OBJECTIVES: The present study was conducted in order to examine the association between socioeconomic status (SES) and osteoporosis prevalence in Korea and to assess whether different associations are found in single-person households. METHODS: A cross-sectional population-based study was conducted using the Korea National Health and Nutrition Examination Survey, from 2008 to 2011. The study subjects were people aged > or = 50 years with osteoporosis as defined by bone mineral density. Multivariate logistic models were used to estimate prevalence odds ratios (pORs) and 95% confidence intervals (CIs). Gender differences in the likelihood of osteoporosis were analyzed based on household income, education level, and residential area. RESULTS: There were 8221 osteoporosis patients aged > or = 50 years, of whom 927 lived in single-person households. There was a gender-specific association between osteoporosis prevalence and all three SES factors that we analyzed: income, education, and residential area. After adjusting for age, SES, and health behaviors, including body mass index (BMI), low household income was only significantly associated with osteoporosis in men, whereas education level had an inverse relationship with osteoporosis only in women (p=0.01, p<0.001, respectively). However, after controlling for age and BMI, rural residency was only associated with osteoporosis in women living in single-person households (pOR, 1.59; 95% CI, 1.05 to 2.43). CONCLUSIONS: The Korean adult population showed a gender-specific relationship between SES and osteoporosis prevalence, with a different pattern found in single-person households.
Aged ; Asian Continental Ancestry Group ; Body Mass Index ; Bone Density ; Cross-Sectional Studies ; Female ; Humans ; Income ; Logistic Models ; Male ; Middle Aged ; Nutrition Surveys ; Odds Ratio ; Osteoporosis/*epidemiology ; Prevalence ; Republic of Korea/epidemiology ; Risk Factors ; *Social Class ; *Socioeconomic Factors

BACKGROUND: Statistical data of undiagnosed people living with human immunodeficiency virus (PLHIV) are of great importance to human immunodeficiency virus (HIV) infection control. This study estimated the total number of PLHIV using nationwide claims data.METHODS: This study used data of the incident HIV cases identified by the National Health Insurance System between 2009 and 2015. The number of patients with acquired immune deficiency syndrome (AIDS) was identified by diagnoses or prescription records. The estimated number of PLHIV and the time to diagnosis were calculated from the incident numbers of HIV and AIDS cases using the HIV Modeling Tool of the European Center for Disease Prevention and Control.RESULTS: Between 2009 and 2015, a total of 7,033 PLHIV and 2,899 AIDS patients were diagnosed. In 2009, the number of incident HIV cases was 873 (460 AIDS patients), increasing to 995 (337 AIDS patients) in 2015. Besides, the estimated number of prevalent cases was 10,753 in 2009, compared to 14,880 in 2015. Patients visiting health facilities accounted for 42.9% (4,616/10,753) in 2009 and 64.1% (9,544/14,880) in 2015. In 2009, there were 8,363 (77.8%) undiagnosed HIV cases, experiencing a decline to 6,215 (41.8%) in 2015. It took a mean of 6.96 years to diagnose after HIV infection.CONCLUSION: This study estimates the total burden of HIV infection in Korea for the first time using an internationally recognized HIV modeling tool. Claims data can be used to estimate the number of undiagnosed cases by identifying the total number of PLHIV and AIDS patients visiting health facilities.
Acquired Immunodeficiency Syndrome ; Diagnosis ; Health Facilities ; HIV Infections ; HIV ; Humans ; Infection Control ; Korea ; National Health Programs ; Prescriptions

PURPOSE: A high risk of cardiovascular disease (CVD) is reported for HIV-infected individuals. While a link between abacavir and CVD risk is suggested, an association between abacavir and hypertension remains unclear. This study evaluated hypertension risk with abacavir use in comparison to non-abacavir antiretroviral treatment (ART). MATERIALS AND METHODS: From a nationwide cohort of HIV-infected individuals on their initial ART, 6493 who were free of hypertension at baseline were analyzed. The use of ART was treated as a time-varying covariate measured as a daily unit. Incidence rate of hypertension was calculated, and Cox proportional hazard models were used to estimate adjusted hazard ratios (HRs) with 95% confidence interval (CI) of incident hypertension overall and among subgroups. RESULTS: From the 6493 participants, 24072 person-years (PY) of follow-up were contributed during 2008–2016. The incidence rates of hypertension were 4.6 and 3.6 per 100 PY for abacavir and non-abacavir ART users, respectively. The population attributable fraction of abacavir use on hypertension was 12%. Abacavir exposure did not elevate the risk of hypertension among overall study population [HR, 1.2 (95% CI, 1.0–1.4), p=0.061]. However, those with poor ART adherence, defined as a medication possession ratio < 50% [HR, 1.9 (95% CI, 1.5–2.4), p < 0.0001] or requiring prophylactic antibiotics [HR, 1.2 (95% CI, 1.0–1.3), p=0.023], were at risk of hypertension induced by abacavir, as were men, individuals aged ≥40 years, and patients visiting tertiary hospitals in urban areas. CONCLUSION: When present, poor ART adherence, requiring prophylactic antibiotics, male sex, and older age may warrant additional concern for hypertension in patients treated with abacavir.
Anti-Bacterial Agents ; Cardiovascular Diseases ; Cohort Studies* ; Epidemiology ; Follow-Up Studies ; HIV ; Humans ; Hypertension* ; Incidence ; Male ; Proportional Hazards Models ; Tertiary Care Centers

Objective: Pharmacotherapy is considered as an essential element in the treatment of psychotic disorders including schizophrenia. Discontinuation of antipsychotic drugs increases medical use and economic burden. Therefore, maintenance of medication is essential to reduce the social burden caused by schizophrenia and schizophrenia similar psychosis (SSP), and hence, it is important to investigate the rate at which pharmacotherapy is maintained. Therefore, this study aimed to examine the current status of drug compliance using national health insurance data. Methods: This was a retrospective cohort study, which analyzed data from the nationwide insurance claims database. A total of 343,134 patients who were newly diagnosed with schizophrenia and SSP during 2011−2015. The adherence to antipsychotic drugs was assessed by medication possession ratio (MPR) and the risk factors of poor adherence were defined as MPR ＜ 40%. Results: The average of the MPRs was 45.8%, and the proportion of patients with less than 40% of MPR was 50.8%. It was found that female patients, the experience of “general hospital outpatient,” “psychiatric hospital admission,” “general hospital admission,” and patients receiving “health insurance” showed high risk of having statistically significant low MPR (＜ 40%). Conclusion In this study, the drug adherence of schizophrenia and SSP patients currently under treatment, as estimated by MPR, was very low. However, it was also found that the MPR was high among patients receiving medical aid, with less medical expenses. Thus, it is possible to consider an institutional mechanism in which schizophrenia and SSP patients can be treated with less economic burden.

BACKGROUND: Statistical data of undiagnosed people living with human immunodeficiency virus (PLHIV) are of great importance to human immunodeficiency virus (HIV) infection control. This study estimated the total number of PLHIV using nationwide claims data. METHODS: This study used data of the incident HIV cases identified by the National Health Insurance System between 2009 and 2015. The number of patients with acquired immune deficiency syndrome (AIDS) was identified by diagnoses or prescription records. The estimated number of PLHIV and the time to diagnosis were calculated from the incident numbers of HIV and AIDS cases using the HIV Modeling Tool of the European Center for Disease Prevention and Control. RESULTS: Between 2009 and 2015, a total of 7,033 PLHIV and 2,899 AIDS patients were diagnosed. In 2009, the number of incident HIV cases was 873 (460 AIDS patients), increasing to 995 (337 AIDS patients) in 2015. Besides, the estimated number of prevalent cases was 10,753 in 2009, compared to 14,880 in 2015. Patients visiting health facilities accounted for 42.9% (4,616/10,753) in 2009 and 64.1% (9,544/14,880) in 2015. In 2009, there were 8,363 (77.8%) undiagnosed HIV cases, experiencing a decline to 6,215 (41.8%) in 2015. It took a mean of 6.96 years to diagnose after HIV infection. CONCLUSION This study estimates the total burden of HIV infection in Korea for the first time using an internationally recognized HIV modeling tool. Claims data can be used to estimate the number of undiagnosed cases by identifying the total number of PLHIV and AIDS patients visiting health facilities.

Objective: We conducted this study to address the incidence and prevalence of schizophrenia and similar psychosis in South Korea with Health Insurance Review and Assessment (HIRA) database. Methods: We used HIRA database, which includes diagnostic information of nearly all Korean nationals to collect number of cases with diagnosis of schizophrenia and schizophrenia-similar disorders (SSP), including schizophreniform, acute/transient psychotic disorders, schizoaffective disorders, and other/unspecific nonorganic psychosis (ICD-10 codes F20/23/25/28/29) between 2010 and 2015. The annual prevalence and incidence were calculated using the population data from the Korean Statistical Office. Results: The 12-month prevalence of SSP of Korea between 2010 and 2015 were 0.48–0.66%. The 12-month prevalence of schizophrenia were 0.40–0.52%; The annual incidence rates (IR) of SSP between 2010 and 2015 were 118.8–148.7 per 100,000 person-year (PY). For schizophrenia, IR per 100,000 PY were 77.6–88.5 between 2010 and 2015. Conclusion The 12-month prevalence found in the present study was higher than that reported in community-based epidemiologic studies in South Korea but similar to those from other countries. The annual incidence of SSP and schizophrenia was found to steadily increase and was higher than that of other countries. The high incidence rate observed in the current study needs to be studied further.

Background/Aims: Biliary complications including biliary strictures and bile leaks are the most common complications that occur after liver transplantation (LT). Endoscopic treatment with endoscopic retrograde cholangiography (ERC) is considered the first-line treatment, and percutaneous transhepatic cholangiography (PTC) can serve as an alternative or rescue therapy.However, nationwide clinical data on the frequency of ERC and PTC following LT have not yet been investigated. Methods: Using the nationwide claims database, we investigated patients who underwent LT between 2012 and 2014 in Korea and followed them until 2015. We analyzed the prevalence and characteristics of patients and biliary procedures, including ERC and PTC implemented after LT. Results: A total of 3,481 patients underwent LT during the 3-year study period. Among them, 3.0% of patients underwent biliary intervention postoperatively during the same hospitalization period, and 21.4% of patients received biliary intervention later on after initially being discharged from the hospital following LT. A total of 16.9% and 12.1% of patients underwent ERC and PTC after LT, respectively. The median period from LT to the first biliary intervention was 7.8 months (interquartile range, 3.5 to 14.6 months), and these patients underwent an average of 3.2±2.8 biliary procedures during the follow-up period. Patients undergoing living donor LT were more than twice as likely to undergo biliary procedures as those undergoing deceased donor LT (25.5% vs 12.1%). Conclusions Approximately one-fourth of patients in Korea who underwent LT subsequently underwent ERC or PTC. Compared with deceased donor LT patients, those undergoing living donor LT underwent more biliary interventions and were more difficult to treat.

Background: /Aim: Endoscopic retrograde choangiopancreatography (ERCP) has been established as an effective tool for the diagnosis and treatment of pancreatobiliary diseases. However, after the evolution for more than 4 decades, nationwide data on current trends and characteristic is not well known. Therefore, we conducted an analysis of nationwide database to determine the number and status of ERCP performed in Korea. Methods: We used the nationwide claims database, Korean Health Insurance Review and Assessment between 2012 and 2015. We investigated the frequencies and characteristics of ERCP procedure performed as well as demographics of the patients. Results: A total of 158,038 ERCP procedures were performed in 114,757 patients during study period. The number of total ERCPs increased every year, and especially the rate of therapeutic ERCPs is on the increased trend. About two-thirds of ERCPs (63.3%) were performed in high-scaled hospitals. In 2015, the proportion of elderly patients over 80 years old increased compared to that in 2011, from 14.3% to 17.2%. Conclusions The annual number of ERCPs performed is increasing in Korea. With increasing ERCP for therapeutic purposes or for older patients, more attention should be paid to safety for patients.

Background: /Aim: Endoscopic retrograde choangiopancreatography (ERCP) has been established as an effective tool for the diagnosis and treatment of pancreatobiliary diseases. However, after the evolution for more than 4 decades, nationwide data on current trends and characteristic is not well known. Therefore, we conducted an analysis of nationwide database to determine the number and status of ERCP performed in Korea. Methods: We used the nationwide claims database, Korean Health Insurance Review and Assessment between 2012 and 2015. We investigated the frequencies and characteristics of ERCP procedure performed as well as demographics of the patients. Results: A total of 158,038 ERCP procedures were performed in 114,757 patients during study period. The number of total ERCPs increased every year, and especially the rate of therapeutic ERCPs is on the increased trend. About two-thirds of ERCPs (63.3%) were performed in high-scaled hospitals. In 2015, the proportion of elderly patients over 80 years old increased compared to that in 2011, from 14.3% to 17.2%. Conclusions The annual number of ERCPs performed is increasing in Korea. With increasing ERCP for therapeutic purposes or for older patients, more attention should be paid to safety for patients.

PURPOSE: To detect signals of adverse drug events after imipenem treatment using the Korea Institute of Drug Safety & Risk Management-Korea adverse event reporting system database (KIDS-KD). MATERIALS AND METHODS: We performed data mining using KIDS-KD, which was constructed using spontaneously reported adverse event (AE) reports between December 1988 and June 2014. We detected signals calculated the proportional reporting ratio, reporting odds ratio, and information component of imipenem. We defined a signal as any AE that satisfied all three indices. The signals were compared with drug labels of nine countries. RESULTS: There were 807582 spontaneous AEs reports in the KIDS-KD. Among those, the number of antibiotics related AEs was 192510; 3382 reports were associated with imipenem. The most common imipenem-associated AE was the drug eruption; 353 times. We calculated the signal by comparing with all other antibiotics and drugs; 58 and 53 signals satisfied the three methods. We compared the drug labelling information of nine countries, including the USA, the UK, Japan, Italy, Switzerland, Germany, France, Canada, and South Korea, and discovered that the following signals were currently not included in drug labels: hypokalemia, cardiac arrest, cardiac failure, Parkinson's syndrome, myocardial infarction, and prostate enlargement. Hypokalemia was an additional signal compared with all other antibiotics, and the other signals were not different compared with all other antibiotics and all other drugs. CONCLUSION: We detected new signals that were not listed on the drug labels of nine countries. However, further pharmacoepidemiologic research is needed to evaluate the causality of these signals.
Anti-Bacterial Agents ; Canada ; Data Mining ; Drug Eruptions ; Drug Labeling ; Drug-Related Side Effects and Adverse Reactions ; France ; Germany ; Heart Arrest ; Heart Failure ; Hypokalemia ; Imipenem* ; Italy ; Japan ; Korea* ; Myocardial Infarction ; Odds Ratio ; Pharmacoepidemiology ; Pharmacovigilance ; Prostate ; Switzerland