Search Results (667)

This study investigates the impact of the COVID-19 pandemic on clinically diagnosed depression in South Korea, focusing on gender disparities and structural risk factors such as job loss and childcare burden. Although mental health inequalities have received growing attention during the pandemic, most existing research relies on self-reported survey data with inherent limitations. To address this gap, we utilized administrative health data from a 2% stratified random sample of the total population (N = 297,368) in the National Health Insurance Database, focusing on employed individuals without a prior history of depression. Multivariable Cox proportional hazard regression revealed that women had significantly higher risks of depression than men, particularly among those in their 20s to 40s, those who experienced job loss, those who had children aged 7–9, and those who belonged to high-income groups. These findings suggest that the intersection of employment instability and caregiving responsibilities disproportionately affected women’s mental health during the pandemic. The results underscore the urgent need for gender-sensitive public health policies that expand childcare support, institutionalize flexible work arrangements such as telecommuting, and enhance access to targeted mental health services to reduce pandemic-induced gender disparities in mental health. Full article

Background/Objectives: Chronic kidney disease (CKD) and osteoporosis are critical public health concerns, particularly among older adults, due to their prevalence and associated complications. While CKD-related disruptions in bone mineral metabolism are believed to increase osteoporosis risk, this relationship remains unclear in diverse populations such as Korea. Methods: This longitudinal cohort study utilized data from the Korean National Health Insurance Service Health Screening Cohort (2002–2019), including 13,622 patients with newly diagnosed CKD and 54,488 matched controls. CKD was defined as having at least two outpatient or inpatient records with ICD-10 codes N18 or N19 and/or evidence of dialysis treatment claims, following a 1-year washout period to exclude prevalent cases. Individuals with a prior history of osteoporosis or incomplete baseline data were excluded. Propensity score overlap weighting was applied, and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards models, with subgroup analyses based on demographic and clinical factors. Results: CKD was not associated with an increased risk of osteoporosis. On the contrary, CKD patients exhibited an 18% lower risk of developing osteoporosis compared to controls (HR = 0.82, 95% CI: 0.77–0.87, p < 0.001). This inverse association was more pronounced among women, non-smokers, individuals with low alcohol consumption, and those with a higher comorbidity burden. Conclusions: These findings suggest that certain subgroups of CKD patients may have a reduced risk of osteoporosis, highlighting the importance of individualized risk assessment and tailored preventive strategies. Full article

Background/Objectives: The two major subtypes of inflammatory bowel disease (IBD)—Crohn’s disease (CD) and ulcerative colitis (UC)—are known to increase the likelihood of developing colorectal cancer (CRC). While this relationship has been well studied in Western populations, evidence from East Asia remains limited and inconsistent. Using nationwide cohort data, this study explored the potential connection between IBD and CRC in a large Korean population. Methods: We conducted a retrospective cohort study using data from the Korean National Health Insurance Service–National Sample Cohort from 2005 to 2019. A total of 9920 CRC patients were matched 1:4 with 39,680 controls using propensity scores based on age, sex, income, and region. Overlap weighting and multivariable logistic regression were used to evaluate the association between IBD and CRC. Subgroup analyses were conducted to assess effect modification by demographic and clinical factors. Results: IBD markedly increased the likelihood of developing CRC (adjusted odds ratio (aOR) = 1.38; 95% confidence interval (CI): 1.20–1.58; p < 0.001), with the association primarily driven by UC (aOR = 1.52; 95% CI: 1.27–1.83). CD appeared unrelated to heightened CRC risk overall, though a significant association was observed among low-income CD patients (aOR = 1.58; 95% CI: 1.15–2.16). The UC–CRC association persisted across all subgroups, including patients without comorbidities. Conclusions: Our findings support an independent association between IBD—particularly UC—and increased CRC risk in Korea. These results underscore the need for personalized CRC surveillance strategies that account for disease subtype, comorbidity burden, and socioeconomic status, especially in vulnerable subpopulations. Full article

Objective: This study aimed to investigate the impact of depression and anxiety disorders on mortality in women diagnosed with gynecologic cancers, utilizing nationwide retrospective cohort data. Methods: Data from the Korean National Health Insurance Service (NHIS) database, covering women diagnosed with cervical, endometrial, or ovarian cancers between 2007 and 2014, were analyzed. Women diagnosed with depression or anxiety disorders within one year after cancer diagnosis were identified and compared with a control group comprising patients with gynecologic cancers who did not develop either disorder during the same post-diagnosis period. Mortality was evaluated as the primary outcome. Results: Of 85,327 women analyzed, 784 (0.9%) were diagnosed with depression or anxiety disorders. Patients with depression or anxiety exhibited significantly higher mortality (38.4% vs. 29.9%; p < 0.001). Multivariate analysis indicated that depression significantly increased mortality risk (OR 1.46, 95% CI 1.27–1.66), whereas anxiety alone showed no significant effect (OR 0.97, 95% CI 0.74–1.27). Combined depression and anxiety showed the highest mortality risk (OR 1.47, 95% CI 1.31–1.65). Conclusions: Depression and anxiety disorders are significant predictors of increased mortality in women with gynecologic cancers, emphasizing the necessity for integrated mental health assessment and interventions in oncologic care to improve both survival and quality of life. Full article

Background/Objectives: Urban green space has been increasingly recognized as a determinant of maternal and child health. This study investigated the association between prenatal exposure to different types of green space and the risk of congenital anomalies in South Korea. Methods: We analyzed data from the National Health Insurance Service (N = 142,422). Green space exposure was measured at the area level and categorized into grassland and forest; statistical analysis was performed using generalized estimating equations and generalized additive models to analyze the associations. Additionally, subgroup and sensitivity analyses were performed. Results: GEE analysis showed that a 10% increase in the proportion of grassland in a residential district was associated with a reduced risk of nervous system (adjusted odds ratio [aOR]: 0.77, 95% confidence interval [CI]: 0.63–0.94) and genitourinary system anomalies (aOR: 0.83, 95% CI: 0.71–0.97). The subgroup analysis results showed significance only for male infants, but the difference between the sexes was not significant. In the quartile-based analysis, we found a slightly significant p-value for trend for the effect of forests on digestive system anomalies, but the trend was toward increasing risk. In a sensitivity analysis with different exposure classifications, the overall and nervous system anomalies in built green space showed that the risk decreased as green space increased compared to that in the lowest quartile. Conclusions: Our results highlight the importance of spatial environmental factors during pregnancy and suggest that different types of green spaces differentially impact the offspring’s early health outcomes. This study suggests the need for built environment planning as part of preventive maternal and child health strategies. Full article

Background: Septic arthritis is an orthopedic emergency. However, optimal biomarkers and diagnostic criteria remain unclear. The study aimed to evaluate the diagnostic performance of routinely used and novel biomarkers, including serum C-reactive protein (CRP), synovial white blood cells (WBC), pentraxin-3 (PTX3), interleukin-6 (IL-6), and presepsin, in distinguishing septic from non-septic arthritis. Methods: Thirty-one patients undergoing arthrocentesis were included. Patients were categorized into septic and non-septic arthritis groups. Synovial fluid and serum samples were analyzed for five biomarkers. Diagnostic performance was assessed by calculating the area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: Synovial WBC demonstrated the highest diagnostic performance among single biomarkers (AUC = 0.837, p = 0.012). Among novel biomarkers, PTX3 showed the highest accuracy and sensitivity. The serum CRP and synovial WBC combination yielded an AUC of 0.853, with 100% sensitivity, 68.0% specificity, 42.9% PPV, and 100% NPV. Adding all three novel biomarkers to this combination increased the AUC to 0.887 (p = 0.004), maintaining 100% sensitivity and NPV. When individually added, PTX3 achieved 100% sensitivity and NPV, while presepsin showed the highest specificity (96.0%), PPV (75.0%), and accuracy (87.1%). Conclusions: Serum CRP and synovial WBC remain essential biomarkers for diagnosing septic arthritis; however, combining them with PTX3, IL-6, and presepsin improved diagnostic accuracy. PTX3 is best suited for ruling out septic arthritis due to its high sensitivity and NPV, whereas presepsin is more useful for confirmation, given its specificity and PPV. These results support a tailored biomarker approach aligned with diagnostic intent. Full article

Purpose: Despite increasing rates of prostate cancer among men, prostate cancer risk assessments continue to rely on invasive laboratory tests like prostate-specific antigen and Gleason score tests. This study aimed to develop a noninvasive, data-driven risk model for patients to evaluate themselves before deciding whether to visit a hospital. Materials and Methods: To train the model, data from the National Health Insurance Sharing Service cohort datasets, comprising 347,575 individuals, including 1928 with malignant neoplasms of the prostate, 5 with malignant neoplasms of the penis, 18 with malignant neoplasms of the testis, and 14 with malignant neoplasms of the epididymis, were used. The risk model harnessed easily accessible inputs, such as history of treatment for diseases including stroke, heart disease, and cancer; height; weight; exercise days per week; and duration of smoking. An additional 286,727 public datasets were obtained from the National Health Insurance Sharing Service, which included 434 (0.15%) prostate cancer incidences. Results: The risk calculator was built based on Cox proportional hazards regression, and I validated the model by calibration using predictions and observations. The concordance index was 0.573. Additional calibration of the risk calculator was performed to ensure confidence in accuracy verification. Ultimately, the actual proof showed a sensitivity of 60 (60.5) for identifying a high-risk population. Conclusions: The feasibility of the model to evaluate prostate cancer risk without invasive tests was demonstrated using a public dataset. As a tool for individuals to use before hospital visits, this model could improve public health and reduce social expenses for medical treatment. Full article

Background: Pain is a common, often debilitating ailment that may necessitate considerable health service utilization. However, there is a need to assess the associations of pain intensity and other variables with health service utilization among United States adults who have pain. Methods: This cross-sectional database analysis made use of the Medical Expenditure Panel Survey full-year consolidated data file and included United States adults (≥18 years) who have pain. The dependent variables consisted of four health service utilization variables, which included the number of emergency room visits, inpatient discharges, office visits, and outpatient visits in 2021. The number of visits or discharges were categorized as either ≥1 or 0. The independent variable was pain intensity (extreme, quite a bit, moderate, or little pain). Other variables analyzed included age, race, ethnicity, sex, marriage, education, employment, income, insurance, chronic conditions, limitations, exercise, smoking, physical health, and mental health. Chi-squared tests compared differences between pain intensity groups, and multivariable logistic regression models assessed the associations of pain intensity and other variables with each of the four health service utilization variables. The analysis was weighted for national estimates. The significance (alpha) level was 0.05. Results: This analysis included 6280 adults, representing 89,314,769 United States adults with pain. In the multivariable analyses, there were statistically significant associations for extreme pain (odds ratio = 1.72, 95% confidence interval = 1.27–2.33), quite a bit of pain (odds ratio = 1.75, 95% confidence interval=1.37–2.24), and moderate pain (odds ratio = 1.28, 95% confidence interval = 1.02–1.60) versus little pain with emergency room visits, extreme pain (odds ratio = 2.10, 95% confidence interval = 1.44–3.08) and quite a bit of pain (odds ratio = 1.66, 95% confidence interval = 1.21–2.28) versus little pain with inpatient discharges, and quite a bit of pain (odds ratio = 1.47, 95% confidence interval = 1.03–2.11) versus little pain with office visits. There was no correlation between pain intensity levels and outpatient visits. In addition, several other variables were associated with various health service utilization variables. Conclusions: This database analysis discovered greater pain intensity levels were often correlated with increased health service utilization, including more emergency room, inpatient, and office visits. These findings may inform the development of targeted interventions for people with specific characteristics. Further work is needed to implement initiatives that optimize health service utilization and ultimately improve health outcomes for United States adults who have pain. Full article

Background/Objectives: Low-density lipoprotein cholesterol (LDL-C) is a causal factor in the development of atherosclerosis and a predictor of cardiovascular disease. However, the association between LDL-C levels and cardiovascular outcomes in patients undergoing dialysis remains controversial, with current guidelines advising against initiating statin therapy in this population. This study investigated the relationship between LDL-C levels and cardiovascular outcomes in Korean adults undergoing dialysis, using nationwide data. Methods: A total of 21,692 patients with end-stage kidney disease undergoing dialysis between 2009 and 2017 were identified from the Korean National Health Insurance Service database. Statin non-users (primary cohort) and users (secondary cohort) comprised 15,414 and 6278 patients, respectively. LDL-C levels were categorized, and cardiovascular outcomes including composites of cardiovascular death, myocardial infarction, and ischemic stroke were analyzed. Results: Among statin non-users, LDL-C levels > 100 mg/dL were significantly associated with an increased risk of the composite outcome, in a dose-dependent manner, compared with LDL-C levels < 70 mg/dL. Specifically, participants with LDL-C levels ≥ 160 mg/dL demonstrated a 43% increased risk of the composite outcome and a 2.25-fold higher risk of myocardial infarction compared to those with LDL-C levels < 70 mg/dL. Among statin users, LDL-C levels > 130 mg/dL were associated with an increased risk of the composite outcome. Conclusions: This study highlights the significant association between elevated LDL-C levels and adverse cardiovascular outcomes in patients undergoing dialysis. These findings underscore the importance of close monitoring and proactive management of LDL-C levels in this high-risk population. Future research should focus on developing tailored lipid-lowering strategies to improve cardiovascular outcomes in these patients. Full article

Obesity has been shown to be an independent risk factor for the development of heart failure (HF) and atherosclerotic cardiovascular disease. Here, we tried to analyze the distribution of obesity by age and sex in a 10-year sample cohort of newly diagnosed HF patients in Korea. A total of 35,869 patients newly diagnosed with HF between 2006 and 2015 from a nationally representative random sample of 1,000,000 people were included in this study. The data of age and sex for each subgroup according to body mass index were analyzed and compared with the general population. The obese group accounted for 43.3% of the total, and the frequency of obese patients was the highest among those in their 60s (4561). The proportion of obesity was the highest among those in their 40s (57.7%) and 30s (57.3%) in men and the highest among those in their 60s (52.2%) in women. The underweight group increases with age in both men and women, and the proportion of the high-aged group over 80 years old in the underweight group of women is significantly much higher than that of men. Conclusively, the proportion of obesity is higher than in the general population in HF patients. Obesity patterns analyzed by age were different for each sex. Full article

Background and Objectives: Air pollutants have been shown to affect hypertensive disorders and placental hypoxia due to vasoconstriction, inflammation, and oxidative stress. The objective of this study was to evaluate whether high levels of maternal exposure to heavy metals during the second trimester of pregnancy are associated with an increased risk of preeclampsia and eclampsia, using national health insurance claim data from South Korea. Methods: Data on mothers and their newborns from 2016 to 2020, provided by the National Health Insurance Service, were used (n = 1,274,671). Exposure data for ambient air pollutants (PM2.5, CO, SO₂, NO₂, and O₃) and heavy metals (Pb, Cd, Cr, Cu, Mn, Fe, Ni, and As) during the second trimester of pregnancy were retrieved from the Korea Environment Corporation. Atmospheric condition data based on the mother’s registration area were matched. A logistic regression model was adjusted for maternal age, infant sex, season of conception, and household income. Results: In total, 16,920 cases of preeclampsia and 592 cases of eclampsia were identified. In the multivariate model, copper exposure remained significantly associated with an increased risk of preeclampsia (odds ratio: 1.011; 95% confidence interval: 1.001–1.023), and higher ozone exposure during pregnancy was associated with an elevated risk of eclampsia. Conclusions: Increased copper exposure during the second trimester of pregnancy was associated with a high incidence of preeclampsia. Full article

In postmenopausal women, the prevalence of hypertension increases sharply, emphasizing the importance of its prevention. This increased risk highlights the critical need for effective prevention strategies specifically designed for this population. To address this issue, the present study aimed to identify easily measurable risk factors that contribute to hypertension in postmenopausal women using explainable artificial intelligence (XAI) and machine learning (ML) techniques. This study conducted hypertension classification by analyzing health checkup data from 3289 postmenopausal Korean women aged 55–79 years, extracted from the 2022–2023 Korea National Health Insurance Service (KNHIS) database, using XGBoost, SVM and ANN. XGBoost was the most effective model (AUC: 92.12%, MCC: 0.71) in hypertension classification. Shapley Additive exPlanations-based feature importance identified age and waist circumference (WC) as the most important risk factors for hypertension. In this study, blood pressure increased with variations in WC, a modifiable risk factor. These findings suggest that WC should be managed more strictly to prevent hypertension in postmenopausal women. Full article

Background and Objectives: Breast reconstruction following mastectomy improves quality of life and psychosocial outcomes, yet it is not consistently performed despite multiple federal mandates. Current data shows decreased reconstruction in minority races, those with a low socioeconomic status, and those holding public health insurance. Many barriers remain misunderstood or unstudied. This study examines barriers to post-mastectomy breast reconstruction to promote a supportive clinical climate by addressing multifactorial obstacles to equitable access to care. Materials and Methods: The California Cancer Registry Data Surveillance, Epidemiology, and End Results (SEER) database and California Health and Human Services Agency Cancer Surgeries Database (2013–2021 and 2000–2021, respectively) were used in this retrospective observational study on mastectomy with immediate breast reconstruction (IBR), delayed breast reconstruction (DBR), or mastectomy only (MO) rates. Data were collected on age, sex, race, insurance type, hospital type, socioeconomic status, and residence. Pearson’s chi-square analysis was performed. Results: We found that 168,494 mastectomy and reconstruction surgeries were performed (82.36% MO, 7% IBR, 10.6% DBR). The 40–49 age group received significantly less MO (38.1%) compared to the 70–74 age group (94.8%, (p = <0.001). Significantly more reconstruction was carried out in patients with private, HMO, or PPO insurance (IBR 75.86%, DBR 75.32%, p = <0.001). Almost all breast surgeries were in urban areas as opposed to rural/isolated rural areas (96.02% vs. 1.55%, p = <0.001). There was no significant difference between races. Of all surgeries, 7.46% were completed in a cancer center with significantly higher rates of IBR. LA County, San Luis Obispo/Ventura County, and Northern CA had significantly more MO than other regions (p = <0.001). Conclusions: Reconstruction rates after mastectomy are low, with only 17.64% of patients undergoing reconstruction. Nationally, 70.5% of patients received MO, with 29.6% undergoing reconstruction. Significant factors positively contributing to reconstruction were private insurance, high SES, cancer center care, and urban residency. Identified barriers include public health insurance enrollment, rural or non-urban residence, older age, low SES, and non-white race/ethnicity, indicating potential monetary influences on care. Full article

Background/Objectives: The outbreak of coronavirus disease 2019 (COVID-19) has restricted access to healthcare, increasing the risk of poor disease control among patients with COPD (Chronic Obstructive Pulmonary Disease). This study aimed to compare adherence to inhalers in patients with COPD before and during the COVID-19 lockdown and determine the characteristics of patients who were adherent to inhaler medications. Method: A retrospective analysis was conducted on a cohort of patients with severe COPD aged 40 or older using South Korea’s National Health Insurance Service (NHIS) database, which documents all healthcare utilization covered for insured individuals. Medication adherence, measured by the proportion of days covered (PDC), was compared before and during the COVID-19 lockdown using a paired t-test. A multivariable logistic regression model was conducted to identify the characteristics of the adherent patients (socio-demographic, including age, sex, income level, insurance type, and residential area), health-conditions (disease severity, underlying diseases, and disability), and pharmacotherapy characteristics (prescriber practice setting, polypharmacy, medication treatment duration, and inhaler type). Result: A total of 15,971 COPD patients were identified (79.2% men). During the COVID-19 lockdown in 2020, there was a significant decrease in medication adherence to COPD inhalers compared to 2019 (49.8% in 2020 vs. 56.3% in 2019, respectively; p < 0.001). Moreover, the proportion of those adherent (≥80%) during the COVID-19 lockdown decreased (22.0% → 18.0%). Patients who remained adherent to inhaler therapy during the COVID-19 lockdown were typically aged in their 60s, beneficiaries of Medical Aid, residents of rural areas, clinic users, and patients without cardiovascular disease. Conclusions: Patients with COPD encountered significant challenges in accessing inhalers during the COVID-19 lockdown. Healthcare authorities should develop targeted strategies to ensure continued medication access for patients at increased risk of poor medication adherence, particularly during periods of restricted healthcare access, such as public health emergencies or pandemic lockdowns. Full article

Flourishing in children is an indicator of positive development in the areas of emotional, social, and cognitive development. Using a recent dataset from the US National Survey of Children’s Health, this study investigates the association between access to a quality healthcare system and flourishing indicators in school-aged children with autism. The outcome variable describes the proportion of children aged 6–17 with autism meeting the flourishing criteria, which include measures related to learning, resilience, and self-regulation. The main independent variable includes six core indicators for school-aged children and adolescents, which assess whether the family feels like a partner in their child’s care, the child has a medical home, receives regular medical and dental preventive care, has adequate insurance, has no unmet needs or barriers to accessing services, and has prepared for transition to adult healthcare. Multivariable logistic regression models were used to examine the relationships between various independent variables and the outcome of interest. The results show that children with autism who receive comprehensive and coordinated care are more likely to flourish compared to those without such care for five of these six indicators, while controlling for sex, race, parental education, household income, self-reported autism severity, general health status, and the number of adverse childhood experiences. Children with autism are more likely to flourish when their families and healthcare providers work together effectively. Addressing gaps in the quality care system is essential for developing holistic approaches that empower children with autism to thrive and reach their full potential. Supportive health policies and effective coordination between families and healthcare providers are crucial for fostering the flourishing of children with autism, ensuring comprehensive, individualized, and continuous care. Full article