The Trend of Dental Check-Up And Incidence of Dental Complications Following The Use of Bone Modifying Agents In Patients With Metastatic Breast And Prostate Cancer: Analysis of Data From The Korean National Health Insurance Service

Purpose: Bone-modifying agents (BMAs) are key components in the management of cancer patients with bone metastasis. Despite their clinical benefits, the use of BMAs is associated with adverse dental events including medication-related osteonecrosis of the jaw (MRONJ). This study investigated the rate of preoperative dental surveillance to reduce the incidence of adverse dental events including MRONJ after BMA treatment in patients with bone metastasis from breast and prostate cancer. Methods: Data, including age, cancer diagnosis, administered BMAs, and adverse dental events during cancer treatment, of patients with bone metastasis from breast and prostate cancer who received at least one infusion of BMA between 2007 and 2019 were extracted from the Korean National Health Insurance Service (KNHIS) dataset. Results: Of the 15357 patients who received BMAs, 1706 patients (11.1%) underwent dental check-ups before BMA treatment. The proportion of patients receiving dental check-ups increased from 4.4% in 2007 to 16.7% in 2019. Referral for dental check-up was more frequent in clinics and primary hospitals than in tertiary hospitals, and from the departments of internal medicine and urology than from the department of general surgery, regardless of the patient's health insurance status. After BMA treatment, 3328 patients (21.6%) developed adverse dental events, including tooth extraction (73.0%), abscess (16.9%), acute periodontitis (5.3%), acute pericoronitis (2.6%), and MRONJ (2.2% of 3328, 0.5% of 15357). Conclusions: Considering the long treatment period in patients with metastatic cancer, coordination between dentists and oncologists is necessary to ensure appropriate dental treatment before the initiation of BMAs.

Risk Factors of Dermatophytosis in Young Adults: A Nationwide Population-Based Study

Dermatophytosis includes all fungal infections caused by dermatophytes in humans. Some risk factors for the development of subtypes of dermatophytosis have been studied; however, large-scale epidemiologic studies on risk factors for total dermatophytosis are scarce. We investigated the risk factors of dermatophytosis using a nationwide study. Total 4,532,655 subjects with dermatophytosis aged between 20 to 40 years were examined using data from the Korean National Health Insurance Service from 2009 to 2018. Women showed a lower risk of development of dermatophytosis compared to men (hazard ratio [HR], 0.848; 95% confidence interval [CI], 0.843–0.853). Subjects with elevated waist circumference (HR, 1.057; 95% CI, 1.048–1.065), heavy drinking (HR, 1.053; 95% CI, 1044–1.061), engaging in mild-to-heavy exercise (HR, 1.071; 95% CI, 1.064–1.077) had a higher risk of dermatophytosis. In addition, subjects with body mass index (BMI) of more than 30 kg/m2 exhibited a higher risk of dermatophytosis (HR, 1.36; 95% CI, 1.342–1.378) compared to those with BMIs in the range of 18.5 to 23 kg/m2. In this study, the risk of developing dermatophytosis significantly increased in individuals with elevated waist circumference or high BMI. Lifestyle modifications, including weight management, are suggested to be important in preventing dermatophytosis.

Vitamin C for ≥ 5 days is associated with decreased hospital mortality in sepsis subgroups: a nationwide cohort study

Background Previous randomized trials of vitamin C, hydrocortisone, and thiamine on sepsis were limited by short-term vitamin C administration, heterogeneous populations, and the failure to evaluate each component’s effect. The purpose of this study was to determine whether vitamin C alone for ≥ 5 days or in combination with corticosteroids and/or thiamine was associated with decreased mortality across the sepsis population and subpopulation. Methods Nationwide population-based study conducted using the Korean National Health Insurance Service database. A total of 384,282 adult patients with sepsis who were admitted to the intensive care unit were enrolled from January 2017 to December 2019. The primary outcome was hospital mortality, while the key secondary outcome was 90-day mortality. Results The mean [standard deviation] age was 69.0 [15.4] years; 57% were male; and 36,327 (9%) and 347,955 did and did not receive vitamin C, respectively. After propensity score matching, each group involved 36,327 patients. The hospital mortality was lower by − 0.9% in the treatment group (17.1% vs 18.0%; 95% confidence interval, − 1.3 to − 0.5%; p < 0.001), a significant but extremely small difference. However, mortality decreased greater in patients who received vitamin C for ≥ 5 days (vs 1–2 or 3–4 days) (15.8% vs 18.8% vs 18.3%; p < 0.001). Further, vitamin C was associated with a lower hospital mortality in patients with older age, multiple comorbidities, pneumonia, genitourinary infection, septic shock, and mechanical ventilation. Consistent findings were found for 90-day mortality. Moreover, vitamin C alone or in combination with thiamine was significantly associated with decreased hospital mortality. Conclusions Intravenous vitamin C of ≥ 5 days was significantly associated with decreased hospital and 90-day mortality in sepsis patients. Vitamin C combined with corticosteroids and/or thiamine in specific sepsis subgroups warrants further study.

Risk of Dementia in Patients Who Underwent Surgery under Neuraxial Anesthesia: A Nationwide Cohort Study

The incidence of dementia in patients with surgery under neuraxial anesthesia and the possibility of surgery under neuraxial anesthesia as a risk factor for dementia were investigated. We performed a retrospective matched cohort study with nationwide, representative cohort sample data of the Korean National Health Insurance Service in South Korea between 1 January 2003, and 31 December 2004. The participants were divided into control (n = 4488) and neuraxial groups (n = 1122) using propensity score matching. After 9 years of follow-up, the corresponding incidences of dementia were 11.5 and 14.8 cases per 1000 person-years. The risk of dementia in the surgery under neuraxial group was 1.44-fold higher (95% confidence interval [95%CI], 1.17–1.76) than that in the control group. In the subgroup analysis of dementia, the risk of Alzheimer’s disease in those who underwent surgery under neuraxial anesthesia was 1.48-fold higher (95%CI, 1.17–1.87) than that in those who did not undergo surgery under anesthesia. Our findings suggest that patients who underwent surgery under neuraxial anesthesia had a higher risk of dementia and Alzheimer’s disease than those who did not undergo surgery under neuraxial anesthesia.

The Change in Metabolic Syndrome Status and the Risk of Nonviral Liver Cirrhosis

Background: Nonalcoholic fatty liver disease is considered to be the hepatic component of metabolic syndrome (MetS). However, the association between changes in MetS status and the risk of liver cirrhosis (LC) has not been investigated to date. This study assessed the association between changes in MetS and subsequent nonviral LC development. Methods: Data were obtained from the Korean National Health Insurance Service. Individuals who participated in health screenings from both 2009 to 2010 and 2011 to 2012 were included. The primary outcome was LC development according to the static and dynamic MetS status. Subjects were stratified into four groups according to the change in MetS status observed from the two-year interval screening (2009–2011). Cox regression analysis was used to examine the hazard ratios of LC. Results: During a median of 7.3 years of follow-up, 24,923 incident LC cases developed among 5,975,308 individuals. After adjusting for age, sex, smoking, alcohol, regular exercise, and body mass index, the adjusted hazard ratios (95% confidence intervals) for LC development were 1.39 (1.33–1.44) for the MetS-Developed group, 1.32 (1.26–1.37) for the MetS-Recovered group, and 1.51 (1.45–1.56) for the MetS-Sustained group, relative to the MetS-Free group. Stratified analyses according to age, sex, smoking, alcohol intake, exercise, diabetes mellitus, hypertension, dyslipidemia, and chronic kidney disease showed similar results. Conclusions: Both static and dynamic MetS status are independent risk factors for LC development. The risk of LC was the highest in people with sustained MetS and was lower in the MetS-Recovered group than in the MetS-Sustained group. These results suggest that improving a person’s MetS status may be helpful in preventing LC.

Association Between Statin use and Chronic Periodontitis: A Longitudinal Follow-Up Study using Korean National Health Screening Cohort

Background: Since potential link between statin and the risk of adverse chronic periodontitis (CP) has been raised, we aimed to validate the associations of statin use on the incidence of CP using a nationwide cohort data. Methods: This longitudinal follow-up study included 169,381 patients who were administered statins matched with an equal number of controls using propensity score from the Korean National Health Insurance Service-Health Screening Cohort database (2002–2015). A Cox proportional hazard model was used to assess the occurrence of CP following statin use after adjusting for multiple covariates.Results: The occurrence of CP was significantly higher with long-term use (1–3 years, 3–5 years, or >5 years) than with short-term use (≤1 year). After adjustment, statin users exhibited a 1.32-fold higher occurrence of CP (95% confidence interval=1.30–1.33) than the matched non-users (incidence: 25.0 and 22.0 per 100 person-years, respectively). Subgroup analyses supported the adverse impact of statins on CP independent of age and sex.Conclusions: Statin use in individuals aged >40 years, of both sexes, may slightly increase the risk of occurrence of CP, especially with long-term use, warranting a caution regarding the onset of CP as a possible adverse effect of long-term statin use.

An increasing trend of posterior cruciate ligament reconstruction in South Korea: epidemiologic analysis using Korean National Health Insurance System Database

Background The posterior cruciate ligament is crucial for posterior stability of the knee joint, and, as well as anterior cruciate ligament reconstruction, posterior cruciate ligament reconstruction (PCLR) has attracted interest in orthopedic literature. A few studies have investigated epidemiologic data of PCLR in Western countries. However, there has been no report on the epidemiological pattern of PCLR in the Asian population, including South Korea. Therefore, this study investigated the incidence and trends of PCLR in South Korea using the Korean National Health Insurance (NHI) System Database. Methods The data was collected by the Korean Health Insurance Review and Assessment Service (HIRA) from 2008 to 2016 in South Korea. Patients with a record of cruciate ligament reconstruction and PCLR were allocated from the database. An analysis of the total number and incidence per 100,000 people/year of PCLR procedures and other epidemiologic parameters was conducted according to sex and age. Results The incidence of PCLR procedures rose from 2.3 to 2.6 per 100,000 people (from 1101 to 1299 total cases; 13% increase) between 2008 and 2016: from 3.8 to 4.0 (from 901 to 1000) in males, and from 0.8 to 1.2 (from 200 to 299) in females. PCLR was performed more frequently in males than in females, however, the rate of increase was higher in females than males. The incidence of PCLR over 9 years was highest in patients in their 20s, followed by patients in their 40s and 30s. Conclusion The incidence of PCLR procedures increased by 13% over 9 years in South Korea. PCLR was performed approximately three times more in men than in women. The incidence of PCLR was highest in patients in their 20s, followed by those in their 40s. The current study will enhance our understanding of the epidemiology of PCLR. Study design Descriptive Epidemiology Study.

Biopsychosocial Correlates of Cognitive Function Among Korean Older Adults: History of Hypertension and Diabetes

Based on biopsychosocial perspectives on health, this study examined risk and protective factors of cognitive function among Korean older adults. Specifically, we focused on comparing the role of these factors based on the respondents' history of having hypertension or diabetes. This study used 2009 Korean National Health Insurance Service data that included a sample of older adults who maintained qualification for health insurance and medical aid in 2002 (n=26,242). Cognitive function was measured using KDSQ-C and biopsychosocial factors included metabolic syndrome, drinking, smoking, and walking. The sample was divided into two groups based on their medical history, and thus four sets of linear regression models were analyzed to explore the associations between biopsychosocial factors and cognitive functioning. Among individuals with a history of hypertension, metabolic syndrome, drinking, and walking were associated with cognitive functioning. For those without a history of hypertension, only drinking and walking were associated with cognitive functioning. For diabetes, smoking and walking were associated with cognitive functioning among older adults with a history of diabetes. For those without a history of diabetes, drinking and walking were associated with cognitive functioning. In sum, metabolic syndrome was a particularly significant correlate of cognitive function among Korean older adults with a history of hypertension. Walking was a consistently significant factor regardless of medical history. These results highlight the importance of considering medical history of chronic conditions such as hypertension and diabetes in identifying factors associated with older adults' cognitive function and further developing tailored prevention programs for cognitive decline.

The Importance of Metabolic Syndrome Status for the Risk of Non-Viral Hepatocellular Carcinoma: A Nationwide Population-Based Study

The positive association between metabolic syndrome (MetS) and hepatocellular carcinoma (HCC) has been suggested. However, no studies have yet looked at how the risk of developing HCC varies with changes in MetS status. Therefore, we aimed to investigate the association between changes in MetS and subsequent HCC development. Data were obtained from the Korean National Health Insurance Service. 5,975,308 individuals who participated in health screenings both in 2009–2010 and 2011–2012 were included. Subjects were divided into four groups according to change in MetS status during the two-year interval screening (from 2009 to 2011): sustained non-MetS, transition to MetS, transition to non-MetS, and sustained MetS. Cox regression analysis was used to examine the hazard ratios of HCC. During a median of 7.3 years follow-up, 25,880 incident HCCs were identified. Compared to the sustained non-MetS group, age, sex, smoking, alcohol, regular exercise, and body mass index-adjusted hazard ratios (95% confidence interval) for HCC development were 1.01 (0.97–1.05) for the transition to MetS group; 1.05 (1.003–1.09) for the transition to non-Met group; and 1.07 (1.03–1.10) for the sustained MetS group. Stratified analyses according to age, sex, smoking, alcohol intake, exercise, diabetes mellitus, hypertension, dyslipidemia, and chronic kidney disease showed similar results. A significantly increased HCC risk was observed in the sustained MetS and transition to non-MetS groups. The baseline status of MetS was associated with the risk of HCC development. Strategies to improve MetS, especially targeting insulin resistance might prevent HCC development.