1.Healthcare Costs of Osteoporotic Fracture in Korea: Information from the National Health Insurance Claims Database, 2008-2011.
Ha Young KIM ; Yong Chan HA ; Tae Young KIM ; Hyemin CHO ; Young Kyun LEE ; Ji Yeon BAEK ; Sunmee JANG
Journal of Bone Metabolism 2017;24(2):125-133
BACKGROUND: The present study estimated healthcare costs of osteoporotic fractures including spine, hip, distal radius and humerus in Koreans over 50 years of age using national claims data. METHODS: Korea National Health Insurance data between 2008 and 2011 was searched for all claims records of outpatient visits or hospital admissions of patients ≥50-year-of-age. Osteoporosis-related fractures were identified using certain the International Classification of Diseases, Tenth Revision codes and site-specific physician claims for procedures in a patient age cut-off value of 50 years. The healthcare costs included acute phase costs accounting for emergency medical care given immediately after fracture, costs due to further hospitalization and surgical procedures, physiotherapy sessions according to the site of the fracture, and outpatient visits in the year after discharge. RESULTS: The total estimated healthcare costs of osteoporotic fractures in 2011 was $722 million. From 2008 to 2011, the total number and healthcare costs of osteoporotic fractures increased 28.9% (from 127,070 to 163,823) and 31.6% (from $549 million to $722 million), respectively. The portion of national health care expenditure was ranged from 2.3% in 2008 to 2.2% in 2011. The mean healthcare cost of osteoporotic fractures per person increased 2.1% from $4,321 in 2008 to $4,410 in 2011.The mean healthcare costs were highest for hip fractures followed by spine, humerus, and distal radius fractures. CONCLUSIONS: Total Healthcare costs of osteoporotic fractures in South Koreans ≥50-year-of-age increased between 2008 and 2011. This trend will likely continue, which is an important health problem in the elderly population and economically.
Aged
;
Delivery of Health Care*
;
Emergencies
;
Health Care Costs*
;
Health Expenditures
;
Hip
;
Hip Fractures
;
Hospitalization
;
Humans
;
Humerus
;
International Classification of Diseases
;
Korea*
;
National Health Programs*
;
Osteoporotic Fractures*
;
Outpatients
;
Radius
;
Radius Fractures
;
Spine
2.Effects of Systemic Glucocorticoid Use on Fracture Risk: A Population-Based Study
Ji Weon KOH ; Junkang KIM ; Hyemin CHO ; Yong-Chan HA ; Tae-Young KIM ; Young-Kyun LEE ; Ha Young KIM ; Sunmee JANG
Endocrinology and Metabolism 2020;35(3):562-570
Background:
Long-term glucocorticoid use increases fracture risk by reducing bone mass. This study evaluated the relationship between hip and vertebral fractures and the total amount of systematic glucocorticoid use.
Methods:
We randomly selected 1,896,159 people aged 20 to 100 years who participated in the National Health Checkup program in 2006. The amount of glucocorticoids prescribed was calculated based on the defined daily dose (DDD). The total DDD was obtained by adding oral and parenteral glucocorticoids for 6 months from the index date. Subjects were categorized into four groups according to total glucocorticoid DDDs: non-users (DDDs=0), low users (0< DDDs ≤45), intermediate users (45< DDDs ≤90), and high users (90< DDDs). We followed them for 2 years. A multivariate Cox proportional hazard model was used to evaluate the effects of the total amount of glucocorticoid use on hip and vertebral fractures.
Results:
Higher glucocorticoid use was associated with a higher risk of vertebral fracture. Relative to non-users, the vertebral fracture risk was 1.39 times higher in the low-user group, 1.94 times higher in the intermediate-user group, and 2.43 times higher in the highuser group. The risk of hip fracture was 1.72 times higher in intermediate users and 3.28 times higher in high users than in non-users.
Conclusion
As the amount of glucocorticoid use for 6 months increased, the risk of hip and vertebral fractures became higher. In order to prevent fractures, it is necessary for doctors to evaluate the total amount of glucocorticoid prescribed to the patient and to provide appropriate treatment.
3.Osteoporotic Fracture Risk Assessment Using Bone Mineral Density in Korean: A Community-based Cohort Study.
Eun Jin JANG ; Young Kyun LEE ; Hyung Jin CHOI ; Yong Chan HA ; Sunmee JANG ; Chan Soo SHIN ; Nam Han CHO
Journal of Bone Metabolism 2016;23(1):34-39
BACKGROUND: Fracture-risk assessment tool (FRAX) using just clinical risk factors of osteoporosis has been developed to estimate individual risk of osteoporotic fractures. We developed prediction model of fracture risk using bone mineral density (BMD) as well as clinical risk factors in Korean, and assessed the validity of the final model. METHODS: To develop and validate an osteoporotic FRAX, a total of 768 Korean men and women aged 50 to 90 years were followed for 7 years in a community-based cohort study. BMD as well as clinical risk factors for osteoporotic fracture including age, sex, body mass index, history of fragility fracture, family history of fracture, smoking status, alcohol intake, use of oral glucocorticoid, rheumatoid arthritis, and other causes of secondary osteoporosis were assessed biannually. RESULTS: During the follow-up period, 86 osteoporotic fractures identified (36 in men and 50 in women). The developed prediction models showed high discriminatory power and had goodness of fit. CONCLUSIONS: The developed a Korean specific prediction model for osteoporotic fractures can be easily used as a screening tool to identify individual with high risk of osteoporotic fracture. Further studies for validation are required to confirm the clinical feasibility in general Korean population.
Arthritis, Rheumatoid
;
Body Mass Index
;
Bone Density*
;
Cohort Studies*
;
Female
;
Follow-Up Studies
;
Humans
;
Korea
;
Male
;
Mass Screening
;
Osteoporosis
;
Osteoporotic Fractures*
;
Risk Assessment*
;
Risk Factors
;
Smoke
;
Smoking
4.Incidence and Mortality Following Hip Fracture in Korea.
Hyun Koo YOON ; Chanmi PARK ; Sunmee JANG ; Suhyun JANG ; Young Kyun LEE ; Yong Chan HA
Journal of Korean Medical Science 2011;26(8):1087-1092
The authors evaluated the incidence of hip fracture and subsequent mortality in Korea using nationwide data obtained from the Health Insurance Review and Assessment Service. This study was performed on patient population, aged 50-yr or older who underwent surgical procedures because of hip fracture (ICD10; S720, S721). All patients were followed using patient identification code to identify deaths. Crude hip fracture rates increased from 191.9/100,000 in 2005 to 207.0/100,000 in 2008 in women and from 94.8/100,000 in 2005 to 97.8/100,000 in 2008, in men respectively. Crude mortality within 12 months after hip fracture showed a similar trend (18.8% in 2005 and 17.8% in 2007). The mean of standardized mortality ratio of hip fracture was 6.1 at 3 months, 3.5 at 1 yr, and 2.3 at 2 yr post-fracture. The increasing incidence and the high mortality after hip fracture are likely to become serious public health problems and a public health program should begin to prevent hip fractures in Korea.
Aged
;
Aged, 80 and over
;
Female
;
Hip Fractures/*epidemiology/mortality
;
Humans
;
Incidence
;
Male
;
Middle Aged
;
Republic of Korea/epidemiology
5.Radiation Synovectomy by 166Holmium-Chitosan complex in Collagenase Induced Arthritis of the Knee in the Rabbit.
Jung Hwan SON ; On LIM ; Jae Do KIM ; Jae Ho JANG ; Ha Yong YEOM ; Sang Kyun BAE ; Hee Kyung JANG
The Journal of the Korean Orthopaedic Association 2000;35(2):313-318
PURPOSE: To evaluate the histological changes of the synovial membrane treated by 166Ho-Chitosan complex in collagenase induced arthritis of the knee in the rabbit. MATERIAL AND METHOD: Arthritis was induced in sixteen rabbits by intra-articular injection of 1mg collagenase II and then treated by intra-articular injection of 0.4mCi 166Ho-Chitosan complex 2weeks later. The radioisotope scan was checked in each rabbit for the distribution and extra-articular leakage of the 166Ho-Chitosan complex. The synovial tissues from the femorotibial joints were evaluated for serial histological changes 2, 4, 8, 12 weeks after the 166Ho-Chitosan complex injetion. RESULTS: Two weeks after 166Ho-Chitosan complex administration, inflammatory cells such as giant cells, lymphocytes, histiocyte, and fibroblasts appeared in the subsynovial stroma. The most synovial cells were necrotized. Four weeks after 166Ho-Chitosan complex administration, the inflammatory cells were decreased and many fibroblasts appeared on the subsynovial stroma. There was neovasculization in the synovial membrane 4 weeks after administration. The fibers of collagen were noticed in the synovial membrane and subsynovial stroma at 8 weeks. There was no synoviocyte in the synovium and the thickness of fibrosis was increased at 12weeks. There were fragmentation of the nucleoli of synoviocyte and endothelial cell on the transmission electron microscope (TEM) . CONCLUSION: This study suggests that the synovial membranes treated by 166Ho-Chitosan complex in the collagenase induced arthritis of the knee in the rabbit show early radiation damage and then subsequently develop the fibrosis, and no synovial cell regeneration was observed until 12 weeks.
Arthritis*
;
Collagen
;
Collagenases*
;
Endothelial Cells
;
Fibroblasts
;
Fibrosis
;
Giant Cells
;
Histiocytes
;
Injections, Intra-Articular
;
Joints
;
Knee*
;
Lymphocytes
;
Rabbits
;
Regeneration
;
Synovial Membrane
6.Physicians' Attitudes to Contemporary Issues on Osteoporosis Management in Korea.
Yong Chan HA ; Young Kyun LEE ; Yong Taik LIM ; Sun Mee JANG ; Chan Soo SHIN
Journal of Bone Metabolism 2014;21(2):143-149
BACKGROUND: In management of osteoporosis, several concerns here have been raised. The current issue included the utilization of dual energy X-ray absorptiometry (DXA) and fracture-risk assessment (FRAX), screening of vitamin D deficiency and secondary osteoporosis, and long-term use of bisphosphonate and calcium supplements. There was no study on physicians' attitude on these current issues in Korea. Therefore, we investigated the physicians' attitude on these issues by survey. METHODS: We administered a 30-item questionnaire to all members of Korean Society for Bone and Mineral Research by email survey form. One hundred participants answered the questionnaire. The questionnaire included the questions about the physicians' attitude to current issues and the barriers to osteoporosis treatment in Korea. RESULTS: Most physicians used bone densitometry devices (99%) and, central DXA was the most accessible device (95%). Eighty-eight percent were aware of FRAX(R), but among them, only 19.3% used it. The main reason for not using FRAX(R) was the lack of time in their proactive (76%). Screening for vitamin D status and secondary osteoporosis was performed by 59% and 52% of the respondents, respectively. The lack of awareness among patients and high costs of medication were perceived as the most important barriers to osteoporosis management in Korea. CONCLUSIONS: This study provides physicians' perspective to the current issue for diagnostic and treatment of osteoporosis in Korea. To further improve osteoporosis management, educational programs for patients and doctors, and the improvement of reimbursement system should be considered in Korea.
Absorptiometry, Photon
;
Calcium
;
Surveys and Questionnaires
;
Densitometry
;
Electronic Mail
;
Humans
;
Korea
;
Mass Screening
;
Osteoporosis*
;
Vitamin D
;
Vitamin D Deficiency
7.Use of Extracorporeal Membrane Oxygenation in a Fulminant Course of Amniotic Fluid Embolism Syndrome Immediately after Cesarean Delivery.
Jae Ha LEE ; Hang Jea JANG ; Jin Han PARK ; Yong Kyun KIM ; Ho Ki MIN ; Sun Young KIM ; Hyun kuk KIM
Korean Journal of Critical Care Medicine 2016;31(3):256-261
Amniotic fluid embolism is rare but is one of the most catastrophic complications in the peripartum period. This syndrome is caused by a maternal anaphylactic reaction to the introduction of fetal material into the pulmonary circulation. When amniotic fluid embolism is suspected, the immediate application of extracorporeal mechanical circulatory support such as veno-arterial extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass should be considered. Without the application of extracorporeal mechanical circulatory support, medical supportive care might not be sufficient to maintain cardiopulmonary stabilization in severe cases of amniotic fluid embolism. In this report, we present the case of a 36-year-old pregnant woman who developed an amniotic fluid embolism immediately after a cesarean section. Her catastrophic event started with the sudden onset of severe hypoxia, followed by circulatory collapse within 8 minutes. The veno-arterial mode of extracorporeal membrane oxygenation was initiated immediately. She was successfully resuscitated but with impaired cognitive function. Thus, urgent ECMO should be considered when amniotic fluid embolism syndrome is suspected in patients presenting acute cardiopulmonary collapse.
Adult
;
Amniotic Fluid*
;
Anaphylaxis
;
Anoxia
;
Cardiopulmonary Bypass
;
Cesarean Section
;
Cognition
;
Embolism, Amniotic Fluid*
;
Extracorporeal Membrane Oxygenation*
;
Female
;
Humans
;
Peripartum Period
;
Pregnancy
;
Pregnant Women
;
Pulmonary Circulation
;
Shock
8.Carcinosarcoma Arising from Mixed Tumor of the Parotid Gland: A case report.
Jae Soo KOH ; Chang Won HA ; Na Hye MYOUNG ; Kyung Ja CHO ; Kyung Kyun OH ; Mi Kyung KIM ; Ja June JANG
Korean Journal of Pathology 1992;26(5):530-532
A case of true malignant mixed tumor of the parotid gland is reported. The tumor, occuring in a 55-year-old man, started to grow rapidly after a long history of parotid mass. Total parotidectomy was carried out and the resected tumor measured 5x4x3 cm with a cut surface showing grayish-white solid and myxoid appearance. Microscopically, the tumor had both carcinomatous and sarcomatous elements, the former consisting of undifferentiated carcinoma with focal areas of ductal differentiation and the latter consisting of pleomorphic sarcoma with chondrosarcomatous differentiation. A remnant of benign pleomorphic adenoma could also be identified. Immunohistochemical study demonstrated focal cytokeratin reactivity in the carcinoma cells and vimentin in sarcomatous elements. It is assumed from these clinical and histological findings that the tumor had transformed from a pre-existing benign pleomorphic adenoma.
Adenoma
9.Trends of Incidence, Mortality, and Future Projection of Spinal Fractures in Korea Using Nationwide Claims Data.
Tae Young KIM ; Sunmee JANG ; Chan Mi PARK ; Ahreum LEE ; Young Kyun LEE ; Ha Young KIM ; Eun Hee CHO ; Yong Chan HA
Journal of Korean Medical Science 2016;31(5):801-805
Spinal fractures have been recognized as a major health concern. Our purposes were to evaluate the trends in the incidence and mortality of spinal fractures between 2008 and 2012 and predict the number of spinal fractures that will occur in Korea up to 2025, using nationwide data from the National Health Insurance Service (NHIS). A nationwide data set was evaluated to identify all new visits to medical institutes for spinal fractures in men and women aged 50 years or older between 2008 and 2012. The incidence, mortality rates and estimates of the number of spinal fractures were calculated using Poisson regression. The number of spinal fractures increased over the time span studied. Men and women experienced 14,808 and 55,164 vertebral fractures in 2008 and 22,739 and 79,903 in 2012, respectively. This reflects an increase in the incidence of spinal fractures for both genders (men, 245.3/100,000 in 2008 and 312.5/100,000 in 2012; women, 780.6/100,000 in 2008 and 953.4/100,000 in 2012). The cumulative mortality rate in the first year after spinal fractures decreased from 8.51% (5,955/69,972) in 2008 to 7.0% (7,187/102,642) in 2012. The overall standardized mortality ratio (SMR) of spinal fractures at 1 year post-fracture was higher in men (7.76, 95% CI: 7.63-7.89) than in women (4.70, 95% CI: 4.63-4.76). The total number of spinal fractures is expected to reach 157,706 in 2025. The incidence of spinal fractures increased in Korea in the last 5 years, and the socioeconomic burden of spinal fractures will continue to increase in the near future.
Aged
;
Aged, 80 and over
;
Databases, Factual
;
Female
;
Humans
;
Incidence
;
Insurance Claim Review
;
Male
;
Middle Aged
;
Republic of Korea
;
Retrospective Studies
;
Spinal Fractures/*epidemiology/mortality
;
Survival Rate
10.Incidence and Mortality after Distal Radius Fractures in Adults Aged 50 Years and Older in Korea.
Gi Doo KWON ; Sunmee JANG ; Ahreum LEE ; Chan Mi PARK ; Young Kyun LEE ; Tae Young KIM ; Ha Young KIM ; Eun Ji PARK ; Yong Chan HA
Journal of Korean Medical Science 2016;31(4):630-634
The purpose of this study was to assess the incidence and mortality of distal radius fracture among patients 50 years of age and older with diagnosis code (ICD10; S52.5, S52.6) and treatment code using a nationwide claims database from 2008 to 2012. All patients were followed using patient identification code to identify deaths. Standardized mortality ratios (SMRs) of distal radius fracture were calculated based on age and gender-specific rates in the entire Korean population. The number of distal radius fractures increased by 54.2% over the 5-year study (48,145 in 2008 and 74,240 in 2012). The incidence of distal radius fracture increased from 367.4/100,000 in 2008 to 474.1/100,000 in 2012. The cumulative mortality rate over the first 12 months after distal radius fracture was decreased from 2.0% (968/48,145) in 2008 to 1.4% (1,045/74,240) in 2012. The mean year mortality over 5 years in men (2.6%, 1,279/50,128) over the first 12 months was 1.7-times higher than in women (1.5%, 3,952/257,045). The mean of SMR of distal radius fracture at 1 year post-fracture was 1.45 in men and 1.17 in women. This study using a nationwide database demonstrates that the distal radius fractures are increasing with a decreasing mortality in Korea.
Aged
;
Aged, 80 and over
;
Databases, Factual
;
Female
;
Humans
;
Incidence
;
Male
;
Middle Aged
;
Radius Fractures/*diagnosis/epidemiology/mortality
;
Republic of Korea/epidemiology
;
Sex Distribution
;
Survival Analysis