국민건강보험공단 청구자료를 활용한 파킨슨병과 관련된 코호트 연구 디자인 분석 및 향후 한의중재 관련 파킨슨 후향적 코호트 연구를 위한 제언

황예채,임정태 대한예방한의학회 2024 대한예방한의학회지 Vol.28 No.1

Objectives : This study is to investigate the current National Health Insurance Database cohort studies related to complications of Parkinson’s Disease (PD) and suggest the design of Korean medical epidemiological studies of PD. Methods : Nationwide longitudinal studies of PD patients in South Korea were collected through Pubmed and the Korea Citation Index (KCI). We selected cohort studies that used the National Health Insurance Database in Korea and targeted Parkinson’s disease patients. Studies published before February 2024 were categorized according to study designs. We examined variables and covariates, enroll dates and matching methods. Results : Of a total of 536 studies, 18 studies met the inclusion criteria. All studies used the National Health Insurance (NHI) Research Database and among them, 5 used sample data and one senior database. Studies can be classified into two types. 11 cohort studies were comparing PD patients and non-PD patients. Another type was 4 PD patients cohort studies. Most studies used two diagnostic codes (G20 and V124) for inclusion criteria. Enroll periods were from 2002 to 2017, and follow-up periods were from 7 to 14 years. 16 studies considered age and sex as covariates. 15 studies used the propensity score matching method to increase the level of causality. There was only one study related to the Korean medical treatment. Conclusion : In future cohort studies on Korean medical treatment, more attempts should be made to reveal the effect of the treatments on PD patients by defining inclusion criteria for patient groups, covariates, exposure variables, and assessment indicators more operatively. Objectives : This study is to investigate the current National Health Insurance Database cohort studies related to complications of Parkinson’s Disease (PD) and suggest the design of Korean medical epidemiological studies of PD. Methods : Nationwide longitudinal studies of PD patients in South Korea were collected through Pubmed and the Korea Citation Index (KCI). We selected cohort studies that used the National Health Insurance Database in Korea and targeted Parkinson’s disease patients. Studies published before February 2024 were categorized according to study designs. We examined variables and covariates, enroll dates and matching methods. Results : Of a total of 536 studies, 18 studies met the inclusion criteria. All studies used the National Health Insurance (NHI) Research Database and among them, 5 used sample data and one senior database. Studies can be classified into two types. 11 cohort studies were comparing PD patients and non-PD patients. Another type was 4 PD patients cohort studies. Most studies used two diagnostic codes (G20 and V124) for inclusion criteria. Enroll periods were from 2002 to 2017, and follow-up periods were from 7 to 14 years. 16 studies considered age and sex as covariates. 15 studies used the propensity score matching method to increase the level of causality. There was only one study related to the Korean medical treatment. Conclusion : In future cohort studies on Korean medical treatment, more attempts should be made to reveal the effect of the treatments on PD patients by defining inclusion criteria for patient groups, covariates, exposure variables, and assessment indicators more operatively.

Effect of Opioids on All-cause Mortality and Sustained Opioid Use in Elderly Patients with Hip Fracture: a Korea Nationwide Cohort Study

Yoo Jun-Il,Jang Suk-Yong,Cha Yonghan,Park Chan Ho,Kim Jung-Taek,Oh Seunghak,Choy Wonsik 대한의학회 2021 Journal of Korean medical science Vol.36 No.19

Background: The purpose of our study was to assess the use of opioids before and after hip fracture in elderly patients in order to determine the effect of opioid use on all-cause mortality, and to analyze how the history of opioid use before fracture increases the risk of sustained use following hip fracture using a Korea nationwide cohort. Methods: Our study identified hip fracture patients from the Korean National Health Insurance Service-Senior cohort. The index date was defined as 90-days after admission to the acute care hospital that fulfilled the eligibility criteria of elderly hip fracture. Patients were classified into past user, current user, and sustained user according to the use of opioid at each period based on the time of admission and index date. The opioids were classified into strong opioids and tramadol. A generalized estimating equation model with a Poisson distribution and logarithmic link function was performed to estimate the adjusted rate ratios (aRRs) and 95% confidence intervals (CIs) to assess the association between past use and sustained use. A multivariable-adjusted Cox proportional hazard model was used to investigate the effects of strong opioid and tramadol use on all-cause mortality. Results: A total of 12,927 patients were included in our study. There were 7,384 (57.12%) opioid past-users, 11,467 (88.71%) opioid current-users, and 7,172 (55.48%) sustained users. In comparison of the death risk according to current use or the defined daily dose of the opioids or past opioid use, there were no significant differences in the adjusted hazard ratio for death in all groups, compared to the current non-users (P > 0.05). Among survivors 1 year after hip fracture, opioid past-use increased the risk of opioid sustained use by 1.52-fold (aRR; 95% CI, 1.45–1.8; P < 0.001). Conclusion: Current use and past use of opioid did not increase all-cause mortality after hip fracture in elderly patients over 65 years of age. Past use of opioid before hip fracture increased risk of sustained use of opioid compared to the current opioid used without past use.

Hydrochlorothiazide use and risk of skin cancer: A nationwide retrospective cohort study in Korea

( Eunjung Park ),( Young Lee ),( Mihn-sook Jue ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Hydrochlorothiazide (HCTZ) is the one of the most commonly prescribed antihypertensive drug and recent data has shown an association between HCTZ use and skin cancer (SC). However, there have been no studies about HCTZ use and the risk of SC in Asian population. Objectives: Examine the risk of SC in the cohort of Korean hypertension patients. Methods: We conducted a retrospective, population-based cohort study using database from the Health Insurance Review and Assessment (HIRA) Service from 2009 to 2016. The risk of SC was evaluated by multivariable Cox proportional hazard ratio (HR) modeling. Covariates included age, sex, comorbidities and prior history of photosensitizing drugs and other medications known to potentially affect the SC risk. Results: A total of 1,714,590 patients with HCTZ-users and 1,851,362 of non-HCTZ users were enrolled. The overall risk of SC was 42.67 and 40.23 per 1000,000 person-years in HCTZ-users and non-HCTZ users, respectively. Compared with non-HCTZ users, no statistically significant associations with the risk of all SC in HCTZ-users (HR=0.97, 95% CI, 0.93-1.02, p=0.26). Whereas, the risk of melanoma was decreased in the HCTZ-users (HR=0.89, 95% CI, 0.81-0.99, p=0.03), and no statistically significant association was seen in the risk of nonmelanoma skin cancer (NMSC) (HR=0.99, 95% CI, 0.94-1.04, p=0.77). Conclusion: Use of HCTZ use maybe associated with decreased risk of melanoma, and no association in the risk of NMSC.

Effect of Opioids on All-cause Mortality and Opioid Addiction in Total Hip Arthroplasty: a Korea Nationwide Cohort Study

Cha Yonghan,Jang Suk-Yong,Yoo Jun-Il,Choi Hyo-Gil,Hwang Jeong Won,Choy Wonsik 대한의학회 2021 Journal of Korean medical science Vol.36 No.13

Background: The purpose of this study was to investigate the use of opioids before and after total hip arthroplasty (THA), to find out the effect of opioid use on mortality in patients with THA, and to analyze whether preoperative opioid use is a risk factor for sustained opioid use after surgery using Korean nationwide cohort data. Methods: This retrospective nationwide study identified subjects from the Korean National Health Insurance Service-Sample cohort (NHIS-Sample) compiled by the Korean NHIS. The index date (time zero) was defined as 90 days after an admission to a hospital to fulfill the eligibility criteria of the THA. Results: In the comparison of death risk according to current use and the defined daily dose of tramadol and strong opioids in each patient group according to past opioid use, there were no statistically significant differences in the adjusted hazard ratio for death compared to the current non-users in all groups (P > 0.05). Past tramadol and strong opioid use in current users increased the risk of the sustained use of tramadol and strong opioids 1.45-fold (adjusted rate ratio [aRR]; 95% confidence interval [CI], 1.12–1.87; P = 0.004) and 1.65-fold (aRR; 95% CI, 1.43–1.91; P < 0.001), respectively, compared to past non-users. Conclusion: In THA patients, the use of opioids within 6 months before surgery and within 3 months after surgery does not affect postoperative mortality, but a past-use history of opioid is a risk factor for sustained opioid use. Even after THA, the use of strong opioids is observed to increase compared to before surgery.

Relationship between Use of Rehabilitation Resources and ICU Readmission and ER Visits in ICU Survivors: the Korean ICU National Data Study 2008-2015

Yun Hee Park,고령은,강단비,JinKyeong Park,Kyeongman Jeon,Jeong Hoon Yang,Chi-Min Park,Joongbum Cho,Young Sook Park,Hyejung Park,조주희,Eliseo Guallar,서지영,Chi Ryang Chung 대한의학회 2020 Journal of Korean medical science Vol.35 No.15

Background: Despite the increasing importance of rehabilitation for critically ill patients, there is little information regarding how rehabilitation therapy is utilized in clinical practice. Our objectives were to evaluate the implementation rate of rehabilitation therapy in the intensive care unit (ICU) survivors and to investigate the effects of rehabilitation therapy on outcomes. Methods: A retrospective nationwide cohort study with including > 18 years of ages admitted to ICU between January 2008 and May 2015 (n = 1,465,776). The analyzed outcomes were readmission to ICU readmission and emergency room (ER) visit. Results: During the study period, 249,918 (17.1%) patients received rehabilitation therapy. The percentage of patients receiving any rehabilitation therapy increased annually from 14% in 2008 to 20% in 2014, and the percentages for each type of therapy also increased over time. The most common type of rehabilitation was physical therapy (91.9%), followed by neuromuscular electrical stimulation (29.6%), occupational (28.6%), respiratory, (11.6%) and swallowing (10.3%) therapies. After adjusting for confounding variables, the risk of 30- day ICU readmission was lower in patients who received rehabilitation therapy than in those who did not (P < 0.001; hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.65–0.75). And, the risk of 30-day ER visit was also lower in patients who received rehabilitation therapy (P < 0.001; HR, 0.83; 95% CI, 0.77–0.88). Conclusion: In this nationwide cohort study in Korea, only 17% of all ICU patients received rehabilitation therapy. However, rehabilitation is associated with a significant reduction in the risk of 30-day ICU readmission and ER visit.