrome (MS) progression and the incidence of gastric cancer utilizing a big data cohort for the national health checkup. (2) Methods: There were 7,785,098 study subjects, and three stages of metabolic syndrome were categorized using the health checkup results from 2009. Incidence of gastric cancer was traced and observed from the date of the health insurance benefit claim in 2009 until 31 December, 2016, and Cox hazard-proportional regression was performed to determine the risk of gastric cancer incidence based on the stage of progression for metabolic syndrome. (3) Results: Hazard ratio (HR) incidence rate for the MS group was 2.31 times higher than the normal group (95% CI 2.22⁻2.40) after adjustment (Model 4). The HR incidence rate of gastric cancer for the pre-MS group was 1.08 times higher (95% CI 1.04⁻1.12) than the normal group, while the HR incidence rate of gastric cancer for the MS group was 1.26 times higher (95% CI 1.2⁻1.32). (4) Conclusions: Causal relevance observed in this study between metabolic syndrome and incidence of gastric cancer was high. Promotion and education for active responses in the general population and establishment of appropriate metabolic syndrome management systems to prevent gastric cancer are needed.

Requirements for Cerebrovascular Surgery in Comprehensive Stroke Centers in South Korea.

OBJECTIVE: Cerebrovascular disease (CVD) was the third most common cause of death in South Korea in 2014. Evidence from abroad suggests that comprehensive stroke centers play an important role in improving the mortality rate of stroke. However, surgical treatment for CVD is currently slightly neglected by national policy, and there is still regional imbalance in this regard. For this reason, we conducted a survey on the necessity of, and the requirements for, establishing regional comprehensive cerebrovascular surgery centers (CCVSCs). METHODS: This investigation was performed using the questionnaire survey method. The questionnaire was consisted with two sections. The first concerned the respondent's opinion regarding the current status of demand and the regional imbalance of cerebrovascular surgery in South Korea. The second section asked about the requirements for establishing regional CCVSCs. We sent the questionnaire to 100 board members of the Korean Society of Cerebrovascular Surgeons. RESULTS: Most experts agreed that cerebrovascular surgery patients were concentrated in large hospitals in the capital area, and 83.6% of respondents agreed that it was necessary to alleviate the regional imbalance of cerebrovascular surgery. With regards to personnel, over 90% of respondents answered that at least two neuro-vascular surgeons and two neuro-interventionists are necessary to establish a CCVSC. Regarding facilities, almost all respondents stated that each CCVSC would require a neuro-intensive care unit and hybrid operating room. The survey asked the respondents about 13 specific neurovascular surgical procedures and whether they were necessary for a regional CCVSC. In the questions about the necessity of cerebrovascular surgical equipment, all seven pieces of equipment were considered essential by all respondents. A further five pieces of equipment were considered necessary on site: computed tomographic angiography, magnetic resonance angiography, conventional angiography, surgical microscope, and surgical navigation. Our results may provide a basis for future policy regarding treatment of cerebrovascular disease, including surgery. CONCLUSION: Raising the comprehensiveness of treatment at a regional level would lower the national disease burden. Policies should be drafted regarding comprehensive treatment including surgery for cerebrovascular disease, and related support plans should be implemented.

Medical visits, antihypertensive prescriptions and medication adherence among newly diagnosed hypertensive patients in Korea.

OBJECTIVES: The objective of this study was to assess the antihypertensive medication adherence in patients who were newly diagnosed with hypertension in Korea. METHODS: Study subjects were diagnosed with hypertension for the first time by the General Health Screening in 2012 and were 65,919. As indices, visiting rate to medical institution, the antihypertensive prescription rate, medication possession ratio and the rate of appropriate medication adherence were used. The qualification data, the General Health Screening data and the health insurance claims data were used. RESUTLS: Visiting rate to medical institution within one-year was 42.3%. Gender, age, family history of hypertension, smoking status, drinking frequency, insurance type, BMI, hypertension status, blood glucose level and LDL-cholesterol level were significant variables for visiting a medical institution. Of the study subjects who visited a medical institution, the antihypertensive prescription rate was 89.1%. Medication possession ratio was 70.9% and the rate of appropriate medication adherence was 60.6%. Age, family history of hypertension, smoking status, BMI level, hypertension level, blood glucose level, status, and LDL-cholesterol level were significant variables for the antihypertensive prescription and gender, age, family history of hypertension, smoking status, BMI, hypertension status, and the time of the first visit to a medical institution were significant variables for appropriate medication adherence. CONCLUSIONS: This study showed that the antihypertensive medication adherence in patients who were newly diagnosed with hypertension was not relatively high in Korea. National Health Insurance Service should support an environment in which medical institutions and those diagnosed with hypertension can fulfill their roles.

Nationwide cervical cancer screening in Korea: data from the National Health Insurance Service Cancer Screening Program and National Cancer Screening Program, 2009-2014.

OBJECTIVE: The rates of participation in the Korean nationwide cervical cancer screening program and the rates of abnormal test results were determined. METHODS: The database of the National Health Insurance Service (NHIS) was used during the study period (2009-2014). RESULTS: The participation rate increased from 41.10% in 2009 to 51.52% in 2014 (annual percentage change, 4.126%; 95% confidence interval [CI]=2.253-6.034). During the study period, women ≥70 years of age had the lowest rate of participation (range, 21.7%-31.9%) and those 30-39 years of age the second-lowest (27.7%-44.9%). The participation rates of National Health Insurance beneficiaries (range, 48.6%-52.5%) were higher than those of Medical Aid Program (MAP) recipients (29.6%-33.2%). The rates of abnormal results were 0.65% in 2009 and 0.52% in 2014, with a decreasing tendency in all age groups except the youngest (30-39 years). Every year the abnormal result rates tended to decrease with age, from the age groups of 30-39 years to 60-69 years but increased in women ≥70 years of age. The ratio of patients with atypical squamous cells of undetermined significance compared with those with squamous intraepithelial lesions increased from 2.71 in 2009 to 4.91 in 2014. CONCLUSION: Differences related to age and occurring over time were found in the rates of participation and abnormal results. Further efforts are needed to encourage participation in cervical cancer screening, especially for MAP recipients, elderly women and women 30-39 years of age. Quality control measures for cervical cancer screening programs should be enforced consistently.

Retrospective observation on contribution and limitations of screening for breast cancer with mammography in Korea: detection rate of breast cancer and incidence rate of interval cancer of the breast.

BACKGROUND: The purpose of this study was to determine the benefits and limitations of screening for breast cancer using mammography. METHODS: Descriptive design with follow-up was used in the study. Data from breast cancer screening and health insurance claim data were used. The study population consisted of all participants in breast cancer screening from 2009 to 2014. Crude detection rate, positive predictive value and sensitivity and specificity of breast cancer screening and, incidence rate of interval cancer of the breast were calculated. RESULTS: The crude detection rate of breast cancer screening per 100,000 participants increased from 126.3 in 2009 to 182.1 in 2014. The positive predictive value of breast cancer screening per 100,000 positives increased from 741.2 in 2009 to 1,367.9 in 2014. The incidence rate of interval cancer of the breast per 100,000 negatives increased from 51.7 in 2009 to 76.3 in 2014. The sensitivities of screening for breast cancer were 74.6% in 2009 and 75.1% in 2014 and the specificities were 83.1% in 2009 and 85.7% in 2014. CONCLUSIONS: To increase the detection rate of breast cancer by breast cancer screening using mammography, the participation rate should be higher and an environment where accurate mammography and reading can be performed and reinforcement of quality control are required. To reduce the incidence rate of interval cancer of the breast, it will be necessary to educate women after their 20s to perform self-examination of the breast once a month regardless of participation in screening for breast cancer.

Effects of delisting nonprescription combination drugs on health insurance expenditures for pharmaceuticals in Korea.

In November 2006, 727 combination drugs in 24 therapeutic classes were delisted in the national formulary in Korea to reduce the country's pharmaceutical expenditure, making these 727 drugs non-reimbursable. This study examines the effects of this delisting on national health insurance expenditures for pharmaceuticals. An interrupted time series analysis was conducted for the period from January 2005 to August 2007 by using administrative claims from Korea's National Health Insurance. The main outcome variable was the total pharmaceutical expenditure measured as a whole and based on the level of health care institutions and therapeutic classes. Comparison between exposure group (delisted drugs) and non-exposure group (listed drugs) were done. No changes in the level of or trend in the total pharmaceutical expenditure were detected. However, the delisting reduced pharmaceutical expenditures in clinics. Delisting effects were also observed according to therapeutic classes of drugs. The results indicate that any delisting should take into account the type of drug.

Association Between Smoking and Physician-Diagnosed Stroke and Myocardial Infarction in Male Adults in Korea.

To evaluate the association between smoking and physician-diagnosed stroke and myocardial infarction, this study used Community Health Survey data from 2009 on 92,082 males over the age of 30 years. Using multiple logistic regression, association index between smoking and physician-diagnosed stroke and myocardial infarction was calculated after adjusting the effects of age, hypertension, and diabetes. The odds ratios (95% confidence interval) of the physician-diagnosed stroke and myocardial infarction in the smoking group were 1.12 (1.02-1.24) and 1.21 (1.06-1.38) compared to the non-smoking group. The values of the physician-diagnosed stroke and myocardial infarction were 0.84 (0.74-0.94) and 0.96 (0.82-1.12) in the current-smoking subgroup, 1.38 (1.24-1.53) and 1.45 (1.26-1.67) in the ex-smoking subgroup, 1.39 (1.18-1.63) and 1.85 (1.53-2.24) in the 10- to 19-year smokers groups, 1.39 (1.22-1.58) and 1.36 (1.15-1.60) in the 30- to 40-year smokers groups, and 0.53 (0.44-0.63) and 0.47 (0.36-0.63) in those who had smoked for over 50 years. These results showed smoking was a risk factor for stroke and myocardial infarction in Korean males. This objective evidence should guide policy-making and public health interventions in the fields of smoking prevention and prohibition.

Effects of diabetic case management on knowledge, self-management abilities, health behaviors, and health service utilization for diabetes in Korea.

PURPOSE: This study aimed to evaluate the effects of a case management program for diabetics, using a pre-post comparison design. MATERIALS AND METHODS: The study population comprised 6007 diabetics who received case management intervention in 2006 and were sampled nationwide in Korea. Before and after the intervention, the study population answered questions regarding their knowledge of diabetes, self-management ability, and health behaviors. Body mass index (BMI) was also calculated. Healthcare service utilization for diabetes was extracted from health insurance claim data from 2005 to 2007. RESULTS: The case management program significantly improved the study population's knowledge of diabetes and ability to self-manage nutrition, blood glucose monitoring, foot and oral care, and medications. This program also significantly changed the study population's health behaviors regarding smoking, alcohol drinking, and exercise, and BMI was positively affected. In the over-serviced subgroup, there was a significant decrease in the number of consultations (mean=7.0; SD=19.5) after intervention. Conversely, in the under-serviced subgroup, there was a significant increase in the number of consultations (mean=3.2; SD=7.9) and the days of prescribed medication (mean=66.4; SD=120.3) after intervention. CONCLUSION: This study showed that the case management program led the study population to improve their knowledge, self-management ability, health behaviors, and utilization of health care. It is necessary in future studies to evaluate the appropriateness of healthcare usage and clinical outcome by using a control group to determine the direct effectiveness of this case management program.

Variation in the numbers of red blood cell units transfused at different medical institution types from 2006 to 2010 in Korea.

BACKGROUND: This study aimed at assessing the number of red blood cell (RBC) units transfused at different types of medical institution and examining the characteristics of transfusion recipients. METHODS: We calculated and compared the number of transfusion recipients, total RBC units transfused, and RBC units transfused per recipient. Study data were extracted from insurance benefits reimbursement claims for RBC units at the Health Insurance Review & Assessment Service from 2006 to 2010. RESULTS: Between 2006 and 2010, the number of recipients of RBC units increased from 298,049 to 376,445, the number of RBC units transfused increased from 1,460,799 to 1,841,695, and the number of RBC units transfused per recipient changed from 4.90 to 4.89. The number of recipients aged ≥65 yr increased from 133,833 (44.9%) in 2006 to 196,127 (52.1%) in 2010. The highest number of RBC units was transfused to patients with neoplastic diseases (31.9%) and diseases of the musculoskeletal system and connective tissue (14.4%). More than 80% of the total number of RBC units were transfused at tertiary and general hospitals. However, this composition rate was slightly decreasing, with the composition rate for hospitals increasing from 12.6% to 16.3%. CONCLUSIONS: This study revealed an increase in the number of RBC units transfused over a 5-yr period due to an increase in the number of transfused recipients, especially recipients aged ≥65 yr; moreover, the number of RBC units transfused differed based on medical institution type. These results provide fundamental data on RBC transfusions required for future research.

Polycyclic aromatic hydrocarbon-induced oxidative stress, antioxidant capacity, and the risk of lung cancer: a pilot nested case-control study.

AIM: We conducted a pilot nested case-control study to prospectively evaluate the effects of polycyclic aromatic hydrocarbons (PAH) exposure, antioxidant capacity, and oxidative stress on lung carcinogenesis. MATERIALS AND METHODS: Thirty-five patients with lung cancer and 140 age- and sex-matched controls were selected from a sub-cohort of the Korean Multi-center Cancer Cohort. PAH metabolites (1-hydroxypyrene and 2-naphthol), oxidative stress markers, and total antioxidant capacity (TAC) were assessed using urine samples collected at baseline. RESULTS: The levels of urinary PAH metabolites and oxidative stress were not different between cases and controls. Urinary 1-hydroxypyrene and 2-naphthol levels were significantly associated with urinary oxidative stress markers only in lung cancer cases. Individuals with low urinary TAC and high urinary oxidative stress levels had significantly higher risk of lung cancer compared to those with high urinary TAC and low urinary oxidative stress levels. CONCLUSION: Oxidative stress induced by PAH exposure and TAC may be important determinants for the susceptibility to lung cancer.

Costs during the first five years following cancer diagnosis in Korea.

OBJECTIVES: We estimated the total medical costs incurred during the 5 years following a cancer diagnosis and annual medical use status for the six most prevalent cancers in Korea. METHODS: From January 1 to December 31, 2006, new patients registered with the six most prevalent cancers (stomach, liver, lung, breast, colon, and thyroid) were randomly selected from the Korea Central Cancer Registry, with 30% of patients being drawn from each cancer group. For the selected patients, cost data were generated using National Health Insurance claims data from the time of cancer diagnosis in 2006 to December 31, 2010. The total number of patients selected was 28,509. Five-year total medical costs by tumor site and Surveillance, Epidemiology, and End Results (SEER) stage at the time of diagnosis, and annual total medical costs from diagnosis, were estimated. All costs were calculated as per-patient net costs. RESULTS: Mean 5-year net costs per patient varied widely, from $5,647 for thyroid cancer to $20,217 for lung cancer. Advanced stage at diagnosis was associated with a 1.8-2.5-fold higher total cost, and the total medical cost was highest during the first year following diagnosis and decreased by the third or fourth year. CONCLUSIONS: The costs of cancer care were substantial and varied by tumor site, annual phase, and stage at diagnosis. This indicates the need for increased prevention, earlier diagnosis, and new therapies that may assist in reducing medical costs.

[Factors affecting preparation stage to quit smoking in men].

PURPOSE: This study was done to investigate factors affecting preparation stage to quit smoking in men. METHODS: Based on data from the Community Health Survey conducted in Chungbuk Province in 2008, we estimated rates and odds ratio (OR) of smoking cessation intention for 2,639 men who were current smokers. Multivariate logistic regression analyses were used to identify factors affecting preparation stage to quit smoking. RESULTS: Among current male smokers, the rate of smoking cessation intention was 17.1%. The OR of factors affecting smoking cessation was as follows: Compared to men with middle school education, the OR for rate of smoking cessation intention in men with high school education was 1.47 (p=.018), and for college or higher, 1.55 (p=.017). Compared to being single, the OR for cohabitation after marriage was 1.61 (p=.011) and living alone after marriage, 2.23 (p=.005). The OR for attempt to quit smoking, exposure to secondhand smoke and participation in smoking education were 6.80 (p<.001), 1.32 (p=.020) and 1.69 (p=.005), respectively. CONCLUSION: Results of this study show that it is necessary to decrease exposure to secondhand smoke and to increase participation in smoking cessation education targeting current smokers to move them from precontemplation or contemplation stage to preparation stage.

Factors associated with medical cost among patients with terminal cancer in hospice units.

This study identified factors associated with higher medical costs for patients with terminal cancer in hospice units in order to develop a daily payment system for hospice services within Korea's National Health Insurance (NHI) program. Through chart reviews conducted by staff nurses, medical information and costs were obtained for 274 patients with terminal cancer in 20 hospice units in October 2007. The daily medical cost per patient was calculated based on the fee-for-service scheme. The characteristics of the hospice units were examined by means of a semistructured questionnaire administered to hospice unit coordinators. Higher daily costs were associated with general hospital-based hospice units (as compared with free-standing units: p<0.01), low Palliative Performance Scale scores (PPS<50, p<0.05), and the presence of fever (p<0.01). In multivariate analysis, hospice unit type was found to be the factor most strongly associated with medical cost. A hospice payment system based on patient characteristics should be thoroughly considered.

Cost-effectiveness analysis of 5 years of postoperative adjuvant tamoxifen therapy for Korean women with breast cancer: retrospective cohort study of the Korean breast cancer society database.

OBJECTIVE: This study aimed to evaluate the cost-effectiveness of postoperative adjuvant tamoxifen therapy using data from a Korean breast cancer registry. METHODS: In this retrospective, observational cohort study, patients were selected from the Korean Breast Cancer Society database. Women with stage I, II, or III breast cancer (diagnosed between 1981 and 2005), for whom information about tamoxifen use (20 mg/d for 5 years) and estrogen-receptor and/or progesterone-receptor status was available, were included. Cost-effectiveness was calculated from the perspective of Korean society. Using a decision analytic model based on standard clinical flow, incremental cost-effectiveness ratios (ICERs) for overall survival were calculated with stratification by disease stage and hormone-receptor status. One-way sensitivity analyses were also conducted. All results were represented as US dollars (US $1 approximately 1000 Korean won, in year-2005 values). RESULTS: A total of 17,579 patients were included in the analysis (10,694 tamoxifen users, 6885 nonusers). Among those with stage I or II breast cancer, ICERs for estrogen-receptor positive (ER+)/progesterone-receptor positive (PR+) tamoxifen users ranged from $739 to $1939. Tamoxifen use among those with either ER+ or PR+ status (but not both) remained cost-effective: $1217 to $3107 for 1 life-year gained. However, among estrogen-receptor negative (ER-)/progesterone-receptor negative (PR-) patients, tamoxifen use was more expensive and associated with shorter survival, and most ICERs were negative values, except for those aged >or=50 years (ICERs ranged from -$462 to -$3738 for 1 life-year gained). In contrast to those with stage I or II disease, tamoxifen use among patients with stage III disease was cost-effective regardless of hormone-receptor status. However, because of the small sample size, further studies are needed. CONCLUSIONS: In this analysis, postoperative adjuvant tamoxifen use was cost-effective for stage I or II ER+ and/or PR+ breast cancer, but not for ER-/PR- disease. Tamoxifen therapy appeared to be cost-effective for patients with stage III breast cancer regardless of hormone-receptor status. Seoul National University Hospital identifier: C-0702-019-198.

Estrogen receptor-1 genetic polymorphisms for the risk of premature ovarian failure and early menopause.

BACKGROUND: The aim of this study was to investigate the role of the estrogen receptor 1 (ESR1) genetic polymorphisms for early menopause that was classified as premature ovarian failure (POF) and early menopause (EM) and to examine whether the associations of ESR1 genetic variants are different for POF and EM. METHODS: We selected 100 POF cases and matched 100 EM cases and 200 normal menopause (NM) controls from the Korean Multi-Center Cohort. Among them, we restricted idiopathic POF and EM cases vs NM controls by excluding POF/EM cases with medical/surgical causes. The XbaI (rs9340799) and PvuII (rs2234693) in the ESR1 gene were genotyped. The single-nucleotide polymorphism (SNP) and haplotype effects were analyzed by multivariate logistic regression and haplotype analysis. Also nominal polytomous logistic regression was used to find whether ESR1 genetic variants are differently associated with POF and EM. RESULTS: The global p values for idiopathic POF and EM were 0.08 and 0.39 (SNP-based), and <0.001 and 0.12 (haplotype-based), respectively. The XbaI genetic variant containing the X allele was marginally significantly associated with a reduced risk of idiopathic POF (OR = 0.6, 95% CI 0.3-1.0). The P-x haplotype and diplotypes significantly decreased the risk of idiopathic POF (OR = 0.5, 95% CI 0.2-0.9; OR = 0.4, 95% CI 0.2-0.9, respectively). In contrast from POF, the P-x haplotypes and diplotypes insignificantly increased the risk for both idiopathic EM (p(polytomous) = 0.009 for P-x haplotype; p(polytomous) = 0.02 for P-x diplotypes). CONCLUSION: Our results suggest that the ESR1 gene including PvuII and XbaI polymorphisms may modify the risk of idiopathic premature ovarian failure (POF) but not idiopathic early menopause (EM) risk.

Evaluation of the hypertension disease management program in Korea.

This study evaluated how the Hypertension Disease Management Program (HDMP) affects patient's blood pressure, knowledge, health behaviors, and use of medical services. Evaluation was performed by 2 measures, which were before and after comparison within the management group (n = 210) and comparison between the management group and control group (n = 1050) in 2005. Systolic and diastolic blood pressure of management group significantly decreased from 137.5 and 86.0 mm Hg to 131.2 and 83.8 mm Hg (P < .001, P < .01), respectively. Dieting, snack control, consumption of low-sodium meals, low-cholesterol meals, and fruits or vegetables, regular checking of blood pressure, and stress management techniques significantly increased after HDMP. However, there was no significant difference in the use of medical service between the disease management group and the control group. This study showed that the HDMP improved lifestyle and reduced blood pressure on the disease management group, but changed neither medical costs nor use of medical services. Long-term evaluation should be performed to determine if the HDMP reduce medical costs and use of medical services.

Lung cancer risk and cigarette smoking, lung tuberculosis according to histologic type and gender in a population based case-control study.

We examined whether the strength of the association of cigarette smoking differs according to histological type and gender, and assessed other risk factors, in particular, tuberculosis. We recruited cases from the Korean Academy of Tuberculosis and Respiratory Diseases and controls from Chungju, a local site of the Korean Multi-Center Cancer Cohort. We matched one case to one control for females and two cases to one control for males according to age (or=70 years old). We used unconditional logistic regression to calculate the odds ratio (OR) and 95% confidence interval (CI) to estimate lung cancer risk by histologic type for males and females separately. The OR (95% CI) of 40 or more pack-years smoked relative to never smokers was 6.78 (4.17-11.00), 3.49 (1.83-6.33), and 2.72 (1.57-4.72) for males, and 13.72 (3.23-58.18), 12.18 (3.12-47.57), and 7.11 (1.78-28.43) for females for squamous cell, adenocarcinoma, and small cell carcinoma, respectively. Among males, the respective OR (95% CI) for past and current history of lung tuberculosis was 3.21 (2.12-4.90), 2.69 (1.63-4.45), and 1.52 (0.83-2.78), and for females was 2.40 (1.30-4.42), 4.20 (2.75-6.39), and 1.37 (0.61-3.06). Our findings provide additional evidence that women are more susceptible to the carcinogenic effects of tobacco, smoking has a higher risk for squamous cell and small cell carcinoma than adenocarcinoma, and tuberculosis is a potential risk factor for certain lung cancer histologic types.