Differences in Physical Activity Levels by Sociodemographic and Health Risk Factors Among Persons With Disabilities in South Korea.

The World Health Organization (WHO) recommends physical activity for more than 150 minutes a week to improve health and reduce disease burden; however, previous studies have shown a lack of participation among persons with disabilities. Logistic regression analysis was performed on National Health Insurance Service data to analyze the relationship between physical activity levels by disability type and socioeconomic factors. The results showed that women with disabilities exercised 0.663 times compared to men with disabilities (95% confidence interval [CI] = [0.659, 0.668]), and individuals with severe disabilities exercised 0.719 times compared to those with mild disabilities (95% CI = [0.71, 0.727]). Those from the highest income level households (adjusted odds ratio [AOR] = 1.442, 95% CI = [1.424, 1.46]) and the re-employed (AOR = 1.119, 95% CI = [1.095, 1.145]) exercised adequately. Thus, physical activity levels and socioeconomic factors are related in persons with disabilities. Exercise policies and programs are required to support persons with disabilities by income level.

Prevalence and Medical Costs of Intellectual Disabilities and Pervasive Developmental Disorder in Korea: Based on National Health Insurance Service Claims Data from 2007 to 2019.

OBJECTIVE: We aimed to investigate the annual prevalence of intellectual disabilities (ID) and autism spectrum disorder employing claims data registered in Korean National Health Insurance Service. We also estimated the annual average of medical costs incurred from these disorders using same datasets. METHODS: In order to obtain the prevalence, we selected patients diagnosed with ID and pervasive and specific developmental disorders (PDD) from 2007 to 2019. The ensuing annual average of medical costs was also estimated from these patients. RESULTS: The annual prevalence of ID and PDD (per 100,000) between 2007 and 2019 ranged from 56.7 to 78.6 and from 22.0 to 44.6 respectively. Regarding the annual average of total medical expenditure per a patient, the expenditure of the ID group was higher than that of PDD throughout the years, as shown that the ID expenditure ranged from 769.7 to 1,501.2 US dollars as opposed to the PDD expenditure in the range of 312.5 to 570.7 US dollars. The further comparison in relation to income levels elaborated that the medical aid beneficiary group constitutes the highest one and the difference of the expenditure across the remaining income groups was not prominent although the very low group generally ranked the highest over the years. CONCLUSION: The prevalence of ID and PDD constantly increased and the same trend was displayed in ensuing health expenditures throughout the period. This implies that increasing needs exist across these patients with regards to therapeutic interventions, thereby contributing to prioritizing medical policies on national perspectives.

Association between Metabolic Syndrome and Risk of Hypopharyngeal Cancer: A Nationwide Cohort Study from Korea.

This study evaluated the relationship between metabolic syndrome (MS) and the risk of hypopharyngeal cancer. This retrospective cohort study used data from the Korean National Health Insurance Research Database. A total of 4,567,890 participants who underwent a health checkup in 2008 were enrolled. The participants were followed until 2019, and the incidence of hypopharyngeal cancer was analyzed. We evaluated the risk of hypopharyngeal cancer according to the presence of MS, including obesity, dyslipidemia, hypertension, and diabetes, using a multivariate Cox proportional hazards model adjusted for age, sex, alcohol consumption, and smoking. During the follow-up period, 821 were newly diagnosed with hypopharyngeal cancer. MS was inversely associated with the risk of hypopharyngeal cancer (hazard ratio (HR), 0.83 [95% confidence interval (CI), 0.708-0.971]). Large waist circumference and high triglyceride levels among MS elements were both inversely related to the risk of hypopharyngeal cancer (HR: 0.82 [95% CI, 0.711-0.945] and 0.83 [95% CI, 0.703-0.978], respectively). The risk of hypopharyngeal cancer decreased with increasing comorbidity of MS in women (N = 0 vs. N = 1-2 vs. N ≥ 3; HR = 1 vs. HR = 0.511 [95% CI, 0.274-0.952] vs. HR = 0.295 [95% CI, 0.132-0.66]), but not in men. This study may improve our etiological understanding of hypopharyngeal cancer.

Healthcare Utilization and Costs According to Frailty Transitions After Two Years: A Korean Frailty and Aging Cohort Study.

BACKGROUND: Korea's aging population has raised several challenges, especially concerning healthcare costs. Consequently, this study evaluated the association of frailty transitions with healthcare utilization and costs for older adults aged 70 to 84. METHODS: This study linked the frailty status data of the Korean Frailty and Aging Cohort Study to the National Health Insurance Database. We included 2,291 participants who had frailty measured by Fried Frailty phenotype at baseline in 2016-2017 and follow-up in 2018-2019. We conducted a multivariate regression analysis to determine the association between their healthcare utilization and costs by frailty transition groups. RESULTS: After 2 years, changes from "pre-frail" to "frail" (Group 6) and "frail" to "pre-frail" (Group 8) were significantly associated with increased inpatient days (P < 0.001), inpatient frequency (P < 0.001), inpatient cost (P < 0.001 and P < 0.01, respectively), and total healthcare cost (P < 0.001) than "robust" to "robust" (Group 1) older adults. A transition to frailty from "pre-frail" to "frail" (Group 6) resulted in a $2,339 total healthcare cost increase, and from "frail" to "pre-frail" (Group 8), a $1,605, compared to "robust" to "robust" older adults. CONCLUSION: Frailty among community-dwelling older adults is economically relevant. Therefore, it is crucial to study the burden of medical expenses and countermeasures for older adults to not only provide appropriate medical services but also to prevent the decline in their living standards due to medical expenses.

Association between oral cavity cancer and metabolic syndrome.

PURPOSE: Few studies have been conducted on the association between oral cavity cancer and metabolic diseases. This study aimed to investigate the relationship between oral cavity cancer and metabolic diseases. METHODS: This cohort study used the database of the Korean National Health Insurance Service, which contains medical data of 97% of the Korean population. Oral cavity cancer occurred in a total of 2718 patients. Metabolic syndrome was defined according to IDF criteria. The Cox proportional hazard regression model was used. RESULTS: The HR for oral cavity cancer in patients with metabolic syndrome was 1.113(95% CI 1.006-1.232), which was significantly higher than that in normal patients, especially in males (p = 0.0386). When the number of metabolic syndrome factors was ≥ 3, the HR of oral cavity cancer was 1.191(95% CI 1.026-1.383), which was significantly higher than that of 0 metabolic syndrome factors, especially in males (p = 0.0218). When the number of metabolic syndrome factors was ≥ 3, the HR for oral cavity cancer was 1.439(95% CI 1.066-1.942), which was significantly higher than that of 0 metabolic syndrome factors, especially in males aged < 50 years (p = 0.0173). CONCLUSION: Metabolic syndrome increases the risk of oral cavity cancer only in males. In addition, the incidence of oral cavity cancer increased as the number of factors constituting metabolic syndrome increased, only in young males aged < 50 years. Thus, metabolic syndrome is an important risk factor for oral cavity cancer, particularly in young males.

Metabolic Diseases and Risk of Head and Neck Cancer: A Cohort Study Analyzing Nationwide Population-Based Data.

The aim of the study was to investigate the association between metabolic diseases and the risk of head and neck cancer (HNC) using nationwide population-based big data. This retrospective cohort study was conducted using the Korean National Health Insurance Service health checkup database. A total of 4,575,818 participants aged >40 years who received a health checkup in 2008 were enrolled, and we studied the incidence of HNC until 2019. We analyzed the risk of HNC according to the presence of metabolic diseases, such as obesity, dyslipidemia, hypertension, and diabetes. Although metabolic syndrome itself was not associated with HNC, each component of metabolic syndrome was associated with HNC. Underweight and diabetes were risk factors for HNC (HR: 1.694). High total cholesterol and high low-density lipoprotein cholesterol levels were factors that decreased the risk (HR 0.910 and 0.839). When we analyzed men and women separately, low total cholesterol level, low low-density lipoprotein cholesterol level, and hypertension were risk factors only in men. In addition, pre-obesity, obesity, and central obesity decreased the risk only in men. Each metabolic disease affects HNC in different ways. Underweight and diabetes increased the risk of HNC, whereas high total cholesterol and high low-density lipoprotein cholesterol levels decreased the risk of HNC.

Nationwide Rate of Adult ADHD Diagnosis and Pharmacotherapy from 2015 to 2018.

There is a paucity of published literature on the epidemiology of adult attention-deficit/hyperactivity disorder (ADHD). We investigated the time trends of the diagnostic and pharmacotherapy incidence of ADHD, including the first used medication, in the adult population based on a Korean population-based database from 2015 to 2018. The number of diagnosed cases of ADHD significantly increased from 7782 in 2015 to 17,264 in 2018 (p = 0.03), which is 0.02% to 0.04% of the total population. Similarly, the number of pharmacotherapy cases of ADHD significantly increased from 3886 in 2015 to 12,502 in 2018 (p = 0.01), which is 0.01% to 0.03% of total population. The most commonly used medication at the initiation of pharmacotherapy shifted from Penid in 2015 to Concerta in 2018. Furthermore, combination therapy with two or more drugs was the preferred method in 2016-2018. In conclusion, the identified diagnoses and pharmacotherapy incidences were very low, highlighting the need to improve the public's awareness of adult ADHD.

Comparison of Persistence and Adherence Between Adults Diagnosed with Attention Deficit/Hyperactivity Disorder in Childhood and Adulthood.

PURPOSE: Long-term treatment of attention deficit/hyperactivity disorder (ADHD) is important, but adherence and persistence in practice are still suboptimal. To better understand medication compliance for ADHD, we divided adults with ADHD into groups based on their history of childhood and adolescent ADHD, and compared their characteristics, medication adherence and persistence, and associated factors. PATIENTS AND METHODS: This study included participants aged 18-23 years with claims related to ADHD (International Classifications of Diseases 10th edition, F90.0x) and anti-ADHD medication from July 1, 2017 to December 31, 2018, and with a history of any F90.0x claim(s) from January 1, 2007 to June 30, 2017 in the Korean National Health Insurance System Claims database. Participants were divided into those diagnosed with ADHD in childhood and adulthood. Persistence with or without a 30-day gap and adherence according to a medication possession ratio (MPR) >80% were calculated. RESULTS: There were 10,604 patients included in the study. Adults with a childhood diagnosis of ADHD showed significant male predominance, more use of National Health Insurance, and were more often treated by psychiatrists and in hospitals than those with an adulthood diagnosis. Combination therapy was the most common initial treatment in those with an adulthood diagnosis, while monotherapy with Concerta was most common in those with a childhood diagnosis. Both groups had over 60% of participants with an MPR >80% and over 50% with persistence without a 30-day gap. Treatment in a private clinic and initial monotherapy with bupropion were found to be significantly associated with adherence in both groups. CONCLUSION: The significant differences found between these groups add evidence to suggest that adult with ADHD diagnosed in adulthood may be a separate entity from those in childhood. A thorough evaluation at diagnosis and treatment in private clinics may improve medication compliance in this population.

Incidence and Direct Medical Cost of Adjustment Disorder and in Korea Using National Health Insurance Service Claims Data From 2011 to 2017.

OBJECTIVE: We aimed to investigate the annual incidence and direct medical cost of adjustment disorder in general population using the National Health Insurance Service Database (NHID) in Korea. METHODS: To examine the incidence, we selected patients who had at least one medical claim for adjustment disorder and had not been diagnosed in the previous 365 days, from 2010 to 2017. RESULTS: The number of newly diagnosed cases of adjustment disorder from 2011 to 2017 were total 101,922. Annual incidence of adjustment disorder was ranged from 22.0 to 36.8 per 100,000 persons. The incidence of adjustment disorder was found more in female and highest among 70-79 years of age group and medical aid beneficiaries group. Annual prevalence of adjustment disorder was in the range from 95.4 to 116.4 per 100,000 persons. Estimated annual medical cost per person of adjustment disorder was ranged from 162 to 231.4 US dollars. CONCLUSION: From 2011 to 2017, the annual incidence and direct medical cost of adjustment disorder in Korea were increased. Proper information on adjustment disorder will not only allows us to accumulate more knowledge but also lead to more appropriate therapeutic interventions.

Incidence and Direct Medical Cost of Acute Stress Disorder and Post-traumatic Stress Disorder in Korea: Based on National Health Insurance Service Claims Data from 2011 to 2017.

BACKGROUND: We aimed to investigate the annual incidence of trauma and stress-related mental disorder including acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) using the National Health Insurance Service Database. In addition, we estimated direct medical cost of ASD and PTSD in Korea. METHODS: To examine the incidence, we selected patients who had at least one medical claim containing a 10th revision of the International Statistical Classification of Diseases and Related Health Problems code for ASD (F43.0) and PTSD (F43.1) and had not been diagnosed in the previous 360 days, from 2010 to 2017. We estimated annual incidence and the number of newly diagnosed patients of ASD and PTSD. Annual prevalence and direct medical cost of ASD and PTSD were also estimated. RESULTS: The number of newly diagnosed cases of ASD and PTSD from 2011 to 2017 totaled 38,298 and 21,402, respectively. The mean annual incidence of ASD ranged from 8.4 to 13.7 per 100,000 population and that of PTSD ranged from 4.2 to 8.3 per 100,000 population, respectively. The incidence of ASD was found more in females and was highest among the 70-79 years of age group and the self-employed individuals group. The incidence of PTSD was also more common in the female group. However, the incidence of PTSD was highest in the 60-69 years of age group and in the medical aid beneficiaries group. The annual estimated medical cost per person of ASD ranged from 104 to 149 US dollars (USD). In addition, that of PTSD ranged from 310 to 426 USD. CONCLUSION: From 2011 to 2017, the annual incidence and direct medical cost of ASD and PTSD in Korea were increased. Proper information on ASD and PTSD will not only allows us to accumulate more knowledge about these disorders themselves but also lead to more appropriate therapeutic interventions by improving the ability to cope with these trauma related psychiatric sequelae.

Estimating Disability-Adjusted Life Years due to Tuberculosis in Korea through to the Year 2040.

Despite efforts to reduce its incidence, tuberculosis continues to burden the rapidly aging Korean society. This study aimed to investigate the current trend of tuberculosis burden in Korea and its projections to 2040. We used National Health Insurance claims data to calculate the disability-adjusted life years due to tuberculosis in Korea. Disability-adjusted life years were measured by summing the years of life lost and the years lived with disability using an incidence-based approach. We modeled the incidence rates using a time-series model for the projection of disability-adjusted life years accrued from 2020 to 2040. The total disability-adjusted life years due to tuberculosis were 69, 64, 59, and 49 disability-adjusted life years/100,000 population in 2014, 2015, 2016, and 2017, respectively. In both sexes, disability-adjusted life years were the highest in those aged ≥80 years. Projected disability-adjusted life years showed a descending trend from 38 disability-adjusted life years/100,000 in 2020, to 14 disability-adjusted life years/100,000 in 2040. Conversely, the projected disability-adjusted life years increased among females aged ≥80 years. Although the tuberculosis burden in Korea is decreasing, a high burden remains among the elderly. Therefore, interventions targeting those vulnerable are required.