Age-Period-Cohort Analysis of Influenza in Koreans: the National Health Insurance Research Database, 2009–2018

변경향,김재용,최보율,Jin Yong Kim,이나경 대한의학회 2020 Journal of Korean medical science Vol.35 No.18

Background: This study aimed to identify the incidence rate of episodes diagnosed with influenza and the effects of age-period-cohort (APC) in Koreans. Methods: The 2009–2018 National Health Insurance Research Database was used for analysis. All time-related claims connected relatively short window period in 100 days. The case definition was defined by all codes diagnosed with J09, J10, and J11. Calculation of the incidence rate and APC analysis adjusted income levels by insurance type, metropolitan city was performed to identify the characteristics of episodes diagnosed with influenza. Results: Incidence rate by age and cohort gradually increased since 2014. The incidence rate of males aged 0–4 years was 171.02 and that of females was 173.31 in 2015–2016 season. In males, 29.19 in 1963 cohort and 243.79 in 2013 cohort were confirmed as high incidence rates in 2017–2018 season. In the females, a high incidence was confirmed in 1953–1967 cohort and 1978–1987 cohort, and the incidence was 251.38 in 2013–2017 cohort. APC effects showed a high relative risk in the infants, the pandemic influenza season in 2010 (1/7/2009 to 30/6/2010) and the adults of 1978–1987 cohort. Conclusion: Since 2014, influenza outbreaks have been increasing every year. The start year of free vaccination decreased the incidence in infants and adults over 65 years of age but the incidence increased from the following year. Because influenza can be primarily prevented by vaccination, reinforcement of vaccination in infants may reduce the disease burden in their parents, and also the risk of infection caused by family transmission. A new vaccination strategy is needed to reduce the incidence and burden of diseases caused by influenza infection.

Factors Affecting the Incidence of Hospitalized Pneumonia after Influenza Infection in Korea Using the National Health Insurance Research Database, 2014–2018: Focusing on the Effect of Antiviral Therapy in the 2017 Flu Season

변경향,김재용,최보율,김진용,이나경 대한의학회 2020 Journal of Korean medical science Vol.35 No.38

Background: This study aimed to investigate the effect of antiviral therapy following influenza outpatient episodes on the incidence of hospitalized pneumonia episodes, one of secondary complications of influenza. Methods: In the National Health Insurance Research Database, data from July 2013 to June 2018 were used. All of the claim data with diagnoses of influenza and pneumonia were converted to episodes of care after applying 100 days of window period. With the 100-day episodes of care, the characteristics of influenza outpatient episodes and antiviral therapy for influenza, the incidence of hospitalized pneumonia episodes following influenza, and the effect of antiviral therapy for influenza on hospitalized pneumonia episodes were investigated. Results: The crude incidence rate of hospitalized pneumonia after influenza infection was 0.57% in both males and females. Factors affecting hospitalized pneumonia included age, income level except self-employed highest (only in females), municipality, medical institution type, precedent chronic diseases except hepatitis (only in females) and antiviral therapy. In the 2017 flu season, the relative risk was 0.38 (95% confidence interval [CI], 0.29–0.50) in males aged 0–9 and 0.43 (95% CI, 0.32–0.57) in females aged 0–9 without chronic diseases, and it was 0.51 (95% CI, 0.42–0.61) in males aged 0–9 and 0.42 (95% CI, 0.35–0.50) in females aged 0–9 with one or more chronic diseases in the aspect of the effect of antiviral therapy on pneumonia. It suggests that antiviral therapy may decrease the incidence of pneumonia after influenza infection. Conclusion: After outpatient episode incidence of influenza, antiviral treatment has been shown to reduce the incidence of hospitalized pneumonia, especially in infants and children, during pandemic season 2017. Antiviral therapy for influenza is recommended to minimize burden caused by influenza virus infection and to reduce pneumonia. In addition, medical costs of hospitalization may decrease by antiviral therapy, especially in infants and children.

Relationship between binge drinking experience and suicide attempts in Korean adolescents: based on the 2013 Korean Youth Risk Behavior Web-based Survey

변경향,지선하,설재웅,최보영,김희진 한국역학회 2018 Epidemiology and Health Vol.40 No.-

OBJECTIVES: Suicide and drinking problems in adolescents are increasing every year, and it is known that suicide is related to drinking. This study aims to identify the relationship between binge drinking experience (BDE) and suicide attempts in Korean adolescents. METHODS: The Ninth Korean Youth Risk Behavior Web-based Survey (KYRBS), conducted in 2013, was used for analysis. Multiple logistic regression analysis was used to identify the relationship between BDE and suicide attempts, and the relationship between BDE and suicide attempts in middle and high school students was stratified by age. RESULTS: BDE and suicide attempts were highly related. The odds ratio (OR) of attempted suicide in BDE was 1.63 times (95% confidence interval [CI], 1.28 to 2.09) higher then non-drinking in males. And the OR of attempted suicide in females was 1.21 times (95% CI, 1.07 to 1.37) higher then non-drinking in non-BDE, 1.79 times (95% CI, 1.47 to 2.19) higher in BDE. BDE was associated with suicide attempts in males aged 12 or 13 years (OR, 3.97; 95% CI, 1.57 to 10.03) and in females aged 15 years (OR, 2.66; 95% CI, 1.79 to 3.96). CONCLUSIONS: BDE is an important factor related to suicide attempts in adolescents. In order to reduce suicide attempts, it is necessary to educate the youth about the regulation of BDE and drinking prevention.

The coverage rates for influenza vaccination and related factors in Korean adults aged 50 and older with chronic disease: based on 2016 Community Health Survey data

변경향,김재용,Boyoung Choi,최보율 한국역학회 2018 Epidemiology and Health Vol.40 No.-

OBJECTIVES: This study aims to identify the coverage rates for influenza vaccination and related factors depending on chronic disease in Korean adults aged 50 and older. METHODS: The 2016 Korea Community Health Survey was used for analysis. Chi-square test was performed to investigate the coverage rates for influenza vaccination depending on chronic disease, and a multiple logistic regression analysis was used to identify the factors associated with influenza vaccination, by chronic disease. RESULTS: In men with ≥1 chronic disease, 39.8% of 50-64 years of age, and 86.8% of elderly (over 65 years of age) received influenza vaccination. In women with ≥1 chronic disease, 58.7% of 50-64 years of age, and 89.9% of elderly (over 65 years of age) received influenza vaccination (p<0.001). The chronic diseases associated with influenza vaccination were hypertension (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.19 to 1.37), diabetes (OR, 1.41; 95% CI, 1.28 to 1.55) in men aged 50-64, hypertension (OR, 1.34; 95% CI, 1.20 to 1.49), diabetes (OR, 1.17; 95% CI, 1.02 to 1.33), chronic cardiovascular disease (OR, 1.31; 95% CI, 1.07 to 1.60) in elderly (over 65 years of age). In women aged 50-64, hypertension (OR, 1.39; 95% CI, 1.30 to 1.49), diabetes (OR, 1.51; 95% CI, 1.35 to 1.68), chronic cardiovascular disease (OR, 1.31; 95% CI, 1.05 to 1.64), and hypertension (OR, 1.55; 95% CI, 1.40 to 1.71), diabetes (OR, 1.27; 95% CI, 1.12 to 1.43) in elderly (over 65 years of age). CONCLUSIONS: Populations in aged 50-64 are recommendation subject for vaccination or classified as high-risk group in case with chronic disease. Though subject over 60 years old is age close to the elderly, the coverage rates for vaccination was low. It is necessary to devise strategies to raise the coverage rates for vaccination.

한국 노인의 만성질환과 낙상경험과의 관련성: 2015년 지역사회건강조사를 기반으로

변경향,남영희 한국학교·지역보건교육학회 2019 한국학교지역보건교육학회지 Vol.20 No.1

Objectives: The purpose of this study is to understand the relevance of chronic disease conditions and fall experience among people aged 65 and older. and use them as basic data to reduce the risk of falling. Methods: The study selected 26,122 men and 37,777 women aged 65 and over as final subjects of the study, using raw data from the Community Health Survey in 2015. The statistical analysis used SAS 9.4 USA. Results: About 20% of those aged 65 and older experienced a fall, with one in five elderly people experiencing a fall, and the ratio of men to women was 3:7, women higher than men. As the age grew, the lower the level of education, the more senior citizens who lived alone occurred falls. In addition, the incidence of falls was higher when the number of chronic diseases was more than three. The incidence of falls was 1.1-1.5 times higher depending on chronic diseases. Conclusion: The development of education and exercise programs for preventing fall of senior citizens aged 65 and older is required and further study is needed.

당뇨병 환자의 인플루엔자 예방접종률과 관련 요인

변경향 ( Kyeong Hyang Byeon ),김재용 ( Jai Yong Kim ),최보영 ( Bo Young Choi ),최보율 ( Bo Youl Choi ) 한국보건행정학회 2018 보건행정학회지 Vol.28 No.2

Background: The purpose of this study was to investigate the estimated proportion for influenza vaccination and to identify factors associated with influenza vaccination in Korean diabetic patients. Methods: Data from the fourth, fifth, and sixth (except for 2013) Korea National Health and Nutrition Examination Survey (n=3,726) was used. A chi-square test was performed to investigate the estimated proportion for influenza vaccination, and a multiple logistic regression analysis was used to identify the factors associated with self-reported influenza vaccination. Results: In men, 28.8% of diabetes patients 30-64 years of age, and 76.1% of elderly (over 65 years of age) diabetes patients received influenza vaccination. In women, 37.7% of diabetes patients 30-64 years of age, and 78.4% of elderly diabetes patients received influenza vaccination (p<0.0001). The determinants of influenza vaccination were marriage, hypertension (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.07-2.24), residence within a mega city, unemployment (OR, 3.94; 95% CI, 1.24-12.54), and exercise via (weekly) walking for diabetic men; and hypertension (OR, 1.71; 95% CI, 1.16-2.52), chronic disease (OR, 1.81; 95% CI, 1.08-3.02), and exercise via walking (OR, 2.65; 95% CI, 1.49-4.73) for diabetic women. Conclusion: Influenza vaccination remains relatively low in young diabetic patients. It is necessary to recommend vaccination to young diabetic patients, and to devise other strategies to improve vaccination.

The Correlation of Comorbidities on the Mortality in Patients with COVID-19: an Observational Study Based on the Korean National Health Insurance Big Data

김동욱,변경향,김재용,Cho Kyu Dong,이나경 대한의학회 2020 Journal of Korean medical science Vol.35 No.26

Background: Mortality of coronavirus disease 2019 (COVID-19) is a major concern for quarantine departments in all countries. This is because the mortality of infectious diseases determines the basic policy stance of measures to prevent infectious diseases. Early screening of high-risk groups and taking action are the basics of disease management. This study examined the correlation of comorbidities on the mortality of patients with COVID-19. Methods: We constructed epidemiologic characteristics and medical history database based on the Korean National Health Insurance Service Big Data and linked COVID-19 registry data of Korea Centers for Disease Control & Prevention (KCDC) for this emergent observational cohort study. A total of 9,148 patients with confirmed COVID-19 were included. Mortalities by sex, age, district, income level and all range of comorbidities classified by International Classification of Diseases-10 based 298 categories were estimated. Results: There were 3,556 male confirmed cases, 67 deaths, and crude death rate (CDR) of 1.88%. There were 5,592 females, 63 deaths, and CDR of 1.13%. The most confirmed cases were 1,352 patients between the ages of 20 to 24, followed by 25 to 29. As a result of multivariate logistic regression analysis that adjusted epidemiologic factors to view the risk of death, the odds ratio of death would be hemorrhagic conditions and other diseases of blood and blood-forming organs 3.88-fold (95% confidence interval [CI], 1.52–9.88), heart failure 3.17-fold (95% CI, 1.88–5.34), renal failure 3.07-fold (95% CI, 1.43–6.61), prostate malignant neoplasm 2.88-fold (95% CI, 1.01–8.22), acute myocardial infarction 2.38-fold (95% CI, 1.03–5.49), diabetes was 1.82-fold (95% CI, 1.25–2.67), and other ischemic heart disease 1.71- fold (95% CI, 1.09–2.66). Conclusion: We hope that this study could provide information on high risk groups for preemptive interventions. In the future, if a vaccine for COVID-19 is developed, it is expected that this study will be the basic data for recommending immunization by selecting those with chronic disease that had high risk of death, as recommended target diseases for vaccination.

50세 이상 천식 환자의 인플루엔자 백신 접종률 및 관련 요인

최보영,변경향 한국학교·지역보건교육학회 2018 한국학교지역보건교육학회지 Vol.19 No.3

Objectives: This study aims to investigate the estimated proportion for influenza vaccination and to identify factors associated with influenza vaccination in Korean adults aged 50 and older with asthma. Methods: Data from 2010-2015 Community Health Survey(n=23,662) was used. A chi-square test was performed to investigate the estimated proportion for influenza vaccination, and a multiple logistic regression analysis was used to identify the factors associated with self-reported influenza vaccination. Results: In men, 42.3-49.5% of asthma patients 50–64 years of age, and 78.5-90.2% of elderly (over 65 years of age) asthma patients received influenza vaccination. In women, 49.7-61.9% of asthma patients 50–64 years of age, and 82.7-89.7% of elderly asthma patients received influenza vaccination(p<0.0001). Low education level, non-smoking, non-drinking, hypertension, diabetes and use of public center were related to high influenza vaccination in 50–64 years old men with asthma. Low education level, non-smoking, bad health status, hypertension, diabetes and use of public center were related to high influenza vaccination in 50–64 years old women with asthma. Non-smoking and use of public center were related to high influenza vaccination in over 65 years old men with asthma. White-collar jobs, smoking, absence of hypertension and use of public center were related to low influenza vaccination in over 65 years old women with asthma. Conclusions: Influenza vaccination remains relatively low in asthma patients 50–64 years of age. It is necessary to recommend vaccination to asthma patients, provide them with information, and devise other strategies to improve vaccination.

Compliance of Antihypertensive Medication and Risk of Coronavirus Disease 2019: a Cohort Study Using Big Data from the Korean National Health Insurance Service

Kim Jaiyong,김동욱,김광일,Kim Hong Bin,Kim Jong-Hun,Lee Yong-Gab,변경향,정해관,Korean Society of Hypertension 대한의학회 2020 Journal of Korean medical science Vol.35 No.25

Background: There is a controversy whether it is safe to continue renin-angiotensin system blockers in patients with coronavirus disease 2019 (COVID-19). We analyzed big data to investigate whether angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers have any significant effect on the risk of COVID-19. Population-based cohort study was conducted based on the prescription data from nationwide health insurance records. Methods: We investigated the 1,374,381 residents aged ≥ 40 years living in Daegu, the epicenter of the COVID-19 outbreak, between February and March 2020. Prescriptions of antihypertensive medication during the year before the outbreak were extracted from the National Health Insurance Service registry. Medications were categorized by types and stratified by the medication possession ratios (MPRs) of antihypertensive medications after controlling for the potential confounders. The risk of COVID-19 was estimated using a difference in difference analysis. Results: Females, older individuals, low-income earners, and recently hospitalized patients had a higher risk of infection. Patients with higher MPRs of antihypertensive medications had a consistently lower risk of COVID-19 than those with lower MPRs of antihypertensive medications and non-users. Among patients who showed complete compliance, there was a significantly lower risk of COVID-19 for those prescribed angiotensin II receptor blockers (relative risk [RR], 0.751; 95% confidence interval [CI], 0.587–0.960) or calcium channel blockers (RR, 0.768; 95% CI, 0.601–0.980). Conclusion: Renin-angiotensin system blockers or other antihypertensive medications do not increase the risk of COVID-19. Patients should not stop antihypertensive medications, including renin-angiotensin system blockers, because of concerns of COVID-19.