BACKGROUND : Diabetes mellitus (DM) remains a major global health challenge, and its burden is intensified by comorbidities, such as obesity, hyperglycemia, and kidney dysfunction. Diverse geography and population, such as Indonesia, create unique provincial variations in DM risk factors, necessitating detailed sub-nationwide analyses to guide policymaking. This study aimed to evaluate regional disparities in diabetes-related mortality and associated risk factors across Indonesian provinces and to examine whether population density influences the distribution of these risk factors. METHODS : We analyzed age-standardized DM mortality and summary exposure values for 9 comorbidities across 34 provinces (GBD 2021), using Pearson's/Spearman's correlations nationally and provincially. Coefficient power was classified as weak (0.01–0.29), moderate (0.30–0.69), or strong (0.70–1.00). RESULTS : At the national scale, DM mortality was moderately associated with high BMI, high FPG, and kidney dysfunction (all R = 0.60; p<0.001). Associations were stronger in high-density provinces and negligible in low-density provinces. Across provinces, BMI and FPG were the most consistent correlates of DM mortality while diet-related factors (e.g., sugar intake) showed the largest gradient by density. CONCLUSIONS These findings support the development of tailored strategies based on population density to effectively reduce diabetes-related mortality. These results indicate that interventions in urban provinces should prioritize curbing sugar intake and reducing obesity prevalence. In intermediate-density regions, the focus should shift to the intensification of management for kidney disease and the optimization of blood pressure control. For low-density provinces, a critical approach involves expanding systematic screening programs and enhancing patient access to healthcare services.
comorbidity ; diabetes ; mortality ; Indonesia ; policy ; regional health planning

OBJECTIVES: To investigate the chronological patterns of diseases in Northern Gyeonggi-do province, South Korea, and compare these with national data. METHODS: A National Health Insurance cohort based on the National Health Information Database (NHID Cohort 2002–2013) was used to perform a retrospective, population-based study (46,605,433 of the target population, of which 1,025,340 were randomly sampled) to identify disease patterns from 2002 to 2013. Common diseases including malaria, cancer (uterine cervix, urinary bladder, colon), diabetes mellitus, psychiatric disorders, hypertension, intracranial hemorrhage, bronchitis/bronchiolitis, peptic ulcer, and end stage renal disease were evaluated. RESULTS: Uterine cervix cancer, urinary bladder cancer and colon cancer had the greatest rate of increase in Northern Gyeonggi-do province compared with the rest of the country, but by 2013 the incidence of these cancers had dropped dramatically. Acute myocardial infarction and end stage renal disease also increased over the study period. Psychiatric disorders, diabetes mellitus, hypertension and peptic ulcers showed a gradual increase over time. No obvious differences were found for intracranial hemorrhage or bronchitis/bronchiolitis between the Northern Gyeonggi-do province and the remaining South Korean provinces. Malaria showed a unique time trend, only observed in the Northern Gyeonggi province, peaking in 2004, 2007 and 2009 to 2010. CONCLUSION: This study showed that the Northern Gyeonggi-do province population had a different disease profile over time, compared with collated data for the remaining provinces in South Korea. “Big data” studies using the National Health Insurance cohort database can provide insight into the healthcare environment for healthcare providers, stakeholders and policymakers.
Cervix Uteri ; Cohort Studies* ; Colonic Neoplasms ; Delivery of Health Care ; Diabetes Mellitus ; Female ; Gyeonggi-do* ; Health Personnel ; Health Services Needs and Demand ; Hemorrhage ; Humans ; Hypertension ; Incidence ; Insurance, Health ; Intracranial Hemorrhages ; Intracranial Hypertension ; Kidney Failure, Chronic ; Korea* ; Malaria ; Myocardial Infarction ; National Health Programs ; Peptic Ulcer ; Regional Health Planning ; Retrospective Studies ; Urinary Bladder ; Urinary Bladder Neoplasms

BACKGROUND: The mental problems of the elderly are at issue as a serious social phenomenon. The purpose of this study is to identify risk factors affecting the mood disorders of the elderly. METHODS: The subjects were 1,779,236 aged ≥65 and participated in health screening. Dependent variable was mood disorders. Independent variables were consisted of community level (regional deprivation index and healthcare resources) and individual level (sex, age, insurance type, disability, smoking, alcohol, physical activity, body mass index, and healthcare utilization). Multilevel logistic regression was performed. RESULTS: At the individual level, women, employed insured, severely disabled people, heavy alcohol drinkers, high-intensity physical activity, body mass index, and patients who had chronic disease and severe disease were significantly associated with mood disorders. As the age has increased, it has let increase of mood disorders. At the community level, as the regional deprivation index has increased by 1, mood disorders has been increased by 1.005 times. The intra-class coefficient was 7.04%. CONCLUSION: We found individual and community level factors are associated with mood disorders. Systematic approach is essential to reduce mood disorders.
Aged* ; Body Mass Index ; Chronic Disease ; Delivery of Health Care ; Female ; Health Services for the Aged ; Humans ; Insurance ; Linear Energy Transfer ; Logistic Models ; Mass Screening ; Mood Disorders* ; Motor Activity ; Multilevel Analysis ; Regional Health Planning ; Risk Factors ; Smoke ; Smoking

BACKGROUND: This study was purposed to analyze the effect of spatial accessibility to the psychiatry department in general hospital on the outpatient visit of mental patients. METHODS: Data was provided from the Statistics Korea and Statistical Geographic Information Service, National Health Insurance Service, Health Insurance Review and Assessment Service, and Korea Transport Institute in 2015. The study regions were 103 administrative regions such as Si and Gu. The 103 regions had at least one general hospitals with a psychiatry department. The number of outpatient visit of mental patients in regions was used as the dependent variable. Spatial accessibility to mental general hospital was used as the independent variable. Control variables included such as demographic, economic, and health·medical factors. This study used network analysis and multi-variate regression analysis. Network analysis by ArcGIS ver. 10.0 (ESRI, Redlands, CA, USA) was used to evaluate the average travel time and travel distance in Korea. Multi-variate regression analysis was conducted by SAS ver. 9.4 (SAS Institute Inc., Cary, NC, USA). RESULTS: Travel distance and time had significant effects on the number of outpatient visits in mental patients in general hospital. Average travel time and travel distance had negative effects on the number of visits. Variables such as (number of total population, percentage of aged population over 65, and number of mental general hospital) had significant effects on the number of visit in mental patients. CONCLUSION: Health policy makers will need to consider the spatial accessibility to the mental healthcare organization in conducting regional health planning.
Delivery of Health Care ; Health Policy ; Health Services ; Hospitals, General ; Humans ; Information Services ; Insurance ; Korea ; Mentally Ill Persons ; National Health Programs ; Outpatients ; Regional Health Planning

The importance of public healthcare system has been widely recognized since the current Middle East respiratory syndrome epidemic began. However, their capacities are not sufficient in both quantitative and qualitative perspective aspects. When a large-scale outbreak develops, public hospitals and community health centers should be primarily responsible for treatment of patients and isolation of individuals who are likely to infect other people, with the supplemented of private hospitals. Clearly, the central and municipal governments, and public healthcare system has failed to deal with the current Middle East respiratory syndrome epidemic, largely due to lack of expertise and professional staff. The governments at various levels and public hospitals should thoroughly and publicly review the work process and problems revealed in dealing with the current epidemic. Based on such evaluation, they should establish action plans for infectious disease control, and regular training and exercise should be done according to them. In addition, more public hospitals should be established under the regional health planning. It is important for public heathcare facilities to hire physicians on a stable and long-term employment contract, and to train them so that they could play a role in case of epidemic.
Communicable Diseases* ; Community Health Centers ; Delivery of Health Care* ; Employment ; Hospitals, Private ; Hospitals, Public ; Humans ; Middle East ; Regional Health Planning

Delivery of Health Care ; organization & administration ; Hospitals, General ; Humans ; Regional Health Planning ; Singapore

PURPOSE: The purpose of this study was to evaluate the appropriateness of prehospital emergency care by 119 rescue services in Seoul. METHODS: We enrolled all patients who used 119 rescue services in Seoul between January and Sepember 2006 and analyzed the 119 ambulance patient care record databases. Major emergencies were defined and categorized into four groups: cardiopulmonary complaint (CP), neurologic complaint (NR), cardiorespiratory arrest (CA) and major trauma (MT). Interventions provided by emergency medical technicians were scored as 2:essential, 1:optional and 0:unnecessary in each category of major emergency. We summed scores of provided interventions per patient and graded them into four levels for conducting the appropriateness review. Multivariate logistic regression analysis was performed to determine the relationship of risk factors to the appropriateness of intervention. RESULTS: Total number of cases was 171,112 of which 36,065 were major emergencies. The proportion of "very low" level appropriate was 40.1% for CP (N=11,522). 49.3% for NR (N=15,239), 14.5% for CA (N=1,591), and 32.7% for MT (N=7,713). The proportion of "high" level was less than 3% except for CA(11.3%). Variables affecting the "moderate" or "high" level of appropriateness of prehospital emergency care, as determined by multivariate logistic regression analysis, were age > or =65(OR: 1.425, 95% CI: 1.337-1.520), female gender (OR: 0.880, 95% CI: 0.828-0.935), and type of complaint in the order CP (OR: 0.181, 95% CI: 0.161-0.204), NR (OR: 0.184, 95% CI: 0.164-0.207), and MT (OR: 0.202, 95% CI: 0.178-0.229). CONCLUSION: The prehospital emergency care of 119 rescue services in Seoul was frequently inappropriate and was influenced by patient's age, gender and chief complaints.
Ambulances ; Emergencies ; Emergency Medical Services ; Emergency Medical Technicians ; Female ; Humans ; Logistic Models ; Patient Care ; Regional Health Planning ; Risk Factors

According to the need for objectivity and convenience the whole planning process is devided into a secries of 8 systematic stages. But it is an unending upward spiral of incremented efforts toward improvement. So many activities should be carried out concurrently, providing a mutual supportive flow back and forth between various stages of the process depending on local conditions and requirements. The eight stages are : (1) Planning the Planning and Developing Planning competence, (2) Statements of Policy and Broad Goals, (3) Data Gathering, (4) Priority Statement, (5) Statement of Major Alternative Proposals, (6) Development of Detailed Plan, (7) Implementation as a Part of the Planning Process, (8) Evaluation. The frame and function of the planning machinery must be adjusted to local conditions, and also flexibility is desirable, especially at the start, when adaptations are more necessary and more frequent.
Mental Competency ; Pliability ; Regional Health Planning*