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Background Suicide and violence exposure are important health related issues in adolescents. This study aimed to investigate suicide attempt and violence victimization in Korean adolescents with migrant parents. Methods Data from the 2016 to 2018 Korea Youth Risk Behavior Web-based Survey (KYRBS) were used. The migration status of the participating students’ parents was defined based on parental birthplace, classified into the ‘both native Korean parents,’ ‘mother born abroad,’ ‘father born abroad,’ and ‘both parents born abroad’ groups. Suicide attempt and violence victimization included events that occurred in the past 12 months. The general characteristics of the population were investigated using chi-square test. The association between dependent and independent variables was examined using multiple logistic regression analysis, expressed as Odds Ratio (OR) and their 95 percent confidence interval (95% CI). Results Of the 170,575 study participants, 4,012 (2.4%) attempted suicide and 3,038 (1.8%) experienced violence victimization. Highest proportions of suicide attempt and violence victimization were found in adolescents with both migrated parents born abroad. Compared to adolescents with both native Korean parents, individuals with both migrated parents were more likely to attempt suicide (OR 2.28, 95% CI 1.37-3.81) and experience violence victimization (OR 5.63, 95% CI 3.73-8.48). Limitations This study was cross-sectional in design. Information was unavailable on which immigrant generation the study participants belonged to. Conclusion Adolescents with both migrated parents were more likely to attempt suicide and experience violence victimization. The findings have important implications in the management of suicide and violence victimization in adolescents.

Woorim Kim,1,* Yeong Jun Ju,2,3,* Soon Young Lee3 1Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea; 2Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea; 3Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon-si, Gyeonggi-do, Republic of Korea*These authors contributed equally to this workCorrespondence: Soon Young LeeDepartment of Preventive Medicine and Public Health, Ajou University School of Medicine 206 World Cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of KoreaTel +82-31-219-5301Fax +82-31-219-5084Email solee@aumc.ac.krIntroduction: Although women commonly report deterioration of sleep quality postpartum, this relationship has been less studied in East Asian countries. This study investigated the association between recent experience of childbirth and sleep quality in South Korean women and additionally examined how healthy practice behavior interplays in the stated relationship.Methods: Data from the 2018 Community Health Survey were used. Sleep quality was measured using the Pittsburgh sleep quality index (PSQI). Women who responded to have given birth in the past year were categorized as having a recent experience of childbirth. The general characteristics of the study population were investigated using chi-square test. The association between the dependent and independent variables was analyzed using multivariate logistic regression analysis.Results: Of a total of 41,708 study participants, 16,877 (40.5%) individuals reported poor sleep quality. Poor sleep quality was more common in women with a recent experience of childbirth (48.4%) than those without (40.0%). Compared to individuals without a recent experience of childbirth, those with such an experience were more likely to show poor sleep quality (OR 1.50, 95% CI 1.34– 1.68). Such differences were reduced in individuals with a healthy lifestyle.Conclusion: Recent experience of childbirth was associated with higher likelihoods of poor sleep quality in women. The degree of risks found was reduced in individuals practicing a healthy lifestyle habit. The findings infer the need to monitor and address sleep-related disturbances commonly reported among postpartum women.Keywords: sleep quality, sleep disturbances, postpartum, childbirth experience, healthy practice behavior

BACKGROUND Depression is a risk factor for various conditions, including suicide. Considering the high prevalence of fear of falling in the elderly, its association with depression requires examination. This study investigated the relationship between depressive symptoms and fear of falling and falling-induced daily activity restrictions in Koreans aged 60 years or above. METHODS Data from the 2006 to 2018 Korean Longitudinal Study of Ageing were used. Depressive symptoms were measured using the 10-item Centre for Epidemiological Studies Depression (CES-D 10) scale. The general characteristics of the study population were analysed using Chi-square tests. The relationship between the dependent and independent variables were investigated using the generalised estimating equation (GEE) model. RESULTS Of the 2933 study participants, 1086 (37.0%) reported fear of falling but no related restrictions in daily activities, and 399 (13.6%) reported fear of falling plus such restrictions. Compared to individuals without fear of falling, participants with fear of falling but no related activity restriction (odds ratio (OR) 2.08, 95% CI 1.94-2.23) and activity limitations (OR 2.51, 95% CI 2.28-2.75) showed higher likelihoods of depressive symptoms in a stepwise manner after adjustment. CONCLUSION Fear of falling and its induced daily activity restrictions were associated with a higher likelihood of depressive symptoms in older adults. The findings infer the need to implement preventive and moderating measures to address fear of falling and its related negative health effects.

Purpose TNF-α is a transmembrane protein which requires cleavage by ADAM17 in order to act systemically. The activation of ADAM17 to generate soluble TNF‑α results in an increased inflammatory activity. We hypothesized that variants spanning the ADAM17 gene contribute towards the observed variation in patient response defined by the number of changes in TNF‑α inhibitors. Patients and methods Seven single-nucleotide polymorphisms (SNPs) of ADAM17 in 63 patients with rheumatoid arthritis who received TNF-α inhibitors were analyzed: rs57467365, rs62117540, rs117645314, rs6432013, rs532704607, rs117179141, and rs12692386. Univariate and multivariate regression analysis were employed to investigate the independent predictable factors for changes in TNF-α inhibitors. Results ADAM17 rs117645314 and rs117179141 showed significant association with the number of changes in TNF-α inhibitors. Patients with GA in rs117645314 and AT in rs117179141 had significantly higher chance of two or more changes of TNF-α inhibitors than those with wild homozygous alleles. Multivariate analysis showed that rs117179141 explained 5.7% of the 23.8% variability in TNF-α inhibitor response. Conclusion This study showed that the number of changes in TNF-α inhibitor is associated with ADAM17 SNPs.

This study aimed to determine the association between hepatocyte nuclear factor 4 alpha (HNF4A) polymorphisms and bleeding complications in patients on warfarin with international normalized ratios between 2.0 and 3.0 after cardiac valve replacement.Nineteen single nucleotide polymorphisms of HNF4A in addition to VKORC1 rs9934438 and CYP2C9 rs1057910 were analyzed. Univariate and multivariate analyses were conducted to evaluate associations between genetic polymorphisms and bleeding risk. Attributable risk and number needed to genotype (NNG) were calculated to assess clinical value of genotyping.Of 142 patients, 21 experienced bleeding complications. Multivariate logistic regression analysis was conducted using factors with P0.1 in univariate analysis. Multivariate analysis showed that patients with the CC genotype of rs6130615 had an 8.4-fold increased risk of bleeding, compared with patients with the T allele. Attributable risk and NNG were 88.1% and 32.2, respectively. Patients with the TT genotype of rs3212191 had a 3.8-fold increased risk of bleeding, compared with C allele carriers, while patients with variant-type homozygotes for rs1884613 showed an 8.7-fold higher bleeding complication than C allele carriers. The attributable risk/NNG of rs3212191 and rs1884613 were 73.4%/17.6 and 88.5%/22.8, respectively. Among comorbidities, atrial fibrillation was the only significant risk factor for bleeding complications.Bleeding complications during warfarin therapy in patients with mechanical heart valves were associated with HNF4A polymorphisms and atrial fibrillation.

Aim To examine the effect of oral diabetes medication on the risk of dementia in an elderly cohort with type 2 diabetes. Methods This was a population-based cohort study using the Korean National Health Insurance claims data from 2002 to 2013. Elderly subjects (60 years of age or older) with and without type 2 diabetes were included; patients with new-onset type 2 diabetes were further divided into the oral diabetes medication group and no-medication group. Results Among 278,290 patients with type 2 diabetes, 56,587 developed dementia (20.3%) over 11 years of follow-up. Type 2 diabetes was associated with a 1.69-fold increased risk of dementia (95% CI 1.66–1.72). Among patients with newly diagnosed type 2 diabetes, the risk of dementia was lower in the oral diabetes medication group than in the no-medication group (adjusted hazard ratio [aHR], 0.79; 95% CI 0.77–0.81). Lower risk of dementia was particularly noticeable in all of the combination therapy groups and especially lower in the combination therapy group treated with dipeptidyl peptidase 4 inhibitor (aHR 0.48, 95% CI 0.45–0.51). Conclusion Overall, the use of oral diabetes medication in type 2 diabetes patients significantly decreased the risk of dementia.

Aim: This study was designed to identify the possible effects of VEGFA polymorphisms on the occurrence of bleeding complications in patients with mechanical heart valves who have achieved therapeutic international normalized ratio (INR). Materials & methods: 13 SNPs of VEGFA were analyzed. Uni- and multi-variate analyses were conducted to identify associations between polymorphisms and bleeding complications. Results & conclusion: Patients with the CC genotype of rs35410204 had an approximately tenfold higher bleeding complication than those with the T allele. For rs866236, patients who had wild-type homozygotes showed an approximately 2.9-fold higher bleeding complication than C allele carriers. This study demonstrated that bleeding complications during warfarin therapy are associated with VEGFA polymorphisms in patients with mechanical heart valves.

Background Intimate partner violence (IPV) is a serious social problem that is often hidden, unnoticed or ignored. However, few studies have explored the effects of partner violence onset and/or persistence on the mental health of individuals. Thus, we aimed to investigate the association between IPV onset and depressive symptoms in both married men and women. Methods In this study, nationally representative data from the Korea Welfare Panel Study were employed to track 1040 men and 3732 women for a period of six years (2010–2015). Depressive symptoms were scored according to the 11-item Center for Epidemiologic Studies Depression Scale (CES-D-11). Results Of our study population, 415 men (39.9%) and 866 women (23.2%) suffered from continuous intimate partner violence, meaning that they reported experience of IPV in both the previous and current year of investigation. Such subjects had significantly higher CES-D-11 scores (men β: 1.745, p ≤ 0001; women β: 1.970, p ≤ 0001) as did subjects whose partners turned violent from non-violent (men β: 1.623, p ≤ 0001; women β: 1.594, p ≤ 0001) than those with continuously non-violent partners (reference group). Subjects whose partners turned non-violent from violent continued to be more depressed (men β: 0.312, p ≤ 009; women β: 0.880, p ≤ 000) than those with continuously non-violent partners. Through subgroup analysis, we also found that lower SES, as a covariate relative to educational attainment, household income, and economic status, was associated with worsened depression following IPV onset. Unemployed women with consistently violent partners (β: 2.957, p ≤ .0001) and unemployed men with newly violent partners (β: 3.010, p ≤ .0001) were more depressed than the employed or self-employed. Conclusion Our findings reveal that continuous IPV, as well as its onset, can have serious consequences for the mental health of its victims.

Purpose: GATA4 and GATA6 are known to have potential roles in vascular regulation by affecting vascular smooth muscle cell differentiation and atrial natriuretic peptide levels. The aim of this retrospective study was to investigate the associations between GATA4 and GATA6 polymorphisms and bleeding complication risk at a therapeutic international normalized ratio (INR) in patients with mechanical heart valves. Patients and methods: Study patients were included from the Ewha-Severance Treatment (EAST) Group of Warfarin. It consisted of 229 patients who received warfarin therapy after undergoing mechanical heart valve replacement and maintained a stable INR (INR of 2.0-3.0 for at least three consecutive times). Twenty single-nucleotide polymorphisms including VKORC1, CYP2C9, GATA4, and GATA6 were analyzed. Multivariate logistic regression analysis was employed to investigate the independent risk factors for bleeding complications. To evaluate the potential clinical value of genotyping for preventing bleeding complications in patients with high-risk genotype, the number needed to genotype (NNG) was also calculated. Results: One hundred forty-two patients were included in this study, 21 of whom had bleeding complications. After adjusting covariates, TT genotype carriers of rs13273672 in GATA4 and CC genotype carriers of rs10454095 in GATA6 showed 5.0- (95% CI, 1.6-15.7) and 3.1-fold (95% CI, 1.1-8.7) higher bleeding complications than carriers of C allele and T allele, respectively. NNG for preventing one patient from experiencing bleeding complications in patients with TT genotype of rs13273672 and CC genotype of rs10454095 was 22.2 and 17.5, respectively. Patients with both TT genotype in rs13273672 and CC genotype in rs10454095 showed 8.7-fold (95% CI, 1.7-46.1) higher bleeding complications than those with other genotypes. NNG in patients having both TT genotype in rs13273672 and CC genotype in rs10454095 was calculated to be 40.0. Conclusions: This study showed that GATA4 and GATA6 gene polymorphisms could affect bleeding complications during warfarin treatment in patients with mechanical heart valves.

Background: This study investigated trends in cancer-related avoidable (preventable and treatable) mortality and its association with area deprivation in Korea. Methods: Cancer-related avoidable mortality rates per 100,000 population between 2015 and 2019 were measured using the Causes of Death Statistics. Area Deprivation Index (ADI) was measured from the Population and Housing Census and information on other independent variables from the Korea Community Health Survey. The gap in avoidable mortality between the more and less deprived groups was expressed as rate ratios (RR) and absolute differences (ADs) with a 95 percent confidence interval (95% CI). The association between avoidable mortality and ADI was investigated through Poisson regression modelling. Results: The more deprived areas had higher avoidable (RR 1.15, 95% CI 1.13–1.17, AD 6.58, 95% CI 5.59–7.57) and preventable (RR 1.19, 95% CI 1.17–1.21, AD 6.22, 95% CI 5.38–7.06) mortality. The overall cancer-related avoidable mortality decreased but the gap between the more and less deprived groups did not decline significantly during the study period. The association between avoidable and preventable mortality and area deprivation remained significant after adjusting for variables, including area levels of smokers and alcohol drinkers. Conclusions: The gap in avoidable mortality signifies the importance of addressing related disparities in cancer.

Background The Chronic Disease Management Program (CDMP) of Korea has been introduced to improve care continuity in patients with hypertension and diabetes. Objective This study evaluated the cost effectiveness of the CDMP in patients with hypertension from the perspective of the healthcare payer. Methods A cost-effectiveness analysis was performed based on a Markov simulation model. The cost and effect of the CDMP versus usual care was compared in individuals aged 40 years or above. The two strategies were presumed to result in a difference in the incidence of myocardial infarction, stroke, and chronic kidney disease. The model was analyzed over the lifetime of the cohort. Incremental cost-effectiveness ratio (ICER) was calculated by dividing the difference in lifetime costs by the difference in lifetime effects (quality adjusted life years, QALYs) between the two strategies. Costs were expressed in Korean Won (KRW). Results The ICER value of the CDMP participation strategy was −5 761 088 KRW/QALY compared to usual care. Similar tendencies were found when limiting the population to only clinic users (−3 843 355 KRW/QALY) and national health examination participants (−5 595 185 KRW/QALY). Conclusion The CDMP was highly cost-effective in patients with hypertension aged 40 years or above. Implementing efficient policies that enhance care coordination and improve outcomes in patients with hypertension is important.

Background In March 2020, the US Food and Drug Administration decided that the dangers related to neuropsychiatric events (NPEs) of montelukast, one of the leukotriene modifying agents (LTMAs), should be communicated through ‘boxed warning’. In case of NPEs, the prevalence has been the highest in elderly people. Because the characteristics of the elderly such as old age itself can act as risk factors. Therefore, an investigation on safety of LTMAs related to NPEs in elderly using LTMAs is needed. Method A nested case-control study using an elderly sample cohort from the Korean National Health Insurance Service database was used. The asthma cohort included asthma patients newly diagnosed between 2003 and 2013. Within the asthma cohort, the case group was defined as patients who were diagnosed with NPEs. Among patients who had never been diagnosed with NPEs, the control group was selected by matching 1:1 by propensity score. Patients who were prescribed LTMAs for 1 year prior to index date were defined as the exposure group. The logistic regression model was used to measure the effect of LTMAs on NPEs. Results We identified 141,165 patients with newly diagnosed asthma, and selected 31,992 patients per each case and control group. Exposure to LTMAs significantly increased the risk of overall NPEs about in comparison with the absence of exposure (crude odds ratio [OR] 1.58, 95% CI 1.50–1.68). After adjusting for confounding factors, the overall NPEs risk increased (adjusted OR, 1.67, 95% CI 1.58–1.78). Conclusion This study suggests that elderly asthma patients prescribed LTMAs had a higher risk of NPEs than patients who were not treated with LTMAs. Therefore, clinicians should be aware of the potential risks of LTMAs.

The aim of this study is to investigate the association between delays in surgical treatment and five- and one- year mortality in patients with lung or gastric cancer. The National Health Insurance claims data from 2006 to 2015 were used. The association between time to surgical treatment, in which the cut-off value was set at average time (30 or 50 days), and five year mortality was analyzed using the Cox proportional hazard model. Subgroup analysis was performed based on treatment type and location of medical institution. A total of 810 lung and 2659 gastric cancer patients were included, in which 74.8% of lung and 71.2% of gastric cancer patients received surgery within average. Compared to lung cancer patients who received treatment within 50 days, the five-year (HR 1.826, 95% CI 1.437–2.321) mortality of those who received treatment afterwards was higher. The findings were not significant for gastric cancer based on the after 30 days standard (HR: 1.003, 95% CI: 0.822–1.225). In lung cancer patients, time-to-treatment and mortality risk were significantly different depending on region. Delays in surgical treatment were associated with mortality in lung cancer patients. The findings imply the importance of monitoring and assuring timely treatment in lung cancer patients.

Although an elevated INR is highly associated with an increased risk of warfarin-associated bleeding, it has been reported that some patients also experience bleeding complications at therapeutic INRs. TGF-β1 polymorphisms has been reported to cause vascular malformations, resulting in bleeding complications, but there are few published genetic studies regarding bleeding complications in patients on warfarin therapy. This study aimed to determine if there is an association between transforming growth factor beta-1 (TGF-β1) polymorphisms and bleeding complications in patients who maintain international normalized ratios (INRs) of 2.0–3.0 with warfarin therapy after cardiac valve replacement. Eleven single nucleotide polymorphis (SNPs) of TGF-β1 (rs1800469, rs2241718, rs4803455, rs2241717, rs2241716, rs2241715, rs2241714, rs11083616, rs2317130, rs747857, and rs1982073) were analyzed. Univariate and multivariable analyses were conducted to evaluate the associations between genetic polymorphisms and bleeding risk. Attributable risk and the number needed to genotype (NNG) were calculated to identify the potential clinical value of genotyping. A discrimination of model was assessed via an analysis of the area under the receiver operating curve (AUROC). To test the model’s goodness of fit, a Hosmer–Lemeshow test was performed. Of 142 patients, 21 experienced bleeding complications. Among analyzed single nucleotide polymorphis (SNPs) of TGF-β1 (rs1800469, rs2241718, rs4803455, rs2241717, rs2241716, rs2241715, rs2241714, rs11083616, rs2317130, rs747857, and rs1982073), AA genotype carriers in rs2241718 had about 5.5 times more bleeding complications than those with the G allele after adjusting for other confounders. The attributable risk and NNG for rs2241718 were 81.9% and 57.8, respectively. The presence of atrial fibrillation and myocardial infarction increased bleeding complications 3.9- and 9.8-fold, compared with those without atrial fibrillation and myocardial infarction, respectively. Bleeding complications during warfarin therapy in patients with mechanical heart valves were associated with TGF-β1 polymorphisms as well as atrial fibrillation and myocardial infarction.

Lung cancer is a leading cause of cancer-related deaths in many countries, including South Korea. As treatment delays after diagnosis may correlate with survival, this study aimed to investigate the association between time-to-treatment and one-and five-year overall mortality in patients aged 60 years or above. Survival analysis using the Cox proportional hazard model were conducted after controlling for all independent variables. Of a total of 1,535 individuals who received surgical treatment due to lung cancer, 837 patients received treatment within 30 days and 698 after 30 days of initial diagnosis. Individuals who received surgical treatment after 30 days of diagnosis were more likely to die within 1-year (Hazard Ratio, HR: 1.15, 95% Confidence Interval, CI: 1.01-1.32) and 5-year (HR: 1.16, 95% CI: 1.02-1.33) compared to those who received treatment within 30 days. The increase in mortality risk with time delay persisted when applying other cut-off times, including standards at 2, 3, and 6 months. We also found that the mortality rate of lung cancer patients differs depending on age (74 years or younger), household income (

This study investigated the association between physical exercise and cognitive function in Koreans aged 45 years or above without dementia. Data from the 2006 to 2018 Korean Longitudinal Study of Aging (KLoSA) were used. The general characteristics of the study population were investigated using analysis of variance (ANOVA). The association between total exercise time per week and cognitive function, measured based on the Mini-Mental State Examination (MMSE) scores, was investigated using the generalized estimating equation (GEE) model. Subgroup analysis was conducted based on age, educational level, and marital status. A total of 8888 participants were investigated, of which 5173 (58.2%) individuals did not exercise regularly. Among participants who did exercise, 676 (7.6%) individuals were categorized into the Q1, 1157 (13.0%) into the Q2, 908 (10.2%) into the Q3, and 974 (11.0%) into the Q4 group. The mean MMSE score was 26.81 &plusmn, 3.17. Compared to the &lsquo, no&rsquo, exercise group, better MMSE scores were found in the Q1 (&beta, 0.3523, p &le, 0.0001), the Q2 (&beta, 0.2011, p &le, 0.0001), the Q3 (&beta, 0.4075, p &le, 0.0001), and the Q4 groups (&beta, 0.3144, p &le, 0.0001) after adjustment. The magnitude of this association was stronger in participants aged 65 years or above and in single or separated individuals. The findings of this study confirm a positive association between physical exercise and MMSE scores in the middle aged and elderly.

Aims Asian patients are known to be more prone to bleeding complications than patients of other ethnicities. Therefore, there are possibilities of other risk factors that should be given special consideration for dosage adjustment in this specific ethnic group. This study aimed to investigate the risk factors for bleeding complications in Asian patients under appropriate edoxaban dosage regimens. Methods Data on patients taking proper dosages, based on the Lixiana package insert, were analysed. Univariate and multivariable analyses were conducted to evaluate associations between risk factors and bleeding outcomes. Subgroup analysis was performed on high-risk patients for bleeding complications whose edoxaban dose was reduced according to the package insert. Results In total, 346 patients were included. Among them, 32 patients experienced bleeding complications. Patients with weight ≤60 kg and with cancer showed around 3.3- and 3.4-fold increased risk of bleeding complications compared to heavier patients (>60 kg) and those without cancer, respectively. In subgroup analysis with high-risk patients who took low-dose edoxaban (15 and 30 mg), weight ≤60 kg remained a significant factor for bleeding outcomes. Conclusion This study showed that weight ≤60 kg and the presence of cancers could affect bleeding complications, which occurred despite proper edoxaban treatment in Asian patients. Therefore, more strict dosage guideline could be considered in populations with high proportions of Asian ethnicities.

Since South Korea’s 5-year policy of increasing National Health Insurance (NHI) coverage began in 2017, related pharmaceutical expenditures have increased by 41%. Thus, there is a critical need to examine society’s willingness to pay (WTP) for increased premiums to include new anticancer drugs in NHI coverage. Participants aged 20–65 were invited to a web-based online survey. The acceptable effectiveness threshold for a new anticancer drug to be included in NHI coverage and the WTP for an anticancer drug with modest effectiveness were determined by open-ended questions. A total of 1817 respondents completed the survey. Participants with a family history of cancer or a higher perceived risk of getting cancer had significantly higher WTPs (RR [relative risk] = 1.17 and 1.21, both P = 0.012). Participants who agreed on adding coverage for new anticancer drugs with a life gain of 3 months had a higher WTP (RR = 1.70, P < 0.0001). These associations were greater among the employed and low-income groups. The adjusted mean of acceptable effectiveness for a new anticancer drug was 21.5 months (interquartile range [IQR] = 19.3 to 24.0, median = 21.9). The WTP for a new anticancer drug with a life gain of 3 months was $5.2 (IQR = 4.0 to 6.0, median = 4.6). The unrealistic expectations in Korean society for new anticancer agents may provoke challenging issues of fairness and equity. Although Korean society is willing to accept premium increases, our data suggest that such increases would benefit only a small proportion of advanced cancer patients.

This systematic review and meta-analysis aimed to evaluate the impact of COVID-19 on pregnant women. We searched for qualified studies in PubMed, Embase, and Web of Science. The clinical characteristics of pregnant women with COVID-19 and their infants were reported as means and proportions with 95% confidence interval (CI). Nine studies involving with 93 pregnant women with COVID-19 and 103 infants were included in the meta-analysis. Pregnant women with COVID-19 have relatively mild symptoms. However, abnormal proportions of laboratory parameters were similar or even increased, compared to general population. Around 30% of pregnant women with COVID-19 experienced preterm delivery, whereas the mean birth weight was 3214.7g. Fetal death, severe neonatal asphyxia, and detection of SARS-CoV-2 were observed in about 2%, whereas no neonatal death was found. In conclusion, the current review will serve as an ideal basis for future considerations in the treatment and management of COVID-19 in pregnant women.

Objectives This study investigated the relationship between drinking behavior (alcohol consumption frequency, average alcohol intake per drinking session) and the prevalence of metabolic syndrome (MetS) and its components (central obesity, raised triglycerides, decreased HDL cholesterol, raised blood pressure, raised fasting plasma glucose) in Korean men and women above the age of 20. Methods Our study employed data from the Korea National Health and Nutritional Examination Survey (KNHANES) for the years 2007–2013. The study population consisted of a total of 16,507 Korean males and 22,548 females; 30.0% (n = 4908) of all males and 29.8% (n = 6663) of all females were diagnosed with metabolic syndrome. Results Relative to abstaining males, males who consumed alcohol more than 2–3 times per week (OR: 1.32, 95% CI: 1.04–1.66), as well as those who consumed more than 10 drinks per drinking session (OR: 1.71, 95% CI 1.41–2.08) had greatly increased odds risk of MetS. Alcohol consumption frequency was not associated with increased odds risk of MetS for females, however. Relative to abstaining females, females who consumed just 3–4 drinks per session had a 17% increased odds risk of MetS (OR: 1.17, 95% CI: 1.02–1.35). Females consuming more than 10 drinks per drinking session (OR: 1.91, 95% CI 1.44–2.52) were likely to have a 91% increase in odds risk of MetS. For males, alcohol consumption frequency was associated with high blood pressure and high fasting plasma glucose levels, while average alcohol intake per drinking session was associated with central obesity, high triglyceride levels, high blood pressure, and high fasting plasma glucose. For females, alcohol intake per session was associated with central obesity, high triglycerides, raised blood pressure, and high fasting plasma glucose. Conclusions Frequent alcohol consumption and high alcohol intake per drinking session were associated with higher prevalence of MetS and its components for Korean men; alcohol intake per drinking session only was associated with higher prevalence of MetS and its components for Korean women.

Purpose The purpose of this study was to conduct a cost effectiveness analysis of strategies designed to improve national cervical cancer screening rates, along with a distributional cost effectiveness analysis that considers regional disparities. Materials and methods Cost effectiveness analysis was conducted using a Markov cohort simulation model, with quality adjusted life years as the unit of effectiveness. The strategies considered were current (biennial Papanicolaou smear cytology of females aged 20 or above), strong screening recommendation by mail to target regions (effect, 12% increase in screening uptake; cost, 1,000 Korean won per person), regular universal screening recommendation by mail (effect, 6% increase in screening uptake; cost, 500 Korean won per person), and strong universal screening recommendation by mail (effect, 12% increase in screening uptake; cost, 1,000 Korean won per person). Distributional cost effectiveness analysis was conducted by calculating the cost effectiveness of strategies using the Atkinson incremental cost effectiveness ratio. Results All strategies were under the threshold value, which was set as the Korean gross domestic product of $25,990. In particular, the 'strong screening recommendation to target regions' strategy was found to be the most cost effective (incremental cost effectiveness ratio, 7,361,145 Korean won). This was also true when societal inequality aversion increased in the distributional cost effectiveness analysis. Conclusion The 'strong screening recommendation to target regions' strategy was the most cost effective approach, even when adjusting for inequality. As efficiency and equity are objectives concurrently sought in healthcare, these findings imply a need to develop appropriate economic evaluation methodologies to assess healthcare policies.

Introduction The use of electronic cigarettes (e-cigarettes) has increased among adolescents. This study aimed to investigate the relationship between e-cigarette use and different sociodemographic factors among Korean adolescents. Methods The study used the 2017 to 2019 Korea Youth Risk Behavior Web-based Survey (KYRBS) data. The study measured sociodemographic status based on living arrangement, economic status, and parental birthplace. We used a Chi-square test to investigate the general characteristics of the study population. We applied multiple logistic regression analysis to analyze the association between e-cigarette use and sociodemographic status. Model 1 included electronic cigarettes only as the outcome variable and model 2 included electronic cigarettes plus combustible cigarettes. The study expressed results as odds ratios (OR) and their 95% confidence interval (95% CI). Results A total of 2.4% of adolescents used e-cigarettes only and 6.5% e-cigarettes and/or conventional cigarettes. In e-cigarettes users (model 1), compared to individuals living with their parents, those living with their relatives (OR 3.23, 95% CI 2.45–4.24) and in protective facilities (OR 4.36, 95% CI 2.98–6.39) were more likely to smoke. The “middle” showed lower odds than the “low” economic status group (OR 0.78, 95% CI 0.69–0.87). Adolescents with both parents born abroad (OR 2.92, 95% CI 1.78–4.82) also had a higher likelihood of smoking than those with both native Korean parents. The study found similar trends in model 2, which accounted for both electronic and combustible cigarettes. Conclusion E-cigarette use among adolescents was associated with living arrangement, economic status, and parental birthplace. E-cigarettes use among adolescents should be monitored, particularly in the vulnerable groups of adolescents that this study identified.

Background Ensuring and improving long-term care services that use limited healthcare resources more efficiently is a major concern for many aging societies. Objectives The aim of this study was to investigate the relationship between use of home-visit nursing services and all-cause hospitalization in a home-visit nursing-recommended group. Design A retrospective cohort study. Setting Population-based sample of long-term care insurance beneficiaries from the long-term care insurance 2002–2013 claims database in South Korea. Participants Long-term care insurance beneficiaries who need one or more types of nursing care were defined as the home-visit nursing −recommended group (n=4173). Measurements The dependent variable in this study was all-cause hospitalization in the home-visit nursing-recommended population. Multivariate Cox proportional hazards regression analysis was used to identify the association between home-visit nursing service use and all-cause hospitalization. Results A total of 3.8% of the subjects used home-visit nursing services. When participants who used home-visit nursing services were set as the reference group, participants who did not use home-visit nursing services had a higher risk of hospitalization (hazard ratio [HR]=1.25, 95% confidence interval [CI]=1.07–1.47). Additionally, participants who did not use home-visit nursing services and who did not have a caregiver showed a marked increase in the risk of hospitalization (HR=6.81, 95% CI=1.17–39.66). Participants who did not use home-visit nursing services with greater comorbidity showed a considerable increase in risk of hospitalization (HR=1.36, 95% CI=1.09–1.70). Conclusions Non-use of home-visit nursing services was associated with an increased risk of all-cause hospitalization in the home-visit nursing-recommended population. The present results suggest that the use of home-visit nursing services reduced the risk of hospitalization. Moreover, home-visit nursing may play an essential role in reducing hospitalization risk in the absence of caregiver support.

Background We evaluated the effectiveness of a policy allowing for the sale of over-the-counter drugs outside of pharmacies by examining its effect on number of monthly outpatient visits for acute upper respiratory infections, dyspepsia, and migraine. Method We used medical claims data extracted from the Korean National Health Insurance Cohort Database from 2009 to 2013. The Korean National Health Insurance Cohort Database comprises a nationally representative sample of claims - about 2% of the entire population - obtained from the medical record data held by the Korean National Health Insurance Corporation (which has data on the entire nation). The analysis included26,284,706 person-months of 1,042,728 individuals. An interrupted-time series analysis was performed. Outcome measures were monthly outpatient visits for acute upper respiratory infections, dyspepsia, and migraine. To investigate the effect of the policy, we compared the number of monthly visits before and after the policy’s implementation in 2012. Result For acute upper respiratory infections, monthly outpatient visits showed a decreasing trend before the policy (ß = −0.0003);after it, a prompt change and increasing trend in monthly outpatient visits were observed, but these were non-significant. For dyspepsia, the trend was increasing before implementation (ß = −0.0101), but this reversed after implementation(ß = −0.007). For migraine, an increasing trend was observed before the policy (ß = 0.0057). After it, we observed a significant prompt change (ß = −0.0314) but no significant trend. Conclusion Deregulation of selling over-the-counter medication outside of pharmacies reduced monthly outpatient visits for dyspepsia and migraine symptoms, but not acute upper respiratory infections. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2434-6) contains supplementary material, which is available to authorized users.

Background Many studies have assessed the volume-outcome relationship in cancer patients, but most focused on better outcomes in higher volume groups rather than identifying a specific threshold that could assist in clinical decision-making for achieving the best outcomes. The current study suggests an optimal volume for achieving good outcome, as an extension of previous studies on the volume-outcome relationship in stomach cancer patients. Methods We used National Health Insurance Service (NHIS) Sampling Cohort data during 2004–2013, comprising healthcare claims for 2550 patients with newly diagnosed stomach cancer. We conducted survival analyses adopting the Cox proportional hazard model to investigate the association of three threshold values for surgical volume of stomach cancer patients for cancer-specific mortality using the Youden index. Results Overall, 17.10% of patients died due to cancer during the study period. The risk of mortality among patients who received surgical treatment gradually decreased with increasing surgical volume at the hospital, while the risk of mortality increased again in “high” surgical volume hospitals, resulting in a j-shaped curve (mid-low = hazard ratio (HR) 0.773, 95% confidence interval (CI) 0.608–0.983; mid-high = HR 0.541, 95% CI 0.372–0.788; high = HR 0.659, 95% CI 0.473–0.917; ref = low). These associations were especially significant in regions with unsubstantial surgical volumes and less severe cases. Conclusion The optimal surgical volume threshold was about 727.3 surgical cases for stomach cancer per hospital over the 1-year study period in South Korea. However, such positive effects decreased after exceeding a certain volume of surgeries.

Aim This study aimed to investigate the effect of the gap between objective income and subjective financial need on depressive symptoms in individuals aged 60 and older. Methods Data from the 2011 and 2013 Korean Retirement and Income Study were used. A total of 4891 individuals aged 60 and older were included at baseline. The Generalized Estimating Equation model was used to examine the association between the gap in objective income and subjective financial need and the presence of depressive symptoms, which were measured using the Center for Epidemiological Studies Depression Scale. Results Compared to individuals in the middle objective income-middle subjective financial need group, individuals in the low-low category (odds ratio (OR): 1.30, 95% confidence interval (CI): 1.04–1.61) and the low-middle category (OR: 1.26, 95%CI: 1.09–1.45) showed a statistically significant higher likelihood of having depressive symptoms. In contrast, participants in the middle-low (OR: 0.74, 95%CI: 0.54–0.99), high-low (OR: 0.50, 95%CI: 0.34–0.73), high-middle (OR: 0.74, 95%CI: 0.63–0.87), and high-high categories (OR: 0.74, 95%CI: 0.55–0.99) were less likely to exhibit depressive symptoms. Additionally, the lower likelihood of depressive symptoms found in middle- and high-income groups with lower levels of subjective financial need was strong among individuals with chronic disease. Conclusions Differences in the prevalence of depressive symptoms generally exist between individuals of the same income category depending on perceived income adequacy. Therefore, it is important to consider discrepancies in objective income and subjective financial need when assessing risk factors for depressive symptoms in older populations.

This study aimed to investigate the relationship between the unemployment experience and depressive symptoms among mid-aged (ages 45–59) and elderly (ages 60 or above) persons and to examine further the effects of unemployment insurance, industrial accident compensation insurance (IACI) and national pension on the stated relationship. Data were used from the Korean Longitudinal Study of Aging (KLoSA) between 2006 and 2012. A total of 1,536 individuals employed at the 2006 baseline were followed. The association between employment status change during 2006 to 2008, 2008 to 2010 or 2010 to 2012 and depressive symptoms in years 2008, 2010 or 2012 were analysed using a generalised estimating equation model. Depressive symptoms were measured with the Center for Epidemiological Studies Depression Scale (CES-D 10) scale. The results showed that the ‘employed to unemployed’ group had statistically significant increases in depression scores in the mid-aged (β = 0.4884,p= 0.0038) and elderly (β = 0.8275,p⩽ 0.0001) categories, compared to the ‘employed to employed’ group. Findings were maintained in groups without a social safety net. Contrastingly, the ‘employed to unemployed’ groups with unemployment insurance and IACI did not show statistically significant increases in depression scores. The ‘employed to unemployed’ category of individuals enrolled in the national pension system exhibited a lower increase of depression. Therefore, an enhanced focus on the mental health of unemployed individuals is required, in addition to the provision of a reliable social safety net.

Background Subjective income inadequacy may be associated with poorer mental health as income comparisons with others can decrease feelings of happiness. This study investigated the association between relative income and depressive symptoms in Korean adults. Methods Data from the 2017 Korea Community Health Survey were used. Relative income was measured by comparing household and community income. Household income was calculated using equalized household income and community income based on the mean income level of the 253 local communities. Relative income was categorized into the high (community household) groups. Analysis was conducted through multivariate logistic regression analysis. Results Of a total of 201,326 study participants, 12,508 (6.2%) individuals had depressive symptoms. Compared to the high relative income group, the middle [Odds Ratio (OR): 1.23, 95 percent Confidence Interval (CI): 1.16–1.29] and the low (OR 1.58, 95% CI 1.50–1.66) groups showed gradually higher likelihoods of depressive symptoms. Such differences were magnified in individuals with low absolute household income or with experiences of unmet need. Conclusion Individuals with lower or equal household than community income had higher likelihoods of depressive symptoms, with such differences augmenting in those with low absolute income or experiences of unmet need. The findings infer the importance of monitoring individuals at poorer relative income standings in addressing mental health.

Following publication of the original article [1], the authors reported an error in Table 2 in their paper. The table entry “Men’s P value” was mistakenly included under the table heading “Women”. The original article [1] has been updated.

Precarious employment and unemployment are important factors that impact suicidal behavior. This study investigated (1) how employment transitions among permanent employment, precarious employment, and unemployment are associated with suicidal ideation in working employees and compared (2) whether individuals transitioning among these three states were more vulnerable than those remaining. Using nationally representative longitudinal data between 2012&ndash, 2017, a total of 25,862 adults aged 25 to 59 years old without a record of suicidal ideation were included at baseline. Transitions in employment status (permanent work, precarious work, or unemployment) and suicidal ideation were analyzed using hierarchical logistic regression models. Compared to the &ldquo, permanent to permanent&rdquo, group, individuals in the &ldquo, permanent to precarious&rdquo, (odds ratio (OR) 1.74, 95% confidence interval (95% CI) 1.29&ndash, 2.35], &ldquo, permanent to unemployment&rdquo, (OR 1.97, 95% CI 1.32&ndash, 2.96), &ldquo, precarious to precarious&rdquo, (OR 1.86, 95% CI 1.21&ndash, 2.85), and the &ldquo, precarious to unemployment&rdquo, (OR 1.43, 95% CI 1.05&ndash, 1.95) groups had higher odds of suicidal ideation. The magnitude of such odds was generally higher than that of individuals at annual unemployment or precarious states. The results show that adults moving in and out of different employment states have higher odds of suicidal ideation than individuals at annually static precarious or unemployment status.

Background The number of patients with depressive symptoms worldwide is increasing steadily, and the prevalence of depression among caregivers is high. Therefore, the present study aimed to identify the effects of individuals’ caregiving status with respect to their family members requiring activities of daily living (ADLs) assistance on depressive symptoms among those aged 45 or over. Methods Data were collected from the 2006–2016 using the Korean Longitudinal Study of Aging surveys. Participants were categorized into three groups based on their caregiving status with respect to family members requiring ADL assistance: whether they provided the assistance themselves, whether the assistance was provided by other caregivers, or whether no assistance was required. We analyzed the generalized estimating equation model and subgroups. Results A total of 3744 men and 4386 women were included for the analysis. Men who cared for family members requiring ADL assistance had higher depressive symptoms than those with family members who did not require ADL assistance. Among women, participants who had family members requiring ADL assistance that they themselves or others were providing had higher depressive symptoms than those without family members requiring ADL assistance. Subgroup analysis was conducted based on age, job status, regular physical activities, participation status in social activities, and the number of cohabiting generations. Conclusions The study results indicated higher depressive symptoms among those with family members requiring ADL assistance and those who care for such family members themselves. This suggests that an alternative to family caregiving is necessary, especially for the elderly, regardless of caregiver sex.

Background Despite the fact that solitary drinking is becoming more common in Korea, few studies have investigated the association between drinking alone and mental health. This study aimed to investigate the relationship between solitary drinking, depressive symptoms, and suicidal ideation in Korean college students. Method Primary data on a nationally representative sample of college students were used. Data were collected by Yonsei University and the Korean Center for Disease Control in 2017 to investigate alcohol-related behaviors and health consequences in students. The association between solitary drinking, depressive symptoms, and suicidal ideation were measured using multivariate logistic regression analysis. Results A total of 3,935 students were analyzed, in which 11.5% had depressive symptoms and 2.8% suicidal ideation. Compared to non-solitary drinkers, solitary drinkers were more likely to have depressive symptoms [Odds Ratio (OR) 2.28, 95% Confidence Interval (95% CI) 1.72–3.02] and suicidal ideation (OR 2.24, 95% CI 1.32–3.81). Moreover, larger differences were found in individuals with higher alcohol use disorders identification test (AUDIT) scores and with more frequent underage drinking experience. Limitations As this study was cross-sectional in design, causal inferences cannot be made on the association between solitary drinking, depressive symptoms, and suicidal ideation. Conclusion Solitary drinking is associated with higher likelihoods of depressive symptoms and suicidal ideation in college students. The results suggest the importance of monitoring solitary drinkers as they may be more vulnerable to the negative mental health effects of alcohol.

Objectives. This study aimed to identify the possible effects of Myc and 8q24 polymorphisms on bleeding complications in patients who maintained international normalized ratio (INR) of 2.0-3.0 with warfarin therapy after cardiac valve replacement. Methods. Twenty-five single nucleotide polymorphisms were analyzed, including VKORC1, CYP2C9, Myc, and 8q24. Univariate and multivariate analyses were conducted to evaluate the associations between genetic polymorphisms and bleeding complications. Attributable risk and the number needed to genotype (NNG) were also calculated to evaluate the potential clinical value of genotyping. Results. We included 142 patients, among whom 21 experienced bleeding complications. Multivariate models showed that patients carrying the CC genotype of rs6983561 and the A allele of rs13281615 at 8q24 had 27.6- and 10.0-fold higher bleeding complications, compared with patients with the A allele and the GG genotype, respectively. For rs6983561, the attributable risk and NNG were 96.4% and 36.8, respectively, whereas, for rs13281615, the attributable risk and NNG were 90.0% and 8.3, respectively. Atrial fibrillation was associated with a 5.5-fold increased risk of bleeding complications. The AUROC value was 0.761 (95% CI 0.659-0.863, pχ2=0.846; 3 degrees of freedom; p=0.838). Conclusions. Bleeding complications during warfarin therapy were associated with 8q24 polymorphisms and atrial fibrillation in patients with mechanical heart valves.

Objectives: As the relationship between diabetes mellitus and thyroid dysfunction is well known, it is important to investigate the factors influencing this association. Continuity of care is associated with better quality of care and outcomes, such as reduced complications, among diabetes patients. Therefore, the purpose of this study was to investigate the association between continuity of care and the onset of thyroid dysfunction among diabetes patients. Methods: We used Korean National Health Insurance Service National Sample Cohort data from 2002 to 2013. Our final study population included 16,806 newly diagnosed diabetes patients who were older than 45 years of age. Continuity of care was measured using the Continuity of Care index. The dependent variable was the onset of thyroid disorder. Cox proportional hazard regression models were used for statistical analyses. Results: Diabetes patients with low continuity of care were at increased risk of the onset of thyroid disorder compared with those with high continuity of care (hazard ratio (HR): 1.28, 95% confidence interval (CI): 1.07&ndash, 1.54). Subgroup analyses showed that this association was significant within patients with type 2 diabetes (HR: 1.24, 95% CI: 1.01&ndash, 1.52) or whose main attending site was a local clinic (HR: 1.32, 95% CI: 1.07&ndash, 1.64). Conclusions: Our results show that diabetes patients with low continuity of care are more likely to experience the onset of thyroid disorder. Therefore, improving continuity of care could be a reasonable method of preventing complications or comorbidities, including thyroid disorder, among diabetes patients.

Although there are many studies on self-esteem, no study has analyzed the relationship between depressive symptom and difference in self-esteem between spouses. We aimed to determine how differences in self-esteem between spouses are associated with depressive symptoms. We used data collected from 2011 to 2013 by the Korean Welfare Panel Study. The initial 2011 baseline data included 3257 married couples over 25 years of age. We used linear mixed-effects models, accounting for the longitudinal nature of the data, to analyze the associations between the self-esteem of spouses and CESD-11 scores. About 20% of the respondents had different self-esteem with their intimate partners. Individuals with spouses having lower self-esteem than self significantly higher depression scores. Individuals with spouses having higher self-esteem than self had significantly lower depression scores regardless of sex. Our findings show how different self-esteem with their intimate partners could be associated with depressive symptoms and imply that one's self-esteem could affect the mental health of one's partner. Therefore, we should give more attention to self-esteem, which can affect families and society.

Background:Noticeable demographic changes have taken place in South Korea, with the general marriage rate decreasing and the average first age at marriage and general divorce rate increasing. The shown trends have contributed to intergenerational discordance in the perception of familial values, which is important in addressing the psychological well-being of parents. This study aimed to investigate the association between the marital status of offspring aged 40 years and over and the depression levels of parents.Methods:Data were from the Korean Longitudinal Study of Aging (KLoSA), 2006–2012. A total of 2,540 individuals with at least two offspring aged 40 years and over were included. Association between offspring marital status and parental depression scores, measured using the Center for Epidemiological Studies and Depression (CES-D 10) scale, was investigated using the generalized estimating equation (GEE) model. Subgroup analysis was performed based on offspring education level.Results:When parents with only married offspring were set as reference, parents with never married offspring (β: 0.27,p= 0.02), parents with separated offspring (β: 0.52,p= 0.03), and parents with never married offspring and separated offspring (β: 0.38,p< 0.001) showed increases in depression scores. In the subgroup analysis, these higher depression score effects were largely limited to parents with high school graduate offspring.Conclusion:It is important to monitor the mental health status of parents with never married, separated, or both never married and separated offspring as this group may be comparatively vulnerable to depressive symptoms.

Background: There are no studies researching the relationship between house-poor persons and mental health. Therefore, this study aimed to investigate the relationship between house-poor status and depressive symptoms. Aim: To examine the relationship between the house-poor and depressive symptoms according to household income. Methods: Data from the Korean Welfare Panel Study were used. House-poor were defined as people having possession with over 10% house-related interest in disposable income. About 7,565 participants over the age of 19 years were followed up from 2011 to 2013. The generalized estimating equations were used for analysis. Results: Individuals with more house-related debt showed increasingly higher depression scores (possession with under 5% related debt to disposable income β = 0.2024, p = .1544; under 10% β = 0.7030, p = .0008; over 10% β = 1.3207, p Conclusion: Individuals without houses and individuals owning houses with higher percentages of house-related interests showed higher levels of depressive symptoms. Therefore, this study affirmed that the importance of considering the most vulnerable groups in addressing the mental health of individual.

Aim To investigate the association between spouse cognitive status and depressive symptoms in cohabiting spouses, and to further analyze how participation in social network-enhancing activities interplays in the objected relationship. Methods Data from the Korean Longitudinal Study of Aging, 2006–2012, were used. A total of 2782 male and 2515 female married participants currently cohabiting with their partners were included in the baseline. The association between spouse cognitive status and depressive symptoms, measured using the Center for Epidemiological Studies Depression scale, was investigated through the generalized estimating equation model. Results When setting the participants living with spouses of normal cognitive function as reference, participants living with spouses having mild dementia (male β 0.7349, P ≤ 0.0001; female β 0.8042, P ≤ 0.0001), and moderate and severe dementia (male β 1.1504, P ≤ 0.0001; female β 1.2462, P ≤ 0.0006) showed higher depression scores in a dose–response relationship. Additionally, male and female subjects participating in social network facilitating activities had lower increases in depression scores than their non-participating counterparts. Conclusions Spouse cognitive impairment is associated with increasing depression scores in cohabiting caregivers. Individuals not participating in social network-facilitating activities are more vulnerable to the negative mental health effects of spouse cognitive impairment. Hence, considering the increasing importance of late life depression and cognitive decline in aging societies, it is important to note the protective effects of social network and support in addressing the mental health of spouse caregivers. Geriatr Gerontol Int 2016; ••: ••-••.

Since 2004, the South Korean government has introduced a policy that decreases copayment for cancer patients by strengthening public coverage in the National Health Insurance (NHI) system (first phase=copayment for outpatient care from 30% to 20%; second phase=copayment for total medical expenditures from 20% to 10%; third phase=copayment for total medical expenditures from 10% to 5%). We aimed to investigate the relationship between the policy introduction and patient visits to hospitals in the capital area. We used data from the NHI Cohort 2003-2013, which included all medical claims (7193 cases) filed for 2124 patients who visited the hospital due to stomach cancer, and performed a segmented Poisson regression analysis. Of all hospital visits, 40.6% of patients were from the capital area. After the introduction of the second phase of the policy, there was an increase in patient concentration in the capital area, although there were no significant effects on patient concentration during the first and third phases of the policy. In conclusion, our findings suggest that the introduction of a policy that reduces copayment for cancer patients had a substantial impact on patient concentration in the capital area. Therefore, health policymakers should consider effective alternatives including efficient allocation of medical resources or support for the more vulnerable population as flexible benefit plans to aid healthcare utilization by cancer patients.

Background: In South Korea, societal perceptions on occupation are distinct, with people favouring white collar jobs. Hence both occupation type and income can have mental health effects. Aim: To examine the relationship between occupational classification and depression, along with the combined effect of occupational classification and household income. Methods: Data were from the Korean Welfare Panel Study (KOWEPS), 2010–2013. A total of 4,694 economically active participants at baseline were followed. Association between occupational classification and depression, measured using the Center for Epidemiological Studies Depression (CES-D) scale 11, was investigated using the linear mixed effects model. Results: Blue collar (β: 0.3871, p = .0109) and sales and service worker groups (β: 0.3418, p = .0307) showed higher depression scores than the white collar group. Compared to the white collar high-income group, white collar low income, blue collar middle income, blue collar middle-low income, blue collar low income, sales and service middle-high income, sales and service middle-low income and sales and service low-income groups had higher depression scores. Conclusion: Occupational classification is associated with increasing depression scores. Excluding the highest income group, blue collar and sales and service worker groups exhibit higher depression scores than their white collar counterparts, implying the importance of addressing these groups.

Background The Chronic Disease Care System (CDCS) has been implemented in Korea to encourage treatment continuity in chronic disease patients. This study investigated the effect of the introduction of the CDCS on health care costs and continuity of care in individuals with type 2 diabetes mellitus (T2DM). Methods The National Health Insurance data from August, 2010 to March, 2012 (pre-policy) and from May, 2012 to December, 2013 (post-policy) were used. Introduction of the CDCS was defined as the intervention. The intervention group consisted of T2DM patients participating in the program and the control group patients not participating in the program. The Difference-in-Differences (DID) method was used to estimate the differences in total health care costs for outpatient services and continuity of care between the intervention and the control group before and after the intervention period. Results Implementation of the CDCS was associated with decreased health care costs (β = − 46,877 Korean Won, P

This study analyzed the type and frequency of physical activity that most effectively reduces the homeostatic model assessment of insulin resistance (HOMA2-IR) among adults (≥19 years) in Asia. We used national representative data from 1645 men and 2272 women who participated in the Korea National Health and Nutrition Examination Survey in 2015 were included in the analysis. The effects of different types and frequencies of physical activity on HOMA2-IR were investigated using a multiple regression analysis. Compared with no activity, moderate-to-vigorous physical activity (MVPA) ≥5 times per week (β: −0.214, p≤0.0198) and walking and MVPA ≥5 times per week (β: −0.183, p≤0.0049) were negatively associated with HOMA2-IR. In the subgroup analysis, the strongest effect was observed among overweight men. Additionally, walking plus MVPA ≥5 times per week had the strongest effect on men with a higher-than-recommended daily calorie intake (β: −0.350, p≤0.0030). Therefore, in conclusion, the appropriate type and frequency of physical activity can help reduce HOMA2-IR in South Korean men, especially those who are overweight and/or have a higher-than-recommended daily calorie intake.

Concerns have been raised about the loss of treatment continuity in unipolar and bipolar depressive disorder patients as continuity of care (COC) may be associated with patient outcomes. This study aimed to examine the relationship between COC and subsequent hospitalization, all-cause mortality, and suicide mortality in individuals with unipolar and bipolar disorder. Data were from the National Health Insurance (NHI) cohort, 2002 to 2013. Study participants included individuals first diagnosed with unipolar depressive disorder or bipolar affective disorder. The independent variable was COC for the first year of outpatient visits after diagnosis, measured using the usual provider of care (UPC) index. The dependent variables were hospitalization in the year after COC measurement, all-cause mortality, and suicide mortality. Analysis was conducted using logistic regression and Cox proportional hazards survival regression. A total of 48,558 individuals were analyzed for hospitalization and 48,947 for all-cause and suicide mortality. Compared to the low COC group, the medium [odds ratio (OR) 0.30, 95 percent confidence interval (95% CI) 0.19-0.47] and the high COC group (OR 0.14, 95% CI 0.09-0.21) showed statistically significant decreased odds of hospitalization. Additionally, lower likelihoods of suicide death were found in the high (HR 0.35, 95% CI 0.16-0.74) compared to the low COC group. The results infer an association between COC after first diagnosis of unipolar or bipolar depressive disorder and hospitalization and suicide mortality, suggesting the potential importance of treatment continuity in improving patient outcomes.

BACKGROUND Avoidable hospitalizations can act as an indicator for primary health care quality, in particular ambulatory care sensitive conditions (ACSCs) as hospitalizations for these conditions are generally considered avoidable through successful management. This study aimed to examine whether differences exist between income levels in rates of avoidable hospitalization. METHODS The South Korea National Health Insurance claims data from 2002 to 2013 were used. All hospitalizations were included and categorized into avoidable and non-avoidable cases. The independent variable was income level classified into quartiles and the dependent variable rates of avoidable hospitalization. Analysis was conducted using the generalized estimating equation (GEE) Poisson model. Subgroup analysis was performed based on chronic versus acute disease status and urban versus rural region. RESULTS A total of 1 310 492 cases were included, in which the crude rate of avoidable hospitalizations was 1444.5 per 100 000 person years. Compared to the Q4 highest income group set as reference, the Q3 (RR 1.07, 95% CI 1.04-1.09), Q2 (RR 1.16, 95% CI 1.13-1.19) and Q1 (RR 1.20, 95% CI 1.17-1.24) income groups showed higher rates of avoidable hospitalizations. CONCLUSION Risks of avoidable hospitalizations for ACSCs was higher in lower than higher income groups, implying that socioeconomic status is related to disparities in avoidable hospitalizations. The findings suggest the importance of monitoring the vulnerable groups identified in managing avoidable hospitalizations.

Objectives The objective of our study was to investigate the relationship between catastrophic health expenditure (CHE) and health-related quality of life (HRQoL) in general population. Methods We used Korean Health Panel Survey data from 2011 to 2013, which included data from 8850 baseline participants of 19 years of age or older. We defined CHE as total annual out-of-pocket health payment that was 40% greater than the household’s capacity to pay. HRQoL was measured using the EuroQol-visual analogue scale (EQ-VAS). We used generalized estimating equations to perform a longitudinal regression analysis. Results A total of 4.5% of the participants (n = 398) experienced CHE. Those with CHE tended to have a lower EQ-VAS index score compared with those without CHE (β: − 1.34, p = 0.013). A subgroup analysis revealed that individuals experiencing CHE had significant decreases as the number of chronic diseases increased (three or more, β: − 1.85, p = 0.014). Conclusions Catastrophic health expenditure influences HRQoL, which was more pronounced in patient with chronic disease. The efforts should focus on people who suffer from excessive health expenditures and chronic diseases.

Background The aim of this study was to examine factors associated with the use of mental health consultation for depressive symptoms. Methods We used data from the 2013 Community Health Survey, which included responses from 13,269 individuals who reported that they had experienced depressive symptoms for more than 2 weeks in Korea. We investigated associations between mental health consultation rates for depressive symptoms and sociodemographic, socioeconomic, and health-related factors. Logistic regression analysis was used to examine the significance of associations. Results Among participants who report depressive symptoms, 16.0% (n = 2120) undergo mental health consultation. Respondents with a college education or over are more likely to undergo mental health consultation (odds ratio (OR) = 1.49; 95% CI: 1.21–1.84) than respondents with less education. Individuals aged 70 years or above are less likely to receive mental health consultation than those aged between 19 and 29 years. Females exhibit higher mental health consultation rates than males. Respondents who are divorced show greater odds of receiving mental health consultation than respondents who are married and cohabitate with their spouse. Conclusions This study indicates that rates of use of mental health consultation services are lower among older adults and men and higher among divorced people. Educational level shows a significant positive association with mental health consultation among Koreans. The results could have implications for mental health policy in many ways in Korea.

Background This study aims to determine whether significant associations exist between the parents' country of birth and adolescent depressive symptoms in the early stages of a multicultural society. Methods We used data from the 2012–2016 Korea Youth Risk Behavior Web-based Survey, which included responses from 327,357 individuals. Participants were classified into groups according to their parent's country of birth. Logistic regression analysis was used to examine the significance of the associations. Results Adolescents whose parents were born abroad are more likely to have depressive symptoms (odds ratio [OR] = 1.68; 95% confidence interval [CI], 1.33–2.12) than adolescents whose parents were native Koreans. Respondents whose father was born in North Korea or Japan or Taiwan show greater odds of depressive symptoms than respondents whose parents were native Korean. Conclusion Adolescents whose parents were born abroad are more likely to have depressive symptoms. Multicultural family support policies should be implemented in consideration of the characteristics of the parents' country of birth., Graphical Abstract

Objective To explore the impact of mandatory adoption of diagnosis-related groups (DRGs) on the use of outpatient care in Korea. Data Sources National Health Claim data from 2,022 hospitals and 1,029,101 admission cases during 2011–2014: tonsillectomy/adenoidectomy, inguinal/femoral hernia operation, and hemorrhoidectomy. Study Design Outcome variables included probability of outpatient visit, number of outpatient visits, and outpatient medical expenditures within 30 days. Presurgery examination before hospitalization for surgery, including basic and other examination, was conducted to evaluate a possible shift in health care service. A difference-in-difference research design was used to evaluate the impact of the DRG system on the use of outpatient care. Principal Findings Before the introduction of the DRG system, 384,609 (91.1 percent) participants used an outpatient clinic either before or after hospitalization. In our study, the number of outpatient visits and outpatient medical expenditures within 30 days increased after mandatory adoption of the DRG system. After adoption of the DRG system, volume and costs for presurgery examinations increased before hospitalization. Conclusion We observed a spillover effect after mandatory adoption of the DRG system. A future payment system should be designed for spillover effects, and the introduction of a new payment system that expands the DRG-based reimbursement system should be considered.

Background In many countries, including South Korea, labour market changes have led to an increase in unstable, temporary jobs. There is evidence that workers in such jobs may experience poorer mental health than those in more stable employment. Aims To investigate the association between temporary employment and depressive symptoms in South Korean workers. Methods We analysed data from the 2010-2014 Korean Welfare Panel Study (KOWEPS). Employment type was categorized into workers paid per day of labour (day labourers), those on short-term contracts (fixed-term workers) and permanent workers. The association between employment type and depressive symptoms, measured using the Center for Epidemiological Studies Depression scale (CES-D 11), was examined using the generalized estimating equation model. Results A total of 3756 workers aged 20-59 were included in the 2010 baseline population. Day labourers had the highest mean CES-D 11 score, followed by fixed-term workers and permanent workers. With the day labourer group as reference, fixed-term workers (β: -1.5027, P < 0.001) and permanent workers (β: -2.1848, P < 0.001) showed statistically significant decreases in depression scores. Conclusions Compared with day labourers, fixed-term workers and permanent workers had progressively lower depression scores. The findings of this study suggest that mental health inequalities based on employment type exist in South Korea.

After 2010, panic disorders became relatively common in South Korea, with many celebrities confessing to the public that they have panic disorder. The annual number of patients with panic disorder and sleep disorder have been gradually increasing. In light of these increases, we analyzed the relationship between sleep disorder and panic disorder. We used national claim data to design a 1:3 nested case-control study. The study included medical claims filed for 29,312 patients during 2004-2013. We performed conditional logistic regression analysis to investigate the relationship between sleep disorder and panic disorder. There were 7436 patients who were diagnosed with panic disorder, and 21,876 patients who were gender- and age-matched as controls. Patients with sleep disorder had higher incidence of panic disorder. In particular, patients with insomnia had the strongest association with panic disorder (adjusted, OR, 1.386; 95% CI, 1.201-1.599; p0.05). These associations were stronger in healthy patients and those with worse socioeconomic status. In conclusion, sleep disorder, in particular, insomnia was positively associated with panic disorder. Thus, healthcare professionals and policy makers should effectively control insomnia and consider strategies for early intervention for vulnerable patients with risk of panic disorder.