Search Results (26)

Background/Objectives: Colorectal cancer (CRC) is a growing public health concern in South Korea, with incidence rising alongside dyslipidemia. Statins, widely prescribed for lipid control, have been proposed to reduce CRC risk, but evidence remains inconsistent, particularly in Asian populations. Methods: Using Korean National Health Insurance Service data (2002–2019), we conducted a nested case–control study of 9920 CRC patients and 39,680 matched controls. To reduce confounding, we applied a matching process with a propensity score and overlap weighting based on demographic and clinical variables. Statin use within two years before CRC diagnosis was categorized by type (lipophilic vs. hydrophilic) and duration. Lifestyle data such as smoking and diet were not available. Results: Short-term statin use was associated with a 17% reduced CRC risk, particularly in younger, metabolically healthier Korean males. Lipophilic statins were consistently associated with lower CRC risk and mortality. However, hydrophilic statins showed mixed results: while short-term use lowered CRC risk, long-term use was linked to increased all-cause mortality. These associations varied by patient subgroup. Conclusion: Among Korean adults, short-term statin use—especially lipophilic agents—was associated with favorable CRC outcomes. However, the observational design, the absence of lifestyle data, and increased mortality linked to long-term hydrophilic statin use limit causal interpretation. Further research using clinically enriched or prospective datasets is warranted to validate these findings and guide personalized preventive strategies. Full article

Background/Objectives: The coronavirus disease 2019 (COVID-19) pandemic significantly disrupted global healthcare. This study explores the effects of perioperative COVID-19 infection on postoperative outcomes, aiming to refine risk assessment and enhance personalized perioperative care using a comprehensive dataset from the Korean National Health Insurance Service. This analysis extends previous research by providing a large-scale validation of risk factors associated with COVID-19 in a perioperative setting. Methods: In this retrospective cohort study, we analyzed data from 2,903,858 patients who underwent surgery under general anesthesia between January 2020 and December 2021. Patients were categorized into COVID-19 (+) and COVID-19 (−) groups within 30 d before or after surgery. Logistic regression models were used to identify independent risk factors for mortality and pulmonary complications. Results: After propensity score matching, the final cohort comprised 19,235 patients (COVID-19 (+): 3847; COVID-19 (−): 15,388). The COVID-19 (+) group had significantly higher overall mortality than the COVID-19 (−) group. No significant difference was observed between the groups concerning 30 d mortality. Pulmonary complications, including pneumonia and acute respiratory distress syndrome, were significantly more frequent in the COVID-19 (+) group. The independent predictors of 30 d mortality included advanced age, emergency surgery, and the American Society of Anesthesiologists physical status classification. Conclusions: Our study confirms that perioperative COVID-19 infection significantly elevates overall mortality and pulmonary complications, emphasizing the necessity of tailored perioperative management. Incorporating individual risk factors into care protocols not only reduces risks for surgical patients but also enhances treatment approaches. These findings advocate for the implementation of personalized medicine principles in surgical settings to improve patient outcomes during and after the COVID-19 pandemic. This research uses a comprehensive national medical claims dataset to set new standards for studying pandemic health impacts and improving clinical strategies. Full article

Differences in the lifestyle and health-service-seeking behavior of persons experiencing homelessness (PEH) are well known. However, a comprehensive estimation of the resulting healthcare utilization differences and health outcome impacts are so far under-researched, especially at the national level. We aim to close this gap of evidence for lung cancer within the Hungarian universal healthcare system. We analyzed lung cancer-related information for the PEH population in the Hungarian national central health insurance register dataset and a matched control population between 2015 and 2021. In this period, 11,857 people were registered as homeless for the majority of at least one year. To capture the effect of homelessness, we created a categorical “homelessness length index” (HLI) according to the proportion of time an individual experienced homelessness during the investigation period (HLI 0: 0; HLI 1: >0–1/3; HLI 2: >1/3–2/3; HLI 3: >2/3). PEH individuals were matched 1:5 with a non-PEH control sample adjusted for age, sex and region. We conducted Kaplan–Meier survival analysis and Cox proportional hazards (CPH) regression adjusted for age, sex, HLI and average lung cancer-related healthcare costs. Our final analysis sample consisted of 641 patients (233 PEH, 408 control) who were newly diagnosed with lung cancer during the observation period. The lung cancer prevalence in the PEH group was 1.97% as opposed to 0.69% in the control group. The Kaplan–Meier curve showed lower average survival times for the PEH group, compared to the control group. Lung cancer associated costs between diagnosis and death/censoring were substantially different with average per patient cumulative costs of EUR 3668 in the PEH group compared to EUR 6827 in the control group (2018 prices). This translated to an average 47% lower annual lung cancer-related healthcare cost per PEH patient. CPH analysis showed that after disease severity, the degree of time spent in homelessness had the most significant effect on mortality, with a HR of 1.47 associated with both HLI 2 and 3 (95% CI: 1.08–2.00 and 1.01–2.14, respectively). We find that in Hungary, homelessness is associated with a much higher lung cancer burden linked to a three-times-higher prevalence, lower overall survival and almost 50% lower annualized disease-specific healthcare costs. Worse outcomes are mainly driven by long-term homelessness. Results could not be further refined according to lifestyle-related factors due to data availability limitations. Full article

Increasingly, information technology facilitates the storage and management of data useful for risk analysis and event prediction. Studies on data extraction related to occupational health and safety are increasingly available; however, due to its variability, the construction sector warrants special attention. This review is conducted under the research programs of the National Institute for Occupational Accident Insurance (Inail). Objectives: The research question focuses on identifying which data mining (DM) methods, among supervised, unsupervised, and others, are most appropriate for certain investigation objectives, types, and sources of data, as defined by the authors. Methods: Scopus and ProQuest were the main sources from which we extracted studies in the field of construction, published between 2014 and 2023. The eligibility criteria applied in the selection of studies were based on the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). For exploratory purposes, we applied hierarchical clustering, while for in-depth analysis, we used principal component analysis (PCA) and meta-analysis. Results: The search strategy based on the PRISMA eligibility criteria provided us with 63 out of 2234 potential articles, 206 observations, 89 methodologies, 4 survey purposes, 3 data sources, 7 data types, and 3 resource types. Cluster analysis and PCA organized the information included in the paper dataset into two dimensions and labels: “supervised methods, institutional dataset, and predictive and classificatory purposes” (correlation 0.97–8.18 × 10⁻¹; p-value 7.67 × 10⁻⁵⁵–1.28 × 10⁻²²) and the second, Dim2 “not-supervised methods; project, simulation, literature, text data; monitoring, decision-making processes; machinery and environment” (corr. 0.84–0.47; p-value 5.79 × 10⁻²⁵–-3.59 × 10⁻⁶). We answered the research question regarding which method, among supervised, unsupervised, or other, is most suitable for application to data in the construction industry. Conclusions: The meta-analysis provided an overall estimate of the better effectiveness of supervised methods (Odds Ratio = 0.71, Confidence Interval 0.53–0.96) compared to not-supervised methods. Full article

Atrial fibrillation (AF) commonly occurs in approximately 2% of cancer patients, and the incidence of AF among cancer patients is greater than in the general population. This observational study presented the incidence risk of AF among cancer patients, including specific cancer types, using a population database. The Taiwan Cancer Registry was used to identify cancer patients between 2008 and 2017. The diagnosis of AF was based on the International Classification of Diseases codes (ICD-9-CM: 427.31 or ICD-10-CM: I48.0, I48.1, I48.2, and I48.91) in Taiwan national health insurance research datasets. The incidence of developing AF in the cancer population was calculated as the number of new-onset AF cases per person-year of follow-up during the study period. The overall incidence of AF among cancer patients was 50.99 per 100,000 person-years. Patients aged older than 65 years and males had higher AF incidence rates. Lung cancer males and esophageal cancer females showed the highest AF incidence risk (185.02 and 150.30 per 100,000 person-years, respectively). Our findings identified esophageal, lung, and gallbladder cancers as the top three cancers associated with a higher incidence of AF. Careful monitoring and management of patients with these cancers are crucial for early detection and intervention of AF. Full article

This study used real-world data (RWD) to explore the long-term effects of East Asian traditional medicine (EATM) on heart failure (HF). A comprehensive search was conducted across five databases to identify relevant studies, which were then reviewed using the Arksey and O’Malley scoping review framework. The analysis focused on a descriptive examination of the long-term outcomes associated with EATM intervention. Methodologically, the study explored various aspects, including study subjects, interventions, applied clinical outcomes, and statistical methods. Out of 258 studies, 12 were selected. Eight studies involved patients with HF, while the others used HF as an outcome. Datasets from the National Health Insurance Research Database were used in Taiwan, while electronic medical record data were used in China and Japan. EATM interventions have been found to be associated with lower mortality and readmission rates. One study indicated that an increased dose of Fuzi, a botanical drug, or prompt use of Fuzi after diagnosis led to a decreased mortality hazard ratio. In two studies examining readmission rates, a significant increase was observed in the non-exposed group, with odds ratios of 1.28 and 1.18. Additionally, in patients with breast cancer, the subdistribution hazard ratio for the occurrence of doxorubicin-induced HF was reduced to 0.69. Although cohort studies with survival analysis were common, methodological flaws, such as issues with statistical methods and HF diagnosis, were identified. Despite these challenges, the study observed an association between EATM and improved clinical outcomes in patients with HF, emphasizing the potential of RWD studies to complement randomized controlled trials, especially for longer-term follow-ups. These results provide foundational data for future RWD research. Full article

Uterine endometrial cancer (EC) is the most common gynecological malignancy in Taiwan. This study aimed to investigate the association between human papillomavirus (HPV) infection and the development of uterine EC among Taiwanese women. A nationwide population cohort research approach was employed, leveraging longitudinal health insurance databases (LHID 2007 and 2015) from the National Health Insurance Research Database alongside data from the Taiwan Cancer Registry datasets. A comparative analysis examined 472,420 female patients with HPV infection and 944,840 without HPV infection. The results demonstrated that the HPV cohort exhibited a significantly elevated risk of uterine EC, as evidenced by an adjusted hazard ratio (aHR) of 1.588 (95% CI: 1.335–1.888). Furthermore, this elevated risk extended to type 1 EC with an aHR of 1.671 (95% CI: 1.376–2.029), specifically the endometrioid adenocarcinoma subtype with an aHR 1.686 (95% CI: 1.377–2.065). Importantly, these findings were statistically significant (p < 0.001). In conclusion, this research unveils a potential association between HPV infection and an increased risk of uterine EC, particularly the type 1 endometrial cancer subtype, within the Taiwanese female population. These findings have implications for preventive measures and screening programs targeting HPV infection to reduce the risk of this prevalent gynecological malignancy in Taiwan. Full article

Chronic kidney disease (CKD) and Parkinson’s disease (PD) are common illnesses found in the geriatric population. A potential link between CKD and PD emergence has been hypothesized; however, existing conclusions are disputed. In this longitudinal research, we analyzed data acquired from the Korean National Health Insurance Service-Health Screening Cohort. The dataset comprised the health information of 16,559 individuals clinically diagnosed with CKD and 66,236 control subjects of comparable ages, all aged ≥40 years. These subjects participated in health examinations from 2002 to 2019. To assess the correlation between CKD and PD, we employed overlap-weighted Cox proportional hazard regression models. The unadjusted, crude hazard ratio for PD was greater in the CKD group than in the control group (crude hazard ration (HR) 1.20; 95% confidence interval (CI) = 1.04–1.39; p = 0.011). However, the Cox proportional hazard regression analysis, incorporating propensity score overlap weighting, revealed no significant discrepancy after considering confounding variables such as demographic factors, socio-economic status, lifestyle, and concurrent health conditions (adjusted HR (aHR), 1.09; 95% CI = 0.97–1.22; p = 0.147). Subgroup analyses showed a higher probability of PD development among certain CKD individuals, including those who resided in rural areas (aHR, 1.19; 95% CI = 1.03–1.37; p = 0.022), maintained a normal weight (aHR, 1.29; 95% CI = 1.08–1.56; p = 0.006), or had fasting blood glucose levels ≥100 mg/dL (aHR, 1.18; 95% CI = 1.00–1.39; p = 0.046). Therefore, these clinical or environmental factors may influence the incidence of PD in CKD patients. In conclusion, our results suggest that the general CKD population may not exhibit a greater propensity for PD than their non-CKD counterparts. However, this might be contingent upon specific lifestyle and comorbid conditions. Thus, certain lifestyle alterations could be crucial in mitigating the potential manifestation of PD in patients diagnosed with CKD. Full article

In recent years, the development and application of artificial intelligence have both been topics of concern. In the medical field, an important direction of medical technology development is the extraction and use of applicable information from existing medical records to provide more accurate and helpful diagnosis suggestions. Therefore, this paper proposes using the development of diseases with easily discernible symptoms to predict the development of other medically related but distinct diseases that lack similar data. The aim of this study is to improve the ease of assessing the development of diseases in which symptoms are difficult to detect, and to improve the utilization of medical data. First, a time series model was used to capture the continuous manifestations of diseases with symptoms that could be easily found at different time intervals. Then, through transfer learning and attention mechanism, the general features captured were applied to the predictive model of the development of diseases with insufficient data and symptoms that are difficult to detect. Finally, we conducted a comprehensive experimental study based on a dataset collected from the National Health Insurance Research Database in Taiwan. The results demonstrate that the effectiveness of our transfer learning approach outperforms state-of-the-art deep learning prediction models for disease course prediction. Full article

Objectives. Whether uric acid-lowering agent use in asymptomatic hyperuricemia can reduce the development of the first gout flare remains unsettled. The goal of the present research was to test the efficacy of benzbromarone and allopurinol on primary prevention of the first gout flare in persons with asymptomatic hyperuricemia in Taiwan. Methods. One observational cohort study was constructed to examine the 2001–2015 dataset adapted from the National Health Insurance Program of Taiwan containing the claims data of 2 million beneficiaries. Asymptomatic hyperuricemia was considered as individuals on uric acid-lowering therapy who did not have gout flares. Individuals aged 20–84 without gout flares who had the use of benzbromarone alone were assigned into a benzbromarone group. Individuals ages 20–84 without gout flares who had the use of allopurinol alone were assigned into an allopurinol group. The final study included 6111 pairs of 1:1 propensity score-matched individuals from both benzbromarone and allopurinol groups. The end point was assigned as individuals who were newly diagnosed with their first gout flare. The incidence rate of the first gout flare was estimated between the benzbromarone and allopurinol groups. A Cox proportional hazards regression model was applied to explore the hazard ratio and 95% confidence interval of the first gout flare related to benzbromarone use and allopurinol use. Results. The incidence rate of the first gout flare was lower in the benzbromarone group compared with an allopurinol group (3.29 versus 5.46 per 1000 person-months, incidence rate ratio = 0.60 and 95% confidence interval = 0.56–0.64). After adjustment for co-variables, the adjusted hazard ratio of the first gout flare was 0.63 (95% confidence interval = 0.59–0.68, p < 0.001) for the benzbromarone group when compared with the allopurinol group. Conclusion. People with asymptomatic hyperuricemia taking benzbromarone have a lower hazard of developing their first gout flare when compared with those taking allopurinol. Based on the medication safety, the therapeutic effects and the low price, with oral administration once daily, we suggest that benzbromarone should be the first drug of choice if clinicians are treating asymptomatic hyperuricemia. Full article

The growth of public expenditure worldwide has set the priority on assessment of trends and establishment of factors which generate the most significant public costs. The goal of the current study is to review the tendencies in public healthcare expenditures in Bulgaria and to analyze the influence of the demographic, economic, and healthcare system capacity indicators on expenditures dynamics. A retrospective, top-down, financial analysis of the healthcare system expenditures was performed. Datasets of the National Statistical Institute (NSI), National Health Insurance Fund (NHIF), and National Center of Public Health and Analysis (NCPHA) were retrospectively reviewed from2014–2019 to collect the information in absolute units of healthcare expenditures, healthcare system performance, demographics, and economic indicators. The research showed that increasing GDP led to higher healthcare costs, and it was the main factor affecting the cost growth in Bulgaria. The number of hospitalized patients and citizens in retirement age remained constant, confirming that their impact on healthcare costs was negligible. In conclusion, the population aging, average life expectancy, patient morbidity, and hospitalization rate altogether impacted healthcare costs mainly due to the multimorbidity of older people and the rising need for outpatient hospital services and medications. Full article

Background: Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in Taiwan. Chronic obstructive pulmonary disease (COPD) is associated with CRC mortality in several population-based studies. However, this effect of COPD on CRC shows no difference in some studies and remains unclear in Taiwan’s population. Methods: We conducted a retrospective cohort study using Taiwan’s nationwide database. Patients newly diagnosed with CRC were identified from 2007 to 2012 via the Taiwan Cancer Registry dataset and linked to the National Health Insurance research database to obtain their medical records. Propensity score matching (PSM) was applied at a ratio of 1:2 in COPD and non-COPD patients with CRC. The 5-year overall survival (OS) was analyzed using the Cox regression method. Results: This study included 43,249 patients with CRC, reduced to 13,707 patients after PSM. OS was lower in the COPD group than in the non-COPD group. The adjusted hazard ratio (aHR) for COPD was 1.26 (95% confidence interval (CI), 1.19–1.33). Moreover, patients with CRC plus preexisting COPD showed a higher mortality risk in all stage CRC subgroup analysis. Conclusions: In this 5-year retrospective cohort study, patients with CRC and preexisting COPD had a higher mortality risk than those without preexisting COPD, suggesting these patients need more attention during treatment and follow-up. Full article

Coronary artery bypass surgery grafting (CABG) is a commonly efficient treatment for coronary artery disease patients. Even if we know the underlying disease, and advancing age is related to survival, there is no research using the one year before surgery and operation-associated factors as predicting elements. This research used different machine-learning methods to select the features and predict older adults’ survival (more than 65 years old). This nationwide population-based cohort study used the National Health Insurance Research Database (NHIRD), the largest and most complete dataset in Taiwan. We extracted the data of older patients who had received their first CABG surgery criteria between January 2008 and December 2009 (n = 3728), and we used five different machine-learning methods to select the features and predict survival rates. The results show that, without variable selection, XGBoost had the best predictive ability. Upon selecting XGBoost and adding the CHA2DS score, acute pancreatitis, and acute kidney failure for further predictive analysis, MARS had the best prediction performance, and it only needed 10 variables. This study’s advantages are that it is innovative and useful for clinical decision making, and machine learning could achieve better prediction with fewer variables. If we could predict patients’ survival risk before a CABG operation, early prevention and disease management would be possible. Full article

Given the increasing burden of chronic diseases in Indonesia, characteristics of chronic multimorbidities have not been comprehensively explored. Therefore, this research evaluated chronic multimorbidity patterns among Indonesians using Indonesian National Health Insurance (INHI) sample data. We included 46 chronic diseases and analyzed their distributions using population-weighted variables provided in the datasets. Results showed that chronic disease patients accounted for 39.7% of total patients who attended secondary health care in 2015–2016. In addition, 43.1% of those were identified as having chronic multimorbidities. Findings also showed that multimorbidities were strongly correlated with an advanced age, with large numbers of patients and visits in all provinces, beyond those on Java island. Furthermore, hypertension was the leading disease, and the most common comorbidities were diabetes mellitus, cerebral ischemia/chronic stroke, and chronic ischemic heart disease. In addition, disease proportions for certain disease dyads differed according to age group and gender. Compared to survey methods, claims data are more economically efficient and are not influenced by recall bias. Claims data can be a promising data source in the next few years as increasing percentages of Indonesians utilize health insurance coverage. Nevertheless, some adjustments in the data structure are accordingly needed to utilize claims data for disease control and surveillance purposes. Full article

Objective: Children with precocious puberty (PP) may have increased physiological and psychological problems. In this study, we aimed to explore the trend of parents seeking medical care for their children with precocious puberty. Methods: The Taiwan National Health Insurance Research Dataset (NHIRD) was used to estimate the prevalence (2000–2013) and incidence (2002–2013) of PP (ICD-9 code: 259.1) among boys aged 0–11 years and girls aged 0–10 years. The proportions of PP management within 1 year from the date of first diagnosis were also compared between two periods (2002–2007 and 2008–2012). The trends of PP prevalence or incidence were determined by join-point regression. Results: In 2000, 309 boys and 2706 girls had at least one visit for PP, the crude prevalence rates (per 10,000 persons) were 0.99 (95% confidence interval, 95% CI 0.87–1.14) and 13.56 (95% CI 13.01–14.13) in boys and girls, respectively. In 2013, the crude prevalence rates increased to 7.01 (95% CI 6.56–7.84) and 110.95 (95% CI 108.97–112.96) in boys and girls, respectively. A total of 2584 girls and 207 boys with incident PP cases were identified in 2002, and 7498 girls and 739 boys were identified in 2013. For girls, the incidence rates (per 10,000 person-years) were 16.17 (95% CI 15.55–16.80) and 70.23 (95% CI 68.65–71.83) in 2002 and 2013, respectively. For boys, the incidence rates were 1.09 (95% CI 0.95–1.24) and 5.72 (95% CI 5.32–6.15) in 2002 and 2013, respectively. The sex ratio (F:M) of the incidence of PP cases was 14.89 in 2002 and 12.28 in 2013. Conclusion: In this study, from 2000 to 2013, the frequency of visiting pediatric endocrinology outpatient clinics for precocious puberty increased in both genders. We advocate that it is important to pay increased attention to children’s health, environmental hormones, and diet. Researchers should consider how to survey precocious puberty and offer parents more education to avoid the waste of medical resources or delays in seeking medical care. Full article