Background: As the prevalence of hypertension is increasing in Korea, the government is seeking policy actions to manage patients with hypertension more efficiently. In this paper, we aimed to identify factors associated with the use of medical care at hospitals among outpatients with hypertension. Methods: We analyzed a total of 15,040 cases of 3,877 outpatients with hypertension obtained from the Korea Medical Panel database from 2010 to 2016. The dependent variable was whether a patient with hypertension visited a hospital or not; and independent variables were the patient’s various socio-demographic, health-related, and heath-status characteristics. We conducted a generalized linear mixed model analysis with logit link for all the cases and then conducted it stratified by gender. Results: As a result of a multivariable analysis, women were less likely than to visit at a hospital (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.32–0.61) and people aged 65 years and older than those aged less than 65 years (OR, 0.71; 95% CI, 0.57– 0.89). Residents in Busan, Ulsan, and Gyeongnam were more likely than those in than Seoul, Gyeonggi, Incheon, and Jeju to visit a hospital (OR, 1.40; 95% CI, 1.05–1.86). The likelihood of visiting a hospital was high in people belonging to a group of: the highest level of annual household income (OR, 1.73; 95% CI, 1.30–2.29); Medical care aid recipients (OR, 1.94; 95% CI, 1.34–2.83); people having three or more complex chronic diseases (OR, 1.59; 95% CI, 1.19–2.11); people having diabetes (OR, 1.81; 95% CI, 1.41–2.32);or people having ischemic heart disease or cerebrovascular disease (OR, 6.80; 95% CI, 5.28–8.76). Also, we found that factors associated with the use of medical care at hospitals among outpatients with hypertension differed between genders. Conclusion A variety of factors seem to be associated with the use of medical care at hospitals among outpatients with hypertension.Future research needs to find a way to help patients with hypertension visit an appropriate medical institution between clinics and hospitals.

Background: There have been many studies on the associations between body mass index (BMI) and cognitive function. However, no study has ever compared the associations across the methods of categorizing BMI. In this study, we aimed to fill the gap in the previous studies and examine whether the obesity paradox is valid in the risk of cognitive function. Methods: Of the 10,254 people aged 45 and older from the Korean Longitudinal Study of Ageing from 2006 to 2016, 8,970 people were finalized as the study population. The dependent variable was whether a person has a normal cognitive function or not, and the independent variables of interest were BMI categorized by the World Health Organization Western Pacific Regional Office (WHO-WPRO) method, the WHO method, and a 10-group method. Covariates included sociodemographic factors, health behavior factors, and health status factors. A generalized linear mixed model analysis with a logit link was used. Results: In the adjusted model with all covariates, first, in the case of BMI categories of the WHO-WPRO method, underweight (odds ratio [OR], 1.16; 95% confidence interval [CI], 1.15–1.17), overweight (OR, 1.36; 95% CI, 1.35–1.36), and obese (OR, 1.34; 95% CI, 1.33–1.34) groups were more likely to have a normal cognitive function than a normal-weight group. Next, in the case of BMI categories of the WHO method, compared to a normal-weight group, underweight (OR, 1.15; 95% CI, 1.14–1.16) and overweight (OR, 1.06; 95% CI, 1.06–1.07) groups were more likely to have a normal cognitive function; however, obese (OR, 0.62; 95% CI, 0.61–0.63) group was less likely to have it. Lastly, in the case of the 10-group method, as BMI increased, the likelihood to have a normal cognitive function changed like a wave, reaching a global top at group-7 (26.5 kg/㎡ ≤ BMI <28.0 kg/㎡ ). Conclusion The associations between BMI and cognitive function differed according to how BMI was categorized among people aged 45 and older in Korea, which suggests that cognitive function may be positively associated with BMI in some categories of BMI but negatively in its other categories. Health policies to reduce cognitive impairment need to consider this association between BMI and cognitive function.

Electronic cigarettes (e-cigarrettes) were recently introduced and advertised as a smoking cession device in South Korea. As the social norm to quit smoking has gained hold in the country, the number of e-cigarette users is growing rapidly. This phenomenon should be urgently considered, because of the lack of research that has been conducted to examine the safety of e-cigarettes and its efficacy as a smoking cessation aid. This paper raises several public health concerns on e-cigarettes in South Korea. Uncertain regulations of the government on e-cigarettes are contributing to an increase of e-cigarette users and allowing the e-cigarette industry to circumvent existing regulations. The aggressive marketing activity of this industry is also a core factor that is responsible for the rapid increase of e-cigarette use, in particular among the youth. Following the enforcement of tobacco control, some cigarette smokers may be encouraged to purchase e-cigarettes in order to circumvent the regulations, even though the dual use of e-cigarette and cigarette may be more harmful. Until there is clear evidence of the e-cigarette's safety, it is recommended that the industry's marketing and promotional activities be banned and closely monitored, and public campaigns be initiated to educate the public regarding e-cigarettes.
Adult ; *Electronics ; Female ; *Government Regulation ; Health Promotion ; Humans ; Male ; Middle Aged ; *Nicotine ; Prevalence ; *Public Health Practice ; Republic of Korea/epidemiology ; Safety ; Smoking/epidemiology/legislation & jurisprudence/*prevention & control ; Smoking Cessation/*legislation & jurisprudence ; Young Adult

Although the Korean government introduced a tobacco tax increase in 2015 and pictorial health warnings on tobacco packages in 2016, the smoking prevalence among Korean adult men has remained steady. More efforts and effective tobacco control policies are needed to tackle the highest smoking prevalence among the member countries of the Organization for Economic Cooperation and Development. Plain or standardized packaging of tobacco products has been evaluated as an effective tobacco control policy after its introduction in Australia in 2012. The purpose of this study was to raise awareness of the need to introduce plain packaging of tobacco products in Korea. This study presents information on the following topics: what plain packaging of tobacco products is; the purposes of this policy; the reasons why we need to implement this policy in Korea; the scientific evidence regarding the effects of plain packaging of tobacco products; international developments in the plain packaging of tobacco products; and what we need to consider in order to prepare for the implementation of this policy in Korea. We propose that introducing plain packaging of tobacco products would be beneficial for reinforcing tobacco control policies in Korea and would simultaneously contribute to implementing articles 11 and 13 of the Framework Convention on Tobacco Control. Further studies must be carried out to develop a plain or standardized packaging design of tobacco products in Korea and to prevent the tobacco industry from interrupting the introduction of this policy in Korea, based on other countries' experience.
Adult ; Australia ; Humans ; Korea ; Male ; Organisation for Economic Co-Operation and Development ; Prevalence ; Product Packaging ; Smoke ; Smoking ; Taxes ; Tobacco Industry ; Tobacco Products ; Tobacco

Although the Korean government introduced a tobacco tax increase in 2015 and pictorial health warnings on tobacco packages in 2016, the smoking prevalence among Korean adult men has remained steady. More efforts and effective tobacco control policies are needed to tackle the highest smoking prevalence among the member countries of the Organization for Economic Cooperation and Development. Plain or standardized packaging of tobacco products has been evaluated as an effective tobacco control policy after its introduction in Australia in 2012. The purpose of this study was to raise awareness of the need to introduce plain packaging of tobacco products in Korea. This study presents information on the following topics: what plain packaging of tobacco products is; the purposes of this policy; the reasons why we need to implement this policy in Korea; the scientific evidence regarding the effects of plain packaging of tobacco products; international developments in the plain packaging of tobacco products; and what we need to consider in order to prepare for the implementation of this policy in Korea. We propose that introducing plain packaging of tobacco products would be beneficial for reinforcing tobacco control policies in Korea and would simultaneously contribute to implementing articles 11 and 13 of the Framework Convention on Tobacco Control. Further studies must be carried out to develop a plain or standardized packaging design of tobacco products in Korea and to prevent the tobacco industry from interrupting the introduction of this policy in Korea, based on other countries' experience.

Background: Cardiovascular risk is a modifiable factor that can help prevent dementia.Given the dearth of optimal treatment options, managing dementia risk factors is crucial. We examined the association between cardiovascular risk, as measured by the Korean coronary heart disease risk score (KRS), and cognitive function in dementia-free elderly individuals. Methods: We enrolled 8,600 individuals (average age: 69.74 years; 5,206 women) who underwent a medical evaluation from the National Health Insurance Service. KRS was calculated using age, sex, blood pressure, lipid profile, diabetes, and smoking status. Cognitive function was evaluated using Korean Dementia Screening QuestionnaireCognition (KDSQ-C). Scores of ≥ 6 indicated a cognitive decline. Logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI). Weight, height, stroke history, coronary heart disease history, alcohol consumption, and physical activity engagement were adjusted. Results: The lowest, middle, and highest groups, according to the KRS, were 5,923 (68.9%), 2,343 (27.2%), and 334 (3.9%), respectively. The highest KRS group in all participants exhibited a greater risk of cognitive decline than the lowest KRS group (OR, 1.339; 95% CI, 1.034–1.734; P = 0.027). The highest KRS female group aged 71–75 years old exhibited greater cognitive decline than the corresponding lowest KRS group (OR, 1.595; 95% CI, 1.045–2.434; P = 0.031). Conclusion Individuals with high cardiovascular risk were associated with poorer cognitive function than those with low risk, especially older women. Cardiovascular risk factors should be carefully managed to promote healthy mental aging in dementia-free elderly individuals.

OBJECTIVES: Abdominal obesity increases mortality and morbidity from cardiovascular disease and there is a possibility that smoking effects obesity. However, previous studies concerning the effects of smoking on obesity are inconsistent. The objective of this study was to examine whether smoking is positively related to abdominal obesity in men with type 2 diabetes. METHODS: Subjects consisted of 2197 type 2 diabetic patients who visited Huh's Diabetes Center from 2003 to 2009. Indices of abdominal obesity were defined as visceral fat thickness (VFT) measured by ultrasonography and waist circumference (WC). Overall obesity was defined as body mass index (BMI). RESULTS: Statistically significant differences in WC and VFT by smoking status were identified. However, there was no statistical difference in BMI according to smoking status. Means of WC and VFT were not significantly higher in heavy smokers and lower in mild smokers. Compared to nonsmokers, the BMI confounder adjusted odds ratio and 95% confidence interval for VFT in ex-smokers and current-smokers were 1.70 (1.21 to 2.39) and 1.86 (1.27 to 2.73), respectively. CONCLUSIONS: Smoking status was positively associated with abdominal obesity in type 2 diabetic patients.
Abdominal Fat/*metabolism ; Adult ; Aged ; Aged, 80 and over ; Body Mass Index ; Diabetes Mellitus, Type 2/*complications ; Humans ; Male ; Middle Aged ; Obesity/*etiology ; Smoking/*adverse effects ; Waist Circumference

PURPOSE: The goal of this study is to assess the interactions among alcohol consumption, cigarette smoking, and aspartate aminotransferase (AST) / alanine aminotransferase (ALT) ratios on esophageal cancer. MATERIALS AND METHODS: Alcohol and the risk of incidence and death from esophageal cancer were examined in a 14-year prospective cohort study of 782,632 Korean men, 30 to 93 years of age, who received health insurance from the National Health Insurance Corporation and had a medical evaluation from 1992 to 1995. RESULTS: Smoking, alcohol intake, and AST/ALT ratios were associated with the increased risk of esophageal cancer in a dose-dependent manner independent of each other. Smoking was associated with an increased risk of incidence [Hazard ratio (HR) = 2.2, 95% CI = 1.8 to 2.5] and mortality (HR = 2.5, 2.0 to 3.1). Combined HR of incidence for alcohol consumption (> 25 g/day) and smoking was 4.5 (3.8-5.5); for alcohol (> 25 g/day) and the AST/ALT ratio (> or = 2.0), it was 5.8 (4.6-7.2); for smoking and the AST/ALT ratio (> or = 2.0), it was 6.3 (5.1-7.5). Similar results were seen for mortality from esophageal cancer. Subjects who drank > or = 25 g/day with an AST/ALT ratio > or = 2 had a higher risk of esophageal cancer incidence (HR = 6.5, 4.8 to 8.7) compared with those who drank > or = 25 g/day with an AST/ALT ratio < 2 (HR = 2.2, 1.9 to 2.6). CONCLUSION: Alcohol, smoking, and the AST/ALT ratio are independently associated with increased risk of esophageal cancer but did not interact synergistically. The combination of the AST/ALT ratio with a questionnaire for alcohol consumption may increase the effectiveness for determining the risk of esophageal cancer.
Adult ; Aged ; Aged, 80 and over ; Alanine Transaminase/*blood ; Alcohol Drinking/*adverse effects ; Asian Continental Ancestry Group ; Aspartate Aminotransferases/*blood ; Esophageal Neoplasms/*enzymology/*epidemiology/etiology ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Risk Factors ; Smoking/*adverse effects

PURPOSE: The goal of this study is to assess the interactions among alcohol consumption, cigarette smoking, and aspartate aminotransferase (AST) / alanine aminotransferase (ALT) ratios on esophageal cancer. MATERIALS AND METHODS: Alcohol and the risk of incidence and death from esophageal cancer were examined in a 14-year prospective cohort study of 782,632 Korean men, 30 to 93 years of age, who received health insurance from the National Health Insurance Corporation and had a medical evaluation from 1992 to 1995. RESULTS: Smoking, alcohol intake, and AST/ALT ratios were associated with the increased risk of esophageal cancer in a dose-dependent manner independent of each other. Smoking was associated with an increased risk of incidence [Hazard ratio (HR) = 2.2, 95% CI = 1.8 to 2.5] and mortality (HR = 2.5, 2.0 to 3.1). Combined HR of incidence for alcohol consumption (> 25 g/day) and smoking was 4.5 (3.8-5.5); for alcohol (> 25 g/day) and the AST/ALT ratio (> or = 2.0), it was 5.8 (4.6-7.2); for smoking and the AST/ALT ratio (> or = 2.0), it was 6.3 (5.1-7.5). Similar results were seen for mortality from esophageal cancer. Subjects who drank > or = 25 g/day with an AST/ALT ratio > or = 2 had a higher risk of esophageal cancer incidence (HR = 6.5, 4.8 to 8.7) compared with those who drank > or = 25 g/day with an AST/ALT ratio < 2 (HR = 2.2, 1.9 to 2.6). CONCLUSION: Alcohol, smoking, and the AST/ALT ratio are independently associated with increased risk of esophageal cancer but did not interact synergistically. The combination of the AST/ALT ratio with a questionnaire for alcohol consumption may increase the effectiveness for determining the risk of esophageal cancer.
Adult ; Aged ; Aged, 80 and over ; Alanine Transaminase/*blood ; Alcohol Drinking/*adverse effects ; Asian Continental Ancestry Group ; Aspartate Aminotransferases/*blood ; Esophageal Neoplasms/*enzymology/*epidemiology/etiology ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Risk Factors ; Smoking/*adverse effects

BACKGROUND AND OBJECTIVES: Medical insurance claims (MIC) data are one of the largest sources of outcome data in the form of International Classification of Diseases (ICD) codes. We evaluated the validity of the ICD codes from the Korean National MIC data with respect to the outcomes from acute myocardial infarction (AMI) in the Korean Heart Study. SUBJECTS AND METHODS: Baseline information was obtained from health examinations conducted from 1994 to 2001. Outcome information regarding the incidence of AMI came from hospital admission discharge records from 1994 to 2007. Structured questionnaires were sent to 98 hospitals. In total, 107 cases of AMI with ICD codes of I21- (93 men, 26-73 years of age) were included in the final analyses. ICD code accuracy and reliability (kappa) for AMI were calculated. RESULTS: A large number of AMI cases were from hospitals located in the Seoul area (75.9%). The accuracy of AMI was 71.4%, according to World Health Organization criteria (1997-2000, n=24, kappa=0.46) and 73.1% according to the European Society of Cardiology/American College of Cardiology (ESC/ACC) criteria (2001-2007, n=83, kappa=0.74). An age of 50 years or older was the only factor related to inaccuracy of codes for AMI (odds ratio, 4.6; 95% confidence interval, 1.2-17.7) in patients diagnosed since January 2001 using ESC/ACC criteria (n=83). CONCLUSION: The accuracy for diagnosing AMI using the ICD-10 codes in Korean MIC data was >70%, and reliability was fair to good; however, more attention is required for recoding ICD codes in older patients.
Cardiology ; Heart ; Humans ; Incidence ; Insurance ; Insurance, Health ; International Classification of Diseases ; Male ; Myocardial Infarction ; Porphyrins ; World Health Organization ; Surveys and Questionnaires