건강보험 청구자료에서 동반질환 보정방법과 관찰기관 비교 연구: 경피적 관상동맥 중재술을 받은 환자를 대상으로

김경훈,안이수,Kim, Kyoung-Hoon,Ahn, Lee-Su 대한예방의학회 2009 예방의학회지 Vol.42 No.4

Objectives : To compare the performance of three comorbidity measurements (Charlson comorbidity index, Elixhauser s comorbidity and comorbidity selection) with the effect of different comorbidity lookback periods when predicting in-hospital mortality for patients who underwent percutaneous coronary intervention. Methods : This was a retrospective study on patients aged 40 years and older who underwent percutaneous coronary intervention. To distinguish comorbidity from complications, the records of diagnosis were drawn from the National Health Insurance Database excluding diagnosis that admitted to the hospital. C-statistic values were used as measures for in comparing the predictability of comorbidity measures with lookback period, and a bootstrapping procedure with 1,000 replications was done to determine approximate 95% confidence interval. Results : Of the 61,815 patients included in this study, the mean age was 63.3 years (standard deviation: ${\pm}$10.2) and 64.8% of the population was male. Among them, 1,598 2.6%) had died in hospital. While the predictive ability of the Elixhauser's comorbidity and comorbidity selection was better than that of the Charlson comorbidity index, there was no significant difference among the three comorbidity measurements. Although the prevalence of comorbidity increased in 3 years of lookback periods, there was no significant improvement compared to 1 year of a lookback period. Conclusions : In a health outcome study for patients who underwent percutaneous coronary intervention using National Health Insurance Database, the Charlson comorbidity index was easy to apply without significant difference in predictability compared to the other methods. The one year of observation period was adequate to adjust the comorbidity. Further work to select adequate comorbidity measurements and lookback periods on other diseases and procedures are needed.

Recalibration and validation of the Charlson Comorbidity Index in acute kidney injury patients underwent continuous renal replacement therapy

이진우,Jung Jiyun,이장욱,Park Jung Tak,Jung Chan-young,Kim Yong Chul,Kim Dong Ki,이정표,신성준,박재윤 대한신장학회 2022 Kidney Research and Clinical Practice Vol.41 No.3

Background: Comorbid conditions impact the survival of patients with severe acute kidney injury (AKI) who require continuous renal replacement therapy (CRRT). The weights assigned to comorbidities in predicting survival vary based on type of index, disease, and advances in management of comorbidities. We developed a modified Charlson Comorbidity Index (CCI) for use in patients with AKI requiring CRRT (mCCI-CRRT) and improved the accuracy of risk stratification for mortality. Methods: A total of 828 patients who received CRRT between 2008 and 2013, from three university hospital cohorts was included to develop the comorbidity score. The weights of the comorbidities were recalibrated using a Cox proportional hazards model adjusted for demographic and clinical information. The modified index was validated in a university hospital cohort (n = 919) using the data of patients treated from 2009 to 2015. Results: Weights for dementia, peptic ulcer disease, any tumor, and metastatic solid tumor were used to recalibrate the mCCI-CRRT. Use of these calibrated weights achieved a 35.4% (95% confidence interval [CI], 22.1%–48.1%) higher performance than unadjusted CCI in reclassification based on continuous net reclassification improvement in logistic regression adjusted for age and sex. After additionally adjusting for hemoglobin and albumin, consistent results were found in risk reclassification, which improved by 35.9% (95% CI, 23.3%–48.5%). Conclusion: The mCCI-CRRT stratifies risk of mortality in AKI patients who require CRRT more accurately than does the original CCI, suggesting that it could serve as a preferred index for use in clinical practice.

만성하지동맥폐색증 환자의 위험인자 및 동반 질환에 따른 개존율 분석

정지현,황홍필,양재도,유희철,한영민,조백환 대한혈관외과학회 2012 Vascular Specialist International Vol.28 No.2

Purpose: The aim of this study is to analyze the patency rates according to the risk factors and comorbidities in patients treated with endovascular treatments or arterial bypass surgery due to chronic arterial occlusive disease in the lower extremity. Methods: Two hundred fifty-seven patients were treated for chronic arterial occlusive disease in lower extremity from January 2000 to December 2010 at Chonbuk National University Hospital; of the 257 patients, we retrospectively reviewed medical records of 142 patients who could be followed-up. We analyzed the patency rates according to the Trans-Atlantic Inter-Society Consensus (TASC) II classification, risk factors and comorbidities. Results: One year, three year, and five year patency rates according to TASC classification had no statistical significance (P=0.301), and those risk factors and comorbidities associated with each other also had no statistical significance. However, the patency rates according to the number of risk factors and comorbidities demonstrated statistical significance (P=0.004), respectively. In addition, when sum of the total number was above 6, the patency rates were the poorest with statistical significance (P<0.001). Also, these analyses had statistical significance in the groups regarding TASC C, D (P<0.001), aorto-iliac lesions ((P<0.001) and femoro-popliteal lesions (P<0.001). Conclusion: Analysis of risk factors and comorbidities in patients with chronic arterial occlusive disease in the lower extremity can be useful in predicting the patency rates prior to endovascular treatments or arterial bypass surgeries.

Effect of Underlying Comorbidities on the Infection and Severity of COVID-19 in Korea: a Nationwide Case-Control Study

Ji Wonjun,Huh Kyungmin,Kang Minsun,Hong Jinwook,Bae Gi Hwan,이예린,Na Yewon,Choi Hyoseon,Gong Seon Yeong,Choi Yoon-Hyeong,Ko Kwang-Pil,Im Jeong-Soo,정재훈 대한의학회 2020 Journal of Korean medical science Vol.35 No.25

Background: The coronavirus disease 2019 (COVID-19) pandemic is an emerging threat worldwide. It remains unclear how comorbidities affect the risk of infection and severity of COVID-19. Methods: This is a nationwide retrospective case-control study of 219,961 individuals, aged 18 years or older, whose medical costs for COVID-19 testing were claimed until May 15, 2020. COVID-19 diagnosis and infection severity were identified from reimbursement data using diagnosis codes and on the basis of respiratory support use, respectively. Odds ratios (ORs) were estimated using multiple logistic regression, after adjusting for age, sex, region, healthcare utilization, and insurance status. Results: The COVID-19 group (7,341 of 219,961) was young and had a high proportion of female. Overall, 13.0% (954 of 7,341) of the cases were severe. The severe COVID-19 group had older patients and a proportion of male ratio than did the non-severe group. Diabetes (odds ratio range [ORR], 1.206–1.254), osteoporosis (ORR, 1.128–1.157), rheumatoid arthritis (ORR, 1.207–1.244), substance use (ORR, 1.321–1.381), and schizophrenia (ORR, 1.614–1.721) showed significant association with COVID-19. In terms of severity, diabetes (OR, 1.247; 95% confidential interval, 1.009–1.543), hypertension (ORR, 1.245–1.317), chronic lower respiratory disease (ORR, 1.216–1.233), chronic renal failure, and end-stage renal disease (ORR, 2.052–2.178) were associated with severe COVID-19. Conclusion: We identified several comorbidities associated with COVID-19. Health care workers should be more careful while diagnosing and treating COVID-19 when patients have the abovementioned comorbidities.

관상동맥우회로술(CABG)환자의 재원일수와 병원 내 사망률 변이에 대한 경피적관상동맥성형술(PTCA)과 소아심장수술(PHS)의 영향분석

김다양,이광수 보건의료산업학회 2014 보건의료산업학회지 Vol.8 No.4

The purpose of this study was to analyze the differences in the outcome for CABG according to whether hospitals provided heart related surgeries. The 2011 National Inpatient Sample (NIS) and inpatient quality indicator principles from the Healthcare Research and Quality (AHRQ) were used for analysis. Hospitals were divided into three groups according to the surgeries they provided. The length of stay and in-hospital deaths were adjusted for the differences in risks. ANOVA was performed to examine the differences for the risk-adjusted in-hospital mortality rate and risk-adjusted length of stay among the three groups. The analysis results showed that hospitals providing CABG, PTCA, and PHS had lower risk-adjusted in-hospital mortality rates or similar risk-adjusted lengths of stay compared to those of hospitals providing only CABG. However, the three groups did not have statistically significant differences in outcome indicators. Another study will be needed with a larger sample.

Diabetes Fact Sheet in Korea 2021

배재현,한경도,고승현,양예슬,최종한,최경묵,권혁상,원규장 대한당뇨병학회 2022 Diabetes and Metabolism Journal Vol.46 No.3

Background: This study aimed to investigate the prevalence and management of diabetes mellitus, risk-factor control, and comorbidities among Korean adults.Methods: We conducted a cross-sectional analysis of data from the Korea National Health and Nutrition Examination Survey to assess the prevalence, treatment, risk factors, comorbidities, and self-management behaviors of diabetes mellitus from 2019 to 2020. We also analyzed data from the Korean National Health Insurance Service to evaluate the use of antidiabetic medications in people with diabetes mellitus from 2002 through 2018.Results: Among Korean adults aged 30 years or older, the estimated prevalence of diabetes mellitus was 16.7% in 2020. From 2019 through 2020, 65.8% of adults with diabetes mellitus were aware of the disease and treated with antidiabetic medications. The percentage of adults with diabetes mellitus who achieved glycosylated hemoglobin (HbA1c) <6.5% was 24.5% despite the increased use of new antidiabetic medications. We found that adults with diabetes mellitus who achieved all three goals of HbA1c <6.5%, blood pressure (BP) <140/85 mm Hg, and low-density lipoprotein cholesterol <100 mg/dL were 9.7%. The percentage of self-management behaviors was lower in men than women. Excess energy intake was observed in 16.7% of adults with diabetes mellitus.Conclusion: The prevalence of diabetes mellitus among Korean adults remained high. Only 9.7% of adults with diabetes mellitus achieved all glycemic, BP, and lipid controls from 2019 to 2020. Continuous evaluation of national diabetes statistics and a national effort to increase awareness of diabetes mellitus and improve comprehensive diabetes care are needed.

Comorbid risks of psychological disorders and gastroesophageal reflux disorder using the national health insurance service—National Sample Cohort : A STROBE-compliant article

Lee, Ye-Seul,Jang, Bo-Hyoung,Ko, Seong-Gyu,Chae, Younbyoung Williams & Wilkins Co 2018 Medicine Vol.97 No.18

<P><B>Abstract</B></P><P>This study was performed to examine the comorbidity risks between psychological disorders, such as depression, and gastroesophageal reflux disease (GERD) using nationally representative data from a National Sample Cohort of the National Health Insurance Service in Korea.</P><P>The National Health Insurance Service—National Sample Cohort (NHIS–NSC) database from 2010 to 2012 was used in this study. GERD patients were defined as those diagnosed with specific tests, with screened medication, and without any other gastrointestinal diseases. Propensity score matching for age, sex, and economic status was applied to form a control cohort. Incidence rate, relative risks, Cox proportional-hazards modeling, and Kaplan–Meier analysis were applied to examine the differences between the GERD and control cohorts with regard to the risk of subsequent psychological disorders.</P><P>The results showed that patients in the GERD cohort (n = 9503) had significantly higher risks of psychological disorders than those without GERD (adjusted hazard ratio [HR] 1.25, 95% confidence interval [CI] 1.07–1.47, <I>P</I> = .006). Specifically, the risk of depressive disorder was significantly higher for patients in the GERD cohort than in the control cohort (adjusted HR 1.41, 95% CI 1.04–1.91, <I>P</I> = .027). Kaplan–Meier analysis showed that the estimated probability of psychological disorders was significantly higher in the GERD cohort compared with the control cohort (log-rank test, <I>P</I> = .007).</P><P>This study suggested that GERD may be a risk factor for subsequent psychological disorders, specifically, depressive disorder. The results of this study in GERD patients compared with non-GERD patients in Korea suggested that psychological disorders and GERD may be inter-related.</P>

Toolkit to Compute Time-Based Elixhauser Comorbidity Indices and Extension to Common Data Models

Shorabuddin Syed,Ahmad Baghal,Fred Prior,Meredith Zozus,Shaymaa Al-Shukri,Hafsa Bareen Syeda,Maryam Garza,Salma Begum,Kim Gates,Mahanazuddin Syed,Kevin W. Sexton 대한의료정보학회 2020 Healthcare Informatics Research Vol.26 No.3

Objectives: The time-dependent study of comorbidities provides insight into disease progression and trajectory. We hypothesizethat understanding longitudinal disease characteristics can lead to more timely intervention and improve clinicaloutcomes. As a first step, we developed an efficient and easy-to-install toolkit, the Time-based Elixhauser Comorbidity Index(TECI), which pre-calculates time-based Elixhauser comorbidities and can be extended to common data models (CDMs). Methods: A Structured Query Language (SQL)-based toolkit, TECI, was built to pre-calculate time-specific Elixhauser comorbidityindices using data from a clinical data repository (CDR). Then it was extended to the Informatics for IntegratingBiology and the Bedside (I2B2) and Observational Medical Outcomes Partnership (OMOP) CDMs. Results: At the Universityof Arkansas for Medical Sciences (UAMS), the TECI toolkit was successfully installed to compute the indices from CDRdata, and the scores were integrated into the I2B2 and OMOP CDMs. Comorbidity scores calculated by TECI were validatedagainst: scores available in the 2015 quarter 1–3 Nationwide Readmissions Database (NRD) and scores calculated usingthe comorbidities using a previously validated algorithm on the 2015 quarter 4 NRD. Furthermore, TECI identified 18,846UAMS patients that had changes in comorbidity scores over time (year 2013 to 2019). Comorbidities for a random sample ofpatients were independently reviewed, and in all cases, the results were found to be 100% accurate. Conclusions: TECI facilitatesthe study of comorbidities within a time-dependent context, allowing better understanding of disease associations andtrajectories, which has the potential to improve clinical outcomes.

Risk, Mechanisms and Implications of Asthma-Associated Infectious and Inflammatory Multimorbidities (AIMs) among Individuals With Asthma: a Systematic Review and a Case Study

Kwon Jung Hyun,Wi Chung-Il,Seol Hee Yun,Park Miguel,King Katherine,Ryu Euijung,Sohn Sunghwan,Liu Hongfang,Juhn Young J. 대한천식알레르기학회 2021 Allergy, Asthma & Immunology Research Vol.13 No.5

Our prior work and the work of others have demonstrated that asthma increases the risk of a broad range of both respiratory (e.g., pneumonia and pertussis) and non-respiratory (e.g., zoster and appendicitis) infectious diseases as well as inflammatory diseases (e.g., celiac disease and myocardial infarction [MI]), suggesting the systemic disease nature of asthma and its impact beyond the airways. We call these conditions asthma-associated infectious and inflammatory multimorbidities (AIMs). At present, little is known about why some people with asthma are at high-risk of AIMs, and others are not, to the extent to which controlling asthma reduces the risk of AIMs and which specific therapies mitigate the risk of AIMs. These questions represent a significant knowledge gap in asthma research and unmet needs in asthma care, because there are no guidelines addressing the identification and management of AIMs. This is a systematic review on the association of asthma with the risk of AIMs and a case study to highlight that 1) AIMs are relatively under-recognized conditions, but pose major health threats to people with asthma; 2) AIMs provide insights into immunological and clinical features of asthma as a systemic inflammatory disease beyond a solely chronic airway disease; and 3) it is time to recognize AIMs as a distinctive asthma phenotype in order to advance asthma research and improve asthma care. An improved understanding of AIMs and their underlying mechanisms will bring valuable and new perspectives improving the practice, research, and public health related to asthma.

Charlson comorbidity index as a predictor of periodontal disease in elderly participants

Lee, Jae-Hong,Choi, Jung-Kyu,Jeong, Seong-Nyum,Choi, Seong-Ho Korean Academy of Periodontology 2018 Journal of Periodontal & Implant Science Vol.48 No.2

Purpose: This study investigated the validity of the Charlson comorbidity index (CCI) as a predictor of periodontal disease (PD) over a 12-year period. Methods: Nationwide representative samples of 149,785 adults aged ${\geq}60$ years with PD (International Classification of Disease, 10th revision [ICD-10], K052-K056) were derived from the National Health Insurance Service-Elderly Cohort during 2002-2013. The degree of comorbidity was measured using the CCI (grade 0-6), including 17 diseases weighted on the basis of their association with mortality, and data were analyzed using multivariate Cox proportional-hazards regression in order to investigate the associations of comorbid diseases (CDs) with PD. Results: The multivariate Cox regression analysis with adjustment for sociodemographic factors (sex, age, household income, insurance status, residence area, and health status) and CDs (acute myocardial infarction, congestive heart failure, peripheral vascular disease, cerebral vascular accident, dementia, pulmonary disease, connective tissue disorders, peptic ulcer, liver disease, diabetes, diabetes complications, paraplegia, renal disease, cancer, metastatic cancer, severe liver disease, and human immunodeficiency virus [HIV]) showed that the CCI in elderly comorbid participants was significantly and positively correlated with the presence of PD (grade 1: hazard ratio [HR], 1.11; P<0.001; grade ${\geq}2$: HR, 1.12, P<0.001). Conclusions: We demonstrated that a higher CCI was a significant predictor of greater risk for PD in the South Korean elderly population.