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Purpose@#We analyzed the incidence and prevalence of neovascular age-related macular degeneration (AMD) and the treatment patterns of AMD in response to changes in health insurance policies in South Korea. @*Methods@#We retrospectively analyzed the incidence and prevalence of neovascular AMD in patients diagnosed between 2010 and 2019. Data were extracted from the Korean National Health Insurance System database. The incidence and prevalence per 10,000 person-years and corresponding 95% confidence intervals were calculated. Furthermore, we recorded the usage of ranibizumab and aflibercept among newly diagnosed patients with neovascular AMD between 2010 and 2014. @*Results@#In total, 90,012 patients were diagnosed with neovascular AMD between 2010 and 2019. The incidence of neovascular AMD increased with age, except for individuals aged ≥ 90 years. The prevalence of neovascular AMD increased significantly from 30.29 per 10,000 person-years in 2010 to 50.8 per 10,000 person-years in 2019. The rate of intravitreal ranibizumab injections decreased following the introduction of aflibercept in 2014. Patients who switched from ranibizumab to aflibercept exhibited a higher drug switch rate than those who switched from aflibercept to ranibizumab (28.83% vs. 8.40%). Among newly diagnosed patients, approximately 65% received treatment covered by the health insurance system. On average, six injections were administered per year between 2010 and 2019; the number of injections increased in accordance with the maximum limit supported by the government. @*Conclusions@#The incidence and prevalence of neovascular AMD demonstrated an increasing trend. The treatment patterns are influenced by changes in government funding support policies. These findings provide valuable information for planning neovascular AMD treatment.
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Background@#The long-term care (LTC) group has higher rates of chronic disease and disability registration compared to the general older people population. There is a need to provide integrated medical services and care for LTC group. Consequently, this study aimed to identify medical usage patterns based on the ratings of LTC and the characteristics of benefits usage in the LTC group. @*Methods@#This study employed the National Health Insurance Service Database to analyze the effects of demographic and LTC-related characteristics on medical usage from 2015 to 2019 using a repeated measures analysis. A longitudinal logit model was applied to binary data, while a linear mixed model was utilized for continuous data. @*Results@#In the case of LTC ratings, a positive correlation was observed with overall medical usage. In terms of LTC benefit usage characteristics, a higher overall level of medical usage was found in the group using home care benefits. Detailed analysis by medical institution classification revealed a maintained correlation between care ratings and the volume of medical usage. However, medical usage by classification varied based on the characteristics of LTC benefit usage. @*Conclusion@#This study identified a complex interaction between LTC characteristics and medical usage. Predicting the requisite medical services based on the LTC rating presented a challenge. Consequently, it becomes essential for the LTC group to continuously monitor medical and care needs, even after admission into the LTC system. To facilitate this, it is crucial to devise an LTC rating system that accurately reflects medical needs and to broaden the implementation of integrated medical-care policies.
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Background@#Although it is known that inhaled corticosteroid (ICS) use may increase the risk of respiratory infection, its influence on the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains unknown. Thus, the aim of this study was to investigate the association between ICS use and the positivity of SARS-CoV-2 infection among patients with chronic respiratory diseases. @*Methods@#Nationwide data of 44,968 individuals with chronic respiratory diseases tested for SARS-CoV-2 until May 15, 2021 were obtained from the Ministry of Health and Welfare and Health Insurance Review and Assessment Service in Korea. The positivity of SARS-CoV-2 infection was retrospectively analysed according to the prescription, type, and dose of ICS taken one year before SARS-CoV-2 test. @*Results@#Among 44,968 individuals tested, 931 (2.1%) were positive for SARS-CoV-2. A total of 7,019 patients (15.6%) were prescribed ICS one year prior to being tested for SARS-CoV-2. Low, medium, and high doses of ICS were prescribed in 7.5%, 1.6%, and 6.5% of total cases, respectively. Among types of ICS, budesonide, fluticasone, beclomethasone, and ciclesonide were prescribed in 3.7%, 8.9%, 2.3%, and 0.6% of total cases, respectively. A multivariate analysis showed no significant increase in infection with ICS use (odds ratio, 0.84; 95% confidence interval, 0.66–1.03). Moreover, there were no associations between the positivity of infection and the dose or type of ICS prescribed. @*Conclusion@#Prior ICS use did not increase the positivity for SARS-CoV-2 infection. Moreover, different doses or types of ICS did not affect this positivity.
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Background@#Early-onset dementia (EOD) is still insufficiently considered for healthcare policies. We investigated the effect of socio-environmental factors on the long-term survival of patients with EOD. @*Methods@#This retrospective cohort study utilized the Korean National Health Insurance Database from 2007 to 2018. We enrolled 3,825 patients aged 40 to 65 years old with all types of dementia newly diagnosed in 2009 as EOD cases. We defined socioeconomic status using the national health insurance premium (NHIP) levels. Residential areas were classified into capital, metropolitan, city, and county levels. All-cause mortality was the primary outcome. Kaplan-Meier curves and log-rank tests were employed. Further, Cox-proportional hazards models were established. @*Results@#The mean survival of the fourth NHIP level group was 96.31 ± 1.20 months, whereas that of the medical-aid group was 85.53 ± 1.30 months (P < 0.001). The patients living in the capital had a mean survival of 95.73 ± 1.34 months, whereas those living in the county had 89.66 ± 1.75 months (P = 0.035). In the Cox-proportional hazards model, the medical-aid (adjusted hazard ratio [aHR], 1.67; P < 0.001), first NHIP level (aHR, 1.26; P = 0.012), and second NHIP level (aHR, 1.26; P = 0.008) groups were significantly associated with a higher long-term mortality risk. The capital residents exhibited a significantly lower long-term mortality risk than did the county residents (aHR, 0.82; P = 0.041). @*Conclusion@#Socioeconomic status and residential area are associated with long-term survival in patients with EOD. This study provides a rational basis for establishing a healthcare policy for patients with EOD.
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Background@#Diabetes is a leading cause of death that is responsible for 1.6 million annual deaths worldwide. However, the life expectancy and age at death of people with diabetes have been a matter of debate. @*Methods@#The National Health Insurance Service claims database, merged with death records from the National Statistical Information Service in Korea from 2006 to 2018, was analyzed. @*Results@#In total, 1,432,567 deaths were collected. The overall age at death increased by 0.44 and 0.26 year/year in the diabetes and control populations, respectively. The disparity in the mean age at death between the diabetes and control populations narrowed from 5.2 years in 2006 to 3.0 years in 2018 (p<0.001). In a subgroup analysis according to the presence of comorbid diseases, the number and proportion of deaths remained steady in the group with diabetes only, but steadily increased in the groups with diabetes combined with dyslipidemia and/or hypertension. Compared to the control population, the increase in the mean death age was higher in the population with diabetes. This trend was more prominent in the groups with dyslipidemia and/or hypertension than in the diabetes only group. Deaths from vascular disease and diabetes decreased, whereas deaths from cancer and pneumonia increased. The decline in the proportion of deaths from vascular disease was greater in the diabetes groups with hypertension and/or dyslipidemia than in the control population. @*Conclusion@#The age at death in the population with diabetes increased more steeply and reached a comparable level to those without diabetes.
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Background@#Clostridioides (Clostridium) difficile is an important pathogen that causes diarrhea in people who take antibiotics. The recent status of C. difficile infection is not wellknown in Korea. @*Methods@#The long-term trend of C. difficile infection in Korean hospitals was analyzed using a nationwide sample cohort. The data also included sociodemographic characteristics, disease severity, and healthcare facilities. C. difficile infection was defined by the prescription of oral vancomycin or all metronidazole prescriptions under C. difficile infectious disease code (A047). @*Results@#The rate of C. difficile infection has steadily increased from 0.030% in 2006 to 0.317% in 2015. The increased rate correlated to age (0.033% for 80 years of age) and the Charlson comorbidity index score (0.048% for zero versus 0.378% for three or more points). It differed by the type of medical institution (0.270 % at referral hospitals versus 0.056 % at general hospitals and mental hospitals). @*Conclusion@#The rate of C. difficile infection in Korea is significant in patients with advanced age and disease severity. The results show that C. difficile infection trend has been increasing steadily in Korea.
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Background@#Clostridioides (Clostridium) difficile is an important pathogen that causes diarrhea in people who take antibiotics. The recent status of C. difficile infection is not wellknown in Korea. @*Methods@#The long-term trend of C. difficile infection in Korean hospitals was analyzed using a nationwide sample cohort. The data also included sociodemographic characteristics, disease severity, and healthcare facilities. C. difficile infection was defined by the prescription of oral vancomycin or all metronidazole prescriptions under C. difficile infectious disease code (A047). @*Results@#The rate of C. difficile infection has steadily increased from 0.030% in 2006 to 0.317% in 2015. The increased rate correlated to age (0.033% for 80 years of age) and the Charlson comorbidity index score (0.048% for zero versus 0.378% for three or more points). It differed by the type of medical institution (0.270 % at referral hospitals versus 0.056 % at general hospitals and mental hospitals). @*Conclusion@#The rate of C. difficile infection in Korea is significant in patients with advanced age and disease severity. The results show that C. difficile infection trend has been increasing steadily in Korea.
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OBJECTIVES: The purpose of this study was to compare scaling rates in 16 cities and provinces using data from the Community Health Survey (CHS) and National Health Insurance Service (NHIS). METHODS: This study involved cross-sectional secondary data analysis. A total of 16,646,190 subjects who participated in the CHS and 218,184 subjects in the NHIS were included in the final analysis. The dependent variable was the scaling rate, and the independent variables were sex, age, and 16 regions. The study included individuals aged 19 years or older who received scaling between August 2014 and August 2015 in the past year in the CHS and codes U2232 (scaling) and U2233 (scaling before periodontal treatment) in the NHIS. The total scaling rates were compared between the CHS and NHIS. The differences in scaling rates according to sex, age, and 16 regions were analyzed. RESULTS: The CHS (42.6%) scaling rates were 17.5% higher than the NHIS (25.1%) scaling rates in 16 regions in 2015. The median in the CHS data was in Busan (41.5%), while that in the NHIS data was in Jeonbuk (23.5%). There was no significant difference between scaling rates above and below the median region in the CHS and NHIS. CONCLUSIONS: The results suggested that CHS data, which show a higher rate, should be used to assess and monitor the dental needs of community residents. NHIS data should be used to evaluate community oral health projects. It is necessary to develop health indicators for the community oral health project of input, process, and outcome evaluation.