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Background: The impact of changes in physical activity after ischemic stroke (IS) on the subsequent myocardial infarction (MI) risk is not fully understood. We aimed to investigate the effects of changes in physical activity on the risk of MI after acute IS using data from the Korean National Health Insurance Services Database. Methods: 224,764 patients newly diagnosed with IS between 2010 and 2016 who underwent two serial biannual health checkups were included. The participants were divided into four categories according to changes in their physical activity: persistent non-exercisers, new exercisers, exercise dropouts, and exercise maintainers. The primary outcome was a new diagnosis of incident MI. Multivariable Cox proportional models were used to assess the effects of changes in exercise habits on the risk of MI. Results: After a median of 4.25 years of follow-up, 6,611 (2.94%) MI cases were observed. After adjusting for confounders, new exercisers and exercise maintainers were significantly associated with a lower risk of incident MI than persistent non-exercisers (aHR, 0.849; 95% CI, 0.792–0.911; P-value < 0.001; and aHR, 0.746; 95% CI, 0.696–0.801; P-value < 0.001, respectively). Effects were consistent across sexes, more pronounced in those > 65 years. Notably, any level of physical activity after stroke was associated with a reduced MI risk compared to no exercise. Conclusions: In this nationwide cohort study, commencing or sustaining physical activity after an IS corresponded to a diminished likelihood of subsequent MI development. Advocating physical activity in ambulatory stroke survivors could potentially attenuate the prospective risk of MI. What is New? • Initiating or maintaining regular physical activity following an ischemic stroke (IS) diagnosis significantly reduces the risk of myocardial infarction (MI), regardless of physical activity intensity, age, or sex. • This large-scale cohort study emphasizes the crucial role of physical activity in post-stroke care and secondary prevention, offering a novel perspective on the relationship between physical activity and post-IS cardiovascular outcomes. What are the Clinical Implications? • Healthcare practitioners should prioritize promoting physical activity as an integral component of post-stroke care for older adults, aiming to reduce MI risk. • The findings underscore the importance of regular physical activity for both IS and MI prevention and highlight the potential for improved patient outcomes through lifestyle modifications. [ABSTRACT FROM AUTHOR]

Background: We investigated the risks of depression/anxiety in patients with multiple sclerosis (pwMS) or patients with neuromyelitis optica spectrum disorder (pwNMOSD). Objectives: MS/NMOSD cohorts were collected from Korean National Health Insurance Service, using the International Classification of Diseases-10th and information on Rare Intractable Disease program. Patients who were younger than 20 years, had a previous depression/anxiety, or died in the index year were excluded. Methods: Hazard ratios (HRs) of depression/anxiety in pwMS and pwNMOSD from controls matched 1:5 for age, sex, hypertension, diabetes, and dyslipidemia were calculated using Cox regressions with a 1-year lag period and estimated over time. Results: During a mean follow-up of 4.1 years, adjusted hazard ratios (aHR) for depression were 3.25 (95% confidence interval (CI) = 2.59–4.07) in MS and 2.17 (1.70–2.76) in NMOSD, and aHRs for anxiety were 1.83 (1.49–2.23) in MS and 1.56 (1.26–1.91) in NMOSD. The risks of anxiety/depression did not differ between MS and NMOSD and were highest in the second year after diagnosis of MS/NMOSD. The relative risk of depression was higher in younger pwMS/pwNMOSD, and the relative risk of anxiety was higher in pwMS who was male, had low income, or lived in a non-urban area. Conclusion: The risk of depression and anxiety was increased in pwMS/pwNMOSD. [ABSTRACT FROM AUTHOR]

Regular physical activity (PA) has been suggested as effective disease preventable strategies for Parkinson's disease (PD). Depression often precedes PD but whether PA also would reduce the risk of PD in patients with depression has not been known. The aim of study is to examine the association of regular PA with risk of PD among patients with depressive disorder. A total of 1,342,282 patients with depressive disorder were identified from a nationwide health screening cohort from 2010 to 2016. The exposure was changes in pattern of regular PA between pre-and post-diagnosis of depressive disorder, categorized as four groups; 1) no PA, 2) increased PA, 3) decreased PA, and 4) maintaining PA. The outcome was risk of incident PD, calculated using multivariate adjusted Cox proportional hazards regressions according to the PA categorization. Total of 8901 PD cases (0.66%) were developed during 5.3 years of follow-up period. Maintaining PA group was associated with the lowest risk of PD (adjusted hazard ratio [aHR] 0.89, 95% CI 0.83–0.97) among all other PA groups with depressive disorder (with no PA group as reference). Otherwise, decreased PA group significantly increased the risk of PD (aHR 1.10, 95% CI 1.03–1.16). Those who maintained PA before and after diagnosis of depressive disorder were associated with lower risk of incident PD. [ABSTRACT FROM AUTHOR]

Stroke survivors are at an increased risk of falls and fractures. Physical activity is inversely associated with the fracture risk in the general population. However, the association between incident fracture risk and changes in habitual physical activity before and after an index stroke remains unclear. This study attempted to explore the association between incident fracture risk and changes in physical activity after stroke. Using the claims database of the National Health Insurance Program in Korea, participants with their first ischemic stroke between 2010 and 2016 were enrolled in the study. The participants were divided into four groups according to changes in physical activity habits evaluated using two consecutive self-reported questionnaires before and after stroke, if available: persistent non-exercisers, exercise dropouts, new exercisers, and persistent exercisers. The primary outcome was a composite of vertebral, hip, and other fractures. We performed multivariable Cox proportional hazard regression analysis and provided adjusted hazard ratios and 95% confidence intervals for each outcome. Among 202,234 participants included from 1,005,879 datasets, 16,621 (8.22%) experienced any type of fracture as the primary outcome. After multivariable adjustment, exercise dropouts (n = 37,106), new exercisers (n = 36,821), and persistent exercisers (n = 74,647) had a significantly reduced risk of any type of fracture (aHR 0.932, 95% CI 0.893–0.973; aHR 0.938, 95% CI 0.900–0.978; aHR 0.815, 95% CI 0.780–0.852, respectively) compared to the persistent non-exercisers (n = 53,660). Furthermore, regardless of pre-stroke exercise status, those who exercised ≥ 1000 metabolic equivalents of tasks post-stroke had a significantly reduced risk of fractures. Initiating or continuing moderate-to-vigorous regular physical activity after acute ischemic stroke was associated with a significantly lower risk of incident fractures, including hip, vertebral, and other types. [ABSTRACT FROM AUTHOR]

Summary: In this national cohort study, the patients with acromegaly had significantly higher risks of clinical vertebral (HR 2.09 [1.58–2.78]) and hip (HR 2.52 [1.61–3.95]) fractures than the controls. The increased fracture risk in patients with acromegaly was time-dependent and was observed even during the early period of follow-up. Purpose: Acromegaly is characterized by the overproduction of growth hormone (GH) and insulin-like growth factor-1 (IGF-1), both play important roles in regulating bone metabolism. We investigated the risk of vertebral and hip fractures in patients with acromegaly compared to age- and sex-matched controls. Methods: This nationwide population-based cohort study included 1,777 patients with acromegaly aged 40 years or older in 2006–2016 and 8,885 age- and sex-matched controls. A Cox proportional hazards model was used to estimate the adjusted hazard ratio (HR) [95% confidence interval]. Results: The mean age was 54.3 years and 58.9% were female. For approximately 8.5 years of follow-up, the patients with acromegaly had significantly higher risks of clinical vertebral (HR 2.09 [1.58–2.78]) and hip (HR 2.52 [1.61–3.95]) fractures than the controls in the multivariate analyses. There were significant differences in the risks of clinical vertebral (P < 0.0001) and hip (P < 0.0001) fractures between the patients with acromegaly and the controls in the Kaplan–Meier survival analysis. The multivariable-adjusted HRs for clinical vertebral fractures comparing the patients with acromegaly with controls during and excluding the first 7 years of observation were 1.69 [1.15–2.49] and 2.70 [1.75–4.17], respectively. The HRs for hip fractures during and excluding the first 7 years of observation were 2.29 [1.25–4.18] and 3.36 [1.63–6.92], respectively. Conclusions: The patients with acromegaly had a higher risk of hip fractures as well as clinical vertebral fractures than the controls. The increased fracture risk in patients with acromegaly was time-dependent and was observed even during the early period of follow-up. [ABSTRACT FROM AUTHOR]

Simple Summary: The global incidence of metabolic syndrome is on the rise, and its association with various types of cancer has been established. However, research into an association between metabolic syndrome and the incidence of head and neck cancer has been relatively limited. This population-based study aimed to report on the association of metabolic syndrome with head and neck cancer and individual subtypes of cancers. The study found that participants with metabolic syndrome exhibited a higher risk of developing head and neck cancer, particularly oral cavity and laryngeal cancers. The elevated levels of fasting glucose and blood pressure present in individuals with metabolic syndrome were independently associated with an increased risk of head and neck cancer. The results of this study could assist with etiological investigations and prevention strategies. The aim of this national population-based retrospective study was to analyze the relationship between MetS and the incidence of HNC. In this Korean population-based cohort study, 9,598,085 subjects above the age of 20 were monitored from 1 January 2009 to 31 December 2018. In the study population, a total of 10,732 individuals were newly diagnosed with HNC during the 10-year follow-up. The hazard ratio (HR), after adjusting for age, gender, smoking status, alcohol intake, and exercise, indicated that participants with MetS were at a 1.06-fold (95% CI: 1.01–1.10) higher risk of having HNC than those without MetS. Participants with MetS showed an increased risk of developing oral cavity cancer (HR, 1.12; 95% CI, 1.03–1.23) and laryngeal cancer (HR, 1.18; 95% CI, 1.09–1.27). Among the components of MetS, elevated fasting glucose (HR = 1.04, 95% CI: 1.00–1.08) and elevated blood pressure (HR = 1.08, 95% CI: 1.04–1.13) were significantly associated with an increased HR for HNC in an adjusted multivariable model. The association between HNC and MetS remained significant even among individuals who had never smoked or were ex-smokers (HR: 1.09; 95% CI: 1.04–1.15), as well as those who did not drink or were mild drinkers (HR: 1.07; 95% CI: 1.02–1.12). The findings of this cohort study suggest MetS was associated with an increased risk for some types of HNCs. The results of this study could assist with etiological investigations and prevention strategies. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess the association between hormone replacement therapy (HRT) and the prevalence of nonarteritic anterior ischemic optic neuropathy (NAION) in menopausal women using national data from the entire Korean population. Methods: The health screening data of 1,381,605 women between 40 and 90 years of age collected by the National Health Insurance Service (NHIS) of Korea between January 1, 2009, and December 31, 2018, were retrospectively reviewed. Before data analysis, the potential cofounders were adjusted for among all participants. Based on HRT use and its duration (classified into four groups), the hazard ratio (HR) and 95% confidence interval (CI) of NAION development were calculated via a Cox proportional hazards regression analysis using the nonuser group as a reference. Results: Overall, 7824 NAION diagnoses were made during the mean follow-up of 8.22 years (standard deviation: 1.09 years) in 1,381,605 post-menopausal women. NAION was more common in the HRT group than in the non-HRT group (HR [95% CI]: 1.268 [1.197–1.344]). Furthermore, the risk of NAION increased along with increased HRT duration (p < 0.0001). In the multivariate analysis, the adjusted HRs of the < 2-year HRT group, the 2–5-year HRT group, and the ≥ 5-year HRT group were 1.19 (95% CI: 1.10–1.28), 1.3 (95% CI: 1.17–1.45), and 1.473 (95% CI: 1.31–1.65), respectively. Compared to women younger than 65 years, the HR of HRT for NAION was significantly higher than that of women older than 65 years (p < 0.0001). Conclusion: Our population-based cohort study found that HRT was significantly associated with increased incidence of NAION. The incidence of NAION also increased with the duration of HRT. [ABSTRACT FROM AUTHOR]

Simple Summary: Obstructive sleep apnea (OSA) increases the risk of numerous cancers. Nevertheless, testicular cancer prevalence in OSA patients has not been documented. Based on KNHIS data, this study examines OSA's effect on testicular cancer incidence. A total of 152,801 newly diagnosed male adult OSA patients and 764,005 controls were studied. Even after confounding correction, OSA's HR for testicular cancer was 1.58 (95% CI: 0.92–2.60). The subgroup analysis showed a 3.39 (95% CI: 1.08–10.06) HR for testicular cancer in those over 65. The 20–40 and 40–65 age groups had no significant HR. OSA may not affect testicular cancer in adults in general. However, those over 65 may be more susceptible to OSA-related testicular cancer than younger individuals. Obstructive sleep apnea (OSA) has been linked to an increased risk of acquiring many types of cancer. No data on the prevalence of testicular cancer in OSA patients have been reported in the literature. The goal of the present investigation is to find out the impact of OSA on the incidence of testicular cancer based on the Korea National Health Insurance Service (KNHIS) dataset. A cohort of adult male patients newly registered with OSA in the KNHIS data from 2007 to 2014 who had no history of any previous cancer diagnosis was included. The main outcome measure was newly diagnosed testicular cancer in the National Medical Expenses Support Program. The control group was set at five times larger than the OSA group, and it was matched with age and sex. The cumulative incidence and hazard ratio (HR) for the development of testicular cancer were compared between the OSA and control groups. Further subgroup analysis was conducted in the three different age groups. In the study period, a total of 152,801 male adult patients newly diagnosed with OSA were included, whereas 764,005 individuals were recruited as the control group. The HR of OSA for developing testicular cancer was 1.58 (95% confidence interval [CI]: 0.92–2.60), showing no significant HR regardless of confounding adjustment. However, the subgroup analysis revealed a significantly increased HR to develop testicular cancer of 3.39 (95% CI: 1.08–10.06) in groups aged more than 65, whereas the age ranges of 20–40 and 40–64 showed no significance (1.19 (0.44–2.75) and 1.27 (0.50–2.80), respectively). OSA may not influence the incidence of testicular cancer in the general adult population. However, compared to younger males, males over 65 may be more susceptible to OSA when it comes to developing testicular cancer. [ABSTRACT FROM AUTHOR]

Background: Few studies have assessed the correlation between coexisting mental disorders in participants with diabetes mellitus (DM) and the risk of heart failure (HF). Herein, we conducted a cohort study to determine the association between the accumulation of mental disorders in participants with DM and the risk of HF. Methods: The Korean National Health Insurance Service records were assessed. 2,447,386 adults with DM who underwent health screening between 2009 and 2012 were analyzed. Participants with major depressive disorder, bipolar disorder, schizophrenia, insomnia, or anxiety disorders were included. In addition, participants were categorized based on the number of coexisting mental disorders. Each participant was followed until December 2018 or until the onset of HF. Cox proportional hazard modelling with confounding factors adjustment was conducted. In addition, a competing risk analysis was conducted. Subgroup analysis assessed the impact of clinical variables on the association between the accumulation of mental disorders and the risk of HF. Results: The median follow-up duration was 7.09 years. The accumulation of mental disorders was associated with a risk of HF (zero mental disorder (0), reference; 1 mental disorder, adjusted hazard ratio (aHR): 1.222, 95% confidence intervals (CI): 1.207–1.237; 2 mental disorders, aHR: 1.426, CI: 1.403–1.448; ≥3 mental disorders, aHR: 1.667, CI: 1.632–1.70. In the subgroup analysis, the strength of association was the strongest in the younger age group (< 40 years, 1 mental disorder, aHR 1.301, CI 1.143–1.481; ≥2 mental disorders, aHR 2.683, CI 2.257–3.190; 40–64 years, 1 mental disorder, aHR 1.289, CI 1.265–1.314; ≥2 mental disorders, aHR 1.762, CI 1.724–1.801; ≥65 years, 1 mental disorder, aHR 1.164, CI 1.145–1.183; ≥2 mental disorders, aHR 1.353, CI 1.330–1.377; Pinter<0.001). In addition, income, BMI, hypertension, chronic kidney disease, history of cardiovascular disease, insulin use, and duration of DM showed significant interactions. Conclusions: Comorbid mental disorders in participants with DM are associated with an increased risk of HF. In addition, the association was stronger in a younger age group. Participants with DM and mental disorders should be monitored with increased frequency for signs of HF; for which they have a higher risk than the general population. [ABSTRACT FROM AUTHOR]

Background: Although diabetes is reportedly associated with the occurrence of acute pancreatitis (AP), the risk of AP according to the duration and severity of diabetes is not yet clear. We aimed to investigate the risk of AP based on glycemic status and the presence of comorbidities using a nationwide population-based study. Methods: We enrolled 3,912,496 adults who underwent health examinations under the National Health Insurance Service in 2009. All participants were categorized by glycemic status as normoglycemic, impaired fasting glucose (IFG), or diabetes. Baseline characteristics and the presence of comorbidities at the time of health check-up were investigated, and the occurrence of AP was followed up until 31 December 2018. We estimated the adjusted hazard ratios (aHRs) for AP occurrence according to the glycemic status, duration of diabetes (new-onset, duration < 5 years, or ≥ 5 years), type and number of anti-diabetic medications, and presence of comorbidities. Results: During the observation period of 32,116,716.93 person-years, 8,933 cases of AP occurred. Compared with normoglycemia, the aHRs (95% confidence interval) were 1.153 (1.097–1.212) in IFG, 1.389 (1.260–1.531) in new-onset diabetes, 1.634 (1.496–1.785) in known diabetes < 5 years, and 1.656 (1.513–1.813) in patients with known diabetes aged ≥ 5 years. The presence of comorbidities associated with diabetes severity had a synergistic effect on the relationship between diabetes and AP occurrence. Conclusion: As glycemic status worsens, the risk of AP increases, and there is a synergistic effect when comorbidities coexist. To reduce the risk of AP, active control of factors that can cause AP should be considered in patients with long-standing diabetes and comorbidities. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of atrial fibrillation (AF) is increasing as the elderly population continues to increase. Chronic kidney disease, diabetes, and hypertension are known risk factors for AF. Since multimorbidity exists in chronic kidney disease, it is difficult to determine the impact of hypertension alone. Furthermore, little is known about the impact of hypertension on predicting AF in diabetic end-stage renal disease (ESRD). Here, we evaluated the effect of differential blood pressure control on AF prevalence among the diabetic ESRD population. Methods: From the Korean National Health Insurance Service database, 2 717 072 individuals with diabetes underwent health examinations during 2005–2019. Exactly 13 859 individuals with diabetic ESRD without a prior history of AF were selected and included in the analysis. Based on blood pressure level and previous hypertension medication history, we subdivided them into five groups: normal (normotensive), pre-hypertension, new onset hypertension, controlled hypertension, and uncontrolled hypertension. AF risk according to the blood pressure groups was estimated using Cox proportional-hazards models. Results: Among the five groups, the new onset hypertension, controlled hypertension, and uncontrolled hypertension groups showed a higher AF risk. In patients on antihypertensives, diastolic blood pressure ≥100 mmHg was significantly associated with AF risk. High pulse pressure showed a significant risk for AF in patients on antihypertensives. Conclusion: In patients with diabetic ESRD, overt hypertension and a history of hypertension impacts AF. AF risk was higher in the ESRD population with diastolic blood pressure ≥100 mmHg and pulse pressure >60 mmHg. [ABSTRACT FROM AUTHOR]

Several studies have suggested a link between panic disorder (PD) and cardiovascular disease (CVD). However, the extent to which PD confers risk for CVD is still unclear, particularly in diabetics, a group showing high risk for CVD. A nationwide population-based cohort of 1,624,718 patients with type 2 diabetes were selected from the National Health Screening Program database covering the years 2009 to 2012. The subjects were divided into two groups: those without panic disorder (non-PD group, n = 1,618,263) and those with newly diagnosed PD (PD-group, n = 6455). Follow-up of subjects for up to 10 years was conducted for evaluation of the incidences of myocardial infarction (MI), stroke, and death. After adjusting for the baseline covariates and diabetes mellitus (DM)-related variables, no difference in the future risk of MI and stroke was observed between the non-PD group and the PD group. Compared with the non-PD group, the PD group showed an increase in the future risk of death. [adjusted hazard ratio (aHR) = 1.120, 95 % confidence interval (CI): 1.039–1.206]. In contrast to the population aged <40 and > 65 years, in the age group of 40–64 years a significantly higher risk of stroke was observed in the PD group compared with the non-PD group (aHR = 1.352, 95%CI: 1.136–1.610). The diagnoses were based on the diagnostic codes of the claim data. The current findings suggested that PD might not contribute to the risk of future MI and stroke in diabetics who have already been at risk of various cardiovascular complications. • A total of 1,624,718 patients with type 2 diabetes were followed up for up to 10 years. • Panic disorder did not increase the risk of future myocardial infarction and stroke in diabetics. • Panic disorder increased the risk of mortality in diabetics. [ABSTRACT FROM AUTHOR]

We aimed to investigate the effects of exercise habit changes on the risk of incident dementia after ischemic stroke using the Korean National Health Insurance Services Database. This study included 223,426 patients with a new diagnosis of ischemic stroke between 2010 and 2016 who underwent two serial ambulatory health checkups. The participants were divided into four categories according to their habit change or regular exercise: persistent non-exercisers, new exercisers, exercise dropouts, and exercise maintainers. The primary outcome was new diagnosis of dementia. Multivariate Cox proportional models were used to assess the effects of changes in exercise habits on the risk of incident dementia. After a median of 4.02 years of follow-up, 22,554 (10.09%) dementia cases were observed. After adjusting for covariates, exercise dropouts, new exercisers, and exercise maintainers were significantly associated with a lower risk of incident dementia than persistent non-exercisers (adjusted hazard ratio [aHR] 0.937; 95% confidence interval [CI] 0.905–0.970, aHR 0.876; 95% CI 0.843–0.909, aHR 0.705; 95% CI 0.677–0.734, respectively). The impact of changes in exercise habit was more prominent in the 40–65 years age group. An energy expenditure ≥ 1000 metabolic equivalents of task-min/wk post-stroke, regardless of pre-stroke physical activity status, was mostly associated with a lower risk of each outcome. In this retrospective cohort study, initiating or continuing moderate-to-vigorous exercise after ischemic stroke was associated with a lower risk of dementia development. Further, pre-stroke regular physical activity also reduced the risk of incident dementia. The promotion of exercise in ambulatory stroke patients may reduce their future risk of incident dementia. [ABSTRACT FROM AUTHOR]

Background and Aims: In the Asian population, existing studies regarding the association between smoking and acute pancreatitis are few in number. The aim of this study was to investigate the incidence of acute pancreatitis according to smoking habits and smoking habit changes of the Korean population. Methods: We used clinical data from individuals (aged 20 years or older) who received health examinations arranged by the Korean National Health Insurance Service in 2009 (n = 4 238 822) or in 2009 and 2011 (n = 2 617 306). The incidence of acute pancreatitis was analyzed according to smoking status or smoking habit change reported by individuals during their health examination. Newly diagnosed acute pancreatitis was identified using claims data from baseline to the date of diagnosis or until December 31, 2018. Results: The risk of acute pancreatitis was significantly higher in current smokers compared with never‐smokers regardless of age or sex. The adjusted hazard ratio (HR) of acute pancreatitis in current smokers increased according to the amount of smoking (HR 1.28; 95% confidence interval [CI], 1.12–1.45 in <10 cigarettes/day, HR 1.4; CI, 1.3–1.52 in 10–19 cigarettes/day, HR 1.66; CI, 1.55–1.78 in ≥20 cigarettes/day). The adjusted HR of acute pancreatitis in continuous smokers was 1.66 (CI, 1.53–1.8) compared with never‐smokers and was higher than smokers who quit smoking (HR 1.34; CI, 1.17–1.54). Conclusions: In this Korean population‐based cohort study, smoking increased the incidence of acute pancreatitis in a dose‐dependent manner, and smoking cessation helped decrease the incidence of acute pancreatitis. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) can cause various atherosclerotic cardiovascular disease including sudden cardiac death (SCD). The impact of being underweight on the risk of SCD in people with DM remains to be revealed. We aimed to evaluate the risk of SCD according to body-mass index (BMI; kg/m2) level in DM population. Methods: We used a nationwide healthcare insurance database to conduct this study. We identified people with DM among those who underwent nationwide health screening during 2009 to 2012. Medical follow-up data was available until December 2018. Results: A total of 2,602,577 people with DM with a 17,851,797 person*year follow-up were analyzed. The underweight group (BMI < 18.5) showed 2.4-fold increased risk of SCD during follow-up (adjusted-hazard ratio [HR] = 2.40; 95% confidence interval [CI] = 2.26–2.56; p < 0.001). When normal-BMI group (18.5 ≤ BMI < 23) was set as a reference, underweight group (adjusted-HR = 2.01; 95% CI = 1.88–2.14) showed even higher risk of SCD compared with the obesity group (BMI ≥ 30; adjusted-HR = 0.89; 95% CI = 0.84–0.94). When BMI was stratified by one unit, BMI and SCD risk showed a U-curve association with the highest risk observed at low BMI levels. The lowest risk was observed in 27 ≤ BMI < 28 group. The association between being underweight and increased SCD risk in DM people was maintained throughout various subgroups. Conclusions: Being underweight is significantly associated with an increased risk of SCD in the DM population. A steep rise in the risk of SCD was observed as the BMI level decreased below 23. The lowest risk of SCD was observed in 27 ≤ BMI < 28 group. [ABSTRACT FROM AUTHOR]

Adenotonsillectomy is the most commonly performed surgery in children. To evaluate the effects of pediatric adenotonsillectomy on health care utilization. From 2006 to 2017, age/sex-matched adenotonsillectomy participants (n = 243.396) and controls (n = 730.188) were selected (62% of male and 38% of female. 47% age≦ 6, 16% 7–9years, 8% 10–12years, 29% 13–18years). The changes in outpatient visits, hospitalization days, and drug prescriptions due to a URI, asthma, and rhinitis before and after the surgery date (from 13 months to 1 month) were compared. Outpatient visits decreased more in the surgery group than the control group (mean change, 3.24 ± 8.61 d and 1.16 ± 6.57 d for URI, 2.07 ± 8.63 d and 0.51 ± 6.47 d for rhinitis, and 0.72 ± 4.81 d and 0.42 ± 3.91 d for asthma, p <.001 for all). Hospitalizations also showed greater decreases in the surgery group (mean change, 0.31 ± 2.96 d and 0.04 ± 1.70 d for URI, 0.13 ± 2.40 d and 0.02 ± 1.48 d for rhinitis, 0.11 ± 2.32 d and 0.04 ± 1.83 d for asthma, p <.001 for all). The prescription of antihistamines, leukotriene modulators, oral antibiotics, oral steroids, and expectorants, cough suppressants and oral bronchodilators was also decreased after surgery. The adenotonsillectomy group showed a greater decrease in post-operative outpatients visits, hospital days and drug prescriptions associated with URI, rhinitis and asthma than the control group. [ABSTRACT FROM AUTHOR]

There is a paucity of research regarding the association between the risk of incident dementia and changes in smoking habits in the acute ischemic stroke population. We aimed to investigate the effects of smoking habit change on the risk of incident dementia in an ischemic stroke population using data from the Korean National Health Insurance Services Database. This nationwide population-based cohort study included 197,853 patients with ischemic stroke. The patients were divided into never smokers, former smokers, smoking quitters, sustained smokers, and new smokers, based on the 2-year change in smoking status between the two consecutive health examinations before and after the index stroke. The patients were followed up from the index date to 2018 to assess the development of dementia. Dementia was further categorized into Alzheimer's, vascular, and other types of dementia according to the International Classification of Diseases, Tenth Revision diagnosis. Multivariable Cox proportional hazards models were used to assess the association between changes in smoking habits and the risk of dementia. After a median of 4.04 years of follow-up, 19,595 (9.9%) dementia cases were observed. Among them, 15,189 (7.7%) were diagnosed with Alzheimer's disease dementia and 2719 (1.4%) were diagnosed with vascular dementia. After adjusting for covariates, including age, sex, alcohol intake habits, cigarette pack-year, regular physical activity, income, history of hypertension, diabetes mellitus, dyslipidemia, and chronic kidney disease, new smokers, sustained smokers, and smoking quitters were significantly associated with a higher risk of all-cause dementia than never smokers (adjusted hazard ratio [aHR] 1.395, 95% confidence interval [CI] 1.254–1.552; aHR 1.324, 95% CI 1.236–1.418; and aHR 1.170, 95% CI 1.074–1.275, respectively). Similar trends were observed for both Alzheimer's dementia and vascular dementia, but the association between new smokers and vascular dementia was not significant. The impact of smoking habit change was more prominent in the 40–65-year-old group. New and sustained smokers had a substantially higher risk of incident dementia after ischemic stroke than never smokers. Smoking quitters also had an elevated risk of incident dementia, but the detrimental effects were lower than those in new and sustained smokers. [ABSTRACT FROM AUTHOR]

Background: Elevated remnant cholesterol (remnant-C) is considered a risk factor for cardiovascular disease (CVD); however, whether this notion applies to the East Asian population with type 2 diabetes (T2D) has not been established. This study investigated the association between remnant-C concentrations and the risk of CVD in Korean patients with T2D. Methods: By using the Korean National Health Insurance Service database, 1,956,452 patients with T2D and without atherosclerotic CVD who underwent regular health checks between 2009 and 2012 were included. Cox regression analyses were conducted to assess the association between remnant-C concentrations and incident CVD comprising myocardial infarction (MI) and ischemic stroke. Results: In total, 50,120 (2.56%) cases of MI and 73,231 (3.74%) cases of ischemic strokes occurred during a median follow-up of 8.1 years. The adjusted hazard ratios for MI and stroke in the highest remnant-C quartile were 1.281 (95% confidence interval [CIs], 1.249–1.314) for MI and 1.22 (1.195–1.247) for ischemic stroke, compared to those in the lowest quartiles. The results were similar, based on stratified analysis by age, sex, use of statin or fibrate, and levels of other cholesterol. The increased risk of CVD in the highest remnant-C quartile was profound in patients who had a longer T2D duration. A remnant-C concentration ≥ 30 mg/dL differentiated patients who were at a higher risk of CVD, compared to patients with a lower concentrations, regardless of whether LDL-C levels were or were not on target at ≤ 100 mg/dL. Conclusion: In Korean patients with T2D, remnant-C was associated with CVD, independent of the LDL-C level or other conventional CVD risk factors. Our finding confirmed evidence of the causal role of remnant-C on CVD, as a residual risk of CVD, in East Asian patients with T2D. [ABSTRACT FROM AUTHOR]

Type 2 diabetes is known as a risk factor for acute pancreatitis, but the risk of acute pancreatitis according to glycemic status and body mass index (BMI) has remained unknown. Therefore, we aim to investigate the risk of acute pancreatitis according to BMI and glycemic status. We included 3,912,496 subjects from the Korean National Health Insurance System cohort who underwent the National Health Screening program in 2009. Each subject's clinical course was examined through follow-ups until December 2018. BMI and glycemic status were each categorized into five groups. Hazard ratios (HRs) of acute pancreatitis according to BMI and glycemic status were calculated. The adjusted HRs of acute pancreatitis were the highest in the underweight group (BMI < 18.5) in all five glycemic status categories. The HR of acute pancreatitis in the underweight group increased as the glycemic status worsened, excluding the category of diabetes for more than five years (HR 1.381 for normal fasting glucose; 1.805 for impaired fasting glucose; 2.332 for new-onset diabetes; 4.51 for diabetes duration <5 years; 4.135 for diabetes duration ≥5 years). We found that the risk of acute pancreatitis was further increased in the underweight group, depending on the status and duration of type 2 diabetes. [ABSTRACT FROM AUTHOR]

We analyzed the relationship between chronic rhinosinusitis (CRS) and the incidence of head and neck cancers (HNCs) in a Korean adult population. This retrospective cohort study included data from the Korean National Health Insurance Service database. Adjustments were made to minimize risk variables for sex, age, diabetes, hypertension, dyslipidemia, and rhinitis between the two groups. The primary endpoint was newly diagnosed HNC between January 2009 and December 2018. Among 1,337,120 subjects in the Korean National Health Insurance Service database, data from 324,774 diagnosed with CRS (CRS group) and 649,548 control subjects (control group) were selected. Patients with CRS exhibited a statistically significant greater risk for nasal cavity/paranasal sinus cancer, hypopharynx/larynx cancer, and thyroid cancer compared with the control group. In the CRS group, the adjusted hazard ratios for nasal cavity/paranasal sinus cancer were 1.809 (95% confidence interval (CI) 1.085–3.016), 1.343 (95% CI 1.031–1.748) for hypopharynx and larynx cancer, and 1.116 (95% CI 1.063–1.173) for thyroid cancer. CRS was associated with a higher incidence of HNCs. Therefore, physicians should carefully consider the possibility of HNC progression and implement therapeutic strategies to minimize the impact of these diseases. [ABSTRACT FROM AUTHOR]

Purpose: Prior research suggests a link between obstructive sleep apnea (OSA) and the likelihood of developing a variety of solid tumors; however, there are no studies assessing OSA and leukemia. This study is the first to identify a potential association between OSA and leukemia using data from the Korea National Health Insurance Service database.Methods: A total of 162,646 patients (≥20 years of age and without any cancer history) newly diagnosed with OSA between 2011 and 2017 were included. A control group of 813,230 subjects was selected using propensity score matching based on age and sex. The mean follow-up time was 4.4 ± 2.0 years. The primary endpoint was newly diagnosed leukemia of any type. The leukemia hazard ratio (95% confidence interval [CI]) was calculated for patients with OSA and compared with that of patients in the control group.Results: The incidence of leukemia among patients with OSA was significantly higher than that in the controls (1.35 [1.05-1.74]). The hazard ratio was the highest, 1.74 in those under 40 years, and gradually decreased with age, to 1.38 in those aged 40-65 years and 0.96 in those over 65. In particular, the incidence of lymphoid leukemia (2.06 [1.18-3.60]) was higher than that of myeloid (1.34 [1.00-1.81]) or unspecified leukemia (0.60 [0.20-1.58]).Conclusion: OSA is associated with an increased incidence of leukemia, particularly in patients younger than 40 years of age. [ABSTRACT FROM AUTHOR]

Metabolic syndrome (MetS) is associated with psoriasis, but it remains unclear whether risk of psoriasis remains in patients whose MetS diagnosis changes. To assess the relationship between risk of psoriasis and changes in MetS components. We obtained data from the National Health Insurance Service of Korea and divided the participants into four groups: individuals without MetS (control); individuals with MetS in 2009, but without MetS in 2012 (pre-MetS); individuals without MetS in 2009, but with newly diagnosed MetS in 2012 (post-MetS); and individuals with MetS during the 2009–2012, period (continuous-MetS). We calculated the risk of psoriasis for each group. Risk of psoriasis was similar in the control and pre-MetS groups but was significantly higher in the post-MetS group (hazard ratio [HR], 1.08; 95% confidence interval [CI], 1.04–1.12) and in the continuous-MetS group (HR, 1.11; 95% CI, 1.07–1.15) than in the control group. Among MetS components, waist circumference showed the strongest association with psoriasis, followed by high-density lipoprotein and triglyceride levels. Risk of psoriasis was higher in patients with continuous- or post-MetS than in those with pre-MetS (regardless of prior MetS status). [ABSTRACT FROM AUTHOR]

Objective: Late-life depression and subjective cognitive decline (SCD) are significant risk factors for dementia. However, studies with a large sample size are needed to clarify their independent and combined risks for subsequent dementia. Methods: This nationwide population-based cohort study included all individuals aged 66 years who participated in the National Screening Program between 2009 and 2013 (N = 939,099). Subjects were followed from the day they underwent screening to the diagnosis of dementia, death, or the last follow-up day (December 31, 2017). Results: Depressive symptom presentation, recent depressive disorder, and SCD independently increased dementia incidence with adjusted hazard ratio (aHR) of 1.286 (95% CI:1.255–1.318), 1.697 (95% CI:1.621–1.776), and 1.748 (95% CI: 689–1.808) respectively. Subjects having both SCD and depression had a higher risk (aHR = 2.466, 95% CI:2.383–2.551) of dementia than having depression (aHR = 1.402, 95% CI:1.364–1.441) or SCD (aHR = 1.748, 95% CI:1.689–1.808) alone. Conclusions: Depressive symptoms, depressive disorder, and SCD are independent risk factors for dementia. Co-occurring depression and SCD have an additive effect on the risk of dementia; thus, early intervention and close follow up are necessary for patients with co-occurring SCD and depression. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of alcohol abstinence on prevention of new-onset atrial fibrillation (AF) in patients with type 2 diabetes mellitus (T2DM).Research Design and Methods: A total of 1,112,682 patients newly diagnosed with T2DM between 2011 and 2014 were identified from the Korean National Health Insurance Service database. After excluding those with a history of AF, 175,100 patients were included. The primary outcome was new-onset AF.Results: During a mean follow-up of 4.0 years, AF occurred in 4,174 patients. Those with heavy alcohol consumption (alcohol intake ≥40 g/day) before T2DM diagnosis had a higher risk of AF (adjusted hazard ratio [aHR] 1.22; 95% CI 1.06-1.41) compared with patients with no alcohol consumption. After T2DM diagnosis, those with moderate to heavy alcohol consumption (alcohol intake ≥20 g/day) who abstained from alcohol had a lower risk of AF (aHR 0.81; 95% CI 0.68-0.97) compared with constant drinkers. Alcohol abstinence showed consistent trends toward lower incident AF in all subgroups and was statistically significant in men (aHR 0.80; 95% CI 0.67-0.96), those aged >65 years (aHR 0.69; 95% CI 0.52-0.91), those with CHA2DS2-VASc score <3 points (aHR 0.71; 95% CI 0.59-0.86), noninsulin users (aHR 0.77; 95% CI 0.63-0.94), and those with BMI <25 kg/m2 (aHR 0.68; 95% CI 0.53-0.88).Conclusions: In patients with newly diagnosed T2DM, alcohol abstinence was associated with a low risk of AF development. Lifestyle modifications, such as alcohol abstinence, in patients newly diagnosed with T2DM should be recommended to reduce the risk of AF. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate whether the incidence of Parkinson's disease (PD) is increased among patients with obstructive sleep apnea (OSA) and whether surgical treatment can prevent such an increase. This was a retrospective cohort study. We analysed the claims data from the Korea National Health Insurance Service. A total of 202,726 patients who were newly diagnosed with OSA between 2007 and 2014 were included. The patients were divided into two groups: patients who underwent uvulopalatopharyngoplasty (surgery group, n = 22,742) and those who did not (conservative group, n = 179,984). The control group (n = 1,013,630) was selected by propensity score matching. They were tracked until 31st December 2015. The hazard ratio of PD diagnosis (95% confidence interval) in the OSA group with respect to the control group was calculated using the Cox proportional hazard model. In the conservative group, the incidence of PD (hazard ratio 2.57 [2.32–2.85]) was significantly higher than that in the control group, while the incidence of PD in the surgery group was similar to that in the control group (hazard ratio 1.45 [0.89–2.22]). Patients with OSA are at an increased risk of developing PD, and uvulopalatopharyngoplasty may mitigate this risk. [ABSTRACT FROM AUTHOR]

We evaluated the impacts of lifestyle behaviors, namely smoking, alcohol consumption, and physical activity, on the development of new-onset AF in patients with DM. Using the Korean Nationwide database, we identified subjects diagnosed with type 2 DM and without previous history of AF between 2009 and 2012. Self-reported lifestyle behaviors were analyzed. Among 2,551,036 included subjects, AF was newly diagnosed in 73,988 patients (median follow-up 7.1 years). Both ex-smokers (hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.02–1.07) and current smokers (HR 1.06, 95% CI 1.03–1.08) demonstrated a higher risk of AF than never smokers. Patients with moderate (15–29 g/day) (HR 1.12, 95% CI 1.09–1.15) and heavy (≥ 30 g/day) (HR 1.24, 95% CI 1.21–1.28) alcohol consumption exhibited an increased risk of AF, while subjects with mild alcohol consumption (< 15 g/day) (HR 1.01, 95% CI 0.99–1.03) had an AF risk similar to that of non-drinkers. Patients who engaged in moderate-to-vigorous physical activity showed a lower risk of AF (HR 0.93, 95% CI 0.91–0.94) than those who did not. This study suggests that smoking, alcohol consumption, and physical activity are associated with new-onset AF in patients with DM, and lifestyle management might reduce the risk of AF in this population. [ABSTRACT FROM AUTHOR]

Various treatment modalities are used for head and neck cancer (HNC). This study analyzed the incidence and risks of myocardial infarction (MI) and stroke by cancer site and treatment modality in 22,737 patients newly diagnosed with HNC registered in the Korean National Health Insurance Service database in 2007–2013. An additional 68,211 patients without HNC, stroke, or MI were identified as the control group. The risks for MI (hazard ratio [HR] = 1.38, 95% confidence interval [CI] 1.24–1.53), stroke (HR = 1.48, 95% CI 1.37–1.60), and mortality (HR = 5.30, 95% CI 5.14–5.47) were significantly higher in the HNC group. Analysis by cancer site showed the risk of MI and mortality was highest in hypopharynx cancer, while the risk of stroke was highest in nasopharynx and paranasal sinus cancer. Analysis by treatment modality showed the highest risks for MI (HR = 1.88, 95% CI 1.31–2.69) and mortality (HR = 2.95, 95% CI 2.75–3.17) in HNC patients receiving chemotherapy (CT) alone, while HNC patients receiving CT with surgery had the highest risk for stroke (HR = 1.81, 95% CI 1.14–2.88). Careful attention to MI and stroke risks in HNC patients is suggested, especially those who received both CT and radiotherapy. [ABSTRACT FROM AUTHOR]

Background: Although elevated serum gamma‐glutamyltransferase (GGT) is a known indicator of increased risk of several cancers, the clinical value of repeated measurements of GGT has not been determined. Therefore, we aimed to investigate whether repeatedly elevated serum GGT levels are associated with the risk of respiratory cancer incidence. Methods: We included participants who had undergone the Korean Health screening four times during 2009–2012 and had previously undergone four consecutive examinations. Those who were diagnosed with respiratory cancer before the date of examination were excluded. The participants obtained one GGT point if their GGT levels were in the highest quartile (the quartile 4 group). We analyzed the association between GGT points and respiratory cancer incidence by Cox proportional hazard models. Results: During mean follow‐up of 6.39 ± 1.2 years, 3,559,109 participants were enrolled. Of them, 8,944 (0.34%) men and 1,484 (0.14%) women were newly diagnosed with respiratory cancer. In multivariate analysis adjusted for confounding factors, male participants with 4 GGT points had a significantly higher hazards of developing respiratory cancer than those with 0 GGT points (hazard ratio [HR]: 1.39; 95% confidence interval [CI]: 1.31–1.48). Among female, participants with the highest points of GGT also had sixfold increased risk of developing laryngeal cancer. However, no significant association was observed between GGT points and lung cancer incidence among women (HR: 0.95; 95% CI: 0.81–1.11). Conclusion: Repeatedly elevated serum levels of GGT were associated with a higher risk of respiratory cancer incidence, especially in men. This finding suggests that physicians can identify a person with a higher risk of respiratory cancer through a simple repeated measurement of GGT. [ABSTRACT FROM AUTHOR]

We evaluated the association between nonalcoholic fatty liver disease (NAFLD) and incident atrial fibrillation (AF) and analyzed the impact of NAFLD on AF risk in relation to body mass index (BMI). A total of 8,048,055 subjects without significant liver disease who were available fatty liver index (FLI) values were included. Subjects were categorized into 3 groups based on FLI: < 30, 30 to < 60, and ≥ 60. During a median 8-year of follow-up, 534,442 subjects were newly diagnosed as AF (8.27 per 1000 person-years). Higher FLI was associated with an increased risk of AF (hazard ratio [HR] 1.053, 95% confidence interval [CI] 1.046–1.060 in 30 ≤ FLI < 60, and HR 1.115, 95% CI 1.106–1.125 in FLI ≥ 60). In underweight subjects (BMI < 18.5 kg/m2), higher FLI raised the risk of AF (by 1.6-fold in 30 ≤ FLI < 60 and by twofold in FLI ≥ 60). In normal- and overweight subjects, higher FLI was associated with an increased risk of AF, but the HRs were attenuated. In obese subjects, higher FLI was not associated with higher risk of AF. NAFLD as assessed by FLI was independently associated with an increased risk of AF in nonobese subjects with BMI < 25 kg/m2. The impact of NAFLD on AF risk was accentuated in lean subjects with underweight. [ABSTRACT FROM AUTHOR]

Background: The metabolic syndrome (MetS) and its components are associated with the development of atrial fibrillation (AF). However, the impact of time-burden of MetS on the risk of AF is unknown. We investigated the effect of the cumulative longitudinal burden of MetS on the development of AF. Methods: We included 2 885 189 individuals without AF who underwent four annual health examinations during 2009–2013 from the database of the Korean national health insurance service. Metabolic burdens were evaluated in the following three ways: (1) cumulative number of MetS diagnosed at each health examination (0–4 times); (2) cumulative number of each MetS component diagnosed at each health examination (0–4 times per MetS component); and (3) cumulative number of total MetS components diagnosed at each health examination (0 to a maximum of 20). The risk of AF according to the metabolic burden was estimated using Cox proportional-hazards models. Results: Of all individuals, 62.4%, 14.8%, 8.7%, 6.5%, and 7.6% met the MetS diagnostic criteria 0, 1, 2, 3, and 4 times, respectively. During a mean follow-up of 5.3 years, the risk of AF showed a positive association with the cumulative number of MetS diagnosed over four health examinations: adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of 1, 2, 3, and 4 times compared to 0 times were 1.18 (1.13–1.24), 1.31 (1.25–1.39), 1.46 (1.38–1.55), and 1.72 (1.63–1.82), respectively; P for trend < 0.001. All five components of MetS, when diagnosed repeatedly, were independently associated with an increased risk of AF: adjusted HR (95% CI) from 1.22 (1.15–1.29) for impaired fasting glucose to 1.96 (1.87–2.07) for elevated blood pressure. As metabolic components were accumulated from 0 to 20 counts, the risk of AF also gradually increased up to 3.1-fold (adjusted HR 3.11, 95% CI 2.52–3.83 in those with 20 cumulative components of MetS), however, recovery from MetS was linked to a decreased risk of AF. Conclusions: Given the positive correlations between the cumulative metabolic burdens and the risk of incident AF, maximal effort to detect and correct metabolic derangements even before MetS development might be important to prevent AF and related cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Premature ventricular contraction (PVC) and atrial fibrillation (AF) are common arrhythmias affecting 1–2% of the general population. During PVC, retrograde ventriculo-atrial activation can occur and act like an atrial ectopy. However, the clinical significance of this phenomenon is not fully understood. We aimed to elucidate whether the clinical diagnosis of PVC can increase the risk of new-onset AF. We performed a nationwide population-based analysis using the Korean National Health Insurance Service database. A total of 9,537,713 people without prior history of PVC and AF were identified. Among these people, 4135 developed PVC in 2009, and people with and without PVC were followed until 2018. People who had PVC showed an increased risk of new-onset AF as compared with people without PVC (hazard ratio [HR] = 2.705; 95% confidence interval [CI] = 2.428–3.013; p < 0.001). The risk of ischemic stroke was also significantly increased in people with PVC (HR 1.160; 95% CI 1.048–1.284; p = 0.0041). New-onset AF developed in 72 people (19.3%) among 374 people with PVC who had ischemic stroke during their follow-up. A significant interaction was observed between PVC and age with people < 65 years at greater risk of new-onset AF for having PVC. In this observational analysis, the risk of new-onset AF and ischemic stroke was increased in people with PVC. Additional evaluation to identify AF in people with PVC can be helpful. [ABSTRACT FROM AUTHOR]

Objective: Previous studies have suggested that diabetes increases the risk of Parkinson disease (PD); however, this has not been conclusively established. We analyzed the risk of PD based on baseline glucose tolerance status in a large-scale cohort representative of the general Korean population.Research Design and Methods: This analysis was performed in a cohort of 15,168,021 adults aged ≥40 years who underwent health checkups under the National Health Insurance Service between January 2009 and December 2010. The clinical course of subjects was monitored until December 2016. Subjects were classified into the following groups: no diabetes, impaired fasting glucose (IFG), diabetes duration <5 years, and diabetes duration ≥5 years. We analyzed the adjusted hazard ratio of PD for each group.Results: During the observation period of 49,076,148.74 person-years, PD occurred in 31,577 patients. Compared with the nondiabetes group, the adjusted hazard ratio was 1.038 (95% CI, 1.009-1.067) in the IFG group, 1.185 (95% CI, 1.143-1.229) in the diabetes duration <5 years group, and 1.618 (95% CI, 1.566-1.672) in the diabetes duration ≥5 years group. These results were consistent with those of the subgroup analysis, and the presence of diabetes further increased the risk of PD regardless of comorbidities such as cardiovascular, cerebrovascular, and chronic kidney diseases.Conclusions: This population-based cohort study suggests that diabetes is an independent risk factor for PD. [ABSTRACT FROM AUTHOR]

Background: The aim was to evaluate whether this gastric cancer-screening programme was effective in reducing oesophageal cancer mortality. Methods: A population-based retrospective cohort study was conducted using the Korean National Cancer Screening Programme (NCSP) database. The study cohort comprised 16,969 oesophageal cancer patients who had been diagnosed in 2007–2014. We analysed the association between the history of NSCP for gastric cancer and oesophageal cancer mortality. Results: Compared with never-screened subjects, ever-screened subjects had an overall HR for oesophageal cancer mortality of 0.647 (95% CI, 0.617–0.679). According to the time interval since screening, the HRs of death were 0.731 (95% CI, 0.667–0.801) for 6–11 months, 0.635 (95% CI, 0.594–0.679) for 12–23 months, 0.564 (95% CI, 0.522–0.610) for 24–35 months and 0.742 (95% CI, 0.679–0.810) for ≥36 months. According to the last screening modality, the HRs of death were 0.497 (95% CI, 0.464–0.531) for upper endoscopy, and 0.792 (95% CI, 0.749–0.838) for UGIS. Upper endoscopy reduced the mortality consistently in all age groups over 50 years, whereas UGIS could not. Conclusion: The NCSP for gastric cancer was effective in reducing the mortality of oesophageal cancer, and upper endoscopy was superior to UGIS. [ABSTRACT FROM AUTHOR]

Background: The aim was to evaluate whether this gastric cancer-screening programme was effective in reducing oesophageal cancer mortality.Methods: A population-based retrospective cohort study was conducted using the Korean National Cancer Screening Programme (NCSP) database. The study cohort comprised 16,969 oesophageal cancer patients who had been diagnosed in 2007-2014. We analysed the association between the history of NSCP for gastric cancer and oesophageal cancer mortality.Results: Compared with never-screened subjects, ever-screened subjects had an overall HR for oesophageal cancer mortality of 0.647 (95% CI, 0.617-0.679). According to the time interval since screening, the HRs of death were 0.731 (95% CI, 0.667-0.801) for 6-11 months, 0.635 (95% CI, 0.594-0.679) for 12-23 months, 0.564 (95% CI, 0.522-0.610) for 24-35 months and 0.742 (95% CI, 0.679-0.810) for ≥36 months. According to the last screening modality, the HRs of death were 0.497 (95% CI, 0.464-0.531) for upper endoscopy, and 0.792 (95% CI, 0.749-0.838) for UGIS. Upper endoscopy reduced the mortality consistently in all age groups over 50 years, whereas UGIS could not.Conclusion: The NCSP for gastric cancer was effective in reducing the mortality of oesophageal cancer, and upper endoscopy was superior to UGIS. [ABSTRACT FROM AUTHOR]

Aims: Before developing a national screening program for pancreatic cancer, more detailed and reliable estimation of pancreatic cancer incidence rate is needed according to sex, age, and diabetes mellitus status. Methods: Among populations who underwent a biennial or annual evaluation provided by the National Health Insurance Service Database of Claims between 2006 and 2015, data were evaluated from the medical records of 34.2 million individuals aged 30 years and over. Results: The annual incidence rate (IR; per 100,000) of pancreatic cancer in 2006 was 5.96, and the IR in 2015 increased to 8.92. The IRs increased consistently and significantly with age (p for trend < 0.0001). The incidence rate ratio (IRR; after adjusting for age and sex) of pancreatic cancer was higher (about 1.5 times) in males than in females for all ages. In particular, the IR (15.8) of pancreatic cancer between 50 and 59 years in patients with diabetes was strikingly higher compared to that in patients without diabetes (IR 7.6). Furthermore, the pancreatic cancer IR (19.1) of men with diabetes between 50 and 59 years was similar to the IR (20.2) in women with diabetes between 60 and 69 years, and it was even greater than the IR (17.0) in non-diabetic women between 60 and 69 years. Conclusions: In middle-aged populations, men with type 2 diabetes had the highest relative risk. Their annual incidence rate of pancreatic cancer persistently increased and was higher by about 10–30% than in women with diabetes. [ABSTRACT FROM AUTHOR]

We analyzed data from the Korean National Health Insurance Service (NHIS) to investigate whether smoking increases the risk of end-stage kidney disease (ESKD). This retrospective nationwide population-based cohort study included the data of 23,232,091 participants who underwent at least one health examination between 2009 and 2012. Smoking status was recorded at baseline. The incidence of ESKD was identified via ICD-10 codes and special medical aid codes from the Korean National Health Insurance Service database till December 2016. A Cox proportional-hazards model with multivariable adjustment was used to evaluate the association between smoking and ESKD incidence. Overall, 24.6% of participants were current smokers; 13.5% and 61.9%, were ex- and non-smokers, respectively. Overall, 45,143 cases of ESKD developed during the follow-up period. Current smokers (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.35–1.43) and ex-smokers (HR, 1.09; 95% CI, 1.06–1.12) demonstrated a significant increase in the adjusted risk of ESKD compared to non-smokers. The risk of ESKD was directly proportional to the smoking duration, number of cigarettes smoked daily, and pack-years. In conclusion, smoking is associated with a greater risk of ESKD in the general Korean population; the risk increases with an increase in the smoking duration, number of cigarettes smoked daily, and pack-years. [ABSTRACT FROM AUTHOR]

Hyperuricemia and anemia share several comorbidities, but the association between the two conditions remains unclear. The purpose of this study was to investigate the association between hyperuricemia and anemia. Data of 10794 subjects from the Korean National Health and Nutrition Examination Survey conducted in 2016–2017 were analyzed using multivariate logistic regression analyses. An association between anemia and hyperuricemia was not evident in subjects without chronic kidney disease (CKD). In patients with CKD, anemia increased the risk of hyperuricemia by 2-fold. This association remained significant when adjusting for the glomerular filtration rate. In subgroup analyses, the association of anemia with hyperuricemia was significant in subjects aged ≥65 years, and in those with diabetes or hypertension. Subgroup analyses of CKD patients showed similar results. In the current study using data from Korean representative samples, anemia in subjects with CKD was associated with a 2-fold increase in the risk of hyperuricemia, which remained significant even after adjustment for renal function. [ABSTRACT FROM AUTHOR]

• Most guidelines suggest a minimum of 150 min/week of moderate-intensity physical activity (PA) to achieve cardiovascular benefits. • PA not only reduces all-cause and cardiovascular mortality, but also lowers the risk of death from respiratory diseases, cancer, and other causes. • The magnitude of mortality risk reduction by increasing PA may be greater in older patients with type 2 diabetes mellitus. • We observed reverse J-shaped associations between all-cause and cause-specific mortalities, and PA with the lowest mortality risk observed at PA levels of 1830–2010 metabolic equivalent of tasks-min/week. Physical inactivity is a modifiable risk factor for cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM); however, little is known about its association with mortality due to other causes. Herein, we investigated the association between physical activity (PA) and cause-specific mortality in patients with T2DM. We analyzed data from the Korean National Health Insurance Service and claims database of adults with T2DM aged >20 years at baseline (n = 2,651,214). Each participant's PA volume was measured as the metabolic equivalent of tasks (METs)-min per week, and hazard ratios of all-cause and cause-specific mortality relative to PA levels were estimated. During the 7.8 years of follow-up, all-cause, CVD, respiratory, cancer, and other causes of mortality were lowest in patients engaged in vigorous PA. MET-min/week was inversely associated with mortality after adjusting for covariates. The reduction in total and cause-specific mortality was greater in patients aged ≥65 years than in those aged <65 years. Increasing PA may facilitate a reduction in mortality from various causes, especially among older patients with T2DM. Clinicians should encourage such patients to increase their daily PA levels to reduce their risk of mortality. [ABSTRACT FROM AUTHOR]

This article examines the connection between lifestyle choices and the likelihood of developing psoriasis in young adults with inflammatory bowel disease (IBD) in South Korea. The study analyzed data from health exams conducted by the Korean National Health Insurance Corporation, including 5,356 IBD patients and 6,648,818 non-IBD controls. The research discovered that smoking and heavy alcohol consumption were linked to a significantly higher risk of psoriasis in young adults with IBD, with smoking having a particularly strong impact on patients in their 20s. The article emphasizes the importance of lifestyle modifications, such as quitting smoking and moderating alcohol intake, in reducing the risk of psoriasis in individuals with IBD, and highlights the need for healthcare professionals to educate their patients, especially young adults with IBD, about the potential benefits of these changes. [Extracted from the article]

The article discusses patients with T2DM who had experienced severe weight loss showed more frequent history of chronic obstructive pulmonary disease and cancer than other groups in our data, Yang et al. (1) raised the possibility of confounding effects from comorbidities and suggested additional analysis.

Background & aims: Sensorineural hearing loss (HL) is one of the most common public health problems, and its prevalence increases with increasing life expectancy. An association between HL and metabolic syndrome (MetS) is suspected. Although previous epidemiological studies have investigated the association between the two variables, there have been conflicting conclusions. Therefore, we aimed to evaluate the association between the presence of MetS—and individual components of MetS—and HL, using a longitudinal design and a large-scale population. Methods: A total of 17,513,555 individuals who underwent national health screening between January 2009 and December 2010 were identified. Subject data from the Korean Health Insurance Review and Assessment Service were reviewed. A total of 11,457,931 subjects were ultimately included in the analysis. Baseline comorbidities were defined according to the ICD-10 code from the Korean Health Insurance Review and Assessment Service data. If the participants had an ICD-10 code for HL during the follow-up, they were defined as having incident HL. Criteria for MetS adhered to the revised National Cholesterol Education Program Adult Treatment Panel III. Results: There were 7,574,432 subjects without MetS and 3,883,499 with MetS. The incidence of HL in subjects without MetS and with MetS was 1.3% and 1.8% at 1 year, 4.1% and 5.2% at 3 years, and 6.8% and 8.6% at 5 years, respectively (P < 0.001). However, multivariate analyses revealed a negative association. Analyses according to the components of MetS demonstrated a positive association for those associated with dyslipidemia; however, the others exhibited an inverse association with HL. We also performed analyses using 4 groups according to the presence of MetS and the components of dyslipidemia. Univariate analysis revealed a positive association between the presence of MetS and HL; however, multivariate analysis revealed a positive association between the presence of dyslipidemia components and HL, regardless of the presence of MetS. Conclusion: Among the components of MetS, the association between low HDL or high TG levels and HL was most apparent. It is useful to evaluate each MetS component in isolation, such as the presence of low HDL or high TG levels, rather than the presence of MetS as a cluster of components. [ABSTRACT FROM AUTHOR]

Background: Underweight imposes significant burden on cardiovascular outcomes in patients with diabetes mellitus. However, less is known about the impact of serial change in body weight status measured as body mass index (BMI) on the risk of sudden cardiac arrest (SCA). This study investigated the association between SCA and temporal change in BMI among patients with diabetes mellitus. Methods: Based on Korean National Health Insurance Service database, participants with diabetes mellitus who underwent health examination between 2009 and 2012 and had prior health examination data (four years ago, 2005–2008) were retrospectively analyzed. BMI was measured at baseline (2005–2008) and 4-year follow-up health examination (2009–2012). Patients were classified in four groups according to the body weight status and its temporal change: sustained non-underweight, sustained underweight, previous underweight, and newly developed underweight. Primary outcome was defined as occurrence of SCA. Results: A total of 1,355,746 patients with diabetes mellitus were included for analysis, and SCA occurred in 12,554 cases. SCA was most common in newly developed underweight (incidence rate = 4.45 per 1,000 person-years), followed by sustained underweight (incidence rate = 3.90), previous underweight (incidence rate = 3.03), and sustained non-underweight (incidence rate = 1.34). Adjustment of covariates resulted highest risk of SCA in sustained underweight (adjusted hazard ratio = 2.60, 95% confidence interval [2.25–3.00], sustained non-underweight as a reference), followed by newly developed underweight (2.42, [2.15–2.74]), and previous underweight (2.12, [1.77–2.53]). Conclusions: In diabetes mellitus, sustained underweight as well as decrease in body weight during 4-year follow-up imposes substantial risk on SCA. Recovery from underweight over time had relatively lower, but yet increased risk of SCA. Both underweight and dynamic decrease in BMI can be associated with increased risk of SCA. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most common cardiac arrhythmia. The association between AF and γ-Glutamyltransferase (GGT) was not fully established. This study demonstrated the independent association of cumulative GGT score and AF incidence with the dose-response relationship. Using the Korean National Health Insurance Corporation database, adult subjects who had 4 consecutive annual health examinations from 2009 to 2012 were enrolled. A cumulative GGT score was calculated as the cumulative number of the highest GGT quartile amongst four examinations (0–4 times). A multivariable Cox proportional hazards regression analysis was performed. Among a total of 3,500,847 people included, AF was developed in 27,752 people (0.793%) during a median of 8.0 years of follow up. The incidence rate of AF and adjusted hazard ratio were increased by a stepwise manner in the higher quartile group and cumulative GGT score group. In subgroup analysis, this trend was more prominent in the elderly, people without hypertension, non-obese people, and people without any four comorbidities (diabetes mellitus, hypertension, dyslipidemia, and obesity). Our results suggest multiple accumulation of elevated GGT levels in health examination might be a useful marker for risk stratification of AF development, especially in the elderly and healthy population. [ABSTRACT FROM AUTHOR]

Objective: Breast-feeding is associated with maternal health, such as electrolyte metabolism, lipid profile and body component change. The aim of this study was to evaluate the relationship between duration of breast-feeding and obesity in postmenopausal women.Methods: We analyzed data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2012, a cross-sectional study in a Korean population. A total of 6621 postmenopausal women were analyzed.Results: Body mass index and waist circumference were greater in women who had breast-fed for 6 months or more than in those who had not (BMI: 23.7±0.1 vs 24.5±0.1, P<0.0001; WC: 80.6±0.4 vs 82.8±0.3, P<0.001). This association persisted after adjustment for confounding factors (BMI: odds ratio[OR]1.54, 95% confidence interval[CI] 1.19-2.0; WC: OR1.67, 95% CI 1.29-2.17). The duration of breast-feeding tended to increase with increasing BMI and WC (P for trend, 0.001 for each). The proportions of women with greater BMI and WC increased with increasing duration of breast-feeding (27.3% in ≤6 months vs 41.2% in >18months, P<0.0001).Conclusion: The results of this study suggest that prolonged breast-feeding may be associated with greater BMI and WC among postmenopausal women. [ABSTRACT FROM AUTHOR]

Simple Summary: Research suggests that a skin condition called atopic dermatitis (AD) and cancer, specifically kidney cancer, might be connected. However, we do not have enough evidence to confirm this link. This study aimed to determine whether the risk is real and whether the severity of AD influences this association. We used a big database of health information from Korea for the investigation and found that people with moderate to severe AD have a higher-than-average chance of getting kidney cancer. This discovery could help doctors better understand these conditions and might lead to more frequent check-ups for kidney cancer in people with AD, especially those with severe disease. Background: Evidence for an association between atopic dermatitis (AD) and cancer is still insufficient. In particular, the association between the risk of renal malignancy and the severity of AD has not been thoroughly investigated. Objective: To investigate the risk of renal malignancy and determine the association between AD severity and cancer risk using data from the Korean National Health Insurance Service (KNHIS) database. Methods: We performed a population-based cohort study using the National Health Claims database from the NHIS in Korea. Results: We found a statistically significant association between AD and overall malignancy (for mild AD, hazard ratio (HR): 1.061, 95% confidence interval (CI): 1.006–1.118; for moderate to severe AD, HR: 1.061, 95% CI: 1.014–1.11) compared with the no AD group. The moderate to severe AD group showed a significantly increased risk for renal malignancy (adjusted HR: 1.533, 95% CI: 1.209–1.944) compared with the no AD group. Limitations: Patient inclusion is solely based on diagnostic codes. We had no data about drug use, genetic factors, or other medical history that could affect the cancer risk. Conclusion: In our large population-based cohort study, moderate to severe AD was associated with increased risk of renal malignancy. Regular check-ups for renal malignancy are recommended in this population. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most common cardiac arrhythmia. The association between AF and γ-Glutamyltransferase (GGT) was not fully established. This study demonstrated the independent association of cumulative GGT score and AF incidence with the dose-response relationship. Using the Korean National Health Insurance Corporation database, adult subjects who had 4 consecutive annual health examinations from 2009 to 2012 were enrolled. A cumulative GGT score was calculated as the cumulative number of the highest GGT quartile amongst four examinations (0–4 times). A multivariable Cox proportional hazards regression analysis was performed. Among a total of 3,500,847 people included, AF was developed in 27,752 people (0.793%) during a median of 8.0 years of follow up. The incidence rate of AF and adjusted hazard ratio were increased by a stepwise manner in the higher quartile group and cumulative GGT score group. In subgroup analysis, this trend was more prominent in the elderly, people without hypertension, non-obese people, and people without any four comorbidities (diabetes mellitus, hypertension, dyslipidemia, and obesity). Our results suggest multiple accumulation of elevated GGT levels in health examination might be a useful marker for risk stratification of AF development, especially in the elderly and healthy population. [ABSTRACT FROM AUTHOR]

Objectives: The study investigated the association between childbirth history and health-related quality of life (QOL) in menopausal South Korean women.Study Design: Cross-sectional analysis of data from the 2010-2012 Korean National Health and Nutrition Examination Surveys (KNHANES) for 4277 menopausal women aged over 50. We used the EuroQol index to measure health-related QOL.Main Outcome Measures: The relationship between delivery history and health-related QOL in menopausal South Korean women was analyzed.Results: After adjustment for age (model 1), women who were younger at their first delivery and who had a greater number of deliveries had a significantly higher risk of problems with mobility, self-care, usual activities and pain or discomfort; the risk of anxiety or depression was not increased. After adjustment for age, BMI, smoking, use of alcohol, exercise, income, education, marital status, metabolic syndrome and stress (model 2), women who were younger at their first delivery and who had a greater number of deliveries had a significantly higher risk of problems with mobility, self-care and pain or discomfort. Age at last delivery was not significantly associated with health-related QOL in either model.Conclusions: South Korean women who were younger at their first delivery and who had more deliveries appear to be at increased risk of health-related QOL problems after menopause. [ABSTRACT FROM AUTHOR]

Purpose: Interest in fractures in patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) has considerably increased in the last decade. However, few studies have compared the incidence of fractures between patients with MS and NMOSD using a nationwide database. This study aimed to evaluate the differences in the risk of fracture between patients with NMOSD and MS compared to that in healthy controls using cohort data from a Korean nationwide database. Methods: In this retrospective cohort study, data from the National Health Insurance Service (NHIS) database from January 2010 to December 2017 were analyzed. A total of 1,217/1,329 patients with MS/NMOSD free of fractures at the index date were included. Matched controls were selected based on age, sex, and the presence of hypertension, diabetes mellitus, and dyslipidemia. The mean follow-up durations after the index date were 4.40/4.08 years for patients with MS/NMOSD and 4.73/4.28 for their matched controls. Results: The adjusted hazard ratios (aHRs) with 95% confidence intervals of any, hip, and vertebral fractures were 1.81 (1.43–2.28), 3.36 (1.81–6.24), and 2.01 (1.42–2.99) times higher for patients with MS than for controls, respectively, and they were 1.85 (1.47–2.34), 3.82 (2.05–7.11), and 2.84 (1.92–4.21) times higher for patients with NMOSD than for controls, respectively. No significant differences were observed in the incidence of fractures between the MS and NMOSD groups. Patients with MS/NMOSD had a 1.8-fold higher risk of fracture than matched controls, and the risk of hip fracture was especially high (3- to 4-fold higher). Conclusions: Clinicians need to regularly assess patients with MS/NMOSD for the risk of fractures and take preventative measures to reduce it. [ABSTRACT FROM AUTHOR]

Background: Alanine aminotransferase (ALT) has been one of the most useful biomarkers reflecting liver damage. Some studies have proposed that serum ALT levels, even those within the conventional normal range, are associated with metabolic syndrome and fatty liver.Aims: We examined the correlation between ALT levels and insulin resistance (IR) and ALT cutoff value for high IR status in Korean adolescents.Methods: A total of 886 subjects (461 boys and 425 girls) who participated in the 2009-2010 Korea National Health and Nutrition Examination Survey were included in this study. Multivariable adjusted logistic regression analyses were used to examine the odds ratios and 95 % confidence intervals (CIs) of the prevalence of the highest quartile of the homeostasis model assessment of IR (HOMA-IR) according to the ALT quartile. The cutoff value of ALT for the highest HOMA-IR quartile (Q4) were obtained using receiver operating characteristic curve analysis.Results: The mean ALT value increased as the number of metabolic syndrome components increased, but in only boys (p for trend <0.001), while the IR quartile increased in both boys and girls (all p for trends <0.001). The prevalence of IR (Q4) was only increased in ALT (Q4) in boys after the adjustment for age, body mass index, and waist circumference (OR 2.49; 95 % CI 1.05-5.91; p for trend = 0.017). The cutoff values were 17.0 IU/L in boys and 11.0 IU/L in girls.Conclusions: The highest ALT quartile was associated with an increased prevalence of the highest quartile of IR in boys but not in girls. [ABSTRACT FROM AUTHOR]