Shifts in Clinical Characteristics, Treatment, and Outcome for Rheumatic Mitral Stenosis: Insights From a 20-Year Multicentre Registry Study in Korea.

BACKGROUND: The rapid economic development of South Korea provides a unique model to study changes in the clinical characteristics, treatment approaches, and clinical outcomes of patients with rheumatic mitral stenosis (MS) relative to socioeconomic growth. METHODS: From the Multicenter mitrAl STEnosis with Rheumatic etiology (MASTER) registry, 2,337 patients diagnosed with moderate or severe rheumatic MS between January 2001 and December 2020 were analyzed. Patients were grouped into consecutive 5-year intervals based on their year of diagnosis. Clinical characteristics, echocardiographic data, and clinical outcomes were assessed. RESULTS: Over 20 years, the severity of mitral stenosis increased from 79.1% to 90.2%; similarly, the average age at diagnosis increased from 54.3 to 63.0 years (all P < 0.001). Comorbidities such as hypertension and atrial fibrillation increased (6.3% to 29.5% and 41.4% to 46.9%, respectively; all P for trend < 0.05). The rate of mitral intervention within five years after diagnosis increased from 31.2% to 47.4% (P for trend < 0.001). However, clinical outcomes of rheumatic mitral stenosis deteriorated over time in the composite outcomes (log-rank test, P < 0.001). Conversely, the incidence of stroke remained stable (60.6-73.7%; P < 0.001), which might be attributed to the increased use of anticoagulation therapy. CONCLUSION: This study observed an increase in patient age, comorbidities, and valve disease severity as the country transitioned from a developing to developed status. Despite a rise in mitral valve interventions, clinical outcomes deteriorated over 20 years, highlighting the need for modified treatment approaches to improve patient outcomes.

Effect of the Presence of Emergency Departments with 300 or More Hospital Beds in Health Service Areas on 30-Day Mortality in Korea: A Nationwide Retrospective Cross-sectional Study.

BACKGROUND: Disparities in emergency care accessibility exist between health service areas (HSAs). There is limited evidence on whether the presence of an emergency department (ED) that exceeds a certain hospital bed capacity is associated with emergency patient outcomes at the regional level. The objective of this study was to evaluate the effect of HSAs with or without of regional or local emergency centers with 300 or more hospital beds (EC300 or nEC300, respectively) by comparing the 30-day mortality of patients with severe emergency diseases (SEDs) admitted to the hospital through the ED. METHODS: The study retrospectively evaluated data from the Korean National Health Insurance Claims database and enrolled patients who were admitted from the ED for SEDs. SEDs were defined using ICD-10 codes for 28 disease categories with high severity, and 56 HSAs were designated as published by the Korean National Health Insurance Service. We performed hierarchical logistic regression analysis using multilevel models with the generalized linear mixed model (GLIMMIX) procedure to evaluate whether EC300 was associated with the 30-day mortality of SED patients, adjusting for patient-level, prehospital-level, hospital-level, and HSA-level variables. RESULTS: In total, 662,478 patients were analyzed, of whom 54,839 (8.3%) died within 30 days after hospital discharge. Of the 56 HSAs, 46 (82.1%) were included in the EC300 group. After adjustment for patient-level, prehospital-level, hospital-level and HSA-level variables, nEC300 was significantly associated with increased 30-day mortality in SED patients (AOR: 1.33, 95% CI: 1.137-1.153). In addition, patients who visited EDs with fewer annual SED admissions were associated with higher 30-day mortality. CONCLUSION: nEC300 had a greater risk of 30-day mortality in patients treated with SEDs than EC300. The results indicate that not only the number of EDs in each HSA is important for ensuring adequate patient outcomes but also the presence of EDs with adequate receiving capacity.

Early life course processes leading to educational and economic attainment in young adulthood: Contributions of early socioeconomic adversity and education polygenic score.

The present study investigated an integrated life course model, drawn from the life course theoretical perspective, to elucidate youth's additive, cascading, and cumulative life course processes stemming from early socioeconomic adversity and education polygenic score (education PGS) as well as potential interactions between them (GxE), which contribute to subsequent young adult socioeconomic outcomes. Additionally, the independent, varying associations among social and genetic predictors, life-stage specific educational outcomes (educational achievement in adolescence and educational attainment, in later stages), and young adult economic outcomes were examined. The study used prospective, longitudinal data from the National Longitudinal Study of Adolescent and Adult Health (Add Health) with a sample of 5,728 youth of European ancestry. Early family socioeconomic adversity and individual education PGS were associated with life stage-specific educational outcomes through additive and cascading processes linked to young adults' economic outcomes (personal earnings) through a cumulative process. A GxE moderation existed between individuals' education PGS and early socioeconomic adversity at multiple life stages, explaining variation in adolescent educational outcomes. Both early socioeconomic adversity and education PGS were persistently associated with youth's educational and economic outcomes throughout the early life course. In sum, the findings based on the integrated life course model showed how additive, cascading, and cumulative processes were related and conditioned one another, generating specific life course patterns and outcomes. The findings highlight the value of incorporating molecular genetic information into longitudinal developmental life course research and provide insight into malleable characteristics and appropriate timing for interventions addressing youth developmental characteristics.

Long-Term Physical Health Consequences of Financial and Marital Stress in Middle-Aged Couples.

OBJECTIVE: To examine psychological health as a mechanism linking economic pressure and marital instability in the early middle years to poor physical health in later life. BACKGROUND: Although previous research suggests that sustained stressful marital experience may lead to mental and physical health problems, little is known about how contextual factors, such as economic pressure, impact marital outcomes, and how changes in marital attributes influence health outcomes in a longitudinal and dyadic context. METHOD: Utilizing an actor-partner interdependence model within a latent growth curve approach and prospective data from couples in enduring marriages, we examined the associations between family economic pressure, marital instability, and mental health over their early middle years (1989-1994) and subsequent physical health in later adulthood (2015). Analyses assessed a couple-level pathway and an individual pathway involving within-spouse and between-spouse effects. RESULTS: During the middle years, family financial difficulties were linked to reduced marital stability, which was associated with increased mental health challenges. The findings also reinforced the salient role of psychological distress for subsequent physical health outcomes as husbands' and wives' anxiety symptoms over their early middle years contributed to declines in their physical health outcomes in later adulthood. A partner effect was noted between husbands' anxiety and wives' physical health. CONCLUSION: For couples, experiences of financial and marital stress in their early middle years can have long-lasting detrimental impacts on their physical health in later adulthood.

Stressful work conditions, positive affect, and physical health of middle-aged couples: A dyadic analysis.

This study investigated actor and partner effects involving middle-aged husbands' and wives' stressful work conditions (SWCs), positive affect (PA), and health outcomes in a dyadic trajectory context in three steps. First, examination of husbands' and wives' individual trajectories showed significant interindividual variations in SWCs and PA over time. Second, a dyadic growth curve model incorporating both husbands' and wives' growth curves of SWCs and PA showed that husbands' and wives' trajectories of SWCs over their early middle years (1991-1994) were negatively associated with their own parallel trajectories of PA independent of depressive symptoms trajectories. Finally, most of the growth factors of PA trajectories of husbands and wives (1991-1994) predicted their own residual changes in physical illness and overall physical health in 2001. In dyadic models, although contemporaneous correlations between most of the study constructs between husbands and wives were significant, all partner effects involving growth parameters of SWCs, PA, and health outcomes were not significant. Most of the indirect effects from SWCs growth factors to health outcomes through PA were significant. The findings suggested that PA was an important health resource for middle-aged husbands and wives that mediates the influence of one's SWCs on own physical health outcomes.

The effect of contextual factors on unintentional injury hospitalization: from the Korea National Hospital Discharge Survey.

BACKGROUND: It has been suggested that health risks are affected by geographical area, but there are few studies on contextual effects using multilevel analysis, especially regarding unintentional injury. This study investigated trends in unintentional injury hospitalization rates over the past decade in Korea, and also examined community-level risk factors while controlling for individual-level factors. METHODS: Using data from the 2004 to 2013 Korea National Hospital Discharge Survey (KNHDS), trends in age-adjusted injury hospitalization rate were conducted using the Joinpoint Regression Program. Based on the 2013 KNHDS, we collected community-level factors by linking various data sources and selected dominant factors related to injury hospitalization through a stepwise method. Multilevel analysis was performed to assess the community-level factors while controlling for individual-level factors. RESULTS: In 2004, the age-adjusted unintentional injury hospitalization rate was 1570.1 per 100,000 population and increased to 1887.1 per 100,000 population in 2013. The average annual percent change in rate of hospitalizations due to unintentional injury was 2.31% (95% confidence interval: 1.8-2.9). It was somewhat higher for females than for males (3.25% vs. 1.64%, respectively). Both community- and individual-level factors were found to significantly influence unintentional injury hospitalization risk. As community-level risk factors, finance utilization capacity of the local government and neighborhood socioeconomic status, were independently associated with unintentional injury hospitalization after controlling for individual-level factors, and accounted for 19.9% of community-level variation in unintentional injury hospitalization. CONCLUSION: Regional differences must be considered when creating policies and interventions. Further studies are required to evaluate specific factors related to injury mechanism.