An Analysis of the Determinants of the Health-Related Quality of Life in Asian Patients With Cluster Headaches During Cluster Periods Using the Time Trade-Off Method

Background@#and Purpose Patients with cluster headache (CH) exhibit impaired health-related quality of life (HRQoL). However, there have been few studies related to the HRQoL of patients with CH from Asian backgrounds. This study aimed to determine the impact of CH on HRQoL and to identify the factors affecting HRQoL in patients with CH during cluster periods. @*Methods@#This prospective study enrolled patients with CH from 17 headache clinics in South Korea between September 2016 and February 2021. The study aimed to determine HRQoL in patients with CH using the EuroQol 5 Dimensions (EQ-5D) index and the time trade-off (TTO) method. Age- and sex-matched headache-free participants were recruited as a control group. @*Results@#The study included 423 patients with CH who experienced a cluster period at the time. EQ-5D scores were lower in patients with CH (0.88±0.43, mean±standard deviation) than in the controls (0.99±0.33, p<0.001). The TTO method indicated that 58 (13.6%) patients with CH exhibited moderate-to-severe HRQoL deterioration. The HRQoL states in patients with CH were associated with current smoking patterns, headache severity, frequency, and duration, and scores on the Generalized Anxiety Disorder 7-item scale (GAD-7), Patient Health Questionnaire 9-item scale (PHQ-9), 6-item Headache Impact Test, and 12-item Allodynia Symptom Checklist. Multivariable logistic regression analyses demonstrated that the HRQoL states in patients with CH were negatively correlated with the daily frequency of headaches, cluster period duration, and GAD-7 and PHQ-9 scores. @*Conclusions@#Patients with CH experienced a worse quality of life during cluster periods compared with the headache-free controls, but the degree of HRQoL deterioration varied among them. The daily frequency of headaches, cluster period duration, anxiety, and depression were factors associated with HRQoL deterioration severity in patients with CH.

Relationship between the Level of Local Extinction and Total Medical Service Uses / 보건행정학회지

Background@#The purpose of this study was to explore the relationship between the local extinction index and total medical service utilization. @*Methods@#A fixed effects model in panel analysis was performed for the 228 administrative districts in Korea. The statistical yearbook on the usage of medical services by region and Korean Statistical Information Service data were used from 2010 to 2019 for analysis.Medical service utilization was represented by the number of visits day, the number of inpatient days, and medical charges. Control variables were selected by using an Anderson model. The local extinction index was calculated using resident registration population data. @*Results@#Descriptive statistics showed that the number of areas at risk of extinction increased from 61 to 95 for the study years. In addition, the number of visits, the number of inpatient days, and medical charges all increased during the study years. After controlling for variables affecting medical service utilization and doing a panel fixed effects model, the result suggested that a one-step increase in the local extinction index was significantly associated with a 12.29% decrease in medical charges of inpatients, a 7.33% decrease in medical charge of outpatient, a 5.21% decrease in the number of inpatient day, and a 5.54% decrease in the number of visits day. @*Conclusion@#This study showed that the higher the region’s extinction risks, the higher the region’s total medical service utilization.The results of this study suggested that there was a disparity in medical service utilization between areas at risk of extinction and areas not at risk of extinction, so measures should be taken to address this disparity.

Effects of Diagnosis-Related Group-Based Payment System on the Risk-Adjusted Cesarean Section Rate / 보건행정학회지

Background@#This study analyzed the effect of applying the diagnosis-related group (DRG)-based payment system, which was implemented in July 2012 for hospitals and clinics nationwide, on the cesarean section rate. @*Methods@#The subjects of the study were divided into new groups that participated in the payment system after July 2012 and maintenance groups that participated in the payment system before July 2012. As an analysis method, a difference-in-difference analysis, which is a quasi-experimental design, was used. The risk-adjusted cesarean section rate was used as a dependent variable. @*Results@#Seven risk factors (malpresentation of fetus, eclampsia, multiple pregnancies, problems in the placenta, previous Cesarean section, cephalopelvic disproportion, problems in amniotic fluid) were included in the final risk-adjustment model, and found to have a statistically significant relationship with the cesarean section rate. Results showed that the risk-adjusted cesarean section rate increased significantly in new groups after the application of the DRG-based payment system. @*Conclusion@#Study results provided policy implications for the reorganization of the DRG-based system should that reflects the demands of obstetricians, such as organizing a consultative body with obstetricians and establishing a reasonable fee.

The Effect of the National Health Insurance Coverage of Chuna Therapy on the Costs and Service Uses of Chuna Therapy in Automobile Insurance Oriental Medical Institutions / 보건행정학회지

Background@#The purpose of this study was to analyze the effect of national health insurance coverage of Chuna therapy in April 2019 on the costs and service uses in automobile insurance. @*Methods@#This study used the claim data from Health Insurance Review and Assessment Service. A total of 189,912 inpatients and 1,550,497 outpatients who received Chuna therapy covered by automobile insurance in oriental medical institutions were included.The analysis period was from July 2018 to December 2019, and a total of 18 months before and after April 2019, when Chuna therapy was covered by national health insurance. Interrupted time series analysis was applied to analyze the impact on the costs and service uses of Chuna therapy in automobile insurance before and after April 2019. @*Results@#From July 2018 to December 2019, for 189,912 inpatients the cost and the number of times for Chuna therapy per capita were increased by 22.0% and decreased by 7.3% respectively right after the implementation of the policy. In the case of 1,550,497 outpatients, the cost of Chuna therapy per capita tends to be increased by 0.4% in overall study periods and increased 28.4% immediately after the implementation of the policy. Meanwhile, the number of times and visits for Chuna therapy per capita tends to be increased by 0.4% in overall study periods but decreased by 0.4% after the implementation of the policy. @*Conclusion@#Results suggest that if the national health insurance coverage of oriental medicine services increases according to the policy stance for benefit expansion in national health insurance, the criteria for providing national health insurance benefits should be considered with the comprehensive impacts on the costs and service uses of automobile insurance.

Relationship between Extinction Risk Regions and Amenable Mortality / 보건행정학회지

Background@#This study purposed to analyze the relationship between extinction risk regions and amenable mortality. @*Methods@#This was a cross-sectional study based on the statistics of 2018 which was extracted from the 228 administrative districts in Korea. Cause of death statistics on each region in 2018 was used to produce the age-adjusted amenable mortality. Regional characteristics were measured by demographic factors, health behavior factors, socioeconomic factors, and medical resources factors. Multiple linear regression model was applied to test their relationship. @*Results@#Results showed that extinction risk regions, crude divorce rates, national cancer screening rates, and independent rate of finance were significantly related to the amenable mortality. @*Conclusion@#The study demonstrated differences in health status by the extinction risks of regions. This study suggests that the use of customized community care program can provide integrated services such as housing, health care or the use of information and communications technology which can make early diagnosis.

Relationship between Local Extinction Index and Medical Service Uses of Chronic Diseases / 보건행정학회지

Background@#This study purposed to analyze the relationship between the local extinction index and medical service uses of chronic diseases. The local extinction index is an indicator of the demographic structure and population aging of the region. @*Methods@#The 2014–2018 statistics of National Health Insurance Corporation and Korean Statistical Information Service data were used for the analysis. First, descriptive statistics were used to analyze the general status of research variables. Second, a panel analysis was performed to analyze the relationship between the local extinction index and medical service uses of chronic diseases (hypertension, diabetes mellitus, periodontal disease, arthritis, mental health, epidemic disease, liver disease). Medical service uses were measured by the number of visits/inpatient days and medical charges of seven chronic diseases. @*Results@#Panel analysis results showed that higher local extinction risks (meaning lower local extinction index) had a positive relationship with the number of visits/inpatient days and medical charges of chronic diseases. But the relationships were varied when the seven chronic diseases were analyzed separately. @*Conclusion@#This study showed a significant relationship between the local demographic structure and medical service uses of chronic disease. Analyzing the local demographic structure will be an essential prerequisite step for implementing appropriate regional health care policies.

The Role of Neurologists in Pain Management – Based on the Survey Conducted by the Korean Neurological Association in 2020

Background@#Pain is one of the most common chief complaints in neurological field. Authors try to inform the current situation of pain medicine in neurological practice and present an effective method for pain-related education during neurology residency and for practicing neurologists. @*Methods@#A survey was conducted from November 16 to November 27, 2020 for members of the Korean Neurological Association, and the results were analyzed. @*Results@#About two-thirds of neurologists replied that more than 25% of their patients were suffered from diverse pain including headache, spine pain or neuropathic pain. Despite many patients are visiting to neurologist for pain treatment, most neurologists are aware that they have not received sufficient practical pain education in the past and present. Therefore, they want more educational opportunities in pain medicine including interventional pain management and physical and pharmacologic therapies for more effective treatment. @*Conclusions@#More follow-up studies on pain treatment and education should be conducted. It is also essential that the members of the society continue to interest and participate in the change of the pain education program.

The Role of Neurologists in Pain Management – Based on the Survey Conducted by the Korean Neurological Association in 2020

Background@#Pain is one of the most common chief complaints in neurological field. Authors try to inform the current situation of pain medicine in neurological practice and present an effective method for pain-related education during neurology residency and for practicing neurologists. @*Methods@#A survey was conducted from November 16 to November 27, 2020 for members of the Korean Neurological Association, and the results were analyzed. @*Results@#About two-thirds of neurologists replied that more than 25% of their patients were suffered from diverse pain including headache, spine pain or neuropathic pain. Despite many patients are visiting to neurologist for pain treatment, most neurologists are aware that they have not received sufficient practical pain education in the past and present. Therefore, they want more educational opportunities in pain medicine including interventional pain management and physical and pharmacologic therapies for more effective treatment. @*Conclusions@#More follow-up studies on pain treatment and education should be conducted. It is also essential that the members of the society continue to interest and participate in the change of the pain education program.

Analysis on the Effects of Particular Matter Distribution on the Number of Outpatient Visits for Allergic Rhinitis / 보건행정학회지

Background@#This study aims to analyze the effects of air pollutants, such as particular matter, to the number of outpatient visits for allergic rhinitis in eup, myeon, and dong administrative boundaries. @*Methods@#Dependent variable was the number of outpatient visits for allergic rhinitis per 10,000 people by region. Independent variables were air pollutants such as PM10 , PM2.5, SO2 , O3 , CO2 , NO2 , and temperature that estimated by using Kriging analysis in all eup, myeon, and dong boundaries. Panel analysis was applied for the analysis to prove the relation between outpatient visits and the concentration of air pollutants. @*Results@#Analysis results showed that particular matter concentration varied by regions and season. Panel analysis showed that outpatient visits for allergic rhinitis had positive relationships with PM10 , PM2.5 , SO2 , O3 , and CO2 in all panel models. @*Conclusion@#Regional variation of particular matter concentration should be considered in establishing regional policies for allergic rhinitis.

A Study on the Regional Factors Affecting the Death Rates of Cardio-Cerebrovascular Disease Using the Spatial Analysis / 보건행정학회지

Background@#The purpose of this study was to analyze the relationship between the regional characteristics and the age-adjusted cardio-cerebrovascular disease mortality rates (SCDMR) in 229 si·gun·gu administrative regions. @*Methods@#SCDMR of man and woman was used as a dependent variable using the statistical data of death cause in 2017. As a representative index of regional characteristics, health behavior factors, socio-demographic and economic factors, physical environment factors, and health care factors were selected as independent variables. Ordinary least square (OLS) regression and geographically weighted regression (GWR) were performed to identify their relationship. @*Results@#OLS analysis showed significant factors affecting the mortality rates of cardio-cerebrovascular disease as follows: high-risk drinking rates, the ratio of elderly living alone, financial independence, and walking practice rates. GWR analysis showed that the regression coefficients were varied by regions and the influence directions of the independent variables on the dependent variable were mixed. GWR showed higher adjusted R 2 and Akaike information criterion values than those of OLS. @*Conclusion@#If there is a spatial heterogeneity problem as Korea, it is appropriate to use the GWR model to estimate the influence of regional characteristics. Therefore, results using the GWR model suggest that it needs to establish customized health policies and projects for each region considering the socio-economic characteristics of each region.

Paramagnetic Rims in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder: A Quantitative Susceptibility Mapping Study with 3-T MRI

Background@#and Purpose: Iron retained by activated microglia and macrophages in multiple sclerosis (MS) lesions may serve as a marker of innate immune system activation. Among several magnetic resonance imaging (MRI) methods, there has been recent interest in using quantitative susceptibility mapping (QSM) as a potential tool for assessing iron levels in the human brain. This study examined QSM findings in MS and neuromyelitis optica spectrum disorder (NMOSD) lesions obtained with 3-T MRI to assess imaging characteristics related to paramagnetic rims around brain lesions in MS and NMOSD. @*Methods@#This study included 32 MS and 21 seropositive NMOSD patients. MRI images were obtained using two 3-T MRI devices (Ingenia, Philips Healthcare; and Magnetom Verio, Siemens Healthineers) during routine diagnosis and treatment procedures. Multi and single echo gradient echo magnitude and phase images were obtained for QSM reconstruction.QSM images were used to characterize the detected lesions, and the findings were compared between MS and NMOSD. @*Results@#Totals of 71 and 35 MRI scans were performed during the study period in MS and NMOSD patients, respectively. In QSM images, paramagnetic rims were found in 26 (81.2%) MS patients and 1 (4.8%) NMOSD patient. Eight of the 22 MS patients and only 1 of the 10 NMOSD patients who underwent follow-up MRI showed new paramagnetic rims. The paramagnetic rim lesions appeared after enhancement or in new T2-weighted lesions without enhancement. @*Conclusions@#Paramagnetic rims might be a characteristic MRI finding for MS, and therefore they have potential as an imaging marker for differentially diagnosing MS from NMOSD using 3-T MRI.

A Study on the Relationship between the Spatial Cluster Patterns of Male Suicide Rate and the Regional Characteristics in South Korea / 보건행정학회지

BACKGROUND: Since 2003, Korea has consistently shown the highest suicide rate among the Organization for Economic Cooperation and Development countries, and suicide remains the major cause of death. In particular, men are 2–3 times more likely to commit suicide than women, which called the ‘gender paradox of suicide.’ The areas with frequent suicide have spatially clustered patterns because suicide with a social contagion spreads around the neighborhood. The purpose of this study was twofold. The first was to estimate the hotspot areas of age-standardized male suicide mortality from 2008 to 2015. The second was to analyze the relationship between the hotspot areas and the regional characteristics for study years. METHODS: The data was collected through the Korean Statistical Information Service. The study areas were 227 si · gun · gu administrative districts in Korea. The hotspot area was used as a dependent variable. Socio-demographic variables (number of marriages per 1,000 population, number of divorces per 1,000 population, and urbanization rate), financial variables (financial independence and social security budget), and health behaviors (EuroQol-5 dimension [EQ-5D], and depression experience rate) were used as independents variables. RESULTS: The hotspot areas were commonly located in Gangwon-do, Chungcheongnam-do, Gyeongsangbuk-do, and Chungceongbuk-do. According to the results of panel logit regression, the number of divorces per 1,000 population, social security budget, and EQ-5D were statistically significant variables. CONCLUSION: The results of hotspot analysis showed the need for establishing a prevention zone of suicide using hotspot areas. Also, medical resources could be considered to be preferentially placed in the prevention zone of suicide. This study could be used as basic data for health policymakers to establish a suicide-related policy.

The Impact of Impulsivity on Quality of Life in Early Drug-Naïve Parkinson's Disease Patients

OBJECTIVE: Impulse control disorders (ICDs) in Parkinson's disease (PD) are mostly related to dopamine replacement therapy (DRT); however, drug-naïve PD patients have also frequently experienced impulsivity. This phenomenon makes clinicians hesitate treating patients with DRT. In this study, we assessed the effect of impulsivity on quality of life (QOL) in drug-naïve PD patients. METHODS: Two hundred three newly diagnosed, nonmedicated PD patients were enrolled, and they received structured clinical interviews, physical examinations and validated questionnaires to evaluate motor and nonmotor symptoms and QOL. Impulsivity was evaluated using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS). RESULTS: Thirty-eight patients (18.7%) had impulsivity with QUIP-RS scores ≥ 1 and 4 patients (2.0%) were diagnosed with combined ICDs. Motor and nonmotor symptoms were significantly correlated with the Parkinson's Disease Questionnaire-39 summary index. Female sex and QUIP-RS scores were also correlated with QOL in drug-naïve PD patients. CONCLUSION: The results of the present study showed that impulsivity negatively influences QOL in early drug-naïve PD patients. In addition, more severe motor and nonmotor symptoms were also associated with lower QOL. Such findings complicate treatment but provide valuable information for managing early PD.

Factors related to cancer screening behaviors / 한국역학회지

OBJECTIVES@#This study aimed to investigate the factors related to cancer screening behaviors (CSB).@*METHODS@#The 2014 Korean Community Health Survey used for analysis. The dependent variable was CSB, and the independent variables were demographic, health behavioral, and regional factor. Propensity score matching (PSM) used to control health behavior and regional factors, which were influencing CSB. For statistical analysis, chi-square test and logistic regression analysis used.@*RESULTS@#Logistic regression analysis after PSM showed that gender, age, marital status, educational level, monthly household income, employment type, alcohol drinking, smoking, body mass index group, chronic disease, and subjective health status influenced the CSB, there were statistical differences.@*CONCLUSIONS@#To improve cancer screening (CS), it is necessary to educate individuals on the need for CS and to carry out a personalized CS program based on an individual's demographic status and health behavior.

Factors related to cancer screening behaviors / 한국역학회지

OBJECTIVES: This study aimed to investigate the factors related to cancer screening behaviors (CSB).METHODS: The 2014 Korean Community Health Survey used for analysis. The dependent variable was CSB, and the independent variables were demographic, health behavioral, and regional factor. Propensity score matching (PSM) used to control health behavior and regional factors, which were influencing CSB. For statistical analysis, chi-square test and logistic regression analysis used.RESULTS: Logistic regression analysis after PSM showed that gender, age, marital status, educational level, monthly household income, employment type, alcohol drinking, smoking, body mass index group, chronic disease, and subjective health status influenced the CSB, there were statistical differences.CONCLUSIONS: To improve cancer screening (CS), it is necessary to educate individuals on the need for CS and to carry out a personalized CS program based on an individual's demographic status and health behavior.

Factors related to cancer screening behaviors / 한국역학회지

OBJECTIVES: This study aimed to investigate the factors related to cancer screening behaviors (CSB). METHODS: The 2014 Korean Community Health Survey used for analysis. The dependent variable was CSB, and the independent variables were demographic, health behavioral, and regional factor. Propensity score matching (PSM) used to control health behavior and regional factors, which were influencing CSB. For statistical analysis, chi-square test and logistic regression analysis used. RESULTS: Logistic regression analysis after PSM showed that gender, age, marital status, educational level, monthly household income, employment type, alcohol drinking, smoking, body mass index group, chronic disease, and subjective health status influenced the CSB, there were statistical differences. CONCLUSIONS: To improve cancer screening (CS), it is necessary to educate individuals on the need for CS and to carry out a personalized CS program based on an individual's demographic status and health behavior.

Cardiovascular Biomarkers during Acute Periods of Ischemic Stroke due to Non-Valvular Atrial Fibrillation

BACKGROUND: A subanalysis study of the ENGAGE AF-TIMI 48 trial showed that cardiac troponin I, N-terminal proB-type natriuretic peptide, and D-dimer, were powerful predictors of cerebrovascular adverse events. We aimed to evaluate D-dimer and cardiac troponin I levels during the acute period of ischemic stroke in anticoagulation-naïve patients with non-valvular atrial fibrillation (NVAF) and also studied the association between these biomarkers and stroke severity. METHODS: Consecutive anticoagulation-naïve patients with acute ischemic stroke due to NVAF were enrolled within two days after each stroke event, and all patients were stratified into either moderate-to-severe or mild neurologic deficit groups using the National Institutes of Health Stroke Scale (NIHSS) at admission. RESULTS: A total of 98 patients were enrolled in this study. The median value for the D-dimer was above the upper limit of the normal reference range, but the troponin I value was within the normal range for all patients. After adjusting for CHA2DS2-VASc risk factors, the log-transformed values for D-dimer were positively correlated with an increasing NIHSS score (r=0.233; P=0.051). In the multivariate logistic analysis, the log-transformed D-dimer was positively associated with more severe strokes (odds ratio, 30.1; 95% confidence interval [CI], 1.9–486.2 and 29.7; 95% CI, 2.0–430.8 in the upper two quartiles respectively). The log-transformed values for troponin I did not correlate with the NIHSS score. CONCLUSION: D-dimer levels were higher and an independent risk factor for severe stroke in anticoagulation-naïve patients with NVAF related stroke. In contrast, troponin I levels were normal and were not associated with stroke severity.

Impact of Hospital Specialization on Hospital Charge, Length of Stay and Mortality for Lumbar Spine Disease Inpatients / 보건행정학회지

BACKGROUND: This study investigates association modified category medical specialization (CMS) and hospital charge, length of stay (LOS), and mortality among lumbar spine disease inpatients. METHODS: This study used National Health Insurance Service–cohort sample database from 2002 to 2013, using stratified representative sampling released by the National Health Insurance Service. A total of 56,622 samples were analyzed. The primary analysis was based on generalized estimating equation model accounting for correlation among individuals within each hospital. RESULTS: Inpatients admitted with lumbar spine disease at hospitals with higher modified CMS had a shorter LOS (estimate, −1.700; 95% confidence interval [CI], −1.886 to −1.514; p < 0.0001). Inpatients admitted with lumbar spine disease at hospitals with higher modified CMS had a lower mortality rate (odds ratio, 0.635; 95% CI, 0.521 to 0.775; p < 0.0001). Inpatients admitted with lumbar spine disease at hospitals with higher modified CMS had higher hospital cost per case (estimate, 192,658 Korean won; 95% CI, 125,701 to 259,614; p < 0.0001). However, inpatients admitted with lumbar spine surgery patients at hospitals with higher modified CMS had lower hospital cost per case (estimate, −152,060 Korean won; 95% CI, −287,236 to −16,884; p=0.028). Inpatients admitted with lumbar spine disease at hospitals with higher modified CMS had higher hospital cost per diem (estimate, 55,694 Korean won; 95% CI, 46,205 to 65,183; p < 0.0001). CONCLUSION: Our results showed that increase in hospital specialization had a substantial effect on decrease in hospital cost per case, LOS, and mortality, and on increase in hospital cost per diem among lumbar spine disease surgery patients.

The Spatial Accessibility of Women in Childbearing Age for Delivery Services in Gangwon-do / 보건행정학회지

BACKGROUND: This study purposed to analyze the spatial accessibility of women in childbearing age to the healthcare organizations (HCOs) providing delivery services in Gangwon-do. METHODS: Network analysis was applied to assess the spatial accessibility based on the travel time and road travel distance. Travel time and travel distance were measured between the location of HCOs and the centroid of the smallest administrative areas, eup, myeon, and dong in Gangwon-do. Korean Transport Database Center provided road network GIS (Geographic Information System) Database in 2015 and it was used to build the network dataset. Two types of network analysis, service area analysis and origin-destination (OD)-cost matrix analysis, applied to the created network dataset. Service area analysis defined all-accessible areas that are within a specified time, and OD-cost matrix analysis measured the least-cost paths from the HCOs to the centroids. The visualization of the number of the HCOs and the number of women in childbearing age on the Ganwon-do map and network analysis were performed with ArcGIS ver. 10.0 (ESRI, Redlands, CA, USA). RESULTS: Twenty HCOs were providing delivery services in Gangwon-do in 2016. Over 50% of the women in childbearing age were aged more than 35 years. Service area analysis found that 89.56% of Gangwon-do area took less than 60 minutes to reach any types of HCOs. For tertiary hospitals, about 74.37% of Gangwon-do area took more than 60 minutes. Except Wonju-si and Hoengseonggun, other regions took more than 60 minutes to reach the tertiary hospital. Especially, Goseong-gun, Donghae-si, Samcheok-si, Sokcho-si, Yanggu-gun, Cheorwon-gun, and Taebaek-si took more than 100 minutes to the tertiary hospital. CONCLUSION: This study provided that the accessibility toward the tertiary hospital was limited and it may cause problems in high-risk delivery patients such as over 35 years. Health policy makers will need to handle the obstetric accessibility issues in Gangwon-do.

The Spatial Accessibility of Women in Childbearing Age for Delivery Services in Gangwon-do / 보건행정학회지

BACKGROUND: This study purposed to analyze the spatial accessibility of women in childbearing age to the healthcare organizations (HCOs) providing delivery services in Gangwon-do. METHODS: Network analysis was applied to assess the spatial accessibility based on the travel time and road travel distance. Travel time and travel distance were measured between the location of HCOs and the centroid of the smallest administrative areas, eup, myeon, and dong in Gangwon-do. Korean Transport Database Center provided road network GIS (Geographic Information System) Database in 2015 and it was used to build the network dataset. Two types of network analysis, service area analysis and origin-destination (OD)-cost matrix analysis, applied to the created network dataset. Service area analysis defined all-accessible areas that are within a specified time, and OD-cost matrix analysis measured the least-cost paths from the HCOs to the centroids. The visualization of the number of the HCOs and the number of women in childbearing age on the Ganwon-do map and network analysis were performed with ArcGIS ver. 10.0 (ESRI, Redlands, CA, USA). RESULTS: Twenty HCOs were providing delivery services in Gangwon-do in 2016. Over 50% of the women in childbearing age were aged more than 35 years. Service area analysis found that 89.56% of Gangwon-do area took less than 60 minutes to reach any types of HCOs. For tertiary hospitals, about 74.37% of Gangwon-do area took more than 60 minutes. Except Wonju-si and Hoengseonggun, other regions took more than 60 minutes to reach the tertiary hospital. Especially, Goseong-gun, Donghae-si, Samcheok-si, Sokcho-si, Yanggu-gun, Cheorwon-gun, and Taebaek-si took more than 100 minutes to the tertiary hospital. CONCLUSION: This study provided that the accessibility toward the tertiary hospital was limited and it may cause problems in high-risk delivery patients such as over 35 years. Health policy makers will need to handle the obstetric accessibility issues in Gangwon-do.