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Abstract Although a robust association between metabolic dysfunction-associated fatty liver disease (MASLD) and cardiovascular disease (CVD) has been established, the impact of MASLD on CVD risk in young adults has not been fully evaluated. This population-based study included adults aged 20–39 years who underwent health screening examinations from 2009 to 2012 based on Korean National Health Insurance Service database. MASLD was defined as a fatty liver index ≥ 30 without any other cause of steatosis, and presence of one or more cardiometabolic risk factors. The primary outcome was newly developed CVD, including myocardial infarction, ischemic stroke, and congestive heart failure. During the median 10.6 years of follow-up, MASLD was observed in 1,435,659 (25.3%) of the 5,666,728 participants. Cumulative incidence of major adverse cardiovascular events was significantly higher in individuals with MASLD compared those without steatosis (P

Abstract Interstitial lung disease (ILD) leads to worse outcomes in subjects with rheumatoid arthritis (RA). Few large-scale longitudinal studies have provided comprehensive data on the incidence and risk of ILD in RA compared with non-RA populations. We compare the risk of incident ILD in subjects with RA and matched controls, while also evaluating the impact of RA serologic status. Using the Korean National Health Insurance Service Data between 2010 and 2017, we identified 52,325 individuals with RA and 261,625 without RA. During a median follow-up period of 4.4 years, 3.7% of the RA cohort and 0.5% of the matched cohort developed ILD, with incidence rates of 8.30 and 1.01 per 1,000 person-years. Compared to controls, the risk of incident ILD was significantly higher in the RA cohort (adjusted hazard ratio [aHR] 7.84 [7.29–8.44]), and seropositive and seronegative RA exhibited aHRs of 9.00 (8.34–9.72) and 4.81 (4.25–5.44). Although the risk of ILD was higher in seropositive RA than seronegative RA, the risk of developing ILD was also higher in subjects with seronegative RA than in matched controls, suggesting that close monitoring for ILD should be performed in this population.

Abstract Background Vertebral fractures are a common medical issue. Physical activity helps improve bone health and manage the risk of fractures. However, much controversy exists about the association between physical activity and vertebral fractures. Therefore, we aimed to investigate the association between changes in regular physical activity (RPA) and vertebral fractures. Methods This study was a nationwide, observational cohort study based on claim data from the Korean National Health Insurance Service. Physical activity level was obtained from self-reported questionnaires from 2009 to 2012. Participants were divided depending on their levels of physical activity and the occurrence of vertebral fractures from 2013 to 2016 was recorded. Results The group with sufficient RPA, compared to the Insufficient group (incidence rate showed a decrease of 1.93/1,000 PY; adjusted HR (aHR): 0.83; 95% CI: 0.81–0.84), had a reduced risk of vertebral fracture. From the perspective of RPA changes, the Continuous Sufficient group had an aHR of 0.74, 95% CI 0.72–0.76, and the Increased group had an aHR of 0.87, 95% CI 0.85–0.88. The Decreased group had an aHR of 0.94, 95% CI 0.92–0.95. Conclusion The degree of RPA could reduce the risk of vertebral fracture. Continuous sufficient RPA helped lower the risk of vertebral fracture.

Abstract Background This study investigates the effect of botulinum toxin A on lipid layer thickness (LLT) and blink dynamics in patients with benign essential blepharospasm (BEB) compared to dry eye disease (DED) patients. Methods We reviewed the medical records of patients with dry eye disease (DED) and BEB treated with botulinum toxin A (BoT A) injections. Data on demographics, lipid layer thickness (LLT), meiboscore, and blink dynamics measured using a LipiView II interferometer before and 2 months after BoT A were collected. Results Each 28 eyes from 28 patients with BEB and age- and sex-matched patients with DED were included. When comparing blink dynamics, complete blink rate was significantly higher in the pre-injection BEB group compared to the DED group (5.25 ± 4.32 times/20 s vs. 2.43 ± 2.82 times/20 s, p = 0.0055). In tear film lipid profiles analyzed in BEB patients at pre-injection and 2-month follow-up after injection, average LLT significantly increased after injection (72.4 ± 22.7 nm to 83.0 ± 22.2 nm, p = 0.0215). Diabetes and young age were associated factors influencing the LLT increase. Significant increase in LLT was observed post-injection, with specific demographic factors, including diabetes and age, associated with this improvement. Additionally, blink dynamics showed a decrease in complete blink rate post-injection. Conclusions These findings suggest that BoT-A may alleviate BEB symptoms, but ophthalmologists should carefully interpret LLT and blink patterns in BEB patients due to potential overestimations of blink efficacy by the interferometer.

Abstract Background Previous studies have shown that weight change has a reverse J-shape association with all-cause mortality. However, its association with suicide mortality remains undetermined. In this study, we investigated the association between weight change and suicide mortality using a large-scale, population-based cohort from the Korean National Health Insurance Service database. Methods A total of 2,103,525 subjects aged ≥ 20 years who underwent a general health screening program twice in the 2-year interval between 2007 and 2009 were included. Subjects were categorized into five groups according to the percent weight change during this period: severe weight loss (

Background: Individuals with type 2 diabetes mellitus (T2DM) have increased colorectal cancer (CRC) risk, but it is unknown whether income dynamics are associated with CRC risk in these individuals. We examined whether persistent low- or high-income and income changes are associated with CRC risk in non-elderly adults with T2DM. Methods: Using nationally representative data from the Korean Health Insurance Service database, 1,909,492 adults aged 30 to 64 years with T2DM and no history of cancer were included between 2009 and 2012 (median follow-up of 7.8 years). We determined income levels based on health insurance premiums and assessed annual income quartiles for the baseline year and the four preceding years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated after adjusting for sociodemographic factors, CRC risk factors, and diabetes duration and treatment. Results: Persistent low income (ie, lowest income quartile) was associated with increased CRC risk (HR5 years vs 0 years 1.11; 95% CI, 1.04–1.18; P for trend = 0.004). Income declines (ie, a decrease ≥25% in income quantile) were also associated with increased CRC risk (HR≥2 vs 0 declines 1.10; 95% CI, 1.05–1.16; P for trend = 0.001). In contrast, persistent high income (ie, highest income quartile) was associated with decreased CRC risk (HR5 years vs 0 years 0.81; 95% CI, 0.73–0.89; P for trend < 0.0001), which was more pronounced for rectal cancer (HR 0.64; 95% CI, 0.53–0.78) and distal colon cancer (HR 0.70; 95% CI, 0.57–0.86). Conclusion: Our findings underscore the need for increased public policy awareness of the association between income dynamics and CRC risk in adults with T2DM.

Abstract Background Suicide is a significant yet preventable public health issue. Body mass index (BMI) is a readily measurable indicator associated with various health outcomes. However, the relationship between BMI and suicidal death risk is complex and warrants further investigation, particularly within contemporary, non-Western contexts with consideration of potential confounders. The purpose of this study was to investigate the relationship between BMI and the risk of suicidal death. Methods This study was nationwide, retrospective, observational study based on Korean National Health Insurance Service database. We analyzed 4,045,081 participants who were aged > 19 years and underwent national health surveillance in 2009. The participants were categorized according to their BMI (underweight: < 18.5 kg/m², normal weight: 18.5–23 kg/m², overweight: 23–25 kg/m², class I obesity: 25–30 kg/m², and class II obesity: > 30 kg/m²). The primary outcome was the death events caused by suicide which was defined by International Classification of Disorders (ICD-10) codes (X60–X84) and death records documented by the Korea National Statistical Office. Multivariate Cox proportional hazard regression analysis was performed to estimate the risk of suicidal death with respect to BMI categories after adjusting for potential confounders (age, sex, income, diabetes, hypertension, dyslipidemia, smoking, drinking, exercise, self-abuse, waist circumference, schizophrenia, bipolar disorder, eating disorder, cancer, anxiety, and substance use disorder). Results Underweight individuals had an increased risk (hazard ratio [HR] 1.44, 95% confidence interval [CI] 1.31–1.57) while overweight (HR 0.79, 95% CI 0.76–0.83), class I (HR 0.76, 95% CI 0.71–0.80) and class II obesity (HR 0.71, 95% CI 0.63–0.81) were associated with decreased risks of suicidal deaths compared to those of the normal weight individuals (BMI 18.5–23). This trend was consistent regardless of the presence of major depressive disorder (MDD) or the type of living arrangements of the participants. Conclusions Suicidal death risk was inversely correlated with BMI categories, independent of MDD or living arrangements. Our data suggests the importance of physiological factors associated with body mass in understanding suicidal death risk. Furthermore, these data provide valuable insights to where the public health resources should be invested to reduce suicidal death rates.

Abstract Background Depression among breast cancer survivors is a significant concern affecting their long-term survivorship and quality of life. This study investigates the incidence of depression among breast cancer survivors and identifies associated risk factors. Methods This retrospective cohort study used data from the Korean National Health Insurance Service database and included 59,340 breast cancer patients without a history of depression who underwent surgery between January 1, 2010, and December 31, 2016. They were individually matched 1:2 by age with a general population without cancer (n = 99,834). The mean follow-up period was 6.4 ± 2.6 years. Sub-distribution hazard ratios (sHRs) and 95% confidence intervals (CIs) were calculated considering death as a competing risk and adjusting for sociodemographic factors and comorbidities. Results Breast cancer survivors with a mean (standard deviation) age of 51.5 (9.2) years had a 39% increased risk of depression compared to non-cancer controls (sHR 1.39, 95% CI 1.36–1.42). During the first year post-diagnosis, breast cancer survivors across all ages exhibited a significantly elevated risk of depression, with a sHR of 3.23 (95% CI 3.08–3.37). Notably, younger survivors had a sHR of 4.51 (95% CI 4.19–4.85), and older survivors had a sHR of 2.56 (95% CI 2.42–2.71). One year post-surgery, younger survivors (age ≤ 50 years) showed a 1.16-fold increase in depression risk (sHR 1.16, 95% CI 1.11–1.20), while older survivors (age > 50 years) showed no significant change in risk, which decreased over time. Use of anthracycline, taxane, or endocrine therapy was associated with an increased depression risk (sHR 1.17, 95% CI 1.13–1.22; sHR 1.12, 95% CI 1.07–1.16; and sHR 1.27, 95% CI 1.14–1.41, respectively), with endocrine therapy showing a 41% increased depression risk in older survivors (sHR 1.41, 95% CI 1.23–1.61). Conclusion This study demonstrates a significant association between breast cancer and depression, with a particularly heightened risk in younger survivors within the first year post-diagnosis. Special attention is needed to meticulously screen for depressive symptoms during the early follow-up years for breast cancer survivors who are premenopausal or have undergone chemotherapy and endocrine therapy.

Abstract Body mass index (BMI) is associated with chronic obstructive pulmonary disease (COPD) risk. We investigated the association between BMI and the risk of COPD among young individuals. Using the Korean National Health Information Database, we screened individuals aged 20–39 years who participated in the national health examination between 2009 and 2012. We identified 6,304,769 eligible individuals, and 13,784 had newly developed COPD. BMI was categorized according to the Asian BMI criteria. We performed multivariate Cox proportional hazards models to estimate the adjusted hazard ratio (aHR) of risk factors for COPD development. Their mean age was 30.8 ± 5.0 years, and 3,732,656 (59.2%) were men. The incidence rate for developing COPD was 0.22/1,000 person-years. Compared to individuals with normal BMI (18.5–22.9 kg/m2), those who were underweight (

Abstract Aims An association between obesity, metabolic abnormalities and clinical hypertrophic cardiomyopathy (HCM) expression has been reported. We investigated whether managing dyslipidaemia with fibrates could affect the clinical expression of HCM. Methods We screened patients who used fibrates between 2010 and 2017 from a nationwide database. After excluding patients with a history of HCM, we identified fibrate‐user group (n = 412 823). We then constructed a 1:1 matched cohort of fibrate‐naïve participants (n = 412 823). After a 1 year lag period, we identified the incident HCM cases for the following 5 years. Results During a median follow‐up period of 3.96 years, we identified 454 incident clinical HCM cases. After adjusting for covariates, fibrate use was associated with a lower risk of clinical HCM expression [hazard ratio (HR) 95% confidence interval (CI): 0.763 (0.630–0.924)]. In subgroup analyses, fibrate use was associated with a reduced risk of clinical HCM expression in patients with a body mass index ≥25 kg/m2 and those with abdominal obesity [HR (95% CI): 0.719 (0.553–0.934) and 0.655 (0.492–0.872)], but not in those without obesity. Fibrate use was also associated with lower risks of incident clinical HCM in patients with triglyceride levels ≥150 mg/dL and those with metabolic syndrome [HR (95% CI): 0.741 (0.591–0.929) and 0.750 (0.609–0.923)], but not in their counterparts. Regarding lifestyle behaviours, fibrate use appeared to provide more prognostic benefits in patients who currently smoked, consumed alcohol or did not engage in regular physical activities. Conclusion The use of fibrates is associated with a lower incidence of clinical HCM expression. This association was also more prominent in those with obesity, unhealthy metabolic profiles and poor lifestyle behaviours.

Abstract Background The association between metabolic syndrome (MetS) and chronic obstructive pulmonary disease (COPD) has not been studied well, particularly in young individuals. We investigated the risk of COPD development in young individuals based on MetS and its components. Methods We used the Korean National Health Information Database to identify 6,891,400 individuals aged 20–39 years who participated in the national health check-up service between 2009 and 2012. Then, we identified individuals with MetS and investigated COPD development based on health insurance claims. Cox proportional hazard regression models were used to calculate the adjusted hazard ratio (aHR) for the risk of COPD development. Results During a mean follow-up period of 8.35 years, 13,784 individuals were newly diagnosed with COPD. MetS was associated with an increased risk of COPD (aHR, 1.18; 95% confidence interval [CI], 1.11–1.24). Among the MetS components, except for hyperglycemia, abdominal obesity (aHR, 1.27; 95% CI, 1.19–1.34), hypertension (aHR, 1.05; 95% CI, 1.01–1.10), hypertriglyceridemia (aHR, 1.11; 95% CI, 1.07–1.16), and low high-density lipoprotein cholesterol levels (aHR, 1.16; 95% CI, 1.11–1.22) were significantly associated with COPD development. A higher number of MetS components correlated with an increased risk of COPD development, with the highest risk observed when all five MetS components were present (aHR, 1.55; 95% CI, 1.28–1.87). Conclusion MetS was associated with COPD development in young individuals. The risk of COPD development increased along with the increasing number of MetS components. These findings suggest that careful monitoring for COPD development is necessary in young individuals with MetS, especially those with multiple components of MetS.

Abstract Background Diabetes mellitus (DM) and alcohol consumption are risk factors for tuberculosis (TB). We investigated the association between alcohol consumption and TB development in individuals with type 2 DM (T2DM). Methods Individuals who underwent the national health examination during 2009–2012 were screened using the Korean National Health Information Database. In total, 2,437,443 eligible individuals with T2DM were followed up until December 2018. We identified 21,275 individuals with newly developed TB. Alcohol consumption was evaluated based on the health examination questionnaire, and individuals were categorized into none (0 g/day), mild-to-moderate (1–29.9 g/day), and heavy (≥ 30 g/day) drinkers. Multivariate Cox proportional hazard models were used to estimate the adjusted hazard ratio (aHR) of risk factors for TB. Results Mild-to-moderate alcohol drinkers had a lower risk of developing TB (aHR 0.92, 95% confidence interval [CI] 0.89–0.96), and heavy alcohol drinkers had a higher risk of developing TB (aHR 1.21, 95% CI 1.16–1.27) than nonalcohol drinkers. When categorized by an alcohol intake of 5 g/day, alcohol drinkers of

Background This study aimed to provide updated insights into the incidence and management of cardiovascular disease (CVD) in Korean adults with diabetes. Methods Using data from the Korean National Health Insurance Service and Korea National Health and Nutrition Examination Survey, we analyzed the representative national estimates of CVD in adults with diabetes. Results The age- and sex-standardized incidence rate of ischemic heart disease (IHD), ischemic stroke, and peripheral artery disease (PAD) decreased from 2010 to 2019 in individuals with type 2 diabetes mellitus (T2DM). However, an increase in the incidence of heart failure (HF) was observed during the same period. Only 4.96% of adults with diabetes and CVD achieved optimal control of all three risk factors (glycemic levels, blood pressure, and lipid control). Additionally, high-intensity statin treatment rates were 8.84% and 9.15% in individuals with IHD and ischemic stroke, respectively. Treatment with a sodium-glucose cotransporter-2 inhibitor (SGLT2i) or a glucagon-like peptide-1 receptor agonist (GLP-1RA) was relatively low in 2019, with only 11.87%, 7.10%, and 11.05% of individuals with IHD, ischemic stroke, and HF, respectively, receiving SGLT2i treatment. Furthermore, only 1.08%, 0.79%, and 1.06% of patients with IHD, ischemic stroke, and HF, respectively, were treated with GLP-1RA. Conclusion The incidence of most CVD (IHD, ischemic stroke, and PAD) decreased between 2010 and 2019, whereas the incidence of HF increased. The overall use of high-intensity statins, SGLT2i, and GLP-1RA remained low among individuals with T2DM and CVD.

Background We investigated the association between uterine leiomyoma (UL) and incident type 2 diabetes mellitus (T2DM) in young women. Methods A nationwide population-based cohort study of 2,541,550 women aged between 20 and 40 years was performed using the National Health Information Database. Cox proportional hazards models were used to analyze the risk of incident T2DM according to the presence of UL and myomectomy. Results The mean age was 29.70 years, and mean body mass index was 21.31 kg/m2. Among 2,541,550 participants, 18,375 (0.72%) women had UL. During a median 7.45 years of follow-up, 23,829 women (0.94%) were diagnosed with T2DM. The incidence of T2DM in women with UL (1.805/1,000 person-years) was higher than in those without UL (1.289/1,000 person-years). Compared with women without UL, women with UL had a higher risk of incident T2DM (hazard ratio, 1.216; 95% confidence interval [CI], 1.071 to 1.382). Women with UL who did not undergo myomectomy had a 1.505 times (95% CI, 1.297 to 1.748) higher risk for incident T2DM than women without UL. However, women with UL who underwent myomectomy did not have increased risk for incident T2DM. Conclusion Young women with UL were associated with a high risk of incident T2DM. In addition, myomectomy seemed to attenuate the risk for incident T2DM in young women with UL.

Abstract Background and aims The association between metabolic dysfunction-associated steatotic liver disease (MASLD) and cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM) is unclear. This study aimed to investigate the impact of spectrum of SLD on the risk of heart failure and cardiovascular (CV) mortality in patients with T2DM. Methods In a nationwide cohort study, 2,745,689 adults with T2DM were followed from 2009 to 2012 until 2018. Participants were categorized into no steatotic liver disease (no SLD) and SLD groups. The SLD group was stratified based on metabolic risk factors, alcohol consumption and viral hepatitis. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for heart failure (HF) and CV mortality risk. Results The prevalence of MASLD, metabolic alcohol-associated liver disease (MetALD), alcohol-associated liver disease with metabolic dysfunction (ALD with MD) and MASLD with viral hepatitis (VH) was 49.6%, 7.2%, 2.3%, and 2.0%. Individuals with MASLD (adjusted HR [aHR], 1.11), MetALD (aHR, 1.14), ALD with MD (aHR, 1.32) and MASLD with VH (aHR, 1.12) had a higher risk of developing HF compared with the no SLD group. The risk of CV mortality was also increased in those with SLD groups compared to those with no SLD. The risk of new-onset HF and CV mortality showed a J-shaped association with alcohol consumption regardless of SLD status. Conclusion SLD is independent risk factor of new-onset HF and CV mortality in persons with T2DM, and alcohol consumption has a J-shaped association with risk of HF and CV mortality, regardless of SLD status.

Abstract Background The antihypertensive efficacy of fimasartan was assessed based on the transition rate from a combination of calcium channel blockers (CCB) and angiotensin receptor blockers (ARB) to three-drug combination therapy, as compared to other ARBs. Methods This nationwide cohort study used data obtained from the Korean National Health Insurance Service database. Patients who had received national health checkups within 2 years prior to January 1, 2017, and were concurrently prescribed ARBs and CCBs for > 30 days during the 6 months from January 1, 2017, to June 30, 2017 were included in the study. Patients were categorized into the ‘fimasartan group’ (those prescribed fimasartan) and the ‘non-fimasartan group’ (those prescribed ARBs other than fimasartan). The index date was set as the last day of a 30-day prescription period for ARBs and CCBs, with a subsequent 2.5-year follow-up to observe the potential addition of a third drug, such as beta-blockers or diuretics. Results The study included 34,422 patients with a mean age of 60.3 years and 58.3% being male. The fimasartan group constituted 2.7% (n = 928) of the total, and the non-fimasartan group, 97.3% (n = 33,494). During the follow-up period, 38 patients in the fimasartan group (14.3 per 1,000 person-years) and 3,557 patients in the non-fimasartan group (42.8 per 1,000 person-years) required additional antihypertensive medications. After multivariate adjustment for age, sex, diabetes mellitus, dyslipidemia, cancer, heart failure, systolic blood pressure, and diastolic blood pressure, the fimasartan group showed a significantly lower rate of adding a third medication (hazard ratio 2.68, 95% confidence interval 1.95–3.69) compared to that of the non-fimasartan group. Conclusions Fimasartan is associated with a lower need for additional antihypertensive drugs compared to other ARBs. This implies its greater effectiveness in hypertension management, potentially enhancing cardiovascular outcomes, and minimizing polypharmacy.

Background We examined the impact of gout on the end-stage renal disease (ESRD) risk in patients with type 2 diabetes mellitus (T2DM) and determined whether this association differs according to chronic kidney disease (CKD) status. Methods Using the Korean National Health Insurance Service, this nationwide cohort study enrolled 847,884 patients with T2DM who underwent health checkups in 2009. Based on the presence of CKD (estimated glomerular filtration rate

The prevalence of obesity in Korea has steadily increased over the past decade, reaching 38.4% in 2021. Notably, the rate of class II–III obesity, defined as a body mass index (BMI) of 30 kg/m2 or higher, exceeded 7% in the same year. Since January 2019, the National Health Insurance Service (NHIS) has provided coverage for bariatric surgery (BS) for eligible patients. Coverage is available for individuals with a BMI of 35 kg/m2 or higher, or those with a BMI of 30 kg/m2 or higher who also have obesity-related comorbidities. Additionally, partial reimbursement is offered for BS in patients with type 2 diabetes mellitus who have BMI values between 27.5 and 30 kg/m2. From 2019 to 2022, the NHIS recorded 9,080 BS procedures, with sleeve gastrectomy being the most commonly performed. The average percentage of weight loss 198±99.7 days post-surgery was 17.9%, with 80.0% of patients losing more than 10% of their body weight. This article presents the trends in obesity and BS in Korea.

BackgroundLittle information is available regarding whether active physical activity lowers mortality risk in individuals with bronchiectasis.MethodsWe used the Korean National Health Insurance Service database from 2010 to 2016 to evaluate the association between changes in physical activity and mortality risk in individuals with bronchiectasis. Of 552,510 individuals with newly diagnosed bronchiectasis, we enrolled 165,842 individuals who had two consecutive health examinations before and after bronchiectasis diagnosis, within two years, as the study aimed to measure changes in exercise habits between the two time points. Active physical activity was defined as engaging in moderate- or vigorous-intensity physical activity at least once a week, either before or after bronchiectasis diagnosis. The outcome measure was all-cause mortality.ResultsDuring a mean follow-up of 6.2 ± 2.1 years, 10,535 (6.4%) individuals with bronchiectasis died. Individuals with bronchiectasis who were physically active exhibited a lower mortality rate than those who were physically inactive. Mortality reduction was particularly evident in the exercise maintainers group (aHR [adjusted hazard ratio] = 0.69, 95% confidence interval [CI] = 0.64–0.74) and individuals with physical activity ≥1,000 metabolic equivalent of task-min per week (aHR = 0.73, 95% CI = 0.70–0.77) compared to those who were physically inactive.ConclusionEngaging in active physical activity is associated with a decreased risk of mortality in individuals with bronchiectasis.

BackgroundDespite a high tuberculosis incidence in Korea, the association between tuberculosis and depression remains underexplored. This study aims to assess depression risk in tuberculosis survivors.MethodsUtilizing South Korea’s National Health Insurance Sharing Service (NHISS) database, we conducted a gender-age-matched analysis comparing depression risk between tuberculosis survivors and the general population.ResultsThis study included 137,996 participants, of whom 34,499 had tuberculosis history, and 103,497 age- and sex-matched individuals were selected as the control group. The risk of developing depression was higher in tuberculosis survivors than in the control group (aHR 1.20, 95% CI 1.15-1.25). In men, the risk of developing depression was 1.32 times (95% CI 1.25-1.39) compared with 1.05 times (95% CI 0.98-1.12) in women. Those taking para-aminosalicylate, cycloserine, and prothionamide had a higher risk of developing depression compared to those using other anti-tuberculosis drugs, with the risk ratio ranging from 1.27 to 1.61.ConclusionTuberculosis survivors had a higher risk of developing depression compared to the control group. Although the prevalence of depression was higher in women compared to men, the risk of developing depression was higher in male tuberculosis survivors than in the control group, in contrast to the findings in women. The risk of developing depression in tuberculosis survivors differed depending on the anti-tuberculosis drug used and was mainly high in most of the second-line anti-tuberculosis drugs.

Purpose: We aimed to investigate the risk of developing depression in individuals with primary open-angle glaucoma with associated vision impairment. Methods: We conducted a nationwide, population-based cohort study using data from the Korean National Health Information Database and National Disability Registry. We assessed baseline characteristics such as age, sex, income level, lifestyle factors, anthropometric data, lab results, and Charlson Comorbidity Index scores through diagnostic codes and health screening data. Depression risk in relation to glaucoma and vision impairment was analyzed using a multivariable-adjusted Cox proportional hazard model. Results: Among 3,680,570 individuals screened through the Korean National Health Screening Program in 2009, 681,515 were newly diagnosed with depression during follow-up. Subjects with glaucoma showed a higher risk of depression than those without glaucoma, with an adjusted hazard ratio (HR) of 2.011 (95 % confidence interval [CI]: 1.946–2.078) pre-adjustment and 1.085 (95 % CI: 1.050–1.121) post-adjustment for covariates. For those with glaucoma and vision impairment, the adjusted HR increased to 1.164 (95 % CI: 1.045–1.297) and to 1.207 (95 % CI: 1.039–1.403) with severe vision impairment. The association between glaucoma and depression was more pronounced in men (P for interaction = 0.001) and those with a Charlson Comorbidity Index

BackgroundAmputation confers disabilities upon patients and is linked to cardiometabolic morbidity and mortality. We aimed to compare the incidence of type 2 diabetes (T2DM) between individuals following amputation with those of the general population.MethodsWe performed a population-based retrospective cohort study using the Nationwide Health Insurance Service database. A total of 21,343 individuals with amputation during 2010–2018 and their 1:3 age- and sex-matched controls was included. We conducted Cox proportional hazard analysis to calculate the risk of T2DM among individuals with amputation.ResultsDuring the 4.2 ± 2.5 year mean follow-up period, there were 912 incident T2DM cases (10.7 per 1,000 person-years) among individuals with amputation. Individuals with amputation had a higher risk for T2DM (adjusted hazard ratio [aHR] 1.11, 95% confidence interval [CI] 1.03–1.20) compared with matched controls. The risks were increased further when accompanied with disability; those with severe disability had a higher risk of T2DM (aHR 1.77, 95% CI 1.20–2.60) than matched controls. Individuals with proximal upper limb amputation (aHR 1.10, 95% CI 1.02–1.18) and proximal lower limb amputation (aHR 3.60, 95% CI 1.50–8.64) had a higher risk of T2DM compared with matched controls.ConclusionsIndividuals with amputation were at significantly greater risk for T2DM than the general population, particularly those with severe disability and proximal amputation. Innovative strategies that improve and support the long-term T2DM risk for severely injured individuals with proximal amputation are warranted.

Abstract Background The potential preventive effect of fenofibrate on lower extremity amputation (LEA) and peripheral arterial disease (PAD) in patients with type 2 diabetes (T2D) is not fully elucidated. Methods We selected adult patients ≥ 20 years of age with T2D from the Korean National Health Insurance Service Database (2009–2012). The fenofibrate users were matched in a 1:4 ratio with non-users using propensity scores (PS). The outcome variables were a composite of LEA and PAD and the individual components. The risks of outcomes were implemented as hazard ratio (HR) with 95% confidence intervals (CI). For safety issues, the risks of acute kidney injury, rhabdomyolysis and resulting hospitalization were analyzed. Results A total of 114,920 patients was included in the analysis with a median follow-up duration of 7.6 years (22,984 and 91,936 patients for the fenofibrate user and non-user groups, respectively). After PS matching, both groups were well balanced. The fenofibrate group was associated with significantly lower risks of composite outcome of LEA and PAD (HR 0.81; 95% CI 0.70–0.94), LEA (HR 0.76; 95% CI 0.60–0.96), and PAD (HR 0.81; 95% CI 0.68–0.96). The risk of acute kidney injury, rhabdomyolysis, or hospitalization for these events showed no significant difference between the two groups. Subgroup analyses revealed consistent benefits across age groups, genders, and baseline lipid profiles. Conclusions This nationwide population-based retrospective observational study suggests that fenofibrate can prevent LEA and PAD in patients with T2D who are on statin therapy.

Abstract Background The association between nonalcoholic fatty liver disease (NAFLD) and atrial fibrillation (AF) has been inconsistent, and the impact of hepatic fibrosis on this relationship remains uncertain. We investigated the association between NAFLD and the risk of new-onset AF across different age groups. Methods A total of 3,179,582 participants from the 2009 Korean National Health Screening Program were divided into five groups based on NAFLD status: no NAFLD (fatty liver index [FLI]

Abstract Previous studies on the association between age-related macular degeneration (AMD) and rheumatoid arthritis (RA) have shown conflicting results. We sought to assess the association between AMD with/without visual disability (VD) and the risk of RA using National Health Insurance data in South Korea. In total, 3,537,293 individuals who underwent health checkups in 2009 were included and followed until 2019. Participants with VD were defined as those with loss of vision or a visual field defect as certified by the Ministry of Health and Welfare of Korea. Using multivariable adjusted Cox regression analysis, RA hazard ratios were estimated for control and AMD with/without VD groups. In total, 43,772 participants (1.24%) were diagnosed with RA. Individuals with AMD were at higher risk of RA compared to controls, regardless of the presence of VD (aHR 1.11; 95% CI 1.02–1.21). Among individuals with AMD, different risk levels of RA were observed between those without VD (aHR 1.13; 95% CI 1.03–1.21) and those with VD (aHR 0.90; 95% CI 0.64–1.27). AMD was associated with a higher risk of RA, which remained significant as a trend even after adjusting for lifestyle factors and comorbidities.

Abstract Background Heart failure (HF) is a serious and common condition affecting millions of people worldwide, with obesity being a major cause of metabolic disorders such as diabetes and cardiovascular disease. This study aimed to investigate the effects of fenofibrate, a peroxisome proliferator-activated receptor alpha (PPARα) agonist, on the obese- and diabetes-related cardiomyopathy. Methods and results We used db/db mice and high fat diet-streptozotocin induced diabetic mice to investigate the underlying mechanisms of fenofibrate’s beneficial effects on heart function. Fenofibrate reduced fibrosis, and lipid accumulation, and suppressed inflammatory and immunological responses in the heart via TNF signaling. In addition, we investigated the beneficial effects of fenofibrate on HF hospitalization. The Korean National Health Insurance database was used to identify 427,154 fenofibrate users and 427,154 non-users for comparison. During the 4.22-year follow-up, fenofibrate use significantly reduced the risk of HF hospitalization (hazard ratio, 0.907; 95% CI 0.824–0.998). Conclusions The findings suggest that fenofibrate may be a useful therapeutic agent for obesity- and diabetes-related cardiomyopathy.

Abstract Patients with diabetes mellitus (DM) are at a higher risk of infectious diseases, and exercise is an important treatment modality for DM. Despite their susceptibility to infection in diabetic patients, the association between the amount of physical activity and the incidence of infective endocarditis (IE) is unclear. We attempted to demonstrate risk reduction by physical activity in diabetic patients with IE. From the National Health Insurance database, patients with DM were verified, and the incidence of IE was investigated. The level of physical activity was categorized into

Abstract Although smoking is an established risk factor for Mycobacterial infection, the association between smoking and nontuberculous mycobacterial pulmonary disease (NTM-PD) remains unclear. We evaluated the association between smoking and NTM-PD and tuberculosis (TB) using a population-based South Korean nationwide cohort. Using the Korean National Health Insurance Database, we screened individuals over 20 years of age who underwent the national health screening program in 2009. Out of 3,774,308 eligible populations, we identified 2,964 and 26,112 cases of newly developed NTM-PD and TB, respectively. We used multivariate Cox proportional hazards models to estimate the adjusted hazard ratios (aHRs) of risk factors for NTM-PD and TB. The incidence rates for developing NTM-PD and TB were 0.08 and 0.68 per 1,000 person-years, respectively. Current smokers (aHR 0.63, 95% confidence interval [CI] 0.56–0.71) and current heavy smokers (≥ 20 pack-years, aHR 0.74, 95% CI 0.63–0.86) were at lower risk for NTM-PD development than never smokers. On the contrary, current smokers (aHR 1.19, 95% CI 1.15–1.23) and current heavy smokers (aHR 1.27, 95% CI 1.22–1.33) had a higher risk for TB development than never smokers. These trends were augmented if individuals started smoking before age 20 years. In subgroup analyses stratified by age, these trends were prominent in the 40–64 years age range. Current smoking was associated with a decreased risk of NTM-PD and increased risk of TB. These risks were augmented by early smoking initiation and in the middle age population.

Abstract Background To examine the association between glycemic status and all-cause mortality risk among individuals with dementia. Methods We enrolled 146,832 individuals aged 40 and older with dementia as identified through the Korean National Health Insurance Service health screening test between 2008 and 2016. Mortality status was evaluated at the end of 2019. Participants were classified into normoglycemia, prediabetes, or diabetes mellitus (DM) categories. The duration of diabetes was noted in those with DM. This study focused on the association between glycemic status and all-cause mortality. Results The cohort, which was predominantly elderly (average age 75.1 years; 35.5% male), had a 35.2% mortality rate over an average 3.7-year follow-up. DM was linked with increased all-cause mortality risk (hazard ratio [HR] 1.34; 95% confidence interval [CI]: 1.32–1.37) compared to non-DM counterparts. The highest mortality risk was observed in long-term DM patients (≥ 5 years) (HR 1.43; 95% CI: 1.40–1.47), followed by newly diagnosed DM (HR 1.35; 95% CI: 1.30–1.40), shorter-term DM (

Abstract Although facial flushing after drinking alcohol (alcohol flushing response) is common in Asian populations, the epidemiological features in a large sample have been investigated in only a few studies. This study assessed the epidemiologic characteristics and associated factors for alcohol flushing in a Korean population. This study was based on data collected during the 2019 Korea National Health and Nutrition Examination Survey (KNHANES). A total of 5572 Korean adults was included in the general population group, and the alcohol flushing group consisted of 2257 participants. Smoking and physical activity were evaluated as possible associated factors for alcohol flushing. The overall prevalence of alcohol flushing was estimated at 40.56% of the general population (43.74% in males and 37.4% in females), and the prevalence was highest at 60–69 years of age and lowest in individuals older than 80 years. Occasional, frequent, and persistent alcohol flushing was reported by 11.9%, 3.7% and 15.0% of current flushers, among whom persistent flushers consumed the least amount of alcohol. Subjects who currently smoke had a higher propensity of alcohol flushing (adjusted OR 1.525, 95% CI 1.2–1.938), and subjects with smoking history of 20–29 pack-years (PYs) showed the highest association (adjusted OR 1.725, 95% CI 1.266–2.349) with alcohol flushing after adjustment for confounders. In contrast, significant association was not found between physical activity and alcohol flushing. The results demonstrated that current smoking status is shown to be significantly associated with alcohol flushing, and that current smokers with a history of smoking ≥ 20 PYs had a higher likelihood of alcohol flushing than non-smokers or ex-smokers.

Abstract Background The beneficial effects of fenofibrate on atherosclerotic cardiovascular disease (ASCVD) outcomes in patients with diabetes and statin treatment are unclear. We investigated the effects of fenofibrate on all-cause mortality and ASCVD in patients with diabetes, high triglyceride (TG) levels and statin treatment. Methods We performed a nationwide propensity-score matched (1:1) cohort study using data from the National Health Information Database in the Republic of Korea from 2010 to 2017. The study included 110,723 individuals with diabetes, TG levels ≥ 150 mg/dL, and no prior diagnoses of ASCVD who used statins and fenofibrate, and an equal matched number of similar patients who used statins alone (control group). The study outcomes included newly diagnosed myocardial infarction (MI), stroke, both (MI and/or stroke), and all-cause mortality. Results Over a mean 4.03-year follow-up period, the hazard ratios (HR) for outcomes in the fenofibrate group in comparison to the control group were 0.878 [95% confidence interval (CI) 0.827–0.933] for MI, 0.901 (95% CI 0.848–0.957) for stroke, 0.897 (95% CI 0.858–0.937) for MI and/or stroke, and 0.716 (95% CI 0.685–0.749) for all-cause death. These beneficial effects of fenofibrate were consistent in the subgroup with TG 150–199 mg/dL but differed according to low-density lipoprotein cholesterol (LDL-C) levels. Conclusion In this nationwide propensity-score matched cohort study involving individuals with diabetes and TG ≥ 150 mg/dL, the risk of all-cause death and ASCVD was significantly lower with fenofibrate use in conjunction with statin treatment compared to statin treatment alone. However, this finding was significant only in individuals with relatively high LDL-C levels. Graphical Abstract

Due to increased life expectancy and lifestyle changes, the prevalence of diabetes among the elderly in Korea is continuously rising, as is the associated public health burden. Diabetes management in elderly patients is complicated by age-related physiological changes, sarcopenia characterized by loss of muscle mass and function, comorbidities, and varying levels of functional, cognitive, and mobility abilities that lead to frailty. Moreover, elderly patients with diabetes frequently face multiple chronic conditions that elevate their risk of cardiovascular diseases, cancer, and mortality; they are also prone to complications such as hyperglycemic hyperosmolar state, diabetic ketoacidosis, and severe hypoglycemia. This review examines the characteristics of and management approaches for diabetes in the elderly, and advocates for a comprehensive yet personalized strategy.

IntroductionEarly age at menopause has been linked to various adverse health outcomes, but its association with suicide risk remains underexplored. This study aims to assess the relationship between age at menopause and suicide risk among postmenopausal women.MethodsThis retrospective cohort study analyzed data from the Korean National Health Insurance System (NHIS), covering 1,315,795 postmenopausal women aged 30 years and above, from 2009 to 2021. Menopausal age was classified as primary ovarian insufficiency (under 40 years), early menopause (40-44 years), average menopause (45-49 and 50-54 years), and late menopause (55 years and older). Suicide incidence was identified using ICD-10 codes for primary cause of death. Multivariable Cox proportional hazards models were utilized to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsAcross the 12-year follow-up, there were 2,986 suicides. Women with primary ovarian insufficiency exhibited the highest suicide risk (HR, 1.43; 95% CI, 1.14–1.78, p

Background & Aims: We investigated the association of physical activity (PA) levels and changes with the risk of hepatocellular carcinoma (HCC) in patients with type 2 diabetes. Methods: Patients with type 2 diabetes who had undergone health examinations in 2009 and 2011 were enrolled. In total, 1,439,152 patients were included in the analysis. The level of PA was classified as inactive (

Abstract Background We investigated the association between exercise habits before or after thyroidectomy and incident type 2 diabetes mellitus (T2DM) in patients with thyroid cancer. Methods An observational cohort study of 69,526 thyroid cancer patients who underwent thyroidectomy for the treatment of thyroid cancer between 2010 and 2016 was performed using the Korean National Health Information Database. Regular exercise was defined as mid-term or vigorous exercise at least 1 day in a week based on a self-reported questionnaire. Patients were divided into four groups according to exercise habits before and after thyroidectomy: persistent non-exercisers, new exercisers, exercise dropouts, and exercise maintainers. Results During a median follow-up of 4.5 years, 2,720 (3.91%) patients developed T2DM. The incidence of T2DM per 1,000 person years was lower in patients who performed regular exercise before or after thyroidectomy than in persistent non-exercisers (10.77 in persistent non-exerciser group, 8.28 in new exerciser group, 8.59 in exercise dropout group, and 7.61 in exercise maintainer group). Compared with the persistent non-exerciser group, the new exerciser group (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.78–0.97), the exercise dropout group (HR 0.81, 95% CI 0.72–0.91), and the exercise maintainer group (HR 0.84, 95% CI 0.76–0.93) had lower risks of incident T2DM. Exercising

Abstract Background Dementia is associated with older adults; however, it can also affect younger individuals, known as young-onset dementia (YOD), when diagnosed before the age of 65 years. We aimed to conduct a retrospective cohort study involving middle-aged women to investigate the association between premorbid depression and YOD development. Methods We included 1.6 million women aged 40–60 years who underwent health checkups under the Korean National Health Insurance Service and investigated the association between depression and YOD. Results Women with depression had a significantly higher risk of developing YOD than women without depression. Among premenopausal women, those with depression had a 2.67-fold increased risk, whereas postmenopausal women with depression had a 2.50-fold increased risk. Late age at menarche (> 16 years) and young age at menopause (

Abstract This study investigated the potential associations between allergic diseases (asthma, allergic rhinitis, and atopic dermatitis) and the development of primary open-angle glaucoma. We utilized authorized data from the Korean National Health Information Database (KNHID), which provides comprehensive medical claims data and information from the National Health Screening Program. We compared the baseline characteristics of subjects with and without allergic diseases and calculated the incidence and risk of glaucoma development. Cox proportional hazard regression analysis was used to determine the risk of glaucoma development in subjects with allergic diseases. A total of 171,129 subjects aged 20–39 with or without allergic diseases who underwent a general health examination between 2009 and 2015 were included. Subjects with allergic diseases exhibited a higher incidence of glaucoma compared to the control group. The hazard ratio (HR) of glaucoma onset was 1.49 and 1.39 in subjects with at least one allergic disease before and after adjusting for potential confounding factors, respectively. Among allergic diseases, atopic dermatitis showed the highest risk for glaucoma development (aHR 1.73) after adjusting for confounders. Allergic rhinitis showed an increased risk for incident glaucoma after adjustment (aHR 1.38). Asthma showed the lowest but still increased risk for glaucoma (aHR 1.22). The associations were consistent in all subgroup analyses stratified by sex, smoking, drinking, exercise, diabetes, hypertension, dyslipidemia, or history of steroid. In conclusion, allergic diseases are associated with increased risk of glaucoma development. Among allergic diseases, atopic dermatitis showed the highest risk for glaucoma development followed by allergic rhinitis and asthma.

Abstract Understanding the association between dipstick-detected proteinuria and oculomotor cranial nerve palsy (CNP) could have significant implications for understanding the mechanism of CNP development and for developing preventive strategies against CNP development in patients with proteinuria. This study aimed to determine the relationship between dipstick-determined proteinuria and ocular motor CNP using National Sample Cohort (NSC) database from Korea’s National Health Insurance Service (NHIS). A nationwide population-based cohort study was conducted using data from the NSC database of Korea’s NHIS. These data were collected from 2009 to 2018. A one-year time lag was established to prevent a situation in which the causal link was inverted. Participants aged 20 years or more who were diagnosed with proteinuria in 2009 were included. Individuals with specific pre-existing CNP, missing data, and those who were newly diagnosed with CNP or who died within one year of being tested were excluded. The study population was classified into six groups according to the degree of proteinuria (negative, trace, or between 1 + and 4 +) based on the urine dipstick test. A Cox proportional hazard regression analysis was performed to determine the linkage between the degree of proteinuria and ocular motor CNP. A total of 5,807 (0.14% of subjects) with ocular motor CNP were assigned to the ocular motor CNP group and 4,047,205 subjects were assigned to the control group. After full adjustment of comorbidities, hazard ratios (HRs) for 1 + , 2 + , 3 + and 4 + proteinuria groups were 1.449 (95% confidence interval [CI] 1.244–1.687), 2.081 (1.707–2.538), 1.96 (1.322–2.904), and 3.011 (1.507–6.014), respectively, for developing ocular motor CNP compared to the proteinuria-negative group. In subgroup analysis, the HR of patients with proteinuria for the development of ocular motor CNP was higher in the younger age group (less than 40 years) (P = 0.0242) and the group with DM (P = 0.04). Our population-based cohort study demonstrated a significant association between proteinuria and the incidence of CNP, suggesting that urine protein level could be a new clinical marker for predicting the development of CNP.

Introduction: Low-density lipoprotein (LDL) cholesterol-lowering treatment is beneficial for the secondary or primary prevention of high-risk atherosclerotic cardiovascular disease (ASCVD). However, the prognostic implications of low LDL cholesterol levels in patients without previous ASCVD and without statin use remain elusive. Methods: From a nationwide cohort, 2,432,471 participants without previous ASCVD or statin use were included. For myocardial infarction (MI) and ischemic stroke (IS), participants were followed-up from 2009 to 2018. They were stratified according to 10-year ASCVD risk (

Abstract Given the pleiotropic effects of statins beyond their lipid-lowering effects, there have been attempts to evaluate the role of statin therapy in IPF, but they have shown inconclusive results. Data from the National Health Insurance Service (NHIS) database of South Korea were used to investigate the effects of statin therapy on IPF. The IPF cohort consisted of a total of 10,568 patients who were newly diagnosed with IPF between 2010 and 2017. These patients were then matched in a 1:3 ratio to 31,704 subjects from a control cohort without IPF, with matching based on age and sex. A case–control study was performed to evaluate the association between statin use and the risk for IPF, and the multivariable analysis revealed that statin use was associated with a lower risk for IPF (adjusted OR 0.847, 95% CI 0.800–0.898). Using the IPF cohort, we also evaluated whether statin use at the time of diagnosis was associated with future clinical outcomes. The statin use at the time of IPF diagnosis was associated with improved overall survival (adjusted HR 0.779, 95% CI 0.709–0.856). Further prospective studies are needed to clarify the role of statin therapy in IPF.

Abstract Many studies sought to demonstrate the association between smoking and fracture risk. However, the correlation between smoking and fractures remains controversial. This study aimed to examine the impact of smoking and smoking cessation on the occurrence of fractures using prospective nationwide cohort data. We enrolled those who underwent a National Health Insurance Service (NHIS) health checkup in 2009–2010 who had a previous health checkup 4-year prior (2005–2006). The study population of 4,028,559 subjects was classified into three groups (non-smoker, smoking cessation, current smoker). The study population was also analyzed according to fracture type (all fractures, vertebral fracture, hip fracture). Lastly, the smoking cessation group and current smoker group were divided into four subgroups based on a lifetime smoking amount cut-off of 20 pack-years (PY). Multivariate-adjusted hazard ratios (HRs) of fracture were examined through a Cox proportional hazards model. After multivariable adjustment, non-smokers showed the lowest risk of fracture (HR = 0.818, CI 0.807–0.828, p

ObjectiveAssociations between acromegaly and several respiratory diseases, such as obstructive lung disease or sleep apnea, have been suggested, but the relationship between bronchiectasis and acromegaly is unclear. We investigated whether acromegaly is related to the development of bronchiectasis.Materials and methodsUsing the Korean National Health Insurance System database between 2006 and 2016, we studied the relationship between acromegaly and bronchiectasis in patients with acromegaly (n=2593) and controls (1:5 age- and sex-matched subjects without acromegaly, n=12965) with a mean follow-up period of 8.9 years. Cox proportional hazards regression analysis was used to assess the risk of bronchiectasis in patients with acromegaly compared with controls after adjusting for age, sex, household income, place, type 2 diabetes, hypertension, and dyslipidemia.ResultsThe mean age of the participants was 47.65 years, and male subjects comprised 45.62% of the cohort. The incidence rate of bronchiectasis in patients with acromegaly was 3.64 per 1,000 person-years and was significantly higher than that in controls (2.47 per 1,000 person-years) (log-rank test p = 0.002). In multivariable Cox proportional hazards regression modeling, the risk of bronchiectasis was significantly higher in patients with acromegaly than that in controls (HR: 1.49; 95% CI: 1.15–1.94, p = 0.0025) after adjusting for age, sex, household income, place, type 2 diabetes, hypertension, and dyslipidemia.ConclusionsOur results suggest that acromegaly may be associated with bronchiectasis.

Abstract BackgroundSmoking is known to be a significant risk factor for various diseases. Migraine, a condition requiring careful lifestyle management, currently lacks specific guidelines advocating for smoking cessation as a preventive measure. Although cross-sectional studies have suggested a potential link between smoking and an increased risk of migraine, the findings have been inconsistent and conflicting. To date, there has been no longitudinal study which investigated the effect of smoking on the risk of migraine in a prospective setting. ObjectiveThis longitudinal study aimed to investigate the impact of smoking on the incidence of migraine in women and examine the modifying effect of menopausal status. MethodsUsing nationally representative National Health Insurance Service (NHIS) data, women aged ≥40 years who participated in national breast cancer screening in 2009 were followed-up until the end of 2019. Baseline data on smoking status (non-, ex-, and current smoker) as well as the duration and amount of cigarette smoking were collected. A Cox proportional hazards regression model was used to examine the independent effect of smoking on the risk of incident migraine after adjusting for demographics, comorbidities, and female reproductive factors. The results were stratified by menopausal status, and an interaction analysis (smoking × menopause) was performed. ResultsIn total, 1,827,129 women were included in the analysis. Women with a history of smoking exhibited a higher risk of developing migraine, compared with nonsmokers. Specifically, a higher risk of migraine was observed in women with past (adjusted hazard ratio [HR] 1.044, 95% CI 1.000-1.089) and current cigarette use (adjusted HR 1.050, 95% CI, 1.023-1.079) than in nonsmokers. The effect was greater in premenopausal women (adjusted HR 1.140, 95% CI, 1.108-1.172) than in postmenopausal women (adjusted HR 1.045, 95% CI 1.018-1.073; PP ConclusionsSmoking increases the risk of migraine in women, with a dose-dependent relationship. Menopause modifies this effect. Our findings suggest that smoking is an important modifiable risk factor of migraine, with a higher impact in premenopausal women. The interaction between smoking and estrogen may increase the vulnerability of the migraine brain.

Background Low socioeconomic status is a risk factor for chronic obstructive pulmonary disease (COPD); however, the association between low household income and COPD in young populations remains unclear.Methods We screened individuals aged 20–39 years who underwent the national health examination between 2009 and 2012 using the Korean National Health Information Database, which was searched until December 2019. We identified 5 965 366 eligible individuals, and 13 296 had newly developed COPD based on health insurance claims. We evaluated household income levels based on the health insurance premiums, categorised them into quartiles and ‘Medical aid’ (the lowest 3% income group), and assessed the annual income status from the preceding 4 years. Multivariate Cox proportional hazard models were used to estimate the adjusted HR (aHR) of risk factors for COPD.Results In the Medical aid group, the incidence rate for developing COPD was 0.56/1000 person-years, with an aHR of 2.45 (95% CI 1.91 to 3.13) compared with that of the highest income quartile group. This association was prominent in consecutive recipients of Medical aid (aHR 2.37, 95% CI 1.80 to 3.11) compared with those who had never been Medical aid beneficiaries. Those who experienced a decline in household income between the previous (preceding 4 years) and baseline time points had an increased risk of developing COPD, regardless of previous income status.Conclusion Low household income was associated with an increased risk of developing COPD in the young population. This risk was augmented by sustained low income and declining income status.

Abstract Background While cancer patients are at an increased risk of cardiovascular disease (CVD), the role of modifiable risk factors remains poorly understood. This study investigated whether lifestyle modifications affect CVD development in gastric cancer patients who undergo surgery. Methods Using data from the Korean National Health Insurance Service (NHIS), gastric cancer patients who underwent surgery from 2010 to 2017 were identified. Lifestyle behaviours, surveyed within 2 years before and after surgery were analysed. Incident CVD, defined as a composite of myocardial infarction and stroke, was compared among subgroups of lifestyle behaviour changes. Results Among 22,211 gastrectomy patients, 628 (2.8%) developed CVD (5.68/1000 person‐years). Persistent smokers (HR: 1.72, 95% CI: 1.33–2.22) and new smokers (HR: 1.85, 95% CI: 1.04–3.30) faced higher CVD risks than non‐smokers, with an especially pronounced risk in persistent‐smoking females (HR: 3.89, 95% CI: 1.20–12.62). Smoking cessation showed no significant risk difference compared to non‐smokers (HR: 1.16, 95% CI: 0.93–1.43). Female new drinkers had a higher CVD risk than non‐drinking females (HR: 2.89, 95% CI: 1.06–7.88), while men did not show such association. Changes in physical activity, when compared to physical inactivity, were not associated with CVD risk. Conclusion Gastric cancer patients who smoked after surgery were more likely to develop CVD irrespective of their prior smoking status, with a notable vulnerability in persistent female smokers. Smoking cessation could potentially mitigate CVD risk to levels observed in non‐smokers. Alcohol intake should be avoided following surgery, especially for female gastric cancer patients.

Background : The 2023 Obesity Fact Sheet aims to present an updated overview of obesity prevalence across all age groups, including children and adolescents. Methods : This study included individuals aged ≥20 years (n=16,941,423 in 2021) who underwent health checkups provided by the Korean National Health Insurance Service between 2012 and 2021. The prevalence of obesity and abdominal obesity was standardized by age and sex using data from the 2010 population and housing census. For children and adolescents (6 to 18 years) (n=884 in 2021), we used the Korea National Health and Nutrition Examination Survey (2012 to 2021), and obesity was defined by the corresponding sex- and age-specific body mass index percentile of 95th or greater based on the 2017 Korean National Growth Chart for Children and Adolescents. Results : The overall prevalence of obesity in 2021 is 38.4% (49.2% in men and 27.8% in women), which is a 1.27-fold increase from 30.2% in 2012. The prevalence of obesity has increased across all age groups, particularly among those aged 20, 30, and 80 years. The prevalence of class III obesity substantially increased from 0.35% (men) and 0.42% (women) in 2012 to 1.21% and 0.97% in 2021, with 3.46- and 2.31-fold increases, respectively. This increase was particularly pronounced in young adults. The prevalence of obesity in children and adolescents has surged from 9.7% in 2012 to 19.3% in 2021, with a greater increase among boys. Conclusion : Our study provides information on the current status of obesity prevalence based on the 2023 Obesity Fact Sheet, emphasizing the urgency of implementing timely strategies to reverse this increasing trend.

Background We aimed to identify the risk of incident depression according to cumulative exposure to a low-household income status in individuals with type 2 diabetes mellitus (T2DM). Methods For this retrospective longitudinal population-based cohort study, we used Korean National Health Insurance Service data from 2002 to 2018. Risk of depression was assessed according to cumulative exposure to low-household income status (defined as Medical Aid registration) during the previous 5 years among adults (aged ≥20 years) with T2DM and without baseline depression who underwent health examinations from 2009 to 2012 (n=2,027,317). Results During an average 6.23 years of follow-up, 401,175 incident depression cases occurred. Advance in cumulative number of years registered for medical aid during the previous 5 years from baseline was associated with an increased risk of depression in a dose-dependent manner (hazard ratio [HR], 1.44 [95% confidence interval (CI), 1.38 to 1.50]; HR, 1.40 [95% CI, 1.35 to 1.46]; HR, 1.42, [95% CI, 1.37 to 1.48]; HR, 1.46, [95% CI, 1.40 to 1.53]; HR, 1.69, [95% CI, 1.63 to 1.74] in groups with 1 to 5 exposed years, respectively). Insulin users exposed for 5 years to a low-household income state had the highest risk of depression among groups categorized by insulin use and duration of low-household income status. Conclusion Cumulative duration of low-household income status, defined as medical aid registration, was associated with an increased risk of depression in a dose-response manner in individuals with T2DM.

Background Further study is warranted to determine the association between estimated glomerular filtration rate (eGFR) or albuminuria and the risk of death from diverse causes. Methods We screened >10 million general health screening examinees who received health examinations conducted in 2009 using the claims database of Korea. After the exclusion of those previously diagnosed with renal failure and those with missing data, 9,917,838 individuals with available baseline kidney function measurements were included. The primary outcome was mortality and cause-specific death between 2009 and 2019 identified through death certificates based on the diagnostic codes of International Classification of Diseases, 10th revision. Multivariable Cox regression analysis adjusted for various clinicodemographic and social characteristics was used to assess mortality risk. Results The hazard ratio of death was significantly high in both the eGFR

Background: Concern has been growing regarding post-tuberculosis (TB) morbidities, including neurologic and vascular comorbidities. However, the association between post-TB status and the risk of dementia has been evaluated in only few studies. Therefore, in the present study, the risk of dementia was investigated in a nationwide population-based cohort. Methods: Using the Korean National Health Insurance Service (KNHIS) database, this study included TB survivors (n = 50,182) and matched controls (n = 50,182) for age, sex, and year of index date. The risk of dementia was estimated using Cox proportional hazards regression, and stratified analyses for related factors were performed. Results: During a mean 3.5 years of follow-up, the incidence of dementia was 9.32 for Alzheimer disease and 1.17 for vascular dementia per 1000 person-years for TB survivors and 7.21 and 0.67, respectively, for matched controls. The overall risk of Alzheimer disease was 1.11 (95% confidence interval (CI) 1.03–1.20)-fold higher in TB survivors than in matched controls. For vascular dementia, 1.48 (95% CI 1.16–1.89)-fold higher risk was found in TB survivors than in matched controls. The strength of the association between TB and dementia was higher in CNS TB (aHR 1.76, 95% CI 1.18 –2.64) than non-CNS TB (aHR 1.11, 95% CI 1.05–1.19) compared to controls, especially for patients with vascular dementia (3.33, 95% CI 1.06–10.49). Conclusion: TB survivors had a significantly higher risk of dementia than the general population.

Abstract Background The risk of incident atrial fibrillation (AF) among breast cancer survivors, especially for younger women, and cancer treatment effects on the association remain unclear. This study aimed to investigate the risk of AF among breast cancer survivors and evaluate the association by age group, length of follow-up, and cancer treatment. Methods Using data from the Korean Health Insurance Service database (2010–2017), 113,232 women newly diagnosed with breast cancer (aged ≥ 18 years) without prior AF history who underwent breast cancer surgery were individually matched 1:5 by birth year to a sample female population without cancer (n = 566,160) (mean[SD] follow-up, 5.1[2.1] years). Sub-distribution hazard ratios (sHRs) and 95% confidence intervals (CIs) considering death as a competing risk were estimated, adjusting for sociodemographic factors and cardiovascular/non-cardiovascular comorbidities. Results BCS had a slightly increased AF risk compared to their cancer-free counterparts (sHR 1.06; 95% CI 1.00–1.13), but the association disappeared over time. Younger BCS (age 65 years. Use of anthracyclines was associated with increased AF risk among BCS (sHR 1.57; 95% CI 1.28–1.92), which was more robust in younger BCS (sHR 1.94; 95% CI 1.40–2.69 in those aged ≤ 50 years). Conclusions Our findings suggest that younger BCS had an elevated risk of incident AF, regardless of the length of follow-up. Use of anthracyclines may be associated with increased mid-to-long-term AF risk among BCS. Graphical Abstract