Background: Given the importance of continuous self-care for people with type 1 diabetes mellitus (T1DM), the Ministry of Health and Welfare of Korea launched a pilot program for chronic disease management. Herein, we applied a home care pilot program to people with T1DM to investigate its effects. Methods: This retrospective cohort study was conducted at a single tertiary hospital (January 2019 to October 2021). A multidisciplinary team comprising doctors, nurses, and clinical nutritionists provided specialized education and periodically assessed patients’ health status through phone calls or text messages. A linear mixed model adjusting for age, sex, and body mass index was used to analyze the glycemic control changes before and after implementing the program between the intervention and control groups. Results: Among 408 people with T1DM, 196 were enrolled in the intervention group and 212 in the control group. The reduction in glycosylated hemoglobin (HbA1c) after the program was significantly greater in the intervention group than in the control group (estimated marginal mean, –0.57% vs. –0.23%, P=0.008); the same trend was confirmed for glycoalbumin (GA) (–3.2% vs. –0.39%, P<0.001). More patients achieved the target values of HbA1c (<7.0%) and GA (<20%) in the intervention group than in the control group at the 9-month follow-up (34.5% vs. 19.6% and 46.7% vs. 28.0%, respectively). Conclusion The home care program for T1DM was clinically effective in improving glycemic control and may provide an efficient care option for people with T1DM, and positive outcomes are expected to expand the program to include more patients.

Background: Social support contributes directly and indirectly to maintaining physical, mental, and social well-being. The aim of the study was to identify the impact of social support on self-rated health among Korean industrial accident workers. Methods: This study used data from the panel study of workers’ compensation insurance (PSWCI). The final subjects were 2,759 workers who responded to a 2018 to 2020 PSWCI. Social support was defined as social contact with friends, neighbors, family, and social participation activities like religious activity, social activity, and club activity. Multivariate logistic regression analysis was performed to investigate causal relationships between social support and self-rated health using a generalized estimating equation model. Results: Proportion of workers’ good self-rated health steadily increased (2018: n=1,447, 63.2%; 2019: n=1,542, 66.2%; 2020: n=1,653, 67.3%). Higher levels of social contacts with friend (worse: reference; same: β=0.442) and higher levels of social activity (yes: reference; no: β=-0.173) were especially associated with good self-rated health. Conclusion This study confirmed social support positively influenced self-rated health among the self-rated health of industrial injured workers. The results of this study suggested that recovery policies that the government served should include programs enhancing social support for improving health among industrial injured workers.

Background: The purpose of this study was to identify factors affecting unmet healthcare needs due to physical accessibility by residential area by utilizing the Korea Community Health Survey (KCHS). Methods: Andersen’s medical service behavioral model was applied to analyze the enabling factors, predisposing factors, and needs factors of unmet healthcare needs focusing on residential areas. This study used data from the KCHS (2017–2019, n=440,792). We used multivariate survey logistic regression analysis in order to identify affecting factors. Sub-group analysis was conducted in order to evaluate the effects of residential areas. Results: Some participants (2,621, 0.59%) had experienced unmet healthcare needs due to physical accessibility and 2,047 subjects (78.1%) of them lived in rural areas. Multivariate survey logistic regressions revealed that experience of unmet healthcare needs due to physical accessibility increased when people lived in rural areas (odds ratio [OR], 3.95; 95% confidence interval, 3.46–4.51). Conclusion This study showed that despite the development of transportation and efforts to alleviate medical inequality, residents in rural areas may still have higher experience of unmet healthcare needs due to physical accessibility compared to the metropolitan city regardless of any other sub-group differences (OR range, 1.90–6.31). This study suggested that government and policymakers should identify the causes of the experience of unmet healthcare needs due to physical accessibility and should develop policies to alleviate those healthcare disparities.

Background: Although Korean government have been adopting several policies to expand coverage of National Health Insurance (NHI) program, the coverage rate is still below average across Organization for Economic Cooperation and Development countries.This study was to identify public perception on appropriateness of coinsurance rate and factors associated with coinsurance rate in National Health Insurance. Methods: For this cross-sectional study, 507 participants over aged 20 years were recruited from telephone surveys. Respondents experienced at least one and more visiting medical facilities due to medical problems in last 12 months. Demographic factors, socioeconomic positions, and experiences on medical utilization were measured in order to identify factors associated with perception appropriateness of coinsurance rate. Results: The 49.9% (n=209) of the public responded that the coinsurance rate of NHI program was appropriate. There were no differences in positive perception according to socio-demographic factors and experiences on medical utilization except for gender, residential area, and felt expensive when using medical services. People who felt burden of medical expenditure were more likely to perceive coinsurance rate inappropriate (odds ratio, 2.33; 95% confidence interval, 1.52–3.58) Conclusion In spite of the relatively low coverage rate of NHI, this study identified that 49.9% of the public perceived the current coinsurance rate was adequate. However, people who felt the burden of medical expenditure were still had a negative perception of the coinsurance rate needed to decrease the coinsurance rate.

BACKGROUND: The extent of coverage rate of the public health insurance is still insufficient to meet healthcare needs. Private health insurance (PHI) plays a role to supplement coverage level of national health insurance in Korea. It is expected that reduce unmet need healthcare. This study was aimed to identify relationship between PHI type and the unmet healthcare need and its associated factors. METHODS: Data were obtained from the 2014 Korea Health Panel Survey using nationally representative sample was analyzed. Respondents were 8,667 who were adults over 20 years covered by PHI but have not changed their contract. According to the enrollment form, PHI was classified into three types: fixed-benefit, indemnity, and mixed-type. To identify factors associated with unmet needs, multiple logistic regression conducted using the Andersen model factors, which are predisposing factors, enabling factors, and need factors. RESULTS: Our analysis found that subjects who had PHI with mixed-type were less likely to experience unmet health care needs compared than those who did not have it (odds ratio, 0.80; 95% confidence interval, 0.66–0.98). As a result of analyzing what affected their unmet healthcare needs, the significant factors associated with unmet medical need were gender, marital status, residence in a metropolitan area, low household income, economic activity participation, self-employed insured, physically disabled, low subjective health status, and health-risk factors such as current smoking and drinking. CONCLUSION: The results of this study suggest that having PHI may reduce experience of unmet healthcare needs. Findings unmet healthcare needs factors according to various subjects may be useful in consideration of setting policies for improving accessibility to healthcare in Korea.
Adult ; Causality ; Delivery of Health Care ; Diagnostic Self Evaluation ; Disabled Persons ; Drinking ; Family Characteristics ; Humans ; Insurance ; Insurance, Health ; Korea ; Logistic Models ; Marital Status ; National Health Programs ; Public Health ; Smoke ; Smoking ; Surveys and Questionnaires

The present study aimed to investigate the distribution of total serum immunoglobulin E (IgE) levels in Korean schoolchildren and to evaluate its utility in the prediction of atopy and allergic diseases. A nationwide, cross-sectional survey was conducted in first grade students from randomly selected elementary and middle schools. Total IgE levels were measured by ImmunoCAP. Skin prick tests were performed for 18 common inhalant allergens to determine the presence of atopy. Children aged 12–13 years and parents of children aged 6–7 years were asked to complete questionnaire assessing allergic diseases. The cut-off levels of total IgE were determined by analyzing receiver operating characteristic curves. The median total IgE level was 86.7 kU/L (range: 1.5–4,523.1) in 3,753 children aged 6–7 years and 94.7 kU/L (range: 1.5–3,000.0) in 3,930 children aged 12–13 years. Total IgE concentrations were higher in children with atopy or allergic diseases than in those without (all P < 0.001). At the cut-off value of 127.7 kU/L, sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were 67.1%, 75.4%, 65.4%, and 76.7%, respectively, in elementary schoolchildren. At the cut-off value of 63.0 kU/L, sensitivity, specificity, PPV, and NPV were 81.9%, 66.6%, 75.0%, and 75.1%, respectively, in middle schoolchildren. PPV and NPV were ≥ 70% when cut-offs of 258.8 kU/L and 38.4 kU/L were used for the diagnosis of atopy in 6–7 year-olds and 12–13 year-olds, respectively. This nationwide population-based study provided the first normal reference ranges of total IgE in Korean schoolchildren.
Allergens ; Child ; Cross-Sectional Studies ; Diagnosis ; Humans ; Hypersensitivity ; Immunoglobulin E* ; Immunoglobulins* ; Korea ; Parents ; Reference Values* ; ROC Curve ; Sensitivity and Specificity ; Skin

BACKGROUND: Women with family history of breast cancer are more likely to be worried about having cancer and participate in breast cancer screening. However, few studies have examined relationship between family history, cancer worries, and participating in breast cancer screening in Korea. This study is to identify relationship between family history, cancer worries, and participating in breast cancer screening among women with and without family history of cancer. METHODS: Respondents were 2,364 women who based on the 2013 Korean National Cancer Screening Survey which is done by National Cancer Center in Korea. Chi-square tests were performed to determine differences of cancer worries, undergoing of breast cancer screening and methods such as mammogram and ultrasonogram with and without cancer family history. Univariate and multiple logistic regression were performed to identify if family history and cancer worries are related factors on participating in breast cancer screening and methods. Stratified analysis was performed to confirm the effect of ultrasonogram on the dense breast by age. RESULTS: Women with cancer family history frequently checked condition for conscious of having cancer (p=0.0299) and had highly perception of risk about having cancer in the future (p≤0.0001). Women aged 30–49 did not perform significantly more ultrasonogram than women aged over 50 years old. Checking condition (moderate odds ratio [OR], 1.38; 95% confidence interval [CI], 1.20–2.08; frequently OR, 1.58; 95% CI, 1.08–1.76) and perception of risk (moderate OR, 3.12; 95% CI, 1.06–7.06; high OR, 2.74; 95% CI, 1.20–8.08) were related to participate in mammogram and ultrasonogram. A positive family history was related to 1.35 higher odds of performing only breast ultrasonogram (95% CI, 1.04–1.75). CONCLUSION: This study requires national education and publicity to reduce the unnecessary cost of screening, to be possible cost effective screening and to encourage women to receive more mammogram, especially women aged over 50 years old and with socioeconomic factors related to opportunistic screening.
Breast Neoplasms* ; Breast* ; Early Detection of Cancer ; Education ; Female ; Humans ; Korea ; Logistic Models ; Mass Screening* ; Odds Ratio ; Socioeconomic Factors ; Surveys and Questionnaires ; Ultrasonography

PURPOSE: Although the Korean government has implemented a universal screening program for common cancers, some individuals choose to participate in opportunistic screening programs. Therefore, this study was conducted to identify factors contributing to the selection of organized versus opportunistic screening by the Korean general population. MATERIALS AND METHODS: Data from 11,189 participants aged ≥ 40 yearswho participated in the fifth Korean National Health and Nutrition Examination Survey (2010-2012) were analyzed in this study. RESULTS: A total of 6,843 of the participants (58.6%) underwent cancer screening, of which 6,019 (51.1%) participated in organized and 824 (7.5%) participated in opportunistic screening programs. Being female, older, highly educated, in the upper quartile of income, an ex-smoker, and a light drinker as well as having supplementary private health insurance and more comorbid conditions and engaging in moderate physical activity 1-4 days per week were related to participation in both types of screening programs. Being at least a high school graduate, in the upper quartile for income, and a light drinker, as well as having more comorbid conditions and engaging in moderate physical activities 1-4 days per week had a stronger effect on those undergoing opportunistic than organized screening. CONCLUSION: The results of this study suggest that socioeconomic factors such as education and income, as well as health status factors such as health-related quality of life and number of comorbid conditions and health behaviors such as drinking and engaging in moderate physical activity 1-4 days per week had a stronger influence on participation in an opportunistic than in an organized screening program for cancer.
Drinking ; Early Detection of Cancer* ; Education ; Female ; Health Behavior ; Humans ; Insurance, Health ; Mass Screening ; Motor Activity ; Nutrition Surveys* ; Quality of Life ; Socioeconomic Factors

PURPOSE: Although the Korean government has implemented a universal screening program for common cancers, some individuals choose to participate in opportunistic screening programs. Therefore, this study was conducted to identify factors contributing to the selection of organized versus opportunistic screening by the Korean general population. MATERIALS AND METHODS: Data from 11,189 participants aged ≥ 40 yearswho participated in the fifth Korean National Health and Nutrition Examination Survey (2010-2012) were analyzed in this study. RESULTS: A total of 6,843 of the participants (58.6%) underwent cancer screening, of which 6,019 (51.1%) participated in organized and 824 (7.5%) participated in opportunistic screening programs. Being female, older, highly educated, in the upper quartile of income, an ex-smoker, and a light drinker as well as having supplementary private health insurance and more comorbid conditions and engaging in moderate physical activity 1-4 days per week were related to participation in both types of screening programs. Being at least a high school graduate, in the upper quartile for income, and a light drinker, as well as having more comorbid conditions and engaging in moderate physical activities 1-4 days per week had a stronger effect on those undergoing opportunistic than organized screening. CONCLUSION: The results of this study suggest that socioeconomic factors such as education and income, as well as health status factors such as health-related quality of life and number of comorbid conditions and health behaviors such as drinking and engaging in moderate physical activity 1-4 days per week had a stronger influence on participation in an opportunistic than in an organized screening program for cancer.
Drinking ; Early Detection of Cancer* ; Education ; Female ; Health Behavior ; Humans ; Insurance, Health ; Mass Screening ; Motor Activity ; Nutrition Surveys* ; Quality of Life ; Socioeconomic Factors

BACKGROUND: Although renal transplantation is known as the best treatment for patients with end-stage renal disease, there are few of literature to identify economic evaluation of renal replacement therapies in Korea. This study was conducted to determine the cost-effectiveness of renal replacement treatments, particularly renal transplantation and hemodialysis. METHODS: We used the quality adjusted life year (QALY) calculated from survey data, which was collected from 124 patients who underwent kidney transplantation and 90 patients who were receiving hemodialysis. Medical costs were collected from five hospitals in Korea. The ERA-EDTA registry data (European Renal Association-European Dialysis and Transplant Association) were used for transition probability. A Markov model was used for predicting the cost-utility of transplantation and hemodialysis over the 10-year period. RESULTS: Renal transplantation offers lower cost and better outcome compared to hemodialysis. QALY per year of transplantation patients is higher than that of hemodialysis patients (transplantation 0.9465 vs. hemodialysis 0.8297). Cost per QALY gained is 15,566,000 won in transplantation patients whereas 32,765,000 won per QALY gained in hemodialysis patients was required. CONCLUSIONS: Although cost of first year after transplantation was expensive, over 2 years, transplantation was more effective and less costly than hemodialysis. The results suggest that transplantation is more cost-effective than hemodialysis in Korea.
Cost-Benefit Analysis ; Dialysis ; Humans ; Kidney Failure, Chronic* ; Kidney Transplantation* ; Korea ; Quality of Life* ; Quality-Adjusted Life Years ; Renal Dialysis* ; Renal Replacement Therapy