건강보험 청구자료에서 동반질환 보정방법과 관찰기관 비교 연구: 경피적 관상동맥 중재술을 받은 환자를 대상으로

김경훈,안이수,Kim, Kyoung-Hoon,Ahn, Lee-Su 대한예방의학회 2009 예방의학회지 Vol.42 No.4

Objectives : To compare the performance of three comorbidity measurements (Charlson comorbidity index, Elixhauser s comorbidity and comorbidity selection) with the effect of different comorbidity lookback periods when predicting in-hospital mortality for patients who underwent percutaneous coronary intervention. Methods : This was a retrospective study on patients aged 40 years and older who underwent percutaneous coronary intervention. To distinguish comorbidity from complications, the records of diagnosis were drawn from the National Health Insurance Database excluding diagnosis that admitted to the hospital. C-statistic values were used as measures for in comparing the predictability of comorbidity measures with lookback period, and a bootstrapping procedure with 1,000 replications was done to determine approximate 95% confidence interval. Results : Of the 61,815 patients included in this study, the mean age was 63.3 years (standard deviation: ${\pm}$10.2) and 64.8% of the population was male. Among them, 1,598 2.6%) had died in hospital. While the predictive ability of the Elixhauser's comorbidity and comorbidity selection was better than that of the Charlson comorbidity index, there was no significant difference among the three comorbidity measurements. Although the prevalence of comorbidity increased in 3 years of lookback periods, there was no significant improvement compared to 1 year of a lookback period. Conclusions : In a health outcome study for patients who underwent percutaneous coronary intervention using National Health Insurance Database, the Charlson comorbidity index was easy to apply without significant difference in predictability compared to the other methods. The one year of observation period was adequate to adjust the comorbidity. Further work to select adequate comorbidity measurements and lookback periods on other diseases and procedures are needed.

건강보험청구자료에서 동반질환 보정방법

김경훈 ( Kyoung Hoon Kim ) 한국보건행정학회 2016 보건행정학회지 Vol.26 No.1

The value of using health insurance claim database is continuously rising in healthcare research. In studies where comorbidities act as a confounder, comorbidity adjustment holds importance. Yet researchers are faced with a myriad of options without sufficient information on how to appropriately adjust comorbidity. The purpose of this study is to assist in selecting an appropriate index, look back period, and data range for comorbidity adjustment. No consensus has been formed regarding the appropriate index, look back period and data range in comorbidity adjustment. This study recommends the Charlson comorbidity index be selected when predicting the outcome such as mortality, and the Elixhauser‘s comorbidity measures be selected when analyzing the relations between various comorbidities and outcomes. A longer look back period and inclusion of all diagnoses of both inpatient and outpatient data led to increased prevalence of comorbidities, but contributed little to model performance. Limited data range, such as the inclusion of primary diagnoses only, may complement limitations of the health insurance claim database, but could miss important comorbidities. This study suggests that all diagnoses of both inpatients and outpatients data, excluding rule-out diagnosis, be observed for at least 1 year look back period prior to the index date. The comorbidity index, look back period, and data range must be considered for comorbidity adjustment. To provide better guidance to researchers, follow-up studies should be conducted using the three factors based on specific diseases and surgeries.

고등학생의 영적 안녕, 인터넷 중독, 공존병리의 관계에 관한 연구

김수현 ( Su Hyun Kim ),강연정 ( Yeon Jeong Kang ) 한국복음주의상담학회 2014 복음과 상담 Vol.22 No.2

본 연구는 고등학생의 영적 안녕, 인터넷 중독, 공존병리의 관계에 대해 살펴 본 것으로, 연구대상은 기독교계 고등학교와 교회에 출석하는 고등학생 212명이며, 질문지법을 이용하여 조사하였으며, 연구 결과는 다음과 같다. 첫째, 대상자의 일반적 특성에 따른 영적 안녕, 인터넷 중독, 공존 병리 간에는 유의미한 차이가 있었다. 둘째, 영적 안녕, 인터넷 중독, 공존병리 간에 유의미한 정적 또는 부적 관계가 있는 것으로 보여 졌다. 영적 안녕과 인터넷 중독 간의 관계와 영적 안녕과 공존병리 간의 관계는 유의미한 부적 상관을, 인터넷 중독과 공존병리 간의 관계는 유의미한 정적 상관을 이룬다. 연구결과를 통해 영적 안녕, 인터넷 중독, 공존병리는 신앙 활동으로 인하여 차이가 났으데, 이는 종교생활 및 영성이 긍정적인 요소로 작용하고 있으며, 영적 안녕 수준이 높아질수록 인터넷 중독과 공존병리의 정도는 낮아지는 것으로 밝혀졌다. 따라서 청소년의 인터넷 중독 및 공존병리 문제에서 보호요인으로 작용하는 영적 안녕의 증진에 관심을 기울여야 할 필요가 있음을 밝힌데 의의가 있다. This research is concerned to correlation between high school student’s spiritual wellbeing and internet addiction or comorbidity. Using questionnaire method, the study is based on 212 student’s answers in Christian high school. The results are as follows. First, there is a meaningful difference in spiritual wellbeing, Internet addiction, and comorbidity according to the general attribute. The students who go the church have been better spiritual wellbeing level and who don’t go to church have been higher internet addition and comorbidity. When the period of attending church is longer, their spiritual wellbeing level was higher. But the period is short their level of withdrawal symptoms of addition and comorbidity was higher. If the students have the conviction of salvation in Christianity, their spiritual wellbeing level was higher and withdrawal symptoms was lower. Second, between the Spiritual wellbeing and Internet addition or comorbidity there was meaningful connection. In relations of wellbeing and Internet addition, there was meaningful negative correlation and between the Internet addition and the comorbidity has meaningful static correlation. As the result of this research, spiritual wellbeing, internet addition or comorbidity has meaningful difference according to student’s spiritual activity. Moreover, the higher spiritual wellbeing leads lower Internet addition and comorbidity. For spiritual wellbeing causes negative correlation between Internet addiction and comorbidity. This research has significant meaning in understanding correlation between spiritual wellbeing and internet addition or comorbidity. And discovering necessity that a society need to concern high school student’s spiritual wellbeing to protect internet addition disorder and comorbidity.

Comorbidity Relationship to Outcome of Radical Cystectomy in Chinese: a Single Institution Study with the ACE-27 Comorbidity Index

Xuan, Zhu,Zhong, Zhao-Hui,Zhang, Xuan-Zhi,Zhang, Lei,Zhao, Xiao-Kun,Lv, Chen,Xu, Ran,Ren, Wei-Gang,Li, Song-Chao Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.3

To determine the relationship between comorbidity and outcome after radical cystectomy in Chinese patients by using the Adult Comorbidity Evaluation (ACE)-27 index. Two-hundred-and-forty-six patients treated with radical cystectomy at the Second Xiangya Hospital of Central South University, Hunan Province, China between 2000 and 2010 were retrospectively analyzed. Medical records were reviewed for age, gender, delayed time of radical cystectomy, urinary diversion type, pelvic lymphadenectomy status, TNM stage, and pathological grade. Comorbidity information was assessed by the ACE-27 index. The outcome measurement was overall survival. Univariate and multivariate Cox proportional hazards regression analyses were used to determine the association between comorbidity and outcome. The study population consisted of 215 (87.40%) males and 31 (12.60%) females with a mean age of $62{\pm}11$ years. Median duration of follow-up was $47{\pm}31$ months. A total of 151 (61.38%) patents died during follow-up. Of those, 118 (47.97%) had at least one comorbidity. According to the ACE-27 scores, 128 (52.03%) patients had no comorbidity, 79 (32.11%) had mild, 33 (13.41%) had moderate, and 6 (2.45%) had severe comorbidities. Multivariate analysis indicated that moderate (p=0.002) and severe (p<0.001) comorbidity was significantly associated with decreased overall survival. In addition, age ${\geq}70$ years (p=0.002), delayed time of radical cystectomy >12 weeks (p=0.044), pelvic lymphadenectomy status (p=0.014), and TNM stage >T3 (p<0.001) were determined to be independent risk factors of overall survival. Increasing severity of comorbidity statistically correlated with decreased overall survival after radical cystectomy.

Comorbidity Study on Type 2 Diabetes Mellitus Using Data Mining

김혜순,신아미,김미경,김윤년 대한내과학회 2012 The Korean Journal of Internal Medicine Vol.27 No.2

Background/Aims: The aim of this study was to analyze comorbidity in patients with type 2 diabetes mellitus (T2DM) by using association rule mining (ARM). Methods: We used data from patients who visited Keimyung University Dongsan Medical Center from 1996 to 2007. Of 411,414 total patients, T2DM was present in 20,314. The Dx Analyze Tool was developed for data cleansing and data mart construction, and to reveal associations of comorbidity. Results: Eighteen associations reached threshold (support, ≥ 3%; confidence, ≥ 5%). The highest association was found between T2DM and essential hypertension (support, 17.43%; confidence, 34.86%). Six association rules were found among three comorbid diseases. Among them, essential hypertension was an important node between T2DM and stroke (support, 4.06%; confidence, 8.12%) as well as between T2DM and dyslipidemia (support, 3.44%; confidence, 6.88%). Conclusions: Essential hypertension plays an important role in the association between T2DM and its comorbid diseases. The Dx Analyze Tool is practical for comorbidity studies that have an enormous clinical database. Background/Aims: The aim of this study was to analyze comorbidity in patients with type 2 diabetes mellitus (T2DM) by using association rule mining (ARM). Methods: We used data from patients who visited Keimyung University Dongsan Medical Center from 1996 to 2007. Of 411,414 total patients, T2DM was present in 20,314. The Dx Analyze Tool was developed for data cleansing and data mart construction, and to reveal associations of comorbidity. Results: Eighteen associations reached threshold (support, ≥ 3%; confidence, ≥ 5%). The highest association was found between T2DM and essential hypertension (support, 17.43%; confidence, 34.86%). Six association rules were found among three comorbid diseases. Among them, essential hypertension was an important node between T2DM and stroke (support, 4.06%; confidence, 8.12%) as well as between T2DM and dyslipidemia (support, 3.44%; confidence, 6.88%). Conclusions: Essential hypertension plays an important role in the association between T2DM and its comorbid diseases. The Dx Analyze Tool is practical for comorbidity studies that have an enormous clinical database.

Treatment Response and Adverse Reactions in Older Tuberculosis Patients with Immunocompromising Comorbidities

김서윤,이상민,임재준,유철규,김영환,한성구,양석철 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.5

Purpose: The aim of this study was to elucidate the effects of immunocompromising comorbidities on treatment response and adverse reactions in older tuberculosis (TB) patients. Materials and Methods: The medical records of 182 patients older than 65 years with proven TB by positive culture of Mycobacterium tuberculosis and with available drug susceptibility tests were reviewed retrospectively. These patients were subsequently assigned to either the comorbidity group (n=78) or non-comorbidity group (n=104) depending on whether they had immunocompromising comorbidities. Results: The mean durations of treatment were 9.9±3.3 months in the comorbidity group and 9.3±3.2 months in the non-comorbidity group (p=0.21). M. tuberculosis culture results converted to negative in most patients with available follow-up cultures at two months after treatment. The successful treatment rates were 94.9% and 98.9% in the comorbidity and non-comorbidity groups, respectively (p=0.30). The most common side effects of anti-TB treatment were skin rash/pruritus (13% in the comorbidity group vs. 11% in the non-comorbidity group, p=0.79), gastro-intestinal problems (14% vs. 9%, p=0.25) and hepatotoxicity (14% vs. 7%, p=0.09). Conclusion: The present study shows that the successful treatment rate for TB is high and that immunocompromising comorbidities have no effect on the response to treatment and adverse effects in older TB patients.

Comorbidity network analysis related to obesity in middle-aged and older adults: findings from Korean population-based survey data

Hye Ah Lee,Hyesook Park 한국역학회 2021 Epidemiology and Health Vol.43 No.-

OBJECTIVES: We conducted a comorbidity network analysis using data from the seventh Korea National Health and Nutrition Examination Survey to systematically quantify obesity-related comorbidities. METHODS: The study included 11,712 subjects aged 45 to 80 (5,075 male and 6,637 female). A prevalent disease was defined as a specific disease for which a subject had been diagnosed by a doctor and was being treated. Comorbidity network analysis was performed for diseases with a prevalence of 1% or more, including overweight and obesity. We estimated the observed-to-expected ratio of all possible disease pairs with comorbidity strength and visualized the network of obesity-related comorbidities. RESULTS: In subjects over 45 years old, 37.3% of people had a body mass index over 25.0 kg/m2. The most common prevalent disease was hypertension (42.3%), followed by dyslipidemia (17.4%) and diabetes (17.0%). Overweight and obese subjects were 2.1 times (95% confidence interval, 1.9 to 2.3) more likely to have a comorbidity (i.e., 2 or more diseases) than normal-weight subjects. Metabolic diseases such as hypertension, dyslipidemia, diabetes, and osteoarthritis were directly associated with overweight and obesity. The probability of coexistence for each of those 4 diseases was 1.3 times higher than expected. In addition, hypertension and dyslipidemia frequently coexisted in overweight and obese female along with other diseases. In obese male, dyslipidemia and diabetes were the major diseases in the comorbidity network. CONCLUSIONS: Our results provide evidence justifying the management of metabolic components in obese individuals. In addition, our results will help prioritize interventions for comorbidity reduction as a public health goal.

Comorbid Depressive Disorders in ADHD: The Role of ADHD Severity, Subtypes and Familial Psychiatric Disorders

Michela Di Trani,Francesca Di Roma,Andriola Elda,Leone Daniela,Parisi Pasquale,Miano Silvia,Donfrancesco Renato 대한신경정신의학회 2004 PSYCHIATRY INVESTIGATION Vol.1 No.2

Objective-To evaluate the presence of Major Depressive Disorder (MDD) and Dysthymic Disorder (DD) in a sample of Italian children with Attention Deficit Hyperactivity Disorder (ADHD) and to explore specific features of comorbid depressive disorders in ADHD. Methods-Three hundred and sixty-six consecutive, drug-naïve Caucasian Italian outpatients with ADHD were recruited and comorbid disorders were evaluated using DSM-IV-TR criteria. To evaluate ADHD severity, parents of all children filled out the ADHD Rating Scale. Thirty-seven children with comorbid MDD or DD were compared with 118 children with comorbid conduct disorder and 122 without comorbidity for age, sex, IQ level, family psychiatric history, and ADHD subtypes and severity. Results-42 of the ADHD children displayed comorbid depressive disorders: 16 exhibited MDD, 21 DD, and 5 both MDD and DD. The frequency of hyperactive-impulsive subtypes was significantly lower in ADHD children with depressive disorders, than in those without any comorbidity. ADHD children with depressive disorders showed a higher number of familial psychiatric disorders and higher score in the Inattentive scale of the ADHD Rating Scale, than children without any comorbidity. No differences were found for age, sex and IQ level between the three groups. Conclusion-Consistent with previous studies in other countries, depressive disorders affect a significant proportion of ADHD children in Italy. Patient assessment and subsequent treatment should take into consideration the possible presence of this comorbidity, which could specifically increase the severity of ADHD attention problems.

Comorbid Depressive Disorders in ADHD: The Role of ADHD Severity, Subtypes and Familial Psychiatric Disorders

Michela Di Trani,Francesca Di Roma,Andriola Elda,Leone Daniela,Parisi Pasquale,Miano Silvia,Donfrancesco Renato 대한신경정신의학회 2014 PSYCHIATRY INVESTIGATION Vol.11 No.2

Objective To evaluate the presence of Major Depressive Disorder (MDD) and Dysthymic Disorder (DD) in a sample of Italian children with Attention Deficit Hyperactivity Disorder (ADHD) and to explore specific features of comorbid depressive disorders in ADHD. Methods Three hundred and sixty-six consecutive, drug-naïve Caucasian Italian outpatients with ADHD were recruited and comorbid disorders were evaluated using DSM-IV-TR criteria. To evaluate ADHD severity, parents of all children filled out the ADHD Rating Scale. Thirty-seven children with comorbid MDD or DD were compared with 118 children with comorbid conduct disorder and 122 without comorbidity for age, sex, IQ level, family psychiatric history, and ADHD subtypes and severity. Results 42 of the ADHD children displayed comorbid depressive disorders: 16 exhibited MDD, 21 DD, and 5 both MDD and DD. The frequency of hyperactive-impulsive subtypes was significantly lower in ADHD children with depressive disorders, than in those without any comorbidity. ADHD children with depressive disorders showed a higher number of familial psychiatric disorders and higher score in the Inattentive scale of the ADHD Rating Scale, than children without any comorbidity. No differences were found for age, sex and IQ level between the three groups. Conclusion Consistent with previous studies in other countries, depressive disorders affect a significant proportion of ADHD children in Italy. Patient assessment and subsequent treatment should take into consideration the possible presence of this comorbidity, which could specifically increase the severity of ADHD attention problems.

Systematic Literature Review of Psychiatric Comorbidities in Adults with Epilepsy

Elaine Lu,Nataliya Pyatka,Christopher J Burant,Martha Sajatovic 대한신경과학회 2021 Journal of Clinical Neurology Vol.17 No.2

Background and Purpose Mental illness is disproportionately common in people with epilepsy (PWE). This systematic literature review identified original research articles that reported the prevalence of psychiatric comorbidities based upon clinical assessments in a sample of PWE and assessed the clinical features of the populations found in studies included in our review of mental health comorbidity. Methods The included articles were written in English and published from 2008 to 2018, and focused on adults aged ≥18 years who had psychiatric diagnoses determined in clinical assessments, such as those found in medical records, clinician psychiatric evaluations, structured diagnostic interviews, and mental health screening questionnaires specific for a psychiatric disorder. The primary outcome was the prevalence of psychiatric comorbidities as a percentage of the total sample of PWE. Additional data included the overall sample size, mean age, epilepsy type, study design, and method of diagnosis. A modified Newcastle Ottawa Scale was used to assess the quality of the studies. All 23 articles that were consistent with the inclusion criteria were related to observational studies. Results Mood disorders and anxiety disorders were the most common psychiatric comorbidities, with prevalence rates of 35.0% and 25.6%, respectively. Major depressive disorder was the most common mood disorder, with a prevalence of 24.2%. Post-traumatic stress disorder (PTSD) had the highest reported prevalence among anxiety disorders, at 14.2%, followed by general anxiety disorder at 11.1%. Other comorbidities included psychosis (5.7%), obsessivecompulsive disorder (3.8%), schizophrenia (1.7%), bipolar disorder (6.2%), and substance abuse (7.9%). The pooled prevalence of suicidality, as reported for two studies, was 9.3%. Temporal lobe epilepsy (TLE) was associated with higher levels of psychiatric comorbidity. Two (8.7%) of the 23 studies compared psychiatric comorbidities in TLE with that of extratemporal lobe epilepsy (ETLE), and one of these two studies found that depression was more common in TLE (53.8%) than in ETLE (25%). Regarding seizure types, partial seizures were associated with a higher prevalence of depression vs generalized seizures. Conclusions This systematic literature review of recent original research found a relatively high prevalence of mental health comorbidities in PWE. Mood and anxiety disorders are the most common comorbidities, while psychotic spectrum conditions such as schizophrenia and bipolar disorder are much rarer. The prevalence of comorbidity may vary with the epilepsy type and treatment responsiveness. These findings suggest that screening tools for depression and anxiety should be included as part of the training for epilepsy care, while resources for other relatively common conditions such as PTSD and substance abuse disorders should be readily available to neurology specialists who treat PWE.