Mortality and morbidity of childhood asthma: a nationwide study in Korea

( Haerin Jang ),( Kyung Won Kim ),( In Suk Sol ),( Juhwan Noh ),( Yoon Hee Kim ),( Changsoo Kim ),( Myung Hyun Sohn ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Background: Despite advances in guidelines and treatment for pediatric asthma, child mortality due to asthma still exists. We aimed to estimate asthma mortality and morbidity and to determine whether asthma contributes to child mortality. Methods: Data on children with asthma, aged under 18, was retrieved from the Korean National Health Insurance claims database for all records between 2002 and 2015. Among them, patients who had asthma a year before death were investigated. Cause of death for all patients deceased were analyzed using data obtained from the Korean Statistical Information Service database. Cause-specific mortality was examined, and the mortality rate was compared with the general population by cause and age. Hospital use of asthma patients, including ICU admission and hospitalization, were analyzed. Results: Asthma mortality decreased from 0.09 per 100,000 children in 2003 to 0.02 per 100,000 children in 2014, with an average mortality rate of 0.06 per 100,000 children. Asthma-related mortality, defined as mortality due to respiratory diseases, also decreased significantly. Asthma-related mortality was four times more common in asthma patients compared to the general population in children older than 5. Likewise, hospitalization for asthma and intensive care in asthmatic children tended to decrease throughout the study period. Conclusions: Asthma mortality in Korea declined for asthmatic children from 2003 to 2015. Asthmatic children are at a higher risk of death from respiratory diseases compared to the general population.

Mortality predictors in critically ill patients with acute kidney injury requiring continuous renal replacement therapy

( Kristianne Rachel P. Medina-liabres ),( Jong Cheol Jeong ),( Hyung Jung Oh ),( Jung Nam An ),( Jung Pyo Lee ),( Dong Ki Kim ),( Dong-ryeol Ryu ),( Sejoong Kim ) 대한신장학회 2021 Kidney Research and Clinical Practice Vol.40 No.3

Background: Because of high cost of continuous renal replacement therapy (CRRT) and the high mortality rate among severe acute kidney injury patients, careful identification of patients who will benefit from CRRT is warranted. This study determined factors associ-ated with mortality among critically ill patients requiring CRRT. Methods: This was a retrospective observational study of 414 patients admitted to the intensive care unit of four hospitals in South Korea who received CRRT from June 2017 to September 2018. Patients were divided according to degree of fluid overload (FO) and disease severity. The Cox proportional hazards model was used to explore the effect of relevant variables on mortality. Results: In-hospital mortality rate was 57.2%. Ninety-day mortality rate was 58.5%. Lower creatinine and blood pH were significant predictors of mortality. A one-unit increase in the Sequential Organ Failure Assessment (SOFA) score was associated with increased risk of and 90-day mortality (hazard ratio [HR], 1.07; p < 0.001). The risk of 90-day mortality in FO patients was 57.2% (p < 0.001) higher than in those without FO. High SOFA score was associated with increased risk for 90-day mortality (HR, 1.79; p = 0.03 and HR, 3.05; p = 0.001) in patients without FO and with FO ≤ 10%, respectively. The highest mortality rates were in patients with FO > 10%, independent of disease severity. Conclusion: FO increases the risk of mortality independent of other factors, including severity of acute illness. Prevention of FO should be a priority, especially when managing the critically ill.

Mortality Characteristic and Prediction of Nasopharyngeal Carcinoma in China from 1991 to 2013

Xu, Zhen-Xi,Lin, Zhi-Xiong,Fang, Jia-Ying,Wu, Ku-Sheng,Du, Pei-Ling,Zeng, Yang,Tang, Wen-Rui,Xu, Xiao-Ling,Lin, Kun Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.15

Background: To analyze the mortality distribution of nasopharyngeal carcinoma in China from 1991 to 2013, to predict the mortality in the ensuing five years, and to provide evidence for prevention and treatment of nasopharyngeal carcinoma. Materials and Methods: Mortality data for Nasopharyngeal Carcinoma in China from 1991 to 2013 were used to describe its epidemiological characteristics, such as the change of the standardized mortality rate, sex and age differences, urban-rural differences. Trend-surface analysis was used to study the geographical distribution of the mortality. Curve estimation, time series, gray modeling, and joinpoint regression were used to predict the mortality for the ensuing five years in the future. Results: In China, the standardized mortality rate of Nasopharyngeal Carcinoma increased with time from 1996, reaching the peak values of $1.45/10^5$ at the year of 2002, and decreased gradually afterwards. With males being 1.51 times higher than females, and the city had a higher rate than the rural during the past two decades. The mortality rate increased from age 40. Geographical analysis showed the mortality rate increased from middle to southern China. Conclusions: The standardized mortality rate of Nasopharyngeal Carcinoma is falling. The regional disease control for Nasopharyngeal Carcinoma should be focused on Guangdong province of China, and the key targets for prevention and treatment are rural men, especially after the age of 40. The mortality of Nasopharyngeal Carcinoma will decrease in the next five years.

우리 나라의 사회경제적 사망률 불평등: 1998년도 국민건강영양조사 자료의 사망추적 결과

김혜련,강영호,Kim, Hye-Ryun,Khang, Young-Ho 대한예방의학회 2006 예방의학회지 Vol.39 No.2

Objectives : This study was conducted to examine the relationships of the several socioeconomic position indicators with the mortality risk in a representative longitudinal study of South Korea. Methods : The 1998 National Health and Nutrition Examination Survey was conducted on a cross-sectional probability sample of South Korean households, and it contained unique 13-digit personal identification numbers that were linked to the data on mortality from the National Statistical Office of Korea. Of 5,607 males and females, 264 died between 1999 and 2003. Cox's regression was used to estimate the relative risks (RR) and their 95% confidence intervals (CI) of mortality. Results: Socioeconomic differences in mortality were observed after adjustments were made for gender and age. Compared with those people having college or higher education, those people without any formal education had a greater mortality risk (RR=2.21, 95% CI=1.12-4.40). The mortality risk among manual workers was significantly greater than that for the non-manual workers (RR=2.73, 95% CI=1.47-5.06). A non-standard employment status was also associated with an increase in mortality: temporary or daily workers had a greater mortality risk than did the full-time workers (RR=3.01, 95% CI=1.50-6.03). The mortality risk for the low occupational class was 3.06 times greater than that of the high and middle occupational classes (95% CI=1.75-5.36). In addition, graded mortality differences according to equivalized monthly household income were found. A reduction of monthly household income by 500 thousand Korean Won (about 400 US dollars) was related with a 20% excess risk of mortality. Self-reported poor living standards were also associated with an increased risk of mortality. Those without health insurance had a 3.63 times greater risk of mortality than the insured (95% CI=1.61-8.19). Conclusions: This study showed the socioeconomic differentials in mortality in a national longitudinal study of South Korea. The existence of socioeconomic mortality inequalities requires increased social discussion on social policies in Korean society. Furthermore, the mechanisms for the socioeconomic inequalities of mortality need to be explored in future studies.

地域社會의 構造的 特性이 死亡水準에 미치는 影響에 關한 硏究

鄭惠瓊 서울大學校保健大學院 1991 國民保健硏究所硏究論叢 Vol.1 No.1

The mortality rate of Korea has gradually decreased from 26.2-30.3 per 1,000 in 1926-30 to 6.4 in 1981-85. Despite the overall decline of the mortality, there remain differentials between areas and social classes, which are indicated as an issue. In general, mortality level of the areas can be seen from two directions. One explains the areal differences with the characteristics of the individuals and the other deals with the community-level characteristics, as the human-beings are social who cannot but be influenced by the community where he lives. As the former approaches have been taken in the researches of the public health fields so far, there have also been some limitations in explaining the health-related issues of area. Therefore, the latter theory, which emphasizes the commuity-level characteristics, will be taken in this study to provide not only the holistic viewpoints in dealing with the mortality data, but also some references for planning, organizing and managing the areal health program. Based on the above-mentioned justification, specific objectives of this study are established. First, to find out the patterns and differences of crude death rates and age-adjusted death rates of the areas, with cities and guns as observation units. Second, to provide the relationship between age-adjusted death rates and the community-level characteristics, in order to clarify the factors arousing the differential mortality. Third, to examine the relative importance of the socio-economic characteristics, in order to clarify the factors arousing the differential mortality. Forth, to examine the relative importance of the socio-economic characteristic variables and health care resource characteristic variables. Data used in this study were secondary data officially published by the Government including local governments. Data were collected as of December, 1985, but there were some gaps according to the data sources. Sources for anlaysis were administrative areas, i.e.,4 special cities, 44 cities, 4 chuljangso's and 129 guns, but the 4 special cities were excluded in actual analyses. Following dependent and independednt variables were chosen, crude death rates and age-adjusted death rates of the cities and guns were selected as dependent variables. Among the various variables which could have impact on the mortality level, 22 aggregate variables were selected as independent variables based on the reliable theory. As statistical methods for analysis, two methods were applied. To illustrate the areal variation of death rates, mapping method was adopted. And because of the multicollinearity of the independent variables, factor analysis was used. Through the factor analysis, 22 variables were summarized in 5 factors. In order to estimate the age adjusted death rate(Y) with 5 factors, Y was transformed by logistic function, and the regression analysis was conducted afterwards. Through analysis, following results were obtained. 1) There are big differentials in mortality level(both crude death rates and age-adjusted death rate) among cities and guns. Crude death rates of the gun areas of the Jeonnam Do was the highest 11.54, and that of the Gyeonggi Do was the lowest 7.00. Age-adjusted death rate of the gun areas of the Jeonnam Do was the highest again, 7.67 and that of the Jeju Do was the lowest, 4.55. 2) To find out the factors causing differential mortality, factor analysis was conducted. As a result, 5 factors were drawn, such as socio-economic development charcteristics, health care resource characteristics and others. Explanation power of the socio-economic development characteristics was three times higher than that of the health care resource characteristics. Similar results were obtained in comparative analysis between Gyeonggi Do where the mortality rate was the lowest, and Jeonnam Do where the mortality rate was the highest. In conclusion, mortality level of a given area can be explained by community-level characteristics, among which the socio-economic development characteristics explained the most. The contribution of the health care resource characteristics on the mortality decline was much less significant than expected. It is considered that in-depth study to investigate the causality between the characteristics should be conducted.

最近 韓國社會의 差別死亡力

정희영(Hee Young Jeung) 한국사회학회 2013 한국사회학회 사회학대회 논문집 Vol.2013 No.6

우리사회의 남녀 평균 기대수명은 이미 80세를 넘어섰으며, 일각에서는 이러한 기대수명의 상승이 당분간 계속될 것이라는 성급한 전망마저 내놓고 있는 형편이다. 이와 같은 사망률 감소 추세에도 불구하고, 인구의 하위집단 사이에서 사망수준이 격차를 드러내는 이른바 차별사망력의 현상은 여전히 엄존하여 관심을 끈다. 인구의 하위 집단간 차별사망력 현상은 전통적으로 연령과 성과 같은 인구학적 요인 외에, 교육수준에 의해서도 크게 좌우되는 것으로 간주해서 분석되어 왔다. 건강불평등과 건강형평성이란 개념들이 우리사회에서 지적되고는 있지만, 아직까지 이 부분에 깊은 관심과 문제점의 해결을 모색하는 것에 있어 미흡한 부분이 많다고 할 수 있다. 본 연구는 사망자의 교육수준이 사망력비에 어떠한 영향이 존재하는지를 검토한다. 한국인의 사망력에 연령, 성별, 교육수준이 어떠한 영향을 미치는지를 알아봄으로써 우리 사회의 차별사망력을 규명하고자 하는 시도이다. 본 연구에서 구체적으로 분석하고자 하는 대상은 1991-2010년 사이에 공표된 통계청 보유 “사망원인통계 연간자료”와, 5년 단위로 실시되어 온 인구총조사의 성을 포함한 연령에 대한 교육수준과 연결시켜서 분석에 활용되었다. 이 연구의 결과는 교육수준에 따라 차별 사망력이 크게 좌우된다는 것을 규명하였다. 즉, 낮은 교육수준을 가진 계층에서 상대적으로 사망위험이 높아진다는 것을 보여준다. 차별사망력을 야기하는 여러 요인들 가운데에서도 특히 교육수준 요인이 사망이라는 현상을 사회 불평등의 결과로서 접근하려는 맥락에서 그 분석적 의의가 한층 제고된 것이라 할 수 있다. 결국 이상의 결과는 사망자의 교육수준에 따른 차별사망력의 현상이 여전히 엄존한다는 것을 확인해 주는 것이다. Like many advanced societies, contemporary Korean society may be characterized by a prolonged life expectancy and low mortality rate. However, there are prominent differences in the level of death among various strata of the population. Mortality rates are known to be strongly influenced by various demographic and socioeconomic factors such as gender, age, educational level, job status, or income. Differential mortality reflects death levels of various population groups and different social stratifications of society. Research on differential mortality is important because it not only explains the causes of difference in mortality rates, but it also predicts the future phenomena relating to mortality. In other words, differential mortality studies help us understand death levels and trends in national population. Such studies provide us an informative index for the different socioeconomic groups" health status. This study attempts to verify the effects of age, gender, educational levels on mortality by comparing population parameter estimates of the logit model with mortality ratios. Data on 4,896,975 cases in total recorded for the 1991-2010 period by Statistical Korean Bureau under the name of "Annual Statistical Data on the Cause of Death" are analyzed for this study. Various factors such as gender, age or educational level status from the Census are also utilized, which are collected every five years by Statistical Korean Bureau. After calculating proportional mortality ratios by gender, age, educational level, the effects of each variable on mortality rates are analyzed by comparing population parameter estimates for the logit model with mortality ratios. Results of the study show that in the lower educational strata, mortality is negatively correlated with the educational levels of death. The study confirms that inequality among mortality ratios is related to the educational level status of the death and that differential mortalities exist among different social strata of the Korean population. A further study is required to analyze other important variables such as geographical differences, or causes of death that may affect differential mortality rates of the Korean society.

종신연금과 종신보험의 사망 리스크 헤징 포트폴리오 전략에 관한 연구

성주호 ( Joo Ho Sung ) 보험연구원 2010 보험금융연구 Vol.21 No.2

본 연구는 사망률의 변화 추세에 따른 사망리스크와 장수리스크에 대해 살펴보고, 이미 여러 연구를 통하여 검증된 Lee-Carter 모형을 이용하여 일반사망률과 연금사망률에 대해 사망률의 변화 추세를 반영함으로써 현행 예정사망률에 의한 상품 설계 속에 내재된 잠재적 손익을 계리적 산출 모형을 통하여 제시하고자 하였다. 본 연구의 결과, 본 연구에서 생사차손익을 0으로 만들기 위한 사망보장급부와 생존보장급부의 비율은 한 가지 상품 내에서 약"52.74792 : 1"이며, 만약 거치기간이 다르다면 그 비율도 달라진다. 그리고 두 가지 상품으로 사망보장급부와 생존보장급부를 각각 설정한 경우의 급부 비율은 약"10.59732 : 1"이다. 이러한 상품운용관리는 보험사업자 스스로 적용할 수 있는 내부헤징전략(internal hedging strategies)으로서, 보험사업자는 사망률의 개선을 반영하여 운용해야할 뿐만 아니라 더 나아가 미래 시장환경을 예측하여 적절한 예정이자율을 설정 함으로써 완전한 헤징이 이루어지도록 해야 할 것이다. The demand for a whole life annuity in pursuit of planning for one`s retirement has been gradually increasing in Korea, and this is rooted in the prolongation of average lifespan. However, this trend is not reflected in the assumed mortality, which is used when designing insurance products. In this study, we first examined mortality, survival, and longevity risks based on the mortality rate changes. Subsequently, we suggested the actuarial gain and loss inherent to a product design through an actuarial model by considering the rate changes both in ordinary mortality rate and annuity mortality rate based on the Lee-Carter model. In the case where both mortality coverage and survival coverage are included in one product, we proposed a mechanism to hedge the aggregate survival-mortality gain and loss adjusted through the mortality coverage benefit to survival coverage benefit ratio in a given period. Furthermore, we suggested a measure to achieve gain and loss management goals of insurance providers by establishing different mortality coverage benefit to survival coverage benefit ratio in order to offset the aggregate survivalmortality gain and loss variable in accordance with the mortality coverage period through our model discussed above. Finally, we emphasized the importance of establishing the assumed interest rate by presenting the aggregate gain and loss estimates as a result of effective interest rate following product management under the assumption that prospective improvement in the mortality rate is guaranteed. In conclusion, the mortality coverage benefit to survival coverage benefit ratio to make the aggregate survival-mortality gain and loss zero in this study was approximately "52.74792 to 1"in one product, and this ratio varied according to the term unredeemed. In addition, the ratio when two products exist was approximately "10.59732 to 1". Therefore, insurance providers must perform product management with the improvement in mortality rate through internal hedging strategies taken into account in order to lead a successful business. In addition, they must pursue complete hedging by predicting future market environment and establishing an appropriately assumed interest rate.

The Relationship Between Nocturia and Mortality: Data From the National Health and Nutrition Examination Survey

문신제,김윤정,정혜수,유재명,박일인,박성곤,박사현,권오성,이영구,조성태 대한배뇨장애요실금학회 2022 International Neurourology Journal Vol.26 No.2

Purpose: We investigated the relationship between nocturia and mortality risk in the United States. Methods: Data were obtained from the National Health and Nutrition Examination Survey 2005–2010. Mortality data were obtained by linking the primary database to death certificate data found in the National Death Index with mortality follow-up up to December 31, 2015. Nocturia was defined based on symptoms reported in the symptom questionnaire. We categorized patients into 2 groups: mild nocturia (2–3 voids/night) and moderate-to severe nocturia (≥4 voids/night). Multiple Cox regression analyses were performed with adjustment for confounding variables at the baseline survey. Results: This study included 9,892 adults (4,758 men, 5,134 women). Nocturia occurred in 3,314 individuals (33.5%). Nocturia was significantly associated with all-cause mortality (hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.10–1.39) and cardiovascular disease (CVD) mortality (HR, 1.55; 95% CI, 1.19–2.01). Moreover, the mortality risk increased with increasing nocturia severity. Further analysis with propensity score matching showed that nocturia was still significantly associated with all-cause mortality and CVD mortality. In subgroup analysis according to sex, nocturia was significantly associated with allcause mortality and CVD mortality in men. In women, moderate-to-severe nocturia was significantly associated with allcause mortality and CVD mortality. In subgroup analysis according to cardio-metabolic diseases, nocturia was associated with CVD mortality in patients with diabetes mellitus, hypertension, dyslipidemia, or CVD at baseline. In subgroup analysis of patients without diabetes mellitus, hypertension or CVD, nocturia was significantly associated with all-cause mortality. Conclusions: Nocturia was significantly associated with mortality in men and women after adjusting for major confounding factors.

성별에 따른 지역 간 자살률 차이 및 영향요인 분석

서은원 ( Eun Won Seo ),곽진미 ( Jin Mi Kwak ),김다양 ( Da Yang Kim ),이광수 ( Kwang Soo Lee ) 한국보건행정학회 2015 보건행정학회지 Vol.25 No.4

Background: Suicide is one of important health problems in Korea. Previous studies showed factors associated with suicide in individual levels. However, suicide was influenced by society that individuals belong to, so it was required to analyze suicide in local levels. The purpose of this study was to analyze the regional disparities of suicide mortality by gender and the association between local characteristics and suicide mortality. Methods: This study included 229 city·county·district administrative districts in Korea. Age- and sex-standardized suicide mortality and age-standardized suicide mortality (male/female) were used as dependent variables. City·county·district types, socio-demographics (number of divorces per 1,000 population, number of marriages per 1,000 population, and single households), financial variable (financial independence), welfare variable (welfare budget), and health behavior/status (perceived health status scores and EuroQol-5 dimension [EQ-5D]) were used to represent the local characteristics. We used hot-spot analysis to identify the spatial patterns of suicide mortality and negative binomial regression analysis to examine factors affecting suicide mortality. Results: There were differences in distribution of suicide mortality and hot-spot regions of suicide mortality by gender. Negative binomial regression analysis provided that city·county·district types (city), number of divorces per 1,000 population, financial independence, and EQ-5D had significant influences on the age- and sex-standardized suicide mortality per 100,000. Factor influencing suicide mortality was the number of divorces per 1,000 population in both male and female. Conclusion: Study results provided evidences that suicide mortality among regions was differed by gender. Health policy makers will need to consider gender and local characteristics when making policies for suicides.

Incidence and Mortality Trends in Critically Ill Children: A Korean Population-Based Study

Choi Jaeyoung,Park Esther,Choi Ah Young,Son Meong Hi,Cho Joongbum 대한의학회 2023 Journal of Korean medical science Vol.38 No.23

Background: Monitoring mortality trends can help design ways to improve survival, but observation of national mortality trends in critically ill children is lacking for the Korean population Methods: We analyzed the incidence and mortality trends of children younger than 18 years admitted to an intensive care unit (ICU) from 2012 to 2018 using the Korean National Health Insurance database. Neonates and neonatal ICU admissions were excluded. Multivariable logistic regression analyses were performed to estimate the odds ratio of in-hospital mortality according to admission year. Trends in incidence and in-hospital mortality of subgroups according to admission department, age, presence of intensivists, admissions to pediatric ICU, mechanical ventilation, and use of vasopressors were evaluated. Results: The overall mortality of critically ill children was 4.4%. There was a significant decrease in mortality from 5.5% in 2012 to 4.1% in 2018 (P for trend < 0.001). The incidence of ICU admission in children remained around 8.5/10,000 population years (P for trend = 0.069). In-hospital mortality decreased by 9.2% yearly in adjusted analysis (P < 0.001). The presence of dedicated intensivists (P for trend < 0.001, mortality decrease from 5.7% to 4.0%) and admission to pediatric ICU (P for trend < 0.001, mortality decrease from 5.0% to 3.2%) were associated with significant decreasing trends in mortality. Conclusion: Mortality among critically ill children improved during the study period, and the improving trend was prominent in children with high treatment requirements. Varying mortality trends, according to ICU organizations, highlight that advances in medical knowledge should be supported structurally.