Publications by authors named "Jeong Yeon Seon"

10 Publications

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Comorbidities and Factors Determining Medical Expenses and Length of Stay for Admitted COVID-19 Patients in Korea.

Risk Manag Healthc Policy 2021 18;14:2021-2033. Epub 2021 May 18.

Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea.

Purpose: No previous investigations of coronavirus disease 2019 (COVID-19) have estimated medical expenses, length of stay, or factors influencing them using administrative datasets. This study aims to fill this research gap for the Republic of Korea, which has over 10,000 confirmed COVID-19 cases.

Patients And Methods: Using the nationwide health insurance claims data of 7590 confirmed COVID-19 patients, we estimated average medical expenses and inpatient days per patient, and performed multivariate negative binomial, and gamma regressions to determine influencing factors for higher outcomes.

Results: According to the results, COVID-19 patients with history of ICU admission, chest CT imaging, lopinavir/ritonavir and hydroxychloroquine use stayed longer in the hospital and spent more on medical expenses, and anti-hypertensive drugs were insignificantly associated with the outcomes. Female patients stayed longer in the hospital in the over 65 age group but spent less in medical expenses that the 20-39 group. In the 40-69 age group, patients with health insurance stayed longer in the hospital and spent more on medical expenses than those aged over 65 years. Comorbidities did not affect outcomes in most age groups.

Conclusion: In summary, contrary to popular beliefs, medical expenses and length of hospitalization were mostly influenced by age, and not by comorbidities, anti-viral, or anti-hypertensive drugs. Thus, responses should focus on infection prevention and control rather than clinical countermeasures.
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http://dx.doi.org/10.2147/RMHP.S292538DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8140929PMC
May 2021

Characteristics in Pediatric Patients with Coronavirus Disease 2019 in Korea.

J Korean Med Sci 2021 May 24;36(20):e148. Epub 2021 May 24.

Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Korea.

Background: Based on the reports of low prevalence and severity of pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, the Korean government has released new SARS-CoV-2 infection response and treatment guidelines for children under the age of 12 years. The government has further directed school reopening under strict preventive measures. However, there is still considerable concern on the impact of school reopening on community transmission of Coronavirus disease 2019 (COVID-19). In the present study, we aimed to evaluate the appropriateness of these directives and the severity of SARS-CoV-2 infections in children as compared to adults using sufficient national sample data.

Methods: In the present study, we evaluated the severity of SARS-CoV-2 infection in pediatric patients as compared to adults by analyzing the length of hospital stays (LOS), medical expenses, and hospital and intensive care unit (ICU) admission rates. A multivariate linear regression analysis was carried out to examine the effects of COVID-19 patients that the characteristics on the LOS and medical expenses, and multivariate logistic regression analysis were performed to identify COVID-19 characteristics that affect hospital and ICU admission rates and to prove the low SARS-CoV-2 infection severity in pediatric patients.

Results: The hospitalization period for children aged 0-9 was 37% shorter and that of patients aged 10-19 years was 31% shorter than those of older age groups ( < 0.001). The analysis of the medical expenses by age showed that on average, medical expenses for children were approximately 4,900 USD lower for children than for patients over 80 years of age. The linear regression analysis also showed that patients who were 0-9 years old spent 87% and those aged 10-19 118% less on medical expenses than those aged 70 and over, even after the correction of other variables ( < 0.001). The probability of hospitalization was the lowest at 10-19 years old (odds ratio [OR], 0.05; 95% confidence interval [CI], 0.03-0.09), and their ICU admission rate was also the lowest at 0.14 (OR, 0.14; 95% CI, 0.08-0.24). On the other hand, the likelihood of hospitalization and ICU admission was the highest in children aged 0-9 years, and among patients under the age of 50 years in general.

Conclusion: This study demonstrated the low severity of SARS-CoV-2 infection in younger patients (0-19 years) by analyzing the LOS, medical expenses, hospital, and intensive care unit admission rates as outcome variables. As the possibility to develop severe infection of coronavirus at the age of 10-19 was the lowest, a mitigation policy is also required for middle and high school students. In addition, children with underlying diseases need to be protected from high-risk infection environments.
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http://dx.doi.org/10.3346/jkms.2021.36.e148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144591PMC
May 2021

Risk Factors of Outcomes of COVID-19 Patients in Korea: Focus on Early Symptoms.

J Korean Med Sci 2021 May 10;36(18):e132. Epub 2021 May 10.

Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea.

Background: Coronavirus disease 2019 (COVID-19) has spread around the globe, and it is important to determine the risk factors of death in the general population. Our study aimed to determine the risk factors of death and severe illness requiring supplemental oxygen therapy based on the demographic and clinical characteristics of COVID-19 patients in Korea.

Methods: In this study, we used data provided by the Korea Disease Control and Prevention Agency (KDCA) and analyzed a total of 5,068 patients with COVID-19, excluding 19 pregnant women and 544 individuals with missing data. We performed logistic regression analysis to determine the impact of early symptoms on survival and severe disease. Logistic regression models included sex, age, number of comorbidities, symptoms on admission, blood pressure, heart rate, and body temperature as explanatory variables, and death and oxygen therapy as outcome variables.

Results: Logistic regression analyses revealed that the male sex, older age (≥ 60 years), higher number of comorbidities, presence of symptoms on admission, heart rate ≥ 120 bpm, and body temperature ≥ 37.5°C presented with higher risk of in-hospital death and oxygen therapy requirement. Conversely, rhinorrhea and headache were associated with a low risk of death and oxygen therapy requirement. The findings showed that cough, sputum, and fever were the most common symptoms on admission, while 25.3% of patients with COVID-19 were asymptomatic.

Conclusion: COVID-19 patients with high-risk early symptoms on admission, such as dyspnea and altered mental status, and those without low-risk symptoms of rhinorrhea and headache should be included in priority treatment groups.
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http://dx.doi.org/10.3346/jkms.2021.36.e132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111043PMC
May 2021

A National Study of Life-Sustaining Treatments in South Korea: What Factors Affect Decision-Making?

Cancer Res Treat 2021 Apr 21;53(2):593-600. Epub 2020 Nov 21.

Department of Preventive Medicine, Kyung Hee University School of Medicine, Seoul, Korea.

Purpose: This cross-sectional study investigated the status of life-sustaining treatment (LST) practices and identified characteristics and factors influencing decision-making practices.

Materials And Methods: The National Agency for Management of Life-sustaining Treatment retains records provided by doctors regarding patients subject to LST implementation. A total of 71,327 patients receiving LST were identified. We analyzed all nationally reported data between February 2018 and October 2019. Indicators such as the proportion of deaths, records for decision to terminate LST, implementation of LST records, and registration of Advance Statements on LST were analyzed.

Results: A total of 67,252 (94.3%) end-of life decisions were implemented in South Korea. The proportion of deaths preceded by a LST plan, non-self-determination LST decision, and any advance statements was 33.5% (23,891/71,327), 66.5% (47,436/71,327), and 1.2% (890/71,327), respectively. The logistic regression model revealed that self-determination to terminate LST was more frequent for men than for women and higher for those aged 30-69. Disability (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.56 to 0.61), living in non-metropolitan areas (OR, 0.84; 95% CI, 0.81 to 0.86), and disease comorbidity was independently associated with a low level of self-determination.

Conclusion: After the implementation of the new LST Act, about a third of patients in end-of-life process made decisions regarding their medical LST. However, family members still play a major role in LST decisions where the patient's intention cannot be verified. Decisions related to LST are predominantly made when death is imminent. Thus, it is necessary to increase awareness of end-of-life LST decision-making among medical staff and the public.
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http://dx.doi.org/10.4143/crt.2020.803DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053857PMC
April 2021

Intensive Care Unit Capacity and Its Associated Risk Factors During the COVID-19 Surge in the Republic of Korea: Analysis Using Nationwide Health Claims Data.

Risk Manag Healthc Policy 2020 12;13:2571-2581. Epub 2020 Nov 12.

Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea.

Objective: To identify risk factors for intensive care unit (ICU) admission and mechanical ventilator usage among confirmed coronavirus disease (COVID-19) patients and estimate the effects of mitigation efforts on ICU capacity in Korea.

Patients And Methods: Data on profiles and medical history of all confirmed COVID-19 patients in the past 1 year were extracted from the Korean National Health Insurance System's claims database to assess risk factors for ICU admission and ventilator use. We used a time-series epidemic model to estimate the ICU census in Daegu from the reported hospital data.

Findings: Multivariate regression analysis revealed male sex, old age, and residing in Daegu city as significant risk factors for ICU admission. The number of patients requiring ICU admission exceeded the bed capacity across all Daegu hospitals before March 9, 2020, and therefore, critically ill patients were transferred to nearby hospitals outside Daegu. This finding was consistent with our prediction that the ICU census in Daegu would peak on March 16, 2020, at 160 through mitigation efforts, without which it would have reached 300 by late March 2020.

Conclusion: Older age and male sex were risk factors for ICU admission. In addition, the geographic location of the hospital seems to contribute to the severity of the COVID-19 patients admitted to the ICU and to the ICU capacity.
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http://dx.doi.org/10.2147/RMHP.S273363DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7669513PMC
November 2020

Influencing Factors of Transportation Costs Regarding Healthcare Service Utilization in Korea.

J Korean Med Sci 2020 Sep 7;35(35):e290. Epub 2020 Sep 7.

Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Korea.

Background: Transportation costs can be a barrier to healthcare services, especially for low-income, disabled, elderly, and geographically isolated populations. This study aimed to estimate the transportation costs of healthcare service utilization and related influencing factors in Korea in 2016.

Methods: Transportation costs were calculated using data from the 2016 Korea Health Panel Study. A total of 14,845 participants were included (males, 45.07%; females, 54.93%), among which 2,148 participants used inpatient and 14,787 used outpatient care services. Transportation costs were estimated by healthcare types, transportation modes, and all disease and injury groups that caused healthcare service utilization. The influencing factors of higher transportation costs were analyzed using multivariable regression analysis.

Results: In 2016, the average transportation costs were United States dollars (USD) 43.70 (purchasing power parity [PPP], USD 32.35) per year and USD 27.67 (PPP, USD 20.48) per visit for inpatient care; for outpatient case, costs were USD 41.43 (PPP, USD 30.67) per year and USD 2.09 (PPP, USD 1.55) per visit. Among disease and injury groups, those with neoplasms incurred the highest transportation costs of USD 9.73 (PPP, USD 7.20). Both inpatient and outpatient annual transportation costs were higher among severely disabled individuals (inpatient, +USD 44.71; outpatient, +USD 23.73) and rural residents (inpatient, +USD 20.40; outpatient, +USD 28.66). Transportation costs per healthcare visit were influenced by healthcare coverage and residential area. Sex, age, and income were influencing factors of higher transportation costs for outpatient care.

Conclusion: Transportation cost burden was especially high among those with major non-communicable diseases (e.g., cancer) or living in rural areas, as well as elderly, severely disabled, and low-income populations. Thus, there is a need to address the socioeconomic disparities related to healthcare transportation costs in Korea by implementing targeted interventions in populations with restricted access to healthcare.
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http://dx.doi.org/10.3346/jkms.2020.35.e290DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476794PMC
September 2020

Analysis of Risk Factors on Readmission Cases of COVID-19 in the Republic of Korea: Using Nationwide Health Claims Data.

Int J Environ Res Public Health 2020 08 12;17(16). Epub 2020 Aug 12.

Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul 02447, Korea.

In South Korea, 4.5% patients of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were readmitted to hospitals after discharge. However, there is insufficient research on risk factors for readmission and management of patients after discharge is poor. In this study, 7590 confirmed coronavirus disease (COVID-19) patients were defined as a target for analysis using nationwide medical claims data. The demographic characteristics, underlying diseases, and the use of medical resources were used to examine the association with readmission through the chi-square test and then logistic regression analysis was performed to analyze factors affecting readmission. Of the 7590 subjects analyzed, 328 patients were readmitted. The readmission rates of men, older age and patients with medical benefits showed a high risk of readmission. The Charlson Comorbidity Index score was also related to COVID-19 readmission. Concerning requiring medical attention, there was a higher risk of readmission for the patients with chest radiographs, computed tomography scans taken and lopinavir/ritonavir at the time of their first admission. Considering the risk factors presented in this study, classifying patients with a high risk of readmission and managing patients before and after discharge based on priority can make patient management and medical resource utilization more efficient. This study also indicates the importance of lifestyle management after discharge.
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http://dx.doi.org/10.3390/ijerph17165844DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7460295PMC
August 2020

Maternal nutrition intervention focused on the adjustment of salt and sugar intake can improve pregnancy outcomes.

Food Sci Nutr 2020 Jul 10;8(7):3900-3911. Epub 2020 Jun 10.

Department of Medical Nutrition Graduate School of East-West Medical Science Kyung Hee University Yongin Korea.

Due to the increasing age of pregnant women, maternal nutrition management is becoming more important. Since pregnant women are more likely to consume sodium and sugars than nonpregnant women of the same age, we investigated whether maternal nutrition intervention focused on the adjustment of salt and sugar intake can help pregnancy outcome. This randomized controlled trial was performed on 142 pregnant women within 22 weeks of gestational age for at least 16 weeks until childbirth. Subjects were unequally assigned to the intervention group ( = 98) and the control group ( = 44). Dietary changes based on perceived taste preferences were evaluated by 24-hr dietary recall and food frequency questionnaires (FFQ) at pre- and postintervention. In the intervention group, while the intakes of energy, protein, and vitamins were maintained, the intakes of sodium ( < .001) and sugar from processed food ( < .05) were significantly reduced after the intervention. The decreases in salt and sugar consumption were more pronounced in the mothers who had a high preference for saltiness and sweetness. The mean neonatal birth weight of the intervention group was significantly greater than the weight of control group, (3,251.5 ± 402.2 g vs. 2,974.5 ± 294.8 g, < .05). Through this study, nutrition intervention was found to be effective for the formation of healthy eating habits such as reduced salt and sugar intake in pregnant women especially with a high preference for saltiness and sweetness. Also, such specialized maternal nutrition intervention during pregnancy promotes the birth of healthy newborn babies of normal weight.
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http://dx.doi.org/10.1002/fsn3.1699DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7382176PMC
July 2020

Duplicated tramadol use in chronic low back pain: A nationwide cross-sectional study.

Basic Clin Pharmacol Toxicol 2020 Mar 8;126(3):226-235. Epub 2019 Oct 8.

College of Pharmacy, Chung-Ang University, Seoul, Korea.

Tramadol is a weak opioid that is commonly used for chronic low back pain (LBP). Despite its effectiveness, duplicated use of tramadol, which may indicate abuse or dependence, may exacerbate potential adverse reactions. This population-based, cross-sectional study aimed to investigate the prevalence of duplication of tramadol and its associated factors among patients with LBP. From a Korean nationwide claims database, non-hospitalized patients aged 40-99 years with LBP without malignancy were prescribed tramadol during 2014-2016. Duplication of tramadol was defined as overlapping of prescription days. Among them, we defined "extensive duplication (ED)" when days of tramadol duplication cover 10% or more of the days prescribed tramadol. Patient and healthcare utilization factors associated with ED were examined using a logistic regression model. The study population was 6 417 503 patients. Of these, 13.7% were ED users. The age- and sex-standardized prevalence of using tramadol twice or more a year was 14.06 per 100 people in 2014, 13.74 per 100 people in 2015 and 13.52 per 100 people in 2016. ED occurred more in those in the group aged 70-79 years (OR 1.12, 95% CI 1.11-1.13) than 40-49 years and in those with comorbidities, such as drug abuse (OR 2.99, 95% CI 2.05-4.36) or depression (OR 1.75, 95% CI 1.72-1.77). Based on the results of this study, a proper management system is needed to avoid tramadol duplication among older people and patients with drug abuse or depression.
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http://dx.doi.org/10.1111/bcpt.13324DOI Listing
March 2020

Factors associated with potentially harmful drug-drug interactions in older Korean people: A population-based study.

Geriatr Gerontol Int 2018 Sep 10;18(9):1378-1382. Epub 2018 Aug 10.

Department of Family Medicine, Chungnam National University Hospital, Daejeon, Korea.

Aim: The present study investigated the status of potentially harmful drug-drug interactions (PHDI) in older adults, to obtain insight into factors that influence the risk of PHDI.

Methods: The present study included Korean people aged ≥65 years who were prescribed one or more drugs included in the list of PHDI under the Beers Criteria 2015 from January to December, 2016 (n = 1 257 317). PHDI were defined based on the Beers Criteria 2015. Among 10 PHDI, a prevalence of >5% was taken to be clinically significant, and the relationships between multiple variables and PHDI were examined.

Results: The most frequent PHDI was corticosteroids and non-steroidal anti-inflammatory drugs (n = 259 499, 20.64%), followed by a combination of two or more anticholinergic drugs (n = 139 622, 11.1%), and three or more drugs acting on the central nervous system (n = 86 023, 6.84%). These three types of PHDI were more frequent in women (OR 1.066-1.141) and medical aid beneficiaries (OR 1.095-1.510). The risk of PHDI increased in proportion to the number of healthcare institutions used by the participants and their outpatient visits during the year (OR 1.043-1.079, 1.008-1.010, respectively). The risk of PHDI was low when patients took no more than five medications in a single prescription (OR 0.017-0.791).

Conclusions: The findings of the present study highlight the three most frequent PHDI in Korea according to the Beers Criteria 2015. Healthcare providers should take PHDI into account when treating female patients, medical aid beneficiaries, patients using multiple healthcare institutions, frequent outpatient visitors and patients prescribed more than six medications in a single prescription. Geriatr Gerontol Int 2018; 18: 1378-1382.
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http://dx.doi.org/10.1111/ggi.13495DOI Listing
September 2018
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