OBJECTIVES: This study explored socioeconomic disparities in Korea using health insurance type as a proxy during the ongoing coronavirus disease 2019 (COVID-19) pandemic. METHODS: We conducted a retrospective cohort study using Korea’s nationwide healthcare database, which contained all individuals who received a diagnostic test for COVID-19 (n=232,390) as of May 15, 2020. We classified our cohort by health insurance type into beneficiaries of the National Health Insurance (NHI) or Medicaid programs. Our study outcomes were infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19-related outcomes, a composite of all-cause death, intensive care unit admission, and mechanical ventilation use. We estimated age-, sex-, and Charlson comorbidity index score–adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using a multivariable logistic regression analysis. RESULTS: Of the 218,070 NHI and 14,320 Medicaid beneficiaries who received COVID-19 tests, 7,777 and 738 tested positive, respectively. The Medicaid beneficiaries were older (mean age, 57.5 vs. 47.8 years), more likely to be males (47.2 vs. 40.2%), and had a higher comorbidity burden (mean CCI, 2.0 vs. 1.7) than NHI beneficiaries. Compared to NHI beneficiaries, Medicaid beneficiaries had a 22% increased risk of SARS-CoV-2 infection (aOR, 1.22; 95% CI, 1.09 to 1.38), but had no significantly elevated risk of COVID-19-related outcomes (aOR 1.10, 95% CI 0.77 to 1.57); the individual events of the composite outcome yielded similar findings. CONCLUSIONS As socioeconomic factors, with health insurance as a proxy, could serve as determinants during the current pandemic, pre-emptive support is needed for high-risk groups to slow its spread.

OBJECTIVES: This study explored socioeconomic disparities in Korea using health insurance type as a proxy during the ongoing coronavirus disease 2019 (COVID-19) pandemic. METHODS: We conducted a retrospective cohort study using Korea’s nationwide healthcare database, which contained all individuals who received a diagnostic test for COVID-19 (n=232,390) as of May 15, 2020. We classified our cohort by health insurance type into beneficiaries of the National Health Insurance (NHI) or Medicaid programs. Our study outcomes were infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19-related outcomes, a composite of all-cause death, intensive care unit admission, and mechanical ventilation use. We estimated age-, sex-, and Charlson comorbidity index score–adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using a multivariable logistic regression analysis. RESULTS: Of the 218,070 NHI and 14,320 Medicaid beneficiaries who received COVID-19 tests, 7,777 and 738 tested positive, respectively. The Medicaid beneficiaries were older (mean age, 57.5 vs. 47.8 years), more likely to be males (47.2 vs. 40.2%), and had a higher comorbidity burden (mean CCI, 2.0 vs. 1.7) than NHI beneficiaries. Compared to NHI beneficiaries, Medicaid beneficiaries had a 22% increased risk of SARS-CoV-2 infection (aOR, 1.22; 95% CI, 1.09 to 1.38), but had no significantly elevated risk of COVID-19-related outcomes (aOR 1.10, 95% CI 0.77 to 1.57); the individual events of the composite outcome yielded similar findings. CONCLUSIONS As socioeconomic factors, with health insurance as a proxy, could serve as determinants during the current pandemic, pre-emptive support is needed for high-risk groups to slow its spread.

BACKGROUND AND OBJECTIVES: With the currently available diagnostic procedure, hearing impaired children are diagnosed at an early age and hearing aids are fitted soon thereafter. Thus, appropriateness of using available correction methods for adult ears and ear models for determining and predicting hearing aid characteristics for these children need to be examined. The objectives of this study are to create a database of resonance frequency and length of external auditory canal (EAC) in all age groups and to adjust the peak frequency response of hearing aid system to take account of the changing resonance peak frequency as child gets older. MATERIALS AND METHOD: We studied 437 ears with no age limitation. We measured rear ear unaided response (REUR) with Rastronics frequency response analyzer and external ear canal length using silastic tube under microscopic or otoscopic finding. Statistical analyses were performed to determine age differences. RESULTS: Ear canal length increased with age, and an adult value was achieved by the age of 14 years. Resonance frequency decreased with age, and reached to an adult value by the age of 9 years. There was significant relationship between ear canal length and resonance frequency. CONCLUSION: Alteration in resonance frequency with age may have practical implications by affecting the insertion gain of hearing aid system in children. The data may be used as useful adjustment factors to correct the current hearing aid system in children.
Adult ; Child ; Ear ; Ear Canal* ; Hearing ; Hearing Aids ; Humans

BACKGROUND AND OBJECTIVES: Although it is widely accepted that nasal obstruction leads to snoring and sleep apnea, the relationship between these variable factors is not clear. Moreover, while nasal blockage in human is known to produce sleep- disordered breathing, it is controversial whether nasal obstruction itself produces obstructive apnea and whether it causes changes in the sleep stages. The purpose of this study is to measure changes in sleep physiology by nasal blockage alone and to evaluate whether the nasal blockage itself ca>i produce the sleep apnea syndrorm or not. MATERIAL AND METHOD: Normal thirty subjects, 15 males and 15 females, who had sleep apnea episodes <2 by polysomnography during sleep, were evaluated using Alice III polysomnography after both nostrils opened, unilateral nostril blockage, and bilateral nostril blockage. The parameters of measurement were hypopnea and apnea episodes and apnea type, apnea index (AI), respiratory disturbance index (RDI), SO and sleep stages. A statistical analysis was performed using a wicoxon signed rank test. RESULTS: Bilateral nasal blockage induces significantly increased apnea and hypopnea episodes, AI, and RDI but induces significantly decreased mean and lowest O. saturation. Also, bilateral nasal blockage significantly prolonged S,-NREM sleep and decreased REM sleep (p(0.05). However, these changes did not correspond with the criteria of the sleep apnea syndrome. CONCLUSION: Unilateral nasal obstruction does not cause any significant changes in the measured parameters compared to the normal nose of unblocked state. Bilateral nasal obstruction does not induce the obstructive sleep apnea syndrome by itself. However, it causes changes in the sleep stages and increases sleep apnea episodes significantly.
Apnea ; Female ; Humans ; Male ; Nasal Obstruction* ; Nose ; Physiology ; Polysomnography ; Respiration ; Sleep Apnea Syndromes* ; Sleep Apnea, Obstructive ; Sleep Stages ; Sleep, REM ; Snoring

This study sought to describe and to evaluate the characteristics of the Health Screening Records Database (HSRD) of the Korea Association of Health Promotion as a data source for epidemiologic studies. The HSRD was compared to a National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) database for 2015. Common variables between the databases were selected, and sex-based analyses were conducted. The HSRD showed statistical concordance when NHIS-HEALS estimates fell within the HSRD estimate's 95% confidence interval. The HSRD and NHIS-HEALS included 946461 and 111690 participants in health screening programs, respectively. Compared to the NHIS-HEALS, the HSRD had more female (55.2% vs. 42.6%) but fewer older adult participants (34.4% vs. 51.2%). Virtually all variables had clinical concordance, with some having statistical concordance as well, among both general and life-transition program participants. The HSRD comprised more clinical information over a wider age range in contrast to the NHIS-HEALS, while showing clinical concordance. Providing more comprehensive clinical data, the HSRD may serve as an alternative resource for epidemiologic studies.
Adult ; Cohort Studies ; Epidemiologic Studies ; Female ; Health Promotion ; Humans ; Information Storage and Retrieval ; Korea ; Mass Screening ; National Health Programs ; Observational Study ; Physical Examination

Background: In South Korea, women aged 66 years are eligible for complimentary bone mineral density (BMD) screening via the National Screening Program for Transitional Ages. We aimed to evaluate the 10-year fracture risk in women receiving BMD screening between January 2008 and December 2015. Methods: BMD was classified as normal (T-score ≥–1.0 standard deviation [SD]), osteopenia (T-score <–1.0 SD and >–2.5 SD), and osteoporosis (T score ≤–2.5 SD) from dual-energy X-ray absorptiometry. Follow-up continued from the screening date until a diagnosis for clinical fragility fracture (including sites of the vertebrae, hip, pelvis, clavicle, humerus, forearm, wrist, lower leg, and ankle), censored at the earliest date of trauma, death, or December 2017; fracture was ascertained using diagnostic codes from the National Health Insurance Service database. A multivariable Cox proportional hazard model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of fracture in women with osteopenia or osteoporosis relative to women with normal BMD. Results: Among the 271,197 women screened, 44.0% had osteopenia and 35.2% had osteoporosis. The 10 year cumulative incidence of fragility fractures was 31.1%, 37.5%, and 44.3% in women with normal BMD, osteopenia, and osteoporosis, respectively. Fracture risk was higher in women with osteopenia (HR, 1.31; 95% CI, 1.28 to 1.34) and osteoporosis (HR, 1.68; 95% CI, 1.64 to 1.72) than in women with normal BMD. Conclusion Women with osteopenia and women with osteoporosis, identified by the national BMD screening program, demonstrated a substantially elevated risk of fracture.

BACKGROUND AND OBJECTIVES: A history of poor weight gain can often be elicited in young children with chronic upper airway obstruction resulting from adenotonsillar hypertrophy. The purpose of this study was to determine the incidence of growth disturbance and what effect, if any tonsillectomy and/or adenoidectomy has on subsequent growth in a group of children. MATERIALS AND METHODS: The subjects consisted of 78 patients with adenotonsillar hypertrophy who had been treated between March 1997 and September 1997 at the department of otolaryngology, Saint Benedict Hospital. Available preoperative data were collected including sex, age at surgery, tonsillar hypertrophy grade, presence of snoring and sleep apnea, preoperative weight, preoperative eating disorder, and URI frequency. RESULT: Many had improvements in growth after adenotonsil-lectomy. The improvement in growth appears to be obvious in chidren with eating disorder, snoring, and sleep apnea resulting from adenotonsillar hypertrophy. CONCLUSION: We can conclude that there exists a relationship beween adenotonsillar hypertrophy children and preoperative eating disorder, growth delay and snoring.
Adenoidectomy ; Airway Obstruction ; Child* ; Feeding and Eating Disorders ; Humans ; Hypertrophy ; Incidence ; Otolaryngology ; Saints ; Sleep Apnea Syndromes ; Snoring ; Tonsillectomy ; Weight Gain

Purpose: Following the withdrawal of propacetamol in Europe owing to safety issues, the regulatory authority of South Korea requested a post-marketing surveillance study to investigate its safety profile. Materials and Methods: We conducted nested case-control and case-time-control (CTC) analyses of cases and controls identified for outcomes of interest, including anaphylaxis, thrombosis, and Stevens–Johnson syndrome (SJS), using the claims database of South Korea, 2010–2019. Risk-set sampling was used to match each case with up to 10 controls for age, sex, cohort entry date, and follow-up duration. Exposure to anaphylaxis, thrombosis, and SJS was assessed within 7, 90, and 30 days of the index date, respectively. We calculated odds ratios (OR) with 95% confidence intervals (CIs) using conditional logistic regression to assess the risk of outcomes associated with propacetamol. Results: We identified cases of anaphylaxis (n=61), thrombosis (n=95), and SJS (n=1) and matched them to controls (173, 268, and 4, respectively). In the nested case-control analysis, the ORs for anaphylaxis and SJS were inestimable given the small number of propacetamol users during the risk period; meanwhile, the OR for thrombosis was 1.60 (95% CI 0.71–3.62). In the CTC design, the effect estimate was only estimated for thrombosis (OR 0.56, 95% CI 0.09–3.47). Conclusion In both nested case-control and CTC analyses, propacetamol was not associated with an increased risk of anaphylaxis, thrombosis, or SJS. The findings from this study, which used routinely collected clinical data, provide reassuring real-world evidence regarding the safety of propacetamol in a nationwide population to support regulatory decision-making.