Publications by authors named "Seok-Jun Yoon"

118 Publications

Measuring the Burden of Disease in Korea, 2008-2018.

J Prev Med Public Health 2021 Sep 30;54(5):293-300. Epub 2021 Sep 30.

Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.

The study aims to examine the current status and differences in the burden of disease in Korea during 2008-2018. We calculated the burden of disease for Koreans from 2008 to 2018 using an incidence-based approach. Disability adjusted life years (DALYs) were expressed in units per 100 000 population by adding years of life lost (YLLs) and years lived with disability (YLDs). DALY calculation results were presented by gender, age group, disease, region, and income level. To explore differences in DALYs by region and income level, we used administrative district and insurance premium information from the National Health Insurance Service claims data. The burden of disease among Koreans showed an increasing trend from 2008 to 2018. By 2017, the burden of disease among men was higher than that among women. Diabetes mellitus, low back pain, and chronic lower respiratory disease were ranked high in the burden of disease; the sum of DALY rates for these diseases accounted for 18.4% of the total burden of disease among Koreans in 2018. The top leading causes associated with a high burden of disease differed slightly according to gender, age group, and income level. In this study, we measured the health status of Koreans and differences in the population health level according to gender, age group, region, and income level. This data can be used as an indicator of health equity, and the results derived from this study can be used to guide community-centered (or customized) health promotion policies and projects, and for setting national health policy goals.
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http://dx.doi.org/10.3961/jpmph.21.478DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8517373PMC
September 2021

Estimation of Years Lived with Disability Using a Prevalence-Based Approach: Application to Major Psychiatric Disease in Korea.

Int J Environ Res Public Health 2021 08 27;18(17). Epub 2021 Aug 27.

Department of Preventive Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Korea.

To help develop policies concerning the prevention of psychiatric disease in Korea, we reviewed the literature on this topic in different countries and used a prevalence-based approach to estimate the years lived with disability (YLDs) in Korean patients with major psychiatric diseases. We calculated YLDs by extracting data on the number of patients with mild, moderate, and severe cases of schizophrenia, bipolar disorder, and major depressive disorder, as classified by International Statistical Classification of Disease (ICD) codes. YLDs were highest for patients with major depressive disorder (1190.6; 73.9%), schizophrenia (303.3; 18.8%) and bipolar disorder (117.9; 7.3%). Men had higher YLDs for schizophrenia, 2502 (20-24 years); bipolar disorder, 477 (40-44 years); and major depressive disorder, 2034 (75-79 years). Women had higher YLDs for schizophrenia, 484 (45-49 years); bipolar disorder, 214 (≥80 years); and major depressive disorder, 3541 (75-79 years). The prevalence-based approach and severity distribution is useful for estimating long-term psychiatric disease burden and YLDs. However, YLD-estimation studies must compensate for the shortcomings of the ICD-10 by referencing the Diagnostic and Statistical Manual of Mental Disorders 5th edition, as well as updating the disability weight score according to disease severity.
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http://dx.doi.org/10.3390/ijerph18179056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8431236PMC
August 2021

Trend of Disease Burden of North Korean Defectors in South Korea Using Disability-adjusted Life Years from 2010 to 2018.

J Korean Med Sci 2021 Aug 16;36(32):e211. Epub 2021 Aug 16.

Department of Preventive Medicine, Korea University College of Medicine of Seoul, Korea.

Background: This study aimed to examine the disease burden of North Korean defectors in South Korea by sex, age, and disease from 2000 to 2018 and to study the changes in the disease burden over time.

Methods: Based on the incidence-based disability-adjusted life year (DALY) developed in a Korean National Burden of Disease (KNBD) study, we calculated the years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY) for approximately 22,753 North Korean defectors in South Korea whose claims data were available from the National Health Insurance Service (NHIS).

Results: In 2018, the rates of YLL, YLD, and DALY for North Korean defectors per 100,000 population was 3,763 (male 8,491; female 2,404), 37,683 (male 27,742; female 40,539), and 41,446 (male 36,233; female 42,943), respectively. Major depressive disorders constituted the highest DALY, followed by cirrhosis of the liver and low back pain. The disease burden of North Korean defectors consistently decreased from 2010 to 2018. The decrease in YLD contributed to the overall decline in DALY per 100,000 population in 2018, which decreased by 25.2% compared to that in 2010.

Conclusion: This is the first study to measure the disease burden of North Korean defectors in South Korea. Given the decreasing or substantially increasing trends in disease burden, it is necessary to establish appropriate public health policies in a timely manner, and the results of this study provide a basis for the development of customized public health and healthcare policies for North Korean defectors in South Korea.
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http://dx.doi.org/10.3346/jkms.2021.36.e211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8369312PMC
August 2021

The prevalence, incidence, and admission rate of diagnosed schizophrenia spectrum disorders in Korea, 2008-2017: A nationwide population-based study using claims big data analysis.

PLoS One 2021 12;16(8):e0256221. Epub 2021 Aug 12.

Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea.

This study estimated the prevalence and incidence rate of schizophrenia, schizotypal, and delusional disorders (SSDD) in Korea from 2008 to 2017 and analyzed the hospital admission rate, re-admission rate, and hospitalization period. It used the Korean nationwide National Health Insurance Service claims database. SSDD patients who had at least one visit to Korea's primary, secondary, or tertiary referral hospitals with a diagnosis of SSDD, according to the International Classification of Diseases, 10th Revision (ICD-10), were identified as SSDD cases if coded as F20-F29. Data were analyzed using frequency statistics. Results showed that the 12-month prevalence rate of SSDD increased steadily from 0.40% in 2008 to 0.45% in 2017. Analysis of the three-year cumulative prevalence rate of SSDD showed an increase from 0.51% in 2011 to 0.54% in 2017. In 2017, the five-year cumulative prevalence rate was 0.61%, and the 10-year cumulative prevalence rate was 0.75%. The hospital admission rate among SSDD patients decreased from 2008 (30.04%) to 2017 (28.53%). The incidence of SSDD was 0.05% and no yearly change was observed. The proportion of SSDD inpatients whose first hospital visit resulted in immediate hospitalization was 22.4% in 2017. Epidemiological indicators such as prevalence, incidence, and hospitalization rate play an important role in planning social and financial resource allocation. Therefore, efforts to produce more accurate epidemiological indicators are very important and this study's findings could have a significant social impact.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0256221PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8360527PMC
August 2021

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

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

The Gaps in Health-Adjusted Life Years (HALE) by Income and Region in Korea: A National Representative Bigdata Analysis.

Int J Environ Res Public Health 2021 03 27;18(7). Epub 2021 Mar 27.

Department of Preventive Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Korea.

This study aims to calculate the health-adjusted life years (HALE) by using years lived with disability (YLD) from the national claims data, as well as to identify the differences and inequalities in income level and region. The study was carried out on total population receiving health insurance and medical benefits. We calculated incidence-based YLD for 260 disease groups, and used it as the number of healthy years lost to calculate HALE. We adopted the insurance premium to calculate the income as a proxy indicator. For the region classification, we chose 250 Korean municipal-level administrative districts. Our results revealed that HALE increased from 2008 to 2018. HALE in males increased faster than that in females. HALE was higher in higher income levels. In 2018, the gap in HALE between Q1 and Q2, the lower income group, was about 5.57 years. The gap in females by income level was smaller than that in males. Moreover, the gap in HALE by region was found to increase. Results suggest that there is an inequality in YLD in terms of income level in Korea. Therefore, we need intensive management for the low-income group to promote HALE at the national level.
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http://dx.doi.org/10.3390/ijerph18073473DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036311PMC
March 2021

The Gaps in Health-Adjusted Life Years (HALE) by Income and Region in Korea: A National Representative Bigdata Analysis.

Int J Environ Res Public Health 2021 03 27;18(7). Epub 2021 Mar 27.

Department of Preventive Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Korea.

This study aims to calculate the health-adjusted life years (HALE) by using years lived with disability (YLD) from the national claims data, as well as to identify the differences and inequalities in income level and region. The study was carried out on total population receiving health insurance and medical benefits. We calculated incidence-based YLD for 260 disease groups, and used it as the number of healthy years lost to calculate HALE. We adopted the insurance premium to calculate the income as a proxy indicator. For the region classification, we chose 250 Korean municipal-level administrative districts. Our results revealed that HALE increased from 2008 to 2018. HALE in males increased faster than that in females. HALE was higher in higher income levels. In 2018, the gap in HALE between Q1 and Q2, the lower income group, was about 5.57 years. The gap in females by income level was smaller than that in males. Moreover, the gap in HALE by region was found to increase. Results suggest that there is an inequality in YLD in terms of income level in Korea. Therefore, we need intensive management for the low-income group to promote HALE at the national level.
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http://dx.doi.org/10.3390/ijerph18073473DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036311PMC
March 2021

Association between body mass index and fragility fracture in postmenopausal women: a cross-sectional study using Korean National Health and Nutrition Examination Survey 2008-2009 (KNHANES IV).

BMC Womens Health 2021 02 9;21(1):60. Epub 2021 Feb 9.

Department of Orthopedic Surgery, Chungnam National University Hospital, Daejeon, Korea.

Background: The present study examined the relationship between body mass index (BMI) and the risk for fragility fractures in postmenopausal Korean women.

Methods: Among subjects who participated in the 4th Korea National Health and Nutrition Examination Survey (2008-2009), 2114 women ≥ 40 years of age were included. BMI was based on standards set by the Korean Society for the Study of Obesity, as follows: < 18.5 kg/m, underweight; 18.5 ≤ to < 25 kg/m, normal weight; and ≥ 25 kg/m, obese. Subjects were also divided into three groups according to the location of fragility fracture: spine, hip, or wrist.

Results: The mean (± SD) rate of fragility fracture was significantly different among the three groups: 5.9 ± 2.9% (underweight), 1.1 ± 0.3% (normal weight), and 3.0 ± 0.7% (obese) (p = 0.001). After correcting for age, family history, and treatment history of osteoporosis and rheumatoid arthritis, smoking and drinking status, and level of exercise, multivariable regression analysis revealed that the odds ratio for fragility fracture in the underweight group was 5.48 [95% confidence interval (CI) 1.80-16.73] and 3.33 (95% CI 1.61-6.87) in the obese group. After subdividing fragility fractures into vertebral and non-vertebral, the odds ratio for vertebral fracture in the underweight group was 5.49 (95% CI 1.31-23.09) times higher than that in the normal weight group; in the obese group, the non-vertebral fracture odds ratio was 3.87 (95% CI 1.45-10.33) times higher. Analysis of non-vertebral fractures in the obese group revealed an odds ratio for fracture 22.05 (95% CI 1.33-365.31) times higher for hip fracture and 3.85 (95% CI 1.35-10.93) times higher for wrist fracture.

Conclusions: Obesity and underweight increased the risk for fragility fractures in postmenopausal Korean women.
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http://dx.doi.org/10.1186/s12905-021-01209-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871625PMC
February 2021

Estimating the disease burden of Korean type 2 diabetes mellitus patients considering its complications.

PLoS One 2021 8;16(2):e0246635. Epub 2021 Feb 8.

Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

Background: The burden of diabetes is considerable not only globally but also nationally within Korea. The Global Burden of Disease study derived the disability-adjusted life years (DALYs) of diabetes depending on its complications as individual severity using prevalence-based approach from 2017. Conversely, the Korean National Burden of Disease study based on an incidence-based approach does not incorporate the severity of diseases. This study aimed to simulate incidence-based DALYs of type 2 diabetes mellitus (T2DM), given diabetic complications as disease severity using a Markov model.

Methods: We developed a model with six Markov states, including incident and existing prevalent cases of diabetes and its complications and death. We assumed that diabetes and its complications would not be cured. The cycle length was one year, and the endpoint of the simulation was 100 years. A 5% discount rate was adopted in the analysis. Transition cases were counted by 5-year age groups above 30 years of age. Age- and sex-specific transition probabilities were calculated based on the incident rate.

Results: The total DALY estimates of T2DM were 5,417 and 3,934 per 100,000 population in men and women, respectively. The years of life lost in men were relatively higher than those in women in most age groups except the 80-84 age group. The distribution of years lived with disability by gender and age group showed a bell shape, peaking in the 55-59 age group in men and 65-69 age group in women.

Conclusions: The burden of T2DM considering its complications was larger compared to the outcomes from previous studies, with more precise morbid duration using the Markov model.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246635PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870056PMC
August 2021

Projecting the prevalence of obesity in South Korea through 2040: a microsimulation modelling approach.

BMJ Open 2020 12 30;10(12):e037629. Epub 2020 Dec 30.

Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea (the Republic of)

Objective: To project the prevalence of obesity in 2040 among individuals 19 years and older in South Korea.

Design, Setting, And Participants: Using the 'Population Health Model-body mass index' (BMI) microsimulation model, the prevalence of obesity in Korean adults 19 years and older was projected until 2040. The model integrated individual survey data from the Korea Health Panel Survey of 2011 and 2012, population statistics based on resident registration, population projections and complete life tables categorised by sex and age. Birth rate, life expectancy and international migration were based on a medium growth scenario. The base population of Korean adults in 2012, devised through data aggregation, was 39 842 730. The prediction equations were formulated using BMI as the dependent variable; the individual's sex, age, smoking status, physical activity and preceding year's BMI were used as predictive factors.

Outcome Measure: BMI categorised by sex.

Results: The median BMI for Korean adults in 2040 was expected to be 23.55 kg/m (23.97 and 23.17 kg/m for men and women, respectively). According to the Korean BMI classification, 70.05% of all adults were expected to be 'preobese' (ie, have BMIs 23-24.9 kg/m) by 2040 (81.23% of men and 59.07% of women) and 24.88% to be 'normal'.

Conclusions: We explored the possibility of applying and expanding on the concept of microsimulation in the field of healthcare by combining data sources available in Korea and found that more than half of the adults in this study population will be preobese, and the proportions of 'obesity' and 'normal' will decrease compared with those in 2012. The results of our study will aid in devising healthy strategies and spreading public awareness for preventing this condition.
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http://dx.doi.org/10.1136/bmjopen-2020-037629DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780552PMC
December 2020

Associations Between Private Health Insurance and Medical Care Utilization for Musculoskeletal Disorders: Using the Korea Health Panel Survey Data for 2014 to 2015.

Inquiry 2020 Jan-Dec;57:46958020981467

Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.

In South Korea, people may increase their medical coverage by purchasing private health insurance to augment low coverage provided by the National Health Insurance (NHI). Frequent and excessive use of medical care by those with private health insurance is an issue, especially for musculoskeletal disorders that require excessive care and contribute to moral hazard. In South Korea, since private health insurance is structurally linked to the scope of coverage with public health insurance, this increased use of medical care may adversely affect public health insurance finances. This study aimed to analyze the effects of private health insurance on medical care use for patients with musculoskeletal disorders. We used the Korea Health Panel 2014 to 2015 data that included 5622 participants who used medical care for musculoskeletal disorders in 2015. Two groups were created: those who purchased private health insurance ( = 3588) and those without private insurance ( = 2034). We compared their medical utilization using logistic regression, negative binomial regression, and multiple linear regression to determine the associations of private health insurance with medical care use. Medical expenditures by private health insurance purchasers were higher than those of non-purchasers for outpatient care ( < .001), but no differences were found for inpatient care. Our findings suggest that the expansion of private health insurance further burdened the NHI financially, ultimately increasing the burden of medical expenses for the population. Research should implement demonstration studies with different groups of diseases.
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http://dx.doi.org/10.1177/0046958020981467DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756039PMC
October 2021

Associations Between Private Health Insurance and Medical Care Utilization for Musculoskeletal Disorders: Using the Korea Health Panel Survey Data for 2014 to 2015.

Inquiry 2020 Jan-Dec;57:46958020981467

Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.

In South Korea, people may increase their medical coverage by purchasing private health insurance to augment low coverage provided by the National Health Insurance (NHI). Frequent and excessive use of medical care by those with private health insurance is an issue, especially for musculoskeletal disorders that require excessive care and contribute to moral hazard. In South Korea, since private health insurance is structurally linked to the scope of coverage with public health insurance, this increased use of medical care may adversely affect public health insurance finances. This study aimed to analyze the effects of private health insurance on medical care use for patients with musculoskeletal disorders. We used the Korea Health Panel 2014 to 2015 data that included 5622 participants who used medical care for musculoskeletal disorders in 2015. Two groups were created: those who purchased private health insurance ( = 3588) and those without private insurance ( = 2034). We compared their medical utilization using logistic regression, negative binomial regression, and multiple linear regression to determine the associations of private health insurance with medical care use. Medical expenditures by private health insurance purchasers were higher than those of non-purchasers for outpatient care ( < .001), but no differences were found for inpatient care. Our findings suggest that the expansion of private health insurance further burdened the NHI financially, ultimately increasing the burden of medical expenses for the population. Research should implement demonstration studies with different groups of diseases.
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http://dx.doi.org/10.1177/0046958020981467DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756039PMC
October 2021

Development of the Korean Community Health Determinants Index (K-CHDI).

PLoS One 2020 8;15(10):e0240304. Epub 2020 Oct 8.

Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea.

This study developed and validated a Korean community health determinants index (K-CHDI), which can be used to assess the health status of the community. To develop composite indicators, we followed the guidelines of the Joint Research Centre of the Organization for Economic Cooperation and Development. We reviewed previous studies and formed a theoretical framework to systematize our domains and indicators, which were decided through a Delphi survey of healthcare experts. Data on indicators were obtained from the Korean Statistics and Community Health Survey. We applied the Min-Max normalization method and measured weights by the analytic hierarchy process. Health outcomes were estimated using mortality, years of life lost, years lived with disability, and disability-adjusted life years by standardizing sex and age. The value of the index is between 0 and 1; higher values indicate more positive health determinants. K-CHDI for 250 subnational regions (cities, counties, and districts, or Si·Gun·Gu) were correlated with health outcomes. The correlation coefficient was stronger in large cities than in medium-sized areas and small areas, and the higher the K-CHDI group, the higher the coefficient. The K-CHDI represents a reference standard for estimating health status using health determinants as composite indicators at the subnational level.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240304PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7544091PMC
December 2020

Time series analysis of meteorological factors and air pollutants and their association with hospital admissions for acute myocardial infarction in Korea.

Int J Cardiol 2021 01 22;322:220-226. Epub 2020 Aug 22.

Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Republic of Korea. Electronic address:

Background: We assessed the association between multiple meteorological factors and air pollutants and the number of acute myocardial infarction (AMI) cases using a multi-step process.

Methods: Daily AMI hospitalizations matched with 16 meteorological factors and air pollutants in 7 metropolitan provinces of the Republic of Korea from 2002 to 2017 were analyzed. We chose the best fit model after conducting the Granger causality (GC) test and examined the daily lag time effect on the orthogonalized impulse response functions. To define dose-response relationships, we performed a time series analysis using multiple generalized additive lag models based on seasons.

Results: A total of 196,762 cases of AMI in patients older than 20 years admitted for hospitalization were identified. The distribution of meteorological factors and air pollutants showed characteristics of a temperate climate. The GC test revealed a complex interaction between meteorological factors, including air pollutants, and AMI. The final selected factors were NO and temperature; these increased the incidence of AMI on lag day 4 during summer (NO: population-attributable fraction [PAF], 3.9%; 95% confidence interval [CI], 3.6-4.0; mean temperature: PAF, 3.3%; 95% CI, 2.7-3.9).

Conclusions: This multi-step time series analysis found that average temperature and NO are the most important factors impacting AMI hospitalizations, specifically during summer. Based on the model, we were able to visualize the effect-time association of meteorological factors and air pollutants and AMI.
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http://dx.doi.org/10.1016/j.ijcard.2020.08.060DOI Listing
January 2021

Estimating global injuries morbidity and mortality: methods and data used in the Global Burden of Disease 2017 study.

Inj Prev 2020 10 24;26(Supp 1):i125-i153. Epub 2020 Aug 24.

Department of Pharmacy, Adigrat University, Adigrat, Ethiopia.

Background: While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria.

Methods: In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced.

Results: GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes.

Conclusions: GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.
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http://dx.doi.org/10.1136/injuryprev-2019-043531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571362PMC
October 2020

Years of Life Lost Attributable to COVID-19 in High-incidence Countries.

J Korean Med Sci 2020 Aug 17;35(32):e300. Epub 2020 Aug 17.

Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.

Background: The coronavirus disease 2019 (COVID-19) pandemic is a major public health problem of international concern. It is important to estimate its impact of COVID-19 for health policy decision-making. We estimated the years of life lost (YLLs) due to COVID-19 in high-incidence countries.

Methods: We collected the YLLs due to COVID-19 in 30 high-incidence countries as of April 13, 2020 and followed up as of July 14, 2020. Incidence and mortality were collected using each country's formal reports, articles, and other electronic sources. The life expectancy of Japanese females by age and the UN population data were used to calculate YLLs in total and per 100,000.

Results: As of April 22, 2020, there were 1,699,574 YLLs due to COVID-19 in 30 high-incidence countries. On July 14, 2020, this increased to 4,072,325. Both on April 22 and July 14, the total YLLs due to COVID-19 was highest in the USA (April 22, 534,481 YLLs; July 14, 1,199,510 YLLs), and the YLLs per 100,000 population was highest in Belgium (April 22, 868.12 YLLs/100,000; July 14, 1,593.72 YLLs/100,000). YLLs due to COVID-19 were higher among males than among females and higher in those aged ≥ 60 years than in younger individuals. Belgium had the highest proportion of YLLs attributable to COVID-19 as a proportion of the total YLLs and the highest disability-adjusted life years per 100,000 population.

Conclusion: This study estimated YLLs due to COVID-19 in 30 countries. COVID-19 is a high burden in the USA and Belgium, among males and the elderly. The YLLs are very closely related with the incidence as well as the mortality. This highlights the importance of the early detection of incident case that minimizes severe acute respiratory syndrome coronavirus-2 fatality.
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http://dx.doi.org/10.3346/jkms.2020.35.e300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431288PMC
August 2020

Subnational Burden of Disease According to the Sociodemographic Index in South Korea.

Int J Environ Res Public Health 2020 08 10;17(16). Epub 2020 Aug 10.

Department of Preventive Medicine, Korea University College of Medicine, Seoul 02841, Korea.

The sociodemographic index (SDI), a composite index per capita income, educational attainment, and total fertility rate in a country, can indicate whether the country's burden of disease varies depending upon its level of socioeconomic development. This study identified the subnational SDI and disease burden of South Korea based on the country's overall SDI, using national representative data. The burden of disease was measured using disability-adjusted life years (DALY) with an incidence-based approach. We used National Health Insurance Services claims data to estimate the years lived with disability (YLD) and cause-of-death statistics to estimate the years of life lost (YLL). Indicators of subnational SDI were also extracted. The Korean subnational SDIs for 250 regions were correlated with YLL, YLD, and DALY for the year 2016. The correlation between SDI and YLL was stronger in big cities than in medium areas and small areas. Moreover, the higher the SDI, the higher the coefficient. The SDI should be used as a standard for interpreting and comparing regions' disease burden at the subnational level.
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http://dx.doi.org/10.3390/ijerph17165788DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7460231PMC
August 2020

Subnational Burden of Disease According to the Sociodemographic Index in South Korea.

Int J Environ Res Public Health 2020 08 10;17(16). Epub 2020 Aug 10.

Department of Preventive Medicine, Korea University College of Medicine, Seoul 02841, Korea.

The sociodemographic index (SDI), a composite index per capita income, educational attainment, and total fertility rate in a country, can indicate whether the country's burden of disease varies depending upon its level of socioeconomic development. This study identified the subnational SDI and disease burden of South Korea based on the country's overall SDI, using national representative data. The burden of disease was measured using disability-adjusted life years (DALY) with an incidence-based approach. We used National Health Insurance Services claims data to estimate the years lived with disability (YLD) and cause-of-death statistics to estimate the years of life lost (YLL). Indicators of subnational SDI were also extracted. The Korean subnational SDIs for 250 regions were correlated with YLL, YLD, and DALY for the year 2016. The correlation between SDI and YLL was stronger in big cities than in medium areas and small areas. Moreover, the higher the SDI, the higher the coefficient. The SDI should be used as a standard for interpreting and comparing regions' disease burden at the subnational level.
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http://dx.doi.org/10.3390/ijerph17165788DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7460231PMC
August 2020

Updating Disability Weights for Measurement of Healthy Life Expectancy and Disability-adjusted Life Year in Korea.

J Korean Med Sci 2020 Jul 13;35(27):e219. Epub 2020 Jul 13.

Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea.

Background: The present study aimed to update the methodology to estimate cause-specific disability weight (DW) for the calculation of disability adjusted life year (DALY) and health-adjusted life expectancy (HALE) based on the opinion of medical professional experts. Furthermore, the study also aimed to compare and assess the size of DW according to two analytical methods and estimate the most valid DW from the perspective of years lost due to disability and HALE estimation.

Methods: A self-administered web-based survey was conducted ranking five causes of disease. A total of 901 participants started the survey and response data of 806 participants were used in the analyses. In the process of rescaling predicted probability to DW on a scale from 0 to 1, two models were used for two groups: Group 1 (physicians and medical students) and Group 2 (nurses and oriental medical doctors). In Model 1, predicted probabilities were rescaled according to the normal distribution of DWs. In Model 2, the natural logarithms of predicted probabilities were rescaled according to the asymmetric distribution of DWs.

Results: We estimated DWs for a total of 313 causes of disease in each model and group. The mean of DWs according to the models in each group was 0.490 (Model 1 in Group 1), 0.378 (Model 2 in Group 1), 0.506 (Model 1 in Group 2), and 0.459 (Model 2 in Group 2), respectively. About two-thirds of the causes of disease had DWs of 0.2 to 0.4 in Model 2 in Group 1. In Group 2, but not in Group 1, there were some cases where the DWs had a reversed order of severity.

Conclusion: We attempted to calculate DWs of 313 causes of disease based on the opinions of various types of medical professionals using the previous analysis methods as well as the revised analysis method. The DWs from this study can be used to accurately estimate DALY and health life expectancy, such as HALE, in the Korean population.
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http://dx.doi.org/10.3346/jkms.2020.35.e219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7358061PMC
July 2020

Trends in the prevalence and treatment of bipolar affective disorder in South Korea.

Asian J Psychiatr 2020 Oct 5;53:102194. Epub 2020 Jun 5.

Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea. Electronic address:

This study aimed to assess trends in the prevalence of bipolar disorder (BP). We also analyzed patterns of medical use by Korean patients with BP, defined as those diagnosed with the International Classification of Diseases (ICD) F31 code who used at least one inpatient or outpatient medical service in a year. We analyzed yearly BP prevalence and inpatient hospitalization periods per year from 2008 to 2017 using National Health Insurance Service (NHIS) claims data for 52.43 million people. Overall, the BP prevalence was 0.2 %, as of 2017, with consistently higher rates in women. The BP prevalence was highest among those aged ≥60 years (0.27 %) and was lowest among those aged 0-29 years (0.12 %), as of 2017. The average annual rate of increase among those aged 0-29 years and ≥60 years was 8.48 % and 7.39 %, respectively, which exceeded the overall mean of 6.58 %. The average annual rate of increase in BP prevalence for those aged 30-59 years was 4.67 %. The proportion of inpatients who were hospitalized for longer than 180 days decreased, while the proportion of those hospitalized for 0-14 days increased. The estimated BP prevalence was higher when using the most recent NHIS data rather than in the surveys. These prevalence rates can be used to support the development of future mental health policies.
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http://dx.doi.org/10.1016/j.ajp.2020.102194DOI Listing
October 2020

The Burden of Disease due to COVID-19 in Korea Using Disability-Adjusted Life Years.

J Korean Med Sci 2020 Jun 1;35(21):e199. Epub 2020 Jun 1.

Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

Background: The world is currently experiencing a pandemic of coronavirus disease 2019 (COVID-19). In Korea, as in other countries, the number of confirmed cases and deaths due to COVID-19 have been rising. This study aimed to calculate the burden of disease due to COVID-19 in Korea.

Methods: We used data on confirmed cases and deaths due to COVID-19 between January 20 and April 24, 2020 provided by the Korea Centers for Disease Control and Prevention, the local governments and the public media to determine disability-adjusted life years (DALYs) by sex and age. Morbidity was estimated directly among the confirmed, cured, and fatal cases. Disability weights were adopted from previous similar causes on the severity of COVID-19 for the years of life lived with disability (YLDs). The years of life lost (YLLs) were calculated using the standard life expectancy from the 2018 life tables for each sex and age.

Results: The YLDs were higher in females (155.2) than in males (105.1), but the YLLs were higher in males (1,274.3) than in females (996.4). The total disease burden attributable to COVID-19 in Korea during the study period, was estimated to be 2,531.0 DALYs, and 4.930 DALYs per 100,000 population. The YLDs and the YLLs constituted 10.3% and 89.7% of the total DALYs, respectively. The DALYs per 100,000 population were highest in people aged ≥ 80 years, followed by those aged 70-79, 60-69, and 50-59 years, but the incidence was the highest in individuals aged 20-29 years.

Conclusion: This study provided the estimates of DALYs due to COVID-19 in Korea. Most of the disease burden from COVID-19 was derived from YLL; this indicates that decision-makers should focus and make an effort on reducing fatality for preparing the second wave of COVID-19.
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http://dx.doi.org/10.3346/jkms.2020.35.e199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261698PMC
June 2020

Influence of Facial Flushing on Pre- or Type 2 Diabetes Risk according to Alcohol Consumption in Korean Male.

Korean J Fam Med 2020 May 20;41(3):153-160. Epub 2020 May 20.

Department of Family Medicine, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Korea.

Background: This study aims to examine the association between alcohol consumption and the risk of pre- or type 2 diabetes mellitus (T2DM) by alcohol-induced flushing response in Korean male adults, particularly based on their body mass index (BMI).

Methods: This study selected 1,030 (158 non-drinkers, 364 flushers, and 508 non-flushers) male adults who had medical checkups. A logistic regression analysis was used to compare the association between alcohol consumption and the risk of pre- or T2DM.

Results: In both the normal-weight group (BMI <23 kg/m) and the overweight group (BMI ≥23 kg/m and <25 kg/ m), the flushers had a higher risk of pre- or T2DM (odds ratio, 95% confidence interval) when consuming more than 8 drinks of alcohol per week than the non-drinkers (normal-weight group: 3.43, 1.06-11.07; overweight group: 4.94, 1.56-15.67). But in the non-flushers among the normal-weight group and the overweight group, there was no significant difference compared to non-drinkers regarding the risk of pre- or T2DM. Obese flushers had a significantly higher risk of pre- or T2DM when consuming more than 4 drinks of alcohol per week than the non-drinkers (>4 and ≤8 drinks: 2.64, 1.10-6.36; >8 drinks: 2.42, 1.11-5.27). However, obese non-flushers had only a significant higher risk of pre- or T2DM when consuming more than 8 drinks of alcohol per week than the non-drinkers (2.72, 1.39-5.30).

Conclusion: These results suggest that obese flushers have an increased risk of developing pre- or T2DM even with less alcohol consumption.
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http://dx.doi.org/10.4082/kjfm.18.0120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272365PMC
May 2020

A comparison of disease burden and the government budget for mental health in Korea.

J Ment Health 2020 May 22:1-8. Epub 2020 May 22.

Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea.

The lifetime prevalence of mental disorders in South Korea was 25.4% in 2016. The Act on Mental Health enabled the expansion of psychiatric facilities; however, resources were allocated without considering the population structure or the characteristics of mental health problems. This paper investigates the status and trends of disease burden and the government budget for Korean mental health. The burden of mental and behavioral disorders (MBDs) was measured using the incidence-based disability-adjusted life years (DALYs), and the mental health budget data was from the Ministry of Health and Welfare of South Korea. We estimated that the disease burden of MBDs accounted for 6.4% of the total disease burden, ranking as the seventh leading cause of Korean DALYs. The mental health budget in South Korea was USD 253.4 million in 2019 (USD 90.3 million from the general account, USD 65.8 million from the National Health Promotion Fund, and USD 97.3 million from the special account for the national mental hospitals). Challenges are created by the MBD burden on the Korean healthcare system, and the budget is insufficient to address this disease burden, suggesting that resource allocation systems should be improved.
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http://dx.doi.org/10.1080/09638237.2020.1765999DOI Listing
May 2020

Global injury morbidity and mortality from 1990 to 2017: results from the Global Burden of Disease Study 2017.

Inj Prev 2020 10 24;26(Supp 1):i96-i114. Epub 2020 Apr 24.

Faculty of Health Sciences - Health Management and Policy, American University of Beirut, Beirut, Lebanon.

Background: Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries.

Methods: We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs).

Findings: In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505).

Interpretation: Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.
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http://dx.doi.org/10.1136/injuryprev-2019-043494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571366PMC
October 2020

Socioeconomic Burden of Cancer in Korea from 2011 to 2015.

Cancer Res Treat 2020 Jul 18;52(3):896-906. Epub 2020 Mar 18.

Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.

Purpose: Though the socioeconomic burden of cancer on patients is increasing in South Korea, there is little research regarding the type of cancer that incurs the highest costs. This study analyzed the socioeconomic burden on cancer patients from 2011 to 2015 according to sex and age.

Materials And Methods: A prevalence-based approach was applied utilizing claim data of the National Health Insurance Service in Korea to estimate the socioeconomic burden of cancer on patients. Patients who received treatment for cancer from 2011 to 2015 were the study subjects. The total socioeconomic burden of their disease and treatment was divided into direct and indirect costs.

Results: There was an increase of 50.7% for 5 years, from 821,525 to 1,237,739 cancer patients. The cancer costs for men and women increased $8,268.4 million to $9,469.7 million and $3,626.5 million to $4,475.6 million, respectively. Furthermore, the 50-59-year-old age group accounted for a large portion of the total disease cost. Liver, lung, stomach, and colorectal cancers created the heaviest economic burdens on patients.

Conclusion: Overall, this study indicates new policies for cancer prevention, early detection, and post-cancer treatment management are necessary to help limit the costs associatedwith cancer, especially in the elderly, and provides a foundation for establishing cancer-related health care policies, particularly by defining those cancers with heavier disease burdens.
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http://dx.doi.org/10.4143/crt.2019.398DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373867PMC
July 2020

Association between Alcohol Consumption and Metabolic Syndrome Determined by Facial Flushing in Korean Women.

Korean J Fam Med 2021 Jan 14;42(1):24-30. Epub 2020 Feb 14.

Department of Family Medicine, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Korea.

Background: This study aimed to examine the relationship between alcohol consumption and metabolic syndrome in Korean women as determined by facial flushing.

Methods: Of the female patients aged <65 years who visited the health promotion center at Chungnam National University Hospital from January 2016 to March 2017, 1,344 women were included. After adjusting for confounding factors such as age, body mass index, smoking, exercise, and menopausal status, multiple logistic regression analysis was performed to assess the association between alcohol consumption and the risk of metabolic syndrome in the facial flushing and non-facial flushing groups compared with the non-drinkers.

Results: Even after adjusting for confounding factors, the risk of metabolic syndrome was significantly high in all drinking subgroups (≤2 standard drinks: odds ratio [OR], 1.68; 95% confidence interval [CI], 1.10-2.68; 2<, ≤4 standard drinks: OR, 2.48; 95% CI, 1.29-4.74; and >4 standard drinks: OR, 4.16; 95% CI, 2.03-8.30) of the facial flushing group. The risk of metabolic syndrome was significantly high only in the subgroup of weekly alcohol consumption >4 standard drinks (OR, 2.20; 95% CI, 1.07-4.52) in the non-facial flushing group.

Conclusion: This study suggests that Korean women experiencing facial flushing when drinking have a higher risk of developing metabolic syndrome even with a low weekly drinking amount than those who do not experience face flushing.
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http://dx.doi.org/10.4082/kjfm.19.0141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884890PMC
January 2021

Erratum: Correction of the Text in the Article "Funding": Incidence-Based versus Prevalence-Based Approaches on Measuring Disability-Adjusted Life Years for Injury.

J Korean Med Sci 2019 Nov 11;34(43):e296. Epub 2019 Nov 11.

Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

This corrects the article on e69 in vol. 34, PMID: 30923486.
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http://dx.doi.org/10.3346/jkms.2019.34.e296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6838610PMC
November 2019

Prevalence and Economic Burden of Autism Spectrum Disorder in South Korea Using National Health Insurance Data from 2008 to 2015.

J Autism Dev Disord 2020 Jan;50(1):333-339

Department of Preventive Medicine, Kyung Hee University School of Medicine, 1 Hoegi-Dong, Dongdaemug-Gu, Seoul, 130-701, South Korea.

The prevalence of autism spectrum disorder (ASD) is increasing worldwide. We investigated the economic burden of ASD in South Korea using a nationally representative data source. The direct medical and non-medical costs, and indirect costs resulting from ASD were estimated. The total prevalence was 5.04 (per 100,000) in 2008, and 10.97 in 2015. The economic cost of ASD was estimated to be $2,700,596 in 2008 and $9,645,503 in 2015. Of the total economic cost in 2015, 72.3% was from direct costs and 27.7% from indirect costs, and 87.5% related to male patients and 12.5% to female patients. The results suggest that the increase in economic costs was greater than the increase in prevalence.
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http://dx.doi.org/10.1007/s10803-019-04255-yDOI Listing
January 2020

Burden of dental caries and periodontal disease in South Korea: An analysis using the national health insurance claims database.

Community Dent Oral Epidemiol 2019 12 1;47(6):513-519. Epub 2019 Sep 1.

Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.

Objectives: It is essential to measure and monitor the burden of dental caries and periodontal disease (PD) in Korea's ageing population due to their potential impact on morbidity, quality of life and economic condition. This study aimed to quantify the size of burden of dental caries and PD using the disability-adjusted life years (DALYs), and their trends.

Methods: DALYs were estimated using incidence-based approaches to calculate the burden of dental caries and PD from 2013 to 2015 in Korea. Incidence and prevalence were estimated using medical claim data by specific algorithms. Additionally, sensitivity analysis was conducted to investigate possible weakness in the study methodology. To conduct the sensitivity analysis, we modified the algorithms to estimate prevalence and incidence.

Results: The burden of dental caries and PD increased by 39.2% and 57.0%, respectively, between 2013 and 2015. In 2015, dental caries and PD ranked 11th and 25th, respectively, in terms of the leading causes of DALYs. The burden of dental caries was the most substantial in children aged 0-9 years, while that of PD was the most substantial among those in their ages of 40 and 50 (per 100 000 population). After sensitivity analysis with a modified disease algorithm, the magnitude of disease burden changed considerably.

Conclusions: Dental caries and PD constitute substantial burdens in South Korea. Despite the known limitations, medical claims data can be a powerful resource for conducting timely and cost-effective measurements of oral health. In countries, where universal dental schemes are available, there is need to estimate the burden of oral disease using claims data, for methodical advances in the research field.
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http://dx.doi.org/10.1111/cdoe.12493DOI Listing
December 2019
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