Healthcare quality assessments: no guarantees of same outcomes for different socio-economic stroke patients.

BACKGROUND: Healthcare quality assessment is being conducted in many countries. Although improving health equity is one of the major objectives of medical quality assessment, it is not clear whether different socio-economic statuses show the same health outcomes even in the same medical quality hospitals. No study has directly compared the health outcomes of different socio-economic statuses in the same hospitals nationwide. OBJECTIVE: To determine whether the mortality rate of acute stroke patients differs according to socioeconomic status. METHODS: This study was a retrospective, observational study of patients who were subject to acute stroke quality assessment in 2013. A total of 10 399 stroke cases were included in the study. When evaluating the mortality rate, the researchers analysed 10 228 cases, after excluding 171 cases that were measured twice for the same person. The levels of socio-economic status were divided according to the use of medical benefits, either National Health Insurance (NHI) for general population or Medical Aid (MA) for the vulnerable. The primary outcomes measured according to socio-economic status were in-hospital mortality rate and 1-year follow-up mortality rate of stroke patients. The secondary outcome was the composite performance score. RESULTS: MA recipients had a higher in-hospital mortality rate (12.5 vs. 8.3%, P < 0.001) and 1-year follow-up mortality rate (14.9 vs. 10.8%, P < 0.001) than NHI subscribers. MA recipients had slightly lower scores than NHI subscribers (83.2 vs. 84.4, P = 0.02). In hospitals of the same grade, MA recipients had lower performance scores than NHI subscribers, although the difference was not statistically significant. CONCLUSIONS: There is a difference in mortality and healthcare performance according to socio-economic status in stroke patients in Korea. Efforts to improve equity are needed, including the development and monitoring of equality indicators and developing policies for healthcare equity.

Incidence, inhospital mortality, and readmission among patients with alcoholic hepatitis in Korea: A nationwide study.

BACKGROUND AND AIM: Alcoholic hepatitis (AH) ranks among the most costly diseases in South Korea. However, accurate hospitalization incidence rates, mortality rates, and contributing factors have not been investigated in South Korea. This study aimed to provide the nationwide incidence of hospitalization, inhospital mortality, and readmission rates for South Korean patients with AH. METHODS: Using the Korean Health Insurance Review and Assessment service database, a total of 39 800 inpatient cases from 2008 to 2012 were identified based on the International Classification of Diseases, 10th Revision diagnosis code for AH (K70.1). Standardized hospitalization incidence and mortality rates were calculated, and logistic regression analysis was performed to identify risk factors for inhospital mortality and readmission. Follow-up data for those admitted in 2008 were collected to assess readmissions. RESULTS: The standardized incidence rate for AH hospitalization per 105 person/year decreased from 19 in 2008 to 14 in 2012 (P = 0.001). The annual inhospital mortality rate ranged from 0.2% to 0.5%. Inhospital mortality was significantly higher in older patients (odds ratio [OR], 1.36) and those with cirrhosis (OR, 4.40). The readmission rate for patients admitted in 2008 was 34.0%. Male sex (OR, 1.21) and low economic status (OR, 2.35) were significantly associated with readmission, whereas older age (OR, 0.96), cirrhosis (OR, 0.77), and urban residency (OR, 0.68) were inversely associated with readmission. CONCLUSIONS: This study captured a 5-year epidemiologic period in South Korea of patients with AH to reflect the real burden of AH and to provide valuable information to policy-makers assessing public health priorities.

Synoptic approach to evaluate the effect of temperature on pediatric respiratory disease-related hospitalization in Seoul, Korea.

BACKGROUND: The spatial synoptic classification (SSC) scheme is a daily weather-type classification scheme that is widely used in climatological and epidemiological investigations. We investigated the modification effect of temperature on respiratory disease-related hospital admissions (RAs) in children based on the SSC type. METHODS: Data on RAs among children aged ≤19 years were collected from the National Inpatient Sample (NIS) database between 2011 and 2015 in Seoul, Korea. In this time-series study, we used Poisson generalized linear models allowing for over-dispersion, with stratification by season and each of the seven distinctive SSC types (Dry moderate [DM], Dry polar [DP], Dry tropical [DT], Moist moderate [MM], Moist polar [MP], Moist tropical [MT], and Transition [T]). We investigated the modification effects of temperature by SSC type through seasonal stratification, adjusting for other meteorological conditions, air pollution, and time trends, and considered the delayed effect for up to four consecutive days. We reported the relative risk percentage change with 95% confidence intervals (CIs) of RAs for every 1 °C increase in ambient temperature, by season and SSC type. RESULTS: Of the 8346 RAs overall investigated between 2011 and 2015, there were 5271 [63.2%] RAs in children aged 0-4 years. Overall, on majority of the days, the SSC types were DM (665 days [36.4%]), and DP (371 days [20.3%]). With regard to seasons, the different SSC types were distributed as follows: spring, DM (193 days [42.0%]); summer, MT (193 days [42.0%]); fall, DM (241 days [53.0%]); and winter, DP (228 days [50.6%]). A stronger association between RAs and temperature was observed overall (1.28% [95% CI; 0.04%, 2.53%]), and in spring (2.10% [0.62%, 3.60%]). According to SSC type, increased associations between RAs and temperature were detected with DM (2.20% [0.47%, 3.97%]) condition during spring and DT (2.41% [0.22%, 4.64%]) during fall. In addition, on re-categorizing the SSC types from a temperature or humidity standpoint, a modified association was observed especially in children aged ≤4 years and 5-9 years during spring. CONCLUSIONS: Using temperature variability to distinguish seasonal characteristics, we found that the relationship between temperature and RAs in children varied by SSC type. Application of the SSC scheme as an integrative approach may assist in gaining an understanding of seasonal characteristics and health effects due to temperature change.

Temperature as a risk factor of emergency department visits for acute kidney injury: a case-crossover study in Seoul, South Korea.

BACKGROUND: Previous studies show that escalations in ambient temperature are among the risk factors for acute kidney injury (AKI). However, it has not been adequately studied in our location, Seoul, South Korea. In this study, we aimed to examine the association between ambient temperatures and AKI morbidity using emergency department (ED) visit data. METHODS: We obtained data on ED visits from the National Emergency Medical Center for 21,656 reported cases of AKI from 2010 to 2014. Time-stratified case-crossover design analysis based on conditional logistic regression was used to analyze short-term effects of ambient temperature on AKI after controlling for relevant covariates. The shape of the exposure-response curve, effect modification by individual demographic characteristics, season, and comorbidities, as well as lag effects, were investigated. RESULTS: The odds ratio (OR) per 1 °C increase at lag 0 was 1.0087 (95% confidence interval [CI]: 1.0041-1.0134). Risks were higher during the warm season (OR = 1.0149; 95% CI: 1.0065-1.0234) than during the cool season (OR = 1.0059; 95% CI: 1.0003-1.0116) and even higher above 22.3 °C (OR = 1.0235; 95% CI: 1.0230-1.0239). CONCLUSIONS: This study provides evidence that ED visits for AKI were associated with ambient temperature. Early detection and treatment of patients at risk is important in both clinical and economic concerns related to AKI.

The association of ambient temperature with incidence of cardiac arrhythmias in a short timescale.

The body response time and an association between the exposure to outdoor temperature and cardiac arrhythmia were not fully understood. Hence, we further investigated the association between ambient temperature and the exacerbations of arrhythmia symptoms on a short timescale using the emergency department (ED) visit data. We used a total of 17,088 arrhythmia-related ED visits in Seoul, from 2008 to 2011 and fitted the model adjusting for other meteorological variables and air pollutants under the case-crossover analysis with the same year-month time stratification. The association was presented as an odds ratio (OR) with a 95% confidence interval (CI) by a 5 °C decrease in the ambient temperature. The delay time (h) between exposure and the onset of arrhythmia exacerbation was considered with time blocks for every 3 h as 1-3 h, up to 118-120 h; and daily lags (1 day), from 25-48 h to 97-120 h, as a multi-time average of exposures. The overall association was increased at lag 4-6 h and the increased association was statistically significant at lag 40-42 h (OR 1.027, 95% CI 1.003-1.051) and the adverse association continued at 97-120 h (OR 1.053, 95% CI 1.027-1.080). However, the delay of several days between ambient temperature and body response should be further investigated considering the modification according to varied demographic characteristics or different environmental circumstances.

Influence of ambient temperature and diurnal temperature range on incidence of cardiac arrhythmias.

We investigated the association between ambient temperature and diurnal temperature range (DTR) and the exacerbation of arrhythmia symptoms, using data from 31,629 arrhythmia-related emergency department (ED) visits in Seoul, Korea. Linear regression analyses with allowances for over-dispersion were applied to temperature variables and ED visits, adjusted for various environmental factors. The effects were expressed as percentage changes in the risk of arrhythmia-related ED visits up to 5 days later, with 95 % confidence intervals (CI), per 1 °C increase in DTR and 1 °C decrease in mean temperature. The overall risk of ED visits increased by 1.06 % (95 % CI 0.39 %, 1.73 %) for temperature and by 1.84 % (0.34, 3.37 %) for DTR. A season-specific effect was detected for temperature during both fall (1.18 % [0.01, 2.37 %]) and winter (0.87 % [0.07, 1.67 %]), and for DTR during spring (3.76 % [0.34, 7.29 %]). Females were more vulnerable, with 1.57 % [0.56, 2.59 %] and 3.84 % [1.53, 6.20 %] for the changes in temperature and DTR, respectively. An age-specific effect was detected for DTR, with 3.13 % [0.95, 5.36 %] for age ≥ 65 years, while a greater increased risk with temperature decrease was observed among those aged <65 (1.08 % [0.17, 2.00 %]) than among those aged ≥65 (1.02 % [0.06, 1.99 %]). Cardiac arrest was inversely related with temperature (1.61 % [0.46, 2.79 %]), while other cardiac arrhythmias depended more on the change in DTR (4.72 % [0.37, 9.26 %]). These findings provide evidence that low-temperature and elevated DTR influence the occurrence of arrhythmia exacerbations or symptoms, suggesting a possible strategy for reducing risk by encouraging vulnerable populations to minimize exposure.

The association between wind-related variables and stroke symptom onset: A case-crossover study on Jeju Island.

BACKGROUND: Although several studies have investigated the effects of ambient temperature on the risk of stroke, few studies have examined the relationship between other meteorological conditions and stroke. Therefore, the aim of this study was to analyze the association between wind-related variables and stroke symptoms onset. METHODS: Data regarding the onset of stroke symptoms occurring between January 1, 2006, and December 31, 2007 on Jeju Island were collected from the Jeju National University Hospital stroke registry. A fixed-strata case-crossover analysis based on time of onset and adjusted for ambient temperature, relative humidity, air pressure, and pollutants was used to analyze the effects of wind speed, the daily wind speed range (DWR), and the wind chill index on stroke symptom onset using varied lag terms. Models examining the modification effects by age, sex, smoking status, season, and type of stroke were also analyzed. RESULTS: A total of 409 stroke events (381 ischemic and 28 hemorrhagic) were registered between 2006 and 2007. The odds ratios (ORs) for wind speed, DWR, and wind chill among the total sample at lag 0-8 were 1.18 (95% confidence interval (CI): 1.06-1.31), 1.08 (95% CI: 1.02-1.14), and 1.22 (95% CI: 1.07-1.39) respectively. The ORs for wind speed, DWR, and wind chill for ischemic stroke patients were slightly greater than for patients in the total sample (OR=1.20, 95% CI: 1.08-1.34; OR=1.09, 95% CI: 1.03-1.15; and OR=1.22, 95% CI: 1.07-1.39, respectively). Statistically significant season-specific effects were found for spring and winter, and various delayed effects were observed. In addition, age, sex, and smoking status modified the effect size of wind speed, DWR, and wind chill. CONCLUSIONS: Our analyses showed that the risk of stroke symptoms onset was associated with wind speed, DWR, and wind chill on Jeju Island.

Outdoor temperature changes and emergency department visits for asthma in Seoul, Korea: A time-series study.

BACKGROUND: Extreme temperatures and temperature changes are known indicators of climate change, and large temperature variations for several consecutive days may affect human health such as exacerbating respiratory symptoms. The objective of this study was to determine the association between outdoor temperature change and asthma-related emergency department visits. In particular, this study examined seasonality and identified susceptible populations, such as the elderly. METHODS: The health data for asthma-related emergency department visits were collected from July 1, 2007, to December 31, 2010 in Seoul, Korea, through the National Emergency Department Information System of the National Emergency Medical Center and we defined temperature change as the absolute difference of mean temperature between the current day and the previous day. We applied generalized linear models with an allowance of over-dispersion for quantifying the estimated effects of temperature change on asthma-related emergency department visits, adjusting for meteorological conditions, air pollution, and time trend. RESULTS: In general, temperature change was adversely associated with asthma-related emergency department visits, with a 1-unit increase of temperature change associated with a 3.5% (95% CI 0.7, 6.4%) increase in emergency department visits. In addition, seasonal variation after adjusting for mean temperature and diurnal temperature range had an adverse effect in spring, summer, and fall and a protective effect in winter. Patients aged ≥65 years experienced the most prominent effect during the fall, with a 17.9% (95% CI 4.1, 33.6%) increase in emergency department visits per 1-unit increase of temperature change, whereas the other seasons showed no statistically significant association. CONCLUSIONS: Along with diurnal temperature range, temperature change may be an alternative indicator of climate change. Temperature change variables are well-known and easy to communicate with the public relative to the health effects of outdoor temperature fluctuations.

Association among the exposure to giving knowledge, attitude and practice for handwashing in people residing in Seoul, South Korea: a retrospective cross-sectional study.

OBJECTIVES: Handwashing is known as the most preventive method for various infectious diseases. Health authorities have conducted various campaigns and public relations targeting the general population but few evaluations of these long-term interventions. This study aimed to investigate the association between experience of educational events or public relations (EXEP), attitude towards the effectiveness of handwashing (AEHW) and handwashing practice (HWP). SETTING: Using a population-based cross-sectional study with a complex sample design, we explored the response outcomes of handwashing. Those outcomes were collected biennially using Community Health Survey among the years 2013, 2015, 2017 and 2019. We applied multivariate logistic regression for the association among sociodemographic factors, health conditions, EXEP, AEHW and HWP. PARTICIPANTS: Total participants residing in Seoul were 23 139 (men 44.2%), 23 004 (men 44.4%), 22 955 (men 44.8%) and 22 930 (men 43.9%), in 2013, 2015, 2017 and 2019, respectively. RESULTS: Overall, participants with EXEP are more likely to be women, aged between the 30s and 60s, and with a higher educational level. Particularly, participants with EXEP had an increased association with HWP (OR 1.21, 95% CI 1.19 to 1.33) and AEHW (OR 1.50, 95% CI 1.38 to 1.63). In addition, AEHW also had an increased association with HWP (OR 1.67, 95% CI 1.53 to 1.81). The mediated effect of AEHW to HWP is not determined evidently. CONCLUSION: The results showed that EXEP is positively associated with HWP and AEHW among community-dwelling people. Our results confirm that educational activity can lead to more pronounced behavioural changes only when it forms a positive attitude.

Seroprevalence of SARS-CoV-2 antibodies during the third wave of COVID-19 in the Seoul metropolitan area of Korea.

OBJECTIVES: After the third wave of coronavirus disease 2019 (COVID-19), by mid-February 2021, approximately 0.16% of the Korean population was confirmed positive, which appeared to be among the lowest rates worldwide at that time. However, asymptomatic transmission is challenging for COVID-19 surveillance. Therefore, a community-based serosurvey of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was conducted to understand the effectiveness of Korea's strong containment strategy. METHODS: We collected 5,002 residual sera samples from January 30 to March 3, 2021, from 265 medical facilities in Seoul, 346 in Gyeonggi Province, and 57 in Incheon. Sixty samples from tertiary institutions were excluded. We defined the sub-regions according to the addresses of the medical facilities where the specimens were collected. Elecsys Anti-SARS-CoV-2 was used for screening, and positivity was confirmed using the SARS-CoV-2 sVNT Kit. Prevalence was estimated using sampling weights and the Wilson score interval for a binomial proportion with a 95% confidence interval. RESULTS: Among the 4,942 specimens, 32 and 25 tested positive for COVID-19 in the screening and confirmatory tests, respectively. The overall crude prevalence of SARS-CoV-2 antibodies was 0.51%. The population-adjusted overall prevalence was 0.55% in women and 0.38% in men. The region-specific estimation was 0.67% and 0.30% in Gyeonggi Province and Seoul, respectively. No positive cases were detected in Incheon. CONCLUSIONS: The proportion of undetected cases in Korea remained low as of early 2021. Therefore, an infection control strategy with exhaustive tracing and widespread pre-emptive testing appears to be effective in containing community spread of COVID-19.

Municipal Residence Level of Long-Term PM10 Exposure Associated with Obesity among Young Adults in Seoul, Korea.

BACKGROUND: long-term effects of ambient pollutants used to be defined in cohort studies using biomarkers. Health effects on young adults from long-term exposure to particulate matters (PM) in residential ambiance have received less attention. METHODS: using the data of population-representative aged 19-29 in Seoul, the relationship between obesity and PM10 levels of the living district was examined. We defined obesity as Body Mass Index (BMI) 25 kg/m2 and more. Survey logistic regression was conducted according to individual residence periods in the current municipality. Individual characteristics were adjusted overall and were age-specific; aged 19-24 and 25-29. RESULTS: study population was 3655 (1680 (46%) men and 1933 aged 19-24 (52.9%)) individuals. Relationship between length of residence in municipalities with a greater level of PM10 from 2001-2005 and obesity was increased over the residing period; 10 years ≤ (odds ratio (OR) 1.071, 95% confidence interval (CI) 0.969-1.185), 15 years ≤ (1.120, 1.006-1.247), and 20 years ≤ (1.158, 1.034-1.297) in aged 19-29. Age-specific effects showed slight differences. CONCLUSIONS: Although PM10 levels are currently decreasing, higher levels of PM10 exposure in the residential area during the earlier lifetime may contribute to obesity increase among young adults.

Searching for the Culprit Drugs for Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis from a Nationwide Claim Database in Korea.

BACKGROUND: Ethnic differences exist in relation to culprit drugs for Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). We wanted to determine culprit drugs for SJS and TEN in Korean population. OBJECTIVE: To evaluate culprit drugs for SJS and TEN by applying an algorithm for assessment of drug causality for epidermal necrolysis (ALDEN) in a nationwide administrative database. METHODS: We used the claims database, which included claims data for the entire South Korean population. A retrospective cohort study was conducted by collecting subjects who were first diagnosed with SJS and TEN in 2011. All drugs prescribed to the subjects were reviewed and scored according to the ALDEN score. Drugs with an ALDEN score ≥2 were considered culprit drugs. RESULTS: A total of 187 subjects were included in the culprit drug analysis; 33 very probable, 101 probable, and 57 possible culprit drugs were identified for SJS and TEN according to the ALDEN score. The most frequently suspected culprit drug was allopurinol (19 cases), followed by carbamazepine (17 cases), lamotrigine (13 cases), amoxicillin (9 cases), and dorzolamide (9 cases). Most cases (78.8%, 52 of 66) associated with the use of allopurinol, carbamazepine, lamotrigine, dorzolamide, and methazolamide occurred between 13 and 44 days after initiating the drug. CONCLUSION: We applied the ALDEN score to the claims database to identify possible culprit drugs for SJS and TEN in South Korea. This approach could shed light on research and policymaking for drug adverse reactions.

Particulate Matter Mortality Rates and Their Modification by Spatial Synoptic Classification.

Air pollution levels are highly correlated with temperature or humidity, so we investigated the relationship between PM10 and the spatial synoptic classification (SSC) scheme on daily mortality, according to age group and season. Daily death data for 2000-2014 from Seoul, Korea, were acquired, and time-series analysis was applied with respect to season and to each of seven distinct SSC types: dry moderate (DM); dry polar (DP); dry tropical (DT); moist moderate (MM); moist polar (MP); moist tropical (MT); and transition (T). Modification effects were estimated for daily, non-accidental, cardiovascular, and respiratory mortality between PM10 and SSC types. The following SSC-type-specific increased mortalities were observed, by cause of death: non-accidental mortality: DT (1.86%) and MT (1.86%); cardiovascular mortality: DT (2.83%) and MM (3.00%); respiratory mortality: MT (3.78%). Based on simplified weather types, increased PM10 effects in non-accidental mortality rates were observed in dry (1.54%) and moist (2.32%) conditions among those aged 40-59 years and were detected regardless of conditions in other age groups: 60-74 (1.11%), 75-84 (1.55%), and 85+ (1.75%). The effects of particulate air pollution, by SSC, suggest the applicability of SSC to the comparison and understanding of acute effects of daily mortality based on weather type.

Pre-Existing Disability and Its Risk of Fragility Hip Fracture in Older Adults.

Background: Hip fracture is one of the significant public concerns in terms of long-term care in aging society. We aimed to investigate the risk for the incidence of hip fracture focusing on disability among older adults. Methods: This was a population-based retrospective cohort study, focusing on adults aged 65 years or over who were included in the Korean National Health Insurance Service⁻National Sample from 2004 to 2013 (N = 90,802). Hazard ratios with 95% confidence interval (CIs) were calculated using the Cox proportional hazards model according to disability adjusted for age, household income, underlying chronic diseases, and comorbidity index. Results: The incidence of hip fracture was higher among older adults with brain disability (6.3%) and mental disability (7.5%) than among those with other types of disability, as observed during the follow-up period. Risk of hip fracture was higher among those who were mildly to severely disabled (hazard ratio for severe disability = 1.59; 95% CI, 1.33⁻1.89; mild = 1.68; 95% CI, 1.49⁻1.88) compared to those who were not disabled. Older men with mental disabilities experienced an incidence of hip fracture that was almost five times higher (hazard ratio, 4.98; 95% CI, 1.86⁻13.31) versus those that were not disabled. Conclusions: Older adults with mental disabilities and brain disability should be closely monitored and assessed for risk of hip fracture.

Prevalence of Pressure Injuries Nationwide from 2009 to 2015: Results from the National Inpatient Sample Database in Korea.

This study aimed to investigate the prevalence pattern of pressure injuries (PIs), or 'sores', in South Korea and investigate the factors affecting its development. We estimated the annual prevalence of PIs using the National Inpatient Sample (NIS) data extracted from the Health Insurance Review and Assessment Service (HIRA) database from 2009 to 2015. Multivariable logistic regression was performed to examine the association between hospitalization and socio-demographic characteristics, such as sex, age, type of health insurance, Charlson Comorbidity Index (CCI), and plegia comorbidity. We found that inpatients with PIs make up to 0.86% of the total population in South Korea in 2015, which had shown a steady increase from the previous years. And male, old age, low socioeconomic status (SES), and the patients' severity such as high CCI and the plegia comorbidity were strongly associated with hospitalization due to PI. Based on our results, it would be anticipated that the medical cost for treatment and management of PIs will increase in the future, and it will be accelerated due to the rapidly aging society. In addition, patients in low SES and patients with severe comorbidities would be relatively more burdensome, threatening their household economy and further reducing the quality of life. Therefore, PIs should not be overlooked as the responsibility of just the nursing care professionals but should be recognized as one of the serious societal problems. The establishment of an intense medical care system is needed not only to reduce the prevalence of PIs but also to increase the awareness in people with PI patients.

Risk Factors for Vertebral, Hip, and Femoral Fractures Among Patients With Parkinson's Disease: A 5-Year Follow-up in Korea.

OBJECTIVES: To investigate the prevalence and incidence of Parkinson's disease (PD) and provide evidence for preventive strategy of vertebral, hip, and femoral fractures (VF, HF, and FF) in PD patients. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Using a nationwide medical service utility database from 2009 to 2014, we enrolled PD patients with diagnosis of G20 as per ICD-10 who used medical services. Overall, the number of PD patients was 97,311, 106,072, 115,762, 127,647, 137,782, and 144,757 through 2009-2014, respectively. We followed 35,663 patients diagnosed with PD in 2010 without prior fracture. MEASURES: We estimated the annual PD prevalence and incidence and used Cox proportional hazards model to estimate the hazards ratio (HR) for factures based on demographic characteristics, underlying disease, and socioeconomic status according to fracture type (osteoporosis-related fracture, VF, HF/FF). Furthermore, we investigated the cumulative incidence of those fractures by month during the 5-year follow-up. RESULTS: The standardized PD prevalence increased from 238 to 279 between 2009 and 2014, and its incidence decreased from 86 to 72 between 2010 and 2014 per 100,000 population based on 2015 census data. We followed 35,663 PD patients: women, 20,732 (58.1%); aged ≥60 years, 29,264 (82.1%); with osteoporosis, 6542 (18.3%); VF experience, 4242 (11.9%); and HF/FF experience, 2112 (5.9%). Osteoporosis was a significant risk factor for VF [HR 1.75, 95% confidence interval (CI) 1.64-1.87] and HF/FF (HR 1.37, 95% CI 1.24-1.51). The cumulative incidence of VF and HF/FF was the highest at 6 months and increased more than half in the coming 2 years after PD diagnosis. CONCLUSIONS/IMPLICATIONS: VF and HF/FF are common among PD patients. VF and HF/FF risks were high for female PD patients aged ≥60 years with osteoporosis. Fracture prevention strategies should be focused on older, women, and osteoporosis patients within 3 years of PD diagnosis.

Emergency department utilization among people with disabilities in Korea.

BACKGROUND: According to prior studies, it is possible to consider the emergency care utilization due to ambulatory care sensitive conditions (ACSCs) as a proxy measure of access to primary care but there was no confirmed study among people with disabilities. OBJECTIVE/HYPOTHESIS: We examined overall emergency department (ED) utilization patterns among people with disabilities compared with the general population and estimated factors affecting ED utilization. Additionally, we examined whether there were any differences in ED visits due to ACSCs according to type and severity of disability. METHODS: The nationally representative Korean Health Panel Survey was used. Data from 14,616 individuals who participated in the survey from 2008 to 2012 were analyzed. The frequency and causes of emergency visits were examined between individuals with and without disabilities. A generalized regression model with Poisson distribution was applied to identify factors that affect ED visits. RESULTS: In 2012, people with disabilities were about two times as likely to visit the ED compared to people without disabilities, and people with external disability represented the largest proportion of people with disabilities. According to generalized linear model, disability was a strong predictor of ED visits, along with lower education level, being elderly, having a chronic disease, and being less healthy. Overall, ED visits due to ACSCs were about three times higher in the disabled group than in the non-disabled group. CONCLUSIONS: Public health authorities should consider strengthening the primary care system to avoid unnecessary and preventable ED utilization among all Korean people, including people with disabilities.

Demographic and Environmental Factors Associated with Mental Health: A Cross-Sectional Study.

Relevant demographic and environmental conditions need to be understood before tailoring policies to improve mental health. Using community health survey data from 25 communities in Seoul, 2013, cross-sectional associations between mental health and community level environments were assessed. Mental health outcomes (self-rated stress levels (SRS) and depressive symptoms (DS)) were analyzed. Community environmental factors included green space, green facilities, and annual PM10 level (AnnPM10); socio-demographic factors included sex, age, education, labor market participation, comorbidity, sleep hours, physical activity, smoking, and drinking. A total of 23,139 people with the following characteristics participated: men (44.2%); age groups 19-39 (36.0%), 40-59 (39.4%), 60-74 (19.2%), and 75+ (5.4%). Women had higher odds ratios (OR) for SRS [OR 1.22, 95% Confidence interval (CI) 1.17-1.27] and DS [OR 1.55, 95% CI 1.42-1.71]. Regular physical activity predicted SRS [OR 0.90, 95% CI 0.84-0.95] and DS [OR 0.98, 95% CI 0.88-1.10]; current smoking and drinking were adversely associated with both SRS and DS. Higher accessibility to green space (Q4) was inversely associated with DS [OR 0.89, 95% CI 0.81-0.97] compared to lower accessibility (Q1). AnnPM10, annual levels for particles of aerodynamic diameter <10 µm (PM10), among communities was associated with poorer SRS [OR 1.02, 95% CI 1.00-1.04] by 10 µg/m³ increases. Therefore, both demographic and environmental factors should be considered to understand mental health conditions among the general population.

Incidence and factors associated with mortality in 2,476 patients with variant angina in Korea.

This study investigated the incidence and risk factors of mortality in 2,476 patients with variant angina (VA) using the National Health Insurance Service-National Sample Cohort between 2004 and 2011. The risk factors of all-cause and cardiac mortality were investigated using Cox proportional hazards model. Most patients (69.5%) were less than 65 years and 42.9% were women. During the median follow-up duration of 4.9 years, there were 178 (7.2%) and 95 (3.8%) cases of all-cause and cardiac mortality, respectively. Older age, hypertension, diabetes mellitus, poor medication adherence, low household income and tertiary teaching hospitals were independent predictors for all-cause mortality, while older age, hypertension, low household income and tertiary teaching hospitals were independent predictors for cardiac mortality. In conclusion, our findings suggest that traditional risk factor control and continued medication are important to improve VA outcomes, and that household income-level factors should be considered in the assessment of risk of VA patients.

Comprehensive approach to understand the association between diurnal temperature range and mortality in East Asia.

An adverse association between diurnal temperature range (DTR) and mortality has been suggested, but with variable relationships in different cities. Comprehensive approaches to understanding the health effects of DTR using multinational data are required. We investigated the association between DTR and cause-specific mortality in an age-specific population and assessed the dependency of the health effects of DTR on geographic and climatic factors. Poisson generalized linear regression analyses with allowances for over-dispersion were applied to daily DTR and cause-specific mortality data from 30 cities in China, Japan, Korea, and Taiwan between 1979 and 2010, adjusted for various climatic and environmental factors. City-specific effects of DTR were estimated and summarized for the overall effects using geographic and climatic determinants in a meta-analysis. For all-cause, circulatory, and respiratory mortality, the greatest city-specific effects per 1°C DTR were found in Tianjin, China (1.80%; 95% confidence interval [CI]: 0.48, 3.14); Tangshan, China (2.25%; 95% CI: 0.65, 3.87); and Incheon, Korea (2.84%; 95% CI: 0.04, 5.73), respectively, and overall effects across 30 cities were 0.58% (95% CI: 0.44, 0.72), 0.81% (95% CI: 0.60, 1.03), and 0.90% (95% CI: 0.63, 1.18), respectively. Using quartile cutoff values for climatic (DTR, and mean temperature) and geographic (latitude, and longitude) characteristics, we divided the 30 cities into 4 different groups and conducted a meta-analysis within the groups using either a random or fixed effects model. Adverse effects of DTR were more pronounced for those aged ≥65years and varied according to geographic, longitudinal (0.07%; 95% CI: 0.05, 0.10), and climatic characteristics and the scale of DTR (0.33%; 95% CI: 0.12, 0.55) for overall all-cause mortality. The DTR is a risk factor affecting human health, depending on geographic location and the temperature variation, with particular vulnerability in aged populations.