Association of Serum Vitamin D Status with Prediabetes and Prehypertension in Korean Adults: An Analysis of the 2013–2015 Korea National Health and Nutrition Examination Survey Data

Background@#Recent studies have indicated that vitamin D deficiency is associated with diabetes and hypertension in adults. However, this association has not been sufficiently studied in cases of prediabetes and prehypertension. Thus, this study aimed to clarify the relationship between vitamin D levels and prediabetes and prehypertension in Korean adults. @*Methods@#Data from 1,808 adults aged ≥19 years who participated in the 2013–2015 Korea National Health and Nutrition Examination Survey were included in this study. The odds ratio of prediabetes and prehypertension according to the 25-hydroxyvitamin D (25[OH]D) status was calculated using multivariable logistic regression analysis. @*Results@#Mean serum 25(OH)D levels were significantly different among females with normal glucose levels, prediabetes, and diabetes mellitus. Further, the mean levels were not significantly different in both males and females of all ages with normal blood pressure, prehypertension, and hypertension. In addition, logistic regression analysis showed that serum 25(OH)D levels were not significantly associated with the odds ratio of prediabetes and prehypertension after adjusting for age, sex, smoking, alcohol consumption, physical activity, calcium supplement intake, income, body mass index, systolic blood pressure, and fasting glucose. @*Conclusion@#Serum vitamin D status was not independently associated with the risks of prediabetes and prehypertension in Korean adults.

Associations of Physical Activity and Sitting Time with Serum Vitamin D Status in Korean Adults: Results from the 2014 Korea National Health and Nutrition Examination Survey

Background@#Recent evidence has reported the relationships between 25-hydroxyvitamin D (25[OH]D) insufficiency and chronic diseases. This study examined the association of physical activity and sitting time with vitamin D status. @*Methods@#This study analyzed the data of 1,598 adults aged ≥19 who participated in the 2014 Korea National Health and Nutrition Examination Survey. Vitamin D insufficiency was defined as a serum 25(OH)D level of ≤20 ng/mL. The odds ratios and 95% confidence intervals of vitamin D insufficiency according to physical activity and sitting time were calculated using a multivariable logistic regression analysis. @*Results@#The mean levels of serum 25(OH)D were 16.5 ng/mL in males and 15.2 ng/mL in females, respectively and was significantly higher in the participants with sitting times of <5 hours/day than those with sitting times of ≥5 hours/day. After adjusting for confounding variables, sitting time of <5 hours/day was associated with decreased odds of vitamin D insufficiency as compared with sitting time of ≥5 hours/day in the total participants and females. In addition, the odds ratio for vitamin D insufficiency was significantly lower in the group with sitting times of <5 hours/ day than in the group with sitting times of ≥5 hours/day even among people with low physical activity in the total participants and females. @*Conclusion@#Serum 25(OH)D level was insufficient in the Korean adults and shorter sitting time was related to lower odds ratio of vitamin D insufficiency. Our findings suggest that sitting time is an independent factor of serum vitamin D status.

Variabilities in Weight and Waist Circumference and Risk of Myocardial Infarction, Stroke, and Mortality: A Nationwide Cohort Study

Background@#Evidence regarding the association between variabilities in obesity measures and health outcomes is limited. We aimed to examine the association between variabilities in obesity measures and cardiovascular outcomes and all-cause mortality. @*Methods@#We identified 4,244,460 individuals who underwent health examination conducted by the Korean National Health Insurance Service during 2012, with ≥3 anthropometric measurements between 2009 and 2012. Variabilities in body weight (BW) and waist circumference (WC) were assessed using four indices including variability independent of the mean (VIM). We performed multivariable Cox proportional hazards regression analyses. @*Results@#During follow-up of 4.4 years, 16,095, 18,957, and 30,200 cases of myocardial infarction (MI), stroke, and all-cause mortality were recorded. Compared to individuals with the lowest quartiles, incrementally higher risks of study outcomes and those of stroke and all-cause mortality were observed among individuals in higher quartiles of VIM for BW and VIM for WC, respectively. The multivariable adjusted hazard ratios and 95% confidence intervals comparing the highest versus lowest quartile groups of VIM for BW were 1.17 (1.12 to 1.22) for MI, 1.20 (1.16 to 1.25) for stroke, and 1.66 (1.60 to 1.71) for all-cause mortality; 1.07 (1.03 to 1.12) for stroke and 1.29 (1.25 to 1.33) for all-cause mortality regarding VIM for WC. These associations were similar with respect to the other indices for variability. @*Conclusion@#This study revealed positive associations between variabilities in BW and WC and cardiovascular outcomes and allcause mortality. Our findings suggest that variabilities in obesity measures are associated with adverse health outcomes in the general population.

Variabilities in Weight and Waist Circumference and Risk of Myocardial Infarction, Stroke, and Mortality: A Nationwide Cohort Study

Background@#Evidence regarding the association between variabilities in obesity measures and health outcomes is limited. We aimed to examine the association between variabilities in obesity measures and cardiovascular outcomes and all-cause mortality. @*Methods@#We identified 4,244,460 individuals who underwent health examination conducted by the Korean National Health Insurance Service during 2012, with ≥3 anthropometric measurements between 2009 and 2012. Variabilities in body weight (BW) and waist circumference (WC) were assessed using four indices including variability independent of the mean (VIM). We performed multivariable Cox proportional hazards regression analyses. @*Results@#During follow-up of 4.4 years, 16,095, 18,957, and 30,200 cases of myocardial infarction (MI), stroke, and all-cause mortality were recorded. Compared to individuals with the lowest quartiles, incrementally higher risks of study outcomes and those of stroke and all-cause mortality were observed among individuals in higher quartiles of VIM for BW and VIM for WC, respectively. The multivariable adjusted hazard ratios and 95% confidence intervals comparing the highest versus lowest quartile groups of VIM for BW were 1.17 (1.12 to 1.22) for MI, 1.20 (1.16 to 1.25) for stroke, and 1.66 (1.60 to 1.71) for all-cause mortality; 1.07 (1.03 to 1.12) for stroke and 1.29 (1.25 to 1.33) for all-cause mortality regarding VIM for WC. These associations were similar with respect to the other indices for variability. @*Conclusion@#This study revealed positive associations between variabilities in BW and WC and cardiovascular outcomes and allcause mortality. Our findings suggest that variabilities in obesity measures are associated with adverse health outcomes in the general population.

Association between Periodontitis and Sarcopenia in Korean Adult Population

BACKGROUND: The development of sarcopenia and periodontitis is multifactorial, and several factors that play a role in periodontitis are thought to contribute to sarcopenia. This study evaluated the association between periodontitis and sarcopenia using data from the 2008–2009 Korea National Examination Survey.METHODS: We used the data of 2,340 Korean adults aged more than 65 years from the 2008–2009 Korean National Health and Nutrition Examination Survey. Sarcopenia was defined as the appendicular skeletal muscle mass divided by weight (kg/kg) <2 deviations less than the sex-specific mean for young adults. Periodontal health .was measured using the Community Periodontal Index (CPI), and periodontitis was defined as a CPI score of 3 or 4.RESULTS: Analysis using the chi-square test and linear logistic regression showed that the prevalence of periodontitis increased significantly. The odds ratio (OR) (95% confidence interval [CI]) for sarcopenia was 2.498 (1.366–4.569). After adjusting for age and sex, the OR (95% CI) was 2.430 (1.323–4.465). The OR (95% CI) after adjusting for age, sex, diabetes mellitus, osteoarthritis, osteoporosis, and cancer was 2.168 (1.160–4.051).CONCLUSION: Sarcopenia is a representative lifestyle disease associated with periodontitis. In addition, sarcopenia is related to poor quality of life, especially mobility and usual activity. Therefore, greater attention must be paid to patients with periodontitis and they must be evaluated for sarcopenia to prevent and improve poor quality of life.

The Prevalence of Osteoarthritis and Risk Factors in the Korean Population: The Sixth Korea National Health and Nutrition Examination Survey (VI-1, 2013) / 가정의학회지

BACKGROUND: Knee osteoarthritis is highly prevalent, especially among the elderly. However, its risk factors have not been well identified, especially in the Korean population. This study aimed to assess the epidemiologic characteristics and risk factors of knee osteoarthritis in the Korean population. METHODS: Data of 2,280 (1,295 women) participants of the 2013 Korea National Health and Nutrition Examination Survey aged ≥50 years who underwent knee radiography were analyzed. According to the American College of Rheumatology clinical/radiographic classification criteria, knee osteoarthritis was defined as knee pain and radiographic knee osteoarthritis. The association between risk factors and knee osteoarthritis was analyzed using the chi-square test and binominal logistic regression. RESULTS: The participants had an average age of 62.6 years; 56.8% of them were women. The average body mass index was 24.2 kg/m2, and 296 (13%) participants were diagnosed with knee osteoarthritis. After adjustment for multiple risk factors, age of ≥65 years (adjusted odds ratio [OR], 2.552; 95% confidence interval [CI], 1.868–3.486), female sex (OR, 2.050; 95% CI, 1.275–3.295), obesity (body mass index, ≥25.0 kg/m2; OR, 1.563; 95% CI, 1.191–2.051), hypertension (OR, 1.394; 95% CI, 1.052–1.846), low educational level (lower than or equal to elementary school: OR, 4.761; 95% CI, 2.131–10.635; middle school: OR, 3.184; 95% CI, 1.375–7.369), and low strength exercise frequency (<2 times/wk; OR, 1.829; 95% CI, 1.202–2.784) increased the risk of knee osteoarthritis. CONCLUSION: Old age, sex, obesity, hypertension, low educational level, and low strength exercise frequency were found to be risk factors for knee osteoarthritis.

The Association between Smoking Status and Influenza Vaccination Coverage Rate in Korean Adults: Analysis of the 2010–2012 Korea National Health and Nutrition Examination Survey / 가정의학회지

BACKGROUND: Globally, smoking is one of the biggest challenges in public health and is a known cause of several important diseases. Influenza is preventable via annual vaccination, which is the most effective and cost-beneficial method of prevention. However, subjects who smoke have some unhealthy behaviours such as alcohol, low physical activity, and low vaccination rate. In this study, we analyzed the relationship between smoking status and factors potentially related to the influenza vaccination coverage rate in the South Korean adult population. METHODS: The study included 13,565 participants aged >19 years, from 2010 to 2012 from the Korea National Health and Nutrition Examination Survey data. Univariate analyses were conducted to examine the association between influenza coverage rate and related factors. Multivariate analysis was obtained after adjusting for variables that were statistically significant. RESULTS: The overall vaccination rate was 27.3% (n=3,703). Older individuals (P < 0.0001), women (P < 0.0001), non-smokers (P < 0.0001), light alcohol drinkers (P < 0.0001), the unemployed (P < 0.0001), and subjects with diabetes mellitus (P < 0.0001), hypercholesterolemia (P < 0.0001), and metabolic syndrome (P < 0.0001) had higher influenza vaccination coverage than the others. In multivariate analyses, current smokers and heavy smokers showed lower vaccination rates (odds ratio, 0.734; 95% confidence interval, 0.63–0.854). CONCLUSION: In the current study, smokers and individuals with inadequate health-promoting behaviors had lower vaccination rates than the others did.

Fast Eating Speed Increases the Risk of Endoscopic Erosive Gastritis in Korean Adults / 가정의학회지

BACKGROUND: Fast eating or overeating can induce gastrointestinal diseases such as gastritis. However, the association between gastritis and speed of eating is unclear. The aim of this study was to determine whether eating speed is associated with increased risk of endoscopic erosive gastritis (EEG). METHODS: We carried out a cross-sectional study involving 10,893 adults who underwent a general health checkup between 2007 and 2009. Two groups, EEG patients and EEG-free patients, were compared by using the t-test and the chi-square test. Multiple logistic regression analyses were performed to investigate the association between eating speed and EEG. RESULTS: The group with EEG had a higher proportion of males, average age, body mass index, and percentages of current smokers and risky drinkers than those without EEG. After adjusting for anthropometric, social, and endoscopic parameters, the group with the highest eating speed ( or =15 min/meal) (odds ratio, 1.71; 95% confidence interval, 1.20-2.45). CONCLUSION: High eating speed is an independent risk factor for EEG. Our results indicate the need for further studies to clarify the role of eating speed in gastritis.

The Effectiveness of Short Term Mobile Phone Text Reminders in Improving Compliance among Hypertensive Patients

BACKGROUND: For the effective management of hypertension, drug adherence and life style modification are important. We investigated the effects of mobile phone text-message reminders on compliance and life style modification in patients with hypertension. METHODS: The study was performed at family medicine outpatient clinics at 15 hospitals in South Korea from July 2008 to June 2010. Study subjects included 1,449 patients who were all prescribed candesartan cilexetil. Patients were randomly divided into two groups- mobile phone text-message reminder group and control group. In the reminder group, contents of text messages were recommendations for antihypertensive adherence, exercise, low salt diet, and reduction of weight and alcohol. In the control group, the date of next visit was sent at 10 week. Mobile phone text-messages were sent at 2, 4, 6, 8 and 10 weeks by the coordinating center. Thereafter, they were followed up for 12 weeks. Chi-square test was performed to compare compliance and performance indexes of the two groups. RESULTS: The reminder group had 719 (49.6%) patients vs. 730 (50.4%) patients in the control group. Attendance rate were 92.8% for the reminder group and 94.7% for the control group (P=0.14). 94.7% of the reminder group and 94.0% of the control group took their medication regularly (P=0.59). The target blood pressure was attained in 75.8% of the reminder group and 75.4% of the control group (P=0.87). Similarly, rates of weight loss, decreased alcohol use, increased physical activity and a low salt diet showed no significant differences between the two groups. CONCLUSIONS: In our study, mobile phone text reminders did not show to have any significant positive effect on the management of hypertension.

Relationship between Plasma Lipids and Osteoporosis in Korean Postmenopausal Women

BACKGROUND: Recent studies have suggested associations between cardiovascular diseases (CVD) and osteoporosis and between serum lipids and osteoporosis. However, there are only a few studies about the relationship between bone mineral density (BMD) and serum lipids in Koreans. The aim of this study was to evaluate the correlation of serum lipid levels with osteoporosis in postmenopausal women in Korea. METHODS: This cross-sectional study consisted of 1,093 Korean postmenopausal women who visited a university hospital for medical checkup from March 2007 to March 2009. Anthropometric measurements and blood tests were done for body mass index (BMI), plasma lipids, and fasting glucose. BMD was measured using a dual energy X-ray absorptiometry. Blood pressure was taken. After the subjects were classified into three groups (osteoporosis, osteopenia, or normal) by lumbar or femur BMD, the correlation between serum lipids and BMD was analyzed. RESULTS: Serum high-density lipoprotein cholesterol (HDL-C) levels were significantly lower in the osteoporosis group (52.74+/-13.94 mg/dL) than in the other two groups (osteopenia, 56.22+/-13.40 mg/dL; normal, 56.54+/-13.22 mg/dL; p=0.007) when participants were grouped by lumbar BMD. In addition, serum triglyceride in the osteoporosis group was higher than in the other two groups. The results were statistically significant after adjusting for confounding factors including age, BMI and blood pressure. However, there was no significant difference when grouped by femur BMD. CONCLUSION: With decreasing lumbar BMD, we saw lower HDL-C levels and higher triglyceride levels. Osteoporosis may play a role as a risk factor for CVD through its relationships with lumbar BMD and serum lipids.

The Effect of Gamma-Glutamyltransferase on Impaired Fasting Glucose or Type 2 Diabetes in Korean Men / 당뇨병

BACKGROUND: We sought to determine the association between serum gamma-glutamyltransferase (GGT) levels within the normal range and the risk for development of impaired fasting glucose (IFG) or type 2 diabetes. METHODS: This retrospective cohort study spanned four years (2002~2006) with 1,717 Korean men who underwent periodic health examinations at a university hospital in Incheon, Korea and were not diagnosed with IFG or type 2 diabetes. Fasting plasma glucose levels were measured at the annual health examination. IFG and diabetes were defined as a serum fasting glucose concentration of 100~125 mg/dL and more than 126 mg/dL, respectively. Cox's proportional hazards model was used to evaluate the association between serum GGT levels and development of IFG or type 2 diabetes. RESULTS: There was a strong dose-response relationship between serum GGT levels and the incidence of IFG and diabetes. A total of 570 cases (33.2%) of incident IFG and 50 cases (2.9%) of diabetes were found. After controlling potential predictors, the relative risks for the incidence of IFG for GGT levels or = 51 were 1.00, 0.99, 1.17, 1.23 and 1.38 respectively (P for trend 0.015), and for the incidence of diabetes were 1.00, 1.44, 1.80, 2.55 and 2.58 respectively (P for trend 0.050). CONCLUSION: The risk for development of IFG and type 2 diabetes increased in a dose-dependent manner as serum GGT increased within its normal range in Korean men.

Effect of Barley on Variation of Blood Glucose and Lipid Metabolism / 가정의학회지

BACKGROUND: It is regarded that contemporary Korean diet, the combination of carbohydrates-based Korean traditional diet and the Western eating patterns, increases the vulnerability to chronic diseases such as coronary vascular disease, diabetes mellitus, and hypertension. Therefore, there is a rising interest in carbohydrate sources with low glycemic index; many researches have proven the medical benefits of low glycemic index diet. Barley has recently drawn attention and various benefits of barley, such as improvements of obesity and bowel function, have been suggested. It seems that the beta-glucan, a content of barley helps to lower blood sugar level. This study aimed to evaluate the advantages of barley consumption compared to wheat consumption in blood sugar and blood lipid profile levels. METHODS: Twenty-four healthy Korea University students were randomly assigned to two groups: 12 of barley bread consumption group (treatment group) and 12 of wheat bread consumption group (control group). Both groups took bread on an empty stomach and the changes of their blood sugar and lipid levels were measured, compared, and analyzed every hour for four hours. RESULTS: The blood sugar level one hour later in the barley bread consumption group was statistically low. In addition, the area under curve of the barley bread intake group was found to be statistically smaller. However, the blood lipid profiles between the two groups did not show meaningful difference. CONCLUSION: This study suggests that the consumption of food containing barley could bring various medical benefits to one's health by lowering blood sugar.

The Perspectives on Development of Korean Quality Measurement Tools for Geriatric Hospitals

The payment system such as national long term care insurance for the elderly and per diem rate for geriatric hospitals introduced in 2008 has greatly changed the Korean medical system for the elderly. Therefore, today it would be inevitable to discuss quality assessment of healthcare services provided by nursing facilities and geriatric hospitals in order to effectively establish and operate the introduced systems. Under these circumstances, in an effort to provide elderly people with high-quality medical services with limited resources, it is believed that the quality indicators need to include the following: (1) provision and management of medical services for major health problems; (2) assessment of quality of life for residents; (3) assessment of ADL and rehabilitation services so as to maintain and improve functions; (4) assessment of convenience of living facilities; and (5) assessment of rate of potential avoidable hospitalization in acute care hospitals. Moreover, along with an effort to define roles of nursing facilities and geriatric hospitals, it would be necessary to set up the feasible stepwise strategy through discussions with relevant institutions.

Retraction: A time Series Analysis of the Death Rates and Rectanularization of the Survival Curve, 1970-2010 / 한국역학회지

No abstract available.

Primary Pulmonary Ewing's Sarcoma/Primitive Neuroectodermal Tumor in a 67-year-old Man

Extraskeletal Ewing's sarcoma (EES) is a branch of neuroectodermal tumor (PNET), which is very rare soft tissue sarcoma. We report a case of EES/PNET arising is the lung of a 67-yr-old man. Computed tomography, bone scintigraphy, and positron emission tomography confirmed the mass to have a primary pulmonary origin. The mass showed positive reactivity in the Periodic Acid Schiff (PAS) stain and MIC-2 immunoreactivity in immunohistochemical stain. Fluorescence in situ hybridization (FISH) was performed, which revealed an EWSR1 (Ewing sarcoma breakpoint region 1) 22q12 rearrangement. The diagnosis was confirmed both pathologically and genetically. The mass lesion was resected, and the patient is currently undergoing chemotherapy.

Biomedical Issues of Dietary fiber beta-Glucan

beta-Glucan is a polysaccharide in the form of fiber and the main element of fiber in grains such as barley, oats, yeast and mushrooms. Many studies have examined the efficacy of beta-Glucan in terms of the lipid lowering effects, blood sugar reduction, weight reduction, immune modulator, and anticarcinogenic effect. However, there is no comprehensive review article on the biomedical issues regarding beta-Glucan. The authors searched for systematic reviews and clinical experiments for each relevant topic and reviewed the biomedical effects of beta-Glucan, for the purpose of developing research strategies for the future.

Hypoadiponectinemia and Insulin Resistance are Associated with Nonalcoholic Fatty Liver Disease

We investigated the association between nonalcoholic fatty liver disease (NAFLD) and plasma adiponectin levels and insulin resistance. We recruited study subjects among one hundred and eighty one persons who were examined abdominal ultrasound at routine screening tests. A standard interview (consumption of alcohol and medical history), physical examination (height, weight, waist circumference, and blood pressure), and biochemical study (lipid parameters, aminotransferases, fasting plasma glucose, fasting insulin, and plasma adiponectin) were performed. Subjects who consumed alcohol more than moderate, evidence of viral hepatitis, toxic hepatitis, and serious cardiac, renal, or hepatic disease were excluded. Thirty-eight NAFLD patients and 53 control subjects diagnosed by ultrasound were finally analyzed. The plasma adiponectin level was significantly correlated with HDL-cholesterol (r=0. 38, p<0.001), triglycerides (r=-0.22, p=0.04), fasting insulin (r=-0.37, p<0.01), and insulin resistance by homeostasis model of assessment-insulin resistance (HOMAIR) (r=-0.39, p<0.01), after adjusting for age, sex, and adiposity. Multiple logistic regression analysis indicated that HOMA-IR was a significant predictor of having NAFLD (odds ratio [OR]=2.38; 95% confidence interval [CI]: 1.52-5.74), while adiponectin had a protective effect against NAFLD (OR=0.22; 95% CI: 0.09-0.55). We demonstrated that hypoadiponectinemia and insulin resistance are associated with NAFLD independent of obesity.

Adverse drug reaction in the aged

No abstract available.

Health Service Utilization Patterns Among The Chronically Disabled Aged in Korea

OBJECTIVE: Author hypothesized that the presence of a chronic disease burden would change patients' use of health services. METHODS: This research used 4,020,172 medical payment requests(corrected for duplication) and a subset of 1,342,845 payment requests for chronic disease to analyze the pattern of health services utilization among the aged in Korea in 1991. Chronic disease was defined by ICD-9 codes as used in the US Health Services Interview Survey. Author traced the utilization of primary, secondary and tertiary facilities by diagnoses of patients. Thereafter author compared the utilization of health service by age groups, sex, and patterns of care in the chronically disabled. RESULTS: Our data showed that younger seniors are more likely to self refer to tertiary health care. Men are more likely to use tertiary care. On the other hand, women tend to use more primary care. Inpatient tertiary level service is strongly preferred over secondary or primary health services. Patients with chronically disabled had increased use of tertiary care facilities and more self-referrals for care. Secondary health service appeared to be under used. CONCLUSIONS: Comparing the results of utilization pathway of elder clients showed chronically disabled patients overutilize the health service and pursuit the multi-pathways. Especially, overused tertiary care by the elderly may play a part in overstraining of tertiary medical resources in Korea. Thus, there is a strong necessity to introduce long term care systems for the chronically disabled elderly in Korea.

The Study of Disease Structure and Utilization of Health Care Facility in the Elderly

BACKGROUND: Rapid progress in medical science and technology has lengthened the average span of life in general population and accelerated the increase in the elderly. This gave rise to the expansion of chronic degenerative disease in the elderly, and then led to an increase in the utilization rate of health care facility and medical fee in sequence. METHODS: In order to grope for an effective control program of chronic degenerative disease and to find out the characteristics of disease structure and utilization patterns of health care facility in the elderly, the author analysed the 6,072,196 cases of insured medical record of Federation of Korean Medical Insurance Societies from January 1st to December 31st of the year 1991. RESULTS: Essential hypertension(5.94%) is the most common disease in the elderly. And what follows are gastritis and duodenitis(4.29%), acute bronchitis and bronchiolitis(3.68%), acute upper respiratory infection of multiple or unspecified site(3.47%) and diabetes mellitus(3.21%). Twenty most frequent diseases constitute the top 50.27% and one hundred constitute over 85% of all frequency of health care facility utilization. There are different patterns of diseases between two sexes. Pulmonary tuberculosis, chronic liver disease and cirrhosis, malignant neoplasm of stomach, chronic obstructive pulmonary disease, occlusion of cerebral arteries, sprains and strains of knee and leg, malignant neoplasm of trachea, bronchus and lung, other open wound of head, erythematosquamous dermatosis are more than 1.5 times higher in male by the standardized frequency ratio. There is a significant dissimilarity of disease structure between primary and other types of health care facility, which presents the point of reinforcement in primary care. The author has also noted elderly patients prefer secondary or tertiary health care facility in case of essential hypertension, diabetes mellitus, pulmonary tuberculosis, heart failure, duodenal ulcer, chronic liver disease and cirrhosis, funtional gastrointestinal disorder, hypertensive heart disease and chronic obstructive pulmonary disease which seems to be not so critical in most cases. CONCLUSIONS: Patients of chronic degenerative disease tend to pursue the high quality of medical care and irregularly utilize health care delivery system.